CLO07: Summarize the importance of proper positioning.

Proper positioning is an important aspect to understand. It is important to understand because improper positioning can lead to image distortion and superimposition of the anatomy. If the anatomy is improperly positioned, then another image needs to be taken which causes the patient to be exposed to more radiation. For example, the AP internal oblique knee above is improperly positioned. The improper positioning causes the fibula head to be superimposed by the tibia and the patella is more centered than medial. To fix this improper positioning, the patient’s leg must be internally rotated forty-five degrees and then a second image can be taken.

CLO01: Identify anatomy on radiographic images.

Anatomy displayed on a PA chest is specific for that position. The apices of the lungs to the costophrenic angles are shown. The apices refer to the top of the lungs. The clavicle is located lateral to the sternum and both clavicles are on the same horizontal plane. The carina is right before the trachea divides into left and right bronchi. The shoulders are rolled forward allowing for the scapulae to be out of the lung field. The diaphragm which separates the internal organs from the lung field is also seen. Ten posterior ribs need to be demonstrated, which indicates proper inspiration. The trachea should be visible in the midline of the body. Pulmonary vascular markings from the hilar regions to the periphery of the lungs is visible.

CLO06: Modify directions to patients with various communication problems.

In some instances, there will be patients with various communication problems seen in the field of radiography. A few methods to expand communication beyond words is to communicate with hand gestures. To demonstrate the position first before putting the patient in the position and confirm that the patient understands before continuing. Another method is to use the patient’s relative for help as they are used to communicating with the patient. Sometimes the relative is their caretaker or know about their medical history and can communicate more effectively than the technologist can. In the hospital setting, language translators are also available to the technologist if needed.

CLO02: Demonstrate proper use of positioning aides.

Positioning aides are used to help the patient to maintain that specific position and provide support where ever needed. These aides range from angled sponges, circular sponges, general support sponges and sandbags. For a lateral projection of the knee, a lateral recumbent position is used. The unaffected leg is placed behind the affected leg to prevent over-rotation, when this is done a supporting sponge should placed under the unaffected leg. Also, an angled sponged should be under the affected foot if the knee is up. Positioning aides can also be used to alleviate discomfort and allow for the patient to hold the position longer, if necessary.

CLO05: Explain radiographic procedures to patient and family members

Communication with the patient and family members is important in order to keep them informed of the upcoming process. A simple explanation of the type of exam along with an estimated time, different positions and the expectations that the technologist will have of the patient. Sometimes, the patient isn’t given any information regarding their exam by their doctor and doesn’t know which body part is being x-rayed. Questions such as if the patient can stand and if so, are they able to stand for a few minutes, should be asked. If the patient is a child then the parent should be present for the history in order to provide a more detail. Transportation to the area if they can’t walk, should also be discussed. A patient shouldn’t have to walk blindly into an exam but given careful instructions by the x-ray technologist.

CLO09: Identify structures demonstrated on routine radiographic images.

Image: PA Oblique Hand

For a PA oblique hand, certain criteria are required to be fulfilled in order to classify it as such. Several of these criteria needed include having anatomy from fingertips to the distal radius and ulna, forty-five degree rotation of anatomy, open metacarpophalangeal (MCP) joints, open interphalangeal (IP) joints and partial superimposition of third, fourth and fifth metacarpal bases. A PA oblique hand can also be identified by whether the digits have concavity on only one or both sides of the digit.

CLO13: Discuss equipment and supplies necessary to complete basic radiographic and procedures.

During a radiographic procedure, specialized equipment and supplies are needed to conduct such an exam. This specialized equipment consists of the x-ray tube and wall bucky. An x-ray tube has rapidly moving electrons that are boiled off of the filaments through thermionic emission. These electrons then travel from the cathode to the anode which generates photons needed to produce the image. The image receptor is a cassette that needs to be put in the bucky drawer of the table or the wall bucky. The wall bucky is a wall unit used for positioning in a upright position. General supplies needed for a procedure are lead aprons, gloves, gowns along with left and right markers.

CLO16: Apply general radiation safety and protection practices associated with radiographic and examinations.

Radiation safety and protection are a priority in patient care. Radiographic technologists as well as student technologists should always abide by ALARA. ALARA stands for as low as reasonably achieveable meaning that when a patient is exposed, the lowest dose that provides adequate exposure is used. Three essential checkpoints following ALARA are time, distance and shielding. For time, the amount of time the technologist spends in the room. For distance, the technologist should be as far away as possible or at a minimum of six feet. For shielding, patient should always be shielded especially if they are pregnant or within child-bearing age. These are essential criteria that follow technologists and student technologists must abide by.

CLO 1: Describe standard positioning terms

Standard positioning terms are as follows: