What position should the patient’s wrist be in for a PA wrist X-ray?

For a PA wrist X-ray, the patient's wrist should be positioned with the fist made and the wrist placed directly on the cassette. This positioning allows for optimal visualization of the carpal bones, as it helps to align them in a way that minimizes distortion and maximizes the clarity of the radiographic image.

When the wrist is in a fist position, it ensures that the alignment of the wrist and hand structures is consistent. This is particularly important as it aids in proper imaging of the joint spaces and provides a comprehensive view of any potential injuries or conditions affecting the wrist.

In contrast, other positions do not offer the same benefits for diagnostic purposes. A neutral wrist position may not achieve the required alignment for optimal imaging, while a fully extended wrist with fingers spread could lead to overlapping structures, potentially obscuring important details. The elbow being flexed at 90° is also not relevant to the wrist's positioning and does not influence the imaging of wrist pathology directly. Therefore, making a fist and placing the wrist directly on the cassette is the correct approach for a PA wrist X-ray.