Set the Language

We weren't able to detect the audio language on your flashcards. Please select the correct language below.

Front

Back

Flashcards
»
Diagnostic Radiography methods techniques

Diagnostic Radiography Methods Techniques

by katie.fenton11, Apr. 2010

Subjects: diagnostic dr hip pelvis radiography shoulder spine techniques vertebra

Favorite

Add to folder

Flag

Shuffle
Toggle On

Toggle Off
Alphabetize
Toggle On

Toggle Off
Front First
Toggle On

Toggle Off
Both Sides
Toggle On

Toggle Off
Read
Toggle On

Toggle Off

Reading...

Front

Card Range To Study

through

Play button

Progress

1/96

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

96 Cards in this Set

Front
Back

	C-spine – list proj's (1 of 4) Basic proj’s (x4)	C-spine – list proj's (1 of 4) - Basic proj’s (x4) 1. –AP “open mouth” proj (C1 & C2) – also “peg”/”odontoid”/”dens” view 2. – AP axial C-spine 3. – Oblique C-spine (both) 4. – Lateral C-spine
	C-spine – list proj's (2 of 4) Trauma proj’s (x5)	C-spine – list proj's (2 of 4) - Trauma proj’s (x5) 1. – Trauma lat – Horiz beam lateral C-spine 2. – AP trauma C-spine 3. – AP (C1 & 2) – 2 alts i) basic AP open mouth (if poss) ii) Alt AP axial (< for dens) 4. – Swimmers Lat trauma – horiz beam 5. – Trauma C-spine obl's – 2 methods i) IR under neck ii) IR under table
	C-spine – list proj's (3 of 4) Alt (to basic) proj’s (x3)	C-spine – list projections (3 of 4) - Alt (to basic) proj’s (x3) 1. – AP Fuch method (1st of 2 alt proj for dens) 2. – PA Judd method (2nd of 2 alt proj for dens) 3. – AP wagging jaw (or ottonello method) – for entire C-spine incl dens
	C-spine – list proj's (4 of 4) Supp (to basic) proj’s (x3)	C-spine – list projections (4 of 4) - Supp (to basic) proj’s (x3) 1. – Swimmers lat - cervicothoracic 2. – functional study – 2 alts i) Flexion ii) Extension 3. – AP axial proj – vertebral arch (pillars) view
	C-spine – indiv proj’s - AP “open mouth” proj (C1 & C2) - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) b) Alt names (if appplic) c) When used d) What viewed (basic)	C-spine – indiv proj’s - AP “open mouth” proj (C1 & C2) - basic info a) Part of series (basic/ trauma/alt to basic/supp to basic) ANS - Basic b) Alt names (if applic) ANS -'peg”/ ”odontoid”/"dens" view c) When used ANS - Every C-spine except some trauma (sometimes possible in trauma patient) d) What viewed (basic) ANS - Axis, atlas and dens
	C-spine – indiv proj’s – AP “open mouth” proj (C1 & C2) – positioning part 1 a) Likely pt presentation b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON c) Body part position (eg arms up/out/rotated) d) Any alternatives to body pos	C-spine – indiv proj’s – AP “open mouth” proj (C1 & C2) – positioning part 1 a) Likely pt presentation ANS - likely walking/mobile – conscious – no ventilator – mostly non trauma b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON ANS - standing/sitting (not too common – but if used, arms by side) – supine (most common and more stable) c) Body part position (eg arms up/out/rotated) ANS – pt midsag line centered to CR and IR - (without opening mouth) biting surface of upper incisors in line with base of skull (mastoid tips) - THEN only move lower jaw to open mouth wide - Tongue in lower jaw (prevent superimp shadow) - No rotation (rot) of head, neck, jaw or thorax - NB have exposure set first (also maybe not best as first picture as uncomfortable, can be painful and req. rapport with pt for them to be comfortable) - Also have collimation and equipment setup before positioning for above reasons d) Any alternatives to body pos ANS - nil
	C-spine – indiv proj’s - AP Axial C-spine - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) b) Alt names (if appplic) c) When used d) What viewed (basic)	C-spine – indiv proj’s - AP Axial C-spine - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) ANS – Basic b) Alt names (if appplic) ANS – AP C3-C7 c) When used ANS – as a part of the basic C-spine series and as a trauma view. - OSCE d) What viewed (basic) ANS – C3 to T1, 2 or 3 – - Vertebral bodies, spaces between pedicles, iv disc spaces - Base of skull superimposing c1 c2
