The Importance Of Radiopaque Markers In Digital X-Ray

Radiopaque Anatomical Markers

Radiographers are taught from day one in school to place radiopaque anatomical markers within the primary beam of radiographs.  We do so as a method of “best practice” to properly distinguish the patient’s right from left on the radiographic image per legal requirements. Conditions like dextrocardia (when the heart is positioned on the right instead of the left) and situs inversus (when all of the internal organs are on the opposite side compared to normal anatomy) exist which can easily be misinterpreted and would normally cause a technologist to inappropriately orient the image to appear similar to normal anatomy.  But when radiographs misrepresent right from left, this presents a huge risk for medical errors.

Computed Radiography & Digital Radiography

When Computed Radiography and Digital Radiography entered the scene, radiologic technologists were provided with a method of digitally annotating right and left.  This further led some to question the necessity of placing radiopaque anatomical markers within the primary beam of each radiograph.  If you’re like me, you’ve more than likely witnessed a decline in the use of markers in your radiology department but make no mistake; they are more necessary now than ever with the introduction of digital radiography.

A Cautionary Tale

Several years ago when I was working with a new Computed Radiography system in a hospital, I was on portable-duty which consisted of 50-60 portable chest and abdomen exams per day on average.  Another technologist, who was assigned the “float” shift, was asked to rotate where needed within the department.  I asked this technologist for help with a STAT portable chest x-ray in ICU around mid-morning, and by mid-afternoon I found myself in the Chief Radiologist’s office with the Radiology Director and Manager.  The door was closed, faces were red, and it was uncomfortably quiet.

After what seemed like an eternity, the Chief Radiologist displayed a portable chest radiograph on his monitor and asked “do you recognize this exam?”  I looked for several seconds and said, “No, I actually don’t.”  They looked at one another confused, and then asked me to critique the image.  I started to go through my image critique steps learned in school one by one, noting the presence of what I thought might be a pneumothorax, and they stopped me when I said there was no marker present.  The radiologist then asked me, “How would you know if this exam was oriented properly on the screen?”  I rattled off some details that would give anyone clues, but when I discussed the location of the heart, he stopped me again.  He horizontally flipped the image and stated “is this hung correctly?”  Ultimately, I concluded that there was no way to know whether the exam was hung appropriately due to lack of a radiopaque anatomical marker or a blocker (which we could use in film/screen imaging to determine if we knew the projection – PA vs. AP).

They all looked at one another again and the radiologist asked me “Did you perform this radiograph?”  I did not remember viewing an image similar to that one during my exams performed that day, so I let them know I didn’t remember performing it.  They asked me if anyone was helping me throughout the day, and my heart sunk, knowing I had to name the only person I had asked for help that day.  They invited me to exit the room and resume my shift.  My manager encouraged me to continue using my markers, and he informed me he would follow up with me before I left for the day.  The door closed behind me.

Later that afternoon, I was called back into the same room that displayed the same chest radiograph.  The radiologist was a bit less intimidating, but not much.  He explained to me that the radiograph indeed displayed a pneumothorax… a “tension pneumothorax.”  He asked if I knew what that was, and at the time I did not.  A tension pneumothorax occurs when one lung is punctured and air enters the pleural cavity around the punctured lung.  The “tension” portion occurs because air entering is not allowed to escape the pleural cavity, and the mediastinal structures as a result are shifted to the opposite side (in this case, from the patient’s left to their right).

After their investigation, it was concluded that the technologist exposed the image without placing a radiopaque marker within the primary beam.  When the image displayed at the computer terminal during processing, it was most likely appropriately displayed.  Due to the appearance of the mediastinal organs on the patient’s right side, the technologist viewed prior radiographs to ensure the patient had normal anatomy (which he confirmed).  He then mistakenly flipped the image horizontally so that the heart appeared on what he thought was the patient’s left side, digitally annotated a “left” marker, then sent the image to the radiologist for dictation.

The radiologist, upon viewing this STAT exam, called the physician who was in ICU and informed them that the patient had a pneumothorax on the right side, although it was actually a tension pneumothorax on the patient’s left.  Because the technologist had inappropriately flipped the image, the ordering physician inserted a chest tube on the wrong side, into the unaffected lung, causing further complication which lead to a Code Blue being called and a much longer recovery process for the patient who was already undergoing treatment for several other problems.

I found out I was originally called into the Chief Radiologist’s office immediately following a 30-minute scolding by that patient’s physician who inserted the chest tube on the wrong side because of an error made in the radiology department.  The patient eventually recovered, but imagine what could have happened as a result of the technologist’s error.  I was glad to be off the hook, but I never found out if the technologist was disciplined or if charges were ever pressed against the hospital.

Lessons Learned

Having experienced something like this, it is easy to see the importance of radiopaque markers on a radiograph.  It is discouraging to know that many departments see a decline in their usage simply because we can place one there after the image is processed; because it’s easy.  It may be true that it is more difficult to remember to place a marker or to remember to simply bring your markers to work with you, however, It is my opinion that allowing this to happen not only encourages error, but causes liability for the technologist, radiologist, and institution that is providing radiographic services.  It should be a goal to have radiopaque anatomical markers on 100% of radiographs.  It is required for images to be admissible in a court of law, and it truly is “best practice.”

Risks vs. Benefits

Whether images need to be repeated if a marker is occasionally not visible on an image, warrants a risks vs. benefits discussion with on-site personnel including the radiologist/s.  Technologists can be held accountable, however, during evaluations and upon the occurrence of failure to use these markers.  Furthermore, it is important for employers to encourage and enable technologists to use these markers and have a quality assurance process with follow-up.  It would also be wise to consider other options such as purchasing disposable, single-use markers which can be utilized for isolation cases which infection control becomes an issue, or for when a technologist misplaces their markers.  There are tools at our disposal which are cost-effective that can prevent situations like the one mentioned earlier.

About the Author 

Jeremy Enfinger is an experienced Radiologic Technologist, Radiography Program Instructor, and published author. He has served in leadership roles in hospital, outpatient and academic settings. His experience includes writing examination questions for the national ARRT Radiography Exam and multiple – modality training. He continues to pursue excellence in education and patient care. An avid blogger, Jeremy strives to promote standards of excellence in imaging through his online community with the sharing of veteran tips and techniques for high-quality imaging.

