Interview Pack 2

Question 1

What are your requirements under IRMER ?

Answer 1

• does are kept to a minimum
• Optimise exposures to children , potentially pregnant patients and for health screening
• Justify exposures

Question 2

Who can justify exposures according to IRMER ?

Answer 2

Radiologist and Radiographers . It’s our role as radiographer to make sure every exposure is justified and we have the right to decline image requests if they are unjustified.

Question 3

What is the role of the Employer ?

Answer 3

• Person with overall responsibility for work involving medical exposure
• ensures all provisions required are in place such as QA check for machine
• installing and buying machines, radiation risk assessments when rooms are designed

Question 4

What is the role of the Referrer ?

Answer 4

-Registered professional who can request exposures

-Required to provide sufficient medical data to allow practitioners to make a informed decision regarding justification

-make sure they are clearly identified on the referral and it’s signed by them

-must provide accurate identification information for patient and procedure so operator can identify patient and give correct medical exposure

Question 5

What is the role of the Practitioner?

Answer 5

-to justify exposures and authorise them
-ensure referrer has provided sufficient information so they can justify accurately

Must consider :
objective and benefit of the exposure, previous exposures and their reporting , alternative techniques involving less radiation,lmp checks

Question 6

What is the role of the operator ?

Answer 6

To carry out practical aspects of exposure they are responsible for :

• justifying exposures
• Patient ID
• Lmp checks
• Setting up and preforming the exposure abiding to ALARP rules
• doing QA on machines

Question 7

What are you supposed to consider during Justification?

Answer 7

• check clinical details on referrals and If they indicate a need for imaging
• Look at previous examinations and check time gap
• Medical exposure shouldn’t tell us information we already have

Question 8

What’s a 3 point ID check

Answer 8

Name , DOB , address

Question 9

Explain how under IRMER you should follow ALARP rules ?

Answer 9

Distance, Time, Shielding

Time : sharing duties among staff to reduce time exposed

Distance : maximising the distance from radiation source ensuring only those needed are near

Shielding: lead shields in walls , around the tube , lead gowns and gloves , beam should never be facing the console wall but towards the door or walls

Question 10

You take an image and notice the image contrast isn’t great what do you do ?

Answer 10

Increase the Kvp

If it’s going up very high I’ll reduce the mAS slightly but not to might as a High gap also leads to poor image contrast

Check correct FDD is used

Question 11

What should you consider when adjusting exposure factors to keep the dose as low as possible?

Answer 11

• When increasing kvp also lower the mAs to compensate and keep dose low
• However you have to factor in that having a high kvp and low mAs reduces image contrasts and image quality
• Increase FDD to decrease patient dose but also increase mAS so same dose is given to detector as this produces better images

Question 12

What do you do when you have a woman of childbearing age ?

Answer 12

Lmp check and have patient sign consent form

28 day rule for X-ray
10 day for ct and barium enimas

If lmp date is out of window get patient to do a pregnancy test

If calling ward patients down get nurses to ask patient for lmp and they should do pregnancy test before sending patient down

If its walking in patient , can ask the HCA to do the test for me if it’s busy , if not I’ll do it myself.

On patients I observed that A&E patient would go back to have the test done by the nurses there.

Just depends on my availability in the moment how I would go about doing the test if needed

Otherwise if all clear , I get consent form and patient to sign before proceeding with anything .

Also document if pregnancy test was needed and the outcome of test .

Question 13

What would you do when presented with a dementia patient?

Answer 13

Gauge their reasoning by engaging them in conversation to see the best way to communicate with them , if I can explain to them directly or will I need to get their career or relative to relay information across

Gauge their and capability by assessing their mobility ( are they coming in walking or using a frame or are they in a wheelchair or trolley

Give information slowly, talking to both the patient and the person who they have come with. Always talk to patient and involve them in conversations

• first test of reasoning can be ID check if they are able to recall their name and all the details , allows me to know how best to present my words

Under the mental capicity act they can’t consent for themselves so I proceed with the examination as they refer has consented on their behalf , if they’ve come with a relative I can seek verbal consent from them when continuing with the procedure .

