Wrist PA is a radiography positioning projection of the Upper Extremity. Seated with forearm on table, wrist pronated. SID 40". The centering point is located midcarpal area, between scaphoid and lunate.. The central ray is perpendicular to the midcarpal area.. Image-quality criteria include wrist shown in true pa with no rotation or tilt., radius, ulna, carpals, and proximal metacarpals included.. Standard exposure ranges from 60 to 70 kVp, 3 to 5 mAs, at an SID of 40 inches (102 cm).
Anatomy demonstrated
- Distal radius and ulna.
- Radiocarpal joint space.
- All eight carpal bones: scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate.
- Proximal metacarpals.
Patient preparation
- Verify patient identity using two identifiers.
- Remove watches, bracelets, and radiopaque items from the wrist.
- Seat the patient at the end of the table.
- Place forearm on table with wrist pronated (palm down).
- Slightly curl fingers to relax soft tissues on wrist.
Position & centering point
Midcarpal area, between scaphoid and lunate.
Central ray
Perpendicular to the midcarpal area.
Exposure / technique
- kVp
- 60–70
- mAs
- 3–5
- SID
- 40" (102 cm)
- Notes
- Tabletop technique. Fingers slightly curled to relax soft tissue.
Image-quality criteria
- Wrist shown in true PA with no rotation or tilt.
- Radius, ulna, carpals, and proximal metacarpals included.
- Radiocarpal joint space open and clearly visible.
- Bone trabeculae and soft tissue sharp, no motion blur.
- Collimation: 2.5 inches distal and proximal to wrist joint.
Common errors / ARRT traps
- 1 Hand supinated (palm up) rotates wrist off true PA.
- 2 Fingers extended or flexed too much alters soft tissue image.
- 3 Wrist rotated medially or laterally tilts the carpal bones.
- 4 CR off-centered clips distal radius or proximal metacarpals.
Clinical indications
- Wrist trauma evaluation for fracture, dislocation, or sprain.
- Suspected scaphoid or other carpal fracture.
- Assessment of wrist joint arthritis or degenerative changes.
- Post-operative follow-up of wrist fixation hardware.
Aligned to the 2025 ARRT Content Specifications.