Name of projection | Shoulder - 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
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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
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Special Notes |
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