Free eBook

 

For any radiologic technologist looking to make improvements and fine-tune their image critique skills; this is a must-have resource. To receive your copy first, sign-up for the “Topics in Radiography” email list and you’ll be able to download the book for free on April 18, 2015.

 

 

 

3 Advantages Of Disposable Skin Markers In Mammography

Is your medical facility performing mammograms?

If so, are you using disposable skin markers during these exams?

Disposable skin markers are a must-have for mammography. Markers are placed over a nipple, mole, scar, area of concern or other features that could be confused with a lesion. When performing screening mammograms, skin markers can save time, improve accuracy, enhance communication and provide a better experience for the patient.

Low-Dose X-Ray System

A mammogram is an X-ray image of the breast. Mammography is a specific type of imaging that uses a low-dose X-ray system that emits ionizing radiation to create images of the breast, allowing the radiologist, a physician specially trained to supervise and interpret radiology examinations, to analyze the images and send a signed report to the primary care or referring physician, who will then discuss the results with the patient.

Reduce Repeat Examinations

Skin markers are an important tool in mammography. Costly repeat examinations can be reduced dramatically by clearly identifying the nipple with a lead ball nipple marker. For example, the Suremark Lead Ball Nipple Marker Label is one of our most popular marker labels for general use purposes. The Suremark label is ideal for distinguishing between a nipple shadow and a lesion.

Easily Locate Raised Moles

Suremark Mole Markers are uniquely designed to locate raised moles and other skin nevi with overshadowing microcalcifications. The radiolucent ring, when placed around a protuberance, prevents flattening due to compression. The mole markers are available with two reference points or three reference points. Ideal for mediolateral oblique view or MLO exams as well as dense breast tissue, these radiolucent mole markers will not burnout.

Improve Patient Comfort

Mammograms are uncomfortable enough for patients with the painful removal of nipple markers. Keeping patient comfort in mind, the Suremark Relief Tabs feature a unique adhesive-free center that won’t stick to sensitive areas of the skin. By using disposable skin markers, exam results will be more accurate and the overall patient experience will be improved.

Not familiar with the Suremark brand? Why not try a sample and compare them to your existing skin markers?

 

 

 

Radiation Protection During Mobile Exams

Do you wear a lead apron during portable exams?

I have found in my years of experience as a radiologic technologist that practices vary from one radiologic technologist to the next.  Of course, we utilize some form of radiation protection when it comes to using a c-arm for mobile fluoroscopy in the operating room.  Fewer people wear lead when performing plain film images during surgical procedures.  And most don’t seem to worry about radiation protection during routine portable exams like chest x-rays and abdomen films.

Why is this?  

We learn in school that lead shielding is required when performing these exams.  For those of you who do not wear radiation protection for mobile exams, I am about to show you something which may cause you to change the way you prioritize wearing radiation protection apparel.

For some context, I want to step back in time, when Computed Radiography (CR) was first implemented at a hospital I was a clinical instructor for.  My job was to accompany student technologists while they performed their exams and to educate and evaluate.  Having never been to the operating room at that facility, I was given the opportunity to tag along with one of the staff techs who had been observing my student for the day.  They were assigned to perform a cross-table lateral lumbar spine image during a discectomy.

I watched as the staff technologist carefully walked around the table, being mindful of the sterile field, and positioned the draped image receptor next to the patient.  My student used the portable x-ray machine to align a horizontal beam to include the lumbar spine for the prone patient.  When they were finished setting up, they indicated to the O.R. staff in the room that they were ready to expose the image.  All of them, including the physician left the room while the three of us from the radiology department stayed to make the exposure.

We had taken two CR image plates into the room with us.  One was positioned next to the patient, and the other had been placed against the wall behind us.  The student made the exposure, extending the full length of the cable that attached the exposure switch to the portable x-ray machine, which was about 12 feet.  The staff technologist and I backed up to the wall behind us – I would guess an additional 3 feet behind the student technologist who exposed the image.  We all wore lead aprons.

Upon returning to the radiology department to develop the image, the student made a mistake that every technologist has done in their career.  He was carrying both the exposed image plate of the lumbar spine image as well as the unexposed image plate that had been resting against the wall behind us, and he forgot which one was the exposed plate.  The logical solution was to process both image plates under the “lateral lumbar spine” algorithm and discard the image that was not exposed.

The first image was not the lumbar spine image we had hoped it would be.  Instead, something peculiar appeared on the monitor in front of us as the scanner slowly revealed more and more of the image during processing.  Once the entire image had been scanned and the processing the algorithm was applied, it was clear that this was an image of a lower leg (a portion of the tibia and fibula).

Thinking we had come across someone else’s image plate that had been exposed for a different patient (and thankful we did not use that plate to image the lumbar spine), we began asking around the department to see if anyone was missing a tib-fib image from any of their exams.  No one was missing an image.  I decided to examine the image further on a PACS monitor for larger viewing.  The image quality was poor, and the resolution was horrible.  The exposure indicator proved that the image was slightly over-exposed.  I then realized what I was looking at.  This was the cassette that was leaning against the wall in the operating room approximately 15 feet from the patient that was x-rayed.  If you recall, the staff technologist and I had backed up against the wall prior to the exposure being made for the lumbar spine.  This was an image of the staff technologist’s leg, which was positioned just a few inches in front of the image plate during the lumbar spine exposure.  This was purely created by scatter radiation from the exposure we took in surgery.

Here are some examples of images created solely from scatter radiation in an experiment based off of lessons learned from this experience:

S# was 1190 at 8 foot distance from lateral lumbar spine phantom, which indicates about 1/4 the exposure required to produce a diagnostic hand x-ray

S# was 980 at a 6 foot distance from lateral lumbar spine phantom

I also decided to x-ray a chest phantom to simulate a portable chest x-ray using 120 kVp and 5 mAs. The following image was created from scatter radiation from about 10 feet away from the chest phantom.

S# was 2780

Though the last image produced from the chest phantom didn’t receive nearly the exposure as the one from the lumbar spine phantom, it is still obvious that there is enough radiation to penetrate the fingers from 10 feet away.  Now that you’ve read this and seen evidence of the radiation we work with every day as a radiologic technologist, are you going to change your practices?  If you already use radiation protection for your mobile exams, will you encourage your co-workers and student technologists to adopt these habits?

