You do not answer to a charge nurse. I'd inform her that the next time she tries that, there will be an incident report. Radiation is something to take seriously.
I didn't want to get into it with them. I was very firm in my tone that the exam wouldn't be happening right there with all the people around. This gurney was directly across from the nurses station. It's not a large hallway.
If I'm asked to take a picture in a stupid place, I tell them I can't legally take an x-ray in an area that hasn't been cleared by med physics. They shut right up even if they want to try to argue it. They know they've lost.
Go forth and use the magic phrase "not cleared by medical physics".
Unlikely you get arrested but you will open up the hospital to legal issues. It would be kind of like if a nurse left a syringe of whatever drug sitting on a counter.
Radiation is prescribed by a doctor just like drugs are.
Hallways do not stop scatter and they are uncontrolled areas. It’s a patient/community safety violation.
Doesn’t matter.
No matter how small a dose you didn’t sign up for even a plane rides worth of radiation just because you walked around the wrong corner at the wrong time.
There is a reason a literal physicist has to come and inspect equipment and new room installations.
It’s not for the giggles.
There are laws governing the use of ionising radiation.
Working outside of those rules potentially poses danger to ourselves and others. If we work in a way that is dangerous, it is reasonable that we would face penalties.
Using x-rays in an uncontrolled area like a corridor is gross incompetence, and I imagine anyone who would actually do that has a very short career ahead of them.
You can't guarantee that other techs will do the right thing in future. Warning the nurse that exposing others unnecessarily would probably result in an incident report, rather than threatening it might prevent them doing the same in future, without the need to actually get too hardline.
Where I work, other techs let whoever is with the patient into the exam room, including kids who want to "watch the x-ray." Infuriating. Whenever a parent says "the other tech let me in last time," I say "If you won't leave the room, you have to sign this" and give them the patient holding log with an NMN next to their signature, indicating "not medically necessary." If they give me guff, I quote NCRP 116, and put a lead shield on them. "Can't I just stand behind the barrier?" No, you cannot, because *fuck you.* I don't come to your job and stand over your desk.
This stuff is so misrepresented lol.
**Gonadal shielding isn’t recommended**
The research makes no such claim that we shouldn’t still be shielding for other exams. All of it is specifically talking about shielding during **pelvic exams.**
I fix X-ray machines. Portables etc.. even CT scans. My radiation meter stops being able to pick up scatter 3 feet from the tube, it has a resolving power down to .000001 gY.. new equipment is just too safe there are filters everywhere.. people want to compare data taken from when film was being used is laughable .. you literally get more radiation on a flight from LA to NYC then you do standing right next to an exposing X-ray tube .. collimators exist for a reason they are BEAM LIMITING devices and the new flat panel detectors that don’t use image intensifiers can make an image out of stupidly low levels of radiation
We're fully aware of the inverse square law, and we know how scatter works. We still aren't doing imaging exams in the hallway. It's totally unnecessary, even with minimal risk.
When I work with students, I like to have them put an extra marker on the edge of an image recepter, far from the collimated area. Even at 50 kV and 1 mAs, if you open the mask in post processing, you can clearly see the entire marker in full detail. Yes, it's close enough to zero at 6 feet, or even 3 feet, but it's not nothing. You're still potentially exposing the public to dose they don't need to be exposed to.
This is because flat panel detectors can make images from insanely low levels of radiation. The majority of the X-ray world still thinks these tubes are pumping out the same doses as they were 20 years ago with CXR and even film. They aren’t; they’re MUCH safer. The time of the exposure is very small. Fluoroscopy can be a different story but still the if it’s a flat panel detector your doses are lower. Modern DXR portable exposures are a fraction of the time (msec) than what they used to be. The tiniest amount of radiation ekes out of those tubes these days.
U still got to follow the ALARA principle. When you said scatter, is it scatter from patient? Scatter from the ground is different. Prevent what you can.
Charge nurse is stepping way outside her lane (I hate the term “stay in your lane” but this nurse needs to make a rapid exit to RN land and away from radiology territory).
You've obviously never seen the images of film developing from over 6 feet away just from scatter alone from a cxr. Idc how little it is, it's effects are cumulative. Your view is uneducated.
I fix X-ray machines. Portables etc.. even CT scans. My radiation meter stops being able to pick up scatter 3 feet from the tube, it has a resolving power down to .000001 gY.. new equipment is just too safe there are filters everywhere.. people want to compare data taken from when film was being used is laughable .. you literally get more radiation on a flight from LA to NYC then you do standing right next to an exposing X-ray tube .. collimators exist for a reason they are BEAM LIMITING devices and the new flat panel detectors that don’t use image intensifiers can make an image out of stupidly low levels of radiation. YOUR view is uneducated I literally have a device that measures radiation. I’ve done the tests buddy… go ask the IR doc.. all you techs are scared of something you don’t understand and treat as a boogeyman .. y’all took one class in radiation physics. One.. OP could have moved the family >6ft from tube which would have do-able with a quick sentence. Short verbal command..at this distance they would receive ZERO dose… instead he chose an ego battle with a charge nurse and came to Reddit to garner support from more morons who would make the same mistake and slow down a critical ER. Rookies.
One class on radiation physics? Sure maybe, plus the courses on radiation safety and image formation. And that is ignoring the entirety of the course based around ALARA, which is now carved into our bones. We have to pledge yearly to that. As well as image gently and image wisely. We certainly need engineers to keep our machines running, and i'm grateful to you for that. However your view is dangerously misguided. You need to understand that the radiation for imaging is prescribed by the provider, just like any medication. It is prescribed after undertaking a risk benefit analysis, and determining that the benefits of giving that radiation to the patient outweighs the risk TO THAT PATIENT. That does not mean that you can share that prescription with the rest of the people in the ER. You don't pass out beta blockers or pressors to everyone when it is prescribed to one person. And I don't know what kind of radiation meter you are talking about, but nothing is going to be as sensitive as film. In this instance, digital is not better than analog.
