DP Hand
Routine & Trauma Radiographic Positioning Guide
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Routine
Trauma / Mobile
Tube Parameters
- Exposure: 52 kVp, 2 mAs
- SID: 100 cm
- Tube Angle: no angle
- Cassette Size: 18x24cm Portrait
- Grid: No
Patient Preparation
Seat the patient at the end of the table with the affected arm flat on the table. Ensure all radiopaque artifacts (rings, watches, bracelets) are removed.
Trauma Note: If the patient is on a bed then slide the detector under the affected hand, making sure it lies flat.
Patient Positioning
- Place the hand palm down onto the cassette (PA/DP position).
- Spread the fingers slightly apart to ensure there is no soft tissue overlap.
- Ensure the wrist remains in contact with the cassette.
Trauma Note: Be aware that patients with hand trauma may have difficulty spreading their fingers.
Centering & Marker
- Centering: Central ray directed to the 3rd Metacarpophalangeal Joint (MCPJ).
- Marker Placement: Place the correct anatomic marker on the lateral (radial) side, oriented AP.
Collimation
- Proximal (Wrist): Collimation should extend approximately 2.5 cm proximal to the radiocarpal joint (wrist).
- Distal (Fingers): Include all distal phalanges to the skin margins.
- Side to side: Include all lateral and medial skin margins of the hand and thumb.
Image Evaluation Criteria
- Coverage: The entire hand must be visualized, from the tufts of the distal phalanges down to 2.5 cm proximal to the wrist joint.
- Rotation: There should be no rotation, evidenced by the equal concavity of the metacarpal and phalangeal shafts on both sides.
- Separation: Fingers must be slightly spread to prevent superimposition of soft tissues.
- Exposure: Optimal exposure should demonstrate bony trabecular detail as well as the surrounding soft tissue margins.