Foundations units 1-3 test

JRCERT

Joint Review Committee on Education in Radiologic Technology.

concerned with compliance with *education* standards developed by and for the profession of radiologic technology

Accreditation

Process to ensure high quality of operations and offerings.

JRCERT accreditation requires compliance with minimum requirements known as Essentials and Guidelines or standards

JRCERT history

Established in 1969

accredits programs in: radiography, radiation therapy technology, medical dosimetry, and magnetic resonance imaging (MRI)

Certification

demonstration of minimum competencies in recognized professional skills and knowledge

competency is generally demonstrated by a test

certification credential initials

Radiography (R)

Nuclear medicine technology (N)

Radiation therapy technology (T)

CT scanning (CT)

MRI (MR)

ARRT

American registry for radiologic technologists

The national certification agency for rad techs

Founded in 1922

ARRT code of ethics

Establishes professional “norms” of conduct; Ethical codes are typically static and slow to
change in order to reflect changing societal trends and values

Ethical codes rely heavily on behaviors that reflect professional etiquette and are respectful of human values; A Code of Ethics can be too narrow and confining in defining acceptable behavior in all situations

Composed of two parts

Part A deals with behaviors a professional should aspire to

Part B deals with MANDATORY rules of acceptable professional conduct

ASRT

American Society of Radiologic Technologists

Oldest and largest national professional association for rad techs (1920); developed curriculum for all modalities.

sets instructional standards across the nation

only nationally recognized society representing all rad techs in the US

Continuing education

24 CE’s are required every two years; 2 required in radiation protection in the state of Massachusetts

ASRT proides CE opportunities at low cost

MSRT

Massachusetts Society for Radiologic Technologists; founded in 1931

facilitate professional growth, development, and recognition of those licensed to practice as rad techs within the commonwealth of Massachusetts

“Official voice” of Rad techs in the commonwealth

Ethical code (1)

Rad techs should behave in a professional manner, respond to patient needs, and support colleagues and associates in providing quality patient care.

Professionalism and respect

Ethical code (2)

provides services to humanity with full respect for the dignity of mankind

perform the best exam to the best of our ability

Ethical code (3)

RTs deliver patient care and service unrestricted by the concerns of personal attributes or the nature of the disease or illness, and without discrimination on the basis of race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, familial status, disability, sexual orientation, gender identity, veteran status, age, or any other legally protected basis

Ethical code (4)

The RT practices technology founded upon theoretical knowledge and concepts, uses equipment and accessories with the purposes for which they were designed, and employs procedures and techniques appropriately.

Using devices the way they were intended

Ethical code (5)

The RT assesses situations, exercises care, discretion, and judgement; assumes responsibility for professional decisions; acts in best interest of the patient

fit requested exam to the patient’s needs, including emotional. Listen to patient and explain the procedure to alleviate fear

Ethical code (6)

The RT acts as an agent through observation and communication to obtain pertinent information for the physician to aid in the diagnosis and treatment of the patient and recognizes that interpretation and diagnosis are out of the scope of practice for the profession.

Get accurate, relevant information for physician to make their own accurate diagnosis. take complete history relevant to exam

Ethical code (7)

The RT uses equipment and accessories, employs techniques and procedures, performs services in accordance with an accepted standard of practice and demonstrates expertise in minimizing radiation exposure to the patient, self, and other members of the healthcare team

Keeping exposure to absolute minimum; As Low As Reasonably Achievable (ALARA)

Ethical code (8)

The RT practices ethical conduct appropriate to the profession and protects the patient’s right to quality radiologic care

Patient has a right to be getting the highest quality of care possible, that ensures optimal images in order to be properly diagnosed.

Ethical code (9)

The RT respects confidences entrusted in the course of professional practice, respects the patient’s right to privacy, and reveals confidential information only as required by law or to protect the welfare of the individual or the community.

