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15.2 Pelvis A-P. Measure: A-P at Trochanters Protection: Males:Bell Females: None SID: 40” Table Bucky No Tube Angle Film: 17” x 14” I.D. up. Pelvis A-P. The Vertical CR is used to center the table and lock wheel locks. Males: place belt for bell at level of ASIS.

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15 2 pelvis a p

15.2 Pelvis A-P

  • Measure: A-P at Trochanters

  • Protection: Males:Bell Females: None

  • SID: 40” Table Bucky

  • No Tube Angle

  • Film: 17” x 14” I.D. up


Pelvis a p

Pelvis A-P

  • The Vertical CR is used to center the table and lock wheel locks.

  • Males: place belt for bell at level of ASIS.

  • Patient lies supine on the table.

  • Heels and Toes are together or heels may be apart with toes together.


Pelvis a p1

Pelvis A-P

  • Horizontal CR: 1” to 1.5” superior to Symphysis pubis

  • Vertical CR: mid-sagittal

  • Film centered to horizontal CR.

  • Collimation: slightly less than film size.

  • Breathing Instructions: Full expiration


Pelvis a p film

Pelvis A-P Film

  • The pelvis should be centered on film.

  • Rotation should be avoided.

  • Both femurs will be in true A-P position if feet were properly positioned.


15 3 pelvis bilateral frog leg lateral

15.3 Pelvis Bilateral Frog leg Lateral

  • Measure: A-P at Trochanters

  • Protection: Males:Bell Females: None

  • SID: 40” Table Bucky

  • No Tube Angle

  • Film: 17” x 14” I.D. up


Pelvis frog leg lateral

Pelvis Frog Leg Lateral

  • The Vertical CR is used to center the table and lock wheel locks.

  • Males: place belt for bell at level of ASIS.

  • Patient lies supine on the table.

  • Patient places heels together with knees bent.


Pelvis frog leg lateral1

Pelvis Frog Leg Lateral

  • The patient then externally rotates legs as far as possible.

  • A sponge may be used under the affected side to improve comfort.

  • Watch the placement of the bell on male patients as it is prone to be too high on this view.


Pelvis frog leg lateral2

Pelvis Frog Leg Lateral

  • Horizontal CR: 1 1/2” superior to symphysis pubis

  • Vertical CR: mid-sagittal

  • Film centered to horizontal CR.

  • Collimation: slightly less than film size.

  • Breathing Instructions: Full expiration


Pelvis frog leg lateral film

Pelvis Frog Leg Lateral Film

  • The pelvis should be centered on film.

  • Rotation should be avoided. Note rotation on this film.

  • Both femurs will be in a lateral oblique position.

  • Note that bell is too high and blocks view of symphysis.


15 4 hip unilateral a p

15.4 Hip Unilateral A-P

  • Measure: A-P at trochanters

  • Protection: Bell: males: Females: None

  • SID: 40” Bucky or Table Bucky

  • No tube angle

  • Film: 10” x 12 I.D. up


Hip unilateral a p

Hip Unilateral A-P

  • This view may be taken erect or supine.

  • For supine view, center and lock table to vertical CR.

  • Place belt for bell on patient at level of the ASIS.

  • Patient stands or lies facing the tube.


Hip unilateral a p1

Hip Unilateral A-P

  • The leg is internally rotated about 15 degrees to get lower leg in A-P position.

  • Males: place bell below symphysis pubis

  • Horizontal CR: 1 1/2” superior to symphysis pubis.


Hip unilateral a p2

Hip Unilateral A-P

  • Center film to horizontal CR

  • Vertical CR: 2” to 3” lateral to mid-sagittal or through the acetabulum.

  • Collimation top to bottom: iliac crest to lesser trochanter

  • Collimation: symphysis to soft tissue of hip


Hip unilateral a p3

Hip Unilateral A-P

  • Check that leg in in true A-P position and bell on male patient is not too high.

  • Breathing Instructions: Full Expiration

  • Make exposure and let patient relax


Hip unilateral a p film

Hip Unilateral A-P Film

  • Must include symphysis pubis and iliac crest.

