TRAUMA RADIOGRAPHY

Sianny Suryawati, dr., Sp.Rad

Radiology Department
Medical Faculty, Wijaya Kusuma University
Surabaya
2016
INTRODUCTION
• Trauma is defined as a sudden,
unexpected, dramatic, forceful, or violent
event
• Blunt, penetrating, explosive and thermal
forces are common causes of traumatic
injuries
INTRODUCTION
• Trauma affects persons in all age range
• Radiographer in the Emergency
Department mus be prepared for all
variety of procedures on patients in all
age groups
PRELIMINARY CONSIDERATIONS
• Specialized trauma imaging systems
reduce the amount of time required to
obtain diagnostic images
• One type provides grater flexibility in
IR/CR maneuverability
• Another type scans the entire body in a
few seconds
• Mobile radiography is often used for ED
procedures
PRELIMINARY CONSIDERATIONS
• Mobile fluoroscopy unites, or C-arms, may
be used in fracture reduction or foreign
body localizarions
• Immobilization devices are a necessity in
trauma imaging
• Trauma patients often cannot hold the
required position
“BEST PRACTICES” IN TRAUMA
RADIOGRAPHY
• Speed
• Efficiency in producing qualtiy images in the
shortest possible time
• Accuracy
• Optimum image quality, minimum repeats
• Quality
• Quality cannot be sacrificed for speed
• Do not use patient condition as an excuse for
poor quality images
“BEST PRACTICES” IN TRAUMA
RADIOGRAPHY
• Positioning
• Important not to aggravate patient’s
condition when obtaining images
• Move tube and IR, instead of patient,
whenever possible
• Practice standard precautions
• Expect to be exposed to body fluids in ED
• Do not touch a patient without gloves !
“BEST PRACTICES” IN TRAUMA
RADIOGRAPHY
• Anticipation
• Some injuries require follow up procedures;
knowing what to do increases appreciation for
radiographer’s role in ED
“BEST PRACTICES” IN TRAUMA
RADIOGRAPHY
• Attention to detail
• Pay careful attention to patient’s condition,
which could change at any time
• Attention to ED protocol and scope of practice
• Know the protocl and scope of practice in your
facility
• Professionalism
• Adhere to Code of Ethics
TRAUMA PROJECTIONS
LATERAL CERVICAL SPINE
• Horizontal CR centered to midpoint of IR
• Prevertebral soft tissue must be
visualized
• Images should demonstrate entire C-
spine from sella tursica to top of T1
• If all seven cervical vertebrae are not
sesn, the a swimmer’s view is required
LATERAL CERVICAL SPINE

