Repeat Image Evaluation Paper

Repeat Image Evaluation Paper Daniele Balsamo The image repeat is a lateral lumbar spine. The lumbar spine protocol is usually part of a three view, anterior posterior (AP) a lateral and a C5 S1 spot image. For trauma, often is requested one lateral to assure that there is no risk to move the head of the patient. A complete sequence includes also to two obliques (LAO and RAO) to visualize the zygapophyseal joint space. . For a proper lateral spine positioning, the radiographer places the patient either standing or recumbent left lateral. Shoulder and ASIS should be aligned vertically through the midcoronal plane, to assure there is no tilt or rotation, the thoracic and lumbar spine should be aligned parallel to the table, to assure no rotation. A contact shield should be placed on the table lateral to the spine to reduce back scattering. A contact shield should be placed on the gonad area if does not interfere with area of interest. The spine should be aligned parallel to the longitudinal line of the collimation light. Ask the patient to suspend their breathing on expiration. The essential anatomy is, longitudinally T-12 to sacrum, laterally including the soft tissue posteriorly to the spine and all the body of the vertebrae anteriorly. Anatomy best demonstrated is the spinous process, the intervertebral disk space and the vertebral body (McQuillen Martensen, 2015, p. 431). Because different body habitus can affect the position of the lumbar spine, depending of the body fat or muscle in the hip area, a special attention is required in positioning the spine laterally. The leg had to be flexed to reduce the natural curvature of the hip, a sponge or a towel is placed superiorly to the iliac crest to the sagging of the spine due the position on a flat table. The sponge allows to keep the natural curvature and the spine parallel to the image receptor (IR.) Different pathology can affect the lumbar spine imaging. Scoliosis is a curvature of the spine to the left or the right side. Lordosis is an accentuated curvature of the spine toward the anterior aspect. Can be reduced flexing the knee and bringing L5 and sacrum more parallel. Will be visualized in AP projection with the intervertebral disc space look closed. If the patient has a lateral curvature (scoliosis) of the spine, should be placed in a lateral position with the curvature toward the IR to keep the intervertebral disk space as open as possible, the center ray should be going through in the maximum curvature point referencing the AP projection. Spondylolysis is a fracture of the pars interarticularis in the vertebral arch, visualized in the oblique projection and appear as a Scotty dog collar. Spondylolisthesis is the slide forward and down of one vertebral body to another inferiorly. These pathologies could limit the motion range of the patient, but they dont affect the positioning technique. Central ray should be on L3, positioning one inch a half superior to the iliac crest. The area of interest is from the first lumbar spine to the intravertebral space between the fifth lumbar spine and the sacrum. The beam is perpendicular to the IR and the distance from the tube is 43 inch. The system is a DR Siemens system, with a fluoroscopy table, and a wall bucket that uses a rail moved x- ray tube. The exposure indicator is express in EXI, the range is 150 under exposed, 250 optimal exposure, 500 overexposed. The system use two method to evaluate the exposure, the first is the setting of the proper anatomic part and body habitus of the patient. The radiographer sets the anatomic part and the body habitus on the display, the machine uses an automatic programmed technique (APT), that follows predefined anatomic chart sets by the manufacturer. Next the machine then uses the automatic exposure control(AEC) to determine the proper exposure. When a certain amount of remnant x-rays are hitting the ionic chamber in the IR, the exposure is terminated. The AEC gives consistency between exposures if the positioning of the anatomy on the right photo cell is correct. For the AP projection of lumbar spine, the EI is 367, the exposure factors are 75 KVp, 189 mAs, For the left anterior oblique is Exposure Index (EXI) is 290, 77Kvp and 200 mAs. The EXI for the right anterior oblique is 205, with 65 Kvp 98 mAs. The left lateral EXI is 258,near to the optimal 250, the 90Kvp and 75 mAs . The left lateral repeat has an EXI of 260 with a 90 Kvp and 83 mAs . The radiographer can evaluate the image visually using the magnify lens in the image Pac viewer. When the quantum noise, is visible in the image and the anatomic edge are blurry this indicates an underexpose image. For an overexpose image the contrast is high and the image has very minimal shades of gray In the DR Siemens system used for this procedure the image receptor size is a 17 by 17. The collimation is done by using the beam limitation device in the machine. The aperture diaphragm in the tube housing can be manipulated by the radiographer with two controls and the light will resize proportionally to the exposure field. In a standard lateral spine, the collimation should be height wise 17 and lengthwise 8. Appropriate shielding in lateral spine should be considered when is possible use