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Medical ANCC-MSN : ANCC (RN-BC) Medical-Surgical Nursing exam Dumps

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Exam Number : ANCC-MSN
Exam Name : ANCC (RN-BC) Medical-Surgical Nursing
Vendor Name : Medical
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Exam Title : Medical-Surgical Nursing Board Certification Exam

Questions : 125 (25 unscored)

The ANCC Medical-Surgical Nursing board certification examination is a competency based examination that provides a valid and reliable exam of the entry-level clinical knowledge and skills of registered nurses in the medical-surgical specialty after initial RN licensure. Once you complete eligibility requirements to take the certification examination and successfully pass the exam, you are awarded the credential: Registered Nurse-Board Certified (RN-BC). This credential is valid for 5 years. You can continue to use this credential by maintaining your license to practice and meeting the renewal requirements in place at the time of your certification renewal. The Accreditation Board for Specialty Nursing Certification accredits this ANCC certification.

There are 150 questions on this examination. Of these, 125 are scored questions and 25 are pretest
questions that are not scored. Pretest questions are used to determine how well these questions will
perform before they are used on the scored portion of the examination. The pretest questions cannot
be distinguished from those that will be scored, so it is important for a candidate to answer all
questions. A candidate's score, however, is based solely on the 125 scored questions. Performance on
pretest questions does not affect a candidate's score.

Category Content Domain Number of Questions Percentage

I Assessment and Diagnosis 52 42%

II Planning, Implementation, and Evaluation 58 46%

III Professional Role 15 12%

TOTAL 125 100%

I Assessment and Diagnosis

A. Skill

1. Health history collection

2. Physical exam (e.g., disease process, review of systems, activities of daily living)

3. Psychosocial exam (e.g., developmental stages, suicide risk, abuse, substance use disorders)

4. Cognitive exam (e.g., neuro status, developmental age, impairment)

5. Diagnostic and laboratory testing (e.g., patient preparation, response to abnormal values, medication considerations)

6. Nursing diagnosis identification and prioritization

B. Knowledge

1. Fluids and electrolytes (e.g., imbalances, disease-related, blood products)

II Planning, Implementation, and Evaluation

A. Skill

1. Nursing care planning (e.g., interventions, modifications, outcomes)

2. Postoperative complication prevention and management (e.g., bleeding, infection, emboli)

3. Patient teaching (i.e., learning preferences, barriers, and confirmation)

B. Knowledge

1. Education courses (e.g., self-management, acute and chronic conditions, population specific)

2. Patient safety measures (e.g., screening tools, infection prevention, restraints, medical equipment)

3. Non-pharmacologic treatments (e.g., complementary and alternative medicine, diversional activities)

4. Medication interactions and adverse effects (e.g., pain management, polypharmacy, drug-drug, food-drug)

5. Health and wellness promotion (e.g., screenings, vaccinations, healthy lifestyle modifications)

III Professional Role

A. Skill

1. Therapeutic communication (e.g., patient- and family-centered care, cultural competence)

B. Knowledge

1. Nursing ethics (e.g., evidence-based practice, advocacy)

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Medical ANCC techniques


The Handbook of Medical Image Perception and Techniques

A state-of-the-art review of key courses in medical image perception science and practice, including associated techniques, illustrations and examples. This second edition contains extensive updates and substantial new content. Written by key figures in the field, it covers a wide range of courses including signal detection, image interpretation and advanced image analysis (e.g. deep learning) techniques for interpretive and computational perception. It provides an overview of the key techniques of medical image perception and observer performance research, and includes examples and applications across clinical disciplines including radiology, pathology and oncology. A final chapter discusses the future prospects of medical image perception and assesses upcoming challenges and possibilities, enabling readers to identify new areas for research. Written for both newcomers to the field and experienced researchers and clinicians, this book provides a comprehensive reference for those interested in medical image perception as means to advance knowledge and Strengthen human health.

