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Positioning 2 > Midterm positioning review > Flashcards

Midterm positioning review Flashcards

1
Q

C-Spine Routine:

A

15° AP Axial

AP Obliques

AP Odontoid

Lateral

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2
Q

Lateral C-spine

A
  • •180cm SID
  • Wall detector
  • •Facing left in true lateral
  • •L shoulder against IR
  • •Stable stance
  • •Look straight ahead
  • •Depress shoulders
  • •raise chin slightly (AML // to floor) (acanthomeatal line)
  • **pt reaches for floor to drop shoulders**
  • •Center along midcoronal plane
  • •Crosshair ~@ thyroid cartilage
  • -top: include just above top of ear (to include sella turcica)
  • •Bottom: include vertebral prominence (slightly above jugular notch)
  • •Rotate collimator to align w/neck
  • •Now collimate to soft tissue side-to-side
  • •Middle: along midcoronal plane
  • •Marker in light or behind mandible on correct side
  • •breathe in, breathe out, hold
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3
Q

AP Axial C-Spine

A
  • •110cm
  • Wall detector
  • •15° cephalad
  • •Turn pt w/back against IR
  • •Head against IR
  • •chin raised
  • ***can collimate tight on soft tissue laterally, anatomy of interest is spine***
  • •top@~1cm above mandible• jaw at correct angle when matches top of light field
  • •Bottom INCLUDES jugular notch
  • •Crosshair @ thyroid cartilage/midsagittal
  • •side-to-side soft tissue neck
  • •marker upper corner
  • don’t breathe
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4
Q

AP Odontoid

A
  • •110cm
  • •Straight ray
  • •Raise IR and tube to mouth ht
  • •ALIGN DETECTOR
  • Teela tip:
  • •Start w/ lil 10x10 square, place marker&ctr to lips
  • •open collimation width out to mastoid tip
  • •Align tips of upper incisors with mastoid to crosshair
  • •drop tube ht by 1cm (REALIGN DETECTOR)
  • •increase horiz. Collimation back to 1finger past mouth
  • •hold pt head and have them open bottom jaw
  • don’t breathe
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5
Q

AP Oblique C-Spine

A
  • •110cm
  • •15° cephalad
  • •ALIGN DETECTOR
  • •pt stands @ 45° LPO (or RPO)
  • •Turn pt’s head & lift chin into true lateral to move mandible off c-spine
  • •can tilt collimator aligned with neck here
  • •top @ EAM (earhole)
  • •Bottom @ jugular notch
  • •Crosshair @ thyroid cartilage level
  • •Mark appropriate side in light/behind nose
  • don’t breathe
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6
Q

T-Spine Routine

A

AP

Lateral

Swimmer’s

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7
Q

AP T-spine

A
  • •@ Table
  • •SID 110cm
  • •pillow moved out a bit to avoid artifact
  • •pt supine w/arms @ sides
  • •slightly flex knees&hips (to flatten spine)
  • •watch for rotation of thorax & pelvis
  • •is pt aligned to IR?
  • **Don’t be afraid to pull tube towards self to check diverging rays**
  • Goal: incl. C7-L1
  • •top @ 5cm above jugular notch (to include C7) (about @ top of shoulder)
  • •bottom @ 2.5cm above LCM ***in single detector rooms- dual detector closer to LCM***
  • •ctr halfway btw those points
  • •side-side ~to edges of neck
  • •marker **we know light field width &height- slip marker diagonal under neck & shoulder**
  • •breathe in, breathe out, hold
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8
Q

Lateral T-Spine

A
  • •Supine•SID 110 cm
  • •CR perpendicular to IR
  • •Center T7, in posterior half of thorax
  • •Collimate to include jugular notch and LCM, and to include spinous processes
  • •Suspend respiration on inspiration
  • •Marker on crosshair anterior or top corner of light field on anterior side (axilla)
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9
Q

