Post on 22-Nov-2014
description
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Clinical I~~~
Chest & Abdomen~~~~~
Image Review
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The following information is only a personal suggested guideline to follow when positioning for Chest and
Abdomen radiologic exams.
For additional information on positioning of these
exams, please reference your Radiographic
Positioning and Related Anatomy Textbook.
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ChestImages
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Hypersthenic- IR is crosswise Asthenic-IR is lengthwise
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Chest*Good
positioning Images will
always be on the right.
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Trachea
Apex
Aortic knob
Hilum
Heart
Breast
CostophrenicAngle
Diaphragm
Lung base
Mediastinum
Scapula
Clavicles equal
3 ribs above clavicle
Posterior rib
Air in stomach
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PA Uprt Chest• CR to IR• SID 72”• Anterior body against Uprt Bucky• Direct CR horizontally to T7• Collimate/place marker• Shield• Suspend Respiration on 2nd Inspiration• Visualize apices to costophrenic angles. and at least 10 ribs
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◄Bra Bra ►
◄ necklace &nipple piercings PLUS poor centering!
ASK… Do you have any metal on under your gown?
Artifacts? Internal
or ? External
Glasses ►
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◄Back brace
Dreads ►
◄Cough drops
More Artifacts
Wet hair ►
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Idiot▲
More artifacts
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Exposure errors – Double exposures - Make sure you keep track of which IR plates have already been exposed!
Repeatable error?
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Repeatable error? Positioning - Chin is in the way of anatomy and clipped apex
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More double exposures!
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Repeatable error? Positioning - Chin is in the way of anatomy
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Repeatable error?
Positioning - Chin is in the way of anatomy
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Repeatable error? Positioning - Clipped anatomy
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Repeatable error? Positioning - Clipped anatomy
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Repeatable error? Positioning - Clipped anatomy
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Repeatable error?
Positioning –Clipped anatomy and artifact
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Repeatable error? w/ Pathology Positioning - Clipped anatomy Pathology - Tumor left lung
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Repeatable error? Positioning - Rotation
*Clavicles should be equal distance away from the spine!
See above.
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Repeatable error?
Positioning - Rotation
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Repeatable error?
Positioning - Rotation
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Repeatable error? Rotation and too many wires in the way
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Repeatable errors? Collimation/CR - Incorrect CR.Positioning - chin in anatomy and rotation.
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For AP Chest imaging, the correct CR angle will produce the visualization of 3 ribs above the clavicles. Anything more or less than that could be because of poor CR angle.
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Repeatable errors -
Positioning - Incorrect patient contact with the IR
Collimation/CR - Incorrect CR to IR. This will cause an apical lordotic image and/or possible grid cut-off
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Repeatable error?
Collimation/CR - Incorrect CR angle
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Repeatable errors? Collimation/CR - Incorrect CR anglePositioning - Clipped anatomy
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Repeatable error? Collimation/CR - Incorrect CR angle
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Pathology -
Pulmonary Edema (“Bat Wings”)
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Pathology - Pleural Effusion
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Pathology - Large amount of Pleural Effusion
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Most common AP/PA Chest Errors
1.Artifacts - accidental2.Clipped anatomy3.Chin in the way4.Rotation5.Marker misuse6.Poor CR angle
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AP or PA Decubitus Chest• CR horizontal and to IR
• SID 56-72”• Body is recumbent & against IR or Uprt
Bucky, ensure arms are out of the way of chest anatomy
• Direct CR horizontally to T7• Collimate/place marker• Shield• Suspend Respiration on 2nd Inspiration• Visualize apices to costophrenic angles. and at least 10 ribs
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Repeatable error?
Positioning - Arm is obscuring lung anatomy
Left side down Decubitus
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Repeatable error?
Positioning - Both Breasts are Obscuring lung anatomy
Right side down Decubitus Chest
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Decubitus Pathology – Pleural Effusion
Right side down Decubitus Chest
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Most common Decubitus Chest Positioning Errors
1. Rotation2. Marker misuse3. Clipped anatomy
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Protocols for Decubitus Chest X-rays
*Remember:Air goes UP
AndFluid goes DOWN
(Abdomen Decubitus ALWAYS goes Left side down! WHY?)
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Pathology -
Pneumonia
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Pathology -
Cardiomegaly w/ pacemaker.
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Pathology -
SUPER Cardiomegaly
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Pathology -
Situs Inverses**Markers are only proof!
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Pathology - Scoliosis
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Pathology - Tortious Aorta
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Pathology - Left Lobectomy/Pneumonectomy
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Pathology - Pneumothorax
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Pathology - Pneumothorax with lung collapse.
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Pathology - Pneumothorax with lung collapse.
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Pathology - Pneumothorax with bilateral lung collapse.
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Pathology - Lung mass
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Pathology - Lung mass in an Infant
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Pathology - Subcutaneous Emphysema
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Pathology - Breast Implants - saline
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Pathology - Breast Implants - silicone
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Pathology -
Pt. is missing an arm and clavicle
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Pathology -
Congenital abnormality
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Pathology - Colon is in the chest cavity.
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Pathology - Colon is in the chest cavity.
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Pathology -
Gun shot
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Pathology - Gun shot/bullet….but where? The Heart?
