วีดีโอ

Excellent, let us know how it goes!

Why

Why? We do this on a regular basis, it is, at least for me, much more consistent than the settegast.

Yes, that is the Merchant position. The Merchant board may look different, there a few different kinds.

Yes, that is a very good suggestion! Especially the internal oblique!

You are correct, this is the Mortise view. We probably should have pointed that out, however, pretty much everyone does the Mortise and calls it an oblique, as the true 45° oblique as fallen into issue. Good eye noticing! Are there any positioning videos you would like to see?

@@thepenumbrabrothersexplain707 single TMJ

TMJ's are good ones too, I will add that to the lit of videos to do, thank you!

Thanks a lot! Let us know if there is something else you would like to see.

Great, we try to help!

Glad to hear it!!!! If there are specific positions you would like to see videos on, let us know!!!

@@thepenumbrabrothersexplain707 Can you review the Prime Factors for radiology ?

That is a good one, it is both a simple and complex answer, but I will definitely put this on the list of the next few videos!

That is a great topic, I will add that to our list of video's to do! Thank you!

Excellent! Love to hear that! Anything specific you would like to see a video on?

@@thepenumbrabrothersexplain707 Yes, ribs and y view on a stretcher.

Great, we though placing the image for reference would be helpful! Glad it works!

You are very welcome, let us know if there is something specific you would like to see a video on!

can you do humerus position @@thepenumbrabrothersexplain707

We will get that on the list! Thank you!!!

Perfect, that was the goal, straightforward and easy!

I like the thought about breathing. I use a straight beam for the lateral, but I rotate the hips so that the pelvis is in a true latera position, this eliminates the need to estimate the angle of the beam. I collimate tightly as well, the lead blocker is not for collimation purposes, it is to help reduce any scatter, makes for a cleaner image.

As you will have seen on my videos, my lead blocker goes on the patient to reduce primary beam dose. The angulation used for lateral sacrum is standardised by introducing as much of a bend in the back as possible. A perfect lateral L5S1 and sacrum should appear with perfect alignment of all vertebra up to T8 if the postural positioning is done correctly. Never a straight tube. That is why my lateral lumbars were always good. My success was 9 out of 10 for perfection whereas my colleagues were satisfied with 3 out of 10, so that meant success was more to do with chance than accurate technique. Putting lead on the xray table behind the pelvis/lumbar spine does absolutely nothing to the presentation of patient anatomy. The lead will stop extra focal and collimator scatter from getting to the receptor but that radiation was not going to degrade the image of bone and flesh. I encourage you to see if I am right by using water phantom. Dispel the myth that has haunted our profession for more than a century.@@thepenumbrabrothersexplain707

I am using digital, so yes, the lead blocker to clean up the scatter does affect the image processing, it is significantly different that film/screen. I collimate so there is no necessity to use a lead blocker to use as collimation.

The lead blocker on the xray table behind the spine didn't do anything to the quality of the image in the days of film and chemistry and it still does nothing in the days of digital processing. I worked with all brands of digital in my last 25 years of radiography as I was a locum and worked in 20 different practices. It is an 'old wives tale' passed on through the generations without challenge. Do an experiment to test it@@thepenumbrabrothersexplain707

I would respectfully disagree with you. As I am sure you are aware, it is a complex process, but scatter and uncollimated areas outside the anatomy do affect the EI number (EI corruption) and the computer processing. The more exposed area outside the VOI's of the histogram make it harder for the computer to isolate just the area of the specific VOI's that need to be processed, this in turn effects the lookup tables, which can effect your digital image. Back in the days of film, you are right, a lead blocked behind the patient did not affect the image, however, it allow scatter on the film, which made for a less aesthetically pleasing image. Like you, I have been in radiology a long time, entering the field in 1982.

I respect your opinion, but I have worked with many orthopedist who would disagree with you. The centering is imperative to have an accurate representation of the joint, off centering, although mild, will still distort to joint, which can be an issue in surgical planning.

Changing a projection by 1 or 2 degrees will make no appreciable difference, particularly to AP ankle and certainly have no effect on assessing any injury or planning surgery or followup studies. There is more than 2 degrees difference in the presentation of AP ankle anatomy between a fat leg and a skinny one.@@thepenumbrabrothersexplain707

If you center exactly on the joint space, there is no change in the joint space as the geometry is exact. Angulation of the beam does not change the geometry of the beam, but off centering, even a little does.

