 Good morning, everyone. Today I'll be presenting my topic, TAMARA and Episcan imaging and disease shoulder instability, and on track of Tract Infects Legion, a cross-sectional study. My name is Dr. Sivit Deshmukh. I'm a junior resident in the department of radiology. I set the SMC in KEMH Mumbai. Shoulder joint has the greatest range of motion of any human joint and this requires a degree of natural instability. As a result, a shoulder joint is the most commonly dislocated joint in adults. Recurrent dislocations of the shoulder are also not uncommon. Antero-inferior glenoid bone loss is associated with recurrent dislocations and the other osteosabnormality commonly found following shoulder dislocation is the hilsex region. A large or a medially placed hilsex region is associated with recurrent anterior instability if it is not repaired properly. The concept of glenoid tract, hilsex interval, and on and off track hilsex region is used to provide the information that will hand and guide the type of tribalization procedure performed on the patient and also identify the risk of postoperative recurrence. Coming to the terminal study, the glenoid tract is the area between the humeral head and the glenoid during shoulder abduction and external glenotation and it comprises approximately 83% of the glenoid width. The hilsex interval is the hilsex region plus the width of the intact bone bridge between the rotator cuff attachment and the lateral margin of the hilsex region. A hilsex region is considered engaging or off track if the hilsex interval exceeds the glenoid tract and non-engaging or on track if the hilsex interval is less than the glenoid tract. The off track lesions are more commonly associated with recurrent dislocations of the shoulder joint. Coming to the methodology, our study was a cross-sectional study with a sample size of 15 patients. The inclusion criteria included newly diagnosed cases and known cases of shoulder dislocation. The exclusion criteria were any patient having metallic implants or any patient having a history of claustrophobia for doing an MRI scan. Both CT and MRI were done as CT is better to tell bipolar bone loss and MRI is good to see any associated soft tissue injury and also entero inferior laboral injury. Two measurements were used to determine whether a lesion was on track or off track which were the glenoid tract and the hilsex interval. For glenoid bone loss, a best fit circle is drawn along the posterior and caudal margins of the glenoid. Next horizontal line is drawn to the center of the circle perpendicular to the long axis of the glenoid estimating the width of the intact glenoid. A second horizontal line is then drawn at the same level and measured from the anterior border of the glenoid to the anterior aspect of the circle indicating the amount of glenoid bone loss. The glenoid tract is then calculated as 0.83 into width of the intact glenoid minus the width of the glenoid bone loss. The hilsex interval is measured as width of the hilsex lesion plus the width of any intact bone bridge between the lateral margin of the region of the lesion and the protetor cuff insertion. Similar method was used to estimate glenoid bone loss and hilsex interval on MRI. A total of 15 cases were done and two representative cases are discussed here. In the first case it was a 48-year-old man with complaints of right recurrent shoulder dislocation. He had a history of trauma to the right shoulder with recurrent dislocation five years ago. Recently there were four episodes of dislocation in sleep. On examination the patient had a right shoulder tenderness and there was no swelling. The glenoid bone loss, the glenoid tract and hilsex interval were calculated on both CT and MRI. As we can see the hilsex interval which was 17.5 mm was greater than the glenoid tract which was 16.7 mm on both CT and MRI indicating that it was an off-track lesion. The second case also had a similar history and in that case also the hilsex interval was greater than the glenoid tract on both CT and MRI showing that it was an off-track or engaging lesion. Coming to the results, out of the 15 patients, 10 patients had more than two episodes of shoulder dislocation and among these 10 patients almost 90% of the patients had an off-track or engaging hilsex lesion whereas the patients with less than two dislocation had no patients with off-track lesions which indicates that in patients with recurrent shoulder dislocation off-track lesion is more prevalent. To conclude, assessment of the unit bone loss and identification of on-track or off-track hilsex lesion is important for the type of stabilization procedure performed on the patients and also to identify the risk of postoperative recurrence. MRI is as good as CT scan for assessment of bipolar bone loss and it also provides additional information about the rotator cuff injury joint diffusion and degenerative changes. Thank you. These were the references used in our study.