RAD 103 Study Guide PDF

Chapter 1 INTRODUCTION TO RADIOLOGIC AND IMAGING SCIENCES Objectives (1 of 2) 1. Explain the use of radiation in medicine. 2. Provide an overview of the history of medicine. 3. Describe the discovery of x-rays. 4. Define terms related to radiologic technology and the other radiologic a...

Chapter 1 INTRODUCTION TO RADIOLOGIC AND IMAGING SCIENCES Objectives (1 of 2) 1. Explain the use of radiation in medicine. 2. Provide an overview of the history of medicine. 3. Describe the discovery of x-rays. 4. Define terms related to radiologic technology and the other radiologic and imaging sciences. 5. Explain the career opportunities within the professions of radiologic and imaging sciences. Objectives (2 of 2) 1. Identify the various specialties within a radiologic and imaging sciences departments. 2. Describe the typical responsibilities of the members of the radiologic and imaging sciences team. 3. Explain the career-ladder opportunities within radiologic and imaging sciences. 4. Discuss the roles of other members of the health care team. Medical Radiation Sciences Medical radiation sciences uses energy to create images of the human body. Various energy forms may be used depending on the application. Some energies create ionizations in human tissue. What is Radiation and Ionization? Radiation- energy transmitted by waves through space or through matter Ionization- when a neutral atom gains or loses an electron which then gains a net charge Energy Forms for Imaging Sound Medical sonography  Electrical Electrocardiography Electroencephalography Heat (thermal) Thermography Magnetic/Radio Wave Magnetic resonance imaging Electromagnetic X-rays Radio waves Nuclear Nuclear medicine technology (Gamma radiation) Why is the term ‘imaging science’ preferred to the ‘radiologic sciences? Imaging science can include technologies that do not involve radiation e.g. U/S & MRI Medical Sonography A diagnostic medical sonographer uses high frequency sound waves to create images Uses high-frequency sound energy to create medical images Does not create ionizations Has wide variety of medical applications Magnetic Resonance Imaging Uses the energy of high-strength magnetic fields and radio waves to create images of the human body Creates no ionizations CT Scanning Uses x-ray energy and sophisticated software to create images of the human body Nuclear Medicine Uses the energy of the atom to create medical images Energy form is gamma radiation Uses radioactive isotopes to create gamma radiation Radiation Therapy Uses very–highenergy ionizing radiation to treat malignant tumors (cancer) Radiation therapists work with other team members to improve the quality of life of cancer patients Cardiovascular Interventional Imaging Uses x-rays to visualize human blood vessels and heart anatomy Requires the use of a catheter and the injection of x-ray contrast material to visualize anatomy What is Radiography? Making of records or producing radiographs of the internal structures of the body Uses electromagnetic energy in the form of x-rays to create medical images What is the other name for x-rays? Roentgen rays History of Radiology Discovered by Wilhelm C. Röngten November 8, 1895 Received Nobel Prize in Physics in1901 First known xray image is of wife’s hand Radiologic Sciences as a Career Offers a wide variety of career paths Often begins with a general radiography background Specialty areas require additional education and certification Career opportunities are nearly limitless and demand initiative and a desire for professional success Career Opportunities Radiography CT Scanning Medical Sonography Radiation Therapy Medical dosimetrist  MRI Scanning Mammography Bone densitometry DEXA Scanning Radiologist Assistant Nuclear Medicine Cardiovascular Interventional Technology PACS Administrator Radiology Administration Education Research Commercial Firms Sales Applications Service Radiographers Radiographer uses x-ray to create images of bones and body parts After passing the ARRT examination what initials can a technologist place after his/her name? RT (R) What are radiopharmaceuticals? Radioactive material, tracers, radioactive solutions that can be administered intravenous, orally or by inhalation. Technician vs. Technologist Training of a technologist typically involves higher level of problem-solving skill and more extensive education Radiology Can be referred to by a number of different names  Radiology X-ray Medical imaging Diagnostic services Imaging services Imaging Predominantly a diagnostic service that focuses on imaging of patients to diagnosis their medical condition Health Care Team Team members: Physicians Nurses Allied health Supporting members Nonclinical Most health careers are referred to as allied health Hospitals are communities within communities Conclusion Xrays were discovered by W.C. Röngten in 1895. Medical imaging consists of many diagnostic areas involving energy, and particularly, radiant energy. Radiologic sciences professionals perform as essential members of a healthcare team. Career opportunities are nearly limitless and demand initiative and a desire for professional success. Chapter 2: Professional Organizations Objectives Differentiate accreditation, certification, and representation functions of various professional organizations. Describe the organizations that carry out the professional aspects of a specific radiologic and imaging sciences area of specialization.  Describe the relationship of various radiologist and physicist organizations with radiologic and imaging sciences. General Classifications of Organizations Accreditation Certification Licensure Professional Organizations Accreditation A process to ensure high quality of operations and offerings A voluntary, peer review-process Involves several areas within health care Accreditation of Schools Joint Review Committee on Education in Radiologic Technology (JRCERT) Joint Review Committee on Education in Diagnostic Medical Sonography (JRCDMS) Joint Review Committee on Education in Nuclear Medicine Technology (JRCNMT) Joint Review Committee on Education in Cardiovascular Technology JRCERT Established in 1969 Board members nominated by four professional organizations concerned with radiology education Currently accredits programs in: Radiography Radiation Therapy Technology Medical Dosimetry Magnetic Resonance Imaging Concerned with compliance with education standards developed by and for the profession of radiologic technology Governed by a Board of Directors known as the Joint