Radiology Review Flashcards

Professional Roles and Behaviors

Healthcare Insurance and Benefit Systems

  • Fee-for-service:
    • Was the primary healthcare model 40 years ago.
    • Insurance company reimburses the patient for costs.
    • The patient covers what the insurance doesn't.
    • Patients can choose their doctors and hospitals.
  • Health Maintenance Organizations (HMOs):
    • Patients pay an insurance premium and a co-pay.
    • Emphasizes preventative care, nutrition, and exercise.
    • Aims to treat potential health problems early.
    • Patients typically see a primary care physician first, who then refers them to specialists if needed.
    • Often involves outpatient facilities and surgeries.
    • Utilizes Nurse Practitioners (NPs) and Physician Assistants (PAs).
  • Managed-care systems
  • Crisis Intervention Care:
    • Individuals only seek help during emergencies.
    • Return to old habits once the crisis is over.
    • This approach is expensive.
  • Federal health insurance:
    • Medicare
    • Medicaid
      • Federal healthcare for the poor.
      • Eligibility is a requirement.
      • States set their guidelines for services and eligibility based on:
        • Age
        • Income/resources
        • Disability
        • Citizenship

Healthcare Facilities

  • Hospitals:
    • Public: Operated by federal/local government.
    • Military
    • Private:
      • Not-for-profit
      • Proprietary (for profit)
  • Outpatient Clinics:
    • Urgent care
    • Surgery centers

Healthcare Team

  1. Physicians
  2. Hospital Organization and Management
  3. Services
  4. Roles in the imaging department

Medical Terminology

  • Root words:
    • Gastro = Stomach
    • Entero = Intestine
    • Geri = Elderly
    • Gyn = Female reproductive organs
    • Optha = Eye
    • Pneumo/pulmo = Lung
  • Suffixes:
    • Itis = inflammation (e.g., Gastritis = Stomach inflammation)
    • Osis = abnormal condition
    • Ectomy = to cut out
    • Megaly = enlarged
    • Tension = Pressure in a vessel
    • Graphy/graph = recording of an image
    • Gram = image
  • Prefixes:
    • Hypo = Low/below normal
    • Hyper = High/above normal
    • Hypertension = High blood pressure

Physicians – Common Specialties

  • Emergency department physician
  • Family-practice physician
  • Gastroenterologist
  • Geriatrician
  • Gynecologist
  • Hospitalist
  • Intensivist
  • Obstetrician
  • Oncologist
  • Ophthalmologist
  • Otorhinolaryngologist
  • Pathologist
  • Pediatrician
  • Pulmonologist
  • Psychiatrist
  • Radiologist
  • Surgeons
    • Abdominal
    • Plastic
    • Neurologic
    • Orthopedic
    • Thoracic

Physicians - Roles

  1. Referring Physician: Personal doctor.
  2. Attending Physician: Doctor responsible for patient care while in the hospital.
  3. Specialists
  4. Hospitalist: Attending physicians for hospital patients (serve as attending physician).
  5. Interns: Recent medical school graduates
  6. Fellows: Licensed physicians receiving more training
  7. Residents: Licensed physicians in an educational program to become certified in a specialty area

Hospital Organization and Management

  • Executive Board or Board of Trustees
  • Hospital Administrator
  • Departments - each with its own supervisor:
    • Business Services
    • Nursing Services
    • Diagnostic
    • Therapeutic
    • Support Services

Imaging Department

The structure typically involves:

  • Hospital administrator
  • Medical staff organization
  • Director of diagnostic imaging
  • Radiologist
  • Services manager
  • Chief technologists (sonographer, nuclear technologist, radiographer, CV angiography technologist)
  • MRI and CT supervisors
  • Clerical staff
  • Support personnel
  • Radiographers

Professionalism

  • Hallmarks:
    • Knowledge passed down from master to student
    • Commitment to truth and the highest good
  • A profession is organized to govern itself:
    • Sets standards of professional behavior, education, and qualification to practice
    • Enforces those standards within its ranks
    • Peer-reviewed journal or publication is also expected of a profession Allows the profession to advance and to review and challenge continually the basis of knowledge on which it functions

ARRT

  • ARRT - American Registry of Radiologic Technologists
    • National organization
    • Provides standards for certification
    • Gives Primary(RT), and Post-Primary Specialty exams Provides the Radiologic Technologist test
    • Certifies eligible candidates Nationally and some Internationally
    • Publishes a list of Radiologic Technologists
    • Encourages study
    • Requires RTs to renew annually, and obtain Continuing ED for renewal of certification (24 credits every 2 years)
    • Recertify every 10 years