	C-spine – indiv proj’s – AP Axial C-spine – positioning part 1 a) Likely pt presentation b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON c) Body part position (eg arms up/out/rotated) d) Any alternatives to body pos	C-spine – indiv proj’s – AP Axial C-spine – positioning part 1 a) Likely pt presentation ANS – many different presentations. Can be -mobile and compliant - Semi mobile - Unconscious - Spine precautions - Intubated/on respirator b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON ANS – Usually supine (mobile and trauma spine precaution patient) - Can be done erect (not often) c) Body part position (eg arms up/out/rotated) ANS – Pt midsagittal plane to CR and to centerline of IR - Back and head in neutral position in contact with the bucky (upright or table) - Raise chin slightly – need CR angle to superimpose the chin and base of skull (stops mandible from superimposing more than C1 and C2) - Line from tip of mandible (or chewing surface of teeth) to base of skull should be 90 deg to IR - No rotation of head or neck - No rotation (ie. spinous processes and SC joints [if visible] equal distance from SC lat borders) d) Any alternatives to body pos ANS – If done erect, have arms by the side
	C-spine – indiv proj’s – AP Axial C-spine – positioning part 2 a) CR/IR position b) Marker position c) Use of padding/sponge/weights	C-spine – indiv proj’s – AP Axial C-spine – positioning part 2 a) CR/IR position ANS –IR in bucky (erect or table) - CR at approx 15-20 deg cephalad angulation (degree of angle should be assessed on a case by case basis taking into account degree of cervical lordosis present and any limitations of patient ie pt in spinal precautions may not be able to raise chin/lower chin as needed) - CR to center of IR b) Marker position ANS – marker either at the middle or down the bottom off to the side c) Use of padding/sponge/weights ANS – No padding/pillows under head – want a fairly natural curvature Support under knees possible for pt comfort
	C-spine – indiv proj’s – AP Axial C-spine – techniques/factors (part 1) a) Angle/level of CR b) IR size c) Collimation d) kVp e) mAs	C-spine – indiv proj’s – AP Axial C-spine – techniques/factors (part 1) a) Angle/level of CR ANS – CR to middle of IR -CR to midline of pt at level of C4 (or C5 – Bontragers) (bottom of thyroid cartilage) - CR 15-20 degree angulation cephalad (correct degree is needed to open IV disc spaces – directs beam between overlapping C-vert bodies to better demonstrate IV spaces - 15 degrees – supine or if less lordotic curve is evident - 20 degrees – when erect or when more of a lordotic curve is present b) IR size ANS – 24 x 30 cm LW (portrait) c) Collimation ANS – collimation center at C4 - Collimate to cassette size then adjust in till - Side to side – collimate till can just see light on either side of neck shadow (ensure soft tissue is included – very important to see) - Include as much of spine lengthways as possible - Ensure all req anatomy is included in collimation field. d) kVp ANS – Bontragers – 75 +/- 5 kVp - OSCE – 65kVp e) mAs ANS – Bontragers – 10 mAs -OSCE - 10 mAs
	C-spine – indiv proj’s – AP Axial C-spine – techniques/factors (part 1) a) Grid b) AEC c) FFD d) Respiration e) Dose	C-spine – indiv proj’s – AP Axial C-spine – techniques/factors (part 1) a) Grid ANS - yes b) AEC ANS – can use but best if not. c) FFD ANS – 100 cm – 110 cm d) respiration ANS – expose on suspended breath (held – not in action of breathing) e) dose ANS – mAs controls therefore best if this is low - thyroid – 53
	C-spine – indiv proj’s – AP Axial C-spine – critiquing points a) structures (focus/want to see) b) anatomy that must be included top/bottom/side to side c) rotation wanted/not wanted – how to tell if correct d) position wanted – how to tell if right e) common problems and how to fix	C-spine – indiv proj’s – AP Axial C-spine – critiquing points a) structures (focus/want to see) ANS – C3 to T1, 2 or 3 - Vertebral bodies, spaces between pedicles, iv disc spaces - Base of skull superimposing c1 c2 - Soft tissue of neck b) anatomy that must be included top/bottom/side to side ANS – top - base of skull and superimposed mandible (covers C1 and C2) - must include at least C3 to C7 – good to include as much of the lower bit of spine as poss, ie include T1, 2 and possibly 3 c) rotation wanted/not wanted – how to tell if correct ANS – No rotation of head and neck wanted - No rotation (ie. spinous processes and SC joints [if visible] equal distance from SC lat borders) d) position wanted – how to tell if right ANS – Pt midsagittal plane to CR and centerline of IR (look from head to feet to check) - Back and head in neutral position in contact with the bucky (upright or table) - Raise chin slightly – need CR angle to superimpose the chin and base of skull (mandible should not superimpose more than C1 and C2) - Line from tip of mandible (or chewing surface of teeth) to base of skull should be 90 deg to IR (visually check this) e) common problems and how to fix ANS – often rejected due to poor centering (fixed by correctly using surface anatomical landmarks to find C4) - incorrect tube angulation (assess pt)