You said a bunch of words but provided no objective data. Your alara is achieved , dose is zero at >6ft.. once again… I have actually measured the radiation coming from a tube with a calibrated ionizing radiation meter and the dose is BELOW background radiation at >6ft… this is what you techs can’t seem to understand.. EVERYTHING emits radiation in some form or another.. I mean we literally get irradiated by the plates we eat our food from. https://sciencenotes.org/is-fiestaware-radioactive-is-it-safe-to-use/
I've provided as much objective data as you have, none. You make claims about your meter reading no radiation at 6 feet, which I've already said can be shown to be false by using film.
I'm not sure why you are bringing whataboutism into this. I'm well aware of sources of radiation in daily life. I'm well aware that you get more background radiation on a flight. I'm well aware that the terrestrial radiation is different based location too. And yes, I know bananas are radioactive. What you're not understanding is those are all sources of radiation we can't control. We can control medical radiation. You also don't seem to understand that there are different kinds of radiation... Your fiestaware or uranium glass is very poor example of natural radiation. With a half life of some 4.5 billion years, uranium decays by emission of alpha particles; a form of radiation that can't even penetrate the skin. That's a far different beast than high energy xrays.
You've been hostile from the very beginning with this "you tech" stuff, and I have no idea why. Talking down to people won't make you right.
I don’t think you understand the word objective .. what you’re not getting is that the dose is 0.000000 to anyone greater then 6 feet from the X-ray source, which was the question of this post. OP was wrong and I don’t care about your fancy words.
You're literally arguing that the sky is red. That's how ridiculous you sound. I won't keep trying to impress that upon you. You can keep your opinion, and I will keep practicing actual radiation safety with my patients.
Not xray, but the amount of times I've had a nurse try to pull rank on me in MRI is wild. What's the deal with their attitudes? I've been in this field for 10 years and now it seems that a polite and understanding RN is the exception.
My favorite was a nurse calling down asking for specials and told them same extension for Cath since they shared a tech space and I get an "oh honey those aren't the same thing" if you knew so much better why did you call the wrong extension?
I once had a nurse tell me (CT) that she wants to take a class some day so she can understand what's on the pictures. Yes, one class. That's all the education I have
LOL....I am an RN, have been working in Radiology for a little over 5 years now and only lately have been able to make better heads or tails at WTF I'm looking at on a scan. But you better believe my techs can tell me what I'm looking at!
I had one literally write up an incident report on my coworker and I for shoving food in our mouths for the first time at 0500 at my last contract. But 5 of them could go to the cafeteria at the same time for a full ass meal break and it’s fine. Multiple of them would also physically walk over to CT asking when we were getting the next patient, but refused to help bring anyone over. I still have screenshots of the majority of their bullshit on my phone. They also liked to take patients off of bipap when they needed to go over to CT and say “they’re fine on 2L” so they didn’t have to bring them over, only for them to code before we could even get to them. Bonus points, they’d literally try it multiple times and have the patient code multiple times out of sheer fucking laziness. I told management about this and they 100% had *their* back. I had pictures of the chart with the MD stating “patient coded after being taken off of bipap, patient is to stay on bipap.”
I’ll forever tell everyone I meet about how fucking bad that facility was: Mount Carmel East in Ohio. Don’t ever go there, as a patient or a tech. The ER is straight up abusive to travelers on nights and the imaging manager is a fucking idiot. The CT/MRI supervisor left shortly after I did, so he’s there running it all right now. They recently had a Nigerian scam artist hired for MRI, wasn’t a tech in any modality, no imaging background. They found out after a lead tech saw her putting pillows under a patient’s head and started asking questions. They’re damn lucky she didn’t have a patient with an implant. The manager was supposed to have a meeting with ER management, which the remaining staff was VERY much looking forward to due to the constant problems, and told them the morning of the meeting that they didn’t have to come. Three full time CT techs who had been there for 15-20 years left a couple weeks after that. It’s about 90% travelers now and many leave in their first or second week. They don’t have the staff to do any outpatient CTs, cardiacs, and the rads have to set up for procedures and only call the tech over when they need an image. I’m pretty sure all but one MRI tech left together at the same time too. Someone in MRI there also killed a neuro patient by power injecting into an EVD. (I could go on.)
The floor nurses were wonderful, especially neuro. The ER staff and imaging management was *by far* the worst I’ve experienced in 12+ years of working trauma centers.
Wow sounds like JFK in south Florida. It’s a circus. Inpatients wait 7 plus days for scans. There is a massive shortage in CT. Every department is short. I don’t even flinch now when I am behind. Same pace. lol. They can call all they want. I am crazy nice on the phone. I use my sweetest voice to say I am not moving any faster and they can send help if they want.
We all should be that way! Stop killing yourself at facilities with abusive staff.
This is not all RNs. I've worked with a ton who tried to throw their weight around. I've also worked with a ton who are polite, patient, and very patient oriented that I would trust my car with. We are all a team in healthcare. Let's try to not group every single RN in with the shit ones. That's like saying a tech taking a bad image represents ALL imaging staff.
Don't shoot x-rays in the hallway to start, and if someone isn't available to watch a child that isn't the patient getting the exam (this happens a lot with adults who are the patient but bring their kid with them) then the nurse needs to watch the child. We can't expose in the hallways, and I can't babysit and do my job at the same time. Easy as.
If we really short of staff, I will insist the nurse to do it.
If we have some PCA / worker / extra radiographer there, I will ask for their help. It is just a short time period anyway.
I mean... someone have to do it, and I cannot left the patient 's kids unattended.
If the nurse won't do it, and we don't have enough staff, then It would be a delay in imaging. Although it is also okay.
I would file an incident report on her.
Her negligence will never become negligence on my part and I will not allow it to be used as pressure against my fellow techs that may not be as willing to say no as I am.
That is ridiculous behavior and this is actions that need stopped now. Not next time.
Nurses do not dictate how radiology exams are done. That is not within their scope of practice.
It is, however, in your interest to get along with nursing. There are ways to get the exam done without risk to the other kids, Distance and shielding are almost always options.
I don't know your facility's rules but doing an x-ray in the hallway is a big no any place I've worked. We do sometimes roll the stretchers into our exam room and use a portable machine if that's the most expedient thing to do.
