Chapter 7: Diagnostic and
Imaging Services
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Cardiographic Technicians
• History of the Profession
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1903: first EKG device developed by Einthoven
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1949: Holter invents monitor bearing his name
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1963: stress testing begun by Bruce & associates
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New technologies required new technicians to operate them
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EKG training programs recently created
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Two professional credentials now available
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Cardiographic Technicians (cont’d)
• Education
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Usually trained on the job
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Training takes 4 to 6 weeks
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Previous experience in health care is preferred by employers
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1-year certificate programs
• Basic EKGs
• Stress tests
• Holter monitor tests
–
Training for specialized EKG testing (18-24 months)
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Cardiographic Technicians (cont’d)
• Certification
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No licensure
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Two organizations offer certification:
• American Society of Phlebotomy Technicians (ASPT)
• Offers EKG Technician credential
• Cardiovascular Credentialing International (CCI)
• Offers Certified Cardiographic Technician (CCT) credential
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Cardiographic Technicians (cont’d)
• General Duties
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Clean & maintain an EKG machine
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Place the EKG electrodes on the body
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Document the patient’s medical history
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Monitor a patient’s heart rhythms
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Perform a 12-lead electrocardiogram
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Document any variation from a normal tracing
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Take vital signs
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Cardiographic Technicians (cont’d)
• Tests Performed by Specialized Cardiographic
Technicians
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Specialized EKG tests
• Rhythm strips
• Signal-average EKGs
• Event recorders
• Device interrogation
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Stress tests
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Holter monitor tests
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Cardiographic Technicians (cont’d)
• Tasks Common to All Tests
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Set up equipment
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Explain procedure to patient
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Provide a gown or drape
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Prepare the patient
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Position the patient
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Communicate results to the physician
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Schedule appointments
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Review patients’ files
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Train new employees & others
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Cardiographic Technicians (cont’d)
• Personal Characteristics
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Good interpersonal skills
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Good communication skills
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Ability to work independently
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Ability to follow instructions
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Good organizational skills
–
Good multitasking skills
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Cardiographic Technicians (cont’d)
• Employment Opportunities and Trends
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24% growth from 2008 to 2018
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Growth due to:
• Increase in heart disease
• Needs of older population, which is increasing
• Rules regarding Medicare & Medicaid reimbursement
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Less demand for technicians qualified to perform multiple tests
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Better prospects for technicians trained to perform multiple tests
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About 75% of jobs are in hospitals
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About 25% of jobs are in physicians’ offices & labs
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Cardiographic Technicians (cont’d)
• Professional Organization: ACVP
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Represents >3,000 cardiovascular personnel
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Mission
• Meet needs of cardiovascular & pulmonary providers
• Promote awareness of standards
• Encourage recognition of cardiovascular occupations
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Operates specialty councils
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Produces >26 publications each year
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Offers continuing education
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Provides chapter meetings & online resources
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Cardiographic Technologists
• History of the Profession
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1953: ultrasound first used to diagnose cardiac disease
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1955: first Doppler instrument developed
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1970s: technology began to move into clinical settings
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1981: AMA recognizes cardiovascular technology as a profession
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1983: educational guidelines for accredited programs drafted
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1985: Joint Review Committee on Education in Cardiovascular
Technology (JRC-CVT) formed
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Cardiographic Technologists (cont’d)
• Education
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Some trained on the job
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Most complete a 2-year associate’s program
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Some complete 4-year program
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37 accredited programs
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HS diploma/experience in other health care profession required
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3-part curriculum is required
• Core courses
• Specialized instruction
• Clinical instruction
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Cardiographic Technologists (cont’d)
