NMT Boards – Patient Care, Ethics & Infection Control

Three types of patient consent

Informed, oral (verbal), implied

Consent requiring active disclosure of diagnosis, risks, alternatives and refusal consequences

Informed consent

Consent inferred from patient actions or an emergency

Implied consent

Patient rolls up sleeve for an injection — type of consent

Implied consent

Unconscious trauma patient treated without a signed form — type of consent

Implied consent (emergency exception)

Spoken agreement that is legally valid but hard to prove

Oral (verbal) consent

Number of required disclosure elements of informed consent

5

Five disclosure elements of informed consent

Diagnosis, nature/purpose, material risks, alternatives, consequences of refusal

Who is legally responsible for obtaining informed consent

The physician (not the technologist)

Technologist's role in informed consent

May witness the signature only

Who consents for an incapacitated adult

Closest relative or legal guardian/healthcare proxy

Minors who can consent for themselves

Emancipated minors (and state "mature minor" exceptions)

Consent rule true for every investigational radiopharmaceutical

Patient must sign an informed consent form

PHI stands for

Protected Health Information

HIPAA exception allowing disclosure without authorization for routine care

Treatment, Payment, and Healthcare Operations (TPO)

Does the HIPAA "minimum necessary" standard apply to treatment disclosures?

No

HIPAA breach notification deadline to affected individuals

Within 60 days of discovery

Breach affecting 500 or more individuals requires notifying

HHS/OCR within 60 days plus prominent media

Breach affecting fewer than 500 individuals reporting to HHS

Annually, by year-end

Patient right to an accounting of disclosures covers how many years

Past 6 years

Year AHA adopted the original Patient's Bill of Rights

1973

Year the Patients' Bill of Rights was replaced by the Patient Care Partnership

2003

What replaced the Patients' Bill of Rights

The Patient Care Partnership (AHA, 2003)

Is the Patient Care Partnership government legislation?

No — voluntary AHA hospital document

Number of core expectations in the Patient Care Partnership

6

Law requiring Medicare/Medicaid hospitals to ask about advance directives

Patient Self-Determination Act (1990)

Advance directive stating WHAT treatments a patient wants or refuses

Living will

Person named to make health decisions when the patient cannot

Health care proxy (durable power of attorney for health care)

DNR order covers only

Resuscitation (CPR) — all other care continues

Family member says "she wouldn't want CPR" — is this a DNR?

No — DNR must be a written physician order

Code status unknown and patient arrests

Treat as full code — start CPR

Portable physician orders for life-sustaining treatment that travel with the patient

POLST / MOLST

Four required elements of negligence

Duty, breach, causation, damages

Error that caused no harm lacks which element of negligence

Damages

Negligence committed by a licensed professional against their standard of care

Malpractice

"The thing speaks for itself"

Res ipsa loquitur

"Let the master answer" — employer liable for employee negligence

Respondeat superior

Does respondeat superior erase the employee's own liability?

No — both can be named

Rule starting the statute of limitations clock when harm is discovered

Discovery rule

Absolute outer filing deadline regardless of discovery

Statute of repose

Threat creating apprehension of harmful contact without touching

Assault

Actual unconsented physical contact

Battery

Patient refuses the injection but the tech gives it anyway

Battery

Telling a competent patient they "can't leave"

False imprisonment

Spoken defamation

Slander

Written or charted defamation

Libel

Discussing a patient's diagnosis in a public hallway

Invasion of privacy

Tort category requiring no intent to harm

Negligence

Ethical principle: do good, act in the patient's best interest

Beneficence

Ethical principle: do no harm

Nonmaleficence

Ethical principle: patient's right to decide for themselves

Autonomy

Ethical principle: treat all patients fairly and equally

Justice

Ethical principle: tell the truth

Veracity

Ethical principle: keep promises and duties

Fidelity

Purpose of an immobilization aid vs a restraint

Immobilization improves image quality; restraint manages behavior

Order of escalation for holding a patient still

Least restrictive first (sandbag, tape, then devices)

Mantel: concerns with restraint devices

Circulation, attenuation artifacts, and comfort (all of the above)

Number of principles in the ARRT Code of Ethics

11 (aspirational)

Number of ARRT Rules of Ethics

22 (enforceable)

Which ARRT ethics document is enforceable

Rules of Ethics

Number of principles in the NMTCB Code of Ethics

7

Most severe ARRT disciplinary sanction

Revocation

Least severe ARRT disciplinary sanction

Private reprimand

Three ARRT modes of communication

Verbal, written, nonverbal

Rephrasing the patient's own statement back to them

Reflection

Is "93% of communication is nonverbal" a valid fact?

No — misapplied Mehrabian finding (trap)

Non-therapeutic communication techniques to avoid

Asking "why," jargon, condescension, watching the clock

Laws requiring free interpreter services

Title VI Civil Rights Act and ACA Section 1557

May a minor ever serve as a medical interpreter?

Never — no exceptions

Correct approach for a hearing-impaired patient

Face them at eye level, normal volume, notepad

Minimum font size for low-vision patients

14-point

Cultural communication model LEARN

Listen, Explain, Acknowledge, Recommend, Negotiate

Kübler-Ross stages of grief in order

Denial, anger, bargaining, depression, acceptance

Anxious patient asks the technologist for scan results

Refer to the physician — tech never gives results

Percent of U.S. adults with proficient health literacy

About 12%

Correct method to verify patient understanding

Teach-back (open-ended, chunk and check)

Why "Do you understand?" is a poor comprehension check

Patients almost always answer yes

Ambulatory means

Able to walk

NPO means

Nothing by mouth (nil per os)

Aphasic means

Cannot talk or understand words

Consent typically needed for routine diagnostic NM exams

Verbal/oral consent

Consent typically needed for therapeutic administrations

Written signed consent (obtained by physician)

First step when communicating radiation dose to a worried patient

Acknowledge the concern first

Breastfeeding guidance after I-131 NaI therapy

Complete cessation for that child

Breastfeeding interruption after Tc-99m MAA (Mantel/ICRP)

About 12 hours (Mantel Q20: 12.6 h)

Breastfeeding interruption after Ga-67 or Tl-201 (Mantel/ICRP)

3 weeks

ICRP breastfeeding interruption for Tc RBCs, phosphonates and DTPA

4 hours

Breastfeeding interruption after Tc-99m pertechnetate (thyroid) per notes

4–24 hours, dose-dependent

Breastfeeding after F-18 FDG

No interruption; limit close contact ~12 h

Breastfeeding interruption ladder

None/hours (Tc) → 12 h → weeks (Ga, Tl) → stop (I-131)

Oncology FDG-PET fasting requirement

At least 6 hours, plain water only

Cardiac sarcoidosis FDG-PET diet

High-fat, low-carbohydrate (ketogenic)

Why full bladder matters on a diuretic renogram

Can mimic false-positive obstruction

Hold levothyroxine (T4) before I-131 uptake/therapy

4–6 weeks

Hold liothyronine (T3) before I-131 uptake/therapy

2 weeks

Hold antithyroid drugs (PTU, methimazole) before uptake/scan

3–5 days

Amiodarone washout before thyroid uptake/scan

3–6 months

IV iodinated contrast washout before thyroid uptake/scan

2–4 weeks (up to 6)

Mantel: which study does NOT require NPO

GI bleeding study

Delay pregnancy after radioiodine therapy

1 year