When performing a PA hand x-ray, which anatomical landmarks should ideally be included in the collimation?

When performing a PA (posteroanterior) hand x-ray, the collimation should ideally include the styloid processes of the radius and ulna. This is important because including the styloid processes ensures that the entire area of the wrist and proximal aspects of the hand are visualized. The styloid processes serve as key anatomical landmarks; they indicate the transition from the wrist to the hand and are closely associated with the distal part of the radius and ulna.

Collimating to include these structures helps provide a comprehensive view necessary for diagnosing any potential fractures, dislocations, or other injuries involving both the wrist and hand. Proper collimation helps to reduce patient exposure to radiation and improves the quality of the x-ray by minimizing scatter.

In contrast, limiting the collimation to only the phalanges or the wrist joint would miss critical areas that might be of interest in a complete assessment of the hand and wrist, reducing the effectiveness of the imaging. Similarly, including the entire forearm would unnecessarily increase radiation exposure without providing additional relevant information for a hand x-ray.