Introduction

Introduction Welcome to the Radiology department. This department is arranged into: 1. General X-ray department 2. CT (computerised tomography) and MRI (magnetic resonance imaging) 3. Ultrasound 4. Nuclear medicine The general Xray department is split into 2 sides, the ‘old’ side and ‘new’ side. Both sides do more or less the same type of work. In this department there are 5 general X-ray rooms, a screening room and a dental machine (called an OPG) The CT/MRI suite is housed separately across the corridor. There are 3 ultrasound rooms on the ‘new’ side of the department and also a Nuclear medicine suite. Taking breaks There is a staff room where we take our breaks. The best way to find this is to accompany the radiographer you are working with. There is also a canteen upstairs where you can purchase hot food and snack and sandwiches. Also for snacks, there is a WRVS bar near the main entrance and a hospital shop. We usually have one hour for lunch and we take tea breaks as the work load permits. There are several toilets dotted around the department, just ask if you are unsure of the nearest one. Making the most of your visit We will endeavour to arrange for you to see most areas of the department. It can vary a little depending on workload and sometimes equipment is our of action for servicing. There are a lot of very different things to see and it can be quite bewildering, so; - Remember to ask questions – The radiographer you are working with will be very happy to answer your questions. Ask about what anatomy is seen, what the x-ray shows and why etc…. - If you are all unsure – Ask for help, we want your time with us to be as enjoyable as possible. Confidentiality Patient confidentiality is vital Everything you hear or see is, and must remain, confidential. You must not discuss any information about a patient outside of this department. No one would want to overhear about their barium enema whilst going about their shopping! You will be asked to read a separate document about confidentiality, if there is anything you are unsure about, then ask one of the radiographers. Work times We work, as a standard day, from 9am to 5pm. Most students join us for these hours. However, if you need to start or finish at different times then just let us know. Radiographer training Included in this pack is some information about student training courses and how to apply. If you require further guidance then just ask. Radiography training is degree based, taking 3 years to qualify. To work in one of the specialised areas of radiography (such as ultrasound or nuclear medicine) there is additional training to post graduate diploma/MSc level. Before going on to do specialised training you would normally work as a radiographer for some years to gain experience. About the areas you will visit: General radiography This forms the vast majority of the work we do in the x-ray department. The work undertaken includes: 1. Patients from A+E (accident and emergency) 2. Patients referred from their GP 3. Patients referred from clinics within the hospital 4. In-patients 5. Dental clinic referrals 6. Mobile X-ray and theatre radiography The work is very varied and ranges from a single hand x-ray to multiple x-rays on badly injured accident victims. When a patient books in at the reception desk, an X-ray helper will bring the patient around to a changing or sub-wait area. Some patients will need to be changed into a hospital gown, depending on what is being x-rayed. The radiographer will then call the patients into an x-ray room. Because we are using radiation, there are stringent checks to be made to ensure that the correct patient is x-rayed for the correct examination. We also have to be sure that the x-ray is ‘justified’ (i.e. needed), that sufficient information has been given for wanting the x-ray done and that the x-ray form is signed by a doctor . The radiographer will assess what is to be x-rayed from the information given on the x-ray request form and by questioning the patient. The patient will then be positioned appropriately for the examination and the radiographer will choose the correct radiation exposure to acquire the x-ray. Of course patients are rarely ‘text book’, so skill and judgement is needed to tailor the examination to the needs of the patient. The images are then processed and the radiographer looks at the films. They have to judge whether the x-ray is adequate in terms of exposure and positioning and whether further views are required. We are trained to note abnormalities on a film and with films from A+E we place a red dot on films we think there is something wrong with (e.g a fracture). It is also possible to undertake postgraduate training to report X-rays. Mobile and theatre radiography: For patients who are very ill and cannot attend the X-ray department, we have mobile x-ray machines that we can move to their bedside. Many theatre procedures are also performed under x-ray control, such as manipulating fractures back into position, inserting pins and plates to mend fractures etc… Screening In screening we undertake examinations such as; 1. Barium meals – Using barium (which shows on x-rays) to see the oesophagus, stomach and duodenum . 