Pediatric hand (PA view)

Last revised by Amanda Er on 21 Apr 2023

The posteroanterior hand view for pediatrics is part of a two view series examining the phalanges, metacarpals, carpal bones and distal radioulnar joint. 

This view is useful in assessing suspected dislocations or fractures, localizing foreign bodies or evaluating juvenile idiopathic/rheumatoid arthritis of the metacarpals, phalanges and joints in the hand.

  • patient is seated alongside the table
  • the affected arm if possible is flexed at 90° so the arm and hand can rest on the table
  • the affected hand is placed, palm down on the image receptor
  • shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam
  • the hand and elbow should be at shoulder height which makes radius and ulna parallel (lowering the arm makes the radius cross the ulna, thus foreshortening the radius)
  • posteroanterior projection
  • centering point
    • third metacarpal head
  • collimation
    • laterally to the skin margins
    • proximal to include distal radioulnar joint; patients may have referred pain from pathology other than the hand
    • distal to the tips of the distal phalanges
  • orientation  
    • portrait
  • detector size
    • 18 cm x 24 cm
  • exposure 1
    • 40-48 kVp
    • 1-3 mAs
  • SID
    • 100 cm
  • grid
    • no

2nd to 5th digits are positioned posteroanterior, with no rotation as evidenced by the symmetric concavities of the phalanges and metacarpals. Interphalangeal and metacarpophalangeal joint spaces of digits 2 to 5 appear open.

The concavity of the metacarpal shafts is equal 2.

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is extremely beneficial for hand imaging as young children may not remain still when their affected hand is brought away from their body.

Ideally, if parental holding is required, the parent holds the proximal part of the child’s arm from anterolaterally in order to be in the child's direct line of sight;

  • this will require clear instructions for parents to follow, hence preventing malrotation/motion artifact from a wriggling child
  • if the parent is accompanying the child by holding them in position, whilst the parent puts on a lead gown, it is the radiographer's responsibility to ensure the child does not fall off the chair
  • if other methods can be used such as distraction techniques, this is ideal to avoid scattered radiation to parents and staff 3

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