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Sacrum _ Coccyx

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					          Sacrum & Coccyx
• The primary beam will pass through the
  general location of the ovaries. Unless the
  female patient of child bearing age is
  large, P-A views are taken.
• The bell will be used for male patients
  needing Sacrum or Coccyx views.
• Measurements are at the trochanters.


                                                1
            7.14 A-P Sacrum
• Measure: A-P at
  trochanters
• Protection: Bell for
  males, none for females
• SID: 40” Bucky
• Tube angle: 15 degrees
  cephalad
• Film: 8” x 10” I.D. up
  Portrait



                              2
               A-P Sacrum
• Patient stands facing
  the tube with back
  touching Bucky.
• Patient may hold onto
  the Bucky.
• Locate the ASIS and
  the symphysis pubis



                            3
               A-P Sacrum
• Horizontal CR:
  midway between the
  ASIS and pubis or 1.5
  inches below the
  ASIS.
• Vertical CR: mid
  sagittal plane
• Center film to
  horizontal CR

                            4
                  A-P Sacrum
• Collimation: slightly less
  than film size
• Breathing Instructions:
  Full Expiration
• Make exposure and let
  patient breathe and
  relax




                               5
            A-P Sacrum Film
• There should be no
  rotation.
• The entire sacrum
  should be seen.
• The S.I. Joints should
  be well visualized.
• The Bell should not
  obstruct the view.


                              6
           7.15 P-A Sacrum
• Measure: A-P at
  trochanters
• Protection:
  positioning
• SID: 40” Bucky
• Tube angle: 15°
  caudal
• Film: 8” x 10” Regular
  I.D. up Portrait

                             7
                  P-A Sacrum
• Patient stands facing the
  Bucky. Get the patient as
  close to the Bucky as
  possible.
• Check feet and torso for
  rotation.
• Locate the PSIS
• Horizontal CR: 1” to 2”
  below the PSIS or mid
  sacrum


                               8
                  P-A Sacrum
• Vertical CR: mid sagittal
• Collimation: slightly less
  than film size.
• Breathing Instructions:
  Full expiration
• Make exposure and let
  patient breathe and
  relax




                               9
             P-A Sacrum Film
• There should be no
  rotation.
• Sacrum and Sacroiliac
  Joints should be well
  visualized.
• Taken only on females
  of childbearing age that
  are not too large.




                               10
              7.16 A-P Coccyx
• Measure: A-P at
  trochanters
• Protection: Bell for
  males, none for females
• SID: 40” Bucky
• Tube Angle: 10 degrees
  caudal
• Film: 8” X 10” regular I.D.
  up portrait



                                11
                  A-P Coccyx
• Patient stands facing the
  tube with feet shoulders
  width apart.
• Make sure patient is as
  close to Bucky as
  possible.
• Locate the ASIS and
  symphysis pubis




                               12
                  A-P Coccyx
• Horizontal CR: 2” above
  the symphysis pubis or
  midway between the
  ASIS and symphysis
  pubis
• Vertical CR: mid sagittal
• Center film to horizontal
  CR
• Collimation: slightly less
  than film size


                               13
                 A-P Coccyx
• Breathing Instructions:
  Full Expiration
• Make exposure and let
  patient relax.




                              14
            A-P Coccyx Film
• Should see distal
  sacrum and coccyx
• No evidence of rotation
• Bell should not obscure
  view of coccyx
• This view can also be
  used to evaluate pubic
  fractures.




                              15
7.17 P-A Coccyx
        • Measure: A-P at
          trochanters
        • Protection: position
        • SID: 40” Bucky
        • Tube Angle: 10 degrees
          cephalad
        • Film: 8” x 10” regular I.D.
          up Portrait




                                    16
P-A Coccyx
     • Patient stands facing
       the Bucky with feet
       shoulders width apart.
     • Make sure the patient
       is not rotated.
     • Patient should be as
       close to Bucky as
       possible.


