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Principles of Mobile Radiography

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Presentation on theme: "Principles of Mobile Radiography"— Presentation transcript:

1 Principles of Mobile Radiography
You bring imaging services to pt using transportable x-ray equipment Where are they commonly used? pt room ER ICU surgery and recovery rooms nursery and neonatal units When was mobile x-ray equipment first used? battlefield WW1 -units were carried to field sites

2 Marie Curie By 1914 many hospitals already had x-ray machines- too far removed from the battlefield Many lives could be saved if only quick diagnosis by x-ray was possible…. Curie launched a project that converted 20 vehicles into mobile x-ray units- directed the work in field herself In 1917 and 1918 more than a million x-rays taken- estimated thousands of lives saved Hundreds of drivers, technicians, and radiologists were women

3 Mobile X-Ray Machines True or false? Portables are as sophisticated as stationary units? False (actually true now for some newest digital models) Typical unit has what 2 controls kVp and mAs mAs range- generally 0.04 to 320 mAs kVp range? -generally 40 to 130 kVp

4 Two basic types of Mobile X-Ray Machines
1. Battery powered Sometimes uses two different sets of batteries (lead-acid, or nickel-cadmium ) One powers driving of machine One set provides power to x-ray tube Fully charged batteries: - can make 10 to 15 exposures - be driven reasonable distances 2. Capacitor discharge (obsolete) No batteries Carries two metal plates that hold electrical charge Capacitor units must be charged prior to each use

5 Battery-operated Unit
Advantages over capacitor discharge: Cordless Provide constant kVp and mAs Many exposures Disadvantages: Heavy hard to control What is “Deadman” type of brake? stops machine instantly when push-handle released

6 Capacitor Discharge Units
Advantages of capacitor discharge over battery operated: lightweight, smaller and easier to maneuver require much less time to charge than battery units Disadvantages? can’t handle thick body parts due to voltage drop during exposure must be charged prior to each use

7 Nomad For places with no electricity or chemical processors
Mainly for dental x-rays (regular office unit cost approx. $1,050)

8 Vehicle Portable Units

9 Remote Service Diagnosis
Can x-ray on battery or plugged in Low energy batteries- need much less charging frequency Image can be seen instantly – sent to radiologist wirelessly Image considered as good as x-ray room equipment Can be used as backup unit in empty room

10 3 important technical factors that must be clearly understood to perform optimum mobile examinations: Grid Anode-heel effect Source–to–image receptor (SID)

11 Grid Must be level! X-ray beam must be properly centered to grid
Correct focal distance must be used (Best grids for mobile radiography have ratios of 6:1 or 8:1 and a focal range of inches) Make sure grid is fastened to cassette properly (tape, newer cassettes may use snaps)

12 Anode Heel Effect Cathode Anode
Correctly place anode-cathode (marked on tube housing) with respect to anatomy Anode should be on thinner part ( top T-spine) Heel effect increases with short SID, larger field sizes (more common in mobile radiography) Beam travels through thicker part of target on anode side, thus attenuating beam more

13 SID- Mobile Units Standard SID is 40” or 72” when possible
Problems with greater SID? Need increased mAs, thus longer exposure time Increases risk of imaging motion Increased drain on battery Possible grid cut-off

14 Performing Mobile Examinations
Plan ahead! Gather all necessary devices to take with you IR (bring extras! Unless you are using new digital) Grid Tape Markers Sponges

15 Before Beginning Examination
Find pt’s x-ray order Let nurse’s station know of your presence and purpose Identify pt and introduce yourself with your title Explain exam and ensure it is appropriate and correct Politely ask any visitors to leave Obtain assistance when necessary!

