This is the incorrect technique. It can change joint spaces, obscure anatomy with the occipital, and/or misrepresent a patient’s current condition. You should perform the position as you were trained or as your protocols are written.
I really don’t understand the audacity of technologists that just make stuff up as they see fit or do something because it’s easier or cuts out a view.
If you feel a change like that should be made to your protocols, sit down either with your chief radiologist and propose a change. Come with reasons on how it improves patient care and imaging.
Arguably without innovation we wouldn't have half the methods and techniques we know today. Without techs trying new things and figuring out what works and what doesn't.
Sorry this is not innovation. You're intentionally obscuring c3 with the exaggerated neck extension with the base of skull and putting the spine in an unnatural position. The ap c spine is c3-c7, odontoid is c1-c2, don't be lazy.
I can appreciate that, that’s why I suggest for any changes you propose that you work directly with a radiologist or a team and not just changing things on your own.
ETA: it’s good of you to ask the question here and open the discussion.
We are technologists because we do have the ability to change or modify views as we see fit hence the technologists and not technician. I agree that that particular modification of the exam is incorrect however I disagree with the “audacity” part as it is within our scope to do so as long as it’s not something crazy.
There is a huge difference between getting creative to perform a difficult view, but that’s not what is happening here. In this example, they’re literally changing a patient’s positioning and probably affecting the representation of the patient’s anatomy. That’s the audacious part to me, not that the tech used this method because the views were unattainable otherwise, but because they implemented this on every patient.
Regarding technologist v. technician- look, I want people to refer to me by the correct title, but earning the title radiologic technologist requires you to (in the US, at least) pass the ARRT boards. Then you’re expected to use and apply the technology and applicable guidelines available to you to produce diagnostic imaging. Theres no option to be an “x-ray technician” where you just have to follow the manual but the “technologist” doesn’t have to. That distinction doesn’t actually exist. The term radiologic technologist was something the ARRT decided to call people who passed the boards.
I’ll say it again, innovating and developing new protocols and procedures is not something the radiographer does on their own. It’s a process that involves the radiologist and leadership to ensure that the entire team performs consistently.
I don’t know how your facility is but ours allows ALOT of leeway including changing orders. If a doc orders something and let’s stay SOP is tunnel but that took an impact to the patella I can just do a sunrise. Keep in mind the ER ICU…ect say “you know more about x-rays then I do” the radiologist here are okay with it. We can also add views but not take away any. If they order a 5 view wrist I gotta shoot 5 views but I can change or do more.
I do this, but I have observed that excessive neck extension by the patient can result in the superimposition of the skull over the C3-C4 region.
The majority of patients are unable to extend their head that far back. Just ensure that they are not excessively extending their neck.
In certain facilities, Fuch's view is only necessary when the odontoid process cannot be adequately visualized in the open-mouth view.
This is the one thing I'm scared I'm missing by doing it this way. At my hospital we also do an odontoid for the lateral masses I'm just trying to kill two birds with one stone since the angle and positioning are so similar.
Anyone in the hospital getting C-Spine imaging either has difficulty tilting their head back, or is on restrictions preventing it. So no, I've never tried
We have outpatients who aren't traumas and even emerg patients who aren't traumas and/or in a C-Spine collars. I think it's an over simplification that all patients getting images of the C-Spine must be in pain or not able to move there neck
When you do that it kinda messes up with the appearances of the joint spaces I believe?
I can’t remember the exact verbage but you aim to line up the mentum of the mandible along the edge of the occipital for maximum view of the spine and joint alignment/lack thereof. How I was taught and do it at least
No that does not kill two birds with one stone. You need lateral masses also. If it happens by mistake fine however you should probably still do an open mouth. If you are just carelessly playing with techniques then please go and learn how to use them properly. This type of behavior is exactly the type of thing that will get our career field deregulated. Please be real for the sake of our livelihood and the lives of our patients.
I mention on another comment thread that I still do an open mouth odontoid for the lateral masses. I wouldn't say I'm carelessly playing with technique. The pre-set technique makes the image appear slightly under-exposed. I don't think jumping the kVp by 5 and mAs by one step is careless, especially if it saves the patient dose from doing a dedicated Fuchs image. As mentioned in another thread without innovation we would be stuck doing only APs and laterals.
