Lateral Hand
Routine & Trauma Radiographic Positioning Guide
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Routine
Trauma / Mobile
Tube Parameters
- Exposure: 55 kVp, 3 mAs
- SID: 100 cm
- Tube Angle: Perpendicular (0°)
- Cassette Size: 18x24cm Portrait
- Grid: Without Grid
Patient Preparation
Seat the patient alongside the table. Have them rest their affected arm flat on the table, bringing the hand to the same level as the shoulder. Ensure all radiopaque artifacts are removed.
Trauma Note: A true lateral may be impossible for a severe trauma patient. If they cannot rotate their wrist/hand, consider a Horizontal Beam Lateral (HBL) instead.
Patient Positioning
- Externally rotate the hand and wrist until it is perpendicular to the cassette (a true lateral position).
- Ensure the medial side (5th digit / pinky side) is resting directly against the cassette.
- Fan the digits out to form an "OK" sign, separating each finger to prevent superimposition of the phalanges (Fan Lateral).
Trauma Note: If checking for foreign bodies or severe metacarpal fracture displacement, an extension lateral (all fingers extended and superimposed) may be requested instead of a fan lateral to better visualize the metacarpals.
Centering & Marker
- Centering: Central ray directed to the 2nd Metacarpophalangeal Joint (MCPJ).
- Marker Placement: Place the correct anatomic marker on the anterior side, oriented AP.
Collimation
- Proximal (Wrist): Collimation should extend approximately 2.5 cm proximal to the radiocarpal joint (wrist).
- Distal (Fingers): Include all fanned distal phalanges to the skin margins.
- Side to side: Include anterior and posterior skin margins of the hand and thumb.
Image Evaluation Criteria
- Coverage: The entire hand must be visualized, from the tufts of the fanned phalanges down to 2.5 cm proximal to the wrist joint.
- Rotation: A true lateral is evidenced by the direct superimposition of the 2nd through 5th metacarpals.
- Separation: The phalanges (fingers) should be fanned out and individually visible without superimposing on each other.
- Thumb: The thumb should appear in a PA/AP projection, free of superimposition from the other digits.