Transcript The Profession of Medical Assisting

CHAPTER
50
Diagnostic Imaging
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50-2
Learning Outcomes
50.1 Explain what X-rays are and how they are
used for diagnostic and therapeutic
purposes.
50.2 Compare invasive and noninvasive
diagnostic procedures.
50.3 Carry out the medical assistant’s role in
X-ray and diagnostic radiology testing.
50.4 Discuss common diagnostic imaging
procedures.
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50-3
Learning Outcomes
50.5 Describe different types of radiation therapy
and how they are used.
50.6 Explain the risks and safety precautions
associated with radiology work.
50.7 Relate the advances in medical imaging to
EHR.
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50-4
Introduction
• Diagnostic
radiology
• Medical assistant
– Role during testing
– Screening
– Safety issues
– Clinical diagnosis
– Proper handling
and storage of films
– Preparation and
instruction of
patients
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50-5
Brief History of the X-Ray
• Discovered in 1895
by Wilhelm
Konrad Roentgen
• X-ray
– High energy level
– Short wavelength
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50-6
Brief History of the X-Ray (cont.)
• Diagnostic and therapeutic uses
• Radiologic technologists
• Radiologist
– Performs invasive
procedures
– Interprets films
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50-7
Diagnostic Radiology
• Use of X-ray technology to diagnose
• Contrast medium
– Makes internal organs denser
– Produces a clearer image
– Types
•
•
•
•
Gases
Heavy metal salts
Paramagnetic compounds
Iodine compounds
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50-8
Diagnostic Radiology (cont.)
• Invasive procedures
– A testing device is inserted
into a blood vessel or organ
– Requires surgical aseptic
technique
– Patients must be closely
monitored
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50-9
Diagnostic Radiology (cont.)
• Noninvasive
procedures
– View internal structures
– Uses the conventional
x-ray machine or
specialized instruments
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50-10
Apply Your Knowledge
electromagnetic
1. X-rays are __________________
waves that travel at the
speed of light and penetrate solid objects
2. What is the difference in noninvasive and invasive
procedures?
ANSWER: Noninvasive procedures do not require
inserting devices, breaking the skin, or special
monitoring and use conventional x-ray machines or
specialized instruments to visualize internal organs.
Invasive procedures require surgical aseptic
technique for the insertion of a catheter, wire, or other
testing device into an organ or blood vessel.
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Medical Assistant’s Role in Diagnostic
Radiology
50-11
• Assist with or perform
procedures
– Based on scope of
practice for state
– Pre- and
postprocedure care
– Patient education
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Medical Assistant’s Role in Diagnostic
Radiology (cont.)
50-12
• Preprocedure care
– Schedule appointments
– Provide preparation instructions
– Explain the procedure
– Ask pertinent questions
• Medication history
• Women – possibility of pregnancy
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Medical Assistant’s Role in Diagnostic
Radiology (cont.)
50-13
• Care during and after a procedure
– Prepare and assist the patient
– Assist the radiologic technologist or
radiologist
Posteroanterior
(back to front)
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Medical Assistant’s Role in Diagnostic
Radiology (cont.)
50-14
• Verifying insurance
– Prior to testing
– Obtain necessary referrals
– Be sure to schedule at a facility
contracted with the patient’s
health insurance
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50-15
Apply Your Knowledge
How can you find out what role you can take in
radiologic testing as a medical assistant?
ANSWER: Check your scope of practice for
the state you are working in.
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50-16
Common Diagnostic Radiologic Tests
• Common tests
• Contrast media in diagnostic tests
– Administered orally, IV, by enema
– Adverse effects
•
•
•
Mild to severe
Localized to systemic
Check for allergy to iodine or shellfish
– Monitor patient for signs of allergy
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50-17
Common Diagnostic Radiologic
Tests (cont.)
• Fluoroscopy
– X-rays cause certain chemicals to emit visible
light
– Allows for viewing movement of an organ or a
contrast medium through organs
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50-18
Common Diagnostic Radiologic
Tests (cont.)
• Hysterosalpingography
– Examination of uterus and fallopian tubes by
fluoroscopy
– Used to evaluate shape and structure of
uterus and patency
of fallopian tubes
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50-19
Common Diagnostic Radiologic
Tests (cont.)
