Image Evaluation: Stretcher Chest

Image Evaluation: Stretcher Chest

Presented By:

Rochelle

Mazzella

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

Radiation

Hygiene

This image now shows

acceptable collimation

Completeness of Position/Projection

PA/AP Chest Lateral Chest

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.


• The part is accurately

aligned to the

longitudinal axis of the

image.


Optimal Alignment Acceptable Alignment


Because this image only has one side of collimation it does not fit optimal or acceptable alignment.


With the newly added collimation, this image would fit optimal alignment


• 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


• 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


• 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


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


Criteria

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.


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.


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

Image Evaluation: Stretcher Chest

Education

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