The role and responsibilities of a radiographer in a cardiac cath-lab

The role and responsibilities of a radiographer in a cardiac cath-lab

●●JOURNAL
●
JOURNALOF
OFPUBLIC
PUBLICHEALTH,
HEALTH,NURSING
NURSINGAND
ANDMEDICAL
MEDICALRESCUE
RESCUE●●No.1/2014
No. 1/2014(11-14)
●
11
The role and responsibilities of a radiographer
in a cardiac cath-lab
(Rola i zadania technika elektroradiologii w zespole diagnostycznoterapeutycznym pracowni hemodynamiki)
Pasieka E 1, A, D, E, F, Lewandowski J 2, B, Żuk J 2, C
Abstract – The article discusses the role and responsibilities of a
radiographer in a cath-lab. The publication is based on the analysis of
the Polish legislation and literature (PubMed database) pertaining to
healthcare services in the interventional cardiology. A radiographer is
a healthcare professional who has professional qualifications required
for providing healthcare services related to diagnostic imaging, electromedical diagnostics and radiotherapy. The primary role of a radiographer in a catheterisation laboratory is to optimize the test results
by minimising the risk of radiation. The fundamental tasks of a radiographer include: the maintenance and operation of the angiography
equipment, cardiopulmonary resuscitation and the application of the
radiation protection principles. Despite the fact that being a radiographer is associated mainly with technical skills, the condition for
professional medical care is the cooperation of the staff forming the
diagnostic therapeutic team in a cardiac cath-lab based on mutual
trust and communication.
Key words - radiographer, catheterisation laboratory, cath-lab, diagnostic therapeutic team.
Streszczenie – W artykule autorzy przedstawili rolę i zadania technika elektroradiologii w zespole diagnostyczno-terapeutycznym pracowni hemodynamiki (kardiologii inwazyjnej). Praca powstała na
podstawie analizy aktów prawnych i piśmiennictwa (przegląd publikacji wyszukiwarki PubMed). Technik elektroradiologii jest pracow
nikiem ochrony zdrowia legitymującym się nabyciem fachowych
kwalifikacji do udzielania świadczeń zdrowotnych z zakresu diagnostyki obrazowej, elektromedycznej i radioterapii. Główną rolą podejmowaną przez technika elektroradiologii w pracowni hemodynamiki jest optymalizacja wyniku badania pod kątem minimalizacji
ryzyka radiacyjnego pacjenta. Podstawowe zadania realizowane przez
technika to: nadzór i obsługa angiografu, resuscytacja krążeniowooddechowa, stosowanie zasad i środków ochrony radiologicznej.
Mimo, że zawód technika elektroradiologii utożsamiany jest głównie
z kompetencjami „technicznymi”, warunkiem profesjonalnej opieki
medycznej jest oparta na zaufaniu i dialogu współpraca poszczególnych pracowników ochrony zdrowia wchodzących w skład zespołu
diagnostyczno-terapeutycznego.
Słowa kluczowe - technik elektroradiologii, pracownia hemodynamiki, pracownia kardiologii inwazyjnej, zespół diagnostycznoterapeutyczny.
Author Affiliations:
1. Department of Radiology, Medical University of Bialystok
2. Cardiac Cath Lab, Autonomous Public Regional Specialist Hospital in Bialystok
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
E Pasieka, Medical University of Bialystok Department of Radiology
M. Curie-Skłodowskiej 24a str, PL-15-276 Białystok, Poland; e-mail
[email protected]
I. INTRODUCTION
eart diseases are a significant cause of deaths in Poland.
As the Polish Cardiac Society estimates, each day around
100 Poles die as a result of acute coronary syndrome [1].
Thanks to catheterisation laboratories emerging throughout the
country, invasive diagnostics using X-rays applied to coronary
heart disease as well as coronary angioplasty are possible. The
range of healthcare benefits provided by such a lab is presented in Table 1).
H
Table 1. The most important health benefits employing X-rays
(interventional cardiology procedures) provided by catheterisation laboratories [2]
DIAGNOSTIC
THERAPEUTIC
coronary angiography
bypassography
aortography
coronary angioplasty
noncoronary interventions
percutaneous aortic valve replacement
mitral, pulmonary or aortic valve valvuloplasty
closing atrial septal defects
ventriculography
intravascular ultrasound
fractional flow reserve measurement
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2014 ●
A necessary condition for the interventional cardiology procedures to be implemented safely and effectively is the professional preparation of the medical staff.