T-Spine Swimmer’s

A
  • •SID 110cm for recumbent(t-spine)
  • •or 180 cm for standing (c-spine)
  • •5°caudad angle
  • •keep pt on their side
  • •steal the pillow
  • •use L arm as pillow out straight
  • •stack shoulders
  • •R arm on side reaching for toes
  • Teela tip: her hand incl. thumb width on table either side of crosshair, and put top @thyroid cartilage.
    Front-back, ctr on neck, collimate to width of neck.
    tilt collimator to angle of shooting through earhole
    Center to about 1 finger of light behind spinous processes
  • -top @ C5 (laryngeal prominence)
  • •bottom @ jugular notch (T2/3) (on table)
  • •ctr @level of vertebra prominens (junction where shoulder becomes neck) (on pt)
  • •anterior clip a tiny bit
  • •posterior: 1 finger width light
  • •For c-spine swimmer, go below jugular notch to thyroid cartilage (px can point to it or can swallow)
  • •rotate collimator for neck alignment
  • •marker upper L corner
  • •breathe in, breathe out, hold
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10
Q

L-Spine Routine:

A

AP

Lateral

L5/S1

Obliques

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11
Q

AP L-Spine

A
  • •110cm SID
  • •Table detector
  • •Patient supine
  • •knees flexed to reduce lordotic curve
  • •watch for tilt and rotation• people often favour a side!
  • •Goal: T12/L1 to bottom SI joints (with diverging rays)
  • •Center @ L3 between LCM and TOP of iliac crests
  • •Bottom @ just below inferior margin of ASIS (on table)
  • -side-side: 5cm medial to ASIS on patient
  • •(Top @ T12•L1)
  • •Shield long bones
  • •marker placement: on crosshair on top of patient
  • •breathe in, breathe out, hold
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12
Q

Lateral L-Spine

A
  • •110cm SID
  • •Table detector
  • •L lateral like all spines
  • •pt on their side
  • •double up pillow
  • •hips & shoulders stacked
  • •check spine for hip dip & use sponge
  • •goal: T12/L1 to bottom SI joints (with diverging rays)
  • •center: •@ L3 between LCM and TOP of iliac crests
    •JUST posterior to midcoronal plane
  • •bottom @ just below inferior margin of ASIS (on table)
  • •anteriorly 2cm posterior to ASIS
  • (•top will be @ T12•L1)
  • (•Posterior edge is where it is)
  • •Shield long bones
  • •marker placement: inferior anterior corner (L marker)
  • •breathe in, breathe out, hold
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13
Q

L5 •S1 Spot

A
  • •5° Caudad Angle
  • (align detector)
  • •110cm SID
  • •Table detector
  • •patient stays in lateral
  • •Goal: L5 body – S2, L5•S1 joint space
  • •Center ~4•5cm inferior to iliac crest
  • ~4•5 cm posterior to ASIS
  • •make field 14cm x 14cm
  • •Shield long bones
  • •marker inferior anterior corner (L)
  • •breathe in, breathe out, hold
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14
Q

Oblique L-Spine

A
  • •REMOVE TUBE ANGLE
  • (align detector)
  • •110cm SID
  • •Table detector
  • •Pt scooches to one side & rolls up, place 45° wedge under hips & shoulders
  • •legs straightish
  • •cross upside arm to opposite shoulder last
  • •Goal: T12/L1 to bottom SI joints (with diverging rays)
  • •Center: •between LCM and TOP of iliac crests (like always)
    •~5cm medial from upside ASIS on patient
  • •Make ASIS bottom lateral corner of light field on patient
  • •**avoid having the medial side of light past midsagittal**
  • (-top @ T12•L1)
  • •Checking vertical: From head palpate vertebra prominens to find spine line. Center over this imaginary spine line.
  • (AKA about halfway btw midsagittal plane & midcoronal plane)
  • •Shield long bones
  • •marker anatomical upside ~on crosshair
  • •breathe in, breathe out, hold
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15
Q

