Upper Extremities Finger - Shoulder
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| How many bones does a hand have? | The 27 bones on each hand and wrist are divided into the following three groups:
Total 27
Phalanges (fingers and thumb) 14 Metacarpals (palm) 5
Carpals (wrist) 8
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| Name the proximal row of carpals: | (1) Scaphoid
(2) Lunate
(3) Triquetrum
(4) Pisiform
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| Name the distal row of the carpals: | (1) Trapezium
(2) Trapezoid
(3) Capitate
(4) Hamate
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| A good criterion by which to evaluate a true lateral position of the elbow when it is flexed 90° is the appearance of the three concentric arcs. What are they? | 1 & smallest arc is the trochlear sulcus. 2nd & intermediate arc appears double-lined as the outer ridges or rounded edges of the capitulum and trochlea. The trochlear notch of the ulna appears as a 3rd arc of a true lateral elbow.
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| Ulnar deviation - why is it used? | The ulnar deviation movement of the wrist “opens up” and best demonstrates the carpals on the opposite side (the radial or lateral side) of the wrist— the scaphoid, trapezium, and trapezoid. Because the scaphoid is the most frequently fx carpal bone...
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| Radial deviation - why is it used? | A less frequent PA wrist projection involves the radial deviation movement that opens and best demonstrates the carpals on the opposite, or ulnar, side of the wrist—the hamate, pisiform, triquetrum, and lunate.
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| AP projections of the elbow a lateral rotation: | separates the radius and ulna
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| AP projections of the elbow a medial rotation | superimposes the radius and ulna
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| The height of the tabletop should be: | near shoulder height so that the arm can be fully supported
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| The principal exposure factors for radiography of the upper limbs are as follows: | Lower to medium kV (55 to 80—digital)
Short exposure time
Small focal spot
Adequate mAs for sufficient density (brightness)
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| CAST CONVERSiON Small to medium plaster cast |
Increase 5 kV to 7 kV
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| CAST CONVERSiON Large plaster cast | Increase 8 kV to 10 kV
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| CAST CONVERSiON Fiberglass cast | Increase 3 kV to 4 kV
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| PA PROJECTION: FINGERS Minimum SID — IR size — kV range - | Minimum SID— 40 inches (102 cm)
IR size— 18 × 24 cm (8 × 10 inches), crosswise (multiple exposures) or lengthwise (single exposure)
Digital systems—55 to 60 kV range
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| PA PROJECTION: FINGERS Patient Position | Seat patient at end of table, with elbow flexed about 90° and with hand and forearm resting on the table.
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| PA PROJECTION: FINGERS Part Position | Pronate hand with fingers extended.
Center and align long axis of affected finger with long axis of IR.
Separate adjoining fingers from affected finger.
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| PA PROJECTION: FINGERS CR | at the PIP joint
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| PA PROJECTION: FINGERS Anatomy Demonstrated | Distal, middle, and proximal phalanges; distal metacarpal; and associated joints.
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| PA PROJECTION: FINGERS how can you tell if there is no rotation in a pa finger projection? | No rotation of fingers is evidenced by symmetric appearance of both sides or
concavities of the shafts of the phalanges and distal metacarpals.
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| PA OBLIQUE PROJECTION—MEDIAL OR LATERAL ROTATION: FINGERS Minimum SID — IR size — kV range - | Minimum SID— 40 inches (102 cm)
IR size— 18 × 24 cm (8 × 10 inches), crosswise (multiple exposures) or lengthwise (single exposure)
Digital systems—55 to 60 kV range
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| PA OBLIQUE PROJECTION—MEDIAL OR LATERAL ROTATION: FINGERS Patient Position | Seat patient at end of table, with elbow flexed
about 90° with hand and wrist resting on IR and fingers extended.
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| PA OBLIQUE PROJECTION—MEDIAL OR LATERAL ROTATION: FINGERS Part Position | Fingers extended against 45° foam wedge, place hand in a 45° lateral oblique(thumb side up) or put hand on cassette so that the long axis of the finger is aligned with the long axis of the IR. in a 45°oblique and parallel to iR.
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| PA OBLIQUE PROJECTION—MEDIAL OR LATERAL ROTATION: FINGERS CR | CR perpendicular to IR, directed to pip joint
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| PA OBLIQUE PROJECTION—MEDIAL OR LATERAL ROTATION: FINGERS Anatomy Demonstrated | 45° oblique view of distal, middle, and proximal phalanges; distal metacarpal; and associated joints.
