INSTRUCTION Course Package

RAD 140

RADIOGRAPHIC POSITIONING II

APPROVED 12/O2/2011 EFFECTIVE SPRING 2012-13

MCC Form EDU 0007 (rev. 09/07/11) INSTRUCTION Course Package

Prefix & Number RAD 140 Course Title: Radiographic Positioning II & Lab Purpose of this submission: New Change/Updated Retire If this is a change, what is being changed? Update Prefix Course Description (Check all that apply) Title Course Number Format Change Credits Prerequisite Competencies Textbook/Reviewed Competencies-no changes needed Does this course require additional fees? No Yes If so, please explain. Is there a similar course in the course bank? No Yes (Please identify) Articulation: Is this course or an equivalent offered at other two and four-year universities in Arizona? No Yes (Identify the college, subject, prefix, number and title: This course is offered in programs in the state. Is this course identified as a Writing Across the Curriculum course? No Yes

Course Textbook, Materials and Equipment Textbook(s) Title Radiographic Positioning and Related Anatomy Author(s) Bontrager, Kenneth L.; Lampignano, John P. Publisher Mosby Elsevier Barnes & Noble Price New 169.00 Used 126.75

Title Radiographic Positioning and Related Anatomy Workbook Volume One and Two Author(s) Bontrager, Kenneth L.; Lampignano, John P. Publisher Mosby Elsevier Barnes & Noble Price New 49.95 Used 37.45

Title Radiographic Image Analysis Author(s) McQuillen Martensen, Kathy Publisher Saunders Elsevier Barnes & Noble Price New 85.95 Used 64.45

Software / Equipment

Course Assessments Description of Possible Course Assessments (Essays, multiple choice, Mid -term and Final exams ; multiple choice, etc.) blanks, Pilot registry exams

Exams standardized for this course? Are exams required by the department ? Midterm No Yes

MCC Form EDU 0007 (rev. 09/07/11) INSTRUCTION Course Package

Final If Yes, please specify: Final exam with multiple Other (Please specify): choice and fill in the blanks; Pilot registry exams

Where can faculty members locate or access the required standardized Director of Radiologic Technology Office exams for this course

The ability to offer comp assionate and Student Outcomes: Identify the general education goals for student professional care, with confidence, applying the learning that is a component of this course. skills of positioning and technique.

Check all that apply: Method of Assessment 1. Communicate effectively. Mid -term and Final exams ; Pilot registry exam ; a. Read and comprehend at a college level. research paper or poster b. Write effectively in a college setting.

2. Demonstrate effective quantitative reasoning and problem Demonstrations, simulations, case studies, solving skills. quizzes, exams, discussions, perform phantom positioning in radiographic procedures, image analysis, corrective actions of images, mid-term and final exams 3. Demonstrate effective qualitative reasoning skills. Demonstrations, simulations, case studies, quizzes, exams, discussions, perform phantom positioning in radiographic procedures, image analysis, corrective actions of images, mid-term and final exams 4. Apply effective methods of inquiry. Research paper or poster; 1500 words a. Generate research paper by gathering information from varied sources, analyzing data and organizing information into a coherent structure. b. Employ the scientific method.

5. Demonstrate sensitivity to diversity The student listens attentively to the patient’s a. Experience the creative products of humanity. concerns; and, professionally explains and helps b. Describe alternate historical, cultural, global the patient through the procedure with an perspectives. understanding of cultural diversity, age-specific care, and a compassionate approach to patients with disabilities.

MCC Form EDU 0007 (rev. 09/07/11) INSTRUCTION Course Package

COURSE INFORMATION

Initiator: Maryann Shepherd Date of proposal to Curriculum Sub-Committee: December 2, 2011 Effective Semester/Year Spring 2013 - 2nd Program Semester Prefix & Number: RAD 140 & 140L Full Title: Radiographic Positioning II and Lab Short Title: Positioning II & Lab Catalog Course Description: The student will be introduced to the radiographic examinations of the vertebral column, and skull to perform quality radiographs; students will also assist the radiologist, and physicians operating fluoroscopic equipment and the C-arm in gastrointestinal studies and special procedures. Content explores identifying anatomy of radiographic images; ability to critique images for appropriate technical, procedural and pathological factors and correct equipment malfunctions. Credit Hours: 4 Lecture Hours: 3 Lab Hours: 3

Prerequisite: Successful completion of the previous semester. Co -requisite: RAD 140 & 140 L RAD 140 -170 are in the same cohort and must be taken during the same semester.

