Radiographers do not have clinical responsibility for patients, something I
never tire of telling my SHOs! Radiographers do, on the other hand, have a
duty to control the use of ionising radiation (a laudable aim), which I
believe produces a conflict of interest when it comes to clinical imaging. I
therefore do not believe radiographers are in a position to decide which
patients require clinical imaging, not least because they are not
clinicians. You may note that even the Royal College of Radiologists still
believes that plain skull radiographs are indicated in certain groups of
patients.
However I accept some of your points; inexperienced "cas" officers will
often request radiography inappropriately, where other diagnostic and
management options are preferable. This does not mean that plain radiography
should be abandoned altogether. You should be able to discuss such cases
with A&E seniors - if you cannot find them or discuss these cases with them,
then there is something wrong with your A&E department.
And in answer to your last point, plain films do indeed make a difference -
see my earlier post. Finally I agree that most x-rays should be carried out
with a view to influencing management, and the management plan should
therefore vary depending on x-ray findings (the astute A&E physician will
appraise his options before he requests the study). There is still however a
role for imaging for reasons that don't directly affect medical management
e.g. for prognostication. I sometimes x-ray (request x-rays!) for body parts
where I know the management will not be affected, but where the professional
sportsman or dancer needs to adjust their recovery depending on the presence
or absence of a fracture. And what of reassurance? We have a duty to treat
patients' minds just as much as their bodies, don't we? When I was younger I
used to spend 5 or 10 minutes attempting to dissuade certain patients from
x-rays. Now I only try for 1 or 2 minutes. Partly as I know dissuading them
only forces them to other hospitals, or back to my own the following day.
Partly also as the x-ray is usually cheaper than 5 or 10 minutes of my time
(I'm not simply talking salary, but the other useful things I can do in
those 5 or 10 minutes). And partly as the normal x-ray neatly finishes the
consultation, and often saves us from lavish management plans and follow up.
Radiographers often frown at the volume of "normal" x-rays. I say that
normal x-rays are as valuable as abnormals, perhaps more so. You may argue
that we shouldn't x-ray skulls when we could simply observe the patients
overnight. I argue that the normal study (whether x-ray or CT) allows me to
discharge the patient when beds are at a premium. Radiographers do not have
to grapple with such concepts, or such patients!!
Adrian Fogarty
----- Original Message -----
From: "Vikki Chase" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, September 27, 2001 1:01 AM
Subject: Re: Head injuries.
> As a radiographer often forced to x-ray screaming children who are called
in
> from running around the waiting room (when the parents often say they just
> came to Cas to be sure) I would wholly support abandoning plain films.
> Children often have to be demonstrating abnormal behaviour ,i.e. able to
> lie still while imaged, before diagnostic views, even with several adults
> pinning them down, is possible.
> And an example from this evening- a 1 week old baby sent for plain films
> after falling off the sofa onto a carpeted floor 2 days ago- with a
history
> of crying and drowsiness since. An SHO request which when questioned
> insisted upon the films.
> Adults are often sent for plain film skulls- which I find frustrating when
> you can often predict their management before imaging - so does the plain
> film make a difference?
>
> Vikki Chase
> BSc (Hons) Diagnostic Radiography
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of Rowley Cottingham
> Sent: 26 September 2001 20:32
> To: [log in to unmask]
> Subject: Head injuries.
>
>
> I believe that we should abandon plain film radiography in the management
of
> head injury.
> My view is that we should CT scan or nothing, as the pick up rate on plain
> film is
> ludicrously low, and if you do see a fracture you are obliged to scan
> anyway. Comments?
>
> Best wishes,
>
>
> Rowley Cottingham
>
> [log in to unmask]
> http://www.emergencyunit.com
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