a contact shield over the gonads, without superimposing essential anatomy. There is no requirement of patient preparation for the L-spine x-ray, except for the appropriate clothes, or hospital gown to avoid artifacts. Other patient artifact could be jewelry, belly piercing, or underwear with sparkle or other metallic materials. Other artifact can be generated by patient movement. System artifact can be grid related and software related. Grid related are: grid cut off, when the center ray is not centered on the image receptor and not parallel to the grid, the result is line artifact visualized through all the image. Software related are the use of wrong algorithm and wrong anatomic chart, this create a wrong image compensation and can enhance details in the wrong anatomic part (tissue instead of bones). Sometimes is use intentionally reapply the algorithm on a chest x-ray to better visualize the pic line. Factors that defines the quality of the image are: brightness, contrast, spatial resolution and distortion. Image brightness, in digital radiography (DR), is the amount of exposure of the image receptor that affect the value of light or dark value of the image. This value can be adjusted in digital radiography with window level in the image viewer. Although is limited to the latitude of the image, in DR can be adjusted 50% up for underexposed image and 200% down for overexposed. The display brightness is a hardware quality factor and need to be calibrated to give a consistent image quality output. Contrast in an image is defined by the visual recognition of a change of density in adjacent part in a tissue, defines the edges of the anatomy improving details visibility. Subject contrast is generated by the differential absorption in the body. Is determined by the patient physical properties, such as weight, muscle mass and body habitus. As the contrast goes up the latitudes and the shades of gray are getting lesser. Two adjacent tissue with same density will have poor if none contrast. In the PACS image viewer the contrast is controlled by window width. Spatial resolution (306-309) is a quality of the image receptor and display, is determined by the matrix of pixels, bigger is the matrix better is the resolution. Does affect the image quality because define how small of an anatomic detail can be visualized. Can be affected by motion, patient(voluntary) and organs(involuntary) such as heart beat or peristalsis of GI tract. Focal spot blur is an effect of the shape of the focal spot on the anode. As the OID of the object increase so will the focal spot blur on the cathode side. Distortion shape size, spatial Is affected by OID and SID and positioning of body part, image receptor and tube angle. When the tube, the anatomy and the IR are not aligned properly elongation and distortion can occur. If the anatomic part is not enough near to the IR magnification will occur. There are two main errors that lead to a repeat of the image all related to positioning. First, the center ray should be centered in L3 instead is centered on L2 -L1 , and consequently the inferior side of the sacrum is cut off the field of view. Second, the lumbar spine between L4 and L1 is not parallel to the image receptor and shows the inferior base of the vertebral body, in this case the leg were not flexed enough. Collimation should be more tight 8 longitudinal. That will also decrease backscattering and will give more contrast to the image. Another visible error is the rotation of the spine References Bontrager, K. L., Lampignano, J. P. (2014). Textbook of Radiographic Positioning and Related Anatomy. (8th ed.) St. Louis, Mo.: Elsevier/Mosby. McQuillen Martensen. (2015). Radiographic Image Analysis. (4th ed.) St. Louis, MO.: Elsevier. [DB1] [DB2]

Book Report On The Outsiders Essay -- Essays Papers

Book Report On The Outsiders Character Analysis: Ponyboy Curtis - Ponyboy is a fourteen-year-old member of a gang called the Greasers. His parents died in a car accident, so he lives alone with his two older brothers, Darry and Soda. He is a good student and athlete, but most people at school consider him a vagrant like his Greaser friends. Sodapop Curtis - Soda is Pony's handsome, charming older brother. He dropped out of school to work at a gas station, and does not share his brothers' interest in studying and sports. Darrel Curtis - The oldest of the Curtis boys, Darry is also the acknowledged leader of the Greasers. Johnny Cade - Johnny is Pony's closest friend and the gang's pet. They are especially protective of him since he is smaller than the rest, his father beats him, and he is afraid to walk the streets alone after being attacked by a group of Socs. Cherry Valance - Cherry is from the richer part of town and associates mainly with the Socs, but she befriends Pony and the other Greasers and gives them information about the Socs. Bob Gardner - Bob is Cherry's boyfriend. Johnny murders Bob to stop him from killing Pony. Dallas Winston - A member of the Greasers, Dally has spent time in prison. He helps Johnny and Pony by telling them to go to Jay Mountain to hide out and by giving them money. Two-Bit Mathews - The Greasers' oldest member. He acts like a mentor or mascot to the Greasers. Steve Randle - Soda's best friend and anoth...

