CHAPTER

Professional Issues in Imaging

STUDENT LEARNING OUTCOMES

After completing the chapter,the student will be able to:

1.Explain the criteria of a profession,and explain how the profession of imaging technology has evolved to meet these criteria.

2.List the members of the health care team with whom the radiographer may frequently interact and briefly describe the role of each.

3.Discuss the purpose of professional organizations, and explain why the radiographer should join the professional organizations in his field.

4.Explain Practice of Standards and professional growth in radiologic technology.

5.Define ethics and discuss ethics as it applies to radiologic technology

6. Explain the legal obligations that the radiographer has toward his patients,peers,and other

members of the health care team.

7.Define the Patient Care Partnership and A Patient's Bill of Rights.

8. Explain the patient's expectations,rights,and

responsibilities when he seeks medical care and the role the radiographer has in protecting these expectations,rights,and responsibilities.

9. Describe the legal responsibilities of the

radiographer when using immobilizing techniques, informed consent,incident reports,and Good

Samaritan laws.

10. Explain the need for professional malpractice insurance.

KEY TERMS

Adhere: To stay fixed or firm

Automatic external defibrillator: An electrical or battery-

operated device applied to the chest of a victim who is

suffering a particular heart dysrhythmia to counter-

shock them;available to the general public who has

been trained to its use

Bias: An inclination or t,mperament based upon personal

judgment;prejudict

Bioethics: Moral issues dealing with human life and death

Common law: Decisions and opinions of courts that are

based on local customs and habits of an area within a

particular country or state

Continuing education: Professional education received fol-

lowing completion of a training to maintain skills

Defaming: To attack or injure a person's reputation

Diagnostic imaging: Modern term for radiography,encom- passing all specialties devoted to producing an image of a body part

Ethical: Conforming to the standards of conduct of a given

profession or group

Holistic: The view that an organic or integrated whole has a reality independent of and greater than the sum of its

parts

Immobilization device:A piece of equipment that assures

restricting patient movement

In-service: Training given to employees in connection with

their work or profession to update or maintain knowl-

edge

Liability: Something that a person is obligated to do or an

obligation required to be fulfilled by law;usually an

obligation of financial nature

Malpractice: Professional negligence that is the cause of

injury or harm to a patient

Mentor: A teacher,coach,or advisor of conduct

Practitioner: Any individual practicing in a specific area or

discipline

1

STUDENT LEARNING OUTCOMES

(Continued)

11. Describe the patient's need for confidentiality and the legal implications for the radiographer.

12. Explain the need for accurate documentation in health care and the radiographer's obligations in this aspect of health care.

13. List and define the current methods of health

care delivery in the United States.

KEY TERMS (Continued

Preceptor: A teacher;directs action or conduct of another

individual

Profession: A calling that requires specialized knowledge

and intensive academic preparation

Radiographer: A radiologic technologist who uses critical

thinking,problem solving,and judgment to perform

diagnostic images

Regulatory compliance: Control of a situation or group of

laws that supervise a profession

Statutory law:Established law that is enacted by a legisla-

tive body and punishable by the court system

Therapeutic:Healing or palliative

Unethical: Not conforming to the standards of conduct of a particular profession or group

Radiologic technology has evolved to meet the criteria of a profession. As in all professions, radiographers are expected to adhere in conduct and behav- ior to the particular ethical and legal standards of the field.Any person who does not adhere to this code may lose his or her license as well as the privileges of the profession.

As a radiographer,one will not work alone in car- ing for the patient.One will work and interact with members of a health care team whose goal is to improve or restore the patient to good health.The health care team consists of physicians,nurses,therapists,social workers,and other health care professionals,all of whom work within their scope of practice and are accountable for performing their professional responsibilities.

The student,who has made the decision to enter the profession of radiologic technology,must realize that he/she is committed to accepting the code of ethics of this profession and must work within the scope of prac- tice.He must also understand that he is accountable for what he does as a radiographer and may be held legally liable for any errors made while caring for patients.

Radiologic technology is a profession oriented toward the diagnosis and treatment of trauma and dis- ease.This means the radiologic technologist,or radiog- rapher,will work in intimate contact with people on a daily basis.He must be prepared to work collabora- tively with people of all cultures,religions,and socio- economic backgrounds and to relate to them in an unbiased,nonjudgmental manner.

Anyone contemplating a career in radiologic tech- nology needs to examine the reasons why he has cho- sen this profession.It would be helpful to ask oneself the following questions before proceeding:

·Am I prepared to accept and practice the pro- fession of radiologic technology and support the American Registry of Radiologic Technologists (ARRT)and American Society of Radiologic Technologist Standards of Ethics?

·Am I prepared to avoid violations of the law in

practicing this profession?

·Will I be willing and able to learn to relate to my patients in a professional and nonjudgmental manner at all times?

If these questions cannot be answered positively,this career choice must be reconsidered.

THE CRITERIA FOR A

PROFESSION

Radiologic technology has evolved from an underedu- cated workforce of x-ray technicians in the early 1900s to the continued advances as a profession in the 21st century(Display 1-1).This progression took place over a number of years with the efforts and dedication of the persons who worked in this field.The term profession implies a body of work that requires extensive training

DISPLAY I-I

Chronology of Events in the History of

the Radiologic Technology Profession

1895 Wilhelm Conrad Roentgen discovered x-rays in Wurzburg,Germany.

1920 The American Association of Radiological Technicians,the first society for the profession,was created

by a group of technologists in Chicago,llinois.The society was dedicated to the advancement of radi- ologic technology

1921 The society's first annual meeting was held.Membership totaled 47.

1922 The American Registry of Radiological Technicians originated.

1930s-1940s Radiographer education was primarily by apprenticeship.

1932 The name of the American Association of Radiological Technicians was formally changed to the

American Society of X-ray Technicians (ASXT).

1936 The ASXT was authorized to make appointment to the Registry Board of Trustees.

1952 The ASXT provided a basic minimum curriculum for training schools.

1955 The ASXT created a new membership category—Fellow of AXST—which recognized individual mem-

bers who have made significant contributions to the profession.

1959 The ASXT membership reached 8,600 members.

1960 Registry applicants were required to have at least 2 years of training or experience.

1963 The American Registry of Radiological Technicians changed its name to the American Registry of Radi-

ologic Technologists (ARRT).

1964 The ASXT changed its name to the American Society of Radiologic Technologists.

1966 Registry applicants were required to be graduates of training programs approved by the American

Medical Association's Council on Medical Education.

1967 The Association of University Radiologic Technologists was established to stimulate an interest in radi-

ologic technology through the academic environment.

1968 The Society membership reached 14,000.1970 Registry Certificate No.I was awarded by the Registry

to Sister Mary Beatrice.

1984 The Association of University Radiologic Technologists changed its name to The Association of Educa-

tors in Radiological Sciences(AERS).Current membership is around I,000 educators from the United States and other countries.

1988 The Summit on Radiologic Sciences and Sonography met in Chicago to develop strategies to alleviate

the personnel shortage in the profession.

1995 The American Registry of Radiologic Technologists announced that,beginning in 1995,x-ray technologists

would henceforth be obligated to obtain 12 continuing education units per year to maintain their licenses.

1996 The Society membership reached 47,000 members.

1997 ARRT marked its 75th anniversary.

1998 ASRT launched an aggressive campaign to protect patients from overexposure to radiation during radi-

ologic procedures and help reduce the costs of health care.

2001 ASRT introduced a bill,known as the Consumer Assurance of Radiologic Excellence (CARE)bill,during the

2001 congressional session.It ensures that the people performing radiologic examinations are qualfied.

2002 ASRT membership reached 100,000 members.

2003 CARE bill reintroduced.

2005 CARE/RadCARE bill is enacted.

2006 RadCARE(S.B.2322)bill is introduced and passes unanimously.

and the mastery of study by its members who have spe- cialized skills,has a professional organization and eth- ical code of conduct,and serves a specific social need. The criteria for a group of practitioners to identify themselves as a profession was summarized by Chitty (2004)as the following:

1.A vital human service is provided to the society by the profession.

2.Professions possess a special body of knowledge that is continuously enlarged through research.

3.Practitioners are expected to be accountable and responsible

4.The education of professionals takes place in insti- tutions for higher education.

