Deborah Starkey and Pam Rowntree

Discipline of Medical Radiation Sciences

Queensland University of Technology

28%

67%

5%

Table 1:Number of Projections Routinely

Performed

2 Projections

3 Projections

4 Projections

Methodology:

A sample survey of Radiographers was undertaken – This included

Radiographers from a range of practices and departments with a range of

experience (mean 9.9 years). The survey form is included here. Specifically

radiographers were asked to indicate the projections they would perform for a

patient with an acute presentation of generalized shoulder trauma. From this

information we obtained a “snapshot” of local diversity.

Bibliography

•Anderson,I., Read, J., and Steinweg, J., Atlas of Imaging in Sports Medicine 1998 McGraw-

Hill

•Cicak, N., “Posterior dislocation of the shoulder” Journal of Bonr and Joint Surgery 2004

86:324-332

•Goud, A., Segal,D., Hedayati,P., Pan,J., and Weissman,B., “Radiographic Evaluation of the

Shoulder” European Journal of Radiology 2008 68:2-15

•Farid, N., Bruce, D., and Chung, C., “Miscellaneous Conditions of the Shoulder: Anatomical,

Clinical and Pictorial review emphasizing potential pitfalls in Imaging Diagnosis” European

Journal of Radiology 2008 68:88-105

•Lugo, R., Kung, P., and Ma, B., “Shoulder Biomechanics” European Journal of Radiology 2008

68 16-24

•McNally, E., and Rees, J., “Imaging in Shoulder Disorders” Skeletal Radiology 2007 36:1013-

1016

•Stiles, R., and Otte, M., “Imaging of the Shoulder” Radiology 1993 188:603-613

Weber. E., Vilensky, J., and Carmichael, S., “Netter’s Concise Radiologic Anatomy” Elsevier

2009

Introduction:

A good plain film series should provide a comprehensive display of bone and

joint anatomy around the shoulder girdle (Anderson 1998).There are a number

of projections that can be used in trauma patients. This poster explores the

diversity of projections that are utilized across a number of departments.

Please Indicate the Projections you would perform for the following patient:

Patient: Trauma shoulder presentation

Projection:

Field size 24 x 30 18 x24

Patient position MSP perpendicular Scapula plane

CR angulation Nil Angle used

Projection:

Field size 24 x 30 18 x24

Patient position ………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………….

CR angulation Nil Angle used

Projection:

Field size 24 x 30 18 x24

Patient position ………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………….

CR angulation Nil Angle used

Projection :

Field size 24 x 30 18 x24

Patient position ………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………….

CR angulation Nil Angle used Introduction:

Results:

0% 50% 100% 150%

AP Shoulder

Girdle

Lateral Scapula

Garth's

Projection

Glenohumeral

Joint Projection Reported Included in Series

Lateral Scapula:

The lateral oblique projection of the shoulder (scapula Y projection) can be

difficult to interpret if not perfectly performed (Goud 2008). Despite this almost

all respondents included this projection in the standard series.

The results of the survey indicate the majority of respondents (67%) utilize 3

projections to image the trauma shoulder patient. While the anteroposterior (AP)

shoulder girdle and lateral scapula projections were included in each series, the

additional projection varied between the Garth’s projection (apical oblique) and the

glenohumeral joint projection. No respondent reported the use of an axial

projection.

Table 2: Projections Performed

Figure 1: Survey Form Figure 2: AP Shoulder Girdle

AP Shoulder Girdle Projection

The AP Shoulder Girdle projection provides an overall image of glenohumeral joint,

acromioclavicular joint, proximal humerus, clavicle, scapula and sterno-clavicular joint.

While the glenohumeral joint is visualized, it is orientated obliquely to the plane of the

image. All responses nominated this projection was performed with the median sagittal

plane perpendicular to the image receptor (no obliquity of the patient). Respondents

indicated this projection would be reviewed to assist in tailoring the use of

supplementary projections to any specific abnormality demonstrated.

Conclusion:

Determining the specific series for a trauma shoulder patient is dependent the specific

clinical trauma history. This snapshot of projections currently performed indicate basic

projections remain the same however additional projections do vary across departments.

Figure 3: AP Shoulder Girdle

projection demonstrating a

scapula fracture

Figure 4: AP Shoulder Girdle

projection demonstrating an

anterior dislocation

Glenohumeral Joint Projection:

This projection allows evaluation of the glenohumeral

joint and proximal humerus. In the standard AP

projection(with the median sagittal plane perpendicular to

the image receptor) the glenohumeral joint is angled 35 to

40 degrees anterorly. By rotating the patient into a

posterior oblique position, the alignment of the

glenohumeral joint is able to be evaluated. Fractures of

the glenoid rim (Bankart lesion) may also be

demonstrated with this projection. (Cicak 2004)

Figure 5: Lateral Scapula projection

demonstrating clavicle fracture Figure 6: Lateral Scapula projection

Figure 7: Glenohumeral joint

projection on a patient with posterior

dislocation of the shoulder

Garth’s Projection:

The Garth projection (apical oblique)

provides an alternative to the axial projection

of the shoulder, allowing evaluation of

subluxation and dislocations of the humeral

head. In particular this projection will

demonstrate anterior or posterior

displacement .This projection was reported as

included in 61 % of the responses. The

addition of this projection to the image series

may assist when interpretation of the lateral

scapula projection is difficult.

Figure 8: Garth’s

projection

demonstrating

posterior dislocation

Figure 9: Garth’s

projection

demonstrating

anterior

dislocation