Shoulder - AP

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

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
Critique PACEMAN	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
Special Notes