1. Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Surgical Radiography

2. Slide 2 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Surgical Team  Consists of  Surgeon  One or two assistants  Surgical tech  Anesthesia provider  Circulating nurse  Various support staff

3. Slide 3 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Surgical Team  Divided into two classifications, according to function  Sterile members  Nonsterile members

4. Slide 4 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Sterile Team Members  Scrub hands, don proper sterile attire, and enter and work in the sterile field  The sterile field is a specially prepared area of the operating room that immediately surrounds the patient  Sterile team members work in and handle only sterile items

5. Slide 5 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Sterile Team Members  Members include  Surgeon = licensed physician specially trained and qualified to perform surgical procedures  Surgical assistant = qualified surgeon or resident in an accredited surgical educational program; must be capable to assume duties of surgeon  Physician's assistant (PA) = allied health practitioner qualified by academic and clinical education  Certified surgical technologist (CST) = responsible for maintaining the integrity, safety, and efficacy of the sterile field

6. Slide 6 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Nonsterile Team Members  Do not enter the sterile field  Function outside and around sterile area  Handle supplies and equipment that are not considered sterile  Follow principles of aseptic technique  Keep sterile team supplied  Provide direct patient care  Respond to requests that arise during procedure

7. Slide 7 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Nonsterile Team Members  Members include  Anesthesia provider = MD or certified registered nurse anesthetist who specializes in the art and science of administering anesthesia  Circulator = preferably an RN; monitors and coordinates all activities in OR, provides supplies to CST, and manages patient care

8. Slide 8 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Nonsterile Team Members  Members include  Radiographers = provides intraoperative imaging in a variety of examinations with a variety of equipment  Others = may also include biomedical technicians, monitoring technicians, persons specialized in specific monitoring or other equipment required for the procedure

9. Slide 9 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Proper Surgical Attire  Attire protocols vary, but common standards exist  Facility design and surgical attire regulations help prevent transportation of microorganisms into surgical settings  Infection control practices involve personal actions including personal fitness, skin disinfection, hand preparation, surgical attire, and personal technique

10. Slide 10 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Operating Room Attire  Policies and procedures should be in place for proper attire in semirestricted and restricted areas of the OR  Protocol strictly monitored to ensure adherence to policies  Street clothes never worn in any area of OR

11. Slide 11 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Operating Room Attire  Clean, fresh attire, surgical “scrubs,” donned at beginning of each shift  Changed as necessary  Soiled scrubs not worn outside OR suite  Protective eyewear  Masks worn at all times in OR  No necessary in semirestricted areas

12. Slide 12 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Operating Room Attire  Shoe covers  Changed as needed  Removed before exiting OR  Caps  Worn in all areas of OR to contain hair  Hoods available to cover facial hair, not contained by mask

13. Slide 13 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Operating Room Attire  Gloves  Worn to protect from body fluids  Radiation badge  Proper ID

14. Slide 14 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Personal Hygiene  Person with known transmittable infection should not be permitted in OR suite  Cold  Acute infection  Open cold sore  Sore throat  Carrier of transmittable conditions  Daily body and hair cleanliness very important to prevent transportation of microbes

15. Slide 15 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. OR Dance  Maintaining the sterile field during surgical procedures is like a well-choreographed dance  There are moves and rules that everyone follows  Once the sterile field is established, the team members work together to maintain it  If the field is compromised, immediate notification is made

16. Slide 16 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. IR Handling in Sterile Field  CST holds sterile IR cover open toward radiographer  Radiographer holds one end of IR while placing other end into sterile cover  Do not touch sterile cover with hand holding IR  CST grasps IR and wraps cover over IR

17. Slide 17 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. IR Handling in Sterile Field  After exposure, the IR is retrieved via  Radiographer must be wearing gloves, in case IR cover is contaminated with blood or body fluids  CST hands covered IR to radiographer  Radiographer opens cover away from self and others and slides IR out of cover  Cover and gloves are disposed of properly before handling uncovered IR

