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StudentofRad



Joined: 13 Jun 2012
Posts: 8

PostPosted: Sun Sep 02, 2012 12:04 am    Post subject: Hips and other land marks - larger patients Reply with quote

Hi everyone. My problem has been hips on well... not so average size patients. lets face it our population is getting larger and its getting harder to locate some of our landmarks. It is harder for me as a male tech I dont want to have the reputation as the touchy feely person who cant find what he's looking for.

Some of the older techs just simiply look at a patient and can get it (experience, that will come in time )

The ASIS isnt that bad to find its always somewhat prominent, at least I think so but I digress

The real issue is the top of the crest for about...90% of the work we do. Whether it is a lumbar spine, an abdomen, KUB, TOMO, etc etc etc we need to find it.

I have heard several ways to find it and some of them I do use. What I do is basically run my hand down the ribs, i know its going to go soft for the floating 11 and 12 ribs and then the next possible thing I will find is either adipose or the crest itself

I have also heard that the belly button is the top of the crest as well, however I dont really care for that because I feel if someone's stomach hangs low enough (especially upright work) then it will throw it off

another was the joints in the thumbs as if they had their hands at their sides.

so many ways to go about it. I would like to hear some more before clinicals start back up in a couple days. Again, I just dont want to be that person who is struggling to find iliac crest when i know what it is but just cant find it under all of that.

bravo



Joined: 25 Aug 2012
Posts: 5

PostPosted: Sun Sep 02, 2012 8:58 pm    Post subject: Reply with quote

Hey there StudentofRad, I just finished the RADT program not to long ago as well. I'm not sure if this will help but it works for me so here goes. Visually i follow the femur up to the hip joint then I ask the patient to bend there knee up. Where the crease from the symphysis and the lateral edge of the hip forms and the line from the femur/center of leg meet is where I center. Even if the patient can not bend the knee, visualize the crease and center at the same point. Hope this helps.

StudentofRad



Joined: 13 Jun 2012
Posts: 8

PostPosted: Mon Sep 03, 2012 12:00 am    Post subject: Reply with quote

Hi,
Thanks for a response. maybe I should've put it in a different way. The issue is more the iliac crest and not hip. The ASIS i usually dont have a problem with and can work with that but the Pelvis work and upright abdomen and etc etc is more of the issue. The adipose just absolutely covers this area and it makes it

do you use the ribs as a point of reference and know that 11 and 12 will give you a gap and then the next thing will be the crest or run up from the ASIS and go 1 1/2 up and over

it's just frustrating, i know what the procedure needs but im looking for some more opinions on how to find the landmark in question

bravo



Joined: 25 Aug 2012
Posts: 5

PostPosted: Mon Sep 03, 2012 10:23 am    Post subject: Reply with quote

It's like you said,"you know what the procedure needs". For flat ABD I know i need to include from the symhysis up, so visually I make sure the bottom of the IR includes the symphysis. Patient is supine so I will place my hand on the prominent part of the ABD which is the 10th rib and follow that border out laterally and down to the crest, I won't press into the patients side to feel for the crest just to the point where the rib border ends. I tend to center with the crest but I also look to make sure the symphysis is included. For Upright you know you need to include the diaphragms so make sure the top of your IR includes the anatomy, I center the top of the IR about 2-3" below the corner of armpit. I know that when patient are larger it makes the collimator light look smaller, on these types of patients you have to use the crest, and usually i will follow that rib border and center at that point maybe a bit lower just to be sure. I will use that same border to center for my L Spines on large patients. I know it's difficult, I had a real hard time with ABD too. I have been working mobile X Ray and these techniques have given me good results, It's even harder when you don't have a floating table and even surface, so I recommend practicing on friends. Focus on the body types you have the most problems with.

StudentofRad



Joined: 13 Jun 2012
Posts: 8

PostPosted: Mon Sep 03, 2012 12:02 pm    Post subject: Reply with quote

yeahhh i guess that kind of helps. the problem i have are those who are just big I guess. I cant really get away from it, just trying to find different ways to find the iliac crest

bravo



Joined: 25 Aug 2012
Posts: 5

PostPosted: Mon Sep 03, 2012 12:31 pm    Post subject: Reply with quote

Try not to focus so much on the crest when it comes to larger patients. Most of the times you will have to do an upper and lower either way. Place you IR crosswise and in the lower be sure to include the symhysis and in the upper be sure to include the diaphragms. Remember to center the IR on the MS plane and make sure the bottom of the IR includes the bladder/symphysis. Good luck and try these tips out they will help.

StudentofRad



Joined: 13 Jun 2012
Posts: 8

PostPosted: Mon Sep 03, 2012 12:35 pm    Post subject: Reply with quote

This is true, I was told a good way to know when to overlap but to know the bottom can have the patient bring up their leg and where the bottom of the crease is in their hip is where the bottom of the bladder is or... have them move their leg and you can feel the greater trochanter

bravo



Joined: 25 Aug 2012
Posts: 5

PostPosted: Mon Sep 03, 2012 12:48 pm    Post subject: Reply with quote

I'm not sure if it will work for you but sometimes if the ASIS is all I can find. I will place my 1st digit or 5th, depending what hand you use, on the ASIS. What the width of my hand is with my finger open is where I will place the bottom of the IR. For example my thumb will be on the ASIS my hand will be spread open and the bottom of the IR will be aligned below my pinky.

StudentofRad



Joined: 13 Jun 2012
Posts: 8

PostPosted: Mon Sep 03, 2012 1:22 pm    Post subject: Reply with quote

ah now that sounds like a good idea to use. my whole concern was finding the iliac crest and if that cant be found use other land marks for sure. ASIS is just another one i can use as well as the xiphoid tip.

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