Axial shoulder X-ray positioning
An extra shoulder view, used when a routine one is not enough. The patient sits, the beam runs along the length of the part (axial), straight on to the receptor, and the centring point is the glenohumeral joint from above.
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
Sitting. Stand the patient beside the holder, lean over it with the arm abducted across a detector on a firm 12–15 cm support.
Centring & collimation
Central ray
axialCentre: the glenohumeral joint from above.
Beam: axial, perpendicular to the receptor.
Collimate: the humeral head and glenoid
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 100 cm | |
| Receptor | 18 × 24 cm | landscape |
| Placement | On a raised support | No grid |
| 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 | 53 | 1 | 0.5 |
| S | 53 | 1.6 | 0.63 |
| M | 53 | 2 | 0.8 |
| L | 53 | 3.2 | 1.25 |
These start from a classic film-screen chart (53 kV, 25 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
- Humeral head relation to the glenoid shown.
- Acromion and coracoid visible.
- 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 not shown | Arm not abducted | Abduct the arm over the detector. |
Common questions
- Where do you centre for a shoulder axial X-ray?
- The centring point is the glenohumeral joint from above.
- What distance and beam angle does a shoulder axial need?
- 100 cm from the tube to the receptor. The beam runs along the length of the part (axial), straight on to the receptor.
- What size receptor, and do you need a grid?
- Use an 18 × 24 cm receptor, landscape, on a raised support. No 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 axial?
- Joint not shown. Usual cause: arm not abducted. The fix: abduct the arm over the detector.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a shoulder axial in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.