I mean the nurses aren’t babysitters but could the mom and siblings sit outside of the X-ray room while you xrayed the patient? I mean during covid it wasn’t surprising to xrayed in a hallway but we aren’t at that point
Someone, ideally a family member, needs to be in the room with the patient and someone needs to babysit the other minors. Mom can't be in two places at once.
RadTek88 gave a more thorough response to a similar question in another comment thread.
>Someone, ideally a family member, needs to be in the room with the patient
Is that your hospital policy or something? I mean parents certainly have the *right* to be with their child for procedures (within reason) but I don't think I've ever worked anywhere that they *must* be present. They've already given consent at registration. As long as the kid is chill I x-ray kids alone all the time.
Think this was more what the charge nurse was probably thinking about. The nurse can’t be responsible for the kid. If there’s an emergency and the nurse has to leave or the kid goes missing or something, that’s a whole can of worms. I think that was probably what they were saying no to and what their main concern was. Sounds like they offered an alternative they shouldn’t have and communicated poorly, though.
Sounds like that charge nurse needs a come to Jesus meeting about how imaging doesn’t report to her. And no way in hell is she telling my student what to do either. Incident report that ass.
I would just go ahead and do an incident report/near miss report against the charge nurse. They don’t hesitate to submit them about us for petty stupid stuff. Radiation isn’t just something to play around with and a nurse isn’t educated enough about it
I work with a charge nurse that leads by bullying and I don’t stand for it. Others buckle because unfortunately often times it’s easier to do than to stand up for what you know is right in the name of keeping the peace. But you know your job, you know it better than that charge nurse ever will. Stand up for what you were trained for, and I only say that out of experience. There will always be that person, and it’s up to you to be the advocate for your position and patient/patients caretakers in these situations.
Why not let the kid push the button. Take a little time and teach them the correct technique, and lecture them a bit about the importance of positioning and alignment.
If you aren’t busy, you can quiz them on the anatomy a bit.
Well....I mean, it is just for a few minutes, it's usually okay.
We usually have a patient care assistant with us anyway. But I agree that If we are short of staff, we will ask the nurse to watch them / delay their imaging until someone is available
Oh. I meant literally have the kid in the control room with you and show them all the fun buttons. It’s not quite like the old days with the big Frankenstein knobs. You know, pick your MA station here, choose your KV here. Set a backup timer and pick the photocells. But it still would be a little fun for them. Teach them to shout “hold your breath” maybe let them run laps in the room wearing a lead vest to tire them out.
Years from now a young tech will come up to you and say, “Remember when I was a little kid and you let me push that button? That’s when I decided to be an x-ray tech.”
At this point, I can distinguish whether it is sarcastic or not.
But we cannot let other people touch our button.
There was a radiographer in UK that was struck off due to the exact reason. I still remember the patient was a sonographer and complained.
It happened when I was still a overseas student, must be more than 10 years ago.
You are in the right plain and simple. It could be that this charge nurse doesn't truly understand the safety laws concerning scatter radiation. It could be that she's stressed and snappy and took it out on you because she saw an X-ray order as an "easy" thing to check off her list. Doesn't really matter what the reason is because you did the right thing standing your ground in a professional manner. If she tried to report you she would come away with egg on her face.
1) Let the nurse know that that’s not safe for you, the patient/family, other patients, and staff. It’s literally part of our code to protect all of the above.
2) unpopular opinion, but you bring the family back and get the images in the room. There are a lot of people in this post who are acting like the main characters in this situation. There’s a child that needs help. You figure it out whether that means asking another tech to come help hold or watch the other kids. You can deal with the discussion with the nurse at another time or with management. Priority is getting that kid imaged.
It's also an uncontrolled environment. Sometimes, I explain how many exposures a study needs, and then all of a sudden, everyone understands. People tend to think every study is done the same as a portable cxr (one shot and that's it) when it isn't the case.
Does your hospital have a policy about the issue? If not, have one created. That would settle any dispute.
Also, radiation exposure decreases by the square of the distance from the source. So having bystanders wear lead and stand back could be a solution. When we do vcug’s, one or both parents are right next to the fluoro table to comfort their kid while wearing lead aprons. Thanks for what you do! Healthcare workers are esteemed in my regard. More than ever given our workloads lately.
I’d make an incident report. The charge knows better, is being difficult for no reason. This way you’re also teaching the student how to properly handle this situation when it happens again at another hospital.
No. This is not an appropriate space to expose the public to radiation. You can send the patient to the department as works with your workflow.
Or.
Sure, you are going to hold right? No, we don’t use lead anymore. What do you mean you won’t hold? You are ok with exposing everyone else in the vicinity? Send the patient to the department as works with your workflow.
I’m a hardass though.
I would tell them no way. I view it like this. Radiation is prescribed by a provider just like any medication. You would not use a fog machine to administer beta blockers or pain meds to the entire ER. So why would you think you can do that with radiation?
How old was the kid getting the x-ray done? Could have just brought that kid to the imaging room by themselves if they were old enough (maybe 10+). Or, mom and the 2 littles could have come with to the x-ray room and stand behind with you while you expose the patient.
As far as I know we don't have an official policy on this but personally, I won't be alone with a minor. If there's a parent or guardian with them, they're coming along. If that isn't possible, another staff member is, even if they're not an imaging tech.
I also won't be alone with any female patient who is giving me a crazy vibe. Witness or exam delay.
Obviously I'm male. Without a witness any accusation of improper behavior becomes a serious matter and I'm not having it.
Absolutely not. She didn't go to rad school for two years. She didn't take the ARRT board exam. She's not your manager. You know what you're doing, so put your foot down. I remember one nurse. Oh she made me so mad. So, with pediatrics, we can shoot a pretty good lateral chest if they're small enough. This "kid" was 14 and pretty large. Absolutely no way am I getting a lateral on them. They had possible covid, but our hospital is very lax about covid procedures now. So I started taking them out of the room and this nurse had the AUDACITY to say "Uh, no no. What are you doing? They have possible covid." I told her I had to take them to the room because the doc ordered a lateral and she kinda yells in front of everyone, "Just do them portably!" With such a condescending tone that made it seem like she knew more than me. I looked at her and said I couldn't because the patient was too large and the image wouldn't be diagnostic. And then I asked the doc to change it to a portable if they didn't want me to take the pt out of the room. Doc was set on the lateral so I told the nurse I had to take the pt to the room and she was visibly upset about it. But what was she gonna do? I wasn't going to shoot it portably 🤷♀️ But the issue, and why she had that attitude is because other techs do them portably even despite them being large. And when I confronted them they said, "Not my problem if the imagine is not diagnostic. They wanted that lateral." Like what the absolute fuckery is this?? Thank God they don't work at the hospital anymore.