Patient and IR centered for trauma lateral of C-

spine
LATERAL CERVICAL SPINE

Lateral projection of C-spine in dorsal decubitus

position; dislocation of C4; C7 not demonstrated, so
swimmer’s view is needed
SWIMMER’S (CERVICOTHORACIC)
• Required if C7 and top of T1 is not
demonstrated on latral C-spine
• Trauma usually requires dorsal decubitus
position
• Patient supine without rotation
• Ask patient to raise arm opposite the X-
ray tube over head
• Assist patiend and provide support
CERVICOTHORACIC SPINE
• Relax shoulder closer to X-ray tube
• Vertical IR centered just above jugular notch
• Horizontal CR centered to C7-T1 interspace and
midcoronal plane.
• Use breathing technique if possible
• Blur ribs and lung markings to better
demonstrate spine
• Image demonstrates lower cervical and upper
thoracic vertebrae in profile between the
shoulders
CERVICOTHORACIC SPINE
CERVICOTHORACIC SPINE
AP AXIAL CERVICAL SPINE
• Patient is supine
• Usually immobilized with collar and spine board
• Place IR under spine board, if present, centered
to C4 (Adam’s apple)
• Head and shoulders without rotation
• Ask patient to look straight ahead
• CR directed 15 to 20 degress cephalad to enter
MSP at C4
• Images demonstrates C3 to T1 or T2,
including all soft tissue
• If backboard is present, unavoidable
artifacts may be seen
AP AXIAL CERVICAL SPINE
AP AXIAL CERVICAL SPINE
AP AXIAL OBLIQUE CERVICAL SPINE
• Trauma Obliques
• Patient is supine
• Usually immobilized with collar and spine
board
• Place IR under spine board (not bucky), if
present, centered to C4 and adjacent
mastoid process
• About 3” lateral to MSP
AP AXIAL OBLIQUE CERVICAL SPINE
• Head and shoulders without rotation
• Ask patient to look straight ahead
• CR has double angle
• 45 degress lateromedially
• 15 to 20 degress cephalic
AP AXIAL OBLIQUE CERVICAL SPINE
• CR enters lateral to MSP at level of C4
• CR exit should be in center of IR
• Images demonstrates side oppoasite CR
• C1-T1 or T2 bodies and disk spaces
• Intervertebral foramina open
• If backboard is present, unavoidalbel
artifacts may be seen
AP AXIAL OBLIQUE CERVICAL SPINE
AP AXIAL OBLIQUE CERVICAL SPINE
THORACIC AND LUMBAR SPINE
• X-table laterals performed first
• Vertical grid and IR
• Top of IR 1.5” tp 2” (3.8 tp 5 cm) above
shouders for thoracic spine
• Centered to level iliac crests for lumbar
spine
• Have patient cross arms on anterior chest
THORACIC AND LUMBAR SPINE
• CR horizontal
• Centered to spine and IR
• Breathing technique improves
visualization of thoracic vertebrae
• Exposure made on suspended respiration
for lumbal vertebrae
THORACIC AND LUMBAR SPINE
• Thoracic image demonstrates T3 or T4 to
L1
• Lumbar images demonstrates T12 to
sacrum
• Vertebral bodies and spinous processes
in profile
TRAUMA LATERAL LUMBAR SPINE
TRAUMA LATERAL LUMBAR SPINE
CHEST
• Supine position used in general surve
image of chest desired
• Check for need to demonstrate air-fluid
levels
• If air-fluid levels are suspected, use X-
table lateral
• If patient’s condition permits, lateral
decubitus position with patient lying on
affected side will also show air-fluid levels
TRAUMA AP CHEST
• Obtain help to lift patient for IR placement
• Top of IR placed about 1.5” to 2” above
shoulders
• Arms abducted
• MCP parallel to IR
• Use maximum SID to reduce heart
magnification
TRAUMA AP CHEST
• Ensure chin extended out of anatomy of
interest
• CR directed perendicular to center of IR
• Look for light field slightly above shoulders
and on sides of chest, CW or LW
• Exposure made upon second full
inhalantion, if possible
TRAUMA AP CHEST
• Image demonstrates lung fields in their
entirety
• Minimal roation and distortion present
ABDOMEN
• If transfer to x-ray table is not possible,
obatin lift help for IR placement
• IR centered to MSP at level of iliac crests
• Check for possibility of flid accumulation
in abdominal cavity
• Affects exposure factors
• Requires close monitoring of patient for
status change during procedures
ABDOMEN
• Mark entrance and exit wounds, if present
• Align shoulders and hips in same place
• MCP parallel to table
• CR perpendicular to center of IR
Images demonstrates entire abdomen
with pubic symphysis visible at lower
border
PELVIS
• Pelvic fractures have a high risk of
hemorrhage – pay close attention to
patient for status change
• Obtain lift help for IR placement if
transfer to x-ray table is not possible
• IR centered 2” above pubic symphisis or
2” below ASIS
• MCP parallel to IP
PELVIS
• Lower limbs internally rotated only of
possible
• Ensure arms are not in anatomy of
interest
• CR perpendicular to center of IR
• Exposure made on suspended respiration
• Image demonstrates entire pelvis and
proximal femora
TRAUMA AP PELVIS
CRANIUM
• Patients with head trauma are often
referred to CT first
• When x-rays are ordered, a general
survey requires AP and lateral projections
• Generally, the patient is supine
• Lateral projection uses dorsal decubitus
position
TRAUMA LATERAL CRANIUM
TRAUMA LATERAL CRANIUM
TRAUMA AP CRANIUM
• Check with physician to determine
anatomy of interest
• AP projection demonstrates anterior
cranium
• AP axial projection (Towne) demonstrates
posterior cranium
TRAUMA CRANIUM
TRAUMA AP CRANIUM
FACIAL BONES
• Patients with facial bone
injuries are often referred to
CT first
• Anticipate profuse bleeding
and use universal
precautions
UPPER AND LOWER LIMBS
• Obtain lift help for IR placemenet
• Injured limbs should be lifted with support
at both joints
• Lift only enough to place IR
• Two projections at 90 degress from each
other required
• Do not attempt to rotate severely injured
limbs for true positions
• Long bones require demonstration of
adjacent joints
• Take separate projections, if necessary
• Maximize patient safety and comfort by
moving IR and CR, rather than injured
limb
OTHER IMAGING PROCEDURES IN TRAUMA
• CT is extensively used in trauma patients
• Often, CT is modality of choice
• Angiography may be uses for vascular injuries
• Contrast studies are often ordered for evaluation
of urinary system
• Blunt abdominal trauma and suspected pelvic
fractures often result in injury to urinary system
TIME FOR THE “GOOD STUFF” !