Do you have to have a Degree to be a Radiographer?

After 2015 anyone who wants to get a job as a radiographer will need to have an associate's degree. However, this degree does not need to be a radiographic degree, not yet at least. Radiologic technologists who were certified before 2015 are grandfathered. They will not be required to have an associate’s degree.

Even though the associate’s degree does not need to be a radiography degree, it does need to come from a school approved by the ARRT.  This is to assure that the education received was a quality one.

This move is one of many steps to improve radiography as a profession and to provide the best patient care possible.

This move is also driven by the fact that technology is improving at light speed.  The ARRT does not just want well educated and well-rounded radiographers, but they also want radiographers who can keep up with technological change.

Radiography of today is about a lot more than aiming a machine at a person’s body part and snapping an x-ray picture.  It has become its own full on specialty, with new subspecialties developing as time passes.

The ARRT, the certifying board in radiography, makes sure radiographer candidates are the best they can be with enough knowledge to provide the best patient care while producing good images.

On the same note, the ARRT and other radiography boards and committees provide protection, guidance and status to radiographers. It is thanks to the groups at the top of the radiographic food chain that have made radiography the respected, well paid, profession that it is today.

Another Major Change in the ARRT

This is not the only major move the ARRT has made in regards to education In 1995 the ARRT required radiographers to take Continuing Education Units to maintain their certification.  State licensing must be renewed every year, but certification is only done once and through CE units.

The CE requirement will stay in place, but their will soon be a new requirement.  In the not to future, radiographers will be required to take the certification test every 10 years. Anyone who was certified before this changes takes place will not have to recertify every 10 years.

This change is a huge step for the ARRT. They have been attempting to find a way to maintain radiography technologist quality without harming current radiographers jobs. The ARRT respects the experience these techs have, but also understand that experience does not always mean quality in the face of new technology.

This new requirement will mean new techs will be held accountable for all information on the certification exam. As of now, many techs tell new students that what you learn for the test can be forgotten once you pass. Then you just follow what you learn on the job.

The new requirement will give some power back to the ARRT, which many experienced techs may have  a problem with. However, with new technologists adhering to ARRT standard, the rest will follow. This translates to higher quality across the county.

There are some who disagree with these new requirements; however, they should  embrace them. As technology improves, new specialties are created and medicine advances, the ARRT must secure status a respect for the profession.

Some may still be looking for a silver lining. Just keep in mind that all of this will also mean more jobs, higher pay, better benefits and more benefits. The ARRT is working on behalf of radiography as profession.

All that they ask in return is for radiographers to remember what they learned in school, provide excellent patient care, continue to learn and to keep up with the latest technology.

Preparing for Non-Trauma Hip Lab Compatency - Radiography

Use this general study guide to learn about giving a non trauma hip x-ray in lab. As always, compare this study guide with what your school's radiography program is teaching. Your school  may require something different. Do not use these x-rays to preform hospital x-rays.  

Ready Room 

1. 1.       Clean Table, image receptors and Change Pillow Case
2. 2        Get Markers
3. 3.       Lower Table and place Tube at end of table
4. 4.       Take unused image receptors behind lead wall
5. 5.       Place 10 x 12 lengthwise in bucky
6. Get Patient
7. 6.       Call Patient. (Mr. or Ms. __________)
8. 7.       Introduce and take patient to safe area
9. 8.       When in safe area ask for first and last name and date of birth
10. 9.       Ask about pregnancy
11. 10.   Say “I see you are properly prepared.” Remove sock and shoe
12. 11.   Help Patient to table

The Procedure

Hip

AP hip

Have patient lie on back

Move tube over hip at 40 SID

Locate femoral neck and alight to CR and Midline of table/IR

Make sure there is no rotation of pelvis

Rotate leg internally 15 to 20 degrees

Float table to center 1 to 2 inches distal to midfemoral neck (1 to 2 inches medial and 3 to 4 inches distal to ASIS)

Collimate on 4 sides to area of interest

Place marker laterally

Have patient hold their breath

Take exposure

Procedures continued

Image analysis

Identify all anatomy

You should see at least 1/3 of the femur

You should see acetabulum, ischium and ilium

If there is an implant you need to see the whole thing, even with large revisions

You want to see the greater trochanter in profile without the lesser trochanter pass the middle of the femur

Look for rotation

Check symmetry of obterator foramin

Look for motion

       Trabecular markings should be seen

Lateral hip Unilateral Frog Leg 

Change cassette in bucky (10 x 12 LW)

Have patient flex affected  leg  45 from vertical (this is not for trauma)

Center to femoral neck (found around 3 inches blow the ASIS

Collimate on 4 sides

Place marker laterally

Have patient hold breath

Get used cassette

Take exposure

Image analysis

Know anatomy

For this the neck of the femur should be in profile and the greater trochanter should be superimposed

Learning Radiographic Quality

Radiographic Quality

Learning radiographic quality can be difficult. However, it is essential because this information is the foundation of technical knowledge. Technical factors is a radiographic term that is used to describe radiographic quality.

