Surgical

Question 1

Is a dynamic experience. The challenges a radiographer encounters in the surgical suite are unique knowing the machinery and its capabilities and limitation is most important

Answer 1

Surgical radiology

Question 2

Surgical fluoroscopic procedures
- abdomen:
- chest-line placement:
- cervical spine:
- lumbar spine:
- hip:
-
-
Humerus:
-
-

Answer 2

Cholangiogra
Bronchoscopy
Anterior cervical discectomy and fusion
Lumbar spine
Cannulated hip screws or hip pinning, decompression hip screw
Femoral and tibial nailing
Extremitt fluoroscopy
Shoulder in beach chair position
Transsphenoidal resection of pituitary tumor
Femoral/tibial arteriogram

Question 3

Mobile surgical radiography procedures

Answer 3

Localization examinations of cervical, thoracic, and lumbar spine
Mobile extremity examination in OR

Question 4

• A surgeon, one or two assistants, a surgical technologist, an anesthesia provider, a circulating nurse, and various support staff surround the patient. These individuals, each with specific functions to perform, form the OR team.

Answer 4

Surgical team

Question 5

scrub their hands and arms, don a sterile gown and gloves over proper surgical attire, and enter the sterile field. The sterile field is the area of the OR that immediately surrounds and is specially prepared for the patient.

Answer 5

Sterile team members

Question 6

is a licensed physician who is specially trained and qualified by knowledge and experience to perform surgical procedures.

Answer 6

Surgeon

Question 7

is a qualified surgeon or resident in an accredited surgical educational program. The assistant should be capable of assuming responsibility for performing the procedure for the primary surgeon.

Answer 7

Surgical assistant (1st)

Question 8

is a nonphysician allied health practitioner who is qualified by academic and clinical training to perform designated procedures in the OR and in other areas of surgical patient care.

Answer 8

Physician assistant

Question 9

is a registered nurse (RN) who is specially trained to work with surgeons and the medical team in the OR.

Answer 9

Scrub nurse

Question 10

is responsible for maintaining the integrity, safety, and efficiency of the sterile field throughout the surgical procedure. The __ prepares and arranges instruments and supplies and assists the surgical procedure by providing the required sterile instruments and supplies. In some institutions, a licensed practical nurse (LPN) or RN may assume this role.

Answer 10

Certified surgical technologist (CST)

Question 11

do not enter the sterile field; they function outside and around it.

Answer 11

Nonsterile team members

Question 12

is physician (anesthesiologist) or certified RN anesthetist who specializes in administering anesthetics.

Answer 12

Anesthesia provider

Question 13

is preferably an RN. The __ monitors and coordinates all activities within the OR, provides supplies to the CST during the surgical procedure, and manages the care of the patient.

Answer 13

Circulator

Question 14

role in the OR is to provide intraoperative imaging in a variety of examinations and with various types of equipment.

Answer 14

Radiographers

Question 15

•The OR team may also include biomedical technicians, monitoring technologists, and individuals specialized in equipment or monitoring devices necessary during the surgical procedure.

Answer 15

Others

Question 16

__ may change from institution to institution but should be available for review, understood, and followed by all staff members. Although some small variances in protocol exist among institutions, there are common standards.

Answer 16

Surgical attire protocols

Question 17

__ should never be worn within semirestricted or restricted areas of the surgical suite.
__ should be donned at the beginning of each shift in the OR suite and as needed if the attire becomes wet or grossly soiled.
__ should be changed to reduce the potential of cross-infection.
__ including shoe covers is unattractive and can also be a source of cross-infection or contamination.

Answer 17

Street clothes,
Clean, fresh attire,
Soiled surgical attire,
Blood-stained or soiled attire

Question 18

•Occupational Safety and Health Administration (OSHA) regulations require __ to be worn when contamination from blood or body fluids is possible.

Answer 18

Protective eyewear

Question 19

should be worn at all times in the OR but are not necessary in all semirestricted areas.

Answer 19

Mask

Question 20

should be worn when contamination from blood or body fluids can be reasonably anticipated. Shoe covers should be changed whenever they become torn, soiled, or wet and should be removed before leaving the surgical area.

Answer 20

Shoe covers

Question 21

should be worn to cover and contain hair at all times in the restricted and semirestricted areas of the OR suite. Hoods are also available to cover hair, such as facial hair, that cannot be contained by a cap and mask.

Answer 21

Caps

Question 22

should be worn when contact with blood or body substances is anticipated

Answer 22

Gloves

Question 23

__ and __ should be worn at all times.

Answer 23

Radiation badge, proper identification

Question 24

•A person with an acute infection, such as a cold, open cold sore, or sore throat, is known to be a carrier of transmittable conditions and ___ within the OR suite.

Answer 24

should not be permitted

Question 25

The CST __ open toward the radiographer. The radiographer should hold one end of the IR while placing the other end of the IR into the sterile IR cover. The CST grasps the IR and wraps the protective cover securely

Answer 25

holds a sterile IR cover

Question 26

After the exposure is made, the radiographer needs to retrieve the IR. The radiographer must be wearing __ to accept a covered IR that has been in the sterile field or under an open incision. The protective cover is possibly contaminated with blood or body fluids and should be treated accordingly.

Answer 26

gloves

Question 27

Lengthy or complex procedures increase the chance of sterile field contamination. Physical limitations, such as crowding, poor lighting, and staffing levels, are also a consideration. The floor is always considered contaminated.

