Dalena Pham

August 7th, 2018

RADS 4114 Clinical Education I
Mrs. Sheree Phifer

Bad Film- SMV Facial:

My bad film is for a submentovertical (SMV) for facial bones. This patient is a female in
her mid 30s who came in to the emergency department. She came in to the hospital with a police
officer due to a person who abused and punched in her face, which left her face swollen and
bruised. The report on this patient was the radiologist stated there were no significant fractures.
Initially, I asked the patient for her name and birthday followed by asking if there was a chance
for pregnancy (as well as when was her last menstrual cycle). Starting the exam, I preformed the
farcical bone protocols that was for my hospital which were the PA, waters, lateral, lastly the
SMV. I always preform this last because this position is a challenging position for the patient to
hold on to compared to the others. For the facial bones, I used the 10 by 12 cassette which was
lengthwise with a SID of 40 inches on the wall Bucky. I had my patient sitting in a chair for all
the positions with a lead shield on her lap. For the SMV facial bones, I had her sit at the edge of
her sit and assisted her as she tilted her head back touching the wall Bucky. For her breathing
instructions for her was to hold her breath and do not move. I collimated to receive all four sides
of her skull. The technique I used for her was a kVp of 70, mAs of 5.77 and the exposure index
as 728. I placed the CR between the mandible angles, and 2 inches inferior of the mandibular
symphysis. In order to make this a good image, I need to make sure her IOML is perpendicular
to the CR by extending the neck. Next, the MSP is perpendicular to the middle of the grid to
show no rotation of the skull.

Good Film- SMV Facial:

The good film is also a submentovertical (SMV) for facial bones. This is a male patient
who is 21 years old who came to the emergency department. The report states this male was
assaulted with a brass knuckle and was punched on the left cheek, which left a fracture on the
left zygoma. I started this exam by asking the patient for his name and birthday, then had him to
sit on the chair facing the wall Bucky. I started his facial bone exam with the SID at 40 inches,
kVp at 85, mAs of 15, and the exposure index at 565. The cassette was set in as a 10 by 12
lengthwise on the wall Bucky with a lead shield on his lap on all of the positions. The exams I
did previous to the SMV were the PA, waters, and the lateral side of the affected side. For this
male patient, I move the chair further out with him sitting on the edge of the chair with his head
tilted back. I assisted him to make sure his IOML is parallel to the IR and perpendicular to the
CR. The MSP then was perpendicular to the midline of the grid to show no rotation. I checked to
make sure the neck was hyperextended in order to have the IOML parallel to the IR. The CR is
then placed between the mandible angles, and 2 inches inferior of the mandibular symphysis.
Collimation was to get all four sides of his skull, finally have the patient hold his breath and do
not have him move. To ensure this is a good film you can clearly see there is no rotation because
the zygomatic arches are laterally equal from each of the mandibular ramus (equal distance).
Also, the superimposition of the mandibular symphysis on the frontal bone.