Lecture Clinical procedures for medical assisting (4/e): Chapter 22 – Booth, Whicker, Wyman

Chapter 22 - X-rays and diagnostic radiology. After completing this chapter, students will be able to: Explain how x-rays are used for diagnostic and therapeutic purposes, compare invasive and noninvasive diagnostic procedures, carry out the medical assistant’s role in x-ray and diagnostic radiology testing,…

X-rays and

Diagnostic

Radiology

Learning Outcomes

22.1 Explain how x-rays are used for

diagnostic and therapeutic purposes.

22.2 Compare invasive and noninvasive

diagnostic procedures.

22.3 Carry out the medical assistant’s role in

x-ray and diagnostic radiology testing.

Learning Outcomes (cont.)

22.4 Demonstrate the medical assistant’s

duties when preparing a patient for an x-ray.

22.5 Explain the risks and safety

precautions associated with radiology work.

22.6 Describe proper procedures for filing

and maintaining x-ray films and

procedures– Safety issues– Proper handling and storage of films

– Preparation and instruction of patients

Brief History of the X-Ray

– Penetrates solid

objects– Reacts with

photographic film

Brief History of the X-Ray (cont.)

• Diagnostic and therapeutic uses

• Radiologist

– Physician

– Interprets films

• Radiologic technologists

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

Diagnostic Radiology (cont.)

– 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

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

– Patient education

Medical Assistant’s Role in Diagnostic

– Ask pertinent questions

• Medication history

• Women – possibility of pregnancy

– Tasks listed in

Procedure 22-1

“Assisting with an X-ray Examination”

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.

Common Diagnostic Radiologic Tests

– Cystography– Myelography– Retrograde pyelography– Nuclear medicine studies

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

• 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

Common Diagnostic Radiologic Tests

• 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

Common Diagnostic Radiologic Tests

• Magnetic resonance imaging (MRI) – uses

strong magnetic field to examine internal

structures and soft tissues

• Mammography – x-ray exam of internal breast

tissues

frequently because of new technology

• Nuclear medicine

– Use of radionuclides

or radioisotopes to evaluate internal organs

– Types include

• SPECT

• PET

• MUGA

Common Diagnostic Radiologic Tests

(cont.)

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

• 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

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

Bravo!

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

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

Radiation Safety and Dose (cont.)

should wear lead shield

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.

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

Storing and Filing X-rays (cont.)

• Document x-ray

information

– Patient record card or

record book– Verify that film is labeled

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

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.

In Summary

22.1 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

22.2 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

In Summary (cont.)

22.3 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

22.4 The medical assistant can prepare the patient for

radiological testing by thoroughly explaining preprocedure care and care during and after the procedure

In Summary (cont.)

22.5 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

In Summary (cont.)

22.6 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

End of Chapter 22

Words can be like X­rays if you use them properly­­they'll 

go through anything. You read and you're pierced.”