• Core Course Work
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Introduction to the field
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General & allied sciences
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Anatomy & physiology
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Basic pharmacology
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Basic medical electronics & medical instrumentation
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Cardiographic Technologists (cont’d)
• Specialized Instruction
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Invasive cardiology
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Noninvasive cardiology
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Cardiac electrophysiology
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Cardiographic Technologists (cont’d)
• Clinical Instruction
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Cardiac & vascular pathophysiology
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Patient history & physical examination
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Patient psychology, care, & communications
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CPR
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Diagnostic & therapeutic measures
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Clinical cardiac & vascular medicine & surgery
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Statistics & data management
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Physics
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Medical & legal ethics
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Cardiographic Technologists (cont’d)
• Certifications Offered by CCI
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Registered cardiac sonographer (RCS)
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Registered vascular specialist (RVS)
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Registered congenital cardiac sonographer (RCCS)
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Registered cardiovascular invasive specialist (RCIS)
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Registered cardiac electrophysiology specialist (RCES)
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Registered phlebotomy sonography (RPhS)
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Cardiographic Technologists (cont’d)
• Certifications Offered by ARDMS
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Registered diagnostic cardiac sonographer (RDCS)
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Registered vascular technologist (RVT)
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Cardiographic Technologists (cont’d)
• General Duties
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Help diagnose patients with cardiac & vascular disease
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Perform ultrasound procedures
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Monitor patients’ heart rates
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Review physicians’ interpretations & patient files
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Compare findings against normal findings
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Schedule appointments
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Explain test procedures
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Care for testing equipment
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Cardiographic Technologists (cont’d)
• Invasive Procedures: Cardiology Technologists
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Cardiac catheterization
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Balloon angioplasty
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Electrophysiology testing
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Open-heart surgery
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Pacemaker or stent insertion
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Cardiographic Technologists (cont’d)
• Noninvasive Procedures
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Noninvasive cardiology: echocardiography
• Cardiac sonographers or echocardiographers
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Noninvasive peripheral vascular study
• Vascular technologists or vascular sonographers
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Cardiographic Technologists (cont’d)
• Personal Characteristics
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Good judgment
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Conscientiousness
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Good communication skills
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Ability to follow detailed directions
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Ability to work effectively with patients
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Pleasant, professional manner
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Cardiographic Technologists (cont’d)
• Employment Opportunities and Trends
–
Rapid growth: 24% between 2008 & 2018
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Growth due to:
• Increase in heart disease & aging population
• Increase in noninvasive procedures
• Early diagnosis of vascular disease
• Technological advances & reimbursement rules
–
77% in hospitals
–
Remainder in physicians’ offices & medical & diagnostic labs
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Cardiographic Technologists (cont’d)
• Professional Organizations
–
Society for Vascular Ultrasound (SVU)
• Represents & advocates for profession
• Offers continuing ed., annual conference, journal, scholarship,
online career center
–
American Society of Echocardiography (ASE)
• Advocates for echocardiographers
• Offers annual scientific sessions, online resources, networking
& continuing ed., journal
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Phlebotomists
• History of the Profession
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Hippocrates & theory of four humours
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Bloodletting: blood drawn to restore balance of humours
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Louis Pasteur & germ theory
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Blood drawn for diagnostic purposes
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1970s: modern occupation emerged as cost-cutting measure
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1978: National Phlebotomy Association (NPA) formed
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1981: NPA administered first certification exam
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Phlebotomists (cont’d)
• Education
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HS diploma or equivalent required
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In-house training at medical facilities vs. formal programs
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59 accredited programs
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Programs:
• Lead to a certificate
• Require at least 100 hours of clinical experience
• Require at least 100 successful unassisted blood collections
• Include both course work & practical experience
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Phlebotomists (cont’d)