ARRT- Exams

  • Establishes minimum standards for certification in imaging specialties and radiation therapy
  • Primary Specialty Exams - Registered Technologist (RT)
    • Radiography (R)
    • Nuclear Medicine (N)
    • Radiation Therapy (T)
    • Magnetic Resonance Imaging (MRI)
    • Sonography (S)
  • Post Primary Specialty Exams
    • Computed Tomography (CT)
    • Magnetic Resonance Imaging (MRI)
    • Mammography (M)
    • Cardiac Interventional Technology (CI)
    • Vascular Interventional Radiography (VI)
    • Quality Management (QM)
    • Sonography (S), Vascular Sonography (VS), Breast Sonography (BS)
    • Bone Densitometry (BD)
    • Registered Radiologist Assistant (RRA)
    • Radiology Practitioner Assistant (RPA)

ASRT

  • ASRT - American Society of Radiologic Technologists
    • National Organization
    • Produces curriculum guidelines for teaching institutions and maintains high standards of education
    • Conducts regional and national educational conferences
    • Self-study materials for technologists
    • A membership organization
    • Produces a journal and a magazine

ASRT Functions

  • Oldest and largest National Assoc. for techs Our state organization also
  • Founded to advance the profession and to promote high standards of education and patient care
  • Education - curriculum design for various programs
  • Holds conferences and self study materials for continuing education (CE) RT’s share ideas and listen to speakers
  • Publishes two scientific journals
  • Legislation - Supports legislation to protect the public from excess radiation by inadequately trained workers.
  • Public Relations - promotes awareness of the profession and its duties of radiographers Radiologic Technology Week Practice Standards - tech duties and responsibilities

ASSRT (AZRT)

ASSRT - Arizona State Society of Radiologic Technologists

  • State branch
  • Holds biannual meetings

ADHS

ADHS: Arizona Department of Health Services

  • Important organization for us
  • Gives us our licensure in Arizona Most states require a state license
  • They “Police the state”
  • Purpose: To protect the public, ensures that we are accredited to work You report un-licensed workers to them
  • keeps secretaries from taking x-rays

Practice Standards

  • ASRT’s written statement describes the radiographer’s duties and responsibilities
  • Defines the clinical practice, technical activities, and professional responsibilities of imaging and therapeutic professionals

Education

  • Hospital-based programs
    • Certificate
  • Community colleges
    • Associate’s degree
  • Universities
    • Associate’s or bachelor’s degrees
    • Usually eligible for advanced postgraduate degree

Educational Requirements

  • Education - Must complete an accredited Radiography 2–5 year program Awarded a certificate, Assoc., Bachelors
  • Pass a national exam by ARRT
  • Be licensed in the state (not all)
  • Good moral character
    • To patients No misdemeanors, or felonies

Credentials

Documents that attest to the qualifications of individuals, such as

  • Licenses
  • Registration
  • Certifications
  • American Registry of Radiologic Technologist (ARRT)
    • Establishes minimum standards for certification in various imaging specialties and radiation therapy
    • Conducts qualifying examinations that entitle applicants who pass the exams to use the designation “Registered Technologist” (RT) in association with their names

RT CERTIFICATION

  1. Agree to perform duties under a qualified physician
  2. Do Not give a written, or oral diagnosis
  3. Abide by the Code of Ethics

Continuing Education

  • Essential to stay abreast of current trends and to maintain competencies
  • Required to maintain ARRT credentials
  • May also be required to maintain state licensure

Career Ladder

  • Lead Technologist
  • Radiology Manager
    • Usually requires a minimum of bachelor’s degree
    • Higher level of administration usually requires master’s degree
  • Education
    • Usually requires master’s degree
    • Program Director
    • Dean
  • Commercial jobs
    • Equipment sales and applications
    • Bachelor’s degree commonly required

Professions Initials and Their Specialty

  1. RT(R) - RT = Registered Technologist, = R = specializing in Radiography
  2. Mammography - R.T.(M)
  3. Computed Tomography - R.T.(CT)
  4. Cardiovascular Interventional Technologist R.T.(CI)
  5. Vascular Interventional Radiography - R.T.(VI)
  6. Nuclear Medicine - R.T.(N)
  7. Radiation Therapy - R.T.(T)
  8. Sonography R.T.(S)
  9. Magnetic Resonance Imaging R.T.(MR)
  10. Bone Densitometry R.T. (BD)

