CHAPTER 53 X-rays and Diagnostic Radiology © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-2 Learning Outcomes 53.1 Explain how x-rays are used for diagnostic and therapeutic purposes 53.2 Compare invasive and noninvasive diagnostic procedures 53.3 Carry out the medical assistant’s role in x-ray and diagnostic radiology testing © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-3 Learning Outcomes (cont.) 53.4 Demonstrate the medical assistant’s duties when preparing a patient for an x-ray 53.5 Explain the risks and safety precautions associated with radiology work 53.6 Describe proper procedures for filing and maintaining x-ray films and records © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-4 Introduction • Diagnostic radiology is a valuable tool – Screening – Clinical diagnosis • Medical assistant – Role in noninvasive and invasive procedures – Safety issues – Proper handling and storage of films – Preparation and instruction of patients © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-5 Brief History of the X-Ray • Discovered in 1895 by Wilhelm Konrad Roentgen • Electromagnetic wave – Travels 186,000 miles/sec – Short wavelength – Penetrates solid objects – Reacts with photographic film © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-6 Brief History of the X-Ray (cont.) • Diagnostic and therapeutic uses • Radiologist – Physician – Interprets films • Radiologic technologists © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-7 Diagnostic Radiology • Contrast medium – Purpose • Makes internal organs denser • Blocks passage of x-rays to film • Provides a clearer image of organs and tissues – Types • Gases • Heavy metal salts • Iodine compounds © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-8 Diagnostic Radiology (cont.) • Invasive procedures – A catheter, wire, or other testing device is inserted into a blood vessel or organ by a radiologist – Requires surgical aseptic techniques – Patients must be closely monitored, especially if anesthesia is used © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-9 Diagnostic Radiology (cont.) • Noninvasive procedures – View internal structures • Standard x-rays • Ultrasonography – Do not require inserting devices, breaking the skin, or as great a degree of monitoring as invasive procedures – Uses the conventional x-ray machine or specialized instruments © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-10 Apply Your Knowledge electromagnetic X-rays are waves that travel at the speed of light and penetrate solid objects What is the difference in noninvasive and invasive procedures? ANSWER: Noninvasive procedures 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-23 Common Diagnostic Radiologic Tests (cont.) • Ultrasound – Directs high-frequency sound waves to produce an echo of the internal organ – Produces image based on echo • Xeroradiography – X-rays developed with powdered toner on specialized paper – Less radiation exposure © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-24 Apply Your Knowledge True or False: ANSWER: T Fluoroscopy is used for many procedures _ Bravo! fallopian tubes F Hysterosalpingography is used to evaluate the patency of the colon _ 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 less often due to advanced technologies F Myelography is done frequently to evaluate for spinal abnormalities _ T Thermography uses an infrared camera to record variations in skin _ temperature © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-25 Common Therapeutic Uses of Radiation • Radiation therapy – used to treat cancer by preventing cellular reproduction • Two types: – Teletherapy – allows deep penetration; used for deep tumors – Brachytherapy • Places temporary radioactive implants close to or directly into the cancerous tissue • Requires special precautions for radiation safety © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-26 Radiation Safety and Dose • Reducing patient exposure – Advances in technology – Assessment of benefit-to-risk ratio • NCRP – Guidelines for protection from radiation – Prevent serious damage from radiation by limiting radiation dose levels – Reduce risk of cancer and genetic effects – Individual dose limits set © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-27 Radiation Safety and Dose (cont.) • Personnel safety – Always wear a radiation exposure badge – Make sure equipment is working properly – Anyone present when equipment is operating should wear lead shield © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-28 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 What should the physician consider before ordering radiologic testing for a patient? ANSWER: The benefit-to-risk ratio Super! © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-29 Storing and Filing X-rays • Keep fresh film on hand • Maintain new and exposed film in good condition at proper temperature and humidity • Prevent pressure marks • Keep expiration dates visible • Use oldest film first • Open all packages or boxes in darkroom • Do not store near acid or ammonia vapors © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-30 Storing and Filing X-rays (cont.) • Document x-ray information – Patient record card or record book – Verify that film is labeled correctly • File correctly – Film-filing envelope – Use “out-card” when removing file © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-31 Electronic Medicine • Telemedicine technology • Advances in radiology – Rapid video – Computer-based communications – Stereotaxis – magnetic neurosurgery technique – 3D/4D ultrasound – “live-action” images • Digital imaging – Eliminates traditional xray films – Decreased exposure