Shoulder AP Internal Rotation

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Questions and Answers

What is the primary reason for performing an AP projection with internal rotation of the shoulder?

  • To assess the acromioclavicular joint for dislocations.
  • To demonstrate the scapulohumeral joint and proximal humerus, specifically the lesser tubercle in profile. (correct)
  • To evaluate the extent of osteoporosis in the shoulder girdle.
  • To visualize fractures of the distal humerus.

Which technical factor is essential for an AP shoulder projection with internal rotation?

  • A short SID to enhance magnification.
  • An IR size of 14 x 17 inches (35 x 43 cm) to include the entire humerus.
  • A kVp range between 70 and 85 to provide sufficient penetration and contrast. (correct)
  • Utilizing a moving grid to blur out bony structures.

During an AP shoulder projection with internal rotation, how should the patient's arm be positioned?

  • Adducted and internally rotated until the epicondyles are perpendicular to the IR.
  • Extended and externally rotated, with the hand supinated.
  • Abducted and externally rotated until the epicondyles are parallel to the IR.
  • Extended and internally rotated until the epicondyles are perpendicular to the IR. (correct)

Where should the central ray (CR) be directed for an AP shoulder projection with internal rotation?

<p>1 inch (2.5 cm) inferior to the coracoid process. (D)</p>
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What radiographic finding indicates correct positioning for an AP shoulder projection with internal rotation?

<p>The lesser tubercle visualized in full profile on the medial aspect of the humeral head. (A)</p>
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What is the recommended collimation for an AP shoulder projection with internal rotation?

<p>Collimate on four sides, adjusting lateral and upper borders to soft tissue margins. (D)</p>
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Which breathing instruction should be given to the patient during an AP shoulder projection with internal rotation?

<p>Suspend respiration. (D)</p>
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Which of the following is a clinical indication for performing an AP projection with internal rotation of the shoulder?

<p>Evaluation of calcium deposits in muscles, tendons, or bursal structures. (B)</p>
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What is the minimum source-to-image receptor distance (SID) typically used for an AP shoulder projection?

<p>40 inches (100 cm) (D)</p>
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Which structure should be positioned to the center of the image receptor (IR) for an AP shoulder projection with internal rotation?

<p>Scapulohumeral joint. (B)</p>
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What positioning adjustment can be made to ensure the shoulder is in contact with the IR?

<p>Rotate the body slightly toward the affected side. (C)</p>
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An AP shoulder radiograph with internal rotation demonstrates the lesser tubercle in profile. What does this indicate?

<p>The shoulder is correctly positioned in internal rotation. (C)</p>
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What should the radiographer do if a fracture or dislocation is suspected before performing an AP internal rotation shoulder?

<p>Modify the projection and consult trauma projection protocols. (A)</p>
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What is the primary purpose of shielding during radiographic procedures?

<p>To reduce patient exposure to radiation in radiosensitive areas. (A)</p>
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What image receptor (IR) size is recommended for an AP shoulder projection to demonstrate the proximal aspect of the humerus?

<p>10 x 12 inches (24 x 30 cm) (A)</p>
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In an AP internal rotation shoulder radiograph, how does the outline of the greater tubercle appear?

<p>Superimposed over the humeral head. (B)</p>
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What aspect of image quality should be optimized during exposure for an AP internal rotation shoulder radiograph?

<p>Optimal density (brightness) and contrast with visibility of sharp bony trabecular markings. (C)</p>
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Which degenerative condition might be evaluated using an AP shoulder projection?

<p>Osteoporosis. (D)</p>
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Why is it important to perform the AP shoulder projection in an erect position if the patient's condition allows?

<p>The erect position is usually less painful for the patient. (A)</p>
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Which of the following structures is best visualized in profile in the AP internal rotation shoulder projection?

<p>Lesser tubercle. (B)</p>
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What is the primary reason for using a grid during an AP shoulder projection?

<p>To reduce scatter radiation and improve image contrast. (C)</p>
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What projection demonstrates a lateral view of the proximal humerus?

<p>AP internal rotation. (C)</p>
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In the evaluation criteria, which structures are included when assessing the anatomy demonstrated?

<p>The lateral view of the proximal humerus, lateral two-thirds of the clavicle, and upper scapula. (A)</p>
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Which of the following is a concern if optimal exposure settings are not used?

<p>Clear, sharp bony trabecular markings with soft tissue detail may not be visible. (C)</p>
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What is the appropriate action if a patient is unable to fully internally rotate their arm for the AP shoulder projection?

<p>Document the limitation and perform the projection to the best of the patient's ability. (C)</p>
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What is the primary goal of collimation in radiography?

<p>To reduce patient dose and improve image quality by reducing scatter radiation. (A)</p>
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Why is it necessary to center the scapulohumeral joint to the center of the image receptor?

<p>To minimize distortion and ensure all relevant anatomy is captured on the image. (B)</p>
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What is the most important consideration regarding patient safety when performing an AP shoulder projection on a patient who has a known shoulder dislocation?

