Our dept is implementing something new and wants us to stand at the bedside during chest xrays.

This is to ensure patients head is in proper placement and or no traction being applied on the ETT at that time.

Question. Do any other department's that you work in require you to be physically at the bedside during c-xrays?

My primary concern is the exposure. Am I off base here? Will wearing the lead vest save me?

I am not aware of any hospital which requires this of their RT's.

However a while back I wondered if an RT was around to adjust/ensure an insp. pause occured that it would improve CXR quality. I made a comment to a co-worker and "poof" like magic I saw a study in Chest shortly after. Chest around 2000, can't find it now. Conclusion was that if an RT arranged for an insp pause the CXR quality was much better.

But doing such, and assuring neck position, all wouldn't necessarily mandate anyone get anymore exposure. You'd just put a pause on, assure patient position, then step way back and observe. It seems to me it's mostly a time and staffing issue. (or just train CXR techs to do same?).

We standby for CXRs as part of our decannulation protocol. We get to wear those pretty lead vests and everything. We also wear the badges,

Ahh I think I found the study I mentioned earlier, though I could swear it was in Chest..

Instead of an RT it mentions an "interface" which I presume to be an actual linking of the ventilator to the CXR. Seems to me that a generous insp pause (and be sure to remove it after) would do the trick.

Am J Respir Crit Care Med. 1999 Dec;160(6):2067-71. Links
Synchronization of radiograph film exposure with the inspiratory pause. Effect on the appearance of bedside chest radiographs in mechanically ventilated patients.Langevin PB, Hellein V, Harms SM, Tharp WK, Cheung-Seekit C, Lampotang S.
The Departments of Anesthesiology and Electrical and Computer Engineering, University of Florida Colleges of Medicine and Engineering, The Brain Institute, University of Florida, and The Veterans Affairs Medical Center, Gainesville, Florida, USA.

The appearance of portable chest radiographs (CXRs) may be affected by changes in ventilation, particularly when patients are mechanically ventilated. Synchronization of the CXR with the ventilatory cycle should limit the influence of respiratory variation on the appearance of the CXR. This study evaluates the effect of synchronizing the CXR film exposure with ventilation on the appearance of the radiograph. Twenty-five patients who remained intubated postoperatively, were mechanically ventilated, and required a CXR were enrolled in this triple-blind, randomized prospective study. Each patient received one radiograph using conventional techniques and another using the interface. The sequence of the two films was randomized, and the two films were taken on the same patient within a few minutes of each other. Hence, each patient served as his own control and the position of the patient, source-film distance, intensity (Kvp), and duration of the exposure (mAs) were identical for the two films. Five board-certified radiologists were then asked to compare paired films for clarity of lines and tubes, definition of the pulmonary vasculature, visibility of the mediastinum, definition of the diaphragm, and degree of lung inflation. Radiologists were also asked to choose which films they preferred. A majority of board certified radiologists preferred CXRs taken with the interface in 21 of 25 patients (p < 0.0001). Furthermore, four of the five criteria evaluated were improved (p < 0.05) on synchronized CXRs. Synchronization of the bedside CXR with the end of inspiration ensures that they are always obtained at maximal inflation, which improves the appearance of a majority of radiographs by at least one of five criteria.

Jeff and all here is the article Jeff mentioned.

Langevin PB. Hellein V. Harms SM. Tharp WK. Cheung-Seekit C. Lampotang S. Synchronization of radiograph film exposure with the inspiratory pause. Effect on the appearance of bedside chest radiographs in mechanically ventilated patients. [Clinical Trial. Journal Article. Randomized Controlled Trial] American Journal of Respiratory & Critical Care Medicine. 160(6):2067-71, 1999 Dec.

Our therapists in our neonatal ICU are required to be at bedside for the initial post intubation CXR. They hold the baby's head midline for the X-ray. They document the position of the ETT on the duplicate CXR we keep in the NICU. We, however, don't have to be at bedside in our adult ICU's.

I'm glad to see others are being asked to stand at bedside during chest x-rays. We do it in our NICU's, but there done infrequently, whereas PICU is daily.

Thanks all.