Radiography Exam Study Guide: Key Terms and Concepts Explained

RADIOGRAPHY UNIT TWO EXAM STUDY GUIDE Reading guide questions/ key terms. Chapter 6 - Radiology Administration ACR - American College of Radiology, a professional medical society that "provides practice guidelines to improve patient safety practices in radiology services." AHRA - A professional organization representing medical imaging management at all levels; manages the certified radiology administrator (CRA) credentialing process American Healthcare Radiology Administrators GOVERNING BOARD- Governance of a hospital begins with the board of directors or governing board, which is authorized by law to operate a hospital. The board employs a chief executive officer (CEO) or president and defines how the operation of the hospital is maintained and conducted. CEO - Chief Executive Officer (CEO) Person appointed by the board of directors who has full accountability for the entire hospital or healthcare organization. CLINICAL SUPPORT SERVICE- Services providing the components of patient care that collectively support the physician’s plan for diagnoses and treatments. CQI- Continuous Quality Improvement (CQI) System of development in the workplace for daily improving performance at every level in every operational process by focusing on meeting or exceeding customer expectations. DEPARTMENT- Unit of the hospital with specific functions or specialized skills such as housekeeping, surgery, radiology, or accounting.

DEPARTMENT CHAIR- Physician who represents a department or service and sits as a formal member of the executive medical staff committee; responsible for all of the medical operations of a hospital department and may also oversee a residency training program. TJC- The joint commission, Independent not-for-profit organization that evaluates and accredits more than 22,000 healthcare organizations and programs in the United States and is the nation’s primary standard-setting and accrediting body in healthcare; TJC standards focus on improving the quality and safety of patient care provided by healthcare organizations. MEDICAL DIRECTOR- Physician responsible for the medical operation and quality of a hospital department or service; also responsible for providing regarding policies and procedures. MEDICAL STAFF- Formal organization of physicians authorized to admit and attend to patients within a hospital; have authorized privileges, by laws, elected officers, and various committees and activities (see Medical Director, Department Chair and Service Chief) MISSION STATEMENT - Statement of an organization that summarizes its intent to provide service in terms of the services it offers, the intended recipients of services, and description of the level of cost. MEDICAL IMAGING DEPARTMENT- Organization of a hospital or medical facility that provides diagnostic imaging through medical technologies such as x-ray examination, fluoroscopy, computed tomography, interventional radiography, Magnetic resonance imaging, mammography, nuclear medicine, and ultrasonography.

TQM - Total Quality Management- Management of quality in the workplace from a perspective of total involvement of every employee, with a strong focus on process measurement and control. CQI- Continuous Quality Improvement (CQI) System of development in the workplace for daily improving performance at every level in every operational process by focusing on meeting or exceeding customer expectations. PI- Performance improvement 1. The organizational chart (org. chart) is an important document. It shows how the chain-of-command is set up in a hospital. List the key players in the decision- making process in a hospital. Board of Directors, Quality Council, Medical Staff President and Executive Committee, Chiefs of service. 2. All large organizations, including hospitals, work collaboratively to come up with mission and vision statements. Explain the difference between the mission and vision of an organization. 3. There are a variety of organizational chart styles. Look at the different styles in Figs.6-1 – 6-4. Which one do you think would allow for better communication between departments and administrators? 4. One question that students often miss on exams is the difference between a radiologist and a radiologic technologist. a. Describe the difference in education required for the two.

