Surgical Radiography Flashcards
Mobile C-arm fluoro includes
- C-arm with x-ray tube and image intensifier
- two tv monitors
Features of the mobile C-arm fluoro
- digital imaging and storage
- image hold feature
- image enhancement, masking and subtraction
Controls and operation modes of the mobile C-arm in fluoro
- mag mode
- pulse mode
- snapshot or digital mode
- automatic/manual exposure control
- foot pedal
- road mapping
C-arm movements
- In-Out lock: moves the c-arm front and back from the base
- wig-wag: enables the c-arm to wave side to side from the base
- lateral-parallel: c-arm “C” moves from AP to lateral position
- cephalad-caudad: angles tube and IR up or down the table
- up and down: raises and lowers the “C” of the c-arm
What does the in-out lock do?
In-Out lock: moves the c-arm front and back from the base
-forward and back
What does wig-wag do?
wig-wag: enables the c-arm to wave side to side from the base
-move from left to right
What does the lateral-parallel do?
lateral-parallel: c-arm “C” moves from AP to lateral position
What does the cephalad-caudad do?
cephalad-caudad: angles tube and IR up or down the table
What does the up and down movement do?
up and down: raises and lowers the “C” of the c-arm
C-arm control panels: collimator controls
Use these controls to position the shutters and iris as close to the area of interest as possible to minimize scatter radiation
Foot pedal for c-arm
- low dose fluoro (LDF): used to guide, position initial fluoro
- vascular foodswitch (to toggle between fluoro and subtraction mode)
- high dose fluoro (HDF)
Setup for C-arm
- Insert view station plug into wall outlet
- Connect the view station cable into the C-arm stand by aligning the red dots
- Connect the foot pedal cable to the C-arm stand by aligning the red dots
- Switch on the system at either the C-arm stand or view station
- Insert the key at the rear of the C-arm to enable radiation
The monitor stand is the
Patient work list
C-arm monitor worklist:
-in most OR suites, you are able to bring your RIS via ethernet cable or WI-FI
-if the network is down, you are also able to manually enter the patient information and send your images later
C-arm monitor dose report displays?
- dose
- demographics
- fluoro time (each c-arm will have an alarm one a max fluoro time has been reached)
- the image of all this is sent with the patients images to PACS
C-arm orientation and exposure patterns for a vertical PA:
- least exposure to the operator
- x-ray rube below
- I.I above patient
C-arm orientation and exposure patterns for a 30 degree C-arm tilt:
-increased exposure to face and neck by a factor of four
C-arm orientation and exposure patterns for a horizontal exposure:
-increased exposure at x-ray tube end
C-arm orientation and exposure patterns for a vertical AP orientation:
- must be avoided, increased exposure to head and neck
- tube and the top and I.I at the bottom
Surgical accessories and clothing:
- scrub clothes
- gown to cover scrub clothes
- hat or hood to cover all hair
- shoe covers
- mask
- (protective eyewear)
- (nonsterile gloves)
Equipment in surgery:
- clean equipment before and after OR procedures
- operational check
- proper equipment location:
- monitor in clear vision of surgeon
- locate power outlet
- not in way of traffic
What two positions should you use to minimize operator dose?
- vertical projection, PA position (x-ray tube under the patient/table)
- horizontal projection, AP position (operator standing on the side of the image instensifier)
- stand 6 feet away when possible
- use LIH (last image hold) features or intermittent fluoro when possible
OR personnel:
- surgeon
- surgical assistant
- anesthesiologist
- scrub nurse
- circulating nurse
- patient
- radiographer
Who’s responsibility is radiation protection?
OURS!
- MRT’s responsibility
- ensure staff is wearing lead aprons, give them enough time and notice to protect themselves
What is included in the sterile field?
- sterile corridor
- sterile instruments
- c-arm could be draped
- shower curtain drape
- temporary patient drape
Surgical asepsis in surgical radiography
- non sterile personnel must not come in contact with sterile personnel
- any contaminated sterile drape or cover must be reported and replaced
sterile gowns considered sterile
- from shoulder to level of sterile field
- at the sleeve from cuff to just above elbow
OR tables are considered sterile only at level of the _____
The table top
What do we do in surgical radiography?
- orthopedic surgeries
- urology procedures
- abdominal surgeries
- cardiac surgeries
Orthopedic procedures
- ORIF (open reduction, internal fixation)
- can be any bone, any joint
ORIF hip and femur
-setup
-c-arm is positioned on unaffected side
PA/AP position:
-approach the affected hip is approximately 45 degrees
-use rotation feature on c-arm to orientate the image
Lateral position:
-superoinferior (swing image intensifier towards you)
-along the axis of the patient unaffected leg
-adjust height over the hip joint
I.I is ____ dose when on the top
Less
Increase brightness you _____ pt dose
Increase patient dose (increasing technical factors)
Max fluoro time is ___ minutes
5
-in extreme, difficult cases, you can go over 5 min
Closer to the x-ray tube = ____ dose
More
Cardiac pacemaker insertion
- the surgeon makes an incision below the collarbone, and the pacemaker is inserted into the chest. Wires are threaded via the superior vena cava directly into the right atrium and/or right ventricle of the heart using fluoro to visualize
- the surgeon will perform tests of the pacemaker to ensure it is functioning correctly
- c-arm will most commonly be parked on right side of patient, opposite the surgeon
- x-ray tech will fluoro over the patient chest to demonstrate location of wires as they are directed towards the heart
Kidney stone removal
- there are several different ways urologists surgically remove kidney stones
- in most cases a catheter is inserted into the ureter and up to the kidney to the location of the stone. The urologist can simply remove small stones with an extractor, or break a large stone into smaller pieces to remove
- some OR suites are equipped with x-ray tables, other times a C-arm is required
- MRT provides fluoro and/or images over the patients kidneys or abdomen to visualize the stone or location of tools being used to remove the stone
- often, one the kidney stone is removed, the urologist uses x-ray contrast to check for any damage to the kidneys or ureters or to check for further blockage
- a stent is often placed in the affected ureter
Operative cholangiogram
- performed during a cholecystectomy to demonstrate the biliary duct system, drainage to the duodenum, or any residual stones in the biliary system
- the surgeon places a small catheter called a T-tube into the biliary ducts and injects a small amount of iodinated contrast
- the radiographer can capture images either using fluoro or digital spot images with a C-arm, or by taking plain abdomen images with a mobile until and grid- cassettes
Foreign body localization in surgery
- can utilize fluoro or “flare plate” radiography with mobile
- used for:
- incorrect sponge count post surgery
- incorrect instrument count post surgery
- locating metallic fragments (buckshot, bullet fragments)
