Which projection of the shoulder best demonstrates the greater tubercle of the humerus in profile?

The shoulder girdle consists of what?

The three aspects of the clavicle are the?

acromial extremity, body, and sternal angle

The (male or female) clavicle tends to be thicker and more curved in shape?

The three angles of the scapula include the?

Lateral, superior, inferior

The anterior surface of the scapula is referred to as the _____ surface?

What is the anatomic name for the armpit?

What are the names of the two fossae located on the posterior scapula?

infraspinous supra spinous

All of the joints of the shoulder girdle are classified as being?

What type of movement does the scapulohumeral joint have?

spherodial joint (ball and socket)

What type of movement does the sternoclavicular joint have?

gliding joint (double plane)

What type of movement does the acromioclavicular joint have?

The use of a grid is not required for shoulder studies that measure less than 10cm.

The kV range for adult shoulder projections is between 80 and 90 kV for analog and 100 to 110 kV for digital imaging systems.

Low mA with short exposure times should be used for adult shoulder studies.

Large focal spot setting should be selected for most adult shoulder studies.

A high-speed screen-IR system is recommended for analog shoulder studies when using a grid.

A 72in source-image distance (SID) is recommended for most shoulder girdle studies.

The use of contact shields over the breast, lung, and thyroid regions is recommended for most shoulder projections.

Which one of the following kV ranges should be used for a shoulder series on an average adult?

a. 70-80 kV

b. 55-60 kV

c. 80-90 kV

d. 65-75 kV

If physical immobilization is required, which individual should be asked to restrain a child for a shoulder series?

a. parent or guardian

b. radiologic technologist

c. radiography student

d. nurse aide

CT arthrography of the shoulder joint often requires the use of iodinated contrast media injected into the joint space.

Magnetic resonance imaging (MRI) is an excellent modality for demonstrating bony injuries of the shoulder girdle.

Nuclear medicine bone scans can demonstrate signs of osteomyelitis and cellulitis.

Radiography is more sensitive than nuclear medicine for demonstrating physiologic aspects of the shoulder girdle.

Sonography can provide a functional evaluation of joint movement that MRI cannot.

Which one of the following clinical indications requires a decrease in manual exposure factors?

a. impingement syndrome

b. bursitis

c. bankart lesion

d. osteoporosis

Which two routine shoulder projections are routinely taken for a shoulder (with no traumatic injury) and proximal humerus?

AP internal and AP external

Specifically, where is the CR placed for an AP projection of the shoulder?

1 inch inferior to coracoid process and CR is perpendicular to IR

Which lateral projection can be performed to demonstrate the entire humerus for a patient with a midhumeral fracture?

Transthoracic lateral projection for humerus

To best demonstrate a possible Hill-Sachs defect, which additional positioning technique can be added to the inferosuperior axial projection?

a. angle CR 10-15 degrees caudad

b. rotate affected arm externally approximately 45 degrees

c. angle CR 3-5 degrees caudad

d. place humeral epicondyles parallel to IR

b. rotate affected arm externally approximately 45 degrees

What type of CR angulation is required for the inferosuperior axial projection for the shoulder?

a. 25-30 degrees medially

b. 35-45 degrees medially

c. 25 degrees anterior and 25 degrees medially

d. CR perpendicular to IR

The _________ projection of the shoulder produces an image of the glenoid process in profile.

posterior oblique (grashey method)

Which one of the following projections produces a tangential projection of the intertubercular groove?

a. fisk modification

b. grashey method

c. hobbs modification

d. lawrence method

The supine version of the tangential projection for the intertubercular groove requires that the CR be angled ____________ posteriorly from the horizontal plane.

Which one of the following projections is best for demonstrating a possible dislocation of the proximal humerus?

a. posterior oblique (grashey)

b. fisk modification

c. inferosuperior axial (clements modification)

d. scapular y projection

The ______ projection is the special projection of the shoulder that best demonstrates the acromiohumeral space for possible subacromial spurs, which create shoulder impingement symptoms. This projection is also referred to as the ______ method.

