SJC Zerbe S1U3
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| AP Projection External Rotation: Cassette size and orientation | 10 x 12 CW with Grid
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| AP Projection External Rotation: CR location | CR 1” inferior to coracoid
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| AP Projection External Rotation: Patient Position | Hand supinated with epicondyles parallel to IR
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| AP Projection External Rotation: What is shown? | Humeral head in profile
Greater tubercle in profile (laterally)
Site of insertion of the supraspinatus tendon
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| AP Projection Internal Rotation: Cassette size and orientation | 10 x 12 CW with Grid
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| AP Projection Internal Rotation: CR location | CR 1” inferior to coracoid
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| AP Projection Internal Rotation: Patient Position | Posterior hand on thigh and epicondyles perpendicular to IR
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| AP Projection Internal Rotation: What is shown? | Lesser tubercle in profile medially.
Site of insertion of subscapular tendon
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| AP Projection Neutral Rotation: Cassette size and orientation | 10 x 12 CW with Grid
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| AP Projection Neutral Rotation: CR location | CR 1” inferior to coracoid
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| AP Projection Neutral Rotation: Patient Position | Palmar surface of hand against thigh with epicondyles at a 45 degree angle
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| AP Projection Neutral Rotation: What is shown? | Humeral head and greater tubercle in partial profile
. Posterior part of the supraspinatus insertion.
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| AP Oblique Projection Grashey Method: Cassette size and orientation | 8 x 10 CW with Grid If available, if not then 10x12 with Grid
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| AP Oblique Projection Grashey Method: CR location | CR 2” medial and 2” inferior to superolateral border of shoulder
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| AP Oblique Projection Grashey Method: Patient Position | Patient rotated 35 to 45 degrees toward affected side until scapula is parallel to IR
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| AP Oblique Projection Grashey Method: What is shown? | Scapulohumeral joint and Glenoid cavity (fossa) in profile.
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| Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: Cassette size and orientation | 10 x 12 LW
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| Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: CR location | CR perpendicular to IR and exits surgical neck
(if patient cannot raise unaffected arm, CR is angled 10 to 15 degrees cephalic)
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| Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: Patient Position | MCP perpendicular to IR with affected side against IR and unaffected arm raised over head
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| Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: Breathing Technique | Shallow breathing is recommended respiration phase,
If unable to do breathing technique then suspend respirations at end of inspiration
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| AP Projection External Rotation: Technique and SID | 75 kVp @ 12.5 mAs, SFS, 40"
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| AP Projection Internal Rotation: Technique and SID | 75 kVp @ 12.5 mAs, SFS, 40"
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| AP Projection Neutral Rotation: Technique and SID | 75 kVp @ 12.5 mAs, SFS, 40"
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| AP Oblique Projection Grashey Method: Technique and SID | 75 kVp @ 16 mAs, SFS, 40"
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| Transthoracic Lateral Lawrence Method Trauma for proximal humerus/shoulder: Technique and SID | SFS, 40", 80 kVp @ 2 second exposure.
•Smaller than average Patient:
20 mAs (10mA @ 2 Sec)
•Average:
32 mAs (16mA @ 2 Sec)
•Above Average:
64 mAs (32mA @ 2 Sec)
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| Inferosuperior Projection Lawrence Method Axillary: Cassette size and orientation | 10 x 12 Crosswise on the table, and lengthwise to the arm. Use 8x10 for smaller patient. IR Placed vertically against the superior surface of the shoulder as far into the neck as possible
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| Inferosuperior Projection Lawrence Method Axillary: CR location | CR is horizontal and angled 15 to 30 degrees medially
Enters axilla, exits AC joint
. The greater the abduction, the greater the angle you will use.
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| Inferosuperior Projection Lawrence Method Axillary: Patient Position | Supine with arm abducted 90 degrees in external rotation with epicondyles parallel to Floor
Raefert Modification- extreme rotation for Hill Sachs
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| Inferosuperior Projection Lawrence Method Axillary: Technique and SID | 60 kVp @ 8mAs, SFS, 40"
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| Inferosuperior Projection Lawrence Method Axillary: What is shown? | You should see a gap in the scapulohumeral joint with minimal overlap.
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| Superoinferior Projection Axillary: Cassette size and orientation | 8 x 10 LW If available, 10 x 12 if not
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| Superoinferior Projection Axillary: CR location | CR angled 5 to 15 degrees from vertical toward the elbow. Enters AC and exits axilla. The less the abduction, the greater the angle.
