Wrist PA

• Distal radius and ulna, and the distal radioulnar joint.
• Carpal bones: scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate.
• Proximal and midmetacarpals.
• Soft tissues of the wrist, such as the fat pads and fat stripes.

• WARNING: with possible spinal injury or severe trauma, do not attempt to move the patient; do not rotate a severely injured part or remove splints (Bontrager). Merrill's: do not attempt true AP or lateral positioning of a severely injured limb; take two projections 90 degrees apart, moving it as little as possible, and move the IR and tube if the patient cannot reach the position.
• Verify patient identity using two identifiers.
• Remove watches, bracelets, and radiopaque items from the wrist.
• Seat the patient at the end of the table with the hand and forearm extended.
• Drop the shoulder so the shoulder, elbow, and wrist are on the same horizontal plane.
• Pronate the hand. Align and center the long axis of the hand and wrist to the IR, carpal area to the CR.
• Arch the hand slightly to place the wrist and carpal area in close contact with the IR.

Midcarpal area, centered to the IR.

Perpendicular to the IR, directed to the midcarpal area.

kVp

66

mAs

DR 0.9 / CR 2

SID

40" (102 cm)

Notes

Tabletop technique. Fingers slightly curled to bring the wrist close to the IR. Bontrager lists 60 to 70 kV analog and 60 ± 5 kV digital; the sample below is Merrill's chart, which uses 66 kVp. Sample technique: DR 0.9 / CR 2 mAs at 66 kVp, 40 in SID, for a 4 cm part. Adjust for your equipment.

kVp and mAs are sample values. Use caution when applying them in your department.

• Wrist shown in true PA with no rotation or tilt.
• Radius, ulna, carpals, and proximal metacarpals included.
• Distal radius and ulna separated, with at most minimal superimposition at the distal radioulnar joint.
• Bone trabeculae and soft tissue sharp, no motion blur.
• Collimation: 2.5 inches distal and proximal to wrist joint.

1. 1 Wrist rotated: the distal radius and ulna overlap and the proximal metacarpals are unevenly spaced.
2. 2 Hand not arched, so the wrist and carpals are not in close contact with the IR.
3. 3 Shoulder not dropped, so the shoulder, elbow, and wrist are not on the same plane.
4. 4 CR off-centered clips the distal radius or the metacarpals.
5. 5 Hand supinated (palm up) gives an AP, a valid alternative but not this projection.
6. 6 Excessive flexion of the digits overlaps and obscures the metacarpals.
7. 7 Wrist rotated medially or laterally tilts the carpal bones.
8. 8 CR not at the midcarpal area.

• Wrist trauma evaluation for fracture, dislocation, or sprain.
• Suspected scaphoid or other carpal fracture.
• Assessment of wrist joint arthritis or degenerative changes.