Topics in Radiography

Here's a Quick Way to Speed Up Your Xray Exams

2013-11-23T15:26:00.002-08:00

Beginning your clinical rotation in x-ray school can be overwhelming. Not only are you plunged into a new environment, you are expected to pick up on a lot of information at a very fast pace. Take a routine chest x-ray for example. Positioning class teaches the appropriate guidelines for how to line the patient up for the central ray, which AEC cells to select, and what kind of breathing instructions to give, but it will not teach you how to become efficient while performing chest x-rays. This must be accomplished with repetition and actual hands-on experience with the unique equipment you are using.

Here's some basic advice on how to develop a series of steps to perform for each x-ray exam that will improve your speed in a very short amount of time:

Develop an ABC system - You may notice seasoned technologists preparing for an exam in a specific order (prior to the patient entering the room). For a standing chest x-ray, my order would be A - set a technique at the control panel, B - place a cassette in the upright bucky (if still using cassettes), and C - detent x-ray tube to wall buck and raise vertically to allow patient to walk under. Only then will I bring the patient into the room.

This way, when the patient is ready to be positioned, I only spend a few seconds adjusting the bucky height and placing the patient against it. Then it takes about a few more seconds to lower the x-ray tube vertically and align it to the bucky (it's already locked in transverse and longitudinal planes). Finally I can begin breathing instructions as I'm walking to the control panel (which has already been set up). By the time my finger is on the exposure button, it's ready to be pushed and I've spent less than 20 or 30 seconds total for one exposure.

You'll notice the same steps for my lateral exposure immediately following the PA, and telling the patient to breathe normally. A - set new technique at the control panel, B - replace cassette in bucky, and C - position patient (bucky is already aligned). You can literally get through a chest x-ray in 2 minutes or less for the average walking/talking patient.

I employ the same basic steps when doing exams on the x-ray table. A - set technique at the control panel, B - place cassette in bucky, and C - position patient. On the table, it will save you a lot of time to leave the tube and bucky aligned, and use the floating table top feature to move the patient as needed between positions. Don't forget to have the tube out of the way while putting the patient on the table. I usually detent in transverse and vertical planes and slide the tube past the head or foot-end of the table so all I have to adjust is the longitudinal plane once the patient is supine.

This is just one method to increase your exam efficiency. The trick is, you'll have to make an effort to practice doing things in the same order every time. After a few repetitions, you will find yourself performing these steps without having to think about it, much like driving a car... remember learning how to do that?

You'll be concentrating on new positioning details and other new information throughout the majority of your x-ray program, and you'll be expected to apply them in clinical practice. The less you have to strive to remember during an exam, the more efficient you will be. And remember, practice makes perfect!

Do you have any proven methods to increase your exam speed?

Here's a Quick Way to Speed Up Your Xray Exams

2013-11-23T15:26:00.001-08:00

Here's some basic advice on how to develop a series of steps to perform for each x-ray exam that will improve your speed in a very short amount of time:

Do you have any proven methods to increase your exam speed?

Medical Imaging Scholarships

2013-11-19T20:06:00.001-08:00

Being in school for radiography or any other modality (CT, ultrasound, nuclear medicine, intervientional radiology, or MRI) can be time consuming and expensive. One thing I've noticed over the years is how many scholarships are actually available for medical imaging, but get awarded without many people aware of them.

I would like to make this an ever-growing, comprehensive list as a resource for my readers... If you are aware of any other scholarships that you do not see on this list, and would like to include them, please either post in the comment section or email me, and I will edit to include it in this post.

Jerman-Cahoon Scholarship - offered by the ASRT to entry-level students in Radiography, Ultrasound, MRI or Nuclear Medicine ($2,500)

Royce Osborn Minority Student Scholarship - offered by the ARRT and private donors to entry-level students in Radiography, Ultrasound, MRI, or Nuclear Medicine (5 scholarships of $4,000)

Elekta Radiation Therapy Scholarship - offered by Elekta for outstanding entry-level students in Radiation Therapy

Ruth McMillan Radiography Student Grant - offered by the California Society of Radiologic Technologists for Radiography students with academic excellence and leadership attributes ($500 - California students only)

Anna B Ames Clinical Excellence Student Grant - offered by the California Society of Radiologic Technologists for Radiography students with clinical excellence and a sense of leadership ($500 - California students only)