Answer 27

The radiographer should avoid placing IRs, lead aprons, and shields on the floor.

Question 28

Used for extremity examinations in OR

Answer 28

C-arm/fluoroscopic system and mini mobile c-arm

Question 29

The x-ray equipment should be __ after each surgical case. If possible, the radiographer should __ the mobile image machine, including the base, in the OR suite, especially when the equipment is obviously contaminated with blood or surgical scrub solution. __ within the OR helps reduce the possibility of cross-contamination.

Answer 29

cleaned, clean, Cleaning

Question 30

Operative cholangiography Px position C-arm position Ss

Answer 30

Supine Centered over right side of abdomen just below rib line Use true pa projection, so C-arm may have to be angled or tilted to align with px anatomy Contrast filled biliary system

Question 31

Or chest Px position C-arm position Ss

Answer 31

Supine Cover with sterile cover, entire sterile field perpendicular to px, for line placement C-arm scans from point of insertion to catheter end Anatomy of chest cavity Any instrumentation introduced during procedure

Question 32

C-spine Px position C-arm position- ap C-arm position- lateral Ss

Answer 32

Supine, chin elevated, neck in flexion C-arm position- ap: cover with sterile drape, entire field perpendicular to px, tilt c-arm 15* cephalad, center beam over c-spine C-arm position-lateral: rotate c-arm to place beam parallel to floor, angle if required to obtain true lat projection, center spine in image Affected area of c-spine, hardware inserted

Question 33

Lumbar spine Px position C-arm position- pa C-arm position- lateral Ss

Answer 33

Prone lying on rolls or frame to flex spine, arms place on boards to bring out of FOV C-arm Pa projection- cover with sterile drape, enters field perpendicular to px center beam over affected area raise C-arm to leave enough room for surgeon to work C-arm lat projection- rotate into lateral position raise or lower to bring spine into center of monitor Affected area of spine, including bodies disk spaces spinous process lamina pedicles and facets

Question 34

hip Px position C-arm position Ss

Answer 34

Supine with legs abducted affected leg in traction arms on affected side crossed over body and kept out of FOV Between px legs, beam center over affected hip rotate as needed to demonstrate hardware relationship to anatomy Proximal femur and hip joint, including acetabular rim femoral head and neck lesser and greater trochanter and hardware

Question 35

Femur nail Px position

Answer 35

Rod or nail inserted into intralmedullary (IM) canal to reduce fracture Inserted either antegrade through greater thorachanter or retrograde through popliteal notch Antegrade insertion (supine or lateral)

Question 36

Tibia nail Px position C-arm position Ss

Answer 36

Supine, knee flexed to allow acess to tibial tuberosity On opposite side of table from injured leg, cover with sterile drape, enter field perpendicular to px, center beam over leg, tilt to match angle of leg, center beam on fracture site and turn wheels horizontally to allow machine to move down the shaft of the leg

Question 37

Humerus Px position C-arm position Ss

Answer 37

Supine or reclining, injured arm resting on mayo stand, shoulder of affected arm off side of table Cover with sterile drape, enter field parallel or at 45* angle to px, surgeon assistant will rotate arm medially and flex eblow 90*, rotate c-arm to accomodate px (arm) angle on lat and pa projection, center beam on humerus

Question 38

Transphenoid resection of pituitarty tumor Px position C-arm position

Answer 38

Supine, head maybe held off end of table in halo, chin extended, head tilt toward surgical team Perpendicular to px, rotate to lat, tilt and rotate to obtain true lat, center beam on temporal bone, sella in center, place IS, closer to skull to magnify pituitary region

Question 39

Femoral/tibial arteriogram Px position C-arm position

Answer 39

Supine, lower limb may be rotated to remove superimposition from vessels Cover with sterile drape, enter perpendicular to px, leg in center of monitor, turn wheels horizontally to allow machine to move L or R without taking leg out of FOV, use road-mapping and subtraction feature

Question 40

Or mobile procedures * Lateral projection of cervical spine * thoracic or lumbar spine - __ - __ * extremity examinations

Answer 40

Lateral projections Pa projections

Question 41

Cervical spine Px position Ir and mobile unit position

Answer 41

Upright, supine, prone, head held in traction device to align spine, chin elevated Ir holder covered in sterile drape, position ir on lateral side of px centered to c-spine, heam horizontal and perepndicular to ir, cr enter center of ir to prevent grid cut-off

Question 42

Thoracic or lumbar spine Px position Ir and mobile unit position- lateral and pa Ss

Answer 42

Prone or supine, arms by head, frame used to support chest and abdomen and flex spine Lateral- ir in holder covered with sterile drape, position along side of px, center to region of spine of interest, cr perpendicular to ir and parallel to floor Pa- Place ir in slot under table and center to spine, cover field with sterile drape, center CR to IR and perpendicular to long axis of spine Spine in pa and lateral projection Spine bodies, spinous processes, facets and lamina, hardware, instrumentation

Question 43

Extremity examinations Px position Ir and mobile unit position

Answer 43

Varies with procedure and part, surgeon may choose to support limb in desired position and hold ir, use of holder and positioning aides reduces exposure to surgeon Unit approaches perpendicular to px, tube, field, and IR may all be covered in sterile drape, if field is draped, surgeon will usually mark or point to center of image Pertinent anatomy in correct alignment All hardware