Hi Jeremy! The X-ray room I'm using doesn't have the capability to tilt the wall bucky and if the patient can not hyperextend their neck, then what do you do to get the waters view?
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'm assuming the reason you angle the patient head (with a buckey that does not angle) instead of angling the tube is for image distortion, no? I was always taught if you can't angle the bucky, to angle the tube. You seem to be altering the angle of the patients head with a perpendicular beam, instead of altering the angle of the beam. Why are you not angling the beam 15 degrees caudally for the non angled bucky view ?
Aaron Palacios for the sinuses you’re looking for air/fluid levels specific to this exam type. That’s really the main reason, so angulation of the tube would not allow for visualization of this within the sinuses (most commonly in the maxillaries)
Thanx for this vid. so useful , but doctor our xray stand bucky can't tilt forward like in PA axial . this position is so common and wanted from doctor also hard for me! what can u advise me plz doc. !
If you can't tilt the bucky, then you can make an imaginary line from the outer canthus to the tip of the nose - it's not perfect, but for most people, that will throw the petrous ridges in the lower third of the orbits. You just need to keep your beam horizontal
Thank you sir. Kindly take lectures of radiation physics also. It will be very helpful to Indians as we don't have proper classes regarding these topics.
If/when I'm ever teaching radiation physics again, I'll do so... up next for me will be Radiation Protection and Fluoroscopy. I'm only doing these videos for courses I teach... for supplemental material though, I would recommend checking out the ASRT website for their courses. Those are great, and a lot of their info is included in our curriculum.
Thanks for such precise explanation! I appreciate your time.
Hi Jeremy! The X-ray room I'm using doesn't have the capability to tilt the wall bucky and if the patient can not hyperextend their neck, then what do you do to get the waters view?
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?
I'm assuming the reason you angle the patient head (with a buckey that does not angle) instead of angling the tube is for image distortion, no?
I was always taught if you can't angle the bucky, to angle the tube. You seem to be altering the angle of the patients head with a perpendicular beam, instead of altering the angle of the beam.
Why are you not angling the beam 15 degrees caudally for the non angled bucky view ?
Aaron Palacios for the sinuses you’re looking for air/fluid levels specific to this exam type. That’s really the main reason, so angulation of the tube would not allow for visualization of this within the sinuses (most commonly in the maxillaries)
@@TopicsInRadiography that makes perfect sense, thank you.
Good information sir ❤
Thanx for this vid. so useful , but doctor our xray stand bucky can't tilt forward like in PA axial . this position is so common and wanted from doctor also hard for me!
what can u advise me plz doc. !
If you can't tilt the bucky, then you can make an imaginary line from the outer canthus to the tip of the nose - it's not perfect, but for most people, that will throw the petrous ridges in the lower third of the orbits. You just need to keep your beam horizontal
@@TopicsInRadiography ok i'll try this .. thank u so much for replying 😊
So helpful thanks, I wish my radiology program was as squared away as Mesa program.
What do you feel is lacking in your program? Have you discussed with your program director?
I’m actually from San Diego traveling to Ontario for school, halfway done. I make the best of it though. Your lectures are on point.
@@jaquta69 Well thanks... I'll take that as a compliment then. Good luck in school!
Thank you sir. Kindly take lectures of radiation physics also. It will be very helpful to Indians as we don't have proper classes regarding these topics.
If/when I'm ever teaching radiation physics again, I'll do so... up next for me will be Radiation Protection and Fluoroscopy. I'm only doing these videos for courses I teach... for supplemental material though, I would recommend checking out the ASRT website for their courses. Those are great, and a lot of their info is included in our curriculum.
@@TopicsInRadiography Thank you so much sir. I will attend your lecture on radiation protection and fluoroscopy too.
@@surbhidogra1965 app x_ray karete ki buile
@@surbhidogra1965 kindly number okh
@@hcfgjigfjkmvgukk1766 what do you want to say? I am not able to understand your language. Sorry