Registered radiologic technologists vow to keep radiation dose “As Low as Reasonably Achievable” (ALARA).  It is our duty not only to protect patients from the harm that can be caused by radiation, but to protect yourself and your co-workers from it as well.  Let us not forget the three basic principles of radiation protection; time, distance and shielding.  Keep the amount of time you are exposed to radiation low.  Keep as much distance from a radiation source as possible.  And finally, use shielding, including during mobile examinations.  Consistent application of all three of these basic principles of radiation protection will keep you, your patients and your co-workers as safe as possible.

About the Author 

Jeremy Enfinger is an experienced Radiologic Technologist, Radiography Program Instructor, and published author. He has served in leadership roles in hospital, outpatient and academic settings. His experience includes writing examination questions for the national ARRT Radiography Exam and multiple – modality training. He continues to pursue excellence in education and patient care. An avid blogger, Jeremy strives to promote standards of excellence in imaging through his online community with the sharing of veteran tips and techniques for high-quality imaging.

Additional Reading Written by Jeremy Enfinger via Topics in Radiography Blog

Experiments with Scatter Radiation (original post from 2009 – with updated images and technical factors)

Reducing Radiation Dose in Diagnostic Radiography

Podcast: How To Communicate Radiation Risks To Patients

What Everyone Should Know About Digital Radiography

Evaluating Microorganism Levels On X-Ray Aprons And Lead Wearables: The Science Of ATP Testing

How Have Microorganisms and Bioburden Been Measured?

In the previous blog post regarding X-Ray lead aprons, we explored the history of healthcare associated infections or HAIs, and how transmission risks are posed to patients and staff via contaminated “high touch, non-critical surfaces,” including X-Ray aprons and protective lead wearables.  In laying out the content of this blog, I was reminded of the phrases, “things aren’t always as they appear” and “don’t judge a book by its cover.” Is it possible that newer (clean looking) X-Ray aprons can carry a higher level of biological contamination when tested in comparison to older X-Ray aprons (which are dirty looking & smelling)? It is completely possible and plausible due to the concept of bioburden.

What is Bioburden?

Bioburden is defined in numerous medical dictionaries as the number of microorganisms contaminating an object.  So how does one assess for bioburden?  The gold standard for assessing for bacterial/fungal contamination has been to assess for colony forming units or CFUs.  A CFU equals one viable bacterium that has the ability to spread and replicate.

3 Main Ways to Measure CFUs: 

  1. A scientist could dilute the sample and count the bacteria by microscopic examination or through the use of a cell counter.  However, if bacteria are too small or clump together, then this method is problematic.  This method will yield total bacteria counts, both living and dead.
  2. A scientist could use Optical Density (OD) to estimate the number of viable bacteria in a sample.  This is where the scientist measures how cloudy a liquid culture of bacteria is.  While the bacteria are actively growing the liquid culture should continually become more and more cloudy.  Again, this method will yield total bacteria counts, both living and dead.
  3. A scientist could make serial dilutions of a liquid culture and plate out the bacteria in known dilutions until they can count single colonies and extrapolate back to figure out total CFU in a sample. This method only yields viable bacteria totals.

4 Challenges Associated with Bioburden Assessment

Assessing for bioburden (microorganisms) by calculating CFUs is not as easy or straight forward as one might imagine.

  1. The first challenge posed is that one needs to have a lab in which to grow bacteria, and depending on the bacteria one is dealing with there are different governmental regulations to follow.
  2. The second challenge presented is that of time, one needs to have the time and equipment to properly grow the bacteria/fungus.  Different species of bacteria or fungus grow at different rates, for example, culturing of bacteria on plates can take anywhere from overnight to multiple days.
  3. A third and very important challenge is posed by the bacteria and fungus themselves.  They are similar to people in the fact that not all of them grow and thrive under the same conditions.  In lab work, if only one kind of food source is used, one will only be able to assess for bacteria that grow on that particular food source.
  4. Finally, one needs to have a trained technician who knows how to assess which bacteria to grow under the correct conditions and then also how to properly count the bacteria.

While assessing for CFUs has traditionally been viewed as the gold standard for assessing bioburden, and it is vitally important for various microbial studies, it is not a good way to assess bioburden in real time.  It can be complicated.

What is ATP and How is it Evaluated?

What if there was an easier way to determine surface levels of biological contamination?

What if there was an easier way to assess for a molecule that is found only in living cells, both bacterial and human living cells?

There IS an easier way to evaluate for this molecule in real time (by using a simple swab and handheld reader), and it can be used by any hospital staff member as a surrogate for such complicated CFU work.  Let me introduce you to the molecule known as the “molecular workhorse,” called adenosine triphosphate (ATP).

Adenosine Triphosphate (ATP)

ATP is an energy molecule utilized by cells. It is present in humans, animals, plants and microbial cells.  ATP levels rise as a cell is undergoing apoptosis (programed cell death), but is generally consider to be completely degraded within 30 minutes of cell death (1).  This makes ATP a useful marker for the presence of unwanted biological contamination, including organisms that can cause infection and disease.

Okay – Get to the Point!

An increase in biological cells on a surface results in an increase in the amount of ATP present on that surface, thus making ATP an effective marker for the assessment of the hygienic status of an environmental surface. Simply stated, the amount of ATP present on a testing swab is a quantitative measurement of the cleanliness of the surface tested! In fact, ATP cell viability assays were determined to be the fastest, most sensitive, and least prone to artifacts, partially due to a lack of an incubation period (2).  The sensitivity of laboratory cell based ATP cell viability assays can detect fewer than 10 cells per well (2).  This technology has been modified to create a portable, ATP bioluminescence test, using a swab instead of plated cells.  This now allows for a real time assessment of bioburden on site.  These tests have been used to assess bioburden in many healthcare settings, including the ICU (3).  ATP measuring units, called luminometers, are handheld, user friendly, and display the results in seconds. (It doesn’t take a scientist to use an ATP luminometer!) The read out of an ATP bioluminescence test is not in CFUs, but is in relative light units or RLUs.  In the past, some scientists have questioned the validity of using a bioluminescence test instead of assaying for CFU.

