Discuss the general procedural considerations for radiographic examinations including: a) patient preparation for examination Many radiologic exams require specific patient preparation prior to the exam in order to ensure that the study is performed in the safest and most accurate manner possible. For example: ❖ MRI- With contrast: No solid foods 4 hours before your study. Clear fluids are allowed up to 2 hours before study. Without contrast: No foods or fluids up to 2 hours before study. Any use of medical or electronic devices should be informed before study. ❖ CT scan- Fluids and food may be restricted for several hours prior to the examination ❖ Mammogram- Do not use any powders, deodorant, perfume or lotions before the study. ❖ Ultrasound- Do not eat, drink, smoke or chew gum after midnight the night before morning appointment, or for at least 6 hours prior to afternoon appointment.
b) Informed consent and who is responsible for obtaining the informed consent Informed consent is a legal protection of a patient's authorization or agreement to undergo a specific medical intervention. It is the responsibility of the attending licensed healthcare professionals- physicians and nurses- to obtain and witness the patient’s signature. The informed consent includes: • The patient’s diagnosis • The patient’s prognosis • The proposed treatment • The risks and benefits associated with the proposed treatment • Any alternative treatments • The risks and benefits of the alternatives • The risks of forgoing treatment, should the patient refuse
2. Describe and define what occurs in each of the following sections of the radiology department. a) Mammography A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal, it is used to detect benign and malignant masses. The area of dark and light represents normal and dense breast tissue. Breast masses will appear light (whiter) because they are denser than other features in the breast. During mammography, the patient's breasts are placed on a firm flat panel and a gentle, but firm pressure is applied to the breast with another panel, resulting in compression of the breast between the two panels. Patient must hold still to reduce the possibility of a blurred image. Usually two x-rays are obtained of each breast. b) CT scan CT scan is a noninvasive medical test that helps physicians diagnose and treat medical conditions. It is one of the best and fastest tools for studying the chest, abdomen and pelvis because it provides detailed, cross-sectional views of all types of tissue. It uses x-ray to produce cross-sectional images of the bones and soft tissues from different angles. Bones appear white on the x-ray; soft tissue, such as organs like the heart or liver, shows up in shades of gray and air appears black. During CT scan, patient is placed on a movable table, and the table is slipped into the center of a large donut-shaped machine which takes the x-ray images around the body. The CT scan "slice" the body part into very detailed multidimensional view. It is important during the CT scan procedure that the patient minimize any body movement to reduce the possibility of a blurred image. c) Nuclear medicine Nuclear medicine procedure is among the safest diagnostic imaging exam available. It is performed to assess the function of nearly every organ. Unlike other imaging techniques, rather than showing anatomy and structure, nuclear medicine imaging exams focus on the molecular, metabolic, physiologic and pathologic conditions in the body to determines the severity of or treat a variety of diseases, including many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities within the body. For most nuclear medicine examinations, the patient is lay on a scanning table underneath a scintillation or gamma camera. Then a radiopharmaceutical is administered intravenously, orally or through inhalation. The camera then detects and records the radioactive emissions from the patient's body. Images are taken an hour, two hours, or even several days after administration of the radiopharmaceutical. d) Ultrasound Ultrasound is a procedure that uses high frequency sound waves and the return echoes to reflect the structures beneath the skin. The ability to measure different echoes reflected from a variety of tissues allows a shadow picture to be constructed. Ultrasound is used to screening and diagnosis for disease, also to aid in treatment of diseases or conditions. Some common uses are to help physicians guide needles into the body, evaluate blockages to blood flow, assess the progression of pregnancy, evaluates the heart, and etc. During the procedure, a jelly-like substance is applied to the skin to improve the transmission of sound through tissue. The transducer is press tightly against the skin since the frequency of sound produced does not transmit though air. The sensitive microphone in the transducer records tiny changes in the sound's pitch and direction, and creates a real-time picture on the monitor. e) MRI Magnetic resonance imaging (MRI) is a noninvasive medical test that does not involve x-rays. It uses powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. MRI scan can be used as an extremely accurate method of disease