Patient Positioning X-Ray Gyroscope
The solution for this problem was invented by Dr. Arthur Pancioli — Professor and Richard C. Levy Chair for Emergency Medicine at UCMC. His idea was for a "radiographic gimbal" that would imprint a patient's back angle and orientation (relative to emitter normal) on a chest x-ray. The design crystallized as a small, clip-on unit to be worn by techs alongside their L/R markers and adhered to the x-ray cassette during a chest x-ray. The device was inspired by a liquid-filled compass and functions in much the same way.
This was a quick project designed over a couple of days and prototyped in the following weeks. The project was executed in Solidworks and prototyped in SLA. Prototypes included a 4X mechanical gimbal version and a 1X liquid-filled design.
Radiology techs in the ED are often seen carrying patient L/R markers attached to their badges. These markers help to identify the left and right side of a film when it is shot but provide no indication of the patient's back angle relative to the ground or orientation relative to the x-ray emitter. In particular, chest x-rays shot at a strange angle can lead to misdiagnoses and/or lost time.
There is an opportunity for a device that can be applied to an x-ray cassette to provide patient positioning information (back angle relative to ground and emitter) to the physician viewing the film.
Dr. Pancioli's invention was executed as a 1" X 1" cube that can be attached to an ID badge alongside standard L/R markers. Adhered to an x-ray cassette, the device provides valuable patient positioning information to the physician by marking the film with patient position (relative to the emitter) and patient back angle (relative to the floor).
PATIENT Position relative to Emitter
When shooting a chest x-ray it's important to maintain a perpendicular position between film and x-ray emitter. This prevents overlapping areas of anatomy from creating a confusing image. In many cases, a poorly shot image simply requires a re-shoot. While this leads to patient discomfort, lost time and increased cost, it rarely causes significant harm. In a few cases, however, a poor x-ray can mean a misdiagnosis, for example when overlapping anatomy darkens a portion of the image leading to the misdiagnosis of a pneumothorax.
To provide an indication of the patients' perpendicularity to the emitter, the cube-shaped case of the device incorporates a reticular pattern of ribs on front and back. The extra thickness (front to back) of material in this ribber area causes a lightening of the image, imprinting both reticles on the film. The relative position of these reticles indicates angle to the emitter. If the image is shot straight on, the reticles becomes bright and clear.
Patient Back Angle relative to floor
Patient back angle is valuable information for many physicians for the same reasons as above. To provide this function, the device uses a floating ball design similar to that of a liquid-filled compass, which provides the "gimbaling" effect Dr. Pancioli described. Inside the liquid-filled cube floats a partially weighted, radio-transparent ball. The ball is marked with radio-opaque lines to indicate degrees of rotation from level. The hole through which the cube is filled is plugged with a small, metal pin that (also radio-opaque) lines up with these markings to indicate the patient's back angle relative to the ground.