5.Practitioners have an independent function and control their own practice.

6.Professionals are committed to their work and are motivated by doing well.

7.A code of ethics guides professional decisions and conduct.

8.A professional organization oversees and supports standards of practice.

All professions have a code of ethics and professional organizations that control the educational and practice requirements of its members.The two organizations that assume these roles for radiographers are the American Society of Radiologic Technologists(ASRT)and the American Registry of Radiologic Technologists (ARRT). If applicable,the professional radiographer is registered by ARRT and by state licensure or certification.

Radiologic technology fulfills the basic require- ments of a profession and is becoming increasingly autonomous in professional practice.The status of a profession demands certain responsibilities and edu- cational requirements that former“x-ray technicians” did not possess.An individual contemplating radio- logic technology as a profession must examine the cri- teria of a profession listed above to make certain that he is willing to uphold the high standards of a profes- sional.These standards include responsibility, accountability,competence,judgment,ethics,profes-

sionalism,and lifelong learning.The professional radiographer is expected to demonstrate all of these qualities,

PRACTICE STANDARDS AND PROFESSIONAL GROWTH IN

R △DIOGRAPHY

ASRT states,“Professional practice standards define the

role of the practitioner and establish the criteria used to

judge performance.”Practice Standards for Medical Imaging and Radiation Therapy is a guide for the

appropriate practice of medical imaging.The practice standards define the practice and establish general cri- teria to determine compliance(Display 1-2).Practice standards are authoritative statements enunciated and promulgated by the profession for judging the quality of practice,service,and education.They include desired and achievable levels of performance against which actual performance can be measured(ASRT,2006). Radiographers are the primary liaison between patients, licensed independent practitioners,and other members of the health care team.Radiographers must remain sensitive to the physical and emotional needs of the patient through good communication,patient assess- ment,patient monitoring,and patient care skills.Radi- ographers use independent,professional,ethical judg- ment and critical thinking.Quality improvement and customer service allow the radiographer to be a respon- sible member of the health care team by continually assessing professional performance.Radiographers en- gage in continuing education to enhance patient care, public education,knowledge,and technical competence while embracing lifelong learning.In addition,the radi- ographer must include professional values in effective oral and written communication skills;critical thinking and problem-solving skills;and a broad knowledge base in developing technology.

The preparatory education for the radiographer has evolved from a hospital-based, preceptor training to formal educational programs.Hospital-based programs, as well as college-or university-based programs of study,are now available.To become a registered radi- ographer,one must successfully complete an accredited educational program.

Programmatic accreditation by the Joint Review Committee on Education in Radiologic Technology (JRCERT)assures that the program will provide the knowledge and skills for quality patient care in compli- ance for the JRCERT accreditation standards.Cur- rently,approved and accredited programs operate under nine standards effective January 1,2002. Included in the nine standards are sixty-one objectives that educational programs must clearly present docu- mentation assuring compliance.The initial accredita- tion process for a program takes about 18-21 months from the receipt of the application/self-study reports. The accreditation process has several steps,which include a site visit,report of team findings,response to report of findings,and program notification of accred- itation.Eight years is the maximum number of years awarded to programs;thereafter,accredited programs provide periodic self-studies and interim reports. Depending on the accreditation status,JRCERT con- ducts periodic site visits.

The formal educational programs include the didac- tic and clinical competency requirements.Two-year certificate,associate degree,and 4-year baccalaureate

degree programs are available in the United States. Within 5 years of successful completion of an accredited formal educational program in radiologic technology, candidates are eligible to participate in the American Registry of Radiologic Technologist national certification examinations.

Radiography program curriculum includes an exten- sive set of courses for the production of diagnostic images for interpretation by a radiologist.The course work includes:anatomy,patient positioning,examina- tion techniques,equipment protocols,radiation safety, radiation protection,and basic patient care.Entry-level radiographers need the skills and abilities to perform the following functions:

1.Apply modern principles of radiation exposure, radiation physics,radiation protection,and radio- biology to produce diagnostic images.

2. Use knowledge of medical terminology,pathology, cross-sectional anatomy,topographic anatomy, anatomy and physiology,and positioning proce- dures to produce diagnostic images.

3.Provide direct patient care such as ECG,contrast media,and other drug administration.

4.Evaluate recognized equipment malfunctions. 5.Evaluate radiographic images.

6.Achieve a level of computer literacy.

7.Teach educational courses at the technical level.

8.Communicate with other members of the health

care team.

9.Provide patient and family education.

10.Participate in community affairs.

In addition,the entry-level radiographer must pos- sess the following qualities:an ability to think in a crit- ical manner;a willingness to participate in lifelong learning,including becoming an active member of pro- fessional organizations;ethical behavior,from a holis- tic caregiver perspective;abroad computer knowledge base;problem-solving skills;and the ability to commu- nicate effectively orally and in writing.

As one becomes more experienced,he will possess all of the qualities and abilities listed above as well as the following:

1. The ability to supervise,evaluate,and counsel staff 2. The ability to plan,organize,and administer pro-

fessional development activities

3. Superior decision-making and problem-solving skills to assess situations and identify solutions for standard outcomes

4. The ability to promote a positive,collaborative

atmosphere in all aspects of radiography

5. Skills as a mentor

6.Knowledge in areas of supervision, in-service and/or continuing education,and regulatory compliance

As a health care professional,one must acquire and maintain current knowledge to preserve a high level of expertise.Continuing education will provide educational activities to enhance knowledge,skills,performance, and awareness of changes and advances in the field of radiologic technology.Continuing education supports professionalism,which fosters quality patient care.

Previously voluntary for radiographers,continuing education became a mandate in 1995 for all who are licensed by ARRT.The radiologic technologist is now required to earn 24 continuing education credits.These credits must be accepted by ARRT and are to be earned every 2 years.The licensing body must verify these cred- its before license renewal.Continuing education credits, such as seminars,conferences,lectures,departmental in-service education,directed readings,home study,and college courses,may be achieved by participating in educational activities that meet the criteria set forth by ARRT.Twenty-four credits may be earned by taking an entry-level examination in another eligible discipline that was not previously passed.The entry-level exami- nations are in radiography,nuclear medicine,or radia- tion therapy.Another way to earn 24 credits is by pass- ing an advanced-level examination in the field after proving eligibility.The advanced-level examinations are in mammography,cardiovascular-interventional tech- nology,magnetic resonance,computed tomography, quality management,and sonography.By participating in continuing education activities,professional knowl- edge and professional performance are enhanced and provide a higher standard of patient care.

PROFESSIONAL

ORGANIZATIONS IN

RADIOLOGIC TECHNOLOGY

Participation in professional organizations is the respon- sibility of all practicing professionals,regardless of their field.Membership in professional organizations pro- vides a pathway to continued successful professional development.It also provides comprehensive opportu- nities to remain current in a constantly changing tech- nological career.Professional organizations provide pathways for technical growth and the development of leadership skills as well as an arena for professional interaction and problem solving,especially in career issues.The mission statement for ASRT“is to lead and serve its members'profession,other health care providers and the public on all issues that affect the radiologic sciences.”ASRT offers many program and member services,including continuing education,a job bank and career information,events,conferences and

seminars,government relations and collective legisla- tive power,group professional liability insurance,and other member benefits and services.In addition,ASRT works with professional certification bodies and accred- itation agencies for radiographers.Ultimately,member- ship in professional organizations enables the radiogra- pher to continue providing quality patient health care in accordance with the standards of the profession.

There are various levels of professional organiza- tions in radiologic technology.Internationally,there is the International Society of Radiographs and Radio- logic Technologists.In the United States,ASRT is the national organization for radiologic technology.ASRT has affiliated societies at state levels,and the state soci- eties have district affiliates.A chronology of the events that stimulated the radiologic technology profession is interesting to review

THE HEALTH CARE TEAM

The radiographer will interact on a daily basis with his peers in diagnostic imaging and with other members of the health care team(Display 1-3).

PROFESSIONAI ETHICS

Ethics may be defined as a set of moral principles that govern one's course of action.Moral principles are a set of standards that establish what is right or good.All

individuals have a personal code of ethics that evolves based on their cultural and environmental background. This same background has taught us to place values on behaviors,as well as on objects in our environment; that is,to assign a judgment of either good or bad to an action.