  • An overview of key techniques allows the reader to adopt these in their own studies
  • A summary of the future of medical image perception enables identification of new areas of research
  • Examples and applications demonstrate the role of information perception in multiple clinical disciplines
  • Read more Reviews & endorsements

    'In The Handbook of Medical Image Perception and Techniques, Samei and Krupinski have assembled a group of internationally-recognized experts to address an important but under-emphasized stage in the process of medical imaging.' William Hendee, Distinguished Professor Emeritus, Medical College of Wisconsin

    'A concise text that offers a unique collection of chapters from all the leading authors in medical perception. I would highly recommend this text for anyone wanting to know more about medical perception from its historical perspective to current research. A must have reference for anyone wanting to join in this exciting discipline.' Lonie R. Salkowski, University of Wisconsin, Madison

    'Drs Elizabeth Krupinski and Ehsan Samei have given us a wonderful new edition of their landmark textbook on medical image perception, with updated chapters throughout and with approximately thirty percent new material added since the first edition was published in 2010. This new volume comprehensively updates and extends the ‘keystone’ publication in the field of medical image perception research. Each chapter is the definitive reference on its topic, authored by a foremost expert. With this new edition, Drs Krupinski and Samei have assembled a compendium of what amounts to decades of research and accumulated wisdom in a compact package-comprehensive and yet still very accessible for a broad audience. … Anyone with an interest in this Topic will find this book to be an invaluable resource.' Michael A. Bruno, Pennsylvania State University

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    × Product details
  • Edition: 2nd Edition
  • Date Published: January 2019
  • format: Hardback
  • isbn: 9781107194885
  • length: 534 pages
  • dimensions: 283 x 225 x 28 mm
  • weight: 1.69kg
  • contains: 279 b/w illus.
  • availability: Available
  • Table of Contents

    1. Medical image perception Ehsan Samei and Elizabeth Krupinski2. A short history of image perception in medical radiology Harold Kundel and Calvin Nodine3. Spatial vision research without noise Arthur Burgess4. Signal detection theory – a brief history Arthur Burgess5. Signal detection in radiology Arthur Burgess6. Lessons from dinners with the giants of modern image science Robert Wagner7. Perception in context David Manning8. Perceptual factors in studying medical images Elizabeth A Krupinski9. Cognitive factors in studying medical images David Manning10. Satisfaction of search in radiology Kevib Berbaum, Edmund Franken, Robert Caldwell, Kevin Schartz and Mark Madsen11. Acquiring expertise in radiologic image interpretation Calvin F. Nodine and Claudia Mello-Thoms12. The first moments of medical image perception Jeremy M. Wolfe, Karla K. Evans and Trafton Drew13. Image quality and its clinical relevance Justin Solomon, Robert Saunders, Jr and Ehsan Samei14. Designing perception experiments Ehsan Samei15. Receiver operating characteristic analysis: basic concepts and practical applications Georgia Tourassi16. Multireader ROC analysis Stephen L. Hillis17. Memory effects and experimental design Tamara Miner Haygood and Karla K. Evans18. Observer models as a surrogate to perception experiments Craig K. Abbey and Miguel P. Eckstein19. Implementation of observer models Matthew A. Kupinski20. Value and limitations of observer models Lucretiu M. Popescu21. Perception of volumetric data Geoffrey D. Rubin, Trafton Drew and Lauren H. Williams22. Performance exam using standardized data sets: the PERFORMS® scheme in breast screening and other domains Yan Chen and Alastair Gale23. Breast screen reader exam strategy (BREAST): a research infrastructure with a translational objective Patrick Brennan, Lee Warwick and Kriscia Tapia24. CAD: an image perception perspective Maryellen Giger and Weijie Chen25. Common designs of CAD studies Yulei Jiang26. Evaluation of CAD and radiomic tools Berkman Sahiner and Nicholas Petrick27. Quantitative imaging – images to numbers Daniel C. Sullivan and Edward F. Jackson28. Optimization of 2D and 3D radiographic imaging systems Jeffrey H. Siewerdsen29. Display optimization from a physics perspective Alisa Walz-Flannigan and Scott Stekel30. Display optimisation from a perception perspective Mark Mcentee and Rachel Toomey31. Perception and training William F. Auffermann and Maciej Mazurowski32. Ergonomics 2.0: fatigue in medical imaging Sian Taylor-Phillips, Chris Stinton and Elizabeth Krupinski33. Perception issues in pathology Liron Pananowitz, Claudia Mello-Thoms and Elizabeth A. Krupinski34. Medical image perception from a clinical perspective Francine L. Jacobson35. Future of medical image perception Elizabeth A. Krupinski and Ehsan Samei.

    Look Inside
  • Marketing Excerpt (142 KB)
  • Table of Contents (54 KB)
  • Copyright Information Page (47 KB)
  • Front Matter (120 KB)
  • Index (66 KB)
  • Editors

    Ehsan Samei, Duke University Medical Center, DurhamEhsan Samei is Professor in Radiology, Physics, Biomedical Engineering, Electrical and Computer Engineering, and Medical Physics at Duke University, where he is the Chief of the Clinical Imaging Physics and the Director of the Medical Physics Graduate Program. His current research includes quality and dose metrics that are clinically relevant and that can be used to design and utilize advanced imaging technologies for optimum interpretive and quantitative performance.

