Exam Two Review
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Exam 2 Review:
Chapter One:
Discovery of x-rays:
Discovered by Wilhelm Conrad Rontgen on November 8, 1895.
Discovered using the crooks tube and was experimenting with cathode rays and the properties of the rays outside of the tube when lights were on and off.
First x-ray was of his wife’s hand and he was awarded the Nobel prize in Physics in 1901. Modalities and radiation or non- radiation used:
Radiography: uses electromagnetic energy in the form of x-rays to create medical images.
Different modalities include but are not limited to: Bone Densitometry (BD), Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Radiation Therapy, Nuclear Medicine, PACS Administrator. MRI does not use radiation, instead uses magnets and radio waves to compute images. Chapter Two:
ARRT:
American Registry of Radiologic Technologists.
Founded in 1922
Certified individuals are listed in the ARRT registry after passing exam and becoming certified in the field of radiology. JRCERT:
Joint Review Committee on Education in Radiologic Technology
Accreditation committee for school healthcare programs and health care programs at hospitals.
Peer reviewed, not mandatory. Established in 1969.
Concerned with education standards developed by and for the profession of Radiology Technologist.
Governed by a board of directors known as the Joint Review Committee.
To become accredited through JRCERT, program must demonstrate compliance with minimum requirements known as essentials and guidelines or standards.
Considered the gold standard
Mission statement: to elevate the quality and safety of patient care through the accreditation of educational programs. ASRT:
American Society of Radiologic Technologists
Professional society of radiologic technologists that represent the general welfare of their members.
Founded in 1920.
Represents radiographers, educators, managers/administrators, and students. DOH-Licensure:
Different from certification and registry.
After passing registry and earning your certification, you must apply for your state license. JRC and JRCERT Standards:
Joint Review Committee
Group of persons appointed by sponsoring organizations to oversee the accreditation process.
JRCERT board is currently nominated by the ACR, the ASRT, the Association of Educators in Imaging and Radiological Sciences, and the American Healthcare
Radiology Administrators. All RT Clinical Expectations: UNSURE!!
Maybe comps?
10 mandatory patient care comps
36 mandatory imaging procedures
15 out of 34 elective imaging procedures
1 out of 15 must be done from the head section
2 out of 15 must be completed in fluoroscopy. Radiation Safety Policy:
ALARA: As Low As Reasonably Achievable
Always wear Dosimeter to track radiation exposure
Threshold for dosage of radiation exposure are 5000 mrem/year, 1300 mrem/semester and 325 mrem/ month. Unless pregnant. Program Policies:
Must be under direct supervision of a registered radiologic technologist until we are comped in exams.
For repeats, OR, and Portables we must be under direct supervision.
Once comped we are allowed to be under direct supervision.
Dress code
Attendance. If late we are marked late do not get to take quiz or turn in homework. Chapter Four:
Steps in Critical Thinking:
Identify and clarify the problem that exists.
Investigate the problem objectively.
Develop viable solutions.
Select and enact the best solution available. ASRT Practice Standards Appendix A:
Performed by individuals who are responsible for administering ionizing
radiation for diagnostic, therapeutic or research purposes.
Perform full scope of radiographic and fluoroscopic procedures and acquires
and analyzes data needed for diagnoses at request of a licensed practitioner.
Prepare, administer, and document activities related to medications and
radiation exposure in accordance with federal and state laws and regulations.
Didactic versus Clinical Learning or Cognitive:
Didactic teaches us skill and critical thinking and being out in Clinical allows
us “real world” experiences.
Requires critical thinking at all levels. Cognitive thinking happens a lot in
didactic because it’s what we know and what we recall during tests and
comps. ARRT Code of Ethics:
Serves as a guide by which certified technologists evaluate professional
aspects of patient care.
Two parts create code of ethics, part A and part B.
Part A: deals with behaviors that a professional should aspire to achieve
Part B: deals with mandatory rules of acceptable professional conduct. Critical Thinking:
Creative action based on professional knowledge and experience involving
sound judgement applied with high ethical standards and integrity.