  • There should be no rotation.

  • Upper femur must be in true A-P position.

  • Adjacent soft tissues should be seen


15 5 hip frog leg lateral

15.5 Hip Frog Leg Lateral

  • Measure: A-P at trochanters

  • Protection: Bell: males: Females: None

  • SID: 40” Bucky or Table Bucky

  • No tube angle

  • Film: 10” x 12 I.D. up


Hip lateral

Hip Lateral

  • This view may be taken erect or supine.

  • For supine view, center and lock table to vertical CR.

  • Place belt for bell on patient at level of the ASIS.

  • Patient stands or lies facing the tube.


Hip lateral1

Hip Lateral

  • The knee is bent and leg externally rotated until the femur is parallel to film. The pelvis may be rotated if necessary.

  • Males: place bell below symphysis pubis

  • Horizontal CR: 1 1/2” superior to symphysis pubis.


Hip lateral2

Hip Lateral

  • For erect views, the patient bends knee and rests foot on rung of stool or chair with femur parallel to film.

  • The film is centered to horizontal CR.

  • Vertical CR: 2” to 3” lateral to symphysis or through the acetabulum.


Hip unilateral a p4

Hip Unilateral A-P

  • Make sure bell is below symphysis and not over acetabulum.

  • Collimation top to bottom: iliac crest to lesser trochanter

  • Collimation: symphysis to soft tissue of hip

  • Breathing Instructions: Full Expiration


Hip lateral film

Hip Lateral Film

  • Must include symphysis pubis and iliac crest.

  • There should be no rotation.

  • Upper femur must be in true lateral position.

  • Adjacent soft tissues should be seen


15 6 femur a p

15.6 Femur A-P

  • Measure: A-P at mid thigh

  • Protection: Bell: males; Male or Female: Apron over pelvis

  • SID: 40” Bucky

  • No Tube angle

  • Film: 7” x 17” I.D. Up or 14” x 17” I.D. Up for large muscular femur


Femur a p

Femur A-P

  • Table locked and centered to Vertical CR.

  • Patient lies recumbent on table with femur internally rotated 15 degrees or until the condyles are parallel to film.

  • The bottom of the film is placed 2” below femur condyles.


Femur a p1

Femur A-P

  • Horizontal CR: centered to the film.

  • Vertical CR: long axis of the femur

  • Collimation Side to side: soft tissues of femur or slightly less than film size. If soft tissue will not fit on the 7” x 17” use a 14” x 17” and collimate


Femur a p2

Femur A-P

  • Collimation top to bottom: from knee joint to trochanters. Most adults will require an A-P hip to complete view.

  • Breathing Instructions: remain still

  • Make exposure and let patient relax


Femur a p film

Femur A-P Film

  • Must include joint space to determine rotation.

  • Soft tissue of femur should be seen.

  • Note that an A-P can be taken from the hip down by placing top of film at level of the ASIS


15 7 femur lateral

15.7 Femur Lateral

  • Measure: Lateral at mid thigh

  • Protection: Apron over pelvis

  • SID: 40: Bucky

  • No Tube Angle

  • Film: 7” x 17 I.D. up


Femur lateral

Femur Lateral

  • Patient lies on affected side with pelvis in lateral position.

  • Knee is flexed 45 degrees.

  • Long axis of femur aligned with vertical CR

  • Bottom of film placed 2” below femur condyles.

  • Apron draped over pelvis.


Femur lateral1

Femur Lateral

  • Horizontal CR: centered to film

  • Vertical CR: centered to long axis of femur

  • Collimation side to side: soft tissue of femur or slightly less than film size. Use 14” x 17” and collimate for large or muscular femur


Femur lateral2

Femur Lateral

  • Collimation Top to Bottom: to include knee joint to trochanters. Lateral hip may be needed to complete study.

  • Breathing Instruction: Hold still.

  • Make exposure and let patient relax


Femur lateral film

Femur Lateral Film

  • The complete exam will include both articulations.

  • Note improper I.D. placement blocking distal joint space.

