Trauma Radiography: A Radiographers Role Within A Trauma Team

Recently, in my intermediate diagnostic imaging lectures we have been given two presentations looking at different aspects of trauma within radiography, the role of a radiographer and the radiographer as part of a multidisciplinary trauma team. This along with the fact that trauma radiography interests me and my fascination with the patient pathway of a trauma patient has provoked me to research further into ‘trauma teams’ and the dynamics of a radiographer.

At my previous placement in the Bristol Royal Infirmary I got to witness and participate within a trauma team, I found it exciting but also rather daunting at the same time, as the patient was very unwell and needed immediate care, there were a lot of people with different roles also participating within the patients immediate care needs. It was very interesting to see how all of these separate individuals worked together.

Trauma radiography can be challenging and exciting for a radiographer, however obtaining images of good diagnostic quality can also be extremely stressful. If a radiographer is well prepared, able to maintain composure and also be willing to interact within a multidisciplinary team then this can slightly ease the pressure of the situation.

Trauma is defined as ‘a serious injury or shock to the body, from violence or caused by an accident’. (Farlex. Inc, 2014). Trauma is the fourth leading cause of death in the UK in individuals within their first forty years of life (Sailsbury NHS Foundation Trust, 2013), This is why when dealing with a trauma patient timing is very important, as this could result in the loss of a patient’s life, to minimise the amount of time a radiographer spends acquiring images from a trauma patient, Emergency Departments usually have designated diagnostic equipment located either in the department or extremely close. The first hour after trauma has occurred is called the ‘golden hour’ (Newgard, 2010), and begins the moment the trauma occurs, it is crucial that the patient receives the best possible care within this hour as it can increase the patients chance of survival. The patient while still at the scene of the trauma may encounter paramedics who will transport the patient to hospital where the trauma team will have already assembled and be prepared to deal with any situation that the patient presents.

Once the patient has arrived within the Emergency Department, he/she will encounter a multitude of health professionals; all of these individuals work together and become the ‘Trauma’ team. The trauma team is a multidisciplinary team, within which multiple health professionals work together to promote the best outcome for the patient and to provide the best standard of care. This team consists of:

  • Team Leader
  • Anaesthetist
  • Anaesthetist assistant
  • General Surgeon
  • Orthopaedic Surgeon
  • Emergency Room Physician
  • Nurses
  • Radiographer
  • Scribe

These individuals make up the core of the team, but there may be other members of staff present such as:

  • Porters
  • Haematologists
  • Biochemists

Outside of the immediate trauma team there may also be other health professionals who are indirectly involved within the patients care, such as radiologists, who will authorise additional radiographic procedures that the trauma team leader may require the patient to undergo, theatre staff may also be prepared and waiting if it is thought that the patient may require immediate surgery. Every individual that participates directly or indirectly within the patients’ immediate care needs are all working together as a multidisciplinary team towards the best outcome for the patient, and to provide ‘patient centred care’ which is the main role of the National Health Service (NHS). (Bates & Grimes, 2014).

The role of the radiographer within this team is to start a trauma series of x-rays, firstly starting with a lateral c-spine, then a chest and pelvis x-ray. These views should be obtained in all trauma patients within a trauma situation unless otherwise told by the team leader. (Trauma.org, 2014). It can be hard for the radiographer to safely obtain these images and comply with radiation protection legislations as there may be a lot of individuals within a small immediate area. Radiation Protection is one of the most important duties of the radiographer within a trauma environment; it is the responsibility of the radiographer to protect the patient, trauma team members and them self. In some high risk trauma situations it is impossible for certain members of the trauma team to leave the patient for an x-ray to be obtained, in this instance the radiographer must ensure that team members are wearing lead aprons and that all other team members have moved away to a safe location. (The Royal College of Radiologists and The Society and College of Radiographers, 2012)

The role of a radiographer is described by the Society of radiographers (2003)  as being responsible for providing safe and accurate imaging examinations in a wide range of clinical environments, whilst using a variety of imaging modalities and techniques so that appropriate management and treatment of patients can proceed. I believe that within a trauma situation the role of the radiographer can evolve, it was evident in my experience of a trauma team that not only did the radiographer acquire the image but also had to undertake tasks that may be classed as ‘outside’ a radiographer’s role. Some hospitals specify that a radiographer must answer a trauma call within 5 minutes (The Royal Childrens Hospital, 2012) as the first hour after trauma is referred to as the ‘golden hour’ (Newgard, 2010) and timing is critical. The Radiographer must not leave until they have been dismissed. It is also very important that the radiographer lets the existing team know that they have arrived and also when the images are available to view. There may also be other radiographers involved within this patient’s pathway, for example, if the patient is required to have a CT scan; it is the radiographer’s job to perform this scan.

In conclusion it can be seen that radiography is fundamental within trauma patients’ as it is one of the main diagnostic tools available, and information that may impact on the outcome of a trauma patients care and/or weather anything can be done to help the survive their trauma is gained from radiographic procedures quickly and accurately.

