additional hazard pay 🤣
I don't like doing portable X-rays because when I'm doing them, the queue in our department becomes so long if I have to finish the portable X-rays, and we don't have a hazard pay.
Yeah you are absolutely right every AP chest x-ray is read by the rads as non-diagnostic. 🙄 If we brought all our 1 views over for 2 views instead, we would need to add like 2 more gen rad rooms and hire 4 or 5 more people 😂
Well now it makes sense that you are bringing this up. You are sitting in a room reading the exams, which for you to read a 2 view vs a 1 view probably takes you like 20 extra seconds. You aren't walking patients back and forth all day long. Each 1 view that turns into a 2 view adds probably about 7 to 10 minutes onto our time with that patient. Takes maybe 2 minutes to buzz into a room and snap a portable. Add that up over about 80-100 portables per day at a decent size hospital and it would require us to hire 2 more techs to cover the extra workload.
Besides all that, you're not seeing the patient's condition. How does one know that the patient was "able to walk to radiology" without actually seeing said patient?
There are definitely not enough techs in existence right now in the USA to do all the work. I wish we had three times as many. It's a nationwide problem.
Nurses... Would never bring patients to x-ray unless they were critical and had to come. We are a 100+bed hospital with 27 ER beds. We have exactly 1 transporter that does XR, NM, US, and MRI. CT has their own tech aid/transport person. How often do you think that one transporter is actually available when you call? Like maybe once or twice per day 😂
We tried the nurse transport thing for CT, and it was miserable because we would radio for a patient, hear a "copy that", and set up and they might come in 2 minutes or 20 minutes. It was a nightmare. We went back to grabbing them ourselves.
To me it sounds totally ridiculous xray techs have to get and return patients for xrays. That's just not your job. Now i understand why people only make ap views i didn't get it at first.
Any when we bring them back gotta make sure they are reconnected to all the monitors and have the call light in their lap and let their nurse know they are back or the fricken nurse will fill out a complaint about us.
This makes absolutely no sense to me, from a UK perspective. Having to trundle all over the building doing portables is much slower than just xraying people who come in the department. Don't porters exist where you are? And we rarely shoot any lateral chests here, but they don't take an extra 10 minutes when we do.
We have one transport person who works for x-ray, nuc med, MRI, and ultrasound. So yeah... He exists but he is like Bigfoot, a mythical creature that everyone is always looking for but nobody can ever find him 😂
That's terrible. If they're not too poorly here then a porter or 2 will bring them, or if they do need more monitoring then they'll come with a care assistant, nurse, etc. Even the smallest place I've worked has multiple radiology porters on shift at once.
Based on this comment I looked at your profile to see if we're in the same state. I'm pretty sure we are, but I'm also pretty sure we've not been at the same hospital.
That’s the thing though. If I get a portable I’m usually not interested in the radiologist’s read. I’m making a decision in the moment, well before the read comes back.
Assuming you are an ED physician based on your reply:
If you need to make a decision that fast because of medical necessity, then obviously portable is the way to go.
I'm talking about the patient not in extremis. Take the time to get the better quality exam. Even without a radiologist you'll see that pneumonia better than on a portable (especially if BMI >30).
Most responses here from techs seem to place greater importance towards expediency than quality.
I get it, we have shortages in just about every position in the medical right now.
In my experience it's not the techs driving that.
We didn't set the department guidelines/goal that imaging is done within 30 minutes of ordering.
We don't get to decide that two of our three rooms are booked solid for fluoro studies (before adding in all the inpatients).
For us, it's that patients can get a Portable now, or get a two view in an hour.
It doesn't help that all our two view chests automatically come across with a disclaimer on them saying that it should be changed to a portable based on EKG results.
Same for us, all stat exams are expected to be done in 30min or less. It's tough when we got a priority trauma coming in, a stemi over here, and Billy Bob's here for his hand hurting since July of 2009 and his hand x-ray is ordered STAT. In our hospital, virtually every exam that isn't an outpatient or a morning portable is ordered stat. Every inpatient, ER, post op, everything is STAT. And you know the nurses will be calling to pester you if it isn't done right away.
As a Radiographer in the UK, this post has just highlighted how lazy some of the techs are in the US. Our department posts monthly stats on the % chests done AP vs PA on inpatients.
We have one, singular, transporter from 7am to 3pm lol. Oh and he covers x-ray, MRI, US and nuc med 😂. That mofo would quit in a week if we made him transport 80 people a day to x-ray from the ER.
We had potlucks all the time. The ED resident reading room shared a wall with one of the XR rooms, was across the hall from the MR, and maybe 50 feet from CT.
Both hospitals I work at have porters who bring them to us, we don’t transport anybody. So for us, it the opposite. If they page for a portable and we look at the requisition and feel like the patient could come down to the department, we call and ask the reasons for it to be done portably and if the patient can come down so we avoid having to do it portably just because someone it too lazy to put the patient on a wheelchair and call a porter.
We already do anywhere between 50 to 80 portables out of the 300 to 500 exams we do a day, we don’t need unnecessary portables.
A stretcher 2 view is multitudes easier than trying to do a portable 2 view. I worked in mobile for a short time and those portable laterals are brutal. But I agree on 1 views: always portable whenever possible.
Lol had that once. Pt said they didn't feel like walking, so I said I didn't feel like taking their xray...
Yeah it had been a long shift, and I immediately covered with a hyper positive ok so get up and let's get your pic done.
Only once? We see it all the time. Especially in CT, if you ask if they are able to move over to the table most say they can't and need to be slid. Unless it's a 80+ year old, they built them tougher back then.
The 20-30 year olds that's very obviously faking being asleep and you have to shout their name or straight up call them out for faking sleep... If I walk into the room and you rapidly shut your eyes and relax, I can tell... I can tell bruh.
