 Good morning everyone and the whole idea of this session was to understand how the faculty, how they are reading the MR, it's their approach and I always believe that everyone has a slightly different perspective, a slightly different way of reading things and we all learn from each other. So let's begin with how I read shoulder MR and I think it's very important to know that it's not enough to know the right answers, you also need to ask the right questions. When it comes to imaging, I think what this means is you need to know what exactly is the orthopedician looking for, that's very important. Because only when you know what are the right questions will you be able to give the right answers and that's what the whole purpose of imaging is to be able to help in the patient management. So let's begin with the first question, how do we do the MR? We use a surface coil like this, so it should be a dedicated coil, it could be a rigid coil like this which is designed for the shape of the shoulder, advantage the respiratory movement artifacts are transmitted less, disadvantage you can only use it for shoulder and not for anything else. So many people tend to use other coils like flex coils which can be multi-purpose and can be used for other coils, that's fine but it should be a dedicated coil, don't try doing it on a routine body coil, the images would not be of good resolution and quality. It's important to scan the patient in neutral position that is with the thumb kept in neutral position or it could be externally rotated a bit but you do not want it internally rotated. This is because the anterior inferior structures get bunched up and that becomes it becomes difficult to see the anterior inferior structures. There are some people who do arthrograms in our practice we do not do any arthrograms since more than a decade and that's because we are able to obtain very high resolution images, 3TS is better showing the labrum and cartilage but even with 1.5 Tesla which we have we report for a large number of centers which is includes both 3N 1.5 Tesla, if you get good resolution you can get good images, it's very important to keep the field of view as less as possible to cover the shoulder, you cannot keep a large field of view and then zoom the image trying to get the resolution, the spatial resolution is lost. We do not do arthrograms like I said but the sequences that we obtain again these can be little different based on everyone's preference. When we are looking for internal derangement we do not do a T1 but then our technologies are trained enough that if they see anything this I am talking only of internal derangement I am not talking of tumor or infection or other marrow pathologies because then yes T1 would be an integral part of the scan and if your technologist is not trained enough to identify something needed and add a T1 you can always keep an additional coronal T1 as a part of this. We begin with the axial PD so this is the resolution again keep the field of view less slice thickness as less as possible and 0 millimeter gap and you can get good images. We do next we follow it by coronal FATSAT T2 it's important that you have one FATSAT T2 and not proton density FATSAT because PD and FATSAT PD FATSAT and T2 FATSAT are different to look for tendon tears to look for marrow pathologies a T2 FATSAT is what is essential. Ster is not preferable in shoulder because the resolution is bit poor it's more grainy image so a FATSAT T2 with adequate homogenous FATSAT suppression is required. Next we do a coronal PD sequence again high resolution follow this with the Satch PD so we take 3 plane high resolution PD high resolution means low field of view thin sections either 0 or 1 millimeter gap not more than that so not more than 3 millimeter thickness and not more than 1 millimeter gap. The last sequence we obtain is something we call the labral sequence which is somewhere between proton density and T1 weighted image with respect to its parameters this we take 2 millimeter with 0 millimeter gap and cover only the labral so these are the 5 sequences that we do anything looks abnormal with the marrow anything different coronal T1 is added if it's a tumor or infection the protocol is different with T1 and T2 weighted images. Now it's important to get the planning right ideally we look at the supraspinatus muscle we can see here this is the supraspinatus muscle and you can see that the scan should be planned coronal parallel to it to the tendon this is muscle and this is the tendon so this tendon axis is what you take to plan coronal and sagittal images so they are oblique coronal and sagittal if you cannot identify the tendon you can take the glenohumeral joint line and take it parallel and perpendicular to it we make sure that the sagittal images are parallel to the inferior portion of the glenoid because we want to assess for glenoid bone loss.