Chapter 12: Diagnostic and Imaging Services

Cardiographic Technicians History of the Profession 1903: first EKG device developed by Einthoven 1949: Holter invents monitor bearing his name 1963: stress testing begun by Bruce & associates New technologies required new technicians to operate them EKG training programs recently created Two professional credentials now available

Cardiographic Technicians (cont’d) Education Usually trained on the job Training takes 4 to 6 weeks Previous experience in health care is preferred by employers 1-year certificate programs Basic EKGs Stress tests Holter monitor tests Training for specialized EKG testing (18-24 months)

Cardiographic Technicians (cont’d) Certification No licensure Two organizations offer certification: American Society of Phlebotomy Technicians (ASPT) Offers EKG Technician credential Cardiovascular Credentialing International (CCI) Offers Certified Cardiographic Technician (CCT) credential

Cardiographic Technicians (cont’d) General Duties Clean & maintain an EKG machine Place the EKG electrodes on the body Document the patient’s medical history Monitor a patient’s heart rhythms Perform a 12-lead electrocardiogram Document any variation from a normal tracing Take vital signs

Cardiographic Technicians (cont’d) Tests Performed by Specialized Cardiographic Technicians Specialized EKG tests Rhythm strips Signal-average EKGs Event recorders Device interrogation Stress tests Holter monitor tests

Cardiographic Technicians (cont’d) Tasks Common to All Tests Set up equipment Explain procedure to patient Provide a gown or drape Prepare the patient Position the patient Communicate results to the physician Schedule appointments Review patients’ files Train new employees & others

Cardiographic Technicians (cont’d) Personal Characteristics Good interpersonal skills Good communication skills Ability to work independently Ability to follow instructions Good organizational skills Good multitasking skills

Cardiographic Technicians (cont’d) Employment Opportunities and Trends 24% growth from 2008 to 2018 Growth due to: Increase in heart disease Needs of older population, which is increasing Rules regarding Medicare & Medicaid reimbursement Less demand for technicians qualified to perform multiple tests Better prospects for technicians trained to perform multiple tests About 75% of jobs are in hospitals About 25% of jobs are in physicians’ offices & labs

Cardiographic Technicians (cont’d) Professional Organization: ACVP Represents >3,000 cardiovascular personnel Mission Meet needs of cardiovascular & pulmonary providers Promote awareness of standards Encourage recognition of cardiovascular occupations Operates specialty councils Produces >26 publications each year Offers continuing education Provides chapter meetings & online resources

Cardiographic Technologists History of the Profession 1953: ultrasound first used to diagnose cardiac disease 1955: first Doppler instrument developed 1970s: technology began to move into clinical settings 1981: AMA recognizes cardiovascular technology as a profession 1983: educational guidelines for accredited programs drafted 1985: Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT) formed

Cardiographic Technologists (cont’d) Education Some trained on the job Most complete a 2-year associate’s program Some complete 4-year program 37 accredited programs HS diploma/experience in other health care profession required 3-part curriculum is required Core courses Specialized instruction Clinical instruction

Cardiographic Technologists (cont’d) Core Course Work Introduction to the field General & allied sciences Anatomy & physiology Basic pharmacology Basic medical electronics & medical instrumentation

Cardiographic Technologists (cont’d) Specialized Instruction Invasive cardiology Noninvasive cardiology Cardiac electrophysiology

Cardiographic Technologists (cont’d) Clinical Instruction Cardiac & vascular pathophysiology Patient history & physical examination Patient psychology, care, & communications CPR Diagnostic & therapeutic measures Clinical cardiac & vascular medicine & surgery Statistics & data management Physics Medical & legal ethics

Cardiographic Technologists (cont’d) Certifications Offered by CCI Registered cardiac sonographer (RCS) Registered vascular specialist (RVS) Registered congenital cardiac sonographer (RCCS) Registered cardiovascular invasive specialist (RCIS) Registered cardiac electrophysiology specialist (RCES) Registered phlebotomy sonography (RPhS)

Cardiographic Technologists (cont’d) Certifications Offered by ARDMS Registered diagnostic cardiac sonographer (RDCS) Registered vascular technologist (RVT)

Cardiographic Technologists (cont’d) General Duties Help diagnose patients with cardiac & vascular disease Perform ultrasound procedures Monitor patients’ heart rates Review physicians’ interpretations & patient files Compare findings against normal findings Schedule appointments Explain test procedures Care for testing equipment

Cardiographic Technologists (cont’d) Invasive Procedures: Cardiology Technologists Cardiac catheterization Balloon angioplasty Electrophysiology testing Open-heart surgery Pacemaker or stent insertion

