Mobile Radiography Procedures PDF

1/14/25 MOBILE RADIOGRAPHY SPECIALISED RADIOGRAPHIC PROCEDURES I MRD551 1 LEARNING OUTCOMES At the end of the lecture, the students...

1/14/25 MOBILE RADIOGRAPHY SPECIALISED RADIOGRAPHIC PROCEDURES I MRD551 1 LEARNING OUTCOMES At the end of the lecture, the students should be able to: Ø Describe the procedures in mobile radiography which covers the technical factors, patient care, radiation safety, aseptic technique, isolation precautions & any special considerations in mobile radiography. Ø Demonstrate teamwork skills through role play of radiographic positioning, technical parameters, image evaluation & special consideration in mobile radiography. 2 1  1/14/25 PRINCIPLES OF MOBILE RADIOGRAPHY Transportable x-ray equipment to bring imaging services to pt Commonly performed in pt room, ER, ICU, CCU, surgery and recovery rooms, nursery and neonatal units Mobile x-ray was first used in military – Units were carried to field sites 3 TECHNICAL CONSIDERATIONS 3 important technical factors must be clearly understood to perform optimum mobile examinations – Grid (Body parts over 12 cm = grid) – Anode-heel effect – Source–to–image receptor (SID) Exposure technique charts essential to optimum exam 4 2  1/14/25 GRID Must be level! Grid and x-ray beam must be properly centered Correct focal distance must be used Best grids for mobile radiography have ratios of 6:1 or 8:1 and a focal range of 36 - 44 inches Make sure grid is fastened to film properly if tape-on grid is used 5 ANODE HEEL EFFECT Heel effect increases with short SID, larger field sizes, and small anode angles Short SID’s and larger field sizes are more common in mobile radiography Pay attention to cathode and anode sides of tube - usually marked on tube housing Correct placement of anode-cathode regarding anatomy is essential 6 3  1/14/25 SID- MOBILE UNITS Should be maintained at 40¢¢ (102 cm) Chest usually done at 150 – 180 cm All other done at 100cm Standardized distance ensures consistent images Longer SID requires increased mAs, which results in longer exposure time – Increases risk of imaging motion 7 RADIATION SAFETY Radiographer may receive a high exposure – Stand at a right angle to tube and scattering object – Lead aprons should be worn – Maximize your distance from pt. – Lead shielding must be used for all pt’s unless it will interfere with examination 8 4  1/14/25 SAFEST PLACE TO STAND 9 BEFORE BEGINNING EXAMINATION Check pt’s chart for order Let nurse’s station know of your presence and purpose Obtain assistance when necessary Identify pt and introduce yourself with your title Explain exam and ensure it is appropriate and correct Move any interfering equipment carefully Politely ask any visitors to leave 10 5  1/14/25 PERFORMING MOBILE EXAMINATIONS Move chairs, IV poles, wastebaskets, etc. out of path of machine If exam in supine position, move base of machine to middle of bed If seated upright, base at end of bed Lateral and decubitus positions, place base parallel or perpendicular to bed 11 PERFORMING MOBILE EXAMINATIONS Make sure collimation is not open larger than IR size Check CR and IR alignment to prevent distortion Use consistent system for keeping exposed and unexposed IRs separate Keep log of procedures, time of examination, technical factors for image ID Assessment of pt’s condition Pt mobility Fractures Interfering devices Positioning and asepsis (to reduce or eliminate contaminants (such as bacteria, viruses, fungi, and parasites) from entering the operative field) 12 6  1/14/25 PT CARE CONSIDERATIONS Body fluids IV, catheter lines, monitors Cassettes should be covered Immobilization devices Patient mobility limitations Equipment considerations 13 COMMON TYPES OF EXAMINATION: Chest - AP & Decubitus ABD – AP and/or LL Decubitus Pelvis - Lat of hip Extremities – 2 VIEWS - 90° Spine – usually C.SP (lat) In OT or Post OP 14 14 7  1/14/25 POSITIONING FOR AN AP CHEST X-RAY 15 POSITIONING APPLICATIONS 1. CHEST – Place C/R ± to sternum 2. or Angle 5° Caudal from ± to cassette C/R Too Cephalic = Apical Lordotic POSITIONING APPLICATIONS C/R Too Caudal = Clavicles in middle of the chest 3. Consider your patient’s body habitus 16 8  1/14/25 Elevate head of the bed as pt’s condition permits Pull pt to head of bed before elevating if condition permits Make sure pt is not rotated Center MSP to cassette CR perpendicular to long axis of sternum, 3 inches below jugular notch Pt position – Depend on condition – Ranges from seated upright, to semi upright, to supine Inspiration, unless otherwise requested – If respiration assistance is provided, watch pt chest to determine inspiratory phase 17 CR AND BEAM ALIGNMENT IS CRUCIAL. 