Emergency radiography focuses on the imaging management of acutely ill and injured patients, requiring radiographers to be well-prepared in high-pressure environments. Key components include patient condition assessment, specialized equipment, and best practices to ensure rapid and accurate imaging while maintaining patient safety. The document discusses various techniques, responsibilities, and technologies relevant to trauma radiography and highlights the growing importance of this subspecialty in providing effective emergency care.

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. 