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The patient arrived on a trolley in extreme pain, with a suspected fracture to her neck of femur or pelvis. Our initial problem was the patient was lying towards one side of the trolley, with the suspected fracture pressed against the trolley sides. This caused a potential problem as I needed to drop the trolley side in order to position the cassette, however I was very conscious of preventing movement in the injured leg.

The way I overcame this problem was to request assistance from three other members of staff in order to help reposition the patient towards the centre of the trolley. This required us to organise and discuss with the other members of staff the best way to do this, so that everyone knew what was required and moved the patient at the same time. Although the movement caused some discomfort to the patient I ensured that she was fully aware of the reasons behind the move.

Once the patient had been repositioned my next problem was to position the cassette and grid. I am not yet comfortable positioning these as I know a lot of the positioning is done by judgement, usually by drawing an imaginary line with the patient’s position and the cassette from the side and the top of the bed. This helps ensure you have all the appropriate anatomy on the projection. Once I positioned them, I then asked the radiographer to check the position in order for us to gain a good image. After we obtained the image it was clear that the patient had a subcapital fracture of the neck of femur (see attached link).

We then required a lateral image in order to ascertain the extent of the fracture. The protocol for this is horizontal beam lateral (HBL) using an air gap technique. The lateral projection of the hip was done by placing a cassette in the wall stand and not using a grid. Although I didn’t ask why it was obtained without the use of a grid, I think it was done like this to reduce the patients radiation dose by using a low KVp, as a higher KVp would be needed if using the grid. However, when I return in the year I will ask their reasons for using it.

I had seen a few HBL’s using an air gap technique so I understood what was involved, but had never participated before. I placed the cassette in the wall stand out of grid, and then positioned the trolley and patient, placing a 45 degree pad under the sheet, lifting the affected side of the mattress. The trolley was positioned so the neck of femur ran parallel to the cassette. I then lifted the good leg onto the leg box so it was away from the area of interest. We then positioned the tube allowing a horizontal beam which was perpendicular to the cassette. Once I had finished, the radiographer checked
all my positioning before the image was exposed.

On examination of the projections we noticed she also had an exostosis at the top of the femur, which seemed to be coming from the lesser trochanter, I found this very interesting as I had never seen this before.

I now plan to read the radiologist’s report on these’s images to see if he remarks on the exostosis.

 

 

 

 

 

 

 

 

 

 

 

This entry was posted on Wednesday, November 19th, 2008 at 3:52 pm and is filed under Reflectives. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.