document resume ed 130 077 ce 008 476 gilpatrick, eleanor · document resume ed 130 077 ce 008 476...

DOCUMENT RESUME

ED 130 077 CE 008 476

AUTHOR Gilpatrick, EleanorTITLE Task Descriptions in Diagnostic Radiology. Research

Report No. 7. Volume 2, Radiologic Technologist TasksDealing with Patient Procedures. Part I: Tasks 7through 386.

INSTITUTION Health Services Mobility Study, New York, N.Y.SPONS AGENCY City Univ. of New York, N.Y. Hunter Coll. School of

Health Sciences.; City Univ. of New York ResearchFoundation, N.Y.; Employment and TrainingAdministration (DOI), Washington, D.C.

PUB DATE 76CONTRACT 82-34-69-34NOTE 566p.; For related documents, see CE 007 705, 008

477, and 008 699-700

EDRS PRICE MF-$1.00 HC-S30.13 Plus Postage.DESCRIPTORS Curriculum Guides; *Health Occupations Education;

Health Services; Instructional Materials; JobDevelopment; *Job Skills; Medical Services;*Occupational Information; Paramedical Ocbupations;Post Secondary Education; *Radiologic Technologists;Radiology; Skill Analysis; *Task Analysis

IDENTIFIERS Health Services Mobility Study

ABSTRACTPart I of the second of four volumes in Research

Report No. 7 of the Health Services Mobility Study (HSMS) , this bookcontains 76 task descriptions covering most of the medical activitiescarried out by radiologic technologists. Chapter I of this volumedefines "tasks" and tells how the descriptions were developed.Chapter 2 lists the task.s by system or area of the body, by the typeof task function involved (such as "plain film" examinations,contrast examinations, teaching), and by main type of recipient(e.g., patient, pediatric patient, etc.). The steps of the taskdescriptions are presented in logical sequence in considerable detailby Code Number in Chapter 3, (part of which is in this book, Part I,the remainder in Vol. 20 Part II). (The work carried out by'diagnostic radiologists and the tasks of administrative,machine-related, and mursing-type functions are found in Volumes 1and 3. Volume 4 is an index of all the tasks in the three volumes.These task descriptions are offered for use as instructionalmaterials, design of career ladders, for the structuring of jobs, andas inputs to the development of performance evaluation instrumentsand proficiency tests). (HD)

Documents acquired by ERIC include many informal unpublished materials not available Prom other sources. ERIC makes everyeffort to obtain the best copy available. Nevertheless, items of- marginal reproducibility are often encountered and this affects thequality of the microfiche and hardcopy reproductions ERIC makes available via the ERIC Document Reproduction Service (EDRS).EDRS is not responsible for the quality of the original document. ReprOductions supplied by EDRS are the best that can be made fromthe original.

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TASK DESCRIPTIONS IN DIAGNOSTIC RADIOLOGY

Research Report No. 7

Volume 2

RADIOLOGIC TECHNOLOGIST TASKSDEALING WITH PATIENT PROCEDURES

Part I: Tasks 7 Through 386

by

Eleanor Gilpatrick, DirectorHealth Services Mobility Study

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U.S. DEPARTMENT OF HEALTH.EDUCATION WELFARENATIONAL INSTITUTE OF

EDUCATION

THIS 00CUMENT HAS BEEN REPRO.OUCEO EXACTLY AS RECEIVEO FROMTHE PERSON OR ORGANIZATION ORIGIN.ATING IT POINTS OF VIEW OR OPINIONSSTATEO DO NOT NECESSARILY REPRESENT OFFICIAL NATIONAL INSTITUTE OFEOUCATION POSITION OR POLICY

Contract No. 82-34-69-34EMPLOYMENT AND TRAINING ADMINISTRATION

US Department of Labor

Sponsored by Hunter College andThe Research Foundation, City University of New York

Copyright 1976 by Eleanor Gilpatrick

2

ACKNOWLEDGEMENTS

We owe many people thanks for making it possible for us to pro-duce the radiologic technologist tasks presented here. We thank Mo Katz,Deputy Director of the Montefiore Hospital and Medical Center in New YorkCity for inviting us to the hospital and making us welcome. The Montefioreadministrative staff were extremely kind and patient with us.

We are grateful to the radiologic technologists at Montefiorewho gave us long hours of interview, observation or review time so thattheir work could be described. These included Alicia Benjamin, MichaelDaly, Mitchell Finkelstein, Neville McWatt, Effraim Mercado, Myrna Roach,and Hector Rodriguez. We also appreciate the cooperation of BarbaraLaughinghouse at Mt. Sinai Hospital and Medical Center in New York City.

We deeply appreciate the extensive time given us by radiologictechnology professionals in critical review of the tasks. These includePatricia Pierce, Chief Technologist, and Robert Shaitelman, Administrator,in the Department of Radiology, Montefiore Hospital. Michael F. Audet,Robert C. Eccleston, Donald A. Flater, Norbert P. Heib, Jr., and JerreJensen, all of whom are staff members of the Allied Health Branch, Divisionof Training and Medical Applications, Bureau of Radiological Health (BRH),Food and Drug Administration, HEW, reviewed our work with great care andattention. We are also grateful to Robert L. Coyle, Executive Director ofthe Joint,Review.Committee on Education in Radiologic Technology, whichfunctions in cooperation with the American Medical Association, Ward M.Keller, Director of Educa.tion of the American Society of Radiologic Tech-nologists,and Professor Leroy Sparks, formerly Chairman of the RadiologicTechnology Department at Hostos Community College, C.U.N.Y., and now Chair-man of the Program in Radiological Sciences at State University of New YorkDownstate Medical Center in New York City. All gave unstintingly of theirtime. Our neuroradiology tasks received additional review from RichardBowling, Chief Technologist at Cohoes Memorial Hospital, Cohoes, New York.

Francis N. Ham, Jr., Field Engineer at EMI Medical Inc.,reviewedour tasks in computerized transverse axial tomography, as did Mitchell L.Finkelstein, formerly Assistant Chief Technologist at Montefiore Hospital,members of the Training Specialist staff of Pfizer Medical Systems, Inc.,and Gene Moss, formerly of the staff of BRH.

Our literature sources have been numerous; but special acknowl-edgement is due Vinita Merrill, whose Atlas of Roentgenographic Pd8itionsand Standard Radiologic Procedures (3rd and 4th Editions, St. Louis: TheC.V. Mosby Company, 1967, 1975) proved extremely valuable. *

We thank these professionals for their help. Any mistakes re-maining, or controversial issues still unresolved in the task descriptions,are solely the responsibility of the Health Services Mobility Study.

3

The bulk of the field work for these task descriptions was car-ried out by HSMS job analysts Jeanne Bertelle, Albertine Brown, Sandra M.Ostling, and Irene A. Seifgr. The very demanding job of typing the taskswas supervised and largely carried out by Julia M. Caldwell.

A special note of thanks goes to our Project Officer, Mr. WilliamThrockmorton, for his continued understanding and encouragement.

The research reported herein was conducted under a contract with theEmployment and Training Administration, U. S. Department of Labor, underthe authority of the Comprehensive Employment Training Act of 1973. Re-searchers are encouraged to express their own judgment freely. Interpre-tations or viewpoints stated in this document do not necessarily representthe official position or policy of the Department of Labor or the CityUniversity of New York

PREFACE

The Health Services Mobility Study (HSMS) has been involved inresearch in the health manpower field in the United States since 1967.It has designed methods to analyze jobs, create job ladders, develop cur-riculum objectives, and evaluate performance. HSMS is sponsored by theCity University of New York (CUNY) through the Research Foundation andthe Hunter College School of Health Sciences. Since 1967, funding forHSMS has come from the Office of Economic Opportunity, the Health Ser-vices and Mental Health Administration and the Bureau of Health Manpower,both of HEW, and, primarily, the U. S. Department of Labor, Manpower Ad-ministration, now the Employment and Training Administration. The Di-

rector of the Project, Eleanor Gilpatrick, holds the rank of AssociateProfessor at the Hunter College School of Health Sciences, City Univer-sity of New York.

This report presents the core data of the first applicationof the HSMS task analysis method to an entire functional area, i.e.,Diagnostic Radiology. This work is reported in two Research Reports as

follows:

ResearchRpt. No. 7Vol. 1Vol. 2

Vol. 3

Vol. 4

TASK DESCRIPTIONS IN DIAGNOSTIC RADIOLOGY

Medical Tasks: What the Radiologist Does.Radiologic Technologist Tasks Dealing With PatientProcedures.Machine-Related, Patient Care and Administrative Tasks:What Radiologists, Technologists, Nurses, and Physi-cists Do To Run Things and Look After Patients andEquipment.Index of Tasks by Code Number and Extended Name.

These four volumes are the "core" documents, i.e.,they pre§ent approved "normative" task descriptionsin radiology. The first three volumes present thetasks in a given area in numerical order by code num-ber. Each document describes how the tasks were de-veloped and how to read them. Each includes listingsthat arrange the tasks by specialty or function. Vol-

ume 4 summarizes the tasks presented in the first threevolumes. It lists the extended names of all the tasksin numerical order by task code number, citing the vol-ume in which the task description is to be found.

iv

5

ResearchRpt. No. 8Vol. 1

Vol. 2

Vol. 3

;..

USING TASK DATA IN DIAGNOSTIC RADIOLOGY

Job Ladders in Diagnostic Radiology: Assigning Tasksto Jobs.Safe Practice and Radiation Health Protection AspeC:sof Tasks.Curriculum Objectives For Radiologic Technology.

These volumes make use of and refer to the tasks pre-sented in Research Report No. 7. Therefore, only theabbreviated names of tasks and their code numbers areused when the tasks are discussed.Volume 1 shows the assignment of tasks to levels, in-dicates how tasks relate to one another, and makes rec-ommendations on a job ladder and job structuring. It

summarizes and includes the skill and knowledge datarelated to the tasks in Regearch Report No. 7. It

tells the hospital administrator how to use the datafor assigning tasks to titles and jobs.Volume 2 111hl1ghts the safe practice features of thetask des.....riptions.

Volume 3 pr^sents the curriculum objectives for use inan educational program at the radiologic technologistlevel. Research Report No. 7 serves as instructionalmaterials in connection with this volume.

CONTENTS: PART I

ACKNOWLEDGEMENTS ii

PREFACE iv

FOREWORD vii

1. ABOUT THE TASK DESCRIPTIONS

IntroductionAbout The Tasks: Collection and CoverageDesiderataUses of The Task DescriptionsThe HSMS Definition of TaskReading The Tasks

2. LISTING OF ABBREVIATED TASK NAMES BY CATEGORY AND CODg,ANUMBER

Tasks Listed By System or Area of The BodyCirculatory SystemDigestive System and AbdomenMusculo-Skeletal System and ChestNervous SystemReproductive and Urinary SystemsRespiratory SystemGeneral Tasks n.e.c.

2-12-12-22-3

2-52-52-62-7

Tasks Listed By Task Function 2-8

"Plain Film" Examinations 2-8

Contrast Examinations 2-10

Examinations and Use of Equipment n.e.c. 2-14

Evaluation, Teaching, Meetings Tasks 2-14

Tasks Listed By Type of Main Recipient, Respondent orCo-Worker 2-15

Tasks With Patient Recipient 2-15

Tasks With Co-workers, Students orOther Main Recipients 2-20

3. TASK DESCRIPTIONS: RADIOLOGIC TECHNOLOGIST PATIENT PROCEDURES

Tasks 7 Through 386

CONIEWS: Part II

3. TASK DESCRIPTIONS: RADIOLOGIC TECHNOLOGIST PATIENT PROCEDURES (continued)

Tasks 387 Through 526

vi

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FOREWARD

The contents of these volumes include the Radio logic Technology tasks dealing withpatient procedures, from the initial phase of the procedure, the desired output,inclusive of each step, to the completion of the task.

One might be inclined to 'state that the contents of these volumes is based upon in-structional strategies; in a sense they are. In developing the trecs; it was evident thatsuch an ambitious undertaking is based upon a premise. The,pternise is that for toolong Radio logic Technology has been lagging in the basic edoCitional principles inclinical education; therefore, instrUctional strategies utilize theelements of currenteducational theory coupled with the eiipertise of noted educates-and practitionerswithin the profession of Radio logic Technology.

.9. 1vieV

Although Radiologic Technologists have contributed to the docurrite by reviewing,evaluating, and when necessary, commenting on certain tasks or terminology, it shouldbe understood that the evaluation and comments were the professione,Lopinion of thetechnologist, and is not reflective 9f any position of the American Sociecy of Radio-logic Technologists.

One final note: The title of this work, Task Description in Diagna.tic,Radiology, isjust that, task descriptions. No attempt is made to impose the content on managers oreducators in the profession of Radiolnic Technology. They are free, of Course, to usethe taA's descriptions whatever way deemed appropriate. We hope that eityoolumesdealing with patient care will be helpful to you in providing the best pessible educationfor your staff. /fri

Ward'M. Keller, R.T.Directoi of EducationThe American Society of

Radiologic Technologists

vii

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FOREWORD

The Bureau of Radiological Heald' of the Food and Drug Administra-tion is responsible for minimizing unnecessary exposure of thepopulation to radiation, including that used in medicine. The.:ireau's programs include activities to improve the education ofhealth care personnel in the safe use of radiation. This isimportant because adequate education of professional and ancillarypersonnel who prescribe, conduct or interpret radiologic examina-tions is a crucial determinant in assuring optimum medical carewith minimum radiation exposure.

The educational process in the medical radiation area, as in anyfield, can be most effective when it is based Upon the actualtasks and responsibilities which individuals will be called uponto undertake in practice. Systematically and comprehensivelyidentifying and describing those tasks is thus arOmportant pre-requisite in designing effective curricula and credentialing tools.The type of research which is represented by the series of projectsentitled "Task Descriptions in Diagnostic Radiology;" cpnducted hythe Health Services Mobility Study, can bL, an'importdnestep inthis direction. These particular projects, culminating in severalindividual reports, contain task descriptions and cum144umobjectives of remarkable depth and scope, including mudt'materialon protecting patients against unnecessary radiation expo30....e.

Although the Bureau of Radiological Health has not contilibuiedto the design of these projects or to the content of the-reports,we hope.that they can serve as a useful resource for those_repon-

. sible for designing basic and continuing educational progiams.formedical radiation users, and thus that they can contribute!,to thesafe and effective use of radiation in me ical diagnosis.

*

N,Mark BarnettAssociate DirectorDivision of Training & Medical ApplicationsBureau of Radiological HealthFood and Drug Administration

viii

,RAPTER 1

ABOUT THE TASK DESCRIPTIONS

INTRODUCTION

Research Report No. 7 is a product of the first full-:.:cale dem-

onstration of the task description method of the Health Serv3o:s Mobility

Study (HSMS). All the work found in a department of Diagnostic Radiology

is presented as task descriptions in the three volumes of the Report.

This volume contains 76 task descriptions of which most are ex-

amination tasks carried out by radiologic technologists. These descrip-

tisr.s were prepared and reviewed over the period August, 1972, through

March, 1976.

The medical work carried out by radiologists and the tasks of

administration, film processing, machine maintenance, nursing, and house-

...keeping are found in Volumes 1 and 3. Volume 4 is an index of all the

tasks in the three volumes.

These task descriptions axe offered.for use as instructional ma-

terials, as inputs to the design of career ladders, for the structuring of

jobs and assignment of work to job titles, and as inputs to the development

of performance evaluation instruments and proficiency tests. In Relearch

Report No. 8, ESNS uses technologist-level tasks to design cUrriculum ob-

jectives. In addition, because the descriptions present desirable work

behaviors, we believe that the task descriptions can be used to improve

the quality of work, especially with regard to radiation protection and

10

patient safety, and can be used for human resources development, plan-

ning, and counseling. The materials are adaptable for consumer educa-

tion as well.

In order for the reader to use this material, he needs to know

how it was collected and developed, what the tasks cover, how HSMS defines

"task," and how to read the task descriptions. This chapter presents such

information. Chapter 2 is a guide to the tasks. Tt arranges the abbre-

viated names of the tasks in several logical groupings with the code num-

bers given so the reader can get to the tasks that interest him or her.

The groupings in Chapter 2 list the tasks by system or area of the body,

by the type of task function involved (such as "plain film" examinations,

contrast examinations, teaching), and by main type of recipient (such as

any patient, pediatric patient, etc.). The task descripcions are present-

ed'in numerical order b'T ,:ode number in Chapter 3. Part I covers tasks

7 through 386; and Part II covers tasks 387 through 526.

ABOUT THE TASKS': COLLECTION AND COVERAGE

The HSMS task definition is presented later in this chapter.

This section describes how the task descriptions were developed and indi-

cates the coverage in this volume.

Orientation

If one conceives of all the kinds of work that get done in a

department in order for it to carry out the function of diagnostic radi-

ology, one might think of a great field or pool of work. Each kind of

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work is carried out in discrete units. Theoretically, it does not mat-

ter how the units are allocated to jobs, as long as all the work is done.

In practice, although common sense is usually enough to discern that some

tasks require someone trained in radiolobjc technology, there are always

areas where it is unclear who should d..) what.

The HSMS method avoids this issue until it is clear what the

work units are. Only at a later stage do we determine the skill and

knowledge requirements for work units and their relative levels. The

HMS method begins with descriptions of all the work units, regardless

1of the job titles in which they are found. We call the work units

"tasks."

This volume is the second of three that together present most

of the work that is done in a department of Diagnostic Radiology. Since

we needed to divide the task descriptions into manageable volumes, we

arbitrarily determined that this volume would contAn task descriptions

that refer to the radiographic examinations of patients done by technolo-

gists, and the teaching and evaluation of such work. Other work that

may be carried out by radiologic technologists, nurses, physicists or

radiologists of an administrative, mach.Lne-related or nursing-type func-

tion appear in Volume.3. Volume 1 contains the medical tasks of the ra-

diologist.

1This assignment of work units to jobs varies according to the size of aninstitution, local practices and laws, relative scarcities of types ofmanpower, and the extent to which an institution is rationally organized.

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Collection of Data

Chapter 3 contains task descriptions. This means that tasks are

identified by name, based (in this case) on the HSMS definition of task,

and then the steps of the task are described in a logical sequence and

include a good deal of detail.2

The work in task identification and description is done in a

mulii-stage process. HSMS job analysts work in teams. They first deter-

mine how many people and what titles they must cover to have access to

every kind of work done in the department. In the case of the radiologic

technologist, we found that there was some specialization such as between

contrast studies and non-c,..Intrast "plain films," angiography, pediatrics,

operating room radiography. With cach "performer" interviewed, the ana-

.lysts first obtain an idea of all the work covered by that individual.

The analysts then apply the HSMS definition of task (discussed later in

this chapter) to break the work down into specific task units, making sure

that nothing is left out. This is the task identification stage. From

this point the performersiare interviewed and sometimes observed, and the

analysts write descriptions of how the tasks are done, including contin-

gencies, alternative approaches and emergencies. We interviewed as many

performers as was necessary to cover all the work in the department, in-

2This differentiates the HSMS method from most other task analysis methodswhich simply identify tasks, usually with a vague definition, and include

a very brief name. The.HSMS method includes a specific definition of task.Once identified, a task has a code number, an abbreviated name, a summarystatement of the task,and a full task description.

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cluding radiologists, nurses, supervisors and physicists as well as

technologists.

Simultaneously, we collected as much current literature as we

could which in any way described the work of the department. This in-

cluded articles in professional journals, text books, operators' manuals

for equipment, current state and federal legis/ation,and proceedings of

conferences dealing with safe practice and related issues of patient

care. We also had informa1 talks with professionals, educators, and

people in government agencies.

We completed the radiologists' medical tasks and nursing and

administrative tasks first, and had them reviewed. We were then able

to lay out the technologists' tasks with reference to the sequence of

events as seen from a team perspective.

The literature and discussions provided an overview concerning

certain steps and activities which should be represented in the task de-

scriptions even if not always represented in current practice. These con-

cern protection of the patient from unnecessary radiation, protection of

the possible fetus, protection from contamination or contagion, sympa-

thetic and dignified attention to the patient, and protection of staff

from exposure to radiation. We call such objectives "desiderata."

The literature also provided information on alternative methods

for carrying out tasks, contingencies to be taken account of, varieties

of equipment available, and some indication of preferred practices. The

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radiologist tasks and the medical literature permitted us to develop tasks

for the technologists that were not being done at the institutions where

we were interviewing and/or are not described in detail in the literature

on radiologic technology. There is little detailed material at the tech-

nologist level on pediatric radiography, angiography, the less common con-

trast studies,and the new technology of computerized transverse axial

tomography. In the latter case we were fortunate to receive access to

operators' manuals for the E.M.I. scanners and Pfizer's A.C.T.A. body

scanner.

The task descriptions are first written by the HSMS analysts

and then go to the HSMS Director for review and editing. At this stage

the tasks are rewritten to incorporate the literature of the field and

.the desiderata. The task identifications are critically reviewed for

conformity to the HSMS definition, and, when necessary, the analysts are

sent back to the field to obtain additional information.

The next phase involves critical review by professionals other3

than the performers who were interviewed by the HSMS analysts. Each of

the tasks presented in Chapter 3 has had a minimum of three reviewers;

most have been evaluated by five reviewers.

We were very fortunate to obtain as reviewers supervisory staff

at Montefiore Hospital and radiologic technologists with national stature.

As indicated in the acknowledgements, staff of the Bureau of Radiological

3 See the acknowledgements page at the beginning of this volume.

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Health of FDA, the American Society of Radiologic Technologists,and the

Joint Review, Committee on Education in Radiologic Technology have given

us the benefit of their expertise, as have educators and equipment manu-

facturers.

The reviewers are asked Lo evaluate the tasks for correctness

of language and sequence of procedures, to note omission of any 'tasks

in the specialty area, and to indicate acceptable alternative methods.

Reviewers are asked to concentrate on how the tasks should be done and

also to reflect national practice.

After the tasks are reviewed, the suggested changes are incor-

porated, additional tasks are collected and described when necessary, and

any new or totally revised tasks are resubmitted for review as described

here. When a task has been reviewed and revised as required by at least

three reviewers, it is _eferred to as a "normative task," or an "N task,"

and is so marked.

Coverage

The reader will note that the collection of task descriptions

is not like a sample survey. A sample survey would not cover all the

work, but would cover only selected work. A sample would pick up the

same work at many locations. We pick up and represent each unit of work

only once. The reason is that our objective is to describe all approved

work procedures for the purposes of developing instructional materials,

curriculum objectives, and career ladders. For such purposes we want not

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just the most ty'pical tasks; we want to cover the accepted but rare or

difficult procedures, the emergencies, the contingencies, and the best

possible practice. We are normative in approach as well as descriptive.

We are not dealing with probability theory, which requires sampling of

the "universe" being studied. We attempt to present the universe.

Most of the tasks in this volume were collected at Montefiore

Hospital and Medical Center in New York City over the period August, 1972,

to January, 1976. Montefiore Hospital is a respected major voluntary hos-

pital. Tasks related to obstetrics and gynecology were collected at Mt.

Sinai Hospital and Medical Center in New York City, another highly regarded

voluntary hospital.

Alternative procedures and those not carried out at the hospitals

where we collected our data were described based, on our use of the litera-

ture, the radiologist tasks we developed, and the inputs of our reviewers.

In several cases we eliminated practices described in the literature which

are now considered to be dangerous, useless, or obsolete.

We include descriptions of some very new procedures involving

computerized transverse axial tomograph}r. To make our task descriptions

more broadly based than the water-box brain scanner used at Montefiore, we

used the literature on this new technology and the manuals to which we had

access to write a general procedure task. Our reviewers were asked to eval-

uate the task for its generic usefulness.

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Every effort was made to include every examination procedure

carried out by radiologic technologists in hospital centers. However,

procedures carried out only in specialized centers, such as some proce-

dures in children's hospitals, or procedures using specialized equipment,

such as for localization of foreign bodies in the eye, are not included.

Our coverage implies that the work at small scale establishments, such as

private offices and ambulatory care facilities, is covered.

Some tasks carried out by radiologic technologists are included

even though the counterpart physician tasks do not exist in our data

base. We did not collect physician tasks not done by radiologists, such

as operating room radiography and retrograde pyelography, but we have the

technologist tasks.

Since some of our radiologist tasks are controversial with re-

spect to their danger or efficacy, we included the technologist's task only

if we included the radiologist's task. Thus we include discography and

spinal cord angiographY, but we do not include pneumomediastinography.

This volume includes several tasks which are not strictly patient

examinations. They cover quality review, teaching, or other activities

which reflect and require the educational levels of the examination tasks.

Other tasks carried out by radiologic technologists seem more

appropriate in a volume presenting the nursing, administrative, and equip-

ment-related work of the department. Such tasks as first aid, record

keeping, film processing, calibration, and equipment set-ups are in Volume

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18

3. The use of the film badge to monitor personal exposure to radiation

is in Volume 3. These decisions were based on general guidelines but

were essentially arbitrary.

DESIDERATA

The radiologic technologist or educator reading these tasks will

find that most include a wide range of options for such activities as po-

sitioning the patient or assisting the radiologist with surgical proce-

dures or with equipment. The variety is offered to cover varying prac-

tices or a wide range of contingencies. We hope that the reader will find

his or her experience represented and not be annoyed by the lengthy array

of possibilities.

In other cases, however, we have consciously opted to include

el-ments, steps, and whole tasks because they represent activities which

are beneficial to the patient, the performer, or others on staff. These

practices, or "desiderata," may not be in current practice in a given in-

stitution, but we include them to promote their usage and to help ensure

the quality of work. Some of these are briefly referred to in this section.

We have the radiologic.fechnologist review the x-ray requisition.

to check on the patient's condition, possible allergies, possible extensive

cumulative exposure, or recent duplication of the present examination or-

dered. We have the techriologist measure the patient before selecting

technique. We have the performer check personally on possible pregnancy,

and consider and supply appropriate shielding to the patient and to anyone

to remain in the room during the exposure.

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19

We have the performer collimate to the area of interest, not

just to the size of the film. We have the performer consciously notice

radiologists' preferences on contrast and density to avoid retakes.

We have the performer record exposure dosage when the institu-

tion provides and posts such information.

We have the performer consider what movement the patient is ca-

pable of; the performer arranges to have the patient attended, cleaned,

and/or taken to the next location when appropriate. We always have the

patient's identity verified.

We have the performer treat the patient with sympathy and dignity,

and provide the patient with information about what is going on or will

go on in the procedure.

USES OF THE TASK DESCRIPTIONS

This document is not intended to describe fully how to use these

task descriptions. However, we offer a list of possible uses that will

be dealt with in subsequent reports:

1 The task descriptions can be used as instructional ma-terials in the classroom and in clinical training.They provide ordered, logical sequences of steps.They suggest what contingencies, options, and emer-gencies are associated with the tasks and, for theless familiar specialities, an indication of what isdone in a given procedure.

2. The task descriptions can be used in the developmentof team training.

3 The task descriptions can provide an introduction to,or a basis for evaluation of, safe practice; they canbe used to check on whether desired objectives arebeing accomplished.

4. The task descriptions, when combined with the HSMSskill and knowledge data, can become inputs in thedevelopment of performance-based curriculum objec-tives and eAucational ladders.

5. The task descriptions can be used as the basis forevaluation i work performance or as inputs to thedevelopment of job relevanj proficiency.tests (par-ticularly for the selection of test content oncethe skill and knowledge data are collected).

6 The task descriptions can be used as objective ref-erences for the development of job descriptions,especially when edited to reflectirthe practices ata given institution.

7. The task descriptions can also be used in occupa-tional counseling and for purposes of consumer edu-cation and protection.

THE HSMS DEFINITION OF TASK

In the HSMS view, each work activity needed to produce products,

such as radiologic medical services, requires manpower which combines ex-

isting technology, knowledge, materials, and equipment with skills. The

HSMS work unit is the "task." The HSMS definition of task is designed

to result in the identification of a unit of work which cln be moved from

one job to another without disrupting other activities. The task is thus

a unit of work which is smaller than a job as a whole, but large enough

to have an identifiable, usable output.

The steps of the task, or elements, unlike the task, do not have

an identifiable, usable output which can be independently consumed or used,

or which can serve as an input in a further stage of production by an in-

dividual other than the performer. The HSMS task definition is as fol-

lows:

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21

A task is a series or set of work activities (ele-

ments) that are needed to produce an identifiable out-put that can be independently consumed or used, or

that can be used as an input in a further stage ofproduction by an individual who may or may not bethe performer of the task.

In order to facilitate use of the definition, hSMS analysts use

the following rules:

1. In principle, someone other than tbe performer of thetask must be able to use or consume the output of the

task.

2. Theoretically, it should be possible for there to be an

elapse of time between tasks.

3. A task includes all the possible conditions or circum-

stances which a single performer is expected to deal with

in connection with the production stage or the output in-

volved.

4. A task includes all the elements that require continuous

judgment or assessment by the same performer in order to

assure the quality of the output.

5. A task includes all of the elements needed to produce an

output which can be independently used or acted upon with-

out special explanations to the next performer in the next

stage of production.

6. A task includes all the elements needed to complete an out-

put to a point at which another performer (who would con-

tinue with the next production sequence) would not have to

redo any elements in order to'continue.

7. A task includes all the elements needed to complete an out-

put to a point at which another performer, in order to con-

tinue with the next stage of production, need not perform

extra steps.

The task must not require that, for another performer to

continue wIth the next stage in a production sequence, cur-

rent institutional arrangements would have to be changed.

9. A task must be sufficiently broad in statement that it can

be rated on its frequency of G currence.

1-13

2 2

In identifying procedure tasks for the technologist, we found

that there was not a one-to-one correspondence of radiologist tasks with

technologist tasks. In some cases several radiologist procedures re-

quired the same essential steps and outputs on the part of the technolo-

gist. In the case of non-contrast "plain films," the tasks vere divided

by parts of the body,based on the likely areas to be called air en a given

x-ray requisition. That is, upper and lower extremities are covered sep-

arately, and both upper and lower extremities are divided into more than

one task each.

READING THE TASKS

The task descriptions in Chapter 3 follow the format presented

in Figure 1, the HSMS Task Description Sheet. At the top right is the

task's Code Number. A code number is assigned to the task which uniquely

stands for the contents of the task, covering the task's output, what is

used, the kind of recipient or respondent dealt with, and how the task is

done. Regardless of the job title, institution, or industry in which the

task is found, it will always have the same code number. The number it-

self has no intrinsic meaning.

The basic aspects ot the task appear in items 1 through 4 on the

left of page 1 of the Task Description Sheet. These help the analysts in

the task identification stage and help differentiate one task from another.

The term "output" is used to mean the result of an independent stage in

a larger process of production in an institution, assuming the current

organization of work activities. "What is used" in a task includes all

1-14

2 3

Figure 1. HSMS

TASK DESCRIPTION SHEET

-'Task Code No.

This is page 1 of for this task.

What is the output of this task? (Be surethis is broad enough to be repeatable.)

List Elements Full

What is used in_performing this task? (Note

if 221.y certain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...( ) No... ( )

es to q. : Name tne of recipient,respondent or co-worker involvea-, with de_

scriptions to indicate the relevant conditioninclude the kind with whom the vrformer isnot allowed to deal if relevant to knowledge

requirements or legal restrictions.

5. Name t e task so that th answers to ques-

tions 1-4 are reflected. Underline *ssen-

tial words.

6. Check7;;;-II thisis a master sheet..( )

2 41-15

WM'

the things which the performer is expected to be able to use or choose

from to produce the identified output.

The "recipient, respondent or co-worker" involved in a task re-

flects the special characteristics or condition of the people with which

the performer must be trained to deal. For example, certain procedures

are carried out in the same way for all patients. These ate "any patient"

tasks. In other cases, a procedure is different according to the age lev-

el of the patient. We can have a "pediatric task" and a different, "non-

pediatric" task related to the same type of examination, and there are

thus two tasks. In some cases the task is only applied to a given type

of patient,such as "gravid female."

WP assume that "pediatric" varies in its ae cut-off reference

as is appropriate to a given procedure. We use "non-infant" in cases

where the cut-off between tasks groups children olde;: than infants with

the rest of the patient,population. Most of the."plain film" examination

tasks are differentiated as infant or non-infant tasks for the technolo-

gist.

The "name of the task" (item 5 on the Task Description Sheet),

summarizes the task in a paragraph-length statement. The underlined por-

tion of the statement is referred to as the "abbreviated task name." The

latter is most useful for listings, while the extended name avoids am-

biguity when tasks are listed for reference to their contents.

Under the Task Code Number the reader is told the number of

pages that the task runs in the statement, "This is page of for

1-16

2 5

this task." All the tasks bear the notation "OK-RP;RR;RR" and are checked

as master sheets on the lower right of the first page. This indicates

that the task has had the required minimum of three reviewers and is a

"normative" task.4

Tha description of how the task is done begins with the column

on the right on the first Task Description Sheet and continues for as many

pages as necessary on "continuation sheets."

As the work progressed, we developed certain language conventions

of which the reader should be aware for ease of comprehension. These are

briefly described as follows:

1. The person doing the task is always referred to as the"performer" regardless of his or her usual job title orrank. This provides a standard format and leaves for alater stage any battles over who should do what.5

2. The task always begins with.an initiating element thatindicates how it comes about that the performer is doingthe task.

3. The same or similar activities tend to be ilescribed withsimilar language wherever these appear to assist ana-lysts in spotting elements that overlap from task to task.This facilitates curriculum development even if it makesfor dull reading.

4RP stands for resource person, i.e., the in-house reviwer; RR stands forresource respondent, i.e., outside reviewer. In actual practice, thesemerely show three reviewers; additional revievers are not recorded on thesheet.

5We have come across individuals who bristle at being referred to as "per-former" rather thar, a formal title. No disrespect is meant, and we askthe reader to indulge us in this.

(Zt-i

1-17

4. Each task is written so that it is complete within itself.Therefore, there is repetition from task to task.

5. Certain phrases should be interpreted by the reader toindicate that another task has been generated by virtueof this task. Phrases such as "performer arranges...,""performer has...[done]" are examples.

6. When a task may either be done by the performer or dele-gated, a separate task is generated. The signal for suchtasks are phrases such as "...or decides to do personally,""performer plans to....," or "performer may decide to...."

7. When a particular part of a task represents an elementthat may or may not be done depending on institutionalpractice, personal preference, the state of the art, orthe patient's condition, we use the phrase "performermay" or "may" before the description. Where the perform-er must make a choice as part of the task we have triedto make that explicit: "performer decides," "performerconsiders whether."

8. The specific content of some steps in a task, such as po-sitions, angles, immobilization equipment to be used mayvary as the state of knowledge in the field changes ornew technology develops. There may be variations whichreflect the condition of the patient, institutional fa-cilities, or what was already done. We do not attemptto resolve these problems; we simply acknowledge them.Thus, the reader will find the phrase "as appropriate" inmany steps. The phrase is used to cover these contin--gencies. We leave it to the instructor to select what is"true" or "correct" at any point in time.

9. We have attempted to use the terms "rfojection," "posi-tion" and "view" consistently for ail the tasks. We usepositi_on to designate the placement or manipulation of

, a_patient.in.relation to the x-ray beam source and film.A projection describes the direction and sequence in whichthe x-ray beam enters the patient's body and then exitsto impinge on the film. The position and projection arethe same with respect to placement. This is, an anterior-posterior (AP) projection enters the front el the patientand passes through the back to the film. The AP positionresults in an AP projection. A view describes the imageof the part as projected on the film, and is thereforethe reverse of the projection. That is, the AP projectionproduces a postero-anterior (PA) view.

1-18

27

Note

The reader should be aware that, though the tasks in Chapter

3 are presented in numerical order by code number, not every number is

represented. The first code number is Code 7; the last is Code 526.

There are only 76 tasks in Chapter 3. The reason is that the code

numbers are assigned in sequence as the tasks are processed,and the other

tasks appear in other volumes or reports.

`z81-19

CHAPTER 2

LISTING OF ABBREVIATED TASK NAMESBY CATEGORY AND CODE NUMBER

TASKS LISTED BY SYSTEM OR AREA OF THE BODY

Category and Abbreviated Task NameTask

Code No.

CIRCULATORY SYSTEM

Blood

Taking peripheral angiograms of any patient (after percutaneousneedle or catheter entry, translumbar puncture, ascending ordescending venous entry).

Taking catheter thoracic and/or abdominal aortograms of any pa-tient, and/or selective visceral arteriograms (bronchial or ab-dominal).

510

511

Taking selective pelvic angiograms of non-pediatric gravid prnongravid female patient. 512

Taking intravenous angiocardiograms of any patient. 513

Taking selective thyroid angiograms of any patient. 514

Taking catheter inferior vena cavograms and/or renal or adrenalvenograms of non-infant patient. 515

Taking percutaneous splenoportograms of any patient. 516

Taking selective subclavian arteriograms of non-pediatric pa-tient for thoracic outlet syndrome evaluation. 517

Taking selective pulmonary angiograms or selective angiocardio-grams of any patient.

Taking percutaneous coronary arteriograms and/or left ventricu-lograms of any patient.

29

518

519

TASKS LISTED BY SYSTEM OR AREA OF THE BODY (continued)

Category and Abbreviated Task Name

OIRCULATORY SYSTEM

Lymph

TaskCode No.

Taking lymphangiograms or lymphadenograms of any patient. 376

DIGESTIVE SYSTEM AND ABDOMEN

Salivary Glands

Taking sialograms of any patient. 375

Abdominal Contents

Taking plain film radiographs of abdominal contents of non-in-fant patient. 363

Taking plain film radiographs of abdomen of infant patient. 495

Gastrointestinal and Biliary Tracts

Taking upper GI radiographs of non-pediatric patient. 381

Taking upper GI radiographs of pediatric patient. 499

Taking small intestine intubation radiographs of a non-pedi-atric patient. 382

2-2



DIGESTIVE SYSTEM AND ABDOMEN

TaskCode No.

Gastrointestinal and Biliary Tracts (continued)

Taking barium enema radiographs of non-pediatric patient. 383

Taking barium enema, intussusception or defecography radiographsof pediatric patient. 500

Taking oral cholecystograms and cholangiograms of non-infantpatient. 384

Taking intravenous cholangiograms and cholecystograms of non-infant patient. 385

Taking percutaneous or T-tube cholangiograms of non-infant

111patient. 386

Taking operative cholangiograms, pancreatograms or similaroperative radiographs of any patient. 371

MUSCULO-SKELETAL SYSTEM AND CHEST

Taking plain film radiographs of the skull and/or face of non-infant patient. 365

Taking plain film radiographs of the paranasal sinuses of anon-infant patient. 366

Taking plain film radiographs of the skull of infant patient. 491

Taking preliminary localization radiographs of foreign bodiesin orbit or eye of non-infant patient. 367

Providing technical assistance for laryngography or cleft palatestudy of any patient (or any similar fluoroscopic examinationincluding spot filming and/or cineradiography).

2-3

31

380



TaskCode No.

MUSCULO-SKELETAL SYSTEM AND CHEST (continued)

Taking plain film radiographs of vertebral column of non-in-fant patient. 361

Taking plain film radiographs of vertebral column of infantpatient. 492

Taking plain film radiographs of fingers, hand(s) or wrist(s)of non-infant patient. 355

Taking plain film radiographs of forearm and/or elbow joint ofnon-infant patient. 356

Taking plain film radiographs of humerus and/or shoulder girdleof non-infant patient. 357

Taking plain film radiographs of the upper extremities of infantpatient. 493

Taking plain film radiographs of toes, foot and/or ankle jointof non-pediatric patient. 358

Taking plain film radiographs of leg(s), knee(s) and/or femur(s)of non-infant patient. 359

Taking plain film radiographs of the lower extremities of infantor pediatric patient. 496

Taking positive contrast arthrograms (especially of knee) of any

patient. 377

Taking plain film radiographs of sternum, ribs and/or thoracicviscera of non-infant patient. 362

Taking radiographs of neck, chest of infant patient. 494

Taking plain film radiographs of pelvis, hips and/or upper

femora of non-infant patient. 360

Taking operative orthopedic radiographs of any patient (such as

in hip pinning). 370

2-4

3 2



NERVOUS SYSTEM

TaskCode No.

Taking cerebral angiograms or venograms of any patient. rnt-.PUY

Taking pneumoencephalograms or brain ventriculograms of anypatient. 505

Taking positive contrast spinal or posterior fossa myelograms ofany patient. 506

Taking diskograms of any patient.

Taking air or gas contrast myelograms of any patient.

Taking spinal cord angiograms of any patient.

REPRODUCTIVE AND URINARY SYSTEMS

Breasts

507

508

509

Taking mammograms (radiography or xeroradiography) of non-infantpatient. 368

Reproductive System and Fetus

Taking pelvic pneumograms and/or hysterosalpingograms of non-pediatric female patient.

Taking radiographs of a pregnant patient's abdomen for fetog-raphy, amniography, placentography.

Taking radiographs of a pregnant patient's uterus for intra-uterine transfusion.

Taking radiographs of a pregnant patient's pelvis for Colcher-Sussman pelvimetry.

2-5

33

465

466

467

468



REPRODUCTIVE AND URINARY SYSTEMS

Urinary System, Peritoneum

TaskCode No.

Taking intravenous pyelograms and urograms of non-pediatricpatient. 387

Taking excretory intravenous inferior vena cavograms and uro-grams of pediatric patient. 502

Taking infusion nephrotomograms of any patient. 388

Taking percutaneous antegrade or renal cyst pyelograms of non-infant patient. 389

Taking cystograms and voiding cystourethrograms r4 any patient. 390

Taking retrograde pyelograms and ureterograms of non-pediatricpatient. 463

Taking percutaneous peritoneograms/herniograms of pediatricpatient. 501

RESPIRATORY SYSTEM

Taking radiographs for choanal atresia study of infant patient. 497

Taking radiographs of anterior portion of the neck of non-in-fant patient. 364

Taking bronchograms of a non-pediatric patient. 378

Taking bronchograms of a pediatric patient. 498

Carrying out radiologic technology for bronchoscopy of needlelung biopsy of a non-pediatric patient. 379

2-6



GENERAL TASKS n.e.c.*

TaskCode No.

Taking genitograms or fistulograms of any patient for intersex,external fistula or sinus tract examination. 503

Taking intravisceral or isolated operating room radiographs ofany patient. 372

Taking operating room radiographs for opaque foreign body search. 373

Providing technical assistance for an examination of any patientrequiring fluoroscopic control and spot filming. 464

Preparing, transporting, setting up and returning mobile por-table radiography equipment for bedside radiography. 369

Providing technical quality review of "plain film" radiographs. 81

Tomography n.e.c.

Taking tomograms of non-infant patient. 374

Taking computerized transverse axial tomographic (C.T.T.)scans of any patient. 526

Meetings, Teaching nee.c.

Participating in meeting of diagnostic x-ray department tech-nologists. 353

Providing clinical training for radiologic technologists orstudents in radiographic technology. 82

Observing and evaluating work of radiologic technologists orstudents in diagnostic radiography, and deciding whether train-ing is needed.

n.e.c.: not elsewhere classified.2-7

35

7

TASKS LISTED BY TASK FUNCTION


"PLAIN FILM" EXAMINATIONS

Non-Contr,Ast Studies

TaskCode No.

Taking plain film radiographs of fingers, hand(s) or wrist(s)of non-infant patient. 355

Taking plain film radiographs of forearm and/or elbow jointof non-infant patient. 356

Taking plain film radiographs of humerus and/or shoulder girdleof non-infant patient. 357

Taking plain film radiographs of the upper extremities of in-fant patient. 493

Taking plain film radiographs of the skull and/or face of non-infant patient. 365

Taking plain film radiographs of the paranasal sinuses of a non-infant patient. 366

Taking preliminary localization radiographs of foreign bodies inorbit or eye of non-infant patient. 367


Taking plain film radiographs of vertebral column of non-in-fant patient. 361


Taking plain film radiographs of abdominal contents of non-in-fant patient. 363

Taking plain film radiographs of abdomen of infant patient. 495

Taking plain film radiogiaphs of toes, foot and/or ankle jointof non-pediatric patient. 35,

2-8

36

TASKS LISTED BY TASK FUNCTION (continued)


Code No.


Non-Contrast Studies (continued)

Taking plain film radiographs of leg(s), knee(s) and/or femur(s)of non-infant patient. 359

Taking plain film radiographs of pelvis, hips and/or upperfemora of non-infant patient.

Taking plain film radiographs of the lower extremities of in-fant or pediatric patient.

Routine Contrast Studies

Taking radiographs of neck, chest of infant patient.

Taking radiographs of anterior portion of the neck of non-in-fant patient.

Taking plain film radiographs of sternum, ribs and/or thoracicviscera of non-infant patient.

Specialized "Plain Film" Studies

Taking mammograms (radiography or xeroradiography) of non-in-fant patient.

Taking tomograms of non-infant patient.

360

496

494

364

362

368

374

Taking radiographs of a pregnant patient's pelvis for Colcher-Sussman pelvimetry. 468

Taking operative orthopedic radiographs of any patient (such as

in hip pinning). 370

2-9


CategorT ead Abbreviated Tark Name


TaskCode No.

Specialized "Plain Film" Studies (continued)

Taking operative cholangiograms, pancreatograms or similaroperative radiographs of any patient. 371


Taking operating room radiographs for opaque foreign body search. 373

CONTRAST EXAMINATIONS

Angiography

Taking lymphangiograms or lymphadenograms of any patient.

Taking cerebral angiograms or venograms of any patient.

Taking spinal cord angiograms of any patient.


376

504

509

510

TakThg catheter thoracic and/or abdominal aortograms of anypatient, and/or selective visceral arteriograms (bronchial orabdominal). 511

Taking selective pelvic angiograms of non-pediatric gravid ornongravid female patient. 512



Taking catheter inferior vena cavograms and/or renal or adrenalvenograms of non-infant patient.. 515

2-10

38

TASK LISTED BY TASK FUNCTION. (continued)


Code No.


Angiography (continued)

Taking percutaneous splenoportograms of any patismt. 516

Taking selective subclavia,. a7teriograms of non-pediatricpatient for thoracic outlet syndrome evaluation. 517

Taking selective pulmonary angiograms or selective angiocardio-grams of any patient. 518

Taking percutaneous coronary arteriograms and/or left ventric-ulograms of any patient. 519

Neuro-Skull Studies, Myelography, Diskography



Taking air or gas contrast myelograms of any patient. 508

Taking diskograms of any patient. 507

Intravenous Injection or Infusion Studies

Taking intravenous cholangiograms and cholecystograms of non-infant patient. 385

Taking intravenous pyelograms and Urograms of non-pediatric-patient. 387


2-11

3 9



Code No.


Intravenous Injection or Infusion Studies (continued)

Taking excretory intravenous inferior vena cavograms and uro-grams of pediatric patient. 502

Taking computn:ized transverse axial tomographic (C.T.T.) scansof any patient. 526

Studies with Oral Ingestion of Contrast


Taking upper GI radiographs of pediatric patient. 499

Taking oral cholecystograms and cholangiograms of non-infantpatient. 384

Instillation, Intubation, Enema Studies


Taking radiographs for choanal atresia study of infant patient. 497

Providing technical assistance for laryngography or cleft palatestudy of any patient (or any similar fluoroscopic examinationincluding spot filming and/or cineradiography). 380


Taking bronchograms of a pediatric patient. 498

Taking small intestine intubation radiographs of a non-pedi-atric patient. 382

Taking percutaneous or T-tube cholangiograms of non-infant pa-tient.

2-12

4 0

386




TaskCode No.

Instillation, Intubation, Enema' Studies (continued)


Taking cystograms and voiding cystourethrograms of any patient. 390

Taking pelvic pneumograms and/or hysterosalpingograms of non-pediatric female patient. 465


Taking barium enema radiographs of non-pediatric patient. i83

Taking barium enema, intussusception or defecography radio-graphs of pediatric patient. 500

Direct Puncture or Injection Studies

Taking positive contrast arthrograns (especially of knee) of anypatient. 377

Carrying out radiologic technology for bronchoscopy or needlelung biopsy of a non-pediatric patient. 379

Taking percutaneous antegrade or renal cyst.pyelograns of non-infant patient. 389

Taking radiographs of a pregnant patient's abdomen for fetog-raphy, amniography, placentography. 466

Taking radiographs of a pregnant patient's uterus for intra-uterine transfusion. 467

Taking percutaneous peritoneograms/herniograms of pediatricpatient. 501

2-13

41


Category and. Abbreviated Task Name

EXAMINATIONS AND USE OF EQUIPMENT n.e.c.

TaskCode No.

Providing technical assistance for an examination of any patientrequiring fluoroscopic control and spot filming. 464

Preparing, transporting, setting up and returning mobile por-table radiography equipment for bedside radiography. 369

EVALUATION, TEACHING, MEETINGS TASKS


Observing and evaluating work of radiologic technologists orstuients in diagnostic radiography, and deciding whether train-ing is needed. 7

Providing clinical training for radiologic technologists orstudents in radiographic technology. 82

Participating in meeting of diagnostic x-ray department tech-nologists. 353

2-14

4 2

TASKS LISTED BY TYPE OF MAIN RECIPIENT, RESPONDENT OR CO-WORKER


TASKS WITH PATIENT RECIPIENT

Any Patient

TaskCode No.


Taking positive contrast arthrograms (especially of knee) of anypatient. 377


Taking cystograms and voiding cystourethrograms of any patient. 390


Taking lymphangiograms or lymphadenograms of any patient. 376



Taking diskograms of any patient. 507

Taking air or gas contrast myelograms of any patient. 508

Taking cerebral angiograms or venograms of.any patient. 504

Taking spinal cord angiograms of any patient. 509


Taking catheter thoracic ancl/or abdominal aortograms of anypatient, and/or selective visceral arteriograms (bronchial orabdominal).

510

511


2-15

43

TASKS LISTED BY TYPE OF MAIN RECIPIENT, RESPONDENT OR CO-WORKER (continued)


Code No.


Any Patient (continued)


Taking percutaneous splenoportograms of any patient. 516

Taking selective pulmonary angiograms or selective angiocardio-grams of 'any patient. 518

Taking percutaneous coronar-Arteriograms and/or left ventric-ulograms of any patient.

Taking operative orthopedic radiographs of any patient (suchas in hip pinning).

519

370

Taling operative cholangiograms, pancreatograms or similaroperative radiographs of any patient. 371


Taking operating room radiographs for opaque foreign body 373

search.

Taking computerized transverse axial tomographic (C.T.T.) scansof any patient. 526

Providing technical assistance for laryngography or cleft palatestudy of any patient (or any similar.fluoroscopic examinationincluding spot filming and/or cineradiography). 380

Providing technical assistance for an examination of any pa-tient requiring fluoroscopic control and spot filming. 464

Any Non-Infant Patient

Taking plain film radiographs of fingers, hand(s) or wrist(s) ofnon-infant patient. 355

2-16



TaskCode No.


Any Non-Infant Patient (continued)

Taking plain film radiographs of forearm and/or elbow joint ofnon-infant patient.

Taking plain film radiographs of the skull and/or face of non-infant patient.

356

365

Taking plain film radiogra2hs of the paranasal sinuses of a non-

infant patient. 366

Taking preliminary localization radiographs of foreign bodies inorbit or eye of non-infant patient. 367

Taking radiographs of anterior portion of the neck of non-in-fant patient.

Taking plain film radiographs of vertebral column of non-in-fant patient.

Taking plain film radiographs of humerus and/or shoulder girdleof non-infant patient.

Taking plain film radiographs of sternum, ribs and/or thoracicviscera of non-infant patient.

Taking mammograms (radiography or xeroradiography) of non-in-

fant patient.

Taking plain film radiographs of abdominal contents of non-in-fant patient.

Taking oral cholecystograms and cholangiograms of non-infantpatient.

Taking intravenous cholangiograms and cholecystograms of non-

infant patient.

364

361

357

362

368

363

384

385

Taking percutaneous or T-tube cholangiograms of non-infant pa-

tient. 386

2-17

4 5



TaskCode No.


Any Non-Infant Patient (continued)

Taking percutaneous antegrade Or renal cyst pyelograms of non-

infant patient. 389

Taking catheter inferior vena cavograms and/or renal or adrenal

venograms of non-infant patient. 515

Taking plain film radiographs of pelvis, hips and/or upperfemora of non-infant patient. 360

Taking plain film radiographs of les(s), knee(s) and/or femur(s)

of non-infant patient. 359

Taking Lon-Trams of non-infant patient. 374

Any Non-Pediatric Patient

Taking selective subclavian arteriograms of non-pediatric patientfor thoracic outlet syndrome evaluatlon. 517


Carrying out ra:lologic technology for bronchoscopy or needle

lung biopsy of a non-pediatric patient. 379


Taking small intestine intubation radiographs of a non-pediatric

patient, 382

Taking barium enema radiographs of non-pediatric patient. 383

Taking intravenous pyelograms and urograms of non-pediatric

patient. 387


2-18

4



TaskCode No.


Any Non-Pediatric Patient (continued)

Taking plain film radiographs of toes, foot and/or ankle joint ofnon-pediatric patient. 358

Non-Pediatric FeMale Patient

Taking pelvic pneumograms and/or hysterosalpingograms of non-pediatric female patient. 465

Taking radiographs of a pregnant patient's abdomen for fetog-raphy, amniography, placentography. 466

Taking radiographs of a pregnant patient's uterus for intra-uterine transfusion. 467

Taking radiographs of a pregnant patient's pelvis for Colcher-Sussman pelvimetry. 468

Taking selective pelvic angiograms of non-pediatric gravid ornongravid female patient. 512

Infant Patient

Taking plain film radiographs of the upper extremities of infantpatient. 493


Taking radiographs for choanal atresia stuef of infant patient. 497

Taking radiographs of neck, chest of infant patient. 494


2-19

4 7


TaskCategory and Abbreviated Task Name Code No.


Infant Patient (continued)

Taking plain film radiographs of abdomen of infant patient.

Taking plain alm radiographs of the lower extremities of in-fant or pediatric pal:ient.

Pediatric Patient

Taking bronchograms of a pediatric patient.

Taking upper GI radiographs of pediatric patient.

Taking percutaneous peritoneograms/herniograms of pediatricpatient.

Taking excretory intravenous inferior vena cavograms and uro-grams of pediatric patient.

Taking barium enema, intussusception or defecography radiographsof pediatric patient.

TASKS WITH CO-WORKERS, STUDENTS OR OTHER MAIN RECIPIENTS

495

496

498

499

501

500

Participating in meeting of diagnos. .c x-ray department tech-nologists. 353

Preparing, transportirg, setting up and returning mobile por-table radiography equipment for bedside radiography. 369


2-20

4 8

a

TASKS LISTED BY TYPE OF MAIN RECIPIENT, RESPONDENT OR CO-WORKER (contimied)


TaskCode No.

TASKS WITH CO-WORKERS, STUDENTS OR OTHER MAIN RECIPIENTS (continued)

Observing and evaluating work of radiologic technologists orstudents in diagnostic radiography, and deciding whether train-ing is needed. 7

Providing clinical training For radiologic technologists orstudents in radiographic technology. 82

2-21

4 9

CHAPTER 3

TASK DESCRIPTIONS:

RADIOLOGIC TECHNOLOGIST PATIENT PROCEDURES

There are 76 tasks included in this chapter. These are ar-

ranged numerically by Task Code. Number from Code 7 to Code 526. Part

I covers tasks 7 through 386; Part II covers tasks 387 through 526.

Please note that not all tasks with code numbers between 7 and 386 are

represented in Part I of this volume.

There is no chapter pagination. Instead, the pages withi, each

task are numbered. The user can find the task by referring to the Task

Code Number.and task page number at the upper right of each page.

Some tasks have a notation at the bottom of the first sheet

which states, "This is a new assignment to this number." This indicates

that an earlier use was made of the number, and the earlier assignment is

now obsolete. All other code numbers in this volume up to code 273 are

tasks that were also found by HSMS in an ambulatory care center where a

pilot test of the HSMS method was carried out.


Task Code No. 7

This is page 1 of 2 for this task.

What is the output of this task? (Be sure - List Elements !Illythis is broad enough to be repeatable.)

Radiologic technologist's or student's work inradiographic procedures observed, evaluated,interrupted if necessary; evaluation and need fortraining noted and/or reported; permission askedto teach or have teaching don....

What is used in performing this task? (Note

if on12 certain items must be-used. If thereis choice, include everything or the kinds ofthinga chosen among.)

Pen; paper; equipment used in diagnostic radio-graphic procedures

. Is there a recipient, respondent or co-workerinvolved in the task? Yes. . . ( )Q No...( )

es to q. Name the in o recipient,respondent or co-worker involved, with de-

scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot al.lowed to deal if relevant to knowledge

requiremclma or legal restrictions.Radiologic technologists or rad. tech. students(in diagnostic :adlography); supervisors; anypatients invo2ye0

5. Name t e task so that the answers to ques-tions 1-4 are reflected. Underline essen-

tial words.

1

Observing and evaluating work of radiologic tech-nologists or students in diagnostic radiography,and deciding whether training is needed by observ-ing, evaluating; comparing with performance stand-ards; deciding whether training is needed; inter-'rupting task and/or reporting or noting conclusions;asking to teach or that individual be taught in de-ficient areas.

Performer observes the work ofradiologic technologists, darkroom aides and/or students indiagnostic radiovaphic proce-dures, film processing, and re-lated procedures, including useof related equipment, and de-cides if additional training isneeded.

1. If appropriate, reviews rele-vant performance standards ofwork to be observed.

2. Performer observes work ofradiologic technologists,dark room aides, or students:

a. While working with theperson being observed.

b. While supervising theperson.

c. While performing admints-trative functions.

d. At the request of staffperson or student, or atrequest of supervisor ofstaff person or student.

e. As part of informal spotcheck procedure.

3. Performer explains own pre-sence to any patients in-volved, if appropriate, whileobserving.

4. Performer notes how the per-son is carrying out the workassignment(s) involved. Com-pares with relevant perform-ance standards.

a. Decides whether the activ-ity is being done prop-erly.

OK-RP;RR;RR

is a master sheet..) 7=16. Check here i this

51

TASK DESCRIPTION SHEET (continued)

Task Code No. 7

2 of 2 for this task.This is page

List Elements Fully List Elements Fully

,

.

b. Considers whether there is a need todemonotrate the procedure and/or ex-plain the proper approach, technique,attitude, or theory involved.

c. Decides whether to interrupt proce-dure and take over. (If so, performerdoes the interrupted procedure as aregular task.)

d. Performer may note whether perform-ance standards should be made cleareror more specific in curriculum orclinical training. Notes as appropri-ate.

e. Performer makes written or mentalnote of evaluation as appropriate.

. If performer decides that further train-ing is needed, performer may decide:

a. To teach the taff person or studentat that point or explain how to im-prove.

b. To explain to person's supervisorthat training is needed and request

.. permission to teach or ask thatteaching be provided.

5 2


Task Code No. 81


. What is the output of this task? (Be sure List Elements Fullythis is broad enough to be repeatable.)

Decision made on completeness and quality of "plainfilm" radiographs;radiologist called to see scouts,wet readings,radiographs of doubtful quality,orthose showing emergency signs;instructions writtenon views missing or "retakes" needed;needed equip-

,ment adjustment,pt. repositioning recorded;super-visor informed of problems with equipment or tech-nologist;desk or radiological technologist informedwhen full set approved;approved radiographs placedfor jacketing,delivery or use.

Performer assesses the technicalquality of "plain film" radio-graphs (radiographs made withoutthe use of special equipment orcontrast media) as a result of:

a. Assignment to review ownwork.

b. Assignment to review all suchradiographs as processed.

c. Request of co-worker foropinion.

The plain films may be radio-,graphic studies of the upperand lawer extremities,should-er girdle, pelvis and hips,

- vertebral column, sternum,ribs, thoracic viscera, ab-dominal contents, skull,para-'nasal sinuses and orbit oreye.

1. Performer obtains a patient'sradiograph(s) and requisitionsheet as follows:

a. Performer collects radio-graphs as they emerge fromautomatic processor.Places on view boxes andarranges those for a givenpatient by noting nameand/or ID number marked on

2. What is used in oerforming this task? (Note

if only certain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Processed "plain film" radiographs; x-ray requisi-tion sheets; view boxes; automatic x-ray film pro-cessor; phone; pen or pencil; charts listing stan-dard views for x-ray exatinations; wax marking pen

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...(K) No...( )

'es to q. . Name t e ina o recipient,respondent or co-worker involved, with de_

scriptiona to indicate the releva-t conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal reste.ctions.

Radiologic technologists; supervisor of technolo-gists; radiologist

. Name t e task so that the answers to ques- radiograph.Performer may be asked toview a set of radiographsby co-worker; or performermay obtain a set whichwere taken by performer.

b. Performer obtains x-rayrequisition sheet, or co-worker brings it to per-former.

OK-RP;RR;RR

tions 1-4 are reflected. Underline essen-

tial words.

Providing technical quality review of "plain film"radiographs by reviewing requisition;arranging andviewing radiographs;checking completeness and assessing diagnostic quality;deciding to order additionalviews and/or retakes for medical reasons only;deter-mining reasons for inadequate radiographs;recordingviews missing or retakes and adjustments needed; dis-cussing and/or reporting problems with technologistsand/or equipment in obtaining quality;notifying and/or consulting radiologist on emergency signs; placinapproved films for jacketing or use.

..,...mm

6. Check here irlhisis a master sheet..

53

TASK DFSCRIPTION SHEET (continued)

Task Code No. 81

This is.page 2 of 4 for this task.

Performer reads the requisition sheetto determine the examination called for,purpose, the patient involved, specialconsiderations, and to check whichviews are called for:

a. Performer checks the' examinationscalled for, purpose, parts involved,side of interest and affected areas,whether bilateral or unilateralviews are requested, the patientpositions and views ordered, numberof exposures, central beam angulatioand the parts to be included. Mayconsult chart listing standard views.Notes whether orders include bilateral views on a single film, whetherthe use of a grid or bucky was to beinvolved. Notes any request for mag-nification. Checks the name of thereferring physician.

b. Performer reads patient's name, identifization number, sex, _tge, andsize. Notes whether patient is in-patient, out-patient, accident, oremergency patient. Notes whetherfilms are to demonstrate air orfluLd levels, foreign body, tumormass, calcifications or E'ractures,as appropriate.

c. Performer notes whether standard and/

or special views have been omitted,ordered or approved to accommodatepatient's condition and/or the na-ture of the suspected pathology.

d. Places radiograph(s) on viewing box,in proper sequence as appropriate.

e. If requisition sheet calls for wetreading or calls for scout (prelimi-nary) films, performer attaches re-quisition form to radiograph(s) andcalls the appropriate resident or radiologist from the immediate area(by phone). Indicates that the radiograph(s) are ready.

3. Performer assesses the plain film radiographs for quality and completenessbased on purpose and type of study:

a. Performer checks that all the spe-cial views ordered are present and/or that all the standard views forthe examination are present. Noteswhich views are missing.

i) Performer way note missing viewsand/or discuss with technologistto de'citrmine whether missingviews were made but not identi-fied, lost, forgotten,or wereomitted because of contraindica-tions in positioning patient.May note reasons already listedon requisition sheet.

ii) Performer may help co-workertechnologist locate missing orunidentified radiographs.

iii) May suggest alternative patientor tube positioning to obtainviews for which conventional po-sitioning is contraindicated.

iv) May record views still neededfor completion of examination.

b. Performer checks that all radio-graphs show proper R-L identifi-cation, patient identification,andother required information. If filmis not fully identified, informstechnologist or radiologist andhelps determine which side is rightand/or left, and other needed in-formation. Writes on film with waxmarker. Does not order"retakes"un-less radiologist decides the ad-ditional exposure is necessary.

c. For each radiograph performer as-sesses whether the correct patientpositioning and the full area ofinterest is demonstrated, whethera needlessly large area has beenexposed, and/or whether this isvisual evidence of proper fieldsize collimation (i.e. a "border"around the view,showing the colli-mated field size and/or evidenceof appropriate shielding).

vPli

54

1.


Task Code No. 81


List Elements Full List Elements Full

i) If the area of interest is "cutoff" performer notes whether tworadiographs were taken to repre-sent the view. If not, performer::ecords and recommends a "retake"with proper collimation to thefeld of interest or an addition-

al view to demonstrate the areathat was cut off, collimated toobtain only the missing area.quggests further radiography onlyto provide missing information,and so as to require as littlefurther exposure of the patientas possible.

ii) If there is no border around theradiograph(which indicates prop-er coilimation),or if the areademonstrated is needlessly largein relation to the area of inter-est, performer indicates this totechnologist (or notes for owninstruction if evaluating ownradiographs). Indicates thedangers to the patient of unnec-essary exposure. May record.

iii) If a patient position called forhas not been correctly obtained,thus not providing the requiredview, performer may consult withsupervisor or radiologist. Indi-cates need for a "retake" onlyif the information required isneeded for medical reasons. Per-former may explain or record theproper patient or tube position-ing and angulation needed to ob-tain the view ordered so that re-take will be correct.

d. Performer evaluates each radiographto determine whether there is ade-quate detail and definition to pro-vide the medical information called

- for. Assesses whether there is toomuch blurring, distortion; whetherdensity is adequate and contrastsufficient to provide proper diag-

nostic quality. Notes whether thereare artifacts which interfere withthe image.

i) Performer considers the purpose ofthe study and the preferences ofOw radiologist (if known).

ii) If performer finds blurring, dis-tortion, excessive or inadequat?.density,.insufficient or excessivecontrast,and/or artifacts in thearea of interest, performer con-siders whether a "retake" shouldbe made. May ask opinion of super-visor or radiologist. Indicatesneed for a retake only for medicalreasons so as to minimize exposurnof patient. Records.

iii) If performer decides that the ra-diograph does not provide properdiagnostic quality, performer con-siders what factors may have con-tributed, such as improper immobi-lization of patient, inappropriatetechnical factors (or failure toadjust for special circumstancessuch as obesity), improper part-film distance, focal-film distance,or failure to adjust exposure fac-tors for a change in such dis-tances.Considers possible probleas withx-ray or processing equipment.Performer may draw on experiencewith the equipment involved toassess what is wrong. If regularassignment, performer maintains annwareness of the equipment outputso as to be able to spot or traceaccumulation of signs indicatingequipment malfunction.

. If performer has questions about thequality of any radiographs, asksavailable resident or radiologist toassist in deciding whether the radio-graph(s) are adequate for interpreta-tion.

r o


This is page

List Elements Full

Task Code No. 81

4 of 4 for this task.

f. The performer may consider whetherthe appearance of radiograph(s), sug-gests a condition in the patientwhich warrants immediate attention.If so, notifies an available residentor radiologist at once.

g. Depending on l_astitutional proce-dures, performer may suggest addi-tioaal views to obtain more completeinformati.on ior the radiologist'sneeds in interpreting. Considers thequality,of the existing radiographs,including areas that appear suspi-cious. Draws on appearance of radio-graphs for signs of pathological con-ditions.

If the performer has judged that thetechnical quality of any of the radio-graph(s is not adequate, considerswhether his is due to technologist'sperformance, malfunctioning of x-ray orprocessing equipment, or a combinationof reasons.

a. If the performer decides that thetechnical quality of the radio-graph(s) is inadequate due to thetechnologist's performance, performerconsiders what technologist shou"dhave done or must do to correct oradjust technical factors or reposi-tion patient.

i) If reviewing own work, performermakes mental note of what isneeded.

ii) If giving opinion to co-worker athis or her request, gives opin-icns, reasons and recommendationsorally.

iii) Performer may decide to assisttechnologist and/or explain whatis needed and why.

iv) Performer may notify supervisorof consistently bad performance ba technologist.

List Elements Fully

b. If the performer decides that thereis a malfunction involving the out-put of the x-ray equipment, perform-er may request that the x-ray ma-chine be examined or calibrated.Notifies supervisor.

c. If the performer decides that thefilm processing equipment requiresexamination, decides to examine per-sonally or notifies supervisor.

Performer records orders for any re-takes and/or any suggestions for addi-tional views on requisition sheet oras appropriate to institution.

a. Performer specifies what is wrongor views missing, and/or what ad-jusuLents to make4Fn technical set-tings, tube or patient positionsand angulation, and any additionalviews recommended.

b. Performer may give requisitionsheet to supervisor, who gives itto 'technologist. May report equip-ment malfunction at this time.

c. Reviews additional views and/or re-takes when they are processed as described above.

. When the performer decides that a ra-diographic study ordered for a givenpatient is complete, performer may de-cide to jacket radiographs, have thisdone, or places with requisition sheetas appropriate.

May notify radiologic technologistor control desk that the patient's ra-diographic examination is completed.

ilay make sure that patient is in thecharge of someone.who will prbperlydischarge patient or accompany to nextlocation.

5


Task Code No. 82


. What is the output of this task? (Be surethis is broad enough to be repeatable.)

Radiologic technologist or student shown and ex-plained radiographic procedures involved in diag-nostic radiography; person being trained evaluated

for readiness to do activities under supervision;person observed and criticized; person evaluatedfor readiness to do tasks without direct supervi-sion; person's work spot checked; questions an-swered; opinions on work given as requested; evalu-ation noted formally,informally,and/or reported.

What is used in performing this task? (Note

if only certair items must be used. If th-..re

is choice, include everything or the kinds ofthings chosen among.)

Patients' x-ray requisition forms and records; ma-terials and equipment needed for procedures inradiologic technology

Is there a recipient, respondent or co-workerinvolved in the task? Yes...()0 No...( )

. If "Yes" to q. 3: Name tne kind of recipient,respondent or co-worker involved, with de-

scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowledge

requirements or legal restrictions.Students in radiologic Lechnology; radiologic tech-nologists; any patients involved;supervisor(s)

. Name tr; task so that th ,..! answers to ques-


tial words.

Providing clinical training for radiologic tech-

nologists or students in radiographic technology by

demonscrating procedures, explaining what is being

done, answering questions; deciding when person

being trained can perform tasks under direct super-

vision; observing and correcting; deciding when

tasks can be done without direct supervision; spot

checking and correcting; advising as requested or as

deemed necessary; evaluating and recording or re-

porting.

This is new assignment to this number.

57

List Elements Fully

Performer provides clinicaltraining for students or sub-ordinates in radiographic pro-cedures and use of relatedequipment in diagnostic radio-graphy as a result of:

a. Request or assignment totrain new employee or stu-dent.

b. Performer's observation ofemployee's or student's workand decision that trainingis needed.

c. Request of employee or stu-dent who has questions aboutwork.

1. Performer may be assigned in-dividuals, may be requested,or may decide to providetraining to individuals. Re-views related performancestandards.

. Performer provides demonstra-tion, explanation, informalevaluation and supervision intechnique, positioning, theprocedures used for specificradiographic examinations,related patient care, sani-tary procedures, film evalu-ation, radiation safety,fluoroscopic techniques, re-lated equipment, film proces-sing, handling of pediatric,sick, or disabled patients.

3. If performer is making a newpresentation of any task,performer may select times,patients, and procedures todemonstrate; performer maytrain while carrying out owntasks:

OK-RP;RR;RR6. Check here if this

is a master sheet..


Task Code No. 82


List Elements Full

a. When performer has person beingtrained present during performer'sown tasks, performer may explain pur-pose to patient and ask permissionto have trainee present.

b. Performer explains to trainee whatwill be taught.

c. Performer may narrate the steps, mayexplain what is being done, or mayexplain the basis for decisions andactions.

d. Performer may decide to solicitquestions to find out what the per-son being trained understands, mayanswer questions, or may elaborateon the explanation of what is beingdone, concentrating on the relevantskills and knowledges.

e. Performer decides when the personbeing trained has observed suffici-ently and has a clear enough under-standing of a procedure to carry itout under close, direct supervisionand/or to assist.

Performer supervises and observes theperson being trained while he or shecarries out the activities assigned:

a. Performer asks the individual to doall or part of a procedure and re-mains at the side of the patient,orcarries out own portion and watchesthe performance of the assigned ac-

tivity.b. While observing, performer decides

whether the activity is being doneproperly, whether there is a speci-fic problem, whether there is needto demonstrate the procedure againor explain, and does so.

c. Performer may comment on the per-formance, encourage or correct asdeemed necessary, or do this later.

d. Performer may decide to interveneand take over the procedure, ex-plaining what was done incorrectlyat that point or later.

58

e.

f.

g.

List Elements Fully

If decision is to demonstrateagain, performer may redo and havethe person being trained observe;may have the procedure repeated

until it is done properly.Performer decides which proceduresor activities can be done by the

individual without direct supervi-sion. Informs proper supervisors,notes for own use, and/or tellsthis to the person being trained.Performer explains own presence toany patient involved when the per-former observes the person being

trained.

. Performer spot checks the person beingtrained while he or she carries outactivities without dirtxt supervisionor responds to requests for guidance,

assistance,or further instruction.

Performer proceeds as in steps 3 or 4as appropriate, observing,noting areasneeding improvement, determining thenature of any problem, assisting, giv-ing opinions, answering questions,and providing further instruction onhow to deal with unusual circum-stances. Reinforces correct work. Sug-

gests areas for improvement.

Performer informally notes the ex-tent of learning or proficiency of the

person being trained throughout the

training:

a. May decide to discuss performancewith individual at any time.

b. May keep formal records on whatwas taught.or on progress.

c. May make personal notes for own

use in later evaluation meetings

or in discussion with supervisorof person being trained or personat student's school in charge of

clinical training.

d.. May decide to revise instruction orperformance Standards.


Task Code No. 353


1, What is the output of this task? (Be sure List Elements Fullythis is broad enough to be repeatable.)

Issues for meeting reviewed and raised; participa-Lion in discussion on departmental matters; informa-tion passed to Subordinates or co-workers.

The performer attends depart-mental meetings of technologistsin diagnostic radiology depart-ment as a result of:

. Request or notification.b. Regular assignment.

1. During periods'between meet-ings performer may mentallynote problems or informationwhich require attention, ormay make notations aboutthem. These include problemswith regard to patient careor departmental functioning.

. Before the meeting performerreviews aliy agenda distrlb-

uted and own notes.

. At the meeting, performer mayreceive information (verbal

.

or written) and/or ask ques-tions about or present prob -lems in regard to:

a. New departmental rules andregulations and announce -ments.

b. The use of new equipment.c. Problems of patient care

and related departmentalfunctioning.

. What is used in performing this task? (Note

if pray_ certain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Pen; paper; Personal notes; information to be pre-sented; notice of meeting and agenda

,, Is there a recipient, respondent or co-workerinvolved in the task? Yes. . . ( X) No...( )

4,n ons orto q. 3: Name the kind of recipient,respondent or co-worker involved, with de_

scriptions to indicate the relevant condition;include the kind with whom the performer isnot allowed to deal if relevant to knowledgereqarements or legal restrictions.

Staff of diagnostic x-ray department. .

. Name t e task so that the answers to ques- d. Problems or complaints re-garding departmental func-tioning or administration.

4. Performer listens, raises is-


tial words.

PartictRating in meeting of diagnostic x-ray depart-ment technolo:ists, by reviewing agenda and notes; sues and/or participates in

dIscussions raised by others.May take notes as desired.

. Performer may receive sugges-tions for own work and dis-cuss.

OK-RP;RR;RR

raising issues; receiving information about and/ordiscussing departmental rules, functioning, newequipment-, Patient care, related problems or com-pla'Lnts.

6. Check here if thisis a master sheet..00 I

59


Task Code No. 355


I 1. What is the output of this task? (Be sure List Elements Fullythis is broad enough to be repeatable.)

Requisition reviewed;pt. reassured,positioned,mea-sured;technical factors selected and set;film iden-tified;technique for multiple views and/or magnifi-cation set up;exposures made;arrangement made tohave radiographs processed and evaluated;proceduresrepeated for full set of views;pt. returned;examina-tion recorded;radiographs placed for use.

Performer receives or obtainsthe x-ray requisition form, pa-tient's identification card, andany appropriate medical-techni-cal history for a non-infantpatient scheduled for radio-graphy of the finger(s), hand(s)or wrist(s):

a. After checking assignment onschedule sheet.

b. From co-worker.c. After having arranged requi-

sitions in order of priority.

1. Performer reads the requisi- '

tion sheet to determine theexamination called for, thepatient involved, specialconsiderations,and to checkthe completeness of the in-formation provided.

a. Performer checks the e:,....am-

ination called for, in-cluding the part(s) of thebody involved, the numberand type of projections(whether standard or spe-dial views, technique),whether there 13 requestfor magnification; noticeswhether right and/or lefthand is involved, specificfinger(s), wrist, wholehand, etc. Checks the nameof the referring physician

b. Performer notices whethersuspected fracture is in-volved and suspected loca-tion, whether foreign bodyin hand is to be found,andlocation of entry site;notes whether study is an

OK-RP;RR;RR

2. What is used in performing this task? (Noteif only certain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Pt.'s x-ray requisition sheet,ID card,bracelet;tech-nical history;pen;x-ray machine control Danel(s)posted technique chart;standard views,tube-rating,dosage,conversion charts;x-ray table and tube,colli-mator,extension cones;cassettes or non-screen filmholders;vertical film stand;leaded rubber shielding;lead or aluminum markers;leaded garments;immobiliza-tion devices;stool;calipers;tape;scissors;stretcheror wheelchair;marking pen

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...( No...( )

'es to q. : Name t e in. o recipient,respondent or co-worker involved, with de-


requirements or legal restrictions,

Non-pediatric patient to be radiographed; radiologictechnologist; radiologist; nurse

. Name tne task so that the answers to ques-tions 1-4 are reflected. Underline essen-

tial words.Taking plain film radiographs of fingers, hand(s) or

wrist(s) of non-infant patient by reviewing re-

quest;reporting observed contraindications;reassurin:pt.;measuring part;setting up for multiple views and/

or magnification technique as approprlate;selecting

and setting technical factors;identifying film;posi-tioning pt. and equipment;providing shielding;colli-

mating;making exposures;having radiographs processed

and reviewed;repeating for full set of views or as

ordered;having pt. returned and placing radiographs

for filing as appropriate;recording examination. 6. Check here i this

is a master sheet. . (.1O

........

6 0

hList Elements Full


This is page

Task Code No. 355


List Elements Full

emergency, whether patient is in-patient or out-patient.

c. Performer reads patient's name, iden-tification number, sex,. age, weight.Notices whether,patient's examinationinvolves a cast on the part to be ra-diographed; reads any notation on thenature of any known pathology whichwould affect technique (such as boneinfection), and the purpose of thestudy.

d. Performer checks whether patient issuffering from a collateral conditionrequiring special handling such asheart disease, communicable or in-fectious condition, infirmity, inco-herence; whether patient has IV drip,

oxygen supply, catheters or simi-lar devices in place, whether patientwill be accompanied by nurse or otherstaff person. Notes shielding needed.

e. If performer is not already assignedto examination room (and a particularmachine) notes the room or machineinvolved. Goes to examination room orcontrol room for machine involved.

f. If magnification has been requested,performer checks that the machine tobe used has a fractional focal spotof appropriate size for direct magni-fication technique (i.e. 0.3 mm or=eller).

g. Performer makes sure that the requestis properly authorized, that informa-tion on requisition sheet is com-plete. Checks whether any special or-ders on exposure factors are in keep-ing with the usual rad exposure in-volved for the examination.

h. Depending on institutional proceduresperformer may review patient's radi-'ation exposure history, prior rec-ord of techniques used,and cumulativeexposure. Notices whether examinationhas been done elsewhere in recentpast, whether number of radiographicexposures ordered or done in pastshould be brought to radiologist'sattention.

. Depending on institutional proce-dures performer notes whether fe-male patient is pregnant, reviewsdate of female patient's last men-strual period,or notes any other in-dication that there is no danger ofexposure of a known or possiblefetus.

j. If patient's record indicates ordersfor sedation or any other prior med-ication performer may check timingto be sure a proper elapse of timehas occurred for medication to takeeffect. May arrange to delay exami-nation if appropriate.

k. If referring physician has requestethat film already on file be sentwith current radiographs and if notalready with patient's jacketed ma-terial, performer arranges to haveprior films delivered.

If the performer determines that therequest is not properly authorized, isincomplete, or that sufficient informa-tion is lacking for performer to se-lect technique or to properly care forpatient, , if performer considers thatthere may ,a contraindications to goingahead with the procedure, yerformernotifies supervisor, radiologist orother designated staff person dependingon institutional procedures. Explains

the problem if appropriate and proceedsafter obtaining appropriate informa-tion, signature or orders. .

3. When performer is clear about what will0be involved in examination, he or sheprepares ahead so as not to keep pa-tient in examination room longer thannecessary:

a. Performer reviews the techniquechart for the machine to be used andtakes note of any newly postedchanges in technical factors (to re-flect accommodation for change inmachine output or a policy decision).


Task Code No. 355


List Elements Fully

b. Performer washes hands as appropri-ate; depending on patient's condi-tion, may decide to arrange for orcarry out isolation or decontamina-tion techniques.

c. Performer makes sure that x-rayequipment is ready for use. Goes tocontrols for x-ray generator andchecks that indicator light showsthat machine is "warmed up," orturns on main switch as appropriateto equipment and allows time for ma-chine to "warm up." If appropriate,performer may set radiography modeselector and manual collimator con-trol setting.

d. Performer checks that appropriateimmobilization devices such as sand-bags, sponges and balsa blocks arepresent.

e. Checks that there is leaded rubbershielding available in room to beused to mask film, protect the pa-tient and/or to place beneath thefilm holder, as appropriate.

f. Performer prepares for identifica-tion of the films using equipmentprovided by institution:i) May obtain lead numerals and tape

and prepare identification stripfor placement on film holder(s)giving appropriate patient iden-tification information.

ii) Performer may prepare for use offlashcard by checking that thereis a lead piece on film holdersurface; may write or type outinformation on card if not re-ceived wieh requisition.

iii) Checks identification againstrequisition sheet.

iv) Performer makes sure that right(R) and left (L) markers-areavailable for use.

. If magnification has been requested,pctrformer prepares the equipment for

List Elements Fully111bWMENI

6 2

the tube-over-table method of magnifi-cation:

a. Performer determines the degree ofmagnification requested on the re-quisition sheet; if the request isexpressed as an area magnification,performer determines the linearmagnification by taking the squareroot. (Linear magnification squzLedequals area magrification.)

b. Performer calculates the requireddistances from target (focal spot)to object (patient) (TOD), and fromobject to film (OFD), as well asthe distance from target to film(TFD) (the sum of TOD and OFD):i) If the distance from the table

top to a film holder placed onthe floor or a stool (OFD) willbe a relatively inflexible dis-tance, performer measures thisdistance or reads indicatorscale. (If stool is to be used,may note the table height in-volved.) Performer may adjusttable height to provide for around number for the OFD.

ii) If the distance from the focalspot to the table top (TOD) willbe the relatively inflexible distance, performer determines whatthis is by measuring or readingappropriate indicator scale ontube housing. Performer may ad-just tube height to provide around number for the TOD.

iii) Depending on whether the OFD orthe TOD is fixel, performer cal-culates the required complemen-tary dis'Ince by referring to amagnification chart for the de-gree of linear magnification re-quired, or uses the formula: de-gree of linear magnificationequals TFD divided by TOD. For atwo-times linear magnificationperformer simply sets the TODe ual to the 0


Task Code No. 355


List Elemeuts Full List Elements Full

iv) Performer adjusts and locks thetable height and/or the tubeheight to the calculated OFD andTOD.

c. Performer aligns the object-film andtarget-object distances:i) Performer moves the x-ray tube

housing until it is centered overthe table top in the approximatea:ea where the patient's area ofinterest (finger, hand or wrist)will be positioned, such as athead of table.

ii) Performer wings the table out ofthe way so that there is no ob-struction between the tube and thefloor. (Does not change height.)If appropriate, places the stoolon the floor under the tube. Mayplace lead shielding on floor oron stool. May place film holder onfloor or stool.

iii) Performer selects the size filmholder designated for the degreeof magnification and the selectedpart to be studied.

iv) Performer sets the collimator (onmanual control) so that the aper-ture directly corresponds to thearea of interest (field size) forthe TOD involved.

v) Performer activates the light inthe collimator and adjusts thetube so that the light beam castoutlines the film holder. Uses thecrss-hairs projected by the beamto center the tube to an area onthe floor or stool.

vi) Performer locks the tube into po-sition so that there is a 900angle of the beam with the flooror stool. Fixes and retains colli-mator setting.

vii) Performer marks the outline of thecollimated light area or film hold-er on the floor or stool or on thelead shielding using tape or otherremovable marker. If not already

6 3

done, checks by placing filmholder in marked area. May markcenter of area as shown by crosshairs.

viii) Performer swings table back intoplace. Activates light beam incollimator and marks the tabletop where the center cross-hairsand field of interest are pro-jected (to be used to center thepart to be radiographed). Usestape or other radiolucent re-movable marker.

ix) Performer may recheck TOD andOFD to be sure that they cor-respond to the calculated dis-tances.

d. Fo..: magnification technique using avertical film holder, performer maywait until patient has been broughtinto examination roam. Adjusts up-right holder to appropriate height;adjusts x-ray tube to right angleprojection of beam to film holder;centers to the film; measures andadjusts TOD to patient's positionand marks patient's position; mea-sures and adjusts OFD from patient'posiLion as marked.

e. If the sum of the new TOD and OFD(TF1.1) is now different from the TFDusea for non-magnification techni-

. que, performer may consult techni-que chart to note the factor to usefor a compensatory change in mAs.May record for later use in settingexposure factors.

f. Performec may also note the changein kVp and mAs necessary to compen-sate for any change in collimationfrom non-magnification technique.Consults appropriate charts forconversion factors. May record.

5. Performer has the patient called fromthe holding area and prepared for theexamination (if not already done), ordecides to do personally.


Task Code No. 355

List Elements Full


=1117MIF

a. Depending on institutional arrange-ments performer may decide to es-cort out-patient to or from dressingroom. May decide to assist in transporting patient from holding area orhave this done.

b. Performer greets patient and any ac-companying staff person; introducesself. Checks patient's identityagainst requisition sheet. With in-patient, checks hospital identifica-tion bracelet or other identifier.If patient is accompanied becanse ofseriousness of condition, performer

checkswith accompanying staff mem-ber on any special precautions nec-essary during procedure.

c. Performer has patient sit comfort-ably on a stool'placed next to thex-ray table. If patient is in wheel-chair, moves patient in chair intoposition next to table. If patientis on wheeled stretcher, placesstretcher into position so that pa-tient's hand can be easily placed onx-ray table while patient lies onstretcher.

d. Performer explains to patient whatwill be involved in the procedure;indicates what types of positionsthe patient will be asked to assumeand the cooperation that will beasked of the patient.

e. Performer answers patient's non-medical questions honestly; attemptsto reassure patient and develop con--fidence. Treats patient with dignityand concern regardless of patient'sbehavior. Remains aware that patientmay be frightened and/or in pain.Performer explains when asked medi-cal questions that it is not appro-priate for technologist to answerthese; encourages patient to speakto physician.

f. If patient has an IV drip in placeperformer checks that needle has notbecome dislodged and that the fluid

List Elements Full

is dripping at an even rate. Ifthere are any problems, performerclamps tube and notifies an appro-priate staff person at once.

g. If appropriate and not already doneperformer questions female patientof child bearing age regarding pos-sible pregnancy. If there is anypossibility that patient is preg-nant and this has not already beenrecorded, performer informs appro-priate physician and proceeds onlywith approval.

. Performer questions patient and/or RNor MD present on what movement is pos-sible in the affected extremity and onthe opposite side; may question patienabout any injury or pain to determinewhat mobility is possible and what po-sitions are available for use.

a. If movement is limited or fractureis suspected, performer considersalternative x-ray tube and patientpositions to use to accomplish theequivalent radiography with a mini-mum of movement by the patient. Maydecide to use upright film holdersin appropriate positions to accom-plish this.

b. Performer reviews the standard num-- ber and types of projections for

the examination. Performer may con-sider a change from routine exami-nation to better accomplish the purpose of the examination such as achange, addition, or deletion of aprojection or a change in technicalfactors. Depending on institutionalarrangements performer may obtainpermission from appropriate radio-logist or decides personally toalter the standard procedure.

. Performer prepares for the examina-tion:

6,4


List Elements Full

Task Code No. 355


a. Performer selects speed,type of filmfor nonscreen film holder or cassetteas determined by institutional prac-tice; selects film and holder sizesbased on the size of the part, thenumber of exposures planned for eachfilm,and the needs of magnificationtechnique.

b. Performer makes sure that an ade-quate supply of the appropriateloaded film holders is available inthe examination room. If not, ar-ranges to obtain or decides to ob-tain personally.

c. If not already done, has patient re-move all jewelry; may arrange tohave patient's belongings checked ordecides to do personally. If patientis suffering from a fracture, per-former has staff member in attend-ance remove the necessary clothingfrom the area. Does not remove oradjust splint personally.

d. If patient has a dressing coveringa wound, performer may have it in-spected and changed if appropriate;may have wet dressing reinforced ordecides to do personally.

e. Performer provides everyone who willremain in room during exposurewith protective shielding. Ex-plains if necessary that this is notcause for alarm but a general pre-caution to minimize unnecessary ra-diation exposure. If a staff memberwill be asked to assist in position-ing or if patient will be asked touse hand not being studied to assistin positioning, performer providesleaded gloves for shielding.

f. Performer obtains the appropriatesize loaded film holder or cassettefor the first projection.

g. If several views will be taken onone film, performer mentally de-cides how these will be positionedso that the film need not be turnedfor viewing each image. Performer

List Elements Full

vses leaded rubber sheets and masksthe film holder completely exceptfor the area to be exposed. Treatsthe area to be exposed from thispoint as though it were the actualfilm size.

h. Performer attaches identificationinformation to the :Film holder ortable top:i) Places right or left marker on

film holder or table-top as ap-propriate to the study and pro-jection or depresses appropri-ate R or L button for automaticmarking.

ii) If patient's identification in-formation is in the form of leadnumerals, performer places on appropriate corner of film holder.

iii) If patient's identification in-formation is to be entered byuse of flasher, sets flashcardaside for later use with spacecreated by piece of leaded rub-ber on appropriate edge of hol-der.

iv) Performer may place patient'scard into card tray for equip-ment using automatic film mark-ing device.

i. Performer places the film holder onthe table top in a position thatcat e comfortably reached by thepatient in final positioning. Hayplace leaded rubber sheet underfilm holder.i) If magnification technique is

to be used, performer placesfilm holder in marked positionon floor or stool.

ii) If appropriate to.make possibleminimal movement of patient,per-former may place upright holderat right angles to table top orin other position to hold film.

j. Performer sets the focal-film dis-tance if not already done (as withmagnification technique):

6 5


Task Code No. 355



i) Operates controls or manuallymoves the x-ray tube into placeover the film holder (or at rightangles to upright holder).

ii) Checks the focal-film distance byreading indicator scale in thetube housing; adjusts up or downuntil the required FFD is obtain-ed.

. Performer has patient place hand in re-laxed position on x-ray table or in anynon-painful position so that the part(s)to by radiographed can be measured inposition.

Depending on the positions to be ra-diographed,performer uses calipers tomeasure the thickness of the part(s)in the directions in which the centerof the x-ray beam will pass throughthe centered part from tube to film,Records for use in determining expo-sure factors.

. Performer selects the exposure factorsfor the first projection by consultingthe technique chart(s) posted for themachine:

a. Locates the information needed for

the body part and projection in-volved according to the centimeterthickness of the part as measuredand the collimated field size to beused. Makes sure technique relatesto the combination of film type andspeed and the use or nonuse of otherrelevant accessories,

b. Makes note of the kVp, mA, T(secondsof exposure time),focal spot size,and the focal-film distance (TFD orFFD) called for.

c. Once the standard kVp, mA and time

have been determined, performernotes whether any conversions arenecessary to account for a path-ological condition, a dry or wet

cast on the part, tle preference o

10.

the radiologist involved, and anyother conversion needed such aswith use of magnification techni-que. Performer looks up numericalfactor(s) and calculates or usesconversion charts to ascertain theappropriate new exposure factor(kVp, mA or time). Multiplies,divides, adds,or subtracts as ap-propriate.

d. Performer checks any new or un-familiar exposure factors againstthe posted limits of the x-raytube on a tube rating chart to besure that technique does not ex-ceed the heat capacities of thetube for the focal spot size tobe used. If appropriate, perform-er reconverts the technique to anequivalent output using higher kVp

and lower mAs.

Performer sets exposure factors asselected:

a. Enters control room. Makes surethat indicator light shows thatx-ray generator is ready for use.Makes sure that machine is warmedup and that all circuits have been

stabilized.b. If appropriate, checks line voltage. meter and, if required,turns com-

pensator dial until needle isaligned properly on line meter.

c. Performer sets milliamperage bychoosing selectors for the correctfocal spot size; sets the mA se-lected.

d. Performer selects and sets the ex-posure time that will produce the

mAs desired.e. Performer sets the kVp selected by

choosing the combination of majorkilovoltage and minor kilovoltagEsettings to produce the desiredkVp.

6 6


Task Code No. 355


List Elements FullL

f. If appropriate for equipment, setscontrols to provide for manual con-trol at table-side of x-ray tube andtable height,position, and for col-limation (unless these have alreadybeen set such as with magnificationtechnique).

List Elements Full

11. Performer places the part to be radio-graphed in final position for the firstexposure. Makes sure that correct hand

and part are being positioned. Perforr-er centers part. Keepe long axis of

part parallel to the film. Performermay demonstrate the positions desired.

For young patients performer may planto make exposure of unaffected side forcomparison purposes depending on insti-tutional practices.

Performer may position as follows (un-less nonconventional positioning isbeing used to avoid having patientmove):

a. For the thumb, performer centerswith reference to the distal end othe proximal segment.i) For AP projection (to obtain

posterior view) performer haspatient place hand on film. Haspatient rotate hand internallyso that beam will enter mid-posterior surface of the thumb.Immobilizes and supports withsandbag or sponges. Instructspatient to hold back aad supportother fingers with other hand,and keep fingers out of centralray; provides lead shielding.

ii) For oblique view has patientplace pa'm flat on holder, prop-erly centered at the mid-portionof the thumb. Uses sandbags tosupport and immobilize.

iii) For lateral view has patientplace palm flat and flex fingersto rotate thumb so that true

lateral position is obtained.Uses sandbags to support andimmobilize.

b. For individual fingers, performercenters with reference to the meta-carpophalangeal joint of the finger.When finger to be studied is ex-.tended has patient close the otherfingers into a fist.

i) r PA projection (to obtain an-

terior view) performer placesthe finger flat on the holderwith hand pronated.

ii) For oblique view rotates handexternally or internally depend-ing on the finger involved.

iii) For lateral view performer haspatient extend the finger withhand at right angles to tabletop. Uses sponge or wood blockto steady and support finger.

c. For the hand, perforner centerswith reference to the distal endsand shafts of the metacarpal bones.If there is a suspected foreignbody in the hand, performer deter-mines the point of entry and tapesa small lead marker over the point.

Usually takes only anterior and

lateral views.

Makes sure that patient is able torest botb hand and forearm comfort-ably on table top. Places hand onfilm holder and ha's patient relaxand separate fint4ers.i) For anterior view (PA projec-

tion) has hand placed in prone

positio.ii) For oblique view has patient

rotate hand externally to about

400, then 'jlex and separate fin-gers and c4xcend thumb. Uses sand

bag, blo:A: or sponge to provide

stability.iii) If lateral view is required has

hand rotated from oblique posi- 4amjtion to true lateral position so .

INN&


Task Code No. 355


List Elements Fully

that metacarpals and phalangesare superimposed. Uses sponge orwood block to support thumb.

d. For the wrist, performer centerswith reference to the radial andulnar styloid processes. If thewriSt is in a cast or splint per-former centers by comparing withopposite wrist in identical posi-

tion.

List Elements Full

Has patient rest hand and forearm on

table top with wrist centered on thefilm holder (or unmasked portion of

holder).i) For anterior view (PA pro:lection)

has patient place hand in prone

position.ii) For oblique view has patient ro-

tate wrist externally 400 from

prone position. Uses sponge orblock for suppc.rt and sandbag to

immobilize.iii) For semi-supinated view, has pa-

tient rotate wrist from AP posi-tion as appropriate.

iv) For lateral view has patient ro-tate wrist externally 90° from

prone position, fingers extended,

and thumbs extended adjacent tohand so that ulnar side of wristis facing film holder.

v) For projection of ulnar flexion

r...13ces wrist in PA position and

then has patient turn hand in-

ward toward the radius as much

as possible.e. If patient shows signs of pain dur-

ing positioning,performer may de-

cide on alternative position.toavoid movement of affected part orreports to physician or RN.

12. Performer checks final positioning by

using light in collimator. Activates

the collimator light and points the

light beam towards the part. Uses'

cross-hair shadows as reference for

center of field. Checks that primary

beam will enter the center of thearea of interest at right angles to

the film and so as to project theview desired. For the first view ofa series may mark a point on the part

that is even with the center cd thefiIm holder so that: later views maybe easily lined up. May readjust tubeposition lengthwise or crosswise toprovide better centering.

13. Performer adjusts collimation. Eithercollimates so that a small unexposedborder will appear around the edge ofthe film or collimates further so asto expose only the area of interest

and thus provide maximum protectionand detail. If appropriate, performermay attach auxiliary extension coneto collimator to further reduce theprimary beam.

14. Performer may add lead shielding toareas that will be in the primarypath of the beam but are not includedin areas of interest. Makes sure thatproper protective shielding has beenprovided to everyone who will remainin room.

15. Throughout procedure performer ob-serves patient for any signs of emer-

gency or accidental harm. If patient

'shows signs of distress or faints,loses consciousness, or has an acci-

dent, performer calls appropriate phy-

sician at once. May decide to provideemergency first aid as well.

16. When everything is ready for the ex-pbsure, performer explains to patient

the need to keep perfectly still when

indicated by performer and until told

to relax. Performer observes the pa-

tient's movement until the moment thathe exposure is made. Readjusts posi-

tion if warranted.

68


Task Code No. 355


List Elements Fully List Elements Full

17. The performer returns to control room.Makes sure controls are properly setand patient is still in position. Tellspatient when to hold still by callingor using intercom. Performer initiates

exposure by pressing hand trigger or

exposure control button.

a. While exposure is underway perform-

er checks that mA meter records ap-propriate current as set, and thatkVp meter dips slightly.

b. May watch for evidence of malfunc-tion such as line surge or excessivedrop; may listen for sound of normalfunctioning of equipment. If thereis malfunction may decide to report;anticipates need to repeat exposure.

c. After exposure is completed tellspatient that he or she can relax.

d. If exposure is terminated by a cir-cuit breaker, rechecks technicalfactors for possible overload orchecks for overload elsewhere onthe circuit. Anticipates need torepeat exposure.

18. Performer returns to patient. Removesfilm holder from its location. Removesany markers.

a. If multiple views are to be taken

on the film, removes lead maskingand remasks all but the next area

to be exposed.b. If the patient is being examined

for possible fracture or if so re-quested, performer arranges to havethe first exposure processed atonce and brought to the appropriate

radiologist.c. Depending on whether radiologist

will evaluate radiographs beforecompletion of all possible expo-sures for the series, performerarranges to process film(s) and.evaluate for quality control per-sonally, have th4s done, or bring

to dark room for processing andlater evaluation, based on timeavailable, institutional arrange-ments or-specific instructions.Attaches ID card for use with'flasher if. appropriate. May sign

requisition.d. While films are being processed

and/or evaluated performer has pa-tiert relax in examination room orholding area. If appropriate makessure that patient is attended.

e. When (or if) performer learns from

1.1ae radiologist the extent of the

injury and/or whether further con-ventional views and/or positionscan be undertaken, eliminated, oraltered, performer proceeds as ap-propriate according to instruc-

tions.f. For further exposures performer re

peats appropriate steps for nextview(s) including identificationof film holder and use of R-L marker, selection and setting of tech-

nique for next view (if different),positioning patient and equipmentfor focus-object-film alignment,proper collimation, shielding, and

making exposure, as describedabove. For multiple views on onefilm keeps R-L reference point cmstant; centers using the point

marked earlier on the part to'line

up with center of film.

g. Performer refrains from commenting

on the films or providing any in-

I

terpretation.

19. If performer is asked to repeat anyexposures, makes sure that the addi-

tional exposures are warranted medi-

cally, since additional radiationwill be incurred.

a. Notes whether need to repeat is

due to performer's own negligenceor lack of attention so that per-former can avoid future "retakes."

6 9


Task Code No. 355


List Elements Full List Elements Fully

d. If appropriate, indicates to staffmember when ready to do next ex-

amination.

,

'.

,

.

b. If request for retakes reflects mal-functioning equIpment performer re-T.nrts malfunction to appropriatestaff member.

c. If request for retakes reflects theprefereace for density or contrastof a ruliologist,performer notes forfuture work done for the given ra-

diologist :,;,., that zatakes can be

avoided.

20. When performer is sure that the exami-nation has been completed, performermay have patient transported back to

holding area or next location, or de-cides to do personally as appropriate.Makes sure that none of the equipmentis projecting over the patient before

I

allowing patient to rise from stool.

21. Performer carries out termination stepsfor the examination:

a. Has equipment and examination tablecleaned after use or decides to dopersonally, depending on institu-tional arrangemeats.

b. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken, thetechnical factors used, and the filmsize; may record the number of expo-sures for each view, including re-

takes; may enter the estimated ra-diation dose to which patient wasexposed (based on posted informa-tion), any comments on equipmentfailure, or special care providedfor patient. If any views called forcould not be obtained records rea-son. Signs requisition.

c. Performer may decide to jacketfilms, requisition sheets, and re-lated materials and/or have infor-mation recorded in log book or hasthis done, depending on institu-tional procedures.

7 0

TASK DESCRIPTIOM SHEET

Task Code No. 356



Requisition reviewed;pt. reassured,positioned;partmeasured;films identified;technical factors selectedand set;technique for magnification set up;exposuresmade;radiographs sent for processing and evaluation;procedures repeated as appropriate for full set ofviews;patient returned;examination rv.corded;radio-graphs placed for use.

Performer receives or obtainsthe x-ray requisition form, pa-tient's identification card, andany appropriate medical-techni-cal history for a non-infantpatient scheduled for radio-graphy of the forearm and/or el-bow joint:




1. Performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, specialconsiderations, and to checkthe completeness of the in-formation provided.

a. Performer checks the exam-ination called for, including the part(s) of thebody involved and extentof the area of interest,the number and type of pro-jections (whether standardor special views, tech-nique), whether there isrequest for magnification;notices whether right and/



Pt.'s x-ray requisition sheet,ID card,bracelet,tech-nical history;pen;x-ray machine control panel(s),tube,table,collimator,extension cones;techniquechart;charts for conversion of technique,standardexamination views,dosage,tube capacity;cassette ornon-screen film holders;vertical film stand;leadedrubber shielding;R and L and ID markers;immobiliza-tion devices;stools;calipers;tape;scissors;stretcheror wheelchair

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...(i) No...( )

. If 'Yes to q. 3: Name the kina of recipient,respondent or co-worker involved, with de-

scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions.

Non-pediatric patient to be radiographed; radiologictechnologist; radiologist; nurse

. Name the task so that the answers to ques- or left arm is involvedand,with forearm,whetherdistal and/or proximaljoint is to be included,or,with elbow,whether lowerhumerus or upper forearm isto be included. Checks nameof referring physician.

b. Performer checks whetherthere is a suspected frac-ture, whether a known frac-

-OKRP;RR;RR


tial words.Taking plain film radiographs of forearm and/or el-bow joint of non-infant patient by reviewing re-quest,reporting observed contraindications;reassurinpt.;measuring pt.'s part(s);selecting and settingtechnical factors;identifying film;positioning pt.and equipment for conventional or magnification technique;providing shielding;collimating;making expos-ures;after processing and review repeating for appropriate views until full set of radiographs are com-pleted as ordered;having pt. returned;placing filmsfor use;recording examination. 6. Check here i this

is a master sheet..(K)

....205m..

7 1


Task Code No. 356


List Elements Fully

ture exists, whether any splintis to be left in place or re-moved by a physician. Noteswhether study is an emergency, wheth-er patient is in-patient or out-pa-tient.

c. Performer reads patient's name, iden-tification number, sex, age, weight.Reads any notation on the nature ofany known pathology which would af-fect technique (such as bone infec-tion), and the purpose of the study.

d. Performer checks whether patient issuffering from a collateral conditionrequiring special handling such asheart disease, communicable or infec-tious condition, infirmity, incoher-ence; whether patient has IV drip,oxygen supply, catheters or similardevices in place, whether patientwill be accompanied by nurse or otherstaff person. Notes shielding needed.

e. If performer is not already assignedto examination room (and a particularmachine) notes the room or machineinvolved. Goes to examination roomor control room for machine involved.

f. If magnification has been requested,performer checks that the machine tobe used has a fractional focal spotof appropriate size for direct magni-fication technique (i.e. 0.3 mm orsmaller).

g. Performer makes sure that the requestis properly authorized, that information on requisition sheet is com-plete. Checks whether any special orders on exposure factors are in keeping with the usual rad exposure in-volved for the examination.

h. Depending on institutional procedurepeitOrmer may review patient's radi-atisn exposure history, prior recordo# techniques used, and cumulativeexposure. Notices whether examina-tion has been done elsewhere in re-cent past.

Ltut Elements Fully

i. Depending on institutional proce-dures,perormer notes whetherfemale patient is pregnant,date of female patient's last men-strual period,or notes any otherindication that there is no dangerof exposure of a known or possiblefetus.

j. If patient's record indicates or-ders for sedation or any otherprior medication performer maycheck timing to be sure a properelapse of time has occurred formedication to take effect. May ar-range to delay examination if ap-propriate.

k. If referring physician has request-ed that film already on file besent with current radiographs,andif not already with patient's jack-eted material, performer arrangesto have prior films delivered.

. If the performer determines that therequest is not properly authorized,is incomplete, or that sufficient in-formation is lacking for performer toselect technique or to properly carefor patient, or if performer consid-ers that there may be contraindica-tions to going ahead with the proced-ure, performer notifies supervisor,tadiologist,or other designated staffperson, depending on institutionalprocedures. Explains the problem ifappropriate and proceeds after obtain-'ing needed information, signature ororders.

3, When performer.is clear about whatwill be involved in examination he orshe prepares ahead so as not to keeppatient in examination room longerthan necessary:

a. Performer reviews the techniquechart for the machine to be used

7 2


List Elements Full

Task Code No. 356


and takes note of newly postedchanges in technical factors (toreflect accommodation for change inmachine output or a policy decision).

b. performer washes hands as appropri-ate; depending on patient's condi-tion, may decide to arrange for orcarry out isolation or decontamina-tion techniques.

c. Performer makes sure that x-rayequipment is ready for use. Goes tocontrol panel for x-ray generatorand checks that indicator lightshows that machine is "warmed up,"or turns on main switch as appropri-ate to equipment, and allows timefor machine to "warm up." If appro-priate, performer may set radio-graphy mode selector and manual col-limator control setting.

d. performer checks that appropriateimmobilization devices such as sand-bags or sponges are present.

e. checks that there is leaded rubbershielding available in room to beused to mask film, protect the pa-tient and/or place beneath thefilm holder, as appropriate.

f. performer prepares for identifica-tion of the films using equipmentprovided by institution:i) MsY obtain lead numerals and tape

and prepare identification stripfor placement on .film holder(s)giving appropriate patient iden-tification information.

ii) Performer may prepare for use offlashcard by checking that thereis a piece of lead on film holdersurface; may write or type outID information on card if notreceived with requisition.


iv) Performer makes sure that right(R) and left (L) markers areavailable for use.

List Elements Full

. If magnification has been requested,performer-prepares the equipment forthe tube-over-table method of magni-fication:

a. Performer determines the degree ofmagnification requested on the re-quisition sheet; if'the request isexpressed as an area magnification,performer determines the linearmagnification by taking the squareroot. (Linear magnification squaredequals area magnification.)

b. Performer calculates the requireddistances from target (focal spot)to object (patient) (TOD), and fromobject to film (OFD), as well asthe distance from target to film(TFD) (the sum of TOD and OFD).i) If the distance from the table

top to a film holder placed onthe floor or a stool (OFD) willbe a relatively inflexible dis-tance,performer measures thisdistance or reads indicatorscale. (If stool is to be used,may note the table height in-volved.) Performer may adjusttable height to provide for around number for the OFD.

ii) If the distance from the focalspot to the table top (TOD) willbe the lelatively inflexible distance, performer determines whatthis is by measuring or readingappropriate indicator scale ontube housing. Performer may ad-just tube height to provide around number for the TOD.

iii) Depending on whether the OFD crthe TOD is fixed, performer cal-culates the required complemen-tary distance by referring to amagnification chart for the de-gree of linear magnification re-quired, or usca the formula: de-gree of linear magnificationequals TFD divided by TOD. Fora two-times linear magnifica-

amaftwass!.1111!

7 3


Task Code No. 356



tion performer simply sets theTOD equal to the OFD.



housing until it is centered overthe table top in the approximatearea where the patient's area ofinterest (forearm or elbow joint)will be positioned, such as athead of table.

ii) Performer swings the table out othe way so that there is no ob-struction between the tube andthe floor. (Does not changeheight.) If appropriate, placesthe stool on the floor under thetube. May place lead shielding onfloor or on stool. May place filmholder on floor or stool.

iii) Performer selects the size filmholder designated for the degreeof magnification and the selectedpart to be studied.

iv) Performer sets the collimator (onmanual control) so that the aper-ture directly corresponds to thefield size (area of interest) forthe TOD involved.

v) Performer activates the light inthe collimator and adjusts thetube so that the light beam castoutlines the film holder. Usesthe cross-hairs projected by thebeam to center the tube to thearea on the floor or stool.

vi) Performer locks t?-w tube into po-sition so that there -Is a 900angle of the beam with the flooror stool. Fixes and retains col-limator setting.

vii) Performer marks the outline ofthe collimated light area.or filmholder on Ow floor or stool or

....x.wamm=immtENNIevommwanalumr:

7 4

on the lead shielding using tapeor other removable marker. Ifnot already donelchecks by plac-ing film holder in marked area.May mark center of area as shownby cross-hairs.

viii) Performer swings table back in-to place. Activates light beamin.collimator arid marks thetable top where the c..niter cosshairs and field of interest areprojected (to be used to centerthe part to be radiugraphed).Uses tape or other radiolucentremovable marker.

ix) Performer may recheck TOD andOFD to be sure that they cor-respond to the calculated dis-tances.

For magnification tedmique usinga vertical film holder, performermay wait until patient has beenbrought into examination room. Ad-justs upright holder f:o ar?ropri-ate height; adjusts x-ray tube toright ang1Q .?rcelection of beam to

film holdw; to the film;

measures ald ad:justs TOD to pa-tient's rositi u. and marks pa-

tientl cositic measures and ad-

justs frcm p4tient's positionas marked.If the num of Oa new TOD and OFD(TFD) i3 :16W (i.:erent from the TFD

used fo': rto:a-ri.gnification techni-

que, pel-Fcr may.consult techni-que chart v..o note the factor to

use for a compensatory chan s,:. inmAs. May rer.ord for later ilac ir

Consultgversion factors. May rLtord.

l

etting exposure factors.Performer may also note the changc.in kVp and mAs necessary to ,:crip,Im-sate for.:sny change in collimationfrom nonLmagnification rpchnique.

appropriate charts for con

1ak

d.

e'

f.


Task Code No. 356

This is page 5 of 11 for thiG

Performer has the patient called from

the holding area and prepared for the

examination (if not already done), ordecides to do personally.

a. Depending on institutional arrange-ments performer may decide to escortout-patient to or from dressingrooms. May decide to assist in transporting patient from holding area or

have this done.b. Performer greets patient and any ac-

companying staff person and intro-duces self. Checks patient's iden-tity against the requisition sheet.

With in-patient, checks hospitalidentification bracelet or otheridentifier. If patient is accompan-ied because of seriousness of condi-

tion, performer checks with accom-panying staff member on any special

precautions necessary during proce-

dure.c. Performer has patient sit comfor-

tably on a stool placed next to the

x-ray table and low enough to place

the entire arm on the same plane. If

patient is in wheelchair, moves pa-tient in chair into position nextto table. If patient is on wheeled

stretcher, places stretcher into

position so that patient's hand and

arm can be easily placed on x-raY

table while patient lies on stretch-

er.d. Performer explains to patient what

will be involved in the procedure;indicates what types of positionsthe patient will be asked tu assumeand the cooperation that will be

asked of the patient.

e. Performer answers patient's non-medical questions honestly; at-tempts to reassure patient and de-

velop confidence. Treats patient

with dignity and concern regardless

of patient's behavior. Remains aware

that patient may be frightened and/

NOZIVIA.

Liilt Elements FullxHiblVioNlept

or in pain. Performer explains whenasked medical questions that it is

not appropriate for technologist

to answer these; encourages patient

to spe0;: to physician.f. If patieat has an IV drip in place,

performer checks that needle has

not bc:.wme dislodged and that the

fluid 1.s dripping at an.even rate..If there are any problems, perform-er clips tube and notifies an ap.-

propriftte staff member at once.

g. If appropriate and not already

done, performer quel;tions femalepatieat of child pea-zing age re-ga_rg possible pregnancy. If

re is any posibility that pa-

tient is preant'and this has notalready been r,i,.:.orded, performer

inorme appruriate physician and

proc.:.edo z.,niy. with approval.

. Performer quAstions patient and/or RN

or MD present on what movement is pos-

sible in the affected extremity and

on tbe opposite side; may question pa-tient Pb'.yut any injury or pain to de-

in.e what mobility is possible and

witt positions are available for-use.

a. If movement is limited or fracture

is suspected, performer decides on

alternative x-ray tube and patientpositions to use to accomplish the

equivalent radiography with a mini-

mum of movement by the patient. May

decide to use upright film standin appropriate positions to ac-complish this.

b. Performer reviews the standard num-

ber and types of projections for

the examination. Performer may con-

sider a change from routine exami-

nation to better accomplish thepurpose of the examinati,n such as

a change, addition, or deletion of

a position, or a change in techni-

cal factors. Depending on institu-

7 5


Task Code No. 356


List Elements Fully

tional arrangements,performer mayobtain permission from appropriateradiologist or decides personallyto alter the standard procedure.

1. Performer prepares for the examinatcl: ,

1a. Performer selects speed,type of fill.,

nonscreen film holder or cassetteas determined by institutional prac-tice; selects film and holder sizesbased on the part to be studied (toinclude both ends of the ulna andradius for forearm study,and to in-clude the designated area of hum-erus and/or forearm in elbow study),and the number of exposures plaanedfor each film. Considers needs ofmagnification technique.

b. Performer makes sure that an ade-quate supply of loaded film holdersof the sizes selected is availablein the examination room. If not, ar-ranges to obtain or decides to ob-tain personally.

c. If not already done, has patient re-move all jewelry; may arrange tohave patient's belongings checkedor decides to do personally.

d. If there is an injured arm to beradiographed performer has patientremove sleeve from unaffected sidebefore slipping sleeve off affectedside. If there is a splint on in-jured area performer has this re-moved by appropriate staff member orleft in place, depending on orders,but does not remove personally.

e. If a wet dressing is involved per-former has it reinTOTCed or decidesto do personally.

f. Performer provides everyone who willremain in room during exposurewith protective shielding. Ex-

plains if necessary that this is notcause for alarm but a general pre-caution to minimize unnecessary ra-diation exposure.

List Elements Fully

g. Performer obtains the appropriatesize loaded cassette or film hol-der for the first proje(:tion.

h. If several views will be taken onone film, performer mentally de-cides how these will be positionedso that the film need not be turnedfor viewing each image. Performeruses leaded rubber shielding andmasks the film holder appropriatelyexcept for the area to be exposed.Treats the area to be exposed fromthis point as though it were theactual film size.

i. Performer attaches identificationinformation to the film holder ortable top:i) Places right or left markers on

film holder or table top as ap-propriate to the study and pro-jection or depresses appropri-ate R or L button for automaticmarking.

ii) If patient's identification in-formation is in the form of leadnumerals, performer places onappropriate corner of film hol-der.

iii) If patient's identification in-formation is to be entered byuse of flasher, sets flashcardaside for later use with spacecreated by piece of leaded rub-ber on appropriate edge of hol-der.

j. Performer places the film holder onthe table top in a position thatcan be comfortably reached by thepatient for final positioning. Mayplace leaded rubber sheet'underfilm holder.i) If magnification technique is

to be used performer places filmholder in marked position onfloor or stool.

ii) If appropriate to make possibleminimal movement of patient,performer may place uprightholder at right angles to the


Task Code No. 356



.

.

table top or in other positionto hold film.

k. Performer sets the focal-film dis-tance (if not already done, as with

magnification technique):i) Operates controls or manually

moves the x-ray tube into place

over the film holder (or at right

angles to upright holder).ii) Checks the focal-film distance by

reading indicator scale in thetube housing; adjusts up or downuntil the required FFD is obtain-

ed.

Performer has patient place hand andelbow on the table top in relaxed su-pine and/or flexed position or in vnynon-painful position so that thepart(s) to be radiographed can be moa-sured. Depending on the positions tcbe radiographed,performer uses centi-

meter calipers to measure the thickness

of the part(s) in the directions in

which the c,mter of the x-ray beam will

pass through the centered part from

tube to film. :ecords for use in de-

termining exposure factors.

Performer selects the exposure factors

for the first projection by consult-

ing the technique chart(s) posted for

the machine:


the body part and projection in-

volved according to the centimeterthickness of the part as measuredand the collimated field size to be

used. Makes sure that technique re-lates to the combination of filmtype and speed and use or nonuse of

other relevant accessories.b. Makes note of the kVp, mA,T(seconds

of exposure time) ,focal spot size,

and the focal-film distance (TFD or

FFD) called for.

_

10.


have been determined, performernotes whether any conversions are .

necessary to account for a patho-logical condition, the preferenceof the radiologist involved, andany other conversion needed such

as with magnification technique.Performer looks up numerical con-version factors and calculates,oruses conversion charts to ascer-tain the appropriate new exposurefactor (kVp, mA or time). Multi-plies, divides, adds, or subtracts

as appropriate.d. Performer checks any new or unfa-

miliar exposure factors against th .posted limits of the x-ray tube on

a tube rating chart to be sure thei

technique does not exceed the heat

capacities cr! the tube for thefocal spot Oze to be used. If ap-propriate, j!..rformer reconvertsthe technique to an equivalent alitput using higher kVp and lower mAs.

Performer sets exposure factors as se

lected:

a. Enters control room. Makes surethat indicator light shows thatx-ray generator is ready for use.

Makes sure that machine is warmed

up and that all circuits have been

stabilized.b. If apprópriate,checks line voltage

meter and, if needed, turns comr

pensator dial until needle is

aligned properly an line meter.

c. Performer sets milliamperage bychoosing selectors for the correctfocal spot size; sets the mA se-

lected.d. Performer selects and sets the ex-

posure time that will produce the

mAs desired.

7 7


Task Code No. 356


List Elements Full

e. Performer sets the kVp selected bychoosing the combination of majorkilovoltage and minor kilovoltagesettings to produce the desired kVp.

f. Depending on the equipment, may setcontrols to provide for manual con-trol of table and tube height, posi-tion, and collimation at tableside(unless these have already been set,as with magnification technique).

11. Performer places du. part to be radio-graphed in final pcsition for the firstexposure. Makes sure that correct armis being positioned. For youug patientsperformer may plan to radiograph the uaffected side for comparison purposes.For nonconventional positioning per-former centers the tube so that theprimary ray will pass through the partat right angles to the film in the pro-jection desired (or at appropriateangle).

Performer may position as follows (un-less nonconventional positioning isbeing used to avoid having patientmove):

a. FoT: the forearm, performer centerswith reference to the radial andulnar styloid processes and thelateral and medial epicondyles ofthe humerus with the central ray atright angles to the center of the.part and the film. Makes sure thatthe long axis of the forearm is par-allel with the film. May help pa-tient to lean laterally to achievedesired positions.i) For the posterior view (AP pro-

jection) performer has the pa-tient rest the hand and elbow onthe film holder in an extendedsupine (palr up) position. In-cludes the joint nearer the in-jured site on the holder. Usessponge or saldbags to immobilize.

Listllements Fully...-

ii) For the lateral view has pathatrotate forearm internally fromthe AT position to 900, and flexthe elbow 900 with the.upper armresting comfortably on the tableand the thumb of the hand up.Makes sure that the long axis ofthe forearm is parallel to film.Includes the distal or proximaljoint in the same plane, as inthe posterioryiew. Makes surethat the radius, ulna and carpalbones are in lateral superimpo-sition. Uses sandbags to supporthand.

b. For the elbow joint, performer cen-ters to the joint. Directs centralray at right angles to film holder(except for view of proximal fore-arm in flexated frontal projectionand for axial projection). May helppatient to lean laterally toachieve desired positions.i) For the posterior view (AP pro-

jection) performer positions pa-tient on low stool with hand insupine position, shoulder insame horizontal plane as elbow,and anterior surface of elbowparallel to plane of film. Makessure that the medial and lateralepicondyles of the humerus areparallel to the film holder.(If a full elbow extension isnot possible, performer may pro-vide a posterior view of theproximal foream.and one of thedistal humerus.)

ii) For the lateral projection haspatient rotate elbow internally900 and flex elbow 900 with up-per arm resting on table andhumerus projecting off the med-ial aspect of the film holder,with arm and forearm in sameplane and parallel to table top.Makes sure wrist is in lateral,thumb up position.

7 0


List Elements Full

This is page

iii) For the AP internal oblique pro-jection (posterior oblique view),performer has patient rotateforearm, elbow,and arm internally450 from the extended position.

iv) For the frontal projection ofacute flexion, performer usesstool low enough for patient torest dorsal surface of upper armon film holder. Has patient flexforearm as far as possible overthe humerus. For view of distalhumerus performer directs thecentral ray at right angles tothe flexed forearm.

v) For axial projection of distalhumerus and olecranon process,performer seats patient so thatthe dorsal surface of the flexedelbow and the forearm are restingon the table top, with the fore-arm at right angles to the medialplane of the body and the palm ofhand turned up. Assists patientinto position so that the processis not rotated. Performer directsthe central ray anteriorly to themost prominant part of the ole-cranon process at an angle ofabout 25°.

c. If, during positioning, patientshows signs of severe pain, perform-er may notify appropriate physicianat once and await orders,or may de-cide on alternative positioning toavoid movement of the affected part.

12. Performer checks final positioning.Activates the light in collimator.Uses cross-hair shadows as referencefor center of field. Checks that pri-mary beam will enter the center of thearea of interest at right angles totne film (or selected angle) so as toproject the view desired. For the firstview of a Series may mark a point onthe part,that is oven with the centerof the film holder for use in lining

.0.11,4*-11L.,

Task Code No. 356


List Elements Fully

up subsequent views. May readjusttube position lengthwise or crosswiseto provide better centering.

13. Once the patient has been positionedand immobilized performer adjusts thecollimator. Either collimates so thata small unexposed border will appeararound the edge of the film,or col-limates further so as to expose onlythe area of interest (and thus providemaximum protection and detail). Ifappropriate, performer may attach aux-iliary extension cone to collimatorto further reduce the primary beam.

14. Performer may add lead shielding toareas that will be in the piimary pathof the beam but are not included in .

the areas of interest. Makes sure thatproper protective shielding has been

provided to everyone who will remainin room.

15. Throughout procedure performer ob-serves patient for any signs of emer-gency or any accidental harm. If pa-tient shows any signs of distress orfaints, loses consciousness, or hasan accident, performer calls appropri-ate physician or nurse at once. Maydecide to provide emergency first aidas well.

16. When everything is ready for the ex-posure, performer explains to patientthe need to keep perfectly still whenindicated by performer and until 6oIdto relax. Performer observes the pa-tient's movement until the moment thatthe exposure is made. Readjusts posi-tion if warranted.

17. The performer returns to control room.Makes sure controls are properly setand patient is still in position.Tellspatient when to hold still by callingor using intercom. Pe:former initiates

79


Task Code No. 356


List Elements Full

1

exposure by pressing hand trigger orexposure control button.

a. While exposure is underway performer

checks that mA meter records appro-priate current as set, that kVpmeter dips slightly.

b. May watch for evidence of malfunc-tion such as line surge or excessivedrop; may listen for sound of normalfunctioning of equipment. If thereis malfunction may decide to report;anticipates need to repeat exposure.


d. If exposure is terminated by circuitbreaker, rechecks technical factorsfor possible overload or checks foroverload elsewhere on circuit. An-ticipates need to repeat exposure.

18. Performer returns to patient. Removes

film holder from its location.

a. Removes any markers. If multiple

views are to be taken on the film,

removes leaded rubber mask and re-

masks all but next area to be ex-posed.

b. If the patient is being examinedfor possible fracture or if so re-quested, performer arranges to havethe first exposure processed atonce and brought to the appropri-

ate radiologist.c. Depending on whether radiologist

will evaluate radiographs beforecompletion of all possible expo-sures for the series, performer ar-

ranges to process film(s) and eval-

uate for quality control personal-

ly, have this done, or bring todark room for processing and later

evaluation, based on time availableable, institutional arrangements,orspecific instructions. Attaches IDcard for use with flasher if appro-priate. May sign requisition.

List Elements Fullx

d. While films are being processedand/or evaluated performer has pa-tient relax in examination room orholding area. If appropriate makessure that patient is attended.

e. When (or if) performer learns from

the radiologist the extent of theinjury and/or whether further con-ventional views and/or positionscan be undertaken, eliminated, oraltered, performer proceeds as ap-propriate according to instruc-tions.

f. For further exposures performerrepeats appropriate steps for nextview(s) including identificationof film holder and use of R-Ler, selection and setting of tech-

nique for next view (if different),positioning patient and equipmentfor focus-object-film alignment,proper collimation and shielding,and making exposure as describedabove. For multiple exposures onone film, keeps R-L referencepoint constant; centers using thepoint marked earlier on the partto line up with center of film.

g. Performer refrains from commenting


terpretation.

19. If performer is asked to repeat anyexposures, makes sure that the addi-

tional exposures are warranted medi-

cally, since additional radiationwill be incurred.

a. Notes whether need to repeat is

due to performer's own negligenceor lack of attention so that per-

former can avoid future "retakes."b. If request for retakes reflects

malfunctioning equipment performerreports malfunction to appropriate

staff member.c. If request for retakes reflects

the preference for density or ccia-trast of a radiologist, performer

8 0


Task Code No. 356


List Elements Full

notes for future work done for thegiven radiologist so that retakescan be avoided.

20. When performer is sure that the exami-nation haE been completed, performermay have patient transported back to

holdifig area or next location,or de-cides to do personally, as appropriate.Makes sure that none of the equipmentis projecting over the patient beforeallowing patient to rise from stool.

21. Performer carries out termination stepsfor the examination:

a. Performer has equipment and examina-tion table cleaned after use or de-cides to do personally, depending oninstitutional arrangements.

b. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken, thetechnical factors used,and filmsize; may record the number of ex-posures made of each view including

retakes; may enter the estimatedradiation dose to which patient wasexposed (using posted informationon dosage); may record any pro!)D.m

with equipment, any.speciLlprovided patient. If any views cal-

led for in the initial requestcould not be obtained performer mayrecord reasons. Signs requisition

sheet.c. Performer may decide to jacket

films, requisition sheets, and re-lated materials and/or have infor-mation recorded in log book, or hasthis done, depending on institu-tional procedures.

d. 1-lay indicate to appropriate staffperson when the performer is ready

to proceed with next eltamination.

*.List Elements Full

+1111111=MONELIZINEINZINI

8 1

+0.


Task Code No. 357


1. What is the output of this task? (Be sure List Elements Fullthis is broad enough to be repeatable.)

Requisition reviewed;pt. reassured,positioned,partsmeasured;films identified;tectical factors selectedand set;technique for magnification set up;expo-sures made;radiographs sent for processing and eval-uation;procedures repeated as appropriate for fullset of views;patient returned;examination recorded;radiographs placed for use.

Performer receives or obtainsthe x-ray requisition form, pa-tient's identification card,andany appropriate medical-techni-cal history for a non-infant pa-tient scheduled for radiographyof the humerus (upper arm) and/or the shoulder girdle (shoulderjoint, clavicle and scapula):



sitions in crder of priority.,

1. Performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, specialconsiderations, and to checkthe completeness of the in-formation provided:

a. Performer checks the ex-aminations called for in-eluding the parts involv-ed, the affected side,whether bilateral or uni-lateral studies are or-dered; notes the patientpositions requested,whether recumbent,seatedor standing,and the projec

,,.....2. What is used in performing this task? (Note


Pt.'s x-ray requisition sheet,TD oard,ID bracelet,technical history;pen;x-ray machine control panel(s),tube,bucky,table,collimator,extension cones;techni-que chart;charts for conversion of technique,stan-dard examination views,dosage,tube capacity;loadedcassettes or nonscreen film holders;vertical filmstand;leaded rubber shielding;R and L and ID mark-ers;immobilization devices;stool;chair;calipers;tape;scissors;stretcher or wheelchair;marking pen;protrac-tor;tube for film roll

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...00 No...( )

es to Name the kind of recipient,respondent or co-worker involved, with de-

scriptions to indicate the relevant condition-include the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions,

Non-infant patient to be radiographed; radiologictechnologist;radiologist;nurse

. Name the task so that the answers to questions, number of expo-sures, central beam angu-lations and body rotationsinvolved. Notes the areasof Interest and joints tobe includei, whether knownor suspected fractures areinvolved or destrultivedisease and the sites.Notes whether the use of abucky will Tie involved.

OK-RP-RR-RR

tions 1-4 are reflected. Underline essen-tial words.

Taking plain film radiographs of humerus and/orshoulder girdle of non-infant patient by reviewingrequest;reporting observed contraindications;reas-suring patient;measuring parts;setting up for con-ventional or magnification technique;selecting andsetting technical factors;identifying film;positiou-ing patient and equipment for erect or recumbcnt ex-

i ,osure;providing shielding;collimating;making expo-sures;having radiographs processed and reviewed;re-peating for full set of views or as ordered;havingpt. returned;placing rac14.ographs for use;recordingexamination,

.......m.

8 2


Task Code No. 357

This is page 2 of _20 for this task.

List Elements Full,/

Notes any request for magnification.Checks the name of the referringphysician.

b. Performer reads patient's name,iden-tification number, sex, age, weight.Notes whether patient is in-patient, out-patient, or emergencypatient. Notes any special informa-tion that will affect patient pcsi-tioning, technique, or handling ofthe patient, such as presence offracture, suspected fracture, pre-sence of plaster cast, splints (to

be left in place or removed by aphysician), whether patient willbe on a stretcher or wheelchair,andany notation on the nature of anyknown pathology which would affecttechnique (such as bone infection),and the purpose of the study.

c. With humerus,notes whether the en-tire humerus or the upper or lowertwo-thirds is called for, whetherboth joints or the joint nearerinjury is to be included.

d. For axial views of shoulder joint,makes sure that patient can and isallowed to abduct the affected armat a near right angle to the longaxis of the body. May check with MD.Notes whether it will be necessaryto prepare a cylinder film holder tobe used with patients not able rd.abduct arm. Notes whether a weightcarrying view of acromioclaviculararticulations is called for.

e. Performer checks whether patient is

suffering from a collateral condi-tion requiring special handling suchas heart disease, communicable orinfectious condition, infirmity, in-coherence; whether patient has IVdrip, oxygen supply,'catheters orsimilar devices in place; whetherpatient will be accompanied bynurse or other staff person.

f. If performer is not already assignedto examination room (and a particu-

List Elements Full

lar machine) notes the room or ma-chine involved. Goes to examinationroom or control room for machineinvolved.

g. If magnification has been request-ed, performer checks that the ma-chine to be used has a fractionalfocal spot of appropriate size fordirect magnification technique(i.e. 0.3 mm or smaller). If pa-tient will be in contact with thex-ray equipment (such as for stern-oclavicular articulation) makessure that equipment, particularlyoverhead system, is shock-proof.

h. Performer makes sure that the re-quest is properly authorized,thatinformation on requisition sheetis complete. Checks whether anyspecial orders on exposure factorsare in keeping with the usual radexposure involved for the examina-tion. Notes shielding needed.

i. Depending on institutional proce-dures performer may review pa-tient's radiation exposure history,prior record of techniques used,and cumulative exposure. Noticeswhether examination haA rieen done

elsewhere in recent paeL,whethernumber of radiographic exposuresordered or done in past should bebrought to radiologist's attention.

j. Depending on institutional proce-dures,performer notes whetherfemale patient is pregnant, reviewsdate of female patient's last men-strual period,or notes any otherindication that there is no dangerof exposure of a known or possiblefetus.

k. If patient's record indicates or- '

ders for sedation,injection oflocal anesthetic,or any other priormedication performer may checktiming to be sure a proper elapseof time has occurred for medica-tion to take effect. May notify MD 1


Task Code No. 357

This is page 3 ,f 20 for this task.

k

List Elements Fully List Elements uly

or RN when ready. May arrange to de- priate to equipment and allows time

lay examination if appropriate,1. If referring physician has request-

for machine to "warm up." If appro-priate, performer may set radio-

ed that films already on file be graphy mode selector and set colli-

sent with current radiographs, and mator control for manual operation.

if not already with patient's jack- d. Performer checks that appropriate

eted material, performer arranges immobilization devices suCh as

to have prior films delivered, sandbags, wedge sponges, tape arepresent and that there is a mat-

2. If the performer determines that the tress, pads, pillows and/or blan-

request is not properly authorized, is kets for comfort of patient if pa-

incomplete, or that sufficient infor- tient will lie on table.

mation is lacking for performer to se- e. Checks that there is leaded rubber

lect technique or to properly position shielding available in room to be

or care for patient, or if performer used to mask film, protect the pa-

considers that there may be contrain- tient, and/or to place beneath the

dications to going ahead with the pro- film holder, as appropriate.

cedure, performer notifies supervisor,radiologist, or other designated staff

f. Performer prepares for identifica-tion of the films using equipment

person, depending on institutional provided by institution:

procedures. Explains the problem if ap- i) May obtain lead numerals and

propriate and proceeds after obtaining cape and prepare identification

needed information, signature,or orders strip for placement on filmholder(s) giving appropriate pa-

. When performer is clear about what will .

tient identification informa-

be involved in examination, he or she tion.

prepares ahead so as not to keep pa- ii) Performer may prepare for use of

tient in examination room longer than flashcard by checking that there

necessary: is piece of lead on film holdersurface; may write or type out

a. Performer reviews the technique ID information on card if not

chart for the machine to be used received with requisition.

and takes note o% any newly posted Ali) Checks identification against

changes in tec*Inical factors (to re- requisition sheet.

flect accommodation for change in iv) Performer makes sure that right

machine output or a policy deci- (R) and left (L) markers are

sion). available for use.

b. Performer washes hands as appropri- g. For weight carrying study perform-

ate; depending on patient's condi- er obtains two weights of equal

tion, may decide to arrange for or amount as oretered.

carry out isolation or decontamina- h. For rolled film positioning per-

tion techniques,c. Performer makes sure that x-ray

equipment is ready for use. Goes to

former obtains an appropriate filmenclosed in a light-proof envelope,a small mailing tube and a pair of

control panel for x-ray generator flexible fluorescent screens. Per-

and checks that indicator lightshows that machine is "warmed up,"

former glues lead foil backing

or turns on main switch as appro- .


This is page

Task Code No. 357


List Elements Full

around tube as appropriate and markscenter. Performer inserts flexiblescreens inside envelope with unex-posed film. Centers loaded envelopeto center of lead foil backing,curves around tube,and secures ateach end.

4. If magnification has been requested,performer prepares the equipment forthe tube-over-table method of magnifi-cation (used without bucky):

a. Performer determines the degree ofmagnification requested on_the re-quisition sheet; if the request isexpressed as an area magnificationperformer determines the linear mag-nification by taking the squareroot. (Linear magnification squaredequals area magnification.)

b. Performer calculates the requireddistances from target (focal spot)to object (patient) (TOD), and fromobject to film (OFD), as well as thedistance frcm target to film (TFD)(the sum of TOD and OFD):i) If the distance from the table

top to a film holder placed onthe floor or a stool (OFD) willbe a relatively inflexible dis-tance, performer measures thisdistance or reads indicatorscale. (If stool is to be used,may note the table height.) Per-former may adjust.table heightto provide for a round numberfor the OFD.

ii) If the distance from the focalspot to the table top (TOD) willbe the relatively inflexible dis-tance, performer determines whatthis is by measuring or readingappropriate indicator scale ontube housing. Performer may ad-just tube height to provide around number for the TOD.

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iii) Depending on whether the OFD orthe TOD is fixed, performer cal-culates the required complemen-tary distance by referring to amagnification chart for the de-gree of linear magnification re-quired, or uses the formula:degree of linear magnificationequals TFD divided by TOD. Fora two-times linear magnificationperformer simply sets the TODequal to the OFD.


c. Performer aligns the object-filmand target-object distances:i) Performer moves the x-ray tube

housing until it is centeredover the table top in the ap-proximate area where the pa-tient's anatomical area of in-terest will be positioned, suchas on table or at head of table.

ii) Performer ..7ings the table outof the way so that there is noobstruction between the tubeand the floor. (Does not changeheight.) If approwdate,placesthe stool on the floor under thetube. May place lead thieldingon floor or on stool. May placefilm holder on floor or stool.

iii) Selects the size film designatedfor the degree of magnificationand the selected part to bestudied.

iv) Performer adjusts the collima-tion to correspond to the fieldsize anticipated (for the TODinvolved).

v) Performer activates the light inthe collimator and adjusts thetube horizontally so that thelight beam cast is centered tothe film holder or lead shield-


Task Code No. 357


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ing on the stool or floor. Uses

_

for a compensatory change in mAs.the cross-hairs projected by the May record for later use in set-beam to center the tube to the ting exposure factors.area on the floor or stool. f. Performer may also note the change

vi) Performer locks the tube into in kVp and mAs necessary to compen-position so that there is a 900 sate for any change in collimationangle of the beam with the floor from non-magnification technique.or stool. Fixes and retains col- Consults appropriate charts forlimator setting.

vii) Performer marks the outline ofthe collimated light area or film

conversion factors. May record.

5. Performer has the patient called fromholder on.the floor or stool or the holding area and prepared for theon the lead shielding using tape examination (if not already done), oror other removable marker. If notalready done, checks by placingfilm holder in marked area. May

decides to do personally.

a. Depending on institutional arrange-mark center of area as shown by ments performer may decide to es-

cross-hairs. cort out-patient to or from dress-viii) Performer swings table back into ing room. May decide to assist in

place. Activates light beam in transporting patient from holdingcollimator and marks the table area or have this done.top where the center cross-hairs b. Performer greets patient and anyand light outline are projected accompanying staff person and in-(to be used to center the part troduces self. Checks patient'sto be radiographed). Uses tape or identity against the requisitionother radiolucent removable mark- sheet. With in-patient, checkser. hospital identification bracelet

ix) Performer may recheck TOD and OFD or other identifier. If patientto be sure that they correspond is accompanied because of serious-to the calculated distance6. ness of condition, performer checks

d. For magnification technique using an with accompanying staff member on

upright film holder, performer may any special precautions necessarywait until patieLt has been brought during procedure.into examination room. Adjusts up- c. Has patient assume a comfortableright holder to appropriate height; position seated on table or chair.

adjusts x-ray tube to right angle If patient is in wheelchair, movesprojection of beam to film holder; patient in chair into position nextcenters to the film;measures and to table. If patient is on specialadjusts TOD to patient's seated or stretcher, places stretcher intostanding position and marks paposition so that radiolucenttient's position; measures and ad- stretcher can be lifted with pa-justs OFD from patient's seated or tient on it from wheeled base tostanding position as marked. x-ray table. Otherwise arranges if

e. If the sum of the new TOD and OFD necessary to move patient to table

(TFD) is now different from the TFD or use upright film holder with pa-

used for non-magnification techni- tient remaining on stretcher.que, performer may consult techni- d. Performer explains to patient whatque chart to note *ha factor to use will be involved in the procedure;


Task Code No. 357


indicates what types of positionsthe patient will be asked to assumeand the cooperation that will beasked of the patient.

e. Performer answers patient's non-med-ical questions honestly;attempts toreassure patient and develop confi-dence. Treats patient with dignityand concern regardless of patient'sbehavior. Remains aware that patientmay be frightened and/or in pain.Performer explains when asked medi-cal questions that it is not appro-priate for technologist to answerthese; encourages patient to speakto physician.

f. If patient has an IV drip in place,performer checks that needle hasnot become dis/odged and that thefluid is dripping at an even rate.If there are any problems, perform-er clamps tube and notifies an ap-propriate staff person at once.

g. If appropriate and not already done,performer questions female patientof child bearing age regarding pos-sible pregnancy. If there is anypossibility that patient is preg-nant and this has not already 'aeenrecorded, performer informs appro-priate.physician and proceeds onlywith approval.

Performer questions patient and/or RNor MD present on what movemerv.. Is pos-sible in the shoulder, the 1,--ectedarm, and on the opposite si ; may

question patient about any or

pain to determine what mobility is pos-sible and what Positions are availablefor use and whether to have patientstanding, seated or recumbent.

a. If open to choice and possible,chooses erect position over recum-bent. With cardiac condition choosesseated or recumbent position overstanding position.

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b. Rules out erect positioning if ex-amination of clavicle may involvefracture or destructive disease.

c. If movement is limited or fractureis suspected, performer decides onx-ray tube and patient positions toaccomplish the radiography with aminimum of movemant by the patient.May decide to use up :ght filmholder in appropriate ;.1-itions toaccompli.sh this.

d. Performer considers the r'r and

'ypr.:s of projections ords,:, for

examination and the p3'ci-lition. Performer maya el'. -r,:s from standard

to b4"-er accomplish th . eql'ose

of th. e2rnm1nat1on, or &letion ofa por,lti., or a change in technicalfacto,:e. Depending on institutlnnaloarra:vmc-.,ts, performer may obtainperwission from appropriate radio-logist ol decides personally toalter the standard procedure.

e. If not already done, has patient remove all jewelry; may arrange tohave patient's belongings checkedor decides to do personally. Makessure female patient has a gown.

f. If there is an .Injured arm to beradiographed performer has patientremove slezve from unaffected sideh.Jore slipping sleeve off affectedside. If there is a splint or cnstor injured area, performer has Ftl;

or MD carry out am orders on re-moval. If there is wet dressing,performer has it reinforced or de-cides to de personally.

7. Performer prepares for examination:

a. PerEormer selects speed and ty!,:eoC film depending on whether bocky,grid, cassettes or non-screen nold-.ers will be involved or as deter-mined by instituticAal policy. Se-lects film sizes based on the size

TAS:1/4 DESCRIPTION SHEET (continued)

411111111=1,71161111MMIIIIW

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Task Code No. 357


of the part and the number of expo-sures planned for each film. Con-siders the areas to be included onfilm, whether bilateral (side-by-side), and the needs of magnifica-tion technique.

b. Depending on the patient's mobilityand the projections requested per-former may choose flexible filmholders, curved cassettes or rolledfilm. For bilateral shoulder studyperformer selects a cassette longenough to be used with the long axisparallel with the shoulder expanseor plans on the simultaneous expo-sure of two cassettes placed side-by-side.

c. Performer makes sure that an adequatsupply of loaaed cassettes or filmholdets of the types and sizes se-lected are available in the examina-tion room. If not,arranges to obtainor decides to obtain personally.

d. Performer obtains the appropriatesize loaded non-screen film holder orcassette for the first projection.

e. If several views will be taken onone film, performer mentally decideshow these will be positioned so thatthe film need not be turned for viewing each image. Performer uses lead-ed rubber sheets and masks the filmholder completely except ior the aleto be exposed. Performer treats thearea to be exposed from this pointas though it were the actual filmsize.

f. Performer attaches identificationinformation to the film holder ortable top:i) Places right or left marker on


ii) If patient's identification in-formation is in the form of lead

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numerals, performer places onappropr'..ate corner of film hol-

der.iii) If patient's identification in-

formation is to be entered by

use of flasher, sets flashcard

aside for later use with spacecreated by piece of leaded rub-

ber on appropriate edge of hol-

der.fv) Performer may place patient's

card into card tray for equip-ment using automatic film mark-

ing device.v) Where two cassettes are to be

exposed simultaneously, perfce-m-er marks both wl_th R or L and

identification information.g. If cassette is to be used with

bucky (under tabletop or in upright

holi,er) performer manually pullsour bucky t:ay and opens retaining

clamp:. Inserts cassette into bucky

tray and 1_,,shes back. Makes sureclamps are closed. Moves cassetteinto ,,:ppropriate:!'storee posttion

or inserts cassette tray into bucky

ot centers._h. if a bucky is not being used, per-

former places nanscreen film hol-

der or cassette -(except rolled film

or curved cassette) in pos.:tion on

table .op wider patient, or where

par will be positioned, or in

ui.,right holder.

i) May place leaded rubber sheet

under nor creen film holder.ii) 1: mgaification technique is to

be us,d performer places film

holder or cassette in marked vo-sition on floor or stool.

i. Performer sets the focal-film dis-

tance appropriate ior the positior

to be used (if not already done, EY

with magnification techniltv). Oper

ates controls or manually moves the

x-ray tube into place oer the filmholder (or at right angies to up-right holder) .Checks the focal-film


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Task Code No. 357


distance by reading indicator scalein the tube housing; adjusts up ordown until the required FFD (TFD)is obtained.

j. Perforaer provides patient andeveryone who will remain in r6omduring exposure with protectiveshielding. Explains if necessarythat this is not cause for alarmbut.a general precaution to minimizeunnecessary radiation exposure.

. Performer has patient assume a comfor-ti,ible recumbent, seated, or standingposition depending on the positions tobP employed, so that the part(s) to beradiographed can be measured in posi-tion.

a. If appropriate, places mattress,pillow or clean linen on x-raytable.

b. Performer may decide to assist pa-tient from wheelchair or stretcherto table or has this done. May ob-tain help. Makes sure that no equip-ment is in the way and may be col-lided with by patient.

c. If assisting patient to step onfootstool in order to get on table,helps patient turn into position,step backwards on stool, and thensit and/or lie on table.

d. For erect position performer ad-justs the upright film holder sothat it is at appropriate heightwhen patient is sitting or standingin comfortable position for the pro-jection.

e. Depending on the positions to beradiographed performer uses centi-meter-calipers to measure the thick-ness of the part(s) in the direc-tion in which the central ray ofthe x-ray beam will pass throughthe centered part from tube to film.Records for use in determining expo-sure factors.

f. After measuring has patient rest inas relaxed a position as possible.

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May place pad, blanket or pillowunder bony prominences to providecomfort.

Performer selects the exposure fac-tors for the first projection by con-sulting the technique chart(s) postedfor the machine:


the body part and projection in-volved according to the centimeterthickness of the part as measuredand the collimated field size tobe used. Makes sure that techniquerelates to the combination of filmtype and speed and use or nonuseof other accessories that are pos-sibIe(such as screens, grid,bucky,etc.).

b. Makes note of the kVp, mA,T(secondsof exposure time),focal spot size,and the focal film distance (TFDor FFD) called for.


have been determined, performernotes whether any conversions areuecessary to account for a path-ological condition, cast, a changein TFD, the preference of the ra-diologist involved, and any otherconversion needed such as with mag-nification technique. Performerlooks up numerical conversion fac-tors and calculates or uses con-version charts to ascertain the ap-propriate new exposure factor (kVp,mA and/or time). Multiplies,di-vides, adds, or subtracts as ap-propriate.

d. Performer checks any new or unfam-iliar exposure factors against theposted limits of tht x-ray tube ona tube rating chart to be sure that

technique does not exceed the heatcapacities of the tube for thefocal spot size to be used. If ap-propriate, performer reconverts the


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Task Code No. 357



,technique to an equivalent outputusing higher kVp and lower mAs.

10. Performer sets exposure factors asselected:

a. Enters control room. Makes surethat indicator light shows thatx-ray generator is ready for use.Makes sure that all circuits havebeen stabilized.

b. If appropriatelchecks line voltagemeter and, if needed, turns compen-sator dial until needle is alignedproperly on line meter.

c. For conventional exposure control:i) Performer sets milliamperage by

choosing selectors fcr the cor-rect focal slot size; sets themA selected.

ii) Performer seiects and sets theexposure time that will producethe mAs desired.

iii) Performer sets the kVp selectedby choosing the combination ofmajor kilovoltage and minorkilovoltage settings to producethe desired kVp.

d. For automatic phototimed exposurecontrol:i) Performer selects and sets the

category corresponding to thetype of study and use or non-useof screens, bucky, etc., and, ifappropriate, focal spot size.

ii) Selects and sets a control cor-responding to the field size(as listed on technique chartfor phototiming).

iii) May select and seL a kVp rangebutton, if called for with equipment, corresponding to kV rangefor the examination.

iv) Sets a density selector corres-ponding to the usual (or spec-ial) requirements for the study.

v) Makes sure backup timer is notlikely to terminate exposure be-

fore phototimed exposure ismade.

e. 7Jepending on the equipment, mayset controls to provide for useof burly, manual tableside ad-justrumts of table and tubeheight, p6Sition, and of collima-tion (unless these have alreadybeen set as with magnificationtechnique).

11. Performer places the part to be ra-diographed in the final position se-lected for the first exposure. Makessure that correct side and part arebeing positioned. For young patientsmay plan to film unaffected side forcomparison. For studies of both thehumerus and shoulder performer plansexposures so that there uill be theleast shifting around; that is, makesall similar standing, seated, supineand/or prone exposures together. Maintains positions which can be used forboth humerus and shoulder(s).Performemay explain or demonstrate the posi-tions required; may obtain help inpositioning patient.

Performer centers the part keepingthe long axis of the part parallel tothe film holder. When using a buckycenters patient to midline. With filmholear or ca8sette on table top cen-ters film to part. With upright hold-er aajustr height of holder to partand centers part to film. Positionsas follows .;unless nonconventionalpositioning is being used):

a. For the humerus, performer makessure that film size will permitprojection of the entire area ofinterest with upper margin of filmabove the head of the humerus. Cen-ters with rnference to the lateraland medial epicondyles of the hum-erus and the acromion process of..th_e_ can


Task Code No. 357


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i) For erect standing AP projec-tion (to provide posterior view)or erect standing lateral pro-jection, performer has patientstand comfortably before the_

film holder so that a true pas-terior or lateral view can beobtained. Centers to film hold-er. Performer locates the epi-condyles. If possible, palpateswiLh thumb and index finger andadjusts position of arm or haspatient turn until the centralray will pass vertically throughthe center of part to the filmin desired projection. Makes surethat all the areas of interestwill be projected.

ii) For erect seated AP projection(posterior view)lespecially fordistal humerus, performei haspatient be seated at end oftable on stool high enough c.orpatient to extend arm over tablewith shoulder and elbow in semeplane. Has patient rotate the up-per arm externally. Centers filmholder to humerus with long axisof film and part parallel.

iii) For erect seated lateral projec-tion, especially for distal hum-erus, performer positions onstool as for AP projection. Haspatient flex elbow 900 and ro-tate forearm until hand is inlateral position, thumb up. Cen-ters as above,

iv) For recumbent AP pro.;ection (pos-terior view) performer has thepatient lie in the supine posi-tion with long axis of humerusover center line of table. Haspatient supinate the hand by ro-tating hand and forearm untilpalm is up. Performer elevatesthe opposite shoulder (or ele-vates the affected arm and cas-sette or film holder on sand-

bags) so that there is minimumpart-film distance and the epi-condyles are parallel with theplane of the film, with thelong axes of both parallel toeach other. Centers film toarea of interest.

v) For recumbent lateral projec-tion has patient lie on tableas above. Has patient abductthe arm somewhat, flex the el-bow, rotate forearm medially,and rest palm of hand on pa-tient's thigh or side withepicondyles at right angles tothe plane of the film. Centersfilm to area of interest.

vi) For decubitus lateral projec-tion has patient lie on the un-affected side. Performer placesthe film holder or cassette be-tween the affected humerus andthe patient's torso as close tothe axilla as possible. Centersthe cassette to the arm. Has patient flex elbow and turn thethumb surface of the hand up.Performer has hand rest on asupport or other hand. Adjustspatient's body so that thelateral surface of the arm isat right angles to the centralray.

vii) For transthoracic lateral pro-jection of humerus and shoulder(either recumbent or erect),haspatient sit, stand (or lie insupine position) with the in-jured arm at the side, with el-bow flexed,and palm of handagainst anterior chest. Has pa-tient elevate opposite arm,withforearm resting on patient'shead,and shoulder elevated asmuch as possible. Performerholds the humeral epicondylesand adjusts the patient's bodyso as to Tlace the lateral as-.


Task Code No. 357


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pect of the humeral head paral-lel with the plane of the filmand the epicondyles at rightangles to the film. Centers filmholder to the area of interest.May direct ray through the sur-gical neck of the humerus to cen-ter of film

b For the shoulder performer notes thepositions involved and whether bi-lateral; notes whether body rota-tion, use of rolled film and/or useof weights is involved. Makes surenot to position for axial projec-tions until advisability of doingso has been verified.i) For the erect or supine AP pro-

jection (posterior view), per-former notes whether external,neutral and/or internal rotatioris involved. Centers to the cora-coid process,and rotates patientso that the blade of the scapulais parallel with the plane of thefilm. If patient is supine,sup-ports elevated shoulder and hip.Performer locates the epicon-dyles and holds between thumb andindex finger of one hand whileadjusting the arm.

With external rotation has pa-tient turn palm forward:Abductsarm slightly so that the coronalplane of the epicondyles is par-allel with plane of film. Sup-ports as needed. With neutral ro-tation has patient rest palm ofhand against thigh. With internalrotation has patient flex elbowsomewhat, rotate arm internally,and rest back of hand on hip.Adjusts arm so that the coronalplane of the epicondyles is per-pendicular to the plane of thefilm.

