Lecture 8; Mobile Radiography Flashcards
What does PACU stand for?
Post-Anesthetic Care Unit or RR
What does CCU stand for?
Coronary Care Unit
What are the special care units in the hospital?
Special Care Units: ICU, NICU, PACU (Post-Anesthetic Care Unit or RR), CCU (Coronary Care Unit)
Read over the list of places where MRTs are present:
Emergency Department
Special Care Units: ICU, NICU, PACU (Post-Anesthetic Care Unit or RR), CCU (Coronary Care Unit)
Patient Rooms
OR - Surgical Suites
Surgical Day Care Units
Morgue
T/F
DR portables changes certain protocols.
True
What type of imaging has the highest occupational exposures for MRTs
Mobile radiography
How should you stand when the x ray tube is exposing with portable machines?
3 meters at 90 degrees
T/F
Lead is not required with mobile radiography.
False; lead is requried
Even though it may be different when we get into placement
T/F
When doing mobile imaging, you should position yourself perpendicular to the central ray
True
Who is responsible if the surgeon is not wearing lead?
The MRT
What are the technical considerations when it comes to mobile imaging?
- SID
- Grid
- Patient Condition (fluid vs. air, cast)
What are APRs?
Preset anatomic programs
What are the two technical factors that you can adjust in mobile radigraphy besides the SID?
kVp and mAs only
There is no reciprocity with mobile equipment
TRUE!!!!!!
How do you decrease motion in mobile radiography?
Increase your kVp by 20 and decrease you mAs by half
What is the minimum source to patient distance in mobile radiography?
-Minimum source to patient distance is 30 cm
If you increase your SID from 40”-72”, how much do you need to increase the exposure?
3.24 times more exposure
Inverse Square Law
72 divided by 40 squared
If you increased your SID from 50”-72”, how much would you need to increase your exposure?
2.07 times more exposure
What are the 3 benefits of larger SIDs?
- Less beam divergence-less anatomy cut off
- Increased SR
- Less dose to the patient
What are the 3 benefits of smaller SIDs?
- Less wear on the tube
- Can use it to our advantage for beam divergence
- Shorter exposure times….less motion
If you were to pick a grid for a portable, what would you pick?
6:1 Parallel grid
When should you use a grid?
When the anatomy is > 10cm (used when greater than 10)
T/F
The grid must be perpendicular and centered to the Central Ray
True
Off-centering of how much will produce cut off on a focused grid?
2.5 cm will produce grid cut-off on a focused grid
What are the benefits of virtual grids?
1.Significant weight reduction
2.Reduces grid misalignment issues
3.Potential for dose reductions (if we are not worrying about being misaligned)
If a patient has a Fiberglass cast, how much of an increase needs to be made to exposure?
25% to 30% (or on average 3-4 kVp)
If a patient has a Plaster cast, how much of an increase needs to be made to exposure?
Medium – 50% (go up 5 kVp)
Large plaster – 100% (go up10 kVp)
If plaster is wet, what changes need to be made to exposure?
You need to go up another step in mAs
What would be the technique for a large, wet plaster cast? Original technique is 60 kVp at 2 mAs. What technique are we using?
70 at 2.5 mAs
What are the steps of mAs starting from 1?
1, 1.25, 1.6, 2, 2.5, 3.2, 4, 5, 6.4
When should you wash your hands?
- When hands are soiled
- After coming in contact with blood or body fluids
- Before beginning invasive procedures
When should hand sanitizer be used?
To be used when hands do not appear to be soiled
When should a hand hygeiene proceedure be done?
- Before initial patient or patient environment contact
- Before aseptic procedure
- After body fluid exposure
- After patient or patient environment contact, after gloves are removed
How long should hand hygeiene be preformed for?
15 seconds
What are the 2 Types of Patients are cared for in Isolation Units?
1) Patients who have an infectious microorganism (disease) that can be spread to HCW (keeps HC and other patients safe)
2) Patients who need protection from potentially lethal microorganisms
What are the 3 different methods of transmission of virses/bacteria/illness?
Contact
Airborne
Droplet
How are contact diseases spread?
- direct contact
- indirect contact (fomites)
What PPE is needed to contact precautions?
Gloves
Gown
Gown only needed if patient is an inpatient
What are the common contact diseases?
Hep A, HIV, MRSA, VRE, C- Diff, Scabies, Lice, ESBL
T/F
No mask is required for contact precautions
True
How are droplet diseases spread?
coughing, sneezing, talking
T/F
No gloves or gown required for droplet precautions
True
What are the common droplet infections?
Influenza, mumps, most pneumonias, meningococcal meningitis, COVID-19
What PPE is required for droplet precautions?
