Shoulder - APThis is a featured page

Radiographic Positioning


Adult
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Name of projectionShoulder - Anterioposterior (AP)
Area Covered Glenohumeral joint, acromioclavicular joint, sternoclavicular joint, coracoid process, clavicle, superior scapula, proximal third of humerus
Pathology shown Fractures, dislocations, calcium deposits in muscle, tendon and bursae
Radiographic Anatomy Shoulder Radiographic Anatomy
IR Size & Orientation 24cm x 30cm
Landscape
Film / Screen Combination Regular
(CR and DR as recommended by manufacturer)
Bucky / Grid Moving or stationary grid
Can be done either in bucky or out of bucky with exposue modified accordingly
Filter Shoulder filter
Exposure 65 kVp
16 mAs (in Bucky expopsure)
FFD / SID 100cm
Central Ray Directed to the glenohumeral joint
Perpendicular to the IR
Collimation Centre: Glenohumeral joint, this is 2.5cm below the palpatable coracoid process
Shutter A: Open to include the top of the shoulder and approximately one third of the proximal humerus
Shutter B: Open to include just beyond the humeral skin line and the sternoclavicular joint
Markers Lateral and superior
Marker orientation is AP
Shielding Gonadal (check your department's policy guidelines)
Respiration Suspended
Positioning
  • Patient standing with back to upright bucky (can be performed supine)
  • Check the patient is standing up straight (their upper mid-coronal plane is vertical and parallel to IR)
  • Rotate the patient slightly, if necessary, so that their affected shoulder is in contact with the upright bucky
Arm rotation
  • An AP shoulder can be performed with either internal or external rotation. This shows both the tubercles.
  • Check your department's policy as to which, internal or external, is preferred
  • If a fracture is suspected DO NOT rotate the arm, leave in the neutral position
Internal rotation of the arm
  • Internally rotate arm
  • Place back of hand against thigh
  • This will show the lesser tubercle in profile
External rotation of the arm
  • Externally rotate arm
  • Do this by supinating the hand until the epicondyles of the distal humerus are parallel to the IR
  • This will show the greater tubercle of the humerus in profile
Critique

 Positioning
  • The entire clavicle
  • Medial end of clavicle is seen next to the lateral vertebral column
  • The humeral head should overlap the glenohumeral joint (this occurs more with internal rotation compared to external or neutral position of the humerus)
  • No foreshortening of the scapular body
  • Humerus parallel with body

Internal arm rotation
  • Lesser tubercle in profile medially
  • Greater tubercle super-imposed on humeral head
External arm rotation
  • Greater tubercle in profile laterally
  • Lesser tubercle super-imposed on humeral head

Area Covered
  • Glenohumeral joint, acromioclavicular joint, sternoclavicular joint, coracoid process, clavicle, superior scapula, proximal third of humerus

Collimation
  • Centre: Glenohumeral joint
  • Shutter A: Open to include the top of the shoulder and approximately one third of the proximal humerus
  • Shutter B: Open to include just beyond the humeral skin line and the sternoclavicular joint

Exposure
  • Bony trabecular patterns and cortical outlines are sharply defined
  • Soft tissues are visualised
Special Notes



AndyC
AndyC 		Latest page update: made by AndyC , Jun 18 2011, 10:39 AM EDT (about this update About This Update AndyC Edited by AndyC

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Keyword tags: Glenohumeral joint Greater tubercle Humeral head Humerus Lesser tubercle Shoulder Shoulder AP
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