                           17
P-A Coccyx
     • Horizontal CR: 2” above the
       level of the trochanters
     • Vertical CR: mid sagittal
     • Center film to horizontal
       CR.
     • Collimation: slightly less
       than film size.
     • Breathing Instructions:
       Full Expiration
     • Make exposure and let
       patient relax




                                     18
P-A Coccyx Film
        • Should see the distal
          sacrum and entire
          coccyx.
        • There should be no
          rotation
        • Gas in the bowel may
          reduce image quality




                                  19
 7.18 Lateral Sacrum & Coccyx
• Measure: Lateral at
  trochanters
• Protection: Lateral
  gonad shield
• SID: 40” Bucky
• No tube angle
• Film: 10” x 12” regular
  I.D. Up Portrait




                                20
      Lateral Sacrum & Coccyx
• Patient stands in lateral
  position with feet
  shoulders width apart.
• Have patient cross arms
  at shoulder level.
• Locate the Iliac Crest and
  Symphysis Pubis
• Horizontal CR: midway
  between Iliac Crest and
  Symphysis Pubis


                                21
      Lateral Sacrum & Coccyx
• Vertical CR: 2” to 3”
  posterior to mid coronal
  plane.
• Center film to Horizontal
  CR.
• Collimation Top to
  Bottom: slightly less than
  film size
• Collimation Side to Side:
  slightly less than film size or
  posterior skin

                                    22
     Lateral Sacrum & Coccyx
• Place Lateral Gonad
  Shield with curve
  following curve of sacrum
  to level of ASIS on females
  and above pubis on males.
• Breathing Instructions:
  Full Expiration
• Make exposure and let
  patient breathe and relax.



                                23
 Lateral Sacrum & Coccyx Film
• Should visualize from
  L5 to tip of coccyx.
• No evidence of patient
  rotation.
• Collimation will reduce
  scatter and improve
  detail.




                                24
  Lumbar Region Radiography
• Accurate positioning requires the doctor to
  locate the positioning landmarks.
  – Lumbar Spine: Iliac Crest, ASIS or PSIS
  – Sacrum or Coccyx: Symphysis Pubis, ASIS or
    Iliac Crest
• Gonad Shielding placement is critical.
  Improperly positioned shield will block
  view.

                                             25
      Full Spine Radiography
• Full spine views will require proper use of :
  – Accurate placement of filtration
  – Higher technical factors and complete
    exposures
  – Relatively high speed film
  – Modern x-ray generators
  – Accurate placement of gonad shielding.



                                              26
      Full Spine Radiography
• Follow up exams on young females can be
  done P-A to further reduce radiation
  exposure to breast tissue and ovaries.
• Some facilities will lower Para spinal shield
  to level just above the iliac crest.




                                             27
  Lumbar Region Radiography
• Because recumbent radiography
  straightens the lumbar spine, posterior
  oblique views are best taken recumbent.
• Horizontal Central Ray Placement:
  – A-P Lumbopelvic: 1” to 1.5 “ below iliac crest
  – Lateral & Oblique Views: 1” above iliac crest




                                                 28
  Lumbar Region Radiography
• Accurate positioning requires attention to
  the placement of the feet.
  – Shoulders width apart
  – Parallel to each other
  – Knees locked to check impact of leg length
    problems
• Back and buttocks should be touching
  Bucky

                                                 29
Sacrum & Coccyx Radiography
• Horizontal Central Ray:
  – Sacrum A-P : Midway between ASIS and
    Symphysis
  – Sacrum P-A: Two inches below PSIS
  – Coccyx A-P: Midway between ASIS and
    Symphysis or 2” above symphysis
  – Coccyx P-A: Midway between trochanters and
    PSIS


                                            30
Sacrum & Coccyx Radiography
• Horizontal Central Ray:
  – Lateral: Midway between Iliac Crest and
    Symphysis
• Proper collimation will reduce scatter and
  improve image quality




                                               31
  8.1 Abdominal and Decubitus
         Radiography
• KUB- Similar to the A-P Lumbopelvic
  except taken recumbent
• Acute Abdomen: P-A erect chest, KUB
  and upright abdomen or decubitus
  abdomen
• Erect and Decubitus Abdomen taken
  looking for free air under diaphragms.
• Gas patterns in abdomen are also
  evaluated.
                                           32
       Chest Decubitus Views
• Decubitus views of the chest will
  demonstrate free pleural effusions as the
  fluid will pool.
• Air and fluid levels will be easily identified.
• Patient must remain on side for ten
  minutes to allow time for pooling of the
  fluid.
• Important to get the entire chest on film.
                                                33
Upright or Decubitus Abdomen
            Views
• Diaphragms must be seen on erect and
  decubitus view of abdomen.
• Patient must remain upright or remain on
  left side for 10 minutes before the films are
  taken.
• An arrow is used to document the films
  being a decubitus or erect film.