Intended Course Goals

By the end of the semester, students will be able to: 1. Prepare the patient by explaining the procedure, explaining the contrast agent, it’s purpose and effect, and obtain a signed informed consent form 2. Demonstrate evidence -based practice principles to prepare and administer the appropriate contrast agent for each procedure 3. Identify ethical, professional and legal frameworks for radiography practice 4. Employ critical thinking skills as the student radiographer responds to adverse reactions that the patient may have 5. Integrate physical, emotional, cultural and spiritual components of caring for the patient, families and medical team 6. Demonstrate clinical competency in assisting the radiologist in procedures while positioning and assisting the patient 7. Document the procedure and contrast agent used 8. Discuss the elements of a radiographic image 9. Apply the process of evaluating images for adequate density. brightness, contrast, recorded detail/spatial resolution and acceptable limits of distortion 10. Produce quality radiographs, problem -solve and analyze radiographs 11. Analyze the radiographic image for structures shown, positioning, collimation, CR, and exposure criteria for views and projections

MCC Form EDU 0007 (rev. 09/07/11) INSTRUCTION Course Package

12. Differentiate images produced by various modalities

MCC Form EDU 0007 (rev. 09/07/11) INSTRUCTION Course Package

Course Competencies and Objectives

By the end of thethethe semester, students will be able to: Competency 1 Compet ently and independently perform quality radiographs involving the vertebral column, cervical spine, and thoracic spine. Objective 1.1 State the radiographic anatomy and physiology of the cervical and thoracic spinal column Objective 1.2 Position the patient for the AP, PA, oblique, lateral, axial and tangential views of the cervical and thoracic spinal column Objective 1.3 Analyze the radiographic image for structures shown, positioning, collimation, CR, and exposure criteria for views and projections stated in objective 1.2 Objective 1.4 Position the patient for the trauma views of the cervical spine: positioning the lateral position, horizontal beam for the cervical spine for trauma patients; Twining Method (Swimmer’s) for C2-T3 Objective 1.5 Analyze the radiographic image for structures shown, positioning, collimation, CR, and exposure criteria for views and projections stated in objective 1.3. Compe tency 2 Competently and independently perform quality radiographs involving the lumbar spi ne, sacrum and coccyx Objective 2.1 State the radiographic anatomy and physiology of the lumbar spine, sacrum and coccyx Objective 2.2 Position the patient for the PA, oblique, lateral, axial and tangential views of the lumbar and sacral area spinal column Objective 2.3 Analyze the radiographic image for structures shown, positioning, collimation, CR, and exposure criteria for views and projections stated in objective 2.2 Objective 2.3 Position the patient for special views: scoliosis, AP, Lateral, right and left bending; hyperextension and hyperflexion lumbar. Objective 2.4 Analyze the radiographic image for structures shown, positioning, collimation, CR, and exposure criteria for views and projections stated in objective 2.3 Competency 3 Competently and independently perform s quality radiographs of the skull and cranial bones Objective 3.1 State the radiographic anatomy and physiology of the skull Objective 3.2 Identify the body planes and landmarks, positioning lines, surface landmarks, and orbital landmarks of the skull and cranial bones Objective 3.4 Position the patient for the AP, PA, oblique, axial and lateral views of the skull Objective 3.5 Analyze the radiographic image for structures shown, positioning, collimation, CR, and exposure criteria for views and projections stated in objective 3.4. Objective 3.6 Position the patient for special views: submentovertex projection, Haas Method of the PA axial projection of the skull. Objective 3.7 Analyze the radiographic image for structures shown, positioning, collimation, CR, and exposure criteria for views and projections stated in objective 3.6. Competency 4 Competently and independently perform quality radiographs of the facial bones and paran asal sinuses Objective 4.1 State the radiographic anatomy and physiology of the facial bones and paranasal sinuses Objective 4.2 Position the patient for the AP, PA, oblique, axial and lateral views of the facial bones Objective 4.3 Position the patient for the Waters Method, Caldwell and modified Caldwell Method for facial bones Objective 4.4 Analyze the radiographic image for structures shown, positioning, collimation, CR, and exposure criteria for views and projections stated in objective 4.2 and 4.3 Objective 4.5 Position the patient for the superoinferior tangential projection for the nasal bones Objective 4.6 Position the patient for the submentovertex projection, oblique inferosuperior projection, and modified Towne method for the zygomatic arches Objective 4.7 Position the patient for the parietoorbital oblique projection for optic foramina Objective 4.8 Position the patient for the axiolateral oblique projection, submentovertex projection, and panorex for the mandible Objective 4.9 Analyze the radiographic image for structures shown, positioning, collimation, CR, and exposure criteria for views and projections stated in objectives 4.5, 4.6, 4.7 and 4.8. Competency 5 Competently prepare the fluoroscop ic room and the patient; and, assist the radiologist in the procedure involving the biliary tract and upper gastrointestinal system Objective 5.1 State the radiographic anatomy and physiology of the , , biliary ducts, and digestive system