Which of the following nontraume projections can be performed erect to provide a lateral view of the proximal humerus in relationship to the glenohumeral joint?

a. tangential projection (fisk modification)

b. AP projection-neutral rotation

c. PA transaxillary projection (hobbs modification)

d. posterior oblique position (grashey method)

c. PA transaxillary projection (hobbs modification)

How much is the CR angled for the inferosuperior axial projeciton (clements modification) if the patient cannot fully abduct the arm 90 degrees?

a. 5-15 degrees

b. 45 degrees

c. 25-30 degrees

d. 20 degrees

What CR angle is required for the AP axial projection (alexander method) for AC joints?

a. 25 degrees cephalad

b. 5-10 degrees caudad

c. 45 degrees caudad

d. 15 degrees cephalad

The PA transaxillary projection (hobbs modification) requires no CR angle.

The transthoracic lateral projection can be performed for possible fractures or dislocations of the proximal humerus.

The affected arm must be placed into external rotation for the transthoracic lateral projection.

The use of a breathing technique can be performed for the transthoracic lateral humerus projection.

A CR angle of 10-15 degrees caudad may be used for the transthoracic lateral projections if the patient is unable to elevate the uninjured arm and shoulder sufficiently.

The scapular Y lateral position requires the body to be rotated 30-40 degrees anteriorly toward the affected side.

Which two landmarks are placed perpendicular to the IR for the scap Y lateral projection?

Superior angle of scapula and AC joint

Which special projection of the shoulder requires that the affected side to be rotated 45 degrees toward the cassette and uses a 45 degree caudad CR angle.

A posterior dislocation of the humerus projects the humeral head ______ to the glenoid cavity with the AP apical oblique axial. (superior or inferior)

A thin-shouldered patient requires (more, less) CR angle for an AP axial clavicle projection than a large shouldered patient.

What must be ruled out before performing the weight bearing study for the AC joints?

Where is the CR centered for the AP scapula projection?

perpendicular to mid scapula

What type of CR angle is required for the lateral scapula position?

a. 10-15 degrees cephalad

b. 5-15 degrees caudad

c. 10-15 degrees caudad

d. none

The following factors were used to produce a radiograph of an AP projection of the shoulder: 85 kV, 20 mAs, high-speed screens, 40" SID, grid, and suspended respiration. The resultant radiograph demonstrated poor radiographic contrast between bony and soft tissue structures. Which of these factors can be altered during the repeat exposure to improve radiographic quality?

Lower the kV to 75 and double mAs to 40, which increases radiographic contrast

A radiograph of an AP axial clavicle projection reveals that the clavicle is projected below the superior border of the scapula. What can the technologist do to correct this problem during the repeat exposure?

Increase CR cephalad angle

A radiograph of an AP scapula reveals that the scapula is within the lung field and difficult to see. Which two things can be the technologist do to improve the visibility of the scapula during the repeat expsoure?

Ensure that the affected arm is abducted to 90 degrees and use a breathing technique

A radiograph of an AP projection (with external rotation) of a shoulder (with no traumatic injuries) reveals that neither the greater nor lesser tubercles are profiled. What must be done to correct this during the repeat exposure?

Supinate the hand and ensure that the epicondyles are parallel to the IR for a true AP

A radiograph of a lateral scapula position reveals that it is not a true lateral projection. (Consider separation exists between the axiallary and vertebral borders) The projection was taken using the following factors: erect position, 40" SID, 45 degree rotation toward the cassette from PA, CR centered to midscapula, an no CR angulation. Based on these factors, how can this position be improved during the repeat exposure?

Palpate the superior angle of the scapula and AC joint articulation and ensure that the imaginary plane between these points is perpendicular to the IR

A radiograph of the AP oblique (grashey) taken as a 35 degree oblique projection reveals that the borders of the glenoid cavity are not superimposed. The patient has large, rounded shoulders. What must be done to get better superimposition of the cavity during the repeat exposure?

