Stancil_ValuePatientHistory

7/28/2019 Stancil_ValuePatientHistory

1/19

The Value of Patient History inMedical Imaging

Glen StancilM.Ed., RT(R)(CT)(ARRT)

Director of ServiceGE Healthcare IT


2/19

LEGAL DISCLAIMER

The opinions expressed in this continuing medical education activities are those of theauthor and do not represent those of AboutImaging.com or its affiliates and subsidiaries.The information provided is for general education purposes only.

The information is not warranted to be inclusive of all approaches to a medical issue orexclusive of other methods for obtaining the same result. The material is not meant to

substitute for the independent professional judgment of a physician or other health careprofessional relative to diagnostic and treatment options for a specific patient's medicalcondition. The author does not warrant the completeness, accuracy, or usefulness of anyopinions, options, advice, services, or other information provided through this educationalactivity.

In no event will AboutImaging.com or its affiliates and subsidiaries be liable for anydecision made or action taken in reliance upon the information provided through thisactivity.

The participant acknowledges that case studies may be modified or changed from theactual case to protect the identity of patients.


3/19

Case Study: JoeAge: 37 Years

Gender: Male

Chief Complaint: Right Flank Pain

Scheduled Exam: CT Abdomen / PelvisProvided History: R/O Renal Stone

Exam was scheduled on the same day as Outpatient

Technologist History: None Additional

Exam Performed: CT Abdomen / Pelvis W/O Only


4/19

Case Study: JoeRadiologist Interpretation:

No evidence of hydronephrosis

No renal calculi identified in the renal pelvis or ureters

Heavy stool in colon

No abnormalities detected

Treatment:

Antibiotics to treat Kidney Infection while awaiting C&S from Urinalysis

Pain Meds

Patient outcome:

Emergency surgery 4 hours later

Initial hospital stay of 8 days

Several follow up visits to hospital required


5/19

What Happened?

Can the primary blame for casemismanagement be placed on the

technologist?

Was there anything that the

technologist could do to prevent thissituation?


6/19

Objectives

At the end of this lesson, the student will beable to:

Discuss the benefits and risks of providingpatient history to the radiologist

Describe the elements of a complete patienthistory


7/19

Why Obtain Patient History?

ASRT (2003) Code of Ethics states thatPatient Diagnosis is outside the scope ofpractice

However, it further states:

The radiologic technologist acts as an agent

through observation and communication toobtain pertinent information for the physician


8/19

Arguments For Obtaining Patient History

Technologists are physician extenders andoften the only person to see the patient in themedical imaging setting

Referring physician provided history may beincomplete or inaccurate

May assist the radiologist in providing

differential diagnoses to referring physician Critical for high risk exams, such as biopsies

and MRI


9/19

Arguments Against Obtaining Patient History

Knowing patient history may skew theradiologists interpretation

Technologists are not trained to examinepatients and therefore it is out of scope forthe profession

Technologists dont have time to elicit a full

patient history from all patients


10/19

Systematic Approach to Patient History

Subjective History

Objective History

Laboratory Tests Deviations from Norm

Radiologists must be SOLD on yourpatients medical history


11/19

Subjective History

What history is the patient providing that isunobserved by the technologist?

Last menstrual period

Mechanism of injury

Progression of symptoms

What makes the pain worse (or better)?

Personal medical history Family medical history


12/19

Objective History

What history can be gained from directobservation by the technologist

Cuts / Bleeding

Discoloration

Deformity

Physical exam techniques

Palpation Range of Motion


13/19

Laboratory Tests

What pertinent lab tests were performed andwhat were the results?

Complete Blood Count

Hemoglobin / Hematocrit

BUN / Creatinine

Urinalysis

HCG

D-Dimer Thyroid Panel (mainly NM and US)

Pathology Results


14/19

Deviations from Norm

What is different from this exam comparedwith routine exam?

Patient Motion

Unusual Positioning or Projections

Patient Refusal to Continue

Technical Issues


15/19

Case Study Follow-Up: Joe

Subjective:

Pain started slowly 2 days ago

Very dull when at referring physician mostly in the right flank

Now sharp and in the Right Lower Quadrant (RLQ) of abdomen

Objective:

RLQ Guarding

Vomiting

Laboratory Tests: UA Clear / No RBCs present; Elevated WBC

Deviations From Norm: None


16/19

Joes Diagnosis

APPENDICITIS

Without contrast, appendix was not visualized due toheavy stool

Joes appendix ruptured due to delay in treatment

Subsequent abscesses required several draining

procedures


17/19

Review

Technologist has the duty to report allpertinent information to the physician

Radiologist may review history before or aftertheir initial interpretation due to their personalphilosophy

Radiologist must be SOLD on the patients

history


18/19

Systematic Approach to Patient History

Subjective History

Objective History

Laboratory Tests Deviations from Norm

Radiologists must be SOLD on yourpatients medical history


19/19

References

American Society of Radiologic Technologists. (2003). Code of ethics.Retrieved from: https://www.asrt.org/media/pdf/rt/codeofethics.pdf

Documents

Stancil_ValuePatientHistory