Rad 1124 Introduction to Radiologic Technology Midterm PDF

DEPARTMENT OF RADIOLOGIC TECHNOLOGY & MEDICAL IMAGING RAD 1124 INTRODUCTION TO RADIOLOGIC TECHNOLOGY Lecture 1 - Medical Imaging History Dr. Amann, DHSc, RT (R)  Learning Outcomes: At the end of the l...

DEPARTMENT OF RADIOLOGIC TECHNOLOGY & MEDICAL IMAGING RAD 1124 INTRODUCTION TO RADIOLOGIC TECHNOLOGY Lecture 1 - Medical Imaging History Dr. Amann, DHSc, RT (R)  Learning Outcomes: At the end of the lecture, the student will be able to: Explain the use of radiation in medicine and describe the discovery of X-rays. List the many diagnostic and therapeutic procedures in medical imaging. Differentiate the many career opportunities and various specialties in radiography. Define terms related to radiologic technology.  Discovery of X-Rays November 8, 1895, Wilhelm Conrad Roentgen discovered X-ray accidentally while working in his lab. It was then called X-Ray or Roentgen ray. December 28, 1895, the first report was titled “On a New Kind of Rays”  Discovery of X-Rays First X-Ray Tube: “Crooke’s Tube”  Discovery of X-Rays X-ray was discovered before Roentgen by other scientists, but all failed to grasp its significance. Roentgen was the first to grasp the significance of Roentgen’s Laboratory the penetrating ability of Barium platinocyanide X-Ray.  History of Radiologic Technology In 1901 Roentgen received the First Nobel Prize in Physics for his discovery. On February 10, 1923, Roentgen died in Munich.  Radiologic Technology Today Medical Imaging (Radiology) provides an essential service in the health care system & offers many career opportunities.  Radiologic Technology Today Diagnostic Imaging: Therapeutic/Treatment: Radiography/Fluoroscopy Special Procedures CT/CAT Cardiac- Interventional Mammography Bone Densitometry Vascular- Interventional Quality Management Radiation Therapy Special Procedures Ultrasound Nuclear Medicine MRI Multi-skilled (Fusion Technology) Radiologist Assistant  Radiologic Technology Today I. Administration II. Business & Industry – Radiology Speaker Administrator/Director Sales Representative – Vice-President Writer – Quality Manager III. Research – PACS Administrator/Informatics IV. Education – Administrative roles in governing agencies  Related Terms Radiology Health science dealing with: – radioactive substances – radiant energy – diagnosis – treatment – ionizing radiation – non-ionizing radiation  Related Terms Radiant Energy Vs. Radioactivity Ionizing Vs. Xray Astronomy vs Medical Xrays. Non-Ionizing  Related Terms Radiology Health science dealing with: – radioactive substances – radiant energy MR – diagnosis X-Ray – treatment – ionizing radiation – non-ionizing radiation Cardiovascular  Related Terms Radiography A general term applied to the making of film records (radiographs) or an electronic image of internal structures of the body by the passage of x-rays through the body to act on specially sensitized film or a computerized or digitized image. + +  Related Terms Radiation Waves transmit energy through space or matter. It can also be said to be a form of energy transmitted through matter. Energy The capacity to do work. Higher forms of energy (radiation) can ionize atoms in nature.  Related Terms Ionization The process by which a neutral atom gains or loses electrons. This process can disrupt the composition of matter, thus disrupting the life process. Therefore, radiation exposure must be limited. X-Ray A man-made form of electromagnetic energy. X-ray is created when electrons moving at high speed are suddenly stopped.  Related Terms Radiologist The Physician or Doctor who specializes in using X-rays and other forms of energy in the diagnosis and treatment of disease.  Related Terms Radiologic Technologist The individual who performs radiography or medical imaging of the internal parts of the body. DEPARTMENT OF RADIOLOGIC TECHNOLOGY & MEDICAL IMAGING Dr. Amann, DHSc, RT (R) RAD 1124 INTRODUCTION TO RADIOLOGIC TECHNOLOGY Week 2 - Imaging Equipment & Specialization  Introduction RADIOLOGY Sonography Radiography Mammography CT MRI Nuclear Medicine Radiation Therapy  Imaging Modalities Radiography Vascular Interventional Fluoroscopy Management CT or CAT Scan Administration MR or MRI Radiologist Assistant Ultrasound/Sonography Research Nuclear Medicine Sales Mammography Writer Interventional Radiography  Radiography Diagnostic X-ray procedure of the human anatomy where images are captured by digital image receptors, reconstructed by computer algorithms, and displayed on a monitor Medical radiography is the largest of the radiologic technology specialties and is an art and a science Provides nearly unlimited opportunities to serve patients using X-ray technology to help provide a diagnosis and to speed the patient on to appropriate treatment. The radiographer is responsible for creating images using radiation Educational programs range in length from two to four years, resulting in either an associate degree or a baccalaureate degree.  Fluoroscopy Dynamic or live X-ray procedure of the human anatomy which can be displayed on a viewing monitor and/or recorded on video to store and view later. https://www.youtube.com/watch?v=1RgnZel7oCw flouroscope  Radiologic Technologist (RT) One who is registered and licensed to perform radiographic & fluoroscopic procedures.  