shoulder, clavicle, and scapula positioning

During radiography of the clavicle, which projection is used to reduce the amount of unsharpness?

Erect PA

3 multiple choice options

Radiographic images of the acromioclavicular articulations are normally performed:

1. In the decubitus position

2. Without and With the patient holding weights

3. Bilaterally

2 & 3 only

3 multiple choice options

A radiographic image of the shoulder is obtained in the AP projection with internal rotation. This will place the humerus in the:

Lateral position

3 multiple choice options

In evaluating a radiographic image of the scapula in the true lateral projection, which of the following structures should be superimposed?

Vertebral and axillary borders

3 multiple choice options

A radiographic image is taken on a supine patient with their arm abducted to a right angle and the elbow is flexed. This best describes:

AP projection of scapula

3 multiple choice options

During a radiographic evaluation of the scapula in the AP projection, respiration should be:

Continued with quiet breathing

3 multiple choice options

In order to obtain a radiographic image of the clavicle in the PA axial projection, the CR should be directed:

25° caudad

3 multiple choice options

A radiographic image of the shoulder is obtained in the AP projection. If the patient's arm is internally rotated this

will provide a profile view of the:

Lesser tuberosity

3 multiple choice options

In order to visualize the glenoid fossa on a radiographic image of the humerus in the AP oblique (Grashey) projection, the patient is medially rotated:

30-45 degrees

3 multiple choice options

A radiographic image of the shoulder is obtained in the inferosuperior axial (Lawrence) projection. This projection requires that the humerus be:

Abducted 90°, externally rotated

3 multiple choice options

There is an open joint space demonstrated between the humeral head and the glenoid cavity in which projection?

AP oblique (Grashey)

3 multiple choice options

For the scapular Y projection, the midcoronal plane forms an angle of how many degrees to the plane of the image receptor?

45-60°

3 multiple choice options

The proper centering point for an AP projection of the shoulder is which of the following?

1" inferior to the coracoid process

3 multiple choice options

To demonstrate the greater tubercle in profile on a projection of the humerus, the hand should be:

Supinated

3 multiple choice options

For proper visualization of the ___ articulation, it is necessary to acquire two images: one with the patient holding 8- to 10-pound weights, one without the patient holding any weight.

Acromioclavicular

3 multiple choice options

When an asthenic patient is standing erect for an AP axial projection of the clavicle, the proper central ray angulation is which of the following?

15-30° cephalad

3 multiple choice options

An axial projection of the clavicle is often helpful in demonstrating a fracture not visualized using a perpendicular central ray. When examining the clavicle in the AP position, how is the central ray directed for the axial projection?

cephalad

3 multiple choice options

For the AP projection of the scapula, the:

1. patient's arm is abducted at right angles to the body

2. patient's elbow is flexed with hand supinated

3. exposure is made during quiet breathing

1, 2, and 3

3 multiple choice options

The humerus is placed in a true lateral position when the arm is in the position.

Internal rotation

3 multiple choice options

With the patient supine, the arm abducted and the central ray directed horizontally through the axilla, one obtains a(an):

Inferosuperior axial projection of the shoulder

3 multiple choice options

The transthoracic projection (Lawrence position) is useful when:

A, B and C

3 multiple choice options

Two separate AP projections of the shoulder are often obtained. They are:

Internal and external rotation

3 multiple choice options

Which of the following would be used in radiography of the shoulder for a suspected fracture when the patient cannot abduct his arm?

Transthoracic lateral

3 multiple choice options

Hemorrhage and swelling of the acromioclavicular joint capsule would be best demonstrated by which of the following?

Bilateral AP shoulders with the patient erect and holding weight

3 multiple choice options

what are the different positions for a routine shoulder?

1. external and internal rotation

2. axillary- Lawrence method

what are the different positions for a trauma shoulder?