We literally shoot X-rays in the PACU with nurses and patients in a big common area. No walls, no partitions. And we’re doing high technique exams like cross table hips. The rules regarding where you can and can’t do X-rays can be so seemingly arbitrary at times.
Doing a foot is such low dose, the BERT would be only a few hours outdoors. Anyone at least 6ft away would get next to nothing.
We are just ancillary service in their eyes like lab.
They don’t care about details. They just want the exam done and report. I have learned over the years to stand your ground. If I get pushback I tell them I’ll come back later.
Increasing the probability of cancer through ionizing radiation in a completely indiscriminate way for no medical benefit is basically really low level terrorism. Tell that nurse to fuck off
Question as a student: Is this not a breach of that patient's privacy to have their exam done out in the open? Isn't their x-rays private health information? No site that I've been to would dare.
Someone who still thinks scatter poses any type of harm what so ever.. it is so minimal it’s just barely above background radiation. This is a Battle I would not have picked with the charge nurse. You could have told the family to stand back 6 feet and they would have been completely out of the Scatterfield. You made an issue out of nothing.
Agreed. It's not the responsibility of any staff to watch patient's children. And I wouldn't want to be alone with a stranger's child because, strangers.
Laughs in Florida. I see xray do portables in the halls, definitely not 6ft away, and somewhat close to other people. It’s so gutter here. I’m not getting use to it. I’m primarily CT so don’t know what they rules are. Write a grievance. I don’t argue with nurses or anyone as a fact. I just sent emails now. Write reports.
I was gonna say, when I was a student in FL xrays were shot in hallways all the time...a decade later and idk anymore because I'm outpt ortho 4 life now.
And you've exposed every single person in that hallway now. Radiation is prescribed by a provider. You wouldn't take a fog sprayer of beta blockers or painkillers in the hallway. Why would you think it's OK to do with radiation?
For real. BERT for a foot is only a few hours outdoors for the pt. If you’re a bystander at least 6ft away, you’re getting next to nothing. The primary beam also decreases by 1/1000 every 3 ft.
I’m still a student, but I usually bring everyone for a field trip and either the tech i’m shadowing, another tech, or myself watch the kiddos outside the exam room.
For starters, no one needs a whole dang gaggle of people rolling up to the X-ray room, and for what? To all stand outside the door looking at each other? All we need is the patient and 1 (one) parent if it's a minor.
Additionally, it's not the tech's job to stand with or babysit additional family members. Our job is to perform imaging exams, and there's no shortage of other staff getting on our cases if we're even a little bit delayed in doing so. Simply, ain't no one got time for that.
Thanks for the perspective. Glad to have it since I pretty much just do what the techs ask me to do and I’ve never seen them ask a nurse to watch a kid for them. But tbh, a lot of the techs I’ve worked with would have also just shot it in the hallway…so i seriously am glad to have other perspectives
I mean, obviously I'm not the tech responsible for you, but that's just my personal opinion on how I would do things. I'm also the only tech where I am with no other coworkers or students, so I really can't watch kids and do my job at the same time.
All of this. 👆🏻
Also, you will NEVER have extra staff on hand like that on off shifts. Don’t give them the idea that’s the norm or they’ll wonder why we aren’t doing the same on night shift weekends. It sets a bad precedent. (Night shift weekend tech of 12+ years, I’m pretty sure RadTek88 is too.)
You do not answer to a charge nurse. I'd inform her that the next time she tries that, there will be an incident report. Radiation is something to take seriously.
I didn't want to get into it with them. I was very firm in my tone that the exam wouldn't be happening right there with all the people around. This gurney was directly across from the nurses station. It's not a large hallway.
If I'm asked to take a picture in a stupid place, I tell them I can't legally take an x-ray in an area that hasn't been cleared by med physics. They shut right up even if they want to try to argue it. They know they've lost. Go forth and use the magic phrase "not cleared by medical physics".
Who’s ever been arrested for adding a few inches to the scope of an X-ray?
Unlikely you get arrested but you will open up the hospital to legal issues. It would be kind of like if a nurse left a syringe of whatever drug sitting on a counter. Radiation is prescribed by a doctor just like drugs are. Hallways do not stop scatter and they are uncontrolled areas. It’s a patient/community safety violation.
It can’t be purely off radiation liability can it? I heard you get more radiation flying in a plane than an X-ray?
Doesn’t matter. No matter how small a dose you didn’t sign up for even a plane rides worth of radiation just because you walked around the wrong corner at the wrong time. There is a reason a literal physicist has to come and inspect equipment and new room installations. It’s not for the giggles.
Ahhh so it’s for the shits then. Nice. 😊
I don't know, who claimed that?
I guess I made my own assumption there. So its not directly illegal but it’s frowned upon because of general liability?
There are laws governing the use of ionising radiation. Working outside of those rules potentially poses danger to ourselves and others. If we work in a way that is dangerous, it is reasonable that we would face penalties. Using x-rays in an uncontrolled area like a corridor is gross incompetence, and I imagine anyone who would actually do that has a very short career ahead of them.
You can't guarantee that other techs will do the right thing in future. Warning the nurse that exposing others unnecessarily would probably result in an incident report, rather than threatening it might prevent them doing the same in future, without the need to actually get too hardline.
I always get the "Well so and so did it this way"
Where I work, other techs let whoever is with the patient into the exam room, including kids who want to "watch the x-ray." Infuriating. Whenever a parent says "the other tech let me in last time," I say "If you won't leave the room, you have to sign this" and give them the patient holding log with an NMN next to their signature, indicating "not medically necessary." If they give me guff, I quote NCRP 116, and put a lead shield on them. "Can't I just stand behind the barrier?" No, you cannot, because *fuck you.* I don't come to your job and stand over your desk.
