Trauma
Radiography
MRD541
Special Radiographic Procedures 1
Ts. Nurul Dizyana Nor Azman | 2024
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Learning Outcomes
At the end of this session, the students should be able to:
• Describe basic principle in Trauma Radiography
• Explain basic steps in dealing with Trauma cases/patients.
• Role of radiographer in trauma cases/trauma radiography.
• Important of diagnostic algorithm in Trauma Radiography
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OVERVIEW
Trauma
Types & Symptoms
Imaging algorithm
Responsibility of radiographers
Assessment of patients
Considerations
References
Thank You
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What is trauma?
Sudden, unexpected, dramatic, forceful, or violent event
injuries caused by external forces that damage the body's
tissues, bones, or organs
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Type of trauma in radiography
1) Blunt Trauma : Caused by an impact or collision with an object or surface, such as
car accidents or falls. It often leads to fractures, internal bleeding, or organ injury.
Abdominal/ Thoracic Trauma.
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Penetrating Abdominal Trauma
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Type of trauma in radiography
2) Penetrating Trauma: Involves injuries where an object pierces the body, like
gunshot or stab wounds. This can cause damage to bones, soft tissues, and internal
organs.
3) Blast Trauma: Caused by explosions, which can create a combination of blunt,
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penetrating, and burn injuries. Blast trauma often affects multiple body systems
simultaneously.
4)Thermal Trauma: Results from exposure to extreme heat (burns) or cold
(frostbite). Burn injuries may involve both the skin and deeper tissues.
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Type of trauma in radiography
5) Orthopaedics Trauma: Specifically involves injuries to the bones, joints, and
ligaments, including fractures and dislocations.
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6) Spinal Trauma: Refers to injuries affecting the vertebral column and spinal cord,
such as fractures, dislocations, and disc injuries.
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Injury
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Blunt Trauma
• Resulting from blunt or penetrating forces, potentially affecting any of the organs within the
abdominal cavity, such as the liver, spleen, kidneys, intestines, stomach, and pancreas
• Abdominal/Thoracic Trauma : Can result from blunt or penetrating injuries to
abdominal/thoracic organs like the liver, spleen, kidneys and rib fractures, lung
contusions, or pneumothorax (collapsed lung)
• Penetrating Abdominal Trauma: Results from an object breaking through the skin and
entering the abdomen, such as gunshot wounds, stab wounds, or shrapnel injuries.
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Symptoms 9
• Pain: Localized or diffuse abdominal pain, which may increase with
movement.
• Tenderness and Swelling: Particularly in the area of the injury.
• Bruising or Hematomas: Visible bruising on the abdomen
(especially for blunt trauma).
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• Shock Symptoms: Low blood pressure, rapid heart rate, pale skin,
and sweating due to internal bleeding.
• Nausea and Vomiting: Due to irritation of the abdominal lining or
bleeding.
• Abdominal Distension: Swelling from internal bleeding or fluid
accumulation.
• Decreased Bowel Sounds: Reduced bowel movement can indicate
an issue with the intestines.
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Systematic method used in trauma settings to quickly assess and
manage patients with potentially life-threatening injuries. to identify
critical injuries and prioritize treatment
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Ensure the airway is clear and secure while 22
protecting the cervical spine in cases where a
neck injury is possible.
Evaluate and support adequate breathing and
ventilation.
Assess and support blood circulation, and
control any active bleeding.
Assess neurological status, including
consciousness level and any motor or sensory
deficits.
Fully expose the patient to assess for
additional injuries while preventing
hypothermia.
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Imaging Algorithm 24
Structured sequence of steps or guidelines designed to help
healthcare providers choose the most appropriate imaging
studies for diagnosing or evaluating specific medical conditions.
Emergency Medicine and Trauma Services
[Link]
0Peg%20Perubatan/[Link]
[Link]
Guidelines for Imaging in ALTS 25
Primary Survey:
Chest X-ray Pelvic X-ray Lateral Cervical
Focused X-ray
(CXR): (PXR): Spine X-ray
Imaging
FAST and E-FAST
(Focused Assessment CT Imaging as the
with Sonography for Standard for Trauma
Trauma)
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Responsibility of radiographers in 28
Emergency Trauma Radiography
• Work in a team with other profession
• Work quickly and efficiently
• Provide a good quality radiographs
• Do not increase severity of trauma
• Cause minimal discomfort to the patient
• Limit radiation dose where possible
Advanced Trauma and Life Support).
