Oblique Elbow, Humerus, Shoulder, Chest Image Analysis

INCORRECT - Open elbow joint, but no external rotation 45 degrees - Radial head and tuberosity superimposed on ulna

External Oblique Elbow

Enough to place the medial and lateral borders of the scapula superimposed and perpendicular to the IR

What is the degree of rotation for the scapular Y

Epicondyles parallel to IR

What is the position of the epicondyles for the AP humerus?

Humeral head and greater tubercle seen in profile

What is the position of the humeral head and greater tubercle for AP humerus

At T4

What level should the clavicles be positioned?

Lesser tubercle seen in profile

What tubercle is seen in profile for the lateral humerus?

Greater tubercle seen in profile

Which tubercle is seen in profile for the AP humerus?

To look at the relationship between the humeral head and glenoid fossa

Why is the inferosuperior axial projection used?

For anterior/posterior fracture displacement of the humeral head who cannot rotate the arm

Why is the transthoracic lateral used?

INCORRECT - Radial tuberosity and ulna are too separated - Elbow joint is closed - OVER OBLIQUED more than 45 degrees - Flexion = olecranon process in the fossa

External Oblique Elbow

Epicondyles at a 45 degree angle

How are the epicondyles positioned for the AP neutral rotation projection

Greater tubercle partially superimposed on humeral head

How are the tubercles seen for the AP neutral shoulder projection

Lesser tubercle in profile and pointing anteriorly

How are the tubercles seen for the inferosuperior axial projection?

CORRECT - Coronoid process in profile - Elongated medial epicondyle - Ulna superimposed by radial head and neck - Olecranon process in fossa

Internal Oblique Elbow

INCORRECT - No superimposition of the radius and ulna - Seeing posterior portion of olecranon process - Humeral epicondyles are superimposed on each other OVER ROTATED

Internal Oblique Elbow

INCORRECT - Too much radial head s separated from the ulna - Patient NOT FULLY ROTATED 45 degrees - Hand was pronated (superimposition of radius and ulna)

Internal Oblique Elbow

HUMERUS ELEVATED - Radial head too posterior on the coronoid process - Capitulum too far distal to the medial trochlea

Lateral Elbow

INCORRECT - Olecranon process in fossa = elbow not flexed 90 degrees - Radial tuberosity seen in profile posteriorly = hand/wrist pronated

Lateral Elbow

WRIST BELOW ELBOW - Radial head too distal to coronoid process - Capitulum is too anterior to the medial trochlea - Forearm too close to the IR

Lateral Elbow

CORRECT: - Entire lung field (apices -> costophrenic angles) - Scapulae projected outside the lung fields - Clavicles positioned on the same horizontal plane - Ten posterior ribs - Lung markings visible

PA Chest

INCORRECT - Poor inspiration = 8 posterior ribs demonstrated - Clavicles high = shoulders not relaxed

PA Chest

INCORRECT - Scapulae in the lung field = roll the shoulders forward

PA Chest

INCORRECT MIDCORONAL PLANE TILTED AWAY FROM IR - Clavicles not on the same plane - Clavicles above T4

PA Chest

INCORRECT MIDCORONAL PLANE TILTED TOWARDS IR - Clavicles not on same horizontal plane - Clavicles below T4 - Scapulae are in the lung field

PA Chest

INCORRECT SHOULDERS SHRUGGED - Clavicles not in same horizontal plane - Need to depress shoulders

PA Chest

INCORRECT = RIGHT SIDE OF PT CLOSER TO IR - ROTATION = left posterior ribs longer in length than right - Left sternal clavicluar end not equidistant

PA Chest

ROATION

PA Chest

SCOLIOSIS - Proper PA - Equidistance between vertebral column and edge of the lung

PA Chest

CORRECT - Humeral head in partial profile - Greater tubercle partially superimposed on humeral head - Some overlap of humeral head on glenoid

AP Projection/Neutral position shoulder

CORRECT: - Open joint space between humeral head and glenoid cavity - Glenoid cavity in profile - Soft tissue scapulohumeral joint - Trabecular detail on glenoid and humeral head

AP oblique (Grashey)

- Radial tuberosity facing anteriorly - Radial head partially superimposing the coronoid process

Relationship between radius and ulna for Lateral elbow

Clear separation of radius and ulna

Relationship between radius and ulna for external oblique

Full superimposition of the radial head on the ulna Coronoid process in profile

Relationship between radius and ulna for internal oblique

CORRECT - Scapular body should not overlap the thorax - Acromion seen laterally and free of superimposition - Coracoid process suerpimosed/slightly below clavicle - Scapula in lateral profile

Scapular Y

INCORRECT - Patient was leaning forward = superior scapular angle is above the level of the clavicle

Scapular Y

OVER ROTATED - Medial and lateral border of the scapula are not superimposed

Scapular Y

UNDER ROATED - Can see full medial and lateral borders

Scapular Y

Scoliosis = distance between vertebral column and edge of the lung vary Rotation = Distances are uniform, although one side of the distance is shorter

Scoliosis vs Rotation

CR angled 10-15 degrees caudad to open the space of the Y, the junction of the acromion and coracoid

Supraspinatus "outlet"

CORRECT - Proximal humerus demonstrated - Scapula, clavicle, and humerus seen through lung field - Scapula superimposed on t-spine - Unaffected clavicle and humerus above shoulder of interest

Transthoracic Lateral

Humeral head seen below the coracoid process - Scapular body on the rib cage = over rotation

Humerus anteriorly dislocated

Humeral head seen below the acromion

Humerus posteriorly dislocated

At T7

What is the centering for the PA chest

CORRECT - Greater tubercle in profile on lateral humerus - Humeral head in profile - Scapulohumeral joint seen with slight overlap of humeral head on glenoid cavity - Outline of lesser tubercle seen between humeral head and proximal humerus

