Surgical Radiography by fjwuxn


									          DMI 63

Intraoperative Radiography
  Intraoperative Radiography:
Running the mobile
 image intensifier or
 taking radiographs
 with the portable
 x-ray unit in OR
 under sterile,
 intense, conditions
    Mobile Image

   Commonly referred to
       C-arm

   Is it sterile?

       No!

       Unless----
           Portable X-ray Unit


Unless covered with
sterile plastic covers
after portable brought
into OR

(X-ray machine should
be cleaned prior to
entering each OR!)
                       OR table




Covered with sterile
         Working in OR requires :
   Super awareness of sterile environment!

   Skill in use of portable machine and c-arm

   Skill in working OR table

   Using radiation protection appropriately

   Knowledge of anatomic landmarks- whether you can
    see them or not!

   Ability to work with surgery staff under high pressure
                      During surgery

Technologist works under direction of
   surgeon not a radiologist

Who will appear to hate you!

You must be able to perform accurately
  and quickly! Repeat is no longer in your

Remember: it’s a high stress situation for
  all –but success or failure rests on
  surgeon’s shoulders
    Check your ego at the door!
You no longer have a name- you
  are “X-ray”

The only person lower than you     You
  is the guy who cleans the OR-
  at least they know him!
Expect some abuse!
Good part -if you screw up, they
  won’t recognize you outside
  the OR!
       You must be able to read
   When running c-arm, when Dr. wants
    fluoro, he expects you to understand that:

   “X-ray”, “now”, “OK”, “uh huh” “ready”,
    and a grunt or a mumble mean hit the
    fluoro pedal even when used
   Or maybe just a glance at the monitor
      Areas of OR

   Unrestricted
   Semi-restricted
   Restricted
       Unrestricted areas of OR

   Provides outside to inside access

   No traffic restrictions

   Street clothes permitted
        Semi-restricted areas of OR

   Authorized personnel only
       Pts and staff

   Provides access from unrestricted area of
    OR to restricted area

   Proper OR attire required
       Scrubs, head and shoe covers
    Examples of Semi-restricted area
   Hallways within OR rooms

   Instrument and supply processing area

   Non-sterile supply areas and utility rooms
                Restricted Areas

   Where surgical procedures are carried out
   Proper OR attire and mask must be worn

   Examples:
       Scrub sink areas
       Sterile supply rooms
       Operating suites
Surgical Suite
           The Surgical Suite
   Restricted area!
   Aseptic technique: the effort taken to keep patients
    as free from hospital micro-organisms as possible
   Know Who is sterile and who isn’t!
   Know What equipment is sterile and non-sterile

   No items should be moved without permission of
    circulating nurse or person in charge!
   Scrub clothes must be worn, and covered if leaving
                Operating Room Attire
   Clean, fresh attire, surgical “scrubs,”
    donned at beginning of each shift

   Are they sterile?
       no

       Change as necessary

    Should soiled scrubs be worn outside
      OR suite?
What the surgery team wears!
Masks worn at all times in OR!

       Are they sterile?

              Operating Room Attire
   Caps
       Worn in all areas of
        OR to contain hair

       Hoods available to
        cover any facial hair
        not contained by mask

       Are they sterile?

       No!
   Surgical Shoe Covers

Top prevent you from tracking in contaminants

To prevent contaminants from soiling your shoes

Are they sterile?

    Operating Room Attire for Techs
   Gloves
       Worn to protect tech from body fluids –
            No!

   Radiation badge

   Proper ID
Lead attire
      Take a bath now and then!

   Daily body and hair
    cleanliness very
    important to prevent
    transportation of
Person with known transmittable infection
  should not be permitted in OR suite!

