RADT-2362: Interventional Radiography and Pharmacology 1

RADT-2362: INTERVENTIONAL RADIOGRAPHY AND PHARMACOLOGY Cuyahoga Community College Viewing: RADT-2362 : Interventional Radiography and Pharmacology Board of Trustees: March 2019

Academic Term: Fall 2019

Subject Code RADT - Radiography

Course Number: 2362

Title: Interventional Radiography and Pharmacology

Catalog Description: Introduction to specialized procedures and interventional imaging within diagnostic radiography. Foundational knowledge and skills to enable effective contribution as a member of a specialized imaging team. Basic concepts of pharmacology in interventional and diagnostic radiography. Laboratory demonstration of related patient care and technical skills.

Credit Hour(s): 1

Lab Hour(s): 2 Requisites

Prerequisite and Corequisite BIO-1221 Anatomy and Physiology for Diagnostic Medical Imaging ; and concurrent enrollment in RADT-2350 Radiographic Pathology ; and departmental approval. Outcomes Course Outcome(s): Demonstrate competency in information literacy required for effective documentation and communication in the clinical environment.

Objective(s): 1. Identify how patient medical information is stored in and queried from hospital information systems. 2. Classify patient informed consent forms. 3. Demonstrate effective communication through patient education and explanation of imaging procedures. 4. Demonstrate competency in taking a patient history. 5. Critique orders, requests and diagnostic reports.

Course Outcome(s): Apply the American Registry of Radiologic Technologists' Standard of Ethics as it pertains to the scope of practice for the radiographer.

Objective(s): 1. Discuss origins of medical ethics. 2. Differentiate between legal and ethical issues in healthcare. 3. Understand how physical, social, emotional, intellectual and spiritual factors influence personal growth. 2 RADT-2362: Interventional Radiography and Pharmacology

4. Understand legal issues as they pertain to ethical decision making. 5. Employ critical thinking strategies to evaluate clinical scenarios.

Course Outcome(s): Identify health science professions that participate in the total health care of the patient.

Objective(s): 1. Discuss career opportunities and advancement for the radiographer. 2. Identify various settings involved in the the delivery of health care. 3. Discuss the reimbursement/payment options for health care services.

Course Outcome(s): Explain types of equipment used in the interventional imaging suite including imaging components and patient care equipment.

Objective(s): 1. Identify features of x-ray suite and equipment construction instrumental in interventional imaging (e.g. generators, x-ray tubes, magnification options). 2. Describe equipment used for image manipulation and viewing (e.g. image amplifiers and television circuits). 3. Demonstrate competency in the laboratory environment in manipulating patient care equipment to take patient vital signs to include temperature, pulse, pulse oximetry, respiration and blood pressure.

Course Outcome(s): Describe the tubes, lines, catheters and other devices encountered by the radiographer.

Objective(s): 1. Identify specific types of tubes, lines, catheters and collection devices. 2. Describe the special problems faced in performing procedures on a patient with a tracheotomy and specific tubes, drains and catheters. 3. Outline the steps in the operation and maintenance of suction equipment. 4. Outline the steps in the operation and maintenance of oxygen equipment and demonstrate proper use. 5. Demonstrate competency in the laboratory environment in a simulated performance of the Seldinger technique.

Course Outcome(s): Describe the role of pharmacology, contrast media and venipuncture in medical imaging.

Objective(s): 1. Distinguish between the chemical, generic and trade names of various drugs. 2. Describe pharmacokinetic, pharmacodynamic and pharmacogenetic principles of drugs. 3. Describe the use and impact on the patient of different categories of drugs. 4. Define categories of contrast agents and give specific examples for each category. 5. Explain the pharmacology of contrast agents. 6. Describe the methods and techniques for administering various types of contrast agents. 7. Identify and describe the routes of drug administration. 8. Demonstrate appropriate venipuncture technique in the laboratory environment through simulation. 9. Differentiate between the two major sites of intravenous drug administration. 10. Identify, describe and document complications associated with venipuncture and the appropriate actions to resolve these complications. 11. Discuss the steps of initiating and discontinuing intravenous access. 12. Differentiate and document dose calculations for adult and pediatric populations. 13. Prepare for injection of contrast agents or intravenous medications using aseptic technique. 14. Explain the current legal status and professional liability issues of the radiographer's role in contrast and drug administration. 15. Describe basic drug categories relevant to medical imaging including uses, side effects and impact on imaging studies. 16. State the six rights of drug safety. RADT-2362: Interventional Radiography and Pharmacology 3

Course Outcome(s): Describe the specialized interventional procedures of the articulatory, nervous, respiratory, urinary, circulatory, digestive and reproductive systems.

