All right. Let’s dive into today’s topic. Today’s topic is the focus on the bread and butter of a x-ray in my eyes, which is the chest x-ray. Well, there’s many different variations of what this stands for. Overall, I’m talking about the first x-ray. Most students learn the most used x-ray that students do, as well as just the overall understanding that this chest x-ray is kind of the basis. It’s the guideline. It’s the bread and butter of x-ray in my eyes. So we’re gonna dive into it a little bit today and kind of focus on the different parts of the chest X-ray, just because I think it’s so highly important to understand why it is important to be able to do this well. Yes. As a new student, a new tech, it is important to prove.
You can do an x-ray, you have to do it well. However, there’s more to it than that. It also focuses on giving the student or tech the first chance to start to get comfortable making small talk during an x-ray explaining how to do it. While it is not one of the harder x-rays we do. It is can be difficult still.
And the understanding of that is understanding. And when you ask someone, okay, put your left side against the board for a two view chest x-ray. And they put their right side or their stomach or their back, or just stare at you and say, I have no idea what you’re talking about. Well, the directions aren’t hard for it.
It starts to open your eyes to understand that you need to be adaptive to your patients on. Meeting them where they’re at, right? So we’re gonna keep with this example of the two view chest x-ray, the true in my eyes, bread and butter, 72 inch SID. You typically have it lengthwise for someone who’s smaller, narrow chested, typically females, and you start with it crosswise for your PA on most males, um, or any patients depending on their body habitus.
So that’s kind of the guidelines, right? Unless you have a 17 by 17 plate, then you just pop that plate in. The bucky going to the basics with this, you always use a grid for your chest X-rays due to the amount of tissue you need to penetrate. It’s over 10 centimeters. So over that, um, guidance that you have to have a grid for, um, as well as just being able to control image quality and work with the a eecs.
So beyond that, diving in a little deeper, um, we do all of our chest x-rays, ideally pa so a posterior, um, to anterior. So what that means is you’re gonna want their chest against the board, not their back, not their side, not space. You want their chest right up against that board. Why do we do that? Because it helps to eliminate the overall magnification of the heart, right?
By having a pa, having that heart closer to that board, we’re eliminating the fact that we might project it and make it look enlarged because that can be concerning. We can cause concerns that way if we cause enlargement of something that’s not necessarily there. Okay. So with that, um, understanding the best way to do breathing instructions and just instructions overall, like I’ve mentioned, you need to meet your patients where they are.
So if you’re doing a PA two view, chest x-ray standing normal bread and butter, right? You’re doing that on a younger patient. Um, their understanding of directions is going to be a lot different than, say, an elderly patient. If you have a patient and you tell them to put their left side against the board and they put their right side or anything like that, that all plays into factors.
Um, depending on the patient’s age and how much they’re understanding. Your instructions based off of their age or even off of how much they can hear you say, they have a hard time hearing. It is important to practice with this patient on their breathing, right? So hopefully everyone listening to this or coming to listen to this or after we at some point you will learn the breathing for two Chest x-ray is by the Meryl’s book, which is personally what I love to use is to have them take a breath in.
Blow it out. Take another deep breath in and hold it. It is always written to have them do their breathing twice. Now why is that to do their breathing twice is first to practice. If they are extremely hard of hearing, if they are at a younger age that you’re concerned, they might not be understanding the directions.
Practice with them while you’re standing out there. Um, I use the example, especially any, with any peds patients. I use the analogy, I like to ask ’em if they go, like to go swimming. Every kid I’ve ever met loves to go swimming, and if they don’t, then I ask ’em, do you like birthday cake? Like you like birthday candles?
Always one of the two. They love him. Then I use that to say, okay, take a big breath in, like you’re gonna go underwater. Take a big breath in, like you’re gonna blow up birthday candles. That analogy, relating it to something they enjoy, relating it to something they already know, makes it a lot easier for them to understand.
Now on the other end of that spectrum, if you are dealing with someone who’s just hard of hearing, they just, they can’t hear you. When you stand behind the lead wall, five, six feet away, practice with them out there. Say, okay, I’m gonna give you some breathing instructions. This is what they’re gonna be.