References

Bates, S. & Grimes, K., 2014. Quality Report Kingston NHS, London: s.n.

Farlex. Inc, 2014. The Free Dictionary. [Online] Available at: http://www.thefreedictionary.com/trauma [Accessed 15 October 2014].

Newgard, C., 2010. Emergency Medical Service Intervals and Survival in Trauma: Assesment of the ‘Golden Hour’. Emergency Medicine, 55(4), pp. 235-246.

Sailsbury NHS Foundation Trust, 2013. Sailsbury NHS Foundation Trust. [Online] Available at: http://www.icid.salisbury.nhs.uk/ClinicalManagement/OrthopaedicsAndTrauma/Pages/TraumaTeam.aspx [Accessed 16 October 2014].

The Royal Childrens Hospital, 2012. Trauma Team Compisition Roles. [Online] Available at: http://www.rch.org.au/paed_trauma/guidelines/Trauma_team_composition_roles/#Radiographer [Accessed 16 October 2014].

The Royal College of Radiologists and The Society and College of Radiographers, 2012. Team Working in Clinical Imaging, London: The Royal College of Radiologists and The Society and College of Radiographers.

Trauma.org, 2014. Trauma.org. [Online] Available at: http://www.trauma.org/archive/resus/traumateam.html [Accessed 15 October 2014].

Article Critique: “Pulmonary Embolism in Pregnant Patients: Fetal Radiation Dose with Helical CT”

This week at University I attended a lecture on Radiobiology as part of our Intermediate Diagnostic Imaging studies. The lecture covered the effects of radiation within cells and resultantly the human body as a whole. The lecture also touched on the radiation doses that foetus’ can be exposed to, as part of our blog we have been given an article that is related to this topic to read over and critique.

The article that I am going to critique was written by Helen T. Winer-Muram, MD, in 2002 and is called “Pulmonary Embolism in Pregnant Patients: Fetal Radiation Dose with Helical CT” (Winer-Muram, 2002) it is a medical physics article and its purpose is to calculate mean foetal radiation doses reported by scintigraphy. Scintigraphy is a diagnostic test in which a two-dimensional picture of a body radiation source is obtained through the use of Radioisotopes (Medicinenet, 2014). The aim of this article is to give readers a detailed explanation of the methods of the experiment, how the experiment was ultimately carried out and the results and outcomes that were obtained on completion of the experiment.

This article was published in August 2002 and is now 12 years old; due to its age and with technology developing so rapidly may no longer be viewed as a creditable source. Due to the incredible amount of advancement it CT over the past years since the experiment was carried out, if the experiment were to be undertaken it may not be possible to obtain the same results.

Helen T Winer-Muram, MD is a practising Radiology Doctor with 41 years experience (WebMD, 2014), She specializes in Diagnostic Radiology and Cardiothoratic Radiology (WebMD, 2014). Helen T Winer-Muram, MD has contributed to 71 publications (Vitals, 2014). This makes her a creditable source. Other individuals that contributed to this article are John M. Boone, PhD, who is a professor of radiology (UC Davis Health System, 2014), Haywood L. Brown, MD who is a maternal-fetal medicine specialist (Duke Medicine, 2014), William C. Mabie, MD, who specializes in Obstetrics and Gynaecology, internal medicine and paediatrics (Vitals, 2014), Gerard T. Lombardo, MD who is a pulmonologist (Vitals, 2014) and S. Gregory Jennings, MD. All of these individuals have multiple publications and are all creditable sources adding to the value of this article.

This Experiment was carried out with 23 partcipants, certain test measures/protocols (CT parameters) were kept continuous throughout the study, these were:

  • 120KkVp and 100Ma
  • The scan time: 1second per scintillation
  • Collimation: 2.5mm
  • A pitch of 1
  • Patient position: Craniocaudal
  • Scan extent: 11 cm

With these protocols the mean foetal dose that would be received whilst undergoing a CT scan of the chest was calculated using Monte Carlo techniques. The Monte Carlo technique is a ‘problem solving technique used to approximate the probability of certain outcomes by running multiple trial runs, called simulations, using random variables’ (Palisade, 2014). Also the ‘Monte Carlo simulation is a method for exploring the sensitivity of a complex system by varying parameters within statistical constraints’ (The Mathworks inc, 1994-2014). The article then goes on to explain how the measurements were made and the differences between the cylindrical size that was used and an actual foetal shape and how this would affect the obtained results, ‘Differences in shape between a cylinder and the actual fetus have only a small effect on the fetal dose calculation, as long as the cylinder dimensions simulate the bounds of the fetus’ (Winer-Muram, 2002).