Is There a Correlation Between CFUs & RLUs? 

Like most assessments, ATP bioluminescence assays also have limitations, but they are an excellent surrogate that allows the everyday staff member to assess bioburden in real time.  Those new to ATP bioluminescence testing often inquire about a correlation between CFUs and RLUs.  (Most laboratory microbiologists have the capability to perform CFU testing, and are not confined to real time assessment of bioburden.)  The most controlled way to achieve this is to look at different known amounts of CFUs and assess whether or not the RLUs increase accordingly.  That is exactly what Dr. Sciortino’s group did when they assessed three different portable ATP bioluminescence kits for their ability to detect various CFUs of two different HAI relevant bacteria (Staphylococcus aureus and Acinetobacter baumannii) and one strain of fungus (Candida albicans).

What they discovered was there was a linear relationship between bacterial CFUs and RLUs for all three luminescence kits, and for two of the three kits between fungal CFUs and RLUs (1).  Such research validates that the use of ATP luminometers can be used to assess for bioburden on surfaces in real time.  This research, plus Dr. Jaber’s study, in which 25 lead aprons were cultured for CFUs and showed that 21 were colonized with Tinea species (the family of fungus that causes ringworm) and 21 were colonized with Staphylococcus aureus, of which 3 aprons were colonized with MRSA (4), validates the ATP bioluminescence results for X-ray aprons and protective lead wearables.

In fact, these X-ray aprons and protective lead wearables, which are worn throughout many different areas within a healthcare system, including the operating rooms, cath labs, radiology/imaging areas, emergency rooms and beyond are regularly testing with RLU readings in the THOUSANDS to HUNDREDS OF THOUSANDS (5), which is scary. The bottom line is regardless if you are a classically trained microbiologist used to looking at CFUs or a hospital staffer looking at luminometer readouts in RLUs, when surfaces inside an OR or Cath Lab are testing in the hundreds of thousands range, it is a problem!

Is ATP Testing Growing in Use?

Through utilization of ATP luminometer testing systems, companies like Radiological Care Services (Indianapolis) are able to enter a facility’s Cath Lab, OR or Radiology Department and test lead apron inventories on site, providing real time numbers (bioburden levels) in a matter of seconds. An advocate for ATP luminometer testing, Dr. Sciortino even states, “ATP system monitoring may uncover the need for new disinfectant designs that adequately remove hospital surface biofilms, rendering used hospital equipment to its native state whereby a zero reading by ATP monitoring can be achieved” (1).  If you look back at the first blog post, “Contaminated X-Ray Aprons and The Risk of HAIs”, I positioned that “using wipes alone” was insufficient and through the use of ATP testing, Dr. Sciortino could be inferring a similar position.

Looking Ahead…

In the next blog post, we’ll specifically look at the science/methodology behind the use of sanitizing wipes and we’ll further explore the differences between true “cleaning” and “sanitization.” We’ll later examine what the governing bodies, such as AORN, CDC, HFAP and JCAHO state regarding their expectations of such surfaces within healthcare facilities. Understanding the science behind HAIs, testing for biological contaminants on surfaces, biofilms, and the difference between “cleaning” and “sanitization” will help us understand that current healthcare protocols in regards “non-critical, high touch surfaces” need to be changed in order to better protect hospital patients and staff.

About The Author:

Kathleen R. Jones received her BS from Purdue University (West Lafayette) in Biology specializing in Genetics and Microbiology.   After working for five years in Quality Control she then completed her MS at Purdue University in Indianapolis.  Her growing interest in Infectious Diseases lead her to the Uniformed Services University of the Health Sciences where she obtained a Doctorate in Emerging Infectious Diseases.  Kathleen has a passion for progressive sciences and initiatives, and employs her keen understanding of the biofilm formation and elimination processes into her research and work.

Sources:

  1. Sciortino, C. V. and R. A. Giles.  2012. Validation and comparison of three adenosine triphosphate luminometers for monitoring hospital surface sanitization: A Rosetta Stone for adenosine triphosphate testing.  AJIC.  40 (e233-9)
  2. Riss T.L., R.A. Moravec, A. L. Niles, H.A. Benink, T.J. Worzella, L. Minor. Minor, L, editor.  2013,  Cell Vialblity Assays. In: Sittampalam G.S., N.P. Coussens, H. Nelson, et al., editors. Assay Guidance Manual [Internet]. Bethesda (MD): Eli Lilly & Company and the National Center for Advancing Translational Sciences; 2004-. Available from: //www.ncbi.nlm.nih.gov/books/NBK144065/
  3. Moore, G., D. Smyth, J. Singleton, P. Wilson. 2010. The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting.  AJIC. 38(8):617-622 DOI: //dx.doi.org/10.1016/j.ajic.2010.02.011
  4. Jaber, M., M. Harvill, E. Qiao.  2014.  Lead aprons worn by interventional radiologists contain pathogenic organisms including MRSA and tinea species.  Journal of Vascular and Interventional Radiology.  25:3:S99-S100.  DOI: //dx.doi.org/10.1016/j.jvir.2013.12.279
  5. “Outcomes: What do your numbers look like?” Radiological Care Services. Nov 20, 2014. //www.radcareservices.com/radiolgical-care-services-outcomes.html

What You Need To Know About Ultrasound Gels And Warmers

The Importance of Ultrasound Gels

Ultrasound gels are placed on a patient’s skin at the beginning of an ultrasound procedure or exam. Ultrasound gels serve several purposes including its use in a variety of procedures, treatments, and routine exams.

Ultrasound technology works by sending a pulse of high-frequency sound waves into the patient’s tissue using an ultrasound transducer or probe.  The ultrasound gel is placed on a patient’s skin and the transducer carefully glides the gel across the patient’s body. This device sends and receives sound waves which are transmitted to a computer screen for a sonographer to view. The computer screen monitor captures real-time imaging of the patient’s internal organs, also allowing for a screen shot image in case a printout is needed.

Conductive Medium

Ultrasound gels are considered a type of conductive medium used in a multitude of ultrasound diagnostic procedures and treatments. Ultrasound gel can be applied to many different areas of the body therefore being an essential tool in a variety of procedures, treatments and routine exams.

