its my another presentation

3.  HUMERUS
-Head
-Anatomic neck
-Surgical neck
-Greater tubercle
-Lesser tubercle
-Intertubercular groove
-Deltoid tuberosity
-Shaft

4.  Antero-posterior
 Lateral
 Axial-
Bicipital Groove
 Humerus –Supracondylar Fracture.
Lateral
Antero posterior
 Lateral oblique

5. INDICATIONS
 Trauma
Dislocation
Fractures
Soft tissue calcifications
Arthitis survey
Bone pain

6.  The
patient sits or stands with their
back in contact with the cassette.
 If the patient’s condition doesn’t
allow,it can be performed in supine
position.
 Adjust the height of the cassette to
place its upper border 1.5 inches
above the head of humerus.

7.  Abduct
the arm
slightly,and
supinate the hand
so that epicondyles
of the elbow are
equidistant from
IR.
 The coronal plane
passing through the
epicondyles should
be parellel to the
IR.

8.  Center Ray-Perpendicular to the mid shaft of
humerus and center to the cassette.
Evaluvation
-Long axis of humerus should be alinged to
the long axis of IR.
-The greater tubercle is seen in profile.
-The humeral head is partially seen in profile
medially,with minimal superimposition of
glenoid cavity.
-The distal radius should show both lateral
and medial epicondyle visualised in profile.

10. 
INDICATIONS
Same as AP projection.




POSITIONING OF PATIENT
The Patient stands against the erect
bucky or lies supine on the table.
Place the top margin of the cassette
1.5 inches above the head of
humerus.
The arm is internally rotated ,and the
elbow is flexed to 90 degrees and
place the hand on the hip.

11. Center
Ray
To the Mid shaft of humerus.
Evaluvation
Epicondyles are superimposed.
 Lesser tubercle is profile in
medially,partially superimposed by
lower portion of glenoid cavity.
 Marker should be placed.
 Collimate the field of area.


13. A
type of injury commonly seen in
children is a fracture of a lower end of
humerus just proximal to the condyles.
 The injury is very painful and even small
movements of the limb can exacerbate
the injury.
 Further causing damage to the adjacent
nerves and blood vessels.

14.  The
cassette is supported vertically in a
cassette holder.
 The patient stands sideways,with the elbow
flexed and the lateral aspect of the injured
elbow in contact with the cassette.
 The arm is gently extended backwards from
the shoulder.
 The patient is rotated forwards until the
elbow is clear of the rib cage but still in
contact with the cassette.

15.  Direction

The horizontal center ray is directed to
the medial epicondyle and the beam
collimated to the elbow.
 Image

and Centering of the beam
Characteristics
The image should include the lower end
of the humerus and the upper third of
the radius and ulna.

16. Supracondylar fracture-lateral

17.  The
cassette is supported in a vertical
cassette holder.
 From the lateral position,the patient’s
upper body is rotated towards the
affected side.
 The patient’s position is adjusted so that
the posterior aspect of the upper arm is
in contact with the cassette.

18. Supracondylar fracture-anterio
posterior

19. The Bicipital groove is situated between the
greater and the lesser tuberosities of the
humerus.
 It transmits the tendon of the long head of the
biceps.

 POSITION OF PATIENT
 The patient sits with their shoulder joint against
a vertical cassette holder.
 Ideally this holder should be angled 15 degrees
forward.
 But if this facility is not available the cassette
can be supported above the shoulder.

20. •The arm is abducted anteriorly and supported to
bring the long axis of humerus perpendicular to the
cassette.
•The hand is rotated 45 degrees laterally from
prone to bring the bicipital groove in profile
 Centering
o The
of the beam
central ray is directed cranially along
the long axis of humerus .
o Centered to the anterior part of the head of
humerus.

21. Axial-bicipital groove

23.  The
patient stands or sits with the lateral
aspect of the injured arm against the
cassette .
 The patient is rotated forwards until the line
joining the medial and lateral borders of
scapula is at right angles to the cassette.
 The cassette is positioned to include the
head of the humerus and the whole scapula.

24.  Centering
of the beam
 The horizontal x ray beam is directed to
the medial border of scapula and
directed to the head of humerus.
 Evaluvation
 The scapula and the upper end of the
humerus should be demonstrated clear
of the throxic cage.

25. Humerus lateral oblique

26. 3
Bones
 Humerus
 Scapula
 Clavicle
 3 Joints
 Glenohumeral
 Acromioclavicular
 Sternoclavicular

27.  BASIC


VIEWS IN SHOULDER
Antero posterior
Axial
-superio inferior
-inferio superior
 SPECIAL
VIEWS
 Outlet projection
 Y projection
 Styker’s projection

28.  Indications
for shoulder x ray
 Scapulohumeral
dislocations
 Fracture
 Osteoporosis
 Osteoarthitis
 Hill
sach’s defect
 Burtitis
 Bony tumours

29.  The
patient stands with the affected
shoulder against the cassette.
 The patient is rotated 15-30 degrees to bring
shoulder closer to the cassette.
 The arm is supinated and slightly abducted
away from the body.
 The medial and lateral epicondyles of distal
humerus should be parallel to the IR.
 The cassette is positioned 5 cm above the
shoulder.

30.  Center
the horizontal ray to the palpable
coracoid process of scapula.
Evaluvation criteria
The image should demonstrate the head and
proximal end of humerus,the inferior angle of
scapula and whole of the clavicle.
 The head of humerus should be seen slightly
overlapping the glenoid cavity but separate from
the acromion process.
 Arrested respirstion aids good rib detail in acute
trauma.


