Trauma Radiography Flashcards
What level of care is this?
Able to care for all levels of injuries
Level one
What level is this describing?
ER trained physician, nurses, and radiology staff on duty 24hs/day
Level 2
What level is this describing?
Provides surgical, radiographic, and fluorographic procedures, CT, MRI
Level 2
What level is this describing?
Smaller community hospitals
Level 3
What level is this?
Make transfer arrangements for more serious injuries
Level 4
What level has specially trained ER and OR staff
Level one
What level is this describing?
Typically is a limited teaching center as not all specialties are offered
Level 2
What level is this describing?
Have ER physician and radiographer on call at night
Level 3
What level is this describing?
Physicians’ roles are to assess, stabilize, and resuscitate
Level 3
What level is this describing?
Provides emergency radiographic, fluoroscopic, angiography, CT, MRI, NM, and US - 24 hrs/day
Level one
What level is this describing?
Highest level of emergency
Level one
T/F
Patients will be transferred to LEVEL 1 from level 2 only if necessary eg. Neurosurgery, pediatrics, ect.
True
What level is this describing?
Provide care for minor injuries or stabilizations
Level 4
What level are clinics?
Level 4
What level is this describing?
Have access to transfer facilities (helicopters)
Level one
What level is this describing?
Typically a teaching center offering all specialties
Level one
What is the biggest difference between level one and level 2 care?
-Biggest difference is that it doesn’t offer all specialties
What are the pros and cons of using this peice of equipment?
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
What type of staff will be present with trauma cases in the room?
Trauma doctor, RT, RN
T/F
Trauma patients that arrive to the x ray room are stabalized
True
T/F
Trauma radiographs must be taken with minimal patient movement, requiring more maneuvering of the tube and image receptor (IR)
True
What are the 3 standards of best practice for trauma imaging?
- Perform quality diagnostic imaging procedures as requested
- Practice ethical radiation protection for self, patient, and other personnel
- Provide competent patient care
What aspects of patient care is the radiographer responsible for?
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)
What are the common trauma views?
-XTL C-Spine
-AP Supine Chest
-AP Supine Pelvis
If a patient needs to be moved off the trauma board, what transfer is used?
Logroll if patient is moved off of board
How do we get IR underneath the patient for trauma views when the patient is on a trauma board?
-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
What artifacts are seen in this image?
-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
Would this be a repeat?
Would not repeat because we can see the pathologies
Is this life-threatening? Why or why not?
-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
What should you do if the trauma patient vomits?
If patient vomits do the log roll patient AND GET HELP
T/F
If patients are un stable they are accompanied by the nurse to the DI department
True
Where can MRT’s provide suction to?
We can suction orally and around the surface of tracheostomy tube
What is the typical order for a Complete Spine Request?
- Lateral C-Spine
- Swimmer’s
- Lateral T-Spine
- Lateral L-Spine
- AP L-Spine
- AP T-Spine
- AP C-Spine
- Odontoid
- Oblique C-Spines (if appropriate equipment, or approved, or trauma views with compound angles)
Would we get a better image with 220 than 180?
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)
What position should be done first in the trauma image of the C spine?
Do the lateral FIRST
Why should the lateral position in a C-spine trauma be done first?
To let the attending physician or Radiologist must rule out fracture or dislocation before other projections are attempted and to see what angle is needed for AP and obliques
T/F
It is rare to see C7/T1 on lateral
True (Swimmer’s View often necessary)
What patient and x-ray tube position is shown in this image?
-Dorsal decubiti’s position
-Right lateral position for the x ray tube
What arm is raised in the Trauma C-spine swimmers view?
Arm closest to detector raised!!!
(place this arm in line with the c-spine)
If the shoulder cannot be depressed enough to see C7/T1 in the swimmers view, what should be done?
-May require a 3° to 5° caudad angle if remote shoulder cannot be depressed enough
If the dependent arm is injured can we raise the remote arm instead?
Yes-can use uninjured arm!!
What types of filters are used for the trauma C spine views?
