Transcript Radiographic Critique off the Shoulder

Radiographic Critique off
the Shoulder
Chapter 4
Shoulder AP
 Contrast


Controlled by kVp (optimal 70-80)
Adequate to demonstrate bony trabecular
patterns and cortical outlines
 Density

Overall not too dark or too light
Shoulder AP
 Bony
trabecular patterns and cortical
outlines are sharply defined




kVp is correct
Respiration and motion are halted
Using a small focal spot
Short OID
Shoulder AP with No Rotation
 The
glenoid fossa is visualized
 The superiolateral border of the scapula is
not over the thorax
 The clavicle is horizontal
 The medial end of clavicle articulates with
the vertebral column
 The glenoid fossa and the medial margin
of the humeral head are slightly
superimposed
Shoulder AP
 Detecting

Rotation
Away from the affected shoulder
• Clavicles will superimpose the vertebral bodies
• Increased visualization of glenoid fossa

Toward affected shoulder
• Clavicles will not superimpose the vertebra
• Scapula will superimpose the thorax
Shoulder AP
 Determining

rotation from dislocation
If all factors remain unrotated with the
exception of the humeral head
• Posterior dislocation

Humeral head is demonstrated beneath the acromion or
spine of the scapula
• Anterior dislocation

Humeral head is demonstrated anteriorly, b beneath the
coracoid
Shoulder AP
 Is


shoulder in center of the film?
The glenohumeral joint, and coracoid are at
the center of the collimated field
Should also include the lateral 2/3 of the
clavicle, the proximal 1/3 of the humerus and
the superior scapula
Shoulder AP
 Determining

rotation of the humeral head
Neutral rotation
• Greater tubercle is partially in profile laterally and
humeral head is partially profile medially

External rotation
• Greater tubercle is profile laterally, the humeral
head is in profile medially

Internal rotation
• The lesser tubercle is demonstrated in profile
medially and the humeral head is superimposed by
the greater tubercle
Shoulder Y view
 No



Rotation
The medial and lateral borders are
superimposed
The scapular body does not superimpose the
thoracic cavity
The scapular body, acromion, and coracoid
form a Y
Shoulder Y view
 To


determine Rotational Direction
If the lateral border (thick border) is
demonstrated next to the ribs the patient was
rotated too far toward the film (increase
obliquity) pg 183
If the vertebral border is demonstrated over
the thorax then the patient is rotated to far
away from the film (decrease obliquity) pg 183
Shoulder Y view
 Detecting

shoulder dislocation
When the humeral head is not located over
the glenoid fossa
• Posterior dislocation

The humeral head is located beneath the acromion (pg
182)
• Anterior dislocation

Shoulder head will be beneath the coracoid (pg 184)
Shoulder Y view
 Anatomical





parts to be included on film
Midscapular body in the center of the film
Entire scapula
Coracoid
Acromion
Proximal humerus
Clavicle AP
 True AP

projection
The medial end of the clavicle lies next to the
lateral edge of the vertebral column, and the
thoracic cavity superimposes the vertebral
scapular border
Clavicle AP
 Positioning


for Kyphosis
Easier to position the patient in the erect
position
If erect position is not attainable, place
shoulders and thorax in the same plane
Clavicle AP
 Detecting


rotation
Medial end of the clavicle superimposes the
vertebral column the patient is rotated away
from affected side
Medial end of the clavicle does not
superimpose the vertebral column, the patient
is rotated toward the affected side. (Pg 186
RAD 24)
Clavicle AP
 Anatomy


to be included on the film
Entire clavicle
Acromion
Clavicle AP Axial
 Bony
trabecular patterns and cortical
outlines are sharply defined




kVp is correct
Respiration and motion are halted
Using a small focal spot
Short OID
Clavicle AP Axial
 Detecting

Rotation
Determined identical to AP view
Clavicle AP Axial

Central Ray
angulation




15 – 30 degrees
cephalically
Clavicle should appear
slightly superior to the
acromion
The medial end should
superimpose the 1st
and 2nd rib
Compare RAD 26 and
27 on page 188 and
189
Scapula AP
 Bony
trabecular patterns and cortical
outlines are sharply defined




kVp is correct
Respiration and motion are halted
Using a small focal spot
Short OID
THE END