If the patient is not staying still and cooperating , I will ask the career or relative if they are happy to pop on a lead gown and help keep them still ( if female and in childbearing age , do Lmp check , make sure to get a consent form signed after)

If patient refuses to comply , I will first attempt to explain the benefits of the procedure to them to convince them to cooperate ,if that doesn’t work and having people come in lead aprons to assist. Let them go and try later and let referrer know.

Question 14

What do you do when presented with a safeguarding scenario ?

Answer 14

If I see signs of neglect and abuse :
- if we are alone I’ll ask them what’s happened and try talk to them to get information (adult )

Immediately report to senior and ask for guidance with trust policies moving forward with the situation

But I do know I should call the safeguarding number , and refer them appropriately

If it’s a child , I’ll not address anything with the the parents , after the procedure , I’ll talk to the nurses in A&E and make sure they don’t let them go home with them child .

Call social services and the police to proceed with safeguarding

Make sure I document everything

Question 15

What would do when you encounter a machine failure (Radiation overexposure)? ✅

Answer 15

If patient is mobile ask then to join me behind screen and leave room

Press emergency stop button

Note down the dose , if it’s overexposed and exceeds report this to CQC

Report manager , and her engineer called in

Explain to patient what happened and arrange for them to be images in another room so they still get a diagnosis

Question 16

1. What projections do you use a Grid for ?

Answer 16

Grids are used for :
Abdomen
Skull
Spine ( except Cspine Lat)
Pelvis

Question 17

What steps do you take to ensure optimal image quality and clarity ?

Answer 17

Make sure I follow all the steps for positioning and techniques such as when the tube needs angling , when grids aren’t or are needed , correct FDD, making sure positioning will get anatomy in the correct alignment required

The exposure is correct for the projection also considering the size of the patient so that we get good image quality if we have a larger increase the Kvp so the beam gets through them easily and we get good image contrast

Collimate appropriately to reduce scatter and get good image contrast

Question 18

Can you troubleshoot common issues with radiographic equipment?

Answer 18

If the tubes not exposing , there’s something it doesn’t like so start checking , if I’ve got the right grid in , if I’ve put the detector in properly with it clicking in .

When the tube is not syncing up with the detector like if should automatically, I change the settings so it allows me to line up the tube and the detector without the systems suppor as if I was doing a AP chest . Then I get that X-ray done , and get patient see and done . Then I’ve observed radiographers troubleshoot a recalibration with the machine

Most times you’ll turn it off and on and hope for the best

With some portable equipment sometimes it needs you to plug it in , other times you need to pull the tube down back to the machine where it turns off , then pull it back out and it would have refreshed it’s system

And when all goes left , call a colleague in for fresh eyes help, as sometimes maybe your not seeing something that’s wrong or your having Brian fuzz.

Question 19

Describe the process of adjusting exposure factors based on patient characteristics.

Answer 19

The Samsung and Toshiba machines have those preset exposure factors for different patient sizes , small, medium and larger , which are the best to use to avoid over or under exposure being solely in your hands

However sometimes , you only need a small adjust as the patient can be between medium and large

So I use the Variable kvp technique where all constants are kept the same apart the Kvp ,and I adjust it depending on patient thickness,

Increase by 2 for a increase in patient thickness this just gives the beam a bit more penetration so it can go through the patient and we get good image contrast

Then when the patient is smaller I’ll half the mAs to reduce the dose but still maintain good image contrast with the exposure being sufficient for that anatomy to be penetrated

Question 20

What are the key factors to consider when positioning patients for various radiographic exams ?