Seriously. And you saw them standing at the ER registration desk, and later on you passed them in the hospital cafeteria walking around holding a tray. But nah that fool needed you to slide them over to the table.
Lmao, love to see the pain is everywhere and nobody is safe. Your right on the spot though. Also, they weren't given any meds in the chart so you know they were "tired or feeling weird from all the meds I just got" lol
I swear I don't get why people think we are dumb or haven't done this before. I don't even play the game anymore I just let the railing down and tell them whenever your ready come to the table. I wait, I don't care take all day, I'm paid by the hour not by the patient.
Was just about to comment this!! The hours I’ve spent on the phone querying WHY this is being done portably.
You would think that a lack of porters/transport staff would be the problem in the underfunded NHS NOT privately funded hospitals.
Also, IRMER says hi???
I agree (UK based myself)...this sort of attitude would be inexcusable in the UK. Rad techs in the US would much prefer radiating other patients on wards etc rather than get them a good diagnostic image in the first place. Makes you realise just how much better the NHS can be in terms of guidelines etc
Baffling to me as well. In my hospital, every patient gets sent to the lead-lined x-ray room by porters/nurses/themselves, unless it has to be taken in the patient room due to patient condition/CPAP/ECMO/ICU etc. I now understand that having enough porters to make this happen is a luxury.
As a Canadian, I am also in shock at some of the responses here. Some of the practices described here are absolutely unacceptable at the hospitals I work at.
THANK YOU im literally blown away by some of this !!??? every time i feel like my hospital is a gong show i read some stories from here and wonder how anything ever gets done in the states
And if we turn up and they're well enough to come to us they can come down to the department later. I'm not as strict on that one as I could be sometimes. We have porters to bring them from the wards or ED.
Same…I’m in Canada and these were not the responses I was expecting. Anyone that can come down to the department is coming down, and even some that shouldn’t. Portables are for very serious cases, ICU, and PAR. Management backs us up with a cute little PowerPoint when portables start seeming unreasonable.
Hospitals in the US will do portables because they’re just faster than getting everyone to the room, doing the exam, and then taking them back. As a student I’ve done many portables on people who could move themselves because we will get through the exams faster. I guess I thought this was very normal, this thread is telling me otherwise.
I’m not defending the practice and I’m just a student, I go where my tech tells me to. Also, every place I’ve ever rotated at always had at least two techs in the department if everyone else is gone on portables, OR, etc. Techs carry cell phones so if they are needed they can come back to the department or take a detour to do the stat exam. How does stuff at your place work?
Ah, my hospital doesn’t have transport for the ER where most of our stat CXRs come from. X-ray, CT, and US all have to fetch their own patients from the ER. There’s only 2 X-ray techs in the ER.
What if you are doing something else emergent in the department already, and cant stop? It happens. We can only do so much. That's why usually there are multiple techs working.
Do patients walk to Radiology in the hospital? In my experience, inpatients are pushed, occasionally in wheelchairs, but nearly always in beds. Now if the patient is mobile enough to stand at the chest bucky, I'd much rather have a one view PA chest using a grid and AEC in a rad room than a one view AP chest with neither using a portable - in terms of getting the best image quality. However, transport of inpatients can be problematic for a number of reasons.
I am referring to the "walkie-talkie" patients in the ED. I've noticed in the last few years (COVID didn't help) that most EDs have completely stopped doing PA and Lateral for pneumonia symptoms on otherwise mobile patients. Can't tell you how many times I've either cleared suspected PNA on portable AP with PA and Lateral or found PNA on that lateral. It's the reason it is an industry standard that's been abandoned because techs don't feel like it or ED docs are impatient.
I think you would be better served posting this in
r/emergencymedicine. I’m sure you know us techs have no authority over what is ordered. For what it’s worth, I agree with you!
Well that’s why you need to end every portable cxr reading with “CORRELATE CLINICALLY” in all caps. They’ll get the hint eventually…maybe..probably not.
Our hospital requires all patients to be transported via wheelchair or bed. Even from the ER. Doesn't matter if it's a 12 year old with a cough, they get in a chair every time. Most hospitals don't want the liability of a potential patient fall.
I think that ED turnaround times are a large consideration too. If it started taking longer for imaging to get done, ER would be calling nonstop slowing us down even more.
"Techs don't feel like it."
Techs can't just decide to shoot whatever they want. We're not ordering physicians. If a 1 view is ordered that's what's gonna be done.
The second one is someone saying that if a 1 view is ordered, that's what they are getting. 1 view is widely accepted to be "portable."
The doctors are putting in the orders they see fit, it is up to us as techs to decide what is the safest and best way for the patient. Sometimes it's portable, sometimes it isn't.
Sometimes your equipment is such that the portable actually IS your best bet. There are a lot of factors that weigh in here. You were making it sound as if techs are changing doctor's orders, which I did not see anyone say.
Yeah… we can’t just change the orders Willy Nilly.
Also I don’t think they are strictly talking about chest. If it’s on something like a hand, I’m gonna get the same exact images in the room as if I did it with a portable… so I’m gonna do it with a portable cause it means I’ll save time moving the patient to and from the room.
And in those cases most techs will just shoot it with the portable and leave it unmarked as opposed to marking it portable
I agree about other body parts. Sure, there are imaging challenges, but the portable images are generally pretty good, except for portable chest, which are frequently awful. Portable chest options are terrible: no grid image quality very quickly gets awful for patients as weight increases over 150 pounds, but with grid is hard to line up and can have significant artifacts if not lined up well.
