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EXAM #7 Instructor Review & PowerPoints Notes

Terms in this set (173)

What is the term used for the Body of ideas, devices, and processes related to handling multiple types of information?
Informatics
What are particular devices to pursue informatics?
Platforms
What are platforms used for medical purpose applications to include patient care, biological applications and activities, and clinical research?
Biomedical Informatics
What are the 4 platforms of BMI?
Picture Archiving and Communication System (PACS)
Hospital Information System (HIS)
Radiology Information System (RIS)
Electronic Medical Record (EMR).
What contains all patient medical record information excluding radiology?
HIS (Hospital information systems)
What is a platform that only pertains to radiology specific information?
RIS (Radiology Information System)
What are some of the capabilities of the HIS & RIS systems?
Capabilities include scheduling appointments, issuing reminders, tracking staff assignments, submit invoices to insurers and patients, filing patient records, printing or mailing reports, and ordering prescriptions.
What are the electronic versions of an individual patient's collection of medical documents which basically replaced paper charts?
EHR & EMR are the same thing. EHR stands for electronic health records & EMR stands for electronic medical records.
What are the 5 subspecialties and their purpose?
Translational Bioinformatics
Clinical Research Informatics
Clinical Informatics
Consumer Health Informatics
Public Health Informatics.
What is a networked group of computers, servers and archives that manage digital images, facilitates storing, retrieving and distributing images, in using separate networks, larger data files can be moved faster but, has issues that include large files, limited bandwidth, special language and problems interfacing with H I S?
PACS (Picture Archiving and Communication System)
What originated in the 1980's by the American College of Radiology and NEMA and is the standard format for communicating imaging files around the world? It allows for multiple platforms to communicate with PACS. It also allows very large files to be sent to other facilities remotely through online transmission and management systems.
DICOM (Digital Imaging and Communication in Medicine)
What allow patients to access their own medical records? These records may include lab results, imaging results and pathology reports just to name a few. Some systems allow messaging the provider or even requesting appointments.
Patient Portals
What is a way of storing images in a nonproprietary manner that use a standard format using a standard interface that can be accessed from different PACS?
VNA or vendor neutral archive
What class contains information about the study and patient?
Object Class
What describes what to do with the object class?
Service Class
When a chest x-ray was sent to a doctor's office. The object is the chest x-ray and the service was sending the image. The two classes form what?
Service Object Pair
What does HIPAA stand for?
Health Insurance Portability and Accountability Act of 1996 protects patient privacy.
What provides standards of interoperability between stakeholders and has standards based on computer related communications involving patient information? These standards have been widely adopted by BMI communities and have been utilized with HIS.
HL-7 or known as Health Level 7 International
What promotes the use of DICOM and HL-7? These systems are very efficient when communicating with each other and provide an infrastructure to share images with new partners seamlessly.
IHE or Integrating Healthcare Enterprises
What should we remember to do to protect patient information?
Log in and out before leaving the computer or leaving work. Do not carry patient information around unless ordered to do so. If you have a paper requisition, keep it face down and not visible to anyone passing by. Patients can be a security threat to themselves. If their record or information is left unattended, some may be tempted to look at it. This is a HIPAA violation although it is the patient's own information.
What includes the mainframe, CPU unit, memory, input devices, output devices and are the tangible components of the computer?
Hardware
What includes computer programs, applications and operating systems?
Software
What is a computer that serves clients by handling data and applications?
Servers
What is a external network available to the public?
Internet
What is one or more networks controlled by a single authority?
Intranet
What is an internal network controlled by the same authority but is not available for public use, must be an authorized user?
Extranet
What is the most inexpensive and simplistic of network switches and acts as a passive method for connected computers to transmit and receive data that are connected to it?
The HUB
What is network that provides a similar design as a hub, but rather actively manages the connections between attached computers?
Bridge
What is a network that is more complex and is capable of determining where data are from based on the internet protocol address, or IP address, that uniquely identifies a device and the network it belongs to?
Router
What is the available data line space on a network that is measure in bits/sec?
Bandwidth
More bandwidth means faster what?
Transmission Speeds
What are set rules for communication between devices on a network and are important for communication between devices?
Network Protocols
What are chunks of data separated before being sent over & they may be transferred by different routes but, end up in the same place?
Data Packets
What determines the number of shades of gray a pixel can display?
