Shoulder (AP glenoid view)

Changed by Andrew Murphy, 15 Jun 2016

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Title was changed:

~~Grashey view (AP oblique shoulder radiograph)~~Shoulder: AP glenoid

Body was changed:

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The~~Grashey~~shoulder AP glenoid view ~~(an AP oblique glenohumeral radiograph with internal rotation)~~is an additional projection to the two view shoulder series. The projection is ~~designed~~used to ~~prevent overlap~~asses the integrity of the ~~humeral head and the glenoid. It is also known as a "true AP" view of the shoulder~~glenohumeral joint.

Patient position

patient is preferably erect
midcoronal plane of the patient is parallel to the image receptor, in other words, the patient's back is ~~toward~~against the image ~~detector~~receptor
glenohumeral joint of the affected side is at the centre of the image receptor
patient is turned toward the affected side in order to show the glenohumeral joint space, ~~with~~this is achieved by rotating the patient~~'s body angled 35~~ 30-45 ~~degrees, and his or her scapula up against the detector~~°
~~the humerus~~affected arm is internally rotated

X-ray beam featuresTechnical factors

~~the beam travels anterior~~anteroposterior projection
centring point
- 2.5 cm inferior to ~~posterior (AP) direction~~the coracoid process, ~~directed parallel~~or 2 cm inferior to the lateral clavicle at the level of the glenohumeral joint
~~source-to-image distance: 40" (100 cm)~~
~~70-75~~collimation
- superior to the skin margins
- inferior to include one-third of the proximal humerus
- lateral to include the skin margin
- medial to 1/3 of the medial clavicle
orientation
- portrait
detector size
- 18 cm x 24 cm
exposure
- 60-70 kVp at
- 10-18 mAs ~~(or AEC~~
SID
- 100 cm
grid
- yes (this can vary departmentally)

Image technical evaluation

the gelnohumeral joint should be open
the anterior and posterior aspects of the glenoid are superimposed
the coracoid process is foreshortened
no foreshortening of the scapular body (as per the patient rotation discussed in the positioning)

Practical points

Rotation of the patient will vary due to body habitus, this is an obvious point but highly relevant. Patients who require these films are often suffering from either chronic or acute shoulder pain and palpating the affected shoulder is far from ideal. It's advisable to observe the clavicle when rotating the patient until the mid shaft of the clavicle is almost end on.

-<p>The <strong>Grashey view</strong> (an AP oblique glenohumeral radiograph with internal rotation) is designed to prevent overlap of the humeral head and the glenoid. It is also known as a "true AP" view of the shoulder.</p><h4>Patient position</h4><ul>
~~-<li>the patient's back is toward the image detector, with the patient's body angled 35-45 degrees, and his or her scapula up against the detector</li>~~
~~-<li>the humerus is internally rotated</li>~~
~~-</ul><h4>X-ray beam features</h4><ul>~~
~~-<li>the beam travels anterior to posterior (AP) direction, directed parallel to the glenohumeral joint</li>~~
~~-<li>source-to-image distance: 40" (100 cm)</li>~~
~~-<li>70-75 kVp at 10 mAs (or AEC)</li>~~
~~-</ul>~~
+<p>The <strong>shoulder AP glenoid view </strong>is an additional projection to the two view <a href="/articles/shoulder-series">shoulder series</a>. The projection is used to asses the integrity of the glenohumeral joint.</p><h4>Patient position</h4><ul>
+<li>patient is preferably erect</li>
+<li>midcoronal plane of the patient is parallel to the image receptor, in other words, the patient's back is against the image receptor</li>
+<li>glenohumeral joint of the affected side is at the centre of the image receptor</li>
+<li>patient is turned toward the affected side in order to show the glenohumeral joint space, this is achieved by rotating the patient 30-45°</li>
+<li>affected arm is internally rotated</li>
+</ul><h4>Technical factors</h4><ul>
+<li><strong>anteroposterior projection </strong></li>
+<li>
+<strong>centring point</strong><ul><li>2.5 cm inferior to the coracoid process, or 2 cm inferior to the lateral clavicle at the level of the glenohumeral joint</li></ul>
+</li>
+<li>
+<strong>collimation</strong><ul>
+<li>superior to the skin margins</li>
+<li>inferior to include one-third of the proximal humerus</li>
+<li>lateral to include the skin margin</li>
+<li>medial to 1/3 of the medial clavicle</li>
+</ul>
+</li>
+<li>
+<strong>orientation </strong><em> </em><ul><li>portrait</li></ul>
+</li>
+<li>
+<strong>detector size</strong><ul><li>18 cm x 24 cm</li></ul>
+</li>
+<li>
+<strong>exposure</strong><ul>
+<li>60-70 kVp</li>
+<li>10-18 mAs</li>
+</ul>
+</li>
+<li>
+<strong>SID</strong><ul><li>100 cm</li></ul>
+</li>
+<li>
+<strong>grid</strong><ul><li>yes (this can vary departmentally)</li></ul>
+</li>
+</ul><h4>Image technical evaluation</h4><ul>
+<li>the gelnohumeral joint should be open</li>
+<li>the anterior and posterior aspects of the glenoid are superimposed</li>
+<li>the coracoid process is foreshortened</li>
+<li>no foreshortening of the scapular body (as per the patient rotation discussed in the positioning)</li>
+</ul><h4>Practical points</h4><p>Rotation of the patient will vary due to body habitus, this is an obvious point but highly relevant. Patients who require these films are often suffering from either chronic or acute shoulder pain and palpating the affected shoulder is far from ideal. It's advisable to observe the clavicle when rotating the patient until the mid shaft of the clavicle is almost end on.</p>

References changed:

1. Merrill's Atlas of Radiographic Positions & Radiologic Procedures, 3-Volume Set. Mosby. ISBN:0323016049. <a href="http://books.google.com/books?vid=ISBN0323016049">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/0323016049">Find it at Amazon</a><span class="auto"></span>

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