Geriatric

Question 1

Safety Considerations for geriatric positioning

Answer 1

• Aging affects balance and co-ordination.
• Increased incidence of vertigo + dizziness = risk of falling
• Ensure safety and reassure your patient.
• Additional care resulting from appropriate communication skills enables the patient to feel secure and comfortable.
• Remember to show patience and empathy

Question 2

Always assist your elderly patient to:

Answer 2

• Get on and off the table.
• To change position.
• To sit down.

Question 3

Technical Factors

Answer 3

• Technical factors must be considered when imaging a geriatric patient.
• Loss of bone mass and atrophy of tissues often requires a lowering of kVp (up to 15% decrease) to maintain appropriate contrast.
• If a patient is unsteady or suffering from tremors, use of short exposure times is indicated to reduce risk motion.

Question 4

Abdominal Radiography for geriatric pts

Answer 4

• Supine AP Projection
• Use a radiolucent mattress on the table to provide comfort, blanket to keep them warm
• Support the patient to get onto the table (lower it as much as possible) appropriately should they require assistance
• Ensure you provide appropriate breathing technique prior to leaving the room to expose the image
• Watch that your patient is following directions
• if pts cant stand then do a decubitus
• if they can stand then give them something to hang on to so they dont wobble

Question 5

Abdominal Radiography

Erect AP Projection for geriatric pts

Answer 5

• If patient is unable to stand a left lateral decubitus view would be indicated
• Provide a support if necessary to ensure patient stability

Question 6

Upper Extremities/Shoulder Girdle for geriatric pts

Answer 6

• Geriatrics can have limited movement and flexibility due to arthritis, fracture or history of stroke. So assess their mobility
• Contracted limbs caused by CVA cannot be forced into position and may require adaptation such as cross table lateral views performed
• Routine projections can be supported with the use of sponges, sandbags and blocks to raise and support the extremity being imaged.
• The shoulder is also a site of decreased mobility, dislocation and fractures
• Assess how much movement the patient can do before attempting to move the arm
• A decrease in techniques may be necessary due to destructive pathologies such as osteoporosis.

Question 7

Chest Radiography for geriatric pts

Answer 7

• Ideal positioning of the chest in the upright PA position
• Have the elderly patient wrap their arms around the chest stand as a means of support and security
• The patient may not be able to maintain arms over the head for the lateral view of the chest. Offer the use of the lateral chest bar to provide stability and support
• Be sure to raise patient’s chin so it is not covering anatomy
• Read your requisition noting reason for the exam to adjust technical factors appropriately.
• most common x-ray in geriatric pts
• increase kVp for pt with pneumonia
• decrease technique for pt with emphysema
• AEC isn’t great for pts with pathologies and you would want to manually adjust the technique

Question 8

Chest Radiography for geriatric positioning

Answer 8

• Elderly patients have less inhalation capability resulting in a more “shallow appearing” lung fields.
• May require a higher CR location perpendicular to T6-T7.
• Utilize the second inspiration exposure rule to ensure deep inspiration.

Question 9

Chest Radiography Sitting

Answer 9

• When the patient cannot stand, the examination may be done seated in a wheelchair or on a stretcher in an AP projection.
• If no grid is required with CR cassette – use a lower kVp and increase mAs.
• Angle your tube to match the angle of the sternum.
• Watch that the patient’s chin does not obscure anatomy.
• On lateral view place a large sponge behind patient’s back and use the lateral chest bar.
• If patient cannot raise their arms, use a radiolucent sponge to support arms and clear the lung fields as much as possible.
• In a sitting position, the patient should be instructed on the importance of a deep inspiration

Question 10

Spines

Answer 10

• Radiographic spine examinations may be painful for elderly patients, especially those suffering from osteoporosis, use a mattress
• Positioning aids such as radiolucent sponges will help with exaggerated kyphosis
• Reassure and support patients into position. They may fear falling off the table.
• High incidence of osteoporosis in geriatric patients may require a decrease in kVp and mAs (if manual exposure)
• Older patients may experience tremors or difficulty holding still – recommend short exposure times (higher mAs) to reduce motion.

Question 11

Cervical Spine for geriatric pts

Answer 11

C-Spine

• May be done sitting, standing or supine depending on patient condition.
• May need to change angles to accommodate extreme lordosis /kyphosis.
• May need to angle tube for odontoid if patient cannot flex neck.

