View source for Top 20 Practical Tips for Radiography in the Operating Theatre

<div class="WPC-editableContent"><blockquote> <blockquote> <div align="center"> <b><font color="#ff0000"><br/></font></b></div><br/></blockquote> <div align="center"> </div></blockquote> <div align="center"> <div align="left"> <b><font size="5">Introduction</font></b></div></div> <blockquote>  The operating theatre (OT) can be a confronting new environment for  student radiographers. The best strategy for dealing with this problem  is to take every possible opportunity to practise your operating  theatre techniques. To help you along the way, here are 20 tips that  you may find useful. Not all of these tips will be applicable to all  theatre situations.<br/><br/></blockquote><br/><b><font size="5">Tip 1. Get to Know Your Operating Theatre Staff<br/></font></b> <blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="54%"> <blockquote> <div align="right"> </div></blockquote> <div align="right"> </div><b><font size="5"> </font></b><div align="right"><b><font size="5"> [[File:EJWsJIKhmKAaL5n FxWcdw103368.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]]</font></b></div> </td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="46%"> <font size="3">This is placed at number one for good reason. You are in their <i>turf</i>  and you may have goals that conflict with theirs. For example, your  goal to produce the best possible images may conflict with the scrub  nurse's goal of keeping a sterile field intact!<br/><br/>Look at this  theatre team..... they look like a team. You would be confident as a  patient in their hands. This is how you should view your role in the  operating theatre. You are joining a team of skilled people in the  interest of a good surgical outcome for the patient.<br/><br/>These  people can make your theatre experience very pleasant or very  difficult. Engendering yourself to them can involve such things as<br/></font><ul><font size="3"> </font><ul><font size="3"> <li>  learning their names   </li><li>  learning their roles   </li><li>  learning their rules. </li><li>helping with patient transfers<br/></li></font></ul></ul><font size="3"><br/>Be a good communicator with the theatre staff</font></td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="54%"><br/></td> <td class="WPC-edit-borderTop-solid2px" width="46%"><br/></td></tr></table></blockquote> <blockquote> <br/><div align="left"> </div></blockquote> <div align="left"> <b><font size="5">Tip 2. Know The Operating Theatre Rules</font></b></div> <blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="54%"> <blockquote> <div align="right"> </div></blockquote> <div align="right"> </div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="46%">  There's a good chance that the operating theatre will have several  folders of protocols. These could cover aspects of theatre procedures  such as attire, infection control, Occupational Health and Safety,  patient safety etc. You will probably not be expected to study these  protocols, but the few that affect you will need to be known.<br/><br/>Apart from the written rules, there are the matters of theatre <i>culture</i>.  These are the rules that are not written down, but the staff tend to  follow them- they are common understandings. It could cover such  matters as how rules are followed, how they are policed, and how you  get around them when required.</td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="54%"><br/></td> <td class="WPC-edit-borderTop-solid2px" width="46%"><br/></td></tr></table><br/><br/></blockquote><br/><div align="left"> <b><font size="5">Tip 3. Assume Everything and Everyone is Sterile</font></b></div> <blockquote> </blockquote> <blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> </div><div align="right">[[File:EHYDgOv1B0CB6d2IymeP5g106707.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]] </div></blockquote> <div align="right"> </div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%">  Once the surgeon breaks the patient's skin, the patient is at risk of  acquiring infection. One of the goals of the operating theatre staff is  to prevent the patient developing a significant post-op infection. <br/><br/>You  should be seen to be sharing in this goal. This will mean that you  should take care not to touch anything or anyone that is sterile. This  will mean not standing too close to a staff member who is gowned and  gloved. It will also require you to point out to others in the  operating theatre when they are at risk of breaching a sterile field,  or indeed, when they have breached a sterile field.