Ethics is a combination of the attributes of honesty, integrity,fairness,caring,respect,fidelity,citizenship,

competence,and accountability.As one can quickly see, the terms “ethics,”“principles,”and “values”are closely linked and may be used interchangeably from time to time.

Bioethics is a relatively new branch of ethics that was established because of the advanced technical methods of prolonging life.It pertains solely to ethics in the field of health care and “narrows ethical inquiry to the moral 'oughts'of those who work in professional clinical practice,basic research,or the education of health care professionals.Bioethics affects all health professionals and those who seek their knowledge and skills”(O'Neil,1995).

The student entering the profession of radiologic technology brings with him a personal code of ethics, moral principles,and personal values.All professionals have a set of professional values,and all professionals have a set of ethical principles or a code of ethics that governs professional behavior.This is true of radiologic technology.

The Standard of Ethics is made up of two parts:the Code of Ethics and the Rules of Ethics.The Code of Ethics was developed,revised,and adopted by ASRT

DISPLAY I-3

The Health Care Team

Members of other health care professions with whom the

radiographer will interact are:

Physicians: A doctor of medicine or doctor of osteopa-

thy.They often specialize in a specific area of practice

and,following licensing,are able to prescribe and

supervise the medical care of the patient.

Registered nurses: Provide patient care,which is often

required 24 hours a day.They also provide home

health care and case management;educate;act as a

patient advocate;administer medications and treatments

as ordered by physicians;monitor the patient's health

status;and coordinate and faclltate all patient care when

the patient is hospitalized.Advance practice nurses

work as clinical nurse specialists and nurse practitioners.

Vocational nurses: Work with patients under the super-

vision of a registered nurse.

Occupational and physical therapists: Members of a profession that work in the rehabilitative area of health care.

Pharmacist: Prepares and dispenses medications and oversees the patient's drug therapy.

Respiratory therapist: Maintains or improves the patient's respiratory status.

Laboratory technologist: Analyzes laboratory speci- mens for pathological conditions.

Social workers: Counsel patients and refer them for

assistance to appropriate agencies.

There are also many unlicensed assistive person- nel including nursing assistants,ward clerks,pharmacy technicians,electrocardiogram technicians,and many more.

and ARRT in July 1998.It serves as a guide in main- taining ethical conduct in all aspects of the radiologic sciences.The rules of ethics were added in 2001.Con- sidered to be mandatory and enforced by ARRT,the 22 Rules of Ethics are designed to promote protection, safety,and comfort of the patient (Display 1-4).

Together,these documents represent the applica- tion of moral principles and moral values to the prac- tice of the profession and are considered to be the min- imum acceptable standards of conduct.They are concerned with the duties and responsibilities that the radiographer must have toward him,his patients,and professional peers and associates.These responsibili- ties deal with rights and correlated responsibilities and are discussed in the following section.

Unfortunately,as the world of health care becomes increasingly complex and the ability to prolong life expands,there are more difficult choices to be made. This leads to a growing number of ethical conflicts and dilemmas.The radiographer will not be immune to these as he performs his professional duties.Profes- sional standards of ethics must be adhered to at all times,even though doing so will,at times,present difficult problems to be resolved.

A set of ethical principles has been derived from the basic ethical philosophies.These are utilitarianism, deontology,and virtue.Utilitarianism is often called consequentialism and advocates that actions are morally correct or right when the largest number of persons is benefited by the decision made.An example of this is as follows:

A large accident occurs and a number of persons are critically injured.The triage team assigns a higher priority to the less injured patients and,since the chance of survival is less for the most severly injured, attends last to those who are critically injured.

This is an acceptable philosophy if one benefits from the decision.In this example,the important ele-

ment is the result of the action.This is based on the

principal known as teleological theory (meaning end or

completion).In other words,it is based on conse- quences with the highest good with the greatest happi- ness for the largest number of people.

Deontology upholds the philosophy that the rules are to be followed at all times by all individuals.Deon- tology comes from a Greek word meaning“duty”; therefore,one judges an action by deciding if it is an obligation.When making decisions using this school of thought,one generally does not take consequences into consideration even if it proves to be beneficial to the patient.Following the rules at all times may be too restrictive,especially when specific circumstances sur- rounding a situation do not fit a set of rules.

An example of deontology is illustrated by the acci- dent portrayed above.Since the health care provider

has the duty to“do no harm,”then assigning a low pri- ority number to the most critical patients would be wrong.Since deontology and utilitarianism are more or less opposite,the more critically injured patients would get the highest priority,and the most likely to survive would be attended to last because they would survive longest without care.

Virtue is a new philosophical belief that focuses on using wisdom rather than emotional and intellec- tual problem solving.With holistic medicine gaining popularity in recent years,virtue ethics incorporates certain principles of both utilitarianism and deontol- ogy to provide a broader view of issues.Analysis, review of consequences,and societal rules are essen- tial to forming decisions using virtue.Again,using the accident example to illustrate,with virtue ethics,the triage of the patients would take into account the significance of each individual.How the family and friends of the victims would be affected by the triage decisions would be the deciding factor in who gets first treatment.

Ethical Principles

To resolve ethical dilemmas,one may apply this estab- lished set of principles to decision making:

Autonomy:Refers to the right of all persons to

make rational decisions free from external pressures.Patients have the right to make deci- sions concerning their lives,and all health care workers must respect those decisions.In prac- tice,the radiographer will act as the liaison between the radiologist and the patient.In these circumstances,the radiographer must act on behalf of the patient.

Beneficience:Refers to the fact that all acts must be meant to attain a good result or to be beneficial.As a radiographer,you must always plan patient care to ensure safe outcomes and avoid harmful consequences.Beneficience requires action that either prevents harm or does the greatest good for the patient.This may require you to side with the patient and against his co-workers.

Confidentiality:Refers to the concept of privacy. All patients have the right to have information concerning their state of health or other per- sonal information kept in confidence unless it will benefit him or her,or unless there is a direct threat to society if not disclosed.The radiographer must not disclose facts concern- ing the patient's health or other personal infor-

mation to anyone uninvolved with the patient's care.

DISPLAY I-4

American Registry of Radiologic

Technologist—Standards of Ethics

The Standards of Ethics of The American Registry of Radi-

From the July I,2005 revision.Please note,the Standards of

Ethics were revised again on August 1,2008.Please refer to

the ARRT website (wwwarrtorg)for the mostrecent version.

Preamble

6. The radiologic technologist 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 outside the scope of practice for the profession.

7.The radiologic technologist uses equipment and accessories,employs techniques and procedures,per- forms services in accordance with an accepted stan- dard of practice,and demonstrates expertise in min- imizing radiation exposure to the patient,self,and other members of the health care team.

8. The radiologic technologist practices ethical conduct appropriate to the profession and protects the patient's right to quality radiologic technology care.

9. The radiologic technologist respects confidences entrusted in the course of professional practice and respects the patient's right to privacy and reveals con- fidential information only as required by law or to pro- tect the welfare of the individual or the community.

10. The radiologic technologist continually strives to improve knowledge and skills by participating in con- tinuing education and professional activities,sharing knowledge with colleagues,and investigating new aspects of professional practice.

B.Rules of Ethics

The Rules of Ethics form the second part of the Standards of Ethics.They are mandatory standards of Ethics of mini- mally acceptable professional conduct for all present Regis- tered Technologists and Candidates.Certification is a method of assuring the medical community and the public that an individual is qualified to practice within the profes- sion.Because the public relies on certificates and registra- tions issued by ARRT,it is essential that Registered Technol- ogists and Candidates act consistently with these Rules of Ethics.These Rules of Ethics are intended to promote the protection,safety and comfort of patients.The Rules of Ethics are enforceable.Registered Technologists and Candi- dates engaging in any of the following conduct or activities, or who permit the occurrence of the following conduct or activities with respect to them,have violated the Rules of Ethics and are subject to sanctions as described hereunder:

1.Employing fraud or deceit in procuring or attempting to procure,maintain,renew or obtain reinstatement of certification or registration as issued by ARRT; employment in radiologic technology;or,state permit license or registration certificate to practice radiologic

ologic Technologists shall apply solely to persons holding

certificates from ARRT who either hold current registra-

tions by ARRT or formerly held registrations by ARRT

(collectively,"Registered Technologists"),and to persons

applying for examination and certification by ARRT in

order to become Registered Technologists ("Candidates").