Society of Nuclear Medicine Scholarships - numerous grants and scholarships from the SNMC for all educational levels (from $750 - $60,000)

Varian Radiation Therapy Advancement Scholarship - offered by Varian for Bachelors, Masters and Doctorial students for Radiation Therapy (19 scholarships of $5,000)

Siemens Clinical Advancement Scholarship - offered by Siemens USA for students seeking a Bachelors or Masters Degree in Radiologic Sciences or Certificate in CT, MRI or Ultrasound (4 scholarships of $4,000)

Osborne Scholarship - for AHRA members to participate in AHRA's Annual Meeting & Exposition, Spring Conference, or Fall Conference

Broadley Scholarship - for current AHRA members who hold a supervisory position within a medical imaging department or imaging center and have been accepted into an initial undergraduate or initial graduate degree program relevant to a supervisory career in the medical imaging field

AHRA Annual Meeting Scholarship - for registration and hotel accommodations to AHRA members who have previously attended the Annual Meeting but have no employer funding to attend this year’s meeting in Orlando, FL

Professional Advancement Scholarship - offered by the ASRT Patrons and HealtheCareers for Bachelors, Masters or Certificate programs (multiple scholarships of $1,500)

Medical Imaging Educators Scholarship - offered by the ASRT for educators pursuing Bachelors, Masters or Doctoral degrees to enhance educational position (4 scholarships of $5,000)

University of North Carolina Allied Health Scholarships - numerous grants and scholarships from UNC covering tuition and other expenses

Scholarships for Radiography Students in Minnesota - various scholarship and grant opportunities

Association for Radiologic and Imaging Nursing - various scholarships for tuition and conferences (RN's only)

American Roentgen Ray Society Scholarship - for those seeking to advance their education in the field of Radiology (2 scholarships of up to $140,000)

Howard S. Stern Scholarship - for those with career goals in oncology or radiology (9 scholarships of $1,000)

Atlantic General Hospital Radiology Scholarship - work/study scholarship where student works 12.5 hrs/wk at the hospital and commits to amount of time of employment after school for exchange of paid tuition

Donald Starr Radiography Scholarship - Available to students attending Armstrong Atlantic State University ($250 - $1,000 based on need)

Mary Sebacher Radiography Scholarship - Available to students at Missouri University ($500)

California Allied Health Care Scholarship - Up to a $4,000 scholarship with a 1 year service-agreement OR 100 hours of community service.

Medical Imaging Scholarships

2013-11-19T20:06:00.000-08:00

Being in school for radiography or any other modality (CT, ultrasound, nuclear medicine, intervientional radiology, or MRI) can be time consuming and expensive. One thing I've noticed over the years is how many scholarships are actually available for medical imaging, but get awarded without many people aware of them.

I would like to make this an ever-growing, comprehensive list as a resource for my readers... If you are aware of any other scholarships that you do not see on this list, and would like to include them, please either post in the comment section or email me, and I will edit to include it in this post.

How to use Twitter to Search for Jobs

2013-11-17T20:32:00.004-08:00

We all know the job market is looking pretty grim these days. It's not impossible to find work as a radiologic technologist, but the competition is fierce. It seems like every day there are new job search engines or websites on the internet and it can be exhausting visiting every single one of these. Enter the vast world of social media and the apps that can be utilized with it.

Twitter is considered a "micro-blogging" website where you can write a few characters of words or post links to let all of your friends know what you've been up to. Social networking might be the last thing on your mind if you're actively looking for a job, but there is a way to make it work for you as an organizational tool, and the beauty of it is you don't even have to post (tweet) anything... just set up an account and let it do the work for you in three easy steps:

Step 1: Get a Twitter account at www.twitter.com. It takes only seconds and an active email address to establish a twitter account. Make sure to fill in profile information and consider leaving it professional if you are going to be using it for job-hunting.

Step 2: Get a TweetDeck account at www.tweetdeck.com. You can log in with your newly created twitter account without having to provide much information.

Step 3: Set up custom columns. Once logged into Tweetdeck, you can create columns by clicking the "+" sign on the left hand side. Here's where you may have to do a few minutes of research on how you would like information presented to you. You can CLICK HERE to see the different types of information available to place into your custom columns.

Once you've done these things, you will see the tweets roll in while you sit back and relax. If they're moving a little too fast to read, consider filtering the column (top right icon of each column). There are filtering options to help keep the feed you see more pertinent to your needs.

