8.3 Introduction to Imaging and Diagnostics
Brandon Censon MPH, CPH, RRT-NPS, CPFT, CPT
Medical imaging and diagnostics refer to a variety of technologies used to evaluate the human body in order to diagnose, monitor, or treat medical conditions. The type of technology used depends on the area of the body being monitored or treated, as well as the specific disease, illness, or condition. It is important to note that professionals in these roles do not diagnose. Rather, they obtain important clinical information that helps the clinical care team make informed decisions about patient care.
Within medical imaging, there are several common types, including X-rays, magnetic resonance imaging (MRI), ultrasound, computed tomography (CT) scans, and nuclear medicine imaging. Each imaging type uses specific technology and modalities.
X-rays
X-rays use ionizing radiation to create images of the body. This is a non-invasive and painless procedure that allows the healthcare team to diagnose diseases and monitor therapy. The images generated by X-rays help support medical and surgical treatment planning, and they can also be used during procedures to verify the correct placement of catheters or other medical devices inside the body. When the X-ray is activated, radiation travels through the body, and the amount absorbed by the tissues depends on their radiological density. For example, bones have a higher radiological density, which allows them to absorb more X-rays and produce high-contrast images. On the black background of the X-ray image, bones appear white. In contrast, tissues that are less radiologically dense, such as muscles or the air-filled lungs, appear as various shades of gray.
Computed Tomography
Computed tomography (CT) uses traditional X-ray imaging along with a computer to process a series of cross-sectional images, or slices. The images produced by CT are far more detailed than traditional radiographs, allowing the healthcare team to view structures from many different angles. These cross-sectional images can then be stacked to create a three-dimensional image of the structure. During a CT scan, the patient lies on a bed that moves in and out of a fixed X-ray tube, which rotates while capturing the images. As it rotates, X-rays are emitted and pass through the patient’s body. The X-ray detectors on the opposite side of the X-ray source pick up the radiation, and the image is transmitted to a computer for processing. Similar to traditional X-rays, radiologically denser structures appear white, while less dense structures appear in various shades of gray.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) uses strong magnetic fields and radio waves to produce images of the internal structures of the human body. The magnetic resonance signal is generated by the protons in fat and water molecules. During the MRI exam, an electrical current passes through coiled wires, creating a temporary magnetic field in the patient’s body. Radio waves are then sent from a transmitter in the MRI machine, and the signals are used to create digital images of the scanned area. MRIs are commonly used to diagnose diseases and monitor treatments. MRIs are particularly useful for evaluating soft-tissues, such as the brain, nerves, muscles, tendons, and ligaments, as these structures can be viewed more clearly than with traditional X-rays or CT scans.
Ultrasound Imaging
Ultrasound imaging is a specialized technique that uses high-frequency sound waves to view internal structures of the body. The images captured during an ultrasound are in real time, which is particularly useful for evaluating the flow of blood and other movements. Unlike traditional X-ray imaging, ultrasound does not use ionizing radiation. The images are produced by the reflection of sound waves off structures within the body.
Other benefits of ultrasound imaging include its non-invasive nature, lower cost, and versatility in being used in various settings. However, there are some limitations. For instance, ultrasound waves can be disrupted by air or gas, making it difficult to evaluate structures surrounded by air. Additionally, a patient’s body composition can affect the clarity of the image, as ultrasound waves are weakened when passing through thick layers of tissue.
Ultrasound is an essential tool used by healthcare providers to diagnose, evaluate, and treat a variety of conditions. Common procedures that utilize ultrasound imaging include:
- Abdominal Ultrasound: Used to evaluate the various tissues and organs in the abdominal cavity.
- Breast Ultrasound: Helps visualize breast tissue to identify breast cancer.
- Fetal Heart Rate Monitoring: Doppler ultrasound allows for non-invasive monitoring of a fetus’s heart rate in the womb.
- Fetal Ultrasound: Used to evaluate the growth and development of a fetus throughout pregnancy.
- Ultrasound-guided Needle Placement or Intravenous Catheter Placement: Helps healthcare providers ensure that they are placing needles or intravenous catheters into specific tissues or vessels.
- Cardiac Echocardiogram: Provides images of the heart and blood flow.