MCC Form EDU 0007 (rev. 09/07/11) INSTRUCTION Course Package

Objective 5 .2 Prepare the fluoroscopic room and the contrast media for the procedure Objective 5.3 Communicate with the patient and family by explaining the procedure, explaining the contrast agent, it’s purpose and effect, answer any questions the patient may have and obtain a signed informed consent form Objective 5.4 Position the patient to begin the procedure and notify the radiologist that the procedure can begin Objective 5.5 Assist the radiologist in performing the procedure, while anticipating the various positions Objective 5.6 Perform plain films if the medical facility requires them Objective 5.7 Analyze the radiographic images for structures shown, positioning, collimation, CR, and exposure criteria Objective 5.8 Assist the patient to the dressing room, providing post-procedure instructions Objective 5.9 Prepare the plain films for the radiologist Objective 5.10 Document the procedure and contrast agent used Competenc y 6 Competently prepare the fluoroscopic room and the patient; and, assist the radiologist in the procedure involving the lower gastrointestinal system Objective 6.1 State the radiographic anatomy and physiology of the lower gastrointestinal system Objective 6.2 Verify with the radiologist whether the procedure will be single or double contrast Objective 6.3 Prepare the fluoroscopic room and the appropriate contrast media for the procedure Objective 6.4 Communicate with the patient and family by explaining the procedure, explaining the contrast agent, it’s purpose and effect, answer any questions the patient may have and obtain a signed informed consent form Objective 6.5 Position the patient to begin the procedure and notify the radiologist that the procedure can begin Objective 6.6 Assist the radiologist in performing the procedure, while anticipating the various positions Objective 6.7 Perform plain films if the medical facility requires them Objective 6.8 Analyze the radiographic images for structures shown, positioning, collimation, CR, and exposure criteria Objective 6.9 Assist the patient to the dressing room, providing post-procedure instructions Objective 6.10 Prepare the plain films for the radiologist Objective 6.11 Document the procedure and contrast agent used Competency 7 Competently prepare the room and the patient in the procedure involving the urinary system Objective 7.1 State the radiographic anatomy and physiology of the urinary system Objective 7.2 Prepare the radiography room for the intravenous (IVP), Excretory Urogram (EXU) or hypertensive urogram (IVU) Objective 7.3 Communicate with the patient and family by explaining the procedure, explaining the contrast agent, it’s purpose and effect, answer any questions the patient may have and obtain a signed informed consent form Objective 7.4 Obtain the creatinine levels if history dictates. Objective 7.5 Verify with the radiologist the amount of contrast, the views and timing of the procedure Objective 7.6 Prepare the appropriate contrast media for the procedure as directed by the radiologist Objective 7.7 Notify the radiologist to begin the procedure Objective 7.8 Recognize if the patient is having an allergic reaction, the severity, and appropriate remedy Objective 7.9 Perform the exposures of plain films and tomograms as directed by the radiologist, and label appropriately Objective 7.9 Show the images to the radiologist at the appropriate times Objective 7.10 At the conclusion of the exam, assist the patient to the dressing room, providing post-procedure instructions Objective 7.11 Document the procedure and contrast agent used Competency 8 Competently assist the urologist or nurse in performing a voiding (VCU) and the retrograde urethrography Objective 8.1 State the radiographic anatomy and physiology of the urinary system Objective 8.2 Take the exposures as directed, and label appropriately Objective 8.3 Document the procedure Competency 9 Competently assist with procedures in the operating room by operating the C -arm, assisting the surgical team and understanding the sterile field Objective 9.1 Identify each member of the surgical team and their responsibilities Objective 9.2 Confidently perform procedures quickly and accurately in a sterile environment Objective 9.3 Operate the C-arm with mastery and competence, anticipating the surgeon’s requests Objective 9.4 Analyze unforeseen problems occurring in surgery, and find solutions to situations quickly Objective 9.5 Conscientiously provide protective lead aprons for the surgical team and alert anyone entering the surgical suite unprotected MCC Form EDU 0007 (rev. 09/07/11) INSTRUCTION Course Package

