Basilio, Mycah

RT - 301

RADPOS1
1st Activity

Projection Patient and Part Central Ray Structures Shown

Position

PA Projection: Fingers Patient Position: The central ray Distal, middle, and
Position the patient (CR) should be proximal phalanges;
at the end of the perpendicular to the distal metacarpal;
table with their image receptor (IR) associated joints.
elbow bent and directed to the
approximately 90 proximal
degrees, and their interphalangeal
hand and forearm (PIP) joint.
resting on the
tabletop.

Part Position:
Rotate the hand into
a pronated position
with fingers
extended. Align the
long axis of the
affected finger with
the long axis of the
image receptor (IR).
Ensure the adjacent
fingers are
separated from the
affected finger.
PA Oblique Projection — Patient Position: The central ray 45° oblique view of
Medial or Lateral Have the patient sit (CR) should be distal, middle, and
Projection: Fingers at the end of the perpendicular to the proximal phalanges;
table with the elbow image receptor (IR) distal metacarpal;
bent at and directed to the and associated
approximately 90 proximal joints
degrees, and the interphalangeal
hand and forearm (PIP) joint.
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placed flat on the
table.

Part Position:
Extend the fingers
and position the
hand in a 45° lateral
oblique (thumb side
up) using a 45°
foam wedge for
support. Align the
hand on the image
receptor so that the
long axis of the
finger matches the
long axis of the IR.
Separate the fingers
and gently place the
finger being
examined against
the wedge block,
ensuring it remains
in a 45° oblique
position and parallel
to the IR.
Lateral — Lateromedial or Patient Position: The central ray Lateral views of
Mediolateral Projections: Position the patient (CR) should be distal, middle, and
Fingers at the end of the perpendicular to the proximal phalanges;
table with the elbow image receptor (IR) distal metacarpal;
flexed and directed to the and associated
approximately 90 proximal joints are visible
degrees. interphalangeal
Rest the hand and (PIP) joint.
wrist on the image
receptor (IR),
ensuring the fingers
are fully extended.

Part Position:
Position the hand in
a true lateral
orientation with the
thumb side up,
ensuring the finger
to be examined is
fully extended and
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centered over the
area of the image
receptor (IR) being
used. Align and
center the finger
with both the long
axis of the IR and
the central ray (CR).
Use a sponge block
or other radiolucent
support to stabilize
the finger and
minimize
movement. Flex the
unaffected fingers
out of the way.
Make sure the long
axis of the affected
finger remains
parallel to the IR.
AP Projection: Thumb Patient The central ray Distal and proximal
Position:Seat the (CR) should be phalanges, first
patient facing the perpendicular to the metacarpal,
table with arms image receptor (IR) trapezium, and
extended forward. and directed to the associated joints are
Rotate the hand first visible.
internally to fully metacarpophalange Interphalangeal and
supinate the thumb, al (MCP) joint. metacarpophalange
positioning it for an al joints should
anteroposterior appear open.
(AP) projection.

Part Position:

AP: Begin by
demonstrating the
position on yourself
so the patient can
observe and better
understand the
expected posture.

Internally rotate the

hand with fingers
extended until the
posterior surface of
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the thumb rests flat
against the image
receptor (IR). Use
tape or other
immobilization
techniques if
necessary to hold
the other fingers out
of the way and
isolate the thumb.
Align the thumb
with the long axis of
the IR. Center the
first
metacarpophalange
al (MCP) joint to
the central ray (CR)
and to the center of
the IR.

PA: (Only if Patient

Cannot Position for
Previous AP)
Position the hand in
a near-lateral
orientation and rest
the thumb on a
sponge support
block. Ensure the
block is high
enough to keep the
thumb in a true
posteroanterior
(PA) position,
avoiding any
rotation.
Pa Oblique Projection— Patient Position: The central ray Distal and proximal
Medial Have the patient sit (CR) should be phalanges, first
Rotation: at the end of the perpendicular to the metacarpal,
Thumb table with the elbow image receptor (IR) trapezium, and
bent approximately and aimed at the associated joints are
90 degrees and the first visualized in a 45°
hand resting on the metacarpophalange oblique position
image receptor (IR). al (MCP) joint.
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RT - 301
Part Position:
Slightly abduct the
thumb while
keeping the palmar
surface of the hand
in contact with the
image receptor (IR),
naturally
positioning the
thumb in a 45°
oblique. Align the
long axis of the
thumb with the long
axis of the IR.
Center the first
metacarpophalange
al (MCP) joint to
both the central ray
(CR) and the center
of the IR.
Lateral Position: Thumb Patient Position: The central ray Distal and proximal
Have the patient sit (CR) should be phalanges, first
at the end of the perpendicular to the metacarpal,
table with the elbow image receptor (IR) trapezium
bent approximately and aimed at the (superimposed),
90 degrees, and the first and associated
hand resting palm metacarpophalange joints are visualized
down on the image al (MCP) joint. in the lateral
receptor (IR). position

