Things that can put Rad Techs at risk.
In my two decades of rad tech experience, there are SEVEN real dangers of being a radiologic technologist to this profession that I didn’t know about when I went to school.
- Exposure to airborne and bloodborne pathogens is a daily concern
- Potential for needle sticks during procedures and IV insertions
- Emotional trauma from seeing the results of horrible accidents and abuse
- Attacked physically by deranged or drunk/drugged patients
- Long-term physical injury from standard daily job duties
- Excessive radiation exposure from equipment not up to standard
- Sued by patients for medical malpractice or substandard care
I still remember sitting in X-ray school and hearing “barium enema” for the first time. As the teacher explained the procedure, I wondered why they had left this out of the interview process and the school brochure. I mean, I get it. How could you put something like that in a brochure? But I still felt a little misled like… “How can you not warn people that they will be putting instruments in places designed for exit-only traffic?” So I got over that because, well… you have to.
As clinical became a daily routine, THAT’S when I learned other things I didn’t know or expect to be a part of my job. Things that would endanger my safety and potentially affect me for the rest of my life. So I’ve created this list for you, hoping it prepares you BEFORE one of these scenarios lands in your lap.
Exposure to airborne and bloodborne pathogens
This one is probably more obvious if you sit down and think about where you are and what type of people you will work with daily. You are in healthcare, working in a clinical setting…your patients aren’t there because they are healthy. But I didn’t expect the frequency of how often I would take an x-ray of a person and two hours later find out they had a contagious illness.
Tuberculosis is the perfect example. Patients come to the emergency room for persistent cough and some other symptoms. They don’t know what is wrong with them; they only want the doctor to make them feel better. Of course, the doctor doesn’t automatically know the problem, so he orders a bunch of tests.
The patient has their blood drawn and sent to the lab. Because they have a cough, they undergo chest X-rays. A physician orders a whole battery of tests for them, and the results go directly to that physician.
The results are what the doctor uses to try and figure out what is wrong with the patient. After analyzing all the results, it logically follows that we can conclude this patient has tuberculosis. That’s when the patient gets a face mask to prevent coughing from spewing contagious germs all over the emergency room. Too little, too late for me, the ER nurse, physician, respiratory therapist, phlebotomist, and anyone else that had an encounter with that patient. This happens every day in one form or another to radiologic technologists. What can you do to protect yourself in these situations? Not much.
Unless you are going to wear a mask for your entire shift, the only thing you can (and should) do is wash your hand before and after every patient. Keep your equipment wiped off and disinfected. Change the table sheets between every patient. Use gloves whenever you feel necessary. Blood, stool, mucus, and urine exposure is just as possible as breathing in the TB airborne molecules.
You never know who has touched the same doorknobs, telephones, and light switches and what they had on their hands when they touched them. The same precautions apply. Clean often, wear protective gear, and pay attention overall.
Potential for needle sticks during procedures and IV insertions
Rad techs train to start intravenous catheters on patients. These are primarily used to administer contrast to the patient during exams, but the nursing staff may also use them for medication administration. Inserting an IV requires having both hands within proximity while performing the procedure. I doubt a working nurse hasn’t been stuck with a needle during an IV start.
Techs are probably not as much due to volume, but it is still pretty common. Sometimes the patient jerks their arm right when the needle pokes the skin. This jerking motion can easily translate into a force that causes you to stick your hand. I’ve done it. I’ve seen other techs do it. It is completely unintentional and no fault on behalf of the tech.
You can’t blame the patient, either. It is normal for your arm to jerk when stuck by a sharp object. MRI techs sometimes use butterfly needles for contrast injections instead of intravenous needles. It doesn’t matter. The same thing happens. I was a phlebotomist for many years in an outpatient clinic before going to a rad tech school, and I stuck myself at least three times. My risk was higher due to seeing 50+ patients daily, which ALL needed venipuncture.
Sticking yourself before it ever touches the patient is a “clean needle stick.” You still report that it happened for liability, but there is usually no follow-up. If you are stuck due to a used needle, it is a “dirty needle stick.” Dirty sticks require reporting the injury and a follow-up with the Employee Health department at your work.
