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Flashcards in Surgical Imaging in OR-PPT Deck (40)

***What is Closed reduction

–Nonsurgical procedure
–Fracture fragments are realigned by manipulation


What is Open reduction

–Surgical procedure
–Screws, plates, or rods
•ORIF (Open reduction with internal fixation)
–Severe fractures


What is External fixation

–Method of immobilizing bones to allow fracture to heal
•Places pins or screws into the bone on both sides
•Pins are secured together outside the skin with clamps and rods
–Quick and easy


***What is Operative Cholangiography?

Performed during biliary tract surgery
–Bile is drained (absence of obstruction); ducts are filled with contrast (6-8 ml)
•Common bile duct through a needle, catheter or T-tube (operative T-tube cholaniography)
–Check for patency of bile ducts and functional status of the sphincter of hepatopancreatic ampulla
•Stones, neoplasms, strictures or dilation of ducts


Perform for Operative Cholangiography

•Patient is supine
–Laparoscopic cases – distended abdomen
•Center C-Arm in the PA projection over right side of abdomen below rib line
–Tilt patient to the left or Trendelenburg position (flow of contrast)
•Portable images


Perform for Chest (Line Placement/Bronchoscopy)

•C-Arm enters sterile field perpendicular to patient (PA projection)
–Line placement – point of insertion & follow catheter; verify position & no kinks
»Bronchoscopy – biopsies, stents & dilation


What catheter begins in upper thorax and ends in the heart used for Chest (Line Placement/Bronchoscopy)



ACDF stand for

Anterior Cervical Diskectomy & Fusion


What is Cervical Spine (ACDF)

•Common surgical procedure that is used when other non-surgical treatments have failed
–Treats nerve root or spinal cord compression by decompressing and stabilizing the corresponding vertebrae
•Disc is completely removed as well as the disc material pressing on the spinal nerve
•Intervertebral foramen is enlarged with a drill giving the nerve more room
•Remaining space is filled with a bone graft to stabilize the vertebrae
–Bone graft joining the vertebrae = fusion


Perform pt for Cervical Spine (ACDF)

–Chin elevated and neck flexed


Perform PA projection for Cervical Spine (ACDF)

–PA projection
•Enter perpendicular to patient
•Tilt C-arm 15 degrees cephalad and center over C-Spine
•Raise C-arm for surgeon to work


***Peform Lateral projection for Cervical Spine (ACDF)

–Rotate C-arm from PA projection
•Rainbow position
–Angle C-arm either cephalad or caudal for true lateral
–Spine should be in the center of the field of view


C-Spine (Rainbow Position) may use for

Larger patients if unable to raise C-Arm to obtain anatomy in center of beam


Laminectomy Procedure

Lumbar Spine
–Performed to relieve pressure on the spinal cord or nerve roots
•Bony obstructions, stenosis & spinal cord impingement
–Posterior arch of vertebra is removed
•Spinal fusion - number of vertebrae excised
•Interbody fusion cages
–Titanium cages filled with bone inserted between vertebral bodies to maintain disk space height & fuse joint


Perform Lumbar Spine (Laminectomy)

•C-arm = determine correct level & provide fluoro guidance for orthopedic plates and/or screws
•Patient prone
•Needle is placed @ level of laminectomy
•Visualized entire spine to determine correct level – verify by C-arm
•C-arm // to spine to avoid distortion


AP Lumbar Spine (Laminectomy)

Enter perpendicular and center beam over affected area of spine


Lateral Lumbar Spine (Laminectomy)

–Rotate C-arm under table
–Place spine in center by raising or lower C-arm
–Angulation may be necessary for true lateral


Hip (Proximal Femur) Fractures

Femoral neck, intertrochanteric and subtrochanteric fxs
•Require ORIF



A long fixator is placed on lateral side of fractured hip and secured with screws through the fixator into femoral head & neck
•Smaller screws are placed below trochanters that transverse shaft of femur


Hip fracture need

•Special fracture or orthopedic table for traction & fluoro during procedure
•Shower curtain method is utilized
•Fracture is reduced through traction and manipulated (C-arm may need to be adjusted to accommodate)
•Patient is supine with legs abducted and affected leg held in traction
–Radiographer is positioned between patient’s leg


Hip fracture Incision is made @

Level or just below greater trochanter and guide pins inserted through fracture


Femoral neck structures

Guide pins are aligned and large screws or some other pin-type device is inserted through fracture


C-arm Hip lateral projection

X-ray tube inferiorly and image intensifier superiorly & exteriorly above hip


Total Hip Replacement (Arthroplasty)

•Degenerative disease or chronic trauma to femoral head and/or acetabulum
•Prosthetic hip is utilized to return normal function to patient
•Vary in composition, design & components
–Single-piece or three-piece design
–Stem of prosthesis is cemented into medullary cavity or held by compression plates & screws
•Postoperative images – include entire device


Femur Nail is

A nail or rod is inserted into the intramedullary canal to reduce a fracture of the shaft


Antegrade (insert femur nail through)

Greater trochanter or proximal end of long bone


Retrograde (insert femur nail through)

Popliteal notch or distal end of long bone


Femur Nail: Fracture table

•Incision is made proximal or distal to long bone
•Bone reamer is used to widen intramedullary cavity


Femur Nail:
Guidewires are inserted & advanced to

Fracture site


Femur Nail:
C-arm is used to verify location of

Guidewires & fracture alignment (PA & lateral perspectives)


Femur Nail:
Intramedullary nail or rod is

Inserted and screws may be used to hold in place – verify with C-arm


Femur Nail - Antegrade
Supine position

–Affected leg in traction with unaffected leg flexed @ knee and hip & raised for C-arm to enter
–C-arm positioned between legs & parallel to unaffected hip


Femur Nail - Antegrade
Lateral position

–Affected extended forward & clears opposite leg
–Enter sterile field & rotate C-arm under table to find PA projection


Femur Nail - Retrograde
Supine position

–Affected leg exposed with knee flexed & supported (access to notch)
–Enter sterile field with C-arm perpendicular to patient
•Tilt C-arm cephalad and find PA projection
•Rotate C-arm under table for lateral position


Perform Femur Nail

•Instruments or hardware may protrude from site
•Center C-arm over fx site during canal reaming to ensure fx remains reduced
•Screws will be inserted into the femur and through nail to fix nail in place
–When lining up the holes, the holes should appear round and not oblong
•Center the screw hole on the monitor
•Magnification feature
•Tilt or rotate C-arm to obtain perfect circles


***Tibia (Nail)

•Supine with knee of affected leg flexed for access to tibial tuberosity
•Affected leg is on opposite side of table to C-arm
•C-arm is perpendicular to patient centered over leg and tilted to match angle of leg (Fig 27)
•Surgeon will manipulate leg – tilt or rotate C-arm to obtain round holes


Humerus uses

•Supine or in a reclining beach chair position
C-arm placement for preliminary imaging – be careful of patient’s head with image intensifier


Perform Humerus procedure

–Injured arm resting on a Mayo stand with assistant holding arm to stabilize and align humerus
–Shoulder is off the side of table (humerus is not blocked by table)
–Assistant will rotate arm medially with elbow @ 90 degrees, hand is pointing upward
–C-arm enters parallel or at a 45 degree angle to the patient


Mobile Extremity Examinations

Patient is supine, prone, reclining, or in the beach chair position


Portable machines approaches patient perpendicular

–Cover sterile field with plastic or cloth drape
•Surgeon will mark area to center on
–Angle tube if necessary to match IR
–Surgeon may hold extremity in position during exposure - shielding