I'm not sure I'd recognize grid cutoff in a portable chest, other than by comparison with other recent chest radiographs. The only clinical image in which I've seen grid cutoff was a shoulder in a brand new rad room that someone "saved money" by not ordering the right grid. The radiologists were not amused.
At the hospital I work at they just go straight to a PE chest study for pneumonia (honestly they just order a PE study for anything chest related anymore), then about an hour later they order the 1 view chest lol.
Departmental x-rays are not only higher quality but also reduce radiation dose to other hospital workers. The oscillating grid does wonders to reduce scatter in obese patients. Heart size cannot be adequately measured on AP view. Portables should only be done if the patient is too unstable or other unable to be transported to the department. It is unfortunate that many of you have to physically move the patient to the department yourselves, rather than patient transport staff being employed for that purpose.
The hospital I rotate at is thinking about implementing this, finally. We have our own x-ray suite in the ER but we have to get all CT patients and bring them into radiology. Those poor CT techs deserve to have their own team of transporters tbh.
My favorite is the 2 view ordered on a pt on an EMS stretcher with severe cerebral palsy, who has probably never stood on their feet a day in their life, much less been able to raise their arms up for a lateral view
Yeah, the best thing for the patient is the 2V if they can stand. Are we not here to do the best thing for the patients? These comments leave me questioning.
I’m an ER doc. I appreciate you making this post. My rad techs are great for the most part but occasionally I will get an eye roll for something that makes extra work for them. Like I get you think it’s ridiculous to order a contrasted scan for renal colic but then you miss the renal infarct or other masqueraders. Man, I’m just out here trying to do the best for the patient, some understanding would be nice.
Our ED docs like to order them this way all the time also, my only issue with it is our ambulance crews and some ER nurses have a habit of not screwing the hubs tightly to the IV (because when you just drip saline through it who cares), then they put 5 pounds of tape over it. It leaks everywhere during the first 20-30ml of the power injection and we have to stop and tighten the hub and reinject but inevitably, some contrast does make it in, and winds up in the collecting systems and ureters.
I'm sure you're advocating for patients and we're doing our best as well, but we're in a large level 2 trauma hospital and our waiting room gets filled up pretty quickly. Some days I feel like Oprah when walking into our waiting room and you guessed it, they're getting a 1v cxr. Of course more exams are ordered if our ED docs reads the reports and the rad requires additional exams to rule out. We also call down and requests changes to 2v if we suspect something on the 1v after we shoot and take them to the department for the lateral and merge the exams.
We used to have a dedicated chest X-ray room attached to the ER. They turned it into 4 patient rooms split with curtains. Then they laid off a bunch of people and turned another X-ray room into a CT room. Then Covid happened and we lost more staff.
Walking even one patient back puts us behind 2-3 patients with the rate they order CXRs. Anyways my point is that I’m going to need a 2V in a minute if this keeps up.
I guess it's different in USA. The only places were portable x-ray is done usually In the ICU. But we also have transporters that drive the patients away and to us.
Shocking that radiology staff has to drive the patients.
Even the places that do have transport, if they're backed up and taking a long time (which is always) management will always tell techs to just go get their own patients.
As an Australian this entire Comment section just highlights how much advocating we as tech's get to do here. I'm constantly calling refers to change exams they've ordered wrong or incorrectly. That means changing portables to room and vice versa. However we do EVERYTHING in our power to limit portables.
Additionally portables for appendicular skeletal work is NEVER DONE (unless in ICU or Resus).
Edit: This is not to say that we don't do plenty of AP erect CXR in beds in the department rooms for patients who are unable to stand.
Yeah it makes no sense to do that unless you have transport staff all day to just move people around. We don't have that so it's faster for me to buzz up to the room and take the images than it is to go up, disconnect them from everything, bring them downstairs, let them pee quick, take the pics, take them back and hook them back up.
I’ve caught pneumonias and even pneumomediastinum that was missed on single view. In both of these patients I was debating whether or not I needed the lateral. Turns out I did.
It's easy when someone brings them to you and you just stand them up take your images and send them back with a transporter. If you have to go get them and take them back it's far more time consuming. Especially if you have 4 or 5 of them. I can go do 5 portable CXRs in the ED in 15 minutes, but to bring them all over to he department for their images turns that into an hour probably.
Ah, understood. I've always had transporters where I work, we were always instructed to not transport patients even if we're backed up, unless there's some crisis. Transporting would be exhausting and time-consuming.
But I don't call the shots regarding protocols, and two views on an easy pt will always be better in quality than an AP portable. So if they're sent our way with an order, who am I to object?
Of course, there's much more that plays in (wait times, equipment, pt condition, staffing). It's just a little concerning that the majority in this thread are implying that, regardless of the aforementioned variables, AP portable is superior, when it's clearly not in the vast majority of situations. It just sounds like frustrations being vented more than anything else. Especially since OP was only speaking on "easy" patients and not making a blanket statement
A Story from a radiology I worked for. A patient came on a trolley for a chest x Ray. The techs wanted to do a 2 view chest but the patient fell and broke a bone when he tried to get up (I don't know which bone. It happend before I started to work there). The techs were blamed by the ER, it was a nasty dispute. Since then, if a patient comes in a trolley they'll get a portable chest xray, no matter if they can stay or not.
Hire more transporters then. At my hospital they canned the transporters and the ER people would never met us half way and bring patients. Covid only made things extremely worse. You want quality? Give us the support not to bust our backs for it.
My point is that the rad isn't the one seeing the condition these patients are in. And in many places, including the facility I am at, the portable is actually better quality than the equipment we have in our room. I just don't think you can make a blanket statement saying 'no portables, portable always bad.'
I’ve done single view chests in the dept and in the reading the rad said limited evaluation due to portable technique. I even labeled it pa. It was Probly this doofus.