Computed Tomography (CT) Advanced pencil-like X-ray beam and detectors that provides cross-sectional images of the anatomy. – 1972 Godfrey N. Hounsfield Responsibilities: – Perform procedures without constant supervision – Maintain inventory of supplies – Provide quality patient care – Maintain a sterile environment – Documentation  Computed Tomography Equipment and Procedures: Scanning unit is called the Gantry – 1- to 10-mm-thick slices – Detectors Computer – Digital image – Video type signal Viewing unit – Monitor Education – ARRT certification exam – Employment opportunities – Hospitals or Outpatient clinics Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Magnetic Resonance Imaging (1 of 2) AKA MR/MRI Introduced in the early 1980s First known as NMR No ionizing radiation Perform MR procedures with limited supervision Knowledge of magnetic fields Computer applications Patient care Sterile technique MR safety Documentation Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Magnetic Resonance Imaging (2 of 2) Equipment and Procedures: Large electromagnetic coils Radio waves Magnetic field Excellent for soft tissue visualization Education and Employment Opportunities ARRT certification exam Formal or informal education Rapidly growing field Hospitals and clinics Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Magnetic Resonance (MR) Imaging Diagnostic imaging of the human body with the use of a strong magnetic field and radio waves along with a computer to generate sectional images. MRI is not an X-ray procedure. No ionizing radiation in this modality Special Procedures & Interventional Radiography (1 of 2) Cannon in 1896 Responsibilities: Special procedures radiography Application of sterile Vascular and nervous technique systems Equipment preparation Interventional radiology Assist physician Angiograms Obtain diagnostic images Cardiac catheterization Patient care Arteriography Maintenance of supplies Venography Works under direction of Biliary or renal stones radiologist Abscess drainage Cancer therapy Special Procedure & Interventional Radiography (2 of 2) Equipment and Procedures: Employment Opportunities Image intensification Large hospitals and medical TV monitor or videotape system centers Pressure injector Monitoring devices Anesthesia equipment Crash cart Education and Certification Usually in conjunction with The baccalaureate degree C-Arm ARRT exam Unit Cardiac interventional Vascular interventional Copyright © 2020 by Elsevier, Inc. All Rights Reserved. Cardiovascular Interventional Technology Specialized diagnostic examination of the cardiovascular system with the use of specialized x-ray equipment. CI Technologist (CIT) - one who is licensed in RT and registered in CIT  Mammography Diagnostic examination of the mammary glands (breasts) with the use of a dedicated X-ray equipment. Mammographer (M) - one who is licensed in RT and registered in Mammography October 1991 FDA Regulations – MQSA Dedicated Mammo Unit ARRT certification required  Bone Densitometry Art and science of measuring the bone mineral content and density of specific anatomic sites or the whole body. The bone measurement values are used to assess bone strength, diagnose diseases associated with low bone density (especially osteoporosis), monitor the effects of therapy for such diseases, and predict risks of future fractures.  Bone Density Exam Bone Densitometry utilizes very low dose radiation emitted from an X-Ray machine. ARRT certification offered January 2001 DEXA Ultrasound or Diagnostic Medical Sonography Diagnostic imaging is used to visualize structures of the body with the use of high- frequency sound waves. Sonography does not utilize ionizing radiation. Ultrasonographer (US) - one who is licensed and registered in Ultrasonography  Diagnostic Medical Sonography Sonography/ Ultrasound High-frequency sound waves WW I and WW II Equipment Transducer-crystal US beam Monitor Responsibilities: Performs examinations Can also be therapeutic tool Work closely with radiologist Equipment maintenance Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Sonography Education varies – Study full time basis in clinical setting with supervision from MD and registered sonographer – ARDMS – RDMS – RDCS – RVT Abdominal sonography Obstetrical-gynecological sonography Certification by ARRT or ARDMS Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Nuclear Medicine A principle of diagnostic procedure in which radioactive materials are introduced into the human body to enhance imaging of the patient. Nuclear Medicine Technology (NMT) - one who is licensed and registered in NMT  Nuclear Medicine (1 of 2) Radioactivity Diagnostic imaging with the use of Marie and Pierre Curie and scintillation or gamma camera Henri Becquerel in 1898 following injection of radionuclide Alpha Responsibilities: Beta Radioactive materials for Gamma diagnostic and therapeutic studies in vivo and in vitro Radionuclides/ radiopharmaceuticals Prepares and administers radiopharmaceuticals Tracer Quality control Radiation protection Imaging procedures Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Nuclear Medicine (2 of 2) Equipment and Procedures materials and then image the Cardiology, oncology, patient psychiatry, pediatrics, as well Education and Certification as general diagnostics JRCNMT accredited program Uses computers 1-4 years in length Didactic and clinical SPECT Certification exam by ARRT or PET NMTCB Radiation detecting equipment Administration of radioactive Copyright © 2020 by Elsevier, Inc. All Rights Reserved. Nuclear Medicine  Nuclear Medicine Nuclear Medicine Positron Emission Tomography (PET) A noninvasive nuclear imaging technique that involves the administration of a radiopharmaceutical and subsequent imaging of the distribution and kinetics of the radioactive material. It is used predominantly to measure human cellular, organ, or system function (metabolic). Other modalities measure structure, size and position of organs or other structures.  