Radiology

The Radiology Department produces images of the patient's body by the use of x-rays. X-rays are invisible electromagnetic waves capable of penetrating opaque or solid substances. The Radiology Department is also referred to as the X-ray Department.

The NUC must be familiar with all procedures performed in the Radiology Department, which include the following:

• Abdominal x-ray (flat plate of abdo or 3 views of abdo)

• Angiogram/Arteriogram

• Arthrogram

• Ba Enema (BE)

• Ba Swallow/Upper Gastrointestinal (UGI) series

• Bone x-ray (i.e., Lt femur, Rt humerus, C-spine, etc.)

• Cholangiogram (percutaneous transhepatic (PTC or PTHC) or T-tube)

• Cholecystogram/Gallbladder (GB) series

• Cystourethrogram (voiding or stress)

• Chest X-ray

• Intravenous Pyelogram (IVP)

• Kidneys, ureters and bladder x-ray (KUB)

• Mammogram

• Myelogram

• Sialogram

• Sinogram

• Venogram

Portable x-rays are only done when the patient can not be transported to the Radiology department. 

A portable x-ray machine is brought to the patient's bedside if the patient is unable to be transported to the Radiology Department. The image from a portable x-ray machine is limited in quality and the use of this machine exposes others in the room to scattered radiation, therefore, this procedure is ordered only when necessary.

Portable x-ray machines are used in the operating room (OR) for patients undergoing orthopedic surgical procedures. These machines are also used in the Intensive Care Unit (ICU) and the Emergency to obtain images for critically ill patients.

When writing an order for an x-ray, the physician will specify if it is to be a portable, e.g. "Portable CXR". 

When completing the requisition for a portable x-ray, the NUC indicates it's to be a portable by putting a check mark in the box next to the word "portable".  It's also a good idea to transcribe the the order as written and put the word "portable" in the Radiology section of the requisition with the procedure ordered.  For example, if the order states "portable chest x-ray", the NUC writes "portable chest x-ray" in the RADIOLOGY section of the requisition and checks off portable.  This ensures the order is well communicated so they know it is to be a portable.

The following are common x-ray views:

AP (anteroposterior) - The x-ray beam passes from the front of the patient to the back. The machine is placed at the patient's front when they are standing or lying supine.

PA (posteroanterior) - The x-ray beam passes from the back of the patient to the front. The machine is placed at the patient's back when they are in an upright position.

Lat (lateral) - This view is taken from the patient's left or right side.

Decubitus - The x-ray beam is positioned horizontally when the patient is lying on their side.

Prosthesis - This view is ordered pre-operatively for patients going to the OR to have a hip or knee prosthesis. The technologist will x-ray a larger portion of the bone on either side of the joint with this view, as compared with a normal knee or hip x-ray.

E & S (erect and supine) - These are two different views that are obtained by having the patient erect (standing) and supine (lying on back).

Contrast Mediums

Angiogram/Arteriogram: Examines an artery after injection of a contrast medium via a catheter inserted into a peripheral vessel, such as the femoral, carotid or brachial artery. The catheter is advanced to the artery to be examined and the contrast medium is then injected.

Arthrogram: Examines a joint after a contrast medium is injected into the joint space.

Ba Enema: Examines the lower bowel after barium (a contrast medium) is introduced into the rectum via a rectal tube. This tube is left in place during the procedure and air is sometimes introduced as a radiolucent (x-rays can easily pass through it) contrast medium.

Ba Swallow/U.G.I. Series: Examines the esophagus, stomach and duodenum after the patient swallows barium. An S.B.F.T. is frequently ordered with this procedure.

Percutaneous Transhepatic Cholangiogram: Examines the biliary ducts after injection of a contrast medium through a needle that is passed through the skin.

T-tube Cholangiogram:  A patient undergoing an open cholecystectomy in the OR will sometimes have a T-tube inserted, for post-operative drainage of bile. The biliary ducts are examined post-op after introducing a contrast medium through this tube.

Oral Cholecystogram/Gallbladder Series: Examines the biliary ducts and gallbladder after the patient ingests an oral contrast medium that is administered the evening before the procedure.

Voiding Cystourethrogram: Examination of the bladder and urethra after a contrast medium is introduced through a catheter inserted into the bladder. The patient voids while the films are taken.