Review Committee JRCERT accreditation requires demonstrated compliance with minimum requirements known as Essentials and Guidelines or Standards JRCDMS Concerned with compliance with education standards developed by and for the profession of medical sonography Established in 1979 and is sponsored by nine organizations Currently accredits approximately 170 institutions dealing with medical sonography JRCNMT Concerned with compliance with education standards developed by and for the profession of nuclear medicine technology Established in 1970 and is sponsored by four organizations Currently accredits approximately 100 nuclear medicine technology programs JRC-CVT Deals with programs seeking accreditation in cardio-vascular imaging: Also provides national accreditation through Commission on Accreditation of Allied Health Education Programs (CAAHE) Established in 1985. Currently is sponsored by 6 organizations Certification 1 of 3 Deals with the demonstration of minimum competencies in recognized professional skills and knowledge. Generally, competency is demonstrated by a test A voluntary process and highly sought after by professionals within health care. It is your personal responsibility to achieve and maintain professional certification. Certification 2 of 3 Certifications offered in a variety of medical imaging professions: Radiography (R) Nuclear medicine technology (N) Radiation therapy technology (T) General sonography (S), vascular sonography (VS), breast sonography (BS) CT scanning (CT) MRI scanning (MR) Cardiac interventional technology (CI) Vascular interventional technology (VI) Quality management (QM)  Bone densitometry (BD) Radiologist assistant (RA) Certified professionals are listed in a national registry as proof of achievement. Certification provides the privilege of displaying professional credentials as earned. Certification 2 of 3 Certifications offered in a variety of medical imaging professions: Radiography (R) Nuclear medicine technology (N) Radiation therapy technology (T) General sonography (S), vascular sonography (VS), breast sonography (BS) CT scanning (CT) MRI scanning (MR) Cardiac interventional technology (CI) Vascular interventional technology (VI) Quality management (QM) Bone densitometry (BD) Radiologist assistant (RA) Certified professionals are listed in a national registry as proof of achievement. Certification provides the privilege of displaying professional credentials as earned. Certification 3 of 3 Certified professionals are listed in a national registry as proof of achievement: Many require ongoing continuing education Certification provides the privilege of displaying professional credentials as earned: RT(R), (CT), (ARRT) RT(R), (M), (ARRT) Popular Certification Agencies in Medical Imaging American Registry of Radiologic Technologists (ARRT) Founded in 1922 www.arrt.org American Registry of Diagnostic Medical Sonographers (ARDMS) Founded in 1975 www.ardms.org Nuclear Medicine Technology Certification Board (NMTCB)  Founded in 1977 www.nmtcb.org State Licensing Agencies Some states may require state licensing to practice radiologic technology. Laws can vary greatly from state to state. It is your responsibility to identify which states have licensing. Contact the ASRT for a current listing. Many states will honor certification from a nationally recognized agency such as the ARRT. Known as licensure Professional Societies Professional societies represent the general welfare of their members. These duties may include: Education Scholarships Research and special reports Governmental affairs and appointments Malpractice insurance plans What is the ARRT Definition of Certification & Registration? Certification Meet all initial eligibility requirement Registration Meet of all continuing eligibility requirements Number of Graded Question on ARRT Examination 200 graded 30 pilot Timing limitations involved in taking the ARRT examination Candidates have a 90-day window within which they can schedule a test appointment Candidates have a three –year window in which they are allowed three attempts to pass Candidates can appeal test administration up to two days after taking an exam Why are there continuing education requirement for the RTs? Bridge the gap between initial formal education and advanced practical needs. Prevent professional obsolescence Assure the public (primary customers) that all technologist maintain competency Advance the profession through continuous growth of all technologists working in the field Provide advanced growth opportunities for technologists through advanced preparation What Are The Continuing Education Requirements? Mandatory proof of continuing education and proof are required biannually (2-year) biennial increments. Credits run from the first day of your birth month to the last day of the month before your birth month two years later. 24 credits each 24 months. How do you document CE credits? Date(s) of attendance Topic/subject title Content of the education opportunity Number of (50-min) contact hours Name of speaker/presenter Name/signature of sponsor or authorized representative The CE –approved reference number when applicable Documentation must be maintained for one year beyond the end of each biennium Actual documentation does not accompany renewal forms. ARRT conducts random audits Noncompliance with CE REQUIREMENTS Technologist not obtaining the necessary continuing education is considered on probation. Probation is granted only for 1 yr. of the next biennium. Further non-compliance during the next 12 months – individual loses ARRT certification. Approval of CE courses?  