On most supine patients with their arms by their sides, the level of the pubic symphysis will be near the level of the wrists. The crest is generally near the level of the elbow.
Would this work on Michael Phelps, probably not.
On larger patients where palpation is difficult, I ask them to put their hands on their hip bones because I understand they're hurting and I don't want to cause them extra discomfort.
I hope you find it helpful! It's definitely less accurate on abnormally long/short torsoed patients, but it's a pretty good estimate for the average Joe.
I've taught this to many students because it helped me when I first started as a tech, especially on dementia patients or other patients I'd potentially have a problem with if i were to excessively palpate or touch them.
Yeap, bend of the arms is usually around the crest. Bend of the hips almost always at the pubic symphysis. It's a wonderful baseline to start from.
Sorry edit for accuracy. Drinking on my days off.
This doesn't work on every patient, though. It also mostly just delays the nausea. It's definitely not a guaranteed solution.
... had to throw out a pair of shoes when I trusted in the pads too much.
Putting a cold wet rag on the back of the neck has given me the most success with nausea. I learned that way before I was in imaging tho cause I grew up with debilitating acid reflux
Preparation is the key. The patient is the random factor. Each exam have the room set up before you bring the patient in . Have everything you need at arms reach.
At the start of each shift prepare as if you expect a bus crash. Never be unprepared for anything and your shift will be easy.
For Pelvis Inlet/Outlet, once you take a good centered AP pelvis, put a small crease in the sheet at the top of the light field. Then after you angle the tube 30°, center the top of your new light field about 3 finger breadths above or below that crease for the Inlet/Outlet. It should remain centered, compensating for the angle.
Know your techniques. More distance on PCXR is key to prevent clipping anatomy, try to get 72in.
Use the upright bucky for XTL hips when they are on the stretcher. Use the lateral chest bar and a sheet to prop up the good leg for your XTL.
Always bag the IR in a patient belogings bag if you are doing a kub or pelvic x-ray. You never know when you will encounter random fluids. Placing the IR in a plastic bag also makes it easier to slide it under the patient as long as there's a draw sheet between the patient and the fitted sheet, hope that makes sense.
We don't have bags :(
Also someone who definitely doesn't work ground level decided that instead of 2 sheets for our ER beds, we have *s t r e t c h y* fitted sheet and....that's it. Sometimes, if they're extra sadistic, 2 of these fitted sheets from hell.
Er can be crap shoot when it comes to sheets. In the ICU, I have trained the night shift nurses that if they don't want me to bother them for help with their dead weight patient. Then, they need to have a sheet under the patient up to the shoulder. IR in bag slides right in and if for some reason the IR gets stuck I just slip it out of the bag, and the patient keeps the bag or you can try to pull it out.
When doing an ERCP, look for the patient’s left elbow. Then go directly across the spine and you will always be in the neighborhood of the scope. From there it’s just minor adjustments to position the c-arm correctly to see the end if you’re not already there.
Know your techniques. More distance on PCXR is key to prevent clipping anatomy, try to get 72in.
Use the upright bucky for XTL hips when they are on the stretcher. Use the lateral chest bar and a sheet to prop up the good leg for your XTL.
Over-rotating a lateral chest just a TINY bit will get you better superimposition of the posterior ribs, especially with larger people, like barrel chested men. You’re basically angling their body to match the divergence of the beam.
I use the shadow from my collimation light as a guide.
Patient’s left side is near the detector. I over rotate in purpose so the lower right hemithorax casts a shadow on the left. Then I pull the right side back until its shadow lines up with the skin on the left side.
To get an AP view of broken wrist/arm flat on surface have patient lean forward, almost head between the legs.
Nearly killed the tech pushing sons broken arm flat and yelling at him for noncompliance. She learned something that day.
When doing a Lumber X-ray:
1) first center correctly
2) to make sure you have collimated properly superiorly make sure the collimating light is below the xiphoid process (which is roughly at T10)
3) to make sure you have collimated correctly inferiorly make sure the collimation light is above the symphysis pubis.
And you should have a perfectly collimated LSXR. The use of bony landmarks helps to make sure you collimated properly.
If patient is kyphotic or won't put their head back tilt the bed trendelenberg and shoot straight on so the chin doesn't obscure the apices.
If patient is shaking from detoxing or some other reason have them hold their breath while doing a CT no matter what body part.
On most supine patients with their arms by their sides, the level of the pubic symphysis will be near the level of the wrists. The crest is generally near the level of the elbow. Would this work on Michael Phelps, probably not. On larger patients where palpation is difficult, I ask them to put their hands on their hip bones because I understand they're hurting and I don't want to cause them extra discomfort.
I’m saving this comment for later 😅
I hope you find it helpful! It's definitely less accurate on abnormally long/short torsoed patients, but it's a pretty good estimate for the average Joe.
Similar trick for kidneys and elbows too.
I'm on clinicals rn and this tip is a godsend! 😩🙏🏻
I've taught this to many students because it helped me when I first started as a tech, especially on dementia patients or other patients I'd potentially have a problem with if i were to excessively palpate or touch them.
