Orthopedic follow ups are largely for anatomical alignment and callous formation (healing). Given that the anatomy is usually immobilized (plaster/fibre glass) than callous cant really be seen very well. This really only leaves anatomical alignment. Whats the best way to determine if the anatomy is normally anatomically aligned? Align the normal anatomy to a normal anatomical position and see if the rest is in a normal anatomical position. As for how to obtain that position - basically, whatever the patient can get. If the patient has a spiral fracture humerus but can externally rotate their arm without much problem then I'll do that. If not, I'll try something else.

How do I know if the patient can do it or not? I don't, but the patient does. "Are you able to do 'x' at all?" if the answers no, try a different way. "Oh yes, I've walked myself to the toilet 10 times today", alright, we probably dont need to bring your whole bed down, a chair will be fine and you can get on the table.

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A pa skull image will show the petrous ridges filling the orbits of the skull. A will the petrous ridges projected into the lower third of the orbits.

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It depends largely on what you mean by "proper" distance. Is 100cm correct for an AP ankle? what about 99cm? 101cm?

Given that no object is going to physically occupy the actual phosphors on an imaging plate on CR/crystals on film/detectors in DR then you are always going to have some OID (or OFD). As we all know, the ratio between OID:SID (or OFD:FFD) will give us a magnification factor. The larger this factor the greater the increase in penumbra or geometric unsharpness, decreasing the interpreters ability to identify 2 very close objects as seperate objects - spatial or high contrast resolution. By this same mechanism a loss of low contrast resolution or low contrast detectability may also occour as the border between 2 objects of similar but different density will be less sharply defined (blurred), creating a more gradual change in radiographic density between two already similarly dense objects. Thus, unless your specific aim is to intentionally magnify the image (like mag scaphoids), better image quality will be achieved as the mag factor is decreased.

As we increase our SID, we also decrease geometric unsharpness. 2m will be better image quality than 1m, 2 km will be better than 2m. 50 km better than 2 km and an infinite distance better again than 50 km. Doubling your SID will require a 4 fold increase in exposure to achieve the same beam energy density by the time the beam has reached your receptor, so increasing distance does need to be weighed against the cooling curves of the tube you are using.

Having said all that, your room is obviously not infinitely wide and I am not familiar with the tube or generator characterstics of your equipment. Increasing SID will increase the quality of your image, decreasing SID will decrease the quality of your image. The actual differences are unlikely to be perceptible far above 2m as systemic limitations (eg. phosphor sizes) are likely to start to dominate.

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This works well with grid chests as well as the face of collimator box can be visually checked with the plane of the ned of the bed to see if there is any angulation across the patient laterally.

Check your FFD. Having the tube at the very end of the bed might be more like 140cm FFD which unless you have a 140cm focused grid will cause grid cutoff in the periprhery even if you have perfect exposure settings and perfect alignment. If you have to bring the distance closer, you will likely need to tilt the foot end of the bed down so that a horizontal beam can still be used.

To try and centre well - get the patient to raise their arms so you can light field on the bed. If you are centred to the grid line then there should be equal amount of light lateral to the grid on both sides. If there is an uneqal amount of light then you are not centred to the grid (I assume it is a portrait grid) and thus will have grid cutoff.

The problem also may be that you just have massive patients. If the people you are doing these grey studies on are usually 110kg (230 pounds) + then there is not a lot you can do.

I would encourage you to bring as many abdos to the department and to abandon AP upright for left lateral ducubitus as often as possible. The grid is much easier to align to the central ray with the departmental tube - if the tube is aligned to the upright bucky normally, then putting the bed in front of the bucky such that the head of the bed is flat against the upright bucky then it would be very unlikely you will be angling across the patient. There is less potential harm from the amount of generated scatter, and the better tube will allow the use of shorter exposure times.

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Very complicated issue, PA erect has more opportunities to create errors although should be a lower dose and better geometric assessment of the spine. AP is easier to perform as everything is more stable and it is much easier to move the patient. The patient may have difficulty standing erect due to their back problems, or even difficulty lying down due to their back problems. Erect gives a better appreciation of the spine in its standard position, table gives increased likelihood of getting a quality picrture first attempt that may or may not be the same quality image.

Best answer, ask your radiologist if they are happy with PA erect lumbar spines and perform them, but tell me how long it is before you want to do them all on the table again.

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I think there are good opportunities in Canada - at least there is in my province of residence, Quebec (but you'd need to speak French). You might need to pass the CAMRT national examination - you can find accurate information on their website. It is also easier for Australians to get a working visa for Canada.

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Hi, I agree with your statement. The terminology used here is in opposition to what I was taught and teach others.
Simply, any angle that directs the central-ray toward the feet is caudal and likewise with the head and cephalic angling.
I scrolled down purely to see if someone had commented.

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