In the picture on the right, you can see two columns I have created in the "search" category. I used "radiography" and "radiologic technologist". If you're going to use this type of search, make sure you are using terms that you would normally type into a job search.

Be creative with these columns... if you set one up and don't like the info you are seeing, feel free to tweak it just a bit. Sometimes a small change in the filtering criteria can make a huge difference, and it's very easy to do. Here are a few of the custom column options I thought were most useful for job hunting:

Timeline - this allows you to follow a single account. It also includes interactions with other account holders who interact with this account.
Search - allows key-word search like the example above (i.e. xray tech, rad tech, ARRT, fluoro, etc). While not all tweets in this column will be composed of job opportunities, they can generate to new leads.
Tweets - similar to the timeline column, it follows a single account, but will not include outside interaction. I would recommend this if you have a stand-out preference for where you would like to work. Place one company's twitter feed into its own column. Make additional columns for other companies you would consider working for.
Custom - this column is a place for you to transfer and store tweets hand-selected by you. For instance, if you don't have time to respond to a potential job opportunity, place it here and return for it later without having to search around. You can assign your own names for these columns (job opportunities, apply, research more).

TweetDeck isn't the only service around that offers filtering of twitter feeds, but I chose to use it for two simple reasons; it's free and it's user-friendly. You can learn how to use it in about ten minutes. Even if you're not "tech-savvy", their help center is fantastic for the tools you'll find. There are also a lot of YouTube video tutorials out there you can view for free if you're more of the visual-learner type (like me). Once your feeds are set up, you can visit the site any time and watch it feed live. The only think you have to do is click on potential opportunities.

Click Here to Learn How to Land a Health Care Job Fast! (AD)

Regardless of your field of work, new tools are coming out every day to get information faster. While I would never recommend using twitter as your sole source of employment prospects, a lot of employers are breaking into social media, and are posting external job opportunities to these accounts. Why not be first among those hearing about them?

How are you using social media to search for a job?

This post contains affiliate links, which means I receive financial compensation if you make a purchase using these links.

How to use Twitter to Search for Jobs

2013-11-17T20:32:00.003-08:00

Step 2: Get a TweetDeck account at www.tweetdeck.com. You can log in with your newly created twitter account without having to provide much information.

Timeline - this allows you to follow a single account. It also includes interactions with other account holders who interact with this account.
Search - allows key-word search like the example above (i.e. xray tech, rad tech, ARRT, fluoro, etc). While not all tweets in this column will be composed of job opportunities, they can generate to new leads.
Tweets - similar to the timeline column, it follows a single account, but will not include outside interaction. I would recommend this if you have a stand-out preference for where you would like to work. Place one company's twitter feed into its own column. Make additional columns for other companies you would consider working for.
Custom - this column is a place for you to transfer and store tweets hand-selected by you. For instance, if you don't have time to respond to a potential job opportunity, place it here and return for it later without having to search around. You can assign your own names for these columns (job opportunities, apply, research more).

Click Here to Learn How to Land a Health Care Job Fast! (AD)

How are you using social media to search for a job?

This post contains affiliate links, which means I receive financial compensation if you make a purchase using these links.

Top 5 Movies for Health Care Workers

2013-11-16T09:44:00.001-08:00

Whether you are a radiologic technologist, registered nurse or a physician, it's easy to become desensitized when faced with daily hardships of illness, trauma, loss of life, grieving, and lack medical insurance coverage. While we must be able to temporarily put aside our emotions in order to perform our jobs involving patient care, we should not forget about taking these things into account when caring for our patients. Understanding not only our patients' experiences, but the effects of their medical condition on their family members, financial status, and ability to undergo treatment can make a huge difference on how we implement their care and its effectiveness. These are my top 5 movies that, in my opinion, provide a broad range of perspective from various points of view. They also serve to periodically remind me of the reasons I entered the medical field.

Patch Adams: I wish more health care workers would take this kind of attitude to heart. While medicine is a serious field to be held with great respect, this movie reminds us that both the patient AND the disease need and deserve to be treated.

John Q: This movie is becoming more relative these days with health care reform / Obamacare. More and more families cannot afford health care, which makes it devastating to a father to know there is treatment available for his child, but he is unable to afford it. The tag line for this movie is perfect: "Give a father no options, and you leave him no choice."

Extraordinary Measures: I find myself watching this from the patient's father's perspective. So often it can feel like you are on different "teams" than your doctors, who are bound by certain rules and regulations. I love this story which shows how much can be accomplished when we work together and put everything you have into finding a solution.