Surgical Mask with Visor or Goggles (within 3 ft)
What PPE is required for airborne precautions
N95 mask
What are the common airborne infections?
SARS, chicken pox, TB
What mode of transmission is this describing?
Microbes remain suspended in air
Airborne
What PPE is required for patients who need protection from potential lethal microorganisms?
Gown
Gloves
Mask
Cap
Boot Covers
What are some other names for Reverse Isolation?
Expanded Precautions/Strict Isolation
What type of patients require reverse isolation?
Transplant recipients (that are in failure), AIDS patients, burn patients
Why would burn patients require reverse isolation?
with burn patients, they have lost the first layer of protection of skin
What are the chronological steps of prior to preforming a mobile exam?
- Announce your presence to nursing staff
- Ensure correct patient (2 forms of ID): Don’t bring in portable yet
- Introduce yourself and explain exam
- Prepare room (move chairs, angle bed
- Ask others to leave room
- Bring in mobile and begin positioning
Why do you need to announce your presence tto the nursing staff prior to communicating with the patient?
Procedure may not have been completed yet, nurse may not want to be present, nurse can provide a patient history, nurse can assist (nurse can help to lift the patient).
Watch the following videos
http://youtu.be/TNPtqwpc5Iw
http://youtu.be/DSH8tU_r7MI
What should be placed over the detector during mobile examinations? Why?
Pillow-case or plastic bag
-To protect the detector
-Pillowcase; patient comfort, slides easier than plastic bag
Do you need to announce “X-ray” every time you preform a mobile exam?
Yes
If the patient is semi-supine, what direction would the arrow be facing?
Sideways (out)
T/F
When moving ECG lines off the patient, MRT’s are only allowed to touch the outside of the gown
True
(nurses can go under the gown)
When is supine imaging reccommended for portable exams?
-initial post-op in ICU (coming from the OR and not awake yet)
-line or feeding tube placement (because stomach may be down to the pelvis if asthenic)
-patient has a femoral line (may kink the line)
-patient is too unstable
-hip or spine fractures, patient in traction
What type of imaging is best for portable chest x rays?
Erect imaging
Patient has a HICMAN; what position are you doing?
Try to do erect
T/F
Detector or cassette is often landscape or crosswise for larger men
True
T/F
Detector or cassette is mainly portrait or lengthwise for women
True
When you are doing feeding tube chest imaging, what orientation should the detector be in?
Always portrait
Where should the CR be in relation to the sternum in mobile imaging of the chest?
CR perpendicular to sternum
If you are imaging a larger patient, and you don’t know how wide you need to collimate, what is a good landmark to collimate out to?
Collimate to middle of humeral heads
T/F
NEVER remove splints without permission
True
Document if splint was unable to be removed
If you are allowed to remove a splint, what should you do prior to removing the boot?
Deflate the boot
When moving fractured extremities, where should you support?
support proximal and distal to fracture site
What movements should you avoid doing on a patient following an arthroplasty?
-Never cross patient’s legs (often pillow between legs)
-Never flex hip past 90 degrees
How much collimation do you need past the arthroplasty prosthesis
Need at least 1” past metal prosthesis
(if you don’t get this, you need to repeat or take another image)
What do the red and yellow arrows measure?
-They measure the distance from the red and the yellow to tell if they are equal (space is starting to wear out)
What do the blue arrows point to?
-Blue arrows; stress response reaction (will turn into a fracture right through the femur)
What is located in between a metal hip prosthesis?
In between the head is the spacer=Plastic device that allows the metal to move freely
What are the three Positioning Principles for Mobile Radiography of Extremities?
- Principle 1:Two Projections - 90˚ to each other
- Principle 2: Entire structure or area of interest on the IR
- Principle 3: Maintain Safety! (Physical and Radiation)
What image/(s) need to be done for Constipation (fecal impaction, fecal loading) on a portable?
Supine imaging
What image/(s) need to be done for Ascites on a portable?
Supine image
What image/(s) need to be done for free air on a portable?
Left lateral decubitus and supine
What image/(s) need to be done for a foreign body on a portable?
Supine and lateral (to figure out where it was)
What image/(s) need to be done for FT, NG tube placement on a portable?
Supine image
T/F
All supine portable x rays should include an arrow
True
What PPE should be worn/done when imaging neonates?
Hand hygiene, gown, glove, mask, disinfect portable
What is a quick and efficient to reduce risk of hypothermia with neonates while imaging?
IR – in tray under isolette OR cover with warm soft blanket
What is one of the biggest risks assosiated with neonates?
Hypothermia is one of the biggest risks
T/F
You should never put a marker on the sliding, under the table IR when imaging neonates.
True
