AP shoulder X-ray positioning (two rotations)
One of the routine shoulder views. The patient lies on their back, the beam passes front to back (AP), tilted 10° towards the feet, and the centring point is the coracoid process.
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
Supine. Supine with a large pillow under the other shoulder so the examined one lies flat. First the arm rotated out (palm up), then rotated in (palm down). Children: one view only.
Centring & collimation
Central ray
APCentre: the coracoid process.
Beam: AP, angled 10° caudad.
Collimate: the glenohumeral joint, upper humerus and lateral clavicle
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 100 cm | |
| Receptor | 24 × 30 cm | landscape |
| Placement | Table bucky | Grid in |
| Angulation | 10° | caudad |
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 | 1.6 | 0.63 |
| S | 70 | 2.5 | 1 |
| M | 70 | 3.2 | 1.25 |
| L | 70 | 5 | 2 |
| Child | 53 | 1.6 | 0.63 |
These start from a classic film-screen chart (70 kV, 6.3 mAs at 140 cm) and are adjusted for a digital detector at 100 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 glenohumeral joint is shown open.
- Greater tuberosity in profile on external rotation.
- 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 |
|---|---|---|
| Joint space closed | Trunk not rotated toward the side examined | Pad the other shoulder. |
Common questions
- Where do you centre for a shoulder AP (two rotations) X-ray?
- The centring point is the coracoid process.
- What distance and beam angle does a shoulder AP (two rotations) need?
- 100 cm from the tube to the receptor. The beam passes front to back (AP), tilted 10° towards the feet.
- What size receptor, and do you need a grid?
- Use a 24 × 30 cm receptor, landscape, in the table 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 shoulder AP (two rotations)?
- Joint space closed. Usual cause: trunk not rotated toward the side examined. The fix: pad the other shoulder.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a shoulder ap (two rotations) in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.