Lorenzo's Oil: It is incredibly frustrating when there's no money for clinical research, therefore no cure for a rare disease that a family member is suffering from. This inspirational story, based on true events, is another example of what parents are willing to do when the health care system fails us.

The Doctor: One of the most under-rated movies ever! William Hurt plays an arrogant, narcissistic physician who has never heard of something we like to call "bedside manner". He undergoes a transformation of character when he becomes diagnosed with cancer.

These movies are great for shaping us to provide better patient care. Do you have any movies that you would put on a list for health care workers?

Top 5 Movies for Health Care Workers

2013-11-16T09:44:00.000-08:00

These movies are great for shaping us to provide better patient care. Do you have any movies that you would put on a list for health care workers?

When to Remove Clothing for X-rays

2013-11-15T09:21:00.001-08:00

Yes, it may take a few minutes of your time, but it never hurts to place a patient in a gown rather than a collared shirt or polo. It's hard to tell which clothes will show up on x-ray and which ones won't, but if there's any doubt, go ahead and remove it.

The image below shows a collared shirt that happened to make an appearance on the radiograph. There is also evidence of clothing laterally near the diaphragm:

There are so many variables in determining whether or not a patient's clothes will show up on your x-rays. Sometimes, it depends on the fabric itself. 100% cotton generally doesn't show up on a radiograph, as long as it's not bunched up or folded. Polyester typically does. The type of exam you're doing with the technical factors you're selecting also contributes to how much you will see clothing, but let's focus on these simple guidelines:

If it's anything other than a plain cotton t-shirt, it will probably show up.
If you're concerned about it overlying the area of interest, remove it.
If it has embroidery, logos, or buttons, better to take it off.

Of course, it never hurts to simply change everyone into patient gowns, but it's up to you to weigh the pros and cons for yourself. If you don't want to go that route, just keep in mind the repeat exposures and amount of time it may take if you have to perform a second exposure every time you see some of these artifacts interfering with your exam.

When to Remove Clothing for X-rays

2013-11-15T09:21:00.000-08:00

The image below shows a collared shirt that happened to make an appearance on the radiograph. There is also evidence of clothing laterally near the diaphragm:

If it's anything other than a plain cotton t-shirt, it will probably show up.
If you're concerned about it overlying the area of interest, remove it.
If it has embroidery, logos, or buttons, better to take it off.

Kindle eBook Giveaway

2013-11-02T13:33:00.001-07:00

From November 4 thru 8, you can get my eBook (Kindle version) "Becoming a Radiologic Technologist" for free! Just wait until Monday, and click here: FREE eBOOK

You do NOT need a Kindle tablet to view a Kindle eBook... you can view on just about any device (smart phones, computers, tablets, cloud readers) of all major manufacturers. Just visit the Free App page for Kindle and select your device of choice.

This is the perfect resource for anyone thinking about radiologic technology as a career in the United States. I would love to hear your feedback after you have read it with an Amazon review!

Kindle eBook Giveaway

2013-11-02T13:33:00.000-07:00

Rad Tech Week Giveaway

2013-10-26T17:04:00.002-07:00

It's that time of year again to celebrate the anniversary of the discovery of x-rays. There will undoubtedly be potlucks, catering, desserts and belly aches, but food shouldn't be the only thing you get for free this year! I have a small contribution I'd like to make for my fellow technologists and student technologists to get you in the mood to celebrate:

Free Downloadable Desktop Wallpaper... here's how it looks on my own laptop:

Also available in many other formats - see below for download links!

Computer / Laptop Wallpaper 1280 x 800

Computer / Laptop Wallpaper 1024 x 768

Computer / Laptop Wallpaper 800 x 600

................................................................

Android for 3-5 screens

Android for 7 screens

................................................................

iPhone (original thru 4S) and iPod Touch (gen 1-4)

iPhone 5 and iPod Touch (gen 5)

iPad (original thru iPad 2)

iPad (gen 3 and 4)

I hope you enjoy... please let me know if there are any issues with the formatting, or if you would like to see any resolution dimensions not listed. This photo is not for redistribution, and will only be available for free from now until November 9, 2013.

Happy National Radiologic Technologists Week!

Rad Tech Week Giveaway

2013-10-26T17:04:00.001-07:00

Also available in many other formats - see below for download links!