Performer directs the central rayat right angles to the coracoid

process. For infrasupinatus in-sertion in external rotationhas ray enter at 25° caudad;forsubacromial space employs anangle of 15°.

ii) For erect or supine view of theteres minor insertion, perform-er exaggerates the AP internalrotation position,as describedabove,with hand moved to pa-tient's back; centers aboutone inch distal to coracoidprocess. Directs central ray tohead of humerus.

iii) For seated or standing super-oinferior projection of the bi-cipital groove, has patientstand or sit facing the end ofthe table. Has patient flex el-bow, lean forward,and rest fore-arm on table with hand supi-nated. Places cassette on fore-arm with long side parallelwith long axis of forearm. Askspatient to close fingers overthe end of cassette. Uses sand-bag to adjust cassette to hori-zontal position. Has patientlean until humerus is 10° to15° from the vertical, openedbackward. Palpates and marks thebicipital groove and directs thecentral ray to the mark. Whenopposite side is to be radio-graphed, too,centers to unmaskedhalf of cassette and repeats onother side with second exposure pon film.

iv) For supine or erect profile viewof the glenoid fosse, performercenters to the joint, rotatesihe body about 45° towards theaffected side. With supine pa-tient supports the elevatedshoulder and hip. Performer ad-justs the degree of rotation sothat the scapula is parallelwith the plane of the film and


Task Code No. 357


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the humerus rests against film, right angles wi.th the long axis

For internal rotation ab4.7-cts of body. Places thumb side of -

arm slightly and places hand hand up. Has patient tilt head

against side of body. Directs towards unaffected shoulder.

central ray at right angles some- Adjusts body to eliminate for-

what medial and distal to the upward or backward leaning. May

per, outer border of shoulder. elevate cassette on sandbags;

v) For supine posterior view of the may use curved cassette. Sup-subscapularis insertion, adjusts ports as needed. Centers. Di-

patient's arms along the sides of rects central ray to joint at

supine body with head resting on 200 to 25" towards elbow.

table.Centers to shoulder joint. viii) For seated or supine inferosu-Elevates the unaffected shoulder perior axial projection of the

about 15°. Abduct: the affected sh'ulder joint,has patient ab-

arm so that it is at right angles dtct arm of affected side at

to the body. Has patient flex the rLght angles to body and flex

elbow and pronate the hand. Sup- elbow. With supine patient ele-

ports and immobilizes hand. Cen- sates head and shoulders 3 to

ters vertical central ray to the / inches ar,d supports arm.

shoulder joint. '(eeps haud and wrist in lateral

vi) For supine inferesuperior pro- position. Has patient grasp a

jection of coracoid process,starts to position body as for

support or supports hand. Haspatient turn head away from af-

v, above, centering 1 to 2 iaches fected side. Performer places

proximal to the coracoid process. cassette on edge above should-

Adjusts shoulders to lie in the er as close as possible to

same transverse plane; abducts neck.Supports cassette or tapes

affected arm slightly and has pa into piece. Directs ray (hori-

tient supinate the hand. Di- zontally for supine patient)

rects central ray to the cora- through the exilla to the acro-

coid process at 15° to 300 ceph- mioclavicular articulation.

alad,with the greater angulationreserved for patients who are

ix) For seated or supine rolled-,f:flm axial projection of should

round-shouldered. er joint,performer obtains film

vii) For seated superoinferior axial rolled on tube prepared earlier.

projection of the shoulder joint,performer seats patient sideways

Has patient seated sideways atend of table or supine. Has pa-

at end of table with shoulder at tient supinate hand and rest it

midline, or on a stool or chair in lap if seated.'Places filmpermitting patient to extend af- roll as high in the axilla as

fected shoulder well over cas- possible,adjusted at right

sette placed near end of table angles to table for supine pa-

parallel with long axis. Has patient and horizontal for seated

tient lean over cassette until patient. Has patient brace arm

shoulder joint is centered over to hold roll in position. Di-

film. Has patient rest elbow of rects central ray at right

affected side on table,flex,and angles to acromioclavicularabduct the arm so that it is at joint or 5° medial or lateral,


Task Code No. 357

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depending on the interest in thebicipital groove or coracoidprocess.

x) For seated or standing hori-zontal transaxilla projection ofshoulder joint, performer usesvertical cassette holder thatwill accommodate the patient'shead and neck beside the standand positions patient seated orstancUng with affected shouldercentered frontally to the cas-sette. Performer has patientlean directly forward and restthe upper border of the stnald-er against cassette, restinghead and-neck beside holder. Di-rects the central ray horizon-tally through the axilla region.

xi) For seated semiaxial antero-posterior projection of gleno-humeral joint (or semiaxial viewof clavicle and scapular spine),performer places cassette atedge of table and seats patientwith back toward and restingagainst cassette and edge ofend of table. Has patient siterect, Provides any needed sup-port for forearm without affect-ing position. Centers cassetteto glenohumeral joint and sup-ports on sandbags if needed toelevate to middorsal area. (Forclavicle and scapular spine ad-justs and supports cassette with450 wedge.) Directs central rayto the coracoid process (orclavicle and/or scapular spine)at 400 to 450 caudad.

xii) For seated or standing bilateralAP or PA projections of acro-mioclavicular articll.ations,performer notes whether weightcarrying projections are re-quested. If so, prepares forunencumbered exposure first,followed by weight carrying ex-

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posure. Performer uses longcassette crosSwise in uprightholder or has two cassettesplaced together for wide sub-jects for simultaneous ex-posure. Performer has patientseated or standing in AP or PAposition before holde; cen-tered to the acromioclavicularjoint% with median sagittalplane of body at midline ofcassette (or between casset-tes) Has patient distributeweight equally on both feet oron chair. Has patient restchest or back against casset-te(s) for support, with armshanging by side unsupported.Adjusts so that shoulders arein the same transverse plane.Directs central ray at rightangles to midline of body atthe level of the centeredjoints. For second, weight car-rying exposure has patient holdobjects of equal weight in eachhand with shJulders hanging re-laxed and repeats exposure withsecond cassette(s).

xiii) For seated or standing unilat-eral AP projection of acromio-clavicular articulation, haspatient turn back toward up-right cassette holder whileseated or standing. Centers toaffected shoulder at thelevel of the joint and thecoracoid process and directscentral ray there at 15° ceph-alad.

xiv) For seated or standing lateralprojection of acromioclavicu-lar articulation,has patientface upright cassette holderwhile seated or standing. Haspatient place hand of affectedside up under the unaffected-side axilla. Rotates the un-


Task Code No. 357


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affected Eide 300 to 350 away

from film. Centers to the medi-al border of the head of thehumerus. Instructs patient tograsp the side of the cassettestand and pull affected shoulderfirmly against it when ordered,just before exposure. May havepatient practice this. Directscentral ray at 15° caudad.

c. For the clavicle and sternoclavi-cular articulation, performer makessure that there is no danger offragment displacement or injury orpresence of destructive disease be-fore using erect positions. Noteswhether bilateral views are re-quested. Where lordotic posiLionis called for makes sure that pa-tient can assume this position. Tfnot, selects alternative axial pro-jection. Makes sure that patientis rehearsed for complicated proce-dures, such as with lateromedialbilateral body-contact projectionof sternoclavicular articulation(for which performer makes two ex-posures without movement of thepart or film),i) For prone or erect PA projection

of clavicle (AP view) and semi-axial projection, performer ad-justs patient's body so that theclavicle is centered to the mid-line of table or cassette holderat the level of coracoid processwith arms alongside of body andshoulders in a single transverseplane. Directs central ray atright angles to film. For semi-axial projection directs centralray to the supraclavicular fossaat 25° to 30° eaudad.

ii) For paired right-angle projec-tions of the clavicle, performerhas patient assume prone posi-tion and centers to clavicle.Arranges body as for PA projec-

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tion. Rests head on cheek of affected side. Performer markstable or cassette tunnel besideshoulder at a point in linewith midpoint of clavicle. Forfirst exposure directs centralray to midpoint of clavicle at45° caudad. Has patiemt retainposition. For second exposureinserts cassette and directscentral ray to same point at45° cephalad.

iii) For supine superoinferior axialprojection of clavicle,elevatespatient's head 2 to 3 inchesand has arms placed alongsidebody. Depresses shoulders sothat clavicle is In transverseplane and has patient turn headaway from affected side. Per-former places the cassette onedge at the top of the should-ers close to the neck and sup-ports it. Adjusts tube so thatcentral ray will pass betweenthe clavicle and st wall asclose to 40° to as pos-sible. May adjut angle 15° to25° outward for medial third ofclavicle.

seated or standing AP lor-dr...ic axial projection of cla-',idle, performer has patientstand or sit with back to averticle cassette holder. Cen-ters to the affected shoulder.Assists patievt to achieve con-cavity of the :_mbar spine asseen from the side and outwardconvexity of the part. Firsthas patient place hands in c.om-fortable position such as clasped over abdomen. Supports lum-bar region with hand-and has patient lean backward and rest,neck and shoulder against cas-sette, with neck flexed. Per-former adjusts the degree of


Task Code No. 357


List Elements Full

leaning until oronal plane ofclavicle is nearly at rightangles to film. Directs centralray to inferior border of clavi-cle at right angles to its cor-onal plane. Performer has patientbecome erect and relax again un-til performer is ready to make eposure;then has position repeated

v) For seated axial projection ofclavicle,performer has patientseated facing end of table. Putsgonadal shielding in plate andthen places pillow or blanketson patient's lap so that a cas-sette can be placed on top atlevel of diaphragm. Centers cas-sette to affected shoulder andhas patient hold cassette or se-cures into position. Asks patientto lean forward slightly. Mayhave patient rest head on sand-bags placed on edge of table.Directs central ray anteriorlyat 900 to coronal plane of cla-vicle.

vi) For bilateral or unilateral PAprojection of sternoclaviculararticulation with body rotation,performer has patient assume aprone position on table or stavdor sit facing upright holder witharms alongside body. May placeforearms above head for inferiorportion of the articulation. Cen-ters to midline. For unilateralstudy may turn patient's head towards the affected side. Centersto the manubrial notch and di-rects central ray at right anglethrougil the third thoracic ver7tebra. For bilateral study doesnot have patient tun-. head. Cen-ters as above and directs beamas above.

vii) For composite lateromedial bi-lateral body-contact projectionof the sternoclavicular articu-

List Elementellilly

lation performer has patientlie on table in a prone posi-tion with arms alongside bodyand head not turned. Performermarks the spinous process ofthe 3rd thoracic vertebra andmarks a point 6cm. on each sideof this first mark. Centers tomauubrial notch. Performer ex-plains to patient that positionls to be held for two exposures,one after the other,without thefilm being changed. Makes surechat equipment is shockproofand places tube aperture incontact with the body for eachexposure at the point of entryfor central ray. For first ex-posure directs central ray at50 towards the midline to thesecond mark (6cm. from the spinous process) and places tube incontact with body. Does notchange film after exposure. Forsecond exposure directs centralr'y at 50 toward the midline onle other side to the thirdark (6cm. from the spinous prozess on other side) and placestube in contact with the body.

viii) For PA oblique projection ofsternoclavicular articulation,performer has patient assume aprone position on table or standor sit facing upright holderwith joint being examined cen-tered. Positions body or ele-vates unaffected side so thatthe midsagittal plane of thehead and body is at right anglewith film. Has prone patientflex knee and elbow of elevac.:-.d

side for support. Directs cen-tral ray at right angles throughsternoclavicular articulation.

ix) For lateral recumbent projectionof sternoclavicular articulationhas patient take lateral recum-


Task Code No. 357


List Elements FtIlly List Elements Fully

bent position on the affectedside. Centers. Has patient ex-tend the arm on the affectedside and grasp the end of thetable. Has patient place otherarm on superior surface of bodyand grasp dorsal surface of hipso that shoulder is held in de-pressed position. Directs centralray 15° caudad through lowersternoclavicular articulation.

x) For lateral erect projection ofsternoclavicular articulation,haspatient stand with body at rightangles to upright cassette hold-,er,centered to manubrial notch.Has patient fold arms behiud backand stand straight, with chinslightly extended. Rotatesshoulders back and checks thatthey are level. Directs centralLay horizontally to center of.

film.d. For the scapula, performer selects

or checks orders for erect or re-

cumbent positioning:i) For AP projection of scapula

(posterior view),performerchooses seated, standing or su-pine position. Centers to theaffected scapula. Performer ab-ducts the arm on the affectedside at right angles to body sothat the scapula is drawn out-ward. Has patient flex elbow.Supports hand. Does not havebody rotate. Directs central rayat right angles to midscapular.area including acromion processand apex of scapula.

ii) For oblique AP or lateral pro-jection of scapula,performerchooses supine, seated,or stand-ing position. Has patient sit,stand or lie in AP position andcenters to the scapula. Foroblique AP projection has pa-tient extend arm upward, flex

elbow and place hand supinatedunder head. Has patient turnaway from the affected side.FOr oblique lateral projectionhas patient raise arm and rest

flexed elbow against forehead.Performer grasps axillary andvertebrae borders of scapulabetween thumb and index fingersof hand and adjusts rotationaway from affected side so asto project scapula free of rib

cage. Directs central ray atright angles to lateral borderof rib cage at mid-scapulararea.

iii) For lateral projection of scap-ula performer chooses seated orstanding position facing cas,-sette holder centered to scap-ula. Has patient place affectedshoulder against cassette hold-

er, flex elbow,and place armbehind,with back of hand againsposterior ribs or drawn acrosschest. Has patient raise oppo-site arm and grasp edge of hold

er with hand, rolling theshoulder anteriorly. Rotatesbody until flat surface of scap-ula is at right angles to filmand centered. Performer mayhave affected arm extended up-ward and with forearm restingon head to demonstrate acromionand coracoid processes. May haveaffected arm hang beside bodyto demonstrate glenohumeraljoint. Directs central ray horizontally to the medial borderof the protruding scapula.

iv) For oblique projection,perform-er chooses seated, standing,or

lateral recumbent position.Places patient in lateral posi-tion. Abducts arm at right an-gles to long axis of body withelbow flexed and hand against


Task Code No. 357



patient's head or has patient ex-tend affected arm obliquely up-ward with hand against head. Ro-tates body somewhat forward andhas patient grasp table or hold-er for support. Directs centralray at right angles to film be-tween chest wall and mid-area ofprotruding scapula.

v) For supine or prone tangentialprojection of scapular spinejper-former centers to shoulder. With 12.

supine position rotates patientso that wing cf scapula is par-allel with table by elevating op-posite shoulder. Has patient turnhead away from affected part. Forprone position has patient placearms along sides of body and ad-justs shoulders to lie in a sin-gle transverse plane. Has patientrest head on chin and supinatehand on affected side. Uses wedgeto elevate shoulder and upperarm until scapula is parallelwith table. Performer directscentral ray through scapularspine at 450 caudad for supine 13.

and 450 cephalad for prone pa-tient.

vi) For standing tangential projec-tion of scapula spine,performeruses a vertical cassette holder

that will accammodate patient'shead at the side. For seated projection, performer seats patientin front of cassette holder withback toward and resting againstend of table. Centers to should-er. Has standing patient leanforward at a 450 angle and restshoulder against cassette,withhead resting at the side. Forseated patient places and cen-ters cassette at end of tableadjusted to an angle of 450 withsandbags or wedge. Directs cen-tral ray at right angles to film

through the anterosuperior as-pect of shoulder at a postero-inferior angle of 45°.

e. If, during positioning, patientshows sIgns of severe pain, per-former may notify appropriate phy-sician at once and await orders ormay decide on alternative position-ing to alioid movement of the af-

fected part.

Performer checks final positioning byusing light in collimator. Activatesthe collimator light and points thelight beam towards the part. Adjuststhe collimator opening to correspondto the film size (or the size of the

unshielded area of the film to .be ex-posed). Uses cross-hair shadows as re-ference for center of field. Checksthat primary beam will enter the cen-ter of the area of interest at theselected angle to the film so as toproject the view desired. May read-just tube position lengthwise orcrosswise to provide better centering.

/Once the patient has been positionedand immobilized performer adjusts thecollimator. Either collimates, so thata small unexposed border will appeararound the edge of the film or colli-mates further so as to expose onlythe area of interest (and thus pro-vide maximum protection and detail).For small fields perforMer may attachauxiliary extension cone to colli-

mator to further reduce the primarybeam.

14. Performer may add lead shielding toareas that will be in the primary

path of the beam but are not includedin the areas of interest. Makes surethat protective shielding has been

*provided to patient and everyone who

/

will remain in roam.

9 8


Task Code No. 357



15. Throughout prucedure performer observes posure by pressing hand trigger or

patient for any signs of emergency and/or to prevent or respond to an accident,With fractured humerus or shoulder gir-

exposure co-zrol button.

a. While exposure is underway per-

dle is alert to signs of nausea, dizzi- former checks that mA meter re-

ness, or sweat, suggesting faintness,Performer may have patient lie down,lower head or raise legs. Notifies

cords appropriate current as set,that kVp meter dips slightly.

b. May watch for evidence of malfunc-

nurse. If patient shows any other emer- tion such as line surge or exces-

gency signs, loses consciousness,or has sive drop; may listen for sound of

an accident, performer calls appropri- noimal functioning of equipment.

ate physician or nurse at once. May de- If there is malfunction may de-

cide to prollide emergency first aid as cide to report; anticipates need

well. to repeat exposure.c. With phototimer notes whether

16. When everything is ready for the ex- backup timer has been involved in

posure, performer explains to patient terminating exposure before photo-

what breath control will be used for timed exposure was completed. If

exposure such as holding breath, breath- so, anticipates possible need to

ing in and holding,or breathing out and repeat exposure (due to underex-

holding,when told to do so by perform- posure if premature cut-off, orer and until told to relax. Has patient overexposure due to faulty timer).

prepare to breathe in and hold for d. After exposure is completed tells

lateral transthoracic, right-angle patient that he or she can relax.

clavicle,lordotic axial, lateral stern- e. If the exposure is terminated by

oclavicular articulation,and AP scap- a circuit breaker, rechecks tech-

ula projections. Has patient exhale and nical factors for possible over-

hold for shoulder views such as AP pro- load or checks for overload else-

jection, teres minor insertion, bici- where on circuit. Anticipates need

pital groove, subscapularis insertion,coracoid process, glenoid fossa, axial

to repeat exposure.

projections,and for PA projections of 18. Performer returns to patient. Removes

clavicle and sternoclavicular articu- -

lation. Has patient prepare to holdbreath for all others. Reminds patient

.cassette or film holder from table,floor or bucky.

about those exposures in which position a. Removes any markers for further

is to be retained for a second expo- use. If multiple views are to be

sure. Performer observes the patient's taken on the film, removes leaded

movement until the moment that the ex- rubber mask and remasks all but

posure is made. Readjusts position if next area to be exposed.

warranted. b. If the patient is being examinedfor a possible fracture or if so

17. The performer returns to control room. requested, performer arranges to

Makes sure controls are properly set have the first exposure processed

I and patient is still in position. Tells at once and brought to the appro-

patient when to take a deep breath, en- priate radiologist.

hale,and/or hold still by calling or c. Depending on whether radiologist

using intercom. Performer initiates ex- will evaluate radiographs before

9 9

CZ:


Task Code No. 357


: Elements Fu

,fflpletion of all possible expo-sures for the series, performer ar-ranges to process film(s) and eval-uate for quality control personally,haye this done, or bring to dark-room for processing and later eval-uation, based on time available, in-stitutional arrangements or speci-fic instructions. Attaches ID cardfor use with flasher if appropriate.May sign requisition.

d. While films are being processed and/

or evaluated performer has patientrelax in examination room or hold-ing area. Explains what will happen

next.i) Performer determines whether pa-

tient should remain on table and/

or in room or requires observe-May consult requisition

shet or attending RN. If appro-prilte, makes sure that patientwill be attended while waiting.

ii) If appropriate, moves x-ray tubeand any protruding film holderaway from patient before patientrises.

iii) May decide to assist patient tochair or stretcher or fromtable. Makes sure patient is re-minded of any footrest in step-ping off table.

19. When (or if) performer learns from the

radiologist the extent of the injuryand/or whether further conventionalviews and/or positions can be under-

taken, eliminated or altered, per-former proceeds as appropriate accord-

ing to instructions.

a. For further exposures performer re-peats appropriate steps for nextview(s) including identificationof film holder or cassette and useor R-L marker, selection and set-ting of technique for next view(if different), positioning patient

List Elements Fully

and equipment for focus-object-film alignment, proper collimationand shielding, and making exposure,

as described above.b. Performer refrains from commenting


terpretation.c. If performer is asked to repeat

any exposures, makes sure that theadditional exposures are warrantedmedically, since additional radia-tion will be incurred.i) Notes whether need to repeat is

due to performer's own negli-gence or lack of attention sothat performer can avoid future

"retakes."ii) If request for retakes reflects

malfunctioning equipment per-former reports malfunction toappropriate staff member.

iii) If request for retakes reflectsthe preference for density orcontrast of a radiologist,per-former notes for future workdone for the given radiologistso that retakes can be avoided.

20. When performer is sure that the ex-amination has been completed, per-former may have pat.lent transportedback to holding area or next location

or decides to do personally, as appropriate. Makes sure that none of theequipment is projecting over the pa-tient before allowing patient to rise

from stool or table,and assists pa-tient as described above.

21. Performer carries out termination'steps for the examination:

a. Performer has equipment and exami-nation table cleaned after use or

decides to do personally,dependingon institutional arrangements.

b. Performer records the examinationaccording to institutional proce-

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Task Code No. 357



dures. May include date, room, ex-amination type, the views taken, thetechnical factors used and filmsizes; may record the number of ex-posures made of each view includingretakes; may enter the estimatedradiation dose to which patient wasexposed (using posted informationon dosage); may record any problemwith equipment, any special careprovided patient. If any views cal-led for in the initial request Couldnot be obtained, performer may re-cord reasons. Signs requisitionsheet.

c. Performer may decide to jacketfilms, requisition sheets, and re-lated materials and/or have infor-mation recorded in log book, or hasthis done, depending on institu-tional procedures.

d. May indicate to appropriate staffperson when the performer is readyto proceed with next examination.

.

.

. .

. .

101.


Task Code No. 358


1. What is the output of this task? (Be surethis is broad enough to be repeatable.)

Requisition reviewed;pt. reassured,positioned,mea-sured;technical factors selected and set;film iden-tified;technique for multiple views and/or magnifi-cation set up;exposures made;radiographs sent forprocessing and evaluation;procedures repeated asappropriate for full set of views;patient returned;examination recorded;radiographs placed for use.

List Elements Fully


if only, certain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Pt.'s x-ray requisition sheet,ID card,ID b7ecelet,technical history;pen;x-ray machine control nanel(s)tube,table,collimator,extension cones;techniquechart;charts for conversion of technique,stardard examination views,dosage,tube capacity;cassetes ornon-screen film holders;verticai film stand.;leadedrubber shielding;R and L and ID markers;immobiliza-tion devices;chair;stool;calipers;tape;scissors;bandage;stretcher or wheelchair;film tunnel;weight-bear-ins-bench

3. Is there a reCipient, respondent or co-workerinvolved in the task? Yes. . . (t No...

Yes to q. ame tne ina o recipient,

respondent or co-worker involved, with de-


requirements or legal restrictions.Non-pediatric patient to be radiographed;radiolo4ictechnologist; radiologist; nurse

.411Performer receives or obtainsthe x-ray requisition form, pa-,tient's identification card, andany appropriate medical-techni-cal history for a non-pediatricpatient scheduled for radiog-raphy of the toes, feet or anklejoint:




.Name the task so that the answers to ques-tions 1-4 are reflected. Underline essen-

tial words.Taking plain film radiographs of toes,foot and/orankle joint of non-pediatric patient by reviewing re-quest;reporting observed contraindications;reassurinpt.;measuring part;setting up for multiple views and/or magnification technique;selecting and settingtechnical factors;identifying film;positioning pt.andequipment for erect or recumbent views;providingshielding;collimating;making exposures;having radio-graphs processed and reviewed;repeating for full setof views or as ordered;having pt. returned;placingradiographs for use;recording examination.

102

1. Performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, specialconsiderations, and to checkthe completeness of the in-

formation provided.

a. Performer checks the ex-aminations called for in-cluding the parts involved,the affected side, whetherbilateral or unilateralstudies, the requested pa-tient positions and views,the number of exposures,the central beam angda-tion, the area of interestto be included, whetherforeign body localizationor fracture fragment align-ment is required, whetherweight-bearing views arerequested. Notes any re-quest for magnification.Checks the name of the re-ferring physician.

b. Performer reads patient'sname,identification number,sex, age, weight. Noteswhether patient is in-pa-

OK-RP.RR.RR. C ec ere i t

is a master sheet.. X


Task Code No. 358


List Elements Fully

tient, out patient, or emergency pa-tient. Notes any special informationthat will affect patient positioning,technique, or handling of the pa-tient, such as presence of fracture,suspected fracture, presence of plas-ter cast, splints (to be left inplace or removed by a staff physi-cian), whether patient will be on astretcher or wheelchair, and any no-tation on the nature of any knownpathology which would affect techni-que (such as bone infection), and thepurpose of the study.

c. With foreign body notes suspectedlocation and entry site. With stressstudy of ankle notes whether ortho-pedic surgeon or physician mill in-ject local anesthetic and/or posi-tion patient. Notes whether specialaccessories such as film tunnel,spe-cial weight bearing bench with filmslot will be required.

d. Performer checks whether patient iEsuffering from a collateral condi-tion requiring special handling suchas heart disease, communicable orinfectious condition, infirmity, in-coherence; whether patient has IVdrip, oxygen supply, catheters orsimilar devices in place; whetherpatient will be accompanied by nurseor other staff person.

e. If performer is not already assignedto examination room (and a particu-lar machine) notes the room or ma-chine involved. Goes to examinationroom or control room for machine in-volved.

f. If magnification has been requested,performer checks that the machine tobe used has a fractional focal spotof appropriate size for direct magnification technique (i.e. 0.3 mm orsmallei). If patient will be stand-ing on bench or table top (such asfor weight bearing studies) makessure that equipment,particularlyoverhead system,is shock-proof.

103

List Elements Fully

g. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheet iscomplete. Checks whether any spe-cial orders on exposure factors arein keeping with the usual rad expo-sure,involved for the examination.

h. Depending on institutional proce-dures performer may review patientradiation exposure history,priorrecord of techniques used,and cum-ulative exposure. NotiCes whetherexamination has been done elsewherein recent past,whether amount of exposures ordered or done in the pastshould be brought to radiologist'sattention.

i. Depending on institatonal proce-dures performer notes whether fe-male patient is pregnant,reviewsdate of female patient's last men-strual period,or notes any other indication that there is no danger ofexposure of a knowh or possiblefetus. Notes shielding needed.

j. If patient's record indicates or-ders for sedation,injection oflocal anesthetic cr any other priormedication performer may check tim-ing to be sure a proper elapse oftime has occurred for medication totake effect. May notify MD or RNwhen ready. May arrange to delayexamination if appropriate.

k. If referring physician has request-ed that films already on file besent with current radiographs, andif not already with patient's jack-eted material, performer arrangesto have prior films delivered.

2. .If the performer determines that therequest is not properly authorized,is incomplete, or that sufficient in-formation is lackinc for performer toselect technique or to properly posi-tion or care for patient, or if per-former considers that there may be Lontraindications to going ahead with theprocedure, performer notifies super-


This is page

Task Code No. 358



visor, radiologist, or other designatedstaff person,depending on institutionalprocedures. Explains the problem ifappropriate and proceeds after obtain-ing needed information, signature,ororders.

. When performer is clear about what willbe involved in examination, he or sheprepares ahead so as not to keep pa-tient in examination room longer thannecessary:

a. Performer reviews the techniquechart for the machine to be usedand takes note of any.newly postedchanges in technical factors (to re-flect ccomodation for change inmachine output or a policy deci-sion).


c. Performer makes sure that x-rayequipment is ready for use. Goes tocontrol panel for x-ray generatorand checks that indicator lightshows that machine is "warmed up,"or turns on main switch as appro-priate to equipment'and anows timefor machine to"warm up." If appro-priate, performer may set radio-graphy mode selector and set colli-mator control for manual operation.

d. Performer checks that appropriateiMmobilization devices such as sand-bags, wedge sponges, gauze bandage,tape are present and that there isa mattress, pads, pillows and/orblankets for comfort of patient ifpatient will lie on table. .

e. Checks that there is leaded rubbershielding available in room to beused to mask film, protect the pa-tient, and/or to place beneath thefilm holder, as appropriate.

f. Performer prepares for identificg-tics of the films using equLpme'.tprovided by institution:i) May obtain lead numerals and

tape and prepare identificationstrip for placement on filmholder(s) giving appropriatepatient identification informa-tion.

ii) Performer may prepare for useof flashcard by checking thatthere is piece of lead on filmholder surface; may write ortype out ID information on cardif not received with requisi-tion,

iii Checks identification againstrequisition sheet.


g. For weight bearing studies of the

foot performer obtains a low benchconstructed with a slot in the cen-ter to hold film holder vprightwhile patient stands with feet to-gether on either side of film hol-der, or prepares such a bench bytaping blocks together to elevatefeet to tube level.and support filmholder and lead mat. For subtalarjoint studies performer may obtaina filM tunnel (to permit several

separate exposures without reposi-tioning the foot).

4. If magnification has been requested,performer prepares the equipment forthe tube-over table method of magni-fication:

a. Performer determines the degree ofmagnification-requested on the re-quisition sheet; if the request isexpressed as an area magnificationperformer determines the linearmagnification by taking the square

1 0 4

TASK DESCRIPTION SHUT (continued)

This is page

Task Code No. 358


List Elements Fully........s.......mw

List Elements Fully...m......m.....

root. (Linear magnification squared ever the table top in the ap-equals area magnification.) proximate area 1...There the pa-

b. Performer calculates the required tient's area of interest will

distances from target (focal spot) be positioned, such as on table.to object (patient) (TOD), and from ii) Performer swings the table out

object to film (OFD), as well as the of the way so that there is no

distance from target to film (TFD) obstruction between the tube and

(the sum of TOD and OFD): the floor. (Does not changei) If the distance from the table height.) If appropriate,places

top to a film holder placed on a stool on the floor under the

the floor or a stool (OFD) will tube. May place lead shielding

be a relatively inflexible dis- on floor or on stool. May place

tam:, performer measures this film holder of appropriate size

diFtance or reads indicator on floor or stool. Performerscale. (If stool is to be used,may note the table height.) Per-

selects the size film designatedfor the degree of magnification

former may adjust table height and :he selected part to be

to provide for a round number for studied.

the OFD. iii) Performer adjusts the collima-

ii.) If the distance from the focal tion to correspond to the field

spot to the table top (TOD) will size anticipated (fur the TOD

be the relatively inflexible dis- involved).

tance, performer determines what iv) Performer activates the light .. .

this is by measuring or reading the collimator and adjusts theappropriate indicator scale on tube horizontally so that the

tube housing. Performer may ad- light beam cast is centered to

just tube height to provide a the film holder or lead shield-

round number for the TOD. . ing on the stool or floor. Usesiii) Depending on whether the OFD or the cross-hairs projected by the

the TOD is fixed, performer cal- beam to center the tube to the

culates the required complemen- area on the floor or stool.tary distance by referring to a v) Performer locks the tube into

magnification chart for the de- position so that there is a 900

gree of linear magnification re- angle of the beam with the floor

quired, or uses the formula: or stool. Fixes and retains col-

degree of linear magnification limator setting.

equals TFD divided by TOD. For vi) Performer marks the outline of

a two-times linear magnification the collimated light area or

performer simply sets the TOD film holder on the floor or

equal to the OFD. stool or on the lead shielding

iv) Performer adjusts and locks the using tape or other removable

table height and/or the tubeheight to the calculated OFD and

marker. If not already done,checks by placing film holder

TOD. in marked area. May mark center

c. Performer 'aligns the object-film of area as shown by cross-

and target-object distances: hairs.

i) Performer moves the x-ray tube vii) Performer swIngs table back into

housing until it is centered place. Activates light beam in

105


Element Full

Task Code NO. 358


ON

collimator and marks the tabletop where the center ,zross-hairsand light outline are projected(to be used to center the partto be radiographed). Uses tapeor other radiolucent removablemarker.

viii) Performer may recheck TOD andOFD to be sure that they corre-spond to the calculated dis-tances.

d. For magnification technique using avertical film holder, performer maywait until patient has been broughtinto examination room. Adjusts up-right holder to appropriate height;adjusts x-ray tube to right angleprojection of beam to film holder;centers to the film; measures andadjusts mOD to patient's positionand mark, patient's position; mea--sures and adjusts OFD from patient'sposition as marked.

e, If the sum of the new TO5 and OFD(TFD) is now different from tl-e TFDused for non-magnification tecnni-que, performer may consult techniquechart to note the factor to use fora compensatOry change in mAs. Mayrecord for later use in setting ex-posure factors.

f. Performer may also note the changein kVp and mAs necessary to compen-sate for any change in collimationfrom non-magnification technique.Consults appropriate charts for con-version factors. May record.


a. Depending on institutional arrange-ments performer may decide to es-cort out-patient to or from dressingroom. May decide to assist in transporting patient from holding area orhave this done.

IIIMMINMEMOMMS".53M.M.M.. MINNIMMIMMOI.M.M.IIMMMit

List Elements Full

b. Performer greets patient and anyaccompanying staff perscn and in-troduces self. Checks patient'sidentity against the requisition.sheet. With in-patient, checkshospital identification bracelei-or other identifier. If patio.0is accompanied because of ,Jer:U:,us-ness of condition, perform,with accompanying staff illmber onany special precautions necessaryduring procedure.

c. Has patient assume a comfortableposition seated on table or chair.If patient is in wheelchair, movespatient in chair into position nextto table. If patient is on specialstretcher, places stretcher intoposition so:that radiolucentstretcher can be lifted with pa-tient on it from wheeled base tox-ray table Otherwise arranges ifnecessary to move patient to tableor use upright film holder with pa-tient remaining on stretcher.


e. Performer answers patient's non-medical questions honestly;attempts toreassure patient and develop confi-dence. Treats patient with dignityand concern regardless of patient'sbehavior. Remains aware that patienmay be frightened and/Or in pain.Performer explains when askee medi-cal questions that it is not appro-priate for technologist to answerthese; encourages patient to speakto physician.

f. If patient has an IV drip in place,performer checks that needle hasnot become dislodged-and that thefluid is dripping at an even rate.If there are any problems, perform-

106


Task Code No. 358


List Elosents Full

er clamps tube and notifies'appro-priate staff member at once.

g. If appropriate and not already done,performer questions female patientof child bearing age regarding pos-sible pregnancy. If there is anypossibility that patient is preg-nant and this has not already beenrecordea, performer informs appro-priate physician and proceeds onlywith approval.

6. Performer questions patient and/or RNor MD present on what movement is pos-sible in the affected extremity and onthe opposite side; may question patientabout any injury or pain to determinewhat mobility is possible and what po-sitions are available for use.

a. Performer evaluates whether patientshould be seated on a chair on x-raytable or on floor, or should be re-cumbent on table. With cardiac con-ditIon chooses seatea or recumbentposition over standing position.

b. Performer evaluates whether patientcan tolerate having the affectedpart placed flat on film holder orrequires ...lternative positioningwith use of an angulation block.

c. Determines whether conventionalflexion can be utilized in thejoints involved, and whether filmholders can be placed in conven-tional positions or need to be usedin upright holders or supported byangle wedges. If movement is limitedor fracture is suspected, performerdecides on alternative x-ray tubeand patient positions to use toaccomplish the equivalent radio-graphy with a minimum of movementby the patient. May decide to useupright film holder in appropriatepositions to accomplish this.

d. Performer considers the number andtypes of projections ordered for the

examination and the patient's con-dition. Performer may consider achange from standard projectionsto better accomplish the purpose .

of the exaurInation, or deletion of

a position 3r a change in technical

factors. Depending on institutionalarrangements, performer may obtainpermission from appropriate radio-logist or decides personally to .

alter the standard procedure.

7. Performer selects speed,type of film,

cassette or nonscreen film holders,or

prepared packets of dental or occlu-sal film,depanding on institutionalpractice; selects film and holdersizes based on the size of the partand the number of exposures planned

for each film. Considers the areasto be included on film, whether bi-lateral (side-by-side), and the needsof magnification technique. Performermakes sure that an adequate supply*I loaded cassettes or film holders

the sizes Selected are availablein the examination room. If not,arranges to obtain or decides to ob-

tain personally.

8. Performer prepares for the examina-

tion:

a. Performer obtains the appropriatesize loaded non-screen film holder

or cassette for the first projec-

tion.b. If several views will be taken on

one film, performer mentally de-cides how these will be positionedso that the film need not be turned

for viewing each image. Performeruses leaded rubber sheets andmasks the film holder completelyexcept for the area to be exposed.For weight bearing studies of thefoot performer masks the lower haif

of the film holder.Performer treatsthe area tc be.exposed from this


Task Code No. 358

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point as though it were the actualfilm size.

c. Performer attaches identificationinformation to the film holder ortable top:i) Piaces right or left marker on


ii) If patient's identification in-formation is in the form of leadnumerals, performer places on ap-propriate corner of film holder.

iii) If patient's identification in-formation is to be entered byuse of flasher, sets flashcardaside for later use with spacecreated by piece of leaded rubberon appropriate edge of holder.


d. Performer places the film holder ina position that can be comfortablyreached by the patient in final po-sitioning. May place leaded rubbersheet under film holder.i) If magnification technique is to

be used, performer places filmholder in marked position onfloor or stool.

ii) If appropriate to make possibleminimal movement of patient,performer may place uprightholder at right angles to tabletop or in ether position to holdfilm.

e. If not already done, has patient re-move shoes and hose from both feet;may arrange to have patient's be-longings checked or decides to dopersonally.

f. If the study relates to a singletoe, performer may tape or u$e

-ist Elements Full

gauze to hold the toe or toesother than the one being examinedin a flexed position to avoidbeing superimposed in the view.

g. If thPre is a splint or cast on aninjured area, performer has RN orMD carry out any orders on re-moval. If there is a wet dressing,performer has it reinforced or de-cides to do personally.

h. Performer provides patient andeveryone who will remain in roomduring exposure with protectiveshielding. Explains if necessarythat this is not cauSe for alarmbut a general precaution to mini-mize unnecessary radiation ex-posure.

9. Performer has patient assume a com-fortable recumbent, seated, or stand-ing nooition depending on the posi-tions to be employee., so that the.part(s) to be radiographed can bemeasured in position.

7

a. If appropriate, plat:es mattress,pillow or clean linen on x-raytable.

b. performer may decide to assist pa-tient from wheelchair or stretcherto table or has this done. Mayobtain help. Makes sure that no ,

equipment is in the way and may becollided.ulth by patient.

c. If assisting patient step onfootstool in order to get on table,helps patient turn into position,step back5iards on stool, and thensit end/or lie on table.

d. Performer uses centineter calipersto measure the thickness of thepart(s) to be radiographed in thedirection in which the central rayof the x-ray beam will pass throughthe centered part from tube tofilm. Records for use in determin-ing exposure factors.

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Task Code No. 358


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e. After measuring,has patient restin as relaxed a position as pos-sible. May place pad, blanket orpillow under bony prominances toprovide comfort.

10. Performer selects the exposure factorsfor the first projection by consultingthe technique chart(s) posted for themachine:

a. Locates the information needed forthe body part and projection in-volved according to the centimeterthickness of the part as measuredand the collimated field size tobe used. Makes Sure that techniquerelates to the combination of filmtype and speed and use or nonuse ofother accessories.

b. Makes note of the kVp, mA,T(secondsof exposure time),focal spot size,and the focal film distance (TFD orFFD) called for.

c. Once the standard kVp, mA and timeare determined, performer noteswhether any conversions are neces-sary to account for a pathologicalcondition, a change in TFD, thepreference of the radiologist in-volved, and any other conversionneeded such as with magnificationtechnique. Performer looks up nu-merical conversion factors and cal-culates,or uses conversion chartsto ascertain the appropriate newexposure factor 'N.Vp, mA and/ortime). Multiplies, divides,adds,or subtracts as appropriate.

d. Performer checks any new or unfam-iliar exposure factors against theposted limits of the x-ray tube ona tube rating chart to be sure thattechnique does not exceed the heatcapacities of the tube for thefocal spot size to be used. If ap-propriate, performer reconverts thetechnique to an equivalent outputusing higher kVP and lower mAs.

1iU

11.

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b. If appropriate,checks line voltagemeter and, if needed, turns com-pensator dial until needle isaligned properly on line meter.

c. Performer sets milliamperage bychoosing selectors for the cor-rect focal spot size; sets themA selected.

d. Performer selects and sets theexposure time that will producethe mAs desired.

e. Pf.trformer sets the kVp selectedby choosing the combination ofmajor kilvvoltage and minor kilo-voltage settings to produce thedesired kVp.

f. Depending on the equipment, may setcontrols to provide for manualtableside adjustment of tableand tube height, position, and ofcollimation (unless these have al-ready been set,as with magnifica-tion technique).

g. Performer returns to overhead unitand sets the focal-film distance(if not already done, as with mag-nification technique). Operatescontrols or manually moves thex-ray tube into place over the filmholder (or at right angles to up-right holder). Checks the focal-film distance by reading indicatorscale in the tube housing; adjustsup or down until the required FFDis obtained.

. Performer plau:s the part to be ra-diographed in the'final position se-lected for the first exposure. Makes'..sure that correct foot and part are


Task Code No. 358



being positioned. For young patientsmay plan to film unaffected side forcomparison. Centers part and keeps the,long axis of the part parallel to thefilm holder. May explain or demonstrateto patient what is required. May obtainhelp in positioning. Positions as fol-lows (unless nonconventional position-ing is being used):

a. For the toes, performer centers withreference to the distal ends of themetatarsal bones so that the centralray will enter the film verticallyat the secor.1 metatarsophalangealjoint of an affected toe or of thethird toe if all the toes are to beradiographed.

Performer has the patient lie in aprone or supine position, dependingon the projection, or seated ap-propriately.i) For AP or dorsoplantar (superior

surface of foot-to-sole) projec-tion (posterior or plantodorpalview) performer has the patientflex the knee and place the soleof the foot on the film holderso that the particular toe (orall the toes) is (are) centeredon the film holder (or the un-masked area). May use sponge be-tween knees and/or compressionband to support and immobilize.Performer may place a 15° foamwedge under the foot and abovethe film holder so that the toesare elevated near the base of thewedge.

ii) For' PA or plantodorsal (sole offoot-to-superior surface) pro-jection (anterior or dorsoplan-tar view) performer has patientassume a prone position with thetoes elevated on small sandbagsso that the toes are in a hori-zontal plane.

Performer places film holderunder toes with midline parallelto the long axis of the foot andcentered appropriately.

iii) For oblique projection performerpositions as for AP projection.Then has patient rotate foot andleg internally or externally for450 depending on the toe(s) in-volved. May use a foam wedge.Supports elevated heel withsandbag and immobilizes.

iv) For a lateral projection per-former has the patient assume alateral recumbent position onthe unaffected side. Has pa-tient extend the affected ex-tremity while performer supportswith sandbags. With great toeperformer rotates the foot as'necessary to obtain a true lat-eral position; immobilizes. Forlesser toes, adjusts to truelateral position on film holderor places the film packet ofdental or occlusal film,pebbledside up, between the toe beingexamined and the lower adjacenttoe; adjusts foot so that toeand film are in horizontal posi-tion and supports elevated heel.

b. For the first metatarsophalangealjoint and sesamoid bones, performrer centers with reference to thefirst metatarsophalangeal joint.i) For axial projection performer

has patient lie prone on thex-ray table. Elevates the ankleon the affected side and putsa folded towel or pad under theknee. Has patient rest thegreat toe on the table whiledorsiflexing the first joint.Adjusts so that the ball of thefoot is at right angles to thelong axis of the big toe. Per-former places a packet of oc-

110

" TASK DESCRIPTION SHEET (continued)

Task Code No. 358



clusal film in contact with theundersurface of the ball of thefoot, centers, and supports witha sandbag.

Performer may seat the patienton the table and adjust foot sothat the medial border is verti-cal and the sole of the foot isat a 75° angle with the filmholder. Performer has patientflex toes and tapes into posi-tion.

ii) For lateromedial projection per-former has patient lie in a lat-eral recumbent position on theunaffected side with knees flex-ed. Partially extends the extrem-ity under study and places sand-bags under knee and foot so thatthe foot is in the lateral posi-tion and the metatarsophalangealjoint is at right angles with thetable. Places a packet of occlu-sal film under the lower meta-tarsal region and centers. Im-mobilizes foot. Performer adjuststhe x-ray tube so that the cen-tral ray will enter the promi-nence of the first metatarso-phalangeal joint at an angle of40° cephalad.

c. For the foot,performer centers withreference to the appropriate meta-tarsal bone. Makes sure that patientis rehearsed for complicated proce-dures,such as with request for pes-planus or pes-cavus films for de-formity of the longitudinal arch(for which performer makes weight-bearing composite AP (dorsoplantar)projection involving two exposureswithout movement of the part orfilm,and makes lateral weight-bear-ing axial projection with one ex-posure of each foot with patientstanding on special bench). If re-

quest is for foreign body localiza-tion or position or alignment offracture fragments,performer makesAP (dorsoplantar) and lateral pro-jections. For foreign body.locali-zation performer determines thepoint of entry and tapes a smalllead marker over the point..i) For AP (dorsoplantar) projection

to obtain posterior (plantodor-sal) view,performer has patientseated on chair or table or ly-ing on table in supine position.Has patient flex knee on af-fected side so that the sole ofthe foot rests on the table,cen-tered on film holder to theproximal end of the third meta-tarsal, with long axis of filmand foot parallel. As an alter-native, performer may hold filmholder in contact with the plan-tar surface of the foot using anangulation block. Performer usessponges and/or compression bandsto immobilize; may place a non-skid mat to keep film holderfrom slipping on table. Depend-ing on orders, positions tubeto enter centered part at rightangles to film or at 15° ceph-alad.

.ii) For lateral projection performerplaces patient in recumbent po-sition,preferably with the me-dial side of the foot in contactwith the film holder (laterome-dial projection and mediolateralview). Elevates the knee so thatthe patella is at right angleswith the table and plantar sur-face of foot is perpendicular tofilm. Centers film holder toproximal end of fifth metatar-sal with long axis of film andfoot parallel. If the lateralside of the foot will be in con-


Task Code No. 358

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tact with film,has patient dorsi-flex foot enough to accomplishsimilar positioning. Immobilizesas appropriate.

iii) For composite weight-bearingdorsoplantar (AP) projection(giving an axial view of thefoot), performer has patientstand erect on floor or table de-pending on equipment. Instructspatient not to touch any over-head mechanism and repeats in-structions on holding foot beingstudied in place for two expo-sures, one with unaffected footplaced one step behind, andsulthsecond exposure,with unaffectedfoot placed one step before thefoot being studied. Places filmholder in position centered underthe foot. For first exposureplaces x-ray tube in front of pa-tient with a posterior angulationof 15° centered to the scaphoid.For the second exposure, withfoot and film unmoved, placesx-ray tube behind patient withan anterior angulation of 25°centered to the posterior sur-face of the ankle.

iv) For lateral weight-bearing viewof longitudinal arch, performertakes film holder which has beenmasked on lower half and placesin film well of special bench orbetween prepared blocks. In-structs patient not to touchoverhead equipment and has pa-tient stand erect on bench orblocks with the unmasked filmbetween feet, and weight equallybalanced on both feet. Centersfilm holder to the base of thefifth metatarsal of the feet. In-.structs patient to retain posi-tion after first exposure so that

..

film can be removed, reversed,remasked,and reinserted forsecond view of other foot. Per-former adjusts tEe tube to thefoot being radiographed so thatit is horizontal and so that thecentra/ ray enters the lateralsurface at right angles to thefilm at the centered point.

v) For oblique projection (obliqueplantodor,sal) performer placesthe patient in lateral recumbentposition on the affected sidewith knees flexed. Has patientextend the affected leg and ro-tate foot laterally until thesole forms a 45° angle with, theplane of the film. May have pa-tient assume prone position withaffected foot elevated on sand-bags and dorsal surface restingon film holder. Rotates heelmedially or laterally dependingon the metatarsal interspacesto be viewed.

For oblique dorsoplantor projec-tion has patient lie in supineposition, flex knee of affectedside and place sole of foot ontable on film holder. Then haspatient rotate leg medially orlaterally as appropriate. Sup-ports elevated side of foot.

d. For the subtalarjoint, performernotes which joint surfaces (ante-rior, middle and/or posterior ar-ticulations) are to be shown.i) For anterior subtalar articula-

tion, oblique lateral projec-tion, performer has patienttake semisupine or seated posi-tion and turn away from affectedside. Has patient flex knee onaffected side, place ankle jointin near right-angle flexion andlean leg and foot medially. Ad-justs leg so that long axis is

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Task Code No. 358



in line with long axis of foot. top where the film holder willSupports the knee and places foam be placed so that after the footwedge under each side of the foot is positioned (on the tunnel)and ankle. Adjusts tube so that for a given projection a sep-central ray enters vertically arate film can be used for eachsomewhet distal and anterior to exposure without repositioningthe lateral malleolus. foot. Has patient assume a su-

ii) For middle articulation, oblique pine position with supportlateral projection, has patient under each knee and unaffectedlie on affected side in lateral ankle. Performer loops a striprecumbent position with unaffect- of bandage around the ball ofed knee comfortably flexed and the foot and has patient pullsupported. Has patient extend theaffected foot. Centers on film

this to dorsiflex foot and main-tai right-angle flexion at then

I

holder so-that ball of foot isangled forward about 25°. Ele-

ankle joint.

vates heel and immobilizes foot. For lateral oblique projections

Directs central ray to ankle has patient rotate leg and foot

joint at eccentric angle of 50 45° laterally in right-angleanterior, 23° distal. flexion and provides support.

iii) For medial oblique axial projec- Angles central beam 15° cranial-tion of middle articulation has ly 'for first exposure with cen-

patient seated on table with tral ray directed somewhat dis-weight on unaffected side and tal and anterior to medial mal-hip and thigh flexed or semire- leolus. For subsequent exposures

cumbent. Has patient rotate legand foot medially and rest side

changes angulation as ordered.

of foot and ankle against foam For medial oblique projectionswedge. Provides support for rotates as above but in medialknee. Has patient maintain a dirLction and centers centraldorsiflexed position by pulling ray towards midpoint of imagi-

on a bandage strip that perform- nary line between the most prom-er loops around ball of the foot. . inert point of the lateral mal-

leolus and the base of the fifthFor lateral oblique axial pro-jection of posterior articula-

metatarsal. Adjusts tube 40°,30°, 20°, and 10° cephalad for

tion,performer positions as in the series of projections or as(ii), above, or as just describ- ordered.ed, but with lateral rotation in- e. For the calcaneus (os calcis) (bi-stead of medial. Directs central lateral: calcanei), performer noteray somewhat distal to medial whether patient is to be studiedmalleolus at 10° cephalad for bilaterally (both feet on oneboth lateral or medial oblique view) or unilaterally, and whetherview,

iv) If request is for right anglea weight bearing view is required.If so, instructs patient not to

oblique views at different cen- touch any overhead apparatus.

tral ray angulations,performer i) For plantodorsal (PA)projectionplaces a film tunnel on table performer has patient assume a

-

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supine or seated position withboth legs fully extended (for bi-lateral study). Centers filmholder under ankles to includeboth joints. Performer loops astrip of gauze bandage around theballs of the feet and has patientpull so that'ankles are at rightangle dorsiflexion. If this isnot possible, performer elevatesextremities to obtain positionin which the soles of the feetare at right angles to table top.Angles tube at 400 cephalad tothe soles of the feet, enteringthe plantar surfaces at the baseof the fifth metatarsals.

ii) For recumbent dorsoplantar (AP)projection has patient assumeprone position with both legsfully extended (for bilateralstudy). Elevates ankles so thatsoles are at right angles totable,and places vertical filmholder against soles of feet.Centers as above and so that cen-tral ray is at 40° with plane offilm.

iii) For weight bearing dorsc.plantarprojection has patient stand onfilm holder. For unilateral studyhas patient place opposite footone step forward. Centers film tolong axis of calcaneus with pos-terior surface of heel(s) at edgeof film. Places tube at 450 an-terior directed through poster-ior surface as described above.

iv) For lateral projection has pa-tient lie on affected side withknees flexed. Has patient par-tially extend affected extremity.Centers calcaneus over center offilm and rotates until a truelateral is obtained with longaxis of film parallel with plan-tar surface of heel. Directs cen-tral ray at right angles to thefilm holder at center of art.

List Elements Fully

f. For the ankle (tarsus) performernotes whether the projections re-quested involve stress studies. Ifso, may have orthopedic surgeon orother physician adjust foot intostress position and hold, strap orindicate to performer that patientcan hold position using bandagestrip looped around ball of foot.i) For stressed AP projection(s)

(posterior views) performerusually works with patient al-ready positioned (seated) ontable with leg extended. If ap-propriate, loops gauze aroundball of foot. Has plantar sur-face of foot at right angles tofilm holder. Has patient holdbandage so that foot is invertedas much as possible for inver-sion study,or everted for ever-sion study. Supports knee andbraces plantar surface. Centersray at right angles to filmthrough the midportion of theankle mortise in line with thetip of the medial malleolus.

ii) For oblique views of the ankleperforner has patient take su-pine position. Centers film holder to the ankle joint. Rotatesentire leg and thigh to 450 ex-ternally for a lateral obliqueprojection. For medial obliqueelevates hip and rotates leg andthigh 45° internally. For "mor-tise" oblique rotates leg inter-nally until tbe medial and lat-eral malleoli are parallel tothe film holder. Uses foam wedgeand sandbags to support. Usesstrip bandage around ball offoot and held by patient to dor-siflex the foot.

iii) For AP projection (posteriorview) has patient move extendedleg (while seated or supine)into AP position with foot

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Task Code No. 358



g.

slightly inverted but without anyrotation of leg. Supports kneesand keeps plantar surface atright angles to film holder. Mayuse bandage held by patient loop-ed around ball of foot to sup-port. Centers to joint and di-rects central ray at right anglesto film holder entering midwaybetween malleoli.

iv) For lateral projection performerattempts to position patient sothat the medial side of the anklewill be in contact with film holder. With patient supine, has pa-tient turn away from affectedside. Has patient turn so thatpatella is at right angles totable top. Supports knee. If thelateral side will be in contactwith film holder has patient lieon affected side in lateral re-cumbent position, assume similarposition and dorsiflex foot. Cen-ters to joint or ,3 ordered soas to include the requested areaof the leg and/or calcaneus. Di-rects central ray at right anglesto joint and film holder.

If, during positioning, patient showssigns of severe pain, performer maynotify appropriate physician at onceand await orders or may decide on al-ternative positioning to avoid move-ment of the affected part.

13. Performer checks final positioning byusing light in collimator. Activatesthe collimator light and points thelight beam towards the part. Adjuststhe collimator opening to correspondto the film size (or the size of theunshielded area of the film to be ex-posed).

Checks that primary beam will enterthe center of the area of interest atright angles to the film (or selected

115

angle) so as to project the view de-sired. For the first View of a seriesmay mark a point on the part that iseven with the center of the film hold-er for use in lining up subsequentviews. May readjust tube positionlengthwise or crosswise to providebetter centering. Uses cross-hairshadows as reference for center offield.

14. Once the patient has been positionedand immobilized performer adjusts thecollimator. Either collimates so thata small unexposed border will appeararound the edge of the film or colli-mates further so as to expose onlythe area of interest (and thus providemaximum protection and detail). If ap-propriate, performer may attach auxil-iary extension cones to collimatorto further reduce the prithary beam.

15. Performer may add lead shielding toareas that will be in the primary pathof the beam but are not included inthe areas of interest. MAikes surethat protective shielding has been provided to everyone who will remain inroom.

16. Throughout procedure performer ob-serves patient for any signs of emer-gency and/or.to prevent or respond toan accident. Is alert to.signs of nau-sea, dizziness, or sweat suggestingfaintness. Performer may have patientlie down, lower head or raise legs.Notifies nurse. If patient shows anyother emergency signs, loses consci-ousness,or has an accident, performercalls appropriate physician. or nurseat once. May decide to provide emer-gency first aid as well.

17. When everything is ready for the ex-posure, performer explains to patientthe need to keep perfectly still when

11111


Task Code No. 358



indicated by performer and until toldto relax. Performer observes the pa-tient's movement until the moment thatthe exposure is made. Readjusts posi-tion if warranted.

18. The'performer returns to control room.Makes sure controls are properly setand patient is still in position. Tellspatient when to hold still by callingor using intercom. Performer initiatesexposure by pressing hand trigger orexposure control button.

a. While exposure is underway performerchecks that mA meter records appro-priate current as set, that kVpmeter dips slightly.

b. May watch for evidence of malfunc-tion such as line surge or excessivedrop; may listen for sound of normalfunctioning of equipment. If thereis malfunction,may decide to report;anticipates need to repeat exposure.

c. After exposure is completed tellspatient that he or she can relax(unless composite exposure is to bemade).

d. If exposure is terminated by circuitbreaker, rechecks technical factorsfor possible overload or checks foroverload elsewhere on circuit. An-ticipates need to repeat exposure.

19. Performer returns to patient. Removeafilm holder from its location (exceptfor composite exposure).

a. Removes any markers for further use.If multiple views are to be taken onthe film, removes leaded rubber maskand remasks all but next area to beexposed. With weight bearing studymasks other side and reverses infilm holder well.

b. If the patient is being examined forpossible fracture or if so request-ed, performer arranges to have the

20.

first exposure processed at onceand brought to the'appropriateradiologist.

c. Depending-on whether radiologistwill evaluate radiographs beforecompletion of all possible expos-ures for the series, performer ar-ranges to process film(s) andevaluate fot quality control per-sonally, have this done, or bringto dark room for processing andlater evaluation, based on time.available, institutional arrange-ments or specific instructions.Attaches ID card for use withflasher if appropriate. May signrequisition.

d. While films are being processedand/or evaluated performer has pa-tient relax in examination room orholding area. Explains what will'happen next.i) Performer determines whether pa-

tient should remain on tableand/or in room, whether patientrequires observation. If appro-priate, arranges to have patientattended while waiting.

ii) If patient is to leave table orrise, performer makes sure allequipment.is moved away from pa-tient such as overhead tube andupright film holder.

iii) May decide to assist patient tochair or stretcher r from chairor table. Makes sure to remindpatient of any footrest whenstepping off table.

When (or if) performer learns from theradiologist the extent of the injuryand/or whether further conventionalviews and/or positions can be under-taken, eliminated, or altered, per-former proceeds as appropriate accord-ing to instructions.

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Task Code No. 358



22. Performer carries out terminationa. For further exposures performer rs-peats appropriate steps for next steps for the examination:view(s) including identification offilm holder and use of R-L marker,selection and setting of technique

a. Performer has equipment and exami-nation table cleaned after use or

for next view (if different), po- decides to do personally, depend-sitioning patient and equipment for ing on institutional arrangements.focus-object-film alignment, proper b. Performer records the examinationcollimation and shielding, and mak- according to institutional proce-ing exposure as described above. For dures. May include date, room, ex-multiple exposures on one film,keeps amination type, the views taken,R-L reference point constant;centers the technical factors used andusing the point marked earlier on film size; may record the numberthe part to line up with center of of exposures made of each view in-film. cluding retakes; may enter the

b. Performer refrains from commenting estimated radiation dose to whichon the films or providing any inter- patient was exposed (using postedpretation. information on dosage); may record

c. If performer is asked to repeat any any problem with equipment, anyexposures, makes sure that the ad- special care provided patient. Ifditional exposures are warranted any views called for in the ini-medically, since additional radia- tial request could not be ob-tion will be incurred,l.) Notes whether need to repeat is

tained performer may record rea-sons. Signs requisition sheet.

due to performer's own negligence c. Performer may decide to jacketor lack of attention so that per- films, requisition sheets, and re-former can avoid future "related =Aerials and/or have infor-takes." mation recorded in log book per-

ii) If request for retakes reflects sonally or have this done, depend-malfunctioning equipment per- ing on institutional procedures.former reports malfunction to d. May indicate to appropriate staffappropriate staff member. person when the performer is

iii) If request for retakes reflects . ready to proceed with next exami-the preference for density or nation.contrast of a radiologist, per-former notes for future workdone for the given radiologistso that retakes can be avoided.

.

21. When performer is sure that the exami-nation has been completed, performermay have patient transported back toholding area or next location or de-cides to do personally, as appropri-ate. Makes sure that none of the equip-ment is projecting over the patient be-fore allowing to rise.patient

I Mr lISVEMMINIA


Task Code No. 359



Requisition reviewed;pt. reassured,positioned:partmeasured;films identified;technical factors selectedand set;technique for magnification and/or multipleviews set up;exposures made;radiographs sent forprocessing and evaluation;procedures repeated asappropriate for full set of views;patient returned;examination recorded;radiographs placed for use.



Pt.'s x-ray requisition sheet,ID card,ID bracelet,technical history;pen;x-ray machine control pan-el(s),tube,bucky,table,collimator,extension cones;technique chart;charts for conversion of technique,standard examination views,dosage,tube capacity;loaded cassettes or nonscreen film holders;verticalfilm holder;leaded rubber shielding;R and L and IDmarkers;immobilization devices;stool;calipers;tape;scissors;stretcher or wheelchair;bandage;elevationbox;protractor

3. Is there a recipient, respondent or co-workerinvolved_12.the task? Yes..,0C) No... )

7777717h.to 4777mkame the kind of recipientrespondent or co-worker involved, with de-


requirements or legal restrictions.Non-infant patient to be radiographed; radiologictechnologist;radiologist;nurse

P---77NTnmele task so that the answers to ques-tions 1-4 are reflected. Underline essen-

tial words.Taking plain film radiographs of leg(s),knees) and/or femur(s) of non-infant patient by reviewingrequest;reporting observed contraindications;reas-suring pt.;measuring part;setting up for multipleviews and/or magnification technique;selecting andsetting technical factors;identifying film;position-ing pt. and equipment for seated (Yr recumbent expo-sure;providing shielding;collimating;making expo-surer;having radiographs processed and reviewed;re-peating for full set of views or as ordered;havingpt. returned;placing radiographs for use;recordingexamination.

118

Performer receives or obtainsthe x-ray requisition form, pa-tient's identification card, andany appropriate medical-techni-cal history for a non-tnfantpatient scheduled for radio-graphy of the leg(s), knee(s)and/or,femur(s):




The plain films of the knees mayserve as preliminary "scout"films for knee arthrography (acontrast study); the plain filmsof the femur(s) may be part of abone-survey.

1. performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, specialconsiderations, and to checkthe completeness of the in-formation provided.

a. Performer checks the ex-aminations called for in-cluding the parts involved,the affected side, whetherbilateral or unilateralstudies are requested,thepatient positions and viewcalled for, the number ofexposures,the central beamangulation,the area of in-terest and joints to be ieluded, the requested angulation of the leg,whetherknown or suspected frac-tures are involved, or de-

OK-RP;RR;1:

6. Check here athisis a master sheet..


Task Code No. 359

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structive disease, and the sites.Notes any request for magnification.Checks the name of the referringphysician.

b. Performer reads patient's name, iden-tification number, sex, age, weight.Notes whether patient is in-patient, out-patient, or emergencypatient. Notes any special informa-,tion that will affect patient posi-tioning, tech17:ue, or handling ofthe patient, such as presence ofplaster cast, splints (to be left inplace or removed by a staff physi-cian), whether patient will be on astretcher or wheelchair, and any no-nation on the nature of any knownpathology which would affect techni-que (such as 'bone infection), and thepurpose of the study.

c. If an axial projection of the patellais ordered, performer checks whethera transverse fracture of the patellahas been ruled out.or arranges tohave this done by planning to take alateral view of knee and awaitingresults. (Does not proceed with ro-sitioning for axial projection unlessthere is no danger of fragment dis-placement.)

d. Performer checks whether patient issuffering from a collateral condi-tion requiring special handling suchas heart disease, communicable orinfectious condition, infirmity, in-coherence; whether patient has rydrip, oxygen supply, catheters orsimilar devices in place; whetherpatient will be accompanied by nurseor other staff person.

e. If performer is not already assignedto examination room (and a particu-lar machine) notes the room or ma-chine involved. Goes to examivationroam or control room for machine in-volved.

f. If Magnification has been requested,performer checks that the machine to

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be used has a fractional focal spotof appropriate size for direct mag-nification technique (i.e. 0.3 mmor smaller).

g. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheet iscomplete. Checks whether any spec-ial orders on exposure factors arein keeping with the usual rad ex-posure involved for the examination.

h. Depending on institutinnal proce-dures performer nay review patient'dradiation exposure history, priorrecord of techniques used, and cu-mulative exposure. Notices whetherexamination has been done elsewherein recent past, whether patient'sradiographic exposure history shouldbe brought to radiologist's atten-tion.

i. Depending on institutional proce-dures performer notes whether fe-male patient is pregnant, reviewsdate of female patient's last men-strual period, or notes any otherindication that there is no dangerof exposure of a known or possiblefetus. Notes shielding'neeried.

j. If patient's record indicatFs or-ders for sedation or any ot.herprior medication performer maycheck timing to be sure a properelapse of time has occurred formedication to take effect. Nay ar-rqnge to delay examination if ap-propriate.

k If referring physician has request-ed that films already on ftle besent with current radiographs, andif not already with patient's jack-eted material, performer arrangesto have prior films delivered.

2. If the performer determines that therequest is not properly authorized, is

. incomplete, or that-sufficient infor-mation is lacking for performer to

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select technique or to properly posi-tion or care for patient, or if per-former considers that there may becontraindications to going ahead withthe procedure, performer notifiessupervisor, radiologist, or other des-ignated staEf person, depending oninstitutional procedures. Explainsthe problem if appropriate and pro-ceeds after obtaining needed informa-tion, signature or orders.

3. When performer is clear about what willbe involved in examination, he or sheprepares ahead so as not to keep pa-tient in examination room longer thannecessary:

a. Performer reviews the techniquechart for the machine to be usedand takes note of any newly postedchanges in technical factors (to re-flect accommodation for change inmachine output or a policy decision).

b. Performer washes hands as appropri-ate; depending on patient's condirtion, may decide to arrange for orcarry out isolation or decontamina-tion techniques.

c. Performer makes sure that x-rayequipment is ready for use. Goes tocontrol panel for x-ray generatorand checks that indicator lightshows that machine is "warmed up,"or turns on main switch as appropri-ate to equipment and allows time formachine to "warm up." If appropri-an, performer may set radiographymode selector and set collimatorcontrol for manual operation.

d. Performer checks that appropriateimmobilization devices such as sand-bags, wedge sponges, gauze bandage,tape are present and that there isa mattress, pads, pillows and/orblankets for comfort of patient ifpatient will lie or table. If appro-priate, obtains protractor for set-

ting leg angulation, and a pre-pared cushion or box for highelevation in kaee study.

e. Checks that there is leaded rubbershielding available in room to beused to mask film, protect the pa-tient, and/or place beneath thefilm holder, as appropriate.

f. Performer prepares for identifica-tion of the films using equipmentprovided by institution:i) May obtain lead numerals and

tape and prepare identificationstrip for placement on filmholder(s) giving appropriate pa-tient identification information.

ii) Performer may prepare for use offlashcard by checking that thereis piece of lead on film holdersurface; may write or type outID information on card if notreceived with requisition.



4. If magnification has been requested,performer prepares the equipment forthe tube-over-table method of magni-ficaion (used without bucky):a. Performer determines the degree of

magnification requested on the re-quisition sheet; if the request isexpressed as an area magnificationperformer determines the linearmagnification by taking the squareroot. (Linear magnificationsquared equals area magnifica-tion.)

b. Performer calculates the re-quired distances from target (fo-cal spot) to object (patient)(TOD), and from object to film(OFD), as well as the distancefrom target to film (TFD) (thesum of TOD and OFD):

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/

i) If the distance from the tabletop to a film holder placed on .

the floor or a stool (OFD) willbe a relatively inflexible dis-tance, performer measures thisdistance or reads indicatorsc...le. (If stool is to be used,may note the table height.) Per-former may adjust table heightto provide for a round number forthe OFD.

ii) If the distance from the focalspot to the table top (DOD) willbe the relatively inflexible dis-tance, performer determines whatthis is by measuring or readingappropriate indicator scale ontube housing. Performer may ad-just tube height to provide around number for the TOD.

iii) Depending on whethei 4.he OFD orthe TOD is fixed, pacColmer cal-culates the required camplemen-tary discance by referring to amagnification chart for the de-gree of linear magnification re-quired, or uses the formula:degree of linear magnificationequals TFD divided by TOD. Fora two-times linear magnificationperformer simply sets the TODequal to the OFD.



housing until it is centered overthe table top in the approximatearea where the patient's area ofinterest will be positioned, suchas on table.

ii) Performer swings the table out ofthe way Eo that there is no ob-struction between the tube and thefloor. (Does not change height.)

If appropriate, places a stoolon the floor under the tube. Mayplace lead shielding on floor oron stool. May place film holderof appropriate size on floor orstool. Performer selects thesize film designated for the de-gree of magnification and theselected part to be studied.

iii) Performer adjusts the collima-tion to correspond to the fieldsize anticIpated (for_the TODinvolved).

iv) Performer activates the light inthe collimator and adjusts thetube horizontally so that thelight beam cast is centered tothe film holder or lead shield-ing on the stool or floor. Usesthe cross-hairs projected by thebeam to ,..onter the tube to thearea on the floor or stool.

v) Performer locks the tube intoposition so that there is a 90°angle of the beam with the flooror stool. Fixes and retains col-limator setting.

vi) Performer marks the outline ofthe collimated light area orfilm holder on the floor orstool or on the lead shieldingusing tape or other removablemarker. If not already done,checks by placing film holderin marked area. May mark centerof area as shown by cross-hairs. 1

vii) Performer swings table back.intoplace. Activates light beam incollimator and marks the tabletop where the center cross-hairsand light outline are projected(to be used to center the partto be radiographed). Uses tapeor other radiolucent removablemarker.

viii) Performer may recheck TOD andOFD to be sure that they corre-spond to the calculated dis-tances._________ .

I.

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d. For magnification technique using avertical film holder, performer maywait until patient has been broughtinto examination room. Adjusts up-right holder to appropriate height;adjusts x-ray tube to right angleprojection of beam to film holder;centers to the film; measures andadjusts TOD to patient's positionand marks patient's position; mea-sures and adjusts OFD from patient'position as narked.

e. If the sum of the new TOD and OFD(TFD) is ow different from the TFDused for non-marnification techni-que, performer may consult techniquechart to note the factor to use fora compensatory change in mAs. Nayrecord for later use in setting ex-posure factors.

f. Performer may also note the changein kVp and mAs necessary to compen-.sate for any change in collimationfrom non-magnification technique.Consults appropriate charts for con-version factors. May record.


a. Depending on institutional arrange-ments performer may decide to es-cort out-patient to or from.dressingroom. May decide to assist in trans-porting patient from holding area orhave this done.Performer greets patient and any ac-companying staff person and intro-duces Pelf. Checks patient's iden-tity against the requisition sheet.With in-pitient, checks hospitalidentification bracelet or otheridentifier. If patient is accompaniedbecause of seriousness .of condition,performer checks with accompanyingstaff member on any special precau-tions necessary during procedure.

b

Task Code No. 359


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c. Has patient assune a comfortablepositicn seated on table or chair.If patient is in wheelchair, movespatient in chair into position nextto table. If patient is on specialstretcher, places stretcher intoposition so that radiolucentstretcher can be lifted with pa-tient on it from wheeled base tox-ray table. Otherwise arranges ifnecessary to move patient to tableor use upright film holder with pa-tient remaining on stretcher.


-e. Performer answers patient's non-medical questions honestly;attempts toreassure patient and develop confi-dence. Treats patient with dignityand concern regardless of patient'sbehavior. Remains awam that pa-tient may be frightened and/or inpain. Performer explains when askedmedical questions that it is not ap,propriate for technologist to an-swer these; encourages patient tospeak to physician.

f. If patient has an IV drip in place,performer checks that needle hasnot become dislodged and that thefluid is dripping at an even rate.If there are any problems, perform-er clamps tube and notifies an ap-propriate staff person at once.

g. If appropriate and not already done,performer questions female patientof child bearing age regarding pos-sible pregnarwy. If there is anypossibility that patient is preg-nant and this has not already beenrecorded, performer informs appro-priate physician and proceeds onlywith approval.

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Task Code No. 359


Performer questions patient and/or RNor MD present on what wvement is pos-sible in the affected extremity and onthe opposite side; may question patientabout any injury or pain to determinewhat mobility is possible and what po-sitions are available for use.

a. Performer evaluatei whether patientshould be seated on x-ray table orShould be recumbent on table. Eval-uates whether patient can toleratehaving the affected part placed flaton film holder or requires alterna-tive positioning with use of anangulation block.

b. For knee, performer determineswhether the knee can be fully ex-tended; if not, performer may decideto elevate a cassette on sandbags;may decide to use a curved cassette,or may use a flexible film holder.

c. For the femora performer noteswhether the size of the patient orthe presence of abnormal bowing ofthe femora requires that the projec-tions be made in two separate ex-posures for each view (one film forthe upper portion of the femora anda smaller filM for the lower portionand knee joint).

d. Determines whether conventional flexion can'be utilized in the joints involved, and whether film holders canbe placed in conventional positionsor need to be used in upright hold-ers or supported by angle wedges. Ifmovement is limited or fracture issuspected, performer decides on al-ternative x-ray tube and patient po-sitions to use to accomplish theequivalent radiography with a min--imum of movement by the patient.

e. Performer considers the number andtypes of projections ordered for theexamination and the patient's con-

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dition. Performer may consider achange from standard projectionsto better accomplish the purposeof the examination, r deletion ofa position or a change in technicalfactors. Depending on institutionalarrangements, performer may obtainpermission from appropriate radio-logist or decides personally toalter the standard procedure.

f. Depending on whether a bucky ortable top technique will be usedand standard institutional prac-tices, performer selects speed andtype of film for nonscreen filmholder or cassette combination.i) Selects size(s) based on the

area(s) to be included, the pa-tient's size, whether single ex-posure bilateral views are in-volved, and the number of viewsto be exposed on ,a single film.

ii) For the legs and femora perform-er may check that cassette islong enough to extend from oneto two inches beyond the distal

. and proximal joints. If the fe-mora or leg(s) are too long forthis and the site of the lesionis not known, performer selectsand plans for two exposnres foreach view, one film tc, includethe proximal joint and one smaller film to include the distaljoint. If the site pf the lesionhas been localized, performerselects cassette to include thejoint nearest the site.

iii) For magnification technique pel--former selects the size film deaignated for the degree uf magni-fication and the selected partto be studied.

iv) Performer makes sure that an adequate supply of loaded cassettesor film holders of the types andsizes selected are available in

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che examination room. If not, ar-ranges to obtain or decides toobtain personally.

. Performer prepares.for the examination:

a. Performer obtains the appropriatesize loaded non-screen film holderor cassette for the first projection.

b. If several views will be taken onone film, performer mentally decideshow these will be positioned so thatthe film need not be turned for view-ing each image. Performer uses leadedrubber sheets and masks the filmholder completely except for the areato be exposed. Treats the area to beexposed from this point as though itwere the actual film size.

c. Performer attaches identificationinformation to the film holder ortable top:i) Places right or left marker on

film holder or table-top as ap-propriate to the study and pro-jection or depresses appropriateR or L button for automatic mark-ing.

ii) If patient's identification in-formation is in the form of leadnumerals, performer places on ap-propriate corner of film holder.

iii) If patient's identification in-formation is to be entered by useof flasher, sets flashcard asidefor later use with space createdby piece of leaded rubber on ap-propriate edge of holder.

iv) Performer may place patient'scard into card tray for equipmentusing automatic film marking de-vice.

d. If cassette is to be used with bucky(under tabletop or in upright holder)performer may manually pull out buckytray and open retaining clamps. In-serts cassette into bucky tray and

lask Code No. 359


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pushes back. Makes sure clamps areclosed. Moves cassette into appro-priate "stored" position or insertscassette tray into bucky slot andcenters.

e. If a bucky is not being used, per-former places nonscreen film holderin a position that can be comfor-tably reached by the patient infinal positioning. May place leadedrubber sheet under film holder.i) If magnification technique is to

be used, performer places filmholder in marked position onfloor or stool.

ii) If appropriate to make possibleminimal movement of patient,performer may place film in up-right holder at right angles totable top or in other positionselected.

f. If not already done, has patient re-move shoes, hose and any garmentscovering either leg. May assist pa-tient or request assistance fromnurse if there is a fracture involv-ed.

g. If there is a splint or cast on aninjured area, performer has RN orND carry out any orders on removal.If there is a wet dressing, perform-er has it reinforced or decides todo personally.

h. Performer provides patient and every-one who will remain in room duringexposure with protective shield-ing. Explains if necessary that thisis not cause for alarm but a generalprecaution to minimize unnecessaryradiation exposure.

8. Performer has patient assume a comfort-able recumbent or seated position de-pending on the positions to be employ-ed, so that the part(s) to be radio-graphed can be measured in position.

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a. If appropriate, places mattress,pillow or clean linen on x-raytable.

b. Performer may decide to assist pa-tient from wheelchair or stretcherto table or has this done. May ob-tain help. Makes sure that no equip-ment is in the way and may be col-lided with by patient.

c. If assisting patient to step on foot.-stool in order to get on table,helpspatient turn into position, stepbackwards,on stool, and then sitand/or lie on table.

d. Performer uses centimeter calipersto measure the thickness of thepart(s) to be radiographed in thedirection in which the central rayof the x-ray beam will pass throughthe centered part from tube to film.Records for use in determining ex-posure factors.

e. After measuring, has patient rest inas relaxed a position as possible.May place pad, blanket or pillowunder bony prominances to providecomfort.

. Performer selects the exposure factorsfor the first projection by consultingthe technique chart(s) posted for themachine:

a. Locates the information needed forthe body part and projection in-volved according to the centimeterthickness of the part as measuredand the collimated field size tobe used. Makes sure that techniquerelates to the combination of filmtype and speed and use or nonuse ofother. accessories (such as screens,

bucky, etc.).b. Makes note of the kVp, mA,T(seconds

of exposure time),focal spot size,and the focal film distance (TFD orFFD) called for.

c. Once the standard kVp, mA and timehas been determined, performer notes

whether any conversions are neces-sary to account for a pathologicalcondition, a cast, change in TFD,preference of the radiologist in-volved, and any other conversionneeded such as with magnificationtechnique. Performer looks up nu-merical conversion factors and calculates, or uses conversion chartsto ascertain the appropriate newexposure factor (kVp, mA and/ortime). Multiplies, divides, adds,or subtracts as appropriate.

d. Performer checks any new or unfam-iliar_exposure factors against thepostcd-limits of the x-ray tube ona tube rating chart to be sure thattechnique does not exceed the heatcapacities of the tube for thefocal spot size to be used. If ap-propriate, performer reconverts thetechnique to an equivalent outputusing higher kVp and lower mAs.



b.. If appropriate checks line voltagemeter and, if needed, turns com-pensator dial until needle isaligned properly on line meter.


choosing selectors for the cor-rect focal spot size; sets themA selected.

ii) Performer selects and sets theexposure time that will producethe mAs desired.

iii) Performer sets the kVp selectedby choosing the combination of

major kilovoltage and minorkilovoltage settings to producethe desired kVp.

eTASK DESCRIPTION SHEET (continued)

Task Code No. 359




category corresponding to thetype of study and use or non-useof screens, bucky,etc., and, ifappropriate, focal spot size.'


iii) May select and set a kVp rangebutton, if called for with equip-ment, corresponding to range forexamination.


v) Makes sure backup timer is notlikely to terminate exposure be-fore phototimed exposure ismade.

e. Depending on the equipment, may setcontrols to provide for use ofbucky,manual tableside adjustmentof table and 'tube height, position,and of collimation (unless theselave already been set as with mag-nification technique).

f. Performer returns to overhead unitand sets the focal-film distance(if not already done, as with mag-nification technique). Operatescontrols or manually moves thex-ray tube into place over thefilm holder (or at right angles toupright holder). Checks the focal-film distance by reading indicatorscale in the tube housing; adjustsup or down until the required FFD

is obtained.

11. Performer places the part to be re-_diographed in the final position se-lected for the first exposure. Makessure that correct leg, knee or femur

is being positioned (with unilateralstudy) .With young patients may plan to

radiograph both affected and unaffect-ed sides for comparidon if so ordered.

Performer centers part and keeps thelong axis of the part parallel to thefilm ho/der. May explain or demon-strate to patient what is required.May obtain help in positioning. Per-former may position as follows (unlessnonconventional positioning is beingused to avoid having patient move):

a. For the leg(s), performer posi-tions for bilateral views so thatboth legs will be projected withone exposure. Where two exposuresare necessary to include the fulllength of the leg and both jointsperformer positions the patientwith casSette centered under upperarea;removes cassette after expos-ure and centers smaller cassetteunder lower area with as littlemovement of patient as possible.Otherwise centers to include thejoint nearest the site of the les-ion. Directs central ray at appro-priate angle to film holder.i) For oblique projections perform-

er has the patient assume a su-pine position. For the lateraloblique projection performerrests the lateral side of thefoot on the affected sideagainst a 450 foam wedge. Forthe medial oblique projectionperformer abducts the leg some-what or has the patient shiftthe pelvis.away from the af-fected extremity. Elevates thehip so that the medial side ofthe foot and ankle rest againsta 450 foam wedge. Supports asappropriate.

ii) For an AP projection (posteriorview),performer retains patientin supine position but adjustsbody so that there is no rota-

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tion at pelvis. Has patient ex-tend the affected leg(s). Withleg(s) in AP position performerinverts the foot (feet) slightlywithout rotating leg(s). Supportssole(s) with sandbags.

iii) For lateral projection,performermoves the patient from the su-pine position to a lateral recum-bent on the affected side withthe unaffected knee flexed. Mayhave patient turn away from af-fected side, cross affected legover and on to cassette. Adjuststhe patient's body so that thepatella is at right angles tothe film holder. Supports withsandbags.

b. For the knee,performer helps patientto assume a prone or supine positionas decided. Uses regular cassette,curved cassette,or flexible non-screen film holder as decided. Ifperforner is to take scout filmspreliminary to arthrography, per-forner makes AP or PA, lateralprojections,and "tunnel" views ofknee or as ordered. If patellarfracture may be involved, makessure not to flex the knees more than10°.

i) For AP projection (posteriorview),performer has patient as-sume a supine or seated positionon table with no rotation of thepelvis. Supports the ankle ofthe affected side. Places filmholder under the knee. Has pa-tient extend legs with unaffect-ed leg flexed somewhat for com-fort. Center, to the apex of thepatella and rotates leg so thata line through both femoralepicondyles is parallel with theplane of the film. Directs thecentral ray as appropriate topurpose of study (at right angleto film for bones of joint and

5° to 7° cephalad for jointspaces).

ii) For PA projection (anteriorview) ,performer has patient liein the prone position with legsextended and ankles and feetsupported. Adjusts positioningby rotating leg. Lamobilizeswith sandbags. Centers ray tothe popliteal depression.

iii) For lateral projection,perform-er notes whether the knee is tobe in right-angle flexion. Ifso, has patient lie on affectedside, bring the affected kneeforward, and extend the otherleg behind it. If the knee isto be in partial flexion or ex-tension has patient bring theunaffected knee forward and supports it. Uses sandbags to pre-vent forward rotation of thepelvis. If there is any patellarfracture performer makes surethat there is no flexion beyond10° or what is needed to relaxthe muscles. After the knee isflexed to the desired angle,performer centers tbe film to thejoint. Adjusts supports so thatlong axis of leg is horizontaland patella is at right anglesto film. Directs central ray 5°cephalad. (Performer awaits re-sults of this view before doingaxial views of patella if thereis suspected fracture.)

iv) For PA oblique projections,per-former has patient take proneposition with ankles supported.Elevates the hip of affectedside and'rotates the leg 45°medially for posteramedial obli-que projection;elevates oppositehip and rotates 45° laterallyfor )osterolateral oblique pro-jection. Centers cassette underknee parallel.to its long axis.

TASK 'DESCRIPTION SHEET (continued)

Task Code No. 359


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Supports elevated hip. Directsthe central ray at r:;3ht anglesto the film.

v) For AP oblique projections, per-former positions as above, butwith patient in supine positionwith ankles supported. If neces-sary, places sandbag under filmholder to minimize part-film dis-tance.

vi) For the semiaxial PA,projectionof the intercondyloid fosse; haspatient take prone poiftion withno rotation in body, and supportsthe ankle and foot of the unaf-fected side. Performer places aspecially prepared cushion or boxhigh enough to support the legwith the knee flexed at a 400 or50° angle as ordered, and adjustsuntil the angle is achieved. Mayuse protractor as guide for ob-taining angulation. Centers theproximal half of the cassette tothe knee joint. Adjusts foot toeliminate any rotation of knee.Adjusts the tube so that centralray will enter at right anglesto the long axis of the leg, cen-tered to the popliteal depression

vii) For a semiaxial PA projection"tunnel view," performer has pa-tient kneel on table or on abench at the end of the tableresting against tabletop. Has thefeet extend over the end so thatthe long axis of the legs areparallel with the surface beingkneeled on. Centers film holderunder one or both knees with ref-erence to the apex of the patellAdjusts patient's body to lean sothat the long axes of the femurand tibia are in the same plane,and the shaft of the femur is at70° to the table. Directs centralray at right angles to film.

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lain For semiaxial AP projection"tunnel view,"has patient liein supine position with no rota-tion in body. Adjusts the ele-vation of the leg and flexionof the knee so that leg andfemur form a 120° angle. Sup-ports knee. Adjusts leg in APposition. Places curved cassetteor flexible film holder beneaththe posterior surface of theknee centered so that centralray will enter the "notch" at aright angle to the long axis ofthe tibia at the center of thecassette or holder. Immobilizesfoot.

c. For the kneecap (patella) ,performernotes whether the knee is painfuland, for prone position, placessandbags to relieve pressure onthe patella.i) For PA projection (anterior

view) has patient lie in proneposition with leg extended andcassette parallel to the longaxis of the knee and centeredto patella. Rotates heel out-ward so that patella is parallelwith plane of film. Directs cen-tral ray at right angles tofilm.

.ii) For oblique PA (superoinferior)projection,has patient remainprone. Elevates and supports hipon affected side and supportsankle and knee. Allows about 10°flexion of knee. Centers film topatella. Turns knee slightlyaway from PA position, pressesindex finger lateralward againstmedial border of patella, andrests knee-on its anteromedialside with patella in lateraldisplacement. Immobilizes. Di-rects the central ray to jointspace between_patella and fe-moral condyles at 25° to 30°caudad.

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iii) For axial view of the patella(unilateral or bilateral),per-former has patient lie in supineor prone position after trans-verse fracture of patella hasbeen ruled out. For prone posi-tion has patient flex the kneeslowly and evenly (to avoid un-due pain) until patella is atright angles to the film. Perform-er loops a long strip of bandagearound ankle or foot and has pa-tient grasp the ends over his orher shoulder to maintain posi-tion. Adjusts leg so that thereis no sideways leaning. Centerscassette under patella. For bi-lateral view performer has pa-tient hold knees in contact witheach other; adjusts similarly,with two strips of bandage used,one over each of patient'sshoulders and flexed to the lim-its set by the injured knee. Forpatients unab': to assume proneposition performer assists withsupine, lataral or seated posi-tion. Has patient flex knee(s) sothat leg and thigh are at rightangles with feet resting on tabletop or supported. Places filmholder on the anterior distalthi3h(s) with patella(s) at cen-ter. Has patient hold film hold-er or tapes into position. Hayuse 450 positioning block. Per-former directs the central rayto pass along the long axis ofthe patelh between the patellaand the femoral condyles.

d. For the femur(s), performer posi-tions for unilateral or bilateralstudy. If both joints are to bedemonstrated and cassette is notlong enough, performer may maintainpatient's position for two exposuresfor each view, one of the distal fe-mur(s) and the other of the proximal

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femur(s). Where there is a pos-sible fracture or.destructivedisease, performer uses supineposition to obtain lateral views.If films are for bone survey, per-former takes AP projection of fe-mura or as ordered.i) For AP projection (posterior

view),has patient assume su-.

pine position with legs fullyextended and feet somewhat in-verted but with pelvis unro-tated. Iamobilizes with sand-gags. Centers to include thearea of interest and the jointnearer to the injured site un-less both joints are requestedor the injury site is unknown.If using two cassettes centersas appropriate to the part of

the view to be exposed. Directscentral ray at right angles tofilm.

ii) For lateral projection,with pa-tient supine,performer uses up-right holder and places cas-sette vertically along the me-dial or lateral aspect of thighand knee. For lateral projec-tion where bone fracture or de-structive disease is not in-volved,has patient lie on theaffected side, flex affectedknee.and draw it backward toinclude hip joint or forwardto include knee joint. Centerslong axis of femur over the center line of table. Uses sand7bags to support. Rotates hipsto avoid superimposition. Cen-ters cassette in bucky tray anddirects central ray at rightangles to center of film.

e. If, during positioning, patientshows signs of severe pain, per-former may notify appropriate phy-sician at once and await orders ormay decide on alternative position


Task Code No. 359

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ing to avoid movement of the af-fected part.

12. Performer checks final positioning byusing light in collimator. Activatesthe collimator light and points thelight beam towards the part. Adjuststhe collimator opening to correspondto the film size (or the size of theunshielded area of the film to be ex-

posed).

Checks that primary beam will enter thecenter of the area of interest at rightangles to the film (or selected angle)so as to project the view desired. For

the first view of a series may mark apoint on the part that is even with thecenter of the film holder for use inlining up subsequent views. May read-just tube position lengthwise or cross-wise to provide better centering. Usescross-hair shadows as reference forcenter of field.

13. Once the patient has been positionedand immobilized performer adjusts thecollimator. Either collimates so thata small unexposed border will appeararound the edge of the film or colli-mates further so as to expose only thearea of interest (and thus providemaximum protection and detail). If ap-propriate, performer attaches auxil-iary extension cones to collimatorto further reduce the primary beam.

14. Performer maY add lead shielding toareas that will be in the primary pathof the beam but are not included inthe areas of interest. Makes sure thatprotective shielding has been pro-

vided to patient and everyone who willrerain in room

List Elements Fully

an accident. Is alert to siims of nau-sea, dizziness, or sOeat suggestingfaintness. Performer may have patientlie down, lower head or raise legs.Notifies nurse. If patient shows anyother emergency signs, loses consci-ousness, or has an accident, performercalls appropriate physician or nurseat once. May decide to provide emer-gency first aid as well.

16. When everything is ready for the ex-posure, performer explains to patientthe need to keep perfectly still whenindicated by performer until told torelax and, for femora, to breath outwhen told and hold until told to_re-lax. Performer observes the patient'smovement until the moment that the ex-posure is made. Readj.tts position if

warranted.

17. The performer returns to control room.Makes sure controls are properly setand patient is still in position.Tells patient when to hold still (orbreath out and hold still) by callingor using intercom. Performer initiatesexposure by pressing band trigger orexposure control button.

a. While exposure is underway per-. former checks that mA meter re-


b. May watch for evidence of malfunc-tion such as line surge or exces-7.sive drop; may listen for sound ofnormal functioning of equipment.If there is malfunction may decideto report; anticipates need to re-peat exposure.

c. With phototimer notes whether back-up timer has been involved in term-inating exposure before phototimer

15. Throughout procedure performer ob- exposure was completed. If so, an-

serves patient for any signs of emer- ticipates possible need to repeat

gency and/or to prevent or respond to .exposure Oiue to underexposure if

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Task Code No. 359


List Elements Full

premature cut-off, or overexposuredue to faulty timer).

d. After exposure is completed tellspatient that he or she can relay.

e. If the exposure is terminated by acircuit breaker, rechecks technicalfactors for .possible overload orchecks for overload elsewhere oncircuit. Anticipates need to repeatexposure.

18. Performer returns to patient. Removescassette or film holder from table,floor or bucky.

a. Removes any markers for further use.If multiple views are to be taken onthe film, removes leaded rubber maskand remasks all but next area to beexposed.

b. If the patient is being examined forpossible fracture or if so request-ed, performer arranges to have thefirst exposure processed at onceand brought to the appropriateradiologist.

c. Depending on whether radiologistwill evaluate radiographs :beforecompletion of all possible expos-ures for the series, performer ar-ranges to process film(s) and eval-uate for quality control personally,have this done, or bring to darkroom for processing and later eval-uation, based an time available, in-stitutional arrangementssor specificinstructions. Attaches ID card foruse with flasher if appropriate. Maysign requisition.

d. If the first radiograph(s) are pre-liminary (scout) films, performerbrings the processed radiograph(s)directly to the radiologist incharge or places on view boxes andinforms radiologist that the Scout(s) are ready. If the radiologistindicates that there is any problemwith the technical factors or the

List Elements Fully 0

patient positioning performer re-cords or notes for'later use inthe examination and/or repeats pre-liminary radiography as ordered.

e. While film; are being processedand/or evaivated performer has pa-tient relax in examination room orholding area. Explains what willhappen next.i) Performer determines whether pa-

tient should remain on tableand/or in room until physicianarrives, and whether patient re-quires observation. If appropri-ate, arranges to have patientattended while waiting.

ii) If patient is to leave table orrise, performer makes sure allequipment is moved away from pa-tient such as overhead tube andupright film holder.

iii) May decide to assist patient tochair or stretcher or from chairor table. Makes sure to remindpatient of any footrest whenstepping off table.

19. When (or if) performer learns from theradiologist the extent of the injuryand/or whether further conventionalviews and/or positions can be under-taken, eliminated, or altered, per-former proceeds as appropriate accord-ing to instructions.

a. Vor further exposures performer re-peats appropriate steps for nextview(s) including identification offilm holder and use of R-L marker,selection and Setting of techniquefor next view (if different), po-sitioning patient and equipment forfocua-object7film alignment,propercollimation and shielding, and mak-ing exposurp,as described above.For multiple exposures on one film,keeps R-L reference point constant;centers using the point marked ear-

131


List Elements Full

Task Code No. 359


List Elements Full

lier on the part to line up withcenter of film.

b. Performer refrains from commentingon the films or providing any inter-pretation.

c. If performer is asked to repeat anyexposures, makes sure that the ad-ditional exposures are warrantedmedically, since additional radia-tion will be incurred.i) Notes whether need to repeat is

due to performer's own negli-gence or lack of attention sothat performer can avoid future"retakes."

ii) If request for retakes reflectsmalfunctioning equipment per-former reports malfunction toappropriate staff member.

iii) If request for retakes reflectsthe preference fnr density orcontrast of a radiologist, per-former notes for future workdone for the given radiologistso that retakes can be avoided.

20. When performer is sure that the exami-nation has been completed, performermay have patient transported back toholding area or next location or de-cides to do personally, as appropri-ate. ''akes sure that none of the equip-ment is projecting over the patient be-fore allowing patient to rise.

21. Performer carries out terminationsteps for the examination:

a. Performer has equipment and exami-nation table cleaned after use ordecides to do personally, depend-ing on institutional arrangements.

b. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken,the teChnical factors used andfilm size; may record the number

of exposures made of each view in-cluding retakes; May enter theestimated radiation dose to whichpatient was exposed (usil:.g postedinformation on dosage); may recordany problem with equipment, anyspecial care provided patient. Ifany views called for in the ini-tial request could not be obtainedperformer may record reasons. Signrequisition sheet.

c. If performer will only carry, outpreliminary "scout" filming andanother technologist will continuewith examination, performer records_-the approved technical factors usedfor the scouts, and the accessoriesemployed,or informs technologistwho will continue. Performer givesthe requisition sheet, name card,and any notes to technologist whowill continue with procedure.

d. Performer may decide to jacketfilms, requisition sheets, and re-lated materials and/or have infor-mation recorded in log book per-sonally or have this done, depend-ing on institutional procedures.

e. May indicate to appropriate staffperson when the performer is readyto proceed with next examination.

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Task Code No. 360


1. What is the output of this task? (Be sure List Elements Fullthis is broad enough to be repeatable.)

Requisition reviewed;pt. reassured,positioned:partsmeasured;films identified;technical factors selectedand set;te:hnique for magnifl-ation set up;exposuresmade;radiographs sent for processing and evaluation:procedures repeated as appropriate for full set ofviews; patient returned;examination recorded;radio-graphs placed for use,

Performer receives or obtainsthe x-ray requisition form, pa-tient's identification card,andany appropriate medical-techni-cal history for a non-infant pa-tient scheduled for radiographyof the pelvis, hip(s) and/orupper femora:


b. From co-morker.c. After having arranged requi-


The plain films of the pelvismay be part of a bone-survey.


a. Performer checks the ex-aminations called for in-eluding the parts involv-ed, the affected side,whether bilateral or uni-lateral studies are re-quested, the patient posi-.tions and views called

2. What is used inyerforming this task? (NGteif only dertain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Pt.'s x-ray requisition sheet,ID card,ID bracelet,technical historY;pen;x-ray machine control pan-el(s),tube,bucky,table,collimator,extension cones;technique chart;charts for conversion of technique,standard examination views,dosage,tube capacity;loaded cassettes;vertical film holder;leaded rubbershielding;R and L and ID markers;immobilization de-vices;stool;calipers;tape;scissors;protractor;com-pression band;stretcher or wheelchair

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes.., .) No... )

xes to q. : ame t e kina o recipient,respondent or co-worker involved, with de_

scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions,

Non-infant patient to be radiographed;radiologictechnologist;radiologist;nurse

. . Name the task so that the answers to ques- for, the number of expo-sures, the central beamangulation,the areas ofinterest and parts to beincluded, whether known orsuspected unhealed frac-turis are involved or de-structive disease,and thesites. Notes whether theuse of a grid or buckywill be involved. Notes

OK-RP;RR;RR


Ta._IT.g_plajl.LfjAlx.Lrlx_d_isg_raphs.of pelvis,hips and/or

upper femora of non-infant patient by reviewing re-quest;reporting observed contraindications;reassur-ing pt.;measuring part;setting up for magnificationtechnique;selecting and setting technical factors;identifying film;poAtioning pt. and equipment forerect or recumbent exposure;providing shielding;collimating;making exposures;having radiographs pro-cessed and reviewed;repeating for full set of viewsor as ordered;having pt. returned;placing radio-graphs for use;recording examination.

/

6. Check herrn thisis a master sheet..

AMM

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Task Code No. 360


List Elements Full List Elements Fuil

any request for magnification. Checksthe name of the referring physician.

b. Performer reads patient's name,iden-tification number, sex, age, weight.Notes whether patient is in-patient, out-patient, or emergencypatient. Notes any special informa-tion that will affect patient posi-tioning, technique, or handling ofthe patient, such as presence of un-healed fracture, suspected fracture,presence of plaster cast,splints (tobe left in place or removed by astaff physician), extremities of un-equal length, whether patient willbe on a stretcher or wheelchair,andany notation on the nature of anyknown pathology which would affecttechnique (such as bone infection),and the purpose of the study. Noteswhether requisition includes needto calculate the shaft-neck angleof the femur.

c. With patients with unhealed frac-tures performer makes sure that asurgeon or radiologist is availableto position the patient. If lateralbody positions are requested per-former makes sure that there is nodanger of fragment displacement,in-jury, presence of unhealed fractureor destructive disease. Hay checkwith ND.

d. Performer checks whether patient issuffering from a collateral condi-tion requiring special handling suchas heart disease, communicable orinfectious condition,infirmity, in-coherence;whether patient has IVdrip, oxygen supply, urinary cathe-ter or similar device in place;noteswhether patient will be accompaniedby nurse or other staff person.

e. If performer is not already assignedto examination room (and a particu-lar machine) notes the room or ma-chine involved. Goes to examinationroom or control room for machine in-volved.

f. If magnificatton has been requested,performer checks that the machineto be used has a fractional focalspot of appropriate size for directmagnification technique (i.e. 0.3or smaller).

g. Performer makes sure that the re-quest is properly authorized,thatinformation on requisition sheet iscomplete. Checks whether any spec-ial orders on exposure factors arein keeping with the usual rad ex-posure involved for the examination.

h. Depending ou institutional proce-dures performer may review pa-tient's radiation exposure history,prior record of techniques used,andcumulative exposure. Noticeswhether examination has been doneelsewhere in recent past,whethernumber of radiographic exposuresordered or done L. past should bebrought to radiologist's attention.

i. Depending on institutional proce-dures performer notes whetherfemale patient is pregnant,reviewsdate of female patient's last men-strual period, or notes any otherindication that there is no dangerof exposure of a known or possiblefetus. Notes shielding needed.

j. If patient's record indicates or-ders for sedation or any otherprior medication performer maycheck timing to be sure a properelapse of time has occurred formedication to take effect. May ac-range to delay examination if ap-propriate.

k. If referring physician has re-quested that films already on filebe sent with current radiographs,and if not already with patient'sjacketed material, performer ar-ranges to have prior films deliv-ered.


List Elements Full

2. If the performer determines that therequest is not properly authorized, isincomplete, or that sufficient infor-mation is lacking for performer toselect technique or to properly posi-tion or care for patient, or if per-former considers that there may be con-traindications to going ahead with theprocedure, performer notifies supervi-sor, radiologist, or other designatedstaff person, depending on institu-tional procedures. Explains the prob-lem if appropriate and proceeds afterobtaining needed information, signature,or orders.

Task Code No. 360


List Elements Full

When performer is clear about what willbe involved in examination, he or sheprepares ahead so as not tr keep pa-tient in examination room longer thannecessary:

a. Performer revie-is the techniquechart for.the machine CD be usedand takes note of any newly postedchanges in technical factors (to re-flect accommodation for change inmachine output or a policy deci-sion).

b. Performer washes hands as appropri-ate; depending on patient's condi-tion, may decide to arrange for orcarry out isolation or decontamina-

tion techniques.c. Performer makes sure that x-ray

equipment is ready for use. Goes tocontrol panel for x-ray generatorand checks that indicator lightshows that machine is "warmed up,"or turns on maih switch as appro-priate to equipment and allows timefor machine to "warm up." If appro-priate, performer may set radio-graphy mode selector and set colli-mator control for manual operation.

d. Performer checks that appropriateimmobilization devices such as sandbags, wedge sponges, compression

band, tape are present and thatthere is a mattress,'pads, pillowsand/or blankets for comfort of pa-tient if patient will lie on table.If'appropriate,..obtains protractor,

e. Checks that there is leaded rubbershielding available in room to beused to mask film, protect the pa-tient, and/or to place beneath thefilm holder, as appropriate.

_. Performer prepares for identifica-tion of the films using equipmentprovided by institution:i) May obtain lead numerals and

tape and prepare identificationstrip for placement on filmholder(s) giving appropriate pa-tient identification informa-tion.

ii) Performer may prepare for use offlashcard by checking that thereis piece of.lead on film holdersurface; may write or type outID information on card if notreceived with requisition.



4. If magnification has been requested,performer vepares the equipment forElle tube-over-table method of magni-fication (used without bucky):

a. Performer determines the degree of

magnification requested on therequisition sheet; if request isexpressed as an area magnificationperformer determines the linearmagnification by taking the squareroot. (Linear magnificationsquared equals area magnifica-tion.)

b. Performer calculates the requireddistances from target (focal spot)

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Task Code No. 360


List Elements Full

to object (patient) (TOD), and fromobject to film (OFD), as well as thedistance from target to film (TFD)(the sum of TOD and OFD):i) If the distance from the table

top to a cassette placed on thefloor or a stool (OFD) will bea relatively inflexible distance,performer measures this distanceor reads indicator scale. (Ifstool is to be used, may note thetable height.) Performer may.P?,-just table height to .provide fora round number for the OFD.

ii) If the distance from the focalspot to the table top (TOD) willbe the relatively inflexible dis-tance, performer determines whatthis is by measuring or readingappropriate indicator scale ontube housing. Performer may ad-just tube height to provide around numter for the TOD.

iii) Depending on whether the OFD orthe TOD is fixed, performer cal-culates the required complemen-tary distance by referring to amagnification chart for the de-gree of linear magnification re-quired, or uses the formula: de-uee of linear magnificationequals TFD divided by TOD. For atwo-time:- linear magnificationperformer simply sets the TODequal to the OFD.

iv) Performer adjusts and locks thetable height.and/or the tubeheight tb the calculated OFD andTOD.

c. Performer aligns the object-4ilm andtarget-object distances:i) Performer moves the x-ray tube

housing until it is centered overthe table top in the approximatearea where the:patient's area ofinterest will be positioned, suchas on table.

ii) Performer swings the table out ofthe way so that there is no ob-

List Element22141y

struction between the tube andthe floor. (Does not changeheight.) If appropriate, placesa stool on the floor under thetube. May place cassette of ap-propriate size on floor orstool. Performer selects thesize film designated for thedegree of magnification and theselected part to be studied.

iii) Performer adjusts the collima-tion to correspond to the fieldsize anticipated (for the TODinvolved).

iv) Performer activates the lightin the collimator and adjuststhe tube horizontally so thatthe light beam cast is centeredto the cassette an the stool orfloor. Uses the cross-hairs pro-jected by the beam to center thetube to the area on the flooror stool.

v) Performer locks the tube intoposition so that there is a 90°angle of the beam with the flooror stool. Fixes and retains col-Alimator setting.

vi) Performer marks the outline ofthe collimated light area orcassette on the floor or stoolusing tape or other removablemarker. If not already done,checks by placing cassette inmarked area. May mark center ofarea as shown by cross-hairs.

vii) Performer swings table back intoplace. Activates light beam incollimator and marks the tabletop where the center cross-hairsand light outline are projected(to be used to center the partto be radiographed). Uses tapeor other radiolucent removablemarker.

viii) Performer may recheck TOD andOFD to be sure that they corre-spond to the calculated dis-tances.

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Task Code No. 360


List Elements Fullx.. List Elements Full

d. For magnification technique using avertical film holder, performer maywait until 3-Itient has been broughtinto examination room. Adjusts up-right holder to appropriate height;adjusts x-ray tube to right angleprojection ofheam to film holder;centers to the film; measures andadjusts TOD to patient's positionand marks patient's position; mea-sures and adjusts OFD from patient'position as marked.

e. If the sum of the new TOD and OFD(TFD) is now different from the TFDused for non-magnification techni-que, performer may consult techniquechart to note the factor to use fora compensatory change in mAs. Mayrecord for later use in setting ex-posure factors.

f. Performer may also note the changein kVp and mAs necessary to compen-sate for any change in collimationfrom non-magnification technique.Consults appropriate charts for con-version factors. May record..

Performer has the patient called fromthe holding area and prepared for theexamination (if not already done), ordecides to do personally.

a. Depending on institutional arrange-ments performer may decide to es-cort out-patient to or from dressingroom. May decide to assist in trans-porting patient from holding area orhave this done.

b. Performer greets patient and any ac-companying staff person and intro-duces self. Checks patient's iden-tity against the requisition sheet.With in-patient, checks hospitalidentification bracelet or otheridentifier. If patient is accom-panied because of seriousness ofcondition, performer checks withaccompanying staff member on any

special precautions necessary dur-ing procedure.

c. Has patient assume a comfortableposition seated on table or chair.If patient is in wheelchair, movespatient in chair into position nextto table. If patient is on specialstretcher, places stretcher intoposition so that radiolucentstretcher can be lifted with pa-tient on it from wheeled base tox-ray table. May arrange to movepatient to table. With accident pa-tient uses upright film holderwith patient remaining on stretcheruntil injury has been localized.


e. Performer answers patient's non-medical questions honestly; attemptsto reassure patient and developconfidence. Treats patient withdignity and concern regardless ofpatient's behavior. Remains awarethat patient may be frightened and/or in pain. Performer explains whenasked medical questions that it isnot appropriate for technologist toanswer these; encourages patient tospeak to physician.

f. If patient has an IV drip in place,performer checks that needle hasnot become dislodged and that thefluid is dripping at an even rate.If there are any problems, perform-er clamps tube and notifies an ap-propriate staff member at once.

g. If appropriate and not alreadydone, performer questions femalepatient of child bearing age re-garding possible pregnancy. Ifthere is any possibility that pa-tient is pregnant and this has notalready been recorded, performer

137

-TASK DESCRIPTION SHEET (continued)

Task Code No. 360


List Elements Full

informs appropriate physician andproceeds only with approval.

. Performer questions patient and/or RNor MD present on what movement is pos-sible in the affected femur and hipjoint and on the opposite side; mayquestion patient about any injury orpain to determine what mobility is pos-sible and what positions are availablefor use. Considers whether to have pa-tient recumbent, standing and/or placedin axial or lateral body positions.

a Pe-rformer notes the patient's bodytyle, whether the area of interestis heavily covered by muscle or softfat, whether the palpation pointswill be easy to find. Notes whetherthe legs or femora are of unequallength.

b. Determines whether conventtonal posi-

tioning can be utilized and whetherfilm holders can be placed in con-ventional positions or need to beused in upright holders or supportedby angle wedges. If movement islimited or fracture is suspected,performer decides on alternativex-ray tube and patient positio.as touse to accomplish the equivalentradiography with a minimum of move-ment by the patient.

c. Performer considers the number and

types of projections ordered for theexamination and the patient's con-dition. Performer may consider achange from standard projections tobette t. accomplish the purpose of theexamination, or deletion of a posi-tion or a chLalge in technical fac-tors. Depending on institutional ar-rangements, performer may obtain per-mission from appropriate radiologistor decides personally to alter t!'.

standard procedure.d. Depending on whether a bucky or table

top technique will be used and stan-

List Elements Full

dard institutional practices, per-former selects speed and type offilm, grid and cassette combination.i) Selects size(s) based on the

area(s) to be included, the pa-tient's size, and whether bilat-eral views are to be exposed ona single film.

ii) For superoinferior projection offemoral neck, performer selectsa curved cassette. For calcula-tion of the shaft-neck angle ofthe femur, performer selects afilm large enough to include atleast six inches of the femoralshaft.

iii) For magnification technique per-former selects the size filmdesignated for the degree ofmagnification and the selectedpart to be studied.

iv) Performer makes sure that an adequate supply of loaded cassettesof the types and sizes selectedare available in the examinationroom.'-,If not, arranges to obtain

or decides to obtain personally.

. Performer prepares for the examination:

a. Performer obtains the appropriatesize loaded cassette for the firstprojection.

b. If bilateral exposures will betaken on one film, performer men-tally decides how these will bepositioned so that the film neednot be turned for vieWing eachimage. Performer uses leaded rubbersheets and masks the cassettecompletely except for the area tobe exposed. Treats the area to beexposed from this point as thoughit were the actual film size.

c. Performer attaches identificationinformation to the cassette ortable top:

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Task Code No. 360


List Elements Full

i) Places right or left marker onfilm holder or table-top as ap-propriate to the study and pro-jection or depresses appropri-ate R or L button for automaticmarking.

ii) If patient's identification in-formation is in the form of leadnumerals, performer places on ap-propriate corner of cassette.

iii) If patient identification infor-mation is to be entered by use offlasher, sets flashcard asidefor later use with space createdby piece of leaded rubber on ap-propriate edge of cassette.

iv) Performer may place patient'scard into card tray for equip-ment using automatic film markingdevice.

d. If cassette iS.,to be used with bucky(under tabletop or in upright hold-er) performer may manually pull outbucky tray and open retaining clampsInserts cassette into bucky tray andpushes back. Makes sure clamps areclosed. Moves cassette into appro-priate "stored" position or insertscassette tray into bucky slot and

centers.e. If a bucky is not being used, per-

former places cassette in a posi-tion that can be comfortably reached

by the patient in final positioning.i) If magnification technique is to

be used, performer places cas-sette in marked position on flooror stool.

ii) If appropriate to make possibleminimal movement of patient, per-former may place cassette in up-right holder at right angles totable top or in other position

selec.ted.iii) With accident patient, after

localization has been establish-ed, performer may obtain assis-

List Elements Full

tance in lifting any part under

which a cassette must be placedwhile the injured extremity is

supported.f. If not already done, has patient's

clothing removed from extremitiesand provides gown or drape. May assist patient or request assistancefrom nurse if there is a fractureinvolved. Keeps torso covered un-til ready for positioning and radiography; reveals only as much ofbody as necessary. Treats youngpatient with as much courtesy asadult.

g. If there is a splint or cast on an

injured area, performer has RN orND carry out any orders on removal.

If there ig a wet dressing, per-former has it reinforced or decideto do personally.

h. Performer provides patient and

everyone who will remain in room

during exposure with protectiveshielding. Explains if necessarythat this is not cause for alarmbut a general precaution to mini-mize unnecessary radiation expo-sure.

8. Performer has patient assume a comfort

able recumbent or seated position de-pending on the positions to be employ-ed,so that the part(s) to be radio-graphed can be measured in position.

a. If appropriate, places mattress,pillow or clean linen on x-ray

table.b. Performer may decide to assist pa-

tient from wheelchair or stretcher

to table or has this done. May ob-

tain halp. Makes sure that noequipment is in the way and may be

collided with by patient.c. If assisting patient to step on

footstool in order to get on tablehelps patient turn into position,

139

TASK DESCRIPTION SHEET.(continued)

Task Code No. 360



step backwards on stool, and thensit and/or lie on table.

d. Performer uses centimeter calipersto measure the thickness of thepart(s) to be radiographed in thedirection in which the central rayof the x-ray beam will pass throughthe centered part from tube to film.Records for use in determining ex-posure factors.i) With fractures or accident pa-

tient has surgeon or radiologistposition the patient.

ii) In locating iliac crest, perform-er is careful not to center toohigh by making sure not to con-fuse the iliac crest with theheavy muscles immediately abovethe crest. May have patient in-hale deeply and breathe out; thenpalpates the point of the crestwhile the muscles are relaxed.

iii) If performer believes that pa-tient will be embarrassed by pal-pation of the symphysis pubis,uses the most prominent point of

the greater trochanter to locatethe same transverse plane.

iv) If patient has a urinary cathe-ter in place, performer turns pa-tient toward the catheter andtubing to prevent separating itfrom drainage bottle and breakingsterile system and to avoid caus-ing pain.

e. After measuring, has patient rest in

as relaxed a position as possible.May place pad, blanket or pillowunder bony prominences to providecomfort.

Performer selects the exposure factorsfor the first projection by consultingthe technique chart(s) posted for themachine:


the body part and projection in-

volved according to the centimeterthickness of the Part as measuredand the collimated field size tobe used. Makes sure that techniquerelates to the combination of filmtype and speed and use or nonuseof other accessories that are pos-sible(such as screens, grids,bucky,etc.).

b. Makes note of the kVp,mA,T(secondsof exposure time),focal spot size,and the focal film distance (TFDor FFD) called for.


have been determined, performernotes whether any conversions arenecessary to account for a patho-logical condition, a cast, changein TFD, extreme fat or muscular-ity, preference of the radiologistinvolved,'and any other conver-sion needed such as with magnifi-cation technique. Performer looksup numerical conversion factorsand calculates, or uses conver-sion charts to ascertain the ap-propriate new exposure factor(01p, mA and/or time). Multiplies,divides, adds, or subtracts asappropriate.

d. Performer checks any new or unfamriliar exposure factors against the

.posted limits of the x-ray tube ona tube rating chart to be surethat technique does not exceed theheat capacities of the tube forthe focal spot size to be used.If appropriate, performer recon-verts the technique to an equiva-lent output using higher kVp and

lower mAs.


a. Enters control room. Makes surethat indicator light shows that

140


Task Code No. 360



x-ray generator is ready for use.Makes sure that all circuits havebeen stabilized.

b. If appropriate checks line voltagemeter and, if needed, turns com-pensator dial until needle isaligned properly on line meter.




iii) Performer sets the kVp selectedby choosing the combination ofmajor kilovoltage and minor kilo-voltage settings to produce thedesired kVp.


category'corresponding to thetype of study and use or non-useof screens, bucky, etc., and, ifappropriate, focal spot size.


iii) May select and set a kVp rangebutton (if called for with equip-ment) corresponding to range forexamination,

iv) Sets a density selector corres-ponding to the usual (or special)requirements for the study.

v) Makes sure backup timer is notlikely to terminate exposure be-fore phototimed exposure is made.

e. Depending on the equipment, may setcontrols to provide for use ofbucky manual tableside adjustmentof table and tube height, position,and of collimation (unless thesehave already been set as with mag-nification technique).

11

f. Performer returns to overhead unitand sets the focal-film distance(if not already done, as with mag-nification technique). Operatescbntrols or manually moves thex-ray tube into place over the

film holder (or at right anglesto upright holder). Checks the

focal-film distance by reading in-dicator scale in the tube housing;adjusts up or down until the re-quired FFD (TFD) is obtained.

Performer places the part to be ra-diographed in the final position se-lected for the first exposure (unless

this is done by physician). Makessure that correct side is being po-

sitioned (with unilateral study).

a. With young patients may plan toradiograph both affected and unaf-

fected sides for comparison.b. May explain or demonstrate to pa-

tient what is resuired. May ob-

tain help in positioning or has

MD position in accident and frac-

ture cases.c. Performer centers part and keeps

the long axis of the part par-allel to the film holder. Whenusing a bucky centers patient tomidline. With cassette on tabletop,centers film to part. With

upright holder adjusts height of

holder to part and centers part

to film.d. When positioning a paLlent with

a balloon catheter in place per-

former makes sure that the clamp

is not lying over a part to be

exposed or that patient is notlying on the clamp.

e. When the patient's extremities

are of unequal length, performernotes whether the legs or thefemora are unequal. Makes ad-justment in positioning at the

141


Task Code No. 360



joint above the unequal part, suchas placing pelvis so thac greatercrochanters are in the same trans-verse plane for unequal feMora, andknees at same transverse plane forunequal legs. In immobilizing iscareful to position and support feetto avoid rotation Of the upper endsof the femora.

12. Performer positions as follows (unlessnonconventional positioning is beingused to avoid having patient move):

a For the pelvis and upper femora per-former makes AP projection for bonesurvey or as ordered.i) For AP projection (posterior view)

of the pelvic girdle and upperfemora, performer has patientassume supine position. Alignsthe median sagittal plane of thebody to the midline of the tablewith both legs extended and kneessupported. Adjusts shoulders tolie in the same transverse plane.Places sandbags under anklejoints and adjusts to same trans-verse plane. For extremities ofunequal length adjusts as de-scribed above. Inverts feet sothat long axes of femora areparallel with plane of film bygrasping heels and turning feetmedially. Performer may checkthat there is no rotation ofpelvis by measuring the distancefrom the anterior superior iliacspine to tabletop on each side.Overcomes rotation of pelvis dueto swelling or atrophy by elevat-ing appropriate side. Immobil-izes. May apply compression band.Centers at the level of the softtissue depression above thegreater trochanter. Directs cen-tral ray to midpoint and at rightangles to film. With congenital

hip dislocation may center tosymphysis pubis.with central

ray at right angles and second

.exposure at 45° cephalad.

For semiaxial AP projection ofmale anterior pelvic bones,di-rects central ray 20° to 350

cephalad,centered to a pointtwo inches distal to upper bor-

der of the symphysis pubis; forfemale, uses angle of 30° to45° cephalad.

ii) For lateral projection of thepelvis and upper femora, per-former selects lateral recumbentor erect, standing position. For

recumbent position, performermay use cross-table projectionwith AP position or has patientlie on side with thighs fullyextended and midaxillary planeof body at midline of table. Mayhave patient grasp side of tablefor support. Supports lowerthorax so that vertebral columnis in a horizontal plane. Sup-ports extremities at hip level,and knee and ankle of affectedleg,and adjusts long axns to lieparallel with table. Adjustspelvis so that anterior super-ior iliac spines are in sanevertical plane. Has erect pa-tient stand straight, withweight equally distributed onboth feet in lateral positionbefore vertical holder. Adjustsbody for median sagittal planealignment. Supports limb of un-equal length. Centers to thelevel of soft tissue depressionabove greater trochanter,and di-.rects central ray at right an-

gles to film.iii) For semiaxial projection of the

pelvis,performer has patient siton side or end of table so that

142


Task Code No. 360


List Elements FullyMMIMMIIM

,

List Elements Full,/

posterior surface of each knee is duct femora. Has MD position if

in contact with edge of table. there is unhealed fracture. Perform-

Centers to median sagittal plane er localizes the long axis of the

of body and table. May support femoral neck (especially with atypi-

feet with bench or stool. Has pa- cal'patients or where the extremity

tient abduct thighs and lean di- is not in anatomic position) by lo-

rectly forward until symphysispubis'is in close contact with

cating the anterior superior iliac ,

spine and the upper margin of the

table. May assist obese patient to symphysis pubis. Defines a line be-

achieve as close to a 45° angle tween them. Palpates the greater

of vertical axis of pelvis as pos- trochanter of the femur and marks a

sible. Haf.4 patient grasp ankles point one inch below its most prami-

to maintain position. Directs cen-tral ray at right angles, cen-

nent part. Defines a line from thepoint marked to the midpoint of the

tered to the lumbosacral region first line as the long axAs of the

at level of greater trochanters,or directs central ray anteriorly

femoral neck.

Performer locates the hip joint byat right angles to coronal plane defining a line between the anteriorof the symphysis pubis. superior iliac spine and the symphy-

iv) For superoinferior axial projec- sis pubis. Determines the midpointtion of anterior pelvic bones,seats patient as above; has pa-

and defines a line at right anglesto the first line at the midpoint

tient extend arms backward for and finds a point on the second linesupport and lean backward so that about tro inches below the first.the pubic arch is in a vertical Uses this point to center.position. Centers at level of the ,. i) For inferosuperior projectiongreater trochanters,with central (axiolateral view, "frog" posi-ray at right angles to film. In- tion) of the femoral neck(s) andcludes sacrum and symphysis pubis hip(s), performer notes whetherwithin field. unilateral or bilateral view is

v) For the PA projection (anterior involved. For bilateral view hasview) of the anterior pelvic patient assume supine positionbones, has patient assume prone with the medial sagittal plane ofposition. Centers to the mediansagittal plane of body at level

body aligned to midline of table,shoulders in a single transverse

of greater trochanters, with norotation of pelvis. Supports an-

plane, elbows flexed, and handsresting on upper chest, with no

kles. Directs central ray at rotation in body. Has patientright angles to film,

vi) For a semiaxial PA projection offlex knees and abduct thighsequally and as much as possible, i

the anterior pelvic bones, posi- with feet turned inward as close

tions as above and dirccts cen- to the buttJcks as possible sotral ray to midpoint at 350 ceph- that femora are in a near verti-

alad. cle position. May apply compres-b. For the femoral neck(s) and hip, per- sion band above hip joints. Cen-

former notes whether requisition is ters and immobilizes feet. Ad-

for unilateral or bilateral study and justs equal abduction of thighs.

the purpose. Selects positions de- so that the long axes of femoral

pending on patient's ability to ab- necks are parallel to plane of

,....., ......

143


Task Code No. 360


List Elements Fully

film. Adjusts central ray angle toparallel the long axes of femoralshafts centered to the symphysispubis (or at right angles).For unilateral projection usingcassette tray,adjusts patient in Apelvis position,centering anteriorsuperior iliac spine of affectedside to midline of table. Extendsunaffected extremity. Supports witsandbags under knee and ankle. Haspatient flex the hip and knee ofthe affected side and draw the footup to the opposite knee. Directscentral ray to central point locat-ed for hip joint (as describedabove). Has patient brace sole offoot against opposite knee andlean thigh lateralward about 400with foot turned on its lateralside.

For unilateral projection usingcassette on table top, has patientlie in AP supine position with af-fected leg extended and unaffectedleg abducted,with knee flexed andfoot on tabletop, or with leg hang-ing off table edge. Positions cas-sette vertically at patient's sidewith long axis parallel to long axis of femoral neck and as far aspossible into depression above il-iac crest.

Supports with sandbags. Invertsfoot slightly. Directs central rayat right angles to long axis of fe-moral neck to hip joint point (asdescribed above) and under the op-posite knee if flexed.

ii) For superoinferior axiolateral pro-jection of femoral neck, usescurved cassette. Has patient as-sume supine position with pelviselevated enough to place greatertrochanters four inches abovetable top. Supports affected ex-tremity at hip level. Flexes hipand knee of unaffected side if notimmobilized already.

List'Elements Full11111111MMEMBIlla

If not already abducted in castor splint, abducts leg suffic-iently to place cassette. Placescassette vertically well up be-tween thighs, centered to thecrease of the groin of affectedside. If not already immobil-ized, inverts foot 15° to 200.Immobilizes with sandbag. Di-rects central ray downward andmedialward at right angLes tolong axis of femoral nee.. cen-tered to lateral surface of hipabove the soft tissue depres-sion.

iii) For mediolateral projection(foraxiolateral view of femoralneck) ,perforner places patientin supine AF position with pel-vis sufficiently elevated toplace greater trochanters aboutsix inches above table top. Sup-ports hips. Places cassette ver-tically along lateral surfaceof the affected hip. Centerstransverse line of cassette togreater trochanter,and tiltscassette backward 25°. Supportscastiette in position. Anglescentral ray laterodorsally,di-rected to greater trechanter at25° cephalad and 25° posteriorcentered to midsagittal plane of

thigh.iv) For AP projection (posterior

view) of femoral neck and foruse in Aculating the shaft-neck angle, performer has pa-tient assume supine AP positionwith sagittal plane lying oneinch medial to anterior super-ior iliac spine,centered to mid-line of table. Performer ab-ducts leg slightly and rotatesthigh internally about 200. Im-mobilizes. Localizes the longaxis of the femoral neck as de-scribed above,and finds midpoint

...01.=.6.-J1117n


Task Code No. 360



of the femoral neck (about twoinches below its intersectionwith -2-.a line between anteriorsuperior iliac spine and upper'margin of symphysis pubis). Ifshaft-neck angle is to be calcu-lated from this view, performermarks midpoint with a Small leadmarker. Performer centers centralray at right angles to film di-rected to center of femoral neck,regardless of position of film,and includes at least six inchesof the shaft of the femur in thefield. Uses processed radiographfor calculation of shaft-neckangle.

v) Yor inferosuperior projection offemoral neck (axiolateral projec-tion based on shaft-neck anglecalculation), performer obtainsprocessed AP projection as de-scribed above. Places tracingpaper over radiograph and drawsin outline of femur and midpointof femoral neck a indicated bylead marker. Performer locatespoint on lateral side ofgreater trochanter one inch be-low the most prominent lateralprojection and marks it on out-line. Connects that point withthe marked midpoint of femoralneck to demonstrate long axis offemoral neck. Ascertains the po-sition of the long axis of shaftof femur and draws it where itintersects the long axis of thefemoral neck. Performer measuresthe obtuse angle formed by theintevsection of the two lines andrecords as the shaft-neck angle.Subtracts 90° from the shaft-neckangle and records for use in ab-duction of thigh.Has patient lie in supine posi-tion with hip and knee flexed sothat thigh is at right angles to

the table. Abducts the thigh tothe angle calculated above (thusplacing femoral neck parallel totable). Supports leg. Centerscassette in bucky tray to thefemoral neck and directs centralray at right angles to the mid-point.

c. For the hip and hip joint, perform-er notes whether bilateral or uni-lateral views are required; makessure that there 's no danger offragment displacement, injury,orpresence of unhealed fracture ordestructive disease before havingpatient assume any lateral body po-sitions. For bilateral superoin-ferior profile view of acetabularehearses patient to retain posi-tion so that second view can be ex-posed on the same film after shiftof x-ray tube and film.i) For AP projection (posterior

view) of hip, has patient assumesupine position with knees andankles supported. For bilateral 1

study centers the sagittal planetwo inches medial to the anter-ior superior iliac spine to themidline of table, aligning partswith no rotation of pelvis,andwith elbows flexed in comforta-ble position,and shoulders in asingle transverse plane. Unlessthere are contraindications, in-verts feet so as to place longaxes of femora parallel to planeof film. Immobilizes feet. Forunilateral projection aligns af-fected hip to midline. Locateship joint as described in (b),above. Centers to level of high-est point of greater trochanterand directs central ray at rightangles to film.

ii) For latStal projection of hipjoint, has patient turn towardaffected side in a near lateral


Task Code No. 360


List Elements Full List Elements Fully 0-

position and grasp table sidefor support. Centers affectedhip to midline. Has patient flexaffected knee and draw thigh upto near right-angle flexion. Haspatient extend opposite thigh;supports at hip level. Adjustspelvis so that upper side is ro-tated slightly backward. Locateship joint as described in (b),above. Directs central ray tothat point at right angles or to200 to 25° cephalad, as ordered.

iii) For inferoLuperior projection,(axiolateral view) of hip,has pa-tient assume lateral recumbentposition on affected side. Haspatient grasp side of table forsupport. Centers midaxillaryplane of body to midline oftable. Extends affected extremityto lateral position and immobi-lizes. Rolls upper, unaffectedside backward gently about 10°and supports. Directs centralray to femoral neck at 35° cel.n-aled or 15° to 20° if soordered.

iv) For posterolateral position,per-former begins with same position-ing as,above; rolls upper, unaf-fected side forward about 15°and supports. Centers to thelevel of the greater trochanterand directs centray ray at rightangles. Performer may also posi-tion as above, but with patientlying on unaffected side.

v) For posterior oblique projectionof hip joint, performer has pa-tient assume semiprone position.Centers affected hip so thatposterior surface of affectediliac bone is at the midline.Elevates unaffected side 40° to45° and has patient support selfon flexed knee and forearm ofunaffected side. Centers to leve

of superior border of greatertrochanter. Directs central rayat right angles to film, pass-ing between posterior surfaceof iliac blade and dislocatedfemoral head.

vi) For anterior oblique projection(pnsterior oblique view) of ili-um, performer has patient assuma supine position with the sag-ittal pla-e passing through thehip joint of affected side,cen-tered to midline of table. Ele-vates unaffected side 40° andsupports elevated shoulder,hipand knee. Adjusts unaffectedleg and thigh so that the enter-ior superior iliac spines arein a single transverse plane.Centers to anterior superioriliac spine and directs centralray at right angles to film.

vii) For posterior oblique projec-tion (anterior oblique view) oilium, performer has patientassume prone position (or lat-eral recumbent) and centers asabove. Elevates unaffected sideabout 400 or so that transverseplane of pelvis is at a 45° en-gle. Has patient rest on fore-arm and flexed knee of unaf-

. fected side. Adjusts upperthigh so that the anterior su-perior iliac spines are in asingle transverse plane. Centersas above and directs central rayat right angles.

viii) For bilateral profile view,superoinferior projection ofacetabula, performer restrictsradiation to one half of filmat a time by using extensioncones or masking cassette. Re-hearses patient so that posi-tion will be retained for twoseparate exposures on the film,one for each side. Has patient

146


List Elements Full

Task Code No. 360


.11List Elements Full

seated on a side of the x-raytable far enough back so thatposterior surface of knees are incontact with edge of table. Cen-ters transverse axis of film tomidaxillary plane of body. Ar-ranges, if appropriate,to havegrid shift appropriately forsecond exposure. Performer cen-ters the midline of the longi-tudinal half of the film oppo-site the side being examined tothe median sagittal plane of bodyand marks for referPnce when sec-ond exposure is mado-Centers un-affected side for first exposureto the median sagittal plane ofbody. Has patient sit erect withthighs together and arms crossedover chest. Centers beam to thecrest of the ilium on the af-fected side at a medial angle of300 from one side. After firstexposure,performer has patienthold position while film is movedinto position for second expo-sure. Centers beam to crest ofthe opposite ilium at a medialangle of 300 from the other side.

ix) For posterior oblique projectionof acetabulum,performar has pa-tient assume semiprone positionon affected side suppprold onforearm and flexed kne of unaf-fected side. Centers afcted hipto midline of table. Adjusts ele-vation of unaffected side so thatanterior surface of body is at a38° with tabletop. Supports

x) For -interior oblique projection

beam through acetabulum at 12°flexed knee and ankles. Centers

cephalad at a point about twoinches above gluteal fold and

L

trp inches lateral to median sag-itLal plane.

of Ecetabulum, has patient as-sumf! s,l,pine position. Centers

".4111

147

sagittal plane passing throughanterior superior iliac spineto midline and elevates affectedhip 60°. Centers at level of upper border of greater trochant-er. Directs central ray at rightangles to midpoint of film.

d. If, during positioning, paLientshows signs of severe pain, per-former may notify appropriate phy-sician at once and await orders ormay decide on .alternative positioning to avoid movement of the af-fected part.

e. Performer chtcks final positioningby using ligc in collimator. Acti-vates the collimator light andpoints the light beam towards thepart. Adjusts the collimator open-ing to correspond to the film size(or the size of the unshielded areaof the film to be exposed). Usescross-hair shadows as referencefor center of field. Uses-,the col-limator light to center the"patientto the x-ray field, or centers thepart to the film holder and usesthe collimator light to center thetube to the part. Checks that pri-mary beam will enter the center ofthe area of interest at the select-ed angle to the film so as to pro-ject the view desired. May read-just tube position lengthwise orcrosswise to provide better center-ing.

13. Once the patient has been positionedand immobilized,performer adjusts thecollimator. Either collimates so thata small unexposed border will appeararound the edge of the film or colli-mates further so as to expose onlythe area of interest (and thus pro-vide maximum protection and detail).For small fields performer may attachan auxiliary extension cone to colli-mator to further reduce the primary


Task Code No. 360


-4....


beam. Adjusts primary beam to minimum Performer initiates exposure by press-

size needed to covet the part(s) of ing hand trigger or exposure control

interest. button.

14. Performer adds lead shielding to areas a. While exposure is underway per-

that will be in the primary path of former checks that mA meter re-

the beam but are not included in theareas of interest. Makes sure that


protective shielding has been pro- b. May watch for evidence of maifune-

vided to patient and everyone who will tion such as line surge or exces- 4

remain in room. sive drop; may listen for sound ofnormal functioning of equipment.

15. Throughout procedure performer ob- If there is malfunction may decideserves patient for any signs of emer- to report; anticipates need to re-

gency and/or to prevent or respond to peat exposure.

an accident. Is alert to signs of nau- c. With phototimer notes whether back-

sea, dizziness or sweat suggesting up timer has been involved in

faintness. Performer may have patient terminating exposure before photo-

lie down, lower head or raise legs. timed exposure was completed. If

Notifies nurse. If patient shows any so, anticipates possible need to

other errargency signs, loses consci- repeat exposure (due to underex-

ousness, or has an accident,performer posure if premature cut-off, or

calls appropriate physician or nurse overexposure due to faulty timer).

at once. May decide to provide emer- d. After exposure is completed tells

gency first aid as well. If a patient's patient that he or she can relax.

catheter becomes disconnected, perform- e. If the exposure is terminated by

er clamps it and immediately notifies a circuit breaker, rechecks tech-

nurse. If catheter should came out,notifies nurse at once.

nical factors for possible overloador cheeks for overload elsewhereon circuit. Anticipates need to re-

16. When everything is ready for the ex-posure, performer explains to patientwhat breath control will be used for

peat exposure.

18. Performer returns to patient. Removes

exposure (primarily holding breath)when told to do so by performer andholding still until told to relax. Re-minds patient about those exposures in

cassette or film holder from table,floor,or bucky.

a. Removes any markers for further

which position is to be retained for a use. If multiple views are to be

second exposure. Performer observes taken on the film, removes leaded

the patient's movement until the moment rubber mask and remasks all but

that the exposure is made. Readjusts next area to be exposed.

position if warranted. b. If the patient is being examinedfor a possible fracture or if so

17. The performer returns to control room. requested, performer arranges to

Makes sure controls are properly set have the first exposure processed

and patient is still in position.Tells at once and brought to the appro-

patient when to hold breath and/or holdstill by calling or using intercom.

priate radiologist.

148


Task Code No. 360



c. Depending on whether radiologistwill evaluate radiographs beforecompletion of all possible expo-sures for the series, performer ar-ranges to process film(s) and eval-uate for quality control personally,have this done, or bring to dark-room for processing and later eval-uation, based on time available, in-stitutional arrangements,or speci-fic instructions. Attaches ID cardfor use with flasher if appropriate.May sign requisition.

d. While films are being processed and/or evaluated performer has patientrelax in examination room or hold-ing area. Explains what will happennext.i) Performer determines whether pa-

tient should remain on table and/or in room or requires observa-tion. May consult requisitionsheet or attending RN. If appro-priate, makes sure that patientwill be attended while waiting.


iii) May decide to assist patient tochair or stretcher or fromtable, Makes sure patient is re-minded of any footrest in step-ping off table.

19. When (or if) performer learns from theradiologist the extent of the injuryand/or whether further conventionalviews and/or positions can be under-taken, eliminated or altered, perform-er proceeds as appropriate according to

instructions.

a. For further exposures performer re-peats appropriate steps for nextview(s) including identification offilm holder or cassette and use ofR-L marker, selection and setting

of technique for next view (ifdifferent), positioning patientand equipment for focus-object-film alignment, proper collimationand shielding, and making exposure,

as described above.b. Performer refrains from commenting

on the films or providing any in-terpretation.

c. If performer is asked to repeat anyexposures, makes sure that the ad-ditional exposures are warrantedmedically, since additional radia-tion will be incurred.i) Notes whether need to repeat is

due to4)erformer's own negli-gence or lack of attention sothat performer can avoid future"retakes."

ii) If request for retakes reflectsmalfunctioning equipment per-former reports malfunction toappropriate staff member.

iii) If request for retakes reflectsthe preference for density orcontrast of a radiologist, per-former notes for future workdone for the given radiologistso that retakes can be avoided.

20. When performer is sure that the ex-amination has been completed, per-former may have patient transportedback to holding area or next locationor decides to do personally, as appro-priate. Makes sure that none of theequipment is projecting over the pa-tient before allowing patient to risefrom stool or table, and assists pa-tient as described above.


a. Performer has equipment and exami-nation table cleaned after use ordecides to do personally,dependingon institutional arrangements.

149

TASK DESCRIPT/ON SHEET (continued)

Task Code No. 360

This is page lg of 18 for this task.

List Elements Full List ElemeuLDIlly

b. Perforner records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views takan,thetechnical factors used and filmSizes; may record the number of ex-posures made of each view includingretakes; may enter the estimatedradiation dose to which patient wasexposed (using posted informationon dosage); nay record any problemwith equipment, any special careprovided patient. If any views cal-led for in the initial requestcould not be obtained, performer mayrecord reasons. Signs requisitionsheet.

c. Performer may decide to jacketfilms, requisition sheets, and re- 1

lated materials and/or have infor-mation recorded in log book, or hasthis done, depending on institu-tional procedures.

d. May indicate to appropriate staffperson when the porformer is readyto proceed with next examination.

1

150


Task Code No. 361


What is the output of this task? (Be sure

this is broed enough to be repeatable.)Requisition.reviewed;pt. reassured,positioned;partsmeasured;films identified;technical factors selectedand set;technique for magnification set up;exposuresmade;radiographs sent for Jcessing and evaluation;procedures repeated as app,ipriate for full set ofviews;patient returned;examtu_ttlon recorded;radio-graphs placed for use.


if ona. certain items must be used. If there


Pt.'s x-ray requisition sheet,ID card,ID bracelet,technical history;pen;x-ray machine control panel(s),tube(s),bucky,table,collimator,extension cones;tech-ique chart;charts for conversion of technique,stand-

ard examination views,dosage,tube capacity;loadedassettes;vertical film holder;leaded rubber shield-.

ing;R-L and ID markers;immobilization,and support de-ices;stool;calipers;tape;scissors;pr6tractor;cam-ression band;stretcher or wheelchair;marking pen;.Laaezhead clamp

3. Is there a recipient, respondent or co-worker

inVolved in the task? Yes...(X) No...( )

es to q. : Name t e in o recipient,

respondent or co-worker involved, with de-


requirements or legal restrictions.Non-infant patient to be radiographed;radiologic

technologist;radiologist;nurse

Lis- Elements Fully

Performer receives or obtains thex-ray requisitiofi form, patient'sidentification card, and any ap-propriate. medical-technical his-tory for a non-infant patientscheduled for radiography of thevertebral column (cervical,thor-acic and/or lumbar spine and/orsacrum, coccyx):

.Name the task so t57a the answers to ques-


tial words.Taking plain film radiographs of vertebral column ofnon-infant patient by reviewing request;reporting ob-served contraindications;reassuring pt.;measuringpart;setting up for magnification technique;select-ing and setting technical factors;identifying film;

positioning pt. and equipment for erect or recumbentexposure;providing shielding;collimating;making ex-posure;having radiographs processed and reviewed:re-

1

peating for full set of views or as ordered;havingpt. returned;placing radiographs for use;recordingexamination.




'r

151

The plain films of the spinemay serve as preliminary"scout" films for contraststudies such as myelographyor discography; the plainfilms of the cervial,thoracic,and/or lumbar spine may bepart of a bone-survey. The re-quisition may call for a scol-iosis or spinal fusion series.

1. Performer reads the requi-sition sheet to determinethe examination called for,the patient involved, spec-ial considerations, and tocheck.the completeness ofthe information provided:

a. Performer checks the ex-aminations called forincluding the parts in-volved and the affectedareas (especially forspinal fusion study),whether bilateral or.unilateral views are re7-quested, the patient po-sitions and views called

OK-RP;RR;RR

6. Check here i this

is a master sheet..(X)


Task Code No. 361



for, the number of exposures, thecentral beam angulation, the areasof interest and parts to be included.Notes whether there will be multipleviews on a single film, whether theuse of a grid or bucky will be in-volved. Notes any request for dragni-fication. Checks the name of the re-ferring physician.

b. Performer reads patieneF name,iden-tificaC_on number, sex, age, weight,height. Notes whether patient is in-patient, out-patient, or emergencypatient. Notes any special informa-tion that will affect patient posi-tioning, technique, or handlin; ofthe patient, such as presence of ac-cident injuries, unhealed fracture,suspected fracture, degeneratingdisease, presence of ,laster cast,whether patient will le on a stretch-'er or wheelchair, the nature of anyknown pathology which would affecttechnique (such as bone infection),and the purpose of the study.

c. With patients with accident injuries

or unhealed fractures,performer maymake sure that a surgeon or radiolo-gist is available to position thepatient,

d. Performer checks whether patient issuffering from a collateral condi-tion requiring special handling,suchas heart disease, communicable orinfectious condition, infirmity, in-coherenca; whether patient has TVdrip, oxygen supply, urinary catne-ter or similar device in place;noteswhether patient will be accompaniedby nurse or other staff person.

e. If studies of the lumbar-lumbosacralvertebrae, sacrum,or coccyx havebeen ordered, performer checkswhether there were orders for priorpreparation such as administralionof cathartic and/cr enema,evacuation,and/or emptying of urinary bladderjust prior to examination. If or-

f.

dered, performer checks to be surethese were carried out; if not, ar-ranges for patient to evacuate and/

or empty bladder.If performer is not already assign-ed to examination room (and a par-ticular machine) notes the room ormachine involved. Goes to examina-tion room or control room for ma-chine involved. If oblique-PA pro-jection of cervical intervertebrateforamina has been ordered,noteswhether bi-plane study is involved.If so, checks that proper equipmentis available in room.

g. If magnification has been requested,performer checks that the machineto be used has a fractional focalspot of appropriate slze for directmagnification technivue (i.e.,0.3mm or smaller).

h. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheet iscomplete. Checks whether any spec-ial orders on exposure factors arein keeping with the usual rad ex-posure involved for the examination

i. Depending on institutional proce-dureperformer may review pa-tient's radiation exposure history,prior record of techniques used,andcumulative exposure. Noticeswhether examination has been doneelsewhere in recent past, whethernumber of radiographic exposuresordered or done in past should bebrought to radiologist's attention.

j. Depending on institutional proce-dures,performer notes whetherfemale patient is pregnant, reviewsdate of female patient's last men-strual period, or notes any other

indication that there is no dangerof exposure of a known or possiblefetus. Notes shielding needed.

k. If patient's record indicates or-ders for sedation or any other

(to


Task Code No. 361



prior medication,performer may checktiming to be sure a proper elapseof time has occurred for medicationto take effect. May arrange to delay

examination if appropriate.1. If referring physician has requested

that films already on file be sentwith current radiographs, and if notalready with patient's jacketed ma-terial, performer arranges to have

prior films delivered.

If the performer determines that therequest is not properly authorized, is

incomplete, or that sufficient informa-tion is lacking for performer to selecttechnique or to properly position orcare for patient, or if performer con-

siders that there may be contraindica-tions to going ahead with the procedure,performer notifies supervisor, radio-logist, or other designated staff per-son, depending on institutional proce-dures. Explains the problem if appropriate,and proceeds after obtaining needed

information, signature, or orders.

. When performer is clear about what willbe involved in examination, he or she

prepares ahead so as not to keep pa-

tient in examination room longer than

necessary:

a. Performer reviews the technique

chart for the machine to be usedand takes note of any newly postedchanges in technical factors (to re-flect accommodation for change inmachine output or a policy deci-

sion).b. Performer washes hands as appropri-

ate; depending on patient's condi-tion, may decide to arrange for orcarry out isolation or decontamina-

tion techniques.c. Performer makes sure that x-ray

equipment is ready for use. Goes tocontrol panel for x-ray generator

ard checks that indicator light

shows that machine Is "warmed up,"or turns on main switch as appro-priate to equipment and allows timefor machine to "warm up." If appro-priate, performer may set radio-graphy mode selector and set colli-mator control for manual operation.

d. Performer checks that appropriateimmobilization devices such assandbags,wedge sponges, compressionband, gauze bandage are present and

that there is a mattress, pads,pillows,and/ot blankets for comfortof patient if patient will lie ontable. If appropriate, obtains pro-tractor, cardboard triangles, cas-sette tunnels, weights, device to

support erect patient, objects to

stand on to compensate for (or

create) spinal curvature,or limbsof unequal length.

e. Checks that there is leaded rubbershielding available in room to be

used to mask film, protect the pa-tient, and/or to place beneath the

film holder, as appropriate.f. Performer prepares for identifica-

tion of the films using equipmentprovided by institution:i) May obtain lead numerals and

tape and prepare identification

strip for placement on filmholder(s) giving appropriate pa-tient identification informa-tion.

ii) Performer may prepare for use of

flashcard by checking that thereis piece of lead on film holder

surface; may write or type outID information on card if notreceived with requisition.


iv) Performer makes sure that right

(R) and left (L) markers areavailable for use.

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Task Code No. 361


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If magnification has been requested,performer prepares the equipment forthe tube-over-table method of magnifi-cation (used without bucky):

a. Pelformer determines the degree ofmagni:ication requested on the re-quiGition sheet; if the request isexpressed as an area magnificationperformer determines the linearmagnification by taking the squareroot. (Linear magnification squaredequals area magnification.)

b. Performer calculates the requireddistances from target (focal spot)to object (patient) (TOD), and fromobject to film (OFD), as well as thedistance from target to film (TFD)(the sum of TOD and OFD):i) If the distance from the table

top to a cassette placed on thefloor or a stool (OFD) will bea relatively inflexible distance,performer measures this distanceor reads indicator scale. (Ifstool is to be used, may note thetable height.) Performer may ad-just table height to provide fora round number for the OFD.


iii) Depending on whether the OFD orthe TOD is fixed, performer cal-culates the required complemen-tary distance by referring to amagnification chart for the de-gree of linear magnification re-quired, or uses the formula: de-gree of linear magnificationequals TFD divided by TOD. For atwo-times linear magnification

performer simply sets the TODequal to the OFD.

iv) Performer adjusts and locks thetable height and/or the tubeheight to the calculated OFDand TOD.


housing until it is centeredover the table top in the ap-proximate area where the pa-tient's area of interest will bepositioned, such as on table.

ii) Performer swings the table outof the way so that there is noobstruction between the tube andthe floor. (Does not changeheight.) If appropriate, placesa stool on the floor under thetube. May place cassette.of ap-propriate size on floor orstool. Performer selects thesize film designated for thedegree of magnification and theselected part to be studied.

iii) Performer adjusts the collima-tion to correspond to the fieldsize anticipated (for the TOD

involved).iv) Performer activates the light

in the collimator and adjuststhe tube horizontally so thatthe light beam cast is centeredto the cassette on the stool orfloor. Uses the cross-hairs pro-jected by the beam to center thetube to the area on the flooror stool.

v) Performer locks the tube intoposition so that there is a 900angle of the beam with the flooror stool. Fixes and retains col-limator setting.

vi) Performer marks the outline ofthe collimated light area orcassette on the floor or stoolusing tape or other removable

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Task Code No. 361


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marker. If not already done,checks by placing cassette in

a. Depending on institutional arrange-ments,performer may decide to es-

marked area. May mark center of cart out-patient to or from dress-

area as shown by cross-hairs. ing room. May decide to assist in

vii) Performer swings table back into transporting patient from holding

plaee. Activates light beam in area or have this done.

collimator and marks the table b. Performer greets patient and any

top where the center cross-hairs accompanying staff person and intro

and light outline are projected duces self. Checks patient's iden-

(to be used to center the part tity against the requisition sheet.

to be radiographed). Uses tape With in-patient, checks hospital

or other radiolucent removable identification bracelet or other

marker. identifier. If patient is accomr

viii) Performer may recheck TOD and panied because of seriousness of

OFD to be sure that they corre- condition, performer checks with

spond to the calculated dis- accompanying staff member on any

tances. special precautions necessary dur-

d. For magnification technique using a ing procedure.

vertical film holder, performer may c. Has patient assume a comfortable

wait until patient has been brought position seated on table or chair.

into examination room. Adjusts up- If patient is in wheelchair, moves

right holder to appropriate height; patient in chair into position next

adjusts x-ray tube to right-angle to table. If patient is on special

projection of beam to film holder; stretcher, places stretcher into

centers to the film; measures and position so that radiolucent

adjusts TOD to patient's position stretcher can be lifted with pa-

and marks patient's position; mea- tient on it from wheeled base to

sures and adjusts OFD from patient' x-ray table. May arrange to move

position as marked. patient to table. With accident pa-

e. If the sum of the new TOD and OFD tient uses upright film holder with

(TFD) is now different from the TFD patient remaining on stretcher

used for non-magnification techni- until injury has been localized.

que, performer may consult techni- d. Performer explains to patient what

que chart to note the factor to use will be involved in the procedure;

for a compensatory change in mAs. indicates what types of positions

May recor6 for later use in setting the patient will be asked to assume

exposure factors. and the cooperation that will be

f. Performer may also note the change asked of the patient.

in kVp and mAs necessary to compen- e. Performer answers patient's non-

sate for any change in collimation medical questions honestly; at-

from non-magnification technique. tempts to reassure patient and de-

Consults appropriate charts for con- velop confidence. Treats patient

version factors. May record, with dignity and concern regardlessof patient's behavior. Remains

. Performer has t patient called from aware that patient may be frighten-

the holding area and prepared for the ed and/or in pain. Performer ex-

examination (if not already done), or plains when asked medical questions

decides to do personally. that it is not appropriate for

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Task Code No. 361



technologist to answer these; en- b. If patient has had a severe injurycourages patient to speak to phy- to the cervical or thoracic spinesician.

f. If patient has an IV drip in place,performer checks that needle has

and arrives on stretcher or bed,performer plans for radiographicpositioning of film and x-ray tube

not become dislodged and that the with patient on stretcher and with-fluid is dripping at an even rate. out rotating patient. If any manip-If there are any problems, perform- ulation of patient's head is re-er clamps tube and notifies an ap- quired, performer has physicianpropriate staff person at once. carry this out.

g. If appropriate and not already done,performer questions female patient

c. For cervical and thoracic vertebrae,notes whether patient will be able

of child bearing age regarding pos- to hyperextend head for AP projec-sible pregnancy. If there is any tion or whether oblique projectionspossibility that patient is pregnant should be substituted.and this has not already been re- d. Performer notes whether patient cancorded, performer informs appropri- assume erect position for projectionate physician and proceeds only with where this is an option. Choosesapproval,

h. If not already done, has patienterect standing or seated positionwhere possible except for patient

with cervical spine involvement re- with standing or sitting difficultymove dentures, hair pins,and any or with cardiac condition.

jewelry around neck. Makes sure that e. Notes whether patient's extremitiesall garments except gown are re- are of unequal length, whether anymoved down to below the area of in- swelling or atrophy of the soft tis-terest. For views of thoracic and sue will cause rotation of the pel-lower spinal areas makes sure that vis when patient is recumbent. Notespatient has an open back gown. Keeps whether adjustments will be neces-body covered until ready for po- sary for excessive muscularity orsitioning and exposure. Reveals only fatty tissue, whether thin patientas much of body as necessary. Treats will need padding under bony prom-young patient with as much courtesy inences.as adult. If there is a wet dress- f. Performer considers the number anding, performer has it reinforced or types of projections ordered for thedecides to do personally. examination and the patient's con-

dition. Performer may consider a

6. Performer questions patient and/or RN change from standard projections toor MD present on what movement is pos- better accomplish the purpose of thesible to determine what positions are examination, or deletion of a posi-available for use. tion,or a change in technical fac-

tors. Depending on institutional ar-

a. When there is unhealed fracture or .rangements, performer may obtaindegenerating disease of upper cer- permission from appropriate radiolo-vical region,is careful to note gist or decides personally to alterwhether any requested positions in-volve axial positions or rotation

the standard procedure.

of head. Does not attempt without 7. Depending on whether a bucky or tablechecking with ND,and has MD posi-tion .atient.

top technique will be used and stan-

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Task Code No. 361


List Elements Fully

dard institutional practices, performrer selecta speed and type of film,grid,and cassette combination.

a. Selects size(s) based on the area(s)to be included, the patient's size,and whether bilateral views are tobe exposed on a single film.

b. For frontal and lateral projectionsof the lumbar-lumbosacral vertebraeperformer assesses whether to uti-lize a single cassette large enoughto accommodate the area of interestor use two films, one centered tothe third lumbar body and one at thelumbosacral joint.

c. For magnification technique,per- .

former selects the size film desig-nated for the degree of magnifica-tion and the selected area to bestudied.

d. Performer makes sure that an ade-quate supply of loaded cassettes othe types and sizes selected areavailable in the examination room.If not, arranges to obtain or de-cides to obtain personally.


a. Ferformer obtains the appropriate:71.7:e loaded cassette for the first

pc.siection.

b. If bilateral exposures will be takenon one film, performer mentally de-cides how these will be positionedso that the film need not be turnedfor viewing each image. Performeruses leaded rubber sheets and masksthe cassette completely except forthe area to be exposed. Treats the'area to be exposed from this pointas though it were the actual filmsize.

c. Performer attaches identificationinformation to the cassette ortable top:

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i) Places right or left marker onfilm holder or table-top as ap-propriate to the study and pro-jection or depresses appropri-.ate R or L button for automaticmarking.

ii) If patient's identification in-formation is in the form of leadnumerals, performer places onappropriate corner of cassette.

iii) If t'.tient identification infor-mation is to be entered by useof flasher, sets flashcardaside for later use with spacecreated by piece of leaded rub-ber on appropriate edge of cas-sette.


d. If cassette is to*be used withbucky (under tabletop or in up-right holder) performer May manual-ly pull out bucky tray and open re-taining clamps. Inserts cassetteinto bucky tray a-A pushes back.Makes sure.clampL .re closed. Movescassette into appropriate "stored"position or inserts cassette trayinto bucky slot and centers.

e. If a bucky is not being used, per-former places cassette in a posi-tion that can.be c:mfortably reacheby the patient in final position-ing.

i) If magnification technique is tobe used, performer places cas-sette in marked position onfloor or stool.

ii) If appropriate to make possibleminimal movement of patient,performer may place cassette inupright holder at right anglesto table top or in other posi-tion selected.


Task Code No. 361


List Elements Fully

iii) With accident patient, after lo-calization has been established,performer may obtain assistancein lifting any part under which acassette must be placed while theinjured extremity is supported.

f. Performer provides patient and every

one who will remain in room duringexposure with protective shield-ing. Explains if necessary Oat thisis not cause for alarm but a generalprecaution to minimize unnecessaryradiation exposure.

