emergency radiography has emerged as one of the newest and fastest growing radiology subspecialties .and to easy radiographer and technologist

1. EMERGENCY RADIOGRAPHY
Milan Timilsina
B.Sc.MIT 2nd YEAR
Roll No. 6
NAMS Bir Hospital

2. Contents
 Introduction
 Patients condition and preparation
 Responsibilities of Radiographers
 Equipment
 Immobilization devices
 Grids
 Exposure factors
 Radiation protection
 Positioning & technique in Emergency/Trauma
 Summary

3. Emergency radiography is defined by
the imaging and imaging
management of patients who are
acutely ill and injured.

4. INTRODUCTION
Emergency radiography can be an exciting
,challenging as well as stressful environment for
the radiographer.
Depends on how prepared the radiographer is
to handle the situation.
Specialized trauma imaging systems reduce
the amount of time required to obtain
diagnostic images

5. EMERGENCY DEPARTMENT
 “Emergency
department” signifies a
specific level of
emergency medical
care.
 A medical emergency
is an injury or illness
that is acute and poses
an immediate risk to
a person's life or long
term health.

6. Trauma is defined as any physical damage to the
body caused by a sudden, unexpected, dramatic,
forceful, violent or accident event or fracture etc.
Emergency medical care often is the difference
between life and death.
Radiographers in the emergency department
(ED) must be prepared for a variety of
procedures on patients in all age groups
Trauma

7. ER at Bir Hospital
 DRGEM Company
 X-ray tube – Toshiba E7239X Model
 Manufactured – June 2014
 Maxm 120 kVp, minim 40 kVp
 Focal spot 2.0/1.0
 Grid ratio 10:1
 Target angle 16’
 X-ray coverage 354*354 mm at SID 750mm

8. ER at Trauma
Allengers company
Maxm kVp 150
mA 500
Rotating anode

9. Patient conditions and preparation
Closely supervise trauma patients at all times
A patient who requires examination of the
whole spine, chest & pelvis, lateral radiograph
should be performed before the anterior
posterior radiograph which avoids wasting
time in moving the tube back and forth
between exposure.

10. Patient preparation
To minimize risk of exacerbating the patient's
condition, the x-ray tube and lR should be
positioned, rather than the patient or the part.
Patient history must be taken into consideration
The items that might cause an artifact on the
images should be checked.
facility for proper storage of a patient's personal
belongings is required.

11. Responsibilities of Radiographers & RT
should develop an understanding of the
imaging equipment utilized in ER
Should know the role of the radiographer as a
vital part of the ER team,
 present the common radiographic procedures
performed on emergency patients.

12. Responsibilities of Radiographers & RT
Perform quality diagnostic imaging
procedures as requested
Practice ethical radiation protection
 Provide competent patient care

13. Equipment
To minimize the time required to acquire
diagnostic x-ray images, many ERs have
dedicated radiographic equipment
It provide greater flexibility with a minimal
patient movement. to minimize movement of
the injured patient while performing imaging
procedures

14. ER equipment
some ERs are equipped with specialized beds or
stretchers that have a moveable tray to hold the
l R.
This type of stretcher allows the use of a mobile
radiographic unit and eliminates the
requirement and risk of transferring an injured
patient to the radiographic table.

15. ER Equipment
Mobile radiography is widely utilized in the ER. (
Battery Powered & Capacitor Discharge)
C-arms are utilized for fracture reduction
procedures, foreign body localization in limbs,
and for reducing joint dislocations
Celling suspended tube, vertical Bucky, floating
table top with Bucky
Skull Unit

16. Fig: A, Dedicated C-arm
type trauma radiographic
room with patient on the
table
Fig: B, Dedicated
conventional trauma
radiographic room with
vertical Bucky.

17. Fig : Mobile fluoroscopic C-arm. STAT SCAN

18. Immobilization devices
 To stabilize injured patients.
 To prevent involuntary and voluntary motion
 Once injuries have been diagnosed or ruled out, the
attending physician gives the order for immobilization to be
removed, changed, or continued.
 Radiolucent foam pads, Sponges, sandbags, and the creative
use of tape are often most useful tools.
 I R holders helps to perform cross-table lateral projections on
numerous body parts with minimal distortion.

20. Fig: A Typical backboard
and neck brace used for
trauma patients.
Fig: B, Backboard
,brace and other
restraints are used
on the patient
throughout
transport.
Fig :C All restraints
will remain with
and on the patient
until all x-ray
examinations are
completed.

21. Grids
 Grids and IR holders are necessities since many projections
require the use of a horizontal central ray.
 Focused grid, lower grid ratio ( 6:1),12:1 bulky patient grids)
 Non-linear water type grid which have wider film range
and better tolerance of central ray angulation and
centering
 Correct FFD for the type of grid is used otherwise cutoff
artifact will result.