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b. Describe the difference in duties performed by each. Management Functions In order to maintain high standards of care, hospital administrators are constantly looking for ways to improve services. CQI, TQM and PI are three methods often used for hospital improvement. 5. Search the internet and provide a brief explanation of each of the process improvement strategies and list areas in which these are most often used. a. CQI - Continuous Quality Improvement; Services providing the components of patient care that collectively support the physician’s plan for diagnoses and treatments. b. TQM- Total Quality Management; " Management of quality in the workplace from a perspective of total involvement of every employee, with a strong focus on process measurement and control" c. PI- Performance improvement Regulating Agencies 6. After reading this chapter, you should be able to provide a basic description of these agencies and their role in hospital regulations.

a. CMS- Centers for Medicare & Medicaid Services; Federal agency that administers the Medicare program and partners with the states to administer Medicaid. b. TJC- The Joint Commission c. NRC - "the Nuclear Regulatory Committee (NRC) or the Agreement State. " d. OSHA - Occupational safety and health association Legislation in Radiology 7. Write a brief description of these different rules, laws and standards that affect imaging departments. a. MQSA - Establishes minimum standards of a mammography program to ensure that all women have access to quality services; regulations developed by the US Food & Drug Administration (FDA) and the National Mammography Quality Assurance Advisory Committee b. HIPAA - Health information privacy accountability act c. FCA- A person who knowingly submits false claims for payment to Medicare or Medicaid can face civil and criminal penalties under the False Claims Act (FCA). d. Image Wisely

Chapter 7- Radiographic imaging Attenuation- Process by which a beam of radiation is reduced in energy when passing through tissue or other materials. Attenuation is the process by which the nature of the primary radiation is changed (partially absorbed or scattered), and the number of x-ray photons in the beam is reduced, as it travels through the patient. Brightness - Function of a display monitor; changes image lightness/darkness. Computed Radiography (CR)- Digital image acquisition modality that uses storage phosphor plates to produce images. Contrast- Contrast is the difference between the ranges of adjacent IR exposures represented as gray tones in an image. Digital Radiography (DR)- Digital image acquisition systems that convert x-ray energy into a digital electronic signal for manipulation and display using direct or indirect conversion. Distortion- Misrepresentation of the true size of the object Fog- Undesirable exposure to the image receptor

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Grid- Device consisting of thin lead strips designed to permit primary radiation to pass while absorbing scatter radiation. Image Receptor - (IR) Device used to capture the image for recording. Kilovoltage Peak (kVp)- Measure of the potential difference, which controls the quality and affects the quantity of x-ray photons produced in the x-ray tube. Latent Image- Invisible image created after exposure but before processing. Milliamperage-Seconds (mAs)- Measurement of milliamperage multiplied by the exposure time in seconds, which controls the total quantity of x-ray photons produced in the x-ray tube. Photon- Quantum or particle of radiant energy Primary Radiation- X-ray beam after it leaves the x-ray tube and before it reaches the object. Radiolucent- Permitting the passage of x-rays or other forms of radiant energy with little attenuation.

Radiopaque- Not easily penetrable by x-rays or other forms of radiant energy. Remnant Radiation- Radiation resulting after the x-ray beam exits the object. Scatter Radiation- Radiation produced from x-ray photon interactions with matter in such a way that the resulting photons have continued in a different direction. Source-to-Image Receptor Distance (SID)- The distance between the point of x-ray emission in the x-ray tube (the focal spot) and the IR. It affects the relative intensity of the radiation that reaches the IR and affects the beam geometry. Spatial Resolution- Degree of accuracy of the structural lines actually recorded in the image. Image Production- A beam of x-rays, mechanically produced by passing high voltage through a cathode ray tube, traverses a patient and is partially absorbed in the process. A device called an image receptor (IR) intercepts the x-ray photons that are able to exit the patient.