<br/><br/>Be  particularly careful when you push the image intensifier over a  patient- ensure that you do not touch the sterile handle attached to  the operating light.</td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table></blockquote><br/><div align="left"> <b><font size="5">Tip 4. Know Your Image Intensifier</font></b></div> <blockquote> </blockquote> <blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> [[File:PXqS840x6wrSNGsxe5MMWg103036.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]]</div></blockquote> <div align="right"> </div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <font color="#000000">I  am assuming that the majority of the imaging procedures in the  operating theatre utilise the image intensifier. This machine's  operation you will need to be understood very well. Modern digital  image intensifiers have a number of pre and post-processing features.  It is very embarrassing if you don't know how to perform a task on the  image intensifier. This is particularly so when the surgeon knows that  other radiographers have performed the task.</font><br/><br/><font color="#000000">A  surgeon will probably forgive you for not being familiar with a  surgical procedure, but will be less forgiving if you are struggling to  use the image intensifier.</font><br/><br/><font color="#000000">If you  are unfamiliar with a procedure, there can be much to be said for  introducing yourself to the surgeon and advising him/her that you know  how to use the image intensifier, but will need guidance with the  procedure. Questions like... </font><br/><br/><blockquote> <div align="center"> <font color="#000000"><b><font size="2">"which side would you like me to come in from?"</font> </b></font></div> <div align="center"> <font color="#000000">or</font></div> <div align="center"> <font color="#000000" size="2"><b>"do you want the image intensifier to go under the table or over the table for the lateral"</b></font></div></blockquote><br/><font color="#000000">Good communication will suggest to the surgeon that you deserve his/her confidence in your abilities.</font></td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/><div align="left"> </div></blockquote> <div align="left"> <b><font size="5">Tip 5. Know Your Procedures</font></b></div> <blockquote> </blockquote> <blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> [[File:E1chCrVerz95wCx3q4PWKg73055.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]]</div></blockquote> <div align="right"> </div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <font color="#000000">There  will be a variety of procedures that you will be expected to assist  with. The surgeon will look to you for signs of confident and competent  operation of the equipment. This will be very difficult if you are  unfamiliar with a procedure.</font><br/><br/><font color="#000000">If you  are unfamiliar with a procedure, let the surgeon know. Better to let  the surgeon know up front, than for the surgeon to find out during the  procedure.</font><br/><br/><font color="#000000">Also, if you know you  have never seen a procedure that you have been called to do, ask  another radiographer to come with you to help explain what is happening.</font></td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/><div align="left"> </div></blockquote> <div align="left"> <b><font size="5">Tip 6. Cover/Drape Your Image Intensifier</font></b></div> <blockquote> </blockquote> <blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> [[File:Ln1j-OLim2Tag2HzVDKzcg104460.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]]</div></blockquote> <div align="right"> </div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%">  It is better to spend 5 minutes at the beginning of an operation  covering your image intensifier than to spend 20 minutes at the end of  an operation cleaning off blood and betadine. </td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/></blockquote><font size="5"><b>Tip 7. Face the Monitor Cart Panel Towards Where you are Standing</b></font> <blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> [[File:UXrpThMbw58PXQ8HRw9PWA101573.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]]</div></blockquote> <div align="right"> </div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <font color="#000000">Set  up the monitor cart so that the control panel is facing you. If you  need to manipulate the image, you do not want to be wasting time  walking around the cart. This will not apply to all image intensifiers.