Bit Depth
How do you calculate image file size?
Image File Size: XY (B/8)
How do you calculate Pixel size?
Pixel Size: Size of Matrix (x-axis)/ FOV Size
What display means the physical piece of film? Hard copy display means the physical piece of film. Soft copy display means an image that is seen on a screen.
Hard Copy
What display means an image that is seen on a screen?
Soft Copy
What type of quality will greatly affect what interpretation?
Monitor Quality
Name two types of monitors that are thinner and take up the least amount of space compared to a CRTs?
LCD & LEDs
Name two types of monitors that use a light source behind the screen that shines on the individual pixels?
LCD & LEDs
What monitor uses liquid crystal and hydrogenated amorphous silicon TFTs between glass plates to regulate pixel transparency?
LCDs
What monitor is measured in Megapixels?
LCDs
Our monitors may not be as nice as a radiologist's monitor. The radiologist's spatial resolution must be on a more sophisticated because they are diagnosing patients.
...
If there are more pixels, the smaller they are which would mean a larger what?
Matrices
If there are more pixels making the pixels smaller in size and the matrices larger what factor would be improved?
Spatial Resolution
Images are typically archived for how long?
5-7 years
Images that were performed on a pediatric patient or any images that were used in court cases are held for how long?
Indefinitely
Images are typically archived for the same length of time in every state and all states abide by the same law for medical image archiving time limits. True or False
False, each state can use different laws for the length of time medical images need to be archived
What is the typical storage requirement for electronic medical images and files?
Terabytes
10,000 Gigabytes or 10,000,00 Megabytes= what
1 Terabyte
A more modern way of storing and sharing medical images is by using what technology?
Cloud computing or "the cloud"
What is an internet-based storage center, is a newer platform that refers to internet-based computing with virtual access of shared resources, Images can be stored and retrieved?
Cloud computing
Cloud computing is usually reliable with what but, internet must be at an appropriate speed to move files?
High Speed Bandwidth
What type of storage includes storing images on local hard drives, and PACS servers?
Short term
What type of storage utilizes Jukeboxes of disks or tapes and uses physical storage to ensures integrity if a catastrophic event were to occur?
Long-Term Storage
A typical radiology department may do about how many examinations per year & would require about how many terabytes of storage per year?
150,000 & 3.2 terabytes
What is integrated into EHR and allows the physician to order bloodwork, imaging, and other tests through this computer system?
CPOE (Computerized Provider Order Entry)
What is different from CPOE because it helps physicians order necessary exams, the system focuses on the quality of exams needed versus the quantity, helps prevent unnecessary ordering of imaging exams & supports the transition from exam volume to exam value imaging?
CDSS (Clinical Decision Support System)
With medical records and image privacy being extremely important what must adhere to HIPAA and SAFER guidelines to ensure protection of patient privacy and to prevent any breeches of data?
EHR (Electronic Health Record)
What part of the Quality Management program is defined as activities that provide adequate confidence that a radiology service will render consistently high-quality images and services? This part of Quality Management deals more with the patient care side of things, operates by identifying problems, monitoring problems and resolving them.
Quality Assurance
What consists of a coherent system designed to monitor equipment performance through a variety of quality assurance and quality control standards or benchmarks?
QM (Quality Management)
What part of Quality Management is defined as the aspect of quality assurance that monitors technical equipment to maintain quality standards, it is the part of the program that tests equipment for performance, & this concept is rooted in the need to stabilize the various equipment components of the radiographic imaging chain?
QC (Quality Control)
What contains both QA & QC?
(QM Quality Management)
What is an ongoing process of improving standards in a QM program?
CQI (Continuous Quality Improvement)
What initiated quality management regulations on equipment that emitted electromagnetic radiation?
Radiation Control for Health and Safety Act of 1968
What added to the scope of the effort in controlling radiation & enforced that the secretary of health and human services in each state had to issue licenses for medical and dental equipment that emitted ionizing radiation?
The Consumer-Patient Radiation Health and Safety Act of 1981
What mandated that all serious injuries or deaths from medical devices must be reported?
The Safety Medical Devices Act of 1990
What ensures all mammo services meet the required standards of quality & plays a major role in mammo education?
The MQSA of 1992
What two Acts have had the most impact in medical imaging?
The SMDA and MQSA
What sets standards for electronic record security, electronic formats for record keeping, electronic identifiers and codes and requirements for confidentiality and privacy rules?
