Mobile imaging Flashcards
CONSIDERATIONS BEFORE GOING TO PERFORM A MOBILE ?
Is the request correctly filled out?
Is the request justified for a chest x-ray?
Is the request justified for a mobile chest x-ray?
Has the patient had any previous imaging?
Is the request urgent?
Where are they?
Ward, ITU, Resus, Theatre, SCBU
Reasons for a portable CXR? Are many and should only be reserved for the sickest patients (those on ITU/CCU, HDU, acutely unwell, peri/post arrest) or those at risk/who pose a risk (barrier/reverse barrier)
WHEN WE GET TO THE PATIENT what do we do?
Can we identify the patient?
Are there relatives around the patient or other patients nearby?
What obstacles are in our way?
In and around the bed space
Lines
Artefacts
Staff?
Pt ID – can they do it themselves? Wristband?
In and around the bed space – curtains, table, chair, Zimmer frame, slippers (floor), traction, catheters, visitors, STAFF!
Lines – NGT’s, chest drains, IV/CVP lines, ECG, O2 tubing
Artefacts – blankets, clothing, hair, jewellery
WHAT SHOULD YOU TELL THE PATIENT?
Conscious vs. unconscious
Check details
Explain what you will be doing
“We need to put the x-ray board behind you, it is hard and cold but won’t be there for long”
Give clear instructions
Reassure!
Regardless of how alert (or not) your patient is, you MUST speak to them!
There is lots of evidence that those who are unresponsive can still hear. More than ever at this current time this is so important.
POSITIONING THE IR
Do we need to put the IR in anything?
Infection control (bag, pillowcase etc.)
Are we going to use Landscape or Portrait?
How are we going to get the IR behind the patient?
Can we move the patient? Can the patient move themselves?
Dead lift? Pull forwards? Pull sheet taut? Assistance?
Check the position/placement of the IR
Should be at the level of the patient’s shoulders
Feel either side. Don’t want to cut off the lungs.
Place IR in slide sheet after (makes it easier to get into position and remove at the end)
Consider MH and your H&S
Ensure that you can see/feel the IR
CXR PA ERECT CXR vs AP ERECT/SEMI/SUPINE CXR
PA erect CXR
Gold standard
Accurate assessment of fluid levels
Heart and mediastinum not magnified
AP erect/semi/supine
Acceptable if patient acutely unwell
Lung fields shortened
Heart and mediastinum magnified
Ribs and clavicles don’t appear as expected
Air/fluid levels cannot be fully appreciated
Ribs appear more horizontal
Clavicles are projected higher
There is no reason why, if a patient is able, not to do a PA CXR mobile – what might you need to consider when doing this mobile?
Heart and mediastinum widening on AP (orange and red arrows), underinflated lungs (green ovals on AP) which makes it appear as though there are bilateral interstitial infiltrates. Scapula not fully removed on AP (nor PA) and clavicles not equidistant (blue ovals).
Skin folds can also be mistaken for pathology (commonly pneumothorax)
Fluid levels erect and supine
On an erect CXR approx. 250mL of fluid is required before it can become evident (left), the same amount of fluid on a supine CXR (middle) would probably not be registered as it becomes more spread out across the lungs (bigger surface area and gravity). If you see fluid on a supine CXR (right) then there must be a lot of it
INFECTION CONTROL for mobile technique
Patient
Is your patient infectious? COVID
Barrier nursing
Reverse barrier nursing
You
What PPE might you require?
Equipment
Protecting the IR
Cleaning afterwards
Usually the equipment on certain areas (ITU, SCBU) doesn’t leave – dedicated units to prevent cross-contamination
“O” TO “U” SYSTEM mobile imaging
O - Observe
PQ – Position with Quality
R - Remove
S – Set X-ray Tube
T – Test Breathing
U – Use Prep
O - OBSERVE mobile imaging
Position
Are they straight? Or rotated?
Supine? Erect?
Artefacts
What are they attached to?
The patient
Assess them, are they alert?
What’s their breathing rate like?
At this stage we are simple observing our patient, not necessarily making any adjustments to their position
PQ – POSITION WITH QUALITY mobile imaging
Can we move the patient?
How? Which way do we need to rotate them?
Can we sit them up erect?
If the patient is comfortable they will be more likely to tolerate the examination
Note shoulder and hip position, can we move them so they are straight? How? Have we got anything to keep them in the optimal position? (Remember blankets etc. can be multifunctional if you don’t have the pads/sponges you are used to in the main rooms).
Are they supine? Do they need to be? Can we sit them up? Where are they within the bed? (Feet against footboard, slide them before sitting them erect).
Can they move themselves?! (Conscious patients only, but saves your back)
R - REMOVE mobile imaging
Artefacts can distract from pathology
Can external lines be safely moved to the side?
Is there anything else that might cause artefact?
Bear huggers/warmers, clamps
Grid? If this is needed ensure you follow the next step (‘S’) to avoid gridlines
Also consider anything that might make it difficult to position the IR
S – SET X-RAY TUBE mobile imaging
Which way do we need to angle?
Caudal
Cranial
How much?
Always check from the end of the bed
We will have placed the IR by this point, ensuring that we happy with its position (should be at the level of the patient’s shoulders, should feel some of IR either side to ensure lungs will be on – refer back to slide 7)
T - TEST BREATHING mobile imaging
Minimal inspirational effort can mimic pathology
Encourage the conscious patient to practice breath-hold
Mimic infection or atelectasis (do you remember what this is from last week?)
Not always practicable in unconscious patients (which is why you need to observe them, allows you to determine their breathing).
Encouraging a conscious patient to practice their inspiratory breath-hold can enable better inspiration on exposure, and allows the radiographer to assess the patient’s respiratory pattern
U – USE ‘PREP’ mobile imaging
Commences anode rotation prior to actual exposure
Minimise breath-hold
Allows radiographer to watch patient and take exposure at the optimal time
CVP Line
What is it?
Used to monitor the pressure in the central venous system
An early warning indicator
Used to administer drugs, never to be used for Contrast.
Inserted into the venous system, usually in the neck via the subclavian vein or the internal jugular vein, on rare occasions the femoral veins can also be used.
Passes through SVC to sit at junction of SVC and RA
Central venous pressure
