Portable and Trauma Radiography

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Moderator: Mr. S.C. BANSAL Deptt. of Radio-Diagnosis

& Imaging PGIMER, Chandigarh

Presented By:

RITIKA MANGLAB.Sc.MT (X-Ray) ± Second Year

Student

Deptt. Of Radio-Diagnosis & imaging

PGIMER, Chandigarh



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Ward or Portable radiography is thatradiography which is restricted to patient

whose medical condition is such that it isimpossible for them to be moved to the x-raydept. without seriously affecting their medicaltreatment and nursing care



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Patient can't be safely transported to radiology

department because of severe illness, Trauma or surgery.

Patient can't be carried to radiology

department because of Quarantine or isolation

conditions recommended for him or her . For example- in ICU, NICU, CCU Patient etc.



CTU

NICU

ICU

CCU

PICU

Orthopedic Ward

Emergency

Recovery Surgical Ward

OT-Recovery

OT ² Radiography

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The patient·s medical condition. The degree of consciousness & co-operation. Restriction due to life support system, drips &

chest or abdominal drains. Location of ECG leads. Traction apparatus. Physical restriction due to room size. An adequate power supply. The shape, size & ability to move mobile or

portable x-ray equipment in confined spaces.



Firstly, the x-ray requisition forms should bechecked to ensure that the examination in theward is necessary.

Correct equipment & Correct cassettes mustbe carried to avoid the repeat examinations

Proper lead apron must be carried.

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Through knowledge of ward is necessary along with complete patient information i.e.-

Name of the patient

Age

Sex

Central Registration no.

Examinations & the Views required Bed number and proper knowledge of x-ray

units.

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There may have a lots of leads connected to thepatient e.g. ² ECG-Leads. So, any disturbanceregarding these should be undertaking with

permission of medical staff. Minimum disturbance should be applied to the

patient while positioning.

Lifting of seriously ill patients should also beundertaken with supervision of nursing staff.

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X-ray equipment fall broadly into two groups:

Portable.

Mobile.

In the Radiography of chest & abdomenthe use of shortest exposure times is essentialto reduce the risk of movement blur. For theseexamination the choice of equipment is

therefore, restricted to high output Mobile sets.

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Portable equipment:-FEATURES:

The word ³portable´ means that x-ray unit is

capable of being carried with implication that it

does not need more than one able bodied person to

do carrying at any given time.

It is very simple to use and can be packed into

carrying cases and so transported . Portable relatively sets have low MA setting can

be dismantled for transfer .



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Compact Vet APR X-ray System

A modern floor-mounted tube

support X-ray system. This system

is available in 10 different versions

with high frequency X-ray

generators, fixed or floating toptables, anatomical programming

(APR) and lots more, including: 40

to 125kV, 10 - 320mA, 0.1 to

500mAs, 1ms to 5 seconds and

rotating anode X-ray tubes.

Automatic Exposure Control (AEC)

is available as an option.



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SP Vet Mobile StandA mobile stand for the portable X-ray unit, facilitating a variety of

examinations down to floor level. Ideal for equine radiography.

Ceiling X-ray Support

A ceiling support system for the portable X-ray unit providing horizontal

and lateral movements over a table. Ideal for small compact X-ray rooms

where space is limited. Made to measure and subject to site survey.

X-ray TablesA range of mobile radiolucent tables suitable for radiography with

options for a moveable cassette tray with a stationary or a moving bucky

grid.

Various parts of equipment



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Mobile equipment:-FEATURES:

The word ³mobile ³means that x-ray equipment

is capable of being moved. It is mounted on thewheels and can be pushed by human power.

It is larger and heavier than portable sets and

need to be motorized or pushed b/w locations.Mobile sets have high MA value and heavier.



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TMX+

Mobile Radiographic Unit

The TMX+ is a mobile powerful

radiography system designed to

fulfill a wide range of clinical

applications in any location of

your department.It has been especially designed

for totally adapted use in

intensive care, emergencies,

pediatrics, neonatology and

orthopedics rooms.



