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Chapter 7: Diagnostic and Imaging Services

Learn about the history, training, certification, and responsibilities of cardiographic technicians. Discover employment opportunities, specialized tests performed, and necessary personal characteristics. Explore the growing field of cardiovascular technology and its professional organizations.

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Chapter 7: Diagnostic and Imaging Services

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  1. Chapter 7: Diagnostic and Imaging Services

  2. Cardiographic Technicians • History of the Profession • 1903: first EKG device developed by Einthoven • 1949: Holter invents monitor bearing his name • 1963: stress testing begun by Bruce & associates • New technologies required new technicians to operate them • EKG training programs recently created • Two professional credentials now available

  3. Cardiographic Technicians (cont’d) • Education • Usually trained on the job • Training takes 4 to 6 weeks • Previous experience in health care is preferred by employers • 1-year certificate programs • Basic EKGs • Stress tests • Holter monitor tests • Training for specialized EKG testing (18-24 months)

  4. Cardiographic Technicians (cont’d) • Certification • No licensure • Two organizations offer certification: • American Society of Phlebotomy Technicians (ASPT) • Offers EKG Technician credential • Cardiovascular Credentialing International (CCI) • Offers Certified Cardiographic Technician (CCT) credential

  5. Cardiographic Technicians (cont’d) • General Duties • Clean & maintain an EKG machine • Place the EKG electrodes on the body • Document the patient’s medical history • Monitor a patient’s heart rhythms • Perform a 12-lead electrocardiogram • Document any variation from a normal tracing • Take vital signs

  6. Cardiographic Technicians (cont’d) • Tests Performed by Specialized Cardiographic Technicians • Specialized EKG tests • Rhythm strips • Signal-average EKGs • Event recorders • Device interrogation • Stress tests • Holter monitor tests

  7. Cardiographic Technicians (cont’d) • Tasks Common to All Tests • Set up equipment • Explain procedure to patient • Provide a gown or drape • Prepare the patient • Position the patient • Communicate results to the physician • Schedule appointments • Review patients’ files • Train new employees & others

  8. Cardiographic Technicians (cont’d) • Personal Characteristics • Good interpersonal skills • Good communication skills • Ability to work independently • Ability to follow instructions • Good organizational skills • Good multitasking skills

  9. Cardiographic Technicians (cont’d) • Employment Opportunities and Trends • 24% growth from 2008 to 2018 • Growth due to: • Increase in heart disease • Needs of older population, which is increasing • Rules regarding Medicare & Medicaid reimbursement • Less demand for technicians qualified to perform multiple tests • Better prospects for technicians trained to perform multiple tests • About 75% of jobs are in hospitals • About 25% of jobs are in physicians’ offices & labs

  10. Cardiographic Technicians (cont’d) • Professional Organization: ACVP • Represents >3,000 cardiovascular personnel • Mission • Meet needs of cardiovascular & pulmonary providers • Promote awareness of standards • Encourage recognition of cardiovascular occupations • Operates specialty councils • Produces >26 publications each year • Offers continuing education • Provides chapter meetings & online resources

  11. Cardiographic Technologists • History of the Profession • 1953: ultrasound first used to diagnose cardiac disease • 1955: first Doppler instrument developed • 1970s: technology began to move into clinical settings • 1981: AMA recognizes cardiovascular technology as a profession • 1983: educational guidelines for accredited programs drafted • 1985: Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT) formed

  12. Cardiographic Technologists (cont’d) • Education • Some trained on the job • Most complete a 2-year associate’s program • Some complete 4-year program • 37 accredited programs • HS diploma/experience in other health care profession required • 3-part curriculum is required • Core courses • Specialized instruction • Clinical instruction

  13. Cardiographic Technologists (cont’d) • Core Course Work • Introduction to the field • General & allied sciences • Anatomy & physiology • Basic pharmacology • Basic medical electronics & medical instrumentation

  14. Cardiographic Technologists (cont’d) • Specialized Instruction • Invasive cardiology • Noninvasive cardiology • Cardiac electrophysiology

  15. Cardiographic Technologists (cont’d) • Clinical Instruction • Cardiac & vascular pathophysiology • Patient history & physical examination • Patient psychology, care, & communications • CPR • Diagnostic & therapeutic measures • Clinical cardiac & vascular medicine & surgery • Statistics & data management • Physics • Medical & legal ethics

  16. Cardiographic Technologists (cont’d) • Certifications Offered by CCI • Registered cardiac sonographer (RCS) • Registered vascular specialist (RVS) • Registered congenital cardiac sonographer (RCCS) • Registered cardiovascular invasive specialist (RCIS) • Registered cardiac electrophysiology specialist (RCES) • Registered phlebotomy sonography (RPhS)

  17. Cardiographic Technologists (cont’d) • Certifications Offered by ARDMS • Registered diagnostic cardiac sonographer (RDCS) • Registered vascular technologist (RVT)

  18. Cardiographic Technologists (cont’d) • General Duties • Help diagnose patients with cardiac & vascular disease • Perform ultrasound procedures • Monitor patients’ heart rates • Review physicians’ interpretations & patient files • Compare findings against normal findings • Schedule appointments • Explain test procedures • Care for testing equipment

  19. Cardiographic Technologists (cont’d) • Invasive Procedures: Cardiology Technologists • Cardiac catheterization • Balloon angioplasty • Electrophysiology testing • Open-heart surgery • Pacemaker or stent insertion

  20. Cardiographic Technologists (cont’d) • Noninvasive Procedures • Noninvasive cardiology: echocardiography • Cardiac sonographers or echocardiographers • Noninvasive peripheral vascular study • Vascular technologists or vascular sonographers