Increase rotation of affected shoulder toward IR to closer to 45 degree angle

A patient with a possible right shoulder dislocation enters the emergency room. The technologist attempts to perform an erect transthoracic lateral projection, but the patient is unable to raise the left arm and shoulder high enough. The resultant radiograph reveals that the shoulders are superimposed, and the right shoulder and humeral head are not well visualized. What can be done to improve this image during the repeat exposure?

Angle the CR 10-15 degrees cephalad to separate the shoulders

A patient with a possible fracture of the right proximal humerus from an automobile accident enter the emergency room. The patient has other injuires and is unable to sit or stand erect. Which positioning routine should be used to determine the extent of the injury?

The routine includes the AP of right shoulder and humerus without rotation and a supine horizontal beam, right transthoracic shoulder. Note: in those cases in which the opposite arm cannot be elevated or extended, a supine posterior oblique scap Y lateral projection could also be used as a second option for a lateral shoulder position

A patient with a clinical history of chronic shoulder dislocation comes to the radiology department. The orthopedic physician suspects that a Hill-Sachs defect may be present. Which specific position(s) may be used to best demonstrate this pathologic feature?

Possible positioning options: inferosuperior axial projection with exaggerated external rotation, inferosuperior axial projection (clements modification) and AP apical oblique axial projection (Garth method)

A patient with a possible Bankart lesion comes to the radiology department. List three projections that can be performed that may demonstrate signs of this injury:

AP internal rotation

Scapular Y lateral

Posterior oblique (grashey)

A patient with a possible rotator cuff tear comes into the radiology department. Which one of the following imaging modalities would best demonstrate this injury?

a. arthrography

b. MRI

c. nuclear medicine

d. radiography

A patient with a clinical history of tendon injury in the shoulder comes to the radiology department. The orthopedic physician needs a functional study of the shoulder joint performed to determine the extent of the tendon injury. Which of the following modalities would best demonstrate this injury?

a. arthrography

b. MRI

c. Ultrasound

d. Nuclear medicine

A radiograph of an AP projection with external rotation of the shoulder does not demonstrate either the greater or lesser tubercle in profile. What is the most likely cause for this radiographic outcome?

The humeral epicondyles were not placed parallel to the plane of the IR.

A patient enters the ER with a definite fracture to the midhumerus. Because of other trauma the patient is unable to stand. Which lateral projection would demonstrate the entire humerus?

Transthoracic lateral projection for humerus

The AP apical oblique axial projection (garth method) is performed on a patient with a shoulder injury. The resultant radiograph demonstrates the proximal humeral head projection below the glenoid cavity. What type of trauma or pathology is indicated with the radiographic appearance?

Anterior dislocation of the proximal humerus.

A radiograph of a transthoracic lateral projection demonstrates considerable superimposition of lung markings and ribs over the region of the proximal shoulder. What can the technologist do to minimize this problem during the repeat exposure?

Use breathing exposure technique to create blurring of ribs and lung makrings

Select the terms that correctly describe the shoulder joint.

a. humeroscapular

b.scapulohumeral

c. glenohumeral

d. b and c

Which specific joint is found on the lateral end of the clavicle?

a. scapulohumeral

b. sternoclavicular

c. acromioclavicular

d. glenohumeral

Which of the following is not an angle found on the scapula?

a. inferior angle

b. medial angle

c. lateral angle

d. superior angle

Which one of the following structures of the scapula extends more anteriorly?

a. glenoid cavity

b. acromion

c. scapular spine

d. coracoid process

The male clavicle is shorter and less curved than the female clavicle.

Which bony structure separates the supraspinous and infraspinous fossae?

a. scapular spine

b. glenoid cavity

c. acromion

d. superior border of scapula

Which one of the following structures is considered to be the most posterior?

a. scapular notch

b. coracoid process

c. acromion

d. glenoid process

What is the type of joint movement for the scapulohumeral joint?

a. plane

b. ellisoidal

c. spheroidal

d. trochoidal

Which one of the following analog technical considerations does not apply for adult shoulder radiography?

a. non-grid

b. high-speed IR

c. 40-44 inch SID

d. 70-80 kV

Even though the amount of radiation exposure is minimal for most shoulder projections, gonadal shielding should be used for children and adults of childbearing age.

