1. Radiographic Critique off the Shoulder
Chapter 4

2. Shoulder AP Contrast Density Controlled by kVp (optimal 70-80)
Adequate to demonstrate bony trabecular patterns and cortical outlines
Density
Overall not too dark or too light
Use grid to absorb scatter
Could use compensating filter to better visualize the clavicles and glenoid humarl articulation

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

13. 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

14. 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

15. 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)

16. Shoulder Y view Anatomical parts to be included on film
Midscapular body in the center of the film
Entire scapula
Coracoid
Acromion
Proximal humerus

18. 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

19. 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

20. 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)

21. Clavicle AP Anatomy to be included on the film Entire clavicle
Acromion

24. 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

25. Clavicle AP Axial
Detecting Rotation
Determined identical to AP view

26. 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

31. 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

36. THE END