Position of the Clavicle, Shoulder, Scapula, AC Joints

What is the technique for the clavicle?

70 kVp at 7-12 mAs

What is the IR size/orientation for the clavicle?

10×12 crosswise

How should you collimate for the clavicle?

Collimate down top to bottom and leave open side to side to include both ends

What is the SID for the clavicle?

40 inch

Where is the CR for the clavicle?

Mid-clavicle area (include both joints/ends)

What is the angle for the AP axial clavicle?

15-30 degree cephalic angle

When would you have to change the angle for the AP axial clavicle?

More of an angle for asthenic patients

If doing a PA axial clavicle, what is the angle of the tube?

15-30 degree caudal angle

Why would a PA axial clavicle be performed?

To reduce OID and decrease dose to thyroid

What is the breathing for the clavicle?

Suspend respiration at the end of inspiration

AP Clavicle

• No tube angle

• CR to mid-clavicle

AP Axial Clavicle

• Use 15 degree cephalic angel

• CR to mid-clavicle

What is the technique for the shoulder?

70-75 kVp at 7-12 mAs

What should you do to your technique for the Y-view of the shoulder?

Go up 10 kVp from the AP

What is the technique for the axillary view of the shoulder?

65 kVp at 5 mAs (tabletop)

What is the SID for the shoulder?

40 inch

What is the IR size/orientation for the AP views of the shoulder?

10×12 crosswise

What is the IR size/orientation for the axillary view of the shoulder?

8×10 lengthwise

What is the IR size/orientation for the Y-view and transthoracic view of the shoulder?

10×12 lengthwise

Where is the CR for the AP shoulder?

1 inch below coracoid process

Where is the CR for the axillary view of the shoulder?

To the joint space

Where is the CR for the Y-view of the shoulder?

Perpendicular to the joint space (follow bottom of armpit up to find joint space)

What is the breathing for the shoulder?

Suspend respiration during exposure

AP External Rotation of the Shoulder

Epicondyles parallel to IR

Where do you see the greater tubercle on the AP external rotation of the shoulder?

Laterally

AP Internal Rotation of the Shoulder

Epicondyles perpendicular to the IR

Where can you see the lesser tubercle on the AP internal rotation of the shoulder?

Medially

AP Neutral of the Shoulder

Epicondyles at 45 degrees to the IR, arm is as is

Posterior Oblique Position- Grashey Method

• 35-45 degree rotation towards affected side, performed to see joint space open

• Hand in neutral postion

• CR to joint space

• Done to see glenoid cavity

• Collimate 8×8

Transthoracic Lateral- Lawrence Method

• CR is lengthwise

• Center on surgical neck

• Use breathing technique (normal breathing) extend time to 3-4 seconds

• Humerus cut in ½ on crosshairs

Shoulder Y-View (PA)

• Arm/hand across belly

• 45-60 degree rotation

• CR to medial boarder (place thumb on medial boarder and rotate until fingers are superimposed)

• Shows whether dislocation is anterior vs posterior

Neer Method (Tangentail Projection-Supraspinous Outlet)

• Patient faces IR

• Rotate into anterior oblique position as for lateral scapula

• 45-60 degree rotation; abduct arm slightly

• 10-15 degree caudal angle, centered posteriorly to pass through superior margin of humeral head

What does the Neer Method demonstrate?

Coracoacromial arch for supraspinatus outlet region for shoulder impingement

Superior-Inferior Axial Projection of Shoulder

• 8×10 IR

• Patient sitting in chair leaning over IR

• Palm down

• CR to joint space (ensure head is out of way-look down)

Inferosuperior Axial Projection (Lawrence Method)

• Abduct arm 90 degrees

• Keep in external rotation with palm up

• CR directly medially 25-30 degrees, centered horizontally to axilla

• Have to push IR into neck revision to ensure include all of joint space

• Make sure to check SID, no grid

What is the technique for the scapula?

70-75 kVp at 7-12 mAs for AP

What is the technique for the lateral scapula?

Increase kVp by 10 for lateral

What is the SID for the scapula?

40 SID

What is the IR size/orientation for the scapula?

10×12 lengthwise

Where is the CR for the scapula?

Perpendicular to mid scapula (2 inches below coracoid process and 2 inches medial from lateral boarder of scapula)

What are the breathing instructions for the AP scapula?

Breathe in and out slowly and increase time to 3-4 seconds

What are the breathing instructions for the lateral scapula?

Suspend respiration

Scapular Y-view (PA)

• Rotate patient 45-60 degrees

• Patient should reach across and grab opposite shoulder (gets arm out of way of scapula)

• Palpate boarder of the scapula to determine degree of rotation for true lateral

• Suspend respiration

• Put marker in top corner

AP Scapula

• CR perpendicular to mid-scapula (leave some light above shoulder)

• Use breathing technique

• Gently abduct arm for AP- do not rest back of hand on head

• Put marker on bottom corner

What is the technique for the AC joints with Bucky?

70-75 kVp at 8-12 mAs

What is the technique for the AC joints without Bucky?

65-70 kVp at 4-6 mAs

What is the IR size/orientation for the AC joints?

14×17 crosswise

What should you do if both shoulders don’t find on one 14×17 for the AC joints?

Two 10×12 crosswise

What marker do you use for the AC joints?

Both markers

Where is the CR for the AC joints?

1 inch above jugular notch and midway to include both AC joints on one image

What is the SID for the AC joints?

72 inch

What is the breathing for the AC joints?

Suspend respiration

AP SC joints without weights

• Do without weights first and have checked

• CR 1 inch above jugular notch and midway to include both joints

AP SC joints with weights

• Gently allow weights to hang from wrists

• Holding on to weights may results in false negative results due to the should muscles contracting rather than relaxing

• Do not shrug shoulders

How much weight should a female have for the AC joints?

8-10 llbs minimum per limb

How much weight should a asthenic patient have for the AC joints?

5-8 llbs per limb

How much weight should a hypersthenic patient have for the AC joints?

May need more weight 10-12 llbs