Things that can put Rad Techs at risk.
In my two decades of rad tech experience, there are SEVEN dangers 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 results of horrible accidents and abuse
- Being physically attacked by deranged or drunk/drugged patients
- Long term physical injury from standard daily job duties
- Excessive radiation exposure from equipment not up to standard
- Being sued by patients for medical malpractice or substandard care
I still remember sitting in x-ray school and hearing the words “barium enema” for the first time. The teacher began explaining the procedure and I couldn’t help but wonder how this got left out of the interview process, 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 that were designed for exit only traffic?” So I got over that because, well.. you have to. As clinicals became a daily routine, THAT’S when I learned there were 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 in hopes that it prepares you BEFORE one of these scenarios lands in your lap.
Exposure to airborne and bloodborne pathogens
This one is probably one of the more obvious if you sit down and think about where you are and what type of people you are going to be working with every day. You are in healthcare, working in a clinical setting…your patients aren’t there because they are healthy. But what I didn’t expect was the frequency of how often I would take an x-ray of a person and two hours later find out they had an illness that is contagious. 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 and all they want is for the doctor to make them feel better. Of course, the doctor doesn’t just automatically know what the problem is either so he orders a bunch of tests. The patient gets blood work drawn and it is sent to the lab. They get chest x-rays done because they have a cough. A whole battery of tests get performed and the results go straight to the ordering physician.
The results are what the doctor uses to try and figure out what is wrong with the patient. It only makes sense that it is after all the results are analyzed that the conclusion can be made… this patient has tuberculosis. That’s when the patient gets a face mask to prevent his coughs 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. Literally. Keep your equipment wiped off and disinfected. Change the table sheets between every patient. Use gloves whenever you feel necessary. Exposure to blood, stool, mucus, and urine is just as possible as breathing in the TB airborne molecules. You never know who has touched the same doorknobs, telephones, light switches and what they had on their hands when they touched it. The same precautions apply. Clean often, wear protective gear and just overall pay attention.
Potential for needle sticks during procedures and IV insertions
Rad techs are trained to start intravenous catheters on patients. They are mostly used for giving the patient contrast during exams but may be used by nursing staff for medication administration. The procedure for inserting an IV calls for having both of your hands within close proximity while performing the procedure. I doubt there’s a working nurse out there who hasn’t been stuck with a needle during an IV start. Techs 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 own 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 really blame the patient either. It is completely normal for your arm to jerk when being stuck by a sharp object. I know MRI techs use butterfly needles sometimes for their contrast injections instead of intravenous needles. It doesn’t matter. The exact same thing happens. I was a phlebotomist for many years in an outpatient clinic before going to rad tech school and I stuck myself at least three times. My risk was higher due to seeing 50+ patients each day and they ALL needed venipuncture. If you stick yourself before it ever touches the patient it is called a “clean needle stick.” You still report that it happened for liability but there is usually no follow up. If you get stuck by a used needle then it is called 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 be required to get a shot of medicine to counteract any possible effect that may occur 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 prior to discarding it. You should never attempt to recap a needle. You should also 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 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 walked out under their own leg power. But what I wasn’t prepared for was the traumatic injuries that would be burned into my memory for the rest of my life. Most facilities assign rad techs to different areas of the hospital for the duration of their shift. I’ll never forget the night I was assigned to cover the ER and two heatstroke victims were brought to us. They were two little sisters who were playing in their backyard on a hot Phoenix Arizona day. For reasons I don’t remember, they died from the extreme heat inside the car that was parked in their backyard. I was told 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 just is no preparations for these types of things and you have to fully perform your job duties right in the middle of it. It is so commonplace that there is a department of employees who have the job of ‘debriefing” any employee who was in the room during certain types of events. Debriefing means to give you the opportunity 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 types of events, you best not work in a hospital. Get yourself a clinic job or outpatient imaging center.
Being 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 is coming from a patient who is drunk or on drugs. In most cases of extreme combatants, the patient will have been brought in by police officers. The patient will be handcuffed 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 in order to get your x-ray exam done. 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 simply too mean and hostile. If I walked in their ER room to get them for their exam and they immediately started yelling and cursing at me with threats…you’re done. I’m out. Sorry Doc. It is a federal offense to physically attack a police officer or a healthcare worker. Any patient who threatens or is successful in an assault is looking at substantially more jail time than what they originally started out with. Technologists can press charges against the patient and the police will help with the paperwork. You have to be very careful when working with altered mental status patients, regardless of why they are 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 gurney to exam table and back. Or up from a wheelchair on to the table and back to the wheelchair. If you get lazy and bend at the waist instead of lifting with our legs, you will surely end up someday with a back injury. How you twist and turn, reach for equipment, push and pull patients all have an effect on 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 all by yourself. You won’t get any medals for doing it and very likely will end up with pulled or torn muscles someday. You also have to watch out for other employees. I haven’t seen it in a while but I have seen my fair share of employees getting their toes ran over by the portable x-ray machine. Not because there was any malicious intent from the driver… but because sometimes it’s just 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. Over ten years ago, my facility was inspected by the state physicist in Arizona. 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 found out that the protective leaded glass in this 50-year-old hospital apparently wasn’t leaded at all, or not enough. Being over 20 feet away from the radiation source, I never gave any thought to the idea that scatter radiation may make it to the control room. I was always taught that six feet were the safe distance from a radiation source. That’s why the bungee cord on a portable x-ray machine reached out about 7-8 feet with the exposure trigger on the other end. According to the physicist, there was noticeable, recordable amounts of radiation registering on his equipment. I had already been working 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. It is my understanding now that this should be done annually by a physicist. Working the night shift, I had never seen it done before at this old hospital…which is now closed for unrelated issues.
Dosimeter badges are collected either monthly or quarterly and submitted for evaluation. The company Radiation Safety Officer is usually in charge of this program. The badges are evaluated to determine the amount of radiation the employee is receiving. 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 investigate the occurrence in a timely manner and report back to the Radiation Safety Committee. Two badges are worn by female technologists 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. There are also some things that can cause false-positive readings on these badges. For example, don’t leave your badge on the dashboard of your car or the direct sunlight can affect it.
Luckily for me, the amount of radiation being allowed through this “protective” barrier was not enough to cause me issues…that I know of…so far. The same can happen if you work a lot of shifts in the operating room or interventional suite. Even routine procedures where the technologist is operating the fluoro tower can put you at risk for overexposure if you aren’t careful. Any location where the technologist is operating the machine while standing right next to it calls for situational awareness and proper shielding. Be proactive by keeping yourself at a safe distance from the primary source of radiation, wearing lead aprons and thyroid shields, and using your dosimeter badge properly.
Being sued by patients for medical malpractice
You don’t have to worry about being a cash register employee at McDonald 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 personal estate. There are several insurance policies that 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. I have never been sued by a patient but I have heard conversations around it from other employees.
There is no way to know everything you are getting yourself into when signing up for a radiography school. Hopefully sharing my experience helps ease your situation a little 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 send me an email: [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: