Image Analysis Anterior Posterior Chest Projection RAD 438

Image Analysis Anterior Posterior Chest Projection RAD 438 LESLIE LYLE

The Suboptimal AP Chest

Image Analysis Criteria �Patient Demographics �Radiation Protection �Marker Placement �Artifacts �Anatomical Position & �Image Corrections Placement �Anatomical Relationships �Recorded Detail �Image Contrast & Density �Histogram �AP Chest Projection Analysis Criteria �Optimal Image with Anatomy

Patient Demographics �Patient name �Patient Date of Birth (DOB) �Facility name �Date & Time of Exam �Identification Plate (Barcode) �Degree of Patient Elevation v. No Patient Demographics are present on image.

Marker Placement � Correct side of patient is marked � Marker does not cover any area of interest. � Marker is positioned away from the center of the image. � In this image the right marker was annotated on a computer after the image was taken. A lead marker should be used to allow image to be legal in a court of law. � Lead markers with BBs can be used to show patient elevation.

Anatomical Position & Placement �Required anatomical structures are visible on image with the exception of apices. �Correct image receptor size was used. �IR was correctly placed behind patient in a crosswise position. �Proper collimation around the area of interest is present. Collimation is within 0. 5 inch of the patient’s skin line.

Anatomical Relationships � Cephalic central ray angulation has projected clavicles up. less than 1 inch of apical lung is visible. � Manubrium is superimposed over the 2 nd thoracic vertebra. Should be over 4 th. � Left sternal clavicular end is projected farther away from manubrium than the right Patient is rotated.

Anatomical Relationships Cont… �The 7 th thoracic vertebra is at the center of the collimation field. �The scapula are demonstrated within the lung field. Shoulders should be rolled forward. � 10 posterior ribs are demonstrated above the diaphragm indicating full inspiration.

Recorded Detail �Correct SID used �Patient’s back was against image receptor. �No motion or respiration errors present �No double-exposure �Image receptor was crosswise �Sufficient recorded detail present. v. Lung markings, diaphragm, heart borders, costophrenic angles, hilum, apices, cortical outlines are seen.

Image Contrast & Density �Both lungs from apices to �No image fog costophrenic angles are demonstrated �OID at a minimum �Appropriate SID �Correct receptor system �Adequate k. Vp & m. As used �Low subject contrast �Appropriate scale of contrast �Correct collimation �No quantum noise demonstrated v. Adequate contrast and density are present.

Histogram • • Histogram below is example chest histogram. X-axis is pixel values Y-axis is brightness value Histogram analysis errors will cause image quality to decrease, similar to images with exposure errors. • Peaks and valley represent subject contrast. • Incorrect histograms cause exposure indicator errors.

Radiation Protection �ALARA (as low as reasonably achievable) should always be used. �Explain exam to patient in clear concise instructions �Use immobilization devices when necessary �Use tape measure to obtain appropriate SID �Collimate field size tightly �Use compensating filter if needed None used for this exam �Set exposure factors to minimize patient exposure �Shield patient appropriately with use of lead shield for males and females �No anatomical artifacts present

Artifacts �Heart monitor leads have been shifted mostly out of the area of interest. �No artifacts related to poor film or poor phosphor plate handling are present. �No anatomic artifacts (artifacts that can be removed) are present.

Image Corrections �Central Ray needs to be aligned caudally until it is perpendicular to midcoronal plane. �To decrease slight patient rotation, rotate patient slightly to the right or adjust central ray perpendicular to image receptor. �Lead marker should be used to mark correct side. �Degree of patient elevation should be annotated. If patient is in ICU SID and technical factors should be included as well �Patient demographics should be visible.

AP Chest Projection Analysis Criteria � Date, time, SID used, patient elevation, and technical factors are recorded on image. � 7 th thoracic vertebra is at the center of the image. � Both lungs are fully visible within the collimated field. � Sternal clavicular ends are equal distances from the vertebral columns & the lengths of left and right posterior ribs are equal. � The 4 th thoracic vertebra is superimposed by the manubrium � 1 inch of the apical lung field is visible above the clavicles. � Scapulae are outside the lung field. � Posterior ribs demonstrate a gentle cephalically bowed contour. � 9 – 10 posterior ribs are visualized above the diaphragm.

Optimal AP Chest with Anatomy

References � Digital Radiographic Image Processing and Manipulation. (2016, December 06). Retrieved April 13, 2016, from http: //clinicalgate. com/digitalradiographic-image-processingand-manipulation/ � Mc. Quillen-Martensen, K. (2011). Radiographic image analysis (3 rd ed. ). St. Louis, MO: Saunders/Elsevier.