Diagnostic Imaging Orders



Diagnostic Imaging Orders



Chapter Objectives


On completion of this chapter, you will be able to:


1. Define the terms in the vocabulary list.


2. Write the meaning of the abbreviations in the abbreviations list.


3. Explain how the health unit coordinator’s responsibilities regarding diagnostic imaging orders differ with the implementation of the electronic medical record and computer physician order entry versus use of the paper chart.


4. List the information regarding the patient that the health unit coordinator must include when ordering procedures to be performed by the diagnostic imaging department.


5. Explain the respective roles of a radiographer and a radiologist.


6. Explain the benefits of picture archiving and communication systems for the patient and the doctor.


7. Name five patient positions that may be included in a diagnostic imaging order.


8. Identify diagnostic imaging orders that do not require routine preparation.


9. Explain when a patient would be required to sign an informed consent before a diagnostic imaging procedure.


10. Explain why contrast media are used, and list types commonly used.


11. Discuss sequencing or scheduling of multiple diagnostic imaging procedures ordered for the same patient.


12. Identify four diagnostic imaging procedures that would require routine preparation, and explain the importance of preparing the patient before these procedures.


13. Explain the purpose of special invasive x-ray and interventional procedures, and list at least three procedures performed in this division of the radiology department.


14. Describe an instruction the doctor would include when ordering computed tomography (CT), and list at least three CT procedures.


15. Describe the purpose of ultrasonography procedures, and list at least three procedures performed in the ultrasonography department.


16. Discuss the purpose of magnetic resonance imaging (MRI) procedures and the purpose of magnetic resonance angiography (MRA) procedures.


17. Discuss the importance of a patient’s nurse completing the interview form before the patient undergoes MRI or MRA, and list contraindications that would exist for patients because of the strength of the magnet.


18. Discuss the purpose of nuclear medicine procedures, and list at least three nuclear medicine procedures.



Vocabulary



C-Arm


A mobile fluoroscopy unit used in surgery or at the bedside.


Cathartic


An agent that causes evacuation of the bowel (laxative).


Clinical Indication


Notation recorded when diagnostic imaging is ordered that indicates the reason for doing the procedure.


Computed Radiology


Use of a digital imaging plate rather than film.


Computed Tomography


A radiographic process that uses ionizing radiation to create computerized images (scans) of body organs in sections or that can be coronal, sagittal, or three-dimensional (referred to as CT scans).


Contrast Media


Substances (solids, liquids, or gases) used in diagnostic imaging procedures that permit the radiologist to distinguish among various body soft tissue structures; may be injected, swallowed, inhaled, or introduced by rectum.


Fluoroscopy


The direct observation of deep body structures made visible through the use of a real-time viewing screen instead of film; a contrast medium is required for this procedure.


Magnetic Resonance Angiography


Use of magnetic resonance to study blood vessels.


Magnetic Resonance Imaging


A technique used to produce computer images (scans) of the interior of the body with the use of a powerful magnetic field and radiofrequency waves.


Metastasis


The process by which tumor cells spread to distant parts of the body.


Modality


A method of application or employment of any therapeutic agent, limited usually to physical agents and devices.


Nuclear Medicine


A branch of medicine that uses radioactive isotopes for the diagnosis and treatment of disease.


“On-Call” Medications


Medications prescribed by the doctor to be given before a diagnostic imaging procedure is performed; the department notifies the nursing unit of the time the medication is to be administered to the patient.


Picture Archiving and Communication Systems (PACSs)


Computers or networks dedicated to the storage, retrieval, distribution, and presentation of images. Full PACSs handle images from various modalities, such as ultrasonography, magnetic resonance imaging, positron emission tomography, computed tomography, endoscopy, mammography, and digital radiography.


Portable X-ray


An x-ray study taken with a mobile x-ray machine that is moved to the patient’s bedside.


Position


Alignment of the body on the x-ray table that is favorable for taking the best view of the part of the body being imaged.


Radiography


The process of obtaining film records (radiographs) of internal structures of the body.