to radiation – DICOM – communication protocol © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-32 Apply Your Knowledge How 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 What is DICOM? ANSWER: DICOM is a communications protocol for handling, storing, printing, and transmitting information in medical imaging © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-33 In Summary 53.1 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, xrays are used to treat cancer by preventing cellular reproduction 53.2 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 not require inserting devices, breaking the skin, or the degree of monitoring needed with invasive procedures © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-34 In Summary (cont.) 53.3 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 53.4 The medical assistant can prepare the patient for radiological testing by thoroughly explaining preprocedure care and care during and after the procedure © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-35 In Summary (cont.) 53.5 The greatest risk associated with a radiology facility is the potential for radiation exposure to patients and health-care 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 © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-36 In Summary (cont.) 53.6 Proper procedures for filing and maintaining x-ray films and records include documenting the patient’s name, the date, the type of x-ray, and the number of x-rays taken in the patient record card or in the record book; properly labeling the film with the referring doctor’s name, the date, and the patient’s name; placing the processed film in a film-filing envelope; and filing the envelope according to office policy © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53-37 End of Chapter 53 Words can be like Xrays if you use them properly they'll go through anything You read and you're pierced.” ~ Aldous Huxley © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed [...].. .53- 11 Medical Assistant’s Role in Diagnostic Radiology • Assist with or perform procedures – Based on scope of practice for state – Pre- and postprocedure patient care – Patient education © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53- 12 Medical Assistant’s Role in Diagnostic Radiology (cont.) • Preprocedure care – Schedule appointments – Provide preparation instructions – Explain... instructions – Explain the procedure – Ask pertinent questions • Medication history • Women – possibility of pregnancy © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53- 13 Medical Assistant’s Role in Diagnostic Radiology (cont.) • Care during and after a procedure – Assist with placing, removing, and developing film – Tasks listed in Procedure 53- 1 “Assisting with an X-ray Examination” ©... to fish • Examples – Angiography – Arthrography – Barium swallow or enema – Cystography – Myelography – Retrograde pyelography – Nuclear medicine studies © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53- 16 Common Diagnostic Radiologic Tests (cont.) • Fluoroscopy • Hysterosalpingography – X-rays cause certain chemicals to emit visible light – Examination of uterus and fallopian tubes... NCRP – Guidelines for protection from radiation – Prevent serious damage from radiation by limiting radiation dose levels – Reduce risk of cancer and genetic effects – Individual dose limits set © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53- 27 Radiation Safety and Dose (cont.) • Personnel safety – Always wear a radiation exposure badge – Make sure equipment is working properly –. .. information – Patient record card or record book – Verify that film is labeled correctly • File correctly – Film-filing envelope – Use “out-card” when removing file © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53- 31 Electronic Medicine • Telemedicine technology • Advances in radiology – Rapid video – Computer-based communications – Stereotaxis – magnetic neurosurgery technique – 3D/4D... (cont.) 53. 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 53. 4 The medical assistant can prepare the patient for radiological testing by thoroughly explaining preprocedure care and care... ultrasound – “live-action” images • Digital imaging – Eliminates traditional xray films – Decreased exposure to radiation – DICOM – communication protocol © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53- 32 Apply Your Knowledge 1 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... enema or swallow – Contrast medium – barium – Diagnose and evaluate obstructions, ulcers, polyps, diverticulosis, tumors, or motility – Patient instructions and compliance important © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53- 18 Common Diagnostic Radiologic Tests (cont.) • Cholecystography – detect gallstones or abnormalities of the gallbladder • Cholangiography – evaluate function... uterus and fallopian tubes by fluoroscopy – Allows for viewing movement of an organ or passage of substances through organs – Used to evaluate shape and structure of uterus and patency of fallopian tubes © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53- 17 Common Diagnostic Radiologic Tests (cont.) • Arthrography – Contrast medium and fluoroscopy – Used to diagnose abnormalities or injuries... ed 53- 14 Apply Your Knowledge How can you find out what role you can take in radiologic testing as a medical assistant? ANSWER: Check with your state’s scope of practice for medical assistants © 2011 T he McGraw -Hill Com panie s, Inc A ll rights reserv ed 53- 15 Common Diagnostic Radiologic Tests • Contrast media in diagnostic tests • Adverse effects – Mild to severe – Localized to systemic – Check