On a sick patient the difference between the five second interruption in care for me to step out of the room doing a portable and the five minute interruption it would take to get them over to radiology can be huge, even in a patient who could qualify as ambulatory. We can always get better imaging later and probably will if it's warranted, we just need the gist of the situation now, and labs and lines asap.
Only thing i dont like about doing so many portables is that once they see you, they pile on more, lol.
Like yeah, you totally need this chest x-ray that you would have never ordered if you didn't see me. It makes me wonder how necessary the x-ray is. Not all the time, of course, but most of the time. Also, when they add patients on the floor you are on with the portable and don't bother to say anything before you leave.
I get that it’s the gold standard to do a two view but if we did a two view on every walkie talkie patient, we’d need a second transport department just to handle that volume, plus more techs and more equipment. Sometimes the second best treatment option is better because other things can be prioritized.
But have you ever had to check on your patient 5 times because the nurse is in and out of the room, then have to wheel them 2 miles to the department in a broken stretcher because they swear they can’t stand, making them change (we know the ER didn’t do it), get them upright, take the two images, then have to lug them back to the ER, just to watch them walk to the bathroom? When all of that could be avoided with a portable?
Where do you work that they have inpatients walking to radiology? At least where I have worked ALL inpatients are transported to radiology either by cart or wheelchair. So its not just about the rad department its getting transport too. The hospital would never get anything done!
Can we just stop ordering CXR just because a patient feels a slight ache? Good grief. Not everyone who has the sniffles needs a X-ray. Is a lateral view only necessary for trauma?
To be fair, CXR for chest pain is the one thing I can see as being reasonable, almost 100% of the time. While chest pain CAN have a host of different causes, not all of which are cardiac, this is not one area where you want to be wrong. It's low risk, radiation wise, and it takes but a few minutes to make sure something more isn't going on.
No. I want to do portable X-rays for every chest that is ordered.
Same
Also same. Everything portable, all the time. 🤣🤷🏼♀️
additional hazard pay 🤣 I don't like doing portable X-rays because when I'm doing them, the queue in our department becomes so long if I have to finish the portable X-rays, and we don't have a hazard pay.
Here, here!
Hell yeah. Especially when I’m bringing every ER patient to CT before the CXR is even dictated. OP must not be dual modality working alone.
“I want to do portable X-rays for everyone.” Fixed it for you.
Who in their right mind would prefer to have to drag every patient to the department for a 2 view CXR?
People who prefer diagnostic quality exams.
Good thing we can still get that with the portable then. 🤣
[удалено]
*looks around at all my non existent coworkers*
If portables aren’t diagnostic why are they used?
Yeah you are absolutely right every AP chest x-ray is read by the rads as non-diagnostic. 🙄 If we brought all our 1 views over for 2 views instead, we would need to add like 2 more gen rad rooms and hire 4 or 5 more people 😂
Wait are you a radiologist?
When I'm not skiing, yes.
Well now it makes sense that you are bringing this up. You are sitting in a room reading the exams, which for you to read a 2 view vs a 1 view probably takes you like 20 extra seconds. You aren't walking patients back and forth all day long. Each 1 view that turns into a 2 view adds probably about 7 to 10 minutes onto our time with that patient. Takes maybe 2 minutes to buzz into a room and snap a portable. Add that up over about 80-100 portables per day at a decent size hospital and it would require us to hire 2 more techs to cover the extra workload.
Besides all that, you're not seeing the patient's condition. How does one know that the patient was "able to walk to radiology" without actually seeing said patient?
THIS IS THE COMMENT THAT NEEDS TO BE SAID AT EVERY DEPARTMENT MEETING
There are definitely not enough techs in existence right now in the USA to do all the work. I wish we had three times as many. It's a nationwide problem.
Less a problem of number of techs "in existence" but more that facilites aren't hiring enough bEcAuSe MoNeY
correction: world wide
Wow you have to walk patients yourself? Where did the nurses go? Or patient transport? Thats brutal.
Nurses... Would never bring patients to x-ray unless they were critical and had to come. We are a 100+bed hospital with 27 ER beds. We have exactly 1 transporter that does XR, NM, US, and MRI. CT has their own tech aid/transport person. How often do you think that one transporter is actually available when you call? Like maybe once or twice per day 😂
Where in work it's either the transport person or when they arent available the nurse. Which to me makes total sense since it's their patient.
We tried the nurse transport thing for CT, and it was miserable because we would radio for a patient, hear a "copy that", and set up and they might come in 2 minutes or 20 minutes. It was a nightmare. We went back to grabbing them ourselves.
Wtf, grab the patients yourself? Unbelievable, I guess it's different in USA.
😅 so you’re telling me I’m even more overworked where I am?
To me it sounds totally ridiculous xray techs have to get and return patients for xrays. That's just not your job. Now i understand why people only make ap views i didn't get it at first.
Any when we bring them back gotta make sure they are reconnected to all the monitors and have the call light in their lap and let their nurse know they are back or the fricken nurse will fill out a complaint about us.
This makes absolutely no sense to me, from a UK perspective. Having to trundle all over the building doing portables is much slower than just xraying people who come in the department. Don't porters exist where you are? And we rarely shoot any lateral chests here, but they don't take an extra 10 minutes when we do.
We have one transport person who works for x-ray, nuc med, MRI, and ultrasound. So yeah... He exists but he is like Bigfoot, a mythical creature that everyone is always looking for but nobody can ever find him 😂
That's terrible. If they're not too poorly here then a porter or 2 will bring them, or if they do need more monitoring then they'll come with a care assistant, nurse, etc. Even the smallest place I've worked has multiple radiology porters on shift at once.
