i

Title Page

PROBLEMS ENCOUNTERD IN THE POSITIONING OF

DIFFERENT BODY TYPES AS EXPERIENCED BY SELECTED
RADIOLOGIC TECHNOLOGY INTERNS OF CALAYAN
EDUCATIONAL FOUNDATION INC. IN LUCENA CITY

An Undergraduate Thesis Presented to

The Faculty of the College of Radiologic Technology of the
Calayan Educational Foundation Inc., Lucena City

In Partial Fulfillment
of the Requirements for the Degree
Bachelor of Science in Radiologic Technology

By:

Kin Aron A. Rocafor

March 2013
 ii

Approval Sheet

The thesis attached here to entitled PROBLEMS IN THE

POSITIONING OF DIFFERENT BODY TYPES AS EXPERIENCED
BY SELECTED RADIOLOGIC TECHNOLOGY INTERNS OF
CALAYAN EDUCATIONAL FOUNDATION INC. IN LUCENA
CITY prepared by KIN ARON A. ROCAFOR is hereby submitted for
review and examination in a public lecture on March 13, 2013 at 2:30 P.M
at the MLQ Hall.

Dr. JaimeM. Buzar

Reseacher Professor

Approved by the Oral Examination Panel during the public lecture

on March 13, 2013 at 2:30 P.M at the MLQ Hall with rating of

Dr. Jaime M. Buzar Dr. Maria Susan Teresita S. Calayan

Member Member

Dr. Manuel P. delos Santos

Chairman

Accepted in partial fulfillment of the requirements for the degree of

Radiologic Technology.

Dr. Manuel P. delos Santos

Dean, College of Radiologic Technology
 iii

Dedication

To ELEANOR…

who never fails to

be the researcher’s inspiration

in everything that he does

…everything that he is

KAAR
 iv

Acknowledgement

The researcher would like to extend his profound gratitude to all the

people who have become his fountain of strength during the time that she was

making this research.

Dr. Jaime M. Buzar, his adviser, for his technical support and guidance in

checking the manuscript. His comments and constructive criticism challenged the

researcher to fulfill this study;

Dr. Manuel P. Delos Santos, for his deep concern for undergraduate

students’ progress in research activities;

Librarians for lending references needed to complete this work;

To Mrs. Eleanor Rocafor, his mother for her prayers, financial support,

inspiration and encouragement;

Katherine Pabelonia, his loving sister, who lighted his path during the

darkest hours of his research;

To his friends, Rey, Ederlyn, Duday, Geng, Eyrah, Jed, and Aljoy who gave

their warmest smiles during his most discouraging moments;

To Sir P, who provided assistance in the statistical analysis of the data

gathered by the researcher;

To his friends at Aurora, Quezon, for their warm friendship, a source of

the researcher’s happiness;

And of course, to the Almighty Father, for all the things that he has…

KAAR
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Table of Contents

Title Page ....................................................................................................... i

Approval Sheet..............................................................................................ii
Dedication ....................................................................................................iii
Acknowledgement ....................................................................................... iv
Table of Contents .......................................................................................... v
Abstract .......................................................................................................vii

CHAPTER I .................................................................................................. 1
Introduction ................................................................................................... 1
Background of the Study ........................................................................... 1
Statement of the Problem .......................................................................... 5
Conceptual Framework ............................................................................. 6
Schematic Flow of the Conceptual Framework .................................... 7
Theoretical Framework ............................................................................. 7
Definition of Terms ................................................................................. 11
Significance of the study ......................................................................... 12
Scope and Delimitation ........................................................................... 13
CHAPTER II ............................................................................................... 14
Review of Related Literature and Studies .................................................. 14
Related Literature .................................................................................... 14
Foreign Literature ................................................................................ 14
Local Literature ................................................................................... 29
Related Studies ........................................................................................ 32
CHAPTER III ............................................................................................. 33
Research Methodology ............................................................................... 33
Research Design ...................................................................................... 33
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Locale of Study ....................................................................................... 33

Research Sample ..................................................................................... 34
a. Respondents ................................................................................. 34
b. Sampling Procedure ..................................................................... 34
Research Instrument ................................................................................ 34
Data Gathering and Statistical Treatment ............................................... 35
CHAPTER IV ............................................................................................. 37
Presentation, Analysis and Interpretation of Data ...................................... 37
Part I. Demography of the Respondents ................................................. 37
Part II. Difficulties Encountered by Radiologic Technology Interns...... 38
Part III. Techniques to Reduce Difficulties ............................................. 42
Part IV. Positioning Techniques to Achieve Clear Images ..................... 43
CHAPTER V .............................................................................................. 45
SUMMARY OF FINDINGS, CONCLUSIONS AND
RECOMMENDATIONS ............................................................................ 45
Summary of Findings .............................................................................. 47
Conclusion............................................................................................... 49
Recommendations ................................................................................... 51
Bibliography ............................................................................................... 54
A. Letter to Respondents ......................................................................... 55
B. Questionnaire ...................................................................................... 56
Curriculum Vitae ........................................................................................ 61
 vii

Abstract

Title : PROBLEMS ENCOUNTERED IN THE

POSITIONING OF DIFFERENT BODY
TYPES AS EXPERIENCED BY
SELECTED RADIOLOGIC
TECHNOLOGY INTERNS OF
CALAYAN EDUCATIONAL
FOUNDATION INC. IN LUCENA CITY

Researcher : KIN ARON A. ROCAFOR

Name and Address

of the Institution : CALAYAN EDUCATIONAL
FOUNDATION, INC. Maharlika Highway,
Red-V Lucena City

Adviser : DR. JAIME M. BUZAR

Year Written : 2012-2013

Body habitus, or simply habitus, is a medical term for “physique” or

“body type.” A wide range of factors can determine body type, and medical

professionals often make a note of a patient's habitus on his or her chart as

part of a general reference to provide information about the patient's

history. It is vitally important that the patient be positioned properly so that

the best possible image can be viewed by the physician to properly

diagnose problems. Getting an image that will work the first time is also

important in order to minimize radiation exposure to their patients

 viii

This study sought to determine the problems in the positioning of

different body types as experienced by selected radiologic technology

interns of Calayan Educational Foundation Inc. in Lucena City.

Particularly, it aims to determine the following: the demographic profile of

the respondents in terms of age, gender, and duration of residency; the

difficulties encountered by radiologic technology interns in handling

patients with different body habitus such as sthenic, hypersthenic,

hyposthenic, and asthenic; the techniques applied to reduce the difficulties

in positioning patients with different body habitus; and positioning

techniques applied to achieve clear images from patients of different body

habitus.

Widening and enriching the knowledge of radiologic technologists in

Lucena City could also be a benefit. Current practices of said radiologic

technologists may be updated with the turnout of the results of this study.

From the projected results of this study, the institution will not just prove

the authenticity of the concepts taught in the Radiologic Department but

also allow the students to grasp the importance of body mechanics in

patient transfer during and after the radiologic procedure, thus produce

productive and practically fit radiologists and radiologic technologists in

the future. Widening and enriching the knowledge of radiologic

technologists in Lucena City could also be a benefit. Current practices of

said radiologic technologists may be updated with the turnout of the results
 ix

of this study. Results gained from this study may be of use as bases for

future studies concerning other factors to be considered in taking chest

radiographs from patients of different body types. Also, students of the

department could be acquainted with how they will be able to apply their

theoretical background in practically during clinical duties in the hospitals

and health center they will affiliate in.

 1

CHAPTER I

Introduction

Background of the Study

Body habitus, or simply habitus, is a medical term for “physique” or

“body type.” A wide range of factors can determine body type, and medical

professionals often make a note of a patient's habitus on his or her chart as

part of a general reference to provide information about the patient's

history. Some studies also suggest that certain extremes in physique can be

indicators of disease or may lead to certain illnesses.

Body positions in x-ray exams are based on body part, suspected

defect or disease, and condition of the patient. The radiographer, also

known as the x-ray tech or more formally as the radiologic technologist,

uses standardized body positions in performing an x-ray exam. Positions

are learned by the radiographer according to body part in relation to body

habitus, anatomical position and bisecting planes, and relationship of the

body to the x-ray equipment.