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ST 3-GENIUS6

0

TECHNIX S.P.A.-TMS150

MARS-15R/SBMCARTLEX

CAPACITOR DISCHARGE MOBILE ART UNIT



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It consists of a polyester base over which a layer of photostimulable phosphor [europium doped barium fluoro bromide crystals- BaFBr:Eu 2] iscoated.A protective layer composed of fluorinated polymer material is applied over it. A supportinglayer which prevents the reflection if light is also

applied. Next is the backing layer. This prevents thescratching on the imaging plates during storageand transfer. Therefore it has a protective action.

CR PLATE



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The next is the bar-code table which contains

the number assigned to the imaging plate.

This bar-code provides a mechanism for associating each imaging plate with patient

identification, related examination and

positioning information.

The imaging plate is flexible and less than 1mmthick .

CONTD«..



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Congestive heart failure.

Coronary heart disease. Lt. ventricular failure. Pulmonary edema. Pulmonary embolus. Pneumothorax.

Plural effusion.

Pneumonia. Dyspnoea. Severe chest pain. Post operative chest

radiography.

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Generally AP view in supine position is done because it

is difficult for the patient to stand or lie in prone

positions.

Common diagnosis which requires portable chestradiography include:



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AP-View: If possible, the patient should be x-rayed in sitting

erect & facing towards x-ray tube. The cassette issupported against the back, using pillow or a largewedge shaped foam pads, with its upper edge above

the lungs field. If this not possible, the patient may be positioned in

supine. The median saggital plane is adjusted at Rt. Angles to,

& in the midline of the cassette.

The rotation of the patient is prevented by the use offoam pads, rotation produces a range of artifacts &must be avoided or minimized. If possible the armsare rotated medially, with the shoulders broughtforward to bring the scapulae away from the lungsfield.



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AP - Erect



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AP - Supine



CR: - It is directed at Rt. Angle tothe cassette at the level of thesternal angle.

For Fluid levels:Views preferred are: Lateral Decubitus.

Dorsal Decubitus.With the use of Horizontal

central ray.

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This projection is used to confirm the presenceof fluid. Moving the patient into a differentposition causes movement of free fluid, so that

loculation is also detected . It may also be usedto demonstrate the lateral chest wall of theaffected side clear of fluid, and to unmask anyunderlying lung pathology.

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Positioning:

Patient is turn on to the affected side & ifpossible, raised on to a supporting foam pad.

A cassette is supported vertically against theanterior chest wall, & the median sagital planeis adjusted at Rt. Angles to the cassette.

The patient·s arm is raised & folded over the

head to clear the chest wall.

CR: It is directed horizontally at the level of6th thoracic vertebrae.

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Lateral Decubitus

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Positioning: The patient lying supine is raised of the bed on to a

supporting foam pad.

Arm extended & supported above the head.

Cassette is supported vertically against the lateralaspect of chest of affected side.

CR: It is directed horizontally & Rt. Angle to the cassettethrough the axilla.

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This projection will show as much as possible of lung fields, clear of a fluid level, when the

patient is unable to turned on their side .



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Dorsal Decubitus



A series of radiographs are taken during post-operative care in order to see the prognosis.

Radiographs are taken with the patients supineat first until the patient is fit to sit.

Consistent radiographs are taken in order toenable accurate comparison of radiographs

over period of time. Care should be taken to expose in full

inspiration.

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Introduction:Neonates suffering from respiratorydistress syndrome are examined soon

after the birth to show the lungs tissuewhich are immature & unable toperform normal respiration.

The baby will be nursed in an

incubator. The primary beam is directed through

the incubator top.

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Indications:-

Respiratorydifficulties.

Infections.

Chronic lungs

disease. Pleural effusion.

Position ofcatheter/tubes.

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Esophageal atresia. Previous anti-natal

ultrasoundabnormalitysuspected.

Thoracic cageanomaly.

Post-operative.



The baby is positioned supine on the cassette, withthe median sagital plane perpendicular to themidline of the cassette, ensuring that the head &

chest are straight, shoulders & hips are at the samelevel.

The head may need a covered sand bag support oneither side.