  • By placing the top of the film at the ASIS and the pelvis in oblique position, a film can be taken from hip down.


21 1 automatic film processors

21.1 Automatic Film Processors

  • Operation divided into six basic systems

    • Roller Transport System

    • Developer Recirculation

    • Water Circulation

    • Fixer Recirculation

    • Replenishment: Developer and Fixer

    • Air Circulation (Dryer)


Roller transport system

Roller Transport System

  • Purpose

  • Transport Film

  • Control Processing Time

  • Control Replenishment Time

  • Agitation

  • Squeegee Action

  • Help Prevent Overlap


Developer recirculation

Developer Recirculation

  • Purpose

  • Develop Films

  • Maintain Solution Activity

  • Temperature Control

  • Filtration

  • Control of Recirculation

  • Help Control Fixer Temperature


Water circulation

Water Circulation

  • Purpose

  • Wash Films

  • Help Control Developer Temperature

  • Water Flow Control

  • Agitation

  • Help Control Fixer Temperature

  • Keep Developer Drain Clean


Fixer recirculation

Fixer Recirculation

  • Purpose

  • Stops Development

  • Clears the Film

  • Hardens the Emulsion

  • Agitation

  • Maintain Solution Activity

  • Constant Control of Recirculation


Developer fixer replenishment

Developer & Fixer Replenishment

  • Purpose

  • Replenish chemical

  • Maintain Solution Activity and Solution Level

  • Control / Adjust Rate of Replenishment

  • Check Replenishment Rates

  • Prevent Siphoning of Replenisher


Air circulation dryer

Air Circulation/Dryer

  • Purpose

  • Dries the Film

  • Temperature Control

  • Constant Control of Circulation and Recirculation


21 2 processor quality control

21.2 Processor Quality Control

  • Purpose

  • Monitor the development of the film to maintain:

    • Proper speed or density of the image

    • Proper level of contrast of the image

    • Minimize any background density on the film


Starting processor qc

Starting Processor QC

  • Have processor cleaned and fresh chemical delivered.

  • Process a test strip for five consecutive days.

  • Record the reading of each step. Average the reading from the strips to set a base line.


Processor quality control

Processor Quality Control

  • Process of Processor Quality Control

    • Check the temperature of the developer by use of a thermometer.

    • Check water temperature.

    • Check fixer temperature.

    • If developer temperature is within ± 0.5° of specifications produce and process the sensitometric strip.


Check developer temperature

Check Developer Temperature

  • Proper development of the latent image is dependent upon:

    • Developer temperature

    • Concentration of developer solution

    • Time film spends in the developer

    • Temperature must be to specifications


Check of water temperature

Check of Water Temperature

  • If the water is too cold, it will be more costly to heat the developer to operating temperature. If water is too warm, the developer will over heat.


Check of fixer temperature

Check of Fixer Temperature

  • The fixing of the image is dependent upon the fixer being within factory specification but is not as critical as developer temperature.


Expose sensitometric strip

Expose Sensitometric Strip

  • The Sensitometer produces highly reproducible step wedge images used to monitor the performance of the developer.

  • Using film set aside for processor quality control, expose both sides of the film with the Sensitometer.


Process the sensitometric strip

Process the Sensitometric Strip

  • Always feed the film into the processor the same way and on the same side of the feed tray.

  • Bromide drag and affect the image.


Read the sensitometric strip

Read the Sensitometric Strip

  • A Densitometer is used to read the optical density of the strip.

  • Read an area of unexposed film to check the base plus fog (B+F) of the image.

  • Then read the Speed and Contrast Steps.


Read the sensitometric strip1

Read the Sensitometric Strip

  • The amount of light passing through the image is the optical density of the image.

  • Speed or Mid Density is the step closest a reading of 1.00 + Base+ Fog or 1.20 OD

  • Contrast or Density Deference is the deference between the steps closest to 0.25 + Base + Fog or 0.45 and the step closest to 2.00 + Base + Fog or 2.20 OD.


Graph the results on the processor qc chart

Graph the Results on the Processor QC Chart

  • The processor should be checked before x-rays are taken on the first patient.