Four terms are generally used to designate the four major types of

body habitus. Since the position of certain organs can vary as much as 6 to

8 inches between body types, it is essential that the X-ray specialist be

 2

familiar with these major body types: hypersthenic, sthenic, hyposthenic

and asthenic.

The hypersthenic body is of massive build with a broad and deep

thorax. The diaphragm is high and the stomach and gallbladder also occupy

high positions. An extreme body type, the hypersthenic classification

accounts for only about five percent of all people. Sthenic means active or

strong. The sthenic body is the one we usually associate with the athletic

type. The body is rather heavy with large bones. The sthenic body type is

the predominant type, with about half of all people falling into this

classification. Hyposthenic refers to habitus which are slender and light in

weight with the stomach and gallbladder situated high in the abdomen.

About 35 percent of all people fall into this classification. Asthenic is

characterized by being extremely slender, light build, with a narrow,

shallow thorax, and the gallbladder and stomach situated low in the

abdomen. An extreme type, the asthenic classification accounts for only

about ten percent of all people.

Since many body parts overlay other internal structures, the

radiographer uses positioning of the body part as well as specific positions

of the x-ray equipment to obtain clearer views of the overlapping

structures. X-ray exams usually consist of two or more radiographs, taken

in orthogonal planes or variations to the relationship of body part and x-ray

 3

equipment. Exams require radiographs to be taken at 90 degrees to each

other where anatomy is superimposed over important structures, where

alignment of fracture ends is questioned, or for localization of foreign

bodies. Exams require a minimum of three radiographs when joints or

articulations are in the area of interest, although some referring physicians

may ask for only two. This allows for evaluation of the bones and well as

the joints.

The use of body positioning requires an understanding of

terminology that refers to the relationship of the body to the x-ray

equipment and to anatomical references. All body positions and exam

requirements are expressed in terms of projection, position, and view. A

projection refers to the path the x-rays take through the body, from entrance

to exit. Position describes the body and its relationship to the x-ray film

device. View is not a positioning term but instead is used in discussing the

radiograph.
Sonography is limited in two ways. First, the increased thickness of

body parts in obese patients results in poor penetration of the ultrasound

beam beyond the focal depth. Second, the increased attenuation of the

ultrasound beam as it passes through subcutaneous and intraperitoneal fat

even further compounds the issue of beam penetration. Sonography is

attenuated by fat at a rate of 0.63 dB/cm.

 4

Although fat appears to be helpful in mammography, with the

improved visibility of lesion relative to the surrounding fat, studies have

shown that increased BMI is associated with decreased geometric

sharpness, decreased image contrast, and higher potential for loss of

sharpness because of motion.

Obese patients can present scheduling, positioning, and technical

challenges to the interventional radiologist. Obese patients may also require

high doses of weight-based sedative medications, which may put them at

risk for respiratory depression. (Destounis et al., 2011)

Individuals responsible for scheduling interventional procedures

should routinely ask for the patient's weight. From past experiences, all

patients greater than 250 pounds (159 kilograms) should be flagged. In this

group of patients, consultation with the referring clinical service and review

of prior images by the interventional radiologist before scheduling the

procedure can ensure the use of the most appropriate imaging technique

and availability of equipment appropriate for the procedure.

Proper patient positioning can also be a problem in obese patients.

Several ancillary staff members need to always be available to help move

the patient from the stretcher to the procedure table and to help position the

patient if necessary. The use of pillows and sandbags is important to secure

the patient position before the start of the procedure. (Foster et al., 2003)
 5

Meticulous planning is important before starting the procedure.

Prior imaging can help determine the depth of fat tissue and the most direct

approach to the organ of interest.

There are four major body planes that the radiographer regularly

uses while performing most radiologic examinations. Positioning

descriptions and methodology always employ these terms. It is essential

that the student radiographer knows and understands these body planes and

their relationship to each other. The midsagittal or median sagittal plane

(MSP) divides the body into left and right halves; the sagittal plane refers

to any plane parallel to the MSP; the midcoronal plane (MCP) divides the

body into anterior and posterior halves; the coronal plane refers to any

plane parallel to the MCP; and the transverse/horizontal plane which refers

to planes perpendicular to the MSP and MCP, and divides the body axially

into superior and inferior portions.

It is vitally important that the patient be positioned properly so that

the best possible image can be viewed by the physician to properly

diagnose problems. Getting an image that will work the first time is also

important in order to minimize radiation exposure to their patients.

Statement of the Problem

This study seeks to determine the problems in the positioning of

different body types as experienced by selected radiologic technology

 6

interns of Calayan Educational Foundation Inc. in Lucena City.

Particularly, it aims to answer the following questions:

1. What is the demographic profile of the respondents in terms of:

1.1. age,

1.2. gender,

1.3. duration of residency?

2. What difficulties are encountered by radiologic technologists in

handling patients with different body habitus such as:

2.1. Sthenic ,

2.2. Hypersthenic,

2.3. Hyposthenic,

2.4. Asthenic

3. What techniques are applied to reduce the difficulties in positioning

patients with different body habitus?

4. What positioning techniques are applied to achieve clear images from

patients of different body habitus?

Conceptual Framework

The conceptual framework reflects the areas of concern as this

study attempts to determine the problems in the positioning of different

body types as experienced by selected radiologic technology interns of

Calayan Educational Foundation Inc. in Lucena City.

 7

It serves as the steering wheel for the researcher‟s realization of the

objectives of the study. The paradigm of the components of the conceptual

framework is shown in figure 1 below.

Schematic Flow of the Conceptual Framework

Figure 1. Paradigm of the Conceptual Framework of the Study

Figure 1 is an input-process-output model of the study. The first

portion is the general term, „radiographic positioning‟. The circle represents

the uncertainty most interns might encounter on determining the

appropriate positioning techniques to use with patients with different body

habitus indicated in the second shape. Considering the experiences of the

intern-respondents in this study, difficulties are then identified. This

process includes the data collection which would be administered through

questionnaires and surveys. Finally, the last part illustrates more circles of

various sizes. This reveals that the researcher is intent on identifying

working and more effective positioning techniques which would suit varied

patients.

Theoretical Framework
 8

The following theories guide the researcher in developing his study.

They are theories which will more or less enable him to deduce possible

outcomes and inspect the validity of the results gathered in the later stages

of developing this study.

In the past, radiologic technicians have noted several disadvantages

and difficulties in acquiring clear images from patients of different habitus.

Problems arise mostly with the positioning of patients and are attributed to

the latter‟s built and physical condition. Studies concerning mammograms

(Destounis, 2011), sonograms, magnetic resonance imaging and computed

tomography (Uppot et. al., 2007) have pointed at the same.

In imaging obese patients, several technical limitations need to be

accounted for in MR scanning, including radiofrequency penetration and

gradient strengths, limited field of view, scanning time, and radiofrequency

energy deposition of the skin. (Uppot et. al., 2007)

Other techniques that can aid in improving image quality include

using a body coil rather than a phased-array multicoil and using saturation

bands to decrease noise from subcutaneous fat. Another factor to consider

in MRI of obese patients is the deposition of radiofrequency energy on the

skin where it abuts the gantry. (Uppot et. al., 2007)

Instruments of appropriate length must be chosen before starting the

procedure. Technically, obese patients are more challenging. The accuracy

 9

in targeting lesions decreases the deeper the lesion that is to be biopsied or

drained.

Sedation of the obese patient can also present challenges. If patients

do not tolerate the administered doses of sedatives, the use of a mix of

different active sedatives or the assistance of an anesthesiologist may be

necessary. Also, if a patient's airway has the potential to be compromised

or difficult to access because of body habitus, the patient may not be a

candidate for conscious sedation, making general anesthesia mandatory. A

few obese patients may require a surgical approach for diagnosis or

treatment if suitable imaging guidance cannot be provided. (Foster et al.,

2003)

In addition, Davis Lab and Diagnostic Tests (2011) revealed a list

of factors that may impair clear imaging which includes: (1) retained

barium from a previous radiological procedure; (2) metallic objects within

the examination field, which may inhibit organ visualization and cause

unclear images; (3) inability of the patient to cooperate or remain still

during the procedure because of age, significant pain, or mental status; (4)

incorrect positioning of the patient which may produce poor visualization

of the area to be examined, for images done by portable equipment and

finally, improper adjustment of the radiographic equipment to

accommodate obese or thin patients, which can cause overexposure or

underexposure and a poor quality study.

