RT Exam 4 - Mobile/Trauma Radiography

What is the goal of the ER?

to stabilize the patient’s condition by treating the acute problem and discharging or transferring the patient.

Acute illness/injury definition

abnormal body condition with sudden, rapid onset

Goal of the ER team

to provide timely, compassionate, and high-quality care

Trauma Room guidelines

The patient is everyone’s priority

Communication is essential

Wear your lead

Announce when you are going to expose

What to avoid in a trauma situation

Avoid moving the patient to much

Never force a patient into position

If the patient can’t move, you need to manipulate CR and IR to get the images necessary for diagnosis

Fracture (Fx) definition

a disruption of bone caused by mechanical forces either applied directly to the bone or transmitted along the shaft of the bone

Apposition Definition

how the fragmented ends of the bone make contact with each other

Anatomic Apposition

The bony fragments touch one another in anatomic position.

Lack of Apposition (distraction)

The bony fragments are not touching

Bayonet Apposition

The bony fragments are touching but have been displaced.

Angulation Definition

the extent to which fracture fragments are aligned

Apex Angulation

Describes the direction or angle of the apex, whether it points medially or laterally

Varus Deformity

Inversion

Distal Fragment towards midline

Apex angles away (laterally)

Valgus Deformity

Eversion

Distal Fragment away from midline

Apex towards midline (medial)

Simple Fracture

Fx where the bone does not break through the skin

Compound/Open Fracture

Fx where a portion of the bone protrudes through the skin

Incomplete Fracture

Partial

Fx does not traverse through the entire bone

Torus, Greenstick

Complete Fx

Break is complete, bone is broken in two pieces

Transverse, Oblique, Spiral

Comminuted Fx

Bone is splintered or crushed at site of impact resulting in two or more fragments

Segmental, Butterfly, Splintered

Impacted Fx

One fragment is driven into the other, quite common with fall on outstretched hand (FOSH)

Avulsion Fx

Fragment of bone is pulled away by an attached tendon or ligament

Chip Fx

Isolated bone fragment not caused by tendon or ligament

Compression Fx

Vertebral fx displays as decreased vertical dimension of anterior vertebral body

Depressed / PingPong Fx

Skull fx where the fragment is depressed in like a ping pong ball

Epiphyseal fx

fx through the epiphsyial plate in children

5 types (SALTER)

Type 1 Epiphyseal Fx

S - Straight Through (Plate)

Type 2 Epiphyseal Fx

A - Above (Plate)

Type 3 Epiphyseal Fx

L - Lower (than Plate)

Type 4 Epiphyseal Fx

TE - Through Everything

Type 5 Epiphyseal Fx

R - cRush

Pathologic Fx

Fx due to disease process

Stellate Fx

Fx radiates in a star like pattern from central point of injury

Stress Fx

Caused by repeated stress on the bone (marchers or runners)

Trimalleolar Fx

Fx of ankle joint involving medial and lateral malleoli and posterior lip of distal fibula

Tuft or Burst Fx

Caused by crushing blow to distal finger or thumb (slamming in a door/hammer)

Blowout or Tripod Fx

Direct blow to the orbit and maxilla or zygoma causing fxs to orbital floor and lateral orbital margin

Colles Fx

fx of the wrist in which distal radius is fx with distal fragment displaced posteriorly

Smith or Reverse Colles Fx

Fx of the wrist with a distal fragment of the radius displaced anteriorly. Results from backwards FOSH

Barton Fx

Intra-articular fx of the distal radius that often involves subluxation or dislocation of the radiocarpal joint

anterior or posterior

Bennett Fx

Longitudinal fx at base of first metacarpal with fracture line entering the CMP joint

Boxer Fx

fx of distal fifth metacarpal.

results from punching someone or something

Hangman Fx

Fx through pedicles of axis (C2)

Hutchinson or Chauffeur Fx

Fx of radial styloid process

Blow to lateral side of distal forearm

Monteggia Fx

Fx of proximal half of ulna with dislocation of radial head.

