WHICH WAY IS UP? THE CONTROL OF IMAGE INTENSIFIER MOVEMENT IN THE OPERATING THEATRE

Abstract

The image intensifier is an essential part of orthopaedic trauma surgery. The Image Intensifier can move in a number of planes and has to be positioned accurately. Frustration arises in the surgeon, the radiographer and the rest of the theatre staff when the image intensifier is moved in the wrong direction and there are also increased radiation hazards to all involved if unnecessary x-rays are taken due to incorrect positioning. Communication between the surgeon and the radiographer lies at the heart of safe practice. A questionnaire was designed and circulated to all the radiographers using the image intensifier and to orthopaedic surgeons including consultants, SpRs in London southwest deanery and SHOs of St George’s Hospital, London. They were then asked to write descriptors on a diagram illustrating the major movements of the image intensifier (Vertically up/down, to the patients left/right and head/feet). The questionnaires were completed by 32 radiographers and 48 surgeons (8 consultants, 33 registrars and 7 SHOs). There was very little consensus either within or between the groups as to what command should be used for which direction. A set of directions was agreed upon and put on image intensifier machine. When used these produced a significant reduction in misunderstood commands Confusion abounds when directing the Image Intensifier. When a set of directions can be agreed upon stress reduces and satisfaction improves although it is difficult to measure the reduction in radiation exposure.