X-RAYS – Personal Profile
A Day in the Life of a Radiographer
Amber Bristow of the Alfred Hospital in Melbourne
I am a radiographer at the Alfred Hospital in Melbourne. The Alfred is Australia’s largest trauma service, receiving more than 800 trauma cases per year. There are 45 radiographers on staff at the Alfred and we work in all different areas and all manner of shifts.
This week I am working ‘B shift’, it’s the first day of my week and I arrive at 1345 hrs. My first task is to check in with the Emergency X-ray Department supervisors and see if they require any of the shift staff to stay and help them. Today it is fairly quiet in the Emergency Department so I go upstairs to the main X-ray Department.
My first patient is an Intensive Care Unit (ICU) patient. He is a 19-year-old boy who was involved in a motorcycle accident and has only now become stable enough to have all his post operative X-rays. He needs his thoracic spine, lumbar spine, pelvis, left femur, left tibia, left shoulder, left humerus and left forearm X-rayed. This will take two radiographers about an hour to complete the work. The ICU patients can only leave the unit if they have a doctor and at least one nurse with them because, like this boy, they are usually ventilated and unconscious and require constant monitoring. We finally get all our images and send the patient on to CT to have his head scanned again to monitor the progress of his head injury. It is a major logistical effort to get an ICU patient out of the unit for any procedures so the staff tries to organise for them to have all their tests on the same day.
After the ICU patient I X-ray the other ward patients that have come down to the department. These are mostly chest X-rays looking for or monitoring the progress of various pathologies such as heart failure, pulmonary oedema, malignancies, pneumonia and other chest infections. There are also outpatients who require X-rays. This is where the variety is, lots of follow up X-rays to assess fracture healing, first presentation X-rays looking for pathologies.
Then it’s 1600 hrs and time for my dinner break. I share it with the two other people on shift with me, Jane and Jeff, and we have a chat about our weekend and so forth and decide who will be doing what for the evening. Jeff and I are both CT qualified so one of us will have to stay in the Emergency X-ray Department at all times in case any trauma patients come in. Jane will cover any theatre cases that may be required and we’ll split the rest of the tasks between us.
1630 hrs: dinner is over, so I get a handover from the day staff in Emergency X-ray then I go around to the Trauma Centre and check that all the equipment is working and we have enough of each type of film cassette. Back around to the department and I X-ray a few emergency patients. One is an elderly lady who has fallen and hurt her hip. She is a difficult patient because she is in a great deal of pain and she also doesn’t speak any English. I X-ray her pelvis first to get an idea of the severity of her injury and I see just from that, that she has fractured her right neck of femur. So while she is still I X-ray her chest as well because eventually she will go to theatre to have that repaired and because she is elderly she is an anaesthetic risk and the doctors will want to know what her lungs look like. Then I have to get a side on picture of her fractured hip, a little trickier, given that she can’t move. That managed, I call an orderly to take her back to the Emergency Department and finish all my paperwork.
It’s time for the day staff to go home now and Jane, Jeff and I are on our own until 2345 hrs. Jeff starts scanning some of the emergency patients that are left over from the day, Jane is X-raying so I go up to ICU to do a mobile chest X-ray on one of the patients there. Some patients are too sick to come down to the department so if it is for just a chest X-ray then we will take the mobile X-ray machine up to them. There are a lot of nasty bugs in ICU at the moment so infection control is very important. I put on my safety glasses, a disposable plastic apron and two pairs of disposable gloves. I get my cassette ready, look at the patient and decide on and set my exposure factors. Then with the help of the patient’s nurse and an orderly we sit the patient upright and I position my film behind them, all the while making sure none of the numerous I V lines and leads and monitors are pulled out because this patient in unconscious and ventilated. Then I strip off my outer gloves and position my machine and clear the area of people and take the X-ray. Then we reverse the process and clean everything before I can leave and process the image.