• Angiography
– Invasive procedure using a
contrast medium
– Assess arteries or veins
– Medical assistant
• Schedule
• Answer questions
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50-20
Common Diagnostic Radiologic
Tests (cont.)
• Arthrography
– Contrast medium and fluoroscopy
– Provides an image during movement
– Used to diagnose abnormalities or injuries in
cartilage, tendons, or ligaments
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50-21
Common Diagnostic Radiologic
Tests (cont.)
• Barium enema
– Contrast media
• Single-contrast – barium
• Double-contrast – barium and air
– Diagnose and evaluate the colon or rectum.
– Patient instructions and compliance important
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50-22
Common Diagnostic Radiologic
Tests (cont.)
• Barium swallow
– Contrast medium – barium
– Diagnose and evaluate the esophagus,
stomach, duodenum, and small intestine
– Patient instructions and compliance important
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Common Diagnostic Radiologic
Tests (cont.)
• Cholecystography
– Oral contrast
medium
– Detect gallstones
or abnormalities of
the gallbladder
50-23
• Cholangiography
– Contrast medium
injected into
common bile duct
– Evaluate function
of bile duct
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Common Diagnostic Radiologic
Tests (cont.)
50-24
• Conventional tomography
– Uses a computerized camera that moves
back and forth over the patient
– One view per arc over patient
• Computer tomography
– Camera rotates completely around the patient
– Cross-sectional view from each rotation
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Common Diagnostic Radiologic
Tests (cont.)
50-25
• Heart X-ray
– Angiocardiography
• Contrast medium used
• Images of medium flowing through the heart,
lungs, and major vessels
– Coronary arteriography
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Common Diagnostic Radiologic
Tests (cont.)
50-26
• Intravenous pyelography (IVP)
– Contrast media is injected into a vein
– Shows contrast medium moving through
kidneys, ureters, and bladder
• Retrograde pyelography – similar to IVP
but contrast medium injected through a
urethral catheter
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50-27
Common Diagnostic Radiologic
Tests (cont.)
• KUB radiography
– X-ray of abdomen
– Assesses the size, shape, and position of
urinary organs
• Magnetic resonance
imaging (MRI)
– With or without contrast medium
– Examines internal structures
and soft tissues
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50-28
Common Diagnostic Radiologic
Tests (cont.)
• Mammography
– X-ray exam of internal breast tissues
– Specially trained radiologic
technologist
• Mammotest Biopsy Procedure
– Stereotactic breast biopsy
– Computer guided
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50-29
Common Diagnostic Radiologic
Tests (cont.)
• Myelography
– Fluoroscopy used to evaluate spinal
abnormalities
– Performed less frequently because of new
technology
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50-30
Common Diagnostic Radiologic
Tests (cont.)
• Nuclear medicine
– Use of radionuclides to evaluate internal
organs
– Types include
• SPECT
• PET
• MUGA scan
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50-31
Common Diagnostic Radiologic Tests
(cont.)
• Ultrasound
– Directs high-frequency sound waves to
produce an echo of the internal organ
– Echoes are converted
to an image
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50-32
Apply Your Knowledge
True or False:
ANSWER:
T Fluoroscopy is used for many procedures.
___
___
F Hysterosalpingography is used to evaluate the patency of the
colon.
fallopian tubes
F Cholangiography is used to detect abnormalities of the
___
gallbladder.
bile duct
F For an IVP, the radiologist injects the contrast medium
___
through a catheter. a retrograde pyelography
T An MRI uses a combination of nonionizing radiation and a
___
strong magnetic field.
___
F Myelography is done frequently to evaluate for spinal
abnormalities.
less often due to advanced technologies
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50-33
Common Therapeutic Uses of Radiation
• Radiation therapy – used to treat cancer
by preventing cellular reproduction
– Teletherapy
• External beam radiotherapy
• Allows deep penetration of tissues
• Stereotactic radiosurgery – precise delivery
of radiation
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50-34
Common Therapeutic Uses of Radiation
– Brachytherapy
• Places temporary radioactive implants
close to or directly into the cancerous
tissue
• Requires special precautions for radiation
safety
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50-35
Apply Your Knowledge
What are the two types of radiation therapy?
ANSWER: Teletherapy allows for deep penetration
and is used for deep tumors.
Brachytherapy involves the implantation of temporary
radioactive implants close to or directly into
cancerous tissue.
Superb!
