Surgical Radiography Unit 1- OR exam 1/13

how to check patients identification in OR

• look at board

• order case before going down (already know name)

• book of information of patient (nurse’s desk)

OR zones: 1,2,3

zone 1- un-restricted- may enter in street clothes (red mark)

zone 2- semi-restricted- only person in scrubs, hair, & shoe covers

zone 3- restricted- must also have mask on

benefits of radiography in the OR

• precision of placement of surgical implants/ shorter surgery time

• less invasive; smaller incisions & decreased infection

• sponge/ needle count

• visualize soft tissue w/ contrast (vascular)

radiation protection in the OR

• place (II) image intensifier on top decreases radiation exposure for all staff (closer to tech, is better)

  • scatter goes up and then back down to the floor

recommended distance from xray machine

6 feet

closer the image intensifier is to the patient, further the tube is, resulting in….

less magnified image, less radiation to patient

mini c-arm

• compact, mobile fluoro for live imaging

• uses lower energy levels due to smaller body parts

  • surgeons use

o-arm

intraoperative surgical imaging system w/ the ability to obtain 2D & 3D images that can help confirm alignment & accuracy during spinal procedures

what is sterile

waist up, front side

distance from sterile field to stand

12 inches

we are a member of what team in the OR?

nonsterile

space between 2 sterile fields

sterile corridor- refrain from walking between

c-arm parts

swivel is also known as

wag

horizontal movement is also known as

boom

horizontal movement (boom) use:

release the brake marked in green to move the horizontal support arm, can move 20cm

swivel (wag) use

release brake marked in orange, can move in horizontal plane ±12 degrees

orbital movement (lateral) use:

release blue brake (up to +110 degrees or -40 degrees)

angulation adjustment (cephalad/ caudad)

release yellow brake (can rotate vertical plane ±225 degrees)

left monitor=

live image

smiley face location

located on II- if standing at base of c-arm, appears on R hand side

smiley face purpose

depicts position of patient

smiley face at head of pt means:

no orientation needs to occur to your image (coming in from left)

smiley face at foot of pt & pt is supine means:

you need to orient by selecting both ‘R’s

smiley face at foot of pt & pt is prone means:

you need to orient by selecting the head to toe “R”

cystoscopy- “cysto”

diagnostic procedure that directly examines the urinary tract, particularly the bladder, the urethra, and the openings to the ureters

what does ND-NC mean?

no dictation, no charge

charge for cystoscopy

XR CYST ROOM ND-NC

ND-NC examples

• cysto

• portacath

• spinal stim

• bladder stim

• at surgeon request

adenocarcinoma of prostate

type of cancer that develops in gland cells

cause of adenocarcinoma of prostate

idiopathic- inherited gene mutation & inflammation of prostate are risk factors

radiographic appearance of adenocarcinoma of prostate

• elevates & impresses the floor of the contrast-filled bladder in an irregular pattern

adenocarcinoma of prostate technical factors

no change typically

benign prostatic hyperplasia

enlargement of prostate gland

cause of benign prostatic hyperplasia

disturbance of hormone secretions from sex glands

radiographic appearance of benign prostatic hyperplasia

• elevates & impresses the floor of the contrast-filled bladder in a smooth pattern

  • j-shaped or fish-hook appearance of distal ureters

benign prostatic hyperplasia technical changes

no changes, ultrasound used to visualize

surgical cholangiography is also known as

interoperative cholangiogram (IOC)

surgical cholangiography

• investigates patency of bile ducts and functional status of the sphincter of the hepatopancreatic ampulla to reveal the presence of calculi that cannot be detected with palpation

  • After exposing, draining, and exploring the biliary tract, and frequently after excising the gallbladder, the surgeon inject contrast (cholangiogram)

anatomy diagram

anatomy diagram 2

anatomy diagram 3

early laparoscopic cholecystectomy (ELC)

surgical removal of the gallbladder using a tiny camera inserted through the navel for guidance (surgical c-arm procedure)

ELC procedure

surgeon located the common bile duct and inserts a catheter to introduce x-ray contrast

ELC procedure- tech responsibilities

• move c-arm over pt’s gallbladder (RUQ)

  • pt is supine (PA projection- tube under patient)

• fluoro while surgeon pushes contrast through bile duct & tree

“OP cholangiogram”- RH charge

any initial laparascopic injection of contrast

“OP cholangiogram ADL SET”- RH charge

additional images, usually after placement of a “T” tube done in an open cholecystectomy

“OP cholangiogram ND-NC”- RH charge

if no images saved since contrast was not successfully injected

endoscopic retrograde cholangiopancreatography (ERCP)

• NOT Sterile

  • use 1 “R”

• used primarily to diagnose & treat conditions of liver, gallbladder, bile ducts, & pancreas including gallstones, inflammatory strictures (scars), leaks (from trauma & surgery), & cancer

