Take it all off.

Problem

The posteroanterior and lateral radiographs of the chest x-ray are 2 of the most common requests in diagnostic imaging departments. It is true that imaging the chest can be relatively simple, especially on the average walk-in patient. After a while, however, the unfortunate tendency is to assume that patients know what to expect and what to do. Some patients do know the routine and can practically position themselves, but others might need a little help. In tact, many patients become anxious or nervous during exams and have trouble processing even simple instructions. Figures 1-4 demonstrate what can happen when patients do not follow changing instructions properly.

Solution

When imaging the chest, ally radiopaque artifact in the area of interest can compromise the diagnostic quality of the image. Although patients are told to undress to the waist and to remove jewelry, this information might not register with the patient who is worried about a medical condition. Some patients will interpret "clothing" as external clothing only and therefore fail to remove undershirts, vests, camisoles or bras. These can contain metallic parts such as wires or buttons, thus creating artifacts on radiographs. In addition, chains can hide under gowns. Occasionally, even a very long earring will obscure part of the lung apex. To prevent unnecessary repeats--and additional radiation dose to the patient--technologists always should double-check patients before imaging. The safest option is to confirm that the patient followed all changing instructions and that no radiopaque object remains in the area of interest.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

[FIGURE 3 OMITTED]

[FIGURE 4 OMITTED]

"Technical Query" is a troubleshooting column that covers image acquisition and processing.

Olive Pearl, MS, R.T.(R)(M), is a clinical instructor at the Stamford Hospital School of Radiography in Connecticut. Ms Pearl is the author oat Spanish for Professionals in Radiography, Appleton & Lange Mammography Review and Mammography and Breast Imaging: Just the Facts.