Radiographer trying to stop me x-raying

tallaght01

Just wanted to see if anyone experiences the same thing in work (as I'm relatively new to A+E).

I dealt with a kid today in resus. Trauma call put out. Fall from a significant height.

Kid was OK considering. One of our consultants happens to be a paediatric trauma specialist (of which there are not many). She was on her way home, but popped in to say hi, and advised a trauma series (c-spine, CXR and pelvis) because of the mechanism.

That was fine. We rolled the resus bed into x-ray.

Then the nurse came out and told me the readiographer said she doesn't think the kid needs a pelvic x-ray, and could I come into x-ray and explain why it's needed.

I went in, and we had a chat. The radiographer had a kinda weird random poke around the pelvis and told me she didn't think the radiograph was indicated.

I told her I thought it was because of the mechanism, and because the kid hadn't walked yet.

She remained argumentative.

Eventually i told her that what she did doesn't constitute an assessment of the pelvis, and our consultant wanted it.

Once she heard the boss asked for it, she did it, reluctantly.

She also tried to convince me the other week not to x-ray a clavicle. I really had to argue with her. It was fractured.

Is this normal in A+E? Never had a bother anywhere else. How do others deal with it?

kelle

Dring training and practice, radiographers are always being advised it's their responsibility to reduce the amount of radiation exposure given to patients, more so children.
Junior doctors tend to produce shopping lists of x-rays, a lot of which are usually unnecessary, without examining the patient properly or considering how much radiation is being given to patients. Some body parts require 3 or 4 projections, and each one is another dose.
Once a consultant asks for an x-ray, it will usually be done without question.
However, this Radiographer sounds particularly argumentative!

tallaght01

Junior docs tend, though, to ask for the x-rays that their seniors have requested.

Plus, how do you decided what it was unneccesary for the doctor to order? This argument has been made by radiography friends a few times....and when we trash it out, they always seem to think that the x-ray was unwarranted if it was negative.

But the real point here is that she seemed to be questioning it on the basis of her physical examination which A) was wholly inadequate and not the issue, as the mechanism of injury was the justification for the xray.

kelle

Usually in A+E, x-rays are requested by Cas Officers who are working on their own and may not be fully experienced.
Anyway, We were alway being briefed over the years how we must not do this x-ray or that x-ray, but as more and more cases arise where a positive was shown on an x-ray that might have been refused in the past our rules have relaxed a lot - we seem to x-ray everything now! An exception is if an x-ray was done recently and the patient had no trauma since, we will question the doctor - they might not realise the patient had the x-ray done.

Traumadoc

Sometimes radiographers can make life difficult for us and refuse to do xrays- sometimes resonably - nasalbones, rib views etc. but refusing to do a pelvic xray in a trauma series is a big no-no.
I would advise informing your bosses of this. Allow a consultant to consultant discussion to occur.

In any case where a radiographer refuses to do an "significant" xray, I usually advise my junior staff document in writing the radiographers name , just to cover themselves and explain to the family why the xray is not being done.

DrIndy

The consequences of not rapidly diagnosing a significant pelvic fracture are quite serious and they should ideally not be questioned.

I have more hassle with radiologists - i normally have a very good working relationship with radiographers in our A&E - they normally augment the views i actually ask for to give the best ones.

I always find discussing what i'm looking for face to face is the best as they often give additional suggestions.

tallaght01

DrIndy wrote: »

The consequences of not rapidly diagnosing a significant pelvic fracture are quite serious and they should ideally not be questioned.

I have more hassle with radiologists - i normally have a very good working relationship with radiographers in our A&E - they normally augment the views i actually ask for to give the best ones.

I always find discussing what i'm looking for face to face is the best as they often give additional suggestions.

I agree.

At 1am on new years day I was being bollocked by a radiologist (dodgy request....patient wasn't mine, but needed a medical escort to CT. The reg who was looking after her was due to finish at midnight. So was I. But she was going home to a family, so I said I'd hang on and do the escort. Knew balls all about the patient except the basics, but got a roasting for my colleague's mess-up. Though, seeing as I finish clinical medicine in a week and don't give a hoot what anyone thinks of me in the hospital, I manged to smile through it, and even be a bit cheeky, which felt good. But, I digress :P ).

Our radiographers are very nice. But it's this same woman who's basically lazy, whatever way we twist it.

Fionnanc

Whenever I request C-spine views I always supervise in the X-ray room. There seems to be a tendacy to remove the bags and tape, flex the neck to place the AP film.
That said dropping in every request personally explaining the treatment plan both if there is a positive or negative result works wonders.
Lastly there is a trend for sending patients with obviously broken long bones/ankles/wrists/hips for X-ray without first reducing and immobilising the fracture. Its not pleasant for both the patient or radiographer to X-ray a fracture only immobilised with a sling
In my current hospital (small elective) radiographers come in from home to take X-rays at any time and provide a great service.

kelle

Fionnanc wrote: »

Whenever I request C-spine views I always supervise in the X-ray room. There seems to be a tendacy to remove the bags and tape, flex the neck to place the AP film.

We need to remove the pads as they make marks on the film and could affect diagnosis. And the neck needs to be in proper AP position. If we suspect a fracture in the lateral view, we will call in a doctor to supervise and help us place neck in proper AP position.

Fionnanc wrote: »

Lastly there is a trend for sending patients with obviously broken long bones/ankles/wrists/hips for X-ray without first reducing and immobilising the fracture. Its not pleasant for both the patient or radiographer to X-ray a fracture only immobilised with a sling. In my current hospital (small elective) radiographers come in from home to take X-rays at any time and provide a great service.

Thank you.

tallaght01

kelle wrote: »

We need to remove the pads as they make marks on the film and could affect diagnosis. And the neck needs to be in proper AP position. If we suspect a fracture in the lateral view, we will call in a doctor to supervise and help us place neck in proper AP position.


.

Exactly what I was thinking!

I always remove the sandbags and the tape. I go and hold the head myself, or pull the shoulders down.