Depending on the policy, you may require a shot of medicine to counteract any possible effect due to something the patient may have been carrying in their blood. Clean sticks tend to happen during the insertion process due to patient movement. Dirty sticks tend to happen after use and result from attempting to recap the needle before discarding it.
You should never attempt to recap a needle. You should never attempt to stop a needle from rolling off a surgical or procedure tray. I’ve seen techs get stuck doing that too. Just let it hit the floor and get another one. Safety is key here, folks.
Emotional trauma from seeing the results of horrible accidents and abuse
Working in a Level One Trauma hospital was both exciting and exhausting. It was certainly more interesting than working in a clinic where all the patients walked in and out under their leg power. But I didn’t prepare for the traumatic injuries that would burn into my memory for the rest of my life. Most facilities assign rad techs to different hospital areas for their shift.
I’ll always remember the night I had ER duty, and we received two heatstroke victims. Two little sisters played in their backyard on a hot Phoenix, Arizona, day. For reasons I don’t remember, they died from the extreme heat inside the car parked in their backyard. Someone told me they had been playing in and around the car. In trauma cases, you show up with your portable X-ray machine on every case.
The doctor either tells you they need an x-ray or they don’t, and you leave. An eternity passed as I sat looking at those two little girls lying on their gurneys while I waited for a doctor to tell me what they needed. I had daughters the same age at the time. There were not many dry eyes in the ER at that time. Their skin was an awful ashen gray.
Domestic abuse, really bad car crashes, gunshot wounds, and suicides are things you can’t unsee. They don’t tell you about these things in the school brochure or during your interview. “How will you cope with the inhumane things you might see in an emergency room on your clinical rotations if we accept you into this program?”
There are no preparations for these types of things, and you have to perform your job duties right in the middle fully. It is so commonplace that there is a department of employees who have the job of ‘debriefing” any employee in the room during certain events. Debriefing means allowing you to talk about what you saw and how it made you feel. The opportunity to ask for help in the form of counseling or time off. If you can’t handle these events, you best not work in a hospital. Get yourself a clinic job or outpatient imaging center.
Physically attacked by deranged or drunk/drugged patients
I’ve been threatened dozens of times in the emergency room but never hit. Same thing when taking patients to the CT suite for an examination. You know, because every drunk has an “altered level of consciousness,” which automatically draws them up for a CT Head. Nine times out of ten, the threat comes from a drunk or on drugs patient.
In most cases involving extremely combative individuals, police officers are the ones who bring the patient in. The patient will handcuff or leather strap tied to the gurney to keep them from moving their arms and legs. But guess what? You have to move them off the gurney and onto your examination table to complete your X-ray exam. That is when they’ll kick at your or swing at you.
It is pretty common to get spit at too. Note: it is your right as a healthcare employee to refuse to image any patient who threatens your safety. I did it a handful of times long ago when drunk patients were too mean and hostile. If I enter their ER room to take them for their exam, they start yelling, cursing, and threatening me… it’s over. I’m out. Sorry, Doc. It is a federal offense to attack a police officer or a healthcare worker physically.
Any patient who threatens or is successful in an assault is looking at substantially more jail time than what they originally started with. Technologists can press charges against the patient, and the police will help with the paperwork. Be very careful when working with patients with altered mental status, regardless of why they altered. They can be very dangerous to themselves and you. Learn situational awareness and practice it regularly.
Long-term physical injury from standard daily job duties
Radiography schools teach proper lifting techniques and ergonomic stretching exercises as preventative medicine. The hope is that you will use these in your daily work to reduce the risk of injury on the job. One of the biggest risks technologists take several times per shift is moving patients from the gurney to the exam table and back. Or up from a wheelchair onto the table and back to the wheelchair.
If you get lazy and bend at the waist instead of lifting with your legs, you will surely end up with a back injury someday. How you twist and turn, reach for equipment, and push and pull patients affects your body. You must embrace proper body mechanics in this job, or you will surely pay the consequences. Sonographers will tell you, too, that stretching pre-shift is very helpful in reducing the chance of wrist and shoulder injuries.
