Hand, Finger, and Thumb X-Ray Positioning Techniques
Finger X-Ray Positioning
PA Projection
Film/IR Size
18 x 24 cm (transverse)
Patient Position
Seat the patient at the end of the table, elbows flexed approximately 90°, with the hand and forearm resting on the table.
Part Position
Hand pronated with fingers straight.
Central Ray (CR)
Perpendicular, directed to the 1st proximal interphalangeal (PIP) joint.
SID
1 meter
Collimation
Collimate on all 4 sides to the finger area.
Notes
Alternatively, a larger film encompassing the entire hand in PA projection may be used to assess for possible secondary injuries.
PA Oblique Projection (Medial or Lateral Rotation)
Film/IR Size
18 x 24 cm (transverse)
Patient Position
Seat the patient at the edge of the table with the elbow flexed approximately 90°.
Part Position
Place the hand in a lateral position with the finger to be examined fully extended. Rotate 45° for oblique.
Central Ray (CR)
Perpendicular, directed to the 1st proximal interphalangeal (PIP) joint.
SID
1 meter
Notes
For the 2nd finger, medial rotation is preferred. If possible, place the 2nd finger in contact with the image receptor.
Thumb X-Ray Positioning
AP Projection
Film/IR Size
18 x 24 cm (transverse)
Patient Position
Seat the patient at the end of the table, arm extended forward.
Part Position
Internally rotate the hand (supination), keeping fingers extended, so the posterior surface of the thumb contacts the image receptor. Center on the 1st carpometacarpal (CMC) joint.
Central Ray (CR)
Perpendicular, directed to the 1st CMC joint.
SID
1 meter
Notes
PA Projection (Exception): Perform only if the patient cannot achieve the AP position. Place the hand in a near-lateral position, supporting the thumb on a radiolucent sponge block high enough to prevent obliquity.
PA Oblique Projection (Medial Rotation)
Film/IR Size
18 x 24 cm (transverse)
Patient Position
Seat the patient at the end of the table with the elbow flexed approximately 90°, hand and wrist resting on the table.
Part Position
Slightly abduct the thumb, placing its palmar surface in contact with the image receptor. (This naturally positions the thumb at a 45° angle).
Central Ray (CR)
Perpendicular, directed to the 1st CMC joint.
SID
1 meter
Lateral Projection
Film/IR Size
18 x 24 cm (transverse)
Patient Position
Seat the patient at the end of the table with the elbow flexed approximately 90°.
Part Position
Hand pronated, thumb abducted, fingers slightly arched. Rotate the hand slightly medially until the thumb is in a true lateral position.
Central Ray (CR)
Perpendicular, directed to the 1st CMC joint.
SID
1 meter
AP Projection (Modified Robert Method)
Film/IR Size
18 x 24 cm (transverse)
Patient Position
Seat the patient at the end of the table with the arm extended.
Part Position
Internally rotate the arm until the posterior aspect of the thumb rests on the image receptor.
Central Ray (CR)
Direct the CR 15° proximally (towards the wrist), entering at the 1st metacarpophalangeal (MCP) joint.
SID
1 meter
Notes
- Pathology Demonstrated: This specialized view demonstrates fractures or dislocations of the 1st carpometacarpal (CMC) joint, the base of the 1st metacarpal, and Bennett’s fracture.
- Structures Visualized: Base of the 1st metacarpal and trapezium.
Hand X-Ray Positioning
PA Projection
Film/IR Size
24 x 30 cm (transverse)
Patient Position
Seat the patient at the end of the table with the elbow flexed approximately 90°, with the hand and forearm resting on the table.
Part Position
Hand pronated with the palmar surface flat on the image receptor, fingers slightly spread.
Central Ray (CR)
Perpendicular, directed to the 3rd metacarpophalangeal (MCP) joint.
SID
1 meter
Collimation
Collimate on all 4 sides to include the hand and wrist margins.
PA Oblique Projection
Film/IR Size
24 x 30 cm (transverse)
Patient Position
Seat the patient at the end of the table with the elbow flexed approximately 90°, with the hand and wrist resting on the table.
Part Position
Hand pronated on the image receptor. Rotate the hand and wrist laterally 45° and support with a radiolucent wedge. Keep fingers extended and slightly separated.
Central Ray (CR)
Perpendicular, directed to the 3rd MCP joint.
SID
1 meter
Notes
For routine hand views, use a support block to position the fingers parallel to the image receptor. This prevents foreshortening of the phalanges and obscuring of the interphalangeal joints. If only the metacarpals are of interest, the image can be taken with the thumb and fingertips touching the image receptor.
Lateral-Medial Projection (“Fan Lateral”)
Film/IR Size
18 x 24 cm (longitudinal)
Patient Position
Seat the patient at the end of the table with the elbow flexed approximately 90°.
Part Position
Rotate the hand and wrist into a lateral position (thumb side up). Fan the fingers and thumb apart (‘fan’ position) and support each finger individually on a radiolucent block.
Central Ray (CR)
Perpendicular, directed to the 2nd MCP joint.
SID
1 meter
Collimation
Collimate on all 4 sides to include the hand and wrist margins.