chapter 12: diagnostic and imaging services

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 12: Diagnostic and Imaging Services


Cardiographic TechniciansCardiographic 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


Cardiographic Technicians (cont’d)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)



• 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



• 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



• Tests Performed by Specialized Cardiographic Technicians

– Specialized EKG tests

• Rhythm strips

• Signal-average EKGs

• Event recorders

• Device interrogation

– Stress tests

– Holter monitor tests



• 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



• Personal Characteristics

– Good interpersonal skills

– Good communication skills

– Ability to work independently

– Ability to follow instructions

– Good organizational skills

– Good multitasking skills



• 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



• 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


Cardiographic TechnologistsCardiographic 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


Cardiographic Technologists (cont’d)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



• Core Course Work

– Introduction to the field

– General & allied sciences

– Anatomy & physiology

– Basic pharmacology

– Basic medical electronics & medical instrumentation



• Specialized Instruction

– Invasive cardiology

– Noninvasive cardiology

– Cardiac electrophysiology



• 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



• 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)



• Certifications Offered by ARDMS

– Registered diagnostic cardiac sonographer (RDCS)

– Registered vascular technologist (RVT)



• 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



• Invasive Procedures: Cardiology Technologists

– Cardiac catheterization

– Balloon angioplasty

– Electrophysiology testing

– Open-heart surgery

– Pacemaker or stent insertion



• Noninvasive Procedures

– Noninvasive cardiology: echocardiography

• Cardiac sonographers or echocardiographers

– Noninvasive peripheral vascular study

• Vascular technologists or vascular sonographers




– Good judgment

– Conscientiousness


– Ability to follow detailed directions

– Ability to work effectively with patients

– Pleasant, professional manner



• 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



• 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


PhlebotomistsPhlebotomists


– 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


Phlebotomists (cont’d)Phlebotomists (cont’d)

• Education– HS diploma or equivalent required

– In-house training at medical facilities vs. formal 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



• 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



• 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





– Attention to detail

– Calmness under pressure



• 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


Diagnostic Medical SonographerDiagnostic 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


Diagnostic Medical Sonographer (cont’d)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


– Classroom instruction combined with lab & clinical activities



• 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



• 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



• Specialties

– Obstetrics/gynecology

– Abdomen

– Neurosonography

– Breast



• Personal Characteristics– Good people skills

– Patience

– Empathy

– Eye for detail

– Good judgment

– Personal responsibility

– Self-motivation


– Good teamwork skills



• 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



• Professional Organization: SDMS

– Works to advance profession & educate medical community

– Advocates on issues affecting profession

– Publications

• Journal of Diagnostic Medical Sonography

• Newsletters

– Online resources


Radiologic Technologists/RadiographersRadiologic 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


Radiologic Technologists/Radiographers (cont’d)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



• Course Work

– Anatomy & physiology

– Patient care procedures

– Radiation physics

– Radiation safety & protection

– Principles of imaging

– Medical terminology

– Patient positioning

– Medical ethics

– Radiobiology

– Pathology



• Specialties

– CT scans

– MRIs

– Mammograms



• 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



• 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




– Positive attitude

– Empathy

– Good people skills

– Self-motivation

– Confidence



– Ability to follow instructions

– Manual dexterity

– Flexibility

– Multitasking skills





• Employment Opportunities and Trends

– Growth: 17% between 2008 & 2018

– Factors prompting growth

• Population growth

• Aging of population

• Increased use of imaging


• >60% in hospitals




• 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


Nuclear Medicine TechnologistsNuclear Medicine Technologists


– 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


Nuclear Medicine Technologists (cont’d)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


– Course work & clinical component required



• 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



• 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



• 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







– Self-motivation



– Flexibility

– Willingness to learn



• 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


• 2/3 in hospitals




• 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

chapter 12: diagnostic and imaging services

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