HIPPA (HIPAA stands for Health Insurance Portability and Accountability Act)
Who is responsible for enforcing the regulations of the safety acts such as SMDA, is a section of the FDA & this section also falls under Health and Human Services?
The Center for Devices and Radiological Health
Who is the largest hospital accreditation agency, is a voluntary accreditation body, & establishes quality standards, assess the standards and provide certification that facilities have met those standards?
The Joint Commission
The institution's performance in the established quality standards, assessments of the standards and certifications for having met those standards will play a role in what from the state and federal governments as well as insurance companies?
Reimbursements
Describe the method to monitor problems?
QA operates by identifying problems, monitoring problems and resolving them.
What is FOCUS PDCA?
Investigating stage.
F stands for finding and defining a problem.
O stands for organizing a team to work on improvement.
C stands for clarifying the problem with current knowledge.
U is for understanding the problem and its causes.
S means to select an appropriate method to improve the issue.

Implementing the Improvement plan
P is for planning the implementation.
D is to do the implementation and measure any changes.
C is for checking results
A means the act to continue improvements.
What should be considered when purchasing equipment? SHORT VERSION
Identification of imaging requirements
Development of equipment specifications
Selection of equipment
Installation and acceptance testing
Continuing education
Monitoring of equipment performance
Processing systems & External beam evaluations
What should be considered when purchasing equipment? LONG INSTRUCTOR VERSION
Identifying what is needed in terms of imaging requirements, is a team effort. Everyone has a role including admin, radiologists, supervisors and staff technologists. Admin usually control financial and space requirements. Supervisors can report staffing needs and patient volume. The needs of the radiologists must be met and the most important, the end-use input, from the techs matter because the techs are responsible for successful implementation and operation.

The person making these specifications should have a technical background to state what is needed to meet imaging requirements. At this point, a medical physicist should be involved to help determine exact specifications. Once these specifications are determined, they are sent to vendors for bidding.

During the selection process, bids are compared. They look at the ability to meet those requirements as well as the cost of equipment and service contracts. It is also important to factor the service, support and life costs needed to maintain equipment. The bargaining process can be restrained if a radiologist has a preference of a vendor, which can make it difficult from the administrator side of purchasing equipment.

The vendor or manufacturer is responsible for installation and acceptance testing. QC tests must confirm that each specification was met. This could require a medical physicist to step in with modern technologies. Full disclosure of evaluation methods must be specified, therefore providing a baseline for future testing.

Continuing education is the last step of the purchasing process. For simple equipment, a manual can be enough for training. Complex equipment should be demonstrated and explained to at least 2 other people. In service and continuing education is also a must. Quality control and in-service education coordinators should be involved in initial training sessions to provide their staff with a good orientation training and they can provide periodic updates on equipment
Who is responsible for daily tests?
Radiographers
What type of exam is fluoro?
Dynamic, real time
Who invented fluoro?
Thomas Edison
The first fluoro unit consisted of what?
X-ray Tube and a Hand-Held Fluoroscopic Screen
When was Image Intensification introduced?
1948
When did Digital fluoroscopic systems take over as the preferred equipment type?
2005
Digital fluoroscopic equipment uses what technology and has post-processing capabilities?
TFT
What are functional studies in fluoro & fluoroscopically guided positioning?
Gastrointestinal (GI) studies
Angiography
Line placements
Orthopedic surgeries
What are the types of equipment used in fluoro?
C-Arm Over Table Units & Under Table Units
When using fluoro equipment you have the ability to raise and lower the image receptor for what reason?
Accuracy and Reducing Patient Dose.
You always want the receptor, or II (image intensifier) where in with regards to the patient?
You want the patient as close to the IR as possible.
By raising and lowering the tube or moving it around can cause variation in what?
Beam Geometry and Resolution.
The "fluoro tower" as you may hear it called floats over the what?
Patient
The tower consists of the what or what for digital?
The tower consists of the II or flat panel in digital.
The tower must be in what position for exposure to occur?
Full Beam Intercept
What is considered a primary barrier in fluoro because radiation from the x-ray tube will be intercepted by the II?
The Image Intensifier
What is the mA range in fluoro?
The mA range for fluoro tubes is .5-5.0 mA
What is the minimum SSD should be used in fixed fluoro equipment?
