Procedures in Radiography

Procedures in radiography
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
Departmental appendicular and axial skeletal radiography

Departmental chest and abdominal radiography
Mammography
Dental
Medical/surgical 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
Departmental appendicular and axial skeletal radiography
Departmental chest and abdominal radiography

Accident and emergency
Mobile resuscitation unit radiography
CT, MRI, US
PATIENT PATHWAYS THROUGH THE IMAGING DEPARTMENT
Figure 6.1 A patient’s pathway through a diagnostic imaging department for routine
appendicular, axial, chest and abdominal radiograph
y.
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.
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.
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).
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
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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Procedures in radiography

Referring source Diagnostic imaging input

Departmental appendicular and axial skeletal radiography

Departmental chest and abdominal radiography

Figure 6.3 Reception desk with separate cubicle.

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