SI Joint Routine:

A

AP Axial

AP Oblique

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16
Q

AP Axial SI Joint

A
  • •110cm SID
  • • 30°to 35° cephalad angle room 1 and 3 manually measure SID to detector
  • •(align detector)
  • •supine
  • •legs straight
  • •check for tilt/rotation from head of table
  • •check for alignment to table too
  • center:•midsagittal
    •5cm inferior to ASIS
  • ***AKA halfway btw ASIS and symph/trochanters***
  • •superior border : @ ASIS on patient
  • @ just below top of crest in diverging rays
  • •inferior border: @symph on patient (trochanter ht)
  • •vertical collimation ≈ 8•10cm
  • •crosswise: 2 fingers medial to SI joints
  • •PLACE SHIELD
  • •marker on anatomical side in top corner
  • don’t breathe
17
Q

AP Oblique SI Joint

A
  • •REMOVE TUBE ANGLE
  • (align detector)
  • •110cm SID
  • •(ROOM 4: ALL THE SPONGES UNDER PATIENT)
  • •want 25-30 degree oblique
  • •Legs straight
  • •patient aligned to table (check from head end)
  • center: •slightly lower than @ ASIS
    •2cm•2.5cm medial to upside ASIS
  • •lateral border on pt @ASIS
  • •vertical collimation ≈ 8•10cm
  • •PLACE SHIELD
  • •(anatomical upside) marker upper lateral corner
  • don’t breathe
18
Q

Sacrum Routine:

A

AP Axial

Lateral

19
Q

AP Axial Sacrum

A
  • •15° cephalad angle
  • •(align detector)
  • •110cm SID
  • •supine
  • •legs straight
  • • from head of table check for tilt/rotation/alignment to table
  • Center:•midsagittal
    •5cm superior to symph (palpate trochanters)
    ***AKA halfway btw ASIS and symph/trochanters)***
  • •superior border : ~@ ASIS on patient
    ***slightly above iliac crest on table***
  • •inferior border: ~@symph
    ***@ trochanter ht on table***
  • •vertical collimation ≈ about a hand’s height
  • •crosswise: video says 5cm medial to ASISes
  • •PLACE SHIELD
  • •marker on anatomical side in top corner
  • •(don’t)
20
Q

Lateral Sacrum and Coccyx

A
  • SID 110 cm
  • CR perpendicular to IR
  • Center 8-10 cm posterior to ASIS
  • Collimate side to side to include L5S1 in top anterior corner and posterior portion ofsacrum. Up and down collimation to entire sacrum and coccyx.
  • Pull tube out to check diverging rays, on the table the upper limit of the light is the iliaccrest and the lower limit is the greater trochanter.
  • Suspend respiration
  • Marker on crosshair, anterior of patient
21
Q

Chest Routine:

A

PA

Lateral

22
Q

PA Chest

A
  • •DETECTOR MUST BE CLEANED BEFORE FACE TOUCHES IT
  • •180cm SID
  • •set wall detector
  • •tracking on
  • •rolling shield ready
  • •pt standing facing detector (or sitting)
  • •will roll shoulders forward (after palpating inferior margin ht)
  • •chin somewhat elevated (doesn’t have to be in the notch)
  • •hug the detector
  • Broader shoulders often require landscape
  • Superior border •@vertebra prominens on pt
    •@just above shoulders on detector
  • •inferior border @ LCM
  • •side-to-side to AC joints
  • •CTR (not priority for this position): •midsagittal
    •near T-7 (@ or below inferior margin before shoulders rolled)
  • •rolling shield
  • •R/L and ↑/upright in superior lateral corner
  • •breathe in, breathe out, breathe in, hold
23
Q

