Lesson 1, Topic 1
In Progress

Radiographic Procedures

April 11, 2024

Radiographic Procedures

Learning Objective: Explain how to prepare the room and the patient for the performing of the radiographic image.

All radiographic procedures should be performed in a systematic, organized manner to ensure safe and effective performance. The approach to performing the procedure may vary based on the patient’s condition, the anatomy of interest, the type of equipment, and departmental protocol. However, the following recommended actions will be effective for most common radiographic procedures.

Preparing the Room and the Patient

Learning Objective: Describe the process for preparing the room and the patient for radiographic procedures.

The following actions focus on preparing for the procedure:

• Prepare the radiographic room: The room should be clean and organized. Depending on the agency’s policies, certain areas may need to be disinfected between patients.
• Select the patient and projection from the computer worklist.
• Choose IR (CR cassette or digital radiography [DR] detector).
• Call the patient from the waiting area: Make sure to identify the patient in a Health Insurance Portability and Accountability Act (HIPAA)–compliant manner. Ask the patient’s first and last name along with the patient’s birthdate. This information should match the information from the requisition.
• Explain the procedure to the patient: Use terminology and language that the patient can understand.
• Assess the patient: Obtain history to determine the correct procedure, ability to cooperate, and fall risk.
• Prepare the patient: Instruct the patient on what clothing and artifact items (e.g., jewelry) should be removed. Provide the patient with a gown. Prepare the patient as needed. Give the patient privacy to change or assist the patient as necessary to change into the gown.

Radiology Requisition

When an imaging study is required, the referring physician fills out a request form. The limited x-ray machine operator must become familiar with the information provided on the x-ray requisition. Every practice will have its specific version, but all requests must contain detailed information, such as the examination required, the patient’s name, and patient location (FIGURE 38.1). Imaging procedures cannot be done without a physician’s order. Performing a procedure without a request may lead to fines, disqualification of one’s radiation license, dismissal, and possible litigation. This information will aid the LXMO in preparing for the examination. The requisition usually includes the following:

• Patient information: name, date of birth, a medical record number
• Clinical indication or details: signs and symptoms, previous imaging results
• Examination requested: specific body part to be imaged
• Mode of transport: ambulatory, wheelchair, or stretcher
• Additional information: background medical information (e.g., diabetic), allergies, communication impairments (e.g., hearing, vision)
• Ordering physician

38.1

Critical Thinking Application

An x-ray requisition for an ankle x-ray just printed. What is the first step that Jonathan should complete to prepare for the imaging examination?

Preparing for Performing the Radiographic Procedure

Learning Objective: Explain the process for performing the radiographic procedure.

The following actions focus on setting up the equipment, positioning the patient, performing the projections, and preparing the projections for the provider:

• Set technical factors: This would include kilovolts peak (kVp) and milliampere/seconds (mAs).
• Set the source-to-image-receptor distance (SID) .
• Align IR and CR.
• Position of patient and position part. Always make sure the patient is not at risk for falls or injuries.
• Collimate to the anatomy of interest.
• Place lead side marker (right or left).
• Provide patient instructions: For all projections, the patient must hold still to achieve a quality picture. Additional instructions include performing a deep breath or exhaling.
• Orient IR, either portrait orientation or landscape orientation .
• Expose IR.
• Evaluate image: Check the appearance, centering, positioning, and for the proper exposure indicator (EI) value.
• Return the patient to the provider’s department or release the patient: Provide the patient with exit instructions, follow-up information, and post-procedure instructions, if applicable.

The procedural steps for a radiographic procedure include both technical and patient care aspects. These aspects should be discussed in detail for the operator to appreciate the need for each of these steps.

38.2

Critical Thinking Application

Jonathan has an x-ray requisition for a hip x-ray. He has brought the patient into the x-ray room and positioned the patient on the table for the first projection. What is the first step that Jonathan should take when he steps up to the control console?