Untitled Flashcards Set

• Early health care- patients were cared for in homes, only using hospitals in critical instances

• Discovery of antibiotics and introduction of sophisticated medical/surgical treatments has led to complex treatment protocols

• Caused a focus on preventive measures as it is less costly to prevent an illness than to treat it

• Health care can be viewed from two perspectives:

  • Crisis intervention – patient seeks medical help only when unable to manage alone; once the emergency has passed, the former lifestyle is resumed

  • Health maintenance/Preventive health care – promotes well-being and health screenings to avoid the need for medical intervention; identify potential health problems before they manifest as illness; treat illnesses promptly

• Health-illness continuum – denotes the spectrum of patient illnesses 

  • Health patients requiring employment screening or preventative care to those critically ill

• Evidence-Based Practice – works at integrating best available scientific knowledge with clinical expertise and patient values to create the best care plan

Health Care Insurance and Benefit System

Private Insurance Options

• Until 40 years ago most health care reimbursement was fee-for-service basis

  • Insurance reimburses for the costs of health care within the limits of the policy and the patient is responsible for any costs not covered

  • Patients could choose which physicians and health care facilities they used

• Rising health care costs made insurance premiums expensive & uninsured could not afford health care costs, this sparked the creation of health maintenance organizations (HMOs)

  • Patient pays cost of the premium and a small fee called a copayment for each visit

  • Control costs by promoting good health and providing care in specified facilities only

    • Physicians who provide care may be employees of organization

    • Patients are expected to become more involved in their own health care needs

• Preferred Provider Organization (PPOs) - a system that offers care at reduced rates within an established network of providers

• Managed care systems – contracts that allow private hospitals and physicians to provide private services in addition to care through insurance plans that operate as HMOs or PPOs

• Affordable Care Act (ACA) enacted in 2010 to ensure all Americans have health insurance

  • Facilitates purchase of insurance thru federal and state insurance exchanges

Federal/Government Insurance

• Medicare – covers a portion of medical care costs for those 65 years and older

• Medicaid –covers low-income families and others based on age, income, and disability

  • Each state sets its own guidelines for services and eligibility

• Medicare and Medicaid account for a considerable % of reimbursement in health care facilities

  • Prospective Payment System (PPS) – Medicare and Medicaid bills are reimbursed based on diagnostic-related groups (DRGs)

    • Cost reimbursed based on patient’s admitting diagnosis NOT based on which services were provided

Self-pay - those that do not have health insurance and must pay all healthcare costs out-of-pocket

Health Care Facilities – Health care facilities that may be privately or publicly (operated by federal or local government) owned

• Hospitals

  • Not-for-profit: those owned by religious or charitable groups

  • Proprietary: health care businesses run for a profit

  • Many hospitals are part of a hospital system – helps cut costs by sharing highly technical equipment and purchasing supplies in volume

• Clinics/Pain Clinics

  • Pain clinics focus on the diagnosis and management of chronic pain 

• Mental Health Facilities

• Long-Term/Extended Care/Residential Facilities

  • Boarding or care homes, assisted living, nursing homes, residential facilities

• Hospice

  • End of life care

• Outpatient/Ambulatory Care

  • Provides health care without requiring hospital stays

• Free Standing Imaging Centers

• Home Health Care

• Telehealth

• Other (jails, prisons, medical examiner offices)

Mission Statement – a one- or two-paragraph declaration of the institution’s basic philosophy and primary goals (outlines the organization’s reason for existence)

Vision Statement – focuses on how an organization wants to develop in the future

Values Statement – reflects the organization’s core principles and ethics

Responsibilities of Health Care Facilities – provide care for all patients, promote health, prevent illness, provide education, research

The Health Care Team

• Patients are the most important people in the health care community

• Physicians/Medical Staff – the physicians that practice within a hospital with authorized privileges, bylaws, elected officers, committees, and organized activities

  • Referring physicians: MD that sends a patient to hospital or another physician

  • Attending physicians: MD responsible for assessing the patient’s needs and prescribing procedures while the patient is in the hospital (oversee the entire health of the patient)

    • Hospitalists - serve as primary care physicians for patients while admitted 

  • Specialized physicians: specialize in treatment of specific areas (see list in Table 4.1)

  • Interns – recent medical school graduates gaining practical experience

  • Fellows – licensed physicians receiving advanced training

  • Residents – licensed physicians in an educational program to become certified in a specialty area

• Hospital Organization and Management

  • Board of Trustees/Governing Board – Authorized by law to operate a hospital

    • Establishes goals, policies, and financial plans for the hospital 

  • Hospital Administrator(s) – defines how operation of the hospital is maintained and conducted (oversees the organizational side of the hospital)

    • May be a CEO (chief executive officer) or a president

    • Ensure the hospital has a staff of well-trained professional, technical, and support personnel

