Oblique hand X-ray positioning
An extra hand view, used when a routine one is not enough. The patient sits, the beam passes at an oblique angle, straight on to the receptor, and the centring point is the head of the third metacarpal.
By the ScanFlo Editorial Team · Updated
In this section · X-ray positioning
- X-ray positioning guides
- Skull positioning
- Face & sinuses positioning
- Soft tissue neck positioning
- C-spine positioning
- Chest positioning
- Shoulder positioning
- Humerus positioning
- Elbow positioning
- Forearm positioning
- Wrist positioning
- Hand positioning
- T-spine positioning
- Abdomen positioning
- L-spine positioning
- Sacrum & SI joints positioning
- Pelvis positioning
- Hip positioning
- Femur positioning
- Knee positioning
- Tibia & fibula positioning
- Ankle positioning
- Foot positioning
Still being checked: a radiographer is reviewing this guide. If your department does it differently, follow your department.
Patient position
Sitting. On request: from the PA, raise the thumb side 45° on a step pad, fingers separated.
Centring & collimation
Central ray
obliqueCentre: the head of the third metacarpal.
Beam: oblique, perpendicular to the receptor.
Collimate: fingertips to the distal forearm
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 100 cm | |
| Receptor | 18 × 24 cm | portrait |
| Placement | On the holder | No grid |
| Angulation | None | Perpendicular to the receptor |
Marker & breathing
- Marker: R or L marker on the side nearest the detector
- Breathing: No breathing instruction needed.
Exposure by patient size
Treat these as a starting point. Your detector, your generator and the patient in front of you will all move the numbers.
| Patient size | kV | mAs (chart) | mAs (DR default) |
|---|---|---|---|
| XS | 46 | 0.5 | 0.5 |
| S | 46 | 0.5 | 0.5 |
| M | 46 | 0.5 | 0.5 |
| L | 46 | 0.8 | 0.5 |
These start from a classic film-screen chart (46 kV, 8 mAs at 140 cm) and are adjusted for a digital detector at 100 cm. The DR column is what ScanFlo's console suggests; each step up or down changes the mAs by about a quarter.
Image quality checklist
- Metacarpal shafts slightly overlapping, not superimposed.
- The anatomical side marker is visible, correct and clear of the anatomy.
- Collimation borders are visible on all sides, no wider than the area requested.
Faults & how to fix them
| Fault | Cause | Fix |
|---|---|---|
| Fingers superimposed | No step pad | Support the fingers parallel. |
Common questions
- Where do you centre for a hand oblique X-ray?
- The centring point is the head of the third metacarpal.
- What distance and beam angle does a hand oblique need?
- 100 cm from the tube to the receptor. The beam passes at an oblique angle, straight on to the receptor.
- What size receptor, and do you need a grid?
- Use an 18 × 24 cm receptor, portrait, on the holder. No grid is needed.
- Where does the lead marker go?
- R or L marker on the side nearest the detector.
- What goes wrong most often on a hand oblique?
- Fingers superimposed. Usual cause: no step pad. The fix: support the fingers parallel.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a hand oblique in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.