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RAD 1129 > CHAPTER 12 > Flashcards

CHAPTER 12 Flashcards

1
Q

What are Holistic approach to patient care?

A

During a diagnostic X-ray procedure, a holistic approach to patient care is essential.

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2
Q

Holistic patient care must begin with effective communication between?

A
  • Holistic patient care must begin with effective communication between the radiographer and patient.
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3
Q

What are the benefits of Effective communication?

A
  • Alleviates the patient’s uneasiness

-Increases the likelihood of cooperation and successful completion of the imaging procedure

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4
Q

How should Radiographers limit the patient’s exposure to ionizing
radiation by:

A

-Employing appropriate
radiation reduction
techniques

-Using protective devices
that minimize radiation
exposure

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5
Q

Patient exposure can be substantially reduced by

A
  1. Effective communication
  2. Use of proper body or part immobilization
  3. Use motion reduction techniques
  4. Use appropriate beam limitation devices
  5. Adequate filtration of the X-ray beam
  6. Use of specific area shielding
  7. Select suitable exposure factors in conjunction
    with computer-generated digital images
  8. Use of appropriate digital image processing
  9. Elimination of repeats of radiographic images
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6
Q

Communication between the radiographer and patient
is effective when?

A

 Verbal messages are understood as intended

 Nonverbal messages (unconscious actions or body language)
are understood as intended

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7
Q

Verbal messages and body language

A

Encourages reduction in anxiety and emotional stress

▫ Enhances the professional image of the radiographer as a person who cares about the patient’s well-being

▫ Increases the chance for successful completion of the x-ray examination

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8
Q

Appropriate communication for procedures
that will cause pain or discomfort

A

-If the radiographic procedure will cause pain, discomfort,
or any strange sensations, the patient must be informed before the procedure begins.

-Radiographer should try not to overemphasize this aspect
of the examination

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9
Q

What will Repat Radiographic exposures result from?

A

Repeat radiographic exposures that result from poor communication

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10
Q

Inadequate or misinterpreted instructions may?

A

Inadequate or misinterpreted instructions may prevent the patient from being able to cooperate.

      If something happens unexpectedly, the patient may move at an inappropriate time.
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11
Q

Effective communication between radiographer and patient

A

will prevent such problems from
occurring.

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12
Q

Good Communication

A
  • Reduces anxiety and emotional stress

▫ Enhances the professional image of the radiographer as a person who cares about the patient’s well-being

▫ Increases the chance for successful completion of the X-ray examination

▫ Words and actions must demonstrate
understanding and respect for human dignity and individuality

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13
Q
  • Importance of clear concise instructions
A
  • Patient protection during a diagnostic x-ray procedure should begin with clear, concise instructions.
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14
Q

Ability of patient to cooperate

A

▫ Consequences when procedures are not explained for the patient

▫ Benefit of explaining procedure to the patient in simple terms

▫ Giving the patient the opportunity to ask questions

▫ Listening attentively and answering patient questions truthfully in an appropriate tone of voice and in accordance with ethical guidelines

▫ Creating a sense of trust between the patient and the radiographer and encouraging further communication

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15
Q

What promotes effective communication between the radiographer and patient?

A

Clear, concise instructions promote effective communication
between the radiographer and the patient

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16
Q

What is the need for patient immobilization?

A

If a patient moves during a radiographic exposure, the radiographic image will be
blurred; it will have little or no diagnostic value.

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17
Q

What are consequences of blurred images?

A
  • Examination needs to be repeated

-Results in additional radiation exposure

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18
Q

How can patient motion be eliminated or minimized?

A

BY:
▫ Proper body or part immobilization
▫ Use of motion reduction techniques

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19
Q

What are the types of Patient motions?

A

▫ Voluntary motion

▫ Involuntary motion

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20
Q

INVOLUNTARY MOTIONS

A

Involuntary motion, caused by muscle groups such as those associated with the digestive organs or the heart, cannot be willfully controlled.

Other clinical manifestations also cause involuntary motion. These include:
* Chills
* Tremors such as those experienced by patients with Parkinson’s disease * -Muscle spasms
* Pain
* Active withdrawal

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21
Q

VOLUNTARY MOTION

A

Voluntary motion would, under normal circumstances, be expected to be controlled by the patient. Inability to exercise such control may be attributed to:

  • The patient’s advanced age
  • Breathing problems or irregularities
  • Increased anxiety
  • Physical discomfort
  • Fear of the examination
  • Fear of unfavorable prognosis
  • Mental instability
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22
Q

What must the radiographer do to to eliminate voluntary motion during radiography?

