The practical imaging aspects of the X-ray procedure

4. Effective communication

Effective communication is an essential element of all imaging examinations and a fundamental skill for radiographer / RTs6,7. Communication with the patient and ward staff are necessary in order to ensure that the examination is delivered in a timely manner whilst acquiring the necessary diagnostic information. Communication is also necessary to ensure that the examination is conducted safely, this being of relevance to patients, visitors and hospital staff. Effective communication with the ward team is necessary for several reasons (see Table 1). On entry to the hospital ward the radiographer / RT should make themselves known to an appropriate member of the nursing team. This will allow the radiographer / RT to ascertain the location of the patient, this is often available on electronic whiteboards or computer monitors. Nursing staff can also provide advice and assistance with regards to patient communication, individual infection control measures and moving and handling issues (Figure 2). Such information is especially important with the COVID-19 pandemic as there can be different PPE requirements depending on the COVID-19 status of the patient and whether any aerosol generating procedures have been undertaken.  

Table 1. Information typically required from ward staff during mobile radiography.
Patient location
Moving and handling requirements
Specific infection control requirements
Additional (relevant) clinical information
Location of adjacent patients / visitors / staff members
Consent & communication issues
Possible pregnancy status of patients / staff members.

Figure 2.Mobile AP erect chest X-ray image of a COVID-19 patient in which the image is rotated (clavicles not equidistant from the spinous process, cardiac silhouette is rotated over right lung field). Such situations cannot be completely absolved but every effort should be made to produce the highest quality image. Image courtesy of Dr Nick Woznitza, London.

It is recommended that positioning a critically ill patient for a mobile X-ray examination should directly involve ward staff. Such individuals will have greater knowledge on the location of catheters, lines and medical devices and will have a stronger understanding of a patient’s needs. It is important that by undertaking mobile radiography there is no detriment to the condition of the patient, i.e. dislodging medical devices or exacerbating pain. Maintenance of patient wellbeing and privacy is important and should be a continual consideration by the radiographer / RT during the examination. Radiographer / RTs should have knowledge of hospital alert systems used by wards, such as the presence of pressure ulcers, epidural catheters or open wounds from which an iatrogenic injury could occur during positioning for the examination.

Effective communication with the patient is also necessary to ensure safety and the optimal diagnostic yield from the examination.  If the patient is conscious and able to respond verbally then the information that they can provide can help deliver an efficient examination (Table 2).



Table 2. Information typically required from the patient during mobile radiography.
Confirmation of a positive identification / justification
History of any recent imaging (supporting justification / procedural awareness)
Moving and handling needs
Understanding of examination specific requirements, i.e. arrested inspiration
Possible pregnancy status.