Advanced diagnostic imaging studies
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Advanced Diagnostic Imaging Studies. Theatre Imaging. Some Essentials. Principles of radiography/terminology Basic anatomy Operative procedures and radiographic technique Dose limitation Health & Safety. Major Directional Terms. AP Position?.

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Advanced diagnostic imaging studies

Advanced DiagnosticImaging Studies

Theatre Imaging


Some essentials

Some Essentials

  • Principles of radiography/terminology

  • Basic anatomy

  • Operative procedures and radiographic technique

  • Dose limitation

  • Health & Safety


Major directional terms

Major Directional Terms


Ap position

AP Position?

  • Actually PA for supine patient as beam enters posteriorly


Imaging in theatres

Imaging in Theatres

  • Discussion.

    • Mobile x-ray units. (CXR etc)

    • Image Intensifier units


Mobile fluoroscopy units

Mobile Fluoroscopy units

  • Flexibility

  • Ease of use

  • Safety features

  • Cross infection issues

  • Radiation protection

  • Image quality

  • Transportation / storage

  • Image storage facilities


Mobile fluoroscopy units1

Mobile fluoroscopy units


Mobile fluoroscopy units2

Mobile fluoroscopy units

  • Flexibility

    • Ability to move in small environments

    • Accurate controls

    • Full isocentric movements

    • Clear measurement markings

    • Manual handling considerations

    • Low base height

    • Foot / hand exposure devices


Mobile fluoroscopy units3

Mobile fluoroscopy units

  • Ease of use

    • Laser marking facility

    • Accurate positioning

    • Hand rails Easy movement

    • Quick access interlocks

    • Simplistic design

    • Clear user features

    • Ability to manipulate data from base unit


Mobile fluoroscopy units4

Mobile fluoroscopy units

  • Image review / print

    • Ability to review data on dual monitor display

    • Freeze –transfer –archive features

    • Manipulate data remotely from unit base

    • Input patient demographics

    • Ability to review “thumbnail” images

    • Ability to play movie clips


Safety features

Safety Features

  • Cable protection on wheels

  • Minimal trailing cables

  • Electro-mechanical brakes

  • Counter balance construction

  • “Glide” mode

  • Key operation (IR(ME)R)

  • Handles to pull / push unit

  • Earthed units

    • Monitor & Image intensification unit

    • Cable connections


Infection control

Infection Control

  • Bodily fluids

    •Areas where bodily fluids may settle:

    –Crevasses (Rails)

    –Wheels

    –Screw heads

    –Cables

    •Easily cleaned surfaces

    •Ability to cover with sterile drapes


Infection control1

Infection Control


Radiation protection

Radiation Protection

  • Pulsing option

    • Up to 70% dose reduction

  • Visual collimator blades

    –Iris

    –Semi-transparent

  • CARE dose facility

  • Image rotation facility

  • Integrated DAP device

  • Exposure time / dose reading

  • Warning light / audible warning


Limiting dose

Limiting dose

  • X-rays are potentially harmful to patients and staff

  • All radiological procedures should seek to keep dose “as low as reasonably practicable” ( ALARP)

  • This is the principle of Optimisation as stipulated in the IRRs – therefore not optional; required by law


Limiting dose1

Limiting dose

  • Collimation – decreasing the size of the radiation field

    • Use of shutters or iris collimator

  • Keep intensifier face as close as possible to the patient

    • Reduces x-ray output necessary to achieve acceptable image

    • Reduces image magnification and blurring


Limiting dose2

Limiting dose

  • Try to position correctly before exposing

    • Think about whether the required area is under the intensifier face before pushing expose button

    • Use of laser positioning

    • Use of anatomical landmarks

  • Lead rubber coats for staff

    • Must be worn by all in controlled area i.e the operating theatre

    • Avoid staff hiding behind other

  • Lead rubber gonad shielding for patient


Contrast

Contrast

Difference between adjacent densities on a radiograph

The number of black, white and grey tones that appear on a radiograph

Controlled by the energy of the x-ray beam


Advanced diagnostic imaging studies

kVp

Main controlling factor in radiographic contrast

Selected by radiographer for every exposure

Has a major influence on quality of the radiograph


Kvp and contrast

kVp and contrast

Photoelectric absorption

probability aZ3

E3

Z atomic number

E beam energy

As kVp increases absorption by photoelectric effect rapidly decreases causing a reduction in radiographic contrast


Advanced diagnostic imaging studies

kVp

Determines the energy of the x-ray beam

Low energy beam is easily absorbed

Differential absorption increases

High contrast

High energy beam penetrates body more easily

Differential absorption decreases

Low contrast


Interprofessional working

Interprofessional Working….

  • Communication skills

  • Cooperative attitude

  • Space awareness

  • Professional performance

  • Compromise


I p w

I.P.W


Interpreting surgeon s requirements

Interpreting surgeon’s requirements

  • Flash

  • Shot

  • Picture

  • Yes

    • All can mean “Please expose the patient and show me an image”


Break time

Break time


Orthopaedic procedures

Orthopaedic procedures

  • Hip pinning

    • Dynamic Hip Screw (DHS)

    • Cannulated screws


Hip fractures

Hip Fractures


Purpose of dhs

Purpose of DHS ?


Accuracy

Accuracy


Screws e g asos

Screws. E.g. ASOS


Nailing procedures

Nailing procedures

  • Femoral(most common), tibial, humeral nail

  • Intramedullary –often requires reaming (drilling) of medullary canal

  • Proximal and distal locking screws


Nailing stages

Nailing stages


Locking screws

Locking screws

  • Proximal locking usually drill guide device

  • Distal locking trickier and done by manual location of where to drill

  • Needs to achieve round holes to enable correct angulation of drill


Guidance systems

Guidance systems

Designed to make life easier for

surgeon to place locking screws

with better accuracy.

Reduces need for x-rays and

reduces time under anaesthetic.


Discussion slide

Discussion slide


Tibial nailing

Tibial Nailing

  • Less common as tends to be less successful than femoral nail

  • Tibia has less vigorous blood supply than femur, and drilling out tends to compromise further. Problems with non-union

  • External frames becoming more popular (Taylor spatial, Ilizarov)


Taylor spatial frame

Taylor spatial frame


Kirschner k wires

Kirschner “K” wires


K wires

K wires


Open reduction and internal fixation orif

Open Reduction and Internal Fixation (ORIF)


Advanced diagnostic imaging studies

ORIF


Tension band of olecranon fracture

Tension band of Olecranon fracture


Other procedures

Other Procedures

  • Central Lines

    • Give long-term central venous access for patients requiring it e.g chemotherapy


Peripherally inserted central catheter picc line

Peripherally inserted central catheter (PICC line)

Typical screening position –intensifier on top


Portacath central lines

Portacath & Central Lines


Facet joint injections

Facet Joint Injections


Other theatres

Other Theatres


New articles

“New” Articles

  • http://www.sciencedirect.com/science/article/pii/S0967586810008131

  • Our role may be developing


Questions

Questions:


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