MRI safety screening
MediumMRI Safety Screening: Modesty and Metal Implant
Setting: X-ray department. Your role: Radiographer
Mr. Ahmed Khan, 69, is scheduled for an MRI due to persistent lower back pain after a fall. He has a history of a metal implant (shrapnel fragment from a war injury 40 years ago) near his spine, requiring a thorough MRI safety screening including a physical examination. He has a specific cultural request regarding the clinician for this screening.
- Listen carefully to Mr. Khan's specific request regarding modesty and clinician gender for the MRI safety screening.
- Understand the cultural context behind his preference for a male radiographer for the physical examination component of the screening.
- Assess the clinical feasibility of accommodating a male radiographer for the safety screening, considering departmental staffing and the critical nature of the metal implant assessment.
- Propose a specific accommodation or compromise, such as arranging for a male radiographer or offering a chaperone, while ensuring the thoroughness of the safety screening.
- Confirm with Mr. Khan that the proposed accommodation is acceptable and addresses both his cultural needs and clinical safety concerns.
Practise this cardChest X-ray procedure
HardCXR for Diego: Cultural Modesty Request
Setting: X-ray department. Your role: Radiographer
You are a radiographer in the X-ray department. Ms Sofia Garcia has brought her 12-year-old son, Diego, for a chest X-ray due to a persistent cough and occasional breathlessness over the past three weeks. Ms. Garcia approaches you with a specific request regarding the procedure.
- Listen carefully to Ms. Garcia's specific request regarding the clinician performing Diego's chest X-ray without making assumptions.
- Understand the cultural context and importance behind Ms. Garcia's request for a female radiographer for her 12-year-old son.
- Assess the clinical feasibility and practical implications of accommodating Ms. Garcia's request for Diego's diagnostic imaging.
- Propose a specific, respectful accommodation or compromise that addresses Ms. Garcia's concerns while ensuring Diego receives his chest X-ray promptly.
- Confirm with Ms. Garcia that the proposed accommodation is acceptable and that she feels comfortable proceeding with Diego's procedure.
Practise this cardPregnancy questions before imaging
MediumSmoking Cessation Counselling for Pregnant Patient (Pre-Imaging)
Setting: X-ray department. Your role: Radiographer
Ms. Hannah Lee, 29, 14 weeks pregnant, has been referred to the X-ray department for an ankle injury. She has questions about the safety of the X-ray during pregnancy. During your initial assessment, you also note she is a smoker (5-7 cigarettes/day) and expresses general concern about her baby's health. Your primary role is to address her concerns about the X-ray and then counsel her on smoking cessation, using motivational interviewing techniques.
- Assess Ms. Lee's readiness to change her smoking habit, specifically asking about her current thoughts on quitting or reducing the 5-7 cigarettes she smokes daily during pregnancy.
- Understand Ms. Lee's specific motivations for considering quitting smoking today, inquiring about her sister's influence and her concerns for her 14-week-old baby.
- Set a SMART goal with Ms. Lee for reducing or quitting smoking, considering her previous failed attempt with nicotine patches and aiming for a specific, measurable target within a defined timeframe.
- Discuss concrete support Ms. Lee can rely on, such as her sister, local smoking cessation services, or mobile apps, to help her achieve her smoking reduction/cessation goal.
- Schedule a brief follow-up check-in, perhaps by phone, in two weeks to review her progress on the agreed-upon smoking cessation goal.
Practise this cardKidney blood test before contrast
HardLaura Bennett's eGFR Dilemma for Contrast CT
Setting: X-ray department. Your role: Radiographer
Ms Laura Bennett, a 38-year-old single parent, has arrived for a CT scan with contrast. Her sister, Sarah, is insisting on a pre-contrast eGFR blood test, which Ms Bennett finds inconvenient and potentially delaying. Your role is to address this conflict, ensuring Ms Bennett understands the clinical necessity while mediating a practical solution.
- Acknowledge Ms Bennett's urgency to complete her CT scan today and her sister Sarah's valid concern about the safety of contrast material given potential kidney risks.
- Name the shared goal of ensuring Ms Bennett receives the most appropriate and safest diagnostic imaging for her condition while minimizing any potential risks to her kidney function.
- Clarify the medical facts regarding the eGFR test: explain that it measures kidney function, which is critical because the contrast dye used in CT scans can potentially harm kidneys if their function is already impaired, specifically mentioning the risk of Contrast-Induced Nephropathy (CIN) if eGFR is below 60.
- Mediate a compromise, such as exploring options: a non-contrast CT today followed by an eGFR test and a separate contrast-enhanced study if needed, or rescheduling the full contrast CT with a pre-booked eGFR blood test done beforehand, explaining that results for an eGFR test typically take 48 hours.