Cardiographic Technologists (cont’d) Noninvasive Procedures Noninvasive cardiology: echocardiography Cardiac sonographers or echocardiographers Noninvasive peripheral vascular study Vascular technologists or vascular sonographers

Cardiographic Technologists (cont’d) Personal Characteristics Good judgment Conscientiousness Good communication skills Ability to follow detailed directions Ability to work effectively with patients Pleasant, professional manner

Cardiographic Technologists (cont’d) Employment Opportunities and Trends Rapid growth: 24% between 2008 & 2018 Growth due to: Increase in heart disease & aging population Increase in noninvasive procedures Early diagnosis of vascular disease Technological advances & reimbursement rules 77% in hospitals Remainder in physicians’ offices & medical & diagnostic labs

Cardiographic Technologists (cont’d) Professional Organizations Society for Vascular Ultrasound (SVU) Represents & advocates for profession Offers continuing ed., annual conference, journal, scholarship, online career center American Society of Echocardiography (ASE) Advocates for echocardiographers Offers annual scientific sessions, online resources, networking & continuing ed., journal

Phlebotomists History of the Profession Hippocrates & theory of four humours Bloodletting: blood drawn to restore balance of humours Louis Pasteur & germ theory Blood drawn for diagnostic purposes 1970s: modern occupation emerged as cost-cutting measure 1978: National Phlebotomy Association (NPA) formed 1981: NPA administered first certification exam

Phlebotomists (cont’d) Education HS diploma or equivalent required In-house training at medical facilities vs. formal programs 59 accredited programs Programs: Lead to a certificate Require at least 100 hours of clinical experience Require at least 100 successful unassisted blood collections Include both course work & practical experience

Phlebotomists (cont’d) Certification Gives advantage in securing jobs Offered by many organizations Continuing education units (CEUs) required for recertification Employers may: Offer in-house education Pay for offsite programs

Phlebotomists (cont’d) Work Responsibilities Perform venipuncture Perform capillary puncture Label blood samples Document procedures Store & transport blood Perform other types of tests Throat cultures Urine tests EKGs

Phlebotomists (cont’d) Personal Characteristics Good interpersonal skills Attention to detail Calmness under pressure

Phlebotomists (cont’d) Employment Opportunities and Trends Growth of 16% between 2008 & 2018 Most jobs in hospitals Some jobs in: Physicians’ offices Medical & diagnostic labs Increased opportunities due to: Population increase Development of new tests

Diagnostic Medical Sonographer History of the Profession 1912: echoes used to detect icebergs World War I: hydrophone invented to detect enemy submarines 1937: first attempt at using sound for medical imaging 1963: first commercial scanners available Sonographers train personnel in hospitals to use scanners 1969: American Society of Ultrasound Technical Specialists (ASUTS) formed 1973: occupation of diagnostic ultrasound technologist created 1975: first credentialing exam

Diagnostic Medical Sonographer (cont’d) Education Training program options Informal training programs at hospitals & schools Formal 2-year (associate’s) & 4-year (bachelor’s) programs 1-year programs leading to certificate 174 accredited programs Classroom instruction combined with lab & clinical activities

Diagnostic Medical Sonographer (cont’d) Licensure and Certification 2009: New Mexico & Oregon first states to license Certification Offered by several organizations Requires passing two different exams Must be renewed every 3 years Registration Offered by American Registry of Radiological Technologists (ARRT) Renewed annually

Diagnostic Medical Sonographer (cont’d) General Duties Evaluate requisitions before a sonogram Set Doppler parameters Select proper transducer Apply sufficient coupling gel, eliminating bubbles Perform abdominal scans Identify artifacts (imaging errors) Prepare written summaries of findings Clean, check, & maintain equipment

Diagnostic Medical Sonographer (cont’d) Specialties Obstetrics/gynecology Abdomen Neurosonography Breast

Diagnostic Medical Sonographer (cont’d) Personal Characteristics Good people skills Patience Empathy Eye for detail Good judgment Personal responsibility Self-motivation Ability to work independently Good teamwork skills

Diagnostic Medical Sonographer (cont’d) Employment Opportunities and Trends Growth: 18% between 2008 & 2018 Factors prompting growth Aging population Increasing use of sonography Development of new sonography procedures Setting distribution 60% in hospitals Remainder in physicians’ offices & medical & diagnostic labs

Diagnostic Medical Sonographer (cont’d) Professional Organization: SDMS Works to advance profession & educate medical community Advocates on issues affecting profession Publications Journal of Diagnostic Medical Sonography Newsletters Online resources

