1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 22 Medical Imaging

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins You reached Medical Imaging Chapter 22! So keep on going—you’re almost through. Stay on the review path—don’t go astray ’Cause certification is not far away! Review Tip

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Radiology is the study and use of radioactive substances to visualize an internal structure. The image of the structure is produced on film and called a radiograph, x-ray, or roentgenogram (all synonymous terms). This process was, for many years, the only noninvasive method to penetrate solid objects and obtain “pictures,” most commonly of bones and dense organs. The department providing the service was called Radiology. Today, different power sources and technologies are used and different images can be produced. Radiation is also used as a treatment, such as in cancer therapy. Therefore, the Radiology Department has been replaced by the Medical Imaging Department. Overview

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Many states require separate certifications to perform any form of medical imaging. The role of the medical assistant and medical administrative specialist, in these states, is not to perform the procedure but to prepare the patient for the test, including providing preparatory education (e.g., fasting, bowel cleansing, ingesting specific substances). Positioning the patient may also be the role of the medical assistant. (Note: Endoscopic procedures are generally not performed in the medical imaging department even though they may be considered diagnostic imaging.) Some endoscopic exams are used in tandem with or as a replacement for radiologic exams. For example, the colonoscopy may be done in place of the lower gastrointestinal (GI) series. This eliminates patient exposure to radiation. Overview, cont’d.

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Radiography—may be used for diagnostic purposes (e.g., to determine a fracture) or therapeutic purposes (e.g., as a treatment for cancer) Angiography—radiographic visualization of blood vessels and blood flow by injecting radiopaque material through a subcutaneous catheter Arthrography—radiographic visualization of a joint by injection of contrast media Barium enema (lower GI series)—rectal administration of barium to radiographically visualize the lower portion of the GI system Barium swallow (upper GI series)—oral administration of barium to radiographically visualize the upper portion of the GI system Common Types of Medical Imaging

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bone x-ray—flat plates including anteroposterior and lateral; when ordering an x-ray of a bone or bones of a body part that is bilateral, such as a foot, the provider frequently wants an x-ray of the same bone(s) of the opposite side as a comparison Chest x-ray (CXR)—flat plates (x-rays) of the chest; includes anteroposterior (AP) and lateral view Cholangiography—radiographic visualization of the bile ducts by injection of contrast media Cholecystography—radiographic visualization of the gallbladder structure and function Computed tomography (CT)—radiographic visualization of body structures in thin cross sections or layers; much more precise than traditional x-ray Intravenous pyelography (IVP)—radiographic visualization of the kidney, ureters, and bladder by injection of contrast media through a vein Common Types of Medical Imaging, cont’d.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Kidney, ureter, and bladder (KUB)—flat plate (x-ray) of the abdomen Mammography—radiographic examination of breasts (usually female) with specialized x-ray equipment Myelography—radiographic visualization of the spinal cord and nerve roots by injection of contrast media into the subarachnoid space Retrograde pyelography—radiographic visualization of the KUB by administration of contrast media through a urinary catheter ■ Magnetic resonance imaging (MRI)—film visualization of internal structures, including soft tissue, by using a magnetic field in combination with radiation ■ Nuclear medicine—area of medicine using radioisotopes to diagnose and treat specific pathology; used in some cancer therapies Common Types of Medical Imaging, cont’d.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Positron emission tomography (PET)—process of producing color images by injecting radioisotopes that combine with particles in the body; used to assess physiology and metabolic activity, not just structures ■ Radiation therapy—using radiation to treat diseases, typically cancer, by shrinking the tumor; may be performed in medical imaging department or outpatient facility ■ Scintigraphy (scintiphotography)—photographic images using a gamma camera to record the distribution of a radioactive agent; used to identify cancer metastasis ■ Ultrasonography (ultrasound)—use of high-frequency ultrasonic waves to produce an image and identify and measure deep body structures and abnormalities Common Types of Medical Imaging, cont’d.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The physician usually orders an x-ray based on the view(s) he or she wants, such as “CXR AP and lateral,” which means a chest x-ray with anteroposterior and lateral views. The medical assistant and the medical administrative specialist must know the meaning of the positions to properly order the tests and, in some instances, set up the patient to obtain the correct film. Production of a radiograph requires the x-ray beam to go from the machine through the patient’s body part(s) to the x-ray plate or cassette that contains the film. Standardized body views or positions are used to perform the x-ray. The views are named for the direction of the beam through the body part: ■ Anteroposterior view (AP)—x-ray beam directed from the front to the back of the body or body part ■ Posteroanterior view (PA)—x-ray beam directed from the back to the front of the body or body part Patient Positioning for Radiology

