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Rad Pro 3 > Trauma Radiography > Flashcards

Trauma Radiography Flashcards

1
Q

What level of care is this?

Able to care for all levels of injuries

A

Level one

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2
Q

What level is this describing?

ER trained physician, nurses, and radiology staff on duty 24hs/day

A

Level 2

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3
Q

What level is this describing?

Provides surgical, radiographic, and fluorographic procedures, CT, MRI

A

Level 2

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4
Q

What level is this describing?

Smaller community hospitals

A

Level 3

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5
Q

What level is this?

Make transfer arrangements for more serious injuries

A

Level 4

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6
Q

What level has specially trained ER and OR staff

A

Level one

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7
Q

What level is this describing?

Typically is a limited teaching center as not all specialties are offered

A

Level 2

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8
Q

What level is this describing?

Have ER physician and radiographer on call at night

A

Level 3

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9
Q

What level is this describing?

Physicians’ roles are to assess, stabilize, and resuscitate

A

Level 3

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10
Q

What level is this describing?

Provides emergency radiographic, fluoroscopic, angiography, CT, MRI, NM, and US - 24 hrs/day

A

Level one

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11
Q

What level is this describing?

Highest level of emergency

A

Level one

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12
Q

T/F

Patients will be transferred to LEVEL 1 from level 2 only if necessary eg. Neurosurgery, pediatrics, ect.

A

True

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13
Q

What level is this describing?

Provide care for minor injuries or stabilizations

A

Level 4

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14
Q

What level are clinics?

A

Level 4

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15
Q

What level is this describing?

Have access to transfer facilities (helicopters)

A

Level one

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16
Q

What level is this describing?

Typically a teaching center offering all specialties

A

Level one

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17
Q

What is the biggest difference between level one and level 2 care?

A

-Biggest difference is that it doesn’t offer all specialties

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18
Q

What are the pros and cons of using this peice of equipment?

A

Advantages: Good for cross table positions-to get your obliques so you are always in line with the grid. And can adjust the SID
Disadvantage; table is very heavy

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19
Q

What are the advantages and disadvantages of using this equipment?

A

Disadvantage: Cannot adjust SID
Advantages: Do lateral, obliques, AP

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20
Q

What type of staff will be present with trauma cases in the room?

A

Trauma doctor, RT, RN

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21
Q

T/F

Trauma patients that arrive to the x ray room are stabalized

A

True

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22
Q

T/F

Trauma radiographs must be taken with minimal patient movement, requiring more maneuvering of the tube and image receptor (IR)

A

True

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23
Q

What are the 3 standards of best practice for trauma imaging?

A
  1. Perform quality diagnostic imaging procedures as requested
  2. Practice ethical radiation protection for self, patient, and other personnel
  3. Provide competent patient care
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24
Q

What aspects of patient care is the radiographer responsible for?

A

1.Not moving the patient excessively
2.Assess for changes in status,
3.Always communicate with patient (eye contact if patient alert-lean over collar on their side otherwise patient may try to move their head)

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25
Q

What are the common trauma views?

A

-XTL C-Spine
-AP Supine Chest
-AP Supine Pelvis

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26
Q

If a patient needs to be moved off the trauma board, what transfer is used?

A

Logroll if patient is moved off of board

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27
Q

How do we get IR underneath the patient for trauma views when the patient is on a trauma board?

A

-lift the entire board and put it underneath because it is radiolucent (lift at foot and head end)

Someone else has to lift so you can put the board underneath

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28
Q

What artifacts are seen in this image?

A

-ET tube
-Chest tube (for a PTX)
-Board artifact seen
-ECG leads (can move the leads if it’s a male patent)

Subcutaneous emphysema
-Rib fracture

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29
Q

Would this be a repeat?

A

Would not repeat because we can see the pathologies

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30
Q

Is this life-threatening? Why or why not?

A

-Life threatening because of the femoral arteries, possible spinal cord injuries and torn rectum (not a sterile environment-can cause infection to spread into the intestines)

-Pubic symph is torn apart
-Ischium is fractured
-Right ilium SI joint dislocated, torn bladder, torn rectum

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31
Q

What should you do if the trauma patient vomits?

A

If patient vomits do the log roll patient AND GET HELP

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32
Q

T/F

If patients are un stable they are accompanied by the nurse to the DI department

A

True

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33
Q

Where can MRT’s provide suction to?

A

We can suction orally and around the surface of tracheostomy tube

34
Q

What is the typical order for a Complete Spine Request?

A
  1. Lateral C-Spine
  2. Swimmer’s
  3. Lateral T-Spine
  4. Lateral L-Spine
  5. AP L-Spine
  6. AP T-Spine
  7. AP C-Spine
  8. Odontoid
  9. Oblique C-Spines (if appropriate equipment, or approved, or trauma views with compound angles)
35
Q

Would we get a better image with 220 than 180?

A

Yes!!! Less diverging beam, however you would need a higher technique!
(If you are using a focus grid, you would have to be within that range that is specified)

36
Q

What position should be done first in the trauma image of the C spine?

A

Do the lateral FIRST

37
Q

Why should the lateral position in a C-spine routine be done first?

A

To let the attending physician or Radiologist must rule out fracture or dislocation before other projections are attempted

38
Q

T/F

It is rare to see C7/T1 on lateral

A

True (Swimmer’s View often necessary)

39
Q

What patient and x-ray tube position is shown in this image?

A

-Dorsal decubiti’s position
-Right lateral position for the x ray tube

40
Q

What arm is raised in the Trauma C-spine swimmers view?

A

Arm closest to detector raised!!!
(place this arm in line with the c-spine)

41
Q

If the shoulder cannot be depressed enough to see C7/T1 in the swimmers view, what should be done?

