remember so what does a radiographer do so again the the radio uh radiologic technology first of all is a healthcare profession that includes all Diagnostic Imaging technologists and radiation therapists so as a field uh it encompasses pretty much all of the Imaging and diagnostic along with radiation therapy uh specifically a radiographer is a radiologic technologist so it's never a tech okay if you guys heard a X-ray tech that's also a misnomer and Miss Christie uh really does not like when you guys say uh X-ray tech it's a technologist and the reason for that is is uh you you guys once you graduate from the full program uh you get a degree and the profession itself uh you are again both the artist and a professional okay a EKG tech that's more you know appropriate because that's a diploma program where they just go through a few months of training and or education and they are more properly called the tech but for us it's a radiological technologist okay so a radiographer is a radiologic technologist who administers ionizing radiation to perform radiographic procedures so ionizing radiation again this we cover more in detail in your physics class and what is ionizing radiation how do we produce it how do we control it so again we as a technologists program the machine to administer a certain amount of ionizing radiation so again you're under uh you have the Direct Control to control the amount of radiation that you are shooting at a patient then we produce radio graphic images at the request of a licensed medical practitioner retirement providers Physicians and PAs and so forth requires technical skills combined with the knowledge of physics we teach you that anatomy and physiology we also go over that briefly in this class as well along with your positioning pathology as well so pathology again is going to be very important I have a separate section in Moodle as well once you guys get a chance to look through it at the very end under the additional resources section I have straight from your ebook condensed all the pathology in in one document and again we quiz you on pathology and also on your exams as well so it's very important to understand pathology especially once you get more experience in the field you guys are going to be able to then identify if if a patient has a fracture if a patient has a pneumothorax there's a patient has fluid in the lungs and so forth uh moving forward radiography practice standards again this is written and maintained by asrt so again it's very important to note that these are our different uh bodies that also put out literature and write our standards so asrt stands for American Society of radiologic Technologies so it's this body that defines the practice of radiography and they describe the necessary education and certification and it also includes the scope of practice so the scope of practice again is very important basically that is uh detailing what you can and cannot do as a radiographer so there are certain things you are allowed to do and there are certain things you're not allowed to do so again it's all outlined uh specifically on their website so again I encourage you to visit this website here and look through that ethics uh basically these pertain more to the right and the wrong or what you should be doing so again it's defined as a health professionals moral responsibility and it's also the science of appropriate conduct prolors others so it's basically your moral gauge okay not once you start practicing and and you know working with patients obviously majority of the time there won't be anybody standing over your shoulders so what is ethical what is the correct thing to do and should you do that or you know you have the option of not doing that as well and obviously that falls into the realm of Ethics so again it's the right and the wrong of an action American registry of radiologic Technologies that's arrt okay so it's completely different from asrt asrt is our overall body these guys uh write the literature and they Define the scope of practice arrt are the uh registry this is uh the body that licenses uh Us in the field so American registry of radiologic technologists it creates and maintains the standards of ethics for radiologic Technologies uh they their purpose is to describe professional values that translate into practice so again arrt standards of Ethics uh they include code of ethics and then there's also rules of Ethics so the code of ethics there's 10 of them and these are more gear for professional Behavior okay that guide that guides uh our tips or radiologic Technologies and there's also 22 different rules and then again these pertain to acceptable uh professional conduct again I encourage you there was it was it this website that outlines these codes and these rules then the camrt is a member code of ethics and also professional conduct this is the Canadian Association of medical radio uh radiation Technologies that's a separate body more uh more of more of this is pertaining more in in Canada and also uh this website uh is at camrt.ca thank you for advanced clinical practice uh the advanced clinical role allows radiographers to act as radiologic extender uh to perform and or assist with patient care activities they select radiologic uh procedures and the the initial image observations so basically you're just an extension of one aspect of the overall patient Health uh Health Care okay we are ancillary staff that again provide patient