Management of Patients in the Radiography Unit - Literature review Example

Radiography Unit: Managing Patients August 26, Radiography Unit: Managing Patients Management of patients in the radiography unit involves a requirement of making adaptations to the usual protocols. Adaptations may be required due to the age of the patient, the patient’s health condition or injury the patient has sustained. Because of this it is critically important that the radiographer have an understanding of not only the reasons for but the techniques that are appropriate for adaptations and in various situations. The images that result from these situations are not what might be deemed to follow the textbook on radiography however, under the circumstances can be considered to be good imaging. I. Adaptation Examples The work of Campeau and Fleitz (2009) states that radiography plays a role that is significant in the “…diagnosis and monitoring of diseases and injuries.” (p. 289) The role of the radiographer is to produce radiographs that are high in quality on a consistent basis for the purpose of providing physicians with the information necessary to accurately diagnose the patient’s condition. Examples of changes that might be needed stated by Campeau and Fleitz (2009) are those as follows: (1) Alteration in the selection of technical x-ray exposure factors; (2) Adaptation of routine positioning to accommodate for the patient’s condition; and (3) Additional care and attention to the patient prior to, during, and after the x-ray examination. (p.289) II. Disease and Condition Indications for Adaptation There are stated to be two types of diseases and conditions that are necessary for consideration by the radiographer. These two are: (1) additive; and (2) destructive diseases and conditions. (Campeau and Fleitz, 2009, p. 292) Additive diseases and conditions are those such as: (1) Acromeguly; (2) Congestive Heart Failure; (3) Hydrocephalus; (4) Paget’s disease; and (5) pulmonary edema. (Campeau and Fleitz, 2009, p. 292) Destructive diseases and conditions are such as: (1) active Tuberculosis; (2) atrophy (either from disease or lack of use; (3) multiple myeloma; and (4) Osteoporosis. (Campeau and Fleitz, 2009, p. 292) Depending upon which type of disease or condition the patient has the radiographer will need to understand the imaging implications. For example, when there is a destructive disease or condition present the radiographer should understand that they need to decrease the technical x-ray exposure factors and when the additive disease or condition is present the radiographer should understand that they can increase the technical x-ray exposure factors. (Campeau and Fleitz, 2009, p. 292) Therefore, the radiographer should make sure to evaluate the patient during the pre-examination period to determine if there are needed adjustments in the standard positioning routines. III. Adaptations Due to Injury Radiography of a patient who has sustained injuries present challenges in terms of positioning in obtaining radiographs of these patients. Depending on the nature and extent of the injury the radiographer will likely need to make adaptations to the standard imaging protocols in order to avoid further injuring the patient and to minimize the pain and discomfort of the patient. Campeau and Fleitz states that when x-ray examinations of several various areas of the body are requested the radiographer “can take all of the AP projections first.” (p.326) The patient’s weight may also play a factor in how imaging should be conducted. For example when imaging the elbow of an obese person the radiographer should understand that the “fat pad sign may demonstrate a false positive if the elbow is improperly positioned or aligned in the lateral position.” (p. 337) Campeau and Fleitz state “…a positive fat pad sign is likely to indicate an occult fracture.” (2009, p. 337) IV. Surgical and Procedures Adaptation Examples The work of Gervais et L (2004) reports that when treating infected or symptomatic fluid collections in the abdomen and pelvis that percutaneous imaging is the first-line treatment when surgery is not indicated. Gervais et al state that “Physicians nurses and technologies in pediatric hospitals are attuned to the needs of children, but the interventional radiology team in a general hospital must remember that children in the interventional radiology suite have specific needs. These include an appropriate level of sedation, dedicated equipment for monitoring and resuscitation, avoidance of body heat loss, minimization of radiation doses, and greater involvement of parents and family compared with that in adult practice.” (2004, p.1) Additionally stated is that the interventional radiology suite has a requirement of being equipped with “blood pressure cuffs, oral airways, endotracheal tubes, face masks, and venous lines of the various sizes appropriate for use in children.” (Gervais, et al, 2004, p.1) Additionally since the child’s body has a higher surface area-to volume ratio causing them to lose heat quicker than do the bodies of adults, it is necessary that only the parts of the body be exposed that is required for the procedure. Heat loss can be limited through use of heating lamps, blanket warmers and war US gel. (Gervais, et al, 2004, paraphrased) Due to the variation of the size of children, “…various amounts of radiation will be needed to obtain images of sufficient quality to guide percutaneous intervention.” (Gervais, et al, 2004, p.1) In the case where computed tomography (CT) is used in guiding abscess drainage it is reported that the “…lowest possible tube current and scanning time are used.” (Gervais, et al, 2004, p.1) Fluoroscopically guided interventions indicate the need to use pulsed fluoroscopy “…if the means are available.” (Gervais, et al, 2004, p.1) Gervais states that if possible “Gonadal shields also should be used…” (Gervais, et al, 2004, p.1) The standard techniques for bringing about a decrease in the overall exposure to radiation of the patient include “…minimization of the distance between the image intensifier and the patient, as well as of the magnification power, collimation, and number of spot film images acquired—also should be used. The capture of fluoroscopic images with the photograph-and-store option is an effective strategy for reducing the number of spot film images that must be acquired.” (Gervais, et al, 2004, p.1) Gervais et al (2004) state that the most straightforward imaging evidence modality for abscess draining in