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Radiology

X-Ray

Procedure

The patient is placed between the X-ray tube, which emits a cone-shaped X-ray beam, and the film or image receptor. Bones do not allow the X-ray beam to pass through them, resulting in an image of the bones on the film.

Film

Radiology


a. The branch of medicine that uses radioactive substances or matter that gives off radiation.
b. Uses various techniques for visualizing the internal structures of the body for the diagnosis and treatment of disease.
c. Uses X-rays, radioactive substances, and other forms of radiant energy such as ultraviolet rays.
d. Divided into three specialties:
• Diagnostic radiology
• Radiation therapy
• Nuclear medicine
2. Individuals that work in radiology include:
a. Radiologist
• Physician specializing in radiology
b. Radiographer or radiologic technologist
• Involved in making diagnostic radiographs or X-rays
• Duties include:
1. Positioning patients for radiographic procedures
2. Determining the proper voltage, current, exposure time for each X-ray
3. Adjusting radiographic equipment
4. Developing the film
5. Assisting the radiologist with special procedures
• To become a radiologic technologist requires a 2- to 4-year college program.
c. The medical assistant in a radiology department will require additional training in order to assist with radiologic procedures.
B. Explore the principles of X-rays.
1. Discovered by Wilhelm Konrad Roentgen in 1895.
2. Produced in a vacuum tube when electrons, traveling at the speed of light (186,000 miles per second), collide into a target made of specific materials such as tungsten.
a. Collision produces electromagnetic rays that have high energy and very short wavelengths, which are not visible to the human eye.
b. When X-rays are emitted from the tube, they form a cone-shaped X-ray beam.
c. The radiation field is the cross section of the X-ray beam and the point of use.
d. Patient is placed between the tube producing the X-ray beam and the film where the image is recorded.
3. Discovery of the X-ray revolutionized the diagnosis of disease.
4. X-rays can penetrate most materials
5. Useful for making photographic images for diagnostic purposes.
6. Used in the procedures of radiography and fluoroscopy.
7. Produced by projecting X-rays through organs or structures of the body onto photographic film.
a. Some structures such as bones are more radiopaque and allow fewer X-rays to pass through.
b. Other softer tissues, such as skin and lungs, are radiolucent, permitting greater penetration of X-rays.
C. Describe the characteristics of X-rays.
1. Can penetrate substances of different densities to varying degrees.
2. Cause ionization of the substances through which they pass.
a. Ionization is the process which causes the gain or loss of electrons from a neutral atom.
b. Loss of electron = positive charge; gain of electron = negative charge.
3. Cause fluorescence of certain substances.
a. Internal structures show up dark on a glowing screen as X-rays pass through, allowing physicians to visualize structures in motion.
4. Travel in a straight line so the X-ray beam can be directed at a specific area.
5. Can destroy body cells and can be used to kill cancer cells.
D. Explain diagnostic imaging and the use of contrast mediums.
1. Diagnostic imaging
a. Involves the use of X-rays, ultrasound, radiopharmaceuticals, radiopaque media, and computers
b. Produces images of internal structures and processes
2. Contrast mediums
a. Radiopaque substance
b. Does not allow the passage of X-rays
c. Facilitates radiographic imaging of internal structures that are difficult to visualize on a regular X-ray or fluoroscopic screen.
d. Include liquids (barium), powders, air, and gas
e. Administered orally, by injection (parenterally), or by enema
f. Acts to convert an organ or structure into an opaque area
3. Positive contrast mediums
a. Barium sulfate and iodine are positive contrast media
b. Means they have more density and thus can absorb more radiation
c. Will appear white on X-ray images
d. Barium sulfate
• Consists of a chalky compound mixed with water and flavoring to the right consistency for a patient to drink
• Technician may administer as an enema
• Used for fluoroscopic examination of the gastrointestinal tract
e. Iodine contrast compounds
• Used to form radiopaque compounds
• Used for thyroid studies, pyelograms, angiograms, and cholecystograms
• Should not be used if the patient is allergic to seafood or iodine
• Interfere with nuclear medicine
4. Negative contrast mediums
a. Include air, carbon dioxide, and other gases
c. Appear black on X-rays
d. Used to visualize the spinal cord, as in a myelogram, and joints
e. Can result in severe headaches following procedures such as myelograms
f. Negative contrast studies have largely been replaced with the use of magnetic resonance imaging (MRI).
E. Discuss preparing and positioning the patient.
1. The role of the medical assistant is to:
a. Schedule the procedure ordered by the physician.
b. Educate the patient about the procedure
c. Explain the preparations needed beforehand.
d. Inform him or her how long the entire procedure will take.
e. After scheduling the procedure, written instructions should be given to the patient and thoroughly reviewed before he or she leaves the office.
f. Once the procedure is concluded, the medical assistant:
• Assists the patient
• Provides post-procedure instructions
• Informs the patient when to expect the test results
2. For some X-ray procedures, special patient preparation must be performed before the patient can be examined. Procedures that require special instructions include:
a. Angiogram:
• No breakfast if morning examination or lunch if afternoon examination.
b. Barium enema (Lower GI):
• Enemas until the bowel return is clear on the evening before the examination.
• Physician 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 jello for dinner.
• Nothing by mouth (NPO) after midnight.
c. Barium meal (Upper GI): NPO after midnight.
d. Bronchogram: NPO.
e. 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.
f. Computerized tomography (CT):
• NPO for 4 hours before X-ray if a contrast medium is used.
g. Intravenous cholangiogram: NPO.
h. 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.
i. Myelogram: NPO.
j. Retrograde pyelogram:
• Enemas or laxatives on the evening before X-ray.
• NPO for 8 hours before the procedure.
k. Ultrasound:
• May require a full bladder or laxatives depending on the type of ultrasound.
3. For many radiology examinations, the patient will be asked to undress and wear a patient gown.
a. Many of the procedures involve positions and interventions that may be embarrassing to the patient.
b. The medical assistant must make every effort to provide an ample size gown and drape the patient to preserve his or her privacy.
c. Request that the patient remove all metallic materials such as jewelry, belt buckles, watches, eyeglasses, hairpins, earrings, and hearing aids.
d. In some X-rays of the head, mouth, and neck, the patient may have to remove dentures.
e. Since the patient is not able to wear jewelry during the procedure, a safe container or locker should be provided for personal belongings.
4. The patient may need assistance getting onto the X-ray table.
a. A footstool should be available if the table is high. X-ray tables do not have side rails.
b. If there is a concern that the patient may become confused, then someone must remain in the room with the patient until the procedure begins.
c. Children may require special attention and need someone to help them maintain the correct position.
d. Anyone who has to be in the room during an X-ray procedure must follow the strictest safety considerations.
F. Review the positions that may be required for radiology procedures. The position of the patient is critical for an accurate X-ray.
1. Radiology positions and descriptions are as follows:
a. Anteroposterior (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.
b. Posteroanterior (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.
c. 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.
d. 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.
e. 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.