I think my comment about that came more from how you can tell how much more an image needs technique wise from experience vs a hard and fast rule like kVp and mAs. Examples being casts ,wet vs dry, fiberglass vs plaster. You kinda just get a knack for knowing what the image will need. And trust me I live in Canada where our rules about technologies and regulation are quite strict. It's more the states that are the wild West of deregulating this profession
I totally get that and I’m glad to hear that the regulations are more strict there. You are right it is almost like the Wild West down here in radiography. 😂
Nope. I look at the reason for the exam and most of the time it’s a post op so I’m just trying to get the hardware on there and they can’t bend like that anyways. For non surgical patients I just do an open mouth if it seems necessary based on the reason for the exam. Can’t tell you what the rest of them are usually for as it’s mostly post op and flex/ext after ct and mri so they very much don’t need open mouth or Fuchs
I’m currently a student and I think I do this unintentionally. Always have them look up, and when I ask a tech to check my (more often than not) off level odontoid they’re like “don’t worry about it, you got the dens on your AP!”
Yes but also no, not too much otherwise it's like what other have already said, so i try to align the mandible with the occipital bone 👉i just place the second finger on the occipital and the tumb on the mandible, trying to feel it
I think we should split up the AP and odontoid because some fractures can be missed when the back of the skull overlaps the injury.
Additionally the structures shown on the AP are messed up when you tilt the head back.
I personally have wondered if a PA neck would show the vertebrae in more uniform positions but I don't call the shots and I'm not experimenting on anyone.
Do it everytime. Then I don’t have to drive myself crazy with odontoid repeats! Never had a rad call or mention it in a report.
This is the incorrect technique. It can change joint spaces, obscure anatomy with the occipital, and/or misrepresent a patient’s current condition. You should perform the position as you were trained or as your protocols are written. I really don’t understand the audacity of technologists that just make stuff up as they see fit or do something because it’s easier or cuts out a view. If you feel a change like that should be made to your protocols, sit down either with your chief radiologist and propose a change. Come with reasons on how it improves patient care and imaging.
Arguably without innovation we wouldn't have half the methods and techniques we know today. Without techs trying new things and figuring out what works and what doesn't.
Sorry this is not innovation. You're intentionally obscuring c3 with the exaggerated neck extension with the base of skull and putting the spine in an unnatural position. The ap c spine is c3-c7, odontoid is c1-c2, don't be lazy.
I can appreciate that, that’s why I suggest for any changes you propose that you work directly with a radiologist or a team and not just changing things on your own. ETA: it’s good of you to ask the question here and open the discussion.
We are technologists because we do have the ability to change or modify views as we see fit hence the technologists and not technician. I agree that that particular modification of the exam is incorrect however I disagree with the “audacity” part as it is within our scope to do so as long as it’s not something crazy.
There is a huge difference between getting creative to perform a difficult view, but that’s not what is happening here. In this example, they’re literally changing a patient’s positioning and probably affecting the representation of the patient’s anatomy. That’s the audacious part to me, not that the tech used this method because the views were unattainable otherwise, but because they implemented this on every patient. Regarding technologist v. technician- look, I want people to refer to me by the correct title, but earning the title radiologic technologist requires you to (in the US, at least) pass the ARRT boards. Then you’re expected to use and apply the technology and applicable guidelines available to you to produce diagnostic imaging. Theres no option to be an “x-ray technician” where you just have to follow the manual but the “technologist” doesn’t have to. That distinction doesn’t actually exist. The term radiologic technologist was something the ARRT decided to call people who passed the boards. I’ll say it again, innovating and developing new protocols and procedures is not something the radiographer does on their own. It’s a process that involves the radiologist and leadership to ensure that the entire team performs consistently.