The Standards of Ethics are intended to be consistent with

the Mission Statement of ARRT and to promote the goals

set forth in the Mission Statement.

A.Code of Ethics

The Code of Ethics forms the first part of the Standards of

Ethics.The Code of Ethics shall serve as a guide by which

Registered Technologists and Candidates may evaluate

their professional conduct as it relates to patients,health

care consumers,employers,colleagues,and other mem-

bers of the health care team.The Code of Ethics is

intended to assist Registered Technologists and Candidates

in maintaining a high level of ethical conduct and in pro-

viding for the protection,safety,and comfort of patients.

The Code of Ethics is aspirational.

1. The radiologic technologist conducts herself or him-

self in a professional manner,responds to patient

needs,and supports colleagues and associates in pro-

viding quality patient care.

2.The radiologic technologist acts to advance the princi-

ple objective of the profession to provide services to

humanity with full respect for the dignity of mankind.

3. The radiologic technologist delivers 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 sex,race,creed,

religion,or socioeconomic status.

4. The radiologic technologist practices technology

founded upon theoretical knowledge and concepts,

uses equipment and accessories consistent with the

purposes for which they were designed,and employs

procedures and techniques appropriately.

5. The radiologic technologist assesses situations;exer-

cisescare,discretion,and judgment;assumes respon-

sibility for professional decisicns;and acts in the best

interest of the patient.

(continued)

technology.This includes altering in any respect any document issued by ARRT or any state or federal agency,or by indicating in writing certification or reg- istration with ARRT when it is not the case.

2. Subverting or attempting to subvert ARRT's exami- nation process.Conduct that subverts or attempts to subvert ARRT's examination process includes,but is not limited to:

(i) conduct that violates the security of ARRT exam- ination materials,such as removing or attempting to remove examination materials from an exam- ination room,or having unauthorized possession of any portion of or information conceming a future,current or previously administered exam- nation of ARRT;disclosing information concern- ing any portion of a future,current,or previously administered examination of ARRT;or disclosing what purports to be,or under all circumstances is likely to be understood by the recipient as,any portion of or "inside"information concerning any portion of a future,current,or previously admin- istered examination of ARRT;

(i)conduct that in any way compromises ordinary standardsof test administration,such as commu- nicating with another Candidate during adminis- tration of the examination,copying another Can- didate's answers,permitting another Candidate to copy one's answers,or possessing unautho- rized materials;

(ii)impersonating a Candidate or permitting an impersonator to take the examination on one's own behalf.

3.Convictions,criminal proceedings or military court-

martials as described below:

(i) Conviction of a crime,including a felony,a gross misdemeanor or a misdemeanor with the sole exception of speeding and parking violations.All alcohol and/or drug related violations must be reported.

(ii) Criminal proceeding where a finding or verdict of guilt is made or returned,but the adjudication of guilt is either withheld or not entered,or a criminal proceeding where the individual enters a plea of guilty or nolo contendere.

(i)Military court-martials that involve substance abuse,any sex-related infractions,or patient- related infractions.

4. Failure to report to ARRT that:

(i) charges regarding the person's permit,license or registration certificate to practice radiologic technology or any other medical or allied health profession are pending or have been resolved adversely to the individual in any state,territory or country(including but not limited to,

imposed conditions,probation,suspension,or revocation);or

(i) the individual has been refused a permit,license, or registration certificate to practice radiologic technology or any other medical or allied health profession by another state,territory,or country.

5.Failure or inablity to perform radiologic technology with reasonable skill and safety.

6. Engaging in unprofessional conduct,including,but not

Jimited to

() departure from orfalure to conform to applicable federal state,or local governmental rules regarding radiologic technology practice;or if no such rule exists,to the minimal standards of acceptable and prevailing radiologic technology practice;

(i) any radiologic technology practice that may cre- ate unnecessary danger to a patient's lfe,health, or safety;or

(i)any practice that is contrary to the ethical con- duct appropriate to the profession that results in the termination from employment.

Actual injury to a patient or the public need not be estab- lished under this clause.

7.Delegating or accepting the delegation of a radiologic technology function or any other prescribed health care function when the delegation or acceptance could reasonably be expected to create an unnecessary dan- ger to a patients life,health,or safety.Actual injury to a patient need not be established under this dlause.

8. Actual or potential inability to practice radiologic technology with reasonable skill and safety to patients by reason of illness;use of alcohol,drugs,chemicals,or any other material;or as a result of any mental or physical condition.

9 .Adjudication by a court of competent jurisdiction as mentally incompetent,mentally ill,chemically depend- ent,or a person dangerous to the public.

10. Engaging in any unethical conduct,incuding but not limited to,conduct likely to deceive,defraud,or harm the public;or demonstrating a willful or careless disre- gard for the health,welare,or safety of a patient.Actual injury need not be established under this clause.

11. Engaging in conduct with a patient that is sexual or may reasonably be interpreted by the patient as sexual,or in any verbal behavior that is seductive or sexually demeaning to a patient or engaging in sexual exploita- tion of a patient or former patient.This also applies to any unwanted sexual behavior verbal or otherwise,that results in the termination of employment.This rule does not apply to pre-existing consensual relationships.

12.Revealing privileged communication or relating to a former or current patient,except when otherwise required or permitted by law.

Double Effect:Refers to the fact that some actions may produce both a good and a bad effect. Four criteria must be fulfilled before this type

of action is ethically permissible:

a.The act is good or morally neutral.

b.The intent is good,not evil,although a bad result may be foreseen.

c.The good effect is not achieved by means of evil effects.

d.The good effect must be more important than the evil effect,or at least there is

favorable balance between good over bad. Radiation exposure may be harmful;however,the

diagnosis obtained by the exposure will aid in restoring the patient to health.

Fidelity:Refers to the duty to fulfill one's commit- ments and applies to keeping promises both stated and implied.The radiographer must not promise patients results that cannot be achieved.

Justice:Refers to all persons being treated equally or receiving equal benefits according to need. One patient must not be favored over another or treated differently from another,regardless of personal feelings

Nonmaleficence:Refers to the duty to abstain from inficting harm and also the duty to prevent

harm.The radiographer is obligated to prac-

tice in a safe manner at all times.

Paternalism:Refers to the attitude that sometimes prompts health care workers to make decisions regarding a person's care without consulting the person affected.If one is tempted to make such a unilateral decision,he must consider whether the action is justifiable based on potential outcomes.The radiographer is justified in taking action in instances in which not acting would do more harm than the lack of patient input into the decision.

Sanctity of life:Refers to the belief that life is the highest good and nobody has the right to judge that another person's quality of life is so poor that his or her life is not of value and should be terminated.One cannot make life-and-death decisions for patients based on personal val-

ues.

Veracity:Refers to honesty in all aspects of one's professional life.One must be honest with

patients,co-workers,and oneself.

Respect for property:Refers to keeping the

patients'belongings safe and taking care not to intentionally damage or waste equipment or supplies with which one works.

Ethical Issues in Radiography

A radiographer is expected to conduct oneself in a pro- fessional manner.He must be reliable;he is expected to report for work on time and complete his assigned share of the workload in a timely,competent,and effi- cient manner.He is also to work as a cooperative mem- ber of the health care team.He must be articulate in his speech and free of vulgar expressions or inappropriate slang.He must treat all patients as persons of dignity and worth and not demonstrate preference for one patient over another.

The student radiographer may observe behavior and patient care problems that may seem ethically questionable in clinical laboratory practice in health care institutions.Some of the problems that might be encountered are protecting professional colleagues who are violating codes of professional ethics,unequal medical resource allocation based on a patient's age or socioeconomic status,lack of respect for a patient, breaches of privacy and confidentiality,and over-treat- ment or under-treatment of patients.In other words, what is observed is not what is taught in the classroom.

In such cases,the student radiographer should observe the issues that are believed to be violations of the ethical code and discuss them with colleagues and instructors in private conference.These issues can become learning situations to contemplate as a group and decide how they should be resolved.

