Scaphoid (lateral view)

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The scaphoid lateral view is part of a four view series of the scaphoid, wrist and surrounding carpal bones. It is a complementary projection to the PA view demonstrating the scaphoid in the orthogonal plane.

Patient position

  • patient is seated alongside the table
  • the affected arm if possible is flexed at 90°, so the arm and wrist can rest on the table
  • abduct the humerus until it is parallel to the image receptor
  • shoulder, elbow, and wrist should all be in the transverse plane, perpendicular to the central beam
  • wrist 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)

Technical factors

  • lateral projection
  • centering point
    • mid carpal region
  • collimation
    • anteroposterior to the skin margins
    • distal to the midway up the metacarpals
    • proximal to include one-quarter of the distal radius and ulna
  • orientation  
    • portrait
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-60 kVp
    • 3-5 mAs
  • SID
    • 100 cm
  • grid
    • no

Image technical evaluation

The academic rule of a true lateral wrist radiograph is defined by the pisoscaphocapitate relationship, where the palmar cortex of the pisiform should lie centrally between the anterior surface of the of the distal pole of the scaphoid and the capitate, ideally in the central third of this interval .

There is a superimposition of the carpal bones, including the distal portion of the scaphoid and the pisiform. The radius and ulna are also superimposed. The ulna styloid can be seen posterior.

Practical points

As scaphoid fractures are associated with FOOSH injuries, it is desirable in the acute setting to collimate to include the wrist in the lateral view, covering all areas around the scaphoid that could be the source of pain. In a follow-up radiograph, coning down to the scaphoid is favored.

It is important to remember this when examining your patient, and it is easy to forget that simply lifting your hand up and placing it on an image receptor could result in substantial pain. More often than not, the pain has not been addressed yet. Offer to move things around to assist in positioning, simple things like lowering/raising the table can go a long way and result in a better experience for the patient.

It is also possible to achieve the lateral scaphoid with the patient supine in bed, by simply following the basic positioning principles, the image receptor can be placed next to the patient on the bed under the affected wrist.