Part Position: Begin

with the hand
pronated and the
thumb abducted,
keeping the fingers
and hand slightly
arched. Then,
gently rotate the
hand medially until
the thumb is
positioned in a true
lateral orientation.
You may need to
use a sponge or
other support under
the lateral side of
Basilio, Mycah
RT - 301
the hand for
stability. Align the
long axis of the
thumb with the long
axis of the image
receptor (IR).
Center the first
metacarpophalange
al (MCP) joint to
the central ray (CR)
and the center of the
IR. Ensure the
entire lateral side of
the thumb is in
direct contact with
the IR.
AP Axial Projection Patient Position: The central ray Anteroposterior
(Modified Position the patient (CR) should be (AP) projection
Robert’s seated parallel to the angled 15° shows the thumb
Method) *: end of the table, proximally (toward and first
Thumb with the arm and the wrist), entering carpometacarpal
hand fully extended at the first (CMC) joint
in front. carpometacarpal clearly, without any
(CMC) joint. overlapping
Part Position: structures.
Rotate the arm The base of the first
internally until the metacarpal and the
posterior side of the trapezium bone
thumb rests on the should be distinctly
image receptor (IR). visible.
Center the thumb on
the IR, aligning it
parallel to the side
edge of the IR.
Extend the fingers
to prevent soft
tissue overlap of the
first
carpometacarpal
(CMC) joint. If
needed, use tape to
immobilize the
other fingers and
isolate the thumb.
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PA Stress Thumb Projection Patient Position: The central ray Entire thumbs from
“Folio Have the patient sit (CR) should be first metacarpals to
Method” at the end of the perpendicular to the distal phalanges.
table with both image receptor (IR) Demonstrates
hands extended and and aimed midway metacarpophalange
pronated, resting between the al angles and joint
flat on the image metacarpophalange spaces at MCP
receptor (IR). al (MCP) joints. joints.
Use a minimum
Part Position: Place source-to-image
both hands side by distance (SID) of 40
side at the center of inches (100 cm).
the image receptor Collimate on all
(IR), rotating them four sides to include
laterally about 45° the second
to achieve a true metacarpals and the
posteroanterior entire thumbs,
(PA) projection of extending from the
both thumbs. Use carpometacarpal
supports under the (CMC) joints
wrists and proximal proximally to the
thumb areas as distal phalanges
needed to prevent distally.
movement. Ensure
the hands are
rotated sufficiently
so the thumbs lie
parallel to the IR for
an accurate PA
projection. Insert a
round spacer, like a
roll of medical tape,
between the
proximal thumb
regions, and secure
the distal thumbs
with rubber bands.
Just before the
exposure, instruct
the patient to firmly
pull their thumbs
apart and hold that
position.
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PA Projection: Hand Patient Position: The central ray The PA projection
Have the patient sit (CR) should be shows the entire
at the end of the perpendicular to the hand and wrist,
table with the elbow image receptor (IR) along with
bent approximately and directed to the approximately 2.5
90 degrees, and the third cm (1 inch) of the
hand and forearm metacarpophalange distal forearm.
resting on the table. al (MCP) joint. The hand’s PA
projection also
Part Position: Turn provides an oblique
the hand into a view of the thumb.
pronated position
with the palm
resting on the image
receptor (IR) and
fingers slightly
spread. Align the
long axis of the
hand and forearm
with the long axis of
the IR.
Center the hand and
wrist on the IR.

PA Oblique Projection: Patient Position: The central ray Oblique projection

Hand Have the patient sit (CR) should be of the entire hand
at the end of the perpendicular to the and wrist and about
table with the elbow image receptor (IR) 2.4 cm (1 inch) of
bent approximately and directed to the distal forearm are
90 degrees, and the third visible.
hand and forearm metacarpophalange
resting on the table. al (MCP) joint.

Part Position: Place

the hand pronated
on the image
receptor (IR),
aligning and
centering the long
axis of the hand
with the long axis of
the IR. Rotate the
entire hand and
wrist laterally by
45° and support
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RT - 301
them using a
radiolucent wedge
or step block,
ensuring all fingers
are separated and
positioned parallel
to the IR.

“Fan” Lateral— Patient Position: The central ray Entire hand and
Lateromedia Have the patient sit (CR) should be wrist and about 2.5
l Projection: at the end of the perpendicular to the cm (1 inch) of
Hand table with the elbow image receptor (IR) distal forearm are
bent approximately and directed to the visible.
90 degrees, and the second
hand and forearm metacarpophalange
resting on the table. al (MCP) joint.