Computer / Laptop Wallpaper 1280 x 800

Computer / Laptop Wallpaper 1024 x 768

Computer / Laptop Wallpaper 800 x 600

................................................................

Android for 3-5 screens

Android for 7 screens

................................................................

iPhone (original thru 4S) and iPod Touch (gen 1-4)

iPhone 5 and iPod Touch (gen 5)

iPad (original thru iPad 2)

iPad (gen 3 and 4)

Happy National Radiologic Technologists Week!

2-Minute Exam Prep Survey

2013-10-11T08:46:00.002-07:00

I'm starting some product research for an upcoming project, and I value your opinions as past, current, or future radiography students. If you have 2 minutes to spare, I would appreciate your feedback. Thank you!

Create your free online surveys with SurveyMonkey , the world's leading questionnaire tool.

2-Minute Exam Prep Survey

2013-10-11T08:46:00.001-07:00

Create your free online surveys with SurveyMonkey , the world's leading questionnaire tool.

Removing Patient Info from Radiographs

2013-10-03T13:52:00.006-07:00

Here's a quick video tutorial for anyone needing to remove patient demographics from a radiograph. Obviously, there are ways to do this prior to acquiring the image copy, but in case that is not an option for you, follow these steps - you do not need photoshop or expensive photo editing software.

Please observe HIPAA guidelines and remove all identifying information.

Removing Patient Info from Radiographs

2013-10-03T13:52:00.005-07:00

Please observe HIPAA guidelines and remove all identifying information.

Guess the Artifact

2013-10-01T16:32:00.005-07:00

Saw this interesting artifact today... luckily I was in the room and know what caused it. Can you figure it out?

Comment with your guess here on the blog or on my facebook page. I'll post the answer in the comments next week.

Guess the Artifact

2013-10-01T16:32:00.004-07:00

Saw this interesting artifact today... luckily I was in the room and know what caused it. Can you figure it out?

Comment with your guess here on the blog or on my facebook page. I'll post the answer in the comments next week.

Free CEU Review

2013-08-19T08:54:00.001-07:00

Just a quick post to let everyone know about the ASRT's promotion going on until National Radiologic Technology Week. If you are creating a CEU course up to 2 hours in length and are presenting it during tech week (November 2-10, 2013), you can get ASRT approval for FREE. You can submit more than one activity, but all submissions must be in before November 4, 2013.

Click here for additional details and application forms.

Free CEU Review

2013-08-19T08:54:00.000-07:00

Click here for additional details and application forms.

Iowa allows Fluoroscopic Supervision by Advanced Registered Nurse Practitioners

2013-06-08T08:40:00.002-07:00

In October, 2011, the Iowa District Court for Polk County ruled that supervision of fluoroscopic procedures by Advanced Registered Nurse Practitioners (ARNP) is indeed beyond their scope of practice. This was primarily due to lack of sufficient training in school, and failure of the nursing board to establish a training curriculum which specifies minimum standards of safety. Prescribing fluoroscopy falls under the same umbrella as practicing medicine, which is clearly out of their scope of practice... until now.

On May 31, 2013, the Supreme Court of Iowa reversed this decision. ARNP's are now legally allowed to supervise fluoroscopic procedures, as long as they have received "special training" to do so. While Nursing Associations around the country hail the Court for its overturning of this verdict, the question comes to mind, "Do they understand the implications?" This overturning has publicly lacked the support of the ACR, the Iowa Radiological Society, The Society of Interventional Radiology, and the ASRT.

There are still a few states in the U.S. that do not require a license/registration for individuals to perform static radiographic examinations. Even in states that do require this for plain film production, they have been practicing fluoroscopic procedures without a "supervisor" of fluoroscopy for a long time... "for over 20 years" in the Iowa Court discussion. As the country moves to improve the education and accreditation of technologists performing imaging exams using radiation, this is a step in the wrong direction. Let the legal loopholes begin.

I have to wonder why the original verdict reached by Polk County was overturned since nearly the entire medical community was not in support of allowing nurses to supervise fluoro procedures. It is substantially clear that individuals involved in reversing this decision have some kind of profit to make (or to avoid losing). Why hire a trained professional (a new added expense) when the old way of doing things would only cost the nurses (not the hospitals) a little bit of money for a class on radiation safety?

