Preparation for the procedure

3. PPE

Personal protective equipment (PPE) required for the examination will be governed by local and national guidelines and will be specific to each individual imaging referral (Figure 4).  All X-ray examinations should commence with a correct hand-washing procedure (see Youtube video).  Healthcare associated infections can often be prevented through correct infection control practices and these should be part of formal radiography training curricula and part of regular mandatory training for qualified radiographer / RTs.  Hand hygiene guidelines can be useful to guide practice.  Correct PPE should be worn by all staff members involved in patient handling and imaging and should follow accepted standards (Figure 5).  In cases of suspected or proven COVID-19 the guidance is available and is constantly being updated11. Not only should the correct PPE be worn but the correct protocol should be followed for donning and doffing.

With regards to the image receptor, generally good practice would recommend that this is placed within a waterproof protective barrier (Figure 6).  In many instances it is advantageous if two radiographer / RTs can perform the examination with one ‘clean’ and one ‘dirty’ in terms of infection control.  The radiographer / RT designated ‘clean’ would be responsible for the operation and positioning of the mobile X-ray unit and the initiation of the X-ray exposure.  The radiographer / RT designated ‘dirty’ would be responsible for direct contact with the patient and the positioning of the image receptor. Such systems would also be common for other transmittable infections, for example MRSA, C.Diff and Norovirus.

Figure 4.Mobile DR unit (Carestream DRX) which has been prepared to undertake an imaging examination on a suspected COVID-19 patient. PPE is present on the mobile X-ray unit and also on the radiographer / RT (lead rubber apron under a disposable apron). Please note that PPE requirements have evolved during the COVID-19 pandemic and recommendations should be continually reviewed. Image courtesy of the Countess of Chester Hospital NHS Foundation Trust.

Figure 5.Examples of stages in clinical practice when hand hygiene is required. Image courtesy of Yi Xiang Tey, Singapore.

Image receptor being covered in a protective barrier.
Figure 6.  X-ray image receptor (CR cassette) being covered by a waterproof protective barrier.  Caution is needed when removing the barrier following completion of the examination.  Additionally, opaque barriers such as the one in this image can make confirming the position relative to the patient problematic.  Image courtesy of Dr Kholoud Alzyoud, Jordan.