care and we contribute towards their correct diagnoses Okay so keep that in mind um we're not the only one that the patient interacts with and deals with so there's providers Pas there's nurses there's respiratory therapy Physical Therapy there's a you know a wide variety of Staff of ancillary staff that work towards a uh correct diagnosis for that patient and provide overall patient care radiographers with Advanced clinical roles are also radio radiologist assistants I haven't seen too many of uh Ras in the field I think they're more geared towards outpatient settings I work in a hospital for Dignity Health and Elk Grove so I've heard that you know some hospitals have uh Radiologists assistants these guys again assist uh the Radiologists with interpreting and reading uh exams and x-rays and then there's also a radiology practitioner assistant RPA so again two different Advanced roles that you know have a separate uh degreed programs and again all of the requirements for all of these different uh sub specialty fields are outlined on the Art website okay moving forward again very important how do you care for your exam room very very important so if you are going to be working in that room as a radiographer then this is what you need to be doing so again keeping your room clean tidy and organized is very important not just because it it shows that you you you're organized and a clean person but the most important is the transmission of infection and providing patient confidence so obviously just like your car or your room if it's dirty and messy you know people are going to think well you're most likely a dirty and messy person so Optics do matter and patience again uh pay very close attention to all these things so it's very important that you wipe everything down after each patient put all you know garbage and whatnot little uh items away and again very important to keep your machine your tabletop and all the accessories for example um positioning AIDS Shields you know wipe down and and put into proper uh place prepare the room prior to Patient arrival so again we'll be working on this in class more specifically in your lab Lab class with Miss Christina so how do you clean your room uh what should you be wiping down how should you be setting up for the different type of procedures so preparing your room is very important again it all falls down to being clean and organized fresh pillowcases if there are pillows and accessories as needed for the different type of exams you're going to be on are doing for that patient that day how do you control the pathogens uh prevent cross-contamination CDC Center for Disease Control again that is a federal body they also have a website they provide directives or infection control so they tell us what we should be doing and helping prevent contamination the foundation is uh standard precautions for all patient care so this is what we should be doing for all patients okay standard precautions uh include the following aspects of professional practice perform hand hygiene so much the best and overall uh practice that we at the hospital and pretty much in any clinical setting is always wash your hands before and after dealing with any patient okay that's the the most important uh aspect in helping prevent uh spread of germs and contamination using PPE uh during when covid was Fierce and rampant personal protective equipment you know masks and gowns and so forth gloves were very important they still are our Hospital still has all these available so again using these when appropriate again it's very important we'll be showing you guys how to use these items uh in lab as well respiratory hygiene cough etiquette principles and ensure appropriate patient placement most important uh clean and disinfect the environment appropriately so if if you are going to be doing a simple chest x-ray after each patient make sure you wipe down your Bucky and wipe down anywhere where a patient touches or stands uh textiles laundry make sure you know dispose of those carefully there's a certain way to even fold your bed sheets in your room okay so you don't just you know yank the bed sheet off and shake it all around you fold it away from it and we'll show you guys that again and and relax follow safe injection practices uh this pertains more to uh special procedures but you know we show you those again we're in surgical mask and or mass in general uh ensure healthcare workers safety including proper handling of needles and other Sharps transmission based precautions uh are used in addition to standard precautions for patients with known or suspect infections so again very important if a patient has for example uh bronchitis which is again very uh infectious and transmissible along with uh TV okay so this is then where you take additional precautions airborne precautions along with contact precautions radiographers should know way to handle isolated patients without contaminating their hands clothing and equipment so again as we move through the class we'll be showing you guys more uh important examples of how to deal with with isolation patients methods of disinfecting contaminated items designed to reduce the risk of transmission of unrecognized sources of pathogen hand washing again very important like I mentioned earlier easiest and most convenient method of preventing uh this part of microorganisms radiographers should wash their hands before and after working with each patient um hands must always