2. CHAPTER © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50 Diagnostic Imaging

3. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-2 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. Learning Outcomes

4. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-3 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. Learning Outcomes

5. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-4 Introduction Diagnostic radiology –Screening –Clinical diagnosis Medical assistant –Role during testing –Safety issues –Proper handling and storage of films –Preparation and instruction of patients

6. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-5 Brief History of the X-Ray Discovered in 1895 by Wilhelm Konrad Roentgen X-ray –High energy level –Short wavelength

7. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-6 Brief History of the X-Ray (cont.) Diagnostic and therapeutic uses Radiologic technologists Radiologist –Performs invasive procedures –Interprets films

8. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

9. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

10. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-9 Diagnostic Radiology (cont.) Noninvasive procedures –View internal structures –Uses the conventional x-ray machine or specialized instruments

11. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-10 Apply Your Knowledge 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. 1.X-rays are __________________ waves that travel at the speed of light and penetrate solid objects electromagnetic

12. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-11 Medical Assistant’s Role in Diagnostic Radiology Assist with or perform procedures –Based on scope of practice for state –Pre- and postprocedure care –Patient education

13. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-12 Medical Assistant’s Role in Diagnostic Radiology (cont.) Preprocedure care –Schedule appointments –Provide preparation instructions –Explain the procedure –Ask pertinent questions Medication history Women – possibility of pregnancy

14. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-13 Medical Assistant’s Role in Diagnostic Radiology (cont.) Care during and after a procedure –Prepare and assist the patient –Assist the radiologic technologist or radiologist Posteroanterior (back to front)

15. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-14 Medical Assistant’s Role in Diagnostic Radiology (cont.) Verifying insurance –Prior to testing –Obtain necessary referrals –Be sure to schedule at a facility contracted with the patient’s health insurance

16. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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.

17. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

18. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

19. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

20. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-19 Common Diagnostic Radiologic Tests (cont.) Angiography –Invasive procedure using a contrast medium –Assess arteries or veins –Medical assistant Schedule Answer questions

21. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

22. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

23. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

24. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-23 Common Diagnostic Radiologic Tests (cont.) Cholecystography –Oral contrast medium –Detect gallstones or abnormalities of the gallbladder Cholangiography –Contrast medium injected into common bile duct –Evaluate function of bile duct

25. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-24 Common Diagnostic Radiologic Tests (cont.) 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

26. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-25 Common Diagnostic Radiologic Tests (cont.) Heart X-ray –Angiocardiography Contrast medium used Images of medium flowing through the heart, lungs, and major vessels –Coronary arteriography

27. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-26 Common Diagnostic Radiologic Tests (cont.) 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

28. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

29. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

30. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-29 Common Diagnostic Radiologic Tests (cont.) Myelography –Fluoroscopy used to evaluate spinal abnormalities –Performed less frequently because of new technology

31. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-30 Common Diagnostic Radiologic Tests (cont.) Nuclear medicine –Use of radionuclides to evaluate internal organs –Types include SPECT PET MUGA scan

32. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

33. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-32 Apply Your Knowledge True or False: ___ Fluoroscopy is used for many procedures. ___ Hysterosalpingography is used to evaluate the patency of the colon. ___ Cholangiography is used to detect abnormalities of the gallbladder. ___ For an IVP, the radiologist injects the contrast medium through a catheter. ___ An MRI uses a combination of nonionizing radiation and a strong magnetic field. ___ Myelography is done frequently to evaluate for spinal abnormalities. ANSWER: less often due to advanced technologies F F F F T T a retrograde pyelography bile duct fallopian tubes

34. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

35. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

36. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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!

37. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

38. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

39. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

40. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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

41. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-40 Apply Your Knowledge 1.What should the physician consider before ordering radiologic testing for a patient? ANSWER: The benefit-to-risk ratio. Great! 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.

42. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-41 Electronic Medicine Telemedicine technology –Rapid video –Computer-based communications –Uses include Viewing medical images Consults Transmission of data electronically

43. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-42 Electronic Medicine Digital imaging and EHR –Digital reader “captures” image –Advantages include Better image quality Faster results Decreased radiation exposure

44. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-43 Electronic Medicine DICOM –Standard for handling, storing, and transmitting information in medical imaging –PAC ~ digital storage area Advances in radiology – 3D/4D ultrasound

45. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-44 Apply Your Knowledge What is DICOM? ANSWER: DICOM is a communications protocol for handling, storing, printing, and transmitting information in medical imaging.

46. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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.

47. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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.

48. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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.

49. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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.

50. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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.

51. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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.

52. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 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.

53. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 50-52 End of Chapter 50 Words can be like X- rays if you use them properly--they'll go through anything. You read and you're pierced.” ~ Aldous Huxley