Trauma Radiography
Trauma Radiography Overview
Professor Vinokur discusses various aspects of trauma radiography in the context of emergency radiographic procedures.
Introduction to Trauma
Definition of Trauma: Trauma is characterized as a sudden, unexpected, dramatic, forceful, or violent event.
Common causes of traumatic injuries include:
Blunt forces
Penetrating forces
Explosive forces
Thermal forces
Trauma can affect individuals across all age ranges.
Radiographers in the Emergency Department (ED) must be equipped to perform a variety of procedures on patients in all age groups.
Trauma Centers
The term trauma center signifies a specific level of emergency medical care as defined by the American College of Surgeons Commission on Trauma.
Levels of Trauma Centers:
Level I: Most comprehensive care, provides 24-hour services, often a teaching or research hospital.
Level II: Offers specialized care but is not a research or teaching hospital.
Level III: Typically found in smaller communities; focuses on resuscitation, stabilization, and transfer of patients to larger centers.
Level IV: Located in clinics or outpatient settings, handling minor injuries and stabilization.
Preliminary Considerations for Trauma Radiography
Specialized trauma imaging systems can significantly minimize the time needed to obtain diagnostic images.
Some systems enhance flexibility in image receptor/central ray (IR/CR) positioning.
Certain systems can scan the entire body within seconds.
Mobile Radiography:
Frequently utilized for ED procedures.
Mobile Fluoroscopy Units (C-arms):
Utilized in fracture reduction and for foreign body localization.
Immobilization Devices:
Essential for trauma imaging, as many trauma patients are unable to hold still for required positions.
Roles and Responsibilities of Radiographers in Trauma
The specific role of the radiographer may depend on department protocols and staffing.
Primary Responsibilities:
Perform high-quality diagnostic imaging procedures.
Adhere to ethical standards of radiation protection.
Provide appropriate patient care.
Best Practices in Trauma Radiography
Speed: Prioritize rapid acquisition of quality images to reduce patient burden.
Accuracy: Aim for optimum image quality to minimize the need for repeat images.
Quality Assurance:
Maintain quality standards, avoiding compromises for speed. Do not use patient condition as a justification for poor-quality images.
Positioning:
Care must be taken not to worsen the patient's condition during imaging.
Move the tube and IR instead of the patient when possible.
Expect exposure to body fluids; standard precautions should be adhered to.
Immobilization:
Do not remove immobilization devices without explicit physician orders.
Proper support and immobilization are necessary to minimize motion risk.
Anticipation:
Be prepared for potential follow-up procedures; understanding these increases appreciation for the radiographer's role in the ED.
Attention to Detail:
Monitor patient conditions closely, as they may change rapidly.
Familiarize with ED protocols and scope of practice relevant to the facility.
Professionalism:
Follow the established Code of Ethics in all procedures.
General Procedural Guidelines
Patient Preparation: Communicate effectively with the patient, using appropriate touch and eye contact, and check for potential artifacts.
IR/Collimated Field Size: Should correspond with routine procedures; utilize the smallest IR possible and closest collimation that depicts the required anatomy.
Source-to-Image-Receptor Distance (SID):
Standardization is part of protocol:
Typically, inches (102 cm) is recommended unless specified otherwise.
For increased object−to−image-receptor distance (OID), to inches (152 to 183 cm) is suggested.
Identification Markers:
Right or left side markers must be included on each image.
Avoid using digital annotation for side markers; they should be physically present on images, especially pertaining to penetrating trauma.
Radiation Protection Protocols
Shielding considerations:
Protect pediatric patients and those of reproductive age.
Follow guidelines specified in pp. 33-34 of Volume 1 of course materials.
Additional radiation protection measures include:
Close collimation.
Use of optimal technique factors.
Patient Instructions in ED
Clear instructions must be provided to the patient regarding positions and respiration techniques when feasible.
Short exposure times are advisable to mitigate the chance of motion affecting images.
Immobilization Practices
Many ED patients will arrive already in some type of immobilization device, which should not be removed without orders.
Imaging can generally be performed without removing these devices. Images assist in evaluating injuries and assessing the safe removal of immobilization.
Documentation Importance
Any deviations from routine procedures necessitate thorough documentation, ensuring practices are within the individual’s scope of work.
Image Critique Standards
Evaluation criteria for trauma imaging should align with those for routine imaging.
Quality is critical; low-quality images should not be accepted due to patient condition or procedural challenges.
Specific Radiographic Procedures in Trauma
Lateral Cervical Spine
This projection should be performed first and reviewed by a physician prior to other imaging.
Positioning:
Patient should be in dorsal decubitus with relaxed shoulders, head positioned straight (looking ahead), and IR placed at the top of the shoulder.
CR Centering: Horizontal CR should be directed to the midpoint of the IR, encompassing the entire cervical spine from sella turcica to top of T1.
If all seven cervical vertebrae are not visible, a lateral projection of the cervicothoracic spine should be taken next.
Lateral Cervicothoracic Spine
Required if C7 and top of T1 are not demonstrated on lateral cervical view.
Patient positioning: Supine without rotation, raising the arm opposite to the x-ray tube for support.
CR Centering: Horizontal CR should be aligned with C7-T1 interspace and midcoronal plane.
A breathing technique may be applied to aid in screening details of the spine.
AP Axial Cervical Spine
Patient positioning is crucial, usually supine and often immobilized with a collar and spine board.
CR Direction: The CR should be directed to degrees cephalad toward the midsagittal plane and C4 to visualize C3-T1 or T2, including associated soft tissues.
AP Axial Oblique Cervical Spine
Imaging is performed after the attending physician evaluates the lateral projection.
Positioning: Place IR centered at C4, approximately \$3\$ inches lateral to MSP. Ensure minimal movement of the patient's head and neck.
CR Considerations: Must be angled at two degrees – lateromedially degrees, and cephalad to degrees.
Thoracic and Lumbar Spine Imaging
Positioning for Thoracic and Lumbar Transitions: Employ dorsal decubitus for initial imaging.
CR Directing: Centered to the spine; horizontal CR should assist in visualizing thoracic structures accurately.
Ensure apprehensive behaviors are closely monitored during examinations as thoracic images will include T3-T4 to L1 and lumbar up to T12 and sacrum.
Abdomen and Pelvis Imaging in Trauma
For abdominal imaging, ensure correct positioning (supine) and centering to the mid-sagittal plane at iliac crests, also noting for potential artifacts caused by foreign materials ingested by the patient.
Pay attention to pelvic fractures due to high risk of hemorrhage, monitor patient status, and ensure accurate patient positioning away from radiographic equipment.
Conclusion
Proper trauma radiography adheres to strict guidelines and practices that prioritize patient safety, accurate diagnostics, and high-quality imaging, adapting obstructions and changing conditions within emergency care environments.