Download SMU-DDE-Assignments-Scheme of Evaluation PROGRAM Bachelor

SMU-DDE-Assignments-Scheme of Evaluation
PROGRAM
SEMESTER
SUBJECT CODE &
NAME
BK ID
SESSION
MARKS
Q.No
1.
A
Bachelor/Diploma in Medical Imaging Technology
III
BMI 303– Radiographic Techniques: Routine Procedures- II
B1977
WINTER 2015
60
Criteria
Marks
Total
Marks
List the various radiographic views of cervical vertebrae. Explain the lateral views of cervical
vertebrae in detail.
(Unit 1;Section 1.3;Pg 10-14)
Various radiographic views of cervical vertebrae are
2
10
 Lateral erects
 Lateral supine
 Open mouth
 AP- third to seventh vertebrae (basic)
 Axial-supine
 Lateral-flexion and extension
 Right and left posterior oblique-erect
3+3+2
A. Lateral erect
The cervical spine lateral x-ray should cover from C1 down to the C7T1 joint space and approximately one-third of T1 (first thoracic
vertebra).
Clinical indications: Indicating possible fracture and arthritis
Procedure: The procedure for cervical lateral erect view radiograph is
as follows.
a) The patient stands or sits with either shoulder against a vertical
Bucky.
b) The median sagittal plane of the trunk and head are adjusted such
that it is parallel to the film.
c) The jaw is slightly raised so that the angles of the mandible separate
from the bodies of the upper cervical vertebrae
d) A point 2.5 cm posterior to the angle of the mandible should be
coincident with the vertical central line of the Bucky and the film is
centered at the level of the prominence of the thyroid cartilage
opposite to the fourth cervical vertebra.
e) Two 45 degree pads placed between the patient's head and the
Bucky will aid immobilization. If the patient is standing, feet should
be separated to aid stability.
f) Just before the exposure, the patient is asked to depress the
shoulders forcibly as shown in the figure below, so that the dense
structures of the shoulders are projected below the level of the
seventh cervical vertebra.
g) When carrying out the above said movements, the head and trunk
must be maintained in position.
SMU-DDE-Assignments-Scheme of Evaluation
Focus film distance
150 cm
kVp
50-55
mAs
12-16
Grid
No
Cassette size
10” x 12”
Breathing Instructions
NA
Centering
The horizontal central ray is centered
to a point vertically below the mastoid
process at the level of the prominence
of the thyroid cartilage.
Radiation Protection
Lead waist apron is used to protect the
gonads
Collimation
Shutter A: To full of the film
Shutter B: Within 1.25cm (half an
inch) of the skin line
If the entire femur cannot be included
in a single image, two must be taken
with a minimum of 5 cm (2 inches)
overlap. The size of the second film
will depend on the coverage required.
In this case it may be simply an AP
knee.
Horizontal central ray to the
cassette
90 degrees
B. Lateral supine
The cervical spine lateral x-ray should cover from C1 down to the C7T1 joint space and approximately one-third of T1.
Clinical indications: When the patient is sent to the radiodiagnostic
department on a casualty trolley for exclusion or confirmation of injury
to the cervical vertebrae, a lateral-supine projection is taken first without
moving the patient. This projection must be examined by a medical
officer to establish whether the patient can be moved for other
projections. Medical supervision of any movement of the patient may be
required. If the patient is rotated or moved to an x-ray table, injury may
become severe or it may even lead to paralysis.
Procedure: The procedure for cervical lateral supine view radiograph is
as follows.
a) The patient will normally be in the supine position.
b) A cassette is supported vertically against either shoulder, parallel to
the median sagittal plane of the trunk, and centered at the level of
SMU-DDE-Assignments-Scheme of Evaluation
the prominence of the thyroid cartilage as shown in figure 1.7.
c) It is important to demonstrate the seventh cervical vertebra. The
patient's shoulders must therefore be depressed, if necessary, by
gripping the patient's wrists and pulling the arms caudally or
downwards by a suitable qualified person in this field.
d) The person applying such traction must wear a lead-rubber apron
and gloves.
e) If the patient's head and neck are turned to one side, more than one
lateral projection may be required with the cassette parallel to: (a)
the median sagittal plane of the trunk; (b) the median sagittal plane
of the head and (c) a plane between (a) and (b).
Focus film distance
150 cm
kVp
50-55
mAs
12-16
Grid
No
Cassette size
10” x 12”
Breathing Instructions
NA
Centering
Direct the horizontal central ray at
right angles to the cassette and to a
point vertically below the prominence
of the thyroid cartilage at the level of
the mastoid process.
Radiation Protection
Lead waist apron is used to protect the
gonads
Collimation
Shutter A: To full of the film
Shutter B: Within 1.25cm (half an
inch) of the skin line
If the entire femur cannot be included
in a single image, two must be taken
with a minimum of 5 cm (2 inches)
overlap. The size of the second film
will depend on the coverage required.
In this case it may be simply an AP
knee.
Horizontal central ray to the
cassette
90 degrees
C. Lateral-flexion and extension
These projections may be required only at the request of a medical
officer to supplement the basic projections in cases of trauma, for
example subluxation, or pathology, for example cervical spondylosis, to
assess the degree of movement and any change in the relationship of the
cervical vertebrae. If an injury is suspected a medical officer must be
present to supervise flexion and extension of the neck.
SMU-DDE-Assignments-Scheme of Evaluation
Clinical indications: To supplement the basic projections in cases of
trauma, for example subluxation (condition where joint begins to
dislocate), or pathology, for example cervical spondylosis, to assess the
degree of movement and any change in the relationship of the cervical
vertebrae.
Procedure: The procedure followed for lateral-flexion and extension xray is as follows.
a) The patient is positioned as for the lateral basic or lateral-supine
projections. However, erect positioning is more convenient.
b) The patient is asked to flex the neck and tuck the chin in as far as
possible for the first projection.
c) For the second projection, the patient should extend the neck and
raise the chin as far as possible.
d) The film is centered in the mid-cervical region and may have to be
placed transversely for the lateral- flexion depending on the degree
of movement.
Focus film distance
100 cm
kVp
60-65
mAs
16
Grid
No
Cassette size
10” x 12”
Breathing Instructions
NA
Centering
Direct the central ray horizontally
towards the mid-cervical region (C4).
Radiation Protection
Lead waist apron is used to protect the
gonads
Collimation
On
Vertical
cassette
2.
central ray to the
30 degree cranial angulation
Explain the various projection terminologies used in skull radiograph.
(Unit 4;Section 4.3;Pg 83-87)
SMU-DDE-Assignments-Scheme of Evaluation
A
To describe a skull projection, it is necessary to state the relative
positions of the skull planes to the image receptor and the central ray
relative to skull planes/image receptor and to give a centring point or
area to be included within the beam. Traditionally, a centring point has
always been given, but this may not always be appropriate.This is
because some centring points will lead to the irradiation of a large
number of radiosensitive structures that are of no diagnostic interest.
Rather than focusing entirely on centring points, it is often better for the
radiographer to be mindful of the anatomy that needs to be
demonstrated for a diagnosis to be made and to ensure that this is
included within the primary beam, while ensuring that it is not obscured
by other structures.
10
10
Explanation of following projection terminologies:
(a) Occipito-frontal projections: Projections in which the central ray is
parallel to the sagittal plane are named according to the direction of the
central ray. The central ray enters the skull through the occipital bone
and exits through the frontal bone. This is therefore an occipto-frontal
(OF) projection.
(b) Fronto-occipital projections: Again, the central ray is parallel to the
sagittal plane, except that the central ray now enters the skull through
the frontal bone and exits through the occipital bone .This is a frontooccipital (FO) projection.
3.
A
Describe the various paranasal air sinuses x-rays.

Paranasal air sinuses occipito-mental (basic)

Paranasal air sinuses lateral (basic)

Paranasal air sinuses occipito-frontal
(Unit 8;Section 8.3;Pg 161-166)
1
10
A. Paranasal air sinuses occipito-mental (basic)
This projection is designed to project the petrous parts of the temporal
bones below the floor of the maxillary sinuses so that fluid levels or
pathological changes in the lower part of the sinuses can be clearly
visualised. It is recommended that the patient keeps the mouth wide
open so that the posterior parts of the sphenoidal air sinuses are
projected through the open mouth. Also the open mouth stretches the
upper lip avoiding it causing a confusing soft tissue shadow over the
lower antra.
Clinical indications: Inflammatory conditions like sinusitis, secondary
osteomyelitis and sinus polyps.