<p>Avoiding any movements that may exacerbate the dislocation or cause further pain. (D)</p>
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What is the significance of visualizing soft tissue detail when evaluating an AP shoulder radiograph?

<p>It can help identify potential calcifications or other abnormalities in the muscles and tendons. (A)</p>
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From an evaluation standpoint, what specific bony landmark should be assessed in relation to the humeral head?

<p>Glenoid cavity. (D)</p>
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Which positioning error is indicated if the lesser tubercle is not visualized in full profile on the medial aspect of the humeral head?

<p>The shoulder was under-rotated or externally rotated. (D)</p>
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If the scapula is excessively superimposed over the humerus, what adjustment should a radiographer consider?

<p>Ensure the patient is not leaning towards the affected side. (D)</p>
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What is the purpose of slightly abducting the extended arm during the AP internal rotation shoulder projection?

<p>To prevent superimposition of the humerus on the ribs. (C)</p>
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Which of the following should be clearly demonstrated on an AP shoulder radiograph with internal rotation to ensure diagnostic quality?

<p>The clear delineation of bony trabecular patterns and soft tissue interfaces. (B)</p>
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What does the term 'landscape' orientation refer to when discussing image receptor (IR) placement for an AP shoulder projection?

<p>The image receptor is positioned with the longer side along the length of the humerus. (B)</p>
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Flashcards

Clinical indications for AP shoulder (internal rotation)

Fractures or dislocations of the proximal humerus and shoulder girdle.

Calcium deposits on AP shoulder (internal rotation)

Deposits in muscles, tendons, or bursal structures.

Degenerative conditions on AP shoulder (internal rotation)

Conditions including osteoporosis and osteoarthritis.

Minimum SID for AP shoulder (internal rotation)

40 inches (100 cm)

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IR size for AP shoulder (internal rotation)

10 x 12 inches (24 x 30 cm)

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kVp range for AP shoulder (internal rotation)

70-85

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Shielding for AP shoulder (internal rotation)

To shield tissues outside the area of interest

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Patient position for AP shoulder (internal rotation)

Erect or supine

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Part position for AP shoulder (internal rotation)

Center scapulohumeral joint to the center of the IR.

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Arm position for AP shoulder (internal rotation)

Internally rotate arm until epicondyles are perpendicular to IR.

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CR Direction for AP shoulder (internal rotation)

1 inch (2.5 cm) inferior to coracoid process

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Recommended collimation for AP shoulder (internal rotation)

Lateral and upper borders adjusted to soft tissue margins.

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Respiration for AP shoulder (internal rotation)

Suspend

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Anatomy demonstrated on AP shoulder (internal rotation)

Lateral view of proximal humerus and clavicle with relationship of the humeral head to the glenoid cavity.

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Position of AP shoulder (internal rotation)

Lesser tubercle visualized in profile on the medial aspect of the humeral head.

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Greater tubercle on AP Shoulder (internal rotation)

Outline of the greater tubercle visualized superimposed over the humeral head.

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Exposure quality for AP shoulder (internal rotation)

Optimal density and contrast with sharp bony details.

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Study Notes

  • AP Projection-Internal Rotation: Shoulder (Nontrauma), Lateral Proximal Humerus

Clinical Indications

  • Fractures or dislocations of proximal humerus and shoulder girdle can be assessed using this projection
  • Useful for visualizing calcium deposits in muscles, tendons, or bursal structures
  • Aids in the evaluation of degenerative conditions, including osteoporosis and osteoarthritis

Technical Factors

  • Minimum SID (Source-to-Image Distance) is 40 inches (100 cm)
  • Use a 10 x 12 inches (24 x 30 cm) image receptor (IR), landscape (or portrait to demonstrate proximal aspect of humerus)
  • Utilize a grid
  • kVp range is 70-85

Shielding

  • Shield radiosensitive tissues outside the region of interest

Patient Position

  • Perform radiograph with patient in an erect or supine position
  • Erect position is usually less painful for patient, if condition allows
  • Rotate body slightly toward affected side; if necessary, place shoulder in contact with IR or tabletop

Part Position

  • Position patient to center scapulohumeral joint to center of IR
  • Abduct extended arm slightly and internally rotate arm (pronate hand) until epicondyles of distal humerus are perpendicular to IR

Central Ray (CR)

  • CR is perpendicular to IR, directed to 1 inch (2.5 cm) inferior to coracoid process
  • Collimate on four sides, with lateral and upper borders adjusted to soft tissue margins

Respiration

  • Suspend respiration during exposure

Evaluation Criteria

  • Anatomy Demonstrated: Shows lateral view of proximal humerus and lateral two-thirds of clavicle and upper scapula, including the relationship of the humeral head to the glenoid cavity
  • Position: Full internal rotation position is evidenced by the lesser tubercle visualized in full profile on the medial aspect of the humeral head; an outline of the greater tubercle should be visualized superimposed over the humeral head; collimation to area of interest
  • Exposure: Optimal density (brightness) and contrast with no motion demonstrate clear, sharp bony trabecular markings with soft tissue detail visible for possible calcium deposits

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