Radiographic positioning and preparation

Question 1

What should we consider before an X-ray?

Answer 1

• If any alternative technique can be done which does not involve ionising radiation

Question 2

Why is sedation or GA used in an X-ray?

Answer 2

• Reduces the risk to human health
• Improves image quality

Question 3

What needs to be prepared for the patient before an X-ray?

Answer 3

• Remove collars, leads, clips, and matter or dirty hair, as metal will appear on the X-ray
• If abdominal radiograph, consult with VS if bladder needs emptying or an enema needs to be performed

Question 4

How should the patient be restrained when conscious? Give an example

Answer 4

• Alone if the animal is well-trained or unwell enough to remain perfectly stationary
• E.g., dyspnoeic cat in sternal for an emergency chest X-ray

Question 5

How should a patient be restrained when sedated?

Answer 5

• Using sandbags, wedges, or foam blocks
• Ties must not be used in non-anaesthetised patients

Question 6

How should a patient be restrained when anaesthetised?

Answer 6

• Ties can be used wrapped around sandbags

Question 7

What are the pre-exposure checks?

Answer 7

• Ensure tube head and all cables are checked for cracks and damage
• Ensure mains isolation point is accessible in case of emergency
• Ensure all equipment is readily available
• Ensure room is clear of clutter
• Check X-ray imaging plates for damage and cleanliness

Question 8

How should the plates be prepared?

Answer 8

• Choose an appropriate cassette
• Area of interest should be fully visible within the X-ray plate
• Larger plates may have less resolution, so use smallest plate possible

Question 9

How should the grid be prepared?

Answer 9

• Tissue depth <10cm= no grid
• Tissue depth >10cm= need a grid

Question 10

How should you prepare positioning on the non-moving table?

Answer 10

• Position the plate under the primary beam, centre the plate and ensure the collimation does not result in overlap of the plate edges
• If using a grid, place grid correct way up on top of cassette

Question 11

How should you prepare positioning on a Bucky table?

Answer 11

• If not using a grid, position the plate under the primary beam
• If using a grid, position plate below the table

Question 12

How should you prepare for labelling?

Answer 12

• Ensure X-ray label is prepared digitally or with X-rite tape
• Date, patient ID, time and BVA joint scoring schemes if required
• Left and right markers

Question 13

How should you prepare the settings?

Answer 13

• Display the correct exposure settings using a chart in the radiography suite for a range of species/weights/anatomical locations

Question 14

How should the patient be positioned for a thorax radiograph?

Answer 14

• Position the patient parallel to the plate
• Palpate the spine and the sternum to confirm no rotation
  -Wedge under sternum to prevent rotation
• Collimate using the thoracic inlet, last rib and skin edges
• For DV views, consider sandbags for hindlimbs

Question 15

How should the patient be positioned for an abdomen radiograph?

Answer 15

• Ensure forelegs and hindlegs are extended and parallel

Question 16

How should the patient be positioned for an axial skeleton radiograph?

Answer 16

• Needs to be perfectly lateral or spin will twist
• Spine needs to be supported
• Try to palpate the spinous processes to determine the depth of area interested
• Put a wedge under cervical spine to prevent rotation