Procedure: The procedure for paranasal air sinuses occipito-mental
(basic) radiographs are as follows:
1. The patient is seated facing an erect Bucky, preferably a universal
3+3+3
SMU-DDE-Assignments-Scheme of Evaluation
Bucky or the vertical object table of a skull unit, either of which can
be tilted to help in positioning the head.
2. The patient’s nose and chin are placed in contact with the midline of
the Bucky and then the head is adjusted to bring the orbito-meatal
plane at 45 degrees to the horizontal with the centre of the Bucky at
the level of the lower orbital margins.
3. To ensure that the median sagittal plane is at right angles to the
midline of the Bucky, check that the outer canthi of the eyes as well
as the external auditory meatuses are equidistant from the film.
B. Paranasal air sinuses lateral (basic)
Lateral radiograph of sinus should cover sphenoid sinuses,
superimposed frontal , ethmoid and maxillary sinuses, sella turcica and
orbital roofs.
Clinical indication: Inflammatory conditions like sinusitis, secondary
osteomyelitis and sinus polyps.
Procedure: The procedure for paranasal air sinuses lateral (basic)
radiograph is as follows:
1. The patient sits with one side of the head against the vertical Bucky,
the arm of the same side extended comfortably by the trunk and the
arm of the opposite side flexed to grip the Bucky support to help
immobilisation.
2. The head and the Bucky heights are adjusted so that the centre of the
Bucky is 2.5 cm along the orbito-meatalline from the outer canthus
of the eye.
3. The median sagittal plane is brought parallel to the film by ensuring
that the interorbital line is at right angles to the Bucky and the
nasion and external occipital protuberance are equidistant from it.
C. Paranasal air sinuses occipito-frontal
To demonstrate the maxillary antra and anterior ethmoidal sinuses, the
horizontal central ray is parallel to the orbito-meatal plane.
Clinical indication: Pathology of maxillary antra and anterior ethmoidal
sinuses.
Procedure: The procedure for paranasal air sinuses occipito-frontal view
is as follows:
1. The patient is seated facing an erect Bucky table with the nose and
SMU-DDE-Assignments-Scheme of Evaluation
centre line of the forehead in contact with the vertical midline of the
Bucky table.
2. The height of the Bucky table is adjusted so that its horizontal
central line is at the level of the infra-orbital line.
3. The position of the head is adjusted so that both the median sagittal
plane and the orbito-meatal plane are at right angles to the Bucky
table, and the head is immobilised in this position
4.
Discuss the various radiographic views of urinary tract.
A
(Unit 10;Section 10.3;Pg 202-206)
Explanation of all the radiographic views of urinary tract with
4+3+3
10
radiographic techniques.
Antero-posterior
Procedure: The procedure for AP view of the urinary tract is as follows:
1. The patient lies supine on the x-ray table with the median sagittal
plane of the body at right angles to and in the midline of the table.
The hands may be placed high on the chest or the arms may be by
the patient’s side slightly away from the trunk.
2. The size of film used should be large enough to cover the region
from above the upper poles of the kidneys to the symphysis pubis.
For the average adult this will be a 35 x 43 cm film.
3. The cassette is placed in the Bucky tray and positioned so that the
symphysis pubis is included on the lower part of the film, bearing in
mind the fact that the oblique rays will project the symphysis
downwards.
4. The centre of the cassette will be at the level of the lower costal
margin in the mid-axillary line, and the upper edge of the cassette is
at the level of the xiphisternum.
5. A wide immobilisation band is applied to the patient’s abdomen and
depending on the patient's condition, compression is applied.
6. This compression is more effective if a long pad is placed along the
midline under the compression band before tightening the band.
Right posterior oblique
Additional information about the relationship of opacities to the renal
tract may be obtained with posterior oblique projections. The right
posterior oblique projection shows the right kidney in outline and the
left kidney facing forward. Similarly the left posterior oblique projection
shows the left kidney in outline and the right kidney facing forward.
Procedure: The procedure for right posterior oblique is as follows:
1. The patient lies supine on the table and then the left side of the trunk
and thorax is raised until the coronal plane is at an angle of 20-30
degrees to the table.
2. The patient is moved across the table until the vertebral column is
SMU-DDE-Assignments-Scheme of Evaluation
slightly to the left side of the midline of the table and then the
patient is immobilised in this position.