A

Gain the cooperation of the patient or adequately immobilize that individual during the radiographic exposure

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23
Q

PIG O STAT

A

Adequate immobilization during
radiographic examinations eliminates or at least minimizes voluntary
motion.

This restraint has
a shield (left) that may be
adjusted to protect the
child’s reproductive organs
from radiation exposure

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24
Q

SOME TYPES OF IMMOBOLIZATION

A

-SPONGE
-TAPE
-VELCRO STRAPS
-MUMMIFICATION

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25
What are the needs for protective shielding?
The potential for radiation exposure to radiosensitive body organs or tissues of a patient requires the use of intelligent patient positioning and/or personal shielding to reduce or eliminate a radiation dose that would otherwise, result in biological damage.
26
What areas of the body should be selectively shielded from the useful beam?
 Lens of the eye  Breasts  Reproductive organs  Thyroid gland
27
Gonadal shielding
▫ Patient gonadal shielding and fetal shielding should be discontinued during diagnostic imaging procedures should be discontinued as routine practice. ▫ Appropriate circumstances for the use of patient gonadal shielding devices  Collimation is the first step in gonadal protection
28
What is CARES committee?
created to educate the profession regarding the AAPM gonadal shielding position statement.
29
WHAT SHOULD ALWAYS BE THE FIRST STEP IN GONADAL SHEIDLING?
Adequate and precise collimation of the radiographic beam must always be the first step in gonadal protection.
30
When the gonads are not in the area of clinical interest, precise collimation of the Radiographic beam WILL?
reduces gonadal exposure.
31
SPECIFIC AREA SHEILDING
Radiosensitive organs and tissues other than the reproductive organs may be selectively shielded from the primary beam during a diagnostic radiographic examination
32
SHIELD FOR THE EYE
Shields for the lens of the eye are the contact type and are positioned directly on the patient. They can reduce or eliminate exposure to that highly sensitive area.
33
WHAT SHOULD ALWAYS BE THE FIRST STEP IN GONADAL SHEILDING?
Adequate and precise collimation of the radiographic beam, to include only the anatomy of interest, must always be the first step in gonadal protection.
34
HOW MANY TIMES MORE EXPOSURE DO FEMALE REPRODUCTIVE ORGANS RECEIVE DURING AN EXAMINATION INVOLVING PELVIC REGION THAN MALE ?
Female reproductive organs receive about 3 times more exposure during an examination involving the pelvic region than do the male reproductive organs.
35
Appropriate gonadal shielding will reduce exposure for both male and female.
-1-mm lead flat contact shield for the female reduces exposure by about 50%. -1-mm lead contact shield for the male patient reduces exposure 90% to 95%.
36
Why must shielding Devices must be correctly placed directly over the patient’s reproductive organs?
to provide protection
37
What would you use to guide placement of a testicular or ovarian shield?
Use external (topographic) landmarks on the patient to guide placement of a testicular or ovarian shield.
38
What can be used to guide the shield placement over the testes?
Male patient in supine position: the symphysis pubis can be used to guide shield placement over the testes.
39
How much cm should the shield be placed medial to each ASIS to protect the ovaries?
-Female patient in supine position: the shield should be placed approximately 2.5 cm (1 inch) medial to each palpable anterior superior iliac spine (ASIS) to protect the ovaries.
40
What are the types of Gonadal shielding devices?
 Flat contact shields  Shadow shields  Shaped contact shields  Clear lead shields
41
An uncontoured, flat contact shield of lead- impregnated material may be placed over the patient’s gonads to provide?
protection from x- radiation during a radiographic procedure
42
SHADOW SHIELDS
Lead filter with a breast and gonad shielding device. This shield functions as a shadow shield.
43
Shaped contact shields- MEN
Shaped contact shields (cuplike in shape) may be held in place with a suitable carrier.
44
What are the Benefit of specific area shielding?
- Minimizes the number of potentially deleterious X-rays- induced mutations expressed in future generations -Reduces exposures to specific areas that are shielded
45
Selection of appropriate technical exposure factors is ?
essential to ensure a diagnostic image with minimal patient dose.
46
A high-quality image has:
▫ SUFFICIENT BRIGHTNESS to display anatomic structures ▫ Appropriate level of SUBJECT CONTRAST to differentiate among the anatomic structures ▫ Maximum amount of SPATIAL RESOLUTION ▫ Minimal amount of DISTORTION`
47
What are some Technical factors Considerations?