A 10°

foam pad should be placed under theshoulders to avoid a lordtic view & top lift the chin& prevent it obscuring the lungs apices.

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Arms should be on either side, separatedslightly from the trunk to avoid being included

in the radiation field. Arms can be immobilized with Velcro bands or

sand bags.

CR:It is directed at Rt. Angles to the centre of

the cassette.

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Portable or mobile radiography is often required in casesof acute abdominal pain or following surgery, when thepatient is unable, to determine any of the following arepresent.

Gaseous distension in any part of the gastro-intestinaltract.

Free gas or fluid in the peritoneal cavity.

Fluid level in the intestine.

Location of radio-opaque foreign body.

Evidence of aortic aneurysm.

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RADIOGRAPHY OF ABDOMEN



For Gaseous Distension:- AP-Abdomen in supine position.

For Free Gas in the Peritoneal Cavity:- AP-Chest in erect position.- AP-Abdomen in supine.

- AP/PA Lt. lateral Decubitous.

For Fluid level:- AP-Abdomen in erect position.

For Radio-Opaque foreign body:- AP-Abdomen in supine position.

For Aortic Aneurysm:- Lateral (Dorsal Decubitous)

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AP-Supine:

With the patient in supine position and cassette withgrid is carefully positioned under the abdomen.

Care should be taken to avoid hurting the patient whilepositioning the patient.

Cassette should be positioned to include symphysispubis on the lower edge of the film.

The cassette should also be in horizontal position onthe bed and not lying at an angle. If the cassette is notflat, there may be grid cut off of the radiation beam.

CR: It is directed at Rt. Angles to the cassette & in the

midline at level of the iliac crests.

Exposure is made on arrested expiration.

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AP - Supine



Depending on the patient·s medical conditions, thepatient·s bed is adjusted to enable the patient toadopt an erect or semi-erect position. If necessary,a no. of pillows or alternating supporting deviceare positioned behind the patient to aid stability.

The patient·s thigh are moved out of the beam toensure that they are not superimposed on theimage.

A cassette is placed against the posterior aspect ofthe patient, with the upper border of the cassettepositioned 2 or 3 cm above the xiphi-sternum joint

to ensure that the diaphragm is included on theimage to enable demonstrate a free air ion theperitoneal cavity.

CR: It is directed at Rt. Angles to the centre of the cassette.

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AP - Erect



This Projection, is selected as an

alternative to the antero-posteriorerect projection when the patient isunable to sit. It is also useful indemonstrating free air in the

peritoneal cavity.

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Patient is turn on to the left side, ideally for20minutes, allowing any free air in the abdominal cavityto rise towards the Rt. Flank to avoid the problem of the differential diagnosis when the air is present onthe Lt. side of the abdomen within the region of the

stomach.

The cassette is supported vertically at Rt. Angle to thehorizontal central ray & is positioned against the

posterior aspect of the patient to include the Rt. Sideof diaphragm.

\

CR: The horizontal central ray is directed to the

centre of the patient. 42



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Lt. Lateral Decubitus



Definition: A physical injury caused byexternal force or violence.

Or

A injury whether physical or psychic isknown as Trauma.

Trauma is divided a/c to body parts:1) Appendicular Trauma.

2) Abdominal Trauma.3) Thoracic Trauma.4) Head Trauma.5) Spinal Trauma.

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INDICATIONSINDICATIONS::

In order to diagnose: -

Fracture. Soft tissue injury.

Ligament tear. Tendon tear.

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The basic of radiographic positioning must be examined in order to understand whilethe established radiographic position arethe way, they are, to be able to adapt themto new situations and to enable theradiological technologist to create his orher own positions.

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1) Whenever possible these views should be an

antero-posterior or postero-anterior view and a

lateral view.

2) Angle the part, CR or the film to avoid anyinterfering objects.

3) Obtain two views, 90 apart.

4) The only thing that matters is the relationship

b/w the part, the CR & the film.

5) Include the entire structure or the area in the

examination.