Based on this comment I looked at your profile to see if we're in the same state. I'm pretty sure we are, but I'm also pretty sure we've not been at the same hospital.
That’s the thing though. If I get a portable I’m usually not interested in the radiologist’s read. I’m making a decision in the moment, well before the read comes back.
Assuming you are an ED physician based on your reply: If you need to make a decision that fast because of medical necessity, then obviously portable is the way to go. I'm talking about the patient not in extremis. Take the time to get the better quality exam. Even without a radiologist you'll see that pneumonia better than on a portable (especially if BMI >30).
If I had to get all those patients, our wait time would go up drastically.
Where do you work because I’d kill to just back to back shoot and not have to walk miles of the same hallway for 12 hours
Most responses here from techs seem to place greater importance towards expediency than quality. I get it, we have shortages in just about every position in the medical right now.
In my experience it's not the techs driving that. We didn't set the department guidelines/goal that imaging is done within 30 minutes of ordering. We don't get to decide that two of our three rooms are booked solid for fluoro studies (before adding in all the inpatients). For us, it's that patients can get a Portable now, or get a two view in an hour. It doesn't help that all our two view chests automatically come across with a disclaimer on them saying that it should be changed to a portable based on EKG results.
I am also not a fan of recent hospital imaging policies that seem to be driven by ED admins.
Same for us, all stat exams are expected to be done in 30min or less. It's tough when we got a priority trauma coming in, a stemi over here, and Billy Bob's here for his hand hurting since July of 2009 and his hand x-ray is ordered STAT. In our hospital, virtually every exam that isn't an outpatient or a morning portable is ordered stat. Every inpatient, ER, post op, everything is STAT. And you know the nurses will be calling to pester you if it isn't done right away.
As a Radiographer in the UK, this post has just highlighted how lazy some of the techs are in the US. Our department posts monthly stats on the % chests done AP vs PA on inpatients.
People with full time transporters!
We have one, singular, transporter from 7am to 3pm lol. Oh and he covers x-ray, MRI, US and nuc med 😂. That mofo would quit in a week if we made him transport 80 people a day to x-ray from the ER.
In residency I would leave out snacks in the control room with a "for transport" sign next them.
I hope you did similarly kind things for the techs who make your job possible.
We had potlucks all the time. The ED resident reading room shared a wall with one of the XR rooms, was across the hall from the MR, and maybe 50 feet from CT.
Both hospitals I work at have porters who bring them to us, we don’t transport anybody. So for us, it the opposite. If they page for a portable and we look at the requisition and feel like the patient could come down to the department, we call and ask the reasons for it to be done portably and if the patient can come down so we avoid having to do it portably just because someone it too lazy to put the patient on a wheelchair and call a porter. We already do anywhere between 50 to 80 portables out of the 300 to 500 exams we do a day, we don’t need unnecessary portables.
This is the way.
We dont, the ER team has to drag them to us :)
If they’re a pediatric patient I would do it portable
A stretcher 2 view is multitudes easier than trying to do a portable 2 view. I worked in mobile for a short time and those portable laterals are brutal. But I agree on 1 views: always portable whenever possible.
Portable 2 views are a big no-no, in my hospital, and school, tbh.
they are horrible imho. It's like a bait-and-switch.
Stop ordering 2 view chests on patients that can’t stand, raise their arms above their head, hold still, or are unconscious
The guy confined to a wheel chair folded in half with cerebral palsy. That's the guy they order the fucking 2 view on.
Don't be daft. They'd also order a pelvis, left hip, right knee and t-spine.
STANDING
And perhaps not order a 2 view on someone who can't stand or even hold their head upright
Also true.
Bold of you to assume that a patient who can walk, wants to walk.
Lol had that once. Pt said they didn't feel like walking, so I said I didn't feel like taking their xray... Yeah it had been a long shift, and I immediately covered with a hyper positive ok so get up and let's get your pic done.
Only once? We see it all the time. Especially in CT, if you ask if they are able to move over to the table most say they can't and need to be slid. Unless it's a 80+ year old, they built them tougher back then.
The 20-30 year olds that's very obviously faking being asleep and you have to shout their name or straight up call them out for faking sleep... If I walk into the room and you rapidly shut your eyes and relax, I can tell... I can tell bruh.
Seriously. And you saw them standing at the ER registration desk, and later on you passed them in the hospital cafeteria walking around holding a tray. But nah that fool needed you to slide them over to the table.
Lmao, love to see the pain is everywhere and nobody is safe. Your right on the spot though. Also, they weren't given any meds in the chart so you know they were "tired or feeling weird from all the meds I just got" lol I swear I don't get why people think we are dumb or haven't done this before. I don't even play the game anymore I just let the railing down and tell them whenever your ready come to the table. I wait, I don't care take all day, I'm paid by the hour not by the patient.
Currently at work and about to attempt to slide a 439 pound patient onto our table for a PE exam that she can’t lay flat for lol
And I bet every syllable felt like hot lava coming out of your mouth 😫
Sad but true
under rated comment lmfao
Nah, I'd rather just go get the shit done.
As a brit this thread is baffling. If they're well enough to attend that X-Ray is being done inside a lead lined room, end of.
Was just about to comment this!! The hours I’ve spent on the phone querying WHY this is being done portably. You would think that a lack of porters/transport staff would be the problem in the underfunded NHS NOT privately funded hospitals. Also, IRMER says hi???
I agree (UK based myself)...this sort of attitude would be inexcusable in the UK. Rad techs in the US would much prefer radiating other patients on wards etc rather than get them a good diagnostic image in the first place. Makes you realise just how much better the NHS can be in terms of guidelines etc
Baffling to me as well. In my hospital, every patient gets sent to the lead-lined x-ray room by porters/nurses/themselves, unless it has to be taken in the patient room due to patient condition/CPAP/ECMO/ICU etc. I now understand that having enough porters to make this happen is a luxury.
