Abstract:
Background: Optimal shoulder images must adhere to specific radiographic criteria before
they are sent to the radiologist for reporting. Repeat x-rays of the shoulder may increase
radiation exposure to the patient.
Aim: The aims of this study were to determine whether images adhered to the required
radiographic criteria for routine shoulder imaging and to identify possible reasons for
non-adherence.
Setting: The study was conducted at an imaging department at a tertiary academic hospital in
Bloemfontein, South Africa.
Methods: A criteria checklist compiled from literature was used to evaluate 578 routine
shoulder images including anteroposterior (AP) with external rotation and lateral-Y (LAT-Y)
projections. The checklist determined whether the shoulder images adhered to the criteria
with regard to the anatomy included, positioning and technical factors, such as inclusion of the
correct anatomical lead marker. Data were analysed using SAS Version 9.2 statistical software.
Results: More than 80% of the AP external rotation images included unnecessary anatomical
structures owing to incorrect centring. In four out of seven criteria pertaining to positioning for
AP external rotation imaging, at least 70% of images were performed incorrectly. Four-sided
collimation was not present in more than 50% of both AP external rotation and LAT-Y images
because of incorrect centring, while more than 30% of shoulder images presented with
anatomical digital markers.
Conclusion: The application of criteria required for shoulder imaging must be addressed at
the participating imaging department to improve overall patient care. An in-service training
session is recommended to enhance the radiographic technique with regard to routine shoulder
projections.
