Midterm positioning review Flashcards
1
Q
C-Spine Routine:
A
15° AP Axial
AP Obliques
AP Odontoid
Lateral
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
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
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
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
6
Q
T-Spine Routine
A
AP
Lateral
Swimmer’s
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
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)
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
10
Q
L-Spine Routine:
A
AP
Lateral
L5/S1
Obliques
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
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
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
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
15
Q
SI Joint Routine:
A
AP Axial
AP Oblique
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
AP Chest (supine)
* **•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
**Acute Abdomen Series:**
**AP Erect**
**AP Supine**
**PA Chest**
27
**2 View Abdomen:**
**AP Erect**
**AP Supine**
28
AP Upright Abdomen
* **•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
AP Abdomen (Supine)
* **•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
**Sternum Routine:**
**RAO**
**Lateral**
31
Lateral Sternum
* •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
RAO PA Oblique
* •**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
**Rib Routines:**
**PA Chest**
**+**
**PA Upper**
**PA Oblique Upper**
**•••••Or•••••**
**AP Upper**
**AP Oblique Upper**
**•••••Or•••••**
**AP Lower**
**AP Oblique Lower**
34
PA Upper Ribs
* 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
45° PA Oblique Upper Ribs
* 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
AP Upper Ribs
* 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
45° AP Oblique Upper Ribs
* 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
AP Lower Ribs
* 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
45° AP Oblique Lower Ribs
* •**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**