  • Assistant Administrators -

    • Work under hospital administrator(s) to oversee clearly defined areas of responsibility for several departments

• It takes a coordinated effort of several departments to provide patients with best possible care

  • Administrative services – those roles that do not provide direct patient care but plan, direct, and coordinate activities that enable an organization to run efficiently

    • Admissions –processes admissions, discharges, transfers, and most procedures that occur in the event of a patient death

    • Information systems – Health information system (HIS) is a system designed to manage healthcare data (collect, store ,manage, and transmit patient’s electronic medical record [EMR])

    • Procurement/Purchasing – responsible for purchasing quality, purchase orders, and negotiating costs and contracts with vendors

    • Accounting – responsible for overseeing the financial statements and balances

      • Hospital accounting – includes hospital’s income statement and balance sheet (revenues, employee salaries/benefits, rent, supplies, utilities, etc.)

      • Patient accounting- track patient-related services, billing the patient, and collecting payment for care

    • Human Resources – focus on staff recruiting, retention, training, and development, workplace safety, compensation and benefits, employee relations, labor laws compliance

    • Administrative support services –Answer phones, coordinate patient care through coordinating and scheduling patient appointments, greeting patients, etc.

  • Clinical services – those roles that provide direct patient care through general, diagnostic, or therapeutic services

    • Emergency room, social services, nursing, CT, x-ray, MRI, phlebotomy, dietary, occupational therapy, physical therapy, respiratory therapy, surgery, etc.

    • Clinical support services – ensure clinical services have the materials, environments, and information necessary to provide patient care

      • Ex. accounting, housekeeping, laundry, purchasing, security

Roles in the Imaging Department 

• Radiology – the science of medical imaging

  • Modalities such as general radiography, mammography, nuclear medicine, ultrasound, cardiovascular interventional/vascular lab, CT, MRI, angiography, etc.

  • As some of these modalities do not use x-rays, imaging departments may be called: Radiology Departments OR Diagnostic Imaging Departments

• Overall responsibility of radiographer:

  • Perform radiographic exams, patient care & assessment, radiation protection, assist radiologists, follow practice standards

• Typical organization of radiology departments looking similar to this:

• Radiologists – physicians who specialize in diagnostic imaging (members of medical staff)

  • Interpret images of various imaging modalities and provide a written report 

  • Perform procedures and work closely with radiographers

  • Help establishing standards of care and technical quality within the department

    • Radiologist assistants – work under radiologists to assist in performing fluoroscopy, special procedures, patient handling, and other tasks traditionally performed by radiologists

• Diagnostic imaging manager/administrator – works with radiologists, radiations safety officers, physicists, and hospital administration to establish policies and budgets for various imaging departments or “teams”

• Department coordinator/lead or chief technologists – manages the day-to-day activities within the specific department such as doing staff schedules are ordering supplies

• Staff radiographers – general staff that report to lead radiographer & work with radiologists

• Other members within the department

  • Administrative assistants and medical secretaries – check patients in, organize orders and necessary paperwork, manage imaging records

  • Equipment maintenance engineers – maintain and fix equipment

  • Medical physicists – evaluate radiation safety and dosages, apply concepts of physics to treat and/or diagnose patients

  • Radiology Nurses – care for patients before, during, and after imaging procedures

• Other members outside of the radiology department

  • Information technology staff – manage clinical software and other processes that are used to keep patient records, admissions, and hospital records running smoothly

  • Transport – bring inpatients from their rooms to necessary tests and procedures

  • Materials specialists – deliver and stock necessary departmental supplies

• Educational Staff – individuals with an interest in teaching any of the specific disciplines can find opportunities in hospitals, colleges, and universities

  • Clinical staff – staff technologists that mentor/interact with student in the clinical settings

  • Clinical preceptor/instructor – teaches students on a one-on-one basis in clinical setting

  • Adjunct faculty – instructor that teaches on a limited-term contract

  • Didactic faculty – teaches students through classroom lectures and laboratory activities

  • Clinical coordinator – teaching responsibilities along with administrative duties such as overseeing clinical education

  • Program director – teaching responsibilities as well as overall administrative responsibility for the entire educational program

Radiography as a Profession

• Profession –not only a field of study, but also the application of specialized knowledge to benefit others

  • Governs itself by setting the standards for professional behavior, education, and qualification to practice and to enforce those standards within its ranks

• Professional Societies - Organizations that represent the interest of various groups to the public and governmental bodies. 