Forensic Imaging Technologist Forensic Radiology uses imaging to: Assist pathologists Identify remains Verify the cause of death Virtopsy, makes use of three-dimensional (3D) computed tomography (CT) or magnetic resonance imaging (MRI) to image remains Plays a major role in cases of child abuse Requires extensive experience as a radiographer with computed tomography and/or magnetic resonance imaging as additional specialties American Academy of Forensic Sciences Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Conclusion Many areas for specialization exist in the profession of radiologic technology Entrance into these areas is usually a matter of the technologist's preference, but other factors may also be included in the decision, such as: – Employment opportunities – Educational requirements – Access to educational programs. Advanced education holds the key to career mobility Copyright © 2020 by Elsevier, Inc. All Rights Reserved. DEPARTMENT OF RADIOLOGIC TECHNOLOGY & MEDICAL IMAGING RAD 1124 INTRODUCTION TO RADIOLOGIC TECHNOLOGY Lecture 3-Imaging Equipment & Specialization Imaging procedures Dr. Lillian Amann, DHSc, RT (R)  Learning Outcomes Understand the basics of various imaging procedures. Know when a specific imaging modality is indicated. Explain what is meant by digital procedures. Define the role of computers in radiologic imaging. Define the role of computers in imaging archiving and reporting systems. Discuss the basics of identifying Radiographic Positioning Terminology  Radiation Therapy (1 of 2) Radiation Oncology Emil Grubbe in 1896 Epilation Damaging effects of early radiation therapy Bergonie and Tribondeau Therapeutic and NOT diagnostic Responsibilities: – Applies ionizing radiation to patients by prescription and instructions of the radiation oncologist – Documentation is critical – Positioning – Molds/wedges/compensating filters – Patient care Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Radiation Therapy (2 of 2) Education and Responsible for: Certification o Under direction of radiation o Graduate from accredited oncologist delivers radiation program therapy treatments o 1 to 2 years in length o Operates linear accelerator, o Didactic and clinical particle generator, brachytherapy equipment, and o ARRT examination superficial therapy equipment o Medical dosimetry o ASRT curriculum o MDCB Eligible to take ARRT certification exam Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Radiologist Assistant Advanced education and Physician-extender specifically certification for radiologists Perform select radiology First class graduated in 2006 procedures from Loma Linda University, Systemic analysis of patient care Loma Linda, California Initial observations of diagnostic ASRT curriculum images with official ARRT certified RT with 1 year interpretations supervised by of post-certification experience radiologists Earn a bachelor’s degree ACR, ASRT, and ARRT developed RA concept Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Quality Assurance Technologist Accreditation procedures The Joint Commission – Voluntary accreditation Quality Assurance (QA) Quality Control (QC) Copyright © 2020 by Elsevier, Inc. All Rights Reserved. Picture Archive and Communication Systems PACS System of computers linked together via a network to store and transmit digital images throughout the network; can be within a hospital but may also include remote sites. Imaging Informatics - PACS Administrator Informatics: information gathering and engineering Patient information, imaging, diagnoses, reports, and billing are all processed digitally PACS is the heart of imaging informatics Blends clinical information with documentation Requires knowledge of the interface between the HIS and the RIS This technologist must also understand DICOM CIIP ABII SIIM ARRT Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Commercial Representative Applications specialist – Technical background – Teaching RTs how to use equipment Sales representative – Business background – Communication skills Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Radiology Administrator/Director Demand has grown for individuals with business and management backgrounds Ideal radiology administrator has combined technical and management experience Involved in purchasing, personnel management, union negotiations, budget preparation, regulatory specifications, decision making and planning Higher education programs available AHRA CRA Role must grow with the profession Copyright © 2020 by Elsevier, Inc. All Rights Reserved. Radiological Technologist Educator (1 of 2) Marie Curie – First RT educator in Europe – Developed first mobile x-ray units Eddy Clarence Jerman – First RT educator in the United States in 1920 – Victor X-Ray Corporation in Chicago—Became ASRT American Registry of X-Ray Technicians established in 1922 – Experts in radiologic technology and who are able to communicate this knowledge to the student radiologic technologist Copyright © 2020 by Elsevier, Inc. All Rights Reserved. Radiological Technologist Educator (2 of 2) Requirements published by JRCERT: Must demonstrate competency in curriculum design and program planning Should have foundations in education Conduct student advisement Formative evaluation Summative evaluation Many educators attain doctorate degree Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Conventional Radiography Conventional Radiographic projection radiography in which the latent image (unseen image) is produced in a light tight cassette and an X- Ray film. The image remains invisible until processed in a darkroom. The processor contains the wet chemistry (developer agents, fixer agents and dryer). The image is viewed using a lighted view box and stored in tangible files.  