Part 5 - Case Scenarios

The four case scenarios found in this section will help you examine your clinical skills and knowledge. Consider how you might approach each case as a practising Canadian radiological technologist.

Case Scenario 1: CT of Head for Trauma Injury

Mrs. Lise Gagnon, a 40 year old female, has come by ambulance to the emergency department after being involved in a car accident. She presents with right sided scalp hematoma and is disoriented. A CT of the head was ordered and the following image acquired.

Things to consider...

  • What medical support equipment might accompany this patient?
  • How will you position your patient for this scan?
  • How will you avoid artifacts in the CT images?
  • How is radiation safety maintained for this patient?
  • Do you understand the clinical history and reason for the exam?
  • Are you able to assess the anatomy & physiology demonstrated on the image?
  • Do images require additional post processing?
    If so, what additional reconstruction or reformatted images are required?
  • Will the patient require an intravenous (IV) contrast injection?
    What factors need to be considered if giving contrast?

Case Scenario 2: Chest X-ray to Rule Out Pneumothorax

Mr. Chan, a 65 year old man with flu and cold symptoms arrives in the X-ray department sitting in a wheelchair. He has suffered from a productive cough for the past 4 weeks. His anxious daughter informs you that he is a chronic smoker and is at present experiencing chest pain and shortness of breath. He needs help to get in and out of wheelchair. The ordering physician has requested a chest X-ray to rule out pneumothorax. The patient prefers to stay in the wheelchair for the examination.

Things to consider...

  • Do you understand the exam requested on the requisition?
  • Are you aware of the images required for this request?
  • Can you change the procedure to meet the patient’s request?
  • How would you explain the benefits of using direct radiography (DR) to complete the procedure?
  • What infection control precautions are required for this patient?
  • Which views are required to demonstrate a pneumothorax?
  • What body mechanics will be needed to position the patient for the required images and ensure your safety as well as the patient’s?
  • What radiographic appearance demonstrates the presence of pneumothorax?

Case Scenario 3: Complete Spine on a Trauma Patient

You work in a busy teaching hospital. Your patients may be outpatients, inpatients, intensive care patients or emergency cases. These include traumatic injuries and postoperative patients. You are responsible for the safety of your patients.
You also teach students and other staff about your profession.

While you are working in the Emergency Room, you receive a requisition for Cervical, Thoracic and Lumbar spine X-rays, upright, to rule out a fracture. The patient history states “Fall from 10 foot ladder onto back and shoulders, pain on palpation”. You notice that the requisition was written by an orthopaedic resident. When you meet the patient, she is lying supine on a spine board with a C-spine collar.

Things to consider...

  • After assessing the patient, how do you plan to follow up on the instructions to X-ray the patient upright?
  • Who would you contact if you needed to ask more questions about the patient’s condition before performing the exam as requested?
  • Will you be doing the examination exactly as specified on the requisition? If not, why not?
  • Have you considered the safety of the patient?
  • Have you asked if the patient is pregnant?
  • What x-rays should be taken and assessed first?
  • Have you assessed the limitations of the patient’s ability to be positioned?
  • Have you made sure that your patient is properly dressed for the X-rays?
  • Have you arranged for, or asked for assistance to transfer the patient?
  • Have you asked the appropriate health professionals to help with the transfer where needed?
  • Have you explained the procedure to the patient?
  • How would you ensure the visualization of C7?
  • What elements of the patient history would you highlight for a student about patient history, safety and exam techniques?

Case Scenario 4: Hip Pinning in OR Sute

You are called to the operating room during your shift to start a hip pinning procedure for an elderly patient. You set up your C-arm for the initial traction images before the patient is draped. You notice that the unaffected leg is very close to the image receptor and this leaves you little room to move from AP to lateral view. One of the surgeons is wearing only a lead skirt and a thyroid collar when he asks you to image the hip.

Things to consider...

  • Have you asked the surgeon to move the unaffected leg to assist in positioning during the procedure?
  • Do you need to move the unaffected leg? If so, why should it be done before procedure begins?
  • If the leg is not moved, what are some of the possible risks once the procedure begins?
    (Think about the sterile drapes and the frail elderly patient.)
  • Who should adjust the leg and why?
  • What should you say to the surgeon about the inappropriate lead apparel he is wearing?
  • What radiation protection practices should be considered for the others in the room?

During the case, the circulating nurse walks past your C-arm and brushes the non-sterile cover over the C-arm with her sleeve. She does not notice that she has touched the drape.

  • Who is responsible to notify the staff operating room that the sterile field has been compromised?
  • When should you or another staff member notify the operating room that sterile procedures have been breached?
  • Are you able to monitor fluoroscopy time?
  • What annotation should be present on the image?