Only Recognized Continuing Education Evaluation Mechanisms (RCEEMS) organizations can approve CE courses for RTs Obtaining CE Credits Professional societies In-services education (done by the institutions where the technologist is employed Private Companies Continuing Qualification Requirements (CQR) All R.T.s, primary and post-primary certifications earned on or after January 1, 2011, are time-limited to 10 years. Recertification requires completion of the CQR process, and the very first CQR deadline is not until 2021. Chapter 3 Educational Survival Skills Objective 1of 2 Discuss the causes and symptoms of stress. Explain behaviors and thoughts that increase the fight-or-flight response. Analyze interventions that can be used to reduce or buffer stressors. Describe several survival techniques to reduce stress. Enumerate steps to manage time through organization, limit setting, and self- evaluation. Objective 2 of 2 Explain the benefit of uplifts in relation to hassles. Identify foods that can be eaten to supply the body nutritionally with additional vitamin C, vitamin B complex, and magnesium. Foster study techniques to enhance retention and to build information into complex concepts. List the steps for successful test taking. Stress  Produced by life events that place a perceived demand on daily activities Causes emotional and biologic changes in the body What is the fight or flight response? Physiologic reaction to a real or imagined threat, arising from emotions of both fear and anger. Physiologic responses include: Increased metabolism of fats/sugars for energy Release of hormones Increased blood flow and cardiac output Stimulated central nervous system What happens to the body during flight or fight response? Your heart rate gets faster, which increases oxygen flow to your major muscles. Your pain perception drops, and your hearing sharpens Your blood pressure rises, and hormones rush into your bloodstream to send sugar to your muscles and brain. Food digestion temporarily ceases so that more blood is available for energy. Typically, it takes 20 to 30 minutes for your body to return to normal and to calm down Stress and your education Radiologic and imaging sciences education offers a unique and completely new set of challenges: o New technology o Clinical experiences o Caring for patients that can be difficult o Performing in a high-stress environment o Stressful events may come at you from many sources: ▪ Family ▪ Friends ▪ Employers and co-workers Strategies to Deal with Stress Self-image is important. Understand the environment around you that is adding to your stress.  Learn to lessen or remove yourself from stressful situations, whenever possible. Adopt a strategy of positive thoughts and emotions. Learn to politely say “no” to those who want to place extraordinary demands on you. Signs of Stress Many signs of stress are physiologic. Family and friends can often sense your stress. Emotions may be noticeably altered. Stressors vary from person to person Stressors A stressor is any event that adds stress to your life. Stressors are unique to the individual. Stressors are best dealt with by using strategies to “buffer” the stress event. Recognize that many stressors are outside of your control. Strategies to Deal with Stressors Know the difference between a stressor and a “hassle.” Plan positive activities (uplifts) to balance the effects of hassles and stressors. Avoid conversations that show out-of- control language and replace with in-control language. Understand the “worry” process and that all stress can never be eliminated completely. Worry Process Recognize when the worry process is in your vocabulary and thought processes. 95% of things you worry about never turn out the way you might expect them to. Many times, we worry about things out of our sphere of control. Procrastination is a “worry contributor.” “Worry” Survival Techniques Avoid procrastination. Take control of your “worry process.”  Identify those events over which you have some degree of control, and exercise it accordingly. Understand that most worrisome events never turn out as you thought they would. Don’t build “worry mountains.” Time as a Stressor We have little or no control over the amount of time available. Practice time management. Avoid indecisiveness when making choices. Set realistic completion timelines. Practice self-management. Self-Management 1. Know yourself. 2. Prioritize your responsibilities. 3. Prioritize your activities. 4. Plan for self-care. Stress Buffer Stress buffers can help reduce the harmful effects of stress. Can you name some stress buffers that work for you? Test-Taking Tips Take a “study-rest-day” the day before a major exam. Avoid last-minute cramming for exams. Wear bright, colorful clothes the day of exams. Avoid a heavy, high-carbohydrate meal before exams. Get a good night’s sleep the night before an exam. Arrive for a test early to prepare mentally. Scan the entire test to develop a test strategy. Answer questions you know first: Tackle remaining questions requiring deeper thought. Review the test carefully and make corrections after additional thought.  Check test answer sheet and correlate with test numbering. After the test is done, “let it go” and learn from the experience. Conclusion Please remember that you are about to become a member of one of the greatest professions in medicine. Take time to consider the wonderful opportunity before you: enjoy the journey with solid strategies for handling stress, studying, and demonstrating your accomplishment of new knowledge and skills. CHAPTER 4 CRITICAL-THINKING AND PROBLEM-SOLVING STRATEGIES OBJECTIVES (1 OF2) 1. Define critical thinking and problem solving. 2. Discuss the importance of critical thinking and problem solving in the radiologic and imaging sciences. 3. Describe the role of critical thinking in clinical, ethical, and technical decision making. 4. Use the steps involved in problem solving. 5. Apply teamwork and self-reflection in critical thinking and problem solving. OBJECTIVE (2 OF2) 1. Analyze and determine appropriate actions for situations that require critical thinking. 2. Identify professional situations that use critical thinking and problem solving skills. 3. Develop critical thinking and problem-solving skills as a radiologic and imaging sciences professional. CRITICAL THINKING Critical thinking involves sound professional judgment applied with high ethical standards and integrity. Professional knowledge and experience.  The nature of medical imaging inherently requires critical thinking skills. Critical thinking skills are traits that employers expect in competent radiologic and imaging sciences professionals. CRITICAL THINKING AND PATIENT CARE Each and every patient experience is unique. Requires adaptability and creativity. Warrants reflection and self-assessment for improvement. CRITICAL THINKING IN LEARNING CRITICAL THINKING REQUIRES MORE THAN JUST THE SIMPLE RECOLLECTION OF KNOWLEDGE AND FACTS. LEARNING ACTIVITIES MAY CONSIST OF PROBLEM SOLVING, ROLE PLAYING, LAB SIMULATIONS, CASE STUDIES, SITUATIONAL JUDGMENT QUESTIONS ON EXAMS, AND SO ON. CRITICAL-THINKING SKILLS ARE TAUGHT AT HIGHER LEVELS OF LEARNING THAT REQUIRE SKILLS IN THE ANALYSIS, APPLICATION, AND EVALUATION OF CONTENT. PROBLEM-SOLVING AND CRITICAL-THINKING STEPS 1. IDENTIFY AND CLARIFY THE PROBLEM. 2. PERFORM AN OBJECTIVE ANALYSIS OF THE PROBLEM. 3. DEVELOP REALISTIC SOLUTIONS TO THE PROBLEM. 