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| LATERAL PROJECTIONS: FINGERS Minimum SID — IR size — kV range - | Minimum SID— 40 inches (102 cm)
IR size— 18 × 24 cm (8 × 10 inches), crosswise (multiple exposures) or lengthwise (single exposure)
Digital systems—55 to 60 kV range
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| LATERAL PROJECTIONS: FINGERS Part Position | Place hand in lateral position (thumb side up) with finger to be examined fully extended and centered to portion of IR being
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| LATERAL PROJECTIONS: FINGERS CR | CR perpendicular to IR, directed to pip joint
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| LATERAL PROJECTIONS: FINGERS Anatomy Demonstrated | Lateral views of distal, middle, and proximal phalanges; distal metacarpal; and associated joints are visible.
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| AP PROJECTION: THUMB Minimum SID — IR size — KV kV range - | Minimum SID— 40 inches (102 cm)
IR size— 18 × 24 cm (8 × 10 inches), crosswise (multiple exposures) or lengthwise (single exposure)
Digital systems—55 to 60 kV range
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| AP PROJECTION: THUMB Patient Position | Seat patient facing table, arms extended in front, with hand rotated internally to supinate thumb for AP projection
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| AP PROJECTION: THUMB Part Position | Demonstrate this awkward position on yourself, so the patient can see how it is done & better understand what is expected. Internally rotate hand with fingers extended until posterior surface of thumb is in contact with IR.
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| AP PROJECTION: THUMB CR | Center first MCp joint to CR and to center of IR. Immobilize other fingers with tape to isolate thumb if necessary.
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| AP PROJECTION: THUMB Anatomy Demonstrated | Distal and proximal phalanges, first metacarpal, trapezium, and associated joints are visible. • Interphalangeal and metacarpophalangeal joints should appear open.
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| PA OBLIQUE PROJECTION—MEDIAL ROTATION: THUMB Minimum SID — IR size — KV - | Minimum SID— 40 inches (102 cm)
IR size— 18 × 24 cm (8 × 10 inches), crosswise (multiple exposures) or lengthwise (single exposure)
Digital systems—55 to 60 kV range
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| PA OBLIQUE PROJECTION—MEDIAL ROTATION: THUMB Patient Position | Seat patient at end of table, with elbow flexed
about 90° with hand resting on IR.
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| PA OBLIQUE PROJECTION—MEDIAL ROTATION: THUMB Part Position | Abduct thumb slightly with palmar surface of hand in contact with IR. (This action naturally places thumb in a 45° oblique position.)
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| PA OBLIQUE PROJECTION—MEDIAL ROTATION: THUMB CR | CR perpendicular to IR, directed to first MCp joint
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| PA OBLIQUE PROJECTION—MEDIAL ROTATION: THUMB Anatomy Demonstrated | Distal and proximal phalanges, first metacarpal, trapezium, and associated joints are visualized in a 45° oblique position
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| LATERAL POSITION: THUMB Minimum SID — IR size — KV - | Minimum SID— 40 inches (102 cm)
IR size— 18 × 24 cm (8 × 10 inches), crosswise (multiple exposures) or lengthwise (single exposure)
Digital systems—55 to 60 kV range
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| LATERAL POSITION: THUMB Patient Position | Seat patient at end of table, with elbow flexed
about 90° with hand resting on IR.
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| LATERAL POSITION: THUMB Part Position | Start with hand pronated and thumb abducted, with fingers and hand slightly arched; then rotate hand slightly medial until thumb is in true lateral position. (You may need to provide a sponge or other support under lateral portion of hand.)
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| LATERAL POSITION: THUMB CR | CR perpendicular to IR, directed to first MCp joint
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| LATERAL POSITION: THUMB Anatomy Demonstrated | Distal and proximal phalanges, first metacarpal, trapezium (superimposed), and associated joints are visualized in the lateral position.
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| AP AXIAL PROJECTION (MODIFIED ROBERT’S METHOD)*: THUMB | Base of first metacarpal is demonstrated for ruling out bennett’s fX - CR directed 15° proximally(toward wrist)entering at the first CMC joint. trapezium should be well visualized.
