One of our students brought this to my attention today, and I thought it would be a great example to share here. The first image was the lateral chest view that I was asked to look at. The technical factors used were 120 kVp, 32 mAs (320 mA at 0.1 sec) which produced an S# of 459:
Let's zoom in to the lower lungs and diaphragm:
This is one of the reasons it is good to magnify your images (if possible) when you QC your work. You can tell that there is motion blur in the lung markings, lower ribs, and the diaphragm. We agreed to repeat the image and we made some changes to the technical factors. We decided to use 130 kVp at 32 mAs and change the mA and time stations (640 mA at 0.05 sec) which produced an S# of 373. Here is image 2:
The difference is clearly noted with this magnified image. Lung markings have clear, crisp detail, as well as well defined diaphragm margins and ribs. You even notice far less visualization of the thoracic spine - another great example of why we do a breathing technique for T-spine.
I know that it doesn't take long to spot this after a couple of years experience as a technologist, but I have often heard students who say they have difficulty spotting motion on lateral chests. This is a great example of how motion normally appears - little or no motion toward the apices and motion more exaggerated toward the bases. Make sure to watch your patients' breathing and keep those time stations low!
Hey, great blog here. It's funny how chest x-rays are the most common exam for most departments, but can also be the most overlooked in terms of image quality. We're more likely to stare at clipped apices/angles, wondering if a repeat is warranted, rather than look for motion. Laterals can be tricky at times. Somehow, asking a patient to raise their arms and hold on to bars for stability is just not enough and they're gonna move sometimes. It's just a matter of being more vigilant...like we're supposed to. Again, great post!
ReplyDeleteThanks Darnell... you're absolutely right about overlooking chest x-rays. They make up the majority of what we do, and usually there are plenty of them to tackle. It's easy to simply look at the acquired anatomy and move on without REALLY looking.
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