<br/></font></td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table></blockquote><br/><div align="left"> <font size="5"><b>Tip 8. Identify Your Patient</b></font></div> <blockquote> </blockquote> <blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="59%"> <blockquote> <div align="right"> </div></blockquote> <div align="right"> </div>INSERT IMAGE HERE   </td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="41%">  This might seem self-evident, but can be remarkably difficult in  reality. You can't ask the patient what their name is. The most common  method for identifying then patient is from the name on the paperwork  in the theatre. Bear in mind that sometimes patient notes are swapped  or there may be patient notes in theatre left from a previous patient. <br/><br/><ul> <li> <div class="MsoNormal"> <font color="#000000">Check age and sex </font></div> </li><li> <div class="MsoNormal"> <font color="#000000">Check name on old imaging</font></div> </li><li> <div class="MsoNormal"> <font color="#000000">Check that there are not two sets of paperwork on different patients</font></div></li></ul><br/>Beware....</td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="59%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="41%"><br/></td></tr></table><br/><div align="left"> </div></blockquote> <div align="left"> <font size="5"><b>Tip 9. Secure your Plug</b></font></div> <blockquote> </blockquote> <blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> [[File:GSrJPyJ5cud0rfvYHIuBOQ101164.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]]</div></blockquote> <div align="right"> </div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <font color="#000000">Securing the mains cord to the boom with a self tightening knot has two advantages. <br/><br/>Firstly,  if someone trips over the cord, they will not rip the cord out of its  socket (they may break their neck, but you’re machine is OK!). If the  plug is pulled out of the socket, it could cause damage to your image  intensifier, or you could lose images. Also, the surgical procedure  will be delayed while you re-boot the image intensifier.</font> <font color="#000000"><br/><br/>Secondly,  when there are multiple sockets with multiple plugs, you will recognize  your plug immediately.... it’s the one with the fancy knot (I have  pulled out the patient’s ventilator plug by mistake).</font> <font color="#000000">Any knot that tightens as you pull on it would be suitable.<br/><br/>Many image intensifiers have a built in uninterruptible power supply (UPS)- if the power cord is accidentally pulled out of the socket, replacing it quickly may cause no harm.<br/></font></td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/></blockquote><font size="5"><b>10. Go to the Toilet Before you Start</b></font> <blockquote><div align="center"> </div><table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"><div align="right"> <blockquote> [[File:CXZBwdWFvnsy49IufIXEAg13231.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]]</blockquote></div> <div align="right"> </div> <div align="right"> <a class="external" href="http://www.bbc.co.uk/nottingham/content/images/2005/07/29/toilet_sign_lead_203x152.gif" rel="nofollow" target="_blank"><font size="1">http://www.bbc.co.uk/nottingham/content/images/2005/07/29/toilet_sign_lead_203x152.gif</font></a></div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%">  You can never be sure how long an operation will take. It is hard to  imagine what would be more painful- the ever increasing size of your  bladder, or the pain of embarrassment when you ask to stop the  operation while you go to the toilet. </td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/></blockquote><font size="5"><b>Tip 11. Check Hard-Drive Space Before Starting a New Procedure</b></font> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> </div></blockquote> <blockquote> <div align="right"> <a class="external" href="http://www.southerneditorial.co.uk/watchthisspace/may05/Theatre_staff.jpg" rel="nofollow" target="_blank"><font color="#497fb1" size="1">[[File:8i5fV3WDf5uulDYO7u3WMw84126.jpeg|500px|Top 20 Practical Tips for Radiography in the Operating Theatre - wikiRadiography]]<br/></font></a></div></blockquote></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%">  If you are using an image intensifier with a hard drive, check that you  have plenty of hard drive space left before you start. It can be very  awkward to stop a theatre case while you <i>free up</i> some hard drive space  on your image intensifier.<br/><br/>Obviously, if you are using a non-digital image intensifier, this will not be an issue.