Alternate axial shoulder projections.

434 July/August 2005, Vol. 76/No. 6 RADIOLOGIC TECHNOLOGY Acromial spurring, bursitis, impingement, rotator cuff strains, tendonitis and traumatic injuries to the shoulder are familiar reasons for shoulder pain. To assist in the diagnosis, plain-film radiography is indispensable for studying shoulder abnormalities. Similarly, radiographs help to demonstrate the relationship of the glenoid fossa and the proximal humerus. Common anteroposterior projections of the shoulder include internal and external rotational views. However, to obtain an axillary view of the proximal humerus, several different approaches have been described. The inferosuperior axial projections (Lawrence and West Point methods) require the patient to be in a recumbent position with the arm abducted. These projections are time-consuming for the radiographer and cumbersome to place the x-ray tube in the required positions. Other modifications include the inferosuperior axial (Clements modification) and the superoinferior axial projections as described by Greathouse, Ballinger and Frank. The Clements modification method places the patient in a lateral recumbent position and requires an awkward placement of the x-ray tube and cassette. Moreover, the superoinferior axial projection results in image magnification unless a curved cassette is used. Though these projections are useful and necessary in a number of instances, the axial projection can be obtained in a quicker and more efficient manner. This article describes 2 such methods of imaging the shoulder in an axial position. Both methods are advantageous because they are quick and easy to perform and require limited movement of the x-ray tube. The drawback is that these methods can only be performed on ambulatory and mobile patients. The reason for this limitation is that both methods require the patient to raise an arm above the head and to bend at the waist. In any case, these positions demonstrate less magnification when compared with the traditional superoinferior axial projections due to the decrease in objectto-image receptor distance (OID). The exception would be if a curved cassette is used as described by Ballinger and Frank. Regardless, the positions are beneficial and demonstrate the same anatomy when compared with the more traditional maneuvers.