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Chapter 7: Diagnostic and Imaging Services

Chapter 7: Diagnostic and Imaging Services. Cardiographic Technicians. History of the Profession 1903: first EKG device developed by Einthoven 1949: Holter invents monitor bearing his name 1963: stress testing begun by Bruce & associates

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Chapter 7: Diagnostic and Imaging Services

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  1. Chapter 7: Diagnostic and Imaging Services

  2. Cardiographic Technicians • History of the Profession • 1903: first EKG device developed by Einthoven • 1949: Holter invents monitor bearing his name • 1963: stress testing begun by Bruce & associates • New technologies required new technicians to operate them • EKG training programs recently created • Two professional credentials now available

  3. Cardiographic Technicians (cont’d) • Education • Usually trained on the job • Training takes 4 to 6 weeks • Previous experience in health care is preferred by employers • 1-year certificate programs • Basic EKGs • Stress tests • Holter monitor tests • Training for specialized EKG testing (18-24 months)

  4. Cardiographic Technicians (cont’d) • Certification • No licensure • Two organizations offer certification: • American Society of Phlebotomy Technicians (ASPT) • Offers EKG Technician credential • Cardiovascular Credentialing International (CCI) • Offers Certified Cardiographic Technician (CCT) credential

  5. Cardiographic Technicians (cont’d) • General Duties • Clean & maintain an EKG machine • Place the EKG electrodes on the body • Document the patient’s medical history • Monitor a patient’s heart rhythms • Perform a 12-lead electrocardiogram • Document any variation from a normal tracing • Take vital signs

  6. Cardiographic Technicians (cont’d) • Tests Performed by Specialized Cardiographic Technicians • Specialized EKG tests • Rhythm strips • Signal-average EKGs • Event recorders • Device interrogation • Stress tests • Holter monitor tests

  7. Cardiographic Technicians (cont’d) • Tasks Common to All Tests • Set up equipment • Explain procedure to patient • Provide a gown or drape • Prepare the patient • Position the patient • Communicate results to the physician • Schedule appointments • Review patients’ files • Train new employees & others

  8. Cardiographic Technicians (cont’d) • Personal Characteristics • Good interpersonal skills • Good communication skills • Ability to work independently • Ability to follow instructions • Good organizational skills • Good multitasking skills

  9. Cardiographic Technicians (cont’d) • Employment Opportunities and Trends • 24% growth from 2008 to 2018 • Growth due to: • Increase in heart disease • Needs of older population, which is increasing • Rules regarding Medicare & Medicaid reimbursement • Less demand for technicians qualified to perform multiple tests • Better prospects for technicians trained to perform multiple tests • About 75% of jobs are in hospitals • About 25% of jobs are in physicians’ offices & labs

  10. Cardiographic Technicians (cont’d) • Professional Organization: ACVP • Represents >3,000 cardiovascular personnel • Mission • Meet needs of cardiovascular & pulmonary providers • Promote awareness of standards • Encourage recognition of cardiovascular occupations • Operates specialty councils • Produces >26 publications each year • Offers continuing education • Provides chapter meetings & online resources

  11. Cardiographic Technologists • History of the Profession • 1953: ultrasound first used to diagnose cardiac disease • 1955: first Doppler instrument developed • 1970s: technology began to move into clinical settings • 1981: AMA recognizes cardiovascular technology as a profession • 1983: educational guidelines for accredited programs drafted • 1985: Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT) formed

  12. Cardiographic Technologists (cont’d) • Education • Some trained on the job • Most complete a 2-year associate’s program • Some complete 4-year program • 37 accredited programs • HS diploma/experience in other health care profession required • 3-part curriculum is required • Core courses • Specialized instruction • Clinical instruction

  13. Cardiographic Technologists (cont’d) • Core Course Work • Introduction to the field • General & allied sciences • Anatomy & physiology • Basic pharmacology • Basic medical electronics & medical instrumentation

  14. Cardiographic Technologists (cont’d) • Specialized Instruction • Invasive cardiology • Noninvasive cardiology • Cardiac electrophysiology

  15. Cardiographic Technologists (cont’d) • Clinical Instruction • Cardiac & vascular pathophysiology • Patient history & physical examination • Patient psychology, care, & communications • CPR • Diagnostic & therapeutic measures • Clinical cardiac & vascular medicine & surgery • Statistics & data management • Physics • Medical & legal ethics

  16. Cardiographic Technologists (cont’d) • Certifications Offered by CCI • Registered cardiac sonographer (RCS) • Registered vascular specialist (RVS) • Registered congenital cardiac sonographer (RCCS) • Registered cardiovascular invasive specialist (RCIS) • Registered cardiac electrophysiology specialist (RCES) • Registered phlebotomy sonography (RPhS)