  • Publish journals/special reports, conduct educational meetings, proved education verification & scholarships, provide information networking and malpractice insurance

• American Society of Radiologic Technologists (ASRT) – founded in 1920, the oldest and largest association for radiographers

  • Goals are to advance the profession, maintain high standards of education, enhance quality of patient care, and further the welfare and socioeconomics of radiologic technologists

  • ONLY nationally recognized professional society representing all radiologic technologist in the United States – it is a member of the International Society of Radiographers and Radiologic Technologists

  • Publishes peer-reviewed journal (Radiologic Technology) & magazine (ASRT Scanner)

  • The ASRT sets forth the curriculum for radiography programs

• Professional societies may be at the local, state, national, and international levels. They may also be specialized for specific demographics within the professions (such as students or educators). Below are some examples of professional societies:

  • American Healthcare Radiology Administrators (AHRA)

  • Association of Educators in Imaging and Radiologic Sciences (AIERS)

  • Society of Diagnostic Medical Sonography (SDMS)

  • Society of Nuclear Medicine (SNM)

  • Association of Vascular and Interventional Radiographers (AVIR)

  • American College of Radiology (ACR) – for radiologists and physicists

• ASRT’s The Practice Standards for Medical Imaging and Radiation Therapy is a written statement that describes the duties and responsibilities of radiographers

• Radiography Education – programs range in length from 2-5 years, and may be based in hospitals, community colleges (associate’s degrees), and universities (bachelor’s degree)

  • All programs have comprehensive academic curricula

  • Clinical experience make up more than half of a student’s time in hospital and community college programs

  • University programs still provide clinical experience, but have a greater portion of student work devoted to academic courses

• Credentials – documents (registration, licenses, permits, and certificates) that attest to qualifications of individuals

  • American Registry of Radiologic Technologists (ARRT) – national organization that establishes the minimum standards for certification in the various imaging specialties; it is recognized nationally and to some extent internationally

    • To be eligible to sit for certifying exam, applicants must have a high school diploma (or equivalent) and completed an approved educational program in radiologic technology

    • Once applicants have passed the exam will use the designationRegistered Technologists (RT) in addition to the primary specialty in which they have passed the exam 

• (R) – radiography 

• (N) – nuclear medicine

• (T) – radiation therapy

• (MRI) – MRI

• (CT) – CT

• (M) – mammography

• (CI) – cardiac-interventional technology

• (VI) – vascular-interventional radiography

• (QM) – quality management

• (S) – sonography

• (VS) – vascular sonography

• (BS) – breast sonography

• (BD) – bone densitometry

• (RRA) – registered radiologist assistant

• ARRT registration must be renewed every year and 24 continuing education credits completed every 2 years.

• In addition to ARRT certification, some states require additional licensure and certifications (may be general or task specific such as CPR, venipuncture, etc.)

• There are currently 6 states that do not require radiographers to be credentialed: Idaho, South Dakota, Missouri, Alabama, Alaska, North Carolina

• Continuing Education (CEUs) is essential to stay abreast of current technologies, processes, and to maintain competencies

  • Required to complete 24 continuing education credits every 2 years

  • There are several opportunities to obtain these credits such as :

    • post-primary certification (becoming certified in another modality)

    • collegiate/educational programs (1 credit equals x amount of CEUs)

    • Self-learning activities

    • Professional conferences

    • Webinars

    • Vendor programs or equipment trainings 

  • Failure to maintain competency, licensure, registration, or required CEUs may result in loss of employment, professional reputation, or certification

• Continuing Qualification Requirements (CQR) – “Once certified, forever learning, evolving, and developing as a qualified professional” - any technologist certifications after Jan. 2011, are time-limited to 10 years; to achieve recertification after these 10 years, the technologist must complete 3 components of the CQR process

  • Professional profile – highlights achievements related to education, work, special skills, and professional development. It gives a big-picture look at how an R.T. has maintained qualifications since first becoming certified and registered

  • Structured Self-Assessment (SSA) Process

    • not considered a test because it cannot be passed or failed

    • learning tool designed to evaluate strengths and weaknesses in knowledge and skills

  • Completing Continuing Education 

    • Based on the results of the SSA, participants will receive a list of “targeted” learning opportunities

    • Continuing education activities focus on these targeted areas must be assigned

  • The ARRT allows for 3 years to complete all 3 steps of this process. 

• Employment Outlook

  • Prior to Covid-19, employment in radiography was expected to grow by 12% between 2016 and 2026 due to ACA requirements for health insurance, aging baby boomers, and increased retirement rate in the career

  • Continued improvements in technology and equipment will create more opportunities for radiographers to specialize in advanced imaging, opening up jobs in general radiography

  • Radiographers entering the field will have geographic mobility, competitive salaries, and opportunities to work in a variety of settings and shifts

• Career Ladder – as technologists gains experience and advances their skills, there are often opportunities to advance based on personal interests, skills, experience, and education

  • Lead technologists/team leaders

  • Administration – department manager, radiology director

    • Require supervisory skills, understanding of operations, management ability/experience (bachelor’s or master’s degree in business or administration OR equivalent experience may be required)

