Clavicle and Scapula Procedures

What is a clavicle series?

AP and AP axial

Where do clavicle fractures usually take place?

80% in the middle, 15% on the lateral end

Explain the positioning for an AP clavicle

• 10×12 CW

• AP upright or supine with table bucky

• shoulders flat, arms at sides, chin raised, look forward

• on inspiration

What is a benefit of doing a clavicle PA?

shorter OID, increases the detail

Where should you center for an AP clavicle?

mid-clavicle

What SID is used for most clavicle and scapula images?

40”

What needs to be demonstrated on an AP clavicle image (film eval)?

• full body of the clavicle

• AC and SC joints in view

• half of clavicle unsuperimposed from thorax

  • clavicle at level of 3rd/4th rib

  • superior scapular angle should be superimposed on mid-clavicle

• marker lateral

How are clavicle and scapula images sent?

as if someone is standing in front of you in anatomic position

Explain the positioning for an AP axial clavicle image

• 10×12 CW

• AP upright or supine

• shoulders flat, arms at sides, chin raised, look forward

• on inspiration

Explain the centering/angulation for an AP axial clavicle image

• 15-30^o angle

  • if AP: cephalic

  • if PA: caudal

• patient may be in a lordotic position to decrease the angle

• asthenic patients use more angle

What needs to be demonstrated on an AP axial clavicle image (film eval)?

• inferior surface of clavicle (tubercles visible)

• lateral 2/3 of clavicle unsuperimposed

• clavicle above superior angle of scapula

• AC and SC joints visible

• medial aspect of clavicle at level of 1st/2nd rib

• marker lateral

What is a scapula series?

AP and Lateral (Y-View)

Explain the positioning for an AP scapula image

• 10×12 LW

• upright or supine

• abduct affected arm 90^o

  • moves scapula off of thorax

  • places scapula lateral to IR

• supinate the hand

• suspend breathing or breathing technique

Explain the centering for an AP scapula image

perpendicular 2 inches inferior to coracoid (with 2 in of IR above shoulder)

What needs to be demonstrated on an AP scapula image (film eval)?

• true AP

• lateral border free of superimposition of ribs

  • arm abducted

• includes inferior angle of scapula

• marker lateral

How is the arm placed for a lateral scapula that the scapular body is of primary focus?

arm (of affected side) brought across the chest

How is the arm placed for a lateral scapula that the acromion and coracoid are of primary focus?

arm tucked behind the back

Explain the positioning for a lateral scapula image

• upright (AP or PA)

• oblique body 45-60^o to place scapula perpendicular to IR

• arm placement (determined by whether you are looking at the body or the acromion and coracoid)

Where do you center for a lateral scapula image?

perpendicular to mid-vertebral border of scapula

What needs to be demonstrated on a lateral scapula image (film eval)?

• superimposed lateral and medial borders

• no superimposition of scapula on ribs

• marked lateral

• acromion and coracoid processes

What are AC and SC joint x-rays done for?

r/o separation or dislocation

What SID is used for AC joints?

72”

Explain the positioning and centering for AC joints

• 14×17 CW

  • centered 1 inch above jugular notch

• upright (standing or sitting) with back against bucky

• arms at sides (neutral rotation)

Explain the breathing recommendations for clavicle, scapula, AC, and SC images

clavicle: on inspiration

scapula: breathing technique

AC: suspend breathing

SC: on expiration

What is the AC joint routine?

without weights first, then with weights

Why do you put the weights around a patient’s wrists for AC images?

so they don’t try to hold their arms up

If the without weights image shows a clavicle fracture, can you still do the with weights image for AC joints?

NO

If the without weights image shows a clavicle dislocation, can you still do the with weights image for AC joints?

YES

What needs to be demonstrated on an AC joints image (film eval)?

• both AC joints, both SC joints, and full clavicle in view

• markers on both sides of patient

• annotate whether it was with or without weights

If a patient has broad shoulders that don’t fit on the IR together for AC joints, how can you alter the procedure?

• two separate images for each joint

  • do both shoulders without weights before doing with weights

• center 1 in below AC joint

• cone in more

Explain the positioning and centering for SC joints

• 10×12 CW

  • center at T2/T3 (3 inches distal to vertebral prominence)

  • PA projection

• upright or prone (but don’t rotate the head)

• arms at sides or up at head

What needs to be demonstrated on an SC joints image (film eval)?

• both SC joints and medial ends of both clavicles

• don’t have to mark bilaterally

Explain the positioning and centering for oblique SC joints

• prone or upright

• rotate thorax 10-15^o to place affected side away from spine on the image

  • turn head away from affected side

  • right joint: RAO

  • left joint: LAO

• center over unaffected side

  • perpendicular to T2/T3

  • 1-2 inches toward side up

  • mark side down

A 10-15^o LAO demonstrates ___

A 10-15^o RAO demonstrates ___

LAO: the left SC joint to the right of the spine

RAO: the right SC joint to the left of the spine

What should the exposure index be for clavicle and scapula images?

EI: 200-600

S: 400-800

What techniques are used for an AP clavicle and an AP axial clavicle?

AP: 80 kVp @ 4 mAs

axial: 80 kVp @ 6.4 mAs

What techniques are used for an AP and lateral scapula?

AP: 80 kVp @ 4 mAs

lat: 80 kVp @ 8 mAs

What technique is used for AC joints?

80 kVp @ 12-16 mAs

(mAs goes way up because it is at 72” SID)

What technique is used for SC joints?

80 kVp @ 4 mAs