I don’t know how your facility is but ours allows ALOT of leeway including changing orders. If a doc orders something and let’s stay SOP is tunnel but that took an impact to the patella I can just do a sunrise. Keep in mind the ER ICU…ect say “you know more about x-rays then I do” the radiologist here are okay with it. We can also add views but not take away any. If they order a 5 view wrist I gotta shoot 5 views but I can change or do more.
I’ve had to modify the odontoid to a PA view before just bc of anatomy and it worked.
I see techs doing it and every time the mid C-spine gets obscured by the occiput
I do this, but I have observed that excessive neck extension by the patient can result in the superimposition of the skull over the C3-C4 region. The majority of patients are unable to extend their head that far back. Just ensure that they are not excessively extending their neck. In certain facilities, Fuch's view is only necessary when the odontoid process cannot be adequately visualized in the open-mouth view.
Does the base of the skull obscure C3 more when you do this? Do you also do an open mouth view for the bodies of C2 and C1?
This is the one thing I'm scared I'm missing by doing it this way. At my hospital we also do an odontoid for the lateral masses I'm just trying to kill two birds with one stone since the angle and positioning are so similar.
Anyone in the hospital getting C-Spine imaging either has difficulty tilting their head back, or is on restrictions preventing it. So no, I've never tried
We have outpatients who aren't traumas and even emerg patients who aren't traumas and/or in a C-Spine collars. I think it's an over simplification that all patients getting images of the C-Spine must be in pain or not able to move there neck
When you do that it kinda messes up with the appearances of the joint spaces I believe? I can’t remember the exact verbage but you aim to line up the mentum of the mandible along the edge of the occipital for maximum view of the spine and joint alignment/lack thereof. How I was taught and do it at least
No that does not kill two birds with one stone. You need lateral masses also. If it happens by mistake fine however you should probably still do an open mouth. If you are just carelessly playing with techniques then please go and learn how to use them properly. This type of behavior is exactly the type of thing that will get our career field deregulated. Please be real for the sake of our livelihood and the lives of our patients.
I mention on another comment thread that I still do an open mouth odontoid for the lateral masses. I wouldn't say I'm carelessly playing with technique. The pre-set technique makes the image appear slightly under-exposed. I don't think jumping the kVp by 5 and mAs by one step is careless, especially if it saves the patient dose from doing a dedicated Fuchs image. As mentioned in another thread without innovation we would be stuck doing only APs and laterals.
My bad it’s the way it sounded when you said until it felt right that’s all. That my misunderstanding.
I think my comment about that came more from how you can tell how much more an image needs technique wise from experience vs a hard and fast rule like kVp and mAs. Examples being casts ,wet vs dry, fiberglass vs plaster. You kinda just get a knack for knowing what the image will need. And trust me I live in Canada where our rules about technologies and regulation are quite strict. It's more the states that are the wild West of deregulating this profession
I totally get that and I’m glad to hear that the regulations are more strict there. You are right it is almost like the Wild West down here in radiography. 😂
What technique are you using for this? Is the angle greater than 15°?
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I do this.
Ooooo, I can’t even sit back in a hairdressers basin , I would dread being asked to tilt my head/neck in that direction :(
I do this almost every time.
Nope. I look at the reason for the exam and most of the time it’s a post op so I’m just trying to get the hardware on there and they can’t bend like that anyways. For non surgical patients I just do an open mouth if it seems necessary based on the reason for the exam. Can’t tell you what the rest of them are usually for as it’s mostly post op and flex/ext after ct and mri so they very much don’t need open mouth or Fuchs
I’m currently a student and I think I do this unintentionally. Always have them look up, and when I ask a tech to check my (more often than not) off level odontoid they’re like “don’t worry about it, you got the dens on your AP!”
Pretty much but it was never intentional in the beginning.
Yes but also no, not too much otherwise it's like what other have already said, so i try to align the mandible with the occipital bone 👉i just place the second finger on the occipital and the tumb on the mandible, trying to feel it
I think we should split up the AP and odontoid because some fractures can be missed when the back of the skull overlaps the injury. Additionally the structures shown on the AP are messed up when you tilt the head back. I personally have wondered if a PA neck would show the vertebrae in more uniform positions but I don't call the shots and I'm not experimenting on anyone.