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50-36
Radiation Safety and Dose
• Patient exposure reduced
– Advances in technology
– Assessment of benefit-to-risk ratio
• NCRP goals
– Prevent serious damage from radiation by
limiting radiation dose levels
– Reduce risk of cancer and genetic effects
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50-37
Radiation Safety and Dose (cont.)
• Personnel safety
– Wear a radiation exposure badge
– Make sure equipment is working properly
– Use lead shields as appropriate
• Patient safety
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50-38
Storing and Filing X-rays
• Keep fresh film on hand
• Keep at proper temperature and
humidity
• Prevent pressure marks
• Keep expiration dates
visible
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50-39
Storing and Filing X-rays
• Use oldest film first
• Open all packages or
boxes in darkroom
• Do not store near acid or
ammonia vapors
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50-40
Apply Your Knowledge
1. What should the physician consider before
ordering radiologic testing for a patient?
ANSWER: The benefit-to-risk ratio.
2. How do you store new and exposed x-ray
film?
ANSWER: X-ray film should be stored at proper
temperature and humidity. Packages should be stored
on end and not stacked.
Great!
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50-41
Electronic Medicine
• Telemedicine technology
– Rapid video
– Computer-based communications
– Uses include
• Viewing medical images
• Consults
• Transmission of data electronically
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50-42
Electronic Medicine
• Digital imaging and EHR
– Digital reader “captures” image
– Advantages include
• Better image quality
• Faster results
• Decreased radiation
exposure
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50-43
Electronic Medicine
• DICOM
– Standard for
handling, storing,
and transmitting
information in
medical imaging
• Advances in
radiology – 3D/4D
ultrasound
– PAC ~ digital
storage area
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50-44
Apply Your Knowledge
What is DICOM?
ANSWER: DICOM is a communications
protocol for handling, storing, printing, and
transmitting information in medical imaging.
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50-45
In Summary
50.1 An X-ray is a high-energy electromagnetic
wave that travels at the speed of light and can
penetrate solid objects.
X-rays can be used for diagnosis by producing
images of internal body structures.
Therapeutically, X-rays are used to treat
cancer by preventing cellular reproduction.
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50-46
In Summary
50.2 Invasive procedures require a radiologist to
insert a catheter, wire, or other testing device
into a patient’s blood vessel or organ through
the skin or a body orifice.
Noninvasive diagnostic procedures do not
require inserting devices, breaking the skin, or
the degree of monitoring needed with invasive
procedures.
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50-47
In Summary (cont.)
50.3 A medical assistant can work directly with a
radiology facility to assist the radiologist or
technicians in performing diagnostic
procedures.
Providing preprocedure and postprocedure
care are duties a medical assistant can
perform in a medical or radiology facility.
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50-48
In Summary (cont.)
50.4 Numerous diagnostic imaging procedures are
used in medicine today including:
angiography, fluoroscopy, MRI, CT,
arthrography, IVP, KUB, mammography,
upper and lower GI series, ultrasound, and
cholangiography.
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50-49
In Summary (cont.)
50.5 The two basic types of radiation therapy are
teletherapy and brachytherapy.
Teletherapy is also called external beam
radiotherapy because an external beam of
radiation is used to penetrate deep tumors.
Brachytherapy uses temporary radioactive
implants positioned close to or directly into
cancerous tissue to treat the tumor and spare
healthy tissue.
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50-50
In Summary (cont.)
50.6 The greatest risk associated with a radiology
facility is the potential for radiation exposure to
patients and healthcare workers.
To eliminate this risk, certain safety
precautions should be followed.
These include careful evaluation by the
physician to determine the medical necessity
of radiology testing, avoiding X-rays altogether
if a patient is pregnant, and requiring all
personnel who work in a radiology facility to
wear a dosimeter.
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50-51
In Summary (cont.)
50.7 Major advances in telemedicine technology,
including rapid video and computer-based
communications of medical information,
enable physicians to “examine” a patient in
another city or country, view highly detailed
medical images, consult with specialists in
other cities, and supervise complex medical
procedures. Sharing records including actual
radiographic images between facilities is
easier with the advent of digital radiographic
procedures and the electronic health record.
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50-52
End of Chapter 50
Words can be like Xrays if you use them
properly--they'll go
through anything. You
read and you're
pierced.”
~ Aldous Huxley
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.