As the scope of practice and the professional responsibilities of radiologic technology grow,so do the ethical responsibilities of radiographers.Often,an ethical decision involves a choice between two unsatis- factory solutions to a problem.This is often the case with health care.If one conscientiously follows his pro- fessional code of ethics and ethical principles previ- ously listed to make difficult decisions as they arise,he will be able to resolve ethical dilemmas in a manner that allows for peace of mind.Combine this approach with critical thinking and the problem-solving process that will be discussed in Chapter 2 of this text.

For ethical dilemmas of some magnitude,most health care institutions have ethics committees that meet on a regular basis to solve problems and formu- late policies that provide guidelines to facilitate deci- sion making.If an ethical dilemma is encountered in the workplace that cannot be readily resolved by fol- lowing one's professional code of ethics,a person is obliged to present the problem to such a body.

LEGAL ISSUES IN IMAGING

TECHNOIQGY

While ethics refers to a set of moral principles,law refers to rules of conduct as prescribed by an authority

or group of legislators.The New World Webster's Dic- tionary defines law as all rules of conduct established and enforced by the authority,legislation,or custom of a given community or group(Agnes and Guralnik, 2001).The group,in the case of the radiographer; includes ARRT and ASRT.The rules of conduct refer to the Practice Standards in Display 1-2.These standards define the practice and establish general criteria to determine compliance with the law as it applies to imag- ing technology.

The standards are general in nature by design to keep pace with the rapidly changing environment in which we live and work.They have been divided into three sections:

1.The Professional Performance Standards define the

activities of the practitioner in the areas of educa- tion,interpersonal relationships,personal and pro-

fessional self-assessment,and ethical behavior.

2.The Clinical Performance Standards define the

activities of the practitioner in the care of patients and the delivery of diagnostic or therapeutic pro- cedures and treatment.The section incorporates patient assessment and management with proce- dural analysis,performance,and evaluation.

3.The Quality Performance Standards define the

activities of the practitioner in the technical areas of performance including equipment and material assessment,safety standards,and total quality management

Patient Rights

The radiographer has a legal responsibility to relate to his colleagues,other members of the health care team, and the patient in a manner that is respectful of each

person with whom he interacts and to adhere to the

Patients Bill of Rights and The Patient Care Partner-

ship(Displays 1-5 and 1-6).These bills delineate the rights of the patient as a consumer of health care. Because all health care workers are required to adhere to the provisions of these bills,they must be familiar with them.The radiographer must also be aware of the areas of practice in which health care workers may infringe upon the patient's rights and be held legally liable.Some of these are as follows:

·Acting in the role of a diagnostician and provid- ing a patient with results,impressions,or diag- noses of diagnostic imaging examinations

·Failing to obtain appropriate consent from women of childbearing age before performing a diagnostic imaging procedure

·Failing to obtain a complete history from a patient before administering an iodinated con- trast agent

DISPLAY 1-5

A Patient's Bill of Rights

Efective health care requires collaboration between

Introduction

the immediate and long-term financial implications of treatment choices,insofar as they are known.

3. The patient has the right to make decisions about the plan of care prior to and during the course of treat- ment and to refuse a recommended treatment or plan of care to the extent permitted by law and hos- pital policy and to be informed of the medical conse- quences of this action.In case of such refusal,the patient is entitled to other appropriate care and serv- ices that the hospital provides or can transfer to another hospital.The hospital should notify patients of any policy that might affect patient choice within the institution.

4. The patient has the right to have an advance directive (such as a living will,health care proxy,or durable power of attorney for health care)concerning treat- ment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy.

Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices,ask if the patient has an advance directive,and include that information in patient records.The patient has the right to timely information about hospital policy that may limit its ability to fully implement a legally valid advance directive.

5. The patient has the right to every consideration of privacy.Case discussion,consultation,examination, and treatment should be conducted in a manner that protects a patient's privacy.

6 .The patient has the right to expect that all communi- cations and records pertaining to his/her care will be treated as confidential by the hospital,except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law.The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records.

7.The patient has the right to review the records per- taining to his/her medical care and to have the infor- mation explained or interpreted as necessary,except when restricted by law.

8. The patient has the right to expect that,within its capacity and policies,a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services.The hospital must provide evaluation,service,and/or referral as

patients and physicians and other health care professionals.

Open and honest communication,respect for personal

and professional values,and sensitivity to differences are

integral to optimal patient care.As the setting for the pro-

vision of health services,hospitals must provide a founda-

tion for understanding and respecting the rights and

responsibilities of patients,their families,physicians,and

other caregivers.Hospitals must ensure a health care ethic

that respects the role of patients in decision making about

treatment choices and other aspects of their care.Hospi-

tals must be sensitive to cultural,racial,linguistic,religious,

age,gender,and other differences as well as the needs of

persons with disabilities.

The American Hospital Association presents A

Patient's Bill of Rights with the expectation that it will con-

tribute to more effective patient care and be supported by

the hospital on behalf of the institution,its medical staff,

employees,and patients.The American Hospital Associa-

tion encourages health care institutions to tailor this bill of

rights to their patient community by translating and/or sim-

plifying the language of this bill of rights as may be neces-

sary to ensure that patients and their families understand

their rights and responsibilties.

Bill of Rights

These rights can be exercised on the patient's behalf by a

designated surrogate or proxy decision maker if the

patient lacks decision-making capacity,is legally incompe-

tent,or is a minor.

1. The patient has the right to considerate and respect-

ful care.

2. The patient has the right to and is encouraged to

obtain from physicians and other direct caregivers

relevant,current,and understandable information

concerning diagnosis,treatment,and prognosis.

Except in emergencies when the patient lacks deci-

sion-making capacity and the need for treatment is

urgent,the patient is entitled to the opportunity to

discuss and request information related to the specific

procedures and/or treatments,the risks involved,the

possible length of recuperation,and the medically rea-

sonable alternatives and their accompanying risks and

benefits.

Patients have the right to know the identity of

physicians,nurses,and others involved in their care,as

well as when those involved are students,residents,or

other trainees.The patient also has the right to know

(continued)

The Patient Care Partnership:Understanding Expectations,Rights,and Responsibilities

DISPLAYI-6

When you need hospital care,your doctor and the nurses and other professionals at our hospital are committed to working with you and your family to meet your health care needs.Our dedicated doctors and staff serve the commu- nity in all its ethnic,religious,and economic diversity.Our goal is for you and your family to have the same care and attention we would want for our families and ourselves.

The sections below explain some of the basics about how you can expect to be treated during your hospital stay.They also cover what we will need from you to care for you better.If you have questions at any time,please ask them.Unasked or unanswered questions can add to the stress of being in the hospital.Your comfort and confi- dence in your care are very important to us.

·Failing to correctly identify a patient before per- forming an examination

·Failing to explain a diagnostic imaging proce- dure to a patient before the examination

·Failing to document technical factors used to facilitate dose calculations for a procedure

·Failing to maintain a patient's physical privacy during an examination

·Failing to maintain the highest quality of images with the lowest possible radiation dose for the patient

The radiographer must never assume the role of other medical personnel in the department.It is not within his scope of practice to read radiographs or other diagnostic tests or to impart the results of these to the patient or the patient's family.This constitutes medical diagnosis and is the physician's responsibility.If a patient is injured in the diagnostic imaging department in any manner,the radiographer must not dismiss the patient from the department until the patient has been examined by a physician and deemed safe for discharge.

Patient Responsibilities

Just as the radiographer has to abide by the Patient Bill

of Rights and The Patient Care Partnership,the patient

has responsibilities when he or she presents for health care.These responsibilities are as follows(Grieco, 1996):

1.The patient has the responsibility to provide,to the best of his or her knowledge,an accurate and com- plete health history.

2.The patient is responsible for keeping appoint- ments and for notifying the responsible practi- tioner or the hospital when unable to do so for any

reason.

3.The patient is responsible for his or her actions when refusing treatment or not following the prac- titioner's instructions.

4.The patient is responsible for fulfilling the financial obligations of his or her health care as promptly as possible,

5.The patient is responsible for following hospital rules and regulations affecting patient care and conduct.

6.The patient is responsible for being considerate of the rights and property of others.

Legal Concerns

Many types of laws affect people in daily life;however, statutory law and common law are the most significant for the radiographer in professional practice.Statutory

laws are derived from legislative enactments. Common law usually results from judicial decisions.