3. For the kidney area alone a 24 x 30 cm cassette is placed
transversely in the Bucky tray and centred to a level midway
between the sterno-xiphisternal joint and umbilicus.
4. For the whore of the renal tract a 35 x 43 cm cassette might be
required and this is centred at the level of the lower costal margin.
Lateral
The procedure for lateral view is as follows:
1. The patient is turned on to the side under examination. The hands
rest near the head and the hips and knees are flexed to help stability.
2. With the median sagittal plane parallel to the table, the vertebral
column (about 8 cm anterior to the posterior skin surface) is
positioned over the midline of the table and an immobilisation band
applied.
3. The cassette is placed in the tray and for the kidney area it is centred
5 cm superior to the lower costal margin.
5.
A
Discuss radiograph of foreign bodies.
(Unit 11;Section 11.3;Pg 218-222)
1. Percutaneous foreign bodies: These are commonly metal, glass or 2+2+2+2+2
10
splinters of wood associated with industrial, road and domestic
accidents. Generally two projections at right angles to each other are
required without movement of the patient between the exposures,
particularly when examining the limbs. The projections will normally be
antero-posterior or postero-anterior and a lateral of the area in question.
A radio-opaque marker should be placed adjacent to the site of entry of
the foreign body. The skin surface and a large area surrounding the site
of entry should be included on the films since foreign bodies may
migrate, for example, along muscle sheaths and high-velocity foreign
bodies may penetrate some distance through the tissues. Compression
must not be applied to the area under examination.
Oblique projections may be required to demonstrate the relationship of
the foreign body to adjacent bone. Profile projections may be required to
demonstrate the depth of the foreign body and are particularly useful in
examination of the skull, face, thoracic and abdominal walls.
2. Ingested foreign bodies: A variety of objects, such as coins, beads,
needles, dentures and fish bones, may be swallowed accidentally, or
occasionally intentionally, particularly by young children.
The patient should be asked to undress completely and wear a hospital
gown for the examination. The approximate time of swallowing the
object and the site of any localised discomfort should be ascertained and
noted on the request card along with the time of the examination.
However, any discomfort may be due to abrasion caused by the passage
of the foreign body. It is important to gain the patient's co-operation,
especially young children, since a partially opaque object may be
missed if there is any movement during the exposure. The patient should
practise arresting respiration before commencement of the examination.
SMU-DDE-Assignments-Scheme of Evaluation
If the patient is a young child, the examination is usually restricted to a
single antero-posterior projection, where the whole alimentary tract is
included on the film. The examination of older children and adults may
require a lateral of the neck to demonstrate the pharynx and upper
oesophagus, a right anterior oblique of the thorax to demonstrate the
oesophagus and an antero-posterior abdomen to demonstrate the
remainder of the alimentary tract, exposed in that order
3. Inhaled foreign bodies: Foreign bodies may be inhaled, for example,
infants and young children habitually put objects into their mouths and
these may be inhaled. Teeth may be inhaled after a blow to the mouth or
during dental surgery. Such foreign bodies may lodge in the larynx,
trachea or bronchi.
The patient should be asked to undress completely to the waist and
wear a hospital gown for the examination. A posteroanterior projection
of the chest, including as much of the neck as possible on the film, and
a lateral chest projection will be required initially. A lateral projection
of the neck, including the naso-pharynx, may also be required. In the
case of a non-opaque inhaled foreign body, postero-anterior projections
of the chest in both inspiration and expiration will be required to
demonstrate the possible lack of change in density of a lung segment
(obstructive emphysema or atelectasis) or mediastinal shift. The kVp
must be sufficiently high to demonstrate a foreign body which might
otherwise be obscured by the mediastinum. A fast film/screen
combination and short exposure time should be employed.
4. Inserted foreign bodies: Foreign bodies are sometimes inserted into
any of the body orifices. Infants and young children, for example, may
insert objects into the nasal passages or an external auditory meatus. In
these cases, radiography is only occasionally required since most of
these objects can be located and removed by alternative methods
without radiography. When radiography is requested, two projections at
right angles to each other of the area concerned will be required.
Swabs may be left in the body following surgery. Such swabs contain a
radio-opaque filament consisting of polyvinylchloride impregnated with
barium sulphate for radiographic localisation. It is sometimes necessary
to check the position of an intrauterine contraceptive device. In this case
ultrasonography should be used to avoid irradiating the gonads.
5. Transocular foreign bodies: Foreign bodies which enter the orbital
cavity are commonly small fragments of metal, brick, stone or glass
associated with industrial, road or domestic accidents. Ultrasound is
used increasingly in their detection and localisation and may
demonstrate associated soft tissue damage. However, the resolution is
not sufficient to demonstrate very small foreign bodies and radiography
may be requested. Computed tomography is particularly useful when it
is necessary to demonstrate the location of multiple foreign bodies and
foreign bodies in the posterior part of the orbital cavity.
SMU-DDE-Assignments-Scheme of Evaluation
6.
A
Describe radiography in the theatre.
(Unit 14;Section 14.3;Pg 218-222)
Theatre radiography plays a significant role in the delivery of surgical
10
10
services. The following settings are typical examples where the
radiographer is required.
a) Non-trauma corrective orthopaedic surgery
b) Trauma orthopaedic surgery
c) Interventional urology
d) Operative cholangiography
e) Specialized hysterosalpinography procedures
f) Emergency peripheral vascular procedures.
Liaison: The radiographer should contact the theatre superintendent on
arrival in the theatre, and maintain a close liaison with all persons
performing the operation. Radiographers should have a working
knowledge of the duties of each person in the operating theatre, and
check on the specific requirements of the surgeon who is operating.
Personal preparation: In many modern theatre suites it is normal for xray equipment and darkroom processing facilities to be housed within
the complex. The first thing that each radiographer must be concerned
with is their own personal preparation before entering an aseptic
controlled area. Uniform and any jewelry is removed and replaced by
theatre wear. The hair is completely covered with a disposable hat, and
theatre shoes or boots worn. Special attention is then made to washing
the hands, using soap, paying particular attention to the nails with a
scrubbing brush. A face mask is put on. If the skin has an abrasion, this
should be covered with a clean plaster. A film monitoring badge is
pinned to the theatre garment.
Equipment: Portable or mobile x-ray units are selected, depending on
the requirement of the radiographic procedure. This may mean a highpowered mobile x-ray unit for abdominal radiography, or a mobile
image intensifier for screening of orthopaedic procedures, such as hip
pinning. Before a unit is removed from its store, it is switched on and
tested. It is then disconnected from the electrical supply and dusted with
a dry absorbent cloth to remove superficial dust. Using a cloth
moistened with a suitable antiseptic solution in alcohol base, all parts of
the mobile unit are cleaned with special attention to cables and wheels.
After the unit has dried, it is transferred to the theatre, tested again, and
if functioning positioned ready for use. Exposure parameters are then
adjusted to those required for screening or image recording on a film.
The image intensifier housing or x-ray tube housing is covered with a
sterile towel by staffs that are scrubbed for the operation.
Darkroom facilities: Processing equipment should be switched on and
tested. Adequate levels of replenisher solutions should be prepared if
required and a supply of cassettes and films made available for use.
Accessory equipment: Cassette holders, stationary grids, cassette
tunnels or serial changer devices should be cleaned and checked if
SMU-DDE-Assignments-Scheme of Evaluation
required. An operating theatre table with an adjustable cassette tray
should be checked for movement, and the radiographer should be
familiar with the function and be able to position cassettes when
requested. Contrast media, if required, should also be supplied to the
theatre staff.
Radiation protection: Radiation protection is the responsibility of the
radiographer operating the x-ray equipment. The radiographer should
ensure that film monitoring badges and lead rubber aprons are worn
where necessary, and staffs are sent out of theatre if not required during
exposure. Use of the inverse square law with staff standing at the
maximum distance from the source of radiation, and outside the path of
the radiation field, should be made during exposure. The radiation field
should be collimated to the size of the film or intensifier and cassette
support devices should be used to hold cassettes. The radiographer
should use the fastest film/screen combination consistent with the
examination and type of processing to reduce radiation dose. Records
should be kept of exposure times when screening is employed. The
radiographer must give clear instructions to staff before exposures are
made regarding their role to reduce the risk of accidental exposure.
Sterile areas: The radiographer should avoid the contamination of
sterile areas. Ideally, equipment should be positioned before any sterile
towels are placed in position, and care should be exercised not to touch
sterile areas when positioning cassettes or moving equipment during the
operation.
*A-Answer
Note –Please provide keywords, short answer, specific terms, specific examples (wherever necessary)
***********