Sexuality, Corruption, and Power Dynamics in the Bloody Chamber

Sexuality, corruption and power dynamics in The Bloody Chamber Sexuality is a prevalent theme in Angela Carter’s story The Bloody Chamber. Sexual violence within a relationship often reveals aspects of each party’s identity and character as well as affects its power dynamics. Carter depicts sex both explicitly and implicitly in the story through the heroine’s own thoughts of her newfound sexuality and her sexual experiences with the Marquis.Carter’s implicit and explicit portrayals of sex and sexuality in The Bloody Chamber reflect changes in the power dynamic between the heroine and the Marquis throughout the text, develop the identity of the heroine and reveal aspects of the Marquis’ character, and challenge notions of gender. The first incident of an implicit portrayal of sexuality occurs during the narrator’s train ride away from her childhood home towards her new life with her future husband, the Marquis.No physical act of sex is describ ed, but it is the first time that the reader sees the heroine’s sensual side and departure from innocence through Carter’s use of sexual language. It is as if the train ride away from home symbolizes her departure from innocence and into womanhood. Carter uses words such as â€Å"ecstasy†, â€Å"burning†, â€Å"pistons thrusting†, shuddered†, and â€Å"throb† to convey the heroine’s newfound sexual arousal and her thoughts about sex.Carter’s description of the heroine’s â€Å"young girl’s pointed breasts and shoulders† depicts her innocence and virginity (Carter, 8), yet she is consumed with thoughts of sex. This contrast symbolizes the development of the heroine’s identity from childhood to womanhood. Implicit sexuality is also seen on the train ride when the heroine expresses her anticipation of sex. She says: â€Å"for the first time in my innocent and confined life, I sensed in myself a po tentiality for corruption that took my breath away. (Carter, 11). The heroine feels this way because of the way the Marquis watches her with an â€Å"assessing eye of a connoisseur inspecting horseflesh†, and sees for the first time the â€Å"carnal avarice† of the way he looks at her. The Marquis views her as a piece of meat; similar to the way a predator would eye his prey. From this scene, it is evident to the reader that the Marquis treats his women as possessions, and has a primal instinct regarding sexuality.The heroine has lived a sheltered, pure life and is completely new to such concepts as lust and sexual passion, but it is at this moment that she realizes the potential of becoming a woman susceptible to sexual domination and corruption. This scene reflects the power dynamic in the relationship stemming from the Marquis’ obvious desire for sexual possession, corruption, and control, and the heroine’s recognition of her impending sexual exploitat ion. The scene further develops the heroine’s identity towards becoming a woman.Despite the Marquis’ obvious misogyny, his actions excite the heroine because they make her feel as if she is a sexual and desirable being. She recounts his marriage proposal, and says: â€Å"When I said that I would marry him, not one muscle in his face stirred, but he let out a long, extinguished sigh. I thought: Oh! how he must want me! And it was as though the imponderable weight of his desire was a force I might not withstand, not by virtue of its violence but because of its very gravity. (Carter, 9) This quote shows how the heroine perceives the Marquis’ sigh as a sign that he is in love with her, when the more likely reality is that it is a sigh of victory, as if he has just conquered his latest possession. Regardless of these opposing interpretations, it is evident in the last line of this quote that the heroine senses the combination of sexual desire and violence inherent i n the Marquis’ character, and the harm it poses to her. Little does the heroine know how real the Marquis’ penchant for sex and violence is, and how he channels that desire towards the murder of women.The heroine seems accepting of the submissive role in her relationship with the Marquis, and the thought excites her. This assumption further reflects the power dynamic between the Marquis and his wife, as well as the gender roles that both characters embody. The Marquis fits the description of a power-hungry, domineering male, and the heroine that of a naive, innocent girl who