Respect HIPAA laws and requirements; protect patient confidentiality

Ethical code (10)

The RT continually strives to improve knowledge and skills by participating in continuing education and professional activities, sharing knowledge with colleague, and investigating new aspects of professional practice.

Continuing education

Ethical code (11)

The RT refrains from the use of illegal drugs and/or any legally controlled substances which result in impairment of professional judgement and/or the ability to practice radiologic technology with reasonable skill and safety to patients

Three General Classifications of Organizations

Accreditation (JRCERT)

Certification (ARRT)

Professional Organizations (ASRT)

Therapeutic Radiology (radiation therapy)

treatment of disease (mostly cancer) through x rays and other radiations, for example, gamma rays from cobalt-60 and radium. High levels of radiation

Involved in the technical planning of the treatment and patient care

additional 1-4 years of school

Nuclear Medicine

use of radioactive nuclides that are introduced into the body to take images of the anatomy and physiology of the patient. Allowing structures and organs to be highlighted, visually monitored, and analyzed so that doctors can make diagnoses.

additional 2-4 yrs of school

Ultrasound

sonographers use equipment that generates high frequency sound waves to record images of soft tissue (no radiation)

can image veins, arteries, tendons, ligaments, and solid organs such as liver, gallbladder, and kidneys, but gas in bowel limits their imaging (gas scatters sound waves)

Angiography (interventional radiology)

technique used to image the inside or lumen of blood vessels and organs of the body, particularly the arteries, veins, and heart chambers

done by injecting a radiopaque contrast agent into the blood vessel and imaging using x ray-based techniques such as fluoroscopy

additional 1+ year

Computed Tomography (CT)

one of the more common modalities radiographers specialize in.

produces “slices”

can easily image both the bone and soft tissue structures of the body, and with assistance of contrast (x ray dye), can demonstrate the blood vessels

6-12 months of training

Magnetic Resonance Imaging (MRI)

One of the newest modalities

similar images to CT, but does NOT use ionizing radiation but rather a large magnetic field

additional 1-2 yr program

Mammography

imaging of the breast

additional 1-2 yrs of school

What does a Rad Tech do

primary role is to perform imaging as requested by referring physician’s orders to help determine diagnosis and treatment.

Make up the third largest group of health care professionals (surpassed only by doctors and nurses)

Typical day as an RT

Receive and interpret referrals and orders form medical practitioners for imaging examinations

determine appropriate imaging techniques

explain procedure to patients, and address any radiation concerns

correctly position patient and imaging equipment

ensure patient welfare throughout exam

analyze and critique images prior to sending to radiologist

Radiologist

Medical doctors (MDs) or Doctors of Osteopathic Medicine (DOs) who specialize in diagnosing and treating diseases and injuries using medical imaging techniques such as x rays, magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography (PET), and ultrasound.

graduate from accredited medical schools, pass a licensing exam, then complete a residency of at least four years of unique post grad medical education.

often complete a fellowship, which is one to two years of specialized training in a particular subspecialty of radiology, such as breast imaging, cardiovascular radiology, or nuclear medicine.

Radiologic disciplines

Therapeutic

nuclear

ultrasound

angiography

CT

MRI

Mammography

Diagnostic

MRI safety

American college of radiology has defined four safety zones within MRI facilities (1-4) and correspond to levels of increasing magnetic field exposure (and hence potential safety concern)

MRI zone 1

All areas freely accessible to the general public without supervision. Magnetic fringe fields in this area are less than 5 Gauss (0.5) mT

MRI zone 2

Still a public area but the interface between unregulated Zone I and the strictly controlled Zone III and IV.

MR safety screening typically occurs under supervision

MRI zone 3

An area near the magnet room where the fringe, gradient, or RF magnetic fields are sufficient to present a physical hazard to unscreened patients and personnel

MRI zone 4

Synonymous with the MR magnet room itself. Has the highest field (and greatest risk) and from which the ferromagnetic objects must be excluded

Diagnostic radiology

radiographer is trained to position the patient and record the relevant position, conditions, and functions of the various anatomical structures and organs of the body.