[Link]
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Consideration in Emergency Trauma 29
Radiography
Speed : produce quality images in shortest
possible time
Accuracy : Plan and get it right at first
Quality : Produce a good quality of radiography for
accurate diagnosis
• Patient condition is not an excuse for poor quality images!
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Principle in Emergency Trauma 30
Radiography
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
Alert with pt’s condition - could change at any time!
• Patient condition is not an excuse for poor quality images!
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Responsibility of radiographers in 31
Emergency Trauma radiography
Assessment of the patient’s condition.
Planning the examination.
Adaptation of technique.
Supervise patient’s condition.
Equipment and imaging considerations
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Why it is important to assess the patient before
examination start?
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Assessment of the patient’s condition. 33
►Scrutinise imaging request.
►Assess patient’s condition.
►Assessment of injury.
►Discussion with patient (if possible) relating to their condition
& capabilities:
►To plan examination and for best diagnostic outcome.
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What is GCS?
The Glasgow Coma Scale (Teasdale and
Jennett, 1974) is a series of tests that are
given a numerical value which can then be
used to objectify an athlete's state of
consciousness
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Planning the examination. 37
► Proper plan first = more effective
examinations.
► Lateral first, then AP.
► When patient enters while on stretchers,
consider the side of any lateral. Thus,
appropriate side can be positioned
early, against the Bucky.
► To get valuable information about the
patient’s condition.
► Good communication with the A&E staff:
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Positioning Principle 38
► The primary difference: Adaptation.
► Evaluatesituation adapt CR angles and
IR placement.
► Principle
One: Two projections 90° to
each other with true CR- part-IR
alignment. (AP or PA and lateral).
► Projections
achieved by:
►Turning body part.
►Angling the CR and IR.
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Positioning Principle 39
• Include entire structure / trauma area on
IR.
• To ensure no pathology is missed. Ex: the
long bone examination.
• Possibility of secondary fractures (Patient
arrive in supine)
• Horizontal beam lateral.
►Example: horizontal beam lateral:
► Head cannot be moved.
► Move head to the table edge.
► IR placed below the level of tabletop.
► Increase OID + magnification.
► Adjustment of exposure factor.
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Adaptation of Technique
► Horizontal beam laterals.
1 ►An advantageous procedure in certain conditions. Eg: Lipohaemathrosis.
► Standing up/sitting.
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2 ►Patient may find it difficult to do supine. Then, it is better to do in erect position.
Eg: Suspected supracondylar fracture of the elbow.
► Consider the pathology.
3 ► Radiographer trying to meet standard projection, but forget to consider the
pathology in question. Eg: Long bone examination
► Be flexible.
4 ► Radiographer should not be accustomed to doing things in a particular manner.
► Eg: Cassette size for lateral cervical spine.
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Equipment and Imaging Considerations.
1 Dedicated x-ray systems: Eg: ?
► Immobilization devices:
2 ► Go o d supply of radiolucent f oam pads an d sandbags.
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► Grids:
3 ► Should be used where is necessary.
► Correct FFD must be considered if a focused grid is being used – to avoid cut-off.
• Object-to-film distance:
4 ► OFD increases as a result from trauma x-ray modifications. Eg.: Horizontal beam
lateral radiograph of the thoracic or lumbar spine
► Collimation:
5 ► Many trauma exams are prone to high level of scattered. Eg.: lateral
horizontal b eam for lumbar. Thus, tight collimation is neede d
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Equipment and Imaging Considerations.
1 Dedicated x-ray systems: Eg: ?
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► Immobilization
2 devices:
► Go o d supply of
radiolucent f oam
pads an d
sandbags.
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Equipment and Imaging Considerations.
3 ► Grids:
► Should be used where is necessary.
► Correct FFD must be considered if a
focused grid is being used – to
avoid cut-off.
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► Object-to-film distance:
4 ► OFD increases as a result from
trauma x-ray modifications. Eg.:
Horizontal beam lateral radiograph
of the thoracic or lumbar spine.
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Equipment and Imaging Considerations.
► Collimation:
5 ► Many trauma exams are prone to high level of
scattered. Eg.: lateral horizontal b eam for lumbar.
Thus, tight collimation is needed
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6 ► Type of trolley:
► Relevant considerations:
• Cassette holder.
• Access to cassette.
• Object-to-film distance.
• Uniform trolley top.
• Vertical cassette holder.
7 ► Image artefacts:
► Clothing, immobilization devices, necklace or earrings under
cervical collar.