Nuclear Medicine Imaging
Nuclear imaging is a type of medical imaging that uses tiny amounts of radioactive material combined with a carrier molecule. This combination is referred to as a radiotracer. Nuclear medicine imaging is a valuable tool for evaluating, diagnosing, and treating various conditions. When the radioactive material is swallowed or injected into the body, the radiotracer accumulates in the area being evaluated. This technique is often used to examine areas that are inflamed or may be suspicious for cancer. Cancerous cells typically consume large amounts of energy, especially glucose. The imaging device used in nuclear medicine detects this excess energy, creating an image that shows the location of the radiotracer.
In addition to helping with diagnoses, nuclear medicine can also be used to treat certain types of cancers and other conditions. The radioactive material attaches to specific cells and delivers a prescribed dose of radiation, which in turn destroys the cells. Nuclear medicine imaging can also be used to evaluate heart function and blood flow, especially after a heart attack, to assess any damage. It can also be used to evaluate the lungs, which is helpful when a blood clot in the pulmonary circulatory system is suspected. Other body systems that can be evaluated using nuclear medicine imaging include the gastrointestinal, endocrine, and neurological systems.
Because many diseases and conditions begin at the cellular level, nuclear medicine allows healthcare providers to detect diseases earlier in their course. With earlier detection, the healthcare team can respond more quickly, providing treatment and therapy that may help stop or slow the spread of the disease.
Attributions
- Figure 7.1: image released under the Pexels License
- Figure 7.2: image released under the Pexels License
It is important for nurses to embody an anti-racist approach to communication. In order to do so, you need to first understand the concepts of race and racism.
Race has been systemically and historically constructed as a variable of difference, whereby people are ascribed to designated groups based on biology, culture, and/or other characteristics (Bakan & Dua, 2014). Racism is the ideology and practice of sustaining, maintaining and reinforcing difference based on race (Bakan & Dua), and it results in racialized persons being excluded from everyday points of access because of their race.
Anti-racism is the active process of changing attitudes, beliefs, practices, and policies with the goal of dismantling systemic hierarchy and oppressive power (Alberta Civil Liberties Centre, ND). An anti-racism approach involves:
- Identifying and challenging racism within institutions.
- Taking specific and directed action towards eliminating racism.
- Recognizing self as an agent for change towards equity.
The focus of anti-racism is acknowledging and working to address power inequities and systemic bias predicated on race as well as unearned privilege that is afforded to non-racialized people. Linked with racism is the concept of white privilege which refers to advantage afforded to those who are to non-racialized over persons of other racial backgrounds. It does not mean that every white person is rich, healthy, or living a lavish life. In a paper entitled “White Privilege: Unpacking the Invisible Knapsack”, McIntosh (2003) lists several daily occurrences that are privileged based on race. For example, when applying for a mortgage, skin colour will not bias financial credibility when non-racialized people are applying, but it can be a significant determining factor for those of other races. Recognizing white privilege can often be conflated with feeling guilty about race, but this is not the aim. The focus on individual guilt deviates the conversation and intention of anti-racism, which is ultimately to dismantle racist structures that subjugate and discriminate against racialized people.
Nurses play an important role in adopting and embodying an anti-racist way-of-being within their respective institutions. As a nurse, you must take an anti-racist approach in your practice and advocate on behalf of your clients when you see racism. As such, communication is essential to demonstrating anti-racism. It often begins with self-reflection and consideration for the perspective of others. See Case Study 3 for an example of an anti-racist approach to communication related to a racialized client.
Case Study 3
A nurse (RN1) receives report from a colleague (RN2). During the night shift, a client was admitted for generalized abdominal pain, and elevated blood pressure and heart rate. At this time, the etiology is undetermined, but the client is scheduled for a CT scan shortly.
RN 2: Hi Rita, it was a pretty quiet night. We just admitted a patient, I can’t even pronounce her name, in bed 2, for generalized pain. She says it is in her abdomen, but who knows what is going on. She’s giving me a lot of attitude, you know how it can be. If you ask me, I think we should have sent her home and told her to come back if things get worse.
RN1: Why is that?
Rationale: RN1 recognizes that there may be some underlying racist attitudes, and attempts to open up the conversation.
RN2: Well you know how these people are … they come to emerg for every little complaint, over-dramatizing everything. They don’t care about the costs of a visit to the emergency room.
RN1: Lorna, I’m uncomfortable with you referring to this patient as ‘these people’. Your tone and choice of words insinuates that because of how the client looks and their culture that we should dismiss their complaints about pain.
