RAD 101 chap 1 voice memo

Professional Roles and Radiologic Practice Standards

• Radiologic Technology Definition: A broad healthcare profession that encompasses all diagnostic imaging technologists and radiation therapists.
• Radiographer: A specialized radiologic technologist who administers ionizing radiation to perform radiographic procedures. This role requires a high level of technical skill integrated with knowledge in physics, anatomy, physiology, and pathology.
• ASRT Practice Standards:     - The American Society of Radiologic Technologists (ASRT) is responsible for writing and maintaining these standards.     - The standards define the practice of radiography, detail the necessary education and certification requirements, and establish the radiographer's scope of practice.     - They include three specific categories of standards: clinical performance standards, quality performance standards, and professional performance standards.     - Current versions are maintained at $asrt.org$.

Ethics and Ethical Standards

• Ethics Definition: Defined as a profession's moral responsibility and the science of appropriate conduct toward others.
• ARRT Standards of Ethics:     - The American Registry of Radiologic Technologists (ARRT) created and maintains these standards.     - The Standards of Ethics are divided into two parts: the Code of Ethics and the Rules of Ethics.
• Code of Ethics: Consists of $10$ statements that serve as a professional behavior guide for Registered Technologists (RTs).
• Rules of Ethics: Consists of $22$ mandatory rules that are enforceable.
• Advanced Practice Roles:     - Radiology Assistant (RA) and Radiology Practitioner Assistant (RPA): These titles designate radiographers who provide advanced imaging services, often referred to as the "PAs" (Physician Assistants) of the radiology field.     - Requirements: ARRT radiography certification, additional specialized education, and clinical experience under the supervision of a radiologist preceptor.     - Scope: RAs can perform fluoroscopy studies and minor procedures, and in some cases, read basic films, allowing radiologists to focus on complex image interpretation.

Radiographer Responsibilities and Infection Control

• General Maintenance: Radiographers are responsible for room cleanliness, minimizing infection transmission, and managing stocks of linens, contrast, ancillary equipment, and "folding bags."
• Fluid Protection: In trauma situations (e.g., bloody cases), plastic bags should be used to cover the Image Receptor (IR) to prevent contamination, making disposal easier and maintaining hygiene.
• CDC Directives: The Center for Disease Control and Prevention (CDC) provides the foundation for standard precautions.
• Standard Precautions:     - Hand Hygiene: Perform hand hygiene before and after entering any patient room or performing X-rays.     - Personal Protective Equipment (PPE): Includes gloves, gowns, and masks, depending on specific precaution requirements.     - Respiratory Hygiene: Practicing cough etiquette (coughing into elbows).     - Patient Placement: Ensuring appropriate placement to prevent spread.     - Equipment Care: Properly cleaning and disinfecting devices. "Face gunk" (makeup, lotion, or oils) should be wiped off equipment after contact with patients.     - Safe Injection Practices: Wearing surgical masks when performing lumbar punctures or entering the spinal canal.     - Textiles and Laundry: Handling laundry carefully; clean sheets should be wrapped to prevent contact with "hospital jerkies" (pathogens) during transport.
• Safe Handling of Sharps:     - Proper handling of needles is critical for healthcare worker safety.     - Kelly Clamp: A tool resembling scissors used for suturing that can be used to pick up needles from sterile trays to avoid direct contact.     - No Recapping: Needles should never be recapped manually. If a safety cap is provided, it may be used, but standard recapping is a primary cause of needle sticks.     - Reporting: Any puncture (clean or dirty needle) must be reported to the clinical preceptor immediately to allow for patient testing (Hep B, Hep C, HIV, meningitis) and prophylactic treatment.
• Transmission-Based Precautions: Used in addition to standard precautions for patients with known or suspected infections.
• Handwashing Specifics:     - If hands are not visibly soiled, hand sanitizer is acceptable.     - If hands are visibly soiled, they must be washed with soap and water.     - Frequent sanitizer use can feel "gross," so periodic washing is recommended.     - Washing is mandatory before invasive procedures, before touching at-risk (immunocompromised) patients, after contact with blood or bodily fluids, and after examining patients with communicable diseases.

Patient Care and Clinical History

• Clinical History: Obtaining a detailed clinical history is a critical responsibility. This includes verifying the correct procedure order and observing abnormalities to relate to the radiologist.
• DOE (Dyspnea on Exertion): An example of a clinical observation where a patient may not report symptoms until they physically exert themselves (e.g., walking from a chair to the chest board).

Management of Motion in Radiography

• Involuntary Motion: Movement that cannot be controlled by the patient.     - Examples: Heartbeat, chills, peristalsis (bowel movement), tremors, spasms, and pain.     - Primary Control: Using the shortest possible exposure time.
• Voluntary Motion: Movement that can be controlled by the patient.     - Examples: Nervousness, discomfort, excitability, mental illness, fear, age, and breathing.     - Control Methods: Giving clear, concise instructions; providing patient comfort (blankets, sponges/positioning aids for back pain); and using immobilization devices.
• Visual Identification: Motion typically appears as a "fuzzy" or blurry image.