4. CONSIDER ALL VIABLE SOLUTIONS TO THE PROBLEM. 5. SELECT THE BEST SOLUTION TO THE PROBLEM, AND IMPLEMENT IT. CRITICAL-THINKING LEARNING CRITICAL-THINKING SKILLS ARE TAUGHT IN A VARIETY OF LEARNING SETTINGS. CRITICAL THINKING ALSO INVOLVES YOUR VALUES AND ATTITUDES TOWARD VARIOUS SITUATIONS ENCOUNTERED IN MEDICAL IMAGING. CRITICAL THINKING IN THE CLINICAL SETTING Critical thinking will require you to thoroughly understand your ethical responsibilities. Every patient experience is unique and requires adaptive measures in a wide variety of settings.  A complete understanding of the principles of this profession is essential. STEPS IN CRITICAL THINKING AND PROBLEM SOLVING 1. Identify the problem. 2. Investigate the problem, objectively. 3. Develop viable solutions. 4. Select the best solution and implement it. CLINICAL APPLICATIONS OF CRITICAL THINKING AND PROBLEM SOLVING Requires a thorough understanding and compliance with ethics of the profession. Requires complete technical competency. Requires patient interactions and an understanding of their uniqueness CASE STUDY 1 You are a technologist working the third shift alone in a small community hospital. You have received a phone call from the local police department regarding a motor vehicle accident patient you radiographed earlier that evening. The person calling is the officer who was in charge of the accident investigation. In the process of completing his paperwork, the officer has asked you to provide him with the results of the radiographic examination. He is insistent and indicates that he has done this many times before at your hospital, as well as at the other hospitals in the area. CASE STUDY 2 You work as a mammography technologist in a small community hospital. After the morning activities have been completed and while you are at lunch with your co-workers, you overhear a conversation between two hospital staff members regarding a mammography patient you saw earlier that morning. The conversation of the staff members is not subtle, and you are certain almost everyone in the immediate area heard some portion of the conversation. You are also aware that the information you overheard is clearly inaccurate. CASE STUDY 3 You are working with one of your team members to complete a digital portable chest radiograph. The portable X-ray machine displays patient information on the computer screen as part of its normal operation. Following the completion of the portable exam, the unit is parked in the hospital ER corridor and left there as your coworker hurries off to lunch. What should you do before joining her for lunch? CRITICAL THINKING: WHEN DO WE USE IT? PATIENT #1: A 86-year-old woman in a wheelchair with difficulty walking – she needs a chest x-ray, and the doctor wants the image with the patient erect PATIENT #2: A 3-year-old boy who injured his arm and is screaming at the top of his lungs – he needs an x-ray examination of his elbow. He will need to stand still for the x-ray PATIENT #3: The vice-president of the hospital – he has a nurse’s order for an ankle x-ray, because he rolled his ankle on the curb. The nurse was not authorized to order any x-ray PATIENT #4: An auto accident victim coming from the ER – he needs cervical spine, chest, right shoulder, and wrist x-rays. His spine is not stabilized to prevent further injury Chapter 5 Introduction to Clinical Education Objective 1 of 2 1. Define terms that relate to the clinical education of radiologic and imaging sciences professionals. 2. Explain the purpose of the clinical education in radiologic and imaging sciences. 3. Describe the steps students may experience in the development of their clinical education skills. 4. Identify the types of supervision necessary to assure safety in the clinical setting. 5. Describe aspects of assessment used to measure and document student performance during clinical education. Objective 2 of 2 1. Explain the importance of adherence to clinical education policies regarding supervision and patient safety.  2. Explain the communication strategies and steps taken by health care workers in the clinical setting to assure continuity of care and patient safety. 3. Describe aspects of Team STEPPS and SBAR as they support teamwork and positive patient outcomes in the clinical setting. 4. Describe the concept of interprofessional education (IPE) and its relevance to the education of healthcare professionals and a collaborative work environment. Education in Radiologic Sciences The clinical setting allows the student to integrate the knowledge gained from didactic courses into clinical practice while caring for patients. Education as a radiologic and imaging sciences professional will include three areas of learning: o Cognitive o Affective o Psychomotor What is the purpose of Clinical Education The purpose of a clinical education is to provide an environment in which the student can transfer learning from the didactic and laboratory settings to real- world, patient-care experiences Requires prior learning in the classroom and laboratory Permits one-on-one, direct patient contact Learning Is a Continuum As your education proceeds, it will necessarily shift from didactic instruction to more clinical education, in a variety of clinical settings. Taxonomy of Learning Cognitive domain: o Deals with concepts, information, knowledge Affective domain: o Deals with values, attitudes, emotions, feelings  Psychomotor domain: o Deals with connection between cognitive learning and motor skills Learning Process Based on performance objectives. Learning observed and measured by way of competencies. Learning outcomes are essential to assessing competency and program effectiveness. What are Competencies? ARRT has established a minimum number of clinical competencies in various exam categories. Competencies are in three classifications. o Mandatory competencies o General patient care competencies o Elective competencies Eligibility for the ARRT credentialing examination requires all clinical skills and competencies completed and documented by program officials. Competency Needed Ten mandatory general patient care procedures; 36 mandatory imaging procedures; 15 elective imaging procedures selected from a list of 34 procedures; o One of the 15 elective imaging procedures must be selected from the head section o Two of the 15 elective imaging procedures must be selected from the fluoroscopy studies section. Major Clinical Education Policies Supervision  Performance of Actual Examinations Simulations Assessments Radiation Protection Practices Professional