Different Gel Formulations

Ultrasound gels are available in different formulations and sizes. For example, the Aquasonic 100 Ultrasound Transmission Gel dispenser bottle is a favorite among many doctors offices and medical centers. This dispenser bottle is used and recommended by manufacturers of medical ultrasound equipment worldwide. The Aquasonic 100 gel formula is hypoallergenic, bacteriostatic, non-sensitizing and non-irritating.

Packaging Designed For Your Needs

The Aquasonic 100 Ultrasound Transmission Gel is available in 20g single-use packettes, 60g Doppler size tubes, 0.25 liter dispenser, 1 liter with dispenser cap, and 5 liter SONICPAC with refillable dispenser. A variety of ultrasound gels are available in refillable containers, dispenser caps and pumps to accommodate your medical setting.

Ultrasound Gel Warmers

An ultrasound gel warmer is a unit designed to keep ultrasound gel bottles at a warm temperature. Ultrasound gel warmers are primarily used to increase patient comfort. These ultrasound gel warmers are easy-to-use and come in a couple different configurations including single bottle and multi-bottle. Using a gel warmer will keep patients relaxed since cold ultrasound gel can cause discomfort for patients. These warmers are constructed of high-quality materials and are made for multiple uses.

Ultrasound gels and warmers are essential tools found in many hospitals, clinics, and doctors offices today. Still not sure which gel is right for you? Why not try a free sample to help you decide? Visit our ultrasound gels and warmers page and select the ultrasound gel that you would like to try and we’ll be in touch shortly.

 

 

Discover Gucci Radiation Resistant Glasses

Are you fashion savvy?

Have you been searching for a fashionable way to protect your eyes from the harmful effects of ionizing radiation?

Then look no further.

Gucci radiation resistant glasses have arrived. Gucci, a name synonymous with high-fashion and stylish sophistication is the latest addition to our radiation protection eyewear line.

Gucci’s styles for women range from the lightweight nylon frames of the Gucci GG 3547/S, to the bold, full-rimmed frame of the Gucci GG 3574/S.

For men, available styles include the classic Gucci GG1000/S full-rimmed acetate frame and the GG 1856/S ultra-sleek wrap frame.

Radiation resistant glasses never looked so good.

Women’s Radiation Resistant Glasses

Gucci GG 3547/S

The Gucci GG 3547/S (shown above) frames are made of lightweight, durable blended nylon for added comfort and flexibility. Unlike the brittle nylon eyeglass frames of the late 1940s, blended nylon frames are more resistant to breakage and are inherently stronger than their predecessor. Consequently, blended nylon frames are ideal for those looking for a high-quality, durable, and resilient frame.

The round shape of these frames subtly draws attention to the eyes and are well-suited for those with diamond-shaped faces. The ‘simultaneous contrast’ of the red and green temples, juxtaposing complementary colors, creates a stunning visual effect. The decorative, high-set temples are emblazoned with the iconic Gucci label (white lettering) on a bold red background. For those who have been seeking a distinctive and sophisticated pair of radiation resistant glasses, your journey finally may be nearing its end.

 

Gucci GG 3574/S

The epitome of Italian luxury, the Gucci GG 3574/S rectangular frame is bold and distinctive. The hypoallergenic black optyl frame is specially coated to resist sweat and cosmetics. These Gucci radiation resistant glasses seamlessly blend fashion, elegance, and sophistication into an integral piece of personal radiation protective equipment. A trendy frame for those who are unwilling to sacrifice style but understand the importance of properly protecting their eyes from the harmful effects of ionizing radiation.

Have you been searching for radiation eye protection that is functional, yet fashionable?

Your search is over.

These Gucci radiation resistant frames are the answer.

Offering the industry standard 0.75mm lead equivalency, the SCHOTT radiation resistant safety glass lenses will protect your eyes from the harmful effects of ionizing radiation.

According to the IAEA (International Atomic Energy Agency), “Many years or decades could pass before radiation-induced eye lens injuries become apparent. At relatively high exposures of a few Gy* , lens opacities may occur after many years¹.”

Ensure that your eyes are properly protected by wearing the appropriate radiation resistant glasses. In a 2010 study, Comparing Strategies For Operator Eye Protection In The Interventional Radiography Suite, “The use of leaded glasses alone reduced the lens dose rate by a factor of 5 to 10.” Reduce your risk of developing cataracts, while staying fashionable and safe with Gucci radiation resistant glasses.

Sources:

Thornton RH, Dauer LT, Altamirano JP, Alvardo KJ, St Germain J, Solomon SB. (2010) Comparing Strategies For Operator Eye Protection In The Interventional Radiography Suite.

//www.ncbi.nlm.nih.gov/pubmed/20920841

IAEA | Radiation Protection of Patients (RPOP) Radiation and cataract: Staff protection

//rpop.iaea.org/RPOP/RPoP/Content/InformationFor/HealthProfessionals/6_OtherClinicalSpecialities/radiation-cataract/Radiation-and_cataract.htm

Gray (Unit)

Wiki: //en.wikipedia.org/wiki/Gray_(unit)

*Gy = Gray, is a derived unit of ionizing radiation dose in the International System of Units (SI). It is a measure of the absorbed dose and is defined and is defined as the absorption of one joule of radiation energy by one kilogram of matter (0.01 Gy is equivalent to 1 rad).

What Is ALARA?

What is ALARA?

As Low As Reasonably Achievable (ALARA) is a buzzword commonly used in medical disciplines utilizing ionizing radiation for the diagnosis and treatment of disease. It is a phrase that should be considered whenever a patient, healthcare professional or a physician is in a situation where they might be exposed to radiation.  However, what does ALARA really mean in this context, where does it come from, and why is it used?  These questions will be addressed in this article from FluoroSafety and Universal Medical.

It’s all based on the LNT model

The linear-no-threshold (LNT) dose-response model describes the risk of stochastic effects following exposure to ionizing radiation, as a function of dose.  This model is based on available scientific data* from large exposed populations, such as Japanese atomic bomb survivors and is widely accepted by regulatory agencies and governments.  If the LNT model is correct, risk increases linearly with radiation dose, and there is no safe amount of radiation exposure where the increased risk is zero.  Because LNT suggests that there is no safe radiation dose, this motivates us to keep both our radiation dose, and the radiation dose that our patients receive very low.   More details on the LNT are available in the Advanced Training Program from FluoroSafety.