Performer has patient assume a comfort-able recumbent or seated position de-pending on the positions to be employ-ed, so that the part(s) to be radio-graphed can be measured in position.

a. If appropriate, ploces mattress,pillow,or clean linen on x-raytable.

b. Performer may decide to assist pa-tient from wheelchair or stretcherto table or has this done. May ob-tain help. Makes sure that no equip-ment is in the way and may be col-lided with by patient. Locks chair.

c. If assisting patient to step onfootstool in order to get on table,helps patient turn into position,step backwhrds on stool, and thensit and/or lie on table.

d. Performer uses centimeter calipersto measure the thickness of thepart(s) to be radiographed in thedirection in which the central rayof the x-ray beam will pass throughthe centered Tart from tube to film.Records for use in determining ex-posure factors.i) With fractures or accident pa-

tient,may have surgeon or radio-logist position the patient.

ii) In locating iliac crest,perform-er is careful not tr, center toohigh by making sure not to con-

List Elements Fully

fuse the iliac crest with theheavy muscles immediately abovethe crest. May have patient in-hale deeply and breathe out;then palpates the point of thecrest while the muscles are re-

laxed.iiJ) If performer believes that pa-

tient will be embarrassed bypalpation of the symphysispubis, uses the most prominentpoint of the greater trochanterto locate the same transverseplane.

iv) If patient has a urinary cathe-ter in place, performer turnspatient toward the catheter andtubing to prevent separating itfrom drainage bottle and break-ing sterile system and to avoidcausing pain.

e. After measuring, has patient restin as relaxed a position as pos-sible. May place pad, blanket or

pillow under bony prominences toprovide comfort.

10. Performer selects the exposure fac-tors for the first projection by con-sulting the technique chart(s) postedfor the machine:

a. Locates the information needed forthe body part and projection in-volved according to the centimetethickness of the part as measuredand the collimated field-size tobe used. Makes sure that techni-que relates to the combination of

film type and speed and use ornonuse of other accessories thatare possible (such as screens,

. grids, bucky, etc.).b. Makes note of the kVp,mA,T(second

of exposure time),focal spot sizeand the focal film distance (TFDor FFD) called for.


List Elements Full

Task Code No. 361


c. Once the standard kVp, mA and timehave been determined, performernotes whether any conversions arenecessary to account for a patho-logical condition, change in TFD,extreme fat or muscularity, pre-ference of the radiologist involved,and any other conversion neededsuch as with magnification techni-que. Performer looks up numericalconversion factors and calculates,or uses conversion charts to ascer-tain the appropriate new exposurefactor (kVp, mA and/or time). Multiplies, divides, adds, or subtractsas appropriate.

d. Performer checks any new or unfam-'Mar exposure factors against theposted limits of the x-ray tube ona tube rating chart to.be sure thattechnique does not exceed the heatcapacities of the tube for the focaspot size to be used. If appropri-ate, performer reconverts the tech-nique to an equivalent output usinghigher kVp and lower mAs.


a. Enters control room. Makes surethat indicator light shows thatx-ray generator is ready for use.Makes sure that all circuits haveoeen stabilized.

b- lf appropriate, checks line voltagemeter and, if aeeded, turns com-pensator dial until needle isaligned properly on line meter.




iii) Performer sets the kVp selectedby choosing the combination of

List Elements Full

major kilovoltage and minorkilovoltage settings to producethe desired kVp.


category corresponding to thetype of study and use or non-use of screens, bucky, etc.,and, if appropriate, focal spotsize.


iii) May select and set a kVp rangebutton (if called for withequipment) corresponding torange for examination.

iv) Sets a density selector corres-ponding to the usual (or spec-ial) requirements for the study

v) Makes sure backup timer is notlikely to terminate exposure before phototimed exposure ismade.

e. Depending on the equipment,may setcontrols to provide for use ofbucky, manual tableside adjustmentof table and tube height, positionand of collimtion (unless thesehave already oeen set as with mag-nification technique).

f. Performer returns to overhead unitand sets the focal-film distance(if not already done, as with mag-nification technique). Operatescontrols or manually moves thex-ray tube into place over thefilm holder (or at right angles toupright holder). Checks the focal-film distance by reading indicatorscale in the tube housing; adjustsup or down until the required FFD(TFD) is obtained.

12. Performer prepares the part to be ra-diographed in the final position se-

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Task Code No. 361


List Elements Fully List Elements PJlly

lected for the first exposure (unlessthis is done by physician).

a. May explain or demonstrate to pa-tient what is required. May obtainhelp in positioning or has MD posi-tion in accident and fracture cases.

b. Performer centers part and keeps thelong axis of the part parallel tothe film holder. When using a bucky,centers patient to midline. Withcassette on table top, centers filmto part. With upright holder, ad-justs height of holder to part andcenters part to film.

c. When positioning a patient with aballoon catheter in place, performermakes sure that the clamp is not ly-ing over a part to be exposed orthat patient is not lying on theclamp.

13. Performer positions as follows (unlessnonconventional positioning is beingused to avoid having patient move):

a. For studies of the cervical verte-brae, including entire cervical col-umn, occipitocervical articulations,the atlas, odontoid processes ofaxis, axis,and the lower cervicalintervertebral foramina, the per-former first determines whether asevere injury of the cervical spinemay be involved requiring specialnon-manipulative positioning for APand lateral projections (to ascer-tain the nature and extent of in-jury) and whether manipulation ofthe patient's head is to be performed by a physician. Arranges for thelatter as appropriate. Takes lateraview of cervical spine as part ofbone-survey.i) For AP projection (posterior

view) of cervical vertebrae whenpatient is on stretcher and can-not be moved, performer drawsbottom sheet of stretcher or bedJr

tight. Holds patient's head toprevent it from turning, andlifts head only enough to slipcassette into position. Performer positions x-ray tube to a15° to 20° cephalad angle ifthe vertebral bodies and inter-spaces are to be studied,and/or20° to 30° caudad for posteriorvertebral elements, articularpillars and facets,laminae,andspinous processes. May includeupper thoracic vertebrae infield.

For conventional AP projection(posterior view) of cervicalvertebrae, has patient lie insupine position with mid-sagit-tal plane of body centered tomidline of table. Has armsplaced alongside body withshoulders in a single trans-verse plane. Supports ankles.May place pad under patient'shead. Adjusts head so that itsmedian saggital plane is atright angles to table top. Ele-vates chin so that edges of up-per incisors and mastoid tipslie in same transverse plane.Performer immobilizes head withhead clamp. Explains what willbe needed during exposure. Nohave patient practice openingand closing mouth until this isdone smoothly and rapidly with-out the teeth striking togetherif this will be required duringthe duration of the exposure.Centers cassette to level offourth cervical vertebra anddirects central ray at right angles to midpoint of film.

ii) For lateral projection of cer-vical vertebrae when patient ison stretcher or bed and cannotbe moved, performer adjusts cassette in vertical-position in

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Task Code No. 361


List Elements Full

upright holder so that lowerportion is in contact with should-er. Centers to the fourth cervi-cal vertebra and immobilizes. Forseventh cervical vertebra mayhave patient assist in holdingshoulders down by first loopingbandage around patient's feet,having knees slightly flexed,andhaving patient grasp bandage endsand extend knees. May have co-worker depress shoulders by pull-ing on arms with symmetrical trac-tion. Centers beam at right an-gles to film across table.

For conventional lateral projec-tion of cervical spine,performerselects seated or standing lat-eral position and adjusts verti-cal cassette stand to center atfourth cervical segment with pa-tient sitting or standingstraight. Has patient rest adja-cent shoulder against stand. Cen-ters coronal plane passingthrough tips of the mastoid proc-esses or level of external audi-tory meatus to midline of film.Rotates rounded shoulders forwardand normal shoulders backwardwith shoulders in single trans-verse plane. Has patient holdsandbags of equal weight to de-press shoulders or grasp and pullon gauze strip as describedabove. Adjusts lateral positionof body with long axis of cervi-cal vertebrae parallel with film.Elevates chin slightly and ad-justs median sagittal plane ofhead to right angles with floor.Has patient fix view on a singlespot straight ahead during expo-sure.

For lateral projections used inflexion-extension studies, per-former positions as above, with

median sagittal plane of headand neck parallel with planeof film. Has patient drop headforward and draw chin in closeto spine for first exposure.For second exposure has patientelevate chin as much as pos-sible. Centers beam as above.

For lateral projections used instudy of spinal processes ofthe cervicothoracic spine, po-sitions as above in front ofupright bucky holder. Centersfilm and central beam at levelof second or third thoracicvertebra. Rotates shoulders forward and down and has patientgrasp knees or cross forearmsand grasp upper arms. Has pa-tient drop head forward and pulchin down. Centers the cervico-thoracic vertebrae to the mid-line of film,and beam as above.

iii) For PA projection of occipito-cervical articulations,perform-er places patient in prone po-sition and centers median sag-ittal plane of body to midlineof table. May place pad underchest. Has patient flex elbowsand place arms in comfortableposition. A.:!justs shoulders sothat they lie in a singletransverse plane. Supports an-kles. Has patient rest head onforehead and nose,with mediansagittal plane at right anglesto film or table and orbito-meatal line vertical to table.Centers to the level of theinfraorbital margins. Immobil-izes head with clamp or band.Directs central ray at rightangles to midpoint of film.

iv) For oblique anteroposteriorprojection of occipitocervicalarticulations, performer may

1 1


Task Code No. 361

This is page _12 of 28 for this task.

List Elements U]l.jr. List Elements Full

plan to expose both sides (with gles to film. Immobilizes head.two exposures side by side on cne Directs central ray at rightfilm) for comparison. Has patient angles to midpoint of openassume supine posiC.on. Centers mouth. Has patient practicemedian sagittal plane of body and keeping mouth wide open andaligns shoulders as above. Centers softly phonating the sound "ah"cassette under patient's head during the exposure.(with reference to unmasked por- vi) For the lateral projection oftion) at level of external audito- the 2tias and axis, performerry meatuses, one inch lateral to starts from the AP position asmedian sagittal plane of head. Re- described above, with patienttates head away from the side of supine or erect. Places cassett-interest so that midpoint of theorbit is at right angles to film,

holder alongside patient's head,in contact with upper neck, cen-

Adjusts flexion so th,t the infra- tered one inch distal to theorbitomeatal line is dt right an- tip of the mastoid process,withgles to film. Immobilizes head cassette parallel with medianwith head clamp or sandbags. Di- sagittal plane of neck. Extendsrects central ray at right angles patient's chin slightly. Sup-to midpoint of film. ports cassette if patient is

supine and immobilizes head.Performer may turn the head 40° Directs central ray at rightto 50° to the side of interest,have patient open mouthiand draw

angles to midpoint of film.vii) For AP projection (posterior

chin down as much as open mouth view) of odontoid process ofwill allow. Directs central ray axis, performer makes sure thatat right angles through open there Is no fracture or degen-mouth to the mastoid tip of the erating disease of the upperaffected side. Repeats as appro- cervical region. Starts frompriate for unaffected side. AP position as described in (v)

v) For the anteroposterior projec- above,with cassette centered totion (posterior open-mouth view) the median sagittal plane atof the atlas and axis, performer the level of the tips of thehas patient assume supine posi- mastoid processes and supported.tion. Aligns mid-sagittal plane Performer tips the patient'sof skull to midline of table,with arms at sides of body and

head backward so that a linepassing through the tip of the

shoulders in a single transverse chin and the tip of the mastoidplane. Performer places the cas- process is at right angles tosette under the patient's neck,centered to the median sagittal

table as well as the mediansagittal plane of the head. Im-

plane at the level of the second mobilizes head and directs cen-cervical segment. Places towel tral ray to midpoint of film.or pad to prevent cassette from viii) For anterior oblique projectionslipping. Has patient open mouth (posterior oblique view) ofas wide as possible and adjusts odontoid process, performerhead so that a line from lower notes whether a bilateral studyedge of upper incisors to tip of is requested (with two expo-mastoid process is at right an- sures side by side on the film).

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Task Code No. 361


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Checks that head can be rotated.May rotate entire body instead.Starts from AP position as de-scribed in (v), above, with un-masked half of film centered as'in (vi), above. Rotates the head400 to 450 away from the side ofinterest for the first exposure(and towards the side of interestfor the second exposure), so thatthe infraorbitomeatal line is atright angles with table. Immobil-izes head. Directs central ray at100 to 15° caudad, centered to apoint midway between the outercanthus and the external auditorymeatus.

ix) For PA projection (anterior view)of atlas and odontoid process (orsemiaxial projection), performerfirst rules out the presence ofunhealed fracture or destructivedisease of the upper cervicalregion. Places patient in proneposition, centering the mediansagittal plane of body to the midline of table. Has patient flexelbows and place arms in comfor-table position with shoulders ina single transverse plane. Sup-ports ankles. Places cassettetransversely. For semiaxial pro-jection inclines cassette 23°caudad and supports to preventslippage. Then has patient ex-tend chin and rest it on upperborder of cassette. Adjusts headso that the median sagittal planeis vertical. Centers film to me-dian sagittal plane of throatabout 1.5 inches distal to tipof mastoid process. Immobilizeshead. Directs centrIl ray atright angles to midpoint of film.If bucky is to be used for semi-axial projection,adjusts angleof central beam to compensatefor lack of angulation of cas-sette and directs beam midway

List Elements ully

through the mastoid tips.

x) For AP projection (posteriorview) of the lower cervicalvertebrae, performer selectserect or supine position andhas patient assume the AP posi-tion as described above. Cen-ters the median sagittal planeof the body to the midline oftable or upright holder withshoulder,: in a single trans-verse plane..,.Xxtends the chinso that the occlusal plane andmastoid tips are in a singletransverse plane. Directs cen-tral ray through the fourthcervical body at 15° to 20°cephalad,and centers film topoint of entry.of beam. Forcervical ribs,directs centralray at right angles through theseventh cervical vertebra. Re-hearses with patient how tosoftly phonate the sound "mmeduring exposure.

xi) For oblique AP projection (ob-lique posterior view) of cervi-cal intervertebral foraminawhen paticnt is on stretcherand cannot be moved, performerdraws bottom sheet on stretch-er or bed tight. Holds pa-tient's head to prevent it framturning, and lifts head onlyenough to slip cassette intoposition, placing the midlineof the film about 3 inches lat-eral to the median sagittalplane of the neck near the sideopposite the si& being studiedat the level of tl.Ye third cer-vical body. Directs :the centralray from the side of interestto the fourth cerv.:cal verte-bra at 45° toward rile mediansagittal plane and at 15° to20° cephalad.

163

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Task Code No. 361


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For conventional oblique AP pro-jection of cervical interverte-bral foramina, has patient assumeerect AP position if possible.Notes whether both sides are tobe radiographed for comparison.Performer has patient assume APposition seated or standing fac-ing away from film holder or su-pine. Adjusts body rotation to a450 angle of midsagittal planewith the table or upright holder,(using a protractor). Centers cer-vical spine at the midline of thefilm one inch proximal to themost prominent point of the thy-roid cartilage. For semisupineposition,supports lower thorax,elevated hipond head so that thecervical column is parallel totable top. May immobilize head.Directs central ray to the fourthcervical vertebra at 15° to 20°cephalad. Takes second exposurewith patient in reverse positionto demonstrate the other side.Rehearses with patient the softphonation of the sound "mmm" dur-ing exposure.

xii) For oblique PA projection (obli-que anterior view) of cervicalintervertebral foramina, has pa-tient assume erect position ifpossible or lie prone on table.Notes whether both sides are tobe radiographed for comparison,whether bi-plane or flexion-ex-tension studies are involved.Performer keeps the shoulder onthe side of interest adjacent tothe film in upright holder orbucky (for the first exposure;the opposite-side shoulder forthe second exposure), with pa-tient facing towards film.Turnsbody until midsagittal plane isat 450 to film. For prone pa-tients centers to midline andhas patient support self on fore

16s, eamaorte.mmonve:

arm and flexed knee of elevated Iside,and supports ankles,knee,and head so that long axis ofcervical column Is parallelwith film. Uses protractor tocheck body rotation. Adjustspatient's head so that mediansagittal plane is in same lineas spine. Extends or elevatesthe chin slightly. May immobil-ize head. Directs central rayto the fourth cervical verte-bra at 15° to 20° caudad toparallel the angle of the foL-amina. May have patient graspside of holder with hand onside away from film. Has pa-tient practice "mme phonationas described above. Takes sec-ond exposure with patient inreverse position to demonstrateother side.

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For flexion-extension-studies,has patient assume direct PAposition seated or standingwith shoulders held against up-right film holder. For firstexposure rotates head maximallyto one side and has patientflex neck. For, second exposurehas patient extend neck in samerotated position. For third andfourth exposures (to comparesides) has patient rotate headin reverse direction, flex, andthen extend neck.

For bi-plane study,performermay use x-ray machine equippedwith two x-ray tubes. Sets uptwo cassette tunnels so thatthe two cassettes are at rightangles to each other and eachat right angles to table, form-ing a "V" in which to supportpatient's head in prone poSi-tion. Centers body to midline.Supports with pillow and ad-


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Task Code No. 361


justs patient in comfortable PAposition. Centers cassette tun-nels to midline and under thehead and neck at the level of thefourth cervical vertebra. Cush-ions and supports forehead andnose. Has orbitomeatal line andmedian sagittal plane at rightangles to table. Directs tubesso that each central ray entersat right angles to midpoint offilm from opposite side of head.If no bi-plane equipment isavailable, positions tube for oneside for first exposure and repo-sitions for other side while pa-tient maintains position.

b. For studies of the cervical and up-per thoracic vertebrae, thoracicvertebrae, and apophysial articula-tions, performer first determineswhether an accident victim patientrequires preliminary filming of lat-eral view of cervical and upperthoracic spine without being movedon or from stretcher or bed. Forbone-survey, performer makes AP andlateral projections of the thoracicspine.i) For lateral projection of cervi-

cal and upper thoracic vertebraewhen patient is on stretcher andcannot be moved, performer usesupright cassette holder for film-ing. May plan to make two expo-sures on a single film using anextension cone for the first ex-posure. If so, performer adjustsupright cassette holder next tostretcher or places a grid cas-sette upright on stretcher andsupports so that x-ray beam maybe directed across stretcher tofilm. Includes first and secondthoracic vertabrae and all sevencervical vertebrae in the ini-tial collimated field. Perfor.deradds extension cone to tube,cen-tered on the first and second

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thoracic and seventh cervicalvertebrae. Performer directscentral ray at right anglesthrough extension cone for firstexposure. Instructs patient notto move; removes cone and, with

repeats exposure on same film t:0

appropriate new exposure factor

include the original field. Per-former may repeat the lateralprojection with a simple expo-sure of the field on a secondcassette.

For conventional lateral pro-jection of cervical and upperthoracic vertebrae, performerselects erect seated or standingposition or lateral recumbentposition. Has patient sit orstand straight before an uprightcassette holder in a lateral po-sition or has patient lie inlateral recumbent position withhead elevated and supported.Centers patient or film Holderto the level of the second thor-acic vertebra with the mid-axilmlary line of boay at midline offilm. For erect position has pa-tient elevate the arm next tothe casset'te holder to a verti-cal position with elbow flexedand forearm resting on pacient'head, with shoulder restingagainst holder for support. Ad-justs head so that median saglt-tal plane is parallel with film.

For recumbent position has pa-tient extend the arm on the sidenext to the table so that thehumeral head is either behind orin front of the vertebrae. Ad-justs other arm in opposite di-rection. Provides support tohead and lower thorax so thatthe long axis of the cervico-

165

TASK DESCRIPTION SHEET continued)

Task Code No. 361



thoracic vertebrae is parallel tral ray to seventh cervicalIto film. vertebra,30° to 40° caudad.

o iv) For oblique PA projection (obli-Depresses shoulder suly from film que anterior view) of cervicalin either erect or recumbent po-sition. Immobil.zes by having pa-

and upper thoracic vertebrae,performer has patient lie in

tient grasp dorsal surface of prone position with median sag-thigh or an anchored hana-hold. ittal plane of body centered toAdjusts body in exact lateral po- midline and cassette placed sosition. If shoulder cannot be that distal edge of film is atwell depressed(or for recumbent the level of the tip of theposition)directs central ray to seventh cervical spinous pro-midpoint of film at 3° to 5° cau- cess. May provide soft supportdad; otherwise at right angles.. under chest. Depresses shoulders

ii) For AP projection (posterior and aligns to a single trans-view) of cervical and upper thor- verse plane. For first exposureacic vertebrae, performer has pa- has patient rest head on onetient assume supine position with cheek; reverses for second ex-median sagittal plane of body cen posure. Adjusts head so that itstered to midline of table,should- median sagittal plane is at 450ers depressed,and in a single angle. To demonstrate 2nd to 5thtransverse plane. To depress cervical vertebrae, flexes headshoulders ma loop bandage around somewhat and immobilizes. Forpatient's feet while knees are 5th to 7th cervical vertebraeslightly flexed. Has patient and 1st to 4th thoracic verte-grasp bandage ends and extend brae extends the head somewhat.knees. Places median sagittal Directs central ray to 7th cer-plane of head at right angles to vical vertebra at 30° to 40°table and then assists patient to cephalad.hyperextend the head;adjusts cas- v) For AP projection (posteriorsette so that upper edge of film view) of the thoracic verte-is at level of the external brae, performer decides on su-audttory meatuses and centered to pine or erect position for pa-the 7th cervical vertebra. Depend tient. Positions patient so that

log on the extent of the cervical median sagittal plane of body islordosis, directs central ray tc centered at midline of table orcoincide with the plane of the vertical cassette holder,andarticular facets (about 20' to long axis of x-ray-tube is par-30° caudad). allel to this line, with the

iii) For oblique AP projection (obli- anode at the head end of the pa-que posterior view) of cervical tient (to provide a view facing

and upper thoracic vertebrae,performer starts from the AP po-

caudally) and the cathode on theside of the feet (to take ad-

sition as described above. For vantage of "heel eifect"). Cen-views of both sidesorotates head ters film at the level of the

45° to 50° (or more as needed) to sixth thoracic vertebra (3 to 4

one side,and to the other side inches distal to the manubrial

for second exposure. Directs cen- notch). Places arms alongside

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Task Code No. 361



body and adjusts shoulders tolie in a single transverse plane.With standing patient,compensatesfor extremities of unequal lengthand has patient stand with weightequally distributed. For supinepatient,has hips and knees flexedenough to put the back in contactwith table, with thighs in verti-cal position. Immobilizes feet.May support extended knees forpatients unable to flex. Directscentral ray to midpoint at rightangles to film.

vi) For lateral projection of thor-acic vertebrae, performer selectslateral recumbent or standing po-sition (preferably left lateralwith the heart on side closer tothe film). Centers the midaxillaryline of the body to the midlineof the table or upright filmholder,with midpoint at the levelof the sixth thoracic vertebra,For erect position, has patientrest adjacent shoulder againstholder for support, with weightdistributed equally on both feet.Provides compensation support forextremity of unequal length. Haslong axis of vertebral columnparallel with film. Has patientraise arms forward at right an-gles to long axis of body. Has pa-tient grasp support stand.For lateral recumbent position,supports patient's head so thatits median sagittal plane is inline with long axis of vertebralcolumn. May support lower thor-acic region. Has patient flexhips and knees. Elevates and sup-ports lower knee to hip level;places sandbag on top and thensuperimposes upper knee. Supportsankles similarly. Adjusts upperarms forward at right angles tolong axis of body and has lower

:

'

hand rest under head. Has pa-tient hold table edge with up-per hand. Adjusts so that scap-ulae are in a single plane. Ad-justs body in true lateral posi-tion. May apply compression bandat level of trochanteric area ofpelvis. Directs central ray atright angles to midpoint of filmor at right angles to long axisof thoracic column centered atthe sixth thoracic vertebra.

vii) For oblique projection(s) of theapophysial articulations of thethoracic vertebrae, performernotes whether forward rotation(for posterior oblique projec-tion) or backward rotation (foranterior oblique projection) isto be employed (the latter assubstitution for direct lateralof cervicothoracic area). Usessame direction of rotation forboth exposures in bilateralstudies. Decides whether to po-sition patient in erect stand-ing or lateral recumbent posi-tion. Performer starts by posi-tioning patient ir erect lateralor lateral recumbent positionas described above. For erectposition has patient flex elbowof arm adjacent to stand andrest hand on hip. For posterioroblique projection (forward ro-tation) has patient grasp sideof stand for support with op-posite hand. For anterior obli-que projection (backward rota-tion) has opposite hand placedon hip. Rotates body forward orbackward as decided so that themedian sagittal plane forms anangle of 200 with film,and coro-nal plane forms an angle of 70°with plane of film, with should-ers in a single transverseplane. For lateral recumbent po-

10


Task Code No. 361


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sition, forward rotation, has pa-tient place arm next to film be-hind back and grasp side of tablewith opposite hand for support.For backward rotation has arm nextto film placed forward at rightangles to long axis of body,withelbow flexed and hand under or be-side head. Draws opposite arm back-ward and supports. Rotates body asdescribed above; may apply compres-sion band. Performer directs thecentral ray at right angles tofilm centered to the sixth thor-acic vertebra.

c. For studies of the lumbar spine in-cluding the lumbar-lumbosacral ver-tebrae, intervertebral foramina,lumbar-lumbosacral apophysial joints,lumbar intervertebral disks, andlumbosacral junction, performer de-cides whether erect position can beutilized. If not, performer mayplace footboard into position ontilt-table and position patient wittable in upright position;then turnstable to the horizontal for finalpositioning and exposure--if this ismore comfortable for patient. Forfrontal projections,performer

,chooses the AP or PA projection de-Pending on the patient's conditionor specific orders. Performer plansseries so that the same basic posi-tion, erect, recumbent, supine orprone,is continued throughout, andgroups exposures so that a minimumof repositioning between exposuresis necessary. For bone-survey, per-former makes AP and lateral projec-tions of the lumbar spine.

For frontal projections of the lum-bar-lumbosacral vertebrae,performereither centers a single cassette atthe level of the iliac crests, orcenters one cassette at the thirdlumbar bodly at the level of the

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inferior mid-axillary costal mar-gin,with central ray direcied atright angles to film, aa.: centersa second cassette to the lumbo-sacral joint,and directs centralray cranially or caudally as de-scribed below. In centering tothe level of the iliac crests per-former makes sure not to use vis-ual'points of muscle or fatty tis-sue and palpates for the crest ofthe bone.i) For prone or erect PA projec-

tion (anterior view) of lumbar-lumbosacral vertebrae, perform-er has patient stand facing up-right cassette holder or liein prone position on table.Centers the median sagittalplane of body to midline "Oftable or holder. Supports an-kles for prone position. Cen-ters film,as described,to levelof iliac crests or third lumbarbody. Has patient flex both el-bows and adjusts arms and fore-arms symmetrically in comfort-.able position with shouldersin a single transverse plane.For prone position,has patientrest head on chin to preventrotation. Directs central rayat right.angles through mid-point of film. When two cas-settes are used,proceeds forsecond exposure to positioningfor lumbosacral joint as de-scribed below (viii).

ii) For supine or erect AP projec-tion (posterior view) of lum-bar-lumbosacral vertebrae, per-former has patient stand facingaway from upright film holderor lie in supine position ontable. Centers body and film asdescribed above. Adjusts headand --pine to single median sag-ittal plane,centered to mid-


Task Code No. 361



line, with shoulders in a single to hin level; places sandbagtransverse line. Has patient flex on knee, and has patient super-elbows and place hands on upper impose other knee. Supports an-chest. Supports extremity of short kles similarly. Supports lowerer length for erect patient)or ab- thorax to place spinal axisnormality causing rotation of pel- parallel with table. Adjustsvis for supine patient so as to to correct any rotation of body.center symmetrically. Has supine Centers one or first of twopatient flex hips and knees enough films as described above. Di-to place the back in contact with rects central ray at right an-table. Has patient lean knees togles to midpoint of film. Ifgether and immobilizes feet. Sup- the spine is not on a horizon-ports knees where flexion is not tal plane, directs central raypossible. Directs central ray as at right angles to its long axisin (i), above,

iii) For lateral projection of lumbar-through the midpoint.

iv) For oblique semiaxial projec-lumbosacral vertebrae, performer tion of the last lumbar inter-continues patient in erect or re- vertebral foramina, performercumbent position from frontal pro- plans on two exposures, turningjection. Continues with one cas- patient from one lateral recum-sette or two, as described above, bent side to the other. For eachFor erect patient, centers film side, performer has patient as-as described above and asks pa- sume lateral recumbent positiontient to turn to lateral position. with body aligned so that theCenters to midaxillary line of coronal plane 1.5 inches poster-body. Has patient grasp an upright ior to the midaxillary line issupport at shoulder height for centered to the midline of thesupport. Has patient stand erect table. Has patient place theor with pelvis tilted forward and forearm of the side next to theupward, with weight equally dis- table under head for supporttributed. Directs central ray at and extend upper opposite armright angles to midpoint, and grasp edge of table above

head so that the thorax will beFor recumbent position has pain a lateral position duringtient turn to affected side and rotation. Rotates patient'sflex hips and knees comfortably. pelvis 300 forward with upperMay pad surface to receive hip. knee flexed and supported. Re-Centers midaxillary line of body adjusts so that thorax remainsto midline of table. Adjusts head in lateral position. Centerssupport to place median sagittal film to the inguinal region ofplane of head in line with spine, the affected side. Directs cen-Has patient flex elbow of affect- tral ray angulation so thated side and place arm forward at beam enters at the superior edgeright angles to body. Has patient of the uppermost iliac crestgrasp side of table with opposite through the fifth lumbar seg-hand. Adjusts so that scapulae ment and exits at the inguinalare in a single vertical plane. region of the affected sideElevates knee on affected side ( 15° to 30° caudad ) . Per-

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Task Code No. 361



former reverses positioning foropposite side.

v) For oblique projections of thelumbar-lumbosacral apophysialjoints, performer determineswhether centering will be to lum-bar region or lumbosacral apophy-sial joints,or both. Continuesbasic position used for frontalprojections (recumbent, AP orPA). Plans for two exposures,oneon each side,for each study.

For PA oblique projection, per-former exposes the patient's backand uses wax marking pencil toindicate the spinous process ofthe third lumbar segment for cen-tcring film,and/or marks a pointjust distal to the spinous pro-cess of the fifth lumbar segmentfor centering last joint. Markspoints two inches on either sideof centering point for centeringspine.

Performer has patient assumesemiprone position supported onforearm and flexed knee of ele-vated side. Supports knee. Cen-ters the plane marked for theelevated side to the midline oftable. Adjusts the degree of bodyrotation to 450 for lumbar regionand 300 for the lumbosacral apo-physial joint. Centers film tothe point as marked. Directs cen-tral ray at right angles to mid-point of film. Repeats in re-verse position for other side.

For AP oblique projection,startswith supine patient as centered.Has patient rotate-, body 45° forlumbar region aLd 30° for lumbo-sacral facets. Asks patient toplace arm on tha side nextto table comforf7a11y. Has mo:ient,

cross and flex upper hip andknee. Has patient grasp side oftable with opposite hand. Sup-ports elevated shoulder, hipand knee. Checks and adjustsbody rotation. For lumbar regioncenters cassette to third lumbarsegment; for apophysial jointcenters at the level of thetransverse plane midway betweeniliac crests and the anteriorsuperior iliac spines. Directscentral ray at right angles tomidpoint of film. Repeats in re-verse position for other side.

vi) For PA projections (anteriorviews) of lateral bending posi-tions of lumbar intervertebraldisks, performer plans on ex-posing both left and right lat-eral bending positions. Has pa-tient stand facing upright cas-sette holder. Adjusts filmheight so that it is centeredat the level of the third lumbarvertebra,and centers median :ng-ittal plane of body to micE-zAk.:

of holder with arms at sideF,and unsupported. Performer In- 3

structs and rehearses Itcalt tolfv:lean laterally (right OY 1.eft1and then reverse for second E.4.posure) as far as possiblAt w!th-tout support or forcing, ,:ndwithout rotating body or 111:J,foot. May use restrainitraround hips. Directs cent".:. rayto midpoint of film at 15° to20° caudad. Repeats for oppositelateral bending,

vii) For lateral projections of for-ward and backward bending posi-tions of lumbar intervertebraldisks, performel: has patientstand in lateral position infront of upright film holder.Centers as for conventional lat-eral view,and centers film

MOMMM MMIMIMM PPRIAMMIMMWOOMM....1.W,AM

1 7 0


Task Code No. 361


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height as above to level of theiliac crests. Performer instructspatient to bend forward as muchas possible without support andwithout moving hips for first ex-posure,and to bend backward asmuch as possible without supportor hip movement for second expo-sure. May use restraining band.Directs central ray at right an-gles to center of film.

viii) For semiaxial projection of lum-bosacral junction (and sacroil-iac joints),performer maintainspatient in same position used forfrontal projection of the lumbarvertet.rde,or starts positioningas described above in (i) PAprone position or (ii) AP su-pine position.

For semiaxial prone projection,performer maintains patient asin prone position as descril;edf,yr PA projection. Centers cas-sette to the lumbosacral junctiont(a point two inches distal to the!spinous process of the fifth lum-bar segment),For the lumbosacraljoint directs the central raythrough the joint to midpoint offilm at. about 35° caudad, enter-ing just distal to spinous pro-cess of the fourth lumbar seg-ment. For the sacroiliac joints,directs central ray at right an-gles,centered at the level ofthe anterior superior iliacspines, entering about twoinches distal to the spinousprocess of the fifth lumbarsegment.

For semiaxial supine projection,performer maintains patiunt insupine position as described forAP projection, but has patientextend the lower extremitiesand supports knees. Centers film

AmmirsImrPfln

List Elements FullN,

at the level of the transverseplane passing midway betweenthe iliac crests and the an-terior superior .1AJ;.c spines.

Performer direct?: the centralray through the lumbosacraljoint at the level of thetransverse line used to centerthe film, at a cranial angleparallel with thu lumbosacralangle (about 30 for males andabout 35° for fetaales). Adjustcenter of film to center ofbeam if necessary.

For AP flexed s'Apine proiectiohas patient star ;.. in supil:re AP

position. Nakes Eure to drapepatient's pubic ai7ea. PlAi-tions cassete and dirs central ray throuth th i.opbosac-

ral junction as deevrtnedabove,before contintiing withpositioning. Then elevates pa-tient's head and si!oulders.Has patient ilex hips andknees and draw fee'c up nearhips. lips patient support position c./th ;:,ands under thighs,

well up Int:o crease of flexedknees.

For AP lithotomy projection,proceeds as above from AP su-pinv.! position. Drapes.patientand adjusts cassette. DirectscentrAl ray through the lumbo-sacral joint at 15° cephalad.Has patient bring each thigh ta vertical. position. Abductsthighs to permit central ray toclear, and supports each foot.May have patient grasp flexedknees for support.

For AP hyperflexed supine pro-jection, has patient positionedas in AP flexed supine projec-

171


Task Code No. 361


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tion, but adjusts central ray to a5° angle cephalad. Has patientgrasp flexed knees and abductthem widely to clear abdomen,thenpull thighs up as close to bodyas possible.

ix) For localized lateral projectionof lumbosacral junction,performermaintains patient in same recum-bent or erect position used forlateral projection of lumbar-lum-bosacral verZebrae (described in(iii), above), unless otherwiseordered. Aligns coronal planepassing 1.5 inches posterior tomidaxillary line to midline oftable or cassette holder. For re-cumbent patient has hips extendedas much as possible. Centers filmat the level of the transverseplane passing halfway between theiliac crests and the anteriorsuperior iliac spines. Directscentral ray at right angles tomidpoint of film (or 50 caudadfor males and 8° caudad for fe-males if spine is not able to bealigned).

d. For studies of the sacroiliac joints,sacral canal, sacrum, and coccyx, per-former considers alternative supineor prone positioning for frontal andoblique views depending on the pa-tient's condition and comfort needs.

i) For anterior oblique projection(posterior oblique view) of thesacroiliac joints, performer haspatient assume supine position

with head elevated. Elevates theside of interest 250 and sup-

ports shoulder, lower thorax, andupper thigh. Aligns body so thatthe sagittal plane one inchmedial to the anterior superioriliac spine of the affected(elevated) side is in line withthe midline of the table. Has pa-

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tient place arm next to tablein a comfortable position andgrasp side of table with op-poE:ite hand. Adjusts shoulderssa that ithey lie in a single.:naverse plane. Adjusts ele-viei tnigh so that the anter-ior svperfor iliac spines liein the same transverse plane.Supports elevated knee tolevel of hip. Adjusts andchecks degree of rotation. Cen-ters film to the level of theanterior superior iliac spines.Directs central ray at rightangles to midpoint of film. Ifa 200 to 25° central ray cran-ial angle is called for, ad-justs and directs central rayto a point 1.5 inches distalto the level of the anteriorsuperior iliac spines.

ii) For posterior oblique projec-tion (anterior oblique view)of the sacroiliac joints,per-former has patient assume asemiprone position with theaffected side next to thetable, resting on forearm andflexed knee of elevated, unaf-fected side. Supports head.Adjusts body rotation as de-scribed above, centering tothe affected part. Centersfilm as described above. If a200 to 25° caudal central rayangle is called for, centersat the level of the transverseplane 1.5 inches distal to thefifth spinous process.

iii) For axial projection of thesacral canal and sacroiliacjoints,performer notes whetherprojections of acute, moderate,and/or slight flexions are or-dered,and plans exposure(s)accordingly. Ras patient sitat end of table far enoughback to center midaxillary

172


Task Code No. 361



line of body to transverse axis tion directs central ray 15°of cassette holder, centered to cephalad, centered to the mid-the region of the sacral canal point of a transverse lineor two inches posterior to the halfway between the pubic sym-greater trochanters. Supports physis and the anterior super-feet on chair or stool. Adjusts ior iliac spines. For prone po-body so that median sagittalplane is at right angles to mid-

sition centers body similarly,with central ray directed 15°

line. Has patient lean forward caudad, centered to the visi-from the hips. For acute flexion ble sacral curve (about 3has patient lean as far forward inches below a line connectingas possible,with upper arms hang- the iliac crests). Centers filing at right angles to floor to the central ray.alongside legs and chin as close v) For frontal projection of theto knees as possible. For moderate coccyx, performer selects su-flexion has patient flex elbows,hands resting on knees, leaning so

pine position (for AP projec-tion) or prone position (for

that upper arms create an acute PA projection) and positionsangle with table top. For slight ?atient as described above.flexion has patient place wrists Centers film holder under softon knees and lean slighely forward ttssue depression just atJveso that upper arms are about at t1-.e greater trochanters,.a-tweenright angles with table. Makes the symphysis pubis and tile en-sure pelvis is not tilted and that terior superior iliac spinespatient is not leaning laterally. or to the central ray. For su-Has patient grasp a convenient pine positiondirects centralhand hold such as ankles, legs,side of table, or knees, depending

ray 10° caudad, centered to apoint about 2 inches proximal

on degree of flexion involved. Di- to the pubic symphysis. Forrects central ray at right angles prone patient, performer pal-to midpoint of film. Repeats for pates for coccyx and directsother degrees of flexion if so central ray 10° cephalad,cen-ordered. tered to the coccyx.

iv) For frontal projection of the vi) For lateral projection of thesacrum, performer selects supine sacrum, performer has patientposition (for AP projection) or assume a lateral recumbent po-prone position (for PA projec- sition on the side of interesttion). Performer aligns patient with the coronal plane 3 incheswith midsagittal plane of body posterior to the midaxillaryat midline of table and legs ex- line centered to the midlinetended. Supports ankles and/or of the table. Has patient bringknees. Compensates for any pelvic arms forward at right anglesrotation. Has patient flex elbows to body and grasp the side ofand place arms symmetrically in table with upper hand for sup-comfortable position. Adjusts port. Has patient flex the hipsshoulders to lie in a single and knees moderately with low-transverse plane. May use com- er knee elevated to hip levelpression band. For supine posi- and support under and between

knees and ankles, with knees

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This is page 24 o

superimposed. Adjusts body sothat long axis of spine is on a

horizontal plane with no rota-tion in pelvis. Centers film tothe level of the anterior super-ior iliac spines. Directs centralray at right angles to the mid-point of film.

vii) For lateral projection of thecoccyx, performer positions pa-tient as described above, withthe palpated coccyx centered o'erthe midline of the table and !Alefilm centered to the center ofthe coccyx. Directs central rayat right angles to the midpointof the film.

e. For scoliosis series, performermakes two AP projections of thethoracic and lumbar vertebrae, in-cluding about one inch of the iliaccrests in the field, with patientseated or standing (one normal AP a9described earlier and second expo-sure varied as described below) .Per-former may also make a normal APprojection of patient standing, anAP projc,ction of patient in supineposition (both as described ear-lier),and two AP supine projections.of patient in right and left lateralflexions (as in fusion series de-scribed below).

For second AP seated or standingprojection, performer notes the con-vex side of the spinal curve andelevates the hip on the convex sideof the curve of seated figure, orelevates oot of standing figureabout 3 to 4 inches by placing ap-propriate object under buttock orfoot. Elevates sufficiently for pa-tient to expend some effort in main-taining position,and does not pro-vide support to patient or a com-pression band during exposure. Di-rects central ray at right anglesto midpoint of film.

Task Code No. 361

28 for this task.

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f. For spinal fusion series, perform-er notes what region is being ex-amined and centers the film to themid-area of the region,and thecentral ray at right angles to themidpoint of film. Performer makestwo AP supine projections of pa-tient in right and left lateralbending positions and two lateralrecumbent projections of the pa-tient in flexion and extension.Performer positions similarly asdescribed earlier except as fol-lows:

i) For maximum lateral bending APprojections in supine right orleft bending, performer has pa-tient cross leg on side to beflexed over opposite leg. Per-former places one hand againstthe side of the lumbar regionand draws the thighs lateral-ward (right or left) enough toplace affected side's heel nearthe edge of table. Immobilizes.Draws shoulders directly lat-eralward as far as possiblewithout rotating patient's pel-vis. May apply compressionband.

ii) With lateral view of flexionand extension performer centerspatient in lateral recumbentposition with coronal planeabout 2 inches posterior tomidaxillary line at midlineof table. For flexion has pa-tient lean forward and drawthighs up as much as possible.For extension has patient leanbackward and extend hips andthighs as much as possible. Mayuse compression band-.

g. If, during positioning, patientshows signs of severe pain, per-former may notify appropriate phy-sician at once and await orders,or may decide on alternative po-


Task Code No. 361


List Elements Full

sitioning to avoid movement of theaffected part.

h. Performer checks final positioningby using light in collimator. Acti-vates the collimator light andpoints the light beam towards thepart. Adjusts the collimator open-ing to correspond to the film size(or the size of the unshielded areaof the film to be exposed). Usescross-hair shadows as reference forcenter of field. Uses the collima-tor light to center the patient tothe x-ray field, or centers thepart to the film holder and usesthe collimator light to center thetube to the part. Checks that pri-mary beam will enter the center ofthe area of interest at the select-ed angle to the film so as to pro-ject the view desired. May readjusttuLe position lengthwise or cross-wise to provide better centering.

14. Once the patient has been positionedand immobilized, performer adjusts thecollimator. Either collimates so thata small unexposed border will appeararound the edge of the film or colli-mates further so as to expose only thearea of interest (and thus providemaximum protection and detail). Forsmall fields performer attaches anauxiliary extension cone to colli-mator to further reduce the primarybeam. Adjusts primary beam to minimumsize needed to cover the part(s) ofinterest.

15. Performer adds lead shielding to areasthat will be in the primary path ofthe beam but are not included in theareas of interest. Makes sure that

proper protective shielding has beenprovided to patient and everyone whowill remain in room.

16. Throughout procedure performer ob-serves patient for any signs of

1 7 5

List Elements Fully

gency and/or to prevent or respond toan accident. Is alert to signs of nau-sea, dizziness,or sweat suggestingfaintness. Performer may have patientlie down, lower head,or raise legs.Notifies nurse. If patient shows anyother emergency signs, loses consci-ousness, or has an accident, perform-er calls appropriate physician ornurse at once. May decide to provideemergency first aid as well. If a pa-tient's catheter becomes disconnected,performer clamps it and immediatelynotifies nurse. If catheter shouldcome out, notifies nurse at once.

17. When everything is ready for the ex-posure, performer explains to patientwhat breath control will be used forexposure; explains that taking breath,breathing out and/or holding still,orphonating as rehearsed should be maintained until patient is told to re-lax by performer. Reminds patientabout those exposures in which posi-tion is to ue retained for a secondexposure. Performer observes the pa-tient's movement until the momentthat the exposure is made. Readjustsposition if warranted.

a. For projections of cervical spine,occipitocervical articulations,atlas, axis, odontoid processes,and intervertebral foramina, per-former has patient hold breath during exposure except as follows:i) For conventional AP projection

of cervical column, has patientopen and close mouth during ex-posure,moving the mandiblesmoothly and fairly rapidlywithout striking the teeth to-gether, as rehearsed. Has pa-tient start just before expo-sure and continue until expo-sure is terminated.

ii) For lateral projection of cerv-ical spine has patient breathe 1out and hold.


Task Code No. 361



iii) For AP open-mouth projection ofthe atlas and axis, performer haspatient keep mouth wide open andsoftly phonate the sound "ah"during the exposure as rehearsed.

iv) For AP projection of lower cer-vical vertebrae and oblique AP orPA projection of cervical inter-vertebral foramina, has patientsoftly phonate the sound "mmeduring the exposure as rehearsed.

b. For projections of the cervical andupper thoracic vertebrae, thoracicspine, lumbar spine, sacrum, coccyx,and sacroiliac joints, has the pa-tient breathe out before the expo-sure and hold breath during the ex-posure except as follows:i) For views of cervical and upper

thoracic vertebrae, the lumbo-sacral junction, lumbar inter-vertebral foramina, sacroiliacjoints, sacrum, and coccyx, per-former may have patient merelyhold breath or hold still duringexposure if so ordered.

ii) For lateral view of thoracic ver-tebrae,performer may have patientbreathe quietly with shallowbreaths if so ordered.

c. For scoliosis and spinal fusionseries performer has patient holdbreath during exposures.

18. The performer returns to control room.Makes sure controls are properly setand patient is still in position.Tellspatient when to hold breath and/or holdstill by calling or using intercom.Performer initiates exposure by press-ing hand trigger or exposure controlbutton.

a. While exposure is underway perform-er checks that mA meter records ap-propriate current as set, that kVpmeter dips slightly.

b. May wa:ch for evidence of malfunc-tion such as line surge or exces-

sive drop; may listen for sound ofnormal functioning of equipment.If there is malfuhction,may decideto report; anticipates need to re-peat exposure.

c. With phototimer notes whether back-up timer has been involved interminating exposure before photo-timed exposure was completed. Ifso, anticipates possible need torepeat exposure (due to underex-posure if premature cut-off, oroverexposure due to faulty timer).

d. After exposure is completed tellspatient that he or she can relax.

e. If the exposure is terminated bya circuit breaker, rechecks tech-nical factors for possible over-load or checks for overload else-where on circuit. Anticipates needto repeat exposure.

19. Performer returns to patient. Removescassette or film holder from table,floor, or bucky.

a. Removes any markers for furtheruse. If multiple views are to betaken on the film, removes leadedrubber mask and remasks all butnext area to be exposed.

b. If the patient is accident victimor if so requested, performer ar-ranges to have the first expo-sure(s) processed at once andbrought to the appropriate radio-logist.

c. If the first radiograph(s) are pre-liminary (scout) films, performerbrings the processed radiograph(s)directly to the radiologist incharge or place2 on view boxes andinforms radiologist that the scout(s) are ready. If the radiologistindicates that there is any problemwith the technical factors ov thepatient positioning,performer re-cords or notes for later use in


Task Code No. 361


List Elements Ful/y

the examination and/or repeats pre-liminary radiography as ordered.

d. Depending on whether radiologistwill evaluate radiographs beforecompletion of all possible exposuresfor the series, performer arrangesto process film(s) and evaluate forquality control personally, havethis done, or bring to darkroom forprocessing and later evaluation,based on time available, institu-tional arrangements, or specific in-structions. Attaches ID card for usewith flasher if appropriate. Maysign requisition.

e. While films are being processed and/or evaluated performer has patientrelax in examination room or hold-ing area. Explains what will happennext.i) Performer determines whether pa-

tient should remain on table and/or in room or requires observa-tion. May consult requisitionsheet or attending RN. If appro-priate, makes sure that patientwill be attended while waiting.


iii) May decide to assist patient tochair or stretcher or from table.Makes sure patient is remindedof any footrest in stepping offtable.

20. When (or if) performer learns from theradiologist the extent of the injuryand/or whether further conventionalviews and/or positions can be under-taken, eliminatee or altered, perform-er proceds as aPpropriate according toinstructions.

a. For further exposures performer re-peats appropriate steps for nextview(s) including identification of

List Elements Full".

film holder or cassette an use u

R-L marker, selection and settingof technique for next view (ifdifferent), positioning patientand equipment for focus-object-film alignment,proper collimationand shielding,breathing instruc-tions, and making exposure, as de-scribed above.

b. Performer refrains from commentingon the films or providing any in-terpretation.

c. If performer is asked to repeatany exposures, makes sure that theadditional exposures are warrantedmedically, since additional radia-tion will be incurred.i) Notes whether need to repeat i


ii) If request for retakes reflectsmalfunctioning equipment,per-former reports malfunction toappropriate staff member.

iii) If request for retakes reflectsthe preference for density orcontrast of a radiologist, per-forther notes for future workdone for the given radiologistco that retakes can be avoided.

21. When performer is sure that the ex-amination has been completed, per-former may have patient transportedback to holding area or next loca-tion, or decides to do personally,asappropriate. Makes sure that none ofthe equipment is projecting over thepatient before allowing patient torise from stool or table, and assistspatient as described above.

22. Performer carries out terminationstt4is fe- the examination:

a. Performer has equipment and ex-amination table cleaned after use

117


Task Code No. 361



or decides to do personally, depend-ing on institutional arrangements.

b. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken,thetechnical factors used and filmsizes; may record the number of ex-posures made of each view includingretakes; may enter the estimatedradiation dose to which patient wasexposed (using posted informationon dosage); may record any problemwith equipment, any special careprovided patient. If any views cal-led for in the initial requestcould not be obtained,performer mayrecord reasons. Signs requisitionsheet.

c. If performer will only carry outpreliminary "scout" filming andnother technologist will continuewith examination,performer recordsthe approved technical factors usedfor the scouts, and the accessoriesemployed, or informs technologistwho will continue. Performer givesthe requisition sheet, name card,and any notes to technologist whowill continue with procedure.


e. May indicate to appropriate staffperson whe-. the performer is readyto proceed ,,ith next examination.

1.=

178


rask Code No. 362

This is pae.e of 22 for this task.

1. What is *he output of this task? (Re sure List Elements Fullythis is broad enough to be repeatable.)

Requisition reviewed;pt. reassw-ed,positioned;partsmeasured;films identified;technical factors selectedand set;technique for magnification set up;bariumadministered;exposures made;radiographs sent forprocessing and evaixation;procedures repeated asappropriate for full set of views;patient returned;examination recorded;radiographs placed for use.

Performer receives-or obtains thx-ray-requisition form,patientidentification card, and any ap-propriate medical-technical his-tory for a non-infant patientscheduled for radiography of thesternum, ribs, and/or thoracicviscera (trachea, lungs, esopha-gus, heart and/or great bloodvessels):

,


b. From co-worker.c. After having arranged requisi

tions in order of priority.

The plain films of the chestmay be part of a bone or ab-dominal survey. Those of thethoracic viscera may serve aspreliminary "scout" films forcontrast studies such as bron-chography; the plain films ofthe heart may be for a car-diac series involving swallowing of a barium sulfate paste1Plain films may also serve tostudy air or fluid levels,foreign body localization,diaphragm excursion.


a. Performer checks the ex-aminations called for in-cluding the affected sideand parts, the purpose ofthe study, the positionsand views called for,

OK-RP.RRRR 4

. What is used in performing this task? (Noteif only certain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Pt.'s x-ray requisition sheet,ID card,ID bracelet,technical history;pen;x-ray machine control pan-el(s),tube,bucky,table,collimator,extension cones;technique chart;charts for conversion of technique,tube angulation,views for standard examinations,dos-age,tube capacity;loaded cassettes;vertical film hold-er;leaded rubber shielding;R-L and ID markers;immo-bilization and support devices;stool;calipers;rape;bandage;scissors;protractor;compression band,headclamp;stretcher or wheelchair;marking pen;barium sulfate paste

3. Is there a recipient, respnndent or co-workerinvolved in the task? Yes...0 ) No...( )

es to q. : Name tne kind of recipientrespondent or co-worker involved, with de-


Non-infant patient to be radiographed; radiologictechnologist; radiologist; nurse

. Name the task so that the answers to ques-tions 1-4 are reflected. Underline essen-tial words.

Taking plain film radiographs of sternum,ribs and/orthoracic viscera of non-infant patient by reviewingrequest;reporting observed contraindications;reassur-ing pr.;measuring par*;setting up for magnificationtechnique;selecring and setting technical factors;identifying film;positioning pt. and equipment forerect or recumbent exposure;providing shielding;col-limating;administering barium for heart series;makingexposures;having radiographs processed and reviewed;repeating for full set of views or as ordered;havingpt. returned;placing radiographs for use;recordingexaminazion.

6. Check here if thisis a master sheet..

...


Task Code No. 362


List Elements F%...1.y List Elements Fully

focal spot of appropriate sizefor direct magnification techni-que (i.e. 0.3 mm or smaller).

f. If the study ordered will involveuse of x-ray tube in direct con-

breathing instructions, the numberof exposures, body angulation,'whether bilateral or unilateralstudies are requested, the centralbeam angulation, the areas of inter-est and parts to be included, wheth- tact with the patient's back,per-er known or suspected unhealed frac- former makes sure that the sys-tures or destructive disease are in- tem in room is shock-proof.volved,and the sites. Notes whether g. Performer makes sure that the re-the use of a grid or bucky will be quest is properly authorized,thatinvolved. Notes any request for mag- information on requisition sheetnification. Checks the name of the is complete. Checks whether anyreferring physician. special orders on exposure fac-

b. Performer reads patient's name,iden- tors are in keeping with thetification number, sex, age, height,weight. Notes whether patient is in-

usual rad exposure involved forthe examination.

patient, out-patient, or emergency h. Depending on institutional proce-patient. Notes any special informa- dures,performer may review pa-tion that will affect patient posi- tient's radiation exposure his-tioning, technique, or handling of tory, prior record of techniquesthe patient, presence of plaster used, and cumulative exposure.cast, taping, extremities of un- Notices whether-exavination hasequal length, whether patient will been done elsewhere in rec,mtbe on a stretcher or wheelchair,and past, whether number of radio-any notation on the nature of any graphic exposures involved shouldknown pathology which would affect be reported to radiologist.technique. For cardiac series makes i. Depending on institutional proce-sure that information on patient's dures,performer notes whether fe-weight and height is available. male patient is pregnant, reviews

c. Performer checks whether patient is date of female patient's last mensuffering from a collateral condi- strualyeriod, or notes'any othertion requiring special handling indication that there is no dan-such as heart disease, communicable ger of exposure of a known oror infectious condition,infirmity,incoherence; whether patient has

possible fetus.j. If patient's record indicates or-

IV drip, oxygen supply, urinary ders for sedation or any othercatheter or similar device in place prior medication performer maynotes whether patient will be ac- check timing to be sure a proper

,companied by nurse or other staff elapse of.time has occurred for

person. medication to take effect. May ard. If performer is not already assign- range to delay examination if ap-

ed to examination room (and a par- propriate. Notes shielding needed.

ticular maaine) notes the room or k. If referring physician has re-machine involved. Goes to examina- quested that films already ontion room or control room frr ma- file be sent with current radio-chine involved, graphs, and if not already with

e. If magnification has been request- patient's jacketed materialj per-ed, performer checks that the ma- former arranges to have priorchine to be used has a fractional films delivered.


Task Code No. 362


List Elements Fully.....

List Elements Fully

. If the p.lrformer determines that the iii) Goes to control panel for

request is not properl authorized, is x-ray generator and checks

incomplete, or that sufficient infor- that indicator light shows

mation is lacking for performer to that machine is "warmed up,"

select technique or to properly posi-tion or care for patient, or if per-former considers that there may be con-

or turns on main switch as ap-propriate to equipment and al-lows time for machine to "warm

traindications to going ahead with theprocedure, performer notifies supervi-

up." If appropriate,performermay set radiography mode se-

sor, radiologist, or other designatedstaff person, depending on institu-

lector and set collimator con-trol for manual operation.

tional procedures. Explains the prob- d. If a cardiac series has been or-

lem if appropriate and proceeds after dered, performer checks that a

obtaining needed information,signature,or orders.

thick barium sulfate mixture hasbeen prepared for patient toswallow,or arranges to have pre-

. When performer is clear about what will pared personally or by staff mem-

be involved in examination, he or sheprepares ahead so as not to keep pa-

ber.

e. Performer checks that appropri-

tient in examination room longer than ate immobilization devices such

necessary:

a. Performer reviews the technique

as sandbags, wedge sponges,gauzebandage, compression band, sup-port stand, tape are present, and

chart for the machine to be usedand takes note of any newly posted

that there is a mattress, pads,pillows and/or blankets for com-

changes in technical factors (to re- fort of patient if patient will

flect accommodation for change inmachine output or a policy deci-

lie on table. If appropriate,obtains protractor. May set up

sion).b. Performer washes hands as appropri-

ate; depending on patient's condi-

footboard at end of tilt-table.f. Checks that there is leaded rub-

ber shielding available in room

tion, may decide to arrange for or to be used to mask film, protect

carry out isolation or decontamina- the patient, and/or to place be-

tion techniques.neath the film holder, as appro-

c. Performer makes sure that x-raypriate.

equipment is ready for use. ,

g. Performer prepares for identifi-

i) For automatic chest x-ray equip- cation of the films using equip-

ment performer makes sure that a ment provided by institution:

sufficient number of unexposed i) May obtain lead numerals and

films are in the loading maga- tape and prepare identifica-

zine and that receiving magazine . tion strip for placement on

is ready to receive exposed film holder(s) giving appro-

films.priate patient identification

ii) P.--former may set up equipmentinformation.

az; appropriate for stereographic ii) Pc.rformer may prepare for.use

projections (involving two films of flashcard by checking that

w:th overlapping exposures for3pecified positions) if ordered.

there is piece of lead onilm holder surface; may writef


Task Code No. 362



or type out ID information oncard if not received with requi-sition.



. If magnification has been requested,performer prepares the equipment forthe tube-over-table method of magnifi-cation (used without bucky):

a. Performer determines the degree ofmagnification requested on the req-uisition sheet; if the request isexpressed as an area magnificationperformer determines the linearmagnification by taking the squareroot. (Linear magnification squaredequals area magnification.)

b. Performer calculates the requireddistances from target (focal spot)to object (patient) (TOD), and fromobject to film (OFD), as well asthe distance from target to film(TFD) (the sum of TOD and OFD):i) If the distance from the table

top to a cassette placed on thefloor or a stool (OFD) will bea relatively inflexible distanceperformer measures this distanceor reads indicator scale. (Ifstool is to be used, may notethe table height.) Performer mayadjust table height to providefor a round number for the OFD.

ii) If the distance from the focalspot to the table top (DOD) willbe the relatively inflexibledistance, performer determineswhat this is by measuring orreading appropriate indicatorscale on tube housing. Performermay adjust tube height to pro-vide a round number for the TOD.

iii) Depending on whether the OFD orthe TOD is fixed, performer cal-

culates the required complemen-tary distance by referring to amagnification chart for the de-gree of linear magnification required, or uses the formula: degree of linear magnificationequals TFD divided by TOD. Fora two-times linear magnificatioperformer simply sets the TODequal to the OFD.

iv) Performer adjusts and locks thetable height and/or the tubeheight to the calculated OFD anTOD.


housing until it is centeredover the table top in the ap-proximate area where the pa-tient's area of interest willbe positioned, such as ontable.

ii) Performer swings the table outof the way so that there is noobstruction between the tubeand the floor. (Does not changheight.) If appropriate,placesa stool on the floor under thetube. May place cassette of ap-propriate size on floor orstool.. Performer selects thesize film designated for thedegree of magnification andthe selected part to bestudied.

iii) Performer adjusts the collima-tion to correspond to the fielsize anticipated (for the TODinvolved).

iv) Performer activates the lightin the collimator and adjuststhe tube horizontally so thatthe light beam case is centeredto the cassette on the stool orfloor. Uses the cross-hairsprojected by the beam to centethe tube to the area on thefloor or stool.


Task Code No. 362


List Elements 111117

Performer locks the tube intoposition so that there is a 900angle of,the beam with the flooror stool: Fixes and retains col-limator setting.Performer marks the outline ofthe collimated light area orcassette on the floor or stoolusing tape or other removablemarker. If not already done,checks by placing cassette inmarked area. May mark center ofarea as shown by cross-hairs.Performer swings table back intoplace. Activates light beam incollimator and marks the tabletop where the center cross-hairsand light outline are projected(to be used to center the partto'be radiographed). Uses tapeor other radiolucent removablemarker.Performer may recheck TOD andOFD to be sure that they corre-spond to the calculated dis-tances.

d. For magnification technique using avertical film holder, performer maywait until patient has been broughtinto examination room. Adjusts up-right holder to appropriate height;adjusts x-ray tube to right angleprojection of beam to film holder;centers to the film; measures andadjusts TOD to patient's positionand marks patient's position; mea-sures and adjusts OFD from patient'dposition as marked.

e. If the sum of the new TOD and OFD(TFD) is now different from the TFDused for non-magnification techni-que, performer may consult techniquechart to note the factor to use fora compensatory change in mAs. Mayrecord for later use in setting ex-posure factors.

f. Performer may also note the changein kVp and mAs necessary tocompen-

List Elements Full

sate for any change in collimationfrom non-magnification technique.Consults appropriate charts forconversion factors. May record.

. Performer has the patient called fromthe holding area and prepared for theexamination (if not already dont1), ordecides to do personally.

Ia. Depending on institutional arrc-ments performer may decide to es-cort ouc-vatient to or from dress- '%

ing room. '''r decide to assist in ,..

transportin: patient from holdingarea or have f"-Lis done.

b. Performer grel:!: patient and anyaccompanying st:.,iff person and in-

troduces self. Ch,ks patient'sidentity agah1:3t the requisitionsheet. With in.-pai:ient, checks hos-pital identifiation bracelet orother identifier. if patient is ac-companied because of seriousness ofcondition, performer checks withaccompanying staff member on anyspecial precautions necessary dur-ing procedure.

c. Ras patient assume a comfortableposition seated on table or chair.If patient is in wheelchair,movespacient in chair into position nextto tt.ble. If patient is on specialstretcher, places stretcher intoposition so that radiolucentstretclier can be lifted with pa-tient on it from wheeled barf._ tox-ray table. May arrange to movepl-A.Aent to table. With accident pa-tient uses upright film holderwith patient remaining on :t.retcheruntil injury har been localized

d. Performer explains t) patient whatwill be inw,ived in the proce6.ure;indicates what types of positionsthe patient will be asked to bssume and the cooperation thav willbe asked of the patient..

TASK DESCRIPTION SHEET (cr:.ntinued)

Task Code No. 362

This is puge 6 of 22 for this task.

List Elements Full

e. Performer answers patient':,! nen-med-ical questions honestly; attempts toreassure patient and develop confi-dence. Treats patient with dignityand concern regardless of patient'sbehavior. Remains aware that patientmay be frightened and/or in pain.Performer explains when asked medi-cal questions that it is not appro-priate for technologist to answerthese; encourages patient to speakto physician.

f. If patient has an IV drip in place,performer checks that needle hasnot become dislodged and that thefluid is dripping.at an even rate.If there are any problems, perform-er clamps tube and notifies an ap-propriate staff person at once.

g. If appropriate and not already done,performer questions female patientof child bearing age regarding pos-sible pregnancy. If there is anypossibility that patient is pregnantand this has not already been re-corded, performer informs appropri-ate physician and proceeds only withapproval.

6. Performer questions patient and/or RNor MD present on what movement is pos-sible to determine what positions areavailable for use. Considers whethertf7 41ave patient erect (seated or stand.-ag) or recumbent, or considers ordersin light of the patient's condition.

a. For accident victim or one with re-cenr: rib injuries, performer plansfot examination of patient in po-sition in which he or she arrives(supine or prone on stretcher,erect in wheelchair;or erect ifambulatory) without moving patient;and plans for PA or AP and leftlateral projections of the chest.Does not proceed with additionalradiography until site and extentof injury is determined,and accept-

List Elements Full

able positioning specified by MD.b. If a cardiac patient is involveo,

performer selects supine posit onunless otherwise indicated.

c. If the examination is to routinelystudy the heart or lungs, perform-er selects erect positions unlessotherwise indicated.

d. If studies of the ribs are orderedperformer selects erect positionsfor ribt above the diaphragm andrecumbent positions for ribs be-low the diaphragm unless other-wise indicated.

e. Performer notes the patient's bodytype, whether the area of interestis heavily covered by muscle orsoft fat, whether the palpe-ionpoints will be easy to find. Noteswhether the extremities are ofunequal length. For female pa-tients, performer judges whetherthe breasts are largR and perdu-lous. If so, may have pntient orstaff member draw the breasts tothe sides and hold in place withwide bandage or by having erectpatient lean breasts a,-Linst -trectcassette holder.

f. For oblique projections performersubstitutes right PA oblique pro-jection for left AP oblique 1:ro-jection and/or left PA obliepreection frer right AP oblique 74

pro,ection as appropria!, to 'nepatient's condition.

g. Performer considers the nr.mberand types of projections orderedfor the examination and thi. pa-tient's condition. Performer mayconsider a change from standardprojections to better accomplishthe purpose of the examination,or deletion of a position or achange in technical factors. De- '

pending on institutional arrange-ments, performer may obtain per-mission from appropriate radiolo-


This is page

Task Code No. 362



gist or decides personally to alterthe standard procedure.

7. Performer prepares tor the examination:

a. If not already done, has patiert'sclothing removed to the waist andprovides gown or drape. May assistpatient or request assistance fromnurse if there is a fracture in-volved. Keeps body covered untilready fur positioning and radiogra-phy. Reveals only as much of body asnecessary. Treats young patient withas much courtesy as adult.

b. If patient has adhesive strappingin place, performer notes whetherit is old and wrinkled and requiresremoval before radiography. If so,performer indicates this to appro-priate staff member and waits forremoval and restrapping by RN or MD.

c. Depending on whether a bucky, tabletop,or automatic chest x-ray tech-nique will be used and standard in-stitutional practices, performerselects speed and type of film,gridand cassette combination:i) Selects size(s) based on the

area(s) to be included, the pa-tient's size, and whether bilat-eral views are to be exposed ona single film.

ii) For magnification technique per-former selects the size filmdesignated for the degree ofmagnification and the seler.tedpart to be studied.

iii) Performer makes sure that an ade-kquate supply of films in magazine,or loaded cassettes of the typesand sizes selected are availablein the examination room. If not,arranges to obtain or decides toobtain personally.

d. Performer obtains the appropriatesize loaded cassette for the firstprojection (unless automatic chest

x-ray equipment is to be used).If bilateral exposures will bemade on one film, performer men-tally decides how these will bepositioned so that the film neednot be turned for viewing eachimage. Performer uses leaded rub-ber sheets,and masks the cassettecompletely except for the area tobe exposed. Treats the area to beexposed from this point as thoughit were the actual film size.

e. Performer attaches identificationinformation to the cassette,table top, or chest x-ray equip-ment:i) Places right or left marker on

film holder or table top as ap-propriate to the study and pro-jection or depresses appropri-ate R or L button for automaticmarking.

ii) If patient's identification in-formation is in the form oflead numerals, performer placeson appropriate corner of cas-sette.

iii) If patient identification in-formation is to be entered byuse of flasher, sets flashcardaside for later use with.spacecreated by piece of leadee'rub-ber on appropriate edge of cas-sette.

iv) Performer may place patient'scard into card slot or trayfor chest x-ray equipment us-ing automatic film marking de-vice.

f. If appropriate to make possibleminimal movement of patient,per-former may place cassette in up-right holder at right angles fotable top or in other positionselected.

g. If automatic chest x-ray equip-2ment is being used, performer haspatient sit or stand in front of

TASeDESCRIPTION SHEET (continued)

Task Code No. 362



film holder and adjusts height ofholder to patient.

h. If cassette is to be used withbucky (under tabletop or in uprightholder) performer may manually pullout bucky tray and open retainingclamps. Inserts cassette into buckytray and pushes back. Makes sureclamps are closed. Moves cassetteinto appropriate "stored" positionor inserts cassette tray into buckyslot and centers.

i. If a bucky or chest x-ray equipmentis not being used, performer placescassctte in a position that can becomfortably reached by the patientin final positioning.

j. If magnification technique is to beused, performer places cassette inmarked position on floor or stool.

k. With accident patient, after locali-zation has been established, per-former may obtain assistance inlifting patient so that cassettecan be placed under patient.

1. Performer provides patient andeveryone who will remaiu in roomduring exposure with protectiveshielding. Explains it necessarythat this is not cause for alarmbut a general praution to mini:-mize unnecessary radiation expo-sure.

8. Performer has patient assume a comfort-able recumbent,standing, or seated po-

,sition,depending on the positions tobe employed, so that the part(s) to beradiographed can be measured. Makessure that wheelchair is in locked po-sition if patient is to be positionedin it.

a. If appropriate, places mattress,pillow or clean linen on x-raytable. May place pillows behindpatient in wheelchair to supportupright cassette.

9.

b. Performer may decide to assist pa-tient from wheelchair or str-ttch-er to table or has this dore. Mayobtain help. Makes sure that noequipment is in the wy and maybe collided With by p,Acient.

c. If assisting patient to step onfootstool in order to get ontable, helps patient turn im"..oposition,step backwards on stool,and then sit and/or lie on table.

d. Performer uses centimeter cali-pers to measure the thickness ofthe part(s) to be radiographed inthe direction in which the centralray of the x-ray beam will passthrough the centered part fromtube to film. Records for use indetermining exposure factors.

e. If patient has a urinary catheterin place, performer turns patienttoward the catheter and tubing toprevent separating it from drain-age bottle and breaking sterilesystem and to avoid causing pain.

f. After measuring, has patient restin as relaxed a position as pos-sible. May place pad, blanket orpillow under bony prominences toprovide comfort for recumbent pa-tient.

Performer selects the exposure fac-tors for the first projection by consulting the technique chart(s) post-ed for the machine:

a. Locates the information needtifor the body part and projectoninvolved according to the centi-meter thickness of the part asmeasured and the collimated fieldsize to be used. Makes sure thattechnique relates to the combine-tion of film type and speed anduse or nonuse of other accessor-ies (such as screens, grids,bucky, etc.).


Task Code No. 362



b. Makes note of the kVp,mA,T(secondsof exposure time), focal spot size,and the focal film distance (TFDor FFD) called for.

c. Once the standard kVp, mA and timehave been determined, performernotes whether any conversions arenecessary to account for a patho-logical condition, a cast, changein TFD, extreme fat or muscular-ity, preference of the radiologistinvolved, and any other conversionneeded such as with magnificationtechnique. Performer looks up numer-ical conversion factors and calcu-lates, or uses conversion charts toascertain the appropriate new expo-sure factor (kVp, mA and/or time).Multiplies, divides, adds, or sub-tracts as appropriate.

d. Performer checks any new or unfam-iliar exposure factors against theposted limits of the x-ray tube ona tube rating chart to be sure thattechnique does not exceed the heatcapacities of the tube for the focalspot si-ze to be used. If appropri-ate, performer reconverts the tech-nique to an equivalent output usinghigher kVp and lower mAs.



b. If appropriate,checks line voltagemeter and, if needed, turns com-pensator dial until needle isaligned properly on line meter.



11.


iii) Performer sets the kVp selectedby choosing the combination ofmajor and minor kilovoltage set-tings for the desired kVp.


category corresponding to thetype of study and use or non-use of screens,bucky,etc.,andif appropriate,focal spot size.



iv) Sets a density selector corres-ponding to the usual (or spe-cial) requirements for study.

v) Makes sure backup timer is notlikely to terminate exposureprematurely.

e. Depending on the equipment,may setcontrols to provide for use ofbucky, manual tableside adjustmentof table and tube height, positionand of collimation.

f. Performer returns to overhead unitand see§ the focal-film distance.Operates controls or manuallymoves the x-ray tube into placeover the film holder (or at rightangles to upright holder). Checksthe focal-film distance by readingindicator scale in the tube hous-ing;adjusts up or down until therequired FFD (TFD) is obtained.

Performer plans to place the part tobe.radiographed in the final positionselected for the first exposure:


Task Code No. 362



a. With accident patient, if the af-fected area of the ribs has not beenlocalized, performer first plans tomake a preliminary film for identi-fication of the extent of the sus-pected trauma or pathology. When thelesion has been localized by thc MD,performer makes the exposures thenordered so that the affected ribregion is parallel with the planeof the film. Performer selects pro-jection from above or below dia-phragm as_appropriate.

b. For bone,chest or abdominal survey,plans for PA and left lateral pro-jections of the chest, with exposurefactors geared for bone details ofribs and sternum or for thoracicviscera, as appropriate.

c. If a cardiac series (including eso-phagus) has been requested, perform-er plans to administer barium paste"swallow," and makes PA and lateralprojections and an oblique projec-tion from each side.

d. If a foreign body search or dia-phragm study is ordered or a pneu-mothorax is suspected, performerplans two exposures for a given po-sition, one on inhalation and oneon exhalation. For diaphragm excur-sion plans both exposures for thesame film.

e. If recumbent positions are specifiedfor an ambulatory accident patient,performer uses footboard set up atend of table; positions patient ontilt-table in the vertical positionand adjusts table to the horizontalfor final adjustments and actual exposure.

f. If patient will be standing andlimbs are of unequal length, per-former provides support to shorterlimb so as to evenly distributeweight.

g. Performer centers part and keeps thlong axis of the part parallel to

the film holder. May explain ordemonstrate to 'patient what isrequired. May obtain help in po-sitioning. When using a bucky cen-ters patient to midline. With cassette on table top, centers filmto part. With upright holder ad-justs height of holder to partand centers part to film.

12 Performer positions as follows (un-less nonconventional positioning isbeing used to avoid having patientmove):

a. For studies of the sternum and thsternoclavicular articulations,performer notes whether suspendedbreathing after exhalation orrapid shallow breathing will beused during exposure for obliqueand lateromedial projections ofsternum. Notes whether body rota-tion or central ray augulationmethods are to be used in latero-medial projection of sternum, andunilateral oblique projections ofsternoclavicular articulations.Notes whether projections of thesternoclavicular articulationswill use direct contact of tubeto part. For sternoclaviculararticulF_ions notes whether uni-lateral or bilateral studies areordered.i) For right posterior oblique

projection (right antzrioroblique view) of the sternum,has patient first assume proneposition; then adjusts-patientto a PA oblique position withright side nearer to table andpatient supported on flexedupper knee and forearm. Alignsbody so that the long axis ofthe sternum is centered to themidline of table. Performer ro-tates thorax by elevating


Task Code No. 362



shoulder and hip. Places a handon patient's sternum and otherhand on the thoracic vertebraejust above,and adjusts rotationso that vertebrae are not super-imposed on sternum. Centers filmto the midsternal area. Appliescompression band around thoraxif light breathing will be uti-lized. Supports flexed knee. Di-rects central ray at right anglesto midpoint of film.

ii) For lateral projection of ster-num, performer selects erect seated or standing position oreral recumbent or supine posi-tion. Has female patient'sbreasts drawn to the sidls as de-scribed above. Centers sternumto midline of table or film hold-er and film to the midsternalarea. Includes the manubrial

notch and distal tip of xiphoidprocess in view unless otherwisespecified. For supine positionadjusts patient if possible inAP position and employs verticalfilm holder and cross-table pro-jection of ray. For lateral re-cumbent position, centers longaxis of sternum to midline oftable. Has patient flex hips andknees in comfortable position,andsupports lower knee and ankle.Has patient extend arms upwardswith head on arm next to table,and upper hand grasping side oftable for support. Supports lowerthoracic region so that long axisof sternum is horizontal. Forerect position has patient sit orstand erect in a lateral posi-tion before upright cassetteholder and adjusts height to cen-ter film. Has patient distributeweight evenly On both feet orbuttocks, with head erect andfacing directly forward. Rotates

shoulders backward; may have .

patient lock hands or fold armsbehind back. Has cassette hold-er close enough for patient torest shoulder against it, keep-ing median sagittal plane ofbody vertical.

For all positions adjusts ro-tation of body so that broadsurface of sternum is at rightangles to plane of film. Di-rects central ray at right an-gles to cew..;er of film.

iii) E'er tube argulation method oflateromedinl projection of thesternum, performer obtainschart giving degrees of x-raytube anguJation for measureddepths of thorax(nfter compres-sion). Performer adjusts pa-tient in prons position, withmedian sagittal plane of bodycentered to midline of filmholder. Centers film so thatmanubrial notch is.about twoinches below upp2.2 border offilm and long axis of sternumis centered to midline. Has pa-tient face.tube and rest headon cheek. Applies compressionband if so ordered. Performeruses calipers to measure thedepth of the thorax in themedian plane at the level ofthe sternal angle (about theleve2 of the spinal process ofthe fifth or sixth thoracicvertebra) . Records. Checks an-gulation on chart based on themeasured thickness: Records.Directs central ray from theleft to the midpoint of film atthe tube angle found on chart.

iv) For PA projection (anteriorview) of sternoclavicular arti-culations, performer noteswhether a bilateral or unilat-


Task Code No. 362


eral examination is ordered, andwhether shock-proof equipmentwill be used in direct contactwith patient (prone or erect).Has patient assume supine,prone,seated, or standing position asdecided and adjusts patient insymmetrical alignment centeredto midline of table, with weightevenly distributed for erect pa-tient, and with shoulders in 2single transverse plane. Centersfilm to the manubrial notch atthe level of the spinous processof the third thoracic vertebra.Has arms at patient's sides, fac-ing upwards for prone patient.

For bilateral examination has pa-tient's head rest on chin (ifprone), or facing straight ahead(if supine or erect), so thatmedian sagittal plane is atright angles to film. For unilat-eral examination has patient turhead to face the side of inter-est, resting on cheek if prone.

With direct contact exposure,centers tube carefully and bringsinto direct contact with the midpoint of patient's back at rightangles.to film. For supine pa-tients adjusts tube from underpatient,and film holder above patient. For non-direct contact exposure,centers tube at right an-gles to midpoint of film.

v) For oblique or lateromedial pro-jections of the sternoclaviculararticulations, performer noteswhether a bilateral or unilateraexamination is ordered, whethershock-proof equipment will beused (in direct contact with pa-tient), whether boe: rotation orcentral ray ansulation will beutilized, and whether patient

will be prone (usually) orseated erect.

For unilateral oblique projec-tion using body rotation, per-former places patient in proneor seated erect position. Thenturns patient obliquely withside of interest facing film.Adjusts cassette holder so thathe sternoclavicular joint isat center of film,with bodyangled so that vertebrae shad-ow will be projected behindthe jc.Lat when the ray entersat right angles. Adjustsshoulders to lie in a singletransverse plane. Directs cen-tral ray at right angles tomidpoint of film.

For unilateral oblique projec-tion using central ray angula-tion, places patient in proneor erect PA position as de-scribed above, with film cen-tered to the sternoclavicularjoint of interest, and arms,shoulders,and head adjusted inPA position as described above.Adjusts x-ray tube so that theray will enter on the side ofthe joint of interest at anangle of 15° toward the mediansagittal planeS of the body.

For bilateral lateromedial projection::, adjusts patient toprone or erect seated PA posi-tion as described above. Cen-ters film to manubrial notchand adjusts head as for PAfilming as described. Locatesspinous process of the thirdthoracic vertebrae and marksa point 6 cm. on either sidefor centering ray. Either usesfilm masked appropriately for


Task Code No. 362



'

filming both sides on the samefilm (without moving patient),orshifts cassette appropriately,Performer adjusts x-ray tube an-gulation) for given focal-filmdistance or in direct contactwith patient's body as decided.Centers ray to one side for firstexposure and to other side forsecond exposure at 5° or 15° asordered, toward the median sagit-tal plane, centered to the pointpreviously marked for that side.Reminds patient to hold positionfor second exposure.

vi) For lateral projection of stern-oclavicular articulations,has pa-tient assume a lateral recumbentor erect position as describedabove, with sternoclavicularregion centered to midline oftable or film holder, with recum-bent hips and knees flexed andsupported as described. Has re-cumbent patient fully extend armnext to table and grasp end oftable. Has patient depressshoulder on opposite side grasp-ing the dorsal surface of hip.Adjusts thorax so that anteriorsurface of manubrium is c- right

,angles to plane of film. Directscentral ray through the lowermoststernoclavicular articulation at15° caudad.

b. For studies of the ribs and costal

erect position. Has erect pa-tient seated or standing withback to vertical cassette hold-er, with weight evenly distrib-uted and shorter limb supportedif required. Centers erect orprone patient so that mediansagittal plane of body is atmidline of table or holder.Has patient rest hands againsthips with palms turned outward.Adjusts shoulders to lie in asingle transverse plane. Witherect patient has shouldersplaced in contact with filmholder. Rests patient's head onchin (if prone) or facing di-rectly ahead,so that mediansagittal plane is at right an-gles to film. Centers film sothat upper border is about 1.5inches above shoulders, cen-tered at the level of thesixth thoracic vertebra. Forupper ribs,directs central rayat right angles to midpoint offilm. For lower ribs,directscentral ray at right anglesabout 5 inches proximal to themidpoint of film.

ii) For AP projection (posteriorview) of posterior ribs, per-former adjusts patient in su-pine or erect position. Posi-tions as for PA projection,asdescribed above, but with pa-tient facing cassette aolderrather than facing away Ro-tates shoulders forward. Forribs above diaphragm, may havepatient place hands over head.Centers film to level of sixththoracic vertebra with 1.5inches of upper border extend-ing above shoulders. Directscentral ray at right angles,centered 4 or 5 inches abovethe midpoint of the film.

-'oints, performer considers whethera preliminary film of upper and/orlower ribs are to be radiographedand the erect or recumbent positionselected. Notes whether a wide an-gle, bilatera! (two cassette) study-is required. Decides whether bilat-eral study of costal joints can beprojected with a ,...ingle exposure orrequires two separate exposures.i) For PA projection (anterior

view) of anterior ribs, perform-er ad]usts patient in prone or


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Task Code No. 362


For ribs below the diaphragm, mayhave patient fold hands overchest. Centers film to level oftwelfth thoracic vertebra andlower border about 1.5 inchesbelow the crests of the ilia.Directs central ray at right an-gles 4 or 5 inches below the mid-point of the film.

iii) For posterior oblique projection(anterior oblique view) of axil-lary portion of ribs, performerstarts from PA position as de-scribed above, with film centeredat the level of the sixth thora-cic vertebra for ribs above dia-phragm and at the level of thetwelfth thoracic vertebra forribs below the diaphragm (or mid-way between for scout film). Ro-tates body about 450 with theside of interest away from film.Has recumbent patient rest onforearm and flexed knee of ele-vated side and supports. Alignsbody so that a longitudinal planemidway between the median sagit-tal plane and the lateral surfaceof body is centered to midlineof holder. For upper ribs directscentral ray at right angles tofilm 4 to 5 inches above mid-point; for lower rib3 directscentral ray at right angles tofilm 4 to 5 inches below mid-point.

iv) For anterior oblique projection(posterior ol311que view) of axil-lary portion of ribs, per).-ormerstarts from AP position 8,3 de-scribed above, with film centeredas in (iii), above. Rotates bodyabout 45° with side of interesttowards the film. Supports ele-vated hip of recumbent patient.Has patient abduct arm of sideof interest and eliwate,and haserect patient rest hand on head;has recumbent patient p]ace hand

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under or above head. Directscentral ray as in (iii), above.

v) For a wide angle, bilateralfrontal projection of ribs,performer arranges two cas-settes at right angles to eachother, facing inward, so thateach is at a 45° angle to thecentral ray. Positions patientin AP or PA position oppositeand centered to the apex of atriangle formed, witi. patient'sbody constituting the base ofthe triangle. Adjusts height ofcassettes to center to the lev-el of the area of interest. Di-rects central ray at right an-gles to the apex of the tri-angle (where the two cassettesmeet), so that both films areexposed at once.

vi) For semiaxial AP projection(posterior view) of the costaljoints, performer positions pa-tient in supine AP position asdescribed above,with arms o,head or along sid,s, depenr"on the need to adjust spir Acontact with table top. MLy ap-ply comr 1:and acrossthorax. .iiateral projec-tion c,o 4complished withone e:(.11,ur, performer cen-ters l'n to central ray anddireccs central ray throughthe sith thoracic vertebra atan angle about 20° cephalad,depending on the degree ofdorsal kyphosis. If a bilateral

_ study requires two separate ex-posures, performer rotates body10° medially in one directionfor first exposure and 10° me-dially in the other directionfor the second exposure.

c. For studies of the trachea,super-ior mediastinum and pulmonaryapices, performer reviews basicposition selected,specific breath-


Task Code No. 362


List Elements Fully( List Elements Fully

ing options,and whether angle block apex, performer positions pa-will be used for lateral projection. tient seated or standingi) For AP projection (posterior erect in a lateral position

view) of trachea, performer has before vertical cassette hold-patient assume seated, standing er,with the affected side nextor supine position. Centers the to the film. Has patient ele-median sagittal plane of body to vate arm nextsto film in ex-midline of table or cassette treme abduction, with elbowholder. Has erect patient dis- flexed and forearm acrosstribute weight evenly. Adlusts head. Centers film as describ-shoulders to lie in a single ed above, to the level of thetransverse plane. Extends head axilla. Has patient restslightly and adjusts so that med- shoulder next to film againstian sagittal plane is at right holder and depress oppositeangles to film. Immobilizes head shoulder as much as possible.with clamp or weighted band. Cen- Directs central ray throughters film at the level of the the adjacent supraciavicularmanubrium. Directs central ray at fossa at 15° caudad.right angles to the film centered iv) For AP projection (posteriorto the manubrium.

. view) of pulmonary apices,per-ii) For lateral,retrosternal projec- former has patient sit or

tion of trachea and superior me- stand in AP position beforediastinum, has patient sit or vertical cassette holder orstand erect in a lateral position lie in AP supine position.before vertical cassette holder May elevate shoulders of su-with weight equally distributed. pine patient on angle block.Centers cassette holder so that Aligns body for true AP posi-upper border is at or above the tion. Centers film to the me-level of the laryngeal prominence dian sagittal plane at thewith coronal plane midway between level of the second thoracicthe manubrial notch and the mid- vertebra. Has patient flex el-axillary line, centered to the bows and place hands on hipsmidline. Rotates shoulders back- with palms out or pronateward and has patient clasp hands hands beside hips. Rotatesbehind body or place hands on shoulders forward and in ahips, with thumbs up, and hold

. single transverse plane. Di-shoulders back. Extends head rects central ray to secondslightly. Makes sure that the thoracic vertebra at 15° tomedian sagittal plane of the 20° cephalad. If shoulders arebody is parallel with film. Di- raised on angle block,directsrects central ray at right an- central ray at right angles togles to Him centered to a point film, centered to lower neck.midway between the manubrial v) For PA projection (anteriornotch and the anterior border of view) of pulmonary apices,per-the head of the humerus. For former has patient sit ordemonstrating entire chest, cen- stand in PA position beforeters 4 to 5 inches lower,

iii) For lateral, trans-shoulder pro-vertical cassette holder,withweight equally distributed.

jection of trachea and pulmonary Centers cassette to the level4

193


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Task Code No. 362



of the manubrial notch,with medi- sides. For erect patient hasan sagittal plane of body cen- weight distributed equally. Hastered to midline. Extends chin prme patient rest head onover top of cassette with mediansagittal plane of head at right

chin.; has erect patient extend.

chin over top of cassette; ad-angles to film. Has patient flex justs head so that median sag-elbows, place hands on hips with ittal plane is at right anglespalms out. Depresses shoulders to film. Has female patient'sand rotates forward in a single breasts held to the sides astransverse plane. Has patient described earlier. Has patientkeep shoulders in position and rotate and depress shouldersin contact with cassette. For ex- forward, flex elbows, and placeposure to be made on inhalation,directs central ray to the third

back of hands well down onhips. Adjusts shoulders to a

thoracic vertebra at 100 to 15° single transverse plane withcephalad. For exposure to be made c1avicles below the apices.on exhalation, directs central Has patient keep shoulders inray at right angles to film, cen- contact with cassette or tabletered at the level of the third top. May have uneteady patientthoracic vertebr474,

d. For studies of the chest, includingplace arms around upright cas-sette. Makes sure that there

lungs and heart, performer notes is no rotation of body. If ex-whether lungs or heart are of prime posures are to be made both atinterest in order to select center- inhalation and exhalation, in-ing for central ray. Makes sure bar- structs patient to maintain po-ium is ready for heart series. Notes sition for second exposure. Ifwhich is the affected side for lat- stereoscopic projections areeral studies and on which side pa- to be made, plans to shift tubetient is to lie. With suspected for- (or have this done automatical-eign body, pneumothorax, or dia- ly) on one respiratory move-phragm study,has patient breathe in ment. For lungs, directs cen-and hold for first exposure; has pa- tral ray to the median sagittaltient hold position; replaces film; plane at the level of theand has patient breathe out and hold fourth thoracic vertebra; forfor second exposure. Performer makes heart and aorta, at the levelboth exposures on one film to study of the sixth thoracic vertebra.excursion of diaphragm. May make PA ii) For AP projection (posteriorchest projection as part of an ab- view) of lungs and heart, per-dominal series,i) For PA projection (anterior view)

former has patient assume anerect seated or standing posi-

of lungs and heart,performer has tion,or a supine position withpatient assume an erect, standing thorax elevated. Centers pa-or seated position if possible,or prone position,facing casset-

tient and cassette as describedabove. For supine patient, pro-

te. Adjusts cassette so that up- nates the hands at the level ofper border of film is about 1.5 the hips and elevates elbows soinches above shoulders,with me- as to draw scapulae outward;fordian sagittal plane of body at erect patient adjusts as de- i

midline of film. Has arms at scribed above. For lungs, di- I

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Task Code No. 362



rects central ray at right an- v) For PA lordotic projection (an-gles to film,centered to the terior view) of the lungs, hassternal angle; for heart,centers patient stand or sit in PA po-to the midsternum. sition before upright cassette

iii) For PA oblique projections (an-terior oblique views) of the

holder or in prone position,with body centered to midline

lungs and heart, performer notes and cassette about one inchwhether left or right view is below upper border of should-ordered, or both. Maintains pa- ers, centered to the 4th thor-tient in same position (standing acic vertebra. Has patientor seated) as for PA projection. grasp sides of stand or table,Has arms free at sides. Has pa- brace abdomen against it, andtient turn to the right (for left lean backward as much as pos-oblique projection) 45°, 55° to sible or with thorax at a 45°60°, or 10° to 20° as ordered; angle. For erect patient di.-or to the left(for right oblique . rects central ray at right an-projection) with weight equally gles to the film,centered todistributed. Centers film to the the fourth thoracic vertebra;thorax, centered to the level of for prone patient directs cen-

' the 5th thoracic vertebra. For tral ray 30° or 45° caudad.left PA oblique projection has vi)yor AP lordotic projectionleft shoulder and breast in con-tact with cassette,with left hand

(posterior view) of the lungs,has patient stand or sit in

on hip, palm down. Has patient AP position one foot away fromraise right arm to shoulder level upright cassette holder. Cen-and grasp side of cassette for ters cassette to the level ofsupport. Adjusts shoulders to a the midsternum,with upper mar-single transverse plane,and has gin of film about 1.5 inchespatient face straight ahead. Re- above upper border of should-verses position for right PA ers when patient is in posi-oblique prbjection. For study of tion. Performer may mark alungs, directs central ray at point just above the vertebraright angles to center of film prominens,and a point over theat level of fourth thoracic ver- upper edge of the manubrialtebra; for heart,to level of 6th notch. Has patient lean back-or 7th thoracic vertebra,

iv) For AP oblique projections (pos-ward until the plane describedby the two points is at right

terior oblique views) of the angles to the plane of thelungs and heart, notes whether film. Has patient flex elbowsleft or right view is ordered. and place back of hands onPositions patient from the AP hips, resting shoulders against

,supine position. Adjusts and cen cassette for support. If soters cassette as for PA oblique ordered, rotates body 30 de-projections(iii);rotates patient grees with affected side to-on table to the desirad side and wards the film (for obliqueangulation as described above. projection).Directs centralSupports elevated hip and arm. ray at right angles to film,Has patient pronate hands beside centered to the level of thehips. Directs central ray as de-scribed above in (iii).

midsternum.


Task Code No. 362


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vii) For lateral projection of thelungs and heart, performer noteswhether left or right lateral hasbeen ordered. Has patient standor sit with arms at sides infront of upright cassette holder,with side of interest next tofilm. Centers cassette so thatupper border of film is about 1.5inches above shoulders,centeredto the thorax, with the midaxil-lary line of the body about 2inches posterior to midline offilm. Has patient stand or sitstraight, with shoulder next tofilm resting against cassetteholder. Has patient extend armsdirectly upwards, flex elbows,and rz-At forearns on head. Mayhave patient extend arms forwardand hold on to vertical supportstand. Makes sure median sagit-tal plane of body is vertical.For lungs, directs central rayat right angles to film, centeredto the fourth thoracic vertebra;for heart centers to the sixthor seventh thoracic vertebra.

viii) For ventral or dorsal lateralprojections of lungs and pleurae(for fluid level study), perform-er adjusts patient in PA proneor AP supine position on tableas ordered, and elevates thoraxwith patient's arms above head.Places cassette verticallyagainst affected side so thatthe laryngeal prominence is in-cluded and film is centered atthe level of the fourth thoracicvertebra. Directs central rayat right angles to midpoint offilm.

ix) For frontal projection (AP or PA)of lungs and pleurae (for fluidlevel and/or pneumothorax study);performer has patient assume alateral recumbent position lyingon the side ordered. If patient

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is lying on affected side,ele-vates body somewhat from sur-face of table. Places and sup-ports cassette verticallyagainst anterior surface ofchest for PA projection andagainst posterior surface ofchest for AP projection,cen-tered to the fourth thoracicvertebra, with film edge ex-tending.about two inches beyondshoulders. Has patient extendarms well above head. Adjuststhorax in a true lateral posi-tion with respect to the planeof the film. Directs centralray at right angles to filmthrough the midpoint of thefield at the level of thefourth thoracic vertebra.

If, during positioning,patientshows signs of severe pain, per-former may notify appropriate phy-sician at once and await orders,or may decide on alternative po-sitioning to avoid movement ofthe affected part.

13. Performer rehearses patient in thetype of breathing that will be re-quired for the exposure(s):

a. Performer has patient breathelightly in shallow, rapid breathsfor obliqu'a projections of thesternum (if so ordered), frontalprojection of upper ribs (if soordered) ,or breathe quietly forlateromedial projection of thesternum (if so ordered).

b. Performer has patient simply holdbreath for lateromedial projec-tions of sternum (if so ordered)and sternoclavicular articula-tions.

c. Performer has patient breathedeeply, and exposes film whilethe patient is breathing in forprojections of the trachea.

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Task Code No. 362


d. Performer has patient breathe outfully and hold for oblique projec-.

tions of the sternum (if so ordered),for frontal projections of the ster-noclavicular articulations, projec-tions of the ribs below the dia-phragm, and for the second exposurein studies such as foreign bodysearch, diaphragm excursion, pneu-mothorax, or fluid levels.

e. Performer has patient breathe indeeply and hold for lateral projec-tions of the sternum and sternocla-vicular articulations, projectionsof the ribs above the diaphragm, thecostal joints, pulmonary apices,survey films of the heart and lungs,for the first of the two exposuresfor foreign body search, diaphragmexcursion, pneumothorax and fluidlevels; performer may ask patient tobreathe in deeply, breathe out,andthen breathe in again and hold onthe second breath.

f. For cardiac series performer givespatient container with barium mix-ture or holds for patient dependingon patient's position and condition.Has patient take two or three swal-lows of the mixture,and then takeabout a tablespoonful and hold thisbolus in mouth until instructed totake a deep breath and swallow justbefore exposure.

14. Performer checks final positioning byusing light in collimator. Activatesthe collimator light and points thelight beam towards the part. Adjuststhe collimator opening to correspondto the film size (or the size of theunshielded area of the film to be ex-posed). Uses cross-hair shadows asreference for center of field. Usesthe collimator light to center the pa-tient to the x-ray field, or centersthe part to the film holder and usesthe collimator light to center thetube to the part. Checks that primary

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beam will enter the center of thearea of interest at the selectedangle to the film so as to projectthe view desired. May readjust tubeposition lengthwise or crosswise toprovide better centering.

15. Once the patient has been positionedand immobilized, performer adjuststhe collimator. Either collimates sothat a small unexposed border willappear around the edge of the filmor collimates further so as to ex-pose only the area of interest (andthus provide maximum protection anddetail). For small fields performer,may attach an auxiliary extensioncone to collimator to further reducethe primary beam. Adjusts primarybeam to minimum size needed to coverthe part(s) of interest.

16. Performer adds lead shielding toareas that will be in the primarypath of the beam but are not includedin the areas of.interest. Makes surethat proper protective shielding hasbeen provided to patient and everyonewho will remain in room.

17. Throughout procedure performer ob-serves patient for any signs of emer-gency and/or to prevent or respond toan accident. Is alert to signs of nausea, dizziness or sweat suggestingfaintness. Performer may have patientlie down, lower head or raise legs..Notifies nurse. If patient shows anyother emergency signs, loses consci-ousness, or has an accident,performercalls appropriate physician or nurseat once. May decide to provide emer-gency first aid as well. If a pa-tient's urinary catheter becomes dis-connected, performer clamps it and immediately notifies nurse. If cathetershould come out, notifies nurse atonce. Makes sure any suction equipmenis clear and functioning.


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20.

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iv) After exposure is completedtells patient that he or shecan relax.

v) If the exposure is terminat:edby a circuit breaker, recheckstechnical factors for possibleoverload or checks for overloadelsewhere on circuit. Antici-pates need to repeat exposure.

Performer returns to patient. Removescassette or film holder from table,floor or bucky.

a. Removes any markers for furtheruse. If multiple views are to betaken on the film, removes leadedrubber mask and remasks all butnext area to be exposed.

b. If the patient is being examinedfor possible fracture or if sorequested, performer arranges tohave the first exposure processedat once and brought to the appro-priate radiologist.

c. If the first radiograph(s) arepreliminary (scout) films, per-former brings the processed radio-,graph(s) directly to the radiolo-gist in charge or places on viewboxes and informs radiologistthat the scout(s) are ready. Ifthe radiologist indicates thatthere is any problem with thetechnidal factors or the patientpositioning,performer records ornotes for later use in the exami-nation and/or repeats preliminaryradiography as ordered.

d. Depending on whether radiologistwill evaluate radiographs beforecompletion of all possible expo-sures for the series, performerarranges to process film(s) andevaluate for quality control per-sonally, have this done, or bringto dark room for processing and

18. When everything is ready for the ex-

posure,performer reminds patient of thebreath control to be used for expo-sure,and about those exposures in whichposition-is to be retained for a secondexposure. Performer observes the pa-tient's movement until the moment thatthe exposure is made. Readjusts posi-tion if warranted.

19. The performer returns to control room.'Makes sure controls are properly setand patient is still in position. Tellspatient when to swallow bolus of bariumand/or breathe as rehearsed by callingor using intercom.

a. If patient is not conscious and/orcannot suspend respiration, perform-er times exposure to the patient'snatural breathing cycle (i.e. atinspiration or expiration as appro-priate).

b. Performer initiates exposure bypressing hand trigger or exposurecontrol bu.tton.

i) While exposure is underway,per-former checks that mA meter re-cords appropriate current asset, that kVp meter dips slight-ly.

ii) May watch for evidence of mal-function such as line surge orexcessive drop; may Listen forsound of normal functioning ofequipment. If there is malfunc-tion may decide to report; anti-cipates need to repeat exposure.

iii) With phototimer notes whetherbackup timer has been involvedin terminating exposure beforephoto-timed exposure was com-pleted. If so, anticipates pos-sible need to repeat exposure(due to underexposure if pre-mature cut-off, or overexposuredue to faulty timer).

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-Task Code No. 362

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later evaluation, based on timeavailable, institutional arrange-ments, or specific instructions.Attaches ID card for use with flash-er if appropriate. May sign requisi-tion. With chest x-ray equipment maydecide when to remove receiving mag-azine of exposed films from machineand take to darkroom for processing.Returns with empty magazine and re-places in machine. May wait untilall films in loading magazine areexposed, depending on the urgency othe study.

e. While films are being processed and/

or evaluated,performer has patientrelax in examination room or holdingarea. Explains what will happennext.

i) Performer determines whether pa-tient should remain on table and/or in room until physician ar-rives, and whether patient re-quires observation. If appropri-ate, arranges to have patient at-tended while waiting.

ii) If patient is to leave table or

rise, performer makes sure allequipment is moved away from pa-tient such as overhead tube andupright film holder.

iii) May decide to assist patient tochair or stretcher or from chairor table. Makes sure to remindpatient of any footrest whenstepping off table.

21. When (or if) performer learns from theradiologist the extent of the injuryand/or whether further conventionalviews and/or positions can be under-taken, eliminated, or altered, perform-er proceeds as appropriate accordingto instructions.

a. For further exposures performer re-peats approptiate steps for nextview(s) including identification o

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film holder and use of R-L marker,selection and setting of techniquefor next view (if different), posi-tioning patient and equipment forfocus-object-film alignment, prop-er collimation and shielding,

breathing instructions, and makingexposure, as described. For bilat-eral exposures on one film, keepsR-L reference constant.

b. Performer refrains from commentingon tne films or providing any in-terpretation.

c. If performer is asked to repeatany exposures, makes suri, that theadditional exposures are warrantedmedically, since additional radia-tion will be incurred.i) Notes whether need to repeat is

due to performer's own negli-gence or lack of attention sothat performer can avoid future"rtakes."

ii) If request for retakes reflectsmalfunctioning equipment, per-former reports malfunction to

appropriate staff member.iii) If request for retakes reflects

the preference for density orcontrast of a radiologist,performer notes for future workdone for the given radiologistso that retakes can be avoided.

22. When performer is sure that the ex-amination has been completed, per-former may have patient transportedback to holding area or next loca-tion, or decides to do personally,as appropriate. Makes sure that noneof the equipnent is projecting overthe patient before allowing patientto rise.



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a. Performer has equipment and examina-tion table cleaned after use or de-cides to do personally, depending oninstitutional arrangements.

b. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken, thetechnical factors used,and filmsizes. For heart series may includepatient's weight, height and age inthe appropriate record form. Per-former may record the number of ex-posures made of each view includingretakes; may enter the estimatedradiatim dose to which patient wasexposed (using posted informationon dosage); may record any problemwith equipment, any special careprovided patient. If any views cal-led for in the initial request couldnot be obtained performer may recordreasons, Signs requisition sheet.'

c. If performer will only carry outprelimlnary "scout" filming andanother technologist will continuewith examination, performer recordsthe approved technical factors usedfor the scouts and the accessoriesemployed, or informs technologistwho will continue. Performer givesthe requisition sheet, name card,and any notes to technologist whowill continue wi procedure.

d. Performer may decide to jacketfilms, requisition sheets, and re-lated materials and/or have infor-mation recorded in log book per-sonally or have this done, depend-ing on ihstititional procedures.


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Task Code No. 363


1. What is the output of thl.s task? (Be surethis is broad enough to be repeatable.)

Requisition reviewedo:.reassured,positioned;parts

measured;films identified;technical factors selectedand set; exposures made; radiographs sent for Iro-cessing and evaluation; procedures repeated as ap-propriate for full set of views; patient returned;examination recorded; radiographs placed for use.

2. What is used in performing this task? (Noteif 2111/ certain items must be used. If thereis choice, include everything or the :ands ofthings chosen among.)

Pt.'s x-ray requisitionsheet,ID card,ID bracelet,

technical history;pen;x-ray machine control panel(s)tube,bucky,table,collimator,extension cones;techni-que chart;charts for conversion of technique,stand-ard examination

views,dosage,tube capacity;loadedcassettes;vertical film holder;leaded rubber shield-ing;R-L and ID

markers;immobilization devices;stool;calipers;tape;scissors;protractor;compression band;stretcher or wheelchair

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...(x) No...( )

4. If "Yes" to q. 3: Name t1177417771 recipient,respondent or co-worker involved, with de_scriptions 'to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant tJ knowledgerequirements or legal restrictions.


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iPerformer receives or obtains thx-ray requisition form,patient'sidentification card, and any ap-propriate medical-technical his-tory for a non-infant patientscheduled for radiography of theabdomen, including the liver,spleen, kidneys, bladder, dia-phragm, abdominal aorta and in-tra-abdominal cavities:


b. From co-worker.

After having arranged requi-sitions in order of priority.

The plain films of the abdomenmay be to determine whether thereis evidence of free gas and/orfluid levels, intra-abduminaltumor masses, calcifications,and/or foreign bodies. The plainfilms may be part of an abdomi-nal series or a KUB (kidneys,ureters, bladder) series. Theplain films may serve as prelim-minary "scout" films for contraststudies such as of the urinarysystem, abdominal fistulae orsinuses, biliary system, intesti-nal obstructions, etc.

5. Name t e task so that the answers to ques-tions 1-4 are reflected. Underline essen-tial words.

Taking plain film radiographs of abdominal contenl_sof non-infant patient by reviewing request;reportingobserved contraindications;reassuring pt.;measuringpart;selecting and setting technical factors;identi-fying film;positioning pt. and equipment for erector recumbent exposure; providing shielding;collimat-ing; making exposure; having radiographs processedand reviewed; repeating for full set of views or asordered; having pt. returned; placing radiographsfor use; recording examination.

1. Performer reads the requisi-tion sheet to determine theexamination called for, pur-pose, the patient involvea,special considerations, andto check the completeness ofthe information provided:

a. Performer checks the exam-inations called for and thepurpose, noting whether airer fluid levels, foreign

OK -RP;RR;RR

6. Check here i thisis a master sheet..

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:-.ody, tumor mass or calcificationsare to be examined, whether routineseries, and/or particular organsare to be examined, such as kidneys,liver, spleen. Notes the affectedareas, the patient positions andprojections called for, the numberof exposures, the central beam angu-lation, the areas of interest andparts to be included. Notes whetherthe use of a grid or bucky will beinvolved. Checks the name of thereferring physician.

b. Performer reads patient's name,iden-tification number, sex, age,weight. Notes whether patient is in-patient, out-patient, or emergencypatient. Notes any special informa-tion that wi-1 affect patient posi-tioning, tecnnique, or handling ofthe patient, such as presence rfacute abdominal signs,, known path-ologies.

c. With patients who are to undergosubsequent contrast studies, per-former'may note whether orders forprior preparation such as evacua-tion or emptying bladder (or keepingbladder full) have been given andcarried out; if not already done,may arrange to have orders carriedout or informs appropriate staffmember.

d. Performer notes whether there arespecial orders for use or nonuse ofcompression devices.

e. If patient is acutely ill, performrer checks whether use of erect po-sition is expressly ordered. Checkswith radiologist if unclear; doesnot plan for erect positioning with-out express permission.

f. Performer checks whether patient issuffering from a collateral condi-tion requiring special handling,such as heart disease, communicableor infectious condition, infirmity,incoherence; whether patient has IV

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g.

drip, oxygen supply, urinary cath-eter, colostomy, T-tube or similardevice in place; notes whether pa-tient will be accompanied by nurseor other staff person, whetherthere are orders for removal ordressings from the abdominal ar,:aIf performer is not alreadysigned to examination room (ead aparticular machine) notes the roomor machine involved. Goes to ex-amination room or control roomfor machine involved.

h. Performer makes sure that the re-cuest is properly authorized,thatinformation on requisition sheetis complete. Checks whether anyspecial orders on exposure factorsare in keeping with the usual radexposure involv,2d for the examina-tion.

i. Depending on institutional proce-dures, performer may review pa-tient's radiation exposure his-tory, prior record of techniquesused, and cumulative exposure.Notices whether examination hasbeen done eisewhere in recentpast, whether number of radio-graphic exposures ordered or donein past should be reported to ra-diologi3t.Depending on institutional proce-dures, performer notes whetherfemale patient is pregnant,reviewsdate of female patient's last men-strual period, or notes any otherindication that there is no dangerof exposure of a known or possiblefetus. Notes shielding needed.

k. If patient's record indicates or-ders for sedation or any otherprior medication, performer maycheck timing to be sure a properelapse of time has occurred for-medication to take effect. Mayarrange to delay examination ifappropriate.

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1. If referring physician has requestedthat films already on file be sentwith current radiographs, and if notalreaiy with patient's jacketed ma-terial, performer arranges to haveprior films delivered.

. If .:he performer determines that therequest is not properly authorized, isincomplete, or that sufficient informa-tion is lacking for performer to selecttechnique or to properly position orcare for patient, or if performer con-siders that there may be contraindica-tions to going ahead with the proce-dure, performer notifies supervisor,radiologist, or other designated staffperson, depending on institutionalprocedures. Explains the problem if ap-propriate, and proceeds after obtainingneeded information, signature, ororders.

. When perforu.er is clear about what ',J.-,be involved in examination, he or sheprepares ahead so as not to keep pa-tient in examination room longer thannecessary:

a. Performer reviews the techniguechart for the machire to be usedand takes note of any newly postedchanges in technical factors (to re-flect accommodation for change inmachine output or a policy deci-sion).


c. Performer makes sure that x-rayequipment is ready for use. Goes tocontrol panel for x-ray generatorand checks that indicator lightshows that machine is "warmed up,"or turns on main switch as appro-

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priate to equipment and allowstime for machine to "warm up." Ifappropriate, performer may setrad:ography mode selector and setcollimator control for manualoperation.

d. Performer checks that appropriate.immobilization devices such assandbags, wedge sponges, compres-sion band, are present and thatthere is a mattress, pads, pil-lows, and/or blankets for comfortof patient if patient will lie ontable. If appropriate, obtainsprotractor, cardboard triangles,device to support erec .. patient,objects to stand on to compensatefor limbs of unequal length.

e. Checks that there is leaded rubbershielding available in room to beused to protect the patient, and/or to place beneath the film hold-er, as appropriate.

f. Performer prepares for identifica-tion of the films using equipmentprovided by institution:i) May obtain lead numerals and

tape and prepare identificationstrip for placement on filmholder(s) giving appropriatepatient identification informa-tion.

ii) Performer may prepare for useof flashcard by checking thatthere is piece of lead on filmholder surface; may write ortype out ID information on cardif rot received with requisi-tion.



4. Performer has the patient called fromthe holding area and prepared for the

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examination (if not already done), ordecides to do personally.

a. Depending on institutional arrange-ments, performer may decide to es-cort out-patient to or from dressingroom. May decide to assist in trans-porting patient from holding area orhave this done.

b. Performer greets patient and any ac-companying staff person and intro-duces self. Checks patient's iden-tity against the requisition sheet.With in-patient, checks hospitalidentification bracelet or otheridentifier. If patient is accom-panied because of seriousness ofcondition, performnr checks withaccompanying staff member on anyspecial precautions necessary dur-ing procedure.

c. Has patient assume a comfortableposition seated on table or chair.If patient is in wheelchair, movespatient in chair into position nextto table. If patient is on specialstretcher, places stretcher intoposition so that radiolucentstretcher can be lifted with pa-tient on it from wheeled base tox-ray table. May arrange to mo7epatient to table. With acutely illpatient uses upright film holder

. with patient remaining on stretcher.d. Explains to patient what will be in

volved in the procedure;indicatespositions patient will be asked toassume,the cooperation that will beasked of the patient. May ask pa-tient to refrain from swallowing ifpossible.

e. Performer answers patient's non-medical questions honestly; attemptsto reassure patient and developconfidence. Treats patient withdignity and concern regardless ofpatient's behavior. Remains awarethat patient may be frightened and/or in pain. Performer explains whenasked medic22.3uestions that it is

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not appropriate for technologistto answer these; encourages pa-tient to-sneak to physician.

f. If patient has an IV drip in placeperformer checks that needle hasnot become disiodged and that thefluid is dripping at an even rate.If there a--.e any problems,perform-er clamps tube and notifies ap-propriate staff person at once.

g. If patient has a wound, colostomy,ileostomy,or T-tube with dressingto be removed, performer checkswhether zinc or iodoform paSte orradiopaque gauze is being used.If so, has appropriate staff mem-ber remove dressing or tube ordecides to do personally (if ap-propriate). Checks that radiopaquepaste or gauze is completely re-moyee.

h. If appropriate ahd not alreadydone, performer que'Aions femalepatient of child bearing age re-garding possible pregnancy. Ifthere is any possibility that pa-tient is pregnant and this has notalready been recorded, performerinfo:7ms appropriate physician andproceeds only with approval.

i. Makes sure that all garments ex-cept gown are removed down to be-low the are,: of interest. Keepsbody covcred until ready for posi-tioriag and exposure. Reveals onlyas much of body as necessar:.Treats young patient with 3: muchcourtesy as adult.

5. Performer questions patient ,tnd/or RNor MD present cn what movement ispossible to determine what positionsare available for use.

a. For abdominal series,especiallyfor air or fluid levels, noteswhether routine use of erectposition is possible. May plan foruse of supine position followed by


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upright filming (if possible) or, ifnot possible, by patient in lateraldecubitus position. May plan to em-ploy semierect position for patientwho cannot assume either positionby using footrest and compression sothat patient can be brought to al-most upright position on table.

b. Performer notes the patient's bodytype, whether the area of interestis heavily covered by muscle or softfat, whether the palpation pointswill be easy to find. Notes whetherthe lower extremities are of unequallength. Notes whether tall patientwill require two exposures for viewsordered, one centered to include thediaphragm and the second centered toinclude the pelvic area. Noteswhether thin patient will need pad-ding under bony prominences.

c. Performer considers whether conven-tional positioning can be utilizedor what alternative x-ray tube andpatient positions to use to accom-plish the equivalent radiographywith a minimum of movement by thepatient.

d. Performer considers the number andtypes of projections ordered for theexamination and the patient's con-dition. Performer may consider achange from standard projections tobetter accomplish the purpose of theexamination, or deletion of a posi-tion,or a change in technical fac-tors. Depending on institutional ar-rangements, performer may obtainpermission from appropriate radio-logist or decides personally toalter the standard procedure.

6. Depending on whether a bucky or tabletop technique will be used and sten-dard institutional practices, perform-er selects speed and type of film,grid, and cassette combination.

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a. Selects size(s) based on the area(s) to be included, the patient'ssize,and whether two exposures(and cassettes) will be needed topresent a given view.

b. Performer makes sure that an ade-quate supply of loaded cassettesof the types and sizes selectedare available in the examinationroom. If not, arranges to obtainor decides to obtain personally.

Performer prepares for the examina-tion:


b. Performer attaches identificationinformation to the cassette ortable top:

i) Places right or left marker onfilm holder or table-top as ap-propriate to the study and pro-jection or depresses appropri-ate R or L button for automaticmarking.

ii) If patienC's identification in-formation is in the form oflead numerals, performer placeson appropriate corner of cas-sette.

iii) If patient identification in-formation is to be entered byuse of flasher, sets flash-card aside for later use withspace created by piece of lead-ed rubber on appropriate edgeof cassette.


c. If cassette is.to be used withbucky (under tabletop or in up-right holder) performer may man-ually pull out bucky tray and open

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retaining clamps. Inserts cassetteinto bucky tray and pushes back.Makes sure clamps are closed. Movescassette into appropriate "stored"position or inserts cassette trayinto bucky slot and centers.

d. If a bucky is not being used, per-former places cassette in a posi-tion that can be comfortably reach-ed by the patient in final posi-tioning. If appropriate to make pos-sible minimal movement of patient,performer may place cassette in up-right holder at right angles totable top or in other positionselected.

e. Performer provides patient andeveryone who will remain in roomduring exposure with protectiveshielding. Explains it necessarythat this is not cause for alarm buta general precaution to minimIze un-necessary radiation exposure.

Performer has patient assume a comfort-able recumbent or seated or standingposition depending on the positions tobe employed, so that the part(s) to beradiographed can be measured.

a. If appropriate, places mattress,pillow, or clean linen on x-raytable.

b. Performer may decide to assist pa-tient from wheelchair or stretcherto table or has this done. May ob-tain help. Makes sure that no equip-ment is in the way and may be col-lided with by patient. Locks chair.


d. Performer uses centimeter calipersto measure the thickness of thepart(s) to be radiographed in thedirection in which the central rayof the x-ray beam will pass through

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the centered part from tube tofilm. Records for use in deter-mining exposure factors.

e. If patient has a urinary catheterin place, performer turns patienttoward the catheter and tubing toprevent separating it from drain-age bottle and breaking sterilesystem and to avoid causing pain.

f. After measuring, has patient restin as relaxed a position as pos-sible. May place pad, blanket orpillow under bony prominences toprovide comfort.

g. If patient is to be examined(next) in the lateral decubitusor erect position, performer haspatient remain in that positionfor an appropriate amount of timebefore making the exposure(s).


a. Locates the information needed forthe body part and projection in-volved according to the centimeterthickness of the part as measuredand the collimated field size tobe used. Makes sure that techni-que relates to the combination offilm type and speed and use ornonuse of other radiographic ac-cessories (such as screens,grids, bucky, etc.).

b. Makes note of the kVp, mA,T(sec-onds of exposure time), focalspot size, and the focal film dis-tance (TFD or FFD) called for.

c. Once the standard kVp, mA'and timehave been determined, performernotes whether any conversions arenecessary to account for the path-ological condition being studied,change in TFD, extreme fat ormuscularity, preference of theradiologist involved, and any

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other conversion needed. Performerlooks up numerical conversion fac-tors and calculates, or uses con-version charts to ascertain the ap-propriate new exposure factor (kVp,mA and/or time). Multiplies,divides,adds, or subtracts as appropriate.

d. Performer checks any new or unfam-iliar exposure factors against theposted limits of the x-ray tube ona tube rating chart to be sure thattechnique does not exceed the heatcapacities of the tube for the focalspot size to be used. If appropri-ate, performer reconverts the tech-nique to an equivalent output usinghigher kVp and lower mAs.

10. Performer sets exposure factors as se-lected:


b. If appropriate, checks line voltagemeter and, if needed, turns com-pensator dial until needle is aligned properly on line meter.





d. For automatic phototimed exposurecontrol:

i) Performer selects and sets thecategory corresponding to thetype of study and use or non-

11.

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use of screens, bucky, etc.,and, if appropriate, focalspot size.



iv) Sets a density selector corres-ponding to the usual (or spec-ial) requirements for thestudy.

v) Makes sure backup timer is notlikely to terminate exposurebefore phototimed exposure ismade.

e. Depending on the equipment, mayset controls to provide for useof bucky, manual tableside adjust-ment of table and tube height,position, and of collimation.

f. Performer returns to overhead uniand sets the focal-film distance.Operates controls or manuallymoves the x-ray tube into placeover the film holder (or at rightangles to upright holder). Checksthe focal-film distance by read-ing indicator scale in the tubehousing; adjusts up or down untilthe required FFD (TFD) is obtain-ed.

Performer prepares patient for thefinal position selected for thefirst (or next) exposure. Makes surethat correct side is being positionedwhen appropriate.

a. May explain or demonstrate to pa-tient what is required. May ob-tain help in positioning or hasMD position in accident or acutecases.

b. Performer centers part and keepsthe long axis of the part par-

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allel to the film holder. When using high enough to include the dia-a bucky, centers patient to midline. phragm (estimates lccation fromWith cassette on table top, centers patient's body type, at thefilm to part. With upright holder level of the iliac zrests, andadjusts height of holder to part and

. inCudes the pelvIc area. Cen-centers part to film. ters the first of two cassettes

c. When positioning a patient with a (for tall patient) high enoughballoon catheter in place, performer to include i.he diaphragm; cen-makes sure that the clamp is not ters second cassette about twolying over a part to be exposed or inches above the upper borderthat patient is not lying on the of the symphysis pubis. May ap-clamp, ply compression band. Performer

directs central ray at right12. Performer positions as follows (unless angles to midpoint of film.

nonconventional positioning is being For erect AP projection performused to avoid having patient move): er positions as described above,

with patient standing or seateda. For studies of abdominal contents in front of upright cassette

(or KUB), performer notes the pur- holder,centered to midline,fac-pose of study and sequence of posi- ing away,and with weight dis-tions selected. For conventional ab- tributed equally. Supports thedominal series makes supine AP pro- shorter extremity if of unequaljection of abdomen, followed byerect AP or PA projection of abdo-

length. .4....,

ii) For erect PA projection (enter-men, or erect lateral projection of ior view) of abdomen, performerabdomen. For demonstration of air has patient stand facing erector fluid level, makes supine AP of vertical cassette holder orabdomen, followed by an erect orlateral decubitus view. For frontal

table, centered to the midline,and with weight equally dis-

AP projections of abdomen, perform- tributed. Has patient extender selects the supine AP and the arms along sides of holder anderect PA position unless otherwise grasp edges. Centers cassettespecified (such as with kidney ex- about one inch above the crestamination or acutely ill patient). of the ilium or as describedFor acutely ill patient performer above; includes the diaphragm.substitUtes semierect position for May apply compression band. Per-erect. former makes sure that patient4)4:For supine AP projection (poster- is maintained in erect position

ior view) of abdomen (or KUB),performer aligns patient in su-

long enough before exposure forair or fluid levels to be accu-

pine position, with the median rately demonstrated. Directssagittal plane of the body cen- central ray at right angles totered to the midline of th9,table. Supports knees and immo-

center of film.iii) For lateral decubitus position-

bilizes ankles. Adjusts should- ing (for frontal or lateral pro-ers so that they lie in a single jections),performer notes whichtransverse plane, with arms at side of the patient's body issides. Centers a single cassette to be next to film holder and

.....

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has patient lie on that side in a patient (depending on the sidelateral recumbent position. Has pa of interest). Directs centraltient flex knees comfortably, and ray horizontally to the mid-centers abdomen to midline. Places point of the film,regardless ofsupports under and between knees the angulation of the table. Al-and ankles. Has patient flex el- lows time for air or fluid levelbows, place lower hand under head,and has patient grasp side of

to be properly demonstrated asdescribed above.

table with opposite hand. For b. For studies of the liver and.

fluid level study, elevates the spleen, performer does not usetorso. compression.For lateral projection, performer i) For AP projection (posteriorcenters cassette in bucky or on view) of liver and spleen,per-table under patient. For frontal former positions patient inprojection, performer centers cas- supine position as describedsette in upright holder in front in(a),above. Has patient flexof patient (for PA projection) or elbows and abduct arms. Cen-behind patient (for AP projection) ters a single cassette so thatCenters film at the level of the about one inch of the iliaciliac crests or as described above bones are included on lowerin (i). border of film. If patient isFor lateral projection directs cen- too tall for a single casset-tral ray vertically at right ante, centers first cassette togles to midpoint of film. For fron. .include the diaphragm and sec-tal projection directs central ray ond to include the iliachorizontally at right angles to crests. Directs central ray atthe midpoint of film through the right angles through the xiph-median line of body. For air or oid process.fluid levels allows patient to ii) For oblique AP projection ofmaintain position long enough be- spleen, performer starts withfore exposure for air or fluid patient in supine positionlevels to be accurately demon- and elevates right side ofstrated. body about 400 to 450 so that

spleen is nearest to film.For acutely ill patients who can- Supports elevated shouldernot assume erect or lateral decu- and hip,with arms comfortablybitus position, performer adjusts placed and shoulders lying inpatient in semierect position by a single transverse plane.starting with supine position as Centers film at or just belowin (i), above. Attaches footrest the level of the xiphoid pro-to end of table and secures pa- cess. Directs central ray attient. May use cmpression bands. right angles to midpoint ofWith patient on table, performer film.moves it to almost vertical posi- iii) For PA projection (anteriortion. For AP semierect projection,centers as above with cassette in

view) of liver, performernotes whether a preliminary

bucky;for lateral projection, cen- film or a diagnostic examina-ters cassette in vertical film tion is involved. Has patientholder on right or left side of assume a prone position with

W)


List Elements Full

the median sagittal plane of bodycentered to midline,and elbowsflexed comfortably. Adjusts shoulders to lie on a single transverseplane. Supports ankles. Performercenters cassette to the centralray. Reminds patient(if diagnosticstudy)that two exposures will berade.

For preliminary or general surveyexamination, directs central rayat right angles through the xi-phoid process. For diagnostic ex-amination directs central raythrough the xiphoid process at 25°caudad for first exposure, and at10° cephalad for the second expo-sure.

c. If, during positioning, patient showssigns of severe pain, performer maynotify appropriate physician at onceand await orders, or may decide onalternative positioning to avoid movement of the affected part.

d. Performer checks final positioning byusing light in collimator. Activatesthe collimator light and points thelight beam towards the part. Adjuststhe collimator opening to correspondto the film size. Uses cross-hairshadows as reference for center offield. Uses the collimator light tocenter the patient to the x-rayfield, or centers the part to thefilm holder and uses the collimatorlight to center the tube to the part.Checks that primary beam will enterthe center of the area of interest atthe selected angle to the film so asto project the view desired. Nay re-adjust tube position lengthwise orcrosswise to provide better centering

Task Code No. 363


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13. Once the patient has been positionedand immobilized, performer adjusts thecollimator. Either collimates so thata small unexposed border will appeararound the edge of the film or colli-mates further so as to expose only the

area of interest (and thus providemaximum protection and detail). Forsmall fields performer attaches anauxiliary extension cone to colli-mator to further reduce the primarybeam. Adjusts primary beam to minimumsize needed to cover the part(s) ofinterest.

14. Performer adds lead shielding toareas that will be in the primarypath of the beam but are not includedin the areas of interest. Makes surethat proper protective shielding hasbeen provided to patient and everyonewho will remain in room.

15. Throughout procedure performer ob-serves patient for any signs of emer-gency and/or to prevent or respond toan accident. Is alert to signs of nau-sea, dizziness, or sweat suggestingfaintness. Performer may have patientlie down, lower head, or raise legs.Notifies nurse. If patient shows anyother emergency signs, loses con-sciousness, or has an accident, per-former calls appropriate physician orstaff member at once. May decide toprovide emergency first aid as well.If a patient's catheter becomes dis-connected, performer clamps it and immediately notifies nurse. If cathetershould come out, notifies nurse atonce.

16 When everything is ready for the exposure, performer explains to patientwhat breath control will be used forexposure. Rehearses breathing outwhen told to do so by performer andholding breath until told to relax.If appropriate, instructs patient notto swallow before and during the ex-amination. Reminds patient aboutthose exposures in which position isto be retained for a second exposure.Observes the patient's movement untilthe moment that the exposure is made.Readjusts position if warranted.

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Task Code No. 363


List Elements Full List Elements Full17. The performer returns to control room.

Makes sure controls are properly setand patient is still in position. Tellspatient when to breathe out and holdstill by calling or using intercom.Performer may wait one or two secondsafter suspension of respiration. Ini-tiates exposure by pressing hand trig-ger or exposure control button,

a. While exposure is underway perform-er checks that mA meter records ap-propriate current as set, that kVpmeter dips slightly,

b. May watch for evidence of malfunc-tion such as line surge or exces-sive drop; may listen for sound ofnormal functioning of equipment.If there is malfunction may decideto report; anticipates need to re-peat exposure.

c. With phototimer notes whether back-up timer has been involved in termi-nating exposure before phototimedexposure'wab completed. If so, anti-cipates possible need to repeat ex-posure (due to underexposure if pre-mature cut-off, or overexposure dueto faulty timer).


e. If the exposure is terminated bya circuit breaker, rechecks tech-nical factors for possible overloador checks for overload elsewhere oncircuit. Anticipates need to repeatexposure.

18. Performer returns to patient. Removescassette or film holder from table,holder, or bucky.

a. Removes any markers for furtheruse. If so requested, performer ar-ranges to have the first exposure(s)processed at once and brought tothe appropriate radiologist.

b. If the first radiograph(s) are pre-liminary (scout) films, performer

,

.

brings the processed radiograph( )directly to the.radiologist incharge or places on view boxes andinforms radiologist' that the scout(s) are ready. If the radiologistindicates that there is any prob-lem with the technical factors orthe patient positioning, performerrecords or notes for later use inthe examination and/or repeats pre-liminary radiography as ordered.

c. Depending on whether radiologistwill evaluate radiographs beforecompletion of all possible expo-sures for the series, performerarranges to process film(s) andevaluate for quality control per-sonally, have this done, or bringto darkroom for processing andlater evaluation, based on timeavailable, institutional arrange-ments, or specific instructions.Attaches IL card for use withflasher if appropriate. May signrequisition.

d. While films are being processedand/or evaluated performer has pa-tient relax in examination room orholding area,' Explains what willhappen next.i) Performer determines whether pa-

tient should remain on tableand/or in room or requires ob-servation. May consult requisi-tion sheet or attending RN. Ifappropriate, makes sure that pa-tient will be attended whilewaiting.


iii) May decide to assist patient to

chair or stretcher or from ta-ble. Makes sure patient is re-minded of any footrest in step-ping off table.

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Task Code No. 363


.


19.

iv) If patient is to switch to erectposition or lateral decubitusposition for fluid or air levelstudy, has patient take and main-tain that position for the re-quired amount of time prior tonext exposure.

When (or if) performer learns from theradiologist the extent of the injuryand/or whether further conventionalviews and/or positions can be under-taken, eliminated or altered, perform-er proceeds as appropriate according toinstructions.

a. For further exposures performer re-peats appropriate steps for nextview(s) including identification offilm holder or cassette and use ofR-L marker,selection and setting oftechniqv for next view (if differ-ent),positioning patient and equip-ment for focus-object-film align-ment, proper collimation and shield-ing, breathing instructions, andmaking exposure, as described above,


c. If performer is asked to repeat anyexposures, makes sure that the ad-ditional exposures are warrantedmedicallY, since additional radia-tion will be incurred.i) Notes whether need to repeat is


ii) If request for retakes reflectsmalfunctioning equipment, per-former reports malfunction toappropriate staff member.

iii) If request for retakes reflectsthe preference for density orcontrast of a radiologist, per-former notes for future work

done for the given radiologistso that retakes can be avoided.

20. When performer is sure that the exam-ination has been completed, performermay have patient transported back toholding area or next location, or de-cides to do personally, as appropri-ate. Makes sure that none of theequipment is projecting over the pa-tient before allowing patient to risefrom stool or table, and assists pa-tient as described above.

21. Performer carries out terminationsteps for the examinat!on:

a. If appropriate,arranges to havefresh colostomy and/or dressingapplied (if removed for radiog-raphy).

b. Performer has equipment and exami-nazion table cleaned after use ordecides to do personally, dependingon institutional arrangements.

c. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken,the technical factors used and filmsizes; may record the number of :x-posures made of each view includingretakes; may enter the estimatedradiation dose to which patient wasexposed (using posted informationon dosage); may record any problemwith equipment, any special careprovided patient. If any views cal-led for in the initial requestcould not be obtained,performer mayrecord reasons. Signs requisitionsheet.

d. If perlormer will only carry outpreliminary "scout" filming andanother technologist will continuewith examination,performer recordsthe approved technical factors usedfor the scout, and the accessories

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List Elements Fullx....... List Element* Full

employed, or informs technologistwho will continue. Performer givesthe requisition sheet, name card,and any notes to technologist whowill continue with procedure.

e. Performer may decide to jacketfilms, requisition sheets, and re-lated materials and/or have infor-mation recorded in log book per-sonally or have this done, depend-ing on institutional procedures.

f. Nay indicate to appropriate staffperson when the performer is readyto proceed with next examination.

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Task Code No. 364

This is page 1 of us for this task.

. What is the output of this task? (Be sure List Elements Fullthis is broad enough to be repeatable.)Requisition reviewed;patient reassured,positioned;parts measured;films identified;technical factorsselected and set;instructions given for breathing,phonation,maneuver,swallowing;exposures made;radio-graphs sent for processing and evaluation;proceduresrepeated as appropriate for full set of views;pa-tient returned;examination recorded;radiographsplaced for use.

Performer receives or obtains thx-ray requisition form,patient'sidentification card, and any ap-propriate medical-technical his-tory for a non-infant patient

scheduled for radiography of theanterior portion of the neck(pharynx, larynx, upper end ofesophagus):


D. From co-worker.c. After having arranged requi-


The plain films of the enter-ior portion of the neck mayserve as preliminary "scout"films for contrast studies ofthe upper portions of therespiratory or digestive sys-tems, and other structures ofthe anterior neck. Requisitionmay require use of barium sul-,fate contrast medium.

1. Performer reads the requisi-tion sheet to determine the

examination called for, thepatient involved, specialconsiderations, and to checkthe completeness of the in-formation provided:


.

Pt.'s x-ray requisition sheet,ID card,ID bracelet,technical history;pen;x-ray machine control pan-el(s),tube,bucky,table,collimator,extension cones;technique chart;charts for conversion of technique,views for standard examinations,dosage,tube capacityloaded cassettes;upright film holder;leaded rubbershielding;R-L and ID markers;immobilization and sup-port devices;compression band;head clamp;calipers;stool;barium sulfate cream;water in cup;ribbon;stretcher or wheelchair;barium-soaked pledget

3. Is there a recipient, respondent or co-workerinvolve.: ill the task? Yes...CK) No...( )

4. If "Yes" to q. .: Name the kin. o recipient,respondent or co-worker involved, with de-scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions,

Non-infant patient to be radiographed;radiologictechnologist; radiologist; nurse

. Name the task so that the answers to ques- a. Performer checks the ex-aminations called for in-cluding the affected parts,the purpose of the study,the positions and viewscalled for, any maneuversor phonation called for,the location of any tumormasses to be studied, thenature of any foreign ob-ject to be localized, the

OK-RP;RR;RR


Taking radiographs of anterior portion of the neckof non-infant patient by reviewing request;reporting

observed contraindications;reassuring pt.;measuringpart;selecting and setting technical factors;identi-fying film;positioning pt. and equipment for erector recumbent exposure;providing shielding;collimat-ing;instructing pt. in breathing,phonating,maneuver,or swallowing;making exposures;having radiographsprocessed and reviewed;repeating for full set ofviews or as ordered;having pt. returned;placing ra-diographs for use;recordinF examination. 6. Check here if this

is aztsterst.....


Task Code No. 364



number of exposures,and the parts to graphic exposures involved shouldbe included in the projections. Notes be reported to radiologist.whether the use of a grid or bucky g. Depending on institutional proce-will be involved. Checks the name of dures, performer notes whetherthe referring physician,

b. Performer reads patient's name,iden-female patient is pregnant, re-views date of female patient's

tification number, sex, age, weight,Notes whether patient is in-

last menstrual period, or notesany other indication that there

patient, out-patient, or emergency is no danger of exposure of apatient. Notes.. ,ny special informa- known or possible fetus.tion that wil.:. affect patient posi- h. If patient's record indicates or-tioning, technique, or handling of ders for sedation or any otherthe patient, whethe,.. patient will be prior medication,performer mayin a stretcher or wheelchair, and any check timing to be sure a propernotation on the nature of any known elapse of time has occurred forpathology which would affect techni- medication to take effect. Mayclue. Notes type of shielding needed. arrange to delay examination ifIf foreign body search is ordered,makes sure that the foreign body is

appropriate.i. If referring physician has re-

known to be radiopaque. quested that films already onc. Performer checks whether patie:t is file be sent with current radio-

suffering from a collateral ro-Li- graphs, and if not already withtion requiring speci_l handling such patient's jacketed material, per-as heart disease, communicable or informer arranges to have priorfectious condition, infirmity, inco-herence, whether patient has IV drip

films delivered.

or similar device in place; notes 2. If the performer determineR that thewhether patient will be accompaniedby nurse or other staff person.

request is not properly au0,orized,is incomplete, or that sufficient

d. If performer is not already assigned information is lacking for perform-to examination room (and a particular er to select technique or to prop-machine) notes the room or machineinvolved. Goes to examination room

erly position or care for patient,or if performer considers that there

or control room for machine involved. may be contraindications to goinge. Performer makes sure that the request ' ad with the procedure, performer

is properly authorized, that infor- notifies supervisor, radiologist,ormation on requisition sheet is com-plete. Checks whether any special or-

other designated staff person, de-pending on institutIonal proce-

ders on exposure factors are in keep- dures. Explains the problem if ap-ing with the usual rad exposure in- propriate, and proceeds after ob-volved for the examination,

f. Depending on institutional proce-dures, performer may review patient s

taining needed information, signa-ture, or orders .

radiation-exposure history, prior 3. When performer iF clear about whatrecord of techniques used, anii cumu- will be involved in examination, helative exposure. Notices whether ex- or she prepares ahead so as not toamination has been done elsewhere in keep patient in examination roomrecent past, whether number of radio longer than necessary:

1

2 1 5


Task Code No. 364


List Elements Full

a. Performer reviews the.techniquechart for the machine to be used;takes note of any newly postedchanges in technical factors (to reflect accommodation for change inmachine output or a policy deci-sion).


c. Performer makes sure that x-rayequipment is ready for use. Goes tocontrol panel for x-ray generatorand checks that indicator lightshows that machine is "warmed up,"or turns on main switch as appro-priate to equipment and allows timefor machine to "warm up." f appro-priate, performer may set radio-graphy mode selector and set colli-mator control for manual operatlon.

d. Checks that appropriate immobiliza-tion devices such as sandbags,wedgesponges, head clamp are present andthat there is a mattress,pads, pil-lows, and/or blankets for comfortof patient. Checks that emergencycart is present,that there is lead-ed rubber shielding available.

e. If a foreign body search has beenordered, arranges to have wateravailable for swallowing maneuver.

f. If a Valsalva or modified Valsalvamaneuver is ordered checks whetherthis nay be contraindicated by pa-tient's condition and proceeds onlywith MD approval if there is anydoubt.

g. If a deglutition study is ordered,checks that barium cream is readyfor use.

h. Performer prepares for identifica-tion of the films using equipmentprovided by institution:

i) May obtain lead numerals andtape and prepare identification

List Elements Full

strip for placement on filmholder(s) giving appropriatepatient identification inform.--tion.

ii) Performer may prepare for useof flashcard by checking thatthere is piece of lead on filmholder surface; may write ortype out ID information on cardif not received with requisi-tion.



Performer has the patient called fromthe holding area and prepared for theexamination (if not already done), ordecides to do personally.

a. Depending on institutional arran-gements,performer may decide toescort out-patient to or fromdressing room. May decide to as-si-,t in transporting patient fromholding area or have this done.

b. Performer greets patient and anyacco-4anying staff person and in-troduces self. Checks patient'sidentity against the requisitionsheet. With in-patient,checkshospital identification braceletor other identifier. If patient isaccompanied because of seriousnessof condition, performer checkswith aczompanving staff member onany special precautions necessaryduring procedure.

c. Has patient,assume a comfortableposition seated on table or chair.If patient is in wheelchair, movespatient in chair into positionnext to table. If patient is onspecial stretcher, places stretch-er into position so that radio-lucent stretcher can be liftedwith patient on it from wheeled

216

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This is page

base to x-ray table. May arrange tomove patient to table. With accidentpatient uses upright film holderwith patient remaining on stretcheruntil injury has been localized.


e. Performer answers patient's non-med-ical questions honestly; attempts toreassure patient and develop confi-dence. Treats patient with dignityand concern regardless of patient'sbehavior. Remains aware that patientmay be frightened and/or in pain.Performer explains when asked medi-cal questions that it is not appro-priate for technologl.:. to answerthese; encages patient to speakto physici3n,

f. If patient has an IV drip in place,performer checks that needle hasnot become dislodged and that thefluid is dripping at an even.rate.If there are any problems, perform-er clamps tube and notifies an ap-propriate staff person at once.

g. If appropriate and not already done,performer questions female patientof child bearing age regarding pos-sible pregnancy. If there is anypossibility that patient is preg-nant and this bas not already beenrecorded, performer informs appro-priate physician and proceeds onlywith approval.

Performer questions patient and/or RNor MD present on what movement is pos-sible to determine what positions areavailable for use. Considers whetherto have patient erect (seated or stand-ing) or recumbent, or considers ordersin the light of the patient's condi-tion.

2 7

Task Code No. 364


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a. Performer selects erect seated orstanding position unless otherwiseindicated, especially for tumormasses and foreign body search.Plans on lateral projection forforeign body search.

b. If a cardiac patient is involved,performer selects recumbent posi-tion unless otherwise indicated.

c. If the study involves examinationof tumor masses, performer locatesthe mass visually so as to be ableto position patient appropriately.

d. Performer considers the number andtypes of projections ordered forthe examination and the patient'scondition. Performer may considera change from standard projectionsto bettel a-complish the purpose ofthe exam!n,Lion, or deletion of aposition, or a change in technicalfactors. Depending on institutionalarrangements, perforver may obtainpermission from appropriate radio-logist,or decides personally toalter the standard procedure.

. Performer prepares for the exanina-tion:

a. If not already done, has patientremove clothing, hair pins, andany jewelry around neck. Makes surethat all garments except gown areremoved down to below the area ofinterest. If patient has a wetdressing, performer has it rein-forced or decides to do personally.

b. Depending on whether a bucky ortable top technique will be usedand standard institutional prac-tices, performer selects speed andtype of film, grid, and cassettecombination. Selects size(s) basedon the area(s) to be included andthe patient's size.

c. Performer makes sure that an ade-Jquate supply of loaded cassettes o..7


This is page

Task Code No. 364



17. Performer has patient assume a comforL-

able recumbent, standing, or seated po-sition, depending on the positions tobe employe.7, so that the part(s) to beradiographed can be measured. Makessure that wheelchair is in locked po-sition if patient is to be positionedin it.

the types and sizes selected areavailable in the examination room.If not, arranges to obtain or de-cides to obtain personally.

d. Performer obtains the appropriatesize loaded cassette for the firstprojection and attaches R or L mark-er and identification information tothe cassette or table top or usesautomatic marking device.

e. If cass-ette is to be used with bucky(under table top or in upright hold-er) performer may manually pull outbucky rray and open retaining clamps.Inserts cassetta into bucky tray andpushes back. Makes sure clamps areclosed. Moves cassette into appropriate "stored"...position or insertscassette tray into bucky slot andcenters.

f. If a bucky is not being used; per-former places cassette in a positionthat can be comfortably reached bythe patient in final positioning.If appropriate to make possible min-imal movement of patient, performermay place cassette in upright holderat right angles to table top or inother position selected.

g. Performer provides patient andeveryone who will remain in roomduring exposure with protectiveshielding. Explains if necessarythat this is not cause for alarm buta general precaution to minimize un-necessary radiation exposure.

a. If appropriate, places mattress,pillow, or clean.linen on x-raytable.

b. Performer may decide to ansist pa-tient from wheelchair or stretcherto, table or has this done. May ob-tain help. Makes sure that noequipment is in the way and may becollided with by patient. Lockschair.

c. If assisting patient to step onfootstool in order to get on table,helps patient turn into position,step backwards oh stool, and thensit and/or lie on table.

d. Performer uses centimeter calipersto measure the thickness of thepart(s) to be radiographed in thedirection in which the central rayof the x-ray beam will pass throughthe centered part from tube tofilm. Records for use in determin-ing exposure factors.

e. After measuring, has patient restin as relaxed a position as pos-sible. May place pad, blanket orpillow under bony prominences toprovide comfort.

. Performer selects the exposure fac-tors for the first projection by con-sulting the technique chart(s) postedfor the machine:

a. Locates the information needed forthe body part and projection in-vulved according to the centimeterthickness of the part as measuredand the collimated field size tobe used. Makes sure that techni-que relates to the combination offilm type and speed,and use ornonuse of other accessories forfilming (such as screens, grids,bucky, etc.).

b. Makes note of the kVp, mA, T(sec-onds of exposure time), focal spotsize, and the focal film distance(TFD or FFD) called for.

c. Once the standard kVp, mA and time.have been determined, performernotes whether any conversions are


List Elements Full

Task Code No. 364


necessary tu a(count for a patho-logical condition present, a changein TFD, extreme obesity, preferenceof the rc:liol.-Tist involved, and/orany other conversion needed. Per-former looks up numerical conversionfactors and calculates, or uses con-version charts to ascertain the ap-propriate new e;posure factor (kVp,mA and/or time). Multiplies,divides,adds, or subtracts as appropriate.



a. Enters control room. Makes sure thatindicator light shows that x-raygenerator is ready for use. Makessure that all C17=its have been

b. If appropriate, checks-line voltagemeter and, if needed, turns compen-sator dial until needle is alignedproperly on line meter.




iii) Performer sets the kVp selectedby choosing the combination ofmajor kilovoltage and minor kilo-voltage settings to produce thedesired kVp.


List Elements Full

i) Performer selects and sets thecategory corresponding to thetype of study and use or nonuseof screens, bucky, etc., and ifappropriate, focal spot size.



iv) Sets a density selector corres-ponding to the usual (or spe-cial) requirements for study.

v) Makes sure backup timer is notlikely to terminate exposurebefore phototimed exposure.

e. Depending on the equipment, may setcontrols to provide for use ofbucky, manual tableside adjustmentof table and tube height, position,and of collimation.

f. Performer returns to overhead unitand sets the focal-film distance.Operates controls or manually movesthe x-ray tube into place over thefilm holder (or at right angles toupright holder). Checks the focal-film distance by reading indicatorscale in the tube housing; adjustsup or down until the required FFD(TFD) is obtained.

10. Performer prepares for final position-ing for the first (or next) view:

a. Performer explains or demonstrateswhat is required to patient.i) For scout films, performer re-

hearses patient in quiet nasalbreathing; plans to make expo-sure just before the chestcomes to rest at the end of anexpansion, on inspiration.

ii) If phonatior has been ordered,performer demonstrates and

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Task Code No. 364


.e............m.i.m.w.

.List Elements Full List Elements Full

,

rehearses patient in phonatinga low pitched "a-a-h" and/ora high pitched, "e-e-e" sound,continuing until told to relax.

iii) If a Valsalva maneuver hasbeen ordered, performer demon-strates and rehearses patientin taking a deep breath, hold-ing breath in, and bearing downas though evacuating until toldto relax.

iv) If a modified Valsalva maneuverhas been ordered, performerdemonstrates and rehearses pa-tient in pinching nostrils to-gether with the thumb and fore-finger of one hand, closingmouth, and making a sustainedbut mild effort to blow noseuntil told to relax.

v) If an opaque foreign body searchha been ordered for upper endof esophagus or pharynx, per-former has :atient practice1

swallowing by holding a sip ofwater in mouth until instructedto swallow, and then swallowingthe water in one movement with-out swallowing again until told.

vi) For deglutition study,showsbarium cream that will be swal-lowed. If a mucosal study isto follow,has patient rehearseswallowing and then not swallow-ing again until performer setsup for,immediate exposure withmodified Valsalva maneuver,

vii) If swallowing is involved, plansto make exposure at peak ofthe forward movement of larynx.May tie a dark colored ribbonor similar ite around the pa-mtient's throat above the thy-roid cartilage and check itto note the elevation of theribbon at time of the exposure.

b. If patient must be positioned inrecumbent position on table becauseiof condition, may position withtable horizontal, then apply com-pression bands to support patient,put up footboard, and turn tilt-table to vertical position forfinal positioning and exposure.

c. If patient will be standing andlimbs are of unequal length, pro-vides support to shorter limb.

d. Performer centers part and keepsthe long axis of the part parallelto the film holder. When using abucky, centers patient to midline.With cassette on table top, cen-ters film to part. With uprightholder, adjusts height of holderto part and centers part to film.

11. Performer positions as follows (un-less using nonconventional positioninto avoid having patient move):

a. For AP projection (posterior view)of pharynx and larynx, performernotes whether study involves visi-.ble tumor masses in neck.

.i) Except for visible tumor mas-ses, performer has patientstand or be seated in erect po-sition with back to uprightcassette holder, or, if neces-sary, aligned in AP supine po-sition on table. Centers themedian sagittal plane of thebody to the midline of the filmholder or table. For erect pa-tient makes sure that weightis equally distributed on but-tocks or feet. Adjusts should-ers to lie on a single trans-verse plane. Centers head andneck to eliminate any rotationand extends head slightly toprevent shadow of mandible fromobscuring larynx. Immobilizeshead. Centers film to the levelof the laryngeal prominence orjust below. Directs central ray

2 z0


Task Code No. 364


List Elements Fully1

List Elements Fully

at right angles to the laryngealprom..:nence.

ii) For demonstration of visibletumor masses in the neck, per-former seats patient in AP posi-tion and centers film to the lev-el of the mass. Performer rotatesthe patient's body so that themass is tangent to the film (thatis, so that the mass is in con-tact or near contact at onepoint). Directs central ray hori-zontally to the inner border ofthe mass.

b. For projection

one inch below the level ofthe external auditory meatusesFor demonstration of the oro-pharynx, performer centersfilm at the level of the man-dibular angles. For demonstra-tion of the larynx, hypophar-ynx, and upper end of theesophagus, performer centersfilm at the level of the lar-yngeal prominence. Performerdirects the central ray atright angles to the midpointof the filth.

c. If, during positioning, patientshowi signs of severe pain, per-former may notify appropriatephysician at once and await or-ders, or may decide on alterna-tive positioning to avoid move-ment of part.

d. Reviews with patient the breath-ing, phonation, maneuver,or swal-lowing required for the exposure.

e. For opaque foreign object search,has patient take a sip of waterand hold in mouth until told toswallow. 1

f. For deglutition study has patienttake a bolus of barium cream inmouth and hold until told toswallow. Has patient refrainfrom swallowing again until newcassette is set up for next ex-posure, and then has patient per-form modified Valsalva maneuver.

12. The performer checks final position-ing by using light in collimator.Activates the collimator light andpoints the light beam towards thepart. Adjusts the collimator openingto correspond to the film size. Usescrosshair shadows as reference for

larynx,or upper end of esophagus,performer reviews the area to bedemonstrated and the purpose of thestudy:

i) Performer positions patient seat-ed or standing in erect lateralposition before upright cassetteholder with indicated side adja-cent to film. (May position pa-tient in supine position as aboveand use horizontal x-ray beamacross table,or may use supineAP position and move table into

. upright position for actual ex-posure.)

Adjusts erect patient so that thecoronal plane passing through oranterior to the temporomandibularjoints is centered to the midlineof the film holder. Has patientrest adjacent shoulder againstholder. Adjusts body in erectposition so that median sagittalplane is parallel with plane offilm. Depresses shoulders as muchas possible and adjusts them tolie in a single transverse plane.Extends patient's head slightly,Immobilizes head or has patientvisually fix on an object directly in line with forward visualaxis.

ii) For demonstration of the naso-pharynx, performer centers film

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Task Code No. 364


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center of field. Uses the collimatorlight to center the patient to thex-ray field, or centers the part tothe film holder and uses the collimrtorlight to center the tube to the part.Checks that primary beam will enterthe center.of the area of interest atthe selected angle to the film so asto project the view desired. May re-adjust tube position lengthwise orcross-wise to provide better centering.

13. Once the patient has been positionedand immobilized, performer adjusts thecollimator. Either collimates so thata small unexposed border will appeararound the edge of the film, or colli-mates further so as to expose only thearea of interest (and thus provide max-imum protection and detail). For smallfields performer attaches an auxiliaryextension cone to collimator to furtherreduce the primary beam. Adjusts pri-mary beam to minimum size needed tocover the part(s) of interest.

14. Performer adds lead shielding to areasthat will be in the primary path ofthe beam but are not included in theareas of interest. Makes sure thatproper protective shielding has beenprovided to patient and everyone whowill remain in room.

15. Throughout procedure performer ob-serves patient for any signs of emer-gency and/or to prevent or respond toan accident. Is alert to signs of nau-sea, dizziness, or sweat suggestingfaintness. Performer may have patientlie down, lower head, or raise legs.Notifies nurse. If patient shows anyother emergency signs, loses consci-ousness, or has an accident, performercalls appropriate physician or nurseat once. May decide to provide emer-gency first aid as well. If a patient'catheter becomes disconnected, performer clamps it and immediately notifies

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nurse. If catheter should come out,notifies appropriate staff member atonce.

16. When everything is ready for the ex-posure, performer reminds patient ofbreathing, phonation, maneuver, orswallowing instructions and of needto maintain it until patient istold to relax by performer. Observesthe patient's movement until themoment that the exposure is made. Re-adjusts position if warranted.

1 . The performer returns to controlroom. Makes sure controls are prop-erly set and patient is still in po-sition. Tells patient when to breathequietly, phonate vowel sound, per-form Valsalva or modified Valsalvamaneuver,or swallow water,or bolus ofcontrast in one movement as rehearsed,by calling or using intercom. Perform-er initiates exposure by pressinghand trigger or exposure controlbutton.

a. While exposure is underway, per-former checks that mA meter re-cords appropriate current as set,that kVp meter dips slightly.

b. May watch for evidence of malfunc-tion such as line surge or exces-sive drop; may listen for soundof normal functioning of equip-ment. If there is malfunction maydecide to report; anticipates needto repeat exposure.

c. With phototimer notes whetherbackup timer has been involved interminating exposure before photo-timed exposure was completed. Ifso, anticipates possible need torepeat exposure (due to underex-posure if premature cut-off, oroverexposure due to faulty timer).

d. After exposure is completed tellspatient that he or she can relaxor reminds patient not to swallowuntil next exposure.


Task Code No. 364


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18. Returns to patient. Removes cassetteor film holder from film stand, table,or bucky. Removes any markers forfurther use. Sets up for next exposureat once if ...ppropriate and repeatssteps.

a. If so requested, performer arrangesto have the first exposure processedat once and brought to the appropri-ate radiologist.

b. If the first radiograph(s) are pre-liminary (scout) films, performerbrings the processed radiograph(s)directly to the radiologist incharge or places on view boxes andinforms radiologist that the scout(s) are ready. If the radiologistindicates that there is any problemwith the technical factors or thepatient positioning, performer re-cords or notes for later use in theexamination and/or repeats prelimi-nary radiography as ordered.

c. Depending on whether radiologistwill evaluate radiographs beforecompletion of all possible expo-sures for the series, performer ar-ranges to process film(s) and eval-uate for quality control personally,have this done, or bring to darkroom for processing and later eval-uation, based on time available, in-stitutional arrangements, or speci-fic instructions. Attaches ID cardfor use with flasher if appropriate,May sign requisition.

d. While films are being processedand/or evaluated, performer has pa-tient relax in examination room orholding area. Explains what willhappen next.

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i) Performer determines whether patient should remain on tableand/or in room until physicianarrives, and whether patientrequires observation. If appro-priate, arranges to have pa-tient attended while waiting.

ii) If patient is to leave tableor rise, performer makes sureall equipment is moved awayfrom patient such as overheadtube and upright film holder.

iii) May decide to assist patient tochair or stretcher or fromchair or table. Makes sure toremind patient of any footrestwhen stepping off table.

