1 / 31

E Scan Patient Positioning

E Scan Patient Positioning. Steven S. Eilenberg, MD Director of MRI North County Radiology. Prepare Your Patients Well. Be a Calming Influence Have Them Arrive in Sweat Suit if Possible. No Metal! If in Street Clothes, is best to get them into Cloth Gown

amy
Download Presentation

E Scan Patient Positioning

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. E Scan Patient Positioning Steven S. Eilenberg, MD Director of MRI North County Radiology

  2. Prepare Your Patients Well • Be a Calming Influence • Have Them Arrive in Sweat Suit if Possible. No Metal! • If in Street Clothes, is best to get them into Cloth Gown • No Shoes, No Bra (if under-wire) , Excess Metal Off • Comfort First! • Immobilize with Sand Bags and or Rice Bags

  3. Patient Preparation • Explain the Procedure • Tell Them that when the MR is Making Noise, it is Like a Camera with the Shutter Open. Any Movement During that Time Makes All the Images Blurry • Even Tapping the Foot will make the Whole Body Move and Make the Images Blurry

  4. Patient Preparation • Make Sure all Pressure Points are Padded • Make Sure they are Warm Enough • Make Sure there is Adequate Air Flow around Them • Claustrophobic Patients Get Warm and this Makes Things Much Worse for Them • Cough Drops if they are Coughing or Clearing Their Throat

  5. Patient Preparation • CD Music System in the Room • Encourage Patients to Bring their own Music • Consider Putting Fake Bamboo in the Room

  6. Position, Position, Position • Feel for the Bony Landmarks • Pad the Patient. Smallest Coil Possible • Scout Images, Make Sure are Dead On • If Not Reposition • Don’t be Embarrassed to Reposition 10 Times if You Need to. The Only Way to Get Good Images!!!!! • Look for Coil Drop Off • Reposition Coil if Need Be

  7. If You See Motion on the Scan… • Find Out Why Patient Moved • Cold? • Nervous? • Fidgety? • Post Nasal Drip? • Parkinsons Disease? • Precariously in the Coil? • Find a Remedy • Repeat the Scan Sequence and Check it Before You Let the Patient Leave the Scanner

  8. What Does Motion Look Like? • knee motion.jpg No Motion Tech Repeated this One Motion It is a sharper image

  9. Shoulder MRI • Comfort First! • Some External Rotation is good • On the Scout Images, Make Sure the Biciptial Groove is Pointing to the Ceiling • Don’t Simply Rely on Position of the Hand as You Can Move the Hand Independent of the Shoulder • Check the Groove on the Scout Axial. • Reposition if Necessary, Again and Again!

  10. Shoulder MRI • Try and Put the Arm Parallel to the floor. Use Pads • Immobilize the Arm/Forearm with Sandbags • Make Sure Arm is Close to the Body and in Line with the Machine • Do this by Going to the Foot of the Table and Looking Up at the Arm • Recheck the Scout Images. • Watch Those Crosshairs!!! • Spend the Time Up Front Now so You Won’t have to Repeat Scans.

  11. Shoulder MRI • Axials: Cover From Top of Acromion Through Entire Joint • Coronals: Rotate Parallel with the Blade of the Scapula • Sagittals: Rotate Perpendicular to the Coronals.

  12. Setting Up the Coronal Shoulder Sequences

  13. Setting Up the Sagittal Knee Sequences • Reference off of the Axial Images • Find Medial and Lateral on the Image • More Fat Medial • Find the “Flat Line of the Lateral Femoral Condyle” • Identify the “Anterior Corner of this Line” • Identify the “Posterior Notch, which is just Medial to this Line” (Click to See the Diagram)

  14. Setting Up the Sagittal Knee

  15. Setting Up the Coronal Knee Sequence • Parallel to the Posterior Margin of the Femoral Condyles • Set This Up Off of the Axials • This is NOT Perpendicular to the Sagittal Series • Be Precise!

  16. Anatomy of a Good Position

  17. Where is Isocenter in the Knee? • Middle of the femoral notch • Keep Leg Parallel in the MRI even if patient is angled • Center coil on center of patella • Slight bend in the knee

  18. Why is this a Good Scan? • OK, So the Anatomy is in the Center of the Magnet. That’s Good! • Now, Be Sure that the Coil is in the Center of the Magnet Too! • Center of the Coil is Brighter • Progressively Gets Darker the Farther Away You Get

  19. Why is this a Good Scan? • The Red Cross-Hairs Let You Know where the Center of the Magnet is. It is Always in the Center of the Image Square • This is Where the Best Imaging is Done • Anything Away from this Spot, Image Quality Drops

  20. Why is this a Good Scan? • I See the Distal Quadraceps Tendon • I See Below the Patellar Tendon • Coil and Patient Are well positioned • There is a Slight Bend in the Knee • No Patient Motion!

  21. Positioning the Wrist MRI • Use Scouts to be Sure Cross-Hairs are Perfectly Positioned at Base of Capitate • Immobilize • Use a Marker Where They are Most Symptomatic • Tape Marker on Gently so as NOT to Distort the Anatomy • Use Axials to Set Up your Coronals • Put the Radial and Ulnar Styloids on the Same Plane (This is Very Important!) • Sagittals Perpendicular to the Coronals

  22. Wrist MRI • Make sure arm is in straight and parallel with the MRI • You may have to angle the body to make the arm straight • Wrist should not be deviated radially or ulnarly • Find the radial and ulnar styloids and go parallel to these for the coronals • Go perpendicular to this line for the sagittals

  23. Where is Isocenter in the Wrist? • At the junction of the lunate and the capitate • This is a pretty good coronal • Carpals are Laid Out • Ulnar and Radial Styloid are in the Same Image • This Patient has a Torn Scapho-Lunate Ligament (see how wide the space is?)

  24. Positioning of the Elbow • External Rotation of the Forearm so that You Uncross the Radius and Ulna • Angle the Table and Patient so the Arm is in Line with the MR Table • Find the Distal Humerus on the Axials • Create Perfect Coronals based on the Epicondyles • Create Perfect Sagittals, Perpendicular to the Coronals • Axials Need to Go Just Distal to the Bicipital Tuberosity • Note: This is More Distal Than You Think!

  25. Coronal Elbow MRI • Should see the epicondyles on the same slice • Also note the bicipital tuberosity of the radius. • This is how low you need to go on the Axials! • It is lower than you think!

  26. Elbow MRI • Do the Axial Scouts • Find the Humeral Epicondyles • Go Parallel to these for the Coronals • Go Perpendicular to these for the Sagittals

  27. Sagittal Elbow • This is what it should look like… • By the way, this patient has a torn biceps tendon

  28. Positioning of the Ankle • Mild Plantar Flexion of the Foot • Sandbags, Immobilize, Mark Site of Maximal Tenderness or Mass • Don’t Distort the Anatomy with Marker • Tape on Lightly • Axials are Not Angled • Cover to Below Mid Foot Bony Structures • Find the Square Talar Dome on the Axial Images • Use This to Set Up Sagittals and Coronals • Skin To Skin

  29. Positioning the Ankle • Patient Supine • Mild Plantar Flexion • Immobilize • Comfort • Do Axial Scouts • Find the Talar Dome • This is a Square • Set Coronals and Sagittals off of this

  30. Ankle coverage • This is good positioning • How low to go with the axials? • Don’t Angle the Axials • Need to see heel pad on these sagittals and on the coronals

  31. Ankle MRI- The Coronals • This is what a good coronal looks like • See where the cross hairs go? In the Sinus Tarsi • Can See the Medial and Lateral Malleoli on the same image

More Related