Radiographer exposed child to '50 times more radiation' in x-ray exam

2020 09 14 22 38 7832 Gavel 400

A radiographer administered 50 times more radiation than was required during an x-ray of a child, and she also took an x-ray of the wrong ankle of an adult patient, a U.K. disciplinary panel has heard.

On 16 October 2018, Camilla Hewitt incorrectly selected adult radiation exposure instead of the correct pediatric setting for a child who needed an abdominal x-ray. The child was then told to have a second x-ray, and the family was informed they "were not to be concerned" by the "low-risk" incident, according to an article posted online on 5 January 2022 by the Birmingham Mail.

The full details of the errors were presented to a Health and Care Professions Council (HCPC) disciplinary panel and made available on the Health and Care Professions Tribunal Service (HCPTS) website. The panel initially suspended Hewitt, but it has now said that her fitness to practice is still impaired and she cannot work unsupervised, the Birmingham Mail stated.

The radiographer's errors occurred at Walsall Manor Hospital. Photo courtesy of Matthew Clarke / Alamy Stock Photo.The radiographer's errors occurred at Walsall Manor Hospital. Photo courtesy of Matthew Clarke / Alamy Stock Photo.

The incidents occurred during Hewitt's five-month spell at Walsall Manor Hospital, near Birmingham, England. The acute general hospital serves a population of around 270,000 and has 550 acute beds and a 24-hour accident and emergency department.

"I was rushing as the [child] was wriggling and crying and I wanted to ensure I exposed (the patient) when they were still," she said. "I should have checked the exposure factors before positioning the patient and then before exposing."

"I could have asked for a pair of hands -- one person positioning and one person behind the control panel ready to prep and two pairs of hands with a crying [child], nurse, and relative is probably a good idea," Hewitt added.

She told the panel she would consider asking for help from colleagues to "not get caught out again," but then she administered adult doses of radiation to a second child, the Birmingham Mail reported.

Role of recruitment firm

The disciplinary panel heard the radiographer was employed at the hospital through an agency called RIG Healthcare, a recruitment company based in Bromley, Kent, that claims to be one of the largest suppliers of allied health professionals and locum doctors to the U.K.

According to a statement submitted to the panel by the hospital's professional lead for the Imaging Services and Clinical Measurement Unit, who was Hewitt’s line manager, "We use agency workers when there are temporary staff shortages. The agency is responsible for completing pre-employment checks on their employees.

"It is common for agency staff to be more experienced than the level of role that they are hired for. Camilla Hewitt was a band 6, but was hired to perform a band 5 role. When she started working at the Trust, Camilla Hewitt went through induction training along with other agency recruits. During induction she had to complete a series of competency tests before being signed off for work," the statement continued.

The disciplinary panel stated: "Upon analysis of the amount of over-exposure to radiation contained in the incident reports, the risk of the patients developing cancer in the future was stated to be relatively minimal. However, the fact remains that the patients were put at risk of harm."

Just a week later, Hewitt then incorrectly took an x-ray of an adult's left ankle on 27 November.

"Her error in x-raying the left ankle had the potential to cause the injury to the right ankle to have gone undiagnosed," the panel pointed out.

Hewitt's contract was terminated by Walsall Healthcare NHS Trust on 30 November, and she was later handed a suspension order by the HCPTS. A panel then replaced her suspension with a conditions of practice order, following a review of her performance, the Birmingham Mail reported.

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