RADPOSI 2 (MOBILE RADIOGRAPHY)

Mobile radiography

___ uses transportable x-ray equipment to bring imaging services to the patient

Mobile radiography

Commonly performed in patient rooms, emergency departments, intensive care units, surgery and recovery rooms, and nursery and neonatal units

military, field sites

Mobile x-ray was first used in the ___. Units were carried to ___

MOBILE X-RAY MACHINES

Not as sophisticated as stationary units

MOBILE X-RAY MACHINES

Vary in exposure controls and power sources (generators)

MOBILE X-RAY MACHINES

Typical unit has controls for setting kVp and mAs

mA and time

mAs controls automatically adjusts __

0.04 to 320

MOBILE X-RAY MACHINES Typical mAs range = ___

40 to 130

MOBILE X-RAY MACHINES kVp = ___

15 - 25 kilowatts

MOBILE X-RAY MACHINES Power varies between ___

present anatomic programs

MOBILE X-RAY MACHINES Some have ___ or (APRs)

DR MOBILE UNITS

Mobile units with direct digital capability

DR MOBILE UNITS

Acquire image within seconds after the exposure on the unit

DR MOBILE UNITS

Increases workflow efficiency

DR MOBILE UNITS

Uses a flat-panel detector

cord, wireless technology

DR MOBILE UNITS is Connected by a ___Communicates through ___

PACS

DR MOBILE UNITS Wirelessly transfers images to ___

Lower radiation doses

DR MOBILE UNITS ___ possible with digital post-processing software

100

Lower radiation doses possible with post-processing software

Grid

Anode heel effect

Source-to-image receptor distance (SID)

Three important technical factors must be clearly understood to perform optimum mobile examinations:

optimum examinations

Exposure technique charts are also essential to___

image degradation

Sensitivity of CR imaging plates to scatter radiation leads to ___

Level

Centered to CR

Used at recommended focal distance or radius

Optimum performance requires grid to be:

Level

Use of grid on unstable surface may cause "off level" grid cutoff

Centered to CR

Midline of a grid more than 1 to 1½ inches off transversely from the CR causes "off level" grid cutoff

Used at recommended focal distance or radius

Exposures outside of the recommended focal range may produce cutoff on the lateral margins

"off level" grid cutoff

Use of grid on unstable surface may cause __

1 - 1½ inches

Midline of a grid more than ___ off transversely from the CR causes "off level" grid cutoff

lateral margins

Exposures outside of the recommended focal range may produce cutoff on the ___

ANODE HEEL EFFECT

Causes decreased image density under the anode side of the x-ray tube

Short SID

Larger field sizes

Small anode angles

ANODE HEEL EFFECT More pronounced with:

Short SID, large field sizes

___ and ___ are common in mobile

anode-cathode axis

Proper placement of ___ with anatomy is essential

40 inches

SID Should be maintained at ___ (102 cm)

consistent images

Standardized distance ensures ___

motion artifacts

Longer SIDs (greater than 40 inches)Increases risk of ___

increased mAs, longer exposure times

Longer SIDs (greater than 40 inches) Requires ___ resulting in ___

RADIATION SAFETY

Mobile radiography produces some of the highest occupational radiation exposure for radiographers

Wear a lead apron

Stand as far away from patient, tube, and beam as possible

Protection for self, patient, and other personnel is critical by:

6ft

Protection Recommended minimal distance is ___(2m)

90 degrees

Stand as far away from beam at a right angle ___ to the primary beam

Examinations performed on children

Examinations performed on reproductive age patients

On patient request

When gonads lie in or near useful beam

When shield will not interfere with anatomy of interest

Shield patients as necessary with appropriate radiation protection devices for:

30 cm

radiation safety. Minimum source-to-skin distance is ___

Those who have contagious infectious microorganisms

Those who must be protected from exposure to infectious microorganisms

Two types of patients in isolation:

Wear required protective apparel for specific situation

Entering strict isolation requires donning mask, gown, gloves

Wash hands before glove

Protect IR with protective cover

Wash hands

Wear clean gloves to clean equipment

Wash hands after removing gloves and before leaving room

ISOLATION CONSIDERATIONS

discard

after procedure, ___protective apparel according to protocol

- IR

- Grid

- Protective covers

- Tape

- Caliper

- Markers

- Positioning blocks

MOBILE EXAMINATIONS necessary devices

1. Announce presence to nursing staff

2. Ask for assistance if needed

3. Confirm patient identity

4. Introduce yourself to the patient and family

5. Explain the examination

6. Observe medical equipment in room and move if necessary

7. Ask family members and visitors to leave

Preliminary steps for the radiographer prior to performing mobile radiography are:

- Supine position - middle of bed

- Seated upright position - foot of the bed

- Lateral and decubitus positions - parallel or perpendicular to bed.

Base of mobile machine placement:

Supine position

- middle of bed

Seated upright position

- foot of the bed

Lateral and decubitus positions

- parallel or perpendicular to bed.

IR size.

Ensure collimation is not larger than ___

distortion.

