RAD 130 CH 5 Positioning
Shoulder Girdle Technical Factors
kV range: analog 70 to 75; digital 75 to 85 kV Grid (>10 cm) High mA (short exposure time) Small focal spot AEC (center chamber) 40 inches (102 cm) SID (except AC joints)
Routine Clavicle
AP bilateral w/weights AP bilateral w/o weights
Routine Shoulder trauma
AP—neutral rotation Transthoracic lateral Lawrence Method Scapular Y
AP Clavicle
CR perpendicular to midclavicle Evaluation Criteria Entire clavicle demonstrated Four-sided collimation Optimal exposure factors AP axial More of clavicle seen above ribs
Inferosuperior axial projection (Clements modification)
CR perpendicular to IR If patient cannot abduct arm, CR 5° to 15° to axilla Evaluation Criteria
Transthoracic lateral Lawrence Method
CR perpendicular to surgical neck Breathing technique Evaluation Criteria Proximal humerus clearly seen Humeral head and glenoid cavity seen Humeral head in neutral rotation Optimal exposure factors
Pearson Method AC Joints: Alternative Supine Position Alexander Method :Alternative AP Axial
CR to midpoint between AC joints With and without weights 72-inch (183-cm) SID Alexander Method: 15* cephalic angle centered at the level of the affected AC joint Evaluation Criteria Both AC joints demonstrated No motion Optimal exposure factors Correct markers visible Close collimation evident
AP—neutral rotation
CR to scapulohumeral joint Evaluation Criteria Greater tubercle superimposed Scapulohumeral joint centered Optimal exposure factors
Special Transthoracic Lateral Humerus (Trauma)
Demonstrates entire humerus without rotation Unaffected limb raised over head CR to mid aspect to involved humerus
Shoulder nontrauma Special
*Inferosuperior axial (Lawrence method) *PA transaxillary projection (Hobbs modification) *Inferosuperior axial projection (Clements modification) *Posterior oblique (Grashey method) *Tangential (Fisk modification)
Routine Humerus Trauma and nontrauma
1. AP 2. Lateral 3. Rotational lateral 4. Horizontal beam lateral
Posterior oblique (Grashey method)
35° to 45° oblique CR perpendicular to IR, 2 inches (5 cm) inferior and medial from superolateral border of humerus Evaluation Criteria Glenoid cavity profiled Scapulohumeral joint centered Optimal exposure factors
AP apical oblique axial Garth Method
45° oblique: CR 45° caudad CR to scapulohumeral joint hint CR enters just inferior to coracoid process Evaluation Criteria Humeral head, glenoid cavity, and neck free of superimposition Scapulohumeral joint centered Optimal exposure factors
Routine Clavicle
AP AP axial
Routine Scapula
AP Lateral
AP Scapula
Breathing technique (optional) CR to midscapula Evaluation Criteria Entire scapula demonstrated Lateral border of scapula free of ribs and lungs Optimal exposure factors
Outlet Projection Neer method
CR 10° to 15° caudad Evaluation Criteria Supraspinatus outlet open and in profile Demonstrates coracoacromial arch Optimal exposure factors Demonstrates coracoacromail arch for supraspinatus outlet region for possible shoulder impingement
AP Axial Clavicle
CR 15° to 30° cephalad to midclavicle Evaluation Criteria Entire clavicle demonstrated Four-sided collimation Optimal exposure factors AP axial More of clavicle seen above ribs
Inferosuperior axial (Lawrence method)
CR 25° to 30° medial to axilla Arm supinated, abducted 90° (or as near 90° as possible) Alternate Position with Exaggerated Rotation Demonstrate possible Hill-Sachs defect Evaluation Criteria Lesser tubercle profiled anteriorly Humeral head and glenoid fossa profiled Optimal exposure factors
Shoulder External Rotation (AP Proximal Humerus)
Epicondyles parallel CR 1 inch (2.5 cm) inferior to coracoid process Evaluation Criteria Greater tubercle profiled laterally Scapulohumeral joint centered Proximal humerus, upper scapula, and clavicle visualized Optimal exposure factors
Shoulder Internal Rotation (Lateral Proximal Humerus)
Epicondyles perpendicular CR 1 inch (2.5 cm) inferior to coracoid process Evaluation Criteria Lesser tubercle profiled medially Scapulohumeral joint centered Proximal humerus, upper scapula, and clavicle visualized Optimal exposure factors
2. Lateral Humerus Recumbent Rotational Lateral
Epicondyles perpendicular to IR Evaluation Criteria Entire humerus demonstrated Lesser tubercle in profile Epicondyles superimposed Exposure factors
3. Lateromedial and Mediolateral Humerus Projections
Epicondyles perpendicular to IR CR to midhumerus Evaluation Criteria Entire humerus demonstrated Lesser tubercle in profile Epicondyles superimposed Exposure factors
Tangential (Fisk modification)
Erect: Humerus 15° to 20° to CR, which is perpendicular to IR Supine: CR 15° to 20° posterior to humerus Evaluation Criteria Anterior humeral head profiled Groove profiled between greater and lesser tubercles Optimal exposure factors
PA transaxillary projection (Hobbs modification)
Evaluation Criteria
4. Horizontal Beam Lateral Mid and Distal Humerus
Evaluation Criteria Mid and distal humerus Distal ⅔ humerus demonstrated 90° perspective from AP projection Epicondyles superimposed Exposure factors
Routine Shoulder nontrauma
External (AP) Internal (Lat)
Lateral Scapula
For body of scapula CR to mid-vertebral border For upper scapula CR to acromion or coracoid Evaluation Criteria Body of Scapula in Profile Borders of scapula superimposed Free of superimposition by ribs Arm elevated to demonstrate scapular body
Scapular Y
For lateral shoulder and proximal humerus CR perpendicular to IR at proximal humerus—2 inches (5 cm) below top of shoulder Evaluation Criteria Body of scapula superimposed on end Acromion and coracoid processes in profile, nearly symmetric Humeral head and glenoid cavity superimposed Optimal exposure factors
1. AP Humerus
Include both shoulder and elbow joints CR to midhumerus Evaluation Criteria: Entire humerus demonstrated Greater tubercle in profile Medial and lateral epicondyles in profile Exposure factors
Special Shoulder trauma
Neer method AP apical oblique axial Garth Method
Oblique projection of humerus- Neutral rotation
Which AP Rotation Position of the Shoulder Is Demonstrated in A
AP projection of humerus- external rotation
Which AP Rotation Position of the Shoulder Is Demonstrated in B
Lateral projection of humerus- internal rotation
Which AP Rotation Position of the Shoulder Is Demonstrated in C