Hand

Question 1

Scaphoid ossification

Answer 1

4-6 years

Question 2

Bone age scan

Answer 2

left hand PA

FFD: 76cm

Question 3

Routine hand projections

Answer 3

PA

PA Oblique

Question 4

PA hand

Position

CR

Angle

Collimation

FFD

kVp

mAs

Answer 4

Patient sitting at end of table parallel to end so
legs not under the table
• Flex elbow at 90o
• Hand and forearm resting on table
• Place palm of hand down on imaging plate and
slightly spread the fingers
• Long axis of third digit should be in line with
forearm and parallel to edge of imaging plate
• Central ray perpendicular to imaging plate
• Center to the 3rd MCP joint
• Collimate on four sides to outer margins of hand
• FFD 110cm
• kVp 45
• mAs 2.5
• Fine focus, no grid

Question 5

PA Oblique Hand

Position

CR

Angle

Collimation

FFD

kVp

mAs

Answer 5

Patient sitting at end of table parallel to end so
legs not under the table
• Flex elbow at 90o
• Hand and forearm resting on table
• From PA position rotate hand and wrist 45o
so
radial aspect is elevated
• Long axis of third digit should be in line with
forearm and parallel to edge of imaging plate
• Central ray perpendicular to imaging plate
• Center to the 3rd MCP joint
• Collimate on four sides to outer margins of hand
• FFD 110cm
• kVp 45
• mAs 2.5
• Fine focus, no grid

Question 6

PA hand oblique criteria

Answer 6

Regional anatomy included – tips
of digits to distal radius and ulna,
including soft tissue
• Midshafts of third, fourth and
fifth metacarpals should not
overlap however some overlap of
distal heads
• No overlap of distal second and
third metacarpals
• Density and contrast optimal to
visualise bone & soft tissue

Question 7

Hand Supplementary projections

Answer 7

PA Both hands (metabolic disease and arthritic evaluation)

Lateral

Norgaard

Question 8

Hand Lateral

Position

CR

Angle

Collimation

FFD

kVp

mAs

Answer 8

Patient sitting at end of table parallel to end so
legs not under the table
• Flex elbow at 90o
• Hand and forearm resting on table
• Hand on side so radial aspect is elevated and
radial and ulna styloid processes are superimposed
• Long axis of hand should be in line with forearm
and parallel to edge of imaging plate
• Central ray perpendicular to imaging plate
• Center to the 2nd MCP joint
• Collimate on four sides to outer margins of hand
• FFD 110cm
• kVp 50
• mAs 4.5
• Fine focus, no grid

Question 9

Norgaard method

Position

CR

Angle

Collimation

FFD

kVp

mAs

Answer 9

Patient sitting at end of table
• Hands and forearms resting on table
• Supinate hands so palms are up and place medial
aspect of hands together
• Internally rotate hands 45o so radial aspect is
elevated
• Extend fingers and abduct the thumbs
• Long axis of hand should be in line with forearm
and parallel to edge of imaging plate
• Central ray perpendicular to imaging plate
• Center in between hands at level of MCP joints
• Collimate on four sides to outer margins of hand
• FFD 110cm
• kVp 45
• mAs 2.5
• Fine focus, no grid