Ultrasound

  • Uses high frequency sound waves to image structures in the body by recording reflections of the pulses of high frequency sound waves directed into the tissue.
  • The sound waves bounce off of a structure, back to the transducer to get an image on a computer screen
  • 1year-18mons. Of school
  • Certified by Society of Diagnostic Medical Sonography (SDMS) ARRT

Magnetic Resonance Imaging

  • Uses a magnetic field and radio waves with a computer to generate cross sectional images of the body
  • Ferrous metals cannot go into an MRI
  • Youngest of modalities
  • ARRT certified

Computed Tomography

  • Uses X-Ray to take many pictures of a predetermined plane of the body
  • Uses cross sectional images
  • ARRT certified

Radiography

  • X-Ray comes out of the tube and into a patient
  • Some x-ray is absorbed by the body, and some passes through the body
  • The x-ray coming out of the body makes changes to an image receptor
  • Computer makes the image visible
  • Radiograph - still (static) picture, made with one exposure of x-ray
  • Fluoroscopy - live action, moving (dynamic) picture, made with continuous x-ray

Types of X-Ray Imaging

  • Radiograph
    • One still (static) picture, made with one exposure of x-ray
  • Fluoroscopy
    • Live action, moving (dynamic) picture, made with continuous x-ray
    • Has an image intensifier attached enhances image by 10,000x so less x-ray is used (110000\frac{1}{10000} less)
    • Against the law not to have it
  • Tomography
    • Means taking a “slice” or tomogram of a predetermined plane

Nuclear Medicine

  • Uses energy to create images of anatomic structures and physiologic actions
  • Uses radioactive isotopes or radionuclides for Diagnostic (discovery) and Therapeutic (treatment) purposes
  • Usually do procedures that image an organ, but can be done on blood or urine
  • On the job training, or 1yr of schooling
  • Certified by ARRT or NMTCB (nuclear medicine technology board)

Nuclear Medicine Procedure

  • A patient is given a radioactive material (radiopharmaceutical) intravenously, orally, or by inhalation
    • Intravenous most common
  • After the patient receives the radioactive substance (tracer), it collects in an organ
  • Radiation comes off the body and is scanned by a Gamma Camera
  • The camera reads the amount of radiation and creates an image

Radiography vs. Nuclear Medicine

RadiographyNuclear Medicine
X-ray comes out of the tube, some x-ray is absorbed, and some goes through the pt, an image is formedPT gets a radioactive isotope, radiation comes out of the body, a machine detects how much and where the radiation is given off, an image is reconstructed by a computer
on an image receptor

Radiation Therapy (Oncology)

  • Therapy only
  • Gives radiation treatments to patients according to the prescription of a Dr.
  • Treats disease by using High Energy Ionizing Radiation, or Radioactive substances to treat primarily malignant tumors
    • Patients may come every day for 6 weeks
  • 1 year of schooling or a 2 year program without a RT

Cardiovascular Interventional Technology

  • A radiographic procedure using x-ray
  • Contrast is injected into the arteries surrounding the heart to visualize diseases of the heart or blood vessels
  • Can be diagnostic - angiography, or can be therapeutic - angioplasty
  • On the job training
  • ARRT certified

Vascular Interventional Radiography (DSA, Specials)

  • Radiographic procedure that uses x-ray to examine arteries, veins, or organs after contrast has been injected
  • Can be therapeutic or diagnostic
  • On the job training
  • ARRT certified

Mammography

  • Radiologic procedure that uses X-ray to visualize the breast
  • ARRT certified

Accreditation

  • Accreditation is the process that applies to an institution that results in documentation attesting to the attainment of certain minimal standards
  • Joint Commission what used to be the Joint Commission on Accreditation of Healthcare Organizations(JCAHO)
  • Joint Review Committee on Education in Radiologic Technology(JRCERT)

Job Satisfaction

Self-Care

  • Hierarchy of Needs
  • Health professionals are responsible for their own well- being
  • Serve as health role models for patients and the community

Empathetic Care

  • An empathetic response is one in which understanding, and compassion are accompanied by an objective detachment that enables one to act appropriately
  • A focus on patient’s needs will help a caregiver respond correctly

Burnout

  • Response to the chronic strain of dealing with the constant demands and problems of people under our care
  • Typically causes exhaustion, dissatisfaction, anxiety, apathy, depersonalization, and withdrawal
  • Risk is reduced by self-care and stress- relief activities

Care of Supplies and Equipment

  • Medical equipment is expensive
  • Appropriate use and care of equipment demonstrates ethical behavior