Routine Preparation


The standard preparation suggested by the radiologist to prepare the patient for a diagnostic imaging study.


Scan


An image produced with the use of a moving detector or a sweeping beam; image is produced by computed tomography, magnetic resonance imaging, nuclear medicine, or ultrasonography.


Special Invasive X-ray and Interventional Procedures


Procedures that involve diagnosing and treating patients using the least invasive techniques currently available in order to minimize risk to the patient and improve health outcomes.


Ultrasonography


A technique that uses high-frequency sound waves to create an image (scan) of body organs (may also be referred to as sonography or echography).



ABBREVIATIONS





























































































































































Abbreviation Meaning Example of Usage on a Doctor’s Order Sheet
abd abdomen, abdominal US of abd
AP anteroposterior chest AP & Lat
BE barium enema BE in am
CI clinical indications BE-CI: tumor
CT computed tomography CT scan of abd
CXR chest x-ray examination CXR today
DSA digital subtraction angiography cerebral DSA
F/U follow-up F/U CXR in am
Fx fracture x-ray lt femur CI: fx
GB gallbladder US of GB
GI gastrointestinal GI study in am
H/O history of CXR H/O chronic asthma
IVP intravenous pyelogram  
IVU intravenous urogram; synonymous with IVP IVU CI: Kidney stones
KUB (also called a flat plate of abdomen) kidneys, ureters, and bladder KUB today
L&S liver and spleen L&S scan tomorrow (nuclear medicine)
lat lateral PA & Lat chest today
LLQ left lower quadrant flat plate of abd att LLQ
LUQ left upper quadrant abd x-ray special attention to LUQ
LS lumbosacral x-ray LS spine (x-ray)
mets metastasis bone scan to determine mets
MRA magnetic resonance angiography MRA of cerebral arteries
MRI magnetic resonance imaging MRI of brain
PA posteroanterior PA & lat chest x-ray
PACS picture archiving and communication system The CXR may be viewed via PACS
PCXR portable chest x-ray PCXR stat
PET positron emission tomography PET scan tomorrow am (nuclear medicine)
PTC or PTHC percutaneous transhepatic cholangiography PTC or PTHC tomorrow
RIS radiology information system x-ray report is available in RIS
RLQ right lower quadrant x-ray of abd: Compare c¯image preoperative x-ray
RUQ right upper quadrant Check RUQ and RLQ
SPECT or SPET single-photon emission computed tomography SPECT L/S spine CI: back pain
SBFT small bowel follow-through UGI c¯image SBFT
SNAT suspected nonaccidental trauma SNAT series CI: abuse
UGI upper gastrointestinal UGI p¯image IVU
US Ultrasound US of GB
VQ Ventilation/perfusion (quotient) VQ scan CI: shortness of breath


image




image EXERCISE 1


Write the abbreviation for each term listed.



1. intravenous pyelogram


2. right lower quadrant


3. kidneys, ureters, and bladder


4. barium enema


5. posteroanterior


6. upper gastrointestinal


7. lateral


8. lumbosacral


9. left upper quadrant


10. anteroposterior


11. gastrointestinal


12. right upper quadrant


13. computed tomography


14. left lower quadrant


15. gallbladder


16. magnetic resonance imaging


17. small bowel follow-through


18. chest x-ray


19. digital subtraction angiography


20. portable chest x-ray


21. percutaneous transhepatic cholangiography


22. fracture


23. history of


24. follow-up


25. clinical indications


26. intravenous urogram


27. ultrasound


28. Picture Archiving and Communication System


29. positron emission tomography


30. liver and spleen


31. radiology information system


32. abdomen


33. metastasis


34. suspected nonaccidental trauma


35. single-photon emission computed tomography


36. ventilation/perfusion (quotient) scan



image EXERCISE 2


The following is a list of orders for imaging procedures that may appear on patients’ charts. Write the meaning of each underlined abbreviation.




