Babeh Edi

Shoulder Scapula Lateral

Indications for imaging Trauma - dislocations, fractures, Anatomy  Demonstrated Demonstrates relationship of humeral  head to glenoid, spine of scapula and head of humerus in lateral profile. Scapula PA Rt Lateral Anatomy Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London   Basic Patient Position The patient stands erect facing the cassette and is rotated into the 60 degree anterior oblique position, of the side under investigation, the radiographers hand placed on the posterior skin surface should be at right angles to the film, the median saggital plane at approximately 60 degrees to the cassette. The arm of the affected side should be brought posteriorly the elbow flexed slightly and the back of the hand placed on the buttock of the affected side. Scapula Rt Lateral 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 protection using a half apron. Central Ray The horizontal central ray should be centered to the midpoint of the medial border of the scapula.   Exposure Factors Kv mAS FFD (cm) Grid Focus AEC Cassette 80 15 100 No Fine No 24x30 cm 85 28 100 Yes Fine Yes 24x30 cm Thickset patients may require the use  of a grid Evaluation of the Image ID and markers must be present and correct in the appropriate area of the film. Limits of the examination, superiorly the skin surface above the acromio-clavicular joint, inferiorly the angle of the scapula, medially chest wall, laterally the skin margin of the humerus. Evidence of collimation on four sides equally around the centering point The scapula should be projected end on without superimposition of the chest wall, the Y shape made by the acromium and the coracoid should be symmetrical. There must be adequate penetration of the head of the humerus and the contrast should be low enough to visualise the soft tissues around the head of the humus. Rt Scapula Lateral Radiograph  Lateral Projection of the Scapula with Patient supine For the lateral scapula, the patient is rotated to the LAO or RAO position with the degree of rotation varying with the patient's body habitus. The aim is to place the affected side down with the body of the scapula perpendicular to the plane of the imaging receptor (IR). If the body of the scapula is of interest, the patient's affected arm is positioned posterior or anterior to the thorax - placing the arm down on the chest or behind the back - to avoid superimposition of the humerus on the body of the scapula. The patient could also grasp the opposite shoulder or place the unaffected arm up, resting the forearm on the head. If the acromion or coracoid process is of interest, the arm should be kept down to avoid superimposing the humerus on either part. The central ray is directed to the medial border of the scapula with the exposure on suspended respiration. The final image (Figure 2) should show the scapula free of rib superimposition. Also, the humerus should not be superimposed on the area of interest. REf: http://www.rt-image.com/content=8104J05C487EB28440769A76446890441 Related Projections Shoulder survey AP Shoulder joint AP Supero-inferior Modified Axial Clavicle PA Acromio-clavicular joint AP Additional modalities MRI  (replaces arthrography)  for the joint structures CT