G

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.