Stress Cystourethrogram: Examination of the bladder and urethra after a contrast medium is introduced through a catheter inserted into the bladder.

Intravenous Pyelogram: Examination of the kidneys, ureters and bladder after a contrast medium is injected intravenously.

Myelogram: Examination of the spinal canal (the cavity that runs through each vertebrae which contains the spinal cord) after a contrast medium is injected into the subarachnoid space via a lumbar puncture.

Sialogram: Examines the salivary ducts after injection of a contrast medium into a duct.

Sinogram: Examines the nasal sinuses after filling them with a contrast medium. Not often ordered anymore, as a CT scan of the sinuses (Head Scan) shows more detail than a sinogram.

Venogram: Examination of the veins after a contrast medium is injected into a vein.

Routine x-ray procedures do not require contrast mediums or booking times. The following are considered routine x-ray procedures:

• Bone x-rays

• Chest x-rays (CXR)

• Abdominal (abd/abdo) x-rays, sometimes referred to as flat plate of abdomen

• Kidneys, ureters and bladder (KUB) x-rays

Role of the NUC - Radiology OrdersWhen processing orders for procedures performed in radiology, the NUC completes the tasks for processing diagnostic imaging orders, as previously outlined:

• Complete the appropriate requisition for the procedure ordered.

• Transcribe the order to the diagnostic section of the patent's kardex.

• Write the notations "RMO, K" next to the order on the physicians order sheet.

• Leave the req in the chart with the completed order for the nurse to check.

• Send the requisition to the appropriate diagnostic department.

If the hospital uses a computer system for ordering diagnostic procedures, the NUC makes a computer entry, rather than a paper requisition. In this instance, the NUC writes the notation "OE" (order entered), instead of "RMO" next to the order. 

The NUC completes the following tasks specifically for certain types of procedures performed in the Diagnostic Imaging department:

• Add consent form to chart for invasive procedures.

• Inform patent's nurse of any patient preparation (prep) required.*

• Flag the kardex with prep instructions.

• Complete pertinent instructions for the prep.

• Inform patent's nurse of date and time procedure is booked.*

• Writing the booked date and time on the kardex.

* Any communication from the Diagnostic Imaging department and/or Scheduling Clerk regarding the patent's procedure is relayed to the patent's nurse.

For a routine x-ray that does not require a booking time, the Radiology Department will call the unit when they are ready for the patient. The NUC relays the message to the porter or the patient's nurse, to transport the patient to radiology.

The chart is sent to radiology with the patient, when indicated or requested.

Consent for Invasive Procedures

The following radiology procedures require the patient's consent:

• Angiogram/Arteriogram: Examines an artery after injection of a contrast medium via a catheter inserted into a peripheral vessel

• Arthrogram: Examines a joint after a contrast medium is injected into the joint space

• IVP: Examination of the kidneys, ureters and bladder after a contrast medium is injected intravenously

• Myelogram: Examination of the spinal column after a contrast medium is injected via a lumbar puncture

• Percutaneous Transhepatic Cholangiogram: Examines the biliary ducts and gallbladder after injection of a contrast medium through a needle that is passed through the skin.

• Sialogram: Examines the salivary ducts after injection of a contrast medium into a duct.

• Venogram: Examination of the veins after a contrast medium is injected into a vein.

Note: In the procedures for Ba enema and voiding /stress cystourethrogram, the tube/catheter is inserted into a body cavity (i.e. bowel and bladder) and therefore, not considered invasive

Patient Preparation (Prep)

The NUC needs to be familiar with all Radiology procedures that require a prep. The hospital may have a Diagnostic Imaging Manual at the nursing station where the preps are outlined.

The following radiology procedures require a patient preparation:

• Angiogram/Arteriogram

• Ba Enema (BE)

• Ba Swallow/UGI series

• Cholecystogram (GB series)

• Cystourethrogram

• Intravenous Pyelogram (IVP)

• Myelogram

• Venogram

The following is an example of the prep required for an angiogram/arteriogram:

Using the above arteriography prep instructions as an example, the NUC performs the following tasks:

1. Transcribes to the dietary section of the kardex "NPO @ 2400" with the applicable date (day before procedure).

2. Notifies the RN that a patient needs an IV of NS initiated in right arm to prepare for the procedure.

3. Requisitions laboratory tests as listed and notes this in the laboratory section of the patient's kardex.

4. Requisitions the vitalograph (a pulmonary function test) and notes this in the diagnostic section of the patient's kardex.