15 inches
There is what type of switch available to the radiologist to control the exposure?
Foot Switch
A Foot Switch is a is a what type switch?
Dead-Man
Once the radiologist takes their foot off the petal of the Foot Switch, the exposure should do what?
Automatically Stop
The collimators controlled how which allow for close collimation?
Electrically
Input phosphor of the II is a .1-.2mm CsI screen that converts x-rays to what?
Light
Photocathode of the II emits what when struck by light emitted from the input screen?
Electrons
The electrostatic lenses of the II then accelerate and focus the electrons across the tube to the what?
Anode
When the electrostatic lenses of the II accelerates electrons, kinetic energy increases which contributes to the what?
Brightness Gain.
The electrostatic lenses of the II then accelerate and focus the electrons across the tube essentially carrying the what?
Fluoroscopic Image.
The electrostatic lenses of the II then accelerate and focus the electrons traveling across the tube are the what in this image, where the black lines cross reverse the image going to the output screen?
The Focal Point
The electrostatic lenses of the II accelerate and focus the electrons traveling across the tube are the focal point in this image, where the black lines cross reverse the image going to the output screen. This causes right becomes left, superior becomes inferior. This is because the image is what?
Optically Focused.
The anode of the II is positively charged at about what kVp?
25
By having the anode of the II positively charged at about 25 kVp, the negative electrons are attracted away from the what?
Photocathode
There is a hole in the center of the anode of the II that allows negative electrons to be attracted away from the photocathode in order to pass through and hit the what?
Output Screen.
The output screen is what type of screen made of zinc-cadmium sulfide?
Glass Fluorescent
When electrons strike the output screen, they are converted to what color light photons?
Green
What type of filter may be used to avoid isotropically traveling light photons from going back and hitting the input screen and degrading the image?
Opaque
What intensifiers prevent light photons from being emitted isotropically and their use helps transfer the image for viewing with little loss of resolution?
Fiber Optic
How do you calculate magnification?
Input Screen Diameter x Diameter of Input Screen during Magnification = MAG
When an image is magnified it will increase patient dose when using what?
Image Intensification.
Digital equipment uses what which does not increase dose?
Electronic Magnification
When the acceleration of the electrons increases, the focal point shifts away from the anode or moves closer to the what?
Input Screen.
There are different types of II's that have been designed to change the voltage on the electrostatic lenses. Dual focus, triple field and quad field give you more what?
Magnification Option
What results from the concentration of a large electron volume from the input phosphor being focused down to the very small output phosphor.
Minifciation gain
The minification gain is an increase in what and is not an improvement in quality or the number of photons?
Brightness or Intensity
How do you calculate minification gain?
Input screen diameter squared, divided by output screen diameter squared= Minification Gain
What is a measurement of conversion efficiency of the output screen?
Flux Gain
If one electron hits the output screen and 50 light photons are emitted per electron striking the output screen, then the what is 50?
Flux Gain
There is no formula for FLUX Gain, this is simply measuring the conversion efficiency of the II's performance. True or False
TRUE
How do you calculate total brightness gain?
Minification Gain X Flux Gain = Brightness Gain
What control uses an electronic feedback loop between the II and the x-ray tube to maintain optimum brightness during operation. This is very important in maintaining image quality? For example, if the radiologist is having the quickly follow a bolus of contrast down the esophagus, there is no time to change mA while moving the tube to compensate for patient thickness changes and image quality changes.
ABC, ABS, ADC, or AGC all the same just depends on the manufacturer
In fluoro what is controlled by increasing the amplitude of the video signal?
Contrast
For fluoro using digital systems what is used to adjust contrast?
Post-Processing with Algorithms and Window Width.
Contrast can be effected by scatter radiation from the patient and penumbral light scatter in what?
Input and Output Screens.
What in fluoro is poorer than x-ray?
Resolution
The edges of the II have lower resolution due to what?
Vignetting
What is affected by the same factors as x-ray, primarily OID?
Size distortion
What can be caused by the shape of the input screen?
Although the input screen is concave to reduce distortion, it does not completely reduce distortion at the edges of the output screen.
Shape distortion
Vignetting or the pin cushion effect can occur. An example of the pin cushion effect can be seen in this image where it looks like a pin is pressing in the center causing the edges of the image to become distorted. This is not an issue with what type of matrices?