The experiment only used a small sample of pregnant patients, 23 in total, this could have been improved by using more pregnant patients, as ‘Increasing sample size can also give greater power to detect differences’ (Select Statistical Services, 2014) and also it is not specified as to how this sample of patients were picked. These 23 Pregnant Patients were all healthy women, of mixed ages – the mean age was 37 indicating that the patients were of a wide range of ages, mixed body mass indexes and in different stages of pregnancy. Eight of the patients were in the first trimester, nine in the second trimester and six in the third trimester, the results obtained from the experiment would have been more reliable if more pregnant patients were used in each trimester and if all of the patients were of similar age and body mass index.

The materials and methods section of the article was very detailed, it discusses how the experiment was implemented on the phantoms and the doses used.

In the conclusion all of the findings of this research are summarized, showing that helical CT scanning results in a lower foetal dose during all three trimesters.

The article is well presented and has diagrams, although I feel that the results section and the discussion section could have been elaborated on.

In conclusion this article and the data presented within it are relevant to the radiography world and also reinforce dose management and patient safety. There could have been certain improvements that could have been made to make the experiment more creditable and reliable, but it was extremely interesting.

References

Duke Medicine, 2014. Duke Medicine. [Online] Available at: http://www.dukemedicine.org/find-doctors-physicians/#!/haywood-l-brown-md [Accessed 6 October 2014].

Medicinenet, 2014. Medicine Net. [Online] Available at: http://www.medicinenet.com/script/main/art.asp?articlekey=9136 [Accessed 6 October 2014].

Palisade, 2014. Palisade. [Online] Available at: http://www.palisade.com/risk/monte_carlo_simulation.asp [Accessed 6 October 2014].

Select Statistical Services, 2014. Select Statistical Services. [Online] Available at: http://www.select-statistics.co.uk/article/blog-post/the-importance-and-effect-of-sample-size [Accessed 8 October 2014].

The Mathworks inc, 1994-2014. Mathworks. [Online] Available at: 2014 [Accessed 6 October 2014].

UC Davis Health System, 2014. UC Davis Health System. [Online] Available at: http://www.ucdmc.ucdavis.edu/radiology/faculty/boone.html [Accessed 6 October 2014].

Vitals, 2014. Vitals. [Online] Available at: http://www.vitals.com/doctors/Dr_Helen_Winer-Muram/credentials [Accessed 6 October 2014].

WebMD, 2014. WebMD Physician Directory. [Online] Available at: http://doctor.webmd.com/doctor/helen-winer-muram-md-8b6ad87c-92f7-4718-8187-ecb794657eca-overview [Accessed 6 October 2014].

Winer-Muram, H. T., 2002. Pulmonary Embolism in Pregnant Patients:Fetal Radiation Dose with Helical CT. Radiology, 224(2), pp. 487-492.

A Little About Myself……

Hello…… 🙂

My name is Natasha and I am 25 years of age. I am from a town in South Wales called Carmarthen, living in a small little village just outside called Abergwilli. In September 2013 I moved to Bristol, to go to university. Deciding to go to university at the age of 25 and moving away from home and the life I had made for myself since leaving school was a drastic change. Since leaving school at the age of 17 I had worked in various different roles throughout the health sector, starting off as a domiciliary carer, working as a support worker within the adult, children and adolescent mental health teams within Carmarthenshire and finishing up as a support worker within a company called Crossroads, which provided rest bite care to individuals and their families within the community – which allowed service users to remain living at home whilst giving their families a break. I thoroughly enjoyed my role within the Crossroads team. When I was 22, I decided that I wanted to create a better life for myself and decided to go back to college to undertake an access course, which I did part time alongside my job. After completing 1 year of my access course I applied to University to study Diagnostic Imaging, I got an offer from a few universities but decided that I wanted to study at UWE. September 2013 came and I moved to the Glenside campus halls and very nervously started my first day in uni.

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This is the September 2013 Cohort, Diagnostic Imaging

Outside of academia, I have a dad, called Chris, a mum, called Gaynor and a (not so) little sister called Laura. Laura also attended UWE to study Diagnostic Imaging and is now a qualified radiographer, she helps my greatly within my course. I have a dog, called Lillie who is a miniature jack Russell and has a very loving/naughty personality and gets up to all sorts of mischief when nobody is watching. I also have a partner called Ben, to whom I recently got engaged to. I am very lucky in the respect that I have so much support in what I am currently doing from family and friends.

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I have made lots of friends in uni and also have friends that live in Carmarthen. In Bristol I live with two fellow radiography students, Jessica and Rob and also Liam who is a student paramedic. In my spare time I enjoy socializing with friends, reading, watching films and driving. I have played the piano since a very young age and also enjoy swimming and motor sport. I enjoy going back home at weekends to see my family, friends and also my dog, who is being looked after by my parents whilst I am at university. Whilst at university I have a job as a radiography assistant and I am looking forward to still having an active involvement within the radiography world alongside my studies and placements.

I have an interest in Forensic Radiography and one day I would like to specialize within this field, also having a keen interest in anthropology and forensics.

More information can be found on forensic radiography here:

http://afr.org.uk/about-us/

I have started this blog as part of my second year radiography studies, aiming to learn how to write reflectively and to improve my communications skills.