Objective(s): 1. Define radiographic terms pertaining to each body system. 2. Identify indications for special/interventional procedures for each body system. 3. Identify basic anatomy on a radiographic image pertinent to each special/interventional procedure. 4. Demonstrate competency in the laboratory environment using surgical asepsis, sterile tray set-up and closed gloving and gowning for interventional procedures.

Course Outcome(s): Accurately demonstrate the various laboratory skills associated with course outcomes that are required to assist during interventional radiography procedures.

Objective(s): 1. Perform an accurate and thorough patient history. 2. Demonstrate the proper technique for taking vital signs. 3. Demonstrate the Seldinger technique. 4. Demonstrate correct venipuncture technique. 5. Demonstrate the proper methods for preparing various forms of contrast media. 6. Demonstrate surgical asepsis and sterile tray set-up. 7. Demonstrate closed gloving and gowning techniques.

Methods of Evaluation: 1. Performance of the following patient care and technical skills: a. Patient history b. Vital signs c. Seldinger technique d. Venipuncture e. Contrast media preparation f. Sterile tray set-up g. Closed gloving and gowning 2. Projects to include an interventional procedure case study and patient education brochure 3. Homework for projects 4. Web-based activities 5. Online self-assessment quizzes 6. Corectec Online Registry Review 7. Midterm and final examinations

Course Content Outline: 1. Information literacy in the healthcare environment a. Storage and retrieval systems for patient health information (Hospital information systems (HIS), Radiology Information System (RIS), Picture Archive Communication System (PACS), etc.) b. Effective communication for patient education 2. Understanding orders, requests and diagnostic reports a. Procedure orders and requests i. Patient identification ii. Procedure ordered iii. Patient history iv. Clinical indications v. Ordering physician/provider b. Diagnostic reports i. Content ii. Interpretation 3. Patient consent a. Definition b. Types 4 RADT-2362: Interventional Radiography and Pharmacology

c. Condition for valid consent d. Documentation of consent 4. Ethics and ethical behavior a. American Registry of Radiologic Technologists Standard of Ethics i. Code of Ethics ii. Rules of Ethics b. Origins and history of medical ethics c. Ethical principles d. Moral reasoning e. Personal behavior standards f. Competence g. Professional attributes h. Standards of practice i. Self-assessment and self-governance j. Ethical concepts, principles and process k. Codes of professional ethics l. Systematic analysis of ethical problems m. Ethical violations and sanctions 5. Ethical issues in health care a. Individual and societal rights b. Cultural considerations c. Economic considerations d. Technology e. Scarce resources f. Access to quality health care g. Human experimentation and research h. End-of-life issues i. Ethical research i. Institutional review board approval ii. Data collection iii. Data reporting 6. Legal Issues a. Parameter of legal responsibility b. HIPAA i. Confidentiality of patient medical records (written and electronic) ii. Electronic communication (e.g. cell phones, social networking sites, email, photography) c. Torts i. Intentional ii. Unintentional 7. Legal doctrines and standards a. Legal risk and risk management b. Medical records i. Timely, accurate and comprehensive methods of communication ii. Radiographic images as legal documents iii. Manipulation of electronic data 8. Health science professions a. Considerations i. Educational requirements ii. Certification requirements iii. Job responsibilities iv. Job outlook and advancement opportunities b. Radiologic technology i. Applications specialist ii. Bone densitometry iii. Breast sonography iv. Cardiac-interventional radiography v. Computed tomography vi. Diagnostic medical sonography vii. Diagnostic radiography RADT-2362: Interventional Radiography and Pharmacology 5

viii. Education ix. Magnetic resonance imaging x. Mammography xi. Management xii. Medical dosimetry xiii. Multiskilled (fusion technology) xiv. Nuclear medicine advanced associate xv. Nuclear medicine technology xvi. PACS administration/informatics xvii. Quality management xviii. Radiation therapy xix. Radiologist assistant xx. Vascular sonography xxi. Vascular-interventional radiography c. Other health care professions 9. Health care environment a. Health care settings i. Hospitals ii. Clinics iii. Mental health facilities iv. Long term/residential facilities v. Hospice vi. Outpatient/ambulatory care vii. Preventative care viii. Home health care ix. Telemedicine x. Other (e.g. jails, prisons, medical examiner offices) b. Payment/reimbursement systems i. Self-pay ii. Insurance iii. Government programs 10. Interventional X-ray equipment and accessories a. Generators b. X-ray tubes c. Timers d. Image amplifiers and television circuits e. Pressure injectors f. Tables g. C-arms h. Vital signs and associated equipment i. Temperature 1. Thermometer ii. Pulse iii. Pulse oximetry 1. Pulse oximeter iv. Respiration v. Blood pressure 1. Sphygmomanometer 2. Stethoscope vi. Normal values vii. Interfering factors viii. Adult vs. pediatric ix. Documentation 11. Tubes, lines, catheters and other devices a. Function and handling of devices b. Nasogastric/nasointestinal c. Suction 6 RADT-2362: Interventional Radiography and Pharmacology

i. Adult vs. pediatric ii. Special precautions d. Tracheostomy i. Suction techniques ii. Cardiopulmonary resuscitation (CPR) with tracheotomy e. Chest (thoracostomy) tube i. Purpose ii. Location f. Implanted devices i. Types ii. Purpose iii. Location g. Venous catheters i. Types ii. Purpose iii. Location iv. Care (e.g. infection control) v. Access h. Tissue drains i. Oxygen administration i. Values ii. Oxygen therapy iii. Oxygen delivery systems 1. Low-flow systems 2. High-flow systems iv. Special precautions j. Urinary collection i. Procedure 1. Male 2. Female ii. Alternative methods of urinary drainage k. Ostomies i. Types ii. Purpose iii. Location iv. Care v. Access l. Seldinger technique 12. Pharmacology a. Drug nomenclature i. Chemical name ii. Generic name iii. Trade name b. Drug classification i. Chemical group ii. Mechanism and site of action iii. Primary effect c. General pharmacological principles i. Pharmacokinetics ii. Pharmacodynamics iii. Pharmacogenetics d. Six rights of drug safety i. Right medication ii. Right dose iii. Right patient iv. Right time v. Right route vi. Right documentation e. Drug categories relevant to radiography (uses and impact on patient) RADT-2362: Interventional Radiography and Pharmacology 7

i. Analgesics ii. Anesthetic agents iii. Antiallergic and antihistamine drugs iv. Antianxiety drugs v. Antiarrhythmic drugs vi. Antibacterial drugs vii. Anticoagulant and coagulant drugs viii. Antidepressants ix. Antiemetic drugs x. Antihypertensive drugs xi. Anti-inflammatory drugs xii. Antiseptic and disinfectant drugs xiii. Bronchodilators xiv. Cathartic and antidiarrheal drugs xv. Diuretics xvi. Sedative and hypotonic drugs xvii. Vasodilators and vasoconstrictors 13. Contrast agents a. Types of compounds i. Metallic salts ii. Organic iodides 1. Ionic contrast agents 2. Nonionic contrast agents iii. Gaseous b. Beam attenuation characteristics i. Radiolucent (negative) ii. Radiopaque (positive) iii. Impact of ionic number c. Pharmacologic profile of contrast agents i. Chemical comparison ii. Absorption characteristics iii. Distribution characteristics iv. Metabolic characteristics v. Elimination characteristics vi. Indications, actions and effects vii. Interactions and contraindications viii. Patient reactions d. Dosage e. Preparation 14. Routes of drug administration a. Oral b. Rectal c. Tube or catheter d. Inhalation e. Topical f. Parenteral i. Intravenous ii. Intra-arterial iii. Intrathecal iv. Intramuscular v. Subcutaneous vi. Intradermal vii. Intraosseous 15. Venipuncture a. Methods i. Continuous infusion ii. Intermittent infusion iii. Direct injection 8 RADT-2362: Interventional Radiography and Pharmacology