be washed so again this is basically what we just covered so again basic patient care so again some of these items again you're going to be quizzed on so make sure you understand even though it sounds very uh you know straightforward make sure you conceptually understand what we're talking about so what is basic patient care this is where you as a radiographer is responsible for patient care during Imaging procedure this is where you provide instructions through communication or effective communication and explain the procedure to the patient they the patient should understand exactly what is being expected from you and them okay and you want to outline any discomfort uh that they're going to be experiencing so they can hold still so the ultimate goal behind uh basic patient care is a educating educating the patient and B you want to give them pretty much a brief synopsis of what they are going to go through so they are not overly just uh uh in discomfort so they can hold still so again if they the patient can hold still that's gonna you know affect your image quality of your x-rays so all of these items are super important uh when it comes to Imaging patients so if you're in your patient again can hold still they're you know uncomfortable they are confused because you know you did not tell them what they are going to be experiencing then they're going to be fidgeting around uh not focus and or you know they they won't know what's coming next so if they're moving around that's gonna again degrade your image quality again that leads to repeats which leads to increased dose which we try to prevent critical for uh RTS to obtain patient clinical history that's very important okay you always want to verify that the procedure that you're performing so if a patient comes in oh hi Mr so-and-so Mrs so and so uh what are you here for today and then most likely they'll tell you exactly what they're here for so again this is to ensure that a you're doing the correct exam and B mistakes can be made so for example if they hurt their right hand and the provider accidentally ordered a left-hand X-ray and their right hand is the one that got injured so they'll tell you oh I jammed my right hand in my door at home or in you know in my car door I hurt my right hand and you look down and the order says left hand this is where you call the provider and make sure that you know the correct uh procedure is ordered so this is why obtaining uh patient history is very important observe conditions or abnormalities to relate to the radiologist as well okay so getting more specific motion and his control I mentioned this briefly a minute ago where if there is motion during your Imaging uh it degrades image quality okay so quickly here looking at a and b forearm x-ray again we'll be learning how to do these uh there's two views for your forearm the APN lateral which we'll go over in detail in class uh forearm uh radiograph x-ray of a patient who Moved during the exposure so maybe refer to this notice the difference here is motion note the fuzzy appearance of the edges of the bones so notice right there and then B is uh radiograph of a patient without motion okay so it's subtle but it's there and your note your you'll hear about it from your uh radiologist so if there is a lot of motion they definitely will mention that in their report uh so again uh Imaging of motion severely degrades image quality okay so understanding the different types of motion assist and eliminating or controlling motion so again there's three types of motion uh one's involuntary one is voluntary and then there's equipment Reloaded again on your quiz so make sure you know and understand the three different types of motion one is involuntary motion this is not in direct control of the patient for example heartbeat chilled peristalsis which again uh has to do with digestion and how food moves through their bowels Tremors spasms and pain primary control to use uh to control involuntary motion is using short exposure time okay we'll show you that again so once you guys start learning how to take X-rays lack of control of voluntary motion so this is not now voluntary under Direct Control it's nervousness again this can be dispelled through uh patient education educating the patient and again effective communication discomfort excitability okay sometimes patients are overly excited there's a mental illness you'll be dealing with you know in patients that have mental illness and how to best deal with a patient that has mental illness in controlling voluntary emotion and there's fear age age related you know if they're very young pediatric patients again most young patients are you know very uh difficult to have them hold still and sit in one spot and same goes with uh your geriatric your older patients they shake a lot they they can't hold still at times okay and then breathing so again the these items here pertain to voluntary motion radiographers can control voluntary patient motion on images by giving clear instructions like I mentioned um effective communication very important provide patient Comfort we'll show you that how to and base it's based on the uh procedure that you're performing so you want to make the patient comfortable so they don't move adjusting support devices and then applying uh immobilization when needed if a patient can absolutely hold still for patients who are unable to cooperate for for example I mentioned young children elderly and individuals