Two major classifications of the law are criminal law and civil law.An offense is regarded as criminal behavior and in the realm of criminal law if it is an offense against society or a member of society.If the accused party is found guilty,he or she is punished.

Criminal law protects the entire community against certain acts.An example of this would be a ter- rorist bombing that results in the destruction of public property and the death of one or more persons.The crime is a crime against society and is a felony.A felony is a crime of a serious nature punishable by a fine higher than $1,000.00 and a prison sentence of more than 1 year or,in extreme cases,by death.

A misdemeanor is a crime of a less serious nature punishable by a fine or imprisonment for less than 1 year.In some instances,driving under the influence of drugs or alcohol may be a misdemeanor provided that no accident or injury has resulted.

Civil law has been broken if another person's pri- vate legal rights have been violated.The person who is found guilty of this type of offense is usually expected to pay a sum of money to repair the damage done.An example of a violation of civil law might be a suit by an individual against a physician for a misdiagnosis that results in injury.This injury is to one person and not to the entire society.

Tort law exists to protect the violator of a law from being sued for an act of vengeance,to determine fault, and to compensate the injured party.A tort involves personal injury or damage resulting in civil action or litigation to obtain reparation for damages incurred.A tort may be committed intentionally or unintentionally. An intentional tort is a purposeful deed committed with the intention of producing the consequences of the deed.Defaming a colleague's character or commit- ting assault or battery are examples of intentional torts. It is possible for a radiographer to be found guilty of a criminal act in professional practice.Generally,in this situation,the radiographer is likely to be legally liable for malpractice in the commitment of a tort.Battery may be charged by a patient to whom the radiographer has administered treatment against the patient's will. Assault and battery are often linked together,meaning that a threat of harm existed before the actual contact; however,assault may be charged without any physical contact if the patient fears that this will occur.Other examples of intentional tort include:

·Immobilizing a patient against his or her will (false imprisonment)

·Falsely stating that a patient has AIDS (defama- tion of character)

·Causing extreme emotional distress resulting in illness through outrageous or shocking conduct

An unintentional tort may be committed when a radiographer is negligent in the performance of patient care and the patient is injured as a result.The follow- ing are examples of unintentional torts:

·Improperly marking radiographic images,such as incorrectly labeling intravenous pyelography images for right and left,which could result in the surgeon removing the healthy kidney,leav- ing only the diseased kidney

·Omitting to apply gonadal shielding on a female patient with a femur fracture who is subse- quently discovered to be pregnant

·Improperly positioning a trauma patient for tibia and fibula projections so that the projec- tions do not adequately demonstrate the entire lower leg,resulting in a fracture being “missed” by the orthopedic physician and the radiologists

·Handing the radiologist the incorrect syringe during a procedure,which results in the injec- tion of Xylocaine(lidocaine)instead of the con- trast media

·Leaving an unconscious patient on a gurney while the radiographer leaves the room,thus allowing the patient to jar the siderails and fall off the gurney because the safety belt was not

secure

·Improperly positioning a footboard on an x-ray table,which results in the patient sliding off the table when the table is placed in the upright position during an examination

Not providing parents of pediatric patients with the proper protective attire when they are aiding in immobilizing their child,especially during fluoroscopic procedures

Radiographers most often have suits brought against them in cases of patient falls.Although the institution where the accident occurs(the employer) may be found liable for the actions of the radiographer (employee)under the principle of respondent superior ("let the master answer"),the technologist is responsi- ble for his or her actions if named in a lawsuit.

Ethical and legal issues are frequently combined in the practice of imaging.The radiographer must be aware of this and take precautions to prevent situations that may lead to problems of this nature.Discrimina- tion and bias shown toward a particular person consti- tute an example of this.It is unlawful to discriminate against any patient or co-worker on the basis of race, color,creed,national origin,ancestry,sex,marital sta- tus,disability,religious affiliation,political affiliation, age,or sexual orientation.Health care must be prac- ticed in a totally nonjudgmental manner.No decisions must be made or any action taken based on these issues.

Use of Immobilization Techniques

Patients may not be immobilized for radiographic imaging procedures simply as a matter of convenience for the radiographer.An order must be obtained from the physician in charge of the patient for immobiliza- tion.A defined period of time must be specified to pro- tect the patient's safety.The method of immobilization must be one that is the least restrictive to the patient's movement and freedom.There must be a need to immobilize the patient to achieve the most satisfactory outcome.The term“restraint”is often substituted for immobilization techniques;the two are used inter- changeably in this text.

Only when the radiographer has exhausted all other safe methods of obtaining a radiograph should immobilizing the patient be considered.If a combative patient threatens the radiographer,security personnel may be called to assist in the immobilization of the patient.All patients who have been immobilized must be carefully monitored.

Immobilizers must be appropriate to the individual needs of the patient.When immobilization devices are necessary,documentation of the reasons for use and a description of specific patient actions,alternatives con- sidered/attempted,the type used,and the length of time applied must be made.In addition,the immobi- lization used should be explained to the patient or fam- ily attending the patient.Immobilizers must be released for specified periods of time when they are in use.Doc- umentation of the time and conditions of immobilizer release are required.

The use of medication as a restraining technique (chemical restraint)occurs only in extreme circum- stances and only as prescribed by the patient's physi- cian.Using immobilization techniques improperly or without a physician's orders can be considered false imprisonment and therefore cause for legal action.An institutional policy for the use of immobilization must be present in all departments,and user instructions must be clearly visible on all immobilizing devices.The technical aspects of application of immobilizers for adults and children are discussed later in this text.

CALL OUT!

Unauthorized use of immobilization techniques can be construed as false imprisonment—a tort.

Incident Reports

An injury to a patient or any error made by personnel in the diagnostic imaging department must be documented in an incident report as soon as it is safe to do so.The

document may also be called an unusual occurrence

report or an accident notification report (Display 1-7).

DISPLAY I-7

Incident or Unusual Occurrence

Reports—Sample form:

This is a confidential report

Section l

Name of the individual reporting the incident:

Institution where the incident occurred:

Date of incident: Time of incident: A,M, PM.

Exact location of incident:

Section 2

Incident occurred to:

□ Staff □ Student □ Patient -ID# □ Equipment Other Explain:

lf staff,student,or patient is checked,see sections 3 &5.

lf equipment is checked,see sections 4 &5.

Section 3

Occurrence: Type of incident:

□ Back injury from lifting patients □ Reaction to foreign substances

□ Miscellaneous back injury □ Contagious disease

□ Injury from a patient □ Laceration

□ Needle stick □ Contusion

□ Unsafe/defective equipment □ Burn

□lImproper use of equipment □ Fracture

□ Patient contact □ Sprain/strain

□ Fall (attended) □ Puncture

□ Fall (unattended) □ Other

□ Fire

□ Other

Did the injury require treatment by a physician?

Was the incident reported to the appropriate personnel?

Section 4

Type of equipment damaged:

How was equipment damaged:

Result of damage(e.g,equipment downtime for repair):

Section 5

Briefly describe the incident factually (what happened):

Name(s)of person(s)notified:

Name(s)of witness(es):

I certify that the above information is correct. /title:

Home address: Date of birth: Telephone:

Signature of person filling out the form: Date ·

Witness Signature: Date ·

An injury may seem slight and not worthy of such a report,but all injuries—whether to patients,visitors, students,or staff or accidents involving equipment regardless of severity—must be reported according to the department procedure.An error in medication administration,imaging the wrong patient,performing the wrong procedure,a patient falling,or any error in treatment or significant change inpatient status must be documented in an incident report.

When filing an incident report,write in simple terms what occurred,at what time,on what date,in which room or department,to whom,who was pres- ent,and what was done to alleviate the situation at the time.If a patient or person is injured,report the condi- tion of the individual involved in the situation.Any injured patient must be examined by a physician before they are allowed to leave the department.Injured health care workers or visitors must be examined according to the agency's policy.

The incident report should be factual regarding the nature of the injury or situation and signed by all who participated or witnessed the event.All incidents resulting in patient or personnel injury must be reported according to the policy and procedures devel- oped by the institution's risk management department. Filing an incident report is not an admission of negli- gence,but simply a record of an event that was not rou- tine in nature.

