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A Radiographic Examination: Justification of Actions Taken

This assignment will present a right foot x-ray examination and explore the justification of action taken for this x-ray.

In addition, this assignment will discuss numerous topics involving X-ray ionizing radiation, including regulations, radiation protection, and exposure factors. This X-ray examination was carried out on an adult male.

Mr. William, male 46 years old, a council gas and boiler engineer, had an accident while replacing a broken boiler for a new one. The old heavy boiler fell on his right foot from one meter and a half height.

Mr. William was brought by ambulance to the Accident and Emergency Department; his colleague accompanied him; after being seen by the A&E doctor, the same doctor referred Mr. William to have a right foot x-ray; he was brought to X-Ray Department in a wheelchair by the porter because he could not bear weight on his right foot. We received an electronic request card which, as the paper request, is a legal document.

The doctor’s request was for a right foot x-ray.

The clinical details: While working a heavy boiler from a height of one meter and a half, it fell on his right foot. Query fracture of the right foot. Pain over 1st, the second and third metatarsophalangeal joint region.

Clinical Record Interactive System (CRIS) and Picture Archive and Communication System (PACS) were checked for previous exposure to ionizing radiation (Admin, 2022). The patient’s last exposure was in March 2018. He was allowed to have this exposure.

Mr. William was called to come into the x-ray room, and his colleague was asked to stay in the waiting area; it is part of the radiation protection. The radiographer brought the patient into the room, and after closing the door to keep the patient’s confidentiality, the ID checking was done by asking the three main points: Name, Date of birth, and Address.

Mr. William, when asked by the radiographer where the pain is, he confirmed that the pain is over the 1st, second, and third metatarsophalangeal joint; consequently, only two images of his right foot were to be produced as the potentially injured bone is evident in two planes Dorsoplantar and Oblique projections, there is no need for lateral projection in this case. This is also part of the radiation protection rules. ‘Do not do any unnecessary exposure to ionizing radiation’ (Admin, 2022).

The patient was asked if he had any questions regarding his x-ray, and he replied no question; the patient was also asked if he was happy to proceed with the examination, and he replied positively.

The radiographers helped the patient to sit on the X-ray table, flex his knee on the affected side, and to step flat on the free image receptor for the DP projection; following that from the DP position, the patient was asked to bring his foot to around 40 degrees for the oblique projection. The source-to-image distance (SID) used was 100 cm. These two radiographic images were produced and sent to Picture Archive and Communication System (PACS), where the doctor can assess them (Avci & Kozaci, 2019). The patient was taken back to the Accident and Emergency Department where he can see the doctor again, can get the x-ray result, and the treatment immediately.

Request card checks

Radiology request forms are vital communication tools doctors use when referring patients for radiological examinations. Their significance needs to be more recognized. According to the Royal College of Radiologists, all forms must be legibly and adequately completed to ensure clarity and understanding. Clinicians must state the reasons for referrals since this goes a long way in assisting the radiologist in knowing better and understanding the patient’s conditions so that the appropriate expertise can be used in aiding proper patient management (Avci & Kozaci, 2019).

A request card must be presented at the department since, if correctly filled, the form offers the radiographer and radiologist enough information to help reduce patient expenses, accurate diagnosis, justification in radiation exposure, and reduced patient waiting times (Lemmers et al., 2019).

A radiographer is responsible when it comes to the scrutiny of the X-ray request card (Lemmers et al., 2019). This staff member must ensure that the information in the request card provides all the required data, including the patient’s information and the reasons for the request. Besides, the radiographer is also the one who is responsible for ensuring that important information has been recorded upon conducting the operation, including the images that were saved throughout the operation (Dvorák et al., 2021).

One staff member can review the request form only if authorized by the radiologist. The radiologist is always responsible for ensuring that the diagnosis is appropriate and that they can order anyone, including the x-ray technician, to crosscheck the request card and ensure that all the essential information about the patient has been recorded (Lemmers et al., 2019).

PACS is utilized in storing and transporting the client’s medical images. Therefore, before the X-ray examination, PACS contains the patient’s personal information and the reasons for the X-ray examination, including the referring physician (Avci & Kozaci, 2019). Besides, PACS allows the radiologist to review the patient’s chronological details of their radiology history.

Scrutinizing the request card before carrying out an X-ray test is always beneficial since one can evaluate the patient’s history regarding X-ray examination. By reviewing PACS, a radiologist can determine whether the patient is fit for the test because repeated exposure to ionizing radiations may affect the patient’s cells in the part of the body that has seen repeated exams (Yu et al., 2019).