Capture X-ray images of the human body using x ray equipment

diagnostic radiology

General radiography

Trauma radiography

Mobile radiography

fluoroscopy

Operating room (OR)

General radiography

often called general, diagnostic, or plain x-rays.

most commonly known and most frequently used form of medical imaging

x-ray imaging is extremely fast and provides a rapid method of evaluating the entire body, especially the joints, bones, and chest

Trauma

challenging examinations on injured individuals

will need to think outside the box often in order to obtain images needed

typically done in emergency room

Mobile (portables)

Patients too sick to travel to the x-ray department, portable x-ray machines are used

Fluoroscopy

radiologist operates the fluoroscopy unit while the radiographer assists with the procedure

fluoroscopy unit uses x-rays and an image intensifier to produce “real time” 2D images, similar to a movie

often, a contrast agent (barium or iodine) is used to make different body parts more visible

can be used to examine the digestive tract, kidneys, bladder, joints, and to perform minor operative procedures such as intravenous line insertions

the x-ray tube in most installations is located inside the x-ray table; radiation passes through the tabletop and the patient, it strikes the fluoroscopic screen to produce an image of the patient’s body part

Operating room (OR)

operating radiographic equipment during surgical procedures to assist surgeons

A C-arm is a portable fluoroscopy equipment most often used during surgery

The OR is a sterile environment in which protocols exist to prevent any infection

Variety of Work Environments

Hospitals

Physicians’ offices or specialty practices

Clinical outpatient facilities

Free standing imaging centers

Portable services to rehabs

Urgent care

Travel tech

Additional radiology job opportunities

Education

Administration

Management (QM)

Commercial

Radiologist assistant (RA)

Research

Sales

Application specialist

Radiology assistant

Must have a primary certification in radiography

requires a bachelor’s degree

often 18 month program

still not widely accepted

must meet clincal requirements

What is radiation

Energy that comes from a source and travels through space and may be able to penetrate through various materials

What are x-rays

electromagnetic radiation with extremely short waves

x-rays use small amounts of radiation. level of exposure is considered safe for adults; however it is not safe for a developing fetus

x-ray beams pass through your body, and are absorbed in different amounts depending on the density of material they pass through

dense material, such as bone and metal, show up white on x-rays

the air in your lungs show up as black. Fat and muscle appear as shades of gray

diagnostic x-rays are useful in detecting abnormalities within the body. they are a non-invasive way to diagnose problems such as broken bones, tumors. dental decay, and the presence of foreign bodies.

Wilhelm Roentgen

November 8, 1895, German physicist at University of Wurzburg discovered x-rays; awarded Nobel prize in physics 1901

Anna Bertha Roentgen

 1st radiograph recorded of her right hand; 30-minute exposure

Thomas Edison

experimented with x-rays, mostly concerned with fluoroscopy (using x-rays to image inner parts of body in movement and motion)

William Coolridge

1903, invents x-ray tube making possible continuous emission of x-rays

Clarence Dally

1904, dies due to rad exposure; favored employee of Thomas Edison, used hands for practice demoing Edison’s fluoroscopic machine

John Ambrose Fleming

1904, invents vacuum tube

Edward C. Jerman

first credited technologist 

Abuse of x-rays

x-rays used regularly/recklessly; Thomas Edison questions x-ray’s effects when complaining of eye sore and redness after working with fluorescent tube 

Odd uses of x-rays

circuses for entertainment to guess items in women’s purse, department stores/fairs offering x-ray bone portrait, rich people owning machines to image guests, manufacturing companies offer lead undergarments “modesty”, England passed law banning glasses with x-ray vision at operas

Early signs of radiation exposure damage

Skin dryness

Erythema (redness)

ulcers (acute rad syndrome)

