1. Chapter 12: Diagnostic and Imaging Services

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

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

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

15. 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

16. 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)

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

18. 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

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

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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

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

29. 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

30. 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

31. 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

32. 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

33. 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

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

35. 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

36. 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

37. 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

38. 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

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

40. 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

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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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