 10

Several factors affect the quality of images obtained in radiographic

procedures, and it is no surprise that the built or habitus of a patient

primarily becomes a problem especially in cases wherein said patients are

larger.
 11

Definition of Terms

Anatomical position refers to a standard position of the body: standing

erect, facing directly forward, feet pointed forward and slightly apart, and

arms hanging down at the sides with palms facing forward. This position is

used as a reference to describe sites or motions of various parts of the body.

Chest Radiography or more commonly known as chest x-ray is the

process of obtaining images of the chest using radiation other than visible

light, usually X rays or gamma rays.

Habitus is the physical and constitutional characteristics of an individual,

especially as related to the tendency to develop a certain disease.

Projection is the orientation of a radiographic machine in relation to the

body or a body part.

Radiographer defines a radiologic technologist whose work is the making

of diagnostic radiographs. Duties include positioning patients for radiologic

examinations; determining the proper voltage, current, and exposure time

for each radiograph and adjusting the x-ray equipment; the production of

radiographs as requested; developing the x-ray film; and assisting the

radiologist in special procedures and in preparation of radiopaque contrast

media.

Radiograph is an image produced on a radiosensitive surface, such as a

photographic film, by radiation other than visible light, as by x-rays passed

through an object.
 12

View is the direction from which a radiologic image is obtained

Significance of the study

This study will determine problems in the positioning of different

body types as experienced by selected radiologic technology interns of

Calayan Educational Foundation Inc. in Lucena City. Also, it may identify

other contributing factors to difficulties encountered by these interns in

obtaining clear and quality images from patients of varying habitus.

To the radiologic technologist

Widening and enriching the knowledge of radiologic technologists

in Lucena City could also be a benefit. Current practices of said radiologic

technologists may be updated with the turnout of the results of this study.

To the faculty and radiologic technology students

From the projected results of this study, the institution will not just

prove the authenticity of the concepts taught in the Radiologic Department

but also allow the students to grasp the importance of body mechanics in

patient transfer during and after the radiologic procedure, thus produce

productive and practically fit radiologists and radiologic technologists in

the future.

To future researchers
 13

Results gained from this study may be of use as bases for future

studies concerning other factors to be considered in taking chest

radiographs from patients of different body types. Also, students of the

department could be acquainted with how they will be able to apply their

theoretical background in practically during clinical duties in the hospitals

and health center they will affiliate in.

Scope and Delimitation

This study covers the Radiologic Technology Interns of Calayan

Educational Foundation Inc. It intends to determine the problems in the

positioning of different body types as experienced by said interns in Lucena

City. This will be conducted during the academic year 2013-2014.

 14

CHAPTER II

Review of Related Literature and Studies

This chapter contains literature, studies and researches, published or

otherwise, which had been relevant to answering the problems focused on

in this study.

Related Literature

Foreign Literature

A chest X-ray is a type of diagnostic radiology procedure used to

examine the chest and the organs and structures located in the chest. Chest

X-rays may be used to assess the lungs, as well as the heart (either directly

or indirectly) by looking at the heart itself. Certain conditions of the heart

may cause changes in the lungs and/or the vessels of the lungs. Changes in

the normal structure of the heart, lungs, and/or lung vessels may indicate

disease or other conditions. (NDT, 2001)

Chest X-rays may provide important information regarding the size,

shape, contour, and anatomic location of the heart, lungs, bronchi, great

vessels (aorta, aortic arch, pulmonary arteries), mediastinum (an area in the

middle of the chest separating the lungs), and the bones (cervical and

thoracic spine, clavicles, shoulder girdle, and ribs).

 15

The usual objective in radiography is to produce an image showing

the highest amount of detail possible. This requires careful control of a

number of different variables that can affect image quality. Radiographic

sensitivity is a measure of the quality of an image in terms of the smallest

detail or discontinuity that may be detected. Radiographic sensitivity is

dependent on the combined effects of two independent sets of variables.

One set of variables affects the contrast and the other set of variables

affects the definition of the image. (NDT, 2001)

Radiographic contrast is the degree of density difference between

two areas on a radiograph. Contrast makes it easier to distinguish features

of interest, such as defects, from the surrounding area. The image to the

right shows two radiographs of the same step wedge. The upper radiograph

has a high level of contrast and the lower radiograph has a lower level of

contrast. While they are both imaging the same change in thickness, the

high contrast image uses a larger change in radiographic density to show

this change. In each of the two radiographs, there is a small circle, which is

of equal density in both radiographs. It is much easier to see in the high

contrast radiograph. The factors affecting contrast will be discussed in

more detail on the following page. (NDT, 2001)

Radiographic definition is the abruptness of change in going from

one area of a given radiographic density to another. Like contrast,

 16

definition also makes it easier to see features of interest, such as defects,

but in a totally different way. In the image to the right, the upper

radiograph has a high level of definition and the lower radiograph has a

lower level of definition. In the high definition radiograph it can be seen

that a change in the thickness of the step wedge translates to an abrupt

change in radiographic density. It can be seen that the details, particularly

the small circle, are much easier to see in the high definition radiograph. It

can be said that the detail portrayed in the radiograph is equivalent to the

physical change present in the step wedge. In other words, a faithful visual

reproduction of the step wedge was produced. In the lower image, the

radiographic setup did not produce a faithful visual reproduction. The edge

line between the steps is blurred. This is evidenced by the gradual transition

between the high and low density areas on the radiograph. (NDT, 2001)

Subject contrast is the ratio of radiation intensities transmitted

through different areas of the component being evaluated. It is dependent

on the absorption differences in the component, the wavelength of the

primary radiation, and intensity and distribution of secondary radiation due

to scattering. (NDT, 2001)

It should be no surprise that absorption differences within the

subject will affect the level of contrast in a radiograph. The larger the

difference in thickness or density between two areas of the subject, the

 17

larger the difference in radiographic density or contrast. However, it is also

possible to radiograph a particular subject and produce two radiographs

having entirely different contrast levels. Generating x-rays using a low

kilovoltage will generally result in a radiograph with high contrast. This

occurs because low energy radiation is more easily attenuated. Therefore,

the ratio of photons that are transmitted through a thick and thin area will

be greater with low energy radiation. This in turn will result in the film

being exposed to a greater and lesser degree in the two areas. (NDT, 2001)

There is a tradeoff, however. Generally, as contrast sensitivity

increases, the latitude of the radiograph decreases. Radiographic latitude

refers to the range of material thickness that can be imaged This means that

more areas of different thicknesses will be visible in the image. Therefore,

the goal is to balance radiographic contrast and latitude so that there is

enough contrast to identify the features of interest but also to make sure the

latitude is great enough so that all areas of interest can be inspected with

one radiograph. In thick parts with a large range of thicknesses, multiple

radiographs will likely be necessary to get the necessary density levels in

all areas. (NDT, 2001)

Film contrast refers to density differences that result due to the type

of film used, how it was exposed, and how it was processed. Since there are

other detectors besides film, this could be called detector contrast, but the
 18

focus here will be on film. Exposing a film to produce higher film densities

will generally increase the contrast in the radiograph. (NDT, 2001)

Lead screens in the thickness range of 0.004 to 0.015 inch typically

reduce scatter radiation at energy levels below 150,000 volts. Above this

point they will emit electrons to provide more exposure of the film to

ionizing radiation, thus increasing the density and contrast of the

radiograph. Fluorescent screens produce visible light when exposed to

radiation and this light further exposes the film and increases contrast.

(NDT, 2001)

Geometric factors of the equipment and the radiographic setup, and

film and screen factors both have an effect on definition. Geometric factors

include the size of the area of origin of the radiation, the source-to-detector

(film) distance, the specimen-to-detector (film) distance, movement of the

source, specimen or detector during exposure, the angle between the source

and some feature and the abruptness of change in specimen thickness or

density. (NDT, 2001)

The effect of source size, source-to-film distance and the specimen-

to-detector distance were covered in detail on the geometric unsharpness

page. But briefly, to produce the highest level of definition, the focal-spot

or source size should be as close to a point source as possible, the source-

 19

to-detector distance should be a great as practical, and the specimen-to-

detector distance should be a small as practical. (NDT, 2001)

The last set of factors concern the film and the use of fluorescent

screens. A fine grain film is capable of producing an image with a higher

level of definition than is a coarse grain film. Wavelength of the radiation

will influence apparent graininess. As the wavelength shortens and

penetration increases, the apparent graininess of the film will increase.