Communication with the Diagnostic Imaging Department


The diagnostic imaging department may also be called medical imaging. Many modalities, including radiography, nuclear medicine, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), are included in the diagnostic imaging department. Diagnostic imaging procedures are performed to diagnose conditions and/or diseases (or to rule them out) and to assist the doctor in determining treatment. When the electronic medical record (EMR) with computer physician order entry (CPOE) is implemented, the doctors’ diagnostic imaging orders are entered directly into the patients’ EMR and are automatically



image HIGH PRIORITY


When the electronic medical record (EMR) with computer physician order entry (CPOE) is implemented, the physicians’ orders are entered directly into each patient’s electronic record, and the diagnostic imaging order is automatically sent to the diagnostic imaging department. The health unit coordinator (HUC) may have tasks to perform, such as coordinating scheduling, ordering special diets, and so forth. An icon indicating an HUC task may appear, or the icon may signify a nurse request. The HUC will have to communicate with the nutritional care department (by e-mail or telephone) when ordering a diet for a patient who has completed a diagnostic procedure that required nothing by mouth (NPO) status.


Note: Some hospital nutritional care departments require that all diet orders be submitted in writing via computer.


sent to the diagnostic imaging department. When paper charts are used the diagnostic imaging orders are communicated by the ordering step of transcription via computer or by completion of a downtime requisition form (Fig. 15-1). Because the patient usually is transported to the diagnostic imaging department for the procedure, it is important to indicate the mode of transportation—wheelchair or gurney (stretcher). The patient may be transported by the diagnostic imaging department staff, transport service, or nursing department staff.


image
Figure 15-1 Downtime requisition for x-ray procedures.

A portable or mobile x-ray examination is an exception to the standard transportation procedure. A request for a portable x-ray requires the radiographer to take the portable equipment to the patient’s room. A portable x-ray examination is ordered when movement might be detrimental to the patient’s condition. A written order from the patient’s physician is required for a portable x-ray examination.


A C-Arm is a mobile fluoroscopy unit used at the bedside and also in surgery. It allows for lower x-ray doses to be used on patients by magnifying the intensity produced in the output image, enabling the viewer to easily see the structure of the object being imaged.


When ordering the diagnostic procedure, indicate the following information about the patient:



This information will assist personnel in the diagnostic imaging department to provide better care for the patient (see Fig. 15-1). The doctor may write the name of the radiologist who will perform an invasive procedure. The health unit coordinator (HUC) should include this information when entering the order or scheduling the test.



image HIGH PRIORITY


Clinical indication (the reason the doctor is ordering the procedure) must be recorded by the HUC when a diagnostic imaging procedure is ordered. Insurance companies require this information before they will provide reimbursement to health care facilities. Diagnostic imaging departments will not perform procedures until they have received documented clinical indications. The clinical indication should be a symptom or complaint rather than a diagnosis.



image HIGH PRIORITY


Downtime requisitions are included in this chapter for learning purposes. The Evolve website associated with the Skills Practice Manual for Health Unit Coordinating includes a simulated hospital computer program that may be used as well.



image HIGH PRIORITY


A written order from the patient’s physician is required to perform an x-ray stat or as a portable examination. The physician’s original order for a routine x-ray study cannot be changed to “portable” or “stat” for convenience or because the original order was missed. If the nurse determines that the patient needs the x-ray examination stat or via the portable x-ray unit, the patient’s physician would have to be called for a change to the original order.



Background Information for Radiology


In 1895, Wilhelm Roentgen discovered a strange phenomenon that produced a photograph of the bones of his wife’s hand. The exact mechanism for the production of these rays was unknown to Roentgen; therefore he used the algebraic symbol for the unknown, x, to title his discovery.


X-ray studies performed in the radiology area of the diagnostic imaging department are carried out by a radiographer, a person with special education in the area of radiography. X-ray images are developed in the department and are interpreted by a radiologist, a doctor who is a specialist in this field. Some studies are done by observing the path of contrast media in the body by means of fluoroscopy. Physicians’ orders do not always include the word “x-ray.” For example, “Chest PA & Lat” indicates a chest x-ray examination that includes two views (posteroanterior and lateral). Some procedures scheduled in the radiology area must be carried out in specific sequence so that the contrast medium necessary for one procedure does not block the image of another. Computed radiology is the use of a digital imaging plate rather than film. The digital image can be viewed and enhanced using software that has functions very similar to other conventional digital image–processing software, such as contrast, brightness, filtration, and zoom.