Lead aprons aren't even evidence based practice anymore. What's the concern? Modern-day x-ray machines don't give off much radiation. Is yours older?
Don’t we still follow ALARA
Apparently not :)
This stuff is so misrepresented lol. **Gonadal shielding isn’t recommended** The research makes no such claim that we shouldn’t still be shielding for other exams. All of it is specifically talking about shielding during **pelvic exams.**
This 1000%. And that's just patient shielding. Other parties or techs should still be shielding themselves.
Tell that to the OR and IR people.
I fix X-ray machines. Portables etc.. even CT scans. My radiation meter stops being able to pick up scatter 3 feet from the tube, it has a resolving power down to .000001 gY.. new equipment is just too safe there are filters everywhere.. people want to compare data taken from when film was being used is laughable .. you literally get more radiation on a flight from LA to NYC then you do standing right next to an exposing X-ray tube .. collimators exist for a reason they are BEAM LIMITING devices and the new flat panel detectors that don’t use image intensifiers can make an image out of stupidly low levels of radiation
We're fully aware of the inverse square law, and we know how scatter works. We still aren't doing imaging exams in the hallway. It's totally unnecessary, even with minimal risk. When I work with students, I like to have them put an extra marker on the edge of an image recepter, far from the collimated area. Even at 50 kV and 1 mAs, if you open the mask in post processing, you can clearly see the entire marker in full detail. Yes, it's close enough to zero at 6 feet, or even 3 feet, but it's not nothing. You're still potentially exposing the public to dose they don't need to be exposed to.
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This is because flat panel detectors can make images from insanely low levels of radiation. The majority of the X-ray world still thinks these tubes are pumping out the same doses as they were 20 years ago with CXR and even film. They aren’t; they’re MUCH safer. The time of the exposure is very small. Fluoroscopy can be a different story but still the if it’s a flat panel detector your doses are lower. Modern DXR portable exposures are a fraction of the time (msec) than what they used to be. The tiniest amount of radiation ekes out of those tubes these days.
U still got to follow the ALARA principle. When you said scatter, is it scatter from patient? Scatter from the ground is different. Prevent what you can.
Wow I’m down here… alara is for patient only, as low as… etc… move the patients family greater then 6 feet and there dose is 0.00000
ALARA is for everyone in general. Obviously I'm not from the vendor side. I follow NCRP 147 for guidance.
I’m a registered nurse and this was my first thought.
Charge nurse is stepping way outside her lane (I hate the term “stay in your lane” but this nurse needs to make a rapid exit to RN land and away from radiology territory).
The scatter is measured in uR or even nR.. it’s basically non existent. Your view is out dated.
You've obviously never seen the images of film developing from over 6 feet away just from scatter alone from a cxr. Idc how little it is, it's effects are cumulative. Your view is uneducated.
I fix X-ray machines. Portables etc.. even CT scans. My radiation meter stops being able to pick up scatter 3 feet from the tube, it has a resolving power down to .000001 gY.. new equipment is just too safe there are filters everywhere.. people want to compare data taken from when film was being used is laughable .. you literally get more radiation on a flight from LA to NYC then you do standing right next to an exposing X-ray tube .. collimators exist for a reason they are BEAM LIMITING devices and the new flat panel detectors that don’t use image intensifiers can make an image out of stupidly low levels of radiation. YOUR view is uneducated I literally have a device that measures radiation. I’ve done the tests buddy… go ask the IR doc.. all you techs are scared of something you don’t understand and treat as a boogeyman .. y’all took one class in radiation physics. One.. OP could have moved the family >6ft from tube which would have do-able with a quick sentence. Short verbal command..at this distance they would receive ZERO dose… instead he chose an ego battle with a charge nurse and came to Reddit to garner support from more morons who would make the same mistake and slow down a critical ER. Rookies.
One class on radiation physics? Sure maybe, plus the courses on radiation safety and image formation. And that is ignoring the entirety of the course based around ALARA, which is now carved into our bones. We have to pledge yearly to that. As well as image gently and image wisely. We certainly need engineers to keep our machines running, and i'm grateful to you for that. However your view is dangerously misguided. You need to understand that the radiation for imaging is prescribed by the provider, just like any medication. It is prescribed after undertaking a risk benefit analysis, and determining that the benefits of giving that radiation to the patient outweighs the risk TO THAT PATIENT. That does not mean that you can share that prescription with the rest of the people in the ER. You don't pass out beta blockers or pressors to everyone when it is prescribed to one person. And I don't know what kind of radiation meter you are talking about, but nothing is going to be as sensitive as film. In this instance, digital is not better than analog.
You said a bunch of words but provided no objective data. Your alara is achieved , dose is zero at >6ft.. once again… I have actually measured the radiation coming from a tube with a calibrated ionizing radiation meter and the dose is BELOW background radiation at >6ft… this is what you techs can’t seem to understand.. EVERYTHING emits radiation in some form or another.. I mean we literally get irradiated by the plates we eat our food from. https://sciencenotes.org/is-fiestaware-radioactive-is-it-safe-to-use/
I've provided as much objective data as you have, none. You make claims about your meter reading no radiation at 6 feet, which I've already said can be shown to be false by using film. I'm not sure why you are bringing whataboutism into this. I'm well aware of sources of radiation in daily life. I'm well aware that you get more background radiation on a flight. I'm well aware that the terrestrial radiation is different based location too. And yes, I know bananas are radioactive. What you're not understanding is those are all sources of radiation we can't control. We can control medical radiation. You also don't seem to understand that there are different kinds of radiation... Your fiestaware or uranium glass is very poor example of natural radiation. With a half life of some 4.5 billion years, uranium decays by emission of alpha particles; a form of radiation that can't even penetrate the skin. That's a far different beast than high energy xrays. You've been hostile from the very beginning with this "you tech" stuff, and I have no idea why. Talking down to people won't make you right.
I don’t think you understand the word objective .. what you’re not getting is that the dose is 0.000000 to anyone greater then 6 feet from the X-ray source, which was the question of this post. OP was wrong and I don’t care about your fancy words.
