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HOSPITAL PRACTICE AND BASIC PATIENT CARE (RG 241)

PROFESSIONAL ETHICS IN RADIOGRAPHY

Ethics may be defined as a set of moral principles that governs ones course of
action. Everyone has a personal code of ethics which is dependent on their
cultural and environmental background. All professions have code of ethics that
governs patterns of behavior when working within the scope of that profession.
This ethical code covers interpersonal relationships, decision making and policy
making. Radiographers are members of health care profession who work as a
team to ensure optimum patient wellness. As a member of this healthcare team,
the radiographer is governed by a code of ethics and by principles of professional
conduct that address all members of the profession. An MR who is acting in
accordance with MR code of ethics must treat all patients and coworkers as
human beings who have dignity and self-worth. The MR must do all in his/her
power to allow the patient to maintain dignity and sense of self-worth while in the
MR’s care.

CODE OF ETHICS/PRINCIPLE OF PROFESSIONAL CONDUCT FOR

RADIOGRAPHERS

The code of ethics is intended to assist the radiographers in maintaining a high

level of ethical conduct.

1. The radiographer conducts himself/herself in a professional manner,

responds to patient needs and supports colleagues and associates in
providing quality patient care.
2. The radiographer acts to advance the principle objective of professional
conduct to provide services to humanity with full respect for the dignity of
mankind.
3. The radiographer delivers patient care and services unrestricted by the
concerns of personal attributes or nature of the disease or illness, and
without discrimination regardless of sex, race, creed, religion or socio-
economic status.

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4. The radiographer practices technology founded upon theoretical

knowledge and concepts, utilizes equipment and accessories consistent
with the purposes for which they have been designed and employs
procedures and techniques appropriately.
5. The radiographer assesses situations, exercises care, discretion and
judgment, assumes responsibility for professional decisions, and acts in
the best interest of the patient.
6. The radiographer acts as an agent through observation and communication
to obtain pertinent information for the physician to aid in the diagnosis and
treatment management of the patient, and recognizes that interpretation
and diagnosis are outside the scope of practice for the profession. In other
words, the radiographer shall not diagnose but in recognition of their
responsibility to the patient, shall provide the physician with all
information they have relative to radiologic diagnosis or patient
management.
7. The radiographer utilizes equipment and accessories, employs technique
and procedures, performs service in accordance with an accepted standard
of practice, and demonstrates expertise in limiting the radiation exposure
to the patient, self, and other members of the health care team.
8. The radiographer practices ethical conduct appropriate to the profession,
and protects the patient’s right to quality radiological care.
9. The radiographer respects confidences entrusted in the course of
professional practice, respects the patient’s right to privacy, and reveals
confidential information only as required by law or to protect the welfare
of the individual or the community.
10. Radiographers shall protect the public from misinformation and
misrepresentation.
11. The radiographer continually strives to improve knowledge and skills by
participating in educational and professional activities, sharing knowledge
with colleagues and investigating new and innovative aspects of

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professional practice. One means available to improve knowledge and

skill is through professional or continuing education.
12. The radiographers shall make every effort to protect all patients from
unnecessary radiation.

SUMMARY

The principles are intended to serve as a guide by which many evaluate their
professional conduct as it relates to the patients, colleagues, other members of the
medical care team, health care consumers and employer and to assist
radiographers in maintaining a high level of ethical conduct.

CLINICAL RESPONSIBILITIES OF THE RADIOGRAPHER

1. The radiographer is responsible for the protection of the patient from excessive
radiation.
2. Provision of privacy for the patient, in terms of where he/she could change his/her
cloth and also in terms of keeping all information gotten from the patient in
absolute confidentiality.
3. It is the duty of the radiographer to position the patient.
4. It is the duty of the radiographer to handle the x-ray machine so that it does not hit
the patient.
5. The radiographer should also ensure that all electrical appliances in the x-ray
room is well placed to avoid electrocution of the patient.
6. The radiographer should make sure the patient doesn’t leave the department
worse than he/she came. That is, aseptic procedure should be observed.
7. The radiographer should not leave the unconscious patient alone.
8. It is the duty of the radiographer to tell the patient, the nature of the examination
that is to be carried out and how long it could take.
9. The radiographer is expected to tell the patient on how to wear the x-ray gown. In
cases where the patient does not get it right, the radiographer should not get angry
but should professionally inform the patient on the right thing to do.