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Lateral view (lat)—x-ray beam directed from one side of the body to the other; view is named after the side closest to the cassette. Caution: This distinction, compared to the AP and PA views, can be confusing. Right lateral view (RL)—x-ray beam directed from the left side of the body to the right Left lateral view (LL)—x-ray beam directed from the right side of the body to the left Oblique view—x-ray beam directed at an angle through the body or body part; view is named after body position closest to the cassette, such as the right anterior oblique Patient Positioning for Radiology, cont’d.

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Figure 22-1. Standard positions for specific x-ray views. Patient Positioning for Radiology, cont’d.

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Radiation is the energy source for producing many of the images described previously. Specific safety measures must be taken to protect the patient, staff, and others in the area of the machine. Some of these measures, such as monitoring the dosimeters and scheduling maintenance, may be the responsibility of the medical assistant or medical administrative specialist. ■ Proper construction of the room(s) in which the machines are housed (e.g., lead-lined walls) ■ Proper care, inspection, and maintenance of machine(s) ■ Personal dosimeter worn by all staff present during xrays; dosimeters are monitored for absorption of radiation ■ Lead aprons, gloves, and so on, made available for staff when the staff is not behind protective shield during x-ray procedures Radiation Safety

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Female patients should be asked whether they are pregnant; if so, physician should be notified before the x-ray ■ Lead shields are used to cover patients’ reproductive organs and other organs not involved in exam ■ X-ray rooms are properly identified and have a red light displayed outside the room when tests are in progress ■ Radioactive materials are disposed of in suitably manufactured and identified containers Radiation Safety, cont’d.

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Most medical imaging requires patient preparation. The education required for the patient to prepare for the specific test is generally performed by the medical assistant or certified medical administrative specialist. Regardless of the procedure, always ask the patient if he or she is allergic to anything and check the medical record. Be alert for iodine and shellfish allergies if contrast materials are to be used. Some procedures (e.g., angiogram) may be done under emergency conditions, and the usual preparation is waived. Common preparations for scheduled tests follow: ■ Angiography Instruct patient to consume nothing by mouth (NPO) for 8 hours before procedure Determine whether the patient is on any blood-thinning medication, including aspirin; report to physician if the patient is on such medication Common Patient Preparation

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Barium swallow Instruct patient to have a light evening meal and NPO usually 8 hours before the procedure Instruct the patient to increase fluids after the test; a laxative is usually recommended ■ Cholangiogram Instruct patient to have a fat-free evening meal prior to the exam Instruct the patient to take color contrast tablets 2 hours after the evening meal Instruct patient NPO after meal and tablets Bowel cleansing may be ordered per facility criteria Common Patient Preparation, cont’d.

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ CT Explain that contrast media will be ingested just prior to procedure Describe whirling sound and motion of machine ■ IVP Instruct the patient to ingest only clear liquids the day before the procedure Instruct NPO usually 8 hours before the procedure Explain bowel cleansing per facility criteria ■ Mammography Instruct patient not to apply lotion, deodorant, or powder from the neck to the waist Instruct the patient to avoid caffeine 1 week before the test, if this is a facility criterion Common Patient Preparation, cont’d.

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ MRI Check for internal metal prostheses or other internal metals (e.g., pacemaker, clips) Instruct patient to not wear metal hair clips or eye makeup for procedure ■ Ultrasound Instruct the patient if a full bladder is required for specific ultrasound (e.g., obstetrical ultrasound); provide water Describe the type of transducer and gel to be used Common Patient Preparation, cont’d.