16 Interfering Devices Watch out for orthopedic beds, fracture frames, tubes, wiring, etc., producing artifacts Know which objects can be moved and which ones you have to work around Ask if unsure whether an object can be moved May have to perform with object in image

17 Portable Position If exam in supine position, move unit to middle of bed If seated upright, at end of bed Lateral and decubitus positions, place base parallel or perpendicular to bed

18 Performing Mobile Examinations
Make sure collimation is not open larger than IR size Check CR and IR alignment to prevent distortion Use consistent system for keeping exposed and unexposed IRs separate, if using multiple cassettes Keep log of procedures, time of examination, technical factors for image ID

19 Wear film badge at collar or waist outside lead protection
Mobile radiography produces some of highest occupational radiation exposure for radiographers! Wear a lead apron! Wear film badge at collar or waist outside lead protection What is single most effective radiation protection measure? Distance! What is minimal safe distance ? 6 feet

20 Safest Place to Stand Least exposure is at what angle to pt and primary beam? Right angle

21 When should you shield pt’s gonads?
X-raying children Person is of reproductive age Pt requests Gonads lie in or near useful beam When shield will not interfere with anatomy of interest

22 Radiation Safety cont’d
What is minimum source-to-skin distance? 12 Have visitors leave area Warn other personnel when you are about to make an exposure

23 Inappropriate movement can further injure pt!
Patient Mobility Never move pt or part without: Assessing ability to move or ability to tolerate movement Checking with staff obtain assistance and permission to move a part that has had surgery or fractured Inappropriate movement can further injure pt!

24 Assess Patient Condition
Be aware of any limitations to procedure! Alertness Respiration Ability to cooperate Language comprehension Mobility Fractures Interfering devices If in OR, don’t break sterile field!

25 Warn pt of potential discomfort from IR
Cold Hard IR can damage skin of older patient Use cloth or paper cover to reduce risk of injury Protect IR from contamination by use of appropriate impermeable cover

26 Isolation Considerations
What are two types of pts in isolation? Those who have contagious infectious microorganisms you want to avoid them! Those who must be protected from exposure to infectious microorganisms- they want to avoid you! This known as? Reverse isolation!

27 Isolation Considerations cont’d
Wear all required protective apparel for specific situation Wash hands before gloving Protect IR with protective cover

28 Isolation Considerations cont’d
After procedure: Discard of protective apparel according to protocol Wash hands! Wear clean gloves to clean equipment and use appropriate aseptic technique Wash hands again after removing gloves

29 Most Common Portable Radiographic Exams
Chest Abdomen Pelvis Femur Cervical spine Neonate

30 AP Chest Elevate head of the bed as pt condition permits
Pull pt to head of bed before elevating if condition permits Make sure pt is not rotated What if pt has respiration assistance? watch pt chest to determine inspiratory phase (or respirator)

31 AP or PA Chest Lateral Decubitus Position
Place firm support under pt to elevate body and keep pt from sinking down in bed Protect pt from rolling off of bed!

32 Lateral Decubitus Position Considerations
Fluid levels best imaged with? affected side down Air levels seen best with? affected side up How long should pts be in this position before exposure? 5 minutes Why to allow fluid or air to settle

33 Orthopedic Examinations
How many images required? at least 2 films at right angles to each other Who do you obtain permission from prior to moving an injured pt? pt’s nurse or physician How do you position pts? very carefully!

34 Lateral Cervical Spine
Dorsal decubitus position CR horizontal If there is a immobilization device when should you remove it? NEVER or until Dr. gives permission

35 Neonate AP projection of chest and abdomen often ordered and shot in one exposure Infant is supine Some bassinets equipped with tray to hold IR If IR placed directly under infant- wrap with soft cover

36 Neonate Move arms out of anatomy of interest Bring legs down
Who should hold infant in position? Nurse- (provide lead apron) Why do you leave head rotated? to avoid advancing endotracheal tube too far Collimate closely Shield gonads

37 Neonate Cross-table Lateral projection
Why do you use dorsal decubitus position? Allow laying of air and fluid Why do you elevate infant on radiolucent block wrapped in soft cover? to see posterior structures Exposure is made on? inspiration Watch out -Infant respirations are rapid! Trying syncing your breathing rhythm with their’s

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