That way you can see for yourself and make sure that they’re understanding before you actually take that picture. It also goes if you are having a hard time with like a language boundary, right? Like they’re able to understand what you’re saying super well. Um, but the language line or however you’re using a translator, it’s not not working right, like you’re having issues with it, practice with them or tell them, okay, I’m gonna tell you one that means take a breath in two means, blow it out. One, take a breath in, two, hold it. Something along those lines can help to make that a lot easier for not only the patient, but yourself to get a good image Now. It is very, very common to see. A lot of techs only do one breathing. I am guilty of it myself. If a patient is having a hard time, I will only do one breathing, one breathing, but I will make sure that I am ready to expose.
So I’m getting ready to expose, I am ready to expose. I tell them to take that big breath in, and I try to get that picture at the biggest breath. However, ideally it is I way more. Efficient to do one breathing. However, it is way more likely to get you a better image if you can do two. And this is because, so that first time you have them take that breath in, you’re just getting their breathing to line up with what you’re saying.
Right. So if they’re breathing on their own or whatnot, they aren’t in sync. So if you were to tell them to take a breath in and hold it, you might catch ’em at a spot that it’s hard for them to understand to take that big breath in. And so you run into that. You run into not being able to take the picture right when you need to.
So say you do two breathings and in the back of your head you’re going, okay, they don’t hold their breath very long, or they don’t take a big breath. Or when you’re looking at the patient telling them to do this, you can see what that breath hold looks like, so you know when you’re gonna take it. Because the best way to get a good chest x-ray is to have a deep breath, right?
You wanna really inflate those lungs. You want to be able to see everything that you need to for your anatomy, right? And by inflating those lungs, giving them that clear picture, making sure it’s a solid breath hold, you aren’t gonna have motion. That is all great ways to get a good chest x-ray. So I mentioned a little bit kind of dealing with the two of you, chest x-ray with peds.
As well as dealing with it, kind of with everyone, just as a routine to view chest x-rays. So now we’re gonna talk about a few of the more extremes. So the first one being the infants. Typically those pigs stats. So if you don’t know what I’m talking about, Google what a pigs stat looks like. You are walking into what a very interesting career with them.
But, um, for those of you that do know them or have the idea, so it’s basically a device that does not hurt the kids. It does not cause any pain or discomfort. It makes them mad because they can’t move. So it puts them in a spot on kind of a little bicycle seat with some clear sides to kind of pin them in place. Biggest thing is I always reassure parents that it does not hurt them. They will not be in pain. They do not hurt from it, nothing like that. I just tell them they’re gonna be mad. They’re mad because they can’t move. Anyone who has met a toddler and a infant, kind of, or any, they wanna move, right?
They’re wiggling their arms, wiggling their toes, they wanna move. So putting them in this biggest stack kind of pins them in spot for us to get a good picture of their chest. But in the flip side of it, they’re mad, they can’t move. So you kind of put them on this bicycle, see it. You have the parent usually help you, like hold their arms above their head and you clip on these sides. So that way it kind of gets them in the spot. Unfortunately, it always is hard to hear, but I tell parents and it’s good to know. As a tech or a student, unfortunately, you want them to cry. I know it sounds horrible. However, it gets really good pictures. Think about what we just talked about with the two of you.
Chest x-ray. You want them to be taking that big breath in. A kid takes a very large breath in when they are crying because they wanna be loud, they wanna be heard. They want people to know that they are mad, so they take those big breaths in. That means we get really good pictures, unfortunately. It’s not fun to hear kids cry, so I always try to have everything ready to go. I reassure the parents. I usually ask if they’ve ever had one of these done, seen, these done, kind of what that entails. And then I also just make sure that I work quickly. I work efficiently. I have everything ready, all of that. I try to work as quick as possible, make the tears as less as possible.