Wedge or ingot filter
Why do we raise the dependant arm for trauma C spine views?
The reason why we lift the dependant arm is because if we used the remote, it would be harder to see the light collimation
What position is shown here? What errors have been made?
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
How do you image the AP C-Spine Trauma?
Same as routine, only supine
Still get your angle from the lateral
15 degree cephalad angle-say you got it from the lateral
How do you position a trauma C-spine odontoid?
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
How do you image the C-spine oblique trauma?
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
Can we use a grid with a compound angle?
NO!
Which image used a compound angle?
B
What cross table position is done for the T and L spines?
Dorsal decubitus position for laterals (XTL)
What position should the forearms be in for the T and L spine?
-Bring forearms together in front of chest for both lateral T and L spines
Why can’t you hug the arms around the chest for the cross table position for the T and L spine?
Hugging the chest may cause the fingers to be projected over the spine
T/F
You cannot bend knees for trauma AP projections of the T and L spine
True
When would we do a ventral decubitus position?
CROSS TABLE LATERAL RECTUM-for barium enema
Patient presents on spine board. The AP and XTL images ordered for the L spine. What view would you do first? Why?
-Do AP first because it may change which lateral that we do
-Lateral doesn’t help us with the AP
What positon should be done?
Left lateral position at 100 SID
How should you image the trauma AP foot?
Get the IR on a spounge against the plantar surface of the foot
-Angle the tube to that the CR is perpendicular to the arch
What errors have been made in this image of the trauma AP foot?
-Not perpendicular to the dorsal plane of the foot
-Marker not in a good place
How do you get a true lateral of the trauma foot?
-Put the foot on a sponge
-Turn the IR so that its parallel to the lateral calcaneus and the 5th metatarsal and angle the tube to be perpendicular
What errors have been made in this trauma lateral foot?
-Foot not dorsiflexed
-Bad centering
-Turn the collimator
-Marker needs to be flipped in the direction of the toes and the marker flipped
How do you demonstrate the proximal fibula (tib/fib joint) without any superimposition? (trauma)
-45-degree lateral medial projection
How do you demonstrate the distal fibula (mortise) without any superimposition?
-15-20 degree lateral medial projection
How do you get a lateral hip when a patient cannot move (role on side or lift either leg)
Clements-Nakayama Modification
How do you position for the Clements-Nakayama Modification?
Cross table of your hip, go perpendicular to the femoral neck by pivoting 45 degrees and then include a 15 degree angle down towards the table. Then match the IR.
What positions are we demonstrating here?
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)
T/F
For the trauma XTL skull you should put the head on a sponge
True
You have to make sure you build the skull up or you are going to clip
How are we going to get a Ruggles method for skull on a C collar by using the OML? The TEA?
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
T/F
ER doctor will “CLEAR” the spines before patient is taken off the board for the spine
True
Why are flexion and extension ordered for the spine?
Flexion and extension views may be ordered to r/o instability
Good communication needed
This is good for ligament instability assessment
Why is flexion and extension of the trauma spine halted? What would they do to assess mobility instead?
-If patient experiences -ain (extreme), and numbness in fingers or hands
-They would do a fluoroscopy in this case (see it in live action)
How do you position normally for the the Caldwell trauma skull?
Line up the laser with the lower third of orbits and align to top of ear attachment
If the OML is on a 20-degree angle, what angle would we use to get a Caldwell projection?
Use a 5 degree caudad angle
-If the OML was 10 degree angle, what angle would we use to get a Caldwell projection?
Use a 5 degree cephalad angle
What is the collimation for the waters facial bones?
Include all of the mandible to middle of the forehead to include all the orbits
-Noramly for the waters when we are using the MML, what is the angle of the OML to the IR?
37 degrees from the IR
What position is this for?
Whatever angle he gives us for the MML, the OML and the other angle has to equal 53
Waters
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?
Answer: 33
OML=20
CR-OML=53
33 degrees cephalad needed
53-20=33
T/F
CTA is becoming the norm for diagnosis
True
