What type of CR angle is required for the superoinferior axial projection (Hobbs modification)?

No angle is required (CR is perpendicular to the axilla and humeral head).

A patient enters the ED with multiple injuries including a possible fracture of the left proximal humerus. Which positioning rotation should be performed to determine the extent of the humerus injury?

AP and horizontal beam transthoracic lateral shoulder projection

AP neutral shoulder rotation and carefully rotated internally proximal humerus

AP shoulder as is; show radiograph to the ED physician before attempting a rotational lateral projection

AP and apical oblique shoulder without any arm rotation

A patient enters the ED with a possible bony defect of the midwing area of the scapula. The patient is able to stand and move the upper limb freely. In addition to the routine AP scapula projection with the arm abducted, which of the following would best demonstrate the involved area?

Have the patient reach across the chest and grasp the opposite shoulder for a lateral scapula projection.

Take an apical oblique projection of the shoulder.

Take a transthoracic lateral projection of the shoulder region.

Have the patient drop the affected arm behind him or her and take a lateral scapula projection.

Which one of the following projections/positions should NOT be performed for a possible shoulder dislocation?

Inferosuperior axial (Clements modification)

AP axial oblique (Garth method)

Transthoracic lateral (Lawrence method)

A patient enters the ED with a midshaft humeral fracture. The AP projection taken on the cart demonstrates another fracture near the surgical neck of the humerus. The patient is unable to stand or rotate the humerus because of the extent of the trauma. What other projection should be taken for this patient?

Horizontal beam transthoracic lateral projection for humerus

Scapular Y lateral-AP oblique projection

Rotational lateral projection for humerus

A referring physician suspects that a subacromial spur may be the cause for a patient’s arm numbness. She asks the technologist for a projection that would best demonstrate any possible spurs. Which of the following projections would accomplish this objective?

PA scapular Y lateral with 10° to 15° caudal angle

PA scapular Y lateral with 10° to 15° cephalad angle

AP oblique shoulder with 45° caudal angle

AP shoulder with 10° to 15° caudal angle

A patient enters the ED with multiple injuries. The physician is concerned about a dislocation of the left proximal humerus. The patient is unable to stand. Which of the following routines is advisable to best demonstrate this condition?

AP shoulder and recumbent AP oblique scapular Y projection

AP shoulder and inferosuperior axiolateral projection

AP shoulder and 35° to 45° LPO position (Grashey method)

AP shoulder and Neer projection

A patient enters the ED with a possible AC joint separation. The patient is paraplegic; therefore, the study cannot be done erect. Which of the following routines would be performed to diagnose this condition?

Non–weight-bearing and weight-bearing type of projections performed with the patient recumbent by pulling down on the shoulders

Recumbent AP and AP axial projection of the clavicles to include AC joints

AP projections of shoulders with external and internal rotation performed recumbent

AP and AP apical oblique projection of the shoulder performed recumbent

A radiograph for an AP projection with external rotation of the proximal humerus reveals that the greater tubercle is profiled laterally. What should be changed to improve this image for a repeat exposure?

Positioning is acceptable; do not repeat it.

Rotate epicondyles so they are perpendicular to the image receptor.

Move the patient obliquely 10° to 15° toward the affected side.

Rotate the arm to place palm of the patient’s hand against the thigh.

A radiograph of an AP clavicle reveals that the sternal extremity is partially collimated off. What should the technologist do?

Repeat the AP projection and correct collimation.

Make sure the sternal extremity is included on the AP axial projection.

Only repeat it if the patient’s pain/symptoms involve the sternal extremity.

Ask the radiologist whether he or she wants the projection repeated.

A radiograph of a scapular Y lateral position reveals that the scapula is slightly rotated (the vertebral and axillary borders are not superimposed). The axillary border of the scapula is determined to be more lateral compared with the vertebral border. Which of the following modifications should be made for the repeat exposure?

Abduct the arm more and flex it at the elbow.

A patient comes to radiology for treatment of an arthritic condition of the right shoulder. The radiologist orders AP internal/external rotation projections and an inferosuperior axiolateral projection of the scapulohumeral joint. However, the patient cannot abduct the arm for this projection. Which other projection will best demonstrate the scapulohumeral joint space?

Posterior oblique (Grashey method)

AP projection–neutral rotation

A patient comes to the emergency department (ED) with a possible right AC joint separation. Right clavicle and AC joint exams are ordered. The clavicle is taken first, and a small linear fracture of the midshaft of the clavicle is discovered. What should the technologist do in this situation?

Consult with the ED physician before continuing with the AC joint study.

Perform the weight-bearing phase as ordered.

Reduce the amount of weight that would normally be given to the patient and perform the weight-bearing study.

