Fingers (lateral view)

LateralFinger lateral view is a standard projection for radiographic assessment of the fingers; it is one of three views of the finger series. it is divided into:

• X-ray oflateral index and middle fingers
• X-raylateral of ring and little fingers

X-rayPatient position

Lateral of index and middle fingers

Index and middle fingers can be radiographed together if required.

Patient position

• patient seated alongside table
• hand is pronated and then medially rotated further to keep the lateral the lateral aspect of the index finger in in contact with cassette 
• index finger is in extension while the middle finger is slightslightly flexed at metacarpophalyngealmetacarpophalangeal joint so as to avoid superimposition  superimposition (only if imaging of this finger is required, otherwise it should be fully flexed, see Figure 1)
• other fingers are fully flexed

X-ray

Lateral of ring finger and little finger

Ring and little fingers can be radiographed together if required.

Patient position

• patient seated alongside the table
• medial aspect of the extended little finger is kept in contact with cassette while ring finger is slightly flexed at metacarpophalyngeal at metacarpophalangeal joint to avoid superimposition (only if ring finger requires imaging, otherwise it should be fully flexed, see Figure 2)
• rest of the fingers are fully flexed

Technical factors

• lateral projection
• Collimation:

  To include finger of interest to mid metacarpal, centring point

  • approximately over the proximal interphalangeal joint
• collimation
  • anteroposterior to the skin margins
  • proximal to include the carpometacarpal joint
  • distal to the tips of the fingerdistal 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

There should be no foreshortening; all interphalangeal spaces are open and no obstruction by other digits over the digit of interestquestion. 

If there is any suspected joint involvement, centre to a point over interphalangeal joint of the finger which is suspected to be involved.

Marker placement: AP, anterior and distal

Grid: no

SID: 100 cm

Exposure factors: 48 kV, 1 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.

Image critique

(Figure 3)

Collimation

Entire 5th digit is visualised to mid metacarpal.

Positioning

5th finger is positioned laterally, with superimposition of the phalangeal and metacarpal heads. Interphalangeal joint spaces visualised, indicating that the finger has been placed parallel to the image receptor and is in the correctcannot maintain a lateral position.

Exposure

Appropriate exposure evidenced by adequate bony detail visible as seen in entireFigures 1 and 2, a foam block can be used to wedge the injured finger, with soft tissue visualised clearly away from the hand.