Conventional Radiography Note: In conventional radiography, the image is acquired on film in a light- tight cassette. It is then immersed in a wet chemistry for development. The final image is seen as a hard copy (radiograph) that is placed on a view box for interpretation. The final processed image is called a: Radiograph  Computed Radiography (CR) Conventional Radiographic projection radiography in which the latent image (unseen image) is produced in digital format using computer technology. The image is acquired in a phosphor material plate inside a closed cassette. It is then inserted into an image reader device where it is scanned by a laser beam and the final image appears on a computer monitor. Digital Radiography  Medical Imaging Terminology & References Anatomic Position –The person is standing erect with palms facing forward. Everything that faces forward is anterior and everything that faces backward is posterior Medical Imaging Terminology & References Projection The path of radiation as it passes through the patient to the IR. When the CR enters the front (anterior) surface of the body and exits the back (posterior), an AnteroPosterioor (AP) projection is obtained. Projections Posteroanterior (PA) – Designates the beam entering the posterior (back) surface of the body and exiting the anterior (front) surface of the body. Posteroanterior (PA) Projection Projections Lateral projection: A projection in which the CR enters one side of the body or body part and traverses and exits on the opposite side.  Projections Oblique Projection: The CR enters the body or body part from a side angle. An oblique projection does not place the body or body part in an AP, PA or a lateral, but somewhere between those positions. Positioning Aids Sponges, sandbags, tapes, restraint are used to control voluntary and involuntary motion. These tools must be radiolucent otherwise will cast a shadow on the radiograph. Voluntary vs. Involuntary Motion Nervousness Heart pulsation Discomfort Chill Excitability Peristalsis Mental illness Tremor Fear Spasm Age Pain Breathing Radiolucent Items which will not cast a shadow on the radiograph. These items are easily penetrated by x-ray. Example: Positioning sponges Radiopaque Metallic or non- metallic items which will cast a shadow on the radiograph. These items are not easily penetrated by x-ray. Example: jewelry, barium, positioning sand bags, prosthesis etc. Bedside or Portable Unit Mobile units used to radiograph patients who are unable to be brought to the radiology department  X-Ray Films Film Screen film mainly sensitive to blue light emitted by intensifying screens. Screen=white part of cassette Also sensitive to x- rays. Cassette with Screens Half inch thick metal framed film holder with a pair of intensifying screens mounted on the inside of the front and back hinged panels. Used with screen film. A thin sheet of cardboard or plastic covered on one side with a fluorescent material that emits blue or green light when exposed to x-rays. Used in cassette film holders.  View Boxes/Monitors Radiographic Illuminators aka: ”View boxes” Used for mounting radiographs for critique and interpretation. Now replaced with high resolution monitors  Calipers Calipers measuring device calibrated in centimeters and inches. Used to measure the part or region to be radiographed.  Lead Letters/Numbers Lead Letters and Numerals Placed on image receptor before exposure to identify left or right side of part or region and to identify the patient and technologist.  Grids & Bucky Grid/Stationary Grid/Moving Grid A wafer thin grid of alternate lead and plastic strips placed between the object to be x-rayed and the x-ray film. Removes unwanted scattered radiation. Bucky Tray Tray beneath x-ray table top for x-ray cassette. Above tray is moving grid placed between table top and tray.  The X-Ray Tube A glass vacuumed tube suspended from the ceiling over the radiographic table. X- rays are produced in the tube and released through the port or window on the underside of tube.  Shields Leaded Rubber Apron & Gloves Used for protection from x-rays. Gonadal Shields Lead impregnated material that is worn over gonad area for protection from x-rays. May use lead rubber mask and lead gloves on males, lead apron on females if no appropriate shield is available. INTRODUCTION TO RADIOLOGIC TECHNOLOGY RAD 1124–Week 4 Dr. Lillian Amann, DHSc, RT (R)  Learning Outcomes Describe the changes to the radiology department since the 1960s. Identify & discuss the organizational structure of a radiology department. Describe the role of a radiology administrator. Explain how radiology is thought of as a business. Identify high volume areas within a radiology department. Review the basics of identifying Medical Terminology.  Historical Perspectives Before the 1960s, hospital radiology departments were very simple in structure and function. The organization tables from one hospital to the next carried great similarities with just one modality.  Evolution of Radiology Most dynamic period of growth: 1960s Responsible: Computer application Outcome: Development ultrasound, CT, MRI, vascular/interventional technology etc.  Evolution of Radiology These new applications gave rise to a change in the reference “Radiology Department” to: “Diagnostic Imaging Department”.  