Get used to the common practice of asking for moving help from co-workers. Don’t try to be a hero and move a large patient alone. You won’t get any medals for doing it and will likely end up with pulled or torn muscles someday. You also have to watch out for other employees. I haven’t watched it happen in a while, but I’ve often seen employees having their toes run over by the portable X-ray machine. Not because there was malicious intent from the driver… but because sometimes it’s hard to see where everyone’s feet are in a cramped ER room. Or swinging the portable X-ray machine tube and smacking your partner in the head on the other side of the bed. I have done that one myself. Sorry, Jim.
Excessive radiation exposure from equipment not up to standard
You don’t think of this scenario until it happens. More than ten years ago, a state physicist in Arizona inspected my facility. He set a piece of equipment up behind the leaded glass shield (aka viewing window) in our tech control room. He asked me to give some exposure in the room as if I was examining a patient. Turns out he was checking the reliability of how well the leaded glass was blocking the X-ray in the exam room from coming into the control room where we stood in safety… or so we thought. That’s when I discovered that the protective leaded glass in this 50-year-old hospital was not led, or at least not sufficiently.
Being over 20 feet away from the radiation source, I never gave any thought to the idea that scattered radiation may make it to the control room. My training always emphasized that the safe distance from a radiation source was six feet. That’s why the bungee cord on a portable X-ray machine reached about 7-8 feet with the exposure trigger on the other end. According to the physicist, there were noticeable, recordable amounts of radiation registering on his equipment.
I had already worked there for about five years and should have asked him how much was reaching me. This is one reason why it is important to wear specially designed-dosimeter badges. Facilities hand these out to all technologists who work with radiation.
I’ve come to understand that a physicist should perform this annually. While working night shifts at this old hospital, now closed due to unrelated issues, I never saw this being done.
Dosimeter badges are collected either monthly or quarterly and submitted for evaluation. The company’s Radiation Safety Officer is usually in charge of this program. The badges determine the amount of radiation the employee receives. There has been an establishment of three “levels” of ALARA that are monitored. An employee dose less than an ALARA Level 1 will usually see no further action. An employee dose equal to or greater than a Level 1 but less than Level 2 will merit a review from the RSO. If a dose exceeds ALARA Level 2, the RSO must promptly investigate the occurrence and report to the Radiation Safety Committee. Female technologists wear two badges during pregnancy. One at the standard location near the shirt collar.
The second one is placed at the waistline to monitor radiation near the baby. Some things can cause false-positive readings on these badges. For example, please don’t leave your badge on the dashboard of your car, or direct sunlight can affect it.
Luckily for me, the amount of radiation being allowed through this “protective” barrier was not enough to cause issues that I know of…so far. The same can happen if you work many shifts in the operating room or interventional suite. Even routine procedures where the technologist operates the fluoro tower can put you at risk for overexposure if you aren’t careful. Any location where the technologist operates the machine while standing beside it calls for situational awareness and proper shielding. Be proactive by protecting yourself from the primary radiation source, wearing lead aprons and thyroid shields, and using your dosimeter badge properly.
Sued by patients for medical malpractice
You don’t have to worry about being a cash register employee at McDonald’s and getting sued because you gave the wrong change. Working in healthcare is a whole different ball game. Fall outside of your stated Scope of Practice for your profession or get caught not providing the appropriate Standard of Care, and you are liable for any wrongdoing that may result from your negligence.
Your facility has insurance that covers you on the job, but that doesn’t mean that the person or persons attempting to sue you will not come after your estate. Several insurance policies exist for the sole purpose of protecting Healthcare workers in situations like this. I don’t see it commonly around radiographers, but I do with sonographers. A patient has never sued me, but I have heard conversations about it from other employees.
There is no way to know everything you are getting into when signing up for a radiography school. Hopefully, sharing my experience helps ease your situation if you find yourself in one of these situations. Common sense and situational awareness will go a long way in keeping you safe in a constantly changing environment like healthcare.
Stay within your Scope of Practice and follow the established safety guidelines (handwashing, lifting techniques, etc.), and your risks will be greatly minimized. I have enjoyed a career in radiology for over 16 years with no permanent injuries and know other techs who have worked for over 30 years and are still injury free.
If you have any questions, you are welcome to email me: [email protected]. Special thanks to Jon, who pointed out some inconsistencies in the dosimeter paragraphs. I have edited and provided more information based on his three emails.
If you are curious about the career of radiography, I have written some articles on various topics: