The Irish Medical Times - A Broken System: A Need for X-ray Reform
My daughter is active, adventurous and impulsive (bordering on reckless), we have rocked up to A&E on more than one occasion. Some of her accidents have been significant including a full and complete fracture of her humerus, to a severe elbow dislocation with the radius bone completely separated from the joint.
Once the initial pain from the fall has settled she can appear quite stoic, this is usually at the point when we arrive at the hospital. I think her stoicism is probably a form of shock but to observers (including medical staff) it can come across as an indication that the complaint is minor. Despite swelling, clear distortion, an inability to move, and extreme pain on attempted movement, we often feel demoted to non-urgent as other sporting injuries arrive after us, are seen before us, and go home with a band aid and batman sticker, while my kid remains unseen in the corner crying silently.
We have noticed that once an x-ray is taken, and the true extent of her injury is revealed, wheels kick into action and we bounce up the priority list. Unfortunately, the x-ray experience has started to become a marked ordeal for my daughter.
A lot of treatment in emergency medicine seems to be bedside (or chairside, in a crowded ED). The nurse will wheel over a blood pressure machine, take your temperature there and then, medication is brought to you through tablets and IVs, the doctors come to you, if you need a cast, they bring the materials to you and put it on as you sit in bed.
But if you need an x-ray (which I feel is the vast number of patients in a children's ED) you have to get out of bed/chair and go to Radiology. This usually involves walking through many double doors, up lifts/stairs, following signs and making wrong turns. A tough journey when your arm is hanging off its hinges and any movement is agony.
Once you are called in by the radiographer their job is to get a good quality image of the injured body part. This is where it gets tricky, and brings me back to my opening paragraph. My daughter is being asked to twist a limb that is severely damaged into a position that gives a lovely clear picture of the bone but causes my child horrendous pain. The radiographer knows that if my child doesn’t get into the right position she will likely be sent back again (through the endless corridors) to have the process repeated and go through the agony all over again. Hence the cajoling and pushing into place.
It has reached a point where I have to petition the doctors to give my daughter powerful painkillers if they expect her to contort her broken body into agonising shapes. There has to be a better way of doing this?
Why are x-rays the last remaining piece of emergency medicine that we don’t bring to the bedside? I know there are portable x-ray machines but they are big, heavy, clunky and you still have to contort your body to suit them.
My 10 year old asked me, why isn’t there an x-ray drone that comes to the patient and flies around the injury taking images? Why can’t the x-ray tech suit us, instead of us suiting the tech?
I’m sure x-ray drones must exist for search and rescue missions, for security and surveillance, for archaeological digs, and so on. Can we harness this technology for hospital patients?
There is the obvious issue of uncontrolled radiation exposure, and I assume there would need to be an image receptor on the other side of the subject matter to “catch” the x-ray, that would require a stable surface, so are we back to pushing a patient into the right position?
I have had many x-rays, CTs, MRIs, and PET scans but luckily I’ve never shown up to the Radiology Dept in pain (mine are usually more sinister presentations). I have however played the waiting game, sometimes for days at a time in a hospital bed.
Most recently I was in hospital and needed a chest CT. I waited for 5 days in a ward until the call came through, the Health Care Assistant (HCA) reefed me out of the bed, flung me into a wheelchair and raced me like a Formula One driver to try and get to the X-ray Dept before 4pm. It was 3.55pm as we tore along the corridors, my hair flapping in the wind. We screeched to a halt at the waiting area at 3.57pm.
A stressful conversation ensued where the HCA was chastised for not getting me there sooner, despite the phone call coming just 10 minutes previously. Apparently it was imperative that my CT start by 4pm or I would have to be sent back and wait for another day. Only emergencies or cases from the ED are allowed after 4pm on a weekday, something to do with the number of radiographers on duty and insurance. So even though I had originally come in through the ED, I was stuck in this waitful roulette.
The elderly patient prior to me was leaving the CT room at a glacial pace, the door was wide open and myself, the HCA and the radiographer were all staring at her, willing her to pick up speed. Her handbag would bang against her knees as she moved, causing her to stop and look down in surprise - every single time she took a step. As soon as she crossed the threshold, I was flattened into the machine, a contrast injection was inserted into my veins. “We have 1 minute to start the CT” squealed the radiographer as she disappeared into a dark room.
Chug-chug-chugchug, we were underway, phew! The stress to meet this ridiculous cut off time was immense. There are fundamental problems with the radiological delivery strategy.
Also, if people are surprised by their own handbags, would they even be capable of dealing with a drone?
Yet, as the healthcare landscape continues to evolve, it’s imperative that we reevaluate outdated practices, especially when it comes to the patient experience. The unchanged process of transporting injured and ill patients to radiology departments for x-rays can be unnecessarily painful and stressful.
While the challenges faced in radiology remain, the future holds promise for more patient-centric and less painful experiences. Perhaps flying x-rays are a while off, but maybe we’ll see advancements in mobile x-ray technology, and more efficient systems that require less radiation. Innovations like portable x-ray machines, 3D imaging, holography, and potentially even drone-based imaging could revolutionize the way we diagnose and treat injuries. Making healthcare experiences more comfortable and less traumatic, especially for children.
Meanwhile, a quick solution to some of the patient frustrations around x-rays is to provide more radiological services (without a 4 o’clock cutoff!). This could free up staff to take time with patients experiencing pain, clear the backlog of patients waiting on never ending lists, and allow time for handbags and surprises. Perhaps the future of X-rays lies not just in technological advancements, but also in a renewed focus on the human experience.
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