C-arm and operation theater radiography
Where operative procedure
requires imaging control, the radiographer plays an important part in the form
of the orthopaedic theater team. Fluoroscopy imaging is required during the
Trauma Orthopaedic Procedure. But radiographer is also required during some
Non-Trauma corrective orthopaedic procedure. However in both instances the
radiographer is required to work primarily in an operation theater environment
using a mobile C-Arm image intensifier
Non-Trauma corrective orthopaedic surgery
Nowadays, a large number of
Non-Trauma corrective orthopaedic procedures are performed. In which there are
a large number of joint replacements such as severe osteoarthritis (OA) of Hip
joint is treated with prosthetic total hip joint replacement, which does not
require imaging control (C-Arm) at all. Still, more complex pediatric operative
procedures (e.g. osteotomies for joint alignment) require imaging control.
Trauma Orthopaedic Surgery
Most of the radiographer's
work during the Orthopaedic Procedure focuses on the aid of the following
Trauma Orthopaedic surgery - Successful reduction of fracture. Implantation and removal of internal or
external fixing devices.
K-wire insertion
K-wire insertion
is mostly done for corrective simple fracture extrimity surgery of extrimity
such as simple fracture of fingers, hands, wrists, elbow and feet. Imaging
controls are required in these procedures. Before processing, it is ensured
that the C-Arm is rotating up to 180 °. To reduce magnification and improve
image quality, keep the affected area as close to the detector as possible.
Open Reduction
and Internal Fixations
Open Reduction
and Internal Fixations are mostly done
in situations where the fracture cannot be satisfactorily conducted by any
other means. The mid shaft forearm fracture can be stabilized with compression
plate and screws. In this situation, to reduce magnification and improve image
quality, keep the affected area as close to the detector as possible.
This imaging
control is mostly required at the beginning and end of the procedure. During
the operation the surgeon can directly view the fracture site and the fixation
device.
During the process, collimation should be used in the area of interest, which reduces scatter radiaiton and improves image quality.
Intramedullary Nailing
During intermittent imaging control is required during the entire procedure. This not only tells the surgeon what is the path of the nail in the medulla in the long bone but also helps in proximal and distal locking in the cortex by the nail screw.
Interventional Procedure
Imaging control is also required during this time. There are many procedures where the radiographer has to assist during the procedure like-
Retrograde pyelography
It is also called ascending
pyelography. In this, organic iodinated contrast agents are mechanically filled
with renal calyces and pelvis and seen with the help of C-Arm. For this, with
the help of cystoscopy, a catheter is attached to locate the affected kidney.
For this, a mobile C-Arm image intensifier / solid state detector and
radiolucent theater table which are suitable for cystoscopy are used. The
patient is made supine. The C-Arm is set for PA projection
Percutaneous Nephrolithotomy (PCNL)
This is an interventional
procedure in which the renal stone is removed with the help of a direct
nephrotomy tract. For this, a mobile C-Arm image intensifier / solid state
detector and radiolucent theater table which are suitable for cystoscopy are
used. In this, large renal stone is damaged by electrohydraulic lithotripsy or
ultrasound shock waves.
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