Procedures in radiography

Chapter 6 Procedures in radiography



Karen Dunmall



CHAPTER CONTENTS


Introduction 67

Patient pathways through the imaging department 68

Mobile radiography 72

Considerations specific to mobile radiography 75

Use of contrast medium 78

Contrast media types 78

Contrast media usage 79

Contrast media safety 80

Examination preparation 80

Pregnancy checks 80

Low dose examinations 80

High dose examinations 80


KEY POINTS


image All patients follow a standardised pathway through the imaging department, coming in to contact with the same key areas regardless of their examination.

image Patient privacy and comfort should be ensured at all times.

image Mobile radiography provides a diagnostic service for patients who are unable to attend the X-ray department.

image Mobile radiography introduces radiation safety issues which should be addressed during all examinations.

image The use of contrast media enhances areas that may not be visualised during conventional examinations.

image Contrast media are either barium or iodine based.

image Some contrast media can cause undesirable side- effects in patients and all patients should be observed after the introduction of the contrast medium to ensure swift action in the event of a reaction.


INTRODUCTION


Radiology is an integral department within the hospital in that many inpatients are required to have at least one radiological examination in some form or another during their hospital stay. There are many other sources of referral forimaging examinations, ranging from outpatient clinics to accident and emergency departments (Table 6.1).


Table 6.1 Referral sources and input in a diagnostic imaging department


























































Referring source Diagnostic imaging input
Medical/surgical Departmental appendicular and axial skeletal radiography
Departmental chest and abdominal radiography
Mammography
Dental
Mobile ward radiography
Departmental and theatre based fluoroscopic examinations
Non ionic iodinated contrast studies
Theatre based appendicular and axial skeletal radiography
CT, MRI, US, RNI
Outpatients/GPs Departmental appendicular and axial skeletal radiography
• Orthopaedic Departmental chest and abdominal radiography
• ENT Mammography
• Gynaecology Dental
• Obstetrics Departmental fluoroscopic examinations
• Oncology Non ionic iodinated contrast studies
• Paediatric CT, MRI, US, RNI
• Care of the elderly  
Accident and emergency Departmental appendicular and axial skeletal radiography
Departmental chest and abdominal radiography
Mobile resuscitation unit radiography
CT, MRI, US

CT, computed tomography; MRI, magnetic resonance imaging; RNI, radionuclide imaging; US, ultrasound



PATIENT PATHWAYS THROUGH THE IMAGING DEPARTMENT


(Figs 6.1 and 6.2)


image

Figure 6.1 A patient’s pathway through a diagnostic imaging department for routine appendicular, axial, chest and abdominal radiography.


image

Figure 6.2 Pathway for appointed special examinations; for example barium enema.



RECEPTION DESK


This is most likely to be the first contact point that a patient or carer has with a diagnostic imaging department. It has been documented that patients should be given good quality information with regards to their care and be sufficiently informed before any medical examination takes place. It is therefore essential that the information process begins well. The reception team must be able to converse with the patients to ascertain their personal details; however, they must also be aware that there is the potential to be overheard by others. In some departments there is a line indicated by a stripe on the floor, indicating that only one patient should be at the desk at one time, whereas in other departments there may be a separate cubicle in which to ask personal details (Fig. 6.3). There are various notices informing patients of the no-smoking policy and zero tolerance of aggressive behaviour.


image

Figure 6.3 Reception desk with separate cubicle.



WAITING AREA


The patient will usually be directed to a sub-waiting area close to the X-ray room where their examination is to be carried out. In Figure 6.4 it can be seen that chairs have wipeable upholstery to reduce the risk of cross-infection. The chairs are also ranging in height and style to suit patients with mobility problems. A waiting area should be light and airy and have a selection of reading materials. The inclusion of wipeable toys may also be preferable in areas dealing with small children. It is important that if there is a delay due to unforeseen circumstances, the patients are aware of the time delay; this can often defuse difficult situations.


image

Figure 6.4 Waiting area.



CHANGING CUBICLE


A changing cubicle should contain a bench or chair to sit on. There should be a supply of gowns to accommodate both male and female statures. The door should be lockable but with safety locks in case of emergencies and patients should not be placed in a cubicle for long periods of time.Some hospitals provide baskets/lockers for the patient’s clothes in order to reduce the risk of theft and also free up cubicles for a more rapid throughput of patients.


For certain examinations (e.g. barium enemas) where patients may need to access a toilet promptly after the examination, a cubicle with toilet and shower facilities should be used. An emergency cord is also essential in case a patient feels unwell (Fig. 6.5).


image

Figure 6.5 Changing facilities with emergency cords highlighted.



GENERAL X-RAY ROOM


In the X-ray room it is important to remember that to a member of the public, old or young, this room containing lots of big pieces of machinery may look rather frightening. Therefore, it is important to make the patient comfortable and at ease by giving instructions in simple non-jargon terms. For example, to most people a bed or couch is what you lie on, not a table, so be aware of potential confusion. Following the examination the patient should be asked to wait until the image is checked and then given information on when and how to get the results. Table 6.2 shows patient preparation and aftercare for some typical departmental examinations.



Table 6.2 Patient preparation and aftercare for some typical departmental examinations

image image


FLUOROSCOPY ROOM


The impression of this type of room is very similar to that of a general radiography room, but more high-tech. It is essential that the patient receives succinct instruction of what to do and is told in advance of any table or X-ray tube movements.


The patient is likely to spend more time in this room than in a general room. It will also be necessary for the patient to wait for any effects that the drugs or the examination may have had to wear off; for example the administration of a muscle relaxant (e.g. Buscopan or glucagon) may give blurred vision and therefore driving is not recommended until adequate vision has returned.



PATIENT SHOWER CUBICLE


In some examinations the end product of the examination might involve emptying the bladder whilst on the X-ray table or the leaking of contrast during the procedure. In either case patients usually feel as though they require a shower before getting dressed to remove traces of contrast medium. For this reason a shower cubicle may be provided in close proximity to the toilets and cubicles.



MOBILE RADIOGRAPHY


The imaging of a patient using equipment other than the static department-based equipment is commonly known as mobile or portable radiography. However, the term portable only relates to equipment that can be carried. Mobile radiography can be divided into two distinct types:


1) Mobile plain-film radiography using mobile X-ray equipment (Fig. 6.6).

2) Mobile fluoroscopy using a mobile image intensifier (Fig. 6.7).

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Feb 20, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Procedures in radiography
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