Chapter 23: Geriatric Radiography

Detailed Chapter Overview

Chapter 23 addresses the specialized field of geriatric radiography, which focuses on the unique needs and challenges of imaging older adult patients. This chapter emphasizes that providing high-quality care to the elderly is not simply a matter of technique but requires a holistic approach grounded in compassion, patience, and a deep understanding of the aging process. The central theme is adaptation—modifying every aspect of the radiographic procedure to accommodate the physical, physiological, and cognitive changes associated with aging. The chapter provides a detailed overview of common age-related conditions, such as osteoporosis, osteoarthritis, and cardiopulmonary diseases, and explains how these pathologies influence imaging techniques and patient handling. A significant portion of the text is dedicated to communication and patient care, highlighting strategies for effectively interacting with patients who may have hearing, vision, or cognitive impairments. It delves deeply into practical positioning adaptations for patients with limited mobility, joint stiffness, and fragile skin. The chapter also thoroughly covers necessary adjustments to technical factors, explaining why shorter exposure times are critical to prevent motion and why changes in tissue density may require modifications to kVp and mAs. For every common examination, from chest x-rays to hip studies, the text outlines specific geriatric considerations and provides practical solutions to common problems, ensuring the radiographer can provide safe, efficient, and diagnostically effective care to this large and growing patient population.

In-Depth Study Guide

The Geriatric Patient: A Holistic Perspective

Geriatric radiography requires more than just technical skill; it demands an understanding of the aging process and its impact on the individual. The primary goal is to provide excellent care with dignity and respect.

1. Communication and Patient Care

Effective communication is the cornerstone of geriatric care. Age-related changes can create barriers that the radiographer must learn to navigate.

• Respect and Empathy: Always address older patients with respect, using their last name (e.g., Mr. Jones, Mrs. Smith) unless invited to do otherwise. Speak clearly, slowly, and directly to the patient, not to their family member or caregiver.
• Sensory Deficits:
  • Hearing Loss: Face the patient, speak in a lower tone (as high-frequency hearing is often lost first), and eliminate background noise. Do not shout.
  • Vision Loss: Provide clear instructions and guide the patient with a gentle touch. Ensure the room is well-lit and free of obstacles.
• Cognitive Impairment: For patients with dementia or confusion, use simple, one-step commands. A calm, reassuring tone and a warm smile can significantly reduce anxiety and increase cooperation.
• Patience and Time: Older adults often move more slowly. Rushing the patient increases their anxiety and the risk of falls. Allow ample time for the examination.

2. Physical Changes of Aging and Their Radiographic Implications

The aging process affects every body system, and these changes directly impact how radiographic procedures are performed.

Skeletal System:

• Osteoporosis: A significant loss of bone mass makes bones brittle and prone to fracture. This requires careful, gentle handling. From a technical standpoint, a **significant decrease in kVp and/or mAs** is often necessary to avoid overexposing the image due to the reduced bone density.
• Osteoarthritis (Degenerative Joint Disease): Characterized by the breakdown of joint cartilage, leading to pain, stiffness, and reduced range of motion. Positioning for views that require flexion or rotation can be extremely difficult and painful. The radiographer must work within the patient's limits of comfort and adapt positioning accordingly.

Integumentary System (Skin):

• The skin becomes thinner, more fragile, and less elastic with age. This makes older adults highly susceptible to tears and bruising. Avoid using adhesive tape directly on the skin. Use blankets and pads on the x-ray table for comfort and to protect the skin from pressure sores.

Cardiopulmonary System:

• Decreased cardiac and respiratory efficiency means patients may become short of breath more easily. Avoid keeping the patient in a supine position for long periods. They may require an erect or semi-erect position for chest x-rays even if they are on a cart.

Technical Adaptations and Positioning Strategies

Exposure Factors

• The Cardinal Rule: Short Exposure Times. Older patients have more difficulty holding still due to tremors, pain, or difficulty breathing. The single most important technical adjustment is to use a **very short exposure time** to minimize the possibility of motion artifact. To achieve this, a higher mA setting should be used.
• kVp and mAs Adjustments: As mentioned, osteoporosis requires a reduction in exposure factors. Conversely, some conditions like pneumonia (fluid in the lungs) or an enlarged heart may require an *increase* in technique. The radiographer must be a critical thinker and adapt accordingly.

Positioning Adaptations

Standard textbook positioning is often not possible. The key is to adapt while still obtaining the required diagnostic information.

• Use of Sponges and Pads: Radiolucent sponges, pillows, and blankets are essential tools. They provide support for arthritic joints, help maintain difficult positions, and increase patient comfort, which in turn reduces motion.
• Vertebral Column:
  • Cervical Spine: Arthritis may prevent the patient from depressing their shoulders for the lateral view. A "Swimmer's" view is often necessary.
  • Thoracic Spine: An exaggerated kyphosis (hunchback) is common. When the patient is supine for an AP view, their head and upper back may need to be elevated on sponges to keep the spine parallel to the IR.
• Chest Radiography: Many geriatric patients cannot stand for the standard PA and lateral views. Perform the exam erect in a chair or wheelchair if possible. If the patient is confined to a cart, perform the exam as erect as possible (semi-erect) to demonstrate air-fluid levels.
• Hip Fractures: This is one of the most common geriatric trauma exams. The patient's leg must **not be rotated** for the AP view. The lateral view must be performed using the **trauma cross-table (Danelius-Miller) method** to avoid displacing the fracture.
• Extremities: Do not force arthritic joints into true AP or lateral positions. It is better to have a slightly oblique image that is sharp than a perfectly positioned but motion-blurred image. Use sponges to support the limb in a comfortable position.