CT & MRI – What is Expected from the Radiological Technologists

Dr. Harsha Dissanayake MBBS, M.Phil, MD(Radiology)Dip. Neurovascular Diseases (France)Consultant Radiologist & Senior Lecturer Faculty of Medical SciencesUniversity of Sri Jayewardenepura

Radiographer

Radiological Technologist

Medical Imaging Technologist

Who is a Radiological Technologist?

• a trained health care professional • who performs medical imaging by • producing high quality images which is useful

to diagnose and treat injury or disease. • patient’s diagnosis and treatment is often

dependent on the images produced.• He is an important member of the Health care

team.

Health Care Professional

• undertakes a specialized set of tasks• enjoys considerable work autonomy• engaged in creative and intellectually

challenging work• Patients place a great deal of trust in them• strict codes of conduct• Ethical and moral obligations

What should be the goal – when encountered with a patient

• To generate the best possible, • Highest quality,• Appropriate images – which will be used to arrive at the diagnosis /

or to treat.

How to achieve this goal ?• Asses the patient’s problem – get the

information• Analyze • Set the goal clear• Formulate a plan to achieve the goal• Workout the plan performing the tasks• Self evaluate your images – “Is this the best

possible images that I can generate?”

Quality control of the procedure• Inferior quality images / study – Area of interest inadequately covered / all

sequences not included ……….etc

May lead to– Inaccurate interpretation / wrong diagnosis– Repeated exposure – Radiation hazards to the patient / self / staff– Additional cost – Additional time

Competency ?• expertise and knowledge of patient handling• physics, anatomy, physiology and radiology to assess

patients• develop optimal radiologic techniques to plan and

evaluate – resulting radiographic images.• Should be able to spot “what is not normal” –

pathology • Radiation Protection • Quality Control

How the competency is gained?

• High school Diploma – Certificate course • University Degree BSc in Diagnostic

Radiography/Diagnostic Imaging – 3yrs • Can specialize in-house or through a university

course as a postgraduate in CT, MRI, Nuclear Medicine ….. with opportunities to gain an MSc in their field.

CT & MRI – What is Expected from the Radiological Technologists

• Before / During / After the procedure • Check the identity and the requested

investigation• Check the consent• explaining the procedure• ensure that the patent has had the correct

preparation• Keep the emergency tray ready

• clothing, ensure that there are no metal objects that may interfere

• Check the clinical details – if inadequate make a note of the patents problem & relevant details. Get previous imaging Ix reports/films

• If the requested investigation is not clear / inappropriate, always discuss with the referring clinician

• Check the patients data sheet / questionnaire – whether it is appropriately filled

• Are there any contraindications / Allergies?

During the scanning

• Radiation dose

• All medical radiation exposures must be justified and the radiation levels optimized

• Radiation to the patient (in diagnostic studies), staff and the general public are to be kept AAs LLow AAs RReasonably AAchievable (the ALARAALARA principle)

Protocols• Protocols are mere guidelines. • Has to modify according to the individual

patients problem – when ever necessary • Timing of the procedure• Whether to give contrast or not• Timing of the contrast injection • Arterial / venous / late phases• Oral /rectal contrast • MRI – additional sequences - ? Haemorrage /

Calcification / stroke ……..

Example 1

• 60yrs• Male• Haematuria

• Ix. – CT KUB

CT KUB – Normal / no calculi

• Are you happy?

Late finding

48 yrs / liver lesion in USS Ix. - Triple phase CTArterial Portal venous

Ix. - Triple phase CT

Arterial Portal venous

Ix. - Triple phase CT

Arterial Portal venous