Radiologic Technologists/Radiographers History of the Profession 1895: Roentgen discovered x-rays Physicians began experimenting with medical uses of x-rays 1917: Jerman began training program for technologists 1920: Jerman founded American Association of Radiological Technicians (AART) 1922: first certification exam 1923: registration begun 1950s: model standardized curriculum developed

Radiologic Technologists/Radiographers (cont’d) Education Most complete 2-year associate’s degree program Other options: Certificate program lasting 21-24 months 4-year bachelor’s degree program HS diploma required for entry into program

Radiologic Technologists/Radiographers (cont’d) Course Work Anatomy & physiology Patient care procedures Radiation physics Radiation safety & protection Principles of imaging Medical terminology Patient positioning Medical ethics Radiobiology Pathology

Radiologic Technologists/Radiographers (cont’d) Specialties CT scans MRIs Mammograms

Radiologic Technologists/Radiographers (cont’d) Licensure and Certification Required in some states Advantageous in job market Requires: Graduation from accredited program Passing a national exam Meeting ethical standards Recertification required every 2 years Specialty certification available

Radiologic Technologists/Radiographers (cont’d) Work Responsibilities Obtain & document patient’s history Provide radiation protection shield for patient Identify radiographs with appropriate lead markers Manipulate radiographic equipment with ease Expose film Process film Evaluate images for appropriate positioning & quality

Radiologic Technologists/Radiographers (cont’d) Personal Characteristics Positive attitude Empathy Good people skills Self-motivation Confidence Ability to work independently Good teamwork skills Ability to follow instructions Manual dexterity Flexibility Multitasking skills Attention to detail Good communication skills

Radiologic Technologists/Radiographers (cont’d) Employment Opportunities and Trends Growth: 17% between 2008 & 2018 Factors prompting growth Population growth Aging of population Increased use of imaging Setting distribution >60% in hospitals Remainder in physicians’ offices & medical & diagnostic labs

Radiologic Technologists/Radiographers (cont’d) Professional Organization: ASRT Largest & oldest organization representing RTs Represents RTs in government & education Monitors state & federal legislation Helps Develop & revise curriculums Set practice guidelines Implement standards Offers continuing education Promotes careers in field

Nuclear Medicine Technologists History of the Profession 1896: discovery of radioactivity by Becquerel Early 20th century: development of radioisotope tracers 1929: invention of cyclotron by Lawrence Making & discovery of artificial nucleotides 1930s: blood disorders treated with radioactive phosphorus 1946: cancer patient successfully treated w. radioactive iodine 1950s: nuclear medicine emerged as a discipline 1980s: development of radiopharmaceuticals

Nuclear Medicine Technologists (cont’d) Education Program options: Associate’s degree Bachelor’s degree Certificate: available at hospitals for graduates of other health care programs 101 accredited programs Course work & clinical component required

Nuclear Medicine Technologists (cont’d) Course Work Patient care methods Nuclear medicine computer applications Nuclear medicine physics & radiation physics Diagnostics nuclear medicine procedures Immunology relating to nuclear medicine Radiation safety & protection Radionuclide therapy Radionuclide chemistry & radiopharmacy Quality control & quality assurance Nuclear instrumentation Statistics

Nuclear Medicine Technologists (cont’d) Licensure and Certification Required by more than half of states Certification is optional, but standard in market Certifying agencies: ARRT Nuclear Medicine Technology Certification Board (NMTCB) Certification requires graduation from accredited program & passing a national exam Continuing ed. required every 2 years Specialty certification available

Nuclear Medicine Technologists (cont’d) Work Responsibilities Select & prepare prescribed dosages of radiopharmaceuticals Verify correct syringe & dose Position patient appropriately Select images for processing Record receipt of radioactive materials Evaluate performance of a scanner Perform wipe tests for radiation Collect blood samples by venipuncture Conduct & document radiation surveys

Nuclear Medicine Technologists (cont’d) Personal Characteristics Good interpersonal skills Good communication skills Attention to detail Self-motivation Ability to work independently Good teamwork skills Flexibility Willingness to learn

Nuclear Medicine Technologists (cont’d) Employment Opportunities and Trends Growth: 16% between 2008 & 2018 Factors promoting growth Development & increased use of newer imaging technologies Development of new nuclear medicine treatments Aging of population Setting distribution 2/3 in hospitals Remainder in physicians’ offices & medical & diagnostic labs

Nuclear Medicine Technologists (cont’d) Professional Organization: SNM Founded in 1954 Represents professionals in nuclear medicine Publishes journals, newsletters, & books Sponsors international meetings & workshops Monitors congressional & regulatory activities Advocates for nuclear medicine science & research Offers grants, awards, & scholarships Offers various benefits for membership