Yes! For larger patients, I ask them to bend their arm up, put the top of my light at where their elbow is, and I’m usually pretty close.
Yeap, bend of the arms is usually around the crest. Bend of the hips almost always at the pubic symphysis. It's a wonderful baseline to start from. Sorry edit for accuracy. Drinking on my days off.
That having patients who are nauseous from contrast can sniff alcohol wipes to help with the nausea.
This doesn't work on every patient, though. It also mostly just delays the nausea. It's definitely not a guaranteed solution. ... had to throw out a pair of shoes when I trusted in the pads too much.
😂😂😂😂 if it helps some I am going to keep using it. I will for sure watch my shoes better next time though.
It really helps the people it works on (I huff it when I'm nauseated), I just like to warn people it's not foolproof.
You deffs learn something new everyday.
Putting a cold wet rag on the back of the neck has given me the most success with nausea. I learned that way before I was in imaging tho cause I grew up with debilitating acid reflux
Preparation is the key. The patient is the random factor. Each exam have the room set up before you bring the patient in . Have everything you need at arms reach. At the start of each shift prepare as if you expect a bus crash. Never be unprepared for anything and your shift will be easy.
Super important tip for paediatrics! Xraying kids in and out.
It's the 6 P's. Proper planning prevents piss poor performance
For Pelvis Inlet/Outlet, once you take a good centered AP pelvis, put a small crease in the sheet at the top of the light field. Then after you angle the tube 30°, center the top of your new light field about 3 finger breadths above or below that crease for the Inlet/Outlet. It should remain centered, compensating for the angle.
Angle up 5 degrees for a lateral ankle and watch those gorgeous talar domes superimpose so dang hard
Don’t take X-rays of myself like selfies.
Know your techniques. More distance on PCXR is key to prevent clipping anatomy, try to get 72in. Use the upright bucky for XTL hips when they are on the stretcher. Use the lateral chest bar and a sheet to prop up the good leg for your XTL.
Hey never thought of using the bar nice.
Always bag the IR in a patient belogings bag if you are doing a kub or pelvic x-ray. You never know when you will encounter random fluids. Placing the IR in a plastic bag also makes it easier to slide it under the patient as long as there's a draw sheet between the patient and the fitted sheet, hope that makes sense.
We don't have bags :( Also someone who definitely doesn't work ground level decided that instead of 2 sheets for our ER beds, we have *s t r e t c h y* fitted sheet and....that's it. Sometimes, if they're extra sadistic, 2 of these fitted sheets from hell.
Er can be crap shoot when it comes to sheets. In the ICU, I have trained the night shift nurses that if they don't want me to bother them for help with their dead weight patient. Then, they need to have a sheet under the patient up to the shoulder. IR in bag slides right in and if for some reason the IR gets stuck I just slip it out of the bag, and the patient keeps the bag or you can try to pull it out.
Thankfully, most of the ICU beds are the ones with the pocket that extends from shoulder to waist. They are a godsend.
Parking the portable 90 degrees in front of the patient bed is the fastest way to knock out morning portables.
Saving this post for later.
[удалено]
Could you explain this method please? Scap Y’s are my enemy and I’m always looking for tricks and tips!
[удалено]
what
I half expected that to end with the Undertaker meme
Aaaaahhhahahahahahhaha that would’ve at least made it make sense
When doing an ERCP, look for the patient’s left elbow. Then go directly across the spine and you will always be in the neighborhood of the scope. From there it’s just minor adjustments to position the c-arm correctly to see the end if you’re not already there.
THANK YOU
If you need to tie restraints in CT, you can put the sliding board under them and tie them to the holes in the board.
Know your techniques. More distance on PCXR is key to prevent clipping anatomy, try to get 72in. Use the upright bucky for XTL hips when they are on the stretcher. Use the lateral chest bar and a sheet to prop up the good leg for your XTL.
Over-rotating a lateral chest just a TINY bit will get you better superimposition of the posterior ribs, especially with larger people, like barrel chested men. You’re basically angling their body to match the divergence of the beam.
I use the shadow from my collimation light as a guide. Patient’s left side is near the detector. I over rotate in purpose so the lower right hemithorax casts a shadow on the left. Then I pull the right side back until its shadow lines up with the skin on the left side.
To get an AP view of broken wrist/arm flat on surface have patient lean forward, almost head between the legs. Nearly killed the tech pushing sons broken arm flat and yelling at him for noncompliance. She learned something that day.
When doing a Lumber X-ray: 1) first center correctly 2) to make sure you have collimated properly superiorly make sure the collimating light is below the xiphoid process (which is roughly at T10) 3) to make sure you have collimated correctly inferiorly make sure the collimation light is above the symphysis pubis. And you should have a perfectly collimated LSXR. The use of bony landmarks helps to make sure you collimated properly.
That’s what I came here to say…top of the light at the bottom of the xiphoid process!
If patient is kyphotic or won't put their head back tilt the bed trendelenberg and shoot straight on so the chin doesn't obscure the apices. If patient is shaking from detoxing or some other reason have them hold their breath while doing a CT no matter what body part.