	C-spine – indiv proj’s – AP Axial C-spine – concerns for OSCE a) phantom selection b) phantom placement/positioning + props needed c) exposures used d) limitations to be aware of	C-spine – indiv proj’s – AP Axial C-spine – concerns for OSCE a) phantom selection ANS – head (clear one) b) phantom placement/positioning + props needed ANS – on top of box and chair aligned as required c) exposures used ANS – 65 kVp for 10 mAs d) limitations to be aware of ANS – Won’t be able to get chin raised - is pretty hard to get it up high enough to get correct angulation - there won’t be the cervico-thoracic junction on film - no thyroid cartilage to palpate – have to visually center CR to C4/C5
	C-spine – indiv proj’s – oblique C-spine (2x) - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) b) Alt names (if applic) c) When used d) What viewed (basic)	C-spine – indiv proj’s – oblique C-spine (2x) - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) ANS - Basic b) Alt names (if applic) ANS – Oblique’s (C1-C7) - PA = RAO or LAO – ie right ant side against board or left - AP = RPO or LPO – ie right post side against board or left c) When used ANS – both taken to use as comparison tool – either both in AP position or both in PA - Do not attempt head and neck movt on trauma (spinal precaution) pt – option for trauma version. - Anterior obliques result in lower thyroid dose d) What viewed (basic) ANS – different for PA and AP - AP – Normally harder & doesn’t sit well with angle of CR and angle of spine - (PO) shows the IV foramina and pedicles of the side away from board - PA – More likely to open iv spaces and demonstrate IV foramina - (AO) Shows the IV foramina and pedicles of the side against the board
	C-spine – indiv proj’s – oblique C-spine (2x) – positioning part 1 a) Likely pt presentation b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON c) Body part position (eg arms up/out/rotated) d) Any alternatives to body pos	C-spine – indiv proj’s – oblique C-spine (2x) – positioning part 1 a) Likely pt presentation ANS – varied as can be used as a basic projection as well as trauma (have to be careful as you may not be able to turn the pt neck – may need to prop up spine board etc – the other option is to get them sitting up in a chair etc and use a grid – the problem is you can only angle one way to avoid grid cutoff.) b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON ANS – PA erect is most common (easier) - can also be erect AP - Pt can be recumbent or prone depending on presentation and situation - trauma pt – if possible have them sitting on a chair at 45 degree angle and angle the tube to match – (have to collimate to film as there is increased OID and hard to go off anatomy shadows) (NB. Can only angle in one direction ie can’t then angle up etc) c) Body part position (eg arms up/out/rotated) ANS – head and thorax in line ie no rotation of head in relation to the thorax - Entire head and thorax turned to 45 degrees to IR - Spine aligned to CR (and centerline of IR) - Raise chin slightly (extend fractionally so mandible doesn’t superimpose over upper C-spine – raise it too much and base of skull will superimpose over C1) - Hands in neutral position by sides - look straight ahead - if erect – may use bar or chair back to help hold steady d) Any alternatives to body pos ANS – some dept. like you to turn head slightly [some want close to lateral] in order to help prevent superimposition of vertebra by mandible – beware – causes some rotation of upper vertebra and loss of obliquity - If in recumbent position, hands are placed as needed to be comfortable and support the pt rather than at side.
	C-spine – indiv proj’s – oblique C-spine (2x) – positioning part 2 a) CR/IR position b) Marker position c) Use of padding/sponge/weights	C-spine – indiv proj’s – oblique C-spine (2x) – positioning part 2 a) CR/IR position ANS – center of IR at center point of CR ie where C4 is projected to - CR to C4 (level of bottom of thyroid cartilage) - CR centered to IR - in bucky or behind grid b) Marker position ANS – common to put both markers on to avoid confusion as to what the marker is signifying (ie if just a right is added, some might see it a s an indication that that is the right side of the body, others may take it as an indication of the side of IV foramina that we are looking at. - Markers go either bottom R and L or halfway up ie middle at edges (even slightly outside collimation field as scatter will still allow them to be seen) NB. ( Shouldn’t be over anatomy) c) Use of padding/sponge/weights ANS – may need chair etc to use as support or to sit on in trauma situation - If recumbent – may require padding etc to help stabilize the pt and prevent movt artifact
