1. Intraoperative Radiography
DMI 63
Intraoperative Radiography

2. Intraoperative Radiography:
Running the mobile image intensifier or taking radiographs with the portable x-ray unit in OR under sterile, intense, conditions

3. Mobile Image Intensifier
Commonly referred to as?
C-arm
Is it sterile?
No!
Unless----

4. Portable X-ray Unit Sterile? No!
Unless covered with sterile plastic covers after portable brought into OR
(X-ray machine should be cleaned prior to entering each OR!)

5. OR table
Sterile?
No!
Unless-
Covered with sterile drapes!

6. Working in OR requires :
Super awareness of sterile environment!
Skill in use of portable machine and c-arm
Skill in working OR table
Using radiation protection appropriately
Knowledge of anatomic landmarks- whether you can see them or not!
Ability to work with surgery staff under high pressure circumstances

7. During surgery
Technologist works under direction of surgeon not a radiologist
Who will appear to hate you!
You must be able to perform accurately and quickly! Repeat is no longer in your vocabulary!
Remember: it’s a high stress situation for all –but success or failure rests on surgeon’s shoulders

8. Check your ego at the door!
You no longer have a name- you are “X-ray” The only person lower than you is the guy who cleans the OR- at least they know him! Expect some abuse! Good part -if you screw up, they won’t recognize you outside the OR!
You

9. You must be able to read minds!
When running c-arm, when Dr. wants fluoro, he expects you to understand that:
“X-ray”, “now”, “OK”, “uh huh” “ready”, and a grunt or a mumble mean hit the fluoro pedal even when used interchangeably
Or maybe just a glance at the monitor

10. Areas of OR
Unrestricted
Semi-restricted
Restricted

11. Unrestricted areas of OR
Provides outside to inside access
No traffic restrictions
Street clothes permitted

12. Semi-restricted areas of OR
Authorized personnel only
Pts and staff
Provides access from unrestricted area of OR to restricted area
Proper OR attire required
Scrubs, head and shoe covers

13. Examples of Semi-restricted area
Hallways within OR rooms
Instrument and supply processing area
Non-sterile supply areas and utility rooms

14. Restricted Areas Where surgical procedures are carried out
Proper OR attire and mask must be worn
Examples:
Scrub sink areas
Sterile supply rooms
Operating suites

15. Surgical Suite

16. The Surgical Suite Restricted area!
Aseptic technique: the effort taken to keep patients as free from hospital micro-organisms as possible
Know Who is sterile and who isn’t!
Know What equipment is sterile and non-sterile
No items should be moved without permission of circulating nurse or person in charge!
Scrub clothes must be worn, and covered if leaving department

17. Operating Room Attire
Clean, fresh attire, surgical “scrubs,” donned at beginning of each shift
Are they sterile? no
Change as necessary
Should soiled scrubs be worn outside OR suite?
-no!

18. What the surgery team wears!

19. Masks worn at all times in OR! Are they sterile? No!

20. Operating Room Attire Caps Worn in all areas of OR to contain hair
Hoods available to cover any facial hair not contained by mask
Are they sterile?
No!

21. Surgical Shoe Covers Purpose:
Top prevent you from tracking in contaminants
To prevent contaminants from soiling your shoes
Are they sterile?
NO!

22. Operating Room Attire for Techs
Gloves
Worn to protect tech from body fluids –sterile?
No!
Radiation badge
Proper ID

23. Lead attire

24. Take a bath now and then!
Daily body and hair cleanliness very important to prevent transportation of microbes!

25. Person with known transmittable infection should not be permitted in OR suite!
Cold
Acute infection
Open cold sore
Sore throat
Carrier of transmittable conditions

26. Aseptic Vs Sterile Aseptic is defined as:
Aseptic technique is used to maintain a sterile field
Aseptic is defined as:
Free from pathogenic microorganisms
Sterile is defined as:
Free from all living microorganisms

27. Nosocomial infections
Infections which are a result of treatment in a hospital or a healthcare service unit
Infections are considered nosocomial if they first appear 48 hours or more after hospital admission
or within 30 days after discharge

28. Nosocomial infections
In United States, Centers for Disease Control and Prevention estimates that 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year Commonly transmitted when hospital officials become complacent and do not practice correct hygiene regularly Also, increased use of outpatient treatment means people who are hospitalized are more ill and have more weakened immune systems than may have been true in past.

