Showing 4 posts
FrankPiccola
FrankPiccola
c-arm operation
Nov 17 2011, 2:30 PM EST | Post edited: Nov 17 2011, 2:30 PM EST
I have recently started working as an OR radiography tech.
I was wondering if you could give some tips or rules about centering the image(body part)
It seems as if I am constantly moving the c-arm in the wrong direction and have to correct myself. Do you find this valuable?    
M.J.Fuller
M.J.Fuller
1. RE: c-arm operation
Nov 18 2011, 5:30 AM EST | Post edited: Nov 18 2011, 5:30 AM EST
You are not the only radiographer to experience this frustration. A laser centring device built into or attached to the II is best. If you haven’t got a laser device the options are not as good. If you are using the II for extremities, and you have a sterile plastic bag over the tube, you can explain to the surgeon that the best chance of success is for him/her to centre the beam (release the locks). I can't see the point in the radiographer lining up the beam from afar when the surgeon has his/her hand on the anatomy. Alternatively, you can centre the II yourself and then ask the surgeon if he/she thinks the beam is centred correctly.

If the surgeon does not appear to be radiation conscious, having the surgeon wear an immediate feedback dose device could help.

Close collimation could also be counter-productive if it takes 3 attempts to find the anatomy.

I have seen several cases where the surgeon was having difficulty seeing a fracture on the II only to realise that the wrong limb (usually ankle) was being imaged.

I also use the low-dose setting to find the anatomy if I am expecting a centring problem.

If you have a second radiographer or student, ask them to stand in a position to guide you in the plane that you can’t see.

I would be interested to hear from anyone who has any good ideas, particularly radiographers who work in a theatre environment constantly.

Michael Fuller


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mrenfinger
mrenfinger
2. RE: c-arm operation
Nov 19 2011, 8:33 PM EST | Post edited: Nov 19 2011, 8:33 PM EST
OR is quite possibly the most intimidating place for a technologist to be... someone I once knew said, "if you've never been yelled at by a surgeon, you're not an x-ray tech." Here are a few things that have helped me out over the years:

If you have a chance before the procedure, orient your image... you can do this by placing a marker on the tube or image intensifier. Place the marker face-up if the patient will be supine, or face down if the patient will be prone. Place the top of the marker wherever the patient's head will be and shoot a quick spot image - rotate and/or flip the image until it is visualized "anatomically correct." Now you don't have to shoot the patient multiple times to accomplish this.

If you have a chance, arrive early and position your c-arm as close to the required position as possible before the patient is draped. If you can't, see if there is any way you can palpate something under the drape to help you know where the anatomy is.

Once you have good positioning, carry some tape with you and place it on the floor where the base of the c-arm is in case you need to pull back. Then you can simply line up the wheels to the tape reducing time and dose.

When all else fails, get your image intensifier over the exposed area (not draped) that the surgeon is working on.

You can accomplish a lot by showing up early, but never be afraid to ask the surgeon for assistance. 2  out of 2 found this valuable. Do you?    
Gajaal
Gajaal
3. RE: c-arm operation
Mar 23 2012, 10:50 PM EDT | Post edited: Mar 23 2012, 11:51 PM EDT
Theatre is an interesting environment and, I am affraid, one into which the unannitiated are thrust, ofter without adiquate preparation. Having said that, it is also the environment where a good and competent Radiographer can be really helpful and greatly appreciated.

Arrive early amd prepare is the number one best piece of advice. Find time to "play" with the machine in a quiet corner somewhere. I sure you Radiographic supervisor and the Theatre Nurse Unit Manager would be impressed by you initiative.

A key difference with the Mobile II, compared to fixed Fluoro and "C" Arm installation, with which you are more likely familiar, is that with the latter you bring the patient to the field of view. Think of it more like holding a Video Camera. That seems a little criptic, but thinking about repositioning in those terms will help. I have assisted many a Cardiology and Radiology Registrar with that suggestion.

Persevere with orientation of the Image and Collimation. Remember, "Attention to detail is the hallmark of the good Radiographer", and practice will make perfect.

Given that you now have about 3 months practice up your sleave, I suspect things are starting to fall into place.

You may have even undertaken some DSA by now.

Regards

Gary Allbutt

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