Pearsons Comprehensive Medical Assisting Administrative and Clinical Competencies

Lesson Objectives Upon completion of this lesson, students should be able to … •

Critical Thinking Question 1. Is a medical assistant qualified to perform the general procedures

Radiology • Branch of medicine that uses radioactive substances or matter that gives off

Radiology Personnel • Radiologist – Physician specializing in radiology • Radiographer or radiologic technologist

Duties of a Radiologic Technologist • Positioning patients for radiographic procedures • Determining the

Principles of X-rays • Developed in 1895 by Wilhelm Konrad Roentgen • X-rays are

Principles of X-rays • Radiation field is the cross section of the X -ray

X-Ray Table Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-Mc.

Characteristics of X-rays • Penetrate substances of different densities to varying degrees • Cause

Diagnostic Imaging • Involves the use of X-rays, ultrasound, radiopharmaceuticals, radiopaque media, and computers

Contrast Medium • Radiopaque substance • Does not allow the passage of X-rays •

Barium Enema Radiograph of the colon after a barium enema. Pearson's Comprehensive Medical Assisting:

Contrast Medium Materials • Barium sulfate – Positive contrast media – Consists of a

Contrast Medium Materials • Negative contrast – Include air, carbon dioxide, and other gases

Role of the Medical Assistant for Radiology Exams • Schedule the procedure • Educate

Role of the Medical Assistant for Radiology Exams • Request patient remove all metallic

X-ray Procedures Requiring Special Preparations • Angiogram: – No breakfast if morning examination or

X-ray Procedures Requiring Special Preparations • Barium meal (Upper GI): – NPO after midnight

X-ray Procedures Requiring Special Preparations • Computerized tomography (CT): – NPO for 4 hours

X-ray Procedures Requiring Special Preparations • Myelogram: NPO • Retrograde pyelogram: – Enemas or

Steps to Assisting with a Radiologic Procedure Step 7: Ask the patient to remove

Positions for Radiology Procedures Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman

Anterioposterior (AP) • X-ray beam is directed from front to back • Patient may

Posterioanterior (PA) • X-ray beam is directed from back to front • Patient will

Oblique • Patient is turned at an angle to the film plate so the

Lateral • X-ray beam is directed toward one side of the body • In

Axial • X-ray tube is angled to direct a ray along the axis of

Information Required for Scheduling a Radiologic Procedure • • • Patient’s name Type of

Special Dietary Restrictions for Radiology Procedures • All-liquid diet on the day before the

Beverages That the Patient May Have on an All Liquid Diet • • •

Guidelines for Sequencing Multiple Diagnostic Procedures • Schedule all radiographic exams and tests that

Guidelines for Sequencing Multiple Diagnostic Procedures • Lower gastrointestinal series (barium enema) • Upper

Questions? Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-Mc. Phillips

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

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

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

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

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

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

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 coneshaped X-ray beam Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman • Fleming-Mc. Phillips • Routh • Gohsman • Reagan Copyright © 2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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