18 18 9  1/14/25 POSITIONING OF PATIENT AS UPRIGHT AS POSSIBLE = WHEN POSSIBLE 19 19 DEMONSTRATION OF AIR- FLUID LEVELS 20 20 10  1/14/25 DEMONSTRATION OF AIR-FLUID LEVELS 21 21 AP/PA CHEST LATERAL DECUBITUS POSITION Used to determine body-fluid level of patient Pt position – Recumbent right or left lateral – Knees flexed – Raise arms over head or out of anatomy of interest Place firm/soft support under pt to elevate body Protect pt from rolling off bed Raise both arms over head if condition permits Fluid levels best imaged with affected side down Air levels seen best with unaffected side down Pt should be in position 5 minutes before exposure to allow fluid or air to settle 22 11  1/14/25 AP ABDOMEN Expiration Hypersthenic pts may require 2 separate crosswise projections 23 AP PELVIS – Horizontal – Check for grid tilt – No rotation of pelvis – Rotate legs medially about 15 degrees, when not contraindicated 24 12  1/14/25 ORTHOPEDIC EXAMINATIONS Always obtain at least 2 films at right angles to each other Obtain permission from pt’s nurse or physician prior to moving an injured pt Position pt very carefully 25 LATEROMEDIAL FEMUR Part position: – Place vertical grid along medial aspect of femur (between patient’s legs) – Make sure knee joint is included 26 13  1/14/25 MEDIOLATERAL FEMUR Pt position – Dorsal decubitus – Medio lateral projection preferred- provides more visualization of proximal femur 27 NEONATAL INTENSIVE CARE UNIT (NICU) Usually requested for premature and low-birth weight infant Common requested projection are CXR, AXR and SXR Neonate maybe placed in incubator or isolette Give radiation protection to yourself, nurse and the infant Disinfect x-ray equipment before enter the room Cassette covered under infant by the nurse 28 14  1/14/25 PROCEDURE May require protective precaution to avoid nosocomial infections. Clean the x-ray equipment, cover uniform with a gown, and perform hand hygiene. Need to work quickly to keep warmth to the infant. To position the cassette pt, ask the nurse in charge to help according to the radiographer’s instruction. If infant is in an open incubator, move the lamp out of the way before centering the x-ray tube. Provide gonad shield for infant, ourselves and nurse. 29 NEONATE AP projection of chest and abdomen often ordered Infant is supine Some bassinets equipped with tray to hold IR If IR must be placed under infant, wrap with soft cover Move arms out of anatomy of interest Bring legs down – Have nurse assist to hold infant in position – Provide lead apron Leave head rotated to avoid advancing endotracheal tube too far Collimate closely Gonads Shield 30 15  1/14/25 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 31 INTENSIVE CARE UNIT A pt who requires intensive care may be defined as one who requires support of a vital function until the disease process is arrested. It must be a high standard of aseptic care. Protective clothing (gown & apron) should be worn when handling pt with contact. 32 16  1/14/25 ICU PROCEDURE Coordinate effort with the nursing staff Return everything in Asses pt normal in cooperation complete Announce ‘x- Check bed ray’ before rails & area making under the exposure bed Wear Bring in x-ray radiation equipment when protection the plan is ready 33 CORONARY CARE UNIT CCU is special designed and equipped facility intended to provide optimum care for pt as with several cardiopulmonary disease. Designed for critical & require frequent monitoring Assess how much pt can cooperate Slide cassette between mattress and sheet Clean the cassette and other equipment after wash hands 34 17  1/14/25 CCU PROCEDURE Check pt ID Check Confer with space limited & the nurse in- charge bed rails Apply Explain the Reverse Barrier procedure Technique to the pt Assess the pt’s condition & cooperation 35 ISOLATION CONSIDERATIONS Two types of technique in isolation – Clean/contaminated technique – Reverse barrier technique 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 hands! Wear clean gloves to clean equipment and use appropriate aseptic technique Wash hands again after removing gloves 36 18  1/14/25 OPERATION THEATRE Radiographer 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 In some hospital, mobile x-ray machine is maintained for surgical use only 37 HANDLING IN OT Radiographer must be familiar with the institution policies and the surgeon’s preferences. Be aware of the sterile area. Safe area for the radiographer to assess the situation is at the head end of the table. The equipment may be positioned in advance and the tube head covered with sterile drapes during the setup. Watch the cables as you manipulate the equipment. 38 19  1/14/25 IMAGING CONSIDERATION IN OT Cassette positioned via tunnel in the OT table Cassette may be reached from the nonsterile area Apply protective precaution technique (reverse barrier) Insert cassette in the sterile cover & positioned by the surgeon 39 ARTIFACT PNEUMONIA 40 40 20  1/14/25 41 41 REFERENCES 1. Ballinger, Philip W. Merrills Atlas of Radiographic Positions and Radiologic Procedures. 2. Clark, KC., 2005, Clark’s positioning in radiography , 12th edn., USA: Hodder Arnold. 3. Bontrager, KL., 2009, Textbook of radiographic positioning and related anatomy,7th edn., St Louis: Mosby. 4. Bushong, S.C. (2013). Radiologic Science for Technologists: Physics, Biology and Protection. 10th ed. St. Louis: Mosby Inc. 42 21