Finger (oblique view)

The finger oblique view is a standard projection for radiographic assessment of the fingers. 

Indications

The oblique view s not required for follow-up studies, or 'query foreign body' unless specifically requested. It is, however, a very useful projection in the acute setting and should be included in the acute finger series to ensure no subtle pathology is missed ². 

Patient position

• the patient is seated alongside the table (similar to a projection of hand)

• from a pronated position for PA fingers, the hand is rotated approximately 45 degrees (thumb side up), resting on a sponge if required (see Figure 1)

• fingers are separated to avoid superimposition

• the long axis of the finger should run parallel to the image receptor (in horizontal and vertical planes)

Technical factors

• posteroanterior oblique projection

• centering point

  • approximately over the proximal interphalangeal joint

• collimation

  • laterally to the skin margins

  • proximal to include the carpometacarpal joint

  • distal to the tips of the distal phalanges 

• orientation  

  • portrait

• detector size

  • 18 cm x 24 cm

• exposure

  • 50-60 kVp

  • 1-5 mAs

• SID

  • 100 cm

• grid

  • no

Image technical evaluation

Digit is examined to include the carpometacarpal joint. The condyles of the phalanges are oblique as seen via little superimposition of the two domes. There is a noted uneven concavity of the mid-shaft of the metacarpal. On the raised side, there is more soft tissue

Practical points

The oblique finger has a proven high diagnostic yield, patients may not be able to maintain an oblique position, you can assist them via a small 30-degree sponge. 

Excessive superimposition of the of the metacarpals indicates the hand is externally elevated too much.

Separation of the metacarpals (almost a PA view) means the hand must be raised slightly.