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Interventional Radiography and Fluoroscopy

• Instructor: Kay Hizzett

Learning Outcomes

• Understand essential equipment and instruments in Interventional Radiography (IR).

• Gain comprehension of equipment application and safety.

• Understand the importance of sterilisation and aseptic techniques.

• Describe the Seldinger technique.

• Link to module learning outcome: Understand and employ sterile techniques during fluoroscopic procedures to reduce hazard and address contamination, including waste management and spillage.

Imaging Equipment

• Fluoroscopy Unit: Central to imaging dynamic processes in real-time.

• Ultrasound Machine: Utilises sound waves for imaging

• CT (Computed Tomography): Provides cross-sectional imaging for diagnostic purposes.

• Contrast Agents: Enhance visibility of vessels and tissues in imaging.

Fluoroscopy Equipment

• Various types, features, and uses.

Equipment Features

• Floor/Ceiling Mounted II: Different tasks use specific mounts (e.g. cardiac tasks).

• C-arms: Versatile for different positions and tasks.

Image Intensifiers & Flat Panels

• Key components in fluoroscopic imaging that enhance image quality and accessibility.

C-arm Features

• C-arm Rotation: Allows for various angles and views during procedures.

• Swiveling: Facilitates easy positioning around patients.

• Up/Down Travel: Adjusts to different heights for better access.

Dynamic X-ray Imaging

• Involves real-time imaging of moving structures (e.g. GI tract).

• Utilises contrast media like Barium for enhanced visibility.

• Applications include imaging for cardiac and vascular assessments.

Benefits of Fluoroscopy

• Real-time Imaging: Vital for guiding minimally invasive procedures.

• Enhanced Visualization: Improved imaging for various bodily structures.

• Uses: In orthopaedics, vascular, cardiac procedures, and functional studies.

Terminology

• Fluoroscopy: Visual examination for moving objects.

• Fluorography: Pulsed digital imaging to acquire and document diagnostic quality images.

Contrast Agents

• Used to enhance imaging by highlighting blood vessels and distinction between normal/abnormal tissues.

Advanced Features in Fluoroscopy Equipment

• 3D Imaging and Cone Beam CT: Offers detailed views.

• AI Tools: Enhances imaging efficiency and accuracy.

• Image Fusion: Combines images from multiple sources for better analysis.

• Robotics Integration: Improves precision and reduces manual workload.

Radiation Protection

• Strategies include:

  • Use of lead coats, dosimeters, lead glasses, and caps.

  • Incorporating lead screens and skirts to reduce scatter.

  • Understanding skin dose risk for patients in certain procedures.

  • Follow the principles: time, distance, shielding, and PPE.

Protective Shields for Interventional Procedures

• Lower Body Shields: For mobile and table-mounted setups.

• Upper Body Shield: Specific to cardiac labs.

• Radioprotective Drapes: Additional protection measures.

Radiographers' Role in Fluoroscopy

• Includes pre-procedural setup, intra-procedure operation, post-procedure tasks, and being advocates for radiation safety.

Vascular Access and Seldinger Technique

• A methodology for vessel access through:

  • Sterile needle puncture (e.g., femoral, brachial, radial).

  • Involves passing a guidewire, needle removal, vascular sheath insertion, and catheter navigation.

Considerations for Puncture Sites

• The choice is driven by the planned procedure with arterial and venous options outlined.

Needles and Micropuncture Sets

• Basic micropuncture sets typically include:

  • 21-gauge needle, 5-F sheath, and Cope wire.

Sheath Assembly and Usage

• As a guide for catheter insertion; important to flush the sheath before use and select size according to procedure needs.

Catheters and Navigation Wires

• Catheter types vary by: end hole, side hole, selective/nonselective, glide/nonglide,

• Wires used for navigating through vessels vary by material, diameter, and coating.

Hemostasis Devices

• Alternatives to manual compression for patient mobility post-procedure (e.g. Angioseal, Perclose).

Sterilisation and Aseptic Techniques

• Importance in IR, addressing:

  • Complete elimination of microorganisms (Sterilisation).

  • Practices to prevent contamination during procedures (Aseptic techniques).

High-Risk Areas in IR

• Locations with increased risk of contamination include:

  • Catheter insertion points.

  • Guidewire manipulation.

  • Contrast media administration.

Methods of Sterilisation

• Various techniques including:

  • ETO sterilization.

  • Chemical sterilization.

  • Single-use items for best practice.

Infection Control in IR

• Best practices to maintain sterility include observing the sterile field, hand hygiene, and proper personnel alerts.

Waste Management

• Importance of proper waste disposal methods: color-coded bags for different types of waste (e.g. clinical, domestic, infectious).

Conclusion

• Reinforce the necessity of understanding equipment handling, sterilisation, radiation safety, and effective waste management in interventional procedures.