63Pathology - Gun shot/bullet in the back muscle
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Pathology -
Gun shot/bullet….in the spine. With Plural Effusion
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Pathology -
Calcified lung
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Pathology – Cystic fibrous
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Pathology & Positioning error & Artifact
Lung Abscess – clipped anatomy – pen in pocket
68Pathology – Meth use
43yo female ~ Aug 2007 43yo female ~ Aug 2006
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Pathology – Lung cancer
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Pathology – MAC InfectionMycobacterium Avium-intracellular
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Pathology – Metastases
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Pathology –
External Artificial Heart
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Pathology –
Internal Artificial Heart
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Pathology – Previous Surgery to the thorax
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Pathology – Free Air/Pneumoperitoneum
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Pathology – Free Air/Pneumoperitoneum
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Uprt Lateral Chest• CR to IR• SID 72”• Left side of patient is against the Uprt
Bucky• Direct CR horizontally to T7• Collimate/place marker• Shield• Suspend Respiration on 2nd Inspiration• Visualize apices to costophrenic angles. and at least 10 ribs
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Apex
Hilum
Thoracic Spine
Intervertebral Disc space
Costophrenic Angle
Lung base
Heart
Scapulae
Arm shadow Aorta
Treachea
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Repeatable error? Positioning - Know where your IR is & make sure the CR is centered to it.
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Repeatable error? Positioning – ArtifactHeart monitor wires are in the anatomy
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Repeatable error? Positioning – Rotation with clipped anatomy
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Repeatable error? Positioning - Rotation
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Repeatable error? Positioning - Rotation
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Repeatable error? Positioning - Rotation
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Repeatable error?Positioning - Anatomy is obscured by the wheelchair. Need to use a sponge behind the patient’s back.
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Repeatable errors? Collimation/CR – CR is centered too high. Artifact – Wheelchair arm
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Repeatable errors? Collimation/CR – poor CenteringCausing clipped anatomy
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Repeatable error?
Collimation/CR – poor centeringCausing clipped anatomy
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Repeatable error? Collimation/CR – centering too lowCausing clipped anatomy
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Repeatable error? Collimation/CR – poor centeringCausing clipped anatomy & tumor
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Repeatable error? Collimation/CR – poor centeringCausing clipped anatomy
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Repeatable error? Collimation/CR – poor centeringCausing clipped anatomy
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Repeatable errors?
Collimation/CR – poor centeringCausing clipped anatomyExposure - motion
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Most common Lateral Chest Errors
1.Clipped anatomy2.Rotation3.Marker misuse
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Supine & Uprt Abdomen
• CR to IR• SID 40”• supine on table or uprt• Direct CR to crest for supine or 2”
above the crest for the uprt• Collimate/place marker• Shield (only when doing 2 crosswise)• Suspend Respiration on Expiration
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Repeatable errors?
ASK- Do you have any metal on under your gown??Anatomy Demonstrated – Artifacts in the way of anatomy
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Repeatable errors?
ASK- Do you have any metal on under your blankets??
Anatomy Demonstrated – Artifacts in the way of anatomy
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Repeatable error? Not always… Anatomy demonstrated - Artifact vs. Foreign Body – Patient swallowed a coin
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Repeatable error? Not always… Anatomy demonstrated - Artifact vs. Foreign Body – Patient swallowed stuff (chains)
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Repeatable error? Not always…Anatomy demonstrated - Artifact vs. Foreign Body – Patient swallowed an earring.
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Repeatable error? Not always… Anatomy demonstrated - Artifact vs. Foreign Body – Patient swallowed a battery.
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Repeatable error? Not always… Anatomy demonstrated - Artifact vs. Foreign Body – Patient swallowed a lot of stuff!
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Repeatable error?Anatomy demonstrated – Artifact vs. Foreign Body???
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Foreign Body - Hx of previous Abd surgery with post surgical Abd Pain
Oops… Forceps left in patient after surgery.
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Repeatable error? Not always…
Patient did not swallow?
Anatomy demonstrated – Artifact vs. Foreign Body???
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Repeatable errors?Anatomy Demonstrated - patienthand in anatomy.Exposure – too light
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Repeatable errors?Anatomy Demonstrated – Patient hand in anatomy.Markers - Poor annotation placement, should have used markers.
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Repeatable error? Collimation/CR – CR not centered to IRKnow where the IR plate is.
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Repeatable error?Collimation/CR – CR not centered to IRKnow where the IR plate is.
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Repeatable error? Positioning - Clipped anatomy
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Repeatable error? Positioning - Clipped anatomy
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Repeatable error? Positioning - Clipped anatomy
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Repeatable error? Positioning – Rotation &Clipped anatomy
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Repeatable error? Markers – are obscuring anatomy
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It is extremely important to shield those who are of child bearing years.
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Pathology -
Scoliosis
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Pathology - Gallbladder stones
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Pathology -
Gun Shot
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Pathology - Gun Shot
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Pathology - Aorta Aneurysm coiling/repair
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Pathology - myeloma
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Pathology - Surgery to back with hardware
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Pathology -
Free air/Pneumoperitoneum
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Pathology -
Free Air/Pneumoperitoneum
Left Lateral Decub
Supine
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Pathology - Free Air/Pneumoperitoneum
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Pathology -
Free Air/Pneumoperitoneum
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Most common Supine & Uprt Abdomen Errors
1.Artifacts accidental and intentional
2.CR not centered to IR3.Rotation4.Marker misuse
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AP or PA Decubitus Abdomen
• CR horizontal and to IR• SID 40”• Body is LEFT side down recumbent,
ensure the back or abdomen is ǁ with IR & arms are out of the way of anatomy
• Direct CR horizontally to 2” above crest• Collimate/place marker• Shield• Suspend Respiration on expiration
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Repeatable error ?
Positioning - Rotation
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Pathology -
Small bowel obstruction with free air
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Pathology -
Free Air/Pneumoperitoneum
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Pathology - Free Air/Pneumoperitoneum
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Most common Decubitus Abdomen Errors
1. Rotation2. Marker misuse3. Clipped anatomy
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~ The End ~