RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric

Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

Background.
Radiography using mobile X-ray equipment should be restricted to the patient whose medical
condition is such that it is impossible for them to be moved to the X-ray department without
seriously affecting their medical treatment and nursing care. Such patients may be found in
surgical and medical ward environments and in the following areas:
 Intensive care unit (ICU, also known as intensive therapy or treatment units).
 Coronary care unit/Cardiac surgery unit (CCU/CSU).
 High-dependency unit (HDU).
 Special care baby unit (SCBU).
 Resuscitation/major trauma.
 Patients being isolation/barrier or reverse barrier nursed.

Key skills for mobile/ward radiography

a. How to use the equipment correctly.
b. Effective communication.
c. Radiation protection of the staff and patients.
d. Infection control.
e. Personal preparation.
f. Safe practice.
g. Production of diagnostic images.
h. Team working.

General comments
Examinations are normally complicated by a variety of situations:
I. The need to communicate effectively to complete the examination without harming the
patients’ progress/recovery and with minimum disruption to the ward.
II. The patient’s medical condition, the degree of consciousness and co-operation.
III. The patient’s treatment and restrictions due to life-support system, drips, and chest or
abdominal drains.
IV. Traction apparatus.
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RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric
Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

V. Physical restrictions due to room size and ability to move mobile or portable X-ray
equipment in confined spaces.
VI. Need to monitor the patient and life-support equipment.

Correct use of the equipment

 A mobile X-ray unit is selected depending upon the requirement of the radiographic
procedure. For example, a mobile X-ray unit may be situated in an area which
undertakes mobiles on a routine basis or needs to be taken to the ward.
 For the prevention of infection, the unit selected and image detectors should be cleaned
and dried before and after each patient.
 Patient demographics may be entered on the Radiology information system/picture
archiving and communication system (RIS/PACS) and exposure parameters adjusted to
those required for the examination. The radiographer must be able to assume total
control of the situation, and should enlist the help, co-operation and advice of nursing
and medical staff before embarking on an examination. A thorough knowledge of the
ward is necessary in order that any problems or difficulties can be resolved with the
minimum of fuss.
 Any X-ray requests should be checked first to ensure that the examination on the ward
is necessary, and that the correct equipment and detectors are obtained for transfer to
the wards.
 Patient identification protocols should be correctly applied.
 Detectors used must be clearly marked to avoid double exposure if more than one
patient needs examining on the ward. Advice regarding the patient’s medical condition
should be sought first, before moving or disturbing the patient. Any disturbance of
traction, electrocardiogram (ECG) leads or drains should be undertaken only with the
permission of the medical staff. Positioning of the image receptor and movement or
lifting of seriously ill patients should be undertaken with the cooperation/supervision of
nursing staff.

Effective communication

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RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric
Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

The radiographer must communicate effectively with the ward staff before, during and after the
mobile X-ray. The key to a stress-free experience is preparation. It is essential that there is a
mechanism for ward staff to communicate effectively and give the radiographer as much notice
of all mobile requests. This enables the radiographer to use their time effectively and not be
kept waiting due to the patient’s or ward management.
The radiographer needs to be informed of the:
a) Justification for the examination to be a mobile.
b) Urgency of the request.
c) Patient’s condition and life support.
d) Infection status.
Following the procedure the radiographer must ensure the ward staff and referrer know when
the image will be available on the PACS and when a report is available.

Red flag
If the X-ray examination of the patient demonstrates a ‘life threatening’ or unexpected
appearance the radiographer has a duty of care to the patient and the referrer and
ward/clinician should be informed immediately, e.g. a nasogastric tube in the lung rather than
the stomach.
Radiation protection
This is of paramount importance in the situation where mobile radiography is undertaken. The
radiographer:
o Is responsible for ensuring that there is a controlled area of 2 metres during exposure of
the patient and that the local rules are adhered to during the examination.
o Must liaise clearly with the ward staff on their arrival on the ward and issue verbal
instructions in a clear and distinct manner to staff and patients to avoid accidental
exposure to radiation.
o Must be protected adequately from scattered radiation, including those assisting, by the
use of personal protective equipment. The use of the inverse square law, with staff
standing as far away as possible from the unit and outside the controlled area, should
be made when making an exposure.