AP External Shoulder Rotation

CORRECT - Elbow and shoulder joints - Maximal visibility of epicondyles without rotation - Humeral head and greater tubercle in profile - Outline of the lesser tubercle seen between the humeral head and greater tubercle

AP Humerus

INCORRECT - Over rotated externally (separation of radius and ulna) - Epicondyles not parallel to IR - Greater tubercle is still in profile

AP Humerus

CORRECT - Collimated field includes superior scapula, lateral half of clavicle, proximal humerus - Lesser tubercle seen in profile and pointing medially - Greater tubercle superimposing radial head - Humeral head overlaps glenoid fossa

AP Internal shoulder rotation

A part of the anatomy that you don't want to see on the image

Anatomic Artifact

Voluntary Motion

Breathing is considered

CORRECT - Radial head, neck, and tuberosity projected free of ulna - Open elbow joint = shoulder, elbow, wrist all in same plane

External Oblique Elbow

INCORRECT - FLEXION = olecranon process not in fossa - Articular surface shown on radial head

External Oblique Elbow

Involuntary Motion

Heart motion is considered

Epicondyles prallel to the IR

How are the epicondyles positioned for the AP external rotation projection

Epicondyles perpendicular to the IR

How are the epicondyles positioned for the AP internal rotated shoulder

- Lesser tubercle seen in profile pointing medially - Greater tubercle superimposing radial head

How do you know if the shoulder AP internally rotated?

Greater tubercle in profile on the lateral side

How do you know if the shoulder is externally rotated?

The right and left posterior ribs are separated (not superimposed)

How do you know if there is rotation for the lateral chest projection?

Right clavicle is superimposed over the spine

How do you know if you have right side rotation (right side closer to IR)?

Supine, dorsal decub CR entering lateral aspect

How do you position the patient/CR for air fluid levels

Humeral head superimposed on Y

How is the humerus seen for a Scapular Y of a normal shoulder

Medial and lateral borders of scapula are superimposed perpendicular to the image receptor

How is the scapula positioned for the Y shoulder?

10 Posterior ribs

How many ribs should be seen for the PA chest?

CORRECT - Scapulohumeral joint with slight overlap - Coracoid process pointed anteriorly - Lesser tubercle in profile and pointing anteriorly - AC joint, acromion, acromial end of clavicle projected through humeral head

Inferiosuperior Axial

CORRECT - Superimposition of ribs posterior to vertebral column - long axis of the long fields in vertical position - Lateral sternum with no rotation - Open thoracic intervertebral spaces and intervertebral foramen - Hilum in approximate center of the radiograph

Lateral Chest

INCORRECT - Humeral soft tissue - Obscured lung apices

Lateral Chest

INCORRECT - Right/left posterior ribs not superimposed - Midsagittal plane not parallel with IR (hip closer to IR) - Lower thorax is closer to IR than upper = FORESHORTENING - Hemidiaphragms not superimposed

Lateral Chest

INCORRECT POOR INSPIRATION - 11th thoracic vertebrae inferior to hemidiaphragm - Humeral soft tissue - Lung apices cut = CR directed below T7

Lateral Chest

CORRECT - Open elbow joint in center of IR - Elbow flexed 90 degrees - Superimposed humeral epicondyles - Radial tuberosity facing anteriorly - Radial head partially superimposing the coronoid process - Olecranon process seen in profile

Lateral Elbow

FOREARM ELEVATED AND INTERNALLY ROTATED - Radial head is proximal to the coronoid process - Capitulum too posterior to the medial trochlea - Radial tuberosity seen posteriorly

Lateral Elbow

HUMERUS DEPRESSED - Radial head too anterior on the coronoid process - Capitulum too far proximal to the medial trochlea

Lateral Elbow

CORRECT - Elbow and shoulder joints - Superimposed epicondyles - Lesser tubercle in profile - Greater tubercle superimposed over humeral head (can open collimation for posterior portion of olecranon process)

Lateral Humerus

INCORRECT - Correct positioning, but soft tissue overlap

Lateral Humerus

INCORRECT - Epicondyles not superimposed/perpendicular to IR

Lateral Humerus

- Most common - Superior heart shadow extends beyond the sternum - Gastric air bubble present

Left lung anteriorly rotated

CORRECT - Clavicles lying just superior to apices, and superimposing first or second ribs - Sternal ends of clavicles equidistant from vertebral column - Apices and lungs in their entirety - Ribs distorted with their anterior and posterior portions superimposed

Lordotic

INCORRECT - Clavicles in apices - Scapulae in lung field

Lordotic

INCORRECT - Clavicles still in lung field = CR not angled enough = Midcoronal plane not tilted back enough

Lordotic

INCORRECT = Excessive angulation of CR or leaning back - Cannot identify individual ribs

Lordotic

INCORRECT - Not enough 45 degree obliquity - Want to see entire heart shadow

Oblique

Left clavicle coming across the spine = LEFT SIDE closer to IR LAO

Oblique

The left side of the chest is closer to the IR

On an AP chest projection, left clavicle above the spine and longer left ribs means ___

- Superior heart shadow not beyond the sternum - Gastric air bubble present posterior - Right and left posterior ribs not superimposed - Can see two costophrenic angles - Lung field present anterior to sternum

Right lung anteriorly rotated

PA oblique

The scapular Y position is what projection

Anterior

The trachea will be seen ____ to the esophagus on the lateral chest view

The patient's midcoronal plane is tilted backwards

What happened if the clavicles are seen above T4

The patient's midcoronal plane is tilted forward

What happened if the clavicles are seen below T4