with mental illness the best way again is to seek help from a family member especially with young children and also for individuals with multigmental illness and then obviously decreasing exposure time serious voluntary motion these are positioning sponges we'll show you guys that in lab how to use those effectively when to use those and so forth [Music] okay moving on to image receptors what are they they're called IRS they're very expensive okay most if not all of you guys are going to be working with digital IRS each one of those have has a you know cost in the tens of thousands of dollars so a they're very expensive B they're very sensitive and see you never ever want to handle those by yourself versus as a student and then once you become uh licensed you have to be super careful when you're working with others image researchers what are they defined as the device that receives the energy of the X-ray being and it forms the image of the body part so this is a device that basically records your x-rays okay there's four different types there's solid state digital detectors there's PSPs photo stimulable storage phosphor image plates they're more on their way out these are those plates again we'll show you guys these in lab where you know you can only shoot one x-ray at a time on these then you feed it into a machine that then takes that image and transfers it in a digital format okay then there's floral image receptors uh you won't work with these too much until you guys get to the full program and then there's cassette which are the uh more uh older type of uh receptors okay so these basically are very very rare in clinical settings so majority of the time you're working with solid-state digital detectors so here's your digital detector there is the IR right there okay tethered and wireless basically each other means they're Connected Wireless majority of the time will be working even in in our lab and most uh your clinical sites will have a wireless image receptor IR okay so you can easily have this uh what what the case okay that protects it from damage and again this is what records your x-rays the floral one here's your floral one this is known as the image intensifier unit basically it takes the image and then it broadcasts it in digital format so here is another unit there is your image intensifier here's your table okay accessory equipment uh positioning AIDS grids and and filters these are all accessory equipment okay up there's apart from the tube and the IR so positioning AIDS they're used to ensure that a body part remains in the appropriate posture during the exposure real quick there was a image here uh positioning AIDS and we're talking about these guys right there so this guy here is used for positioning correctly uh hands and fingers these are for more uh for comfort and also turning a patient so we place these in in on in the back of the patient and then you know different uh different uses for those accessories positioning AIDS grids will talk more specifically about these you cover these again in physics as well so basically grids go over uh the uh image receptor your IR and what they do is they reduce scatter radiation to the IR for now just understand a grid basically cleans up your X-ray and reduces scatter okay so it goes over your IR and then there's compensating filters what these are they they result in a more uniform image due to a very tissue thickness and part density so compensating filters sometimes we use these for uh uh c-spine images and we can also use these for uh foot x-rays so if you have uh for example for a foot okay the heel is more dense than the the front of the foot so basically we use a compensating filter to you know even out and make the image more uniform again if it's confusing or you know you don't really understand what what what what a filter is we'll go over this in lab as well okay so for again for now just understand there's positioning AIDS there's grids and then there's compensating filters okay moving forward common steps for a radiographic procedure okay radiographers follow a set of common steps for each videographic procedure this improves efficiency ensures patient safety reduces mistakes and minimizes patient radiation exposure the order of these steps will vary by the anatomy of Interest the patient's condition type of equipment available and by Department protocol and or the clinic that you will be at as a student and then later once you start working so basically in a nutshell what steps you take in order for you to follow so you can accurately correctly and in in a most efficient manner complete that exam okay so if you're doing a chest x-ray the steps are going to be different compared to say a hand that's a wrist x-ray and as we go through the material we'll be going over these steps and which steps to take and again miss Christina Christy and Therese will again go over these steps in more detail as we uh show you guys in lab okay the different procedures and and what steps you take technical factors we'll learn more about these as we go through the material technical factors again control how your x-rays uh get recorded and these are also known as Prime technical factors okay so there's Millie amperage which is ma also known as mass then there's kilovolt Peak which is known as kvp and then the third prime factor is exposure time okay and then that's usually in seconds I'll be going over this in detail right now it might seem foreign