Fundamentals Pt. 3

Pediatrics

Patients from infancy through 17 years of age.

Radiologic Technologist Responsibilities with Pediatric Patients

Be sensitive, communicate appropriately for age, establish rapport, acquaint the child with the environment, and respect modesty.

Role of Parents/Guardians During Pediatric Imaging

Explain the procedure, enlist cooperation, and clarify expectations during the exam.

Common Pediatric Radiographic Procedures

Chest, Nose-to-Rectum, Pelvis/Hips, Skull, Extremities, Bone Age, Scoliosis, Bone Survey, Soft Tissue Neck, and Fluoroscopy procedures.

Pyloric Stenosis

Narrowing of the pylorus causing gastric outlet obstruction.

Craniosynostosis

Premature fusion of skull sutures.

Hip Dysplasia

Abnormal development of the hip joint.

Intussusception

Telescoping of one part of the intestine into another.

Vesicoureteral Reflux

Backward flow of urine from the bladder into the ureters.

VCUG

Voiding Cystourethrogram used to evaluate urinary reflux.

Bone Age Exam

Radiograph used to assess skeletal maturity.

Scoliosis Exam

Imaging performed to evaluate spinal curvature.

Nursemaid's Elbow

Radial head subluxation/dislocation common in children.

Child Refuses to Follow Directions

Remain calm, repeat directions, explain the need for the exam, possibly ask the adult to leave, and remain nonjudgmental.

Purpose of Pediatric Immobilization

Assists positioning and prevents motion while ensuring patient safety.

Pediatric Immobilization Is NOT

A form of punishment.

Pigg-O-Stat

Immobilization device used for upright pediatric chest and abdominal radiography

Parent Education for Pigg-O-Stat

Explain its purpose and answer questions to reduce anxiety.

Sheet Immobilizer

Large sheet used for swaddling or "mummification" during imaging.

Other Names for Sheet Immobilization

Swaddling, Mummification, or Bunny Method.

Common Use of Sheet Immobilizer

Soft Tissue Neck imaging.

Octostop

Pediatric immobilization device with straps allowing 360° rotation.

Maximum Age for Octostop Use

Approximately 12 months old.

Image Gently Campaign

Initiative promoting radiation dose reduction in pediatric imaging.

Image Gently Founded

2007.

Goal of Image Gently

Ensure appropriate pediatric imaging techniques while minimizing radiation dose.

Pediatric Bone Characteristics

Less calcified than adult bones.

Pediatric Exposure Factor Consideration

Lower kVp is generally required than for adults

Recommended Focal Spot for Pediatrics

Small focal spot for improved spatial resolution.

When AEC Should Be Used in Pediatrics

Only when anatomy completely covers active detector cells.

Two Important Pediatric Imaging Principles

Measure and Collimate.

Child Abuse

Physical, emotional, sexual abuse, or neglect of a child.

Radiographer's Responsibility Regarding Child Abuse

Ethical and legal obligation to recognize and report suspected abuse.

Possible Indicators of Child Abuse

Injuries inconsistent with history, unexplained bruises, burns, fractures, or neglect.

Action if Child Abuse Is Suspected

Notify supervising technologist or area supervisor.

Should Parents Be Told Abuse Is Suspected?

No; remain professional and explain only that additional images are needed if ordered.

Geriatric Patient

Generally defined as an adult 65 years or older.

Fear of Hospitalization in Elderly

Greatest among older adults.

Impact of Falls in Elderly

Approximately 40% admitted for falls do not return to independent living.

Fastest Growing Age Group in America

Adults 65 years and older.

Aging Process

Includes physical, psychological, and social changes.

Radiographic Utilization in Elderly

Undergo almost 2.5 times more radiographic procedures than adults under 65.

Common Biological Changes of Aging

Arthritis, muscle atrophy, cataracts, decreased cardiac function, decreased GI motility, loss of skin elasticity, osteoporosis, slower psychomotor responses, sensory decline.

Mental Health Concerns in Elderly

Dementia, dependency, depression, fear of death, frustration, Alzheimer's disease.

