The Challenges In Paediatric Radiography

In generally paediatric radiography is take the radiography image of children. The purpose to take the radiography image has two purposes which are for the diagnostic and therapeutic purpose. Diagnostic purpose commonly is for evaluate or see the children body condition in anatomical and pathological aspect. But therapeutic purpose mainly is for treatment like surgical repair the fracture such as insert plate to join the bone that fracture. Children presenting to do radiographic examination range from newborn (neonates), toddlers (12 months to 2 years old), school age (6 to 8 years old) and adolescent (10 to 13 years old) Different age of children group representing the different challenges to the diagnostic radiographer on duty. Diagnostic radiographer have think many or different method to examine the children at same must reduce total dose receive by the children and provide high quality image to radiologist for diagnosis.

Paediatric patient will always come with special or in other word say as a unique problem to the radiographer. This situation always challenges diagnostic radiographer in both physically and mentally aspect. They have to use different way to communicate will paediatric patient. Staff on the radiography department must always response to the non verbal communication of paediatric patient. Because they are not like adult patient which can voice any complication to us.

Paediatric Patient Consideration

Like what have mention above, Paediatric Patient is not like adult patient. When Paediatric Patient present in the department for the diagnostic examination, few aspect should be consider in order to make they fell comfort and friendly. Some Paediatric Patient will not understand the normal word which we use to communicate to adult patient, because adult patient easy to communicate and they can understand the as a radiographer attempt to say and the level of understanding is much higher than child. But for Paediatric Patient, they can’t understand the many word. Paediatric Patient has limited range of word or limited knowledge about the world especially if the Paediatric Patient is under school age or adolescent patient and they have lower level of understanding. For school age patient and adolescent patient they may be able to communicate easily than other Paediatric Patient. So, in communication aspect. Radiographer has to shown excellent communication skill to all kind Paediatric Patient according they age. Radiographer must use appropriate, easy and simple wording and language to the Paediatric Patient, the tone of voice must low and friendly. Don’t ever using the high tone of voice when talk to Paediatric Patient, they may think you (radiographer) is try to hurting them. Don’t ever try to rude to the Paediatric Patient when they are not understand what you (radiographer) attempt to saying. Always observe the non verbal communication of the Paediatric Patient. This kind of communication always provides more information about what Paediatric Patient wants to express. Example of non verbal communication is facial expression, body posture and other.

Staff in the department must always allow the Paediatric Patient is company by parent or guardian during the examination in order to comfort them. The present of parent or guardian always make radiographer work become easy, because present of them can give security factor through the eye or physical contact to the Paediatric Patient. The presence of family member which stand behind the protective screen from radiation also reduce the fear of the Paediatric Patient School age and adolescent patient commonly is can do the radiography examination independently. Because the level of understanding of them is higher compare to toddlers.

Don’t leave the paediatric patient alone in the imaging room. When we left them alone at the imaging room, they will start to fear to the stranger environment and the dark area. This condition will lead to the some unfavourable complication such as rapid heart rate, paediatric patient start to cry or paediatric patient may ingest or inhale foreign body due to the interesting. If the complication is severe and paediatric patient health condition is critical, then the whole department will get in trouble. So , to avoid all this unwanted phenomena happen in imaging department, please don’t ever try to left them alone although they are school age or adolescent because they in the range of the age to explore to world. Environmental and privacy factor are also must considered in advance of the examination. Check the imaging room temperature whether too warm or too cold, if the temperature is not suitable for the particular patient, radiographer can adjust the room temperature to the appropriate degree according to the patient size and age. When radiographer takes off some cloths from they and allow strangers to see their body, try to ask they permission or confirmation from their parent or guardian, because we don’t want they feel like shame and uncomforted. If can, try use hospital grown to cover their body after takeoff some their cloths, this can give them comfortable.

Role of the Radiographer before Examination

Before the examination, radiographer has to do something in order to the whole examination procedure in carry smoothly without facing any problem. In other word, to make sure your (radiographer) work is easy. When you (radiographer) see the imaging request form, make sure you (radiographer) know the name of patient, especially they age and indication. This will help radiographer in aspect of communication, how to talk will them because different age of paediatric patient have different level of understanding, tone of voice and how to handle the paediatric patient will especial indication including alternative method to conduct the examination. Before start examination, make sure that the physical environment in imaging room is suitable for the particular paediatric patient including the room temperature and all the facility including the suitable immobilization devices is provide. This is very important factor to ensure the work can carry smoothly. After then, introduce yourself (radiographer) including your age and name or other relevant information about yourself. Try asking the paediatric patient name, bringing them walk around the imaging department, and introducing some staff and the instrument to them to make them familiar in new environment to avoid the feeling of strange and fear from of the paediatric patient. When taking to the paediatric patient, try use simple and appropriate language to give the instruction to them. To ensure them whether they understand or not, you can ask the feedback from them. If you failure to communicate with them, you can explain the instruction to them parent or guardian. Otherwise radiographer has to think other way to communicate. Let the child known about the examination mean tell them what will happen before, during and after the examination, the whole procedure about the examination, inform them during examination will have some noisy from the movement of table , x ray tube and anode rotation. When talking to them, make sure talk at the eye level in order to get the trust and cooperation from them. Try to establish the rapport with them, ask the question from them. Always allow the parent and guardian present in imaging room to give better feeling to child.