	C-spine – indiv proj’s – oblique C-spine (2x) – techniques/factors (part 1) a) Angle/level of CR b) IR size c) Collimation d) kVp e) mAs	C-spine – indiv proj’s – oblique C-spine (2x) – techniques/factors (part 1) a) Angle/level of CR ANS – CR is centered to level of C4 in midline of C-spine - PA (RAO or LAO) angle CR 15-20 degrees caudad (down) - AP (RPO or LPO) angle CR cephalad (up) b) IR size ANS – 18 x 24 cm lengthways (portrait) c) Collimation ANS – collimate to IR first then adjust in from there. - collimate to C-spine and junctions - have as much of spine top to bottom as possible (may get some of thoracic spine and especially the junction of cervical and thoracic vert) - collimate in on sides so that only a little bit light is seen to the sides of the soft tissue shadow – this way you know that you have all soft tissue on) d) kVp ANS – Bontragers – 75 +/- 5 kVp range - OSCE – 70 kVp e) mAs ANS – Bontragers – 10 - 20 mAs - OSCE – 10 mAs
	C-spine – indiv proj’s – oblique C-spine (2x) – techniques/factors (part 2) a) Grid b) AEC c) FFD d) Respiration e) Dose	C-spine – indiv proj’s – oblique C-spine (2x) – techniques/factors (part 2) a) Grid ANS - Yes always - screen is optional for small pt – partly due to air gap b) AEC ANS – Bontrager says yes – center chamber - try not to (more reliable and potentially lower dose to pt c) FFD ANS – 180 cm maximum (more commonly at higher end of 100-150 cm) - can use smaller FFD to make use of magnification due to larger OID - OSCE – use 170-180 cm FFD d) respiration ANS – Suspend respiration during exposure e) dose ANS – PA (RAO or LAO) Thyroid 5, breast 0 - AP (RPO or LPO) Thyroid 69, breast 4
	C-spine – indiv proj’s – oblique C-spine (2x) – critiquing points a) structures (focus/want to see) b) anatomy that must be included top/bottom/side to side c) rotation wanted/not wanted – how to tell if correct d) position wanted – how to tell if right e) common problems and how to fix	C-spine – indiv proj’s – oblique C-spine (2x) – critiquing points a) structures (focus/want to see) ANS – different for PA and AP - AP – Normally harder & doesn’t sit well with angle of CR and angle of spine - (PO) shows the IV foramina and pedicles of the side away from board - PA – More likely to open iv spaces and demonstrate IV foramina - (AO) Shows the IV foramina and pedicles of the side against the board - C3-C7 IV foramina are open and clearly seen - Cervical pedicles well visualized - Base of skull not superimposed over C1 b) anatomy that must be included top/bottom/side to side ANS – All of C-spine and its articulations - As much spine top to bottom as possible - must include soft tissue at sides of neck c) rotation wanted/not wanted – how to tell if correct ANS – head should be in line with thorax at 45 degree angle to CR (except for those dept where head is turned to stop superimposition) - Correct rotation and CR angulation shown by IV spaces open, IV foramina (C2- C7) open, and pedicles in full profile, - Over or under rotation will narrow/partly obscure IV foramina - On end pedicles should be aligned to the midline of the cervical bodies - Over rotation indicated by visualization of zygoapophyseal joints - Under rot shown by obscured IV foramina d) position wanted – how to tell if right ANS – want head and thorax in line ie no rotation of head in relation to the thorax - Entire head and thorax turned to 45 degrees to IR - Spine aligned to CR (and centerline of IR) - Raise chin slightly (extend fractionally so mandible doesn’t superimpose over upper C-spine – raise it too much and base of skull will superimpose over C1) - Hands in neutral position by sides (if erect – may use bar or chair back to help hold steady or if recumbent – hands may be needed to help stabilize pt) - look straight ahead - Some of the ways to tell if position is right are in above explanation - supporting pt helps reduce motion artifact e) common problems and how to fix ANS – incorrect elevation of chin - correct elevation of chin (rami of mandible not superimposing upper C-vert and base of skull should not superimpose C1)
	C-spine – indiv proj’s – oblique C-spine (2x) – concerns for OSCE a) phantom selection b) phantom placement/positioning + props needed c) exposures used d) limitations to be aware of	C-spine – indiv proj’s – oblique C-spine (2x) – concerns for OSCE a) phantom selection ANS – head (clear) b) phantom placement/positioning + props needed ANS – on top of box and chair c) exposures used ANS – 70 kVp for 10 mAs at 170-180 FFD d) limitations to be aware of ANS – Won’t be able to get chin raised - is pretty hard to get it up high enough to get correct angulation - there won’t be the cervico-thoracic junction on film - no thyroid cartilage to palpate – have to visually center CR to C4/C5