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10. It is the duty of the radiographer to prepare all materials that is to be used for any
examination.

THE ROLE OF MEDICAL RADIOGRAPHER (MR) IN THE HEALTH

TEAM

The MR plays a central role in linking seven areas of key importance in the
imaging or radiography department. No other member of health care team fulfils
this function. The seven areas:

 Patient welfare - Prime responsibility

 Clinical responsibility
 Organizational aspects (Management)
 Radiation protection
 Quality assurance
 Education and training
 Technology
1. Patient welfare: The MR has both direct and supervisory role with regard to
the welfare of the patient in his or her care. This is a prime responsibility of
the MR.

The welfare of the patient will depend on:

a. Recognition by the MR of relevant physical and psychological factors

which may affect the patient, together with an understanding of the
patient’s social and cultural needs and reporting these when necessary.
b. The MR making appropriate arrangements for the patient’s general safety
and comfort
c. The MR ensuring that all required information is present and correct and
that correct identification procedures are carried through.

Clinical responsibility: The MR’s prime expertise and responsibility is to

undertake the whole range of techniques in diagnostic imaging and/or
radiotherapy and to subsequently assess the quality of their own work. They are
thus one of the key members of the health care team.

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Organizational aspect (Management): Depending upon the level in the

organization to which an MR is appointed he/she has responsibility for the proper
and efficient organization of their work, the resources and the application of
department policies in the areas for which they are responsible.

Radiation protection

ICRP 36 states that the MR is in key position regarding radiation protection of the
patient, and will by their skill and care, determine within wide limits the amount
of radiation administered. Therefore, the MR must:

a. Be able to interpret and apply all relevant laws, rules, regulations and
recommendations relating to the application of ionizing radiation to
patients and staff.
b. Understand both the somatic and the genetic hazards which are consequent
upon the medication and research uses of ionizing radiations and to be able
to explain these in appropriate terms to inquiries.
c. By their attitude, authority and maintenance of current knowledge, help in
the control of use of radiation for medical purposes.

Quality assurance: (this is a way of preventing mistakes or defects in

manufactured products and avoiding problems when delivering solutions or
services to customers). All areas of the MR’s responsibility require quality
assurance procedures. In all specializations, there must be a full member of the
team that develops, maintains and monitors the quality standards of the
department. If no program is in place, then the MR has the responsibility to
initiate one, and to ensure its implementation.

In the diagnostic and radiotherapy, Quality control is carried out to achieve a

constantly high image quality or patient treatment with minimum radiation to the
patient in an efficient and effective manner.

Education and training: The MR working in the clinical field must be involved
with the practical education of the MRs. The MR’s qualifications, abilities and
role enable him or her to advise, instruct, and supervise other staff in appropriate

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circumstances. In addition they may be required to participate in the theoretical

training of the students, other professionals and the general public.

Technology: The MR tends to specialize in one of the three branches of radiation

medicine technology; diagnostic imaging, nuclear medicine or radiotherapy. One
of the major factor which has contributed to this specialization is the grouping of
patients into those requiring:

a. Diagnostic imaging using ionizing and/or non-ionizing radiation.

b. Treatment using ionizing radiations.

THE ROLE OF THE MR IN A RADIODIAGNOSTIC DEPARTMENT

In the modern diagnostic department, imaging modalities commonly include

general radiographic and fluoroscopic examinations, computerized tomography,
digital subtraction, angiography, ultrasound, Magnetic Resonance Imaging (MRI).

The role of the MR is similar in all these with specific additional responsibilities
in some of these modalities.

Equipment

a. The MR must be able to use and care for the equipment in such a way that;
i. There is minimum possible hazard to patient, staff, or any
other person.
ii. There is no unnecessary irradiation of the patient, staff or
any other person.
iii. Any error in the final radiographic image is not due to
incorrect use of equipment.
iv. The equipment is used safely and correctly.
v. The performance of the equipment is constantly monitored.
b. In order to fulfill these functions, the MR must be able to:
i. Check that the equipment provided is in satisfactory working
order.

