All Special Procedures Info & Other Modalities

Info gathered from notes on: peds imaging, working with bariatric PTs, diagnostic & therapeutic procedures, digestive system imaging, patient communication from 3065, and 3062 other modalities

Full term newborns are born between how many weeks of pregnancy?

39-40 weeks

Extreme premature newborns (preemies) are born between how many weeks of pregnancy?

23-28 weeks

What is the #1 cause of death in children world wide?

Being born premature

Taking preemies to a NICU increases their survival rate by what percent?

90%

What technical factors should be used when imaging a preemie?

0.5 mAs, 58-64 kVp

Between what ages are patients asked about pregnancy status?

11-55 years old

If PT is unsure/confirms chance of pregnancy, what are some options the ordering physician may choose to do?

• Continue with exam if urgent/time sensitive

• Postpone imaging until pregnancy test is done

• Adjust exam to have less exposures

• Choose non-radiating modality

• Favour PA imaging

What are examples of exams unique to pediatric PTs?

• Braces/temporary orthopedic device fitting

• Scanograms

• Scoliosis exams

• Bone age

• Pigg-o-stat chest

• Skeletal surveys for S.C.A.N. or congenital abnormalities

When considering pediatric cases, what may scanograms be used for?

• Pre-surgery

• Bowing of the legs

• Leg length differences

What are attention techniques used for?

Directing a child’s gaze to a specific area

What are distraction techniques used for?

Diverting attention away from a procedure
(helps child relax + less aware of stress/pain)

What are visual indications of an inspiration in children?

Seeing the ribs/intercostal spaces through the skin

Does a cry indicate inspiration or expiration?

Expiration

Does the quiet pause between cries indicate inspiration or expiration?

Inspiration

According to Bontragers, grid use begins at what body part thickness?

~10 cm

With advancements of DR systems, grid use can begin at what body part thickness?

~20 cm

At what may grids start to be used for CXRs of average sized children?

~10 years old

Pelvis grids appear starting when a child reaches what age?

~18 months old and above

Pigg-o-stats can be used for children between what ages?

4 months to 4 years

What may happen if the sleeve on a Pigg-o-stat is too large?

Acrylic will overlap causing density artifact

What may happen if the sleeve on a Pigg-o-stat is too small?

Skin at the chest will be squeezed

A BMI of ___ = obese

30-39.9

A BMI of ___ = morbidly obese

40+

If a PT is ~100 lbs overweight or more, they are considered ___

Morbidly obese

The aperture diameter of a CT or MRI machine is accurately measured in what plane?

Horizontally

The vertical measurement of a gantry/bore must consider what?

The table thickness entering the aperture

Typically, the table takes up ___cm of the stated gantry/bore vertical diameter

15-18

Bariatric PT beds have a width of ___in and can hold PTs up to ___lbs

34 inches, 750 lbs

Transferring a PT from a cart to a table may require up to how many people?

8-10

What exams are considered as attainable with bariatric PTs?

• skull

• c-spine

• upper limb

• lower limb distal to the knee

What exams are considered usually obtainable with bariatric PTs?

Shoulder and femur

What exams are considered challenging to obtain with bariatric PTs?

All projections of the thorax/abdomen

(T/L-spine, lungs, abdomen, pelvis, hips)

What exams are considered very difficult to nearly impossible

Organs (stomach, small and large bowel)

Your PT is < 5 ft. Symphysis is approximately how many inches below jugular notch?

21 inches

Your PT is between 5-6 ft. Symphysis is approximately how many inches below jugular notch?

22 inches

Your PT is taller than 6 ft. Symphysis is approximately how many inches below jugular notch?

24 inches

When imaging bariatric PTs, placing the bottom edge of a 35×43 IR lengthwise/portrait shows what anatomy?

L-spine and abdomen

When imaging bariatric PTs, placing the bottom edge of a 35×43 IR crosswise/landscape shows what anatomy?

Pelvis and hips

What range of mA may automatically engage the large focal spot?

250-320 mA

A backup timer greater than the customary __% of anticipated mAs is likely required when imaging bariatric PTs

150% of anticipated mAs

Clinical indications: esophagogram

• Achalasia

• Esophageal carcinoma

• Esophageal varices

• Foreign bodies

• GERD

What exam is used to demonstrate the form and function of the pharynx and distal esophagus?

Esophagogram (AKA Ba swallow – different from MODIFIED Ba swallow)

An Esophagogram/Ba swallow demonstrates what?

Form and function of pharynx and esophagus

Esophagogram: placing the PT in an RAO position does what?

Displaces esophagus away from spine, between vertebral column and heart

Esophagogram: What PT position demonstrates the esophagus between the vertebral column and the heart?

35-45° RAO

Esophagogram: What PT position moves the Ba slower?

Recumbent RAO

Esophagogram: placing the PT in a LAT position does what?

Allows visualization of the anterior and posterior aspects of the esophagus, placing it anterior to the vertebral column

Esophagogram: What position visualizes the anterior and posterior aspects of the esophagus?

LAT

A Modified Ba Swallow demonstrates and assesses what?

Demonstrates: oral cavity and pharynx
Assesses: (initial stages) swallowing function and safety

Clinical indications: Modified Ba Swallow Study

Dysphagia and aspiration

A Modified Ba Swallow study involves what 3 healthcare staff?

SLP, radiologist, MRT

Modified Ba Swallow: placing the PT in a LAT position demonstrates what?

The epiglottis and PT swallowing

Modified Ba Swallow: what PT position demonstrates the epiglottis and the function of swallowing in the PT?