Common Physical Health Conditions in Elderly

Arthritis, COPD, hypertension, osteoporosis, diabetes, coronary artery disease, cancer, Parkinson's disease.

Common Geriatric Imaging Procedures

Chest, abdomen, knee, hip, spine, fluoroscopy procedures, and bone surveys.

Positioning Consideration for Elderly Patients

Maintain body temperature with blankets.

Skin Care Consideration for Elderly Patients

Transfer carefully to avoid skin tears.

Postural Hypotension Prevention

Allow supine patients to sit before standing

Communication with Elderly Patients

Ask questions rather than making assumptions.

Positioning Aids for Elderly Patients

Pillows and sponges for comfort and support.

Important Safety Rule for Elderly Patients

Never leave them alone in the x-ray room

Cultural Competence in Geriatric Imaging

Develop cultural awareness, knowledge, and sensitivity.

Image Wisely Campaign

Radiation safety initiative focused primarily on adult imaging.

Elder Abuse

Physical, emotional, sexual, financial abuse, neglect, or abandonment of an older adult.

Radiographer's Responsibility Regarding Elder Abuse

Ethical and legal obligation to report concerns.

Signs of Physical Elder Abuse

Bruises, fractures, lacerations, restraint marks, untreated injuries, medication misuse.

Signs of Financial Elder Abuse

Unexplained withdrawals, forged signatures, sudden asset transfers, unpaid bills despite resources.

Signs of Neglect or Abandonment

Dehydration, malnutrition, poor hygiene, unsafe living conditions, lack of food.

Signs of Sexual Elder Abuse

Bruising, unexplained bleeding, genital infections, behavioral changes

Signs of Emotional/Psychological Elder Abuse

Withdrawal, anxiety, depression, agitation, unusual behavior.

Trauma

A deeply distressing experience or physical injury.

Radiologic Technologist's Role in Trauma Imaging

Ensure comfort, minimize pain, educate the patient, communicate effectively, and monitor condition changes.

Pain Complaints in Trauma Patients

Never ignore them.

When to Stop a Trauma Procedure

If the patient's condition changes.

Importance of HIPAA in Trauma Care

Protect patient privacy and confidentiality.

Trauma Imaging Goal

Work quickly, efficiently, and accurately to avoid repeat images.

Helpful Trauma Preparation

Have an emesis basin available.

Trauma Imaging Rule: Dressings and Splints

Never remove them unless directed.

Trauma Imaging Rule: Backboards and Stretchers

Backboards and Stretchers

Do not move the patient unless ordered by a physician.

Impaled Objects During Imaging

Do not remove; stabilize and support them.

Pneumatic Antishock Garments/CPR Compression Vests

Never remove during imaging.

Trauma Imaging Procedure Guidelines

Assess situation, create action plan, obtain two views at 90°, modify positioning, include anatomy of interest, support joints, follow ALARA.

Minimum Trauma Radiographs

At least two images at 90-degree angles.

Cervical Collar Purpose

Prevent life-threatening neck movement.

Removal of Cervical Collar

Requires physician approval and removal by physician or RN.

Backboard Purpose

Supports the entire body during trauma care.

Backboard Characteristic

Usually radiolucent.

Fracture Immobilization Examples

Traction, traction splints, air splints, casts, arm immobilizers, leg immobilizers, back braces.

Trauma Immobilizer Removal Rule

Trauma Immobilizer Removal Rule

Never remove without physician or RN approval.

OSHA Requirement in Trauma Imaging

Always maintain Standard Precautions.

Reading Hospital Trauma Designation

Level I Trauma Center.

Level I Trauma Center

Provides 24/7 specialty and subspecialty care for complex injuries.

Emergency Imaging Equipment in Trauma Bay

Trauma beds with IR holders, portable x-ray, CT, and ultrasound.

Trauma Alert

Highest level trauma activation.

Trauma Response

Intermediate trauma activation level.

Tier 3 Trauma

Lower-level trauma activation category.