Positions Central ray Structure shown Part position Evaluation criteria

Shoulder joint: Infraspinatus insertion Direct at the coracoid - Greater tubercle in - Arm in AP projection
AP Axial projection process at an angle of 25 profile (externally rotated)
degrees caudad - Site of insertion of
spinatus tendon
-Supine - oens up the
subacromial spaces.

Proximal humerus: teres minor Perpendicular to the head Rotates the head of - Flex the arm and place - Outline of greater tubercle
insertion PA projection of humerus humerus so greater tubercle it at the back should super impose the
(blackett- healy) brought it interiorly. - Arm in extreme humeral head.
internal rotation - Lesser tubercle should be in
8x10 CW profile and pointing medially
prone - Soft tissue around humerus
should be demonstrated
along with trabecular detail
on the head.
Proximal humerus: subscapularis Direct the cr perpendicular Present a tangential image Abduct the affected arm - Outline of greater tubercle
insertion AP Projection to the shoulder joint of the insertion of the Flex the elbow should super impose the
(blackett-healy) subscapularis at lesser Rotate the arm internally humeral head.
tubercle by pronating the hand - Lesser tubercle should be in
8x10 CW profile and pointing inferiorly
10x12 CW - Soft tissue around humerus
Supine should be demonstrated
along with trabecular detail
on the head.
Glenoid cavity: AP oblique projection Perpendicular to IR at the Scapulohumeral joint Let the patient hold 1lb - Open joint spaces between
(apple) level of the coracoid weight and abduct the humeral joint and glenoid
process arm 90 degrees. cavity.
10x12 CW - Glenoid cavity in profile.
Upright, seated - Arms in 90 degrees position.

Glenoid cavity: AP Axial oblique Angle 45 degrees cephalad - Scapulohumeral Flex the elbow of affected - scapulohumeral joint,
projection(Garth) at scapulohumeral joint. joint side and place it across the scapulohumera head& neck,
- Humeral head chest. Humeral head are free from
10x12 LW - Coracoid process superimposition.
Supine - Scapular head & - -Coracoid process are well visualized
Upright neck
seated
SHOULDE GIRLDLE Direct the CR Bilateral frontal of AC joints - Patient should - Both AC joints should
Acromioclavicular articulation: perpendicular to the hold sand bags included
Bilateral AP projection (pearson) midline of the body at the with equal weight - No rotation
level of the AC joints in each hand - AC joints should visual with
11x14 CW some soft tissue without
14X17 CW excessive density.
Upright

Acromioclavicular articulation: AP Direct CR through coracoid AC joints is seen projected - Center the - AC joints & clavicle should
Axial projection (alexander M. ) process at an angle of 15 slightly superior shoulder to the projected above the
degrees cephalad. grid acromion.
8X10 LW - Center the - AC joints should visual with
STANDING coracoid p. to the some soft tissue without
SEATED film excessive density.
UPRIGHT
Acromioclavicular articulation: PA Direct CR through coracoid PA Axial projection - Center the AC - AC joints should visual with
Axial projection (alexander M. ) process at an angle of 15 joints to the mid- some soft tissue without
degrees caudad. line of the grid. excessive density.
8X10 LW - AC articulation should be
SEATED demonstrated in profile.
STANDING

CLAVICLE
CLAVICLE: PA projection Direct the CR perpendicular Frontal projection of the Center the clavicle to the - Entire clavicle should included
to the midshaft of clavicle clavicle midshaft of the table. - Density should not be excessive
10X12 CW to the 3rd lateral clavicle but
Prone/upright should be sufficient to
demonstrate the medial third
thorax.
- Radiograph should be centered at
the level of the coracoid p.
CLAVICLE: PA axial position Angled 15-30 degrees An axial position of the - Clavicle should lie above the ribs
caudad clavicle and scapula with the medial end
10X12 CW overlapping the 1st or 2nd ribs.
Prone/standing - Clavicle should assume in more
horizontal orientation
- Entire clavicle should include
from AC to SC joints