Patient Safety Reporting

The Patient Safety and Quality Improvement Act of 2005 was signed by President Bush and enacted to amend title IX of the Public Health Service Act to pro- vide for the improvement of patient safety and to reduce the incidence of events that adversely affect patient safety.The act created a voluntary system for health care providers to report medical errors and other patient safety information to improve patient safety. The reported information is confidential and privileged under the Patient Safety and Quality Improvement Act. Therefore,adverse actions may not take place against individual(s)for good faith reporting to recognized patient safety organizations.

Good Samaritan Laws

All states in the United States now have Good Samari- tan laws.These laws were enacted to protect persons who give medical aid to persons in emergency situa- tions from civil or criminal liability for their actions or omissions under these circumstances.State laws vary, but generally if one stops to render aid at the scene of an accident,he is not held liable for any adverse results of his actions,provided that he acts within accepted standards and without gross negligence.

Automatic external defibrillators (AEDs)have been added to emergency medical procedures,and the equipment for this procedure is now available in many areas of public use such as in airplanes and city build- ings.“To permit and encourage the use of AEDs by the lay public,nearly all states have enacted facilitating leg- islation.In addition,the Cardiac Arrest Survival Act provides immunity for lay rescuers who use AEDs and for businesses or other entities or individuals who pur- chase AEDs for public access defibrillation”(American Heart Association,2005).The radiographer will be instructed to use the AED as part of his or her Basic Life Support for Healthcare Providers education.

Informed Consent

Many procedures performed in diagnostic imaging departments require special consent forms to be signed by the patient or,in the case of minor children or other special cases,by parents or legal representatives.The radiographer must be familiar with the procedures that require special consent forms and not confuse these with the blanket consent forms,which are often signed when the patient enters the hospital,as these are not valid if an informed consent is required.

A consent is a contract wherein the patient volun- tarily gives permission to someone(in this case,the imaging staff)to perform a procedure or service.The legal aspect of obtaining consent deals with the imag- ing staff's“duty to warn”and the ethic“do no harm.” The medical aspect of consent hopes to establish rap- port with the patient through communication to secure a successful outcome.Informed consent is required for the following procedures:

·Invasive procedures such as a surgical incision,

a biopsy,a cystoscopy,or paracentesis

·Procedures requiring sedation and/or anesthesia ·A nonsurgical procedure such as an arteriogra-

phy that may carry risk to the patient ● Procedures that involve radiation

Consent is not legal if the patient is not informed of all aspects of the procedure to be performed.These include the potential risks,benefits,and suggested alternatives.The patient must also be informed of the consequences if the suggested procedure is not com- pleted.Because a patient usually consents or refuses a procedure based on the information that the health care professional provides,the duty of obtaining the informed consent involves the patient's physician or radiologist and the radiographer.

Although special consent forms may be signed before the patient comes to the diagnostic imaging department,it is the duty of the radiographer to recheck the patient's chart to be certain that this has been

accomplished.The radiographer must also make sure that the patient understands what is going to be done and the essential nature of the choices available to him. If the patient,parent,or legal representative denies knowledge of the procedure or withdraws consent, notify the radiologist and/or the patient's physician.The procedure should be postponed until the matter is sat- isfactorily resolved.It is not the radiographer's respon- sibility to determine whether a procedure should be ter- minated.It is his responsibility to bring the problem to the physician or supervisor in charge for resolution.

There are several levels of informed consent:

1.Simple consent is a matter of obtaining a patient's

permission to perform a procedure without knowl- edge of that procedure.Simple consent is divided into express and implied consent.

a. Express consent occurs when the patient does not stop the procedure from taking place. By allowing the procedure to occur, the patient has given his or her express consent to the radiographer; however, legally, silence is not an agreement.

b.Implied consent occurs in emergency situations when it is not possible to obtain consent from the patient,his or her parents,or a legal repre- sentative. The health care provider operates under the belief that the patient would give per- mission if able; it is“implied”that permission would be given.

2.Inadequate consent is also known as ignorant con-

sent.This occurs when the patient has not been informed adequately to make a responsible deci- sion.The patient can bring charges of negligence (an unintentional tort)when he or she has had inadequate consent,particularly if the patient sus-

tains injury (when consent is not obtained,battery may be charged)

Obtaining informed consent protects the health care worker from legal action.The radiographer must also understand that communicating effectively with the patient is essential to alleviate his or her anxiety as well as to improve outcomes from all procedures.Dis- play 1-8 lists the criteria for valid informed consent.

Malpractice Insurance

Precautions should be taken by radiographers to safe- guard against a lawsuit.In recent years,professional (malpractice) liability protection has become an impor- tant kind of insurance,especially for members of the medical profession.All radiographers should carry their own malpractice insurance,even if their employer car- ries insurance for them.A member service ASRT pro- vides is a resource for individual professional liability insurance(malpractice).

Malpractice is a wrongful act by a physician,lawyer; or other professional that injures a patient or client.The patient or client may file a civil lawsuit to recover dam- ages(money)to compensate for the injury.The radiog- rapher could be named in a lawsuit in which the legal expenses for defense are not completely covered by his employer,and he may still be liable for his own negli- gence.Without a malpractice insurance policy in one's own name,risk may be assumed.Professional liability insurance provides protection against claims of malprac- tice.It is not wise to place oneself in professional jeop- ardy when a professional malpractice policy can be pur- chased for a reasonable price.With a malpractice liability insurance policy,the insurance company assumes the risk in accordance with the policy contract.

MEDICAL RECORDS AND

DOCUMENTATION

A medical record is kept for each patient who seeks medical treatment whether he or she is an outpatient or has been admitted to the hospital for care.This record, called a chart,is started the moment the patient arrives or is admitted for care and is kept until he or she is dis- missed or discharged from the hospital.The medical record is kept for a number of reasons:

1.To transmit information about the patient from

one health care worker to another

2.To protect the patient from medical errors and duplication of treatments

3.To provide information for medical research

4.To protect the health care worker in cases of litigation 5.To provide information concerning quality of

patient care for institutional evaluation teams such as The Joint Commission

The chart contains the patient's identifying data, documentation of all physician's orders,physician's consultation notes,patient progress notes,medications and treatments received,around-the-clock nurse's notes,all patient visits for outpatient or ambulatory care,laboratory and radiology reports,medical history and physical examination,admitting and discharge diagnosis,results of examinations,surgical reports, consent forms,education received by the patient,dis- charge planning,health care team planning,nursing care plans,and discharge summaries.All members of the health care team are expected to document the care they have rendered for the patient on this chart.

In imaging departments,a requisition from a physi- cian contains the orders for specific procedures to be performed on patients.In addition,the requisition includes the following data:the patient's name,gender, date of birth,diagnosis,and other patient information, which the radiographer uses to verify the correct exam- ination to be performed on the correct patient.The radiographer must assume responsibility for obtaining a medical history from the patient that is pertinent to the treatment or examination he or she is to receive in the department.This information includes the fol- lowing:

1.Female patients'responses to questions concerning pregnancy and date of last menstrual period docu- mented,if pertinent.

2.History of allergies;trauma,if pertinent;contrast media or radionuclide administered.

3.Vital signs,patient education before and after each procedure,names and credentials of the members of the health care team participating in the proce-

dure,and the diagnostic report by the physicians involved following the procedure.Many of these issues are discussed in detail in the chapters that follow.

Nurses and physicians who participate in diagnos- tic imaging examinations or treatments are also respon- sible for documentation;however,radiographers must review the documentation and bring any omissions to their attention.Any item that has not been documented on the chart is considered to be "not performed"in a court of law.All entries on a medical record must list the time and date of the procedure and be signed by the person who administered it.The credentials of the per- son must also be listed.

Certain documentation is specific to radiographic imaging.The radiographer is accountable for the doc- umentation or record keeping according to depart- mental protocol of any radiographic images taken, including the number of images or exposures,the exposure factors,the radiographic room or equip- ment,and the amount of fluoroscopic time used dur- ing a procedure.The radiographer must also docu- ment any patient preparation for procedures that he makes,medications that he administers,and any adverse reactions to medications or treatments received.

Abbreviations must be approved by the institution in which the radiographer is employed.A list of accept- able abbreviations must be on record at that institution and learned by those using them.No others are accept- able.

