Saturday, March 22, 2014

X-ray of the Shoulder (Trauma Patient) : AP Projection

Warning: Taking this projection if the patient is in trauma or suspected to have a facture or dislocated articulation. When performing Anteroposterio (AP) Shoulder do not attempt to rotate the arm of patient, ask patient is he/she suffersx-ray the part in neutral position this means that the arm it is in normal posture and it will place the humerus in an oblique position.

Demonstrated Pathology | Fracture and Dislocation

Possible pathology are can be seen are Osteophorosis, Shoulder Arthritis and Calcification of muscles tendons and bursal structures ( a sac containing synovial) can be seen.

Fractures or dislocation on Shoulder Girgle are evident.

Technique Factor | Film Size | Grid | Shielding on Patient

Technique is 70 kV range or add more or less 5kV
mAs 6
Film size (Image Receptor)  24 x 30 cm or 10 x 12 inches.
Grid use is either stationary or moving Grid. (see note)
Note: If the proximal half of humerus in injured put the film in legnthwise to include the entire humerus.
Shield the patient in pelvic area to avoid unnecessary scatter radiation exposure to gonad area.

Patient Positioning | Part Position | Central Ray and Collimation | SID | Respiration

Patient Position:

Position the patient in an erect or supine. Patient erect is usually less painful for patient condition allows.
Body is rotated slightly toward affected side to place shoulder in contact with image receptor or in x-ray table.

Part Position
arm neutral position
The palm of the hand placed against the hip
will position the humerus in neutral rotation.
Center the scapulohumeral joint to Image receptor.
Arm at side in neutral position. In this position the Epicondyles generally are almost 45 degree to plane of image receptor.

Central Ray Angulation  Collimation |

Central Ray: No CR angulation.CR is perpendicular to the middle of scapulohumeral joint, which is 3/4 inch or 2 cm inferior and insignificantly lateral to the coracoid process. On most patient the coracoid process is difficult to palpate, but it can be estimated in about 2cm inferior to lateral of the palpated clavicle. Moreover the scapulohumeral joint is commonly found at the base of the concave like depression medial to the head of humerus.

Collimation: Four sides of the part in IR must be collimated and adjusted to soft tissue in lateral and the upper borders.

SID: The minimum Source to Image Receptor Distance (SID) is 100 cm.

Patients Respiration during exposure is suspended to eliminate blurring cause by patient motion.


Radiograph Evaluation

Structure Shown | Position | Collimation and Central Ray | Exposure Standards
AP shoulder x ray
AP shoulder. Neutral rotation Humerus.
Greater tubercle (arrow)

Structures should be seen are the proximal 1/3 of the humerus, upper
scapula and the lateral 2/3 of the clavicle are shown, the relationship of the head of  humerus to the glenoid cavity.

Correct part position in neutral rotation, if greater and lesser tubercles are mostly been superimposed to the head of humerus.

Proper collimation if the four sides of the affected shoulder are seen on radiograph.
Central ray and center of collimation field should be at middle of scapulohumeral joint.

Exposure Standards is achieve if Sharp bony trabecular marking will visualize when the film is in optimal density and contrast with no motion during exposure
Medial aspect profile of humeral head will be visibe through the glenoid cavity and soft tissue details should be clear to demonstrate possible calcification.

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