-Mass per unit volume of tissue of the area of clinical interest -effective atomic numbers and electron densities of tissues involved -Type of Image receptor -Source to image receptor distance SID -Type and quantity of filtration employed -Type of x-ray generator used -Balance of radiographic density or brightness and contrast required
48
USE OF STANDARDIZED TECHNIQUE CHARTS
REQUIREMENT
49
When AEC is not used, to ensure a uniform selection of technical X-ray exposure factors
each X-ray unit should have a standardized technique chart
50
What is the radiographer responsible for in relations to the technique chart?
Radiographer is responsible for consulting the technique chart before making each radiographic exposure, to ensure a diagnostic image with minimal patient dose.
51
What must be considered for the patient when selecting technical exposure factors?
-A patient’s specific condition - Patients history Must also be considered when selecting technical exposure factors.
52
Use of high kVp and low mAs exposure factors to reduce dose to the patient
REQUIRMENTS
53
Why must Radiographers achieve a balance in technical radiographic exposure factors ?
To ensure the presence of adequate information in the recorded image and minimize patient dose.
54
What technical factors reduces Patient dose?
-HIGH KVP -LOW mAS OR LOW mA & TIME (S) The use of higher kVp and lower mA and exposure time is seconds (mAs) reduces patient dose.
55
Compare digital radiography (DR) with screen- film imaging
HOW?
56
GOOOD CHEST RADIOGRAPHY WITH 75KVP AND 16 MAS OR 100KVP WITH 4.5 MAS
The use of higher kilovoltage (kVp) and lower milliamperage and exposure time in seconds (mAs) reduces patient dose. (A) The use of high kVp and low mAs results in a high-energy, penetrating x-ray beam and a small patient-absorbed dose. (B) The use of low kVp and high mAs results in a low-energy x-ray beam of greater intensity, the majority of which the patient will easily absorb. (LARGE PATIENT DOSE) (C) Example of a higher kVp, lower mAs technique resulting in a 70% reduction in patient exposure without significantly compromising radiographic quality.
57
What happens in the POST PROCESSING OF THE RADIOGRAPHIC IMAGE?
-CORRECT IMAGE POST PROCESSING -QUALITY CONTROL PROGRAM
58
WHY IS CORRECT IMAGE POST PROCESSING ESSENTIAL?
It is essential to produce a high-quality diagnostic image in which artifacts produced by the IR, software, or patient- related problems are controlled
59
What does the QUALITY CONTROL PROGRAM INCLUDE?
- Includes regular monitoring and maintenance of processing and imaging display equipment -Mandated full acceptance of new equipment, regular calibration and performance evaluation of existing equipment, and proactive and consistent image review QC can prevent errors
60
To ensure standardization in the processing of radiographic images, it is absolutely essential that every imaging department establish a quality control program that includes?
Regular monitoring and maintenance of all processing and image display equipment in the facility, to ensure the production of optimal-quality images
61
What is the AIR GAP TECHNIQUE?
(it is the Reduction of scattered radiation)
62
How exactly does the AIR GAP TECHNIQUE REDUCE SCATTER RADIATION?
As an alternative procedure instead of using a radiographic grid for reducing scattered radiation during certain examinations, an air gap technique can possibly be used.
63
MY NOTES AIR GAP
- NO GRID USED -DISTANCE BETWEEN PATIENT AND IR The air gap technique is a way to reduce scattered radiation without using a radiographic grid Instead of using a grid, A gap of air is left between the patient and the image receptor (like the film or digital detector). This distance allows scatter radiation to disperse away, improving image contrast.
64
Procedure fo performing an air gap technique
How it's done: Create a small gap (4–6 inches) between the patient and the image receptor and increase the distance (SID) to 10–12 feet.) OID-4-6 INCHES SID-INCREASE 10-12 INCHES
65
High-kVp Radiography
▫ Over 90 kVp air gap techniques are for the most part not as effective. ▫ For chest radiography using 120 to 140 kVp air gap techniques can be successful. ▫ At less than 90 kVp, air gap techniques are more useful.
66
While an "air gap" may serve the same purpose as a grid
While an "air gap" may serve the same purpose as a grid in some cases, the SID however must be increased in order to counteract the magnification which would result. The patient dose with air gap is increased (compared to the table top dose), but the increase is not. as great as needed for a grid
67
What are the consequences of repeat images?
1. Additional exposure increases patient dose. 2. “Double dose” to the patient’s skin and possibly the gonads.
68
Where does repeats resulting from?
It results from carelessness or poor judgment on the part of the radiographer must be eliminated.
69
Is it permissible to obtain a additional disgonstic images?