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| Superoinferior Projection Axillary: Patient Position | Seated with arm abducted over IR and flexed with anterior forearm resting on table
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| Superoinferior Projection Axillary: Technique and SID | 60 kVp @ 8 mAs, SFS, 40"
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| Superoinferior Projection Axillary: What is shown? |
Axillary view demonstrating scapulohumeral joint, but not the preferred method due to OID. May also see ribs, scapulohumeral joint demonstrated with obvious superimposition, no gap.
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| PA Oblique Projection of the shoulder Scapular Y: Cassette size and orientation | 10 x 12 LW
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| PA Oblique Projection of the shoulder Scapular Y: CR location | CR perpendicular through the scapulohumeral joint
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| PA Oblique Projection of the shoulder Scapular Y: Patient Position | Patient PA and rotated 45 to 60 toward the affected side until scapular body is perpendicular to the IR with arm hanging by the side. Can be done in recumbent LPO for trauma
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| PA Oblique Projection of the shoulder Scapular Y: Technique and SID | SFS, 40", 75 kVp
•Smaller than average patient size:
16 mAs
•Average patient:
32 mAs
•Above Average patient:
64 mAs
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| PA Oblique Projection of the shoulder Scapular Y: What is shown? | Demonstrates anterior/posterior dislocations of the shoulder. Humerus and scapular body will be superimposed.
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| PA Oblique Projection of the shoulder Scapular Y: Modifications | For Neer method (supraspinatus outlet view), angle 15 degrees caudal at the superior humeral head
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| Tangential Projection Intertubercular groove Supine method: Cassette size and orientation | 8 x 10
placed vertically on the table against superior shoulder. If available if not then 10 x 12
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| Tangential Projection Intertubercular groove Supine method: CR location | CR angled 10 to 15 degrees posteriorly from horizontal skims the anterior surface of humeral head through the bicipital groove
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| Tangential Projection Intertubercular groove Supine method: Patient Position | Patient supine with arm by side and hand supinated
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| Tangential Projection Intertubercular groove Supine method: Modifications | Can do standing (Fisk) with patient leaning over IR and humerus angled 10 to 15 degrees, with cassette held on forearm. Not preferred due to OID
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| AP Projection Acromioclavicular Joints Pearson Method: Cassette size and orientation | 14 x 17 CW or
2 – 8x10s
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| AP Projection Acromioclavicular Joints Pearson Method: CR location | CR horizontal at the level of the AC joints and centered to MSP
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| AP Projection Acromioclavicular Joints Pearson Method: Patient Position | Seated or standing in AP position. Patient's arms hang by the sides, plane of shoulders parallel to IR. 2 exposures– one without weights, one with 5-8lb affixed to each wrist, pt should let arms hang, not hold weights up.
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| AP Projection Acromioclavicular Joints Pearson Method: Technique and SID | 75 kVp @ 12.5 mAs, SFS, *** 70" SID ***
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| AP Projection Acromioclavicular Joints Pearson Method: What is shown? | Shows separation between acromial extremity and acromion process
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| AP Projection Acromioclavicular Joints Pearson Method: Collimation | 6 × 17 or smaller if patient size allows.