</td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/><br/></blockquote><font size="5"><b>Tip 12. Check That the Surgeon is Operating on the Correct Side</b></font> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> </div></blockquote> <blockquote> <div align="right"> <a class="external" href="http://www.southerneditorial.co.uk/watchthisspace/may05/Theatre_staff.jpg" rel="nofollow" target="_blank"><font color="#497fb1" size="1">[[File:E laCIcKJdLF4Ch36F Pag81016.jpeg|500px|Top 20 Practical Tips for Radiography in the Operating Theatre - wikiRadiography]]<br/></font></a></div></blockquote></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%">  It is sound practice to have a good look at the patient's old imaging.  You can often pick up points that will help during the operation. The  operation may also make more sense to you if you understand the  patient's history and the nature of their injuries. <br/><br/>Importantly,  check that the surgeon is operating on the correct side of the patient.  Once the scrub nurse has prepared one side of the patient for surgery,  the surgeon will tend to assume that is the affected side.<br/><br/>In  short, the surgical team should aim to perform the correct operation,  on the correct side of the patient, on the correct patient.<br/><br/>Beware, errors are made.</td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/><br/></blockquote><font size="5"><b>Tip 13. Watch the Surgeon's Eyes When Screening</b></font> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> </div></blockquote> <blockquote> <div align="right"> <a class="external" href="http://www.southerneditorial.co.uk/watchthisspace/may05/Theatre_staff.jpg" rel="nofollow" target="_blank"><font color="#497fb1" size="1">[[File:B7izycVKm1zVVrbPp2CkXA123205.jpeg|500px|Top 20 Practical Tips for Radiography in the Operating Theatre - wikiRadiography]]<br/></font></a></div></blockquote></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%">  This is not a matter of romance- it's a radiation protection issue. If  it is normal procedure for the radiographer to initiate fluoroscopy, or  if the surgeon has the fluoro' peddle, this is still good practice (this is a debatable point- researchers have reported conflicting findings).  What you are trying to minimise is the time that the surgeon spends  screening when he/she is not looking at the image. It is not uncommon  for the surgeon to ask you to initiate fluoroscopy but not tell you to  stop. They are simply concentrating on what they are doing and forget  that they have initiated fluoroscopy.<br/><br/>It helps if you understand  what they are doing at every stage of the operation. This will help you  to decide whether the surgeon has averted their eyes momentarily from  the image (and wants you to keep screening) or whether they have simply  forgotten to tell you to stop screening.</td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/></blockquote><font size="5"><b>Tip 14. Use a Sequence Acquisition When Appropriate</b></font> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> </div></blockquote> <blockquote> <div align="right"> <a class="external" href="http://www.southerneditorial.co.uk/watchthisspace/may05/Theatre_staff.jpg" rel="nofollow" target="_blank"><font color="#497fb1" size="1">[[File:5DxSoiWheaSQUgvLyjJrVw69623.jpeg|500px|Top 20 Practical Tips for Radiography in the Operating Theatre - wikiRadiography]]<br/></font></a></div></blockquote></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%">  Modern mobile digital Image Intensifiers are able to store images in a  run or sequence. You set the relevant parameters such as capture rate,  and the images will be stored in a sequence (it's a bit like an  animated GIF). <br/><br/>I see this as having several advantages.  Firstly, my understanding is that the Image Intensifier is performing  screen capture and there is no cost in terms of increased radiation  dose to the patient.<br/><br/>Secondly, you are able to record dynamic  information. This can be particularly useful in cases such as ERCP or  Laparoscopic Cholangiogram. If there appears to be a stone in the CBD  you can play the sequence back to the surgeon and see if the stone acts  more like an air bubble or a stone. <br/><ul> <li>  does it deform in shape   </li><li>  does it divide in two when it reaches the hepatic ducts   </li><li>  does it float up hill or down hill </li></ul><br/>Another less obvious use is when the surgeon wants to assess the stability of a joint following ORIF.