To Michael Smith

Feelings

I was uncomfortable with the as the patient was very tolerable despite of her pain. I was thankful since the patient was communicative and made my work pretty much easier. I enjoyed the task throughout the procedure. I was pleased with my adapted technique and appraisal skills; furthermore, I was overwhelmed for identifying the fracture site on the image.

Evaluation – what is good and bad about the experience?

The good thing was that my communication with the patient was excellent from start to end. I was very attentive with positioning technique; I tried not to cause any pain to the patient. I was satisfied by my technique to demonstrate the lateral horizontal beam knee view; in addition, I was stunned for identifying knee joint effusion called lipohaemarthrosis. Lipohaemarthrosis is defined as the presence of blood and fat in the joint space and is an indication of intra-articular joint fracture (Yochum & Rowe, 1996). I did not have any bad experience during the procedure or image appraisal, the procedure went very well from start to the end of the task. I was really disappointed by my assessor for giving me lower mark for my appraisal part.

Analysis

Looking back to the task, I was confident and comfortable during the examination because firstly, I had enough practicing with the HBL knee view technique previously. Normally, horizontal lateral beam knee view performed as the patient is seated and his/her leg is flexed, using 24 x 30 cm CR cassette is placed on patient’s medial aspect of the trauma knee, the x ray beam is pointing horizontally over lateral aspect of the knee joint, aiming to detect blood and fat level at the patellar supra bursa area of the knee (Venkatasamy et al, 2014).

Secondly, my patient was supportive and understood to all my positioning instructions, I showed good professional behaviour throughout the process of the task, including patient care, infection control, and effective communication and also using the x-ray equipment according to the standard practice (Ehrlich et al, 2004). I was also very happy with my appraisal skills; successfully I followed the 10 systematic approach of image appraisal properly, including recognising the abnormality and applying the red dot protocol (Carver & Carver, 2012).

The one which disappointed me was that I was mentioned the condyles of the femur were not fully superimposed during the image appraisal however the image answered the clinical history, a lipohaemarthrosis was demonstrated and I decided not to repeat or take additional image. My assessor agreed by my decision but she asked me if you asked to re do it, how could you think fix it? The fibula was clear of the tibial metaphysis; I was not sure; any way my answer was I should rotate the knee externally instead of responding internally. For that reason, my assessor gave me a lower mark “B” for my appraisal part. \I felt, I deserved more because finding the lipohaemarthrosis of the knee was the most significant image interpretation of my overall practice.

Conclusion

To summarize, overall my involvement on this staged assessment was a very good experience. Taking an x-ray of trauma patient can be challenging and stressful, the experience thought me organizing all necessary equipment and using adapted technique according to the patient’s condition help to minimize the hectic task. My patient was unable to hold still the required positioning but applying positioning aids such as, sponges pad helps me to simplify the work. I realise good communication can destruct and reduce pain to patient. I was satisfied by adhering patient management care in the x-ray department such as, infection control, radiation protection and personal care as well. Obtaining quality image in my first attempt and as well as finding the lipohaemarthrosis on the image was the best highlights of my day.

Action plan

Considering to the experience I had during the knee trauma patient x-ray procedure, as a radiographer you need to perform the procedure efficiently that means you are minimising patient movement as a result you will get a quality diagnostic image result. Working along senior radiographers and observing them applying different types of adapted technique on trauma patient could help me in my future practice.

As a radiographer I have a responsibility to manage patient pain so that to reduce the pain on patient you have to move the trolley and the x-ray tube instead of the patient. Reflecting this paper helps me to realise that I have to continue improving my own image appraisal skills. I will support my knowledge of image interpretation by joining the ‘interpretation e-learning’ of the society and college of radiographers’ website.

References

Carver, E. & Carver, B., 2012. Medical imaging: techniques, reflection & evaluation [online]. 2nd ed. Edinburgh: Elsevier.

Ehrlich, R.A., McCloskey, E.D. & Daly, J.A., 2004. Patient care in radiography: with an introduction to medical imaging, 6th ed. St. Louis: Mosby.