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| PA PROJECTION: HAND Minimum SID — IR size — KV - SAME ON PA OBLIQUE PROJECTION: HAND | Minimum SID—40 inches (102 cm) •
IR size—24 × 30 cm (10 × 12 inches),lengthwise
55 to 60 kV range
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| PA PROJECTION: HAND Patient Position | Seat patient at end of table, with elbow flexed
about 90° with hand resting on IR.
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| PA PROJECTION: HAND Part Position | Pronate hand with palmar surface in contact with IR; spread fingers slightly.
•Align long axis of hand and forearm with long axis of IR.
•Center hand and wrist to IR.
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| PA PROJECTION: HAND CR | CR perpendicular to IR, directed to third MCp joint
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| PA PROJECTION: HAND Anatomy Demonstrated | PA projection of entire hand and wrist and about 2.5 cm (1 inch) of distal forearm are visible. • PA projection of hand demonstrates oblique view of the thumb.
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| PA OBLIQUE PROJECTION: HAND Part Position | Pronate hand on IR; center and align long axis of hand with long axis of IR.
• Rotate entire hand and wrist laterally 45° and support with radiolucent wedge or step block, as shown, so that all digits are separated and parallel to iR
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| PA OBLIQUE PROJECTION: HAND CR | CR perpendicular to IR, directed to third MCp joint
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| PA OBLIQUE PROJECTION: HAND Anatomy Demonstrated | Oblique projection of the entire hand and wrist and about 2.4 cm (1 inch) of distal forearm are visible.
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| “FAN” LATERAL—LATEROMEDIAL PROJECTION: HAND Minimum SID — IR size — KV - | Minimum SID—40 inches (102 cm) •
IR size—24 × 30 cm (10 × 12 inches),lengthwise
65 to 70 kV range
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| “FAN” LATERAL—LATEROMEDIAL PROJECTION: HAND Part Position | Rotate into lateral position with thumb side up. Spread fingers and thumb into a fan Position, &support each digit on Radiolucent block.Ensure that ALL are separated and parallel to iR and that the mCs are not rotated but remain in a true lateralposition.
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| “FAN” LATERAL—LATEROMEDIAL PROJECTION: HAND CR | CR perpendicular to IR, directed to second MCp joint
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| “FAN” LATERAL—LATEROMEDIAL PROJECTION: HAND Anatomy Demonstrated | Entire hand and wrist and about 2.5 cm (1 inch) of distal forearm are visible.
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| PA PROJECTION: WRIST Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm) •
IR size—24 × 30 cm (10 × 12 inches),lengthwise
65 TO 70 kV range
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| PA PROJECTION: WRIST Patient Position | Seat patient at end of table with elbow flexed about 90° and hand and wrist resting on IR, palm down. Drop shoulder so that shoulder, elbow, and wrist are on same horizontal plane
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| PA PROJECTION: WRIST Part Position | Align and center long axis of hand and wrist to IR, with carpal area centered to CR.
• With hand pronated, arch hand slightly to place wrist and carpal area in close contact with iR.
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| PA PROJECTION: WRIST CR | CR perpendicular to IR, directed to midcarpal area
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| PA PROJECTION: WRIST Anatomy Demonstrated | Midmetacarpals and proximal metacarpals; carpals; distal radius, ulna, and joints; and soft tissues of the wrist joint, such as fat pads and fat stripes, are visible
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| PA OBLIQUE PROJECTION: WRIST Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm) •
IR size—24 × 30 cm (10 × 12 inches),lengthwise
65 TO 70 kV range
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| PA OBLIQUE PROJECTION: WRIST Patient Position | Seat patient at end of table, with elbow flexed
about 90° and hand and wrist resting on IR, palm down.
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| PA OBLIQUE PROJECTION: WRIST Part Position | Center to IR. From pronated position, rotate wrist and hand laterally 45°. For stability, place a 45° block under thumb side of hand to support hand and wrist in a 45° oblique position or partially flex fingers to arch hand so that tips rest lightly on IR
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| PA OBLIQUE PROJECTION: WRIST CR | CR perpendicular to IR, directed to midcarpal area
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| PA OBLIQUE PROJECTION: WRIST Anatomy Demonstrated | Distal radius, ulna, carpals, and at least to midmetacarpal area are visible. • Trapezium and scaphoid should be well visualized, with only slight superimposition of other carpals on their medial aspects.