language okay but I'll go over each one of these in detail in class because this pertains to both technique and dose okay so what is mass what is kvp and what is exposure time and how do we keep these things in balance manual and automatic exposure control these are known as AC and what are they and how we use these uh we'll again learn about these as we move through the material so for now just kind of get used to the terminology so AC means automatic exposure control and then again these are set of factors that pertain to our Prime technical factors you as a radiographer selects specific factors after Consulting a technique chart each facility has a spec and each machine to be more specific that you're working with for example a Toshiba uh Care Street Samsung they all have a different technique chart you learn about what the technique charts are in Lab okay the machines that we have here on campus which is Samsung it has a technique chart as well so we'll be showing that in class as well and in a lab each part of the chapters at the end has a technique chart for example here is a sample exposure chart for the essential projections for the chest once we start learning about the chest a lot of information seems a little bit intimidating but it's really not okay so first of all what is this it's a technique chart it should be in every room and on every mobile machine for example portable there specifies projections performed in a room and also includes exposure factors for each projection so briefly ignoring all all the intimidating information just look just just look at a chest here so here's a chest PA will show you what that means what is it and how to take that PA image okay and this is based on body habitus we'll look at that and what we'll understand and study what body habitus is and then these are our you know recommended exposure techniques so somebody has a chest that's 22 centimeters kvp is about 120 Sid source to image distance we'll learn that should be 72 inches collimation will show you what that is should be about 14 by 16 and then here's your CR and your Dr mass and dose what's the recommended mass for CR and Dr so we'll be going over this in class but right now just make sure you uh are more familiar with with what you're looking at here it's very very important you don't have to memorize any of these numbers okay all you have to do is be able to figure out what you're looking at and how to use the appropriate sample chart exposure technique continues here primary factors must be considered to establish correct Foundation technique for each unit so like I mentioned ma or Mas which is your milliamperes per second okay kilovolt Peak kvp aec is automatic exposure control again each one of these takes you know a lot of uh information both physics and also uh the background information to fully understand what each one of these items are right now we're not too concerned about the the nitty-gritty details of each right now we just want you guys to be comfortable understanding when you see the word just understand what it means and how we're going to be applying it okay so again Mass kvp Sid these are more of the prime factors that we discussed along with time and seconds automatic exposure control is aec part thickness based on patients body habitus how big how small they are we talked about a grid right it goes over your IR and it helps clean up scatter makes your image nice and pretty there's CR and Dr exposure indicators and they pertain more to uh digital exposure values we'll talk about those in more detail remember there's two different types of ir we mentioned earlier one is your digital and then one is your CR that's the one that you can only take one extra at a time IR or collimated field dimensions we'll talk about those and then electrical supply characteristics that pertain to face frequency and again you'll be learning more about these guys in physics okay moving forward now completely different topic Granado shielding when do we shield now your first discussion uh question pertains to this okay so it's very important you guys read that uh literature that I have a link to for your uh to that website AARP so Recent research by a art PM resulted in the position statement which states that bernado shielding can negatively impact exam efficacy so by shielding basically they've through research and new information uh they figured out that you know it negatively impacts the image and it does not provide too much benefit for the patient if that Shield is right in the way of what we're Imaging for example here they're Imaging a pelvis okay now if they're using aec which means notice the image receptor the IR is right underneath the patient okay aec in a nutshell is automatic exposure controls so when you press that button and radiation starts going through that patient's body anything in the way of that radiation the automatic exposure here uh control will detect it and what it will try to go through that by increasing the technique okay same thing here so sometimes by using a shield where actually negatively impacting the patient because their dose goes on so again a lot of research this is a completely you know a hotly debated topic we'll talk about more in detail when you should Shield there are certain uh instances where you can Shield but majority of the time uh especially for me uh for most of my exams um I don't Shield unless it is for example for example if you say extremity American