	C-spine – indiv proj’s – Lateral non trauma - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) b) Alt names (if applic) c) When used d) What viewed (basic)	C-spine – indiv proj’s – Lateral non trauma - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) ANS – basic b) Alt names (if applic) ANS – upright lateral (as opposed to a cross table lateral for trauma) c) When used ANS – can be used when pt is able to lie on side or stand/sit against the upright bucky - NB best performed erect unless pt presentation/condition dictates otherwise - Weights only used when pt presentation does not contraindicate their use. d) What viewed (basic) ANS – C1-7 demonstrated - Rami of mandible not superimposed over C1,2 - No rotation - must see base of skull - all of C-vert bodies, IV disc spaces, articular pillars, zygopop joint surfaces and spinous processes - C7/T1 junction
	C-spine – indiv proj’s – Lateral non trauma – positioning part 1 a) Likely pt presentation b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON c) Body part position (eg arms up/out/rotated) d) Any alternatives to body pos	C-spine – indiv proj’s – Lateral non trauma – positioning part 1 a) Likely pt presentation ANS – pt presentation decides how projection is taken. - can have mobile cooperative pt (erect or sitting) - Less mobile/bed ridden but no spinal precautions (recumbent lateral) - This projection NEVER used for trauma spinal precaution patients b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON ANS – erect /sitting is preferred - On table is another option however it is hard to get C-spine into a natural position c) Body part position (eg arms up/out/rotated) ANS – patient coronal plane 90 degrees to IR (or midsagittal plane // to IR) – true lateral position (may need to stand behind pt to check for no rotation) - Shoulder in contact with bucky - Have pt hands behind back - stretch neck up - Raise chin slightly – stops angle of mandible from superimposing upper C-spine - Relax and drop the shoulders – evenly! - Weights (5-10lbs from strap about wrist) may be applied to ‘pull’ the shoulders down in order to visualize C7 – NB pt should not hold them up but let them hang - C-spine should be aligned to the CR (and centerline of IR) - Be careful of unstable pt – may need a low bar or back of chair to help steady - can also help to have shoulders forward to visualize C7 (this is last movt to be made as the position is difficult to maintain d) Any alternatives to body pos ANS -
	C-spine – indiv proj’s – Lateral non trauma – positioning part 2 a) CR/IR position b) Marker position c) Use of padding/sponge/weights	C-spine – indiv proj’s – Lateral non trauma – positioning part 2 a) CR/IR position ANS – IR top should be 3-5 cm above level of EAM. (approx at top curve of ear) - CR is centered to IR - CR 90 degrees to IR - To level of C4 (or C5 – bottom of thyroid cartilage) b) Marker position ANS – close to very top and near to the edge if not slightly outside the collimation field on the side with base of skull or just in front of sternum c) Use of padding/sponge/weights ANS – weights to help depress the shoulders (only if pt is able to) - Sponges help pt to be stable on the table also need support for under head to get C-spine in as natural position as possible - Worth shielding around collimated area. - Radiation protection to radiosensitive areas is recommended – ie breasts and eyes.
	C-spine – indiv proj’s – Lateral non trauma – techniques/factors (part 1) a) Angle/level of CR b) IR size c) Collimation d) kVp e) mAs	C-spine – indiv proj’s – Lateral non trauma – techniques/factors (part 1) a) Angle/level of CR ANS – CR centered to IR -CR to midline of C-spine seen of pt at level of C4 (or C5 – Bontragers) (bottom of thyroid cartilage) - CR is usually 90 degrees to IR however can be angled slightly caudad (down) to try and visualize C7 b) IR size ANS – 18 x 24 cm LW (portrait) c) Collimation ANS – collimate to IR first - include as much lengthways as possible - Top to bottom - must see base of skull and want to see C7-T1 junction - Side to side – want to see all soft tissue structures (allow a little bit of light on either side of soft tissue shadows to allow this) - collimate on four sides to C-spine d) kVp ANS – Bontragers – 75 +/- 5 kVp range - OSCE – 70 kVp e) mAs ANS – Bontragers – 20 – 28 mAs - OSCE – 10-15 mAs
