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Emergency in Radiology Department

What is the radiology department?

Radiology is a branch of science that uses medical imaging techniques to diagnose (by giving images of internal anatomical structures) and treat the diseases within the body.

The radiology department is that part of healthcare or healthcare that uses a variety of imaging technologies such as X-ray, Mammography, Fluoroscopy, Computer Tomography (CT) scan, Magnetic Resonance Imaging (MRI), Ultrasound and Positron Emission Tomography (PET) scan to diagnose and treat the disease in your body.

The radiology department usually located in the basement or ground floor of any healthcare or hospital, near the emergency department. The purpose of this is radiation safety and easy access during an emergency.

Manpower in Radiology Department

Radiology Technicians

The acquisition of radiography is usually carried out by the radiographers, radiology technicians, and radiology technologists.

Radiologists

The medical images taken by them are interpreted by specially trained doctors, the doctors interpret these images and produce a relevant report of their findings impressions or diagnosis, knowns as radiologists.

Radiology nurse

A radiology nurse is a registered nurse, the work of a nurse is to prepare the patients before the procedure who are going under radiation treatment, getting ultrasound & MRIs, or receiving radiation therapy for cancer. They also monitor the vitals such as pulse, blood pressure, etc. of the patients.

So, these are the important staff of the radiology department. There is some other non-medical staff who are also enrolled in the department.

The strength of manpower may vary according to the daily workload.

The workflow in the radiology department

The radiology department provides health facilities during routine and emergency case by functioning 24 hours a day.

During any medical emergency patients usually come to the casualty/emergency department and for further diagnosis and management, the patient is sent to the radiology department if indicated.

Emergencies in the radiology department can occur while handling the traumatic, vulnerable patients and in some critical circumstances.

Emergencies in Radiology Department

Trauma

What is trauma?

Trauma is defined as a sudden, unexpected, dramatic, forceful, or violent event. Or it also is defined as a serious injury caused to the body that may be life-threatening. Trauma affects a person in all ranges.

Causes of trauma can be blunting, penetrating, explosive and thermal forces commonly.

The radiographers in the radiology department must be prepared for a variety of procedures and examinations on the patients of all age groups.

Specialized trauma imaging systems can reduce the amount of time required for obtaining diagnostic images.

For the fractures and foreign body localization imaging modalities like portable radiographic units, mobile fluoroscopy units, dedicated trauma c-arm unit, and CT scan may be used.

During the radiographic procedures, the primary necessity is immobilization devices because trauma patients cannot hold the required position and some parts that are injured need external support.

Imaging modalities-

Stat scan critical imaging system

A stat scan critical imaging system is a flexible format of the digital radiography (DR) system. It works as a whole-body scanner for skeletal and soft-tissue using a lower dose of radiation (x-ray) with digital enhancement and enlargement capabilities. A stat scan is a recent advancement for the examination of trauma patients.

In India, it is yet to be introduced but several trauma centers in other countries have incorporated this technology into their advanced trauma life support protocols.

With this technology anterior-posterior and lateral images can be acquired within 3-5 minutes by using 1/3rd of the radiation required for this radiography.

Digital subtraction angiography (DSA)

Digital subtraction angiography (DSA) can be very useful in the case of any vascular injuries caused by trauma. Angioplasty can be also done with the help of DSA. Learn more about DSA

Immobilization devices and stabilizers

Immobilization devices and stabilizers are those part of medical equipment that helps to keep a body part in a fixed position for an extended period of time. These devices include:

  • Elbow splint
  • Finger splint
  • Cervical collar trauma
  • Cervical collar- pediatrics trauma
  • Spinal board

Basic practices in trauma radiography

Radiographers in the radiology department must always be conscious about not removing any immobilization devices such as the cervical collar, stabilizers, polyurethane from casts, spine boards, etc. during any radiological procedure or examinations.

These immobilization devices need to be removed in cases of further fatal injury or sudden death of the patient.

Role of Radiographer

What is the role of radiographer?

The role of radiographer includes:

  • Speed: Radiographers should be efficient in producing quality images in the shortest possible time.
  • Accuracy: They should take radiographic images in optimum image quality and minimum repeats.
  • Quality: For a radiographer or radiology technologist the quality of the image they are producing is a must. The quality should not be sacrificed for speed. Do not use the patient’s condition as an excuse for a bad quality image.
  • Positioning: It is important for a radiographer not to aggravate patient’s conditions when taking images. Move tube and IR (image receptor) or cassette as much as possible, instead of a patient.
  • Practice standard precautions: Always wear gloves before touching the patients. Do not expose to body fluids.

Radiation Emergencies Situations

Radiation accident

What is a radiation accident?

A radiation accident is a situation where there is an unintentional exposure to ionizing radiation or radioactive contamination. These accidents include:

  • Radiological accidents
  • Nuclear accidents

The main type of radiation accidents

These can be classified into three groups, these groups involved:

  1. Workers- Accidents during work
  • Radiographers, radiology technicians, radiology technologist
  1. Public exposure- Accidents due to loss of control over the radiation source
  1. Patients- Accidents in medical applications
  • Missed administration of radiopharmaceuticals
  • Miscalculation dose for the radiotherapy
  • Multiple radiographic procedures and CT procedures exceeding dose limit

 

Radiation accidents can occur at

  • Irradiation facilities
  • Material testing (sealed sources)
  • Material testing (x-ray devices)
  • X-ray and radiotherapy devices (medicine, research)
  • Isotope production facilities
  • Unsealed radionuclides (medicine, research)
  • Nuclear reactors
  • During transportation of radionuclides

Radiation-induced injuries

Ionizing radiation can affect human bodies internally and externally. The radiation injuries include:

Hematopoietic

In this type of radiation injury, all blood stem cells (lymphocytes, granulocytes, thrombocytes, and RBC precursors) undergo radiation-induced cell death. Other conditions include:

  • Pancytopenia
  • Sepsis may the cause of death
  • Hemorrhage

Gastrointestinal

This targets G.I stem cells, lymphocytes in Peyer’s patches.

The result of this can be mucosal lining sloughs, mucosal integrity damage, mucosal hemorrhage, ulceration, electrolyte/fluid imbalance, sepsis (bacterial translocation), paralysis of ileus, etc.

Cardiovascular / neurologic

These may be results in pyrexia, decreased higher cortical and motor function, hypotension, increased intracranial pressures within minutes to hours of the radiation exposure.

Necropsy: brain hemorrhage and necrosis, white matter edema, demyelination, microvascular, and endothelial damage.

Miscellaneous conditions

Skin

Initial transient erythema for few days primarily and secondary erythema progressing to blisters to ulcers under one month. The more the exposure the earlier the manifestations

Pulmonary

  • Acute radiation pulmonitis
  • Significant crepitus
  • Significant mortality from hypoxia comma within 2-4 weeks

Chronic radiation syndrome

It is a constellation of the health effects of radiation that happens after months or maybe after years of chronic exposure to a high amount of radiation.

The development of chronic radiation syndrome depends on the speed and severity proportional to the radiation dose received. 

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