- Confirm a specific shared plan with Ms Bennett that balances the need for timely diagnosis with kidney safety, ensuring she understands the next steps for her CT scan and eGFR assessment.
Practise this cardImage-guided joint injection
MediumMr Wong's Second Opinion on Shoulder Injection
Setting: X-ray department. Your role: Radiographer
Mr Isaac Wong, a 39-year-old software engineer, has been referred for an image-guided steroid injection for his shoulder pain. He has come to you seeking a second opinion, expressing concerns about the procedure based on information from a friend.
- Acknowledge Mr Wong's right to seek a second opinion regarding his image-guided steroid injection and reassure him that it is a normal and acceptable step in his healthcare journey.
- Withhold any judgement or negative comments about the referring clinician's advice, focusing instead on Mr Wong's concerns about the steroid injection for his shoulder.
- Review the clinical question of an image-guided steroid injection for shoulder pain, discussing the procedure, its purpose, and potential risks, based on the information Mr Wong provides and your professional knowledge.
- Share an independent assessment of the suitability of an image-guided steroid injection for Mr Wong's shoulder pain, providing clear reasoning regarding its benefits, potential side effects like tendon weakening, and the actual procedure time and sensations.
- Support Mr Wong's ultimate decision about whether to proceed with the image-guided steroid injection or explore alternative options, ensuring he feels empowered and informed.
Practise this cardNuclear medicine imaging
HardNuclear Medicine Scan: Prayer Time Accommodation
Setting: X-ray department. Your role: Radiographer
Mr. Ben Thompson, 34, is scheduled for a Technetium-99m bone scan today. The procedure involves an intravenous tracer injection followed by a crucial 90-minute uptake (dwell) period before the imaging can commence. Mr. Thompson has indicated a need to discuss the timing of his scan.
- Listen carefully to Mr. Thompson's specific request regarding the timing of his nuclear medicine scan.
- Understand the cultural or religious context behind Mr. Thompson's request without passing judgment.
- Assess the clinical feasibility of accommodating his request, considering the Technetium-99m tracer's half-life and the optimal imaging window.
- Propose a practical accommodation or compromise that respects his beliefs while ensuring diagnostic quality.
- Confirm with Mr. Thompson that the proposed plan is acceptable and addresses his concerns.
Practise this cardBarium swallow examination
MediumBarium Swallow Prep Non-Adherence
Setting: X-ray department. Your role: Radiographer
Mr Ben Thompson, a 34-year-old warehouse supervisor, is scheduled for a barium swallow examination to investigate his difficulty swallowing. He attempted the procedure last week but was unable to complete it due to inadequate preparation, specifically not being able to fast for the required 6 hours beforehand.
- Explore the challenges Mr Thompson faced in following the 6-hour fasting instruction prior to his last barium swallow appointment, ensuring a non-judgmental approach.
- Validate Mr Thompson's difficulty with fasting, acknowledging the demanding nature of his work, while clearly explaining why strict adherence to the 6-hour fasting is crucial for accurate imaging results.
- Co-design a revised preparation plan for the barium swallow, specifically focusing on a fasting schedule that is more feasible for Mr Thompson's work shifts and personal routine.
- Safety-net Mr Thompson by outlining clear steps he should take if he anticipates or experiences difficulties adhering to the newly agreed-upon fasting plan for the rescheduled examination.
- Schedule a brief phone call or follow-up appointment for the day before his rescheduled barium swallow to confirm his understanding and confidence with the preparation plan.
Practise this cardLimb X-ray after injury
HardFall Prevention & Activity Post-X-ray
Setting: X-ray department. Your role: Radiographer
Mrs. Janet Morris, 66, has returned to the X-ray department for a follow-up discussion regarding her right ankle, injured 6 weeks ago in a fall from a step stool. Her recent X-ray shows no fracture, but her GP has specifically recommended she discuss fall prevention and increasing physical activity to improve her balance and strength.
- Assess Mrs. Morris's readiness to increase her physical activity to improve balance and prevent future falls, especially given her recent ankle injury.
- Understand what specific concerns or events, such as her grandson's upcoming 5th birthday party, are motivating her to consider changes to her activity levels today.
- Set a SMART goal with Mrs. Morris for increasing her physical activity, focusing on low-impact exercises she can integrate into her routine, such as walking for 20 minutes, 3 times a week, over the next month.
- Discuss concrete support systems Mrs. Morris can rely on, such as her existing walking group or using a step-counting app, to help her adhere to her activity goal.
- Schedule a follow-up consultation in 4 weeks to review her progress on the agreed physical activity goal and discuss further steps.
Practise this card
