CHIR916 2015 Assignment 1
IMAGE 1: APOM of Cervical spine.
Image critique: critique the image for diagnostic quality and radiation protection principles with consideration of the following categories:
– Visible anatomy: The APOM of the cervical spine shows the correct anatomy. The atlas and axis can clearly be seen. Although I think there seems to be too much anatomy on the image. We are able to see down to C6 which is not needed.
– Collimation: The image could have been collimated in a little more. There is a large black area to the left of the image that isn’t need, and it could have been collimated up to the patients’ mandible to eliminate the rest of the cervical spine. Wider collimation exposes the patient to extra radiation that is harmful for them.
– Density: This image seems to have low density. There isn’t a lot of blackening in the image. There is a lot of greyness in the areas where there is no bone. These areas should be black.
– Contrast: The contrast on this image is too low. There isn’t a great difference between the light and dark areas on the x-ray. The image is too grey.
– Image blur: There is no image blur in this image.
Image re-take: state whether the image would need to be re-taken to achieve adequate diagnostic quality. Explain your answer.
I would retake this image. The anatomy that is intended to be seen is not clearly focused on in the x-ray. There is too much of the cervical spine shown in the image that is not needed. Also the shadow of the tongue and the base of the occiput are superimposed on the atlas, which makes it hard to see it well. The density and contrast may also be improved so that the image isn’t too grey.
Image corrections: outline and explain any corrections that could be made to improve diagnostic quality and/or radiation protection.
The superior border needs to be 1cm lower as it is too high under the eyes. The inferior border of the x-ray needs to be collimated up to the mandible about 3cm. The left hand side of the image needs to be collimated medially by 3cm to the soft tissue border, as there is extra film that is not needed and 1cm medially on the right. Collimating the image will allow for less radiation dose exposed to the patient, and more focus on the anatomy needed in the APOM. Also, the head of the patient is a little too extended. The base of the occiput and the incisors are not superimposed on each other which causes the image to have overlapping of the anatomy, making it difficult to read. Neck flexion of 5 degrees will allow the two structures to be on top of one another. This will shift the occiput more superior and allow for better view of the tip of the dens and C1 vertebra. The density of the image should be increased so that the bones look whiter than the soft tissues in the area.
IMAGE 2: Lateral Thoracic spine.
Image critique: critique the image for diagnostic quality and radiation protection principles with consideration of the following categories:
– Visible anatomy: Image two shows a lateral x-ray of the thoracic spine, showing part of C6-C7, the thoracic vertebra, ribs, diaphragm and the humeral shafts. The air spaces can also be seen in the lungs.
– Collimation: The collimation is too wide if the image is only intended for the thoracic spine. It should have been collimated in closer to the spine.
– Density: This image has low density and is too grey. The vertebral bones are not white enough.
– Contrast: The contrast seems to be high over the soft tissue areas rather than the bones. This is especially seen at the cervico-thoracic junction, the sternum and the diaphragm. The bones are also too grey.
– Image blur: There is a great deal of blur in this image due to the movement of the ribs. The patient should have been told to hold their breath or not breathe when the image was being taken. This would have eliminated the blur over the chest area.
Image re-take: state whether the image would need to be re-taken to achieve adequate diagnostic quality. Explain your answer.
This image would have to be retaken. The upper thoracic spine cannot be seen well due to the increase in contrast of the area. The bones are not well corticated and are too grey. Also the motion blur needs to be eliminated by asking the patient to hold their breath when taking the image.
Image corrections: outline and explain any corrections that could be made to improve diagnostic quality and/or radiation protection.
This lateral thoracic x-ray is displaying too much anatomy. The x-ray should be collimated in lateral to medial by 4cm to the front of the anterior aspects of the vertebral bodies. This will subject to patient to a lower dose of radiation. There is also no marker displayed on this image to differentiate between the left and right side of the patient. It is important to have a marker on the image so the practitioner can orientate themselves with the anatomy. To eliminate the motion blur seen in the image, the patients back should be placed against the Bucky to help stabilise them, and also be told to hold their breath before the radiographer takes the image. By holding their breath it stops the ribs from moving, creating a clearer image. The image should be taken on inspiration so that the diaphragm is not obstructing the lower thoracic vertebra. In order to decrease the contrast in the upper cervico-thoracic region, an increase in kVp will need to be made. Increasing the kVp by 15% will increase the penetrability of the x-ray beams. This will allow for better image quality and less radiation exposure to the patient.
IMAGE 3: AP Lumbo-pelvic.
Image critique: critique the image for diagnostic quality and radiation protection principles with consideration of the following categories:
– Visible anatomy: Image three is an AP of the lumbo-pelvic region. It shows the eleventh and twelfth rib, lumbar vertebra, pelvic bones and the heads of the femur bones. The image also shows bowel gas in the abdominal region, over the sacrum and a little on the top of the left and right iliac bones. There is a black lucent line that can be seen bilaterally. It runs diagonally under the ischial tuberosity, through the neck of the femur to the end of the soft tissue shadow. It is clearer on the left side of the pelvis as the right side is a little cut off due to the collimation.
– Collimation: The image could have been collimated in close to the left of the image by one cm and collimated out by two cm on the right of the image to include the greater trochanter of the femur bone.
– Density: The density is good on this image. The bones are white and well corticated.
– Contrast: The contrast is too high. There is too much whitening of the soft tissue. This makes it difficult to clearly read the x-ray image, especially around L1 and L5-S1.
– Image blur: There is no image blur.
Image re-take: state whether the image would need to be re-taken to achieve adequate diagnostic quality. Explain your answer.
I would retake this image. Although the bones are well corticated, there is too much soft tissue density in the abdominal and pelvic region. This makes it difficult to visualise the anatomy properly. Also L1 cannot be seen too well, and the lumbosacral junction is too dense/white.
Image corrections: outline and explain any corrections that could be made to improve diagnostic quality and/or radiation protection.
This AP lumbopelvic x-ray is showing the correct anatomy although, the x-ray should be collimated medially by 1cm on the left of the image and laterally by 2cm on the right of the image to include the greater trochanter. The image should include T11/T12, which cannot be seen on this x-ray. To address this, the x-ray beam should be collimated superiorly by 3cm. tighter collimation produces better image detail as there is less scatter radiation. The patient should be wearing gonadal protection for safety and to limit radiation to that area, as they are very radio sensitive. The kVp should be increased by 15% in order to reduce the contrast, allowing the x-ray beams to penetrate through the soft tissue, resulting with an image of better quality.
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