► Need good communication with the A&E staff.
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Equipment and Imaging Considerations.
► Exposure factors:
8 ► Considerations:
• Reducing exposure time.
► Increase kV, reduce mAs.
► Increase mA, reduce time.
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► Faster imaging system.
► Use bro ad focal spot size.
• Enhance contrast.
► Low kV, high contrast to demonstrate foreign body.
• Aut omatic exposure devices.
► Center correctly to the Bucky.
• Correct labeling of images
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SUMMARY
1. Whenever possible these projections should be an anteroposterior (AP) or
posteroanterior (PA) projection and a lateral projection.
[Link] two projections, 90 degrees apart.
[Link] the part, the CR, or the film to avoid any interfering objects.
[Link] only thing that matters is the relationship between the part, the
CR, and the film.
[Link] the entire structure, or area, in the examination.
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Consideration in
Common Projection
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Cross-table Lateral Cervical Spine
Perform 1st and check with physician before proceeding with other projections.
Dorsal decubitus position, horizontal beam
• Shoulders relaxed
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• Head -no rotation- ask pt to look straight ahead without moving head or neck
Vertical IR placed at top of shoulder in holder
Lateral Cervicothoracic Spine (Swimmers) 48
Trauma- usually Dorsal decubitus position
Required if C7 and top of T1 not demonstrated on lateral C-spine
Patient supine -no rotation
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Ask pt to raise arm opposite x-ray tube over head
AP Axial Cervical Spine 49
CR directed 15 - 20 degrees
cephalad to enter MSP and C4
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Image demonstrates C3-T1 or
T2
Include all soft tissues
Thoracic and Lumbar Spine 50
Dorsal decubitus positions performed 1st
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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
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Trauma AP Chest
Patient 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
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Use maximum SID to reduce heart magnification
Ensure chin extended out of anatomy of interest
CR directed perpendicular to centre of IR
• Enters pt at MSP at about 3"" below jugular notch
Exposure on 2nd full inhalation, if possible
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Trauma AP Chest
Image must demonstrate
lung fields in their entirety
• Minimal rotation and
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distortion present
Collapsed lung
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Lateral Decubitus
If pt’s condition permits, position pt lying on affected side
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Trauma Lateral Chest
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If air-fluid levels are suspected, use dorsal decubitus position
Penetrating wounds to Abdomen
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► Stabbings, gunshots
► Mark entrance and exit wounds,
if present
► Align shoulders and hips in same
plane
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Bullet Wound
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• Demonstrate entire abdomen
• Pubic symphysis must be visible
at lower border
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Why lateral decubitus is requested?
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Which decubitus is this?
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Pelvis 59
► Pelvic# have high risk of hemorrhage –
pay close attention to patient for status
change
► Obtainlift help for IR placement under pt if
transfer to x-ray table is not possible
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► IRcentered 2” above pubic symphysis or
2” below ASIS
► Lowerlimbs usually not rotated internally
15 degrees in trauma cases.
► Suspend respiration
► Demonstrate entire pelvis and prox.
femur
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Cranium
► Patient with head trauma are often referred to CT 1st- Why?
► Muchmore information
► Standard x-ray routine
AP and lateral
►
► Generally, pt is supine
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AP Cranium
► AP projection
► for anterior cranium
► AP axial projection
► 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!
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Lateral Cranium
► Elevate head on
radiolucent support
► C-spine injury ruled out 1st!
► Place vertical IR centred to
cranium
► Make sure interpupillary line
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is perpendicular to IR and
MSP is vertical
► Horizontal CR enters center
of IR and pt at 2"" above
EAM ► dorsal decubitus position
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Upper and Lower Limbs
• Obtain lift help for IR placement
• Injured limbs should be lifted with support at both
joint (Move IR and CR, not injured limb when
possible!)
• Do not attempt to rotate severely injured limbs for
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true positions
• 2 projections at 90 degrees apart, Must
demonstrate both adjacent joints
• Take 2 separate projections if need be
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References
1. Ballinger, Philip [Link] Atlas of Radiographic Positions and
Radiologic Procedures.
2. Clark, KC., 2005, Clark’s positioning in radiography , 12th edn., USA:
Hodder Arnold,
3. Bontrager, KL., 2009, Textbook of radiographic positioning and related
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anatomy,7th edn., St Louis: Mosby.
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THANK YOU
TUTORIAL
1. What types of injuries detected via ABCDE in chest trauma radiography
2. Identify relevancy of each steps diagnosis in ALTS