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ii. Carry out whatever checks and tests that are required to monitor
the performance of the equipment.
c. The MR is responsible for;
 Reporting any defects in equipment or its function and ensuring that
necessary repairs are requested from the appropriate person.
 Ensuring that all testing equipment required to carry out function tests is
available in the department and is in good working order.
 Ensuring that the equipment and its environment does not present a health
hazard.
 Selecting from the range of equipment and accessories provided, those
items which will help produce the best radiographic image, taking into
account departmental protocols.

PATIENT CARE

The MR will undertake imaging procedures only if he has ascertained that;

a. The patient has been properly identified.

b. No previously preformed imaging procedure has already provided the
information requested.
c. A relevant clinical history has been obtained from the patient prior to the
x-ray examination, and that an appropriate examination has been
requested. If not, that referral to an appropriate member of the medical
staff occurs.
d. No concurrent treatment or investigation will prevent a good result.
e. Any preparatory instructions or pre-medication and/or contrast media
ordered have been administered correctly.
f. Appropriate after care is carried out.
g. The 28 day rule is being observed.

PATIENT POSITIONING

It is the responsibility of the MR to position the patient and film and direct the x-
ray beam in such a way that the final image is optimum. The following aspects
must be considered:
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a. The patients comfort

b. Immobilization
c. Departmental protocols and necessary modifications
d. Radiation protection for all present.

EXPOSURE FACTORS

It is the responsibility of the MR to select suitable combination of exposure

factors and image recording material to produce the correct radiographic densities
and image detail (sharpness), allowed for the patient’s condition. The following
aspect must be considered:

a. The penetrating power of the beam,

b. Correct usage of any automatic exposure device or mA/time/distance
combinations.
c. The focus size selected and the tube rating.
d. The use of all possible and appropriate equipment to limit primary and
secondary radiation.
e. The image recording system selected, and the processing required.

IMAGE RECORDING

It is the responsibility of the MR to maintain and control all the steps involved in
the production and storage of a permanent and visible image. They should be able
to judge subsequently whether the image is of sufficient standard for a report to be
given. The MR is responsible for the following aspects:

a. The processing equipment and chemicals are in good order.

b. Image quality is optimum for its purpose.
c. Identification is correct, complete and permanent (this is a medico-legal
requirement).
d. Documentation is completed before the image is presented to the
appropriate member of medical staff.

RADIATION PROTECTION AND LIMITATION OF DOSE

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The MR has a major responsibility relating to somatic and genetic hazard from
ionizing radiation. The following aspects must be considered:

a. The equipment is fit for its purpose.

b. Proper filtration of the primary beam
c. Proper selection and use of accessories which control radiation during
each exposure.
d. Ensure that appropriate gonad protection is used
e. Ensure that the 28-hhgday rule is applied to appropriate patients.
f. React appropriately to incidents during the use of ionizing radiation
g. Ensure that any regulations or local rules are obeyed.
h. Keep up to date with current requirements.

EXAMINATIONS REQUIRING A MULTIDISCIPLINARY APPROACH

It is the responsibility of the MR to co-operate with the radiologist or trained

clinician with procedures such as:

 Fluoroscopy and image intensification

 Complex radiological examinations such as angiography, and treatment
procedures
 Radiographic examinations carried out external to the main department
such as in the operating room or cardiac laboratory.

The MR’s responsibilities in these situations may include the co-ordination of the
examinations, in addition to the following:

 Preparation and use of equipment

 Patient care and positioning
 The selection of exposure factors
 Limitations of dose
 Documentation of the procedure and image recording.

ADDITIONAL RESPONSIBILITIES OF THE MR IN COMPUTERIZED

TOMOGRAPHY (CT)

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The MR must understand the operation of computer controlled equipment to be

able to:

a. Select programs
b. Record, adopt and reconstruct data
c. Store and retrieve information

NB: With the rapid development of technology, knowledge of CT is becoming

essential for all MRs, both diagnostic and therapy.

ADDITIONAL RESPONSIBILITIES OF THE MR IN DIGITAL

SUBTRACTION ANGIOGRAPHY

The MR must;

a. Understand the operation of the equipment so as to be able to give advice

as to the likely quality of the image with the parameters selected e.g. use
and placement of compensating filters, timing of injection and exposure.
b. Be able to manipulate the digitized data to obtain optimum image quality
through a sequence of images. Procedures may include re-masking or
pixel shift.
c. Be able to assess the resultant images for suitability for interpretation and
diagnoses.

This usually in co-operation with clinical staff.

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