6095_FM_i-xxvi 09/06/17 6:01 PM Page iii The Radiography Procedure and Competency Manual T H I R D E D I T I O N n n n ANITA BIEDRZYCKI, BS, RT(R) Larchmont Medical Imaging, L.L.C. Burlington County, New Jersey 6095_FM_i-xxvi 09/06/17 6:01 PM Page iv F.A. Davis Company 1915 Arch Street Philadelphia, PA 19103 Copyright © 2018 by F.A. Davis Company Copyright © 2018 by F.A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Chapter opening art used from McKinnis, L, Fundamentals of Musculoskeletal Imaging, 4e, F.A. Davis, Philadelphia, 2014. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Senior Acquisitions Editor: Melissa Duffield Director of Content Development:George W. Lang Art and Design Manager:Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging in Publication Data Names: Biedrzycki, Anita, author. Title: The radiography procedure and competency manual / Anita Biedrzycki. Description: Third edition. | Philadelphia, PA : F.A. Davis Company, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2017001908| ISBN 9780803660953 (pbk.) | ISBN 0803660952 (pbk.) Subjects: | MESH: Radiography—methods | Clinical Competence | Examination Questions Classification: LCC RC78 | NLM WN 18.2 | DDC 616.07/57—dc23 LC record available at https://lccn.loc.gov/2017001908 2007046907 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F.A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-6095-3/18 0 +$.25. 6095_FM_i-xxvi 09/06/17 6:01 PM Page v Dedication God grant me the Serenity to accept that she is gone Courage to change and be more like her and the Wisdom to know she is never truly gone but is still by my side. Mom, you were my “footprints in the sand” You were my shining star, my rock, my sunshine AND MY UNCONDITIONAL SUPPORT! We miss you now that you are gone! More than you ever thought! 6095_FM_i-xxvi 09/06/17 6:01 PM Page vii Preface The Radiography Procedure and Competency Manual is designed to help students become competent, meticulous, conscientious, confident, and professional radiologic tech- nologists. I’m sure that other radiography educators have experienced frustrations similar to my own in trying to find a comprehensive, organized, and practical method to teach and track performance and competency. I hope this text will fill that void. Balancing the many components of producing high-quality radiographs is a daunting task. This manual introduces students to new material, provides a foun- dation from which to expand, and provides students and instructors with an easy- to-follow, comprehensive text that explains intricacies on a comprehensible level. It is a progressive text based on clinical theories that are the foundations for mastering all clinical applications and skills, and it bridges the gap between theory and per- formance. Because this manual is very detailed, students can use it as a reference to practice and learn from their mistakes. When students are familiar with the format of the manual, they acquire habits that allow them to perform systematically, without leaving out important details. The Joint Review Committee on Education in Radiologic Technology (JRCERT) re- quires critical-thinking and problem-solving skills in the curriculum of radiography programs to further enhance students’ competence. As of January 1, 2002, the American Registry of Radiologic Technologists (ARRT) required documentation of mandatory and elective student competency performances. This book addresses both the JRCERT and the ARRT requirements. It also includes additional examinations that are not re- quired by the ARRT, to broaden the scope of practice and not to limit exams to the “norms,” mainly because the routine protocols are not always achievable. All program directors are required to sign documentation verifying that each stu- dent has met competency requirements as identified by the ARRT before the student is eligible to take the national certification examination. This text was written so that ARRT standards and student progression toward meeting the requirements can easily be accomplished and monitored. Also required by the ARRT is documentation of general patient care, including cardiopulmonary resuscitation, vital signs (blood