Steps for a general X-ray examination
1. Check X-ray examination order.
2. Check necessary X-ray equipment as needed.
3. Identify the patient.
4. Determine patient compliance with procedure preparation instructions.
5. Explain the procedure to the patient.
6. Instruct the patient to remove all clothing appropriate for the procedure.
7. Ask the patient to remove all jewelry and metals as needed for the procedure.
The following steps will most likely be performed by a radiologic technologist:
8. Position and drape the patient correctly.
9. Align the X-ray tube and cassette at the correct distance and set the controls.
10. Ask the patient to hold breath as necessary.
11. Leave the room and stand behind the lead shield to take the X-ray(s).
12. Ask the patient to take a comfortable position while the X-rays are processed and reviewed.
13. Instruct the patient to dress if the X-rays are satisfactory.
14. Label the X-rays and place in an envelope according to office procedures.
15. Document appropriately.
G. Note the guidelines for scheduling a patient for a radiologic procedure.
1. The medical assistant often has the responsibility of scheduling the patient and providing instruction for radiologic procedures.
2. If the procedure is performed in a facility other than the medical office, you may have to call to make the appointment.
3. When setting an appointment, have the following available:
a. The patient’s name
b. Type of insurance with pre-certification or approval number
c. The referring physician’s name
d. Type of radiologic procedure to be performed
4. Special dietary restrictions involving radiographic procedures often call for an all-liquid diet on the day before the test.
a. All-liquid diets mean that the patient may have any of the following beverages:
• Coffee
• Tea
• Carbonated beverages
• Clear gelatin desserts
• Strained fruit juices
• Bouillon
• Clear broth
• Tomato juice
b. The patient may not have any dairy products.
c. Remind the patient that NPO means nothing by mouth.
d. It is up to the physician to decide whether the patient should or should not take his or her daily medications.
5. When multiple procedures need to be scheduled, it is important to consider the sequence of scheduling.
a. Attention to sequencing is important because some procedures, such as those that require the use of contrast medium, may interfere with other tests.
b. In addition, the patient may not be able to tolerate multiple procedures on one day.
c. In general, examinations that do not require the use of contrast medium are performed before those examinations with contrast medium.
d. Always check with the facility performing the tests to obtain specific instructions for scheduling.
6. Guidelines for sequencing multiple radiographic procedures include:
a. Schedule all radiographic examinations and tests that do not require contrast media and iodine uptake.
b. Radiographic tests of the urinary tract.
c. Radiographic tests of the liver and gallbladder.
d. Do CT scans of abdomen and pelvis before procedures requiring barium.
• Lower gastrointestinal series (barium enema)
• Upper gastrointestinal series
e. CT procedures that require IV contrast media may be done AFTER blood is drawn for an iodine uptake series.
7. Some procedures require long waiting periods between filmings because it takes time for the contrast medium to move through portions of the body.
a. This should be carefully explained to the patient in order to schedule his or her time appropriately.
b. The patient may have to allow a full morning for a series of X-ray procedures.

Diagnostic Imaging Procedures

1. Angiography:
a. Cardiovascular: status of blood flow, collateral circulation, aneurysm, hemorrhage, vessel malformation
b. Cerebral: aneurysm, hemorrhage, evidence of CVA, arteriosclerosis, gastrointestinal (GI), upper gastrointestinal bleeding
c. Pulmonary: pulmonary emboli, evaluation of pulmonary circulation in heart conditions prior to surgery
d. Renal: abnormalities of blood vessels in urinary system
2. Arthrography:
a. joint conditions
3. Barium enema (lower GI):
a. Obstructions
b. Ulcers
c. Polyps
d. Diverticulosis
e. Tumors
f. Motility problems of colon or rectum
4. Barium swallow (upper GI):
a. Obstructions
b. Ulcers
c. Polyps
d. Diverticulosis
e. Tumors
f. Motility problems of esophagus, stomach, duodenum, and small intestines
5. Cholangiography and cholecystography:
a. Gallstones
b. Gallbladder
c. Common bile duct stones or obstructions
d. Ability of gallbladder to concentrate and store bile
6. Computed tomography (CT):
a. Aortic and heart aneurysms
b. Disorders of liver and biliary systems
c. Renal and pulmonary tumors
d. Brain abnormalities (tumors, blood clots, CVA, outlines of brain ventricles)
e. GI tract lesions
f. GI tract disorders (pancreatic cyst, abdominal abscesses, biliary obstruction)
g. Breast diseases and disorders
h. Spinal disorders
i. Biopsy guides
7. Fluoroscopy:
a. Structure, process, and function of organs in motion to detect abnormalities
8. Intravenous pyleography (IVP), excretory urography:
a. Urinary system abnormalities, including renal pelvis, ureter, and bladder (kidney stones)
b. Abnormal size, shape, or structure of kidneys, ureter, bladder
c. Tumors
d. Cysts
e. Pyelonephrosis
f. Hydronephrosis
g. Trauma to urinary system
9. KUB (kidneys, ureters, bladder) radiography:
a. Size, shape, and position of urinary organs
b. Urinary system diseases or disorders
c. Kidney stones
10. Magnetic resonance imaging (MRI):
a. Cancerous tissue
b. Atherosclerotic tissue
c. Blood clots
d. Tumors
e. Deformities, particularly of the heart valves, brain, spine, and joints
11. Mammography:
a. Breast tumors
b. Lesions
12. Myelography:
a. Irregularities or compression of spinal cord
13. Nuclear medicine (radionuclide imaging):
a. Abnormal function
b. Lesions or disorders of bone, brain, lungs, kidneys, liver, pancreas, thyroid, and spleen
14. Radiation therapy:
a. Treatment of cancer and some benign tumors or scars
15. Retrograde pyelogram:
a. Obstruction of ureters, bladder, or urethra
16. Stereoscopy:
a. Fractures
b. Dense areas that indicate tumor or increase pressure within skull
17. Thermograph:
a. Breast tumors
b. Breast abscesses
c. Fibrocystic disease
18. Ultrasound:
a. Abnormalities of gallbladder, liver, spleen, heart, kidneys, gonads, blood vessels, lymph system
b. Fetal conditions: number of fetuses, age, sex, fetal development, position, and deformities
19. Xeroradiography:
a. Breast cancer
b. Abscesses
c. Lesions
d. Calcifications
B. Review the types of radiologic procedures that involve the use of contrast media and then discuss some of them in further detail.
1. Angiography
2. Arthrography
3. Barium enema (lower GI)
4. Barium swallow (upper GI)
5. Cholangiography
6. Cholecystography
7. Fluoroscopy
8. Intravenous pyelogram (IVP)
9. Myelography
10. Nuclear medicine studies, retrograde pyelogram, and sometimes MRI

Fluoroscopy
1. Technique in radiology for visually examining a portion of the body or the function of an organ using a fluoroscope.
2. Technique allows the radiologist to have immediate images which can be used to assess heart function such as cardiac catheterization.
3. The moving image that is seen on the fluoroscope can then be filmed using a radiograph (X-ray) to obtain a permanent record.
4. Contrast media are often used during fluoroscopic procedures to better visualize organ function and abnormalities.
5. Fluoroscopic procedures include the gastrointestinal series, IVP+, cholecystogram, and myelogram.