1. neutral rotation

2. transthoracic lateral (Lawrence method)

3. PA oblique (Y view)

shoulder: patient positioning for external and internal rotation, AP neutral, AP oblique (grayshey), transthoracic lateral

supine or AP erect

shoulder: AP neutral-part positioning

1. rotate body slightly toward the affected side so the scapula is parallel to the IR (will decrease OID)

2. arm at side in neutral position (epicondyles at 45 degree angle) palm of hand against thigh

shoulder: AP neutral, internal and external rotation- CR

perpendicular centered 1 inch inferior to coracoid process

shoulder: AP neutral- structure shown and C for E

1. proximal 1/3 of humerus

2. upper scapula (lateral 2/3 of scapula)

3. humeral head superimposing glenoid cavity

4. greater and lesser tuberosities superimposed on head of humerus

shoulder: AP external rotation- part position

1. hand everted (supinated) in true anatomical position. humeral epicondyles parallel to IR

2. rotate body slightly toward the affected side so the scapula is parallel to the IR (will decrease OID)

shoulder: AP external rotation- C for E

1. head of humerus seen in profile

2. greater tuberosity seen in profile in lateral aspect

3. lesser tuberosity seen between greater tuberosity and head of humerus

shoulder: AP internal rotation- part position

1. hand inverted, back of hand on the hip. humeral epicondyles superimposed (perpendicular to IR)

2. rotate body slightly toward the affected side so the scapula is parallel to the IR (will decrease OID)

shoulder: AP internal rotation- C for E

1. demo lesser tubercle in profile medially

2. greater tuberosity superimposed on head of humerus

3. more overlap of humerus and glenoid fossa

shoulder: inferosuperior or axial projection (Lawrence method): patient positioning

supine

shoulder: inferosuperior or axial projection (Lawrence method): part position

1. arm abducted 90 degree and externally rotated (do not attempt on trauma patient)

2. turn head away from affected side

3. IR is vertical in holder against neck (parallel to joint)

shoulder: inferosuperior or axial projection (Lawrence method): CR

1. horizontally through axilla (perpendicular to the shoulder joint)

2. angle medially 25-30 (depends on amount of abduction of the arm

shoulder: inferosuperior or axial projection (Lawrence method): structure shown

1. scapulohumeral joint (glenohumeral joint)

2. coracoid process

3. lesser tubercle

4. AC joint

5. dislocation of shoulder

shoulder: inferosuperior or axial projection (Lawrence method): C for E

1. slight overlap of scapulohumeral joint

2. coracoid process seen in profile and pointing anteriorly

3. lesser tubercle in profile

shoulder: AP oblique (LPO or RPO) or Grashey method- part position

1. affect shoulder rotated 35-45 degree toward IR

2. scapula parallel to IR

3. arm neutral position or placed across body

shoulder: AP oblique (LPO or RPO) or Grashey method- CR

perpendicular to glenoid cavity

shoulder: AP oblique (LPO or RPO) or Grashey method- structure shown

demo scapulohumeral joint space

shoulder: AP oblique (LPO or RPO) or Grashey method- C for E

1. profile view of glenoid cavity

2. anterior and posterior rim of glenoid fossa are superimposed

shoulder: PA transaxillary or Hobbs mod: patient position

prone or erect PA

shoulder: PA transaxillary or Hobbs mod: part position

1. arm is raised superiorly as much as possible

2. turn head away from affected side

shoulder: PA transaxillary or Hobbs mod: CR

perpendicular to axilla and humeral head passing through the glenohumeral joint

shoulder: PA transaxillary or Hobbs mod: structure shown and C for E

1. lateral view of the proximal humerus in relation ship to glenohumeral articulation