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| LATERAL PROJECTION: WRIST Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm) •
IR size—24 × 30 cm (10 × 12 inches),lengthwise
65 TO 70 kV range
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| LATERAL PROJECTION: WRIST Patient Position | Seat patient at end of table, with arm and forearm resting on the table and elbow flexed about 90°. Place wrist and hand on IR in thumb-up lateral position. Shoulder, elbow, and wrist should be on same horizontal plane.
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| LATERAL PROJECTION: WRIST Part Position | Adjust hand and wrist into a true lateral position, with fingers comfortably flexed; if support is needed to prevent motion, use a radiolucent support block and sandbag, and place block against extended hand and fingers
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| LATERAL PROJECTION: WRIST CR | CR perpendicular to IR, directed to midcarpal area
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| LATERAL PROJECTION: WRIST Anatomy Demonstrated | Distal radius and ulna, carpals, and at least the midmetacarpal area are visible.
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| PA AND PA AXIAL SCAPHOID—WITH ULNAR DEVIATION: WRIST CR | Angle CR 10° to 15° proximally, along long axis of forearm and toward elbow. (CR angle should be perpendicular to long axis of scaphoid.)
• Center CR to scaphoid. (Locate scaphoid at a point 2 cm [34 inch] distal and medial to radial styloid process.)
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| CARPAL CANAL (TUNNEL)—TANGENTIAL, INFEROSUPERIOR PROJECTION: WRIST CR | Angle CR 25° to 30° to the long axis of the hand. (The total CR angle in relationship to the IR must be increased if patient cannot hyperextend wrist as far as indicated.)
•Direct CR to a point 1inch distal to the base of third metacarpal
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| AP PROJECTION: FOREARM Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm)
IR size—30 × 35 cm (11 × 14 inches), for smaller patients; 35 × 43 cm (14 × 17 in), for long forearms, lengthwise
70-75 KV
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| AP PROJECTION: FOREARM Patient Position | Seat patient at end of table, with hand and arm
fully extended and palm up (supinated).
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| AP PROJECTION: FOREARM Part Position | Drop shoulder to place entire upper limb on same horizontal plane. Place entire wrist, forearm, and elbow in as near a true frontal position as possible. Epicondyles same distance from IR.
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| AP PROJECTION: FOREARM CR | CR perpendicular to IR, directed to mid-forearm
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| AP PROJECTION: FOREARM Anatomy Demonstrated | AP projection of the entire radius and ulna is shown, with a minimum of proximal row carpals and distal humerus and pertinent soft tissues, such as fat pads and stripes of the wrist and elbow joints.
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| LATERAL PROJECTION: FOREARM Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm)
IR size—30 × 35 cm (11 × 14 inches), for smaller patients; 35 × 43 cm (14 × 17 in), for long forearms, lengthwise
70-75 KV
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| LATERAL PROJECTION: FOREARM Patient Position | Seat patient at end of table, with elbow flexed 90°
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| LATERAL PROJECTION: FOREARM Part Position | Drop shoulder to place entire upper limb on same horizontal plane.
Rotate hand and wrist into true lateral position, and support hand to prevent motion, if needed. (Ensure that distal radius and ulna are superimposed directly)
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| LATERAL PROJECTION: FOREARM CR | CR perpendicular to IR, directed to mid-forearm
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| LATERAL PROJECTION: FOREARM Anatomy Demonstrated | Lateral projection of entire radius and ulna, proximal row of carpal bones, elbow, and distal end of the humerus are visible as well as pertinent soft tissue, such as fat pads and stripes of the wrist and elbow joints.
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| AP PROJECTION: ELBOW Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches)
—70 to 75 kV range
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| AP PROJECTION: ELBOW Patient Position | Seat patient at end of table, with elbow fully extended, if possible.
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| AP PROJECTION: ELBOW Part Position | Extend elbow, supinate hand, and align arm and forearm with long axis of IR.
Center elbow joint to center of IR. • Ask patient to lean laterally as necessary for true Ap projection.
(Palpate humeral epicondyles to ensure that they are parallel to
IR.)
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| AP PROJECTION: ELBOW CR | CR perpendicular to IR, directed to mid-elbow joint, which is approximately 2 cm (3/4 inch) distal to midpoint of a line between epicondyles
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| AP PROJECTION: ELBOW Anatomy Demonstrated | Distal humerus, elbow joint space, and proximal radius and ulna are visible.