  • If a problem exists, it must be corrected before processing patient films.


21 3 processor qc problem solving

21.3 Processor QC Problem Solving

  • Processor QC monitors the development of the film. These factors impact development:

    • Developer Temperature

    • Time of Development

    • Activity of the Developer

    • Also the darkroom and film storage conditions will impact Processor QC.


Base plus fog

Base Plus Fog

  • Any unexposed area of the film can be tested to determine the Base Plus Fog exposure level.

  • Base Plus Fog is the level of pre-existing exposure exposure above the blue tint of the base of the film.


Base plus fog1

Base Plus Fog

  • Items that will impact the Base Plus Fog includes:

    • Condition of film storage after manufacture.

    • Light integrity of the dark room

    • The light spectrum from the safelight

    • Temperature of the developer

    • Contamination of the developer


Speed index or mid density

Speed Index or Mid Density

  • This is the step closest to 1.00 plus B+F or 1.20 Optical Density. It corresponds to the middle of the useful exposure level on x-ray film.

  • Factors that will impact the Speed Index include:

    • Developer Temperature: Low Temperature will produce lower speed.


Speed index or mid density1

Speed Index or Mid Density

  • Developer Temperature: High Temperature will produce increased speed.

  • Fog level of the film: Increased Base + Fog will increase the Speed Index.

  • Time spent in the developer: Increased time at the correct temperature will increase speed.

  • Activity of the developer: under replenishment will lower the Speed Index


Speed index or mid density2

Speed Index or Mid Density

  • Activity of the developer: under replenishment will lower the Speed Index

  • Over replenishment will result in increased Speed Index.

  • Contaminated Developer: If fixer gets into the developer, the developer will be contaminated.


Contrast or density difference

Contrast or Density Difference

  • Contrast Index is the difference between a step that produces a light shade of gray (0.25 O.D. + B+F) and the step that produces upper range of viewable light on an exposed film (2.00 + B+F)

  • Step closest to 2.20 minus Step closest to 0.45 equals the Contrast Index.


Contrast or density difference1

Contrast or Density Difference

  • Factors that will affect the contrast level include:

  • Fog level on the film

  • Developer Temperature

  • Development Time

  • Contamination of the developer


Processor qc limits

Processor QC limits

  • The action level or results that should result in corrective steps being taken vary between national limits and those recommended by California.

  • California recommends the tightest standards that will produce the most consistent image quality.


Processor qc limits1

Processor QC limits

  • Developer Temperature: ± 0.5° F (Ca); ± 1 to 2° F.(US)

  • B+F: + 0.03 OD (California); + 0.05 OD (US)

  • Speed Index: ± 0.10 OD (Ca.); ±0.15 OD (US)

  • Contrast Index: ± 0.10 OD (Ca.); ±0.15 OD (US)

  • The California Standards are used in this course.


Monitoring frequency

Monitoring Frequency

  • Daily when patients will be x-rayed:

    • Check fresh chemical levels

    • Check that water flowing into wash tank and tank is full

    • Check drive gears for wear.

    • Check developer temperature when heater begins to cycle.

    • Clean work surface and feed tray of processor.


Monitoring frequency1

Monitoring Frequency

  • Daily when patients will be x-rayed:

    • Clean cross over rollers or process two to three roller cleaning films.

    • Perform Processor Sensitometry or QC

    • Determine B+F, Speed and Contrast Index

    • Chart results

    • Analyze results and take action as indicated.


Monitoring frequency2

Monitoring Frequency

  • At close of business each day or shut down:

    • Raise cover of processor about two inches

    • Drain wash tank

  • Semi-annual and at startup tests:

    • Immersion time or Speed of Processor Drive

    • Water Flow Rate


Chart 1

Chart 1

  • Problem solving:

  • Start with developer temperature

  • Then look at Base + Fog

  • Then look at Speed Index


Processor within limits chart 1

Processor within Limits Chart 1

  • With proper developer temperature, reasonable volume of films processed and proper rate of replenishment the processor should stay within limits.