Requires more than simple recollection
Requires skills in analysis, application and evaluation of content. HIPAA:
Health Insurance Portability and Accountability Act of 1996
Protects patients privacy
Chapter Five:
What is an RT, Clinical Preceptor, Instructor, Program Director and Clinical Coordinator?
RT is a radiologic technologist. Clinical Preceptor is an RT who has been there two years, do student evals and schedule us to do different exams.
Clinical coordinator: program official responsible for coordinating clinical education and evaluation of its effectiveness.
Instructor: program official responsible for clinical instruction, supervision, and evaluation of students.
Program Director: program official that provides leadership for the program and ensures program effectiveness.
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Domains or Categories for learning:
Cognitive: thinking and understanding
Psychomotor: performing job and duties
Affective: emotions, how we manage stress.
Also Known As the taxonomy of learning. Direct and Indirect Supervision:
Direct: oversight of clinical procedures or treatment by a qualified professional present in the exam or treatment room with student.
Indirect: oversight of clinical procedures by a qualified professional immediately available to the student. Subjective or Objective:
Objective: is a concise description of an observable behavior achieved by students, which is relevant to a specific topic within a course or educational module. Chapter Six:
ADE:
adverse drug events: injuries, large or small, caused by the use of a drug, can
be as harmless as a drug rash or as serious as death from an overdose.
Two types: caused by errors and those that occur despite proper use. CEO:
Chief executive office: person appointed by the board of directors who has full accountability for the entire hospital or healthcare organization. Board of Directors:
Group of people authorized by law to conduct, maintain, and operate a hospital for the benefit of the public and whose legal and moral responsibility for policies and operations of the hospital are not for personal benefit of the members. HR:
Human resources: ancillary department of the hospital responsible for recruiting, selecting, supporting, and compensating employees; developing and maintaining skills, quality, and motivation.
Medical Error:
Failure to complete a planned action as intended or the use of a wrong plan to achieve an aim; can be related to an incorrect diagnosis, equipment failure, infections, or a misinterpretation of an order.
Mission Statement:
Statement of an organization that summarizes its intent to provide service in terms of the services it offers, the intended recipients of service and a description of the level of cost. OSHA:
Occupational safety and heath administration; a federal agency that enforces
standards for safety in the workplace, conducts inspections, and directs determination of fines for noncompliance with policies and regulations. Radiology:
Organization of a hospital or medical clinic that provides diagnostic imaging through medical technologies such as x-ray, fluoroscopy, CT, IR, MRI etc.
Radiologist:
Medical professional that specializing in reading imaging and providing interpretation and diagnosis.
Reports to medical chair of a department.
RSO:
Radiation safety officer.
A person who is delegated within an organization that is responsible for the safe operation and use of radiation and radioactive materials, as well as implementing the radiation protection programs. Where can RT’s work?
Clinics, Hospitals, Physician offices, imaging centers, mobile imaging, ER or Urgent Care centers, outpatient surgical centers and industry and research. Internal versus External communities:
External communities such as the joint commission, OSHA, FDA, and ACR, and state departments. Typically federal.
Internal communities include regulatory groups and committees such as infection control, radiation safety, risk management and safety. Risk Management:
Developed to manage and control the amount of legal and financial risk to the organization and ensure that a hospital continues to remain in good standing with its reputation in the community. PACS:
Picture Archiving Communication System
System for acquiring, archiving, interpreting, and distributing digital images throughout a health system enterprise.
Allows a health care provided to access digital imaging information
All positioning terminology and projections, body planes and movements.
Hand a wrist anatomy
Medical Terminology
X-ray properties:
x-rays are highly penetrating electromagnetic waves and invisible due to high
energy.
Electrically and magnetically neutral and therefore not effected by either electric or magnetic fields
Heterogeneous and polyenergetic
Each photon travels in a straight line
Travel at the speed of light 3x10 8p meters per second in a vacuum
Can ionize matter-process of adding or removing an electron from an atom
Cannot be focused by a lens
They effect photographic film
They produce chemical and biological changes in matter through ionization and excitation
Produce secondary and scatter radiation.
C/kg, gray, and sievert’s measurements:
Gray (gy): unit in the international system used to measure the amount of energy absorbed in any medium: 1 Gy = 100 radiation absorbed doses.