Slowly give the patient more weight to hold until he begins to complain and then

How much CR angulation is required for an asthenic patient for an AP axial projection of the clavicle?

No CR angulation should be used for this projection.

Where is the CR centered for the bilateral acromioclavicular (AC) joint projection on a single 14- × 17-inch (35 × 43 cm) image receptor?

At the level of the thyroid cartilage

1 inch (2.5 cm) above jugular notch

A radiograph of a transthoracic lateral projection reveals that it is difficult to visualize the proximal humerus due to the ribs and lung markings. The following analog exposure factors were used: 75 kV, 30 mAs, 40-inch (102 cm) SID, grid, and suspended respiration. Which of the following changes will improve the visibility of the proximal humerus?

Use an orthostatic (breathing) technique.

Make the exposure on second inspiration.

Use a compression band to prevent patient movement.

How much posterior CR angulation is required for the supine version of the tangential projection for the intertubercular (bicipital) groove?

No angle is used for this projection.

Which ionization chamber(s) for the AEC should be used for a tangential projection for an intertubercular groove?

Cannot use AEC with this projection

Which of the following projections can be performed using a breathing technique?

Inferosuperior axiolateral projection

Where is the CR centered for a transthoracic lateral projection for proximal humerus?

1 inch (2.5 cm) inferior to the acromion

Which of the following shoulder positions is considered a trauma projection (can be performed safely for a possible fracture or dislocation)?

AP apical oblique axial (Garth method) projection

Inferosuperior axial (Clements modification) projection

AP Projection–internal rotation

What additional maneuver must be added to the inferosuperior axial shoulder (Lawrence method) projection to best demonstrate a possible Hill-Sachs defect?

Perform exaggerated external rotation of the affected upper limb.

Angle the CR 10° to 15° downward or posteriorly in addition to the medial angle.

Increase abduction of the affected upper limb.

Chapter 5 Shoulder Girdle and Humerus

Authored by Andre Bell

Health Sciences

University

Used 13+ times

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This quiz covers advanced radiographic positioning and pathology of the shoulder girdle and humerus, specifically targeting students in post-secondary radiologic technology programs. The questions assess complex technical knowledge including specific positioning methods (Grashey, Lawrence, Clements modification, Garth method), central ray angulations, anatomical landmarks for centering, and clinical decision-making for trauma patients. Students must demonstrate mastery of radiographic technique modifications, pathological conditions such as impingement syndrome and Hill-Sachs defects, and the relationship between patient positioning and anatomical visualization. The core concepts require understanding of three-dimensional anatomy, the effects of patient rotation on image quality, appropriate projections for specific clinical conditions, and safety considerations when imaging trauma patients. This material demands sophisticated reasoning about spatial relationships, technical problem-solving when standard positions cannot be achieved, and the ability to correlate clinical symptoms with appropriate radiographic examinations. Created by Andre Bell, a Health Sciences teacher in the US who teaches grade 13. This quiz serves as a comprehensive assessment tool for students in radiologic technology programs studying musculoskeletal imaging. The material works effectively as a capstone review for shoulder girdle positioning before clinical rotations, formative assessment during advanced positioning coursework, or preparation for national registry examinations. Students can use this as homework to reinforce lecture content about specialized projections and modifications, or instructors can implement it as a summative assessment following hands-on laboratory practice. The quiz supports skill development in clinical decision-making, particularly valuable when students encounter patients who cannot assume standard positions due to trauma or physical limitations. This assessment aligns with ARRT content specifications for radiographic procedures and positioning, supporting competency development in skeletal radiography and patient care considerations essential for professional practice.

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MULTIPLE CHOICE QUESTION

Do nothing; this is an acceptable AP axial clavicle projection.

Increase the caudal CR angle during repeat exposure.

Increase the cephalic CR angle during repeat exposure.

Make the exposure upon complete inspiration.

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Chapter 5 Shoulder Girdle and Humerus

Sonography is an effective diagnostic tool in studying the shoulder joint.

Where is the CR centered for the posterior oblique position for the glenoid cavity?

What is the common term for idiopathic chronic adhesive capsulitis?

A patient is scheduled for an arthrogram. During the course of the study, the radiologist requests a projection to demonstrate the intertubercular groove. Which one of the following projections would best demonstrate this structure?

An inferosuperior axial projection (Clements modification) is performed on a patient with a nontraumatic shoulder injury. The patient cannot fully abduct the upper limb 90°. Which of the following modifications of the position should be performed for this patient?

A radiograph of an AP axial projection of the clavicle demonstrates that the clavicle is within the midaspect of the lung apices. What should the technologist do to correct this error?

What is a possible radiographic sign for impingement syndrome of the shoulder?

What type of CR angle is required for the superoinferior axial projection (Hobbs modification)?

The Alexander method for AC joints requires a 15° cephalic CR angle.

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