obeys her husband. The heroine’s naivety is reflected when she says she is â€Å"bemused that, after those others, he should now have chosen me. She obviously does not understand that the reason he is not still in mourning for his last wife is because he murdered her. Carter’s explicit portrayal of sex occurs when the Marquis first shows the heroine the mirrored room and disrobes her . The heroine narrates the scene as if she is describing a rape, similar to the ones in the Marquis’ collection of pornographic paintings: â€Å"And when nothing but my scarlet, palpitating core remained, I saw, in the mirror, the living image of an etching by Rops from the collection he had shown me when our engagement permitted us to be alone together. (Carter, 15). When the Marquis later takes the heroine’s virginity, it is a form of punishment for the heroine’s disobedience in perusing his collection of books. This reveals the power dynamic that will present itself again in the story, of the Marquis setting the heroine up to disobey him, then punishing her. He makes her wear the choker of rubies as if it is a collar, kisses it before he kisses her, and â€Å"twines her hair into a rope† as if it is a weapon he could use to hurt her. These actions further exemplify the Marquis’ desire for violence and corruption enveloped in sex.Once the heroin e is no longer a virgin and the Marquis leaves the castle, the heroine takes on the role of woman of the house. The reader sees the development of the heroine’s identity, as her independence is revealed through solitary actions such as playing the piano, her true passion, and directing the staff. The heroine is portrayed as a woman who is in control of her domain, rather than a girl under the control of her husband, even though she is still very much trapped in the castle. Power dynamics shift once the heroine loses her virginity, because that was what defined her corruptibility, innocence and youth.The heroine and the reader also witness for the first time a Marquis who has had all the force and power knocked out of him. The narrator says â€Å"He lay beside me, felled like an oak, breathing stertorously, as if he had been fighting with me. In the course of that one-sided struggle, I had seen his deathly composure shatter like a porcelain vase flung against a wall; I had he ard him shriek and blaspheme at the orgasm. † (Carter, 18). Prior to this sexual experience, the heroine had never seen the Marquis be emptied of his composure or expose his vulnerability.She believes that she may have discovered the man underneath the powerful facade when she says â€Å"And perhaps I had seen his face without its mask; and perhaps I had not. † The Marquis is always so in control and holds power over the heroine, but she realizes that if his exterior is removed for a moment, he is not as powerful as he seems. This scene influences the power dynamic within the relationship, since the heroine is no longer convinced that the Marquis holds so much unquestionable authority over her.This transition in the power dynamic aids the heroine’s decision to disobey the Marquis’ instructions when he leaves. The heroine’s identity is further developed after the she discovers the bloody chamber and the Marquis returns to the castle. Now that she has discovered the truth about her husband and the fate of his previous wives, the narrator admits to herself that she is in true danger. â€Å"How could I know, indeed? Except that, in my heart, I’d always known its lord would be the death of me. † (Carter, 33).She is no longer an unknowing, innocent, uncorrupted girl, as she now knows who the Marquis truly is and what he plans to do to her, and she realizes there is nothing desirable about him or their relationship. The narrator realizes that she has played directly into the Marquis’ hands, and has â€Å"lost at that charade of innocence and vice in which he had engaged me. Lost, as the victim loses to the executioner. † (Carter, 34). The heroine has fallen for every trap that the Marquis has set for her, right up until her impending death.The power dynamics of the relationship shift at this moment in the story. The heroine has discovered the Marquis true intentions, so he no longer holds any secrets that she is unaware of. She sees him as the monster he is, and not as the powerful man he pretends to be. The narrator observes as the Marquis â€Å"raised his head and stared at me with his