The greatest technical concern during a pediatric shoulder study is voluntary motion.

Which one of the following imaging modalities or procedures provides a functional, or dynamic, study of the shoulder joint?

a. ultrasound

b. CT arthrography

c. MRI

d. nuclear medicine

Which one of the following projections and/or positions best demonstrates signs of impingement syndrome?

a. AP and lateral shoulder external rotation

b. inferosuperior axial

c. inferosuperior axial with exaggerated rotation

d. tangential projection (neer method)

Which one of the following pathological conditions often produces narrowing of the joint space?

a. osteoarthritis

b. bursitis

c. osteoporosis

d. idopathic chronic adhesive capsulitis

Which one of the following pathological conditions may require a reduction in manual exposure factors?

a. bursitis

b. rheumatoid arthritis

c. rotator cuff tear

d. bankart lesion

Which routine projection of the shoulder requires that the humeral epicondyles be parallel to the IR?

a. external rotation

b. neutral rotation

c. internal rotation

d. posterior oblique-grashey method

Where is the CR centered for an AP projection - external rotation of the shoulder?

a. acromion

b. 1" superior to coracoid process

c. 1" inferior to coracoid process

d. 2" inferior to acromioclavicular joint

c. 1" inferior to coracoid process

Which position of the shoulder and proximal humerus projects the lesser tubercle in profile medially?

a. external rotation

b. neutral rotation

c. internal rotation

d. exaggerated rotation

What CR angle should be used for the inferosuperior axial projection for the scapulohumeral joint space?

a. 15 degrees medially

b. 25-30 degrees medially

c. 25 degrees anteriorly and medially

d. 35-45 degrees medially

b. 25-30 degrees medially

To best demonstrate the Hill-Sachs defect on the inferosuperior axial projection, which additional positioning maneuver must be used?

a. angle CR 35 degrees medially

b. use exaggerated external rotation

c. use exaggerate internal rotation

d. abduct arm 120 degree rotation from midsagittal plane

b. use exaggerated external rotation

How are the humeral epicondyles aligned for a rotational lateromedial projection of the humerus?

a. 45 degrees to IR

b. perpendicular to IR

c. parallel to IR

d. 20 degree angle to IR

Which special projection of the shoulder places the glenoid cavity in profile for an "open" scapulohumeral joint?

a. garth method

b. fisk modification

c. transthoracic lateral - lawrence method

d. grashey method

For the erect version of the tangential projection for the intertubercular groove, the patient leans forward _______ from vertical.

a. 5-7 degrees

b. 20-25 degrees

c. 10-15 degrees

d. 35-45 degrees

What is the major advantage of the supine, tangential version of the intertubercular groove projection over the erect version?

a. less radiation exposure

b. reduced OID

c. less risk for motion

d. ability to use automatic exposure control

Which one of the following projections best demonstrates the supraspinatus outlet region?

a. tangential projection (neer method)

b. fisk method

c. inferosuperior axial

d. PA transaxillary projection (hobbs modification)

a. tangential projection (neer method)

Which one of the following projections can a breathing technique be employed?

a. grashey method

b. transthoracic lateral for humerus

c. scapular Y lateral

d. garth method

b. transthoracic lateral for humerus

What CR angulation is required for the tangential projection-supraspinatus outlet(neer method)?

a. 10-15 degrees caudad

b. 45 degrees caudad

c. 25 degrees anteriorly and medially

d. none, CR is perpendicular

Which clinical indication is best demonstrated with the Garth method?

a. bursitis

b. rheumatoid arthritis

c. scapulohumeral dislocations

d. signs of shoulder impingement

c. scapulohumeral dislocations

Which anatomy of the shoulder is best demonstrated with a PA transaxillary projection (Hobbs modification)?