Scrutinizing patient information is always critical for legal and medical reasons (Uysal et al., 2021). Legally, one must always ensure that they abide by the set X-ray guidelines failure to do so may lead to legal issues (Lemmers et al., 2019). Patient information is always vital, and the staff must ensure they follow all the guidelines to avoid landing them in legal battles.


Regularly cleaning the room, especially before the patient is admitted, reduces microbial contamination, removes organic material, and provides a visually clean environment (Yu et al., 2019). The focus of routine cleaning is often on surfaces that are within the patient’s zone.

Centers for Disease Control and Prevention covers this regulation by requiring that all healthcare facilities are cleaned and disinfected to avoid further damage to the patient being operated on (Uysal et al., 2021). Also, the World Health Organization is always strict as far as hospitals and other healthcare facilities are concerned about calling for all the stakeholders to provide a clean environment for patients and staff (Yu et al., 2019).

The X-ray room should have a wall whose thickness is the same level as the defined shielding standards and should not have windows to avoid radiation penetration into the surrounding environment (Bhatkar et al., 2020). Also, the room should be presented to accommodate the essential components to produce x-ray beams, including a beam filtration system, tube, collimator, generator, and tube housing.

Before the patient is called in, the radiographic room should be prepared by ensuring it is organized and clean and removing all the disarrangements from the previous operation. This includes putting fresh linens on the pillow and the table and placing all the required accessories where they should be (Yu et al., 2019).

Some aspects of X-ray examination that can be prepared in advance are removing metal objects like hearing aids, jewelry, and hairpins (Uysal et al., 2021). Also, one can change into a gown or wear comfortable clothing before an X-ray examination. Besides, the patient can prepare for an x-ray examination in advance by not drinking or eating anything several hours before the test.

Shielding is one of the considerations one observes when asking a patient to wear a gown. This is one of the three basic concepts of radiation safety, which must always be utilized when distance and time are impossible (Avci & Kozaci, 2019). When asking the patient to wear a clinical gown for the examination, the radiographer or radiologist aims to shield the potentially harmful impacts of ionizing radiation.

The radiographer should check the patient details on the request card. This card carries all the relevant information about the patient, including the reasons for the exam and their name, date of admission, and the referring physician (Dvorák et al., 2021).

An operator conducting an X-ray must confirm the patient’s pregnancy status before exposure so that appropriate steps can be taken to minimize the radiation dose to the fetus (Lemmers et al., 2019). As a result, we should ask patients whether they are of childbearing age to avoid exposing radiation to the unborn child. The unborn child in the mother’s womb is more sensitive to ionizing radiation than an adult hence the need to be careful when examining people, especially mothers of childbearing age.

The SOR inclusive pregnancy policy does not require all men to be asked whether they are pregnant (Uysal et al., 2021). Instead, the policy recommends the establishment of local risk groups based on the MPE’s advice and has been a standard practice for many years. Typically, this policy applies to ages twelve to fifty-five years and for higher radiation doses in which the pelvis is irradiated.

We should ask patients when they last had a period to avoid irradiating a woman who might have missed or may be pregnant (Uysal et al., 2021).

The question about the patient’s last time having her period should be asked before carrying out a radiological examination (Kravchenko, 2022).

Exposure to X-ray radiation can adversely affect the pregnant patient, hence the need for the 10- and 28-day rule (Dvorák et al., 2021). The International Commission on Radiological Protection developed the ten-day rule to reduce the potential of carrying out X-ray tests on pregnant women. This rule was based on carrying out pelvic and abdominal X-ray exams only during the ten days following menstruation onset (Uysal et al., 2021). Conversely, the twenty-eight-day rule applies to radiological examinations that can occur throughout the menstrual cycle until one misses her period and low dose radiological examination (chest x-ray) becomes suitable (Dvorák et al., 2021).

Radiation Protection

Steps must be taken to minimize the amount of ionizing radiation a patient receives because too much radiation over time may damage cells leading to an increased risk of cancer (Dvorák et al., 2021). Therefore, reducing the amount of ionizing radiation a patient receives will significantly reduce the risk of developing cancer later in life.

Equipment can be considered a radiation protection tool if it helps in maintaining personnel exposures to radiation as low as reasonably achievable. Lead, in particular, has long been considered an element of choice regarding radiation protection (Khalid et al., 2020). Therefore, radiation protection equipment should be a malleable and corrosion-resistive metal. Besides, the equipment should have a high density to make it an effective barrier against gamma-ray and X-ray radiation (Prancisca & Halim, 2022).

