Why can't doctors order X-rays correctly - Pinner
image by: NIH Image Gallery
"We as technologists know the limitations to our scope of practice. Radiography Students, while learning, should be familiar with them as well because it can be very easy to cross the line if it is not well defined.
Patients (particularly those with no formal medical background of any kind) will not always be able to determine who in a hospital is a doctor, nurse, radiologic technologist, or lab technician. We are simply one more person in scrubs who has information about their health. In order to stay within our scope of practice and maintain excellent standards of patient care, we must know how to handle some difficult questions with tact. Here are 5 typical questions requiring some forethought:
What did you see on my x-rays?
This is probably the most common question, and it can also get you in the most trouble for answering. No matter how good you are at identifying fractures, dislocations, pneumothorax, or other types of pathology, it is illegal for you to give your opinion while remaining in your scope.
You can always inform patients of this fact. Some patients will say “I know that you know what you’re looking at” in an attempt to get you to budge, but are you willing to risk your license providing information that will be provided to the patient soon by their doctor? A good apology and encouragement that they will learn the results from their exam by the expert soon should satisfy their curiosity for the moment.
Inform them that their doctor should be the one discussing any results and a plan of care with them. Most reasonable people will understand. If they act frustrated, it is probably because it took them a long time to get the exam and they are expecting results soon, so don’t take it personally if they vent a little bit.
Why did the doctor order this exam?
In an ideal world, every single physician would explain the reason for every exam to every patient they refer for imaging procedures. Unfortunately, that is not the case. The prescription should state a reason for the exam ordered, and you can acquire some information based on a good patient history. Aside from those things, we as technologists don’t really know much about the physician’s reasoning.
We should, however, be willing to contact the ordering physician if the patient seems apprehensive about having a procedure without knowing why it was ordered. We should always refer the patient back to their doctor if after explaining the exam, they are not sure they want to proceed. Try to avoid talking them into a procedure or giving possible reasons for the exam when you do not know the facts. It is ultimately up to the patient if they want to continue.
Why won’t they let me eat or drink anything?
Sometimes outpatients have exams that require an NPO prep… these are easily explainable in that we need the stomach/intestines empty to allow our contrast to coat the lining. It can also produce a false-positive exam if there is food mixing with contrast. Some ER patients need to be NPO for the same reasons, or if surgery may be required based on your imaging results.
It’s probably not a good idea to explain that they can’t eat because there’s a chance of surgery though. There are other reasons patients can be kept NPO such as lab work. In any case, it’s a good idea to instruct the patient to discuss the reasons with their nurse or ER doctor, and that you are following the directions of the physician. It’s usually for a precautionary reason, but we aren’t doing anyone justice by guessing.
How much radiation am I getting with this x-ray?
Thanks to the Internet, social media, and Dr. Oz, there are many warnings about overexposure to radiation. It is true that we need to be conscious of our radiation dose and try to prevent unnecessary testing, but for some people, being informed means becoming a hypochondriac.
You obviously cannot simply tell a patient “you will receive about 10 mRads from this exam” and consider them informed and at ease about their exam. Most hospitals and outpatient imaging departments offer fliers explaining the risk vs. benefits for their exams.
There are even some websites that allow you to calculate your x-ray risk that can be referred to. We can inform them that we will take every effort to keep the dose as low as possible while using collimation and shielding, or we can even ask a Radiologist to explain the risk if they want more information about the dose itself.
If a patient wants to know about whether or not the test is necessary though, that should be a conversation between the patient and the ordering physician because we know very little about complete medical history and why the exam was ordered.
What will happen if I get this x-ray and I am pregnant?
We have a responsibility to explain that with any dose of radiation, no matter how small, some risk exists. That risk is increased when there is direct interaction with the x-rays and the fetus, especially in the first trimester, but it can be greatly reduced if the primary beam is far away from the fetus and appropriate radiation protection precautions are taken.
It also increases when a large number of exams are performed. A radiologist should always be consulted when we perform x-rays on a pregnant patient, and they can determine whether or not a limited procedure should be performed or the exam should be avoided altogether. Ideally, the radiologist would communicate risk to the patient. They might decide to contact the ordering doctor to learn more about the patient’s history first, and even recommend another imaging method if necessary. Our goal is to inform the patient while reassuring them that every safety precaution is being taken.
Our patients do not always understand our scope of practice. They might not understand the difference between a radiologic technologist and a radiologist. Patients even ask questions that are difficult for us to answer. We don’t have to have an exact answer prepared for each patient, but we should be able to either find them answers or point them in the right direction. We should be striving to keep them informed so they can be included in their health care decisions without providing false information or reason for alarm. A little tact will go a long way."
Source: Top 5 Difficult Questions from Patients, Topics in Radiology, September 28, 2012.
“InsideRadiology” provides consumers and health professionals with free and easily accessible accurate, up to date, credible information about medical imaging tests and procedures.
The website ranks #1 on Google for "learning radiology." There are thousands of links to material on this site from Google alone including hundreds of university programs in radiology, emergency medicine, internal medicine, physician assistant, emergency medical technician and radiologic technologist programs.
Here, the internet comes to the rescue and RadBuzz.net is an attempt to fill the lacuna and address this need of radiologists for connection with each other. Radbuzz.net is intended for all professionals affiliated with the field of radiology. This network allows one to discuss, share, and see interesting cases with fellow radiologists from around the world.
Welcome to the Radiology Assistant...The Educational site of the Radiological Society of the Netherlands
Radiopaedia.org is a free educational radiology resource with one of the web's largest collections of radiology cases and reference articles.