Early years of Rad tech

nurses/nurse aids taught on the job, no special education, led by experience, first technologist EDWARD C. JERMAN, in 30 years developed from technical trade to profession

Technical advancements in radiology

1. Modern day imaging department any diagnostic/therapeutic devices

2. Tubes can produce accurate multiple exposures 

3. Films capable of resolving structures smaller than the human eye can see

4. Many new specialities 

5. Diagnosing/treating med problems not possible w/out radiology

6. Film screen imaging = rarely used, sheet of x-ray film into cassette between pair of intensifying screen; when struck with rad, phosphors flow with visible light which exposes x-ray film

Computed radiography

1. x-rays exit pt and strike cassette w/ imaging plate IP

2. IP coated in photostimulable phosphor 

3. Phosphor becomes excited from deposit of x-ray energy + remains so until cassette placed in reader

4. When in reader, IP scanned with laser beam releasing x-ray energy which is converted to visible image by computer

5. Resulting image viewed on high-resolution monitor

Digital imaging

1. 2 types = computed radiography CR (cassette); digital radiography DR (cassette-less uses detector)

2. screen and film being replaced by computer imaging 

3. advances in computer tech brought revolutionary change in med imaging

4. computer manipulates electronic digital image to construct visible image

5. applied in most of the imaging performed in radiology

Digital imaging equipment

1. advantage is ability to post-process images to provide multiple views of anatomy

2. receptor exposure/contrast can be altered after picture taken without re-exposing patient

3. images stored in computer + can be transferred to multiple locations via network/email

direct digital radiography

1. cassette-less replaced by imaging plate reaming in table/wall bucky

2. DR image appears on monitor saving time/need to handle cassettes 

Laws and Characteristics of laws

1. body of rules, regulations and guidelines that govern/conduct in society to protect health, safety, welfare of its citizens

2. reflect value of society

3. exists so rights of person/group cannot be encroached by another person/group

4. law based on what reasonable person would do in similar situation

5. all individuals have basic rights/responsibilities

Relation between patient and health care practitioner

1. defined in 1914 by case Schloendork v. Society of NY Hospital = every adult human of sound mind has right to determine what will be done with one’s own body and surgeon who performs operation without patient’s consent commits assault and is liable

Professional Ethics

one of several criteria that distinguishes a profession from other occupations/trade

Ethics (4)

1. ethics deal with rightness/wrongness of act/behavior as compared with natural reason

2. societal behavior defined by laws, rules, regulation, ordinances  

3. professional behavior defined by professional Standards of Conduct and Scope of Practice

4. Society expects professions to self-regulate

Professional Behavior

1. society expects profession through its members to make its own statement of acceptable/unacceptable behavior

2. Defined by 2 documents = 1) establish norms of professional conduct, 2) radiological sciences professionals must know ethical/professional standards of profession 

Medical Law (TORT)

A patient’s claim that he or she has been wronged or has sustained some injury, other
than a breach of contract, for which he or she believes cause exists for an action for damages.

2 kinds of torts: Intentional and unintentional misconduct

Negligence is the most common TORT in the United States

Intentional torts

Acts that a person intends to commit in which the wrong doer realizes to a certain degree that harm may result; acts that were not intended to do harm but still resulted in damage to a person or property

ex. Assault, Battery, defamation of character, false imprisonment, intentional infliction of emotional distress, invasion of privacy

Assault

Acts that are intentional (deliberate) in which the victim is fearful and apprehensive of physical harm

potential victim must be aware threat exists

Threats of any kind

Touching or physical contact is NOT required

ex. threatening a patient - “you have to do this x-ray”

Battery

Most common tort associated with radiographers

Unwanted contact or intentional contact without consent

potential victim does not have to be aware battery was committed

Pulling or pushing patients during positioning, not obtaining informed consent, or improperly
informing a patient, X-raying the wrong patient or wrong part.

ex. unwanted touching, pushing a patient - Forcing a body part into position, performing an unnecessary exam intentionally