children is that of “ultrasonography (US).” (p.1) US is stated to make provision of “real-time observation of the abscess and the catheter, without exposure of the patient to ionizing radiation.” (Gervais, et al, 2004, p.1) In abscesses that are large and that are readily accessible, Gervais et al reports that “deployment of the catheter by using the trocar technique with real-time US observation is the simplest and fastest way to achieve percutaneous drainage. “ (2004, p. 1) In the case that the US depicts the abscess only in part of if there is a requirement of positioning the catheter more precisely due to the closeness of other structures the US “must be supplemented with fluoroscopy for guidance of catheter deployment.” (Gervais, et al, 2004, p.1) V. Mobile Imaging Mobile imaging techniques are reported in the work of Peart (2002) who states that mobile radiography presents challenges due to the environment no longer being under the control of the radiographer. Peart (2002) provides advice concerning methods of imaging and this includes chest examination imaging. It is stated that in the case where the patient is able to sit upright that the perpendicular position may be made impossible by the construction of the bed. Therefore, the radiographer must make note of any changes to the imaging standard protocol on the patient’s radiographs. When imaging the extremities the greatest challenge is stated to be “usually an encounter with patients on traction therapy…” because normal positioning is prevented by the traction bars, cables and pins. (Peart, 2002, p.1) Imaging of the abdomen is often difficult due to the complication of “placing the patient on the image recorded. The other complication is the possibility of grid cutoff if the patient leans even slightly from side to side” (Peart, 2002, p. 1) As well imaging the obese patient can be difficult and Peart (2002) state that when imaging obese patients the radiographer should “try not to increase the kVp too much” as doing so “lowers contrast, lengthens the scale of contrast and increases scatter.” (p. 1) In the even that a grid is necessary, Peart (2002) states that the preference is the “lowest grid ratio possible” and that the preference is a 5:1 or 6:1 for use if possible. VI. Pediatric Imaging Special considerations of the radiographer when imaging nursery patient include the three dangers of: (1) hypothermia; (2) infection; and (3) handling since premature babies “have a greater surface area in comparison to body mass.” (Peart, 2002, p. 1) Premature babies are unable to store the needed fat for warmth and as well have an increased rate of metabolism. Peart (2002) reports “All the sources of heat loss, evaporation, convection (circulation in fluids), conduction and radiation are greater in the pre-term infant.” (p. 1) Hypothermia can be prevented by imaging the infant “in the warmer or isolate whenever possible and by not placing the infant in contact with a cold image recorder.” (Peart, 2002, p. 1) It is also important that the radiographer understand that infants and newborns have lower immune systems than do adults making it a requirement that careful gloving and handwashing are ensured and that the image recorded is properly covered all of which brings about a drastic reduction in the infections transmitted to the newborn. The third danger is that of handling since the heart of the newborn slows when they are handled therefore there should be a great level of care taken when tubing and other equipment is removed since “maneuvering can be tricky in the narrow space of the nursery unit, but mistakes can be deadly.” (Peart, 2002, p. 1) VII. Stress to Patients There is a need for the radiographer to ensure avoidance of stress to all patients which includes limiting the noise in the patient’s environment and limiting the movement of the patient. The mobile unit should never be left in the room of patient and this includes in checking the radiograph. Instead the unit should be parked outside of the patient’s room and out of the way of other medical personnel and medical equipment. Discussion From the literature reviewed in this brief study it has been demonstrated that the considerations of the radiographer and the radiography unit are multiple and diverse in nature. Adaptations are needed to the standard imaging protocol for many reasons as well. The radiography unit images patients who are being seen in the hospital emergency room, patients who are scheduled for surgical procedures, patients who have recently had surgical procedures and the radiography unit also images patients during surgical procedures. Adaptations to the imaging protocol may be needed due to the weight, age, health condition, the injury the patient has sustained as well as due to other factors relating to the treatment the patient is receiving. Summary & Conclusion This work stated the goals of identifying the possible adaptations to standard imaging protocol that the radiography unit might encounter. Adaptations to the standard imaging protocol have been shown in this brief study to include those related to the weight, age, health condition, the injury the patient has sustained as well as due to other factors relating to the treatment the patient is receiving. Specific examples provided in this review have included imaging of children, infants as well as imaging of obese patients and patients who are in traction. Also reviewed in this study have been standard imaging protocol adaptation based on the area of the body being imaged. As noted in the work of Campeau and Fleitz (2009) imaging adaptations may include, although not be limited to adaptation in the selection of technical x-ray exposure factors, routine positioning adaptations for accommodating the condition of the patient and additional care and attention being given to the patient before, during and after x-ray examination. Because of the need for adaptation to standard imaging protocols, radiographers and radiography units should have education and training in making such adaptations. References Campeau, F. and Fleitz, J. (2009) Limited Radiography. Cengage Learning. 2009. Gervais, D.A. et al (2004) Percutaneous Imaging-guided Abdominal and Pelvic Abscess Drainage in Children. RadioGraphics Journal. May 2004. Online available at: http://radiographics.rsna.org/content/24/3/737.full?sid=8a94fba7-9c22-4ace-b170-c3ba7e2bebdf#sec-15 Peart, O. (2002) Mobile Imaging Part 2. Image Journal. 1 July 2002. Online available at: http://www.rt-image.com/0701mobile2 Read More