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

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Advanced DiagnosticImaging 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?

  • Actually PA for supine patient as beam enters posteriorly

Imaging in Theatres

  • Discussion.

    • Mobile x-ray units. (CXR etc)

    • Image Intensifier units

Mobile Fluoroscopy units

  • Flexibility

  • Ease of use

  • Safety features

  • Cross infection issues

  • Radiation protection

  • Image quality

  • Transportation / storage

  • Image storage facilities

Mobile fluoroscopy units

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 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 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

  • 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

  • Bodily fluids

    •Areas where bodily fluids may settle:

    –Crevasses (Rails)


    –Screw heads


    •Easily cleaned surfaces

    •Ability to cover with sterile drapes

Infection Control

Radiation Protection

  • Pulsing option

    • Up to 70% dose reduction

  • Visual collimator blades



  • CARE dose facility

  • Image rotation facility

  • Integrated DAP device

  • Exposure time / dose reading

  • Warning light / audible warning

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 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 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


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


Main controlling factor in radiographic contrast

Selected by radiographer for every exposure

Has a major influence on quality of the radiograph

kVp and contrast

Photoelectric absorption

probability aZ3


Z atomic number

E beam energy

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


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….

  • Communication skills

  • Cooperative attitude

  • Space awareness

  • Professional performance

  • Compromise


Interpreting surgeon’s requirements

  • Flash

  • Shot

  • Picture

  • Yes

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

Break time

Orthopaedic procedures

  • Hip pinning

    • Dynamic Hip Screw (DHS)

    • Cannulated screws

Hip Fractures

Purpose of DHS ?


Screws. E.g. ASOS

Nailing procedures

  • Femoral(most common), tibial, humeral nail

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

  • Proximal and distal locking screws

Nailing stages

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

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

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

Kirschner “K” wires

K wires

Open Reduction and Internal Fixation (ORIF)


Tension band of Olecranon fracture

Other Procedures

  • Central Lines

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

Peripherally inserted central catheter (PICC line)

Typical screening position –intensifier on top

Portacath & Central Lines

Facet Joint Injections

Other Theatres

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