a. scaulohumeral joint space.

b. coracoacromial arch

c. coracoid process

d. scapula in profile

a. scapulohumeral joint space

If the patient cannot fully abduct the affected arm 90 degrees for the inferosuperior axial projection (clements modification), the technologist can angle the CR ________ degrees toward the axilla.

a. 5-10

b. 20-25

c. 25-30

d. 45

Which one of the following projections requires the CR to be centered 2" inferior and medial from the superolateral border of the shoulder?

a. tangential projection (fisk modification)

b. inferosuperior axial (clements projection)

c. posterior oblique (grashey method)

d. scapular y lateral projection

c. posterior oblique (grashey method)

100

Which anatomy is best demonstrated with the alexander method?

a. scapulohumeral joint

b. coracoid process

c. proximal humerus

d. AC joints

101

Which type of injury must be ruled out before the weight-bearing phase of the AC joint study?

a. shoulder separation

b. fractured clavicle

c. bursitis of the scapulohumeral joint

d. bankart lesion

102

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?

a. 5-7 pounds

b. 8-10 pounds

c. 12-15 pounds

d. 20-30 pounds

103

A PA axial projection of the clavicle requires a 35-45 degree caudal CR angle.

104

A 72" SID is recommended for AC joint studies.

105

Which two positioning lankmarks are aligned perpendicular to the IR for the lateral scapula projection?

a. scapular spine and greater tubercle

b. superior angle and AC joints

c. AC joint and greater tubercle

d. acromion and coracoid process

b. superior angle and AC joints

106

A radiograph of a posterior oblique (grashey method) reveals that the anterior and posterior glenoid rims are not superimposed. The following positioning factors were used: erect position, body rotated 25-30 degrees toward the affected side, CR perpendicular to scapulohumeral joint space, and affected arm slightly abducted in neutral rotation. Which one of the following modifications will superimpose the glenoid rims during the repeat exposure?

a. angle CR 10-15 degrees caudad

b. rotate body less toward affected side

c. place affected arm in external rotation position

d. rotate body more toward affected side

107

A patient with a possible shoulder dislocation enters the emergency room. A neutral AP projection of the shoulder has been taken, confirming a dislocation. Which additional projection should be taken?

a. inferosuperior axial (clements method)

b. alexander method

c. garth method

d. AP, external rotation

108

A 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, CR angled 15 degrees cephalad, 40" SID, and respiration suspended at the end of expiration. Which one of the following modifications should be made during the repeat exposure?

a. increase CR angulation

b. suspend respiration at end of inspiration

c. reverse CR angulation

d. use 72" SID

a. increase CR angulation

109

A patient with a possible right shoulder separation enters the emergency room. Which one of the following routines should be used?

a. AC joint series: non-weight-bearing and weight-bearing projections

b. AP neutral projection and garth method

c. AP neutral projection and transthoracic lateral projections

d. AP internal and external projections

a. AC joint series: non-weight bearing and weight-bearing projections

110

A patient comes to the radiology department with a history of tendonitis of the bicep tendon. Which of the following projections will best demonstrate calcification of the tendon within the intertubercular groove?

a. garth method

b. grashey method

c. PA transaxillary projection (hobbs modification)

d. tangential projection - fisk modification

111

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 x-ray tube, 45 degree rotation of affected shoulder toward the IR, 45 degree cephalad angle, and CR centered to the scapulohumeral joint. What of the following factors would have contributed to this poor garth position?

a. wrong direction of CR angle

b. incorrect CR centering

c. position must be performed recumbent

d. shoulder rotated in wrong direction

a. wrong direction of CR angle

112

A patient is referred to radiology department 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?

a. ask another technologist to hold the patient erect for the projection

b. perform the projection with the patients upper chest prone on the table

c. perform a recumbent posterior oblique (grashey method) instead

d. eliminate projection from positioning routine

b. perform the projection with the patient's upper chest prone on the table