Transcript Surgical and Portable Radiography

Mobile and Surgical Radiography
RAD 113
Summer 2015
The images in the following presentation follow
the “fair use” rules of the U.S. Copyright law.
Objectives
On completion of this class, you should be able to:
• Describe the use of portable radiographic and fluoroscopic units.
• Identify the steps followed during bedside radiography:
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Technical Considerations
Communication and Patient Care
Infection Control
Isolation Considerations
Initial Procedures
Examination
Patient Considerations/Skin Safety
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Surgical Team
Proper Surgical Attire
Operating Room Attire
Equipment Preparation and Cleaning
Sterile Fields
Communication
• Identify the steps followed during surgical radiography:
• Understand Radiation Protection procedures for:
▫ Patient
▫ Radiographer
▫ Other
Mobile Radiography
• Principles of Mobile Radiography
▫ Mobile radiography using transportable
radiographic equipment allows imaging services to
be brought to the patient.
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Patient rooms
Emergency departments
Intensive care units
Surgery and recovery rooms
Nursery and neonatal units
Mobile X-Ray Machines
• Vary in their exposure controls and power
sources (or generators)
▫ Typical machines have controls for setting kVp
and mAs
▫ Maximum settings differ among manufacturers
• AEC
• Computed Radiography
• Digital Radiography
Technical Considerations
• Optimal Mobile Examinations:
▫ Grid
 Level, centered to central ray, correctly used at
recommended focal distance.
▫ Anode Heel Effect
 Causes a decrease in image density under the anode side
of the tube.
 Heel effect more pronounced with:
 Short SID
 Larger field size
 Small anode angles
▫ Source-to-Image receptor Distance (SID)
 Should be maintained at 40 inches for most exams.
▫ Exposure Charts
 Should be available for use with every mobile machine.
Accurate Grid Position in Mobile
Radiography
Communication and Patient Care
• Communication with:
▫ Nurse
▫ Other members of the health care team
▫ Patient
 AIDET
▫ Family members
• Patient Care
▫ Effective communication
▫ Compassion
▫ Recognizes and meets patient’s needs
Infection Control
• Chain of Infection
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Host
Infectious microorganism
Mode of transmission
Reservoir
• Nosocomial Infections
▫ Hospital-acquired condition
• Compromised Patients
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Hospital patients have a greater sensitivity to
infection
• Standard Precautions
Isolation Considerations
1. Patients who have infectious microorganisms
that could be spread to health care workers
and visitors.
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Gown, cap, mask, shoe covers, and gloves
2. Patients who need protection from potentially
lethal microorganisms that may be carried by
health care workers and visitors.
▫ Follow institutional policy
▫ Reverse Isolation
Isolation Considerations
• Wash hands with warm soapy water before putting
on gloves.
• Don protective apparel.
• X-ray machine taken into room and moved into
position.
• Place IR in Rad Bag.
• Place lead shield in Rad Bag before placing on
patient.
• Proper removal and disposal of Rad Bags and
protective apparel worn by radiographer.
• Proper cleaning of equipment.
• Wash hands before leaving the patient’s room.
Initial Procedures
• Ensure all necessary equipment is on machine
▫ IR, grid, tape, markers
• Ensure machine is charged
• Before entering the patient’s room with the machine:
▫ Announce your presence to the nursing staff, and ask for
assistance if needed.
▫ Introduce yourself
▫ Verify the correct patient
▫ Verify the correct exam
 Explain the exam
▫ Observe medical equipment in the room and move if
necessary.
▫ Ask family members and visitors to leave
 Children are the exception
Examination
• Move obstacles in room
• Adjust lighting, if necessary
• Position of machine in the room
▫ Patient supine
▫ Patient erect
▫ Lateral and/or decubitus radiographs
• Proper IR and tube alignment
• CR to center of the IR
• Collimation
Patient Considerations
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Patient assessment
Patient mobility
Fractures
Interfering devices
Positioning and asepsis
Neonates
Orthopedic patients
Patient Assessment
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Level of alertness
Respiration
Communication
Ability to cooperate/any limitations
• A thorough examination of the patient’s
condition and room allows the radiographer to
make necessary adaptations to ensure the best
possible patient care and imaging outcome.
Patient Mobility
• Assess patient’s ability to move or tolerate
mobility
• Gentleness and caution
• Check with nursing staff or physician
• Broken limbs and/or surgical repaired limbs
• Inappropriate movement of the patient
Fractures
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Simple fractures
Multiple fractures
Traction
Conscious vs. Unconscious patients
Critical Thinking and Analytical Reasoning
ASK FOR HELP!
Interfering Devices
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Wires
Tubes
Oxygen Masks
Splints
Hardware
Traction
Skin Safety
• Rad Bags
▫ Skin integrity
▫ Skin tears
 Infection
• Communication
• Ask for help!
Positioning and Asepsis
• Positioning:
▫ IR is perceived as cold, hard, and uncomfortable
▫ Warn the patient of possible discomfort
▫ Assure the patient the exam will go as quick as
possible
• Asepsis:
▫ Rad Bag
▫ Cloth
▫ Proper cleaning of contaminated IR and equipment
Neonates
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Radiation protection
Proper handling
Proper central ray placement
Collimation
Immobilization
Chest Radiographs
▫ Not intubated: keep head and neck straight
▫ Intubated: do NOT move head and neck
 Could inadvertently advance an endotracheal tube
too far into the trachea
Orthopedic Patients
• Assessment of patient is key
• Communication
• If able to move, support limb above and below
fracture site.
