One of the most difficult things about performing any cranial work is those maticulous angles that must be acquired... 15 degrees caudal for the caldwell skull for example. Here's a simple suggestion to help you acquire the appropriate angulation when the patient cannot move:
First, place the patient in the desired position (or as close as they can manage). For the caldwell, the OML must be perpendicular to the image receptor. When the patient cannot do this, align the central ray to the OML by the side crosshair on the collimator housing or the laser light if you have one. If you don't have a light that is visible on the side of the patient's head, you can use your tape measure for a rough estimation. Once the tube is angled to the patient's OML, note the degree of angulation (10 degrees cephalic in this example).
Once you know how many degrees and in which direction the OML lies, you can angle accordingly. We know that a 15 degree caudal angle is applied to the OML if the patient were able to assume to position, so because it is a caudal angle, we subtract 15 degrees from the previously noted angulation of (+)10 degrees. 10 - 15 = -5 degrees, or 5 degrees caudal angulation.
Of course, with any degree of angulation, you may see some shape distortion on your radiographic image, but that is an acceptable sacrifice when you have all of the anatomy appropriately presented on film (or the monitor) for the Radiologist.
First, place the patient in the desired position (or as close as they can manage). For the caldwell, the OML must be perpendicular to the image receptor. When the patient cannot do this, align the central ray to the OML by the side crosshair on the collimator housing or the laser light if you have one. If you don't have a light that is visible on the side of the patient's head, you can use your tape measure for a rough estimation. Once the tube is angled to the patient's OML, note the degree of angulation (10 degrees cephalic in this example).
Once you know how many degrees and in which direction the OML lies, you can angle accordingly. We know that a 15 degree caudal angle is applied to the OML if the patient were able to assume to position, so because it is a caudal angle, we subtract 15 degrees from the previously noted angulation of (+)10 degrees. 10 - 15 = -5 degrees, or 5 degrees caudal angulation.
Of course, with any degree of angulation, you may see some shape distortion on your radiographic image, but that is an acceptable sacrifice when you have all of the anatomy appropriately presented on film (or the monitor) for the Radiologist.
Keep up the blogging! I'll pass this on to my students. As far as angling cephalic on oblique c-spines-- generally if the standing patient is a "no-neck", that is hunched over with their neck coming out of their chest, then I angle more than a straight posture.
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Keep up the blogging! I'll pass this on to my students. As far as angling cephalic on oblique c-spines-- generally if the standing patient is a "no-neck", that is hunched over with their neck coming out of their chest, then I angle more than a straight posture.
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Thanks for the recommendation... for the c-spine, I absolutely agree. I was hoping to communicate that that for some people you have to angle more and for some you have to angle less... but I would definitely angle more for the kyphotic patient.
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