Chapter 22: Ethics, Legal considerations and Professionalism in Radiography

1. Chapter 22: Ethics, Legal considerations and Professionalism in Radiography Alyssa Cihak, Nicole Hoheisel, Jodell Nelson, and Jerilyn Scott

2. Interviewee JenniferBenoit, RTR Jenny is a Registered Radiographic Technologist at the St. Cloud Hospital. She got her license through ARRT and has been working in this field for 24 years.

3. Ethics in Radiography • Ethics in Radiography is intended to help radiologists not only individually but collectively maintain a high level of ethical conduct. • The code of ethics is not a set of laws. It is guidelines by which radiologists may determine the decency of conduct in their relationship with patients, the public, with colleagues and other members of allied professions. Clinton, Muscatine, Scott 2010

4. Principle 1- Functions Efficiently • Responds to patient’s needs • Performs tasks completely • Supports colleagues and associates in providing quality patient care American Medical Association

5. Principle 2- Advance the Principle Objective • Participates in and actively supports the professional organizations for radiologic technology • Acts as a representative for the profession and the tenets for which it stands • Serves as an advocate of professional policy and procedure to colleagues and associates in the health care delivery system American Medical Association

6. Principle 3- Discrimination • Exhibits no prejudice for sex, race, creed or religion • Provides service without regard to social or economic status • Delivers care unrestricted by concerns for personal attributes, nature of the disease or illness American Medical Association

7. Principle 4- Practices Technology Founded on Scientific Basis • Applies theoretical knowledge and concepts in the performance of tasks appropriate to the practice • Utilizes equipment and accessories consistent with the purpose for which it has been designed • Employs procedures and techniques appropriately, efficiently and effectively American Medical Association

8. Principle 5- Care, Discretion and judgment • Assumes responsibility for professional decisions • Assesses situations and acts in the best interest of the patient American Medical Association

9. Principle 6- Diagnosis, Treatment, Management of patient • Complies with the fact that diagnosis and interpretation are outside the scope of the practice for the profession • Acts as an agent to obtain medical information through observation and communication to aid the physician in diagnosis and treatment management American Medical Association

10. Principle 7- Protection from unnecessary radiation • Performs service with competence and expertise • Utilizes equipment and accessories to limit radiation to the affected area of the patient • Employs techniques and procedures to minimize radiation exposure to self and other members of the health care team American Medical Association

11. Principle 8- Practice Ethical conduct • Protect the patient’s right to quality radiologic technology care • Provides the public with information related to the profession and its functions • Supports the profession by maintaining and upgrading professional standards American Medical Association

12. Principle 9- Respect Confidences • Protects the patient’s right to privacy • Keeps confidential information relating to patients, colleagues, and associates • Reveals confidential information only as required by law or to protect the welfare of the individual or the community American Medical Association

13. Principle 10- Continuing education • Participates as a student in learning activities appropriate to specific areas of responsibility as well as the scope of the practice • Shares knowledge with colleagues • Investigates new and innovative aspects of professional practice American Medical Association

14. Interview with jenny Q: What does your facility do to enforce radiographic safety and ethics? We make sure that we are consistently following MN standards and are ACR accredited (American College of Radiology.) As I am sure you have learned, we use ALARA in all radiographic procedures. It is also a great idea for facilities to belong to associations such as Image Gently, which pledges to reduce radiation exposure to pediatrics.

15. Interview with jenny Q: Radiography poses some risk to the patient and therefore needs to be discussed before the procedure. What steps do you take to properly educate your patient about their care? I start out by explaining the involvements of radiation, but assure them that ALARA is used. If the patient still has any additional concerns, I offer to call in a radiologist to come and talk to them.

16. Legal Considerations The Radiation Control provisions was originally enacted as the Radiation Control for Health and Safety Act of 1968.

17. Examples of electronic products: Medical diagnostic x-ray or ultrasound imaging devices, microwave blood warmers or sterilizers, laser coagulators, x-ray or electron accelerators, ultraviolet dental curing devices.

18. REGULATIONS OF PERFORMANCE STANDARDS: The FDA limits leakage at 1 meter from the source to 100 mR in 1 hr and at 5 cm from any other components to 2 mR in 1 hr specifies beam limitations and beam quality criteria; user and assembler instructions and technical information requires control and indication of technique factors; timer termination conditions; accuracy and reproducibility specifications; indication and limits on field size and alignment, etc. limits transmission through mammographic image system at 5 cm to 0.1 mR for each tube activation

19. X-ray energy has a small potential to harm living • tissue. The most significant risks are: • a small increase in the possibility that a person exposed to x-rays • will develop cancer later in life • cataracts and skin burns only at very high levels of radiation exposure

20. Information for Patients: You can reduce your radiation risks and contribute to your successful examination or procedure by: Keeping a “medical x-ray history” with the names of your radiological exams or procedures, the dates and places where you had them, and the physicians who referred you for those exams.