What is reasonable?

The use of ionizing radiation is necessary in many medical disciplines and while the LNT tells us that there is no safe level of radiation, we also understand that there are many cases where radiation must be used.  For example, before X-rays and CT scans, exploratory surgery was often utilized to diagnose unknown medical conditions.  Certainly, no patient would choose to receive exploratory surgery instead of a CT scan because they were concerned about radiation risk!  These risks must be put into perspective and the benefit weighed against the risk—for both patients and medical professionals who work around radiation.

For patients, the benefit of medical exposure to diagnose and treat disease is clear.  However, just because the patient receives a well-defined benefit, does not mean that radiation can be used indiscriminately.  The smallest amount of radiation that will allow the physician to diagnose or treat the suspected condition should be used—in other words, doses should be kept ALARA.  ALARA in diagnostic imaging may be as simple as using the lowest possible CT, X-ray or fluoroscopic technique factors.  It may also include protection devices such as lead aprons or gonadal shields to protect organs that do not need to be imaged.   Newer protection devices such as bismuth breast and eye shields can be useful for certain CT exams and can reduce dose to these sensitive tissues.

In occupationally exposed individuals, the benefit is entirely that of gainful employment.  There is no potential health benefit like there is for a patient receiving a chest X-ray to diagnose disease; therefore, risk/benefit must be adjusted accordingly.  The federal government strictly enforces dose limits for the occupationally exposed to protect this population which does not receive a well-defined benefit for their radiation exposure.  In practice, very few occupationally exposed individuals approach the federal dose limits, primarily due to their job function.  A CT technologist for instance, leaves the scanner room prior to starting the scan.  Lead shielding in the walls keeps the technologist’s dose ALARA.

However, technologists, nurses and physicians involved in fluoroscopic procedures often do not have the luxury of leaving the examination room while X-rays are being produced.  For these individuals, doses may be maintained ALARA by following the three cardinal rules of radiation protection, which are also discussed in detail in the Advanced Training Program from FluoroSafety.

Time, Distance and Shielding

In fluoroscopic procedures, occupational dose is proportional to the amount of time spent in the room when X-rays are being produced.  Staff dose can be reduced by keeping non-essential personnel out or by stepping outside when performing digital acquisition imaging or rotational CT angiography.  Power injectors are necessary in these cases and allow for both a reduction in staff dose as well is improved vascular contrast.

Another key component of keeping occupational doses ALARA is distance.   Often times the scattered radiation coming from a patient in a fluoroscopic, CT or X-ray procedure can be approximated as a point source; to this end the inverse square law applies.  Therefore, if one doubles their distance away from the source of radiation, the dose to that individual is decreased by a factor of four.  In fluoroscopy or CT procedures, it is often the case that taking one step back away from the patient will cut your dose in half.  Ancillary personnel who do not need to be near the patient can minimize their dose by maximizing their distance.

The final way to maintain doses ALARA is to use shielding whenever possible.  Personnel protective equipment consisting of lead or lead-free garments an integral component of proper radiation safety practice when working near fluoroscopy, CT or X-ray procedures.  Individuals in the room during fluoroscopy procedures should also wear protective thyroid collars and lead glasses to protect these sensitive organs.  For interventional fluoroscopy procedures, some operators find that sterile radiation reduction drapes can decrease their exposure to radiation.  Rolling and hanging glass shields provide superior protection compared to radiation reduction garments and should always be worn when commensurate with the goals of the procedure.

About the Author: 

Alexander S. Pasciak, PhD, DABR
Co-Founder, Fluoroscopic Safety, LLC
www.FluoroSafety.com
 
 Dr. Alexander Pasciak earned his B.S. in electrical engineering from the University of Washington and his M.Sc. in health physics and Ph.D. in nuclear engineering from Texas A&M University. Dr. Pasciak completed a two-year diagnostic medical physics residency program at MD Anderson Cancer Center in 2009.  For the past five years, Dr. Pasciak has worked as Diagnostic Medical Physicist at the University of Tennessee in Knoxville where he carries the rank of Associate Professor of Radiology.
 

Sources: 

*National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII—Phase 2. National Academies Press; Washington, DC: 2005.

 

3 Different Types Of Prescription Lead Glasses

For those who wear corrective lenses and need to protect their eyes from radiation, we offer three different prescription lens types for our lead glasses. After reading this post you will understand the different types of prescription lens types that we offer, eyeglass prescription terminology, and what prescription information is needed to properly place your order.

Before placing your order, it is important for you to understand the differences between the various corrective lenses before making your decision. Lead glasses provide you with the necessary eye protection to help reduce your risk of developing cataracts from prolonged exposure to ionizing radiation. In the past, those who wore corrective lenses would often be required to wear bulky radiation safety goggles or fit over lead glasses. However, a number of the lead glasses that we now offer are available with various types of prescription lens.

Prescription lens types:

  • Single vision prescription lenses
  • Lined bifocal prescription lenses
  • Progressive bifocal lenses

Single Vision

Single vision prescription lenses have the same magnification throughout and correct for only one distance. These lenses are designed to correct conditions such as myopia (nearsightedness¹), hyperopia (farsightedness), and astigmatism². Our single vision prescription radiation safety lenses offer the industry standard 0.75mm lead equivalency and are manufactured using SCHOTT SF-6 HT radiation resistant glass.

How do I know if I have a single vision prescription?

To illustrate, an example of a single vision prescription is shown below. While reviewing the sample prescription, you may notice several abbreviations, listed below are common terms found on eyeglass prescriptions. If your prescription doesn’t have any values or abbreviations in the ADD column, you have a single vision prescription.

