Mobile and Surgical Radiography
RAD 113
Summer 2017
The images in the following presentation follow
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Objectives
On completion of this class, you should be able to:
• Describe the use of portable radiographic and
fluoroscopic units.
• Identify the steps followed during bedside radiography:
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Technical Considerations
Communication and Patient Care
Infection Control
Isolation Considerations
Initial Procedures
Examination
Patient Considerations/Skin Safety
Objectives
• Identify the steps followed during surgical radiography:
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Surgical Team
Proper Surgical Attire
Operating Room Attire
Equipment Preparation and Cleaning
Sterile Fields
Communication
• Understand radiation protection procedures for:
▫ Patient
▫ Radiographer
▫ Others
Mobile Radiography
• Principles of Mobile Radiography
▫ Mobile radiography using transportable radiographic
equipment allows imaging services to be brought to the
patient.
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Patient rooms
Emergency department
Intensive care unit
Surgery and recovery room
Nursery and neonatal unit
Mobile Radiography
• Mobile X-ray Machine (Portable)
▫ Vary in their exposure controls and power sources (or
generators)
▫ Controls for setting kVp and mAs
▫ Maximum settings differ among manufacturers
▫ No AEC
▫ 15 – 25 kilowatts (power)
• Digital Radiography
Technical Considerations
• Optimal Mobile Examinations:
▫ Grid
 Level, centered to central ray, correctly used at
recommended focal distance
▫ Anode Heel Effect
 Causes a decrease in image density under the anode
side of the tube
 Heel effect more pronounced with:
 Short SID
 Larger field sizes
 Small anode angles
Technical Considerations
▫ Source-to-Image receptor Distance (SID)
 Maintained at 40 inches for most exams
▫ Exposure Charts
 Must be available for use with every mobile machine
▫ Radiology Department
▫ Attached to side panel of portable (in a document
sleeve)
Accurate Grid Position in Mobile
Radiography
Initial Procedures for Patient Care
• Communication with:
▫ Nurse
▫ Other members of the health care team
▫ Patient
 AIDET
▫ Family members
• Patient Care
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Use of plain language
Effective listening skills
Recognition of patient needs
Compassion/empathy
Initial Procedures for Examination
• Ensure all necessary equipment is on machine
▫ IR, grid, tape, markers
• Ensure all portable equipment is charged
• Before entering the patient’s room with the machine:
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Speak to the nursing staff; ask for assistance (if needed)
Verify the correct patient/exam
Begin AIDET process
Ask family members and visitors to leave
 Children are the exception – (family member may need to
be present for exam)
Examination
• Move obstacles in room
▫ Observe medical equipment in the room
• Adjust lighting (if necessary)
• Position of machine in the room
▫ Patient supine
▫ Patient erect
▫ Lateral and/or decubitus radiographs
• Proper IR and tube alignment
• CR to center of the IR
• Collimation
Radiation Protection
• TIME, DISTANCE, SHIELDING
• Radiographer must wear a lead apron
• Stand as far away from patient, x-ray tube,
and useful beam as possible.
▫ Minimum of 6 feet
▫ Lowest amount of scatter radiation occurs at a
90° angle from the primary x-ray beam.
Radiation Protection
• Proper selection of technical factors
• Lead protection for the patient
• Lead protection provided for anyone in the room
• SID should be maintained at 40 inches
▫ Source-to-Skin Distance (SSD) cannot be less than
12 inches
Infection Control
• Chain of Infection
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Host
Infectious microorganism
Mode of transmission
Reservoir
• Nosocomial Infections
▫ Hospital-acquired condition
• Compromised Patients
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Hospital patients have a greater sensitivity to
infection
Standard Precautions
Isolation Considerations
2 Primary Types:
• Patients with infectious microorganisms that could
spread to health care workers and visitors
▫ Gown, cap, mask, shoe covers, and gloves
• Patients who need protection from potentially lethal
microorganisms carried by health care workers and
visitors
▫ Follow institutional policy
▫ Reverse Isolation
Isolation Considerations
STEP BY STEP:
• Wash hands with warm soapy water before putting on gloves.
• Don protective apparel.
• X-ray machine taken into room and moved into position.
• Place IR in Rad Bag.
• Place lead shield in Rad Bag before placing on patient.
• Proper removal and disposal of Rad Bags and protective apparel
worn by radiographer.
• Proper cleaning of equipment.
• Wash hands before leaving the patient’s room.
Patient Considerations
• Patient Assessment
• Patient Mobility
• Fractures
• Interfering Devices/Artifacts
• Positioning and Asepsis
• Orthopedic Patients
• Neonates
Patient Assessment
• Level of alertness
• Respiration
• Communication
• Ability to cooperate/any limitations
▫ A thorough examination of the patient’s condition and
room allows the radiographer to make necessary
adaptations to ensure the best possible patient care
and imaging outcome.
Patient Mobility
• Check with nursing staff or physician
• Assess patient’s ability to move or tolerate
mobility
• Gentleness and caution
▫ Broken limbs and/or surgical repaired limbs
• AVOID inappropriate movement of the patient
Fractures
• Simple fractures
• Multiple fractures
• Traction
• Conscious vs. Unconscious patients
• Critical Thinking and Analytical Reasoning
• ASK FOR HELP!
Interfering Devices/Artifacts
• Wires
• Tubes
• Oxygen Masks
• Splints
• Hardware
• Traction
Skin Safety
• Rad Bags
▫ Skin Integrity
▫ Skin Tears
 Infection
• Communication
• ASK FOR HELP!
