2. CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 6 X-rays and Diagnostic Radiology

3. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-2 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

4. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-3 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

5. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-4 Brief History of the X-Ray (cont.) Diagnostic and therapeutic uses Radiologist –Physician –Interprets films Radiologic technologists

6. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-5 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

7. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-6 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

8. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-7 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

9. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-8 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

10. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-9 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

11. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-10 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

12. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-11 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”

13. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-12 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.

14. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-13 Common Diagnostic Radiologic Tests Contrast media in diagnostic tests Adverse effects –Mild to severe –Localized to systemic –Check for allergy to fish Examples –Angiography –Arthrography –Barium swallow or enema –Cystography –Myelography –Retrograde pyelography –Nuclear medicine studies

15. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-14 Common Diagnostic Radiologic Tests (cont.) Fluoroscopy –X-rays cause certain chemicals to emit visible light –Allows for viewing movement of an organ or passage of substances through organs Hysterosalpingography –Examination of uterus and fallopian tubes by fluoroscopy –Used to evaluate shape and structure of uterus and patency of fallopian tubes

16. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-15 Common Diagnostic Radiologic Tests (cont.) Arthrography –Contrast medium and fluoroscopy –Used to diagnose abnormalities or injuries in cartilage, tendons, or ligaments Barium enema or swallow –Contrast medium – barium –Diagnose and evaluate obstructions, ulcers, polyps, diverticulosis, tumors, or motility –Patient instructions and compliance important

17. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-16 Common Diagnostic Radiologic Tests (cont.) Cholecystography – detect gallstones or abnormalities of the gallbladder Cholangiography – evaluate function of bile duct 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

18. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-17 Common Diagnostic Radiologic Tests (cont.) Heart x-ray – shows configuration of the heart and cardiac enlargement or aortic dilation Intravenous pyelography (IVP) –Used to evaluate urinary system –Shows contrast medium moving through kidneys, ureters, and bladder Retrograde pyelography – Similar to IVP but contrast medium injected through a urethral catheter

19. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-18 Common Diagnostic Radiologic Tests (cont.) Kidneys, ureters, and bladder (KUB) radiography –X-ray of abdomen –Assesses the size, shape, and position of urinary organs Magnetic resonance imaging (MRI) – uses strong magnetic field to examine internal structures and soft tissues Mammography – x-ray exam of internal breast tissues

20. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-19 Common Diagnostic Radiologic Tests (cont.) Myelography –Fluoroscopy of the spinal cord used to evaluate spinal abnormalities –Performed less frequently because of new technology Nuclear medicine –Use of radionuclides or radioisotopes to evaluate internal organs –Types include SPECT PET MUGA

21. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-20 Common Diagnostic Radiologic Tests (cont.) Stereoscopy – specially designed microscope used to produce 3-D images of abnormalities in the skull Thermography –Infrared camera photographs variations in skin temperatures –Diagnosis of breast tumors, breast abscesses, and fibrocystic breast disease

22. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-21 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

23. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-22 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. ___ Thermography uses an infrared camera to record variations in skin temperature. ANSWER: less often due to advanced technologies F F F F T T T a retrograde pyelography bile duct fallopian tubes Bravo!

24. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-23 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

25. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-24 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

26. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-25 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

27. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-26 Apply Your Knowledge 1. 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. 2. What should the physician consider before ordering radiologic testing for a patient? ANSWER: The benefit-to-risk ratio. Super!

28. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-27 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

29. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-28 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

30. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-29 Electronic Medicine Telemedicine technology –Rapid video –Computer-based communications –Stereotaxis – magnetic neurosurgery technique Digital imaging –Eliminates traditional x- ray films –Decreased exposure to radiation –DICOM – communication protocol Advances in radiology –3D/4D ultrasound –“live-action” images

31. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-30 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 stacked. 2. What is DICOM? ANSWER: DICOM is a communications protocol for handling, storing, printing, and transmitting information in medical imaging.

32. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-31 In Summary 53.1An 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. 53.2Invasive 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.

33. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-32 In Summary (cont.) 53.3A 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. 53.4The medical assistant can prepare the patient for radiological testing by thoroughly explaining preprocedure care and care during and after the procedure.

34. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-33 In Summary (cont.) 53.5The 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.

35. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-34 In Summary (cont.) 53.6Proper 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.

36. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 53-35 End of Chapter 53 Words can be like X-rays if you use them properly--they'll go through anything. You read and you're pierced.” ~ Aldous Huxley