2. coracoid process is seen on the end

3. demo bursitis, shoulder impingement, osteoarthritis, and tendonitis

shoulder: transthoracic lateral projection (lawrence method)- part position

1. lateral to IR with affect shoulder against IR with arm in neutral position

2. unaffected arm raised and placed on top of head

3. breathing tech can blur lung out

shoulder: transthoracic lateral projection (lawrence method)- CR

perpendicular to surgical neck of humerus

(trauma recumbent- if pt can't move unaffected arm above head, angle CR 10-15 degrees cephalad)

shoulder: transthoracic lateral projection (lawrence method)- structure shown

demo proximal humerus seen through lung field

shoulder: transthoracic lateral projection (lawrence method)- C for E

1. unaffected clavicle projected above shoulder closest

to IR

2. Scapula superimposed over T-spine

3. Proximal humerus seen through lung field

shoulder: PA oblique (RAO or LAO) scapular Y method- position patient

erect or recumbent

shoulder: PA oblique (RAO or LAO) scapular Y method- part

1. midcoronal plane rotated 45-60 from IR

2. anterior of affected shoulder centered to IR

3. abduct the arm slightly

4. scapula is perpendicular to IR

shoulder: PA oblique (RAO or LAO) scapular Y method- CR

1. perpendicular to IR

2. center to scapulohumeral joint (2 inches below the top of the shoulder)

shoulder: PA oblique (RAO or LAO) scapular Y method- structure shown

1. Humeral head superimposed directly over the "Y" intersection

2. Scapula in lateral profile

3. Useful to evaluate fractures and dislocations

shoulder: PA oblique (RAO or LAO) scapular Y method- C for E

1. Humeral shaft and body of scapula superimposed

2. Humeral head and glenoid cavity

superimposed, acromion projects laterally

3. Coracoid superimposed on clavicle

4. Lateral and vertebral borders of scapula superimposed

5. Coracoid, acromion and humerus create the arms and legs of the Y

shoulder: modified scapular Y outlet (neer method)- CR

angle CR 5-15 degree caudad

shoulder: modified scapular Y outlet (neer method)- structure shown

1. Demonstrates shoulder

impingement to evaluate the

subacromial space and the

supraspinatus outlet.

2. Acromion is seen in profile

clavicle: AP and AP axial- patient position

supine or erect

clavicle: AP and AP axial- part position

true AP position

clavicle: AP- CR

perpendicular to mid clavicle

clavicle: AP- structure shown

Clavicle with medial half superimposing the thorax

clavicle: AP- C for E

1. Entire clavicle seen

2. Lateral half above scapula

3. Medial half superimposed on thorax

clavicle: AP axial- CR

angle 15-30 degrees cephalad

*thin patient angle more

clavicle: AP axial- C for E

Majority of clavicle seen above ribs

clavicle: PA- position patient

PA

clavicle: PA- part

do not do PA on recumbent trauma patient. best done detail

clavicle: PA- CR

angle 15-30 degree caudad

clavicle: AC joint (AP or PA)- patient position

erect AP- 72 inch SID

clavicle: AC joint (AP or PA)- part position

done bilateral with and without weights

clavicle: AC joint (AP or PA)- CR

perpendicular in midline 1 inch above jugular notch

* if there is a fracture or dislocation do not do weight bearing

clavicle: AC joint (AP or PA)- structure shown

1. demo bilateral AC joint

2. shows dislocation, separation,

and function of joints

clavicle: AC joint (AP or PA)- C for E

1. No rotation of patient

2. Both AC joints demonstrated

* can be done recumbent- have pt pull down on shoulder

scapula: AP- position pt

supine or erect AP

scapula: AP- part position

arm abducted at right angle to body with elbow flexed and hand supinated

*trauma patient do not move arm

scapula: AP- CR

Perpendicular to the midscapular 2" inferior to the coracoid process, and 2 inches medial form lateral border of body

scapula: AP-structure shown

Scapula seen through lung and ribs

scapula: AP- C for E

Lateral boarder of scapula seen free of superimposition

scapula: lateral projection ( Y view)- position pt

erect PA oblique body; true lateral of scapula

scapula: lateral projection ( Y view)- part position

1. axillary border of affected scapula closest to IR

2. rotate pt 45-60 degrees in RAO or LAO position

3. rotated pt until vertebral and axillary borders are superimposed (scapula will be perpendicular to IR_