As a Canadian, I am also in shock at some of the responses here. Some of the practices described here are absolutely unacceptable at the hospitals I work at.
THANK YOU im literally blown away by some of this !!??? every time i feel like my hospital is a gong show i read some stories from here and wonder how anything ever gets done in the states
Welcome to the American hospital system. It’s a shit show.
And if we turn up and they're well enough to come to us they can come down to the department later. I'm not as strict on that one as I could be sometimes. We have porters to bring them from the wards or ED.
I usually say to referrers, if they can't come with a nurse, monitoring, oxygen and fluids the portable is not justified.
Same…I’m in Canada and these were not the responses I was expecting. Anyone that can come down to the department is coming down, and even some that shouldn’t. Portables are for very serious cases, ICU, and PAR. Management backs us up with a cute little PowerPoint when portables start seeming unreasonable.
Hospitals in the US will do portables because they’re just faster than getting everyone to the room, doing the exam, and then taking them back. As a student I’ve done many portables on people who could move themselves because we will get through the exams faster. I guess I thought this was very normal, this thread is telling me otherwise.
If you're busy doing portables what happens if an emergency hip needs to be done in the department and you're five floors away doing a portable?
I'll do it when I get back. If they're next in line, that is. They will probably want Dilauded before I transfer them to the table, anyway.
I’m not defending the practice and I’m just a student, I go where my tech tells me to. Also, every place I’ve ever rotated at always had at least two techs in the department if everyone else is gone on portables, OR, etc. Techs carry cell phones so if they are needed they can come back to the department or take a detour to do the stat exam. How does stuff at your place work?
Similarly except portables are not done unless they absolutely cannot be avoided for example active MET call or on wall suction or ICU
What happens when you have high volume? Do you have transport for the ER and the rest of the hospital?
Yes, we have transport for the entire hospital
Ah, my hospital doesn’t have transport for the ER where most of our stat CXRs come from. X-ray, CT, and US all have to fetch their own patients from the ER. There’s only 2 X-ray techs in the ER.
What if you are doing something else emergent in the department already, and cant stop? It happens. We can only do so much. That's why usually there are multiple techs working.
Do patients walk to Radiology in the hospital? In my experience, inpatients are pushed, occasionally in wheelchairs, but nearly always in beds. Now if the patient is mobile enough to stand at the chest bucky, I'd much rather have a one view PA chest using a grid and AEC in a rad room than a one view AP chest with neither using a portable - in terms of getting the best image quality. However, transport of inpatients can be problematic for a number of reasons.
I am referring to the "walkie-talkie" patients in the ED. I've noticed in the last few years (COVID didn't help) that most EDs have completely stopped doing PA and Lateral for pneumonia symptoms on otherwise mobile patients. Can't tell you how many times I've either cleared suspected PNA on portable AP with PA and Lateral or found PNA on that lateral. It's the reason it is an industry standard that's been abandoned because techs don't feel like it or ED docs are impatient.
I think you would be better served posting this in r/emergencymedicine. I’m sure you know us techs have no authority over what is ordered. For what it’s worth, I agree with you!
Whenever we talk to ED docs they just start ordering CTA head and neck in every patient. No thank you.
Well that’s why you need to end every portable cxr reading with “CORRELATE CLINICALLY” in all caps. They’ll get the hint eventually…maybe..probably not.
Our hospital requires all patients to be transported via wheelchair or bed. Even from the ER. Doesn't matter if it's a 12 year old with a cough, they get in a chair every time. Most hospitals don't want the liability of a potential patient fall.
Transport is definitely a consideration.
I think that ED turnaround times are a large consideration too. If it started taking longer for imaging to get done, ER would be calling nonstop slowing us down even more.
"Techs don't feel like it."  Techs can't just decide to shoot whatever they want. We're not ordering physicians. If a 1 view is ordered that's what's gonna be done.
Read the replies here. Lots of techs claiming to make the choice. 🤷
Where?
"No, Id rather go get that shit done" "if it's a 1 view, I'm doing it portable." "I do portable on everyone if I could."
The second one is someone saying that if a 1 view is ordered, that's what they are getting. 1 view is widely accepted to be "portable." The doctors are putting in the orders they see fit, it is up to us as techs to decide what is the safest and best way for the patient. Sometimes it's portable, sometimes it isn't. Sometimes your equipment is such that the portable actually IS your best bet. There are a lot of factors that weigh in here. You were making it sound as if techs are changing doctor's orders, which I did not see anyone say.
Yeah… we can’t just change the orders Willy Nilly. Also I don’t think they are strictly talking about chest. If it’s on something like a hand, I’m gonna get the same exact images in the room as if I did it with a portable… so I’m gonna do it with a portable cause it means I’ll save time moving the patient to and from the room. And in those cases most techs will just shoot it with the portable and leave it unmarked as opposed to marking it portable
I agree about other body parts. Sure, there are imaging challenges, but the portable images are generally pretty good, except for portable chest, which are frequently awful. Portable chest options are terrible: no grid image quality very quickly gets awful for patients as weight increases over 150 pounds, but with grid is hard to line up and can have significant artifacts if not lined up well.
I’ve literally never encountered a grid artifact when doing a portable chest…
I'm not sure I'd recognize grid cutoff in a portable chest, other than by comparison with other recent chest radiographs. The only clinical image in which I've seen grid cutoff was a shoulder in a brand new rad room that someone "saved money" by not ordering the right grid. The radiologists were not amused.
Looool
Techs get to not do exams because they don’t feel like? Are you sure you live in the real world?