When less dense, the material becomes more effective as a radiation protector than others since they shield against particles, preventing them from going through (Prancisca & Halim, 2022). Density is the main factor considered when evaluating materials and their ability to protect against radiation (Admin, 2022). For example, lead blankets and aprons are the most effective radiation protectors due to their density.

Changing exposure factors may be necessitated by medical conditions like pregnancy and the patient’s age. Ionizing rules and guidelines prohibit fetus exposure (Ford et al., 2021). Therefore, a radiologist may be forced to change exposure factors for the patient.

A greater distance can reduce radiation exposure (Prancisca & Halim, 2022). This is because the distance from the radiation source is not inversely proportional to the amount of radiation exposure (Dvorák et al., 2021). However, the amount of radiation exposure is inversely proportional to the square of the distance.

The radiation dose received by the patient is recorded in the form of an image (Prancisca & Halim, 2022). This image carries all the vital information, such as the part of the body that was scanned and the conditions of that part. This detailed information helps the referring physicians identify the next step to treat the patient.


For healthcare institutions and hospitals, ensuring proper patient care involves making diagnoses and conducting procedures (Al Shamsi et al., 2020). Communication is critical in every step of health care processes. Research reveals that organizations with solid communication policies can go a long way in enriching their client’s health. However, those needing more effective communication can adversely affect their clients’ well-being (Al Shamsi et al., 2020). As a result, healthcare institutions and professionals must recognize the significance of communication in healthcare for them to thrive.

Language barriers may directly affect the clinician’s and radiographer’s ability to achieve care provision goals because of a lack of effective communication (Burgener, 2020). Therefore, during the conversation with the patient, it is essential to evaluate their understanding.

Language use should be considered when discussing their health with the patient, especially in informing them about the x-ray procedure and its implications. When discussing with the patient, the clinician should avoid using medical terms that may be difficult to understand (Burgener, 2020). Also, language considerations should be made when giving the patient x-ray results.

Eye contact is among the most critical forms of nonverbal communication in health care and many societies. This form of communication, particularly in most Western European nations, is a polite and proper way for nurses and healthcare professionals to communicate with their clients (Al Shamsi et al., 2020). By maintaining eye contact, the healthcare professional will ensure that the patient is listening and that one can better observe and address emotions behind the specific concerns that may be affecting the patient (Burgener, 2020). Besides, making eye contact with the patient indicates interest in what they say. Research shows that patients report improved satisfaction when healthcare professionals make eye contact with them during communication.

Non-verbal communication refers to how one reacts, listens, and looks, which tells the other person they are communicating with, whether they are being truthful and caring, and how well they are listening (Al Shamsi et al., 2020). Matching non-verbal communication with spoken words is essential in increasing clarity, trust, and rapport. Good communication ensures safer and better care outcomes for the patient. Besides, good communication is critical in creating a more satisfactory environment for healthcare professionals.

During the examination, it is crucial to ask the patient questions to be informed about the test and what they will expect after the dose (Burgener, 2020). This will make them comfortable throughout the examination process, and their information can be used to improve their health outcomes.

Communicating effectively with other colleagues is essential to minimize communication failures (Al Shamsi et al., 2020). Through effective communication, healthcare providers can work effectively with their clients and the care team and establish rapport with their patients.

There is the opportunity for less accountability and increased misunderstanding when there needs to be better communication. Poor communication often leads to adverse outcomes like patient dissatisfaction, decreased adherence to treatment, inefficient utilization of resources, poor healthcare outcomes, misdiagnosis, errors, and inappropriate treatment of patients (Al Shamsi et al., 2020).


The patient was referred because of the request to investigate a right foot fracture—pain over the First, Second, and Third Metatarsophalangeal joint region.

Carrying out justification steps is critical in determining whether the patient is fit for the recommended X-ray scanning procedure to justify the applied exposures and to evaluate the requested examination (Ford et al., 2021).

It is essential to consider the preparation of the room and equipment to remove germs that may cause severe infections in the patient (Ford et al., 2021). A proper arrangement of the room is also essential for ensuring that all the required accessories are available for patient operation.

It is essential to follow all the regulations and protocols in X-ray examination to ensure the patient is not exposed to unnecessary radiation (Uysal et al., 2021). Besides, it helps the radiologist and other staff abide by the legal demands.

Communication is critical since it allows the radiologist and other staff to establish rapport with their patients, work effectively with all care teams, and solicit relevant healthcare information (Al Shamsi et al., 2020).


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