Exam 1 - Radiographic Procedures

radiologic technology

diagnostic imaging techs + radiations therapists

radiographer

rad tech who administers ionizing radiation to perform radiographic procedures

practice standards for medical imaging

written + maintained by the american society of radiologic technologists (ASRT)

ethics

health professionals’ moral responsibility

science of appropriate conduct toward others

american registry of radiologic technologists (ARRT)

creates + maintains standards of ethics for rad techs

describes professional values that translate into practice

Code of Ethics

11 statements guiding professional behavior for RTs

more so rules

Rules of Ethics - 22 Rules of Ethics

mandatory standards of minimally acceptable professional conduct

professional + legal trouble if violated

ASRT

makes curriculum + defines scope of practice

ARRT

licensure + describes professional values that translate to practice

advanced clinical roles

radiographers act as radiologist extenders

radiologist extenders assist with?

patient care

select radiographic procedures

initial image observations

radiologist assistant (RA)

PA but with radiology specialty → more exams

radiographer responsibilities

maintain x-ray room (machine, tabletop, accessories)

prepare room prior to patient arrival (clean/organize, fresh linens, accessories needed)

pathogen control

hand hygiene

PPE

respiratory hygiene/cough etiquette

appropriate patient placement

number one way to control germ spread

washing your hands

reverse isolation

patient immune system is bad/suppressed

need to protect pt from you (cancer, nicu)

standard precautions

handle isolation status patients w/o contaminating hands, clothes, equipment

disinfecting contaminated items

PPE to mitigate pathogen spread

cleaning agents for different diseases

control of pathogens

fold laundry toward middle + drop in bins

splash mask for lumbar punctures

proper handling of needles/sharps

transmission-based precautions

GLOVES

how to handle bodily fluids on laundry?

fold to middle + throw in biohazard bins

how to handle needles?

NEVER recap needles

throw in sharps bin

handwashing

easiest way to prevent spread of microorganisms

wash before + after working with each patient

basic patient care

explain procedure (tell/demonstrate positioning)

gently guide patients

verify correct procedure + observe conditions

how to handle patient in pain?

don’t manipulate patient too much

write down additional observations

motion

number one cause of a bad image

degrades image quality

3 types of motion

involuntary

voluntary

equipment

involuntary motion

heartbeat, chills, peristalsis, tremor, spasms, pain

how to control involuntart motion?

use short exposure time

voluntary motion

nervousness, discomfort, excitability, mental illness, fear, age, breathing

how to control voluntary motion?

give clear instructions, provide comfort, adjust support devices, immobilize

have patient hold breathe for image

decrease exposure time

equipment motion

make sure machine is set

image receptors (IR)

device receiving the energy of the x-ray beam and forms the image of the body part

4 types of IR

solid-state digital detectors

fluoroscopic IR

photostimulable storage phosphor image plate (PSP IP)

cassette with film

fluorscopic IR

dynamic and live image

higher dose of radiation

static image

one image

C-arms

live or static images

used in OR

accessory equipment

positioning aids

grids

compensating filters

positioning aids

ensure body part remains in appropriate posture during exposure

e.g. sponges, tape, tongue depressor

bones

appear white in image - hard to get through

air

appear dark in image

artifact

not part of the body

shows up in image when not supposed to

grids

reduce scattered radiation to IR

compensating filters

helps absorb radiation to image better

results in more uniform image brightness due to varied tissues thickness + part density

prime technical factors

milliamperage (mA) - how much

kilovolt peak (kVp) - how strong

exposure time (s) - how long

anatomically programmed technique

computer programs technical factors

technique charts

each body part has specific exposure factors

gonad shielding

can negatively impact exam efficiency

lead aprons

for protection

thicker - more protection

covering neck to knees

thyroid shield

thyroid is most sensitive to radiation

only employees/students wear lead

3 general IR placements

lengthwise

crosswise

diagonal

what is position name based on?

IR relation to long axis of the body

what position is used to the most?

lengthwise placement

central ray (CR)

central or principal beam of rays

where is CR centered?

anatomy of interest (bony landmarks)

IR

CR perpendicular to part + IR to minimize distortion

why would you angle CR?

avoid superimposition

straighten out a curved structure

align CR through angled joint space

avoid distortion of angled structure

SID

source to image receptor distance

SID info

distance from anode inside x-ray tube (source) to IR

why is SID critical?

affects magnification, spatial resolution, patient dose

longer SID

reduces magnification + increases spatial resolution

SID standards

40 inches - 102 cm (minimum)

72 inches - 183 cm

SSD

source to skin distance

SSD info

distance between anode inside x-ray tube (source) to patient’s skin

affects dose to patient

minimum SSD

NCRP recommends SSD minimum is 30 cm for mobile exams

38 cm minimum for fixed exams

collimation

restriction of radiation field

collimation purpose

minimize patient exposure

reduce scatter radiation → reduces risk of adverse effect on contrast resolution

collimation ARRT violation

collimating larger than required radiation field size

how to collimate

adjust light field + frame anatomy pertinent to radiograph

collimate as tight as possible

anatomic markers

every radiograph must have marker identify patients right or left side

annotation on images after image acquisition not recommended

marker identifiers

identify side of body

whichever side is closer to IR

where to place markers?

in lightfield not covering anatomy

radiograph needs to be diagnostic

assists in diagnosis of patient

radiograph

image recorded by exposing any of the image receptors to x-rays

radiograph must be evaluated for?

acceptability of image features

proper radiation safety practices

objectives for performing procedure have been met

image evaluation criteria

presence of patient identification

proper marker placement

proper collimation

evidence of required shielding

absence of artifacts

how are radiographs viewed?

viewed in anatomic position

exceptions to radiograph viewing

hands, fingers, wrists, feet, toes

distal ends will be toward ceiling

required info on all radiographs

date

patients name or ID number

right or left marker

institution identity

obese patients and machines

radiographic tables have weight limits (350lbs)

fluoroscopy towers have max diameter

CT + MRI have diameter limits

in the last 15 years?

obesity has doubled

what percent of americans are overweight, obese, morbidly obese?

71%

obesity

increase in body weight by an excessive accumulation of fat

measured by BMI

obese BMI

30 - 39.9

morbidly obese BMI

40+

what are determinants to whether a radiographic exam can be performed?

body diameter + weight

working with obese patients

larger wheelchairs + transport beds + stretchers

use proper body mechanics

have 2+ people for movement

sliding or high-capacity power lifts

obese communication

empathetic

avoid mentioning weight

explain personnel required to move patient + each part of transfer

explain positioning required - give support + assistance

obese landmarks

most landmarks are inaccessible in morbidly obese

locate jugular notch

jugular notch locations

<5 ft: 52 cm (21 in)

5-6 ft: 56 cm (22 in)

>6 ft: 61 cm (42 in)