Objective 9.6 Practicing radiation protection using intermittent and last image hold feature Objective 9.7 Practicing radiation protection by announcing “x-ray” before an exposure Objective 9.8 Monitor personal dosimetry report to modify work habits if excessively high dose levels are reported Objective 9.9 Competently assist the urologist in the operating with retrograde urography Objective 9.10 Competently assist the orthopedic surgeon with surgical procedures Objective 9.11 Exercise free movement of the C-arm from the PA to a horizontal beam lateral position Objective 9.12 Describe the various orthopedic procedures and the ability to differentiate between closed and open reduction, internal, external and intramedullary fixation, laminectomy, scoliosis corrective surgery, vertebroplasty, kyphoplasty and pacemaker insertion Competency 10 Competently prepare for additional ra diography procedure s, such as arthrography of the knee and shoulder, endoscopic retrograde cholangiopancreatography (ERCP), postoperative (T-Tube), (HSG), , , orthoroentgenography, conventional Objective 10.1 State the radiographic anatomy and physiology of each of the additional radiography procedures Objective 10.2 Prepare the fluoroscopic room and the appropriate contrast media for the procedure Objective 10.3 Communicate with the patient and family by explaining the procedure, explaining the contrast agent, it’s purpose and effect, answer any questions the patient may have and obtain a signed informed consent form Objective 10.4 Position the patient to begin the procedure and notify the radiologist that the procedure can begin Objective 10.5 Assist the radiologist in performing the procedure, while anticipating the various positions Objective 10.6 Perform plain films if the medical facility requires them Objective 10.7 Analyze the radiographic images for structures shown, positioning, collimation, CR, and exposure criteria Objective 10.8 Assist the patient to the dressing room, providing post-procedure instructions Objective 10.9 Prepare the plain films for the radiologist Objective 10.10 Document the procedure and contrast agent used Competency 1 1 Evaluate and demonstrate knowledge of anatomy, positioning, technical factors and tube alignment for quality images of the cervical and thoracic spine Objective 11.1 Identify the required anatomy on cervical and thoracic vertebrae projections Objective 11.2 Describe how to properly position the patient, image receptor (IR), and central ray for cervical and thoracic vertebrae projections Objective 11.3 State how to properly mark and display each cervical and thoracic vertebrae projections Objective 11.4 List the image analysis requirements for cervical and thoracic vertebrae projections with accurate positioning and state how to reposition the patient when less than optimal projections are produced Objective 11.5 Explain how a patient with a suspected subluxation or fracture of the cervical vertebral column is positioned for cervical projections Objective 11.6 Discuss the curvature of the cervical vertebrae and explain how the intervertebral disk spaces slant and how to obtain open disk spaces on AP projections Objective 11.7 Describe why a 5-degree cephalic central ray angulation is often required for an AP open-mouth projection of the atlas and axis Objective 11.8 State how the relationship between the dens and atlas’s lateral masses changes when the patient’s head is rotated Objective 11.9 Describe how the prevertebral fat stripe is used as a diagnostic tool Objective 11.10 Discuss when it is necessary to achieve a lateral cervicothoracic projection of the cervical vertebrae Objective 11.11 List two methods used to obtain uniform image density on an AP thoracic vertebrae projection Objective 11.12 Explain the breathing methods used to demonstrate the thoracic vertebrae on a lateral thoracic projection Objective 11.13 Describe two methods that are used to offset the sagging of the lower thoracic column that results when the patient is in a lateral projection Competency 12 Evaluate and demonstrate knowledge of anatomy, positioning, technical factors and tube alignment for quality images of the lumbar, sacrum and coccyx Objective 12.1 Identify the required anatomy on lumbar, sacral and coccygeal projections Objective 12.2 Describe how to properly position the patient, image receptor (IR), and central ray for lumbar, sacral and coccygeal projections Objective 12.3 State how to properly mark and display lumbar, sacral and coccygeal projections Objective 12.4 List the image analysis requirements for lumbar, sacral and coccygeal projections with accurate positioning and state how to reposition the patient when less than optimal images are produced MCC Form EDU 0007 (rev. 09/07/11) INSTRUCTION Course Package