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RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric
Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

The patient should also receive appropriate radiation protection. Lead protective shields may
be used as backstops when using a horizontal beam to limit the radiation field, e.g. when the
absorption nature of room-dividing walls is unknown. Exposure factors used for the
examination should be recorded, enabling optimum results to be repeated.

Control of infection
The control of infection plays an important role in the management of all patients, especially
following surgery and in the nursing of premature babies.
To prevent the spread of infection, local established protocols should be adhered to by staff
coming into contact with patients, e.g. hand-washing before and after every patient and
cleaning of detectors and X-ray equipment used for radiographic examination before, between
and after each examination. Patients with a known highly contagious infection, and those with a
compromised immune system and at high risk of infection, will be isolation-nursed (barrier
nursed). In such circumstances, it is important that local protocols associated with the
prevention of spread of infection are followed.
The X-ray equipment used in ICU, CSU and SCBU should, ideally, be dedicated units and kept on
site. If shared with other areas in the hospital they should be cleaned with disinfectant solution
before being moved into infection-controlled units. Equipment is wheeled over dust-absorbent
mats at the entrance of such units.
Radiographers should wear gowns or disposable plastic aprons, facemasks and over-shoes
before entering these areas. Image receptors should be cleaned and covered with plastic sheets
or clean pillowcases/towels before use. After use, image receptors and all equipment should be
cleaned with antiseptic solution. Disposable gloves are worn when touching the patient.
Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile) are
hospital-acquired bacterial infections that need to be controlled and not spread to other
patients. MRSA is resistant to methicillin and many other antibiotics and is a particular threat to
vulnerable patients; it can cause many symptoms, including fever, wound and skin infections,
inflammation and pneumonia. Both these organisms can be spread readily from an infected
patient to others. They are spread mainly from person to person by hand.

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RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric
Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

When healthcare workers deal with any potentially infected patients, the bacteria may transfer
to their hands and can then be passed on to a vulnerable patient. Controls such as effective
hand-washing, wearing of gloves and aprons, and the cleaning of the environment and
equipment are necessary to prevent spread of the bacteria.
When undertaking radiography on more than one barrier-nursed patient on a ward or ICU, it is
important that disposable aprons are changed between patients as well as ensuring that the
hands of the operators are washed between patients to prevent the spread of infection. A
number of speciality wards use differently coloured aprons per patient bay as a prompt to
confine the use of aprons to a specific patient.

Isolation/barrier nursing
Isolation nursing is required to reduce the risk of spreading certain infections or antibiotic
resistant germs to other patients and staff. It is also applied to protect patients from infection if
they have a weak immune system due to disease, transplant surgery or taking certain drugs.
o Isolation nursing is carried out by placing the patient in a single room or side room.
o Barrier nursing occurs when a patient(s) is kept in a bay and extra precautions are
implemented to prevent spread of infection.
PAEDIATRICS RADIOGRAPHY
Successfully completing paediatric radiographic studies starts with room preparation and the
radiographer’s attitude toward children. Properly preparing the room for a paediatric patient
can reduce the amount of time the child is in the exam room and create a better workflow or
the radiographer. This includes organising the room to remove potential hazards, setting the
technical components, and having immobilization devices available.
Dealing with paediatric patients can be frustrating at times because of their inability to follow
instructions. It is important to remember that the paediatric patient might be scared, confused,
hurting, or a combination of all three. The paediatric radiographer sees children as special
persons who need to be handled with care and understanding. This approach requires patience
and taking the necessary time to talk to and build a rapport with the child. Explaining
instructions to children in a way that they can understand is extremely important in developing
trust and cooperation.

