Rt 124 – Spring Image Review pt 2 ABD & CHEST 2 Rt 124 – Spring Image Review pt 2

Position & Projection Look at blocker for PROJECTION Look at air/fluid levels for Upright vs Supine vs Decubitus Look at Pathology: Excessive Fluid or Air indicates pathology and may need adjustment in technique

Projection ? AP

Projection ? AP –AXIAL (APICAL LORDOTIC

Projection ? PA Note Pathology – Rt middle lobe Lt lower lobe atelectasis

Projection ? AP REMEMBER TO MOVE CARDIAC MONITOR WIRES OUT OF THE WAY Pathology note bilateral effusion both bases

PROJECTION? AP

LAT UPRIGHT ON GURNEY NOTE AIR /FLUID LEVELS Note poor positioning of CR to part (cr too low & too anterior – not at mcp

Position ? Projection? AP semi upright note – fluid levels in RT lung what else is needed? Decubs –for fluid levels

Position / Projection? Projection – cant’ tell because no blocker Position – LLD 1) look for the humerus that is raised 2) look for fluid levels 3) note: poor centering for upside of image

Position / Projection? Projection – AP blocker lower RT Position – RLD 1) look for the humerus that is raised 2) look for fluid levels 3) poor marker placement – label of image look for fluid levels

BILATERAL DECUB Projection? PA AP LLD RLD

PROJECTION? POSITION? GO BACK AND CHECK PREVIOUS SLIDE

PROJECTION? POSITION? GO BACK AND CHECK PREVIOUS SLIDE

ABDOMEN - SUPINE – UPRIGHT - LLD

KUB WHAT IS THE CRITIQUE TO JUDGE PROPER TECHNIQUE?

Upper abd - should center higher to include more diaphram

Centering better for upper abd – should put blocker down – to keep out of diaphram area

Supine KUB – what are the white dots? Residual barium

KUB – POST CT SCAN RESIDUAL CONTRAST IN COLON AND KIDNEYS DARK LINE ACROSS ABDOMEN??? FROM COMPRESSED SOFT TISSUE – TIGHT WAISTBAND OF CLOTHING

Case example of SUPINE – upper & KUB Upright Should have collimated to upper abd – not exposed lower abd twice (repeated – diaphram clipped)

KUB FLAT PLATE SUPINE ABD INCLUDES ENTIRE ABD (TAKEN AT 48” SID)

POSITION. UPRIGHT PROJECTION PA – WHAT ELSE POSITION? UPRIGHT PROJECTION PA – WHAT ELSE? BLOCKER PLACEMENT & CLOTHING

KUB SUPINE

UPPER ABD SUPINE NOTE PATHOLOGY (GB STONES)

UPRIGHT ABD CRITIQUE WHAT IS THE DARK LINE IN THE CENTER

PATHOLOGY & Positioning

Obstruction lg bowel

Example: may need 4 films in quadrant to include all of abd structures (obstruction)

Free air in the abdomen

Position? Look at air/fluid levels

LEFT LAT DECUB

Need at least 2 crosswise films

CRITIQUE IMAGES FOR POSITIONING COLLIMATION & CENTRAL RAY PLACEMENT

Critique: If taken for AP chest – CR is < too cephalic – moving clavicles above apex

AP Chest CR – too cephalic PT kyhphotic – need to change CR direction to maintain ┴ to sternum

Projection – AP Critique – collimation not centered ekg wires over chest

CRITIQUE SEE EARLIER IMAGES

Lat gurney chest prop arms up with sponges get ST of arms off of chest

CRITIQUE SEE EARLIER IMAGES

Also review images on first presentation Written test on Tues Lab on Thursday

More pathology & positioning We will cover in more detail in GI section

Cecal volvulus LG bowel obstruction critique for positioning and centering

Toxic megacolon

Projection? Postion? PA – according to blocker Supine – no air fluid levels

Projection? AP

Projection? PA

What is this step ladder sign indicate for pathology What is this step ladder sign indicate for pathology? Obstruction see air-fluid levels Position? Upright!

Small bowel obstruction- remember to include all areas of the abdomen what could have improved this image? 2 cross wise 14 x 17

Critique for positioning& projection

AP Chest – CR too low Collimation too open KVP too low – too short of contrast Lat – CR too forward – Sit pt up more

Projection AP Pathology? COPD