The aim of this paper is to present the role and responsibilities
of a radiographer in a cardiac catheterisation laboratory. The
article is based on the analysis of the Polish legislation and
literature (PubMed database) pertaining to healthcare services
in the interventional cardiology. According to the definition
provided in the Minister of Health regulation of 18 February
2011 on the conditions of safe application of ionising radiation
to all kinds of medical exposure, the noun “radiographer” is
used here in reference to a person who “graduated from a radiography tertiary education programme and has a B.Sc. or an
M.A. degree" [3]. It has to be noted that even though two
routes of radiography education can be selected, there is no
difference between the professional qualifications of the graduates of medical colleges or schools and of higher education
facilities [4,5,6].
II. THE ROLE AND RESPONSIBILITIES OF A
RADIOGRAPHER
IN A CARDIAC CATH-LAB
The profession of a radiographer has been assigned to the
medical and social field of professional education purposes
with the number 321103 in the classification of profession and
specialisations. A radiographer is a healthcare professional
who has specific qualifications required to provide health benefits related to diagnostic imaging, electromedical diagnostics
and radiotherapy [7]. In order to prepare the candidates for the
position of “a radiographer in a cardiac catheterisation laboratory”, a three-month-long internship in a laboratory where at
least 1500 procedures are implemented annually is recommended [8]. What is more, a certificate of having undergone
the training on radiation protection of patients is required [3].
In a diagnostic therapeutic team of a cardiac cath-lab, the doctor, the nurse and the radiographer are to cooperate [8,9]. All
healthcare employees’ professional responsibilities are individual contributions to achieve the main goal of the team,
which is the implementation of an interventional cardiology
procedure with the observance of patient safety rules and basic
patient rights, i.e. respecting the confidentiality of their data,
dignity, privacy etc. The actions taken by the staff might
change the patient’s everyday life, e.g. ordering secondary
prevention following coronary angioplasty performed because
of acute coronary syndrome – the patient needs to change his
or her diet because of that, which may affect the lifestyle of the
whole family. Here are the most important tasks a radiographer
in a cath-lab is to perform [3,10,11,12,13]:
12
 confirming the patient’s personal data,
 participating in the process of reducing the patient’s
fear before and during the interventional cardiology
procedure by means of reassuring the patient and
clarifying the respective phases of the procedure,
 operating the X-ray generator for coronary angiography (angiograph),
 testing the functionality of X-ray generator and additional devices (e.g. monitors of the station),
 archiving X-ray images according to the standards of
exchanging, forwarding and storing digital data (according to the Digital Imaging and Communications
in Medicine, DICOM 3.0),
 keeping the record in medical documentation (e.g. recording the time of X-ray emitting and the dose of radiation a patient received),
 observing the principles of radiation protection of patients and staff and implementing the relevant precautionary measures,
 observing radiation dose reference points during coronary angiography (Dose Area Product 60 [Gy·cm2])
and coronary angioplasty (Dose Area Product 120
[Gy·cm2] and radiation emission duration 20 [min.])
 observing the principles of epidemiology,
 monitoring the patient’s vital signs,
 taking actions when life is at risk – implementing mechanical breathing using a bag valve mask, performing external cardiac massage.
The basic role of a radiographer in a cardiac cath-lab related
to his or her professional qualifications is the optimisation of
the healthcare procedure implemented in terms of radiation,
i.e. to make an effort to provide the highest quality of X-ray
imaging with the least radiation dose possible [14,15]. In clinical practice, that is connected with a range of actions which
include: adjusting the physical parameter settings of the angiograph (e.g. voltage [kV]) to the examined area, the patient’s
body weight and his or her body composition. It is important
to remember that actions taken to decrease the X-ray radiation
dose a patient receives contribute to the minimisation of the
radiation risk of the X-ray room staff. Radiographers employed at cardiac catheterisation laboratories should implement the following patient radiation protection principles
[16,17,18,19]:
 proper selection of the X-ray radiation exposure parameters and registering X-ray images with an optimal speed [frames per second],
 avoiding zooming in the X-ray image,
 avoiding radiation doses of high energy in [Gy/s],
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2014 ●
 applying collimation (limiting the range) of X-ray imaging,
 using additional filtration of radiation in order to exclude from the primary beam of X-ray radiation the
low-energy component which does not contribute to
the imaging and is fully absorbed by the patient’s
body,
 avoiding the use of an antidiffusion screen, especially
in the cases of children and slim adults (as long as it
is possible given the technical structure of the angiograph),
 retaining the optimal distance between the patient’s
body and X-ray tube (usually around 100 [cm]), at the
same time ensuring the closest possible distance to
the image detector,
 changing the angle of the primary beam of X radiation
(protecting patients against late complications such as
necrosis),
 avoiding the placement of the patient’s arm (on the opposing side of the vascular access limb) along the
body in order to enlarge the body volume penetrated
by the direct radiation),
 applying shields made of a radiation-absorbing material to the patient’s radiosensitive tissues such as gonads.