  • Advanced practice – experience radiographer who works with a high level of autonomy and complex decision making, have developed expert skills and knowledge of radiography, and work as an integral part of the radiography team and is also involved with multidisciplinary meetings

  • Education – works to educate future radiographers within the classroom, lab setting, or clinical environment

    • Usually requires and advanced education and at least 3 years of clinical experience

  • Commercial positions

    • Sales representative for radiographic equipment and/or supplies

    • Applications specialists – assist radiographers on the use of the machine applications

    • Technical services – repair, maintenance, installation

    • Marketing of radiographic equipment

  • Research and development

  • Industrial radiography – use x-ray or gamma rays to check products for cracks or damage not seen by the naked eye

    • Used to check gas/oil pipelines, metal welding, boilers, vehicle parts, aircraft parts

  • Medical Informatics – study and application of methods to improve the management of patient data and clinical knowledge; often times in radiography this relates to PACs (picture archiving and communication system)

  • Medical physics - evaluate radiation safety and dosages, apply concepts of physics to treat and/or diagnose patients

    • Often requires additional education requirements

  • Safety Officer – ensures the hospital/facility has proper license or permission for the use of ionizing radiation, monitor radiation badge dosing, create and monitor implementation of radiation protection program and standards

    • Often requires additional training and licensure

Additional Health Professions 

• Bone densitometry –measures bone mineral density and evaluate bone health

• Breast sonography – ultrasound to image the breast to help diagnose breast abnormalities

• Cardiac-interventional radiography- diagnostic and treatment procedures of the heart

• Computed tomography (CT)- using radiation to create cross-sectional imaging of the body 

• Diagnostic medical sonography – using high-frequency sound waves to image the body 

• Diagnostic radiography – using radiation to produce pictures of the body’s internal structures 

• Echocardiography – using ultrasound to image the heart

• Health physics –protect people and the environment from radiation hazards while ensuring radiation can still be safely used to benefit society

• Magnetic resonance Imaging – using magnetic fields to create cross-sectional images

• Mammography – radiographic imaging of the breast

• Medical dosimetry – works closely with radiation oncology teams to design, generate and measure radiation dose distributions for radiation therapy treatments 

• Molecular imaging – utilizes radiopharmaceuticals to image processes inside the body at molecular and cellular levels

• Multi-credential tech – a technologists certified to work in more than 1 specialty

• Nuclear medicine – creating diagnostic images after the administration of radioactive materials

• Nuclear medicine advanced associates – advanced-level nuclear medicine technologist that works under the supervision of a licensed physician to perform tasks such as supervision, interpretation, protocoling studies, and management

• Quality management – oversees a system of activities that ensure overall quality is being upheld and maintained

• Radiologists Assistant – work closely with radiologists to assist in fluoroscopy, special procedures, patient handling, and other tasks traditionally performed by radiologists

• Vascular sonography – using ultrasound to obtain images of vessels

• Vascular-interventional radiography – diagnostic/treatment procedures of the vascular system

Accreditation – a process of peer review that attest to the adequacy of an institution or program in meeting certain minimum standards

• The Joint Commission certifies that health care institutions meet a certain minimum standard; this credential is required for the hospital to receive reimbursement from Medicare and other health insurance programs

• The Centers for Medicare & Medicaid Services also require some “advanced diagnostic imaging” modalities to be accredited as well to qualify for reimbursement. These modalities include MRI, CT, and PET. Accreditation in modalities can be obtained through the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC)

• Radiography educational programs are also required to be accredited. 

  • Radiography program accreditation is provided by the Joint Review Committee on Education in Radiologic Technology (JRCERT)

    • JRCERT is composed of members of the ASRT, ACR, and AEIRS and ensures that minimum educational standards have been met

    • College and universities themselves are also often accredited by state or regional agencies to attest that certain standard of education are being met

  • The accreditation process for both hospitals and schools involve periodic self-assessments and on-site visits that include interviews, surveys, and documentation review.

• Other Regulating Agencies

  • External regulators may be from the federal and state level and include:

    • State Health Departments

    • Nuclear Regulatory Commission

    • Occupational Safety and Health Administration (OSHA)

    • American College of Radiology Accreditation and the Mammography Quality Standards Act

    • Health Insurance Portability and Accountability Act

  • Internal regulators are those within the facility and include:

    • Safety Committee, Infection Control Committee, Radiation Safety Committee, Risk Management & Corporate Compliance

Interprofessional Practice & Education

• Patient care requires the collaboration of several different professionals and specialties

• Interprofessional Education (IPE) occurs when 2 or more professionals learn about, from, and with each other

  • Enables effective collaborations & leads to improved health outcomes

• Interprofessional Practice – multiple health care workers from different professional backgrounds working together to deliver the highest quality of care possible