Positioning and Asepsis
• Positioning:
▫ IR is perceived as cold, hard, and uncomfortable
▫ Warn the patient of possible discomfort
▫ Assure the patient the exam will go as quick as possible
• Asepsis:
▫ Rad Bag
▫ Cloth
▫ Proper cleaning of contaminated IR and equipment
Orthopedic Patients
• Patient Assessment
• Communication
• Radiation Protection
• Move tube and IR versus the patient
• If able to move, support limb above and below
fracture site.
• ASK FOR HELP!
Neonates
• Radiation protection
• Proper handling
• Proper central ray placement
• Collimation
• Immobilization
• Chest Radiographs
▫ Not intubated: keep head/neck straight
▫ Intubated: do NOT move head/neck
 Could inadvertently advance an endotracheal tube too far
into the trachea
Surgical Radiography
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Dynamic experience
Unique challenges
Capabilities and limitations of equipment
Communication
Common procedures
Familiarity with equipment
Teamwork
Preparedness
Standard health and safety protocols
Surgical Team
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Surgeon
Assistants (1-2)
Surgical Technologist
Anesthesia provider
Circulating nurse
Various support staff
• The surgical team is subdivided, according to the
functions of its members, into sterile and non-sterile
teams.
Sterile Team Members
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Surgeon
Surgical Assistant
Physician Assistant
Certified Surgical Technologist (CST)
▫ Preparation to Work in Sterile Environment
 Scrub hands and arms, put on sterile gown and
gloves over proper surgical attire, and enter the
sterile field
 Work in sterile environment and handle sterile items
only
Non-Sterile Team Members
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Anesthesia provider
Circulating RN
Radiographers
Others
▫ Preparation to Work in Non-Sterile Environment
 Maintain sterile techniques during procedure,
handle only supplies and equipment that are nonsterile; follow aseptic technique
 Do NOT enter the sterile field; function outside and
around it
Proper Surgical Attire
• Common standards:
▫ Proper facility design and surgical attire
regulations
▫ Infection control practices
 Proper hand hygiene
 Skin disinfection
 Surgical attire
 Personal hygiene
 Personal fitness for work
 Personal technique
Operating Room Attire
• OR Scrubs (AKA “Greens”)
▫ Street clothes - never worn within semi-restricted
or restricted areas of the surgical suite
▫ Clean, fresh surgical attire - should be worn from
the beginning of each OR shift and changed as
needed (attire becomes wet or soiled)
▫ One time wear of attire
▫ Underclothing should be clean and totally covered
by scrub attire
Other Aspects of Proper OR Attire
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Protective eyewear
Masks
Shoe covers
Caps
Gloves
Radiation badge
Identification (I.D.) Badge
Sterile Field
• An area of the OR that immediately surrounds
and is specially prepared for the patient
• To establish a sterile field, all equipment
necessary for the surgical procedure is sterilized
• Sterile drape protects the area after patient prep
▫ Following this process, surgical team members
function within this limited area and handle only
sterile items
Dance of the Operating Room
• Maintain sterile field in the OR
• Proper adherence to aseptic technique
 Infection control – all levels
• Non-sterile team members:
 Never reach over sterile field
Dance of the Operating Room
• Sterile drape/cover on C-arm
• Notify OR staff if sterile field is compromised
• Communication
• Proper IR handling in the sterile field
• Enemies of the sterile field
Communication
• Communication is of utmost importance
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Professional communication
Verbal
Non-verbal
Ask questions
Equipment in the OR-Technical
• Dedicated radiologic equipment
 C-arm
 Mobile machine (portable radiography)
• Radiologic technologists must demonstrate
knowledge of the following:
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Routine positioning
Radiographic equipment
Manipulation of radiographic equipment
Imaging process
Critical thinking/problem-solving skills
Safety and Radiation Protection
• TIME, DISTANCE, SHIELDING
• Wear a lead apron
▫ Everyone in the room
• Stand as far away from the patient, x-ray tube,
and useful beam as possible
▫ Most effective means of radiation protection is
distance
 Minimum of 6 feet
 Stand at right angle to the primary beam and patient
being radiographed (least amount of scatter)
Safety and Radiation Protection
• X-ray tube placed under the patient
• Gonadal shielding
• Source-to-skin distance
(SSD) should not be less
than 12 inches
Cleaning of Equipment
• Clean after EVERY surgical case
▫ Try to clean in the OR suite-helps reduce the chance of
cross-contamination.
▫ Use only hospital-approved cleaning solution
▫ Do NOT spray cleaning solutions during the
procedure.
• Wear gloves – always
• Clean after an isolation case
• Less frequently used machines:
 thorough cleaning at least once a week and before
immediate use
OR Fluoroscopic Procedures
• Cholangiography
• Line Placement
• Bronchoscopy
• Spines
• Extremities
• Arteriogram
Mobile Radiography Procedures for the OR
• Spines
• Search films
• Extremities (post-op)
References
This power point presentation contains material, text,
and pictures extracted from:
Adler, A.M., & Carlton, R.R. (2016).Introduction to radiologic sciences
and patient care (Sixth Ed.) St. Louis: Saunders.
Ballinger, P.W., & Frank, E.D. (2016). Merrill’s atlas of radiographic
positions and radiologic procedures (13th ed.). (Volume Three). St. Louis:
Mosby.