College of radio uh radiology and other professional Imaging organizations endorse this position some states still require gonado shielding some patients request it then we you know obviously allow them unless it's in the direct uh view of what we're editing students and technologists must be aware of these changes okay now again each one of these is a completely different topic that we can go into for you know various length of time okay so here's your IR and the IR placement that's important so there's three different positions for how we place the IR and what we're Imaging so lengthwise is the general lengthwise position for for example if we are Imaging the chest if we are Imaging the arm the humerus the forearm okay lengthwise crosswise pertains more to the abdomen which you guys don't do for the pelvis okay that's crosswise so this is the crosswise orientation of our large IR this is lengthwise lengthwise means the longer side runs parallel and perpendicular to that body part everybody see that so here's 14 by 17 and here's 14 by 17. now we can also use diagonal and for example for a tidfit okay tibia fibio uh x-ray we can use it crosswise to if the if the patient's leg is not too long we can get that entire image diagonally now if you're wondering well why can't we just use lengthwise and get two images that's perfectly fine as well okay position name based on IR relation to the long axis of the body okay so this is your long axis of the body and then here as well again we'll look at this more in detail and you'll have plenty of practice in that lengthwise placements most often used for example here for most of these we use lengthwise okay Central Ray what is that that's your being of x-rays okay known as CR Central ready CR Central Ray is always centered to the anatomy of interest and it's always centered to the IR unless IR displacement is being used General voice for the central Ray to be perpendicular to the IR and IR to minimize distortion so Central Ray for example if I'm Imaging this arm I'm going to put this arm right there in the center so if I'm Imaging this area I'm going to put that area right there in the center I'm going to point my CR my central Ray that's the beam that's coming from this tube right to the center of the IR that's what this means okay the central or principle beam of x-rays is termed CR and it's only centered to the anatomy of Interest again if that's a little confusing we'll work on this in class as well angle the CR through the part of interest to avoid superimposition of the structures straightening it out if it's a curved structure we'll work on that in lab as well right now we'll just mention it and align the CR through an angle angle joint space and also we want to avoid distortion okay now let's look at what Sid is notice we mentioned Sid earlier when we're looking at the central exposure chart that's your source to image distance here's your two here's your patient everybody see that this is your central room here's your IR body see that so if this is the tube from the two comes x-rays now from that tube to the IR is your source to image distance S ID source to image receptor distance everybody okay with that now SSD is source to subject distance so this is when you start from the tube to your patient which is a subject and that's the distance we're measuring okay right now just be comfortable with what Sid is and what SSD is more importantly what is Sid source to image distance critical technical components uh are important because they affect magnification a special resolution and patient dose we'll talk about more of these why they're important later in the class and also you'll be covering a lot of these in physics as well so again s i d okay so let's look at longer Sid and why we use that so if you notice for the chest for your sample uh exposure chart earlier we were looking at chest and I was 72 inches so the longer the Sid the better it reduces magnification we'll talk about why that's important when we image the chest and it also increases spatial resolution how pretty your picture is your experience Sid is standardized for exams okay so each exam has a specific recommended Sid and again they're indicated on your uh technique charts 40 inches is the traditionally most often used 48 inches is also being used in most facilities and 72 inches is used for most of your chest and your C-SPAN okay your lateral C-SPAN one very important item to note here for California okay by law you never ever want to go under 40. very important okay so it's either 40 or more Sid and Merrell's uh it does mention 30 inches but we don't practice that okay because of California law we'll talk about this in detail in class uh source to skin distance defined as the distance between the anode inside the X-ray tube to the patient's skin subject skin same thing affects the dose to the patient okay so as I so the closer this tube is to this patient's skin or subject uh the more the dose is going to be entering that patient okay these wavy lines here is scattered okay so again you'll learn more about this in your physics class so from the beam from the tube it comes x-rays that's this beam here x-rays ionizing radiation is being shot at this patient so the closer this tube is to this patient the higher the dose the the further the tube is from the patient because of the the way that the beam is coming out there's more scatter so there's less dose uh of x-rays entering the patient okay