  17. Cardiographic Technologists (cont’d) • Certifications Offered by ARDMS • Registered diagnostic cardiac sonographer (RDCS) • Registered vascular technologist (RVT)

  18. Cardiographic Technologists (cont’d) • General Duties • Help diagnose patients with cardiac & vascular disease • Perform ultrasound procedures • Monitor patients’ heart rates • Review physicians’ interpretations & patient files • Compare findings against normal findings • Schedule appointments • Explain test procedures • Care for testing equipment

  19. Cardiographic Technologists (cont’d) • Invasive Procedures: Cardiology Technologists • Cardiac catheterization • Balloon angioplasty • Electrophysiology testing • Open-heart surgery • Pacemaker or stent insertion

  20. Cardiographic Technologists (cont’d) • Noninvasive Procedures • Noninvasive cardiology: echocardiography • Cardiac sonographers or echocardiographers • Noninvasive peripheral vascular study • Vascular technologists or vascular sonographers

  21. Cardiographic Technologists (cont’d) • Personal Characteristics • Good judgment • Conscientiousness • Good communication skills • Ability to follow detailed directions • Ability to work effectively with patients • Pleasant, professional manner

  22. Cardiographic Technologists (cont’d) • Employment Opportunities and Trends • Rapid growth: 24% between 2008 & 2018 • Growth due to: • Increase in heart disease & aging population • Increase in noninvasive procedures • Early diagnosis of vascular disease • Technological advances & reimbursement rules • 77% in hospitals • Remainder in physicians’ offices & medical & diagnostic labs

  23. Cardiographic Technologists (cont’d) • Professional Organizations • Society for Vascular Ultrasound (SVU) • Represents & advocates for profession • Offers continuing ed., annual conference, journal, scholarship, online career center • American Society of Echocardiography (ASE) • Advocates for echocardiographers • Offers annual scientific sessions, online resources, networking & continuing ed., journal

  24. Phlebotomists • History of the Profession • Hippocrates & theory of four humours • Bloodletting: blood drawn to restore balance of humours • Louis Pasteur & germ theory • Blood drawn for diagnostic purposes • 1970s: modern occupation emerged as cost-cutting measure • 1978: National Phlebotomy Association (NPA) formed • 1981: NPA administered first certification exam

  25. Phlebotomists (cont’d) • Education • HS diploma or equivalent required • In-house training at medical facilities vs. formal programs • 59 accredited programs • Programs: • Lead to a certificate • Require at least 100 hours of clinical experience • Require at least 100 successful unassisted blood collections • Include both course work & practical experience

  26. Phlebotomists (cont’d) • Certification • Gives advantage in securing jobs • Offered by many organizations • Continuing education units (CEUs) required for recertification • Employers may: • Offer in-house education • Pay for offsite programs

  27. Phlebotomists (cont’d) • Work Responsibilities • Perform venipuncture • Perform capillary puncture • Label blood samples • Document procedures • Store & transport blood • Perform other types of tests • Throat cultures • Urine tests • EKGs

  28. Phlebotomists (cont’d) • Personal Characteristics • Good interpersonal skills • Attention to detail • Calmness under pressure

  29. Phlebotomists (cont’d) • Employment Opportunities and Trends • Growth of 16% between 2008 & 2018 • Most jobs in hospitals • Some jobs in: • Physicians’ offices • Medical & diagnostic labs • Increased opportunities due to: • Population increase • Development of new tests

  30. Diagnostic Medical Sonographer • History of the Profession • 1912: echoes used to detect icebergs • World War I: hydrophone invented to detect enemy submarines • 1937: first attempt at using sound for medical imaging • 1963: first commercial scanners available • Sonographers train personnel in hospitals to use scanners • 1969: American Society of Ultrasound Technical Specialists (ASUTS) formed • 1973: occupation of diagnostic ultrasound technologist created • 1975: first credentialing exam

  31. Diagnostic Medical Sonographer (cont’d) • Education • Training program options • Informal training programs at hospitals & schools • Formal 2-year (associate’s) & 4-year (bachelor’s) programs • 1-year programs leading to certificate • 174 accredited programs • Classroom instruction combined with lab & clinical activities

  32. Diagnostic Medical Sonographer (cont’d) • Licensure and Certification • 2009: New Mexico & Oregon first states to license • Certification • Offered by several organizations • Requires passing two different exams • Must be renewed every 3 years • Registration • Offered by American Registry of Radiological Technologists (ARRT) • Renewed annually

  33. Diagnostic Medical Sonographer (cont’d) • General Duties • Evaluate requisitions before a sonogram • Set Doppler parameters • Select proper transducer • Apply sufficient coupling gel, eliminating bubbles • Perform abdominal scans • Identify artifacts (imaging errors) • Prepare written summaries of findings • Clean, check, & maintain equipment