The amount is not significant. If it was 5 degrees it would be. Considering that centring 2 inches above the joint space will reduce the radiation dose to half it is worthwhile. Why should we follow the instructions devised 100 years ago? They didn't have the light beam diaphragm and weren't concerned about dose.@@thepenumbrabrothersexplain707

Although that sounds great, these videos are for students and techs who are learning or refreshing. If you mean a 2x4 field on the image, there are times you are going to clip appropriate anatomy. The SI joint, with proper angulation and normal magnification, on the image, often 3-4 inches long.

My method of doing radiography meant I was always striving for perfection. Every image related exactly to the prediction made with the illuminated field. It was possible to collimate extremely accurately as you have seen in my videos. The problem with centring points is that what is in the middle of a radiograph is of no value. What is contained within the collimated field is important.@@thepenumbrabrothersexplain707

I respectfully disagree. What is in the middle is what is best demonstrated by an accurate representation of the anatomy. That being said, does not mean that you cannot accurately and precisely collimate.

Do you centre on T7 for a chest xray, then find T7 on the radiograph to assess whether you have been successful? Of course not. No one does. No one knows where T7 is unless a lot of palpation happens and it is totally unnecessary.@@thepenumbrabrothersexplain707

I do get that, and yes, we do need to make adjustments for each persons individual anatomy, and knowledge of that anatomy is very important! However, for those just starting out, the positioning guidelines should be adhered to as they are learning, they can make those additional adjustment as they mature in their skill. Clearly, you have been doing this awhile, me too, and that experience is invaluable! Nice images by the way!

Thank you!!!! Are there any specific positioning videos you would like to see?

@@thepenumbrabrothersexplain707 chest xray full details and how to diagnosis every inflamation and other problem?

Yes, there is one on the sacrum and coccyx! Just type in Penumbra Brothers Sacrum in TH-cam, and it should come up!

Hello there, clearly you are in the medical field! A few points though...Through our positioning guides, primarily Merrill's and Bontrager's, probably the most commonly used positioning guides, describe and demonstrate the lateral wrist positioning as the Ulna and Radius superimposed (and yes, the shoulder, elbow and wrist should all be in the same plane), neither describe the specific superimposition of the pisiform and the scaphoid. For the scaphoid view, the standard scaphoid is what is demonstrated, but the Stetcher view, which is a specialty view (we were just demonstrating the standard views on this video) which is positioned with the hand flat on the palmar surface, with the IR angle 20° with a perpendicular beam, or the IR flat with a 20° CR, a variation of the Stetcher view is to clench the fist. That maneuver elevates the distal end of the scaphoid so it is positioned more perpendicular to the IR and widens the the fracture line, this maneuver may be very uncomfortable for the patient.

By the current standards, no. As you can see, her legs are not under the table, so she is not in the path of the beam. It is a recent change and the governing bodies that set the standards, due to research and long term evidence, in most cases, lead aprons are not needed.

But what about in the instance of scatter rays. Is it because the Msv is so small for a hand x ray?​@@thepenumbrabrothersexplain707

Exactly! 40 years ago (actually a little more that that), when I started in x-ray, we used roughly 10 times the radiation to create an image, so the doses used now are MUCH lower. Aside from that, the scatter is created from the patient, so any scatter is created inside the tissue. It is also not like the radiation created in the x-ray tube, it is extremely low power, so any scatter radiation likely would not have the power to even penetrate the skin.

This is really informative. Thank you for your time.​@@thepenumbrabrothersexplain707

No problem at all!

By the current standards, no. As you can see, her legs are not under the table, so she is not in the path of the beam. It is a recent change and the governing bodies that set the standards, due to research and long term evidence, in most cases, lead aprons are not needed.

Are there any specific positioning videos you would like to see?

Are there any specific positioning videos you would like to see?

Please do! Feel free to share as much as you would like. The videos on Inverse and Direct square law have a simplified formula with a some really great short cuts too!

Yes it’s me. I teach in Houston now.

