William J. Callaway

Outline

Patient preparation and contrast media

Depending on the examination, patient preparation is performed either internally or externally. External preparation requires removing clothing and jewelry that may be covering the area of the body through which the x-rays must pass. Many types of clothing material show up on film as obscure shadows. Buttons and zippers may hide small disease processes or fractures. If a region of the head is being radiographed, dentures must be removed because they interfere with the passage of x-rays through the mouth. Rings and watches must be removed when radiographing the hand or wrist. One of the most common mistakes is forgetting to remove a necklace before performing a chest examination (Fig. 9-1, A). Always ask each patient to remove jewelry before beginning an examination. In addition, ask the patient if the area of the body to be radiographed is pierced; if so, request that all piercing jewelry be removed from the body part. Failure to do so results in a double dose of radiation to the patient because the radiographs must be retaken. Note if a tattoo is in the area being radiographed. If the ink used in the tattoo contains metallic pigmentation, it may appear as a faint shadow on the radiographic image. Proper examination of the patient is the responsibility of the radiographer. Checks for unwanted objects should be verbal, visual, and tactile.

Internal preparation for some examinations includes cleansing enemas, which are performed so that structures in the abdomen are not obscured by gas and fecal material. Most of these preparations are administered on the nursing units or by the patient at home. However, awareness of hospital procedures helps explain the importance of this preparation and answers any questions the patient may have. As a competent radiographer, you must be aware of all aspects of patient care that relate to the examination, regardless of whether you perform them.

Contrast media are solutions or gases introduced into the body to provide contrast on a radiograph between an organ and its surrounding tissue. The three general types of contrast media used in radiography are (1) iodine-based media, (2) barium-based media, and (3) air.

The element iodine has a relatively high atomic number. Because x-rays do not readily pass through iodine, solutions that contain this element are placed in organs and blood vessels to provide a contrast between these structures and their surrounding tissues. The radiographer must be alert to possible adverse reactions the patient may experience when using iodinated contrast media. The use of nonionic contrast media greatly reduces the occurrence of such side effects, but it does not eliminate them.

The element barium has approximately the same contrast qualities as iodine, but the similarities end there. Barium sulfate is inert and cannot be absorbed by the body; this makes it the medium of choice for gastrointestinal studies (Fig. 9-1, B-C). Patient allergic reaction to barium is almost nonexistent because of its inert properties.

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