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首页 x线拍片图谱与条件

x线拍片图谱与条件.pdf

x线拍片图谱与条件

137*****681@sina.cn
2011-10-15 0人阅读 举报 0 0 暂无简介

简介:本文档为《x线拍片图谱与条件pdf》,可适用于自然科学领域

TheWHOmanualofdiagnosticimagingRadiographicTechniqueandProjectionsEditorsHaraldOstensenMDHolgerPetterssonMDAuthorStaffanSandstromMDIncollaborationwithKAkermanRT,TChakeraMD,PCorrMD,KEklundRT,LFrostgardRT,CFyledalKastbergRT,RGarciaMonacoMD,RGuntherMD,THolmMDVJacksonMD,MJoshiMD,PPalmerMD,MWatnickMDPublishedbytheWorldHealthOrganizationincollaborationwiththeInternationalSocietyofRadiologyWHOLibraryCataloguinginPublicationDataSandstrom,StaffanTheWHOmanualofdiagnosticimaging:radiographictechniqueandprojectionsStaffanSandstromeditorsHaraldOstensen,HolgerPettersson(WHOmanualofdiagnosticimaging)DiagnosticimagingmanualRadiographymanualIOstensen,HaraldIIPettersson,HolgerIIITitleVlSeriesISBN(NLMclassification:WN)©WorldHealthOrganizationAllrightsreservedPublicationsoftheWorldHealthOrganizationcanbeobtainedfromMarketingandDissemination,WorldHealthOrganization,AvenueAppia,Geneva,Switzerland(tel:fax:email:bookorderswhoint)RequestsforpermissiontoreproduceortranslateWHOpublicationswhetherforsaleorfornoncommercialdistributionshouldbeaddressedtoPublications,attheaboveaddress(fax:email:permissionswhoint)ThedesignationsemployedandthepresentationofthematerialinthispublicationdonotimplytheexpressionofanyopinionwhatsoeveronthepartoftheWorldHealthOrganizationconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundariesDottedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreementThementionofspecificcompaniesorofcertainmanufacturers'productsdoesnotimplythattheyareendorsedorrecommendedbytheWorldHealthOrganizationinpreferencetoothersofasimilarnaturethatarenotmentionedErrorsandomissionsexcepted,thenamesofproprietaryproductsaredistinguishedbyinitialcapitallettersTheWorldHealthOrganizationdoesnotwarrantthattheinformationcontainedinthispublicationiscompleteandcorrectandshallnotbeliableforanydamagesincurredasaresultofitsuseDesignedandtypesetinSwedenPrintedinIndiaContentsEditors,authorsandcollaboratorsiiForewordiiiPrefaceivChapterGeneralprinciplesforgoodradiographicpracticeChapterHowtousethemanualChapterChestChapterAbdomenChapterHeadChapterSpineChapterArmChapterLegChapterFilmprocessingChapterTechnicalbackgroundfortheWHISRADequipmentChapterDetailedexposuretablesListofeditors,authorandcollaboratorsEditorsHaraldOstensenMD,Coordinator,TeamforDiagnosticImagingandLaboratoryTechnology,WHO,Geneva,SwitzerlandHolgerPetterssonMD,ProfessorofRadiology,LundUniversity,Sweden,Cochairman,TheGlobalSteeringGroupforEducationandTraininginDiagnositicImaging,Director,TheWHOCollaboratingCentreforTrainingandEducationinDiagnosticImaging,Lund,SwedenAuthorStaffanSandstromMD,Consultantradiologist,HeadofthePediatricSection,DepartmentofRadiology,KingFahdNationalGuardHospital(KFNGH),Riyadh,SaudiArabia,SeniorConsultant,TheWHOCollaboratingCentreforEducationandTraininginRadiology,LundUniversityHospital,Lund,SwedenCollaboratorsKAkermanRT,HopitaldePanzi,Bukavu,DRKongoTChakeraMD,RoyalPerthHospital,AustraliaPCorrMD,UniversityofNatal,SouthAfricaKEklundRT,LundUniversityHospital,Lund,SwedenLFrostgardRT,LundUniversityHospital,Lund,SwedenCFyledalKastbergRT,LundUniversityHospital,Lund,SwedenRGarciaMonacoMD,HospitalItalianodeBuenosAires,ArgentinaRGiintherMD,TechnicalUniversityofAachen,GermanyTHolmMD,LundUniversityHospital,Lund,SwedenVJacksonMD,IndianaUniversitySchoolofMedicine,Indianapolis,IN,USAMJoshiMD,LTMGHospital,Bombay,IndiaPPalmerMD,UniversityofCalifornia,Davis,CA,USAMWatnickMD,NobleHospital,Westfield,MA,USAForewordModerndiagnosticimagingoffersavastspectrumofmodalitiesandtechniques,whichenablesustostudythefunctionandmorphologyofthehumanbodyindetailsthatapproachessciencefictionHowever,itshouldbenotedthateveninthemostadvancedImagingDepartmentintheeconomicallyprivilegedpartsoftheworld,ofallclinicallyrelevantquestionsmaybesolvedbyusingthetwomaincornerstonesofdiagnosticimaging,whichareRadiography(Xray)andUltrasonographyItshouldalsoberememberedthatthousandsofhospitalsandinstitutionsworldwidedonothavethefacilitiestoperformeventhesefundamentalimagingprocedures,forlackofequipmentandordiagnosticimagingskillsTherefore,WHOincollaborationwiththeInternationalCommissionforRadiologicEducation(ICRE)oftheInternationalSocietyofRadiology(ISR)iscreatingaseriesof"WHOManualsofDiagnosticImaging',developedundertheumbrellaoftheGlobalSteeringGroupforEducationandTraininginDiagnosticImagingAmongthemembersofthisgrouparethemajorregionalandglobalsocietiesinvolvedinDiagnosticImaging,includingtheInternationalSocietyofRadiology(ISR),theInternationalSocietyofRadiographersandRadiologicalTechnologists(ISRRT),andtheWorldFederationforUltrasoundinMedicineandBiology(WFUMB)ThefullseriesofmanualswillprimarilycovertheexaminationtechniquesandinterpretationofRadiography,inalaterstagealsoUltrasonographyThemanualsaremeantforhealthcarepersonnelwhointheirdailyworkareresponsibleforproducingandinterpretingradiographs,betheyradiologistsorothermedicalspecialists,generalpractitioners,orradiologicaltechnologistsworkinginruralareasThemanualsareauthoredbyauthoritiesinthespecificfieldsdealtwithwithineachmanual,andsupportedbyagroupofcollaboratorswhotogethercovertheexperience,knowledgeandneeds,whicharespecificfordifferentregionsoftheworldItisoursincerehopethatthemanualswillprovehelpfulinthedailyroutine,facilitatingthediagnosticworkupandhencethetreatment,tothebestbenefitforthepatientanditiswithgreatpleasureandanticipationwepresenttoyou,thereaders,thenextmanualinthisseries:"RadiographicTechniqueandProjections'Geneva,SwitzerlandandLund,Sweden,MayHaraldOstensenHolgerPetterssonIIIPrefaceThismanualonradiographictechniqueandprojections,isasuccessortotheManualofRadiographicTechniquethatwaspublishedinwithDrsTHolm,PPalmerandELehtinenasauthors,andwasmeantasamanualfortheWHOBasicRadiologicalSystemWHOBRSThepresentmanualcanbeusedwithanyequipment,butisespeciallydesignedfortheusewithXraymachinesthatcomplywiththespecificationsfortheWorldHealthOrganizationImagingSystemforRadiology,WHISRADThepositioningofthepatientisillustratedwithacomputedanimationtechnique,showingonemaleandonefemalepatientthataremeanttorepresentallethnicgroupsintheworldReasonablecassettescreenfilmcombinationsaresuggested,aswellasexposurevalues,whichhavetobeadjustedtolocalconditionsEachpagecontainsashortrecommendationofhowtohandlethepatient,anditshould,asarule,bepossibletoperformtheexaminationofthepatientonlyfollowingtheillustrationsandinstructionsontherelevantpageAnacceptable,usuallynormal,resultingXrayimageisshownFollowingtheinstructions,theresultwillbeastandardprojectionthatiseasilyrepeatedforcomparisonandeasilyunderstoodbyphysiciansandotherstrainedtointerpretradiographsTheworkwiththismanualhasbeendoneattheWHOCollaboratingCentreinLund,withtheoldBRSmanualasbase,andwithastrongsupportfromthewholeDepartmentofDiagnosticImagingattheLundUniversityHospital,aswellaswithinputfrommembersoftheISRRTandmembersoftheInternationalCommissiononRadiologicEducation(ICRE)TheimportantinputfromDrThureHolmandDrPhilipPalmershouldbenotedThedevotedandhighlyprofessionalandskillfulworkofthedepartmentphotographer,GoranEliasson,shouldbespecificallyacknowledged,andsoshouldtheworkwiththefinallayout,performedbyDrKajKnutsonLundandRiyadh,MayStaffanSandstromIVCHAPTERGENERALPRINCIPLESGeneralprinciplesforgoodradiographicpracticeEquipmentAppropriateequipment,wellmaintained,isthebasisforallgoodradiographicpracticeThepresentmanualisprimarilymeantfortheWHISRADsystem(theWorldHealthImagingSystemforRadiology),butwithappropriatemodificationstheinstructionsmaybeusedwithanytypeofadequateradiographicmachinesForadetaileddescriptionoftheWHISRADsystem,seepageMaintenanceandmanagementItismandatoryforgoodradiographicpracticethattheexaminationroomwithitsXrayequipmentandaccessories,aswellasthedarkroomandthefacilitiestoevaluateradiographsareingoodconditionForathoroughdescriptionofmanagementandmaintenance,seetheWHOManual"QualityAssuranceWorkBook",Geneva(WHODIL)PatientcareAradiographicexaminationisanintegratedpartofclinicalmanagementandcareofapatient,andthesamerulesforgoodpatientcareapplyfortheradiographicpersonnelasfortherestoftheclinicalteamAlwaysgiveeachpatientsafriendlygreeting,treatthemwithcareandrespecttheirindividualityObservethemedicalclinicalinstructions(concerningthepatient'smobility,possiblemedication,etc),givenbythereferringdoctorAlwaysmakesurethatthefilmsaremarkedwithcorrectnameofthepatient,dateandnameofthehospitalAndalwaysremember:aprofessional,wellperformedexaminationisgoodpatientcareRadiationprotectionXraysarepotentiallyharmful,andshouldbeusedwithcareCareforthepersonnelandpersonsaccompanyingthepatient:•standbehindthecontrolpanelwhentheXrayexposureismade•makesurethatleadapronsarewornifthepatientneedstobeheld•ifpossible,donotallowanyoneelseintheXrayroomIfotherpersonsmustbepresent,keepthembehindthecontrolpanelwhentheexposureismade•whensupplied,alwayswearyourfilmbadgeHaveitcheckedregularlyCareforthepatient:Theradiationriskforthepatientsbeingxrayedisverylowbecausetheyareexposedtoxraysinfrequently,andbecauseonlyasmallpartofthebodyisexposedforeachpatientTherefore,wheneverthereisaclinicalreasonforXrayexaminationsuchanexaminationisjustifiedandshouldbeperformedHowever,alwaystrytogetallthedetailsrightthefirsttime,sothatthereisnoneedforasecondexposureTheguidingruleforradiographicexaminationsmustbetheALARAprinciple:RadiationdosestoeverybodyinorinthevicinityofanactiveXrayroomshallbeAsLowAsReasonablyAchievable(ALARA)takingintoaccounteconomicandsocialfactorsThatrulewillbekeptifyoufollowwhatissaidaboveinthegeneralprinciples,andifyoufollowtheinstructionsforexaminationsgiveninthismanualAndalwaysremember:XRAYSMAYCAUSEHARMEVENIFYOUDONOTSEEORFEELTHEM!THEWHOMANUALOFDIAGNOSTICIMAGING•RADIOGRAPHICTECHNIQUEANDPROJECTIONSThispageintentionallyleftblankCHAPTERINSTRUCTIONSHowtousethemanualTheinstructionsinthepresentmanualaremeanttobeselfexplanatoryEachpagedisplaysoneexaminationReadthroughthetext,lookattheimages,andfollowtheinstructionsgiven,stepbystepTechniques:BASICorADDITIONALAllBASICviewsmustbetakenwheneveranexaminationisorderedADDITIONALviewsaretakenonlywhen:(a)theconditionofthepatientdoesnotpermitabasicviewor(b)thediagnosticinformationprovidedbythebasicviewisinsufficientPositionofthepatientERECTSUPINEPRONEDECUBITUSOBLIQUELATERALstandingorsittingup,lyingontheback,lyingonthestomach,lyingontheside,turnedalittle,usuallyatagivenangle,standingorsittingorlyingwithonesideclosetothecassetteorcassetteholderXraybeamdirection:APorPAAP=AnteroPosterior(fronttoback)andPA=PosteriorAnterior(backtofront)indicatesthedirectionoftheXraybeamthroughthepatientontothecassetteInstructionsoneachpageThepositionoftheXrayequipmentThecassettesizeandnominalspeedofthescreenfilmcombination(seebelow)*WhenappropriatetouseRightorLeftmarkerRecommendationtocollimate(theXrayfield)Exposurefactors(seebelow)**ThepositionofthepatientAnexampleofresultingradiograph*FilmspeedandcassettesThespeedofthescreenfilmcombinationshouldbewrittenonthecassettesInthe"blue"system(calciumtungstateandrapidyttriumtantalatescreens)thenominalspeedisequaltotheactualspeedatanykVvalueInthemanual,theusedspeedsofthescreenfilmcombinationsareandforthe"blue"systemInthe"green"system(gadoliniumoxysulfide)theactualspeedvarieswiththekVvalue,lowspeedatlowkVvalues,nominalspeedatkVandalittlehigherspeedathigherkVvaluesInthemanual,theusedspeedsofthescreenfilmcombinationsare,,andforthe"green"systemActualspeedisshownfordifferentkVvaluesasnominalspeedactualspeed,forexampleandInafewcasesaloosegridisrecommended,butagridcassetteispreferable**ExposurefactorsThepresentedexposurevaluesarebasedonastandardWHISRADinstallation,withafocusfilmdistance(FFD)ofcm,afixedPbAlgrid(witharatioof:andlinescmfocusedatcm)builtintothecassetteholderWhereshown,thecassetteisplacedoutsidethecassetteholder,adjacenttothebodypartexaminedTheexposurefactorsarebasedona"referenceman"withaheightofcm(feet)andaweightofkg(Ibs)Notethattheexposurefactorsalsoaredependentonthebrandofscreens,brandoffilms,andthefilmprocessingThevalueshavetobelocallyadjustedExposurefactorsforchildrenareverydifficulttogive,dependingonthedifferentshapeofchildrenwiththesameweightorageApproximatevaluesaregivenbuthavetobeindividuallyadjustedThekVvaluewilldeterminethecontrastintheimageThemAsvaluewilldeterminetheimageblackeningFordetailedexposuretables,seechapterTHEWHOMANUALOFDIAGNOSTICIMAGING•RADIOGRAPHICTECHNIQUEANDPROJECTIONSThispageintentionallyleftblankCHAPTERSCHESTChestLUNGSANDHEARTPatientsabletostandChestPA,pageChestlateral,pagePatientsunabletostandbutabletositChestAP,pageSChestlateral,pagePatientslyingdown,unabletostandorsitChestAP,pageOtheradditionalviewsChestapical(lordotic)AP,pageChestlateraldecubitusAPorPA,pageRIBSAChestPA,oraChestAP,oraChestAP,asdescribedabovemustalwaysbetakenfirstPatientsabletoeitherstandorsitRibsobliqueAP,pageTwoviewstobetakenPatientslyingdown,unabletostandorsitRibsobliqueAP,pageINFANTSWEIGHINGUPTOkgLUNGSANDHEARTChestAPerect,pageChestAPsupine,pageTHEWHOMANUALOFDIAGNOSTICIMAGING•RADIOGRAPHICTECHNIQUEANDPROJECTIONSCHESTCHESTPAStandingerectBASICCassettespeedCassettewithscreenfilmcombination,nominalspeedinthecassetteholderCassettesizexcm(xinches)xcm(xinches)xcm(xinches)forachildUseaRightorLeftmarkerExposurevaluesAdultChildkVmAsaveragemAsrangeBringinthepatient,decidethecassetteformatandputthecassetteinthecassetteholderCollimatetothatformatPositionthepatient,makesurethepatient'sshouldersarewellpressedforwardCollimatefurther,ifpossibleTellthepatienttotakeadeepbreathandholdthebreathinExposeTellthepatienttobreathenormallyForINFANTSweighinglessthanandSMALLCHILDRENkg,seeCHESTorCHESTCommentsThetopofthelungsmustbevisibleTheexposureshallbemadeatfullinspiration:ribshallbevisibleposteriorlyabovethediaphragmandribanteriorlyMakesurethatthelowerpartsofthediaphragmisvisibleonbothsides,includingbothcostophrenicanglesThelungstructureandthespinemustbediscernible(seen)behindtheheartTHEWHOMANUALOFDIAGNOSTICIMAGING•RADIOGRAPHICTECHNIQUEANDPROJECTIONSCHESTCHESTLATERALStandingerectleft(orright)BASICCassettespeedCassettewithscreenfilmcombination,nominalspeedinthecassetteholderCassettesizexcm(xinches)xcm(xinches)xcm(xinches)forachildExposurevaluesAdultChildkVmAsaveragemAsrangeBringinthepatient,decidethecassetteformatandputthecassetteinthecassetteholderCollimatetothatformatPositionthepatient,(normallyleftlateralasshown)Thepatientshouldbeuprightorleaningslightlyforwards,notbackwardsUsethecassetteholderarmforsupportCollimatefurther,ifpossibleTellthepatienttotakeadeepbreathandholdthebreathinExposeTellthepatienttobreathenormallyCommentsThetopofthelungsmustbevisibleStraightlateralviewofthesternumMakesurethatthelowerpartsofthediaphragmisvisibleTHEWHOMANUALOFDIAGNOSTICIMAGING•RADIOGRAPHICTECHNIQUEANDPROJECTIONSCHESTCHESTAPSittingerectonastoolortrolleyonlyusedwhenthepatientisunabletostandCassettespeedCassettewithscreenfilmcombination,nominalspeedinthecassetteholderCassettesizexcm(xinches)xcm(xinches)xcm(xinches)forachildUseaRightorLeftmarkerExposurevaluesAdultChildkVmAsaveragemAsrangeBringinthepatient,decidethecassetteformatandputthecassetteinthecassetteholderCollimatetothatformatPositionthepatient,makesurethepatientissittingerect!Collimatefurther,ifpossibleTellthepatienttotakeadeepbreathandholdthebreathinExposeTellthepatienttobreathenormallyForINFANTSweighinglessthanandSMALLCHILDRENkg,seeCHESTorCHESTCommentsThetopofthelungsmustbevisibleTheexposureshallbemadeatfullinspirationMakesurethatthelowerpartsofthediaphragmisvisibleonbothsides,includingbothcostophrenicanglesThelungstructureandthespinemustbediscernible(seen)behindtheheartTHEWHOMANUALOFDIAGNOSTICIMAGING•RADIOGRAPHICTECHNIQUEANDPROJECTIONSCHESTCHESTLATERALSittingerectleft(orright)onastoolortrolleyonlyusedwhenthepatientisunabletostandCassettespeedCassettewithscreenfilmcombination,nominalspeedinthecassetteholderCassettesizexcm(xinches)xcm(xinches)xcm(xinches)forachildExposurevaluesAdultChildkVmAsaveragemAsrangeBringinthepatient,decidethecassetteformatandputthecassettein

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x线拍片图谱与条件

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