Ethics Practice Standards HIPAA Professional Appearance and Behavior Attendance & Tardiness Pregnancy Disciplinary Procedures 3 phases of Clinical Development 1. Observing Watching someone else performing the procedure 2. Assistance Actual performance of the procedure on the patient with help 3.Performance Demonstrating ability to successful perform all examinations independently DIRECT SUPERVISION Supervision is provided by a certified radiographer/clinical instructor. It is the responsibility of the radiographer/clinical instructor to: o review the consult to determine the examination in relation to the student’s level of achievement o evaluate the condition of the patient in relation to the student’s knowledge o be physically present in the radiography room while the student performs the radiographic examination o review and approve the final radiographs INDIRECT SUPERVISION Supervision is provided by a certified radiographer who is immediately available to assist student, regardless of the level of student achievement o “Immediately available” is interpreted as the presence of a radiographer in or adjacent to the room or location where the procedure is being performed. o The radiographer should not be involved in an additional radiographic procedure, as this could render the radiographer not immediately available under some circumstances. Pregnancy Policy 1. Disclosure of a student’s pregnancy is voluntary. 2. Students strongly encouraged to declares the pregnancy immediately upon knowledge of the pregnancy 3. The declaration of pregnancy may be withdrawn by the student at any time, but she must do so in writing to the Program Director. Declared Pregnant Student 1. Gets a baby monitor 2. Continue without any interruption in the program. 3. Continue with deferral of fluoroscopy, surgery and portable rotations until pregnancy is completed. These rotations will be made up. 4. Continue with classroom participation only. All clinical rotation requirements deferred until pregnancy is completed. These rotations will be made up. 5. Withdraw from the program and reenter later upon completion of the pregnancy. Radiographic and Fluoroscopic Equipment & X-ray Tube Adler Chapter 8 (p89 – 103) Bushong Chap7 (p113-126) Objectives 1. Discuss the role of the radiographer in maximizing diagnostic yield. 2. Identify the typical features of a radiographic system. 3. Explain radiographic equipment manipulation. 4. Explain the purpose of the collimation assembly and its importance in radiation protection.  5. Distinguish among the various types of radiographic tables and their functionality. 6. Explain the major controls on the radiographic system control console. 7. Differentiate between the types of tube support systems. 8. Briefly explain the operation of photostimulable phosphor (PSP) technology. 9. Explain the purpose of the upright image receptor and its functionality. 10. Discuss the concept of alignment of the various radiographic system components. 11. Briefly discuss the two classes of digital imaging detectors and future technologies resulting from digital detectors. 12. Summarize the significant R/F equipment design changes that have resulted in modern-day equipment design and functionality. 13. Discuss mobile radiographic systems and their applications. Diagnostic Yield The amount of clinically useful information on a diagnostic image Different medical imaging modalities provide different types of information o Radiography o Fluoroscopy o Sonography o CT scanning o MRI scanning o Nuclear medicine Each modality has its own considerations for ordering the procedure. o Physicians expect a certain amount of diagnostic yield when exams are ordered. o Diagnostic yield of information must outweigh the input factors of the procedure. o Competent imaging professionals will strive to maximize diagnostic yield using a minimum of input factors. Diagnostic Efficacy The accuracy of diagnostic information on a medical image is its diagnostic efficacy. Any extraneous information on an image that does not reflect the patient’s true medical condition detracts from diagnostic efficacy. Diagnostic efficacy and diagnostic yield must be optimized as the standard of care. X-Ray Machine Design Features Radiographic table  X-ray generator and control Upright image receptor Chest stand X-ray tube and x-ray tube support Collimator assembly X-Ray Tube Design 1. Tube is inside a lead-lined metal housing. 2. Made of heat tolerant, Pyrex glass with high vacuum. 3. Produces X-radiation when high-energy electricity passes through the tube. 4. X-radiation exits the tube through a window in the housing and is directed toward a patient. Radiographic Table 1. May be fixed height or variable height 2. Typically has a four-way “floating” tabletop 3. Some table designs permit a variable-speed, tilting capability. 4. Uniform radiolucent surface Must be: Easy to clean Free of crevices that could collect contrast media Difficult to scratch Bucky tray Tilting Radiographic Table These designs permit table tilt from horizontal position to vertical, upright position, to Trendelenburg. Most tables have four- way tabletop travel. Tables typically do not have variable height capabilities. Bucky Assembly Consists of a receptor tray and radiographic grid Tray holds receptor tightly in position and is centered to longitudinal axis of table. Radiographic grid oscillates during exposure to blur out the lead grid lines. Console  Control console is the interface between the radiographer and the sophisticated electronics of the x-ray machine. Console features include the exposure button. Operating/Control Console Most are microprocessor controlled and use a simple computer interface. Permits selection of all exposure factors. o mA, Time (S), mAs o KVp o Focal spot size o Automatic exposure control (AEC) Operating console o Can be digital with touch screen technology o Anatomical programming (APR) Uses icons to indicate body parts, size, and shape o Newer systems may be integrated with a digital radiographic (DR) detector Exposure Technique Selection Consists of three key factors o kVp – penetrating power of the beam o mAs – number of x-ray photons in the beam o SID – distance from the source to the IR Other factors o Automatic exposure control (AEC) may be optional o Focal spot size selection o Exposure technique selection may be anatomically programmed. o Technique selection is critical to good radiography. Anatomically Programmed Radiography (APR) APR is a radiographic system that allows the radiographer to select a particular button on the control panel that represents an anatomic area. A preprogrammed set of exposure factors is displayed and selected for use. Once an anatomic part and projection or position has been selected, the radiographer can adjust the exposure factors that are displayed. Exposure Switch Used to take the x-ray  o Type o Deadman switch Method of use o Depress in one motion to maximize tube life Features o Separate anode and rotor switches also used E.g. Prep before the exposure o Mobile equipment requires 1.8 meters (approx. 