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
