1
Q
Where do we go in the hospital to take images
A
- Emergency department
- Special Care Units
- Pateint Rooms
- OR/Surgical Suites
- Surgical Day Care Units
2
Q
What is seen in this image
A
Portable CR x-ray unit
3
Q
DR portables
A
- newer and more practical (dont have to process CR plates)
- good for 2 step feeding tube checks
1. to make sure its still in the middle past carina
2. image when its placed - con of DR is detector is heavier to put behind patient (becomes a 2 person job)
4
Q
Mobile Imaging Produces….
A
some of the highest occupational exposures for MRTs
5
Q
How to reduce occupational exposure in mobile imaging
A
- protect yourself
- stand atleast 3m away (cable should be 3m in length) (still need lead)
- position yourself perpendicular to central ray (90* to the patient)
- *wear lead
6
Q
Who is the radiographer responsible for when it comes to radiation protection
A
- anyone in the immediate area of the patient
- remind everyone to wear lead
7
Q
What are technical considerations when taking a mobile image
A
- SID
- Grid
- Patient condition (fluid vs air cast)
8
Q
Technique chart in mobile imaging
A
- there should be one in every mobile unit when using CR
- DR units have present anatomical programs
- can adjust kVp and mAs only
9
Q
SID in mobile imaging
A
- must maintain a minimum of 40” SID
- measure SID
- know your focusing range if you are using a focused grid
10
Q
Increasing Technique in mobile imaging
A
- increase kVp by 10 to reduce mAs by half
- less chance of motion
11
Q
When you increase your SID from 40” to 72” how much should you increase your exposure
A
need 3.24x more exposure
- triple mAs
12
Q
When you increase your SID from 50” to 72” how much should you increase your exposure
A
- need 2.07x more exposure
- double mAs
13
Q
What are the benefits of a larger SID
A
- lower dose
- less anatomy cut off/beam divergence
- less distortion
- better spatial resolution
14
Q
What are the benefits of a smaller SID
A
- can use beam divergence to our advantage
- less wear and tear on tubes
- shorter exposure time = less motion
15
Q
What are the technical considerations for using a grid
A
- anatomy imaged is > than 10cm
- must be perpendicular and centered to the central ray
- parallel vs focused grid
- grid ratio (6:1 or 8:1)
16
Q
What will cause grid cut off
A
- being 2.5 cm off centre
- if grid is angled (soft bed)
17
Q
What is a virtual grid
And what are the benefits
A
- algorithm replaces the physical grid
- weight reduction (dont have to carry grid)
- reduces grid misalignment issues (potential for dose reductions)q
18
Q
What technical considerations do we need to make based on patient position
A
- more technique required for decubitus patient vs supine and erect
19
Q
Increase in technique for
- fiber glass casts
- small plaster casts
- large plaster casts
- wet plaster casts
A
- fiberglass: ^ kvp 25-30% (3-4kVp)
- medium plaster cast: 50% kVp increase (5 kvp)
- large plaster cast: 100% increase (10 kvp)
- wet plaster cast: go up one step in mAs (increases by 25%)
20
Q
What are the standard Precautions for PPE
A
Blood
All body fluids
Secretion and excretions (except sweat)
Non-intact skin
Mucous Membranes
*assume that every pt. has the potential for having an infectious disease
use with every patient
21
Q
How to prevent the Spread
A
Proper hand washing (when hands are soiled, after coming in contact with blood or body fluids, before beginning invasive procedures)
Hand Sanitize (used when hands do not appear soiled)
22
Q
What are the 4 “moments” of hand hygiene? (on exam)
A
- Before initial pt. or pt. environment contact
- Before aseptic procedure
- After body fluid exposure
- After pt. or pt. environment conact, after gloves are removed
*15 seconds (with alcohol)
23
Q
What are the two types of patients that cared for in isolation units?
A
- Pt. who have an infectious microorganism that CAN BE SPREAD to health care workers
- Pt. who NEED protection from potentially lethal microorganisms
24
Q
3 different mode of transmission from pt that who have an infectious microorganism that CAN BE SPREAD to workers
A
- Contact
- Airborne
- Droplet
Types of isolation for patients in special care units
25
Contact **Isolation**:
how does it spread
what PPE is needed
examples of these illnesses
- Spread by: direct contact & indirect contact (fomites)
- PPE: Gloves & gown (if needed pt. is incontinent, has diarrhea, ileostomy, draining wound etc..)