2m) or (6-foot cord) External Components of X-ray Room Ceiling support system o Allows for longitudinal and transverse travel of the x-ray tube. Telescoping column o attaches the x-ray tube housing to the rails o allows for variable SID o Detent position o position the x-ray tube assumes when it is centered above the x-ray table o Locks o Locks the tube in place or allows the tube to ‘float’ X-Ray Tube Supports Two basic designs: o Floor Mounted o Ceiling suspended Other Features o Facilitate easy and efficient positioning of the x-ray tube assembly around the patient in any orientation o Capable of various motions depending on need o Ergonomically friendly o Aesthetically pleasing and not intimidating to patients Overhead Tube crane (OTC) Motions Tube Travel Vertical travel Longitudinal Transverse l Vertical axis rotation Tubehead rotation Collimator Assembly Controls the size and shape of the x-ray field directed toward the patient Projects a high-intensity light field on the patient, which represents the area of the x-ray field exposure May be manual or automatic (PBL) User-Friendly Overhead Tube/crane Controls (OTC) Newer overhead tube crane(OTC) designs permit selection of exposure factors at the tube head control, with a flat panel screen. Digital radiography systems may display the image from the last exposure for review. Auto-tracking feature permits synchronous movement of OTC and vertical upright holder. Exposure requires the operator to be behind the control booth. Image Receptors Receive remnant radiation from patient and convert x-ray energy into electronic signals. Most systems are digital radiography (DR). Computed Radiography (CR) also called PSP is in limited use and quickly being replaced with DR. Referred to as flat-panel technology. Receptor is a cassette-style design. Often referred to as a “panel” DR systems use thin-film transistors (TFTs). o Indirect digital detector technology o Direct digital detector technology Type of X-ray System Digital Radiography (DR)- uses flat panel detectors Indirect Direct Computed Radiography (CR)- uses reusable phosphor plates to capture images Fluoroscopy Provides live, real-time images of patients using x-rays  Requires special equipment designs that feature an x-ray tube with attached image receptor in a perpendicular relationship Used for a wide array of diagnostic procedures Radiographic/Fluoroscopic (R/F) System Capable of static radiographic imaging as well as live imaging (fluoroscopy) Complete system consists of R/F table, image receptor, x- ray generator and control, ceiling-mounted x-ray tube and video display monitor. Image intensifier above the table Newer systems replace the image intensifier with a flat panel fluoroscopy detector. Tilting Radiographic Table These designs will tilt the table from horizontal position to vertical upright position to Trendelenburg. These tables typically do not have variable height capabilities. Mobile X-Ray Imaging Mobile radiographic units are used extensively in hospitals and clinical settings. Travel movement is motorized. X-ray capabilities similar to those of a fixed radiographic unit. Mobile X-Ray Unit High-frequency output Limited power for X-ray studies. Commonly referred to as a “portable”. Need to be plugged into wall outlet for charging when not in use Mobile X-Ray Features Newer systems use a wireless portable DR detector to replace cassette. Exposure switch on a coiled cord to maximize distance from patient during exposure Length = Approx 2 meters Mobile Fluoroscopy Commonly called a “C-arm” due to its design. Fixed SID and centered to X-ray tube. System components.  C-arm and generator Monitor cart with on-board computer Image processing and enhancement Typically, 2- monitors C-Arm Fluoroscopy System Used in a variety of settings. o ER o Surgery o Pain clinics o Interventional fluoroscopy procedures E.g. Heart stenting o Mini-C arms popular for small body parts. o Limited power o Newer systems use digital technology X-ray Production Process What year was x-ray discovered? o X-rays were discovered in 1895. X-ray beam energy is produced using high- voltage electricity. X-rays pass through matter and strike an image receptor. o Image receptor converts the energy of x-rays into an image X-Ray Production Requirements X-ray tube with a vacuum inside. Source of electrons o Cathode filament Method to accelerate electrons to great speed. o Voltage Method to stop electrons and cause energy transformation. o Target X-ray Tubes Tube is inside a lead-lined metal housing. Made of heat tolerant, Pyrex glass with high vacuum. Produces X-radiation when high-energy electricity passes through the tube.  X-radiation exits the tube through a window in the housing and is directed toward a patient. Oil bath –a thermal cushion to dissipate heat Glass x-ray tubes are made of Pyrex (borosilicate glass) that is resistant to heat What is a vacuum? An empty space in which there is no air or other gas Why a Vacuum? Allows for efficient x-ray production if the tube become gassy – electron flow from cathode to anode is reduced. Leakage Radiation Radiation exiting the x-ray tube at areas other than the window of the tube Tube Design Cooling Fan o To Dissipate Heat Oil expands when heated – bellows-like device allows for expansion and a microswitch activated to prevent exposure if expansion is too great. Tube Window o Area of glass or metal enclosure that is thin to allow passage of x-ray beam Function of Cathode Negative side of the x-ray tube has two parts – filament & focusing cup. An electric current will cause the filament to glow an emit heat & electrons Small & Large Filament Sizes Small used with the small focal spot Used to image small body parts. Large used with the large focal spot. Used to image large body parts. Material of Filament Coil of tungsten wire. Unlikely to burn out or takes longer to vaporize. Has a very high melting point Focusing Cup Negatively charged to confine electrons to a small area on the anode The focusing cup