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RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric
Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

Age of understanding and cooperation

All children do not reach a sense of understanding at the same predictable age. This ability
varies from child to child, and the paediatric radiographer must not assume that a child will
comprehend what is occurring. However, by age 2 or 3 years, most children can be talked
through a diagnostic radiographic study without immobilization or parental aid. Most important
is a sense of trust, which begins at the first meeting between the patient and the radiographer;
the first impression that the child has of the radiographer is everlasting and forges the bond or
a successful relationship.
Pre-Examination Introduction and Child and Parent Evaluation.
Introduction of Radiographer
At the first meeting, most children are accompanied by at least one parent or caregiver.
The following steps are important:
 Introduce yourself as the radiographer who will be working with the child.
 Find out what information the attending physician has given to the parent and patient.
 Explain what you are going to do and what your needs will be.
Tears, fear, and combative resistance are common reactions for a young child. The
radiographer must take the time to communicate to the parent and the child in language they
can understand exactly what he or she is going to do. The radiographer must try to build an
atmosphere of trust in the waiting room before the patient is taken into the radiography room;
this includes discussing the necessity of immobilisation as a last resort if the child cannot
cooperate.
Evaluation of Parent’s Role
The first meeting is also the time to evaluate the role of the parent or caregiver. Three
possibilities are as follows:
a) Parent is in room as an observer, lending support and comfort by his or her presence.
b) Parent actively participates, assisting with immobilisation.
c) Parent is asked to remain in the waiting area and not accompany the child into the
radiography room.

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RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric
Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

Sometimes a child who acts fearful and combative in the waiting room with the parents present
is more cooperative without their presence. This is the time when the radiographer’s
communication skills are tested.
The assessment of the parent’s role is important and requires an objective evaluation by the
radiographer. If it is determined that the parent’s anxiety would interfere with the child’s
cooperation, option 3 should be chosen. However, parents generally do wish to assist in
immobilising the child, and if this option is chosen (if the parent is not pregnant and proper
shielding is used), the radiographer should carefully explain the procedures to both the parent
and the patient. This explanation includes instructions to the parent on correct immobilization
techniques. Parental cooperation and effectiveness in assisting tend to increase with
understanding how proper but firm immobilization improves the diagnostic quality of the image
and reduces radiation exposure to the patient by reducing the chance of repeats. If the parent
is unable or unwilling to assist with immobilisation, soliciting the help from another
radiographer or using immobilization devices is the next best option.
GERIATRIC RADIOGRAPHY
Geriatrics is the branch of medicine dealing with the aged and the problems of aging
individuals. The field of gerontology includes illness prevention and management, health
maintenance, and promotion of quality of life for aging individuals. The ongoing increase in the
number of people older than age 65 in the Nigeria population is well known. An even more
dramatic aging trend exists among people older than 85 years. Every aspect of the health care
delivery system is affected by this shift in the general population.
The 1993 Pew Health Commission Report noted that the “aging of the nation’s society and the
accompanying shift to chronic care that is occurring foretell major shifts in care needs in which
allied health professionals are major providers of services.” As members of the allied health
professions, radiographers are an important component of the health care system. As the
geriatric population increases, so does the number of medical imaging procedures performed
on older adult patients. Students and practitioners must be prepared to meet the challenges
that this dramatic shift in patient population represents. An understanding of geriatrics can
foster a positive interaction between the radiographer and the older adult patient.

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RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric
Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

Patient and Family Education

Educating all patients, especially older adult patients, about imaging procedures is crucial to
obtain their confidence and compliance. More time with older adult patients may be necessary
to accommodate their decreased ability to process information rapidly. Older adults have been
diagnosed with at least one chronic illness. They typically arrive at the clinical imaging
environment with a natural anxiety because they are likely to have little knowledge of the
procedure or the highly technical modalities employed for their procedures. A fear concerning
consequences resulting from the examination exacerbates their increased levels of anxiety.
Taking time to educate patients and their families or significant caregivers in their support
system about the procedures makes for a less stressful experience and improved patient
compliance and satisfaction.

Communication
Good communication and listening skills create a connection between the radiographer and the
patient. Older people are unique and should be treated with dignity and respect. Examples of
appropriate communication may include addressing the patient by his or her title and last
name. It is inappropriate to call someone “honey” or “dear.” Each older adult is a wealth of
cultural and historical knowledge that becomes a learning experience for the radiographer. If it
is evident that the patient cannot hear or understand verbal directions, it is appropriate to
speak lower and closer. Background noise can be disrupting to an older person and should be
eliminated if possible when giving precise instructions. Giving instruction individually provides
the older adult time to process a request. An empathetic, warm attitude and approach to a
geriatric patient result in a trusting and compliant patient.

