Medical Radiation Technology

Five Tests and Treatments to Question

by
Canadian Association of Medical Radiation Technologists
Last updated: July 2021

Don’t image a patient without a relevant clinical history and a complete requisition in order to prevent unnecessary or redundant studies.
1

An accurate and comprehensive clinical history ensures patient safety and reduces unnecessary repeat examinations. Medical Radiation Technologists (MRTs) are encouraged to engage patients in conversation to fill in any gaps in the clinical information available. MRTs should speak with other members of the healthcare team to address any discrepancies with an imaging request.

Sources:

Canadian Association of Medical Radiation Technologists. Appropriateness of requisition, order or prescription. Best Practice Guidelines, CAMRT. [Internet]. May 2016. [Accessed 15 Jul 2021].

Castillo C, Steffens T, Sim L, Caffery L. The effect of clinical information on radiology reporting: A systematic review. J Med Radiat Sci. 2021;68(1):60-74. PMID: 32870580.

Doshi AM, et al. Impact of patient questionnaires on completeness of clinical information and identification of causes of pain during outpatient abdominopelvic CT interpretation. Abdom Radiol. 2017 Dec;vol42(12):2946-2950. PMID: 28647766.

Gunderman RB, et al. Improving Clinical Histories on Radiology Requisitions. Academic Radiology. 2001;vol8(4):299-303. PMID: 11293777.

Gyftopoulos S, et al. Patient Recall Imaging in the Ambulatory Setting. Am J Roentgenol. 2016;vol206(4):787-791. PMID: 26866338.

Lacson R, Laroya R, Wang A, et al. Integrity of clinical information in computerized order requisitions for diagnostic imaging. J Am Med Inform Assoc. 2018;25(12):1651-1656. PMID: 30517649.

Zhou Y, et al. Errors in medical imaging and radiography practice: a systematic review. JMIRS. 2015;vol46(4):435-441.
Don’t perform medical imaging/radiation therapy procedures before assessing patient preparedness in order to prevent repeat procedures.
2

Proper patient preparation reduces the need for repeat procedures and is an important quality and safety consideration for both medical imaging and radiation therapy. A multidisciplinary approach to pre-procedural care emphasizes the importance of advanced planning to achieve the desired outcomes for the procedure and ensures that the procedures do not need to be cancelled or repeated. This includes necessary laboratory results, adherence to dietary requirements and administration of pre-procedure medications. It is the Medical Radiation Technologist’s (MRT) responsibility to ensure patients have completed all necessary pre-procedural instructions.

Sources:

Canadian Association of Medical Radiation Technologists. Patient education. Best Practice Guidelines, CAMRT. [Internet]. Nov 2015. [Accessed 15 Jul 2021].

Canadian Association of Medical Radiation Technologists. Patient preparation. Best Practice Guidelines. CAMRT. [Internet]. Oct 2021. [Accessed 15 Jul 2021].

Cramp V, et al. Use of a prospective cohort study in the development of a bladder scanning protocol to assist in bladder filling consistency for prostate cancer patients receiving radiation therapy. J Med Radiat Sci. 2016 Sep;vol63(3):179-185. PMID: 27648282.

Frush DP. Overview of CT technologies for children. Pediatr Radiol. 2014 Oct;vol44(S3):422-426. PMID: 25304699.

Taslakian B, et al. Patient evaluation and preparation in vascular and interventional radiology: What every interventional radiologist should know (Part 1). Cardiovasc Intervent Radiol. 2016 Mar;vol39(3):325-333. PMID: 26493820.

Taslakian B, et al. Patient evaluation and preparation in vascular and interventional radiology: What every interventional radiologist should know (Part 2). Cardiovasc Intervent Radiol. 2016 Apr;vol39(4):489-499. PMID: 26606917.