Sievert (Sv): unit in the international system used to measure the dose equivalence, or biologic effectiveness, of differing radiations: 1 Sv = 100 rem.
Ionization:
Any process by which a neutral atom gains or loses an electron, thus acquiring a net charge
EM Spectrum:
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Wavelength, frequency and energy of a photon and their relationships:
Starting at raido – long wavelengths with low frequency. As WL increases energy decreases.
Wavelengths are not frequent, so as wave length increase frequency decreases.
Energy and frequency have a direct relationship.
Further down the spectrum at x-ray and gamma shorter wavelengths which results in higher energy and high frequency. Lab Terms:
SID: Source-to-image receptor distance. The distance between the source of the x-rays and the image receptor.
IR: image receptor. Device used to capture the image for recording, such as photo-stimulable phosphor imaging plate.
Source of radiation
Bucky tray
Collimator
Quality versus Quantity: quality image to reduce exposure for patients and ourselves.
mAs: milliampere-seconds – controls the total quantity of x-ray photons produced in the x-ray tube.
kVp: kilovoltage peak – measures of the potential difference, which controls the quality and affects the quantity of x-ray photons produced in the x-ray tube.
Scatter: radiation produced from x-ray photon interactions with matter in such a way that the resulting photons have continued in a different direction. Chapter Twenty-Four:
Autonomy:
person’s self-reliance, independence, liberty, rights, privacy, individual choice, freedom of the will and self-contained ability to decide.
Beneficence:
doing of good; active promotion of goodness, kindness, and charity.
Confidentiality:
belief that health-related information about individuals should not be revealed.
Consequentialism
: belief that the worth of actions is determined by their ends or consequences.
Ethics:
systematic study of rightness and wrongness of human conduct and character as known by natural reason.
Fidelity:
strict observance of promises or duties; loyalty and faithfulness to others.
Morals:
generally accepted customers, principles, or habits of right living and conduct in a society and the individual’s practice in relation to these.
Nonconsequentialism:
belief that actions themselves, rather than consequences determine the worth of actions.
Nonmaleficence:
ethical principle that places high value on avoiding harm to others.
Veracity:
duty to tell the truth and avoid deception. Chapter Twenty-Five:
EHR
:
Electronic health records. A longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. HIPAA:
Health insurance portability and accountability act of 1996. Federal legislation passed to improve the efficiency and effectiveness of the healthcare system. Health Records:
Required to maintained for a minimum of 5 years.
Doctors, and healthcare workers have access to health records.
Promotes effective communication
All departments that take part in the patients care must document that care in the health record.
Must have documentation of medical necessity, a diagnosis, sign or symptom
for which testing is being performed. TJC:
The Joint Commission
Organization that accredits hospitals and other health care institutions in the US.
Correcting or Amending Records:
Proper method for correcting an error that an author makes is for the author to draw a single line through the error and write “ERROR”.
Should also date and authenticate the entry. Chapter Twenty-Six:
Standard of Care:
Degree of skill (proficiency), knowledge, and care ordinarily possessed and
employed by members in good standing within the profession.
Consent Forms:
Implied: agreement to allow something to happen but inferred by person’s
actions or inactions.
Informed: agreement to allow something to happen but based on full
disclosure of the facts needed to make the decision intelligently. Knowing
risks involved.
Constitutional:
Defines the government and articulates the rights of citizens.
Legislative:
Law enacted by the legislative bodies or administrative agencies. System of
statutes and regulations written at local, state, and federal levels. Case:
Type of law that is decided on a case-by-case by either judge or jury.
Decisions in these cases determine outcome for other parties and future
precedents. Torts:
Patient’s claims that they have been wronged or have sustained some injury.
Breach of contract needs to exist. Assault:
Patient believes he or she has been threatened in such a way that reason to
fear or to expect immediate bodily harm exist. Battery:
May occur even if no injury arises from unwarranted patient contact.
Any unlawful touching may constitute batter if the patient thinks they have
been touched in an offensive manner. False Imprisonment:
A person being restrained or believes that he or she is being restrained
against his or her will.