	C-spine – indiv proj’s – Lateral non trauma – techniques/factors (part 2) a) Grid b) AEC c) FFD d) Respiration e) Dose	C-spine – indiv proj’s – Lateral non trauma – techniques/factors (part 2) a) Grid ANS – Yes – almost always – screen is optional for smaller patients – partly due to air gap effect b) AEC ANS – Bontrager says yes – center chamber c) FFD ANS – 150 – 180 FFD - longer SID or FFD provides a better visualization of C7 due to less divergent rays – also gives less magnification to compensate for increased OID [due to shoulder]) - OSCE – 180 cm d) respiration ANS – taken on complete held expiration (shoulders at lowest level – max depression) e) dose ANS – Thyroid 6, Breast 3, - no dose information for eyes – still need to protect them
	C-spine – indiv proj’s – Lateral non trauma – critiquing points a) structures (focus/want to see) b) anatomy that must be included top/bottom/side to side c) rotation wanted/not wanted – how to tell if correct d) position wanted – how to tell if right e) common problems and how to fix	C-spine – indiv proj’s – Lateral non trauma – critiquing points a) structures (focus/want to see) ANS – C1-7 demonstrated plus articulations - All of C-vert bodies, IV disc spaces, articular pillars, zygopop joint surfaces and spinous processes b) anatomy that must be included top/bottom/side to side ANS – top to bottom must see base of skull and want to see C7-T1 junction - Side to side - want to see all soft tissue structures c) rotation wanted/not wanted – how to tell if correct ANS – true lateral wanted with no rotation away from this - No rotation shown by superimposition of both rami of mandible - Rotation of the lower C-vert shows a lack of superimposition of R and L zygopop joints and posterior borders of vert bodies d) position wanted – how to tell if right ANS – true lateral – see above (patient coronal plane 90 degrees to IR [or midsagittal plane // to IR]) - may need to stand behind pt to check for no rotation - Shoulder in contact with bucky - Have pt hands behind back - stretch neck up - Raise chin slightly – stops angle/rami of mandible from superimposing upper C-spine (C1 or C2) - Relax and drop the shoulders – evenly! – Otherwise shows on x-ray and stops visualization of C7 - Weights to ‘pull’ shoulders down to visualize C7 – may not get C7 otherwise - C-spine should be aligned to the CR (and centerline of IR) - If unstable pt – low bar or back of chair to help steady - can also help to have shoulders forward to visualize e) common problems and how to fix ANS – poor centering – level of bottom of thyroid cartilage (palpate) - Patient movement – placing supports against the body to stop movt when on table – when erect, holding the back of a chair or low bar can help stop movt - Inability to demonstrate the C7-T1 disc space – often a supplementary lateral C7-T1 junction swimmers projection is required to visualize this area
	C-spine – indiv proj’s – Lateral non trauma – concerns for OSCE a) phantom selection b) phantom placement/positioning + props needed c) exposures used d) limitations to be aware of	C-spine – indiv proj’s – Lateral non trauma – concerns for OSCE a) phantom selection ANS – clear head b) phantom placement/positioning + props needed ANS – on top of box and chair aligned as required c) exposures used ANS – 70 kVp for 10 mAs at 180 FFD d) limitations to be aware of ANS – Won’t be able to get chin raised - is pretty hard to get it up high enough - there won’t be the cervico-thoracic junction on film - no thyroid cartilage to palpate – have to visually center CR to C4/C5
	T-spine – list projections (1 of 4) Basic proj’s (x2)	T-spine – list projections (1 of 4) - Basic proj’s (x2) 1. – AP thoracic 2. – Lateral thoracic
	T-spine – list projections (2 of 4) Trauma proj’s (x2)	T-spine – list projections (2 of 4) - Trauma proj’s (x2) 1. – AP thoracic trauma 2. – Lateral thoracic trauma (horizontal beam)
	T-spine – list projections (3 of 4) Alt (to basic) proj’s (nil)	T-spine – list projections (3 of 4) - Alt (to basic) proj’s (nil) nil
	T-spine – list projections (4 of 4) Supp (to basic) proj’s (x1 with 2 choices)	T-spine – list projections (4 of 4) - Supp (to basic) proj’s (x1 with 2 choices) 1. – both Right and Left oblique’s (either AP or PA)
