Babeh Edi

Shoulder Acromio-Clavicular Joints AP

Indications for imaging Trauma - dislocations, fractures, Arthritis survey Anatomy  Demonstrated Acromio-clavicular joints, medial end of clavicle and acromium Anatomy of the acromio-clavicular joint area Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London Basic Patient Position The patient stands erect AP median saggital plane 90 degrees to the film coronal plane parallel to the film. Take care to prevent the patient leaning backwards and hunching up the shoulder. two exposures one each side / both sides are made, the first pair in the normal relaxed position and the second with the patient holding* a 1.5 kg weight in each hand to stress the joint and accentuate any subluxation or an unstable joint, care must be taken not to further injure the patient. * Weights suspended from wristbands rather than being held reduces shoulder hunching. Acromio-clavicular AP Lt Patient Position Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London Radiation protection Avoid irradiating the thyroid and breast tissue as much as possible. Direct lead rubber gonad protection using a "half apron". Rather than irradiating the whole width of the chest some centers prefer individually centered collimated images of each area, however this does not demonstrate the medial end of the clavicles which may be involved in an injury. Central Ray The horizontal central ray is centered in the midline at the level of the palpable acromio-clavicular joints. Exposure is made on suspended expiration. Exposure Factors Kv mAS FFD (cm) Grid Focus AEC Cassette 80 4 100 No Fine No 24x30 cm Evaluation of the Image ID and anatomical markers must be present and correct in the appropriate area of the film. Limits of the examination, superiorly the skin margins above the acromio-clavicular joints, inferiorly the lower borders of the acromium processes or medial ends of clavicles, lateral the later skin margins of the acromio-clavicular joints. Evidence of collimation on four sides equally around the centering point The image should demonstrate no rotation, the sterno-clavicular joints should be symmetrical. Exposure should be such that the soft tissues around the joints are well visualised, Images should be marked with the stressed view indictors.   Single image of both Acromio-clavicular joints horizontal central ray Related Projections A useful alternative is the standard projection but with a 20 degree cephalad angulation of the central ray. Two separate images of both Acromio-clavicular joints 20 degree cephalad central ray Shoulder joint AP Clavicle PA Additional modalities