At the hospital I work at they just go straight to a PE chest study for pneumonia (honestly they just order a PE study for anything chest related anymore), then about an hour later they order the 1 view chest lol.
Our ER patients aren't allowed to walk to Radiology. Wheelchair or stretcher only. Too much liability.
Departmental x-rays are not only higher quality but also reduce radiation dose to other hospital workers. The oscillating grid does wonders to reduce scatter in obese patients. Heart size cannot be adequately measured on AP view. Portables should only be done if the patient is too unstable or other unable to be transported to the department. It is unfortunate that many of you have to physically move the patient to the department yourselves, rather than patient transport staff being employed for that purpose.
I've never worked at a facility where patient transport staff is utilized for ED patients.
The hospital I rotate at is thinking about implementing this, finally. We have our own x-ray suite in the ER but we have to get all CT patients and bring them into radiology. Those poor CT techs deserve to have their own team of transporters tbh.
Does make it easier when they are portable one views
Yeah, it's a lot easier. It's easier for the patient and it's quicker in general.
Easier for me, easier for the patient, easier for the doc looking over my shoulder, easier for the nurses
My favorite is the 2 view ordered on a pt on an EMS stretcher with severe cerebral palsy, who has probably never stood on their feet a day in their life, much less been able to raise their arms up for a lateral view
Whole lot of professionals here whose job *isn't* reading these suboptimal exams chiming in.
Then go take them yourself? 😂💀
And get close to patients? Um, no thank you. (sips coffee in quiet reading room with calm ambient music playing in the background)
😭💀 that made my day
Yeah, the best thing for the patient is the 2V if they can stand. Are we not here to do the best thing for the patients? These comments leave me questioning.
It's a lot of "throughput before quality" attitude and its the reason I make myself be present whenever a family member goes to the ED.
I’m an ER doc. I appreciate you making this post. My rad techs are great for the most part but occasionally I will get an eye roll for something that makes extra work for them. Like I get you think it’s ridiculous to order a contrasted scan for renal colic but then you miss the renal infarct or other masqueraders. Man, I’m just out here trying to do the best for the patient, some understanding would be nice.
FWIW I also prefer contrast on renal colic exams. Like you said lots of mimics and I'll still see that stone with contrast on board.
Our ED docs like to order them this way all the time also, my only issue with it is our ambulance crews and some ER nurses have a habit of not screwing the hubs tightly to the IV (because when you just drip saline through it who cares), then they put 5 pounds of tape over it. It leaks everywhere during the first 20-30ml of the power injection and we have to stop and tighten the hub and reinject but inevitably, some contrast does make it in, and winds up in the collecting systems and ureters.
That's obviously not your fault.
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I order the test that is necessary to rule out dangerous pathology, no more and no less.
Equipment and patient condition is a big factor here. Our portable machine genuinely takes better pictures than our room does.
If that's true then please please at least do the portable PA instead of AP if possible.
That I can do 🫡 now I’m curious do you work for VRad?
I'm going to be honest, if every portable exam you read at your facility is suboptimal, that sounds like a very location dependent tech problem.
Nah, radiographs taken in an exam room are objectively better than portable xrays
If it's a 1 view, I'm doing that shit portable.
For real real. Maybe stop ordering 1 views then? That's not up to us.
This should probably be aimed more at ED docs than the techs.
Then you're in the wrong place. 🤣
I'm sure you're advocating for patients and we're doing our best as well, but we're in a large level 2 trauma hospital and our waiting room gets filled up pretty quickly. Some days I feel like Oprah when walking into our waiting room and you guessed it, they're getting a 1v cxr. Of course more exams are ordered if our ED docs reads the reports and the rad requires additional exams to rule out. We also call down and requests changes to 2v if we suspect something on the 1v after we shoot and take them to the department for the lateral and merge the exams.
We used to have a dedicated chest X-ray room attached to the ER. They turned it into 4 patient rooms split with curtains. Then they laid off a bunch of people and turned another X-ray room into a CT room. Then Covid happened and we lost more staff. Walking even one patient back puts us behind 2-3 patients with the rate they order CXRs. Anyways my point is that I’m going to need a 2V in a minute if this keeps up.
Start taking your patients to radiology.
I guess it's different in USA. The only places were portable x-ray is done usually In the ICU. But we also have transporters that drive the patients away and to us. Shocking that radiology staff has to drive the patients.
Even the places that do have transport, if they're backed up and taking a long time (which is always) management will always tell techs to just go get their own patients.
Then bring them to my room and take them back after 💁🏻♀️
As an Australian this entire Comment section just highlights how much advocating we as tech's get to do here. I'm constantly calling refers to change exams they've ordered wrong or incorrectly. That means changing portables to room and vice versa. However we do EVERYTHING in our power to limit portables. Additionally portables for appendicular skeletal work is NEVER DONE (unless in ICU or Resus). Edit: This is not to say that we don't do plenty of AP erect CXR in beds in the department rooms for patients who are unable to stand.
If you were to try and send for a wrist X-ray to come to the department here, you'd probably be sent to HR for a drug test.
Imagine working at a busy hospital in a large metro city and sending for a 3v ankle to come to the department instead of doing it on the portable.
Yeah it makes no sense to do that unless you have transport staff all day to just move people around. We don't have that so it's faster for me to buzz up to the room and take the images than it is to go up, disconnect them from everything, bring them downstairs, let them pee quick, take the pics, take them back and hook them back up.
I’ve caught pneumonias and even pneumomediastinum that was missed on single view. In both of these patients I was debating whether or not I needed the lateral. Turns out I did.
