Hand Lateral Radiography – Positioning Guide

Hand – Lateral

Area Covered
Hand, wrist and 2.5cm (1 inch) of distal forearm

IR Size & Orientation
18 x 24cm (8 x 10 inches) Portrait

Film / Screen Combination
Detail(CR and DR as recommended by manufacturer)

Bucky / Grid
No

Filter
No

Exposure
66 kVp3 mAs

FFD / SID
100 – 115cm (40 inches)

Central Ray
Directed to the 2nd metacarpophalangeal joint

• Patient seated at end of table
• Elbow flexed at 90 degrees
• Hand and forearm resting on table
• Rotate hand and wrist into lateral position with thumb on up side
• For the “Fan” lateral, digits are spread out
• a step block may be used
• For a “Flexion” lateral, digits 2 through to 5 are superimposed and held in extension with the thumb held clear
• For an “Extension” lateral, digits 2 through to 5 are superimposed and held in flexion with the thumb held clear

Critique

PACEMAN

Positioning

• The hand is in the lateral position,
• The metacarpal midshafts are superimposed
• The ulna is slightly posterior to the radius
  (Note: the wrist is not necessarily lateral when the hand is. In a lateral wrist the radius and ulna are superimposed)
• The interphalangeal joints are open
• Phalanges are not foreshortened

“Fan lateral”

• 2nd through to 5th digits are separated with little superimposition of bony and soft tissue structures
• 2nd through to 5th metacarpals are superimposed
• Thumb has no superimposition
• Thumb position varies from PA to slightly oblique

“Extension lateral”

• 2nd through to 5th digits fully extended and superimposed

“Flexion lateral”

• 2nd through to 5th digits are flexed and superimposed

Area Covered Phalanges, metacarpals, carpals and 2.5cm (1 inch) of distal radius and ulna

Collimation Include the distal phalanges to the distal forearm and soft tissue

Exposure Bony trabecular patterns and cortical outlines are sharply defined. Soft

tissues are visualised

Special Notes

• The extension lateral is sometimes preffered in cases of suspected foreign bodies
• Metacarpals are used in assessing how lateral the hand is
• To identify metacarpals, the 2nd metacarpal is the longest and the 5th metacarpal is the shortest