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The First Principle is necessary because peopleare three dimensional. A PA Projectionradiograph shows height & width but no

depth. If a lateral Projection is taken with theCR 90* From the PA, the height is repeated, butthe depth is also included.

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´ The second Principle concerns angulation ofthe x-ray beam, the patient, or the film. Ingeneral, angulation should be avoided. The

optimum situation would have the x-ray beamperpendicular to the film, with no rotation ofthe patient. Ofcourse, this is not alwayspossible. Principle 2 is used when super

imposition of structure is a problem. For ex. Inradiography of the skull, the petrous portionof the temporal bone is often a problem

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The third Principle calls for an AP or PA

projection & lateral projection. These projections

are best because the physicians are most familiar

with viewing the body from these aspects. If it isnot possible to obtain these projections, then the

radiographer should attempt two other

projections, 90* apart- possibly two obliques.

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The fourth Principle is the key 2 adapting

position to non routine condition. As long as the

CR, the part, and the film maintain their

relationships, the position will produce thedesired results. In routine radiography, the CR is

usually vertical & the film is horizontal(either in

the bucky tray or on top of the radiographic

table.

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The fifth Principle is designed to

ensure that no injuries are missed.For structures, it means that both joints must be included with a bone;

for example, the knee & ankle mustbe included in an examination oflower leg.

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It is divided into:

Upper Limb. Lower Limb.

The Appendicular skeleton, comprises of 126

bones, includes 2-limbs girdles & their attachedlimb bones.

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CHONDRAL FRACTURE:CHONDRAL FRACTURE: -- Cartilageinvolved.

OSTEOCHONDRAL FRACTUREOSTEOCHONDRAL FRACTURE-- Both bone &cartilage involved.

CLOSED FRACTURE:CLOSED FRACTURE: -- Skin intact.

OPEN FRACTURE:OPEN FRACTURE: -- Disruption of skin

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GREENSTICK GREENSTICK FRACTUREFRACTURE::Perforates one cortex ramifying within themedullary bone (proximal metaphysis /diaphysis of the tibia, middle third of the radius and ulna).

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COLLES specifically described fracture of the distal radius withdorsal impaction, displacement, or angulation. This term is usedto refer both extra-articular & intra articular fractures.

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Dislocation of the shoulder joint: -The following clinical types should be recognized:

1. Acute dislocation:

a) Anterior dislocation -- Commonest type.b) Posterior dislocation -- This is rare.c) Inferior dislocation² Lux erecta

2. Old unreduced.

3. Recurrent dislocation.

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NORMAL

ANTERIOR DISLOCATION



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RecommendedRecommended ProjectionProjection areare::

AP Trans-thoracic LateralPositioning Positioning ofof TransTrans--ThoracicThoracic LateralLateral:: Ask the patient to seat or stand in lateral

position in front of a vertical grid device. Raise the uninjured arm. Elevation of uninjured shoulder, give the

desired depression of the injured side. Centre the cassette to the region of surgical

neck of a affected humerus. Instruct the patient to hold the breath at full

inspiration.

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ViewsViews::1) AP2) Axial: - i) Supero-inferior. &

ii) Infero-superior.1) AP-View:

Positioning: the patient stands or lies supine facing the X-ray

tube. The patient is rotated towards the affected side to

bring the posterior aspect of the injured shoulderinto contact with the midline of the cassette.

The cassette is positioned to include the achromialprocess & proximal half of the humerus.

CR: It is directed at Rt. Angles to the humerus & centeredto the head of the humerus.

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AP - Erect AP - Supine



2)2) Axial ViewAxial View::i.i. SuperoSupero--inferiorinferior:: This projection can be taken

even when only a small degree of abduction ispossible.

Positioning: The patient is seated at one end of the table, with

trunk leaning towards the table, the arm of the

side being examined in its maximum abduction,& the elbow resting on the table. The height of the table is adjusted to enable the

patient to adopt a comfortable position. The cassette rest on the table b/w the elbow and

the trunk.CR: - It is directed at the tip of the acromion process

of the scapula

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ff



ii.ii. InferoInfero--superiorsuperior:: This projection is usuallyundertaken with the patient supine on a trolley or theX-ray table.