    Elizabeth A. Krupinski, Emory University, AtlantaElizabeth Krupinski is a Professor and Vice Chair for Research at Emory University, Atlanta, in the Departments of Radiology, Psychology and Biomedical Informatics. Her research interests include medical image perception, exam of observer performance, and human factors issues.


    Ehsan Samei, Elizabeth Krupinski, Harold Kundel, Calvin Nodine, Arthur Burgess, Robert Wagner, David Manning, Kevib Berbaum, Edmund Franken, Robert Caldwell, Kevin Schartz, Mark Madsen, Calvin F. Nodine, Claudia Mello-Thoms, Jeremy M. Wolfe, Karla K. Evans, Trafton Drew, Justin Solomon, Robert Saunders, Jr, Georgia Tourassi, Stephen L. Hillis, Tamara Miner Haygood, Craig K. Abbey, Miguel P. Eckstein, Matthew A. Kupinski, Lucretiu M. Popescu, Geoffrey D. Rubin, Lauren H. Williams, Yan Chen, Alastair Gale, Patrick Brennan, Lee Warwick, Kriscia Tapia, Maryellen Giger, Weijie Chen, Yulei Jiang, Berkman Sahiner, Nicholas Petrick, Daniel C. Sullivan, Edward F. Jackson, Jeffrey H. Siewerdsen, Alisa Walz-Flannigan, Scott Stekel, Mark Mcentee, Rachel Toomey, William F. Auffermann, Maciej Mazurowski, Sian Taylor-Phillips, Chris Stinton, Liron Pananowitz, Francine L. Jacobson

    Medical Records

    / Health Center

    Medical records contain information regarding your health center interactions. They keep them confidential for your safety. 

    This could include:

  • Phone conversations
  • Office visit records
  • Laboratory/radiology records
  • E-mail correspondences
  • Immunization records
  • Medication log
  • Referral/consult notes from other providers (if requested)
  • Emergency department records
  • Insurance information
  • Medical records are kept in order to mark progress, identify trends or concerns, and serve as a medical history should the student transfer or see a different provider. Medical records are kept for seven years after the student graduates, or seven years after their last encounter with the health center. Medical records are shredded at the end of the seven-year period.


    Medical records are regulated by the State of Michigan and by the Family Education Rights and Privacy Act (FERPA).

    Read more
  • In Michigan, if there is evidence of clear and imminent danger of harm to self and/or others, a health care provider is legally required to report this information to the authorities responsible for ensuring safety.
  • Michigan state law requires that health care personnel who learn of, or strongly suspect, physical or sexual abuse or neglect of any person under 18 years of age must report this information to county child protection services.
  • Michigan state law requires health care personnel to report certain communicable diseases. This information is shared with medical staff at Ottawa County Health Department.
  • A court order, issued by a judge, may require the Hope Health Center staff to release information contained in records and/or require medical staff to testify in a court hearing. Efforts will be made to contact and to obtain permission for the release of this information prior to compliance with the court’s request. If the student is no longer at Hope College, a letter informing the person of the request for the information will be sent to the last known permanent address listed with the college. If the student does not respond to attempts to contact them, then a decision will be made in consultation with both ethical and legal resources.
  • Medical records are classified as “treatment records” under FERPA and as such are excluded from the “educational records” regulation of FERPA. Hope Health Center medical records are kept separate from all other Hope College student records (both treatment records and educational records) and are considered to be the sole possession of the medical director of the Hope Health Center, Mark Stid, M.D. Medical records are kept in a locked and secure place when the health center is closed. Access to medical records is made only to the staff of the Hope Health Center.
  • Hope College Health Center is not a “covered entity” under HIPPA and is not regulated by the HIPPA Privacy Rule. Services are not provided to non-students and thus they are governed by FERPA standards. For this reason, only students who are currently enrolled at Hope College are able to use the services of the Hope Health Center.
  • Accessing or sharing your medical record

    A student may access their Hope College Health Center medical record through the use of their Release of Information form, or produce a letter that includes the same information.

    A release of information is a formal agreement between the student and the Hope Health Center. It includes specific information and allows for disclosure of private health information for specific purposes.

