Radiography: Communication and Immobilization

Effective Communication

• Taking a holistic approach to patient care is essential during X-ray procedures
• Must begin with effective communication between the radiographer and patient

Benefits of Effective Communication

• Alleviates a patient's uneasiness
• Increases the likelihood of their cooperation leading to the success of the procedure
• Communication is effective when verbal and nonverbal messages are understood as intended
• Poor communication results in repeat radiographic exposures

Immobilization - Patient Motion

• If a patient moves during radiographic exposure, the radiographic image blurs
• A repeat means more patient dose
• Patient motion can be eliminated or at least minimized
• Use proper body or part immobilization
• Employ motion reduction techniques

Types of Patient Motion

• Voluntary motion is expected to be controlled by the patient
• Causes of voluntary motion:
• Age
• Breathing Problems
• Anxiety
• Discomfort
• Fear
• Mental Instability
• Solution via communication
• Involuntary motion is caused by muscle groups associated with digestive organs/heart
• This cannot be willfully controlled
• Causes of involuntary motion
• Chills
• Muscle spasms
• Active withdrawal
• Tremors and Peristalsis
• Solution is to decrease exposure time while appropriately increasing milliamperage (mA) to maintain sufficient mAs

Protective Shielding

• Shield the following body areas from the useful beam when possible:
• Lens of the eye
• Breasts
• Reproductive organs
• Thyroid gland
• Gonadal shielding should be used on the reproductive organs
• When in or within approximately 5cm of a properly collimated beam
• Unless it will compromise diagnostic value

Gonadal Shielding Placement

• Female reproductive organs receive about 3x more exposure than male organs during pelvic region exams
• Must be correctly placed directly over the patient's reproductive organs to provide protection
• Male patient in supine position: Level of pubic symphysis
• Female Patient in supine position: 2.5cm medial to each ASIS

Types of Gonadal Shields

• Flat contact
• Shadow
• Shaped contact
• Clear lead

Technical Exposure Factors

• Selection of appropriate technical exposure factors is essential to ensure a diagnostic image with minimal patient dose
• Using standardized technique charts are essential
• High kVp and low mAs exposure factors reduce a patient's dose
• The quality Control Program includes regular monitoring and maintenance of processing and imaging display equipment

Repeat Images

• Additional exposure increases patient dose
• Results in "double dose" to patient's skin and possibly the gonads
• Repeats from carelessness/poor judgement must be eliminated
• Result from unacceptable Image parameters:
• Patient Mispositioning
• Incorrect Centering of the radiographic beam
• Patient Motion during the radiographic exposure
• Incorrect Collimation of the radiographic beam which causes more scatter and fog
• Presence of External Foreign Bodies / Artifacts
• Postprocessing Artifacts
• Window width and Histograms control what

Repeat Analysis Programs

• Benefits include
• Helps identify existing problems and conditions in an imaging department
• Providing valuable information for the process of improvement
• Minimizing patient exposure
• Improving overall departmental performance

Nonessential Radiologic Examinations

• Examinations performed when there are no definite medical indications
• A chest x-ray exam automatically scheduled on admission to the hospital
• A chest x-ray exam as part of a pre-employment physical
• Lumbar spine exams as part of a pre-employment physical
• Chest x-ray exam/other unjustified x-ray exam as part of a routine health checkup
• Chest x-ray exam for mass screening for tuberculosis (TB)
• Whole-body computed tomography (CT) screening

Determining the Amount of Radiation Received by a Patient

• Amount of radiation received from diagnostic imaging can be presented in these 3 ways:
• Entrance Skin Exposure (ESE)
• Bone Marrow Dose
• Gonadal Dose
• Skin dose refers to the dose to the epidermis
• ESE may be converted to patient skin dose
• Thermoluminescent Dosimeters (TLDs) are the sensing devices most often used for direct skin dose determination
• Lithium fluoride (LiF), the sensing material in TLDs, responds similarly to human tissue when exposed to ionizing radiation

Gonadal Dose

• Dose to the reproductive organs
• Genetically Significant Dose (GSD) is equivalent to the EqD to the reproductive organs
• If received by all humans, it would cause an identical gross genetic injury to the population
• Estimated GSD for U.S population is 0.20 mSv
• Bone marrow dose cannot be measured accurately by a direct method, it can only be estimated

Protection of Pregnant Patients

• Radiographers should carefully question female patients of childbearing age about pregnancy possibility
• If a possibility is present, the ordering physician may order a pregnancy test
• They will also determine whether to proceed with the x-ray examination
• Irradiating an unknown pregnancy requires listing particulars of the x-ray exam with as much detail as possible
• Collect details on a summary form report to the radiation safety officer (RSO) / medical physicist
• Determine Absorbed EqD to the patient's embryo-fetus

Pediatric Radiography

• Children are more vulnerable to late somatic and genetic effects of radiation vs adults
• Children require smaller radiation doses than adults
• Consider patient motion and reduction methods
• Use specially designed rooms for exams with suitable entertainment/distraction devices.
• Use gonadal shielding and consider gonadal dose
• Collimate to the area of interest
• Follow the "Image Gently" campaign