Lecture_C_Tools_of_the_Trade__4_

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.