Question 12

Thoracic and Lumbar Spines for geriatric pts

Answer 12

T-Spine and L- Spine

• Kyphotic patients may have trouble lying flat. Give them multiple pillows and radiolucent mattress or perform the exam standing at wall detector.
• Use compensating filters to maintain density through the spine such as on Swimmer’s view.
• May need to angle tube for Swimmer’s view if patient cannot move shoulders.
• Ensure patient can lie on their left side for lateral views (no recent hip surgery or joint pain that could hinder them).

Question 13

Immobilization Devices for geriatric pts

Answer 13

• Positioning sponges and sandbags are commonly used as immobilization devices
• The thoracic and lumbar spines are sites for compression fractures.
• The use of positioning blocks may be necessary to help the patient remain in position.
• For the lateral projection, a lead blocker or shield behind the spine should be used to absorb as much scatter radiation as possible.

Question 14

Femur and Pelvic Girdle

Answer 14

• most common fracture in geriatric pts
• Hip pathologies include osteoporosis and osteoarthritis due to age
• Geriatric patients are prone to hip fractures due to falls and increased incidence of osteoporosis
• Femoral neck fractures are very common with trauma
• An AP projection of the pelvis should be done to examine the hip.
• If the indication is trauma, and/or one of the legs appear shorter than the other, the radiographer should not attempt to rotate the limbs if foot and leg are externally rotated.

Question 15

Femur and Pelvic Girdle

trauma for geriatric pts

Answer 15

Trauma

• An AP projection of the pelvis should be done to examine the hip
• If the indication is trauma, and/or one of the legs appear shorter than the other, the radiographer should not attempt to rotate the limbs if foot and leg are externally rotated
• When transferring the patient on a slider board, be sure to move their legs over simultaneously with their body
• The second view taken should be a axiolateral inferosuperior projection of the affected hip.

Question 16

Femur and Pelvic Girdle

Non-Trauma/ Routine Exam for geriatric pts

Answer 16

Non-Trauma/ Routine Exam

• assist the patient to internal rotation of the legs with the use of sandbags if necessary

Exception:

• Post hip replacement surgery patient should not be places in “frogleg” position .
• An axiolateral inferosuperior projection of the affected hip and AP projection is indicated

Question 17

Lower Extremities

Answer 17

• May need to adapt positioning to accommodate patient’s potential pathology and lack of joint flexibility/mobility.
• Positioning on the X-ray table may need to be modified when a patient cannot turn on his or her side.
• Projections of the feet and ankles may be obtained with the patient sitting in the wheelchair by utilizing a stool to support your image receptor and the body part.
• Feet may need to angle the image receptor using a sponge if patient cannot put their feet flat.
• The use of positioning sponges and sandbags support and maintain the position of the body part being imaged while maintaining patient comfort.

Question 18

Cranium for geriatric pts

Answer 18

• A mobile kyphotic patient may be more comfortable with sitting at upright detector instead of lying on the table.
• Have the patient sit tall and hold onto the hand supports on either side of the detector.
• Water’s view may require an angulated tube if patient is unable to extend chin enough
• Towne’s view on a kyphotic patient may be positioned more accurately supine on the table using sponges to avoid large OID and maintain comfort.
• Horizontal lateral view may be necessary if patient is unable to sit.
• Utilize sponges when necessary to help patient hold a position.

Question 19

Lower G.I System for geriatric pts

Answer 19

• Barium enemas are especially stressful for patients.
• Be patient and explain exam completely.
• Maintain patients modesty. Keep covered with a blanket as much as possible.
• If the patient is required to turn on the table, this can cause space disorientation and increase the fear of falling.
• Provide support guiding them into positions and provide words of encouragement.
• Post exam escort your patient to the restroom and check on them every few minutes to make sure they are OK.
• For BE use retention enema tip as the elderly have limited sphincter control.

Question 20

Interventional Radiology Procedures for geriatric pts

Answer 20

• Patient may require additional patience, assistance and monitoring throughout.
• Nervousness, fear of falling as fluoro tables can be narrow.
• Reassure your patient and give additional care.
• Use a radiolucent mattress and offer additional blankets.
• Check in with your patient throughout the exam to ensure they are doing OK.
• Encourage and praise your patient throughout to maintain their comfort.