Improve your Exam Efficiency

While this post might apply more to beginners in the field, or students, I think even seasoned Technologists can make small tweaks to their routines, based on different places of employment, to improve their efficiency in the Radiology Department.

Place some forethought into your exams - develop a routine for performing exams that will remain the same every time you do it.  This helps on two levels... first, it will make something that you originally had to put a lot of thought toward into a habitual routine that you will later realize that you may be performing subconsciously.

Example:  When I do an outpatient chest x-ray, I bring the patient to the dressing room, and while they are changing, I will set up my control panel for my first exposure.  I use AEC with the two outer cells on the wall bucky.  I set the kVp to 120 and bump up the mA station as high as it will go.  I then place a CR cassette into the upright bucky (pre-scanned), and then detent my x-ray tube to 72" and transverse to the wall bucky, and raise it far above head-level so the patient doesn't have any chance of collision.  I also place the rolling lead apron near the wall bucky.

When the patient enters the room, they simply need to walk to the upright bucky for the PA view where I adjust bucky height, align my x-ray tube, and roll the shield behind them (less than 10 seconds) before giving breathing instructions.  On an average patient, start to finish is from 5-10 minutes but the patient will feel like it's about 1 minute because that's how long they are in the exam room.  You can be completing paperwork while they are getting dressed, and don't forget to keep an eye out for them leaving the dressing room so you can walk them out.

I always suggest to my students that you can start this practice simple with the ABC's of beam alignment once the patient is ready to be positioned.  A - set your control panel... do this first so that if a position is uncomfortable or awkward, you can run quickly to expose, keeping the patient from having to hold the position very long.  B - line up the tube with the image receptor (if using the table)... don't get carried away with palpating and aligning the central ray.  A common student mistake is forgetting to line up your bucky/image receptor.  C - position the patient... make sure the patient is in the position you need, then float the table top to fine-tune your positioning.

If you're performing multiple exams, do them in a sequence that requires the least patient movement.  For example, if you're doing a C-spine, T-spine and L-spine, this is an example of how I would perform the exams:

1. upright lateral C-spine
2. upright obliques for C-spine
3. supine odontoid
4. supine AP C-spine
5. AP T-spine
6. AP L-spine
7. RPO L-spine
8. LPO L-spine
9. Lateral L-spine
10. L5-S1 spot film
11. Lateral T-spine
12. swimmer's view if needed

This might not sound efficient by switching the order of the different body parts you need, but think about the patient.  How much time will you spend if you do the entire C-spine series, then the entire T-spine, then the L-spine.  How many times will you roll the patient up on their side, and how much discomfort will you cause if they are in pain when they move?  If you plan it out in advance it should be much quicker with the least amount of movement required from the patient.

Enlist some help... have someone process your images (if you're not lucky enough to have DR).  Ask for assistance with sliding patients up in a gurney or leaning them forward to place a gridded cassette behind them.  Someone else can be moving the patient out of the room while you complete your tracking and/or paperwork.  It's true that it only takes a few seconds, but over the course of an entire day, the cumulative total of time saved could mean that you get to go to lunch on time or go home on time.  Looking even more long-term, it will increase the productivity in your department, allowing your Manager to hire additional Technologists more easily.  This also means that you should also be seeking opportunities to help your fellow techs too when you are not otherwise occupied with an exam.  Good teams don't necessarily have to ask for help.

For portable exams, check to see if there are any pending portables on the way or near an exam that you are heading out to perform.  If someone is already on a portable run and a STAT portable is ordered near where they are, take a cassette to the tech and offer to process their original images, or take the portable machine from them when they are finished with their original exam and perform the STAT procedure yourself.  If your department has a mobile phone, it's a good idea to have the portable tech carry one with them to communicate STAT exams.

Fluoroscopic exams can be tedious to set up for.  It's a great idea to try to have some supplies set up at the beginning of the day when you have a busy schedule ahead.  Be mindful not to open any supplies that would need to be discarded if not used.  Sometimes patients do not show, and you may have filled an enema bag already.  It will have to be discarded if not used that day.  I would recommend keeping an un-used enema bag around until the end of your shift, even the patient that you prepped it for does not show.  You never know when you will receive an add-on enema due to an incomplete colonoscopy.  You might just be saving some time later in the afternoon by hanging onto it.

Make the most of slow moments.  The first thing that anyone wants to do who works on their feet all day when there is a lull in activity is sit down.  If you can resist this urge for a few moments, it can pay off later in the day.  Check linens and supplies to see if there's any stocking that may be needed.  Make sure there's fresh sheets and pillow cases on your table, and that the rooms are clean.  These things should only take seconds if regularly kept up with, and if you're totally exhausted, take turns doing this with your teammates.  Nobody wants to have a BE blowout only to learn there are no towels in the room!

These are just a few examples of what I like to do to increase efficiency in my department.  Everyone has their own system that works for them, and I'm sure there are endless variations from the way that I like to do things, which is okay.  Regardless of whether you like my routines in this post or you are being shown a different way than you might go about things, try to keep an open mind.  You need to spend some time to develop routines that work for you, as well as the team you are working with.  You are all there for the common goal of providing quality care in an efficient manner to the patients you serve.