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Rad Positioning I

ALARA "As Low As Reasonably Achievable"
4 types of image receptors 1)cassette w/ film 2)PSP IP- Photostimulable Storage Phosphor Image Plate 3)DR- Solid State Digital Detector 4)Fluoroscopic Image Receptor
What information must be on every radiograph? 1)Date of exam 2)patient's name or ID number 3)institution where exam was done 4)right or left anatomical marker
Anatomic Markers -must be on every image -can be placed laterally or anteriorly (u will never have choice of both) -cannot be in any anatomy or interfere w/ image ID
Gonadal Shielding Guidelines per book 1)if gonads lie w/i or will be w/i 5cm of primary beam 2)when exam will not be compromised 3)if patient has reproductive potential
Scale of Contrast -controlled by kvp -HIGH kvp:LONG or LOW scale;many shades of grey (chest or abdomen) -LOW kvp:SHORT or HIGH scale;black and white (bone work: knee,hand,shoulder,etc)
Body Planes Sagittal and Midsaggital Coronal and Midcoronal Horizontal Transverse Axial Oblique
Additional Body Planes Interiliac plane:transacting trunk at tops of iliac crests Occlusal plane:formed by biting surfaces of teeth
Topographical Landmarks C5, thyroid cartilage T2,T3 jugular notch T4,T5 sternal angle T7 inferior angle of scapula T9,T10 xiphoid process L2,L3 inferior costal margin L4,L5 iliac crest S1 ASIS (anterior superior iliac spine) Coccyx,pubic symphysis,& greater trochanters
Projection definition Path of central ray as it enters and exits patient and hits IR
Axial Projection Angled 10° or more Angled toward feet (caudal/caudad) or head (cephalic/cephalad)
Tangential Projection Central ray skims surface of area of interest Ex:xray of patella of knee or zygomatic arch of skull,etc.
Lateral Projection Named by side closest to IR
Lateromedial and Mediolateral Central ray enters lateral aspect and exits medial aspect *thumb side is always lateral side*
Position: Right or Left Anterior Oblique Recumbent Projection: Posteroanterior Oblique
Position: Right or Left Posterior Oblique Recumbent Projection: Anteroposterior Oblique
Position: Right or Left Lateral Erect or Lateral Recumbent Projection: Right or Left Lateral
Decubitus ALWAYS a position, NEVER a projection Central ray is horizontal and patient is lying down
3 Decubitus Positions Named for what surface of body patient is lying on 1)right or left lateral decubitus 2)dorsal decubitus 3)ventral decubitus
Position: Right or Left Lateral Decubitus Projection: anteroposterior or posteroanterior depending on placement of the IR
Position: Dorsal Decubitus or Ventral Decubitus Projection: Left or Right Lateral, depending on which side is closest to the IR
Lordotic Position Posterior erect position standing a foot from the wall bucky and leaning against it creating an angulation of the central ray. Projection: Anteroposterior Axial Central ray direction: cephalic
Compensating Filters Used to improve image quality on anatomical parts with varying tissue density
Contents of thoracic cavity Heart,lungs, respiratory organs, cardiovascular system, lymphatic system, esophagus, and thymus gland
3 Chambers of Thoracic Cavity 1)pericardial 2)right pleural 3)left pleural
Mediastinum:Between Lungs
Contains "THET" T-thymus gland H-heart and great vessels E-esophagus T-trachea
Pharynx 3 Sections: 1)nasopharynx 2)oropharynx 3)laryngopharynx
Trachea -16 to 20 "c" shaped cartilage rings -down the Midsaggital plane -anterior to esophagus -c6 to t4,T5 (sternal angle) -bifurcation at carina
Larynx (voice box) Suspended from hyoid bone. Epiglottis situated above opening to prevent food from entering trachea. Framework consists of cartilage (thyroid and cricoid)
Right Lung Right lung has 3 lobes (superior,middle,and inferior) separated by horizontal fissure and Oblique fissure. Apex to costophrenic angle. Contains Hilum.
Left lung 2 lobes (superior and inferior) separated by Oblique fissure. Has cardiac notch where the heart rests. Apex to costophrenic angles. Contains Hilum.
Hilum Depression in the lung where bronchi and vessels pass. Visible on lateral xrays.