21. Making your current healthcare providers aware of your medical x-ray history; Asking your healthcare provider about whether or not alternatives to x-ray exams would allow the provider to make a good assessment or provide appropriate treatment for your medical situation; Providing physicians with recent x-ray images and radiology reports; and Informing radiologists or x-ray technologists in advance if you are pregnant or think you may be pregnant.

22. Interview with jenny Q: Patient rights are important and need to be taken into consideration anytime throughout their care. What advice can you give in regards to meeting patient’s needs and still getting a satisfactory x-ray image? The most important factor is considering the patient’s modesty during the exam. Remember to reassure their privacy and make sure they feel comfortable at all times. Inform them of the procedure and ask their opinion about what you can do to improve the experience.

23. Interview with Jenny Q: In an occurrence of any type of intentional misconduct from a patient, what should be done to protect you, your coworkers, and the safety of the machines and equipment? First of all, call security. This is the safest way to handle a situation like this. In the mean time, use your words. Advice the patient to control their actions or their exam will be canceled. If possible, escort them out of the x-ray room to avoid any damages.

24. Interview with jenny Q: What type of information do you look for in a patient’s chart before you proceed with the radiographic examination? I check to see if this particular exam has been done before. This way, I can compare notes about how it went and what was done to guarantee a good image. It is also a good idea to check to see if there are any health concerns that might interfere with the exam or any physical limitations for lying on the table.

25. Professionalism Professionalism is the conduct and qualities that characterize or mark a profession Style of behavior in the workplace Values and professional roles exhibited in our behavior Respect for self and others Appearance Merriam Webster

26. What does Professionalism look like? Self care: a professional who is not looking healthy is not a good health role model Having empathy: action of understanding, being aware of, and being sensitive to the experiences, feelings and thoughts of another without having the feelings, thoughts or experiences Appearance: avoiding jewelry on hands or arms, personal cleanliness and grooming, finger nails reasonable short and smooth, shoes are quiet and comfortable to wear, and use fragrance sparingly Merriam Webster

27. Teamwork Work done by several associates with each doing a part but all subordinating personal prominence to the efficiency as a whole Cooperative efforts by everyone involved will make your business look professional. Merriam Webster

28. Characteristics Professionals are considered experts. Professionals have a high degree of generalized and systematic knowledge with a theoretical base. The primary orientation of professionals is to their public and/or community interest. Professionals have a high degree of self-control of their behavior and are governed by a code of ethics. Small Library Management Training Program

29. Professionals are expected to . . . Establish a special relationship with clients or patrons. Have a lack of self-interest. Be involved in all aspects of the profession. Publicize what the profession "does" and "is." Small Library Management Training Program

30. Becoming a professional involves... Unique training Formal education Achieving credentials Activity in continuing education opportunities Joining and actively involving yourself in professional associations Small Library Management Training Program

31. Interview with Jenny Q: What do you consider to be professional characteristics or behaviors that are appropriate in the radiology setting? I think that appearance is very important, both outward and what is presented by your body language. Non-verbal communicate is evident to a patient. The more of a caring attitude you have, the more it will show. This proves true to your professional appearance as well. What you show on the outside affects how the patient feels about you. The more professional you look, the more professional you’ll appear to be when it comes to the knowledge of their care.

32. Interview with jenny Q: How does your facility handle language barriers with non-English speaking patients? We have a phone line that we call and are connected with a translator to help us communicate with the patient. Make sure that when you need this service, you check the patient’s records to determine the language needed.

33. Interview with jenny Q: The stress of a job can weigh on both the performance of job duties and the relationships between yourself and patients. How do you balance this consideration? Take time during the day, away from patient contact, to reconnect and have discussions about your frustrations with your co-workers. It helps to know that you are on the same boat as others.

34. Interview with jenny Q: How do you handle a difficult relationship between you and a co-worker? Stay professional at all times! You do not have to be their friend, but treat them with respect and communicate your differences to be able to work around them. Just make sure that you keep all conflicts away from the presence of a patient.

35. Interview with jenny Q: What us the best advice you can give to help a new employee reach job satisfaction in a radiology career? Remember why you are there and put the patients first!! Knowing that you are making a difference really keeps the smile on your face. Also, learn to balance the input and expectations of the other health care workers that you are involved with to make the x-ray you need. It is hard, but just do what you need to do to get the best outcome possible.