Lateral Chest

A
  • •180cm SID
  • •use overhead bar
  • •tracking on
  • •pt standing in left lateral against detector
  • •holding bar (arms through)- arms as high as possible
  • •spine as straight as possible, watch kyphotic & lordotic curves
  • •watch for rotation
  • •Superior border @vertebra prominens
  • •inferior @ LCM
  • •posterior @ ≤1cm behind back
  • •anterior @ include sternum
  • •L and ↑/upright in superior anterior corner -patients w/breasts bring L arm down while we place markers
  • •breathe in, breathe out, breathe in, hold
24
Q

Chest: Other

A

AP Chest

25
Q

AP Chest (supine)

A
  • •biggest SID
  • (•bontrager wants 5° caudad)
  • •table lowest
  • •tube highest
  • •pull pillow out like t-spine
  • •supine on table
  • •check for alignment to IR/tilt/rotation
  • •43 x 35 cm to start
  • •Center mid thorax (inferior angle/10cm below sternal angle) (~@ nipple ht if pt has breasts)
  • -top of field ≥5cm above jugular notch,<1” light above shoulders
  • (•bottom of field @LCM on table)-less important
  • •side-to-side to AC joints
  • •probably 35cm length on pt, landscape orientation
  • •supine or ↓ and R/L marker in upper corner
  • •breathe in, breathe out, breathe in, hold
26
Q

Acute Abdomen Series:

A

AP Erect

AP Supine

PA Chest

27
Q

2 View Abdomen:

A

AP Erect

AP Supine

28
Q

AP Upright Abdomen

A
  • •110cm SID- bring in tube
  • •set wall detector
  • •tracking on
  • •pt standing back to detector
  • •arms at sides, away from body
  • •check for rotation/tilt
  • •PT HOLDS SHIELD, either lead strip or holds apron with arms out
  • **priority: top & ctr***
  • •set 35 x 43cm, shouldn’t need to collimate in vertically
  • •center: •midsagittal
    •@ or slightly above crests
  • -top @ axilla in diverging rays
  • ***note: can get pt to move over to check top of field–while they’re moved, place ↑ and R/L markers in bottom corner of field
  • •side-to-side: on pt at lateral aspect of ASIS
  • •breathe in, breathe out, hold
29
Q

AP Abdomen (Supine)

A
  • •110 SID
  • •set table detector
  • •supine on table
  • •check for alignment to IR/tilt/rotation
  • (can start w/ 43cm length)
  • Center: •midsagittal
    •@ height of crests
  • •inferior border @ trochanters on table
  • •side-to-side on pt at lateral aspect of ASIS (35 cm max)
  • (•superior border: pt can show you “where their ribs come together”, must at least be here)
  • •supine/↓ and R/L marker in lower lateral corner
  • •breathe in, breathe out, hold
30
Q

Sternum Routine:

A

RAO

Lateral

31
Q

Lateral Sternum

A
  • •wall detector
  • •180cm SID
  • •shield on pt
  • •tracking on
  • •true L lateral
  • •clasp arms behind back, straighter arms if possible
  • •superiorly: include jugular notch
  • •inferiorly include xyphoid
  • •rotate collimator to match angle of sternum ( imagine CR hitting just behind sternum)
  • -side-side: a little on shoulder to a bit of light anteriorly (have pt take a deep breath to check sternum movement- may need to widen field)
  • •marker anterior/superior
  • •deep breath in, hold,
32
Q

RAO PA Oblique

A
  • •110cm SID
  • •wall detector
  • •CLEAN DETECTOR @ START OF EXAM
  • •shield on pt
  • •tracking on
  • •stand pt in true AP to sort out field size
  • Then:
  • •RAO, R arm rests on bar at base of detector
  • •L hand holds corner of detector
  • • ~20° obliquity (visualize putting the jugular notch btw vertebral edge of scapula and spine)
  • •sternum length // to IR length• watch for tilt
  • In AP:
  • •superior border include jugular notch (on patient)
  • •inferior border include xyphoid process (on patient) (pt can point to where ribs come together)
  • •side-to-side width a bit past SC joints
  • In RAO:
  • •center of beam wants to hit btw medial edge of scap and spine
  • •width should hit about @ those same 2 points
  • •marker anatomic &upper lateral corner
  • •breathe in, out, in, hold
33
Q

