Hand (oblique view)

Changed by Andrew Murphy, 5 Aug 2016
Back to revision history

Updates to Article Attributes

Title was changed:
Hand DP: oblique view
Body was changed:

The DP (dorsopalmar) oblique hand view is also referred to as the anterior oblique or PAHand oblique view is part of a two view series metacarpals, phalanges, carpal bones and distal radial ulnar joint.

Patient position

  • patient is seated alongside the table as with PA view
  • the affected arm if possible is flexed at 90° so the arm and hand can rest on the table
  • the hand is rotated externally by 45 degreesfrom the basic PA position with fingers kept in extension and parallel to image receptor

X-ray

  • shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam features

    Collimation:

    To include entire
  • the hand to distal forearm, centring approximately overand elbow should be at shoulder height which makes radius and ulna parallel (lowering the arm makes radius cross the ulna and thus relative shortening of radius)

    • Technical factors

    • posteroanterior projection
    • centring point
      • third metacarpal head.
    • collimation
      • laterally to the skin margins
      • proximal  to include distal radioulnar joint 
      • distal to the tips of the distal phalanges 
    • Grid:orientation no
      • portrait
    • detector size
      • 18 cm x 24 cm
    • exposure
      • 50-60 kVp
      • 1-5 mAs
    • SID:
      • 100 cm
    • Exposure factors: grid50 kV, 1.6 mAs

      Please note:These are average exposures using a Siemens DR system. Exposures may vary between different CR or DR systems and with different patient body habitus.

      • no

    Image critiquetechnical evaluation

    (Figure 2)

    Collimation

    Collimation is appropriate with entire hand is visualised, including distal forearm.

    Positioning

    Fingers are positioned parallel to image receptor, indicated by open interphalangeal and metacarpophalangeal joint spaces. Correct obliquity is evidenced by the following:

    • midshafts of 3rd to 5th metacarpals do not overlap
    • some overlap of the distal heads of the 3rd to 5th metacarpals
    • no overlap of the distal heads of the 2nd and 3rd metacarpals
    Exposure

    Practical points

    Appropriate exposure evidenced by adequate bony detail visible in entirePatients 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, with soft tissue also visualised clearly is externally elevated too much.

    Separation of the metacarpals (almost a PA view) means the hand must be raised slightly.
    • -<p>The <strong>DP (dorsopalmar) oblique hand view</strong> is also referred to as the <strong>anterior oblique or PA oblique view</strong>.</p><h4>Patient position</h4><ul>
    • -<li>patient is seated alongside the table as with PA view</li>
    • -<li>the hand is rotated externally by 45 degrees<sup> </sup>from the basic <a href="/articles/hand-pa-view">PA position</a> with fingers kept in extension and parallel to image receptor</li>
    • -</ul><h4>X-ray beam features</h4><p><strong>Collimation:</strong></p><p>To include entire hand to distal forearm, centring approximately over the third metacarpal head.</p><p><strong>Marker placement:</strong> AP, lateral and distal</p><p><strong>Grid: </strong>no</p><p><strong>SID: </strong>100 cm</p><p><strong>Exposure factors: </strong>50 kV, 1.6 mAs</p><p>Please note:<br>These are average exposures using a Siemens DR system. Exposures may vary between different CR or DR systems and with different patient body habitus.</p><h4>Image critique</h4><p>(Figure 2)</p><h5>Collimation</h5><p>Collimation is appropriate with entire hand is visualised, including distal forearm.</p><h5>Positioning</h5><p>Fingers are positioned parallel to image receptor, indicated by open interphalangeal and metacarpophalangeal joint spaces. Correct obliquity is evidenced by the following:</p><ul>
    • +<p>The <strong>Hand oblique view</strong> is part of a <a href="/articles/hand-series">two view series</a> metacarpals, phalanges, carpal bones and distal radial ulnar joint. </p><h4>Patient position</h4><ul>
    • +<li>patient is seated alongside the table</li>
    • +<li>the affected arm if possible is flexed at 90° so the arm and hand can rest on the table</li>
    • +<li>the hand is rotated externally by 45 degrees from the basic <a href="/articles/hand-pa-view-1">PA position</a> with fingers kept in extension and parallel to image receptor</li>
    • +<li>shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam</li>
    • +<li>the hand and elbow should be at shoulder height which makes radius and ulna parallel (lowering the arm makes radius cross the ulna and thus relative shortening of radius)</li>
    • +</ul><h4>Technical factors</h4><ul>
    • +<li><strong>posteroanterior projection</strong></li>
    • +<li>
    • +<strong>centring point</strong><ul><li>third metacarpal head</li></ul>
    • +</li>
    • +<li>
    • +<strong>collimation</strong><ul>
    • +<li>laterally to the skin margins</li>
    • +<li>proximal  to include distal radioulnar joint </li>
    • +<li>distal to the tips of the distal phalanges </li>
    • +</ul>
    • +</li>
    • +<li>
    • +<strong>orientation </strong><em> </em><ul><li>portrait</li></ul>
    • +</li>
    • +<li>
    • +<strong>detector size</strong><ul><li>18 cm x 24 cm</li></ul>
    • +</li>
    • +<li>
    • +<strong>exposure</strong><ul>
    • +<li>50-60 kVp</li>
    • +<li>1-5 mAs</li>
    • +</ul>
    • +</li>
    • +<li>
    • +<strong>SID</strong><ul><li>100 cm</li></ul>
    • +</li>
    • +<li>
    • +<strong>grid</strong><ul><li>no</li></ul>
    • +</li>
    • +</ul><h4>Image technical evaluation</h4><p>Fingers are positioned parallel to image receptor, indicated by open interphalangeal and metacarpophalangeal joint spaces. Correct obliquity is evidenced by the following:</p><ul>
    • -</ul><h5>Exposure</h5><p>Appropriate exposure evidenced by adequate bony detail visible in entire hand, with soft tissue also visualised clearly.</p>
    • +</ul><h4>Practical points</h4><p>Patients may not be able to maintain an oblique position, you can assist them via a small 30-degree sponge. </p><p>Excessive superimposition of the of the metacarpals indicates the hand is externally elevated too much.</p><p>Separation of the metacarpals (almost a PA view) means the hand must be raised slightly.</p>

    ADVERTISEMENT: Supporters see fewer/no ads