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| AP OBLIQUE PROJECTION—LATERAL (EXTERNAL) ROTATION: ELBOW Best visualizes? | Lateral (external rotation) oblique Best visualizes radial head and neck of the radius and capitulum of humerus
(supinated hand)
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| AP OBLIQUE PROJECTION—MEDIAL (INTERNAL) ROTATION: ELBOW Best visualizes? | Medial (internal rotation) oblique Best visualizes coronoid process of ulna and trochlea in profile
(pronated hand)
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| LATERAL PROJECTION: ELBOW Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches)
—70 to 75 kV range
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| LATERAL PROJECTION: ELBOW Patient Position | Seat patient at end of table, with elbow flexed
90°
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| LATERAL PROJECTION: ELBOW Part Position | Center elbow joint to CR and to center of IR. Drop shoulder so that humerus and forearm are on same horizontal plane. Rotate hand and wrist into true lateral position, thumb side up.
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| LATERAL PROJECTION: ELBOW CR | CR perpendicular to IR, directed to mid-elbow joint (a point approximately 4 cm [1-1/2 inches] medial to easily palpated posterior surface of olecranon process)
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| LATERAL PROJECTION: ELBOW Anatomy Demonstrated | Lateral projection of distal humerus and proximal forearm, olecranon process, and soft tissues and fat pads of the elbow joint are visibl
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| Located anteriorly on proximal humerus in a true AP projection. | lesser tubercle
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| Located laterally on proximal humerus in a true AP projection. | greater tubercle
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| The expanded distal end of the spine of the scapula that extends superiorly and posteriorly to the glenoid cavity (fossa). | acromion
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| This rotation position represents a true aP projection of the humerus in the anatomic position | External rotation
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| In this rotation position, the epicondyles of the distal humerus are perpendicular to the iR, placing the humerus in a true lateral position. The hand must be pronated and the elbow adjusted to place the epicondyles perpendicular to the iR | Internal rotation
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| AP PROJECTION: HUMERUS Minimum SID — IR size — KV | Minimum SID—40 inches
IR size—lengthwise (large enough to include entire humerus) For larger patient, 14 × 17 inches) may be needed to place cassette diagonally to include both joints •For smaller patient, 11 × 14 inches)
- 75-85 KV
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| AP PROJECTION: HUMERUS Patient Position | Position patient erect or supine. Adjust the height of the cassette so that shoulder and elbow joints are equidistant from ends of IR
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| AP PROJECTION: HUMERUS Part Position | Rotate body toward affected side as needed to bring shoulder and proximal humerus in contact with cassette. Abduct arm slightly and gently supinate hand so that epicondyles of elbow are parallel and equidistant from IR.
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| AP PROJECTION: HUMERUS CR | CR perpendicular to IR, directed to midpoint of humerus
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| AP PROJECTION: HUMERUS Anatomy Demonstrated | AP projection shows the entire humerus, including the shoulder and elbow joints
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| TRANSTHORACIC LATERAL PROJECTION: HUMERUS Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm) •
IR size—35 × 43 cm (14 × 17 inches),lengthwise
80-90 KV
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| TRANSTHORACIC LATERAL PROJECTION: HUMERUS Patient Position | Place patient in an erect or supine position. Place patient in lateral position with side of interest closest to IR. With patient supine, place portable grid lines horizontally and center CR to centerline to prevent grid cutoff
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| TRANSTHORACIC LATERAL PROJECTION: HUMERUS Part Position | Place affected arm in neutral rotation; drop shoulder if possible. Raise opposite arm and place hand over top of head; elevate shoulder as much as possible to prevent superimposition of affected shoulder. Ensure that thorax is in a true lateral position
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| TRANSTHORACIC LATERAL PROJECTION: HUMERUS CR | Center mid-diaphysis of affected humerus and center of IR to CR as projected through thorax.
CR perpendicular to IR, directed through thorax to mid-diaphysis
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| TRANSTHORACIC LATERAL PROJECTION: HUMERUS Anatomy Demonstrated | Lateral view of entire humerus and glenohumeral joint should be visualized through the thorax without superimposition of the opposite humerus.
