This is a complete project materials on challenges associated with spinal trauma cases in radiography. A CASE STUDY OF UNIVERSITY OF NIGERIA TEACHING HOSPITAL (UNTH), NATIONAL OTHORPEDIC HOSPITAL ENUGU (NOHE) AND ENUGU STATE UNIVERSITY TEACHING HOSPITAL (ESUTH) from chapter one to five with references and abstract.
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ABSTRACT
This research work was aimed at assessing the challenges that are associated with spinal trauma cases in radiography using UNTH, NOHE and ESUTH as case study.
It is a non experimental, questionnaire based research. A total of 48 questionnaires were filled and returned and the respondents were radiographers including interns and youth corpers.
This result of the research showed various challenges that radiographers encounter while examining patients with spinal trauma. Some of the challenges include lifting and transferring of patients to couch, non cooperation of patients among others.
The research also showed some of the methods that radiographers employ to overcome these challenges.
TABLE OF CONTENTS
Title page
Certification page
Acknowledgement
Abstract
List of tables
Table of contents
CHAPTER ONE
Introduction
1.1Background of study
1.2 Statement of problems
1.3 Objectives of the study
1.4 Significance of the study
1.5 Scope of the study
1.6 Review of the related literature
CHAPTER TWO
Theoritical background
2.1Role of radiography in trauma care
2.2 Equipment used in trauma radiography
2.2.1 Dedicated equipment
2.2.2 Features of trauma equipment
2.4 Anatomy of the spine
2.4.1 The vertebrae
2.4.2 Spinal cord
CHAPTER THREE
Research methodology
3.1Design of study
3.2 Population of study
3.3 Instrument used for data collection
3.4 Procedure for the data collection
3.5 Method of data analysis
CHAPTER FOUR
Data presentation, Discussion and Summary
4.1Data presentation
4.2 Discussion of data
4.3 Summary of findings
CHAPTER FIVE
Recommendations, Areas for further study, Limitations and Conclusion
5.1Recommendations from the study
5.2 Areas for further study
5.3 Limitations of study
5.4 Conclusion
REFERENCES
APPENDIXÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF STUDY
The practice of radiography entails sound scientific knowledge and technical skills founded upon theoretical concepts, utilizing of equipment and accessories consistent with the purpose for which they have been designed, employing procedures and techniques appropriately, with effective patient interaction to provide quality care and useful diagnostic information.
One of the ethical requirements of radiographers is to provide quality patient care and services unrestricted by the concern of personal attributes or nature of disease.1This, he achieves most times through the adequate co-operation of the patient.
However, at some other times, patient co-operation becomes difficult and compromised as observed with most fractured patients, accident and emergency cases, unconscious patients and generally in trauma cases. It is still expected of radiographers to produce images of reasonable diagnostic quality in the above cases.
This, most times, poses serious challenges to radiographers during radiological procedures especially the young radiographers and student radiographers who are less versed in clinical practice.
Spinal cord trauma can be caused by any number of injuries to the spine. They can result from motor vehicle accidents, falls, sports injuries (particularly diving into shallow water), industrial accidents, gunshot wounds, assault, and other causes2.
For all health care professionals, mental preparation and communication are key factors when dealing with trauma situations. Usually trauma patients and the health care team are anxious and don’t know what to expect. Effective communication by radiographers is essential so the imaging process is effective and as stress-free as possible.
Any problem with communication, major or minor, will affect the outcome of the case. Many aspects of dealing with a trauma situation are taught in the radiography curriculum: anatomy, image production, positioning and patient care. However, effective communication in stressful trauma situations is seldom taught.
Unfortunately, it is usually learned by hard experience. It is expected that images be produced without causing further harm to patient3.
Besides mental preparation and effective communication, there are also necessary modifications we adopt when confronted with cases of trauma. These range from equipment selection and orientation, factor selection, patient positioning and the use of positioning accessories/aids. Also of utmost importance is the maintenance of a sterile environment as trauma can be exposed and thus, have increased chance of contamination.
