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Trauma and Foreign Body Radiography

Trauma and Foreign Body Radiography. Chapter 13. 2 24 2014 online ed. What is trauma?. Sudden, unexpected, dramatic, forceful, or violent event Common types: Blunt trauma- physical trauma caused to body part by impact, injury or physical attack

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Trauma and Foreign Body Radiography

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  1. Trauma and Foreign Body Radiography Chapter 13 2 24 2014 online ed.

  2. What is trauma? Sudden, unexpected, dramatic, forceful, or violent event Common types: Blunt trauma- physical trauma caused to body part by impact, injury or physical attack Blunt Abdominal trauma- physical trauma to abdomen Penetrating trauma- when object pierces skin, enters tissue of body, creating an open wound Explosion Thermal forces- fire

  3. Blunt Abdominal Trauma(BAT) 50% to 75 percent of all blunt trauma is blunt abdominal trauma- mostly car collisions due to rapid deceleration by steering wheel or dashboard

  4. Immobilization Many ER pts arrive in immobilization devices Do not remove immobilization devices unless ordered by Dr.!!!! -perform exam with immobilization still in place 1st images - to rule out injury and show if safe to remove immobilization

  5. PreliminaryConsiderations in Trauma Radiography • Speed • produce quality images in shortest possible time • Accuracy • Get it right the 1st time! Or minimal repeats • Quality • Quality cannot be sacrificed for speed • Do not use pt condition as excuse for poor quality images!

  6. Mobile fluoroscopy units C-arms may be used in instead of plain images for: Fx. reduction Or foreign body localizations

  7. When Positioning-Do no harm! Important not to aggravate pt’s condition when obtaining images Provide immobilization support to reduce risk of motion Move tube and IR, instead of pt, whenever possible Expect to be exposed to body fluids Pay careful attention to pt’s condition- could change at any time!

  8. Remember: Trauma often causes anxiety! • Use good communication skills with appropriate touch and eye contact • Explain and demonstrate positions, when possible • Check pt for potential artifacts • Explain what you are removing and why • Secure all personal effects using proper procedure for your facility • Use short exposure times --why?

  9. SID When SID not specified for a projection, Merrill’s Atlas recommends 48 ? • 60 to 72 SID recommended for projections with increased OID • Why?

  10. Radiation Protection Shield all pediatric pts and pts of reproductive age Unless it will compromise exam! Use tight collimation Optimum technique factors (high mA, low time)

  11. If backboard is present, unavoidable artifacts may be seen

  12. Crosstable Lateral Cervical Spine • Perform 1st and check with physician before proceeding with other projections! • Dorsal decubitus position, horizontal beam • Shoulders relaxed • Head -no rotation- ask pt to look straight ahead without moving head or neck • Vertical IR placed at top of shoulder in holder

  13. Lateral Cervicothoracic Spine(Swimmers) • Required if C7 and top of T1 not demonstrated on lateral C-spine • Trauma- usually Dorsal decubitus position • Pt supine -no rotation • Ask pt to raise arm opposite x-ray tube over head

  14. Swimmer’s Demonstrates: lower cervical upper thoracic Vertebrae in profile between shoulders

  15. AP Axial Cervical Spine • Pt supine • Usually immobilized with collar and spine board • Place IR under spine board, if present, centered to C4 • Head and shoulders - no rotation • Ask pt to look straight ahead • Do not rotate head

  16. AP Axial Cervical Spine • CR directed 15 - 20 degrees cephalad to enter MSP and C4 • Image demonstrates C3-T1 or T2 • Include all soft tissues

  17. AP Axial Oblique Cervical Spine • Head and shoulders without rotation • Ask pt to look straight ahead • Do not rotate head • CR has double angle • 45 degrees lateromedially • 15 to 20 degrees which way? • Use a grid?