TFTs have uniform resolution across the image
What occurs when there was insufficient exposure to the input phosphor?
Quantum Mottle
How is quantum mottle improved by in fluoro?
Increasing total exposure to the input phosphor. You can do this by increasing mA, reducing the distance between the patient and II and increasing kVp.
What are the most common video viewing systems?
Video system which uses a video camera attached to the output phosphor.
The video tubes were eventually replaced in the 80's with what?
CCDs.
Digital fluoro systems that use what are the most common than video viewing systems today?
Flat Panel Displays
Digital, or flat panel fluoroscopy is the standard in what systems?
Angiographic
Digital fluoroscopy is a technology that does not have the II tube and has no peripheral fall- off, no vignetting, and no dose increase?
Solid State
Digital fluoroscopy has a detector surface that is rectilinear in shape and can rotate. The image quality is excellent with optimum resolution across the what?
TFT detector surface
Newer digital fluoroscopy systems have completely replaced the II with an a-Si flat panel detector. The DEL size is about what size?
200-400 microns
Digital fluoroscopy uses a high-power generator which allows for what? This takes pulses of exposure instead of continuous exposure which reduces patient dose.
Pulse Progressive Mode
What time is the length of time it takes for the generator to come on and adjust kV and mAs?
Interrogation
What time is the length of time is takes to shut down the generator in preparation of the next pulse?
Extinction Time
The II output screen is coupled with a what?
TFT
What allows the physician or radiologist to work from the most recent image before reactivating the machine again?
Last Image Hold Function.
Photodiodes are connected to each what?
Pixel
Pixel binning is a concept used to reduce what?
Noise
What basically means that 2 to 4 pixels are combined in units?
Pixel Binning
What is not as high as it is in radiography because of patient dose concerns?
Resolution
However, digital fluoro systems have good what? Meaning that fluoro systems have good low contrast resolution or the ability to image small structures.
Separation of Acquisition and Display
How can digital images in fluoro be stored?
Dynamic and static image recording reduces patient exposure. Any recording media with enough storage can be used. Any digital recording device can do. Flashdrives are common as well as DVDs and digital storage.
How can we protect the patient, ourselves, and others during fluoro?
Use Cardinal Rules: time, distance, and shielding.
Tabletop exposure rate for general fluoroscopy should not exceed what?
10 R/min, or 21 mGya/min/ mA or 100 mGya/min
For high level fluoroscopy, it should not exceed what?
20 R/min or 200 mGya/min.
Normally, general fluoro operates around what?
1-3 R/min.
Source to skin distances should not exceed how many inches for mobile equipment and how many inches for stationary systems?
12 & 15
The audible alarm will sound after how long of fluoro and shut off?
5 minutes
What should be used sparingly or when necessary in older equipment?
Magnification
When what is activated, this can increase dose 2 times?
Magnification
With flat panel digital fluoro, no dose increase occurs due to the use of what?
Electronic Magnification.
What are the 2 types of fluoro tube designs?
There are two designs of fluoro systems including the tube above or below the patient. Multidetector systems have a fluoro detector located under the table. There are 2 additional detectors incorporated into the system to allow table radiography and upright imaging. Single detectors are more innovative. This type of equipment only requires 1 detector that allows both static and dynamic radiography. The newer equipment replaces the II with a TFT detector. Fluoro isodose curves significantly differ between he 2 designs. Refer to the image in figure 33-5 to view the isodose curves. The further away you are from the source, the lower the dose.
How thick should lead aprons be?
Lead aprons should be worn and should be atleast .25 mm Pb/eq.
Where should we stand during fluoro?
Behind the RAD, the highest energy scatter will occur at a 90 degree angle from the incident beam. This typically falls at the same level of the gonads.
What does image file size depend upon?
Matrix size, pixel size, and bit depth
What is LAN? WAN?
LAN or local area network connects all the computers that are separated by short distances. For example, a department or building. The college or hospitals are good examples.
What is WAN?
WAN or wide area network, connects computers that are separated by large distances. For example. Another state or country. Teleradiography is an example. Teleradiography allows images to be sent to other doctors in other states or even other countries.
What allows more room for storing more images?
DATA compression
What compression means all information is retained without the loss of any information?
Lossless Compression
What compression means data can be lost once compressed then uncompressed & means a loss of information can occur which can be detrimental to the image?
Lossy Compression
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