Mobile Radiography Techniques and Considerations

• Mobile radiography involves specialized radiographic procedures.
• Students should be able to describe mobile radiography procedures, including technical factors, patient care, radiation safety, aseptic technique, and special considerations.
• Students should be able to demonstrate teamwork skills in mobile radiography.

Principles of Mobile Radiography

• Mobile x-ray equipment brings imaging services to the patient.
• Mobile radiography is commonly performed in patient rooms, ER, ICU, CCU, surgery, recovery rooms, nurseries, and neonatal units.
• Mobile x-ray was first used in military field sites.

Technical Considerations

• Optimum mobile exams require clear understanding of important technical factors.
• Use a grid for body parts over 12 cm.
• Anode-heel effect considerations are important.
• Use exposure technique charts.
• X-rays are produced by the x-ray tube.
• Collimators confine the primary beam.
• Images are captured using a film/screen or flat panel detector.

Grid Usage

• Grids must be level.
• The grid and x-ray beam must be properly centered.
• The correct focal distance must be used.
• Suitable grids for mobile radiography have ratios of 6:1 or 8:1 and a focal range of 36-44 inches.
• Make sure the grid is fastened to the film properly if using a tape-on grid.

Anode Heel Effect

• The heel effect increases with short SID, larger field sizes, and small anode angles.
• Short Source Image Receptor Distance (SID) and larger field sizes are more common in mobile radiography.
• There is attention paid to the cathode and anode sides of the tube which is usually marked on the housing.
• Correct placement of anode-cathode is essential.

SID: Mobile Units

• SID should be maintained at 40 inches (102 cm).
• Chest X-rays are usually done at 150-180 cm
• All other exams are done at 100 cm.
• A standardized distance ensures consistent images.
• Longer Short Image Distance (SID) requires increased mAs, resulting in longer exposure time, which increases the risk of imaging motion.

Radiation Safety

• Radiographers may receive a high exposure.
• Stand at a right angle to the tube and scattering object.
• Lead aprons should be worn.
• Maximize distance from the patient.
• Lead shielding must be used for all patients unless it interferes with the examination.

Safest Place to Stand

• Radiographers should position themselves to minimize radiation exposure.

Before Beginning Examination

• Check the patient's chart for the order.
• Let the nurse's station know of your presence and purpose.
• Obtain assistance when necessary.
• Identify the patient and introduce yourself with your title.
• Explain the exam and ensure it is appropriate and correct.
• Interfere with any equipment carefully.
• Politely ask any visitors to leave.

Performing Mobile Examinations

• Move chairs, IV poles, and wastebaskets out of the path of the machine.
• If the exam is in supine position, move the base of the machine to the middle of the bed.
• If seated upright, place the base at the end of the bed.
• For lateral and decubitus positions, place the base parallel or perpendicular to the bed.
• Ensure collimation is not larger than the IR size.
• Check CR and IR alignment to prevent distortion.
• Maintain a consistent system for keeping exposed and unexposed IRs separate.
• Keep a log of procedures, time of examination, and technical factors for image ID.
• Assess patient's condition, including mobility, fractures, and interfering devices.
• Position, and maintain asepsis reducing/eliminating contaminants from entering the field.

Patient Care Considerations

• Be mindful of body fluids, IV/catheter lines, and monitors.
• Cover cassettes appropriately.
• Consider immobilization devices, patient mobility limitations, and equipment considerations.

Common Types of Examination

• Common mobile radiography exams include Chest (AP & Decubitus), Abdomen (AP and/or LL Decubitus), Pelvis (Lat of hip), Extremities (2 views - 90 degrees), Spine (usually C.SP lat), and those in OT or Post OP.

Positioning for an AP Chest X-Ray

• Place CR to the sternum.
• Or, angle 5 degrees caudal from the sternum to the cassette.
• CR too cephalic results in an apical lordotic view.
• CR too caudal results in clavicles in the middle of the chest.
• Take into account patient’s body habitus

Performing AP Chest X-Ray

• Elevate the head of the bed as the patient's condition permits.
• Pull the patient to the head of the bed before elevating if the condition permits.
• Ensure the patient is not rotated.
• Center MSP to the cassette.
• Position CR perpendicular to the long axis of the sternum, 3 inches below the jugular notch.
• Patient position depends on the condition, ranging from seated upright to semi-upright to supine.
• Take inspiration, unless otherwise requested.
• If respiration assistance is provided, monitor patient's chest to determine inspiratory phase.

Positioning of Patient

• Position the patient as upright as possible when possible.

Demonstration of Air-Fluid Levels

• Air-fluid levels can be demonstrated in various body positions.

AP/PA Chest: Lateral Decubitus Position

• Used to determine body-fluid level of patient.
• Put patient in recumbent right or left lateral position with knees flexed.
• Raise arms over head or out of anatomy of interest.
• Place firm/soft support under patient to elevate body.
• Protect patient from rolling off bed.
• Raise both arms over head if condition permits.
• Fluid levels are best imaged with the affected side down.
• Air levels are best seen with the unaffected side down.
• Patient should be in position 5 minutes before exposure to allow fluid or air to settle.

