Interventional Radiography and Fluoroscopy

Interventional Radiography and Fluoroscopy

Learning Outcomes

• Provide understanding of equipment and instruments essential to Interventional Radiography (IR).
• Understand application and safety of various equipment.
• Importance of sterilization and aseptic techniques in IR.
• Describe the Seldinger technique.
• Link to module learning outcome: Employ sterile techniques during fluoroscopic procedures to reduce hazards and manage contamination, including waste and spillage.

Imaging Equipment

• Fluoroscopy Unit: Used for real-time imaging.
• Ultrasound Machine: Utilizes sound waves for imaging.
• CT Scanner: Provides cross-sectional images of the body.
• Contrast Agents: Enhance imaging by highlighting structures.

Fluoroscopy Equipment Features

• Important to note configurations of C-arms and other devices:
  • Image Intensifiers: Enhance brightness and clarity of images.
  • Flat Panels: Provide improved imaging capabilities and flexibility.
• Equipment varies for specific task requirements (e.g., cardiac procedures).

Dynamic X-ray Imaging

• Imaging of moving organs and structures within the body.
• Applications include imaging the GI tract with barium contrast, cardiac imaging, and angiography.
• Provides real-time image guidance for special investigations.

Benefits of Fluoroscopy

• Real-time imaging capabilities aid in minimally invasive procedures.
• Enhanced visualization of internal structures.
• Applicable in orthopedic, vascular, and cardiac procedures.

Terminology

• Fluoroscopy: Visual examination of moving objects, often for aid in catheter navigation.
• Fluorography: Used for short sequences of diagnostic-quality images; it archives procedural outcomes.
• Frame speeds can vary based on application (e.g., 30 fps for cardiac procedures).

Contrast Agents

• Used to:
  • Enhance visibility of vessels and blood supply.
  • Differentiate between normal and abnormal tissue.
  • Assess functionality of organs.

Advanced Features in Fluoroscopy

• Modern equipment includes:
  • 3D imaging and Cone Beam CT
  • AI tools for enhanced imaging
  • Image fusion techniques
  • Robotics integration to streamline procedures

Radiation Protection

• Protection measures include:
  • Use of lead coats, dosimeter badges, and lead glasses.
  • Mobile and table-mounted protective shields.
  • Reduction strategies focus on time, distance, shielding, and PPE usage.

Role of Radiographers in Fluoroscopy

• Responsibilities include:
  • Pre-procedural setup.
  • Intra-procedural operation of equipment.
  • Post-procedural tasks and advocacy for radiation safety.

Access Techniques

• Seldinger Technique:
  • A sterile procedure for accessing blood vessels.
  • Involves needle puncture followed by guide wire insertion, catheterization, and contrast injection.
  • Common access points: femoral and brachial arteries, internal jugular and subclavian veins.

Vascular Access Considerations

• Choice of puncture site depends on procedure type:
  • Arterial Access: Femoral, radial, brachial, popliteal arteries.
  • Venous Access: Femoral, jugular, subclavian veins.
• Use of micropuncture sets for initial access.

Catheters and Wires

• Guidewires are essential for navigating within vessels and must be used when pushing catheters.
  • Types vary by material, diameter, coating, and length.
  • Hydrophilic wires are preferable in fluid environments for easier navigation.
• Catheters come in various forms and must always be advanced over a guidewire.

Hemostasis Devices

• Alternatives to manual compression include:
  • Angioseal: Collagen plug for sealing puncture sites.
  • Perclose: Suture device.
  • Femstop: Manual compression assist.

Sterilization and Aseptic Techniques

• Sterilization: Complete elimination of microorganisms and spores.
• Aseptic Technique: Practices to prevent contamination during medical procedures.
• Prioritizing high-risk areas such as catheter insertion points and contrast administration.

Common Errors in Maintaining Sterility

• Breaks in technique, improper sterile setup, and non-compliance with hand hygiene must be addressed.

Waste Management in IR

• Importance of proper waste segregation and disposal in accordance with color codes:
  • Black: Domestic/general waste.
  • Yellow: Clinical infectious waste.
  • Orange: Offensive clinical waste.
  • Cytotoxic waste: Special handling for items contaminated with cytotoxic agents.