1. During an operative (surgical) cholangiogram, the C-arm is used in the AP position. Which C-arm orientation BEST reduces scatter to the head and neck of the surgical team?
Ankle and wrist ORIF
ORIF means open reduction and internal fixation: the surgeon opens the skin, puts the bones back in place, and holds them with plates and screws. Ankle and wrist fractures are the most common ORIF cases you'll run. They're often done with a mini C-arm.
What the ARRT tests
- AP, mortise (15–20° internal rotation) and lateral ankle; the mortise shows the whole ankle joint space open.
- PA, oblique and lateral wrist.
- Distal radius fractures: Colles (dorsal tilt, from a fall on an outstretched hand) and Smith (volar tilt, the reverse Colles, from a fall on a flexed wrist).
- Keep the beam collimated and the surgeon's hands out of the beam; scatter and dose to the hands add up.
Why it's done
- Ankle: unstable or displaced fractures of the medial, lateral or posterior malleolus (bi- and trimalleolar fractures), often from twisting, and injuries to the syndesmosis between the tibia and fibula.
- Wrist: a displaced distal radius fracture, usually from a fall on an outstretched hand, that can't be held in a cast.
- Symptoms: swelling, deformity, pain and trouble bearing weight or moving the joint.
Who's in the room
- Orthopedic surgeon and assistant
- Reduce and fix the fracture with plates and screws, sometimes testing the ankle under stress.
- Scrub tech and circulating nurse
- Instruments, implants and the room.
- Anesthesia
- General anesthesia or a nerve block.
- Radiographer (you)
- Runs the large or mini C-arm, gets the views on command, and saves the final images.
Step by step
- Setup. Patient supine with a tourniquet on the thigh or arm. For the wrist, the arm is on a hand table. With a mini C-arm the limb often rests right on the receptor.
- Before draping. Get the AP, mortise or oblique, and lateral the surgeon wants.
- Reduction and fixation. Images as the surgeon reduces the fracture, places plates and drills screws. Ankle: the surgeon may stress the ankle to check the syndesmosis.
- Final images. Final views of all the hardware, saved and sent to PACS.
Your job
- Know each view for the ankle (AP, mortise, lateral) and the wrist (PA, oblique, lateral) and how to get it: by rotating the C-arm or by the surgeon turning the limb.
- Mini C-arm: the receptor is often the surface the limb rests on; keep it draped and keep the tube side away from the surgeon's hands.
- Save the final images the surgeon wants.
Watch out for
- Surgeon's hands in the beam: say so.
- Mini C-arm cords and the boom swinging into the field.
- Don't touch the limb or the receptor drape once the area is prepped.
Tips from the room
- For a true lateral of the ankle, line up the talar dome so it looks like one curve, not two.
- Ask the surgeon whether they'll move the limb or want you to rotate the C-arm for each view.
Images
Quick check
2. During a C-arm hip pinning, the radiographer wears a wraparound lead apron and stands about 2 m from the patient. The surgeon will operate the fluoroscopy footswitch for the next several minutes, and the radiographer is not needed at the C-arm. Which action BEST further reduces the radiographer's occupational dose?
3. Which ankle projection BEST demonstrates the entire mortise, with the medial, superior, and lateral joint spaces open and equal?
4. The operating room schedule lists four cases needing intraoperative fluoroscopy. For which case is a mini C-arm the appropriate unit?
5. During a lumbar interlaminar epidural steroid injection with the patient prone, the physician wants to judge how deep the needle tip has advanced. Which C-arm view is used?
Practice it in 3D
More in the guide
C-arm basics
The parts, the movements, the dose modes, and where to stand.
Sterile basics
What's sterile, what you can touch, and how to move around the field.
Esophagram and upper GI series
Barium swallow and UGI: why they're ordered, the positions, and your role.
Modified barium swallow (swallow study)
Video swallow study with speech therapy: bolus types, the field of view, and your role.
Small bowel follow-through
Timed films as barium moves from the stomach to the colon.
Barium enema
Single- and double-contrast BE: prep, tip insertion, positions, and overheads.
Cystogram and VCUG
Bladder filled through a catheter: leak checks, reflux, and voiding images.
Hysterosalpingogram (HSG)
Uterus and fallopian tubes for infertility: timing, setup, and dose.
Arthrogram
Joint injection under fluoro, usually before MRI or CT.
Myelogram
Contrast in the spinal canal: needle site, table tilt, and keeping contrast out of the head.
Lumbar puncture (fluoro-guided)
Spinal tap under fluoro when bedside attempts fail.
ERCP and cholangiograms
Bile ducts through a scope, in surgery, or through a T-tube.
Hip pinning (hip fracture fixation)
The most common C-arm case: the fracture table, the two views, and your role.