29. Aseptic Technique (cont’d)
Radiographers or other non-sterile personnel must maintain a safe margin from any sterile field-
What is worse than contaminating a sterile field is bad?
- not reporting it!

30. What is the sterile corridor?
Area between instrument table and draped pt
Must not be entered by any non-sterile personnel!
Notify proper personnel immediately if a sterile field is contaminated!!

31. What parts of sterile gown are considered sterile?
On sleeves- elbow to cuffs
On body- shoulder to level of sterile field

32. Surgical Instrument Tray

33. If you are not sure, consider it sterile!

34. Loading A Cassette in Sterile Cover
Tech
OR staff
Tech
2 person job!

35. Retrieving IR in Sterile Field
Why must Radiographer be wearing gloves?
in case IR cover is contaminated with blood or body fluids
Surgical tech or nurse gives covered IR to radiographer
OK to contaminate cover now, but not person handing you the film!
Cover and gloves are disposed of properly before handling uncovered IR
Hot foot it up to develop and return with image

36. Logistical Problems
Getting c-arm or portable through jungle of equipment and people
Getting cassette under pt without breaking sterile field
Centering CR to pt and to cassette when you can’t see or touch either one!
When x-ray is table top, covered with sterile cloth- you can’t see body part!
Watch out for your lead apron hitting field

37. Take a 5 second break!

38. Common Surgical Procedures requiring our services

39. Cardiac Surgery
Anything pertaining to heart and related major blood vessels
Most common procedures:
pacemaker and automatic internal cardiac defibrillator insertions (C-arm)
Coronary artery bypass grafts
What is generally required after above mentioned procedures?
post-op CXR

40. Cholangiogram

41. Neurosurgery Laminectomies Shunt placements Transphenoidal cases
Requires x-table lateral projections
Shunt placements
Transphenoidal cases
Requires C-arm or skull films

42. Cross-Table Lateral Cervical Spine

43. Oncology Catheter placements Brachytherapy localization
Usually by C-arm
Requires a post-op CXR
Brachytherapy localization
Requires two views at right angle to each other
Cesium Implant

44. Orthopedic Surgery ORIF What does it stand for?
Open reduction internal fixation
May require C-arm or plain film radiography
Closed reduction is what?
No surgical incision- just manipulation
C-arm or plain films

45. Open Reduction -Internal Fixation

46. Joint Replacement

47. Orthopedic Surgery

48. Pain Management Usually in:
Requires C-arm to locate injection site for facet block
Usually in:
Lumbar spine or
SI joint or
Cervical spine

49. Vascular Surgery Utilizes both plain film and mobile fluoroscopy
AV fistulas, AV grafts are most common procedures
What is an AV fistula?
abnormal connection or passageway between artery and vein)

50. Urology Suite Retrograde Pyelograms IVU’s
Kidney & gall stone extractions
Percutaneous Nephrolithotomy
(removal stones from kidney by small puncture wound (up to about 1 cm) through skin)

51. Radiation Protection Or else!! Shield patient if possible!
The mobile unit should not be used as shield by you
YOU must provide Lead aprons for all personnel!
Monitoring badges should be worn by all personnel
You are responsible for making sure all personnel who can or want to leave room prior to making an exposure are given a loud clear warning and have a chance to get at
Or else!!

52. Fluroscopy
When using the c-arm, the radiation source is generally under pt, so where should shielding should be placed?
Under the pt!
between source and pt
Must be done before pt is put on table

53. Summation of Important Things To Remember in OR!
Upon entering OR, alert all staff of your presence and purpose
Be aware of sterile fields and personnel
Enlist aid of circulating nurse to move equipment out of way
Any cassettes placed in sterile field must be covered first by a sterile member of the team
Allow team to clear room prior to making the exposure
Do it right the first time!!!