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Spearfame

Diagnostic radiographer. I love my job.

Cost-benefit analysis and the patient’s best interests

Me: She’s all skew-whiff in the collar. My lateral is garbage. CT her.
Ortho: OK, but find out who’s on call because if it’s Dr. Doo then I’ll not.
Me: Dr. Doo’s on call.

I ended up X-raying her too much, wasting time, hurting her and although most of my pictures were diagnostic, in the end I would have been better off recommending a radiological discussion and whole body CT. Or at the very least c-spine CT in the first instance.

I’ve learned from this. If I know that CT is better (because I cannot get adequate C-spine views) I need to stop sooner and involve a radiologist.

She did get CT in the end, but a different doctor asked a different radiologist for it and it was hours later than it should have been.

I wasn’t my fault: The ortho didn’t want to ask his grown-up to ask my grown-up and there’s nothing I could have done about that. I need to remember that and get over it.

Aug 19, 2014
  • leave--butdontleaveme:

    Last night my pt got their chest tube pulled in the AM and had multiple portable chest X-rays that showed the pneumo getting bigger without the tube. At 8pm, radiology called and asked if they could do the next X-Ray as a portable instead of a lateral because we have no transport techs after 7pm, so I said sure because the pt was getting Qday chest portables. Then the trauma resident called saying it needed to be lateral. Could you explain portable vs lateral in regards to a pneumo/chest tube?

  • Hi Ali,

    I’m used to doing frontal (AP/PA) views for everything and laterals only for pacemaker wires. Laterals are usually good for localising things (in conjunction with the frontal view). Your resident probably wants a lateral because he thinks it’ll help him visualise the pneumothorax’s size and the tube’s position more accurately. When monitoring something like a pneumothorax however, it is important that the images be comparable and on another AP he should best see how much it’s changed.

    I think laterals are hard and largely unnecessary, but even in the UK the jury’s still out with some places doing them routinely and some (like where I’ve worked) using them almost exclusively for post-pacemaker views.

    Furthermore, a mobile X-ray will probably not have a horizontal beam (we angle perpendicular-ish to sternum), which is preferable for gas and fluid levels. A departmental PA or lateral chest X-ray would have a truly horizontal beam and so the pneumo will be more accurately represented. Same for pleural effusions or bowel perforations.

    Lastly, short-staffing should not be a reason to do a mobile — patient condition should be the only factor.

    In short: I agree that it should be a departmental image and if there’s no Radiology opinion available and he’s sure that a lateral will change patient management immediately, then fine, but a lateral is harder to follow up and for most doctors I’ve met the AP/PA is good enough.

    I hope that answers your question, if not please ask again,

    Yours,
    Spearfame xxx

Aug 18, 2014

The slow shift

Last night was mercifully — I have to say it — quiet. Exactly what I’d prayed for. Between patients who kept turning up for imaging I managed to make some headway on my paperwork.

All night I only had to repeat one image and the most exciting thing was a broken toe. The new F1s started recently, but I hardly noticed because the registrars over-request just as much.

Then when the morning began one of the radiology consultants arrived and did my washing up. Just like that, without a word to anyone.

Aug 17, 2014

Good morning! (Or whatever time it is… about 4pm here.) I’m up bright and early for my weekend shifts and ready for anything.

The weather’s not amazing, so hopefully nobody’ll be out and I’ll have a peaceful night with no poorlyness or broken bones. I’ve a backlog of emails to read, some to write and paperwork to spend time on tonight and don’t really want to be distracted by patients. 

Truth be told, I feel a little rusty. I’ve had a fortnight off and while it might not sound like a long time, for me it is. So I’m going to psyche myself up and get ready to face the day.

Aug 16, 2014

From days to nights

After a disappointing day I’m now preparing for a night shift. I’ve Paul (Pegg & Frost) waiting for me at home for the wee hours, but right now I’m in town at a bar (alone — what a loser) listening to live music and drinking ginger beer.

Aug 15, 2014

A little late spring cleaning

Today I’ve done things!

I cleared out the junk from my room and did my shredding. I vacuumed my floor and cleaned the oven. I wrote birthday cards and I wrapped presents. I cleaned up the glass bottle of maple syrup that I dropped on the floor (it smashed into a million pieces) and I took out the recycling. I emptied the dishwasher and filed my bank statements.

What a day of accomplishments. Next I’m taking some friends out to dinner. They’ve just moved to the area (although they’re not new to the city) and I felt that I should be friendly.

Aug 14, 2014

"

Habakkuk’s Complaint

How long, Lord, must I call for help,
    but you do not listen?
Or cry out to you, ‘Violence!’
    but you do not save?

Why do you make me look at injustice?
    Why do you tolerate wrongdoing?
Destruction and violence are before me;
    there is strife, and conflict abounds.

Therefore the law is paralysed,
    and justice never prevails.
The wicked hem in the righteous,
    so that justice is perverted.

"

Habakkuk 1:2–4
New International Version

Who says the Old Testament isn’t relevant today?

I’m often reassured that the prophets were just ordinary chaps.

Aug 13, 2014

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