It's only fair that I address the one and only problem this would require the hospitals to face if the decision was not overturned... in a time when health insurance coverage is taking its toll on the financial health of hospital organizations, this would require an increased cost to hospitals to find qualified personnel, especially in rural areas where there may be a shortage of these people to perform the job. Hospitals would encounter the issue of attracting qualified professionals to fill these needs in their areas. Even given this credit, what I'm left asking is should the difficulty of this task compromise patient safety? In my humble opinion, no.

In my professional experience working in three different states as a radiologic technologist, I have seen very strict radiation protection guidelines and very loose ones. I can't fathom the reasoning behind sacrificing a standard of safety so that (with all due respect to their traditional scope of practice) a nurse can take a short course and supervise a radiologic technologist to perform a fluoroscopic procedure. The argument, "we've been doing it for over 20 years" no longer suffices. Radiologic Technologists have at least two years of background education, and I don't believe we are even qualified to supervise a fluoroscopic procedure. I'm uncomfortable with the idea that prescribing a radiation dose for any patient is being allowed despite the opinion of both national and state-level authorities on imaging and radiation protection.

I would love to learn about the training regimen that will be introduced for ARNP's that will be proposed that will be deemed sufficient for the State of Iowa. At this time, I could not find any references. But unless this decision goes to the national Supreme Court, the citizens of Iowa will be subject to its legal system and its band-aid solution.

What's your take on this situation? Do you think the Iowa Supreme Court made a good decision to allow ARNP's to supervise fluoroscopic procedures?

Resources:

American Society of Anesthesiologists

Iowa Society of Anesthesiologists

Iowa Medical Society

ASAQH

Official Iowa Supreme Court Decision (33 pages)

Iowa allows Fluoroscopic Supervision by Advanced Registered Nurse Practitioners

2013-06-08T08:40:00.001-07:00

How to Create a Radiographic Technique Chart

2013-06-05T10:26:00.001-07:00

Having an accurate technique chart is key for maintaining image quality while using the lowest dose possible in any radiology department. Sure, you may already know what kind of technical factors to apply on that portable chest x-ray in the emergency room, but what about people who aren’t as familiar with your equipment as you are like students, registry/float techs, or new employees? Though some of these people I mentioned may already have an x-ray license, it can still be challenging for any of these people to catch up to the learning curve at your facility.

Not only are these individuals learning their way around, but they also need to adapt to new software, physician preferences, and unfamiliar imaging protocols. Why not make it easier for them to help you? Chances are, they want to do a good job to continue to be able to work there, but they might just need a little assistance getting their bearings. One of these people might say “help me help you.” Yes, I just quoted Jerry Maguire.

Creating a technique chart is not a difficult task, but it can be time consuming depending on the resources you have at hand. If you wait until a chart is needed, it's probably too late. I’ve always thought it was a great student task, but anyone can do it. I have made technique charts for many facilities I've worked for, and although there are quite a few methods for deriving one, I’m going to discuss the best methods that have worked for me.

Here’s a list of things you might need around during the creation of a chart for your facility:

calipers
calculator
technique chart template
list of available grid ratios in your site
x-ray phantom
acceptable exposure indicator ranges from your CR/DR equipment vendor

Steps for creating a technique chart:

Produce radiographs with technical factors above and below average level:

The hardest part of creating a technique chart for a lot of people is knowing where to start. I like to pick one specific body part that is medium in size. For instance, I usually start with a knee. It’s a common body part to x-ray, and it’s a part that you can sometimes perform table-top or with a grid. If you have a phantom, try taking a series of AP knees at different kVp ranges (60, 65, and 70 for example). For non-grid techniques, use 60 kVp first. Keep repeating the exposures until you have an image with an appropriate exposure indicator value. Then create some images at 65 kVp and 70 kVp that all produce exposure indicators within acceptable range. Note the thickness of the phantom with calipers. It is important to measure exactly through the central ray (I’ll discuss what to do with this later).

If you do not have a phantom, you may decide to record several AP knee views on patients, possibly even using AEC. I don’t recommend performing test exposures on actual patients, but pick a few exams that come out within acceptable exposure indicator ranges, and note their measurements with calipers. Remember to try different kVp ranges, and consider using AEC. Simply record the mAs value that AEC provides and measure the patient thickness if the exposure indicator is within diagnostic range.

Note: If you do not have calipers, simply note "small", "medium", or "large" for patient size reference. While this method is less accurate, having this information will be far more useful than no information at all to the newcomer to your facility.

