FAILURE TO CONSULT THE RECORDS OR QUESTION THE PATIENT
ABOUT HIS OR HER MEDICAL HISTORY
A radiologist, assisted by an x-ray technologist, instructed a patient to step up
onto the footboard of an x-ray table, which was in the vertical position. After
the lights ware turned down and the fluoroscopic exam was begun the patient
fainted and fell to the floor. The fall resulted in a fractured hip. This injury
resulted in the need for an open reduction, which, in turn, aggravated a
preexisting vascular disorder. The vascular disorder caused a pulmonary
embolism, which necessitated additional surgery triggering a kidney Infection.
The court held that the radiologist had not acted reasonably by failing to
acquaint himself with the patient's history before beginning the examination.
He was, therefore, found negligent by failing to anticipate the possibility of the
patient's fainting. The radiologist's failure to secure a history was held to be
the proximate cause of the patients fall. Had a history been secured, it would
have revealed a prior fainting episode and would have prompted increased
alertness on the part of the radiologist and radiographer.
In addition to finding the radiologist negligent, the court also imposed liability
upon the hospital. The hospital was held liable for the errors committed by the
attending nurse and the x-ray technologist. The nurse failed to complete the
may requisition or to include the patient's medical history. The x-ray
technologist failed to anticipate the possibility of a fainting spell during the
course of the examination. The court pointed out that x-ray technologists are
trained to anticipate reactions such as fainting, and this knowledge imposed a
duty to guard against this eventuality.
a. The X-Ray Requisition Form (SF 519-A or-B). The radiology department
should enter an accurate and complete recording of the patient's exam on the x-ray
requisition form (SF 579-A or-B). The x-ray technologist will need to review the clinical
history, the history of treatment, and any allergic conditions before proceeding. If there
is a request for a neck exam, the requisition form should specify which kind, soft tissue
neck or cervical spine neck. By indicating what is wrong with the patient in the patient's
history, e.g., penny lodged in the throat, the radiographer then knows that a soft tissue
neck exam, and not a cervical spine exam, is required.
b. Exposure Factors. Correct factors should be used, following the guidelines
set in the technical charts. Any deviations from the standard settings should be noted to
assist in determining the appropriate radiation dose. Some activities do not require
exposures to be written. Others require exposures only for fluoroscopy, while still
others require exposures for all procedures. If the record indicates that the patient is
pregnant, you should ask the patient if she is, in fact, pregnant. If she says "no" you
should have her sign a statement indicating that she is not pregnant. If the patient later
finds out that she was pregnant at the time of radiation, you will have the exposure