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Questions and Answers
What is the primary purpose of the anatomic markers in radiography?
What is the primary purpose of the anatomic markers in radiography?
Where should the anatomic markers be placed on a radiograph?
Where should the anatomic markers be placed on a radiograph?
What should never be done when adding markers to a radiograph?
What should never be done when adding markers to a radiograph?
Why is placing markers directly on the body part being imaged not recommended?
Why is placing markers directly on the body part being imaged not recommended?
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What specific equipment is typically used for placing the markers?
What specific equipment is typically used for placing the markers?
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In what situations are exceptions made for the marker placement rules?
In what situations are exceptions made for the marker placement rules?
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What is the legal implication of improper marker placement?
What is the legal implication of improper marker placement?
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What type of markers are commonly used in radiography for identification?
What type of markers are commonly used in radiography for identification?
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What should the marker indicate for lateral projections of the head and trunk?
What should the marker indicate for lateral projections of the head and trunk?
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In a right posterior oblique (RPO) position, where should the marker be placed?
In a right posterior oblique (RPO) position, where should the marker be placed?
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For limb projections done with two images on one IR, how many projections need to be marked?
For limb projections done with two images on one IR, how many projections need to be marked?
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Where should the marker be placed for AP, PA, or oblique chest projections?
Where should the marker be placed for AP, PA, or oblique chest projections?
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For decubitus positions, where should the R or L marker be placed?
For decubitus positions, where should the R or L marker be placed?
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What does the source-to-skin distance (SSD) refer to?
What does the source-to-skin distance (SSD) refer to?
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Why has collimation become a technical issue in radiography recently?
Why has collimation become a technical issue in radiography recently?
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What is the primary purpose of using a collimator in radiography?
What is the primary purpose of using a collimator in radiography?
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Study Notes
Anatomic Markers
- Each radiograph must include a marker to identify the patient's right (R) or left (L) side.
- Markers are made of lead and placed directly on the imaging plate or tabletop.
- Markers should not obscure anatomy or patient identification information. Ideally, place markers on the edge of the collimation border.
- Markers must be placed outside of lead shielding.
- Digitally placing markers is not recommended due to potential errors and legal implications.
- Do not place the markers directly on the body part as distortion may result.
Specific Marker Placement Recommendations
- AP and PA projections: Use R marker for body parts like head, spine, chest, abdomen, and pelvis
- Lateral projections: Mark the side closest to the imaging plate for head and trunk
- Oblique projections: Mark the side closest to the imaging plate
- Limb projections: Markers should be placed within the collimated x-ray beam
- Multiple exposures: Only one projection on an imaging plate needs to be marked in limb projections
- Images side by side: Use markers to clearly identify the two sides
- Chest projections: Place the marker in the upper-outer corner to prevent obscuring the thoracic anatomy.
- Decubitus projections: Mark the side that is up.
Source-to-Skin Distance (SSD)
- The distance between the x-ray tube focal spot (source) and the patient's skin.
- National Council on Radiation Protection (NCRP) recommends a minimum SSD of 12 inches (30cm)and not less that 15 inches (38 cm)
Collimation of X-Ray Beam
- Restrict the x-ray beam to the area of interest only.
- Collimation reduces/minimizes patient exposure to radiation.
- Reduces scatter radiation for better image quality.
- Avoid collimating an area larger than the required field size. This needlessly exposes the patient to unnecessary radiation.
- Manual adjustments with DR systems are crucial.
Gonad Shielding
- Protect the patient's gonads from exposure when imaging the abdomen, pelvis, or hips.
- Shield is recommended when the gonads are in or close to (within 5 cm) the primary x-ray field.
- Use shielding when reproductive potential is moderate to high.
- Gonad shielding is typically necessary during seated imaging of the limbs.
Digits (Second Through Fifth)
- General Procedures: Remove rings, watches, and other non-radiopaque objects. Seat patient comfortably. Position IR for comfort. Direct central ray at a right angle to the midpoint of the IR.
Digits (Second Through Fifth): PA Projections
- Image receptor: 8x10 or 10x12 inches. This can be done lengthwise or crosswise on the same imaging plate. Position patient seated. Position the part with the palmar surface down on the unmasked portion of the IR. Center the digit under examination. Center the PIP joint to the IR.
