Surgical Radiography

Question 1

Mobile C-arm fluoro includes

Answer 1

• C-arm with x-ray tube and image intensifier

- two tv monitors

Question 2

Features of the mobile C-arm fluoro

Answer 2

• digital imaging and storage
• image hold feature
• image enhancement, masking and subtraction

Question 3

Controls and operation modes of the mobile C-arm in fluoro

Answer 3

• mag mode
• pulse mode
• snapshot or digital mode
• automatic/manual exposure control
• foot pedal
• road mapping

Question 4

C-arm movements

Answer 4

• In-Out lock: moves the c-arm front and back from the base
• wig-wag: enables the c-arm to wave side to side from the base
• lateral-parallel: c-arm “C” moves from AP to lateral position
• cephalad-caudad: angles tube and IR up or down the table
• up and down: raises and lowers the “C” of the c-arm

Question 5

What does the in-out lock do?

Answer 5

In-Out lock: moves the c-arm front and back from the base

-forward and back

Question 6

What does wig-wag do?

Answer 6

wig-wag: enables the c-arm to wave side to side from the base
-move from left to right

Question 7

What does the lateral-parallel do?

Answer 7

lateral-parallel: c-arm “C” moves from AP to lateral position

Question 8

What does the cephalad-caudad do?

Answer 8

cephalad-caudad: angles tube and IR up or down the table

Question 9

What does the up and down movement do?

Answer 9

up and down: raises and lowers the “C” of the c-arm

Question 10

C-arm control panels: collimator controls

Answer 10

Use these controls to position the shutters and iris as close to the area of interest as possible to minimize scatter radiation

Question 11

Foot pedal for c-arm

Answer 11

• low dose fluoro (LDF): used to guide, position initial fluoro
• vascular foodswitch (to toggle between fluoro and subtraction mode)
• high dose fluoro (HDF)

Question 12

Setup for C-arm

Answer 12

1. Insert view station plug into wall outlet
2. Connect the view station cable into the C-arm stand by aligning the red dots
3. Connect the foot pedal cable to the C-arm stand by aligning the red dots
4. Switch on the system at either the C-arm stand or view station
5. Insert the key at the rear of the C-arm to enable radiation

Question 13

The monitor stand is the

Answer 13

Patient work list
C-arm monitor worklist:
-in most OR suites, you are able to bring your RIS via ethernet cable or WI-FI
-if the network is down, you are also able to manually enter the patient information and send your images later

Question 14

C-arm monitor dose report displays?

Answer 14

• dose
• demographics
• fluoro time (each c-arm will have an alarm one a max fluoro time has been reached)
• the image of all this is sent with the patients images to PACS

Question 15

C-arm orientation and exposure patterns for a vertical PA:

Answer 15

• least exposure to the operator
• x-ray rube below
• I.I above patient

Question 16

C-arm orientation and exposure patterns for a 30 degree C-arm tilt:

Answer 16

-increased exposure to face and neck by a factor of four

Question 17

C-arm orientation and exposure patterns for a horizontal exposure:

Answer 17

-increased exposure at x-ray tube end

Question 18

C-arm orientation and exposure patterns for a vertical AP orientation:

Answer 18

• must be avoided, increased exposure to head and neck

- tube and the top and I.I at the bottom

Question 19

Surgical accessories and clothing:

Answer 19

• scrub clothes
• gown to cover scrub clothes
• hat or hood to cover all hair
• shoe covers
• mask
• (protective eyewear)
• (nonsterile gloves)

Question 20

Equipment in surgery:

Answer 20

• clean equipment before and after OR procedures
• operational check
• proper equipment location:
  
  • monitor in clear vision of surgeon
  • locate power outlet
  • not in way of traffic

Question 21

What two positions should you use to minimize operator dose?

Answer 21

• vertical projection, PA position (x-ray tube under the patient/table)
• horizontal projection, AP position (operator standing on the side of the image instensifier)
• stand 6 feet away when possible
• use LIH (last image hold) features or intermittent fluoro when possible

Question 22

OR personnel:

Answer 22

• surgeon
• surgical assistant
• anesthesiologist
• scrub nurse
• circulating nurse
• patient
• radiographer

Question 23

Who’s responsibility is radiation protection?

Answer 23

OURS!

• MRT’s responsibility
• ensure staff is wearing lead aprons, give them enough time and notice to protect themselves

Question 24

What is included in the sterile field?

Answer 24

• sterile corridor
• sterile instruments
• c-arm could be draped
• shower curtain drape
• temporary patient drape

Question 25

Surgical asepsis in surgical radiography

Answer 25

- non sterile personnel must not come in contact with sterile personnel - any contaminated sterile drape or cover must be reported and replaced

Question 26

sterile gowns considered sterile

Answer 26

- from shoulder to level of sterile field | - at the sleeve from cuff to just above elbow

Question 27

OR tables are considered sterile only at level of the _____

Answer 27

The table top

Question 28

What do we do in surgical radiography?

Answer 28

- orthopedic surgeries - urology procedures - abdominal surgeries - cardiac surgeries

Question 29

Orthopedic procedures

Answer 29

- ORIF (open reduction, internal fixation) | - can be any bone, any joint

Question 30

ORIF hip and femur

Answer 30

-setup -c-arm is positioned on unaffected side PA/AP position: -approach the affected hip is approximately 45 degrees -use rotation feature on c-arm to orientate the image Lateral position: -superoinferior (swing image intensifier towards you) -along the axis of the patient unaffected leg -adjust height over the hip joint

Question 31

I.I is ____ dose when on the top

Answer 31

Less

Question 32

Increase brightness you _____ pt dose

Answer 32

Increase patient dose (increasing technical factors)

Question 33

Max fluoro time is ___ minutes

Answer 33

5 | -in extreme, difficult cases, you can go over 5 min

Question 34

Closer to the x-ray tube = ____ dose

Answer 34

More

Question 35

Cardiac pacemaker insertion

Answer 35

- the surgeon makes an incision below the collarbone, and the pacemaker is inserted into the chest. Wires are threaded via the superior vena cava directly into the right atrium and/or right ventricle of the heart using fluoro to visualize - the surgeon will perform tests of the pacemaker to ensure it is functioning correctly - c-arm will most commonly be parked on right side of patient, opposite the surgeon - x-ray tech will fluoro over the patient chest to demonstrate location of wires as they are directed towards the heart

Question 36

Kidney stone removal

Answer 36

- there are several different ways urologists surgically remove kidney stones - in most cases a catheter is inserted into the ureter and up to the kidney to the location of the stone. The urologist can simply remove small stones with an extractor, or break a large stone into smaller pieces to remove - some OR suites are equipped with x-ray tables, other times a C-arm is required - MRT provides fluoro and/or images over the patients kidneys or abdomen to visualize the stone or location of tools being used to remove the stone - often, one the kidney stone is removed, the urologist uses x-ray contrast to check for any damage to the kidneys or ureters or to check for further blockage - a stent is often placed in the affected ureter

Question 37

Operative cholangiogram

Answer 37

- performed during a cholecystectomy to demonstrate the biliary duct system, drainage to the duodenum, or any residual stones in the biliary system - the surgeon places a small catheter called a T-tube into the biliary ducts and injects a small amount of iodinated contrast - the radiographer can capture images either using fluoro or digital spot images with a C-arm, or by taking plain abdomen images with a mobile until and grid- cassettes

Question 38

Foreign body localization in surgery

Answer 38

- can utilize fluoro or "flare plate" radiography with mobile - used for: - incorrect sponge count post surgery - incorrect instrument count post surgery - locating metallic fragments (buckshot, bullet fragments)