Hand (bilateral PA view)
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The bilateral PA view is merely a single film that includes both hands, side by side. Although convenient, recent research has shown that the distortion due to divergent ray when imaging bilaterally can impact diagnosis and x-raying the hands individually is preferred at a minimal dose increase 1.
This view often complements the ball-catcher view and is performed almost exclusively to examine for evidence of rheumatological disorders (e.g. rheumatoid arthritis, osteoarthritis, psoriatic arthritis etc.). It allows symmetry and distribution to be assessed easily without having to switch between images or account for slight differences in positioning.
patient may be seated alongside or facing the table
both hands are pronated with their palmer surfaces placed on the detector
posterior-anterior bilateral projection
between the two hands at the level of the metacarpophalangeal joints
laterally to the skin margins
distal to the skin margins of the fingertips
proximal to the include one-third of the distal radius and ulna
24 cm x 30 cm
Image technical evaluation
There is neither overlap of the midshafts of the metacarpals nor is there overlap of the phalange bases.
Hands are equal distance apart.
The projection should appear to mimic that of a PA hand
The hand is not a technically challenging radiograph, always ensure the fingers are equal distance apart and the detector is high enough to avoid overlap at the wrist.
Always include the wrist joint on your PA radiograph, patients may have referred pain from pathology other than the hand.
- 1. Keir A & Braithwaite V. Together or Separate: What is Best Practice when Imaging Bilateral Hands for Rheumatoid Arthritis Examinations? J of Medical Radiation Sci. 2023. doi:10.1002/jmrs.689 - Pubmed
- 2. Whitley AS, Sloane C, Hoadley G et-al. Clark's positioning in radiography. Hodder Arnold Publication. ISBN:0340763906. Read it at Google Books - Find it at Amazon