again we'll talk more specifically about this in class uh and ncrp recommends that SSD should never uh be less than 12 inches and should not be less than 15 inches okay so those are two important uh numbers to note collimation of radiation field collimation again is basically how much radiation we're allowing for a specific body part so the radiation field also called the exposure field must be restricted that's what we mean by collimation to eradicate only the anatomy of Interest this restriction of the radiation field is called collimation and it serves two purposes one it minimizes patient exposure second it also reduces radiation scatter radiation which in turn reduces the risk of adverse effect on contrast resolution okay so make sure your pictures more uh grainy and it also adds scattered when you don't uh properly column it also it's a violation of the Arts code of ethics asrt's practice standards to collimate larger than the required radiation field we'll talk about collimation again in detail in class as well and you'll learn about it in lab as well so the collimator should be manually adjusted for example they're x-raying this patient's left shoulder notice that so the light is your collimated field you have the ability as a radiographer to make this larger or smaller okay so obviously if they open this light all the way to his right shoulder that's uh too much collimation we're only Imaging the left shoulder here okay so this is the recommended uh collimated field if we're only Imaging the left shoulder like there now if we expand this all the way here and we unnecessarily unnecessarily radiate the thyroid and all the way pretty much across his chest that's too much collimation and that is what they mean here by violating the Art's code of ethics okay does that make sense hopefully again we'll talk more about this in class as well shuttering uh used for image display uh Aesthetics only in Dr systems it's used to provide black background against a collimated exposure field RTS radiographers are often tempted to use a larger than necessary exposure field and then shutter or crop for example if they if this was our a collimated field and they just you know had the patient you know move this way a bit and they covered and they x-rayed pretty much all of his chest along with his left shoulder and then through the software they shuttered that basically means that you know how you crop a picture they crop that x-ray only on the left shoulder and and they they eliminated all that additional Anatomy that they x-rayed that's what they mean by shuttering very cropping again that's a violation because you should only to some extent maybe should be a little bit extra but not overtly where you you know unnecessarily Imaging pretty much you know all the chests just to image the left shoulder okay so that again it increases those it also increases over exposure and also leads to uh increased scatter and again it causes legal and ethical liability issues as well okay markers those are important each one of you guys are going to have a lead marker uh each lead marker will be appropriate for both left and right okay um and again markers lead markers are super important because every time you take an image when you're a student and then obviously once you are a licensed radiographer you want to have your marker on that image okay that validates that you took that image we never want to annotate digitally on on an image okay it's not recommended so again important right and left markers the marker again should never obscure an anatomy for example if we were taking this x-ray here we would put our marker right there okay the left marker because we're taking a left uh uh shoulder extra so the marker should always be placed in the exposure field on the edge okay again we'll show you guys how to properly place the markers in lab the marker should always be placed outside of any uh lead shielding and right and left marker should be used with CRM Dr the image recorded by exposing any of the image receptors to x-rays is called a radiograph that's your X-ray so another name for x-rays or radiograph each procedural step must be accurate to ensure that the maximum amount of recorded image information the information obtained by radiographic procedure shows the presence or absence of disease or abnormality okay in trauma as well and again your radiographs assist in the correct diagnosis and treatment of the patient very important the radiographer must ensure each radiograph to determine acceptability of image features proper radiation safety practices and whether the objectives for for performing the procedures have been met again we cover this in Nito as we move through the course as well additional image evaluation should be also taken into consideration presence of patient identification proper radiographic marker placement we just mentioned that proper collimation we mentioned that evidence of required patient shielding when appropriate and then on artifacts as well okay and we'll talk about artifacts when uh we talk about how to correctly position different body parts so artifacts again are items that don't belong in your radiographs image evaluation also requires the understanding of anatomy this is why we go over uh important relevant Anatomy okay image geometry image display characteristics and image appearance of pathology okay so we touch briefly on on pathology in this class uh geometry and image display characteristics