5. If the patient is on anticoagulant medication, notifies the RN that blood thinners must be discontinued 24 hours prior to the test, notes this on the medication section of the kardex and the medication record.

The following is an example of a prep required for a Ba Enema.

BARIUM ENEMA

For Barium Enema prep, the NUC performs the following tasks:

1. Transcribes to the dietary section of the kardex - Clear fluids only for 2 days prior to Ba Enema with the applicable date. Two days prior to procedure, enters the diet change to order clear fluids.

2. Notify nurse and ensure Magnesium Citrate is available; order if needed. Magnesium Citrate is a cathartic/laxative, ordered to cleanse the bowel.

3. Notify nurse and ensure Dulcolax tabs are available; order if needed.

4. The day before the procedure, transcribe to the dietary section of the kardex - "NPO @ 2400" with the applicable date.

5. Notify nurse and ensure Dulcolax suppositories are available; order if needed.

Note: Some NUCs find it helpful to write the appropriate dates next to the orders on the prep sheet, once they have the booking date. For example, if the Ba Enema was booked for April 6^th, instruction #1 would begin the morning of Apr. 4, instruction #2 would be given at lunchtime on Apr. 5, etc.

The following is an example of a prep required for a Ba Swallow/U.G.I. series

BARIUM SERIES OR STOMACH OR UPPER G.I. TRACT

For a barium series or stomach or upper GI tract prep, the NUC performs the following tasks:

1. Enter the diet change to order a light supper for the patient (day before procedure).

2. Transcribe to the dietary section of the patient's kardex - NPO @ 2400 with the applicable date (day before procedure).

The following is an example of a prep required for a Cholecystogram.

ORAL CHOLECYSTOGRAM (GALLBLADDER SERIES)

For an oral cholecystogram prep, the NUC performs the following tasks:

1. Enter the diet change to order a high fat lunch for the patient (day before procedure).

2. Enter the diet change after lunch to order a light and fat free supper.

3. Notify nurse and ensure Oragrafin available; order if needed. Oragrafin is an oral contrast medium.

4. Transcribe to dietary section of kardex - NPO @ 2400, sips H₂O only, with applicable date (day before procedure).

The following is an example of a prep required for a Cystourethrogram.

CYSTOURETHROGRAM

For a cystourethrogram prep, the NUC:

1.  Notifies the nurse of the catheter order.

The following is an example of a prep required for an Intravenous Pyelogram (IVP).

INTRAVENOUS PYELOGRAM
(IVP OR DRIP INFUSION PYELOGRAM)

For a intravenous pyelogram prep, the NUC performs the following tasks:

1. Notify nurse and ensure X-PREP available; order if needed.

2. Enter the diet change to order a light supper for the patient (day before procedure).

3. Transcribes to the dietary section of the kardex - NPO @ 2400 with applicable date (day before procedure).

The following is an example of a prep required for a Myelogram.

MYELOGRAM PREPARATIONS: NON-IONIC

For a myelogram (non-ionic) prep, the NUC performs the following tasks:

1. If the patient is on antipsychotic medication, notify the patient's RN to discontinue this medication 48 hours prior to the test, note this on the medication section of the kardex and the medication record.

2. Notify nurse: The patient is to receive fluids only beginning 8 hours prior to procedure; NPO for the last 3 hours prior to procedure.

3. Enter the diet changes and transcribe to the dietary section of kardex for any applicable meals.

 The following is an example of a prep required for a Venogram:

VENOGRAM

For a venogram prep the NUC:

1. Puts a hold on any meal tray that will arrive in the 4 hour time frame before the procedure.

Booking Time

Radiology procedures that take longer to perform and those that use a contrast medium require a booking time.

The following radiology procedures require a booking time:

• Angiogram/Arteriogram

• Arthrogram

• Ba Enema

• Ba swallow/UGI series

• Cholangiogram

• Cholecystogram

• Cystourethrogram

• IVP

• Mammogram

• Myelogram

• Sialogram

• Sinogram

• Venogram

Note: The only procedures performed in radiology that don't require a booking time are the routine x-rays