                                              34
          Abdomen Views

• The A-P lumbopelvic view may
  demonstrate abdominal pathologies and
  disease. Don’t just look at the spine.
• Conditions such as kidney stone,
  abdominal aortic aneurysms, vascular
  calcifications and gallstones can be
  identified on the A-P lumbopelvic view.


                                            35
Left side Kidney Stone




                         36
           Abdomen Views

• The KUB or recumbent abdomen view is
  used to identify many abdominal
  conditions.
• It must demonstrate the Kidneys, path of
  the Ureters and Bladder.
• Often kidney stone are seen on this view.


                                              37
           Abdomen Views

• Kidney stones can present with very
  similar symptoms as a low back injury.
• Chiropractors can often make this
  diagnosis from their radiographs.
• The KUB is better for seeing stones
  because the air and fluid levels are not
  seen since it is taken recumbent.

                                             38
      Acute Abdomen Series
• Study is a non-contrast survey of the acute
  abdomen. The exam consists of:
• P-A Chest erect
• Erect or Up right Abdomen
• KUB
• If patient can not stand, left lateral
  decubitus view of abdomen may be done.

                                           39
            P-A Chest Erect
• Free Air in the
  abdomen will be seen
  under the
  diaphragms.
• Air in stomach will be
  seen.




                              40
     Erect or Upright Abdomen
• Free Air in the
  abdomen will be seen
  under the
  diaphragms.
• Air in stomach will be
  seen.
• Bowel gas pattern
  and fluid levels seen.


                                41
     Erect or Upright Abdomen
• Free Air in the
  abdomen will be seen
  under the
  diaphragms.
• Air in stomach will be
  seen.
• Bowel gas pattern
  and fluid levels seen.


                                42
     8.2 KUB or A-P Abdomen
• Should seen the gas
  patterns present in
  the bowel.
• Look for calcifications
  or other abnormalities
  in the abdomen.
• Note stent from
  kidney to bladder


                              43
     8.2 KUB or A-P Abdomen
• Measure: A-P at
  umbilicus
• Protection: Males: Bell
  or apron draped over
  testes. Females: None,
  may take P-A view
• SID: 40” to table Bucky
• Film: 14” x 17” regular
  I.D. up



                              44
         KUB or A-P Abdomen
• Position table in the
  room. Align the vertical
  central ray to the center
  line of the table.
• Lock the table wheel lock.
• Have patient lie on back
  on the table.
• Make sure the table did
  not move when patient
  got on table.


                               45
          KUB or A-P Abdomen
• Locate the umbilicus.
  Have patient move on the
  table until the umbilicus is
  aligned with the vertical
  central ray.
• Locate the symphysis
  pubis and position bell or
  drape apron below the
  symphysis pubis.



                                 46
         KUB or A-P Abdomen
• Locate the iliac crest.
• Horizontal CR: 1” to 1.5”
  below the iliac crest or
  midway between the
  crest and ASIS.
• Vertical CR: mid sagittal
• Center film to horizontal
  CR.
• Collimation: slightly less
  than film size.


                               47
        KUB or A-P Abdomen
• Breathing Instructions :
  Full Expiration
• Make exposure and let
  patient breathe and
  relax.
• A sponge may be
  placed under the
  patient’s knees to
  relieve the pressure on
  the spine


                             48
    KUB or A-P Abdomen Film
• Both kidneys
  should be
  seen.
• Psoas
  muscles
  seen
• Symphysis
  pubis seen




                              49
                KUB ERROR
• Horizontal CR was not
  low enough to get
  pubis on film.
• Symphysis pubis not
  seen because bell was
  positioned too high. A
  stone could be missed.