Gastrointestinal series
1. Fluoroscopic study of the digestive tract using contrast media to detect abnormalities such as tumors, ulcers, polyps, and diverticulosis.
2. Guidelines for the patient undergoing an upper GI (an examination of the esophagus, stomach, duodenum, and small intestine)
a. Patient should not eat or drink after midnight since the stomach must be empty for this procedure.
b. Not even water should be swallowed while brushing teeth.
c. Physician may order that no morning medications be taken.
d. Patient should be instructed not to smoke since this can stimulate gastric secretions.
e. Patient will have to undress and put on a patient gown.
f. A barium sulfate drink is prepared for the patient to drink. This may be flavored but will still retain a slightly chalky taste.
g. Patient will stand in front of the fluoroscopic screen while drinking the mixture.
h. Radiologist will observe the progress of the barium as the patient drinks.
i. Patient is then placed on an X-ray table that will tip into various positions for additional views.
j. Permanent X-rays are taken while the patient is told to hold his or her breath.
k. Procedure may last for several hours during which time the barium will move out of the stomach and into the small intestine.
l. Patient may resume normal eating after the examination, but should be reminded to drink water to assist in flushing out the remaining barium, as this may cause constipation.
m. Patient’s stool may remain chalky for a couple of days.
3. Guidelines for the patient undergoing a lower GI (the administration of a barium enema, which outlines the colon and rectum on a radiographic picture):
a. The colon and rectum need to be free of stool for a clear view of the area on X-ray.
b. Day before the examination:
• The patient may be instructed to follow a low-residue diet for several days before the test.
• On the morning before the test, he or she will change to an all-liquid diet (such as water and clear soup) because NO solid foods may be taken until after the procedure.
• A cathartic, such as castor oil or citrate of magnesia, may be ordered to be taken at 4:00 P.M. the day before the procedure.
• Enemas need to be taken until the return fluid is clear.
c. Day of the examination:
• Patient must undress and wear a patient gown for the procedure.
• Another cleansing enema may be given before the procedure.
• Patient lies on his or her side on the X-ray table while the technician gives an enema of barium sulfate.
• Patient is asked to retain or hold the enema within the rectal and colon area.
• Patient is then moved or tipped into different positions on the table while the radiologist observes the flow of barium on the fluoroscope.
• Periodically radiographs (X-rays) are taken during the procedure.
• Patient is asked to expel the barium into the toilet.
• A final X-ray is taken of the empty bowel.
• Patient may return to a regular diet after this procedure.
• Whitish stools may be present for one or two days after the procedure.
• Patient should be encouraged to drink water to flush out the remaining barium with stool.

Intravenous pyelogram (IVP) or excretory urogram
1. Also called a pyelogram or intravenous pyelogram.
2. A radiologic examination of the kidneys, ureters, and bladder.
3. Patient should be screened for iodine sensitivity prior to the procedure.
4. This procedure takes between 60 and 90 minutes.
5. Patient is instructed to eat a low-residue diet and drink plenty of water the day before the procedure.
6. Patient is allowed nothing by mouth (NPO) after midnight.
7. A cathartic, such as castor oil or citrate of magnesia, may be ordered along with an enema to be taken the night before the examination.
8. Patient will need to undress and wear a patient gown for this procedure.
9. A contrast medium containing iodine is injected into the vein. This substance may cause the patient to have a warm, flushed feeling and a metallic taste in the mouth.
10. Patient should be instructed to notify the radiologist if there are any unusual symptoms, such as shortness of breath or itching, that could indicate an allergic reaction to the dye.
11. Patient is tipped into various positions on the X-ray table, which allows the radiologist to view the dye as it flows through the urinary system.
12. Patient may be asked to urinate, and then have one final X-ray taken.
13. After the examination, the patient can return to a normal diet.
14. He or she should be encouraged to drink water to flush out the contrast medium through the kidneys.

Cholecystogram
1. Radiologic examination of the gallbladder using a contrast medium, usually iodine.
2. Procedure is done to detect abnormalities such as the presence of gallstones.
3. Although this procedure has been replaced by ultrasound in many facilities, it is still ordered when ultrasound scanning fails to provide a definitive diagnosis.
4. It is important for the patient to understand that there is a significant time involved in preparation the night before and the day of the procedure.
a. Patient is instructed to have a fat-free meal the evening before the procedure and NPO after midnight.
b. The contrast medium, in the form of pills, is taken after dinner.
c. Patient is instructed to take one pill at a time every few minutes with water until the six pills have been ingested.
5. The procedure
a. In some facilities, the contrast medium is administered by intravenous (IV) injection.
b. The patient undresses and wears a patient gown for this procedure.
c. An initial X-ray is taken to see if the gallbladder is visible.
d. A study is then conducted using the fluoroscope.
e. Radiographs (X-rays) are taken also.
f. After this portion of the procedure, the patient is asked to eat a fatty meal.
g. This meal stimulates the gallbladder to empty.
h. Another X-ray is taken 1 hour after the meal.
i. Patient can resume a normal diet after the procedure is complete.
j. Patient should be told that diarrhea is an expected side effect of the contrast medium used in this procedure.
k. Patients should be encouraged to drink plenty of fluids to replace the fluids lost as a result of diarrhea.

Myelography
1. A fluoroscopic procedure of the spinal cord.
2. A lumbar puncture is done to remove some cerebrospinal fluid (CSF) and instill contrast medium.
3. This procedure produces a myelogram and is used to detect compression of the spinal cord or herniated disks.
CT scans and MRIs are more commonly done now; however, a myelogram may be needed if the other procedures do not reveal enough detail.

Pneumoencephalograph
1. Performed by injecting air instead of contrast media after some cerebral spinal fluid has been removed.
2. This procedure allows visualization of the cavities of the brain.