Before the 1960s Radiology Department X-Ray  Before the 1960s Administrator Chief Tech X-Ray Techs Support Staff  From the 1960s on Director/Manager Chief Technologist Radiologic Technologists Support Staff Modern Medical Imaging Departments Administrative Director (1) Assistant Administ. Administrative Secretary Director (1) (1) And Assistant Technical. Manager (1) Supervisors (4) Technologists (Many) Support Staff (Many) Modern Medical Imaging Departments NM PET US CT General MRI Diagnostic CT Imaging Bone Mammo Special/ Mammo Dens. Interventional  Equipment Location Another change to consider is the placement of radiology equipment and services in different areas of the hospital. Such equipment may be found today in an endoscopy suite, interventional vascular suite in surgery, in the ER, the outpatient pre-admission testing department etc. Modern Medical Imaging Departments  One Consistency There is one consistency, however, found between the old and the new department. High volume area within a radiology department remains: General In-patient and General Out-patient. Modern Medical Imaging Departments The organizational structure of the modern radiology department is very complex. Because of the constant emergence of new technology, staffing and management role continues to experiment with new titles, new responsibilities and additional training accordingly.  Administrative Director Responsibilities: The role of the Administrative director of radiology is to oversee the operation of the whole department including departmental planning and organization, rad. safety, Quality management, budgeting, staffing of technical and clerical services, and equipment maintenance.  Administrative Director Additional Responsibilities: equipment selection, personnel evaluations, hiring and firing, policy and procedures, and department productivity. This position usually reports to the department’s medical director.  The Business of Radiology The radiology department of today is thought of as a business. Through health care reform, managed care brought about the following challenges: Cost containment Competition  Cost Containment Radiology is forced to position itself as a revenue-making department with an eye on set benchmark which must be met per month or quarter. This is done through active financial analysis. This challenges radiology managers to maintain tighter control over staffing and allocation of supplies as well as other resources.  Competition Due to shorter hospital LOS, radiology must compete with other departments from other hospitals and private centers for business. This is done by offering: A. Shorter turnaround of radiology reports (within 6 hours of the procedure) B. Better quality images (consistent) C. Faster services to the patients: (less than 15 min wait)  Competition D. Greater patient satisfaction E. Broader range of services to the patients and referring physicians F. State-of-the-art equipment G. Employee satisfaction (incentives given to employees: tuition reimbursement, sign-on bonus, profit sharing, CE training, promotions etc.) H. Cross-training  Summary/Review Questions What was the hospital radiology department structure and function before the 1960s? The most dynamic period of growth occurred in the ….. What brought about this change? What is the difference between these references: “radiology department” and “diagnostic imaging department”? Other change(s)? What is the one consistency which remained between the old and the new system?  Summary/Review Questions Explain the major differences between the old and the modern radiology departments. Who is the head of the radiology department and what are his/her functions? Who does the head of radiology report to? Name the two challenges brought to the radiology department as part of health care reform? How is cost contained in the radiology department? How do radiology departments compete with each other? DEPARTMENT OF RADIOLOGIC TECHNOLOGY & MEDICAL IMAGING RAD 1124 INTRODUCTION TO RADIOLOGIC TECHNOLOGY WEEK 5 – HC DELIVERY SYSTEM Dr. Lillian Amann, DHSc, RT (R)  Learning Outcomes Discuss background and structure of the HC system Identify the three levels of care Discuss the philosophy of a hospital organization Define the principles of a mission statement List basic management principles Define concepts of TQM and QA/QC Differentiate between internal and external regulating agencies Review basics of identifying medical terminology 2  Health Care System Structure Before the mid-1800s, health care was delivered in the comfort of patients’ homes. 3  HealthofCare Structure System Structure the Health Care System In the US, institutionalization began in the mid- 19th century when large hospitals were built such as: ◆ Bellevue - in NY ◆ Cook County - in Chicago ◆ Massachusetts General – in Boston 4  Hospital System Structure Back then, health care providers attempted to alter the course of a disease process by sweating, blistering, purging and bleeding the body. The sick were placed together according to the following categories: aged, orphaned, mentally ill and physically ill; in almshouses or poor houses. Infections were treated by amputation and debridement of wounds during the civil was. 5  Health Care System Structure ❑ The medical society known today as the American Medical Association (AMA) was formed in 1847. ❑ In the mid to late 1800s, public awareness brought the need to separate the mentally ill from those with infectious and chronic diseases. 6  Health Care System Structure Medical schools trained physicians in an apprenticeship (non-academic) environment. 7  Health Care System Structure In the late 1800s to early 1900s, medical specialties were experimented with and soon became widely accepted. Today, health care is delivered through hospitals, private practice, health care clinics, centers etc. 8  Health Care System Structure As it stands, health care is delivered today on three levels: 1. Primary care 2. Secondary care 3. Tertiary care 9 3 Levels of HC Delivery Primary Care: The first contact in any given episode of illness that leads to a decision regarding a course of action to resolve a health problem. 10 3 Levels of HC Delivery Secondary Care: An intermediate level of health care that includes diagnosis and treatment is preferred in a hospital with specialized equipment and laboratory facilities. 