Patient Care and New Technologies

Physics

Verification markers are:

patient’s full name

date of birth

MRN

ON WRISTBAND

When did HIPAA enact?

2003

What does HIPAA stand for?

Health Insurance Portability and Accountability Act

HIPAA attempts to:

establish new standards for the release of health records

protect health records by establishing new standards for health care professionals to follow

apply strict penalties for those who violate patient confidentiality and patient rights

provide more patient education

Proper image documentation

patient’s name and other identifying info

facility information

date of exam

image orientation (annotations)

Always make sure the patient is fully ______ even in scenarios when the patient may not speak ________

informed: speak english

Clinical history should be discussed when:

before the exam begins

Questions for patients complaining of pain

where is the problem or area of pain?

when did the pain start?

how severe is the pain?

what makes the pain go away or get worse?

what else happens when the pain begins?

are you diabetic?

do you have high blood pressure?

do you smoke?

do you take any medications?

have you had any surgeries?

Patient’s may need CPR if they present with:

loss of consciousness

drop in blood pressure

dilation of pupils

possible seizures

Shock

body’s pathologic response to illness, trauma, or severe physiologic or emotional stress

Anaphylactic shock

subcategory of distributive shock

results from an exaggerated allergic reaction, leading to vasodilation and pooing in the peripheral blood vessels

can be caused by medications, iodinated contrast agents, ad insect venoms

Cardiogenic shock

failure of the heart to pump the proper amount of blood to the vital organs

caused by myocardial infection, cardiac tamponade, dysrhythmias, or other cardiac pathology

Distributive shock

when the blood vessels lack the ability to constrict and assist in the return of blood to the heart

Hypovolemic shock

when the amount of intravascular fluid decreases by 15-25%

caused by internal or external hemorrhage, loss of plasma from burns, or fluid loss from vomiting, diarrhea, or medications

Neurogenic shock

which there is loss of the sympathetic tone causing vasodilation of the peripheral blood vessels

caused by spinal cord injuries, severe pain, neurogenic damage, medications, lack of glucose, and adverse effects of anesthesia

Obstructive shock

results from pathologic conditions that interfere with the normal pumping action of the heart

caused by a pulmonary embolism, pulmonary hypertension, arterial stenosis, and possibly tumors that obstruct normal flow

Septic shock

the immune response of the body that leads to capillary permeability and vasodilation

caused by invasive organisms like bacteria

Patients with diabetes mellitus may suffer from:

hypoglycemia

diabetic ketoacidosis

hyperglycemic hyperosmolar nonkeotic syndrome

Complications of diabetes include:

tachycardia

headache

blurred vision

extreme thirst

polyuria

sweet odor of the breath

Common diseases to watch out for

MRSA

Hep B

Hep C

HIV/AIDS

MRSA

methicillin-resistant staphylococcus aureus

manifests as an infected area on the skin

resistant to antibiotics

Which vaccine is provided for all healthcare workers?

Hep B

HIV is spread through

childbirth or breast milk

sexual contact

sharing needles

transfusion of infected blood

Tuberculosis

airborne disease found in the lungs and possibly other organs

MOST COMMON nosocomial infection

UTI

Nosocomial infection

hospital acquired infection

Disinfection of endocavity transducers should be:

well documented

Surgical asepsis

complete removal of microorganisms and their spores from an object or surface

Sterile technique

1. always be aware of what is considered sterile

2. if an objects sterility is questionable, one must assume it is not sterile

3. never reach or lean across a sterile field

4. to be considered sterile, a person must don sterile gloves and a sterile gown

5. the cuffs of the sterile gown are not considered sterile

6. the edges of the sterile wrapper are not sterile

7. never leave a sterile tray unattended

8. if you recognize that a sterile item has become contaminated, remedy the issue immediately

ALARA

as low as reasonably achievable

Absorption is greater in ____ than in ____ _____

bone; soft tissue

The maximum heating of tissue is relate to the sound beams:

spatial peak temporal average (SPTA)

No effects have been observed for an ______ beam having free-field ______ intensities below _____ mW/cm² or a focused beam having intensities below ___ W/cm² or temperature increases of less than 1.5 degrees celsius

unfocused; SPTA; 100; 1

What is the presetted thermal index on our machines?

0.2 - 1.0

Nonthermal mechanisms and mechanical index

include radiation forces

streaming

acoustic cavitation

Thermal index

calculation used to predict the maximum temperature elevation in tissues as a result of the attenuation of sound

Cavitation

action of an acoustic field within fluid to generate bubbles

Stable cavitation

produces bubbles that oscillate, or fluctuate, in size but DO NOT rupture

Transient cavitation

aka COLLAPSE

has the potential of causing the most biologic damage

larger bubbles are produced and subsequently rupture

produces a shock wave and an increase in tissue temperature in that area

ASSOCIATED WITH BIOLOGIC EFFECTS

Mechanical index

peak rarefaction pressure / square root of frequency

Lower MI numbers are seen with:

higher frequencies and small pressure variations

Higher MI numbers are seen with:

lower frequencies and large pressure variations

MI was developed to :

assist in evaluating the likelihood of cavitation to occur

Elastography

uses sound waves to virtually palpate lesions in the body to evaluate stiffness

What organs are elastographies normally done on?

breast

liver

Strain elastography

measures the tissue strain, or tissue length as a result of COMPRESSION

relies on the operator

Shear wave elastography

aka transient elastography

measures the stiffness of tissue as a result of shear waves

produces a quantitative result in the form of pressure

USES CONCEPT SIMILAR TO ACOUSTIC RADIATION FORCE IMPULSE elastography

Contrast enhances ultrasound

contrast agents help with the visualization of blood vessels and may be widely used to identify neoplasms

Typical CEUS

microbubble usually smaller than 10 micrometers

bubble made up of albumin, a phosphlipid, a surfactant, a cyanoacrylate

WHEN ULTRASOUND STRIKES THE MICROBUBBLE IT CAUSES IT TO RESONATE CREATING A HARMONIC SIGNAL THAT CAN BE DETECTED

These contrast bubbles can be:

ingested

injected

Contrast agents must be:

safe

metabolically inert

long lasting

strong reflector of ultrasound

small enough to pass through capillaries

CEUS creates

harmonics during reflection when the pulse interacts with the microbubble

Contrast harmonics is better than ______ because:

tissue harmonics because it occurs during reflection and not transmission

High pressure causes the microbubble to:

shrink and increases the inside pressure

Low pressure causes the microbubble to:

expand and decreases the inside pressure

MI estimates hte amount of contrast harmonics produced which is:

dependent on the freq of the transmitted wave and the pressure of the sound wave

Other uses of CEUS:

targeted delivery of drugs through a specialized outer shell and medication inside the bubble

after the bubbles reach the area of interest , high-intensity sound waves can be used to pop the bubbles, releasing medication contained within

Fusion imaging

hybrid imaging, enables the simultaneous display of real-time sonography and a stored CT or MRI

improves biopsy guidance and the ability to assess relevant anatomy during tissue ablation

Intravascular ultrasound

procedures that pairs a miniture ultrasound transducer and a vascular catheter

UTILIZES FREQUENCIES MUCH HIGHER THAT STANDARD ULTRASOUND IMAGES

HIFU

high-intensity focused ultrasound

sound waves interact with targeted issues underneath the skin

similar to a magnifying glass focusing sunlight on a target

noninvasive, non surgical procedure

HIFU is used for

cancers

uterine fibroids

Parkinson’s diease tumors

thyroid nodules