Positioning: The patient lies supine on the trolley, with the arm of

the affected side abducted as much as possible, thepalm of the hand facing upwards, & the medial &

lateral epicondyles of the humerus equidistance fromthe table top.

The shoulder & the arm raised slightly on a non-opaque pads, & the cassette supported verticallyagainst the shoulder is pressed against the neck toinclude as much of the scapula as possible in image.

CR: - It is directed to the patient·s axilla with minimumangulations towards the trunk.

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When movement of the patients arm is restricted, a

modified technique is required.1)1) AP AP Erect ViewErect View:: --Positioning: The cassette is placed in an erect cassette holder. The patient sits or stands with their back in contact with

the cassette. The patient is rotated towards the affected side to bring

the posterior aspect of the shoulder, upper arm & elbowinto contact with the cassette.

The position of the patient is adjusted to ensure that the

medial & lateral epicondyles of the humerus areequidistant from the cassette.CR : - It is directed at Rt. Angle t o the shaft of the

humerus & centered midway b/w the shoulder &elbow joints.

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2)2) LateralLateral ViewView::Positioning: The cassette is placed in a erect cassette holder. From the anterior position, the patient is rotated

through 90Ý until the lateral aspect of the injuredarm is in contact with the cassette.

The patient is now rotated further until the arm is just clear of the rib cage.

CR: - The horizontal central ray is directed at Rt.Angles to the shaft of the humerus & centered

b/w the shoulder & the elbow joint.

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LateralLateral ViewView::Positioning: -It can be done in two waythey are:1) The patient sits or stands facing the X-ray tube. A cassette is supported b/w the patient·s trunk &elbow, with the medial aspect of the elbow in

contact with the cassette. A lead rubber sheet or other radiation protection

device is positioned to prevent the patient·s trunkfrom the primary beam.

CR : - It is directed perpendicular to the shaft of thehumerus & centered to lateral epicondyle.

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A



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2. A cassette is supported vertically in a cassetteholder.

The patient stands side ways, with the elbow flexed& the lateral aspect of the injured elbow in contact

with the cassette. The arm is gently extended backwards from the shoulder. The patient is rotatedforwards until the elbow is clear of the rib cage.

CR: - It is directed to the medial epicondyle & thebeam is collimated to the elbow.

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APAP ²² ViewView::

Positioning: From the lateral position, the patient·s upper body is

rotated towards the affected side.

The cassette is placed in an erect cassette holder, & thepatient·s position is adjusted so that the posterioraspect of the upper arm is in contact with the cassette.

CR: -i. If the elbow joint is fully flexed, the CR is directed

at Rt. Angle to the humerus to pass through theforearm to a point midway b/w the epicondyles of

the humerus.ii. If the elbow joint is only partial flexed, the CR is

directed at Rt. Angle to the humerus to a pointmidway b/w the epicondyles of the humerus

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LateralLateral HorizontalHorizontal BeamBeam::

This projection is used in the suspected fracture of the neck of the femur.

Positioning:

The patient lies in supine on the stretcher or a x-ray table.

The legs are extended & the pelvis adjusted to make themedian sagital plane perpendicular to the table top. This maynot always be possible if the patient is great pain.

If the patient is slender, it may be necessary to place a non-radiopaque pad under the buttocks so that the whole of theaffected hip can be included in the image.

The grid cassette is positioned vertically, with the sorter edgepressed firmed against waist, just above the iliac crest.

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The longitudinal axis of the cassette should be parallel

to neck of the femur. This can be approximated byplacing a 45Ý foam pad b/w the front of the cassette &the lateral aspect of the pelvis.

The cassette is supported in this position by sand bagsor specific cassette holder affected to the table.

The unaffected limb is raised until the thigh is vertical,with the knee flexed this position is maintained bysupporting the lower leg on a stool or specializedinstrument.

CR : - It is directed midway b/w the femoral pulse &palpable prominence of the greater tronchanter withthe central ray directed horizontally & at Rt. Angle tothe cassettes.