  • After cleaning the speed will increase due to fresh developer. This is normal.


Processor within limits chart 11

Processor within Limits Chart 1

  • Trends can be monitored when the processor is within limits.

  • Continued lower than normal speed index is a symptom of under replenishment. A slight increase in replenishment may be warranted


Processor within limits chart 12

Processor within Limits Chart 1

  • If you are under replenishing the chemicals and the case volume drops, the developer may go bad.

  • Continued high reading means over replenishing of the developer.


Chart 2

Chart 2

  • Problem solving:

  • Start with developer temperature

  • Then look at Base + Fog

  • Then look at Speed Index


Problem 1 chart 2

Problem #1 Chart 2

  • Symptoms:

    • B+F and Speed are up

    • Contrast is down

    • Developer Temp normal

  • Diagnosis:

    • Problem with dark room with safelight or light leak in darkroom.


Problem 1 chart 21

Problem #1 Chart # 2

  • Solutions:

    • Check bulb wattage in safelight

    • Check for light leaks

    • Check for damage to filter in safelight.

    • Check fluorescent fixture for after glow.

    • Move safelight


Chart 3

Chart 3

  • Problem solving:

  • Start with developer temperature

  • Then look at Base + Fog

  • Then look at Speed Index


Problem 2 chart 3

Problem #2 Chart #3

  • Symptoms:

    • Gradual decrease in Speed Index

    • Temperature within limits

    • B+F within limits

  • Diagnosis:

    • Low volume of films processed

    • Under replenishment


Problem 2 chart 31

Problem #2 Chart #3

  • Solutions:

    • Run two to three fresh 14”x17” films or roller cleaning films each day through processor. Do Not run rejected films as they will contaminate the developer with residual fixer.


Problem 2 chart 32

Problem #2 Chart #3

  • Solutions:

    • Slightly increase the developer replenishment rate until the volume of cases increase.

    • Check for low levels of chemical in processor tanks.


Chart 4

Chart 4

  • Problem solving:

  • Start with developer temperature

  • Then look at Base + Fog

  • Then look at Speed Index


Problem 3 chart 4

Problem #3 Chart 4

  • Symptoms:

    • Gradual rise in speed and contrast

    • Sudden drop in Speed, Contrast and Developer temperature

  • These are two separate but common problems.


Problem 3 chart 41

Problem #3 Chart 4

  • Symptoms: Gradual rise in speed and contrast.

  • Problem: If the volume of x-ray films processed each day increases significantly, the developer will be over replenished.

  • Solution: If film processing volume remains high, reduce replenishment .


Problem 3 chart 42

Problem #3 Chart 4

  • This is not typically recommended because a drop in film volume will quickly result in under replenishment.

  • Other factors that can cause this increase:

    • a new box of control film that is a little faster. Change aim if speed changes with the new box of control film.


Problem 3 chart 43

Problem #3 Chart 4

  • Other factors that can cause this increase:

    • a drop in the drive speed will cause the film to remain in the developer longer. This can be the result of a bad bearing, or roller or problem with the drive motor.

    • Always check the developer temperature first.


Problem 4 chart 4

Problem #4 Chart 4

  • Problem 2 Symptoms:

    • Drop in developer temperature, speed and contrast.

  • Diagnosis: Developer Temperature Control Problem or the test was done before the developer reached operating temperature.


Problem 4 chart 41

Problem #4 Chart 4

  • Solutions:

    • If the developer temperature was checked before the strip was run, the problem would have been addressed without the need for the film.

    • It is very important to know how long it takes the processor to warm up in the morning. Time varies from 20 to 45 minutes.


Problem 4 chart 42

Problem #4 Chart 4

  • If some time has passed between the check of the developer temperature and processing the control strip, the following must be considered:

    • The developer thermostat, developer heater or fuse for the heater has failed.

    • Most processor will have a light that blinks when the heater is on. If the light remains out, the heater is not working.


Problem 4 chart 43

Problem #4 Chart 4

  • If the water coming into the processor is too cold, the developer heat controls will:

    • Fail prematurely because of excessive needs for heat.