Angiography
1. The X-ray visualization of the internal anatomy of blood vessels after a radiopaque material has been injected into the blood vessels.
2. Procedure is used to assist in the diagnosis of many conditions including:
a. Myocardial infarction (MI or heart attack)
b. Cerebrovascular accident (CVA or stroke)
c. Renal artery stenosis as a cause of hypertension
d. Clots
e. Stenosis in arteries in the lower extremities and abdomen
f. Aneurysm of the aorta
g. Pulmonary emboli or clots
3. Contrast medium is injected into an artery or vein by way of a catheter and threaded through the vessel until it reaches the correct site.
a. Since iodine is used as the contrast medium, the patient should be tested for allergy to iodine before the procedure begins.
b. The patient is monitored for a few hours after the procedure for any signs of bleeding from the puncture site.
4. Procedure is usually done in the hospital or same-day surgical facility and requires the use of local anesthetic.
5. Facilities that specialize in angiography have patient preparation sheets available.

Cardiac catheterization
1. A form of angiocardiography.
2. Frequently performed to assess the status of the coronary arteries.
3. A catheter is inserted into the femoral artery and fed through the arteries until it reaches the heart.
4. If obstructions are discovered, therapeutic interventions can take place, such as balloon angioplasty or stent insertion, to relieve blockage of coronary arteries.
5. These procedures are costly, carry risks, and are not usually performed unless other procedures have failed to provide enough information.

Arthrography
1. Diagnostic procedure used to produce an arthrogram or image inside a joint.
2. Performed by a radiologist to help diagnose abnormalities of the joints, tendons, ligaments, and cartilage of the knee, hip, or shoulder.
3. Procedure involves injecting a local anesthetic followed by contrast medium or air or both into the joint.
4. A fluoroscope is used to evaluate the function of the joint.
5. Procedure usually takes about one hour and the patient should be advised to expect some slight discomfort and swelling for a day or two.
6. Patient should be advised to rest the joint during that time.

C. Describe radiology procedures not requiring contrast media.
1. The procedures not requiring contrast media include films of:
a. Abdomen
b. Bones
c. Chest
d. Kidneys
e. Ureters
f. Bladder (KUB)
g. Paranasal sinuses
2. These examinations or films require that the patient be positioned properly.
3. No prior preparation, such as an enema, is required.
4. Commonly performed radiology tests performed with no contrast material include:
a. Abdomen
• Used for suspected tumors, hematomas, enlarged organs, or abscesses.
b. Bone
• Studies of bones for suspected abnormalities from disease or trauma such as fractures and tumors.
c. Spinal X-rays
• Cervical: X-ray of neck area
• Thoracic: X-ray of the middle back
• Lumbosacral: X-ray of lower back
d. Chest X-rays
• Taken to rule out any abnormality and to pick up hidden disease in the lungs and some cardiac abnormalities (cardiomegaly)
• Patient assumes the posteroanterior erect position and a lateral position.
e. Kidneys, ureters, and bladder (KUB)
• Assess the size, shape, and location of the organs of the urinary tract.
• Detect kidney stones and diseases of the urinary tract.
• Detect the location of an IUD or other foreign object.
f. Paranasal sinuses
• X-ray of the sinuses found within the maxillary, frontal, ethmoid, and sphenoid bones for signs of infection, inflammation, and abnormalities.
D. Explore issues related to mammography.
1. Radiology examination of the soft tissue of the breast to provide identification of benign and malignant neoplasms (tumors).
2. Contrast medium is not used for this procedure.
3. Patient should be instructed not to use underarm deodorant, talcum powder, body lotion, or perfume prior to the procedure since the clarity of the image could be affected.
4. Patient stands in front of the X-ray equipment and the technician positions the patient carefully to have all breast tissue examined under X-ray.
5. Patient should be instructed to follow the technician’s direction regarding placement of hands, arms, and body position.
6. Patients of childbearing age are given a lead apron to wear during the procedure.
7. Each breast is alternately compressed by the mammography equipment to spread the tissue for better viewing.
8. X-rays are directed at angles into the breast tissue.
9. Procedure takes a few seconds for each view with the entire procedure lasting about a half hour.
10. Some patients may feel discomfort during the procedure due to pressure during the breast compression.
a. For most patients, the discomfort is over as soon as the compression is completed (less than a minute).
b. Occasionally patients will complain of discomfort for several days after a mammogram and the physician may suggest they take an over-the-counter analgesic.
11. Women over the age of 40 are advised by the American Cancer Society to have a yearly mammogram for early detection of breast cancer.
12. Many abnormalities detected on mammograms are benign and present no danger to the patient.
13. If a lump is detected, the patient should follow up immediately with further testing and not wait to see if the lump disappears over time.
14. Once a mammogram reveals suspicious tissue, a breast biopsy should be done to confirm the type of mass detected.
15. A new type of biopsy known as stereotactic breast biopsy is less invasive and less painful than previous types of biopsies.
a. This procedure is done with the patient lying face down with the breast compressed between two paddles with the suspicious mass centered in the window of the paddle.
b. A computer determines the precise positioning of the biopsy needle.
c. A small sample of cells is taken and sent for review by a pathologist.
d. After the examination is complete, the physician informs the patient of the pathologist’s findings.
E. Define tomography and explain its purpose.
1. The sectioning of the body using roentgenography.
2. Allows the technician to penetrate dense areas of the body that could not otherwise be visualized.
3. When tomography was first introduced it was considered the most significant advancement in diagnostic medicine since the discovery of the X-ray.
4. Tomography produces tomograms.
5. Tomography has the ability to remove, or blur out, areas that are not within the plane being examined.

Computed tomography (CT)
1. Combines radiography with computer analysis of tissue density.
2. The X-ray camera rotates completely around the patient and the computer accumulates cross sectional slices from each rotation of the camera.
3. The CT scanner consists of a moveable table with a remote control, the circular structure or gantry that houses the X-ray equipment, and an operator console with monitor and computer equipment.
4. Ancillary software and hardware sort, manage, retrieve, and store images.
5. This procedure is painless, noninvasive, and requires no special preparation.
6. The patient lies on a narrow table that slides into the scanner.
7. A narrow beam of X-ray rotates in a continuous 360-degree motion around the patient to slice the images of the body in cross-sectional angles.
8. The computer then calculates various factors including tissue absorption and displays a printout that determines the density of the tissue. In this way, tissue masses, such as tumors, bone displacement, and fluid accumulation are detected.
9. Images produced are more detailed than those obtained through conventional X-rays.
10. Scan identifies space-occupying tumors such as those found in the brain, liver, gallbladder, and spleen.
11. Can help to evaluate malignant conditions in the lungs and bones, which can eliminate the need for more invasive procedures.
12. CT scanning and MRI have largely replaced the use of tomography.
13. CT scans are useful when there is conflicting information about the cause of the patient’s condition or defining exactly where radiation therapy must be directed for tumor masses.
14. Other uses for CT include:
a. Detecting cerebral abnormalities, such as tumors, hematomas, childhood cancers, abdominal masses.
b. Surveying difficult to visualize glands, such as the pituitary gland and tissue.
15. CT scanner is able to scan the entire body in 15 to 20 minutes, which allows one scanner up to about 20 patients to be scanned in one day.