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Neck of femur



For Shaft FractureFor Shaft Fracture::

The patient remains on the trolley or bed. If possible,the leg may be slightly to centralize the patella b/wthe femoral condyles.

The cassette is supported vertically against thelateral aspect of the thigh, with the lower border of the cassette level with the upper border of the tibialcondyle.

The unaffected limb is raised above the injured limb,with the knee flexed & the lower leg supported on astool or specialized support.

CR: - It is directed t o the mid-shaft of the femur.

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Shaft of femur



Lateral Horizontal ViewLateral Horizontal View::This projection is used in the suspected transversefracture of the patella.

Positioning: the patient is remains on the trolley, with the limb

gently raised & supported on pads. If possible, the leg may be rotated slightly to

centralized the patella b/w the femur condyles. The film is supported vertically against the medial

aspect of the knee. The centre of the cassette is level with upper

border of the tibial condyle.

CR: - It is directed to the upper border of the lateraltibial condyle at 90Ý to the long axis of the tibia.

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Trauma to the abdomen contributes to 10% oftrauma mortality and higher % of themorbidity.

Abdominal trauma is classified intwo parts:

1)Blunt trauma.

2)Penetrating trauma.

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It occurs approximately 2/3rd

of the abdominalinjury patients. Motor vehicle accidents accountsfor up to 80 % of the blunt trauma with theremainder being caused by falls, assault andindustrial accidents.

Organ injuries in the blunt trauma canbe :

Kidney.

Intestine.Liver.Pancreases.Spleen.

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It can be caused by gun shoot injury, stabwounds.

Organ injured in penetrating trauma

can be:Liver.Stomach.Colon.Kidney.Billiary System.

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The majority of the patients who suffer bluntabdominal trauma are stable and requireddiagnostic studies. For e.g.:

Plain abdominal radiography.

Ultrasonography.Nuclear medicine study.

MRI.

AngiographyComputed tomography

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Plain RadiographyPlain Radiography::

Recommended projection are:1) AP: - Same as Portable Radiography

2) Dorsal Decubitous: - Same as portableRadiography.

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ItIt isis divideddivided intointo twotwo partsparts::

1) Blunt Trauma: - Chest wall remains intact.

2) Penetrating Trauma: - Chest wall integrity isbreached, producing even if only transiently,communication b/w the external environmentand internal contents of the thorax.

Recommended projection is: AP-Supine: - Same as Portable Radiography

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For an examples: - Pneumothorax. With or without haemothorax.

Pneumomediastinum or Haemomediastinum. Lungs parenchymal contusion. Pneumopericardium. Chest wall.

Heavy diaphragm injuries. The position of various internal catheters,

lines and tubes can be assessed.

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Trauma to the head & spine causes most of thedeath no.

Up to 10 % cases are fatal & 10 % to 40 % are

moderate head injuries. Head injuries may be classified as: -

1. Mild.

2. Moderate.3. Severe.

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HEAD INJURYHEAD INJURY

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Moderate/Severe Mild

NeurologicalStable

NeurologicalUnstable

MRI CT-Scan

Headache No Headache

CT-Scan



In order to have accurate detection ofhaemorrhage CT is the choice of the study.

In order to have precision in the diagnosis offracture, plane radiography is preferred.

Views recommended:1. Lateral Supine (Cross Table Lateral Position).

2. Fronto ² Occipital 30Ý caudal angulations.

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With patient supine on a trolley or a buckytable, the head is raised on non-opaque pad.

The head is immobilized in this position.

Cassette with grid is supported verticallyagainst the lateral aspect of the head includingthe vertex & cervical vertebral upto three.

CR: It is directed horizontally centered

midway b/w glabella & external occipitalprotuberance.

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Lateral Horizontal Bean



Positioning:Patient supine on trolley, adjust the head tobring orbito-meatal line at right angle to thecassette placed under head with grid.

CR: It is directed at an angle 30Ý towards thefeet midway b/w two EAM.

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Mainly the Cervical and Lumber vertebral gotaffected by trauma.