18. Slide 18 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Enemies of Sterile Field  Lengthy or complex procedures increase risk of sterile field contamination  The floor is always considered contaminated  Avoid placing IRs, lead aprons, and shields on the floor

19. Slide 19 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Equipment  Knowledge of imaging equipment and accessories key to successful OR procedures  Some procedures may be rare; equipment competence and good communication skills help ensure favorable results

20. Slide 20 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Cleaning Equipment  Cleaning should be done after every case  If equipment becomes contaminated during procedure, RT can clean it in the OR  Wear gloves  Do not spray cleaner – pour onto a rag  Seldom used equipment should be cleaned once a week and just before use

21. Slide 21 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Radiation Exposure  Mobile radiography and fluoroscopy in OR result in some of the highest occupational radiation exposure for radiographers  Protection of self, patient, and other personnel is critical  Wear a lead apron  Stand as far away from patient, tube, and beam as possible

22. Slide 22 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Radiation Exposure  Minimal safe distance is 6 feet (2 m)  Least exposure is at right angle to patient and primary beam  Distance is single most effective radiation protection measure

23. Slide 23 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Radiation Exposure  Shield patient’s gonads on procedures performed on  Children  Persons of reproductive age  Shield when gonads lie in or near useful beam  Shield when it will not interfere with anatomy of interest

24. Slide 24 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Radiation Exposure  Minimum source-to-skin distance is 12  (30 cm)  In fluoroscopy, the source is under the patient, so shielding should be placed between source and patient

25. Slide 25 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. OR Fluoroscopic Procedures  Operative (immediate) cholangiography  Chest – line placement; bronchoscopy  C-spine  Lumbar spine  Hip

26. Slide 26 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. OR Fluoroscopic Procedures  Femur nail  Tibia nail  Humerus  Transphenoidal resection of pituitary tumor  Femoral/tibial arteriogram

27. Slide 27 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Operative Cholangiography  Patient position  Supine  C-arm position  Centered over right side of abdomen just below rib line  Use true PA projection, so C-arm may have to be angled or tilted to align with patient’s anatomy

28. Slide 28 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Operative Cholangiography  Structures shown  Contrast-filled biliary system

29. Slide 29 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. OR Chest  Patient position  Supine  C-arm position  Cover with sterile cover  Enter sterile field perpendicular to patient  For line placement, C-arm scans from point of insertion to catheter end  Structures shown  All anatomy of the chest cavity  Any instrumentation introduced during procedure

30. Slide 30 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. C-Spine  Patient position  Supine  Chin elevated  Neck in flexion  C-arm position – AP projection  Cover with sterile drape  Enter field perpendicular to patient  Tilt C-arm 15 degrees cephalad  Center beam over C-spine

31. Slide 31 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. C-Spine  C-arm position – lateral projection  Rotate C-arm to place beam parallel to floor  Angle, if required, to obtain true lateral projection  Center spine in image  Structures shown  Affected area of C-spine  Hardware inserted

32. Slide 32 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Lumbar Spine  Patient position  Prone lying on rolls or frame to flex spine  Arms placed on boards to bring out of field of view  C-arm position – PA projection  Cover with sterile drape  Enters field perpendicular to patient  Center beam over affected area  Raise C-arm to leave enough room for surgeon to work

33. Slide 33 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Lumbar Spine  C-arm position – lateral projection  Rotate into lateral position  Raise or lower to bring spine into center of monitor  Structures shown  Affected area of spine, including bodies, disk spaces, spinous processes, lamina, pedicles, and facets

34. Slide 34 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Hip  Patient position  Supine with legs abducted  Affected leg in traction  Arm on affected side crossed over body and kept out of field of view

35. Slide 35 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Hip  C-arm position  Between patient’s legs  Beam centered over affected hip  Rotate as needed to demonstrate hardware relationship to anatomy  Structures shown  Proximal femur and hip joint, including acetabular rim, femoral head and neck, lesser and greater trochanters, and hardware