Image Receptors (IR) and Accessory Equipment

• Definition: A device that receives the energy of the X-ray beam and forms the image of the body part.
• Types of IRs:     1. Cassette with Film: Traditional method involving a darkroom for processing.     2. PSP (Photostimulable Phosphor) Plate: Used in Computed Radiography (CR). The plate has an emulsion film that creates light when hit by X-rays; a reader then converts this light into a digital image.     3. Solid-State Digital Detectors: Used in Digital Radiography (DR). These provide nearly instant images. Options include tethered (with a cord) and wireless detectors.     4. Portable Radiography and Fluoroscopic IR: Used in mobile units or real-time imaging.
• Fluoroscopy Geometry: In traditional rooms and C-arms, the radiation source typically comes from the bottom, and the reader/image intensifier is on top. Bringing the reader closer to the patient improves image quality.
• Accessory Equipment: Includes positioning aids (sponges), grids, and compensating filters.

Procedural Standards and Geometric Factors

• Common Steps: Establishing a routine/script for every procedure improves efficiency, ensures safety, and reduces radiation dose. These steps vary based on anatomy and department protocols.
• Technical Factors:     - mAs: Milliampere-seconds; represents the quantity or amount of radiation.     - kVp: Kilovoltage peak; represents the quality, energy, and penetration ability of the beam.     - AEC: Automatic Exposure Control.     - SID: Source-to-Image Distance.
• SID Standard Values:     - $40\,inches$ ($102\,cm$): Traditional distance for most examinations.     - $48\,inches$: Used for abdomens and lumbar spines to provide better spatial resolution.     - $72\,inches$: Used for chest X-rays to reduce heart magnification due to the increased Object-to-Image Distance (OID).
• Central Ray (CR): The principal beam of the X-ray. It should generally be perpendicular to the IR and the body part to minimize distortion.
• Intentional Distortion: Sometimes used to open joint spaces or avoid superimposition, such as in foot imaging where the tube is angled to see the bones clearly.
• Detent: The process of centering the central ray exactly to the image receptor.

Radiation Protection and Gonad Shielding

• ALARA: "As Low As Reasonably Achievable" — the fundamental principle of radiation safety.
• Collimation: Restricting the radiation field to the anatomy of interest. This reduces patient dose and scatter radiation, which improves contrast resolution.
• Gonad Shielding Guidelines:     - Use when gonads lie within or close to ($5\,cm$) the primary field.     - Only use when it does not compromise the clinical objective of the exam.     - Examples: Men can be shielded for pelvic/abdominal exams because their gonads are external/lower. Women cannot be shielded for abdominal exams because the gonads are located in the pelvis, which is the area of interest.     - Radio-sensitive Tissues: Shields protect against cancers in the thyroid, breast tissue, and gonads.     - Patient Population: Pregnancy questions must be asked of females between ages $10$ and $60$.
• Shielding Controversy: Some research suggests scatter radiation produced inside the body can hit a lead shield and bounce back into the body, potentially increasing dose; however, hospital policy currently mandates shielding.

Image Evaluation and Anatomic Markers

• Anatomic Markers: Every radiograph must have a physical Right (R) or Left (L) lead marker. Digital annotations (post-processing markers) are not acceptable because they can be applied incorrectly if the computer flips the image.
• Marker Placement: Place markers on the lateral aspect of the anatomy, on the edge of the collimated border, and outside of any lead shielding.
• Shuttering/Cropping: A digital software feature that adds a black background. It is a violation of the ARRT Code of Ethics to collimate larger than necessary and then crop the image. This over-radiates the patient and can hide pathology (e.g., a tumor), making the RT legally liable for misdiagnosis.
• Evaluation Criteria:     - Presence of patient ID.     - Proper marker placement.     - Proper collimation and shielding evidence.     - Absence of artifacts (jewelry, necklaces, piercings, bedazzled shirts).
• Patient Preparation: For chest X-rays, patients should remove everything from the waist up (including bras with adjusters or plastic) and wear a gown.
• Viewing Convention: Radiographs are viewed in anatomic position. Exception: Hands, wrists, feet, and toes are usually viewed with digits pointing upward.

Imaging Obese Patients

• Definitions:     - Obese: BMI of $30$ to $39.9$.     - Morbidly Obese: BMI of $40$ plus.
• Communication: Use empathetic communication; avoid mentioning weight directly. Explain the need for additional personnel for safety.
• Equipment Limits: RTs must know the weight limit of their tables. A typical standard is $550\,lbs$ for a stationary tabletop. Moving a tabletop reduces the capacity by approximately $50\,lbs$.
• Image Quality: Larger patients produce more scatter radiation, which can degrade image contrast.

Questions & Discussion

• Question: What is the difference between PSP and Digital Detectors?
• Response: PSP (Photostimulable Phosphor) is for Computed Radiography (CR). It uses an emulsion film that creates light, which is later read by a machine to produce a digital image. Digital Radiography (DR) is instant.
• Question: Why is the radiation source on the bottom in fluoroscopy?
• Response: This is a question better suited for "Doctor G," though the speaker recalls it related to image quality and reader proximity.
• Question: How wide is the field of scatter radiation?
• Response: It depends on the energy of the beam. Technologists should stand at least $6\,feet$ away to avoid scatter.
• Question: Is shielding done on the breast for a female abdomen X-ray?
• Response: No, because you do not know how high the diaphragm is sitting; a shield might obscure anatomy.
• Question: What bones are imaged diagonally?
• Response: Typically the Tibia/Fibula (tib-fib) and the Humerus, to fit the length of the bone onto the $17\,inch$ IR.
• Question: What are the required IDs for an image?
• Response: Date, patient name or ID number, right or left marker, and institution identity. Referring physician's name is NOT required.
• Question: What is excluded from a technique chart?
• Response: Pathology type is not included on a standard technique chart.