19. When (or if) performer learns fromthe radiologist whether further con-ventional views and/or positions canbe undertaken, eliminated, or alter-ed, performer proceeds as appropri-ate according to instructions.

a. For further exposures performerrepeats appropriate steps for nextview(s) including identificationof film holder and use of R-Lmarker, selection and setting oftechnique for next view (if dif-ferent), positioning patient andequipment for focus-object-filmalignment, proper collimation andshielding, instructions forbreathing, phonation, maneuvering,or swallowing, and making expo-sure, as described above.


c. If performer is asked to repeatany exposures, makes sure esat theadditional exposures are warranted

I

medicall-, since additional radia-tion will be incurred.

i) Notes whether need to repeat isdue to performer's own negli-

tio


Task Code No. 364


List Elements Fu11 7

gence or lack of fzttention sothat performer can avoid futureretakes."


iii) If request for retakes reflectsthe preference for density. orcontrast of a radiologist,'per-former notes for future workdone.for the given radiologistso that retakes can be avoided.

20. When performer is sure that the exami-nation has been completed, performermay have patient transported back toholding area or next location, or de-cides to do personally, as appropriate.Makes sure that none of the equipmentis projecting over the patient beforeallowing patient to rise.


a. Performer has equipment and examination table cleaned after use or de-cides to do personally, dependingon institutional arrangements.

b. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken,the technical factors used, andfilm sizes. Performer limy recordthe number of exposures made ofeach view including retakes; mayenter the estimated radiation doseto which patient was exposed (usingposted information on dosage); mayrecord any problem with equipment,any special care provided patient.If any views called for in theinitial request could not be ob-tained, performer may record rea-sons. Signs requisition sheet.

c. If performer will only carry outpreliminary "scout" filming And

List Elements Fula._

another technologist will con-tinue with examination, performerrecords the approved technicalfactors used for the scouts andthe accessories employed, or in-forms technologist who will con-tinue. Performer gives the req-uisition sheet, name card, andany notes to technologist whowill continue with procedure.

d. Performer may decide to jacketfilms, requisition sheets, andrelated materials and/or haveinformation recorded in log bookpersonally or have this done, de-pending on institutional proce-dures.

e. May indicate to appropriate staffperson when the performer isready to proceed with next ex-amination.

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Task Code No. 365



Requisition reviewed;pt. reassured,positioned;partsmeasured;films identified;technical factors selectedand set;technique for magnification,bilateral film-ing,stereography set up;localization equipment andcentering marks applied;exposures made;radiographssent for processingand evaluation;procedures repeated as appropriate for full set of views;patient re-turned;examination recorded;radiographs placed foruse.

Performer receives or obtains thx-ray requisition form,patient'sidentification card, and any ap-propriate medical-technical his-tory for a non-infant patientscheduled for radiography of thcskull (cranium and/or facialbones, excluding paranasal sinus-es):




The plain films of the skull mayserve as preliminary "scout"films for contrast studies ofthe brain and other organs lo-cated in the skull; the plainfilms may be part of a bone-sur-vey.

1. Performer reads the requisi-tion sheet to determine theexamination called for, pur-pose, the patient involved,special considerations, andto check the completeness ofthe information provided:

a. Performer checks the ex-aminations called for, in-cluding the parts involved


Pt.'s x-ray requisition sheet,ID card,ID bracelet,technical history;pen;x-ray machine control panel(s)tube,bucky,table,collimator,extension cones;techni-que chart;charts for conversion of technique,stand-ard examination views,dosage,tube capacity;loadedcassettes;occlusal film packets;upright film holder;leaded rubber shielding;R-L and ID markers;immobili-zation devices;precision localizer devices;face resthead clamp;weighted band;.tape;chair;calipers;protrac

tor;triangles;stool;scissors;cork;wax marking pen;cassette tunnel;stretcher or wheelchair

. 3. Is there .1% recipient, reapondent or co-workerinvolved in the task? Yes...(x) No...( )

4. A -Yes" to q. 3: Name the kind of recipient,respondent or co-worker involved, with de-



.........5. Name the task so that the answers to ques- and the affected areas,

whether bilateral or uni-lateral views are request-ed, the patient positionsand views called for, thenumber of exposures, thecentral beam angulation,the areas of interest andparts to be included. Notewhether there will be bi-lateral views on a single

OK-RPRRRR

tions 1-4 are reflected. Underline essen-tial.words.

Taking plain f:am radiographs of the skull and/orface of non-infant patient by reviewing request;re-porting observed contraindications;reassuring pt.;measuring part;setting up for magnification techni-que,bilateral exposures,stereography as ordered;se-lecting and setting technical factors;identifyingfilm;applying localization marks and/or devices;posi-tioning pt. and equipment for seated or recumbent .2):posure;providing shielding;collimating;making expo-sure;having radiographs processed and reviewed;re-peating for full set of views or as ordered;havingpt. returned;placing radiographs for use;recordingexamination. 6. Check here i this

is a master sheet..


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Task Code No. 365



film, whether the use of a grid orbucky will be involved. Notes anyrequest for magnification. Checksthe name of the referring physician.

machine involved. Goes to examine-tion room or control room for ma-chine involved. Checks that propershock-proof equipment is avail-

b. Performer reads patient's name,iden- able in.room for use in direct con-1

tification number, sex, age, and tact with patient's head.weight. Notes whether patient is in- g. If magnification has been request-patient, out-patient, accident or ed, performer checks that the ma-

emergency patient. Notes any special chine to be used has a fractionalinformation that will affect patient focal spot of appropriate size for

positioning, technique, or handling direct magnification technique

of the patient, such as presence of (i.e.,0.3 mm.or smaller).

accident injuries, unhealed or sus- h. Performer makes sure that the re-pected fracture, degenerating dis- quest is properly authorized, that

ease, whether patient will be on a information on requisition sheet

stretcher or wheelchair, the nature is complete. Checks whether any

of any known pathology which would special orders on exposure factors

affect technique, and the purpose are in keeping with the usual rad

of the study.I

exposure involved for the examina-

c. With patients with accident injuriesi tion.

or unhealed fractures, performer mayl i. Depending on institutiona- proce-

make sure that a surgeon or radiolo dures, performer may review pa-

gist is available to position the tient's radiation exposure his-

patient;checks whether rotation and tory, prior record of techniques

extension of head is contraindicat- used, and cumulative exposure.ed. Notices whether examination has

d. Performer checks whether patient is been done elsewhere in recent

suffering from a collateral condi- past, whether number of radio-

tion requiring special handling,such as heart disease, communica-

graphic exposures ordered or donein past should be reported to ra-

ble or infectious condition, infir- diologist.

mity, incoherence; whether patient j. Depending on institutional proce-

has IV drip, oxygen supply, urinary dures, performer notes whether fe-

catheter or similar device in male patient is pregnant, reviews

place; notes whether patient will date of female patient's last men-

be accompanied by nurse or other strual period, or notes any other

staff person. i dication that there is no danger

e. With patients who are to undergo of exposure of a known or possible

subsequent contrast studies, pe .fetus. Notes shielding needed.

former may note whether orders for k. If patient's record indicates or-

prior preparation have been given ders for sedation or any other

and carried out; if not already prior medication, performer may

done, may arrange to have orders check timing to be sure a proper

carried out,or informs appropriate elapse of time has occurred for

staff member. medication to take effect. May ar-

f. If performer is not already assign- range to delay examination if ap-

ed to examination room (and a par- propriate.

ticular machine) notes the room or 1. If referring physician has requested that films already on file be

-----

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Task Code No. 365



sent with current radiographs, andif not already with patient's jack-eted material, performer arrangesto have prior films del'ered.

. If the performer determines that therequest is not properly authorized, Isincomplete, or that sufficient info-:ma-tion is lacking for performer to Lclecttechnique or to properly position orcare for patient, or if performer con-siders that there may be contraindica-tions to going ahead with the proce-dure, performer notifies supervisor,radiologist, or other designated staffperson, depending on institutionalprocedures. Explains the problem if ap-pronriate, and proceeds after obtainingneeded information, signature, or or-ders.

. When performer.is clear about what willbe involved in examination, he or sheprepares ahead so as not to keep pa-tient in examination room longer thannecessary:

a. Performer reviews the techniquechart for the machine to be usedand takes note of any newly postedchanges in technical factors (to refleet accommodation for change inmachine output or a policy deci-sion).

b. Performer washes hands as appropri-are; depending on patient's condi-tion, may decide to arrange for orcarry out isolation or.decontamina-tion techniques.

c. Performer may set up equipment asappropriate for stereographic pro-jections if ordered.

d. Performer makes sure that x-rayequipment is ready for use. Goes tocontrol panel for x-ray generatorand checks that indicator lightshows that machine is "warmed up,"or turns on main switch as appro-

4.

priate to equipment and allowstime for machine t , "warm up." If

appropriate, performer may set ra-diography mode selector and setcyllimator control for manualoperation.

e. Performer checks that appropriateimmobilization devices such assandbags, angle blocks, tape,weighted band, Granger face restare present and that there ic amattress, pads, pillows, and/orblankets for comiort of patient ifpatient will lie on table. If ap-propriate, obtains protractor,cardboard triangles, cassette tun-nels, localizer devices.

f. Checks that there is leaded rubbershielding available in room to beused to protect the patient, and/or to place beneath the film hold-er, as appropriate.

g. Performer prepares for identifica-tion of the films using equipmentprovided by institution:

i) May obtain lead numerals andtape and prepare identificationstrip for placement on filmholder(s) giving appropriatepatient identification informa-tion.

ii) Performer may prepare for useof flashcard by checking thatthere is piece of lead on filmholder surface, may write ortype out ID information on cardif not received with requisi-tion.



If magnification has been requested,performer prepares the equipment for

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Task Code No. 365


the tube-over-table method of magnifi-cation (used without bucky):

a. Performer determines the degree ofmagnification requested on the re-quisition sheet; if the request isexpressed as an area magnificationperformer determines the linearmagnification by taking the squareroot. (Linear magnification squaredequals area magnification.)

b. Performer calculates the requireddistances from target (focal spot)to ob-!ect (patient) (TOD), and fromobject to film (OFD), as well as thedistance from target to film (TFD)(the sum of TOD and OFD):

i) If the distance from the tabletop to a cassette placed on thefloor or a stool (OFD) will be arelatively inflexible distance,performer measures this distanceor reads indicator scale. (Ifstool is to be used, may note thetable height.) Performer may ad-just table height to provide fora round number for the OFD.


iii) Depending on whether the OFD orthe TOD is fixed, performer cal-culates the required complemen-tary distance by referring to amagnification chart for the de-gree of linear magnification re-quired, or uses the formula: de-gree of linear magnificationequals TFD divided by TOD. For atwo-times linear magnificationperformer simply sets the TODequal to the OFD.

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iv) Performer adjusts and locks thetable height and/or the tubeheight to the calculated OFDand TOD.

c. Performer aligns the object-filmand target-object distances:

i) Performer moves the x-ray tubehousing until it is centeredover the table top in the ap-proximate area where the pa-tient's area of interest willbe positioned, such as on table.

ii) Performer swings the table outof the way so that there is noobstruction between the tube andthe floor. (Does not changeheight.) If appropriate, placesa stool on the floor under thetube. May place cassette of ap-propriate size on floor orstool. Performer selects thesize film designated for thedegree of magnification and theselected part to be studied.


iv) Performer activates the lightin the collimator aLi adjuststhe tube horizontally so thatthe light beam cast is centeredto the cassette on the stool orfloor. Uses the cross-hairs projected by the beam to center thtube to the area on the flooror stool.

v) Performer locks the tube intoposition so that there is a 900angle of the beam with the flooror stool. Fixes and retains collimator setting.

vi) Performer marks the outline ofthe collimated light area orcassette on the floor or stoolusing tape or other removablemarker. If not already done,

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Task Code No. 365


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checks by placing cassette in a. Depending on institutional arrange-marked area. May mark center of ments, performer may decide to es-area as shown by cross-hairs.cort out-patient to or from dress-vii) Performer swings table back into ing room. May decide to assist inplace. Activates light beam intransporting patient from holdingcollimator and marks the table area or have this done.

top where the center cross-hairs b. Performer greets patient and anyand light outline are projected accompanying staff person and in-(to be used to center the parttroduces self. Checks patient'sto be radiogra?hed). Uses tape identity against the requisitionor other radiolucent removable sheet. With in-patient, checksmarker.

,

viii) Performer may recheck TOD and OFDhospital identification braceletor other identifier. If patient isto be sure that they correspond accompanied because of seriousnessto he calculated distances. of condition, performer checks withaccompanying staff member on anyd. For magnification technique using a special precautions necessary dur-vertical film holder, performer may ing procedure.wait until patient has been brought c. Has patient assume a comfortableinto examination room. Adjusts up- position seated on table or chair.right holder to appropriate height; If patient is in wheelchair, movesadjusts x-ray tube to right-angle patient in chair into position nextprojection of beam to film holder; to table. If patient is on specialcenters to the film; measures and stretcher, places stretcher intoadjusts TOD to patient's position position so that radiolucentand marks patient's position; mea- stretcher can be lifted with pa-sures and adjusts OFD from patient'stient on it from wheeled base toposition as marked.x-ray table. May arrange to move

i

e. If the sum of the new TOD and OFD(TFD) is now different from the TFD

patient to table. With accident pa-tient uses upright film holder withused for non-magnification techni- patient remaining on stretcherque, performer may consult techni- until injury has been localized.que chart to note the factor to use d. Performer explains to patient whatfor a compensatory change in mAs. will be involved in the procedure;May record for later use in settingindicates what types of positionsexposure factors.the patient will be asked to assumef. Performer may also note the changeand the cooperation that will bein kVp and mAs necessary to compen- asked of the patient.

sate for any change in collimation e. Performer answers patient's non-from non-magnification technique. medical questions honestly; at-Consults appropriate charts for con- tempts to reassure patient and de-version factors. May record.velop confidence. Treats patientwith dignity and concern regardless. Performer has the patient called from of patient's behavior. Remainsthe holding area and prepared for the aware that patient may be frighten-examination (if not already done), or ed and/or in pain. Performer ex-decides to do personally.plains when asked medical questions

2 9


Task Code No. 365



that it is not appropriate for tech-nologist to answer these; encouragespatient t-o speak to physician,

f. If patient has an IV drip in place,performer checks that needle hasnot become dislodged and that thefluid is dripping at an even rate.If there are any problems, performerclamps tube and notifies an appro-priate staff person at once.

g. If there is a wet dressing, perform-er has it reinforced or decides todo personally.

h. If appropriate and not already done,- performer questions female patient

of child bearing age regarding pos-sible pregnancy. If there is anypossibility that patient is pregnantand this has not already been re-corded, performer informs appropri-ate physician and proceeds only withapproval.

i. If not already done, has patient re-move dentures, hair pins, specta-cles, and any jewelry from head andneck. Makes sure that all garmentsare removee down to below the neck,

6. Performer questions patient and/or RNor MD present on what movement is pos-sible to determine what positions areavailable for use.

a. Performer notes whether patient canbe examined in the standard bodypositions called for with the skullprojections ordei.2.d; if not, plansto substitute alternative body po-sitions to achieve the same skullprojections.

b. If patient is an accident victimand arrives on stretcher or bed,performer plans for radiographicpositioning of film and x-ray tubewith patient on stretcher and with-out rotating head or torso. If anymanipulatioo,of patient's head isrequired,-peiformer has physiciancarry this out.

7.

c. Performer notes whether patientcan assume erect seated positionsfor projections where this is anoption. Chooses erect seated posi-tion where possible except for pa-tient with cardiac condition or ifotherwise specified.

d. If requisition involves possibleuse of dental occlusal film pack-ets such as for projections ofnasal bones,maxillae and/or mandi-ble, performer determines whetherpatient will be able to hold filmpacket in mouth or support with

. hands as appropriate. If not,plansto use nonscreen film or cassettesas appropriate. If occlusal filmis to be used, chooses seated po-sition if headrest is available onchair and erect position is notcontraindicated.

e. Observes whether patient is obeseor has a short neck requiring spe-cial positioning or use of angleblock under film. Notes whetherthin patient will need paddingunder bony prominences.

f. Performer considers the number andtypes of projections ordered for ,

the examination and the patient's .

condition. Performer may considera change from standard projectionsto better accomplish the purposeof the examination, or deletion ofa position, or a change in techni-cal factors. Depending on insti-tutional arrangements, performermay obtain permission from appro-priate radiologist or decides per-'sonally to alter the standard pro-.cedure.

Depending on whether a bucky ortable top technique will be used andstandard institutional practices,per-former selects speed and type offilm, grid, and cassette combination.

240'


Task Code No. 365


........wwList Elementsv211117 Iimm.....

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a. Selects size(s) based on the area(s) pletely except for the half to beto be included, the patient's skull exposed, Treats the half to be ex-size, and whether bilateral views posed from this point as though itare to be exposed on a single film. were the actual film size.

b. For magnification technique, per- d. If bilateral views are to be pro-former selects the size film desig- jected on a single film for a ste-nated for the degree of magnifica- reoscopic examination,performertion and the selected area to be numbers or marks cassettes so thatstudied,

c. Performer makes sure Lhat an ade-the order of their placement andexposure will be correct.

quate supply of loaded cassettes . If requisition calls for a facialand/or occlusal film packets of the profile study of bony and soft tistypes and sizes selected are avail- sue contours, performer preparesable in the examination room. If cassette for lateral view. Thennot, arranges to obtain or decides prcpares a second film of the sameto obtain personally. size encased in a seamless black-

paper envelope or has this done.8. Performer prepares for the examination: Places loaded envelope on top of

cassette and secures. Plans to ex-a. Performer obtains the appropriate pose both films simultaneously us-

size loaded cassette or packet for ing exposure factors for lateralthe first projection. facial bone technique.

b. May mark midpoiut of eaf-.11 cassette f. Performer attaches identificationto be used for separate bilateral i information to the cassette, oc-views. Uses radiolucent marker. clusal film packet or tabie top:

i) For half axial oblique projectio i) Places right or left marker onof auditory ossicles and attic= I film holder or table-top as ap-auditus-antrum areas, marks cas- propriate to the study and pro-settes or vertical film holder1.5 inches above the midpoint.

jection or depresses appropri-ate R or L button for automatic

ii) For parieto-orbital projectionof the optic foramen, superior

/

marking.ii) If patient's identification in-

orbital fissures and anterior formation is in the form ofclinoid processes where bilat- lead numerals, performer placeseral vi':ws are to be exposed on appropriate corner of cas-separately, marks each half of sette or occlusal film packet.cassette 1.5 inches lateral to iii) If patient identification in-the midpoint of the respective formation is to be entered byhalf. use of flasher, sets flashcard

aside for later use with spacec. If bilateral exposures will be made created by piece of leaded rub-

separately on one filM, performer ber on appropriate edge of cas-mentally decides how these will be sette.

positioned so that the film need iv) Performer may place patient'snot be turned for viewing each card into card tray for equip-image. Performer uses leaded rubber ment using automatic filmsheets and masks the cassette com- marking device.

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Task Code No. 365


If cassette is to be used withbucky (under tabletop or in uprightholder) performer may manually pullout bucky tray and open retainingclamps. Inserts cassette into buckytray and pushes back. Makes sureclamps are closed. Moves cassetteinto appropriate "stored" positionor inserts cassette tray into buckyslot and cennrs.

h. If a bucky is not being used, per-former places cassette in a posi-tion approximating final position-ing.

i) If magnification technique is tobe used, perfcrmer places cas-sette in marked positIon on flooror stool.

ii) If appropriate to make possibleminimal movement of patient, per-former may place cassette in up-right holder at right angles totable top or in other positionselected.

iii) With accident patient, after lo-calization has been established,performer may obtain assistancein lifting skull so that cassettecan be placed under patient.

i. Performer provides patiert andeveryone who %ill remain in roomduring exposure with protectiveshielding. Explains if necessarythat this is not cause for alarmbut a general precaution to mini-mize unnecessary radiation exposure.

Performer has,patient assume a comfort-able recumbent or seated position, de-pending on the positions to be employ-ed, so that the relevant skull dimen-sions can be measured. Makes sure thatwheelchair is in locked position if pa-tient is to be positioned in it.

List Element tally


b. Performer may decide to assist pa-tient from wheelchair or stretcherto table or has this done. May ob-tain help. Makes sure that noequipment is in the way and may becollided with by patient.


d. With suspected fractures or acci-dent patient, may have surgeon orradiologist position the patient.

e. Performer uses centimeter calipersto measure the thickness of thepert(s) to be radiographed in the i

direction in which the central ray rof the x-ray beam will pass throughthe centered part from tube tofilm. Records for use in determin-ing exposure factors.

f. After measuring, has patient restin as relaxed a position as pos-sible. May place pad, blanket orpillow under bony prominences toprovide comfort.


a. Locates the information needed forthe body part and projection in-volved according to the centimeter0-ickness of the part as measuredand the collimated field size tobe used. Makes sure that techniquerelates to the combination of filmtype and speed and use or nonuseof other accessories (such asscreens, grids, bucky, etc.).

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Task Code No. 365



b. Makes note of the kVp, mA, T(secondsof exposure time), focal spot size,and the .al film distance (TFD orFFD) called for.

c. Once the standard kVp, mA and timehave been determined, performernotes whether any conversions arenecessary to account for a patho-logical condition, change in TFD,extreme fat, preference of the ra-diologist involved, and any otherconversion needed such as with mag-nification technique. Performerlooks up numerical conversion fac-tors and calculates, or uses conver-sion charts to ascertain the appro-priate new exposure factor (kVp,mA and/or time). Multiplies, di-vides, adds, or subtracts as appro-priate.



a. Enters control room. Makes sure thatindicator light shows that x-raygenerator is ready for use. Makessure that all circuits have beenstabilized.

b. If appropriate, checks line voltagemeter and, if needed, turns compen-sator dial until needle is alignedproperly on line meter.

c. For conventional exposure control:

i) Performer sets milliamperage bychoosing selectors for the cor-rect focal spot size; sets themA selected.




i) Performer selects and sets thecategory corresponding to thetype of study and use or nonuseof screens,. bucky, etc., and,if appropriate, focal spot size.

ii) Selects and sets a control cor- 0responding to the field size(as listed on technique chartfor phototiming).



v) Makes sure backup timer is notlikely to terminate exposure be-fore phototimed exposure ismade.

e. Depending on the equipment, may '.ietcontrols to provide for use ofbucky, manual tableside adjustmentof table and tube height,position,and of collimation (unless thesehave already been set as with mag-nification technique or stereo film-ing).

f. Performer returns to overhead unitand sets the focal-film distance(if not already done, as with magni-fication technique). Operates con-trols or manually moves the x-raytube into place over the film hold-er (or at right angles to uprightholder). Checks the focal-film dis-


Task Code No. 365


List Elements

tance by reading indicator scale inthe tube housing; adjusts up or downuntil the required FFD (TFD) is ob-taiaed.

12. Performer prepares the part to be ra-diographed in the position selectedfor the first (or next) exposure (un-less this is done by physician):

a. May explain or demonstrate to pa-tient what is required. May obtainhelp in positioning or has MD posi-tion in accident and fracture cases.

b. If studies of the mastoid processeshalf-axial projections of the

auditory ossicles and attic-aditus-antrum area are requested, performermarks centering points on patient'shead (as described below) and thentapes the auricles of each ear for-ward with a narrow strip of adhesivtape. Makes sure that tape does notextend beyond the posterior junc-tion of the auricle and the head.

c. Performer positions patient byfirst positioning body and then po-sitioning head. In positioning body,performer proceeds as follow3:

i) For positJoning patient in AP orPA supine or erect position, performer arranges body so that itsmedian sagittal plane is center-ed to the midline of table orfilm holder.

For lateral positioning has me-dian sagittal plane paralleluith midline. Supports any ele-vated parts. Has seated patientsdistribute weight evenly on bothbuttocks.

ii) Has semiprone patient rest onforearm and flexed knee of ele-vated side,and supports anklesand flexed knee.Has prone patient flex elbows,

place arms in a comfortable po-sition. Supports ankles. Restspatient's head on forehead andnose. May have patient resthands beneath chest.Has erect patient face filmholder for PA projection andface away from film holder forAP projection.

Has supine patient place armsin a comfortable position andsupports ankles and knees.For oblique erect position ad-justs body to make possiblecorrect angulation of the head.Places arms in comfortable position.

iii) For thin patient in recumbentlateral, PA and oblique posi-tioning, performer may elevatechest so that the cervical ver-tebrae are at a correct level.

iv) For obese patient performeruses a portable cassette holderif possible in the vertical orhorizontal position to obtain acorrect part-film distance without unprescribed magnification.Adjusts tube position as appro-priate. If not able to achievecorrect part-film distance,per-former adjusts focal-film dis-tance to compensate as describ-ed above in magnification tech-nique. Performer positionsobese patients in seated erectposition when possible.

v) With all positions arrangesshoulders to lie on a singletransverse plane.

d. In positioning head, performer re-fers to standard reference lines.May use wax marker to draw in ref-erence lines or points on skullor visualizes mentally. In posi-tioning head, has patient first relax muscled of neck and then moveshead gently.


Task Code No. 365

11 44This is page of for this task.

List Elements Fu/lyList Elements Full

i) Performer marks or defines theorbitomeatal line for reference

film to part. With upright holder,adjusts height of holder to part

by finding the line connecting and centers part to film. May ob-the external auditory meatus andthe outer canthus of the pa-tient's eye.

tain help in positioning.

i) In setting tube angulation per-. ii) Performer marks or defines the former measures the angles be-, infraorbitomeatal line by finding tween the central ray and ref-

the line connecting the external erence lines on the patient'sauditory meatus and the infra-orbital margin. May palpate to

skull, such as the orbitomeatal,infraorbitomeatal, interpupil-

find infraorbital margin. lary lines. Checks skull rota-iii) Performer marks or defines the tion by measuring the angle be-

acanthiomeatal line, by finding tween the horizontal plane orthe line connecting the external the vertical central ray andauditory meatus and the acan- the median sagittal line.thion. ii) In centering and directing the

iv) Performer defines the median central ray for stereoscopicsagittal plane of the skull by examination, performer centersreferring to the sagittal line

and adjusts the central ray atconnecting nasion, acanthion and the angle as for a single planesymphysis menti (mental point). study.

v) Performer defines the interpupil- For first exposure moves center-lary line by referring to the ing point the correct distancetransverse line which connects in the appropriate directionthe pupils of the eyes when the (such as lateralward or poster-patient is looking straight ior); then increases or de-ahead, with the nasion at its creases the angle as appropri-midpoint.

vi) Performer defines the glabello-ate. For the second exposure,removes the first cassette and

alveolar line as that connectingreplaces with a second cassette

the most prominent point in theand, starting from single plane

midsagittal plane between theangulation, shifts centering ineyebrows and the most prominentthe opposite direction and forpoint in the midsagittal planethe same distance; changes theof the upper alveolus.angulation in the opposite di-

e. Performer immobilizes skull with a rection (increases or decreas-head clamp or a weighted band and es). For bilateral studies on arechecks angulation and position, single cassette, has the firstUses extension cone in direct con- cassette include both sidestact with head when appropriate for shifted in the same directionimmobilization as well as for prop- and the second cassette includeer collimation,

f. Performer centers parr and keepsboth sides shifted in the oppo-site direction, so that each

the long axis of the part parallel cassette has bilateral viewsto the film holder. When using a with a common shift direction;bucky, centers patient to midline, makes a total of four exposuresWith cassette on table top, centers for each study.

2 3


Task Code No. 365



13. Performer positions as follows (unless Centers cassette at the levelnonconventional positioning is being of the sella turcica (3/4 inchused to avoid having patient move): above and 3/4 inch anterior to

the external auditory meatuses).a. For studies of the cranium,cranial For supine patients who cannot

base, sella turcica and superior be moved, centers as above,butorbital fissures, performer notes with reference to a cassettewhether lateral-oblique and axio- placed vertically. Directs cen-lateral projections are to be uni- tral ray to the sella turcicalateral or bilateral, whether tan- at right angles to film and/orgential views are involved, whether parallel to the interpupillarystereographic views are requested. line.Reviews areas of interest and re- For stereographic views takesquired angulation. first exposure with tube shift-For bone survey, performer makes a ed two inches below centeringlateral projection of the skull. point and second exposure withFor accident victims performer makes tube two inches above centeringleft and right laterals_of the skull point. Reminds patient to re-and an AP projection of the base of tain same position for bothskull with patient on stretcher,with minimum movement of patient.

stereo exposures.For bilateral study performerhas patient reverse position

i) For a lateral projection of the after first exposure,and setscranium, and/or sella turcica,performer has patient assume a

up equipment for opposite-sidelateral view. For a "spot" film

semiprone or prone position as of the sella turcica, performerdescribed, unless a seated erect uses extension cone to limitlateral position is selected for the field to the area of inter-obese patient,or a supine posi- est.tion is required for accident ii) For a PA projection (anteriorpatient. Except for patients who view) of the cranium, sellacannot be moved, performer has turcica, and/or superior orbit-patient turn the side of the al fissures, performer has pa-skull to be examined to the film tient assume a prone or erectholder and adjusts body as ap- seated PA position as describ-propriate so that the region of ed, resting head on foreheadthe sella turcica (coronal plane and chin. For superior orbitalpassing 3/4 inch anterior to fissures has patient rest headexternal auditory meatus) is cen on forehead and nose. For supe-tered to the midline of table or rior and lateral portions offilm holder. Has the median sag- the frontal bone, has patientittal plane of the head par- rest head on chin. If patientallel with the plane of the cannot be moved to a prone po-film. Checks that the interpupil sition, elevates supine patientlary line is at right angles to on one side so that head is inthe plane of the film using a lateral position with shoulderright angled object or protrac- and hip supported,and uses antor. Supports underside of jaw. upright cassette holder.

,...--,...


Task Code No. 365

13 44This is page of for this task.

List Elements Full

Adjusts head so that the mediansagittal plane is centered tomidline and at right angles toplane of film. Adjusts orbito-meatal line so that it is atright angles to the plane of thefilm. Supports chin. For generalstudy centers film to the mid-point of the interpupillary line(nasion). To include vertex,shifts cassette cranially about 3inches. For sella turcica,centersfilm to the glabella. For superi-or orbital fissures, centers filmat the level of the inferior mar-gin of the orbits. For superiorand lateral portions of the fron-tal bone, sellar region and/orpetrous pyramids, centers film tocentral ray.

Performer directs central raydepending on the area of inter-est. Refers to angulation betweencentral ray and the orbitomeatalline rather than external perpen-dicular line. For a generalstudy, directs the central rayto the midpoint of film or so asto exit at the nasion at 15°caudad. For study of frontal bonedirects central ray at right an-gles to nasion (parallel to orbi-tomeatal line). For study of thesuperior and lateral portions ofthe frontal bone, directs centraray to enter near coronal sutureand exit through supraorbital.ridges. For study of superiororbital fissures, directs cen-tral ray through mid-orbits at20° to 25° caudad. For study ofsellar structures, directs cen-tral ray 1.5 inches above nasionat the cranial angle prescribedor directs central ray at theglabella at 10° cephalad.

Performer may use the Grangerface rest for PA projection of

AMMINUMWMAIMMINIIMEMMI, 111111111.21111M

List Elements Fully

sella turcica for seated orprone patient. If so, placescassette and face rest in posi-tion on angle block, centeredto the median saggital plane ofthe body and close in to chest.Secures against slipping. Haspatient place face on the restwith nose in opening providedand with head resting on fore-head and alveolar process ofthe upper jaw. Checks thatglabella and upper alveolus arein firm contact with face rest.Directs central ray throughlower occiput to glabella at10° cephalad.

iii) For an AP projection (posteriorview) of the cranium, performerhas patient assume a supine orerect seated AP position as de-scribed, unless patient'sstructural difficulties make atrue supine position difficult.If so, elevates recumbent pa-tient so as to place head in alateral position with elevatedparts supported,and uses an up-right cassette holder.Adjusts patient's head with chinOdepressed so that its mediansagittal plane is at right ah-gles to midline of film and theorbitomeatal line is at rightangles to the plane of the film.For a study of the entire occi-pitobasal region, centers nearthe level of the foramer magnumwith upper margin of film atthe level of the highest pointof the cranial vertex. For lo-calized projection of the dor-sum sellae and petrous pyramids,centers film to central ray atabout the level of the occlusalplane. For study of the posterior portion of the cranial vault,centers film to the nasium.

2 .-17


Task Code No. 365


Performer directs the central rayas ordered, depending on the areaof interest. Refers to angulationbetween central ray and the orbi-tomeatal line. For a generalstudy directs the central raythrough the foramen magnum at 300caudad. For a study of the entireforamen magnum and jugular for-amina,directs central ray asabove at 400 to 600 caudad, de-pending on the flexion of thehead. For study of the posteriorportion of the cranial vault,di-rects central ray at right an-gles to the nasium (or parallelto orbitomeatal line).

iv) To localize lesions of the cal-varium or scalp, performer ad-justs patient's head so that theouter cranial table of the areaof interest touches the centerof the film (i.e, is tangent tocenter). Directs central ray tright angles to center of film.

v) For a submentovertical (under-side of chin to highest point attop of cranium) projection of thefull cranial base (AP), perform-er has patient assume a seatederect AP position if possible ora supine position with an up-right bucky that can be tilted.Adjusts body in AP position asdescribed. For seated erect pa-tient performer places a low-back chair far enough away fromthe cassette holder to allow asemi-upright position with pa-tient leaning back and restingthe vertex of the skull againstthe film holder. For supine pa-tient, elevates torso so thathead can be extended completelywith head resting on the vertex.Flexes patient's knees. Perform-er supports head after adjustingcentral ray angulation and repo-

sitions only when ready to makeexposure so as to keep strainon neck to a minimum.Adjusts head so that mediansagittal plane is at right an-gles to film and so that theinfraorbitomeatal line isclosely parallel to the planeof the film. Adjusts the cen-tral ray so that it is atright angles to the infraor-bitomeatal line, centered tothe sella turcica (coronal planpassing 3/4 inch anterior toexternal auditory meatuses).Centers film to central ray.Directs cisntral ray to enterthe median sagittal plane ofthe throat between the anglesof the mandible and the sellaturcica. May immobilize headwith tape placed on the chinand anchored to the sides ofthe table or film holder.

vi) For a verticosubmental (top ofcranium to underside of chin)projection of the full cranialbase (PAN.), performer has patientassume a prone PA position asdescribed. Has patient extendchin fully and rest head on thetip of chin,with median sagittalplane at right angles to film.Centers film to central ray. Di-rects central ray at right an-gles to the infraorbitomeatalline,directed to the sellaturcica.

vii) For an axiolateral projectionof the cranial base, performerhas patient assume a semiproneor erect seatel position asdescribed. Has patient turn theside of the skull to be ex-amined to the film holder in atrue lateral alignment,with themedian sagittal plane of thehead parallel with the film.

lASK DESCRIPTION SHEET (continued)

Task Code No. 365


:,enters so that the externalauditory.meatus is at the midlineof the table,and extends head sothat the infraorbitomeatal lineis parallel with the transverseaxis of the film. Checks that theinterpupillary line is at rightangles to film. Supports under-side of jaw. Centers film to cen-tral ray. Directs central ray toa point on the midline one inchdistal to the lower externalauditory meatus at an angle 27°to 35° caudad. For a bilateralstudy performer has patient re-verse position after the firstexposure and sets up equipmentfor opposite side axiolateralprojection similarly.

viii) For a semiaxial AP projection ofthe sella region and the petrouspyramids, performer notes thearea of interest and angulationrequired. Has patient assume su-pine position as described. Forpatient who is short necked, per-former may elevate cassette onan angle block directed caudally.If so, deducts the angulation ofthe block from the prescribedcentral ray angulation. Adjuststhe median sagittal plane of thehead to the midline of the cas-sette,with head flexed so thatthe infraorbitomeatal line is atright angles to the plane of thefilm. Centers film to the mediansagittal plane at the level ofthe occlusal line. Directs thecentral ray to a point directlybelow the occlusal line. Forstudy of the dorsum and tuber-culum sellae and anterior clinoidprocesses,angles central ray at300 caudad. For dorsum sellae andposterior clinoid processes an-gles central ray at 37° caudad.

ix) For a semiaxial PA projection ofthe sella turcica (dorsum sellae

larsonceise4

and posterior clinoid proces-ses), performer has patient as-sume prone position as describ-ed. Centers the median sagittalplane of the head to the mid-line of the film holder, rest-ing on forehead and nose. Ad-justs flexion of head so thatthe orbitomeatal line is atright angles to plane of film.Supports chin. Centers film ata point about 1.5 inches abovethe nasion. Directs central rayto enter at a point 1.5 inchesbelow the inion (external oc-cipital protruberence) at anangle 25° cephalad, to exitabout 1.5 inch above thenasion.

x) For an occipito-frontal (PA)projection of the cranium, sellaturcica and ear, performer notesthe areas of interest so as tochoose correct reference linefor positioning patient and centering central ray and film. Haspatient assume prone or erectseated PA position as described.With prone position elevatesthorax. Performer has patientrest head on the upper frontalregion so that the median sagit-tal plane is at right angles tofilm. Performer uses triangleor protractor to adjust flexionof head. For demonstration ofdorsum sellae and/or internalauditory canals and labyrinthsof the ears, performer adjustshead so that infraorbitomeatalline forms an angle of 50 de-grees to the plane of the film.For demonstration of the exter-nal auditory canals, cympaniccavities and bony part ofeustachian tubes, performer ad-justs head so that orbitomeatalline forms an angle of 50 de-grees to the ylane of the film.

2 A .

IMIERMA=111.17.15, ..1111M1111112IMINIMIMIIIMN,


Task Code No. 365


List Elements FullI..

List Elements Full

Performer centers film based onthe area of interest. Centersfilm at the level of the externalauditory canals for demonstrationof sella turcica; one inch aboveIfor inclusion of the vertex. Forprojection of dorsum sellae, cen-ters to a point .5 cm. distal tothe nasion. For projection of thepetrosae, centers to the foramrmmagnum. Directs central ray atright angles to the midpoint offilm as centered,

b. For studies of the optic foramen,

i:..)

If using the Pfeiffer or similaroptic canal localization device,performer positions device nearto and parallel with the sideedge of the table for erect pa-tient or end of table for pronepatient with support in the apexof the "V." Has patient placehead in the apparatus wif-h chinresting on support in tta apexof the "V." Adjusts head JO thatmedian sagittal plane of theskull is vertical. Adjusts headwith eyes open so that outercanthi overlie marks on the de-vice and so that orbitomeatallines form a 300 angle withvertical lines on the cassettetunnel surfaces of the device.Supports head with foreheadrest. Directs central ray onfirst side at 37° towards itsrespective cassette tunnel (atright angles to the plane ofthe tunnel) ,centered to crossmark on tunnel. Centers unmaskedportion of cassette in tunnel.After making first exposure haspatient retain position whileperformer removes cassette andplaces cassette for exposure ofothcr side in other tunnel. Di-rects central ray similarly onother side. Perforner makesstereo exposures for one sideusing two _assettes masked forbilateral study as described.For first exposure shifts 1.25inches cranially; for second exposure (of same side, on secondcassette) shifts 1.25 inchescaudally. Shifts similarly forthird and fourth exposures ofthe opposite side.For an orbitoparietal projec-tion (cross section view) ofthe optic foramen, performerplans for bilateral views on a

sphenoid strut, orbital fissures,and anterior clinoid process, per-former reviews purpose of examina-tion, whether bilateral views areordered, special localizing equip-ment needed,and marks cassette forcentering if appropriate. ,

i) For a parieto-orbital -projection

(cross section view) of the op-tic foramen, performer plans forbilateral views on a single film.Has patient assume a PA position,erect or prone,as described. Sup-ports feet of recumbent patient.Has patient rest head on thezygoma, nose and chin of the sidesof interest. Adjusts flexion sothat the acanthiomeatal line isat right angles to the plane ofthe film and the rotation so thatJthe median sagittal plane of thehead is at a 530 angle with theplane of the film. Centers theorbit on the side of interest tothe midpoint of the unmaskedhalf of the film. Directs thecentral ray at right angles tothe midpoint of the film. Afterfirst exposure, performer has patient reverse position of headand sets up similarly for expo-sure of opposite side.

24U


Task Code No. 365


...


single film. Has patient assume a unmasked half of the film. Di-supine position as described. If

rects the central ray to theperforz.c.,. will work without an

midpoint of the film at 7° cau-angle block, performer rotatesdad, passing through the centerthe head to the side of interest of the orbit. Alter first ex-so that the median sagittal planeposure, performer has patientof the head is at a 500 angle withreverse position of head andthe plane of the film. Adjusts ex- sets up similarly for exposuretension so that the acanthiomeatalof opposite side.line is at right angles to the

.iv) For an orbitoparietal projec-

plane of the film. If performerwill work with an angle block,ele-

tion of the sp'senoid strut,

performer has patient assume avates shoulders and adjusts a 15°supine position as described inangle block under the head so that(ii), above. Rotates head tothe angle is directed cranially.the side of interest and ad-Adjusts head so that the medianjusts flexion so that the in-shgittal plane is at a 40° anglefraorbitomeatal line is at

with the plane of the film and the right angles to the plane ofacanthiomeatal line is at right

the film and the median sagit-angles to plane of film. Performer tal plane is at 19° toward thecenters unmasked half of the film

film on the side of interest.to the uppermost orbit. Directs

Centers film to the uppermostthe central ray at right angles to orbit and directs the centralthe midpoint of the film, entering ray to the midpoint of the filmat the lower outer margin of the

at 7° cephalad, passing throughuppermost orbit. Aftcr first ex- the center of thP orbit.posure, performer has patient re-

v) For a PA projection (anteriorverse position of head and sets

view) of the inferior orbitalup similarly for exposure of op- fissures, performer has patientposite side,

iii) For a parieto7orbital projectionassume prone position as de-scribed,with head resting onof the sphenoid strut, performerforehead and nose. Adjusts head

may plan for bilateral views on so that its median sagittala single film. Has patient as- plane is centered and at rightsume a PA position, erect or

angles to the midline of theprone, as described in (i), above,

film holder. Adjusts flexion soHas patient rest head on the su- that the infraorbitomeatal lineperciliary arch and the side of

is at right angles to the planethe nose of the side of interest,

of the film. May elevate fore-'Adjusts extension so that the in-

head to achieve this. Centersfraorbitomeatal line is at right

film to the central ray. Directsangles to the plane of the film,and rotation so that the median

central ray to the nasion at20° to 25° cephalad.

sagittal plane is at 200 towards vi) For a parieto-orbital projectionthe film on the side of interest.

(at ecceucrir angle) of the op-Centers the orbit on the side of

tic fotamen, supec.lor orbitalinterest to the midpoint of the

fissures and anterior clinoidprocesses, performer reviews

241

TASK DESCRIPTION SHEET (continue4)

Task Code No. 365


List Elements Full

area of interest. Prepares cas-sette for bilateral views n asingle cassette (if not alreadydone) by marking each side asdescribed. Performer has patientassume a prone position as de-scribed,with head resting onforehead and nose. Adjusts headso that median sagittal plane isat right angles to film holderand orbitomeatal line is at rightangles to the plane of the film;may elevate forehead to achievethis. For each exposure, centersthe unmasked half of the cassetteso that the adjacent orbit onthat side coincides with the markon that side of the cassette. Forstudy of the optic foramen and/oranterior clinoid process,directscentral ray to the midpoint ofthe unmasked half of the film,sat

,v

an eccentric angle 200 caudad andlaterally at 20°. For study ofthe superior orbital fissure ane/or anterior clinoid process,di-rects central ray to the midpointof the unmasked half of the filmat an eccentric angle 300 caudadand laterally at 20°. Instructspatient to retain position afterfirst exposure; centers secondhalf of film to the oppositeside and directs central ray asabove, on opposite side.

c. For studies of the mastoid proces-ses of the temporal bones, perform-er notes whether bilateral, stereo-graphic and/or tangential studiesare requested. Reviews areas of in-terest, whether special localizingdevices are needed, and marks pa-tient and cassettes for centeringas appropriate. Notes whether part-angulation or central ray angula-tion methods are requested.

List Elements Fully

If request is for bilateral stereoexposures,performer makes posteriorshift for exposures one and threeon the same cassette, showing thetwo sides; makes the anterior shiftfor exposures two and four, on thesecond cassette, also representingthe two sides. Increases centralray angulation by 3° for posteriorshifts and decreases by 3° for theanterior shifts.

For centering mastoid processesperformer marks a point on eitherside of head. For lateral viewsmarks a point one inch directlybackward from the center of eachexternal auditory meatus. For tan-gential projections marks a pointone inch above the palpable tip ofeach mastoid process. For semiaxialateral projections marks a pointat the junction of the auricle andthe head immediately behind eachexternal auditory Meatus. Usesmarking pen or wax pencil. If notalready done, tapes each auricleforward as describ, d.

i) For lateral projection of mas-toid process, performer noteswhether part angulation or cen-tral ray angulation method is tbe used or a special localiza-tion device. Has patient assumePA position, prone or seated,as described,resting head onthe side of interest.

For part-angulation or central. ray angulation method centers

the localization mark on headto the center of the, unmaskedportion of the film holder. Forpart-angulation method has pa-tient rest head on the flat surface of the cheek. Adjusts head

2 4 z


Task Code No. 365


List Elements Full

so that median sagittal plane isat a 15° forward angle and at 15°caudad. Directs central ray atright angles to the midpo!mt ofthe unmasked area of film.

For central ray angulation method,adjusts head in lateral positionso that infraorbitomeatal line isparallel with transverse axis offilm, median sagittal plane isparallrl with plane of film, andinterpupillary line is at rightangles to plane of film. For re-cumbent patient raises and propsopposite shoulder and.supportsunderside of jaw. Directs centralray to midpoint at an angle 15°caudad and 15° towards the face.In both methods central ray en-ters about 2 inches posterior to,and 2 inches above the uppermostexternal auditory meatus. Afterfirst exposure has patient turnto opposite side; centers otherhalf of cassette and sets upsimilarly for opposite side.

If using Granger mastoid localiz-er, performer adjusts Engle blockto an angle 15° caudad and 15°towards the face. Places :loadrest

and cassette in positicv ahd im-mobilizes block. Has pationt resthead in lateral position oh sideof interest through opening,whilein prone or seated position. Ad-justs head so that its mediansagittal plane is parallel withplane of film, with glabella andupper alveolus in firm contactwith inner surface of localizerplate, Adjusts height of crossbarso t-o-t side of nose restsagainst it. Directs central rayat rig angles to midpoint offilm a8 aescribed above. Forsecond exsure reverses the

List Elements Full

transverse inclination of blockand position of headrest. Forstereoscopic projections di-rects central ray 3' anteriorlyfor posterior tube saift and 30posteriorly for anterior tubeshift.

If using the Bullitt mastoid de-vice, has patient assume supineposition with occiput lying onheadrest between the verticalplates of the device. Adjustsbody and III .drest so that the

two localization marks on headare centered to the intersec-tion of the crosslines of theinserts. Adjusts head so thatmedian sagittal plane and in-fraorbitomeatal lines are atright angles to plane of film.Immobilizes head with uprightplates. (Tube angulation isautomatic.) Uses cassette hold-ers adjacent to right mastoidfor exposures one and two inappropriate positions for singleplane or stereo views, and hold-er adjacent to left mastoid forexposures three and four,so thatthe posterior tube shift pro-jection of each mastoid is madeon a single cassette, and,forstereoscopic views, the anteriortube shift projection of eachmastoid is made on a second cas-sette. Maintains patient in sameposition for all four exposures.

ii) For posterior tangential projec-tion (anterior tangential view)of mastoid process, performerhas patient assume prone (PA)position for part-angulation orseated PA position for centralray angulation method. For pronepatient places cassette on a 150block angled cranially,and ad-justs and immobilizes under pa-


Task Code N 365



tient's head. For erect, seated 550 with the plane of the filmpatient,positions cassette invertical film bolder.

(with head rotated away from th,side of interest to achieve an-

Has prone patient rest head on gle) and with infraorbitomeatalcheek of side Of interest and line at right angles to planecenters localization point to of film. For supine patient di-center of unmasked half of film. rects central ray at right an-Adjusts head so that infraor- gles to midpoint of unmaskedbitomeatal line is at right an- half of film. For seated patiengles to plane of film and so that directs central ray at 15° cau-median sagittal plane forms an dad. For either supine or seat-angle of 550 with the plane ed patient directs centre] rayof film. Directs central ray at so as to enter the anteriorright angles to midpoint of un- border of the mastoid processmasked half of film. at the junction of the auricleFor seated patient centers and -,, of the ear and head. Proceedspositions head as above, but di- similarly with exposure of otherects central ray 15° cepha- side.lad. For either prone or seated iv) For semi-axial lateral projec-pat!ent directs central ray to tions of the mastoid and pet-enter the posterior border of the rous regions,performer reviewsmastoid process at the junction orders on area of interest orof the auricle of the ear and the central ray angulation. Posi-head.After first exposure has pa- tions patient in prone PA posi-tient reverse head position for tion with shoulder oppositeview of other side, and sets vp side of interest raised andsimilarly. propped, or seated in PA posi-

iii) For anterior tangential projection before vertical cassettetion (posterior tangential view ) holder as described. Adjustsof mastoid process, performer patient's head in lateral posi-has patient assume supine AP po-sition for part-angulation,orseated AP position for central

tion on side of interest, cen-tered to localization point,with point 314 inch above mid-

ray angulation method (with cas- ppint of unmasked half of film.sette vertical). For supine pa- Adjusts head so that mediantient places cassette on a 15° sagittal plane is parallel withblock angled caudally,and adjusts plane of film and interpupil-and immobilizes under patient's lary line is at right angleshead. with plane of film. AdjustsCenters cassette to the median flexion so that the infraorbito-sagittal plane_ of the head at the,level of the localization points,

meatal line is parallel withthe transverse axis of the film.

Rotates head toward the side of For demonstration of the pneu-interest so that localization matic structure of mastoid pro-spot is centered -.(1 the midpoint cess, mastoid antrum, tegmanof unmasked half of cassette. Ad- tympani, internal and externaljusts head so that the median acoustic meatuses, sinus, duralsagittal plane forms an angle of plates and mastoid emissary


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vessel, performer directs centralray to exit at the external audi-tory meatus on the side of inter-est at an angle of 25° caudad.Adjusts angulation to 15° caudadfor mastoid cells,mastoid antrum,internal and external auditorymeatuses and tegmen tympani; andto 350 caudad for mastoid cells,mastoid antrum, external acousticmeatus, tegmen tympani, labyrin-thal area, and carotid canal. Ifthe petrous apex between the an-terior wall of the external acoustic meatus and the mandibularcondyle is area of interest, haspatient open mouth for exposureand directs central ray at 350caudad.

For studies of the petrous portionsof the temporal bones, performernotes whether request involves sep-arate projections of each side forfrontal studies. Reviews areas ofinterest.

For profile projections of the pet-rous portions, performer marks eachcheek at a point one inch directlyforward from (anterior to) the ex-ternal auditory meatus. For parieto-temporal (profile) projections ofthe petrous portions, performermarks each cheek at a point 1.5inches forward from the externalauditory meatus. For demonstrationof fractures of the labyrinth, per-former marks a point one inch medialto the external auditory meatus onthe side of interest.For half-axial oblique projection ofthe auditory ossicles and attic-adi-tus-antrum areas, performer marks apoint at the junction of the auricleand the head immediately behind eachexternal auditory meatus.

i) For posterior profile projection(anterior profile view) of pet-rous port' se performer lans on

separate bilateral exposureson one film. Has patient as-sume a prone or seated PA po-sition as described, with cas-sette placed horizontally orvertically as appropriate. Haspatient place or rest head onforehead, nose and zygoma onaffected side, and centers theunmasked half of the cassetteto the localization point marked on cheek. Adjusts flexionso that the infraorbitomeatalLine is parallel with thetransverse axis of the film,and rotation so that the mediasagittal plane forms a 40° an-gle with the plane of the filmDirects central ray to midpoinof film at 12° cephalad. Afterfirst exposure has patient re-verse position of head;centersother side of cassette, andsets up similarly.

ii) For anterior profile projectio(posterior profile view) ofpetrous portion, performerplans on separate bilateral exposures on one film. Has pa-tient assume a supine or seateAP pbsition as described, withaffected side of head restingon or placed against film holder. Rotates head away from theside of interest so that mediasagittal plane forms a 45' an-gle with the plane of film;ad-justs flexion so that infraor-bitomeatal line is parallelwith the transverse axis offilm.Centers unmasked half offilm directly below locali7a-tion point. Directs central rato midpoint of film at 10° caudad,entering about 3/4 inchabove the opposite side localization mark. After first expo-sure has patient reverse posi-tion of head; centers other


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side of cassette and sets up patient's head so that mediansimilarly. sagittal plane is at right an-

iii) For parietotemporal projections(profile views) of petrous por-

gles to film. If possible,flexes head so that the orbito-

tion, performer plans on separate meatal line is at right anglesbilateral exposures on one film. to plane of film. Otherwise ad-Has patient assume semiprone po- justs so that infraorbitomeatalsition as described. If central line is at right angles to planray angulation method is to be of film. Centers film to theused, has patient rest head in rentral ray if both sides arelateral position on the side of zo be projected on a single ex-interest,and centers to midpoint posure. If each side is to beof unmasked half of film using projected separately, centerslocalization mark. Adjusts flex- to the level of the median sideion so that the infraorbitomeatal of the outer third of the orbitline is parallel with the trans- on the side of interest. Forverse axis of film. Checks that simultaneous bilateral projec-median sagittal plane is parallel tion, if orbitomeatal line isto plane of film,and interpupil- at right angles, directs centrelary line is at right angles to ray to the intersection of theplane of film. Supports jaw. Di- median sagittal plane of therects central ray to midpoint of head and a transverse line con-unmasked half of film anteriorly necting the external auditory(towards the face) at 33°, and at meatuses,at 30° caudad. If in- .

10° cephalad. fraorbitomeatal line is atright angles,directs central

If requested, performer may have ray as above at 37° caudad. Forsemiprone patient rest head on unilateral projections,anglestemple. Centers localization central ray as above, but di-point on side of interest to mid- rects central ray to intersec-point of unmasked half of film. tion with the appropriate trans-

, Adjusts flexion so that the in- verse line. For separate expo-fraorbitomeatal line is at a sures has patient retain posi-cranial angle of 5' to the trans- tion after first exposure andverse axis of the film. Adjusts centers opposite side of cassetrotation so that median sagittal te and central ray to other sid&plane forms an angle of 15° with v) For PA semi-axial projectionthe plane of film. Directs cen- (anterior semi-axial view) oftral ray to midpoint of film at petrous portions, performer hasanterior angle of 30°. patient assume a prone PA posi-After first exposure has patient tion as described. Has patientreverse position of head; cen- rest head on forehead and noseters other side of cassette and so that median sagittal planesets up similarly. is at right angles to midline.

iv) For AP semi-axial projection Adjusts flexion so that orbito-(posterior semi-axial view) of meatal line is at right anglespetrous portions, performer has to plane of film. Centers cas-patient assume supine or seated sette to a point about one inch,AP position as described. Adjust above nasion. Directs central

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ray to exit through nasion at25° cephalad.

vi) For occipitofrontal projectionof petrous por ls,performer re-views area of , _erest. Has pa-tient assume seat(d PA positionor has patient assume prone posi-tion as described,with thoraxelevated. Has natient rest headon the upper -ental region,andadjusts so t median sagittalplane is at right angles and cen-tered to midline of film holder.For labyrinth and internal audi-tory canal, adjusts flexion sothat infraorbitomeatal line idat 500 with plane of film. Forexternal auditory canals, tym-panic cavities and bony part ofthe eustachian tubes,adjustsflexion so that orbitomeatal lineis at 50° with plane of film.Centers film to midpoint at orabove the level of the externalauditory meatuses. Directs cen-tral ray at right angles throughthe foramen magnum or to the mid-point.

vii) For subbasal submentovertical(AP) projections of petrous poi-tions,performer reviews centralray angulation, whether full ex-tension of the head is requestedor possible, and whether the twosides are to be projected sep-arately. Has patient assumeseated or supine AP position asdescribed. For supine patientelevates trunk. Has patient resthead on the,vertex, just anter-ior to the lamda,and adjusts sothat median sagittal plane is atright angles and centered to themidline of the film holder. Ifpossible, adjusts extension sothat orbitomeatal line is paral-lel with plane of film; other-wise adjusts flexion so that

supraorbitomeatal line is par-allel with plane of film.If both sides are to be projected on one exposure, centersfilm or unmasked half to cen-tral ray. For unilateral pro-jection centers at a level justmedial to the tip of the mas-toid process.For full extension position di-rects central ray at right an-gles to orbitomeatal line atcenter of the line connectingthe external auditory meatuses.May direct central ray one inchanterior to this point at an-terior angle of 5°.If full extension was notachieved, directs central rayto the point one inch anteriorto center of line connectingauditory meatuses, but at an-terior angle of 15° to 20°. Forseparate exposures has patientretain position; centers otherside of cassette to oppositeside and sets up similarly.

viii) For subbasal verticosubmental

(PA) projection of petrous por-tions,perfermer adjusts casset-te on 23° angle block directedcaudally,and supports. May ele-vate cassette and angle blockand then immobilize. Has patienassume seated or prone PA posi-tion with median sagittal planeof head centered to midline.Has patient extend head as faras possible and rest chin neartop of cassette. Adjusts so thamedian sagittal plane is verti-cal. Directs central ray at 15°to 20° to the orbitomeatal linealong a line passing immediate-ly anterior to the tragus andimmediately posterior to theangle of the jaw.


Task Code No. 365



ix) For half-axial oblique projec-tion of the auditory ossiclesand attic-aditus-antrum areas,performer uses premarked center-ing points on patient, cassetteand vertical holder. Reviews thecentral ray and skull angulationordered. Performer seats patientlaterally before a vertical filmholder or has patient assume su-pine p.,sition as described; mayelevate and support outer sideof cassette for close part-filmcontact. Places ear on the sideof interest adjacent to film andcenters mark on cassette or I.old-er to localization point behindauricle. Depresses chin so thatmastoid process is in contactwith film and infraorbitomeatalline is parallel with transverseaxis of film. Performer rotateshead so that its median sagittalplane is at a 450 angle with theplane of the film (or at the an-gulation ordered). Directs thecentral ray to exit through theexternal auditory meatus at 450caudad (or at the angulation or-dered). After first exposure haspatient reverse position of head.Centers second pretharked casset-te to other side and sets upsimilarly.

x) For slightly oblique projectionsof the rtttic-aditus-antral areasperformer has patient assumeseated or supine AP position asdescribed. If central ray angu-lation technique will be used,adjusts head so that mediansagittal plane of head and or-bitomeatal line are both atright angles to plane of film.Centers film to a point 3/4 inchdistal to tragus. Directs cen-tral ray through middle ear at20° caudad and at a medial angleof 10° to 200.

If rotation and flexion will beused, centers side of interestso that a point one inch medialto the tragus is at the midline.Rotates head away from affectedside so that median sagittalplane is at 80° to 90° withplane of film. Adjusts flexionso that orbitomeatal line isparallel with transverse axisof film. Directs central ray toa point midway between outermargin of orbit and tragus at20° caudad.

If a wedge angle, flexion, androtation will be used, adjustspatient in supine vsition withhead on wedge block that is ata 30° caudal inclination. Ro-tates head away from affectedside so that median sagittalplane is at 88° to 92° with thehorizontal. Adjusts flexion sothat infraorbitomeatal lineforms a 30° caudal angle withthe vertical. Directs centralray at right angles to the mid-po!At, entering slightly above,and lateral to,the superolat-eral margin of the orbit.

After first exposure has patienreverse position of head. Cen-ters opposite side of cassetteor second cassette to otherside and sets up similarly.

xi) For demonstration of fracturesof the labyrinth, performerplans on five projections in APor PA position. If PA projec-tions are ordered,has patientassume prone or seated PA posi-tion as described. Performerplaces cassette tunnel underhead or has head rest againstcassette tunnel adjusted to a12° cranial angulation. Adjustshead so that median sagittalplane is at a 450 angle with

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the plane of the film. Centerslocalization mark to the midpointof film with forehead, nose andzygoma resting against tunnel onside of interest. Adjusts head sothat infraorbitomeatal line isparallel with the transverse axisof the film.If AP projections are ordered,has patient assume supine orseated AP position as described.Places cassette tunnel under orbeside head at 12° caudal angu-lation. Rotates head away fromthe side being examined so thatmedian sagittal plane is at anangle of 45° with the plane ofthe film. Centers to localizationmark and adjusts angle of infra-orbitomeatal line as above.Centers central ray to the mid-point of film for all five pro-jections and adjusts central rayangulation as follows. First: atright angles to film. Second:from right side at a 6° trans-verse angle. Third: from rightside at a 12° transverse angle.Fourth: from left side at a 6°transverse angle. Fiith: fromleft side at a 12° transverse an-gle. Reminds patient to retain position for each exposure. Changesand identifies cassettes and ad-justs central ray angulationafter each exposure. If bilateralstudy is ordered, repeats entireset-up with head rotated in op-posite direction and cassettetunnel arranged on opposite side.

e. For studies of the styloid proces-ses of the temporal bones, perform-er notes whether bilateral study isordered. For oblique AP projectionof the temporal styloid processes,performer marks two points on thepatient's posterior neck surface

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one inch lateral on either side ofthe median sagittal plane at thelevel of the mastoid tip.

i) For AP projection (posterior

view) of temporal styloid pro-cesses, performer has patientassume a supine AP position asdescribed. Adjusts a 13° angleblock under head,directed cau-dally,and places cassette onblock. Centers film to the med-ian sagitta2 plane of the headat the level of the externalauditory meatuses,and immobil-izes block. Adjusts head so thamedian sagittal plane: is atright angles to the horizontal,with acanthiomeatal line atright angles to the plane ofthe film.Immobilizes head and has patienopen mouth wide. Checks thatacanthiomeatal line is still atright angles to film. Noteswhether patient can immobilizemouth in open position by pho-nating the sound "ah-h." If not,performer selects a cork of ap-propriate size and has patientgrasp it between teeth. Recheckacanthiomeatal line.Directs central ray at right angles to the horizontal at themidpoint,between the floors ofthe external auditory meatuses.

If an angle block Is not used,adjusts median sagittal planeof head and acanthiomeatal lineat right angles to cassette, orone inch proximal to the tip ofthe mastoid processes. Centersas above. Directs central rayto film at an angle defined bythe infraorbitomeatal line.

ii) For oblique AP projection(oblique posterior view) of the

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"

temporal styloid processes, per-former plans on bilateral views.Has patient assume supine AP po-sition as described. Rests pa-tient's head on the occiput. Cen-ters localizing mark on the sideof interest to the midline of2ilm or unmasked half of casset-te. Rotates head towards the sidebeing examined so that mediansagittal plane is at 88° with theplane of the film. Extends headso that the occlusal plane of theupper teeth is at right angleswith plane of film. Performer haspatient open mouth and phonate,oruses cork as described in (1),above, and rechecks angulation ofhead. Directs central ray at an8° cranial angle along a linepassing about 1/4 inch distal tothe tip of the mastoid processon the side of interest.After first exposure has patientrotate head for view of otherside; uses unmasked side of cas-sette or second cassette and setsup similarly.

iii) For lateral projection of tem-poral styloid processes, performer has patient assume a semipron-or prone position as described,with head resting in a lateralposition on the side of interest,Centers the floor of the exter-nal auditory meatus to midpointof unmasked half of film. Adjust-head so that median sagittalplane is parallel with plane offilm,and interpupillary line isat right angles to plane of film.Adjusts flexion so that acanthiomeatal line is parallel withtransverse axis of film. Has pa-tient open mouth and phonate oruses cork as described in (i),above, and rechecks angulationof head. Directs central ray to

midpoint of film at an angle 100cephalad and 10° anterior (towardthe face).After first exposure has patientrest head on opposite side andsets up similarly.

iv) For semiaxial PA projection(semiaxial anterior view) of tem-poral styloid processes, perform-er has patient assume a prone PAposition as described,with headresting on forehead and nose. Ad-justs head so that median sagit-tal plane is at right angles tomidline. Adjusts flexion so thatorbitomeatal line is at right an-gles to plane of film. Centersfilm at,or one inch proximal to,nasion. Directs central ray tothe nasion at 25° cephalad.

f. For studies of the occipital bone,incluqing the jugular foramina andhypoglossal canals, notes whetherbilateral views are ordered. For an-terior profile projection of hypo-glossal canal, marks a point on eachcheek one inch forward from and .5inch below the level of the externalauditory meatus.

i) For subbasal projection (AP) ofthe jugular foramina, performerhas patient assume an erect seat-ed AP position as described,orelevates trunk of'a patient inthe supine AP position. Noteswhether central ray or part angu-lation has been ordered. Posi-tions patient with head restingon vertex.If central ray will enter at rightangles, adjusts head so that medi-an sagittal plane of head is cen-tered to midline and at right an-gles to film. Adjusts head sothat orbiromeatal line is at a 25angle with the plane of the film.

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Centers film just distal to thelevel of the external auditory

meatuses. Directs central ray atright angles to the midpoint,centering about 2 cm. distal tothe mandibular symphysis. If pa-tient's jaw is judged prominent,directs central ray caudally from5° to 10°.

If central ray angulation hasbeen ordered, adjusts mediansagittal plane as above, but hasorbitomeatal line parallel withplane of film. Centers film tocentral ray; and directs centralray one inch distal to the man-dibular symphysis at 20° caudad.

ii) For transoral projection (AP) ofthe jugular foramina, has pa-tient assume AP position as de-scribed. If patient is short-necked, elevates shoulders. Ro-tates patient's head toward theside of interest so that themedian sagittal plane forms an80° angle with the plane of thefilm. Centers inner canthus ofthe side of interest to the mid-line. Adjusts extension so thatacanthiomeatal line is at acranial angle of 10° with thevertical. Immobilizes head andhas patient open mouth wide.Checks that head angles are still.correct. Notes whether patientcan immobilize mouth in open po-sition and phonate the sound"ah-h." If not, performer se-lects a cork of appropriate sizeand has patient grasp it betweenteeth. Rechecks position. Di-rects central ray through theopen mouth , 25° cephalad. Ifbilateral vi.es are ordered,per-former rotates patient's head asappropriate in the other di-rection after the first exposure,and sets up similarly.

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iii) For transmandibular projection(AP) of the jugular foramina,

performer has patient lie insupine position as described,and elevates trunk so that pa-tient can rest head on vertexjust anterior to the lambda.Rotates patient's head awayfrom the side being examinedso. that median sagittal planeof head is at a 70° to 75° anglewith the plane of film. Extendshead so that infraorbitomeatalline is at a cranial angle of25° with the vertical. Centers'lateral margin of orbit andmandibular ramus of the upperside tu the midline,and centersfilm to a level just distal tothe external auditory meatus.Directs central ray at rightangles to the mid-area of theupper mandibular ramus. Afterfirst exposure,rotates head inopposite direction and sets upsimilarly.

iv) For anterior (AP) profile pro-jection (posterior profile view)of the hypoglossal canals (an-terior condyloid foramen), per-former places patient in seatedor supine AP position as de-scribed. Rotates head away fromthe side of interest so that themedian sagittal plane of headis at 45° with the plane of thefilm. Centers localization markto midline,and film 3/4 inch be-low localization mark. Ras pa-tient open mouth as wide as pos-sible and phonate or uses corkas described in (ii), above. Ad-justs so that the infraorbito-meatal line is parallel with thtransverse axis of the film. Di-rects central ray to the locali-zation point at 12° caudad.After first exposure reversesrotation and sets up similarly.

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g. For studies of the facial bones, center of film. For facial pro-file centers canine fossa tonotes whether stereoscopic views are

ordered. If so, plans to employ midpoint. Adjusts flexion solongitudinal tube shifts. that the infraorbitomeatal lineFor radiographic demonstration of is parallel with transverse axisblowout fractures performer.makes of film,and rotation so that in-views with patient in "Waters" PA terpupillary line is at right(parietoacanthial) position. For angles to the plane of the film.accident patients makes view with Supports jaw if patient is re-patient in parietoacanthial posi- cumbent. Directs central ray attion and makes lateral views, adapt- right angles to the midpoint ofing positioning so as to require no the film. For stereography makemovement of the patient from the the appropriate longitudinalsupine position. tube shift. If bilateral viewsIf a profile study of bony and soft have been ordered, performertissue contours has been ordered,uses double film set-up (film in

sets up similarly for oppositeside after first exposure of

envelope placed over loaded cas- the side of interest.sette). ii) For parietoacanthial projection

(oblique frontal view ini) For lateral projection of the "Waters" position) of the fa-

facial bones., performer notes cial bones, performer has pa-whether stereoscopic projections tient assume a prone or seatedare ordered, bilateral views, and PA position as described. Forwhether a facial profile showing stretcher patients, adjusts pa-the relationship of the bony and tient in supine position; posi-soft tissue contours is request- tions x-ray tube under theed. Performer has patient assume , stretcher; and adjusts the cas-a semiprone position on table,or sette holder so that film canseated obliquely,or in PA posi- . be placed over the patient'stion before a vertical cassette face in a horizontal plane. Hasholder, as described. For patient in PA position rest tipstretcher patients maintains pa- of extended chin against film.tient in supine position and ad- For supine patient, supportsjusts cassette in vertical hold- shoulders and neck so that header, with x-ray tube set for horl- drops naturally back, and lowerszontal filming across stretcher. cassette so that it touches pa-

tient's chin. Centers medianAdjusts patient's head so that sagittal plane of head to mid-the median sagittal plane is line of film. Adjusts flexionparallel with plane of film. For so that orbitomeatal line is atfacial profile has patient's 400 angle with the plane of thehead rest against film holder in film,and rotation so that medianlateral position after the two- sagittal plane is at right an-film set-up has been put into gles with plane of film. Directsplace,with film in envetope hold- central ray at right angles toer on top of film in cassette. midpoint of film.Centers zygoma to the midline at

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iii) For oblique projection of facial i) For oblique lateral projectionsbones, performer reviews angula- of zygomatic arches, performertion and notes whether stereo- has patient assume a seated orscopic views are ordered. Has pa- recumbent lateral position astient assume semiprone or seated described. Depresses shoulderposition as described. Has pa- on the side next to film. Hastient rest head on cassette, on patient rest parietal regionthe zygoma, nose,and chin, with of head against cassette on thethe orbit of interest centered side of interest, and adjuststo the midline at the level of so that head is in lateral po-the infraorbital margin. Adjusts sition, median sagittal planeflexion of head so that acanthi- forms 300 longitudinal angleomeatal line is parallel with with plane of film,and is par-transverse axis of film; adjusts allel with the transverse planerotation so that median sagittal of the film. Centers unmaskedplane of head is at a 53° angle half of film to the zygoma onwith plane of film. Directs cen- the side next to the film. Im-tral ray to midpoint of film at mobilizes head and has patientright angles or 10° to 15° cepha- open mouth wide. Notes whetherlad,as ordered. Shifts tube as patient can immobilize mouth inappropriate for stereoscopy. When,first exposure has been made, ro-

open position by phonating thesound "ah-h." If not, perforiaer

tates head to other side and sets selects a cork of appropriateup similarly,

iv) For inferosuperior oblique pro-size and has patient grasp itbetween teeth ard hold breath

jection (superoinferior oblique during exposure. Rechecks angu-view) of facial bones, has pa- lation. Directs ,tral ray attient lie in semiprone position 7° to 8° cephala, so that itas described, with the side of enters just below the mandibu-interest uppermost. Extends the lar angle on the side away fromhead and rests it on nose, zygoma film, emerging at the lowerand chin. Centers the film so temporomandibular joint on thechaL orbit cf the side next to opposite side. After first ex-the table is at the midpoint,with posure centers other side ofthe midpoint of film about two film to patient's opposite sideinches above the floor of the and sets up similarly.antrum on the side next to film. ii) For semiaxial (PA) projectionDirects central ray to the lower (inferosuperior view) of zygo-antrum at 25° to 30° cephalad,to enter neck just behind the an-

matic arches, performer placesfilm horizontally or inclines

gle of the jaw. If bilateral film in cassette holder on aviews are ordered, _reverses sides block angled 23° caudc.,d. Has paand proceeds similarly after tient assume prone PA or seatedfirst exposure, position as described,with head

resting on nose and chin, andh. For studies of the zygomatic arches, with tip of chin centered to

the midpoint of film. Adjustsperformer notes whether bilateralviews are requested. Reviews areasof interest.

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median sagittal plane of head so ters as above. Adjusts flexionthat it is at right angles to so that acanthianeatal line isplane of film. at right angles to the plane ofIf patient is resting on hori- the film,and rotation (awayzontally place film, directs cen from side of interest) so thattral ray to midpoint at 23° cau- median sagittal plane is at 450dad, entering the vertex midway angle with plane of film. Di-between the zygomatic arches. If rects central ray at right an-patient is resting on caudally gles to midpoint of film, en-inclined film holder, directs tering the most prominent pointcentral ray at right angles to

. of the upper zygoma.midpoint of film or at 100 to After first exposure centers15° caudad. other side of film to opposite

iii) For semiaxial oblique(PA)projec- side and sets up similarly.tion (tangential view) of zygo- iv) For semiaxial AP projectionmatic arches, performer notes (symmetrical posterior view)whether an angle block will be of zygomatic arches, performerused. Adjusts patient in prone notes whether cassette will beor seated PA position for posi- used horizontally or inclinedtioning head on horizontally caudally. Adjusts patient inplaced or caudally inclined cas- supine AP position as describedsette, as described. For horizontal cassetl:e centers

film to the level of the mandi-For horizontal cassette place- bular angles,with median sagit-ment,has patient extend head and tal plane at midline. For an-rest on chin. Rotates head away gled cassette adjusts so thatfrom the side of interest sothat the median sagittal plane

film is at a 30° caudal angle,and centers to median sagittal

is at a 75° angle with the plane plane at a point about 2 inchesof the film. Extends head so distal to external auditorythat the infraorbitomeatal line meatuses.is as parallel to plane of film Has median sagittal plane atas possible. Centers unmasked right angles to plane of filmhalf of film to a point 3 inches and head flexed so that orbi-distal to the most prominent tomeatal line is at right an-point of the zygoma of the upper gles to plane of film. Directsside. Supports cheek. Directs central ray at 30° caudad forcentral ray at right angles to horizontal cassette and atthe infraorbitomeatal line,di- right angles to the horizontalrected through the zygomaticarch at a point about 1.5 inches

plane with angled cassette,directed to the glabella.

posterior to the outer canthus. v) For submentovertical (AP) axialprojection (symmetrical axial

For angle block positioning,per-former adjusts cassette on 35°

view) of zygomatic arches, per-former adjusts patient in seat-

block placed at a caudal angle. ed or supine AP position asHas patient rest cheek of unaf- described, with supine trunkfected side on cassette,and cen- elevated. Has patient rest head


Task Code No. 365



on vertex,and extends so that in- gles to the infraorbitomeatalfraorbitomeatal line is as nearly line directed to the zygomaticparallel with plane of film as arch. After first exposure ro-possible. Adjusts so that median tates head to opposite side;sagittal plane is at right an- centers other half of film,andgles to film. Applies tape to sets up similarly.inferior surface of chin and vii) For transoral axial projectiondraws towards top of head in line (oblique axial AP view) of zy-with median sagittal plane. gomatic arches, performer ad-Anchors to edge of table or cas- justs patient in AP supine po-sette holder. Centers film to sition as described,with trunkcentral ray. Directs central ray elevated, head resting on ver-at right angles to infraorbito- tex, and infraorbitomeatal linemeatal line midway beLween zygo- parallel with plane of film;matic arches, passing through a may elevate cassette if needed.coronal plane lying about one Centers unmasked half of filminch posterior to outer canthi. to a point two inches lateral

to the zygoma on the side ofFor mento-frontal projection ad- interest. Adjusts so that med-justs patient in AP supine posi- ian sagittal plane of head istion and places cassette in verti at right angles to plane ofcal position behind head,angled film. Adjusts central ray ataway from patient at 800 with the right angles to plane of filmhorizontal plane. Hyperextends and then at lateral angle ofneck; supports; and directs cen- 25° to enter the midpoint oftral ray at right angles to in- the adjacent mandibular body.fraorbitomeatal line, centered Performer has patient openbeneath the mandibular symphy- mouth and phonate or uses corksis.

as described '..n (i), above; re-vi) For oblique axial (AP) projection checks anguLttion of head and

of zygomatic arches, performer central ray so that, with mouthhas patient assume a supine or open, the central ray passesseated AP position as described through the zygoma. Afterwith supine trunk elevated. Has first exposure has patientpatient extend head and rest it maintain position. Centerson vertex so that the infraorbi- other half of film to oppositetomeatal line is parallel with side and angulation to 25° inthe plane of the film. Elevates opposite lateral direction.cassette if patient is supine toaccomplish this. Rotates head

i. For studies of the nasal bones,performer notes whether occlusal

towards the side of interest so film packets or cassette will bethat the median sagittal plane used,and positions film according-is at a 75° angle with the plane ly; notes whether bilateral viewsof the film. Centers unmaskedhalf of film to the zygomatic

are called for.

arch or to the central ray. Tapes 0 For lateral projection of nasalhead as described in (v), above,Directs central ray at right an-

bones, performer uses cassette,.

nonscreen film holder,or, dental


Task Code No. 365



occlusal film. For occlusal film,has patient assume semiprone po-

distal to the nasion. After thefirst exposure,adjusts for film

sition as described. Adjusts head ing the opposite side similarly.so that median sagittal plane is ii) For axial, superior-inferiorparallel with the horizontal projection (inferior-superior(table top), and interpupillary view) of the nasal bones, per-line is at right angles to table former uses cassette, nonscreentop. Adjusts flexion so that infilm holder or dental occlusalfraorbitomeatal line is parallel film.with transverse axis of table. If patient is most comfortableSupports jaw. Places sandbags in erect position, adjusts headand/or blocks under the side of so that median sagittal planethe nose against the orbit and and glabelloalveolar line arecheek of side of interest,and vertical. Otherwise,adjusts soplaces film packet on top, with that median sagittal plane ispebbled surface facing and par- vertical and glabelloalveolarallel with the median sagittal line is horizontal or parallelplane. Slips it under nose so with any plane of elevation ofthat upper border extends about the head..5 inch above superorbital ridge,and rests it against maxilla and

If patient can hold film be-tween anterior teeth, inserts

superorbital ridge. May place film packet (with pebbled sur-film packet at an angle to avoid face of occlusal packet facingdiscomfort of patient, but has upward) about one inch intopacket parallel the median sagit mouth,with long axis of film intal plane of head. Gives patient AP direction. Centers to theleaded gloves and has patient median sagittal plane. Has pa-hold film packet tn position. tient close lips and teeth. Ad-

justs so that film is held inFor nonscreen film holder or cas position with its plane atsette, has patient take seated right angles to glabelloalveo-erect position before vertical lar line. Adjusts mandible backcassette holder or in chair with ward to correct for upward an-headrest. Adjusts head so that gulation and forward to correctmedian sagittal plane is paral- for downward angulation. Maylel with plane of film, inter- tilt seated patient forward topupillary line is at right an- avoid exposure to the area ofgles with plane of film, and in- the gonads.fraorbitomeatal line is parallel For patients who cannot holdwith transverse axis of film, film between teeth, performerCenters unmasked half of film to places cassette or nonscreenthe fronto-nasal region on the film holder under iratient'saffected side, at the level of chin at right angles to glabel-the nasion. loalveolar line and supports.

Adjusts so that median sagittalDirects central ray at right an- plane is vertical,and centersgles to the profiled bridge of unmasked half of film to medianthe nose, at a point 3/4 inch sagittal plane.

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Task Code No. 365


List Elements Full List Elements FullAMP'

Directs central ray along the the anterior part of hard palateglabelloalveolar line at right ane alveolor process, performerangles to the plane of the film, has supine patient rest head.on

an angle block caudally inclinedj. For studies of the maxillae, per- at 15°. Adjusts so that median

former prepares dental occlusal film sagittal plane of head is yard-packets. Does not insert in pa- cal and occlusal plane is attient's mouth until head has been right angles to the plane of thepositioned and immobilized, patient block. Directs central ray tohas been shielded, and central ray lower third of nose at 45° toadjusted in approximate position. 500 caudad.Utilizes seated position if headrest Performer adjusts seated patientis available, as in (i), above, and directs

central ray so that it forms ai) For axial, intraoral projection 60° to 65° angle with the plane(axial, occlusal view) of the of the film.hard palate and dental arch of

Just before exposure, performerthe maxillae, performer has su- has patient open mouth. Insertspine patient rest head on table film packet with pebbled sur-or caudally inclined block, and

face facing up and long axis inadjusts so that median sagittal AP direction. Centers film toplane and occlusal plane are

the median sagittal plane andboth at right angles to table.inserts back so that it is inPerformer adjusts seated patient contact with the anterior bor-

so that median sagittal plane isders of the mandibular rami. Has

vertical andOcclusal plane is patient close mouth to holdhorizontal.film. Rechecks and readjusts po-

Adjusts central ray so that itsition of head and x-ray tube aswill be at right angles to film described above.

(when it is held in mouth) center- iii) For semiaxial, intraoral projec-ed to intersection of the median tion (oblique crclusal view) ofsagittal plane and a coronal

the posterior p.....1-t of hard pal-plane passing through the outer ate and alveolar process, per-canthi. Just before exposure, performer has supine patient restformer has patient open mouth. head on table. Rotates away fromPerformer inserts film packet with the side of interest so thatpebbled surface facing up and long median sagittal plane of head isaxis directed transversely. Cen- at 60° with plane of table,andters film to the median sagittal

adjusts so that occlusal planeplane of the head, and moves it is at right angles with table.back so that film is in contact Directs central ray to the ca-with the anterior borders of the nine fossa at 60° caudad.mandibular rami. Has patient

Performer adjusts seated patientlightly close mouth to hold film,Rechecks and readjusts position

as in (1), above, and directscentral ray to the canine fossa

of head and x-ray tube as de- at an angle of 30° to the medianscribed above,

ii) For semiaxial, intraoral projec-tion (oblique occlusal view) of

plane and an angle of 60° withthe plane of the film.

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Task Code NJ. 365


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Just before exposure performer supine, with cassette placedhas patient open mouth. Inserts vertically. If bilateral viewsfilm packet with pebbled surface are called for, employs similarfacing up and long axis in AP di- pos:Itioning for opposite siderection. Centers about .5 inch after first exposure.laterally from the median sagit- When hekA is resting on affectedtal plane towards the side of part, does not apply pressureinterest,and inserts back so thatfilm is in contact with the an-terior border of the mandibular

when immobilizing.

i) For an axiolateral projectionramus. Has patient close mouth to of the body of the ramus ofhold film, Rechecks and readjusts mandible, performer reviewsposition of head and x-ra, tube position,area of interestas described above. If so order- and angulation called for.ed, repeats for opposite side. ia) Adjusts head of semiprone

or seated patient on ank. For studies of the mandible, per- angle block placed at a 15°

former reviews purpose and areas of cranial angle. Extends cheekinterest. Notes whether examination of affected side over angleis to demonstrate mandibular frac- block and depresses shouldertures. Unless otherwise ordered,makes direct lateral and frontal

of elevated side. Places cas-sette under cheek, with long

projections of rami, axial projec- axis of mandibular body par-tion of mandibular body, and intra- allel with transverse axis oforal or extraoral projection of film, ceatered to the occlu-mandibular body. sal plane midway between theFor intraoral or extraoral projec- angle and the symphysis oftions of the body, dental arch and the jaw. Tapes cassette tosymphysis of the mandible, performer angle block. Adjusts head sochooses dental occlusal packet,non- that the broad surface of thescreen film holder,or cassette as mandibular body is paralleldetermined by institutional prac- with the plane of the film.tices. Directs central ray to theIf dental occlusal film is to be midpoint of the film at 30°used, performer does not position cephalad.in patient's mouth until head and ib) Adjusts head of prone orcentral ray have been positioned. seated patient on a cassetteFor axiolateral projections of man- placed horizontally. Extendsdible, performer notes whether pa- arm of the side being examin-tient is to be positioned in a semi ed above head in comfortableprone,or seated position with head position and arranges body inon a cranially inclined block, or slightly oblique position.prone or seated with head on hori- Has patient rest affectedzontally placed cassette, or semi- cheek on cassette so thatsupine with head on cranially in- long axis of the mandibularclined cassette. For accident pa- body is parallel with thetients or for those whose skull transverse axis of film, andshould not be rotated, has patient centers to the area of the

.--,

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Task Code Nr. 365


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first molar. Rotates so thatbroad surface of the mandibularbody is parallel with the planeof the film. Directs central rayto the midpoint of the film at25° cephalad and 100 anteriorly.

(ic) Adjusts head of semisupine pa-tient on an angle block directedcranially,with affected cheek inlateral position on cassette, andaffected side of body next totable. Adjusts elevation of cas-sette adjacent to shoulder sothat cassette is in close contactwith jaw. Extends head so thatlong axis of mandibular body isparallel with transverse axis offilm. Centers unmasked half offilm to body of mandible and sup-ports. Rotates head so that thebroad surface of the mandibularbody is parallel with the planeof the film. Rests head on cheek(for posterior area of body ofmandible) or on side of chin (foranterior area of body of mandi-ble). Directs central ray to themidpoint of the unmasked half offilm at 20° cephalad, enteringabout 2 inches distal to the an-gle of the upper side of the jaw.

(id) With accident patient in supineposition where rotation is con-traindicated, performer placescassette in vertical position onthe side of interest, parallelwith the median sagittal plane.Centers to the occlusal plane.Directs central ray horizontallyat 30° to 350 cephalad and at10 posteriorly.

ii) For an axiolateral projection ofthe mandibular ramus, per-former positions as for the body,(i) above, except for the follow

1

ing differences:(iia) For semiprone or seated position

ing with head at 15° cranial an-gle, performer centers cassPtte

List Elements Fully

to a point .5A.ftch anterior toand one inch inferior to the ex-ternal auditory meatus. Adjustshead so that broad surface oframus is parallel with plane offilm and acanthiomeatal line isparallel with transverse axisof film. Directs central ray 30°cephalad anc 1.00 posteriorly,directed to llLidpoint of film.

(iib) F-_:r prone or seated patient with

horizontally placed head, cen-ters film as in (iia) above,with broad surface of ramus par-allel to plane of film and chinextended. Directs central rayto midpoint of film at 25° ceph-alad.

(iic) For semisupine patient,centersfilm as in (iia), above, withbroad surface of ramus parallelto plane of film and chin ex-tended so that the acanthiomea-tal line is parallel with thetransverse axis of the film.Directs central ray to the mid-point of the film at 25° ceph-alad.

(iid) For supine accident patient po-sitions as in (id). Directs cen-tral ray at 30° to 35° cephaladand 10° to 20° posteriorly.

iii) For an axiolateral projectionof the symphysis of the mand4_-ble, performer positions as forthe body,(i) above, except forthe following differences:

(iiia) For semiprone or seated posi-tioning with head at 1.5° cranialangle, has patient elratu'. chin.Centers cassette to the regionof the mental foramen. Restshead on side of chin wlf.ti thelong axis of the mandioular bodyparallel with thp transverseaxis of the film. Directs cen-tral ray to midpoint of film atangle 30° cephalad and 10° pos-teriorly.

259

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Task Code No. 365


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(iiib) For prone or seated patient withhorizontally placed head, cen-ters film to occlusal surface of

canine region with head rest-ing on extended chin, nose andzygoma. Directs central ray tomidpoint of film at angle 200cephalad.

(iiic) For semisupine patient, adjustsas in (ic) above, but has headrest on the side of the chin.

iv) For PA and semiaxial projections(anterior views) of the body ofthe mandible, has patient assumeprone or seated PA position'asdescribed. Centers median sagit-tal plane of head to midline offilm, with head resting on noseand chin, with anterior surfaceof mandibular symphysis parallelto the plane of the film. Ad-justs median sagittal plane ofhead so that it is at right an-gles to plane of film. Centersfilm to a point midway betweenthe lips and the tip of the chin.Directs central ray at right an-gles to midpoint of film.

v) For PA and semiaxial projections(anterior views) of the mandibu-lar rami, reviews area of inter-est. Adjusts patient in prone orerect position as in (iv), al-weexcept as follows:

Centers film about 2 inchesabove mandibular symphysis. Forsurvey film centers to the lips;and for condylar processes, cen-ters to the glabella.Directs central ray midway be-tween the temporomandibularjoints at 30° cephalad. For sur-vey film directs central ray atright angles to the lips. Forcondylar processes, directs cen-tral ray to the glabella at 20°1:o 25° cephalad.

260

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Performer may rehearse patientin 'Ailing mouth with air andholding breath to provide bet-ter contrast.

vi) For a verticosubmental projec-tion (axial view) of the mandi-ble, performer has patiem: as-sume a prone or seated positionwith head resting on chin ex-tended across a cassette lyinghorizontally and supported. Centers median sagittal plane ofhead to midline of film at alevel just below the externalauditory meatuses. Supports cassette so that it is in directcontact witli throat and, if an-gulation is needed, at a cran-ial angle. Adjusts head so thatmedian sagittal plane is verti-cal. If cassette is horizontal,directs central ray to midpointof film at right angles to theinfraorbitomeatal line. If cas-sette is angled cranially, di-rects central ray to midpointat right angles to the occlusalplane.

vii) For a submentovertical projec-tion (axial view) of the mandi-ble, performer has patient sitin AP position before a verti-cal cassette holder or lie insupine AP position with trunkelevated. Has patient extendhead and rest it on vertex. Ad-justs so that median sagittalplane is vertical and orbito-meatal line is parallel withplane of film. If full exten-sion cannot be attained, in-clines cassette caudally. Cen-ters cassette to central ray.Directs central ray at right angles to the infraorbitomeatalline at midpoint of the externa'auditory meatuses.


Task Code No. 365


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viii) For superoinferior (AP) extra-oral projection (oblique PA view)of the mandibular symphysis, per-former has seated patient extendchin ovet a film packet or cas-sette placed Worizontally at endof table and supported at com-fortable heighc. With occlusalfilm places it with pebbled side

`'up and long axis in AP direction.Centers median sagittal plane ofhead to midline with chin wellforward. Directs central ray pos-teriorly at 400 .to 45°,centeredto mandibular symphysis midway between lips and tip of chin.

Performer has supine patient resthead on its occiput, with mediansagittal plane at right angles totable. Adjusts flexion so thatinferior border of body of mandi-ble is vertical. Adjusts packetof occlusal film under chin withlong axis in AP direction, cen-tered to the median sagittalplane, with pc.tbbled surface incontact with chin. Tapes packetin place or supplies leadedgloves and has patient hold filmpacket in place. Directs centralray to the mandibular symphysisas above, at 40° to 45° caudad.

ix) For an oblique inferosuperior

intraoral projection (oblique oc-clusal view) of the mandibularsymphysis, performer has supinepatient rest head on its occiput.Adjusts so that median sagittalplane and the occlusal plane areat right angles to table. Directscentral ray to tip of the chin at55° cephalad.

Performer adjusts seated patientso that median sagittal plane isvertical and occlusal plane formsan angle-of 55° with the horizon-tal plane.

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Directs central ray to the tipof the chin parallel with theocclusal plane.

Just before exposure, performerhas patient open mouth. Perform-er inserts film packet with pebbled surface facing caudally andlong axis in AP direction. Cen-ters film to the median sagittalplane of head and moves it backso that it is in contact withthe anterior borders of the man-dibular rami. Has patient closemouth to hold film. Rechecks andreadjusts position of head andx-ray tube as described above.

x) For an inferosuperior intraoral

projection (occlusal view) ofthe body and dental arch of themandible, performer supportsthorax of supine patient. Haspatient extend head and rest iton vertex. Adjusts so that themedian sagittal plane is verti-cal.

Performer adjusts seated patientso that median sagittal planeand occlusal plane are both ver-tical.

Directs central ray at right an-gles to expected plane of filmpacket (once inserted),centeredto the median sagittal plane atthe level of the coronal planepassing through the second mo-lars.

Just before exposure, performerhas patient open mouth. Insertsfiim packet with pebbled surfacefacing caudally, and long axisdirected transversely. Centersfilm to the median sagittalplane of head and moves it backso that it is in contact withthe anterior surfaces ot themandibular rami. Has patientclose mouth to hold film. Re-


Tank Code No. 365


List Elements Full..List Elements Full

checks and readjusts position of cheek .5 inch anterior to the ex-head and x-ray tube as describedabove.

ternal auditory meatus.

1. For studies of the temporuandibular i) For a lateral projection of thearticulations, performer reviews temporomandibular articulationswhether closed and/or open mouth po-sitions are called for. For acci-

using direct contact technique,performer has patient assume

dent patient does not attempt upen semiprone or seated positionmouth position unless approved by in front of vertical cassetteMD. Makes frontal and lateral pro- holder. Has patient rest headjection. May use stereography. against film holder in lateralFor closed-mouth positions explains position on the side of inter-to patient that the posterior teeth est. Centers unmasked half ofmust be occluded rather than the film to the marked centeringincisors. Rehearses patient and point. Adjusts head so thatchec%s occlusion,For open-mouth positions performer

median sagittal plane is par-allel with the plane of the

immobilizes head after positioning. film and interpupillary lineHas patient open mouth as wide as is at right angles with theposaible. Makes sure that jaw is not .plane of the film. Extends headprotruded. Rechecks position of so that occlusal plane is par-head. Performer notes whether pa- allel with the transverse axistient can immobil ,2 mouth in open of the film. Centers x-ray tube

,position by phonating the sound"ah-h." If not, performer selects

in contact with 'the cheek onopposite side of face, directed

a cork of appropriate size and has along the long axis of the up-patient grasp it between teeth. Re- per condyle at 15° cephaladchecks position of head. and 10° anteriorly, or at rightIf both open-and closed-mouth pro- angles to the plane of the filjections are called for,performer through the upper centeringuses a cassette tunnel or bucky and mark.has patient maintain position of Performer explains open- andhead while cassetle is repositioned closed-mouth procedures to pa-for second exposure. Places casset- tient. Asks patient to retainte changing tunnel into position be position for first and secondfore positioning patient. exposure (closed and then open-Marks patient and cassettes for centering as appropriate. For semiax-

mouth position) if appropriate,while cassette is shifted or

ial, transcranial projection, marks changed. Performer then posi-a point on each cheek .5 inch an- tions patient on opposite sideterior to and one inch below the for bilateral study and has pa-external auditory meatus. For intient hold position for thirdferosuperior transfacial projec- and fourth exposurer.tion, marks a point on each cheek For closed muuth exposure per-.5 inch anterior to and one inch former rehearses patient inabove the external auditory meatus.For lateral and oblique transfacial

closing mouth as describedabove and inhaling slowly

I

projections, marks a point on each through the nose during the

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Task Code No. 365


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exposure; rechecks angulation. cassette holder in lateral po-For open-mouth exposure perform- sition. Centers unmasked halfer has patient practice opening of film to the marked centeringmouth and phonating or uses cork,as described above; rechecks an-

point. Adjusts head so that me-dian sagittal plane is parallel

gulation. with plane of film and inter-ii) For a lateral transcranial pro- pupillary line is at right an-

jection of temporomandibular gles with plane of film. Ex-articulations, performer has pa-tient assume semiprone or seated

tends head so that the infra-orbitomeatal line is parallel

I

position with head placed oncassette changing tunnel that is

with transverse axis of film.Directs central ray through the_

caudally inclined at 15°. Has pa- centering point on the side oftient rest cheek on affected side interest at 20° cephalad or an-and centers unmasked half of tun- teriorly 20° and cephalad 20°.nel to the marked centering Performer explains open- andpoint. Adjusts head so that acan- closed-mouth procedures and bi-thiomeatal line is parallel with lateral positioning as describ-transverse axis of film. Directs ed above; performer recheckscentral ray at right angles to angulation after patient closesthe midpoint of film, through mouth or opens as appropriate..the centering marks. iv) For a semiaxial AP projectionPerformer explains open- and clos (semiaxial posterior view) ofed mouth procedures to patient. the temporomandibular articula-Asks patient to retain position tions, performer prepares cas-for first and second exposure sette tunnel inclined caudally(closed and then open-mouth po- at 30° or 35°. Has patient as-sition) if appropriate while cas- sume supine position -,s describ-sette is shifted or changed. Per- ed,with head resting un cassetteformer then positions patient on holder. Centers to the medianopposite side for bilateral study sagittal plane of the patient'sand has patient hold position for neck at a level directly belowthird and fourth exposures. Per- the temporomandibular joints.former rehearses patient for Adjusts head so that median sag-closed-mouth exposure as describ- ittal plane is vertical and or-ed above. Rechecks angulation. bitomeatal line is at right an-If appropriate, rehearses open- gle to plane of film. Placesmouth exposure by having patient tape across chin and anchors toopen mouth and phonate, or uses table or holder. Directs centralcork, as described above; re- ray at right angles to the hori-checks angulation. zontal plane,directed to a point

iii) For a lateral transfacial projec about three inches above thetion of temporomandibular arti- nasion. Performer explains open-culations, performer has patient and closed-mouth procedures asassume a semiprone position or described above; performer re-be seated in front of vertical checks angulation after patientcassette holder. Has patient res closes mouth or opens as appro-cheek on affected side against priate.

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Task Code No. 365

44This is page 40 of for this task.

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v) For a semiaxial transcranial pro-jection (semiaxial lateral view)of the temporomandibular articu-lations, performer positions pa-tient in semiprone or seated po-sition in front of vertical cas-sette holder. Has patient restcheek on affected side againstcassette holder in lateral posi-tion. Centers unmasked half offilm to the marked centeringpoint. Adjusts Ilead so that med-ian sagittal plane is parallelwith plane of film and interpu-pillary line is at right angleswith plane of film. Directs cen-tral ray to the centering mark onthe side of interest at 25° or300 caudad, entering the upperparietal region.Performer explains open- and cloed-mouth procedures and bilateralpositioning as described above;performer rechecks angulationafter patient closes mouth oropens as appropriate.

vi) For an oblique transfacial pro-jection (axiolateral view) of thetemporomandibular articulations,performer has patient assume alateral position, recumbent orseated, with patient's head rest-ing on the parietal region of theside of interest in a lateral po-sition. Centers unmasked half offilm to marked centering point.Rotates head slightly from thelateral position and adjustslongitudinal position of thehead so that the median sagittalplane forms a 300 angle with theplane of the film,open towardsthe feet. Directs central ray atright angles to the marked cen-tering point on the side of in-terest, entering just distal tothe angle '2 the jaw on the up-permost side.

%COGS&

List Elements Ful3N

Performer explains open- andclosed-mouth procedures ard bi-lateral positioning as described

above; performer rechecks an-gulation after patient closesmouth or opens as appropriate.

vii) For an inferosuperior trans-facial projection (oblique lat-eral view) of the temporomandi-bular articulations, performerhas patient in a semiprone posi-tion,turned toward the side ofinterest. Has patient rest headon the parietal region with me-dian sagittal plane horizontal.Rotates head slightly from thelateral. Centers unmasked halfof film to the marked centeringpoint on the side of interest.Adjusts longitud.inal positionof head so that the median sag-i%tal plane forms a 10° to 15°angle with the plane of the filopen towards the feet. Directsthe central ray to the markedcentering point on the side ofinterest at 30° cephalad, enter-ing below the angle of the jawon the uppermost side.Performer explains open- andclosed-mouth procedures and bi-lateral positioning as describedabove; performer rechecks an-gulation after patient closesmouth or opens as appropriate.

14. If, during pos!tioning, patient showssigns of severe pain, performer maynotify appropriate physician at onceand await orders, or may decide onalternative positioning to avoid move-ment of the affected part.

15. Performer checks final positioningusing triangles, protractor and lightin collimator. -1.ctivates the collima-tor light and points the light beamtowards the part. Adjusts the collima-

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Task Code No. 365


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tor opening to correspond to the filmsize (or the size of the unshieldedareas of the film to be exposed). Usescross-hair shadows as reference forcenter of field. Uses the collimatorlight to center the patient to thex-ray field, or centers the part tothe film holder and uses the collimatorlight to center the tube to the part.Rechecks angulation of head and centralray. Checks that the primary beam willenter the center of the area of inter-est at the selected angle to the filmso as to project the view desired. Mayreadjust tube position lengthwise orcrosswise to provide better centering.

16. Once the patient has been positionedand immobilized, performer adjusts theCollimator. Either collimates so thata small unexposed border will appeararound the edge of the film or colli-mates further so as to expose only thearea of interest (and thus providemaximum protection and detail). Forsmall fields (if not already done inpositioning) performer attaches anauxiliary extension cone to collima-tor to further reduce the primary beam.Adjusts primary beam to minimum sizeneeded to cover the part(s) of inter-est.

17. Performer adds lead shielding to areasthat will be in the primary path ofthe beam but are not included in theareas of interest. Makes sure thatprotective shielding has been pro-vided to patient and everyone who willremain in room.

18. Throughout procedure performer ob-serves patient for any signs of emer-gency and/or to prevent or respond toan accident. Is alert to signs of nau-sea, dizziness, or sweat suggestingfaintness. Performer may have patientlie down, lower head, or raise legs.

Notifies If patient shows anyother emergency signs, loses consci-ousness, or has an accident, perform-er calls appropriate physician orstaff member at once. May decide toprovide emergency first aid as well?If a patient's catheter becomes dis-connected, performer clamps it andimmediately notifies nurse. If cathe-ter should come out, notifies staffmember at once.

19. When everything is ready for the ex-posure, performer reviews with patientwhat breath control will be used forexposure:

a. Performer has patient hold breathuntil told to relax by performerfor all projections of the cranium,cranial base, sella turcica, opticforamen, inferior and superior or-bital fissures, anterior clinoidprocesses, sphenoid strut, mastoidprocesses, petrous portions, tem-poral styloid processes, jugularforamina, facial bones, zygomaticarches, nasal bones, maxillae,mandible, and closed-mouth projec-tions of the temporomandibular

articulations, except as follows:

i) For lateral, AP or oblique APprojections of the temporalstyloid processes, transoralprojection of the jugular for-amina, anterior profile projec-tion of hypoglossal canal,oblique lateral and transoralaxial projections of the zygo-matic arches, and open-mouthstudies of the temporomandibular

articulations, performer has pa-tient open mouth wide and softlyphonate the sound "ah-h" duringthe exposure as rehearsed. Mayhave patient hold cork in teethjust prior to exposure and hold

2 65


Task Code No. 365



breath as rehearsed. Rechecks po-sition and angulation.

ii) For PA and semiaxial projectionsof the rami and condylar proces-ses of the mandible, performermay have patient fill mouth withair, and then hold breath duringexposure, as rehearsed.

iii) For closed-mouth projections ofthe temporomandibular articula-tions, performer has patientclose mouth by occluding poster-ior teeth. Has patient holdbreath or inhale slowly throughthe nose until told to relax,depending on the projection, asrehearsed earlier.

b. Reminds patient about those posi-tions which are to be maintainedfor a second exposure.

c. Performer observes the patient'smovement until ,the moment that theexposure is made. Readjusts posi-tion if warranted.

20. The performer returns to control room.Makes sure controls are properly setand patient is still in position. Tellspatient when to breathe as instructedby calling or using intercom. Perform-er initiates exposure by pressing handtrigger or exposure control button.

a. While exposure is underway perform-er checks that mA meter records ap-propriate current as set, that kVpmeter dips slightly.

b. May watch for evidence of malfunc-tion such as line surge or exces-sive drop; may listen for sound ofnormal functioning of equipment. Ifthere is malfunction, tnay decide toreport; anticipates .1 ed to repeatexposure.

c. With phototimer notes whe'..her back-up timer has been involved in termi2nating exposure bef,re phototim.

2 ki

exposure was completed. If so,anticipates possible need to re-peat exposure (due to underexpo-sure if premature cut-off, or over-exposure due to faulty timer).



21. Performer returns to patient. Removescassette or film holder from table,floor, or bucky.

a. Removes any markers for furtheruse. If bilateral views are to betaken on the film, removes leadedrubter mask and remasks all butnext area to be exposed.

b. If the patient is accident victimor if so requested, performer ar-ranges to have the first expo-sure(s) processed at once and 4%

brought to the appropriate radic:-logist.

c. If the first radiograph(s) pte-§

liminary (scout) films, perfLyirgerbrings the processed radiogra;,,b(s)directly to the radiologist Acharge or places on view boxeri amiinforms radiologist that the F,c:-.4st

(s) are ready. If. the radioloiindicates that there is any pr,!,-lem with the technical factors orthe patient positionlmg, performerrecords or notes for '.ter use in

Jle examination and/or rcpeats pre-iiininary radiography as Ordered.

d. Depending on whether radiologistwill evaluate radiographs beforecompleticm of all possible expo-sures for the series, performer arranges to process film(s) and evaluate for quality control personal-ly, hav:., this done, or brin to


Task Code No. 365



darkroom for processing and laterevaluation, based on time available,institutional arrangements, or spe-cific instructions. Attaches ID cardfor use with flasher if appropriate.May sign requisition.

e. While films are being processed and/or evaluated performer has patientrelax in examination room or holdingarea. Explains what will happennext.

i) Performer determines whether pa-tient should remain on table and/or in room or requires observa-tion. May consult requisitionsheet or attending RN. If appro-priate, makes sure that patientwill be attended while waiting..


iii) May decide to assist patieat toehae or stretcher or from table.Makes sure patient is remindedof any footrest in stepping offtable.

22. When (or if) performer learns from theradiologist the extent of the injuryand/or whether further conventionalviews and/or positiehs can be under-taken, eliminated or altered, perform-er proceeds as appropriate according toinstructions.

a. For further exposures performer re-peats appropriate steps for nextview(s) including identification offilm holder or cassette and use ofR-L marker, selection and settingof technique for next view (if dif-ferent), positioning patient an6equipment for focus-object-filmalignment, proper collimation andshielding, breathing instructions,and making expoeure, as described

above. For bilateral exposures onone film, keeps R7-L refeeence con-stant; centers using the Eointmarked earlier on the ceeeette.

b. Performer refrains from commentingon the films or providieee any in-terpretation.

c. If performer is asked repeat anyexposures, makes sure eeat the ad-ditional exposures are learrantedmedically, since additienal radia-tion will be incurred.

i) Notes whether need repeat idue to performer's ewn negli-gence or lack o! attention sothat performer cen avoid future"retakes."

ii) If request for re:ekes reflectsmalfunctioning egelemeet,former reperts malfunction toappropriate staff member,

iii) If request for retakes reflectsthe preference for density orcontrast of a radio3ogist, per-former notes for futeee workdone for the given radiologistso that retekee een be avoided.

23. When performer is suee that the exam-ination has been completed, performermay have patient transported back toholding area or next location, or de-cides to do personally, as appropri-ate. Makes .sure 'that nore of theequipment is erojecting over the pa-tient before Lliewing patient to risefrom stool or table, and assists pa-tient as described above.

24. Performer carries out terminationsteps for tfee examination:


267


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Task Code No. 365


b. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken, thetechnical factors used and filmsizes; may record the number of ex-posures made of each view includingretakes; may enter the estimatedradiation dose to which patient wasexposed (using posted informationon dosage); may record any problemwith equipment, any special careprovided patient. If any views cal-lad for in the initial request couldnot be obtained, performer may re-cord reasons. Signs requisitionsheet.

c. If pirformer will only carry outpreliminary "scout" filming andanother technologist will continuewith examination, performer recordsthe approved technical factors usedfor the scouts, and the accessoriesemployed, or informs technologistwhd will continue. Performer givesthe requisition sheet, name card,and any notes to technologist whowill continue with procedure.


e. For profile study of relationshipof bony and soft tissue contours offacial bones, performer obtainsfilms after processing. Marks boneprojection (film from cassette) tobe used in preparing contact printfor mask, (as in subtraction technique) to be superimposed on soft tissue projection (film from envelope)for a composite print; marks softtissue projection appropriately.May fill out order for preparationof composite print (same process assubtraction technique), and place

10

268

with radiographs for processing bdarkroom aid, or decides to dopersonally.

f. May indicesc4. to appropriate staffperson whiln the performer isready to pI6cec :;'. with next exami-

nation.


Task Code No. 366



Requisition reviewed;pt. reassured,positioned;partsmeasured;fiIms identified;technical factors selectedand set; technique for bilateral filming, stereo-graphy set up; exposures made; radiographs sent forprocessing and evaluation; procedures repeated as appropriate fo- full set of views; patient returned;examination recorded; radiographs placed for use.

Performer receives or obtainsthe x-ray requisition form, pa-tient's identification card, andany appropriate medical-techni-cal history for a non-infant pa-tient scheduled for radiographyof the paranasal sinuses:




The plain films of the sinusesmay aerve as preliminary "scout"films for contrast studies.

1. Performer reads the requisi-tio% sheet to determine 0-1examination called for, pd,-pose, the patient involved,

special considerations, andto check the completeness ofthe information provided:

a. Performer checks the exam-inations called for in-cluding the side of inter-est and the affectedareas, whether the studyis to provide pre-opera-tive measurements, whetherbilateral or unilateral


Pt.'s x-ray requisition sheet,ID card,ID bracelet,technical history;pen;x-ray machine control panel(s),tube,bucky,table,collimator,extension cones;techniqu.chart;charts for conversion of technique,standard examination views,dosage,tube capacity;loaded cas-settes;upright film holder;leaded rubber shielding;R-L and ID markers;immobilization devices;sinus maskor face rest;head clamp;weighted band;tape;chair;cal

ipers;protractor;triangles;stool;scissors;cassettetunnel;marking pen;cork;stretcher or wheelchair

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...C() No...( )

. If "Yes"777. 3: Name the kin of recipient,respondent or co-worker involved, with de_



. Name the task so that the answers to ques-views are requested, thepatient positions andviews called for, the num-


Taking plain film radiographs of the paranasal sinus-es of a non-infant patient by reviewing request; re- ber of exposures, the cen-

tral beam angulation, theareas and parts to be in-cluded. Notes whetherthere will be bilateralviews on a single film,whether the use of a gridor bucky will be involved.

OK-RP;RR;RR

porting observed contraindications; reassuring pt.;measuring part;setting up for bilateral exposures,stereography as ordered;selecting and setting techni-cal factors;identifying film;positioning pt. andequipment for erect seated or recumbent exposure;pro-viding shielding;collimating;making exposure;havingradiographs processed and reviewed;repeating for fullset of views or as ordered;having pt.returned;placingradiographs for use;recording examination. 6. Check here if this

is a master sheet.. 4

269


This is page

Task Code No. 366


List Elements Flal List Elements Fully

Checks the name of the referring phy-sician.

b. Performer reads patient's name, iden-tification number, sex, age, andweight. Notes whether patient is in-patient, out-patient, or emergencypatient. Notes any special informa-tion that will affect patient posi-tioning, technique, or handling ofthe patient, whether patient will beon a stretcher or wheelchair, andthe nature of any known pathologywhich would affect technique.

c. Performer checks whether patient issuffering from a collateral condi-tion requiring special handling,such as heart disease, communicableor infectious condition, infirmity,incoherence; whether patient has IVdrip, oxygen supply, urinary cathe-ter or similar device in place; notewhether patient will be accompaniedby nurse or other staff person.

d. With patients who are to undergo subsequent contrast studies, performermay note whether orders for priorpreparation have been given and car-ried out; not already done, mayarrange to have orders carried outor informs appropriate staff member.If patient's record indicates ordersfor sedation or any other prior medication, performer may check timingto be sure a proper elapse of timehas occurred for medication to takeeffect. May arrange to delay examination if appropriate.

e. If performer is not already assignedto examination room (and a particu-lar machine) notes the room or ma-chine involved. Goes to examinationroom or control room for machine in-volved. Checks that proper shock-proof equipment is available in roomfor use in direct contact with pa-tient's head.

f. Performer makes sure that the re-quest is properly authorized, that

information on requisition sheet iscomplete. Checks whether any spe-cial orders on exposure factors arein keeping with the usual rad ex-posure involved for the examination

g. Depending on institutional proce-dures, performer may review pa-tient's radiation exposure history,prior record of techniques used,and cumulative exposure. Noticeswhether examination has been doneelsewhere in recent past, whethernumber of radiographic exposuresordered or done in past should bebrought to radiologist's atcention.

h. Depending on institutional proce-dures, performer notes whether fe-male patient is pregnant, reviewsdate of female patient's last men-strual period, or notes any otherindication that there is no dangerof exposure of a known or possiblefetus. Notes shielding needed.

i. If referring physician has re-quested that films already on filebe sent with current radiographs,and if not already with patient'sjacketed material, performer ar-ranges to have prior films deliv-ered.

If the p2rformer determines that therequest is not properly authorized, isincomplete, or that suffiuient infor-mation is lacking for performer to se-lect technique or to properly positionor care for patient, or if performerconsiders that there may be contraindications to going ahead with the proce-dure, performer notifies supervisor,radiologist, or other designated staffperson, depending on institutionalprocedures. Explains the problem ifappropriate, and proceeds after obtaining needed information, signature, ororders.

9.1 0


Task Code No. 366


List Elements FullT

When performer is clear about what willbe involved in examination, he or sheprepares ahead so as not to keep patientin examination room longer than neces-sary:

List Elements Full

a. Performer reviews the technique chartfor the machine to be used and takesnote of any newly posted changes intechnical factors (to reflect accom-modation for change in machine out-put or a policy decision).


c. Performer may set up equipment as appropriate for stereographic projec-tions if ordered.

d. Performer makes sure that x-rayequipment is ready for use. Goes tocontrol panel for x-ray generatorand checks that indicator lightshows that machine is "warmed up,"or turns on main switch as appropri-ate to equipment and allows time formachine to "warm up." If appropriate,performer may set radiography modeselector and set collimator controlfor manual operation.

e. Performer checks that appropriate im-mobilization devices such as sand-bags, angle blocks, tape, weightedband, Granger sinus mask or facerest are present, and that there isa mattress, pads, pillows, and/orblankets for comfort of patient ifpatient will lie on table. If appro-priate, obtains protractor, card-board triangles, cassette tunnels.

f. Checks that there is leaded rubbershielding available in room to beused to protect the patient, and/orto place beneath the film holder, asappropriate.

g. Performer prepares for identifica-tion of the films using equipmentprovided b institution:

i) May obtain lead numerals andtape and prepare identifica-tion strip for placement onfilm holder(s) giving appro-priate patient identificationinformation.

ii) Performer may prepare for useof flashcard by checking thatthere is piece of lead on filmholder surface; may write ortype out ID information oncard if not received with req-uisition.


iv) Performer makes sure thatright (R) and left (L) markersare available for use.

4. Performer has the patient calledfrom the holding area and preparedfor the examination (if not alreadydone), or decides to do personally.

a. Depending on institutional ar-rangements, performer may decideto escort out-patient to or fromdressing room. May decide toassist in transporting patientfrom holding area or have thisdone.

b. Performer greets patient and anyaccompanying staff person andintroduces self. Checks patient'sidentity against the requisitionsheet. With in-patient, checkshospital identification braceletor other identifier. If patientis accompanied because of seri-ousness of condition, performerchecks with accompanying staffmember on any special precautionsnecessary during procedure.

c. Has patient assume a comfortableposition seated on table orchair. If patient Ls in wheel-chair, moves chairinto position next to table.If patient is on special


Task Code No. 366


stretcher, places stretcher intoposition so that radiolucent stret-cher can be lifted with patient onit from wheeled base to x-ray table.May arrange to move patient to table.

d. Performer explains to patient whatwill be involved in the procedure;indicates what types of positions thpatient will be asked to assume andthe cooperation that will be askedof the patient.

e. Performer answers patient's non-medical questions honestly; attempts toreassure patient and develop confi-dence. Treats patient with dignityand concern regardless of patient'sbehavior. Remains aware that patientmay be frightened and/or in pain.Performer explains when asked medi-cal questions that it is not appro-priate'far technologist to answerthese; encourages patient to speakto physician.

f. If patient has an IV drip in place,performer checks that needle has notbecome dislodged and that the fluidis dripping at an even rate. Ifthere are any problems, performerlamps tube and notifies an MD or ap

propriate staff person at once. Ifthere is a wet dressing, performerhas it reinforced or decides to dopersonally.

g. If appropriate and not already done,performer questions female patientof child bearing age regarding pos-sible pregnancy. If there is any possibility that petient is pregnantand this has not already been recorded, performer informs appropriatephysician and proceeds only with ap-proval,

h. If not already done, has patientremove dentures, hair pins, spec-tacles, and any jewelry from headand neck. Makes sure that all gar-ments are re:aoved down to below theneck.

List Elements Full

Performer questions patient and/or RNor MD present on what movement is pos-sible to determine what positions areavailable for use.

a. Performer notes whether patient canbe examined in the standard bodypositions called for with the pro-jections ordered; if not, plans tosubstitute alternative body posi-zions to achieve the same projec-tions.

b. Performer notes whether patient canassume erect positions for projec-tions where this is an option.Chooses erect seated position fordemonstrating fluid levels unlessotherwise indicated,such as forcardiac patient.

c. Where erect and recumbent, ortilted positions are ordered, per-former plans to allow enough timebefore exposure to permit exudate tgravitate to its natural level.

d. Observes whether patient is obeseor has a short neck requiring spe-cial.positioning or use of angleblock under film. Notes whetherthin patient will need padding un-der bony prominences.

e. Performer considers the number andtypes of projections ordered forthe examination and the patient'scondition. Performer may consider achange from standard projections tobetter accomplish the purpose ofthe examination, or deletion of aposition, or a change in technical-factors. Depending on institutionalarrangements, performer may obtainpermission from appropriate radiologist or decides personally to alterthe standard procedure.

Depending on whether a bucky or tabletop technique will be used and stan-dard institutional practices, perform-


Task Code No. 366

This is page 5. of 15 for this task.


er selects speed and type of film, grid,and cassette combination.

a. Selects size(s) based on the area(s)to be included, the patient's skullsize, and whether bilateral views areto be exposed on a single film.

b. Performer makes sure that an adequatesupply of loaded casmettes of thetypes and sized selected are avail-able in the examination room. If not,arranges to obtain or decides to ob-tain personally. %



b. May mark midpoint of each cassette(or each half of a cassette to beused for separate bilateral views).Uses radiolucent marker.

c. If bilateral exposures will be madeseparately on one film, performermentally decides how these will bepositioned so that the film need notbe turned for viewing each image.Performer uses leaded rubber sheetsand masks the cassette completelyexcept for the half to be exposed.Treats the half to be exposed fromthis point as though it were the ac-tual film size.

d. If bilateral views are to be projected on a single film for a stereo-scopic examination, performer num-bers or marks cassettes so that theorder of their placement and expos-ure will be correct.

e. Performer attaches identification information to the cassette or tabletop:

i) Places right or left marker onfilm holder or table-Lop as ap-propriate to the study and pro-jection or depresses appropri-ate R or L button for automaticmarking.


iii) If patient idenLification infor-mation is to be entered by useof flasher, sets flashcard asidefor later use with space createdby piece of leaded rubber on ap-propriate edge of cassette.


f. If cassette is to be used withbucky (under tabletop or in uprightholder) performer may manually pullout bucky tray and open retainingclamps. Inserts cassette into buckytray and pushes back. Makes sureclamps are closed. Moves cassetteinto appropriate "stored" positionor inserts cassette tray into buckyslot and centers.

g. If a bucky is not being used, per-former places cassette in a posi-tion that approximates its loca-tion in the final positioning. Ifappropriate to make possible mini-mal moveml!pt of patient, performermay ?lace cassette in upright hold-er at right angles to table top orin other position selected.

h. Performer provides patient andeveryone who will remain in roomduring exposure with protectiveshielding. Explains if necessarythat this is not cause for alarmbut a general precaution to mini-mize unnecessary radiation expo-sure.

8. Performer has patient assume a com-fortable reculTop.mt: or seated position,def:ending on tne positions to be em-ployed, so that the relevant skulldimensions can be measured. Makes sure

23


List Elements Full

Task Code No. 366


that wheelchair is in locked positionif patient is to be positioned in it.

a. If appropriate, places mattress, pil-low, or clean linen on x-ray table.

b. Performer may decide to assist pa-tient from wheelchair or stretcher totable or has this done. May obtainhelp. Makes sure that no equipment isin the way and may be collided withby patient.

c. If assisting patient to step on foot-stool in order to get on table, helpspatient turn into position, stepbackwards on stool, and then sit and/or lie on table.

d. Performer uses centimeter calipersto measure the thickness of thepart(s) to be radiographed in thedirection in which the central rayof the x-ray beam will pass throughthe centered part from tube to film.Re -Ids for use in determining ex-posure factors.

e. After measuring, has patient rest inas relaxed a position as possible.May place pad, blanket or pillowunder bony prominences to providecomfort.

Performer selects the exposure factorsfor the first projection by consultingthe technique chart(s) posted for themachine:

a. Locates the information needed forthe body part awl projection in-volved according to the centimeterthickness or the part as measuredand the collimated field size to beused. Makes sure that technique re-lates to the combination of filmtype and speed and use or nonuse ofother accessories (si-J1 as screens,grids, bucky, etc.).

b. Makes note of the kVp, mA, T(secondsof exposure time), focal spot size,and the focal film distance (TFD or

POW,

2 1.

List Elements Full

FFD) called for. Makes note of anydifferenr,.. between FFD for pre-operative measurements and otherpurposes and uses relevant dis-tance as appropriate.

c. Once the standard kVp, mA and timehave been determined, performernotes whether any conversions arenecessary to account for a patho-logical condition, change in TFD,preference of the radiologist in-volved, and any other conversionneeded. Performer looks up numeri-cal conversion factors and calcu-lates, or uses conversion chartsto ascertain the appropriate newexposure factor (kVp, mA and/ortime). Multiplies, divides, adds,or subtracts as appropriate.

d. Performer checks any new or unfam-iliar exposure factors against theposted limits of the x-ray tube ona tube rating chart to be surethat technique does not exceed theheat capacities of the tube forthe focal spot size to be used. Ifappropriate, performer reconvertsthe technique to an equivalent out-put using higher kVp and lower

10. Performer sets exposure factors as selected:


b. If appropriate, checks line voltegmeter and, if needed, turns compensator dial until needle is alignedproperly on lind meter,

c. For zo-,..ventional expo3ure control:

i) Performer sets milliamperageby choosing selectors for thecorrect focal spot size; setsthe mA selected.


List Elements Full

This is page

TAsk Code No. 366

15 for this task.


iii) Performer sets the kVp select-ed by choosing the combinationof major kilovoltage and minorkilovoltage settings to producethe desired kVp.


i) Performer selects and sets thecategory corresponding to thetype of study and use or nonuseof screens, bucky, etc., and,if appropriate,focal spot size.



iv) Sets a density selector corres-ponding to the usual (or spec-ial) requirements for thestudy.

v) Makes sure backup-timer is notlikely to terminate exposurebefore phototimed exposure ismade.

e. Depending on the equipment, may setcontrols to provide for use ofbucky, manual tableside adjustmentof table and tube height, position,and of collimation, unless thesehave already been set.

f. Performer returns to overhead unit;sets the focal-film distance,if notalrealy done, as appropriate to pur-pose of the study. Operates controlsor manually moves the x-ray tubeinto place over the film holder (orat right angles to upright holder).Checks focal-film distance by read-ing indicator scale in the tubehousing; adjusts up or down untilthe required FFD (TFD) is obtained.

11.

List ElemeaLLIally

Performer prepares the part to be ra-diographed in the position selectedfor the first (or next) exposure (un-less this is done by physician):

a. May explain or demonstrate to pa-tient' what is required. May obtainhelp in positioning.

b. Performer positions patient byfirst positioning body and thenpositioning head. In positioningbody, performer proceeds as fol-lows:

i) For positioning patient in APor PA supine or erect posi-tion, performer arranges bodyso that its median sagittalplane is centered to the mid-line of table or film holder.For lateral positioning hasmedian sagittal plane ofbody lie parallel to the mid-line.

Supports any elevated parts.Has erect seated patientsdistribute weight evenly onboth buttocks.Has erect patient face filmholder for PA projection andface away from film holderfor AP projection.

ii) Has prone patient flex elbowsplace arms in a comfortableposition. Supports ankles.Rests patient's head on fore-head and nose. May have pa-tient rest hands beneathchest.

Has semiprone patient reston forearm and flexed knee ofelevated side; supports ankleand flexed knee.Has supine pat!ent placearms in a comfortable posi-tion and supports ankles andkneg.s.

For oblique erect positionadjusts body to make possible


Task Code No, 366



correct angulation of the head.Places arms in comfortable position.

iii) For thin patient in recumbent

iv) PerLormer marks or definesthe acanthiomeatal line asthat connecting the externalauditory meatus and the acan-

lateral, PA,and oblique posi- thion.tioning, performer may elevate v) Performer defines the inter-chest so that the cervical ver- pupillary line as the trans-tebrae are at a correct level,

iv) With all positions arrangesverse line which connects thepupils of the eyes when the

shoulders to lie on a single patient is looking straighttransverse plane. ahead, with the nasion at its

v) For obese patient performer midpoint.positions in seated erect posi- vi) Performer defines the glabel-tion when possible. Uses a por- loalveolar line as that con-table cassette holder if pos- necting the most prominentsible in the vertical or hori- point in the midsagittalzontal position to obtain a cor plane between the eyebrowsrect part-film distance withoutmagnification. Adjusts tube pos

and the most prominent pointin the midsagittal plane of

ition as appropriate. If not the upper alveolus.

I

able to achieve correct part- vii) Performer immobilizes skullfilm distance, performer adjust- with a head clamp or a weight-focal-film distance to compen- ed band and rechecks angula-sate.

c. In positioning head, performer re-tion and position. Uses exten-,sion cone in direct contact

fers to standard reference lines. with head when appropriateMay use wax marker to draw in refer for immobilization (as wellence lines or points of skull, or as for proper collimation).visualizes mentally. Has patient Rechecks positioning afterfirst relax muscles of neck and immobilizing.then moves head gently. d. Performer centers part and keepsi) Performer defines the median the long axis of the part parallel

sagittal plane of the skull by to the film holder. When using areferring to the sagittal line bucky, centers patient to midline.connecting nasion, acanthion I,

and symphysis menti (mentalWith cassette on table top, cen-ters film to part. With upright

point),ii) Performer marks or defines the

holder, adjusts height of holderto part and centers part to film.

orbitomeatal line for reference May obtain help in positioning.as that connecting the external i) In setting tube angulationauditory meatus and the outer performer measures the anglescanthus of the patient's eye. between the central ray and

iii) Performer marks or defines the reference lines on the pa-infraorbitomeatal line by find- tient's skull, such as theing the line connecting the ex- orbitomeatal or interpupil-ternal auditory meatus and the lary lines. Checks skull rota-infraorbital margin. May pal- tion by measuring the anglepate to find infraorbital mar- between the horizontal plane:in.


Task Code No. 366

9This is page of 15 for this task.

List Elements Fully

or the vertical central ray andthe median sagittal line.

ii) In centering and directing thecentral ray for stereoscopicexamination, performer centersand adjusts the central ray atthe angle for a single planestudy. For first exposure movescentering point the correctdistance in the appropriatedirection (such as lateralwardor posterior); then increasesor decreases the angle as ap-propriate. For the second expo-sure, removes the first casset-te and replaces with a secondcassette. Starts again fromsingle plane angulation;shiftscentering in the opposite di-rection for the same distance,and changes the angulation inthe opposite direction (in-creases or decreases). For bi-lateral studies on single cas-settes, has the first cassetteinclude both sides shifted inthe same direction and the sec-ond cassette including bothsides shifted in the oppositedirection, so that each casset-te has bilateral views with acommon shift direction; makesa total of four exposures foreach study.

iii) If pre-operative measurementsare to be taken from the radio-graphs, perflrmer takes spec-ial precal:cions in measuringangulation. Uses triangles,rectangles, and protractors tocheck every angle or,lineplacement.

12. Performer pc.,tions as follows (unlessnonconventioltal positioning is beingused to avoif' having patient move):

a. For a lattral projection of theparanasal sinuses, performer has

List Elements Full

patient seated in a true lateralposition before vertical cassette,with side of interest against cas-sette; may have patient lie insemiprone position or sit with headresting on a horizontally placedcassette on side of interest.Performer has patient rest head onthe parietal eminence. Centers cas-sette or stereo cassette-changingtunnel to the outer canthus of theside of interest. Uses carefulmeasuring to place median sagittalplane of head parallel with theplane of the film,and the inter-pupillary line at right angles tothe plane of the film. Directscentral ray at right angles to themidpoint, entering at the outercanthus of the uppermost side.For stereographic views,takesfirst exposure with tube centeredas for single plane study. Shiftstube in posterior direction forsecond view. Reminds patient toretain position for second viewwhile cassette is changed orshifted. If a bilateral study hasbeen ordered, performer sets upsimilarly for opposite side later-al view.

b. For a PA projection (posteriorview) of the paranasal sinuses,performer notes area of interestand whether Granger sinus mask orsimilar face rest will be used.For stereoscopic projections makestube shifts in transverse or long-itudinal direction.i) For PA projection of the

frontal sinuses and anteriorethmoidal cells, performerhas patient assume a seatedor prone PA position. Has pa-tient rest head on the fore-head and nose, adjusted sothat median sagittal plane isat right angles to the plane


This is page

Task Code No. 366



of the film. Centers to thenasion. Adjusts flexion so thatthe orbitomeatal line is atright angles to plane of film.Directs central ray to glabellaat 15° caudad or as ordered.

ii) For PA projection of the sphe-noidal sinuses, performer haspatient assume a seated orprone PA position. Has patientrest head on forehead and nose,adjusted so that median sagit-tal plane is at right angles tofilm. Centers to the glabella.Adjusts flexion so that the orbitomeatal line is at rightangles to the plane of thefilm. Directs central ray toexit at the glabella at 10°-12°cephalad or as ordered.

iii) For a PA projection of the posterior ethmoidal cells, per-former positions as for (i),above, but directs central rayat right angles to the midpointof the film, entering in theoccipital area.

iv) For a PA projection of theantra (maxillary sinus?s) andthe anterior ethmoidal cells,performer positions as for (i),above, but centers to themedian saggital plane at alevel midway between the infraorbital margins and the acau-thion. Directs central ray atright angles to the midpointof the film.

v) For a PA projection of thesphenoids, posterior ethmoids,and antra using a sinus maskfor positioning, performerplaces a Granger or similarface rest for the sinuses on a17° angle block directed cran-ially. Places cassette in position and immobilizes block.Has patient assume a seated or

prone PA position with facelying on sinus mask so thatnose projects through openingand face rests on the glabel-la and the upper alveoLus.Locates a point on the mediansagittal axis at the 1e-Je1 ofa line passing through thefloor of the external auditorymeatus. Directs central ray atright angles to that point orat cephalad angulation ordered.

c. For a PA parietoacanthial projec-tion (anterior view) of the maxil-lary sinuses (antra), performerpositions patient in erect seatedPA position with the chin restingon cassette, cassette tunnel ortable top. Adjusts so that mediansagittal plane is vertical. Placeshead so that the orbitomeatal lineforms a 37° angle with plane offilm. Checks to be sure that headis extended so that a line connect,ing the external auditory meatusto the mental point is at rightangles to the plane of the film.Centers cassette to the acanthion.Directs central ray at right an-gles to the midpoint of the film,entering the vertex and emergingat the acanthion.

For a study of questionable shad-ows, performer may tilt the headlaterally to one side or the otherso that the median sagittal planeforms an angle of 30° to 40° withthe horizontal plane. For stereoprojections makes tube shifts intransverse or longitudinal direc-tion.

d. For an axial view of the paraddsalsinuses,performer selects PA or-APpositioning, erect or recumbent.

i) For a verticosubmental projec-tion of the paranasal sinuses,primarily sphenoid sinuses


Task Code No. 366

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and/or hyoid bone, performerhas patient assume a prone orseated PA position with headextended over a horizontallyplaced cassette. Performer elevates the side of the cassette

_adjacent to the patient so thatthe extension of the throatprovides the minimal part-filmdistance. Centers film to thethroat midway between mastoidtips. Adjusts head so that median sagittal plane is vertical.Directs central ray at rightangles to the infraorbitomeataline, centered to the intersection of the median sagittalplane and a coronal plane con-necting the sella turcica andthe angles of the jaw.

ii) For a submentoverttcal projec-tion of the paranasal sinuses,performer has patient assume aseated erect or supine AP position. For seated erect patient,performer places a low-backchair far enough away from thecassette holder to allow asemi-upright position,with pa-tient leaning back and restingthe vertex of the skull againsthe film holder. For supine patient, elevates torso so thathead can be extended completelwith .head resting on the ver-tex. Flexes patient's knees.Performer supports head afteradjusting central ray angula-tion,and repositions only whenready to make exposure so asto keep strain on neck to aminimum.Adjusts head so that mediansagittal plane is at rightangles to film and so that theinfraorbitomeatal line isclosely parallel to the planeof the film. Adjusts the cen-

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tral ray angulation to be atright angles with the infra-orbitomeatal line, centeredto the sella turcica f;oronalplane passing 3/4 inch anter-ior to external auditorymeatus). Centers film to cen-tral ray. Directs central rato enter the median sagittalplane of the throat betweenthe angles of the mandibleand th e. sella turcica. May

'ead with tapeplaced oLt %e chin andanchored to t' a sides of thetable or fiE. h lder.

e. For semiaxial PA pr.,Joctions (an-terior view) of tho ne- ,nasalsinuses, performer r!ores area ofinterest and whethet (ranger sinusmask or similar fac:a will beused.

i) For semiaxial PA projectionof the frontal anterior eth-moid and maxillary (antra)siauses using a sinus mask,performer positions patientund equipmnt as in (b,iv),above,with angle block ot a23° caudal angle. Directscntral ray vertically to a

in midway between the in-fraorbie.rl'margins.

ii) For a semiaxial transoral projection of the sphenoidsinnses, Fuls patient assumeseated erect or prone PA posit:Jn. For prone positioning,prepares cassette on a caudally inclined angle blockcovered with saLitary, radio-lucent paper. PerforAer haspatient re:zt after adjustingfilm and central ray angula-tion, and repositions onlywhen ready to make exposure.Has patient rest nose andchin firmly on cassette, rith

TASK DESCRIPTIO SHEET (continued)

Task Code No. 366

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median sagittal plane vertral.Has patient open mouth wide.Centers to the open mouth. Dir-ects central ray along a lineconnecting the sella turcica tothe center of the open mouth atthe median sagittal plane. Justbefore exposure performer im-mobilizes head. Has patientopen mouth as wide as possibleand practice phonating thesound "ah-h." Rechecks positionof head.

f. For oblique projections of the pare-nasal sinuses, performer notes areasof interest and whether bilateralviews are ordered.

i) For an oblique projection ofethmoid, frontal,and sphenoidsinuses, performer has pati-ntassume seated or prone PA posi-tion. Has patient rest head onthe zygoma, nose and chin. Centers unmasked half of film tothe orbit on the side of interest. Adjusts flexion of head sothe acanthiomeatal line is parallel with the transverse axisof the film. Adjusts rotationso that the median sagittalplane forms an angle of 530iiith the plane of the film.Directs the central ray atright angles to the midpoint othe film, entering at the uppeparietal region. After firstexposure positions other sideof film to the opposite orbitam.: sets up similarly.

ii) For an inferosuperior obliqueprojection of the floor of theantrum showing its relation-whip to the teeth, performerhas patient assume prone orseated position with head resting on horizontally placed cassette. Has patient extend chinand rest on chin, nose, and

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zygoma. Centers the regionof the antrum on the side ofinterestto the unmasked halfof the film. Dit:ects centralray to midpoint of film at25° to 300 cephalad, enteringjust behind the angle of thejaw on the uppermost sid.o.After first exposure positionsother side of film and patientsimilarly for view of oppositside.

13. If, during positioning, patient showssigns of severe pain, performer maynotify appropriate physician at onceand await orders, or may decide on alternative positioning to avoid move-ment of the affected part.

14. Performer checks final positioningusing triangles, protractor and lightin collimator. Activates the collima-tor light and points the light beamtowards the part. Adjusts the collimator opening to correspond to the filmsize (or the size of the unshilded g

area of the film to be exposed,. Uses'cross-hair shadows as reference forcenter of field. Uses the collimatorlight to center the patient to thex-ray field, or centers the part tothe film holder and uses the dollima-,,tor light to center the tube to v:lepart. Rechecks angulation of head andcentral ray. Checks that the prima7ybeam will enter the center of the nreof interest at the selected angle L.)the film so as to project the view desired. May readjust tube positionlengthwise or crosswise to providebetter centering.

15. Once the patient has been positionedand immobilized, performer adjuststhe collimator. Either collimates sothat a small unexposed border will apppar around the edge of the film or


Task Code No. 366


I7.177raelne"sFuqirmla

collimates further so as"to expose onlythe area of interest (and thus providemaximum protection and detail). Forsmall fields (if not already done inpositioning) perform.r_attaches an aux-iliary extension cone to collimator tofurther reduce the primary beam. Ad-justs primary beam to minimum sizeneeded to cover the part(s) of inter-est.

16. Performer adds lead shielding to areasthat will be in the primary path ofthe beam but are not included in theareas of interest. Makes sure thatproper protectii.e shielding has beenprovided to patient and everyone whowill remain in room.

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1 . Throughout procedure performer observespatient for any signs of emergency and/or to prevent or respond to an acci-dent. Is alert to signs of nausea, dizizinE.ss, or,sweat suggesting faintness. IPerformer may have patient lie dowa,lower head, or raise legs. Notifiesnurse. If patient shows any other emer-gency signs, loses consciousness, orhas an accident, performer calls appro-priate physician or staff member atonce. May decide to provide emergencyfirst aid as well. If a patient's cath-eter becomes disconnected, performerclamps it and immediately notifiesnurse. If catheter should come out,nutifies staff member at once.

18. When everything is ready for the expo-sure, performer reviews with patientwhat breath control will be used forexposure:

a. Performer has patient hold breathuntil told to relax by performerfor all projections except as fol-lows:

For semiaxial transoral projectionof the spheno:d sinuses, performer

has patient open mouth wide andsoftly phonate the sound "ah-h"during the exposure as rehearsed.Rechecks position and anguiation.

b. Reminds patient about those posi-tions which are to be maintainedfor a second exposure.

c. Performer observes the patient'smovement until the moment that theexposure is made. Readjusts posi-tion if warranted.

19. The performer returns to control roomMakes sure controls are properly setand patient is still in poSition.Tells patient when to breathe as in-structed by calling or using intercomPerformer initiates exposure by pressing hand trigger or exposure controlbutton.

a. While exposure is underway performer checks that mA meter records appropriate current as set, that kVpmeter dips slightly.

b. May watch for evidence of malfunc-tion such as line surge or exces-sive drop; may listen for sound ofnormal functioning of equipment.If there is malfunction, may de-cide to report; anticipates needto repeat exposure.

c. With phototimer notes whether backup timer has been involved interminating exposure before photo-timed exposure was completed. Ifso, anticipates possible need torepeat exposure (due to underexpo-sure if premature cut-off, oroverexposure due to faulty timer).




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Task Code No. 366


2 . Performer returns to patient. Removescassette or film holder from table,floor, or bucky.

a. Removes any markers for further use.If Wateral views are to be takenon the film, removes leaded rubbermask and remasks all but next areato be exposed.

b. If requested, performer arranges tohave the first exposure(s) processedat once and brought to the appropri-ate radiologist or viewed wet indarkroom.

c. If the first radiograph(s) are pre-liminary (scout) films, or are tobe viewed wet, performer bringsthe processed radiograph(s) directlyto the radiologist in charge,placeson view boxes and/or arranges tohave viewed in darkroom; informsradiologist that the radiographsare ready. If the radiologist indi-cates that there is any problem witthe technical factors, processing,or patient positioning, performerrecords or notes for later use inthe examination and/or repeats pre-liminary radiography as ordered.

d. Depending on whether r.-tiaologistwill evaluate radiographs beforecompletion of.all possible exposurefor the series, performer arrangesto process film(s) and evaluate forquality control personally, havethis done, or bring to darkroom forprocessing and later evaluation,based un time available, institu-tional arrangements, or specific instructions. Attaches ID card foruse with flasher if appropriate.May sign requisition.

e. While films are being processed andor evaluated,performer has patientrelax in examination room or hold-ing area. Explains what will happennext.

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i) Performer determines whether ptient should remain on tableand/or in room or requires -b-servation. May consult re'xisi-tion sheet or attending RN. Ifappropriate, makes sure thatpatient will be attended whilewaiting.

ii) If appropriate, moves x-raytube and any protruding filmholder away from patient beforepatient rises.

iii) May decide to assist patient tochair or stretcher or fromtable. Makes sure patient isreminded of any footrest instepping off table.

21. Whet (or if) performer learns from thradiologist whether further conven-tional views and/or positions can beundertaken, eliminated or altered,performer proceeds as appropriate ac-cording to instructions.

a. For further exposures performer rpeats appropriate steps for nextview(s) including identificationof film holder or cassette and useof R-L marker, selection and set-ting of technique for next view(if different), positioning patienand equipment for focus-oLject-film alignment, proper collima'-ionand shielding, breathing instruc-tions, and making exposure, as :la-scribed above. For bilateral expo-sures on one film, keeps R-L ref-erence constant; centers using thepoint marked earlier on the cas-sette.


c. If performer is asked to repeatany exposures, makes sure that theadditional exposures are warranted


Task Code No. 366



medically, since additional radia-tion will be incurred.

i) Notes whether need to repeat isdue to performer's own negli-gence or lack of attention sothat performer can avoid future"retakes."

ii) If request for retakes reflectsmalfunctioning equipment, per-former repOrts malfunction toappropriate staff member.

iii) If request.for retakes reflectsthe preference for density orcontrast of a radiologist, per-former notes for future workdone for the given radiologistso-that retakes can be avoided.

d. Performer may arrange to have thefull set of pro(:essed radiographsreviewed by a radiologist so thatany additional views required canbe made at once,.

22. When performer is sure that the ex-amination has been completed, perform-er may have patient transported backto holding area or next location, ordecides to do personally, as appropri-ate. Makes sure that none of theequipment is projecting over the pa-tient before allowing patient to risefrom stool or table, and assists pa-tient as described above.



b. Performer records Lhe examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken,thetechnical factors used and filmsizes; may record the number of ex-

posures made of each view includ-ing retakes; may enter the esti-mated radiation dose to which pa-tient was exposed (using postedinformation on dosage); may recordany problem with equipment, anyspecial care provided patient. Ifany views called for in the ini-tial request could not be obtainedperformer may record reasons.Signs requisition sheet.

C. If performer will only carry outpreliminary "scout" filming andanother technologist will continuewith examination, performer re-cords the approved technical fac-tors used for the scouts, and theaccessories employed, or informstechnologist who will continue.Performer gives the requisitionsheet, name card, and any notes totechnologist who will continue).-ith procedure.



I.


Task Code No. 367



Requisition reviewed;pt. reassured,positioned;partsmeasured;films identified;technical factors selectedand set;head immobilized;exposures made;radiographssent for processing and evaluation;procedures re-peated as appropriate for full set of views;patientreturned;examination recorded;radiographs placed foruse.

2. What is used in performing_ this task? (Noteif only certain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Pt.'s x-ray requisition sheet,ID card,ID bracelet,technical history;pen;x-ray machine control panel(s),tube,table,collimator,extension cones;techniquechart;charts for conversion of technique,standard ex-amination views,dosage,tube capacity;cassette or non-Iscreen film holders;periapical dental film laolders;upright film holder;leaded rubber shielding;R-L andID markers;immobilization devices;head clamp;weight-ed band;tape;chair;calipers;protractor;scissors;film changing tunnel;stretcher or wheelchair

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...(30 No...( )

4. If "Yes" to q. 3: Name the kind of recipient,respondent or co-worker involved, with de_




Taking preliminary localization radiographs of for-eign bodies in orbit or eye of non-infant patient byreviewing request;reporting observed contraindica-tions;reassuring pt.;measuring part;selecting andsetting technical factors;identifying film;position-ing pt. and equipment for seated or recumbent expo-sure;providing shielding;collimating;making exposure;having radiographs processed and reviewed;repeatingfor full set of views or as ordered;having pt. re-turned;placing radiographs for use;recording exami-nation.

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Performer receives or obtainsthe x-ray requisition form, pa-tient's identification card, andany appropriate medical-techni-cal history for a non-infant pa-tient scheduled for preliminaryradiographic localization offoreign bodies in the orbit oreye:

a

1.

After checking assignment onschedule sheet.From co-worker.After having arranged requi-sitions in order of priority.

The plain film may serve aspreliminary "scouts" for morespeciulized procedures usingspecial equipment.

Performer reads the iequisi-tion sheet to determine theexaminationsalled for, pur-pose, the patient involved,special considerations, andto check the completeness ofthe information provided:

a. Performer checks the ex-aminations called for in-cluding the method to use,the suspected location ofthe object(s), the patientpositions and vi.ews calledfor, the number of expo-sures and the central beamangulation. Notes whetherthere will be severalviews on a single film,whether the use of a gridwill be involved. Checksthe name of the rei,--ingphysician.

OK -RP;RR;RR


is a master sheet..(X


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Task Code No. 367


b. Performer reads patient's name, iden-tification number, sex, age, andweight. Notes whether patient is in-patient, out-patient, accident oremergency patient. Notes any specialinformation that will affect patientpositioning, technique, or handlingof the patient, such as presence ofaccident iujuries, unhealed or sus-pected fracture, degenerating di-sease, whether patient will be on astretcher or wheelchair, and thenature of any known pathology whichwould affect technique.

c. With patients with accident injuriesor unhealed fractures, performer maymake sure that a surgeon or radiolo-gist is available to position thepatient; checks whether rotation and/or extension of head is contraindi-cated.

d. Performer checks whether patient issuffering from a collateral condi-tion requiring special handling,suchas heart disease, communicable orinfectious condition, infirmity, in-coherence; whether patient has IVdrip, oxygen supply, urinary cathe-ter or similar device in place;noteswhether patient will be accompaniedby nursf._ or other staff person.

e. If periormer is not already assignedto examination room (and a particu-lar machine) notes the room or ma-chine involved. Goes to examinationroom or control room for machine in-volved. Checks that proper shock-proof equipment is available in roomfor use in direct contact with pa-tient.

f. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheet iscomplete. Checks whether any specialorders on exposure factors are inkeeping with the usual rad exposureinvolved for the examination.

g. Depending on institutional proce-dures, performer may review pa-

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tient'r. radiation exposure history,prior record of techniques used,andcumulative exposure. Noticeswhether examination has been doneelsewhere in recent past, whethernumber of radiographic exposuresordered or done in past should bebrought to radiologist's attention.

h. Depending .on institutional proce-dures, performer notes whether fe-male patient is pregnant, reviewsdate of female patient's last men-strual period, or notes any 3therindication that there is no dangerof exposure of a known or possiblefetus. Notes shielding needed.

i. If referring physician has request-ed that films already on file besent with current radiographs, andif not already with patient'Ejacketed material, perform..7.ranges to have prior films deliver-ed.

2. If the performer detervlines that therequest is not properly authorized,incomplete, or that sufficientjanfor-mation is lacking for performer toselect technique or to properly, posi-tion or care for patient, or if per-former considers that there may bl contraindications to going ahead with theprocedure, performer notifies super-visor, radiologist, or other desig-nated staff person, depending on in-stitutional procedures. Eyplains theproblem if appropriate, and proceedsafter obtaining needed information,signature, or orders.

3. When performer is clear about what wilbe involved in examination, he or sheprepares ahead so as not to keep pa-tient in examination room longer thannecessary:

a. Performer reviews the techniquechart for the machine to be usedand takes note of anriy...._j_u_Uneve


Task Code No. 367

This is page 3 of -11 for this task.


.

,

-changes in technical factors (to re-Elect accomodation for change in ma-chine output or a policy decision).

b. Performer washes hands as appropri-ate; may decide to arrange for orcarry out isolation or decontamina-tion techniques.

c. Performer goes to control panel forx-ray generator. Makes sure thatx-ray equipment is ready for usa.

d. Performer checks that appropriate de-vices such as head clamp, weightedband, cassette tunnel, protractor,mattress, pads, pillows, leaded rub-ber shielding and glov..s are avail-able in room.

e. Performer prepares 'or identifica-tion of the films using equipmentprovided by institution:

,. i) May obtain lead numerals and tape,- and prepare identification strip

for placement on film holder(s)giving patient identification in-formation.

ii) Performer may prepare for use offlashcard by checking that thereis piece of lead on film holdersurface; may wrie or type out IDinformation on card if not re-ceived with requisition.


iv) Performer makes sure that right(R) and left (L) markers are available for use.

. Performer has the patient called fromthe holding area and prepared for theexamination (if not already done), ordecides to do personally.

a. Depending on institutional arrange-ments, performer may decide to es-cort out-patient to or from dressingroom. May decide to assist in trans-porting patient from holding area urhave this done.

b. Performer greets patient and anyaccompanying staff person and introduces self. Checks patient's iden-tity against the requisition sheet.With in-patient, checks hospitalidentification bracelet or otheridentifier. If patient is accompan-ied because of seriousness of con-dition, performer checks with ac-companying staff member on any spe-cial precautions necessary.

c. Has patient assume a comfortablepositirn seated on table or chair.If patien- is in wheelchair, movespatient in chair into position nextto table. If patient is on specialstretcher, places stretcher intoposition so that radiolucentstretcher can be lifted with pa-tient on it from wheeled base tox-ray table. May arrange to movepatient to table.


e. Performer answers patient's non-medical questions honestly; attemptsto reassure patient and develop confidence. Treats patient with dig-nity and concern regardless of pa-tient's behavior. Remains awarethat patient may be frightened and/or in pain. Performer explains whenasked medi,!al questions that it isnr.t appropriate for technologist toanswer these; encourages patient tospeak to physician.

f. If appropriate and not already done,qt:^3tions fEmale patient of childbearing age regarding possible pregnancy. If there is any possibilitythat patient is pregnant and thishas not already been recorded, in-forms appropriate physician and proceeds only with approval.


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Task Code No. 367


g. If not already done, has patient re-move dentures, hair pins,spectacles,and any jewelry from head and neckand has all garments removed down tobelow the neck.

Performer questions patient and/or RNor MD to deterolne what positions areavailable for zse.

a. If patient is an accident victim andarrives on stretcher or bed, performer plans for radiographic positioninof film and x-ray tube with patienton stretcher and without rotatinghead or torso.

b. Notes whether patient can assumeerect seated positions for projec-tions where this ic an option orwhether recumblnt position is preferable, such as with cardiac patients.

c. Performer may consider a change fromstandard projections to better accomplish the purpose of the examina-tion, or deletion of a position, ora: change in technical factors. De-pending on institutional arrange-ments, performer may obtain permis-sion from appropriate radiologist ordecides personally to alter thestandard procedure.

. Depending on institutional practicesperformer selects speed and type offilm, grid, and film holder combina-tion:

a. Selects size(s) based on area to beincluded, and whether several viewsare to be exposed on a single film.

b. Performer makes sure that an ade-quate supply of nonscreLn or cas-sette holders and/or periapicaldental films of the types and sizesselected are available in the ey-amination room. If not, arrangesto obtain or decides to obtaia per-sonally.


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a. Performer obtains the appropriatesize loaded film holder for thefirst projection.

b. If more than one exposure will bemade sepatately on one film, per-former mentally decides how thesewill be positioned so that the filmneed not be turned for viewing eachimage. Performer uses leaded rubbersheets and masks the cassette com-pletely except for the area to beexposed. Treats the area to'be ex-posed as though it were the actualfilm size.

c. Attaches identification informationto the film holder or packet:i) Places right or left marker on

film holder as appropriate tothe study and projection or de-presses appropriate R or L but-ton for automatic marking.

ii) If patient's identification in-formation is in the form of leadnumerals, performer places onappropriate'corner of holder orpacket.

iii) If patient identification infor-mation is to be entered by useof flasher, sets flashcardaside for later use with spacecreated by piece of leaded rub-ber on appropriate edge of cas-sette.

iv) Parformer may place patient'scard into card tray if equiprenthas automatic film marker.

d. Performer places film hold_r in ap-propriate final position in uprightfilm holder or oli table top, orplaces for later use.

e. Prformer provides patient andeveryone who will remain in roomduring expoEmre with protectiveshielding. Explains if necessarythat this is not cause for alarmbut a general precaution to mini-mize unnecessary radiation expo-sure.


Task Code No. 367


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8. Performer has patient assume a comfort-able recumbent or seated position, de-pending on the positions to be employ--ed, so that the relevant skull dimen-sions can be measured. Makes sure thatwheelchair ts in locked position if pa-tient is to be positioned in it.

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b. Performer may decide to assist pa-tient from wheelchair or stretcherto table or has this done. May ob-tain help. Makes sure that no equip-ment is-in the way and may be Col-lided with by patient.


d. Performer uses centimeter calipersto measure the thickness of thepart(s) to 1sP radiographed in thedirection i Lich the central ray

the x-r .eAM will pass throughcente,,.: part from tube to film.

Rx,..cords for use in determining ex-posure factors.

After measuring, has patient restin as relaxed a position as pos-sible. May place pad, blanket orpillow under bony prominences toprovide comfort.

9. Performer selects the exposure factorsfor the first projection by consultingthe technique chart(s) posted for themachine:

a. Locates the inf'ormation needed forthe body part and projection in-volved according to the centimeterthickness of the part as measuredand the collimated field size tobe used. Makes sure that techniquerelates to the combination of film

type and speed and use or nonuseof other accessories.

b. Makes note of the kVp, mA, T(sec-onds of exposure time), focal spotsize, and the focal film distance(TFD or FFD) called for.

c. Once.the standard kVp, mA and timehave been determined, performernotes whether any conversions arenecessary to accOunt for a patho-logical condition, chav3e in TFD,preference of the radiologist in-volved, and any other conversionneeded. Performer looks up numer-ical conversion factors and cal-culates, or uses conversioncharts to ascertain the appropri-ate new exposure factor (kVp, mAand/or time). Multiplies, divides,adds, or subtracts as appropriate.

d. Performer checks any new cr unfam-iliar exposure factors against theposted limits of the x-ray tube ona tube rating chart to be surethat technique does not exceed theheat capacities of the tube forthe focal spot size to be used.If appropriate, performer recon-verts the technique to an equiva-lent output using higher kVp andlower mAs.



b. If appropriate, checks line volt-age meter and, if needed, turnscompensator dial until needle isaligned properly on line meter.

c. Performer sets milliamperage bychoosing selectors for the cor-rect focal spot size; sets the mAselected.