pres- sure, temperature, pulse, respiration, and pulse oximetry), sterile and medical aseptic technique, venipuncture, transfer of patients, and care of patient medical equipment. A section documenting each of the required components is included in the Radiog- raphy Procedure and Competency Table of Contents and Grade Record. I genuinely hope that this text will contribute to the knowledge, confidence, and expertise of students and their future careers as radiologic technologists—and ultimately to the enhancement of quality patient care. © 2018 by F.A. Davis Company. All rights reserved. vii 6095_FM_i-xxvi 09/06/17 6:01 PM Page ix Acknowledgments Paula and Chris THANK YOU FOR JUST BEING YOU! Our relationship is priceless and our friendship is irreplaceable. I treasure our times together and the memories we make! PD © 2018 by F.A. Davis Company. All rights reserved. ix 6095_FM_i-xxvi 09/06/17 6:01 PM Page x 6095_FM_i-xxvi 09/06/17 6:01 PM Page xi Radiography Procedure and Competency Table of Contents and Grade Record Student Name: Expected Year of Graduation: Requirements P – Performed on Patient M–ARRT Mandatory (37) S– Simulated (up to 8 mandatory E– ARRT Elective (15 of 34) procedures may be simulated) PE – Program Elective Circle One(P/S) PROCEDURE REPEAT COMPETENCY EVALUATION EVALUATION EVALUATION PAGE GRADE DATE GRADE DATE GRADE DATE 1 CHAPTER 1 n Clinical Equipment 3 Radiology Equipment 5 CHAPTER 2 n Abdomen 7 Supine Abdomen M P/S 11 Abdomen Upright M P/S 15 Abdomen Decubitus E P/S 19 Dorsal Decubitus Abdomen PE P/S 23 Obstruction Series PE P/S 27 Lateral Abdomen PE P/S 31 Pediatric Abdomen (Age 6 or Younger) E P/S 35 CHAPTER 3 n Chest 37 Routine Chest M P/S 41 Lordotic Chest PE P/S 45 Chest Lateral Decubitus E P/S 49 Bilateral Oblique Chest PE P/S 53 Wheelchair Chest M P/S OR 57 Stretcher Chest P/S 61 Pediatric Chest (Age 6 or Younger) M P/S 65 Geriatric Chest (At Least 65 Years M Old and Physically or Cognitively Impaired as a Result of Aging) © 2018 by F.A. Davis Company. All rights reserved. xi 6095_FM_i-xxvi 09/06/17 6:01 PM Page xii PROCEDURE REPEAT COMPETENCY EVALUATION EVALUATION EVALUATION PAGE GRADE DATE GRADE DATE GRADE DATE 69 CHAPTER 4 n Upper Extremities 71 Finger/Thumb M P/S 75 Hand M P/S 79 AP Oblique Hand (Norgaard/Ball PE P/S Catcher’s Method) 83 Wrist M P/S 87 Carpal Canal (Tunnel) PE P/S 91 Carpal Bridge PE P/S 95 Navicular/Scaphoid PE P/S 99 Forearm M P/S 103 Elbow M P/S 107 Acute Flexion (Axial) Elbow PE P/S 111 Partial Flexion Elbow PE P/S 115 Radial Head PE P/S 119 Humerus M P/S 123 Shoulder M P/S 127 Trauma* Shoulder—A (AP Neutral With Transthoracic Humerus/ Shoulder) OR M P/S 131 Trauma Shoulder—B (AP Neutral With PA Oblique/Scapular Y) OR 135 Axial Shoulder 139 Glenoid Fossa (Grashey Method) PE P/S 143 Scapula (AP and Scapular Y) E P/S 147 Clavicle M P/S 151 Acromioclavicular (AC) Joints E P/S 155 Trauma Upper Extremity M P/S (Nonshoulder) *Trauma is considered a serious injury or shock to the body and requires modifications in positioning and monitoring of the patient’s condition. xii © 2018 by F.A. Davis Company. All rights reserved. 6095_FM_i-xxvi 09/06/17 6:01 PM Page xiii PROCEDURE REPEAT COMPETENCY EVALUATION EVALUATION EVALUATION PAGE GRADE DATE GRADE DATE GRADE DATE 159 Pediatric Upper Extremity E P/S (Age 6 or Younger) 163 Geriatric Upper Extremity (At Least M P/S 65 Years Old and Physically or Cognitively Impaired as a Result of Aging) 167 CHAPTER 5 n Lower Extremities 169 Toe E P/S 173 Sesamoids PE P/S 177 Foot M P/S 181 Weight-Bearing Lateral Foot PE P/S 185 Calcaneus (Os Calcis) E P/S 189 Ankle M P/S 193 Tibia-Fibula M P/S 197 Knee M P/S 201 Weight-Bearing Knee PE P/S 205 Patella E P/S 209 Intercondylar Fossa (Camp-Coventry) PE P/S 213 Femur M P/S 217 Hip M P/S 221 Trauma Hip (Crosstable) M P/S 225 Trauma Lower Extremity M P/S 229 Pediatric Lower Extremity E P/S (Age 6 or Younger) 233 Geriatric Lower Extremity (At Least M P/S 65 Years Old and Physically or Cognitively Impaired as a Result of Aging) 237 CHAPTER 6 n Spine, Pelvis, and Trunk 239 Sternum E P/S 243 Sternoclavicular Joints PE P/S 247 Ribs M P/S 253 Cervical Spine M P/S 259 Swimmer’s Cervical Spine PE P/S © 2018 by F.A. Davis Company. All rights reserved. xiii