Babeh Edi

Shoulder General Survey AP

Indications for imaging Trauma - dislocations, fractures, tendon calcifications Arthritis survey Bone pain. Anatomy  Demonstrated Rt Shoulder Survey Anatomy Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London Basic Patient Position The patient stands erect AP median saggital plane 90 degrees to the film coronal plane parallel to the film, . The arm is placed in normal  anatomical position palm forwards with the distal humeral epicondyles equidistant from the film, with slight (15 degree) abduction. Take care to prevent the patient leaning backwards and hunching up the shoulder. AP Rt Shoulder Survey Plan view Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London Radiation protection Direct lead rubber gonad protection using a "half apron". Avoid irradiating the thyroid and breast tissue as much as possible. Central Ray The horizontal central ray is direct to a point in the mid clavicular line at the level of the lower margin of the gleno humeral joint. Exposure is made on suspended expiration. Exposure Factors Kv mAS FFD (cm) Grid Focus AEC Cassette 80 8 100 No Fine No 24x30 cm 85 12 100 Yes Fine Yes 24x30 cm Thickset patients may require the use  of a grid Evaluation of the Image ID and markers must be present and correct in the appropriate area of the film. Limits of the examination, superiorly the skin surface above the clavicle, inferiorly the angle of the scapula, medially the medial end of the clavicle, laterally the skin margin of the humerus. Evidence of collimation on four sides equally around the centering point The greater tubercle of the head of the humerus should be seen in profile. If the patient is leaning backwards there will be superimposition of the humeral head on the acromium. There must be adequate penetration of the area around the coracoid process and the contrast should be low enough to visualise the soft tissues around the head of the humus. Lt Shoulder AP Survey Radiograph Normal  (from) http://www.vh.org Related Projections Shoulder joint AP Supero-inferior Modified Axial Scapula lateral Clavicle AP Acromio-clavicular joint AP Additional modalities MRI  (replaces arthrography)  for the joint structures CT RNI evaluation of metastases