LAT (often the only projection required)

Modified Ba Swallow: placing the PT in an AP position demonstrates what?

Pharyngeal contractions and lateral spread of residual Ba

Modified Ba swallow: What PT position demonstrates pharyngeal contractions and the lateral spread of residual Ba?

AP

An Upper GI Series study is also called what?

ES&D

• if study continues past the duodenum into the small bowel, it is called a ES&D follow through or ES&DFT

Clinical indications: ES&D

Used to detect abnormal anatomic and functional conditions

• peptic ulcer

• hiatal hernia

• diverticula

• gastritis

• tumor

Considering stomach orientation: the fundus is ___?

The most posterior portion

Considering stomach orientation: the body is ___ to the fundus?

Anterior and inferior to the fundus

Considering stomach orientation: the pylorus is ___ to the body?

Posterior and distal to the body

A hypersthenic patient has what stomach orientation and what speed of gastric emptying?

High and transverse stomach; slow gastric emptying

A hypo/asthenic patient has what stomach orientation and what speed of gastric emptying?

Vertical stomach along midline; fast gastric emptying

ES&D: supine PT position demonstrates what?

Air in the body and pylorus of the stomach

ED&D: prone PT position demonstrates what?

Air in the fundus

What is used as a negative contrast agent in an ES&D?

Gas crystals

What purpose do gas crystals serve in an ES&D study?

• Negative contrast agent

• Distends the stomach

• Demonstrates mucosal lining

What position/technique may be used in an ES&D to demonstrate a hiatal hernia?

Trendelenburg or Valsalva maneuver

(increases pressure in abdominal cavity to exacerbate hernia)

Placing the PT in a supine or Trendelenburg position for an ES&D demonstrates what anatomy, and is best for what clinical indication(s)?

Demonstrates: entire stomach and duodenum

Clinical indication: hiatal hernia

Placing the PT in a recumbent right LAT position demonstrates what anatomy, and is best for what clinical indication(s)?

Demonstrates: retrogastric space, pylorus, C-loop of duodenum (in hypersthenic PTs)

Clinical indications: gastric diverticuli, ulcers and tumors (specifically of retrogastric space)

Placing the PT in a 40-70° RAO position for an ES&D demonstrates what anatomy?

Entire stomach and Ba filled duodenal bulb in profile

What PT prep is required for an ES&D?

PT should be NPO for 8 hours prior to study

PT should avoid chewing gum and smoking (otherwise causes gastric secretions preventing Ba from sticking to gastric walls)

A Small Bowel Series is also called what?

SBFT / ES&B

Clinical indications: Small Bowel Series

Used to study form and function of small bowel to detect abnormal conditions

• Chron’s

• Enteritis

• Ileus

• Giardiasis (an infection caused by parasite)

Contraindications: small bowel series

1. Pre-surgical PTs/suspected hollow viscus

2. Suspected LBO

What PT prep is required for a small bowel series?

Low residue diet 2 days prior to study

PT should be NPO for 12 hours prior to study

PT is to ingest ___ml of ____for a small bowel series

450-900 ml of Ba Sulfate

Small bowel series: how many ml should the PT drink if performing this study after an ES&D?

450 ml

Small bowel series: how many ml of Ba should the PT drink if doing an independent study? (meaning no other Ba study was done prior to this SBFT)

900 ml

Where should the CR be centered for a PA projection 15 minutes into a small bowel series?

Perpendicular to MSP 5 cm above iliac crest

Where should the CR be centered for a PA projection 60 minutes into a small bowel series?

Perpendicular to MSP at level of iliac crest

For a small bowel series, regardless of the time interval being used for the study, an image MUST be taken at the ___ minute mark

60 minute mark, regardless of the time interval being used (eg. every 5, 10, 15 mins etc)

Clinical indications: Barium enema

• Colitis

• Ulcerative colitis

• Polyps

• Diverticulosis/itis

• Volvulus

• Intussusception

• Adenocarcinoma

Contraindications: Barium enema

1. Perforation risk (post-op PT, biopsy, perforated hollow viscus)

2. Possible LBO

What PT prep is required for a barium enema?

1. Low residue diet

2. Laxatives

3. Cleansing enema

Barium enema: an AP/PA (prone position) demonstrates what anatomy?

Entire large bowel

Barium enema: an RAO position (PA OBL projection) best demonstrates what anatomy?

Hepatic (right colic) flexure

Barium enema: an LAO position (PA OBL projection) best demonstrates what anatomy?

Splenic (left colic) flexure

Barium enema: a lateral or ventral decubitus position best demonstrates what anatomy?

Rectum and distal sigmoid

(decubitus shows A/F levels)

Define: therapeutic communication

Techniques used to encourage PTs to express themselves

Define: non-therapeutic communication

Communication that diminishes or dismisses the PT experience

(Judgemental statements, cliches, false reassurance, defending, changing the subject, giving advice, subjective interpretation, agreeing/disagreeing, probing, demanding an explanation)

If a patient is Deaf they have _____

total hearing loss

If a patient is deaf they are ____

unable to hear well enough to process info

Age range for neonates/infants

Birth to 1 year

Age range of toddlers

1-2 years

Age range of pre-schoolers

3-5 years

Age range of school age children

6-12 years

Age range of adolescents

13-18 years

Age range of young adults

19-45 years

Age range of middle age adults

46-64 years

Age range of late adults and old adults

Late: 65-79 years

Old: 80+ years