Task Code No. 367



ii) For lateral views places med-ian sagittal plane of bodyparallel with midline. Sup-ports elevated parts if supine.

iii) Has semiprone patient rest on

d. Performer selects and sets the ex-posure time that will produce themAs desired.

e. Performer sets the kVp selected bychoosing the combination of majorkilovoltage and minor kilovoltage forearm and flexed knee ofsettings to produce the desired kVp. elevated side and supports an-

f. Depending on the equipment, may set kles and flexed knee.controls to provide for use of man-ual tableside adjustment of table

iv) Has prone patient flex elbws,place arms in a comfortable

and tube height, position, and of position. Supports ankles.collimation unless these have al- Rests patient's head on fore-ready been set. head and nose. May have pa-

g. Performer returns to overhead unit tient rest hands beneath chest.and sets the focal-film distance (if v) If patient is thin, and willnot already done). Operates controlor manually moves the x-ray tube in

be in recumbent position, per- ,former may elevate chest so

to place over the film holder. that cervical vertebrae are atChecks the focal-film distance by correct level.reading indicator scale in the tube vi) Performer positions obese pa-housing; adjusts up or down until tients in seated erect posi-the required FFD (TFD) is obtained. tion unless otherwise pre-

h. Supplies leaded glove to patient if scribed. Uses film holder inpatient will hold periapical *.ilm i vertical or horizontal posi-place. tion if possible.

vii) For all positions arranges11. -Performer prepares the part to be ra- shoulders to lie on a single

diographed in the position selectedfor the first (or next) exposure.

transverse plane.

c. In positioning head, performera. May explain or demonstrate to pa- refers to standard reference

tient what is required. May obtain lines. Has patient relax muscleshelp in positioning or has MD posi- of neck and then moves head gent-tion in accident and fracture cases

b. Performer positions patient byfirst positioning body and then po-

ly into position.

i) Performer defines the orbito-sitioning head. In positioning body meatal line for reference byperformer proceeds as follows: finding the line connecting

the external auditory meatusi) For PA positioning, prone or and the outer canthus of the

seated, performer arranges body patient's eye. .

so that its median sagittal ii) Performer defines the medianplane is centered to the midline sagittal plane of the skull byof table or film holder. Has referring to the sagittal lineseated patient face tilm holder connecting nasion, acanthionwith weight distributed evenly and symphysis menti (nentalon both buttocks. point).

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Task Code No. 367



d. Performer immobilizes skull with ahead clamp or a weighted band andrechecks angulation and position.Uses extension cone in direct con-tact with head for immobilization(as well as for proper collimation).

e. Performer centers part and keeps thelong axis of the part parallel tothe film holder. Centers patient tomidline. With film holder on tabletop, centers film to part. With up-right holder, adjusts height ofholder to part and centers part tofilm. May obtain help in position-ing.

f. In setting tube angulation perform-er measures the angles between thecentral ray and refefence lines onpatient's skull. Checks skull rota-tion by measuring the angle betweenthe horizontal plane or the verti-cal central ray and the median sag-ittal line.

12. Performer positions as follows:

a. For a preliminary examination, per-former plans to make lateral, PAand bone-free projections unlessotherwise specified. Notes whetherPA projection is to be done in forehead-nose or chin-nose position.For bone-free projections preparesperiapical dental films.

i) For lateral projection, perform-er has patient assume semiproneor erect seated position withouter centhus of the eye of in-terest next to film. Centers midpoint to the outer canthus. Ad-justs head so that median sagit-tal plane is parallel with theplane of the film. Directs cen-tral ray at right angles to thefilm through the outer canthi.Immobilizes head as described.Performer rehearses patient in

keeping a steady gaze fixed atan object directly in front ofpatient.

ii) For PA projection (anteriorview), has patient assume proneor erect position with head Onfilm holder, resting on fore-head and nose or chin and nose.For forehead-nose position, cen-ters film about 3/4 inch distalto the nasion. Adjusts head sothat its median sagittal planeand the orbitomeatal line areat right angles to the plane ofthe film. Directs central raythrough the center of the or-bits at 300 caudad. Immobilizeshead and rehearses patient inclosing eyes and concentratingon holding them still for the ,

length of the exposure.

For chin-nose position, centersfilm at the level of the centerof the orbits. Adjusts head sothat the median sagittal planeis at right angles with theplane of the film. Directs cen-tral ray at right angles tofilm through the mid-orbits.Immobilizes head and rehearsespatient in closing eyes andholding them still as described'above.

iii) For bone-free projections per-former notes whether eyeballwill be directed straight forward, vertically up and down,or horizontally right and left.

For lateral bone-free projec--';'tion,performer has patient as-sume seated or supine position.Eases corner of periapical filmpacket and places film diagonal-ly in the space between the in:-ner canthus of the affectedcorher.of the eye and the nose,


Task Code No. 367


lst Elements Full List Elements Full

on the affected side. Adjustsso that the plane of the filmparallels the median sagittalplane of head. Has patient holdin position and adjusts. Directscentral ray at right angles tothe film through the outer andinner canthi. Immobilizes head.Rehearses patient in fixing gazeat an object directly ahead, ordirectly above or below, depend-ing on requisition, without mov-ing head, and holding until toldto relax. For further exposuresmaintains head in same position;replaces film packet and has pa-tient direct gaze in appropriateopposite direction.

For superoinferior bone-free projection, performer has patientassume seated or supine position.Places periapical film packetagainst the lower eyelid of theside of interest between infer-ior margin of the orbit and theeyeball, or diagonally under theinner-or outer part of the eye-ball. Has patient hold film withfirm pressure so that plane offilm is at right angles to med-ian sagittal plane of head. Di-rects central ray at right an-gles to the plane of the film,passing just anterior to thesuperior margin of the orbit,midway between the inner and outercanthi. Immobilizes head; in-structs patient in gazing di-rectly ahead, or to the right orleft, and holding gaze, as de-scribed above. .

b. For parallax motion studies, per-

13.

14.

i) For lateral parallax projec-tions, performer adjusts pa-tient in erect or semiproneposition, with head restingon film-changing tunnel onside of interest. Centersunmasked half of film toouter canthus of affectedeye. Adjusts head and cen-tral ray as in (a,i) above.Rehearses patient in fixinggaze at an object directlyabove (cephalad), withoutmoving head, and holding un-til told to relax. For nextexposure centers other sideof film as above and has pa-tient direct gaze directlybelow (caudad), and hold.

ii) For PA parallax projections,performer adjusts patient inchin-nose position on film-changing tunnel as describedin (a,ii), above. Centersand directs central ray asin (a,ii). Rehearses pa-tient in fixing gaze at anobject to the extreme rightwithout moving head and holding until told to relax. Fornext exposure centers otherside of film as above andhas patient direct gaze tothe extreme left, and hold.

If, during positioning, patient showssigns of severe pain, performer maynotify appropriate physician at onceand await orders.

Performer checks final positioning using triangle or protractor and lightin collimator. Activates the collima-tor light and points the light beamtowards the part. Adjusts the colli-mator opening to correspond to thefilm size (or the size of the un-shielded area of the film to be ex-

former plans to make two lateraland two PA projections with eyeballin different positions. Uses filmchanging tunnel.

291


Task Code No.


367

task.


posed). Uses cross-hair shadows asreference for center of field. Usesthe collimator light to center the pa-tient to the x-ray field, or centersthe part to the film holder and usesthe collimator light to center thetube to the part. Rechecks angulationof head and central ray. Checks thatthe primary beam will enter the center

-of the area of interest at the select-ed, angle to the film so as to projectthe view desired. May readjust tubeposition lengthwise or cross-wise toprovide better centering.

15. Once the patient has been positionedand immobilized, performer adjusts thecollimator. Either collimates so thata small unexposed border will appeararound the edge of the film or colli-mates further so as to expose only thearea of interest (and thus providemaximum protection and detail). If notalready done in positioning, performerattaches an auxiliary extension coneto collimator to further reduce theprimary beam. Adjusts primary'beam tominimum size needed to.cover thepart(s) of interest.

16. Performer adds lead shielding to areasthat will he in the primary path ofthe beam but are not included in theareas of interest. Makes 6ure.thatprotective shielding has been pro-vided to patient and everyone who.willremain in room.

17. Throughout procedure performer ob-serves patient for any signs of emer-gency and/or to prevent or respond toan accident. Is alert to signs of nau-sea, dizziness, or sweat suggestingfaintness. Performer may have patientlie down, lower head, or raise legs.Notifies nurse. If patient shows anyother emergency signs, loses consci-ousness, or has an accident, performer

calls appropriate physician or staffmember at once. May decide to provideemergency first aid as well. If a pa-tient's catheter becomes disconnectedperformer clamps it and immediatelynotifies nurse. If catheter shouldcome out, notifies staff member atonce.

18. When everything is ready for the ex-posure; performer reviews with pa-tient what immobilization controlwill be used for exposure:

a. Performer has patient gaze straighahead until told to relax as re-hearsed for lateral view, and forbone-free projections if so re-quested.

b. Performer has patient close eyesand concentrate on holding themstill until told to relax as re-hearsed for PA projection.

c. For bone-free and parallax motionstudies has patient fix gaze on anobject directly above or below orto extreme right or left as appro-priate, without moving head. Haspatient hold gaze until told torelax, as rehearsed.

d. Reminds patient about those posi-tions which are to be maintainedfor the next exposure.

e. Performer observes the patient'smovement until the moment that theexposure is made. Readjusts posi-tion if warranted.

19. The performer returns to controlroom. Makes sure controls are prop-erly set and patient is still in po-sition. Tells patient when to holdposition and gaze as instructed bycalling or using intercom. Performerinitiates exposure by pressing handtrigger or exposure control button.,

292


Task Code No. 367

10 ofThis is page 11 for this task.


20.

a. While exposure is underway perform-er checks that mA meter records ap-propriate current as set, that kVpmeter dips slightly,

b. May watch for evidence of malfunc-tion such as line surge or exces-sive drop; may listen for sound ofnormal functioning of equipment. Ifthere is malfunction, may decideto report; anticipates need to re-peat exposure.


d. If the exposure is terminated by acircuit breaker, rechecks technicalfactors for possible overload orchecks for overload elsewhere oncircuit. Anticipates need to repeatexposure.

Performer returns to patient. Removespacket or film holder from table or patient's hand.

a. Removes any markers for furtheruse. If more than one view is to betaken on the film, removes leadedrubber mask and remasks all butnext area to be exposed.

b. If so requested, performer arrangesto have the first exposure(s) pro-cessed at once and brought to theappropriate radiologist.

c. If the first radiograph(s) are pre-liminary (scout) films, performerlirings the processed radiograph(s)directly to the radiologist incharge or places on view boxes andinforms radiologist that the scout(s) are ready. If the radiologistindicates that there is any problemwith the technical factors or thepatient positioning, performer re-cords or notes for later use in theexamination and/or repeats preli-minary radiography as ordered.

d. Depending on whether radiologistwill evaluate radiographs before

completion of all possible expo-sures for the series, performerarranges to process film(s) andevaluate for quality control per-sonally, have this done, or bringto darkroom for processing andlater evaluation, based on timeavailable, institutional arrange-meats, or specific instructions.Attaches ID card for use withflasher if appropriate. May signrequisition.

e. While films are being processedand/or evaluated performer haspatient relax in examination'roomor holding area. Explains whatwill happen next.

i) Performer determines whetherpatient.should remain on tableand/or in room or requires ob-servation. May consult requisi-tion sheet or attending RN. Ifappropriate, makes sure thatpatient will be attended whilewaiting.

ii) If appropriate, moves x-raytube and any protruding filmholder away from patient beforepatient rises.

iii) May decide to assist patient tochair or stretcher or fromtable. Makes sure patient isreminded of any footrest instepping off table.

21. When (or if) performer learns fromthe radiologist whether further con-ventional views and/or positions canbe undertaken, eliminated or altered,performer proceeds as appropriateaccording to instructions:

a. For further exposures performerrepeats appropriate steps for nextview(s) including identificationof film holder and use of R-L marker, selection and setting of tech-


Task Code No. 367


List Elements Full

nique for next view (if different),positioning patient and equipmentfor focus-object-film alignment,proper collimation and shielding,immobilization ipstructions, andmaking exposure, as described above.For more than one,exposure on onefilm, keeps R-L'reference constant.

b. Performer refrains from commentingon the films or providing any intet-pretation.

c. If performer is asked to repeat anyexposures, makes sure that the ad-ditional exposures are warrantedmedically, since additional radia-tion will be incurred.

i) Notes whether need to repeat isdue -a performer's own negli-gence or lack of attention sothat performer can avoid future"retakes."


iii) If request for retakes reflectsthe preference for density orcontrast of a radiologist, per-former notes for future workdone for the given radiologistso that retakes can be avoided.

22. When performer is sure that the ex-amination has been completed, perform-er may have patient transported backto holding area or next location, ordecides to do personally, as appropri-ate. Makes sure that none of the equip-ment is projecting over the patientbefore allowing patient to rise fromstool or table, and assists patientas described above.


List Elements Fully

a.Perie,rmer has equipment attd'exami-nation table cleaned after use ordecides to do personally, depend-ing on institutional arrangements.

b. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken,the technical factors used andfilm sizes; may record the numberof exposures made of each view in-cluding retakes; may enter theestimated radiation dose to whichpatient was exposed (using postedinformation on dosage); may recordany problem with equipment, anyspecial care provided patient. Ifany views called for in the ini-tial request could not be obtainedperformer may record reasons.Signs requisition sheet.

c. If performer will only carry outpreliminary "scout" filming andanother technologist will continuewith examination, performer re-cords the approved technical fac-tors used for the scouts and theaccessories employed, or informstechnologist who will continue.Performer gives the requisitionsheet, name card, and any notes totechnologist who will continuewith procedure.




Task Code No. 368



Requisition reviewed;pt. reassured;breaste measured;films identified;technical factors selected or set;pt. positioned;compression applied;exposures made;mammograms sent for processing or xeroradiographsprocessed;mammograms taken to radiologist;additionalor repeat exposures made as ordered;pt. returned;examination recorded;mammograms placed for use.

Performer receives or obtainsthe x-ray requisition form, pa-tient's identification card, andany appropriate medical-techni-cal history for a non-infant pa-tient scheduled for mammography(radiography or xeroradiographyof the breast):



sitions in order of priority.d. From attending radiologist.

. Performer reads the requisi-etion sheet to determin the

examination called for, thepatient involved, specialconsiderations, and to checkthe completeness of the in-formation provided:

a. Performer notes whetherexamination is routinecheck-up or to investigatesuspected pathology. Notesviews ordered, whetherstandard and/or specialprojections. 145;tes loca-

tion of any suspected patology and side of inter-est, whether bilateralviews are called for.

2. What is used in performing this task? (Note


Pt.'s x-ray requisition sheet,ID card,ID bracelet,technical history;pen;x-ray machine control pan-el(s), tube,table,collimator;mammography and exten-sion cones;compression devices;film holder stands;stool;technique chart;charts for conversion of tech-nique,standard views for examinations,dosage,tubecapacity;loaded nonscreen film holders;leaded rubbershielding;R-L and ID markers;scissors;protractor;calipers;wedge sponges;xeroradiograph conditioner,processor,storage boxes,cassettes,plates;markingpen;B.B.shot;radiolucent tape or adhesive;gown;radio-lucent wrap material;adhesive remover;cotton;stretch-er or wheelchair

3. Is there a recipient, respondent or co-worker

No..."Immm.TimmiiilFigli;Isiir : ame tne ina o recipienes to q. t,

respondent or co-worker involved, with de_

scriptions to indicate the relevant condition;include the kind with whom the performer isnot allowed to deal if relevant to knowledge

requirements or legal restrictions.Non-infant patient to be radiographed; radiologist

5. Name the task so that the answers to ques- Checks the name of the re-ferring physician.

b. Notes any special require-ments such as focal spotsize, use of compressiondevice, or other radio-graphic accessories.

c. Performer reads patient'sname, identification nun-'ber,sex,age,Wight achdweight.-

OK-RP;RR;RR


tial words.Taking mammograms (radiography or xeroradiography)of non-infant patient by reviewing request;reportingobserved contraindications;reassuring pt.;position-ing pt.;applying Lompression cone;measuring part;selecting and setting technical factors;identifyingfilm;positioning equipment for erect and recumbentexposures;providing shielding;collimating;making ex-pcsures;having mammograms processEd or processingxeroradiographs;reviewing;taking to radiologist;con-tinuing and/or repeating as ordered for full set ofviews;having pt. returned;placing mammograms for use;recording examination.

6. Check here if this -

is a master sheet..00

29.3


Task Code No. 368


List Elemel2m12127

Notes whether patient is i%-patient,out-patient, or emergency patient.Notes any special information thatwould affect technique, such as presence of breast scars, severe benigndisease, whether there is known pregnancy, lactation, history of priorpregnancies, presence of siliconeprosthesis. Notes any conditions af-fecting positioning, suspension ofrespiration or immobilization suchas cardiac or respiratory disease,presence of injuries, whether patienwill be on a stretchr or in a wheelchair. Notes shielding needed.

. Performer checks whether patient issuffering from a collateral condi-tion requiring special handling,such as communicable or infectiouscondition, infirmity, incoherence.

e. If performer is not already assignedto examination room (and a particu-lar machine) notes the room or ma-chine involved. Checks that the ma-chine to be used has a fractionalfocal spot of appropriate size, andthat all added filters have been re-moved from the x-ray beam column.

f. Performer makes sure that the re-quest is properly authorized, thatlaformation on requisition sheet iscomplete. Checks whether any specialorders on exposure factors are inkeeping with the usual rad exposureinvolved for the examination.

g. Depending on institutional proce-dures, 1)erformer may review pa-tient's radiation exposure history,prior record of techniques used, andcumulative exposure. Notices whetherexamination has been done elsewherein recent past, whether number ofradiographic exposures ordered ordone in past should be reported.

h. Depending on institutional proce-dures, performer notes whether fe-male patient is pregnant, reviewsdate of female patient's last men-

List Elements Full

strual period, or notes any otherindication that there is no dangerof exposure of a known or possiblefetus or that an explicit decisionhas been made to radiograph a preg-nant female.

i. If referring physiclan has request-ed that films already on file besent with current radiographs, andif not already with patient's jack-

'eted material, performer arrangesto have prior films delivered.

If the performer etermines that therequest is not properl) authorized, isincomplete, or that sufficient infor-mation is lacking for purformer toselect technique or to properly posi-tion or care for patient, or if per-former considers,that there may becontraindications to going ahead withthe procedure, performer notifiessupervisor, radiologist, or other des-ignated staff person, depending on in-stitutional procedures. Explains theproblem if appropriate, and proceedsafter obtaining needed information,signature, or orders.


a. Depending on institutional arrange-ments, performer may decide to es-cort out-patient to or from dress-ing room. May decide to assist intransporting patient from holdingarea or have this done.

b. Performer greets patient and anyaccompanying staff person and iiitroduces self. Checks patient'sidentity against the requisitionsheet. With in-patient, checks hos-pital identification bracelet orother identifier. If patient is ac-companied because of seriousness of

to


Task Code No. -368


List Elements Ful3

condition, performer checKs with ac-companying staff member on any spec-ial precautions necessary during pro-cedure.

c. Has patient asiume a comfortableposition seated on table or chair.If patient is in wheelchair, movespatient in chair into position nextto table. If patient is on specialstretcher, places atretcher intoposition so that-radiolucent stretcher can be. lifted with patient on itfrom wheeled base to x-ray table.May arrange to move patient to table.

d. Performer clplains to patient whatwill be involved in the procedure;indicates what tnoes of positionsthe patient will be asked to a3sumeand the cooperation that will beasked of the patient.

e. Performer answers patient's non-medi-cal questions houesely; attempts toreassure patient and develop confi-dence. Treats patient with dignityand concern regardless of patient'sbehavior. Remains aware that patientmay be frightened and/or apprehen-sive. Performer explains when askedmedical questions that it is not ap-propriate for technologist to answerthese; encourages patient to speakto physician.

f. If appropriate and not already done,performer questions female patient ofchild bearing age regarding possiblepregnancy. If there is any possibili-ty that patient is pregnant and thishas not already been recorded, per-former informs appropriate physicianand proceeds only with approval.

g. If not already done, has patient re-move any clothing or jewelry down tobelow waist. Makes sure that thebreast region is free of any bodypowder. If not already done, providespatient with open front gown. Allowspatient to cover up until ready forexamination, positioning and/or expo-

List Elements Full

sure. Accords young patient as m,..Lchprivacy as adult.

. Performer informs attending radiolo-gist when patient is ready to be exaM-ined. May introduce patient to radiol-ogist.

. While patient is beiug examine4, per-former prepares ahead sy :is not tokeep patient in examination room long-er than necessary:

a. Performer reviews the techniquechart for the mar.aine to be usedand takes note of any newly postedchanges in technical factors (toreflect..iccommodation for change inmachine output or a policy deci-sior).

b. Perform.; washes.hans as appropri-ate; depending on patient's condi-tion, may der:ide to arrange for orcarry out isolation or decontami-nation techniques.

c. Performer checks that x-ray and/orxeroradiography equipment is readyfor use. Goes to control ?anel(s)and checks that indicator light(s)shows that machine(s) are "warmedup," or turns on main switch as ap-propriate to equipment and allowstime for machine(s) to "warm up."If appropriate, performer may setradiography mode selector and setcollimator control for manual oper-atior.

d. If-appropriate, performer preparescompression device for use. May in-flate a rubber balloon and place inside compression cone. Shapes bal-loon with plastic tape. May attach.styrofoam device to cone or attachmammography cones to beam column.Decides on size by observing sizeof patient's breast during examina-tion.

e. Checks that there is leaded rubbershielding available in room to be

297


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Task Code No. 368


List Elements Fully

1.,.3ed to protect the patient, and/orto place beneath the film holder,as appropriate.

f. Performer prepares for identifica-tion of the films using equipmentprovided by institution:

i) May obtain lead numerals andtape and prepare identificationstrip for placement on filmholder(s) giving appropriate pa-tient identification information.

ii) Performer may prepare for use offlashcard by checking that thereis piece of lead on film holdersurface; play write or type outID information on card if notreceived with requisition.


iv) Performer makes sure that right(R) and left (L) markers arep-;ailable for use.

6. When radiologist has completed examina-tion of pient, performer notes anyadditional orders on views to obtaindecided by radiologist. If orders aregiven orally, makes suresthat theseare recorded on requisition sheet withsignature as appropriate.

7. When performer is :leer about what willbe involved in examination, he or shecontinues with preparation for examrination:

a. Performer notes whether patient canbe examined in the standard bodypositions called for with the pro-jections ordered; if not, plans tosubstitute alternative body posi-tions to achieve the same projec-tions.

b. Performer notes the type of breasttissue involved for determinationof exposure factors by observationand from chart. Considers dense

c.

d.

e.

tissue technique for immaturebreast, p/egnant woman, lactatingwoman, severe benign disease, pal-pable mass near the skin, abnormal-ly thick skin. Considers patient'sage, size breast, number ofchildron borne by female patient,firmncs5 of breast tissue. Consid-ers 1:.:1,1 dc-Asity technique for elder

ly 4:emale patients, those withthree or more children, with pendu-lous breasts, fatty tissuesoratrophic patients and those withsilicone prosthesis. Notes tech-nique for male breast if appropri-ate.Performer may question patient, ob-serve breasts and palpate breastsin determining firmnef:s and appro-priate technique. Per..,:ormer deter-mines whether the patient will beunable to suspend motion and/orrespiration during exposure. If so,plans to modify exposure techniqueto compensate.For standard examination performerplans on bilateral study of thebreasts in right-angle mediolateraland craniocaudal positions. May in-clude axillary'view(s). Checks re-quisition for other special viewsrequired or requested by radiolo-gist.

Performer considers the number andtypes of projections ordered forthe examination and the patient'scondition. Performer may consider achange from standard positioning tobetter accomplish the purpose of thexamination, addition of a positionor a change in technical factors.Depending on institutional arrange-ments, performer may obtain permis-sion from appropriate radiologistor decides to alter the standardprocedure based on institutionalguidelines.

2


Task Code No. 368


List Elements Full

f. Depending on institutional practicesperformer selects speed and type ofnonscreen film, nonscreen holders,

prepacked mammographlr films or xero-radiography cassette and chargedplate. Selects size(s) based on thearea(s) to be included, the size ofthe patient's breasts, and whetherbilateral views are to be exposed ona single film or plate.

g. Performer makes sure that an adequatesupply of loaded nonscreen film hold-ers or mammography packets of thetypes and sizes selected are avail-able in the examination room.For xeroradiography, checks thatempty cassettes are available in des-ignated holder and that sufficientplates are stored in the conditioner.If needed materials are not avail-able, arranges to obtain or decidesto obtain personally.

h. If radiJlogist has attached smalllead ;54-,.t over any palpable masses,scars, oi suspicious area, performerchecks to make sure that no puckeringof the skin has occurred. If so,eases thE tabs to release the pucker-ing, being careful not to alterplacement of pellet.If performer has been asked to useB.B. shot to localize a given palp-able kamp, scar or designated area,performer finds location, attacheslead shot on skin at location usingradiolucent tape or adhesive glue asappropriate.

i. Performer provides patient and every-one who will remain in room duringexposure with protective shield-ing. Explains if necessary that thisis not cause for alarm but a generalprecaution to minimize unnecessaryradiation exposure.

. Performer has patient assume a comfort-able recumbent, standing or .seated posi-tion, depending on the positions to be

List Elements Full

employed, so that the relevant breastdimensions can be measured. Makes surethat wheelchair is in locked positionif patient is to be positioned in it.


b. rerformer may decide to assist pa-tient from wheelchair or stretcherto table or has thia done. May ob-tain help. Makes sure that no equipmere: is in the way and may be col-lided with by patient.

c. If assisting patient to ster onfootstool in order to get on table,helps patient turn into position,step backwards on stool, and thensit and/or lie on table.

d. Performer positions patient as forfinal positioning (as describedin step 11, below). Has patientremove gown above waist. Appliesselected breast compression coneor extension cone and breast com-pression device as appropriate:

i) If using mammography compres-sion cone, performer selectssize according to patienesbreast size,and chooses lengthsuitable for prescribed focal-film distance (FFD). May useextension cone for longer FFD.

ii) Performer makes sure thatbreast is firmly supported andadjusts for right-angle viewsso that nipple is directedstraight forward in an exactprofile position. Applies sup-port and compression to smoothout any wrinkling or puckeringof the skin..

iii) Centers mammography or exten-sion cone over the breast withflat side in contact with thechest, juát above the base of.the breast.

299


Task Code No. 368


List Elements FA&

iv) Adjusts FFD so that the fieldof exposure extends about 3/4inch beyond the periphery cf thebreast.

v) For a compression study ottumor-bearing areas, performerselects cone of smallest diamet-er possible. Performer placescotton or gauze on the breastand then applies gentle pressurewith the cone, directly coveringtne area of interest.

vi) Notes FFD obtained for use indetermining exposure factors.

vii) Checks that pressure is not un-comfortable.

e..Performer uses centimeter calipersto measLire the thickness of thebreast(s) to be radiographed in thedirection in which the central rayof the x-ray beam will pass throughthe centered part from t ly2. to film.

Records for use in determining expos-ure factors.

f. After measuring may release compres-sion and have patient rest in as re-laxed a position as possible. Mayplace pad, blanket or pillow underbony prominences to provide comfort.

9. Performer selects the exposure factorsfor the first projection by consultingthe technique chart(s) posted for themachine (end/or for use with xeroiadio-graphy).

a. Locates the information needed forthe body part and projection in-volved according to the centimeterthickness of the part as measuredand the collimated field size to beused. Makes sure that technique re-lates to the combination of filmtype and speed, focal spot size,FFD,and use or nonuse of other accessor-ies

List Elements Full

and the focal-film distance (TFDor FFD) called for or obtainedwith compression.

c. Once the standard kVp, mA and timehave been determined, performernotes whether any conversions arenecessary to account for patho-logical condition, breast type,change in TFD, unavoidable move-ment by patient during exposure,preference of the radiologist in-volved, and any.other conversionneeded. Performer looks up numeri-cal conversion factors and calcu-lates, or uses conversion chartsto ascertain the appropriate newexposure factor (kVp, mA and/ortime). Multiplies, divides, adds,or subtracts as appropriate.

d. Performer checks any new or unfam-iliar exposure factors against theposted limits of the x-ray tube ona tube rating chart to be surethat technique does not exceed theheat capacities of the tube forthe focai spot size to be used. Ifappropriate, performer reconvertsthe technique to an equivalent output.

10. Performer sets exposure factors andprepares film or xeroradiographyplate as follows:

a. Enters control room. Makes suretnat indicator light shows thatx-ray generator is ready for use.Makes sure that all circuits havebeen stabilized. -

b. As appropriate, checks line volt-age meter-and, if needed, eUrnscompensatöf-dial until Ileedle isaligned properly on line meter.

c. Performer sets milliamperage bychoosing selectors for the correctfocal spot size; sets the mA se-7

b.-Makes note of the kVp, mA, T(seconds lected.

of exposure time), focal spot size,

300

TASK DESCRIPTION SHEET (continued) .

Task Code No. 368


List Elements Full

d. Performer selects and sets the ex-posure time that will produce themAs desired.

e. Performer sets the kVp selected bychoosing the combination of majorkilovoltage and minor kilovoltagesettings to produce the desired kVp.

f. Depending on the equipment, perform-er may set controls to provide foruse of manual tableside adjustmentof table and tube height, position,and of collimation.

g. If using xeroradiography equipment,performer obtains an empty cassettefrom the storage containet; goes toconditioner and selects the level ofimage contrast desired as appropri-ate to the type of breast, withhigher contrast for more dense tis-sue. Inserts cassette in conditionerslot green dot facing up).When indicat-or light shows thatplate has been electrostaticallycharged, performer obtains "loaded"cassette from machine.If using conventional radiography,performer obtains the appropriatesize loaded nonscreen film holderor mammography film packet.

h: Performer attaches identificationinformation to the cassette, filmholder packet or table top as appro-priate:

i) Places right or left marker onfilm holder or table top as ap-propriate to the study and pro-jection,or depresses appropri-ate R or L button for automaticmarking.

ii) If patient's identification in-formation is in the form oflead numerals, performer placeson appropriate corner of filmholder or xeroradiography cas-sette.

iii) If patient identification in-formation is to be entered byuse of flasher, sets flash

11.

List Elements Full

card aside for later use withspace created by piece ofleaded rubber on appropriate_edge of film holder or xero-radiography cassette.

iv) Performer may place patient'scard into card tray for equipment using automatic filmmarking device.

i. Performer places film holder orxeroradiography cassette in posi-tion on table, film holder stand,or in receptacle as appropriatefor final positioning. May placelead sheet under nonscreen filmholder.

j. For views to be taken without useof compression, performer sets thefocal-film distance as required.Uses controls or manually movesthe x-ray tube into place rver thefilm holder or at appropriateangle. Checks the focal-film dis-tance by reading indicator scale ithe tube housing; adjusts up ordown until the required FFD (TFD)is obtained.

Performer prepares the patient in theposition selected for the first (ornext) exposure. May explain or demon-strate to patient what is required.May obtain help in positioning. Haspatient drop gown to below the waist.

a. For mediolateral projection (lateral view) of the breast, performernotes side of interest (unless bi-lateral views are ordered). Has pa-tient assume a semilateral posi-tion on table on the side of inter-est. Has patient rest head on pil-low with chin extended. Places armon side of interest at right anglesto body with elbow flexed and handnext.ta pillow.

i) Performer places film holderor xeroradiography cassette


Task Code No. 368



on raised support stand underbreast or, if a table levelwindow is used with film holderplaced beneath, places patientover window and supports breastwith wedge sponge.

ii) Rotates body so that it is inlateral position with nipple ofbreast in exact profile. Ad-justs patient or film holder sothat the entire breast and ax-illa are inclnded in field, andenough of chest wall to showthe retro-mammary tissues..

iii) If using flexible nonscreenholder, has about an inch offilm project over supportstand on the side next to pa-tient so that it curves inclose contact with chest wall.If using xeroradiography cas-sette on support stand, makessure that cassette is placedwell under breast so that aportion of the rib cage is in-cluded in the field.

iv) Checks that there is no wrinkl-ing of the skin on the under-side of the breast.

v) If mammography compressioncone and/or extension cone isto be used, applies compres-sion as described earlier in(8,d), above. Brings flat sideof cone to a point just abovesternum.

vi) Makes sure that cone serves tokeep opposite breast retractedor has patient retract oppositebreast with fingertips. Makessure that fingers are not su-perimposed over any area ofbreast on side of interest.

vii) Directs central ray at rightangles to the film, centeredto the central portpn at thebase of the breast.

viii) If bilateral views are re-quested, has patient reverseposition and sets up similar-ly for second exposure.

ix) Performer rehearses patientin maintaining position with-out moving or respiratingfor the length of the expo-sure so that patient can pre-pare to hold breath withoutmoving for required amountof time.

b. For craniocaudal projection (cau-dal view) of the breast(s), per-former notes side of interest,whether bilateral views are or-dered. Has patient take erectseated or standing position be-fore an adjustable film standor seated at end of x-ray tableon adjustable stool.

i) Adjusts height of stand orstool so that lower borderof breast is at the levelof the film on stand or tabletop.

ii) Performer places the flex-ible film holder or xeroradi-csraphy cassette beneath thebreast being examined withthe edge firmly against thechest wall.Extends the breast to be ra-diographed on the film holderso that a complete profile ofbreast and nipple is extendedand centered over the filmsurface.

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Task Code No. 368

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iii) Has patient hold back straightand turn head as far as pos-sible away from the side ofinterest,

* iv) Performer adjusts level of filmso that breast is completelysupported, retracted away fromthe chest wall, with all skinfolds or wrinkles eliminated,and so that nipple is in exactprofile.

v) If usiv,g flexible nonscreen filmholder, has about an inch of filmproject over the support stand onthe side nearest patient so thatit fits against chest wall. Haspatient grasp stand to keep filmpressed firmly against the body.If using xeroradiography cas-sette,has patient use one hand ortwo, resting on table or stand,to press cassette tightly againstchest wall and hold.

vi) If mammography compression coneand/or extension cone is to beused, applies compression as de-scribed earlier in (8,d), above.

vii) Directs central ray at right an-gles to the film,centered to themidpoint of the breast.

viii) If radiography of opposite sideis brdered, sets up oppositebreast similarly for second ex-posure.

ix) Performer rehearses patient insuspending respiration as de-scribed in (a), above,

c. For caudocranial projection (cranial

ii) Attaches film holder or xero-radiography cassette to verti7cal holder so that the planeof the film is parallel withthe plane of the covered ori-fice of the cone.

iii) Positions patient and film asin (b), above, and applies ap-propriate pressure on breastbetween cone and film. Continues as in (b), above.

d. For axillary projection of thebreast, ;'erformer notes side of interest (unlesc bilateral views areordered). Notes degree of abduc-

I tion ordered for upper arm on sideof interest.

i) Has patient lie in a supineposition on table,and rotatesbody 30° to 350 towards theside of interest.

ii) Has patient rest head on pil-low with chin extended.Places arm on side of inter-est so that upper arm is ab-ducted about 120° or as or-dered, with elbow flexed. Haspatient drop opposite armback posteriorly.

iii) Performer places film holderor xeroradiography cassetteon table top or table-levelholder below window so thatits long axis is parallel tothe sternomanubrial joint.Centers about 2 inches distalto the apex of the axillaryfossa, with the humeral headoccupying the upper margin ofthe film or cassette.

iv) Allows the breast to hang un-supported. Makes sure that opposite breast is retracted.

v) Performer applies cone of ap-propriate diameter. Directscentral ray at right anglesto center of plane of film,passing through superior por-tion of breast.

view) of the breast, performer di-rects x-ray tube in caudocranial di-rection and attaches mammography ex-tension cone.

i) Covers orifice of cone with ra-diolucent wrap material so thatit is held tautly in place andserves as a support stand.

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Task Code No. 368



vi) If bilateral view is requestedhas patient reverse positionand sets up similarly for sec-ond exposure.

vii) Performer rehear:les patient insuspending respirati,n as de-scribed in (a), above.

e. For lateromedial projection (media).view) of the breast, performer notesside of interest. Performer has pa-tient assume a semilateral positionon table on the side opposite theside of interest. Has patient resthead on pillow with chin extended.

i) Places arm on side next totable in a comfortable forwardextended position. Has patientabduct and hyperextend arm onthe side of interest.

ii) Performer places sufficientsupport under the breast to beexamined to reduce thicknessof breast and eliminate allskin folds. Uses pillows, stanor wedge sponge. Places flexi-ble nonscreen holder or xeroradiography cassette on a supt:urtunder the medial side of breas

iii) Positions body and breast sothat nipple is in exact profiland cassette or film holder isvessed against chest wall.

iv) Continues to position as in(a), (iii) through (vi).

v) Directs central ray at rightangles to the film, centeredto the base of the breast at apoint a little above the nip-ple.

vi) Performer rehearses patient insuspending respiration as de-scribed in (a), above.

f. For caudal-exaggerated projectionof the lateral half of the breast,performer notes side of interest.Has patient take erect seated or.standing position before an adjust-able film stand or seated at end ofx-ray table on adjustable stool.

k

i) Adjusts height of stand orstool so that lower border ofbreast is at the level of thefilm on stand or table top.

ii) Places flexible film holderDr xeroradiography cassettebeneath the breast being ex-amined.

iii) Rotates patient's trunk about200 so that axillary portionof the breast on the side ofinterest is brought onto thearea of the film.

iv) Moves edge of film holder ofcassette firmly against thechest wall and extends breaston film holder so that nippleis in exact profile.

v) Continues to position as in(b), (iv) through (vi).

vi) Directs central ray to thebase of the breast, enteringmidwai between the nipple andthe axillary fold.

vii) Performer rehearses patientin suspending respiration asdescribed in (a), above.

g. For caudal-exaggerated projectionof the medial half of the breast,performer positions as in (0,above except'as follows:

i) Has patient thrust chest for-ward and rotate trunk 10° to15° so that the medial quad-rant of the breast is includ-ed on the film surface;has patient rotate head towards theside of interest.

ii) Directs the central ray tothe base of the breast, entering at a point slightly med-ial to the nipple line.

h. For tangential and localized spotfilms of the breast, performer re-views location of areas of inter-est or refers to B.B. shots placedon breasts by MD or self.

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TASK DESCRIPTION SHEET (tontinued)

Task Code No. 368



i) Arranges and supports patientso that the area of interest(lesion) on the breast is asnearly at right angles to thefilm or xeroradiograph cassetteas possible.

ii) Directs central ray at rightangles to the lesion or asdirected.

iii) Rehearses patient in suspensionof respiration as appropriate.

12. If, during positioning, patient showssigns of severe pain, performer maynotify appropriate physician at onceand await orders, or may decide on al-ternative positioning to avoid movementof the affected part.

13. Performer checks final positioning:

14.

a. Makes sure that as much of thebreast as possible will be includedin the image field, or that local-ized area designated is in the 15.

field.b. Checks that the nipple of the breast

is in profile (except for specialnon-right angle projections).

c. Checks that the breast tissue issmooth and there are no folds ofbreast tissue.

d. Checks that sufficient even, com- 16.

fortable compression of the breasthas been accomplished.

e. If not using direct compression, ac-.

tivates the collimator light andpoints the light beam towards thepart. Adjusts the collimator openingto correspond to the film size (orthe size of the unshielded areas ofthe film to be exposed). Uses crosshair shadows as reference for the 17.

center of the field. Uses the col-limator light to center the breast

to the x-ray field, or centers thepart to the film holder and usesthe collimator light to center thetube to the part. Rechecks angula-tion of body and central ray.Checks that the primary beam willenter the center of the area of in-terest at the selected angle to thefilm so as to project the view de-sired. May readjust tube positionlengthwise or crosswise to provide*better centering.

If a breast cone is not being used,performer adjusts the collimator.Either collimates So that a small un-exposed border will appear around theedge of the fiIm,or collimates furtheso as to expose only the area of in-terest (and thus provide maximum pro-tection and detail). Adjusts primarybeam to minimum size needed to coverthe part(s) of Interest.

Performer adds lead shielding to areasthat will be in the primary path ofthe beam but are not included in theareas of interest. Makes sure thatprotective shielding has been pro-vided to patient and everyone who wilremain in room.

Throughout procedure performer ob-serves patient for any signs of emer-gency and/or to prevent or respond toan accident. If patient shows anyemergency signs, loses consciousness,or has an accident, performer callsappropriate physician or staff memberat once. May decide to provide emer-gency first aid as well.

When everything is ready for the ex-posure, performer reviews with patientthe breath control to be used for ex-posure:

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Task Code No. 368


List Elements Full

a. Performer has patient hold breath 20.

and hold still until told to relaxby performer.

b. Performer observes the patient'smovement until the moment that theexposure is made. Readjusts positionif warranted.

18. The performer returns to control room.Makes sure controls are properly setand patient is still in position. Tellspatient when to hold breath as in-structed by calling or using intercom.Performer initiates exposure bypressing hand trigger or exposurecontrol button.

a. While exposure is underway performerchecks that mA meter records appro-priate current as set, that kVpmeter dips slightly.

b. May watch for evidence of malfunc-tion such as line surge or excessivedrop; may listen for sound of norm-al functioning of equipment. Ifthere is malfunction, may decide toreport; anticipates need to repeatexpsure.


d. If the exposure is terminated by acircuit breaker, rechecks technicalfactors for possible overload orchecks for overload elsewhere oncircuit. Anticipates need to.repeatexposure.

19. Performer returns to patient. Removesxeroradiography cassette or film hold-er from table or film holder.

a. Removes any markers for further use.b. If appropriate, performer arranges

to h7,..ve the first or standard set ofexposure(s) processed at once andbrought to the appropriate radiolo-

.gist.

List Elements Fully

If nonscreen x-ray film is beingused, performer arranges to processfilm(s) and evaluate for quality con-trol personal:1y, have this done, orbring to darkroom for processing andevaluation. If appropriate, may ar-range to have films.processed manual-ly, or decides to do personally. At-taches ID card for use with flasherif appropriate. May sign requisition.

21. If xeroradiography is being used, performer processes the exposed plate asfollows:

a. Performer places the exposed plate(in its cassette) into the appro-priate slot of the xeroradiographyprocessor (red dot facing up).

b. Selects the development mode (pos-itive) and waits for the requirednumber of seconds while the plateis processed.

c. Removes processed xeroradiographfrom receptacle and inspects fordebris, artifacts and quality. Ifthere are problems with the qualitof the xerograph, performer decideto make any adjustments that seemappropriate.

d. Removes empty cassette when it isreleased and replaces in cassetteholder.

22. While films are being processed and/or evaluated performer has patient relax in examination room or holdingarea. Explains what will happen next.

a. Performer determines whether pa-tient should remain on table and/orin room or holding area. If appro-priate, makes sure that patientwill be attended while waiting.

b. If appropriate, moves x-ray tubeand any protruding film holder awayfrom patient before patient rises.

306


List Elments Full

Task Code No. 368


c. May decide to assist patient tochair or stretcher or from table.Makes sure patient is reminded ofany footrest in stepping off table.

23. Performer brings the processed mammo-gram(s) directly to the radiologist incharge or places on view boxes and in-forms radiologist that they are ready.Presents xeroradiographs directly toradiologist without light source.

a. If the radiologist indicates thatthere is any problem with the tech-nical factors or the patient posi-tioning, performer records or notesfor later use in the examinationand/or repeats procedure as ordered.

b. When (or if) performer learns fromthe radiologist whether further con-ventional views and/or positions areto be radiographed or special pro-jections made, performer proceeds asappropriate according to instruc-tions.

c. For further exposures performe.: re-peats appropriate steps for nextview(s) including identification offilm holder or xeroradiography cas-sette,and use of R-L marker, selec-tion and setting of technique fornext view (if different), position-ing patient and equipment for focus-object-film alignment, proper com-pression, collimation,and shielding,breathing instructions, making ex--posure ,and proceLsing,as describedabove.

d. Performer refrains from commentingon the films or providing any inter-pretation.

e. If performer is asked to repeat anyexposures, performer notes whetherneed to repeat is due to performer'sown negligence or lack of attentionso that performer can avoid future."retakes."

List Elements Fully

i) If request for retakes re-flects malfunctioning equip-ment, performer reports mal-function to appropriate staffmember.

ii) If request for retakes re-flects the preference for den7sity or contrast of the. radi-ologist, performer notes forfuture work done for the givepradiologist so that retakescan be avoided.

f. Performer shows second set of ra-diographs"to radiologist whenprocessed and proceeds as describedabove until radiologist indicatesthat examination is completed.

-4. When performer is sure that the exam-ination has been completed, performermay have patient transported back toholding area or next location, or de-cides to do personally, as appropri-ate. Makes sure that none of theequipment is projecting over the pa-tient before allowing patient .to risefrom stool or table, and assists pa-tient as described above.


a. If B.B. shot has been applied to .

patient's breast(s), removes gentlor applies appropriate remover forthe adhesive used.

b. Performer has equipment and etami-nation table cleaned after use ordecides to do personally, depend-ing on institutional arrangements.

c. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken,the technical factors used and filmsizes; may record the number of ex-posures made of each view includingretakes; may enter the estimated

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radiation dose to which patient wasexposed (using posted informationon dosage); may record any probleiwith equipment, any special careprovided patient. If any viewscalled for in the initial requestcould not be obtained, performermay record reasons. Signs requisi-tion sheet.

d. Performer may decide to jacketfilms, requisition sheets, and re-lated materials and/or have informa-tion recorded in log book personallyor have this done, depending on in-stitutional procedures.


3tib


Task Code No. 369


1. What is the output of this task? (Be surethis is b:oad enough to be repeatable.)

Portable x-ray equipment selected or evaluated forexamination ordered; equipment assembled, trans-ported, set up at bedside; completed requisitionobtained; procedure selected; equipment disassembledand returned to storage after use.


Order for bedside radiography;requ'isition sheet;pt.'s ID information;pen;portable x-ray equipment;technique chart;charts for conversion of technique,standard examination views,dosage,tube capacity;loaded cassettes or nonscreen film holders;upright filmholder;leaded rubber shielding;R-L and ID markers;inmobilization devices;cassette tunnel;tape;cali-pers;protractor;triangles

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes..,(4) No...( )

4. If -Yes- to q. Name the kind of recipient,respondent or co-worker involved, with de_

scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowlcdgerequirements or legal restrictions.

Nurse in charge of pt.;any pt. to be radiographed;co-worker;radiologist or referring MD

5. Name the task so that the answers to ques-tions 1-4 are reflected. Underline essen-

tial words.Preparing, transporting, setting up and returningmobile portable radiography equipment for bedsideradiography by selecting appropriate equipment;pre-paring equipment and materials for use; transportingsetting up as appropriate for needs of examinationand safety; checking for appropriate requisition andorders; deciding on radiography procedure; disman-tling and returning equipment after use.

List Elements Futtt

Performer receives or obtains aspecial record of an order forbedside radiography,or a requi-sition form with patient's iden-tification card:

a. As regular assignment.b. After checking assignment on

schedule sheet.. From co-worker.

d. After having arranged requi-sitions in order of priority.

. Performer reads the specialorder or requisition to de-termine the examination call-ed for, the patient involved,location in the hospital,sge,and referring physician,

a. Performer checks the ex-amination called for andthe patient's age and sexto determine the probableviews to be obtained andthe likely positioning andexposure technique to berequired. May consultchart listing standard ex-amination views. Checksname of referring physi-cian.

b. If the information isavailable, performer noteswhy bedside radiography isrequired so as to considerlhnitations on patient po-sitioning, technique, and/or need to obtain assis-tance in positioning.Notes whether patient isin traction, is criticallyill, is post-operative,has a cardiac condition,is receiving respiration

OK-RP ; RR; RR

6. Check here if thisis a master sheet..(X)

309


Task Code No. 369


List Elements Full

or oxygen therapy, di requires iso-lation to prevent contamination ofothers,or to prevent exposure of pa-tient to contamination.

c. Performer notes any special requestsuch as for magnification, stereo-scopic views. Notes patient's loca-

' tion in hospital or institution.

2. If the institution has a variety of mo-bile equipment available, performer mayconsider which unit is most appropriatefor the examination ordered, taking ac-count of the exposure technique re-quired, the likely flexibility neededin positioning the patient, and theline voltage available in the'patient'slocation. May consult available infor-mation on power supply in various lo-cations of hospital. Compares needs ofexamination with output capacities,tube limits, and power supply needs ofequipment.

If the institution has only one type ofmobile equipment, performer considerswhether its rating limitations and thepower source are compatible with therequested examination, taking accountof the factors described above.If magnification has been requested,performer checks that the machine to beused has a fractional focal spot of ap-propriate size for direct magnificationtechnique (Le. 0.3 mm or smaller).If there is a problem, performer con-sults appropriate supervisor or physi-cian and follows any orders given.

Once the mobile equipment is selected(or predetermined) performer preparesthe equipment and collects all the ma-terials needed for transportation tothe patient's bedside. Goes to appro-priate storage area.

a. If unit is battery operated, checksthat batteries are charged. If notalready done, performer assemblestube stand of unit and device to

List Elements Full

measure target film distance asappropriate to equipment.

b. Performer collects appropriateaccessories depending on the ex-amination requestcd and the equip-ment to be used. May check techni-que chart for unit.

i) Performer makes sure techniquechart, tube capacity chart forthe given unit, and charts forconversion technique are in-cluded with materials or at-tached to unit.

ii) Performer collects calipers,im-mobilization devices (such assandbags, angle blocks, tape,head.clamp,weighted band), pro-tractor, cardboard triangles,cassette tunnels, localizer de-vices, cassette stands andother devices as appropriate fthe examination and the pa-ttent's condition. Places incarrier.

iii) Collects appropriate leaded rubber shielding and aprons to beused to protect patient,basedon sex and positions,and forperformer and others in room,and/or to mask or place beneathfilm holder. Places in carrier.

iv) Makes sure that appropriategrounding cord and remote con-trol exposure cord are attached.

c. Depending on the equipment, exami-nation, condition of patient andstandard institutional practices,performer selects speed and type ox-ray film,grid,and cassette com-binations.

i) Selects size(s) based on thearea(s) to be examined,whetherthere is order for use of mag-nification technique.


Task Code No. 369


List Elements Full

ii) Performer loads an adequate sup-ply of loaded cassettes of thetypes and sizes selected in ap-propriate container on mobileunit.

d. Performer prepares for identifica7tion of the films:

i) May obtain lead numerals aodtape and prepare identificationstrip for placement on filmholder(s) giving appropriate pa-tient identification information.




v) Loads identification materialson carrier.

e. If referring physician has request-ed that films already on file besent with current radiographs, andif not already with patient's jac-.keted material, perfonner arrangesto have prior films delivered toreferrino Aysician.

4. If not already done, performer may de-cide to test the equipment to makesure that it is functioning. Checksfor proper filter in x-ray beam. Forpatients to be protected from contami-nation, performer may decide to wipeell the equipment with appropriateantiseptic. Washes hands as appropri-ate.

5. If appropriate, performer may arrangeto have another co-worker assigned to

List Elements Full

assist in positioning or in isolationand decontaminatioa procedures. Maydecide to carry out appropriate isola-tion and decontamination procedures.

6. Whev the evipment and materials havebeen assembled, performer prepares theequipment for transporting to patient.

a. Adjusts x-ray tube in storage po-sition. Makes sure that tube, col-limator and arm are in positionwhere they cannot fall and locksinto position.

b. Performer stores all cables andcords in box provided or gathersup and secures into place on car-rier.

c. Makes sure that all movable pro-jecting or looming parts are cen-tered and not projecting out frommachine.

. Performer transports the equipment anorder for radiography to the pr.tient'slocation. Performer makes str..a he or

she has a firm hold on ane pod con-trol of the machine. Walks on rightside of corridors; moves slowly andwith care when going around cornersand up and down ramps.

. Performer 'reports to nurse in chargeof floor or ward on arrival.

a. Indicates patient to be examinedand deternines exact location ofpatient.

b. If appropriate, arranges for as-sistance with patient positioningand/or isolation teJlnique.

c. Performer asks about specific pre-cautions in dealing with patient.May record. Asks about patientcare equipment which must remainin place and be taken account ofin eetting up radiography unit.

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List Elements FullyList Elements Fully

9.

10.

11.

Performer greets patient before wheel-ing in x-ray machine. Checks patient'sidentity. Introduces self and explatnawhat will be involved in the proceduce;indicates what cooperation will beasked of the patient. Answers patient'snon-medical questions honestly; at-tempts to reassure patient and developconfidence. Treats patient with dignityand concern regardless of patient'sbehavior. Remains aware that patientmay be frightened and/or in pain. Per-former explains when asked medicalquestions that it is not appropriatefor technologist to answer these; en-courages patient to speak to physician.

Performer determines where the portablemachine can be placed, considering thecare beirg given patient, such astraction, oxygen, IV drip, nasaltubing, suction apparatus, etc.

a. Performer closes door or draws cur-tains to provide patient with pri-vacy after wheeling unit into room.

b. Places machine so that a patient tobe moved can be positi-,d withoutdislodging any apparatus, or so tha.x-ray tube can be positioned aboveor below patient's bed. Is carefulnot to collide with patient's bedor apparatus.

c. Makes sure that there is adequateroom for requiled target (focalspot)-to-object (patient) distanceand target-to-film distance.

d. Makes sure that performer will beable to stand minimal required dis-.tance from x-ray beam during expo-sure or outside of room.

e. Locks and/or uses brakes to im-mobilize equipment in place.

If appropriate, connects power supplyfor which equipment is designed.

d. May make sure that live powerswitch is off. Checks that line

12.

13.

14.

cord has attached grounding -1r-minal and is attached to unit, orthat there 4.s proper grounding asappropriate.

b. May connect all low voltage cablesto control panel if not alreadydone.

c. May connect power cable to linepower outlet after checking thatvoltage is appropriate. After ma-chine has warmed up checks voltagereading without making exposure.If appropriate, adjusts line volt-age compensator.

d. When performer determines that ma-chine is operating, turns off linepower switch (if appropriate).

Once the equipment has been set upfor use, performer may obtain a moredetailed requisition sheet from re-ferring physician, specifying numberand type of views and patient posi- ,

tions. If so, performer makes surethat the request is properly autho-rized, that information on requisi-tion sheet is complete. Checks wheth-er any special orders on exposure factors are in keeping with the usualrad exposure involved for the examinetion. If not,contacts appropriatestaff member for further information.

Once an approved requisition sheet isavailable, performer decides to carryout radiography of the ;Jfected partas appropriate,or provide:: anothertechnologist with needed information.

When the appropriate radiography taskhas been completed by performer oranother technologist, performer maycarry out termination steps for bed-side radiography:

a. Checks that all diagnostic radiog-raphy has been completed.

b. Makes sure that main switch is off.c. Disconnects power cable with at-

tached grounding cord.

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Task Code No. 369

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List Elements Fully

d. Performer may clean the equipmentafter use. Washes hands as appropriate.

e. Reports to nurse in charge that ra-diography is completed.

f. Reassembles equipment and materialsas in 3, above.

g. Prepares for transporting back toradiology department as in. 6, above

h. Transports as in 7, above and storevarious compOnents as appropriate.

i. May indicate'to appropriate staffperson when'.the performer is readyto proceed with next examination.

List Elements Fully

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Task Code No. 370


. What is the outut of this task? (Be sure List Elements Fullthis is broad enough to be repeatable.)

Requisition reviewed;x-ray equipment checked,cleaned,transported,set up in operating roal;ac-cessories assembled for use;pt.,cassette tunnels orholders,x-ray tubes positioned;part measured;cas-settes identified and placed;technique selected andset;preoperative and operative exposures made understerile technique;processing and viewing arranged;retakes made es ordered;examination recorded;equip-ment returned after uSe.

Performer receives or obtainsthe x-ray requisition form andidentification card for a pa-tient scheduled for operatingroom radiography involving hipnailing or pinning (fixation ofa fractured hip or femur withhip nail or pin) or similarorthopedic surgery as a resultof:

a. Regular assignment.b. Checking assignment on sched-

ule sheet.c. Having arranged requisitions

in order of priority.

1. Performer reads informationon the requisition sheet inorder to plan for the proce-dure:

a. Notes the patient's nameand ID number; confirmsthe type of orthopedicsurgery involved and theradiography ordered.

b. Notes the operating roomassigned and its location;checks the time for thescheduled surgery and, if(or as) appropriate, thetime to report for pre-liminary preparations and

. What is used in erformin this task? (Noteif only certain items must be used. If thereis choice, include everything or the kinds ofthings chcaen among.)

Pt.'s requisition sheet,ID card;portable operatingroom x-ray units;control panels;electrical outlets;x-ray or polaroid cassettes;pan;cassette tunnels orholders;immobilization devices;grids;cylinder exten-sion cones;collimators;soap;calipers;antiseptic,dis-infectant solutions;cleaning cloths;sterile pillowcases or wraps;hospital cap,mask,gown,"boots";leadedshielding;ID,R-L and sequence markers;technique,expo-sure,positionin: and tube ratin: charts;view boxes

s t ere a rec p ent, respon.ent or co-workerinvolved in the task? Yes.., X) No...

'es to q. : ame t e in. o recipient,respondent or co-worker involved, with de-

scriptions to indicate the relevant condition;include the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions,

Operating room supervisor or charge nurse;supervisorattending orthopedic surgeon;pt. to have surgery;anesthesiologist;surgical team;co-worker

. Name tne task so that the answers to ques- pre-operative radiography.Notes name of attendingsurgeon and/or chargenurse or operating roomsupervisor.

c. Performer considers theviews likely to be requir-ed. May consult standardprocedure chart. Notes thepatient's age, height,

OK-RP;RR;RR .


Taking operative orthopedic radiographs of any pa-tient (such as in hip pinning) by re.eiewing request;

assembling,checking,cleaning,transperting and set-ting up x-ray equipment for use in operating room;selecting and cleaning accessories;measuring part;selecting and setting technical factors;positioningtubes;indicating placement of cassette tunnels andpatient on table;providing shielding;making pre-op-erative and operative exposures as ordered,obcervingsterile.technique;arranging for processing and view-ing by surgeon as films are proéessed;recording ex-amination;returning equipment after use.

6. Check here if thisis a master sheet..(X1


,Task Code No. 370

2 of 10 for this task.This is page

List Elements Full

weight and sex for later determina-tion of exposure technique.

d. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheet isLomplete..If the performer determines that therequest is not properly authorized,is incomplete, or that sufficientinformation is lacking for perform-er to carry out radiography, noti-fies supervisor, radiologist, orother designated staff person, de-pending on institutional proce-dures. Explains the problem if ap-propriate and proceeds after ob-taining needed information, signa-ture, or orders.

2. Performer determines what prior prep-arations will be needed, such as pro-vision of mobile x-ray equipment andaccessories, proper dress, consulta-tion with operating room staff:

a. Performer determines whether assigned operatiag room has one or morex-ray units already available, orwhether one or two units must betransported to the operating room.Plans to check and clean x-rayequipment in appropriate storagearea(s).

b. Performer notes whether film pro-cessing equipment (in darkroom orpolaroid Processing) is availableadjacent to operating room. Iffilms must be processed in radio-logy department, performer makessure that someone is assigned topick up, process, and return radio-graphs to operating room as theyare ready.

c. Performer checks awn clothing tomake sure that undergarments, uni7form and shoes are made of fabricsthat comply with institutional'rules for safe operating roomdress.

List Elements Fully

d. If appropriate, performer contactsoperating room staff to discussoperating room safety procedures,type of grounding, possible use ofexplosive gases in anesthesia, andany information on timing or availability of relevant equipment.

Performer goes to storage location ofthe designated hazard-proof portablex-ray unit(s) and/or of unit(s) keptin or near nonsterile area of operat-ing room. Cleans and checks two unitsneeded to make simultaneous radio-graphs, regardless of location. (Mayprepare one portable unit and oneoperating room unit.) Washes handsbefore and after assembling materi-als..

a. Performer checks whether each unitis hazard-proof and authorized foroperating room use, is equippedwith rubber casters to. insulate(if-room is not insulated for usewith nongrounded equipment byhaving conductive floor with builtin electrical resistence). Maycheck for proper filter on x-raytube(s). May note whether lightbeam in collimator is not to beused with equipment due to electrical hazard.

b. Performer prepares damp clothswith appropriate antiseptic and/ordisinfectant solutions. Makes sureequipment is disconnected, Andwipes equipment thoroughly to re-move eirt, dust, and lint.

c. If not already done, performer as-sembles tube stands of unit(s) asappropriate to equipment. Makessure that grounding cords and re-mote control exposure tords areattached as appropriate.

d. Performer may decide to test func-tioning of equipment. Uses electri

1cal outlets in storage .area. Se-


This is page

List Elements Full

lects and sets anticipated exposuretechnique and makes an exposure. Ifperformer notes any possible defectin equipment reports this to super-visor and arranges to use alternateequipment.

Task Code No. 370


Performer collects,prepares and cleansall the materials needed for transpor-tation to the operating room. May checktechnique charts. Goes to appropriatestorage areas:

a. Depending on the equipment andstandard institutional practices,performer selects appropriate speedand type of x-ray film, grid, andcassette (polaroid or regular) com-binations.

i) Notes whether portable cassettetunnel will be used or whetherorthopedic operating table hasbuilt-in cassette holders.

ii) Notes whether medical x-ray filmor polaroid cassettes (for usewith polaroid processing will beused).

iii) Selects size(s) based on thearea(s) to be included and pa-tient's age and size.

iv) Collects adequate supply ofloaded cassettes of the typesand sizes selected or decides toprepare personally. Cleans andplaces in appropriate containeron mobile unit.

b. Selects cylinder extension cones assmall as possible in order to mini-mize secondary radiation. Cleansand places on carrier.

c. Performer collects calipers,cas-sette tunnel(s), cassette standsor supports,and other devices asappropriate for the equipment and.procedure. Cleans and places oncarrier.

List Elements Full

d. Performer makes sure techniquecharts, tube capacity charts forthe given units, and charts forconversion of technique are in-cluded with materials or attachedto units.

e. Collects leaded rubber shieldingand aprons to be used to protectpatient, performer, and others toremain in operating room. Placeson carrier.

f. Performer prepares for identifi-cation of the films:

i) May obtain lead numerals andtape and prepare identifica-tion strip for placement onfilm holder(s) giving appro-

. priate patient identificationinformation.



iv) Performer makes sure thatright (R) and left (L) markersare available for use and markers to indicate the sequencein which exposures are made.


g. Performer makes sure that own person, uniform and shoes are cleanand garments appropriate for op-erating room.

h. When the equipment and materialshave been assembled, checked,andcleaned, performer prepares theequipment for transporting tooperr'fing room:

316

AMP


.Task Code No. _370



i) Adjusts x-ray tubes in storageposition. Makes sure that tubes,collimators and.arms are in posi-tion where they cannot fall;locks into position.

ii) Performer stores all cables andcords in boxes provided or gath-ers up and secures into placeon carrier.

iii) Makes sure that all movable pro-jecting or looming parts are cen-tered and not projecting outfrom machines.

i. Performer transports the equipmentand order for radiography to the ap-propriate location outside of oper-ating room. Performer makes sure heor she has a firm hold on, and goodcontrol of, the carrier. Walks onright side of corridors; movesslowly and with care when goingaround corners and up and downramps.

Performer reports to the charge nurseor operating room supervisor (with theportable equipment if transported).

a. Indicates name of patient and de-termines e*act location for settingup equipment.

b. Performer asks about specific pre-cautions in dealing, with patient.May record. Asks about any specialequipment which must remain inplace and be taken account of insetting up radiography units.

c. If not already done, dons leadapron and a clean gown, cotton"boots," cap, and mask receivedfrom the charge nurse or operatingroom supervisor. Performer donsthese before entering operatingroom. Washes hands as appropriate.Carries out appropriate steps tomaintain the integrity of the ster-ile area of the operating room and

does not touch patient,drapes, surgeons, scrub nurses, instrumenttables or "back table."

d. Performer may report to anesthe-sia area of operating room todiscuss appropriate timing ofpre-operative and operative_filmsand/or presence of any explosivegases.

e. Performer may discuss placementof cassette tunnels or grids withoperating room supervisor (if notpart of operating table) so thatthey can be placed on table whileprior preparations are beingmade. May give cassette tunnelsto appropriate staff member andcheck that they are placed sothat openings face the free endOf the table while being part ofsterile field,and that verticalholder is positioned properly.

If performer will be able to measurepatient before he or she is anesthe-tized, performer greets patient be-fore setting up equipment. Checkspatient's identity. Introduces selfand explaias own role in the proce-dure. Attempts to reassure patientand develop confidence. Treats pa-tient with dignity and concern re-gardless of patient's behavior. Re-mains aware that patient may befrightened and in pain. Explains theneed to measure patient for radiog-raphy.

7. Before patient is draped, or cleansed,performer measures patient and sets

up equipment:

a. Performer has patient positionedin the supine, AP position. Ifany movement of patient is needed,arranges to have surgeon position.


Task Code No. 370



e. Performer wheels in portable ap-paratus being careful not to dis-

i) Performer notes the patient'sbody type, whether the area ofinterest is heavily covered by turb any equipment or electrical

muscle or soft fat, whether the cords plugged in. Does not run

palpation points will be easy over cords; lifts cords when pos-

to find. sible or asks for assistance.

ii) If factors are not already known,performer uses centimeter cali-

f. Performer checks out equipmentfor use in operating room before

pers to measure the thickness of setting up for use at operating

the part(s) to be radiographed table. Uses anticipated exposure

in the directions in which the technique:

central rays of the x-ray beamswIll pass through the centered i) May make sure that line power

part from tube to film (antero- switch(es) are off. Attaches

posterior and lateral). Records line cords with grounding ter-

for use in determining exposure minals to unitS or attaches

factors. proper grounding as (or if)

iii) In locating iliac crest, per- appropriate.

former is careful not to center ii) May connect all-low voltage

too high by making sure not to cables to control panels if

confuse the iliac crest with the not already done.

heavy muscles immediately above iii) May connect power cables to

the crest. May have patient inline power outlets after check-1

hale deeply and breathe out; then ing that voltage is appropri-

palpates the point of the crest ate. Tests equipment by select-

while the muscles are relaxed. ing (for each unit) mA, kVpand time as appropriate and

b. If performer is present when the turning on main switch. After

patient is placed on table, checks machines are warmed up, checks

that cassette tunnel and/or pa- for kV readings. If appropri-

tient is properly adjusted so that ate, adjusts line voltage com-

any perineal post of the table pensators.

will not interfere with lateral iv) When performer determines that

projection, that cassette holder each machine is operating,turn

is placed just above the crest 3f off line power switches (if ap-

the hip and at proper angle.c. Performer provides patient and

everyone who will remain in operat-

propriate).

g. Once the machines have been

ing room with protective shielding. checked, performer sets up the

Explains if necessary that this is two x-ray units:

not cause for alarm but a generalprecaution to minimize unnecessary i) Places machines so that one

radiation exposure. tube can be directed verticall

d. Performer determines where the from above and one tube can be

portable machines can be placed,considering the care being given

directed across the table fromthe unaffected side. Checks

patient, such as anesthesia, IVdrip, etc.

that tubes can be adjusted to

318

.IASK DESCRIPTION SHEET (continued)

Task Code No. 370

This is page 6 .of 10 for this task.

List Elements Full

required distances (focal-objectdistance, FOD, and focal-filmdistance, FFD).

ii) Makes sure that performer willbe able to stand minimal requir-ed distance away from x-raybeams during exposure (behindshielding).

iii) Locks and/or uses brakes to im-mobilize equipment in place andmoves overhead tube out of theway until needed.

8. Performer places cassettes and pre-selects exposure techniques before pa-tient is draped:

a. Performer obtains the two appropri-ate size loaded cassettes for thefirst simultaneous projections (APand lateral).

b. Performer attaches identificationinformation to the cassettes:

i) Places right or left marker oncassettes or cassette holders asappropriate. Attaches markers toindicate that these are thefirst in a series of exposures.

ii) If patient's identification in-formation is in the form of leadnumerals, performer places onappropriate corner of cassettesor cassette holders.

iii) If patient identification infor-mation is to be entered by useof flasher, sets flash cardaside for later use with spacecreated by piece of leaded rub-ber on appropriate edge of cas-settes.

c. Performer places cassettes as ap-propriate in cassette tunnels orcassette holding devices that arepart of table.

d. Performer makes sure the.. the x-ray,units are ready for use. Checksthat indicator lights shows thatmachines are "warmed up," or turns

on main switches as appropriateto equipment and allows time formachines to "warm up."

e. Performer reviews the techniquecharts for the machines to be usedand takes note of any newly postedchanges in technical factors (toreflect accommodation for changein machine output or a policy de-cision).

f. Performer locates the informationneeded for the body part and pro-jection involved for each unit ac-cording to the centimeter thick-ness of the part as measured andthe collimated field size to beused. Makes nure that techniquerelates to the combination offilm type and speed and use ornonuse of other accessories thatare possible (such as screens,grids, etc.). Makes note of thekVp, mA, T(seconds of exposuretime), focal spot size, and thefocal film distance called for.

g. Once the standard kVp, mA and timehave been determined, performernotes whether any conversions arenecessary to account for change inFFD, extreme fat or muscularity,preference of the radiologist or

- surgeon involved, and any otherconversion needed. Performer looksup numerical conversion factorsand calculates, or uses conver-sion charts to ascertain the ap-propriate new exposure factor(kVp, mA and/or time). Multiplies,divides, adds, or subtracts asappropriate.

h. Performer checks any new or unfamriliar exposure factors against theposted limits of the x-ray tube ona tube rating chart to be surethat technique does not exceed theheat capacities of the tube forthe focal spot size to be used.

319


Task Code No. 370


List Elements Fully List Elements Fullyasammma-limm

extremity is not in anatomic posi-tion) by locating the anteriorsuperior iliac spine and the uppermargin of the symphysis pubis. De-fines a line between them. Pal-pates the greater trochanter ofthe femur and marks a point oneinch below its most prominentpart. Defines a line from thepoint marked to the midpoint ofthe first line as the long axis othe femoral neck.

d. Performer finds a point on thelocalization line for the longaxis of the femoral neck about 2.5inches below the midpoint of thefirst localizing line. Uses thisas centering point for hip joint.

e. Has patient adjusted in AP posi-tion with shoulders lying on asingle transverse plane and withaffected hip aligned to midlineof cassette placed for AP projec-tion. May have pelvis or hip ele-vated or supported.

10. Performer positions units for radiog-raphy as follows:

a. For AP projection locates hip

If appropriate, performer recon-verts the technique to an equiva-lent output.

i. Performer makes sure that all cir-cuits have been stabilized. If ap-propriate, adjusts line voltagemeters. Sets exposure factors:

i) Performer sets milliamperage bychoosing selectors for the cor-rect focal spot size; sets themA selected for each unit.

ii) Performer selects and sets theexposure time that will producethe mAs desired for each unit.

iii) Performer sets the kVp selectedby choosing the combination ofmajor kilovoltage and minor kilo-voltage settings to produce thedesired kVp for each unit.

. When the equipment is ready,performerreports to surgeon in charge to havepatient positioned in supine positionfor pre-operative radiography (takenbefore patient is draped). May receivefinal orders from surgeon on position-ing of tubes or cassettes.

a. Performer indicates what is neededin the positioning so that the partwill be centered, with the long axisof the part parallel to the fill,:holders. Has patient centered tomidline of cassette tunnels or holders or has cassettes centered to thepart. With the upright holder ad-justs height of holder to part, centers to part,and has holder sup-ported.

b. If patient has a balloon catheter iplace performer makes sure that theclamp is not lying over a part tobe exposed or that patient is notlying on the clamp,

c. Performer localizes the long axis othe femoral neck (especially withatypical patients or where the

joint as described in (d), above.Centers to level of highest pointof greater trochanter,and directs

- central ray vertically at rightangles to film. Adjusts tube torequired FFD.

b. For lateral _projection has knee an.hip on unaffected side flexed andadjusted so that neither centralray will be obstructed. May haveunaffected thigh placed and sup-ported in vertical position.

i) May have surgeon grasp the heelof the affected side, invert thefoot about 15° or 20°. Performermay have patient immobilized.

3zO


Task Code No, 370


List Elements Full1111111/111.1M1111

ii) Performer adjusts cassette inholder or cassette tunnel invertical position so that theupper border is in contact withthe lateral surface of the bodyon the affected side, at or justabove the level of the crest ofthe ilium. May angle the lowerborder away from the body so thathe cassette is parallel withthe long axis of the femoralneck. Locates long axis of fem-oral neck as described above (c).

iii) If cassette is not in holder at-tached to table,performer sup-ports cassette or cassette tun-nel in place.

iv) Performer positions x-ray tubefrom side opposite affected side.Places tube with its cylinderextension tube under the flexedknee on the unaffected side,directed at the affected joint.

v) Directs central ray at right an-gies to long axis of the femoralneck, centered Z..o hip joint cen-tering point described above (d).

vi) Adjusts the x-ray tube to therequired FFD.

c. Once the patient has been positioneand inmobilized, performer adjuststhe collimator of the AP tube. (Doenot use light beam in operatingroom unless it has been certifiedas hazard proof for use in presenceof explosive gases.) Either colli-mates so that a small unexposedborder will appear around the edgeof the film or collimates furtherso as to expose only the area ofinterest (and thus provide maximumprotection and detail).

d. If not already done, performer addslead shielding to areas that willbe in the primary path of the beambut are not included in the areas'of interest. Makes sure-that proper

List Elements Full

protective shielding has been pro-vided to patient and everyone whowill remain in room.

11. When everything is ready for the ex-posure, performer checks with sur-geon or anesthesinlogist on timingfor the first pair o!! radiographsbefore patient is draped. Has allpersons not needed in room leaveduring exposure.

a. If patient is to be radiographedat this stage while conscious,performer explains to patientneed for patient to hold breathwhen told to do so by performerand to hold still until told torelax.

b. If patient is to be radiographedwhile under anesthetic, performerarranges to wait for signal fromanesthesiologist that respiratoryarrest has been induced.

c. Performer checks controls of ma-chines and walks to safe distancefrom tubes holding exposure con-trols.

d. Performer either triggers thesimultaneous exposures on signalfrom anesthesiologist, or tellspatient when to hold breath andhold still by calling. Performerinitiates both exposures by press-ing hand trigger(s) or exposurecontrol button(s) simultaneously.

i) While exposures are underway,performer checks that mA metersrecord appropriate current asset, that kVp meters dip slightly.

ii) May watch for evidence of mal-function such as line surge orexcessive drop; may listen forsound of normal functioning ofequipment.

iii) After exposure is completedtells anesthesiologist to


Task Code No. 370


kList Elements Fully

resume respiration or tells pa-tient that he or she can relax.

12. Performer returns to patient. RemoVescassettes from tunnels or cassetteholders.

a. Removes any markers for further use.b. Performer arranges to have the two

exposures processed at once:

i) If there is no processing equip-ment adjacent to operating room,performer gives cassettes to co-worker for processing.

ii) If there is a darkroom with pro-cessing equipment next to operat-ing room or a polaroid processor,performer arranges to have cas-settes processed at once or de-cides to do personally.

c. Attaches ID card for use with flash-er if appropriate. Nay sign requi-sition.

13. When the films have been processed,performer places these on view boxesin appropriate nonsterile area ofoperating suite and informs surgeonthat they are ready for inspection.

a. Performer obtains orders from thesurgeon on any Turther radiographsto be made before the patient isdraped for surgery.

b. Notes any changes ordered for place-ment of cssette holders, exposurefactors, centering of tubes, or po-sition of patient. Adjusts as appropriate or has this done.

c. Fcr further pre-operative exposuresrepeats appropriate steps for nextview(s) including identification offilm holders or cassettes and use ofR-L markers,identification of se-quenca, selection and setting of

:techniques, positioning equipmentfor focus-object-film aignment,

List Elements Full

proper collimation and shielding,making exposures, and arrang-ing for processing and viewing asdescribed above.

d. If performer is asked to repeat anexposures, notes whether need torepeat is due to performer's ownnegligence or lack of attentionso that performer can avoid future."retakes."

14. When the surgeon indicates that nofurther pre-operative films are re-quired, performer prepares for opera-tive radiography:

a. Observes while parts of the x-rayequipment are draped into the sur-gical field.

b. NOtes or reviews procedure forplacing and removing cassettefrom tunnel or holder from underdrape while scrub nurse liftsdrape (for AP projections).

c. Checks that sterile pillowcasesor wraps are available for holdingcassette for lateral projections.

15. During surgery, performer awaitsorders from surgeon on when to takeoperative films as ordered.

a. Performer identifies cassettes bypatient ID, R-L and sequence num-ber as described above.

b. On signal, performer places cas-sette for AP projection in table'scaisette holder or cassette tun-nel by having scrub nurse liftsterile drape, uncovering the opening on non-sterile side of table.Performer inserts cassette and in-dicates when to allow drape tofall.

c. Performer places cassette for lat-eral projection by having scrubnurse hold open a sterile wrap orpillowcase. Performer drops

322


Task Code No. 370



cassette into covering, being care- ber of exposures made of each viewful to maintain sterile technique including retakes; may enter theand not allow cassette or own hands estimated radiation dose to whichto touch the outside of the covering patient was exposed (using postedor ci e. Checks while nurse places information on dosage); may recordcoverek_ cassette in upright holder any problem with equipment. Signs(which is nou part uf sterile requisition sheet.field). e. Performer may arrange to jacket

d. Performer vislially checks the cone films, requisition sheets, and re-and tube positions, collimation,and lated materials and/or have infor-patient position. Indicates to ap- mation recotde5149 log book,depend-propriate surgical team member any ing on institational procedures.adjustments needed. f. Reports to supervisor or nurse in

e. Checks technical factors. charge of operating room that ra-f. Performer coordinates with acesthe- diography is completed.

siologist on timing for exposuie. g. Reassembles equipment and materi-Indicates when ready and when ap- als as described above. Preparespropriate staff should leave expo- for transporting back to radiologysure area. On signal from anesthe- department as described. Trans-siologist, performer makes the next ports as described and stores var-set of exposures as described above,

g. Performer arranges for removal ofious components as appropriate.

h. May indicate to appropriate staffcassettes, processing,and viewing person when the performer is readyas rapidly as possible, as describe& to proceed with next radiographicabove,

h. Performer repeats operative radiog-raphy as ordered by surgeon (asdescribed) until told that radiog-raphy has been completed.

procedure.

16. When the radiography has been complet-ed, performer carries out terminationsteps:

a. Makes sure that main switch is offfor each unit.

b. Disconnects power cables and ground-1ing cords if appropriate.

c. Performer may clean the equipmentafter use. Washes hands as appropri-ate. Removes operating room gar-ments and shielding.

d. Performer records the radiographyaccording to institutional proce-dures. May include date, operatingroom, surgical pr,cedure, the views.taken, the technical factors usedand film sizes; may record the num-

323


Task Code No. 371


. What is the output of this task? (Be sure List Elements Fullthis is broad enough to be repeatable.)

Requisition reviewed; x-ray equipment and accessor-ies checked for use in operating room, cleaned,transported and set up;pt.,cassette tunnel or bucky,x-ray tube positioned;paIt measured;cassette identified and placed;technique selected and set;scoutand contrast radiographic exposures made;processingand viewing arranged;changes made and retakes doneas ordered;examination recorded;equipment returned,

Performer receives or obtainsthe x-ray requisition form andidentification card for a pa-tient scheduled for operatingroom radiography such as opera-tive cholangiography (contraststudy of biliary tract duringsurgery), operative p,Acreato-graphy (contrast stuoy of pan-creas during surgery) or similarradiography during surgery,as aresult of:



in order of priority.. Receiving emergency order toperform task after surgicalprocedure has begun.

1. Performer reads informationon the requisition sheet oremergency order to plan forthe procedure:

a. Notes the patient's nameand ID number; confirmsthe type of surgical procedure involved and the ra-aiography ordered.

b. Notes the operating roomassigned and its location.


Pt.'s x-ray order or requisition card;por:able operating room x-ray unit;control panel;electrical out-lets;x-ray or polaroid cassettes;cassette tunnel orbucky;immobilization devices;grid;extension cone;collimator;calipers;soap;antiseptic,disinfectantsolutions;cleaning cloths;cap,mask,gown,"boots";lead aprons,shielding;pt. ID,R-L,sequence markers;technique,exposure,positioning and tube ratingcharts;view boxes;pen

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes. . , ( 4 No... )

les to q. ame tile in. o recipient,respondent or co-worker involved, with de-


Operating room supervisor or charge nurse;supervis--or:attending surgeon;pt.to have surgt_ry;anesthesiol-ogist;surgical team;co-worker

. Name the task so that the answers to ques- Checks the time for the,,scheduled surgery and, ifappropriate, the time toreport for preparatoryprocedures, or notes wheth-er surgery has begun andamount of time left to pre-Dare and set up equipment.

c. Totes name of attendingsurgeon and/or chargenurse or operating roomsupervisor.

OK-RP-RR-RR

tions 1-4 are reflected. Underline essen-tisl words,

Taking operative cholangiograms,pancreatograms orsimilar operative radiographs of any patient by re-viewing request;assembling,checking,cleaning,trans-porting and setting up x-ray equipment in operatingroom;measuring part;positioning equipment and cas-sette ',elders and/or patient;selecting and settingexposure factors for scout and contrast films;colli-mating;providing shielding;observing sterile proce-dures;making exposures on signal;arranging for proc-jessing and viewing by surgeon;repeating as ordered;recording examination;returning equipment after use. 6. Check here it this

is a master sheet..

324

TtSK DESCRIPTION SHEET (continued)

Task Code No. 371

9 for this task.

List E ements Fully

This is page

d. Performer notes the patieAt's sex,height, weight, and body type, if in-formation is available, in order toancicipate probable exposure tech-nique and cassette size.

e. Performer makes sure that the requestis properly authorized, that information on tequisition sheet is com-plete. If the performer determinesthat the request is not properly au-thorized, is incomp2ete, or that suf-ficient information ie lacking forperformer to select technique, noti-fies supervisor, radiologist, orother designated staff person,. de-pending on institutional proce-dures. Explains the problem if appro-priate, and proceeds after obtainingneeded information or signature.

f. Performer may have request that priorradiographs be made available. If so,performer may arrange to have priorfilms delivered to operating room ormay arrange to transport personally.

. Performer determines what prior prepara-tions are needed, such as provision ofmobile x-ray equipment and accessories,proper dress, cooperation with operatingroom team:

a. Performer determines whether assignedoperating room has an x-ray unit al-ready available or whether performerwill transport a mobile unit.i) Checks whether a Potter-Bucky di-

aphragm or grid-front cassettesand a cassette tunnel will beused.

ii) Plans to check and clean equip-ment in appropriate storagearea;

b. Performer notes whether film process-

ion...1m

ing equipment (in darkroom or polar-oid processing) is available adjacentto operating room. If films must beprocessed in radiology department,performer makes sure that someone is

Elements Full

assigned to pick up, process, andreturn radiographs to operatingroom as they are made.

c. Performer checks own,clothing tomake sure that undergarments, uni-form, and shoes are made of :fabricsthat comply with institutionalrules for safe operating room dress

d. Performer may contact operatingroom staff to receive more detailedorders, information, or to check onsafety, timing or availability ofequipment,.

. Performer goes to storage location forx-ray unit to be used in operatingroom (in radiology department or ad-jacent to operating room) in order tocheck, clean and assemble.the x-rayunit. Dons lead apron.

a. Performer makes sure that unit tobe used has an adequate output forthe required radiography and is hozard-proof and certified for operat-ing room use. If operating room isnot insulated for use with non-grounded equipment with conductivefloor, checks that unit is equippedwith rubber casters.May check for proper filter inx-ray beam, fractional focal spotsize, whether light beam in collim-ator is hazard-proof or not to beused in operating room.Checks whether use of bucky is compatible with safety requirements.

b. Performer prepares damp cloths withappropriate antiseptic and/or disinfectant solutions. Makes sure unitis disconnected, and wipes equipmenthoroughly to remove dirt, dust andlint. If not already done, performeassembles tube stand of unit as ap-propriate to equipment.

c. Makes sure that ground cord and re-mote control exposure cord are present and properly attached.

3.26


This is page

Task Code No. 371


List Elements Full

d. Performer makes sure technique chart,tube capacity chart for the givenunit, and chart for conversion oftechnique are included with or at-tached to unit.

e. Performer decides to test the func-tioning of the x-ray equipment. Useselectrical outlet in storage areaand phantom or test object; selectsand sets anticipated technical fac-tors. Reports defective unit and ar-ranges to replace with alternateunit.

f. Selects and cleans appropriate extension cone(s) so that effective beamcan be reduced as much as possible.

Performer prepares and collects all thematerials needed for transportation tothe operating room. Goes to approPriatestorage areas. Selects and cleans appropriate accessories depending on institutional procedures and the unit to beused. May check technique chart forunit.

41.11.sianatm_Faui.e. Performer prepares for identifica-

tion of the films:

i) May obtain lead numerais andtape and prepare identificationstrip for placement on filmholder(s) giving appropriate pa-tient identification informatiom



iv) Performer makes sure that right(R) and left (L) markers areavailable for use and markers toindicate sequence of exposures.

v) Places on carrier.

f. Washes hands as appropriate beforeand after assembling and cleaningequipment.

. When the equipment and materials havebeen assembled, checked and cleaned,performer prepares the equipment fortransporting to operating room:

a. Adjusts x-ray tube in storage posi-

tion. Makes sure that tube, colli-mator and arm are in position wherethey cannot fall, and locks intoposition.

b. Performer stores all cables andcords in box provided or gathers upand secures into place on carfier.


d. Performer transports the equipmentand order for radiography to theappropriate location outside ofoperating loom. Performer makes

sure he or she has a firm hold onand gocd control of the carrier.'Valks on right side of corridors;

a. Performer makes sure that any buckyto be used is authorized for operat-ing room use and is padded. Cleansand prepares for transl-ortation tooperating room.

b. Performer may prepare and clean acassette tunnel for use instead ofbucky. Places on carrier.

c. Selects loaded cassettes of appropriate speed and type,with use of gridor not,.depending on established procedures. Uses prepared polaroid cas-settes'if polaroid processing is tobe used. Selects size based on pa-tient's size, age and area of inter-est. Collects an adequate supply ofloaded cassettes of the type andsize selected or decides to preparepersonally. Cleans and places in ap-propriate container on mobile unit.

d. Performer collects and cleans appro-priate lead shielding and aprons,calipers. Places on carrier.


Task Code No. 371


List Elements List Elements Full

moves slowly and with care whengoing around corners and up anddown ramps.


a. Indicates name of patient and deter-mines exact locatb.- F.or setting upequipment.

b. Performer asks about specific precautions in dealing with patient. Mayrecord. Asks about any special equiment which must remain in place andbe taken account of in setting upradiography unit.

c. Performer may receive a clean hospi-tal gown,cotton "boots," cap andmask from the charge nurse or oper-ating room supervisor. Performerdons these before entering operatingrcom. Washes hands.as appropriate.Carries out appropriate steps tomaintain the integrity of the ster-ile area of the operating room anddoes not touch patient, drapes, sur-geons, scrub nurses, instrumenttables or "back table."

d. Performer may report to anesthesiaarea of operating room to discussappropriate timing of pre-operativescout film (or operative scout ifsurgery has begun) and/or presenceof any explosive gasses.

7 Performer wheels in portable apparatusbeing careful not to disturb any equipment or electrical cords plugged in.Does not run over cords. Lifts cordswhen possible or asks for assistance.Places machine in a convenient, easilymaneuverable position before settingup at operating table.

. Performer checks out equipment for usein.operating room before setting upfor use at operating table:

a. May make sure that line powerswitch is off. Attaches line cordwith grounding terminal to unit,or attaches proper grounding as(or if) appropriate.

b May connect all low voltage cablesto control panel if not alreadydone. May connect power cable toline power outlet after checkingthat type of outlet and voltageare appropriate.

c. Performer tests equipment for useat operating table:

1) Reviews the technique chart forthe machine to be used andtakes note of any newly postedchanges in technical factors(to reflect accommodation forchange in machine output or apolicy decision).

ii) Turns on line power switch. Se-lects the technical factors (mA,kVp and time) anticipated foruse with patient and turns onmain switch. After machine haswarmed up checks for kV read-ing. If appropriate, adjustsline voltage compensator.

iii) When performer determines that 1

machine is operating, turnsoff line power switch (if ap-propriate).

Performer determines patient's rele-vant measurement for final selectionof exposure technique. Checks pa-tient's identity.

a. If patient has not yet been placedunder general anesthesi:.1, perform-er greets patient before settingup equipment at operating table.Introduces self and explains ownrole in the procedure. Attempts toreassure patient and develop con-fidence.

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Task Ccde No. 371


1

10. If performer is present for placementof bucky or cassette tunnel on operat-ing table, performer checks that cas-


Treats patient with dignity and con-cern regardless of patient's behav-ior. Remains aware that patient maybe frightened and in pain. Explainsthe need to measure patient for ra-diography.

b. If patient has been anesthetizedbut is not yet undergoing surgery,performer checks with anesthesiolo-gist before measuring. Notes respi-ration pattern.

c. If surgery has begun, performer es-timates patient's measurements basedon charted information on weight,height, body type,age,and sex. Notesbreathing pattern. May consult sur-geon or other staff member.

d. If performer is to measure patientdirectly, has patient placed in su-pine'AP position with shovlders ina single transverse plane. If anymovement of patient is required,mayask to have this done.

i) Performer notes patient's bodytype to judge location of bil-iary tract,or performer may placeprior localizing radiographs onview box to judge location.

ii) If factors are not already known,uses centimeter calipers to mea-sure the thickness of the part tbe radiographed in the directionin which the central ray of thex-ray beam will pass through thecentered part from tube to film(right AP oblique projectionfor cholangiography and/or re-flux pancreatography,and AP pro-jection for transduodenal pan-creography,. Records for usedetermining exposure factors.

11.

sette tunnel or buckey is arrangedappropriately:

a. For cholangiography,checks thatcassette,when inserted,will lie ina transverse position in relationto operating table,slightly later-al to right side. Has cassetteholder placed so that opening ison the left side, away from whatwill be the sterile field,and sothat the right upper quadrant ofthe patient's body can be centeredto the film area.

b. For pancreatography,adjusts sothat cassette will be centered tothe median sagittal plane of thepatient's body at the level of thexiphoid process.

Performer sets up x-ray unit,after itis checked,on the left side of thetable opposite the operating field.

a. Performer determines where theportable machine can be placed,considering the care being givenpatient,.such as anesthesia, IVdrip, etc.

b. Places machine so that x-ray tubecan be directed from above and(for cholangiography) angled fromleft to right, at the properfocal-film distance (FFD).

c. Makes sure that performer will beable to stand minimal required distance from x-ray beam during ex-posure.

d. Locks and/or uses brake to immob-ilize equipment in place.

12. Performer preselects exposure tech-nique for scout (preliminary) filmunless operation is already underway:

a. Performer makes sure that thex-ray unit is ready for use.Checks that indicator light shows.

328


Task Code No. 371


List Elaments,Fullywormanimasmimw List Elements Fully

that machine is "warmed up," orturns on main switch as appropriateto equipment and allows time for machines to "warm up."

b. Locates on technique chart the in-formation needed for the body partand projection involved accordingto the centimeter thickness of thepart as measured (or estimated) andthe collimated field size to beused. Makes sure that technique re-lates to the combination of filmtype and speed, and use or nonuseof other accessories that are pos-sible (such as screens, grids,bucky, etc.). Makes note of the kVp,mA, T(seconds of exposure time),focal spot size, and the focal filmdistance called for.

c. Once the standard kVp, mA and timehave been determined, performernotes whether any conversions arenecessary to account for change inFFD, extreme fat or muscularity,preference of the radiologist orsurgeon involved, and any other con-version needed or posted. Performerlooks up numerical conversion fac-tors and calculates,or uses conver-sion chart to ascertain the appro-priate new exposure factor (kVp, mAand/or time). Multiplies, divides,adds, or subtracts as appropriate.

d. Performer checks any new or unfamiliar exposure factors against theposted limits of the x-ray tube ona tube rating cnart to be sure thattechnique does not exceed the heatcapacity of the tube for thefocal spot size to be used. If ap-propriate, performer reconverts thetechnique to an equivalent output.Keeps exposure time to a minimum.

e. Performer makes sure that all cir-cuits have been stabilized. If ap-propriate, adjusts line voltagemeter. Sets exposure factors:

i) Performer sets milliamperagebY choosing selectors for thecorrect focal spot size; setsthe mA. selected.

ii) Performer selects and setsthe exposute time that will*produce the mAs desired.

iii) Performer sets the kVp se-lected by choosing the combination of major kilovoltageand minor kilovoltage set-tings to produce the desiredkVp.

13. Performer requests that the surgeonin charge place the patient in sup-ine AP pusition for pre-operativepreliminary radiography. May receivefinal orders from surgeon on posi-tioning of tube or cassette.

a. Performer indicates what is neededin the positioning so that thepart will be centered.

b. For cholangiography,has patient adjusted in AP position so that theright upper quadrant of the abdom-en is centered to the bucky gridor cassette tunnel film area.

i) If tube will not be angled,has left side of body elevateand supported 15° to 20°. Supports elevated shoulder,hipand knee.

ii) Has hips and knees fully ex-tended.

c. For pancreato ra h ,has patierft adjusted in AP position so that thexiphoid process is centered overthe bucky grid or exposure area ofcassette tunnel at the median sag-gital plane.

14. Performer places cassette for thescout film:

a. Performer obtains the appropriatesize loaded cassette.

3


Task Code No. 371


List Elements Fully

b. Attaches identification informationto the cassette or cassette holder:i) Places right or left marker on

cassette or cassette holder asappropriate.

ii) If patient's identification in-formation is in the form of leadnumerals, performer places on ap-propriate corner of cassette orholder.

iii) If patient identification infor-mation is to be entered by useof.flasher, sets flash card asidefor later use with space createdby piece of leaded rubber on ap-propriate edge of cassette.

List Elements Fully

c. if patient has already been draped,performer has scrub nurse or someonewho is part of surgical team liftthe drape to expose opening of buckyor cassette tunnel,and replace drapeafter cassette is placed.

d. If cassette is to be used with buckyperformer may manually pull outbucky tray and open retainingclamps. Inserts cassette into buckytray and pushes back. Makes sureclamps are closed. Moves cassetteinto appropriate "stored" positionor inserts cassette tray into buckyslot and centers.

e. If a cassette tunnel is being used,performer places cassette in tunnel.

Z. If not already done, performer pro-vides patient, self, and everyonewho will be in opetating room durinradiography with protective leadaprons. Explains if necessary thatthis is not cause for alarm but ageneral precaution to minimize un-necessary radiation exposure.

15. Performer positions x-ray tube:

a. For cholangiography, performer ad-justs the x-ray tube to obtain a

right AP oblique projection (RPAoblique view). Positions tube onthe left side of the patient, cen-tered to the right side, to enterthe area of the biliary ductal system:

i) If patient has been drapedand surgery is in progress,performer centers to pointindicated by surgeon.

ii) If tube angulation is to beused, directs central ray tocenter of cassette area or indicated area at 200 to theright.

iii) If patient has had lert sideelevated, performer directscentral ray at right angles tmidpoint of cassette or area.

b. For pancreatography,performer ad-justs the x-ray tube to obtain anAP projection (posterior view).Centers tube at right angles to thmidpoint of the cassette area(medial sagittal plane of body atlevel of the xiphoid process or asindicated by surgeon).

c. Checks and adjusts the focal-filmdistance by reading indicatorscale in the tube housing; adjustsup or down until the required FFDis obtained.

d. Performer collimates so that asmall unexposed border will appeararound the edge of the film, orcollimates further so as to exposeonly the area of interest (andthus provide maximum protection andetail). Performer may attach anauxiliary extension cone to colli-mator to further reduce the primarybeam. Adjusts primary beam to minimum size needed to cover thepart(s) of interest. (Does not uselight beam in operating room unlessit has been certified as safe foruse in presence of explosivegases.)

3 43 0


Task Code No. 371


List Elements Full

e. If not already done, performer addslead shielding to areas that will bein the primary path of the beam butare not included in the areas of in-terest, or has this done.

16. When everything is ready for the pre-liminary exposure performer checks withsurgeon and/or anesthesiologist on tim-ing. Has all persons not needed at op-erating table during exposure leaveroom.

a. If patient is to be radiographed be-fore being anesthetized, performerexplains to patient how to holdbreath without moving when told todo so by performer and hold untiltold to relax. Observes patient un-til moment that exposure is made.

b. If patient is under anesthesia andis to be radiographed prior to sur-gery, performer arranges to make exposure on signal from anesthesiolo-gist that respiratory arrest hasbeen induced.

c. If surgery has begun, performer ar-ranges timing with surgeon and anesthesiologist, and waits for signal.

d. Performer checks controls of x-raymachine and walks to safe distancefrom tube with exposure control (onlong cord).

e. Tells patient when to hold breath bcalling,or notes anesthesiologist'ssignal. Initiates exposure by pressing trigger of exposure control cord

i) While exposure is underway,performer checks that mA meter records appropriate current asset, that kVp meter dipsslightly.

ii) May watch for evidence of mal-function such as line surge orexcessive drop; may listen forsound of normal functioning ofequipment'.

List Elements Full

-iii) After exposure is completedindicates_to anesthesiologistthat respiration can be re-suned,or tells patient thathe or she can relax.

17. After exposure performer returns topatient. If patient has been draped,has surgical drape raised to exposecassette holder.

a. Removes cassette.b. Removes any markers for further

use.

c. Performer arranges to have thescout film processed at once:

i) If there is no processingequipment adjacent to operat-int room, performer gives cassette to co-worker for proc-essing.

ii) If there is a darkroom withprocessing equipment next tooperating room or a polaroidprocessor, performer arrangesto have cassette processed atonce GC decides to do person-ally.

iii) Attaches ID card for use withflasher if appropriate. Maysign requisition.

18. When the scout film has been' proc-essed and returned, performer placeson view box in appropriate nonsterilearea of operating suite. May alsohang prior films. Informs surgeonthat radiograph(s) are ready for viewing.

a. Notes any orders to repeat scoutfilm and/or timing for contraststudy.

b. Performer notes surgeon's orderson any change in technical factorsneeded, any change in tube or cas-sette position, or any change tObe made in centering or .patient

1t

Itt:


Task Code No. 37;


List Elements rullY . List Elements Full

c. If performer is to repeat scout 21. When the radiography has been com-film, repeats appropriate steps as pleted, performer carries out termi-described above, including process- nation steps:ing and review,making appropriatechanges as ordered. a. Makes sure that main switch of

i) Notes whether need to repeat x-ray unit is off.is due to performer's own b. Disconnects power cable andnegligence or lack of atten- grounding cord (if appropriate).tion so that performer can c. Performer may clean the equipmentavoid future "retakes." after use. Washes hands as appro-

ii) If request for retakes re- priate. Removes operating roomflects the preference for den garments and shielding.sity or contrast of the sur- d. Performer records the radiography

, geon, performer notes for fu-ture work done for the given

according to institutional proce-dures. May include date, operat-

surgeon so that retakes canbe avoided,

ing room, surgical procedure, theviews taken, the technical factorsused and film size; may record

19. Performer prepares for contrast radio- the number of exposures made ofgraphy during surgery: each view including retakes; may

enter the estimated radiation dosea. Inserts properly identified cas- to which patient was exposed (us-

sette into bucky or cassette tunnel ing posted information on dosage);under lifted surgical drape, as de- may record any problem with equip-scribed above.

b. Adjusts technical factors to allowment. Signs requisition sheett.,

e. Performer may arrange to jacketfor use of contrast medium. (May films, requisition sheets, and re-check technique chart.) Sets tech- lated materials and/or have infor-nical factors. mation recorded in log book de-

c. At signal of surgeon (after instil- pending on institutional proced-lation of contrast), performer cen- ures.

ters tube at appropriate angle to f. Reports to supervisor or nurse incentering point indicated by sur- charge of operating room that ra-geon. Walks to position for expos- diography is completed.ure, and has appropriate personnel g. Reassembles equipment and materi-leave room. als as described above. Prepares

d. At signal from anesthesiologist,performer makes exposure as de-

for transporting back to radiologydepartment as described. Trans-

scribed above, ports as desc-ibed and stores var-ious components as appropriate.

20. Performer has first operative radio- h. May indicate to appropriate staffgraph processed at once for viewing,as person when the performer is readydescribed above. Continues with radio- to proceed with next radlographicgraphy at intervals determined by sur-geon, following steps as describedabove,until told by surgeon that radi-ogtaphy has been completed,

procedure.

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Task Code No. 372


1. What is the output of this task? (Be sure4....... ...

List Elements Full....

this is broad enough to be repeatable.)Requisition reviewed;x-ray equipment and accessorieschecked for use in operating room,cleaned,trans-ported and set up;film packets prepared for use;filmpacket identified and placed in sterile holder;tubepositioned and exposure made;film packet removedfrom holder;processing and viewing arranged;changesmade and retakes done as ordered;examination re-corded;equipment returned,

Performer receives or obtainsthe x-ray requisition form andidentification card for a pa-tient scheduled for intravis-ceral or isolated operating roomradiography (such as isolatedkidney or choledochography) asa result of:

a. Regular assignment.b. Checking assignment on sche-

dule sheet.c. Having arranged requisitions

in order of priority.d. Receiving emergency order to

perform task after surgicalprocedure has begun.

1. Performer reads informationon the requisition sheet oremergency order to plan forthe procedure:

a. Notes the patient's nameand ID number; confirmsthe type of surgical pro-cedure and the organ to beradiographed.

b. Notes the operating roomassigned and its location.Checks the time for thescheduled surgery and, ifappropriate, the time toreport for preparatory

.......


Pt.'s x-ray requisition form:portable operating roomx-ray unit;control panel;electrical outlets;dentalocclusal film packets or x-ray film,black paper andlead foil;scissors;tape;extension cone;collimator;soap;antiseptic,disinfectant solutions;cleaningcloths;cap,mask,gown,"boots";lead shielding;forceps;sterile film packet holders;pt. ID,R-L markers;tech-nique,exposure,positioning and tube rating charts;view boxes;pen

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...(X) No...( )

. If "Yes" to q. 3: Name the kind of recipient,respondent or co-worker involved, with de-

script:ions to indicate the relevant condition;include the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions.

Operating room supervisor or charge nurse;supervi-sor;attending surgeon;pt. to have surgery;anesthe-siologist;surgical team;co-worker

5. Name the task so that the answers to ques- procedures, or noteswhether surgery has begunand amount of time leftto prepare and set upequipment.

c. Notes name of attendingsurgeon and/or chargenurse or operating roomsupervisor.

d. Performer notes the pa-tient's sex, height,weight

OK-RP;RR;RR


tial words,Taking intravisceral or isolated operating room ra-diographs of any patient by reviewing request;as-sembling,checking,cleaning,transporting and settingup x-ray equipment in operating room;preparing smallsize film packets;placing in sterile packet-holderfollowing sterile technique;adjusting x-ray tube;se-lecting and setting exposure factors;collimating;checking shielding;making exposure on signal;remov-ing film packet from bloody holder;arranging forprocessing and viewing by surgeon;repeating as or-dered;recording examination;returning equipmentafter use.

6. Check here it thisis a master sheet...

.....mommim=mmm.mmmim

333


Task Code No. 372


List Elements F4117 List Elements Full,

and body type,if information isavailable,in order to anticipateprobable exposure technique andfilm size needed.

e. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition is com-plete. If the performer determinesthat the request is not properlyauthorized, is incomplete, or thatsufficient info-mation is lackingfor performer to select technique,notifies supervisor, radiologist,or other designated staff person,depending on institutional proce-dures. Explains the problem if ap-propriate, and proceeds after ob-taining needed information nr signature.

f. If appropriate, performer may ar-range to have prior radiographs de-livered to operating room or mayarrange to transport personally.

. Performer determines what prior prep-arations are necessary and plans tocarry these out:

a. Performer determines whether as-signed operating room has an x-rayunit already available or whetherperformer will transport e mobileunit. Makes sure that unit to beused has an adequate output capac-ity for the required radiographyand is hazard proof and certifiedfor operating room use. Plans tocheck and clean equipment in appro-priate storage area.

b. Performer notes whether film processing equipment with capacity tohandle small size film is availableadjacent to operating room. Iffilms must be processed in radiol-ogy department, performer makessure that someone is assigned topick up, process and return radio-'graphs to operating room as theyare made.

e. Performer notes whether packetsof denttli occlusal film or medicalx-ray film cut to size and wrappedwith lead foil in black paper willbe used, whether sterile envelopeor surgical glove will be used tohold film packet, and whetherprior preparations to sterilizeholders must be made with operat-ing room staff.

d. Performer checks own clothing tomake sure that undergarments, uni-form and shoes are made of fabricsthat comply with institutionalrules for safe operating roomdress.

e. Performer may contact operatingroom staff to receive more detail-ed orders, information or to checkOn safety, timing or availabilityof equipment,or to arrange to havefilm packet holders of appropri-ate size and quantities autoclavedand ready for surgical use.

3. Performer goes to storage l3cationfor x-ray unit to be used in operat-ing room (in radiology dept. or ad-jacent to operating room) in orderto check, clean and assemble theunit. Washes hands as appropriatebefore and after assembling and clean-ing equipment.

a. Performer makes sure that unit ishazard proof, authorized for oper-ating room use,and, if operatingroam is not insulated for usewith nongrounded equipment withconductive floor,whether unit isequipped with rubber casters.Checks for proper kilter inx-raybeam, appropriate focal spot size;notes whether light beam in colli-mator is hazard-proof or not to beused in operating room.

b. Performer prepares damp clothswith appropriate antiseptic and/or

to


Task Code tic). 372



disinfectant solutions. Makes sure packets or obtain dental occlusal

unit is disconnected and wipes equip-ment thoroughly to remove dirt,dustand lint. If not already done, as-

film packets:

a. If performer is to prepare film

sembles tube stand of unit as appro- packets,performer selects a sizepriate to equipment. that will demonstrate the entire

c. Performer makes sure technique chart area under *study (such as kidney)

and tube capacity chart for the and small enough to be inserted ingiven unit, and chart for conversion sterile holder (such as Manilaof technique are included with orattached to unit.

d. Makes sure that FFD device, grovnd

envelope) dn body cavity.

i) Performer collects materialscord and remote control exposure and works in darkroom undercord are present and properly at- safelight.

tached. ii) Obtains an adequate number ofe. Performer decides to test the func- x-ray films of appropriate

tioning of the x-ray equipment. Dons type, speed and size. Cuts to

lead apron. Selects and sets the size if necessary.

anticipated technical factors; uses iii) Places each individual film on

a phantom or test object and elec- lead foil backing of same size.

trical outlet in storage area. Re- iv) Wraps each film-foil unit in

ports any defective unit and ar- black paper and tapes.

ranges to obtain alternate. v) Marks foil side of packet forf. Performer selects smallest possible placement away from x-ray beam

extension cone for reduction of ef-fective beam to only the organ to beisolated; cleans with antiseptic or

source.

b. If performer is to use prepared

disinfectant solution. film packets or dental occlusal,

g. Collects and cleans additional lead film packets, performer selects

shielding and aprons, calipers, those of appropriate size and type

Places on mobile carrier,h. Performer prepares for identifica-

as described above.c. Places film packets on mobile car-

tion of the films: rier in clean container.

0 May obtain lead numerals and tape 5. When the equipment and materials haveand prepare identification stripgiving appropriate patient iden

been assembled, checked,and cleaned,performer prepares the equipment for

tification information for place- transporting to operating room:ment on film packets.

ii) Checks identification against a. Adjusts x-ray tube in storage po-requisition form. sition. Makes sure that tube,col-

iii) Performer makes sure that right limator and arm are in position(R) and left (L) markers are where they cannot fall and locksavailable for use and markers to

,

indicate sequence of exposures.into position.

b. Performer stores all cables andiv) Places on carrier. cords in box provided or gathers

up and secures into place on car-. DePending on institutional arrange-ments,performer may prepare x-ray film

..........

rier.

335

List Elements


Full

This is page 4

Task Code No. 372

of 8 for this task.


d. Performer transports the equipmentand order for radiography to theappropriate location outside ofoperating room. Performer makessure he or she has a firm hold onand good control of the carrier.WalkE on right side of corridors;moves slowly and.with care whengoing around corners and up anddown ramps.


a. Indicates name of patient and de-termines exact location for settingup equipment

b. Performer asks about specific pre-cautions in dealing with patient.May record. Asks about any specialequipment which must remain inplace and be taken account of insetting up radiography unit.

c. Performer may receive clean hospi-tal gown,cotton "boots," cap, andmask from the charge nurse oroperating room supervisor. Perform-er dons these before entering oper-ating room. Washes hands as appro-priate. Carries out appropriatesteps to maintain the integr4cy ofthe sterile area of the opt. Atingroom and does not touch patient,drapes, sgrgeons, scrub nurses,instrument tables or "back table."

d. Performer may report to anesthesiaarea of operating room to discusspresence of any explosive gases ortiming for procedure.

e. Checks that sterile film packetLolders are available among sterilesupplies.

Jammamms....lrasuereansfacznowammariammemmeraminamosamarir

List Elements Fully 0

. Performer wheels in portable appara-tus being careful not to disturb anyequipment or electrical cords pluggedin. Does not run over cords. Liftscords when possible or asks for assis-tance. Places machine in a conven-ient, easily meaneuverable positionbefore setting up at operating table.

8. Pfxformer checks out equipment foruae in operating room before settingup for use at operating table:

a. May make sure that line powerswitch is off. Attaches line cordwith grounding terminal to unit,or attaches proper grounding as(or if) appropriate.

b. May connect all low voltage cablesto control panel if not alreadydone. May check that type of out-let and voltage are appropriateand connect power cable to linepower outlet.

c. Performer tests equipment for useat operating table:

i) Reviews the technique chart forthe machine to be used andtakes note of any newly postedchanges in technical factors(to reflect accommodation forchange in machine output or apolicy decision).

ii) Performer locates informationon chart for the organ involvedaccording to the approximatethickness of the part and thecollimated field size to beused. Makes sure that techniquerelates to the combination offilm type and speed and use ornonuse of other accessories.Makes note of kVp, mA, T(sec-onds of exposure time), focalspot size, and the focal filmdistance called for.


Task Code No. 372


List Elements Fullx.... List Elements Full

Once the standard kVp, mA andtime have been determined, per-former notes whether any conver-sions are necessary td accountfor change in FFD, preference ofthe 1 dologist or surgeon in-volved, and any other conversionneeded. Performer looks up numer-ical conversion factors and cal-culates, or uses conversionchart to ascertain the apprc.lri-ate new exposure factor (kVp, mAand/or time). Multiplies, di-vides, adds, or subtracts as ap-propriate.Performer checks any new or un-familiar exposure factors againstthe posted limits of the x-raytube on a tube rating chart tobe sure that technique does notexceed the heat capacities ofthe tube for the focal spot sizeto be used. If appropriate, per-former reconverts the techniqueto an equivalent output.Performer turns on main switch.After machine has warmed upchecks for kV reading. If appro-priate, adjusts line voltagecompensator.

vi) Performer sets milliamperage bychoosing selectors for the cor-rect focal spot size; sets themA selected.SeleCts and sets the exposuretime that will produce the mAsdesired.Sets the kVp selected by choos-ing the combination of majorkilovoltage and minor kilovolt-age settings to produce the de-sired kVp.

vii) When performer determines thatmachine is operating, turns offline power switch (if appropri-ate).

9. Once x-ray unit has been checked,performer sets it up at operatingtable on the side opposite the ster-ile field:

a. Performer determines where the .

portable machine can be placed,considering the care being givenpatient, such as anesthesia, IVdrip, etc.

b. Places machine so that x-ray tubecan be directed easily and at theproper focal-object distance (POD)and focal-film distance (FFD).

c. Makes sure that performer will beable to stand minimal requireddistance from x-ray beam duringexposure.

d. Locks and/or uses brake to immo-bilize equipment in place.

e. Performer makes sure. that thex-ray unit is ready for use.Checks that indicator light showsthat machine is "warmed up," orturns on main switch as appropri-ate to equipment and allows timefor machine to "warm up." Makessure that all circuits have beenstabilized. If appropriate, ad-justs line voltage.

10. Performer attaches identificationmarkers to the film packet(s):

a. Places right or left marker as ap-propriate, in relation to foilside of packet.

b. If patient's identification infor-mation is in the form of lead num-erals, places on appropriate corneof packet.

c. If patient identification infor-mation is to be entered by use offlasher, sets flash card asicle forlater use and places preparedpiece of leaded rubber on appro-priate edge of packet.

337


Task Code No. 372


List Elements Fully

d. If not already done, performer pro-vtdes self and everyone who will bein operating room during radiographywith protective shielding. Explainsif necessary that this is not causefor alarm but a general precautionto minimize unnecessary radiationexposure. Checks that sterileshielding is available for use onpatient within sterile field.

List Elements Full

11. Performer indicates to surgeon wheneverything is ready for radiographyand awaits orders to work with scrubnurse for film packet placement.Stands at nonsterile end of table.Prepares to work as quickly and ef-ficiently as possible.

12. At the signal of the surgeon,performertakes up the first film packet to beused. As scrub nurse holds sterileenvelope or surgical glove open, per-former introduces the film packet intothe sterile holder,being careful toavoid touching the outer parts. Indi-cates verbally to nurse and surgeonwhich side is to be placed away fromthe x-ray source (the foil side).With occlusal film has pebbled sidefacing the x-ray beam source.

13. Performer waits while surgeon insertsfilm packet(in holder)into incisionand places in position and/or adjustsorgan in front of film area.

a. Performer then positions x-ray tubeso that the central ray will be atright angles to center of film area(or at angle indicated by surgeon).

b. Performer adjusts the requiredfocal-film distance by reading in-dicator scale in the tube housing;adjusts up or down until the re-quired FFD is obtained.

c. Performer adjusts the collimationso as to expose only the area of

interest (and thus provide maximumprotection and detail). Ferformermay attach selected auxiliary ex-tension cone to collimator tofurther reduce the primary beam.Adjusts primary beam to minimumsize needed to cover the part ofinterest. (Does not use light beamin operating room unless it hasbeen certified as safe for use inpresence of explosive gases.)

d. Performer may indicate where ster-ile lead shielding should be plac-ed so that areas not being studieddirectly will be shielded from theprimary path of the beam. Hassterile gonads. shielding appliedif possible.

14. When everything is ready for the ex-posure,performer checks with surgeonand anesthesiologist on timing.

a. Has all persons not needed atoperating table during exposureleave room.

b. Performer checks controls of x-raymachine and walks to safe distancefrom tube with exposure control(on long cord).Waits for signalfrom surgeon or anesthesiologist.

c. On signal from surgeon(or anesthe-siologist if induced respiratoryarrest is required) performerinitiates exposure by pressingtrigger of exposure control cord.

d. While exposure is underway per-former checks that mA meter re-cords appropriate current as set,that kVp meter dips slightly.

e. May watch for evidence of malfunc-tion such as line surge or exces-sive drop; may listen for sound ofnormal functioning of equipment.

f. Indicates when exposure is com-pleted.

336


Task Code No. 372



15. After exposure, performer returns tooperating table. Stands by to receivefilm packet as surgeon removes it(inholder)from patient's body and hands toscrub nurse or other member of team.

a. As the now bloody film-packet holderis held open, performer removes filmpacket, being careful to keep itfrom contact with the blood. May useforceps.

b. Removes any mlrkers for furtheruse.

c. Performer arranges to have the filmprocessed at once:

i) If there is no appropriate pro-cessing equipment adjacent tooperating room, performer givesfilm packet to co-worker for pro-cessing.

ii) If there is a darkroom with pro-cessing equipment next to operat-ing room,performer arranges tohave film processed at once ordecides to do personally.

iii) Attaches ID card for use withflasher if appropriate.

iv) May sign requisition.

1

1 . 'Jii2n the radiograph has been processed.Id returned, performer places on viewbc4T in appropriate nonsterile area ofverating suite. May also hang priorfilms. Informs surgeon that radio-graph is ready.

a. Performer notes surgeon's orders onneed to "retake" radiograph or needfor further radiography:

i) Performer notes surgeon's orderson any change in technical fac-tors needed, or any change intube position.

ii) Notes whether need to repeat isdue to performer's own negli-

gence or lack of attention sothat performer can avoid futum.11 retakes."

iii) If request for retakes reflectsthe preference for density orcontrast of the surgeon, per-former notes for future workdone for the given surgeon sothat retakes can be avoided.

b. Performer repeats filming as or-dered,carrying out appropriatesteps described above, includingprocessing and review, making ap-propriate changes as ordered,untiltold by surgeon that radiographyhas been completed.

17. When the radiography has been com-pleted, performer carries out termi-nation steps:

a. Makes sure that main switch ofx-ray unit is off.

b. Disconnects power cable and grounding cord (if appropriate).

c. Performer may clean the equipmentafter use. Washes hands as appro-priate. Removes operating roomgarments and shielding.

d. 2erformer records the radiographyaccording to institutional proce-dures. May include date, operatingroom, surgical procedures, the viewtaken, the technical factors used,and film size; may record the num-ber of exposures made of each viewincluding retakes; may enter theestimated radiation dose to whichpatient was exposed (using postedinformation on dosage); may recordany problem with equipment. Signsrequisition sheet.

e. Performer may arrange to jacketfilms, requisition sheets, and re-lated materials and/or have infor-mation recorded in log book, de-pending on institutional proce-dures.


Task Code No. 372



f. Reports to supervisor or nurse incharge of operating room that ra-diography is completed.

g. Reassembles equipment and materialsas described above. Prepares fortransporting back to radiology de-partment as described. Transportsas described and stores variouscomponents as appropriate.

h. May indicate to appropriate staffperson when the performer is readyto proceed with next radiographicprocedure.


Task Code No. 373


. What ia the output of this task? (Be surethis ia broad enough to be repeatable.)

Requisition reviewed;x-ray equipment and accessor-ies checked for use in operating room, cleaned,transported and set up;positioning of patient and/orcassette, cassette tunnel directed under steriletechnique;cassette identified and placed;techniqueselected and set;tube positioned;exposure made;processing and viewing arranged;retakes made asordered; examination recorded; equipment returnedafter use.

List Elements Fully

Performer receives or obtainsthe x-ray requisition form andidentification card or emergencyorder for operating room opaqueforeign body search (such as forgauze sponges,marked with bar-ium, lost during abdominal sur-gery) as a result of:

a.

. What is used in erformin this task? (Note 13.


Pt.'s requisition sheet,ID card;portable operatingroom x-ray unit;electrical outlets;x-ray or polaroidcassettes;cassette tunnel or holder;grid;extensioncone;collimator;soap;antiseptic,disinfectant solu-tions;cleaning cloths;sterile pillow cases or wraps;hospital cap,mask,gown,"boots";leaded shielding;pt.ID,R-L markers;technique,exposure,positioning andtube rating charts;exposure control panel;view box;_pen

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...(y) No...( )

es to q. I:NatiirThe=atio recipient,respondent or co-worker involved, with de-

scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knewledgerequirements or legal restrictions.

Operating room supervisor or charge nurse;supervis-or; attending surgeon; pt. to have surgery; anesthe-siologist; surgical team; co-worker 4

. Name the task so that the answers to ques-tions 1-4 are reflected. Underline essen-tial words.

Taking operating room radiographs for opaque foreignbody search by reviewing request;assembling,check-,ing,cleaning,transporting and setting up x-rayequipment in operating room; selecting and settingtechnical factors; arranging for patient and cas-sette placement,observing sterile technique; posi-tioning tube; arranging for shielding; collimating;making exposure on signal; arranging for processingand viewing by surgeon; repeating as ordered; recording examination; returning equipment after use.

c.

1.

Regular assignment.Checking assignment sheet.Emergency request based onavailability for procedure.

Performer reads informationon the requisition sheet oremergency order so as to planfor the procedure:

a. Notes the patient's nameand ID number; confirmsthe type of object and na-ture of the surgery in-volved.

b. Notes the operating roomassigned and its location;notes name of attendingsurgeon and/or chargenurse or operating roomsupervisor.

c. Performer considers theradiographs likely to berequired. Notes the pa-tient's sex, height,weight, age,and body type,if information is avail-able,in order to antici-pate the proper exposuretechnique and cassettesize to select.

d. Performer makes sure thatthe request is properlyauthorized, that informa-tion on requisition sheetis complete.

OK-RP;RR;RR


is a master sheet. . (X)

AMMIIMI


Task Code No. 373


List Elements Full

If the performer determines that therequest is not properly authorized,is incomplete, or that sufficientinformation is lacking for performerto carry out radiography, notifiassupervisor, radiologist, or otherdesignated staff person, dependingon institutional procedures. Ex-plains the problem if appropriateand proceeds aEter obtaining neededinformation, signature, or orders.

Performer determines what prior prep-arations are necessary and what willbe'involved. Plans to work as rapidlyand carefully as possible.

a. Performer determines whether assign-ed operating room has an x-ray unitalready aVailable, or whether a unitmust be transported to the operatingroom. Plans to check and clean x-rayequipment in appropriate storagearea.

b. Performer notes whether film proces-sing equipment (polaroid processingor in darkroom) is available adjac-ent to operating room. If films mustbe processed ia radiography depart-ment, performer makes sure thatsomeone is assigned to pick up,process, and return radiographs tooperating room as they are made.

c. Performer determines whether theoperating table in use has a built-in cassette holder or whether per-former or surgical staff must pre-pare to insert and remove cassettesunder patient using sterile covers.Checks whether a cassette tunnel orgrid will be required.

d. Performer checks awn clothing tomake sure that undergarments, uni-form and shoes are made of fabricsthat comply with institutional rulesfor safe operating room dress.

e. If appropriate, performer contactsoperating room staff to discussoperating room safety procedures,

List Elements Full

type of grounding, possible use ofexplosive gases in anesthesia, andany information on availabilityof relevant equipment.

3. Performer goes to storage locationof the designated hazard-proof por-table x-ray unit or of unit kept inor near nonsterile area of operatingroom in order to check, clean andassemble the unit. Washes hands asappropriate before and after cleaningequipment.

a. Performer makes sure that unit tobe used has an adequate outputcapacity for the required radiog-raphy and is hazard-proof andcertified for operating room use.Checks that, if operating roomis not insulated for use withnongrounded equipment with con-ductive floor, unit is equippedwith rubber casters.

b. Checks for proper filter in x-raybeam,FFD measuring device. Noteswhether light beam in collimatoris not to be used with equipmentdue to electrical hazard.

c. Performer prepares damp clothswith appropriate antiseptic and/ordisinfectant solutions. Makes sureequipment is discunnected andwipes equipment thoroughly to re-move dirt, dust, and lint.

d. If not alread:, done, performer as-sembles tube stand of unit asappropriate to equipment. Makessure that grounding cord and re-mote control exposure cord areattached as appropriaLe.

e. Performer decides to test func-tioning of equipment. Uses electrical outlet in storage area andphantom or test object. Selectsand sets anticipated exposuretechnique and makes an exposure.If performer notes any possibledefect in equipment reports this


Task Code No. 373


List Elements

to supervisor and arranges to usealternate equipment.

f. Selects and cleans appropriateextension cone(s) so that effectivebeam can be reduced as much as pos-sible to minimize secondary radia-tion.

g. Performer makes sure techniquechart, tube capacity chart for thegiven unit, and chart for conver-sion of technique are includedwith or attached to unit.

h. Collects and cleans leaded rubbershielding and aprons to be used toprotect patient, performer, andothers to remain in operating room.Pla..tes on carrier.

i. If appropriate, cleans cassettetunnel and places on carrier.

j. Performer selects loaded cassettesof speed and type, with use or non-use of grid,depending on establish-ed procedures. May check techniquechart. Chooses polaroid cassettesif polaroid processing will be used

i) Selects size based on the areato be radiographed and informa-tion on the patient's size.

ii) Collects adequate supply of loaded cassettes of the types andsizes selected or decides toprepare personally. Cleans andplaces in appropriate containeron mobile unit.

k. Performer prepares for identifica-tion of the films:

i) May obtain lead numerals andtape and prepare identificationstrip for placement on filmholder giving appropriatepatient identification informa-tion.

ii) Performer may prepare for use offlashcard by checking that there

List Elements Full

is piece of lead on film hold-er surface; may write or typeout ID information on card 4fnot received with requisition.




1. Performer makes sure that own per-son, garmeats and shues are cleanand garments appropriate for op-erating room.

4. When the equipment and materialshave been assembled, checked, andcleaned, performer prepares theequipment for transporting to oper-ating room:

a. Adjusts x-ray tube in storage po-sition. Makes sure that tube,collimator, and arm are in posi-tion where they cannot fall;locks into position.

b. Performer stores all cables andcords in box provided or gathersup and secures into place oncarrier.

c. Makes sure that all movable pro-jecting or looming parts are cen-tered and not projecting out frcmmachine.

d. Performer transports the equip-ment and order for radiography tothe appropriate location outsideof operating room. Performermakes sure he or she has a firmhold on, and good control of,the carrier. Walks on right sideof corridors; moves slowly andwith care when going around cor-ners and up and down ramps.

34 3


Task Code No. 373



5. Performer reports to the charge nurseor operating room supervisor (with theportable equipment if transported).

a. Indicates name of patient and de-termines exact location for settingup equipment.

b. Performer asks about specific pre-cautions to be taken. May record.Asks about any special equipmentwhich must remain in place and betaken account of in setting up ra-diography unit.

c. Performer dons lead apron and mayreceive a clean gown, cotton"boots," cap, and mask from thecharge nurse or operating roomsupervisor. Performer dons thesebefore entering operating room.Washes hands as appropriate. Car-ries out appropriate steps to main-tain the integrity of the sterilearea of the operating room and doesnot touch patient, drapes, surgeons,scrub nurses, instrument tables or"back table."

d. Performer may report to anesthesiaarea of operating room to discussappropriate timing and/or presenceof any explosive garls. May checkthat sterile shielding is availablefor use with patient.

e. Performer may discuss placement ofcassette tunnel or cassette withappropriate staff member (if notpart of operating table).

f. Performer provides everyone who will,remain in operating room duringexposure with protective shielding.Explains if ner'ssary that this isnot cause for alarm but a generalprecaution to minimize unnecessaryradiation exposure.

g. Performer determines where theportable machine can be placed,considering the care being givenpatient, such as anesthesia, IVdrip, etc.

h. Performer wheels in portable ap-paratus being careful not to dis-turb any equipment or electricalcords plugged in. Does not run

-over cords; lifts cords wheneverpossible or asks for assistance.

. Performer sets up equipment for usein operating room before placing foruse at operating table

a. Connects machine to power source:

i) May make sure that line powerswitch is off. Attaches linecord with grounding terminalto unit, or attaches propergrounding as (or if) appropri-ate.

ii) May connect all low voltagecables to control panel if notalready done.

iii) May connect power cable to linepower outlet after checkingthat voltage and outlet are ap-propriate.

b. Performer preselects the exposurefactors for the radiography:

i) Reviews the technique chart forthe machine tc be used and takenote of any newly posted changein technical factors (to re-flect accommodation for changein machine output or a policydecision).

ii) Locates the information neededfor the area to be radiographedand projection involved accord-ing to the centimeter thicknessof the part as estimated fromthe patient's age, height,weight,and sex and the colli-mated field size to be used.Makes sure that technique re-lates to the combination offilm type and speed and use or

34,1


Task Code No. 373

This is page .5 of 8 for this task.


nonuse of other accessories (suchas screens, grids, etc.). Makesnote of the kVp, mA, T(secondsof exposure time), focal spotsize, and the focal film dis-tance called for.

iii) Once the standard kVp, mA andtime have been determined, per-former notes whether any conver-sions are necessary to accountfor change in FFD, extreme fator muscularity, preference ofthe radiologist or surgeon in-volved, and any other conv.rsiorneeded. Performer looks up numer-ical conversion factors and cal-culates,.or uses converF.ioncharts to ascertain the appropri-ate new exposure factor (kVp,mA and/or time). Multiplies,divides, adds, or subtracts asappropriate.

iv) Performer checks any new or un-familiar exposure factors againstthe posted limits of the x-raytube on a tube rating chart tobe sure that technique does notexceed the heat capacity ofthe tube for the focal spot sizeto be used. If appropriate, per-former reconverts the techniqueto an equivalent output.

c. Performer turns on line powerswitch. After machine has warmedup, performe makes sure that allcircuits have been stabilized.Checks for kV reading. If appropri-ate, adjusts line voltage meter.

d. Performer sets exposure factors:


ii) Performer selects and sets theexposure time that will producethe mAs desired for the exami-nation.

iii) Performer sets the kVp selectedby choosing the combination ofmajor kilovoltage and minorkilovoltage sittings to producethe desired kVp.

iv) When performer determines thatmachine is operating, turns off dline power switch (if appropri- Iate).

e. Once the machine has been checked,performer sets up the unit at theoperating table opposite the ster-ile operating field. Makes surenot to make contact with any ster-ile objects or staff and keepsequipmeat away from sterile area. p

i) Places machine so that x-raytube can be directed easily andat the proper focal-object dis-tance (FOD) and focal-film dis-tance (FFD).

ii) Makes sure that performer willbe able to stand minimal re-quired distance from x-ray beamduring exposure behind shielding

iii) Locks and/or uses brakes to im- Imobilize equipment in place.

f. Performer identifies first cassetteto be used:

i) Places right or left marker oncassette as appropriate.

ii) If patient's identiftcation in-formation is in theTorm of leadnumerals, performer places onappropriate corner of cassette.

iii) If patient identification infor-mation is to be entered by useof flasher, sets flash cardaside for later use with spacecreated by piece of leaded rub-ber on appropriate edge of cas-sette.

. When the equipment is ready,performerreports to surgeon in charge to havepatient moved into an appropriate

3 45


Task Code No. 373


IList Elements Fully List Elements Full

position for radiography. May receive a. Directs central ray at right an-final orders from surgeon on position- gles to center of area of interesting of tube or cassette or on area of or cassette, or as directed by

.

interest, surgeon.b. Adjusts the x-ray tube to the re-

a. If a cassette tunnel has already quired FFD by reading appropriatebeen placed under patient,or if indicator scale; adjusts up ortable has a built-in cassette hold- down until the required FFD ising drawer, performer asks that obtained.sterile drape be lifted to expose c. Performer adjusts the collimationthe location. Performer checks so as to expose only the area ofwhether patient or cassette tunnel interest (and thus provide maximumhas been properly centered for the protection and detail). Performerprojection required. Indicates any may attach selected auxiliary ex-adjustments needed. tension cone to collimator toOnce placement ia judged appropri- further reduce the primary beam.ate, performer has sterile drape Adjusts primary beam to minimum 1-

held up to expose opening of cas- size needed to cover the area ofsette holder. Performer places cas- interest. (Does not use light beamsette inside and into position. Hasdrape replaced.

b. If the cassette or cassette tunnel

in operating room unless it hasbeen certified as safe for use inpresence of explosive gases.)

is to be placed into the sterile d. If appropriate may indicate wherefield, performer holds cassette or sterile lead shielding should becassette tunnel while scrub nurse placed so that areas not beingholds open a sterile wrap or pillow studied directly will be shieldedcase. Performer drops cassette or from the primary path of the beam.cassette tunnel into covering, or Has gonadal shielding applied ifcase,being careful to maintain sterile technique and not allow cas-sette,tunnel,or own nands to touch

possible.

9. When everything is ready for the ex-the outside of the covering or case posure, performer checks with sur-Performer directs the placement ofthe cassette or cassette tunnelunder patient so that it is prop-

geon and anesthesiologist on timing.

a. Has all persons not needed aterly centered under the area of operation table during exposureinterest with correct side facing leave room.the x-ray beam source. b. Performer checks controls of x-rayIf a cassette tunnel has been used,has scrub nurse expose entrance of

machine and walks to safe shieldeddistance from tube,holding expo-

tunnel while performer inserts and sure control on long cord. Waitsplaces cassette while maintaining for signal from anesthesiologist.sterile technique. c. When anesthesiologist signals that

respiratory arrest has been in-8. Once the cassette has been placed,

performer adjusts the x-ray tube,being careful to avoid touching anysterile area:

duced, performer initiates expo-sure by pressing trigger of expo-sure control cord.


Task Code No. 373



i) While exposure is underway, per- b. Notes any changes required informer checks that mA meter placement of cassette, tube posi-records appropriate current as tion or centering, and/or techni-set, that kVp meter dips slight- cal factors.ly. c. If appropriate,directs reposition-

ii) May watch for evidence of mal- ing of cassette tunnel and/or car-function such as line surge or ries out appropriate identificationexcessive drop; may listen for and placement of next cassette.sound of normal functioning of d. Performer repeats filming as or-equipment. dered,carrying out appropriate

iii) Indicates when exposure is com- steps described above, includingpleted. processing and review, making ap-

propriate changes as ordered until10. After exposure, performer returns to told by surgeon that radiography

operating table. Has sterile drapelifted while performer removes cas-

has been completed.

,

sette. Leaves cassette tunnel in place 12. When the radiography has been complet-if additional radiograph:. may be re- ed, performer carries out terminationquired. steps:

I

a. Removes any markers for further use. a. Makes sure that main power switchb. Performer arranges to have the ex- is off for x-ray unit.

posure processed at once: b. Disconnects power cable and ground-ing cord if appropriate.

i) If there is no processing equip- c. Performer may clean the equipmentment adjacent to operating room,performer gives cassette to co-

after use. Washes hands as appro-priate. Removes operating room

worker for processing. , .garments and shielding.

ii) If there is a darkroom with pro- d. Performer records the radiographycessing equipment next to operat- according to institutional proce-ing room or a polaroid processor,performer arranges to have cas-

dures. May include date, operatingroom, surgical procedure, the

sette processed at once or de- views taken, the technical factorscides to do personally. used and film sizes; may record

iii) Attaches ID card for use with the number of exposures made in-flasher if appropriate. May cluding retakes; may enter thesign requisition. estimated radiation dose to which

patient was exposed (using postedinformation on dosage); may record

11. When the film has been processed, per- any problem with equipment. Signsformer places on view box in appropri- requisition sheet.ate nonsterile area of operating suite e. Performer may arrange to jacketand informs surgeon that it is ready films, requisition sheets, and re-

for inspection. lated materials and/or have infor-mation recorded in log book, de-

a. Performer notes any orders from Pending on institutional proce-surgeon for further radiography. dures.


Task Code No. 373


List Elements PullL List Elementt.11.1117

f. Reports to supervisor or nurse incharge of operating room that ra-diography is completed.

g. Reassembles equipment and materialsas described above. Prepares fortransporting back to radiology de-partment or storage area as describ-ed. Transports as described andstores various components as appro-priate.

h. May indicate to appropriate staffperson when the performer is readyto proceed with next radiographicprocedure.

348


Task Code No. 374


1


Requisition reviewed;patient reassured;lesion lo-calized on plain films;tomographic equipment set up;films identified;technical factors,amplitude andlayer height selected and set;patient positioned;scout tomograms taken,sent for processing,taken toradiologist;procedures repeated as ordered;patientreturned;examination recorded;tomograms placed foruse.

AMIEMP.

. What is used in performing_this task? (Noteif onlx certain item nust be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical and technical history,prior radiographs;viewboxes;pen;paper;x-ray generator;tomographic attach-.ment;control panel;tube,bucky,table,collimator,ex-tension cones;technique,cooling,tube rating,and rad

4exposure charts;cassettes;beam filter;footrest;re-straining bands;lead shielding;R-L,level and ID markers;sand bags;head clamp;weighted band;tape;centi-

meter.scale;calipers;stool;wax marker;body marker;intercom;stretcher;wheelchair.1=1 10t

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...(10_ No...( )

. fr"7775777:Narr--777=1 o recipient,

respondent or co-worker involve, with r:e-

scriptions to indicate the rele nt conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions.

Patient to have tomography;accompanying adult;radiologist;anesthesiologist;co-worker

. Name the task so that the answers to ques-tions 1-4 are reflected. Underline essen-

tial words.Taking tomograms of non-infant patient by reviewingrequest;reporting observed contraindications;prepar-ing equipment;reassuring pt.;localizing lesion fromplain films;setting up layer height,amplitude andtechnical factors for scout tomograms as ordered;providing shielding;positioning pt.;collimating;identifying;exposing -scout tomograms and arrangingfor processing;taking to radiologist;taking full setof tomograms,continuing as orderedihaving pt. re-turned;placing tomograms for use;recording examina-tion.

List Elements Fully

Performer receives or obtainsthe x-ray requisition form, pa-tient's identification card,andany appropriate medical-techni-cal history for a non-infantpatient scheduled for tomography(body section radiography) (ex-cept for positive contrastnephrotomography and neurologictomography or other such contin-gencies of scheduled contraststudies), as a result of:


ule sheet.. Having arranged requisitionsin order of priority.

d. Decision of radiologist toexpedite and have tomographydone at once.

Depending.on instititional ar-rangements, performer may re-ceive frontal and lateral radio-graphs of the patient with re-cord of technical factors usedfor use in localizing:the areaof interest.

1. Performer reads the requisi-tion sheet to determine thetype of tomography calledfor, the area of interest,the patient involved, specialconsiderations, and to checkthe completeness of the in-formation provided:

a. Performer checks the partof the body involved,such as skull, neck;vertebrae, thoracic orabdominal area, and thespecific organ. Notes thename of the radiologistin charge.

OK-RP;RR;RR

6. Check here it-7isis a master shuLajap


Task Code No. 374


..........List Elements.ally List Elements Full

b. Notes whether tube-film travel pat-tern is spectfied (if more than onetype of equipment is available),such as linear, circular, ellipti-cal, or hypocycloidal tomography.Notes whether zonography is calledfor (exposure angle of 100 or less),whether olesiotomography is calledfor (simultaneous multi-level tomog-raphy using "book" casz,ettes). Noteswhether asymmetrical tomography(in-complete linear sweep) is ordered.For linear motion checks whethervertical or horizontal drive is"prescribed,

c. Perforter notes the patient posi-tions (recumbent or vertical), andviews called for, the areas to beincluded in the central beam; noteswhether the exposure angle (ampli-tude), speed, the number of "cuts,"and the suspected level have beenindicated. Notes whether performerwill be expected to use prior ra-diographs to localize the plane ofinterest. If not assumed as stan-dard procedure,notes orders for"scout" tomograms (such as one"cut" at expected plane of inter-est, one or more at given cm'sabove.and/or below),

d. Performer reads patient's name,identification number, sex, age,and weight. Notes whether patientis in-patient, out-patient, acci-dent,or emergency patient. Notesany special information on knownpathology that will affect patientpositioning, technique,or handlingof the patient, such as presenceof accident-injuries, unhealed orsuspected fracture, degeneratingdisease, whether patient will beon a stretcher or wheelchair.

e. With patients with accident in-juries or unhealed fractures, per-former may make sure that a sur-geon or radiologist is available

to position the patient; checkswhether rotation and extension ofaffected parts is contraindicated.

f. Performer checks whether patientis suffering from a collateralcondition requiring special han-dling, such as heart disease,communicable or infectious con-dition, infirmity, incoherence;whether patient has IV drip, oxy-gen supply, urinary catheter, orsimilar device in place; noteswhether patient will be accompa-nied by nurse or ocher staff per-son.

g. Performer notes whether the partof the body to be examined andthe exposure amplitude orderedrequire any special precautionsagainst unnecessary exposure ofsensitive organs (such as use ofshielding for eyes, gonads, po-sitioning of patient at right an-gles to direction of linear tubetravel, use of additional filterin beam column for hypocycloidalmovement). Notes shielding needed.

h. Depending on institutional proce-dures, performer may review pa-tient's radiation exposure his-tory, prior record of techniquesused, and cumulative exposure.Notices whether exemination hasbeen done elsewhere In recentpast, whether number of tomograph-ic exposures ordered or done inpast should be reported to radio-logist.

i. Depending on institutional proce-dures, perfo.mer notes whetherfemale patient is pregnant, re-views date of female patient'slast menstrual period, or notesany other indication that thereis no danger of exposure of aknown or possible fetus.

j. If patient's record indicates or-ders for sedation or any otherprior medication, or if anesthesia

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Task Code No. 374


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may be ordered for pediatric pa-tient, performer may check timingto be sure a proper elapse of timehas occurred fcr medication to takeeffect. May arrange to delay exami-nation if appropriate.

k. If performer is not already assign-ed to examination room (and a par-ticular machine) notes the room ormachine involved.

1. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheetis complete.

?. If the performer determines that therequest does not include suggestedamplitude and level for scout tomo-grams, is not properly authorized,orthat sufficient information is lackingfor performer to set up equipment,select technique or to properly posi-tion or care for patient, or if per-former considers that there may becontraindications to going ahead withthe procedure, performer brings thisto attention of radiologist in charge:

a. Performerpatient'sand priordiologiston view b

brings requisition sheet,medical history, cbert,films of the area to ra-May display prior films

oxes.b. Performer tells radiologist about

any difficulties encountered withregard to information, equipment,possible contraindications,or any-thing else that should be broughtto physician's attention. Notes anyorders or change in procedure de-cided by radiologist. Notes whetheranesthesia will be administered topediatric patient. Proceeds afterobtaining needed information, sig-nature, or orders. May have radio-logist mark area of lesion onradiographs.

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c. If radiologist decides to cancelprocedure, performer arranges toterminate and reschedule as ap-propriate.

3. When performer is claar about whatwill be involved in the tomographicexamination, he or she preparesahead so as not to keep the patientin the examination room longer thannecessary:

a. Performer washes hands as appro-priate; depending on patient'scondition, may decide to arrangefor or carry out isolation ordecontamination techniques.

b. Performer makes sure that x-rayequipment is ready for use. Goesto control panel for x-ray gen-erator and checks that indicatorlight shows that machine is"warmed up," or turns on mainswitch as appropriate to equip-ment and allows time for machineto "warm up." If appropriate,performer may set radiography ortomography mode selector and setcollimator control for manualoperation.

c. Performer reviews the techniquechart for the machine to be usedand takes note of any newly post-ed changes in technical factors(to reflect accommodation forchange in machine output or apolicy decision).

d. Performer checks that approprir.reimmobilization devices are pre-sent, and that there is a mat-tress, pads, pillows an2/orblankets for comfort of patient.

e. Makes sure that right (R) andleft (L) markers are availablefor use and identification cardsor leaded numerals for film iden-tification and recording of leveland amplitude.

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Task Code No. 374



f. Performer makes sure that an ade-quate supply of loaded cassettes ofthe appropriate types and sizes areavailable in the examination room,including book cassettes if appro-priate. If not, arranges to obtainor decides to obtain personally.

g. Checks that leaded rubber shieldingis available for protection of pa-tient and/or anyone to remain inroom during exposure.

h. Performer prepares Tor identifica-tion of the films using equipmentprovided by institution:

i) May obtain lead numerals and tapeand prepare identification stripfor placement on film holder(s)giving appropriate patient iden-tification information.

ii) Performer may prepare for use offlashcard by checking that thereis piece of lead on film holdersurface; may write out ID infor-mation on card if not receivedwith requisition.


i. Performer sets x-ray table in hori-zontal position. If patient is tobe positioned vertically, sets upfootrest at end of table.

j. If appropriate, such as with wideangle hypocycloidal tomography, per-former may insert additional filter(as designated) into beam column.

k. If institution has polytomographyunit, sets mode corresponding to ap-propriate tube-film travel patternand sets up as appropriate to modeselected-

1. If a tomography attachment is toput in place (to be used with con-ventional tubemount, generator, andhorizontal bucky x-ray table), per-former obtains the necessary equip-ment and assembles:

i) Checks that table is in hori-zontal position.

ii) Attaches fulcrum assemblyalong the table top rail athead end of table and secures.

iii) Attaches fulcrum assembly plugto appropriate electrical re-ceptacle.

iv) Attaches the fulcrum bar andbucky link bar as appropriateto equipment and moves thetubemount over the fulcrumassembly. Adjusts so that an-gulation and fulcrum levelindicators are facing appro-priately.Slides fulcrum bar into ful-crum assembly as appropriateand locks.Adjusts tubemount to prescribefocal-film distance.(May checktechnique chart for tomog-raphy.)

If vertical tomography will beused, makes sure that fulcrumbar is released and movestable into vertical position.Moves the tomographic mecha-nism manually through the max-imum travel and checks thatthere are no restrictions suchas from cables or other at-tachments. Adjusts as appro-priate.

Engages the drive mechanismfor horizontal or verticaltravel as appropriate and re-moves engaging rod. Sets lockswitch if appropriate to pre-vent alternative travel motionReturns table to horizontalposition.

m. Makes sure that tomography powerswitch is off (if appropriate).

n. Washes hands again as appropriate.

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Task Code No. 374



. Performer has the patient called fromthe holding area and prepared for theexamination (if not al:eady done), ordecides to do personally,

a. Depending on institutional arrange-ments, performer may decide to es-cort out-patient to or from dressingroom. May decide to atsist in trans-porting patient from holding area orhave this done. Has patient undergeneral anesthesia wheeled in under _

supervision of anesthesiologist.b. Performer greets patient (if con-

scious) and any accompanying staffperson, and introduces self. Checkspatient's identity against the req-uisition sheet. With in-patient,checks hospital identificationbracelet or other identifier. Ifpatient is accompanied because ofseriousness of condition, performercheck-.; with accompanying staff mem-bar on any special precautions nec-essary during procedure.

c. Performer has patient assume a com-fortable recumbent supine position(unless prone position is called forand repositioning will be painful),

i) If appropriate, places mattress,pillow or clean linen on x-raytable.

ii) If patient is in wheelchair, maymove patient in chair into po- .

sition next to table. Makes surethat wheelchair is in locked po-sition.

iii) May decide to assist patient fr...wheelchair or stretcher to tableor has this done; may obtainhelp. Makes sure that no equip-ment is in the way that may becollided with by patient.If assisting patient to step onfootstool in order to get ontable, helps patient turn intoposition, step backwards onstool, and then sit and/or lieon table.

iv) If patient is on radiolucentstretcher, places stretcherinto position so thatstretcher can be liftedwith patient on it from wheel-ed base to x-ray table. Mayarrange to move or have pa-tient moved to table dependingon patient's condition.

v) If the area of the body to betumographed is such that anextended exposure angle willexpose sensitive portions ofthe body not being studied toprimary radiation (because ofthe travel of the central rayparallel with the patient'sbody) performer may have pa-tient lie so that the x-raytube will move at right anglesto the body: For example,if the neck or thorax is tobe.studied, performer may lockstretcher bed into positionat same height and at rightangles to x-ray table so thatpatient can lie on stretcherwith area of interest extendedover the bucky portion of thex-ray table. Assists patientinto position as describedabove.

d. Performer explains to patientwhat will be involved in the pro-,cedure; indicates what types ofpositions the patient will beasked to assume, the cooperationthat will be asked of the pa-tient. Performer may manuallydemonstrate the action of thex-ray tube during tomography.Answers patient's non-medicalquestions honestly; attempts toreassure patient and develop con-fidence. Treats patient withdignity and concern regardlessof patient's behavior. Remains

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Task Code No. 374

of 14 for this task.

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aware that patient may be frighten-ed and/or in pain. Performer ex-plains, when asked medical ques-tions, that it is not appropriatefor technologist to answer these;encourages patient to speak to phy-sician.

e. If not already done,has 2...Itient re-

move clothing, jewelry, hair pins,spectacles, dentures,as appropri-ate from all areas of the body thatmay be exposed,down to below thearea of interest. Permits patientto keep covered with gown untilmeasurements are taken and untilexposure. Treats young patientwith as much courtesy as adult.

f. if patient has an IV drip in place,performer checks that needle hasnot become dislodged and that thefluid is dripping at an even rate.If there are any problems, per-former clamps tube and notifies anappropriate staff person at once.

g. If there is a wet dressing, per-former has it reinforced or decidesto do personally.

h. If appropriate and not alreadydone, performer questions femalepatient of child bearing age re-garding possible pregnancy. Ifthere is any Possibility that pa-tient is pre'gnant and this has notalready been recorded, performerinforms radiologist and proceedsonly with approval.

i. Performer questions patient and/orRN or MD present on what movementis possible to determine if thepositions ordered are availablefor use. Notes whether injuriespresent require positioning by MD.

i) Performer considers the posi-tions ordered for the examina-tion and the patient's condi-tion. Performer may consider achange from standard position-

List Elements Fullz

ing to better accomplish thepurpose of the examination.

ii) Depending on institutionalarrangements, performer mayobtain permission from radio-logist or decides personallyto alter the standard proce-dure.

5. If performer has been asked tolocalize the suspected lesion, haspatient relax in supine position;explains what sill be done. Obtainswax marker, marker for use on pa-tient's body, calipers, centimeterscale and the patient's frontal(AP or PA) and lateral radiographs.Places radiographs on view boxes.Marks the center of the suspectedlesions (if not already done) oneach radiograph or has done by MD.

a. Performer works first withfrontal projection. Keeps R and Lsides in line with patient's cur-rent supine position. Judges howdimensions on radiograph corre-spond with dimensions on pa-tient's body in area of the sus-pected lesion:

i) Performer measures the dis-tance between two topographicanatomical points near areaof suspected lesion on filmand then corresponding dis-tance on patient's body.

ii) Judges a one-to-one corre-spondence or determines theratio to use to convert.

b. On the frontal film, performerlocates the marked center of thearea of the suspected lesion.

i) Locates a known anatomicalpoint visible on the midlineand marks on radiograph.


Task Code No. 374


List Elements Full List Elements Full_

ii) Follows the midline to the ii) Defines the point where thelevel of the lesion on radio- line crosses the table asgraph and marks a point on the vzero cm. s.midline at the level of the iii) Defines the point where thelesion. line crosses the patient's

iii) Connects the two points on the anterior body surface as themidline, Connects the points anterior location of therepresenting the lesion and its lesion.

level at the midline (forming a iv) Defines the distance fromright angle at the midl, e). zero an. to the anterior

iv) Performer measures the two lines location of the lesion as(from anatmnLcal point to level the AP distance measured in

of lesion on midline,and from (d), above.that point on midline to le- v) Divides the distance into

sion). Records.

c. Performer reproduces the markings

four equal horizontal quar-ters in cm's. Locates thearea of the lesion within

on the patient's body using wash- one of the quarters so that

able dye. the cm. distance to the tableat, above,and below the le-

i) Locates the known anatomicalpoint as in (b, i), above,andmarks on body.

sion can be estimated.

f. Performer may determine the

ii) Lays off the measured distance level of the initial cut (low-

along the midline towards the est probable cm.) and a secondintersection with second line and/or third cut at somewhat

(using conversion ratio if nec- higher levels, or brings marked

essary) and marks point rm mid- radiographs and measurements toline at level of lesion on body. radiologist who determines the

iii) Lays off (at right angles to levels for the two or threemidline), the distance to thecenter of the lesion (convert-ing if necessary). Marks point

scout tomograms.

6. When performer has the informationwhich defines the anterior loon the number of scouts, level(s)

cation of the lesion on body. for the scout tomogram(s), and thesize of the "slice" (exposure angle

d. Performer measures the AP thick- or amplitude), performer prepares

ness of the patient at the marked the equipment to make the prelimi-

lesion point using calipers. Re- nary exposure(s):cords. Has patient lie in relaxed

tposition.

e. Performer works with the lateral

a. Performer selects the appropri-ate cassette size, with film and

radiograph: screen speeds appropriate to theequipment and the area of inter-

i) Performer draws a vertical line est. Performer attaches identi-

at right angles to table, pass- fication information to the cas-

ing through the visible area of sette or table top:

the lesion (as marked).

355


Task Code No.


374

task.


i) Places right or-left marker onfilm holder or table-top as ap-propriate to th'..! study and pa-tient position, or depresses ap-propriate R or L button forautomatic marking.


iii) If patient identification info-r-mation is to be entered by useof flasher, sets flash cardaside for later use with spacecreated by piece of leaded rub-ber on appropriate edge of cas-sette.


v) Performer prepares marker givingthe level at which the fulcrumwill be set for the given ex-posure and attaches to cassetteor table-top as appropriate.

b. Performer places cassette intobucky tray. May manually pull outbucky tray and open retainingclamps. Inserts cassette into buckytray and pushes back..Makes sureclamps are closed. Moves cassetteinto appropriate "stored" positionor inserts cassette tray intobucky slot. Makes sure that buckycarriage is in center of buckyslot.

c. Performer sets the fulcrum (layerheight) level for the first (ornext) exposure:

i) If a "book" cassette is to beused, performer sets the ful-crum level to coincide with theuppermost body layer to be pro-jected.

ii) If an automatic layer heightselector is available, performer sets the controls to the interval distances selected, andsets .the fulcrum for the uppemost LT: lowermost body layerdesired depending on the direction of the automatic change.

iii) Sets the fulcrum level usinghand crank or power switch andchecks the setting on the ful-crum (layer height) indicator.

d. Performer sets the amplitude(sweep):

i) Makes sure that x-ray tube iscentered at zero angle. Checksfocal-film distance.

ii) Sets the prescribed exposureangle or amplitude as appro-priate to equipment and checksangle on indicator.

e. Performer sets the.sweep speedas prescribed, according to thespeeds available for the equip-ment, the exposure angle select-ed, and established procedure forthe area of interest (or pa-tient's age). Notes the durationor actual exposure time as theproduct of the angle and thesweep speed selected.

f. For linear tomography, performersets the directional controlswitch to right or left for hori-zonte travel or up or down forw=tical travel depending on thedirection in which the tube willtravel during the actual expo-sure.

For asymmetrical exposure, de-termines whether the arc to beused will be at the beginning oftube travel or near the end, andadjusts equipment as appropriate.


Task Code No. 374


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g. For other types of tube-film travelmotion performer sets the selector(s) as appropriate for directioncontrol (if any).