Depending on the task distribution between the staff in a
cardiac catheterisation lab (stemming from the employees’
experience or a routine in a given laboratory), some of the
aforementioned actions are to be taken by the doctor operator.
The effectiveness of the particular members of the medical
team is dependent on how clearly defined their responsibilities
are. A helpful factor in defining the range of responsibilities of
each team member may be the operating procedures that need
to be developed wherever radiation is used for medical purposes. These procedures are at the foundation of the Quality
Management System, which is a necessary regulation to observe in Poland in accordance with the art. 33c par. 7 of the
Bill of Nuclear Law [20]. It has to be emphasised that the joint
effort made by a doctor and a radiographer in order to reduce
the radiation dose is an example of solid cooperation based on
mutual trust and dialogue.
A. Xyrichis et al. observed that the outcomes of teamwork
influence the satisfaction of employees, communication within
the team, the well-being and behaviour of the employees and,
above all, the quality of healthcare [21]. Quality in healthcare
is most frequently associated with a high standard of health
benefits in which a patient is perceived as a subject of teamwork of specialists [22-26]. The respect for the patient’s dignity during the implementation of interventional cardiology pro-
13
cedures seems to be a determinant of the team’s ethical foundations. The most important indicators of the proper functioning of a diagnostic therapeutic cath-lab team include [27]:
 providing quality service for the benefit of the patient,
 identifying the tasks and responsibilities,
 the identification of the leader – the doctor operator,
who determines the direction and prospective aims
within a given healthcare benefit, supervises the team
effort and provides support,
 internal culture based on mutual trust and dialogue,
 effective internal communication,
 respecting the autonomy of individual roles within the
team,
 continuous professional development of the medical
team members.
III. CONCLUSIONS
The role and responsibilities of a radiographer in a cardiac
catheterisation laboratory contribute to professional and successful medical care. In spite of the fact that the profession of a
radiographer is associated predominantly with technical skills
(i.e. operating medical equipment, it needs to be emphasised
that such skills are always connected to adapting to a patient’s
needs and the actions of other staff members.
IV. REFERENCES
[1] Majewicz A, Marcinkowski JT. Epidemiologia chorób
układu krążenia. Dlaczego w Polsce jest tak małe
zainteresowanie programami profilaktycznymi? Probl Hig
Epidemiol 2008; 89 (3): 322-325.
[2] Dudek D, Legutko J, Siudak Z el al. Interventional cardiology in Poland in the year 2011. Summary report of the Association of Cardiovascular Interventions of the Polish
Cardiac Society. Post Kardiol Interw 2012; 8, 2 (28): 102107.
[3] Rozporządzenie Ministra Zdrowia z dnia 18 lutego 2011r. w
sprawie warunków bezpiecznego stosowania promieniowania jonizującego dla wszystkich rodzajów ekspozycji medycznej (Dz. U. z 2011r. Nr 51 poz. 265 z póź. zm.).
[4] Rozporządzenie Ministra Edukacji Narodowej z dnia 7 lutego 2012r. w sprawie podstawy programowej kształcenia w
zawodach (Dz. U. z 2012r. poz.184).
[5] Załącznik nr 2 Wzorcowe efekty kształcenia dla kierunku
studiów elektroradiologia studia pierwszego stopnia – profil praktyczny W: Rozporządzenie Ministra Nauki i Szkolnictwa Wyższego z dnia 15 czerwca 2012 r. zmieniające
rozporządzenie w sprawie wzorcowych efektów kształcenia
( Dz. U. z 2012r. poz. 744).
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2014 ●
[6] Janaszczyk A, Bogusz-Czerniewicz M, Malicki J. Porównanie kwalifikacji, umiejętności i uprawnień zawodowych
elektroradiologów w Polsce i wybranych krajach Unii Europejskiej. Zdr Publ 2011; 121 (4): 401-406.
