In an effort to avoid medicolegal complications associated with ordering medical imaging examinations on a patient, a better understanding of the advantages and especially the disadvantages of radiography, computed tomography (CT), and magnetic resonance imaging (MRI) is beneficial. Having a clinical appreciation of these imaging modalities will assist the medical professional to correctly order the right examination. Providing additional patient information that may be helpful for the technologist performing the various examinations will help improve the outcome of the examination and smooth patient flow through the imaging department.
Basic radiographic examinations are usually the first line of imaging in the work-up of a patient. Each examination has a series of views or positions that are considered routine. These examinations usually consist of either an anteroposterior (AP) or posteroanterior (PA), lateral, and if required an oblique view of the anatomical structure of interest. Information specific to the request should focus on the patient and the examination being requested. Information that is helpful for the technologist performing the examination would include: (1) whether the patient is ambulatory or if assistance is needed along with the type of assistance required; (2) if the patient is a child, they will need a patient or legal guardian to accompany them for their examination; (3) if the examination requires the use of an IV contrast agent, have recent lab work available. Providing this information is also helpful when ordering CT or MRI examinations.
In an examination of an ankle on a 50-year-old female, the examination was ordered to be performed weight bearing; however, routine ankle examinations are performed as a table top. In this case, a student radiographer being supervised by a technologist had not performed a weight-bearing procedure before. The supervising technologist encouraged the student to perform this examination and to continue without the technologist being present. During the standing (weight-bearing) procedure, the patient lost her balance during the oblique positioning of the ankle and unfortunately fell. The fall resulted in a fracture in the patient’s ankle. To compound the problem, it was discovered that the patient was diabetic and complications unfortunately led to the patient’s death.
In this situation, the student radiographer and the technologist used poor judgment during this examination. For the student radiographer, education and training focus on routine procedures. Radiographic examinations of the ankle are usually performed as a table top procedure, not standing, and include an AP, lateral, and oblique views. The student radiographer had successfully performed routine ankle examinations; however, they had not performed this examination as a weight-bearing, standing procedure. The technologist supervising the student chose to remain outside the x-ray room and failed to supervise the student. Further, information regarding the patient’s ability to stand for the time required and specifically during the oblique position should have been considered prior to ordering the examination as a weight-bearing procedure.