CLAVICLE: AP axial
projection (lordotic)
10X12 CW
Standing/seated
Direct the CR 15-25
degrees cephalad to inferior
border of the midclavicle
An axial position of the
clavicle
Neck in extreme flexion
- Clavicle should lie above the ribs
and scapula with the medial end
overlapping the 1st or 2nd ribs.
- Clavicle should assume in more
horizontal orientation
- Entire clavicle should include
from AC to SC joints

CLAVICLE: tangential CR will pass between the Inferior image of the Turn away the head of the - Midclavicle should projected
position clavicle and chestwall clavicle side of being examine w/out super imposition.
perpendicular to the plane - Acromial end & sternal end
10X12 CW of the film should super imposed.
Supine - Entire clavicle should include
from AC to SC joints.

CLAVICLE: tangential Direct the cr anterior and Clavicle is projected above Ask the patient to lean - Clavicle should assume in
position (Tarrant) inferior to the midshaft of the thoracic cage slightly forward horizontal orientation
the clavicle at 25-35 Entire clavicle should include from AC to
10x12 CW degrees SC joints.
seated
Scapula
Scapula: AP Projection
10X12 LW
Upright/supine
Scapula: lateral projection
10X12 LW
Upright/standing
Scapula: PA oblique
projection (LORENZ)
10X12 LW
Upright/lateral
recumbent
Scapula: PA oblique
projection (lilienfield)
10X12 LW
Upright/lateral
recumbent
Direct the cr perpendicular
to the midscapular area at a
point app. 2 inches inferior
to the coracoid p.
Direct the cr perpendicular
to the medial border of the
protruding scapula.
Directed perpendicular to
the plane of the film
between chest wall and the
protruding scapula
Directed perpendicular to
the plane of the film
between chest wall and the
protruding scapula
AP projection of scapula Center the affected
scapula to the midline of
the grid.
Lateral position of the Patient in an oblique
scapula position.
An oblique position of the Arm at a right angle . flex
scapula the elbow and rest the
hand against the patients
head.
Rotate the body slightly
forward , and have the
patient grasp the side of
the table or stand for
support
An oblique position of the Extent the arm of the
scapula affected side, obliquely
upward, and have the
patient rest the hand on
his head
Rotate the body slightly
forward , and have the
patient grasp the side of
the table or stand for
support
- Scapula is horizontal and not
oblique.
- Acromion process and inferior
angle is demonstrated.
- Lateral portion of the scapula is
free from superimposition of the
ribs.
- Lateral and medial border
should be superimposed
- Scapular body should not be
superimposed on the ribs.
- Humerus should not
superimposed the area of
interest.
- Scapula should demonstrated
obliquely.
- Medial border should be
adjacent to the ribs.
- Acromion process and inferior
angle should be included in the
radiograph.
- Scapula should demonstrated
obliquely.
- Medial border should be
adjacent to the ribs.
- Acromion process and inferior
angle should be included in the
radiograph.
 Scapula: AP oblique projection Direct perpendicular to the An oblique image of the Extend the arm superiorly, - scapula should
lateral border of the rib cage scapula. And projected free or flex the elbow, supinate the demonstrated obliquely.
10x12 LW at midscapular are nearly free from rib hand under the head, or have
superimposition. the patient extend the -lateral border should
Supine or adjacent to the ribs
affected arm across the
upright when shoulder is anterior chest. -acromion process and
painful inferior angle should be seen
on the radiograph.

Scapularspine:

Scapularspine: tangential Directed perpendicular to the The spine of the scapula is Centre the shoulder on the - Scapular spine should
projection. posterosuperior regin of the free from superimposition midline of the table be projected superior
(laquerrierre- perquin ) shoulder at an angle of 45 except the outer end of the to scapular wing
degrees caudad. clavicle - Scapularspine should
8x10 CW be visualized with soft
supine tissue around it and
without excessive
density
 Scapularspine: tangential Directed perpendicular to the Tangential image of scapular Seat the patient with his/her - Scapular spine should
projection. anterosuperior regin of the spine back resting against the end be projected superior
(prone position ) shoulder at an angle of 45 of the table and center it to scapular wing
degrees caudad. - Scapular spine should
8x10 CW be visualized with soft
Prone tissue around it and
without excessive
density