CT scan preparation:
1. In many instances, CT scans involve little prior preparation for the patient.
2. For some CT procedures, a contrast medium is used so the patient may be instructed to have NPO for four hours before the procedure.
3. The imposing size of computed tomography equipment may cause considerable apprehension in a new patient. As with any procedure, a thorough explanation when scheduling the scan helps to relieve patient anxiety.
4. Many patients have never seen a CT scanner, and having a diagram listing the major parts and their basic functions is helpful.
5. Any metallic objects will interfere with the CT scan. Instruct the patient to remove all metallic objects and inquire whether he or she has a pacemaker or metallic prosthesis.
6. The table may move continuously in a spiral scanning motion or stop and start depending on the area being scanned.
7. The patient should be reassured that he or she will not be in a confined space as with an MRI.

Positron emission tomography (PET)
1. A computerized radiographic method that uses radioactive substances to examine the metabolic activity within the body.
2. Patient is either injected with or inhales a chemical, such as glucose, which carries a radioactive substance.
3. Substance emits positively charged particles called positrons that combine with negatively charged electrons found within the body.
4. Rays that are produced are converted into color-coded images that indicate the degree of metabolic activity.
5. PET is used to assist in the treatment of epilepsy, brain tumors, stroke, Alzheimer’s disease, blood flow, and metabolism of the heart and blood vessels.
6. This procedure can detect mild early changes in the brain before nerve damage, memory loss, or other symptoms occur.
7. The radioactive elements used in PET are short lived, which results in minimal radiation exposure for patients.

F. Discuss magnetic resonance imaging (MRI)
1. One of the newest imaging technologies.
2. The MRI uses a powerful magnetic field to visualize internal tissues, organs, and structures.
3. The images produced with this technique are excellent.
4. All areas of the body can be scanned using the MRI.
5. There is no ionizing radiation used and the MRI has no known risks.
6. The signal or nuclear magnetic resonance produced by the MRI varies with different body tissues.
7. Signals are processed by the computer and form a visual image.
8. An MRI scan can give the viewer a three-dimensional view of tissues or organs of the body in total or as slices.
9. Can be useful for tumor detection.
10. Explaining the procedure to the patient should include a description of the type of chamber in which the patient will be placed.
a. One type of chamber consists of a large cylindrical electromagnet.
• The patient is rolled into it on a pallet.
• The chamber is sealed, which allows the patient’s entire body to come into contact with the electromagnetic field.
• The procedure, while painless, can be upsetting to patients who have claustrophobia, which means they are afraid of closed-in spaces.
• The space inside a closed MRI machine is only slightly larger than the average patient.
• The MRI machine makes loud thumping noises intermittently during the procedure.
• The patient should be made aware of this noise and be provided with earplugs or earphones to listen to music.
• In cases of extreme apprehension, the patient may need to be given a medication to promote relaxation.
b. Open MRIs are available for patients who are too large for the enclosed MRI or too apprehensive. However, the images produced may not be as accurate or detailed.
11. There are some limitations to the use of the MRI.
a. It is not possible to view the hard portion of bone matter. For visualizing fractures and other abnormalities, the CT scan and general X-rays are still used.
b. The strong magnetic field is not appropriate for patients who have pacemakers or metallic clips on blood vessels.
12. Prior to the MRI the patient should be instructed to:
a. Remove all jewelry, eye shadow, and metallic objects, such as watches, belts, hearing aids, and hairpins.
b. Identify which devices, if any, have been inserted within the patient’s body such as:
• Pacemakers
• Dental implants
• Surgical staples
• Intrauterine devices
• Joint or bone pins
• Prosthesis
• Metallic clips on blood vessels
• Metal fragments, for example from a gunshot
c. Leave credit cards or devices which contain metallic or magnetic code strips outside the MRI chamber.
d. Use a patient gown if the patient’s clothing has zippers or metal snaps.
13. The technician is not in the chamber with the patient during the procedure.
14. The patient should be told that the technician will be in constant contact with the patient via a microphone and camera.
15. The patient should be instructed to remain still during the procedure.
16. An MRI scan takes from 20 to 60 minutes depending on the amount of the body to be scanned.

Functional MRI
1. Advancement in MRI technology.
2. Enables physicians to observe the function of organs.
3. Able to provide information about nerve activity in the brain and locate areas of the brain activated in memory.

G. Explain digital radiology and the use of ultrasound.
1. Digital radiology
a. Use of standard fluoroscopy, which is digitized, stored as computer bits, processed, and then converted into an image on a television or video monitor screen.
b. Image is stored on a videotape or digital disc.
2. Digital angiography
a. Used for cardiac and pulmonary arteries and head and neck angiograms.
3. Ultrasound or sonography
a. Use of high-frequency sound waves to image internal structures.
b. Consists of projecting a beam of sound waves into the body.
• The waves, at about 20,000 cycles per second, bounce back as the beam comes into contact with a structure, such as a fetus, which then produces an outline of the internal structure.
c. Valuable uses of the ultrasound include:
• Fetal monitoring and detecting abnormalities such as gallstones, tumors, and heart defects.
• Scanning organs such as the liver, heart, kidneys, thyroid, gonads, and blood vessels.
d. Not used to image the lungs, brain, or skeleton since they are made of or surrounded by bone, which sound waves cannot penetrate.
e. Uses no ionizing radiation.
f. Painless, noninvasive procedure.
g. Widely accepted as a safe examination of delicate tissues and the fetus.

Fetal ultrasound
1. Commonly performed to detect the presence of multiple pregnancies, fetal and placental positioning, and internal organ development.
2. Not recommended simply to determine gender of the fetus.