Zaorsky NG, et al. ACR Appropriateness Criteria® external beam radiation therapy treatment planning for clinically localized prostate cancer, part I of II. Adv Radiat Oncol. 2017 Jan-Mar;vol2(1):62-84. PMID: 28740916.
Don’t perform medical imaging or radiation procedures prior to assessing the patient’s ability to tolerate the procedure in order to prevent repeat or poor quality studies.
3

Many patients have difficulty tolerating medical imaging and radiation therapy procedures that often cause repeat examinations and/or poor-quality outcomes. Medical Radiation Technologists (MRTs) must communicate with patients, their families and other healthcare providers to ensure patients are physically, mentally and emotionally able to perform the procedure requested.

Sources:

American Society of Radiologic Technologists. The practice standards for medical imaging and radiation therapy, Radiography Practice Standards. ASRT. [Internet]. June 2017. [Accessed 15 Jul 2021].

Canadian Association of Medical Radiation Technologists. Claustrophobia. Best Practice Guidelines, CAMRT. [Internet]. Feb 2016. [Accessed 15 Jul 2021].

Canadian Association of Medical Radiation Technologists. Patient and family-centered care in practice. Best Practice Guidelines, CAMRT. [Internet]. Nov 2015. [Accessed 15 Jul 2021].

Clover K, et al. Disruption to radiation therapy sessions due to anxiety among patients receiving radiation therapy to the head and neck area can be predicted using patient self-report measures. Psycho-Oncology. 2011 Dec;vol20(12):1334-1341. PMID: 20878722.

Grilo A, et al. Anxiety in cancer patients during 18F-FDG PET/CT low dose: A comparison of anxiety levels before and after imaging studies. Nurs Res Pract. 2017;vol(2017):3057495. PMID: 28392942.

Katz RC, et al. Anxiety and the determinants in patients undergoing magnetic resonance imaging. J Behav Ther Exp Psychiatry. 1994 June;vol25(2):131-134. PMID: 7983222.

Perry H, Eisenberg RL, Swedeen ST, Snell AM, Siewert B, Kruskal JB. Improving Imaging Care for Diverse, Marginalized, and Vulnerable Patient Populations. Radiographics. 2018;38(6):1833-1844. PMID: 30303790.

Woodworth DC, Scambray KA, Corrada MM, Kawas CH, Sajjadi SA. Neuroimaging in the Oldest-Old: A Review of the Literature. J Alzheimers Dis. 2021;82(1):129-147. PMID: 33998539.
Don’t perform medical imaging or radiation therapy without using appropriate and/or available radiation dose reduction strategies and technologies.
4

Stopping patients from receiving unnecessary radiation dose is a primary consideration for Medical Radiation Technologists (MRTs). MRTs should use all available hardware, software, accessory devices, and patient instructions (pre and post procedure) to minimize dose to patients during medical imaging and radiation therapy planning and treatment alignment. All imaging should be performed using the As Low as Reasonably Achievable (ALARA) principle to optimize the appropriate dose for each clinical situation.

Sources:

Akin EA, et al. Optimizing-Oncologic-FDG-PET-CT-Scans-to-Decrease-Radiation-Exposure. Image Wisely. [Internet]. Updated April 2017. [Accessed 15 Jan 2021].

Alessio AM, et al. Role of Reference Levels in Nuclear Medicine: A Report of the SNMMI Dose Optimization Task Force. J Nucl Med. 2015 Sep;vol56(12):1960-64. PMID:26405164.

Canadian Association of Medical Radiation Technologists. Minimizing Patient Exposure. Best Practice Guidelines, CAMRT. [Internet]. Feb 2021. [Accessed 28 Jul 2021].

Canadian Association of Medical Radiation Technologists. D iscontinuing the Use of Gonadal and Fetal Shielding for Patients. May 2021 [Accessed 15 July 2021].

Canadian Nuclear Safety Commission. Regulatory Guide. Keeping Radiation Exposures and Doses As Low as Reasonably Achievable (ALARA). G-129, Revision 1. CNSC. [Internet]. Oct 2004. [Accessed 15 Jul 2021].

Canadian Nuclear Safety Commission. Regulatory Guide. Radiation Protection Regulations SOR/2000-203. CNSC. [Internet]. Amended Jan 2021. [Accessed 15 Jul 2021].

Image Wisely. Diagnostic Reference Levels, CT Diagnostic Reference Levels From the ACR CT Accreditation Program. Image Wisely. [Internet]. Nov 2010. [Accessed 15 Jul 2021].