Down in the department, things have gotten very busy. Two trauma patients have been brought in and Jane and Jeff are doing their preliminary X-rays. These are car accident victims from two different accidents. One is a pedestrian who was struck by a car and is in a critical condition with multiple fractures, internal damage and worst of all head injuries. Jane does the bare minimum, chest, pelvis and cervical spine X-rays because the doctors are very keen to get the patient into CT and see what the patient’s brain looks like. There are about 20 medical staff around this patient so I go and give Jane a hand while the CT scanner warms up. Jeff’s trauma patient was the driver of a car who hit a tree at low speed and they are quite stable but still will require X-rays and CT scans to ensure that nothing has been missed.
Jane’s patient is ready to be scanned now so with the help of the nurses and doctors I get them positioned on the scanner and begin. This patient is so critical that two of the nurses, wearing lead aprons, stay inside the scan room while I’m scanning to monitor the patient. I start with a brain scan which is looking very nasty, the patient’s brain is swelling and because the brain is encased by the skull there is nowhere for it to go and if the pressure is not released immediately then the patient will die. The trauma doctors and the radiologist look over my shoulder while I scan and they are already on the phone organising a theatre for this patient. The radiologist and the neurosurgeon are discussing the severity of the swelling and the likely outcome to decide if there is time for me to scan the chest, abdomen and pelvis to assess the internal injuries. They decide there isn’t time and the neurosurgeons rush the patient to theatre to relieve the pressure on the brain and hopefully save the patient’s life. We won’t see this patient again tonight, they will go to ICU from theatre and when they are more stable they will have the rest of their X-rays and CT scans, probably in a few days.
Meanwhile the X-ray requests have built up so Jane is prioritising them and I start calling for the patients to come around. Jeff continues scanning the non-trauma emergency patients. We get a bit of a system going and Jane and I work together lifting the heavier patients and getting their X-rays done. Then the trauma pager goes off again and this time it’s a man who has electrical burns as well as his other injuries. He was electrocuted while working at the top of a power pole and has fallen the full height of the pole. He is conscious but in a serious condition. Since Jane and Jeff have already X-rayed traumas tonight I go around and start. At the Alfred we start with a supine chest X-ray and process it immediately because this is the X-ray that will give the doctors the most information about injuries, other than head injuries, which will kill the patient. From there depending on what the doctors and nurses are doing and what we can reach we do a pelvis X-ray and full spine X-rays, that is two views of each of the cervical, thoracic and lumbar spine. Then we do any limbs that may be required. All the trauma team wear lead aprons so they can continue working on the patient while we X-ray. This man has gotten away fairly lightly except for his burns, considering that he fell the height of a power pole he has only broken his left femur. He is wearing a cervical collar to protect his neck because he will need CT scans of his neck before the radiologist will declare that his cervical spine is clear of fractures. Meanwhile, the plastic surgeons have been assessing his burns and they have decided, after consulting with the trauma doctors, that he is stable enough to go to theatre and have his burns debrided and treated. Depending on his condition, the orthopaedic surgeons will be able to stabilize the fracture in his femur when his burns have been treated.
After I have finished processing all my images and doing my paperwork and handing them all on to the radiologist to report I go back to the department. Everything has returned to a manageable level of chaos and some lovely person has bought lollies for a little sugar lift before we continue. Jeff has finished scanning and is X-raying some more emergency patients. Jane has left a note saying she has gone to ICU to do three mobile chest X-rays so I scan the burns patient’s neck and then he goes back to trauma to wait for a free theatre. I then go and give Jeff a hand to try and finish before the night shift arrive.
Jane returns and finally the night shift arrive at 2330 hrs. We give them a handover and let them know the status of the trauma patients and which ones still need examinations that for various reasons we weren’t able to do. Finally it’s time to go home and I realise that I haven’t sat down once except for our 30-minute dinner break, which was at 1600 hrs. No wonder I’m tired!