8th Baltic Congress of Radiology

Thoracic Radiology

oral abstract

X-ray examination with a mobile X-ray machine was already used in the last century, when there was a need to examine patients in difficult places. The development and need for mobile X-ray equipment is not losing its essence even now and is becoming more and more current. Mobile X-ray machines are currently being used to access medically heavy patients whose medical condition is not stable for the doctors to transport them to stationary X-ray equipment. The aim of the work is to find out the criteria for X-ray quality in the thoracic examination of patients after heart surgery, performing an X-ray with a mobile device. This topic is important to discuss, when working with a mobile X-ray machine and performing chest examinations in the cardiopulmonary department, each performer has its own subjective view on the choice of parameters and the performance of the projection. As the technical possibilities of mobile X-ray equipment are limited both in the choice of technical parameters and in the quality of projection performance, the image quality may differ for each performer. Quality of the image must be correct, which is more difficult to obtain when working with mobile X-ray equipment. Both the positioning distance and the technical parameters that will need to be observed for each patient individually, as well as factors that may be unpredictable by the radiologist's assistant when visiting the patient and on which the image quality of the examination is performed, must be considered.

In this study was used qualitative quantitative research method. Analysis of literature sources were used to find information about X-ray machines prating principle, about anathomy of chest and how the images should look in perfect mobile X-ray, about what are the accurate X-ray positioning criteria. There was developed tables of image quality criteria and projection criteria when performing examinations with a mobile X-ray machine in the cardiopulmonary department of patients after cardiac surgery. Projection criteria consists of seven parameters and image quality criteria consists of ten parameters. Total of 35 X-rays were taken with a mobile X-ray machine in the cardioreanimation department, in the straight/AP projection.

Criteria for the patient's position during the examination is lying down (supine). In 85% of cases, patients meet this criterion because the patient is in the back position, however, in 15% of cases the patient may be bent to one side or the other and may not be fully positioned in the back position for various reasons. The central beam must be incident perpendicular to 90° of the test site. Lung visualization- the roots of the lungs should be structured, which indicates that the ventilation of the lungs are not disturbed, the trachea and major bronchi also need to be visualized. In the examinations of the chest it is possible to see pleural cavities, in the straight projection only the anterior ones are visualized. When evaluating the results of the study in the examinations in 100% of cases this criterion was met. Ribs may overlap over important anatomical structures when preforming chest X-ray. It is seen when the bed is not positioned exactly horizontally and the head is slightly raised. When evaluating the results of the study in 100% of cases this criterion was observed and the ribs did not cover important anatomical structures. Examination with a mobile X-ray machine is much more limited because the patient can be examined in a straight projection (AP), but standard examinations such as a straight projection (PA) and a lateral projection (LL) cannot be performed. Image quality is mostly affected by the inability of the radiologist to interact with the patient, as the patient may be unconscious and unable to participate in proper projection. The technical capabilities of mobile X-ray equipment are also slightly more limited than those of stationary X-ray equipment. The distance of the focus detector of the mobile X-ray machine is 1.30m, but in order to examine the chest we need of the focus detector is 1.50m - 1.80m.

The protection of the patient, the radiologist's assistant and the surrounding patients is a key factor. The radiologist's assistant must understand and be able to explain the safety rules to others, as well as provide personal protective equipment against ionizing radiation. In hospital when preforming X-ray in departments the protection dos not preform that well. When performing a chest X-ray of patients after cardiac surgery in cardiology departments, the radiologist's assistant is often unable to meet the criterion of correct projection because the patient is connected to life-support devices that may make it difficult to access the mobile X-ray machine.

In this work were analyzed literature and sources on normal chest anatomy, physiology and radiological chest anatomy. Also analyzed literature on the criteria for precise positioning by performing an examination with a mobile X-ray machine and precise imaging criteria. Lastly in research methodology was about the course of the research, the obtained research data, literature and sources are analyzed and evaluated.

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