</td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/></blockquote><font size="5"><b>Tip 15. Be Careful When Moving the C-arm</b></font> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> </div></blockquote> <div align="right"> <a class="external" href="http://www.southerneditorial.co.uk/watchthisspace/may05/Theatre_staff.jpg" rel="nofollow" target="_blank"><font color="#497fb1" size="1">INSERT IMAGE HERE<br/></font></a></div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%">  It is possible to do harm when you are moving the C-arm.<br/><br/>When  you are assisting with a hip operation, the surgeon will usually want  to see that anatomy in the lateral projection. The image intensifier is  usually set up to roll under the operating table for the lateral  projection. The first time you roll the C-arm into the lateral  projection be very careful. Go slowly and ask the surgeon if everything  is " Ok over there". <br/><br/>Similarly, you can fracture a patient's  pelvis when lowering the C-arm. Also watch the anaesthetist who is  raising or lowering the operating table when the C-arm is in place.</td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/><br/></blockquote><font size="5"><b>Tip 16. You are Responsible for your Students</b></font> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> </div></blockquote> <div align="right"> </div> <div><div align="right"> <blockquote> [[File:EzVXw7sJ33AIP-d95DexAg94670.jpeg|500px|Top 20 Practical Tips for Radiography in the Operating Theatre - wikiRadiography]]<br/></blockquote></div> <div align="right"> <font size="+0"><a class="external" href="http://www.jetmag.co.nz/Portals/4/Images/xray.JPG" rel="nofollow" target="_blank"><font size="1">http://www.jetmag.co.nz/Portals/4/Images/xray.JPG</font></a></font></div></div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <font color="#000000">Qualified  radiographers will generally be held accountable for the students under  their instruction. I have seen a scrub nurse drop a pair of forceps- the radiography student picked them up and put them back on the sterile  tray for her. </font><font color="#000000">It is worth emphasizing to  a student radiographer who is entering the operating theatre for the  first time the following three points.</font> <br/><br/><ul> <li> <div class="MsoNormal"> <font color="#000000">Assume everything and everyone is sterile- touch nothing and you can't go wrong</font></div></li></ul><ul> <li class="MsoNormal"> <font color="#000000">If you feel unwell, leave the theatre immediately<br/></font></li></ul><ul> <li class="MsoNormal"> <font color="#000000">If you feel faint, back up to a wall and slide down it until you are sitting on the floor</font></li></ul><br/><font color="#000000">I  was once told that the true measure of a surgeon's ability to train a  student lies in their preparedness to let that student operate on them.  We should think of student radiographers in the same way- we train them  to a level that we would be confident to be their patient.</font></td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <div> </div> <div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/></blockquote><b><font size="5">Tip 17. <font color="#000000">Use Equipotential Earthing for Cardiac Cases</font></font></b> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> [[File:QH5AH8 E2F0eejRtuSehfA116911.jpeg|500px|Top 20 Practical Tips for Radiography in the Operating Theatre - wikiRadiography]]</div></blockquote> <div align="right"> </div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%">  You may have wondered why your image intensifier has a separate earth  lead when it is earthed through the plug. This extra earthing wire can  be used during cardiac cases (pacing wires, defibrillator insertion,  ablation etc) when <b>equipotential earthing</b> is required. If all of the  equipment in the operating theatre is earthed to the same earth point,  the grounding of the equipment will be identical. This can assist with  electrical safety and avoid static discharge during surgery.</td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/></blockquote><b><font size="5">Tip 18. Don't Clean the Image Intensifier During Open Surgery</font></b> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> [[File:OPJW8FYPpesRgX98jfZFQQ92963.jpeg|500px|Top 20 Practical Tips for Radiography in the Operating Theatre - wikiRadiography]]</div></blockquote> <div align="right"> </div> <div align="right">  h<a class="external" href="http://www.jwodcatalog.com/imgLg/8125004887952.jpg" rel="nofollow" target="_blank"><font size="1">ttp://www.jwodcatalog.com/imgLg/8125004887952.jpg</font></a></div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <font color="#000000">It  can be tempting to do a little bit of cleaning of the image intensifier  during the operation. This is inadvisable. If you are using a spray  bottle, the aerosol will potentially enter an open wound and cause  infection.