An additional image, when recommended by the radiologist for the purpose of obtaining additional diagnostic information, is permissible.
70
INCREASE IN REPEAT RATES
▫ Approximately 5% and as high as 17% ▫ Positioning errors ▫ Due to ease of repeating an image ▫ Repeating an exposure to improve an acceptable image is unnecessary and increases patient radiation dose.
71
Benefit of a repeat analysis program
- By determining the number of repeats and the reasons for producing unacceptable radiographic images, existing problems and conditions in an imaging department will be identified.
72
WHAT ARE REASONS FOR UACCEPTABLE IMAGES?
1. Patient mispositioning 2. Incorrect centering of the radiographic beam 3. Patient motion during the radiographic exposure 4. Incorrect collimation of the radiographic beam 5.presence of external foreign bodies 6. Postprocessing artifacts
73
* Benefit of a repeat analysis program
▫ Provides valuable information for process improvement ▫ Helps minimize patient exposure ▫ Improves overall performance of the departmen
74
Concern About Risk of Exposure From Diagnostic Imaging Procedures
what are they?
75
Is CONCERN GROWING ABOUT THE COLLECTIVE RISKS OF EXPOSURES FROM DIAGNOSTIC IMAGING PROCEDURES?
In the United States, more people undergo diagnostic imaging procedures each year. Concern is growing about collective risk of exposures from these procedures.
76
How must Imaging personnel reduce the risk to patients?
Imaging personnel must reduce the risk to patients whenever possible by employing methods that produce high-quality images with lower radiation exposure. WE WANT- HIGH QUALITY IMAGE' LOW RADIATION DOSE EXPOSURES
77
What is the BENEFIT VS RISK SAY?
▫ Responsibility for ordering a radiologic examination lies with the referring physician -Physician must determine whether the benefit to the patient in terms of medical information gained sufficiently justifies subjecting the patient to the risk of the absorbed radiation resulting from the procedure
78
Nonessential radiologic examinations
- Examinations performed in the absence of definite medical indications -No benefit for the patient in terms of useful information gained
79
Concern About Risk of Exposure From Diagnostic Imaging Procedures
1. A chest x-ray examination automatically scheduled on admission to the hospital 2. Lumbar spine x-ray examination as part of a pre-employment physical 3.. Whole-body computed tomography (CT) screening 4. A chest x-ray examination for mass screening of TB Tuberculosis 5. A chest x-ray examination as part of pre employment physical 6. A chest x-ray examination examination or unjustified x ray examiations as part of routine health check up
80
Specifying the amount of radiation received from a diagnostic imaging procedure
- Bone Marrow and Gondal dose - Entrance skin exposure ESE (INCLUDES SKIN AND GLANDULAR)
81
Entrance skin exposure (ESE) (includes skin and glandular)
Most frequently reported because it is the simplest to determine -Use of thermoluminescent dosimeters (TLDs) to measure skin dose directly
82
BONE MARROW OR GONADAL DOSE
Dose cannot be measured accurately by a direct method; it can only be estimated
83
Concern about Risk of Exposure from Diagnostic Imaging Procedures
* Skin dose—dose to the epidemis * Entrance skin exposure (ESE)—may be converted to patient skin dose ▫ Measuring skin dose directly—thermoluminescent dosimeters (TLDs) are used most often Lithium fluoride is the sensing material and responds similar to human tissue when exposed to ionizing radiation.
84
What is the Estimated GSD for U.S. population?
0.20 mSv
85
Gonadal dose—dose to the reproductive organs
Genetically significant dose (GSD) used to assess the impact of gonadal dose. Equivalent to the EqD to the reproductive organs that, if received by every human, would be expected to bring about an identical gross genetic injury to the total population, as does the sum of the actual doses received by exposed individual members of the population).
86
What is the Bone marrow dose?
Dose cannot be measured accurately by a direct method; it can only be estimated
87
Fluoroscopically Guided Positioning (FGP)
The practice of using fluoroscopy to determine the exact location of the central ray before taking a radiographic exposure * American Society of Radiologic Technologists (ASRT) does not condone FGP (textbook) * Pros and cons of the use of FGP * Standard of Ethics as published by the American Registry of Radiologic Technologists (ARRT)
88
FGP
Value of blind positioning, or positioning using the radiographer’s skill and anatomic landmarks * Radiation exposure and dose considerations for the patient ▫ Patient ESE ▫ Need for radiographers to maintain ALARA * Technologists must not use FGP for positioning of patients * Unacceptable and unethical practice

RAD 1129 (4 decks)

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