Transportation and Lifting

Balance and coordination of an older adult patient can be affected by normal aging changes.
The patient’s anxiety about falling can be diminished by assistance in and out of a wheelchair
and to and from the examination table. Many older adult patients have decreased height
perception resulting from some degree of vision impairment. Hesitation of the older adult

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RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric
Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

patient may be due to previous falls. Assisting an older patient when there is a need to step up
or down throughout the procedure is more than a reassuring gesture. Preventing opportunities
for falls is a responsibility of the radiographer. The older adult patient often experiences vertigo
and dizziness when moving from a recumbent position to a sitting position. Giving the patient
time to rest between positions mitigates these disturbing, frightening, and uncomfortable
sensations. The use of table handgrips and proper assistance from the radiographer create a
sense of security for an older adult patient. A sense of security results in a compliant and
trusting patient throughout the imaging procedure.

PERFORMING THE RADIOGRAPHIC PROCEDURE

Radiographer’s Role
The role of the radiographer is no different than that of all other health professionals. The
whole person must be treated, not just the manifested symptoms of an illness or injury.
Medical imaging and therapeutic procedures reflect the impact of ongoing systemic aging in
documentable and visual forms. Adapting procedures to accommodate disabilities and diseases
of geriatric patients is a crucial responsibility and a challenge based almost exclusively on the
radiographer’s knowledge, abilities, and skills. An understanding of the physiology and
pathology of aging and an awareness of the social, psychological, cognitive, and economic
aspects of aging are required to meet the needs of older adult patients. Conditions typically
associated with older adult patients invariably require adaptations or modifications of routine
imaging procedures. The radiographer must be able to differentiate between age-related
changes and disease processes. Production of diagnostic images requiring professional decision
making to compensate for physiologic changes, while maintaining the compliance, safety, and
comfort of the patient, is the foundation of the contract between the older adult patient and
the radiographer.

It is important that the radiographer becomes aware of and understands the various types of
physical and cognitive impairments associated with geriatrics disease. It requires patience and
compassion and attentiveness when dealing with this patient group. Patients who are at risk of

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RADG 427 [RADIOGRAPHIC TECHNIQUE III] Ward Radiography, Paediatric
Radiography and Geriatric Radiography. Lecture note by M.Y Mohammed.

falling must never be left alone whether in the radiology waiting room or in the examination
room.

Caregivers should be encouraged to accompany the patient to appointments whenever

possible. It is sometimes more comforting to the patient to have a familiar person with him or
her in an unfamiliar setting. In addition, depending on the stage of the disease, some patients
may tend to wander, often wanting to “go home.” Home sometimes is their native town, state,
or even country. So they can travel considerable distances before they are found. There have
been cases where patients have wandered off, never to be found, or never to be found alive.
For that reason the patient should never be left alone. Whenever possible, and whenever a
caregiver has not accompanied the patient, a two-technologist team should be available to care
for the patient while in the diagnostic radiology suite—one acquiring the images and one in the
role of companion to the patient while the images are being processed and reviewed. The
patient should be then handed off to the unit or responsible party upon completion of the
exam.
The radiographer should exercise a great deal of patience and use distraction techniques to
eliminate the frustration this may cause. Simply changing the subject or asking an unrelated
question may reduce the repetitive questioning or conversation. There may be occasions when
the patient will require restraints to complete the exam. Note, however, that restraints should
only be applied in cases where the patient can potentially cause harm to himself or to others.
Working quietly and smoothly around the patient and maintaining calm, relaxing, and noise-
free surroundings is the preferred situation for Alzheimer’s patients in the radiology
department. The music, if any, should be soothing and relaxing. This will potentially benefit all
types of patients.
Radiographic Positioning for Geriatric Patients
Understanding of the physical, cognitive, and psychosocial effects of aging can help
radiographers adapt to the positioning challenges of the geriatric patient. In some cases,
routine examinations need to be modified to accommodate the limitations, safety, and comfort
of the patient. Communicating clear instructions with the patient is important.

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