  18. APAxial Oblique Cervical Spine Which projection? Which formina demonstrated? (RPO, Left)

  19. Thoracic and Lumbar Spine • Dorsal decubitus positions performed 1st • Vertical grid IR • Top of IR 1.5 to 2 above shoulders for thoracic spine • Centered to level of iliac crests for lumbar spine • Have pt cross arms on anterior chest

  20. Trauma Lateral Lumbar Spine CR and IR positioned for trauma lateral projection of lumbar spine using dorsal decubitus position

  21. Trauma AP Chest • Pt. supine • Obtain help to place cassette under pt. • Top of IR placed about 1.5 to 2 above shoulders • Arms abducted • MCP parallel to IR • Use maximum SID to reduce heart magnification

  22. Trauma AP Chest (cont’d) • Ensure chin extended out of anatomy of interest • CR directed perpendicular to center of IR • Enters pt at MSP at about 3 below jugular notch • Exposure on 2nd full inhalation, if possible

  23. Trauma AP Chest (cont’d) Image must demonstrate lung fields in their entirety Minimal rotation and distortion present Collapsed lung

  24. Lateral Decubitus Chest X-ray If pt’s condition permits, position pt lying on affected side

  25. Trauma Lateral Chest If air-fluid levels are suspected, use dorsal decubitus position

  26. Penetrating wounds to Abdomen • Stabbings, gunshots • Mark entrance and exit wounds, if present • Align shoulders and hips in same plane

  27. Bullet Wound (IVP) Demonstrate entire abdomen Pubic symphysis must be visible at lower border

  28. When the pt. arrives- If transfer to x-ray table not possible, obtain lifting help to place IR with grid directly under pt Monitor pt closely for status change during procedures!

  29. Why take a Decubitus Abdomen? Rule out free air

  30. Which decub is this? Left (right would confuse free air with stomach gas)

  31. Pelvis • Pelvic fxs have high risk of hemorrhage – pay close attention to pt for status change! • Obtain lift help for IR placement under pt if transfer to x-ray table is not possible • IR centered 2 above pubic symphysis or 2 below ASIS

  32. Pelvis (cont’d) • Lower limbs usually not rotated internally 15 degrees in trauma cases • Ensure arms not in anatomy of interest! • Suspend respiration • Demonstrate entire pelvis and prox. femora

  33. Trauma AP Pelvis Note: fracture of left ilium and separation of pubic bones

  34. Contrast studies Why is a study of the urinary system often ordered? • Suspected pelvic fxs often result in injury to urinary system

  35. Cranium • Pts with head trauma are often referred to CT 1st • Why? • Much more information • Standard x-ray routine • AP and lateral • Generally, pt. is supine

  36. Trauma AP Cranium • AP projection • for anterior cranium • AP axial projection- (aka?) • Towne (for posterior cranium) • Obtain lift help for IR placement if transfer to x-ray table is not possible • C-spine injury should be ruled out first!

  37. Trauma AP Cranium (cont’d) • Check for rotation and tilt • CR centered perpendicular - nasion • IR is to center of CR

  38. Trauma AP Cranium (cont’d) Demonstrates anterior cranium with petrous ridges filling orbits

  39. Trauma AP Axial Cranium (Towne) CR angled how many degrees? 30 deg. Caud 2 - 2 ½ “ above glabella Demonstrates posterior cranium Foramen magnum in center

  40. Trauma AP Axial Cranium (Towne) Check for rotation and tilt of head OML perpendicular to IR • If IOML used, what must CR angle be changed to ? 37 degrees caudad!

  41. Trauma Lateral Cranium • Elevate head on radiolucent support • C-spine injury ruled out 1st! • Place vertical IR centered to cranium • Make sure interpupillary line is perpendicular to IR and MSP is vertical • Horizontal CR enters center of IR and pt at 2 above EAM dorsal decubitus position

  42. Trauma Lateral Cranium Multiple fxs in frontal bone -2 gunshot wounds

  43. Facial Bones • Often referred to CT first • Anticipate profuse bleeding and use universal precautions

  44. Acanthioparietal Facial Bones • Also known as? - Reverse waters • Image demonstrates facial bones and maxillary sinuses • Facial bones should be symmetric opaque right maxillary sinus – evidence of fx

  45. Modified Waters- reverse For orbits and facial bones Leave Pt. “as is” on guerney or table Angle CR cephalic if necessary to accommodate for lack of pt cooperation flexing neck Normal modified waters Reverse modified waters with compensating angle

  46. Alternate Water’s Method Do not angle pt’s head unless safe! Extend head so acanthiomeatal line is 30 deg to image receptor if pt. can cooperate

  47. Upper and Lower Limbs Obtain lift help for IR placement Injured limbs should be lifted with support atboth jts (Move IR and CR, not injured limb when possible!) Lift only enough to place IR Do not attempt to rotate severely injured limbs for true positions 2 projections at 90 degrees apart Must demonstrate both adjacent jts (Take 2 separate projections if need be)

  48. Many projections can be reversed or modified Most trauma pts. arrive in supine position radiograph pt. as is! Move as little as possible

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