Most common reason for legal action.
Defamation:
Holding a person to ridicule, scorn, or contempt in a respectable and
considerable part of community.
Slander – verbal defamation
Libel – written defamation. Fraud:
Willful and intentional misrepresentation of facts that may cause harm to an
individual or result in the loss of an individuals right.
Three sources of proof required. Negligence:
Failure to use such care as a reasonably prudent person would use under
similar circumstances.
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Respondeat Superior:
The master speaks for the servant.
Let the superior respond. The physician may be liable in certain cases for
wrongful acts of employees and subordinates. Corporate Liability:
Requires the health care provider to be responsible for the quality of care
provided.
Res Ipsa Loquitur:
The thing speaks for itself.
Legal theory: 1) type of injury did not occur except for negligence, 2) activity
was under the complete control of the defendant, and 3) plaintiff did not
contribute to their own injury in any way. Chapter Ten
What is multiculturalism?
Being able to negotiate two or more different cultures competently, individual
and mainstream. Understanding Human Diversity:
Fact or quality of being diverse, different.
Significant human diversity traits within society:
o
Age
o
Ethnicity and national origin
o
Race
o
Gender and sexual orientation o
Mental and physical abilities
o
Religion
Homophobia:
Irrational fear of and hostility toward homosexuality. Table on page 136… 10.4:
Chapter Eleven:
Maslow’s Hierarchy of Needs:
Provides insights into types of behavior for all persons, professionals, and patients alike.
Built from the bottom up and builds off the foundation
Emotional Intelligence:
Ability to evaluate, perceive, and control emotions
Patient Dignity:
Do not use inconsiderate abuse and help patients who arrive at facility achieve basic levels of maslow’s hierarchy in order to achieve their higher needs.
Maintain patient respect. Types of Patients:
Inpatient:
someone who has been admitted to the hospital for diagnostic studies or treatment.
Outpatient:
patient who comes to a health care facility for diagnosis or treatment but does not usually occupy a bed overnight. Methods of Communication:
Verbal skills such as speech and grammar
Non-verbal
o
Paralanguage: music of language. Pertains to pitch, tone, emphasis.
o
Body Language
o
Touch
Emotional: for support
Emphasis: to direct
Palpate: application of light pressure to body with finger tips. Advanced Directive:
Legal document prepared by a living, competent adult to provide guidance to the health care team if the individual should become unable to make decisions regarding their medical care. Also called a living will. Elisabeth Kubler-Ross Model:
Denial and Isolation: initial reactions and should be supported by silence and acceptance.
Anger: may occur as result of the realization that life will be interrupted.
Bargaining: focuses on hope and may be based in religion.
Depression: occurs when remission ends, and additional treatments must begin.
Preparatory Depression: realization of the inevitability of death.
Acceptance: final stage. Characterized by a near total lack of feelings. Chapter Twelve:
Your Role as an Imaging Professional
History taking in order to get information about patient’s condition. Best way to extract information.
Sacred Seven:
1.
Localization:
exact and precise area for the patient’s chief complaint. Requires carefully worded questions accompanied by proper palpation of the patient.
2.
Chronology
: time element of the history. The duration, frequency, onset and course of symptoms. Should be described in seconds, minutes, hours, days, weeks, or months. 3.
Quality
: character of the symptoms. Does it include color, odor, consistency, size etc. If pain is involved should be either acute or chronic. 4.
Severity: intensity, quantity, or extent of the problem. 5.
Onset:
patient should explain what they were doing when the illness or condition began.
6.
Aggravating or Alleviating Factors:
circumstances that produce the problem or intensify should be well defined. What aggravates the condition or
alleviates it. 7.
Associated Manifestations:
do other symptoms accompany the chief complaint and are they related to the complaint or apart of another problem. Questioning Skills:
Objective data: signs that can be seen heard or felt. Perceived to the senses.
Subjective data:
received only by the affected individual.
Ask open ended questions
Encourage elaboration
Allow silences
Ask probing questions
Reword and clarify
Summarize information
Chief Complaint: primary medical problem as defined by the patient; important because it focuses the clinical history toward the single most important issue.
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