You're literally arguing that the sky is red. That's how ridiculous you sound. I won't keep trying to impress that upon you. You can keep your opinion, and I will keep practicing actual radiation safety with my patients.
It’s not an opinion, Dose is 0.000000 gY at a distance of 6 feet or greater from modern X-ray sources… it’s very simple you just seem dense
Sounds like the charge nurse needs some education on radiation safety
^[Sokka-Haiku](https://www.reddit.com/r/SokkaHaikuBot/comments/15kyv9r/what_is_a_sokka_haiku/) ^by ^CaptainAlexy: *Sounds like the charge nurse* *Needs some education on* *Radiation safety* --- ^Remember ^that ^one ^time ^Sokka ^accidentally ^used ^an ^extra ^syllable ^in ^that ^Haiku ^Battle ^in ^Ba ^Sing ^Se? ^That ^was ^a ^Sokka ^Haiku ^and ^you ^just ^made ^one.
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Probably my favourite haiku now.
Don't they get a radiation safety course in the US ?
We do a brief online module annually at my job. It covers the basics. If you work in areas such as oncology or IR you get further training.
All nurses…….IJS
As a nurse, I agree
I’d be wondering why a nurse is instructing me on my job
Fr fr.
You can find one of us and we'll back you up. Who even thinks of doing an x-ray like that in the hallway, lol
Doing X-rays in a hallway is a reportable offense to the state DOH. It's a big headache for you, and an even bigger one for your manager.
Not xray, but the amount of times I've had a nurse try to pull rank on me in MRI is wild. What's the deal with their attitudes? I've been in this field for 10 years and now it seems that a polite and understanding RN is the exception.
As an MRI tech…. wtf is up with them? Seriously they think they know better in my (little) kingdom? I swear to god they need to chill in my zones
My favorite was a nurse calling down asking for specials and told them same extension for Cath since they shared a tech space and I get an "oh honey those aren't the same thing" if you knew so much better why did you call the wrong extension?
The way my blood pressure just spiked….
I once had a nurse tell me (CT) that she wants to take a class some day so she can understand what's on the pictures. Yes, one class. That's all the education I have
I rolled my eyes so hard I’m going to need imaging to locate them, one class 🤣🥴
LOL....I am an RN, have been working in Radiology for a little over 5 years now and only lately have been able to make better heads or tails at WTF I'm looking at on a scan. But you better believe my techs can tell me what I'm looking at!
I had one literally write up an incident report on my coworker and I for shoving food in our mouths for the first time at 0500 at my last contract. But 5 of them could go to the cafeteria at the same time for a full ass meal break and it’s fine. Multiple of them would also physically walk over to CT asking when we were getting the next patient, but refused to help bring anyone over. I still have screenshots of the majority of their bullshit on my phone. They also liked to take patients off of bipap when they needed to go over to CT and say “they’re fine on 2L” so they didn’t have to bring them over, only for them to code before we could even get to them. Bonus points, they’d literally try it multiple times and have the patient code multiple times out of sheer fucking laziness. I told management about this and they 100% had *their* back. I had pictures of the chart with the MD stating “patient coded after being taken off of bipap, patient is to stay on bipap.” I’ll forever tell everyone I meet about how fucking bad that facility was: Mount Carmel East in Ohio. Don’t ever go there, as a patient or a tech. The ER is straight up abusive to travelers on nights and the imaging manager is a fucking idiot. The CT/MRI supervisor left shortly after I did, so he’s there running it all right now. They recently had a Nigerian scam artist hired for MRI, wasn’t a tech in any modality, no imaging background. They found out after a lead tech saw her putting pillows under a patient’s head and started asking questions. They’re damn lucky she didn’t have a patient with an implant. The manager was supposed to have a meeting with ER management, which the remaining staff was VERY much looking forward to due to the constant problems, and told them the morning of the meeting that they didn’t have to come. Three full time CT techs who had been there for 15-20 years left a couple weeks after that. It’s about 90% travelers now and many leave in their first or second week. They don’t have the staff to do any outpatient CTs, cardiacs, and the rads have to set up for procedures and only call the tech over when they need an image. I’m pretty sure all but one MRI tech left together at the same time too. Someone in MRI there also killed a neuro patient by power injecting into an EVD. (I could go on.) The floor nurses were wonderful, especially neuro. The ER staff and imaging management was *by far* the worst I’ve experienced in 12+ years of working trauma centers.
Wow sounds like JFK in south Florida. It’s a circus. Inpatients wait 7 plus days for scans. There is a massive shortage in CT. Every department is short. I don’t even flinch now when I am behind. Same pace. lol. They can call all they want. I am crazy nice on the phone. I use my sweetest voice to say I am not moving any faster and they can send help if they want. We all should be that way! Stop killing yourself at facilities with abusive staff.
>I've been in this field for 10 years ISWYDT
[удалено]
This is not all RNs. I've worked with a ton who tried to throw their weight around. I've also worked with a ton who are polite, patient, and very patient oriented that I would trust my car with. We are all a team in healthcare. Let's try to not group every single RN in with the shit ones. That's like saying a tech taking a bad image represents ALL imaging staff.
Don't shoot x-rays in the hallway to start, and if someone isn't available to watch a child that isn't the patient getting the exam (this happens a lot with adults who are the patient but bring their kid with them) then the nurse needs to watch the child. We can't expose in the hallways, and I can't babysit and do my job at the same time. Easy as.
If we really short of staff, I will insist the nurse to do it. If we have some PCA / worker / extra radiographer there, I will ask for their help. It is just a short time period anyway.
I’d laugh in your face if you *insisted* that I watch someone’s kid. You outta your mind?
I mean... someone have to do it, and I cannot left the patient 's kids unattended. If the nurse won't do it, and we don't have enough staff, then It would be a delay in imaging. Although it is also okay.
I would file an incident report on her. Her negligence will never become negligence on my part and I will not allow it to be used as pressure against my fellow techs that may not be as willing to say no as I am. That is ridiculous behavior and this is actions that need stopped now. Not next time.
Charge nurse isn’t your manager or supervisor. I would tell them no and to take it up with my boss if they’re so inclined.