Charting formats are also made and approved by each institution;however,the contents of the record are reviewed and either approved,disapproved,or changed according to recommendations made by the accreditation bodies inspecting the charts.

If an error is made while writing an entry into a chart,a single line may be drawn through the error, “mistaken entry”is written above the error,and the signature of the person making the error is signed to the error.A corrected entry may then be written.If doc- umenting by computer,the items listed above must still be included on the chart.

Radiographic images are considered part of the patient's medical record and may be used as legal evi- dence in the event of a lawsuit.For this reason,all radiographic images must clearly indicate the patient's name,identification number,the name of the facility where taken,and a right or left marker correctly placed.The release of any patient medical records that include originals,copies,or electronic images requires a consent written and signed by the patient or legal guardian.A consent must be pre-

sented before any patient records are released for any reason.

CONFIDENTIALITY,PRIVACY,

THE HEALTH INSURANCE

PORTABILITY AND

ACCOUNTABILITY ACT IN

RADIOLOGIC TECHNOLOGY

In 1996,Congress recognized the need for national patient record privacy standards.For this reason,the Health Insurance Portability and Accountability Act of 1996(HIPAA)was enacted.The law included provi- sions designed to save money for health care businesses by encouraging electronic transactions,but it also required new safeguards to protect the security and confidentiality of information.

In November 1999,the Department of Health and Human Services(DHHS)published proposed regula- tions to guarantee patients new rights and protections against the misuse or disclosure of their health records. In December 2000,DHHS issued the final rule,which took effect on April 14,2001.Most covered entities had 2 full years—until April 14,2003—to comply with the final rule's provisions.All medical records and other individually identifiable health information, whether electronic,on paper,or oral,are covered by the final rule.

The radiographer must abide by the same rules concerning confidentiality,security,and privacy of patient information with computerized records as with previous systems.Written consent by the patient is the only legitimate reason to obtain and pass on confiden- tial material.The student radiographer must familiar- ize himself with the potential abuses of the new tech- nology so that he will not unknowingly violate the law.

HEALTH CARE DELIVERY

In the recent past,the rising cost of health care became a major concern of the medical community and of the nation.This gave rise to major changes in the health care delivery system in the United States and has become a major political concern.The belief was that the exorbitant cost of health care and its continued ris- ing cost did not necessarily improve the quality of patient care.Based on this belief,many restraints were placed on the institutions and the practitioners of health care.These changes are complex,and it is not within the scope of this text to discuss them at length. However,a very brief outline of the current methods of health care delivery follows.

Medicare:Covers persons 65 years of age and

older,permanently disabled workers and their dependents,and persons with end-stage renal disease.There are 2 parts to Medicare:

Medicare,Part A:covers acute hospital care and

home health care service and requires enrollees to pay an $840.00 deductible for hos-

pitalization.

Medicare,Part B:covers physician services,outpa-

tient hospital care,laboratory testing,durable medical equipment,and special services.This service requires a $100.00 deductible and a premium monthly.This premium is in the process of being increased and changed and will not be listed in this text.

All persons paid by Social Security are automati- cally enrolled in Part A of Medicare.Part B is optional.Medicare does not cover long-term care and limits other aspects of health care and promotion of health.This encourages elders to enroll in private health care plans called Medi-

gap insurance if they can afford to do so.

Medicaid:This is a federally funded and state-

administered program that provides medical care for families with dependent older adults, children,or otherwise disabled persons with incomes below the federal poverty level.It also provides maternal and child care for the

poor.

Prospective Payment System(PPS):Instituted by

Medicare,this system uses financial incentives to decrease total charges by reimbursing for medical treatment based upon diagnosis- related groups(DRGs).This is a method of grouping for payment dependent upon diagno- sis.That is,every person with the same diag- nosis receives the same financial payment for treatment.The DRGs have resulted in a great

deal of controversy in medical circles.

Managed Care Organizations (MCOs):Are divided

into two groups that supervise patient care services;they are Health Maintenance Organi- zations(HMOs)and Preferred Provider Orga- nizations(PPOs).HMOs are group insurance plans that charge each person insured under their plan a preset fee for care and health care service.This fee is paid by the participant regardless of whether they utilize the HMO's services or not.The HMO attempts to perform preventative health care by education,periodic health care screening(i.e.,immunizations, mammograms,physical examinations),and other preventative methods to reduce the cost of medical care.This type of financial manage- ment is called capitation.PPOs gather a group of health care providers who are guaranteed a group of consumers of health care(patients) based on their promise of discounting their fees.The patient is guaranteed health care at lower cost provided they use the PPO provided.

Point of Service Plans:A primary care provider is

selected from a group of providers.The pri- mary care physician then acts as a gatekeeper for the patient and authorizes any referrals the patient may require,thus reducing unneces- sary referrals.

Physician Hospital Organizations:evolved as a

result of financial concerns of hospitals and physician practices.The PHO creates a corpo- rate structure between a hospital and a group of its physicians;they contract with a managed care organization to negotiate fees for services for their self-insured employees (Chitty,2005).

There is a growing demand for evidence that care provided by health care providers is of high quality as well as cost-effective.Regulatory bodies such as The Joint Commission and organizations for consumers of health care have been established.These organizations examine the readmission of patients to hospitals within 30 days of discharge,wound infection rates,pressure

SUMMARY

Radiologic technology has evolved to meet the criteria of a profession by requiring extended education and clinical practice.It has a theoretical body of knowledge and leads to defined skills,abilities,and action.It also provides a specific service,and its members have a degree of decision-making autonomy when working within their scope of practice.

There are several educational avenues to obtain a career in radiologic technology.Each category has defined educational requirements and responsibilities that are expected to be fulfilled and continuing educa- tion requirements that are necessary to renew the radi- ographer's license.

The professional radiographer is expected to join and participate in professional organizations.Such par- ticipation allows one to keep informed of technological changes and alterations in professional standards.The strength of the profession is also promoted in this man- ner as well as prevention of infringement from groups that desire to assume parts of the professional respon- sibilities of the radiographer.

The practicing radiographer interacts with mem- bers of the health care team on a daily basis.It is advantageous to recognize the educational background and duties of these team members so that a harmo- nious working relationship with them can be built on professional knowledge and respect.The health care professionals with whom the radiographer will work most frequently are the physician,the nurse,the phar- macist,occupational and physical therapists,and the respiratory therapist.

ulcers acquired in hospitals,documentation,and many other factors that indicate quality of care.

Because of these regulatory bodies,protocols for

managing care have been derived.These protocols are

known as guidelines or standards for managing

patient care.Critical pathways for diagnoses and pro- cedures to treat particular illness have also been developed.Following the course of these pathways is one of several methods used to examine quality of patient care.All of these methods examine and assess morbidity and mortality rates,admissions per year for chronic illness,complications,and patient satisfac- tion.

In spite of efforts to control the cost of medical care,it continues to be extremely expensive,and there are many who are unable to afford medical insurance or preventative health care of any kind.When there is a medical crisis,these people are left to seek care in city emergency facilities throughout the country.The emer- gency may be treated;however,there is no follow-up care for these patients.

If radiologic technology has been selected as a pro- fession,the student must be aware of and willing to accept the ethical and legal constraints that govern prac- tice as a member of this profession.The Code of Ethics and The Practice Standards of this profession must be understood and these principles maintained.The rights of the patient must be understood,and each patient must be treated as a human being with dignity and worth.

All professional work performed must be within the scope of the radiographer's practice at all times.It must be understood that to do otherwise is a violation of the law.The radiographer must also follow the poli- cies concerning unusual occurrence and accident reports of the institution or health care facility in which he works.Any patient injured during a procedure must not be discharged without the consent of the physician from the radiographic imaging department.

Documentation and maintenance of medical records constitute an important aspect of health care.These records transmit information to other health care work- ers,protect the patient from errors,provide information for medical research,protect the radiographer and others in cases of litigation,and provide information concerning the quality of patient care for institutional evaluation.

The radiographer is believed to be a competent professional.As such,he is expected to act in a respon- sible and safe manner when caring for patients.It is his obligation to communicate effectively with other mem- bers of the health care team and document patient care correctly and completely.He must also respect the patient's right to refuse treatment.