2. Barium enemas – Using barium to visualise the lower end of the digestive tract (Large bowel and rectum) 3. Venograms – to visualise the deep veins of the leg, to look for clots in the veins (DVT) 4. Arterograms – to see the arteries, usually of the legs (in this department). To see whether there is narrowing of the arteries. In some larger hospitals this techniques is used to visualise the arteries of the heart (coronary angiography) ,brain etc… These are the commonest examinations, but you may see other examinations as well. A radiologist will undertake these procedures, assisted by a radiographer and a nurse/radiography helper. However, some procedures such as barium enemas are starting to be performed by specially trained radiographers with post graduate training. IVU’s (intravenous urogram) These are performed to visualise the urinary tract (kidneys, ureters and bladder). The examination involves injecting a ‘contrast agent’ into the patient via a vein in the arm. This contrast agent gets filtered out of the blood by the kidneys and as it shows up on x-rays, we can take a series of pictures as the contrast passes through the kidneys and down to the bladder. Again this is an area where radiographers are ‘role extending’ to inject and report these examinations (with post grad training) Ultrasound Ultrasound uses high frequency sound waves to visualise parts of the body. There are many uses for this technique, the most commonly known procedure is to scan pregnant women. It can be used to see the internal organs of the abdomen and pelvis; to scan babies brains; to visualise certain blood vessels (such as in the neck and leg) etc etc ….. The radiographer who performs the scans will have had postgraduate training to undertake and report these examinations. Nuclear medicine Nuclear medicine is the use of radioactive isotopes to image various parts of the body. The images produced show ‘functional’ information about how a particular system or organ is working rather than what is looks like. Radioactive isotopes are given by injection or inhalation. The most commonly used isotope is called technetium 99m. This has a half-life of 6 hours, so it does not stay in the body for long. The isotope emits gamma rays, and it is these that the camera detects. The isotope is labelled with a substance which will ‘target’ a particular organ or system, depending on what we are trying to image. A large proportion of the work is bone scanning. In this examination the isotope gets taken up into the bone cells, and the more active the bone cells in a certain area are, the more isotope they will take up. So the image we get is of bone cell activity. Bone cells are more active, for example, if there is a fracture, infection or bone cancer. Other systems we can image include the brain (for dementia type conditions), kidneys, liver, gall bladder, parathyroids, thyroids etc…. The radiographers in this department will have undergone postgraduate training and undertake their own injections. CT This stands for Computerised tomography and is a technique using x-rays to image ‘slices’ or ‘cross sections’ through the body. The uses are many and varied and can include scanning a patient’s head to see if there is a bleed (stroke or injury) to see the extent of a fracture (for surgery planning), to see the extent of tumours and how it involves other organs etc etc….. The radiographers working in here will have had training in the techniques and some will have undergone postgraduate training. MRI This stands for Magnetic resonance imaging. This is a technique using a strong magnetic field and radio pulses to generate cross sectional images of the body. The physics behind this is very complicated, but there is a separate handout available if you are interested. Its uses are many and varied! Useful Websites National radiological protection board – this organisation produces a very good leaflet entitled ‘X-rays – how safe are they?’ – www.nrpbdev.org.uk The society of radiographers – www.sor.org About the discovery of X-rays – www.pa.msu.edu/people/brock/home_folder/xrays_flat.html About how x-rays are produced – www.anu.edu.au/physics/courses/physics2000/xray/making_xra ys.html For an in-depth look at radiological anatomy and pathology – www.sbu.ac.uk/~dirt/museum.html For further careers info on training as a radiographer – www.nhscareers,nhs.uk/nhs-knowledge_base/data/4737.html A website from the society of radiographers, designed to encourage youngsters to consider radiography as a career option – www.radiographycareers.co.uk To help you get the most out of your visit with us you might like to fill this ‘quiz’ sheet in whilst on your placement. Hopefully it will help you learn a bit more about what we do and why We all talk in abbreviations, so with this in mind what do the following mean?  CT …………………………………………………..  MRI …………………………………………………  NM ………………………………………………….  CXR …………………………………………………  AXR …………………………………………………  KV …………………………………………………..  MAs …………………………………………………. To ensure we have the correct patient, which details do we confirm… 1) … 2) … 3) … True or false…… The X-ray tubes contain a radioactive substance and it is that that ‘makes’ the X-rays………………………. How do we protect ourselves from the radiation? 1) … 2) … 3) … Every X-ray must be justified under protocols written to conform with IRMER guidance – what is IRMER? For an X-ray to be justified, the benefits must outweigh the risks – but how much background equivalent radiation will a patient receive from: 1) A Chest X-ray….. 2) A lumbar spine X-ray…. 3) A CT scan of the head… What is background radiation and where does it come from? Why does it vary depending on where you live? How are the request forms generated (there are two ways)? – Who can request an examination? The X-ray department should more correctly be called the imaging department, so with this in mind, which three imaging modalities do not use X-rays to produce their images? 1) … 2) … 3) … Where in the body is…. 1) … The lumbar spine? 2) … The cervical spine? 3) … The patella? 4) … The gleno-humeral joint? 5) … The L5/S1 junction? 6) … The zygoma? 7) … The lower costal margin? 8) … The A.S.I.S? 9) … The costal cartilages? 10) .. The xiphisternum? Ask any of the radiographers for advice – they should know the answers