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| AP PROJECTION—EXTERNAL ROTATION: SHOULDER Minimum SID — IR size — KV SAME AP PROJECTION—INTERNAL ROTATION: SHOULDER | •Minimum SID—40 inches
IR size— 10 × 12 inches, crosswise
78-85 KV
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| AP PROJECTION—EXTERNAL ROTATION: SHOULDER Patient Position SAME - AP PROJECTION—INTERNAL ROTATION: SHOULDER | Perform radiograph with the patient in an erect or supine position. (The erect position is usually less painful for patient, if condition allows.) Rotate body slightly toward affected side if necessary to place shoulder in contact with IR or tabletop
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| AP PROJECTION—EXTERNAL ROTATION: SHOULDER Part Position | Position patient to center scapulohumeral joint to center of IR. • Abduct extended arm slightly; externally rotate arm (supinate hand) until epicondyles of distal humerus are parallel to IR.
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| AP PROJECTION—EXTERNAL ROTATION: SHOULDER CR SAME - AP PROJECTION—INTERNAL ROTATION: SHOULDER | CR perpendicular to IR, directed to 1 inch (2.5 cm) inferior to coracoid process
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| AP PROJECTION—EXTERNAL ROTATION: SHOULDER Anatomy Demonstrated | AP projection of proximal humerus and lateral two-thirds of clavicle and upper scapula, including relationship of the humeral head to the glenoid cavity.
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| AP PROJECTION—INTERNAL ROTATION: SHOULDER Part Position | Position patient to center scapulohumeral joint to center of IR. • Abduct extended arm slightly; internally rotate arm (pronate hand) until epicondyles of distal humerus are perpendicular
to IR.
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| AP PROJECTION—INTERNAL ROTATION: SHOULDER Anatomy Demonstrated | Lateral view of proximal humerus and lateral two-thirds of clavicle and upper scapula is demonstrated, including the relationship of the humeral head to the glenoid cavity.
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| INFEROSUPERIOR AXIAL PROJECTION: SHOULDER -LAWRENCE METHOD Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm). •
IR size—18 × 24 cm (8 × 10 inches)
75-85 KV
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| INFEROSUPERIOR AXIAL PROJECTION: SHOULDER -LAWRENCE METHOD Patient Position | Position patient supine with shoulder raised about 2 inches (5 cm) from tabletop by placing support under arm and shoulder to place body part near center of IR.
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| INFEROSUPERIOR AXIAL PROJECTION: SHOULDER -LAWRENCE METHOD Part Position | Move patient toward the front edge of tabletop Place vertical cassette on table as close to neck as possible, and support w/ sandbags. Abduct arm 90° from body if possible;keep in ext rotation, palm up, with support under arm& hand.
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| INFEROSUPERIOR AXIAL PROJECTION: SHOULDER -LAWRENCE METHOD CR | Direct CR medially 25° to 30°, centered horizontally to axilla and humeral head. If abduction of arm is less than 90°, the CR medial angle also should be decreased to 15° to 20° if possible.
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| INFEROSUPERIOR AXIAL PROJECTION: SHOULDER -LAWRENCE METHOD Anatomy Demonstrated Respiration Suspend respiration during exposure. | Lateral view of proximal humerus in relationship to scapulohumeral cavity is shown. • Coracoid process of scapula and lesser tubercle of humerus are seen in profile. • The spine of the scapula is seen on edge below scapulohumeral joint
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| POSTERIOR OBLIQUE POSITION—GLENOID CAVITY: SHOULDER ---GRASHEY METHOD Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm).
IR size—18 × 24 cm (8 × 10 inches), crosswise
75-85 KV
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| POSTERIOR OBLIQUE POSITION—GLENOID CAVITY: SHOULDER ---GRASHEY METHOD Patient Position | Perform radiograph with patient in an erect or supine position. (The erect position is usually less painful for patient, if condition allows.)
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| POSTERIOR OBLIQUE POSITION—GLENOID CAVITY: SHOULDER ---GRASHEY METHOD Part Position | Rotate body 35°-45° toward affected side. Center midscap-humral joint to center of IR. Adjust cassette so that top of IR is about 2" above shoulder and side of IR is about 2" from lateral border of humerus. Abduct arm slightly w/arm in neutral rotation.
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| POSTERIOR OBLIQUE POSITION—GLENOID CAVITY: SHOULDER ---GRASHEY METHOD CR | CR perpendicular to IR, centered to scapulohumeral joint, which is approximately 2 inches (5 cm) inferior and medial from the superolateral border of shoulder
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| POSTERIOR OBLIQUE POSITION—GLENOID CAVITY: SHOULDER ---GRASHEY METHOD Anatomy Demonstrated | Glenoid cavity should be seen in profile without superimposition of humeral head.