Performer selects the exposure factorsfor the first tomographic projectionby consulting the technique chart(s)posted for the machine deaiing withtomography:

a. Locates the information needed forthe body part and projection in-volved according to the exposureangle (amplitude), and speed se-lected. May first refer to conven-tional exposure factors in order toconvert if commercial techniquechart is used, or reads tomographymAs or mA and kVp directly from thetechnique chart.Makes sure that technique relatesto the combination of film type andspeed and use of other accessoriessuch as screens, grids.

b. Once the tomographic kVp and mA ormAs have been determined, performernotes whether any conversions arenecessary to account for a patho-logical condition, unusual position-ing, extreme fat, preference of theradiologist involved, and any otherconversion needed such as with post-ed changes in technique. Performerlooks up numerical conversion fac-tors and calculates, or uses con-version charts to ascertain the ap-propriate new exposure factors.Multiplies, divides, adds, or sub-tracts as appropriate.

c. Performer checks any new or unfam-iliar exposure factors against theposted limits of the x-ray tube ona tube rating chart to be sure thattechrique does not exceed the heatcapacities of the tube for the focalspot size to be used.

i) Takes account of total heatunits and checks with coolingchart. May plan pacing ofexposures to allow cooling.

ii) If appropriate, performer re-converts the technique to anequivalen': output usinghigher kVp, lower mA, orfaster sweep speed.

iii) Performer may plan to varythe exposure technique forthe scout radiographs so asto provide radiologist withvisual choice for the partic-ular patient. If so, recordsthe planned techniques foreach scout film in relationto the level of the "cut" foreach.


a. Enters control room. Makes surethat indicator lfght shows thatx-ray generator is ready for use.Makes sure that all circuits havebeen stabilized. Sets mode fortomography. Sets control formoving grid.

b. If appropriate, checks line volt-age meter and, if needed, turnscompensator dial until needle isaligned properly on line meter.

c. For conventional exposure control;


ii) Performer sets the kVp selectedby choosing the combination ofmajor kilovoltage and minorkilovoltage settings to producethe desired kVp.

iii) Sets backup timer at an incre-ment slightly longer than theactual exposure time (calcu-

357


Task Code No. 374



lated as the product of the an-gle of amplitude and the sweepspeed nr as listed on chatt).


i) Performer selects and sets thecategory corresponding to thetl-le of st.,1dy and use of screensbucky, etc., and, if appropri-ate, focal spot size.

ii) Seleots and sets a control cor-responding to the field size(as listed on technique chartfor phototiming).

iii) May select and set a kVp rangebutton (if called for withequipment) corresponding.torange for examination.


v) Makes sure backup timer is notlikely to terminate exposure be-fore phototimed exposure ismade astd sweep is completed.

Performer prepares the part to be ra-diographed in the position selectedfor the first (or next) tomographicexposure (unless this is done by phy-sician):

a. May explain o demonstrate to pa-tient what is required. May obtainhelp in positioning or has ND posi-tion.

b. Performer positions patient byfirst positioning body and then po-sitioning head if necessary. In po-sitioning body, performer proceedsas follows:

i) For positioning patient in APsupine or PA prone position, per-former arranges body so that itsmedian sagittal plane is center-

ed to the midline of table orstretcher.

ii) For lateral or oblique posi-tioning has median sagittalplane parallel with midline.Supports any elevated parts.

iii) Has prone patient flex elbows,place arms in a comfortableposition. Supports ankles.Rests patient's head on fore-head and nose. May have pa-tient rest hands beneathchest.

iv) Has supine patient place armsin a comfortable position;supports ankles and knees.

v) For thin patient in recumbentlateral, PA or oblique posi-tioning, performer may ele-vate chest so that the cervi-cal vertebrae are at a correctlevel.

vi) With all positions arrangesshoulders to lie on a single'transverse plane.

c. If positioning head, performerrefers to standard referencelines. May use wax marker todraw in reference lines orpoints on skull or visualizesmentally. Has patient first re-lax muscles of neck and thenmoves head gently. Lmmobilizesskull with a head clamp or aweighted band and rechecks angu-lation and position.

d. Performer centers part to midlineand keeps the long axis of thepart parallel to the film holder,unless patient is being position-ed transversely across table tominimize unnecessary radiationexposure. May draw back mandibleif throat is to be radiographed.

e. If patient is to be radiographedin erect position (vertical tubetravel), performer positions pa-


Task Code No. 374



tient on table in horizontal posi- 10. Once the patient has been positionedtion. Then attaches footrest and and immobilized, performer adjustsrestraining bands. Places table in the collimator. Collimates so as tovertical position just prior to expose only the area of interestexposure. Returns table to hori- (and thus provide maximum protectionzontal position for any change in and detail). For small fields (ifpositioning. not already done in positioning) per-

f. Performer positions patient in AP; former attaches an auxiliary exten-PA, lateral or oblique recumbent sion cone to collimator to furtherpositions as called for, following reduce the primary beam. Adjustsprocedures as for "plain" films of primary beam to minimum size neededthe area of interest. Centets areaof interest to center of film (inbucky) using light beam in colli-

to cover the part(s) of interest.

11. May add lead shielding to gonads and

mator, cross-hair shadows as ref- areas that will be in the primary-

erence for center of field and by path of the beam but are not included

moving bucky carriage. May use in the areas of interest. Provides

automatic aligning mechanism. Im- shielding to eyes if any exposure of

mobilizes patient as appropriate,g. If, during positioning, patient

orbital area is indicated and/orsmall shielding over corneas.

shows signs of severe pain, per-: Provides everyone who will remain in

former may notify radiologist at room during exposure with protective

once and await orders or may de-,

cide on alternative positioning to

shielding. Explains if necessary thatthis is not cause for alarm but a

avoid movement of the affected general precaution to minimize unnec-

part. essary radiation exposure.

h. Performer rehearses patient in 12. Performer tests tomographic set-upproper breathing for exposure such by proceeding with tubemount sweepas holding breath, breathing in or but not activating exposure. Has pa-out and holding, breathing regu- tient practice breathing and holdinglarly and shallowly and/or pho- still as ordered and permits patientnating a sound (such as high-

"e-e-e"to sense the duration time for each

pitched for study of lar- sweep:ynx or pharynx).

a. Turns on power for tomographic at-i) Cautions patient to keep fingers tachment or mode. Using appropriat

away from table edges. switch, activates tomographic sweeFjii) Advises p-tient to keep eyes

closed to avoid following theaction without activating exposure,and holds until tubemount reaches

movement of the x-ray tube. the extreme limit of travel.iii) Explains that patient must hold. b. Returns tubemount to other extreme

position for successive "cuts." position, holding until tubemounttravel is complete. Interrupts

i. Performer checks that no obstruc- travel at any point and makes anytions are present which might re- adjustments necessary. Returnsstrict tubemount travel such aspalpator or cables.

equipment to "start" position.

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Task Code No. 374


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13 When everything is ready for the expo-sure, performer reviews with patientthe breath control to be used for ex-posure. Rechecks position.Reminds patient if position is to bemaintained for further cuts. Performerobserves the patient's movement untilthe moment that the exposure is made.Readjusts position if warranted.

14 The performer returns to control room.Makes sure controls are properly setand patient is still in position.Tells patient when to breathe as in-structed by calling or using intercom.Performer initiates tubemount actionand exposure by pressing hand triggeror exposure control button (twice iftwo-stage control is appropriate).Holds down or continues to press ex-posure control until tube travel iscompleted. Then releases exposureswitch at once.

a. For asymmetrical exposure initiatesexposure or terminates at appropri-ate stage of tube travel.

b. After exposure is completed tellspatient that he or she can relax.

c. If there is any problem during theexposure, performer releases switchat once and sets back to "start" po-sition before attempting anothersweep.

15. After exposure performer returns topatient. Removes cassette from bucky.

a. Removes any markers.b. Performer places ID, R-L and appro-

priate next layer height markerson cassette for next scout (unlessbook cassette was used).

c. Inserts new cassette as described.d. Changes fulcrut, to new layer height

(level) as appropriate,unless thiswill.be done automatically.

.X1111.11.41144AWList Elements Fully

31 more than one patient positionis to be used-for scouts, repo-sitions patient if appropriate.

f. If new patient position is re-quired that calls for change inexposure factors,or if a varietyof factors are to be used, per-former changes technical factorsas appropriate.

g. Performer adjusts collimation andshielding and repeats exposurefor next scout tomogram.

h. Performer continues until allscout tomogram exposures havebeen made.

16. Throughout procedure performer ob-serves patient for any signs of emergency and/or to prevent or respondto an accident. If patient shows anyother emergency signs, loses consci-ousness, or has an accident, performer calls radiologist or staff memberat onci=. May decide to provide emer-gency first aid as well. If a pa-tient's catheter becomes disconnect-ed, performer clamps it and imme-diately notifies nurse. If cathetershould come out, notifies staffmember at once.

17.

18.

Performer arranges to have the scouttomograms processed at once or de-cides to do personally. Attaches IDcard for use with flasher if appro-priate. May sign requisition. Whilefilms are being processed, makessure that patient is comfortableand, if necessary, attended by staffperson or self.

Performer brings the processed scouttomograms directly to the radiolo-gist in charge or places on viewboxes and informs radiologist thatthey are ready. May also hang priorfilms. If not already done, brings

TASK DESCRIPTION SHEET-(continued)

Task Code No. 374



requisition sheet and pati(-1,t's medi-cal records.

Performer notes instructions from ra-diologist regarding the position andthe layer levels, amplitude,and num-ber of cuts to be made for each posi-tion. Notes radiologist's preferencefor technical factors.

19. Depending on radiologist's orders,performer makes tomographic exposuresat the selected interval cuts (ampli-tude) and levels required for eachposition ordered,as described above:

a. Readjusts fulcrum level, technicalfactors, patient positioning, col-limation and shielding as appropri-ate. Makes sure ID, R-L and layerheights are marked. Makes exposuresand has tomograms processed at onceas above,

b. Brings tomograms to radiologist anddisplays on view boxes as before.

c. Performer notes whether a givenlevel will be further defined bysmaller "slices"(expanded amplitudewithin a more restricted area. Ifso, repeats procedures after adjusting amplitude and redetermining ex-posure techniques.

d. Performer refrains from commentingon the films to patient or provid-ing any interpretation.

e. If performer is asked to repeat anyexposures, performer notes whetherneed to repeat is due to perform-er's own negligence or lack of at-tention so that performer can avoidfuture "retakes."

f. If request for retakes reflectsmalfunctioning equipment, performerreports malfunction to appropriatestaff member.

g. If request for retakes reflects thepreference for density or contrastof the radiologist, performer notes

20.

for future work done for thegiven radiologist so that re-takes can be avoided.

h. Performer shows subsequent setsof tomograms to radiologist asprocessed,and proceeds as de-scribed above until radiologistindicates that tomographic exam-ination is completed.

Performer carries out terminationsteps for the examination:

a. Turns off energy for tomographicattachment and/or unplugs.

b. If patient has been anesthetized,checks with anesthesiologist onremoval of patient. Otherwise,may have patient transported backto holding area or next location,or decides to do personally, asappropriate. Makes sure that noneof the equipment is projectingover the patient before allowingpatient to rise from stool ortable, and assists patient.

c. Performer has equipment and ex-amination table cleaned afteruse or decides to do personally,depending on institutional ar-rangements.

d. With tomographic attachment,dis-assembles by reversing the at-tachment procedures.

e. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the views taken,the amplitude, speed, layerheights and technical factors usedand film sizes; may record thenumber of exposures made includingretakes; may enter the estimatedradiation dose to which patientwas (..xposed (using posted informa-tion on dosage); may record anyproblem with equipment, any spe-cial care provided patient. If

3 1


Task Code No. 374


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any views called for in the initialrequest could not be obtained, per-former may record reasons. Signsrequisition sheet.

f. Performer may decide to jacketfilms, requisition sheets, and re-lated materials and/or have infor-mation recorded in log book per-sonally or have this done, depend-ing on institutional procedures.

g. May present requisition sheet toradiologist for comments, ordersand signature.

h. May indicate to appropriate staffperson when the performer is readyto proceed with next examination.

AM=MIS, iMMulln. a

3

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Task Code No. 375

This is page 1 f 15 for this task.

. What is.the output of this task? (Be L;'M List Elementsthis is broad enough to be repeatable.)

Requisition reviewed;pt.reassured,positioned;parcsmeasured;films identified;technical factors selected

and set;technique for.magnification set up;re.ientpositioned;scouts taken;radiologist assistO withinstillation of.contrast;exposures made;rnd.:graphssent for processing,taken to radiologist;proceduresrepeated;delayed films taken after contrast removed;patient returned;examination recorded;siagramsplaced for use.

Fully

2. What is used in_perfOrming this tailk? (Note

if only, certain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Pt.'s x-ray.requisition sheet,ID card,T.Dmedical and technical history,prior radioraphs,scouts;pen;x-ray control panel,tube,cky,1;ab1e,co1-limator,extension cones;technique,standard view,tubelrating,and rad exposure charts;cassettes;occlusalfilm packets;film holder;shielding;R-L and II) mail.-ers;sand bags;head clamp;weighted band7-7...4)e;..hu!r;

calipers;stool;scissors;view boxt,:a;emergency caltand supplies;sterile gloves,gown;sterile proceurtray;iodi%ed oil contrast;lemon slices;basin;orderforms; hone;stretcher or wheelchair

...11114.1.

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes..,* )

Ire,JAAMMISo 11.121i.frM7171917777n: Name t577111.c. Gt recipient,respondent or co-worker involw,a, with de_

scriptions to indicate thil relevant condition,include the kind with whom vile performer isnot allowed to deal if relevant to knowledgerequirements or legal restr4.ctions.

Patient to have E.ialography;accompanying adult;radiologist:co-workev;

Name g;77177ao that thy: answers to ques-tions 1-4 are reflected. Underline essen-

tial words.Taking sialograms of my patient by reviewing re-quest:preparing equipment;preparing and reassuringpt.;mesuring part;setting up for magnification technique;;:aking scout films as ordered;selecting andsetting technical factors;identifying films;posi-tioning pt. and equipment;providing shielding;assisting with instillation.and evacuation of contrast;collimating;making exposures as and when ordered;ar-ranging for processing;taking to radiologist;con-tinuingirepeating;taking post-evacuation films asordered;having pt. returned;placing sialograms for

use;ecording examination.

Performer receives or obtainsthe x-ray requisition form,pa-tient identification card, andany appropriate medical-techni-cal history for a patient sched-uled for sialography (radio-graphic contrast study of thesalivary glands, ducts andalveoli), as a result of:


,./le sheet.

:. !laving arranged requisitionsin order of priority.

d. From co-worker.

1.

Depending on institutionalarrangements, performer mayalso receive scout film(s)already taken by co-workerwith record of technical fac-tors used and/or any changesnecessary.

Performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, specialconsiderations, and to checkthe completeness of the in-formation provided:

a. Performer checks the ex-amination called for in-cluding the type of con-trast medium ordered andthe name of the radiolo-gist in charge.

b. Notes whether a bilateralstudy is indicated or, ifunilateral, which side.Notes which glands are in-volved (parotid or subman-di6ular). Notes the posi-

OK-RP;RR;RR


is a master sheet..

363

TASK DESCRIPTION SHEET'..continued)

Task Code No. 375



tions and views called for and anyspecial.requests. Notes name ofreferring clinician. N*tcs whethermagnification is orderee.

c. Performer reads patient',1 nama,identification number, wx, age,andweight. Notes whether p!..r1 ec. isin-patient, out-patient, or emer-

. gency patient. Notes any specialinformation on any known pathologythat would affect technique. Notesany conditions affecting position-ing, suspension of respiration orimthobilization such as cardiac orrespiratory disease, presence ofinjuries, whether patient will beon a stretcher or in a wheelchair.Notes whether patient has historyof allergies.

d. Performer checks whether patient issuffering from a collateral condi-tion requiring special handlingsuch as heart disease, communicableor infectious condition, infirmity,incoherence; whether patient hasIV drip, oxygen supply, urinarycatheter or similar device in place;notes whether patient will be ac-companied by nurse or other staffperson. Notes shielding needed.

e. If performer is not already assign-ed to examination room (and a par-ticular machine) notes the room ormachine involved,If magnification has been request-ed, performer checks that the ma-chine to be used has a fractionalfocal spot of appropriate size fordirect magnification technique(i.e.,0.3 mm or smaller),

f. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheetis complete.

i) Depending on institutional pro-cedures, performer may reviewpatient's radiation exposure

......

......

history,prior record of tech-niques u:led, and cumulative ex-posure. Notices whether exami-nation has been done elsewherein recent past,whether there ishistory of extensive radiog-raphy to be brought to radiolo-gist's attention.

ii) Checks whether any specialorders on exposure factors arein keeping with the usual radexposure involved for the ex-amination.

iii) Depending on institutional pro-cedures, performer noteswhether female patient is preg-nant, reviews date of femalepatient's last menstrual period'or notes any other indicationthat there is no danger of ex-posure of a known or possiblefetus.

iv) If patient's record indicatesorders for sedation or anyother prior medication, per-former may check timing to besure a proper elapse of timehas occurred for medication to

-

take effect.

g. If the performer determines thatthe request is not properly auth-orized, is incomplete, or thatsufficient information is lackingfor performer to select techniqueor to properly position or carefor patient, or if performer con-siders that there may be contra-indications to going ahead withthe procedure, performer bringsthis to attention of radiologistin charge. Explains the problemif appropriate, and proceeds afterobtaining needed information, sig-nature, or orders. -

h. If referring physician has requested that films'already on file bepresented with current radiographsand if not already with patient's

30,1


Task Code No. 375



jacketed material, performer ar-ranges to have prior films deliver-ed.

Performer prepares ahead so as not tokeep patient in examination room longethan necessary:

a. Washes hands as appropriate.b. Checks that procedure tray has been

prepared or decides to do person-ally. Prepares or checks for lemonslices or juice.

c. Checks that proper accessories areavailable for procedure includingleaded rubber shialding, aprons,and gloves to be used by performer,radiologist, the paient, and/oranyone who will remain in the roomduring exposure.

d. Performer checks that appropriateimmobilization devicee are present,and that there is a uattress, pads,pillows and/or blankets for com-fort of patient if patient willlie on table. Makes sure that right(R) and left (0 markers are avail-able for use and identificationcards, leaded numerals or markers.

e. Performer makes sure that an ade-quate supply of loaded cassettesand/or dental occlusal film packetsof the appropriate types and sizesare available in the examinationroom. If not, arranges to obtain ordecides to obtain personally.

f. Performer reviews the techniquechart for the machine to be usedand takes note of any newly postedchanges in technical factors (toreflect accommodation for changein machine output or a policy de-cision).

g. Performer checks that x-ray equip-ment is ready for use. Goes tocontrol panel and checks that in-dicator light shows that machine

is "warmed up," or turns on mainswitch as appropriate to equip-ment and allows time for the ma-chine to "warm up." If appropriate,performer may set radiography modeselector and set collimator con-trol for manual operation.

h. Performer prepares for identifi-cation of the films using equip-ment provided by institution:

i) May obtain lead numerals andtape and prepare identifica-tion strip for placement onfilm holder(s) giving appropri-ate patient identification in-formation.

ii) Performer may prepare for useof flashcard by checking thatthere is piece et lead on filmholder surface; may write ortype out ID information oncard if not received with req-uisition.

La) Checks identification againstrequisition sheet.

. If magnification has been requested,performer prepares the equipment forthe tube-over-table method of magni-fication (used without bucky):

a. Performer determines the degree ofmagnification requested on the requisition sheet; if the request isexpressed as an area magnificationperformer determines the linearmagnification by taking the squareroot. (Linear magnificationsquared equals area mcignifica-tion.)

b. Performer calculates the requireddistances from target (focal spot)to object (patient) (TOD), andfrom object to film (OFD), aswell as the distance from targetto film (TFD) (the sum of TOD andOFD):

365


Task Code No. 37L

This is page 4 of 15 for this tas!

i) If the distance from the tabletop to a cassette placed on thefloor or a stool (OFD) will be arelatively inflexible distance,performer measures.this distanceor reads indicator scale. (Ifstool is to be used, may notethe table height.) Performer mayadjust table height to providefor a round number for the OFD.

ii) If the distance from the focalspr,t to the table top (TOD) willbr: the relatively inflexible dis-tance,----performer determines what

this is by measuring or readingappropriate indicator scale ontube housing. Performer may ad-just tube height to provide around number for the TOD.

iii) Depending on whether the OFD orthe TOD is fixed, performer cal-culates the required complemen-tary distance by referring to amagnification chart for the de-gree of linear magnification re-quired, or uses the formula: de-gree of linear magnificationequals TFD divided by TOD. For atwo-times linear magnificationperformer simply sets the TODequal to the OFD.

iv) Performer adjusts and locks thetable height end/or the tubeheight to the calculated OFDand TOD.

c. Performer aligns the object-filmand target-object distances:

i) Performer moves the x-ray tubehousing until it is.centeredover the table top in the ap-proximate area where the pa-tient's area of interest willbe positioned, such as on table.

ii) Performer swings the table outof the way so that there is noobstruction between the tube andthe floor. (Dnes not change

E1emet..!%;

height.) If approp2iate, placesa stool on the floor under thetube. May place cassette of ap-propriate size on floor orstool. Performer selects thesize film designated for thedegree of magnification and theselected part to be studied.


iv) Performer activates the lightin the collimator and adjuststhe tube horizontally so thatthe light beam cast is centeredto the cassette on the stool orfloor. Uses the cross-hairs pro-jected by the beam to centerthe tube to the area on thefloor or stool.

v) Performer locks the tube intoposition.so that there is a 900angle of the'beam with thefloor or stool. Fixes and re-tains collimator setting.

vi) Performer marks the outline ofthe collimated light area orcassette on the floor or stoolusing tape or other removablemarker. If not already done,checks by placing cassette inmarked area. May mark center ofarea as shown by cross-hairs.

vii) Performer swings table backinto place. Activates lightbeam in collimator and marksthe table top where the centercross-hairs and light outlineare projected (to be used tocenter the part to be radin-graphed). Uses tape or otherradiolucent removable marker.

viii) Performer may recheck TOD andOFD to be sure that they cor-respond to the calculated dis-tances.

366


Task Code Nu. 375



d. For magnification technique using avertical film holder, performer maywait until patient has been broughtinto examination room. Adjusts up-right holder to appropriate height;adjusts x-ray tube to right-angleprojection of beam to film holder;centers to the film; measures andadjustaTOD to patient's positionand marks patient's position; mea-sures and adjusts OFD.from patient'position as marked.

e. If the sum of the new TOD and OF4(TED) is now different from the TFDused for non-magnification techni-que, performer may consult techni-que chart to note the factor to usefor a compensatory change in mAs.May record for later use in settingexposure factors.

f. Performer May also note the changein kVp and mAs necessary to compen-sate for any change in collimationfrom non-magnification technique.Consults appropriate charia for con-version factors. May record.

Performer readies patient for examina-tion by radiologist:

a. Performer washes hands as appropri-ate. Depending on patient's condi-tion, may decide to arrange for orcarry out isolation or decontami-nation techniques.

b. Performer has the patient calledfrom the holding area and preparedfor the exatination (if not alreadydone), or decides to do personally.

c. Depending on institutional arrange-ments, performer may decide to es-cort out-patient to or from dress-ing room. May decide to assist intransporting patient from holdingare4 or have this done.

d. Performer greets patient and anyaccompanying staff person and in-tv,duc.es self. Checks patient's

identity against the requisitionsheet. With in-patient, checks hos-pital identification bracelet orother identifier. If patient isaccompanied because of seriousnessof condition, performer checkswith accompanying staff member onany special precautions necessaryduring procedure.

e. Performer has patient assume acomfortable recumbent or seatedposition,.as appropriate.

i) If appropriate, places mattress,pillow or clean linen on x-raytable. May place pillows behindpatient in wheelchair.

ii) If patient is in wheelchair,may move patient in chair intoposition next to table. Makessure that wheelchair is in locked position if patient is to bepositioned in it.

iii) Performer may decide to assistpatient from wheelchair orstretcher to table or has thisdone. May obtain help. Makessure that no equipment is inthe way that may be collidedwith by patient.

iv) If assisting patient to step onfootstool in order to get ontable, helps patient turn intoposition, step backwards onstool, and then sit and/or lieon tablct.

v) If patient is on specialstretcher, places stretcherinto position so that radio-lucant stretcher can be liftedwith patient on it from wheeled zbase to x-ray table. May ar-range to move or have patientmoved to table.

f. If not already done, has patientremove lentures, hair pins, specta-cles, and any jewelry from head

3 7


This is page

Task Code No. 375


List Elements Full

and neck. Makes sure that all gar-ments are removed down to below theneck. Treats young patient with asmuch courtesy as adult.

g. Performer explains to patient whatwill be involved in the procedure;indicates what types of positionsthe patient will be asked to assumeand the cooperation that will beasked of the patient.

i) May question patient or accom-panying adult about any aller-gies to shellfish or adverse re-actions to contrast medium (es-pecially iodine based). Checkswhether an allergy test is re-quired. Notifies radiologist ifany sensitivity should be broughtto his or her attention.

ii) Performer may explain to patientwhat side effects may be feltfrom contrast medium such asfeeling of nausea, flushing,choking sensation.

iii) If appropriate and not alreadydone, performer questions femalepatient of child bearing age re-garding possible pregnancy. Ifthere is any possibility that pa-tient is pregnant and this hasnot already been recorded, per-former informs radiologist andproceeds only with approval.

iv) Performer answers patient's non-medical questions honestly; at-tempts to reassure patient anddevelop confidence. Treats pa-tient with dignity and concernregardless of patient's behav-ior. Remains aware that patientmay be frightened and/or in pain.Performer explains, when askedmedical questions, that it isnot appropriate for technologistto answer these; encourages pa-tient to speak to physician.

List Elements Fully

h. Performer measures patient's skullfor the dimensions relevant forviews ordered:

i) Uses centimeter calipers tomeasure the thickness of theskull part(s) to be radiographein the directions in which thecentral ray of the x-ray beamwill pass through the centeredpart from tube to film. Recordsfor use in determining exposurefactors.

ii) After measuring, has patientrest in as relaxed a positionas possible.

. Performer may note whether a prelim-inary radiograph (scout film) hasalready been made of the patient (donby another radiologic technologist ifwork is organized in this way at in-stitution).

a. If a scout film has already beenmade and viewed by radiologist,performer notes the technique usedor ordered and plans to set uptechnical factors for the overheadradiography, adjusting for use ofcontrast medium.

b. If a scout film has been made butnot approved, performer placesprocessed scout film with pa-tient's chart or places on viewbox for viewing by radiologist.

c. If a scout film has not been made,performer awaits orders from ra-diologist.

Performer informs attending radiolo-gist when patient is ready to be ex-amined.

a. Pprformer brings requisition sheet,patient's medical hiscory, chart,prior films if ordered,and any

366


List Elements Full

Task Code No. 375

This is page 7 Lf 15 for this task.

"IIMIM11M

scout films already processed toradiologist. May display prior filmsand scouts on view boxes.

b. Performer fells radiologist aboutany difficulties encountered withregard to information, equipment,possible contraindications or any-thing else that should be broughtto physician's attention. Notes anyspecial orders or change in proce-dure decided by radiologist.

c. Performer may accompany radiologistto examination room and introducepatient to radiologist.

d. If not already done, performer car-ries out radiologist's orders forscout films with regard to theside(s) and gland(s) to be studied,positions, use of intraoral occlu-sal film, use of gonadal and/orother protective shielding.

i) Performer provides patient, ra-diologist and everyone who willremain in room during exposurewith appropriate protectiveshielding. Explains if necessarythat this is not cause for alarmbut a general precaution to mini-mize unnecessary radiation ex-posure.

ii) Proceeds with scout films for ap-Ipropriate area of interest; hasscouts processed; places on viewboxes and notifies radiologistwhen scouts can be viewed.

During radiologist's review of requi-sition, scouts,and examination of pa-tient, performer notes radiologist'sorders for any changes in technicalfactors, size and amounts of materialsto be used in procedure, special or-ders for overhead radiogr-?hs; dis-cusses timing for procedure. May ar-range signals fo,- exposure as soon ascontrast is administered. May discuss

List Elements Full

sequence in which gland(s) or side(s)will be examined.

a. If radiologist decides to cancelprocedure, performer arranges toterminate and reschedule as ap-propriate.

b. If decision is to proceed, per-former arranges to provide orchange any equipment or suppliesas ordered by radiologist.

c. Resets technical factors if appropriate for soft tissue techniqueallowing for use of contrast material and request of radiologist:

i) Enters control room and checksthat controls are set for ra-diography mode.

ii) For conventional exposure con-trol, performer selects milli-amperage and chooses selectorsfor the 'correct focal spotsize. Selects and sets theposure time that will producethe mAs desired. Sets the kVpselected by choosing the com-bination of major kilovoltageand minor kilovoltage settingsto produce the desired kVp.

iii) For automatic phototimed expo-sure control, performer se-lects and sets the categorycorresponding to the type ofstudy and use or nonuse ofscreens, bucky, etc., and, ifappropriate, focal spot size.Selects and sets a controlcorresponding to the fieldsize (as listed on techniquechart for phototiming).May select and seL a kVp rangebutton (if called for withequipment) corresponding torange for examination.Sets a density selector corresponding to the usual (or spe-cial) requirements for thestudy.

3i3J


Task Code No. 375


Makes sure backup timer is notlikely to termi.ate exposure be-fore phototimed exposure is made.

iv) Depending on the equipment, mayset controls to provide for useof bucky, manual adjustment oftable and tube height, position,and of collimation, unless thesehave already b..ten set.

d. Performer obtains the appropriatesize loaded cassette or packet forthe first contrast projection.Attaches identification informationto the cassette, occlusal film pack-et or table top:

i) Places right or left marker onfilm holder, packet or table-topas appropriate to the study andprojection or depresses appro-priate R or L button for auto-matic marking.

ii) If patient's identification in-formation is in the form of leadnumerals, performer places on ap-propriate corner of cassette orocclusal film packet.

iii) If patient identification infor-mation is to be entered by useof flasher, sets flash card asidefor later use with space createdby piece of leade c. rubber on ap-propriate edge of cassette.


e. If cassette is tc be used withbucky (under tabletop or in uprightholder) performer may manually pullout bucky tray and open retainingclamps. Inserts cassette into burAytray and pushes back. Makes sureclamps are closed. Moves cassetteinto appropriate "stored" position

List Elements Fully

or inserts cassette tray intobucky slot and centers.

.f. If a bucky is not being used, per-former places film holder in a po-sition approximating final posi-tioning.

i) If magnification.technique isto be used, performer placescassei.te in marked position onfloor or stool.

ii) If appropriate to make possibleminimal movement of patient,performer may place cassettein upright holder at right an-gles to table top or in otherposition selected.

g. Performer checks that patient, ra-diologist and everyone remainingin room is provided with protectiveshielding.

Performer prepares patient and equip-ment for instillation of contrast sothat the overhead films can be madeimmediately after the contrast is in-stilled (one gland at a time).Performer-prepares the part to be ra-diographed in the position selectedfor the first (or next) exposure (un-less this is done by physician):

a. May explain or demonstrate to pa-tient what is required. May obtainhelp in positioning or assists MDto position.

b. Performer positions patient byfirst positioning body and thenpositioning bead. In positioningbody, performer proceeds asfollows:

i) For positioning patient in APor PA (supi.te or seated erect)position, performer arrangesbody so that its median sagit-tal. plane is centered to themidline of.table or film holder.

'411111i111111111.%ell


Task Code No. 375.

This is page 9 of 15 for thisAask.

List LlemcnIt.Zilly List Elements Full

ii) For lateral positioning has me-dian sagittal plane parallelwith midline. Supports any ele-vated parts. Has seated patientsdistribute weight evenly on bothbuttocks.

iii) Has semiprone patient rest onforearm and flexed knee of ele-

.vated_side, and supports ankles..and flexed knee.

iv) Has seated erect patient facefilm holder for PA projection andface away from film holder forAP projection.

v) Has supine patient place armsin a comfortable position andsupports ankles and knees.

vi) For oblique erect position ad-justs body to make possible cor-rect angulation of the head.Places arms in comfortable posi-tion.

viii) With all positions arrangesshoulders to lie on a singletransverse plane.

c. In positioning head, performer re-fers to standard reference lines.Has patient first relax muscles ofneck and then moves head gently.

i) Performer defines the mediansagittal plane of the skull byreferring to the sagittal lineconnecting nasion, acanthion andsymphysis menti (mental point).

ii) Performer defines the infraor-bitomeatal line by finding theline connecting the externalauditory meatus and the infra-orbital margin. May palpate tof,ind infraorbital margin.

iii) Performer defines the acanthio-meatal line as that connectingthe external auditory meatus anithe acanthion.

d. Performer centers part and keepsthe long axis of the part parallel

to the film holder. When using abucky, centers patient to midline.With cassette on table top, cen-ters film to part. With uprightholder, adjusts height of holderto part and centers part to film.

e. Performer sets the focal-filmdistance (if not already done.as with magnification technique).Operates controls or manuallymoves the x-ray tube into placeover the film holder (or at rightangles to upright holder) . Checksthe focal-film distance by read-ing indicator scale in the tubehousing; adjusts up or down untilthe required TFD (FFD) is ob-tained.

f. For intraoral studies, performerprepares dental occlusal filmpackets. Does not insert in pa-tient's mouth until head has beenpositioned and immobilized, pa-tient has been shielded, centralray has been adjusted in approxi-mate position and contrast hasbeen administered. If occlusalfilm is to be used, chooses seat-ed position if headrest is avail-able oa chair and if erect posi-tion Ls not contraindicated. Maydiscuss with radiologist.

9. Performer positions as follows (unlessnonconventional positioning is beingused to avoid having patient moveor patient is positioned by radiolo-gist):

a. For studies of the parotidgland(s), performer notes theside of interest and the positionrequired (AP or PA, recumbent orseated) and whether an intraoralview is required.

i) For a tangential projection ofthe ;.arotid gland using AP po-sition, performer has the pa-


Task Code No. 375

This is page a of is for this task.


tient assume a seated or supine spine and mandibular rami.position facing the central ray Adjusts head so that mediansource. Rotates patient's head saggital plane is rotated for-toward the side of interest so ward about 15° from the lat-that the parotid area of the side eral position. Centers filmof interest is at right angles to on side of interest to a pointthe plane of the film. Has pa- about one inch above the an-tient rest head on the occiput gle of the jaw. Directs cen-so that the mandibular ramus is tral ray at right angles toparallel with the longitudinal midpoint of film.axis of the film. Has patient iv) For an oblique lateral projec-tuck in chin. Centers film to the tion (axiolateral view) of thearea of interest. Directs cen- parotid gland, may adjust headtral ray at right angles to plane of seated patient on an angleof film along the outer surface block placed at a 15° cranialof the mandibular ramus. angle. Extends cheek of af-For a tangential projection of fected side over angle blockthe parotid gland using PA posi- and depresses shoulder of ele-tion, performer has patient as- vated side. Places film holdersume a seated position facing under cheek and centers to athe film holder. Rotates pa- point .5 inch anterior to andtient's head as in (i), above,and has patient rest head on

one inch inferior to the ex-ternal auditory meatus. Ad-

forehead and nose. Continues as justs head so that broad sur-in (i), above,Performer may rehearse patient in

face of ramus is parallel withplane of film and acanthio-

filling mouth with air and hold-ing breath to provide better con-

meatal line is parallel withtransverse axis of film. Tapes

trast.ii) For an intraoral anterior pro-

film holder to angle block.,Directs central ray 30°ceph-

jection of the parotid gland,performer may rehearse patient

alad and 10° posteriorly, di-rected to midpoint of film.

in film packet placement. Has Performer may adjust head ofpatient relax mouth; performer semisupine patient on an an-places ieatal occlusal filmvertically in the oral vestibule

gle block dir cted cranially,with affected cheek in lateral

in front of the upper molars. position on film holder, andDirects the central ray to mid- affected side of body next topoint of film at about 5° cau- table. Adjusts elevation ofdad. holder adjacent to shoulder

iii) For a lateral projection of the so that film is in close con- .

parotid gland, performer has pa- tact with jaw. Rotates headtient assume semiprone or seated so that broad surface of ramuserect lateral position. For seated patient has shoulder of sidebeing examined against film

is parallel to plane of film,and extends chin so that the.

acanthiomeatal line is paralle.....q4

holder. Extends patient's head with the transverse axis ofto clear space between cervical the film. Directs central ray


Task Code No. 375



to the midpoint of the film at25° cephalad.

b. For studies of the -submandibular(submaxillary) gland(s), performernotes the side of interest, theviews required, and the order inwhich they are to be done.

i) For a lateral projection of thesubmandibular gland, performerpositions patient in semiproneor seated erect, lateral positionwith side of interest againstfilm holder,and extends patient'head. Adjusts head in true lat-eral position. Centers film tothe inferior margin of the angleof the mandible. Directs centralray at right angles to midpointof film. May rehearse patient indepressing floor of mouth duringexposure by having patient placean index finger on the back oftongue on affected side.

ii) For oblique lateral projection(axiolateral view) of the sub-mandibular gland(s), performerpositions patient as in (a, iv),above, but centers to the angleof the mandible.

iii) For a verticosubmental projec-tion (axial view) of the subman-dibular gland area posterior orlateral to the floor of the oralcavity, performer has patientassume a seated position withhead resting on chin, extendedacross a film holder lying hori-zontally and supported. Centersmedian sagittal plane of headto midline of film at a leveljust below the external auditorymeatuses. Supports film holderso that it is in direct contactwith throat and, if angulationis needed, at a cranial angle.Adjusts head so that median

sagittal plane is vertical. Iffilm is horizontal, directscentral ray to midpoint offilm at right angles to theinfraorbitomeatal line. Iffilm is angled cranially, di-rects central ray to midpointof film at right angles tothe occlusal plane.

c. For intraoral projection of theduct anteromedial part of sub-mandibular sland areas or sub-lingual gland area (submentover-tical projection) ,performer haspatient assume seated positionwith head in headrest so thatthe occlusal plane is vertical.If no headrest is available haspatient assume supine positionwith thorax supported and headextended, resting on vertex, withmedian sagittal plane vertical.Performer rehearses patient inplacement of film, and just be-fore exposure places film infinal position. Performer has pa-tient open mouth. Inserts filmpacket with pebbled surface fac-ing ,audally and_with long axisdirected transversely. Centersfilm to the median sagittal planeand gently insert'a far back sothat it is in contact with theanterior borders of the mandibu-lar rami.May have patient assist by de-pressing and retracting ,Jwntongue or by phonating "ah" andbreathing deeply through themouth. Has patient close mouthto hold film. Rechecks position.With film packet in position,performer directs the central rayat right angles to the plane ofthe film, centered to the inter-section of the median sagittalplane and a coronal plane passingthrough the second molars.


Task Code No. 375


List Elements Full

d. Performer immobilizes skull with ahead clamp or a weighted band and/or uses sandbags to support. Re-checks angulation and positioning.

e. Performer checks positioning byusing light in collimator. Activatesthe,collimator light and points thelight beam towards the part. Adjuststhe collimator opening to correspondto the film size. Uses cross-hairshadows as reference for center offield and collimator light to cen-ter the tube to the part. Checksthat primary beam will enter thecenter of the area of interest atthe selected angle to the film soas to project the view desired.May readjust tube position length-wise or crosswise to provide bet-ter centering.

f. Once the patient has been posi-tioned and immobilized, performeradjusts the collimator. Eithercollimates so that a small unex-posed border will appear aroundthe edge of the film or collimatesfurther so as to expose only thearea of interest (and thus providemaximum protection and detail).May use extension cone (in directcontact with head when appropriatefor immobilization) for propercollimation. Adjusts primary beamto minimum size needed to coverthe part(s) of interest. Removesfilm packets from patient's mouthuntil ready for exposure.

List Elements Full

10. Performer checks that everything isready for administration of the con-trast medium:

a. Rechecks that all equipment isready for use.

b. Performer indicates to radiologistwhen the patient and equipment areready for instillation of the con-trast medium. Makes any adjust-ments as ordeT-cd.

c. Performer washes hands for proce-dure observing sterile techniqueas appropriate.

d. If appropriate, performer openspacket of sterile gloves for ra-diologist, observing sterile tech-1nique so that wrapper, own hands,or other objects will not contami-nate gloves.

e. May assist in sterile surgicaltechniques as appropriate by hand-ing materials asked for.

f. If so ordered, performer may use 1lemon juice or slices and placea few drops of lemon juice in pa-tient's mouth to cause saliva-tion.

g. When ordered, performer holds sy-ringe end while radiologist re-moves dilator and inserts a can-nula into ductal opening ofglaad.

11. On orders from the radiologist, per-former makes the sialograms for thegland that was opacified in the position(s) ordeled, and as quickly aspossible:

a. Performer rechecks positioning ofpatient, film, and central ray.

b. If intraoral films are to beused, performer inserts filmpacket as described above. Haspatient close mouth to hold film.Rechecks and readjusts positionof head and x-ray tube as de-scribed above.

c. Performer sets the focal-filmdistance, if not already done,as appropriate.

d. Rechecks that patient has beenproperly shielded.

e. When everything is ready for tLeexposure, performer reminds pa-tient of the breath control tobe used for exposure:


Task Code No. 375


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i) May have patient depress tongue.ii) May have patient fill mouth with

air when ordered and hold breathuntil told to relax.

iii) May have patiant hold breathwhen ordered until told to re-lax.

f. Performer observes the patient'smovement until the moment that theexposure is made. Readjusts,posi-tion if warranted.

12. The performer returns to co room.Makes sure controls are prol: 7 setand patient is still in position.Tells patient when to breathe asstructed by calling or using intere.m.Performer initiates exposure by presing hand trigger or exposure cont:,-olbutton.

-a. While expcsure is underway perform-

er checks that mA meter records ap-propriate current as set, that kVpmeter dips slightly.

b. May watch for evidence of malfunc-tion such as line surge or exces-sive drop; may listen for sound ofnormal functioning of equipment.If there is malfunction, may de-cide to report; anLicipates needto repeat exposure.

-/c. With phototimer, notes vhnther backup timer has been involved interminaOlig exposure before photo-timed :.-:posure was completed. Ifso, anticipates possible need torepea osure ((ie to underexpo-sure if premature cut-off, oroverexposure due to faulty timer).

d. After exposure is completed tellapatient that he or she can relax.

e. If the exposure is terminae.4 bya circuit breaker, rechecks tech-nical factors for possible over-load or checks for overload else-where on circuit. Anticipates needto repeat exposure.

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f. After exposure performer returns.to patievt. Removes cassette,packet or film holder from table,floor, bucky or patient's mouth.Removes any markers for :urtheruse.

g. Performer repeats radiographysteps for all exposures orderedlv radiologist, adjusting techni-c- factors, tube, and positionof or film holder as appro-pri..:c.... each view ordered foropact'c,-, gland.

h. Perfi..- arranges to have thefirt ! ..(s) processed atonce or riedes to do personally.Att.T;vs for use with

appropliate. May signrequieition.

i. While films arcs being processed,makes sure that patient is comrfortable and, if necessary, at-tended by radAologist,- staff per-son or self.

Throughout radiography procedureperformer remains alert for anysymptom of adverse reaction, espe-cially reaction to contrast such assevere flushing, salivation, chok-ing, vomiting, pallor, fainting, orshock. As soon as performer judgesthat reaction may be severe, ceasesexposure and notifies radiologistor attending physician at once.

14. Per:ormer brings the first process-ed radiographs d4reet1y to the ra-diologist in charge or places onview boxes and informs radiologistthat they are ready. May also hangprior 'ilms a,,i/ scouts.

a. Ferformer 1-:tes instructionsfrom radiologist ,egarding needto repeat instillation of con-t:rast, to repeat radiography withchange in patlent, '.:(lbe or film

...POILIESER,711MmelIMIMP,


Task Code No.

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positioning, or with change in'technical factors.

Notes instructions with regard toinstillation of opposite side oranother duct.

b. Performer repeats appropriate stepsdepending on radiologist's orders.For further exposures performerrepeats appropriate steps for nextview(s) including identificationof film, use of R-L marker, se-lection and setting of technique,positioning patient and equipment,collimation, shielding, breathinginstructions, making exposure, andprocessing, as described above.

c. Performer refrains from commentiragon the films or providing any in-terpretation.

d. If performer is asked to repeat anyexposures, performer notes whetherneed to repeat is due to perform-er's own negligence or lack of at-tention so that performer can avoidfuture "retakes."

e. If request for retakes reflectsmalfunctioning equipment, performerreports malfunction to appropriatestaff member.

f. If request for retakes reflects thepreference for density or contrastof the radiologist, performer notesfor future work done for the givenradiologist so that retakes can beavoided.

g. Performer shows subsequent sets cfradiographs to radiologist as pro-cessed and proceeds as describedabove until radiologist indicatesthat examination is completed.

15. When the radiologist indicates thatthe radiography is completed, perform-er carries out termination steps:

a. Performer may give patient lemonslices to suck on to induce sali-vation as a means of evacuating

the contrast medium from thegl:Ids and ducts. Reassures pa-tl2nt; has patient spit contrastout into basin.

. b. Notes any orders for post-evacua-tion films to be taken after anelapse of several minutes. If so,

i) May arrange to have patienttaken to appropriate holdingarea after evacuation of con-trast medium.

IA) Keeps track of time elapseand takes delayed films asappropriate (following stepsfor radiography as deribedabove) when indicated.

iii) May have radiologist fill outrequisition if delayed filmsor additional radiography isrequired.

c. After all radiography is complet-A, may decide to assist patientto criair or stretcher or fromtable. Makes sure patient is re-minded of any footrest in steppinf.;.f taLle. Makes sure that none oLLe equipment is projecting overthe patient before allowing pa-tient to rise fror stc.,o1 or table,and assists patient.

d. ':'erformer may have patient trans-ported back to holding area orn:xt location, or di!cides to dopersonally, as appropkiate. Ifappropriate, makes sure that pa-tient is in the care of a staffpezsoo who will tranoport ap-propriate next location.

e. Performer may have room andequipment cleaned; has any otherappropriate clean-up proceduresfollowed to avoid infection crcontam'nation, or dLc:ies to dopersonally, dollendihg on institu-tional arrangemcnts.

f. Performer records Ole examinationaccording to histitutional proce-


Task Code No. 375


_..List Elements Full

_

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dures. May include date, room, ex-amination type, the overhead viewstaken, the technical factors used,and film sizes. Performer may re-cord the number of exposures madeoi each overhead view including re-takes; may enter the estimated ra-diation dose to which patient wasexposed (using posted informationon dosage); may record any problemwith equipment, anY special careprovided patienp. Signs requisitionsheet.

g. May present requisition sheet toradiologist for Omments, ordersand signature.

h. Performer may decide,tö, jacket ra-diographs, requisition,..bheets, andrelated materials and/or have in-formation recorded in 19g book per-sonally or have this dble, depend-ing on institutional procedures.

i. May indicate to appropriate staffperson when the performeer-is readyto proceed with next examination.

...,.

I.

.-

.

.

_1


Task Code No. 376



Requisition reviewed;pt. reassured,positioned,mea-sured;films identified;technical factors selected ,

and set;equipment and procedure tray plPk)ared;ra-diologist assisted with uverhead of ne?dle placementand injection of contrast;pt. positioned;contrqstscout taken or lymphangiograms or lymphadenoE:amsmade;radiographs sent for processing,taken to radio-logist;procedures repeated;patient returned;examina-tion recorded;radiographs placed for use.

Performer receives or obtainsthe x-ndy requisition form, pa-tient identification card, and.any appropriate medical-techni-cal history for a patient sched-uled for lymphography (lymph-angiography, radiography of thelymphatic vessels, and/or lymph-adenography, radiography of thelymph nodes, after injection ofa contrast medium) as a resultof:



in order of priority.d. At request of radiologist.

Request may be for initial ex-amination covering a scout filmand lymphangiograms after injec-tion of contrast, or delayedlymphadenograms made at least aday after injection of contrast.If not initial examination, per-former may also receive priorscouts,lymphangiograms and/orrecord of exposure technique(s)used.

1. Performer reads the requisi-tion sheet to determine theexamination called for, thearea of interest, the patientinvolved, special considera-tions, and to check the com-pleteness of the informationprovided:

a. Performer checks the ex-amination called for, thename of the radiologistin charge and the area(s)

OK-RP;RR;RR

2. What is used in performing_ this task? (Note


Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical-technical history,prior radiographs,scouts ,

pen;x-ray control panel,tube,bucky,table,collimator,extension cones;technique,standard view,tube rating,and rad exposure charts;cassettes;film holder;shield-ing;R-L ani ID markers;immohilization devices;cali-persstool;view boxes;emergency cart and supplies;sterile gloves,gown;sterile procedure tray;iodizedoil contrast;injector-heater;phone;order forms;stretcher or wheelchair


. ir es to q. 3: Name.t. e Kiwi o recipient,

respondent or co-worker,InVolved, with de-

scriptions to indicate the relevant conditioninclude the kind with whom the performer ishot allowed to deal if relevant to knowledge


Any patient to have lymphography;accompanying Adult;radiologist;nursing staff;co-worker

5. Name t e task so that the anawerEcto ques-tiona 1-4 are reflected. UnderlAne,essen-

.,

tial words. %

Taking lymphangiograms or lymphadenograms of uty pa-tient,by reviewing request;reassuring pt.;theaslringpart(s);preparing equipment;arranging foe radio-graphy of need1t placement;assisting witi; 'administration of contrast;selecting and setting technical factors;identifying film(s);positioning pt. and equip-ment;providing shielding;collimating;making expo-sures of iliac nodes,lymph vessels or nodes as and/

or when ordered;arranging for processing;taking toradiologist;continuing,as ordered;arranging for de-layed films of lymph nodes if ordered;having pt. re-turned;placing radiogruphs for use;recording exami-

nation.

16. Check here if this

I is a master sheet..0C)


Task Code No. 376


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of involvement (such as lower ex-tremities, groin area, iliopelvic-abdominoaortic region, thoracicduct, axilla, and/or upper extremit-ies).,Notes whether, for extremit-ies, bilateral or unilateral studyis ordered; if the latter, notesthe side of interest.

b. Notes whether order covers initialexamination or delayed films. Ifthe latter, notes record of techni-ques used and projections requested.

c. Performer reads patient's name,identification number, sex, age,height and weight.. Notes whetherpatient is in-patient, out-patient,or emergency patient. Notes anyspecial information on any knownpathology that would affect techni-que. Notes any conditions affectingpositioning, suspension of respira-tion or immobilizaiion such ascardiac or respiratory disease,presence of injuries, whether pa-tient will be on a stretcher or ina wheelchair. If initial examina-tion, notes whether patient hashistory of allergies.

d. Performer checks whether patient issuffering from a collateral condi-tion requiring special handlingsuch as heart disease, communicableor infectious condition, infJrmity,incoherence; whether patient aasIV drip, oxygen supply, urinarycatheter or similar device in place;notes whether patient will be ac-companied by nurse or other staffperson. Notes thielding needed.

e. If performer is not already assign-0ed to examination room (and a par-ticular machine) notes the room or'machine involved.

f. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheetis complete.

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i) Depending on institutional pro-cedures, performer may reviewpatient's radiation exposurehistory, prior record of tech-niques used, and cumulative ex-posure. Notices whether exami-nation has been done elsewherein recent past, whether thereis history of extensive radiog-raphy to be reported to radio-logist.

ii) Checks whether any specialorders on exposure factors arein keeping with the usual radexposure involved for the ex-amination.

iii) Depending on institutional pro-cedures, performer noteswhether female patient is preg-nant, reviews date of femalepatient's last menstrualperiod, or notes any other in-dication that there is nodanger of exposure of a knownor possible fetus.

iv) If patient's record indicatesorders for sedation or anyother prior medication, per-former may check timing to besure a proper elapse of timehas occurred for medication totake effect.

g. If the performer determines thatthe request is not properly auth-orized, is incomplete, or thatsufficient information is lacking.for performer to select techniqueor to properly position or carefor patient, or if performer con-siders that there may be contra-indications to going ahead withthe procedure, performer bringsthis to attention of radiologistin charge. Explains the problemif appropriate, and proceedsafter obtaining needed informa-tion, signature, or orders.


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Task Code No. 376



h. If referring physician ha3 request-ed that films already on file bepresented with current radiographs,and if not already with patient'sjacketed material, performer ar-ranges to have prior films deliver-ed.

If the surgical procedure for injec-tion of the contrast medium is to bedone in the radiology department, per-former may check that patient is pre-sent, is ready to be seen by radiolo-gist,and/or is ready for the surgicaltechnique. May check with nurse ormay be assigned to do personally.Makes sure that procedure tray andemergency cart is ready in appropri-ate location or decides to preparepersonally.

a. Performer may inform attending ra-diologist when patient is ready tobe examined. Brings requisitionsheet, patient's medical history,chart, and any prior films, toradiologist. May display priorfilms on view boxes:

b. Performer tells radiologist aboutany difficulties encountered withregard to information, possiblecontraindications or anything elsethat should be brought to physi-cian's attention.

c. During radiologist's review ofrequisition, prior films and ex-amination of patient, performernotes radiologist's orders forpositioning, technical factors,size of cassettes or materials tobe used in procedure. Discussestiming for radiography. May dis-cuss sequence in which areas ofinterest will be radiographed.

d. If radiologist decides to cancelprocedure, performer arranges toterminate and reschedule as ap-propriate.

. Depending on the point at which per-former sees the patient (before orafter injection of contrast medium),performer may see patient and preparefor radiography. May do any or all ofthe following:

a. Performer washes hands as appropri-ate. Depending on patient's condi-tion, may decide to arrange foror carry out isolation or decon-tamination techniques.

b. Performer has the patient calledfrom the holding area and preparedfor the examination (if not al-ready done), or decides to dopersonally.

c. If contrast has not yet been in-stilled, performer may decide toescort out-patient to or fromdressing room. May decide toassist in transporting patientfrom holding area or have thisdone.

d. Performer greets patient and anyaccompanying staff person and in-troduces self. Checks patient'sidentity against the requisitionsheet. With in-patient, checkshospital identification braceletor other identifier.

If patient is accompanied becauseof seriousness of condition, per-former checks with accompanyingstaff member on any special pre-cautions necessary during proce-dure.

e. Performer may explain to patientwhat will be involved in the pro-cedure; indicates what: types ofpositions the patient will beasked to assume and the coopera-tion that will be asked of thepatient.


Task Code No. 376



i) If not already done, may ques-tion patient o: accompanyingadult about any allergies toshellfish or adverse reactionsto contrast medium (especiallyiodine based). Checks whether anallergy test is required. Noti-fies radiologist if any sensi-tivity should be brought to hisor her attention.

ii) Performer may explain to patientwhat side effects may be feltfrom contrast medium such as

. feeling of nausea, flushing,choking sensation.

iii) If appropriate and not alreadydone, performer questions femalepatient of child bearing age re-garding possible pregnancy. Ifthere is any possibility that pa-tient is pregnant and this hasnot already been recorded, per-former informs radiologist andproceeds only witi. approval.,

iv) Performer answers patient's non-medical questions honestly; at-tempts to reassure patient anddevelop confidence. Treats pa-tient with dignity and concernregardless of patient's behav-ior. Remains aware that patientmay be frightened and/or in pain.Performer explains, when askedmedical questions, that it isnot appropriate for technologistto answer these; encourages pa-tient to speak to physician.

f. Performer has patient assume a com-fortable supine position (or remainin supine position if contrast hasalready been instilled).

i) If appropriate, places mattress,pillow or clean linen on exami-nation table.

ii) If contrast has not been instill-ed and patient is in wheelchair,

may move patient in chair intoposition next to table. Makessure that wheelchair is inlocked position.

iii) May decide to assist patientto table or has this done; mayobtain help. Makes sure thatno equipment is in the way thatmay be collidedvith by pa-tient. If assrSting patientto step on footstool in orderto get on table, helps patientturn into position, step back-wards on stool, and then sitand/or lie on table.

iv) If patient is on radiolucentstretcher, places stretcherinto position so that stretch-er can be lifted with patienton it from wheeled base tox-ray table. May arrange tomove or have patient moved totable.

v) Makes sure that there is noclothing or jewelry on area(s)of interest. Permits patientto keep covered with gownuntil measurements are takenand until exposure. Treatsyoung patient with as muchcourtesy as adult.

g. If patient has an TV drip inplace, performer checks thatneedle has not become dislodgedand that the fluid is drippingat an even rate. If there areany problems, performer clampstube anOtotifies an appropriatestaff perion ar.once.

h. Performer questions patient and/orRN or MD present on what Movementis possible to determine if thepositions ordered are availablefor use. Notes whether injuriespresent require positioning by MD.

i. Performer notes the patient'sbody type, whether the area of


Task Code No. 376



interest is heavtly covered bymuscle or soft fat, whether thepalpation points will be easy tofind. Notes whether the lower ex-tremities are of unequal length.

j. Depending on the areas of interestto be radiographed, performer usescentimeter calipers to measure thethickness of the part(s) in thedirection in which the central rayof the x-ray beam will pass throughthe centered part from tube to film.Records for use in determining expo-sure factors.

,

i) In locating iliac crest, perform-er is careful not to center toohigh by making sure not to con-fuse the iliac crest with theheavy muscles immediately abovethe crest. May have patient in-hale deeply and breathe out;then palpates the point of thecrest while the muscles are re-laxed.

ii) If performer believes that pa-tient will be embarrasLied bypalpation of the symphysis

.pubis, uses the most prominentpoint of the greater trochantert') locate the same transverseplane.

iii) If moving patient with a urinarycatheter in place, performerturns patient toward the cathe-ter and tubing to prevent sep-arating it from dTainage bottleand breaking stetIle system andto avoid causing pain.

iv) After measuring, has patientrest in as relaxed a position aspossible.

v) If patienc has not yet seen ra-diologist, performer may informradiologist or co-worker thatpatient is ready to be examinedor prepared.

4.

5.

.

Once radiologist indicates that in-stillation is to proceed, arrangesto provide or change any equipment orsupplies as ordered by radiologist.

If performer is to assist with in-jection of contrast medium, washeshands, observing sterile techniqueas appropriate.

a. If appropriate, performer openspacket of sterile gloves for ra-diologist, observing sterile tech-

.

nique so that wrapper, own hands,or other objects will not contami-nate gloves.

b. May assist in sterile surgicaltechniques as appropriate by hand-ing materials asked for. .

c. May have syringes prepared withcontrast medium (iodized oil) ordecides to do personally. Mayplace in injector-heater machine.May check periodically to see thattemperature of injector-heater ismaintained, as ordered.

If the surgical procedure for injec-tion of the contrast medium is donein the radiology department, perform-er may take radiograph(s) of injec-tion site(s) (in lymphatics of thefeet or hands, depending on area ofinterest) for check of needle place-ment(s). May have these radiographstaken with bedside wobile equipmentor decides to radiograph personally:

a. If overhead check of needle place-ment is ordered, arranges for ra-diographs as indicated by the ra-diologist. Positions as for plainfilms of the hands or feet withpatient in the supine position onexamination table.

b. Has radiograph(s) processed im-mediately and places on view boxesfor radiologist.


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c. Continues as ordered until radiolo-gist is satisfied with needle place-ment (in two sites if both hands orboth feet are injected).

d. Notes timing for overhead filmingand lymphangiography after injec-tion.

7. If requisition is for initial exami-nation, perfOrmer prepares for scoutfilming of iliac nodes and vesselsto check progress of contrast mediumafter injection. Plans for lymphangio-graphy after proper elapse of timeafter injection (one half o one anda half hours after injection, withpriority given to any study of thoracicduct). If requisition is for delayedfilming (at least 24 hoc-_-s after in-jection), performer reviews techniqueused for lymphangiograms (done by selfor co-worker) and proceeds as for priorfilms.

a. Checks that proper accessories areavailable for radiography includingleaded rubber shielding, lead apronsto be used by anyone who will re-main in the room during expos.rChecks Li,at appropriate imm,.)4..i7.-tion devices are present. J s

sure that right (R) and le t (12Markers are available for /If-J.:2 and

identification cards or leatied num-erals or markers.

b. Performer prepares for identifica-tion of the films using equipmentprovided by institudon:

i) May obtain lead numerals andtape and prepare identificationstrip for placement on filmholder(s) giving appropriate pa-tient identification informa-tion.

ii) Performer may prepare for use offlashcard by checking that there

Task Code No. 376


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is piece of lead on film hold-er surface; may write or typeout ID information on card ifnot received with requisition.


c. Makes sure thz.t an adequate sup-ply of loaded cassettes of theappropriate types and sizes areavailable in the examinationroom: If not, arranges to obtainor decides to obtain personally.

i) Depending on whether a buckyor table top technique willbe used and standard institu-tional practices, performerselects speed and type offilm, grid, and cassette com-bination.

ii) Selects size(s) based on thearea(s) to be included, thepatient's size, and whethertwo exposures (and cassettes)will be needed to present a-4ven view.

d. Performer reviews the techniquechart for the machine to be usedand takes note of any newly post-ed changes in technical factors(to reflect accommodation to achange in machine output or apolic7, decision).

e. Performer checks that x-ray equip-ment is ready for use. Goes tocontrol panel and checks that in-dicatt,r light shows that machineis "warmed up," or turns on mainswitch as appropriate to equip-ment and allows time for the ma-chine to "warm up." If appropri-ate, performer may set radiog-raphy mode selector and set col-limator control for manual opera-


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Task Code No. 376


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tion. Makes sure that all circuitshave been stabilized.

f. Unless already done, performer se-lects technical factors for scoutfilm of pelvic area, first,or nextlymphangiogram, or first or nextlymphadenogram:

i) Consults technique chart(s) post-ed for machine. Locates the in-formation needed for the bodypart and projection involvedaccording to the centimeterthickness of the part as measur-ed and the collimated field sizeto be used. Makes sure that cech-nique relates to the combinationof film type and speed and useor nonuse of other accessories(such as screens, grids, bucky,etc.).

ii) Makes note of the kVp, mA, T(seconds of exposure time), focalspot size, and the focal filmdistance (TFD or FFD) called for.

iii) Once the standard kVp, mA andtime have been determined, per-former notes whether any conver-sions are necessary to accountfor a pathological condition, achange in TFD, the preference ofthe radiologir,;t involved,.andany other conversion needed suchas with obese patients or postedchanges. Performer looks up nu-merical conversion factors andcalculates or uses conversioncharts to ascertain the appro-priate new exposure factor (kVp,mA and/or time). Multiplies, di-vides, adds, or subtracts as ap-propriate.

iv) Performer checks any new-or un-familiar exposure factors againsthe posted limits of the x-raytube on a tube rating chart tobe sure that technique does notexceed the heat capacities of

List Elements Full

the tube for the focal spotsize to be used. If appropri-ate, performer reconverts thetechnique to an equivalentoutput using higher kVp andlower mAs.

g. Performer sets exposure factorsas'selected:

i) If appropriate, checks linevoltage meter and, if needed,turns compensator dial untilneedle is aligned properly online meter.

ii) For conventional exposurecontrol: Performer sets mil-liamperage by choosing selec-tors for the correct focalspot size; sets the mA select-ed. Selects and sets the expo-sure time that will producethe mAs. desired. Sets the kVpselected by choosing the com-bination of rajor kilovoltageand minor kilovoltage settingsto produce the desired kVp.

iii) For automatic phototimed expo-sure control: Performer se-lects and sets the categorycorresponding to the type ofstudy and use or non-use ofscreens, bucky, etc., and, ifappropriate, focal spot size.Selects and sets a controlcorresponding to the fieldsize (as listed on techniquechart for phototiming).May select and set a kVp rangebutton, if called for withequipment, corresponding to-kV range for the examination.Sets a density selector corresPonding to the usual (or spec-ial) requirements for thestudy. Makes sure backup timeris not likely to terminate ex-posure before phototimed expo-sure is made.


Task Code No. 376

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iv) Depending on the equipment, mayset controls to provide for useof bucky, manual tableside ad-justments of table and tubeheight, position, and of colli-mation.

8. Performer returns to exAmination roomand prepares for the exposure:

a. Performer obtains the appropriatesize loaded cassette for the first(or next) projection. Attachesidentification information to thecassette or table top:

i) Places right or left marker onfilm holder or table-top as ap-propriate to the projection,.ordepresses appropriate R or Lbutton for automatic marking.


iii) If patient identification infor-mation is to be entered by useof flasher, sets flash cardaside for later use with spacecreated by piece of leaded lubberon appropriate edge of cassette.

iv) Performer may place patient'scard 'into card tray for equip-ment using autoratic film mark-ing device.

b. If cassette is to be used.withbucky (under tabletop) performermay manually pull out bucky tray.and open retaining clamps. Insertscassette into bucky tray and pushesback. Makes sure clamps are closed.Moves cassette into appropriate"stored" position or inserts cas-sette tray into bucky slot and cen-ters.

411MEN11 List Elements Full

c. If a bucky is not being used, performer places film holder in a

position approximating finalpositioning. If appropriate tomake possible minimal movement ofpatient, performer may place cas-sette in upright holder at rightangles to table top.

d. Performer sets the focal-filmdistance (if not already done).Operates controls or manuallymoires the x-ray tube into placeover the film holder (or at rightangles to upright holder). Checksthe focal-film distance by read-ing indicator scale in the tubehousing; adjusts up or dawn untilthe required FFD (TFD) is ob-tained.

9. Performer prepares the part to be radiographed in the supine positionselected for the first (or next) ex-posure (unless this is done by phy-sician):

a. May explain or demonstrate to pa-tient what is required. May ob-tain help in positioning or as-sists MD to position.

b. Performer positions patient inAP, lateral or oblique AP recum-bent positions or as called for,following procedures as for"plain" films of the area ofinterest.

i) Has patient place arms in a

comfortable position; supportsankles and knees. For thin pa-tient performer may elevatechest so that the cervicalvertebrae are at a correctlevel. Arranges shoulders tolie on a single transverseplane.

385


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Task Code No. 376


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ii) For positioning patient in APsupine position, performer ar-ranges body so that its mediansagittal plane is centered tothe midline of table or filmholder.

iii) For lateral or oblique posi-tioning has median sagittalplane parallel with midline.Supports any elevated parts.

c. Performer centers part and keepsthe long axis of the part parallelto the film holder. When using abucky, centers patient to midline.With cassette on table top, contersfilm to part. With vertical holder,adjusts height of holder to partand centers.

d, . When positioning a patient with aballoon catheter in place, performrer makes sure that the clamp is notlying over a part to be exposed orthat patient is not lying on theclamp.

e. If patient has a wound, colostomy,ileostomy, or T-tube ,Jith dressingto be removed, performer checkswhether zinc or iodoform paste orradiopaque gauze is being used.If so, has appropriate staff mem-ber remove dressing or tube ordecides to do personally (if ap-propriate). Checks that radiopaquepaste or gauze is completely re-moved.

10. Performer places the part to be ra-diographed in the final position se-lected for the first or next expo-sure as follows:

a. For projections of the iliopelvic-abdominoaortic region (scout filmto check progress of the contrastmedium to the common iliac nodes,or regular radiographs to demon-strate possiblepathology in the

List Elements Fully

area), performer checks to besure what areas are to be in-cluded in the radiograph andnotes whether gonadal protectioncan be provided without interfer-ing with diagnostic purpose ofstudy.

i) For AP projection (posteriorview) of iliopelvic-abdomino-aortic region, performer haspatient lie in supine AP po-sition. Centers body to mid-line; supports knees and im-mobilizes ankles. Places thecassette low enough to includethe lower border-of the ischi-um. Centers to the level of theiliac crests; may palpate forthe crest. Has patient flexelbows and place l!ands on up-per chest. May have patientflex hips and knees to placeback in contact with table,and supports. Directs centralray at right angles to centerof film ac the level of theiliac crests.

ii) For right and left oblique APprojections, performer hassupine patient rotate body30° in the direction of theside of interest. Asks patientto place arm on the side nextto table comfortably. Has pa-tient cross and flex upper hipand knee. Has patient graspside of table with oppositehand. Supports elevated shoulder, hip and knee. Checks andadjusts body rotation. Centerscassette at the level of theiliac crests and includes thelower border nf the ischium.Directs central ray at rightangles to midpoint of film.After exposure, rep .ats in re-verse positi' : for other side.

3 d 6

NEM


Task Code No. 376


List Elements Full List Elements Filly

b. For projections of the thoracic umn. May support lower thor-acic region.

For lateral recumbent position,has patient flex hips andknees. Elevates and supportslower knee to hip level;places sandbag on top and thensuperimposes upper knee. Sup-ports ankles similarly. Adjustsupper arms forward at rightangles to long axis of bodyand has lower hand rest underhead. Has patient hold tableedge with upper hand. Adjustsso that scapulae are in asingle plane. Adjusts body intrue lateral position.

Directs central ray at rightangles-to midpoint of film.

c. For AP projections (posteriorview) of lower extremity, per-

duct, performer checks proper timingfor lymphangiograms (if orderedafter instillation of contrast) soas to make projections while con-trast remains in the duct. For lat-eral view notes whether lateral re-cumbent vertical filming or supinehorizontal filming will be involved,

i) For AP projection (posterior. view) of thoracic duct, perform-

er has supine, patient assumetrue AP position with long axisof x-ray tube parallel to themidline, with the anode at thehead end of the patient (to pro-vide a view facing caudally) andthe cathode on the side of thefeet (to take advantage of "heeleffect"). Centers film so thatupper margin is about two inchesabove the supraclavicular area(upper border of shoulders).Places arms alongside body andadjusts shoulders to lie in asingle transverse plane. Mayhave hips and knees flexed toput the back in contact withtable. Immobilizes feet. Directscentral ray at right angles tomidpoint of film.

ii) For left lateral projection ofthoracic duct, has patient moveinto a lateral recumbent position with the left side closerto the film. May have patientremain in AP position and Useupright holder for cross-tablefilming. Centers the midaxillaryline of the body to the midlineof the plane of the film, andplaces upper margin of filmabout two inches above the upperborder of the shoulders. Sup-ports patient's head so that itsmedian sagittal plane is in linewith long axis of vertebral col-

former notes whether the areaof interest will include thelower leg, upper leg and/or groin.Plans for three radiographs if all

three areas are to be included.Positions for bilateral viewso that both legs will be pro-jected with one exposure.

If the patient's extremities areof unequal length, performer noteswhether the legs or the femoraare unequal. Makes adjustment inpositioning at the, joint abovethe unequal part, su-.111 as placingpelvis so that greater trochanterare in the same transverse planefor unequal femora, and knees atsame transverse plane for unequallegs. In immobilizing is carefulto position and support feet toavoid rotation of the upper endsof the femora.

i) For AP projection of the lowerlegs (tibias and fibulas) ,posi-


Task Code No. 376



tions to include the anklejoints. Has supine patient liein AP position and adjusts bodyso that there is no rotation atthe pelvis. Extends the legs andslightly inverts the feet with-out rotating legs. Sloportsknees. Supports soles with sand-bags. Keeps plantar surface atright angles to film holder. Cen-ters cassette to midpoint betweenlegs at the level of the midpointof the tibias. Directs centralray at right angles to centerof film.

ii) For AP projection of the femora,

level of the symphysis pubis.

Directs the central ray atright angles to the midpointof the film.

d. For projections of the upper ex-tremity (arm and forearm), theperformer checks the side of in-

i terest. May place the cassettediagonally on the table so thatthe entire extremity can be in-eluded in the projection.

i) For an AP projection (poster-ior view) of arm and iorearm,performer has the patient liein supine position with theelbow extended and hand supi-nated. Elevates the oppositeshoulder so that entire ex-tremity is in contact withsurface of cassette. May placesandbag on upturned palm. Cen-ters film (on diagonal) to theelbow. Directs central ray at

1

right angles to the midpoint,entering at the elbow joint.If a bilateral study has beenordered, sets up similarly foropposite side.

ii) For a lateral projection ofarm and forearm, has patientlie on table as above. Has pa-tient abduct arm and flex el-bow about 900, rotating fore-arm internally (medially),with epicondyles at right an-gles to the plane of the film.Checks that arm and forearmare in the same plane and par-allel with table top. Makessure wrist is in lateral,thumb up position. Makes surethat the radius, ulna andcarpal bones are in lateralsuperimposition. Uses sandbagsto support hand. Centers filmto elbow and includes areas of

performer positions to includethe knee joints. Has supine pa-tient lie in AP position withlegs fully extended and feetsomewhat inverted, with pelvisunrotated. Supports ankles. Cen-ters cassette to midpoint be-tween femora at the level of themidfemora. Directs central rayat right angles to center offilm.

iii) For AP projection of the groinareas (pelvis and upper femora),performer has supine patient ex-tend both legs. Supports knees.Places sandbags under anklejoints and adjusts to same trans-verse plane. For extremities ofunequal length adjusts as de-scribed above. Inverts feet sothat long axes of femora areparallel with plane of film bygrasping heels and turning feetmedially. Performer may checkthat there is no rotation ofpelvis by measuring the distancefrom the anterior superior iliacspine to tabletop on each side.Overcomes rotation of pelvis dueto swelling or atrophy by elevat-ing appropriate side. Immobili-zes. Centers cassette to the

338


Task Code No. 376



interest. Directs central rayat right angles to the elbowjoint. If a bilateral study hasbeen ordered, sets up similarlyfor opposite side.

e. For projections of the axilla, per-

11.

of the side of interest. Cen-ters film to the region ofthe coracoid process, includingthe supraclavicular region.Supports the elevated shoulderand hip. Performer adjusts thedegree of rotation so Lhat thescapula is parallel with theplane of the film and the hum-erus rests against film. Forinternal rotation abducts thearm slightly and places thehand against the side of body.Directs the central ray atright angles to the midpointof the film. After exposure,repeats in reverse position,rotating body 450 in the op-posite direction away from theside of interest. If a bilat-eral study has been ordered,sets up similarly for R and Loblique views of axilla jointon opposite side.

f. Throughout procedure performerremains alert for any symptom ofadverse reaction, especially re-action to contrast, such as se-vere flushing, salivation, chok-ing, vomiting, pallor, fainting,or shock. As soon as performerjudges that reaction or pain maybe severe, notifies radiologistor attending physician at once.

Performer checks final positioningby using light in collimator. Acti-vates the collimator light andpoints the light beam towards thepart. Adjusts the collimator open-ing to correspond to film size. Usescross-hair shadows as reference forcenter of field. Checks that primarybeam will enter the center of the

former checks side of interest andwhether bilateral study is ordered.

i) For AP projection (posteriorview) of axilla, performer hassupine patient lie in AP posi-tion. Centers to the coracoidprocess, and places upper partof cassette about two inchesabove the supraclavicular region.Supports shoulder and hip on op-posite side.

Notes whether external, neutraland/or internal rotation is re-quested. Performer locates theepicondyles and holds betweenthumb and index finger of onehand while adjusting the arm.With external rotation has pa-tient turn palm forward. Ab-ducts arm slightly so that thecoronal plane of the epicondylesis parallel with plane of film.Supports as needed. With neutraliotation has patient rest palmof hand against thigh. Wtih in-ternal rotation has patient flexelbow someighat, rotate arm in-terually, and rest back of handon hip. Adjusts arm so that thecoronal plane of the epicondylesis perpendicular to the plane ofthe film. Directs central ray atright angles to midpoint at thelevel of the coracoid process.If a bilateral study has beenordered, sets up similarly foropposite side.

ii) For right and left oblique APprojections, has supine patientrotate body 450 in the direction


Task Code No. 376


List Elements Fully ........m...e...

List Elements Full

area of interest at the selected angle or breathe qtdetly, by callingto the film so as to project the view or using intercom. Performer ini-desired. May readjust tube position tiates exposure by pressing handlengthwise or crosswise to providebetter centering.

trigger or exposure control button.

a. While exposure is underway per-12. Once the patient has been positioned former checks that mA meter re-and immobilized,performer adjusts thecollimaxor. Either collimates so that


a small unexposed border will appear b. May watch for evidence of mal-around the cdge of the film or colli- function such as line surge ormates further so as to expose only excessive drop; may listen forthe area of interest (and thus pro- sound of normal functioning ofvide maximum protection and detail). equipment. If there is malfunc-For small fields periormer may attach tion may decide to report; anti-auxiliary extension zone to colli- cipates need to repeat exposure.mator to further reduce the primary

c. With phototimer notes whetherbeam.backup timer has been involvedin terminating exposure before13. Performer adds lead shielding to areas phototimed exposure was completedthat will be in the primary path of If so, anticipates possible needthe beam but are not included in the to repeat exposure (due to under-

areas of interest, especially gonads.exposure if pLemature cut-off, or,

Provides patient and everyone who will overexposure due to faulty timer.)remain in room during exposure with d. After exposure is completed tellsappropriate protective shielding. Ex- patient that he or she can relax.plains if necessary that this is not e. If the exposure is terminated bycause for alarm but a general precau- a circuit breaker, rechecks tech-tion to minimize unnecessary radiation nical factors for possible over-exposure.

load or checks for overload else-where on circuit. Anticipates

14. When everything is ready for the ex-posure, performer explains to patientwhat breath control will be used for

need to repeat exposure.

16. Performer returns to patient. Re-exposure as appropriate, such as hold- moves cassette or film holder froming still, breathing out and holding,or breathing quietly when told to doso by performer and until told to re-

table or bucky.

a. Removes any markers for furtherlax. Performer observes the patient's use. Repeats steps for position-movement until the moment that the ex-posure is made. Readjusts position if

ing, identification, co1limatio4,-shielding and selection of tech-

warranted.nical factors as appropriate forany other projections ordered

15. Thesperformer returns to control room. for the area of interest and re-Makes sure controls are properly set peats exposures.and patient is still in position. b. If the exposure(s) are scouts,Tells patient when to take a deep lymphangiograms,or if so request-breath and exhale, and/or hold still

ed, performer arranges to have

.........

3 0


Task Code No. 376


List Elements Fullx...... List Elements Full

the exposure(s) processed at once i) If request for retakes re-or decides to do personally. Has flects malfunctioning equip-lymphadenograms processed as appro- ment, performer reports mal-priate. Attaches ID card for use function to appropriate staffwith flasher if appropriate. May member.sign requisition. ii) If request for retakes re-

c. While films are being processed,makes sure that patient is comfort-

flects the preference fordensity or contrast of the

able and, if necessary, attended by radiologist, performer notesstaff person or self. for future work done for the

given radiologist so that re-17. Performer brings the first processed

scouts or lymphanglograms directly tothe radiologist in charge or places.

takes can be avoided.

18. When lymphadenography is completedon view boxes and informs radiologist or when the radiologist indicatesthat they are ready. May also hangprior films and scouts.

that lymphangiography is completed,performer carries out terminationsteps:

a. Performer notes instructions fromradiologist regarding any need to a. Notes any orders for delayedcontinue instillation of contrast,to repeat radiography with change

films to be taken after an elapseof 24 hours or more (lymphadeno-

in patient, tube, or film position- grams). May have radiologist filling, or with change in technical out requisition.factors. b. If performer is completing lymph-

b. Notes instructions with regard to angiography, may return to pa-lymphangiography or delayed films: tient to explain need to return

fcr lymphadenograms. May explaini) If processed film is a scout,

performer makes note of appro-to patient that the intradermalinjection of dye may cause pa-

priate timing for lymphangio- tient's skin and urine to begrams and any special orders tinted blue for one or two days.from radiologist. May discuss. With in-patient may arrange to

ii) If processed films are lymph- have nursing staff in charge of..

angiograms, performer carries patient's care informed.out or repeats orders until ra-diologist indicates that lymph-

c. After radiography is completed,performer may decide to assist

angiography is complete. patient from table or to chairor stretcher. Makes sure patient

c. Performer refrains from commcnting is reminded of any footrest inon the films or providing any instepping off table. Makes sureterpretation to patient. that none of the equipment is

d. If performer is asked to repeat projecting over the patient be-any exposures, performer notes fore allowing patient to risewhether need to repeat is due to . from stool or table, and assistsperformer's own negligence or lackof attention so that performer canavoid future "retakes."

patient.

391


Task Code Nc. 376



d. Performer may have patient trans-ported back to recovery or holdingarea, next location or room, or de-cides to do personally, as appro-priate. If appropriate, makes surethat patient is in the care of astaff person who will transport toappropriate next location or whowill have out-patient discharged.

e. Performer may have room and equip-ment cleaned; has any other appro-priate clean-up procedures followedto avoid infection or contamination,or decides to do personally, depend-ing on institutional

arrangements.f. May present requisition sheet to

radiologist for comments, ordersand signature.

g. If performer will only carry outpreliminary "scout" filming and/orlymphangiography, performer recordsthe approved technical factors usedfor the radiographs, and the acces-sories employed, or informs tech-nologist who will continue. Perform-er gives the requisition sheet,name card, and any notes to tech-nologist who will continue with pro-cedure or placf,s for further useas appropriate.

h. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the overhead viewstaken, the technical factors used,and film sizes. Performer may r,1.-cord the number of exposures madeof each overhead view including re-takes; may enter the estimated ra-diation dose to which patient wasexposed (using posted informationon dosage); may record any problemwith equipment, any special careprovided patient. Signs requisitionsheet.

i. Performer may decide to personallyjacket radiographs, requisitionsheets, and related materials and/

332

or have information recorded inlog book, or have this done,depending on institutional pro7cedures.

j. May indicate to approp%iate staffperson when the performer isready to proceed with next exami-nation.


Task Code No. 377


......mm. What is the output of this task? (Be sure List Elements Fullthis is broad enough to be repeatable.)

Requisl-ion reviewed;pt. reassured,positioned,mea-sured;tilms identified;technical factors selectedand set for fluoroscopy,spot filaing and overheads;scouts taken;radiologist assisted with instillationof contrast,positioning,fluoroscopy;overhead expo-sures made;radiographs sent for processing,taken toradiologist;procedures repeated as ordered;pt. re-

Oturned;examination recorded;arthrograms placed.

,

Performer receives or obtainsthe x-ray requisition forms pa-tient identification card, andany appropriate medical-techni-cal history for a patient sched-uled for positive contrastarthrography (radiographic st-Idy-of the joints, especially ka-2e,after injection of contrastmedium into the joint) as a re-sult of:

a. Regular assi6nment.b. Checking assignment on sched-


in order of priority.d. From co-worker.

,

Depending on institutionalarra-,gements, perf,rmer mayalso receive prior films orscout film(s) already takenby co-worker with record oftechnical factors used and/or any changes necessary.



Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical-technical history,prior radiographs,scouts;view boxes;pen;x-ray generator,control panels,tube,bucky,table,collimator,extension cones;fluorosc-oyunit,image intensifier,spot film device,TV monitor;cassettes,roll film;R-L and ID markers;typewriter;sterile gloves,procedure tray;emergency cart;con-trast medium;protective lead shieldirg;immobiliza-tion devices;technique,standard view,tube rating andrad exposure charts;calipers;phantom or test object;stretcher or wheelchair;intercom;specJmen container;order forms;restraining devices


'es to g. Name the kin. o recipient,respondent or co-worker involved, with de_


Patient to have arthrography;accompanying adult;radiologist;co-workers;nursL

5. Name the task so that the answers to ques-a. Performer checks the ex-

amination called for in-eluding the joint involvedand the affected side, thepurpose of the study, andany special requests.Notes the name of the ra-diologist in charge; maynote the name of the re-ferring clinician.

OK-RP;RR;RR


Taking positive cOntrast arthrognms (especially ofknee) of any patient,by reviewing request;preparingequipment;preparing and reassuring pt.;measuringpart;setting up tor fluoroscopy and spot filming;arranging for scout films as ordered;selecting andsetting technical factors;identifying films;provid-ing shielding:assisting with instillation of con-trast,positl.oning of patient,fluoroscopy, andspot filming;taking overhead radiographs as ordered;arranging for processing;taking to radiologist;con-tinuing,repeating as ordered;having pt. returned;placing arthrograms for use;recording examination,

6. Check here if thisis a master sheet..(X)

3.-)3


Task Code No. 377

This is p,ge 2 of 14 for this task.


b. Performer reads patient's name,identification number, sex, age,weight, and heighc. Notes whetherpatient is in-patient, out-patient,or emergency patient. Notes anyspecial information or note onknown pathology that could affectpatient positioning, technique, orhandling of the patient, such asacute injury, fracture, recurringdislocation. Notes whether thereis history of allergies.

c. Performer notes whether fluoroscopywill be combined with spot.filmingand overhead radiography. Noteswhether the use of a grid or buckywill be involved, shielding needed.Notes any special requests.

d. Periormer checks whether patient issuffering from a collateral condi-tion requiring special handlingsuch as heart 04.sease, communicableor infectious condition, infirmity,incoherence; whether patient hasIV drip, oxygen supply, urinarycatheter or similar device in place;notes whether patient will be ac-companied by nurs L! or other staffperson.

e. Performer makes sure,that the re-quest is properly authorized, thatinformation on requisition sheet iscomplete.

i) Depending on institutional pro-cedures, performer nay reviewpatient's radiation exposurehistory, prior record of tech-niques used, and cumulative ex-posure. Notices whether exami-nation has been done elsewherein recent past, whether thereis history of extensive radiog-raphy to bring to radiologist'sattention.

ii) Checks whether any special or-ders on exposure factors are inkeeping with the usual zad ex-posure in-T)lved for the exami-nation.

iii) Depending on institutional pro-cedures, performer noteswhether female patient is preg-nant, reviews date lf femalepatient's last Ir.Litrual period,or notes any ();11r indicationthat there nc. danger of ex-posure of a V.:Jdn or possiblefetus.

iv) If patient!s record indicatesordezs for sedation or anyother prior medication,perform-er may check timing to be surea proper elapse of time hasoccurred for medication to takeeffect.

f. If the perfe)rmer zletermines thatthe request is not properly auth-o.:ized, is incomplete, or that6ufficient information is lackingfor performer to select techniqueor to properly position or carefor patient, or if performer con-siders that there may be contra-indications to going ahead withthe procedure, performer bringsthis to attention of radiologistin charge: Explains the problemif appropriate, and proceeds afterobtaining needed information,signature, or orders.

g. If referring physician has request-ed that films already on file bepresented with current radiographs,and if not already with patient'sjacketed material, performer ar-ranges to have prior films deliv-ered.

2. Performer goes to appropriate roomfor the type of examination involvedand the equipment required, or notesroom assigned on requisition sheet.Checks that x-ray equipment is pro-vided with small fractional focalspot and that overhead,and fluoroscopycapabilities are available.


Task Code No. 377


List Elements FullYList Elements Full

rrepares ahead so as not to keep pa-tient in examination room longer thannecessary:


prepared for the joint involved ordecides to do personally. Checksthat emergency cart is present.

c. Checks that proper accessories areavailable for procedure includingspecial frame or other restrainingdevice and equipient for applyingstress to the joint. Checks forleaded rubber shielding, apron's,and gloves to be used by performer,radiologist, the patient, and/or*anyone who will remain in the roomduring exposure.

i mmobilization devices are present,

I

d. Performer checks that appropriate

and that there is a mattress, pads,pillows and/or blancs on thetable for comfort -. patient. Makessure that right (R., and left (L)markers are available for use andidentification card or leaded num-erals or markers.

e. Performsr makes sure that an ade-quate supply of loaded crssettesor othsr film holders of the appro-priate types and sizes for over-head filming are wvailable in thEexamination room. If not, arrangesto obtain or decides to obtainpersonally.

f. Performer prepares for identifica-tion of overhead films using equio-ment provided by institution:

i) May obtr.in lead numerals andtaperand prepare identificationstrip for placement on filmholder(s) giving appropriatepatient identification informa-tion.

ii) Performer may prepare for useof flashcard by checking that

there is piece of lead on filmholder surface; may write ortype out ID information on cardif not received with requisi-tion.


g. If examination will include spot-filming using a camera (attachedto image intensifier) and rollfilm, performer checks film supplyindicator to make sure that thereis sufficient film in the roll

.

film cassette.

i) If there is insufficient rollfilm in camera, performer ar-

.ranges to have roll film cas-sette loaded, or decides to dopersonally.

ii) When lued roll film cassetteAis obtained, performer checksloading in subdued light.

.

Checks that end of film is cutcorrectly and is properlythreaded and attached to take-up spool so that film unwindsapproPriately. Checks that filmis properly engaged on sprock-et. Locks into operating.posi-tion. If appropriate, cuts offexcess film at exit port andremoves. Attaches film cassetteto camera and locks into place.Replaces camera cover.

iii) If there is an adequate filmsupply, checks that film isproperly loaded.

iv) Performer advances film to com-pensate for any exposure offilm due to installation orcheck.

v) Removes dark slide from cameralens.

vi) If not already done, performerwrites or t.ipes a card with

395


Task Code No. 377

This is page 4.0f 14 for this task.

List Elements Fullanaoslausle List Elements Fully

patient's identification in-formation for use with spotfilm device. Inserts in slotin spot film camera as appro-priate.

h. If examination will include spotfilming using a cassetce/buckyspot film device, performer checksthat there is an adequate supplyof appropriate size cassetts inroom.

i) If there is insufficient sup-ply of cassettes, arranges toobtain or decides to obtainpersonally.

ii) Performer prepares for iden-tification of the spot filmcassettes as for overheadfilms.

iii) Performer may use controlsor manually pull out spotfilm bucky tray and open re-taining clamps. Inserts cas-sette into bucky tray andpushes back. Makes sure clampsare closed. Moves cassette in-to appropriate "stored" posi-tion.

iv) If R-L markers are to be usedwith spot filming, performertapes into place on image in-tensifier screen or plan.1 totape to patient's body.

i. If a grid.will be used with theimage intenSifier for fluoroscopy.and/or spot,filming, performerpositions and centers grid ifnot already done. May use con-trol button or slides grid intopositions. May check that the

grid is oriented toward the x-ray

tube, with grid lines parallelto the long axis of the tube.

3. Performer preselects technical ex-.2osure factors for overheads, flu-oroscopy and spot filming, based..)n standards set by the institu-

tion as appropriate for examina-tion involved:

a. Dons protective leaded rubbergarments such as apron andgloves.

b. Makes sure that no one is inexamination room or controlroom.

c. Performer reviews the techniquechart(s) for the unit(s) to beused:

i) LocaLes information for bodyviews involved. Takes note oftLe exposure factors to beused for overheads, fluoros-copy, and spot filming. Con-siders preferences of the ra-diologist involved.

ii) Notes any newly posted changesin technical factors (to re-flect accommodation to a changein,machine output or a policydecision).

iii) Performer checks any new orunfamiliar exposure factorsagainst the posted limits ofthe x-ray tube on a tube rat-ing chart to be sure that tech-nique does not exceed the heatcapacitieL, of the.'tube for thefocal spot size'to be used. Ifappropriate, performer recon-verts the technique to anequivalent output using higherkVp and lower mAs.

39kj


Task Code No. 377



d. In the control room performer i) Selects and sets the kVp atmakes sure that indicator light

standard setting for the ex-shows that x-ray generator is

amination. May check indi-"warmed up" and ready for use. cator dial. With automaticMakes sure that all circuits

density control, sets den-have been stabilized. If appro- sity selector as appropri-priate, checks line voltage ate for examination.meter and, if needed, turns com- ii) If mA is automatically con-pensator dial until needle is trolled according to patientaligned properly on line meter. thickness, performer turnse. As appropriate, performer sets fluoroscope mA selector tox-ray generator mode selector(s)

maximum standard position.to fluoro-scopic mode and for If not automatically controll-use of spotfilm camera or cas- ed, sets as appropriate forsette device, and/or overhead

focal spot size and examine-filming.

tion involved.f. Performer sets controls on image iii) Sets fluoroscopic examination

intensifier for spotfilm cameraor cassette device:

timer to maximum position.

j. If appropriate, performer selectsi) For spotfilm cameia, peIform- and sets exposure factors for

er selects and sets the rate spot filming:(frames per second) for thecamera according to standards i) For conventional manual expo-set for examination.

sure control, performer se-ii) For cassette.spotfilming per- lects and éets the appropri-

former may select and set a ate spotfilm time for thestandard spotfilm program pro- examination.viding for format combinations ii) For automatic, phototimed ex-such as single, half, or quart- posure control, performerer combinations on a single selects a density exposurecassette and related spotfilm control appropriate for thesizes. Selects program appro- examination.priate for examination or iii) Performer selects the appropriawaits orders from radiolo- ate mA for the examination andgist.

the focal spot size to beused.

g. f not already done, performeriv) Performer selects and sets kVp

connects TV monitor to power out- by combining settings on onelet. Turns on monitor and checks major and one minor kVp se-that "ready" light is on. lector as appropriate for the

h. If appropriate, performer selectsthe proper field size selector(if there is dual image intensi-

examination.

4. Performer returns to examination.

fier). room to set up x-ray and fluoroscopei. Performer selects and sets expo-

sure factors for fluoroscopy:tube(s), image intensifier, coin-

4

397


Task Code No. 377


List Elements Full

mator and accessories, as appropriate,for check of equipment prior to ex-amination:

a. Makes sure that no one is in room.b. Places phantom or appropriate test

object on radiography table wherepatient's area of interest will becentered for examination.

c. Adjusts fluoroscopic tube stand(above or below table) so thattube is at zero degrees and cen-tered to the area of interest.

d. If not already done, moves imageintensifier and any spot film de-vice into position; centers (overor under) the area of interest.

e. Performer adjusts the x-ray tubeto appropriate focal spot/objectdistance (target to skin distance,TOD). For fluoroscopy adjusts dis-tance between focal spot and imageintensifier (focal spot to filmdistance, FFD). Makes sure thatTOD is 15 inches or more. Operatescontrols or manually moves thex-ray tube(s) into place. Checksthe focal-film distance by readingindicator scale in the tube hous-ing; adjusts up or down until therequired FFD is obtained.

f. Performer collimates fluoroscopytube (ahd x-ray tube used for spot-filming if different), dependingon nature of the equipment and con-trols:

i) Adjusts fluoroscopy beam shut-ters ta the field size antici-pated for fluoroscopic examina-tion or sets shutter mode se-lector to automatic collimation.

ii) Manually sets collimator forthe spotfilm field size to beused, or selects and sets fieldsize control to be used forautomatic collimation with

List Elements Fully

programmed spotfilm cassetteexpOsure sequence.

g. If appropriate, performer attachesor sets up footboard at end oftilt-table; adjusts or attachesshoulder rest, hand grips if re-quired.

Performer checks functioning of equipment by entering remote control roomor operating controls in examinationroom behind leaded screen:

a. To check fluoroscopy mode, per-former turns on TV power switchcontrols as appropriate. Acti-vates fluoroscope exposure bypressing footswitch or as appro-priate. Views test object beingfluoroscoped on TV monitor.

i) Performer adjusts kVp control(and mA control if appropriate)and observes effects on TVmonitor to be sure that equip-ment is operating properly.

ii) Checks mA meter and noteswhether appropriate readingis obtained.

iii) Performer checks that TVbrightness controls are oper-ating and adjusts for prelim-inary viewing.

iv) Checks examination timer bynoting whether time elapseindicator moves during expo-sure showing decreasing timeleft for examination. Maycheck that exposure is termi-nated when maximum examinationexposure time is reached.

b. To check spotfilm functioning,per-former may move cassette or rollfilm into x-ray exposure fieldusing appropriate controls.

3 8


Task Code No. 377



i) Performer activates controlsfor spotfilm exposure. Noteswhether cassette or roll filmtransport is operating appro-priately. Notes whether expo-sure is terminated by photo-timer or, if manual timer, intime set. If appropriate, re-leases spotfilm control afterexposure.

ii) If equipment is operating appro-priately, perfo-mer unloads cs-sette and reloads or advancesroll film as appropriate. Movesbucky out of 1..ay until fluoros-copy is completed.

c. After the performer has checkedthe equipment, resets forstandard exposure factors. If per-former decides that any of thefluoroscopic equipment is not func-tioning properly, performer in-forms appropriate staff member.Arranges for alternate unit to beused.

. When fluoroscopy equipment has beenset up, performer may note whetherpreliminary radiographs (scout films)have already been.made of the patient(done by another radiclogic technolo-gist if work is organized in this wayat institution),

a. If scout films have already beenmade and viewed by radiologist,performer notes the technique usedor ordered and sets up technicalfactors for any overhead radiog-raphy, adjusting for use of con-trast medium.

b. If scout films have been made butnot approved, performer placesprocessed scout films and anyprior films with patient's chartor places on view boxes for view-ing by radiologist. ,

7.

c. If scout films have not been madeand are required before patient isseen by radiologist, performer ar-ranges to take "plain films" ofthe joint in standard positions.Plans to proceed as for plain filmradiography after readying patient.

Performer readies patient for exami-nation by radiologist:

a. Performer washes hands as appro-priate. Depending on patient'sccndition, may decide to arrangefor or carry out isolation ordecontamination techniques.

b. Performer has the patient calledfrom the holding area and pre-pared for the examination (if notalready done), or decides to dopersonally.

c. Depending on institutional arrangements, performer may decide to es-cort out-patient to or from dress-ing room. May decide to assist intransporting patient from holdingarea or have this done.

d. Performer greets patient and anyaccompanying staff person and in-troduces self. Checks patient'sidentity against the requisitionsheet. With in-patient, checkshospital identification braceletor other identifier. If patientis accompanied because of ser-iousness of condition, performerchecks with accompanying staffmember on any special precautionsnecessary during procedure.

e. Performer has patient assume acomfortable recumbent or seatedposition, as appropriate.


ii) If patient is in wheelchair maymove patient in chair into po-

399


Task Code No. 377



sition next to table. Makes s....r e.. , shellfish or adverse reactionsthat wheelchair is in locked to contrast medium (especiallyposition. iodim! based). Checks whether

iii) Performer may decide to assist an alLergy test is required.patient from wheelchair or Plana to notify radiologist ifstretcher to table or has this any sensitivity should bedone, May obtain help. Makes brought to his or her atten-sure that no equipment is in the tion.way that may be collided with ii, Performer may explain to pa-by patient. tient what side effects may

iv) If assisting patient to step on be felt from contrast mediumfootstool in order to get ontable, helps patient turn into

such as feeling of nausea,flushing, choking sensation.

position, step backwards on iii) If appropriate and not alreadystool, and then sit and/or lie done, performer questions fe-on table. male patient of child bearing

v) If patient is on special age regarding possible preg-stretcher, places stretcher nancy. If there is any possi-into position so that radio- bility that patient is preg-lucent stretcher can be liftedwith patient on it from wheeled

nant and this has not already,been recorded, performer plans

base to x-ray table. May ar- to inform radiologist and torange to move or have patient proceed only With-approval.moved to table. iv) Performer answers patient's

vi) Has patient rest in as relaxed non-medical questions honestly;a position as possible. May attempts to reassure patientplace pad, blanket or pillow and develop confidence. Treatsunder bony prominences to pro- patient with dignity and con-vide comfort for recumbent pa- cern regardless of patient'stient. I behavior. Remains aware that

patient may be frightened and/f. Makes sure that there is no cloth-

ing or jewelry on area of interest,or in pain. Performer explains,when asked medical questions,

Permits patient to keep covered that it is not appropriate forwith gown until measurements are technologist to answer these;taken and until exposure. Treats encourages patient to speakyoung patient with as much courtesyas adult.

g. Performer explains to patient what

to physician.

h. Unless measurements have alreadywill be involved in the procedure; been made, and depending on theindicates what types of positions joint to be radiographed, per-the patient will be asked to as- former uses centimeter caliperssume and the cooperation that will to measure the thickness of thebe asked of the patient. part. Measures in the direction

in which the central ray of thei) If not already done, may ques- x-ray beam will pass through the

tion patient or accompanying centered part from tube to film.adult about any allergies to Records for use in determining

,.....

400

TASKDESCRIPTION SHEET

(continued)

Task Code No. 377This is page 9 of 14 for

tbistask.List Elements FullLexposure factors for

overheads.Aftermeasuring, has patient rest in asrelaxed a positionas possible.i. Performer

may tape R or L markerto patient ifappropriate for usein spot

filming.j. If

appropriate beforeradiologist'sexamination, performer arranges totake "plain film" scouts and havethem processed at once.

Performer informs attending radiolo-gist whenpatient is ready to be ex-amined. Brings

requisition sheet, pa-tient's medical history, chart, scoutfilms (ifalready done) and any priorfilms, toradiologist. Displays ra-diographs on view boxes.

List Elements Full

a. If notalready done, performer tellsradiologist about any difficultiesencountered with regard to infor-mation, possible

contraindicationsor anythingelse that should bebrought to radiologist's

atten-tion. Notes any special orders orchange in procedure decided by ra-diologist. Proceeds as ordered.b. Performer may accompanyradiologistto examination

room and introducepatient toradiologist.c. If not

already done, performerawaits and carried outradiologist'orders for scout films and pro-ceeds as

appropriate.for body part.. During

radiologist's review.of requi-sition,scouts, prior films and exami-nation of patient, performer notesradiologist's orders for an Y changesin thetechnical factors, mater-.ials to be used in procedure,

ordersfor overhe.adradiographs; discussessequence and timing for

procedure.Mayarrange signals for exposure,changing of spotfilm cassettes, opera-tion of

exposure controls.

a. Ifradiologist decides to cancelprocedure, performer arranges toterminate and

reschedule as ap-propriate..

b. Performerarranges to provide orchange any equipment

or suppliesas ordered byradiologist.c. Arranges to have patient preparedfor sterile

injection of localanesthetic andcontrast,or decidesto do

personally. Has area aroundjoint shaved ifappropriate. Hasa container

labeled and preparedto receivesample of fluid fromjoint,or decides to do

personally.d. Changes or adjuststechnical fac-tors and settings as appropriatefor

fluoroscopy and spot filming.For overheadradiographs, perform-er notes needed adjustment oftechnical factors from those usedfor scout film(s) to allow foruse of contrast material; notesany changes

requested by radiolo-gist in views or positions.Resetstechnical

exposure factors as ap-propriate for overheads:

i) Enters control room and setscontrols forappropriate mode.ii) For

conventional exposure con-trol, performer selects milli-amperage and chooses selectorsfor thecorrect focal spot size.Selects and sets the exposuretime that will produce the m&sdesired. Sets the kVp selectedby choosing the combination ofmajor kilovoltage and minor

kilovoltage settings to pro-duce thedesired kVp.iii) For

automatic phototimed expo-sure control,performer se-lects and sets the category

corresponding to the type ofstudy and use or nonuse ofscreens, bucky, etc., and, if

4 i


Task Code No. 377



appropriate, focal spot size.Selects and sets a controlcorresponding to the field size(as listed on technique chartfor phototiming).May select and set a kVp rangebutton (if called for with equip-ment) corresponding to range forexamination.Sets a density selector corres-ponding to the usual (or spec-ial) requirements for the study.Makes sure backup timer is notlikely to terminate exposurebefore phototimed exposure ismade.

iv) Depending on the equipment, mayset controls to provide for useof bucky, manual adjustment oftable and tube height, position,and of collimation, unless thesehave already been set.

10. Performer may assist with injectionof contrast medium.

a. May help position patient as appro-priate.

b. Performer gives leaded gloves andapron to radiologist. If appropri-ate, places leaded curtain inplace. Provides patient and every-one remaining in room with appro-priate protective shielding. Ex-plains if necessary that this isnot cause for alarm but a generalprecaution to minimize unnecessaryradiation exposure.

c. Washes hands as appropriate observ-ing sterile technique.

d. If appropriate, performer openspacket of sterile gloves for ra-diologist, observing sterile tech-nique so that wrapper, own hands,or other objects will not contami-nate gloves.

e. May assist in sterile surgicaltechniques as appropriate by hand-ing materials asked for.

11.

f. May check and help prepare syringeswith local anesthetic and contrastmedium as ordered.

g. When radiologist aspirates fluidfrom joint, performer may assistin transferring of fluid fromsyringe to sterile, labeled con-tainer; performer caps and ar-ranges to send for laboratorytesting.

Performer assists radiologist duringfluoroscopic viewing of progress ofinjection:

a. On signal from radiologist, per-former may dim room lights. Turnson TV power switch. May go to con-trol room and operate fluoroscopeand spot film controls on ordersfrom radiologist. Adjusts kVp and/or mA controls according to ra-diologist's orders.

b. Performer may operate tilt tableon orders from radiologist, orassist in positioning patient asordered.

12. After radiologist distributes con-trast medium in joint, performer, onorders, attaches special frame orother equipment to table for use inapplication of stress.

a. May adjust or help strap jointinto position in frame,or posi-tions other apparatus as ordered.

b. Helps position ratient as orderedfor viewing the medial meniscus(of knee), and lateral meniscus.

13. Performer assists radiologist duringfluoroscopic examination and spotfilming by operating exposure con-trols as ordered or positioningtable or tube as ordered.

a. Performer may slide extension coneinto place under image intensifier.

402


Task Code No. 377

This is page ll'of 14 for this task.


b. If spotfilm attachment uses cas- d. Performer sets the focal-film dis-settes, performer may unload as tance, if not already done, asused, identify, and insert addi- appropriate to the study.tional cassettes, as described e. Performer checks final positioningabove, throughout procedure. by using light in collimator.

c. Depending on institutional proce-Activates the collimator light

dures,performer may keep radiolo- and points the light beam towardsgist informed of cumulative expo- the part. Adjusts the collimatorsure as shown on fluoroscope timer

opening to correspond to the filmindicator.

size. Uses cross-hair shadows asd. For viewing of cruciate ligaments,

performer removes frame and re-reference for center of field.Checks that primary beam will

straints. Assists as above;assists enter the center of the area ofsimilarly for viewing of lateral interest at the selected angleand medial patellar cartilage. to the film so as to project the

view desired.14. Performer carries out overhead radiog- f. Once the patient has been posi-raphy as ordered by radiologist. Per-. tioned and immobilized, performer

former may discuss what movement is adjusts the coll.:mator. Eitherpossible to determine the positions collimates so that a small unex-available for use, or performer may posed border will appear aroundassist while radiologist positions the edge of the film or collimatespatient for overheads.

further so as to expose only thearea of interest (and thus pro_

a. Performer readjusts technical fac- vide maximum protection and de-tors for first (or next) overhead tail). Performer attaches anradiograph if any change was or- auxiliary extension cone to col-dered.

limator to further reduce theb. Identifies cassette and places primary beam. Adjusts primary

right or left marker on film beam to minimum size needed toholder or table top as appropriate cover the part(s) of interest.to the study and projection, or de- g. Rechecks that patient has beenpresses appropriate R or L button properly shielded.for automatic marking. Places cas- h. Performer rehearses patient insette, in position on table or in holding still during expo-bucky. A

tc. Performer positions as ordereci assure until told to relax.

i. Throughout procedure performerfor plain films. Centers to th,J,joint area of interest and'keeps

remains alert for any sympton ofadverse reaction, especially re-

the long axis of the part parallel action to contrast such as severeto the film holder. May explain ordemonstrate to patient what is re-

flushing, salivation, choking,vomiting, pallor, fainting, or

quired. May obtain help in posi- shock. As soon as performer judgestioning. When using a bucky, cen-ters patient to midline. With cas-

that reaction may be severe,ceases exposure and notifies ra-

sette on table top, centers film diologist or attending physicianto part. With upright holder ad-justs height of holder to part.

at once.

403


Task Code No. 377

This is page .12 of 14 for this task.

List Elements Full

j. When everything is ready for theexposure, performer reminds patientto hold still during exposure. Ob-serves the patient's movement untilthe moment that the exposure ismade. Readjusts position if war-ranted.

k. Performer returns to control room.Makes sure controls are properlyset, that equipment is set for ra-diography mode, and that patientis still in position. Tells patientwhen to hold still as rehearsed bycalling or using intercom. Initi-ates exposure by pressing handtrigger or exposure control button.

i) While exposure is underway, per-former checks that mA meter re-cords appropriate current asset, that kVp meter dips slight-ly.

ii)_Mfyyatch for evidence of mal-function such as line surge orexcessive drop; may listen forsound of normal functioning ofequipment. If there is malfunc-tion may decide to report; anti-cipates need to repeat exposure.

iii) With phototimer notes whetherbackup timer has been involvedin terminating exposure beforephototimed exposure was com-pleted. If so, anticipates pos-sible need to repeat exposure.


v) If the exposure is terminatedby a circuit breaker, recheckstechnical factors for possibleoverload or checks for overloadelsewhere on circuit. Antici-pates need to repeat exposure.

vi) After exposure removes cassetteand removes markers for furtheruse.

Li U

List Elements Full

vii) Repeats radiography for allthe exposures ordered by ra-

. diologist, adjusting techni-cal factors, tube,and posi-tion of patient or film holder as appropriate to eachview ordered. Repeats iden-tification, collimation,shielding and exposure asabove.

15. After spotfilming and overhead film-ing is completed, or when ordered byradiologist, performer arranges tohave spo films and overhead arthro-grams processed:

a. May sign or have radiologist signrequisition sheet.

b. Checks that equipment is turnedoff.

c. With cassette spot films or over-head exposures removes any markersfor further use. Attaches ID cardfor use with flasher if appropri-ate.

d. With spotfilm camera, performeradvances the film so that allexposures made will be wound onthe take-up spool in the rollfilm cassette. Replaces darkslide on camera lens. Uses de-vice to cut film and create alight shield. Resets counter andremoves film cassette.

e. Removes any markers from patient'body.

f. Performer arranges to have spotfilms and overheads processed atonce if appropriate or decides toprocess personally.

g. While films are being processed,makes sure that patient is com-fortable and, if necessary, at-tended by radiologist, staff mem-ber, or self.


Task Code No. 377This is page 13 of 14 for this task.

List Elements Fullx.,

List Elements Full16. Performerbrings the processed spotfilms andradiographs directly to theradiologist in charge or places onview boxes and informs

radiologistthat they are ready. May hang priorfilms and scouts.

a. Performernotes any order for re-peat of any part of

fluoroscopicexamination. Changes technicalfactors as ordered.Assists incontinued examination as describedabove, repeating appropriate steps.b. If the

radiologist indicates thatthere is any problem with thetechnical factors or the patientpositioning for overheads, per-former records or notes for use in"retakes."

c. When (or if) performerlearns fromthe radiologist that further con-ventional overheads or special

projections are to he made, per-former proceeds as appropriateaccording to instructions.d. Fot further overhead exposuresperformer repeats appropriatesteps including

identification ofcassette, use of R-L marker, se-lection and setting of technique,positioning patient and equipmentforfocus-object-film alignment,collimation, shielding, breathinginstructions, making exposure, andprocessing, as described above.e. Performer

refrains from commentingon the filmsor providing any

interpretation.f. If performer is asked to repeatany exposures,

performer noteswhether need to repeat is due toperformer's own negligence or lackof attention so that performer canavoid future "retakes."

i) If request for retakes reflectsmalfunctioning equipment, per-former reports malfunction toappropriate staff member.

If request for retakes reflectsthe preference for density orcontrast of the

radiologist,performer notes for future workdone or the given

radiologistso that retakes can be avoided.

g. Performer shows subsequent setsof radiographsto radiologist asprocessed, and procc,As as de-

scribed above until radiologistindicates thatexamination is

completed.h. Performer notes any orders for arepeat of examination at a latertime. May have

radiologist fillout requisitionsheet. May arrangefor scheduling.

17. When the radiologistindicates thatthe radiography is completed, per-former carries out termination steps:

a. May makesure that all equipmentis turned off.

b. Performer may havepatient cleans-ed; may have room and equipment

cleaned; hal any other appropri-ate clean up proceduresfollowedto avoid infection or contamina-tion, or decides to do personally,depending on institutional ar-rangements.

c. May decide to assist patient fromtable or to chair. Makes sure pa-tient is reminded of any footrestin stepping off table. Makes surethat none of the equipment is pro-jecting over the patient beforeallowing patient to rise fromstool or table, and assists pa-tient.d. If delayed films are ordered re-quiring a specific period of timeto elapse, performer arranges tohave patient taken to appropriateholding area. Keeps track of the

time elapsed.Follows steps a9 ap-ropriate as described above.

405


Task Code No. 377


List Elements Fully List Elements Fully1

e. Performer may have patient trans-ported back to holding area ornext location, or decides to dopersonally, as appropriate. If ap-propriate, makes sure that patientis in the care of a staff personwho will transport to appropriatenext location or,if out-patient,will arrange to discharge or send

- .

patient hone.

f. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the overhead viewstaken, the technical factors used,and film sizes. Performer may re-cord the number of exposures madeof each overhead view includingretakes; may enter the estimatedradiation dose to which patientwas exposed (using posted informa-tion on dosage); may record anyproblem with equipment, any spec-Sal care provided patient. Signsrequisition sheet.

g. Performer may record the fluoros-copy examination including exposuretine and rad dosage.

h. May present requisition form toradiologist for comments and sig-nature.

i. Performer may decide to jacketradiographs, requisition sheets,and related mhterials, and/or haveinformation recorded in log bookpersonally,or have this done, de-pending on institutional proce-dures.

j. May indicate to appropriate staffperson when the performer is readyto proceed with next examination.

,

.

4 Uti


Task Code No. 378


1. What is the output of this task? (Be surethis is broad enough to be repeatable.)Requisitionreviewed;pt.-reassured;part measured;films identified;technical

factors selected and setfor fluoroscopy,spotfilming,overheads;scouts taken;radiologist assisted with instillation,pos....tioning,

fluoroscopy;pt. instructed in cough suppression;overhead exposures made;radiographs sent for processing,taken to radiologist;procedures repeated as orderedfor other side,delayed films;pt. returned;examina-,tion recorded;bronchograms placed for use.2. What is used in performing this task? (Note


Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical-technical history,prior

radiographs,scouts;view boxe6;pen;x-raygenerator,control panels,tube,

bucky,table,collimator;fluoroscopy unit,image inten-sifier,spot film device,TV monitor;cassettes;rollfilm;R-L,ID markers;procedure tray;emergency cart;contrast medium;heater;emesis

basin;pad;towels;pro-tective lead shielding;immobilization devices;tech-nique,standard view,tube rating and rad exposurecharts;calipers;phantom or test object;stretcher orwheelchair;intercom;order forms;instruction sheet

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes... ) No...( )

es to q. 3: Name t e kind of recipientrespondent or co-worker involved, with de_scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions.

Non-pediatric patient to have bronchograPhy;radio-logist;co-workers;nurse

5. Name the task so that the answers to ques-tions 1-4 are reflected. Underline essen-tial words.

Taking bronchograms of a non-pediatric pt., by re-viewing request;preparing equipment;preparing and reassuring pt. ; measuring chest;setting up for fluoroscopy and spot filming;arranging for scout films asordered;se:ting technical factors;identifying films;providing shielding;assisting with instillation ofcatheter,contrast,positioning of pt.,fluoroscopy,spot filming;taking overhead bronchograms as ordared;arranging for processing;taking to radiologist;con-tinuing,repeating as ordered for second side,delayedfilming;assisting in removal of contrast;having pt.returned;placing bronchograms for use;recording.4Ma

4 07

List Elements Fullx._

Performer receives or obtainsthe x-ray requisition form, pa-tient identification card, andany appropriate medical-tschni-cal history for a non-pediatricpatient Schedalotd for bronchog-raphy (radiographic examinationof the lung(s) alAd bronchiaftevinstillation of iodizedoil contrast medium in bronchus)as a result of:



d. From co-worker.. Having arranged, on orders,or received orders to proceedwith bronchography of patientwho has just undergone bron-choscopy (with bronchoscopeor catheter still in place).

Depending on institutional

arrangements, performer mayriso receive scout film(s)already taken by co-workerwith record of technicalfactors used and/or anychanges necessary.

. Performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, specialconsiderations, and to checkthe completeness of tbe in-formation provided:

a. Performer checks the ex-amination called for in--cluding the areas involvedand the affected side(s),

OK -RP;RR;RR

6. Check here if thisis a master sheet.. (X)


Task Code No. 378



the purpose of the study, aftd anyspecial requests. Notes the nameof the radiologist in charge; maynote the name of the referring cli-nician. Notes whether erect orrecumbent positioning is calledfor, views ordered, breathing in-structions, whether a bilateral orunilateral study is requested.

b. Performer reads patient's name,identification number, sex, age,weight, and height. Notes whetherpatient is in-patient, out-patient,or emergency patient. Notes anyspedial information or note onknown pathology that could affectpatient positioning, technique, orhandling of the patient, such asacute injury, presence of taping.Notes whether there is history ofallergies, whether patient Will beon a'stretcher or in a wheelchair.Notes whether the use of a grid orbucky will be involved, shieldingneeded. Notes any special requests.

c. Performer checks whether patient is

suffering from a collateral condi-tion requiring special handlingsuch as heart disease, communicableor infectious condition, infirmity,

incoherence; whether patient hasIV drip, oxygen supply, urinarycatheter or similar device in place;notes whether patient will be ac-companied by nurse or other staffperson.

d. Performer wakes sure that the re-quest is properly authorized, that,information on requisition sheet iscomplete.

i) Depending on institutional pro-cedures, performer may reviewpatient's radiation exposurehistory, prior record of tech-nique, used, and cumulative ex-posure. Notices whether examina-tion has been done elsewhere in

recent past, whether there is

bistory of extensive radiographyto bring to radiologi_:.'s

notice.ii) Checks whether any special or-

ders on exposure factors arein keeping with the usual radexposure involved for the ex-

amination.iii) Depending on institutional pro-

cedures, performer noteswhether female patient is preg-nant, reviews date of femalepatient's last menstrual period,or notes any other indicatirmthat there is ao danger of ex-posure of a known or possiblefetus.

iv) Notes orders for prior absti-nence from food and drink, useof postural drainage, priormedication and/or sedation.May check whether these havebeen carried out; performermay check timing to be sure aproper elapse of time has oc-curred for medication or seda-tion to take effect.

e. If the performer determines thatthe request is not properly auth-orized, is incomplete, or thatsufficient information is lackingfor performer to select techniqueor to properly position or carefor patient, or if performer con- 14

siders that there may be contra- )

indications to going ahead withthe procedure, performer bringsthis to attention of raiiologistin charge. Explains the problemif appropriate, and proceeds afterobtaining needed information,signature, or orders.

f. If referring physician has requested that films already on file bepresented with current radiographs,

408


Task Code No. 378



and if not already with patient'sjacketed material, performer ar-ranges to have prior films deliv-ered.

Performer goes to appropriate roomfor the type of examination involvedand the equipment required, or notesroom assigned on requisition sheet.Prepares ahead so as not to keep pa-tient in examination room longer thaanecessary:


prepared for the study involved ordecides to do personally. Checksthat emergency cart is present.

c. Checks that proper accessories ir

available for procedure includrurubber shielding, aprons,

and gloves.to be used by performer,radiologist, the patient, and/oranyone who will remain in the roomduring exposure.

d. Performer checks that appropriate-mobilization devices are present,and that there is a mattress, pads,pillows and/or blankets for comfortof patient if patient will lie ontable. Makes sure that right (R)and left (L) markers are availablefor use and identification cards,orleaded numerals or markers.

e. For overhead filming performermakes sure that an adequate supplyof loaded cassettes and appropri-ate film holder are available inthe examination room. Selects ap-propriate speed and type of film,grid and cassette combination de-pending on whether a bucky, tabletop, or automatic chest x-ray tech-nique will be used and standard in-stitutional practices. If not inroom,arranges to obtain or decidesto obtain personally.

f. Performer prepares for identifi-cation of overhead films usingequipment provided:by institu-tion:


ii) Performer may prepare for useof flashcard by checking thatthere is piece of lead on filmholder surface; may write ortype out ID information on.cardif not received with requisi-tion.


g. If examination will include spotfilming using a camera (attachedto image intensifier) and rollfilm, performer checks film sup-ply indicator to make sure thatthere is sufficient film in theroll film cassette.

i) If there is insufficient rollfilm in camera, performer ar-ranges to have roll film cas-sette loaded, or decides todo personally.

ii) When loaded roll film cassetteis obtained, performer checksloading in subdued light.Checks that end of film is cutcorrectly and is properlythreaded and attached to take-up spool so that film unwinds

appropriately. Checks thatfilm is properly engaged onsprockets. Locks into operatingposition. If appropriate, cutsoff excess film at exit port

:


Task Code No. 378



and removes. Attaches film cas-sette to camera and locks intoplace. Replaces camera cover.


iv) Performer advances film to com-pensate for any exposure offilm due to installation or

,check. .


vi) If not already done, performerwrit.:s or types a card withpatient's identffication infor-mation, for use with spotfilmdevice. Inserts in slot in spot-film camera as appropriate.

h% If examination will include spotfilming using a cassette/bucky

. spotfilm device, performer checksthat there is an adequate supplyof appropriate size cassettes inroom.

i) If there is insufficient supplyof cassettes, arranges to ob-tain or decides to obtain per-sonally.

ii) Performer carries out identi-fication of the spetfilm cas-settes as for overhead films.

iii) Performer may use controls Ormanually pull out spotfilmhucky tray and open retainingclamps. Inserts cassette intobucky tray and pushes back.Makes sure clamps are closed.Moves cassette. into appropri-ate "stored" position.

iv) If R-L markers are to be usedwith spot filming, perfcrmertapes into place on image in-tensifier screen or plans totape to patient's body.

i. If a grid will be used with the_.,. image intensifier for fluoroscopy

and/or spot filming, performer po-sitions and denters grid if notalreadY'done. May use control but-ton or slides grid into position.May theck that the grid is orient-ed toward the x-ray tube, withgrid lines parallel to the longaxis of the tube.

3. Performer reviews technical expo-sure factors for overheads, fluoros-copy and spot filming, based onstandards set hy the institution asappropriate for the examination in-volved:

a. Dons protective leaded rubber gar-ments such as apron and gloves.

b. Makes sure that no one is in ex-amination room or control room.

c. Performer reviews the techniquechart(s) for the unit(s) to be )

used:

i) Locates information for thechest views involved. Takesnote of the expoSure factorsto be used for overheads,fluoroscopy, and spot filming.Considers preZerences of theradiologist involved.

ii) Notes any newly posted changesin technical factors (to re-flect accommodation to a change

ein machin output or a policydecision).

iii) Performer checks any new or un-familiar exposure factors .

against the posted limits ofthe x-ray tube on a tube rating:hart to be sure that techniquedoes not exceed the heat capac-ities of the tube for the focalspot size to be used. If appro-priate, performer reconvertsthe technique to an equivalent

4 10


Task Code No. 378


List Elements Full List Elements Full,

output using higher kVp andlower mAs.

d. in the control room, performermakes sure that indicator lightshows that x-ray generator is"warmed up" and ready for use.Makes sure that all circuits havebeen stabilized. If appropriate,checks line voltage meter and,if needed, turns compensator dialuntil needle is aligned properlyon line meter.

e. As appropriate, performer setsx-ray generator mode selector(s)to fluoroscopic mode and for useof spot film camera or cassettedevice, and overhead filming.

f. Performer sets controls on imageintensifier for spot film cameraor cassette device:

i) For spot film camera, per-former selects and sets therate (frames per second) forthe camera according to stan-dards set for examination,

ii) For cassette spot filmingperformer may select and seta standard spot film programproviding for format combi-nations such as single, half,or quarter combinations ona single cassette and re-lated spot film sizes. Se-lects program appropriatefor examination or awaitsorders from radiologist,

g. If not already done, performerconnects TV monitor to poweroutlet. Turns on monitor andchecks that "ready" light ison.

h. If appropriate, performer se-lects the proper field size

selector (if there is dual imageintensifier).

i. Performer selects and sets expo-sure factors for fluoroscopy:

i) Selects aad sets the kVp at

, standard setting for theexamination. May check in-dicator dial. With automaticdensity control, sets densityselector as appropriate forexamination.

ii) If mA is automatically con-trolled according to patientthickness, performer turnsfluoroscope mA selector tomaximum standard position. Ifnot automatically controlled,sets as appropriate for focalspot size and examination in-volved.

iii) Sets fluoroscopic examinationtimer to maximum position.

j. If appropriate, performer selectsand sets exposure factors forspot filming:

i) For conventional manual ex-posure control, performer se-lects and sets the appropri-ate spotfilm time for the ex-amination.

ii) For automatic, phototimed ex-posure control, performerselects a density exposurecontrol appropriate for theexamination.

iii) Pal-former selects the appropri-ate mA for the examination andthe focal spot size to be used.

iv) Performer selects and sets kVpby combining settings on onemajor and one minor kVp se-lector as appropriate for theexamination.

..-,

TASK DESCRIPTION SKEET (continued)

Task Code No. 378



used, or selects and sets fieldsize control to be used forautomatic collimation withprogrammed spot film cassetteexposure sequence.

. Performer returns to examination roomto set up x-ray and fluoroscopetube(s), image intensifier, colli-mator and accessories, as appropriate,for check of equipment prior to ex-amination:

g. If appropriate, performer attachesa. Makes sure that no one is in room. or sets up footboard at end ofb. Places phantom or appropriate test tilt-table; may adjust or attach

object on radiography table where shoulder rest, hand grips, com-patient's area of interest will becentered for examination.

c. Adjusts fluoroscopic tube stand

pression band.

5. If not already done, performer checks(above or below table) so that functioning of fluoroscopy equipmenttube is at zero degrees and cen- by entering remote control room ortered to the area of interest,

d. lf not already done, moves imageoperating controls in examinationroom behind leaded screen:

intensifier and any spot film de-vice into position; centers (over a. To check fluoroscopy mode, per-or under) the area of interest,

e. Performer adjusts the x-ray tubeformer turns on TV power switchcontrols as appropriate. Acti-

to appropriate focal spot object vates fluoroscope exposure bydistance (target to skin distance, pressing footswitch or as appro-TOD). For fluoroscopy adjusts dis- priate. Views test object beingtance between focal spot and imageintensifier (focal spot to filmdistance, FFD). Makes sure that

fluoroscoped on TV monitor.

i) Performer adjusts kVp controlTOD is 15 inches or more. Operates (and mA control if.appropriate)controls or manually moves the and observes effects on TVx-ray tube(s) into place. Checks monitor to be sure that equip-the focal-film distance by read- went is operating properly.ing.indicator scale in the tube ii) Checks mA meter and noteshousing; adjusts up or down until whether appropriate readingthe required Fill is obtaired. is obtained.

f. Performer collimates fluoroscopy iii) Performer checks that TVtube (and x-ray tube used for spot brightness cOntrols are oper-filming if different), depending ating and adjusts for prelimi-on nature of the equipment and nary viewing.controls: iv) Checks examination timer by

noting whether time elapse in-i) Adjusts fluoroscopy beam shut- dicator moves during exposure

ters to the field size antici- showing decreasing time leftpated for fluoroscopic examina- for examination. May checktion or sets shutter mode se- that exposure is tem.! atedlector to automatic collimation,

ii) Manually sets collimator forthe spotfilm field size to be

when maximum examination expo-sure time is reached.

4

4 12



List Elements Full

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6.

b. To check spot filmfunctioning, per-former may move cassette or rollfilm into x-ray exposure fieldusing appropriate controls.

i) Performeractivates controls forspot filmexposure. Notes

whether cassette or roll filmtransport is operating appropri-ately. Notes whether exposure isterminated by phototimer or, ifmanual timer, in time set. Ifappropriate, releases spot filmcontrol after exposure.ii) If equipment is operating appro-priately, performer unloads cas-sette and reloads or advancesroll film as appropriate. Movesbucky out of way until fluoros-copy is completed.

c. Afterequipment has been checked,performer shuts and resets forstandard exposure factors. If per-former decides that any of the

fluoroscopic equipment is not func-tioning properly, performer in-forms appropriate

staff member.Arranges for alternate unit to beused.

When fluoroscopyequipment has beenset up, performer may note whether

preliminary radiographs (scout films)have already been made of the patient(done by another radiologic technolo-gist if work is organized in this wayat institution),

a. If scout films have already beenmade and viewed by radiologist,performer notes the technique usedor ordered and sets up technicalfactors for any overhead radiog-raphy, adjusting for use of con-trast medium.

b. If scout films have been made butnot approved,

performer places

processed scout films and anyprior films with patient's chartor places on view boxes for view-ing by radiologist.c. If scout films have not been madeand are required

before patient isseen by radiologist,performer ar-ranges to take "plain films" ofthe chest in standard positions,depending on orders for unilateralor bilateral studies and erect orrecumbent positions for broncho-grams. Plans to proceed as forplain film

radiography afterreadying patient.

7. Performerreadies patient for exami-nation by radiologist:

a. Performer washes hands as appro-priate. Depending on patienc'scondition, may decide to arrangefor or carry out isolation ordecontamination techniques.b. Performer has the patient calledfrom the holding area and pre-pared for the examination (if notalready done), or decides to dopersonally.

c. Depending on institutional arrangements, performer may decide toescort out-patient to or fromdressing room. May decide toassist in transporting patientfrom holding area or have thisdone.

d. Performer greets patient and anyaccompanying staff person and in-troduces self. Checks patient'sidentity against the requisitionsheet. With

in-patient, checkshospital identification braceletor other

identifier. If patientis accompanied because of ser-iousness of condition, performerchecks with

accompanying staffmember on any special precautionsnecessary during procedure.

4 t.)


Task Code No. 378

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List Elements FullyList Elements Full

e. If patient has just undergone bron- g. If not already done, has patient's

choscopy and bronchoscope or cathe-clothing removed to the waist and

ter is still in place, performerprovides gown or drape. May assist

proceeds directly to preparationspatient or request assistance from

for removal of bronchoscope and/ornurse if there is an injury in-

instillation of contrast medium byvolved. Makes sure that patient

radiologist, and is careful in handl removes any dentures. Permits

ing patient.patient to keep covered with gown

f. Performer haspatient assume a com- until measurements are taken and

fortable recumbent or seated posi- until exposure. Treats young pa-

tion, as appropriate.tient with as much courtesy as

adult.

i) If appropriate, places mattress,

pillow or clean linen on x-ray

h. If patient has adhesive strapping

in place, performer notes whether

table.it is old and wrinkled and re-

ii) If patient is in wheelchair mayquires removal before radiography.

move patient in chair into po-If so, performer indicates this

sition next to table. Makes sure to appropriate staff member and

that wheelchair is in lockedwaits for removal and restrapping

position.by RN or MD.

iii) Performer may decide to assist i. Performer notes the patient's body

patient from wheelchair or

stretcher to table or has this

type, whether the area of interest

is heavily covered by muscle or

done. May obtain help. Makessoft fat, whether the palpation

I

sure that no equipment is in thepoints will be easy to find. Notes

way that may be collided withwhether the extremities are of

by patient.unequal length. For female pa-

iv) If assisting patient to step on tients, performer.judges whether

footstool in order to get on the breasts are large and pendu-

table, helps patient turn intolous. If so, may plan to have pa-

position, step backwards ontient or staff member draw the

stool, and then sit and/or liebreasts to the sides and hold in

on table.place with wide bandage or by

v) If patient is on specialhaving erect patient lean breasts

stretcher, places stretcheragainst erect cassette holder.

into position so that radio- j. If patient is to be radiographed

lucent stretcher can be lifted in erect position, performer ad-

with patient on it from wheeledjusts vertical

film-holder to ap-

base to x-ray table. May ar-

range to move or havez-Patient

propriate height for patient.

moved to table.8. If not already done, performer ex-

vi) Has patient rest in as relaxedplains to patient what will be in-

a position as possible. Mayvolved in the procedure:

place pad, blanket or pillow

under bony prominences to pro- a. Indicates what types of positions

vide comfort for recumbent pa- the patient will be asked to as-

tient.sume and the cooperation that will

be asked of the patient.


Task Code No. 378



b. If not already done, checks thatprior preparation such as absti-nence from food, administrationof medication, and postural drain-age have been carried out.

C. If not already done, may questionpatient or accompanying adult aboutany allergies to shellfish or ad-verse reactions to contrast medium(especially iodine based). Checkswhether an allergy test is required.Plans to notify radiologist if anysensitivity should be brought tohis or her attention. Performer mayexplain to patient what side ef-fects may be felt from contrastmedium such as feeling of nausea,flushing, choking sensation.

d. Unless this will be done by radio-logist, performer explains theeffects of the instillation of thecontrast medium in promoting thecoughing reflex. Explains why andwhen patient needs to exert-a realeffort to control coughing. Helpspatient practice rapid shallowbreathing or panting to suppresscoughing. Reassures patient aboutany fears in having air passagesentered by catheter and contrastmaterial.

e. If sedative has been administered,performer may make sure that anout-patient has made arrangementsto be escorted home and postponenormal activities for the rest ofthe day.

f. If appropriate and not alreadydone, performer questions femalepatient of child bearing age re-garding possible pregnancy. Ifthere is any possibility that Pa-tient is pregnant and this has notalready been recorded, performerplans to inform radiologist a-d toproceed only with approval.

g. Performer answers patient's non-medical questions honestly; attemptE

to reassure patient and developconfidence. Treats patient withdignity and concern regardless ofpatient's behavior. Remains awarethat patient may be frightenedand/or in pain. Performer ex-plains, when asked medical Ties-tions, that it is not appropriatefor technologist to answer these;encourages patient to speak tophysician.

h. Unless measurements have alreadybeen made, performer uses centi-meter calipers to measure thethickness of the chest in thedirection in which the centralray of the x-ray beam will passthrough the centered part fromtube to film. Records for use indetermining exposure factors foroverheads. After measuring, haspatient rest in as relaxed a po-sition as possible.

i. Performer may tape R or L markerto patient if appropriate for usein spot filming.

j. If appropriate before radiologist'examination, performer arrangesto take "plain film" scouts andhave them processed at once.

9. Performer informs attending radiolo-gist when patient is ready to be ex-amined. Brings requisition sheet, pa-tient's medical history, chart, scoutfilms (if already done) and any priorfilms, to radiologist. Displays ra-diographs on view boxes.

a. If not already done,performertells radiologist about any dif-ficulties encountered with re-gard to information, possiblecontraindications, or anythingelse that should be brought toradiologist's attention. Notesany special orders or change inprocedure decided by radiologistProceeds as ordered.

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Task Code No, 378

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List Elements Fully

b. Performer may accompany radiologistto examination room and introducepatient to radiologist.

c. If not already done, performerawaits and carries out radiologist'sorders for scout films and proceedsas appropriate for chest radiog-raphy in positions ordered. Pre-sents for review as describedabove.

10. During radiologist's review of requi-sition, scouts, prior films and exami-nation of patient, performer notesradiologist's orders for any changesin patient positioning and/or techni-cal factors. Notes radiologist'sfinal choice of contrast (dependingon allergies) and any other orders.Discusses sequence and timing for pro-cedure. May arrange signals for expo-sure, changing of spot film cassettes,operation of exposure controls.


b. Performer arranges to provide orchange any equipment or suppliesas ordered by radiologist. Oncecontrast medium has been selected,performer checks and may help pre-pare in syringes. Shakes and placesin appropriate heating device;checks that contrast medium ismaintained at appropriate bodytemperature until ready for use.

c. Performer changes or adjusts tech-nical factors, program,and settingsas appropriate for fluoroscopyand spot filming.

d. For overhead radiographs, perform-er notes needed adjustment oftechnical factors from those usedfor scout film(s) to allow foruse of contrast material and anychanges requested by radiologist

List Eleme1a2u11 y

in technique or positions. Setsor resets technical exposure fac-tors as appropriate for overheadswhile radiologist continues withpatient:

i) Enters control room and setscontrol for appropriate mode.

ii) For conventional exposure con-trol, performer selects milli-amperage and chooses selectorsfor the correct focal spotsize. Selects and sets the ex-posure time that will producethe mAs desired. Sets the kVpselected by choosing the com-bination of major kilovoltageand minor kilovoltage settingsto produce the desired kVp.

iii) For automatic phototimed expo-sure control, performer se-lects and sets the Categorycorresponding to the type ofstudy and use or nonuse ofscreens, bucky, etc., and; ifappropriate, focal spot size.Selects and sets a controlcorresponding to the field size(as listed on technique chartfor phototiming).May select and set a kVp rangebutton (if called for withequipment) corresponding torange for examination.Sets a density selector corres-ponding to the usual (or spec-ial) requirements for the study.Makes sure backup timer is notlikely to terminate exposurebefore phototimed exposure ismade.

iv) Depending on the equipment, mayset controls to provide for useof automatic chest x-ray equip-ment, bucky, manual adjustmentof table and tube height, po-sition, and of collimation,unless these have already beenset. ---

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Task Code No. 378


11. Performer may assist radiologist withpreparation of patient:

a. Washes hands as appropriate.b. May help position patient as appro-

priate on or in front of x-raytable.

c. Performer gives leaded gloves andapron to radiologist. If approprt-ate, places leaded curtain inplace. Provides patient and every-one remaining in room during ex-posure with appropriate protectiveshielding. Explains if necessarythat this is not cause for alarmbut a general precaution to mini-mize unnecessary radiation expo-sure.

d. May open packet of gloves for ra-diologist and assist with mask andgown.

e. Unless a bronchoscope is in place,may assist with anesthetizationof patient's throat by providingpatient with emesis basin and pad(for patient to hold tongue outof mouth). May assist with prepa-ration of catheter. Reassures pa-tient.

If bronchoscope is in place mayassist with preparation of guidewire; may arrange to have broncho-scope sterilized and stored; mayassist with preparation of cathe-ter.

12. Performer assists radiologist duringfluoroscopic viewing of progress ofpositioning of catheter and instilla-tion of contrast:

a. On signal from radiologist, per-former may dim room lights. -Turnson TV power switch. May go to con-trol room and operate fluoroscopecontrols on orders from radiolo-gist. Adjusts kVp and/or mA con-trols according to radiologist'sorders. 4.=1

List Elements Full

b. Performer may operate tilt tableon orders from radiologist, orassist in positioning patient asordered.

13. After radiologist has insiilled con-trast medium in bronchus on firstside, performer assists radiologistwith spot filming:

a. Operates exposure controls as or-dered,or positions table, tube,orpatient as ordered.

b. Comforts patient and encouragesto suppress coughing.

c. If spot film attachment uses cas-settes, performer may unload asused, identify, and insert addi-tional cassettes, as describedabove, throughout procedure.

d. Depending on institutional proce-dures, performer may keep radio-logist informed of cumulative ex-posure as shown on fluoroscopetimer indicator.

14. When the radiologist indicates thatthe given side has been sufficientlyobserved under fluoroscopy and suf-ficient spot films have been taken,performer proceeds with overheadfilming of the bronchi on the sideof interest as ordered:

a. Performer proceeds as rapidly aspossible to avoid having patientsuppress cough reflex needlesslylong.

b. Performer repeats to patient theneed to suppress coughing to avoidspreading the contrast materialto the lung fields.

c. Performer reminds patient of thetype of breathing required forthe exposure(s), such as breath-ing in deeply and holding. May re-hearse patient.

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Task Code No. 378

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List Elements Full%.... List Elements Fully

d. Performer positions patient insame positions ordered for scoutfilms unless otherwise ordered.ImMobilizes as appropriate.

e. Identifies cassette and placesright or left marker on film hold-er or table top as appropriate tothe study and projection. Placescassette in position in holder orbucky as appropriate. For chest x-ray equipment using automatic filmmarking device may place patient'scard into card slot or tray and de-press appropriate R or L button forautomatic marking.

f. Performer sets the focal-film dis-tance, if not already done, asappropriate,

g. Performer checks final positioningby using light in collimator. Acti-vates the collimator light andpoints the light beam towards thepart. Adjusts the collimator open-ing to correspond to the film size.Uses cross-hair shadows as refer-ence for center of field. Checksthat primary beam will enter thecenter of the area of interest atthe selected angle to the film soas to project the view desired.

h. Once the patient has been posi-tioned and immobilized, performeradjusts the collimator. Eithercollimates so that a small unex-posed border will appear aroundthe edge of the film or collimatesfurther so as tl expose only tl ;area of interest (and thus pro-vide maximum protection and de-tail). Adjusts primary beam to mini-mum size needed to cover the

-part(s) of interest.

i. Rechecks that patient has beenproperly shielded.

j. Throughout procedure performerremains alert for any sympton ofadverse reaction, especially re-action to contrast, such as severe

flushing, saliva:Aon, choking,vomiting, pallor, fainting, orhock. As soon as performers

judges that reaction may be se-/vere, ceases exposure and noti-fies radiologist or attending phy-sician at once.

k. When everything is ready for theexposure, performer reminds pa-tient of the breath control to beused for exposure. Observes thepatient's movement until the momrent that the exposure is made.Readjusts position if warranted.

1. Performer returns to control room.Makes sure controls are properly 4

set, that equipment is set forradiography mode, and that pa-tient is still in position. Tellspatient wh-, to breathe and holdas reheat,;ed,by calling or usingintercom. Initiates exposure bypressing hand trigger or expo-sure control button.

i) While exposure is underway,performer checks that mA meterrecords appropriate current aset, that kVp meter dips slights

ly.

ii) May watch for evidence of mal-function such as line surge orexcessive drop; may listen forsound of normal functioning ofequipment. If there is malfunc-tion may decide to report;anticipates need to repeat ex-posure.

iii) With phototimer notes whetherbackup timer has been involvedin terminating exposure beforephototimed exposure was com-pleted. If so, anticipates pos-sible need to repeat exposure.

iv) After exposure is completedtells patient that h s

can relax.e or he

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Task Code No. 378

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.

15.

,

v) If the exposure is terminatedby a circuit breaker, recheckstechnical factors for possibleoverlrd or checks for overloadelsewheYe on circuit. Antici-pates need to repeat exposure.

vi) After exposure removes cassetteand removes ma-kers for furtheruse.

vii) Repeats radiography for all theexposures ordered by radiolo-gist for first side, adjusting

technical factors, tube, and.. position of patient or film

holder as appropriate to eachview ordered. Repeats identi-fication, collimation, shield-ing and exposure as above.Keeps encouraging patient tosuppress cough reflex and re-assures.

After spot filming and overhead film-ing is completed for first side, oras ordered by radiologist, performerarranges to have spot films and over-head bronchograms processed:



c. With cassette spot films or over-head exposures,removes any markersfor further use. Attacho.s ID cardfor use with flasher if appropri-ate.

d. With spot film camera, performeradvances the film so that allexposures made will be wound onthe take-up spool in the rollfilm cassette. Replaces darkslide on camera lens. Uses de-vice to cut film and create alight shield. Resets counter andremoves film cassette.

e. Removes any markers from patient'sbody.

16.

f. Performer arranges to have spotfiLis and overheads processed atonce if appropriate or decides toprocess personally.

g. While films are being processed,makes sure that patient is com-fortable and, if necessary, st-tended by radiologist, staff mem-ber, or self.

Performer brings the processed spotfilms and radiographs of first sidedirectly to the radiologist incharge or places on view boxes andinforms radiologist that they areready. May hang prior films andscouts.

a. Performer makes note of radiolo-gist's decisions regarding ade-quacy of the bronchograms:

i) If radiologist decides to in-ject more contrast medium,per-former assists as above withfilling, fluoroscopy and spotfilming. Repeats additionaloverhead bronchography as or-dered.

ii) If the radiologist indicatesthat there is any problem withthe technical factors or thepatient Positioning for over-ht=tads, performer records ornotes for use in "retakes."Notes whether need to repeatis.due to performer's ownnegligence or lack of atten-tion so that performer canavoid future "retakes." Ifrequest for retakes reflectsmalfunctioning equipment, per-former reports malfunction toappropriate staff member. Ifrequest for retakes reflectsthe preference for density orcontrast of the radiologist,performer notes for future useto avoid future "retakes."

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Task Code No. 378


List Elements Full

iii) If radiologist requires addi-tional views and/or positions,performer repeats overhead film-ing as appropriate to new projec-tions, as described above.

iv) For further overhead exposuresperformer repeats appropriatesteps including identificationof cassette, use of R-L marker,selection and setting of tech-nique, positioning patient andequipment for focus-object-filmalignment, collimation, shield-ing, b,eathing instructions,making exposure, and processing,as described above.

v) Performer refrairs from comment-ing on the films or providingany interpretation to patient.

vi) Performer shows subsequent setsof spot films and bronchogramsof first side to radiologist asprocessed, and proceeds as de-scribed above until radiologistindicates that examination offirst side is completed.

b. Performer makes note of radiolo-gist's decision regarding study ofthe other side:

i) If radiologist decides to ex-amine the other bronchus atonce, performer assists withfluoroscopy while radiologistpulls back catheter and entersother bronchus. Assists as de-scribed above with instillation,fluoroscopy and spot filming ofsecond side. Repeats overheadfilming for second side as or-dered; has bronchograms pro-cessed and continues until ra-diologist indicates that ex-amination of second side iscompleted.

ii) If radiologist decides to ex-amine the other bronchus at a

List Elements Fullx____

later time, performer may haveradiologist fill out requi:sition sheet. May arrange forscheduling.

17. After bronchography is completed,performer makes note of radiologist'orders for delayed films (post-tussive) after an appropriate elapseof hours and/or orders for posturaldrainage and post-drainage radiography or tomography after a day ortwo. May have radiologist fill outand sign approviate order forms.

18. Performer may assist radiologist inremoval of catheter from patient.Provides emesis basin and helps orencourages patient to cough gentlyand/or spit up contrast medium. Pro-vides patient with towels or tis-sues.

19. Performer carries out follow-up pro-cedures as appropriate:

a. Performer may have patient cleans-

ed; may have room and equipmentcleaned; has any other appropri-ate clean up procedures followedto avoid infection or contamina-tion, c-r decides to do personally,depending on institutional ar-rangements.

b. If appropriate performer rein-forces instructions to patientnot to eat or drink for an ap-propriate number of hours becausethe anesthetized pharynx aadlarynx could allow material to beaspirated into the tracheJbron-chial tree. With out-patient,maywrite out instructions or present printed sheet of instruc-tions to patient. Performer mayreinforce explanation of whatresidual effects may be exper-ienced. Reassures patient.



List Elements Full

List Elements Fullc. Performerexplains to patient ifpostural drainage, delayed films,or a laterexamination has beenordered.

d. If postural drainage and/or de-layed films are ordered.requiringa specific period of .time toelapse, performer arranges to havepatient taken to appropriate hold-ing area. Keeps track of the timeelapsed.

e. May decideto assist

patient fromtable or to chair. Makes sure pa-tient is reminded of any footrestiu stepping off table. Makes surethat none of the equipment is pro-jecting over the patient beforealloWing patient to rise from stoolor table, and assists patient.f. For delayed filming performer takesappropriate delayed bronchogramsin projectionsordered as for plainfilms and earlier

bronchograms.Has delayed films processed andreviewed by radiologist at onceas descrihed above.

20. When the radiologistindicates that allthe radiography

is completed, per-former carries outtermination steps:

a. Performer may have patient trans-ported to recovery area, forpostural drainage,or next assignedlocation, or decides to do per-sonally, as appropriate. If appro-priate, makes sure that patient isin the care of a staffperson whowill transport to appropriate nextlocation or, if

out-patient, willarrange to discharge or send pa-tient home with escort as appropri-at,.b. Performer

records the examinationaccording to institutionalproce-dures. May include date, room, ex-amination type, the overhead viewstaken, the technical factors used,

and film sizes. May record thenumber ofexposures made of eachspot film and

overhead view in-)cluding retakes; may enter theestimated radiation dose to whichpatient was exposed

(using postedinformation on dosage); may re-cord any problem withequipment,any special care provided

patient.Signs requisition sheet.c. Performermay record the fluoros-.copy examination

including expo-sure time and rad dosage.d. May present requisition form toradiologist for comments and, sig-nature. May present forms for req-uisitions for later delayed filmsand/or additional examination.e. Performer may decide to jacketradiographs, requisition sheets,and related

materials, and/or haveinformation recorded in log bookpersonally, or have this done,depending on institutionalproce-dures.

f. May indicate toappropriate staffperson when the performer is readyto proceed with next

examination.

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1. What is tne output of this task? (Be surethis is broad enough to be repeatable.)Requisition reviewed;pt. reassured;chest measured;filmsidentified;technical factors selected and setfor fluoroscopy,spot

filming,overheads;scouts taken;radiologist assisted withpositioning,fluoroscopyspot filming;overhead

exposures made;radiographssent for processing,taken to radiologist;pt. return-ed;examinationrecorded:radiographs placed for use.2. What is used in performing this task? (Noteif only certain

items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)Tt.'s x-ray requisitionsheet,ID card,ID bracelet,medical-technical history,prior radiographs,scouts;view boxes;pen;x-ray

generator,control panels,tube,.ucky,table,collimator;fluoroscopy

unit,image inten-sifier,spot film device,TVmonitor;cassettes;rollfilm;R-L,ID

markers;bronchoscopepower-pack,camera;labels,test tubes,slides,lab jars with media,preser-vative;procedure tray;emergency cart;emesis basin;

towels;shielding;immobilizationdevices;techniqu ,standard view,tube rating,rad exposure charts;cali-pers;phantom or test

object;stretcher;wheelchair;intercom;order formsOnstruction sheets3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...(x) No...( )rn. If Yes to q. 3: Name the kind of recipient,respondent or co-worker involved, with de-scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions.

Non-pediatric pt. to have needle lung biopsy or bronchoscopy;raCologist;co-worker;nurse


Carrying out radiologic technology for bronchoscopyor needle lung biopsy of a non-pediatric patient, byreviewing request;preparingequipment;preparing andreassuring

pt.;measuring.chest;setting up for flu-oroscopy and spot

filming;arranging for scout filmsas ordered;setting technical factors;identifyingfilms;providing shielding;assisting with positioningof pt.,fluoroscopy,spot filming,removal of broncho-scope;taking overhead chest films as ordered;arrang-ing for processing;taking

to radiologist;continuing,repeating as ordered;having pt. returned;placing ra-diographs for use;recording examination.

List Elements Fully".Performer receives or obtainsthe x-ray requisition form, pa-tient identification card, andany appropriate medical-techni-cal history for a non-pediatricpatient scheduled for bronchos-copy or needle lung biopsy as aresult of:


ule sheet.. Having arranged

requisitionsin order of priority.

. From co-worker.

4 2

Depending on institutionalarrangements, performer mayalso receive prior films orscout film(s) already takenby co-worker with record oftechnical factors used and/or any changes necessary.

Performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, specialconsiderations, and to checkthe completeness of the in-formation provided:

a. Performer checks the ex-amination called for in-cluding the areas involNed,the affected side(s), thepurpose of the study, andany special requests.Notes the name of the ra-diologist in charge; maynote the name of the re-ferring clinician. Noteswhether erect or recumbentpositioning is called for,views ordered, breathing

OK -RP;RR;RR

6. Check here if thisis a master sheetQC)


Task Code No. 379


List Elements Fully..., List Elements Full

instructions, whether bilateral orunilateral overheads are requested.

b. Performer reads patient's name,identification number, sex, age,weight, and height. Notes whetherpatient is in-patient, out-patient,or emergency patient. Notes any

special information such as note onknown pathology that could affectpatient positioning, technique, -,handling of the patient, such E.sacute injury, presence of taping.

Notes whether patient will be on astretcher or in a wheelchair. Noteswhether the use of a grid or buckywill be involved, shielding needed.

Notes any special requests.c. Performer checks whether patient is

suffering from a collateral condi-tion requiring special handlingsuch as heart disease, communicableor infectious condition, infirmity,

incohelence; whether patient has

IV drip, oxygen supply, urinarycatheter or similar device inplace; notes whether patient willbe accompanied by nurse or other

staff persond. Performer makes sure that the re-

quest is properly authorized, that

information on requisition sheet

is complete.

i) Depending on institutional pro-cedures, performer may reviewpatient's radiation exposurehistory, prior record of tech-niques used, and cumulative ex-posure. Notices whether examina-

tion has been done elsewhere in

recent past, whether there is

history of extensive radiographyto bring to radiologist's notice.

ii) Checks whether any special or-ders on exposure factors are inkeeping with the usual rad ex-posure involved for the examina-

tion.

iii) Depending on institutional pro-cedures, performer noteswhether female patient is preg-nant, reviews date of femalepatient's last menstrual peri-od, or notes any other indica-tion that there is no dangerof exposure of a known or pos-

sible fetus.iv) Notes any orders for prior

abstinence from food anddrink, use of postural drain-age, prior medication and/orsedation. May check whetherthese have been carried out;performer may check timing tobe sure a proper elapse oftime has occurred for medica-tion or sedation to take ef-fect.

e. If the performer determines thatthe request is not properly auth-orized, is incomplete, or thatsufficient information is lackingfor performer to select techniqueor to properly position or carefor patient, or if performer con-siders that there may be contra-indications to going ahead withthe procedure, performer bringsthis to attention of radiologistin charge. Explains the problemif appropriate, and proceeds after

obtaining needed information,signature, or orders.

f. If prior chest radiographs and/ortomograms already on file are tobe presented with scou- films,and if not already with patient'sjacketed material, performer ar-ranges to have prior films deliv- I

ered.

2. Performer goes to appropriate roomfor the type of examination involved

and the equipment required, or notesroom assigned on requisition sheet.

423


List Elements Full

Task Code No. 379

Th.is is page 3 of 14 for this task.

Prepares ahead so as not to keep pa-tient in examination room longer thannecessary:


prepared for the Study involved ordecides to do personally. Checksthat emergency cart is present.

C. Checks that proper accessories areavailable for procedure includingleaded rubber shielding, aprons,'and gloves to be used by performer,radiologist, the patient, and/oranyone who will remain in the roomduring exposure.

d. For bronchoscopy, may obtain bron-choscope power-pack and camera.

e. Performer checks that appropriateslides, labels and containers forspecimens ordered are prepared ordecides to do personally.

f. Performer checks that appropriateimmobilization devices are present,and that there is a mattress, pads,pillows and/or tlankets for com-fort of patient if patient willlie on table. Makes sure that right(R) and left (L) markers are avail-able for use and identificationcards or leaded numerals or mark-ers.

g. For overhead filming performermakes sure that an adequate supplyof loaded cassettes and appropriatefilm holder are available in theexamination room. Selects appropri-ate speed and type of film, grid,and cassette combination dependingon whether a bucky, tab ?,.. top, crautomatic chest x-ray techniquewill be used and standard institu-tional practices. If not in room,arranges to obtain or decides toobtain personally.

h. Performer prepares for identifica-tion of overhead films using equip-ment provided by institutior:

List Elements Full

i) May obtain lead numerals andtape and prepare identificationstrip for placement on filmholder(s) giving appropriatepatient identification informa-tion.

ii) Performer may prepare for useof flashcard by checking thatthere is piece of lead on filmholder surface; may write ortype out ID information on cardif not received with requisi-tion.


i. If examination will include spotfilming using a camera (attachedto image intensifier) and rollfilm, performer checks film sup-ply indicator to make sure thatthere Is sufficient film in theroll film cassette.

'1) If there s insufficient rollfilm in cara, performer ar-ranges to have roll film cas-sette lo.ided, or decides todc personally.

ii) When loaded roll film cassette .

is'obtained, performer checksloading in subdued light.Checks that end of film is cutcorrectly and is properlythreaded and attached to take-up spool so that film unwindsappropriately. .Checks that filmis properly engaged on sprock-ets. Locks into operating posi-tion. If appropriate, cuts offexcess film at exit port andremoves. Attaches film cassetteto camera and locks into place.Replaces camera cover.



Task Code No. 379


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vi) If not already done, performerwrites or types a card withpatient's identification infor-mation for use with spotfilmdevice. Inserts in slot in spot-film camera as appropriate.

j. If examination will include spotfilming using a cassette/buckyspotfilm device, performer checksthat there is an adequate supplyof appropriate size cassettes inroom.

i) If there is insufficient sup-ply of cassettes, arranges toobtain or decides to obtainpersonally.

ii) Performer carries out identi-fication of the spotfilm cas-settes as for overhead films.

iii) Performer may use controls ormanually pull out spotfilmbucky tray and open retainingclamps. Inserts cassette into'bucky tray and pushes back.Makes sure clamps are closed.Moves cassette into appropri-ate "stored" position,

iv) If R-L markers are to be usedwith spot filming, performertapes into place on image in-tensifier screen or plans totape to patient's body.

k. If a grid will be used with theimage intensifier for fluoroscopyand/or spot filming, performerpositions and centers grid if not

List Elements Full

already done. May use control but-ton or slides grid into position.May check that the grid is orient-ed toward the x-ray tube, withgrid lines parallel to the lo-Igaxis of the tube.