    • You will use more power to maintain the developer temperature.


Chart 5

Chart 5

  • Problem solving:

  • Start with developer temperature

  • Then look at Base + Fog

  • Then look at Speed Index


Problem 5 chart 5

Problem #5 Chart 5

  • Problem: Repeated increases in developer temperature, Speed Index and Contrast Index

  • Solutions: The developer temperature is controlled by the heater, thermostat and water temperature on most processors. The problem will generally be within these systems.


Problem 5 chart 51

Problem #5 Chart 5

  • If the water was not turned on, the developer will over heat.

  • If the water was turned on but the water flow control valve is defective or clogged, the developer will over heat.

    • Test control valve every six months

    • Use a water filter to control mineral content of water.


Problem 5 chart 52

Problem #5 Chart 5

  • The thermostat may have failed closed resulting in the over temperature condition.

  • The film may have been run with the processor set at the wrong speed and developer temperature.

    • Medical facilities use extended processing for mammography to reduce radiation by increasing speed and improve contrast.


  • Problem 5 chart 53

    Problem #5 Chart 5

    • Medical facilities use extended processing for mammography to reduce radiation by increasing speed and improve contrast.

      • The drive speed is reduced and the developer temperature increased. Special film designed for extended processing is used.

    • IF the Speed Index, Contrast Index and Base + Fog increased with normaldeveloper temperature, the drive system is faulty.


    Chart 6

    Chart 6

    • Problem solving:

    • Start with developer temperature

    • Then look at Base + Fog

    • Then look at Speed Index


    Problem 6 chart 6

    Problem #6 Chart 6

    • Symptoms: Speed Index and Contrast Index continue to fail with normal developer temperature and processing speed. The processor is fine right after service.

    • Solution: The processor is under used due to very low exam volume.


    Problem 6 chart 61

    Problem #6 Chart 6

    • The developer in the processor tanks will oxidize if fresh solutions are not added to the tank. As developer ages, it turns brown.

    • The replenishing tanks should be air tight.

    • To avoid this problem the following may be done:


    Problem 6 chart 62

    Problem #6 Chart 6

    • Every other day or daily turn on the processor and run two or three 14” x 17 films to pump fresh chemicals into the tanks.

    • When you turn on the processor check chemical levels in the tanks. Evaporation is also a problem when film volume is low.


    Problem 6 chart 63

    Problem #6 Chart 6

    • Use flood replenishment to pump fresh chemicals into the tanks. Every few hours, fresh chemicals are pumped into the processor.

    • This will maintain the proper chemical levels in the tanks and avoid chemical deposits on the rollers.


    Water fixer and q c

    Water, Fixer and Q C

    • Fixer Problems:

      • Contamination: A very small amount of fixer getting into the developer will ruin or contaminatethe developer.

        • Improperly clearing of a film jam can cause this.

        • Running rejected films to clean the rollers will contaminate the developer.

        • Use new film or roller cleaning film.


    Water fixer and q c1

    Water, Fixer and Q C

    • Fixer Problems: Under replenishment

      • If the replenishment of the fixer is too low, the film will jam in the wash tanks or dryer because of a lack of hardening of the emulsion.

      • The films will not dry properly.

      • The film will be easily scratched and will not last as long in the files.


    Other processor qc tests

    Other Processor QC Tests

    • Water Flow Meter Accuracy: Measure water flow into processor. Criteria: ± 5% Done quarterly

    • Processor Transport Time: Measure time from when the leading edge of the film enters the processor until leading edge exits the dryer. Criteria: ± 3% Done annually


    Conclusions

    Conclusions

    • Processor Q C monitors the developer.

    • Developer replenishment, temperature and time the films spend in the developer are critical to consistent image quality.


    Processor troubleshooting

    Processor Troubleshooting


    Processor troubleshooting1

    Processor Troubleshooting


    Processor troubleshooting2

    Processor Troubleshooting


    Processor troubleshooting3

    Processor Troubleshooting


    Processor troubleshooting4

    Processor Troubleshooting


    End of lecture

    End of Lecture

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