However, the crying is good, right? You’re watching their breathing. When they’re crying, they’ll take that big breath in, bam. Great way to get a good chest x-ray. And usually the second you take them out of the ptat parents arms, they’ve got ’em. They’re fine. They’re back at it. They are akay. They usually give you a little bit of a look, but they’re akay just fine being in mom and dad’s arms. So that is kind of how to navigate. Now, the Pegostat is super helpful, like I said, for infants, the smaller toddlers, anything that way. However, there’s a fine line. You cannot use a Piga stat on. A baby or an infant that is not able to hold their head up, right? It’s a safety thing, so you’re gonna put ’em in there.
They’re straight upright. You need to make sure that that baby is old enough to be able to do that safely and say they aren’t okay. Plan B, that’s when you do that supine chest x-ray with them just laying on the board and you do it flat, not ideal, right? You can’t kind of watch air fluid levels, but we’ve got workarounds for that.
Biggest thing with the biggest stat is to just make sure you’re being safe for that patient. That goes with them being too small and that goes with them being too large. So I’ve kind of mentioned we use it for infants and small toddlers. You can use it. If the toddler fits, however, you have to keep in mind, toddlers can be quite strong and that will them kicking or moving or wiggling still be safe within that device.
So kind of varies on the size of the child you’re doing, but that’s just something to keep in the back of your head. Just because they fit in the device does not mean it’s gonna be safe for them, and you need to pick the thing that’s going to be the safest for you to get good pictures and the safest for the patient Now.
After talking about this one end of the spectrum, the infants, toddlers, little ones, all that stuff, let’s go to the other side. So say you’ve got a patient that is too sick to do the two of you routine chest x-ray, you’re gonna be doing that portable right. You’re gonna be using your portable machine to go do a chest x-ray.
So these can be a little bit funky per. Place you’re at. But ideally you want to recreate the structure you have in your extra room. Ideally in wherever you’re doing this portable, right, like you want your 72 inches, your grid, you’re gonna have it crosswise just above their shoulders, like you want them sitting upright as far as you can, you want the tube to match where the um, grid is.
You want all of that to be the same or as close to as you can get. That is going to help you get the best image that is hopefully going to be almost equivalent to doing it in the room. Now we have circumstances and issues with that that make it harder to have that patient sitting up all the way right.
Their breathing’s gonna be harder. Those are the ones I find as a tech myself. I’m doing one breathing breath. Hold on. Because they just can’t do breathing instructions because they’re too unwell. They can’t hold their breath like that. They’re hard of hearing, they’re wiggly. All of the things, you just have to take that into consideration.
You gotta be ready for it, and you still have to try to get a good quality image. The biggest thing that I see with texts, newer texts, newer students, anything like that, even seasoned texts. Is your angling. So if they’re sitting upright and you have got a strong angle on that portable tube, if you have a funky angle on that, that does not match where the grid cassette is or the patient, you are gonna start to throw their clavicles, which I use as the best landmark to see where your angle is.
You’re gonna start throwing those up or down. So like farther into the lung fields, projecting them up out of the lung fields well. That starts to be a problem, right? ’cause that starts making the anatomy look different. That starts making the heart look enlarged or smaller than it needs to be. That starts to make like little patches of possibly pneumonia or things like that kind of all project funky, and that causes issues on comparing.
That causes issues on diagnosing, and that can mean repeats or more x-rays or imaging for the patient, which is the last thing we want, right? We want to get good quality images so we can help the radiologist and providers come up with a diagnosis for that patient. We don’t want them to get our image and then question that they need more imaging.
Yes, there’s a time and place if they see something, if they find something that they need more imaging. But you don’t want it to say suboptimal positioning, question something you don’t wanna see questioning something, but they can’t say for sure because of how you were positioned. That is the last thing as a tech you want.
’cause that means what you did was not helpful for getting that diagnosis for that patient. Like yes, you got the image, but was it a good quality image to me that is. The highly most important factor to keep in mind as a new tech seasoned tech student. All of the above. We are here for good quality images and a chest x-ray man.
That’s the bread and butter of radiology. That is something you will have days that you love to do, you will hate to do, but that is the best way to feel confident with your skills, is to feel confident doing a chest x-ray.