Professional Behavior

Morals and Ethics

  • Personal morality is based on lessons of right and wrong that were taught to us at an early age
  • Group morality refers to moral principles that apply specifically to certain groups of people

Morals and Ethics - Examples

  • The moral duties of physicians were defined in ancient Greece in the Hippocratic oath
  • Examples of group morality for today’s health professionals include the duties to provide due care, to maintain professional competence, and to maintain confidentiality of patient information
  • Ethics is a branch of philosophy that may be defined as a systematic reflection on morality

Standards of Ethics for Radiographers

A two-part document that includes the:

  • 1. Code of Ethics - an aspirational document
  • 2. Rules of Ethics - a more specific list of standards

Standards of Ethics

  • Principles of professional behavior and willingness by the profession to control its own conduct
  • Standard of Ethics in Radiology
    • ASRT Code of Ethics
      • Establishes broad principles of professional conduct
      • Specific behaviors to achieve them are detailed in the Practice Standards
    • ARRT Rules of Ethics
      • Mandatory specific standards of minimally acceptable conduct
      • For Techs and Applicants
      • Enforced by ARRT

Ethical Judgments and Conflicts

  • Ethical analysis
    • The process of evaluating situations in which the correct action is in question
    • Four basic steps:
      1. Identify the problem
      2. Develop alternate solutions
      3. Select the best solution
      4. Defend your selection

Patient Rights

  • Considerate and Respectful Care
  • Information
  • Privacy and Confidentiality
  • Informed Consent
  • Right to Refuse Treatment or Examination
  • Death with Dignity

Patient’s Rights - Details

  1. Right to considerate and respectful care
  2. Right to information
    • Explain procedure
    • Identify self as radiographer
    • Copy of billing and medical records, and images
  3. Right to privacy and confidentiality
    • Modesty and dignity
    • Physicians or health care workers are not left alone with patients of opposite sex in exams that require exposing genitalia

HIPAA

HIPAA - Health Insurance Portability and Accountability Act

  • Protects privacy rights of patients
  • April 2003 hospitals are required to provide protection for patients concerning the release of financial and medical information without written consent

HIPAA Applications

  • No schedules or documents with PT’s names may be posted in public areas
  • Use only first name
  • Research patient’s - all info must be de-indentified
  • When medical info is released - only designated information may be given (labs, H&P)
  • Only individuals trained in HIPPA compliance are allowed to access protected health care info
  • All computer files that contain patient info must be encrypted

Informed Consent

  • Necessary for any procedure that is experimental or has risk
  • Patient and witness (you), sign the form
  • Medically trained interpreters should be used when the patient does not speak, read, or write English
  • Radiographer is responsible for knowing which procedures require a written consent, and for checking the chart that these forms are in order

Litigation

Was Successful From Lack of Compliance When:

  • Patient’s received full explanation of procedure with risks and benefits BEFORE sedation/anesthesia
  • Patient must be competent to sign
  • Only parents or legal guardians may sign for a minor
  • Only a legal guardian may sign for a mentally incompetent patient
  • Consent forms must be completed before being signed, never a blank form or one with spaces
  • Only Dr. on form may do procedure
  • All conditions on form must be met
  • Can be revoked at any time by patient

Patient's Rights

  • Right to Refuse Treatment and Exam
    • Consent may be revoked at any time during a procedure
    • Even after patient signs a consent, they can refuse
  • Death With Dignity
    • DNR - Do Not Resuscitate
    • DNR/DNI - Do Not Resuscitate/Do Not Intubate
  • Advance Directive
    • Medical care wishes when patient loses ability to make decisions
  • Appointment of a Power of Attorney
    • POA acts patient’s behalf when patient is unable to communicate wishes
    • Can sign consent for them

Legal Considerations

Laws are divided into 2 categories

  • CRIMINAL - Offenses against state or society at large (divided by severity)
    • 1. Felony - punished by imprisonment
    • 2. Misdemeanor - punished by a fine or imprisonment less than a year
  • CIVIL LAW - Rights and duties of individuals with respect to one another
    • Tort - A civil wrong committed by one individual against the person or property of another
      • a. Civil lawsuit seeks damages not punishment.
      • b. Civil law allows compensation to individuals who have been injured by a noncriminal act.

