Shoulder

Question 1

Shoulder

X-Ray Series

Answer 1

Normal Series

• AP
• Scapular Y View

Special Views

• Glenoid Fossa
• Internal Rotation
• Superoinferior Axial

Question 2

AP Shoulder

Answer 2

• Cassette - 34x30, horizontal
• Positioning - pt is standing against the buckey and arm is slightly abducted and externally rotated. Do not rotateif suspect fracture or dislocated
• Stabilization - pt is comfortable standing and leaning against bucky
• Shielding - Gonad shielding/
• Instructions - To see the scapula in AP, rotate the pt 1-30 and palpate the scapula to get parallel to bucky
• SID - 100cm
• Central Ray - perpendicular to image plate, centred at GH joint and 2.5cm below the coracoid process
• Tube Tilt - 0
• Collimation - M-L, medial clavucle and all soft tissues of the shoulder. S-I, all soft tissue of the shoulder and 1/3 of humerus shaft
• kV - Children 60 and adults 70
• Marker Placement - lateral to the anatomy

Question 3

Scapula Y View

Answer 3

• Cassette - 24x30 vertical
• Positioning - pt is standing chest to bucky, roate the pt so that the medial border of the scapula and AC joint line is perpendicular to the bucky. Arm extended placing the hand on the hip so thatg the elbow is in the lateral position with respect to the bucky
• Stabilization - pt is standing comfortably and leaning against bucky
• Shielding - Gonad shielding
• Instructions - palpate the scpaula to ensure you have the positiong
• SID - 100cm
• Central Ray - centered to the middle of the medial border for the scapula
• Tube Tilt - 0
• Collimation - M-L, medial clavicle to the outside soft tissues of the shoulder. S-I, soft tissues of the acromion to the inferior scapula level
• kV - Children 60 and adults 70
• Marker Placement - lateral to the anatomy

Question 4

Glenoid Fossa View

Answer 4

• Cassette - 24x30 cm horizontal
• Positioning - pt stands back to bucky and rotates 35-45 towards side of interest. Abducts arm slightly with neutral rotation
• Stabilization - pt is standing comfortably and leans against
• Shielding - Gonad shielding, point the jaw up
• Instructions - palpate the coracoid process
• SID - 100cm
• Central Ray - Mid GH joint - 2.5cm inferior to coracoid process
• Tube Tilt - 0 or 10-15 to show acromion space
• Collimation - M-L, include soft tissues of the shoulder. S-I, include the superior soft tissues of the shoulder
• kV - Children 60 and adults 70
• Marker Placement - lateral to the anatomy

Question 5

Internal Rotation Shoulder

Answer 5

• Cassette - 24x30 horizontal
• Positioning - pt is standing with back against the bucky, arm is slightly abducted and internally rotated so that epicondyles are perpendicular to buckey
• Stabilization - pt is standing and leaning against buckey
• Shielding - Gonad shielding/lead apron
• Instructions - do not rotate if suspect fracture or dislocation
• SID - 100cm
• Central Ray - centred to coracoid process
• Tube Tilt - 10 caudal
• Collimation - M-L, include soft tissues of the shoulder. S-I, include the superior soft tissues of the shoulder
• kV - Children 60 and adults 70
• Marker Placement - lateral to the anatomy

Question 6

Superoinferior Axial Projection

Answer 6

• Cassette - 18x24cm vertical
• Positioning - pt is sitting at trhe end of the table with the axilla over the cassette. Pt is leaning as much as possible over the cassette
• Stabilization - support forearm with sponge if needed
• Shielding - Gonad shielding and no legs under table
• Instructions - lean over
• SID - 100cm
• Central Ray - perpendicular and on the medial portion of the humeral head
• Tube Tilt - 0-5 depending on how far they are leaning over
• Collimation - M-L, medial and lateral to the GH joint affected. S-I to include the inferior and superior GH joint afffected
• kV - Children 60 and adults 70
• Marker Placement - lateral to the anatomy