Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Shoulder - AP Oblique Axial (Modified Trauma Axial)
Area Covered	Scapulohumeral joint, humeral head, scapular head and neck
Pathology shown	Posterior scapulohumeral dislocations, glenoid fractures, Hill-Sachs lesions, and soft tissue calcifications
Radiographic Anatomy	Shoulder Radiographic Anatomy
IR Size & Orientation	18cm x 24cm Portrait
Film / Screen Combination	Regular (CR and DR as recommended by manufacturer)
Bucky / Grid	Upright bucky or table bucky (trauma)
Filter	No
Exposure	65 kVp 16 mAs
FFD / SID	100cm
Central Ray	CR angled 45° caudal Directed to the scapulohumeral joint
Collimation	Centre: Scapulohumeral joint Collimate closely to area of interest
Markers	Lateral and superior Marker orientation is AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	Suspended
Positioning	Patient standing upright with back against the bucky or supine Flex elbow on affected side and place the forearm across the chest Rotate the patient approximately 45° towards the effected side
Critique PACEMAN	Positioning The coracoid process is projected over part of the humeral head, humeral head appears elongated, acromion and AC joint are projected superior to the humeral head Area Covered Humeral head, glenoid cavity, neck and head of scapula Collimation Centre: Scapulohumeral joint Collimation: visible on four sides of area of the affected shoulder Exposure Bony trabecular patterns and cortical outlines are sharply defined Soft tissues are visualised
Special Notes	The modified AP axial oblique can be used in trauma situations when the patient cannot abduct their arm for a standard axial shoulder radiograph. This projection allows the patient to maintain their arm position in a sling or otherwise. Posterior dislocation projects the humeral head superiorly from the glenoid cavity. Anterior dislocation projects the humeral head inferiorly from the glenoid cavity.

Sources

Bontrager KL, Lampignano JP. AP apical oblique axial projection: Shoulder (trauma). In: Textbook of Radiographic Positioning and Related Anatomy. 6th ed. St. Louis, MI: Elsevier Mosby; 2005: 201.

Frank ED, Long BW, Smith BJ. Glenoid cavity: AP axial oblique projection. In: Merrill's Atlas of Radiographic Positioning & Procedures. 11th ed. St. Louis, MI. Elsevier Mosby; 2007: 198-199.

NEEP MJ, AZIZ A 2011 "Radiography of the acutely injured shoulder" Radiography 17(3) pp 188-192.