 Single Vision Prescription Lenses
RxSPHERICALCYLINDRICALAXIS
O.D.-2.00-0.5040
O.S.-1.75
Pupillary Distance65

Prescription Abbreviations & Terminology 

  • OD – Oculus Dexter, from the Latin word dexter meaning “right”, means the right eye.
  • OS – Oculus Sinister, sinister which is derived from the Latin word sinistra meaning “left hand”, means the left eye.
  • SPH – Spherical, is the main strength of the lens prescription, and is written in 0.25 increments. It is also referred to as power and is abbreviated as PWR.
  • CYL – Cylinder, this will only appear on your prescription if you have an astigmatism, and is written in 0.25 increments. It is possible that this will only apply to one eye. If you don’t have an astigmatism, your doctor may leave this field blank, or they may choose to put ‘00’, ‘DS’, SPH’, or ‘Plano’ in this field. If the field has one of those abbreviations you will know that you don’t have an astigmatism correction in one or both eyes.
  • AX – Axis can be abbreviated as AX, or simply X. If the cylinder field is left blank or has any of the following abbreviations including ‘00’, ‘DS’, SPH’, or ‘Plano’, this field will be left blank or have an ‘0’.
  • PD – Pupillary distance or interpupillary distance (IPD) is the distance (industry standard is in millimeters) between your right pupil and left pupil. The PD is usually written in the lower row labeled P.D. on your prescription.

Single-Vision Pupillary Distance

  • Binocular P.D. – 65
  • Monocular P.D. – 30/30.5  (OS/OD)

Bifocal/Progressive Pupillary Distance Binocular

  • Near/Reading P.D. – 62
  • Distance P.D. – 65

The American Optometric Association states that Astigmatism is a vision condition that causes blurred vision due either to the irregular shape of the cornea, the clear front cover of the eye, or in other cases the curvature of the lens inside the eye. Astigmatism is a particularly common vision condition.

Lined Bifocal

Bifocal prescriptions are for patients who have difficulty seeing both far and near. They are commonly prescribed to individuals with presbyopia who also require a correction for myopia, hyperopia, and/or astigmatism. As their name suggests, lined bifocals offer distance correction on the upper portion of the lens, and near vision correction on the bottom portion of the lens. Lined bifocal lenses, provide two distinct optical powers with different focal lengths – one for distant vision and one for near vision. The near vision lens has a semicircle (bottom) that measures 28mm wide and has a flat-top (top). Traditional lined bifocal lenses are separated by a visible line.

Progressive Bifocal

Progressive bifocals, or simply progressive lenses, allow you to experience bifocal vision without the traditional bifocal lines. Progressive lenses provide you with a more natural way of seeing. Presbyopia³ is a common vision condition for those over the age of 40 where the eye has difficulty focusing on near-field objects. Individuals who have worn traditional bifocals in the past may have experienced “image jump”, this occurs when there is an abrupt break from distance to near-field vision. Progressive bifocal lenses provide  you with optimum vision and a seamless progression of lens strength.

How do I know if I have a bifocal prescription?

If you notice that there are numbers in the ADD column of your prescription, you have a bifocal prescription.

 Lined Bifocal/Progressive Bifocal Prescription Lenses
RxSPHERICALCYLINDRICALAXISADD
O.D.-2.00-0.5040+1.75
O.S.-1.75+2.00 PAL
Pupillary Distance65

ADD – ADD is the value commonly used for bifocal or progressive lenses. ADD indicates how much power is added to the distance prescription to create the reading-only prescription. ADD corrections will usually have the same value for both eyes. The abbreviation PAL may appear next to one of the numbers in the ADD field, or it may be written elsewhere on your prescription, this indicates that your doctor determined that you will need a different ADD correction for progressive lenses.

PAL– Progressive additive lens (ADD value specifically for progressive bifocal lenses).

Ordering Information

We hope that this post has provided you with helpful information that you will assist you during your research. To review, we covered the different types of prescription lead glasses that we offer, common terminology and abbreviations found on your prescription, and what prescription information we need to properly place your prescription lead glasses order. When ordering, please fax or email your prescription (Rx) including your pupillary distance (PD). For your convenience, prescription information can also be noted in the “Order Comments/Special Instructions” section under “Payment Information” while checking out.

Please note: Lens enhancements options are not available in combination with prescription lenses. 

Questions? Comments?

If you have any questions regarding the different types of prescription lead glasses that we offer, please feel free to contact us via live chat or simply leave a comment below.

Sources:

American Optometric Association – Eye & Vision Problems

 

How Do I Order Prescription Lead Glasses?

Question: How Do I Order Prescription Lead Glasses?

This is a frequently asked question that we receive from our new and existing customers. This post will walk you through the necessary steps to ensure that your order is processed in a timely manner. It is our goal to make your experience as painless as possible.

We currently offer over 75 different styles of lead glasses available with different types of enhancements. There are three prescription lens types available, including single vision, lined bifocal, and progressive bifocal (progressive lenses). Please note that the availability of Rx lenses will vary by frame type.

Step 1 – Find your pair of lead glasses

Step 2 – Determine prescription type

  • Single vision
  • Lined bifocal
  • Progressive bifocal (no-lines)

Step 3 – Choose Your Lens Style

Please note that options will vary by frame style and manufacturer. Due to the custom nature of prescription lead glasses they cannot be returned.

  • Standard
  • Anti-reflective (not available with prescription lens)
  • Fog free (not available with prescription lens)
  • Single vision Rx
  • Lined Bifocal Rx
  • Progressive bifocal Rx

Pricing adjusts in real-time as you add enhancements to the frames. The single vision, lined bifocal, and progressive bifocal prescription radiation safety lenses all offer the industry standard 0.75mm lead equivalency and are manufactured using SCHOTT SF-6 HT radiation resistant glass.

Step 4 – Choose frame color

Please note that color options will vary by frame style and manufacturer

Step 5 (Optional) – Add frame imprint text

  • Frames will be laser engraved
  • Imprint limit is 35 characters (may vary by model)
  • Engraved glasses are non-returnable

 Step 6 – Select desired quantity and click “add to cart”

Step 7 – Review your order

  • Review your order for accuracy

 

Step 8Proceed to checkout

  • Returning customers can sign in for faster checkout
  • New customers can create a personal account (Benefits of registering: quick checkout on future orders, easy order tracking, and special offers)

Step 9 – Enter billing and shipping information

  • Enter your billing information
  • Enter your shipping information
  • Choose your shipping method (Selecting Next Day or 2nd Day Air will only change the shipping transit time, as prescription lenses are made to order)
  • Enter payment information

Step 10 – Add Prescription Information

Please note that the manufacturer will contact us if they have any additional questions regarding the prescription after their initial review to ensure accuracy.