3. Performer reviews technical expo-sure factors for overheads, fluoros-copy and spot filming, based onstandards set by the institution asappropriate for the examination in-volved:

a. Dons protective leaded rubbergarments such as apron and gloves.



i) Locates information for thechest views involved. Takesnote of the exposure factorsto be used for overheads, flu-oroscopy, and spot filming.Considers preferences of theradiologist involved.

ii) Notes any newly posted chAnge,;in technical factors (to re-flect accommodation to a changein machine output or a policydecision).

iii) Performer checks any new or un-familiar exposure factorsagainst the posted limits ofthe x-ray tube on a tube ratingchart to be sure that techni-que does not exceed the heatcapacities of the tube for thefocal spot size to be used. Ifappropriate, performer recon-verts the technique to an equivalent output using higher kVpand lower mAs.

445

INlk

TASK DESCRIPTIONSHEET (continued)

List ETements Full

Task Code No. 379


d. In the control room Performermakes sure that indicator lightshows that x-ray generator is"warmed up" and ready for use.Makes sure that all circuits havebeen stabilized. If appropriate,checks line voltage meter and, ifneeded, turns compensator dial un-til needle is aligned properly online meter.

e. As appropriate,performer sets

x-ray generator mode selector(s)to fluoroscopic mode and for useof spot film camera or cassettedevice, and overhead filming.

f. Performer sets controls on imageintensifier fur spot film camera orcassette device:

i) For spot film camera, performerselects and sets the rate(frames per second) for the'camera according to standardsset for examination.

ii) For cassette spot filming per-former may select and set astandard spot film program pro-viding for format combinationssuch as single, half, or quart-er comIdnations on a single cas-sette and related spot filmsizes. Selects program appropri-ate for examination or awaitsorders from radiologist.

g. If not alreadydone, performer con-nects TV monitor to power outlet.

Turns on monitor and checks that"ready" light is on.

h. If appropriate, performer selectsthe proper field size selector (ifthere is dual image intensifier).


i) Selects and sets the kVp atstandard setting for the exami-

Ilmos

List Elements Fully

nation. May check indicatordial. With automatic den-sity control, sets densityselector as appropriate forexamination.

ii) If mA is automatically con-trolled according to patientthickness, performer turns;fluoroscope mA selector to'maximum standard position.If not automatically con-trolled, sets as appropriatefor focal spot size and ex-amination involved.

iii) Sets fluoroscopic exami-nation timer to maximum po-sition.

j. If appropriate,performer se-

lects and sets exposure factorSfor spot filming:

i) For conventional manual ex-posure control, performerselects and sets the appro-priate spot film time forthe examination.

ii) For automatic,phototimed

exposure control, performerselects a density exposurecontrol appropriate for theexamination.

iii) Performer selects the appro-priate mA for the examina-tion and the focal spot sizeto be used.

iv) Perforther selects and setskVp by combining settingson one major and one minorkVp selector as appropriatefor the examination.

4. Performer returns to examinationroom to set up x-ray and fluoro-scope tube(s), image intensifier,

446


List Elements Fully

Task Code No. 379


collimator and accessories, as appro-priate, for check of equipment prior

to examination:

a. Makes sure that no one is in room.

b. Places phantom or appropriate test

object on radiography table where

patient's area of interest will be

centered for examination.

c. Adjusts fluoroscopic tube stand(above or below table) so thattube is at zero.degrees and cen-tered to the area of interest.

d. If not already done, moves image

intensifier and any spotfilm de-vice into position; centers (over

or under) the area of interest.

e. Performer adjusts the x-ray tube

to appropriate focal spot/objectdistance (target to skin distance,

TOD). For fluoroscopy adjusts dis-

tance between focal spot and image

intensifier (focal spot to filmdistance, FFD). Makes sure that

TOD is 15 inches or more. Operates

controls or manually moves the

x-ray tube(s) into place. Checks

the focal-film distance by reading

indicator scale in the tube hous-

ing; adjusts up or down until the

required FFD is obtained.

f. Performer collimates fluoroscopy

tube (and x-ray tube used for spot-

filming if different), depending

on nature of the equipment and

controls:

i) Adjusts fluoroscopy beam shut-

ters to the field size antic-

ipated for fluoroscopic exami-

nation or sets shutter mode se-lector to automatic collimation.

ii) Manually sets collimator for

the spotfilm field size to be

used, or selects and sets field

size control to be used for

automatic collimation with

programmed spot film, cassette

exposure sequence.

g. If appropriate, performer attaches

or sets up footboard at end of

tilt-table; may adjust or attach

shoulder rest, hand grips.

. If not already done, performer checks

functioning of fluoroscopy equipment

by entering remote control room or

operating controls in examination

room behind leaded screen:

a. To check fluoroscopy mode, per-former turns on TV power switch

controls as appropriate. Acti-

vates fluoroscope exposure bypressing footswitch or as appro-priate. Views test object being

fluoroscoped on TV monitor.

i) Performer adjusts kVp control

(and mA control if appropriate)

and observes effects on TV

monitor to be sure tliat equip-

ment is operating properly.


iii) Performer checks.that TV

brightness controls are oper-ating and adjusts for prelimi-nary viewing.

iv) Checks examination timer by

noting whether time elapseindicator moves during expo-

sure showing decreasing time

left for examination. May

check that exposure is termi-

nated when maximum examination

exposure time is reached.

b. To check spot film functioning,performer may move cassette orroll film into x-ray exposurefield using appropriate controls:

1

427


Task Code No. 379



i) Performer activates controlsfor spot film exposure. Noteswhether cassette or roll filmtransport is operating appro-priately. Notes whether expo-sure is terminated by photo-timer or, if manual timer, intime set. If appropriate, re-leases spot film control afterexposure.

If equipment is operating appro-priately, performer unloads cas-sette and reloads or advancesroll film as appropriate. Movesbucky out of way until fluoros-copy is completed.

c. After equipment has been checkedperformer shuts and resets forstandard exposure factors. If per-former decides that any of theflloroscopic equipment is not func-tioning properly, performer in-forms appropriate staff member.

6. When fluoroscopic equipment has beenset up, performer may note whetherpreliminary radiogxaphs (scout films)have already been made of the patient(done by another radiologic technolo-gist if work is organized in this wayat institution).

a. If scout films have already beenmade and viewed by radiologist,performer notes the technique usedor ordered and sets up technicalfactors for any later overheadradiography such as for lung bi-opsy.

b. If scout films have been made butnot approved, performer placesprocessed scout films and anyprior films with patient's chartor places on view boxes for view-ing by radiologist.

4 Z8

c. If scout films have not been madeand are required before patient isseen by radiologist, performer ar-ranges to take "plain films" ofthe chest in standard positions,depending on orders,for unilateralor bilateral studies in erect orrecumbent positions,after readyingpatient.

. Performer readies patient for exami-nation by radiologist:

a. Performer washes hands as appro-.priate. Depending on patient'scondition, may decide to arrangefor or carry out isolation ordecontamination techniques.

b. Performer has the patient calledfrom the holding area and pre-pared for the examination (if notalready done), or decides to dopersonally.

c. Depending on institutional arrange-ments, performer may decide toescort out-patient to or fromdressing room. May decide toassist in transporting patientfrom holding area or have thisdone.

d. Performer greets patient and anyaccompanying staff person and in-troduces self. Checks patient'sidentity against the requisitionsheet. With in-patient, checkshospital identification braceletor other identifier. If patientis accompanied because of ser-iousness of condition, performerchecks with accompanying staffmember on any special precautionsnecessary during procedure.


armaamelmonworwacamturalmoraoss.r.ccon


Task Code No. 379




ii) If patient is in wheelchair, maymove patient in chair into po-sition next to table. Makes surethat wheelchair is in lockedposition.

iii) Performer may decide to assistpatient from wheelchair orstretcher to table or has thisdone. May obtain help. Makessure that no equipment is in theway that may be collided withby patient.

iv) If assisting patient to step onfootstool in order to get ontable, helps patient turn intoposition, step backwards onstool, and then sit and/or lieon table,

v) If patient is on specialstretcher, places stretcherinto position so that radio-lucent stretcher can be liftedwith patient on it from wheeledbase to x-ray table. May ar-range to move or have patientmoved to table.

vi) Has patient rest in as relaxeda position as possible. Mayplace pad, blanket or pillowunder bony prominences to pro-vide comfort for recumbent pa-tient.

f. If not already done, has patient'sclothing removed to the waist andprovides gown or drape. May assistpatient or request assistance fromnurse if there is an injury in-volved. For bronchoscopy makes surethat patient removes any dentures.Permits patient to keep coveredwith gown until measurements aretaken and until examination. Treatsyoung patient with as much courtesyas adult.

................................megmaannsawhass..

g. If patient has adhesive strapping

in place, performer notes whetherit is old and wrinkled and re-quires removal before fluoroscopy.I f so, performer indicates thisto appropriate staff member andwaits for removal and restrappingby RN or MD.

h . If patient is to be radiographedin erect position, performer ad-justs vertical film holder to ap-propriate height for patient.

. If not already done, performer ex-plains to patient what will be in-volved in the procedure:

a. Indicates what types of positiow:the patient will be asked to as-sume and the cooperation thatwill be asked for.

b. If not already done, checks thatprior preparation such as ab-stinence from food, administra-tion of medication, and/or pos-tural drainage have been carried

out.c. Performer may make sure that an

out-patient has made arrange-ments to be escorted home andto postpone normal activitiesfor the rest of the day.

d. If appropriate and not alreadydone, performer questions fe-male patient of child bearingage regarding possible preg-nancy. If there is any possi-bility that patient is preg-nant and this has not alreadybeen recorded, performer plansto inform radiologist and toproceed only with approval.

e. Performer answers patient's

non-medical questions honestly;attempts to reassure patientand develop confidence. Treatspatient with dignity and con-cern regardless of patient's

429


Task Code No. 379


List Elements Full

behavior. Remains aware that pa-tient may be frightened and/or inpain. Performer explains, whenasked medical questions, that itis not appropriate for technologistto answer these; encourages patientto speak to physician.

f. Unless measurements have alreadybeen made, performer uses centi-meter calipers to measure thethickness of the chest in the di-rection in which the central rayof the x-ray beam will pass throughthe centered part from tube tofilm. Records for use in determin-ing exposure factors for overheads.After measuring, has patient restin as relaxed a position as pos-sible.

g. Performer may tape R or L markerto patient if appropriate for use-in spot filming.

h. If appropriate before radiologist'sexamination, performer arranges totake "plain film" scouts and havethem processed at once.

Performer informs attending radiolo-gist when patient is ready to be ex-amined. Brings requisition sheet, pa-tient's medical history, chart, scoutfilms (if already done) and any priorfilms to radiologist. Displays ra-diographs.on view boxes.

a. If not already done, performertells radiologist about any diffi-culties encountered with regardto information, possible contra-indications, or anything elsethat should be brought to radio-logist's attention. Notes anyspecial orders or change in pro-cedure decided by radiologist.Proceeds as ordered.


VIRIMMatList Elements Flay

10. During and/or after rad.telogist'sreview of scout films and examina-tion of patientlpeilormer makes noteof radiologist's decisions and or-ders and proceeds as appropriate.

a. If radiologist decides to cancel

procedure, performer arranges toterminate and reschedule as ap-propriate.

b. For lung biopsy notes orders forchange in technical factors and/or patient positioning. Notes de-cisions on aspiration or tissuebiopsy, on sizes of instruments,types of laboratory tests, andtype of anesthetic to be used.

c. For bronchoscopy notes orders on

use of nasopharyngeal airway,anesthetic, types of laboratorytests and samples to be taken.

d. Performer arranges to provide anyequipment or materials not alreadypresent or decides to do personal-ly. Adjusts technical factors andprogram for fluoroscopy and spotfilming as ordered.

e. For overheads with lung biopsy

performer notes needed adjustmentof technical factors from thoseueed for scout film(s) to allowfor any changes requested by ra-diologist in technique or posi-tions.

f. Sets or resets technical exposurefactors as appropriate for over-heads while radiologist continueswith patient:

4J0

i) Enters control room and setscontrols for appropriate mode.

ii) For conventional exposure con-trol, performer selects milli-amperage and chooses selectorsfor the correct focal spot sizeSelects and sets the exposuretime that will produce the mAsdesired. Sets the kVp selectedby choosing the combination of


Task Code No. 379

This is page in of 14 for this task.


major kilovoltage and minorplace. Provides patient and every-kilovoltage settings to pro-one remaining in room with appro-duce the desired kVp.priate protective shielding. Ex-iii) For automatic phototimed expo- plains if necessary that this issure control, performer se-not cause for alarm but a generallects and sets the categoryprecaution to minimize unnecessarycorresponding to the type ofradiation exposure.study and use or nonuse of

c. Washes hands as appropriate, ob-screens, bucky, etc., and, ifserving sterile technique.appropriate, focal spot size. d. If appropriate, performer opensSelects and sets a controlpacket of sterile gloves for ra-corresponding to the field sizediologist, observing sterile tech-(as listed on technique chart

for phototiming). nique so that wrapper, own hands,or other objects will not con-May select and set a kVp rangetaminate gloves.bntton (if called for with e. With bronchoscopy, performer mayequipment) corresponding to assist with anesthetizing of pa-range for examination.tient's throat by providing pa-Sets a density selector corres- tient with emesis basin and padponding to the usual (or spec- (for patient to hold tongue outial) requirements of the study. of mouth).

Makes sure backup timer is notlikely to terminate exposure 12. Performer assists radiologist duringbefore phototimed exposure is fluoroscopic viewing to determinemade.

site of lesion or to check positioniv) Depending on the equipment, may of bronchoscope as ordered:set controls to provide for useof automatic chest x-ray equip- a. On signal from radiologist, per-ment, bucky, manual adjustment former may dim room lights. Turnsof table and tube height, posi- on TV power switch. May go to con-tion, and of collimation, unless trol room and operate fluoroscopethese have already been set. controls on orders from radiolo-

gist. Adjusts kVp and/or mA con-g. Performer discusses sequence andtiming for procedure with radiulo-

trols according to radiologist'sorders.gist. May arrange signals for ex- b. Performer may operate tilt tableposure, changing of spot film cas- on orders from radiologist, orsettes, operation of exposure con- assist in positioning patient astrols.ordered.

11. Performer may assist with further 13. Performer ur.y assist in sterilepreparation for procedure:surgical techniques for lung biopsyas appropriate by handing materialsa. May help position patient as appro-

priate.b. Performer gives leaded gloves and

asked for.

Assists with fluoroscopy to checkapron to radiologist. If appropri- placement of needle or bronchoscopeate, places leaded curtain in as described in step 12, above.

431

TASK DESCRIPTION SHEET(continued)

Task Code No. 379This is page 11 of _14 for.this task.

List Elements Fullx

14. Duringlung biopsy and throughoutbronchoscopic

examination, performerassists withspot filming:

a. Operatesexposure controls as or-dered or positions

table, tube,or patientas ordered.b. If spot filmattachment uses cas-settes, performer may unload asused, identify, and insert addi-tional casscAtes, as describedabove,

throughout procedure.c. Dependingon institutional

proce-dures, performer may keep ladiolo-gist informed ofcumulative expo-sure as shown onfluoroscope timerindicator.

d. Performer may recordlocation oflesion, assist with

labeling ofsamples and/orrecord and iden-tify

photographs taken (with bron-choscope camera) as ordered.e. Performerarranges to have spotfilms processed as they are takenor ac ordered.

i) With cassette spot films re-moves any markers for furtheruse. Attaches ID card for usewith flasher ifappropriate.ii) With spot film

camera, perform-er advances the film so thatallexposures made will be woundon the take-up

spool in theroll filmcassette. Uses de-vice to cut film and create alight shield. Resets counterand removes film

cassette.iii) Performer brings theprocessedspot films

directly to the ra-diologist or places on viewboxes and informs radiologistthat they are ready. May hangprior films and scouts.iv) Changes technical factors as or-dered andassists with any con-tinued

fluoroscopy and spot filing as described until radiolo-

List Elements Full411311.

gist indicatesfluoroscopic ex-amination is completed.

15. With lung biopsyperfoimer carriesout overhead

radiography as and whenordered byradiologist:

a. Performermay position

patient asapprolriate for cheSt films tochecl anypneumothorax or as or-dered. Performer may assist ra-diologist in

positic:Ang.b. Performerproceeds with overheadfilming using

technical factorsdecided as for scout("plain")films of chest.

c. Performerrehearses patient inthe type of breathing

requiredfor theexposure(s), such al&

breathing in deeply and holding.d. Placesidentification marker oncassette, and right or left markeron cassette or table top as appro-priate to the study and projec-tion. Places

cassette in positionon table or in buckyas appropri-ate.

e. Performer sets thefocal-film dis-tance, if not already done, as

appropriate. Checks final posi-tioning by using light in colli-mator. Activatesthe collimatorlight and points the light beamtowards the part. Adjusts thecollimator opening to correspondto the film

size. Usescross-hairshadows as reference for centerof field. Checks that primarybeam will enter the center of thearea of interest at the selectedangle to the film so as to pro-ject the view desired.

f. Once the patient has been posi-tioned andimmobilized, performeradjusts thecollimator. Eithercollimates so that a small unex-posed border will appear aroundthe edge of the film or collimatesfurther 30 as to

expose only the

4 3 2


Task Code No. 379


List Elements Fully

area of interest (and thus pro-vide maximum protection and de-co:a). Adjusts primary beam tominimum size needed to cover thepart(s) of interest.

.g. Rechecks that patient has beeproperly shielded.

h. Throughout procedure performer re-mains alert for any emergencysymptom. If performer judges thatpatient's reaction may be severe,ceases exposure and notifies ra-diologist or attending physicianat once.

i. When everything is ready for theexposure, performer reminds pa-tient of the breath control to beused for exposure. Observes thepatient's movement until the momentthat the exposure is made. Read-justs position if warranted.

j. Performer returns to control room.Makes sure controls are properlyset, that equipment is set for ra-diography mo-1?., and that patientis still in position. Tells patientwhen to breathe and hold as re-hearsed by calling or using inter-com. Initiates exposure by pressinghand trigger or exposure controlbutton.

i) While exposure is underway, per-former checks that mA meter re-cords appropriate current asset, that kVp meter eips slight-ly.

ii) May watch for evidence of mal-function such as line surge orexcessive drop; may listen forsound of normal functioning ofequipment. If there is malfunc-tion may decide to report; anti-cipates need to repeat exposure.

iii) With phototime- notes whetherbackup timer has been involvedin terminating exposure beforephototimed exposure was com-

List Elements Full

pleted. If so, anticipates pos--sible need to repeat exposure.



vi) After exposure removes cassetteand removes markers for furtheruse.

vii) Repeats radiography for allthe exposures ordered by ra-diologist, adjusting techni-cal factors, tube, and posi-tion of patient or film hold-er as appropriate to eachview ordered. Repeats identi-fication, collimation, shield-ing and exposure as above.

k. After overhead filming is com-pleted, perf:.,rmer arranges tohave overhead chest radiographsprocessed:

i) May sign or have radiologistsign requisition sheet.

ii) Removes any markers for furth-er use. Attaches ID card foruse with flasher if appropri-ate.

iii) While films are being processedmakes sure that patient is com-fortable and, if necessary,attended by radiologist, staffmember, or self.

1. Performer brings the processedradiograph(s) directly to theradiologist in charge or placeson \clew box(es) and informs ra-diolobist that they are ready.May hang prior films, spots andscouts.

433


Task Code No, 379


i) Performer notes any order forrepeat of any part of radio-grr.phic examination.

ii) Repeats appropriate steps asdescribed above until radiolo-gist indicates that examinationcan be terminated.

iii) Notes any orders for delayedfilms.

_ . With bronchoscopy performer notes ra-diologist's decision on whether toproceed at once to bronchography, orto order delayed bronchography.

a. If bronchography is not to followat once, performer may assist inremoval of bronchoscope. Performerprovides emesis basin and helpsor encourages patient to coughgently and/or spit up into basin.Provides patient with towels ortissues.

b. May disassemble bronchoscope andarrange to hale sterilized andstored.

c. If appropriate,performer reinforcesinstructions to patient not to eator drink for an appropriate numberof hours because the anesthetizedpharynx and larynx could allow ma-terial to be aspirated into thetracheobronchial tree. With out-patient may write out instructionsor present printed sheet of in-structions to patient. Performermay reinforce explanation of whatresidual effects may be experiencedReassures patient.

17. Performer carries out terminationsteps as appropriate:

a. Performer may have patient cleans-ed. Removes any markers from pa-tient's body.

b. Performer may have patient trans-ported to room, recovery area,or

to appropriate location (such asfor bronchography), or decides todo personally, as appropriate. Ifappropriate, makes sure that pa-tient is in the care of a staffperson who will transport to ap-propriate next location or, ifout-patient, will arrange todischarge or send patient homewith escort,as appropriate.

c. Performer may have room and equip-ment cleaned; has any other ap-propriate clean up proceduresfollowed to avoid infection orcontamination, or decides to dopersonally, depending an institu-tional arrangements.

d. May present requisition form toradiologist for comments andsignature. May have radiologistfill out requisition sheet fordelayed films or bronchography.May arrange for scheduling.

e. May check that all samples havebeen prepared for laboratory,are properly identified,or de-cides to do personally. May pre-sent lab. order forms to radiolo-gist for signature.

f. Performer records the examinationaccording to institutional pro-cedures. May include date, room,examination type, any overheadviews taken, the technical fac-tors used, and film sizes. Per-former may record the number ofexposures made of each overheadview including retakes; may en-ter the estimated radiation doseto which patient was exposed(using posted information ondr,age); may record any problemIth equipment, any special care

provided patient. Signs requisi-tion sheet.

g. Performer may record the fluoros-copy examination including expo-sure time and rad dosage.


Task Code No. 379


list Elements Fully List Elements Fully

h. Performer may decide to jacketradiographs, requisition sheets,and related materials, and/orhave information recorded in logbook personally, or have this dope,depending on institutional proce-dures.

i. May indicate to appropriate staffperson when the performer is readyto proceed with next examination.

433


Task Code No. 380


1. What is the out.ut of this task? (Be sure List Elements Fullythis is broad enough to be repeatable.)Requisition reviewed;films identified;technical fac-tors selectcd and set for fluoroscopy,spot filming,cineradiography;radiologist assisted with instilla-tion,positioning, fluoroscopy;spot films sent forprocessing,taken to radiologist;procedures repeatedas ordered;pt. returned;examination recorded;spotfilms placed for use.

Performer receives or obtainsthe x-ray requisition form, pa-tient identification card, andany appropriate medical-techni-cal history for a patient sched-uled for a fluoroscopic examine-tion not requiring overheadviews such as laryrgography

(radioscopic examination of thelarynx after instillation ofiodized oil contrast medium)or a cleft palate study (radio-scopic study of the structuresinvolved in speech) as a re-suit of:



. From co-worker.


a. Performer checks the ex-amination called for in-cluding whether contrast


Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical-technical history,prior radiographs;viewboxes;pen;x-ray generator,control panels,tilt-table;fluoroscopy unit,cine camera,film;tube,image inten-sifier;grid;bucky,spot film device;roll film or cas-settes;TV monitor;collimator;R-L,ID markers;proce-dure tray;emergency cart;contrast medium,heater;emesis basin,pad,towels;straw,water in cup;instruc-tion sheet;leaded shielding,aprons,gloves;immobili-zation devices;cephalostat;technique,standard view,tube rating and rad exposure charts;phantom or testobject;stretcher or wheelchair


'es to 5. : Name the in. o recipient,respondent or co-worker involved, with de-scriptions to indicate the relevant conditioninclude the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions.

Any pt. to have cleft palate study;non-pediatric pt.to have laryngography;accompanying adult;radiologistco-worker;nurse

5. Name the task so that the answers to ques- medium will be involvedand the purpose of thestudy. Notes the name ofthe radiologist in charge;may note the name of thereferring clinician.

b. Performer reads patient'sname, identification num-ber, sex and age. Noteswhether patient is in-pa-tient, out-patient, or

OK-RP;RR;RR


Providing technical assistance for laryngography orcleft palate study of any patient (or anY similarfluoroscopic examination including spot filming and/or cineradiography) by reviewing request, preparingequipment and patient;setting factors for fluoros-copy,spot filming,cineradiography;identifying films;providing shielding;assisting with positioning ofpt.,tube,table;arranging for processing;having pa-tient returned;recording examination.

6. Check here if thisis a master sheet...;.4Z

436

Tt6K DESCRIPTION SHEET (continued)

Task Code No. 380


List Elements Full

emergency patient. Notes any spec-ial information or note on knownpathology that could affect patientpositioning, technique, or handlingof the patient. For contrast studysuch as laryngography notes whetherthere is history of allergies.Notes whether patient will be ona stretcher or in a wheelchair.

c. Depending on the examination orderedperformer notes whether fluoroscopywill be combined with spot filming,and/or cineradiography, and whethergrid will be used, shielding needed.

d. Performer checks whether patient issuffering from a collateral condi-tion requiring special handling suchas heart disease, communicable orinfectious condition, infirmity,incoherence; notes whether.patientwill be accompanied by nurse, otherstaff person or member of family.

e. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheet iscomplete.

i) Depending on institutional pro-cedures, performer may reviewpatient's radiation exposurehistory, prior record of tech-niques used, and cumulative ex-posure. Notices whether exami-nation has been done elsewherein recent past, whether thereis history of extensive radiog-raphy to bring to radiologist'snotice.

ii) Checks whether any special or-ders on exposure factors arein keeping with the usual radexposure involved for the ex-amination.

iii) Depending on institutionvl pro-cedures, performer notes whetherfemale patient of child-bear-ing age is pregnant, reviewsdate of female patient's lastmenstrual period, or notes any

List Elements Full

other indication that there isno danger of exposure of aknown or possible fetus.

iv) For laryngography, notes or-ders for prior abstinence fromfood-and-drinkT-prior admin-.istration of mediC-ation and/orsedation. May check whetherthese have been carried out;performer may check timing tobe sure a proper elapse oftime has occurred for medica-tion or sedation to take ef-fect.

f. If the performer determines thatthe request is not properly auth-orized, is incomplete, or thatsufficient information is lackingfor performer to select techni-que or to properly continue withpreparations, or if performerconsiders that there may be con-traindications to going aheadwith the procedure, performerbrings this to attention of ra-diologist in charge. Explainsthe problem if appropriate, andproceeds after obtaining neededinformation, signature, or orders.

g. If referring physician has re-quested that films already onfile he presented with current ra-diographs, and if not alreadywith patient's jacketed material,performer arranges to have priorfilms delivered.

. Performer goes to appropriate roomfor the type of examination involvedand the equipment required, or notesroom assigned on requisition sheet.Prepares ahead so as not to keep pa-tient in examination room longer thannecessary:

a. Washes hands as appropriate.

es


Task Code No. 380


List Elements FullyList Elements Full

b. Checks that procedure tray has If appropriate, cuts off excessbeen prepared for the study infilm at exit port and removes.volved or decides to do personally. Attaches film cassette to cam-For contrast study checks that era and locks into place. Re-emergency'cart is present.

uplaces camera cover.

c. Checks that proper accessories are iii) If there is an adequate filmavailable for procedure including supply, checks that film isleaded rubber shielding, aprons,and gloves to be used by performer,radiologist, the patient, and/or

properly loaded.iv) Performer advances film to com-

pensate for any exposute ofanyone who will remain in the room film due to installation orduring exposure. check.

d. Performer checks that appropriate v) Removes dark slide from cameraimmobilization devices are present. lens.For cleft palate may obtain cephal- vi) If not already done, performerostat for positioning skull in true writes or types a card with '.

lateral position. Checks that there patient's identification infor-is a mattress, pads, pillows and/or mation for use with spotfilmblankets for comfort of patient if device. Inserts in sloZ: in spotpatient will lie on table. Makessure that right (R) and left (L).markers are available for use,and

film camera as appropriate.

f. If examination will include spot-identification cards or leaded num- filming using a cassette/buckyerals or markerr.

I spotfilm device, performer checkse. If examination will include spot P that there is an adequate supply

filming using a camera (attached of appropriate size cassettes into image intensifier) and rollfilm, performer checks film sup-ply indicator to.make sure that

room.

i) If there is insufficient supplythere is sufficient film in the of cassettes, arranges to ob-roll film cassette. tain or decides to obtain per-

sonally.i) If there is insufficient roll ii) Performer prepares for iden-

rfilm in.camea, performer ar- tification of the spotfilmranges to have roll film cas- cassettes. Depending on in-

Isette loaded, or decides to stitutional procedures, per-do personally,

ii) When loaded roll film cassetteformer may prepare for use offlash card by checking that

is obtained, performer checks there is piece of lead on cas-loading in subdued light. sette surface; may write orChecks that end of film is cut type out ID information oncorrectly and is properly card if not received with req-threaded and attached to take- uisition. Sets flash cardup spool so that film unwinds aside for later use with spaceappropriately. Checks that film created by piece of leaded rub-is properly engaged in sprockets. ber on appropriate edge of cas-Locks into operating position. sette(s). May place card into

.4

438

TASK DESCRIPTiON SHEET (continued)

Task Code No. 380


List Elements Full%mumommmv4sir List Elements Full

card tray for equipment usingautomatic film marking device.

iii) Perform- may use controls ormanuall ull out spotfilmbucky tnty and open retainingclamps. luserts cassette intobucky tray and pushes back.Makes sure clamps are closed.Moves zssette into appropriate"stor position.

iv) If R-L markers are to be usedwith spotfilming, performertapes into place on image in-tensifier screen or plans totape to patient's body.

g. If examination will include use ofcineradiography camera (attachedto image intensifier), performerchecks the amount of unexposedfilm remaining in the cine camerafilm magazine.

i) If appropriate, performer ar-ranges to have film magazineloaded with film or decides todo personally (in darkroom).

ii) If performer has obtained newlyloaded film magazine, attachesto camera by aligning and en-gaging film drive couplings.Slides in magazine until en-gaged; locks into position. Ad-justs film and checks operationof film transport. Closes cam-era door and locks.

iii) Performer advances film as ap-propriate onto the take-upspool.

iv) If not already done, performerprepares card for identifica-tion of the cine film. Writesout or types appropriate pa-tient identification informa-

,

tion: Inserts identificationcard in cine camera in appro-priate slot so that each frame

will bear the ID information,or uses other identifier as ap-propriate to equipment.

h. If a grid will be used with theimage intensifier for fluoroscopyand/or spot filming, performerpositions and centers grid if notalready,done. May use controlbutton or slides grid into po-sition. May check that the gridis oriented toward the x-raytube, with grid lines parallelto the long axis of the tube.

3. Performer reviews technical expo-sure factors for fluoroscopy, spotfilming and/or cineradiographybased on standards set by the in-stitution as appropriate for theexamination involved:

a. Dons protective leaded rubbergarments such as apron andgloves.


c. Performer reviews the techniquechart(s) for the unit(s) to be.used:

i) Locates information for theexamination involved. Takesnote of the exposure factorsto be used for fluoroscopy,spot filming, and/or cinera-diography. Considers prefer-ences of the radiologist in-volved.

ii) Notes any newly posted changesin technical factors (to re-flect accommodation to achange in machine output ora policy decision).

iii) Performer checks any new orunfamiliar exposure factoragainst the posted limits ofthe x-ray tube on a tube ratin


Task Code No. 380


List Elements Fully List Elements Full, ..14

chart to be sure that technique and then make a finer adjust-does not exceed the heat capac- ment within the range.ities of the tube for the focalspot size to be used. If appro- g. If not already done, performerpriate, performer reconverts connects TV monitor to power out-the technique to an equivalent let. Turns on monitor and checksoctput using higher kVp and low- that "ready" light is on.er mAs. h. If appropriate, performer selects

the proper field size selectord. In the co%trol room, performer (if there is dual image intensi-

makes sure that indicator light fier).shows taat x-ray generator is i. Performer selects and sets expo-"warmed up" and ready for use. sure factors for fluoroscopy:Mekes sure that all circuits havebeen stabilized. If appropriate,checks line voltage meter and, if

i) Selects and sets the kVp atstandard setting for the ex-

aeeded, turns compensator dial un- amination. May check indicatortil needle is aligned properly on dial. With automatic densityline meter. control, sets density selector

e. As appropriate, performer sets as appropriate for examination.x-ray generator mode selector(s) ii) If mA is automatically con-for fluoroscopic mode and for use trolled accordlng to patientof spot film camera or cassette thickness, performer turnsdevice, and/or cineradiography. fluoroscope mA selector to

f. Performer sets controls on image maximum standard position. Ifintensifier for spot film cameraor cassette device:

not automatically controlled,sets as appropriate for focalspot size and examination in-

i) For spot film camera, pe:'ormer volved.selects and sets the rate iii) Sets fluoroscopic examination(frames per second) for thecamera according to standardsset for examination.

timer to maximum position.

j. If appropriate, performer selectsii) For cassette spot filming,per- and sets exposure factors for

former may select and set a spot filming:standard spot film program pro-viding for format combinations i) For.conventional manual expo-such as single, half, or quart- sure control, performer se-er combinations on - single lects and sets the appropri-cassette and related spot film ate spot film time for thesizes. Selects program appro- examination.

...

priate for examination or awaits ii) For automatic, phototimed ex-orders from radiologist. posure control, performer

iii) For cineradiography, performer selects a density exposureselects and sets the frame rate control appropriate for theappropriate to the examinationinvolved. May select an appro-priate frame per second range

examination.

4 4 0


Task Code No. 380


List Elements Full

iii) Performer selects the appropri-ate mA for the examination andthe focal spot size to be used.


k. If appropriate, perfo:mer selectsand sets exposure factors for cinefilming:

i) If standard procedure calls forconstant exposure timing perframe; performer selects andsets appropriate time in milli-seconds.

ii) If standard procedure calls forconstant average density, per-former selects the appropriatedensity control setting as ap-propriate to examination.

iii) Performer selects and sets acombination of one major andone minor kVp setting to obtainappropriate kVp for examination.

iv) Performer sets appropriate mAfor the examination and focalspot size to be used.

4. Performer returns to examination roomto set up x-ray and fluoroscopetube(s), image intensifier, colli-mator and accessories as appropri-ate for check of equipment prior toe7t.amination:



List Elements Fully

c. Adjusts fluoroscopic tube stand(above or below table) so thattube is at zero degrees and cen-tered-to the area of interest.

d. If not already done, moves imageintensifier and any spotfilmdevice into position; centers(over or under) the area of in-terest.

e. Performer adjusts distance be-tween focal spot and image in-tensific_ (for-.al spot to filmdistance, FFD). Makes sure thatTOD is 15 Inches or more forfluoroscopy. Operates controlsor manually moves the x-raytube(s) into place. Checks thefocal-film distance by readingindicator scale in the tube hous-ing; adjusts up or down untilthe required FFD is obtained.

f. Performer collimates fluoroscopytube (and x-ray tube used forspotfilming if different), de-pending on nature of the equip-ment and controls:

i) Adjusts fluoroscopy beam shut-ters to the field size antici-pated for fluoroscopic ex-amination or sets shuttermode selector to automaticcollimation.

ii) Manually sets collimator forthe spotfilm field size tobe used, or selects and setsfield size control to be usedfor automatic collimation withprogrammed spotfilm cassetteexposure sequence.

g. If appropriate, performer at-taches or sets up footboard atend of tilt-table; may adjustor attach shoulder rest, handgrips, cephalostat.

441.


Task Code No. 380



. If not already done, performer checks ii) If equipment is operating ap-functioning of equipment by entering propriately, performer un-remote control room or operating con- loads cassette and reloadstrols in examination room behind lead- or advances roll film as ap-ed screen: propriate. Moves bucky out

of way until fluoroscopy isa. To check fluoroscopy mode, per-

former turns on TV power switchcompleted.

controls as appropriate. Acti- c. To check operation of cine equip-vates fluoroscope exposure by ment, performer may start anodepressing fOotswitch or as appro- rotation. Performer activatespriate. Views test object being appropriate exposure switch forfluoroscoped on TV monitor. cine exposure and checks that

film take-up is functioning ap-i) Perforraer adjusts kVp control propriately. Shuts camera after

(and mA control if appropriate) testing and advances film asand observes effects on TV appropriate.monitor to be sure that equip- d. After equipment has been checkedment is operating properly. performer shuts and resets for

ii) Checks mA meter and notes selected exposure factors. If perwhether appropriate reading is former decides that any of theobtained. fluoroscopic equipment is not

iii) Performer checks that TV bright- functioning properly, performerness controls are operating and informs appropriate staff mem-adjusts for preliminary viewing. ber. Arranges for alternate unit

iv) Checks examination timer bynoting whether time elapse in-

to be used.

dicator moves during exposure 6. Performer readies patient for exami-showing decreasing time left nation by radiologist:for examination. May checkthat exposure is terminated a. Performer washes hands as appro-when maximum examination expo- priate. Depending on patient'ssure time is reached. condition, may decide to arrange

for or carry out isolation orb. To check spot film functioning, per- decontamination techniques.

fdrmer may move cassette or roll b. Performer has the patient calledfilm into x-ray exposure field from the holding area and pre-using appropriate controls. pared for the examination (if not

already done), or decides to doi) Performer activates controls for personally.

spot film exposure. Notes c. Depending on institutional ar-whether cassette or roll film rangements, performer may decidetransport is operating appro- to escort out-patient to or frompriately. Notes whether expo-

bydressing room. May decide to

insure is terminated photo-timer or, if manual timer, in

assist transporting patientfrom holding area or have this

I

, time set. If appropriate, re-leases spot film control afterexposure.

done.

442


Task Code No. 380



d. Performer greets patient and anyaccompanying staff person or fam-ily member and introduces self.Checks patient's identity againstthe requisition sheet. With in-pa-tient, checks hospital identifica-tion bracelet or other identifier.If patient is accompanied becauseof seriousness of condition, per-former checks with accompanyingstaff member on any special pre-cautions necessary during proce-dure.-

e. Performer has patient assume a com-fortable recumbent or seated posi-tion, as apnropriate.


ii) If patient is in wheelchair maymove patient in chair into po-sition next to table. Makessure that wheelchair is inlocked position.


iv) If assisting patient to step onfootstool in order to get ontable, helps patient turn intoposition, step backwards onstool, and then sit and/or lieon table.

v) If patient is on specialstretcher, places stretcherinto position so that radio-lucent stretcher can be liftedwith patient on it from wheeledbasr to x-ray table. May ar-ran6 to move or have patientmoved to table.

f. If not already done, has any jew-elry or clothing removed from neck.

1

May provide gown or drape. Forlaryngography makes sure that pa-tient removes any dentures.Treats young patient with as muchcourtesy as adult.

g. If not already done, performerexplains to patient what willbe involved in the procedure:

i) Indicates what types of go-sitions the patient will beasked to assume and the co-operation that will be askedof the patient such as pho-nation.

ii) For laryngography, may checkthat prior preparation on thepart of patient such as ab-Stinence fran food has beencarried out.If not already done, may ques-tion patient or accompanyingadult about any allergies toshellfish or adverse reactionsto contrast medium (especiallyiodine based). Checks whetheran allergy test is required.Plans to notify radiologistif any sensitivity should bebrought to his or her atten-tion. Performer may explainto patient what side effectsmay be felt from contrast med-ium such as feeling of nausea,flushing, choking sensation.

iii) If appropriate and not al-ready done, performer ques-tions female patient of childbearing age regarding possiblepregnancy. If there is anypossibility that patient ispregnant and this has not al-ready been recorded, performerplans to inform radiologistand to proceed only with ap-proval.

iv) Performer answers patient'snon-medical questions honestly;attempts to reassure patient

.443


Task Code No. 380

This is page 9.of 12 for this task.

List Elements Fully

and develop confidence. Treatspatient with dignity and con-cern regardless of patient'sbehavior. Remains aware thatpatient may be frightened and/or in pain. Performer explains,when asked medical questions,that it is not appropriate fortechnologist to answer these;encourages patient to speak tophysician

h. Performer may tape R or L markerto patient if appropriate for usein spot filming.

7 Performer informs attending radiolo-gist when patient is ready to be ex-amined. Brings requisition sheet, pa-tient's medical history, chart, andany prior films to radiologist. Dis-plays radiographs on view boxes.

a. If not already done, performertells radiologist about any dif-ficulties encountered with regardto information, possible contra-indications, or anything else thatshould be brought to radiologist'sattention. Notes any special or-ders or change in procedure de-cided by radiologist. Proceeds asordered.

b. Performer may accompany radiolo-gist to examination room and in-troduce patient to radiologist.

8. During and/or after radiologist'sreview of prior films and examina-tion of patient,performer makes noteof radiologists' decisions and or-ders such as choice of contrast med-ium for laryngography (based onwhether there is allergy), change instandard technical factors, and/orfinal orders on program for spotfilming and/or cineradiography.

List Elements Fully


b. Performer discusses sequence andtiming for procedure with radiolo-gist. May arrange signals for ex-posure, changing of spot filmcassettes, operation of exposurecontrols. Discusses how patientwill be assisted or held.

c. Performer arranges to provide orchange any equipment or suppliesas ordered by radiologist.

d. For laryngography or similar con-trast study, performer may helpprepare syringes. Shakes andplaces in appropriate heatingdevice and checks that contrastmedium is maintained at appropri-ate body temperature until readyfor use.

e. Changes or adjusts technical fac-tors and settings as appropriatefor fluoroscopy, spot filmingand/or cineradiography.

f. Performer makes note of radiolo-gist's instructions to patientfor phonation of standard maneu-vers for laryngography or testpattern for cleft palate st,idy.If so ordered, performer mayprovide water to swallow,or astraw to blow through,or otherobject needed for cleft palatestudy.

g. Performer gives leaded glcves andapron to radiologist. If appro-priate, places leaded curtain inplace. Provides patient and any-one to remain in room during ex-posure with appropriate protectiveshielding. Explains if necessarythat this is not cause for alarmbut a general precaution to mini-mize unnecessary radiation expo-sure.


Task Code No. 380


List Elements FullAMP

List Elements Full-

Performer assists with preliminaryadjustment of fluoroscopic factors:

a. Performer may assist in positioningof patient; may operate tilt-tableas ordered.

b. On signal from radiologist, per-.former may dim room lights. Turnson TV power switch. May go to con-trol room and operate fluoroscopeand spot film controls on ordersfrom radiologist. Adjusts kVp and/ormA controls according to radiolo-

,gist's orders.c. If preliminary spot films are to

be made (as in laryngography) andif spot film attachment uses cas-settes, performer may unload asused, identify, and insert addi-tional cassettes, as describedabove.

Performer prepares to process spotfilms at once:

i) With cassette spot films, re-moves any markers for furtheruse. Attaches ID card for usewith flasher if appropriate.

ii) With spot film camera, perform-er advances the film so thatell exposures made will bewound on the take-up spool inthe roll film cassette. Usesdevice to cut film and createa light shield. Resets counterand removes film cassette.

iii) Arranges to have spot filmsprocessed at once or decides toprocess personally.

iv) When the spot films have beenprocessed and returned, per-former places on view boxes.May also hang prior films. In-forms radiologist that radio-graph(s) are ready.

d. Performer notes any orders forchanges in the technical factorsand adjusts as ordered.

e. For laryngography, performer mayassist with preparation of pa-tient:

i) Washes hands as appropriate.ii) May help position patient.

iii) May open packet of gloves forradiologist and assist withmask and gown.

.1-v) May assist with anesthetiza-tion of patient's throat byproviding patient with emesisbasin and pad (for patientto hold tongue out of mouth).

10. Performer assists radiologist dur-ing fluoroscopic examination:

a. On signal from radiologist, per-former may dim room lights.Turns on TV power swi..:ch. Maygo to control room and operatefluoroscope, spec film, cine con-trols on orders from radiologist.Adjusts kVp and/or mA controlsaccording ) radiologist's or-ders.

b. Performer may operate tilt tableon orders from radiologist, orassist in positioning patientas ordered.

c. For cleft palate performer mayprovide patient with straw toblow through or water to swallowas ordered. May assist patientor reinforce phonation instruc-tions. Reassures patient.

d. For laryngography with cassettespot film attachment, performermay unload cassettes as used,identify, and insert additionalcassettes, as described above,throughout procedure.

e. Depending on institutional pro-cedures,performer may keep ra-diologist informed of cumulativeexposure as shown on fluoroscopetimer indicator.

443


Task Code No. 380



11. From time to time on orders, or whenradiologist indicates that fluoro-scopic examination is completed, per-former arranges to process spot filmsand/or cine film:'



c. With cassette spot films removesany markers for further use. At-taches ID card for use with flash-er if appropriate.

d. With spot film camera, performeradvances the film so that all ex-posures made will be wound on thetake-up spool in the roll filmcassette. Replaces dark slide oncamera lens. Uses device to cutfilm and create a light shield.Resets counter and removes filmcassette. When spot filming iscompleted, removes any markersfrom patient's body.

e. With cineradiography, performerchecks that cine camera is turnedoff and that the film transportmechanism has come to a completestop. Unlocks and removes filmmagazine.

f. Performer arranges to have spotfilms and/or cine film processedat once if appropriate or decidesto process personally.

12. When the films have been processedand returned, performer places spotfilms on view boxes. May also hang anyscout spots and priol: films. May giveprocessed cine film to radiologist andset up cine projector and screen.Informs radiologist that radiograph(s)are ready for viewing.

13. Performer notes any order for repeatof any part of fluoroscopic exami-nation. Changes technical factors

14.

as ordered. Assists in continued ex-amination as described above, repeat-ing appropriate steps.

For laryngography performer may as-sist radiologist in follow-up pro-cedures:

a. Provides emesis basin and helpsor encourages patient to coughgently and/or spit up contrastmedium. Provides patient withtowels or tissues.

b. If appropriate,performer rein-forces instructions to pat:.entnot to eat or drink for a:: ap-propriate number of hours becausethe anesthetiied pharynx andlarynx could allow material tobe aspirated into the tracheo-bro:Ichial tree. With out-patientmay write out instructions orpresent printed sheet of instruc-tions to patient. Performer mayreinforce explanation of whatresidual effects may be experi-enced. Reassures patient.

15. After the radiography is completed,performer carries out terminationsteps:

446

a. Performer may have patient cleans-ea. May have patient transportedto recovery area, to room, or tonext assigned location, or de-cides to do personally as appro-priate. If appropriate, makessure that patient is in the careof a staff persc. who will trans-port to appropriate next locationor, if out-patient, will arrangeto discharge or sent patient homewith escort as appropriate.

b. May decide to assist patient fromtable or to chair. Makes sure


Task Code No. 380



patient is reminded of any footrestin stepping off table. Makes surethat none of the equipment is pro-jecting over the patient beforeallowing patient to rise fromstool or table and assists patient.

c. May have room and equipment cleaned;has any other appropriate clean upprocedures followed to avoid in-fection or contamination, or de-cides to do personally, dependingon institutional arrangements.

d. Performer records the examinationaccording to institutional proce-dures. May inclLie date, room, ex-amination type, the technical fac-tors used. Performer may record

. the number of spot films made in-cluding retakes; may enter theestimated radiation dose to whichpatient was exposed (using postedinformation on dosage). May recordfluoroscopic exposure time and raddosage; may record any problem withequipment, any special care pro-vided patient. May sign requisitionsheet.

e. May present requisition form toradiologist for comments and sig-nature.

f. Performer may decide to jacket spotfilms, requisition sheets, and re-lated materials, and/or have in-formation recorded in log bookpersonally, or have this done, de-pending on institutional proce-dures.

g. May indicate to appropriate staffperson when the performer is readyto proceed with next examination.

.

4 47


Task Code No. 381


. What is the output of this task? (Be sure List Elements Fullythis is broad enough to be repeatable.)Requisition reviewed;pt. reassured;parts measured;films identified;technical factors selected and setfor fluoroscopy,spot filming,cine,overheads;scoutstaken;pt.assisted in swallowing contrast;radiolo-gist assisted with positioning,fluoroscopy;over-head exposures made;radiographs sent for processing,taken to radiologist;procedures repeated as ordered;delayed series taken;pt. returned;examination re-corded.radlo:ra.hs .laced for use

Performer receives or obtainsthe x-ray requisition form, pa-tient identification card, andany appropriate medical-techni-cal history for a non-pediatricpatient scheduled for any uppergastrointestinal series (con-trast study of esophagus, stom-ach, small intestine) involvingingestion of contrast by mouthas a result of:

. Regular assignment.b. Checking assignment on sched-


d. From co-worker.e. Having arranged,after receiv-

ing orders, to proceed withair contrast study of stom-ach of patient who has justundergone upper GI series.

Requisition may indicate or-ders for routine GI seriesand/or be focused on a par-ticular area of interest.

Depending on institutionalarrangements, performer mayalso receive scout film(s)and/or prior films alreadytaken by co-worker with re-cord of technical factors

. What s use n er orm n: t s tas . Noteif only certain items must be used. If thereis choice, include everything or the kinds ofthings chosen among.)

Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical-technical history,prior radiographs;scouts;view boxes;pen;x-ray generator,control panels,tube,bucky,table,collimator;fluoroscopy unit,image inten-sifier,spot film device,TV monitor;cassettes;rollfilm;cine camera,film;R-L,ID,timing markers;preparedbarium colloidal suspension;barium pill;cup;straw;prepared straw,carbonated beverage or gas releasingpowder;compression devices;pen;phone;extension conesstool;calipers;upright holder;lead aprons,shielding;immobilization devices;technique,standard view,tuberating and rad exposure charts;forms;phantom ortest obiectistretcher or sheelchairOntercom

3. Is ehere a recipient, respondent or co-workerinvolved in the task? Yes...00 No...( )

4. If "Yes" to q. 3: Name the kind of recipient,respondent or co-worker involved, with de_


Non-pediatric patient to have upper GI radiography;radiologist:co-wprker

5. Name t e task so that the answers to ques- used and/or any changes nec-essary.

1. Performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, specialconsiderations, and to check

OK-RP;RR;RR

tions 1-4 are reflected. Underline eesen-tial words.

Taking upper GI radiographs of non-pediatric pt., byreviewing request;preparing equipment;preparing an d

reassuring pt.;measuring parts;setting up for flu-oroscopy,spot filming and cine;arranging for scout

i films as ordered;setting technical factors;identify-ing films;providing shielding;assisting pt. to swal-low barium sulfate contrast;assisting in positioningof pt.,fluoroscopy,spot filming;taking overhead ra-diographs as ordered;arranging for processing;takingdelayed film E.eries as ordered;having pt. returned;placing radiogra hs for use.record1rp.

w

6. Check here if thisis a master sheet.. 4

448


Task Cade No. 381


List Elements Full

the completeness of the informationprovided:

a. Performer checks the examinationcalled for and the areas involved.Notes whether a routine GI seriesis ordered, a study of individualorgans, such as esophagus, stomach,small intestines, whether a specialstudy is ordered such as air con-trast of stomach, hiatal or dia-phragmatic hernia.

b. Notes the name of the radiologistin charge; may note the name of thereferring clinician.Notes the purpose of the study, andany special requests,shielding need.Notes whether erect and/or recum-bent positioning is called for, anyoverhead views ordered, breathingand/or phonation instructions,whether compression devices willbe required. Notes side of inter-est for lateral or oblique views.Notes any request for use of bi-plane equipment.

c. Performer reads patient's name,identification number, sex, age,weight, and height. Notes whetherpatient is in-patient, ont-patient,or emergency patient. Notes anyspecial information or note onknown pathology that could affectpatient positioning, technique, orhandling such as critical condi-tion of patient. Notes whether pa-tient will be on a stretcher or ina wheelchair. Notes whether the useof a grid or bucky will be involved-

d Performer checks whether patientis suffering from a collateral con-dition requiring special handlingsuch as heart disease, communicableor infectious condition, infirmity,incoherence; whether ratient hasIV drip, oxygen supply, urinarycatheter, colostomy, T-tube orsimilar device in place; notes

List Elements Fully

whether patient will be accompan-ied by nurse or other staff per-son, whether there are orders forremoval of dressint;s from the ab-dominal area.

e. Performer makes sure that the re-quest is properly authori7d, thatinformation on requisition sheetis complete:

i) Depending on insti:utional pro-cedures, performer may reviewpatient's radiation exposurehistory, prior record of tech-niques used, and cumulative ex-posure. Notices whether exami-nation has been done elsewherein recent past, whether thereis history of extensive radi-ography to bring to radiolo-gist's attention.


iii) Depending on institutional pro-cedures, performer noteswhether female patient is preg-nant, reviews date of femalepatient's last menstrual peri-od, or nf-res any other indi-.cation that there is no dangerof exposure of a known or pos-sible fetus.

iv) Notes orders for prior prep-aration of patient such asabstinence from smoking, food,and drink, use of cleansing

enemas. Notes whether thesehave been carried out.

f. If the performer determines thatthe request is not properly auth-orized, is incomplete, or thatsufficient information is lackingfor performer to select techniqueor to properly position or carefor patient, or if performer con-

449


Task Code No. 381

This is page 3, of 24 for this task.

List Elements Ftja.)j.

siders that there may be contra-indications to going ahead withtho procedure, performer bringsthis to attention of radiologistin charge. Explains the problemif appropriate, and proceeds aftsrobtaining needed information, sLg-nature, or orders.

g. If prior radiographs already onfile are to be presented with scoutfilms, and if not already with pa-tient's jacketed material, perform-er arranges to have prior films de-live:2d.

2. Performer goes to appropriate roomfor the type of examination involvedand the equipment required, or notesroom assigned on requisition sheet.Prepares ahead so as not to keep pa-tient in examination room longer thannecessary:


prepared for the study involved ordecides to do personally: Checksthat the barium sulfate colloidalsuspension has been prepared inthe appropriate consistency(ies)for the study ordered, such as thinmixture, cream, and/or paste.Checks that barium pills, cups,straws, spoons,carbonated beverage,gas releasing powder and/or waterare available if ordered or stan-dard; or decides to prepare per-sonally.

c. Checks that emergency cart is pre-sent or available.

d. Checks that proper accessories areavailable for procedure includingleaded rubber shielding, aprons,and gloves to be used by performer,radiologist, the patient, and/oranyone who will remain in the rof)mduring exposure.

e. Checks that appropri- immobili-zation devices are pr( .,ent, and

List Elemenallilly

that there is a mattress, pads,pillows and/or blankets for com-fort of patient if patient willlie on table. If appropriate,

prepares balsa wood or foam rub-ber compression device or angleboard with grid, cassette trayand padding (for use in study ofhiatal hernia). May set up for bi-plane radiography for retrogastricsoft tissue study.

f. Makes sure that right (R) andleft (L) markers are availablefor use and identification cardsor leaded numerals or markers.

g. For overhead filming performermakes sure that an adequate sup-ply.of loaded cassettes and ap-propriate film holders are avail-able in the examination room.Selects appropriate speed andtype of film, grid and cassettecombination depending on whethera bucky or table top techniquewill be used and standard insti-tutional practices. Selects sizebased on patient's size and areaof interest. If adequate supplyis not in room, arranges to ob-tain or decides to obtain per-sonally.

h. Performer prepares for identifi-cation of overhead films usingequipment provided by institu-tion:

i) May obtain lead numerals andtape and prepare identifica-tion strip for placement onfilm holder(s) giving appro-priate patient identificationinformation and time elapsefor serial exposures.

ii) Performer may prepare for useof flashcard by checking thatthere is piece of lead on film


Task Code No. 381


List Elements Full,

List Elements Full

holder surface; may write or device. Inserts in slot in spottype out ID information on cardif not received with requisi-tion.

film camera as appropriate.

j. If examination will include spotiii) Checks identification against filming using a cassette/bucky

requisition sheet. spot film device, performer checksthat there is an adequate supply

i. If examination will include spot of app. priate size cassettes infilming using a camera (attachedto image intensifier) and rollfilm, performer checks film sup-ply indicator to make sure thatthere is sufficient film in theroll film cassette.

room.


i) If there is insufficient roll ii) Performer carries out identi-

film in camera, performer ar- fication of the spot film cas-

ranges to have roll film cassettes as for overhead films.

sette loaded, or decides to iii) Performer may use controls or

do personally. manually pull out spot film

ii) When loaded roll film cassette bucky tray and open retaining

is obtained, performer checks clamps. Inserts cassette into

loading in subdued light. bucky tray and pushes back.

Checks that end of film is cut Makes sure clamps are closed.

correctly and is properly Moves cassette into appropri-

threaded and attached to take- ate "stored" position.

up spool so that film unwinds iv) If R-T. markers are to be used

appropriately. Checks that film with spot filming, performer

is properly engaged in sprock- tapes into place on image in-

ets. Locks into operating posi- tensifier screen or plans to

tion. If appropriate, cuts offexcess film at exit port andremoves. Attaches film cassette

tape to patient's body.

k. If examination will include use ofto camera and locks into place. cineradiography camera (attached

Replaces camera cover,iii) If there is an adequate film

to image intensifier), performerchecks the amount of unexposed

supply, checks that film is film remaining in the cine camera

properly loaded,iv) Performer advances fi]m to com-

pensate for any exposure of film

film magazine.

i) If appropriate, performer ar-due to installation or check. ranges to have film magazine

v) Removes dark slide from camera loaded with fi)te or decides tolens. do personally (in darkroom).

vi) If not already done, performer ii) If performer has obtained newlywrites or types a card with loaded film magazine, attachespatient's identification infor-mation, for use with spot film

to camera by aligning and c..n-

- ,....- ......-

I 5 1


Task Code No. 381



3.

.7

gaging film drive couplings.Slides in magazine until en-gaged; locks into posit4.on. Ad-justs film and checks operationof film transport. Closes cam-era door and locks.

iii) Performer advances film as ap-propriate onto the take-upspool.

iv) If not already done, may pre-pare card for identification ofthe cine film. May write out ortype appropriate identificationinformation. Inserts identifica-tion card in cine camera in ap-propriate slot so that eachframe will bear the ID informa-tion,or places other ID markeras appropriate,

1. If a grid will be used with theimage intensifier for fluoroscopyand/or spot filming, performer po-sitions and centers grid if notalready done. May use control but-ton or slides grid into position.May check that the grid is orient-ed toward the x-ray tube, withgrid lines parallel to the longaxis.of the tube.

Performer reviews technical exposurefactors and sets for fluoroscopy, spotfilming and cineradiography based onstandards set by the institution as appropriate for the examination involVed:

a. Dons protective leaded.rubber gar-ments such as apron and gloves,

b. Makes sure that no one .is in ex-amination room or control room.


i) Locates information for theprojections involved. Takesnote of the exposure factors

.

to be used for overheads, flu-oroscopy, and spot filming.Considers preferences of theradiologist involved.

ii) Notes any newly posted changesin technical factors (to re-flect accommodation to a changein machine output or a policydecision).

iii) Performer checks any new or un-familiar exposure factorsagainst the posted limits ofthe x-ray tube on a tube ratingchart to be sure that techniquedoes not exceed the heat capac-ities of the tube for the focalspot size to be used. If appro-priate, performer reconvertsthe technique to an equivalentoutput using higher kVp andlower mAs.

. In control room performermakes sure that indicator lightshows that x-ray generator is"warmed up" and ready for use.Makes sure that all circuits havebeen stabilized. If appropriate,checks line voltage meter and, ifneeded, turns compensator dial un-til needle is aligned properly online meter.

e. As appropriate, performer setsx-ray generator mode selector(s)to fluoroscopic mode and for useof spot film camera or cassettedevice, cineradi.:graphy,and over-head filming.

f. Performer sets controls on imageintensifier for spot film cameraor cassette device':

i) For spot film camera, performerselects and sets the rate(frames per second) for thecamera according to standardsset for examination.


Task Code No. 381



ii) For cassette spot filming per-former may select and set astandard spot film program pro-viding for format combinationssuch as single, half, or quart-er combinations on a single cas-

'Bette and related spot filmsizes. Selects program appropri-ate for examination or awaitsorders'from radiologiat.

iii) For cineradiography, performerselects and sets the frame rateappropriate to the examinationinvolved. May select an appro-.priate frame per second range,and then make a finer adjustmentwithin the range.

g. If not already done, performer con-nects TV monitor co power outlet,Turns on monitor and checks that"ready" light is on.



i) Selects and sets the kVp atstandard setting for the ex-amination. May check indicatordial. With automatic densitycontrol, sets density selectoras appropriate for examination,

ii) If mA is automatically con-trolled according to patientthickness, performer turnsfluoroscope mA selector to max-imum standard position. If notautomatically controlled, setsas appropriate for focal spotsize and examination involved.


j. If appropriate, performer selectsand sets exposure factors for spotfilming:

4.

i) For conventional manual expo-sure control, performer selectsand sets the appropriate spotfilm time for the examination.

ii) For automatic, phototimed ex-posure control, performer ,

selects a density exposure con-trol appropriate for the ex-amination.

iii) Performer selects the appropri-ate mA for the examination andthe focal spot siza to be used.


k. If appropriate, performer selectsand sets exposure factors for cinefilming:

i) If standard procedure calls forconstant exposure timing perframe, performer selects andsets appropriate time in milli-seconds.

ii) If standard procedure calls forconstant average density, per-former selects the appropriatedensity control setting as ap-propriate to examination.

iii) Performer selects and sets acombination of one major andone minor kVp setting to ob-tain appropriate kVp for ex-amination.

iv) Performer sets appropriate mAfor the examination and focalspot size to be used.

Performer returns to examination roomto set up x-ray and fluoroscope

.

tube(s), image intensifier, colli-mator and accessories, as appropriatefor check of equipment prior to ex-amination:

_

453


Task Code No. 381


List Elements Fullz.

a. Makes sure that no one is in room.b. Places phautom or appropriate test

object on radiogl.lphy table wherepatient.'s area ot interest will becentered for examination.

c Adjusts fluoroscopic tube stand.(aboNd or below table) so thattube is at zero degrees and cen-tered to the area of interest.

d. If not alrea, done, -;Ioves image

intensifier and any spot film de-vice into position; centers (overor under) the ai'ea of interest.

e. Performer adjusts the x-ray tube(s)to appropriate focal spot-objectdistance (target to object distance,TOD). For fluoroscopy,adjusts dis-tance between focal spot and imageintensifier (focal spot to filmdistance, FFD). Makes sure thatTOD is 15 inches or more. Operatescontrols or manually moves thex-ray tube(s) into place. Checksthe focal-film distance by readingindicator scale in the tube hous-ing; adjusts up or down until therequired FFD is obtained.

f. Performer collimate& fluoroscopytube (and x-ray tube used for spotfilming if different), dependingon nature of the equipment andcontrols:

i) Adjusts fluoroscopy beam shut-ters to the field size antici-pated for fluoroscopic examina-tion or sets shutter mode se-lector to automatic collima-tion.

ii) Manually sets collimator forthe spot film fielcl size to beused, or selects and sets fieldsize control to be used forautomatic collimation withprogrammed spot film cassetteexposure sequence.

List Element.2.1ally

g. If appropriate, performer attachesor sets up footboard at end oftilt-table; may adjust or attachshoulder rest, hand grips, com-pression band.

5. If not already done, performer checksfunctioning of fluoroscopy equipmentby entering remote control room oroperating controls in examinationroom behind leaded screen:

a. To check fluoroscopy mode, per-former turns on TV power switchcontrols as appropriate.. Acti-vates fluoroscope exposure bypressing footswitch or as appro-priate. Views test object beingfluoroscoped on TV monitor.



iii) Performer checks that TVbrightness controls are oper-ating and adjusts for prelimi-nary viewing.

iv) Checks examination timer bynoting whether time elapse in-dicator moves during exposureshowing decreasing time leftfor examination. May checkthat exposure is terminatedwhen maximum examination expo-sure time is reached.

b. To check spot film functioning,performer may move cw,sette orroll film into x-ray exposurefield using appropriate dontrols.

i) Performer activates controlsfor.,,spot film exposure. Notes


Task Code No. 381



whether cassette or roll filmtransport is operating appro-priately. Notes whether expo-sure is terminated by photo-timer or, if manual timer, intime set. If appropriate, re-leases spot film control afterexposure.

ii) If equipment is operating appro-priately, performer unloadi cas-sette and reloads or advancesroll film as appropriate. Movesbucky out of way until fluoros-copy is completed.

c. To check operation of cine equip-ment, performer may start anoderotation. Performer activates ap-propriate exposure switch for cineexposure and checks that film nice-up is functioning appropriately.Shuts camera after testing and ad-vances film as appropriate.

d. After equipment has been checked,performer shuts and resets forstandard exposure factors. If per-former decides that any of theequipment is not functioning prop-erly, performer informs appropri-ate staff member. Arranges for al-ternate unit to be used.

6. When fluoroscopy equipment has beenset up, performer may note whether apreliminary scout film(s) has al-ready been made of the patient (doneby another radiologic technologistif work is organized in this way atinstitution).

a. If a scout film has already beenmade and.viewed by radiologist,performer notes the technique usedor ordered and plans technicalfactors for overhead radiography,adjusting for use of contrast med-ium.

b. If a scout film has been made butnot approved, performer placesprocessed scout film and anyprior films with patient's chartor places on view box for re-view by radiologist.

c. If a scout film has not been madeand is required before patient isseen by radiologist, performerarranges to take a "plain film"of the abdomen in standard APposition or as ordered. May ar-range to take standard view ofchest or anterior portion of neckfor study of esophagus. Plans toproceed as for plain film radiog-raphy after readying patient.


a. Performer washes hands as appro-priate. Depending on patient'scondition, may decide to arrangefor or carry out isolation ordecontamination techniques.

b. Performer has the patient calledfrom the holding area and pre-pared for the mination (if notalready done), or decides to dopersonally.

c. Depending on institutional arrangements, performer may decide toescort out-patient to or fromdressing room. May decide toassist in transporting patientfrom holding area or have thisdone.

d. Performer greets patient and anyaccompanying staff person and in-troduces self. Checks patient'sidentity against the requisitionsheet. With in-patient, checkshospital identification braceletor other identifier. If patientis accompanied because of ser-iousness of condition, performer

456


Task Code No. 381


1

List Elements

checks with accompanying staff mem-ber on any special precautionsnecessary during procedure..

e. If patient has just undergone abarium study of the upper gastro-intestinal system, performer pro-ceeds directly to preparations forair contrast,examination of stom-ach.

f. Performer has patient assume a com-fortable recumbent or seated posi-tion, as appropriate.

i) If appropriate, places mattress,pillow or clean linen on x-raytable. May place pad, blanketor pillow under bony prominencesto provide comfort for recumbentpatient.

ii) If patient is in wheelchair maymove patient in chair into po-sition next to table. makes surethat wheelchair is in lockedposition.

iii) Performer may decide to assistpatient from wheelchair orstretcher to table or has thisdone. May obtain help. Makessure that no equipment is in theway that may be collided withby patient.


v) If patient is on specialstretcher, places stretcherinto position so that radio-lucent stretcher can be liftedwith patient on it from wheeledbase to x-ray table. May ar-range to move or have patientmoved to table.

g. If not already done, has patient'sclothing removed (down to waist

.710,4AJMWaMMWList Elements Fully

fo. study of esophagus) and pro-vid ..,,own or drape. May assist

patient or request assistance fromnurse if there is a critical ill-ness involved. Permits patient tokeep covered with gown until mea-surements are taken and until ex-posure. Treats young patient withas much courtesy as adult:

h. Performer evaluates the patient'sbodily habitus to estimate thesize, shape and position of thestomach and variations in loca-tion between erect and recumbentpositions for later centering.Notes whether the areas of in-terest are heavily covered bymuscle or soft fat, whether thepalpation points will be easy tofind. Notes whether the extremi-ties are of unequal length. Forfemale patients where esophagusis involved, performer judgeswhether the breasts are large andpendulous. If so, may plan tohave patient or staff member drawthe breasts to the sides and holdin place with wide bandage.

i. If patient has a wound, colostomy,ileostomy, or T-tube with dress-ing to be removed, performerchecks whether zinc or iodoformpaste or radiopaque gauze is beingused. If so, has appropriate staffmember remove dressing or tube ordecides to do personally (if ap-propriate). Checks that radiopaquepaste or gauze is completely re-moved.

j. If patient is to be radiographedin erect position, performer ad-justs vertical film holder to ap-propriate height for patient andmoves this out of the way untilneeded.

8. If_not already done, performer ex-plains'to patient what will be la-volVed in the procedure:


Task Code No. 381


List Elements Full

a. Depending on the examination to bedone, performer describes how thebarium sulfate mixture will beadministered orally, what coopera-tion will be requested of patient,and what the contrast mixture willtaste like. Describes what thedoctor will be doing and what laterctivities can be expected such asoverhead filming, delayed serialfilming, and the need to abstainfrom food during delayed film pro-cedures. VIndicates what types ofpositions the patient will be askedto assume. Describes any probablebreathing control, phonation, useof compression devices, as appropri-ate. May demonstrate how tilt tablewill be used and reassure patientthat he or she will be held safely.

b. If not already done,performer checksthat orders for prior preparationfor study of stomach and/or smallintestines,such as diet, abstinencefrom food,drink,smoking(and perhapsmedication) on day of examinationhave been carried out. May checkwhether orders for prior evacuationor emptying of bladder (or keepingbladder full) have been given andcarried out; if not already done,mayarrange to have micturition orderscarried out. Plans to notify radiol-ogist if any prior orders have notbeen carried out.

c. If appropriate and not already done,performer questions female patientof child bearing age regarding pos-sible pregnancy. If there is anypossibility that patient is pregnantand this has not already been re-corded, performer plans to informradiologist and to proceed onlywith approval.

d. Performer answers patient's non-medical questions honestly; at-tempts to reassure patient and de-velop confidence. Treats patient

List Elements Fully

wit' dignity and concern.regard-less of patient's behavior. Re-mains aware that patient may befrightened and/or in pain. Per-former explains, when asked medi-cal questions, that it is not ap-propriate for technologist toanswer these; encourages patientto speak to physician.

e. Unless measurements have alreadybeen made, performer uses centi-meter calipers to measure thethickness of the chest and abdo-men in the directions in whichthe central ray of the x-ray beamwill pass through the centeredpart from tube to film. If bothrecumbent and erect positioningwill be used for radiography ofabdominal contents, performer mea-sures or estimates thickness inboth positions. Records for usein determining exposure factors

for overheads. After measuring,has patient rest in as relaxed aposition as possible.

f. Performer may tape R or L markerto patient if appropriate foruse in spot filming.

g. If appropriate before radiolo-gist's examination, performer ar-ranges to take "plain film"scout(s) of abdomen and have pro-cessed at once, or decides to dopersonally. Uses AP supine posi-tion or follows orders or insti-tutional procedures for scoutfilm(s). For esophagus study makesscout of chest and/or anteriorportion of neck.

9. Performer informs attending radiolo-gist when patient is ready to be ex-amined. Brings requisition sheet,patient's medical history, chart,scout films (if already done) andany prior films to radiologist. Dis-plays radiographs on view boxes.

4 57


Task Code No. 381


a. If not already done, performertells radiologist about any dif-ficulties encountered with regardto information, possible contrain-dications, or anything else thatshould be brought to radiologist'sattention. Notes any special or-ders or change in procedure de-cided by radiologist. Proceeds asordered.


c. If not already done, performerawaits and carries out radiolo-gist's orders for scout film(s) andproceeds as appropriate for viewsand positions ordered. Presentsfor review as described above.

10. During radiologist's review of requi-sition, scouts, prior films and ex-amination of patient, performer notesradiologist's orders:

a. If radiologist decides to cancelprocedure, performer may arrange toterminate and reschedule as ap-propriate, have forms filled out.

b. Performer notes whether radiolo-gist requires a change in techni-cal factors and/or patient posi-tioning.or centering for lateroverhead filming.

c. Notes radiologist's orders forprogram and settings for spot film-ing and/or cineradiography as ap-propriate.

d. Notes iadiologist's final orderson sequence of examinatim and useof contrast including consistencyof mixture(s).;Thr air contrast of stomach,noteswhether a straw, carbonated bever-age,or gas releasing powder willbe used. For esophagus, notesvhether a :o.rium pill will be use .

0 '14.7.1011,01111.111!MOft

11.

e. Discusses sequence and timing forprocedure with radiologist. Mayarrange signals for exposure,changing of spot film cassettes,operation of exposure controls.

f. Performer arranges to provide orchange any equipment or suppliesas ordered by radiologist. Oncecontrast medium has bee!. selec..ed,performer restirs mixture and pre-pares to administer.

g. If required, changes ol adjuststechnical factors, program, andsettings for fluoroscopy, spotfilming, cineradiography.

Performer assists radiologist withfluoroscopic preparations;

a. Washes hands as appropriate.b. Performer gives leaJad gloves and

apron to radiOlogist. If :.ppropri-ate, places leaded curtain inplace. Prole5 patient and every-one remain .zom dl.:cing ex-posure with app::opriate protectiveshielding, Fxpis if necessarythat t..; is Lc:. cause for alarmbut a o,)ttrzil v%:caution to mini-mize unncescJey radiation expo-sure.

12. If patient ,2an av,ume erect positionperformer 1!:,ris patient in frontof vertical -Ale. Performer st1),scontrast mixture.

a. 'Far study of esophagus,perIurmci: I

may feed a spoonful of thicL mix-ture to patient and caution pa-tient to hold in mouth. Turns pa-tient's head to the le;,: and haspatient follow radiologist's or-ders. Performer stands oy withcup containing mixture and spoon,or has patient hold these.

458


Task Code No. 381


List Elements Full

b. For esophagus, stomach and smallintestine, performer may give cupor glass of barium mixture to pa-tient to hold in left hand restingagainst left shoulder, or performermay hold. Has patient await radiolo-gists' orders on when to swallow.

c. For air contrast of stomach, per-former gives straw to patient (withhole placed so that patient can suckin air) or a cup of carbonated bev-erage, or powder and water in cupto wash it down with. Instructs pa-tient in how to suck in air, drinkbeverage or powder and water. Posi-tions and prepares patient with bar-ium mixture in cup as in b, above,unless radiologist has decided thatprior contrast study has eliminatedneed for more barium.

13. Performer assists radiologist duringfluoroscopic examination as ordered:

a, On signal from radiologist, per-former may dim room lights. Turnson TV power switch. May go to con-trol room and operate fluoroscopecontrols on orders from radiolo-gist. Adjusts kVp and/or mA con-trols according to radiologist'sorders:-

b. Performer may hold cup while pa-tient sips barium mixture or mayfeed thick mixture to patient withspoon as ordered throughout exami-nation.

c. Performer may assist radiologistwith spot filming:

i) Operates exposure controls asordered, or positions table,tuba, or patient as ordered.

ii) If spot film attachownt usescassettes, performer may unloadas used, identify, and insertadditional cassettes, as de-scribed above, throughout pro-cedure.

MTIVIrr

List Elemenk9 Full

d. Performer may help radiologist toposition patient in appropriatesupine, prone, oblIque and Tren-delenburg posits. May operatetilt table on elders from radio-logist.

e. For study of stomach, performermay position vssure cone on or-ders from radiologist.

f. If patient hao wallowing difficulty,performer mar. when ordered,provide patient with a barillm pill.and barium mixture to wash it downAssists pat.Leni. as needed.

g. Depending on ititutional proce-dures, pe:-i-mer may keep radio-*gist informed of cuml.iative ex-posure as shown cn floo-,oscopetimer indiczor.

h. Performer note3 .Aer for re-peat'of any part ol !Tluoroscopicexamination. Chang.,,.s technical

factors as ordered. Assists incontinued examfmation as describedabove, repoating appropriatesteps.

14. When the radiologist informs perform-er that tb r:! fluoroscopic portion ofthe examiration perfprmer .

notes order3 for immediate overheadfilming and any delayed serial film-ing:

a. Notes whether additional contrastis to ne administered by per-former.

b. Notes whether standard series ofoverheads are required and/orspecial I,ositions, views, time3equence3, breathing instruc-tions for exposures.

c. Notes any orders on delayed ser-ial filming.

d. Notes particular areas of inter-est.

e. May note whether radiologist hasmarked patient's back at location

4 5 9


Task Code No. 381


List Elements Full Ltst Elements Fully

of duodenal bulb or pylorus forcentering purposes. If so, noteswhether this was with patient inerect or prone position.

f. May discuss with radiologist alIT

special precautions needed intient positioning, to avoid in-juring patient.

g. May have radiologist fill out and/or sign requisition sheet.

15. Performer explains to patient whatoverhead radiography will be done andthe positions that have been orderedand then quickly prepares for filmingas follows:

a. Performer obtains the appropriatesize loaded cassette for the first(or next) projection.


i) Places right or left marker onfilm holder or table-top as ap-propriate to the study and 7ro-jection or depresses appropri-ate R or L button for automaticmarking.

ii) If patient's identification in-formation is in the form oflead numerals, performer placeson appropriate corner of cas-sette.

iii) If patient identification in-formation is to be entered byuse of flasher, sets flashcard aside for later use withspace created by piece of lead-ed rubber on appropriate edgeof cassette.


v) If exposure is part of a seriesplaces marker to indicate time

elapse or the numbar of the ex-posure within the series.

c. If cassette is to be used withbucky (under tabletop or in up-right holder) performer may man-ually pull out bucky tray and openretaining clamps. Inserts cassetteinto bucky tray and pushes back.Makes sure clamps are closed.Moves cassette into appropriate"stored" position or inserts cas-sette tray into bucky slot andcenters.

d. Performer-may place cassette inupright holder at right anglesto tabletop or in other positionselected.

e. Performer sets or resets the ex-posure factors for the first (ornext) projection:

i) Enters control room and setscontrol for radiography mode.

ii) Adjusts technical exposure fac-tors to account for instruc-tions from radiologist basedon viewing of scout film(s),use of contrast material, and/or measured change of thickness(of abdomen) between erect andrecumbent prsitioning, extremefat or muscularity.

iii) For conventional exposure con-trol, performer selects milli-amperage and sets selectorsfor the correct focal spotsize. Selects and sets the ex-posure time that will producethe mAs desired. Sets the kVpselected by choosing the com-bination of major kilovoltageand minor kilovoltage settingsto produce the desired kVp.

iv) For automatic phototimed expo-sure control, performer se-lects and sets the categorycorresponding to the type of


Task Code No. 381



study and use or nonu6e .ofscreens, bucky, etc., and, ifappropriate, focal spot size.Selects and sets a controlcorresponding to the field size(as listed on technique chartfor photefiming).May select and set a kVp rangebutton (if called for withequipment) corresponding torange for examination.-Sets a density selector corres-ponding to the usual (or spec-ial) requirements for the study.Makes sure backup timer is notlikely to terminate exposurebefore phototimed exposure ismade.

v) Depending on the equipment, mayset controls to provide for useof bucky, manual adjustment oftable and tube height, position,and of collimation, unless thesehave already beet set.

16. Performer prepares patient for.thefinal position ordered for the first(or next) exposure. Makes sure thatcorrect side is being positioned whenappropriate,

a. May explain or demonstrate to pa-tient what is required. May ob-tain help in positioning.

b. If patient has a urinary catheterin place, performer turns patienttoward the catheter and tubing toprevent separating it from drain-age bottle and breaking sterilesystem and to avoid causing pain.

c. When positioning a patient with aballoon catheter in place, per-former makes sure that the clampis not lying over a part to beexposed or that patient is notlying on the clamp,

d. If patient will be standing andlimbs are of unequal length, per-

17.

former provides support to short-er limb so as to evenly distributeweight. .

e. Performer centers part and keepsthe long axis of the part parallelto the film holder. When using a ,

bucky, centers patient to midline.With cassette on table top, cen-ters-film to part. With uprightholder adjusts height of holderto part and centers part to film.

f. Performer positions patient inprone PA, supine AP, or erect pe-sitions by arranging body so thatits median sagittal plane is cen-te..:ed to the midline of table orfilm holder.For lateral positioning has me-edian sagittal plane parallel withmidline. If rttcumbent, supportsany elevated parts.

i) With all positions arranges pa-tient's shoulders so that theylie on a single transve-seplane.

ii) Has prone patient flex elbows,place arms in a comfortable po-sition. Supports ankles. Restspatient's head on forehead andnose. May have patient resthands beneath chest.

iii) Has erect patient face filmholder for PA projection-

)face away from film holder forAP projection.

iv) Has supine patient place armsin a comfortable position andsuppeits ankles and knees.

v) For thin patient in recumbentlateral, PA and oblique posi-tions, performer may elevaLechest to place the cervicalvertebrae at a correct level.

If performer is to take immediateoverheads of the esophagus, per-former notes the positions and viewsordered, whether barium sulfate is


List Elements Full

Task Code No. 381


to be administered, and the consistencyto use. Performer has patient assumerecumbent position unless otherwiseordered. .

a. Performer rehearses patient intaking the barium sulfate througha drinking straw or being fed byperformer with spoon, depending onits consistency. Depending on or-ders, performer may demonstrate howpatient is to swallow several mouth-fuls in rapid succession on orders,hold a mouthful,and swallow on or-ders just before exposure. Noteswhether no additional contrastwill be given.

b. Performer rehearses patient inbreath control as ordered:

i) May demonstrate how to exhalefully, swallow the mouthful ofbarium mixture, and hold breathuntil told to relax.

ii) May demonstrate how to take adeep breath, hold breath, swal-low mouthful of barium mixtureand perform Valsalva maneuver.For the latter demonstrates andrehearses patient in bearing downas though evacuating while hold-ing breath until told to relax.

iii) May demonstrate how to swallowbarium mouthful on moderateinhalation. Performer plans tomake exposures during the fewseconds following deglutition.

iv) May demonstrate how to drinkbarium mixture through a tubein rapid continuous swallows,

v) If a modified Valsalva or Mullermaneuver is ordered, performerdemonstrates and rehearses pa-tient in inhaling deeply andslowly on orders, exhaling com-pletely three or four times,pinching nostrils togetherwith the thumb and forefinger

List Elements Full

of one hand, closing mouth,and making a sustained butmild effort to blow nose untiltold to relax;or pinch nostrilsclose mouth,and blow cheecksoutward as if blowing up aballoon,until told to relax.

c. For the PA projection (anteriorview) of the esophagus, performerhas patient assume a prone posi-tion:

i) Adjusts cassette to includethe area of interest as or-dered. If entire esophagus isto be studied, centers to thelevel of the 5th or 6th tho-racic vertebra.

ii) Has patient rest head on chin.Adjusts head so that mediansagittal plane is at rightangles to film. Has patientrotate and depress shouldersforward, flex elbows, and placeback of hands well down onhips. Adjusts shoulders in asingle transverse plane withclavicles below the apices.Has patient keep shoulders incontact with cassette or tabletop. Makes sure that there isno rotation of body.

iii) Directs central ray at rightangles to the'center of thefilm.

d. For a lateral projection of theesophagus:

i) Performer may maintain patientin PA prone position on tableand elevate thorax, placingpatient's arms above head. Ad-justs upright cassette holderon side of interest next totable or places a grid cas-sette upright on table andsupports so that x-ray beam

4 6 2


Task Code No. 381



may be directed across table tofilm. Centers to the 5th or 6ththoracic vertebra or the centerof area of interest. Directs cen-tral ray at right angles to mid-point of film across table.

ii) Performer may have patient lie inlateral recumbent position withhead elevate-i and supported. Cen-ters film holder to the level ofthe 5th or 6th thoracic vertebrawith the mid-axillary line ofbody at miiline of film. Adjustshead so that median sagittalplane is parallel with film. Pro-vides support to head and lowerthorax so that the long axis ofthe cervicothoracic vertebrae isparallel to film. Depressesshoulder on side away from film.Immobilizes by having patientgrasp dorsal surface of thigh oran anchored hand-hold. Adjustsbody in exact lateral position.Directs central ray at right an-gles to midpoint of film.

e. For a PA oblique projection (anter-ior oblique view) of the esophagus,performer chooses the right anter-ior oblique view unless otherwiseordered:

i) Performer has patient begin inor move from the prone position.Rotates patient so that thoraxis at an angle of 45° withtable top or film holder, withright shoulder and breast incontact with cassette or holderand head resting on right cheek.May provide soft support underchest.

ii) Centers film to the chest atthe level of the 5th or 5ththoracic vertebra.

iii) Has patient support himse:..f orherself on the forearm

flexed knee of the elevated(left) s!de.

iv) Directs central ray at rightangles to center of film atlevel of 5th or 6th thoracicvertebra.

f. For radiographic demonstrationof hiatal hernia and/or esoph-ageal regurgitation, performernotes whether supine or pronemodifications of the Trendelen-burg position will be used, thedegrees to which the head endof the table will be lowered,whether any head rotation willbe employed, and whether patientwill be positioned over a semi-cylindrical radiolucent compres-sion device or special 34° pad-ded anr,le board. If the latteris oldered, plans on no addi-tional contrast and plans to usemodified Valsalva or Muller man-euvel:

i) For variations of supine posi-tions, performer adjusts pa-tient in supine position. Cen-ters thorax to the midline oftable and centers cassette tothe level of the 6th or 7ththoracic vertebra. As ordered,lowers the head end of table10° to 15° or 25° to 30°. Ifso ordered, rotates patientslightly to the right side andsupports elevated side. Di-rects central ray at rightangles to the midpoint of thefilm.

ii) If a semicylindrical radiolu-cent compression device is tobe used, performer has patientlie prone on table and thenassume a modified knee-chestposition. Performer places tl.ecompression device transversely

4-03


Task Code No. 381


List Elements Full

under the abdomen, just belowthe costal margin. Performerthen adjusts patient in a 400to 450 right PA oblique posi-tion,as described in (e) above,with head resting on cheek.Centers thorax to midline oftable. Directs central ray atright angles to the long axisof patient's back at the levelof the 6th or 7th thoracicvertebra. Centers midpoint offilm to coincide with midpointof central ray as it willemerge at the anterior surfaceof the body.

Has patient hold barium mixturein left hand and suppliesdrinking tube or straw. Demon-strates to patient how to drinkmixture in rapid continuousswallows.

iii) If a 34° padded angle boardis to be used, performer placesthe device on the table andinserts cassette into trayincorporated into device. Cen-ters film area to midline oftable. Performer assists pa-tient to assume kneeling po-sition on table with thighsagainst board and median sag-ittal plane of body centered'to film area of device. Asksor assists patient to leanstraight forward and restfull weight on padded surfaceof board. Centers xiphoid pro-cess to film area. Directscentral ray at right anglesto the plane of the film atits midpoint. Demonstrates topatient how to perform modifiedValsalva or Muller maneuver.

18. If performer is to take immediateoverheads of the stomach and/or duo-denum, performer notes the positions

List Elements Full

and views ordered and the area ofinterest. Notes whether patient isto swallow additional barium mix-ture and when. Does not use com-pression band unless so ordered.

a. Performer notes any centeringmark made by physician to showthe location of the pylorus (andwhether made with patient erector recumbent); or performerjudges the location of the py-lorus based on the patient's typeof body (habitus) and the evi-dence of the scout film. If botherect and recumbent positions areordered, centers three to sixinches lower for erect position-ing than for recumbent positions,allowing greater change for thin,asthenic patient.

b. Performer has patient drink ad-ditional barium mixture if soordered.

c. For a PA projection (anteriorview) of the stomach and duo-denal bulb, performer noteswhether erect or prone positionis ordered and whether centralray is to enter at right anglesto film or to be angled.

i) Has patient assume a prone po-sition on table or erect po-sition facing upright cas-sette holder. If prone patientis thin, supports thorax andpelvis. Has erect patient dis-tribute weight evenly.

ii) If central ray is to be di-rected at right angles, pf,r-former centers patient sothat the sagittal plane pass-ing about 2.5 inches to theleft of the marked or esti-mated location of the pylorusis at the midline. Centersfilm at the level of the py-


Task Code No. 381



lorus as estimated or marked,andallows for difference in erector prone centering. Directs cen-tral ray at right angles to mid-point of film.

iii) If the central ray is to be an-gled, has patient lie in proneposition with the median sagit-tal plane centered to the mid-line. Places film lengthwise sothat upper edge is at the levelof the chin. Directs the cen-tral ray to the midpoint of thefilm at an angle of 25° to 450cephalad, as ordered.

d. For a right PA oblique projection(right anterior oblique view) ofthe stomach and duodenal loop, per-former notes the degree of rota-tion required depending on the pa-tient's body type. Unless otherwiseordered, positions hypersthenic(large, obese) patient with great-er degree of rotation than thinnerpatients. Plans for 100 to 15°degree changes in obliquity ofbody between 40° to 70°, with ex-posures taken at 30 to 40 secondintervals or as ordered. Marks cas-settes with notation of timeelapse:

i) Performer positions patient inthe prone position with headresting on right cheek andright arm alongside body. Ro-tates body so that left side iselevated. Has patient supporthimself or herself on left fore-arm and flexed knee and adjustsrotation for the desired de-gree, depending on body typeand the given exposure of theseries involved.

ii) Centers patient so that a longi-tudinal plane halfway betweenthe spinal column and the an-

terior left surface is at themidline. Centers film at themarked or estimated level ofthe pylorus.

iii) Directs central ray at rightangles to midpoint of film.

iv) Rehearsea patient in suspend-ing breathing at end of ex-halation for exposure and re-maining in position until di-rected to change rotation fornext exposure in series.

e. If lateral projections are or-dered, performer notes whetherright or left projections are in-volved

i) For a left lateral projectionof the left retrogastric space,performer positions patient inerect lateral position beforean upright holder with leftside against film holder.

ii) For a right lateral projectionof the right retrogastricspace, duodenal loop and duo-denojejunal junction, perform-er positions patient in lat-eral recumbent position lyingon right side. Has patientgrasp side of table or standfor support.

iii) Centers body so that a coronalplane passing midway betweenthe midaxillary line and theanterior surface of the abdo-men is at the midline. Centersat the marked or estimatedlevel of the pylorus and al-lows for difference in erector prone centering if markedposition was mad.: while pa-tient was in opposite positionfrom the one for this exposure.

iv) Directs central ray at rightangles to the midpoint of thefilm.

4 6 ,3


Task Code No. 381


List Elements FullList Elements Fully

f. For an AP projection (posteriorview) of the fundus of stomach,antrum, posterior stomach wall,retrogastric portion of duodenumand jejunum, or to study grossdiaphragmatic herniations, perform-er notes orders for centering, bodyrotation and/or degree of Trendel-enburg angulation:

i) Performer positions patient inthe supine position either cen-tered to the midline or with asagittal plane passing halfwaybetween the median sagittalplane and left side of thoraxat the midline,as directed. Un-less otherwise ordered, centersfilm to the marked or estimatedlevel of the pylorus.

ii) For thin patients or if so or-dered (for diaphragmatic hernia-tions), performer rotates thebody slightly towards the leftwith right side against tableand/or tilts head end of tabledown in a Trendelenburg posi-tion.

iii) Performer directs the centralray at right angles to the mid-point of the film.

g. If a biplane projection has beenordered for study of retrogastricsoft tissues, performer preparesfor filming with patient in supineposition. Notes centering pointmarked by radiologist. Plans tomake projections as quickly as pos-sible after placing patient in su-pine position:

i) If biplane equipment is avail-able, sets up tubes for AP andhorizontal lateral projections.

ii) If biplane equipment is notavailable, performer adjustscentral ray and fflm first for

lateral filming with tube di-rected horizontally across pa-tient from left to right, withvertical cassette holder placedon right side of patient, andpatient in supine position.

iii) Performer positions patientin the supine position withthe left side of the body cen-tered to the micline of thetable.

Centers vertical cassette forlateral filming to localize--tion point indicated by ra-diologist. Centers cassettein bucky for AP projection tothe level of the localizationpoint.

Directs central ray at rightangles to the midpoint of thefilm for each exposure.If no biplane equipment isavailable, instructs patientto retain position after lat-eral exposure while performerrepositions tube and placescassette for AP exposure.Plans to make both exposuresat the same phase of suspend-ed expiration.

h. Throughout procedure performerremains alert for any symptom ofsevere pain or adverse reaction,especially to contrast. As soonas performer judges that reactionmay be severe, ceases exposureand notifies radiologist or at-tending physician at once.

19. Performer sets up for exposure afterpositioning patient:

a. Performer sets the fcal-filmdistance if not already (Lone asappropriate. Operates controlsor manually moves the x-ray tube

116

110+


Task Code No. 381

This i3 ptge 20.of 24 for this task.


into place over the film holder (orat right angles to upright holder).Checks the focal-film distance byreading indicator scale in thetube housing; adjusts up or downuntil the required FFD (TFD) isobtained.

b. Performer checks final posctioningby using light in collimator. Acti-vates the collimator light and,points the light beam towards thepart. Adjusts the collimator open-ing to correspond to the film size.Uses cross-hair shadows as refer-ence for center of field. Checksthat primary beam will enter thecenter of the area of interest atthe selected angle to the film soas to project the view desired.

c. Once the patient has been position-ed and immobilized, performer ad-justs the collimator. Either colli-mates so that a small unexposedborder will appear around the edge 1

of the film or collimates furtherso as to expose only the area ofinterest (and thus provide maximumprotection and detail). For smallfields performer attaches an auxil-iary extension cone to collimatorto further reduce the primary beam.Adjusts primary beam to minimumsize needed to cover the area(s)of interest.

d. Performer adds lead shielding toareas that will be in the primarypath of the beam but are not in-cluded in the areas of interest.Makes sure that proper protectiveshielding has been provided to pa-tient and everyone wbo will remainin room.'

e. When everything is ready for theexposure; performer reminds pa-tient of the cooperation andbreath._eontrol to be used for ex-posure. Observes the patient'smovement until the moment that

the exposure is made. Rendjustsposition if warranted.

f. Performer returns to control room.Makes sure controls are properlyset, that equipment is set forradiography mode, and that patientis still in'position.

g. Calls or uses intercom to remindpatient of what to do in relationto breathing, swallowing contrast,holding breath and/or carryingout maneuver as rehearsed.

20. Performer determines when to makethe exposure as approptiate:

a. For esophagus, proceeds as fol-lows:

i) If patient is to swallow con-trast bolus and has not beengiven instructions to holdbreath, performer makes expo-sure immediately after deglu-tition.

ii) Tf respiration has been sus-pended, performer waits oneor two seconds to allow ill,voluntary movement of viecrunto subside and then makes ex-posure.

iii) If patient is drinking in

rapid swallows,performer makesexposure after third or fourthswallow.

iv) Tf a Valsalva or modified Val-salva or Muller maneuver isbeing carried out,performermakes exposure during the man-euver.

b. For stomach and/or duodenuM, per-former makes exposure after thepatient has be,m instructed tobreathe out and hold unless other-wfse ordered:


Task Code No. 381

This is page 21 of k4 for this task.

List Elements Fully

i) For right anterior obliqueseries performer makes exposureand removes cassette; reinsertscassette and changes the obliq-uity of patient's position 100to 15°. Makes exposures at 30to 40 second intervals and con-tinues as appropriate until com-pleted. Makes sure that cas-settes are marked for propertime elapse.

ii) If a biplane study has been or-dered and automatic biplaneequipment is not available, per-former has patient retain posi-tion while first cassette isremoved (lateral view) and sec-ond cassette is placed for theAP projection,centered to thearea of interest. Makes both ex-posures on the same phase ofsuspended respiration.

21. Performer initiates exposure by press-ing hand trigger or exposure controlbutton.

a. While exposure is underway perform-er checks that mA meter recordsappropriate current as thatkVp meter dips slightly.

b. May watch for evidence of malfunc-tion such as line surge or exces-sive drop; may lisr. for sound ofnormal functioning of equipment.If there is malfunction may decideto report; anticipates need to re-peat exposure.

c. With phototimer notes whether back-up timer has been involved, in ter-minating exposure before photo-timed exposure was completed. Ifso, anticipates possible need torepeat epasure.


e. If the exposure is terminated bya circuit breaker, rechecks tech-

List Elements Fully

nical factors for possible over-load or checks for overload else-where on circuit. Anticipates needto repeat exposure.

f. After exposure removes cassetteand removes markers for furtheruse.

g. Repeats radiography for all theexposures ordered by radiologist,adjusting technical factors, tube,and position of patient or filmholder as appropriate to eachview ordered. Repeats identifica-tion, collimation, shielding, or-ders for breath control and expo-sure as above.

22. Performer arranges to have-spbt films,overheads,and any cine film processedat once:



c. With cassette spot films and over-head exposures, removes any mark-ers for further use. Attaches IDcard for use with flasher if ap-propriate.

d. With spot film camera, performeradvances the film so that allexposures made will be wound onthe take-up spool in the _allfilm cassette. Replaces darkslide on camera lens. Uses de-vice to cut film and create alight shield. Resets counter andremoves film cassette.

e. With cineradiography, performerchecks that cine camera is turnedoff and that the film transportmechanism has come to a completestop. Unlocks and removes filmmagazine.


Task Code No. 381



f. Performer arranges to have over-heads, spot films and cine filmprocessed at once if appropriateor decides to process personally.

g. While films are being processed,makes sure that patient is com-fortable and, if necessary, at-tended by radiologist, staff mem-ber, or self.

23. When the overheads and spot films havebeen processed and returned, perform-er places on view boxes. May also hangscout and prior films. May give pro-cessed cine film to radiologist andset up cine projector and screen. In-forms radiologist that radiograph(s)are ready for viewing.

a. Performer makes note of radiolo-gist's decisions regarding ade-quacy of the radiographs:

i) If radiologist decides to havepatient swallow more contrastmedium, perforner assists asabove and with any fluoroscopyand spot filming. Repeats ad-

' ditional overhead radiographyas ordered.

ii) If the radiologist indicatesthat there is any problem withthe technical factors or thepatient positioning for over-heads, performer records ornotes for use in "retakes."Notes whether need to repeatis due to performer's ownnegligence or lack of atten-tion so that performer canavoid future "retakes." If re-quest for retakes reflects mal-functioning equipment, perform-er reports malfunction to ap-propriate staff member. If re-quest for retakes reflects thepreference for density or con-trast of the radiologist, per-

former notes for future useto avoid future "retakes:11hpIf radiologist requires ad i-tional views and/or positions,performer repeats overhead filming as appropriate to new pro-jections; as described above.For further overhead exposuresperformer repeats appropriatesteps including identificationof cassette, use of R-L andSeries markers, selection andsetting of technique, swallow-ing of additional contrast mix-ture, positioning patient andequipment for focus-object-filmalignment, collimation, shield-ing, breathing instructions,making exposure, and processingas described above.Performer refrains from commenting on the films or providinganyi interpretation to patient.Performer shows subsequent setsof spot films and radiographsto radiologist as processed,and proceeds as described aboveuntil radiologist indicaterthat this stage of examinr.tionis completed.

b. Perforuer makes note of radiolo-gist's decision regarding any de-layed filming such as motilitystudy, delayed films:

i) Notes any orders for delinea-tion of the small bowel;timing,and position required.

ii) Notes any orders to proceed toair contrast study of stomachAnd timing.

iii)1Notes any orders for gastro-'intestinal motility study, cen-tering, positioning and timeintervals.

iv)1Notes any order for other delay-ied films and the time elapseIrequired.


Task Code No. 381


14-List Elements Fully

v) If appropriate has radiologistfill out or sign requisitionorder for delayed filming.

vi) If appropriate has radiologistauthorize withelding order forfood or drink until delayedfilming is completed.

c. If radiologist decides to orderanother barium study or decides todo an air contrast study of stom-ach at a later time, performermay have radiologist fill out req-uisition sheet. May arrange forscheduling.

24. If delayed films are ordered, perform-er proceeds as follows:

a. May return to patient to reinforceorders on taking nothing by mouthuntil all radiography is completed.With in-patient may arrange tohave nursing staff in charge ofpatient's care informed.

b. Performer may arrange to have pa-tient taken to appropriate holdingarea. Keeps track of the timee1ap2ed. If appropriate, makessure that patient is in the careof a staff person who will trans-port to appropriate location andreturn patient at apptepriate time.

25. At appropriate time(s) and as oftenas appropriate to complete delayedseries, performer carries out stepsfor delayed filming as ordered, fol-lowing similar positioning and expo-sure steps as described above.

a. Performer takes films of the smallbowel as ordered. Positions insupine position unless otherwiseordered and centers to includethe pubic symphysis,'

b. If a delayed film is ordered ofstomach after 2 or 3 hero, per-

11! List Elements Fully

former may position for right PAoblique projection unless other-wise ordered.

c. If a gastric-motility series isordered, and/or a small intestinesmotility series, performer posi-tions and centers as appropriateas the barium column progresses:

i) While the stomach is included,positions patient in prone PAposition and centers film toinclude stomach.

ii) When the stomach is empty, po-sitions patient in supine APposition and centers film toinclude the pubic symphysis.

d. If a compression study of theileececal region and appendix isordered, performer positions asordered and may apply compressionband.

e. In all delayed series performermakes sure to include time-inter-val marker on each Cilm.

f. Performer makes radiographs andarranges for processing as de-scribed above. Depending on insti-tutional arrangements performerplaces processed delayed radio-graphs for later viewing by ra-diologist or places on view boxesas processed and informs radio-logist that they are ready andnotes radiologist's further or-ders.

26. When the radiographic series arecompleted, or at intervals duringprecedure,performer may carry outtermination or follow-up procedures:

a. Performer may have patient cleans-ed; may have room and equipmentcleaned; has any other appropri-ate clean up procedures followedto avoid infection or contamina-


Task Code No. 381


List Elements Full

tion,or decides to do personally,depending on institutional arrange-ments. Removes any markers from pa-tient's body.

b. If appropriate, reinforces instruc-tions to patient on use of catharticor, if there is contraindication ofcathartic, drinking of water andmineral oil until stools are clearedof contrast medium.

c. May decide to assist patient fromtable or to chair. Makes sure pa-tient is reminded of any footrestin stepping off table. Makes suretnat none of the equipment is pro-jecting over the patient beforeallowing patient to rise from stoolor table, and assists patient.

d. Performer may have patient trans-ported to next assigned location,or decides to do personally, asappropriate. If appropriate, makessure that patient is in the careof a staff person who will trans-port to appropriate next locationor, if out-patient, will arrangeto discharge or send patient homewith escort as appropriate.

e. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the overhead viewstaken, the technical factors used,and film sizes. May record thenumber of exposures made of eachspot film and overhead view in-cluding retakes; may enter theestimated radiation dose to whiel-patient was exposed (using postedinformation on dosage); may re-cord any problem with equipment,any special care provided patient.Signs requisition sheet.

f. Performer may record the fluoros-copy examination including expo-.sure time and rad dosage.

g. May present requisition form toradiologist for comments and sig-

List Elements Fully

nature. May present forms for req- 5uisitions for later delayed filmsand/or additional examination(s).

h Performer may decide ;:o jacketradiographs, requisition sheets,and related materials, and/or haveinformation'recorded in log bookpersonally, or haye this do,a,depending on institutionaldures. 4

i. May indicate to appropriate statperson when the performer is reaA'yto pro,:. with next examinatio,


This is page

Task Code No. 382

of 16 for this task.

. What iz Lhe output of this task? (Be sure List Elements Fullthis is broad enough to be repeatable.)

Requisition reviewed;pt. reassured;abdomen measured;films identified;technical factors selected and r..,et

for fluoroscopy,spot filming,overheads;scouts tehen;radiologist assisted with catheter,contrast,positioning,fluoroscopy;overhead exposures and series, madrradiographs seht for processing,taken tO radiologistprocedures repeated as ordered;pt. returned;examina-tion recorded;radiographs placed for use.

....

Performer :eceives or obtainsthe x-ray requisition form, pa-tient identification card, andany.appropriate medical-techni-cal history for a non-pediatricP atient scheduled for a smallintestine study involving gas-trointestinal intubation (suchas small bowel enema or hypo-tonic duodenography) as a re-sult of:

.

a. Regular assignment.F. Checking assignment on sched-

ule sheet.c. Haviag arranged requisitions

in order of priority.A. From co-worker.

.

Requisitien may indicatethat ;, nasoenteric tube hasllready LP.en inserted andallowed to travel throughthe gastrointestinal ttactto a potnt of obstruction ,or ma:, include orders for'

intuhation.

Performer may also receiVt,radiographs of prior studlessuch .;s GI series, views ofintestjaes to show progress:',1 the nasoenteric tube. Ascout film may also be pre-sent wl.th record of'technicalfac:or use :. and/or any

changes aecessary.

1. Performer reads the requisi-tion shee:.: to determine theexamination callod for, thepatient involved, specialconsideratfrns, and tothe completeness of :he in-formation provided:

OK-RP;RR.RR

2. What is used in performing this task? (Noteif only certain items must be used. If thereis choice, include everything or the kinds of

. things chosen among.)Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical-technical history,prior radiographs;scouts;view boxes;pen;x-ray generator,control panels,tuLa,bucky,table,collimator;fluoroscopy unit,image inten-sifier,spot film device,TV monitor;cassettes;rollfilm;R-L,ID,timing markers;procedure tray;emergencycart;barium colloidal suspension;sterile lubricant,nasoenteric tube,syringes;phone;stool;calipers;emesi-basin;waterproof sheeting;lead aprons,shielding;immobilization devices;technique,standard view,tube rat-ing,rad'exposure charts;calipers;phantom or test ob-ject;stretcher or wheelchair;intercom;forms


. If -Yes' to q. 3: Name the kind of recipientrespondent or co-worker involved, with de-

scriptions to indicate the relevant condition;include the kind with whom the performer isnot allowed to deal if relevant to knowledgerequirements or legal restrictions.

Non-pediatric patient to have small intestine intu-bation radioera h .radioloeist'co-workers.nurse

5. Name the task so that the answers to ques-tions 1-4 are reflected. Underline essen-tial words.

Taking small intestine intubation radiographs of anon-pediatric pt., by reviewing request;preparingequipment;preparing and reassuring pt.;measuring ab-domen;setting up for fluoroscopy and spot filming;a:ranging for scout films as ordered;setting techni-cal factors;identifying films;providing shielding;assisting with insertion of catheter,use of contrastpositioning of pt.,fluoroscopy,spot filming;takingoverhead radiographs and series as ordered;arrangingfor processing;taking to radiolpgist-;continuing,re-peating as ordered;having pt. returned;placing ra-riincern,Ila frvr Iloimrimnrorrlinc.

6. Chack here it thisic a master sheet..N) i


Tab- at,/

This is page

Task Code No. 382


. List Elements Full

a. Performer checks the examinationcalled for. Notes whether intuba-tion in connection with smallbowel enema or hypotonic duodenog-raphy is called for. Notes the pur-pose of the study, and any specialrequests.

b. Notes the name of the radiologistin charge; may note the name of thereferring clinician.

c. Performer reads patient's name,identification number, sex, age,weight, and height. Notes whetherpatient is in-patient, out-patient,or emergency patient. Notes anyspecial information or note onknown pathology that could affectpatient positioning, technique, orhnndling,such as acute conditionof patient. Notes whether patientwill be on a stretcher or in awheelchair. Notes whether the useof a grid or bucky will be in-volved. Notes shielding need-d.

d. Performer checks whether patient issuffering from a collateral condi-tion requiring special handlingsuch as heart disease, communica-ble or infectious condition, in-firmity, incoherence; whether pa-tient has iv drip, oxygen supply,urinary catheter, colostomy, T-tubelnasoenteric tube or otherdevice in place; notes whether pa-tient will be accompanied by nurseor other staff person, whetherthere are orders for removal ofdressings from the abdominal area.

e. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheetis complete:

i) Depending on institutional pro-cedures, performer may reviewpatient's radiation exposurehistory, prior record of tech-niques used, and cumulative ex-

List Elements Fully

posure. Notices whether, exami-nation has been done elsewherein recent past, whether thereis history of extensive radi-ography to report to radiolo-gist.


iii) Depending on institutional pro-cedures, performer noteswhether female patient is preg-nant, reviews date of femalepatient's last menstrual peri-od, or notes any other indica-tion tLat there is no danger ofexposure of a known or possiblefetus.

iv) Notes orders for prior prep-aration of patient such as ab-stinence from smoking, food,and drink, administration ofcleansing enema. May notewhether these have been carriedout.

f. If the performer determines thatthe request is not properly auth-orized, is incomplete, or thatsufficient information is lackingfor performer to select techniqueor to properly position or carefor patient, or if performer con-siders that there may be contra-indications to going ahead withthe procedure, performer bringsthis to attention of radiologistin charge. Explains the problemif appropriate, and proceeds afterobtaining needed information,signature, or orders.

g. If prior radiographs already onfile are to be presented withscout films, and if not alreadywith patient's jacketed material,performer arranges to have priorfilms delivered.


Task Code No. 382


List Elements Fully

Performer goes to appropriate roomfor the type of examination involvedand the equipment required, or notesroom assigned on requisition sheet.Prepares ahead so as not to keep pa-tient in examination room longer thannecessary:


prepared for the study involved ordecides to do personally: checksthat the barium sulfate colloidalsuspension has been prepared inthe appropriate consistency forthe study ordered. If appropriate,checks that each lumen of na:o-enteric tube to be inserted isaccurately identified. Checks thatwater is present to drink. Checksthat emergency cart is present.

c. Covers examination table with rub-ber sheeting and/or absorbent papersheet.

d. Checks that proper accessories areavailable for procedure includingleaded rubber shielding, aprons,and gloves to be used by performer,radiologist, the patient, and/oranyone who will remain in the roomduring exposure.

e. Checks that appropriate immobili-zation devices are present, andthat there is a mattress, pads,pillows and/or blankets for com-fort of patient.

f. Makes sure that right (R) andleft (L) markers are availablefor use and identification cards,or leaded numerals or markers.

g. For overhead filming performermakes sure that an adequate supplyof loaded cassettes are ave....lel-Ile

in the examination room. Selectsappropriate speed and type of film,grid, and cassette combination de-pending on whether a bucky or table

PList.EI.Ernents Fully

top tr,chnique will be use:i and

stam.lard institutional practices.Selts size based on patient'ssize and al. a of interest. Ifadequate supply is not in room,arranges to'obtain or decides toobtain personally.

h. Performer prepares for identifi-cation of overhead films usingequipment provided by institu-tion:




i. If examination will include spotfilming using a camera (attach,.ito image intensifier) and rollfilm, performer checks film sup-ply indicator to make sure thatthere is sufficient film in theroll film ca.zset:.e.

i) If .Lhere is insufficient rollfilm in camera, performer ar-ranges to have L'oll film cas-sette loaded, or decides todo personally.

ii) When loaded roll film cassetteis obtained, performe-i-checksloading in subdued light.Checks that end of film is cutcorrectly and is properly


Task Code No. 382



threaded and attached to take-up spool so that film unwindsappropriately. Checks thatfilm is properly engaged insprockets. Locks into operatingposition. If appropriate, cutsoff excess film at exit portand removes. Attaches film cas-sette to camera and locks intoplace. Replaces camera cover.


iv) Performer advances film to com-pensate for any exposure oftilm due to installation orcheck.


vi) If not already done, performerwrites or types a card withpatient's identification infor-mation for use with spot filmdevice. Inserts in slot in spotfilm camera as appropriate.

j. If examination will include spotfilming using a cassette/buckyspot film device, performer checksthat there is an adequate supplyof appropriate size cassettes inroom.


ii) Performer carries out identi-fication of the spot film cas-settes as for overhead films.

iii) Performer may use controls ormanually pull out spot filmbucky tray and open retainingclamps. Inserts cassette intobucky tray and pushes back.Makes sure clamps are closed.Moves cassette into appropriate

,,

"stored" position.iv) If R-L markers are to be used

with spot filming, performertapes into place on image in-tensifier screen or plans totape to patient's body.

k. If a grid will be used with theimage intensifier for fluoroscopyand/or spot filming, performerpositions and centers grid if notalready done. May use control but-ton or slides grid into position.May check that the grid is orient-ed toward the x-ray tube, withgrid lines parallel to the lorgaxis of the tube.

. Performer reviews technical expo-sure factors and sets for fluoros-copy and spot filming based onstandards set by the institution asappropriate for the examination in-volved:




i) Locates information for theprojections involved. Takesnote of the exposure factorsto be used for overheads,fluoroscopy, and spot filming.Considers preferences of theradiologist involved.

ii) Notes any newly posted changesin technical factors (to re-flect accommodation to a changein Machine output or a policydecision).


Task Code No. 382


List Elements Full111pMEIMENN=F=1I

iii) Performer checks any new or un-familiar exposure factors againstthe posted limits of the x-raytube on a tube rating chart tobe sure that technique does notexceed the heat capacities ofthe tube for the focal spot sizeto be used. If appropriate, per-former reconverts the techniqueto an equivalent output usinghigher kVp and lower.mAs.

d. In the control room, performermakes sure that indicator ligiv;shows that x-ray generator is"warned up" and ready for use.Makes sure that all circuits havebeen stabilized. If appropriate,checks line voltage meter and, ifneeded, turns compensator dial un-til needle is aligned properly online meter.

e. As appropriate, performer setsx-ray generator mode selector(s)to fluoroscopic mode' and for useof spot film camera or cassettedevice, and overhead filming.



ii) For cassette spot filming,per-former way select and set astandard spot film program pro-viding for format combinationssuch as single, half, or quart-er combinations on a single cas-sette and related spot filmsizes. Selects program appropri-ate for examination or awaitsorders from radiologist.

g. If not already done, performer con-nects TV monitor to power outlet.

List Elements Fullx___.

Turns on monitor and checks that"ready" light is on.

h. If appropriate, performer selectsthe proper field size. selector(if there is dual image intensi-fier).


i) Selects and sets the kVp atstandard setting for the ex-amination. May check indicatordial. With automatic densitycontrol, sets density selectoras appropriate for examination.

ii) If mA is automatically con-trolled according to patientthickness, performer turnsfluoroscope mA selector tomaximum standard position. Ifnot automatically controlled,sets as appropriate for focalspot size and examination in-volved.



i) For conventional manual expo-sure control, performer se-lects and sets the appropriatespot film time for the ex-amination.

ii) For automatic, phototimed ex-posure control, performer se-lects a density exposure con-trol appropriate for the ex-amination.

iii) Performer selects the appro-priate mA for the examinationand the focal spot size to beused.

iv) Performer selects and setskVp by combining settings onone major and one minor kVp


Task Code No. 382


List Elements Full

selector as appropriate for theexamination.

4. Performer returns to examination roomto set up x-ray and fluoroscopetube(s), image intensifier, colli-mator and accessories as appropri-ate for check of equipment prior toexamination:


object on radiography table I.:Herepatient's area of interest will becentered for examination.



e. Performer adjusts the x-ray tube toappropriate focal spot/object dis-tance (target to object distance,TOD). For fluoroscopy adjusts dis-tance between focal spot and imageintensifier (focal spot to filmdistance, FFD). Makes sure thatTOD is 15 inches or more. Operatescontrols or manually moves thex-ray tube(s) into place. Checksthe focal-film distance by read-ing indicator scale in the tubehousing; adjusts up or down untilthe required FFD is obtained.

f. Performer collimates fluoroscopytube (and x-ray tube used for spotfilming if different), dependingon nature of the equipment andcontrols:

i) Adjusts fluoroscopy beam shut-ters to the field size antici-

List Elements Fully__

pated for fluoroscopic examina-tion or sets shutter mode se-.lector to automatic collima-tion.

ii) Manually sets collimator forthe spot film field size tobe used,.or selecte and setsfield size control to be usedfor automatic collimation withprogrammed spot film cassetteexposure sequence.

g. If appropriafe, performer attachesor sets up f)otboard at end oftilt-table; may adjust or attachshoulder re:lt, hand grips, com-pression band.

If not already done, performerchecks functioniag of fluoroscopyequipment by ehtering remote controlroom or operating controls in ex-amination room behind leaded screen:


i) Performer adjusts kVp control(and mA control if appropri-ate) and observes effects onTV monitor to be sure thatequipment is operating prop-erly.



iv) Checks examination timer bynoting whether time elapse in-dicator moves during exposure


Task Code No. 382


showing decreasing time leftfor examination. May check thatexposure is terminated when max-imum examination exposure timeis reached.

b. To check spot film functioning, per-former may move cassette or rollfilm into x-ray exposure fieldusing appropriate controls.

i) Performer activates controls forspot film exposure. Noteswhether cassette or roll filmtransport is operating appropri-ately. Notes whether exposureis terminated by phototimer or,if manual timer, in time set.If appropriate, releases spotfilm control after exposure.

ii) If equipment is operating appro-priately, performer unloads cas-sette and reloads or advancesroll film as appropriate. Movesbucky out of way until fluoros-copy is completed.

c. Aftar equipment has been checked,perfo2.aer ,..tuta and resets for

. standard exposure factors. If per-former decides that any of theequipment is not functioningproperly, performer informs appro-priate staff member. Arranges foralternate unit to be used.

6. When fluoroscopy equipment has beenset up, performer may note whether apreliminary scout film has alreadybeen made of the patient's abdomen(done by another radiologic technolo-gist if work is organized in thi.way at institution).

a. If a scout film has already beenmade and viewed by radiologist,performer notes the technique usedor ordered and plans technical

factors for overhead radiography,adjusting for use of contrastmedium.

b. If a scout film has been made butnot apprcved, performer placesprocessed scout film and anyprior films with patient's chartor places on view boxes for reviewby radiologist.

c. If a scout film has not been madeand is required before patient isseen by radiologist, performerarranges to take a "plain film"of the abdomen in the standardAP position or as ordered. Plansto proceed as for plain film ra-diography after readying patient.


a. Performer washes hands as appro-priate. Depending on patient'scondition, may decide to arrangefor or carry out isolEtion ordecontamination techniques.

b. Performer has the patient calledfrom the holding area and pre-pared for the examinatior. (if notalready done), or decidEA to dopersonally.

c. Depending on institutional arranp,-ments, performer may decide toescort out-patient to or fromdressing room. May decide toassist in transporting patientfrom holding area or have thisdone.

d. Performer greets patient and anyaccompanying staff person and in-troduces self. Checks patient'sidentity against the requi_sitionsheet. With in-patient, checkshospital identification braceletor other identifier. If patientis accompanied because of ser-iousness of condition, performerchecks with accompanying staff


Task Code No. 382


List Elements tar.,

member on any specialnecessary during proc

e. Performer has patientfortable recumbent ortion, as appropriate.

precautionsedure.

assume a com-seated posi-

i) If appropriate, places mattress,pillow or clean linen on x-raytable. May place pad, blanketor pillow to support bony promi-nences to provide comfort forrecumbent patient.

ii) If patient is in wheelchair may-MO-ve patient in chair into po-sition next to table. Makes /

sure that wheelchair is in 1

locked position.iii) Performer may decide to assist

patient from wheelchair orstretcher to table or has thisdone. May obtain help. Makessure that no equipment is inthe way that may be collidedwith by patient.


v) If patient is on specialstzetcher, places stretcherinto position so that radio-lucent stretcher can be liftedwith patient on it from wheeledbase to x-ray table. May ar-range to move or have patientmoved to table.

f. If pati .-.1t already has a naso-enteric tube inserted,performertakes care not to dislodge tubeand proceeds directly to prepara-tions for instillation of contrastmedium by radiologist.

g. If not already done, has patient'sclothing removed and provides gownor drape. May assist patient or--

List Elements Failly

request assistance from nurse ifthere is critical illness in-volved. Permits patient to keepcovered with gown until measure-ments are taken and until expo-sure. Treats young patient withas much courtesy as adult.

h. Performer evaluates the patient'sbodily habitus to estimate thesize, shape and position of thestomach. Notes whether the areasof interest are heavily coveredby muscle or soft fat, whetherthe palpation points will be easyto find.

i. If patient has a wound, colostomy,ileostomy, or T-tube with dress-,ing to be removed, performerchecks whether zinc or iodoformpaste or radiopaque gauze isbeing used. If so, has appropri-ate staff member lemove dressingor tube or decides to do personal-ly (if appropriate). Checks thatradiopaque paste or gauze is com-pletely removed.

. If not already done, performer ex-plains to patient what will be in-volved in the procedure:

a. Depending on the examination tobe done, performer describes howthe nasoen-ceric tube will heinserted, and jhat coopenttionwill be requested of patient.May explain how to assist in pass-ing the tube by sitting erect,leaning slightly forward:Jr beingelevated on table. Performer mayexplain and reassure patient thatnausea may be a normal occurrenceduring the procedure.Performer may describe what theradiologist will be doing andthat overhead filming will bedone. Indicates what types ofpositions the patient will be


List Elements Full

Task Code No. 382


asked to assume. May demonstrateuse of tilt table and reassure pa-tient that he or she will be heldsafely.

b. If not already done,performer

checks that orders for prior prep-aration for study such as diet,abstinence from food, drink,andomoking have been carried out. Maycheck whether orders for priorevacuation or emptying of bladder(or keeping bladder full) havebeen given and carried out; ifnot already done, may arrange tohave micturition orders carriedout. Plans to notify radiologistif any prior orders have not beenLarried out.

c. If appropriate and not alreadydone, performer questions femalepatient of child bearing age re-garding possible pregnancy. Ifthere is any possibility that pa-tient is pregnant and this has notalready been recorded, performerplans to inform radiologist and toproceed only with approval.

d. Performer answers patient's non-medical questions honestly; at-tempts to reassure patient anddevelop confidence. Treats patientwith dignity and concern regard-less of patient's behavior. Re-mains aware that patitnit may befrightened and/or in pain. Perform-er explains, when asked medicalquestions, that it is not appro-priate for technologist to answerthese; encourages patient to speakto physician.

e. Unless mevurements have alreadybeen made, performer uses centi-meter calipers to measure thethickness of the abdomen in thedirection in which the centralray of the x-ray beam will passthrough the centered part fromtube to.film. Records for use in

List Elements Full

determining exposure factors foroverheads. After measuring, haspatient rest in as relaxed a po-sition as possible.

f. Performer may tape R or L mark-er to patient if appropriatefor use in spot filming.

g. If approeriate before radiolo-gist's examination, performerarranges to take a "plain film"scout a:.c1 have it processed atonce, ca- decides to do personally.Uses AP supine position unlessotherwise ordered.

h. Performer has patient blow nose(unless nasoenteric tube isalready inserted) to clear thepassages.

9. Performer informs attending radiolo-gist when patient is ready to beexamined. Brings requisition sheet,patient's medical history, chart,scout films (if already done) andany prior films,including progressfilms of nasoenteric tube,to ra-diologist. Displays radiographs onview boxes.

a. If not already done, performertells radiologist about any dif-ficulties encountered with re-gard to information, possiblecontraindications, or anythingelse that should be brought toradiologist's attention. Notesany special orders or change inprocedure decided by radiologist.Proceeds as ordered.

b. Performer may accompany radio-logist to examination room andintroduce patient to radiologist.

c. If not already done, performerawaits and carries out radiolo-gist's orders for scout film.Presents for review as descrih%aabove.


Task Code No. .382

This is page .1,0 of 16 for this task.


10. During radiologist's review of requi-sition, scouts, prior films and ex-amination of patient, performer notesradiologist's orders:-

a. If radiologist decides to cancel,procedure, performer arranges toterminate and reschedule as ap-propriate.

b. Performer notes whether radiologistrequires a change in technical fac-tors and/or patient positioning orcentering for later overhead film-ing.

c. Notes radiologist's orders forprogram ani settings for spot film-ine as appropriate.

d. Discusses sequence and timing ofprocedure with radiologist. Mayarrange signals for exposure,changing of spot film cassettes,operation of exposure controls.

e. Performer arranges to provide orchange any equipment or suppliesas ordered by radiologist.

f. If required, changes or adjuststechnical factors, program, and'settings as appropriate for flu-oroscopy and spot filming.

11. Performer assists radiologist withpreparations:

a. Washes hands as appropriate.b. Performer gives leaded gloves and

apron to radiologist. If appropri-ate, places leaded curtain inplace. Provides patient and every-one remaining in room during ex-posure with appropriate protectiveshielding. Explains if necessarythat this is not Cause for alarmbut a general precaution to mini-mize unnecessary radiation expo-sure.

c. On signal from radiologist, per-former may dim room lights. Turnson TV power switch. May go to con-

trol room and operate fluoroscopecontrols on orders from radiolo-gist. Adjusts kVp and/or mA con-trols according to radiologist'sorders.

d. If a nasoenteric tube is to beinserted, performer may lubricatecatheter tube on orders. May pro-vide glass of water for patientto drink to assist in swallowingtube. May help position patient.May provide emesis basin if need-ed.

12. After the nasoenteric tube has beenjudged by radiologist to be in place,performer may assist with contrastinstillation and spot filming:

a. May assist radiologist to preparesyringe with contrast mixture.May help position patient forfluoroscopic viewing.

b. Operates exposure controls asordered, or positions table, tube,or patient as ordered.

c. If spot film attachment uses cas-settes, performer may unload asused, identify, and insert addi-tional cassettes, as describedabove, throughout procedure.

d. May operate tilt-table on ordersfrom radiologist.

e. Depending on institutional proce-dures, performer may keep radio-logist informed of cumulative ex-posure as shown on fluoroscopetimer indicator.

f. Performer notes any orders for re-peat of any part of fluoroscopicexamination. Changes technicalfactors as ordered. Assists incontinued examination as describedabove,.repeating appropriatesteps.

g. With hypotonic duodenography per-former may assist with the hypo-tonic phase of examination:

4


Task Code No. 382



i) Washes hands as appropriate ob-serving sterile technique.

ii) If apprOpriate, performer openspacket of sterile gloves forradiologist, observIng steriletechnique so that wrapper, ownhands, or other objects willnot contaminate gloves,

iii) May assist by handing materialsasked for.

iv) May help prepare syringes.v) Assists with continued flu-

oroscopic examination and spotfilming as described above andagain after injection of aircontrast.

13. When the radiologist laforms perform-er that the fluoroscopic portion ofthe examination is over, performernotes orders for overhead filming:

a. Notes orders on area of interestfor centering, views, positions,whether series are ordered andtiming, special angulation oftable, breathing instructions.

b. May discuss with radiologist anyspecial precautions needed in pa-tient positioning to avoid in-juring patient.

c. May have radiologist fill out and/or sign requisition,sheet.

14. Performer explains to patient whatoverhead radiography will be doneand the positions that have been or-dered and then prepares for filmingas follows:

a. Performer obtains the appropriatesize loaded cassette for the first(or next) projection.


i) Places right or left marker onfilm holder or table-top asappropriate to the study andprojection or depresses appro-priate R or L button for auto-matic marking.

ii) If patient's identification in-formation is in the form oflead numerals, performer placeson appropriate corner of cAs-sette.

iii) If patient identification In-formation is to be entered byuse of flasher, sets flash cardaside for later use with spacecreated by piece of leaded rub-ber on appropriate edge of cas-sette.

iv) Performer may place patient'scard into card tray for equip-ment using automatic film mark-ing device%

,v) If exposure is part of a seriesplaces marker to indicate timeelapse or the number of the ex-posure within the series.

c. If cassette is to be used withbucky performer may manually pullout bucky tray and open retain-ing clamps. Inserts cassette intobucky tray and pushes back. Makessure clamps are closed. Movescassette into appropriate "stored"position or inserts cassette trayinto bucky slot and centers.

d. Performer sets or resets the ex-posure factors for the first (ornext) projection:

,


ii) Adjusts technical exposur6factors to account for instruc-tInns from radiologist based

,....., ....

482


Task Code No. 382



' on viewing of scout film anduse of contrast material.

iii) For conventional exposure con-trol, performer selects milli-amperage and sets selectors forthe correct focal spot size.Selects and sets the exposuretime that will produce the mAsdesired. Sets the kVp selectedby choosing the combination ofmajor kilovoltage and minorkilavoltage settings to pro-duce the desired kVp.

iV) For automatic phototimed expo-sure control, performer se-lects and sets the categorycorresponding to the type ofstudy and use or nonuse ofscreens, bucky, etc., and, ifappropriate, focal spot size.Selects and sets a controlcorresponding to the field size(as listed on technique chartfor phototiming).May select and set a kVp rangebutton (if called for withequipment) corresponding torange for examination.Sets a density selector corres-ponding to the usual (or spec-ial) requirements for the study.Makes sure backup timer is notlikely to terminate exposurebefore phototimed exposure ismade.

v) Depending on the equipment, mayset controls to provide for useof bucky, manual adjustment oftable and tube height, posi-tion, and of collimation, un-less these have already beenset.

15. Performer preparea patient for ,diefinal position ordered for the first(or next) exposure:

a. Keeps track of time elapse andreadies patient for each exposureas appropriate.

b. May explain or demonstrate topatient what is required. Mayobtain help in positioning.

c. If patient has a urinary catheterin place, performer turns pa-tient toward the catheter andtubing to prevent separating itfrom drainage bottle and break-ing sterile system and to avoidcausing pain.When positioning patient with aballoon catheter in place, per-former makes sure that the clampis not lying over a part to beexposed or that patient is notlying on the clamp.

d. Performer positions patient insupine AP position unless other-wise ordered. Arranges body sothat its median sagittal planeis centered to the midline oftable. Arranges shoulders to lieon a single transverse plane.Performer centers part and keelisthe long axis of the part par-allel to the film holder. Whenusing a bucky centers patientto midline and adjusts to thelevel of area of interest.

16. For an AP projection (posteriorview) of the fundus of stomach,antrum, posterior stomach wall,retrogastric portion of duodenumand jejunum, or to study grossdiaphragmatic herniations, perform-er notes orders for centering, bodyrotation and/or degree of Trendelen-burg angulation:

a. Performer positions patient inthe supine position either cen-tered to the midline or with asagittal plane passing halfwaybetween the median sagittal planeand left side of thorax at the

4 dti


Task Code No. 382



midline,as directed. Unless other- part. Adjusts the collimator open-wise ordered, centers film to the ing to correspond to the filmestimated level of the pylorus and size. Uses cross-hair shadows asincludes the pubic symphysis. reference for center of field.

b. For thin patient or if so ordered,performer rotates the body slightly

Checks that primary beam willenter the center of the area of

towards the left with right side interest at the selected angleagainst table and elevated side to the film so as to project thesupported. view desired.

c. May, if so ordered, tilt h:ad end c. Once the patient has been posi-of table down in a Trendelenburg tioned and immobilized, performerposition. As ordered, lowers the adjusts the collimator. Eitherhead end of table 100 to 15° or collimates so that a small unex-25° to 30°. posed border will appear around

d. Performer directs the central ray the edge"of the film or colli-at right angles to the midpoint mates further so as to exposeof the film. only the area of interest (and

e. Unless otherwise ordered rehearses thus provide maximum protectionpatient in breathing in and then and detail). For small fieldsbreathing out when ordered, and performer attaches an auxiliaryholding until told to relax. extension cone to collimator to

f. Throughout procedure performer re- further reduce the primary beam.mains alert for any symptom of Adjusts primary beam to minimumsevere pain or adverse reaction,especially to contrast medium. As

size needed to cover the area(s)of interest.

soon as performer judges that re- d. Performer adds lead shielding toaction may be severe, ceases expo- areas that will be in the primarysure and notifies radiologist or path of the beam but are not in-attending physician at once. cluded in the areas of interest.

Makes sure that proper protective17. Performer sets up for exposure after shielding has been provided to

positioning patient: patient and anyone who will re-main in room during exposure.

a. Performer sets the focal-film dis- e. When everything is ready for thetance if not already done as ap- exposure, performer reminds pa-propriate. Operates controls or tient: of the breath control tomanually moves the x-ray tube into be used for exposure. Observesplace. Checks the focal-film dis- the patient's movement until thetance by reading indicator scale moment that the exposure is made.in the tube housing; adjusts up Readjusts position if warranted.or down until the required FFD f. Performer returns to control room.(TFD) is obtained. Makes sure controls ate properly

b. Performer checks final positioning set, that equipment is set forby using light in collimator, radiogtaphy mode, and that pa-Activates the collimator light and tient is still in position. Callspoints the light beam towards the or uses intercom to instruct pa-

tient in breath control as re-hearsed.


Task Code No. 382


List Elements Fully

g. Performer makes exposure after thepatient has been instructed tobreathe out and hold,unless other-wise ordered.

18. Performer initiates exposure by press-ing hand trigger or exposure controlbutton.

a. While exposure is underway per-former checks that mA meter recordsappropriate current as set, that161,13 meter dips slightly.


c. With phototimer notes whether back-up timer has been involved in terminating exposure before phototimedexposure was completed. If so, anticipates possible need to repeat ex-posure.



f. kfter exposure removes cassetteand removes markers for furtheruse.

g. Repeats radiography for all theexposures ordered by radiologistin the time sequences ordered. Ad-justs technical factors, tube, andposition of patient or film hold-er if appropriate. Repeats identi-fication, collimation, shielding,orders for breath control and ex-posure as above.

List Elements Fully

19. Performer arranges to have spot filmsand overheads processed at once:



c. With cassette spot films and over7head exposures, removes any mark-ers for further use. Attaches IDcard for use with flasher if ap-propriate.


e. Performer arranges to have over-heads and spot films processed asthey are taken if appropriate,and/or decides to process per-sonally.

f. While films are being processed,makes sure that patient is com-fortable and, if necessary, at-tended by radiologist, staff mem-ber, or self.

g. Between serial Millings, performermay arrange to have patient takento appropriate holding area. Keepstrack of the tine elapsed.

20. When the overhead(s) and spot filmshave been processed and returned,performer places on view boxes. Mayalso hang scout and prior films. In-forms radiologist that radiograph(s)are ready for viewing.

a. Performer makes note of radiolo-gist's decisions regarding ade-quacy of the radiographs:

4


Task Code No. 382


List Elements Fullx.......eamk

List Elements Fully

to radiologist as processed,and proceeds as describedabove until radiologist indi-cates that examination is com-pleted.

21. When radiologiSt indicates radiog-raphy is completed, performer car-ries out termination procedures:

a. May assist radiologist in removalof nasoenteric tube.

b. May have patient cleansed; mayhave room and equipment cleaned;has any other appropriate cleanup procedures followed to avoidinfection or contamination, ordecides to do personally, depend-ing on institutional practice.Removes any markers from patient'sbody.

c. If appropriate, performer rein-forces instructions to patienton use or nonuse of cathartic,drinking liquids, mineral water.

d. May decide tc assist patient fromtable or to chair. Makes sure pa-tient is reminded of any footrestin stepping off table. Makes surethat none of the equipment is pro-jecting over the patient beforeallowing patient to rise fromstool or table, and assists pa-tient.

e. Performer may have patient trans-ported to next assigned location,or decides to do personally, asappropriate. If appropriate,makes sure that patient is in thecare of a staff person who willtransport to appropriate nextlocation or, if out-patient, willarrange to discharge or send pa-tient'home with escort as appro-priate.

f. Performer records the examinationaccordiAg to institutional price-dures. May include date, room,ex-aminarion type, the overhead Views

......,- n.

i) If radiologist decides to in-ject more contrast medium, per-former assists as above and withany fluoroscopy and spot film-ing. Repeats additional overheadradiography as ordered.

ii) If the radiologist indicatesthat there is any problem withthe technical factors or thepatient positioning for over-heads, performer records ornotes for use in "retakes."Notes whether need to repeatis due to performer's ownnegligence or lack of atten-tior so that performer cansidcie future "retakes." If re-quest for retakes reflects mal-functioning equipment, perform-er reports malfunction to ap-propriate staff member. If re-quest for retakes reflects thepreference for density or con-ttast of the radiologist, per-former notes for future use toavoid future "retakes."

iii) If radiologist requires addi-tional views and/or positions,performer repeats overhead film-ing as appropriate to new pro-jections, as described above.

b. For further overhead exposures per-former repeats appropriate steps in-,cluding identification of cassette;use of R-L and series markers, se-lection and setting of technique,positioning patient and equipmentfor focus-object-film alignment,collimation, shielding, breathing in-structions, making exposure, andprocessing, as described above,

i) Performer refrains from comment-ing on the films or providingany interpretation to patient.

ii) Performer shows subsequent setsof spot films and radiographs

TASK DESCRIPTION SHEET (contthlued)

Task Code No. 382



taken, the techniCal factors used,and film sizes. May record thenumber of exposures made of eachspot film and overhead view in-cluding retakes; may enter theestimated radiation dose to whichpatient was exposed (using postedinformation on dosage); may re-cord any problem with equipment,any special care provided patient.Signs requisition sheet.

g. Performer may record the fluoros-copy examination including expo-sure time and rad dosage.

h. May present requisition form toradiologist for comments and, sig-nature.

i. Performer may decide to jacketradiographs, requisition sheets,and related materials, and/or haveinformation recorded in log bookpersonally, or have this done,depending on institutional proce-dures.

j. May indicate to appropriate staffperson when the performer is readyto proceed with next examination.

.

-.

.

4 d


Task Code No. 383



Requisition reviewed;pt. reassured;parts measured;I

Performer receives or obtains

films identified;technicPi factors selected and 3et the x-ray requisition form, pa-

for fluoroscopy,spot filming,overheads;scouts taken;assistance given with insertion of enema tip,flow ofcontrast,positioning,fluoroscopy;pre-and post-evac-uation and air contrast exposures made;radiographssent for processing,taken to radiologist;procelituresrepeated as ordered;clean up arranged;pt. returned;examination recorded.radio raphs placed for use

2. WI= is used in performing this task? (Note

'if only certain items must be used. If there

is choice, include everything or the kinds of

things chosen among.)Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical-technical hIlstory,prior radiographs;scouts;view boxes;pen;x-ray generator,control panels,tube,bucky,table,collimator;fluoroscopy unit,image inten-sifier,spot film device,TV cionitor;cassettes;rollfilm;R-L,ID,markers;prepared barium enema;ballooncatheters or other air insufflator,syringe;tubes,clamps,rectal enema tips;colostomy dressings;bedpan;paper toweling;water-proof table covering;basin;antiseptic solutions;enema stand;phone;extensioncones;stool;calipers;upright holder;lead aprons,shielding;immobilizatiou devices;technique,standardview,tube rating and rad exposure charts;forms;phan-tom or test ob ect;stretcher or wheelchairintercom


1 es to q. : Name the ina o recipient,respondent or co-worker involved, with de-


Non-pediatric patient to have barium enema radiog-ra h radiologistico-worke

5. Name tKi-iask so that the answers to ques-tions 1-4 are reflected. Underline essen-

tial words.Taking barium enema radiographs of non-pediatric pt.by reviewing request;preparing equipment,pt.lreassur-ing;measuring;setting up for fluoroscopy,spot film-ing;arranging for scout films;setting.technical fac-tors;identifying films;providing shielding;insertingenema tip;assisting with flow of contrast,fluoros-

copy,spot filming,air contrast;taking pre-post-evac-uation and air contrast radiographs as ordered;ar-

ranging for processing,clean up;having pt.returned;placing radiogralhs for use;recording.

488

tient identification card, andany appropriate medical-techni-cal history for a non-pediatricpatient scheduled for a bariumenema atudy (radiographic studyof the large intestine, especially colon, using barium sulfateas contrast medium) as a result

of:

a. Regular nssignment.b. Checking assignment on sched-


. From co-worker.

Requisition may indicateorders for a routine studyand/or be focused on a par-ticular.area of interest.Depending ou institutionalarrangements, performer mayalso receive scout film and/or.prior, lilms.already takenby co-worker witt record pftechnical factors used and/orany changes necessary.

Performer reads the requisi-'tion sheet to dotermine theexamination called for, thepatient'involved, specialconsiderations, and to checkthe completeness of the in-formation provided:

a. Performer checks the ex-amination called for;notes whether a routinestudy is ordered or spe-cific purpose of study andany speCial requests.

OK-RP;RE;RR6. Check here i this

is a master sheet..41mmommommo

TASK.DESCRIPTION SHEET (continued)

Task Code No. 383


List Elements Fully

Notes whether an air contrast studyhas been ordered.

b. Notes the name of the radiologistin charge; may notz.: the name of the

referring cliniciar.c. Performer reads patient's name,

identification number, sex, age,weight, and height. Notes whetherpatient is in-patient, out-patient,or emergency patient. Notes anyspecial information or note onknown pathology that could affectpatient positioning, technique, orhandling such as presence of colos-tomy, any anal nbnormality, hemor-rhoids, acute symptoms. Noteswhether patient will be on astretcher or in a wheelchair. Note.whether the use of a grid or buckywill be involved,shielding needed.

d. Notes whether erect and/or recum-bent positioning is called for,the overhead views ordered. Notesside of interest for lateral oroblique views ordered.

e. Performer checks whether patientis suffering from a collateral con-dition requiring special handlingsuch as heart disease, communicableor infectious condition, infirmity,incoherence; whether patient has IVdrip, oxygen supply, urinary cathe-ter, T-tube or similar device inplace; notes whether patient willbe accompanied by nurse or otherstaff person, whether there areorders for removal of dressingsfrom the abdominal area.

f. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheet isconplete:

i) Depending on institutional pro-cedures, performer may reviewpatient's radiation exposurehistory, prior record of tezh-niques used, and cumulative ex-

posure. Notices whether exami-nation has been done elsewherein recent past, whether thereis history of extensive radi-ography to bring to radiolo-gist's notice.

ii) Checks whether any special or-ders on exposure factors arein keeping with the usuza raciexposure involved for thc: ex-

amination.iii) Depending on institutional pro-

cedures, performer noteswhether female pa:cfent is preg-nant, reviews date of femalepatient's last menstrual peri-od, or notes any other indi-cation that there is no dangerof exposure of a known or pos-sible fetus.

iv) Notes any . ders for priorpreparation of patient suchs prior diet, use or nonuse

of cathartic, abstinence fromfood for given period of time,use of cleansing enemas;

notes whether there is indica-tion that these have been car-ried out.

g. If the performer determines thatthe request is not properly auth-orized, is incomplete, or thatsufficient information is lackingfor performer to select techniqueor to properly position or carefor patient, or if performer con-siders that there may be contra-indications to going ahead withthe procedure, performer bringsthis to attention of radiologistin charge. Explains the problemif appropriate, and proceeds afterobtaining needed information, sig-nature, or orders.

h. If prior radiographs already onfile are to be presented withscout films, and if not alreadywith patient's jacketed material,

489


List Elements Fully

Task Code No. 383


performer arranges to have priorfilms delivered.

. Performer goes to appropriate roomfor the type of examiration involvedand the equipment required, or notesroom assigned on requisition sheet.Prepares ahead so as not to keep pa-tient in examination room longer thannecessary:


prepared for the study involved ordecides to do personally:

i) Dependiug on institutional pro-cedures and equipment,performerchecks that barium enema hasbeen nrepared in proper propor-tions or decides to do personal-ly. Hangs on standard or polenext to examination table. Ifnot already done, checks thatenema suspension is at propertemperature. If not alreadydone, attaches tubing and main-tains clamp in closed position.

ii) If a closed-system disposableenema kit is to be ueed, per-former has mixture prepared,air and excess water removedfrom bag, tube clamped,and mix-ture Shaken and kneaded beforehanging bag in place.

iii) Depending on information avail-able, performer may check thatappropriate rectal tip or re-tention catheter is provided.Checks for air Injection appara-tus, bedpan, water soluble lub-ricant, towels. May check thatlocal anesthetic is available

iv) If patient has colostomy, maycheck that device to preventstomal leakage is present.

v) If balloon catheter may be used,has it checked or decides tocheck personally.

List Elements Full

c. Performer makes sure that exami-nation table is provided withdisposable and/or waterproofunderpadding or decides to dopersonally. Cher.1 that emergency;.o.rt is present ol available.

d necks that propr.z.r accessoriestire available ror vocedure in-Auding leaded rubber shielding,aprons, and gloves to be used byperformer, radiologist, the pa-tient, and/or anyone who will re-main in the room during exposure.Checks that appropriate immobili-zation devices are present, andthat there is a mattress, pads,pillows and/or blankets fo-c com-fort of patient on examinationtable.

e. Makes sure Lhat rlght (R) andleft (L) markers are availablefor use and identification cards,or leaded numerals or markers.

f. For overhead filming performermak3s sure that an adequate nip-ply of loaded cassettes and an up-right film holder are availablein the examination room. Selectsappropriate speed and type offilm, grid and cassette combine-tiOn depending on whether a buckyor table top tBchnique will beused and standard iiistitutionalpractices. Selects size based onpatient's size and area of inter-est. If adequate supply is not inroom, arranges to obtain or de-cides to obtain personally.

g. Performer prepares for identifi-cation of overhead films usingequipment provided by institution:

i) May obtain lead numerals andtape and prepare identifica-tion strip for placement onfilm holder(s) giving appro-

490


Elements Full

Task Code No. 383


1111111111M,

priate patient identificationinformation.

ii) Performer may prepare for useof flashcard by checicing thatthere is piece of leau on filmholder surface; may write ortype out ID information on cardif noc received with requisi-tion.


h. If spot filming during examinationwill in-Jolve use of a camera (at-tached to image intansifier) androll film, performer checks filmsupply indicator to make sure thatthere is sufficient film in theroll film cassette.

i) If there is insufficient rollfilm in camera, performer ar-ranges to have roll film cas-settP 1ed, or decides todo personally.

ii) When loaded roll film cassetteis obtained, performer checksloading in subdued light.Checks that end of film is cutcorrectly and is properlythreaded and attached to take-up spool so ihat film unwindsappropriately. Checks thatfilm is properly engaged insprockets. Locks into operatingposition. If appropriate, cutsoff excess film at exit portand removes. Attaches film cas-sette to camera and locks intoplace. Replaces camera cover.

iiis/ If there is an adequate filmsupply, checks that film isproperly loaded.

iv) Performer advances film to com-pensate fn. any exposure offilm due to installation orcheck.

List Elements Fully



i. If spot filming during examinationwill involve use of a casEtte/bucky spot film device, performerchecks that there is an adequatesupply of appropriate size cas-settes in room.


ii) Performer Carries out identi-ficaticn of the spot film cas-sette as for overhead films.

iii) Performer may use controls ormanually pull out spot filmbucky tray and open retainingclamps. Inserts cassette intobucky tray and pushes back.Makes sure clamps are closed.Moves cassette into appropriate"stored" position.

iv) If R-L markers are to be usedwith spot filming, performertapes into place on image in-tensifier screen or plans totape to patient's body.

j. May position and center grid to beused with image intensifier andcheck that grid is oriented prop-erly.

. Performer.reviews and sets technicalexposure facnrs for fluoroscopy and

spot filming based on standards setby the institution appropriate fOrthe exaemation involved:

mmimelf

4 I


Task Code No. 383


List Elements Full


b. Makes sure that no one Is in ex-amination room or control room.


i) Locates information for theprojections involved. Takes noteof the exposure factors to beused for overheads, (pre- andpost-evacuation and air con-trast), fluoroscopy, and.spotfilming. Considers preferencesof the radiologist inyolved.


iii) Performer :becks any new or un-familiar expJsure factorsagainst the pocted limits cfthe x-ray tube on a tube matingchart to be sure that techniquedoes not exceed the heat capac-ities of the tube for the focalspot size to be used. If appro-priate, performer reconvertsthe technique to an equivalentoutput using higher kVp and low-er mAs.

d. Makes sure that indicacor lightShows nat x-ray generator is"warmd up".and ready for use.Makes sure that all circuits havebeen stabilized. If appropriate,checks line voltage meter and, ifneeded, turns compensator dial un-

til needle is aligned properly online meter.

e. As appropriate, performer setsx-ray generator mode selector(s)to fluoroscopic mode and for useof spot film camera or cassettedevice, and overhead filming.

List Elements Full


i) For spot film camera, perform-er selects and sets the rate(frames per se2ond) for thecamera according to standardsset for examination.

ii) For cassette spot filming per-former may select and set astandard spot film program pro-viding for format combinationssuch as single, half, or quart-er combinations on a singlecassette and related spot filmsizes. Selects program appro-priate for examination orawaits orders from radiolo-gist.

g. If not already done, performerconnects TV-monitor to power out-let. Turns on monitor and checksthat "ready" light is on.

h. If appropriate, performer selectsthe proper field size selector(if there is dual image intensi-fier).

i. Performer selects and sets expo-sure factors for fluoroscopy:.


ii) If mA is automatically con-trolled acdording to patientthickness, performer turnsfluoroscope mA selector tomaximum standard position. Ifnovautomatically controlled,gets as appropriate for focalspot size and examination in-volved.


List Elements Full

Task Code No. 383





ii) For automatic, phototimed ex-posure control, performerselects a density exposure con-trol appropriate for the ex-amination.



Performer returns to examination roomto set up x-ray and fluoroscopetube(s), image intensifier, colli-mator and accessories as appropriatefor check of equipment prior to ex-amination:




d. If not already done, moves imageintensifier and any spot film de-vice into position; centers (overor under) the rea of interest.

e. Performer adjusts the x-ray tubeto appropriate focal spot/object

List Elements Full

distance (target to object dis-tance, TOD). For fluoroscopy, ad-justs distance between focal spotand image intensifier (focal spotto film distance, FFD). Makes surethat TOD is .15 inches or more. Op-erates controls or manually movesthe x-ray tube(s) into place.Checks the focal-film distance byreading indicator scale in thetube housing; adjusts up or downuntil the required FFD is obtained.

f. Performer collimates fluoroscopytube (and x-ray tube used for spotfilming if different), dependingon nature of the equipment andcontrols:

i) Adjusts fluoroscopy beam shut-ters to the field size antici-pated for fluoroscopic exami-nation or sets shutter modeselector to automatic collima-tion.

ii) Manually sets collimator for'the spot film field size tobe used, or selects and setsfield size control to be usedfor automatic collimation withprogrammed spot film cassetteexposure sequence.

g. If appropriate, performer at-taches or sets up footboard atend of tilt-table; may adjustor attach shoulder rest, handgrips.

5. If not already done, performerchecks functioning of fluoroscopyequipment by entering remote con-trol room or operating controls inexamination room behind leadedscreen:

493


Task Code No. 383



a. To check fluoroscopy mode, perform- bucky out of way until flu-er turns on TV power switch con-trols as appropriate. Activatesfluoroscope exposure by pressingfootswitch or as appropriate,

oroscopy is completed.

c. After equipment has been checked,performer shuts and resets for

Views test object being fluoro- standard exposure factors. Ifscoped on TV monitor. performer decides that any of

the equipment is not functioningi) Performer adjusts kVp control properly, performer informs ap-

(and mA control if appropriate) propriate staff member. Arrangesand observes effects on TV moni- for alternate unit to be used.tor to be sure that equipment

.

is operating properly. 6. When fluoroscopy equipment has beenii) Checks mA meter and notes set up, performer may note whether

whether appropriate reading a preliminary scout film has alreadyis obtained,

iii) Performer checks that TV bright-been made of the patient (done bya co-worker if work is organized in

ness controls are operating andadjusts for preliminary viewing.

iv) Checks examination timer bynoting whether time elapse in-

this way at the institution).

a. If a scout film has already beendicator moves during exposureshowing decreasing time left

made and viewed by radiologist,performer notes the technique

for examination. May check that used or ordered and plans techni-'exposure is terminated when cal factors for overhead radiog-maximum examination exposure raphy, adjusting for use of bar-

time is reached. ium contrast medium.b. If a scout film has been made

b. To check spot film functioning, per- but not approved, performerformer may move cassette or roll places processed scout film andfilm into x-ray exposure field any orior films with patient'susing appropriate'controls. chart or places on view boxes

for review by radiologist.i) Performer activates controls c. If a scout film has not been

for spot film exposure. Notes made and is required before pa-whether cassette or roll filmtransport is operating appro-

tient is seen by radiologist,performer arranges to take a

priately. Notes whether expo- "plain film" of the abdomen insure is terminated by phototimer standard AP position or as or-

or, if manual timer, in time dered. Plans to proceed as for

set. If appropriate, releases plain film radiography afterspot film control after expo-sure.

ii) If equipment is operating appro-

readying patient.

7. Performet readies patient for exami-priately, performer unloads nation by radiologist:cassette and reloads or advancesroll film as appropriate. Moves

494


This is page

Task Code No. 383

8 of 22 for.this task.


a. Performer washes hands as appro- i) If patient is in wheelchair may

priate. Depending on patient's move patient in chair into po-

condition, may decide to arrange sition next to table. Makes

for or carry out isolation or sure that wheelchair is in

decontamination techniques. locked position.

b. Performer has the patient called ii) Performer may decide to assist

from the holding area and prepared patient from wheelchair or

for the examination (if not al-ready done), or decides to do per-

stretcher to table or has thisdone. May obtain help. Makes

sonally. sure that no equipment is in

c. Depending on institutional arrange- the way that may be collided

ments, performer may decide to with by patient.escort out-patient to or from iii) If assistimg patient to stepdressing room. May decide to as- on footstool in order to get

sist in transporting patient from on table, helps patient turnholding area or have this done. into position, step backwards

d. Performer greets patient and any on stool, and then sit and/or

accompanying staff person and in- lie on table.

troduces self. Checks patient's iv) If patient is on special

identity against the requisition stretcher, places stretcher

sheet. With in-patient, checks into position so that radio-

hospital identification bracelet lucent stretcher can be lifted

or other identifier. If patient with patient on it from wheeled

is accompanied because-of ser- base to x-ray table. May ar-

iousness of condition, performer range to move or have patient

checks with accompanying staff mem- moved to table.

ber on any special precautionsnecessary during procedure. g. Performer evaluates the patient's

e. If not already done, has patient's bodily habitus to estimate the

jewelry and clothing removed and size, shape and position of the

provides gown or drape with open- abdominal organs and variations

ing in back (or as appropriate in location between erect and re-

for location of colostomy). May cumbent positions for later cen-

assist patient or request assist- tering. Notes whether the areas

ance from nurse if there is a of interest are heavily covered

critical illness involved. Per- by muscle or soft fat, whether

mits patient to keep covered with the palpation points will be easy

gown until measurements are taken to find. Notes whether the extre-

and until exposure. Treats young mities are of unequal length.

patient with as much courtesy as Notes whether patient is extreme-

adult. ly wide in abdaminal area and

f. If not already done, may place pad- will require two exposures for

ding and waterproof covering on views ordered, one centered to

table. Has patient assume a comfort- include the diaphragm and the

able recumbent or seated position,as appropriate,

second centered to include therectal area, with films placedtransversely.

495

eTASK DESCRIPTION SHEET (continued)

Task Code No. 383


List Elements Fully

1

8. If not already done, performer pre-ares patient for the procedure:

h. If patient has 2 wound, colostomy,ileostomy, or T-tube with dressingto be removed, performer arrangesto have this done or decides to dcpersonally usIng sanitary techni-que. If zinc or itioform paste oz.radiopaque gauze is being used, per-former checks that radiopacue pasteor gauze is completely re:gloved.Checks that patient has a freshdressing available; may supply atemporary dressing for use untilenema tip is inserted.

i. If patient is to be radiographedin erect position, performer ad-justs vertical film holder to ap-propriate height for patient andmoves out of the way until needed.

a. Performer explains the process ofinstilling the barium mixture. Mayindicate that some cramping mayoccur. indicates the positions pa-tient will be in, tube 1.--ertion,and what instructions radiologistmay give to direct the flow of thebarium.

i) Performer instructs patient inkeeping the anal sphincter con-tracted against rectal tube tohold it in position and retainenema.

ii) May rehearse patient in deeporal breathing to ease cramping.Assures patient that enema willbe stopped if cramping is se-vere.

iii) Indicates to patient how enemawill be evacuated (returned byway of tube with disposablekit, or use of basin,and/orgoing to bathroom).

b. Performer stresses importance ofretaining enema until told to

List Elements Fully_

evacuate. May question patientto determine whether patient is'able to retain an enema; plansto report information to radio-logist.