	T-spine – indiv proj’s - AP thoracic - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) b) Alt names (if applic) c) When used d) What viewed (basic)	T-spine – indiv proj’s - AP thoracic - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) ANS – Basic – can be for trauma b) Alt names (if applic) ANS - c) When used ANS - d) What viewed (basic) – C7 to L1 -T-vert- bodies, IV joint spaces, spinous and transverse processes - Vertebral bodies well penetrated (even though they have largely different densities - Posterior ribs - Costovertebral articulations - SC joints equidistant from SC (no rot) - No rotation -Sharp bony margins of vert body and IV spaces and trabecular markings must be seen (indicates no movement) - Include as much of the spine top to bottom as possible (ensure firstly that all of T-spine on) - Need to see a portion of the posterior ribs and their articulations with the T- vert.
	T-spine – indiv proj’s - AP thoracic – positioning part 1 a) Likely pt presentation b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON c) Body part position (eg arms up/out/rotated) d) Any alternatives to body pos	T-spine – indiv proj’s - AP thoracic – positioning part 1 a) Likely pt presentation ANS - Many different presentations. Can be -mobile and compliant - Semi mobile - Unconscious - Spine precautions - Intubated/on respirator b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON ANS - Usually supine (mobile and trauma spine precaution patient) - Can be done erect (not often) c) Body part position (eg arms up/out/rotated) ANS – Pt midsagittal plane to CR and to centerline of IR - Back and head in neutral position in contact with the bucky (upright or table) - Have feet at cathode end to take advantage of the anode-cathode heel effect - Flex hips and knees to reduce lordotic curve - Padding under knees for comfort - Arms by side - Pillow for under head - No rotation of head, neck, thorax or pelvis - No rotation (ie. spinous processes and SC joints [if visible] equal distance from SC lat borders) - Shield gonads d) Any alternatives to body pos ANS - Pt can be erect rather than supine – hands slightly out to the side.
	T-spine – indiv proj’s - AP thoracic – positioning part 2 a) CR/IR position b) Marker position c) Use of padding/sponge/weights	T-spine – indiv proj’s - AP thoracic – positioning part 2 a) CR/IR position ANS – IR in bucky (erect or table) - CR at 90 deg to IR (however this may need to be changed for a severely kyphotic patient etc and should be assessed on a case by case basis taking into account degree of curvature present and any limitations of patient) - CR to center of IR - CR at level of T7 as per AP chest (8-10 cm below jugular notch or 3-6 cm below the sternal angle) - IR should be 4 cm above shoulders on a 35 x 43 cm cassette b) Marker position ANS – markers at very top in corner - not covering anatomy c) Use of padding/sponge/weights ANS – padding under knees - Pillow under head - Gonad shielding
	T-spine – indiv proj’s - AP thoracic – techniques/factors (part 1) a) Angle/level of CR b) IR size c) Collimation d) kVp e) mAs	T-spine – indiv proj’s - AP thoracic – techniques/factors (part 1) a) Angle/level of CR ANS – CR at 90 deg to IR - CR to middle of IR - CR to midline of pt at level of T7 (as per AP chest - 8-10 cm below jugular notch or 3-6 cm below the sternal angle) - Depending on pt presentation, there may be so0me level of angulation required to visualize the spine ie in the case of a severely kyphotic pt. b) IR size ANS – Best if have access to long skinny films. - Other option is to use a 35 x 43 cm film c) Collimation ANS – On a 35 x 43 cm cassette sideways – 2 options…… 1) Collimate to skinny section (you control the collimation) 2) Use a T-spine exposure on the CR machine and it automatically only seems this portion. - Long narrow field to T-spine - collimate to film – CR to center of IR – then bring collimators so that there is only about 9 cm each side of midline – include all of IR long ways. - Collimation is set then pt is moved into the right position (can still collimate down but unlikely that you would need to) - Collimation side to side will lie at approx midclav line - NB that this collimation will show as only 4-6 cm each side of midline when projected onto surface of pt but with divergent beams – will translate to approx 9 cm either side of midline on the IR d) kVp ANS – Bontragers – 80 +/- 5 kVp range (12 mAs) Or – 90 +/- kVp range (7 mAs) - for greater latitude - OSCE – 75 kVp - NB though that the best way to image thoracic vertebra is to use a high kVp (up to 95 kVp for lateral thoracic) e) mAs ANS – Bontragers – 12 mAs for (80 +/- 5 kVp range) Or – 7 mAs for (90 +/- kVp range) - OSCE – 15mAs
