Caring for Patients with Special Needs: Pediatric, Geriatric, and Trauma

Caring for Patients with Special Needs: Pediatric, Geriatric, and Trauma

Radiologic technologists work with patients of every age and condition. A single technique never fits all. Adapting communication, positioning, and safety precautions to the individual patient is both a professional obligation and a requirement of every credential you will sit for.

Pediatric Patients

Children are not small adults. Their anatomy, physiology, and emotional responses differ in ways that directly affect how you image them.

Communication. Speak directly to the child at their developmental level. Use simple, friendly words — "hold still like a statue" rather than "do not move." Involve the parent or caregiver: a calm parent at the child's side reduces fear and movement. For infants and toddlers, explain the procedure to the caregiver, not the child.

Immobilization. Voluntary cooperation is always preferred, but when a young child cannot hold still safely, immobilization devices protect image quality and reduce repeat exposures. The Pigg-O-Stat is a commercially available device used for upright chest radiography in infants; it supports the child in position without requiring a person to hold them in the beam. Tape, Velcro straps, and positioning sponges are also used for limb radiography. Any device must be applied gently and monitored throughout the exposure. Document the use of immobilization in the patient record.

Dose reduction — Image Gently. The Image Gently campaign, led by the Alliance for Radiation Safety in Pediatric Imaging, promotes the principle of using the lowest radiation dose that produces a diagnostic image in children. Key practices include: collimating tightly to the area of interest, selecting pediatric technique protocols (not adult techniques), using the fewest views necessary, avoiding repeat exposures, and using gonadal or other shielding in accordance with your department's current protocol and state regulations. Children's tissues are more radiosensitive than adults' because their cells are rapidly dividing and they have more years ahead in which radiation effects could manifest. Every unnecessary exposure carries real risk.

Special safety note. Never leave an infant or small child unattended on a table. Side rails must be up when you step away, even for a moment.

Geriatric Patients

Older adults make up a large share of imaging patients. Age-related changes affect every system relevant to your care.

Fall prevention. Falls are a leading cause of serious injury in older adults. Always keep the side rail up or maintain hand contact when assisting a patient onto or off the table. Use a step stool and never rush the patient. Offer your arm rather than grabbing the patient's hand. Know your department's fall-risk policy and document fall-risk status.

Skin integrity. Aging skin is thinner, more fragile, and slower to heal. Bony prominences — coccyx, heels, elbows — are at risk when a patient lies on a hard table. Use positioning sponges or folded sheets for padding. Minimize the time spent in uncomfortable positions. Remove tape slowly and carefully; tape tears can be serious injuries in elderly skin.

Musculoskeletal changes. Arthritis, osteoporosis, and kyphosis (curvature of the spine) are common. A standard position may be impossible or painful. Adapt your positioning to the patient's range of motion — support the natural curve of the spine, use rolled towels or sponges to close gaps between the patient and the image receptor. Never force a joint beyond its comfortable range.

Cognitive changes. Dementia, delirium, and medication effects can impair a patient's ability to follow instructions or to report pain reliably. Speak slowly, use short sentences, give one instruction at a time, and allow extra time. Confirm that the patient understands before proceeding. If capacity is uncertain, involve the accompanying family member or nurse. Document any observed cognitive concerns so the care team is informed.

Image Wisely. The Image Wisely campaign promotes dose optimization for adult patients. While adults are less radiosensitive than children, unnecessary radiation is never acceptable at any age. Use appropriate technique charts, collimate carefully, and follow department protocols.

Trauma Patients

Trauma patients present unique challenges because injury mechanisms, pain, and spinal precautions all alter how you approach positioning and communication.

Spinal precautions. Until spinal injury has been clinically ruled out, treat every trauma patient as though a spinal injury exists. A cervical collar (C-collar) limits neck movement and must remain in place unless a physician explicitly orders its removal. Do not tilt or rotate the patient's head for positioning. Obtain the necessary views by angling the tube or by using alternative projections that do not require patient movement.

Log-roll technique. If a patient must be repositioned — for example, to place a cassette or image receptor under them — use the log-roll: maintain the head, neck, and spine in neutral alignment as a unit while turning the patient. This always requires at least two people; more may be needed for a larger patient or one with multiple injuries. Communicate clearly with the team before any movement: "On my count of three, we roll together."

Pain management communication. Trauma patients are often in significant pain. Acknowledge the pain: "I know this is uncomfortable — I'll work as quickly as I can." Alert the supervising nurse or physician before undertaking any positioning that will increase discomfort. You do not administer pain medication, but you can request that the nurse address pain management before you begin. Document pain level using a standard scale (0–10) if required by your department protocol.

Equipment awareness. IV lines, monitoring leads, oxygen tubing, and cervical collars must all remain intact and undisturbed. Before moving a patient, trace every line and tube so nothing is dislodged.

Connecting It All

For every patient — pediatric, geriatric, or trauma — the same framework applies: assess the patient before you position them, communicate clearly, modify your technique to fit the patient rather than the patient to fit your technique, and document what you did and why. These habits protect patients, protect you legally, and produce diagnostic images that improve patient outcomes.