  • combines x-rays & endoscope

ERCP- tech responsibilities

• performed by gastroenerologist

  • pt in LAO position, center over RUQ

    • fluoro over biliary system

different charges for ERCP

ERCP- if biliary ducts & pancreatic duct visualized
ERC- if only biliary ducts
ERP- if only pancreatic duct

cholelithiasis

• gallstones (hardened deposits of cholesterol & bilirubin)

cause of gallstones

• idiopathic

gallstones radiographic appearance

• Most gallstones are radiolucent and visible only on contrast exams or US

• Alternating opaque and lucent rings

• Can have a Mercedes-Benz sign – if gas fissure is present inside it

cholecystitis

inflammation of gallbladder

cause of cholecystitis

95% occurs after obstruction of cystic duct

radiographic appearance of cholecystitis

distended gallbladder w/ gallstones w/ edema under US

Radionuclide cholescintigraphy

failure to accumulate radioactivity in gallbladder

anterior hip replacement

surgeon makes 4-inch incision through front of leg

• surgical c-arm procedure

benefits of anterior approach with a hip replacement

• Frontal entry makes it possible to reach the joint by separation, rather than cutting & reattaching muscles

• Recovery time is faster

  • Less risk for hip dislocation after surgery

anterior hip replacement- tech responsibilities

• c-arm enter on opposite side of hip of interest

• see trochanters & obturators- PA views

• radlink

what is radlink at RH?

software that allows a live image to be grabbed from c-arm (always ordered as ND w/ radlink order)

Hana table

used for hip & knee replacements

hip nailing

ORIF- open reduction internal fixation of a fractured proximal femur

• surgeon uses x-ray to guide placement of hardware into the femur

  • extend down to knee= rodding

• sterile team on affected side

• c-arm approaches from unaffected side & center on affected hip

• tech takes pre-sterile AP & lat scout

ELC uses what R’s?

uses both Rs

femur rodding

intramedullary rod inserted into femur to correct fracture

• can be done w/ antegrade (from hip) or retrograde (from knee)

  • very vascular, just like hip nailing

• screws for rod must be imaged laterally to form “perfect circles”

orthopedic extremities

• surgical repair of any extremity w/ fluoro guidance (open or closed repair)

  • tech must maintain AP & lateral images on C-arm monitor

external fixation

screws are placed into the bone above & below the fracture; a device is attached to the screws from outside the skin, where it is adjusted to realign the bone

spinal surgery- fusion

• Permanent fixation of 2 or more vertebrae using metal screws and rods

• takes away some flexibility but may stop the progress of deterioration, such as scoliosis

spinal surgery- discectomy

• Removal of a portion of a herniated disc or complete disc removal during a spinal fusion

  • The disc is replaced by a “cage” during fusions

spinal surgery- laminectomy

• Surgical operation to remove the back of one or more vertebrae, usually to give access to the spinal cord or to relieve pressure on nerves

cervical surgery pt position

supine

thoracic & lumbar surgery pt position

prone

c-arm for spinal surgery

• tube should be perpendicular to patient’s spine to ensure true lateral image

  • may need to angle c-arm to open spaces

vascular studies (arteriograms)

• Use injections of contrast under fluoro to evaluate blood vessels for strictures or ruptures

  • Intra-operative Arteriograms

  • Venous bypasses in extremities

  • Aortic stent placement for abdominal aneurysms

vascular studies- subtraction

• Removal all bone or other artifacts from an image for better visualization of contrast-filled vessels

vascular studies- roadmapping

• contrast is injected ONCE, but the image of that contrast is superimposed over subsequent images that are not contrast injected resulting in less radiation exposure and contrast use

port-a-cath

• a reservoir connected to a catheter that is inserted into a vein near the heart.

  • designed to permit repeated access to the venous system for the parenteral delivery of medications, fluids, and nutritional solutions and for the sampling of venous blood.

pain management

• fluoro-guided injections of analgesics and/or steroids to alleviate chronic pain (w/ or w/o sedation)

  • semi-sterile environment

nerve blocks

relieve pain by interrupting pain sensory pathways & preventing them from reaching the brain

types of pain management:

1. transforaminal’s

2. facets

3. epidurals

4. cervical epidurals

bronchoscopy

• endoscopic technique of visualizing the inside of the airways

  • a scope is inserted into the airways, usually through the nose or mouth (can examine airways for foreign bodies, bleeding, tumors, or inflammation.)

(Specimens may be taken from inside the lungs)

on a sthenic patient the gallbladder is in what quadrant?

RUQ

bronchoscopy tech responsibilities

• pt is supine

• center over lung (bronchoscope tip should be in middle of the image)

  • PA images of lungs

EPIC or master charge list

we charge for x-ray, not the surgery

transcribed vs cosign required

transcribed= order will end with ND-NC
cosign- all other orders

dictation vs no dictation

• orders that end w/ ND-NC will always be NO dictation

  • ex: cysto, portacath, spinal stim, bladder stim

what is the c-arm password?

U12345

c-arm jack

Orange ethernet cable to C-Arm must be plugged into wall jack to connect  to the internet to pull up worklist and send images to PACS