That is awesome! I am sure you are an excellent instructor!!

Are you looking for how kVp and mAs work, or a technique chart?

@@thepenumbrabrothersexplain707 I mean exposure chart 4 every part of body

The techniques are different for each machine, they are all usually pretty close, but the equipment should have a technique chart with the unit. To develop a technique chart properly for a x-ray unit is a very specific process, that depends on your specific equipment, what detector system, you have, all of these can make a big difference.

@@thepenumbrabrothersexplain707 Thanks alot, we have DR x_ray machine

You should be able to contact the manufacturer and get a technique chart. Do you know if it has APR? It may already be built into the system.

I don't know about a perfect image every time, but I do know how it is done. A good start is that Merchant view, which is a modification of the of the Knutsson view. The primary difference is that the knees are bent more on the Knutssen view, therefore you have to angle more as well. You can use the Merchant board, you simply adjust the board so that the knees are bent 45°, the tube is angled 30° caudally, make sure the cassette is angled so it is perpendicular to the CR. You should strap the claves tog ether using Velcro, a belt, or even some form of an elastic bandage or ace wrap. the only difference on a Merchant view is the knees are bent 40°. I do have an old article that gives some really good information about it, even a way to do it if you don't have a merchant board, using a chair and a foot stool with a handle. Let me know if you would like a copy of that.

I found that article, but can't attach it here. You can email me here gskinner@valleyic.com and I will send you the article if you are interested.

@@thepenumbrabrothersexplain707 oh that’s amazing, thank you so much, I’ll flick you an email

Sent the article!

@@thepenumbrabrothersexplain707 thank you very much! I really appreciate that ☺️

You are welcome! We are actively working on more videos. Subscribe to be notified of when those are posted. Anything specific you would like to see on video?

You are right, it was a slip of the tongue, definitely cephalic!! I did it right, but said it wrong! Great catch!!!

Glad it was helpful! Are there other positioning videos you would like to see?

Thank you for comments on both! We are working on more, trying to get a few more out very soon!

You are welcome, let us know what other videos you would like to see! We recently added videos on the Direct and Inverse Square laws. There are a few good short cuts that are very helpful.

around 55 kVp and 2 mAs most likely

thank you :)@@simsimma6554

It depends on your equipment, normally 1-2 mAs and 55 kVp, but that can change depending on your x-ray machine and the film/detector system you are using

Thank you! We try to have a little fun!

No, there will be different distance, you may be asked to change distance from 40" to 55", or other distances. Knowing the formulas is important, but the simplified formulas are much easier!

Example: We only went over the old way of inverse square law. I’ve never seen it presented at all in the new way. So now I know about another way of getting to the answer

Excellent! I am glad it helped! We will be releasing one on the Direct Square law very soon. It has a very similar modified formula and the very similar shortcut to go between 40-72" (or 100-180cm).

Thank you, those are the two positioning videos that we are doing next! They are definitely coming soon. We have already shot Inverse Square and Direct Square laws, so they will be out in the next two weeks or so, the T and L spine.

Those are on the top of the list for the next round of videos. Inverse and Direct Square law's are done and will be posted very son, then spine is next.

Thank you! We definitely try! There are more videos being released very soon! Are there any specific subjects you would like to see?

hello Janice. I totally agree. I began my career in veterinary medicine in 1975, then transitioned to an RT in 1988. A good share of the "art" we used to use is lost forever

I get that! I started in 1982, it is very different now.

You're welcome

Glad you enjoyed

Thanks Ruba409, we are gettying ready to post anothyer round. Do you have any requests?- Brent (AKA, the better looking penumbra bother)

Weeeeeeelllllllll, I don't know about the "better looking" part! lol

😊@@thepenumbrabrothersexplain707

We just posted one on the Inverse Square Law, and should have one on the Direct Square Law published by the end of next week. We are currently working on some more positioning videos.

Thanks

Good catch

When we shot this, due to the available room, I did position the patient so the camera would have a good view of the positions, but you are right! I should have said so! It does look like I shot one view on each side, very good catch!!! 😃

thanks

Anything specific?

Are there specific positions you would like to see? We are putting out some in Inverse Square Law, Direct Square Law and a few other, but we are gearing up for more positioning videos too.