Digits (Second Through Fifth): Lateral Projections
- Image receptor: 8x10 or 10x12 inches. This can be done lengthwise or crosswise on the same imaging plate. Position patient seated. Position part with the palmar down on the unmasked portion of the IR centered to the PIP joint.
Digits (Second Through Fifth): Evaluation Criteria
- Ensure proper collimation.
- Image should show the entirety of the digit from fingertip to the distal portion of the adjoining part.
- Soft tissue should not overlap from other digits
- No rotation of the digital parts.
- Open IP and MCP joint spaces (without any overlapping)
- Fingernail should be in profile, if visible, and centered in the distal phalanx(if healthy)
- Adequate soft tissue and bony trabecular detail.
First Digit (Thumb)
- General Procedures: Remove rings, watches, and other non-radiopaque objects. Seat patient comfortably. Position IR allowing for comfortable patient position.
First Digit (Thumb): AP Projections
- Place the thumb on the IR surface. Center the MCP joint to the IR. Adjust the position of the hand to ensure a true AP projection of the thumb. Ensure other digits will not cause any superimposition.
First Digit (Thumb): PA Projections
- Position the hand in the lateral position. Rest the elevated and abducted thumb on a radiographic support or hold it up with a radiolucent stick. Centralize the MCP Joint.
First Digit (Thumb): Lateral Projections
- Seat patient, and place hand on the IR, in its natural arched position. Extend the digit of interest. Centralize the MCP joint to the IR. Ensure the long axis of the digit is parallel to the IR.
First Digit (Thumb): PA Oblique Projections
- Place the patient on the radiographic table with the palm or hand resting on the IR. Ensure the thumb is abducted and the ulnar side of the hand faces the IR. Carefully center the MCP joint of the digit to the IR. Shield gonads.
First Digit (Thumb): Evaluation Criteria
- Ensure proper collimation,
- Show entire digit including the base of the adjoining metacarpal,
- No tissue overlap from other digits,
- No rotation,
- Open IP and MCP joint space,
- Presence and positioning of a thumbnail (if present),
- Adequate soft tissue and bony trabecular detail; with a magnified view
Foot
- Fourteen phalanges
- Five metatarsals
- Seven tarsals
Forearm
- General Procedures and specific anatomical features are addressed to prevent elongation or foreshortening of the bones during the procedure. Position of patient is described as sitting or lying down, dependent on availability
- Specific Anatomical features should be accurately documented to prevent any errors or misunderstanding
- All images should show the appropriate part, and proper collimation
- Proper central ray and appropriate body positioning
Knee
- General Procedures and positions of parts are addressed
- Evaluation criteria should include evidence of proper collimation, the knee or joints free of rotation or distortion, appropriate soft tissue and bony details, and any other anatomical features
Lateral Cervical Spine: Hyperflexion and Hyperextension
- The procedure should only be performed when cervical spine pathology or fracture has been ruled out.
- The position of the patient is described for both seated and supine procedures for greater patient comfort and accurate positioning for appropriate analysis.
- The positioning of the patient's head is very important to obtain the true lateral view of the Cervical Spine.
- Central ray orientation should be perpendicular to the center of the image
Axiolateral Projection
- The procedure is used to show the region of the mandible that's the same level as the image receptor (IR)
- Positioning of the patient is described and anatomical features are presented
- The evaluation criteria should show the image quality, and the anatomy should be correctly visualized with no distortions or rotations
- The use of a vertical grid device is recommended for accurate adjustments to produce the radiographic images
PA Projection: Anterior Pelvic Bones
- Positioning of the parts, and position of the patient is described to assure a correct anatomical location
- Imaging should show the appropriate view for the examination and use an appropriate receptor
Paranasal Sinuses
- The procedure should be performed with the patient in the upright body position and the horizontal direction of the central ray.
- Positioning of the patient and parts is described for proper technique in accordance with anatomical guidelines
- Procedure requirements should be checked to confirm image quality
- The appropriate angular relationship between the structures in the image to ensure proper visualization
Ribs (details)
- The procedure is described by positioning patient upright or lying down.
- The body position(s) are described
- The placement of the image receptor is in detail, and how to position the patient to prevent superimposition of the structures of interest
- Evaluation criteria should be checked for accuracy
Other Joints
- Procedures are explained according to the desired view
- Patient position and body part positioning is clearly explained to assure proper results, and anatomical structures shown
- Evaluation criteria are presented so the examiner can review and verify the quality of the images received
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