Part Position: Align

the long axis of the
hand with the long
axis of the image
receptor (IR).
Rotate the hand and
wrist into a lateral
position with the
thumb side facing
up. Spread the
fingers and thumb
into a “fan” shape,
supporting each
digit on a
radiolucent block as
needed. Make sure
all digits, including
the thumb, are
separated and
parallel to the IR,
and that the
metacarpals remain
in a true lateral
position without
rotation.
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AP Oblique Bilateral Patient Position: Direct the central Both hands from
Projection: Seat patient at end ray (CR) the carpal area to
Hand of table with both perpendicular to the the tips of digits in
“Norgaard hands extended. IR, aimed at the 45° oblique
Method” midpoint between position are visible.
Part Position: both hands at the
Supinate both hands level of the fifth
and bring their metacarpophalange
medial sides al (MCP) joints.
together at the
center of the image
receptor (IR).
From this position,
internally rotate the
hands 45° and
support the
posterior aspects on
45° radiolucent
blocks. Extend the
fingers, keeping
them relaxed,
slightly separated,
and parallel to the
IR. Abduct both
thumbs to prevent
overlap.
PA (AP) Projection: Wrist Patient Position: Direct the CR Midmetacarpals and
Have the patient sit perpendicular to the proximal
at the end of the IR, aimed at the metacarpals;
table with the elbow midcarpal area. carpals; distal
bent about 90 radius, ulna, and
degrees and the associated joints;
hand and wrist and pertinent soft
resting palm down tissues of the wrist
on the image joint, such as fat
receptor (IR). pads and fat stripes,
Lower the shoulder are visible. All the
so that the shoulder, intercarpal spaces
elbow, and wrist all do not appear open
lie on the same because of irregular
horizontal plane. shapes that result in
overlapping.
Part Position: Align
and center the long
axis of the hand and
wrist to the image
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receptor (IR),
ensuring the carpal
area is centered to
the central ray (CR).
With the hand
pronated, slightly
arch the hand to
bring the wrist and
carpal area into
close contact with
the IR.

Alternative AP: An
AP wrist may be
taken, with hand
slightly arched to
place wrist and
carpals in close
contact with IR, to
demonstrate
intercarpal spaces
and wrist joint
better and to place
the intercarpal
spaces more parallel
to the divergent rays
PA Oblique Projection— Patient Position: The central ray Distal radius, ulna,
Lateral Have the patient sit (CR) should be carpals, and at least
Rotation: at the end of the perpendicular to the to midmetacarpal
Wrist table with the elbow image receptor (IR) area are visible.
bent approximately and directed to the Trapezium and
90 degrees and the midcarpal area. scaphoid should be
hand and wrist well visualized,
resting palm down with only slight
on the image superimposition of
receptor (IR). other carpals on
their medial aspects.
Part Position: Align
and center the hand
and wrist on the
image receptor (IR).
From a pronated
position, rotate the
wrist and hand
laterally by 45°. To
maintain stability,
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place a 45° support
under the thumb
side of the hand to
hold the hand and
wrist in a 45°
oblique position, or
partially flex the
fingers to arch the
hand so the
fingertips rest
lightly on the IR.
Lateral—Lateromedial Patient Position: The central ray Distal radius and
Projection: Have the patient sit (CR) should be ulna, carpals, and at
Wrist at the end of the perpendicular to the least the
table with the arm image receptor (IR) midmetacarpal area
and forearm resting and directed to the are visible.
on the table and the midcarpal area.
elbow flexed about
90 degrees. Place
the wrist and hand
on the image
receptor (IR) in a
thumb-up lateral
position. Ensure the
shoulder, elbow,
and wrist are
aligned on the same
horizontal plane.

Part Position: Align

and center the hand
and wrist along the
long axis of the
image receptor (IR).
Position the hand
and wrist in a true
lateral orientation,
with the fingers
comfortably flexed.
If needed to prevent
movement, use a
radiolucent support
block and sandbag,
placing the block
against the extended
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hand and fingers as
demonstrated.