Lung movement during respiration -inspiration:inferior movement (fills costophrenic angles) -expiration:superior movement
Pleura around each lung Visceral layer:inner Parietal layer: outer B/w layers called Pleural Cavity
Esophagus Connects pharynx to stomach. Posterior to trachea. Esophageal hiatus: passageway through diaphragm for esophagus to get to stomach
Thymus Temporary. Decreases in size with age. Associated with the immune system.
Radiography of heart and lungs Done erect for 3 reasons: 1)prevents engorgement of pulmonary vessels 2)allows diaphragm to reach lowest position allowing max visualization of lungs 3)shows free air/fluid levels
Left Lateral Projection Places heart closer to film to reduce magnification
Posteroanterior Gets heart closer to film. Erect anterior position. Rotation evidenced by sternoclavicular joints (equidistant from Midsaggital means no rotation)
Evidence of lateral rotation If ribs are not superimposed there's some rotation.
Evidence of proper breathing-chest 10 Posterior ribs above right hemidiaphragm.
Pneumothorax Air in pleural cavity
Atelectasis Full or partial collapse of lungs
Pleural effusion Fluid in pleural cavity
Technical Preparation:kVp High kvp yields a long or low scale of contrast. (Chest xray:faint visualization of thoracic spine through shadow of heart) Low kvp yields high or short scale of contrast.
What can be seen on properly penetrated chest? Apex,carina,costophrenic angles, clavicle,aortic arch,heart, ribs,trachea, and right and left hemidiaphragms
When is shielding used? 1)if patient has reproductive potential 2)if gonads lie w/i 5cm of primary beam 3)if it won't compromise exam
All Chest Exams Are: -done at 72" SID on 14"by17" -exposure on 2nd inspiration -patient shielded -central ray perpendicular to T7@MSP -entire lung field shown
Left Lateral Projection -Position:erect left lateral -Central ray:perpendicular at T7 down MCP -exposure at end of 2nd inspiration -Rotation? Superimposed ribs or not.
Supine Chest Projection:anteroposterior SID as high as possible Central ray:perp to T7 down MSP,3" below jugular notch. Notate position and SID on film
Posteroanterior Oblique Projections Position:erect RAO or LAO Central ray:perp to midthorax at T7 sagittal If positioned correctly, side of interest will appear twice as wide. "PA away"=side of int. away from IR
Anteroposterior Oblique Projections Patient in RPO or LPO position. Side of interest closer to film. Central ray 3" below jugular notch on sagittal plane.
AP Axial/Lordotic Positions Central ray perp to Midsaggital plane at midsternum. SID is 72". Look at clavicular symmetry to check for rotation. Apices should be free of clavicular superimposition.
Decubitus Position Right lateral decubitus or left lateral decubitus: raise patient 2" or 3" w/ decub sponge. IR 1.5"-2" above shoulders. Central ray:horiz.& perp. to T7@MSP
Right and Left Lateral Decubitus Position Used to rule out pleural effusion or pneumothorax. Air up, fluid down
Dorsal Decubitus Right or left lateral projection. Center Midcoronal plane to midpoint of IR. Central ray:horiz.&perp.to 3"-4" below jugular notch @ MCP
Situs inversus All internal organs on opposite side
Dextrocardia Heart on opposite side
Hemothorax Blood in pleural cavity
Emphysema Over inflation of alveolar. Evidenced by "barrel chest"
Contents of Abdominal Stomach, intestines, liver, gallbladder, spleen, pancreas, kidneys & ureters
Pelvic Cavity 1)rectum 2)urinary bladder 3)reproductive organs
Addison's Planes Rt Hypochondrium/epigastrium/Lt hypochondrium Rt lateral/umbilical/left lateral Rt inguinal/hypogastrium/lt inguinal
Abdominal Landmarks L2,L3:inferior costal L4,L5:iliac crest S1,S2:Anterior superior iliac spine Greater Trochanters: -Pubic symphysis -Coccyx
Anatomy of Digestive System "SAMPLES" Small intestine,anus,mouth,pharynx, large intestine,esophagus, stomach
Pneumoperitoneum Free air in the peritoneal cavity
KUB Correct Exposure Technique -Lower border of liver -l&r kidneys -l&r psoas muscles -lower ribs -transverse process of lumbar spine
Abdominal projections/positions Ap/supine Ap/erect Posterior Left lateral decubitus Dorsal decubitus PA or ap cxr may be included
Hysterosalpingogram Shows where female reproductive organs are located
Aneurysm Abnormal widening of blood vessel
Ascites Accumulation of fluid in peritoneal cavity
Created by: Rsuter