INTRODUCTION:

Cervical spine injuries can be critical. The occurrence is very common. In west ,Roadside accidents accounts for 32- 57% of

c-spine injuries. In rural region ,mostly c-spine injuries due to fall,

sporting accidents and slip from mountain tops. Technologists play a critical role in evaluation of c-

spine trauma by directing the entire extent andtype of c-spine injury.

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1. Cervical Spine fractures:

Most of the cervical spine fractures occur at two

levels.

1/3rd of the fractures occur at the level of C2.

1/2 of the fractures occur at the level of C6 ±C7.

Atlas is the least common fracture site.



BASIC PROJECTION:

AP VIEW CROSS TABLE LATERAL

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Positioning: With the patient supine the cassette is supported

vertically against the shoulder and centered at the

level of thyroid cartilage prominence. The patient's shoulders are depressed.

CR: - Directed at Rt. Angles to the cassette at apoint vertically below the prominence of thyroidcartilage at the level of mastoid process.

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Cross Table Lateral Projection



LateralLateral (Horizontal(Horizontal Beam)Beam) viewview::

Positioning: The trolley is placed adjacent to the vertical bucky.

Adjust the position of the trolley so that the lowercostal margin of patient coincide with the verticalline of bucky.

CR: It is directed to the centre of the cassette.

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Control of infection play an importantrole in management of all patients,especially following surgery & nursingof premature babies.

To prevent the spread of infection ,local established protocols should beadhered to by staff coming into contactwith patient for example:-hand

washing b/w patients & the cleanlinessof equipment used for radiographicexamination.

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The radiological technologist should wear

Sterilized gown.

Face mask.

Sterile gloves when touching the patient.

Over shoes before entering these areas.

Cassette should be cleaned & covered with sterilesheet.

X-ray equipment used in ICU, Cardiac surgery&special care baby unit should ideally be dedicatedunits and they should be cleaned with antiseptic

solution before bein moved into infection. 107



1. Accurate collimation of the x-ray beam using lightbeam diaphragm with additional lead masking withinthe primary field balanced on top of the incubator.

2. It is our responsibility to ensure that the holders hands

are not in the primary beam.

3. The abdomen should be included in a chest radiographonly if a assessment of catheters or relevant pathologyis present. In this case, male gonad should be protected.

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4. An accurate exposure chart a/c to infant weightshould be available.

5. All mobile equipment should have a dose areaproduct meter.

6. From safety point of view, Incubator of child tobe examined should always be away from theIncubators of other babies.

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This is of paramount importance. The radiological technologist is responsible for

ensuring that nobody enters the controlled area

during the exposure of the patient. The radiological technologist give appropriate

advice to ward staff in a clear & distinctmanner to avoid accidental exposure toradiation.

Any one assisting in an examination must beprotected from scatter radiation by use of leadapron.

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Use of inverse square law, with staff standingas far away as possible from the unit andoutside the radiation field, should be madewhen making an exposure.

Lead protective shields may be used asbackstops when using a horizontal beam tolimit the radiation field.

Exposure factors used for the examinationshould be recorded, enabling optimum results

to be repeated. Patients tend to be X-rayedfrequently when under intensive care.

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1. Don·t move the patient when are on stretcher or backboarduntil ordered to do so by the physician incharge of patient.

2. Ensure that correct patient & correct region are beingexamined.

3. Ensure that equipment used should be in good workingorder and be capable of giving good results when usedcorrectly.

4. Using pads, sandbags and other immobilizing device, thepatient or part should be immobilized in as comfortable aposition as possible and the shortest possible exposuretime used to avoid having to repeat the examination due topatient movement.

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5. Radiographer must take care that a carefully planned

routine is carried out so that the examination does nothave to be repeated owing to faulty technique.

6. The field of radiation should be limited to minimumnecessary by use of cones & diaphragms.

7. Fastest possible screens and film consistent with therequired image quality should be used .

8. Take special care to make sure that the more radiation

sensitive regions are excluded from the beam of radiationwhenever possible . For example the use of gonad shields& the modification of projections to reduce irradiation oflens of eye or the thyroid gland.

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Portable and Trauma Radiography

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