Objective 12.5 Describe how the upper and lower lumbar vertebrae can move simultaneously and independently Objective 12.6 Describe how spinal scoliosis is distinguished form rotation on an AP lumbar projection Objective 12.7 State which zygapophyseal joints are demonstrated when AP and PA oblique lumbar projections are produced Objective 12.8 List the anatomic strictures that make up the parts of the “Scottie dogs” demonstrated on an AP oblique lumbar projection with accurate positioning Objective 12.9 Explain which procedures are used to produce lateral lumbar, L5-S1 spot, sacral, and coccygeal projections with the least amount of scatter radiation reaching the IR. Objective 12.10 State two methods of positioning the long axis of the lumbar column parallel with the long axis of the imaging table for a lateral lumbar projection Objective 12.11 Describe how the patient is positioned to demonstrate AP mobility of the lumbar vertebral column Objective 12.12 State why the patient is instructed to empty the bladder and colon before an AP sacral or coccygeal projection is taken Competency 13 Evaluate and demonstrate knowledge of anatomy, positioning, technical factors and tube alignme nt for quality images of the cranium, facial bones and sinuses Objective 13.1 Identify the required anatomy on cranial, facial bone, mandible and sinus projections Objective 13.2 Describe how to properly position the patient, image receptor (IR), and central ray on cranial, facial bone, mandible and sinus projections Objective 13.3 State how to properly mark and display cranial, facial bone, mandible and sinus projections Objective 13.4 List he image analysis requirements for cranial, facial bone, mandible and sinus projections with accurate positioning and state how to reposition the patient when less than optimal projections are produced Objective 13.5 State how the central ray is adjusted to obtain accurate cranial positioning when the patient has a suspected cervical injury or is unable to adequately align the head with the IR Objective 13.6 Define and state the common abbreviations used for the cranial positioning lines Objective 13.7 Discuss why the parietoacanthial projection (Waters method) is taken with the patient’s mouth open Objective 13.8 Explain how the patient and central ray are positioned to demonstrate accurate air-fluid levels in the sinus cavities Competency 14 Evaluate gastrointestinal i mages to identify anatomical structures Objective 14.1 Identify the required anatomy on upper and lower gastrointestinal projections Objective 14.2 Describe how to properly position the patient, image receptor (IR), and central ray for upper and lower gastrointestinal projections Objective 14.3 State how to properly mark and display upper and lower gastrointestinal projections Objective 14.4 Explain the patient preparation procedure used before upper and lower gastrointestinal examinations to prevent residual debris and fluid from obscuring area so interest Objective 14.5 List the image analysis requirements for upper and lower gastrointestinal images with accurate positioning and state how to reposition the patient when less than optimal projections are produced Objective 14.6 Describe the differences in size, shape, and position of the and abdominal cavity placement of the small and large intestinal structures among the different types of habitus Objective 14.7 Define the difference in the barium suspension that is ingested for upper and for lower gastrointestinal projections Objective 14.8 State how a woman who has had one breast removed may have to be positioned at a greater object- image receptor distance (OID) for PA projections Objective 14.9 Describe the differences in the appearance of the stomach on projections of patients with different types of body habitus Objective 14.10 State where the barium and air will be situated for the different upper and lower gastrointestinal double-contrast projections Objective 14.11 Explain why the is imaged at set time intervals for small intestine study Competency 15 Competently perform and obtain diagnostic quality images in special procedures Objective 15.1 Identify the required anatomical structures in the images obtained Objective 15.2 List image analysis requirements for the arthrography, special procedures, biliary and urinary system Objective 15.3Describe the differences in the appearance of the biliary and urinary system on projections of patients with different types of body habitus

MCC Form EDU 0007 (rev. 09/07/11)