X-rays and Diagnostic Radiology

CHAPTER

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

53X-rays and Diagnostic Radiology


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.


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.


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


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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


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Brief History of the X-Ray (cont.)

• Diagnostic and therapeutic uses

• Radiologist – Physician – Interprets films

• Radiologic technologists


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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


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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


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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


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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


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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


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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


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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”


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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.


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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


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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


53-17


• 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


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• 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


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• 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


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• 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


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• 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


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• 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


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• 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


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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!


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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


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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


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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


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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!


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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


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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


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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


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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.


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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.


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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.


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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.


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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.


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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

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X-rays and Diagnostic Radiology