Shoulder AP Projection: External Rotation

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Questions and Answers

For an AP projection-external rotation of the shoulder, what is the required minimum SID?

  • 40 inches (100 cm) (correct)
  • 60 inches (152 cm)
  • 50 inches (127 cm)
  • 30 inches (76 cm)

What is the correct placement of the central ray (CR) for an AP projection-external rotation of the shoulder?

  • Perpendicular to the IR, directed to the mid-clavicle
  • Angled 10 degrees caudad, directed to the glenohumeral joint
  • Angled 15 degrees cephalad, directed to the acromion
  • Perpendicular to the IR, directed to 1 inch (2.5 cm) inferior to the coracoid process (correct)

What image receptor (IR) size is recommended for an AP projection-external rotation of the shoulder?

  • 10 x 12 inches (24 x 30 cm) (correct)
  • 14 x 17 inches (35 x 43 cm)
  • 8 x 10 inches (20 x 25 cm)
  • 5 x 7 inches (13 x 18 cm)

When positioning a patient for an AP projection-external rotation of the shoulder, how should the arm be positioned?

<p>Extended and abducted slightly, with external rotation until the epicondyles of the distal humerus are parallel to the IR (A)</p>
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Which of the following is a clinical indication for performing an AP projection-external rotation of the shoulder?

<p>Evaluation of fractures or dislocations of proximal humerus and shoulder girdle (D)</p>
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Which structure is fully visualized in profile on the lateral aspect of the proximal humerus in a correctly positioned AP projection-external rotation?

<p>Greater tubercle (D)</p>
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During an AP projection-external rotation of the shoulder, which structure is superimposed over the humeral head?

<p>Lesser tubercle (D)</p>
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What should the radiographic image demonstrate in terms of bony detail and soft tissue when evaluating an AP projection-external rotation of the shoulder?

<p>Clear, sharp bony trabecular markings with soft tissue detail visible for possible calcium deposits (C)</p>
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What is the recommended collimation for an AP projection-external rotation of the shoulder?

<p>Collimation on four sides, with lateral and upper borders adjusted to soft tissue margins (C)</p>
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What breathing instructions should be given to the patient during an AP projection-external rotation of the shoulder?

<p>Suspend respiration (D)</p>
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In the AP projection-external rotation of the shoulder, what anatomy should be demonstrated?

<p>AP projection of the proximal humerus, lateral two-thirds of the clavicle, and upper scapula (A)</p>
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Which of the following statements is true regarding patient shielding for an AP projection-external rotation of the shoulder?

<p>Shielding should be applied to radiosensitive tissues outside the region of interest (C)</p>
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For the AP projection-external rotation of the shoulder, if a patient cannot stand, what other position is acceptable?

<p>Supine position (C)</p>
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Which technical factor range is appropriate for the kVp when performing an AP projection-external rotation of the shoulder?

<p>kVp range: 70-85 (D)</p>
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What should you do if a fracture or dislocation is suspected before attempting to rotate the arm for an AP shoulder projection?

<p>Do not attempt to rotate the arm and follow the trauma routine (A)</p>
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Why is it important to place the affected shoulder in contact with the image receptor or tabletop if possible?

<p>To improve spatial resolution by reducing OID (D)</p>
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For the AP external rotation shoulder projection, how far inferior to the readily palpated AC joint can one approximate the coracoid process?

<p>Approximately 2 inches (5 cm) (B)</p>
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For the AP external rotation shoulder projection, what is the approximate distance, in inches, that the CR is directed inferior to the coracoid process?

<p>1 inch (C)</p>
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Which technical consideration is crucial for visualizing potential calcium deposits in muscles and tendons during an AP shoulder projection?

<p>Ensuring optimal density and contrast without motion (C)</p>
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In performing an AP external rotation shoulder examination, which patient demographic might find the erect position less painful, influencing the decision to perform the radiograph upright?

<p>Patients that do not have any condition affecting their comfort (D)</p>
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If the epicondyles of the distal humerus are not parallel tot he IR, what corrective action must be taken?

<p>Adjust the degree of rotation of the arm (C)</p>
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An AP projection of the shoulder demonstrates positioning of the proximal humerus and the clavicle; however, the upper border of the scapula is not visualized. What adjustment can the technologist male to correct this?

<p>Adjust Upper Collimation Border (B)</p>
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Radiographic images of the shoulder joint show motion blur due to involuntary patient movement during the exposure. What can the technologist adjust to minimize this?

<p>Suspend respiration during exposure (C)</p>
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A radiograph of an AP shoulder shows poor visualization of bony trabecular markings. Considering the exposure factors were automatically set, what should be evaluated to enhance image quality?

<p>Evaluate Anatomical Programming (C)</p>
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What are the clinical indications for performing an AP Projection - external rotation?

<p>Osteoarthritis (B)</p>
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What image receptor size should be selected to demonstrate the proximal aspect of the humerus on an AP external rotation shoulder radiograph?

<p>10 x 12 inches (C)</p>
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A patient reports pain during the AP external rotation shoulder examination; what modification can the technologist undertake to reduce discomfort during the procedure?

