AP AND AP AXIAL PROJECTION : CLAVICLE

Pathology demonstrated:

  • Fracture and/or dislocation of the clavicle are demonstrated.
  • Departmental routines commonly include both AP and AP axial projections.


Technical Factors:

  • IR size - 24 x 30 cm (10 x 12 inches), crosswise
  • Moving or stationary grid
  • AEC not recommended
  • Digital IR -  requires very close collimation
  • 70 to 5 kV range


Shielding:

  • Shield pelvic area.
AP - CR 0 degree


Patient Position:

  • Perform radiograph with the patient in an erect or supine position with arm at sides, chin raised, and looking straight ahead. Posterior shoulder should be in contact with IR or tabletop, without rotation of body.


Part Position:

  • Center clavicle and IR to CR. (Clavicle can be readily palpated with medial aspect at jagular notch and lateral portion at AC joint above shoulder.)


Central Ray:
AP

  • CR perpendicular to mid clavicle


AP Axial:

AP Supine - CR 15 to 30 degree
  • CR 15 to 30 degrees cephalad to midclavicle (see note below)
  • Minimum SID of 40 inches (100 cm)


Collimation:

  • Collimate to area of clavicle. (Ensure that both AC and sternoclavicular joints are included.)


Respiration:

  • Suspend respiration at end of inhalation (Helps to elevate clavicles).


Alternate PA:

  • The radiograph may also be taken as a PA projection and/or a PA axial with a 15 to 30 degree caudal angle.


Note:

  • Thin (asthenic) patients requires 10 to 15 degree more angle than do patients with thick shoulders and chest (hypersthenic).


Radiographic Criteria:

AP 0 degree:

  • Collimation border should be visible with entire clavicle visualized, including both AC and sternoclavicular joints.
AP - CR 0 degree


AP Axial:

  • Correct angulation of CR will project most of the clavicle above the scapula and ribs.
  • Only the medial portion of the clavicle will be superimposed by the first and second ribs.
  • Optimal exposure will demonstrate the distal clavicle and AC joint without excessive dnesity.
  • The bony margins and trabecular markings should appear sharp, indicating no motion, and the medial clavicle and sternoclavicular joint also should be visualized through the thorax.
AP Axial clavicle of 3 year-old child, showing fracture (arrow). 

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