In A&E, you notice your colleague has produced an AP view of the shoulder where the base of the scapula and proximal third of the clavicle are not demonstrated. What should you do?

In A&E, you notice your colleague has produced an AP view of the shoulder where the base of the scapula and proximal third of the clavicle are not demonstrated. What should you do?

• A. There is anatomy that isn't demonstrated and you should work together to get a better view.
• B. As a healthcare professional it is our responsibility to ensure others are adhering to best practice.
• C. Do nothing and proceed with the image.
• D. Discharge the patient.

Answer: (A)

Ensuring all relevant anatomy is captured in a radiograph is essential for a reliable diagnosis. If an AP view of the shoulder doesn’t show the base of the scapula and the proximal clavicle, the image is incomplete and may miss injuries or obscure pathology. The appropriate response is to address this with the colleague and work toward obtaining a better view. This reflects professional responsibility to provide diagnostic-quality imaging and to safeguard patient care. Discuss with your colleague what anatomy is missing and why the current image isn’t adequate. Review technique and positioning together—adjust the patient’s shoulder rotation, ensure the scapula sits within the field, and verify the clavicle isn’t overlapped. Consider alternative views that better demonstrate the shoulder girdle, such as an axillary or Grashey projection, to visualize the glenohumeral joint and surrounding structures more clearly. After agreeing on adjustments, obtain a repeat radiograph with proper positioning and exposure, ensuring the patient remains safe and comfortable. Choosing to proceed with a suboptimal image or to discharge the patient would compromise care and potentially miss injuries, whereas addressing the issue promptly aligns with the duty to uphold best practices and deliver diagnostic-quality imaging.

Ensuring all relevant anatomy is captured in a radiograph is essential for a reliable diagnosis. If an AP view of the shoulder doesn’t show the base of the scapula and the proximal clavicle, the image is incomplete and may miss injuries or obscure pathology. The appropriate response is to address this with the colleague and work toward obtaining a better view. This reflects professional responsibility to provide diagnostic-quality imaging and to safeguard patient care.

Discuss with your colleague what anatomy is missing and why the current image isn’t adequate. Review technique and positioning together—adjust the patient’s shoulder rotation, ensure the scapula sits within the field, and verify the clavicle isn’t overlapped. Consider alternative views that better demonstrate the shoulder girdle, such as an axillary or Grashey projection, to visualize the glenohumeral joint and surrounding structures more clearly. After agreeing on adjustments, obtain a repeat radiograph with proper positioning and exposure, ensuring the patient remains safe and comfortable.

Choosing to proceed with a suboptimal image or to discharge the patient would compromise care and potentially miss injuries, whereas addressing the issue promptly aligns with the duty to uphold best practices and deliver diagnostic-quality imaging.