Defamation of character

communication to a third party whether written or spoken about someone that puts them in a false light; Making unprofessional statements whether written or spoken, about patients, physicians, or other healthcare workers

only false statements are considered defamatory

libel - written

slander - spoken

False imprisonment

Unlawful restraint or confinement

ex. tying a patient to a stretcher or bed to make them hold still for an exam

Infliction of emotional distress

Comments about a patient’s physical problems or deformities which are construed as abusive and lead to mental or emotional distress

Invasion of privacy

An invasion of a person’s right to personal privacy; breach of confidentiality is a type of invasion of privacy

Restraint

Requires a doctor’s order! patient may require restrain if they are pulling out tubes or lines that are required for survival

Doctors restrain

Immobilization

sponges, tape, and lead aprons are used for short periods of time to obtain radiographs

Techs immobilize

Patient confidentiality

Information the Healthcare team obtains from the patient that cannot be disclosed to a third party without the patient’s consent

ex. divulging personal information, discussing a patient’s condition in public, reading charts or reports of patients and sharing it with friends, or releasing radiographs without the patient’s written consent

Healthcare Information Policy

Patient Care Bill of Rights clearly defines that health care records are to be held private and confidential

Health records are the property of the provider, the information within the record belongs to the patient.

Health Insurance Portability and Accountability Act (HIPAA; 1996)

PHI- protected health information

Common violations include:

using computer system to look up results in a patient’s chart without being authorized

improper disposal of patient information; all documents with patient information must go into blue “HIPAA” bin

revealing information in public, such as a waiting room

social media posts

Unintentional misconduct (Torts)

Acts that were not intended to do harm but still resulted in damage to a person or property

ex. negligence, medical malpractice, failure to obtain informed consent, and breach of patient confidentiality

Negligence

A form of conduct caused by heedlessness or carelessness that constitutes a departure from
the standard of care generally imposed on reasonable members of society

negligence is a tort and not considered criminal conduct

ex:

-leaving guard rails down on a stretcher or a patient’s bed and they roll off

-Leaving an unsteady patient standing at the wall stand and leaving the room, and they fall

-leaving locks on wheelchair unlocked, causing patient to fall when they sit down

-forgetting to obtain informed consent prior to procedure start

Malpractice

Injurious or unprofessional treatment of a patient including neglectful actions

includes: Duty, breach of duty, causation (as a result of breach), and damage

David Karps 7 Cs of malpractice (important for test!!)

Competence

Compliance

Charting

Communication

Confidentiality

Courtesy

Carefulness

Informed consent

Permission to perform a procedure; must be given by patient who is competent

patient either agrees to or denies treatment after being informed of the risks and benefits of the procedure

Only legal guardian can sign for a mentally incompetent patient, or a minor

Only physician named on consent form can perform procedure

Informed consent may be revoked at any time

Autonomy

The individuals right to make his or her own decisions

Respondeat Superior “let the master answer”

Legal doctrine stating that an employer is held liable for employee’s negligent act

The employer is responsible for the actions of their employees

Res ipsa loquitur “the thing speaks for itself”

Legal doctrine stating that the cause of the negligence was obvious

ex. forceps being left in patient during surgery

radiographic images

Considered legal documents, whether taken digitally or on film; images are property of the facility in which they were obtained

images must include:

• patient identification'

• anatomic markings (L R lead markers) BEFORE exposure is taken

• date of exposure

Retention of images

Varies according to state law

Normally maintained for 5-7 years after date of last radiographic examination (excluding mammograms and Black lung images, which are kept for the lifespan of the patient)

Files on minors are normally kept for 5-7 years after the patient turns 18 or 21, depending on state

Results + Rules

technologists are not able to give ANY information regarding the patient’s image. That is the responsibility of the radiologist and then given to the patient’s ordering doctor.

We are NOT able to x-ray without an order, show a patient their x-rays, or delete an x-ray so they are not billed