AP Abdomen

• Take the image at expiration.
• Hypersthenic patients may require 2 separate crosswise projections.

AP Pelvis

• Ensure the table is horizontal.
• Check for grid tilt.
• Ensure there is no rotation of the pelvis.
• Rotate legs medially about 15 degrees, unless contraindicated.

Orthopedic Examinations

• Always obtain at least 2 films at right angles to each other.
• Obtain permission from the patient's nurse or physician before moving an injured patient.
• Position patient very carefully.

Lateromedial Femur

• Place vertical grid along the medial aspect of the femur (between patient's legs).
• Make sure the knee joint is included.

Mediolateral Femur

• Patient position is dorsal decubitus.
• Medio lateral projection is preferred and provides more visualization of the proximal femur.

Neonatal Intensive Care Unit (NICU)

• Commonly requested for premature and low-birth weight infants.
• Common projections requested are CXR, AXR, and SXR.
• Neonates may be placed in an incubator or isolette.
• Provide radiation protection to yourself, the nurse, and the infant.
• Disinfect x-ray equipment before entering the room.
• Cover the cassette under infant by the nurse.

Procedure in NICU

• May require protective precautions to avoid nosocomial infections.
• Clean the x-ray equipment, cover uniform with a gown, and perform hand hygiene.
• Work quickly to keep the infant warm.
• Ask the nurse in charge to help position the cassette and patient according to the radiographer's instruction.
• Move the lamp when performing in NICU.
• Provide a gonad shield for infant, ourselves and nurse.

Neonate Procedures

• AP projection of chest and abdomen often ordered.
• Infant is typically supine.
• Some bassinets are equipped with a tray to hold IR.
• Wrap IR with a soft cover if placed under the infant.
• Move arms out of anatomy of interest.
• Bring legs down.
• Have nurse assist to hold infant in position.
• Provide lead apron.
• Rotate head to avoid advancing the endotracheal tube too far.
• Collimate closely.
• Gonads should be shielded.

Neonate: Lateral Projection

• Use dorsal decubitus position.
• Elevate infant on radiolucent block wrapped in soft cover.
• Center infant's chest and abdomen to IR.
• Have nurse hold arms and legs out of collimated field.

Intensive Care Unit

• A patient who requires intensive care may be defined as one who requires support of a vital function until the disease process is arrested.
• There needs to be a high standard of aseptic care.
• Protective clothing (gown & apron) should be worn when handling the patient with contact.

ICU Procedure

• Coordinate effort with the nursing staff.
• Assess patient cooperation.
• Announce x-ray before making exposure.
• Check bed rails & area under the bed.
• Use radiation protection.
• Wait to bring in x-ray equipment when the plan is ready.
• Return everything to normal after procedure.

Coronary Care Unit

• A CCU is a special designed and equipped facility to provide optimum care patients with several cardiopulmonary diseases.
• CCUs are designed for critical patients that require frequent monitoring.
• Assess how much the patient can cooperate.
• Slide the cassette between the mattress and sheet.
• Clean the cassette and other equipment after washing hands.

CCU Procedure

• Check patient identification.
• Confer with the nurse in charge.
• Explain the procedure to the patient.
• Assess the patient's condition and cooperation.
• Apply Reverse Barrier Technique due to patients having higher risk of infection.
• Check small space.

Isolation Considerations

• There are two types of technique in isolation: Clean/contaminated and Reverse barrier.
• Wear all required protective apparel for specific situation.
• Wash hands before gloving.
• Protect IR with protective cover.
• After procedure, discard of protective apparel according to protocol.
• Wash your hands.
• Wear clean gloves to clean equipment and use appropriate aseptic technique.
• Wash hands again after removing gloves.

Operation Theatre

• Radiographers must be skilled in setting up and operating the equipment and obtaining the images with accuracy and efficiency.
• Change into surgical attire (Scrub clothes).
• Wipe x-ray equipment.
• Some hospitals maintain a mobile x-ray machine for surgical use only.

Handling in OT

• The radiographer must be familiar with the institution policies and the surgeon's preferences.
• Be aware of the sterile area.
• A safe place for the radiographer to assess the situation is at the head end of the table.
• The equipment may be pre-positioned, with the tube head covered with sterile drapes.
• Watch the cables as you manipulate the equipment.

Imaging Consideration in OT

• Cassette positioned via tunnel in the OT table.
• The cassette may be reached from the nonsterile area.
• Apply protective precaution technique (reverse barrier).
• Insert cassette in the sterile cover & positioned by the surgeon.

Artifact

• Knowledge of artifacts versus actual pathology is crucial.

Pneumonia

• Example image to compare for diagnostic purposes.

This quiz covers essential aspects of mobile radiography, including grid usage, image quality factors like the anode heel effect, and the importance of technique charts. It also addresses specific considerations for neonatal radiography, such as positioning and incubator protocols, ensuring optimal imaging practices.