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57
The Technique and Standardisation of Chest Radiographs.
In view of the enormous increase of X-ray examinations undertaken
in the Chest Clinic Service, it is important that the quality of
each film taken should not be sacrificed to the quantity. Unless the
film is technically satisfactory no responsible physician can attempt
to interpret it. This requires time, patience and meticulous attention
to detail. The following minimum criteria have to be fulfilled.
(i) Confidence and co-operation from the patient.
(ii) Closest possible contact between patient and film.
(iii) Finest grain of film and intensifying screen, the former
uniformly compressed between the latter.
(iv) Fine focus tube at such distance that radiations through
the patient are relatively parallel.
(v) Activation of tube for shortest possible time by stabilised
transformer unit.
(vi) Careful dark-room technique.
(vii) Inspection of films against a uniformly lighted surface
which will give visualisation of higher degrees of contrast
transparency.
A trial drill with a careful rehearsal of the correct positioning
of the patient is often advisable. All this necessarily takes up time,
but is essential.
Films taken in various positions are often of vital importance in
diagnosis, viz, postero-anterior and antero-posterior positions, as
well as lateral and sometimes apical, oblique and lordotic.
The special Medical Research Council report in this connection
is a valuable document. In the routine work of the Clinic a high
quality of film is regarded as of no less importance than a good clinical
examination, and experience repeatedly shows how dangerous it is to
express any opinion on a film which is technically unsatisfactory.
Collapse Therapy.
In addition to the well recognised methods of collapsing the
diseased lung by Artificial Pneumothorax, Phrenic Crush, Extrapleural
Pneumolysis, Cavity Drainage (Monaldi operation) and
Thoracoplasty, recent advances in thoracic surgery have brought still
further methods into use and already both at the Chest Clinic and
Harts Sanatorium these have been gradually introduced.