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