  21. Cardiographic Technologists (cont’d) • Personal Characteristics • Good judgment • Conscientiousness • Good communication skills • Ability to follow detailed directions • Ability to work effectively with patients • Pleasant, professional manner

  22. Cardiographic Technologists (cont’d) • Employment Opportunities and Trends • Rapid growth: 24% between 2008 & 2018 • 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

  23. 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

  24. Phlebotomists • History of the Profession • Hippocrates & theory of four humours • Bloodletting: blood drawn to restore balance of humours • Louis Pasteur & germ theory • Blood drawn for diagnostic purposes • 1970s: modern occupation emerged as cost-cutting measure • 1978: National Phlebotomy Association (NPA) formed • 1981: NPA administered first certification exam

  25. Phlebotomists (cont’d) • Education • HS diploma or equivalent required • In-house training at medical facilities vs. formal programs • 59 accredited programs • 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

  26. Phlebotomists (cont’d) • Certification • Gives advantage in securing jobs • Offered by many organizations • Continuing education units (CEUs) required for recertification • Employers may: • Offer in-house education • Pay for offsite programs

  27. Phlebotomists (cont’d) • Work Responsibilities • Perform venipuncture • Perform capillary puncture • Label blood samples • Document procedures • Store & transport blood • Perform other types of tests • Throat cultures • Urine tests • EKGs

  28. Phlebotomists (cont’d) • Personal Characteristics • Good interpersonal skills • Attention to detail • Calmness under pressure

  29. Phlebotomists (cont’d) • Employment Opportunities and Trends • Growth of 16% between 2008 & 2018 • Most jobs in hospitals • Some jobs in: • Physicians’ offices • Medical & diagnostic labs • Increased opportunities due to: • Population increase • Development of new tests

  30. Diagnostic Medical Sonographer • History of the Profession • 1912: echoes used to detect icebergs • World War I: hydrophone invented to detect enemy submarines • 1937: first attempt at using sound for medical imaging • 1963: first commercial scanners available • Sonographers train personnel in hospitals to use scanners • 1969: American Society of Ultrasound Technical Specialists (ASUTS) formed • 1973: occupation of diagnostic ultrasound technologist created • 1975: first credentialing exam

  31. Diagnostic Medical Sonographer (cont’d) • Education • 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 • Classroom instruction combined with lab & clinical activities

  32. Diagnostic Medical Sonographer (cont’d) • Licensure and Certification • 2009: New Mexico & Oregon first states to license • 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

  33. Diagnostic Medical Sonographer (cont’d) • General Duties • Evaluate requisitions before a sonogram • Set Doppler parameters • Select proper transducer • Apply sufficient coupling gel, eliminating bubbles • Perform abdominal scans • Identify artifacts (imaging errors) • Prepare written summaries of findings • Clean, check, & maintain equipment

  34. Diagnostic Medical Sonographer (cont’d) • Specialties • Obstetrics/gynecology • Abdomen • Neurosonography • Breast

  35. Diagnostic Medical Sonographer (cont’d) • Personal Characteristics • Good people skills • Patience • Empathy • Eye for detail • Good judgment • Personal responsibility • Self-motivation • Ability to work independently • Good teamwork skills

  36. 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

  37. Diagnostic Medical Sonographer (cont’d) • Professional Organization: SDMS • Works to advance profession & educate medical community • Advocates on issues affecting profession • Publications • Journal of Diagnostic Medical Sonography • Newsletters • Online resources

  38. Radiologic Technologists/Radiographers • History of the Profession • 1895: Roentgen discovered x-rays • Physicians began experimenting with medical uses of x-rays • 1917: Jerman began training program for technologists • 1920: Jerman founded American Association of Radiological Technicians (AART) • 1922: first certification exam • 1923: registration begun • 1950s: model standardized curriculum developed

  39. 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

  40. Radiologic Technologists/Radiographers (cont’d) • Course Work • Anatomy & physiology • Patient care procedures • Radiation physics • Radiation safety & protection • Principles of imaging • Medical terminology • Patient positioning • Medical ethics • Radiobiology • Pathology

  41. Radiologic Technologists/Radiographers (cont’d) • Specialties • CT scans • MRIs • Mammograms

  42. Radiologic Technologists/Radiographers (cont’d) • Licensure and Certification • 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

  43. Radiologic Technologists/Radiographers (cont’d) • Work Responsibilities • Obtain & document patient’s history • Provide radiation protection shield for patient • Identify radiographs with appropriate lead markers • Manipulate radiographic equipment with ease • Expose film • Process film • Evaluate images for appropriate positioning & quality

  44. Radiologic Technologists/Radiographers (cont’d) • Personal Characteristics • Positive attitude • Empathy • Good people skills • Self-motivation • Confidence • Ability to work independently • Good teamwork skills • Ability to follow instructions • Manual dexterity • Flexibility • Multitasking skills • Attention to detail • Good communication skills

  45. 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

  46. Radiologic Technologists/Radiographers (cont’d) • Professional Organization: ASRT • Largest & oldest organization representing RTs • 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

  47. Nuclear Medicine Technologists • History of the Profession • 1896: discovery of radioactivity by Becquerel • Early 20th century: development of radioisotope tracers • 1929: invention of cyclotron by Lawrence • Making & discovery of artificial nucleotides • 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

  48. 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

  49. Nuclear Medicine Technologists (cont’d) • Course Work • Patient care methods • Nuclear medicine computer applications • Nuclear medicine physics & radiation physics • Diagnostics nuclear medicine procedures • Immunology relating to nuclear medicine • Radiation safety & protection • Radionuclide therapy • Radionuclide chemistry & radiopharmacy • Quality control & quality assurance • Nuclear instrumentation • Statistics

  50. 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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