When I was a student, the most difficult x-rays for me to get right was the lateral knee. No matter what I did or who helped me, the radiograph would always turn out being either over rotated or just funky looking. Eventually, I figured out that by shooting the lateral knee cross-table, that I could get the condyles to perfectly superimpose almost
Is there one single view or a series that has been your Achilles heel (pun intended)?
Through my time working in radiography departments, emergency rooms, ortho offices, and, as a mobile radiography tech I have picked up a few tips on what has helped me to get a good radiograph, most of the time.
TIP #1: Learn the Equipment
This sounds like a no-brainer, but not all equipment or imaging rooms for that matter are the same. I have worked at places where each room seemed to have a mind of their own. What I mean by this, is that what worked perfectly in
Often this was due to having different manufacturers equipment from room to room. For example, one room would have a state of the art Siemens DR equipment where another would have a CR based Philips system dating back to the civil war!
In order to best prepare yourself for success, you need to know the nuts and bolts of these rooms and how each manufacturers equipment works. Here are some examples.
- Is there auto-collimation or do you have to do all collimation manually?
- Are the techniques saved within the imaging system accurate?
- Are there any weird bugs in the room that might cause the tube and IR to not line up correctly or drift?
- Do you fully understand how to navigate within the imaging system’s computer interface?
- Is one room better for table work where another has a better upright bucky?
Knowing these points, will not only dramatically increase your chances of success but will also save you from looking confused once you are in the room with the patient.
TIP #2: Learn from your co-workers
I know there can be a tendency within some radiography departments to want to be known as a “RADTECH SUPERSTAR!”
I would be lying if I said that I have not struggled with this in the past, but at the end of the day our job is to help people get better not get a big head because we can get the odontoid 90% of the time!
The way I learned how to get rockstar lateral knee x-rays was that I ate a little crow and asked a senior tech to show me his technique. By doing this, I was able to learn a few simple tips that would have otherwise taken me ten years and over 100 retakes to figure out. This tip was to always shoot the lateral knee cross-table and to have the IR parallel to the femur no the tube. WARNING this technique might not work for you since there are some nuances, but for me, it tends to get the job done.
Tip #3 Learn from bad images
Next time you over rotate an oblige lumber spine or clip the pubic symphysis on a KUB, instead of just repeating the image, take a second to either take a mental note or actually write down what you think caused the image to need repeating.
I am not saying that
For example, say your lateral wrist x-rays never seem to be 100% superimposed, and you just can’t seem to figure out if you are rotating too much internally or externally.
Instead of continually making the same mistake, you can purchase an imaging critique book or find some information
Tip #4: Do the same thing every time
There is a saying in the hospital world, “first time every time.” At my old job, we use to say this about the endoscopy department. It seemed like every case was their first. They would call us 5 seconds before the physics was ready for images (GERRRR!!) and they never knew any of our names (we had all been there for years), and the list goes on and on.
Don’t be the endo department of x-ray! What I mean by this is that you should try to do the same thing every time, IE having a system.
For example, when I am performing an exam, I will always do the same thing in the same order (if possible). This includes (before I get the patient), getting the room ready, pulling the patient’s information up on the computer, having the correct exposures set on the imaging system, having the cassette in the buck (if the room is not DR) having the tube set to correct SID, and so on. When the patient is in the room. I will always say the same thing and do the images in the same order (AP, OBL, LAT). Doing this helps me not only be efficient but also very consistent. After I started doing this, it was like my brain already knew what the next step was, so I could focus on if the anatomy was positioned correctly collimation, and imaging factors.
This was particularly helpful when doing mobile radiography since with this kind of work; you never know what situation you are going into.
Tip #5 Be patient
No one likes to hear this, but it takes a while before you get good at this.
I get it when you are a new tech you want to take over the world and have statues made of you to commemorate you as being the god amongst all other technologists!
Sorry, but it does not work that way. Taking great x-rays is an art, and you are going to have to take a lot of them before you get good at this.
With that said, I am 100% confident that if you follow the steps I have outlined, you will become a better technologist much faster then if you just did nothing.
I would love to continue this conversation.
What can you add to this blog post that may help others take better x-rays?
Written by Ari B – Founder of Clover Learning, Inc
Hi, my name is Evelyn. I graduated from xray school in 2005. I worked in the field for five years. I stopped working when my first child was born in 2010. I have not worked since. Now that my third child is getting ready to start elementary school, I would like to go back to my career as a radiology tech. I have to reinstate my license due to not keeping up with my cme credits. I feel discouraged at times having to study for the arrt after all this time. I also feel nervous getting back into the field after all this time. I am sure lots has changed. What advice and suggestions do you have for me? I will greatly appreciate it.
Thank you,
Evelyn
I’m in your situation but worse. I was a technologist until 2003 and now I need to do the program all over again. I graduated with a 4.0 and got a 92% on the registry.
The reason I am thinking of doing this program again and not find another career path is I also have a child going into third grade and I know the field. I have been out of the field for 15 years but even though technology changed the information doesn’t (besides new technology or possibly new techniques and procedures.
I don’t have time to learn all new information this is why I am choosing this over (for example) dental hygienist. Good luck.
Hi. I think I got you both beat! My license has not been active since 2000. I called ARRT to find out about reinstating and they just said I have to re-examine. They didn’t mention having to do the program all over again. Were you told you have to do the program again? Thanks and good luck
Any advice for Pelvis x-rays? This is the most repeated position by all the techs at our place.
14 x 17 crosswise. 40″ SID. Top of crest should be just at or below the top of the plate and light field. Center properly and after all this….increase SID as high as you can get it. Ofcourse tell pts to toe in. This will reduce magnification and get all of the Pelvis on the plate. If you have 17/17 DR even better…you rarely have to repeat a Pelvis.
Thank you for mentioning the importance of familiarizing yourself with the x-ray equipment. My uncle would like to open a health clinic this year, and he would like to find a simple x-ray machine that can be used to train new employees. Maybe it would be best for him to ensure that his staff is familiar with the equipment being used.
For lateral knees, a tech taught me something as a student that I still use to this day and it works every time. Just make sure the femur is straight 🙂 and I also feel their patella sometimes, if they can tolerate it, to make sure they’re not rotated. I bring their hips back if they’re too far forward.
Good afternoon,
Too all.
I’m originally from Dominican Republic, but living here in Cayman Island since 2005
working here as a radiology tech.
nice to meet you all.
thank you for these amazing tips