ICTC positioning chapter 5

A patient enters the ER with a proximal and midhumeral fracture. The patient is in extreme pain. What position routines would demonstrate the entire humerus without excessive movement of the limb
AP and thoracic lateral of the humerus
A patient with a possible shoulder dislocation enters the emergency room. A neutral ap projection of the shoulder has been taken, confirming dislocation. Which additional projection should be taken
Garth method
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radiograph of an AP axial clavicle taken on an asthenic type patient reveals that the clavicle is projected in the lung field below the top of the shoulder. the following positioning factors were used: erect position, central ray angled 15* cephlad, 40 in SID, and respiration suspended at end of expiration. Which modifications should be made during the repeat exposure
increase central ray angulation
a patient with a possible right shoulder separation enters the emergency room. Which routine should be used
acromioclavicular joint series: weight and non weight
a patient comes to the radiology department with a history of tendonitis of the bicep tendon. Which projection will demonstrate calcification of the tendon within the intertubercluar groove
tangential projection-fisk medification
An AP apical oblique axial(garth method) radiographic image demonstrates poor visibility of the shoulder joint. The technologist used the following factors: patient erect, facing the xray tube, 45* of rotation of affected shoulder toward the IR, 45*cephalad angle. and the CR centered to the scapulohumeral joint. What factors would have contributed to this poor Garth position
wrong direction of CR angle
a patient is referred to radiology for a nontrauma shoulder series. The routine calls for a PA transaxillary projection (HOBBS modification) be included. But the patient is unable to stand and is confined to a wheelchair. What should the technologist do at this point?
perform the projection with the patients upper chest prone on the table
what clinical indication is best demostrated with the garth method
scapulohumeral dislocation
which anatomy of the of the shoulder is best demonstrated with a PA transaxillary projection (hobbs modification)
scapulohumeral joint space
if the patient cannot fully abduct the affected arm 90* for the inferosuperior axial projection (clements)
Which projection requires the CR to be centered 2in inferior and medial from the superolateral border of the shoulder
posterior obliques (Grashy method)
Which anatomy is best demontrated with the Alexander method
AC joints
which type of injury must be ruled out before the weight bearing phase of an AC joint study
fractured clavicle
what is the minimum amount of weight a large adult should have strapped to each wrist for the weight bearing phase of an AC joint study
8-10 lbs
which two positioning landmarks are aligned perpendicularly to the IR for the lateral scapula projection
superior angle and AC joint
a radiograph of a posterior oblique (Grashy Method) reveals that the anterior and posterior glenoid rims are not superimposed. The following technical factors were used: erect position, body rotated 25-30* toward the affected side, central ray perpendicular to scapulohumeral joint space, and affected arm slightly abducted in neutral rotation. What modification will superimpose the glenoid rims
rotate body more toward affected side
the largest and longest bone of the upper limb.
the length of the humerus on an adult equals approximately __ of body height
the most proximal part of the humerus
head of the humerus
The slightly constricted area directly below and lateral to the head
anatomic neck
process directly below the anatomic neck on the anterior surface is the
lesser tubercle
the greater tubercle is larger and more ___
where do the pectoralis major supraspinatus muscles attach
greater tubercle
the deep groove between the the two tubercles is
intertubercular groove
the tapered area below the head and tubercles is the
surgical neck
part of the humerus distal to the surgical neck
body of the humerus
what is the site of frequent fractures requiring surgery
surgical neck
roughened raised triangular elevation along the anterolateral surface of the body to which the deltoid muscle is attached
deltoid tuberosity
the shoulder girdle consists of which bones
clavicle and the scapula
where does the shoulder girdle connect to the trunk anteriorly
what connects the shoulder girdle to the trunk posteriorly
a long bone with a double curvature
the lateral joint of the clavicle where the shoulder blade meets the clavicle
acromioclavicular joint
the medial joint of the clavicle where the clavicle meets the sternum
sternoclavicular joint
the 2 sternoclavicular joints help form the
jugular notch
whos clavicle is usually shorter and less curved
who has the most curved clavicle
heavily muscled men
what are the borders of the scapula
medial, superior, and lateral
medical term for the arm pit
angle of the scapula that is sometimes called the head of the scapula and is the thickest part and ends laterally in a shallow depression called the glenoid cavity
lateral angle
The humeral head articulates with the glenoid cavity of the scapula to form the
scapulohumeral joint
the constricted area between the head and the body of the scapula
neck of scapula
the body of the scapula is arched for
greater strength
