Shoulder Positioning

Question 1

What is the kvp used for shoulder imaging?

Answer 1

75-85

Question 2

When is a grid used for a shoulder?

Answer 2

If anatomy is measuring over 10cm

Question 3

T/F
Children and asthenic patients may require exposure factor adjustments without the use of grids

Answer 3

True
They may measure less than 10cm

Question 4

What kv is required for AC joint projections?

Answer 4

Around 65-70
Because they are usually less than 10cm and do not require a grid

Question 5

What projections is the AEC not recommended for?

Answer 5

-inferosuperior
-PA oblique
-AP oblique (grashey)
-lateral scapula
-clavicle
-AC joints

Question 6

Why is a short exposure time used for most shoulder projection?

Answer 6

To reduce motion

Question 7

What technical factors are used for an AP scapula? Why?

Answer 7

Low mA/high time
High exposure time to move anatomy away from scapula when patient is breathing

Question 8

Why is a small focal spot used?

Answer 8

For increased detail

Question 9

What SID is used for all shoulder projections?
What is the exception?

Answer 9

102-110cm

AC joints done at 180cm if done bilaterally

Question 10

What 3 bones make up the shoulder girdle?

Answer 10

Humerus, scapula, clavicle

Question 11

What is the joint called where the clavicle articulates with the manubrium of the sternum?

Answer 11

Sternoclavicular joint

Question 12

What is the joint called where the clavicle articulates with the acromion?

Answer 12

Acromioclavicular joint

Question 13

What shoulder projections are considered trauma?

Answer 13

AP neutral
PA oblique - transcapular Y
*Inferior-superior

Question 14

What shoulder projections are considered non trauma?

Answer 14

AP internal/external
AP oblique -Grashey?
Superior inferior
Inferosuperior

Question 15

For a trauma case, the hand is left in a neutral position. If the hand is in a neutral position, how will the epicondyles be situated in relation to the IR?

Answer 15

45 degrees to IR

Question 16

Where is the CR centres for an AP neutral projection?

Answer 16

Midscapularhumeral joint space
Approx. 2cm inferior and slightly lateral to the coracoid process

Question 17

For an AP neutral projection, where will the tubercles be seen?

Answer 17

Greater tubercle and lesser tubercle will both be not in profile

Question 18

In an AP external projection, where will the epicondyles be in relation to the IR?

Answer 18

Parallel to the IR

Question 19

Where is the CR centres for an external/internal AP projection?

Answer 19

1 inch (2cm) inferior to coracoid process

Question 20

In an AP projection with external rotation, where will the tubercles be situated?

Answer 20

Greater tubercle in profile laterally
Lesser tubercle anterior

Question 21

In an AP projection with internal rotation, where will the epicondyles be in relation to the IR?

Answer 21

Perpendicular to IR

Question 22

In an AP projection with internal rotation, where are the tubercles situated?

Answer 22

Greater tubercle anterior
Lesser tubercle in profile medially

Question 23

T/F
In an AP oblique projection (grashey method) the patient is rotated toward their affected side

Answer 23

True

Question 24

What is the grashey method used for?

Answer 24

To visualize the glenoid cavity

Question 25

How is the patient positioned for an AP oblique grashey projection?

Answer 25

35-45 degrees posterior oblique position (Taken as a AP oblique) Scapula should be placed parallel to IR

Question 26

What anatomy is included in the collimated field for a AP oblique grashey projection?

Answer 26

Glenoid fossa, numeral head, coracoid, acromion, distal clavicle

Question 27

Which part of the scapula form the “Y” in the PA oblique projection (scapular Y lateral)

Answer 27

Acromion and coracoid

Question 28

What is the PA oblique should projection (scapular y) particularly useful to diagnose?

Answer 28

Shoulder dislocations

Question 29

T/F For a PA oblique scapular Y projection, the mid coronal plane should be placed at 45-60 degrees (anterior oblique position)

Answer 29

True

Question 30

Where is the CR centered for a PA oblique scapular Y?

Answer 30

Directed at the medial border of the scapula, halfway between the inferior scapular and criminal angles

Question 31

What angulation is used for the tangential supraspinatus outlet projection (neer)?

Answer 31

10-15 degrees caudad *same position as PA oblique scapular Y

Question 32

What can the inferosuperior axial projection demonstrate?

Answer 32

Dislocation Fractures Arthritic changes Hills Sach defect

Question 33

For an inferosuperior projection, where is the lesser tubercle presented?

Answer 33

In profile anteriorly

Question 34

What CR angle should be for an inferosuperior axial projection?

Answer 34

25-35 degree medial to axilla *angle depends on abduction of the humerus, less abduction = lesser angle

Question 35

For the superoinferior projection, what angle is used, and what is the direction of the angle?

Answer 35

5-15 degrees through the shoulder joint towards the elbow Greater angle when the patient cannot extend the shoulder over the IR

Question 36

What are the 3 borders of the scapula?

Answer 36

Lateral (axillary) Medial (vertebral) Superior

Question 37

What are the 3 angles of the scapula?

Answer 37

Superior Inferior Lateral

Question 38

What projections are taken for the scapula?

Answer 38

AP projection Scapular Y lateral

Question 39

T/F Slight Rotation of the shoulder to come in contact with the IR is not used for an AP scapula projection because it would result in greater superimposition of the rib cage

Answer 39

True

Question 40

T/F The curve of the clavicle is more pronounced on males than females

Answer 40

True

Question 41

T/F The mid clavicle lies at the same transverse level as the superior scapular angle

Answer 41

True

Question 42

What are the essential projections for the clavicle?

Answer 42

AP AP axial

Question 43

Where is the CR centered for a clavicle projection?

Answer 43

Perpendicular to mid shaft of clavicle

Question 44

What angulation is used for an AP axial clavicle?

Answer 44

15-30 degrees cephalic

Question 45

Is more or less angle needed for thinner (asthenic) patients on an axial clavicle?

Answer 45

More angle

Question 46

Is more or less angle needed for thicker (hypersthenic) patients for an axial clavicle?

Answer 46

Less angle

Question 47

Why is respiration suspended at the end of inhalation for a clavicle?

Answer 47

To help elevate the clavicle

Question 48

For alternative PA axial projections of the clavicle, what CR angulation is used?

Answer 48

15-30 degrees caudal to the supraclavicular fossa and midshaft of the clavicle

Question 49

Why is an upright position required for AC joints instead of supine?

Answer 49

Supine position will reduce dislocation/separation