Supervisors or Radiologists discard unacceptable images and select preferred images:

If you do not have a group of quality control personnel in your facility, consider showing your collection of images to a chief radiologist. Only select the exposures with acceptable exposure indicator ranges to present. You don’t need to let the doctor know all the technical details… simply ask them which ones they like best. A radiation-conscious doctor may inquire about dose between the images, and you can inform them when prompted about which images have more or less exposure to the patient. If you keep your original kVp ranges adequate to part thickness within reason, you should not have a lot of variation. Select the technical factors that the radiologist, or group of quality control personnel deem most acceptable to move onto the next step with. For an example, I’ll use the technical factors 65 kVp and 4 mAs for a table-top knee measuring 9 cm with the calipers.

Prepare the chart for preliminary trials:

Starting your technique chart with a knee allows you to have a wide range of body parts with similar composition to derive techniques for. As a table-top technique, the baseline of 60 kVp can be used from the knee all the way down to the toes. Here’s where all those lessons in school will come in handy… estimate some techniques using the 4cm rule. Remember, every 4cm of tissue thickness requires a double in mAs value to maintain density. If we are going to work from the knee down, we need to remember that if we decrease 4cm in tissue thickness, we need to ½ the mAs to maintain density.

An example would be an AP ankle. If we have an ankle measuring 5cm, we can compare the knee technique and reduce the mAs by ½ because it is 4cm less than the knee. Being similar tissue composition (muscle, bone, tendon, ligaments, etc.), 65 kVp at 2.0 mAs should provide an ideal exposure indicator. For a foot, consider lowering the kVp due to the dramatic decrease in part thickness compared to the knee. Keep your mAs at 2.0, but try 60 kVp if it measures 2 cm.

This, of course, can all be derived on paper before it is applied to a phantom or patients. Once you get to larger knees above 10cm, or the femur, you can start adding additional details like what grid ratios you are using. We shouldn’t use less than 70 kVp with a grid. Let’s think about how we would image a 13cm knee:

Our original technique was 65 kVp at 4 mAs. There are a couple of steps to consider here. First, we know that we need to double the exposure to maintain density with a 4cm increase in technique. Since I know that I’ll need to increase kVp to account for grid usage, I’m going to increase kVp 15% (about 75 kVp) for this step. This serves to double exposure to the image receptor as well as provide the adequate kVp I need for grid usage. Next, I have to account for the grid conversion. If I’m using an 8:1 grid, my conversion factor is 4. I need to multiply my mAs by 4 to maintain density to account for the grid. My new technique for a 13cm knee is 75 kVp at 16 mAs with the 8:1 grid. If I’m going to move to the table bucky, that’s a conversion factor of 5 (most buckies are a 12:1 ratio), so I would use 75 kVp at 20 mAs.

These techniques seem a little high for the site I’m currently working, but remember, they’re just an example based off an original technique that worked. Once you have a beginning technique with grids, you can continue to compensate for body thickness as you go proximally up the leg. You’ll find that shoulders and knees are similar in thickness, as well as ankles and elbows, feet and wrists, etc. For pediatric work, a 2 year-old abdomen is about the thickness of an adult knee. The key is to find a starting point so you can make a calculated guess on the next projection you will need to make.

Test the new chart on phantoms of different sizes:

Once you have some good calculated technical factors, it’s time to test on phantoms. If you don’t have phantoms, I would suggest performing these on patients. Start performing them on parts closer to the ones you started with so you can eliminate as many variables as possible like body habitus, pathology, presence/absence of air, etc.

Useful information to have on your technique charts include mA, time, kVp, SID, grid vs. no grid, focal spot size, exposure indicator values, body part thickness/habitus, or any other factors that you may change between exams. I recommend keeping a digital copy in excel, or any other software you feel comfortable with that is easily edited. A technique chart is never really "finished" as equipment is constantly replaced, wear and tear on equipment affects performance, and as calibration occurs over the years. Remember to update your chart with any changes. You can view and/or download a Sample Technique Chart Here.

Creating a technique chart from scratch can be quite tedious, but it is a skill that should be developed for all technologists. Knowing manual techniques will improve your portable and OR imaging skills, and it can provide early indicators for quality control or equipment repair concerns. There are many circumstances where AEC can produce inadequate images such as improper bucky selection, prosthetics over the ion chamber, or general operator error. Manual techniques are great to know and provide the technologist with a lot of versatility.