RMH

Housekeeping

  • R2 collimation is inaccurate so have a good amount of collimation (try to do CXR/HIP in R2)

  • Xray Order Priority: ER/IN > cast clinic > Out Patient > Walk in

General Workflow

Before Imaging

  1. Grab req

  2. Check for previous images if applicable

  3. Open PT Examination

  4. Select Detector

  5. Prep Room

    • tube out of the way

    • table lowered

    • table completely hovered over bucky

During Imaging

  1. Grab PT (last name_?)

  2. Close door

  3. Confirm full name and DOB

  4. Confirm part

  5. Position/ gather hx

  6. Take image

After Imaging

  1. Dismiss PT

    • Out-PT: send home

    • EMG: send back to EMG

    • Cast Clinic: send back to cast clinic (doc is waiting for them)

  2. Accept all Images

  3. Meditech

    • (T) Taken

    • CO (checked out)

    • Start Time (5-10mins prior end time)

    • Tech Initials and Student S#

    • # of Images taken

    • Record Repeats/Rejects

    • Tech comments (~. IDV. EEL (BCIT) CI)

  4. PACS

    • rearrange images if necessary (click save, top 2nd left button)

    • click verify

    • exit (top 3rd left button)

Upper Extremities

Shoulder

  • PA Y-view: we apply a 15 caud angle to make a nice Y-view (beam travels the superior scapular border) technically called a Supraspinatus Y-view

  • AP Y-view: use a perp CR as beam divergence will do its trick

  • AP OBL: 45 degree rotation + slightly more, cross-hair should kind of wrap around humeral head

Elbow

  • LAT Elbow: always slightly ele wrist so coronoid and radial head SI

Hand

  • PA OBL: less obliquity than it seems

Wrist

  • LAT: always kind of have to externally rotate more, feel for styloids- should feel relatively perp

Lower Extremities

Ankle

  • AP/OBL Ankle: can apply a ceph angle if PT can’t dorsiflex (to push lateral malleoli off the calc)

  • AP: align 3MT to lower leg, better to internally rotated than externally for AP

Foot

  • LAT Foot: lat aspect of heel should be touching the IR → this naturally causes the knee to be elevated which everts the foot so the talor domes are SI

Hip

  • X-Table Hip

    • manual technique 81kV, 80mAs

    • always slightly rotate hip away from bucky → ischial tub SI

  • AP Hip: always done AP Pelvis + X-table Hip, never AP Hip unless asked by Dr.Kim, or had very recent Pelvis Hip (a day ago)

Knee

  • AP: toes pointed straight forward for nice APs

  • LAT: always slightly externally rotate from AP, heel should slightly be elevated from table, hips relatively stacked, feel for condyles and patella