Also, increased development of the film will increase the apparent

graininess of the radiograph. (NDT, 2001)

The use of fluorescent screens also results in lower definition. This

occurs for a couple of different reasons. The reason that fluorescent screens

are sometimes used is because incident radiation causes them to give off

light that helps to expose the film. However, the light they produce spreads

in all directions, exposing the film in adjacent areas, as well as in the areas

which are in direct contact with the incident radiation. Fluorescent screens

also produce screen mottle on radiographs. Screen mottle is associated with

the statistical variation in the numbers of photons that interact with the

screen from one area to the next. (NDT, 2001)

Centralizing on chest radiography and technique factors, the

Commission of the European Communities (CEC) research project

„„Predictivity and optimization in medical radiation protection‟‟ by

 20

Lanhede et al, (2002) addressed fundamental operational limitations in

existing radiation protection mechanisms. The first part of the project

aimed at investigating (1) whether the CEC image quality criteria could be

used for optimization of a radiographic process and (2) whether significant

differences in image quality based on these criteria could be detected in a

controlled project with well-known physical and technical parameters. In

the present study, chest radiographs on film were produced using healthy

volunteers. Four physical/technical parameters were varied in a carefully

controlled manner: tube voltage (102 kVp and 141 kVp), nominal speed

class (160 and 320), maximum film density (1.3 and 1.8) and method of

scatter reduction (grid (R512) and air gap). The air kerma at the entrance

surface was measured for all patients and the risk-related dose HGolem,

based on calculated organ-equivalent dose conversion coefficients and the

measured entrance air kerma values, was calculated. Image quality was

evaluated by a group of European expert radiologists using a modified

version of the CEC quality criteria. For the two density levels, density level

1.8 was significantly better than 1.3 but at the cost of a higher patient

radiation exposure. The correlation between the number of fulfilled quality

criteria and HGolem was generally poor. An air gap technique resulted in

lower doses than scatter reduction with a grid but provided comparable

image quality. The criteria can be used to highlight optimum radiographic

technique in terms of image quality and patient dose, although not

 21

unambiguously. A recommendation for good radiographic technique based

on a compromise between image quality and risk-related radiation dose to

the patient is to use 141 kVp, an air gap, a screen–film system with speed

320 and an optical density of 1.8.

To optimize the relationship between image quality and patient

exposure in general radiographic practice, a number of important

prerequisites must be fulfilled: (i) “image quality” must be defined; (ii) this

definition must be simple and be accepted by the radiological community in

order to have a successful optimization process (i.e. it has to be understood

by the radiologists and regarded as being meaningful in relation to their

daily work); (iii) the definition must be such that the quantification of

important image features is facilitated; and (iv) the intended effect on the

quantifiable image features mentioned in point (iii) must be achievable

given the available set of physical and technical image parameters of the

radiographic process.(Lanhede, 2002)

Item (ii) is necessary for the optimization process to be successful

in the radiological community and in fact rules out optimization strategies

based on pure radiation physics alone. Item (iv) is the strongest of the

prerequisites mentioned, since without an existing correlation between a

given choice of available parameters of the radiographic process and the

 22

resulting „„image quality‟‟, optimization cannot be performed with the tools

available in the clinic. (Lanhede, 2002)

The energy (you can consider this the penetrating power) of the x-

ray beam is controlled by the voltage adjustment. This control usually is

labeled in keV (thousand electron volts) and sometimes the level is referred

to as kVp (kilovoltage potential). Do not be confused by the different

terminology, just remember there is a control by which the difference in

potential between the cathode and anode can be controlled. The higher the

voltage setting, the more energetic will be the beam of x-ray. A more

penetrating beam will result in a lower contrast radiograph than one made

with an x-ray beam having less penetrating power. It is probably obvious

that the more energetic the beam, the less effect different levels of tissue

density will have in attenuating that beam. The generator waveform if is

not constant potential (medium frequency etc.) will affect the effective Kv.

The second control of the output of the x-ray tube is called the mA

(milliamperage) control. This control determines how much current is

allowed to flow through the filament which is the cathode side of the tube.

If more current (and therefore more heating) is allowed to pass through the

filament, more electrons will be available in the "space charge" for

acceleration to the target and this will result in a greater flux of photons

when the high voltage circuit is energized. The effect of the mA circuit is
 23

quite linear. If you want to double the number of "x" photons produced by

the tube, you can do that by simply doubling the mA. Changing the number

of photons produced will affect the blackness of the film but will not affect

the film contrast.

The third control of the x-ray tube which is used for medical

imaging is the exposure timer. This is usually denoted as an "S" (exposure

time in seconds) and is combined with the mA control. The combined

function is usually referred to as mAs or milliampere seconds so, if you

wanted to give an exposure using 10 milliampere seconds you could use a

10 mA current with a 1.0 second exposure or a 20 mA current for a 0.5

second exposure or any combination of the two which would result in the

number 10. Both of these factors and their combination affect the film in a

linear way. That is, if you want to double film blackness you could just

double the mAs.

In an article by Morley and Babiar (2006) the authors focused on

the increase of obesity in the United States and the doubling of the number

of inconclusive diagnostic imaging exams over a 15-year period. In a study

by Upott et al. featured in the August issue of Radiology, a monthly journal

devoted to clinical radiology, researchers assessed all radiology exams

performed at Massachusetts General Hospital (MGH) between 1989 and

2003 to determine the effects of obesity on imaging quality and diagnosis.

 24

In an effort to quantify how obesity affects diagnostic imaging

quality, Dr. Uppot and colleagues (2006) analyzed radiology records from

a 15-year span at MGH. They searched for incomplete exams that carried

the label "limited by body habitus," meaning limited in quality due to

patient size.

When radiologists are faced with images of limited quality due to

factors related to a patient‟s habitus, they often qualify their reports with

the phrase “These images are limited due to body habitus.” The consistent

use of the terms limited and habitus (hereafter, habitus limited) by

radiologists in their dictated reports has allowed for the assessment of the

longitudinal effect of obesity on image quality. A retrospective review of

dictated radiology reports that included the phrase “habitus limited” and

that were filed over 15 years was performed with use of electronic medical

records. (Upott, 2003)

Morley and Babiar stated that while 0.10 percent of inconclusive

exams were due to patient size in 1989, by 2003 the number had jumped to

0.19 percent, despite advances in imaging technology," said Raul N. Uppot,

M.D., lead author and staff radiologist at MGH. "Americans need to know

that obesity can hinder their medical care when they enter a hospital."

By 2003, the modality that yielded the most difficulties in rendering

a diagnosis was abdominal ultrasound (1.90 percent); followed by chest x-

 25

rays (0.18 percent), abdominal computed tomography (CT), abdominal x-

rays, chest CT and magnetic resonance imaging (MRI).

For exams that require radiation exposure, such as x-rays and CT,

the power can be increased on standard machines in an attempt to acquire a

higher-quality image. However, this leads to an undesirable increase in

radiation dose.

Furthermore they confirmed in relation with the studies by Upott

(2003) that incomplete examinations related to obesity can lead to serious

consequences for the patient, as in the case of misdiagnosis or failure to be

able to assign a diagnosis at all. There can also be economic ramifications.

Further testing might be required in the event of an inconclusive exam, as

well as increased hospitalization time.

Upott et al. (2007) said that after choosing the appropriate

technique, transporting the patient, and fitting the patient, the final hurdle

in imaging obese patients is the ability to obtain diagnostic quality images.

The difficulties and solutions for imaging obese patients are specific for

each imaging technique.

He added that radiographs are limited by X-ray beam attenuation

that results in lower image contrast. Also, the increased body thickness

through which the X-ray beam must travel results in increased exposure

time and introduces motion artifact. The typical setting to obtain a chest
 26

radiograph is a kVp of 90-95 and mAs of 2-2.5. However, in obese patients

these settings can result in inadequate penetration of the X-ray beams

through the patient's body, along with more background scatter.