Rationale: RN1 states how they feel using “I” statements and specifically refers to the racist language that RN2 used. RN1 also uses direct language to identify passive actions of RN2.
RN2: Oh no, that’s not what I meant, I am not a racist, I was not trying to say it like that. I just meant that some people are more likely to take advantage of free health care than others.
RN1: I know this might be a difficult conversation to have, but referring to a client as “these people” and “taking advantage of the system” is racist, especially since you have attached it to the patient’s race and culture.
RN2: But that’s not what I meant.
RN1: It might not be what you meant, but the words you chose and the meaning are racist, and not acceptable. Considering our conversation, it would be good that I request our manager to organize a workshop for all of us about racism and language. Additional training will illuminate how language and beliefs like “taking advantage” are micro-aggressions that become pervasive and ultimately lead to poorer treatment and access to healthcare for racialized clients. It’s important to reflect on our communication skills and ensure we are not using oppressive language in our workplace.
Rationale: RN1 is very clear in identifying the communication as racist, but also doing so a respectful way. Even RN1’s language in inclusive in terms of the group responsibility when referring to “our” workplace.
Summary
It is important to embody an anti-racist approach to communication. It often begins with self-reflection and consideration of other peoples' perspectives. This approach involves an active process of changing attitudes, beliefs, practices, and policies with the goal of dismantling systemic hierarchy and oppressive power. As a nurse, you must acknowledge and work to address power inequities and systemic bias predicated on race as well as unearned privilege that is afforded to non-racialized people.
Clinical laboratories are healthcare facilities that perform a variety of laboratory procedures to help a patient’s care team develop a diagnosis and create a care plan. These laboratories are where blood and other bodily tissues are sent for testing and analysis. A number of health professionals work in clinical laboratories, and in the following sections, we will discuss their roles in greater detail.
Medical Laboratory Technician
Medical laboratory technicians gather collected samples from a variety of bodily fluids and blood. They prepare, process, and test these samples, analyze the results, document and log the data into patients’ medical records, and operate an assortment of lab equipment throughout the process. For example, after receiving a blood sample from a phlebotomist, a medical laboratory technician may perform the required tests, analyze the results, and send the analysis to the care team for evaluation.
Medical laboratory technicians play a critical role in the healthcare team, helping determine a patient’s diagnosis. They are skilled in investigating, identifying clues, and uncovering answers that are vital in guiding patients toward the most appropriate treatment. While their work is often behind the scenes, it is hands-on and essential. For example, technicians may run blood samples through an automatic cell counter or use a microscope to identify pathogens.
Academic Requirements and Career Pathway
The academic requirements for medical laboratory technicians include earning an associate or bachelor’s degree in clinical laboratory science. The training includes both classroom training and hands-on clinical training in the laboratory setting.
After completing the degree program, students are eligible to take the American Society of Clinical Pathology (ASCP) medical laboratory technician certificate exam (American Society of Clinical Pathology, n.d.).
Medical laboratory technicians can pursue specialty certifications in areas such as cytology, hematology, microbiology, molecular biology, blood banking, and chemistry. These credentials allow individuals to specialize in narrower branches of medical laboratory science. For those interested in management or leadership roles within clinical laboratories, advanced degrees are available.
Phlebotomist
A phlebotomist is a healthcare professional who is trained to perform phlebotomy (blood draws) or venipuncture. The blood collected can be used for a variety of tests or donation. A phlebotomist is responsible for preparing patients for the blood draw procedure, which may involve educating them on the process. They ensure that the blood draw site is clean to prevent infection and that blood samples are properly labeled for analysis. They are also responsible for storing and tracking blood samples, which may be sent to other facilities for testing.
Phlebotomists work in various settings, including hospitals, medical offices, blood donation centers, laboratories, skilled nursing facilities, and long-term care facilities.
Academic Requirements and Career Pathway
The academic requirements for a phlebotomist generally include a certificate of completion from a phlebotomy program. Additional education and/or certifications may be required.
Attributions
- Figure 7.8: image released under the Pexels License
- Figure 7.9: image released under the Pexels License
Professional communication is an important part of becoming a nurse and being a nursing student. You are entering a "profession" which means there are certain expectations in terms of your professional conduct specifically in terms of how you communicate.