Picture Archiving and Communication System


Picture archiving and communication systems (PACSs) are computers or networks dedicated to the storage, retrieval, distribution, and presentation of images. Full PACSs manage images from various modalities, such as ultrasonography, MRI, positron emission tomography, CT, endoscopy, mammography, and radiography (plain x-ray images). PACSs replace hard copy–based means of managing medical images, such as film archives. PACSs provide off-site viewing and reporting (distance education, telediagnosis).


When a study has been reported by the radiologist, the PACS can mark it as read; this avoids needless double reading. Dictation of reports can be integrated into a single system. The dictated recording is automatically sent to a transcriptionist workstation for typing; it also can be made available for access by physicians, avoiding typing delays for urgent results, or retained in cases of typing error. The report can be attached to the images and be viewable to the physician.


Physicians at various physical locations may access the same information simultaneously.


Global PACSs and other networks enable images to be sent throughout the world. These systems provide growing cost and space advantages over film archives. PACSs should interface with the existing hospital information system (HIS), the information technology (IT) department, and the radiology information system (RIS). An icon indicating a diagnostic medical image in a patient’s medical record would allow the physician to view the image and the radiologist’s report. Benefits for the doctor include faster results, ability to compare an image with a previous image (if applicable), ability to share with other physicians, and reduced risk of film loss. Benefits for the patient include reduction in treatment delays, reduced risk of film loss, and protection of confidentiality. An additional benefit is noted for the environment, in that x-ray photographic darkroom chemicals and toxins are eliminated from the process.



Patient Positioning


The doctor may wish an x-ray image to be taken while the patient is placed in a specific position on the x-ray table or erect (e.g., chest studies) to allow the best view of the area to be exposed. The HUC must be careful to include all of the x-ray order without making any changes, and to be absolutely accurate when transcribing such orders. For example, the HUC should not write AP (anteroposterior) when the order calls for PA (posteroanterior) positioning. The wrong abbreviation can cause the radiographer to film a different view, which may obscure an abnormality.


Following is a list of the positions used most frequently in the writing of x-ray orders:




image HIGH PRIORITY


Examples of procedures performed in each of the modalities of diagnostic imaging are included in this chapter. They are too numerous to list, but the examples provided are a good representation of procedures that are performed in each modality.



Radiographic (X-ray or General Diagnostic ) Procedures


X-ray Examinations that Do Not Require Preparation (Plain Radiographs or Plain X-ray Images)


X-rays can penetrate solid material, such as bone; this in turn produces a shadow that is recorded on film. Procedures that require the filming of bone structures or that are ordered to determine the position of other organs in relation to these structures can be performed by qualified radiology personnel without the need for preparation for the procedure (Fig. 15-2).


image
Figure 15-2 A, Radiographic table with chest unit. B, Chest x-ray image. C, Skull x-ray image, lateral view. Pointers indicate fracture line in temporal bone. C, Cervical vertebra; F, frontal bone; M, mandible; O, occipital bone; P, parietal bone; S, sella turcica. (A from Ballinger PW, Frank ED: Merrill’s atlas of radiographic positions and radiologic procedures, ed 10, St Louis, 2003, Mosby. B from Bontrager KL, Lampignano JP: Textbook of radiographic positioning and related anatomy, ed 6, St Louis, 2005, Mosby. C from Pagana KD, Pagana TJ: Diagnostic testing and nursing implications: a case study approach, ed 4, St Louis, 1994, Mosby.)

Following are x-ray studies as they commonly are written on a doctors’ order sheet.



image Doctors’ Orders for X-Ray Examinations that Do Not Require Preparation



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Apr 8, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Diagnostic Imaging Orders

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