In turn, Upott (2007) proposed solutions such as using a grid and

increasing the kVp and mAs (in chest X-ray, increase kVp to 100 and mAs

to 4) and after acquisition increasing the film development speed from 400

speed film to 800 speed film and adjusting window and level settings.

These equipment adjustments can help in imaging the obese patient.

Another viewpoint stresses on the importance of immobilization

and respiration. McGraw-Hill (2007) states that motion obliterates recorded

detail; thus, it is essential that the radiographer be able to reduce patient

motion as much as possible. Several means can be employed to reduce

motion unsharpness, but good patient communication is the most important

because it is required before any other means can be effective.

The single most important way to reduce involuntary motion is to

use the shortest possible exposure time. Various types of immobilization

devices can also be used to effectively reduce motion. Motion from

muscular tremors as a result of anxiety or pain is involuntary and can be

greatly minimized with good communication, a carefully placed

positioning sponge or sandbag, and the use of the shortest exposure time

possible.
 27

Suspension of patient respiration for parts other than the extremities

is an effective means of reducing voluntary motion; patient understanding

and cooperation is required, thus making good communication the most

effective means of reducing voluntary motion. The phase of respiration on

which the exposure is made can be essential to the diagnostic quality of the

radiographic image. Chest radiography, e.g., normally requires that the

exposure be made on inspiration (the second inspiration for better filling of

the lungs). Most abdominal examinations are exposed on expiration.

The phase of respiration on which the exposure is made can also

make a significant difference in the resulting radiographic density

Additional projections are often required in order to demonstrate the

structure(s) of interest. Since human bodies are not identical and pathologic

processes often unpredictable, routine protocols occasionally require

supplemental images.

If a patient is unable to assume or maintain the routine position used

for a particular examination, the radiographer should be capable of

modifying it to provide the required information. This is often a good

measure of the radiographer‟s skill. Skillful maneuvering of the x-ray tube

and correct placement of the image receptor can often yield excellent

images of an anatomic part difficult or impossible to manipulate.

 28

It is not within the radiographer‟s scope of practice to supply

additional unrequested images, but the radiographer should advise the

physician of other positions or modifications that may provide better

visualization of the affected area.

 29

Local Literature

In 1980, the World Health Organization (WHO) organized in

Germany a training workshop on Quality Control and Assurance in

Diagnostic Radiology. Later in 1982, an expert meeting was again held that

worked out a framework on the same subject. The results of [said] meeting

were published as a guidebook on "Quality Assurance in Diagnostic

Radiology."

In 1984, a training workshop was again organized by WHO

emphasizing the practical aspectsof Quality Assurance (QA). This

workshop was intended to establish the efficient use of radiological

facilities. This was expected to result in improved image quality, for

optimal diagnosis, cost containment and dose reduction.

The Radiation Health Service in 1990 established, as a pilot project,

quality assurance/quality control programs in the x-ray departments of

selected Department of Health hospitals. The said training has produced

the following results which had been the bases for most of the standards

that had been set in the practice of radiologic technology in the Philippines.

In order to produce high quality radiographs, standards of quality

should be set against which the results oaf given radiological study may be

judged as good or repeat/reject. For developing countries with scarce

 30

resources, such as the Philippines, some facilities/departments may include

a third category in their standards, that of poor quality images. These are

radiographs with inferior quality images but which may still contain certain

information that is considered useful to the study. The x-ray/radiologic

technologists who will perform the study should be familiar with the

criteria standards of image quality set by radiologists.

The following are some of the things to be considered in setting up

the standards: evidence of proper collimation on all sides of the radiograph;

evidence of the use of gonadal shield, where appropriate; image density

and contrast appropriate for the visualization of the anatomy of interest;

absence of image degradation due to patient motion or artifacts due to poor

film processing, old screens, etc.; adequate display of anatomy of interest

for the examination; evidence of markers to properly identify the patient‟s

left and right anatomy, hospital name, patient number, date, etc.

According to WHO (2001) Optimal interpretation of a chest

radiograph will depend on the quality of the image and the methods used to

interpret the image. Since interpretation will mainly be performed on

digitized images, the quality of the image being interpreted will depend on

the quality of the original image (the radiograph) as well as the quality of

the digitization process. In addition the monitor and the setting of the
 31

monitor used to view the digitized images are crucial for optimal

interpretation.

It is recommended that radiologists at the study sites closely interact

with radiographers and technicians, stressing the importance of film quality

as well as adequate radiation protection measures. This is to ensure that the

proportion of uninterpretable and suboptimal films are kept to a minimum,

and that radiation exposure for patients as well as staff members and/or

other people is kept as low as possible, and according to national and

international laws and regulations. Initial training workshops for all

radiographers involved in the trial, with periodic reinforcement would be

one way of achieving this. When the initial radiograph is unsatisfactory for

the purposes of treating the patient, the treating physician may authorize a

repeat radiograph. (WHO, 2001)

A few suggested guidelines for checking film quality are as follows:

exposure or being able to discern the bones, soft tissue and lungs as

different densities; development or the complete blackening of the film

outside the body on the edge of the film (where the X-rays have passed

through air) and maintaining of whiteness in the very dense areas such as

the lower thoracic spine behind the heart – if the film outside the body were

hazy or mottled, shadows within the lung would be difficult to interpret –

 32

and; positioning or the assurance that the medial ends of the clavicles are

approximately equidistant from the midline.

Related Studies

In a related study by Fernandez (2013) on the problems encountered

by selected sonographers, sinologists and radiologists of Lucena City in

handling obese patients, results show that the most common problems

encountered in handling obese patients is positioning, increasing exposure

time and too much subcutaneous fat. These may affect quality of the image

obtained from the organ. Most of the respondents of the study

recommended the use of high resolution machines and familiarization to

the machine and to the anatomical parts of the body.

 33

CHAPTER III

Research Methodology

This chapter concerns the research methodology to be employed in

the conduction of this study composed of; the research design, research

locale, research sample (respondents and sampling technique), research

instrument, data gathering procedure, as well as the statistical treatment.

Research Design

This study entitled “Problems in the Positioning of Different Body

Types as Experienced by Selected Radiologic Technology Interns in

Lucena City” shall employ the descriptive method of research which will

focus on the responses posed by said radiologic technologists. The

descriptive method of research describes and interprets how a particular

facet or aspect of a given subject develops.

Locale of Study

The researcher, in conducting his study, will pay particular attention

on the hospital, Lucena MMG General Hospital which is located at

Barangay Ibabang Dupay, Lucena City.

 34

Research Sample

a. Respondents

The main targets of this study are the Radiologic Technology

interns of sCalayan Educational Foundation Inc. in Lucena City. The

researcher deduced that target samples will have the necessary knowledge

and information needed to come up with reliable results from his study.

b. Sampling Procedure

Since random selection or sampling will not be applicable in the

conduction of this study, the respondents will be selected using purposive

sampling. The twenty respondents will be picked out according to their

availability, readiness and willingness to answer the survey-questionnaire.

Research Instrument

An interview-questionnaire will be constructed to obtain the

information needed by the researcher. It will be composed of four interview

questions.

The first part of the questionnaire will yield answers pertaining to

the demographic profile of the respondents. Specifically, the age, gender,

and duration of residency of the latter will be revealed.

 35

The second part will include a likert scale which will be dedicated

to determine the difficulties encountered by radiologic technologists in

handling patients with sthenic, hypersthenic, hyposthenic and asthenic

body habitus.

The third part will aim at establishing techniques necessary to

reduce difficulties in getting radiographs from patients undergoing chest

radiography. A checklist will be used to gather results and responses.

Finally, the fourth part will uncover positioning techniques that

should be applied to achieve clear images from patients of different body

habitus. This will be in the form of a checklist. Also, notes from the

respondents are relevant at this point.

Data Gathering and Statistical Treatment

Data will be gathered using the abovementioned instrument. The

instruments, after being tested for validity will then be handed out to 18

respondents from the research locale.

Results of the survey and assessment will be analyzed using

different statistical methods. The demographic profile of the respondents

will be studied by using the percentage distribution of the answers of the

 36

respondents. The researcher will use the formula, P = F/N x 100, where F is

the frequency and N is the total sample size.