• Certification
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Gives advantage in securing jobs
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Offered by many organizations
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Continuing education units (CEUs) required for recertification
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Employers may:
• Offer in-house education
• Pay for offsite programs
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Phlebotomists (cont’d)
• Work Responsibilities
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Perform venipuncture
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Perform capillary puncture
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Label blood samples
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Document procedures
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Store & transport blood
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Perform other types of tests
• Throat cultures
• Urine tests
• EKGs
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Phlebotomists (cont’d)
• Personal Characteristics
–
Good interpersonal skills
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Attention to detail
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Calmness under pressure
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Phlebotomists (cont’d)
• Employment Opportunities and Trends
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Growth of 16% between 2008 & 2018
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Most jobs in hospitals
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Some jobs in:
• Physicians’ offices
• Medical & diagnostic labs
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Increased opportunities due to:
• Population increase
• Development of new tests
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Diagnostic Medical Sonographer
• History of the Profession
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1912: echoes used to detect icebergs
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World War I: hydrophone invented to detect enemy submarines
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1937: first attempt at using sound for medical imaging
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1963: first commercial scanners available
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Sonographers train personnel in hospitals to use scanners
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1969: American Society of Ultrasound Technical Specialists
(ASUTS) formed
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1973: occupation of diagnostic ultrasound technologist created
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1975: first credentialing exam
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Diagnostic Medical Sonographer (cont’d)
• Education
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Training program options
• Informal training programs at hospitals & schools
• Formal 2-year (associate’s) & 4-year (bachelor’s) programs
• 1-year programs leading to certificate
–
174 accredited programs
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Classroom instruction combined with lab & clinical activities
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Diagnostic Medical Sonographer (cont’d)
• Licensure and Certification
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2009: New Mexico & Oregon first states to license
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Certification
• Offered by several organizations
• Requires passing two different exams
• Must be renewed every 3 years
–
Registration
• Offered by American Registry of Radiological Technologists
(ARRT)
• Renewed annually
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Diagnostic Medical Sonographer (cont’d)
• General Duties
–
Evaluate requisitions before a sonogram
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Set Doppler parameters
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Select proper transducer
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Apply sufficient coupling gel, eliminating bubbles
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Perform abdominal scans
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Identify artifacts (imaging errors)
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Prepare written summaries of findings
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Clean, check, & maintain equipment
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Diagnostic Medical Sonographer (cont’d)
• Specialties
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Obstetrics/gynecology
–
Abdomen
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Neurosonography
–
Breast
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Diagnostic Medical Sonographer (cont’d)
• Personal Characteristics
–
Good people skills
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Patience
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Empathy
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Eye for detail
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Good judgment
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Personal responsibility
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Self-motivation
–
Ability to work independently
–
Good teamwork skills
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Diagnostic Medical Sonographer (cont’d)
• Employment Opportunities and Trends
–
Growth: 18% between 2008 & 2018
–
Factors prompting growth
• Aging population
• Increasing use of sonography
• Development of new sonography procedures
–
Setting distribution
• 60% in hospitals
• Remainder in physicians’ offices & medical & diagnostic labs
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Diagnostic Medical Sonographer (cont’d)
• Professional Organization: SDMS
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Works to advance profession & educate medical community
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Advocates on issues affecting profession
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Publications
• Journal of Diagnostic Medical Sonography
• Newsletters
–
Online resources
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Radiologic Technologists/Radiographers
• History of the Profession
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1895: Roentgen discovered x-rays
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Physicians began experimenting with medical uses of x-rays
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1917: Jerman began training program for technologists
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1920: Jerman founded American Association of Radiological
Technicians (AART)
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1922: first certification exam
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1923: registration begun
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1950s: model standardized curriculum developed
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Radiologic Technologists/Radiographers
(cont’d)
• Education
–
Most complete 2-year associate’s degree program
–
Other options:
• Certificate program lasting 21-24 months
• 4-year bachelor’s degree program
–
HS diploma required for entry into program
