I'm finding it more and more common for facilities all across the country to require that all PA chests be attempted lengthwise first, regardless of whether or not you believe the lungs will fit on a lengthwise film. If you are reading this and your facility does this, I would be interested in learning about the reason for it.
I have heard that some Radiologists prefer this because they can get a better assessment of heart size when comparing with a lengthwise film on the next monitor over. When performed crosswise, the monitor (due to its shape) decreases the image size in order to fit the whole radiograph on the Doctor's screen, making the comparison lengthwise chest x-ray a different magnification. My issue with this is that handy dandy measure tool on the PACS system. If we have the capability to plot measuring points and obtain a detailed measurement, we should still be able to acquire an accurate assessment of how large the heart is with a few extra seconds of mouse-play. If this is the only reason for the lengthwise chest to be performed first, it would seem that radiation protection standards are being compromised in order to save a few extra seconds for the Doc.
So far, this is the only reason I have heard of for performing the lengthwise chest prior to obtaining a crosswise to include the costophrenic angles. If there are more reasons out there, I would love to hear them from you.
Here comes the disclaimer:
I would absolutely NOT recommend (especially for students reading) that you approach your Radiologists with this in an accusatory manner. To simply ask a question is what I am hoping to accomplish here. Managers, Radiation Safety Officers, and the Radiologists should be making these decisions, and tact will go a long way to preserving your Technologist - Radiologist working relationships. I would hope that you could gather information out there, and have discussion in here with the convenience of anonymous comments :-)
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One of the rads I work with brought this up one time about 6 months ago, while I was still a student. He didn't say why, but simply said I could be fitting alot of my cross wise chests on a lengthwise cassette. I tried it out a bit, but kept clipping, so I switched back.
ReplyDeleteNow I still work with the same rad group, but at a different hospital. The hospital now has digital instead of CR and one of the rooms has a plate that is 17x17...I don't know how that screws with their dimensions on their monitors...you'd think it would cause some size or shape distortion, but it doesn't.
I agree with you on the rads ability to to measure anything and it only taking a few seconds longer to do that, vs taking 2 chest x-rays.
One of the rads I work with brought this up one time about 6 months ago, while I was still a student. He didn't say why, but simply said I could be fitting alot of my cross wise chests on a lengthwise cassette. I tried it out a bit, but kept clipping, so I switched back.
ReplyDeleteNow I still work with the same rad group, but at a different hospital. The hospital now has digital instead of CR and one of the rooms has a plate that is 17x17...I don't know how that screws with their dimensions on their monitors...you'd think it would cause some size or shape distortion, but it doesn't.
I agree with you on the rads ability to to measure anything and it only taking a few seconds longer to do that, vs taking 2 chest x-rays.
It seems this wouldn't be a problem with the digital image receptor. We strangely enough don't digital at any of our clinical sites... I'm sure this will not be an issue once everyone switches over. Every film should come over the same size on your 17x17, even if you collimate.
ReplyDeleteIt seems this wouldn't be a problem with the digital image receptor. We strangely enough don't digital at any of our clinical sites... I'm sure this will not be an issue once everyone switches over. Every film should come over the same size on your 17x17, even if you collimate.
ReplyDeleteThey pop up as different sized images when you see the "thumbnails" on stentor. Its kind of weird. Then when you select the image, its displayed at the size of the monitor, so if the image is more like a crosswise cassette would be (say a lateral foot being wider then it is tall) the overall image is smaller than the AP of the same series.
ReplyDeleteI"m really tired, so I have no idea if that makes sense, but it seems to go along the same lines as the heart size difference...
They pop up as different sized images when you see the "thumbnails" on stentor. Its kind of weird. Then when you select the image, its displayed at the size of the monitor, so if the image is more like a crosswise cassette would be (say a lateral foot being wider then it is tall) the overall image is smaller than the AP of the same series.
ReplyDeleteI"m really tired, so I have no idea if that makes sense, but it seems to go along the same lines as the heart size difference...
Hey, Jeremy! 'Tis Sarah. It's interesting that this is one of your topics, as just recently the facility I work for changed the protocol to not attempt a lengthwise chest first. . . if you think it most likely won't fit to go ahead with cross-wise. Normally this was the case for AP chests, but is now in use for upright bucky chests as well. There are so many toys and tools with Amicas (PACS) that it would surprise me if they did not have a way to get an accurate measure of heart size regardless, you know?
ReplyDeleteHow's life treating ya? :)
Hey, Jeremy! 'Tis Sarah. It's interesting that this is one of your topics, as just recently the facility I work for changed the protocol to not attempt a lengthwise chest first. . . if you think it most likely won't fit to go ahead with cross-wise. Normally this was the case for AP chests, but is now in use for upright bucky chests as well. There are so many toys and tools with Amicas (PACS) that it would surprise me if they did not have a way to get an accurate measure of heart size regardless, you know?
ReplyDeleteHow's life treating ya? :)
It is my understanding that it is degrading to the image to include different anatomy. For example, you do not want to include all that abdomen tissue on a chest x-ray.
ReplyDeletePerhaps you could use this strategy when discussing this with your Radiologists.
It is my understanding that it is degrading to the image to include different anatomy. For example, you do not want to include all that abdomen tissue on a chest x-ray.
ReplyDeletePerhaps you could use this strategy when discussing this with your Radiologists.