Radiographic quality is the penetration of the x-ray beam. This will not only affect how good the x-ray looks diagnostically, but it will also affect how much dose the patient gets. 

Producing a good x-ray means understanding the foundation of radiographic quality. It will not only reduce the patients exposure, it will give the radiologist a good image to work from. This means patient safety.

If you become a radiographer, then you will hear this term in everyday vocabulary. It encompass both photographic properties, as seen in the chart below, and geographic properties (second chart). 

Photographic qualities is further categorized into four types kVP, mAs, exposure time and source to image distance. You will be intimate with these four categories by the time you become a radiographer. 

Geometric factors are equally important. These factors are distortion and spacial resolution, which is also called recorded detail. You can not get a good image unless you understand them.

Use the following charts to study the components of radiographic quality.

                                                              Photographic Properties

1.kVp	2.mAs
Quality	Quantity
Force	Current
1 kilovolt = 1000 volts	10 mA – 1200 mA
30-150 kVp on Control Panel	150 < small filament/body part
General Rad. Never less than 55	150> large filament/bod part
Travels from negative to positive	Thermionic Emission – Electron Burns of filament
kVp Major- increment change by 10	Visible Difference – 25-35%
kVp Minor – increment change by 1 or 2	Dose
Lower kVp for smaller body parts	Amount of electrons
Contrast	Density
High contrast – less shades of gray	Brightness
Difference between densities/visibility	Insufficient density – Not enough mAs, too bright
Makes detail visible	Excessive density – Too much mAs, too Dark
Image Manipulation Parameter – Window Width	Image Manipulation Parameter – Window Level
High kVp – Low Contrast – Long Scale	Contrast medium
Low kVp – High Contrast – Short Scale	Positive – White – Barium/Iodinated
	Negative – Black -  Air
3.Exposure Time	4.Distance
Length of time cathode heated	Source-image distance (SID)
Quantitative	From tube to image plate
Combined with mAs	Increase in distance decreases beam intensity
mA x time = mAs	Inverse square law When distance doubles = intensity cut by 4
	Density maintenance formula

·         Type in bold indicates Technical Factors/Chief controlling factors

Page 1

Geometric Properties

1.      Spatial resolution/recorded detail – Ability to see small lines and structures on a radiograph.

2. Distortion- Misrepresentation of body part being radiographed.

1.Distortion	2.Spatial Resolution/Recorded Detail
1.Shape Distortion	Chief Affecting Factors
True Distortion
Foreshortening Angled object	1.FSS – Focal Spot Size
Elongation Angled tube	In X-ray tube – Width of beam
	Smaller FSS – Better recorded detail
2.Size Distortion
Magnification	2.SID – Source-to-Image Distance
Occurs when body part is not next to image receptor (IR)	Sharpness
Use smallest OID	Longer SID – Better recorded detail
OID – Object to image distance
	3.OID – Object-to-Image Distance
	Distance from IR to Part being radiographed
	Smaller OID – Better recorded detail

·         Type in bold indicates Technical Factors/Properties

How to Preform an Ankle X-ray in a Lab Setting

                                                  
This radiography study guide is a general explanation that explains what professors will expect out of you during a lab competency. This routine explains how to perform an AP Ankle, Oblique ankle (mortise) (not 45 degree) and a lateral ankle.

No two schools are alike, so this general outline may not match what your school expects. For that reason you should replicate your own study guide that fits your needs.

For this projection you will be working with bare feet. If you can’t handle that, this this isn’t the profession for you. Only use this study guide u lab testing. Do not use it in the hospital.

Instead you need to ask hospital techs how they do things. No two hospitals are the same, and you  should follow your radiographic technologist’s instructions.