forces the emitted electrons to keep together as they travel to the anode Plays a vital role in the production of x-ray Dissipates heat Positive side of the x-ray tube o Components: ▪ Anode ▪ Stator ▪ Rotor Material of Anode Tungsten (tungsten-rhenium alloy) The stem is made of molybdenum the rotor made of copper Graphite is the material immediately below the tungsten Why Tungsten? High melting point (3400⁰C. vs. 1100 for copper) can withstand higher tube currents without pitting or bubbling High thermal conductivity – Efficient metal for dissipating heat Thermal conductivity Ability of a given material to conduct/transfer heat THE TARGET Area on the anode struck by electrons from the cathode Stationary anode uses tungsten alloy embedded in copper anode. Rotating anode – entire anode disc is the target Useful Beam X-rays emitted from the x-ray tube window x-rays are emitted isotopically (equal intensity in all direction.) What is Anode Heat? The heating of the anode with electron bombardment Kinetic energy of projectile electron is converted to heat. Doubling the tube current doubles, the heat produced  Heat produce is directly related to increased kVp Tube Failure Too rapid heating of anode Glass housing can crack Vaporized tungsten on the glass or metal enclosure can disturb the electric balance of the x-ray tube current – leading to arcing and tube failure. Prolonged heating of anode – causes pitting and melting or cracking Damage to the ball bearing – causes a wobble anode rotation Broken filament Extending Tube Life Using factor appropriate Faster imaging systems Heat Dissipation in X-ray Tubes Occurs by x-ray exposure caused by Radiation transfer of heat by emission of electromagnetic radiation, including x-rays, visible light, ultraviolet, and infrared Heat Dissipation in X-ray Tubes After the exposure o Conduction – From the stem to rotor assemble to oil bath transfer of heat by touch o Convection –Within the oil bath –transfer of heat by the movement of a heated particles from one place to another Purpose of Warm-Up Procedure To spread heat over the entire target surface Prevent uneven thermal expansion or concentration of heat in a single spot Should be performed if the tube has not be used for an extended period o E.g. of warm up exposure: Two 70kV exposures at low mA and 3 seconds Important to Remember!  1. The only radiation that is of any clinical value is: a. Remnant radiation absorbed in the detector. b. Converted to an electrical signal, digitized, and sent to a computer for processing. c. Creates electronic data set d. Finally presented as a radiographic image for interpretation. Projections & Positions Terminology General, Systemic, and Skeletal Anatomy and Arthrology Levels of Human Structural Organization Cells– Basic structural and functional unit of the entire human being. Every part of the body is composed of cells Tissue– Groups of similar cells which together with their intercellular material will perform a specific function Organs– Tissues that are joined to perform a specific function. Generally have specific shape. Systems– group or association of organs that have similar or common function. 10 systems in the body Circulatory System Distributes oxygen to cells Transports waste products from cells Digestive System Absorption Elimination Respiratory and Urinary Systems Respiratory System – Supplies oxygen – Eliminates carbon dioxide  Urinary System – Regulates blood – Eliminates waste products Reproductive System Reproduces organism 1. Ovaries 2. Testes Nervous and Muscular Systems Nervous System – Regulates body activities Muscular System – Allows for movement – Skeletal, visceral, and cardiac types Endocrine and Integumentary Systems Endocrine System – Ductless glands of body – Regulates body via hormones Integumentary System – Protects the body – Eliminates waste through perspiration Skeletal System 206 separate bones Axial and Appendicular Skeletons o Axial skeleton (80 bones) – Central axis of body – Skull, vertebral column, ribs, and sternum o Appendicular skeleton (126 bones) – Limbs – Shoulder and pelvic girdles Short and Flat Bones Carpal and tarsal bones  Calvarium, sternum,ribs, and scapulae Classification of Bones Long Bones Limbs Compact bone Spongy bone Periosteum Irregular Bones Limbs Peculiar shapes (vertebrae, facial bones, and pelvic bones) Classification of Joints (Arthrology) Structural (classified by tissue type) Functional (classified by function) Fibrous (held together by fibrous tissue) Synarthrodial (immovable) Cartilaginous (held together by cartilage) Amphiarthrodial limited movement) Synovial (synovial fluid in joint capsule) Diarthrodial (freely movable) Synovial Joints Movement Types – Plane (gliding) – Ginglymus (hinge) – Trochoid (pivot) – Ellipsoid (condyloid) – Sellar (saddle) – Spheroidal (ball and socket) – Bicondylar Synovial Joints Movement Types 1. Plane (gliding) 2. Ginglymus (hinge) 3. Trochoid (pivot) 4. Bicondylar/Ellipsoid/ Condyloid 4. Bicondylar/Ellipsoid/Condyloid 5. Sellar (saddle) 6. Spheroidal (ball and socket) Projection Projection describes the direction or path of travel of the x-ray bean (central ray or CR) Positions Position describes the actual patient position in relationship to the x-ray table or image plate (cassette). Position can also refer to general body position e.g. seated, standing etc. E.g. We are going to perform a PA projection of the chest with the patient in the upright position Anatomical Position Patient standing erect with the face and eyes directed forward, arms extended by the sides with the palms of the hands facing forward, heels together, and toes pointing anteriorly Posterior/dorsal – back Anterior/ventral- front PA projection Patient’s front is to the IP The x-ray travels through the patient from the back to the front AP Projection Patient back is to the IP The x-ray travels through the patient from the front to the back AP & PA Anteroposterior (AP) projection – CR passes from anterior to posterior aspect of the body  Posteroanterior (PA) projection – CR passes from posterior to anterior aspect of the body Lateral The central ray enters the left or right side of the patient’s body – Lateral can be used to describe a patient position, a projection or the relationship between two structures Oblique Oblique – Rotation of trunk between lateral and prone or supine position Projection – PA oblique (Posterior Oblique) Position – Left Anterior Oblique or LAO Left side down – The right anterior oblique (RAO) places the Right side against the IP Right side down