This week I was on an out of hour’s placement at Queen Margaret hospital. It was my very last block of placement as a student and I was preparing for my competence to practice. I had mixed feelings of real excitement coupled with extreme nervousness. Despite the fact that I have worked at Queen Margaret many times, the pressure was greater this time as I really wanted to perform to an exceptionally high standard. The first day went well however there was the usual period of trying to familiarise myself again with the computerised radiology information system (CRIS).
I had informed the radiographer that this was the last opportunity for me to get as much hands on as possible before my competency to practice and therefore I asked her if I could perform as many of the examinations as possible and be treated as if I were getting assessed. There was an orthopaedic clinic on until 7.30pm during which I managed to get lots of hands on experience albeit with relatively straight forward examinations. However after the clinic finished the requests were predominately A&E referrals, along with ward and mobile requests. One of the exams I performed was a mobile chest examination on a 73 year old female with reduced air entry and basal crackles. On entry to the ward I identified myself as the radiographer to the duty nurse and received the request card. I then performed the usual ID checks with the patient and prepared myself along with the equipment for the examination.
Once I had everything in place I proceeded to ask the patient who was sitting on the edge of her bed if she would get up onto her bed so I could perform the examination. Chest x-rays are usually performed posteroanterior (PA) as this reduces magnification of the heart; however mobile requests or ward patients that are unable to attend the department are usually performed anteroposterior (AP). According to Clarks (2005) ward radiography is normally complicated by a variety of situations, some of these complications being the patients’ condition, degree of consciousness and cooperation.
Most books demonstrate mobile x-ray examinations being performed with the patient in an AP position. According to Ohioswallow an AP portable chest is inferior to a PA or lateral. Problems with an AP chest include magnification of the heart shadow, artifacts from lead wires, lines, bedsheets, and skin folds, patient rotation, visualisation of the chest in one plane only and variable exposure factors related to the equipment used.
The radiographer who was with me, then stopped me and advised me to just leave the patient where she was sitting and to perform the examination with the patient sitting on the edge of her bed. I had not seen this done and couldn’t understand how I was going to position the cassette.
I told her that I had once performed a chest examination with the patient sitting on the edge of a trolley using the upright bucky but although I understood the theory of what she was asking I was not sure of the best way to position the cassette in this situation. She then advised me to position the cassette on the patients lap and ask her to give it a cuddle placing her finger tips under the bottom. After following her instructions I was able to perform the examination without having to move the patient at all.
This was one of those occasions that allowed me to build on my knowledge and gain a better understanding from a very experienced radiographer. I was able to perform the chest x-ray without causing upset or difficulty to the patient as well as reducing positioning problems for myself, while achieving a diagnostic PA image.
I felt this was a much easier technique to achieve a diagnostic image and is definitely one technique that I will use in the future.
As a student you find yourself working with many different radiographers and quite often they’ll have their own way of working and performing examinations. This has both advantages and disadvantages. The main advantage is that you get shown many different ways of performing the same examination and an insight into why they prefer that technique. As a student you are then able to try the different techniques you have been shown and choose which one you find the most suitable. Conversely, many varied techniques can be a disadvantage if you already have your own style of performing an examination only to be shown other techniques and potentially get confused as to the best method. Working with this particular radiographer definitely had its advantages for me and I feel that I finished the week a better radiographer than when I started.
Clark, K.C. 2005. Clarks positioning in radiography. 12th ed. London: Arnold.