the anterior surface of the scapula is termed the
costal surface
the middle area of the costal surface presents a large concavity or depression know as the
subscapular fossa
a long, curved process that extends laterally over the head of the humerus
a thick beaklike process that projects anteriorly beneath the clavicle
coracoid process
prominent structure on the dorsal or posterior surface of the scapula
what forms the Y of the scapula
acromion and the coracoid process
what type of joint is the sternoclavicular joint
double plane or gliding joint
what type of joint is the acromioclavicular joint
plane or gliding
on which AP shoulder will the greater tubercle be seen laterally in profile
external rotation
on which AP shoulder will the lesser tubercle be seen medially in profile
internal rotation
an injury in which the distal clavicle usually is displaced superiorly
acromioclavicular dislocation
trauma to the upper shoulder region resulting in a partial or complete tear of the AC or coracoclaviular ligament or both ligaments
AC joint separation
an injury of the anteroinferior aspect of the glenoid labrum. This type of injury often is caused by anterior dislocation of the proximal humerus. repeated dislocation may result in a small avulsion fracture in the anteroinferior region of the glenoid rim
bankart lesion
a compression fracture of the articular surface of the posterolateral aspect of the humeral head that often is associated with an anterior dislocation of the humeral head
Hill-Sachs defect
a disability of the shoulder joint that is caused by chronic inflammation in and around the joint. it is characterized by pain and limitation of motion
idiopathic chronic adhesive capsulitis (frozen shoulder)
acute or chronic and traumatic injury to one or more of the muscles that make up the rotator cuff-teres minor, supraspinatus, infraspinatus, and subscapularis.
rotator cuff
what muscle is impinged in a common rotator cuff injury
suprasinatus muscle
occurs as traumatic removal of humeral head from the glenoid cavity. 95% are anterior in which the humeral head is projected anterior to the glenoid cavity
shoulder dislocation
and inflammatory condition of the tendon that usually results from a strain
what is the most superior structure on a inferosuperior axial projection
What is the CR angle and CR positionfor the ALexander method for AC joints
15* cephalic centered at AC joint
what does the neer method demonstrate
subacromial spurs and the coracoacromial arch
what do you do on a transthoracic lateral if the patient cannot raise the unaffected arm over their head completely
angle CR 10-15* cephalad
what is the CR angle and placement for hobbs method
CR is perpendicular to the axilla and humeral head to pass through glenohumeral joint
on the clements method, what do you do if the patient cannot fully abduct the upper limb 90*
angle tube 5-15* toward axilla
what is the most common dislocation
95% anterior dislocation of shoulder
what is the CR angle for the bilateral AC joints on a 14×17 in cassette
CR perpendicular
where do you place the CR for the bilateral AC joints
1 in above jugular notch
can you use the AEC for the fisk method?
for the garth method, how will the humerus be projected with an anterior dislocation
how do you position the patient on a lateral scapula in order to demonstrate the body (wings)
hand on opposite shoulder
what extra step is performed in order to demonstrate the HIll Sachs defect
exaggerated external rotation
what is the CR angle and placement for the transthoracic lateral of the proximal humerus
CR perpendicular; directed through thorax to mid diaphysis
AP apical oblique axial projection:shoulder
Garth Method
tangential projection-supraspinatus outlet: shoulder
Neer method
Tangential projection-intertubercular (bicipital) groove: shoulder
fisk modification
posterior oblique position -glenoid cavity
grashey method
inferosuperior axial projection
clements modification
pa transaxillary projection
hobbs modification
for an AP projection of the shoulder, the CR should be positioned __ infereior to the coracoid process
1 inch
what are the kVp and mAs for the lab shoulder prositions
75-85 kv and any mAs over 75
what central ray angulation is required for the tangential projection-supraspinatus outlet (Neer)
10*-15* caudal
what projection can a breathing technique be employed
transthoracic lateral for humerus
what projection best demonstrates the supraspinatus outlet region
tangential projection (Neer)
what is the major advantage of the supine tangential version of the intertubercular groove projection over the erect version
reduced OID
for the erect version of the tangential projection for the intertubercular groove, the patient leans forward ____
the Grashey method places the ___ ___ in profile for an “open” scaulohumeral joint
glenoid cavity
how are the humeral epicondyles aligned for a rotational lateromedial projection of the humerus
perpendicular to IR
what central ray angle should be used for the inferosuperior axial projection, which additional positioning maneuver must be used
25*-30* medially
which imaging modalities or procedures best demonstrates ostomyelitis
nuclear medicine
what are the proper names for the shoulder joint
scapulohumeral and glenohumeral
which specific joint is found on the lateral end of the clavicle
which structure of the scapula extends most anteriorly
coracoid process

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