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Discussion: Morbidly Obese Patient
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2B-XRAYTECH |
Morbidly Obese Patient
Oct 19 2010, 9:49 AM EDT
Hey All, I am a first year xray student, what is a good technique for a portable chest x-ray on a morbidly obese patient, like for a 300-400 lb patient. I know there is no one standard technique that works on all machines but what is a good starting point when someone is that large. The clinical site i am at now uses like 80Kv @ 4 mas non-grided for about an average sized man.
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Keyword tags:
chest x-ray
obesity
techniques
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mrenfinger |
1. RE: Morbidly Obese Patient
Nov 5 2010, 8:55 PM EDT
You will definitely need a grid and at least 110 kVp... I did a portable chest x-ray with a 8:1 grid on a 550lb patient last week at 120 kVp and 32 mAs with a FUJI CR S# of around 260. Most average-sized males in our department would take about 115 kVp at 5-6 mAs with the same grid. It sounds like you have a prime opportunity to create a technique chart!
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metal-fan-666 |
2. RE: Morbidly Obese Patient
Oct 13 2011, 8:56 PM EDT
Could not agree more with mrenfinger.I have worked in many places where very few people ever used a grid for a mobile CXR. Unless the patient is anorexic or a child you should ALWAYS use a grid for mobile CXR's. Departmental CXR's are taken with a grid and most places will have kV's around 110-125kV. Check the grid ratio of the grid in the bucky and the grid ration of your stationary grid and if they are pretty similar you should be using the same kV. You can use the same mAs as what your departmental AEC provides (make a mental note of the mAs) although you will have to adjust it for the FFD you are using when performing a mobile CXR (you are unlikely to be using 180cm for a portable). Essentially, for my mobile CXR's on CR i use 110kV for all adults, with mAs ranging from 3.2 for frail old ladies up to about 12-16 for very obese patients. 110 for 5ish should produce nice images for a "normal" adult male. An mAs of 6-8 is good for an overweight male. 2 images produced at the same exposure can have vastly different numbers depending on other factors (grid cut off, collimation) so have a look at the image and not the exposure index. Are you seeing a mottle or grainy appearance int he lung field (especially costaphrenic angles under breast tissue on females? then you need a higher exposure. Are you seeing a beautiful T-spine study? Your exposure was too high. Do you find this valuable? |