1. There have been many advances in the field of radiology, however the basic mechanism of x-ray production remains somewhat consistent. Describe the basic process for x-ray production. 1. Vacuum (tube envelope) 2. Source of electrons (filament) 3. Method to accelerate the electrons rapidly (voltage) 4. Method to stop the electrons (target) 2. After the beam of x-ray photons exit the x-ray tube it can be described in multiple ways before it interacts with the Image Receptor. a. Define the following: i. Primary Radiation- ii. Remnant Radiation- Radiation resulting after the x-ray beam exits the object. iii. Absorption iv. Scatter Radiation- An x-ray photon may interact with the body’s matter in such a way that the resulting photon continues its travel in a different direction. This type of radiation may or may not be able to reach the IR, but it does not carry any useful information. Scatter

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radiation is the term generally used to describe this type of nondiagnostic radiation. 3. The terms radiolucent and radiopaque are used to describe the ease at which x-rays pass through matter. Define each and give at least three examples of each. a. Radiolucent- Permitting the passage of x-rays or other forms of radiant energy with little attenuation. b. Radiopaque- Not easily penetrable by x-rays or other forms of radiant energy. 4. The radiologic technologist controls the image quality of the radiograph by setting the technical factors at the control panel. a. Define the following technical factors: i. Milliamperage (mA) ii. Seconds (s) iii. Kilovoltage Peak (kVp)- A measure of the electrical pressure (potential difference) forcing the current through the tube. It controls

the penetrating ability of the beam and primarily affects the quality but also the quantity of the x-ray photons produced. Image Quality Factors 5. Image quality Characteristics fall into two basic categories. Those that affect the signal or visibility of the image and those that affect the resolution or sharpness and accuracy of the image. Identify and describe the four primary image quality factors. a. Image signal factors (Visibility) i. IR Exposure ii. Contrast b. Image resolution factors (Sharpness and Accuracy) i. Spatial Resolution ii. Contrast Resloution

Chapter 8- Medical Imaging Equipment Anode- Positive electrode of the x-ray tube. Bucky Mechanism- Grid that is an integral part of the x-ray table, located below the tabletop and above a cassette receptor tray. It decreases the amount of scatter radiation reaching the image receptor and can improve image quality. It also moves during exposure so that no grid lines appear on the image. Cassette - Lightproof holder for the image receptor. It may be a computerized radiography (CR) plate or a wireless, digital radiography (DR) panel. Cathode- Negative electrode of the x-ray tube. Collimator- An essential device designed to define the dimensions and direction of the x-ray beam. This device consists of four rectilinear, radiopaque blades that are adjustable to control the x-ray’s field size and shape. The collimator may be operated manually or automatically. Digital Imaging- Acquisition of static images in an electronic fashion to create an electronic data set; conversion of images to a digital format for image manipulation, enhancement, archival, and networking; often referenced as DR (digital radiography). Fluoroscopy- Examination by means of the fluoroscope, employing image intensification or a flat panel detector. Latent Image - Invisible image created electronically after x-ray exposure and before image processing.

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Longitudinal - Lengthwise, or along the long axis Mobile Radiography- Overhead Tube- Mechanical support for suspending the x-ray tube and collimator assembly from the ceiling of the radiography room. PACS- Transverse Tube Angulation Vertical X-ray Tube- Manipulation of Radiographic Equipment- 1. Radiologic Technologist must be comfortable with the manipulation of the x-ray equipment. Regardless of the manufacturer, x-ray systems have the same basic features. a. Using figure 8.1, identify the basic components of the radiographic system and describe each. i. X-ray Tube ii. Collimator Assembly iii. Radiographic Table iv. Control Console

v. X-ray Tube Support 2. List the five generic controls found on the control console: 3. List the additional controls that are typically found on the control console: 4. X-ray tubes have two basic designs for support. What are they? 5. The x-ray tube has the ability to move in various directions. Describe the following: a. Vertical: b. Longitudinal: c. Transverse: 6. In the past, radiographic images were captured on film which was housed inside a cassette. Today digital image receptors are used to capture these images. Identify and list the greatest advantages of using Digital Radiography systems: 7. Define Fluoroscopy:

8. Mobile units are available in radiographic and fluoroscopic systems. What is the specific name of a mobile fluoroscopic unit and what area of the hospital are they typically located?

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RADIOGRAPHY UNIT TWO EXAM STUDY GUIDE

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