Ready Room

1. Clean Table, image receptors and Change Pillow Case
2. Get Markers
3. Lower Table and place Tube at end of table
4. Take unused image receptors behind lead wall

Get Patient

5. Call Patient. (Mr. or Ms. __________)
6. Introduce and take patient to safe area
7. When in safe area ask for first and last name and date of birth
8. Ask about pregnancy
9. Say “I see you are properly prepared.”
10. Help Patient to table

The Procedure

Ankle

AP Ankle 

Have patient lie on back
Shields Patients gonads
Place a 10 x 12 on TT under foot/ankle
Move Tube over ankle at 40 SID
Dorsiflex foot
Float table to center midway between malleoli
Colimate to ½ of metatarsals and 1 inch of tib/fib
Check for rotation by lining up the interior crest and centering point
Place marker laterally
Take exposure


Image Analysis 

Identify bones
Check for rotation
     Medial – Maliolus opened up too much, especially medial mortise
     Lateral -  Distal tibia oversuperimposed on fibula and closed mortise
     Knee flexed- closes down tibiotalur joint




Oblique Ankle – Mortise 

Change Cassettes, setting used one aside
Medially rotate leg and foot 15 – 20 degrees, intermalleolar line parallel to IR
Float table to center midway between malleoli
Collimate to include 1/3 tib fib and mid metatarsals
Place marker laterally
Get used cassette
Take exposure
Image Analysis
Know anatomy
Check for rotation
     Not enough rotation – Lateral mortise closed
     Too much rotation – Malleoli closing down, especially medial mortise and tibio talur
     No dorsiflexion – Calcaneus under tibia creating off lateral malleoli


AP Lateral – mediolateral ankle

Take out used cassette
Have patient roll up on affected side placing unaffected leg behind flexed 45 degrees
Dorsiflex foot
Place new cassette under ankle lengthwise with toes
Plantar surface parallel
Place sponge under knees for support to get leg on same plane
Float table to center at medial malioli
Collimate foot  to metatarsals and 1/3 of tib fib
Place marker
Take exposure
Image analysis
Talur domes super imposed
Tibiofibular joint open
Distal fibia superimposed by posterior tibia
Check for positioning errors
   Elevated proximal tibia –distal tarsals not superimposed, Talur Domes not superimposed
    No Dorsiflextion – Not enough of tarsals and Talur Domes not superimposed
    Calcaneus depressed – Lateral dome anterior
    Calcaneus elevated – Lateral dome posterior

How to Preform an Alternative Knee X-ray in Lab

This routine is meant to be a rough outline on how to preform knee x-ray’s in the lab. This routine includes lateral – lateromedial knee and Tangential (axial sunrise) projection, Settegast Method – patella.

This guide is only meant to be used in the lab setting. Do not use this for a hospital setting, as each hospital has their own way of doing things.

Even schools have their way of proving student competency. For that reason you should copy this to a word document, make adjustments to match your schools requirements. Then print it and take it to the lab with you.

Radiography is cumulative, so I also suggest you save the adapted file to a USB drive. That way you 

can study from it later. However, do not reproduce this material for comercial uses.

Ready Room

1.       Clean Table, image receptors and Change Pillow Case

2.       Get Markers

3.       Lower Table and place Tube at end of table

4.       Take unused image receptors behind lead wall

5.       Place 10 x 12 lengthwise in bucky

Get Patient

6.       Call Patient. (Mr. or Ms. __________)

7.       Introduce and take patient to safe area

8.       When in safe area ask for first and last name and date of birth

9.       Ask about pregnancy

10.   Say “I see you are properly prepared.” Remove sock and shoe

11.   Help Patient to table

The Procedure

Alternative Knee

Lateral – lateromedial knee

Have patient lie on back , roll up on affected side and move unaffected leg behind from affected leg

Sheld patient

Move tube over knee at 40 SID table bucky and subtract 1 inch

Place 5-7 degree angle on tube (the wider the pelvis the more the angle)

Make sure leg is on same plane

Float table to center to ½ dial to apex of patella

Collimate crosswise to skin and leave lengthwise full

Place marker laterally

Take exposure

Image analysis

Know anatomy

Should see distal femur, proximal tibia and fibula and patella in lateral position

Femoropatellar knee and joint space open

Posterior borders of femoral epicondyles superimposed

Check for flexion

      Not enough-  patellar joint space starting to close and proximal fibula not superimposed

      Too much – patteler space totally closed and epycondiles not super imposed

Check patellar distance from IR

       Too far from IR – patellofemoral joint closed  medial condyle posterior to later condyle

       Too close to IR – patellofemoral joint too open medial condyle anterior to lateral condyle

Tangential (axial sunrise) projection, Settegast Method – patella

Have patient roll on to stomach

Shield patient

Get cassette out of bucky(10 x 12 LW)

Move tube to 40 sid TT, 15 – 20 and subtract  3 or 4 inches from TT

Have patient flex knee to 90 degrees        

Interepicondylar   line parallel to ir and kees perpendicular to IR

Float table or move tube to center to femoropatellar joint space

Collimate tightly on 4 sides to     patellae and anterior femoral condyles

Place marker laterally

Get used cassette

Take exposure

Image analysis

Intercondylar sulcus (trochlear grove) and the patella of each distal femur should be in profile

Femoropatellar joint space open

Patella, anterior femoral condyles and intercondylar sulcus should be symmetrical              

Flexion

     Too much flexion – patella superimposed over femur

     

Check for rotation

How to Preform a Knee X-ray in a Lab Setting

Use this radiography study guide to learn how to perform a knee x-ray for lab competency. Current students already know that you have to show your professors you can give an x-ray  lab before you can become competent in clinical settings (the hospital).