detection throughout the body. In the head, trauma to the brain can be seen as bleeding or swelling. Patients will be placed on a narrow table, which slides into a large tunnel-shaped MRI scanner. Their head, chest, and arms may be held with straps to help remain still to produce clear images. A device that contain coils may be placed around the area of the body being studied , it is capable of sending and receiving radio waves. Because MRI can target specific atoms, it sees through bone and clearly defines soft tissue. f) Specials (Interventional radiology) Interventional radiologists use X-rays, ultrasound, CT scans and other imaging techniques to guide miniaturized instruments through small nicks in the skin to treat a variety of conditions without surgery. One interventional radiology procedure I observed was the Biliary Drainage. Biliary Drainage is a procedure in which the catheter is placed through patient's skin and into the liver to drain bile due to bile obstruction. Patient should be on clear liquid diet after midnight on the night before the procedure. On the day of procedure, radiology nurse will provide moderate sedation to the patient and radiologist will also numb the area with a local anesthetic. Ultrasound may be used to help radiologist to guide the needle into the liver. Then radiologist will insert a needle into the bile duct, place a guide wire farther into the duct, and connect a drainage catheter over the wire. g) PICC and Outpatient Infusion nursing A Peripherally Inserted Central Catheter (PICC) is a long, very thin, flexible tube that is placed into patients who need medical treatment over a long period of time. This procedure is done in the intervention radiology room. Patient will be placed on a fluoroscopic procedure table with the arm chosen for insertion resting on an arm board support. Radiologist will use ultrasound to select the vein for venipuncture. Once the vein is selected, a thin safety guidewire with a coiled, floppy safety tip is inserted through the needle and into the vein, then to the vena cava. The whole procedure is performed under sterile conditions. Once the PICC line is inserted, nurses can administer medications via the tube. My rotation in outpatient oncology involved many infusion therapies. Outpatient infusion therapy may include administration of nutrition, antibiotic therapy, and fluid and electrolyte repletion. Nurses carefully calculate the drug dosage before administration to prevent medication error. Then the hub should be scrubbed for at least 15 seconds to prevent infection. The access line of the catheter should be flushed thoroughly with at least 10 mL of D5W. Last is to connect the medication to the IV line and input the infusion rate. Nurses should monitor the infusion rate spontaneously and provide comfort to the patients.
What is the role of the radiology nurse in each section? The radiology department is a place for nurses seeking a challenging, autonomous, and rewarding environment to use critical care and emergent care for all the patients. Radiology nurse work closely with radiologist and the radiologic technologist to provide the best clinical diagnostic data but little discomfort for the patients. From what I had observed on my clinical rotation, nurses from different section intercommunicate with each other to provide the fastest and most accurate service, and yet, they play different roles in the department. Interventional Radiology The primary role of the radiology nurse in this section is to provide moderate sedation to the patients. The nurse administers medications under the direction of radiologist and informs the radiologist of the condition of the patient. In each procedure, they are responsible to monitor the vital signs, comfort and safety of the patient. If the patient were not sedated enough during the procedure, nurse will inform the radiologist and administer more medications if request. Nuclear Medicine The nurse's role in nuclear medicine is to provide patient education and preparation for the examination. As I mentioned before, radiopharmaceutical is necessary for the study so the nurse is responsible to monitor any allergic reaction to the it. The contrast dye can be administered via intravenous, oral, or inhalation. Nurse may start an IV line on a patient, draw blood, place indwelling catheters, provide moderate sedation, and offer comfort and safety to the patient during the nuclear medicine examination. Magnetic Resonance Image MRI uses powerful magnetic field to produce detailed pictures of organs. It is important for the nurse to check if the patient has any medical or electronic devices, such as pacemakers, defibrillators, implants, cerebral aneurysm clips, and etc. Nurse may provide moderate sedation to patient, and offer comfort and safety to the patient during examination. CT Scan This examination may require contrast dye so nurse must monitor closely for any allergic reaction. Because the CT scan is frequently used in diagnostic imaging of patients who have suffered from trauma, the radiology nurse works closely with emergency room staff and the critical care department to care for these patients while they are in the radiology department.