31. Shoulder anterio posterior

33.  The
patient is seated at the side of the
table,which is lowered at waist level.
 The cassette is placed on the tabletop,and
the arm under examination is abducted over
the cassette.
 The patient leans towards the table to
reduce the object-to-film distance.
 The elbow can remain flexed,but the arm
should be abducted to a minimum 45
degrees.

34.  DIRECTION
AND CENTERING OF THE
BEAM
The vertical center ray is directed through the
proximal aspect of head of humerus.
 If there is a large OFD,it may be necessary to
increase the overall FFD to reduce
magnification.

 EVALUVATION
CRITERIA
Lateral view of proximal humerus in relationship
to the glenohumeral articulation is visualised.
 Corocoid process of scapula is seen on end.


35. Shoulder superio inferior view

37.  Pathology
Demonstrated:
Osteoporosis, osteoarthritis, and the HillSachs defect with exaggerated rotation may
be demonstrated.
 Positioning of patient:
 The patient lies supine on the table.
 The arm of the affected side slightly
abducted and supinated.
 The affected shoulder and arm raised on
non-opaque pads.

38.  The
cassette is supported vertically against
the shoulder
 And pressed against the neck to include as
much as possible of the scapula on the film.
 Center
Ray
 The horizontal center ray is directed
towards the axilla.
 With
minimum angulation towards the trunk.

39.  Evaluvation
The image should demonstrate the
 Head of humerus
 Acromion process
 Corocoid process
 Glenoid cavity
 The lesser tuberosity in profile.
 The acromion process and the superior aspect of
glenoid cavity will be superimposed on the head
of humerus.


40. Shoulder inferio superior

42.  The
patient stands or sits facing the
cassette.
 With lateral aspect of the affected arm in
contact.
 The arm is extended backwards,with the
dorsum of the hand resting on the patient’s
waist.
 The patient is now rotated forward until a
line joining the medial and lateral borders of
scapula is at right angles to the cassette.

43.  The
scapula and proximal end of the
humerus is clear of the rib cage.
 Center
Ray
 Requires a 10 to 15 degree CR caudal
angle.
 Centered posteriorly to pass through the
superior margin of humeral head

44.  Evaluvation
criteria
The humeral head should
appear superimposed and
centered to the glenoid
fossa.
 The extent of the anterior
projection of the
acromion and the
subacromial space.


45. Shoulder outlet view

46.  The
patient stands or sits with the lateral
aspect of the injured arm against the
cassette.
 And adjusted so that the axilla is in center of
the film.
 The patient rotates 45-60 degrees.
 The arm is abducted with the elbow flexed
to allow the back of the hand to rest on the
hip.
 The cassette is positioned to include the
superior border of scapula.

47.  Center

Ray
CR to the medial border of scapula.
 Evaluvation
criteria
Entire scapula
 Body of scapula should be seen in profile,free of
superimposition of ribs.
 The scapula and head of humerus are clear of rib
cage.


48. Shoulder Y view

50.  The
patient is supine or erect,with the
posterior aspect the affected shoulder
against the cassette.
 The arm of the affected side is abducted to
above shoulder level .
 Allow the hand to rest on the patients head.
 The patient is now rotated slightly to bring
the affected side away from the cassette.
 The position of the cassette is adjusted so
that it is centered to axilla.

51.  Center

ray
Centered to the axilla of the affected side.
 Evaluvation
The clear view of posterior and superior aspects
of the head of humerus.
 The inferior borders of glenoid fossa and joint
will be seen.
 It is useful in detecting hill-sach’s defects and
anterior instability.


52. Stryker’s notch view

55.  BASIC


VIEWS
Antero posterior
Posterio anterior
 SPECIAL
VIEWS
 Inferio superior-axial view

56.  INDICATION
 Fracture
 Dislocation
 POSITION
 The
patient is supine on the table with
the arms at side.
 The posterior aspect of shoulder should
be in contact with the IR.
 No rotation of body.
 Center clavicle and IR to CR.

57.  CENTER
RAY
 CR perpendicular to Mid clavicle.
 EVALUVATION
CRITERIA
Entire clavicle
 Acromio clavicular joint
 Sterno clavicular joint

 No
rotation of clavicle.

58. Clavicle anterio posterior view

60.  The
patient sits or stands facing an erect
cassette holder.
 The position is adjusted that the middle of
clavicle is in center of the cassette.
 The patient’s head is turned away from the
side being examined.
 The affected shoulder is rotated slightly
forward to allow the clavicle in close contact
with the cassette.

61.  CENTER
 To
RAY
the mid clavicle.
 EVALUVATION
 Entire
CRITERIA
length of clavicle.
 The lateral end of clavicle will be clear of
the thoracic cage.
 No foreshortening of clavicle.

62. Clavicle posterio anterior view

64.  The
patients sits facing the x ray tube with
the cassette placed cassette holder.
 Some holders allow 15 degrees angulation
towards the shoulder.
 This reduces the distortion caused by the
cranial angulation.
 The unaffected shoulder is raised slightly to
bring the scapula in contact.
 The patient’s head is turned away.

65.  CENTER
RAY
 The
center ray is angled 30 degrees cranially.
 Centered to the mid clavicle.
 The 30 degrees is needed to separate the
clavicle.
 The medial end of clavicle can be shown in
good detail by adding 15 degrees lateral
angulation.
 EVALUVATION
 Entire
CRITERIA
length of clavicle.
 No foreshortening.

66. Clavicle axial view-inferio superior