When you do lab competencies you will have a classmate as your patient. You will preform the routine for a teacher who will decide if you are competent. Each school has a different way of doing things. So my advice is to open this in a word program.

Then you should change anything in this study guide to match your schools requirements. Then print it, and work off it when you practice in the lab. You MUST practice these in your school’s lab. If you don’t make time for that, you won’t pass.

This study guide is not meant to be used in a hospital setting on real patients. Hospitals have their own routines, and their own way to preform them. A tech at the hospital should teach you how to do it there.

This study guide is for AP knee and Cross table lateral. Your school may have other x-rays in the comp. It also includes image analysis, which you will be tested on as well.

Ready Room

1. Clean Table, image receptors and Change Pillow Case
2. Get Markers
3. Lower Table and place Tube at end of table
4. Take unused image receptors behind lead wall
5. Place 10 x 12 lengthwise in bucky

Get Patient

6. Call Patient. (Mr. or Ms. __________)
7. Introduce and take patient to safe area
8. When in safe area ask for first and last name and date of birth
9. Ask about pregnancy
10. Say “I see you are properly prepared.” Remove sock and shoe
11. Help Patient to table

The Procedure - Knee

AP Knee

Have patient lie on back  move unaffected leg away from affected leg
Move tube over knee at 40 SID
Measure table top to anterior superior iliac spine
     If less than 19 - 3 to 5 degree caudad angle.  3 degrees subtract .5 inch  for 5 subtract 1 inch  SID
    If 19 to 24 no angle or adjust in SID
    If greater than 24 cm use 3 to 5 degree cephalad angle and subtract .5 to 1 inch SID
Rotate line 3 to 5 degrees, interepicondylar line parallel to IR
Float table to center to ½ dial to apex of patella
Collimate crosswise to skin and leave lengthwise full
Place marker laterally
Take exposure

Image analysis

Identify all anatomy
Distal femur and tibia shown
Femorotibial joint space open
Femoral and tibial condyles and joint space should be symmetric (no rotation
Medial half of fibular head should be superimposed by tibia
Check for rotation
         Externally rotated – medial condyle and fibular head over superimposed
         Internally rotated – lateral condyle larger, no (or not enough) superimposition of fibular head
Recognize deformity
       Valgus – lateral joint space closed but correct placement of fibia
       Varus – medial joint space closed/narrowed
Check for correct angle
       Too much cephalic angle – too much medial plateau seen
       Too much caudal angle – medial joint closed and fibular head elongated
Check for flexed knee
        Intercondylar fossa superior to patellar apex


Cross –Table Lateral – mediolateral knee

Move tube to cross table position and angle 5 – 7 degrees
Get cassette out of bucky(10 x 12 LW)
Place cassette between knees
Place sponge under knee
Position knee so femoral interepycondylar are superimposed and patella is perpendicular to IR
Center to 1 inch distal to patella
Collimate crosswise but not lengthwise
Place marker laterally
Get used cassette
Take exposure

Image analysis

Know anatomy
Should see distal femur, proximal tibia and fibula and patella in lateral position
Femoropatellar knee and joint space open
Posterior borders of femoral epicondyles superimposed
Check for flexion
      Not enough-  patellar joint space starting to close and proximal fibula not superimposed
      Too much – patteler space totally closed and epycondiles not super imposed
Check patellar distance from IR
       Too far from IR – patellofemoral joint closed  medial condyle posterior to later condyle
       Too close to IR – patellofemoral joint too open medial condyle anterior to lateral condyleal

For in depth image analysis of this and other x-rays check out Projectional Radiography.

How to Preform a Foot X-ray In Lab Settings

The following radiography study guide is a general outline that shows how to perform a foot x-ray in the lab setting.  If you are currently a student, then you know what that  means. If you are a new student, or still waiting to get in your program you might be confused. 

When you are in a radiology program you will have classroom teaching about many procedures. Then you will have to prove competency in the lab. This is like a test, only there is no pen and paper. Instead, an instructor will watch you preform the x-ray on a classmate.