Rib Routines:

A

PA Chest

+

PA Upper

PA Oblique Upper

•••••Or•••••

AP Upper

AP Oblique Upper

•••••Or•••••

AP Lower

AP Oblique Lower

34
Q

PA Upper Ribs

A
  • For Anterior ribs 1-10
  • •110cm SID
  • •wall detector
  • •CLEAN DETECTOR @ START OF EXAM
  • •shield on pt
  • •like a 1-sided chest
  • •arm on side of interest UP on detector to lift scap
  • •medial/superior corner: include vertebra prominens (1” light above shoulders when arm down)
  • •inferior border: @ level of LCM on detector
  • •width: spine to AC joint (or a lil beyond)
  • mark anatomical side being imaged upper corner
  • •breathe in, out, in, hold
35
Q

45° PA Oblique Upper Ribs

A
  • For Anterior ribs 1-10
  • •110cm SID
  • •wall detector
  • •shield on pt
  • •45° Oblique
  • -side of interest AWAY from detector
  • -side of interest arm draped on corner of detector
  • ***Can start w/ collimation from PA***
  • •superior border: include vertebra prominens
  • •inferior border: @ level of LCM on detector
  • •side-to-side: (A BIT WIDER THAN) MSP to AC joint was
  • (I want to include the spinal processes and the lateral margin of the ANTERIOR ribs)
  • mark anatomical side being imaged upper corner
  • •breathe in, out, in, hold
36
Q

AP Upper Ribs

A
  • For posterior ribs 1-10
  • •110cm SID
  • •wall detector
  • •shield on pt
  • •AP position
  • •check for tilt
  • •arm resting on head
  • •superior border: ~5cm+ above jugular notch on pt
  • •inferior border: @ level of LCM on detector
  • •side-to-side: MSP to AC joint (or a bit beyond)
  • mark anatomical side being imaged upper corner
  • •breathe in, out, in, hold
37
Q

45° AP Oblique Upper Ribs

A
  • For Posterior ribs 1-10
  • •110cm SID
  • •wall detector
  • •shield on pt
  • •45° Oblique
  • -side of interest TOWARDS detector
  • •arm resting on head
  • ***Can start w/ collimation from AP/PA***
  • •superior border: ~5cm+ above jugular notch on pt
  • •inferior border: @ level of LCM on detector
  • •side-to-side: WIDER THAN MSP to AC joint -medially aligned to neck, laterally aligned to AC joint
  • (I want to include the spine and the lateral margin of the ribs)
  • mark anatomical side being imaged upper corner
  • •breathe in, out, in, hold
38
Q

AP Lower Ribs

A
  • For posterior ribs 8-12
  • •110cm SID
  • •wall detector
  • •shield on pt
  • •AP position
  • •check for tilt
  • •arm resting on head
  • •superior border: T-7 on pt (@ or a lil below inferior angle scap)
  • •inferior border: exclude iliac crest from field on detector
  • •side-to-side: MSP to @ or just beyond AC joints
  • (I want to include the spine and the lateral margin of the ribs)
  • mark anatomical side being imaged upper corner
  • •breathe in, out, hold
39
Q

45° AP Oblique Lower Ribs

A
  • •110cm SID
  • •wall detector
  • •shield on pt
  • •45° Oblique
  • -side of interest TOWARDS detector
  • •arm raised like a dramatic person checking their own fever
  • ***Can start w/ collimation from AP***
  • •superior border: T-7 (@ or a lil below inferior angle scap)
  • •inferior border: exclude iliac crest from field on detector
  • •side-to-side: WIDER THAN MSP to @ or just beyond AC joints
  • (I want to include the spine and the lateral margin of the ribs)
  • mark anatomical side being imaged upper corner
  • •breathe in, out, hold

Positioning 2 (4 decks)

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