    Cold
    Acute infection
    Open cold sore
    Sore throat
    Carrier of
                       Aseptic Vs Sterile
   Aseptic technique is used to
    maintain a sterile field

   Aseptic is defined as:
        Free from pathogenic

   Sterile is defined as:
        Free from all living
        Nosocomial infections
   Infections which are a
    result of treatment in a
    hospital or a healthcare
    service unit
    Infections are considered
    nosocomial if they first
    appear 48 hours or more
    after hospital admission
    or within 30 days after
         Nosocomial infections
In United States, Centers for Disease Control and
   Prevention estimates that 1.7 million hospital-associated
   infections, from all types of bacteria combined, cause or
   contribute to 99,000 deaths each year

Commonly transmitted when hospital officials become
  complacent and do not practice correct hygiene regularly

Also, increased use of outpatient treatment means people
  who are hospitalized are more ill and have more
  weakened immune systems than may have been true in
        Aseptic Technique           (cont’d)

Radiographers or other non-sterile personnel
must maintain a safe margin from any sterile

What is worse than contaminating a sterile
field is bad?
    - not reporting it!
       What is the sterile corridor?

•   Area between instrument
    table and draped pt

   Must not be entered by
    any non-sterile

   Notify proper personnel
    immediately if a sterile
    field is contaminated!!
What parts of sterile gown are considered

                       On sleeves- elbow
                       to cuffs
                      On body- shoulder to
                      level of sterile field
Surgical Instrument Tray
If you are not sure, consider it sterile!
       Loading A Cassette in Sterile Cover
                   OR staff


                  2 person job!
           Retrieving IR in Sterile Field

   Why must Radiographer be
    wearing gloves?
         in case IR cover is
         contaminated with blood or
         body fluids

   Surgical tech or nurse gives
    covered IR to radiographer

   OK to contaminate cover now,
    but not person handing you
    the film!

   Cover and gloves are disposed
    of properly before handling
    uncovered IR

   Hot foot it up to develop and
    return with image
                      Logistical Problems
   Getting c-arm or portable through
    jungle of equipment and people

   Getting cassette under pt without
    breaking sterile field

   Centering CR to pt and to cassette
    when you can’t see or touch either

   When x-ray is table top, covered
    with sterile cloth- you can’t see
    body part!

   Watch out for your lead apron
    hitting field
Take a 5 second break!
Common Surgical Procedures requiring our services
                                Cardiac Surgery
   Anything pertaining to heart and
    related major blood vessels
   Most common procedures:
      pacemaker and automatic
        internal cardiac defibrillator
         insertions   (C-arm)

        Coronary artery bypass grafts

   What is generally required after
    above mentioned procedures?
        post-op CXR
   Laminectomies
       Requires x-table lateral

   Shunt placements

   Transphenoidal cases
       Requires C-arm or skull films
Cross-Table Lateral Cervical Spine

   Catheter placements
            Usually by C-arm
            Requires a post-op CXR
   Brachytherapy
       Requires two views at
        right angle to each

                                      Cesium Implant
                   Orthopedic Surgery
   ORIF What does it stand for?
       Open reduction internal fixation
       May require C-arm or plain film radiography
   Closed reduction is what?
       No surgical incision- just manipulation
       C-arm or plain films
Open Reduction -Internal Fixation
Joint Replacement
Orthopedic Surgery
        Pain Management

   Requires C-arm to locate
    injection site for facet block

   Usually in:
       Lumbar spine or
       SI joint or
       Cervical spine
                     Vascular Surgery
   Utilizes both plain film
    and mobile fluoroscopy

   AV fistulas, AV grafts are
    most common procedures
   What is an AV fistula?
        abnormal connection or
         passageway between artery and
                     Urology Suite
   Retrograde Pyelograms

   IVU’s

   Kidney & gall stone

   Percutaneous

       (removal stones from kidney by
        small puncture wound (up to about   1
        cm) through skin)
           Radiation Protection
   Shield patient if possible!

   The mobile unit should not be used as shield by you

   YOU must provide Lead aprons for all personnel!

   Monitoring badges should be worn by all personnel

   You are responsible for making sure all personnel who
    can or want to leave room prior to making an exposure
    are given a loud clear warning and have a chance to get

          Or   else!!

   When using the c-arm, the
    radiation source is generally
    under pt, so where should
    shielding should be placed?
    Under the pt!
     between source and pt

     Must be done before pt is put
      on table
    Summation of Important Things To Remember in
   Upon entering OR, alert all
    staff of your presence and
   Be aware of sterile fields and
   Enlist aid of circulating nurse
    to move equipment out of way
   Any cassettes placed in sterile
    field must be covered first by a
    sterile member of the team
   Allow team to clear room prior
    to making the exposure
   Do it right the first time!!!

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