Preparation for the Examination

When preparing for the examination, radiographer always prepared alternative way to perform the examination. The primary method may not be allowed by the imaging room condition such as lack of immobilization devices, temperature too cold or other factor. Patient condition also one of the factor which make radiographer prepare alternative way to perform examination. They may come with wheel chair, with trolley or limited in movement. Some child may have disability, so have use other method to do the examination. Before the paediatric patient enter the imaging room, in advance take the image receptor, immobilization pads to the imaging room. Place the image receptor, immobilization devices, x ray tube and table on the correct position according to examination request. So, this action will can decrease the working ‘noise’ like movement of the X ray tube and table during the examination. Choose the suitable exposure factor like low Mas for examination according to the part be x ray and patient’ age and size. Make sure that the exposure factor that select can produce high quality image if not the examination need to repeat, it will give more dose to the paediatric patient. Radiographer also can collimate the radiation field to the size of cassette and place the anatomical marker in advance, so this will reduce time for the child in the imaging room. When the stages of preparation are complete, position the paediatric patient accurate and allow parent or guardian accompanies their child, and gives the lead grown to them.

Immobilization Devices

Immobilization devices are instrumentation that can found in radiology department. This kind instrumentation in create to make the radiography examination undergo more successfully. Immobilization devices normally have few important functions. The devices can hold the patient in position according to the radiography examination procedure requirement. Radiographer will use these devices when the desire position of the paediatric patient cannot be achieved. Other than this function, immobilization devices also can prevent movement of the paediatric patient due to the physical condition. Patient movement during the examination will cause artifact on the image that produce. Artifact effect on the radiography image will make the radiologist difficult to diagnose and cannot further evaluate the image. If the examination is repeated due to image artifact, this will cause double exposure to the paediatric patient. Another function of the immobilization devices is to make patient in comfort position. Paediatric patient may feel uncomforted when place their hand or feet on the x ray table relative cold. So, when use the devices, we can direct contact of child’s body part to the x ray table and child also feels comfortable. The immobilization devices also can use to compress the thicker part of patient like during the abdomen examination. Thicker part means have many tissue, these tissue will attenuate the total amount of x ray and dose receive by patient is high. The type of immobilization devices is adhesive tape, sandbags, compression bands, towels, ace bandages and radiolucent sponges

Radiation Protection and Dose Reduction for Paediatric Patient

Whenever the paediatric patient come to imaging department, radiographer must apply the radiation protection to the paediatric patient and parent, guardian or family member when they in the imaging room. Application of the Radiation protection has 2 functions in imaging department. One is to reduce the total effective dose receive by the patient and the scattered radiation receive by the radiographer. If the dose receive by the patient and radiographer is exceed the recommend dose, the bad effect will happen to they like loss of hair, effect the reproductive part, effect the eye and other. Another function is to protect the patient, radiographer, family member from direct expose by the primary beam. This protection is very important in order to reduce the total dose receive by them. The selection of the exposure factor like KvP, MaS should be according to the examination requirement, patient size and patient age. Normally, small and low age patient is requiring low exposure factor than adult patient. Radiographer must using low MaS to the small and young patient. Because the MaS control the total x ray beam that produce, amount of the x ray is direct proportionally to the MaS. Mean when increase the MaS; we will increase the amount of the x ray. Short examination time should be apply, so the examination period will be short and further reduce the movement of patient. Movement of patient can cause the artefact on the radiography image. Accessory equipment should be provide in the department to hold the patient in the position, so it can reduce the movement of the patient and decrease the possibility to repeat the examination. Proper collimation also one of the way that can reduce the radiation expose to the patient. Radiographer can collimate the primary beam to the area to be exam and no longer than unnecessary area. So, patient unnecessary part would not expose to the radiation. When the parent or family member is in the imaging room to hold their child during examination, radiographer must provide the lead grown to them to avoid direct expose by the radiation. Before any examination, ask patient (female above 10 years old) last menstrual period. If they are suspecting in pregnant, the examination cannot be perform. Because the radiation will directly affected the fetus. While the radiographer is applying the radiation protection to the patient, must also produce the high quality image.

Point for the Radiographer

This is meant the thing which radiographer must do before, during and after the examination. Before the examination, a clear and simple instruction should give to the child, don’t try using the language level more than they understanding level. When they want change to hospital grown, please give the sufficient time to them. Because paediatric patient is take slightly longer time than adult and ask the family member to assist them. Avoid behave rudely to them, because this will hurt them.

What to Think about Paediatric Patient

When handle them, radiographer must use appropriate approach don’t ever use threatening approach toward them. Communication skill is very important especially communicate will child due to the level of understand, appropriate language must apply. The concept of ALARA must apply in all the examination. Patient care in one of the aspect which radiographer has to apply, like give blanket during examination, assists patient whenever they need.