Babeh Edi

Shoulder Modified Axial (Wallace)

Indications for imaging Trauma - dislocations, fractures, Anatomy  Demonstrated Gleno humeral joint, lateral of proximal humerus, acromium,  and corocoid without superimposition. Shoulder Axial Anatomy Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London Basic Patient Position The patient is seated with their back to the couch or horizontal bucky, the trunk is rotated 30 degrees to the affected side so that the blade of the scapula is parallel to the edge of the table, if possible the tip of the elbow rests on the edge of the table top. The cassette is placed horizontally behind the humerus and in contact with the arm.  Position of the patient and x-ray tube for modified axial of the shoulder (Wallace) Radiation protection Avoid irradiating the thyroid and breast tissue as much as possible. Direct lead rubber gonad protection using a "half apron". Central Ray The vertical central ray is angle 30 degree posteriorly and centered to the coracoid process and through the glen humeral joint. An extended Focus subject distance is required to reduce magnification.* Exposure Factors Kv mAS FFD (cm) Grid Focus AEC Cassette 80 20 150* No Fine No 24x30 cm Evaluation of the Image ID and markers must be present and correct in the appropriate area of the film Limits of the examination, anteriorly the anterior skin surface of the shoulder and anterior chest wall, posteriorly the spine of the scapula, laterally the proximal quarter of the humerus, medially the coracoid process. Evidence of collimation on four sides equally around the centering point The position of the head of the humerus related to the glenoid must be well demonstrated, the acromium spine of scapula and the coracoid process should all be clearly visible. Normal Shoulder Axial Anatomy (from) http://www.vh.org Related Projections Shoulder survey Shoulder joint AP Supero-inferior Scapula lateral Clavicle AP Acromio-clavicular joint AP Additional modalities --   Wallace, W. Hellier, M.1983  Improving radiographs of the injured shoulder: Radiography 49,586