	T-spine – indiv proj’s - AP thoracic – techniques/factors (part 2) a) Grid b) AEC c) FFD d) Respiration e) Dose	T-spine – indiv proj’s - AP thoracic – techniques/factors (part 2) a) Grid ANS – Yes – moving or stationary Filter – Use wedge filter – thick end at top of pt and thin at feet end. - CR machines have a built in one that does the filtering during processing (Creates the same effect but doesn’t save the pt any dose) b) AEC ANS – Bontrager says yes – center chamber - try not to as thickness of T-spine changes so much and may not get even penetration c) FFD ANS – 100 – 110 cm d) respiration ANS – expose on expiration for more uniform density (reduces air volume in lungs/thorax and gives a more uniform density/brightness) - breathing technique can also be used e) dose ANS - @80 kVp – Thyroid 5, Breast 61 - @ 90 kVp – Thyroid 4, Breast 49
	T-spine – indiv proj’s - AP thoracic – critiquing points a) structures (focus/want to see) b) anatomy that must be included top/bottom/side to side c) rotation wanted/not wanted – how to tell if correct d) position wanted – how to tell if right e) common problems and how to fix	T-spine – indiv proj’s - AP thoracic – critiquing points a) structures (focus/want to see) ANS – C7 to L1 -T-vert- bodies, IV joint spaces, spinous and transverse processes - Vertebral bodies well penetrated (even though they have largely different densities - Posterior ribs - Costovertebral articulations - SC joints equidistant from SC (no rot) - No rotation -Sharp bony margins of vert body and IV spaces and trabecular markings must be seen (indicates no movement) b) anatomy that must be included top/bottom/side to side ANS – Include as much of the spine top to bottom as possible (ensure firstly that all of T- spine on) - Need to see a portion of the posterior ribs and their articulations with the T- vert. c) rotation wanted/not wanted – how to tell if correct ANS – No rotation of the spine or pelvis wanted - SC joints will be equidistant from vert bodies if not rotated. d) position wanted – how to tell if right ANS – Pt midsagittal plane to CR and to centerline of IR (look from pt head to feet) - Feet at cathode end (anode-cathode heel effect) - Flex hips and knees (pad for comfort) to reduce lordotic curve - Arms by side - Pillow for under head - No rotation of head, neck, thorax or pelvis - No rotation (ie. spinous processes in centerline and SC joints [if visible] equal distance from SC lat borders) - Shield gonads e) common problems and how to fix ANS –
	T-spine – indiv proj’s - AP thoracic – concerns for OSCE a) phantom selection b) phantom placement/positioning + props needed c) exposures used d) limitations to be aware of	T-spine – indiv proj’s - AP thoracic – concerns for OSCE a) phantom selection ANS – thorax with no arms b) phantom placement/positioning + props needed ANS – On table laying down (easier) or standing up on a chair/box etc - will probably need sponges to help position it. c) exposures used ANS – 75 kVp for 15 mAs d) limitations to be aware of ANS – remember how the torso would sit if it still had a bum, legs etc - Has a C7/T1 junction (pretty sure) but may not have a T12/L1 junction. - may be hard to tell sternal angle so use the jugular notch and center 10 cm below.
	T-spine – indiv proj’s - Lateral thoracic - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) b) Alt names (if applic) c) When used d) What viewed (basic)	T-spine – indiv proj’s - Lateral thoracic - basic info a) Part of series (basic/trauma/alt to basic/supp to basic) ANS – Basic – Non trauma b) Alt names (if applic) ANS – T-spine lateral non trauma c) When used ANS - d) What viewed (basic) ANS -
	T-spine – indiv proj’s - Lateral thoracic – positioning part 1 a) Likely pt presentation b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON c) Body part position (eg arms up/out/rotated) d) Any alternatives to body pos	T-spine – indiv proj’s - Lateral thoracic – positioning part 1 a) Likely pt presentation ANS - b) Options for overall pos (standing/sitting/lying down) – FOCUS = MOST COMMON ANS – recumbent on table (usual) - Or erect (not so usual but still gives a good image) – chiropractors and some radiologists require functional ie erect views c) Body part position (eg arms up/out/rotated) ANS – recumbent on table lying on side -pt feet at cathode end (anode heel effect) -Support for head and neck - True lateral position of body and head - Hips and knees flexed (may put pillow between them) – increases stability - Arms broughtright up & to the front with elbows flexed (brings scapula off the spine) - Sponge under waist etc in order to get a more natural spine curvature (especially important in those with large shoulders and hips) d) Any alternatives to body pos ANS -

Share This Flashcard Set

Set the Language

Diagnostic Radiography Methods Techniques

Add to Folders

Upgrade to Cram Premium

Card Range To Study

96 Cards in this Set