Pediatric Radiography Techniques
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A radiology technologist shares his insights for imaging pediatric patients.
By Terry Ferguson, Sales Development Manager, Carestream Health.
Radiology technologists interact with people who are sick and frightened every day. However, pediatric radiography requires heightened sensitivity to our patients.
We professionals are much like a brush saturated with fresh paint. We leave our texture and our color on everyone we touch – and even more so on children. Have you ever wondered what kind of art work you’ve produced some days?
Whether you’re a novice or a veteran at imaging pediatric patients, it is worthwhile to review techniques for imaging our youngest patients. My insights are based on my 41 years of experience as a radiology technologist.
First and foremost, remember that children are not little adults. Do not expect adult reactions. Also keep in mind that:
- Your behavior with pediatric patients will influence their perception of and mood for all future radiology examinations.
- Technologists are rarely trained in Pediatric Psychiatry. However, we can go about the task of imaging young children with good common sense, and extra patience and compassion.
- The personality and psyche of children vary dramatically with age and to some extent with gender.
- The more sensitive and adaptable we are in dealing with a child will in turn make them more cooperative and also ease the anxiety of their hovering parents. Unfortunately, the inverse also is true.
- Children, like most patients, are likely to be confused, frightened, and feeling ill.
Inside the mind of the pediatric patient
There are several factors that influence a child’s behavior more than adult patients. These generalities are perhaps obvious to many of you. However, it is easy to forget them in the midst of a busy day.
Degree of anxiety: Often patients have fear of the possible primary illness. But children have less context and rationale than adults to corral their fears. Also, some children might think their injury is a punishment for having been “bad”.
Family attitude toward the medical profession: The effect of a negative, critical attitude of parents toward doctors is no less damaging than an unrealistic attitude toward teachers or law enforcement. Parents might threaten a child’s bad behavior with “Do that again and I’ll have the doctor give you a shot.”
Read the related blog on Diagnostic Reference Levels for Pediatrics.
Developmental level: A chest radiograph for a 12-year-old female is an embarrassing ordeal. In contrast, most 12-year-old males have little modesty about their chests. However, all children are modest to some degree about having their genitals or backsides exposed after ages 4 to 5. This is partly due to modesty, but also due to fear.
Reaction to the procedure: Patient response is greatly influenced by existing emotional problems. For example, a fearful child will be more fearful. A pediatric patient who kicks and screams might be extremely scared or disoriented. Don’t misinterpret their actions as those of a “mean little kid”, or “spoiled brat”.
Separation anxiety: The move to a hospital is especially traumatic for the under 5 years-of-age group. They don’t understand why they are no longer at home. They left the security of their home for a strange place where everything – the mattress, room, smells, noises, and people – are foreign to them.
Stranger Anxiety: At age 5 months, even when mother is nearby, the child has a sobering reaction when approached by a stranger. At eight to nine months, the child will react to separation from mother, even though some stranger (perhaps you) offers “goodies”.
These are factors that the pediatric patient brings with them to the hospital. Now let’s consider what is happening in the hospital environment.
Impact of the hospital environment on pediatric patients
For radiology technologists, the hospital is an integral part of our lives. It is so familiar to us that we might forget that for others, it is a foreign, noisy, and possibly frightening place. This is especially likely at general hospitals where it is not routine to image infants and children.
Based on my experience, here are some of the more significant factors within the hospital in general and some specific to Radiology that can trigger a strong reaction from a child.
The mood of the hospital personnel: Sick patients might lie still with their eyes closed, but they are listening – and probably more acutely than usual. Everything you do, even your mood, leaves an impression on them. No matter how personal you make the radiology exam, you are only one of many interactions that the pediatric patient will have with hospital personnel. It is also likely that the child will have a different technologist on a repeat visit. A well-executed visit with you can set the tone for the child’s future imaging exams and interactions with other hospital personnel.
Large machines: Children are fascinated but usually not scared of cement mixers or bulldozers although they are large and unfamiliar. However, an unfamiliar and large X-ray unit can be terrifying. Why? Because it is suspended directly overhead while the child is in a highly vulnerable position. He or she is immobilized on a hard impersonal table and they aren’t holding mom or dad’s hand.
Noise: Noise can be the catalyst that converts inner tension with an outward varnish of calm into unmanageable convulsive fright. In addition to being utilitarian, the X-ray table is a perfectly constructed sound box. Are you driving the bucky tray “home” with a good bang? Do you slam cassettes on the tables?
Here’s something to try on yourself. Lie on an X-ray table on your side with your ear glued to it and ask a colleague to slam a cassette down. Better yet, repeat the procedure someday when you have a fever of 102, a headache, and every muscle is throbbing.
Odor: Odors are capable of generating all sorts of emotions. You’ve probably never given a thought to the insults of your early morning coffee breath or stale cigarette odors.
Temperature: Cold hands, frigid tables, icy cassettes, and refrigerated cleansing solutions applied to any body’s bare skin is unwelcome. For a sick child, it can be intolerable.
Movement: X-ray table movement is very important! Take time to explain to the patient what you are doing before you begin tilting an X-ray table in either direction. Pause the table half way down to give them time to orient themselves. Even better, make it a game with youngsters: Science fiction? Astronauts? Magic? I realize that in certain instances it is imperative to move quickly, but this should be explained before and during the examination.
Helplessness: Being powerless creates a very anxious state. The young pediatric patient is helpless and exposed in the presence of a stranger who – in their small minds – could be a potential enemy.
Immobilization: We ask children to lay still, thus stifling the very tactics they use to cope with anxiety. They are unable to fidget, suck their thumb, or stroke their hair to calm themselves down.
I hope you found these insights into pediatric imaging helpful. If nothing else, remember to treat pediatric patients as though they were your own children. For the brief time you are performing your exam … they are!
Terry Ferguson is an Air Force trained Registered Radiologic Technologist with a BS in IT Management. He has been a Staff Technologist and Chief Technologist at St. Louis University Hospital and the Radiology Director at Cardinal Glennon Children’s Hospital. Terry has held Sales Manager, Product Specialist, Training Development Manager, and Sales Development Manager Positions in the commercial arena. Currently, he is the Sales Development Manager at Carestream Health.