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Radiologic Technologists/Radiographers
(cont’d)
• Course Work
–
Medical terminology
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Anatomy & physiology
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Patient positioning
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Patient care procedures
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Medical ethics
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Radiation physics
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Radiobiology
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Radiation safety &
protection
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Pathology
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Principles of imaging
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Radiologic Technologists/Radiographers
(cont’d)
• Specialties
–
CT scans
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MRIs
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Mammograms
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Radiologic Technologists/Radiographers
(cont’d)
• Licensure and Certification
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Required in some states
–
Advantageous in job market
–
Requires:
• Graduation from accredited program
• Passing a national exam
• Meeting ethical standards
–
Recertification required every 2 years
–
Specialty certification available
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Radiologic Technologists/Radiographers
(cont’d)
• Work Responsibilities
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Obtain & document patient’s history
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Provide radiation protection shield for patient
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Identify radiographs with appropriate lead markers
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Manipulate radiographic equipment with ease
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Expose film
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Process film
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Evaluate images for appropriate positioning & quality
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Radiologic Technologists/Radiographers
(cont’d)
• Personal Characteristics
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Positive attitude
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Empathy
–
Good people skills
–
Self-motivation
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Confidence
–
Ability to work
independently
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Good teamwork skills
–
Ability to follow
instructions
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Manual dexterity
–
Flexibility
–
Multitasking skills
–
Attention to detail
–
Good communication skills
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Radiologic Technologists/Radiographers
(cont’d)
• Employment Opportunities and Trends
–
Growth: 17% between 2008 & 2018
–
Factors prompting growth
• Population growth
• Aging of population
• Increased use of imaging
–
Setting distribution
• >60% in hospitals
• Remainder in physicians’ offices & medical & diagnostic labs
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Radiologic Technologists/Radiographers
(cont’d)
• Professional Organization: ASRT
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Largest & oldest organization representing RTs
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Represents RTs in government & education
–
Monitors state & federal legislation
–
Helps
• Develop & revise curriculums
• Set practice guidelines
• Implement standards
–
Offers continuing education
–
Promotes careers in field
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Nuclear Medicine Technologists
• History of the Profession
–
1896: discovery of radioactivity by Becquerel
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Early 20th century: development of radioisotope tracers
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1929: invention of cyclotron by Lawrence
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Making & discovery of artificial nucleotides
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1930s: blood disorders treated with radioactive phosphorus
–
1946: cancer patient successfully treated w. radioactive iodine
–
1950s: nuclear medicine emerged as a discipline
–
1980s: development of radiopharmaceuticals
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Nuclear Medicine Technologists (cont’d)
• Education
–
Program options:
• Associate’s degree
• Bachelor’s degree
• Certificate: available at hospitals for graduates of other
health care programs
–
101 accredited programs
–
Course work & clinical component required
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Nuclear Medicine Technologists (cont’d)
• Course Work
–
Radiation safety &
protection
–
Radionuclide therapy
–
Radionuclide chemistry &
radiopharmacy
–
Patient care methods
–
Nuclear medicine computer
applications
–
Nuclear medicine physics &
radiation physics
–
–
Diagnostics nuclear
medicine procedures
Quality control & quality
assurance
–
Nuclear instrumentation
–
Immunology relating to
nuclear medicine
–
Statistics
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Nuclear Medicine Technologists (cont’d)
• Licensure and Certification
–
Required by more than half of states
–
Certification is optional, but standard in market
–
Certifying agencies:
• ARRT
• Nuclear Medicine Technology Certification Board (NMTCB)
–
Certification requires graduation from accredited program &
passing a national exam
–
Continuing ed. required every 2 years
–
Specialty certification available
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Nuclear Medicine Technologists (cont’d)
• Work Responsibilities
–
Select & prepare prescribed dosages of radiopharmaceuticals
–
Verify correct syringe & dose
–
Position patient appropriately
–
Select images for processing
–
Record receipt of radioactive materials
–
Evaluate performance of a scanner
–
Perform wipe tests for radiation
–
Collect blood samples by venipuncture
–
Conduct & document radiation surveys
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Nuclear Medicine Technologists (cont’d)
• Personal Characteristics
–
Good interpersonal skills
–
Good communication skills
–
Attention to detail
–
Self-motivation
–
Ability to work independently
–
Good teamwork skills
–
Flexibility
–
Willingness to learn
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Nuclear Medicine Technologists (cont’d)
• Employment Opportunities and Trends
–
Growth: 16% between 2008 & 2018
–
Factors promoting growth
• Development & increased use of newer imaging technologies
• Development of new nuclear medicine treatments
• Aging of population
–
Setting distribution
• 2/3 in hospitals
• Remainder in physicians’ offices & medical & diagnostic labs
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Nuclear Medicine Technologists (cont’d)
• Professional Organization: SNM
–
Founded in 1954
–
Represents professionals in nuclear medicine
–
Publishes journals, newsletters, & books
–
Sponsors international meetings & workshops
–
Monitors congressional & regulatory activities
–
Advocates for nuclear medicine science & research
–
Offers grants, awards, & scholarships
–
Offers various benefits for membership
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