Image Evaluation: Stretcher Chest
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Transcript of Image Evaluation: Stretcher Chest
HIPAA
Compliance
• This image is HIPAA compliant.
• Patient identification has been removed from this image
• Any information that could lead to the institution where the image was take has been removed.
• This image does not violate the privacy of the patient.
Markers and Patient ID
• A correct anatomical side marker visible in the image.
• The side marker is properly placed in this image.
• The marker does not superimpose anatomy.
• This image is displayed anatomically correct.
Markers and Patient ID
• Additional markers are needed for this image• A position marker indicates if
the patient was upright or supine• An up arrow marker is being
used to show that the patient was positioned upright
• An “AP” or “PA” marker needs to be used to show if the how the patient was positioned for the image• An “AP” marker is being used in
this image to indicate that the patient was in an AP orientation
• The image is correctly displayed based on marker placement.
Radiation Hygiene
• Beam Restriction Rule:
• A minimum of three sides of beam restriction must be visible on an image
• There is only one side of collimation visible on this image.• This does not fit minimum standards
• Beam restriction must be shown on the side closest to the gonads.• Which is shown in this image
• Shielding rule:
• Gonadal shielding must be provided if the gonads are within five centimeters of the primary beam.
• No evidence of secondary shielding
Completeness of
Position/Projection
• This Image does
comply with routine
position/projections
• All anatomical
parts are correctly
visualized in this
image.
Artifact
Identification • There are not any preventable physical artifacts visible in the image.
• There are not any body parts superimposed that should not be.
• There are not any hospital paraphernalia present and/or visible in the image.
Artifact
Identification
• There are not any
patient
clothing/belongings
visible in the image.
• There are not any
indwelling
artifacts/foreign
bodies visible in the
image.
Artifact Identification
• There is not excess
fog degrading image
quality.
• There are no CR/DR
artifacts.
Image
Sharpness• There is not
any “gross” voluntary motion visible in the image.
• There is not any excessive quantum mottle (or image noise) visible in the image.
• There is not any evidence of a pervious exposure.
Image Sharpness
• There are not grid lines,
grid artifact &/or grid cut-
off visible in the image
because a grid is not
typically used for a
stretcher chest.
• Size distortion does not
appear greater than
expected.
• Slight shape distortion is
being caused by poor
CR/IR/part alignment.
Accurate Part Positioning
• The part is adequately
aligned to the image
media.
• The part is not
adequately centered to
the image media.
• The CR is not centered
to within 1 cm of the
anatomical part.
Accurate Part Positioning
Because this image only has one side of collimation it does not fit optimal or acceptable alignment.
Accurate Part Positioning
• Clean x-ray machine before
exiting patient room
• Use appropriate personal
coverings
• Cover IR with plastic bag or
pillow case
• Appropriate technical date
have been set
• Record the required data
Accurate Part Positioning
• Position the patient in an upright, seated AP projection
• Center a 14x17 inch IR cassette or digital plat CW/LW beneath the chest to fit the body habitus
• Align the IR and midcoronal plane parallel with the bed
• Align the front face of the collimator parallel with the IR
• Align the CR perpendicular to the IR
• Elevate the chin out of the collimate field
• Depress the shoulders
Accurate Part Positioning
• Place the back of the hands on the hips and rotate the elbows and shoulders, anteriorly if possible
• Center the CR to the MSP at a level 4 inches inferior to the jugular notch
• Move the arms and any moveable lead wires outside the collimation field
• Take the exposure after the second full suspended inspiration
Accurate Part Positioning: Evaluation
Criteria • Evidence of proper collimation
• Medial portion of the clavicles equidistant from the vertebral column
• Trachea visible in the midline
• Clavicles lying more horizontal and obscuring more of the apices than in the PA projection
Accurate Part Positioning: Evaluation
Criteria • Equal distance from the
vertebral column to the lateral border of the ribs on each side
• Faint image of the ribs and thoracic vertebrae visible through the heart shadow
• Entire lung fields, from the apices to the costophrenic angles
• Pleural vascular markings visible from the hilar regions to the periphery of the lungs
Judicious Exposure Technique
• The most radiolucent
structure seen in this
image is the air in the
lungs and trachea. The
air is adequately seen
in the image.
• The most radiopaque
structure in the image
is the patient’s
stomach.
Judicious Exposure Technique
Assessment of Window Width
• A image of the chest should display short scale contrast.• Short scale contrast is a
minimum number of grays between black and whites on a radiograph.• I think this image displays
adequate short scale contrast.
Judicious Exposure Technique
Assessment of Window Level
• This image appears to
have acceptable
brightness.
• All structures are clearly
seen.
• I believe the EI value will
be in acceptable range,
but will in the lower range
of the acceptable range.
Accept/Reject
• This image does meet
all evaluation criteria
and does show all
anatomy needed for
the given radiograph.
• I would accept this
radiograph.
Accept/Reject
• To make this a more diagnostic image:• Adjusting the collimation
• Ensuring that there is at least 3 sides of collimation
• Collimation should show only anatomy of interest• This could adjust the high
brightness seen at the bottom of the image
• Apply secondary shielding to the patient
• Have patient depress shoulders more to have clavicles lay more horizontal
References
• Fauber, T. L. (2013). Radiographic Image and Exposure
(4th ed.) St. Louis, MO: Elsevier.
• Frank, E. D., Long, B. W., Smith, B. J., Merrill, V., &
Ballinger, P. W. (2007). Merrill’s Atlas of Radiographic
Positioning & Procedures. St. Louis, MO: Mosby/Elsevier.
Page 519
• McQuillen-Martensen, K. (2015). Radiographic Image
Analysis. Vol. 4. St. Louis, MO: Elsevier. Page 99