I typically line up the laser or centering light to align with the OML and that would be my straight AP view. If I do a Caldwell, I'd just angle 15 degrees cephalic from whatever degree mark the tube is at when aligned to the OML. I'll be uploading a video demo in a few weeks as well.

Thank you for responding! I'll be looking out for the video!!

But does angling an additional 15° cephalad doesn't throw the orbits up too high when you still want the petrous ridges in the lower one third of the orbits?

@@Afrancis2774 No because in traditional positioning, you're still angling 15 degrees relative to the OML. The only difference is the OML is not going to be perpendicular to the IR in a trauma situation, so you need to find out how many degrees it lies from perpendicular and adjust 15 from that point.

Yes, traditionally it's very common here for Skull and also covered on the ARRT Registry Examination Content Specifications.

They are both instructors, but Jerre Erwin is the "patient" and George Hutti is the "radiographer"

Glad it was helpful!

Glad it was helpful!!

Since the mandible isn't part of the cranium, you can collimate to exclude it.

I'm not using any voice modifications. Curious how it sounds on your end.

@@TopicsInRadiography I don't know the problem might be in me or something... But, I think you sometimes tend to not use your purely natural and simple voice... maybe making it more hyponasal or something Anyways, keep the great work up!

@@mzziaey LOL nope that's just my voice. I'm not intentionally doing anything with it - just talking as I normally do.

Intensity is not inversely proportional. It's inversely related to the square of the distance. Being inversely proportional would mean if you double your distance, you halve the intensity, which would be incorrect. This formula shows the relationship (and how to calculate for changes) between radiation intensity and the distance from its source. Hope that helps... I've been thinking of a more visual way to explain this for a future video, but this is how you'd do the math.

Can you clarify what you mean by "30 60 90 patella views"? Are you just talking about the amount of knee flexion, rotation, or something else? There are numerous ways to perform the tangential projection, but you must always angle the tube related to how much the knee is flexed.

Yes. The doctor wants the knee flexed in these different angles. The doctor just replied, "flex the knee OR angle the tube" when we asked what he wanted. Is there a way to keep the knee in a fixed position and angle the tube or the detector?

We have been acquiring 3 different images with the knee in 30 60 & 90° flexion. We're angling the tube as needed. Someone suggested angling the detector at those degrees.Do you think we could just angle the detector at 30 60 & 90° and achieve the same result?

@@Afrancis2774 Regardless of how much flexion the knee is in, you'll need to have the x-ray tube near the foot to where the beam skims the proximal tibia and the CR is centered at the space between the tibia and patella.

@@Afrancis2774 Angling the detector won't affect how much the joint space is open. You can always do that, but it will result in elongation.

I think tilting the Bucky for a Water's view, even if you had the option, would produce too much elongation on the radiograph to be very useful. That should just be left for the Caldwell view IMO. For the Water's view, you have some options: I think I'd assess the reason for the examination and then have a conversation with the radiologist and let them know the patient cannot extend their neck enough for a successful view in order to keep your beam horizontal... You could offer the option of angling the tube to acquire the image, but you'd lose the ability to evaluate air-fluid levels. Let the radiologist make that call. They might go for it or opt to do CT, which is more common these days, but I wouldn't make that call yourself if you can avoid it. If you're by yourself, I'd just document the patient's limited mobility and do the views you can (perhaps only perform a limited study). Or depending on the patient's mobility, it may be possible to lie them on a stretcher and place a 45 degree sponge behind the patient's shoulders, then sit them up until it looks like the MML is horizontal. You'd need a way to hold the IR behind them, which would likely cause air gap, so bump up your SID as well. The set-up for this would require the patient to hold an awkward position for a little while and may or may not work depending on the patient's abilities, but it might be worth a shot.

I truly appreciate your response. Your videos have helped me tremendously!

@@Afrancis2774 Glad they're helpful 🙂

Will you explain why it's impossible to assess fluid levels if the tube is angled?

Is it simply because the tube angle will "move" the line of fluid if present as it moves petrous ridges in skull imaging?

The radiologist's routine would include upright and recumbent positioning. Patient should be recumbent for the overhead views (if performed) - you can technically perform them upright, but you'll have a more difficult time filling the esophagus with contrast for the overhead views if gravity is assisting the barium emptying in an upright position.

I'm not sure what you mean by "cystografic isotopic". Can you please elaborate?

If the manufacturer is recommending that technique, then it should just prolong the life of the tube. Overheating a cold tube runs the risk of melting the filament or cracking the glass housing, but you should always go by manufacturer recommendations. Just out of curiosity, did their technique include mA and time specifications?

I'd start with a degree in engineering (far different than my scope)

@@TopicsInRadiography I already have a PhD in physics. My advisor would often get upset at me for not being able to explain how these things work under the hood, like he expects me to be able to build them.

@@cryora Wow that sounds rough. I can only name the major components, provide basic explanations for how they work to form the fluoroscopic image, and operate one safely and within current regulations. Construction/assembly is well beyond my scope... you could consider reaching out to OEMs regarding that process and likely obtain more information than I'd be able to provide you. You could check out GE, Siemens, Toshiba, Shimadzu, Carestream, Philips, etc.

No, the 3 point landing would be after the required rotation. If you start in a PA position, then you'd rotate the side of interest 37 degrees toward the IR from that point (which should allow the chin, nose and cheek to make contact).

Thanks Tom!

I removed it a couple of years back... sorry.

Explain... Why would you repeat?

What makes you say that?

Doesn't look like it.

No problem... it's an old video but still applicable today 🙂

Unfortunately, I no longer have that textbook to reference those page numbers, but I've used different photos in my video here to illustrate each position. We've switched to Merrill's at our school, which does not have a AP Axial Towne view for the mandible (only for TMJs which does not include the entire mandible in the projection and uses a different tube angle).

Yes!

I guess that depends on how much detail you're trying to relay and what kind of capacity they have to understand. In lay terms, I'd probably just let them know that the machine produces invisible "x-rays" that allow us to be able to see details within the body (at its simplest form). Are you looking for something more specific? I don't usually provide a lot of detail to patients. Too much will lead to more questions and there's a fine line with what's in our scope to be explaining. I wouldn't be giving any physics lectures haha.

According to their website, they're 2" x 7/8". It doesn't list their thickness, but they are slightly thicker than most x-ray markers I've used, so be cautious when using them in a bucky tray - they may get stuck in there depending on how much room you've got between the IR and the table once closed.

fluoro uses mA, not mAs because it's operating in real time. You may be looking at something different, but if you send an image I may be able to make sense of what you're seeing

Unless you're talking about flat panel detectors. Remember that the mA (tube current) is only part of the equation when it comes to dose. Higher mA that you see with flat panel detectors allow for substantially less operating time to for m an image, but also, the detectors have a larger dynamic range and can allow visualization of images at lower doses as a result. Hope that makes sense.