1. Hand injection 2. Mechanic pressure injector b. Sites of administration i. Peripheral ii. Central c. Venipuncture procedures i. Equipment ii. Patient identification, assessment and instructions iii. Informed consent iv. Dosage, dose calculations and dose-response 1. Adults 2. Pediatric patients v. Patient preparation vi. Application of standard precautions vii. Procedure 1. Injection through an existing line 2. Venipuncture viii. Site observation ix. Emergency medical treatment procedure 1. Appropriate codes 2. Emergency cart (crash cart) 3. Emergency medications 4. Accessory equipment 5. Emergency medical treatment follow-up tasks d. Complications i. Infiltration ii. Extravasation iii. Phlebitis iv. Air embolism v. Drug incompatibility vi. Low fluid level in container e. Discontinuation i. Equipment and supplies for withdrawal ii. Patient preparation iii. Application of standard precautions iv. Withdrawal procedure v. Site observation vi. Patient observation vii. Postprocedural tasks f. Documentation of administration g. Documentation of complication or reaction 16. Current practice standards a. Professional standards i. Scope of practice ii. Practice standards iii. Professional liability and negligence b. State statutes c. Employer prerogative 17. Interventional procedures a. Articulatory anatomy and procedures i. Arthrography 1. Knee 2. Wrist 3. Shoulder 4. Hip b. Nervous system anatomy and procedures i. Anatomy of ventricular system ii. Myelogram c. Respiratory system anatomy and procedures RADT-2362: Interventional Radiography and Pharmacology 9

i. Nasopharynx ii. Oropharynx iii. Laryngopharynx iv. Bronchography d. Urinary system anatomy and procedures i. Cystography ii. Cystourethrography e. Circulatory system anatomy and procedures i. Cerebral angiography ii. Carotid angiography iii. Cardiac catheterization studies iv. Coronary arteriography v. Aortography vi. Renal arteriography vii. Inferior vena cava (IVC) filter placement viii. Selective visceral arteriography and venography ix. Percutaneous transluminal angioplasty and stenting x. Peripheral angiography f. Digestive system anatomy and procedures i. Cholecystography ii. Cholangiography iii. Endoscopic retrograde cholangiopancreatography (ERCP) g. Reproductive system and procedures i. Hysterosalpingogram ii. Mammography iii. Male reproductive 1. Sonography 18. Laboratory activities and competencies a. Patient history and case study b. Vital signs i. Temperature ii. Pulse iii. Pulse oximetry iv. Blood pressure v. Respiration c. Seldinger technique d. Venipuncture e. Contrast and intravenous medication preparation f. Sterile tray set-up g. Closed gloving and gowning

Resources Adler, A. & Carlton, R. (2019) Introduction to Radiologic Imaging Sciences and Patient Care, Elsevier Saunders.

American College of Radiology Committee on Drugs and Contrast Media. (2018) ACR Manual on Contrast Media, American College of Radiology. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf

Jense, S. C. & Peppers, M. P. (2005) Pharmacology and Drug Administration for Imaging Technologists, Elsevier Mosby.

Kaufman, J. & Lee, M. (2013) Vascular and Interventional Radiology, Elsevier Saunders.

Lille, S. l. & Marshall, W. J. (2018) Mammographic Imaging a Practical Guide, Philadelphia: LWW.

Long, B.W., Hall Rollins, J. & Smith, B.J. (2018) Merrill's Atlas of Radiographic Positions and Radiologic Procedures, St. Louis, MO: Elsevier Mosby. 10 RADT-2362: Interventional Radiography and Pharmacology

Moscucci, M. (2013) Grossman and Baim's Cardiac Catheterization, Angiography and Intervention, Lippincott, Williams and Wilkins.

Snopek, A. M. (2006) Fundamentals of Special Radiographic Procedures, Philadelphia: W. B. Saunders.

Woodrow, R., Colbert, B.J., & Smith D.M. (2018) Essentials of Pharmacology for Health Occupations, Delmar.

Resources Other 1. American Society of Radiologic Technologists Radiography Curriculum www.asrt.org 2. American Registry of Radiologic Technologists radiography certification examination content specifications www.arrt.org

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