Performing an ultrasound procedure:
1. A conduction material such as water, special jelly, or oil is used to conduct the sound waves into the body.
2. An instrument called a transducer (a device that both produces and senses ultrasonic waves) with a conduction head is then placed on or near the skin.
3. As sound waves pass through the skin, they bounce off the body tissues or fetus and remit back to the instrument an echo reflection of the image.
4. These echoes of the body tissue or fetus are then recorded as a series of dots on an oscilloscope (an instrument that displays a visual picture).
5. The record is called an echogram or a sonogram.
6. The patient is often able to view the sonogram on the screen as it occurs.
7. A printout of this visual picture can then be printed for the patient’s record and in some cases, a copy of this printout is given to the patient.
8. Patient preparation for the ultrasound examination is minimal.
a. The patient should wear loose-fitting garments or clothing that is easy to remove since the procedure is performed over bare skin.
b. During a fetal ultrasound or pelvic ultrasound, the patient is instructed not to urinate right before the test since a full bladder displaces the intestines and allows for a better view of the uterus.
c. The patient may be asked to drink a quart or more of water just prior to either of these examinations.
d. For an ultrasound of the gallbladder or liver, the patient may be asked not to eat for several hours before the procedure.

H. Describe radiation therapy, the type of rays used, and the uses of radiation therapy.
1. Radiation is the use of a radioactive substance in the diagnosis and treatment of disease.
2. When radiation is used to treat cancers or other conditions, it is called radiation therapy.
3. Radiation therapy is the process of administering a particular dosage of radiation to a specific area on the patient’s body for the purpose of killing diseased cells, such as cancers.
4. Radiation actually alters the cells so they cannot reproduce and thus eventually die leaving no new cells to develop.
5. Both diseased and normal cells are altered with radiation.
6. Diseased cells are eventually destroyed; however, normal or healthy cells are able to repair themselves and regrow new cells.
7. Radiation therapy is also known as cobalt treatment, X-ray treatment, or radiotherapy.

Radiation rays
1. In radiation therapy, the radioactive substances used emit three types of rays:
a. Alpha rays
• least penetrating rays
• positively charged helium particles released by the disintegration of radioactive material
b. Beta rays
• able to penetrate body tissues a few millimeters
• are negatively charged electrons released when atoms of radioactive substances disintegrate
c. Gamma rays
• have great penetrating power
• are electromagnetic waves emitted by atoms of radioactive elements as they undergo disintegration
• can penetrate most body tissue, but are absorbed by lead
d. All three ray types are similar to X-rays, but they come from the element’s nucleus, while X-rays come from the orbit of the element’s atom.

Uses of radiation therapy
1. Administered after the tumor is well defined in the patient.
a. Tumors are located through the use of CT scan and ultrasound.
b. The boundary of the tumor can be localized by these radiologic procedures.
2. Factors to consider when determining whether or not to use radiation therapy to treat a cancer patient include:
a. The tumor must be surrounded by normal tissue that can repair itself after radiation treatment.
b. Radiation is used to alleviate symptoms if the cancer has metastasized.
c. The tumor must be sensitive to radiation.
3. Patients receive radiation therapy for a variety of types of cancers including cancer of the ovaries, testes, skin, larynx, and oral cavity.
4. Hodgkin’s disease, Wilms’ tumor (a type of kidney tumor found in children), and retinoblastoma are also treated with radiation therapy.
5. For some types of malignancies, such as cervical cancer, a combination of radiation and chemotherapy is used.
6. In some cases, when a cure is not probable, radiation may be used to shrink tumors to alleviate pain, relieve pressure, or stop bleeding. In these instances, radiation therapy may improve the patient’s quality of life.
7. Certain benign conditions may be treated with radiation such as keloids (abnormal scars), and malformed blood vessels in the brain, which cannot be accessed any other way.

Two methods for administering radiation
1. External radiation therapy
a. Involves administering calculated doses of radiation from a machine positioned at a specific distance from the site (tumor).
b. A marker or tattoo is placed on the patient at the exact site or port of entry.
c. A computer calculates the dosage required to destroy the largest number of malignant cells while causing the least damage to surrounding cells.
d. It may be necessary to schedule a series of ERT treatments over a period of weeks or months.
2. Internal radiation therapy
a. Can be administered into the body in two forms: sealed or unsealed radiation therapy.
b. Sealed radiation
• involves the implantation of sealed containers of radioactive material near the tumor in the body
c. Unsealed radiation
• involves introducing a liquid form of radioactive substance into the patient by mouth, bloodstream, or instilling into a body cavity
3. Radiation therapy is not usually disfiguring, but may cause side effects in some patients including:
a. Hair loss
b. Skin changes
c. Nausea
d. Diarrhea
e. Irritation of the mucous membranes in the mouth, throat, bladder, and vagina
f. Chromosome changes
The symptoms vary in intensity and may last three to six weeks.

I. Introduce the branch of nuclear medicine.
1. Uses radioactive isotopes in the diagnosis and treatment of disease.
a. Isotopes are chemical elements which may have several forms but identical properties.
b. Radioactive refers to the ability to give off radiation as the result of the disintegration of the nucleus in an atom.
2. Nuclear medicine is also known as radionuclide imaging.
3. Radioactive isotopes of iodine, cobalt, and other elements are used in nuclear medicine for the treatment of tumors and for nuclear imaging certain parts of the body.
4. Radionuclides
a. isotopes whose nuclei (central core) are undergoing decay
b. administered to the patient intravenously, orally, or instilled into body cavities or organs
c. travel to a point within the body that attracts them
d. have a short life, which results in very few side effects for the patient
5. Radionuclide imaging exposes the patient to lower doses of radiation than some other radiologic procedures.
6. A concentration of radionuclides is referred to as either “hot” or “cold.”
a. If the radionuclide is in an area with an abnormality, it is referred to as “hot.”
b. If the radionuclide does not concentrate into a tumor, but is situated in the surrounding area, it is referred to as “cold.”
c. Both hot and cold areas can indicate the presence of abnormalities.
7. Scans of different areas of the body require various preparations and varying lengths of time. The patient must be informed of the expected time.
a. For instance, a bone scan takes about an hour; however, the patient is given an injection two hours prior to the scan and then must drink a quart of water.
b. Kidney scans last two hours.
c. Thyroid uptake may not be completed until two days. After the patient takes the initial capsule, he or she must return 24 and 48 hours after the capsule is taken.
8. The process of studying an area with a concentration of a radioactive substance is called scanning.
a. The technician uses a gamma counter or camera that detects the radiation and converts it into an image or scintigram, which is displayed on a screen.
b. The thyroid, liver, and brain are frequently evaluated using the scanning process.
c. If a radioisotope is used in a high dose for treatment, then the patients may have symptoms that are similar to those found with radiation.These include:
• Hair loss
• Nausea
• Diarrhea
• Mucous membrane irritation (in the mouth, throat, and bladder)
• Chromosome changes
J. Describe how radiation doses are measured and the safety precautions that should be taken when performing radiology procedures.
1. Radiation dose is measured in several different units, all of which relate to the amount of energy deposited.
a. The units include the roentgen (R), the gray (Gy), and the sievert (Sv).
b. The sievert and the gray are similar, except that the sievert takes into account the biologic effects of different types of radiation.
c. The biological effect of radiation exposure varies with the type of radiation and its energy.
d. Equal doses of different types of radiation will not always result in the same biological effects.
e. A rad, which stands for radiation absorbed dose, is the unit used to measure the amount of ionizing radiation absorbed during an X-ray procedure.
2. To measure occupational exposure or other exposure that may involve more than one type of radiation, the unit used is the rem, which stands for “roentgen equivalent in man.”
The dosimeter or personal radiation badge containing the occupational exposure dose is reported in rem.