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| SCAPULAR Y LATERAL—ANTERIOR OBLIQUE POSITION: SHOULDER Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm). •
IR size—24 × 30 cm (10 × 12 inches),lengthwise
—75 to 85 kV range
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| SCAPULAR Y LATERAL—ANTERIOR OBLIQUE POSITION: SHOULDER Patient Position | Perform radiograph with patient in erect or recumbent position
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| SCAPULAR Y LATERAL—ANTERIOR OBLIQUE POSITION: SHOULDER Part Position | Rotate into an anterior oblique position (45°-60°)as for a lateral scapula with patient facing IR. Palpate the superior angle of the scapula and aC joint articulation. Rotate the patient until an imaginary line between those two points are perp. to IR.
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| SCAPULAR Y LATERAL—ANTERIOR OBLIQUE POSITION: SHOULDER CR | CR perpendicular to IR, directed to scapulohumeral joint (2 or 2-1/2 inches [5 or 6 cm] below top of shoulder)
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| SCAPULAR Y LATERAL—ANTERIOR OBLIQUE POSITION: SHOULDER Anatomy Demonstrated | True lateral view of the scapula, proximal humerus, and scapulohumeral joint.
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| Explain the Neer Method | Same as SCAPULAR Y SHOULDER except that the angle of the CR is 10°-15° caudal,centered posteriorly to pass through superior margin of humeral head. This puts the Proximal humerus superimposed over thin body of the scapula, seen on end without ribs
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| AP AND AP AXIAL PROJECTIONS: CLAVICLE Minimum SID — IR size — KV | Minimum SID—40 inches (102 cm). •
IR size—24 × 30 cm (10 × 12 inches),lengthwise
—75 to 85 kV range
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| AP AND AP AXIAL PROJECTIONS: CLAVICLE Patient Position | Perform radiograph with patient in erect or supine position with arms at sides, chin raised, and looking straight ahead. Posterior shoulder should be in contact with IR or tabletop, without rotation of body.
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| AP AND AP AXIAL PROJECTIONS: CLAVICLE Part Position | Center clavicle and IR to CR. (Clavicle can be readily palpated with medial aspect at jugular notch and lateral portion at AC joint above shoulder.)
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| AP AND AP AXIAL PROJECTIONS: CLAVICLE CR --AP AND AP AXIAL | AP
CR perpendicular to midclavicle
AP Axial
CR 15° to 30° cephalad to midclavicle
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| AP AND AP AXIAL PROJECTIONS: CLAVICLE Anatomy Demonstrated --AP AND AP AXIAL | aP 0°
Anatomy Demonstrated:
• Entire clavicle visualized, including both AC and sternoclavicular joints and acromion.
aP axial
Anatomy Demonstrated:
• Entire clavicle visualized, including both AC and sternoclavicular joints and acromion
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| AP PROJECTION: AC JOINTS Minimum SID — IR size — KV | Minimum SID—72 inches (183 cm) •
IR size—35 × 43 cm (14 × 17 inches), crosswise, or (10 × 12 inches) crosswise for unilateral exposures
Digital systems—70 to 80 kV range
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| AP PROJECTION: AC JOINTS Patient Position | Patient in erect position, shoulders against IR w/ equal weight on both feet; arms at side; no rotation of shoulders or pelvis; &looking straight ahead. 2 sets of bilateral AC joints are taken in the same position, 1 w/o weights & 1 stress view w/weights.
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| AP PROJECTION: AC JOINTS Part Position | Position patient to direct CR to midway between AC joints. • Center midline of IR to CR (top of IR should be approximately
2 inches [5 cm] above shoulders).
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| AP PROJECTION: AC JOINTS CR | CR perpendicular to midpoint between aC joints, 1 inch
(2.5 cm) above jugular notch
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| AP PROJECTION: AC JOINTS Weights | 1st exposure is made w/o weights, for large adult patients, strap 8-10 lbs min weights to each wrist, w/shoulders relaxed, let weights hang from wrists while pulling down on each arm and shoulder. The same weight must be used on each wrist.
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| AP PROJECTION: AC JOINTS Anatomy Demonstrated | Anatomy Demonstrated: • Both AC joints, entire clavicles, and SC joints are demonstrated.
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