The second part, in the form of a likert scale will be analyzed using

the mean distribution of the responses. The total weighted value and

weighted mean will be determined using the weight assigned to each

individual item. Then, the items will be ranked according to the results.

The weighted mean formula to be applied is:

WM = (5f+4f+3f+2f+1F)/N
where:
WM = weighted mean
f = frequency
N = total number of respondents
The following scale were used for the interpretation of the

respondents‟ answers.

Range Interval
4.50 – 5.00 Most Effective
3.50 – 4.49 More Effective
2.50 – 3.49 Effective
1.50 – 2.49 Less Effective
1.00 – 1.49 Not Effective
The responses for the different survey questions, however, shall be

tallied, and frequency of similar responses shall be interpreted using the

percentage formula.
 37

CHAPTER IV

Presentation, Analysis and Interpretation of Data

This chapter deals with the presentation, analysis and interpretation

of the study‟s data. It is further divided into four parts according to the

researcher‟s questionnaire.

Part I. Demography of the Respondents

This part reveals the demography of the eighteen respondents

randomly selected by the researcher as his respondents for the study.

Table I. Percentage Distribution of the Male and Female Respondents

Gender Frequency Percentage

Male 12 66.67
Female 6 33.33
TOTAL 18 100

The table above shows the number of male and female respondents

that the researcher has purposively picked from the population of the

radiologic technology interns of Calayan Educational Foundation Inc.

Twelve or 66.67 percent of the respondents are male while 6 or 33.33

percent of the respondents are female. Female respondents tend to be more

cooperative in answering questionnaires and are more intent on providing

feedback to this study.

 38

Table II. Percentage Distribution of Respondents according to Age

Age Frequency Percentage

18 – 20 9 50
21 – 23 6 33.33
24 – 26 2 11.11
27 – 29 1 5.56
TOTAL 18 100

Table II reveals the ages of the respondents majority are from the

lower age bracket of 18 to 20. Six or 33.33 percent are 21 to 23 years old.

Meanwhile, only two out of 18 or 11.11 percent range from 24 to 26 years;

while only one respondent is between the age of 27 to 29.

Table III. Percentage Distribution of Respondents according to Affiliation to

Hospitals

Age Frequency Percentage

MMG 2 11.11
UPH 4 22.22
MMMC 7 38.89
PHC 1 5.56
Not Indicated 4 22.22
TOTAL 18 100

The third table shows the number of radiologic technology interns

who have affiliated in the different hospitals which offer radiologic

services. Two or 11.11 percent affiliated with MMG; four practiced at UPH

with a percentage of 22.22; seven out of 18 decided to affiliate with

MMMC; and still some 5.56 percent affiliated with PHC. The other

respondents did not indicate where they practiced as radiologic technology

interns.

Part II. Difficulties Encountered by Radiologic Technology Interns

 39

This portion reveals the difficulties encountered by radiologic

technology interns in handling patients of different body habitus.

Table IV. Mean Distribution Table of Difficulties Encountered by Interns

Total
Weighte Verbal
Weighte
CRITERIA d Descripti
d Mean
Frequen on
cy
STHENIC
1. Difficulty in locating/palpating one or
more topographic positioning 48 2.67 Observed
landmarks
2. Uncertainty in alignment and placement 36 2.00 Less
of image receptor Observed
3. Inaccuracy in centering the central ray 40 2.22 Less
(CR) to the center of the lung fields Observed
4. Involuntary rotation and/or tilting of
58 3.22 Observed
patient due to body type
5. Excessive rotation and/or tilting of
49 2.72 Observed
patient due to body type
6. Inaccuracy in collimation resulting to 36 2.00 Less
cutting off of vital organs in images Observed
HYPERSTHENIC
1. Difficulty in locating/palpating one or
more topographic positioning 62 3.44 Observed
landmarks
2. Uncertainty in alignment and placement 58 3.22 Observed
of image receptor
3. Inaccuracy in centering the central ray More
64 3.56
(CR) to the center of the lung fields Observed
4. Involuntary rotation and/or tilting of More
70 3.89
patient due to body type Observed
5. Excessive rotation and/or tilting of 73 4.06 More
patient due to body type Observed
6. Inaccuracy in collimation resulting to More
73 4.06
cutting off of vital organs in images Observed
HYPOSTHENIC
1. Difficulty in locating/palpating one or
more topographic positioning 45 2.50 Observed
landmarks
2. Uncertainty in alignment and placement 42 2.33 Less
of image receptor Observed
 40

3. Inaccuracy in centering the central ray 41 2.28 Less

(CR) to the center of the lung fields Observed
4. Involuntary rotation and/or tilting of 39 2.17 Less
patient due to body type Observed
5. Excessive rotation and/or tilting of 39 2.17 Less
patient due to body type Observed
6. Inaccuracy in collimation resulting to 40 2.22 Less
cutting off of vital organs in images Observed
ASTHENIC
1. Difficulty in locating/palpating one or
44 2.44 Less
more topographic positioning
Observed
landmarks
2. Uncertainty in alignment and placement Less
43 2.39
of image receptor Observed
3. Inaccuracy in centering the central ray 41 2.28 Less
(CR) to the center of the lung fields Observed
4. Involuntary rotation and/or tilting of Less
43 2.39
patient due to body type Observed
5. Excessive rotation and/or tilting of 42 2.33 Less
patient due to body type Observed
6. Inaccuracy in collimation resulting to
54 3.00 Observed
cutting off of vital organs in images

The table above summarizes the respondents‟ answers on the likert

scale provided in the questionnaire inquiring on the difficulties they

encounter in handling patients of different body habitus. The most common

problem experienced by intern-respondents in sthenic patients is the

involuntary rotation and/or tilting of patient due to body type garnering a

weighted mean of 3.22 which indicates that it is generally observable

among patients of this type.

For the hypersthenic patient, excessive rotation and/or tilting due to

body type and inaccuracy in collimation resulting to cutting off of vital

organs in images are the primary problems. Both have a weighted mean of
 41

4.06 which goes to show that it is More Observable in this particular body

type.

Difficulties in handling hyposthenic patients have been deemed by

most of the interns to be sometimes similar with those of the asthenic.

However, It had been generally notable that they find it a bit difficult to

locate/palpate one or more topographic positioning landmarks on the chest.

It received a weighted mean of 2.5 which means that this particular

problem is observable.

Interns have considered the inaccuracy in collimation which results

to the cutting off of vital organs in images a common problem when

dealing with patients who are asthenic. It is revealed in its weighted mean,

3.0 and its verbal equivalent, observed.

In addition to the problems selected by the interns in handling

patients of said body types, their responses to the follow-up questions have

also been noted. Sthenic patients are apparently, the easiest to take clear

images from since none of the respondents have indicated any additional

problems they encounter when dealing with the latter; however, their

written responses expose that centering the lung field and adjusting the

factor settings become problems when dealing with patients who are

hypersthenic. Also, rotation was said to not be noticeable when dealing

with these same patients due to their body fats.

 42

For patients of hyposthenic built, choosing the correct cassette size

presents itself a problem. This is also true for asthenic patients in addition

to their too long lungs which causes their costophrenic angles to be cut off

in images.

Part III. Techniques to Reduce Difficulties

The checklist allowed the respondents to choose as much of the

techniques they employ when dealing with patients of different body

habitus while the second half of the third part encourages the latter to

indicate more techniques that could be used to reduce said difficulties.

Table V. Frequency Distribution Table of Techniques to Reduce Difficulties

in Handling Patients of Different Body Habitus

Responses Frequency
Familiarization with more prominent and bony 17
topographic positioning landmarks
Considering age and gender of patient in determining 8
position of internal organs
Use of immobilization devices for uncontrolled motion 12
Thorough explanation of procedure and clear breathing 13
instructions
Decrease in exposure time associated with increase in 11
milliamperage
Intentional slight anterior rotation depending on which 6
part is to be superimposed/focused on

The table points out „familiarization with the more prominent and

bony topographic positioning landmarks‟ as the primary solution to reduce

difficulties in handling patients in general with 17 votes. This is followed

by „thorough explanation of procedure and clear breathing instructions to

 43

be given to the patient‟ which received 13 approvals, and use of

immobilization devices for uncontrolled motion on third answered by 12

respondents.

