October 2023

What You Need to Know About Hands-Free Radiology in Veterinary Medicine

By Julia Bitan, RVT

In this VETgirl online veterinary continuing education blog, Julia Bitan, RVT reviews what you need to know about hands-free radiology in veterinary medicine. While this sounds “lofty” and very safe, is it achievable in busy veterinary practices? Minimizing occupational exposure to ionizing radiation in veterinary medicine is important for the health and safety of our veterinary staff who often manually restrain animals for radiographs. Tune in to learn about hand-free radiology, restraint devices, and what we can do to keep our staff safe while producing diagnostic radiographs!

Please note the opinions and views of this author are not directly or indirectly endorsed by VETgirl.

Hands-Free X-Rays: Is it time to put restraints on Veterinary Radiography?

Despite the ever-advancing world of veterinary medicine and technology, the practice of acquiring images has generally been unchanged for the past few decades. We put on our lead PPE, position the patient on the table, hold, expose, and carry on. We do not question these steps, because “we’ve always done it this way.”

In my experience working as a small animal RVT for the past 15 years, before creating the Hands-Free X-Rays initiative, I never questioned the method of handholding for X-rays, it was the way to do it. We followed the regulatory requirements as much as we could, and we joked around about growing horns and tails from all the exposure. Still, the only alternative to manual restraint was sedation, which was rarely used for x-rays in my hospital.

Digital Radiography – A Quick Snap, But Mind the Radiation Gap

The convenience of digital radiography has made it tempting to take more shots for minor adjustments. We press the exposure switch, and aside from the image on the screen and, we see, smell, and feel nothing. Yet, every exposure means a burst of ionizing radiation that scatters around the patient and has the potential to damage our cells and our DNA, especially if we are staying close.

Hands-Free Radiography: it is doable!

What if I tell you that in many practices around the world, the necessity of physically restraining patients for X-rays is a rarity, occurring only in exceptional circumstances? And a significant number of the patients don’t require sedation. This scenario might appear to be an ideal situation, doesn’t it?

But how? Patient Comfort

The primary focus of hands-free radiography revolves around ensuring the patient’s comfort, as any discomfort may lead to the patient moving requiring  manual restraint. The following outlines the techniques utilized to accomplish this:

  • Training: Proper training using hands-free techniques by a qualified trainer with sufficient experience working with different types of Veterinary Hospitals and specialty.
  • Positioning tools: Positioning tools allow the operator to increase their distance during x-ray exposure.
  • Efficiency: This is especially true when working with awake or mildly sedated patients; efficiency is key. Know what anatomy is ordered, asses the patient, and make a positioning plan (depending on age, the reason for imaging, pain, mental state, etc.), and prepare the x-ray room before bringing the patient (computer, settings, and ready-to-use positioning tools). The goal is to keep the patient just enough time in the x-ray room to get the image and not longer.
  • Sedation (when needed): Sedation can be helpful when working with anxious or painful patients. Reducing or taking away the anxiety and providing analgesia provides a much more comfortable experience for the patient.
  • Positive change: Changing the way we practice after doing it the same way for years can be challenging, intimidating, and easily perceived as negative. The introduction of hands-free radiography into a hospital must start with a positive discussion with your team to ensure everyone feels heard and all concerns are addressed.


Positioning Tools

Having the proper positioning tools is essential for hands-free radiography. These tools replace our hands and ensure the patient is properly positioned and comfortable. Below are the common positioning tools recommended for hands-free techniques:

  • Sandbags: Sock-style loose sandbags that allow for manipulation of the sand are best. This allows the operator to distribute the sand so it is hugging the patient rather than having all the weight of the sand directly over them. Loose sandbags can also be used for extremity manipulation. Soft cover materials such as water-resistant suede are great at gripping the x-ray table and assisting with positioning.

  • Foam V-Troughs: For VD and DV positioning, foam troughs are essential for keeping the patient comfortable and straight.

  • Elastic extremity straps: Stretchy material straps allow the patient to keep some mobility of their limbs during positioning. The design of the straps also provides for a very quick attachment (Velcro-action), which is very important when working with awake patients), and quick disconnection from the table in the case the patient panics (the straps will disconnect from the table rather than tighten).

  • X-ray table Liner: The purpose of the liner is to work with the extremity straps. The liner can go around the X-ray table, visible or below the edges (depending on the table). The liner acts as a hook-style attachment to the extremity straps.
  • Positioning Wedge: When we no longer manually restrain the patient, gravity might cause the patient to tilt and cause a rotated x-ray. Foam wedges are important to have on hand to ensure we keep the patient straight and not rotated for diagnostic quality radiographs.

  • Other positioning tools exist on the market. The above are the tools we found work the best for awake and sedated hands-free techniques, which many hospitals already have.


  • Reduction of radiation exposure by replacing our hands with positioning devices; we can increase our distance from the x-ray source during exposure.
  • Patients are more comfortable as they tend to respond better to less handling and gentle approach of hands-free technique.
  • Often, with the hands-free approach, only one staff member is required compared to two when using traditional manual restraint.
  • Pregnant staff members can continue participating with x-rays when able to leave the room during exposure.
  • Hospitals that have transitioned to a hands-free approach, often say they notice an improvement in the quality of the X-rays, especially once the team has mastered the techniques.

Hands-Free is not All or Nothing

The goal of hands-free is to allow the operator to increase their distance from the x-ray source during exposure. Distance is the key to exposure reduction, but we do not have to go very far to get a significant reduction in exposure (think inverse square law). A few steps away are significant.

Hands-free is often confused with everyone out-of-room, but that is not the case. The distance can vary, and as mentioned earlier, every step counts.
Here are some examples of the ways hands-free can be used:

  • Using hands-free techniques only for lateral views
  • One staff member to stay in the room with the patient (wearing the full set of personal protective equipment as well as a dosimeter) but stand as far back as possible in the room during exposure.
  • One staff member manually restraining one end of the patient, and the other staff member (the other end) is replaced with a sandbag.
  • If required to manually restraint a patient – use the elastic extremity straps to avoid using your hands directly on the patient. This will allow for additional distance.
  • Leaving the room when able to keep an eye on the patient (window on door)

Remember: The typical exposure time is only 0.1 seconds, so the patient should not be left for more than a few seconds.

You Can do it!

Many hospitals across the world are adapting to these new techniques. The hands-Free approach makes sense for both staff protection and patient care. Like all new skills, it takes time and patience to know when and how to use hands-free techniques. Do not set yourself up for failure and use baby steps. Start with the easy cases: calm patients, laterals only, sedated patients, etc.

Speak up – communicate with your team, address concerns and make a plan together.
Always consider hands-free approach first and use manual restraint as a last resort only when necessary.
Find support: training, positioning tools, client education and general support is available at www.handsfreexrays.com.

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