Radiation exposure
1. People are constantly exposed to low levels of natural ionizing radiation or background radiation from outer space and radon exposure.
2. In addition, people are exposed to ionizing radiation from human-made sources such as nuclear weapons testing and radiation from medical testing and treatments.
3. On average, diagnostic imaging emits lower doses of ionizing radiation than occur naturally.
4. Advances in diagnostic imaging have reduced the radiation dose a patient is exposed to during a diagnostic procedure.
5. Excessive exposure to radiation causes tissue damage and side effects.
6. Overexposure to radiation may result in radiation sickness causing symptoms such as:
a. Lowered red blood cell and white blood cell count
b. Bone marrow alteration
c. Burns
d. Damage to ovaries and testes
e. Fetal damage (especially during the first three months of pregnancy)
f. Cancer
7. Radiation sickness from overexposure is usually the result of long-term exposure and is generally delayed.
a. Radiation sickness may result in cancer and premature aging.
b. The severity of radiation sickness depends on the dose of radiation, the type of radiation, duration of exposure, and what areas of body were exposed.
c. Radiation sickness can occur after nuclear reactor accidents.

Cellular effects of radiation
1. At the cellular level, radiation damages the DNA of cells in both malignant and normal cells.
2. Normal cells are better able to repair DNA damage than cancer cells. Therefore treatment with radiation kills the cancer cells, while after a period of time, damaged normal cells in the area will repair themselves.
3. Sensitivity to radiation of cells increases with their increased rate of cell division.
a. For example, cells that divide more frequently, such as hair, mucous membranes of nose, mouth, skin, and GI tract; as well as some glands, such as breast and thyroid, are more sensitive.
4. The less specialized a normal cell is, the more affected by radiation it will be. Cells of the bone marrow, and germ cells, such as sperm and ovum, fall into this category.
5. Excessive radiation to embryonic cells causes spontaneous abortion, retardation, genetic abnormalities, and increased risk of leukemia and other cancers.
6. Some cancers, such as leukemias, lymphomas, and squamous cell carcinomas of the mouth and skin, are more radiation sensitive and are treated using radiation therapy.

Personnel safety precautions
1. Since X-rays are potentially dangerous to both the patient and the health care personnel, special precautions must be taken.
2. Radiation is discussed in terms of primary and secondary radiation.
a. Primary radiation
• Strikes the patient for either therapeutic reasons or for an X-ray examination.
• Once the primary beam strikes the patient, it can then become secondary radiation as it bounces off the patient.
b. Secondary radiation
• Strongest closest to the patient.
3. Lead has been proven to be an effective barrier to an X-ray beam.
4. Lead aprons, shields, and gloves are provided for personnel coming into close contact with X-ray equipment.
5. X-ray technicians do not normally remain next to the patient during the X-ray process. They stand behind a lead-shielded divider.
6. X-ray rooms are lined with metal (one-inch thick) as a precaution against X-ray beams escaping from the room.
7. Some facilities have a red flashing light when X-ray equipment is in use to warn others not to enter.
8. A film badge or dosimeter is worn on the outer clothing of all personnel working with or near radiologic equipment.
a. The badge records the level and intensity of radiation exposure.
b. It is periodically examined to ensure that the health care worker is not exposed to excessive radiation.
c. Radiation exposure is cumulative, meaning that each exposure to radiation is added to the effect of all previous exposures.
9. All radiographic equipment should be checked on a regular basis to ensure it is in good working condition and to check for radiation leakage.
10. Radioactive diagnostic materials must be stored in a safe environment and amounts of radioactive material closely monitored.
11. Radioactive materials should be stored in lead containers and handled only with forceps, never with bare hands.
12. Most facilities have a radiation safety monitor who specifies the requirements for the facility making sure OSHA guidelines are observed.