Welcome to wikiRadiography - A free website for Radiographers, Sonographers and students
American Registry of Radiologic Technologists
The American Registry of Radiologic Technologists (ARRT) is the world’s largest credentialing organization that seeks to ensure high quality patient care in medical imaging, interventional procedures, and radiation therapy. We test and certify technologists and administer continuing education and ethics requirements for their annual registration.
American Society of Radiologic Technologists
The mission of the American Society of Radiologic Technologists is to foster the professional growth of radiologic technologists by expanding knowledge through education, research and analysis; and promoting exceptional leadership and service.
AuntMinnie.com provides the first comprehensive community Internet site for radiologists and related professionals in the medical imaging industry. AuntMinnie provides a forum for radiologists, business managers, technologists, members of organized medicine, and industry to meet, transact, research, and collaborate on topics within the field of radiology with the ease and speed that only the Internet can provide.
Collaborative Hypertext of Radiology CHORUS is a "quick reference" hypertext for physicians and medical students. More than 1,100 documents describe diseases, radiological findings, differential-diagnosis lists ("gamuts"), and pertinent anatomy, pathology, and physiology.
Diagnostic Imaging is an online publication that informs and engages radiologists and other medical imaging professionals with the latest news and commentary in medical imaging.
Health Imaging is the leading news, business, and technology magazine for medical imaging, healthcare executives, and health IT professionals looking for practical tools to boost workflow, reduce costs, and manage their departments and facilities more efficiently.
Health Imaging Hub
Health Imaging Hub is a leading medical imaging and healthcare IT website with an emphasis on e-learning, online education, global news and industry resources that began with an aim to provide readers and advertisers a global perspective with regionally focused coverage.
The Imaging Economics Web Site is dedicated to helping radiologists, radiology administrators, and health care executives meet the increasingly complex economic challenges of providing quality imaging in both the inpatient and outpatient settings.
ImagingBiz, founded by longtime industry veteran Curtis Kauffman-Pickelle, includes a portfolio of specialized publications delivering business intelligence for hospitals, imaging centers, and radiology practices. This education and information portal offers a wealth of expertise on the rapidly changing world of medical imaging.
International Society of Radiographers and Radiological Technologists
ISRRT is the only global organization representing over 300,000 medical imaging practitioners (called Radiographers in this document) in more than 85 countries .In many of the more developed countries regulation and licensure ensures a critical standard of practice. This includes the effective and efficient use of radiation.
Joint Review Committee on Education in Radiologic Technology
The JRCERT is the only agency recognized by the United States Department of Education(USDE) and the Council for Higher Education Accreditation (CHEA), for the accreditation of traditional and distance delivery educational programs in radiography, radiation therapy, magnetic resonance, and medical dosimetry.
Medicalphysicsweb is the number one online resource for medical physicists. Our remit is to major on in-depth news, analysis and commentary about the fundamental research, emerging technologies and clinical applications that underpin the core disciplines of medical physics: diagnostic radiology, radiation therapy, nuclear medicine and biomedical optics.
Radiology Information Center from MedPage Today, the only service for physicians that provides a clinical perspective on the breaking medical news that their patients are reading.
Peer Reviewed Teaching File Cases and Medical Image Database from MedPix™.
News, features and expert opinion on radiology.
Multi Detector Computed Tomography
To be the leading national and international organisation representing the practice of CT Radiographers and Radiologic Technicians by promoting the highest achievable standards of patient care and professional practice.
Our concept from the beginning was to develop a web-based networking community dedicated to medical imaging professionals, providing members a vehicle for expression of opinions on relevant topics affecting us all. Our goal is also to privide a forum for discussion on technology, opportunities, and events taking place in the medical imaging industry.
OB-GYN Ultrasound Online
An interactive site with Teaching Files (Fetal Congenital Anomalies, Gynecology, Artifacts and Pitfalls, Abstracts and Commentary of the Current Literature, Tables, Charts, Important Links and Bulletin Board.
This award-winning bimonthly Journal covers all disciplines and specialties within medical imaging, including radiography, mammography, computed tomography, magnetic resonance imaging, nuclear medicine imaging, sonography and cardiovascular-interventional radiography.
X-ray, Radiation, RadTech, Radiology, Radiologic information.
Radiology.org provides radiology directory and custom search services to radiologists and professionals in the medical imaging industry.
RadiologyInfo was established to inform and educate the public about radiologic procedures and the role of radiologists in healthcare, and to improve communications between physicians and their patients.
Welcome to RadiologyPics.com, a large open access database of high quality radiology cases, differential diagnoses, and mnemonics!
The international community for Radiology professionals. Grow your professional network, get help for your daily practice, prepare for the boards and more...
Radiology and medical imaging professional network for building relationships in clinical practice, education, career, research and industry.
News on medical imaging from ScienceDaily, one of the Internet's leading online magazines and Web portals devoted to science, technology, and medicine.
SonoWorld was launched in 1999 as a way to use the emerging Internet to provide free educational materials to ultrasound practitioners in developing countries around the world. As the founders explored ways to accomplish this mission, it became apparent that there was a global need for a centralized resource for information as well as educational resources, and that this could best be accomplished by creating a new education-focused virtual community for physicians, sonographers and industry.
UK Imaging Informatics Group
This forum is open to all healthcare imaging professionals — radiologists, radiographers, health informatics professionals, project managers, physicists, imaging industry employees etc. interested in PACS, teleradiology and other related IT & imaging developments.
Virtual Imaging Laboratory
This site is intended to provide a teaching supplement for courses in medical imaging. The four different imaging modalities that are represented here are Ultrasound, MRI, Nuclear Medicine, and X-Ray Imaging.