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Resultant Image
The resultant image will show a horizantal slice of the kidney at the selected fulcrum level. Typically, once contrast is injected, 3 nephrotomograms will be taken during the "blushing" phase.
With conventional tomography, the longer the arc, the thinner the slice. Depending on your equipment, you may have the option of one or two angles. The
preferred angle is decided by the radiologist.
You should always alert your patient that the tube head will move above and they may feel the table vibrate as the Bucky travels below.
Fulcrum Level Selection
The fulcrum is the axis of rotation for the tomogram. Structures at this point will be free of motion and structures above and below blurred due to motion. Because the kidneys are retroperitoneal and sit in an oblique plain, three (3) fulcrum levels are needed to demonstrate the majority of the kidney.
With calipers, measure the patient, in centimeteres, at the level of the kidneys. Be sure to include the table pad.
Take this number and divide by 3. This will be a good estimate of where the scout nephrotomogram should be performed to determine levels for the actual procedure.
The apparatus is attached to the back of the tube head and the back of the Bucky. The specifics of the attachment varies by manufacturer. There is a "tomo" switch on the tube head that needs to be unlocked to allow the tube head to flow freely.