Shoulder - AP Axial ObliqueThis is a featured page


Radiographic Positioning


Adult
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Name of projection Shoulder - AP Oblique Axial (Modified Trauma Axial)
Area Covered Scapulohumeral joint, humeral head, scapular head and neck
Pathology shownPosterior scapulohumeral dislocations, glenoid fractures, Hill-Sachs lesions, and soft tissue calcifications
Radiographic AnatomyShoulder 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)
FilterNo
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)
RespirationSuspended
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

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 NotesThe 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.


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