Harkness B. Dose Reduction in Planar Nuclear Medicine Imaging. Image Wisely. [Internet]. Nov 2012. [Accessed 15 Jan 2021].

Health Canada. Safety Code 35: Safety Procedures for the Installation, Use and Control of X-ray Equipment in Large Medical Radiological Facilities. Government of Canada. [Internet]. Updated 14 Jan 2015. [Accessed 15 Jul 2021]. 2008.

Hedgire SS, et al. Recent advances in cardiac computed tomography dose reduction strategies: a review of scientific evidence and technical developments. J Med Imaging (Bellingham). 2017 Aug;vol4(3):031211. PMID: 28894760.

International Commission on Radiological Protection. ICRP Publication 105. ICRP. [Internet]. 2007. [Accessed 15 Jul 2021].

Moser JB, et al. Radiation dose-reduction strategies in thoracic CT. Clin Radiol. 2017 May;vol72(5):407-420. PMID: 28139204.

Raff GL, et al. Advanced Cardiovascular Imaging Consortium Co-Investigators. Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. JAMA. 2009 June;vol301(22):2340-2348. PMID: 19509381.

Rawat U, et al. ACR White Paper-Based Comprehensive Dose Reduction Initiative Is Associated With a Reversal of the Upward Trend in Radiation Dose for Chest CT. J Am Coll Radiol. 2015 Dec;vol12(12 Pt A):1251-1256. PMID: 26482816.

Reiner BI. The Quality/Safety Medical Index: a Standardized Method for Concurrent Optimization of Radiation Dose and Image Quality in Medical Imaging. J Digit Imaging. 2014 Dec;vol27(6):687-691. PMID: 25193788.
Don’t start peripheral venous lines when an appropriate central access is available.
5

All available central venous access lines should be assessed for compatibility with contrast injections before a new peripheral venous line is started. This prevents starting unnecessary lines which are uncomfortable for patients.

Sources:

Bonciarelli G, et al. GAVeCeLT consensus statement on the correct use of totally implantable venous access devices for diagnostic radiology procedures. J Vasc Access. 2011 Oct-Dec;vol12(4):292-305. PMID: 21534233.

Bujis SB, et al. Systematic review of the safety and efficacy of contrast injection via venous catheters for contrast-enhanced computed tomography. Eur J Radiol Open. 2017 Sept;vol4:118-122. PMID: 29034281.

Herts BR, et al. Power injection of contrast media using central venous catheters: feasibility, safety, and efficacy. AJR Am J Roentgenol. 2001 Feb;vol176(2):447-453. PMID: 11159092.

Plumb AA, et al. The use of central venous catheters for intravenous contrast injection for CT examinations. Br J Radiol. 2011 Mar;vol84(999):197-203. PMID: 21325362.

Tee FY, et al. Patient Perceptions and Experience of Pain, Anxiety and Comfort during Peripheral Intravenous Cannulation in Medical Wards: Topical Anaesthesia, Effective Communication, and Empowerment. International Journal of Nursing Science. 2015;vol5(2):41-46.

Wienbeck S, et al. Prospective study of access site complications of automated contract injection with peripheral venous access in MDCT. Am J Roentgenol. 2010 Oct;vol195(4):825-829. PMID: 20858804.
How the list was created

The Canadian Association of Medical Radiation Technologists (CAMRT) established its Choosing Wisely Top 5 recommendations by creating a subject matter expert Choosing Wisely Core Committee representing all four Medical Radiation Technology (MRT) disciplines: radiological technology, nuclear medicine, magnetic resonance and radiation therapy. This committee created and sent outlines for 10 recommendations to key professional stakeholders including the CAMRT Board of Directors, the MRT Alliance of Regulators and Provincial MRT Associations. This consultation used a Delphi survey to establish the top 5 recommendations. Individual recommendation committees were then created for each to perform an extensive literature review and participate in a rigorous critical appraisal process. All recommendations were then reviewed by the Core Committee for consistency in language, by the Choosing Wisely Physician Committee, and finally by Choosing Wisely stakeholders.