[7] Rozporządzenie Ministra Pracy i Polityki Społecznej z dnia
27 kwietnia 2010 r. w sprawie klasyfikacji zawodów i specjalności dla potrzeb rynku pracy oraz zakresu jej stosowania. (Dz. U. Nr 82, poz. 537 z póź. zm.)
[8] Kubica J, Gil RJ, Pieniążek P. Wytyczne dotyczące koronarografii. Kardiol Pol. 2005; 63, 5 (supl. 3): 491-500.
[9] Levine GN, Bates ER, Blankenship JC et al. 2011
ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology
Foundation/American Heart Association task force on practice guidelines and the society for cardiovascular angiography and interventions. Circulation. 2011; 124 (23):
2574-2609.
[10] Watson L, Odle TG. Patient safety and quality in medical
imaging: the radiologic technologist’s role. ASRT White
Paper 2013:1-12.
[11] Costa AM, Badin RS, Leite MS, Caldas LVE. Constancy
check of beam quality in conventional diagnostic X-ray
equipment. Appl Radiat Isot 2008; 66 (10): 1403– 1405.
[12] Watson S, Gorski KA. Invasive cardiology. A manual for
cath lab personnel. London; Jones & Bartlett Learning,
2011: 64-68.
[13] Dzik M, Klamut H, Krupienicz A. Propozycja standardów
postępowania z pacjentem przyjmowanym do koronarografii i angioplastyki wieńcowej. Pielęgniarstwo XXI wieku,
2012; 38 (1): 47-56.
[14] Einstein AJ. Effects of radiation exposure from cardiac imaging: how good are the data? J Am Coll Cardiol. 2012; 59
(6): 553–565
[15] Martin CJ. The importance of radiation quality for optimization in radiology. biij. 2007; 3(2): e38. [online] Available
from:
URL:http://www.biij.org/
2007/2/e38
Data:
20.07.2012r.
[16] Chambers CE, Fetterly KA, Holzer R et al. Radiation safety
program for the cardiac catheterization laboratory. Catheter
Cardio Inte. 2011; 77 (4): 546–556.
[17] Einstein AJ, Knuuti J. Cardiac imaging: does radiation matter? Eur Heart J. 2012; 33 (5): 573–578.
[18] Miller DL, Balter S, Schueler BA, Wagner LK, Strauss KJ,
Vañó E. Clinical radiation management for fluoroscopically guided interventional procedures. Radiology. 2010; 257
(2): 321-332.
[19] Tylkowski M, Kośmider M. Bezpieczeństwo radiologiczne
w pracowni hemodynamiki. Post Kardiol Interw. 2007; 3, 4
(10): 217–223.
14
[20] Obwieszczenie Marszałka Sejmu Rzeczpospolitej Polskiej
z dnia 24 stycznia 2012r. w sprawie ogłoszenia jednolitego
tekstu ustawy – Prawo atomowe (Dz. U. z 2012r. poz.
264).
[21] Xyrichis A, Ream E. Teamwork: a concept analysis. J Adv
Nurs. 2008; 61 (2): 232–241.
[22] Kazura R, Cichá M, Brukwicka I, Kopański Z , Marczewska S , Kurowski A. Rozważania o jakości. JPHNMR 2011;
1: 3-5.
[23] Kazura R, Cichá M, Brukwicka I, Kopański Z , Marczewska S , Kurowski A. Jakość w opiece zdrowotnej i pielęgniarskiej. JPHNMR 2011; 1: 9-12.
[24] Kazura R, Cichá M, Brukwicka I, Kopański Z , Marczewska S , Kurowski A. Przedmioty oceny jakości w opiece
pielęgniarskiej. JPHNMR 2011; 1: 13-15.
[25] Kazura R, Cichá M, Brukwicka I, Kopański Z , Marczewska S , Kurowski A. Standardy w praktyce pielęgniarskiej.
JPHNMR 2011; 1: 16-18.
[26] Kazura R, Cichá M, Brukwicka I, Kopański Z , Marczewska S , Kurowski A. Procedury jako sformalizowany sposób
działania w opiece nad pacjentem. JPHNMR 2011; 1: 1922.
[27] Nancarrow S, Booth A, Ariss S, Smith T, Enderby P, Roots
A. Ten principles of good interdisciplinary team work.
Hum Resour Health. 2013; 11:19 [online] Available from:
URL:http://www.human-resourceshealth.com/content/11/1/19 Data: 4.08.2013r