Check CR and IR alignment to prevent ___

"double exposure"

Use a consistent system for keeping exposed and unexposed IRs separate to avoid ___

log of procedures, time of examination, and technical factors

Keep a ___,___,___ for image identification

1. Chest - AP

2. Abdomen

3. Pelvis

4. Femur

5. Cervical spine

6. Neonate

MOBILE RADIOGRAPHIC EXAMINATIONS (6)

Lying Erect on Stretcher

72 Inch SID

Angled Caudally to Match IR

AP Chest Radiograph

Depends on condition

Seated upright, semi upright, supine

(AP) CHEST Patient position

Center MSP to IR

(AP) CHEST Part position

Perpendicular to sternum, 3 inches below jugular notch level of t7

(AP) CHEST CR

Inspiration

(AP) CHEST Respiration

Anatomy of thorax: Heart, Trachea, Diaphragmatic domes, Entire lung fields, Vascular Markings

(AP) CHEST Structures Shown

No motion; well-defined diaphragmatic domes and entire lung fields including costophrenic angles

No rotation - medial portion of clavicles, lateral border of ribs equidistant from vertebral column

(AP) CHEST Evaluation Criteria

Anatomy of thorax: Entire lung fields, Air or fluid levels

AP/PA CHEST LATERAL DECUBITUS POSITION Structures shown

No motion or rotation, Affected side in its entirety, Arms out of region of interest

AP/PA CHEST LATERAL DECUBITUS POSITION Evaluation criteria

Supine

AP ABDOMEN Patient position

grid under body centered to MSP and level of iliac crests

AP ABDOMEN Part position

Inferior margin of liver, Spleen, Kidneys, Psoas muscles, Calcification, Evidence of tumor masses, Size and shape of liver if upper abdomen diaphragm included

AP ABDOMEN Structures shown

Left lateral recumbent position

Flex knees for stability

Place firm support under patient to elevate body

Raise both arms out of anatomy of interest

Ensure patient cannot roll out of bed

AP/PA ABDOMEN LEFT LATERAL DECUBITUS POSITION Patient position

True lateral without rotation

Place vertical grid centered at 2 inches iliac crests to demonstrate diaphragm

Ensure patient has been in position for at least 5 minutes to allow air to rise and fluid to settle

AP/PA ABDOMEN LEFT LATERAL DECUBITUS POSITION Part position

Horizontal and perpendicular to center of grid

Enters at MSP at level 2 inches above iliac crests

AP/PA ABDOMEN LEFT LATERAL DECUBITUS POSITION CR

Air or fluid levels

Right border of the abdominal region must be visualized

AP/PA ABDOMEN LEFT LATERAL DECUBITUS POSITION Structures Shown

No motion

Well-defined diaphragm and abdominal viscera

Air or fluid levels (if present)

Right and left abdominal wall and flank structures

No rotation

Radiographic markers

Evidence of proper collimation

AP/PA ABDOMEN LEFT LATERAL DECUBITUS POSITION Evaluation Criteria

Pelvis with both hip bones

Sacrum and cocсух

Proximal femora including head, neck, and trochanters

AP PELVIS Structures shown

Entire pelvis, including proximal femora and hip bones

No rotation

Radiographic markers

Evidence of proper collimation

AP PELVIS Evaluation criteria

Supine

AP FEMUR Patient position

grid lengthwise under femur

Centered midline of femur

AP FEMUR Part position

Distal two-thirds of femur

Knee joint

AP FEMUR Structures shown

Most of femur including knee joint for distal

No rotation of knee

Adequate penetration

Orthopedic appliance in its entirety

Radiographic markers

Evidence of proper collimation

AP FEMUR Evaluation criteria

vertical grid along medial aspect of femur

knee joint is included

grid is perpendicular to epicondylar plane

LATERAL FEMUR Lateromedial projection

vertical grid along lateral aspect of femur

grid distal edge low enough to include knee joint

LATERAL FEMUR Mediolateral projection

Right or left Dorsal decubitus position

LATERAL CERVICAL SPINE Patient position

No rotation of upper torso, cervical spine, and head

Top of grid 1 inch above EAM and centered to C4

LATERAL CERVICAL SPINE Part position

Enters level of C4

Increased OID – SID of 60-72 inches

LATERAL CERVICAL SPINE CR

Full expiration

LATERAL CERVICAL SPINE Respiration

- Seven cervical vertebrae

- Base of skull

- Soft tissue of the neck

LATERAL CERVICAL SPINE Structures shown

All seven cervical vertebrae

Neck extended

C4 centered

Radiographic markers

Evidence of proper collimation

LATERAL CERVICAL SPINE Evaluation Criteria

end of the bed

Where would the mobile radiographic unit be placed to perform an AP projection of the chest on a patient who is able to sit upright?

Grid ratio

Occupational exposure

Anode heel effect

Which of the following is increased in mobile radiography?

Left lateral decubitus

How would a very ill patient be positioned for a mobile chest examination to demonstrate fluid in the left lung?

Leave the traction device and if possible, adjust the CR angle or IR to obtain the best image

When performing a mobile examination on a patient in traction the radiographer should:

AP abdomen, Left lateral decubitus with immediate exposure

A critically ill patient is suspected of having free air in the abdomen. Which of the following would best demonstrate the presence of free air?