A

-May require a 3° to 5° caudad angle if remote shoulder cannot be depressed enough

42
Q

If the dependent arm is injured can we raise the remote arm instead?

A

Yes-can use uninjured arm!!

43
Q

What types of filters are used for the trauma C spine views?

A

Wedge or ingot filter

44
Q

Why do we raise the dependant arm for trauma C spine views?

A

The reason why we lift the dependant arm is because if we used the remote, it would be harder to see the light collimation

45
Q

What position is shown here? What errors have been made?

A

Left Lateral swimmers view with L arm raised
-Could have extended their arm more
-Didn’t use an angle-we know this because we can see through the joint spaces

46
Q

How do you image the AP C-Spine Trauma?

A

Same as routine, only supine
Still get your angle from the lateral

15 degree cephalad angle-say you got it from the lateral

47
Q

How do you position a trauma C-spine odontoid?

A

Need to angle caudad
Remove any dentures
Angle the laser from the teeth to the base of skull and adjust the centering to the edge of the open mouth

48
Q

How do you image the C-spine oblique trauma?

A

Rotate the column 90 degrees and angle towards the midline of the table 45 degrees and then rotate the column more towards the patients head 15 degrees

49
Q

Can we use a grid with a compound angle?

A

NO!

50
Q

Which image used a compound angle?

A

B

51
Q

What cross table position is done for the T and L spines?

A

Dorsal decubitus position for laterals (XTL)

52
Q

What position should the forearms be in for the T and L spine?

A

-Bring forearms together in front of chest for both lateral T and L spines

53
Q

Why can’t you hug the arms around the chest for the cross table position for the T and L spine?

A

Hugging the chest may cause the fingers to be projected over the spine

54
Q

T/F

You cannot bend knees for trauma AP projections of the T and L spine

A

True

55
Q

When would we do a ventral decubitus position?

A

CROSS TABLE LATERAL RECTUM-for barium enema

56
Q

Patient presents on spine board. The AP and XTL images ordered for the L spine. What view would you do first? Why?

A

-Do AP first because it may change which lateral that we do

-Lateral doesn’t help us with the AP

57
Q

What positon should be done?

A

Left lateral position at 100 SID

58
Q

How should you image the trauma AP foot?

A

-CR perpendicular to the dorsal plane of foot
-Sponge under the calcaneus
-Use a 15 degree cephalad angle

59
Q

What errors have been made in this image of the trauma AP foot?

A

-Not perpendicular to the dorsal plane of the foot
-Marker not in a good place

60
Q

How do you get a true lateral of the trauma foot?

A

-Need to find the angled between lateral calcaneus and proximal head of 5th metatarsal and angle the CR perpendicular (do the same thing for the lateral ankle)

61
Q

What errors have been made in this trauma lateral foot?

A

-Foot not dorsiflexed
-Bad centering
-Turn the collimator
-Marker needs to be flipped in the direction of the toes and the marker flipped

62
Q

How do you demonstrate the proximal fibula (tib/fib joint) without any superimposition?

A

-45-degree lateral medial projection

63
Q

How do you demonstrate the distal fibula (mortise) without any superimposition?

A

-15-20 degree lateral medial projection

64
Q

How do you get a lateral hip when a patient cannot move (role on side or lift either leg)

A

Clements-Nakayama Modification

65
Q

How do you position for the Clements-Nakayama Modification?

A

Cross table of your hip, you go perpendicular to the femoral neck 45 degrees and then include a 15 degree angle (down) towards the table

66
Q

What positions are we demonstrating here?

A

Y scap on the left side or the right glenoid by centering different (this would produce less distortion than if we were to have them flat)

67
Q

T/F

For the trauma XTL skull you should put the head on a sponge

A

True

You have to make sure you build the skull up or you are going to clip

68
Q

What pathology is seen here? What is this caused by?

A

-Fluid in the sinus
-From the basal skull fracture

69
Q

How are we going to get a Ruggles method for skull on a C collar by using the OML?

A

Use the laser to angle from the OML (caudal) and include the entire skull (vertex to the base of skull-close to the shoulders)
OR
Using the TEA: Align the Top of ear attachment with the supraorbital margin and center between the vertex and the base of the skull

70
Q

T/F

ER doctor will “CLEAR” the spines before patient is taken off the board for the spine

A

True

71
Q

Why are flexion and extension ordered for the spine?

A

Flexion and extension views may be ordered to r/o instability

Good communication needed

This is good for ligament instability assessment

72
Q

Why is flexion and extension of the trauma spine halted? What would they do to assess mobility instead?

A

-If patient experiences -ain (extreme), and numbness in fingers or hands
-They would do a fluoroscopy in this case (see it in live action)

73
Q

How do you position normally for the the Caldwell trauma skull?

A

Line up the laser with the lower third of orbits and align to top of ear attachment

74
Q

If the OML is on a 20-degree angle, what angle would we use to get a Caldwell projection?

A

Use a 5 degree caudad angle

75
Q

-If the OML was 10 degree angle, what angle would we use to get a Caldwell projection?

A

Use a 5 degree cephalad angle

76
Q

What is the collimation for the waters facial bones?

A

Include all of the mandible to middle of the forehead to include all the orbits

77
Q

-Noramly for the waters when we are using the MML, what is the angle of the OML to the IR?

A

37 degrees from the IR

78
Q

What position is this for?

Whatever angle he gives us for the MML, the OML and the other angle has to equal 53

A

Waters

79
Q

A trauma patient in a collar requires a Water’s method to rule out facial bone fractures. The OML is measured at 20°. What angle is required for this image?

A

Answer: 33
OML=20
CR-OML=53
33 degrees cephalad needed
53-20=33

80
Q

T/F

CTA is becoming the norm for diagnosis

A

True

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