• Get help, if needed
• Move tube and IR versus the patient
• Radiation Protection
Radiation Protection
• TIME, DISTANCE, SHIELDING
• Radiographer must wear a lead apron
• Stand as far away from patient, x-ray tube,
and useful beam as possible.
▫ Minimum of 6 feet
▫ Lowest amount of scatter radiations occurs at a right
angle from the primary x-ray beam.
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Proper technical factors
Lead protection provided for anyone in the room
Lead protection for the patient
SID should be maintained at 40 inches
▫ Source-to-Skin Distance (SSD) cannot be less than 12
inches
Surgical Radiography
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Dynamic experience
Unique challenges
Capabilities and limitations of equipment
Communication
Common procedures
Familiarity with equipment
Teamwork
Preparedness
Standard health and safety protocols
Surgical Team
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Surgeon
Assistants (1-2)
Surgical Technologist
Anesthesia provider
Circulating nurse
Various support staff
• The surgical team is subdivided, according to the
functions of its members, into sterile and nonsterile teams.
Sterile Team Members
• Scrub hands and arms, don a sterile gown and
gloves over proper surgical attire, and enter the
sterile field.
• Work in sterile environment and only handle
sterile items.
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Surgeon
Surgical Assistant
Physician Assistant
Scrub Nurse
Certified Surgical Technologist (CST)
Non-Sterile Team Members
• Do not enter the sterile field; they function
outside and around it.
• Maintain sterile techniques during procedure,
but handle supplies and equipment that are not
sterile; follow aseptic technique.
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Anesthesia provider
Circulator
Radiographers
Others
Proper Surgical Attire
• Common standards:
▫ Proper facility design and surgical attire
regulations
▫ Infection control practices
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Personal fitness for work
Skin disinfection
Preparation of personnel hands
Surgical attire
Personal technique
Daily body cleanliness and clean hair
Operating Room Attire
• Street clothes-never worn within semi-restricted
or restricted areas of the surgical suite.
• Clean, fresh attire-donned at the beginning of
each shift in the OR and as needed if attire
becomes wet or soiled.
• One time wear of attire.
• Underclothing should be clean and totally
covered by the scrub attire.
Other Aspects of Proper OR Attire:
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Protective eyewear
Masks
Shoe covers
Caps
Gloves
Radiation badge
Identification
Personal hygiene
Dance of the Operating Room
• Maintain sterile field in the OR
• Proper adherence to aseptic technique
• Infection control
▫ All levels
• Non-sterile team members:
▫ Never reach over sterile field
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Sterile drape
Sterile cover on c-arm
Notify OR staff if sterility is compromised
Communication
Proper IR handling in the sterile field
Enemies of the sterile field
Equipment in the OR-Technical
• Dedicated radiologic equipment
• C-arm
• Mobile machine (portable radiography)
• No matter what equipment used, you must:
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Demonstrate knowledge of routine positioning
Demonstrate knowledge of radiographic equipment
Manipulate radiographic equipment
Understand the imaging process
Demonstrate critical thinking and problem solving
skills
Cleaning of Equipment
• Clean after EVERY surgical case
▫ Try to clean in the OR suite-helps reduce the
chance of cross-contamination.
• Use only hospital-approved cleaning solution
• Do NOT spray cleaning solutions during the
procedure.
• Wear gloves-always
• Clean after an isolation case
• Less frequently used machines: thorough
cleaning at least once a week and just before
going into the OR.
Sterile Fields
• Area of the OR that immediately surrounds and
is especially prepared for the patient.
• To establish a sterile field, all items necessary for
the surgical procedure are sterilized.
▫ After this process, the scrubbed and sterile team
members function within this limited area and
handle only sterile items.
Communication
• Communication is of utmost importance.
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Professional communication
Verbal
Non-verbal
Ask questions
Fluoroscopic Procedures for the OR
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Cholangiography
Line Placement
Bronchoscopy
Spines
Extremities
Arteriogram
Mobile Radiography Procedures for the OR
• Spines
• Search films
• Extremities (post-op)
Safety and Radiation Protection
• TIME, DISTANCE, SHIELDING
• Wear a lead apron.
▫ Everyone in the room.
• Stand as far away from the patient, x-ray tube,
and useful beam as possible.
▫ Most effective means of radiation protection is
distance.
 Minimum of 6 feet.
 Stand at right angle to the primary beam and patient
being radiographed.
 Least amount of scatter
Safety and Radiation Protection
• X-ray tube placed under the patient.
• Gonadal shielding.
• Source-to-skin distance
(SSD) should not be less
than 12 inches.
VIDEO
OEC Clinical Excellence
This power point presentation contains material,
text and pictures extracted from:
Adler, A.M., & Carlton, R.R. (2010).Introduction to Radiologic Sciences
and Patient Care (Fifth Ed.) St. Louis: Saunders
Ballinger, P.W., & Frank, E.D. (2012). Merrill’s Atlas of Radiographic
Positions and Radiologic Procedures (12th ed.). (Volume Three).
St. Louis: Mosby