                            50
      8.3 Upright
       Abdomen
• Measure: A-P at
  umbilicus
• Protection: Bell for
  males; female: none or
  taken P-A
• SID: 40” Bucky
• No tube angle
• Film: 14” x 17” regular
  I.D. up



                            51
 Upright Abdomen
• Bell placed below level
  of pubis.
• Patient stands facing
  tube with back next to
  Bucky.
• Method 1
• Locate xiphoid process
• Position top of film 2.5”
  above the xiphoid
  process.


                              52
 Upright Abdomen
• Horizontal CR
  centered to film
• Method 2
• Horizontal CR: 2”
  above the iliac crest
• Film centered to
  horizontal CR.
• Vertical CR: mid
  sagittal



                          53
           Upright Abdomen
• Collimation: slightly less
  than film size
• Breathing Instructions:
  Full expiration
• Make exposure and let
  patient relax.
• Note: patient needs to
  be erect for 10 minutes
  before taking film.



                               54
      Upright Abdomen Film
• Domes of diaphragms
  must be seen
• Gas pattern and air fluid
  levels of abdomen may
  be evaluated.
• Note fluid level in
  stomach.




                              55
      8.4 Decubitus Abdomen
• Measure: A-P at
  umbilicus
• Protection: Males apron
  draped over testes.
  Female: None or do P-A
• SID: 40” to Bucky
• No tube angle
• Film: 17” x 14” regular
  I.D. up



                              56
           Decubitus Abdomen
• Place table next to Bucky
• Align bottom of film just
  below table to to assure
  that the dependent side
  will be on film.
• Have patient lie on table
  with their left side down.
• Patient to stay in this
  position for about 10
  minutes.


                               57
          Decubitus Abdomen
• Horizontal CR:
  along mid sagittal
  plane.
• Vertical CR: 2.5”
  lateral and superior
  to the iliac crest
• Move table or patient
  to align vertical CR.
• Collimation: slightly
  less than film size.


                              58
          Decubitus Abdomen
• Breathing Instructions:
  Full Expiration
• Make exposure and let
  patient breathe and
  relax.
• Note : P-A positioning.
  The key to decubitus
  views is alignment of
  bottom of film with table
  top.


                              59
      Decubitus Abdomen Film
• Right side diaphragm
  must be seen to detect
  abdominal free air.
• It is easier to see air
  around liver border.
• Arrow marker on film to
  document side up.
• Gas and fluid level
  patterns in abdomen can
  be evaluated.


                               60
      8.5 Chest Decubitus View
• Chest decubitus
  views are taken to
  evaluate pleural and
  pericardial
  effusions.
• In the lung, fluid will
  pool in the
  dependent side. In
  the hilar and
  pericardium, fluid will
  be seen in the side
  up.
                                 61
     8.5 Chest Decubitus View
• Measure: A-P at mid
  chest
• Protection: Lead apron
  draped over abdomen
• SID: 72” Bucky
• No tube angle (90
  degrees)
• Film: 17” x 14” regular
  I.D. up. Small patient:
  14” x 17” I.D. up


                                62
       Chest Decubitus View
• Table placed next to
  wall Bucky with bottom
  of film just below the
  table top.
• Patient placed on table
  lying on the side where
  the effusion is
  suspected.
• Patient should be
  facing tube.
• Patient needs to stay
  on side for 10 minutes      63
        Chest Decubitus View
• Horizontal CR: mid-
  sagittal plane
• Vertical CR: mid
  chest
• Note view can be
  taken P-A if patient
  can get arm straight
  over their head. It is
  important to avoid any
  lordotic angle of chest.
• Collimation: less
  than film size.              64
       Chest Decubitus View
• Breathing
  Instructions: Full and
  deep inspiration
• Make exposure and
  let patient breathe
  and relax.




                              65
        Chest Decubitus Film
• All of lung fields
  should be seen.
• Arrow marker
  should be used
  to note the side
  up
• Deep inspiration
  (below 10th ribs)
  is very important
  to see true
  extent of any
  effusion
                               66
      End of Lecture

Return for Winter 2008 Index and
            Schedule
 Return to PB-322 Home Page

                                   67

				
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