1Chapter_Positioning_and_Imaging_Principles_RADR1311_Accessible_Summer2020_SC(4)(1) (2).pdf

Positioning and Imaging Principles Chapter 1 5 General Steps to a Radiographic Examination 1. Positioning of body part and alignment with the IR and CR 2. Application of radiation protection – ALARA 3. Selection of exposure factors – kVp & mAs 4. Patient instructions & x-ray exposure 5. Image proces...

Positioning and Imaging Principles Chapter 1 5 General Steps to a Radiographic Examination 1. Positioning of body part and alignment with the IR and CR 2. Application of radiation protection – ALARA 3. Selection of exposure factors – kVp & mAs 4. Patient instructions & x-ray exposure 5. Image processing Image Evaluation Positioning Principles Evaluation Criteria Patient Identification Image Markers Anatomic Side/Positioning Markers Procedure Marker Professional Ethics & Patient Care AIDHET ALARA Evaluation Criteria A systemic format for evaluating radiographs Acceptable vs Optimal 1. Anatomy demonstrated 2. Positioning Placement of body part in relation to IR Correctly positioned Centering of anatomy (CR) Collimation 3. Exposure NO motion (time) Optimal density and contrast 4. Marker placement Correct marker, correct side Evaluation Criteria PA Oblique Finger Patient Identification Double Identifier First and Last Name DOB Check patient’s arm band for confirmation ALL information MUST be correct Patient information will be attached to all radiographs in PACS Image Markers Anatomic Side Right and Left – indicate patient's side or which limb is being radiographed Must be placed within collimation RT(R) identification = 3 initials Procedure Marker Time indicators Position Breathing Image Markers Professional Ethics & Patient Care RT(R) is responsible for your own actions under the ARRT Code of Ethics and ASRT Practice Standards High Integrity The patient is the #1 PRIORITY AIDHET (clinic = AIDET) Consistent method to communicate with patients and gather pertinent information related to a patient’s exam. Acknowledge: Greet the patient by name. Make eye contact, smile, and acknowledge the patient and any family or friends present. Introduce: Introduce yourself with your name and title (student radiographer). Duration: Give an accurate time expectation for the exam/procedure. History: Gather a brief patient history related to the chief complaint or reason for the exam/procedure. Explanation: Provide a brief summary at the beginning of the exam/procedure and confirm with the patient that they will be able to complete the exam. Continue to explain the exam/procedure to the patient as you complete the steps. Answer any questions that patient may have. Thank you: Thank the patient and/or family for choosing “Dallas College Radiology.” Provide the patient with your business card so they can contact you or the hospital if needed. Radiation Protection As Low As Reasonably Achievable Technique chart kVP mAs Time Shielding Essential Projections Projections taught in the lab Routine Projections Basic projections commonly performed on patients that can fully cooperate Special Projections Projections most commonly taken to demonstrate specific anatomic parts, pathologies, or necessary for patients that cannot fully cooperate Adaptations: Projections adapted to meet the patients needs or ability Positioning Routines Minimum of 2 projections 90 degrees from each other Superimposition of anatomic structures Localizations of lesions or foreign bodies Determination of alignment of fractures Positioning Routines Minimum of 3 projections when joints are in area of interest AP or PA Oblique Lateral Exceptions: forearm, humerus, femur, hip, tibfib, chest, abdomen, pelvis, postreduction of upper and lower limbs Positioning Routines Long bones typically only require 2 projections AP Lateral Palpation of Topographic Landmarks Topographic Landmarks: bony landmarks Palpation Applying gentle, light pressure with fingertips pads of your hands directly on the patient to locate positioning landmarks. No poking or prodding with fingertips ALWAYS inform the patient prior to touching them Confirm that you have the patients consent Make sure not to manhandle your patient – use verbal instruction in addition to palpation Topographic Landmarks Bony landmarks used to locate specific structures and organs within the body, many of which are not visible to the eye. Used to ensure accurate positioning of the part and centering of the CR. Styloid Malleolus IR Size and Alignment important consideration for positioning IR sizes – use the smallest size available 8x10, 10x12, 11x14 14x17 - lab 17x17 - clinic IR Orientation - Long axis of the IR aligned with the long axis of the part. Allows the majority of anatomy to the demonstrated Portrait (lengthwise) Landscape (crosswise) Viewing Radiographs Determined by radiologist preference & common practice Patient in anatomic position Patient is facing the RT(R) Patient’s right side is on RT(R) left side Patient’s left side is on RT(R) right side Viewing Radiographs Determined by radiologist preference & common practice Lateral positions – marked with R or L by the side of the patient closest to the IR Viewing Radiographs Determined by radiologist preference & common practice Decub projections – viewed how the x-ray tube “sees” them Viewing Radiographs Determined by radiologist preference & common practice Upper and lower extremities R or L determine side radiographed Finger, hand, wrist, toes, foot are oriented to “hang” with the digits up Viewing Radiographs Determined by radiologist preference & common practice Upper and lower extremities R or L determine side radiographed Finger, hand, wrist, forearm, toes, and foot are oriented with digits up. Elbow, humerus, shoulder, clavicle, ankle, tib-fib, knee, femur, hip are oriented in anatomic position with the limp hanging down. Radiation Protection Minimize dose limits for RT(R) and patient RT(R) Cardinal Principles time, distance, shielding Personal dosimeter Worn near the thyroid Worn at waist for pregnancy ALARA Radiation Protection Minimize dose limits for RT(R) and patient Patient Cardinal Principles time, distance, shielding ALARA Collimate FOV Shield Minimize repeats Procedures Resource http://www.wikiradiography.net/