</font><br/><br/><font color="#000000">This is not to suggest  that the image intensifier does not need cleaning between cases. If you  want to see what the theatre staff look like when they are upset, try  wheeling a blood covered image intensifier into an operation.</font><br/><br/><font color="#000000">Cleaning  the image intensifier can be more difficult and time consuming than it  looks. There can be crevices that are hard to access. Also, you will  need to turn the c-arm upside down to be sure that the image  intensifier is completely clean. </font></td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/></blockquote><b><font size="5">Tip 19. Distance, Shielding, Time</font></b> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> [[File:1DWOHMKODd8ZxZKqa8utVA105261.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]]</div></blockquote> <div align="right"> </div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <font color="#000000">The three basic principles of radiation protection are </font><br/><br/><ul> <li> <font color="#000000">distance, </font> </li><li> <font color="#000000">shielding </font> </li><li> <font color="#000000">time. </font></li></ul><br/><font color="#000000">Distance  is often overlooked as a radiation protection technique. This is  possibly related to a notion that if you are wearing a lead gown, you  are receiving no ionising radiation. Of course, the lead gown is not  covering your entire body. In keeping with the ALARA principle, it is  good practice, where appropriate, to move away from the image  intensifier as far as possible.<br/><br/>It is also worthwhile considering other radiation protection issues. eg.<br/></font> <ul> <li> <font color="#000000">When should you use overcouch techniques and when should you use undercouch techniques?</font> </li><li> <font color="#000000">What is the shape of the radiation scatter cloud from an image intensifier- where is it safest to stand?</font> </li></ul></td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table><br/></blockquote><b><font size="5">Tip 20. What if I feel like I am About to Faint?</font></b> <br/><blockquote> <table align="bottom" cellpadding="3" class="WPC-edit-border-none" width="100%">  <tr> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderLeft-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <blockquote> <div align="right"> [[File:NtHB U7TXQD2RF0jjCkSeg102850.jpeg|500px|Top 20 Tips for Radiography in the Operating Theatre - wikiRadiography]]</div></blockquote> <div align="right"> <div class="O"> <div> <a class="external" href="http://www.hrdctheater.com/" rel="nofollow" target="_blank"><font size="1">www.hrdctheater.com</font></a></div> <div> </div></div></div></td> <td class="WPC-edit-borderTop-solid2px WPC-edit-borderRight-solid2px WPC-edit-borderBottom-solid2px" width="50%"> <font color="#000000">If  you feel like you are going to faint, back up to a wall and slide down  it. You are not the first person to faint in an operating theatre and  you will not be the last. Even a hardened radiographer can feel faint  in certain circumstances- e.g</font>.<br/><br/><ul> <li> <font color="#000000">if you are dehydrated</font> </li><li> <font color="#000000">if the operative theatre is very hot</font> </li><li> <font color="#000000">if the operation is very long</font> </li><li> <font color="#000000">if you are standing for a long period wearing a lead gown</font></li></ul><br/><font color="#000000">I  find it useful during long theatre cases to find a seat and take the  weight off my feet. Check with your departmental and theatre rules on  this one.</font><br/><br/><br/><br/><div align="center"> <font color="#000000"><b><i>Fainting doesn't have to be a drama!</i></b></font></div></td></tr> <tr> <td class="WPC-edit-borderTop-solid2px" width="50%"> <br/><div align="right" class="O"> </div></td> <td class="WPC-edit-borderTop-solid2px" width="50%"><br/></td></tr></table> <i><br/>  Jeremy Enfinger has some notes on where to centre for surgical procedures at his website <a class="external" href="http://bloggingradiography.blogspot.com/search?updated-min=2007-01-01T00%3A00%3A00-05%3A00&amp;updated-max=2008-01-01T00%3A00%3A00-05%3A00&amp;max-results=36" rel="nofollow" target="_blank">here</a><br/> <br/> <br/>  ....back to the applied radiography home page </i>[[Applied Radiography - by M.J.Fuller|here]]<br/></blockquote><br/></div>