11  3 Levels of HC Delivery Tertiary Care: A specialized, highly technical level of health care that includes diagnosis and treatment of disease and disability in sophisticated large research and teaching hospitals. 12 3-Levels of Care 13  Management Principles Fee-for-Service The traditional form of payment in which the patient or insurer pays for each doctor visit or service provided. 14  Management Principles Managed Care Use of planned and coordinated approach to providing health care with the goal of quality care at lower cost. This principle emphasizes preventive care and often associated with an HMO. 15  Management Principles Financing Orgs: An organization that finances, organizes, and provides health care using the principles of managed care. 16  Management Principles Primary Care Physician General practitioner or doctor of internal medicine who treats routine injuries and illnesses and focuses on preventive care. “Gatekeeper” for managed care. 17  Management Principles Capitation A plan that is based on per-member, per-month fixed payment to a health- care provider or health plan for each member enrolled, regardless of the amount of care a member requires. The specific services that are covered must be indicated in the plan. 18  Management Principles Deductible The amount a patient must pay out of pocket before coverage kicks in. Co-Payment A set fee paid by the patient for an office visit or other covered service (began with generally $5.00 to $15.00; now as much as $50) 19  Management Principles Centers for Medicare and Medicaid Services (CMS) Previously known as (HCFA) Part of the US Department of Health and Human Services. CMS is the contracting agency for HMOs that seek direct contractor- provider status for provisions of the Medicare benefit package. 20 21 Hospital’s Philosophy, Mission & Goals Philosophy: Hospitals’ philosophy is that wellness is a right, not just a privilege. Wellness is related to all aspects of a patient’s life. Thus, health care delivery should take a holistic approach in caring for the physical, emotional, social and economic needs of the public. 22 Hospital’s Philosophy, Mission & Goals Mission: A statement summarizing the institution’s intent to provide health care services. – “The mission of the LICH is to provide quality health care in a caring environment.” – “The mission of Louisiana State University is the generation, preservation, dissemination, and application of knowledge and cultivation of the arts for the benefit of the people of the state, the nation, and the global community.” 23 Regulating Agencies & Hospital Committees External Joint Commission on Accreditation of Health Care Organizations (JCAHO). State Health Departments Nuclear Regulatory Commission (NRC) Occupational Safety and Health Administration (OSHA) 24 Regulating Agencies & Hospital Committees Internal Committees: Safety Committee Infection Control Committee Radiation Safety Committee Pharmacy and Therapeutics Committee 25  TQM – QA & QC Total Quality management (TQM) Management of quality in the workplace from the perspective of total involvement of every employee. Quality Assurance and Quality Control Management of quality through the allocation of dedicated personnel in various departments within the organization 26  Summary Background and Structure of the Health Care System Before the mid 1800s, HC was delivered at home Institutionalization began in the mid 19th century with the building of Bellevue, Cook County and Massachusetts General Hospitals Infections were treated by amputation and debridement The AMA was formed in 1847 Physicians were trained through apprenticeship Medical specialties became widespread in the early 1900s HC is delivered today through hospitals, private clinics, HC centers and even the home 27  A Few Brain Teasers ❑ Identification of three levels of health care delivery Primary, secondary, and tertiary ❑ List of (10) Health Care Management Principles ❑ Discussion of the Hospital’s Philosophy, Mission, and Goals ❑ Regulating Agencies: Differentiate between External and Internal ❑ Concepts of TQM and QA & QC 28  TEAMWORK Makes the Dream work RAD 1124 INTRODUCTION TO RADIOLOGIC TECHNOLOGY Week 6 – HEALTHCARE TEAM Dr. Amann, DHSc, MSRS, RT (R)  Teamwork in Healthcare Defined! Today’s healthcare team is an identified group of persons involved in delivering health care. This group consists of all members of the healthcare discipline. All healthcare team members contribute to the patient’s diagnosis, treatment, and possible re-attainment of health.  The Healthcare Team There are over 200 healthcare careers, and each one plays an essential role as part of the healthcare system. This is especially important to provide proper patient care. Although many members of the team have no patient contact, each member individually plays a specific and important role in patient care. Failure of one or several of the many job functions results in a system breakdown.  Teamwork in Healthcare Within the healthcare community, the most important people are the patients. They come to the hospital for help in preserving health or solving health-related problems. They entrust their lives to the healthcare team. Campeau’s Healthcare Team Model Healthcare Team Patient Medical Care Care Team Team Campeau’s Healthcare Team Model Team members are determined in terms of “patient contact”. This collective team is divided into two separate components. They are the patient-care team and the medical-care team.  Patient Patient Care Team Care Team Members (physicians, nurses, therapists) who have the most sustained patient contact and provide individualized services related to the program of care.  