  • Add prescription information in the “Order Comments/Special Instructions” box
  • Include OD/OS values from prescription
  • Include Pupillary Distance (PD)
  • Prescriptions can be faxed to 1-800-535-6229
  • Prescriptions can be emailed to order@universalmedicalinc.com

Ordering Information

Prescription lead glasses normally take at least two weeks to produce (may vary depending on item availability). If you need prescription lenses before a certain date contact, please customer service for specific information regarding frame availability and production time. As mentioned above, selecting priority shipping will only expedite the transit time of the package. Since the prescription lenses are made for your unique eye prescription, production times will vary. In an upcoming post, we will discuss the different prescription lens types that we offer in more detail. If you’re curious as to how prescription lead glasses are made, you’ll want to make sure and check out our video.

Questions? Comments? 

Not sure what type of frame is right for you? Many of our lead glasses have product demonstration videos to help you find the right style. If you have any additional questions, please feel free to contact us or leave a comment in the box below.

7 Reasons To Pick These Carbon Fiber Armboards

Why Carbon Fiber? 

Carbon fiber is a popular material used in many industries including the medical device field, aerospace, and automotive engineering. The fiber-reinforced polymer which contains carbon fibers is extremely strong and lightweight. Although carbon fiber may be more expensive when compared to other materials, the impressive strength-to-weight ratio and rigidity of carbon fiber makes it an excellent candidate for various immobilization and medical support devices. This fiber-reinforced polymer also helps keep radiation doses to a minimum.

Medical Applications of Carbon Fiber

Carbon fiber provides one distinct advantage over other materials in the medical device field, that advantage is that carbon fiber is radiolucent, meaning that it is virtually transparent to x-rays and appears black on x-ray images. The radiolucent quality of carbon fiber makes it an excellent material to support limbs being x-rayed or treated with radiation. This is why you may have noticed more surgical table accessories like carbon fiber armboards appearing in hospitals and clinics.

Patient Positioning Challenges 

Medical imaging equipment (X-ray systems and CT scanners) will often present unique patient positioning challenges to medical personnel. Listed below are some of the attributes patient positioning systems will generally require for overall patient safety and image quality:

  • Lightweight
  • Durability and strength
  • Rigidity
  • Minimal impact to image quality (e.g. artifacts)

7 Reasons Why You Will Want To Choose Carbon Fiber Armboards

  1. Fully radiolucent
  2. High strength-to-weight ratio
  3. No mounting hardware is required for setup or breakdown
  4. 180° of lateral rotation
  5. Easy setup and removal
  6. Fold together for safe and compact storage
  7. Two armboard styles (rail mount carbon fiber armboard with quick release swivel and shoulder mount carbon fiber armboard with hexagonal base)

Rail Mount Carbon Fiber Armboard with Quick Release Swivel

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Strength And Durability

The rail mount carbon fiber armboard has been engineered to achieve a high degree of strength, durability, and radiolucency. Utilizing a quick release mounting mechanism, the carbon fiber armboard attaches quickly and easily to any surgical table that has a standard side rail.

Radiolucent 

This single, radiolucent armboard allows complete imaging of the arm and can be used in conjunction with other carbon fiber tabletops and extensions where ionizing radiation (x-ray) is used for imaging. Ideal for imaging in a variety of medical settings, including hospitals, clinics, and private practices. This armboard has been designed for use as an imaging platform and is not to be used as a surgical platform.

Rail Mount Carbon Fiber Armboard Specifications

Dimensions 

  • 26″ Length
  • 5.5″ Width

Maximum Capacity Tested Per ISO 6061

  • 25 pounds

Aluminum Equivalency 

  • AAE @ 100 kVp = 1.15mm

Accessories  

An optional armboard pad is available and has been specifically designed for the rail mount carbon fiber armboard with quick release swivel. Constructed of high-density comfort foam, the 2″ thick pad is covered with a conductive vinyl cover for easy cleaning and patient comfort.

Shoulder Mount Carbon Fiber Armboard With Hexagonal Base

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High Strength-To-Weight Ratio

The shoulder mount carbon fiber armboard has been engineered to provide the highest strength, durability, and radiolucency of any armboard on the market today.

Easy Setup and Breakdown 

Simply place the hexagonal base under the surgical table pad. By using the weight of the patient to hold the armboard in place, removal is quick and easy. A rubber brake disc is used to keep the board in position under the weight of the patient’s arm. The unique pivoting attachment allows for a full 180 degree of lateral adjustment, making patient positioning more efficient.

Radiolucent 

This shoulder mount radiolucent armboard allows for the complete imaging of the arm and can be used in conjunction with other carbon fiber tabletops and extensions where ionizing radiation (x-ray) is used for imaging. This armboard has been designed for use as an imaging platform and is not to be used as a surgical platform.

Shoulder Mount Carbon Fiber Armboard Specifications

Dimensions 

Swivel Base

  • 14″ Length
  • 18″ Width

Armboard

  • 27″ Length
  • 5.5″ Width

Maximum Capacity Tested Per ISO 6061

  • 25 pounds

Aluminum Equivalency 

  • AAE @ 100 kVp = 1.15mm

Accessories  

An optional armboard pad is available and has been specifically designed for the shoulder mount carbon fiber armboard with quick release swivel. Constructed of high density comfort foam, the 2″ thick pad is covered with a conductive vinyl cover for easy cleaning and patient comfort.

Material Of Choice

These two unique carbon fiber armboards are ideal for improving positioning accuracy for optimum imaging results. The physical properties and characteristics of carbon fiber make it an excellent material for use in the medical device field. The impressive strength-to-weight ratio, rigidity and radiolucency of the carbon fiber are attributes that make it the material of choice for supporting limbs being x-rayed or treated with radiation.

Share Your Experience

Have you used carbon fiber in your imaging department? Would you like to share your experience with us? We’d like to hear from you and learn more about your experiences. In an upcoming post, we will discuss how to properly clean and disinfect carbon fiber armboards and pads. Sign up for our blog and we will notify you when this post is available.