Likewise, in the respondents‟ written responses, they emphasized

that patient cooperation is key to reducing difficulties, coupled with

extensive knowledge in the procedure and proper communication with the

patient so that the patient will clearly understand the things he must do.

Also, the part to be imaged should be properly aligned with the IR.

Part IV. Positioning Techniques to Achieve Clear Images

Positioning techniques are likewise important to achieve clear

images of parts to be radiographed. For specific body types, some

techniques are more preferable over others.

Table VI. Frequency Distribution Table of Positioning Techniques to Achieve

Clear Images from Patients

Responses Frequency
Asthenic
Posteroanterior 15
Lateral 16
Anteroposterior 7
Lateral Decubitus 5
Hypersthenic
Posteroanterior 17
Lateral 14
Anteroposterior 9
Lateral Decubitus 2
Hyposthenic
Posteroanterior 15
 44

Lateral 15
Anteroposterior 4
Lateral Decubitus 3
Asthenic
Posteroanterior 17
Lateral 16
Anteroposterior 7
Lateral Decubitus 4
The table above displays and summarizes the respondents‟ answer

when asked what particular positioning techniques could be employed to

capture images of optimum quality from patients of different habitus. For

asthenic patients, respondents recommend the lateral position which is

chosen by 16 out of 18; Hypersthenic patients on the other hand could be

employed the posteroanterior positioning which is chosen by 17 of 18;

fifteen trusts to achieve clear images from hyposthenic patients through the

posteroanterior and lateral positioning techniques; and 17 encourage the

use of posteroanterior positioning for Asthenic patients.

Moreover, in response to the second and third items in the fourth

part of the questionnaire, half of the respondents believe that hypersthenic

patients are the hardest to get clear images from. Eight specifically

indicated this body type; one deviated pointing out that hyposthenic

patients are harder to deal with. The other half of the respondents, however

suppose that no body type is particularly hard to get clear images from.
 45

CHAPTER V

SUMMARY OF FINDINGS, CONCLUSIONS AND

RECOMMENDATIONS

In this chapter, the data gathered from the response of the intern

respondents on the questions provided in the questionnaires are summed

up.

Specifically, this project seeks to answer the following questions:

5. What is the demographic profile of the respondents in terms of:

5.1. age,

5.2. gender,

5.3. duration of residency?

6. What difficulties are encountered by radiologic technologists in

handling patients with different body habitus such as:

6.1. Sthenic ,

6.2. Hypersthenic,

6.3. Hyposthenic,

6.4. Asthenic

7. What techniques are applied to reduce the difficulties in positioning

patients with different body habitus?

8. What positioning techniques are applied to achieve clear images from

patients of different body habitus?

46
 47

Summary of Findings

The following findings are derived from the analyzed data shown in

the preceding chapter.

1. Nine of the respondents are between 18 and 20 years old, 6 are from

21 to 23 years old, 2 are between 24 and 26, while one is 27 years

old. Majority of the respondents are male they comprise two thirds

of the entire number of respondents. Six are female. Most or 7 of

the respondents also had their internship with MMMC, four had

theirs at UPH, two at MMG, one at PHC and the other four did not

indicate where they served their affiliation.

2. The most prominent difficulty experienced by intern-respondents in

sthenic patients is the involuntary rotation and/or tilting of patient

due to body type garnering a weighted mean of 3.22; for

hypersthenic patients, excessive rotation and/or tilting due to body

type and inaccuracy in collimation resulting to cutting off of vital

organs in images are the primary problems with a common

weighted mean of 4.06; Respondents noted that they find it a bit

difficult to locate/palpate one or more topographic positioning

landmarks on the chest. It received a weighted mean of 2.5. Interns

have considered the inaccuracy in collimation which results to the

cutting off of vital organs in images a common problem when

 48

dealing with patients who are asthenic. It is revealed with its

weighted mean, 3.0.

3. „Familiarization with the more prominent and bony topographic

positioning landmarks‟ as the primary solution to reduce difficulties

in handling patients chosen by 17 respondents. This is followed by

„thorough explanation of procedure and clear breathing instructions

to be given to the patient‟ which is chosen by 13, and use of

immobilization devices for uncontrolled motion on third answered

by 12 respondents.

4. For asthenic patients, respondents recommend the lateral position

which is chosen by 16 out of 18; Hypersthenic patients on the other

hand could be employed the posteroanterior positioning which is

chosen by 17 of 18; fifteen trusts to achieve clear images from

hyposthenic patients through the posteroanterior and lateral

positioning techniques; and 17 encourage the use of posteroanterior

positioning for Asthenic patients. Moreover, in response to the

second and third items in the fourth part of the questionnaire, half of

the respondents believe that hypersthenic patients are the hardest to

get clear images from. Eight specifically indicated this body type;

one deviated pointing out that hyposthenic patients are harder to

deal with. The other half of the respondents, however suppose that

no body type is particularly hard to get clear images from.

 49

Conclusion

The following conclusions were drawn after the presentation of

findings.

1. Majority of the respondents are male, are from 18 to 21 years old

and have affiliated in Mary Mediatrix Medical Center.

2. The most common problem experienced by intern respondents in

sthenic patients is the involuntary rotation and/or tilting of patient

due to body type; for the hypersthenic patient, excessive rotation

and/or tilting due to body type and inaccuracy in collimation

resulting to cutting off of vital organs in images are the primary

problems. Difficulties in handling hyposthenic patients have

been deemed by most of the interns to be sometimes similar with

those of the asthenic. However, It had been generally notable that

they find it a bit difficult to locate/palpate one or more topographic

positioning landmarks on the chest. Interns have considered the

inaccuracy in collimation which results to the cutting off of vital

organs in images a common problem when dealing with patients

who are asthenic.

In addition to these, sthenic patients are apparently, the easiest to

take clear images from since none of the respondents have indicated

any additional problems they encounter when dealing with the

latter; however, centering the lung field and adjusting the factor
 50

settings become problems when dealing with patients who are

hypersthenic. Also, rotation was said to not be noticeable when

dealing with these same patients due to their body fats.

For patients of hyposthenic built, choosing the correct cassette size

presents itself a problem. This is also true for asthenic patients in

addition to their too long lungs which causes their costophrenic

angles to be cut off in images.

3. „Familiarization with the more prominent and bony topographic

positioning landmarks‟ is the primary solution to reduce difficulties

in handling patients in general. This is followed by „thorough

explanation of procedure and clear breathing instructions to be

given to the patient‟, and use of immobilization devices for

uncontrolled motion on third.

It was also emphasized that patient cooperation is key to reducing

difficulties, coupled with extensive knowledge in the procedure and

proper communication with the patient so that the patient will

clearly understand the things he must do. Also, the part to be

imaged should be properly aligned with the IR.

4. In terms of positioning techniques, respondents recommend the

lateral position for asthenic patients. Hypersthenic patients on the

other hand could be employed the posteroanterior positioning.

Respondents also trust to achieve clear images from hyposthenic

 51

patients through the posteroanterior and lateral positioning

techniques. The use of posteroanterior positioning for Asthenic

patients was also recommended.

Half of the respondents believe that hypersthenic patients are the

hardest to get clear images from. One deviated pointing out that

hyposthenic patients are harder to deal with. The other half of the

respondents however, supposed that no body type is particularly

hard to get clear images from.

Recommendations

Based on the findings, interpretations, and conclusions of the study,

the researcher gives the following recommendations for the verification of

the research findings:

1. To the radiologic technologists, employ different handling and

positioning techniques not just to ensure the achievement of

optimum quality images from the patients but also to ease their

discomfort while undergoing the radiologic processes. This

would help not only in keeping the patient immobile during the

entire procedure, but ultimately, in avoiding misdiagnosis that

could lead to further damages to the patient. Also, undergoing

trainings can expose technologists to more methods and

procedures that could benefit both them and their patients.

 52

2. To the radiologic technology department; studies and researches

help in enriching and furthering the possibilities not just for said

students but the medical radiological field in general. Old

practices could be outdated and debunked; therefore, exposing

faculty and students alike to current and revolutionized trends

could pave the way to better and bigger researches, and

consequently to advancement in the field.