Medical Medical Care Team Care Team Members (radiographers, medical technologists, pathologists, pharmacists) who provide essential back-up services for the patient-care teams. These individuals have very limited contact with patients for short periods of time or perform tests without necessarily making personal contact.  The Radiographer’s Role in Healthcare 1. Be a technically competent practitioner 2. Provide information through imaging 3. Eliminate the need for invasive procedures or exploratory surgery 4. Recognize and respect areas of expertise and professional role of other disciplines 5. Work compatibly or cooperate with other members of the team 6. Ability to relay information systematically and effectively to others  Professional Relationships Physician/Doctor: The physician is the team leader because he/she is the one who makes the primary commitment in the patient/physician contract. Therefore, the radiographer generally follows the procedures a physician has ordered. This means that a radiographer must be presented with a signed request from a physician to proceed with a radiographic procedure.  Professional Relationships The relationship between physician/radiographer involves written and oral communication as well as human respect and professional courtesy.  Professional Relationships Nurses: Contact with nurses is not as frequent as contact with other technologists. However, it is important for radiographers to coordinate their work with the work of nurses wherever coordination is pertinent.  Professional Relationships If, for example, a physician orders a procedure on an in-patient, the nurse must properly contact radiology and arrange radiology scheduling, patient preparation and transportation, etc.  Professional Relationships The relationship between nurses/radiographer involves written and oral communications as well as human respect and professional courtesy.  Professional Relationships Other Technologists: The following pertains to and includes all technologists found in the radiology department including nuclear medicine technologists, diagnostic medical sonographers, mammographers, MRI and CT technologists. They all share similar educational backgrounds in the physical sciences.  Professional Relationships Other Technologists The relationship between other technologists/radiographers is that of colleagues and peers.  Recent Changes in the Healthcare Team During the 1990s healthcare reform was developed and reintroduced to the health care community. This new concept deviated from “patient care orientation” to “cost-containment outcome”. It known as “patient-centered care”. In this type of healthcare delivery, there is a demand for nurses and technologists to be cross-trained in other disciplines to serve multifunction.  Recent Changes in the Healthcare Team Additionally, radiographers are being called upon to step outside the boundaries of their traditional role and expand their educational base and skills. Radiographers may be required to adapt to new methodologies of delivering close and personal patient care in the near future. This will broaden the scope of practice as well.  Team Approach to Healthcare Hospitals provide: Both inpatient and outpatient services Continuing education for personnel Research and prevention of disease Team approach important to better serve the patient Conditions for successful team – Clear understanding of hospital mission – Defined purpose for each role – Most importantly, provide high quality care Word Analysis  Word Analysis Working in a medical setting means you are going to use medical terms daily EXAMPLE: Arthritis, electrocardiogram, hepatitis, hematology and anemia Medical words are like individual jigsaw puzzles. Once you divide the terms into their parts and learn the meaning of the individual parts, you can use that knowledge to understand many other new terms.  Suffix and Root Word Word Analysis Divide the terms into their parts and learn the meaning of the individual parts. Step #1 SUFFIX: Begin at the end of the word. The suffix in hematology is – LOGY Step #2: ROOT WORD: Evaluate the beginning of the word. Provides the central meaning. Step #3: Combining Vowel which acts as a connector  Putting it all Together Suffix + Root Word= Hematology: The study of blood  Putting it all Together Electrocardiogram: Suffix + Root Word + Root Word Some words have two root words To Analyze: Divide the terms into their parts and learn the meaning of each part Step #1 SUFFIX: -GRAM meaning “study of” Step #2: ROOT WORD #1: -CARDI meaning “heart” and... ROOT WORD #2: -ELECT meaning ”electricity” All combined with “o” as a connecting vowel Electrocardiogram: Records the electrical signal from the heart (to check for different heart conditions)  Putting it all Together (Part #2) Combining Form: The combining vowel plus the root. For Example: There are two combining forms in Electrocardiogram 1. Electr/o 2. Cardi/o Note: If the suffix begins with a vowel, The combining vowel is omitted. Example: (Arthritis)  Let’s Look at Another... Gastroenterology 1. Gastr/o = Root word meaning stomach 2. Enter/o = Root word meaning intestines 3. -ology = Suffix meaning study of MEANING: Study of both the stomach and intestines  Word Analysis Prefix and Root Word Divide the terms into their parts and learn the Adding the suffix –ic which means meaning of the individual parts. “pertaining to” and changing the prefix (sub, trans, retro) will give you these as Step #1 PREFIX: The prefix in examples: Subgastric is Sub- Step #2: ROOT WORD: The root word is gastric Step #3: No combining vowel needed Subgastric: Below the stomach  Additional Examples PREFIX: A syllable placed before a word to alter its meaning. Example: dys/phagia = difficult swallowing dys = difficult (prefix phagia = swallowing (word root) SUFFIX: A word part that follows a word root. Example: rhinitis = inflammation of the nose rhin = word root that means nose itis = suffix that implies inflammation Example: Cholecystectomy = removal of the gallbladder. cholecyst/ ectomy = Cholecyst = word root that means gall bladder Ectomy = suffix that implies removal of  Summary Questions Who makes up the health care team? Who is the team leader? Who is the most important person in health care? Describe Campeau’s model of the health care team? Who makes up the medical care team? Who makes up the patient care team? State the concept in health care in the 1990s State the working relationship between the RT and nurses State the working relationship between the RT and other technologists State the working relationship between the RT and the radiologist  DEPARTMENT OF RADIOLOGIC TECHNOLOGY & MEDICAL IMAGING RAD 1124 INTRODUCTION TO RADIOLOGIC TECHNOLOGY From Classroom to Clinic Dr. Lillian Amann, DHsc, MSRS, RT (R)  The RT Curriculum Intro to Rad Tech Radiation Protection & Applied Radiobiology Health Care Ethics Principles of Diagnostic Imaging I, II Radiographic Procedures I, II, III, IV Patient Care Radiation Physics Radiologic Pathology  Introduction In order to effectively educate students and develop as well as refine the skills required of a competent radiographer, planned and structured learning experiences and activities in various clinical settings are required. This is achieved through a clinical affiliation between hospital facilities and the college. 10/23/2024  Introduction According to the “Standards of an Accredited Educational Program for the Radiographer,” a goal of clinical education is to ensure that program graduates will competently perform a full range of radiologic procedures on children and adults. Areas of competence include head and neck, abdominal, gastrointestinal, genitourinary, bedside, and surgical procedures. 10/23/2024  Clinical Terminology Standards of an Accredited Educational Program: Document that describes the standard of quality for the educational program. 10/23/2024  Clinical Terminology Clinical: Procedures and activities that occur in the clinic or hospital setting. 10/23/2024  Clinical Terminology Three (3) Domains of Learning: Cognitive Domain One of the three major categories or domains of learning, which includes various levels of thought such as knowledge, understanding, reason, and judgment. 10/23/2024  Clinical Terminology Psychomotor Domain One of the three major categories or domains of learning, which includes behaviors involving physical actions, neuromuscular manipulations, and coordination. 10/23/2024  Clinical Terminology Affective Domain One of the three major categories or domains of learning, which includes behaviors guided by feelings and emotions that are influenced by one’s interests, attitudes, values and beliefs. 10/23/2024  Clinical Terminology Clinical Competency: Observable, successful achievement of a performance objective. 10/23/2024  Clinical Terminology Objective: Concise description of an observable behavior. Didactic: Informational and instructional activities that may occur in formal or informal settings. 10/23/2024  Clinical Terminology Direct Supervision: A radiographer is present during the entire procedure; from reviewing the request for the examination to reviewing and approving the radiographs for submission. Indirect Supervision: The radiographer is immediately available to assist the student if required, regardless of the level of student’s achievement. 10/23/2024  Clinical Terminology Repeats: Radiographs that must be repeated may only be done in the presence of a qualified radiographer, regardless of the level of student achievement. 10/23/2024  Progressive Clinical Development Clinical education is sequential, with each course building on the previous one. The first aspect of development is known as the “process”. It involves passive participation to active performance. The student progresses in the following steps: 1. Observation 2. Assistance 3. Performance 10/23/2024  Progressive Clinical Development The second aspect is known as “assessment”. This is where an instructor assesses the knowledge, comprehension and ability to apply, analyze, synthesize or evaluate specific radiographic procedures. 10/23/2024  Concepts of Clinical Environment 1. Assignment of Initials and use of Lead Markers 2. Clinical Competencies and Simulations 3. Discussion: Clinical Attendance (Signing in & out) Reporting to assigned rotation areas Preparations of room and clean-up procedure 10/23/2024  Concepts of Clinical Environment 4. Responsibilities of the Student: a. Learn about the equipment b. Learn department protocol 10/23/2024  Concepts of Clinical Environment 5. Conflict of interest: a. When orders of exam conflicts with hospital policy b. When orders from radiologist conflict with school policy c. Conflicting orders from clinical instructors and staff technologists d. Student’s rights 10/23/2024  Clinical Education Policies: 1. Clinical supervision 2. Avoidance of using students to replace staff 3. Radiation protection policies 4. Professional ethics 5. Professional appearance 6. Attendance 7. Pregnancy 8. Disciplinary procedures 10/23/2024 Radiography Program Officials and Support Staff: Program Chairperson (1) Clinical Coordinator (2) Didactic/Classroom Faculty (Many) Clinical Instructors (Many) Medical Advisor (1-optional) College Lab Technician (1.5) Secretary/Receptionist (1) 10/23/2024  Recap Name the 3 domains of learning Define the domains of learning What is a clinical competency? Define direct supervision – indirect supervision Explain what is meant by clinical competency evaluation. Name the steps involved in progressive clinical development. List and describe basic courses essential to the RT education.