C. Explains what the radiologist andperformer will be doing, the spotfilming, overhead filming withenema retained, evacuation, post-evacuation filming and possibleuse of air contrast enema, withneed to use anal sphincter toretain air.

d. Performer assures patient aboutprivacy and the assistance thatwill be available to patient toavoid embarrassment if patientcannot retain enema.

e. If patient is suffering from in-flamed anus, hemorrhoids, oranal abnormality, performer mayhave patient lie in prone, knee-chest position while performerapplies local anesthetic such assuppository and/or salve. Mayhave this done or have patientapply personally. Performer usesgloves or supplies gloves anddiscards after use. Washes hands.

f. Performer may demonstrate howtilt-table will be used and re-assure patient that he or shewill be held safely.

g. If not already done, performermay question patient to checkthat prior preparations werecarried out. If not, may arrangeto have these done or plans tonotify radiologist.

h. As appropriate and if not alreadydone, performer questions femalepatient of child bearing age re-garding possible pregnancy. Ifthere is any possibility that pa-tient is pregnant and this hasnot already been recorded, per-former plans to inform radiolo-gist and to proceed only withapproval.


Task Code No. 383

This is page 10 of 22 for this taslc.


k. Performer may tape R or L marker

ip.a.e......notm.

i. Performer answers patient's non-medical questions honestly; attempts to patient if appropriate for useto reassure patient and develop in spot filming.confidence. Treats patient with 1. If appropriate before radiolo-dignity and concern regardless of gist's examination, performer ar-patient's behavior. Remains aware ranges to take "plain film" scoutthat patient may be frightened of abdomen and have processed atand/or in pain. Performer explains,when asked medical questions, that

once, or decides to do personally.Uses standard AP supine position

it is not appropriate for techno- centered to iliac crest,or fol-logist to answer these; encourages lows special orders or standardpatient to speak to physician.

j. Unless measurements have alreadybeen made, performer uses centi-

institutional procedure.

9. Performer informs attending radiolo-meter calipers to measure the gist when patient is ready to be ex-

thickness of the abdomen in the amined. Brings requisition sheet, pa-directions in which the centralray of the x-ray beam will pass

tient's medical history, chart,scout film.(if already done) and any

through the centered part from prior films to radiologist. Displaystube to film. If both recumbentand erect positioning will be

radiographs on view boxes.

used for radiography of abdominal a. If not already done, performers.contents, performer measures or tells radiologist about any dif-estimates thickness in both po- ficulties encountered with re-

sitions. gard to information, possiblecontraindications, or anything

i) In locating iliac crest, per- else that should be brought toformer is careful not to cen- radiologist's attention. Notester too high by making sure any special orders or change innot to confuse the iliac crest procedure decided by radiologist.

with the heavy muscles im- Proceeds as ordered.mediately above the crest. May b. Performer may accompany radiolo-have patient inhale deeply and gist to examination room and in-

breath out; then palpates the troduce patient to radiologist.

point of the crest while the c. If not already done, performermuscles are relaxed. awaits and carries out radiolo-

ii) If performer believes that pa- gist's orders for scout film andtient will be embarrassed by proceeds as appropriate. Presentspalpation of the symphysis processed scout for review as

pubis, uses the most prominentpoint of the greater trochanterto locate the same transverse

described above.

10. During radiologist's review of requi-

plane. .sition, scout, prior films and ex-

iii) Records measurements for deter- amination of patient, performer notes

mining exposure factors for over- radiologist's orders:

heads.iv) After measuring, has patient a. .If radiologist decides to cancel

rest in as relaxed a positionas possible.

procedure, performer may arrange

4


Task Code No. 383


List Elements FullT List Elements Fully

11.

to terminate, record,and resched-ule as appropriate. May reinforcepatient in proper preliminarypreparation for examination orhave this done.

b. Performer notes whether radiolo-gist requires a change in techni-cal factors and/or patient posi-tioning or centering for lateroverhead filming.

c. Notes radiologist's orders forprogram and settings for spotfilming and/or technical factorsfor fluoroscopy. Sets or changesas appropriate,

d. Performer notes radiologist'sorders on use of simple rectalenema tip, use of balloon cathe-ter or other retention device,probable use of air contrast. Ar-ranges to provide any equipmentmissing or to be changed. If bal-loon catheter is to be used,makes sure that it has been checkedfor defects.

e. Readjusts height of enema on standif so ordered.

f. Discusses sequence and timing forprocedure with radiologist. Mayarrange signals for flow of enema,exposure, changing of spot filmcassettes, operation of exposurecontrols.

Performer prepares for insertion Ofenema:

a. Performer gives leaded gloves andapron to radiologist. If appro-priate, places leaded curtain inplace. Provides patient and every-one remaining in room during ex-posure with appropriate protec-tive shielding. Explains if neces-sary that this is not cause foralarm but a general precaution tominimize unnecessary radiation ex-posure.

b. Washes hands as appropriate anddons gloves.

c. Performer unclamps enema tube andallows the barium to run-out intobasin to expel air; reclamps.

d. Performer lubricates rectal tip,balloon catheter tip, or stomalcatheter tip with water solublelubricant.

e. If performer will position pa-tient for enema, performer as-sists patient to lie prone ontable, and then turn onto leftside, lean forward, and -draw upright knee and thigh, with leftknee slightly flexed. Reassurespatient. May adjust lamp.

f. Has patient with colostomy lieon back.

g. Adjusts gown to expose only anusor stoma. Waits while radiologistinserts stomal catheter.

h. If performer will insert rectaltip or balloon catheter tip, per-former proceeds as follows:

i) May place rectal tube or bal-loon tip in fold of severalsheets of paper toweling.

ii) Exposes anus and inspects con-dition, such as presence of

..

hemorrhoids, so as to antici-pate correct insertion tech-nique.

iii) Reassures patient and haa himor her relax anal sphincter.

iv) Pushes right buttock upwardto open gluteal fold.

v) On relaxed exhalation of pa-tient, performer slowly in-serts catheter or rectal tipinto anal opening, forward forabout an inch, then followingcurve of rectum, slightly back-ward. Inserts no more than fourinches.

.

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Task Code No. 383



vi) If patient indicates severe painor if performer cannot inserttip easily, performer informsradiologist at once.

vii) If balloon catheter ts to be

used,inserts and indicates whentip has been inserted in rectum.Waits while radiologist in-flates the catheter balloon byattaching syringe to balloonlumen and injecting water or airto inflate balloon inside rec-tum. May indicate to radiolo-gist when catheter is being heldin place. May clamp off lumenand disconnect syringe. Insertsa self-sealing device or usesclamp.

i. If radiologist has inserted stomalcatheter, performer may supply ad-hesive and/or toweling to holdstomal catheter in place. May at-tach tubing of enema container tostomal catheter. May assist whileradiologist adjusts stomal c!eviceso that patient can hold it inposition between buttocks.

j. Once rectal tip has been inserted,performer holds tube in place andassists patient to turn to supineor prone position as ordered. Per-former adjusts underpadding andadjusts tubing to ensure free flowof enema mixture.

12. Performer assists radiologist withenema flow and fluoroscopy:

a. Removes gloves and washes hands asappropriate. May put on freshgloves.

b. On signal from radiologist, per-former may dim room lights. Turnson TV power switch. May go to con-trol room and operate fluoroscopecontrols on orders from radiolo-

4

gist. Adjusts kVp and/or mA con-trols according to radiologist'sorders.

c. Performer stands to the right ofradiologist and controls the flowof the barium sulfate mixture asordered. Opens clamp and reclampsas ordered. Checks that enema isflawing. Reassures patient andreminds patient to retain enema.

d. If appropriate, lowers enema bagor can on orders to relievepressure on patient. If appropri-ate,provides basin for patient torelieve pressure. Carries out ap-propriate sanitary clean-up stepsas required if there is soiling.

e. Performer may assist radiologist,-Ith spot filming:

i) Operates exposure controls asordered, or positions table,tube, or patient as ordered.

ii) If spot film attachment usescassettes, performer may un-load as used, identify, andinsert additional cassettes,as described above, throughoutprocedure.

f. Performer may help radiologistto position patient. May operatetilt table on orders from ra-diologist.

g. Depending on institutional proce-chl.res, performer may keep radio-logist informed of cumulative ex-posure as shown on fluoroscopetimer indicator.

h. Performer notes any order for re-peat of any part of fluoroscopicexamination. Changes technicalfactors as ordered. Assists incontinued examination as de-scribed aboveiTrepeating appro-priate steps.

711MM


Task Code No. 383



1 . When the radiologist informs perform- iv) Performer may place patient'ser that the fluoroscopic portion of card into card tray for equip-the examination is over, performer ment using automatic filmnotes orders for immediate overheadfilming with enema retained and post-evacuation films. Notes whether stan-

marking device.

c. If cassette is to be used withdard views and positions are ordered bucky (under tabletop or in up-and/or special views and positions. right holder) performer may man-Notes orders for recumbent or sitting ually pull out bucky tray andpositions. open retaining clamps. Inserts

cassette into bucky tray anda. May discuss with radiologist any pushes back. Makes sure clamps

special precautions needed in pa- are closed. Moves cassette intotient positioning to avoid injuring appropriate "stored" position orpatient. inserts cassette tray into bucky

b. May have radiologist fill out and/or slot and centers.sign requisition sheet. d. Performer may place cassette in

upright holder at right angles14. Performer explains to patient what to table top or in other posi-

overhead radiography will be done and tion selected.quickly prepares for filming as fol- e. Performer sets or resets the ex-lows: posure factors for the first

(or next) projection:a. Performer obtains the appropriate

, size loaded cassette(s) for the i) Enters control room and setsfirst (or next) projection(s). control for radiography mode.

b. Performer attaches identification ii) Adjusts technical exposureinformation to the cassette(s) or factors to account for in-table top: structions from radiologist

based ell viewing of scouti) Places right or left marker on

film holder or table-top as ap-film, use of barium contrast,and/or measured change of

propriate to the study and pro- thickness of abdomen betweenjection or depresses appropri- erect and recumbent position-ate R or L button for automatic ing, extreme fat or muscu-marking. larity.

ii) If patient's identification in- iii) For conventional exposure con-formation is in the form of trol, performer selects milli-lead numerals, performer places amperage and sets selectorson appropriate corner of cas- for the correct focal spotsette. size. Selects and sets the.ex-

iii) If patient identification in- posure time that will produceformation is to be entered by the mAs desired. Sets the kVpuse of flasher, sets flash selected by choosing the com-card aside for later use with bination of major kilovoltagespace created by Piece of lead- and minor kilovoltage setting?.ed rubber on appropriate edgeof cassette.

to produce the desired kVp.

500


Task Code Nn. 383


List Elements FullyMINII11111)- List Elements Fullx___

so that its median sagittal planeis centered to the midline oftable or film holder.

iv) Frr automatic phototimed expo-sure control, performer selectsand sets the category correspond-ing to the type of study and useor nonuse of screens, bucky,etc., and, if appropriate, focal

i) Has supine patient place armsin a comfortable position and

spot size. Selects and sets a supports.ankles and knees.

control corresponding to thefield size (as listed on.tech-

ii) Has prone patient flex elbows,place arms in a comfortable

nique chart for phototiming). position. Supports ankles.

May select and set a kVp range Rests patient's head on fore-

button (if called for with equip- head and nose. May have.pa-

ment) corresponding to range forexamination.

tient rest hands beneath chest.

Sets a density selector corres- e. For lateral positioning has me-

ponding to the usual (or spec- dian sagittal plane parallel with

ial) requirements for the study. midline. If recumbent, supports

Makes sure backup timer is not any elevated parts.

likely to terminate exposure f. With all positions arranges

before phototimed exposure is shoulders to lie on a single

made. transverse plane.

v) Depending on the equipment, may g. Performer centers part and keeps

set controls to provide for use the long axis of the part par-

of bucky, manual adjustment of allel to the film holder. When

table and tube height, position,and of collimation, unless these

using a bucky, centers patient tomidline. With cassette on table

have already been sel.. top, centers film to part. Withupright holder adjusts height of

15. Performer prepares patient for the holder to part and centers part

final position ordered for the first(or next) exposure. Makes sure thatcorrect side is being positioned when

to film..

i) Performer may judge the point

appropriate. for centering based on the pa-tient's type of body (habitus)

a. May explain or demonstrate to pa- and the evidence of the scout

tient what is required. May ob- film. If both erect and recum-

tain help in positioning.b. Performer is careful to turn pa-

bent positions are ordered,centers somewhat lower for

tient towards the enema tubing so erect positioning than for re-

as not to dislodge tip. cumbent positions, allowing

c. When positioning a patient with a greater change for thin, as-

balloon catheter in place, per- thenic patient.

former makes sure that the clamp is ii) In centering to the level of

not lying over a part ,.o be exposedor that patient is not lying on the

the iliac crests performermakes sure not to use visucl

clamp,d. For frontal positions (AP or PA)

points of muscle or fatty tis-sue and palpates for the crest

performer adjusts patient's body of the bone.

5 u


Task Code No. 383


rh. Notes any orders for rotation ofbody, angulation of table or cen-tral ray.

16. Performer positions as follows depend-ing on orders:

a. For standard supine AP projection(posterior view) of large intes-tine, performer decides whether,to use a single cassette or whethertwo cassettes placed crosswisewill be required (for wide patient):

i) Centers two cassettes so that'the first is high enough to in-clude.the splenic flexure andthe second is low enough to in-clude the rectum.

ii) Centers a single cassette atthe level of the iliac crests,somewhat higher for hypersthe-nic (large, obese) patients andsomewhat lower for asthenic(thin) patients).

iii) For a localized view of therectum and rectosigmoid junc-tion,centers at the level ofthe upper border of the pubicsymphysis.

iv) Directs central ray at rightangles to midpoint of film.

v) If two exposures are to bemade, performer has patienthold position for second expo-sure.

b. For erect or prone PA projection(anterior view) of large intestine,performer positions patient inprone or standing position facingfilm holder:

i) For erect position, has patientstand facing erect verticalcassette holder or tabl- cen-tered to the midline, ai withweight equally distributed. Has

List E1ements...Fu11y

patient extend arms along sidesof holder and grasp edges. Cen-ters cassette just below thelevel of the iliac crests f.1-justing for body type. Includesthe splenic flexure.

ii) For prone position supportsankles. Has patient rest headon chin. Centers film as de-scribed above but somewhathigher to account for body typeand shift in centering fromerect to recumbent position.

iii) Directs central ray at rightangles to midpoint of film.

c. For Trendelenburg views of over-,lapping loops of the large bowel,performer positions patient inthe supine position or rotatedslightly as ordered. Tilts headend of table down 300 to 40°. Cen-ters film to the area of interestor at the level of the iliaccrests. Directs central ray atright angles to midpoint of film.

d. For a lateral projection of rec-tum and rectosigmoid, performernotes which side of the patient'sbody is to be next to film holder,and has patient lie on that sidein a lateral recumbent position.Has patient flex knees comfort-ably.

i) Centers the coronal planepassing about 2 inches behindthe midaxillarY line of bodyto the midline.

ii) Places supports under and be-tween knees and ankles. Haspatient flex elbows, placelower hand under head, andhas patient grasp side oftable with opposite hand.

iii) Centers film about two inchesabove the level of the pubicsymphysia.


Task Code No. 383

This is page 16 of 22 for this. task.

List Elements Full

iv) Directs central ray at right an-gles to midpoint of film.

v) For patients who cannot assumelateral recumbent position, per-former adjusts patient in semi-erect position by starting withsupine position. Attaches foot-rest to end of table and securespatient. With patient on table,performer moves it to almostvertical position. Centers cas-sette in vertical film holderon right or left side of patient(depending on the side of in-terest). Directs central rayhorizontally at right angles tothe midpoint of the film, regard-less of the angulation ci thetable.

e. For AP projections (posterior views)to demonstrate selected intestinalareas, performer notes prescribedcentral ray angulation.

i) Positions patient in supine po-sition as described above.

ii) For rectosigmoid and sigmoidareas, centers film at the levelof the anterior superior iliacspines. Directs central ray at350 to 45° cephalad to midpointof film.

iii) For rectosigmoid area, centersfilm to a po4 - about 1 inchabove the upper border of thepubic symphysis. Directs cen-tral ray at 12° caudad to mid-point of film.

f. For oblique projections of intes-tine,notes whether anterior obliquenrojections are ordered or poster-ior oblique projections,and the sideuf interest; notes.whether bilat-eral views are ordered. Performermay substitute right PA oblique

List Elements Fully

projection for left AP obliqueprojection and/or left PA obliqueprojection for right AP obliqueprojection as appropriate to thepatient's condition.

i) For anterior (AP) oblique pro-jections (posterior obliqueviews) performer starts withpatient in supine position.

ii) For a left AP oblique projec-tion of the rectosigmoidjunction and the sigmoid, ro-tates the supine body 30° to35° and supports the elevated(right) side. Centers to apoint at the level of the an-terior superior iliac spines.Directs central ray at 30° to35° cephalad or as ordered.

iii) For a left AP oblique projec-tion of the hepatic flexureand adjacent portions of theproximal colon, performer po-sitions and centers as in (i5.),above, but rotates the body45° and directs the cent-alray at right angles to mid-point of film.

iv) For a right AP oblique projec-tion of the splenic flexureand the adjacent transverseand descending portions of thecolon, performer rotates thesupine body 45° and supportsthe elevated (left) side. Cen-ters to a point at the levelof the anterior superior iliacspines. Directs central rayat right angles to midroint offilm.

v) For posterior (PA) obliqueprojections (anterior obliqueviews) performer starts withpatient in prone position.


Task Cede Nn. 383



vi) For a right PA oblique projec-tion of the hepatic flex.lre andadjacent portions of tha colon,performer positions prone patientwith head resting on right cheekand right arm alongside body.Rotates body so that left sideis elevated 450 Has patientsupport himself or herself onleft forearm and flexed knee.Centers patient so that a longi-tudinal plane halfway between

1 the spinal column and the an-terior left surface is at themidline. Centers to the levelof the iliac crest. Performerdirects central ray at rightangles to midpoint of film.

vii) For a left PA oblique projec-tion of the splenic flexure andthe left sided portions of thecolon, performer positions asin (vi), above, but rotates toopposite side so that rightside is elevated 45° Centers.

film to the anterior right sur-face at the _Level of the iliaccrest.

g. Performer rehearses patient inbreath control such as breathingin deeply, breathing out, and hold-ing breath (suspended exhalation)when ordered. Reinforces encour-

. agement to retain enema.

17. Throughout procedure performer re-mains alert for any symptom of severepain or adverse reaction, especiallyto contrast. As soon as performerjudges that reaction may be severe,ceases exposure and notifies radio-logist or attending physician at once.

18. Performer sets up for exposure afterpositioning patient:

a. Performer sets and cher!ks thefocal-film distance if -.ot al-rearlr done,as appropriate. Checksy reading indicator scale in theb

tube housing; adjusts up or downuntil the required FFD (TED) isobtained.

b. Performer checks final position-ing by using light in collimator.Activates the collimator lightand points the light beam towardsthe part. Adjusts the collimatoropening to correspond to the filmsize. Uses cross-hair shadows asreference for center of field.Checks that primary beam will en-ter the center of the arsa of in-'terest at the selected angle tothe film so as to project theview desired.

c. Once the patient has been posi-tioned and immobilized, perform-er adjusts the collimator. Eithercollimates so that a small vilex-posed border will appear aroundthe edge of t!le film or colli-mates further so as to exposeonly the area of interest (andthus provide maximum protectionand detail). For small fieldsperformer attaches an auxiliaryextension cone to collimator tofurther reduce the primary beam.Adjusts primary beam to minimumsize needed to cover the area(s)

I)

of interest.d. Performer adds lead shielding to

areas that will be in the primarypath of the beam but are not in-cluded in the areas of interest.Makes sure that proper protectiveshielding has been provided topatient and everyone who will re-main in room during exposure.

e. When everything is ready for theexposure, performer reminds pa-tient of the cooperation andbreath control to be used for

504


Task Code No. 383


List Elements Full

exposure. Observes the patient'smovement until the moment thatthe exposure is made. Readjustsposition if warranted.

f. Performer returns to control room.Makes sure controls are properlyset, that equipment is set forradiography mode, and that patientis still in position.Calls or uses intercom to remind_patient of breathing instructionsas rehearsed and to retain eLema.

g

19. Performer makes exposure after thepatient has been instructed to breatheout and hold unless otherwise ordered.Performer initiates exposure by press-ing hand trigger or exposure controlbutton.

a. While exposure is underway perforn-er checks that mA meter recordsappropriate current as set, thatkVp meter dips slightly.


c. With phototimer notes whether back-up timer has been involved in ter-minating exposure before photo-timed exposure was completed. Ifso, anticipates possible need torepeat exposure.

d. After exposure is completed tellspatient that he or she can relaxbut retain enema. If two cassettesare being used for a given pro-jection has patient maintain posi-tion while performer centers tubefor second exposure.

e. If the exposure is terminated by acircuit breaker, rechecks techni-cal factors for possible overload

List Elements Fully

or checks for overload elsewhereon circuit. Anticipates need torepeat exposure.

f. After exposure removes cassette.and removes markers for furtheruse.

Repeats radiography for all theexposures ordered by radiologist,adjusting technical factors, tube,table, and/or position of patientor film holder as appropriate toeach view ordered Repeats iden-tification, collimation, shield-ing, orders for breath control,and exposure as above.

g.

20. Performer arranges to have spot filmsand overheads processed at once:



c. With cassette spot films and over-head exposures removes any mark-ers for further use. Attaches IDcard for use with flasher if ap-propriate.


e. Performer arranges to have over-heads and spot films processedat once if appropriate or decidesto process personally.

f. While films are being processed,makes sure that patient retainsenema, is comfortable and, ifnecessary, attended by radiolo-gist, staff member, or self. Mayarrange to have enema repeated ifpatient cannot retain enema.

11IMINNIMulrov


Task Code No. 383

This is page lq of 92 for this task.

List Elements Full List Elements Fullx...

21. When the overheads and spot films have iv) Performer refrains from com-been prcessed and returned, perform- menting on the films or pro-er places on view boxes. May also viding any interpretation tohang scout and prior films. Informs patient.radiologist that radiograph(s) are vi) Performer shows subsequent setsready for viewing. of radiographs to radiologist

as processed, and proceeds asa. Performer makes note of radiolo-

,

described above until radiolo-gist's decisions regarding ade- gist indicates that this stagequacy of the radiographs: of examination is completed.

i) If the radiologist indicates b. When radiologist indicates thatthat there is any problem with radiography with enema retainedthe technical factors or the is completed,performer notes or-patient positioning for over- ders for evacuation, post-evad- .

heads, performer records or uation radiographs and whethernotes for use in "retakes." a double contrast study will fol-Notes whether need to repeat low with instillation of air. Ifis due to performer's own appropriate,has radiologist fillnegligence or lack of atten-tion so that performer canavoid future "retakes." If re-

out or sign requisition order.

22. Performer returns to patient and ex-quest for retakes reflects mal- plains what will happen next. Indi-functioning equipment, perform- cates that patient can now expeller reports malfunction to ap- the enema and that post-evacuationpropriate staff member. If re- film and air contrast enema (if or-quest for retakes reflects thepreference for density or con-trast of the radiologist, per-

dered) will follow.

a. If the enema apparatus involvesformer-notes for future useto avoid future "retakes."

a closed system disposable kit,performer lowers enema bag from

ii) If radiologist requires addi- pole and instructs patient totional views with barium re- release the enema back into thetained, performer repeats over- lowered bag. When this is donehead filming as appropriate to and patient feels that.enema isnew projections, as described expelled, performer leaves bag

above,iii) For further overhead exposures

hung in position below the levelof the table if air contrast

performer repeats appropriate.

study may follow. Otherwise re-steps including identifization moves and discards as discussedof cassette, use of R-L mark.ers,selection and setting of tech-

below.b. If the enema apparatus involves

nique, positioning patient andequipment for focus-object-film

a retention balloon catheter,performer opens balloon lumen and

alignment, collimation, shield- allows air or water to drain.

ing, breathing instructions,making exposure, and processing,as described above.

Uses paper toweling and gentlyremoves the enema tip.

......-...

506

TList Elements Full


i) Assists patient to descend fromtable and walk to toilet, orprovides bedpan for patient toexpel enema.

ii) Performer checks with any pa-tient in toilet to make surehe or she is all right.

Ic. For patient with colostomy,perform-er lowers bag from pole and assistspatient to sit on table, lean for-ward, and drain the barium mixturethrough the tubing into basin. Mayassist by massaging patient.

d. Performer cleans patient and anysoiled equipment using sanitarytechnique. Provides patient.withapprcpriate towels, cleansing solu-tions and fresh gown as appropri-ate. Replaces covering on table.

23. Performer proceeds to take post-evac-uation radiographs as ordered:

a. Takes any projections ordered asdescribed above, but decreasesexposure factors to reflect de-crease in frontal thickness ofabdomen.

b. Is careful not to dislodge rectaltip if left in place for laterair contrast.

c. If order is for an axial projectionof the rectum, rectosigmoid junc-tion and sigmnid, performer haspatient sit op side or end ortable so that posterior surfaceof each knee is in contact withedge of table.

i) Centers median sagittal planeof body to midline of table sothat transverse axis of filmcoincides as nearly as possibleto midaxillary plane of the body

ii) Centers film to median sagittalplane of pelvis.

iii) May support feet with bench orstool. Has patient abduct thighsand lean 'irectly forward until

24.

List Elements Full

symphysis pubis is in closecontact with table. May assistobese patient to achieve asclose to a 450 angle of verti-cal axis of pelvis as possible.Has patient grasp ankles tomaintain position.

iv) Directs central ray at rightangles to film,centered to thelumbosacral region at the leveof the greater trochanters. Ifflexion is restricted,directscentral ray anteriorly at righangles to the coronal plane ofthe symphysis pubis.

d. Performer has post-evacuation ra-diographs processed and present-ed for radiologist's review asdescribed above.

i) If so ordered, performer ar-ranges to have patient givenhot tea or coffee to stimulatefurther evacuation. Assistspatient to evacuate again andcontinues as ordered untilradiologist indicates thatpost-evacuation radiographyis completed.

ii) Notes radiologist's ordersfor air contrast enema withfluoroscopy and overhead film-ing. Provides any materialsneeded.

Performer assists radiologist withair contrast enema as ordered:

a. Performer explains to patientwhat will happen.

b. If a disposable enema kit isbeing used and rectal tube isstill in place, performer in-verts the enema bag which is hungbelow the level of the table sothat air will automatically rise.

c. If the enema tip has been remov-ed, performer may prepare ballooncatheter and air syringe and

507


Task Code No. 383


List Elements Full LiSt Elements Fully

attach rectal tip and clamp orhave this done. May insert tipinto patient's rectum as describedabove.

d. Performer assists while radiolo-gist injects air through insuf-flater (or by squeezing invertedbag) while checking on TV monitor.

e. Performer assists with fluoro-scope controls, patient position-ing, tilt table and/or changingof spot film cassettes, as de-scribed above, as ordered.

25. Performer makes overhead films as or-dered with air enema retained,asdescribed above. Adjusts technicalfactors to account for air contrast(decreased techniques from thoseused for barium enema). Has doublecontrast overheads processed and re-viewed as above,and repeats with ene-ma retained until radiologist indi-cates that radiography is completed.

26. When radiography has been completed,performer assists in termination pro-cedures:

a. Washes hands and dons gloves. Re-moves any markers from patient'sbody.

b. With disposable kit, has patientexpel air into bag:

i) Performer gently removes rectaltip.

ii) Wraps apparatus in paper, drainscontents into a toilet, and dis-cares in appropriate receptacle.

iii) Removes gloves and washes hands.

c. With conventional equipment, per-former uses paper toweling andgently removes enema tip. As-sists patient to toilet or suppliesbedpan. Checks with patient to besure he or she is all right.

0 Empties bedpan contents intotoilet. Performer removes anyfecal masses from rectal tubewith paper toweling. Discardsin appropriate receptacle.

ii) Rinses equipment and placesfor sterilizing or decidesto do personally.

iii) Removes gloves and washeshands.

d. With colostomy patient performermay leave catheter in place andhave patient go to lavatory andempty enema bag. Performer sup-plies clean pad or arranges tohave clean dressings suppliedor applied after patient or NDremoves catheter. Removes glovesand washes hands.

e. May decide to assist patient fromtable. Makes sure patient isreminded of any footrest in step-ping off table. Makes sure thatnone of the equipment is pro-jecting over the patient beforeallowing patient to rise fromstool or table, and assists pa-tient.

f. Performer has patient cleansed;may have room and equipmentcleaned with disinfectant. Hasany other appropriate clean upprocedures followed to avoidinfection or contamination, ordecides to do personally, de-pending on institutional ar-rangements.

g. If not contraindicated, may rein-force instructions to patienton use of saline or water tohelp eliminate contrast medium.Reinforces information on whenpatient can eat (unless GI ser-ies is to follow).

h. Perfo.mer may have patient trans-ported to next assigned location,or decides to do personally, as

508


Task Code No. 383



appropriate. If appropriate, makessure that patient is in the careof a staff person who will trans-port to appropriate next locationor, if out-patient, will arrangeto discharge or send patient homewith escort as appropriate.

i. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the overhead viewstaken, the technical factors used,and film sizes. May record thenumber of exposures made of eachspot film and overhead view in-cluding retakes; may enter theestimated radiation dose to whichpatient was exposed (using postedinformation on dosage); may re-cord any problem with equipment,any special care provided patient.Signs requisition sheet.

j. Performer may record the fluoro-scopic examination including expo-sure time and rad dosage.

k. May present requisition form toradiologist for comments and sig-nature.

1. Performer may decide to jacketradiographs, requisition sheets,and related materials, and/or haveinformation recorded in log bookpersonally, or have this done,depending on institutional proce-dures.

m. May indicate to appropriate staffperson when the performer is ready

. to proceed with next examination.

.

o

.

5 9


This is page 1 of

Task Code No. 384

20 for this task.


Requisition reviewed;pt. reassured;abdomen measured;films identified;technical factors selected and setfor fluoroscopy,spot filming,overheads;scoutstaken;radiologist assisted with positioning,flu-oroscopy;cholecystograms taken as ordered,processed,presented;fatty meal arranged;post-fatty meal chol-angiogram series,post-evacuation films taken as or-dered;pt. returned;examination recorded;radiographsplaced for use.

2. What is used in performinL this task? (Note

if only certain items must be used. If there


Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical-technical history,prior radiographs;phone;view boxes;pen;x-ray generator,control panels,tube,bucky,table,collimator;fluoroscomr unit,image intensifier,spot film device,TV monitor;cassettes;rollfilm;ID,R-L,series,respiration markers;compressionband,inflated bag;marking pen;extension cones;stool;calipers;vertical cassette holder;lead aprons,shielding;immobilization devices;technique,standardview,tube rating and rad exposure charts;forms;phan-tom or test object;wheelchair;intercom;instructionsheet;contrast pills or capsules

3. Is there a recipient, respondent or co-workerinvolved in the task? Yes...00 No...( )

. es to q. : Name the in o recipient,respondent or co-worker involved, with de-


Non-infant patient to have oral cholegraphy;radio-loist;co-worl_L_iinadultnurse


Taking oral cholecystograms and cholangiogramsof non-infant pt., by reviewing request;preparing,instructing and reassuring pt.;measuring abdomen;setting up for fluoroscopy,spot filming;taking scoutfilms as ordered;setting technical factors;identify-ing films;providing shielding;assisting in position-ing of pt.,fluoroscopy,spot filming;taking overheadcholecystograms as ordered;auanging for processing;

1

arranging for fatty meal;taking post-meal,post-evac-uation cholangiograms as ordered;having pt. return-ed;placing radiographs for use;recording.

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Performer receives or obtainsthe x-ray requisition form,pa-tient identification card, andany appropriate medical-techni-cal history for a non-infantpatient scheduled for oral cho-legraphy (radiographic study ofthe gallbladder (cholecystog-raphy) and/or biliary ducts(cholangiography) after oralingestion of a contrast mediumin tablet or capsule form) asa result of:

. Regular assignment.b. Checking assignment on sched-


in ordeNiof priority.

Requisition may be for aninitial study or may be fora "second day" study afterinitial use of contrast didnot result in proper visual-ization of gallbladder andadditional contrast was or-dered. Performer.may alsoreceive prior scout film(s)from initial study with re-cord of technical factorsused and/or any changes nec-essary.


a, Performer checks the ex-

1

amination called for andthe purpose. Notes

OK-RP;RR;RR6. Check here if this

is a master sheet..0)


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Task Code No. 384


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whether routine scout film(s) areordered and/or any special requests,positions,or views.

b. Notes the name of the radiologistin charge;may note the name of thereferring clinician.

c. Performer reads patient's name,identification number, sex, age,weight, and height. Notes whetherpatient is in-patient or out-pa-tient. Notes any special informatior note on known pathology thatcould affect patient positioning,technique, or handling, or may becontraindications (such as absenceof gallbladder, acute abdominal orgastrointestinal symptoms). Noteswhether patient will be in a wheel-chair.

d. Notes whether erect and/or recum-bent positioning is called for,breathing instructions, whethercompression devices will be re-quired,type of shielding needed.

e. Performer checks whether patientis suffering from a collateral con-dition requiring special handlingsuch as heart disease, communicableor infectious condition, infirmity,incoherence; whether patient hasIV drip, oxygen supply, urinarycatheter, colostomy, or similardevice in place; notes whether pa-tient will be accompanied by nurseor other staff person, whetherthere are orders for removal ofdressings from the abdominal area.

f. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheetis complete:

i) Depending on institutional pro-cedures, performer may reviewpatient's radiation exposurehistory, prior recorl of tech-niques used, and cumulative ex-posure. Notices whether exami-

nation has been done elsewherein recent past, whether thereis history of extensive radi-ography to bring to radiolo-

* gist's notice.ii) Checks whether any special or-

ders on exposure factors arein keeping with the usual radexposure involved for the ex-amination.

iii) Depending on institutional pro-cedures, performer noteswhether female patient is preg-nant, reviews date of femalepatient's last menstrual peri-od, or notes any other indica-tion that there is no danger ofexposure of a known or possiblefetus.

g. Performer notes orders for priorpreparation of patient such asdiscontinuance of particularmedication, preliminary diet,tiMing of ingestion of contrast,abstinence from food and drink,use of cleansing enemas. May notewhether these have been carriedout. May arrange to have omittedsteps carried out with delay inexamination if appropriate.

h. If the performer determines thatthe request is not properly,auth- ,

orized, is incomplete, or thatsufficient information is lackingfor performer to select-techniqueor to properly position or carefor patient, or if performer con-siders that there may be contra- .

indications to going ahead withthe procedure, performer bringsthis to attention of radiologistin charge. Explains the problemif appropriate, and proceeds afterobtaining needed information, sig-nature, or orders.

i. If prior radiographs already onfile are to be presented to ra-diologist with scout films, and


Task Code No. 384


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if not already with patient's propriate cassette holders are\

jacketed material, performer ar- available in the examination room.ranges to have prior films de- Selects appropriate speed andlivered. type of film, grid and cassette

combination based on standard in-.2. Performer goes to appropriate room stitutional practices. Selects

for the type of examination involved size based on patient's size andand the equipment required, or notes area of interest. If adequateroom assigned on requisition sheet. supply is not in room, arrangesPrepares ahead so as not to keep pa- to obtain or decides to obtaintient in examination room longer than personally.necessary: h. Performer prepares for identifi-

cation of overhead films usinga. Washes hands as appropriate,b. Checks that procedure tray has been

equipment provided by institu-tion:

prepared for the study involved ordecides to do personally; checks i) May obtain lead numerals andthat emergency cart is present or tape and prepare identifica-

available. tion strip for placement onc. May make sure that x-ray tube has film holder(s) giving appro-

a fractional focal spot of appropriate patient identificationpriate size. information and time elapse

d. Checks that proper accessories are for .serial exposures.

available for procedure including ii) Performer may prepare for useleaded rubber shielding, aprons,and gloves to be used by perform-

of flashcard by checking thatthere is piece of lead on film

er, radiologist, the patient, and/ holder surface; may write oror anyone who will remain in the type out ID information on

room during exposure. card if not received with req-

. e. Checks that appropriate immobili- uisition.zation devices are present, such iii) Checks identification againstas compression band and air-filled requisition sheet.compression bag, that there is a .

mattress, pads, pillows and/or i. If examination may include spotblankets for comfort of patient. filming using a camera (attached

May set up footboard at end of to image intensifier) and roll

tilt-table and attach compression film, performer checks film sup-

devices,f. Makes sure that right (R) and

ply indicator to make sure thatthere is sufficient film in the

left (L) markers are availablefor use, identification cards,leaded numerals or markers, -marker

roll film cassette.

i) If there is insufficient rollto indicate films exposed on inha- filM in camera, performer ar-lation if so ordered, and markers ranges to have roll film cas-to number series films. sette loaded, or decides to

g. For overhead filming performermakes sure that an adequate sup-ply of loaded cassettes and ap-

do personally.

.

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Task Code No. 384


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ii) When loaded roll film cassetteis obtained, performer checksloading in subdued light.Checks that end of film is cutcorrectly and is properlythreaded and attached to take-up spool so that film unwindsappropriately. Checks that filmis properly engaged in sprockets.Locks into operating position.If appropriate, cuts off excessfilm at exit port and removes.Attaches film cassette to cameraand locks into place. Replacescamera cover.





j. If examination may include spotfilming using a cassette/buckyspot film device, performer checksthat there is an adequate supplyof appropriate size cassettes inroom.



iii) Performer may use controls ormanually pull out spot filmbucky tray and open retainingclamps. Inserts cassette intobucky tray and pushes back.Moves cassette into appropri-ate "stored" position.

iv) If R-L markers are to he usedwith spot filming, performertapes into place on image in-tensifier screen or plans totape to patient's body.

k. If a grid will be used with theimage intensifier for fluoroscopyand/or spot filming, performer po-sitions and centers grid if notalready done. May use control but-ton or slides grid into position.May check that the grid is orient-ed toward the x-ray tube, withgrid lines parallel to the longaxis of the tube.

3. Performer reviews and sets technicalexposure factors for fluoroscopy andspot filming based on standard setby the institution as appropriatefor the examination:



c. Performer reviews the ;Ochniquechart(s) for the unit(s) to beused:

i) Locates information for theprojections involved. Takesnote of the exposure factorsto be used for overheads andfluoroscopy. Considers prefer-erences of the radiologist in-volved and presence of contrastin biliary tract.

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Task Code No. 384


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iii) Performer checks any new or un-familiar exposure factorsagainst the posted limits ofthe x-ray tube on a tube ratingchart to be sure that techniquedoes not exceed the heat capac-ities of the tube for the focalspot size to be used. If 'appro-priate, performer reconvertsthe technique to an equivalentoutput using higher kVp andlower mAs.

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d. Performer makes sure that indicatorlight shows that x-ray generator is"warmed up" and ready for use.Makes sure that all circuits havebeen stabilized. If appropriate,checks line voltage meter and, ifneeded, turns compensator dialuntil needle is aligned properlyon line meter.

e. As appropriate, performer setsx-ray generator mode selector(s)for overhead scout films, for lateruse of fluoroscopic mode, and useof spot film camera or cassettedevice.


i) For E,)ot film camera, performerselects and sets the rate(frames per second) for thecamera according to standardsset for examination.

ii) For cassette spot filming per-former may select and set astandard spot film program pro-viding for format. combinationssuch as single, half, or ci1lart-

er.combinations on a singlecassette and related spot filmsizes. Selects program appro-priate for examination orawaits orders from radiologist.

g. If not already done, performer connects TV monitor to power outlet.Turns on monitor and checks that"ready" light is on.

h. If appropriate, performer selectsthe proper field size selector(if there is dual image intensi-fier).



ii) If mA is automatically con-trolled according to patientthickness, performer turnsfluoroscope mA selector to max-imum standard position. If notautomatically controlled, setsas appropriate for focal spotsize and examination.


j. If appropriate, performer selectsand sets exposure factors for spotfilming:

i) For conventional manual expo-sure control, performer se-lects and sets the appropriatespot film time for the exami-nation.

ii) For automatic, phototimed ex-posure control, performer se-lects a density exposure con-trol appropriate for the ex-amination.

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Task Code Nu. 384




iv' Performer selects and sets kVp,;y combining settingc on onemajor and one minor kVp se-lector a appropriate for theexam

s

ination.

. If not already done, performer re-turns to examination room to set upx-ray and fluoroscope tube(s), imageintensifier, collimator and accesso-ries as appropriate for check ofequipment prior to examination:


object on radiography table wherepatient's area of interest will becentered for examination,

c. Adjusts fluoroscopic tube stand(above or below table) so thattube is at zero degrees and cen-tered to the area of interest,


e. Performer adjusts the x-ray tubeto appropriate focal spot-objectdistance (target to object distance,TOD). For fluoxoscopy adjusts dis-tance between focal spot and imageintensifier (foal spot to filmdistance, FFD). Makes sure that TODis 15 inches or more. Operates con-trols or manually moves the x-raytube(s) into place. Checks thefocal-film distance by readingindicator scale in the tube hous-ing; adjusts up or down until therequired FFD is obtained.

f. Performer collimates fluoroscopytube (and x-ray tube used for spot

5.

filming if different), dependingon nature of the equipment andcontrols:

i) Adjusts fluoroscopy beam shut-ters to the field size antici-pated for fluoroscopic examine-tion or sets shutter mode se-lector to automatic collimation

ii) Manually sets collimator for.

the spot film field size to beused, or selects and setsfield size control to be usedfor automatic collimation withprogrammed spot film cassetteexposure sequence.

If not already done, performer checksfunctioning of fluoroscopy equipmentby entering remote control room oroperating controls in .examinationroom behind leaded screen:





iv) Checks examination timer bynoting whether time elapse in-dicator moves during exposureshowing decreasing time leftfor examination. May check

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Task Code No. 384


Airlift

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6.

that exposure is terminated when

maximum examination exposuretime is reached.

b. To check spot fill-a functioning,performer may move cassette orroll film into x-ray exposurefield using appropriate controls.


ii) If equipment is operating appro-priately, perfotmer unloads cas-sette and reloads or advancesroll film as appropriate. Movesbucky out of way until fluoros-copy is completed.

c. After equipment has been checked,performer shuts and resets forstandard exposure factors. If per-former decides that any of theequipment is not functioning prop-erly, performer informs appropri-ate staff member. Arranges for al-ternate unit to be used,

Performer readies patient for the ex-amination:

a. Performer washes hands as appro-priate. Depending on patient'scondition, may decide to arrangefor or carry out isolation ordecontam.nation techniques.

b. Performer has the patient calledfrom the holding area and pre-pared for the examination (if not

, already done), or decides to do..

personally.

c. Depending on institutional arrangements, performer may decide toescort out-patient to or fromdressing room. May decide toassist in transportiAg patientfrom holding area or have thisdone.

d. Performer greets patient and anyaccompanying staff perso, and in-

- troduces self. Checks patient'sidentity against the requisitionsheet. With in-patient, checkshospital identification braceletor other identifier. If patientis accompanied because of ser-iousness of condition, performerchecks with accompanying staff member on any special precauti6nsnecessary during procedure.

e. Performer has patient assume a comfortable recumbent or seated posi-tion, as appropriate.

i) If appropriate, places mattress,pillow or clean linen on x-raytable. May place pad, blanketor pillow under bony promi-nences to provide comfort forrecumbent patient.

ii) If patient is in wheelchairmay move patient in chair intoposition next to table. Makessure that wheelchair is inlocked position.

.

iii) Performer may decide to assistpatient from wheelchair orstretcher to table or has thisdone. May obtain help. Makessure that no equipment is inth2 way that may be collidedwith by patient.

iv) If assisting patient to stepon footstool in order to get .

on ta"le, helps patient turninto position, step backwardson stool, and then sit and/orlie on table. ,

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Task Code No. 384


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f. If not already done, has patient'sclothing removed and provides gownor drape. May assist patient orrequest assistance from nurse.Permits patient to keep coveredwith gown until measurements aretaken and until exposure: Treatsyoung patient with as much courtesyas adult.

g. Performer questions patient or ac-companying adult about preparatoryprocedures to check that patienthas followed them correctly and tofind out about patient's reactionto contrast:

i) Performer questions patient onwhether any listed orders on ces-sation of a particular medica-tion,use of preliminary diet, orthe time that the contrast was tobe injected were carried out, andabout orders for abstinence fromfood and drink after taking con-trast. Checks that any orders forcleansing enema(s) were carriedout.

ii) Performer questions patient oraccompanying adult on any reac-tion to the contrast such asvomiting and/or diarrhea and onwhen this occurred.

iii) Performer notes any unusual orsevere reaction,and reports thisor any failure of patient tocarry out preparatory routineto radiologist. Follows out anyorders to postpone examination.Continues with examination asorde.red.

h. Performer evaluates the patient'sbodily habitus to estimate theposition of the gallbladder andvariations in location between in-halation and exhalation for cen-tering. Notes whether the areasof interest are heavily covered by

7.

muscle or soft fat, whether thepalpation points will be easy tofind. Notes whether the extremi-ties are of unequal length. Forfemale patients,performer jndgeswhether the breasts are large andpendulous. If so, may plan tohave patient or staff member drawthe breasts to the sides and up-wards and hold in place with widebandage.

i. If patient has a wound, colostomy,or ileostomy with dressing to beremoved, performer checks whetherzinc or iodoform paste or radio-paque gauze is being used. If so,has appropriate staff member re-move dressing or tube or decidesto do personally (if ap2ropriate).Checks that radiopaque paste orguaze is completely removed.

j. If appropriate and not alreadydone, performer questions femalepatient of child bearing age re-garding possible pregnancy. Ifthere is any potsibility that pa-tient is pregnant and this has notalready been recorded, performerinforms radiologist and proceedsonly with approval.

Performer explains to patient whatwill be involved in the procedureand continues to prepare:

a. Performer explains the purposeof the preliminary proceduresand what will be involved in theexamination:

i) Performer indicates the needto visualize the gallbladderand explains use of scouts,fluoroscopy,and overhead film-ing. Gives indication of vari-ations in amount of time thatmay be involved.

517


Task Code No. 384


List Elements Full:111=111113:1?

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ii) Explains probable use of fattymeal,post-fatty meal and postevacuation films and likelytime intervals.

b. Performer explains what coopera-tion will be asked of patient. De-scribes what the radiologist willbe doing. Indicates what types ofpositions the patient will beasked to assume. Describes anyprobable breathing control, useof compression devices, as appro-priate. May demonntrate how tilttable will be used and reassurepatient that he or she will beheld safely.

c. Performer encourages patient torelax. Rehearses patient in sus-pending respiration (inhalationor exhalation) and relaxing. Per-former may check patien 's relax-ation by keeping hand on patient'sback to detect tenseness. Perform-er may judge time interval neededafter cessation of respiration forpatient to relax and plans to ad-just exposure timing accordingly.

d. Performer answers patient's non-medical questions honestly; at-tempts to reassure patient and de-velop confidence. Treats patientwith dignity and concern regard-less of patient's behavior. Re-mains aware that patient may befrightened and/or in pain. Per-former explains, when asked medi-cal questions, that it is not ap-propriate for technologist toanswer these; encourages patientto speak to physician.

e. Unless measurements have alreadybeen made, performer uses centi-meter calipers to measure thethickness of the abdomen in thedirections in which the centralray of the x-ray beam will passthrough the centered part from

tube to film. If both recumbentand erect positioning will beused, performer may measure orestimates thicr.ness in ooth posi-tions. Records for use in deter-mining exposure factors for over-heads. After measuring, has pa-tient rest in as relaxed a posi-tion as possible.

f: Performer may tape R or L markerto patient if appropriate. foruse in spot filming.

g. Performer obtains the appropriatesize loaded cassette for thefirst scout projection and at-taches identification inforrationto the cassette:

i) Places right or left marker onfilm holder or table-top asappropriate or depresses ap-propriate R or L button forautomatic marking.

ii) If patient's identificationinformation is In the form oflead numerals or marker, per-former places on appropriatecorner of cassette.

iii) If patient identification in-formation is tn 'e entered byuse of flasher, sets flashcard aside for later use withspace created by piece of lead-ed rubber on appropriate edgeof cassette.

iv) Performer may place patient'scard into card tray for equip-ment uring automatic film mark-ing device.

v) If suspended inhalation (ratherthan exhalation) has been or-dered,marks cassette to indi-cate this.

h. Performer places cassette inbucky. May manually pull outbucky tray and open retainingclamps. Inserts cassette into

518


Task Code No. 384


,m..........m:List Elements Full List Elements Full___.

,

bucky tray and pushes back. Makessure clamps are closed. Moves cas-sette into appropriate "stored"position or inserts cassette trayinto bucky slot and centers.

. Performer selects and sets the expo-sure factors for the first (or next)scout projection by consulting thetechnique chart(s) po.9J-0: for the

machine:

s. Locates the information needed forthe body part and projection in-volved according to the centimeterthickness of the part as measured(erect or recumbent as appropriate)and the collimated field size tob.:. used. Makes sure that techniquerelates to the combination of filmtype and speed and use or nonuseof other radiographic accessories(such as screens, grids, bucky,utc.).

b. toakes note of the kVp, mA,T(sec-olds of exposure time), focalspot size, and the focal film dis-tance (TFD or FFD) called for.


.have been determined, performermakes any conversions necessaryto account for the use of contrast,extreme fat or muscularity, prefer-ence of the radiologist involved,and any posted changes. Performerlooks up numerical conversion fac-tors and calculates, or uses con-version charts to ascertain theappropriate new exposure factor(kVp, mA and/or time). Multiplies,divides, adds, or subtracts as ap-propriate.

d. Performer sets the exposure-fac-tors for the first (or next) scoutprojection:


9.

.........

ii) For conventional exposure con-trol, performer sets the milli-amperage selected for the cor-rect focal spot size. Sets theselected exposure time thatwill produce the mAs desired.Sets the kVp selected bychoosing the combination ofmajor kilovoltage and minorkilovoltage settings to pro-duce the desired kVp.

iii) For automatic phototimed expo-sure control, performer setsthe category corresponding tothe type of study and use ofscreens, bucky, etc., and, ifappropriate, focal spot size.Sets a control correspondingto the selected field size(as listed on technique chartfor phototiming).May set a kVp range button (ifcalled for with equipment)corresponding to the appropri-ate range for the examination.Sets .a density selector cor-responding to the usual (orspecial) requirements fur thestudy. Makes sure backup timeris not likely to terminate ex-posure before phototimed expo-.sure is made.

iv) Depending on the equipment, mayset controls to provide foruse of bucky, manual adjustmentof table and tube height, po-sition, and of collimation,unless these have already beenset.

Performer prepares patient for po-sitioning for first (or .ext) scoutfilm(s). Selects prone-PA or supineAY position for standard scout filmof abdomen and/or right side of ab-domen, and may make other specialprojections as ordered or as deter-mined by standard institutional pro-cedures for scouts:

IMMIt


Task Code No. 384



a. Performer may explain or demonstrateto patient what is required. Mayobtain help in potitioning.

b. If patient has a urinary catheterin place, performer turns pazienttoward the catheter and tubing toprevelit separating it from drain-age bottle and breaking sterilesystem and to avoid causing pain.

c. When positioning a patient with aballoon catheter in place, per-former makes sure that the clampis not lying over a part to beexposed or that patient is notlying on the clamp.

d. If patient will be standing andlimbs are of unequal length, per-former provides support to short-er limb so as to evenly distributeweight.

e. Performer keeps the long axis ofthe part parallel to the cassetteholder. With upright holder ad-justs height of holder to part andcenters part to film.

i) Performer arranges patient'sshoulders to lie on a singletransverse plane.

ii) Has prone patient flex elbows,place arms in a comfortable po-sition. Supports ankles. Restspatient's head on forehead andnose. May have patient resthands beneath chest.

iii) Has supine patient place armsin a comfortable position andsupports ankles and knees.

f. Performer judges the location ofthe gallbladder based on the pa-tient's type of body (habitus) andthe evidence of any prior scoutfilms.Performer plans to center higherfor supine positioning and lowerfor prone and erect positioning.

Centers higher for obese, hyper-sthenic patients and lower forthin, asthenic patients.

10. Performer positions as follows (oras described below for later steps)depending on the positions orderedfor scout film(s).

a. For a prone PA projection (an-terior view) of the gallbladder,performer has the patient lie ina prone position on the table.

i) Depending on whether an ab-dominal survey view or aright abdominal view is or-dered, performer centers themedian sagittal plane or themiddle of the right side ofabdomen to the midline of thetable.

ii) May have patient rest head onleft cheek. Has patient flexright elbow and adjust armin comfortable position withleft arm alongside body. Ele-vates ankles. With thin pa-tients maYISlace pillow underhead and position it so thatupper chest is also supported.May place pad under iliacspines. If female patient haspendulous breasts, has herspread breasts upward and out-ward.

iii) Performer centers film to thelevel of the estimated lo-cation of the gallbladder asdetermined by patient's bodytype and prior films, breathcontrol to be used$and posi-tion of patient, or to centerof abdominal area. May markcentering point on body forlater adjustment.


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Task Code No. 384


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b. For a supine AP projection (poster-ior view) of the gallbladder, per-former has the patient lie in asupine position on the table.

i) Performer centers median sagit-tal plane or the center of theright side of abdomen to themidline of table.

ii) Has patient flex elbows and ab-duct arms. For thin patients orif so ordered, performer ro-tates the body slightly withright side against table.Supports knees and immobilizesankles.

iii) Centers film to the level of thegallbladder as estimated, allow-ing for body type'and positionof patient. May mark centeringpoint.


c. Performer applies compression bandand air filled bag if appropriateto upper abdominal region.

d. Checks whether patient is able torelax as positioned and immobilized.If not, performer readjusts andrecenters until patient is com-fortable.

e. Performer rehearses patient insuspended exhalation (or sus-pended inhalation if so ordered)until patient can hold suspendedrespiration and remain relaxeduntil told to breathe again.

f. Throughout procedure performer re-mains alert for any synptom ofsevere pain or adverse reaction.Ifperformer judges that patient's dis-comfort is severe, ceases exposureand notifies radiologist or attend-ing physician at once.

I11. Performer sets up for exposure afterpositioning patient:

a. Performer sets the focal-filmdistance if not already done asappropriate. Checks the focal-film distance by reading indi-cator scale in the tube housing;adjusts up or down until the re-quired FTD (TFD) is obtained.

b. Performer checks final position-ing by using light in collimator.Activates the collimator lightand points the light beam towardsthe part. Adjusts the collimatoropening to correspond to the filmsize. Uses cross-hair shadows asreference for center of field.Checks that primary beam willenter the center of the area ofinterest at the selected angleto the film so as to project theview desired.

c. Performer adjusts the collimatorso that a small unexposed borderwill appear around the edge ofthe film or collinates furtherso as to expose only the area ofinterest (and thus provide maxi-mum protection and detail). Forsmall fields performer attachesan auxiliary extension cone tocollimator to further reduce theprimary beam. Adjusts primary beamto minimum size needed to coverthe area(s) of interest.

d. Performer adds lead shielding toareas that will be in the priLarypath of the beam but are not in-cluded in the areas of interest.Makes sure that voper protectiveshielding has been provided to pa-tient and everyone who will remainin room during exposure. Explainsif necessary that this is notcause for alarm but a general pre-caution to minimize unnecessaryradiation exposure.


Task Code No. 384


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e. When everything is ready for theexposure, performer reminds pa-tient of the cooperation and breathcontrol to be used for exposure.Encourages patient to relax. Ob-serves the patient's movement untilthe moment that the exposure ismade. Readjusts position if war-ranted.

f. Performer returns to control room.Makes sure controls are properlyset, that equipment is set forradiography mode, and that patientis still in position.

12. Performer makes exposure:

a. Calls or uses intercom to tell pa-tient to carry out breathing in-structions as rehearsed. Has pa-tient breathe out and hold unlesssuspended inhalation has been or-dered.

b. When respiration has been suspend-ed, performer waits one or twoseconds to allow involuntary move-ment of viscera to subside andthen makes exposure or waits num-ber of seconds judged necessaryfor patient to relax.

c. Performer initiates exposure bypressing hand trigger or expo-sure control button.

i) While exposure is underway per-former checks that mA meterrecords appropriate current asset, that kVp meter dips slight-ly.

ii) May watch for evidence of mal-function such as line surge orexcessive drop; may listen forsound of normal functioning ofequipment. If there is malfunc-tion may decide to report; an-ticipates need to repeat expo-sure.

List Elements Fullym...m

iii) With phototimer notes whetherbackup timer has been involvedin terminating exposure beforephototimed exposure was com-pleted. If so, anticipatespossible need to repeat expo-

..

sure.iv) After exposure is completed

tells patient that he or shecan breathe.


d. After exposure removes cassetteand removes markers for furtheruse.

e. Repeats radiography for all thescout films required. Adjuststechnical factors, tube, and po-sition of patient or film holderas appropriate to each view or-dered. Repeats identification,collimation, shielding, ordersfor breath control and exposureas above.

13. The performer arranges to have thescout films processed at once ordecides to do personally.

a. Attaches ID card for use withflasher if appropriate. May signrequisition.

b. While films are being processedand/or evaluated performer haspatient relax in examination roomor holding area. Explains whatwill happen next. If appropriate,makes sure that patient will beattended while waiting.

c. If appropriate, moves x-ray tubeand any protruding film holderaway from patient before patient


Task Code No. 384


List Elements Full List Elementa Full,

rises and decides to assist patient and that an additional dose offrom table. Makes sure patient is oral contrast and/or additionalreminded of any footrest in step- cleansing is needed, performerping off table. may arrange to reinforce instruc-

tions to patient for prior prep-14. The performer brings the_requisition arations for second day study and

sheet, the patient's medical history,chart, the processed scout film(s) and

taking of additional contrast ormay decide to do personally. May

any prior films to radiologist. Dis- arrange to reschedule patient.plays radiographs on view boxes. c. If radiologist decides that flu-

oroscopy is necessary to providea. If not already done, performer more information on location

tells radiologist about any dif-ficulties encountered with regard

and condition of gallbladder,performer notes radiologist's

to information, possible contrain- orders for program and settingsdications, or anything else that for spot filmins and proceeds toshould be brought to radiologist's prepare for fluoroscopy (as de-attention. Notes any special or-ders or change in procedure de-

scribed earlier).

cided by radiologist. i) Discusses sequence and timing' b. Performer may accompany radiolo- for procedure with radiolo-

gist to examination room and in- gist. May arrange signals fortroduce patient to radiologist or exposure, changing of spotcalls patient from holding area. film cassettes, operation of

_exposure controls.

15. During radiologist's review, of requi- ii) If required, changes or ad-sition, scouts, prior films and ex- justs technical factors, pro-amination of patient, performer notes gram, dnd settings for flu-radiologist's decisions and orders: oroscopy and spot filming.

a. If radiologist indicates that pro- d. If radiologist indicates thatcedure is to be terminated be- the scout films do not providecause gall stones are in evidence enough information on locationon scout(s) or (if second daystudy)if radiologist decides to

or condition of gallbladder,performer notes radiologist's

proceed immediately to intravenous orders for change in technicalmethod, performer proceeds to factors, patient positions, tubetermination steps as described positions, and/or centering ofbelow. If appropriate,arranges to film. Plans to make additionalhave proper forms filled out and/ overheads, send for processingor new requisition made out and and present for review, one atsigned. a time, until radiologist in-If scout film is judged adequate dicates that gallbladder isand no further examination is properly visualized (as describedneeded, performer proceeds to below).terminate as described below. e. If radiologist indicate:, that

b. If radiologist decides that thegallbladder is poorly visualized

the scout film(s) are adequate,and if radiologist decides to

5 6


Task Code No. 384



16.

=rm..proceed with fatty meal, post-fatty meal and post-evacuationfluoroscopy and/or overheads, per-former notes radiologist's ordersfor the fatty meal, time sequencefor meal, any fluoroscopy and over-head series, projections ordered,and positions of patient and cen-tral beam. If appropriate,has ra-diologist fill out or sign requi-sition orders for filming and meal.

If radiologist has decided to examinepatient fluoroscopically, performerproceeds as follows:

a. Performer washes hands as appro-priate.

b. Performer gives leaded gloves andapron to radiologist. If appropri-ate, places leaded curtain inplace. Provides patient and every-one remaining in room during ex-posure with appropriate protectiveshielding. Explains if necessarythat this is not cause for alarmbut a general precaution to mini-mize imnecessary radiation expo-sure.

c. On signal from radiologist, per-former may dim room lights. Turnson TV power switch. May go to con-trol room and operate fluoroscopycontrols on orders from radiolo-gist. Adjusts kVp and/or mA con-trols according to radiologist'sorders.

d. Performer may help radiologist toposition patient in appropriateposition. May operate tilt-tableon orders from radiologist. Mayposition pressure device(s) onorders.

e. Performer may assist radiologistwith spot filming:

i) Operates exposure controls asordered, or positions table,tube, or patient as ordered.

17.

ii) If spot film attachment usescassettes, performer may unloadas used, identify, and insertadditional cassettes, as de-scribed above, throughout pro-cedure.

f. Depending on institutional proce-dures, performer may keep radio-logist informed of cumulative ex-posure as shown on fluoroscopetimer indicator.

g. When the radiologist informs per-former that the fluoroscopic por-tion of the examination is over,performer notes orders for anypre-fatty meal overhead filmingand/or orders for fatty meal andpost-fatty meal radiography.

i) Notes particular areas of in-terest, special positions,breathing instructions.

ii) May note whether radiologisthas marked location of gall-bladder for use in centering.If so, notes whether this waswith patient in erect, prone,or supine position.

iii) May discuss with radiologistany special precautions neededin patient positioning, toavoid injuring patient.

If radiologist has ordered additionaloverheads for localization and/orvisualization of the gallbladder,performer proceeds as for scoutfilms, as described above, except asfollows:

a. Performer acts on radiologist'sorders for changes in technicalfactors,and converts as appropri-ate when setting factors for eachradiograph.

b. If radiologist has used fluoros-copy, performer may note centering

524


Task Code No. 134_


List Elements Full List Elements Full. ,

mark made by physician. When cen-tering, takes account of patient'sposition when centering mark wasmade (erect, supine, prone) andadjusts centering to account forshift to any different current po-sition. Wipes away any inappropri-ate centering marks made fox scouts.

c. Performer repeats as appropriatethe steps for setting exposure fac-tors, identifying cassette, placingin bucky, explaining to patient,and positioning patient, film, andtube, as describ,A, except as notedbelow,

d. When positioning patient in erector decubitus position, performermay have patient maintain the po-sition and relax for several min-utes to allow any small gallstonesto come to rest. Makes sure gridlines are at right angles to thefloor,

e. For an erect PA projection Canter-

f. For right lateral decubitus po-sitioning for projections of thegallbladder, performer uses avertical bucky or cassette holderwith patient lying on table. Noteswhether PA or AP projection isrequired for frontal view.

0 Has patient lie on right side.Has patient flex knees com-fortably. Places supports underand between knees and ankles.Has patient flex elbows, placelower hand under head, andhas patient grasp side oftable with opposite hand. Ele-vates the torso. May apply com-pression. Supports in position.

ii) For frontal projection placesfilm vertically and directsx-ray tube horizontally. Placesfilm behind patient and tube infront for AP projection; thereverse for PA projection.Directs central ray horizontal-ly at right angles to midpointof film.

iii) For a lateral view centers cas-

ior view) of the gallbladder, per-former has patient stand facingvertical cassette holder or buckyin PA position with weight evenlydistributed,

i) Centers film in bucky to themarked location (adjusted forshift from position when marked)or centers film to estimatedcenter of gallbladder.

ii) May have patient extend armsalong sides of holder and graspedges.

iii) Applies compression band and/orbag if appropriate. Performermakes sure that patient is main-tained in erect position longenough before exposure for small'gallstones to be accuratelydemonstrated.

iv) Directs central ray at right an-gles to center of film.

sette in bucky in table anddirects central ray verticallyat right angles to center offilm.

iv) Centers film to marked center-ing point (adjusted) or toestimated location of gall-bladder, allowing for likelydrop in location in this posi-tion towards the midaxillaryline,

v) Allows patient to maintain po-sition long enough before ex-posure for small gallstones tobe accurately demonstrated.

g. For a left PA oblique projection(left anterior oblique view) ofgallbladder, performer notes thedegrees of rotation required, thenumber of oblique views ordered,

......


Task Code No. 384


List Elements Full List Elements Fully_

and the change in rotation betweenexposures. Marks cassettes to showorder in series.

0 Performer positions patient inthe prone position with headresting on left cheek and leftarm alongside body. Rotatesbody so that right side is ele-vated. Has patient support him-self or herself on right fore-arm and flexed knee and adjustsrotation to the desired degree.

ii) Centers patient so that previ-ously localized or estimatedlocation of the gallbladder isat the midline. Centers filmat the marked or estimatedlevel of the galladder adjust-ed for position.

iii) Applies inflated bag or radio-lucent wedge under abdomen.


v) Rehearses patient in suspend-ing breathing at end of ex-halation for exposure unlessotherwise ordered,and remainingin position until directed tochange rotation for next expo-sure in series.

h. For PA lordotio projection (an-

iii) Ccntels film to the estimatedlevel of the gallbladder.

iv) Directs central ray horizontal-ly at right angles to midpointof film.

i. If gallbladder location has notyet been determined, performernay mark the centering pointbeing used on patient's body.

j. Performer again checks for abil-ity of patient to relax and re-peats appropriate breathing in-structions. Repeats appropriatecollimation. Provides shieldingand makes exposure as describedabove.

18. Performer arranges for processingand review of any spot films andeach overhead view as taken:



c. With cassette spot films and over-head :exposures, removes any mark-ers.for further use. Attaches IDcard for use with flasher if ap-propriate.


e. Performer has overheads and anyspot films processed at once ordecides to process personally.

f. While films are being processed,makes sure that patient is com-fortable and, if necessary, at-tended by radiologist, staff mem-ber, or self.

terior view) of the gallbladder,performer uses upright cassetteholder or bucky.

i) Performer has patient stand orsit in PA position before up-right cassette holder withright side of abdomen centeredto midline,

ii) Has patient grasp sides of standor table, brace abdomen againstit, and lean backward as muchas possible or with thorax ata 450 angle.


Task Code No. 384


List Elements Full .List Elements Full

g. When the overheads and spct filmshave been processed and returned,performer places on view boxes.

film alignment, collimation,shielding, breathing instru2-tions, making exposure, and

May also hang scout(s) and prior processing, as described above.films. Informs radiologist that v) Performer refrains from com-radiograph(s) are ready for view- menting on the films or pro-ing and makes note of radiologist's viding any interpretation todecisions: patient.

vi) Performer shows subsequent ra-i) Notes orders for further over- diographs to radiologist as

heads to locate gallbladder or processed, and proceeds as de-provide better visualization. scribed above until radiolo-

ii) If overhead has not localized gist indicates that this stagegallbladder, performer removestrial centering mark until local-ization has been determined.

of examination is completed.

h. When radiologist indicates thatiii) If the radiologist indicates pre-fatty meal radiography is

that there is any problem with completed, notes any orders for

the technical factors or the 2atty meal, post-fatty meal andpatient positioning for over- post-evacuation fluoroscopy and/

heads, performer records ornotes for use in "retakes."

or overheads.

Notes whether need to repeatis due to performer's own

19. If a fatty meal has been ordered,performer has radiologist's orders

negligence or lack of atten- carried out and patient given meal

tion so that performer can or fed as appropriate. May decideavoid future "retakes." If re-quest for retakes reflects mal-functioning equipment, perform-

to do personally.

a. If patient may leave the depart-

er reports malfunction to ap- ment for meal, performer makespropriate staff member. If re- sure that patient or accompanying

quest for retakes reflects the adult knows exact time to return.

preference for density or con- b. With in-patient, may arrange to

trast of the radiologist, per- have nursing staff in charge of

former notes for future use patient's care informed.

to avoid future "retakes." Performer may arrange to have pa-

iv) if radiologist requires addi- tient taken to appropriate hold-tional centering and/or posi- ing area. Keeps track of the time

tions, performer repeats ap- elapsed. If appropriate, makes

propriate steps including sure that patient is in the care

identification of cassette,use of R-L and series markers,selection and setting of tech-

of a staff person who will trans-port to appropriate location andreturn patient at appropriate

nique, positioning patient andequipment for focus-object-

....

time.

7


Task Code No. 384



20. After patient has had fatty meal and/orafter appropriate elapse of time,performer has patient returned aneprepared (or prepares) as appropriatefor fluoroscopy and/or overhead film-ing of extrahepatic ducts (cholangi-ography). Performer may have patientassume right AP oblique position atonce and may maintain patient in po-sition until series are completed.

21. If radiologist will use fluoroscopy,performer assists as described above;has spot films processed; displayswhen ready on view boxes.

22. If performer will take a series ofpost-fatty meal radiographs, proceedsas ordered and as described above ex-cept as follows:

a. In series films performer makessure to include time-interval mark-er on each cassette.

b. Performer uses marked location ofgallbladder on patient's body asreference for location of extra-hepatic bile ducts. When centeringtakes account of patient's positionwhen centering mark was made andadjusts as appropriate.

c. For a right AP oblique projection(right posterior oblique view) ofthe extrahepatic bile ducts, per-former plans series at appropri-ate intervals.

i) Performer has patient assume su-pine position with the area ofthe gallbladder centered to themidline of the table. Elevatesthe left side of the body about15° to 20°. Supports the ele-vated shoulder, hip and knee.Has patient extend hips andknees so that back is arched.May place arms in comfortable

position with hands under orabove head.

ii) Centers film to.estimated lo-cation of gallbladder and ap-propriately higher than forprone position.

iii) Places inflated bag or r.dio-lucent wedge under abdomen.

iv) Directs central ray at rightangles to mddpoint of film.

d. Performer provides collimation,shiel!ing, instructions forbreathing,and makes exposure asdescribed above. Arranges tohave each overhead processed astaken and reviewed by radiologist.Keeps track of timing and con-tinues at regular intervals un-til radiologist indicates thatopacification of ducts is optimaland series is completed.

23. If radiologist orders post-fattymeal, post-evacuation films,perform-notes the timing, projections, andpatient positions ordered.'

a. Proceeds as appropriate as de-scribed above to make, process,and present post-fatty meal, post-evacuation radiographs.

b. Notes any orders for delayedfilms. If so, performer may pro-vide requisition sheet and haveradiologist fill out and sign.

24. When performer is told by radiologistthat the examination has been com-pleted, performer carries out termi-nation steps for the examination:

a. If appropriate, arranges to havefresh colostomy and/or dressingapplied (if removed for radiog-raphy). Has patient cleansed ifappropriate. Removes any R-L mark-

528


Task Code No. 384



ers or centering marks from :)a-tient's body.

b. May have patient transported backto holding area or next location,or decides to do personally, asappropriate. Makes sure that noneof the equipmer is projecting overthe patient beiore allowing patientto rise.

c. If appropriate, makes sure that pa-tient is in the care of a staffperson who will tr%lsport to ap-propriate next location or, if out-patient, will arrange to dischargeor send patient hone (with escortif appropriate).

d. May have room and equipment cleaned;has any other appropriate clean upprocedures followed to avoid infection or contamination, or de-cides to do personally, dependingon institutional procedures.

e. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the overhead viewstaken, the technical factors used,and film sizes. May record thenumber of exposures made of eachspot film and overhead view in-cluding retakes; may enter theestimated radiation dose to whichpatient was exposed (using postedinformation on dosage); may re-cord any problem with equipment,any special care provided patient.Signs requisition sheet.

f. Performer may record the fluoros-copy examination including expo-sure time and rad dosage.

g. May present requisition form toradiologist for comments and sig-nature. May present forms for req-uisitions for later delayed filmsand/or additional examination(s).

h. Performer may decide to jacketradiographs, requisition sheets,and related materials, and/or have

information recorded in log bookpersonaily, or have this done,depending on institutional proce-dures.

i. May indtcate to appropriate staffperson when the performer is readyto proceed with next examination.

er3'.;9


Task Code No. 385


1. What is the output of this task? (Be sure List Elements Fullythis is broad enough to be repeatable.)

Requisition reviewed;pt. reassured,measured;scouttaken;technical factors selected and set for cholan-

'giograms,cholecystograms;radiologist assisted withtest dose,infusion of contrast;postinjection cholan-giograms,tomograms,cholecystograms taken as ordered ,

.processed,presented;fatty meal arranged;post-fattymeal overheads taken as ordered;pt. returned;examina-tion recorded;cholegrams placed for use.

Performer receives or obtainsthe x-ray requisition form,pa-tient identification card, andany appropriate medical-techni-cal history for a non-infant pa-tient scheduled for intravenouscholegraphy (radiographic studyof the biliary ducts (cholangi-ography) and the gallbladder(cholecystography) after intra-venous infusion of contrast med-ium) as a result of:


ule sheet.c. saving arranged requisitions

in order of priority.d. From co-worker.e. Having arranged, after re-

ceiving orders, to proceedafter nonvisualization of,gallbladder by oral method.

Performer may also receivea scout film and/or priorcholegrams with record oftechnical factors used and/or any changes necessary.

1. Performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, special


if only certain items must be used. If thereis choice, include e%erything or the kinds ofthings chosen among.)

Pt.'s x-ray requisition sheet,ID card,ID bracelet,medical-technical history,prior radiographs;phone;view boxes;pen;x-ray generator,centrol panels,tube ,

bucky,table,collimator;ID,R-L,series,breath controlmarkers;compression band,inflated bag;marking pen;procedure tray with test dose,IV equipment,watersoluble,iodine based contrast;emergency cart;clock;tomographic attachments;extension cones;stool;cali-

pers;vertical holder;cassettes;lead apron,shielding;immobilization devices;technique,standard view,tuberating,cooling,and rad exposure charts;forms;inter-com;stretcher;wheelchair


'es to q. : Name t e ina o recipient,respondent or co-worker involved, with de-


Non-infant pt. to have intravenous cholegraphy;radiologist;co-workers;accompanying adult;nurse

S. Name t e task so that the answers to ques- considerations, and to checkthe completeness of the in-formation provided:

a. Performer checks the ex-amination Called for andthe purpose. Notes whethera routine scout film isordered or any specialrequests.

OK-RP;RR;RR


tial w1.4rds.Taking intravenous cholangiograms and cholecysto-grams of non-infant pt. by reviewing request;prepar-ing patient and equipment;measuring;taking scout;assisting with test dose and infusion of contrast;setting technical factors,identifying film,position-ing pt.,providing shielding,collimatAg,teachingbreathing;taking postinjection chola..igiograms asordered;arranging for processing;taking tomograms,cholecystograms,arranging for fatty meal and post-meal radiographs as ordered;having pt. returned;placing radiographs for use;recording.

1

6. Check here it thisis a master sheet..0()


Task Code No. 385


List Elements Full

b. Notes the name of the radiologistin charge; may note the name of thereferring clinician.

c. Performer reads patient's name,identification number, sex, age,weight, and height. Notes whetherpatient is in-patient, out-patient,or emergency patient. Notes anyspecial information or note onknown pathology that could affectpatient positioning, technique, orhandling,such as absence of a gall-bladder (cholecystectomized pa-tient). Notes shielding needed.

d. Notes whether patient has alreadyundergone oral cholegraphy. If so.proceeds directly to preparationsfor infusion omitting steps al-ready carried out.

e. Notes whether patient has historyof allergies, whether test doseof contrast is planned.

f. Performer checks whether patientis suffering from a collateral con-dition requiring special handlingsuch as heart disease, communicableor infectious condition, infirmity,incoherence; whether patient hasIV drip, oxygen supply, urinarycatheter, colostomy, or similar

vice in place. Notes whether pa-will be on a stretcher or in

a woelchair. Notes whether pa-ttimt will be accompanied by nurseC7 other staff person, whetherthere are orders for removal ofdressings from the abdominal area.

g. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheetis complete:

i) Depending on institutional pro-cedures, performer may reviewpatient's radiation exposurehistory, prior record of tech-niques used, and cumulative ex-posure. Notices whether exami-

List E1ementLI2lly

nation has been done elsewherein recent past, whether thereis history of extensive radi-ography to report to radiolo-gist.


iii) Depending on institutional pro-cedures, performe.: noteswhether female pavient is preg-nant, reviews date of femalepatient's last menstrual peri-od, or notes any other indi-cation that there is no dangerof exposure of a known or pOs-sible fetus.

h. Performer notes orders for priorpreparation of patient such aspreliminary diet, abstinencefrom food and drink, use of cleansing enemas. May note whether thesehave been recorded as carried out.If appropriate arranges to haveany omitted steps carried outwith delay in examination.If the performer determines thatthe request is not properly,.auth-orized, is incomplete, or thatsufficient information is lackingfor performer to select techniqueor to properly position or carefor patient, or if performer con-siders that there may be contra-indications to going ahead withthe procedure, performer bringsthis to attention of radiologistin charge. Explains the problemif appropriate, and proceeds afterobtaining needed information, sig-nature, or orders.If prior radiographs already onfile are to be presented withscout film to radiologist and ifnot already with patient's jacket-ed material, performer arrangesto have prior films delivered.

5 1


This is page

Task Code No. 385



2. Performer goes to appropriate room forthe type of examination involved andthe equipment required, or notes roomasc;igned on requisition sheet. Pre-pares ahead so as not to keep patieatin examination room longer than nec-essary:

a. Washes hands as appropriate.b. Checks.that procedure tray has been

prepared for the study involved ordecides to do personally. Checksthat materials are present for in-fusion of contrast solution andfor test dose. Makes sure emergencycart is present. Checks for emesisbasin and towels.

c. Performer makes sure that equip-ment has a tomography capabilityor that tomographic attachment isin room. Checks that x-ray tubehas appropriately small fractionalfocal spot and that, if appropri-ate, additional filtration isavailable for tomography.

d. Checks that proper accessories areavailable for procedure includingleaded rubber shielding, aprons,to be used by the performer, thepatient, and anyone who will remainin the room during exposure.

e. Checks that appropriate immobili-zation devices are present, such ascompression band and air-filledcompression bag, that there is amattress, pads, pillows and/orblankets for comfort of patient.

f. Makes sure that right (R) andleft (L) markers are availablefor use, identification cards,or leaded numerals or markers,and markers to indicate post-injec-tion time intervals, post-fattymeal views, and any special posi-tions or breath control.

g. If appropriate, performer makessure that contrast solution is at

body temperature. May arrange tohave it warmed or cooled.

h. Performer makes sure that an ade-quate supply of loaded cassettesand appropriate cassette holdersare available in the examinationroom. Selects appropriate speedand type of film, grid and cas-sette combination depending onthe techniques to be used andstandard institutional practices.Selects size based on patient'ssize and area of interest. Ifadequate supply is not in room,arranges to obtain or decidesto obtain personally.

i. Performer prepares for identifi-cation of overhead films usingequipment provided by institu-

.tion:




j. Performer reviews the techniquechart for the machine to be usedand takes note of any newly post-ed changes in technical factors(to reflect accommodation to achange in machine output or apolicy decision).

532


List Elements Full

This is page

k. Performer checks that x-ray equip-ment is ready for_use. Goes tocontrol panel and Checks that in-dicator light shows that machineis "warmed up," or turns on mainswitch as appropriate to equip-ment and allows time for the ma-chine to "warm up." If appropri-ate, performer may set radiog-raphy mode selector and set col-limator control for manual opera-tion. Makes sure that all circuitshave been stabilized.

1. Performer may note whether a pre-liminary scout film has alreadybeen made of the patient (doneearlier or by another radiologictechnologist).

i) If a scout film has already beenmade and viewed by radiologist,performer notes the techniqueused or ordered and plans tech-nical factors for overhead ra-diography, adjusting as appro-priate.

ii) If a scout film has been madebut not approved, performerplaces processed scout film andany prior films with patient'schart or places on view boxesfor rerjiew by radiologist.

iii) If a scout film has not beenmade and is required before pa-tient is seen by radiologist,performer plans to proceedafter readying patient.

3. Performer readies patient for the ex-amination:

a. Performer washes hands as appro-priate. Depending on patient'scondition, may decide to arrangefor or carry out isolation ordecontamina%ion techniques.

b. Performer has the patient calledfrom the holding area and prepared

.11X

Task Code No. 385


List Elements Fully

for the examination (if not al-ready done), or decides to do per-sonally.

c. Depending on institutional proce-dures,performer may decide toescort out-patient to or fromdressing room. May decide toassist in transporting patientfrom holding area or have thisdone.

d. Performer greets patient and anyacconpanying staff person and in-troduces self. Checks patient'sidentity against the requisitionsheet. With in-patient, checkshospital identification braceletor other identifier. If patientis accompanied because of ser-iousness of condition, performerchecks with accompanying staffmember on any special precautionsnecessary during procedure.


i) If appropriate, places mat-tress, pillow or clean linenon x-ray table. May place pad,blanket or pillow under bonyprominences to provide comfortfor recumbent patient.

ii) If patient is in wheelchairmay move patient in chair intopcsi.tion next to table. Makessure that wheelchair is inlocked position.


iv) If assisting patient to stepon footstool in order-to geton table, helps patient turnon stool, and then sit and/orlie on table.

533


Task Code No. 385



h. If patient has a wound, colostomy,or ileostomy with dressing to beremoved, pertormer checks whetherzinc or iodoform paste or radl- .

opaque gauze is being used. If so,has appropriate staff member removdressing or tube or decides to dopersonally (if appropriate). Checksthat radiopaque paste or gauze iscompletely removed.

,

i. If not already done, performer ex-plains to patient what will be in-volved in:the procedure:

7

i) Performer describes what willhappen in the allergy test, ininfusion of the contrast solu-tion, and in the overhead film-ing. If patient has a gallblad-der, describes what will happenwhen fatty meal and the post-fatty meal radiographs are tak-en. Gives patient an idea of how,long the entire procedure maytake, that there may be possi-bility of tomography, that pa-tient may be asked to wait inholding area during filming ofseries.

ii) Performer may explain to pa-tient that side effects maybe felt from contrast mediumsuch as feeling of nausea,flushing, choking sensation. May re-assure patient that vomiting isnormal and that emesis basinwiLl be provided for use.

iii) Performer explains what ,Joperation will be asked lf patient.Explains the importance of pa-tient's being able to relax.Indicates what types of posi-tions the patient will be askedto assume. Describes any prob-able breathing control, use ofcompression devices, as appro-priate. May demonstrate how tilttable will be used and reassurepatient that he or she will beheld safely. "......

I

v) If patient is on specialstretcher, places stretcherinto position so that radio-lucent stretcher can be liftedwith patient on it from wheeledbase to x-ray table. May arrangeto move or have patient movedto table.

F. If not already done, has patient'sclothing removed and provides gownor drape. May assist patient orrequest assistance from nurse.Permits patient to keep coveredwith gown until measurements aretaken and until exposure. Treatsyoung patient with as much courtesyas adult.

g. If not already done, performerquestioas patient or accompanyingadult about preparatory procedures.

i) Ch2cks that any preliminarydiet ordered was followed,Checks that any order forprior abstinence from food anddrink was adhered to. Checksthat any orders for cleansingenc.:ma(s) were carried out.

ii) If not already done, questionspatient or accompanying adultabout any allergies, especiallyto shellfish or adverse re-actions to contrast medium(especially iodine based).

iii) If appropriate and not alreadydone, performer questions fe-male patient of child bearingage regarding possible preg-nancy.

iv) If there is any possibilitythat patient is pregnant andthis has not already been re-corded, or that patient hassensitivity to contrast, orthat patient has not abstainedfrom food as ordered, performerinforms radiologist at once andproceeds only with approval,


Task Code No. 385



,

I

iv) Performer answers patient's non-medical questions honestly; at-tempts to reassure patient anddevelop confidence. Treats pa-tient with dignity and concernregardless of patient's behavior,Remains aware that patient maybe frightened and/or in pain. Per-former explains, when asked medi-cal questions, that it is not ap-propriate for technologist toanswer these; encourages patientto speak to physician.

j. Performer encourages patient to re-lax. Rehearses patient in suspendingrespiration on exhalation and re-laxi,Ig. May check patient's relax-ation by keeping hand on patient'sback to detect tenseness. Performermay judge time interval neededafter cessation of respiration forpatient to relax. Plans to adjustexposure timing accordingly.

k. Unless measurements have alreadybeen made, performer uses centi-meter calipers to measure the thick-ness of the abdomen in the direc-tions in which the central ray ofthe x-ray beam will pass throughthe centered part from tube to film.

i) Performer evaluates the patient' sbodily habitus to estimate theposition of the gallbladder andvariations in location betweeninhalation and exhalation, andbetween prone, supine or erectpositions for centering.

ii) If both recumbent and erect po-sitioning may be used, performermeasures or estimates thicknessin both positions.

iii) Notes whether the areas of in-terest are heavily covered bymuscle or soft fat, whether thepalpation points are easy tofind,

4.

.........a.

iv) Notes whether the ex'.:remitiesare of unequal length. If soplans to support shorter limbfor any erect filming.

v) With female patient performerjudges whether the breasts arelarge and pendulous. If so,may plan to have patient cr:staff member draw the breaststo the sides and upwards andhold in place.

vi) Records measurements for usein determihing exposure fac-tors for overheads. Notes po-sitions for which measurementsapply. After measuring, haspatient rest in a relaxed su-pine position on table.

Unless already done, performer se-lects and sets the technical factorsfor the scout film of the abdomen(or the next overhead radiograph).

a. Performer consults the techniquechart posted for the machine.Locates the information neededfor the body part and projectioninvolved according to the centi-meter thickness of the part asmeasured for the position and thecollimated field size to be used.Makes sure that technique relatesto the combination of film typeand speed and use or nonuse ofother accessories (such as screeas,grids, bucky, etc.).

b. Makes note of the kVp, mA, T(sec-onds of exposure time), focalspot size, and the iocal filmdistance (TFD or FFD) called for.

c. Once the standard kVp, mA andtime has been determined, per-former makes any conversions nec-essary to account for extreme fator muscularity, age, the prefer-ence of the radiologist involved,and any other conversion needed

535


Task Code No. 385


HList Elements Fully

such as posted changes. Performerlooks up numerical conversion fac-tors and calculates or uses conver-sion charts to ascertain the appro-priate new exposure factor (kVp,mA and/or time). Multiplies, di-vides, adds, or subtracts as ap-propriate.

d. Performer checks any new or un-familiar exposure factors againstthe posted limits of the x-raytube on a tube rating chart to besure that technique-does not ex-ceed the heat capacities of thetube for the focal spot size tobe used. If appropriate, performerreconverts the technique to anequivalent output using higher kVpand lower mks.

e. Performer sets the exposure cactorsas selected:

i) Sets control for radiographymode.

ii) If appropriate, checks linevoltage meter and, if needed,turns compensator dial untilneedle is aligned properly online meter.

iii) For conventional exposure con-trol, petormer sets the mil-liamperage selected for thecorrect focal spot size. Setsthe selected exposure time thatwill produce the mAs desired.Sets the kVp selected by choos-ing the combination of majorkilovoltage and minor kilo-voltage settings to produce thedesired kVp.

iv) For automatic phototimed expo-sure control, performer setsthe category corresponding tothe type of study and use ofscreens, bucky, etc., and, ifappropriate, focal spot size.Sets a control corresponding tothe selected field size (as

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listed on technique chart forphototiming).May set a kVp range button, ifcalled for with equipment, cor-responding to the appropriatekV range for the examination.Sets a density selector corres-ponding to the usual (or spec-ial) requirements for thestudy. Makes sure backup timeris not likely to terminate ex-posure before phototimed expo-sure is made.

v) Depending on the equipment, mayset controls to provide for useof bucky, manual tableside ad-justments of table and tubeheight, position, and of colli-mation.

. Performer obtains the appropriatesize loaded cassette for the first(or next) scout projection. Attachesidentification information to thecassette or table top:

a. Places right or left marker onfilm holder or table-top as ap-propriate or depresses appropri-ate R or L button for automaticmarking.

b. If patient's identification in-formation is in the form of leadnumerals or marker, performerplaces on appropriate corner ofcassette.

c. If patient identification infor-mation is to be entered by useof flasher, sets flash cardaside for later use with spacecreated by piece of leaded rubberon appropriate.edge of cassette.

d. Performer may place patient'scard into card tray for equip-ment using automatic film mark-ing device.

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Task Code No. 385


e. Performer places cassette in bucky.May manually pull out bucky trayand open retaining clamps. Insertscassette into bucky tray and pushesback. Makes sure clamps are closed.Moves cassette into appropriate"stored" position or inserts cas-sette tray into bucky slot and cen-ters.

The performer positions the patientfor the first or next scout film insupine AP position unless otherwisespecified. Plans to center to abdo-men and/or right abdomen dependingon standard institutional procedures.

a. Performer may explain or demon-strate to patient what is required.May obtain help in positioning.

b. When positioning a patient with aballoon catheter in place, per-former makes sure that the clampis not lying over a part to beexposed or that patient is notlying on the clamp.

c. For supine AP projection (posteriorview) of the abdomen performer haspatient lie in a supine positionon table.

i) Centers the median sagittalplane of the body (or centerof right side of abdomen) tothe midline of table. Arrangesshoulders and hip:. to lie onsingle transverse planes.

ii) Has patient flex elbows andabduct arms. For thin patientsor if so ordered, performer ro-tates the body slightly withright side against table. Sup-ports knees and immobilizesankles.

iii) Performer centers the cassetteat the level of the iliaccrests unless otherwise speci-fied.

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iv) Directs central ray at rightangles to the midpoint ofthe film.

d. Performer may apply a compressionband and/or air filled bag toupper abdominal region.

e. Checks whether patient is ableto relax as positioned and im-mobilized. If not, performer re-adjusts and recenters until pa-tient is comfortable.

f. Performer rehearses patient inbreathing in, breathing outfully, and holding breath whileremaining relaxed until told tobreathe again.

g. Performer sets the focal-filmdistance if not already done asappropriate. Checks the focal-film distance by reading indi-cator scale in the tube housing;adjusts up or down until therequired FFD (TFD) is obtained.

h. Performer checks final position-ing by using light in collimator.Activates the collimator lightand points the light beam towardsthe part. Adjusts the collimatoropening to correspond to the filmsize. Uses cross-hair shadows asreference for center of field.Checks that primary beam willenter the center of the area ofinterest at the selectci angleto the film so as to project theview desired.

i. Performer adjusts the collimatorso that a small unexposed borderwill appear around the edge ofthe film or collimates furtherso as to expose only the area ofinterest (and thus provide maxi-mum protection and detail).Adjusts primary beam to minimumsize needed to cover the area(s)of interest.

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Task Code No. 385


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j. Performer adds lead shielding to excessive drop; may listen for

areas that will be in the primary sound of normal functioning of

path of the beam but are not in- equipment. If there is malfunc-

cluded in the areas of interest,especially gonads. Provides pa-

tion may decide to report;anticipates need to repeat ex-

tient and everyone who will remain posure.

in room during exposure with ap- iii) With phototimer notes whether

propriate protective shielding. backup timer has been involved

Explains if necessary that this in terminating exposure before

is not cause for alarm but a gen- phototimed exposure was com-

eral precaution to minimize unnec- pleted. Tf so, anticipates pos-

essary radiation exposure. sible'need to repeat exposure.

k. When everything is ready for the iv) After exposure is completed

exposure, performer reminds pa- tells patient that he or she

tient of the breath control to be can breathe.

used for exposure. Encourages pa- v) If the exposure is terminated

tient to relax. Observes the pa- by a circuit breaker, rechecks

tient's movement until the moment technical factors for possible

that the exposure is made. Read- .

overload or checks for over-

justs position if warranted.- load elsewhere on circuit.Anticipates need to repeat

. Performer returns to control room,

a. Makes sure controls are properly

exposure.

e. After exposure removes cassette

set for radiography mode and that and removes markers for further

patient is still in position.b. Tells patient when to take a deep

breath and exhale, and hold still

use.

8. The performer arranges to have the

while relaxing,as rehearsed,by scout film processed at once or de-

calling or using intercom.c. When respiration has been sus-

pended, performer waits one or

cides to do personally.

a. Attaches ID card for use with

two seconds to allow involuntary flasher if appropriate. May sign

movement of viscera to subside and requisition.

then makes exposure or waits ndm- b. While film is being processed

ber of seconds judged necessary and/or evaluated performer has

for patient to relax,d. Performer initiates exposure by

patient relax in examination roomor holding area. Explains what

pressing hand trigger or exposurecontrol button,

will happen next. If appropriate,makes sure that patient will beattended while waiting.

i) While exposure is underway per- c. If appropriate, moves x-ray tube

former checks that mA meter and any protruding film holder

records appropriate current as away from patient before patient

set, that kVp meter dips slight- rises. May decide to assist pa-

ly. tient from table. Makes sure pa-

ii) May watch for evidence of mal- tient is reminded of any footrest

function such as line surge or in stepping off table.

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Task Code No. 385


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9. Unless already done, performer in-forms attending radiologist when pa-tient is ready to be examined. Bringsrequisition sheet, patient's medicalhistory, chart, the processed scoutfilm and any prior films to radiolo-gist. Displays radiographs on viewboxes.

a. If not already done, performertells radiologist about any dif-ficulties encountered with regardto information, possible contrain-dications, or anything else thatshould be brought to radiologist'sattention. Notes any special or-ders or change in procedure de-cided by radiologist.


c. During radiologist's review ofrequisition, scout, prior films andexamination of patient, performernotes radiologist's orders:

i) If radiologist decides to ter-minate procedure,performer pro-ceeds to termination steps de-scribed below. If appropriatearranges to have proper formsfilled out.

ii) If radiologist decides thatadditional cleansing is needed,performer may arrange to havethis carried out and/or ar-range to reschedule patient.

iii) Performer notes whether radio-logist requires a change intechnical factors and/or pa-tient positioning or centeringfor later overhead filming.

iv) Notes radiologist's final or-ders on sequence of examinationand whether a test dose will beadministered.

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v) Discusses sequence and timingof procedure with radiologist.

vi) Once radiologist indicates thatinfusion of contrast is to pro-ceed, arranges to provide orchange any equipment or sup-plies as ordered by radiolo-gist.

10. If performer is to assist with testinjection of contrast medium, washeshands, observing sterile techniqueas appropriate.

a. If appropriate, performer openspacket of sterile gloves for ra-diologist observing sterile tech-nique.

b. May assist as appropriate by hand-ing materials asked for.

c. May check syringes prepared withcontrast medium (iodine basedsolution) or decides to do per-sonally.

d. Performer may use the time whilephysician or co-worker observespatient's reactions to resettechnical factors for next over-head film, accounting for useof contrast, radiologist's or-dersband the patient positionto be employed.

e. Performer may provide emesis basinfor patient if he or she feelsnausea. May reassure patient.Provides clean towels and gownif necessary and assists incleansing patient and/or equip-ment.

f. If radiologist decides to cancelprocedure performer proceeds asdescribed below.

11. If radiologist decides to proceedwith IV infusion of contrast, per-

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Task Code N . 385

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former assists radiologist to set upIV; position's patient as appropriate.

a. Performer assists radiologist tocare for patient if there is nau-sea or vomiting as described above,May provide damp cold towel to al-leviate flushing symptoms.

b. Performer stands by to assist ra-diologist or patient while infusionproceeds over the appropriate peri-od of time and while IV apparatusis removed.

c. Performer notes radiologist's or-ders for the series of cholangio-grams or notes order for standardseries.

i) Notes number of radiographs,time intervals, patient posi-tion(s) and any orders for cen-tering.

ii) Notes the time that the infusionis completed and calculates in-tervals from that time,

iii) Plans to make a series of over-heads, send for processing, andpresent to radiologist for re-view as each exposure is madeuntil radiologist is satisfied.

12. Performer positions for the firstcholangiogram as described aboveexcept as follows:

a. Performer plans series for appro-priate intervals and marks eachcassette to indicate the post-in-jection time elapse.

b. If centering has not been indi-cated by radiologist,performerjudges the location of the biliaryarea based on the patient's typeof body (habitus) and the evidenceof any prior films. Plans to ad-just for higher centering for su-pine positions and obese, hyper-

sthenic patients, and lower cen-tering for prone or erect posi-tioning and thiL, asthenic pe-tients.

c. Throughout procedure performerremains alert for any symptom ofsevere pain or adverse reactionto the contrast. As soon as per-former judges that reaction maybe severe, ceases exposure andnotifies radiologist or attendingphysician at once.

d. If patient has a urinary catheterin place, performer turns patienttoward the catheter and tubing toprevent separating it from drain-age bottle and breaking sterilesystem and to avoid causing pain.

e. Performer positions a3 followsor as described above or in latersteps depending on the position(s)ordered.

f. For a right AP oblique projection(right posterior oblique view) ofthe extrahepatic bile ducts, per-former has patient assume a su-pine position with the esUmatedarea of the biliary tract centeredto the midline of the table.

i) Elevates the left side of thebody afinut 15° to 200. Supportsthe elevated shoulder, hip andknee. Has patient extend hipsand knees so that back isarched. May place arms incomfortable position withhands under or above head.

ii) Centers film to estimatedbiliary tract area adjustedfor patient's position andbody type or as indicated.

iii) Places inflated bag or radio-lucent wedge under abdomen.

iv) Directs central ray at rightangles to,midpoint of film orat 200 cephalad to the centerof the film.


Task Code No. 385


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g. Performer repeats shielding andcollimation steps as appropriateas described above. For smallfields performer attaches an auxil-iary extension cone to collimatorto further reduce the primary beam,Repeats orders for breath controland relaxation and makes exposureas described above.

13. Performer arranges to have eacl_chol-angiogram processed as soon as it isexposed and presents to radiologist,

a. While films are being processed,performer makes sure that patientis comfortable and, if necessary,attended by radiologist, staffmember, or self. -.

b. Performer keeps track of timingand continues with filming at ap-propriate intervals,

c. Carries out radiologist's ordersfor changes in technical factors,tube or table angulation, patientposition and/or centering.

d. Continues until radiologist indi-cates that opacification of ductsand series filming is completed.

e. When the post-injection series arecompleted, performer notes radi-ologist's orders for termination,tomography, and/or choL.,cystagrams,fatty meal, a post-fatty meal ser-ies, and any delayed films.

14. Throughout procedure, if performer isasked to repeat any exposures, per-former notes whether need to repeatis due to performer's own negligenceor lack of attention so that'perform-er can avoid future "retakes."

a. If request for retakes reflectsmalfunctioning equipment, perform-er reports malfunction to appropri-ate staff member.

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b. If request for retakes reflectsthe preference for density orcontrast of the radiologist, per-former notes for future work donefor the given radiologist so thatretakes can be avoided.

If the radiologist decides to or-der tomography, performer notesradiologist's orders. May providerequisition sheet for radiologistto fill out and sign. Prepares fortomography:

a. Performer notes the type of tube-film travel pattern involved (suchas linear, circular, elliptical,or hypocycloidal tomography).Notes whether zonography iscalled for (exposure angle of100 or less), whether plesio-tomography is called for (simul-%taneous multi-level tomographysing "book" cassettes). Notes

whether asymmetrical tomography(incomplete linear sweep) isordered.

b. Performer notes the patient posi-tions and views called for, theareas to be included in the cen-tral beam; notes the exposureangle (amplitude), speed, thenumber of "cuts," for the firstpreliminary tomograms (such asone "cut" at expected plane ofinterest, one or more at givencm's above and/or below).

c. If appropniate, performer mayset radiography or tomographymode selector and set collimatorcontrol for manual operation.

d. Makes sure that markers areavailable for recording of leveland amplitude.

e. Makes sure that an adequate sup-ply of loaded cassettes of the

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Task Code No. 385

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appropriate types and sizes areavailable in the examination room,including book cassettes if appro-priate. If not, arranges to obtainor decides to obtain personally.

f. If appropriate, such as with wideangle hypocycloidal tomography,performer may insert additionalfilter (as designated) into beamcolumn.

g. If a tomography attachment is tobe pu: in place (to be used withconventional tubemount, generator,and horizontal bucky x-ray table),performer obtains the necessaryequipment and assembles:

i) Checks that table is in hori-zontal position.

ii) Attaches fulcrum assembly alongthe table top rail at head endof table and secures.

iii) Attaches fulcrum assembly plugto appropriate electrical re-ceptacle.

iv) Attaches the fulcrum bar andbucky link bar as appropriateto equipment and moves the tube-mount over the fulcrum assembly.Adjusts so that angulation andfulcrum level indicators arefacing appropriately.

v) Slides fulcrum bar into fulcrumassembly as appropriate andlocks.

vi) Adjusts tubemount to prescribedfocal-film distance. (May checktechnique chart for tomography.)

vii) Moves the tomographic mecha-nism manually through the max-imum travel and checks thatthere are no restrictions suchas from cables or other attach-ments. Adjusts as appropriate,

viii) Engages the drive mechanismfor horizontal travel as appro-priate and removes engaging rod.Sets lock switch if appropriate

16.

to prevent alternative travelmotion.

h. Makes sure that tomography powerswitch is off (if appropriate).

i. Washes hands again as appropriate.j. Performer has patient assume a

comfortable recumbent supine po-sition (unless prone position iscalled for and repesitioning willbe painful).

k. Explains to patient what will beinvolved in the procedure; indi-cates what types of positions thepatient will be asked to assume,the cooperation that will beasked of the patient. Performermay manually demonstrate theaction of the x-ray tube duringtomographx.

Performer prepares the equipment tomake the preliminary tomogram(s):

a. Performer selects the appropri-P.ate cassette size, with filrvmp&screen speeds appropriate to tfieequipment and the area of ikter-est. Performer attaches identf-fication information to the cas-sette or table top as describedearlier. Prepares marker givingthe level at which the fulcrumwill be set for the given ex-posure and attaches to cassetteor table-top as appropriate.

b. Performer places cassette intobucky tray as described earlier.

c. Performer sets the fulcrum (layerheight) level for the first (ornext) exposure:

i) If a "book" cassette is to beused, performer sets the ful-crum level to coincide withthe uppermost body layer tobe projected.

.

.

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Task Code No. 385



ii) If an automatic layer height used will be at the beginning

selector is available, perform-er sets the controls to the

o f tube travel or near the end,and adjusts equipment as appro-

interval distances selected,and sets the fulcrum for theuppermost or luwermost body

priate.

g. Performer selects and set.:s the

layer desired depending on the exposure factors for the first

direction of the automatic tomographic projection. Consults

change. technique chart for tomography

iii) Sets the fulcrum level usinghand crank or power switch andchecks the setting on the ful-

for the unit being used.

i ) Takes account of total heat

crum (layer height)'indicator. units and checks with coolingchart. May plan pacing of ex-

d. 7,2rformer sets the amplitude posures to allow cooling.

(sweep): ii) If appropriate, performer re-converts the technique to an

i) Makes sure that x-ray tube is equivalent output using higher

centered at zero angle. Checks kVp, lower mA, or faster sweep

focal-film distance. speed.

/

ii) Sets the prescribed exposure iii) Performer may plan to vary the

angle or amplitude as appro-priate for equipment and checks

exposure technique for the

.scout radiographs so as to

angle on indicator. provide radiologist with visu-al choice for the particular

e. Performer sets the sweep speed as patient. If so records the,

prescribed, according to the speeds planned techniques for each

available for the equipment, the scout film in relation to the

exposure angle selected and es- level of the "cut" for each.

tablished procedure for the area iv) Performer sets the exposure

of interest (or patient's age).Notes the duration or actual expo-sure time as the product of theangle and the sweep speed selected.

factors selected as describedlier.ear .

.

17. Performer carries out scout tomog-

f. For linear tomography, performersets the directional control switch

raphy. Positions patient in AP, PA,lateral or oblique recumbent posi-

to right or left for horizontal tions as called for, following pro-

travel to reflect the direction incedures described above or in later

which the tube_will travel during steps except as follows:

the actual exposure.a. Centers area of interest to cer.-

i) For other types of motion per- ter of film (in bucky) using light

former sets comparable selec- beam in collimator, cross-hair

tor(s) so that tubemount is in uhadows as reference for center

start position.of field,and by moving bucky car-

ii) For asymmetrical exposure, de- riage. May use automatic aligning

termines whether the arc to be mechanism. Immobilizes patient asapprol.riate.

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Task Code No. 385



b. Cautions patient to keep fingersaway from table edges. Advisespatient to keep eyes closed toavoid following the movement ofthe x-ray tube. Explains that pa-tient must hold position for suc-cessive "cuts."

c. Performer checks that no obstruc-tions are present which might re-strict tubemount travel such aspalpator or cables.

d. Performer provides shielding, col-limation and breathing instruc-tions as described above.

e. Performer tests tomographic set-upby proceeding with tubemount sweepbut not activating exposure. Haspatient practice breathing out andholding still as ordered and per-mits patient to sense the durationtime for each sweep:

i) Turns on power for tomographicattachment or mode. Using ap-propriate switch, activatestomographic sweep action with-out activating exposure, andholds until tubemount reachesthe extreme limit of travel.

ii) Returns tubemount to otherextreme position, holding untiltubemount travel is complete.Interrupts travel at any pointand makes any adjustments neces-sary. Returns equipment to"start" position.

f. When everything is ready for theexposure, performer reviews withpatient the breath control to beused for exposure. Rechecks posi-tion.Reminds patient if position is tobe maintained for further cuts.Pel-former observes the patient'smovement until the moment that theexposure is made. Readjusts posi-tion if warranted. .

g. The performer returns to controlroom. Makes sure controls areproperly set and patient is stillin position. Tells patient whento breathe as instructed by call-ing or using intercom. Performerinitiates tubemount action andexposure by pressing hand triggeror exposure control button (twiceif two stage control is appropri-ate). Holds down or continues topress exposure control until tubetravel is completed. Then releasesexposure switch at once.

i) For asymmetrical exposure ini-tiates exposure or terminatesat appropriate stage of tubetravel.

ii) After exposure is completedtells patient that he or shecan breathe.

iii) If there is any problem duringthe expoAre, performer re-leases switch at once and setsback to "start" position be-fore attempting another sweep.

h. After exposure performer returnsto patient. Removes cassette frombucky.

i) Removes any markers.ii) Performer places ID, R-L and

appropriate next layer heightmarker on cassette for nextscout (unless book cassettewas uaed).

iii) Inserts new cassette as de-scribed.

iv) Changes fulcrum to new layerheight (level) as appropriate,unless this will be done auto-matically.

v) If more than one patient posi-tion is to be used for scouts,repositions patient if appro-priate.

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Task Code No. 385


vi) If new patient position is re-quired that calls for change inexposure factors, or :tf a varietyof factors are to be used, per-former changes technical factorsas appropriate.

vii) Performer adjusts collimationand shielding and repeats expo-sure for next scout tomogram,

viii) Performer continues until allscout tomogram exposures havebeen made.

ix) Performer arranges to have thescout tomograms processed atonce or decides to do personally.Attaches ID card for use withflasher if appropriate. May signrequisition. While films arebeing processed, makes sure thatpatient is comfortable and, ifnecessary, attended by staffperson or self.

x) Performer brings the processedscout tomograms directly to theradiologist in charge or placeson view boxes and informs radi-ologist that they are ready. Mayalso hang prior films.

xi) Performer notes instructionsfrom radiologist regarding theposition and the layer levels,amplitude, and number of cutsto be made for each position.Notes radiologist's preferencefor technical factors.

1S. Depending on radiologist's orders,performer makes tomographic exposuresat the selected interval cuts (ampli-tude) and levels required for eachposition lidered, as described above:

a. Readjusts fulcrum level, technicalfactors, patient positioning, col-limation and shielding as appro-priate. Makes sure ID, R-L andlayer heights are marked. Makes

exposures and has tomograms pro-cessed at once as above.

b. Brings tomograms to radiologistand displays on view boxes asoefore.

c. Performer notes whether a givenle.rel will be further defined bysmaller "slices" (expanded ampli-tude) v....thin a more restricted

area. If so, repeats proceduresafter adjusting amplitude andreeletermining exposure techni-ques.

d. Performer refrains from comment-ing on the films to patient orproviding any interpretation.

e. Performer shows subsequent setsof tomograms to radiologist asprocessed, and proceeds as de-scribed above until radiologistindicates that tomographic exam-ination is completed.

f. When radiologist indicates thattomography is completed performerdisassembles tomography equipmentas appropriate.

i) Turns off energy for tomo-graphic attachment and/or un-plugs.

ii) With tomographic attachment,disassembles by reversing theattachment procedures.

19. If patient has gallbladder and radi-ologist has decided to order chol-ecystograms, performer notes thetiming required before gallbladderis opacified and radiologist's or-ders for patient positions, projec-tions and centering.

a. Performer judges the location ofthe gallbladder based on evidenceof the prior films and the pa-tient's body type.

b. Plans to process each film as ex-posed and present to radiologist.

545

TASK DESCRIPTION SHEET (continued).

Task Code No. 385



2

c. Marks each cassette with indicatorto show time elapse andior use ofsuspended inhalation if so ordered;

. Performer positions as follows forgallbladder views or as describedearlier depending on positions or-dered:

a. For a prone PA projection (anterior

lowing for body type and posi-tion of patient. Applies compres-sion.

c. For an erect PA projection (an- .

terior view) of the gallbladder,performer has patient stand inPA position facing vertical cas-sette holder or bucky.

i) Has patient distributeweightevenly. Supports shorter limbif limbs are of unequal1.ength.

ii) Centers estimated area ofgallbladder to midline andfilm to estimated level ofgallbladder,adjusted for po-sition and body type.

iii) May have patient extend chinover top of cassette. May havepatient extend arms alongsides of holder and graspedges.

iv) Applies compression as appro-priate. Performer makes surethat patient is maintained inerect position long enough

. before exposure for smallgallstones to be accuratelydemonstrated.

v) Directs central ray at rightangles to center of film.

d. For a right lateral decubitus

view) of the gallbladder, performerhas patient lie in prone PA posi-tion on table.

i) May have patient rest head onleft cheek. Has patient flexright elbow; adjusts arm incomfortable position with leftarm alongside body. Elevatesankles.

ii) Centers estimated area of gall-bladder to midline of table.Centers film to the center ofthe estimated location of thegallbladder adjusted for the pa-tient's body tvpe,evidence onprior films, b:eathing instruc-tions,and position of patient,as described,

iii) May place pillow under head andextend with thin patients sothat upper chest is also sup-ported. May place pad underiliac spines. If female patienthas pendulous breasts, has herspread breasts upward and out-ward.


v) Applies compression band and/orair filled bag to upper abdomi-nal region.

b. For a supine AP projection (pos-

projection of the gallbladder,performer uses a vertical buckyor cassette holder with patientlying on table. Notes whether PAor AP projection is required.

i) Has patient lie on right sidewith left side supported andfilm placed vertically infront of patient with tubepositioned horlzontally be- .

hind (for PA projection) orthe reverse(for AP projection)

terior view) of the gallbladder,performer positions as describedabove, but centers to the area ofthe gallbladder as estimated, al-

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ii) Centers film to estimated areaof gallbladder, adjusted forlikely drop in location of gall-bladder in this position towardsthe midaxillary line.

iii) Has patient flex knees comfort-ably. Places supports under andbetween knees and ankles. Haspatient flex elbows, place lowerhand under head, and has pad( tgrasp side of table with oppositehand. Elevates the torso.

iv) May apply compression. Allowspatient to maintain positionlong enough before exposure forsmall gallstones to be accuratelydemonstrated.

v) Directs central ray horizontallyat right angles to midpoint offilm.

vi) For a lateral view centers cas-

iii) Applies inflated bag or ra-diolucent wedge under abdomen.


v) Rehearses patient in suspend-ing breathing at end of ex-halation for exposure; has pa-tient plan to hold positionuntil directed to change rota-tion for the next exposure inseries.

f. For PA lordotic projection (an-terior view) of the gallbladder,performer uses upright cassetteholder or bucky.

i) Has patient stand or sit inPA position before uprightcassette holder with rightside of abdomen centered tomidline.

ii) Has patient grasp sides ofstand or table, brace abdomenagainst it, and lean backwardas much as possible or withthorax at a 450 angle.

iii) Centers film to the estimatedlevel of thc: gallbladder (ad-justed).

iv) Directs central ray horizon-tally at right angles to mid-point of film.

g. If grAlbladder location has notyet been determined, performermay mark the centering pointbeing used on patient's body.

h. Performer again checks for abil-ity of patient to relax,and re-peats appropriate breathing in-structions. Repeats appropriatecollimation. Provides shieldingand makes exposure as describedabove. .

i. Performer has each e7posure pro-cesse and presents to radiolo-gist for review as describedabove.

sette in bucky in table and di-rects central ray verticallyat right angles to center offilm.

e. For a left PA oblique projection(left anterior oblique view) ofgallbladder, performer notes thedegrees of rotation required, thenumber of oblique views ordered,and the change in rotation betweenexposures. Marks cassette to showangulation.

0 Performer positions patient inthe prone position with headresting on left cheek and leftarm alongside body. Rotatesbody sc that right side is ele-vated. Has patient support himself or herself on right fore-arm and flexed knee and adjustsrotation to the desired degree.

ii) Centers patient so that estimat-ed. location of gallbladder is at

.

the midline; centers film toestimated level of gallbladder,adjusted for body type and posi-tion.


Task Code No. 385


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i) Notes orders for further over-heads to locate gallbladder orprovide better visualizatIon.

ii) If ove...head has not localizedgallbladder, performer removesany centering mark until locali-zation has been determined. Thenuses correct mark for furthe:centering.

iii) If radiologist requires addi-tional centering and/or posi-tions, performer repeats over-head filming as appropriate tonew projections, as describedabove.

iv) Continues until radiologist issatisfied with technical factors,centering and visualization.

j. When radiologist indicates thatpre-fatty meal radiography is com-pleced, notes any orders for fattymeal, post-fatty meal and post-evacuation overheads. Notes re-quired time intervals.

21. If the radiologist has ordered a fattymeal, performer has radiologist's or-ders carried out and patient givenmeal or fed as appropriate. Mey de-cide to do personally.

a. If patient may leave the deOrt-ment for meal, performer makessure that patient or accompanyingadult knows exact time to return.

b. With in-patient, may arrange tohave nursing staff in charge ofpatient's care informed.Performer may arrange to have pa-tient taken to appropriate holdingarea and records or keeps track ofthe time elapsed. If appropriate,makes sure that patient is in thecare of a staff person who willtransport to appropriate locationand return patient at appropriatetime.

List Elements

c. After appropriate elapse of timeafter fatty meal,performer haspatient returned, and preparesfor overhead filming of post-fatty meal radiographs.

d. Marks each cassette with post-fatty meal time elapse.

e. Performer may have patient as-sume right AP oblique positionas described earlier,or perforn-er positions as ordered or asstandard fol: series (or singlefilm). Carries out all appropri-ate steps as described earlier,

22. If, when post-fatty meal evacuationfilms are completed,radiologist or-ders a delayed series of tbe com-mon bile duct and/or gallbladder,performer may provide requisitionsheet and have radiologist fill out.and sign, or proceeds as appropri-ate as described above to make,process,and present post-fatty meal,post-evacuation radicgraphs.

23. When performer is told by radiolo-gist that the examination has beencompleted, performer carries outtermination steps for the examina-tion:

a. If appropriate, arranges to havefresh colostomy and/or dressingapplied (if removed for radiog-raphy). Has patient cleansed ifappropriate.

b. May have patient transported backto holding area or next location,or decides to do personally, asappropriate. Makes sure that noneof the equipment is projectingover the patient before allowingpatient to rise.

c. If appropriate, makes sure thatpatient is in the care of a staffperson who will transport to

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Task Code No. 385


List Elemens!.12Ily List Elements Fully

appropriate next location or, ifout-patient, will arrange to dis-charge or send patient home (withescort if aropriate).

d. May have room and equipment cleaned;has any other appropriate clean upprocedures followed to avoid in-fection or contamination, or de-cides to do personally, dependingon institutional procedures. .

e. Performer records the examinationaccording to institutional proce-dures. May include date, room, ex-amination type, the overhead viewstaken, the technical factors used,and film sizes. May record thenumber of exposures made of eachoverhead view including retakes;may enter the estimated radiationdose to which patient was exposed.(using posted information on dos-age); may record any problem withequipment, any special care pro-vided patient. Signs requisitionsheet.

f..May present requisition form toradiologist for comments and sig-nature. May present fonts for req-uisitions for later delayed filmsand/or additional examination(s).

g. Performer may decide to jacketradiographs, requisition sheets,and related materials, and/or haveinformation recorded in log bookpersonally, or have this done,depending on institutional proce-dures.

h. May indicate to appropriate staff

......

,

_

. person when the performer is readyto proceed with next examination.


Task Code No. 386



Requisition reviewed;pt. reassured;abdomen measured;films identified;technical factors selected and setfor fluoroscopy,spot filming,overheads;scouts taken;radiologist assisted with injection,positioning,flu-oroscopy;serial cholangiograms taken as ordered,pro-cessed,pzesented,repeated as ordered;pt. returned;examination recordedradiographs placed for use


if on1L certain items must be used. If there


Pt.'s x-ray requisition sheet,ID card,ID bracelet,medicai-technical history,prior radiographs;phone,procedure tray for percutaneous puncture or T-tubeinjection;iodine-based contrast solution;heater;emergency cart;view boxes;pen;x-ray generator,con-trol panels,tube,bucky,table,collimator;fluoroscoPYunit,image intensifier,spot film device,TV monitor;cassettes;roll film;ID,R-L,series,breath controlmarkers;compression band,inflated bag;marking pen;extension cones;stool;calipers;vertical cassetteholder;lead aprons,shielding;immobilization devices;technique,standard view,tube rating and rad exposurecharts;forms;phantom or test object;stretcher;wheel-chair:intercom

,3. Is there a reciplent,_respondent or co-workerinvolved in the task? Yes...(x) No...( )

List Elements Fully

es to q. : Name the kind o recipient,

respondent or co-worker involved, with de_

scriptions to indicate the relevant condition-include the kind with whom the performer isnot allowed to deal if relevant to knowledge


Non-infant pt. to have percutaneous or T-tube chol-angiography:radiologist;co-workers;accompanyingadult;nurse

5774717The task so that the answers to ques--'tions 1-4 are reflected. Underline essen-

tial words.Taking percutaneous or T-tube cholangiograms of non-infant pt. by reviewing request,preparing pt. andequipment;mcasuring;setting up for fluoroscopy,spotfilming;taking scout films as ordered;setting tech-

nical factors;identifying films;collimating;provid-ing shielding;assisting in positioning of pt.,flu-

oroscopy,spot filming;taking postinjection cholangi-

ograms as ordered;arranging for processing;coutinu-ing as ordered;having pt. returned;placing radio-graphs for use;recording.

Performer receives or obtainsthe x-ray requisition form,pa-tient identification card,andany appropriate medical-techni-cal history for a non-infant patient scheduled for percutan-eous transhepatic cholangiog-raphy (preoperative contraststudy of biliary ducts afterdirect puncture injection of thducts) or T-tube cholangiograph(postoperative contrast studyof biliary tract by direct in-jection into a tube left inplace in common bile duct durinprior surgery) as a result of:

. Regular assignment.b. Checking assignment O'h sched

ule sheet.. Having arranged requisitionEin order of priority.

. Receiving from co-worker.

Performer may also receiveprior films and/or a scoutfilm already taken by co-worker,with record of technical factors used and/or anychanges necessary.

Performer reads the requisi-tion sheet to determine theexamination called for, thepatient involved, specialconsiderations, and to checithe completeness of the in-formation provided:

a. Performer checks the ex-amination called for andthe purpose. Notes whethoa routine scout film isordered and any specialrequests.

OK-RP;RR;RR6. Check here i this

is a master sheet..0K)


Task Code No. 386



b. Notes the name of the radiologist

in charge; may note the name of thereferring clinician and/or surgeon.

c. Performer reads patient's name,identification number, sex, age,weight, and height. Notes whetherpatient is in-patient or out-pa-tient. Notes any special informs.-tion,such as whether patient has agallbladder,or note on known path-ology that could affect patient po-sitioning, technique, or handling,Notes whether patient has history ofallergies, results of any prior al-lergy test. Notes shielding needed.

d. Performer checks whether patient issuffering from a collateral condi-tion requiring special handling suchas heart disease, communicable orinfectious condition, infirmity,incoherence; whether patient has IVdrip, oxygen supply, urinary cathe-ter, colostomy, or similar devicein place. Notes whether patient willbe on a stretcher or in a wheel-chair. Notes whether patient willbe accompanied by nurse or otherstaff person, whether there are or-ders for removal of dressing fromthe abdominal area.

e. Performer makes sure that the re-quest is properly authorized, thatinformation on requisition sheetis complete:

i) Depending on institutional pro-cedures, performer may reviewpatient's radiat'on exposurehistory, prior record of tech-niques used, and cumulative ex-posure.

ii) Checks whether any special or-ders on exposure factors are inkeeping with the usual rad expo-sure involved for the examine-tion.

iii) Depending on institutional pro-cedures, performer notes whether

2.

female patient is pregnant, re-views date of female patient'slast menstrual period, or notesany other indication that thereis no danger of exposure of aknown or possible fetus.

f. Performer notes orders for priorpreparation of patient such asprelihinary diet, abstinence fromfood and drink; use of cleansingenemas, and/or sedation. May checkwhether these have been carriedout;. performer may check timing tobe sure a proper elapse of timehas occurred such as for sedationto take effect. If appropriate,arranges to have any omitted stepscarried out with delay.in exami-nation or plans to notify radio-logist.

g. If the performer determines thatthe request. is not properly auth-orized, is incomplete, or thatsufficient information is lackingfor performer to select techniqueor to properly position or carefor patient, or if performer con-siders that there may be contra-indications to going ahead withthe procedure, performer bringsthis to attention of radiologistin charge. Explains the problemif appropriate, and proceeds afterobtaining needed information, sig-nature, or orders.

h. If prior radiographs already onfile are to be presented withscout film to radiologist, and,ifnot already with patient's jacket-ed material, performer arrangesto have prior films delivered.

Performer goes to appropriate roomfor the type of examination involvedand the equipment required, or notesroom assigned on requisition sheet.Prepares ahead so as not to keep pa-


Task Code No. 386


List Elements Nay

tient in examination room longer nhaanecessary:


prepared for the study involved ordecides to do personally. Checksthat materials are present for in-jection of contrast solution. Makessure that emergency cart is present.Checks for emesis basin and towels.

c. Performer makes sure that x-rayequipment has a fluoroscopic cap-ability, that x-ray tube has appro-priately small fractional focalspot. May check that contrast so-lution is at appropriate tempera-ture or arranges to heat or cool.

d. Checks that proper accessories areavailable for procedure includingleaded rubber shielding, aprons,and gloves to be used by performer,radiologidt, the patient, and/oranyone who will remain in the roomduring exposure.

e. Checks that appropriate immobili-zation devices are present such ascompression band and air filled compression bag, that there is a mat-tress, pads, pillows and/or blanketfor comfort of patient. May set upfootboard at end of tilt-table andattach compression devices.

f. Makes sure that right (R) andleft (L) markers are available foruse, identification cards or lead-ed numerals or markers, and mark-ers to indicate Lime elapse inseries and unusual breath controlorders or pc5itions.

g. For overhead filming performermakes sure that an adequate supplyof loaded cassettes and appropri-ate cassette holders are availablein the examination room. Selectsappropriate speed and type of film,grid and cassette combination basedon standard inptititional practices

AMMO,

List Eleme14:2117

Selects size based on patient'ssize and area of interest. If ade-quate supply is not in room, ar-ranges to obtain or decides toobtain personally.

h. Performer prepares for identifi-cation of overhead films usingequipment provided by institution:




i. If spot filming will utilize acamera attached to image intensi-fier and roll film, performerchecks film supply indicator tomake sure that there is sufficientfilm in the roll film cassette.

i) If there is insufficient rollfilm in camera, performer ar-ranges to have roll film cas-sette loaded, or decides to dopersonally.

ii) When loaded roll film cassetteis obtained, performer checksloading in subdued light.Checks that end of film is cutcorrectly and is properlythreaded and attached to take-up spool so that film unwindsappropriately. Checks that filmis properly engaged in sprock-eZ:s. Locks into operating posi-

552


Task Code No. 386



tion. If appropriate, cuts .,ffexcess film at exit port andremoves. Attaches film cassetteto camera and locks into place.Replaces camera cover.




vi) If not already done, performerwrites or types a card withpatient's identification infor-mation for use with spot filmdevice. Inserts in slot in spotfilm camera as appropriate,

j. If spot filming during examinationwill involve use of a cassette/bucky spot film device, performerchecks that there is an adequatesupply of appropriate size cas-settes in room. ,



iii) Performer may use controls ormanually pull out spot filmbucky tray and open retainingclamps. inserts cassette intobucky tray and pushes back.Makes sure clamps are closed.Moves cassette into appropriate"stored" position,

iv) If R-L markers are to be usedwith spot filming, performer

AINNM1

3.

tapes into place on image in-tensifier screen or plans totape to patient's body.

k. If a grid will be used with theimage intensifier for fluoroscopyand/or spot filming, performer po-sitions and centers grid if notalready done. May use control but-ton or slides grid into position.May check that the grid is orient-ed toward the x-ray tube, withgrid lines parallel to the longaxis of the tube.

Performer reviews and sets technicalexposure factors for fluoroscopy andspot filming based on standards setby the institution for the examinatioinvolved:

a . Dons protective leaded rubber gar-ments such as apron and gloves.

b Makes sure.that no one is in ex-amination room or control room.


i) Locates informaticn for theprojections involved. Takesnrte of the exposure factorsto be used for overheads andfluoroscopy. Considers pref-erences of the radiologist in-volved.


iii) Performer checks any new or un-familiar exposure factorsagainst the posted limits ofthe x-rc/ tube on a tube rating

. chart to be sure that techniquedoes not exceed the heat capac-ities of the tube for the focal

:-.)t..)

r )


Task Code No. 386

ibis is page 5 of 17 for this task.

List Elements Full

spot size to be used. If appro-priate, performer reconvertsthe technique to an equivalentoutput using higher kVp andlower mAs.

d. Performer makes sure that indicatorlight shows that x-ray generatoris "warmed up" and ready for.use.Makes sure that all circuits havebeen stabilized. If appropriate,checks line voltage meter and, ifneeded, turns compensator dialuntil needle is aligned properlyon line meter.

e. As appropriate performer sets x-raygenerator mode selector(s) for over-head scout film, for later use offluoroscopic mode, and use of spotfilm camera or cassette device.



ii) For cassette spot filming, pc,r-former may select and set astandard spot film program pro-viding for format combinationssuch as single, half, or quarL-er combinations on a singlecassette and related spot filmsizes. Selects program appro-priate for examination or awaitsorders from radiolog..ist.

g. If not already done, performer con-nects TV monitor to power outlet.Turns on monitor and checks that"ready" light is on.


i. Performer selects and sets expo-sure Yactors for fluoroscopy:

Mail.tOMMMWAIIMMMMWOM,

List Elements Full),

0 Selects and sets the kVp atstandard setting for the ex-amination. May check indicatordial. With automatic densitycontrol, sets density selectoras appropriate for examination.

ii) If mA is automatically controlled according to patient thick-ness, performer turns fluoro-scorn- mA scaector to maximumstandard position. If not auto-matically controlled, sets asar4ropriate for focal spot sizeand examination involved.


j. If appropriate, performer selectsand sets exposure factors for spot


ii) For automatic, phototimed ex-pornre control, 'performer se-lects a density exposure con-trol appropriate for the ex-amination.

ai) Performer selects the appropri-ate mA for the examination andthe focal spot size to be used.

Iv) Performer selects and sets kVpby combining settings on onemajor and one minor kVp se-lector as appropriate for the

I

examirmllon.

If not alredy ;lone, performer re-turns to exakeLnatir!n room tox-ray and fluorrJ3cope tube(s), imageintensifier, collimator and acces-sories, as appropriate, for checkof eqn4pmc.nt prior to examination:


ob ect on radio apjL table where

554


Task Code No. _386_


patient's area of interest will becentered for examination.



e. Performer adjusts the x-ray tube toappropriate focal spot-object dis-tance (target to object distance,TOD). For fluoroscopy,adjusts dis-tance between focal spot and imageintensifier (focal spot to filmdistance, FFD). Makes sure thatTOD is 15 inches or more. Operatescontrols or manually moves thex-ray tube(s) into place. Checksthe focal-film distance by read-ing indicator scale in the tubehousing: adjusts up or down untilthe required FFD is obtained.

f. Performer may collimate fluoroscopetube (and x-ray tube used for spotfilming if different), dependingon nature of the equipment andcontrols:

i) Adjusts fNoroscopy beam shut-ters to the field size antici-pated for fluoroscopic examina-tion or sets shutter mode se-lector to automatic collimz-tion.

ii) Manually sets collimator Luz thespot film field size to be used,or selects and sets field sizecon:rol'to be used for automat-ic ,7ollimation with programmedspot film cassette exposure se-quence.

5. If nct already done, performer checksfunctioning of fluoroscopy equipmentby entering remote control room or

555

List Elements Fullysamaudmeumx.

operating controls in examinationroom behind leaded scl'een:

a, To check fluoroscopy mode, per-,:ormer turns on TV power switch -

controls as appropriate. Activate'fluoroscope exposure by pressingfootswitch.or as appropriate.Views test object being fluoro-scoped on TV monitor.

i) Performer adjusts kVp control(and mA control if appropriate)and ob:...er,;,es effects on TV moni

tor to be sure that equipnentis operating properly.

ii) ChecIA:;. mA meter and notes

whther appropriate reading isobtaned.-Pc:ormer checks that TV bright

s controls are operating andP4djusts for preliminary viewing.Cbcks exaMination timer bynoting whether time elapse in-dicator moves during exposureshowing decreasing time leftfor examination. May check thatexposure is terminated whenmaximum examination exposuretime is reached.

b. To check spot filM functioning,performer.may move cassette orroll film into x-ray exposurefield using appropriate controls.


ii)ltf equipment is operating ap-.

propriately, performer unloads


Task Code No. 386


List Elements Fullummimmilmw

cassette and reloads or ad-vances roll film as appropri-ate. Moves buzky out of way untilfluoroscopy is completed.

c. After equipmF:nv has been checkedperformer strotv sn6 resets forstandard exposure factors. If per-former decides that any of theequipment is not functioning prop-erly, performer informs appropri-ate staff member. Arranges for al-ternate unit to be used.

Performer readies patient for theexamination:

a. Performer washes hands as appro-priate. Depending on patient'scondition, may 0-.,r'ide to arrangefor or carry out _sol:::ion ordecontamination techniques.

b. Performer has the patient"calledfrom the holding area and pre-pared for the examination (if notalready done), or decides to dopersonally.

c. Depending on institutional arrange-ments, performer may decide toescort out-patient to or fromdressing room. May decide to as-sist in transporting patient fromholding area or have this done.

d. Performer greets patient and anyaccompanying staff person and in-troduces self. Checks patient'sidentity against the requisitionsheet. With in-patient, checkshospital identification braceletor other identifier. If patientis accompanied because of serious-ness of condition, performer checkswith accompanying staff member onany special precautions necessaryduring procedure.

e. Performer has patient assume a com-fortable recumbent or seated posi-tion, as appropriate.

List Elements Fully

i) If appropriate, places mattress,11

pillow or clean linen on x-raytable. May place pad, blanketor pillow under bony promi-nences to provide comfort forrecumbent patient.

ii) If patient is in wheelchair maymove patient in chair into po-sition next to table. Makessure that wheelchair is inlocked position.


iv) If assisting patient to stepon footstool in order to geton table, helps patient turninto position, step backwardson stool, and then sit and/orlie on table.

v) If patient is on specialstretcher, places stretcherinto position so that radiolu-cent stretcher can be liftedwith patient on it from wheeledbase to x-ray table. May arrangto move or have patient movedto table.

f. If not already done, has patient'sclothing removed and provides gownor drape. May agsist patient orrequest assistance from nurse.Permits patient to keep coveredwith gown until measurements aretaken and until exposure. Treatsyoung patient with as much courtesas adult.

g. If not already done, performerquestions patien'or accompanyingadult about preparatory proceduresordered:

55G


Task Code No. 386

This is page 8_ of 17 for this task.

List Elements Full List Elements Fully4

i) If not already done, questions vices, as appropriate. Maypatient or accompanying adult demonstrate how tilt table willabout any allergies, especially be used and reassure patientto shellfish, or adverse reac- that he or she will be heldtions to contrast medium (espec- safely.ially iodine based). ii) Performer encourages patient to

ii) Performer may make sure that an relax. Rehearses patient inout-patient has made arrangements suspending respiration (inhale-to be escorted home and to posttion and/or exhalation) and re-pone normal.activities for the laxing. Performer may check pa-rest of the day. tient's relaxation by keeping

iii) If appropriate and not already hand on patient's back to de-done, questions female patient tect tenseness. Performer mayof child bearing age regarding judge time interval neededpossible pregnancy. after cessation of respiration

iv) Checks whether patient with T-tube for patient to relax and planhas a dressing involving zinc or to adjuA exposure timing ac-iodoform paste or radiopaque cordingly.gauze. If so, has appropriate iii) Performer answers patient's non-staff member remove dressing or medical questions honestly; at-paste or decides to do personally tempts to reassure paLient and(if appropriate). Checks that ra- uevelop confidence. Treats pa-diopaque paste or gauze is com- tient with dignity and concern .

pletely removed. May unclamp regardless of patient's Lehav-T-tube and allow bile to drain ior. Remains aware that patientinto basin or may have this done. may be frightened and/or in

v) If lny preparatory procedures pain Performer explains, whenwere not carried out, if patient asked medical questions, thathas sensitivity to contrast, or it is not appropriate for tech-if there is any possibility that nologist to answer these; en-patient is pregnant, and these courages patient to speak tohave not already been recorded,performer informs radiologist atonce and proceeds only with ap-

physician.

i. Unless measurements have alreadyproval.

h. If not already done, performer ex-

been made, performer uses centi-meter calipers to measure the

plains to patient what will be in- thickness of the abdomen in the

volved in the procedure: directions in which the centralray of the x-ray beam will pass

i) Performer explains what coopera- through the centered part from

tion will be asked of patient. tube to.film.

Describes injection procedurefor contrast and what radiolo- i) Performer evaluates the pa-

gist will be doing. Indicates tient's bodily habitus to esti-

what types of positions the pa- mate thP position of the bil-

tient will be asked to assume. iary tract and variations in

Describes any probable breathing location between inhalation

control, use of compression de- and exhalation, and between

5 5 7


Task Code 386

This is page 9 of 17 for 0 rask.

List Elements Full

prone, supine or erect posi-tions for centering purposes.

ii) If both recumbent and erect po-sitioning may be used, perform-er measures or estimates thick-ness in both positions.

iii) -Notes whether the areas of in-terest are heavily covered bymuscle or soft fat, whether thepalpation points are easy tofind.

iv) Notes whether the extremitiesare of unequal length. If so,plans to support shorter limbfor any erect filming.

v) Records measurements for usein determining exposure factorsfor overheads. Notes positionsfor which measurements apply.After reassuring, has patientrest in a relaxed supine posi-tion on table.

vi) Performer may tape R or L markerto patient if appropriate foruse in spot filming.

j. Performer may note whether a pre-liminary scout film has alreadybeen made of the patient (done byanother radiologic technologist).

i) If a scout film has already beenmade and viewed by radiologist,performer notes the techniqueused or't1rdered and plans tech-nical fadtors for overhead ra-diography', adjusting as appro-priate. ,

ii) If a scout-film has been madebut not approved, performerplaces processed scout film andany prior films with patient'schart or places on view boxfor review by radiologist.

iii) If a scout film has not been

I

made is required before pa-tient is seen by radiologist,performer plans to proceed as

lements Fully

described below,following or-ders or standard procedure.

Performer informs attending radiolo-gist when patient is ready to be ex-amined. Brings requisition sheet, pa-tient's medical history, chart, scoutfilm (if already done) and any priorfilms to radiologist. Displays radio-graphs on view boxes.

a. If not already done, performertells radiologist about any diffi-culties encountered with regardto information, possible contra-indications, or anything else thatshould be brought to radiologist'sattention. Notes any special or-ders or change in procedure de-cided by radiologist.

b. Performer may accompany radiolo-gist to examination room and in-troduce patient to radiologist.

c. During radiologist's review ofrequisition, prior films and ex-amination of patient, performernotes radiologist's orders:

i) If radiologist decides to ter-minate procedure, performer proceeds to termination steps de-scribed below. If appropriatearranges to have proper formsfilled out.

ii) If radiologist decides that ad-ditional cleansing is needed,performer may arrange to havethis carried out and/or per-former arranges to n.schedulepatient.

iii) If not already done, performernotes radiologist's order forscout film. Notes patient po-sition, projection and center-ing ordered or plans to carryout standard procedure.

558


Task Code No. 34'6_


List Elements Full List Elements rull

Unless already done, performer se-lects and sets the technical factorsfor the scout film of the abdomen(or the next overhead radiograph).

a. Performer consults the techniquechart posted for the machine.Locates the information neededfor the body part and projectioninvolved according to the centi-meter thickness of the part asmeasured for the position andthe collimated field size to beused. Makes sure that techniquerelates to the combination offilm type and speed and use ornonuse of other accessories (suchas screens, grids, bucky, etc.).

b. Makes note of the kVp, mA, T(sec-onds of exposure time), focalspot size, and the focal filmdistance (TFD or FFD) called for.

c. Once the standard kVp, mA andtime have been determined,perform-er makes any conversions nece, ,aryto account for extreme fat ormuscularity, age, the preferenceof the radiologist involved, andany other conversion needed suchas posted changes. Performer looksup numerical conversion factorsand calculates or uses conversioncharts to ascertain the appropri-ate new exposure factor (kVp, mAand/or time). Multiplies, divides,adds, or subtracts as appropriate.

d. Performer checks any new or un-familiar exposure factors againstthe posted limits of the x-raytube on a tube rating chart to besure that technique does not ex-ceed the heat capacities of thetube for the focal spot size tobe used. If appropriate, performerreconverts the technique to anequivalcot output using higher kVpand lower mAs.

e. Performer sets the exposure fac-tors as selected:

i) Sets control for radiographymode.

ii) If appropriate, checks linevoltage meter and, if needed,turns compensator dial untilneedle is aligned prol3erly online meter.

iii) For conventional exposure con-trol, performer sets the milli-amperage selected for the cor-rect focal spot size. Sets theselected exposure time that wilproduce the mAs desired. Setsthe kVp selected by choosingthe combination of major kilo-voltage and minor kilovoltagesettings to produce the desiredkVp.

iv) For automatic phototimed expo-sure control, performer setsthe category corresponding tothe type of study and use ofscreens, bucky, etc., and, ifappropriate, focal spot size.Sets a control correspondingto the selected field size (aslisted on technique chart forphototiming).May set a kVp range button, ifcalled for with equipment, cor-responding to the appropriatekV range for the examination.Sets a density selector corres-ponding to the usual (or spec-ial) requirements for the study.Makes sure backup timer is notlikely to terminate exposurebefore phototimed exposure ismade.

v) Depending on the equipment, mayset controls to provide for useof bucky, manual tableside ad-justments of table and tubeheight, position, and of colli-mation.


Task Code No. 386

This is page llof 17 for this task.


.

f. Performer obtains the appropriatesize loaded cassette for the first(or next) scout projection. At-taches identification informationto the cassette or table top:

i) Places right or left marker onfilm holder or table-top asappropriate or depresses ap-propriate R or L button for,utomatic marking.

ii) if patient's identification in-formation is in the form oflead numerals or marker, per-former places on appropriatecorner of cassette.

iii) If patient identification in-formation is to be entered byuse of flasher, sets flashcard aside for later use withspace created by piece of lead-ed rubber on appropriate edgeof cassette.

iv) P.erformer may place patient'scard into card tray for equip-went using automatic film mark-ing device.

g. Performer places cassette in bucky.May manually pull out bucky trayand open retaining clamps. Insertscassette into bucky tray and pushesback. Makes sure clamps are closed,Moves cassette into appropriate"stored" position or inserts cas-sette tray into bucky slot andcenters.

The performer positions the patientfor the first or next scout film inthe supine AP position unless other-wise specified. Plans to center toabdomen and/or right abdomen depend-ing on standard institutional pro-cedures.

a. Performer may explain or demon-strate to patient what is required.May obtain help in positioning.

b. When positioning a patient with aballoon catheter in place, per-former makes sure that the clampis not lying over a part to beexposed or that patient is notlying on the clamp.

c. For supine AP projection (poster-ior view) of the abdomen, perform-er has patient lie in a supine po-sition on table.

i) Centers the median sagittalplane of the body (or centerof right side of abdomen) tothe midline of table. Arrangesshoulders and hips to lie onsingle.transver,se planes.

ii) Has patient flex elbows and ab-duct arms. For thin patients orif so ordered performer rotatesthe body slightly with rightside against table. Supportsknees and immobilizes ankles.

iii) Performer centers the cassetteat the level of the iliaccrests unless otherwise speci-fied.

iv) Directs central ray at rightangles to the midpoint of thefilm.

d. Performer may apply a compressionband and air filled bag to upperabdominal region.

e. Checks whether patient is able torelax as positioned and immobi-

.

lized. If not, performer read-justs and recenters until patientis comfortable.

f. Performer rehearses patient inbreathing in, breathing out fully,end holding breath while remaiu-ing relaxed until told to breatheagain (or in suspended inhalationif so ordered).

g. Performer so,.s the focal-filmdistance if not already done asappropriate. Checks the focal-filmdistance by reading indicator

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Task Code No. 386

This is page 12_ of 11 t,r this task.

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scale in the tube housing; adjustsup or down until the required FFD(TFD) is obtained.

h. Performer checks final positioningby using light in collimator. Acti-vates the collimator light andpoints the light beam towards thepart. Adjusts the collimator open-ing to correspond to the film size.Uses cross-hair shadows as refer-ence for center of field. Checksthat primary beam will enter thecenter of the area of interest atthe selected angle to the film soas to project the view desired.Performer adjusts the collimatorso that a small unexposed borderwill appear around the edge of thefilm or collimates further so as toexpose only the area of interest(and thus provide maximum protec-tion and detail). Adjusts primarybeam to minimum size needed tocover the area(s) of interest.

i. Performer adds lead shielding toareas that will be in the primarypath of the beam but are not in-cluded in the areas of interest,especially gonads. Provides pa-tient and everyone who will remainin room during exposure eith ap-propriate protective sIlLelding.Explains if necessary that 0-is isnot cause for alarm but a generalprecaution to minimize unnecessaryradiation exposure.

j. When everything is ready for theexposure, performer reminds patientof the breath control to be usedfor exposure. Encourages patient torelax. Observes the patient's move-ment until the moment that the ex-posure is made. Readjusts positionif warranted.

10. Performer returns to control room.

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a. Makes sure controls are properlyset for radiography mode andthat patient is still in position.

b. Tells patient when to take a deepbreath and exhale and hold stillwhile relaxing, as rehearsed, bycalling or using intercom.

c. When respiration has been sus-pended, performer waits one ortwo seconds to a:llow involuntarymovement of viscera to subsideand then makes exposure or waitsnumber of seconds judged neces-sary for patient to relax.

d. Performer initiates exposure bypressing hand trigger or exposurecontrol button.

i) While exposure is underway performer checks that mA meterrecords appropriate current asset, that kVp meter dipsslightly.

ii) May watch for evidence of mal-function such as line surgeor excessive drop; may listenfor sound of normal function-ing of equipment. If there ismalfunction may decide to re-port; anticipates need to re-peat exposure.

iii) With phototimer notes whetherbackup timer has been involvedin terminating exposure be-fore phototimed exposure wascompleted. If so, anticipatespossible need to repeat expo-sure.After exposure is completedtells patient that he or shecan breathe.If ehe exposure is terminatedby a circuit breaker, re-checks technical factors forpossible ow:load or checksfor overload elsewhere oncircuit. Anticipates need torepeat exposure.

iv)

v)


Task Code No. 386


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e. After exposure removes cassetteand removes markers for furtheruse.

11. The performer arranges to have thescout film processed at once or de-cides to do personally.

a. Attaches ID card for use withflasher if appropriate. May signrequisition.

b. While film is being processed and/or evaluated performer has patientrelax in examination room or hold-ing area. Explains what will hap-pen next. If apptopriate, makessure that patient will be attendedwhile waiting.

c. If appropriate, moves x-ray tubeand any protruding film holderaway from patient before patientrises. May decide to assist pa-tient from table. Makes sure pa-tient is reminded of any footrestin stepping off table.

d. Performer places processed scoutfilm on view box. May displayprior films as well. Notes ra-diologist's orders:

i) Performer notes whether radio-logist requires a change intechnica... factors and/or pa-tient positioning or centeringfor later overhead filming.

ii) Notes radiologist's final or-ders on sequence of examina-tion. Discusses sequence andtiming for procedures such asfractional filling with spotfilms and/or overheads withradiologist.Notes radiologist's orders forprogram and settings for spotfilming and sets or resets asappropriate. May arrange sig-nals for exposure, changing ofspot film cassettes, operationof exposure controls.

maxwam

12. If appropriate, performer preparesfor injection of contrast:

a. Arranges to provide or change anyequipment or supplies as orderedby radiologist.

b. Arranges to have patient preparedfor surgical procedure (for per-cutaneous cholangiography) orT-tube instillation by having pa-tient lie in supine position ontable.

c. Performer gives leaded gloves andapron to radiologist. If appropri-ate, places leaded curtain inplace. Provides patient and every-one remaining in room during ex-posure with appropriate protectiveshielding. Explains if necessarythat this is not cause for alarmbut a general precaution to mini-mize unnecessary radiation expo-sure.

d. Washes hands, observing steriletechnique as appropriate.

e. If appropriate, performer openspacket of sterile gloves for ra-diologist, observing sterile tech-nique,so that wrapper, own hands,or other objects will not contami-nate gloves.

f. May assist as appropriate by hand-ing materials asked for such asin anesthetization of patient forpercutaneous injection or prep-aration for T-tube injection. Ob-serves sterile technique.On signal from radiologist, per-former may dim room lights. Turnson TV power switch. May go tocob!:rol room and operate fluoro-.scope controls on orders fromradiologist. Adjusts kVp and/ormA controls according to rad4D-logist's orders until visualiza-tion is adequate.

g.

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Task Code No. 386


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i) For percutanenus injection per-former repeats as appropriatewhile radiologist places needle,tests for bile, and makes testinjection under fluoroscopiccontrol.

ii) May help position patient inright AP oblique position oras ordered. May position compres-sion devices as ordered.

h. Performer may assist radiologistwith spot filming:

.

i) Operates exposure controls asordered,. -or positions table,tube, or'patient as ordered.

ii) If spot film attachment usescassettes, performer may un-load as used, identify, andinsert additional cassettes,as described above, throughoutprocedure.

i. Depending on institutional proce-dures, performer may keep radio-logist informed of cumulative ex-posure as shown on fluoroscopetimer indicator,

j. For fractional filling performerrepeats appropriate steps as or-dered. If appropriate, makes over-head exposures as ordered as de-scribed below,

13. Throughout procedure or when the flu-oroscopic portion of the examinationis over, performer notes radiologist'sorders for standard or special over-head films. Notes patient positions,projections, tube angulation, breathcontrol and centering ordered. Notestime elapse ordered for each series.

a. Performer is careful not to dis-lodge puncture needle or drainagetube left in place after puncture,or T-tuhe left clamped and inplace.

b. Performer plans each series forappropriate'intervals and markseach cassette to indicate the timeelapse and/or use of suspendedinhalation if so ordered.

c. If centering has not been indi-cated by radiologist, performerjudges the location of the biliaryarea based on the patient's typeof body (habitus) and the evidenceof any prior films. Plans to ad-just for higher centering for su-pine positions and obese, hyper-sthenic patients, and,lower cen-tering for prone or erect positioning and thin, asthenic patients.

d. Performer resets technical factorsas appropriate for each projectionto account for use of contrast andany orders from radiologist afterhaving reviewed scout (and later)films.

e. Throughout procedure performer re-mains alert for any symptom ofsevere pain or adverse reactionto the contrast. As soon as per-former judges that reaction maybe severe, ceases exposure andnotifies rqdiologist or attendingphysician at once.

14. Performer positions patient for over-head views of biliary ducts as fol-lows or as described earlier, depend-ing on the position(s) ordered:

a. For a right AP oblique projection(right posterior oblique view) ofthe extrahepatic bile ducts, per-former has patient assume a su-pine position with the estimatedarea of the biliary tract center-ed to the midline of the zable.

i) Elevates the left side of thebody about 15° to 20°. Supportsthe elevated shoulder, hip andknee. Has patient extend hips


Task Code No. 386



i) Has patient lie on right sidewith left side supported andfilm placed vertically in frontof patient with tube positionedhorizontally behind (for PA projection) or the reverse (forAP projection).

ii) Centers film to estimated areaof biliary ducts adjusted forlikely drop in location ofgallbladder (if present) inthis position toward the mid-axillary line.

iii) Has patient flex knees comfort-ably. Places supports underand between knees and ankles.Has patient flex elbows, placelower hand under head, and haspatient grasp side of tablewith opposite hand. Elevatesthe torso.

iv) May apply compression. Allowspatient with gallbladder tomaintain position long enoughbefore exposure for small gall-stones to be accurately demon-strated.

v) Directs central ray horizontal-ly at right angles to midpointof film.

vi) For a lateral view centers cas-

and knees so that back is arched.May place arms in comfortableposition with hands under orabove head.

ii) Centers film to estimated bil-iary tract area adjusted forpatient's position and body typeor as indicated.

iii) Places inflated bag or radio-lucent wedge under abdomen.

iv) Directs central ray at rightangles to midpoint of film orat 200 cephalad to the centerof the film.

b. For an erect PA projection (an-terior view) of the biliary tract,performer has patient stand inPA position facing vertical cas-sette holder or bucky.

i) Has patient distribute weightevenly. Supports shorter limbif limbs are of unequal length.

ii) Centers estimated area of bil-iary tract to midline awl filmto estimated level of biliaryducts adjusted for position andbody type.

iii) May have patient extend chinover top of cassette. May havepatient extend arms along sidesof holder and grasp edges.

iv) Applies compression as appropri-ate. If patient hat; gallbladder,performer makes sure that pa-tient is maintained in erect

. position long enough before ex-posure for small gallstones tobe accurately demonstrated.

v) Directs central ray at rightangles to center of film.

c. For right lateraldecubitus posi-

sette in bucky on table anddirects central ray verticallyat right angles to center offilm.

d. Performer repeats shielding andcollimation steps as appropriateas described above. For smallfields performer attaches anauxiliary extension cone tocollimator to further reduce theprimary beam.

e. Performer rehearses patient insuspended exhalation (and/or sus-pended inhalation if so ordered)while remaining relaxed.

tioning for projections of the bil-iary tract, performer uses a verti-cal bucky or cassette holder withpatient lying on table. Notes whether PA or AP projection is required.

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Task Code No. 386


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f. Performer makes exposure as de- ii) Notes any decision by radiolo-scribed earlier, waiting a few gist to inject more contrastseconds after suspension of and repeat any portion of therespiration. procedure.

iii) If the radiologist indicates15. Performer arranges for processing and that there is any problem with

review of spot films and each overhead the technical factors or theview as taken: patient positioning for over-

heads, performer records ora. May sign or have radiologist sign notes for use in "retakes."

requisition sheet. Notes whether need to repeat isb. Checks that equipment is turned due to performer's own negli-

off.. gence or lack of attention so

c. With cassette spot films and over- that performer can avoid futurehead exposures, remoVes any mark- "retakes." If request for re-ers for further use. Attaches ID takes reflects malfunctioningcard for use with flasher if ap- equipment,. performer reportspropriate. malfunction to appropriate staff

d. With spot film camera, performer member. If request for retakesadvances the film so that all ex- reflects the preference forposures made will be wound on the density or contrast of the ra-take-np spool in the roll film diologist, performer notes forcassette. Replaces dark slide on future use to avoid future "re-'camera lens. Uses device to cut takes."film and create a light shield. iv) If radiologist requires addi-Resets counter and removes film tional centering and/or posi-cassette. tions, performer repeats over-

e. Performer has overheads and spot head filming as appropriate tofilms processed at once or decides new proje..tions, as describedto process personally,

f. While films are being processed,makes sure that patient is com-

above.v) For further overhead exposures

performer repeats appropriatefortable and, if necessary, attend- steps including identificationed by radiologist, staff member,or self.

of cassette, use of R-L andseries markers, selection and

g. When the overheads and spot films setting of technique, position-have been processed and returned,performer places on view boxes. Mayalso hang scout and prior films.

ing patient and equipment forfocus-object-film alignment,collimation, shielding, breath-

Informs radiologist that radio- ing instructions, making expo-graph(s) are ready for viewing and sure, and processing, as de-makes note of radiologist's deci- scribed above.sions: vi) Performer refrains from cour

menting on the films or pro-i) Notes orders for change in tech- viding any interpretation to

nical factors, change in patient patient.positioning, centering and/or vii) Performer shows subsequenttube angulation. radiographs to radiologist asA


Task Code No. 386



processed. Keeps track of timingand continues at appropriateintervals or as ordered and pro-ceeds as described above untilradiologist indicates that ex-amination is completed.

viii) Notes any orders for delayei:film. If so, performer may pro-vide requisition sheet and haveradiologist fill out and sign.

16. When performer is told by radiolo-gist that the examination has beencompleted, performer carries outtermination steps for the examina-tion:

a. If appropriate, arranges to havefresh dressing applied to T-tube(if removed for radiography). Haspatient cleaned if appropriate.Removes any R-L markers or center-ing marks from patient's body.

b. May have patient transported backto holding area or next location,or decides to do personally', asappropriate. Maker, sure that noneof the equipment is projecting overthe patient Lefore allowing pa-tient to rise.

c. If appropriate, makes sure that pa-tient is in the care of a staffperson who will transport to appro-priate next location or, if out-patient, will arrange to dischargeor send patient home (with escortif appropriate).

d. May have room and equipment clean-ed; has any other appropriate cleanup procedures followed to avoid in-fection or contamination, or de-cides to do personally, dependingon institutional procedures.

e. Performer records the examinationaccording to institutional proce-dures. May include date, room, eic-amination type, the overhead viewstaken the technical factors used,

and film sizes. May record thenumber of exposures made of eachspot film and overhead view in-cluding retakes; may enter theestimated radiation dose to whichpatient was exposed (using postedinformation on dosage); may re-cord any problem with equipment, .

any special care provided patient.Signs requisition sheet.

f. Performer may record the fluoros-copy examination including expo-sure time and rad dosage.

g. May present requisition form toradiologist for comments and sig-nature. May present forms for req-uisitions for later delayed films.

h. Performer may decide to jacketradiographs, requisition sheets,and related materials, and/or haveinformation recorded in log bookpersonally, or have this done,depending on institutional proce-dures.

i. May indicate to appropriate staffperson when the performer is readyto proceed with next examination.