If you are cringing at the idea of working with someone’s feet, or showing your own, you need to get past that. When you are working in a hospital, you are going to see tons of feet. Some pretty, and some not so pretty. If you can’t cope with taking an x-ray of a foot that is broken, deformed or smelly, this might not be the career for you.

These are general instructions for lab comps only. Each school will have a different way they want their competencies done. Not all schools will go by the following guide. The best way to study giving a foot x ray is to copy this in to a word document, and then change what your school does differently.

This study guide is for AP foot, AP Oblique and AP lateral. Your school may have other x-rays in the comp. This study guide should not be used on real patients in a hospital. Every hospital has their own routines and way they like them done.

For information on how to give a foot x-ray in a hospital you need to ask the techs on staff. No two hospitals does things the same way, and only the techs can tell you how your hospital does things.

Schools will also test you on image analysis. For that reason, I have included radiographic criteria for the foot and common imaging errors, such as rotation and flexion.  

The following pocket guide is a great resource for radiographers. It can be used in both lab and hospital settings. I recommend all students buy one of these. The program will require a handbook at some point; however, utilizing one of these from the start will help get you get ahead.

The Procedure

Ready Room

1.       Clean Table, image receptors and Change Pillow Case

2.       Get Markers

3.       Lower Table and place Tube at end of table

4.       Take unused image receptors behind lead wall

Get Patient

5.       Call Patient. (Mr. or Ms. __________)

6.       Introduce and take patient to safe area

7.       When in safe area ask for first and last name and date of birth

8.       Ask about pregnancy

9.       Say “I see you are properly prepared.” Or prepare patient

10.   Help Patient to table

The Procedure

Foot

AP Axial (Dorsoplantar projection)

Place shield over patient’s gonads

Bed patients knee

Place a 10 x 12 IR on TT lengthwise under foot.

Move tube over foot at 40 SID

Determine angle: 5-15 degrees

                (The higher the arch the more the angle)

Subtract 1 inch of SID for every 5 degrees

Center by floating table – base of 3^rd Metatarsal

Collimate to skin line checking for shadows

Check for rotation (leg, foot and knee aligned)

Place marker laterally

Tell patient to hold still and take exposure

AP Axial (dorsoplantar) Image Analysis

Identify bones of the foot and ankle including anatomical side

Check for rotation

                Lateral rotation – first tarsalmetatarsal joint space closing

                                           More calcaneus

                Medial rotation -  Base o first Metatarsal closed

                                            TMT too open

                                             Less calcaneus

Check for tube angle

AP Medial Oblique

Move Tube to 40 inches

Change Cassette setting used one aside

Rotate foot medially so that plantar surface is 30 to 40 degrees to IR

           (the higher the arch the more the angle 30 = flat 40 = high)

Place sponge under side of foot

Float table to center to the base of the third metatarsal

Collimate of four sides

Place marker laterally

Get used cassette

Take exposure

Image analysis

Obilique opens up 3^rd cuneiform  and shows more cuboid

3^rd through 5^th metatarsals are free of superimposition

Should see sinus tarsi

1^st and 2^nd cuniforms should over lap

Tuberosity at base of 5^th metatarsal should be seen in profile

Opens up joint spaces and shows more of calcaneus and calcaneus tuberosity (for achelie’s tendon)

Check for rotation

         Under rotated -  sinus tarsi closed down and cuboid superimposes 3^rd cuniform

         Over rotated – super imposition of metatarsals 3^rd cuniform superimposed by 1^st and 2^nd

Procedures continued

AP Lateral – Mediolateral

Take out used cassette

Have patient roll up on affected side and flex knee about 45 degrees

Bring unaffected leg behind affected leg

Place new cassette under foot  lengthwise with toes

Dorseflex foot                  

Adjust foot so that plantar surface parallel to IR

Check that leg is on same plane

Float table to center at the  base of 3^rd  cuniform (near base of 3^rd metatarsal)

Collimate margins, include 1 inch of distal tib/fib

Get used cassette

Take exposure

Image analysis

Metatarsals superimposed with tuberosity of 5^th metatarsal seen in profile

Tibiofibular joint open

Distal fibula superimposed by posterior tibula

Distal metatarsals superimposed

Check for positioning errors

    Elevated proximal tibia –distal tarsals not superimposed, Talur Domes not superimposed

    No Dorsiflextion – Not enough of tarsals and Talur Domes not superimposed

    Calcaneus depressed – Lateral dome anterior

    Calcaneus elevated – Lateral dome posterior