Professional communication involves a level of formality and is an important component of your post-secondary nursing education. It is different than the informal communication that you may engage in with your friends and family. It also applies to your verbal and written communication including emails.
The principles of professional communication include being truthful, accurate, clear, and both concise and comprehensive. For example, you should say or write something in a succinct and short way while also including all relevant information. You should also have a professional tone that is conveyed through appropriate greetings, complete sentences, and grammar. In order to be professional, you need to know your audience; both the content and form of your message should be tailored to your audience.
Here are some tips to follow in terms of professional communication:
- Introduce yourself fully by name, role/institution and pronouns, such as: "I am Mateo Reyes, a year one nursing student from Toronto Metropolitan University. My pronouns are they/them."
- Address the person you are speaking to formally. Also, do not assume the gender or pronouns of the person you are speaking to. For example, you should avoid using terms such as “miss,” “ma’am,” “sir,” “mister,” “ms,” etc., until you know how the recipient wants to be addressed. If you are uncertain, introduce yourself fully and ask how the recipient would like to be addressed and what pronouns they use.
- Clearly articulate your message (what you are trying to say).
- Speak in full sentences.
- Be honest.
- Be polite. Your communication is a reflection of YOU and your professionalism.
- Consider reciprocity (mutual influence). For example, a person may answer your question after you have emailed (or contacted them in some other way) with a question. If so, it is important to respond back to them so that they know that you have received their reply. It may be something like "Thank-you so much Professor Shevchenko. That helps me understand the topic better."
Because a lot of communication occurs electronically, it is important to consider how to construct an email. Here are some tips:
- Use a professional email address. At most universities, your email communication with a professor should originate from your university email.
- Begin with a clear description in the subject line. For example, students should include the course code in the subjective line and a brief description identifying the reason for the email (e.g., “NSE 54: question regarding week 3 quiz”).
- Use a professional email greeting and salutation to address your professor, or the salutation preferred by the professor.
- Appropriate: “Dear Professor Dodge” or “Hello, Dr. Chen.”
- Inappropriate: “Hey teacher", "Hi", or "Yo."
- Introduce yourself so that the email recipient knows who you are. Remember, professors teach several courses and course sections. Thus, you might say “I am Minta Li. I am a student in your Wednesday section of NSE 678.” Additionally, you may need to consider including your student number in an email when you introduce yourself. This is particularly when inquiring about course issues, grades, or program status in order to clearly identify yourself as student names can be similar.
- Refer to any attachments in the email text.
- Avoid point form, slang, and abbreviations.
- Include a signature block at the end of your email identifying your full name, role, institution, and contact information. You should NOT include your student number or a personal cell phone number in the signature block because it is considered part of your private information at the university. This private information can be used in the body of the email when communicating with certain individuals who may require this information such as your professor or a student affairs coordinator.
- Proofread your email for accuracy, grammar, and spelling - important to have your program name spelled correctly.
- Avoid humour and excessive use of exclamation points and all caps. These can easily be misinterpreted.
Signature Block Example
Sharod Hadi, nursing student year one, pronouns: he/him
Toronto Metropolitan, Centennial, George Brown Collaborative Nursing Degree Program, Toronto, Ontario
Professional/institutional email address (insert your own email)
Points of Consideration
Addressing and referring to your instructor
Students are often uncertain how to address their instructors. It is okay to ask your instructors how they would like to be addressed. Until you know how, you should refer to them as "Professor X" (insert their surname) or "Dr. X" (insert their surname).
Although some instructors may invite you to use their first name, it is part of professional communication etiquette to use "Professor X" or "Dr. X" (including both their first and last name) when referring to them to others. In addition to ensuring professional communication, this helps to provide clarity if your instructors share a first or last name with another instructor.
Example: Dr. Huang is your course instructor, and they have encouraged you to reach out to another professor to discuss potential research opportunities. Although Dr. Huang has given you permission to call her Lisa in the classroom, you should always refer to them as Dr. Lisa Huang in communication with others. Thus, when initiating communication with the instructor that Dr. Huang has referred you to, you may consider a beginning such as: "Dear Dr. Hameed. I am a student in the undergraduate year one nursing communication course with Dr. Lisa Huang. Dr. Huang has encouraged me to reach out to you about potential research opportunities because of my interest in critical feminism."
Activity: Check Your Understanding
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