4. affected arm either across upper chest (rotated patient 45 degrees) or behind lower back (rotated pt 60 degrees)

scapula: lateral projection ( Y view)- CR

perpendicular to medial border of affected scapula

scapula: lateral projection ( Y view)- structure shown

1. Lateral scapula free of superimposition of ribs

2. Shows affected scapula closest to the IR

scapula: lateral projection ( Y view)- C for E

1. Body of scapula in profile

2. Vertebral & axillary borders superimposed

3. Humerus NOT superimposed on scapula

Situation: A radiograph of an AP oblique

projection for the glenoid cavity reveals that

the anterior and posterior rims of the glenoid

process are not superimposed.

Solution: To produce a more acceptable image, the rotation of the body should be increase

Situation: A radiograph of a transthoracic lateral projection reveals that it is difficult to visualize the proximal humerus due to the ribs and lung markings. The exposure was made on suspended respiration.

Solution: Using a breathing technique would improve the quality of the image.

Situation: A radiograph of an AP clavicle

reveals that the sternal extremity is partially

collimated off. What should the technologist

do?

solution: repeat with the correct collimation to include both ends of the joints

Situation: A radiograph of a scapular Y lateral

position reveals that the scapula is slightly

rotated (the vertebral and axillary borders are

not superimposed). The axillary border of the

scapula is determined to be more lateral compared with the vertebral border.

Solution: The rotation of the thorax should be increase for the repeat exposure.

Situation: A patient comes to radiology for

treatment of an arthritic condition of the right

shoulder. The radiologist orders AP internal/external rotation projections and an inferosuperior axial projection of the scapulohumeral joint. However, the patient cannot abduct the arm for this projection. Which other projection/method will best demonstrate a profile view of the glenohumeral joint space?

solution: grashey method

Situation: A patient comes to the ER with a

possible right AC joint separation. Right

clavicle and AC joint exams are ordered. The

clavicle is taken first, and a small linear

fracture of the midshaft of the clavicle is discovered. What should the technologist do in this situation?

solution: consult with the ER physician before doing weighted AC joint study

Situation: A patient enters the ER with multiple injuries. The physician is concerned about a dislocation of the left shoulder. The patient is unable to stand. Which two projections are advisable to best demonstrate this condition?

solution: AP neutral rotation and scapular Y view (AP oblique) or transthoracic lateral

Situation: A patient enters the ER with a

possible AC joint separation. The patient is

paraplegic; therefore, the study cannot be done

erect.

solution: Nonweight-bearing and weight-bearing type of projections with the patient recumbent and pulling down with sheets on the shoulders could be performed to diagnose this condition.

Situation: A patient enters the ER with a dislocated shoulder. The technologist attempts to position the patient into the transthoracic lateral projection, but the patient is unable to raise the unaffected arm over his head completely.

Solution: The technologist can

angle the CR 10° to 15° cephalad to

compensate for the patient's inability to raise his arm completely.

Situation: A radiograph of an AP axial projection of the clavicle demonstrates that the clavicle is within the midportion of the lung apices.

Solution: The technologist should angle more cephalad to correct this error.

Internal Rotation Error: humerus is not in alignment; it is angled outward

correction: Humerus should be placed parallel to the body if possible

axillary shoulder error: humerus not in same place as shoulder. humerus is foreshortened

correction: place entire arm in the same place, correctly align the CR, part, and IR; arm is foreshortened

Axillary Shoulder Error; Central ray not

directed correctly to axilla

correction: correctly align CR, part, and IR; arm is elongated

Axillary Shoulder Errors: Incorrect centering of IR, also quantum mottle and incorrect collimation

to correct: center IR correctly, collimate, and increase amount of radiation

grashey error: patient underrotated. head of humerus overlaps glenoid fossa

correction: rotated the pt more

Scapula Y View Error- oblique too little- humerus farm from body

Scapula Y View Error- oblique too much- humerus too close