Answer 20

• make sure I’ve written everything down
• what sides am I doing, look at the request card and
• make sure I’m doing the correct side for each xray
• did they request for specific views like normal for hands we will do AP and obliques but sometimes they request a true lateral
• Making sure the exposure factors are correctly adjusted for each view to make sure I’m not giving the dose for a pelvis on a ankle X-ray
• Depending on trust policies , I could also consider if I can reduce the amount of exposures by getting two xrays in one view . Like can I open up my collimation to get the forearm and the elbow in one take

Question 21

Explain the principles behind different radiographic techniques (e.g., AP, PA, lateral views)?

Answer 21

AP is we want the posterior side on the detector and the beam coming in on the anterior

PA anterior on the detector beam coming in on posterior

Lateral is getting the side view and normal involve super imposition of anatomy

Question 22

What measures do you take to minimise radiation exposure for patients?

Answer 22

Correct exposure factors being used so if it’s a smaller patient I’ll reduce the kvp and mAS .. ( the automatic dose adjustments what I saw on placement)

keeping in with ALARP and IREMR , I’ll think about time distance and shielding

Make sure I’ve used the correct FDD and ensure tube is far enough from patient normally 100 for most X-rays , 180 for chests , 120 for pelvis

To reduce repeats , make sure I’ve done all my checks for artefacts , positioning accuracy like have I got the patient that turn in their toes, have I told them to hold their breath for the cheat , put their hands up like they are praying for the lateral spine views . These checks will reduce their exposure times

Also Collimating as tight as I can , but make sure all the needed anatomy is within my collimation marks to avoid a retake

Question 23

Describe the process of evaluating and critiquing radiographic images for diagnostic accuracy.

Answer 23

PLATECAANN

P = patient identification
Can I see the patients details are they the correct ones according to image request

L= labels
Has the correct marker been used according to how image presents

Are any other labels needed , like portable , AP for chest

A= area of interest
Is all the anatomy required seen , has anything been cut off

T= technique
Is positioning correct, has this been centred properly, is anatomy superimposed as required

E= exposure
How is the image quality , is contrast okay , is sharpens okay

C= collimation
Could if have been collimated more

A= artefacts
Does patient need to take any clothing of jewellery off , is there any detector or grid artefacts

A= abnormalities
Is there a pathology, do I need to red dot this and make sure patient doesn’t go home and is seen by doctor

N= need for repeats

Do I need to adjust exposure factory’s for better image contrast

Is an artefact blocking anatomy

Does positioning need to be adjusted for diagnostic purpose

N= need for further views

Do I need to do further views, getting lateral view if I see displacement in a fracture

for example a hand X-ray i would get a lateral view if I see a fingers been displaced anteriorly or posterior or bone fragments have been displaced

Question 24

. How do you ensure accurate positioning for capturing specific anatomical views?

Answer 24

When it’s AP or PA I want to make sure there is no rotation of anatomy that’s not meant to be seen as such

Lateral will make sure the anatomy is rotated in a way that’s it’s completely superimposed

Oblique have to assure anatomy is rotated to the extent it’s neither almost lateral or PA

Question 25

How does knowledge of anatomy influence your approach to adjusting exposure factors?

Answer 25

I’ll have to think about how dense is this bone and how much penetration power will be needed to get the beam through

Question 26

How do you adapt imaging techniques when dealing with patients of different body sizes or conditions?

Answer 26

For some patients I can easy see where the bones roughly are to make sure patients positioned correctly for anatomy to be seen as needed

Whereas with larger patients you can judge by the eye and I’ll need to palpate , after asking for permission of course , but I’ll need to feel to know okay this is the patella

Question 27

Explain how you would handle imaging situations involving mobility-limited patients.

Answer 27

I may have to use sponges to support them in certain positions a cushion to help them prop up or lean against

Or when it’s really difficult for them to move I’ll do their X-ray keeping them in the wheelchair, pop their legs on a chair

Sometimes you won’t be able to get them into Clark’s positioning you’ll have to adapt techniques thinking about how you want the anatomy to be in your mind and position with that in mind