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performing a Valsalva maneuver when taking in their breath. In other
words, the patient, when they hear the breathing command, is "gulping"
or strenuously inhaling and then bearing down in order to hold their
breath. The resulting change in the internal pressure in the thoracic
cavity has the ability to change the flow of blood and contrast by as
much as 7-10 seconds different than normal flow. The amount differs
because of how hard they bear down, their own cardiac output, and/or the
amount of available lung parenchyma. My suggestion, and what I see sites
that are routinely successful with this software, is education of the
customer and a new voice command. Before the scan, as the patient is
being prepared with I.V. lines and positioned correctly to iso-center,
go over the process and describe how and when you need them to hold
their breath. Do this several times! Explain that when they hold their
breath to simply and easily inhale and then to stop breathing. Explain
there is no need for a big gulp of air, or extra air, and do not force
the air to stay in the longs by bearing down. Demonstrate by
exaggeration of someone getting a big mouthful of air and then puffing
out your cheeks like you are really straining. Sounds silly and it is,
but education prior to the exam plays a huge roll in achieving a
successful exam. I also see sites that have recorded their own voices
and have changed the command to, " Take in a breath (pause two to three
seconds), stop breathing". This eliminates the phrase : Hold Your
Breath" which is the trigger to do just that " HOLD". Subconsciously
they equate "hold" with "Hold tightly" or "Hold Hard" thus triggering a
Valsalva maneuver.
Good luck figuring out how to educate your customers and setting up
your scan sequence to be more successful more often. Remember an
important part of the scan process is your scan parameters so please use
the ALARA principles when setting up any radiographic procedure.
Jack Risner
CT Clinical Product Specialist
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