Which procedure should be performed to demonstrate only one sternoclavicular joint with the PA projection?

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Citation:

Murphy, A., Fahrenhorst-Jones, T. Sternoclavicular joint (PA view). Reference article, Radiopaedia.org. (accessed on 08 Sep 2022) https://doi.org/10.53347/rID-54296

The sternoclavicular PA view is part of the plain radiographic series assessing the sternoclavicular joint. The projection produces a bilateral view of the sternoclavicular joints in the posteroanterior plane.

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The PA view of the sternoclavicular joint is often requested in the context of significant trauma that can result in sternoclavicular joint dislocation or medial end clavicular fractures. Furthermore, this projection can be requested when following up on already known sternoclavicular injuries in the setting of outpatient appointments. 

• the patient is preferably laid prone with arms resting above the head. However, this projection can be mimicked erect.

• posteroanterior projection
• centering point
  • centered at the level of the second to third thoracic vertebra at the midline
• collimation
  • laterally to include the medical third of both clavicles 
  • inferior to include the sternoclavicular joints and part of the manubrium 
  • superior to include the entirety of the sternoclavicular joint
• orientation  
  • landscape
• detector size
  • 24 cm x 18 cm
• exposure
  • 60-70 kVp
  • 10-30 mAs
• SID
  • 100 cm
• breathing
  • suspended expiration
• grid
  • yes (this can vary departmentally)

• both sternoclavicular joints are clearly evident
• when assessing for rotation, the spinous processes should be an equal distance from each sternoclavicular joint

• the most challenging aspect when performing this projection is collimation; collimation must be tight to avoid scatter thus decreasing the image quality. Time should be taken to ensure the image is collimated appropriately.
• patients may find it uncomfortable to lay prone, and this can be alleviated via placing a pillow under the patient's knees and head. 
• the projection can be performed erect, be wary of the patients' movement 
• ensure the use of a side maker, as this projection is quite tightly collimated and determining the side can be tricky

References

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