PA AND PA Axial Patient Position:

Angle CR 10° to Distal radius and
Scaphoid— Position the patient
15° proximally, ulna, carpals, and
With Ulnar seated at the end of
along long axis of proximal
Deviation: the table with the forearm and toward metacarpals are
Wrist wrist and hand elbow. (CR angle visible. Scaphoid
placed palm down should be should be
on the imageperpendicular to demonstrated
receptor (IR).
long axis of clearly without
Ensure the shoulder,
scaphoid.) Center foreshortening, with
elbow, and wrist are
CR to scaphoid. adjacent carpal
aligned on the same(Locate scaphoid at interspaces open
horizontal plane. a point 2 cm [3 4 (evidence of CR
inch] distal and angle)
Part Position: medial to radial
Position the wrist styloid process.)
for a PA projection
with the palm down,
aligning the hand
and wrist along the
center of the long
axis of the image
receptor (IR), and
center the scaphoid
to the central ray
(CR). Without
moving the forearm,
gently evert the
hand (move it
toward the ulnar
side) as far as the
patient can
comfortably
tolerate, ensuring
the distal forearm
remains flat without
lifting or rotating.
PA Scaphoid—Hand Patient Position: Center CR Distal radius and
Elevated Have the patient sit perpendicular to IR ulna, carpals, and
And Ulnar at the end of the and directed to proximal
Deviation: table with the elbow scaphoid. (Locate metacarpals are
Wrist bent and resting on scaphoid at a point 2 visible. Carpals are
“Modified the table. cm [3 4 inch] distal visible, with
Basilio, Mycah
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Stecher Place the wrist and and medial to radial adjacent interspaces
Method” hand palm down on styloid process.) more open on the
the image receptor lateral (radial) side
(IR). Ensure the of the wrist.
shoulder, elbow, Scaphoid is shown,
and wrist are without
aligned on the same foreshortening or
horizontal plane. superimposition of
adjoining carpals.
Part Position: Place
the hand and wrist
palm down on the
image receptor (IR),
elevating the hand
on a 20° angled
sponge. Make sure
the wrist remains in
direct contact with
the IR.
Gently evert or turn
the hand outward
toward the ulnar
side, unless
contraindicated due
to severe injury.

(Alternative method
Have patient clench
the fist with ulnar
deviation to obtain a
similar position of
the scaphoid)
PA Projection—Radial Patient Position: The central ray Distal radius and
Deviation: Have the patient sit (CR) should be ulna, carpals, and
Wrist at the end of the perpendicular to the proximal
table with the elbow image receptor (IR) metacarpals are
bent at 90 degrees and directed to the visible. Carpals are
and resting on the midcarpal area. visible, with
table. Place the adjacent interspaces
wrist and hand palm more open on the
down on the image medial (ulnar) side
receptor (IR). of the wrist.
Ensure the shoulder,
elbow, and wrist are
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aligned on the same
horizontal plane.

Part Position:
Position the wrist
for a PA projection
with the palm down,
aligning the wrist
and hand along the
center of the long
axis of the image
receptor (IR).
Without moving the
forearm, gently
invert the hand
(move it medially
toward the thumb
side) as far as the
patient can
comfortably
tolerate, ensuring
the distal forearm
remains flat without
lifting or rotating.
Carpal Canal (Tunnel)— Patient Position: Angle the central The carpals are
Tangential, Have the patient sit ray (CR) between demonstrated in a
Inferosuperi at the end of the 25° and 30° to the tunnel-like, arched
or table with the wrist long axis of the arrangement.
Projection: and hand placed hand. If the patient
Wrist palm down cannot hyperextend
“Gaynor- (pronated) on the the wrist fully,
Hart image receptor (IR). increase the CR
Method” angle relative to the
Part Position: Align image receptor (IR)
the hand and wrist accordingly. Direct
along the long axis the CR to a point 2
of the image to 3 cm (about 1
receptor (IR). Ask inch) distal to the
the patient to base of the third
hyperextend metacarpal, which
(dorsiflex) the wrist is roughly at the
as far as possible, center of the palm.
using a piece of tape
or band to gently
but firmly hold the
wrist in this
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position. Aim to
position the
metacarpals and
fingers as close to
vertical (90° to the
forearm) as possible
without lifting the
wrist and forearm
off the IR.
Rotate the entire
hand and wrist
about 10° internally
(toward the radial
side) to prevent
superimposition of
the pisiform and
hamate bones.
Carpal Bridge—Tangential Patient Position: Angle the central Tangential view of
Projection: Have patient stand ray (CR) 45° to the the dorsal aspect of
Wrist or sit at end of the long axis of the the scaphoid,
table and then lean forearm. Direct the lunate, and
over and place CR to the midpoint triquetrum is
dorsal surface of of the distal visible. Outline of
hand, palm upward, forearm, the capitate and
on IR approximately 4 cm trapezium
(1½ inches) superimposed is
Part Position: proximal to the visible.
Center dorsal aspect wrist joint.
of carpals to IR.
Gently flex wrist as
far as patient can
tolerate, or until the
hand and forearm
form as near a 90°
(right angle) as
possible. Angle CR
45° to the long axis
of the forearm.