Body Planes Sagittal plane – divides into ANY right and left sections Median/midsagittal plane – Divide patient EQUAL right and left sections Planes Coronal (frontal) plane – dividing patient into ANY anterior and posterior sections Mid Coronal – dividing patient into EQUAL anterior and posterior sections Planes Sagittal plane - divides into ANY right and left sections Median/midsagittal plane - Divide patient EQUAL right and left sections Coronal (frontal) plane - dividing patient into ANY anterior and posterior sections Mid Coronal - dividing patient into EQUAL anterior and posterior sections Horizontal/Transverse plane - any horizontal plane at right angle to coronal or sagittal plane Oblique plane - any plane not classified as any of main planes i.e. slant or deviate from the perpendicular, or horizontal, longitudinal or transverse External Body Landmarks Cervical area C1 Mastoid tip C2/ C3 Gonion (angle of mandible) C3/ C4 Hyoid bone C5 Thyroid cartilage C7/ T1 Vertebra prominens Thoracic area T1 2 in (5 cm) above level of jugular notch T2/ T3 The jugular notch T4/ T5 The sternal angle T7 The inferior angles of scapulae T9/T10 The xiphoid process Lumbar area L1/L2/ L3 The Inferior Costal margin Navel Approximately L3 (not accurate because of body habitus) L4/ L5 Superior aspect of crests Sacrum and pelvic area L5/S1 At the Posterior Superior Iliac Spine (PSIS)–dimples in the back S1/ S2 At the Anterior Superior Iliac Spines (ASIS) Coccyx At the upper border of the pubic symphysis & most prominent portion of the greater trochanter Positions Supine (dorsal recumbent) – on back Prone(ventral recumbent position) – face down Recumbent – lying down Erect – Upright Seated – sitting on a chair or stool Trendelenburg – patient lying with head lower than the feet Fowler’s – Patient recumbent with trunk and head higher than feet Sim’s & Lithotomy Sim’s position – semiprone with left anterior side down (LAO) Lithotomy position – recumbent (supine) with knees and hips flexed and thighs abducted and rotated externally (supported with ankle supports) Lateral Lateral position path closest to IP or body part from which the CR exits – for extremities it is named for aspect of structure the CR entered then exited e.g. mediolateral – for chest it is named for the side nearest the film Decubitus – Imaging the trunk – patient is recumbent – Using a horizontal bean Left lateral decubitus – (AP projection) – patient on left side with horizontal ray Dorsal decubitus position – (lateral projection) – Patient supine – horizontal ray Right lateral decubitus (PA projection) – patient on right side with horizontal ray Ventral Decubitus Ventral decubitus position (lateral projection) – patient prone – horizontal Plantodorsal Dorsoplantar and plantodorsal projections  – Dorsoplantar – path of CR from dorsal (anterior) to plantar (posterior) of foot Axial plantodorsal projection – angled CR entering the plantar surface & exits the dorsum surface Medial or Lateral Rotation Medial/medial – toward the median plane or middle of a part/body Lateral – away from the median plane or middle of a part Proximal & Distal Proximal Closest to the point of origin or attachment, toward the center of the body Distal Parts furthest form the point of origin or attachment. Away from center of body Cephalad/Caudad Cephalad/cephalic/cranial/superior – to ward the head, or above Caudad/caudal/inferior – toward the feet, or below Terms Interior – inside the body Exterior/external – parts outside an organ or on the outside of the body/on or near outside Superficial – to parts near the skin or surface Deep – refers to parts far from the surface Ipsilateral – a part or parts on the same side of the body Contralateral – a part or parts on the opposite side of the body Movement Terms Flexion – Bending. Extension  – Straightening of joint Hyperextension – Extension beyond the normal limits Hyperflexion – Flexion beyond the normal limits Deviation Ulnar deviation (flexion) – turn or bend hand and wrist toward ulnar Radial deviation (flexion) – turn or bend hand and wrist toward radius Dorsiflexion & Planter Flexion Dorsiflexion of foot – Flexion between the lower leg and foot angle between the two is less than or equal to 90º Planter flexion of foot – Extending the ankle joint – moving foot and toes downwards Evert/Eversion – Turning foot outward at the ankle joint Invert/Inversion – Turning foot inward at the ankle joint Valgus – Bending of part outward or away from midline (e.g., bow-leg) Varus – Bending part inward or toward midline (e.g. knock-knee) Medial & Lateral Rotation Medial rotation – Rotation of part. – Moving anterior aspect of part toward the inside or median plane Lateral rotation – Rotation of part. – Moving anterior part toward the outside or away from the median plane Rotation circular movement around a specified axis Abduct/Abduction – movement away from the midline of the body Adduct/Adduction – movement toward the midline of body Supinate/Supination – turning onto back Pronate/Pronation – turning onto stomach Elevation – Lifting or raising moving superiorly Depression – Letting down or moving part inferiorly Movement Terms Circumduction – moving around in the form of a circle (flexion, abduction extension and adduction resulting in a ‘cone’ shaped movement Tilting Tilt – slanting or movement with respect to the long axis. – Moving the body part so the sagittal plane is not parallel to the long axis of the rest of the body/or support table Surface of Hands & Feet Plantar /sole – Posterior surface of foot Dorsal or dorsum – Top or anterior surface of foot Back – Posterior aspect of hand Palmar or ventral – Anterior of hand (palm) Position/ Projection The terms position and projection are sometimes used interchangeably and incorrectly Incorrect use leads to confusion for the student who is attempting to learn the correct terminology of the profession.  The word projection is the only term that accurately describes how the body part is being examined The term position should be used only when referring to the placement of the patient’s body. These are two distinct terms that should not be interchanged. A correct example is: “We are going to perform a PA projection of the chest with the patient in the upright position Positioning Rules and Principles 1. Minimum of two projections – Anatomic structures superimposed – Localization of lesions or foreign bodies – Determination of alignment of fractures 2. Minimum of three projections when joints are in prime interest area – AP or PA – Lateral – Oblique