36. Slide 36 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Femur Nail  Rod or nail inserted into intramedullary (IM) canal to reduce fracture  Inserted either antegrade through greater trochanter or retrograde through popliteal notch  Patient position  C-arm position  Structures shown

37. Slide 37 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Femur Nail  Patient position – antegrade insertion  Supine or lateral  C-arm position  Structures shown

38. Slide 38 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Tibia Nail  Patient position  Supine  Knee flexed to allow access to tibial tuberosity

39. Slide 39 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Tibia Nail  C-arm position  On opposite side of table from injured leg  Cover with sterile drape  Enter field perpendicular to patient  Center beam over leg  Tilt to match angle of leg  Center beam on fracture site and turn wheels horizontally to allow machine to move down the shaft of the leg

40. Slide 40 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Humerus  Patient position  Supine or reclining  Injured arm resting on mayo stand  Shoulder of affected arm off side of table

41. Slide 41 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Humerus  C-arm position  Cover with sterile drape  Enter field parallel to or at 45-degree angle to the patient  Surgeon’s assistant will rotate arm medially and flex elbow 90 degrees  Rotate C-arm to accommodate patient (arm) angle on lateral and PA projection  Center beam on humerus

42. Slide 42 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Transphenoid Resection of Pituitary Tumor  Patient position  Supine  Head may be held off end of table in a halo  Chin extended  Head tilted toward surgical team

43. Slide 43 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Transphenoid Resection of Pituitary Tumor  C-arm position  Perpendicular to patient  Rotated to lateral  Tilt and rotate to obtain true lateral  Center beam on temporal bone  Sella in center  Place image intensifier closer to skull to magnify pituitary region

44. Slide 44 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Femoral/Tibial Arteriogram  Patient position  Supine  Lower limb may be rotated to remove bony superimposition from vessels

45. Slide 45 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Femoral/Tibial Arteriogram  C-arm position  Cover with sterile drape  Enter perpendicular to patient  Leg in center of monitor  Turn wheels horizontally to allow machine to move left or right without taking leg out of field of view  Use road-mapping and subtraction feature

46. Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. OR Mobile Procedures Slide 46

47. Slide 47 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. OR Mobile Procedures  Lateral projection of cervical spine  Thoracic or lumbar spine  Lateral projection  PA projection  Extremity examinations

48. Slide 48 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Cervical Spine  Patient position  Upright, supine or prone  Head held in traction device to align spine  Chin elevated

49. Slide 49 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Cervical Spine  IR and mobile unit position  IR in holder covered in sterile drape  Position IR on lateral side of patient centered to C- spine  Beam is horizontal and perpendicular to IR  CR enters center of IR to prevent grid cutoff

50. Slide 50 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Thoracic or Lumbar Spine  Patient position  Prone or supine  Arms by head  Frame used to support chest and abdomen and flex spine

51. Slide 51 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Thoracic or Lumbar Spine  IR and mobile unit position – lateral projection  IR in holder and covered with sterile drape  Position along side of patient  Center to region of spine of interest  CR perpendicular to IR and parallel to floor

52. Slide 52 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Thoracic or Lumbar Spine  IR and mobile unit position – PA projection  Place IR in slot under table and center to spine  Cover field with sterile drape  Center CR to IR and perpendicular to long axis of spine

53. Slide 53 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Thoracic or Lumbar Spine  Structures shown  Spine in PA and lateral projections  Spine bodies, spinous processes, facets, and lamina  Hardware  Instrumentation

54. Slide 54 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Extremity Examinations  Patient position  Varies with procedure and part  Surgeon may choose to support limb in desired position and hold IR  Use of holder and positioning aides reduces exposure to surgeon

55. Slide 55 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Extremity Examinations  IR and mobile unit position  Unit approaches perpendicular to patient  Tube, field, and IR may all be covered in sterile drape  If field is draped, surgeon will usually mark or point to center of image

56. Slide 56 Mosby items and derived items © 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Extremity Examinations  Structures shown  Pertinent anatomy in correct alignment  All hardware