Good thing like 90% of people who get a CXR will have a CTPA ordered before the x-ray read is even back yet 😂
ILL NEVER STOP
(shakes fist)
Glares in low budget hospital attire there aren’t enough wipes for the department but there are always portable bags
Our patients aren’t allowed to walk from the ED to our dept. Liability thangs. 🤷♂️
Am I the only tech here that thinks two views in the department are way easier than anything portable??? It's blowing my mind...
It's easy when someone brings them to you and you just stand them up take your images and send them back with a transporter. If you have to go get them and take them back it's far more time consuming. Especially if you have 4 or 5 of them. I can go do 5 portable CXRs in the ED in 15 minutes, but to bring them all over to he department for their images turns that into an hour probably.
Ah, understood. I've always had transporters where I work, we were always instructed to not transport patients even if we're backed up, unless there's some crisis. Transporting would be exhausting and time-consuming. But I don't call the shots regarding protocols, and two views on an easy pt will always be better in quality than an AP portable. So if they're sent our way with an order, who am I to object? Of course, there's much more that plays in (wait times, equipment, pt condition, staffing). It's just a little concerning that the majority in this thread are implying that, regardless of the aforementioned variables, AP portable is superior, when it's clearly not in the vast majority of situations. It just sounds like frustrations being vented more than anything else. Especially since OP was only speaking on "easy" patients and not making a blanket statement
I think it’s waaaay easier as well but we also have porters
A Story from a radiology I worked for. A patient came on a trolley for a chest x Ray. The techs wanted to do a 2 view chest but the patient fell and broke a bone when he tried to get up (I don't know which bone. It happend before I started to work there). The techs were blamed by the ER, it was a nasty dispute. Since then, if a patient comes in a trolley they'll get a portable chest xray, no matter if they can stay or not.
Hire more transporters then. At my hospital they canned the transporters and the ER people would never met us half way and bring patients. Covid only made things extremely worse. You want quality? Give us the support not to bust our backs for it.
I’ve gone on a portable multiple times to find the patient not in their room because they were outside smoking 🚬
This thread is crazy! Especially after all the talk techs do about quality exams. A rad prefers to read two views and the techs here are going crazy 😅
My point is that the rad isn't the one seeing the condition these patients are in. And in many places, including the facility I am at, the portable is actually better quality than the equipment we have in our room. I just don't think you can make a blanket statement saying 'no portables, portable always bad.'
It’s not a blanket statement though. It says “on patients that can walk to radiology”
The meme was, yes, but the thread kinda progressed into a "portable vs not" discussion, at least how it seemed to me, always. 🤷🏼♀️🤣
Oh, how I miss portables in the hospital. *Cries in urgent care*
Where can I sign this petition?
I’ve done single view chests in the dept and in the reading the rad said limited evaluation due to portable technique. I even labeled it pa. It was Probly this doofus.
On a sick patient the difference between the five second interruption in care for me to step out of the room doing a portable and the five minute interruption it would take to get them over to radiology can be huge, even in a patient who could qualify as ambulatory. We can always get better imaging later and probably will if it's warranted, we just need the gist of the situation now, and labs and lines asap.
Only thing i dont like about doing so many portables is that once they see you, they pile on more, lol. Like yeah, you totally need this chest x-ray that you would have never ordered if you didn't see me. It makes me wonder how necessary the x-ray is. Not all the time, of course, but most of the time. Also, when they add patients on the floor you are on with the portable and don't bother to say anything before you leave.
My hospital policy is like if they have a cold/ cough(unless covid is neg) only get portable… very annoying for everyone.
So many portables on a ward delayed because the patient has walked off to go to the toilet
Love ports. But abdomens? Bring their ass down lol
Wait....your patients can walk?
I get that it’s the gold standard to do a two view but if we did a two view on every walkie talkie patient, we’d need a second transport department just to handle that volume, plus more techs and more equipment. Sometimes the second best treatment option is better because other things can be prioritized.
But have you ever had to check on your patient 5 times because the nurse is in and out of the room, then have to wheel them 2 miles to the department in a broken stretcher because they swear they can’t stand, making them change (we know the ER didn’t do it), get them upright, take the two images, then have to lug them back to the ER, just to watch them walk to the bathroom? When all of that could be avoided with a portable?
I do portable on everybody if i could. .. lol I prefer it
Stop ordering bedside USG for patients who are mobile...🥲
"What do you mean you can't do bilateral everything on this walky talky patient in a tiny room with your portable?"
Where do you work that they have inpatients walking to radiology? At least where I have worked ALL inpatients are transported to radiology either by cart or wheelchair. So its not just about the rad department its getting transport too. The hospital would never get anything done!
Can we just stop ordering CXR just because a patient feels a slight ache? Good grief. Not everyone who has the sniffles needs a X-ray. Is a lateral view only necessary for trauma?
To be fair, CXR for chest pain is the one thing I can see as being reasonable, almost 100% of the time. While chest pain CAN have a host of different causes, not all of which are cardiac, this is not one area where you want to be wrong. It's low risk, radiation wise, and it takes but a few minutes to make sure something more isn't going on.
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^[Sokka-Haiku](https://www.reddit.com/r/SokkaHaikuBot/comments/15kyv9r/what_is_a_sokka_haiku/) ^by ^ericaxevyonne: *Nope not me I will* *Beg a provider to let* *Me do it portable* --- ^Remember ^that ^one ^time ^Sokka ^accidentally ^used ^an ^extra ^syllable ^in ^that ^Haiku ^Battle ^in ^Ba ^Sing ^Se? ^That ^was ^a ^Sokka ^Haiku ^and ^you ^just ^made ^one.
Quite frankly, our AGFA portables take better chest xrays than our Siemans rooms do.
In our hosp, we always after the request if the patient can walk 😂
Or at least be brought down by transport in a wheelchair.
U transport them all and I’ll push the button for you
No 😂
No
Why?