Crimes - Classifications

  • Felony
    • A serious crime that may be punished by imprisonment
  • Misdemeanor
    • A less significant crime usually punished by a fine or by imprisonment for less than a year

Radiographers - Potential for Crimes

  • Felonies - Theft and some drug related crimes
  • Misdemeanors - Violations of laws that regulate practice, such as licensure requirements, or scope of practice limitations
  • Fraud or Misrepresentation with respect to credentials or qualifications may be classified as a Felony or a Misdemeanor, depending on circumstance
  • Violation of the Law? Lose Your License!!!

Torts

A civil wrong committed by one individual against the person or property of another

  • Two categories:
    • Intentional misconduct
    • Negligence

Torts - Civil Lawsuits

Civil lawsuits alleging personal injury are increasing

  • Intentional Misconduct
    • Assault
    • Battery
    • False Imprisonment
    • Invasion of Privacy
    • Libel
    • Slander
  • Unintentional Misconduct
    • Negligence
    • Malpractice

Intentional Misconduct - Examples

  • False Imprisonment - Unjustifiable detention of a person against his or her will
    • Patient wants to leave
    • Physical restraints
    • Side rails
  • Invasion of Privacy - When confidentiality has not been maintained, or when a patient’s body has been improperly and unnecessarily exposed or touched
    • Disclosure of confidential information from a patient or medical record
    • If information reflects negatively on the patient’s reputation = Defamation of character
    • Photographs are published without patient’s permission

Intentional Misconduct

Libel and Slander - the malicious spreading of information that causes defamation of character or loss of reputation

  • Libel - A false accusation written, printed, or typewritten, or presented in a picture or sign that is made with malicious intent to defame the reputation of a person who is living, or dead, resulting in public embarrassment, contempt, ridicule, or hatred
  • Slander - Any words spoken with malice that are untrue and prejudicial to the reputation, professional practice, commercial trade, office, or business of another person

Intentional Misconduct - Touching

  • Assault - “Threat” of touching in an injurious way
  • Battery - Unlawful touching of a person without consent
    • Radiograph taken against patient’s will or on the wrong patient is battery Double check ID Proper informed consent

Unintentional Misconduct

  • Negligence - The act that a prudent person would not have done, or the omission of a duty that a prudent person would have fulfilled, resulting in injury or harm to another person
  • Malpractice - Professional negligence that is the cause of injury or harm to a patient, resulting from a lack of professional knowledge, experience, or skill that can be expected in others in the profession or from failure to exercise reasonable care or judgment in the application of professional knowledge, experience, or skill

Malpractice Prevention - The 7 C’s

  • Competence - Know and follow professional standards
  • Compliance - Follow policies and procedures by health professionals
  • Charting - Chart completely and consistently
  • Communication - Injuries and resulting malpractice cases can be avoided by improved communication
  • Confidentiality - Protect the confidentiality of medical information
  • Courtesy - Courteous attitude can improve rapport with the patient and lessen lawsuits
  • Carefulness - Pay attention and be careful. Personal injuries can occur unexpectedly

Malpractice Prevention

Research indicates that lawsuits are most likely to occur when patient’s feel alienated from the people providing their care. When a trusting relationship is established, lawsuits are less likely to occur

Malpractice Prevention - Tips

  • Proper patient ID
  • Accuracy in medication administration
  • Compliance with patient safety requirements
  • Contrast administration and allergic reactions (identified quickly and treated)
  • Poor image quality leads to misdiagnosis
  • Appropriate responses in an emergency
  • Ask questions or for help when needed

Medical Recording by Radiographers

Medical Records

  1. Effective documentation
    • A. Charting is defined as any records you are expected to add to a document
      1. Paper
      2. E-Chart

Medical Recording on Computers

Record Keeping - Responsibilities

Proper record keeping is required to ensure:

  • Patients are billed accurately
  • New supplies are ordered
  • Insurance companies receive verification of the care provided to their clients
  • All information in patient records is considered permanent and confidential
  • The chart is a legal document that can substantiate or refute charges of negligence or malpractice and can also serve as a record of behavior

Chart as a Resource

  • Used to validate impressions in patient assessment
  • Used to obtain vital information on a patient
    • DNR/DNI orders
    • Allergies
    • Lab reports
    • Diagnoses

Diagnostic Images as Records

  • Images are legally considered to be part of the medical record
  • Belong to the institution in which they are made
  • Normal retention period is 5 to 7 years
  • Patients must sign a release form to obtain images for another provider – HIPAA requirement

Accidents and Incident Reports

Any fall, accident, or occurrence that results in injury or potential harm must be immediately reported to the departmental supervisor and/or to the radiologist

  • This is an essential component of the hospital’s risk-management program