Lateral scapula X-ray positioning
One of the routine shoulder views. The patient stands turned at an angle, the beam passes from side to side, straight on to the receptor, and the centring point is the medial border of the scapula.
By the ScanFlo Editorial Team · Updated
In this section · X-ray positioning
- X-ray positioning guides
- Skull positioning
- Face & sinuses positioning
- Soft tissue neck positioning
- C-spine positioning
- Chest positioning
- Shoulder positioning
- Humerus positioning
- Elbow positioning
- Forearm positioning
- Wrist positioning
- Hand positioning
- T-spine positioning
- Abdomen positioning
- L-spine positioning
- Sacrum & SI joints positioning
- Pelvis positioning
- Hip positioning
- Femur positioning
- Knee positioning
- Tibia & fibula positioning
- Ankle positioning
- Foot positioning
Still being checked: a radiographer is reviewing this guide. If your department does it differently, follow your department.
Patient position
Oblique, erect. Seat the patient with the affected shoulder against the bucky, hand behind the head (or the arm down if painful), trunk turned until the scapula is end-on. Not under 10 years.
Centring & collimation
Central ray
lateralCentre: the medial border of the scapula.
Beam: lateral, perpendicular to the receptor.
Collimate: the whole scapula
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 110 cm | |
| Receptor | 24 × 30 cm | portrait |
| Placement | Erect (wall) bucky | Grid in |
| Angulation | None | Perpendicular to the receptor |
Marker & breathing
- Marker: R or L marker on the side nearest the detector
- Breathing: Suspend respiration.
Exposure by patient size
Treat these as a starting point. Your detector, your generator and the patient in front of you will all move the numbers.
| Patient size | kV | mAs (chart) | mAs (DR default) |
|---|---|---|---|
| XS | 70 | 8 | 3.2 |
| S | 70 | 12.5 | 5 |
| M | 70 | 16 | 6.3 |
| L | 70 | 25 | 10 |
These start from a classic film-screen chart (70 kV, 25 mAs at 140 cm) and are adjusted for a digital detector at 110 cm. The DR column is what ScanFlo's console suggests; each step up or down changes the mAs by about a quarter.
Image quality checklist
- The scapula is seen as a 'Y', body clear of the ribs.
- The anatomical side marker is visible, correct and clear of the anatomy.
- Collimation borders are visible on all sides, no wider than the area requested.
Faults & how to fix them
| Fault | Cause | Fix |
|---|---|---|
| Scapula over the ribs | Under-rotated | Turn the trunk further. |
Common questions
- Where do you centre for a scapula lateral X-ray?
- The centring point is the medial border of the scapula.
- What distance and beam angle does a scapula lateral need?
- 110 cm from the tube to the receptor. The beam passes from side to side, straight on to the receptor.
- What size receptor, and do you need a grid?
- Use a 24 × 30 cm receptor, portrait, in the wall bucky. A grid is needed.
- What should the patient do with their breathing?
- Ask them to stop breathing for the moment of the exposure.
- What goes wrong most often on a scapula lateral?
- Scapula over the ribs. Usual cause: under-rotated. The fix: turn the trunk further.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a scapula lateral in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.