May happen if raises arms to block blows to the head

Pott Fx

Complete fx of distal fibula, may involve ligament damage and fx of medial malleolus and distal tibia.

Closed Reduction

Fx fragments are realigned by manipulation and immobilized by cast or splint.

Non-surgical buy may use fluoroscopy

Open Reduction

Surgery using screws, plates, or rods to maintain alignment of parts while bone regrowth takes place

AKA Open Reduction with Internal Fixation (ORIF)

Mobile definition

capable of being moved

trauma definition

an injury that can be caused by an outside force

what is considered ‘mobile’ in mobile radiography

The x-ray tube and IR can be taken out of the x-ray room and go throughout the hospital

T/F Mobile Radiography can only be performed on specific parts of the body.

False - any part of the body

Emergency Definition

a medical condition requiring immediate treatment

Mini C-Arm

comes directly off the machine.

Can set up and leave it for the Dr. to run (in NE)

C-arm

two separate machines, connected.

Must have a technologist immediately present

O-arm

looks like a donut - 3D images

Must have a technologist immediately present

Where is the circuit breaker found on a portable machine?

usually the ‘back’ wheel to the RTs right

what does the bumper do?

Breaks the machine so you don’t run something over

Where are the drive controls?

the handle bar in the ‘back’

How long does the exposure switch cord need to be?

at least 6 ft

What are positioning aides for portables?

decubitus board, sponges, medical tape

What are the three cardinal principles of radiation protection?

time, distance, and shielding

What cardinal principle is used when you reduce your overall dose by decreasing the amount of exposures you are around

Time

What cardinal principle is used when you increase how far away you are from the exposure

Distance

What cardinal principle is used when you put on lead?

Shielding

What is the most effective way to reduce dose?

Distance

how many lead apron should each portable have?

At least one

Portable Chest SID

72 in

Portable Chest IR Size

14×17 landscape or portrait

Portable Chest CR Grid Technique

125 kVp @ 5-12.5 mAs

Portable Chest CR No Grid Technique

90-95 kVp @ 4-6.5 mAs

Portable Chest DR Grid Technique

117 kVp @ 3-8 mAs

Portable Chest DR No Grid Technique

90 kVp @ 2-3 mAs

Portable Chest CR Location

level of T7

Portable AP Supine Chest Positioning

Patient Supine

IR 1.5 in above shoulders

roll shoulders forward if possible

CR 3-5 degree caudal (perpendicular to long axis of sternum)

Centered to level of T7

Portable AP Semi-Erect Chest

Patient Semi-Erect or in cart/wheelchair

IR 1.5 in above shoulders

roll shoulders forward if possible

CR perpendicular to long axis of sternum

Centered to level of T7

Portable Decubitus Positioning

Patient lying on side indicated for 5 mins before exposure

arms above head

IR 1 in above vertebral prominins

CR horizontal

CR to level of T7

Mark side up

Portable Abdomen SID

40 in

Portable Abdomen CR Technique (Grid)

80 kVp @ 50-100 mAs

Portable Abdomen DR Technique (grid)

80 kVp @ 8-40 mAs

What Decubitus is done for an Abdomen and why?

Left Lateral Decub,

looking for air against the liver. Air away from the gastric bubble.

Portable AP Supine Abdomen Positioning

Patient supine

Arms away from body

CR centered midline at level of iliac crest

Must include symphysis pubis

Portable LLD Abdomen Positioning

Patient on left side

Arms above head

Top of IR at axilla

Patient on side for 5 minutes prior to exposure

CR centered 2 in above iliac crest

Mark side up

Portable Pelvis SID

40 in

Portable Pelvis CR Technique

80 kVp @ 20-32 mAs

Portable Pelvis DR Technique

80-85 kVp @ 25 mAs

Portable Pelvis Positioning

Patient Supine

Arms away from body

internally rotate feet 15 degrees if possible

Top of IR is 1 in above iliac crest

CR centered midway between ASIS and symphysis pubis