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Case Study Chapter 7, Case 10 (Pneumothorax)

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raylean uribe

on 16 November 2015

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Transcript of Case Study Chapter 7, Case 10 (Pneumothorax)

Group #1 - Hazel P, Millicent L, Raylean U, Sue N
2) Prior to taking radiographs, you place your TLD badge on the collar of your lab coat. Identify the function of the badge. How often should the badge be replaced?
The badge measures the amount of radiation that the radiographer wearing it receives each time they are exposed to radiation. The TLD badge measures radiation by converting the x-rays to light through the use of a crystal. The light released from the crystal is what is measured by the badge. The badge should not be replaced unless found to be damaged or defective. The badge is linked to the user's social security number so the dose of occupational exposure can be monitored over the user’s lifetime. The exposure should be monitored monthly or quarterly to ensure that the user does not exceed the allowed annual occupational dose of radiation. The principle of ALARA should always be applied to keep exposure to a minimum.

4) The veterinarian requested thoracic radiographs. You and the assistant are positioning the dog for a left lateral film. The assistant asks the following questions, “Should I extend the front limbs cranially or caudally? Should I shoot the film on inspiration or expiration?
Nome should be placed on the table in left lateral recumbency. The front legs should be extended cranially to prevent the humerus, radius, and ulna from superimposition of the thoracic cavity. Shoot the film on full inspiration so that the lungs and diaphragm are expanded to provide a clear image of the thoracic cavity.
5) You began positioning the dog for the lateral view when the animal became extremely dyspneic. You were unable to obtain the radiograph. Describe an alternative method for obtaining a lateral view. (Hint: Think of a horizontal view.)
Nome should be placed on the table in the sternal recumbency position. His two front legs should be pulled cranially and his two hind legs should be pulled caudally. The x-ray beam should be collimated cranially at the manubrium, caudally at the last rib, dorsally at the spinous process, and ventrally at the xiphoid process (sternum & the ventral aspect of the ribs). The head of the x-ray should be rotated 90 degrees so that the beam of the x-ray shoots horizontally through the right lateral and left lateral thoracic cavity.

6) The veterinarian wants to confirm the presence of air within the thoracic cavity. He requested a lateral decubitus view. Describe how you will position the animal for this view.
The beam will be horizontal. Expose at full inspiration. First place patient in left lateral recumbency. Extend forelimbs cranially and extend hind limbs caudally. Keep head and limbs in place with sandbags. A foam pad can be put medially between the forelimbs and hindlimbs. These foam pads can prevent rotation. Support ventral abdomen so that the sternum is leveled with the thoracic vertebrae.
8) Your assistant is placing the lead aprons back on the storage rack. Upon returning, she states, “The rack was coming off the wall so I folded the aprons and placed them on the shelf”. Is this an acceptable protocol? Please explain.

This is not an acceptable protocol. Folding can result in cracks in the lead apron which decreases their protective integrity and exposes the user to harmful radiation.
9) An important component of your job as the head technician is to examine the clinic’s dosimetry reports. To date, no one in your clinic has recorded any exposure. An assistant that sees you examine the reports every month asks “How much exposure is permitted? Please respond.
The allowable annual occupational dose of radiation for any persons is 5000 mREM/yr, however, following ALARA protocols is required to keep personal dose limits much lower than the maximum legal dose.

3) You examine the cassettes prior to obtaining the radiographs. The external surfaces are soiled with blood and other stains. Identify appropriate means of cleaning both the internal and external surface of a cassette. How often should cassettes be cleaned?

To clean the stains off the external surface of the cassettes, dampen the gauze with distilled water and gently remove debris. To clean the internal surface of the cassette, it is best to use distilled water and lens wipes when available but gauze can also be used. Wipe the screen in one direction and then wipe again ninety degrees. Leave the cassette upright and open to air dry. The cassettes should be cleaned on a regular schedule depending on how often they are used and the build up of debri.
7) You examine the completed radiographs. The technique is too hot. Should you increase or decrease kVp? You are surprised by the poor quality of the radiograph as previous radiographic logs demonstrate that the technique worked well for other dogs of similar size. You return to the radiograph room to rest the technique when you notice that the tube head was set to 36 inches. The standard FFD at your clinic is 40 inches. Describe how a change in the FFD will affect technique.
The kVp should be decreased (Low contrast regions like the thorax respond strongly to kVp changes). The focal film distance is set to 40 inches because x-rays cannot be focused through lenses. The electron beam is sent from the cathode to the anode where the electrons are converted into x-ray beams. The angle of the anode directs the x-ray beams down toward Nome. If the FFD is is too low, the image becomes overexposed and if too high, the image becomes underexposed which both create poor images.

Case Study Chapter 7, Case 10 (Pneumothorax)
Patient: Nome, 7 year old, canine, Siberian Husky, neutered male

1) Identify appropriate technician evaluations based upon the above subjective and objective data.
S: respiratory distress, refuses to go outside, dyspnea, mm: pale pink, BCS: ⅗, BAR, muffled lung sounds, uncomfortable

O: panting, W:75lbs, T:102.6*F, P: 120 bpm, CRT: 2 seconds

Technician evaluations: altered breathing pattern, muffled lung sounds, altered perfusion, increased heart rate, impaired thermoregulation, pain, adequate nutrition, normal mentation, normal ambulation, sensitive to palpation on left thorax.
10) After answering her question you explain the overnight agencies involved in protecting individuals from the effects of ionizing radiation. Please identify the following acronyms: NCRP, MPD, ALARA,Sv.
NCRP - National Council on Radiation Protection and Measurements. Supports radiation safety by providing independent scientific analysis, information, and recommendations that represent the consensus of leading scientists.
NCRP- National Council on Radiation Protection & Measurements. Supports radiation safety by providing independent scientific analysis, information, & recommendations that represent the consensus of leading scientist.
MPD - Maximum Permissible Dose. The maximum amount of radiation exposure an individual is allowed occupationally.
ALARA - As Low As Reasonably Achievable. Principle that each person working with radiographic equipment should strive to achieve the lowest amount of radiation exposure to his or her body.
Sv - Sievert. It measures the biological effect of radiation energy on tissue.

Lattimer, Jimmy. “Radiography.” The Merck Veterinary Manual. Merck Sharp & Dohme Corp. 2014. web. 18 Oct. 2015. http://www.merckvetmanual.com/mvm/clinical_pathology_and_procedures/diagnostic_imaging/radiography.html?qt=veterinary%20radiography%20positions&alt=sh

Brown, Marg, Lois C. Brown, and Lisa M. Lavin. Lavin's Radiography for Veterinary Technicians. Fifth ed. St. Louis: Saunders Elsevier, 2014. Print.

Peter, Carl. "VT 70 Radiology." Foothill College Veterinary Technology Program. Foothill College, Los Altos. 10 Oct. 2015. Reading.

Rockett, Jody, and Chani C. Christensen. "Chapter 10." Case Studies in Veterinary Technology: A Scenario Based Critical Thinking Approach. Heyburn, ID: Rockett House, 2010. 175-76. Print.

Smith, David A. "To Support Radiation Protection by Providing independent Scientific Analysis, information, and Recommendations that Represent The consensus of Leading Scientists." National Council on Radiation Protection & Measurements (NCRP). N.p., 2015. Web. 10 Oct. 2015.

Not a Decubitus view
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