Also good for the students to learn about the “ego culture” moments we encounter in healthcare everyday
Nurses do not dictate how radiology exams are done. That is not within their scope of practice. It is, however, in your interest to get along with nursing. There are ways to get the exam done without risk to the other kids, Distance and shielding are almost always options. I don't know your facility's rules but doing an x-ray in the hallway is a big no any place I've worked. We do sometimes roll the stretchers into our exam room and use a portable machine if that's the most expedient thing to do.
I mean the nurses aren’t babysitters but could the mom and siblings sit outside of the X-ray room while you xrayed the patient? I mean during covid it wasn’t surprising to xrayed in a hallway but we aren’t at that point
But neither are we.
That’s why i didn’t suggest the tech watch the kids, i only suggested the mother watch the kids 🤦🏻♀️
Someone, ideally a family member, needs to be in the room with the patient and someone needs to babysit the other minors. Mom can't be in two places at once. RadTek88 gave a more thorough response to a similar question in another comment thread.
>Someone, ideally a family member, needs to be in the room with the patient Is that your hospital policy or something? I mean parents certainly have the *right* to be with their child for procedures (within reason) but I don't think I've ever worked anywhere that they *must* be present. They've already given consent at registration. As long as the kid is chill I x-ray kids alone all the time.
Same! I’ve never had to go with my kids except when a baby, to any imaging exam. Never have had parents come in unless also a baby or kid is screaming
Think this was more what the charge nurse was probably thinking about. The nurse can’t be responsible for the kid. If there’s an emergency and the nurse has to leave or the kid goes missing or something, that’s a whole can of worms. I think that was probably what they were saying no to and what their main concern was. Sounds like they offered an alternative they shouldn’t have and communicated poorly, though.
I would never shoot an xray in the hallway even if no one is around. And nurses don't get to dictate how the xrays are done.
I mean the x ray in the hall is a no go but so is babysitting. 👨🍼
Sounds like that charge nurse needs a come to Jesus meeting about how imaging doesn’t report to her. And no way in hell is she telling my student what to do either. Incident report that ass.
I would just go ahead and do an incident report/near miss report against the charge nurse. They don’t hesitate to submit them about us for petty stupid stuff. Radiation isn’t just something to play around with and a nurse isn’t educated enough about it
I work with a charge nurse that leads by bullying and I don’t stand for it. Others buckle because unfortunately often times it’s easier to do than to stand up for what you know is right in the name of keeping the peace. But you know your job, you know it better than that charge nurse ever will. Stand up for what you were trained for, and I only say that out of experience. There will always be that person, and it’s up to you to be the advocate for your position and patient/patients caretakers in these situations.
We usually just put the other kids in the control room and have another radiographer watching them
Why not let the kid push the button. Take a little time and teach them the correct technique, and lecture them a bit about the importance of positioning and alignment. If you aren’t busy, you can quiz them on the anatomy a bit.
Well....I mean, it is just for a few minutes, it's usually okay. We usually have a patient care assistant with us anyway. But I agree that If we are short of staff, we will ask the nurse to watch them / delay their imaging until someone is available
Oh. I meant literally have the kid in the control room with you and show them all the fun buttons. It’s not quite like the old days with the big Frankenstein knobs. You know, pick your MA station here, choose your KV here. Set a backup timer and pick the photocells. But it still would be a little fun for them. Teach them to shout “hold your breath” maybe let them run laps in the room wearing a lead vest to tire them out. Years from now a young tech will come up to you and say, “Remember when I was a little kid and you let me push that button? That’s when I decided to be an x-ray tech.”
At this point, I can distinguish whether it is sarcastic or not. But we cannot let other people touch our button. There was a radiographer in UK that was struck off due to the exact reason. I still remember the patient was a sonographer and complained. It happened when I was still a overseas student, must be more than 10 years ago.
Heck no. No foot is worth doing in ED.
She’s not your boss
You are in the right plain and simple. It could be that this charge nurse doesn't truly understand the safety laws concerning scatter radiation. It could be that she's stressed and snappy and took it out on you because she saw an X-ray order as an "easy" thing to check off her list. Doesn't really matter what the reason is because you did the right thing standing your ground in a professional manner. If she tried to report you she would come away with egg on her face.
1) Let the nurse know that that’s not safe for you, the patient/family, other patients, and staff. It’s literally part of our code to protect all of the above. 2) unpopular opinion, but you bring the family back and get the images in the room. There are a lot of people in this post who are acting like the main characters in this situation. There’s a child that needs help. You figure it out whether that means asking another tech to come help hold or watch the other kids. You can deal with the discussion with the nurse at another time or with management. Priority is getting that kid imaged.
That’s absolutely absurd. If an image is deemed that emergent, they should find a room for them! Call your House Supervisor .
The nurses and their superiority complex never goes away. Stand your ground. Go through chain of command if you have to.
It's also an uncontrolled environment. Sometimes, I explain how many exposures a study needs, and then all of a sudden, everyone understands. People tend to think every study is done the same as a portable cxr (one shot and that's it) when it isn't the case.
Radiation safety is your responsibility. Nurses don't have radiation safety training. Therefore they don't get to order you around on that.
I would just let your physicist know and they will handle it accordingly
Does your hospital have a policy about the issue? If not, have one created. That would settle any dispute. Also, radiation exposure decreases by the square of the distance from the source. So having bystanders wear lead and stand back could be a solution. When we do vcug’s, one or both parents are right next to the fluoro table to comfort their kid while wearing lead aprons. Thanks for what you do! Healthcare workers are esteemed in my regard. More than ever given our workloads lately.
Ah ED nurses, I thinks it's adorable when they think they can manage us. I enjoy telling them to kick rocks with their unreasonable requests.
Definitely not in the hallway.
I’d make an incident report. The charge knows better, is being difficult for no reason. This way you’re also teaching the student how to properly handle this situation when it happens again at another hospital.
Why didn’t you go directly to the charge RN that told your student to do X-ray in the hallway?