<p>Perform the exam in a supine position (A)</p>
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While reviewing an AP external-rotation shoulder radiograph, you observe the lesser tubercle is fully visualized on the lateral aspect of the humerus. What positioning error likely occurred?

<p>Excessive Internal Rotation (A)</p>
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Which structure is superimposed over the humeral head during external rotation?

<p>Lesser Tubercle (B)</p>
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An AP external rotation shoulder projection shows excellent contrast and density, but the bony trabecular patter is not sharp and distinct. What factor should be evaluated to improve image quality?

<p>Motion (C)</p>
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During post-processing review, the AP external rotation shoulder image appears washed out and lacks sufficient contrast. What can the technologist adjust?

<p>kVp (B)</p>
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During an AP projection on a patient's shoulder, what is the primary purpose of collimating the x-ray beam to the area of interest?

<p>Reduce Scatter Radiation (A)</p>
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In assessing the AP external rotation shoulder radiograph, the relationship of the humeral head should be correctly aligned to which anatomical structure?

<p>Glenoid Cavity (A)</p>
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How does positioning the patient with the affected shoulder in contact with the IR improve image quality for AP shoulder projection?

<p>Reduce Magnification (B)</p>
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Which anatomical structure is utilized as the reference point in aligning the central ray (CR) for an AP shoulder projection?

<p>Coracoid Process (A)</p>
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A patient presents to the radiology department for an AP shoulder examination. The clinical history indicates possible calcific tendonits. Which technical exposure factor is most critical in optimizing the radiographic image to demonstrate this condition?

<p>Adjustment of kVp and mAs to demonstrate tissue contrast (B)</p>
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Which action best demonstrates the full profile of the greater tubercle?

<p>In an AP projection of the shoulder, the greater tubercle is in full profile laterally (B)</p>
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Flashcards

Clinical indication for shoulder X-ray

Fractures or dislocations of the proximal humerus and shoulder girdle.

Clinical indication for shoulder X-ray

Calcium deposits in muscles, tendons, or bursal structures.

Clinical indication for shoulder X-ray

Degenerative conditions, including osteoporosis and osteoarthritis.

SID for AP shoulder?

Minimum SID is 40 inches (100 cm).

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IR size for AP shoulder?

10 x 12 inches (24 x 30 cm), landscape (or portrait).

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Shielding

Shield radiosensitive tissues outside region of interest.

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Patient position.

Erect or supine position; rotate body slightly toward affected side.

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Part Positioning

Center scapulohumeral joint to the center of IR.

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Arm Position

Abduct arm slightly; externally rotate arm until epicondyles of distal humerus are parallel to IR.

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CR placement for AP shoulder

Perpendicular to IR, directed 1 inch (2.5 cm) inferior to coracoid process.

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Collimation

Collimate on four sides, adjust to soft tissue margins.

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Eval Criteria: Full external rotation

full external rotation is evidenced by greater tubercle visualized in full profile

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Respiration

Suspend respiration during exposure.

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Anatomy Demonstrated

AP projection of proximal humerus, clavicle, and upper scapula.

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Image Quality

Optimal density and contrast with no motion.

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Study Notes

  • AP projection with external rotation visualizes the shoulder for nontrauma cases and focuses on the proximal humerus.
  • Warning: Avoid rotating the arm if a fracture or dislocation is suspected

Clinical Indications

  • Used to identify fractures or dislocations of the proximal humerus and shoulder girdle
  • Detects calcium deposits in muscles, tendons, or bursal structures
  • Shows degenerative conditions, including osteoporosis and osteoarthritis

Technical Factors

  • Minimum SID should be 40 inches (100 cm)
  • The image receptor (IR) size should be 10 x 12 inches (24 x 30 cm), using a landscape or portrait orientation to demonstrate the proximal aspect of the humerus.
  • Use a grid.
  • kVp range: 70-85
  • Shield radiosensitive tissues outside the region of interest.

Patient and Part Positioning

  • Patient can be erect or supine. The erect position may be less painful.
  • Rotate the body slightly toward the affected side to ensure the shoulder is in contact with the IR or tabletop.
  • Center the scapulohumeral joint to the center of the IR
  • Abduct the extended arm slightly and externally rotate the arm (supinate hand) until the epicondyles of the distal humerus are parallel to the IR

Central Ray

  • CR should be perpendicular to the IR, directed 1 inch (2.5 cm) inferior to the coracoid process.
  • Collimate on four sides, adjusting lateral and upper borders to soft tissue margins.
  • Suspend respiration during the exposure.
  • The coracoid process is approximately 2 inches (5 cm) inferior to the lateral portion of the AC joint, which is easier to palpate.

Evaluation Criteria

  • The image should demonstrate an AP projection of the proximal humerus, lateral two-thirds of the clavicle, and upper scapula, including the relationship of the humeral head to the glenoid cavity
  • Full external rotation is evident when the greater tubercle is visualized in full profile on the lateral aspect of the proximal humerus, with the lesser tubercle superimposed over the humeral head
  • Collimation should be appropriate for the area of interest
  • Optimal density and contrast, combined with no motion, should demonstrate clear, sharp bony trabecular markings, with soft tissue detail visible for possible calcium deposits.

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