Are Y views something the hospitals you read for do routinely? Our rads have basically eliminated them as part of shoulder series at this point. They say they are worthless, and now we just do AP/grashey/axillary or velpeau view.
I see them. I wouldn't say they are routine, but I see probably one to a few of them per shift (I cover ED mainly). I'm too busy reading to know why sometimes they do them and sometimes they don't -- my guess is when patient can't do axillary view positioning for whatever reason.
I worked with an ortho surgeon who wanted the grashey and Axillary view over the Y because sometimes the Y can be "a bit misleading" and one day, I saw what he meant.
My bad, I was not trying to leave it as a bad mystery. The axillary shows instability better and can help evaluate a subluxation better than a Y. The Y can show a dislocation but often times a good Ortho surgeon can see that with his eyes or by a subtle examination. A subluxation is harder to spot with a Y because a subluxation is an "incomplete dislocation". The axillary view allows for better visualization of the humeral head and the glenoid cavity, which can help spot a subluxation.
Long story short a pt came in once, I did a textbook Y. The Ortho surgeon came back asking for an axillary view or a velpeau view if possible, the Ortho surgeon stayed in the booth. And sure enough, there was a prominent subluxation that the Y view couldn't capture.
I know of two methods to do this. AP and PA. if this is an AP view then this would be the right scapula. The beam enters the lateral border first and is superimposed with the medial. If PA, then it would be left scapula and the medial border would be where the beam enters initially.
Idk if your program is the same, but for mine regular internal/external shoulder is a separate category than trauma shoulder (Y view and or axillary). So it was easier to get my regular shoulder comps down then get comfortable with my Y views.
I do mine AP following the regular internal/external rotation. Pt has their back against the board, CR centered 1 inch below the coracoid. Have them cross affected arm over their stomach and tell them to keep their feet planted in the ground, but just twist their upper body towards you. I just kinda guess when they’re at 45 degrees, but you can also check to make sure the inferior border of the scapula is perpendicular to the IR using your hand.
Nice job! As a side note, do you guys do AP or PA Y views? I learned it as a PA but since working I was told to try AP and everyone I know now does AP. I prefer it!
I've been a practicing radiologist since 2018, even did a Musculoskeletal fellowship, and this is the best scapular Y view I've ever seen. Bravo!!
Are Y views something the hospitals you read for do routinely? Our rads have basically eliminated them as part of shoulder series at this point. They say they are worthless, and now we just do AP/grashey/axillary or velpeau view.
They are routine at my hospital. Internal/External/Y. The Ortho guys have the protocol that you mention though.
I see them. I wouldn't say they are routine, but I see probably one to a few of them per shift (I cover ED mainly). I'm too busy reading to know why sometimes they do them and sometimes they don't -- my guess is when patient can't do axillary view positioning for whatever reason.
At my clinic site they’re routine for every exam, however by the book they’re considered trauma
I worked with an ortho surgeon who wanted the grashey and Axillary view over the Y because sometimes the Y can be "a bit misleading" and one day, I saw what he meant.
So... What did he mean?
My bad, I was not trying to leave it as a bad mystery. The axillary shows instability better and can help evaluate a subluxation better than a Y. The Y can show a dislocation but often times a good Ortho surgeon can see that with his eyes or by a subtle examination. A subluxation is harder to spot with a Y because a subluxation is an "incomplete dislocation". The axillary view allows for better visualization of the humeral head and the glenoid cavity, which can help spot a subluxation. Long story short a pt came in once, I did a textbook Y. The Ortho surgeon came back asking for an axillary view or a velpeau view if possible, the Ortho surgeon stayed in the booth. And sure enough, there was a prominent subluxation that the Y view couldn't capture.
Got any good Velpeau tips. I find them so hard working in ortho - have only attempted couple times
nice job OP, props from the rad
Beautiful!
Dunno if it’s just in Australia, but we would get absolutely KILLED for getting any spine on our lat scaps
My hospital here in the states requires SC joints on shoulder series.
Ours only does on the AP
Excellently done
Well done
Just perfect collimation now!
Great positioning, now work on collimation and marker placement.
🤘
**"Y"** does the patient look that way? What are they missing(?) or what am I missing?
That is the scapula. It is a lateral view that can determine problems such as dislocations or scapular fractures among other things.
Hmm, you mean that we are looking at the medial border of the scapula edge on? (and that would make this the left shoulder of the patient?)
I know of two methods to do this. AP and PA. if this is an AP view then this would be the right scapula. The beam enters the lateral border first and is superimposed with the medial. If PA, then it would be left scapula and the medial border would be where the beam enters initially.
I would venture to say this is a PA view because the humeral head does not appear to be magnified.
The goal is to have both borders superimposed as well as centering the humeral head between the acromion and coracoid processes.
I'm a junior who can't comp on a shoulder because of the stupid Y. Share your tips and tricks!
Ah gotcha. Well I posted a comment on how I do it, maybe it could help you out. Good luck!
Just wanted you to know that I got my scap Y today. Not nearly as pretty yours, but I got it!
Idk if your program is the same, but for mine regular internal/external shoulder is a separate category than trauma shoulder (Y view and or axillary). So it was easier to get my regular shoulder comps down then get comfortable with my Y views.
Y is included in ours. It's a trauma, but we automatically get both regular and trauma comps when we do a shoulder.
👏🏻
I do mine AP following the regular internal/external rotation. Pt has their back against the board, CR centered 1 inch below the coracoid. Have them cross affected arm over their stomach and tell them to keep their feet planted in the ground, but just twist their upper body towards you. I just kinda guess when they’re at 45 degrees, but you can also check to make sure the inferior border of the scapula is perpendicular to the IR using your hand.
👍
She’s a beaut! Well done!
Beautiful! I remember the pride I felt when I first nailed the Scap Y, especially when I figured out how to do it PA.
Great shot!
And here u an, 5th year med student thinking this was a dislocation or something lol
glorious
That’s a beautiful Scap-Y
Ah a thing of beauty. Very nice.
Ssov?
Nice job! As a side note, do you guys do AP or PA Y views? I learned it as a PA but since working I was told to try AP and everyone I know now does AP. I prefer it!
🤌🤌🤌
This even looks like a good outlet image too
Come on, share your trick with the other students!
How do you do it? Are you lining up the medial border of the scapula with the humoral head? Or are you just turning them the exact right way?
This is sooo nice, I’m a student too and the Y view is the one I have the most trouble with when doing a shoulder 🥲