Patient Care
18%of exam
IdentityConsentHIPAAInfection ControlEmergencies
Safety
40%of exam
Image Production
42%of exam
Procedure Modules
20-25%of exam
ChestExtremitiesSkull/SinusesSpinePodiatric
Quick Facts
- Exam
- Limited Scope
- Owner
- ARRT/state agencies
- Core
- 100 scored
- Pilots
- Core +15
- Modules
- State assigned
- Core time
- 1h 55m
- Fee
- $150
- Pass
- State-determined 75
Identifier vs Room
Identifier
- Name/DOB
- Matches order
- Patient-specific
Room
- Location only
- Can change
- Never enough
Verify the person
Patient Action Picker
- Patient refuses→Stop exam(Document)
- Wrong identity→Reverify(Two IDs)
- Pulseless patient→CPR/AED(Activate help)
- Airway reaction→Emergency response(Oxygen/epi)
- Contact isolation→Gown/gloves(Before entry)
- Catheter transfer→Bag below(Closed system)
- Pregnancy question→Follow policy(Protect fetus)
- Order mismatch→Clarify order(Before exposure)
Patient Rights
- Two identifiers
- Name plus DOB
- Consent
- Permission for care
- Refusal
- Stop and document
- HIPAA
- Protect PHI
- Battery
- Unauthorized touching
- Negligence
- Care below standard
- Respondeat
- Employer liability
- Res ipsa
- Thing speaks
Sterile vs Aseptic
Sterile
- No microorganisms
- Sterile field
- Surgical asepsis
Aseptic
- Reduce microbes
- Clean technique
- Break transmission
Eliminate vs reduce
Infection + Emergency
- Hand hygiene
- Before/after contact
- Standard
- Every patient
- Contact
- Gown + gloves
- Droplet
- Mask close contact
- Airborne
- N95 isolation
- Asepsis
- Reduce microbes
- Sterile
- No microorganisms
- CPR/AED
- Pulseless response
- Contrast airway
- Emergency reaction
ALARA
ALARA: time distance shielding
TimeDistanceShieldingCollimation
Deterministic vs Stochastic
Deterministic
- Threshold
- Severity increases
- Tissue reaction
Stochastic
- No threshold
- Probability increases
- Cancer risk
Severity vs chance
Radiation Physics
- Thermionic
- Electron release
- Bremsstrahlung
- Braking radiation
- Characteristic
- Shell transition
- Primary beam
- Useful x-rays
- Remnant beam
- Exit radiation
- Photoelectric
- Absorption interaction
- Compton
- Scatter interaction
- Attenuation
- Beam reduction
- Gy
- Absorbed dose
- Sv
- Dose equivalent
Grid vs Collimation
Grid
- Absorbs scatter
- Improves contrast
- May raise dose
Collimation
- Limits field
- Lowers scatter
- Protects patient
Clean vs restrict
Radiation Protection
- ALARA
- Keep dose low
- Time
- Shorter exposure
- Distance
- Inverse square
- Shielding
- Barrier attenuation
- Collimation
- Restrict beam
- Filtration
- Remove low energy
- Dosimeter
- Personnel monitor
- Pregnancy
- Follow policy
- Scatter
- Patient source
- DAP
- Dose-area product
Technique
mAs quantity; kVp quality
mAskVpEINoise
kVp vs mAs
kVp
- Beam quality
- Contrast effect
- Penetration
mAs
- Beam quantity
- Receptor exposure
- Noise control
Quality vs quantity
Image Correction Picker
- Quantum noise→Increase exposure(More signal)
- Motion blur→Shorter time(Immobilize)
- Magnification→Lower OID(Increase SID)
- Shape distortion→Align part(Reduce angle)
- Scatter fog→Collimate/grid(Clean contrast)
- Rotation error→Reposition(Check landmarks)
- Anatomy clipped→Repeat view(Include anatomy)
- Wrong marker→Correct marker(Legal ID)
Technique Factors
- kVp
- Beam quality
- mAs
- Beam quantity
- 15% rule
- Doubles receptor exposure
- SID
- Source distance
- OID
- Object distance
- Focal spot
- Detail control
- Motion
- Blur source
- Grid
- Scatter cleanup
- AEC
- Automatic exposure
- EI
- Exposure indicator
Geometry
SID up; OID down
Long SIDShort OIDSmall focalNo motion
SID vs OID
SID
- Source distance
- Longer reduces blur
- Affects intensity
OID
- Part distance
- Shorter reduces magnification
- Affects distortion
Far source, close part
Digital + QA
- Pixel
- Image element
- DEL
- Detector element
- DQE
- Detector efficiency
- SNR
- Signal/noise ratio
- Histogram
- Exposure distribution
- Artifact
- Unwanted image mark
- Marker
- Side identification
- Fog
- Unwanted exposure
- Calibration
- Detector maintenance
- Monitor QC
- Display quality
Core Counts
Core: PC=18 S=40 IP=42
Patient CareSafetyImage Production
Position vs Projection
Position
- Patient placement
- Body orientation
- Landmarks
Projection
- Beam path
- Entry/exit
- CR direction
Body vs beam
Procedure Picker
- State assigns chest→Chest module(20 scored)
- Routine chest→PA/lateral(Upright)
- Fluid level→Decubitus(Horizontal beam)
- Extremity trauma→Modify views(Do no harm)
- Long bone→Include joints(Both ends)
- Sinus fluid→Erect view(Shows levels)
- C-spine trauma→No manipulation(Stabilize)
- Foot alignment→Weightbearing(If ordered)
Procedure Modules
- Chest
- 20 scored
- Extremities
- 25 scored
- Skull/Sinuses
- 20 scored
- Spine
- 25 scored
- Podiatric
- 20 scored
- Each module
- Five pilots
- CSR
- Assigned modules
- State agency
- Sets eligibility
Positioning Hooks
- PA chest
- Upright routine
- Lateral chest
- Second routine view
- Decubitus
- Air/fluid levels
- Long bone
- Include joints
- Oblique
- Unsuperimpose anatomy
- C-spine
- Do not force
- Sinuses
- Erect when possible
- Weightbearing
- Podiatric comparison
Common Traps
Consent vs order
Order requests exam ≠ Consent permits care
Room vs patient
Room number moves ≠ Identifiers stay patient-specific
ALARA scope
Patient dose minimized ≠ ALARA names personnel
mAs vs kVp
mAs controls quantity ≠ kVp controls quality
Grid vs dose
Grid cleans scatter ≠ Grid may raise exposure
Position vs projection
Position is body ≠ Projection is beam
Pilot vs scored
Pilots are hidden ≠ Pace every item
Last Minute
- 1.Confirm state modules
- 2.Core has 100 scored
- 3.Safety has 40 scored
- 4.Image Production has 42
- 5.Patient Care has 18
- 6.Use two identifiers
- 7.ALARA: time distance shielding
- 8.kVp quality; mAs quantity
- 9.15% rule doubles exposure
- 10.Never disclose exam items
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