  34. Diagnostic Medical Sonographer (cont’d) • Specialties • Obstetrics/gynecology • Abdomen • Neurosonography • Breast

  35. Diagnostic Medical Sonographer (cont’d) • Personal Characteristics • Good people skills • Patience • Empathy • Eye for detail • Good judgment • Personal responsibility • Self-motivation • Ability to work independently • Good teamwork skills

  36. Diagnostic Medical Sonographer (cont’d) • Employment Opportunities and Trends • Growth: 18% between 2008 & 2018 • Factors prompting growth • Aging population • Increasing use of sonography • Development of new sonography procedures • Setting distribution • 60% in hospitals • Remainder in physicians’ offices & medical & diagnostic labs

  37. Diagnostic Medical Sonographer (cont’d) • Professional Organization: SDMS • Works to advance profession & educate medical community • Advocates on issues affecting profession • Publications • Journal of Diagnostic Medical Sonography • Newsletters • Online resources

  38. Radiologic Technologists/Radiographers • History of the Profession • 1895: Roentgen discovered x-rays • Physicians began experimenting with medical uses of x-rays • 1917: Jerman began training program for technologists • 1920: Jerman founded American Association of Radiological Technicians (AART) • 1922: first certification exam • 1923: registration begun • 1950s: model standardized curriculum developed

  39. Radiologic Technologists/Radiographers (cont’d) • Education • Most complete 2-year associate’s degree program • Other options: • Certificate program lasting 21-24 months • 4-year bachelor’s degree program • HS diploma required for entry into program

  40. Radiologic Technologists/Radiographers (cont’d) • Course Work • Anatomy & physiology • Patient care procedures • Radiation physics • Radiation safety & protection • Principles of imaging • Medical terminology • Patient positioning • Medical ethics • Radiobiology • Pathology

  41. Radiologic Technologists/Radiographers (cont’d) • Specialties • CT scans • MRIs • Mammograms

  42. Radiologic Technologists/Radiographers (cont’d) • Licensure and Certification • Required in some states • Advantageous in job market • Requires: • Graduation from accredited program • Passing a national exam • Meeting ethical standards • Recertification required every 2 years • Specialty certification available

  43. Radiologic Technologists/Radiographers (cont’d) • Work Responsibilities • Obtain & document patient’s history • Provide radiation protection shield for patient • Identify radiographs with appropriate lead markers • Manipulate radiographic equipment with ease • Expose film • Process film • Evaluate images for appropriate positioning & quality

  44. Radiologic Technologists/Radiographers (cont’d) • Personal Characteristics • Positive attitude • Empathy • Good people skills • Self-motivation • Confidence • Ability to work independently • Good teamwork skills • Ability to follow instructions • Manual dexterity • Flexibility • Multitasking skills • Attention to detail • Good communication skills

  45. Radiologic Technologists/Radiographers (cont’d) • Employment Opportunities and Trends • Growth: 17% between 2008 & 2018 • Factors prompting growth • Population growth • Aging of population • Increased use of imaging • Setting distribution • >60% in hospitals • Remainder in physicians’ offices & medical & diagnostic labs

  46. Radiologic Technologists/Radiographers (cont’d) • Professional Organization: ASRT • Largest & oldest organization representing RTs • Represents RTs in government & education • Monitors state & federal legislation • Helps • Develop & revise curriculums • Set practice guidelines • Implement standards • Offers continuing education • Promotes careers in field

  47. Nuclear Medicine Technologists • History of the Profession • 1896: discovery of radioactivity by Becquerel • Early 20th century: development of radioisotope tracers • 1929: invention of cyclotron by Lawrence • Making & discovery of artificial nucleotides • 1930s: blood disorders treated with radioactive phosphorus • 1946: cancer patient successfully treated w. radioactive iodine • 1950s: nuclear medicine emerged as a discipline • 1980s: development of radiopharmaceuticals

  48. Nuclear Medicine Technologists (cont’d) • Education • Program options: • Associate’s degree • Bachelor’s degree • Certificate: available at hospitals for graduates of other health care programs • 101 accredited programs • Course work & clinical component required

  49. Nuclear Medicine Technologists (cont’d) • Course Work • Patient care methods • Nuclear medicine computer applications • Nuclear medicine physics & radiation physics • Diagnostics nuclear medicine procedures • Immunology relating to nuclear medicine • Radiation safety & protection • Radionuclide therapy • Radionuclide chemistry & radiopharmacy • Quality control & quality assurance • Nuclear instrumentation • Statistics

  50. Nuclear Medicine Technologists (cont’d) • Licensure and Certification • Required by more than half of states • Certification is optional, but standard in market • Certifying agencies: • ARRT • Nuclear Medicine Technology Certification Board (NMTCB) • Certification requires graduation from accredited program & passing a national exam • Continuing ed. required every 2 years • Specialty certification available

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