However, the positioning principles for trauma cases are similar to those applied for routine general radiography. The primary difference can be summarized with the word adaptation. Each trauma case and situation is unique and the radiographer must evaluate the patient and adapt4. The challenges associated with imaging in spinal trauma cases by radiographers have not been assessed in the institutions under study and this has prompted me to embark on this research.
 1.2 STATEMENT OF PROBLEMS
Injury to the spinal cord is a serious and life-threatening one. Paralysis and loss of sensation of part of the body are common. This includes total paralysis or numbness and varying degrees of movement or sensation loss. Death is possible, particularly if there is paralysis of the breathing muscles.2
In addition to the above, the researcher, during his clinical posting observed increased repeat examinations with spinal trauma cases.
1.3Â OBJECTIVES OF THE STUDY
- To assess the difficulties frequently encountered by radiographers during examination of spinal trauma cases.
- To assess the attitude of radiographers towards spinal trauma patients.
- To assess how the radiographers cope with spinal trauma cases despite challenges.
1.4Â SIGNIFICANCE OF THE STUDY
- With the knowledge of the common challenges associated with examination of spinal trauma patients and some idea of how to cope, radiographers will be better guided in their handling of such cases.
- The research will reveal how radiographers cope with the challenges and avoid much repeat. This would ensure reduced dose to patients and staff, wastage of resources and further injury to patients.
1.5 SCOPE OF THE STUDY
The study will be restricted to radiographers at UNTH, ESUTH and NOHE.
1.6 REVIEW OF RELATED LITERATURE
Radiography is an essential tool in the diagnosis and management of spinal trauma cases. However, this could be very challenging to the radiographer, the radiologist as well as other health care professionals.
Miller et al in their work CT in the evaluation of spine trauma wrote that One of the most challenging and vexing problems in emergency medicine is cervical spine trauma. Not only do patients with such trauma often have multisystem injuries-in which abdominal and thoracic injuries may have the highest treatment priority-but they also may have an altered mental status from associated head injury or concomitant use of alcohol or drugs.
Interpreting preliminary radiographs is often difficult because of the complex anatomy of the area and the technically suboptimal studies that sometimes result from portable technique, poor patient cooperation and reluctance to move a patient for proper positioning.5
Shaffer et al opined that although the traditional radiographic examination for suspected cervical spine trauma has been a cross-table lateral view, some injuries like Jefferson and odontoid fractures, as well as rotary injuries of C1-2, may not be apparent on the cross-table lateral view, and injuries involving C-7 may be difficult to interpret because of overlapping soft tissues and bony structures of the shoulder.
Occasionally, even mid cervical injuries may be missed on a single cross-table lateral view because of the subtlety of the injury or poor technical quality of the initial radiographs.They conclude that a standard anteroposterior and open-mouth or modified odontoid view should be done routinely before mobilizing a patient’s head or neck in all cases of suspected cervical spine injury and likewise, vertebral arch views (pillar views) should be done if there is evidence of a hyperextension injury.6
Bohlman wrote that the diagnosis of an unstable spinal injury and its subsequent management can be difficult, and a missed spine injury can have devastating long-term consequences,therefore, spinal column injury must therefore be presumed until it is excluded.7
Some studies of spinal trauma have recorded a missed injury rate as high as 33%. Delayed or missed diagnosis is usually attributed to failure to suspect an injury to the cervical spine, or to inadequate cervical spine radiology and incorrect interpretation of radiographs.8
Writing on the immobilization and patient handling during the management of the multiply injured patient, Callenoff et al asserted that the ideal position is with the whole spine immobilised in a neutral position on a firm surface. This may be achieved manually or with a combination of semi-rigid cervical collar, side head supports and strapping. Strapping should be applied to the shoulders and pelvis as well as the head to prevent the neck becoming the centre of rotation of the body.9
Children have a disproportionately larger head size than adults, and when supine on a firm surface will be in a position of slight flexion. This slight degree of flexion is rarely a problem, though it can give rise to difficulties in X-ray interpretation. This can be corrected by placing a folded towel or sheet under the patient’s shoulders to bring the cervical spine into the neutral position.
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