1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies Second Edition CHAPTERCHAPTER CHAPTER 48 Radiology Lesson 1: Introduction to Radiology

2. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. List six X-ray procedures that require preparations ahead of time. Describe the preparations. List and explain four basic positions used for taking X-rays.

3. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Question 1.Is a medical assistant qualified to perform the general procedures for an X-ray examination? Explain your answer.

4. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Radiology Branch of medicine that uses radioactive substances or matter that gives off radiation Uses various techniques for visualizing the internal structures of the body for the diagnosis and treatment of disease Divided into three specialties: –Diagnostic radiology –Radiation therapy –Nuclear medicine

5. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Radiology Personnel Radiologist –Physician specializing in radiology Radiographer or radiologic technologist –Involved in making diagnostic radiographs or X-rays –Requires a 2- to 4-year college program Medical assistant in a radiology department –Will require additional training in order to assist with radiologic procedures

6. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Duties of a Radiologic Technologist Positioning patients for radiographic procedures Determining the proper voltage, current, exposure time for each X-ray Adjusting radiographic equipment Developing the film Assisting the radiologist with special procedures

7. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Principles of X-rays Developed in 1895 by Wilhelm Konrad Roentgen X-rays are produced in a vacuum tube when electrons collide into a target of specific material such as tungsten Collision produces electromagnetic rays X-rays emitted from the tube form a cone- shaped X-ray beam

8. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Principles of X-rays Radiation field is the cross section of the X-ray beam and the point of use Patient is placed between the tube that produces the X-ray beam and the film

9. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan X-Ray Table

10. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Characteristics of X-rays Penetrate substances of different densities to varying degrees Cause ionization of the substances through which they pass Cause fluorescence of certain substances Travel in a straight line Can destroy body cells

11. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Diagnostic Imaging Involves the use of X-rays, ultrasound, radiopharmaceuticals, radiopaque media, and computers Produces images of internal structures and processes

12. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Contrast Medium Radiopaque substance Does not allow the passage of X-rays Facilitates radiographic imaging of internal structures that are difficult to visualize on a regular X-ray or fluoroscopic screen Include liquids (barium), powders, air, and gas Administered orally, by injection (parenterally), or by enema Acts to convert an organ or structure into an opaque area

13. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Barium Enema Radiograph of the colon after a barium enema.

14. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Contrast Medium Materials Barium sulfate –Positive contrast media –Consists of a chalky compound mixed with water –Used for fluoroscopic examination of the gastrointestinal tract Iodine contrast compounds –Used to form radiopaque compounds –Cannot be used on patients allergic to seafood or iodine –Interfere with nuclear medicine

15. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Contrast Medium Materials Negative contrast –Include air, carbon dioxide, and other gases –Appear black on X-rays –Used to visualize the spinal cord

16. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Role of the Medical Assistant for Radiology Exams Schedule the procedure Educate patient about the procedure Inform patient about the length of the procedure Explain to patient about any preparation required Ensure patient is provided an ample size gown and drape

17. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Role of the Medical Assistant for Radiology Exams Request patient remove all metallic materials Assist the patient during and after the procedure Provide post-procedure instructions Inform patient of when to expect test results

18. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan X-ray Procedures Requiring Special Preparations Angiogram: –No breakfast if morning examination or lunch if afternoon examination Barium enema (Lower GI): –Enemas until the bowel return is clear on the evening before the examination –Doctor may order rectal suppository in the morning or a cathartic such as 2 oz. of castor oil or citrate of magnesia at 4:00 P.M. the day before the X-ray –Clear liquids and gelatin for dinner –Nothing by mouth (NPO) after midnight

19. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan X-ray Procedures Requiring Special Preparations Barium meal (Upper GI): –NPO after midnight Bronchogram: –NPO after midnight Cholecystogram (GB series): –Light supper of non-fatty food such as fruit and vegetables without butter or oil the evening before the X-ray –Gallbladder tablets (prescribed by the physician) are taken with water after supper –NPO except for water until X-ray the following day

20. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan X-ray Procedures Requiring Special Preparations Computerized tomography (CT): –NPO for 4 hours before X-ray if a contrast media is used Intravenous cholangiogram: –NPO after midnight Intravenous pyelogram (IVP): –Three Dulcolax tablets or 2 oz. castor oil at 4:00 P.M. the day before the X-ray –Eat a light supper –NPO after midnight

21. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan X-ray Procedures Requiring Special Preparations Myelogram: NPO Retrograde pyelogram: –Enemas or laxatives on the evening before X-ray –NPO for 8 hours before the procedure Ultrasound: –May require a full bladder or laxatives depending on the type of ultrasound

22. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Step 1: Check X-ray examination order. Step 6: Instruct the patient to remove all clothing appropriate for the procedure. Step 3: Identify the patient. Step 2: Check necessary X-ray equipment as needed. Step 7: Ask the patient to remove all jewelry and metals as needed. Step 4: Determine patient compliance with procedure preparation requirements. Step 5: Explain procedure to the patient. Steps to Assisting with a Radiologic Procedure

23. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Positions for Radiology Procedures

24. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Anterioposterior (AP) X-ray beam is directed from front to back Patient may be standing or supine Patient’s front will face the X-ray equipment and patient’s back will be near the film plate

25. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Posterioanterior (PA) X-ray beam is directed from back to front Patient will be standing upright Patient’s back will face the X-ray equipment and his or her front will be near the film plate

26. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Oblique Patient is turned at an angle to the film plate so the X-ray beam can be directed at areas that would be hidden on an AP, PA, or lateral X-ray

27. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Lateral X-ray beam is directed toward one side of the body In the right lateral (RL) position, the patient’s right side is near the film plate and left side is near the X-ray equipment In a left lateral (LL) position, the patient’s left side is near the film plate

28. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Axial X-ray tube is angled to direct a ray along the axis of the body or body part Cephalad angulation: the X-ray beam is directed at an angle from the feet toward the head Caudal angulation: the X-ray beam is directed from the head toward the feet

29. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Information Required for Scheduling a Radiologic Procedure Patient’s name Type of insurance Pre-certification or approval number Referring physician’s name Type of radiologic procedure to be performed

30. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Special Dietary Restrictions for Radiology Procedures All-liquid diet on the day before the test Nothing by mouth after a specific time It is up to the physician to decide whether the patient should or should not take his or her daily medications.

31. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Beverages That the Patient May Have on an All Liquid Diet Coffee Tea Carbonated beverages Clear gelatin desserts Strained fruit juices Bouillon Clear broth Tomato juice The patient may not have any dairy products

32. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Guidelines for Sequencing Multiple Diagnostic Procedures Schedule all radiographic exams and tests that do not require contrast media and iodine uptake Radiographic tests of the urinary tract Radiographic tests of the liver and gallbladder CT scans of the abdomen and pelvis Procedures requiring barium

33. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Guidelines for Sequencing Multiple Diagnostic Procedures Lower gastrointestinal series (barium enema) Upper gastrointestinal series CT procedures that require IV contrast media may be done AFTER blood is drawn for iodine uptake series

34. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Questions?