22. Exposure factors
 shortest possible exposure time that can be set should be
used in every procedure, except when a breathing technique
is desired.
 Radiographic exposure factor compensation may be required
when making exposures through immobilization devices, like
a spine board or backboard.
 Pathologic changes should also be considered when setting
technical factors. For instance, internal bleeding in the
abdominal cavity would absorb a greater amount of radiation
than a bowel obstruction.

23. Radiation Protection
 Collimation to the anatomy of interest to reduce scatter,
 Gonad shielding for the patients of child-bearing age
 Lead aprons for all personnel that remain in the room
during the procedure
 Exposure factors that minimize patient dose and scattered
radiation
 Announcement of impending exposure to allow unnecessary
personnel to exit the room

24. Best Practices in Trauma Patients
 Speed - Performing Quick or rapid diagnostic examination
is critical to saving the patients life.
 Accuracy - must provide an accurate images with a minimal
amount of distortion and the maximum amount of recorded
detail.
 Quality - The quality of a radiograph does not have to
sacrifice to produce an image quickly.

25. Gloves, mask, and gown must be properly worn.
Protect the IR and sponges and keep all equipment
and accessory devices clean
Wash hand frequently, especially between patients.
Adhere to Code of Ethics for Radiologic Technologist
and the Practice Standards of professionalism
Practice Standard Precautions

26. Positioning & technique in Trauma
Chest
Ribs & sternum
Abdomen
Upper extremities
Lower extremities
Spine
Skull

27. Chest
 AP
 Lateral
 Lateral decubitus AP

28. Chest AP
 Don’t elevate patient in erect position who have suspected
spinal injury
 Film is placed crosswise
 Head end of the bed can be elevated to achieve semi-erect
positon
 Cassettes is placed 2 inch above the shoulder
 Arms should be internally rotated to remove scapulae out of
lung field
 CR is directed 3-4 inches below the jugular notch with CR 3-5
inch caudally
 SID 72 inches or 48 inches if not possible

29. Multiple buckshot in
chest caused a
hemopneumothorax.
Arrows show the margin
of the collapsed lung
with free air laterally.
Arrowhead shows fluid
level at the costophrenic
angle,left lung
Patient and IR
positioned for a
trauma AP
projection of the
chest.
Open safety pin
lodged in
esophagus of a
1 3-month-old
baby.

30. Chest AP
 The lung fields entirety ,adequate aeration of the lungs, ribs
and lung parenchyma must be visualized with minimal rotation
and distortion.
 signs of respiratory distress or changes in level of
consciousness must be checked
 SID must be made max to minimize magnification of the
heart shadow

31. Sternum
 AP
 Left posterior oblique (LPO)
 Lateral Horizontal beam

32. Ribs
 AP
 Obliques
 Alternatives Oblique view

33. Abdomen
Supine AP
Left lateral decubitus
Dorsal decubitus ,
Lateral position

34. Upper extremities
 AP, Obliques, Lateral ( Fingers, Thumb, Hands, Wrist,
Forearm)
 Elbow PA & Lateral
 Humerus AP & Lateral
 Shoulder AP, Lateral, Y-view
 Scapula AP
 Clavicle AP & Axial

35. Lower extremities
 Toe and foot ( AP & Lateral)
 Ankle ( AP, Mortice, lateral, lateromedial)
 Leg (AP)
 Knee ( AP & Lateral, Oblique with lateromedial angulation
 Thigh and Hip region ( AP & Lateral )
 Pelvis and Hip joint ( AP, Inferiosuperior, Skiagram, Lateral)

37. Spine
Cervical Spine: - AP, AP
open mouth, Lateral,
Swimmer’s lateral,
Obliques)
Thoracolumbar: - AP,
Lateral

38. Swimmer’s
Lateral

39. Skull
Lateral, AP, Reverse
Caldwell view, Townes view
Facial bones ( Lateral, AP
Reverse waters view)
Mandible ( AP, AP Axial,
Axiolateral Oblique)

40. Reverse waters view

41. Other imaging modalities
 Computed tomography (MDCT, WBCT, CTPA for
active bleeding, ICH, hemoptysis & GI bleed, Dual
energy CT for cardiac imaging )
 Ultrasonography
 Magnetic Resonance Imaging (multiple vertebral
injuries)

42. Summary
 Emergency radiography has emerged as one of the newest
and fastest growing radiology subspecialties.
 Today, with the ready availability of cross-sectional imaging
with CT, MRI, and ultrasound, the emergency radiology
facility has become the acute diagnostic imaging center.
 Use of emergency cross-sectional imaging can expedite
patient care as well as prevent unnecessary hospital
admissions and unnecessary emergency surgery

43. References
 Clarks positioning 12th edition
 Text book of radiology for resident and technician,
5th edition
 www.radiologyinfo.org
 www.radiopedia.org

44. 