Patient safety precautions
1. The guiding principle in the use of radiation is “as low as reasonably achievable” (ALARA).
2. The exposure of both patients and workers should always be guided by the idea that it is most prudent to use the lowest amount of exposure to perform the task.
3. Patient safety requires that a thorough history of the patient be taken.
a. If the patient is female, the 10-day rule about the possibility of pregnancy should apply.
b. An X-ray may be taken only within 10 days of the last menstrual period to avoid taking an X-ray of a female who is unknowingly pregnant.
c. If a patient is unsure about a pregnancy, then a pregnancy test should be performed or the radiographic test postponed until a pregnancy test is completed unless an emergency situation exists.
d. In cases of emergency, the danger of exposure to the embryo or fetus should be explained to the mother.
4. Patients should be protected from secondary or scatter radiation by the use of a grid during radiographic procedures.
a. Excess scatter may add density to the image and expose the patient unnecessarily.
b. The grid is positioned between the X-ray machine and the patient to absorb radiation scatter before it reaches the film.
c. A Potter-Bucky diaphragm or a bucky is a type of grid that has alternating strips of lead and radiolucent material.
d. Not all secondary radiation is absorbed by a grid, so other safety precautions are necessary.
5. A lead barrier or lead shields should be used by both patients and workers.
a. Patients should be provided with a lead shield for gonads, eyes, breasts, and thyroid whenever appropriate.
b. Employees should use gonad shields, if at the reproductive age (55 years or under), whenever the sex organs are going to be exposed to radiation.
c. For a female patient, the gonad shield should be placed with its lowest margin at the level of the pubic symphysis.
d. In the male, the upper edge of the lead shield should be placed one inch below the pubic symphysis.
6. An implant may present a hazard while the implant is in place in the patient who is undergoing radiation therapy.
a. The length of time the hazard exists depends on the half-life of the material used.
b. The half-life is the time it takes for 1/2 of the isotope to decay.
7. Symptoms caused by radiation therapy will generally not begin for several days after the first treatment.
a. This allows time for the patient and family to thoroughly understand what to expect and what steps to take to make the patient more comfortable.
b. The skin is at most risk and frequently results in inflammation similar to sunburn.
c. If the burns are deep enough hair roots are damaged and hair will fall out.
8. Radiation side effects, healing time, and patient interventions:
a. Alopecia: hair may grow back in several months.
• Shampoo with mild soap, brush, and comb gently.
• Wear scarves or wigs if hair loss is extensive.
b. Bone marrow and lymphoid tissue: depends on dosage and degree of damage.
• Protect from infection.
• Assess for anemia.
• Watch lymphoid tissue for bleeding and signs of thrombocytopenia.
• Avoid trauma from injections and IVs.
c. Ear: depends on dosage and degree of damage.
• Assess for blockage of Eustachian tube and bulging eardrum.
• Protect from falls due to dizziness.
• Assess for hearing loss.
• Administer antibiotic for infection.
d. Eyes: depends on dosage and degree of damage.
• Assess for drying.
• Excessive tearing.
• Conjunctivitis.
• Damage to lens.
• Cataract formation.
• Use artificial tears as needed and antibiotic for infection.
e. Intestinal mucosa: several weeks or months depending on irritation.
• Check intake/output levels.
• Assess for diarrhea and vomiting.
• Administer antidiarrhetic or antiemetic agents if necessary.
• Encourage intake of potassium-rich food.
• Avoid diary products.
• Weigh daily.
f. Nervous system: necrosis of brain can develop as late as a year after treatment. Assess for:
• Level of cognition
• Dizziness
• Slurred speech
• Weakness
• Numbness or tingling in extremities
• Spinal cord damage
• Changes in gait
• Pain
• Incontinence
g. Oral mucosa: within weeks if irritation not severe.
• Increase fluid intake.
• Avoid hot, spicy foods and liquids.
• Restrict smoking.
• Suck ice chips.
• Use lip balm.
• Use artificial saliva if necessary.
h. Skin (1st to 4th degree burns): 7 days to several weeks or months.
• Assess skin daily.
• Do not use drying substances such as alcohol.
• Avoid lying on area.
• Avoid direct sunlight or direct heat source.
i. Urinary mucosa: several weeks to months depending on level of irritation.
• Increase fluid intake.
• Measure urinary output.
• Urinalysis.
• Administer antibiotics if infection present.
9. Guidelines for maintaining personnel safety:
a. Wear a film badge on outer clothing at all times when exposed to any form of X-rays. Do not wear a patient gown or lead shield over the badge. These badges are submitted for routine—usually weekly—evaluation of the levels of radiation exposure.
b. Health care personnel should stay behind a lead shield in a lead-lined room when the X-ray equipment is in use.
c. A sign or lighted display should be visible when X-ray equipment is in use and X-ray room door should be closed.
d. Nonessential personnel should leave the X-ray room when equipment is in use.
e. All equipment should be inspected on a frequent, routine basis to check for radiation leakage.
f. The patient should not be held or supported during radiologic procedures. There are devices which can be used to hold and position the patient.
g. If it is necessary to remain in the room with the patient, the attendant should wear a protective lead apron and lead-lined rubber gloves. The attendant should face the patient with the lead apron between the patient and the attendant.
h. Periodic blood tests may be required by facilities to determine the presence of blood abnormalities from radiation exposure.
10. Guidelines for maintaining patient safety:
a. Ask if the patient has recently been exposed to X-rays from other examinations or through work-related activities.
b. If the patient is female, inquire about the possibility of a pregnancy. If the patient is pregnant, report this to the physician before scheduling or assisting with any X-ray procedure. Due to liability concerns, it is important to obtain a release, or even a pregnancy test, prior to some X-ray procedures.
c. Advise female patients of the potential radiation risk before X-rays are taken.
d. Place a lead shield over the abdominal and reproductive organs of patients who are of childbearing age or pregnant, and children.
e. Patients must be carefully positioned to obtain an accurate image.
f. Only perform this procedure if you have been fully instructed and trained, and are authorized to do so in your state.
K.Identfy and explain radiographic equipment.
1. X-ray tube
a. Contains the source of the radiation.
b. Located inside a protective covering or housing.
2. Housing
a. Protects the X-ray tube.
b. Provides places for various attachments that allow the radiographer to move the tube and adjust the size and shape of the X-ray beam.
c. May be attached to the ceiling or mounted on a stand to provide mobility and flexibility of positioning.
3. X-ray or radiographic table
a. Provides support for the patient, but is highly specialized as well.
b. Some tables have adjustable heights, tilt into various positions, and float to allow ease in positioning the patient.
4. A grid and bucky slide
a. Below the table to prevent excess scatter radiation.
b. Bucky holds a cassette tray, which holds the X-ray film.
c. Grid is placed between the tabletop and the film.
d. Bucky moves the grid during exposure so that it is invisible on the X-ray.
5. Control console
a. Located in the lead-lined booth where the radiographer stands.
b. Here the radiographer determines exposure factors and controls the functions of the procedure.
6. Cassette
a. Provides a rigid structure to hold the film.
b. Holds two intensifying screens one in front and one behind the film.
7. Intensifying screens
a. Coated with phosphors or fluorescent crystals that emit light when exposed to X-rays.
b. Enable lower doses of radiation to be used on the patient.
c. Radiographic film is very sensitive to light emitted by the intensifying screens.
d. Routine X-ray film is coated with an emulsion on both sides so that the film responds to the intensifying screens on both sides.
e. Films and cassettes come in various sizes and are labeled in inches and centimeters.
L. Explain the processing of X-ray film.
1. Film development takes place in the darkroom of the facility because exposure to light can ruin the film.
a. Red or orange safe lights in the darkroom are dim, but provide enough light to see where items are located.
b. The darkroom should always be locked when processing film.
c. Both manual and automated processing methods are used.
d. The automated processing method is able to meet quality control standards since the equipment can be tested frequently for accuracy.
e. Automated processing may take about 90 seconds or up to 10 minutes depending on the equipment used.
f. The film is fed into the processor that transports the film through processing chemicals, dries the film, and moves it out of the equipment for the radiologist to view and read.
M. Explore how X-ray materials for radiologic procedure must be kept in special storage containers. The film must be protected from damage due to light, heat, chemical fumes, and moisture.
1. In order for film to remain fresh, it should be kept in a dry, cool place within a sealed package.
2. X-ray film should be stored on end to prevent pressure damage from stacking the film.
3. The expiration dates, which are printed on the top end of the package, can be seen clearly when stored on end.
4. X-ray developer is also kept in a cool location that is moisture-free since damage to this fluid can affect the quality of the film.
5. When handling film, it should only be touched with one hand hanging the film vertically to avoid damage.
6. The film packages are only opened in the darkroom of the medical facility because light will destroy the film imaging ability.
7. All film records are maintained in a record or log book that is kept in the X-ray room.
a. Entered in this rec
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