The projections required for this emergency patient would be as follows:
For the cervical spine a horizontal beam lateral (if this projection was unsuccessful in providing a diagnostic image then a Swimmers lateral would be used) and an AP C3-7 view (with doctors permission to pull the patients shoulders down).
For the pelvis an AP pelvis projection would be sufficient to analyse if there is any damage to the pelvis. If any abnormalities are detected, further imaging would be conducted accordingly i.e. horizontal beam lateral hip shoot through.
For the right tibia an AP tibia/fibula projection would be needed (to include both the ankle and knee joints) and a horizontal beam lateral tibia/fibula (again including both joints). An additional view would also be an AP mortise ankle as tibial fractures can occur at the malleolar and this view will demonstrates both joint spaces of the ankle.
Order projections should be performed
The projections should be performed in a logical order to complete the examination as quickly as possible and limit the movement of the patient. This order should be determined by considering the tube angles needed as well as how the patient will need to move for each projection. The examination should begin with the horizontal beam lateral cervical spine series as out of the three requests this is the most serious injury and this projection will provide the most information. If this image is not of diagnostic quality a Swimmers lateral should be performed. Considering the tube is now shooting horizontally the next projection should also be horizontal beam; working from the top of the patient to the bottom this projection will be the horizontal beam lateral right tibia/fibula. The next projection (following this pattern) will be the antero-posterior tibia/fibula view and then the antero-posterior mortise ankle view. Then an antero-posterior pelvis should be performed, followed by an AP C3-7 cervical spine view. By following this order the patient has not had to move considerably and the images have been done moving the tube as little as possible.Radiographic technique to achieve projections (including and modifications)
In a trauma situation projections may have to be modified to suit the mobility of the patient. In this instance the patient should not be moved as he has a cervical collar and a splint; therefore the views which would normally be a vertical beam lateral (C-spine lateral and Lateral tib/fib) must be performed using the tube horizontal. The cassette will also need to be supported with sponges etc. to sit perpendicular to the central ray. Another modification to be used is an aluminium filter, as shown in figure 1, for the lateral c- spine according to (Challens, A. (2010), para 1). It should be used over the upper and middle cervical vertebra; this is to even out the densities and avoid performing a swimmers lateral (Fuller, M.J. (2011), para 5). A high kVp...