3. To future researchers, this research considered interns as its

respondents. However, practicing radiologic technologist would

give better and more reliable responses that could shed light on

areas of this research that had not been dwelt on enough. Also,

more respondents mean more reliability of the results and

findings of future researches. Incorporate a step by step

discussion on the obtaining of radiographs to ensure a more

detailed approach to this subject.

53
 54

Bibliography
Ballinger , P. W. (1991). Merrils Atlas of Radiographic Positioning and
Radiologic Procedure.

Bontrager, K. L., & Lampignano, J. P. (2010). Textbook of Radiographic

Positioning and Realated Anatomy. Singapore: Elsevier.

Destounis, M. (2009). Body Positioning in X-Ray Studies. Retrieved June

14, 2013, from Healthline Web Site:
http://www.healthline.com/galecontent/body-positioning-in-x-ray-
studies#1

Lanhede, K. (n.d.). Procedures and Considerations in Radiographic

Positioning. Retrieved June 13, 2013, from ncbi website:
http://www.ncbi.nlm.nih.gov/pubmed/12483408

Reynolds, A. (2011). Obesity and Medical Imaging Challenges. Journal of

the American Society of Radiologic Technology, 219.

Tatsumi, M., Clark, P. A., Nakamoto, Y., & Wahl, R. L. (2009). Impact of
Body Habitus on Quantitative and Qualitative Image Quaity in
Whole-body FDG-PET. 50-62.

Uppot, R. (2005). How Obesity Hinders Image Quality and Diagnosis in

Radiology. Bariatrics Today, 31-33.

Uppot, R., Sheehan, A., & Seethamraju, R. (2005). Obesity and MR

Imaging. MRI hot topics, 28-37.

Yumul, R. D. (2012). Introduction to Radiologic Technology with Science,

Technology and Society.
 55

APPENDICES

APPENDIX A

June 5, 2013

Dear Respondent:

The Undersigned is a junior Bachelor of Science in Radiologic Technology

student presently working on an undergraduate thesis entitled Influence of
Body Habitus in Positioning Patients of Chest Radiography as
Perceived by the Radiologic Technologists of Hospitals and Radiology
Clinics in Lucena City.

In this light, we are asking for your cooperation in accomplishing the

attached questionnaire with utmost honesty. Rest assured that your
responses would be kept and treated with strict confidentiality.

Thank you very much!

Respectfully yours,

KIN ARON ROCAFOR

Endorsed by:

Dr. JAIME BUZAR

Research Adviser, CEFI

Noted by:

Dr. MANUEL DELOS SANTOS

Dean, College of Radiologic Technology
 56

APPENDIX B

PROBLEMS ENCOUNTERED IN THE POSITIONING OF

DIFFERENT BODY TYPES AS EXPERIENCED BY SELECTED
RADIOLOGIC TECHNOLOGY INTERNS OF CALAYAN
EDUCATIONAL FOUNDATION INC. IN LUCENA CITY

QUESTIONNAIRE

Demographic Profile of Respondent

Age: _______ Gender: ____ Years of experience: _____________

Part II. Difficulties encountered by radiologic technologists in handling

patients of different body habitus.

DIRECTION: The following items describe difficulties observed in

positioning patients of different body habitus. Tick/check (/) the column
opposite those which you have observed.

Code Description Weight

MSO Most Observed 5

MRO More Observed 4

MSO MRO O LO NO
O Observed 3

LO Less Observed 2

NO Not Observed 1

STHENIC

7. Difficulty in locating/palpating one or more

topographic positioning landmarks
8. Uncertainty in alignment and placement of
image receptor

9. Inaccuracy in centering the central ray (CR)

to the center of the lung fields
 57

10. Involuntary rotation and/or tilting of

patient due to body type
11. Excessive rotation and/or tilting of patient
due to body type
12. Inaccuracy in collimation resulting to
cutting off of vital organs in images
HYPERSTHENIC

7. Difficulty in locating/palpating one or more

topographic positioning landmarks
8. Uncertainty in alignment and placement of
image receptor
9. Inaccuracy in centering the central ray (CR)
to the center of the lung fields
10. Involuntary rotation and/or tilting of
patient due to body type
11. Excessive rotation and/or tilting of patient
due to body type
12. Inaccuracy in collimation resulting to
cutting off of vital organs in images
HYPOSTHENIC

7. Difficulty in locating/palpating one or more

topographic positioning landmarks
8. Uncertainty in alignment and placement of
image receptor
9. Inaccuracy in centering the central ray (CR)
to the center of the lung fields
10. Involuntary rotation and/or tilting of
patient due to body type
11. Excessive rotation and/or tilting of patient
due to body type
12. Inaccuracy in collimation resulting to
cutting off of vital organs in images
ASTHENIC

7. Difficulty in locating/palpating one or more

topographic positioning landmarks
8. Uncertainty in alignment and placement of
image receptor
9. Inaccuracy in centering the central ray (CR)
to the center of the lung fields
10. Involuntary rotation and/or tilting of
 58

patient due to body type

11. Excessive rotation and/or tilting of patient
due to body type
12. Inaccuracy in collimation resulting to
cutting off of vital organs in images

Part III. Techniques to reduce difficulties in positioning patients of

different body habitus

Tick/check (/) one or more of the boxes below preceding techniques which
are necessary to reduce difficulties in positioning patients with different
body habitus.

 Familiarization with more prominent and bony topographic

positioning landmarks

 Considering age and gender of patient in determining position of

internal organs

 Use of immobilization devices for uncontrolled motion

 Thorough explanation of procedure and clear breathing instructions

 Decrease in exposure time associated with increase in

milliamperage

 Intentional slight anterior rotation depending on which part is to be

superimposed/focused on

 Others

_____________________________________________________

Part IVa. Positioning techniques to achieve clear images from patients of

different body habitus

 59

Tick/check (/) one or more of the boxes below preceding positions that,
according to your experience, guarantee/s obtaining of clear images from
patients of different body habitus.

 Posteroanterior Projection

 Lateral Position

 Anteroposterior supine or semierect Projection

 Lateral Decubitus Position

 Anteroposterior Lordotic Projection

 Anterior Oblique Position

 Posterior Oblique Position

Part IVb. Positioning techniques to achieve clear images from patients of

different body habitus

1. Which particular body type/s is/are hardest to get clear images

from?

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

2. What positioning techniques could be applied to achieve optimal

radiographs?

______________________________________________________

______________________________________________________
 60

______________________________________________________

______________________________________________________

Thank you very much!

KAAR
 61
Curriculum Vitae
Kin Aron A. Rocafor
Pearl St. West Employees Village, Lucena City
Contact Number: 09108480168
Email Address: ron_rocafor@yahoo.com
OBJECTIVES

To be able to apply the theories and principles learned

in the different areas of radiologic technology in
practical situations

SEMINARS ATTENDED
Profile
1st Scientific Symposium: “Basic Nuclear Medicine and
Radiation Leakage from Fukushima Incident” Age: 20 years old
Feb. 08, 2012, CEFI, L.C. Gender: Male

Rad Tech Synergy Civil Status: Single

Date of Birth: January 16, 1994
PART Quezon Chapter
Place of birth: Lucena City
Sept. 23, 2012, CEFI, L.C.
Father’s Name: Lorenzo Rocafor
st
21 Radiologic Technology National Congress Mother’s Maiden Name: Eleanor A. Allarey
“Benchmarking the Standards of Patient Care and Religion: Roman Catholic
Professional Practice”
Educational Background
November 8-10, 2012 Held at Skyrise Hotel, Baguio City
Tertiary Education:
Contact Person BS in Radiologic Technology
Calayan Educational Foundation, Inc.
Lucena City
Mrs. Delcie Flores Jader, RRT S.Y. 2010-2014
Secondary Education:
Adviser, College of Radiologic Technology San Francisco Parochial Academy
Brgy. Poblacion, San Francisco
CEFI, Lucena City Quezon
S.Y. 2006-2010
(710-2514)
Primary Education:
San Francisco Adventist Elementary School
Purok 5, Brgy Poblacion, San Francisco
Mr. Manuel P. Delos Santos Quezon
S.Y. 2001-2006
Dean, College of Radiologic Technology
I hereby certify that all given information is true and
CEFI, Lucena City correct to the best of my knowledge and ability.
(710-2514)
__________________________
Kin Aron A. Rocafor
(Signature over printed name)