you'll be covering in in physics and also in your digital class okay image display uh radiographs x-rays usually are viewed in the anatomical position so this here is your anatomical position okay your hands are in uh you know facing forward your feet are facing forward standing erect okay so again here's a hand x-ray radiograph of the left hand image ID based on different facilities protocols required information on all radiograph is the date patient's name or ID number generally is their MRN number and they're named okay right and left marker this here again is annotated marker this is what we don't want you guys to do okay a lead marker looks a lot different an Institutional identity sometimes they have the name of the institutions majority of the time did not many ways to imprint ID on radiographs as well okay so this here again is in PAX last and final items here we'll mention briefly working effectively with obese patients these are your Hypersonic patients okay so research shows that obesity has doubled in the last 15 years 71 percent of Americans are overweight obese or morbidly obese you'll see this in clinic okay you'll see this in clinic you'll be working with uh obese and Hypersonic patients okay and how do we deal with with those type of patients so again technique factors are different positioning is going to be a factor with these type of patients as well okay obesity is defined as an increasing body weight by excessive accumulation of fat measured by body mass index BMI 30 to 39 is characterized as obese and 40 plus is morbidity abuse body diameter and weight are both determinants on whether a radiographic exam can be performed so working effectively for for the equipment consideration the table has weight limits okay at our facility there's a certain weight limit for both the X-ray table and our CT table okay so if a patient exceeds that weight limit we don't put that patient on that table so again these are considerations for equipment floral Towers uh most of you won't have to deal with that IR units are also have limitations so there's a certain amount of stress and weight the IR unit if you are Imaging a certain type of a patient can can handle overstand before it breaks IR units are more popular in imaging obese patients due to the greater distance between those two on the table CT and MRI scanners also have dimensions without appropriate equipment patients weigh more than 350 to 450 pounds cannot be image because they'll break your table I mean it's that simple you place a 500 pound uh patient on a table that's maximum maximum weight capacity is 450 pounds you'll break that table and then you know so big mess and management has to be called and your table will be down and you can't use your room so again these are things that you'll learn uh once you start clinic and you know you start Imaging patients manufacturers redesign of radiographic and flow tables uh weight limits have doubled to 700 pounds our facility has uh 475 to 500 pounds Max Capacity so again some facilities have that working effectively with obese patient continues for Transportation uh larger Wheelchairs and transport beds uh bariatric beds are needed okay notice here that they are moving this large obese patient onto the CT table okay using these harnesses consider risk of injury to the radiographer another Healthcare team during that movement okay so you have to move that patient this is known as a hover mat okay and it inflates and then you can move the patient we use this in our hospitals a lot for very large patients always be sure uh adequate Personnel are available to assist and obviously and most of the time uh when it comes to these type of patients there's plenty of help but so the key is you never want to just do it by yourself transfer by Society or higher capacity power lips such as hover mats and then these uh overhead patient transfer devices communication again is very important so again you want to communicate both to the team and to the patient what you're doing avoid mentioning weight a lot of people especially nowadays are very sensitive so you want to use keywords that are uh Health Care Friendly for example for obese patients they're they're Hypersonic patients Hypersonic the book outlines these body types so you would use these keywords communicate each part of the transfer what's your team okay explain to the Personnel how to effectively and safely move the patient and then again positioning and for the Imaging procedure as well for palpable landmarks we'll get to these later uh we'll talk about how to palpate okay palpate means to actually touch physically uh the different landmarks for obese patients so notice here they're trying to measure and locate the jugular Notch but based on because of the large body habitus um you know to make locate the jugular Notch to the pubic symphysis they have these different recommendations again not too important for for us now we'll learn about these later okay so I know we covered a lot of information um like I said this is only your first uh introduction I wanted to be thorough and go over this in detail okay so again I will see you guys again on um the following Monday so again if you have any questions on this lecture uh material please email me I will be definitely uh responding back to any emails uh or questions you guys have uh so until then I will see every one of you guys uh the following Monday thank you and nice meeting you all see you guys soon