obese patients
obesity has doubled over the last 15 years
- 75% of americans are obese
-18 % of children 2-19
-difficulty in obtaining and interpreting images
challenges about obesity
obese patients effect functionality of equipment
-weight limits of tables (xray/ CT)
- diagnostic image quality
- technique/ radiation dose
equipment
weight limits based on structural integrity
-exeeding limit voids warranty
-fluoroscopy towers have a max diameter
-common weight limits
R/F= 700 lbs
CT= 680 lbs
MRI= 550 lbs
transportation
requires larger wheelchairs, or larger beds
-wider doorways
-moving obese patients could harm healthcare worker.
lift equipment
-hoyer lift
-slide assisting inflatable slide sheets
-safe moving techniques for us and pt
communication
communication with patients who are obese is no different than other patients other then being mroe sensitive
imaging challenge
imperative that pt is centered to the table accurately
-hard to palpate bony landmarks
-organs and skeleton are not bigger
bony landmarks
folds of skin can make palpating very difficult
-jugular notch is important for imaging obese patients
oblique and lateral projections
turning pt on side can be very difficult- use additional personnel if needed
- xray tube limits may prohibit imaging due to thickness of the part
-tissue density may limit transmission of xray photons and = unerexposed images
what size IR should we use?
the part size does not change with obesity
-bony anataomy stays the same with obesity
-using a larger IR or increased field size to include soft tissue ^ doese of radiation
light field size
when obese pt is closer to tube and CR light field will appear small
-beam divergence
-collimate to the part size = light field never bigger than IR
-smaller field size will reduce scatter radiation
1.
technique
when taking an xray of an obese person the machine needs a stronger setting
- xrays have to go through more body tissue
why are stonger setting needed?
the more tissue the xrays pass through the harder it is to get a clear image
higher dose
exposure factors
limitation is due to inadequate penetration
- adhere to ALARA
-use highest kVp and lowest mA
-higher voltage (energy)= increase penetration of beam
-lower current ( # of photons) = decrease mA will decrease pt dose