- examples: Hep A, HIV, MRSA, VRE, C-Diff, Scabies, Lice, ESBL (Extended-spectrum beta-lactamase)
| all can become antibiotic resistant
## Footnote
dont need gown when dealing with outpatient as their shouldnt be bodily fluids
26
Droplet **Isolation**:
how does it spread
what PPE is needed
examples of these illnesses
- PPE: Surgical mask w/ Visor or Goggles (within 3 ft wear gloves but if only breathing it in IF not then no)
- Examples: Influenza, Mumps, Most pneumonias, Meningococcal, Meningitis
| *normally have signs on the door w/ PPE needed
27
Airbone **Isolation**:
- how does it spread
- what PPE is needed
- examples of these illnesses
- Spread by: Microbes remain suspended in air (through inhalation)
- PPE: N95 Mask
- Examples: SARS, Chicken pox, TB, Covid -19
| *normally have signs on the door w/ PPE needed
28
What PPE do we use for pt. who NEED protection from potentially lethal microorganisms and what are examples
| on Strict/Reverse Isolation
## Footnote
For immunocomprimised patients
PEE needed:
EVERYTHING
Gown, Gloves, Mask, Cap, Boot Covers
Examples: Transplant recipients (in failure), AIDS pt., Burn pt. (skin is 1st layer of defense)
29
6 Steps Prior to performing a mobile exam
1. Must announce your presence to nursing staff (get their approval and if there is any new issues we should know about like MRSA positive so need new PPE or need to put in new lines)
2. Ensure correct pt. (2 forms of ID)
3. Introduce yourself and explain exam
4. Prepare the room (move chairs, angle bed, done all before you bring the mobile unit into the room)
5. Ask others to leave room
6. Bring in the mobile and begin positioning
30
Advantages of using pillow case to cover detector in mobile exam
- readily available and disposable
- easier to slide behind patient
- not wasteful
- better for patient comfort
31
What is needed on images for portable chest x ray
Need date on time on image for radiologist
Do erect if possible (pneumothorax or pleural effusions)
Should have an arrow on your image
| patients in ICU get daily portables or even multiple
32
When are supine images acceptable in mobile chest imaging
Initial post-op in ICU
Line or feeding tube placement
Pt. has femoral line (cant sit them up could kink the line)
Pt. is too unstable
Hip or spine #
Pt. in traction
33
What orientation do we put the detector or Cassette in for male chest x ray?
landscape
34
What orientation do we **always ** put the detector or Cassette in for feeding tube checks?
Portrait
35
What orientation do we put the detector or Cassette in for female chest x ray?
Portrait
36
Imaging Requirements for portable chest xray
- CR perp to sternum
- collimate to middle of humeral heads
37
Why do we do portable images of extremities
- knees/hips/pelvis common in PACU or RR to make sure they havent # above or below surgery area
38
Rules of spint removal for portable imaging of extremities
- NEVER remove splints without permission
- document if splint was unable to be removed
- may remove with permission
39
How do you move # extremities?
Support proximal and distal to # site
40
When doing a portable hip arthroplasty what must you NEVER do
how much of the arthroplasty must we include?
- Cross pt. legs (often have a pillow between the legs)
Flex hips past 90 degrees
*need at least 1" past metal prosthesis (may have # under it)
41
Why do we constantly image hip arthroplasty
Not straight down (# below arthroplasty)
Distance between head of femur and acetabulum (need equal distance)
42
Positioning Principles for Mobile Radiography of Extremities
Principle 1 -> Two projections 90 degrees to each other
Principle 2 -> Entire structure or area of interest on the IR
Principle 3 -> Maintain safety (physical & radiation)
43
What must be included in a portable abdomen?
Include marker and arrow
44
What position must the pt be in for FT, NG tube placement for a portable abdomen?
Supine abdomen only
45
What position must the pt be in for constipation (fecal impaction, fecal loading) for a portable abdomen?
Supine abdomen only
46
What position must the pt be in for ascites?
Supine abdomen only
47
What position must the pt be in for free air for a portable abdomen?
Supine abdomen & left lateral decubitus
48
What position must the pt be in for foreign body for a portable abdomen?
Supine abdomen & lateral (anterior to posterior) want to see where foreign body is exactly
eg. Gunshot may do decubitus for air
49
What are neonates most at risk for?
Hypothermia (need to be quick and efficient)
- in the NICU
- have an immature immune system
50
Infection Control for Neonates
- hand hygeine
- gown
- gloves
- mask
- disinfect portable
51
Where do we put our IR for images of neonates?
In a tray under isolette OR cover with warm soft blanket
52
Do we use markers for neonates?
NO! use electronic markers after images are taken as may risk covering anatomy
| because we cant see IR in tray
53
What is wrong with this image
- HORRIFIC
- never put neonate on detector
- theyre cold need to use warm blanket if tray not available
Rad Pro 3
flashcards
Decks in class (10)
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