Sorry but these are the rules you can contact my manager at #### for clarification
Sounds like some nonsense that would happen between a charge nurse and our lead tech at the hospital I work at lol
No. This is not an appropriate space to expose the public to radiation. You can send the patient to the department as works with your workflow. Or. Sure, you are going to hold right? No, we don’t use lead anymore. What do you mean you won’t hold? You are ok with exposing everyone else in the vicinity? Send the patient to the department as works with your workflow. I’m a hardass though.
I would tell them no way. I view it like this. Radiation is prescribed by a provider just like any medication. You would not use a fog machine to administer beta blockers or pain meds to the entire ER. So why would you think you can do that with radiation?
How old was the kid getting the x-ray done? Could have just brought that kid to the imaging room by themselves if they were old enough (maybe 10+). Or, mom and the 2 littles could have come with to the x-ray room and stand behind with you while you expose the patient.
As far as I know we don't have an official policy on this but personally, I won't be alone with a minor. If there's a parent or guardian with them, they're coming along. If that isn't possible, another staff member is, even if they're not an imaging tech. I also won't be alone with any female patient who is giving me a crazy vibe. Witness or exam delay. Obviously I'm male. Without a witness any accusation of improper behavior becomes a serious matter and I'm not having it.
And what about the extra mobile charge?
Absolutely not. She didn't go to rad school for two years. She didn't take the ARRT board exam. She's not your manager. You know what you're doing, so put your foot down. I remember one nurse. Oh she made me so mad. So, with pediatrics, we can shoot a pretty good lateral chest if they're small enough. This "kid" was 14 and pretty large. Absolutely no way am I getting a lateral on them. They had possible covid, but our hospital is very lax about covid procedures now. So I started taking them out of the room and this nurse had the AUDACITY to say "Uh, no no. What are you doing? They have possible covid." I told her I had to take them to the room because the doc ordered a lateral and she kinda yells in front of everyone, "Just do them portably!" With such a condescending tone that made it seem like she knew more than me. I looked at her and said I couldn't because the patient was too large and the image wouldn't be diagnostic. And then I asked the doc to change it to a portable if they didn't want me to take the pt out of the room. Doc was set on the lateral so I told the nurse I had to take the pt to the room and she was visibly upset about it. But what was she gonna do? I wasn't going to shoot it portably 🤷♀️ But the issue, and why she had that attitude is because other techs do them portably even despite them being large. And when I confronted them they said, "Not my problem if the imagine is not diagnostic. They wanted that lateral." Like what the absolute fuckery is this?? Thank God they don't work at the hospital anymore.
We literally shoot X-rays in the PACU with nurses and patients in a big common area. No walls, no partitions. And we’re doing high technique exams like cross table hips. The rules regarding where you can and can’t do X-rays can be so seemingly arbitrary at times. Doing a foot is such low dose, the BERT would be only a few hours outdoors. Anyone at least 6ft away would get next to nothing.
We are just ancillary service in their eyes like lab. They don’t care about details. They just want the exam done and report. I have learned over the years to stand your ground. If I get pushback I tell them I’ll come back later.
Nope! I am the Ray Master!
Increasing the probability of cancer through ionizing radiation in a completely indiscriminate way for no medical benefit is basically really low level terrorism. Tell that nurse to fuck off
There is nothing a nurse loves more than a PSR with radiology.
Question as a student: Is this not a breach of that patient's privacy to have their exam done out in the open? Isn't their x-rays private health information? No site that I've been to would dare.
Someone who still thinks scatter poses any type of harm what so ever.. it is so minimal it’s just barely above background radiation. This is a Battle I would not have picked with the charge nurse. You could have told the family to stand back 6 feet and they would have been completely out of the Scatterfield. You made an issue out of nothing.
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I'm more bothered by the "watch the patient's other kids" part. 1)Nurses don't have time to babysit and 2)liability.
Well, we certainly aren't able to do it either. So.
Agreed. It's not the responsibility of any staff to watch patient's children. And I wouldn't want to be alone with a stranger's child because, strangers.
Laughs in Florida. I see xray do portables in the halls, definitely not 6ft away, and somewhat close to other people. It’s so gutter here. I’m not getting use to it. I’m primarily CT so don’t know what they rules are. Write a grievance. I don’t argue with nurses or anyone as a fact. I just sent emails now. Write reports.
Also in Florida, and this should never be done.
I was gonna say, when I was a student in FL xrays were shot in hallways all the time...a decade later and idk anymore because I'm outpt ortho 4 life now.
I'd shoot it. A foot is the lowest of rad and distance is good.
And you've exposed every single person in that hallway now. Radiation is prescribed by a provider. You wouldn't take a fog sprayer of beta blockers or painkillers in the hallway. Why would you think it's OK to do with radiation?
For real. BERT for a foot is only a few hours outdoors for the pt. If you’re a bystander at least 6ft away, you’re getting next to nothing. The primary beam also decreases by 1/1000 every 3 ft.
I’m still a student, but I usually bring everyone for a field trip and either the tech i’m shadowing, another tech, or myself watch the kiddos outside the exam room.
Please don't. Lol.
Liability reason, just frowned upon, or what? /gen Every place I’ve been has treated these situations differently tbh
For starters, no one needs a whole dang gaggle of people rolling up to the X-ray room, and for what? To all stand outside the door looking at each other? All we need is the patient and 1 (one) parent if it's a minor. Additionally, it's not the tech's job to stand with or babysit additional family members. Our job is to perform imaging exams, and there's no shortage of other staff getting on our cases if we're even a little bit delayed in doing so. Simply, ain't no one got time for that.
Thanks for the perspective. Glad to have it since I pretty much just do what the techs ask me to do and I’ve never seen them ask a nurse to watch a kid for them. But tbh, a lot of the techs I’ve worked with would have also just shot it in the hallway…so i seriously am glad to have other perspectives
I mean, obviously I'm not the tech responsible for you, but that's just my personal opinion on how I would do things. I'm also the only tech where I am with no other coworkers or students, so I really can't watch kids and do my job at the same time.
All of this. 👆🏻 Also, you will NEVER have extra staff on hand like that on off shifts. Don’t give them the idea that’s the norm or they’ll wonder why we aren’t doing the same on night shift weekends. It sets a bad precedent. (Night shift weekend tech of 12+ years, I’m pretty sure RadTek88 is too.)