blind, shuttered eyes as though he did not recognize me, I felt a terrified pity for him, for this man who lived in such strange, secret places that, if I loved him enough to follow him, I should have to die† (Carter, 35).The heroine begins to pity the Marquis rather than fear him, and sees his loneliness underneath his powerful disguise. One could argue that the power dynamics truly shift in the heroine’s favor once her mother kills the Marquis, as he is destroyed, but the true shift takes place once the heroine discovers who the Marquis really is, because she no longer has any reason to obey him as a husband. Once the narrator realizes that she is not in a legitimate husband-wife relationship and her husband intends to murder her, there is no reason for her to act like a loving, faith ful wife or submit to this man.The end of the text shows how Carter challenges gender roles throughout the story. At the beginning, the heroine is portrayed as a naive girl who marries a man not because she’s sure she loves him, but because she’s sure she wants to marry him (Carter 8). The reader sees how she fits the notion of the inexperienced, submissive gender willing to obey a man and accept all the riches he offers her. The Marquis fits the notion of a masochistic, domineering male who sees women as objects and seeks to control them and entice them with wealth.However, by the end of the novel, the heroine outlives the Marquis and is no longer the object of a man’s desire for violence and sexual corruption. She marries a man who is blind and poor, so that he can neither objectify her for her beauty nor buy her love with money and gifts, and she no longer has any desire for these things. This change is seen when the narrator says: â€Å"We lead a quiet life , the three of us. I inherited, of course, enormous wealth but we have given most of it away to various charities. (Carter, 40). The Marquis has fallen from his position as a powerful, wealthy, controlling man, and in true feminist fashion, the heroine emerges the victor. Carter’s descriptions of implicit and explicit scenes of sex and sexuality involving the heroine and the Marquis illustrate the development of the two characters’ relationship with each other and the power dynamics involved, as well as their own identity transitions throughout the story.The reader witnesses the narrator’s journey from girlhood and her desire for sexual corruption, through her torture, submissiveness and sexual self-discovery, all the way until her assumption of power over the Marquis. The heroine defeats the preconceived notions of gender roles as her values and character are completely altered by the end of the story. The Bloody Chamber depicts the lethal combination of sexual ity and violence and the desire to be sexually corrupted without comprehending the implications and true nature of the relationship.

The Integration Of Law And Ethics - 945 Words

As the subject title indicates, Substantive ethics is about the integration of law and ethics in corporate ethics programs. The author of this article gives numerous examples of why integration of law and ethics is needed. There are numerous areas of concern, such as dishonest corporate dealings, global human rights, tort lawsuits, and questionable executive salaries (Blodgett, 2012). There is a view that laws are rules meant to be followed and not necessarily understood for its ethical value. This in turn is a major factor as to why ethical violations exist. New regulations are created often times in the corporate environment or society in response to ethical petitions for change (Blodgett, 2012). In order to have â€Å"ethical sustainability† (Blodgett, 2012, p. 39), the ethical component of laws must be incorporated with new regulations (Blodgett, 2012) The article examines the correlation of law and ethics as it focuses on managerial decision making and corporate governance. It is approached in three ways via the applied approach, change of corporate ethics codes, and restructuring the current view of law and ethics (Blodgett, 2012). The three main applied approach are the â€Å"separate realm view† (Paine, 1994a. b., p. 154). This view interprets a law as a minimum or base level standard that must be followed. In contrast, the ethical principles of morals and behavior are viewed as grander and distinguished from the law (Jennings, 2006). 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