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| AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): Cassette size and orientation | 10 x 12 CW
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| AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): CR location | CR perpendicular to IR and centered to clavicular midshaft
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| AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): Breathing Instructions | Respiration suspended at end of expiration for uniform density or brightness levels
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| AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): Technique and SID | 75 kVp @ 12.5 mAs, SFS, 40"
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| AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): What is shown? | Sternal extremity will be demonstrated within the thorax
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| AP Projection Clavicle (Can also be done PA to reduce OID and improve recorded detail): Collimation | 6 × 12 or smaller if patient allows
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| AP Axial Clavicle: Cassette size and orientation | 10 x 12 CW
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| AP Axial Clavicle: CR location | Centered to clavicular midshaft. CR angled 15 to 30 degrees cephalic. OR 0 to 15* if patient is in lordotic position (Caudal if done PA)
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| AP Axial Clavicle: Breathing Instructions | Suspend at end of inspiration
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| AP Axial Clavicle: Technique and SID | 75 kVp @ 16 mAs, SFS, 40"
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| AP Axial Clavicle: Collimation | 6 × 12 or smaller if patient allows
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| AP Scapula: Cassette size and orientation | 10 x 12 LW
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| AP Scapula: CR location | CR: 2” inferior to the coracoid. Top of IR 2” above shoulder
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| AP Scapula: Breathing Instructions | shallow breathing
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| AP Scapula: Technique and SID | 70 kVp @ 10 mA @2 seconds "breathing technique" (20 mAs), 40"
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| AP Scapula: Collimation | Collimate IR size or smaller if patient size allows. Mark lateral margin
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| AP Scapula: Patient Position | Standing or supine with arm abducted 90 degrees "crossing guard"
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| Lateral Scapula: Cassette size and orientation | 10 12 LW
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| Lateral Scapula: CR location | CR entering mid vertebral border
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| Lateral Scapula: Breathing Instructions | Suspend
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| Lateral Scapula: Technique and SID | 75 kVp 32 mAs SFS
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| Lateral Scapula: Collimation | Adjust to 12" in length and 1 " from the lateral shadow
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| Lateral Scapula: Patient Position | Arm across the posterior thorax to demonstrate coracoid and acromion
. Arm across anterior chest or over the head to demonstrate body
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| AP Projection External Rotation: Breathing Instructions | Suspend
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| AP Projection Internal Rotation: Breathing Instructions | Suspend
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| AP Projection Neutral Rotation: Breathing Instructions | Suspend
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| AP Oblique Projection Grashey Method: Breathing Instructions | Suspend
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| Inferosuperior Projection Lawrence Method Axillary: Breathing Instructions | Suspend
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| Superoinferior Projection Axillary: Breathing Instructions | Suspend
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| PA Oblique Projection of the shoulder Scapular Y: Breathing Instructions | Suspend
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| AP Projection Acromioclavicular Joints Pearson Method: Breathing Instructions | Suspend
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| What percent of dislocations are anterior (subcorocoid)? | 97%
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| Hill-Sachs defect | Impacted fracture of posterolateral aspect of the humeral head with dislocation
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| Bursitis | Inflammation of the bursa
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| Dislocation | Displacement of a bone from the joint space
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| Fracture | Disruption in the continuity of bone
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| Tendinitis | Inflammation of the tendon and tendon-muscle attachment
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| Osteopetrosis | Increased density of atypically soft bone (think petrified)
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| Osteoporosis | Loss of bone density (think porous)
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| Rheumatoid Arthritis | Chronic, systemic, inflammatory collagen disease
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| Osteoarthritis or degenerative joint disease | Form of arthritis marked by progressive cartilage deterioration in synovial joints and vertebrae
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| For a transthoracic lateral projection of the shoulder, lung detail may be blurred to better visualize the shoulder area. According to your text what exposure time is recommended to blur the lung structures? | Minimum of 3 seconds
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| The sternoclavicular articulation is formed by the sternal extremity of the clavicle and the: | Manubrium and 1st rib cartilage
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| The superior surface of the greater tubercle slopes posteriorly 25 degrees and has how many flattened impressions for muscle (tendon) insertion? | 3 Anterior, Middle, Posterior
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| The anterior impression of the greater tubercle provides the insertion site for what tendon? | The tendon of the Supraspinatous muscle
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| The middle impression of the greater tubercle is the site of insertion for which tendon? | The tendon of the infraspinatous muscle
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| The posterior impression of the greater tubercle is the insertion for which tendon? | The upper fibers of the teres minor (the lower fibers attach to the body just below this site)
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| Which AP Projection will sometimes demonstrate calcific deposits in the joint that can be indicative of Bursitis | Neutral Rotation
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| What Projections will demonstrate the humerus in a lateral projection | AP internal rotation Transthoracic lateral
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| The superoinferior and inferosuperior Axillary projections demonstrates which tendon insertion sites? | Subscapularis of less tubercle and Teres minor of greater tubercle
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| For a transthoracic lateral projection, the proximal humerus should be projected: | between the vertebral column and sternum
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| When the tangential projection of the intertubercular groove is performed with the patient supine, the position of the hand is: | Supinated
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| All of the joints of the shoulder girdle are: | Synovial: freely movable
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| The lesser tubercle is situated on which surface of the humerus? | anterior
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| How many degrees is the body rotated for the AP oblique projection (Grashey method) of the shoulder joint? | 35-45* towards the affected side
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| Which shoulder projection clearly demonstrates the glenoid cavity? | AP Oblique Projection (Grashey Method)
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| The West Point method is useful in demonstrating what? | Hill-sachs defect and Bankart lesions associated with anterior dislocations of the shoulder
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| Test slide | Ignore me
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