    The following information is needed for a valid Release of Information:

  • Description of the information that may be disclosed
  • Identified individual(s) who may disclose information and who may receive information
  • An expiration date
  • Signature of the student and a witness to the signature (not the person who will be receiving the information)
  • A statement explaining the student’s right to revoke the release and the process for doing so
  • An understanding that the release was not signed under coercion or duress
  • The Hope Health Center does not share information with your parents

    There are several reasons that the Hope Health Center does not share information with parents unless the student has asked for information to be shared:

  • We want students to understand that, as an adult, their medical information is their personal information. They want students to share information truthfully without worries that the information will be shared with a parent.
  • We want students and parents to communicate with each other as adults. This may be a transition for some families, but they believe college is the perfect time to further develop trust and respect for each other. They hope families will discuss their attitudes and personal information and expectations of privacy and develop an understanding of how and why information might be shared.
  • We believe the student is the best person to share information with the parent.
  • We respect the laws of the State of Michigan.

  • Referring medical practitioners

    Radiological imaging is a major and increasing source of radiation exposure worldwide. Computed tomography (CT) is the largest contributor to medical radiation dose patients receive. Typically, CT scans impart doses to organs that are 100 times higher than doses imparted by other lower dose modalities such as chest X-rays. In general, CT examinations may involve doses (typically an average of 8 mSv) which may be equal to the dose received by several hundreds of chest X-rays (about 0.02 mSv/chest X-ray).

    During an IAEA consultation on justification in 2007, it was estimated that up to 50% of examinations may not be necessary. It should be anticipated that part of the increase in global annual mean dose that has been observed recently is due to unjustified radiological procedures. Direct epidemiological data suggest that medical exposure to low doses of radiation even as low as 10-50 mSv might be associated with a small risk of cancer induction in the long term. The fact that a considerable percentage of people may undergo repeated high dose examinations , such as CT (sometimes exceeding 10 mSv per examination) dictates that caution should be used when referring a patient for radiological procedures. Health professionals need to make sure the patient benefits from the procedure and risk is kept minimal. 

    However, ensuring maximum benefit to risk ratio for the patient is not a trivial task. Referring medical practitioners, in a large part of the world, lack training in radiation protection and in risk estimation. 97% of practitioners who participated in a study underestimated the dose the patient would receive from diagnostic procedures. The average mean dose was about 6 times higher  than the physicians had estimated. The fundamental principles of radiation protection in medicine are justification and optimization of radiological protection. Referring medical practitioners have a major role in justification. They are responsible in terms of weighing the benefit versus the risk of a given radiological procedure.

    » What is justification and what is the framework?

    Justification requires that the expected net benefit be positive. According to principles established by the International Commission on Radiological Protection (ICRP) and accepted by major international organizations, the principle of justification applies at three levels in the use of radiation in medicine.

  • At the first level, the use of radiation in medicine is accepted as doing more good than harm to the patient. This level of justification is now taken for granted. According to the revised International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources (BSS), generic justification of a radiological procedure shall be carried out by the health authority in conjunction with appropriate professional bodies, and shall be reviewed from time to time, with account taken of advances in knowledge and technological developments;
  • At the second level, a specified procedure with a specified objective is defined and justified (e.g., a CT examination for patients showing relevant symptoms, or a group of individuals at risk to a condition that can be detected and treated). The aim of the second level of justification is to judge whether the radiological procedure will usually Strengthen the diagnosis or treatment, or will provide necessary information about the exposed individuals. Professional bodies have prepared appropriateness criteria and recommend appropriateness of different radiological procedures in a variety of clinical conditions;
  • At the third level, the application of the procedure to an individual patient should be justified (i.e., the particular application should be judged to do more good than harm to the individual patient). At this level, the responsibility lies jointly with the referring medical practitioner and the radiological practitioner. 
  • » Is the referring medical practitioner responsible for justification of radiological procedures?

    Yes, jointly with the radiological practitioner. As stated above, justification at the third level is the responsibility of the referring medical practitioner, as is the awareness about appropriateness criteria for justification at level 2. According to the BSS, the radiological exposure has to be justified through consultation between the radiological medical practitioner and the referring medical practitioner, as appropriate, or be part of an approved health screening programme.

    Since referring medical practitioners usually have the most complete picture of the patient’s health, they should be responsible for the guidance of the patient in undergoing only necessary procedures and benefitting from them. Particularly, this responsibility weighs more on generalists such as primary care providers. In order to facilitate justification in the case of radiological procedures, it is desirable that referring medical practitioners are knowledgeable about radiation effects in regard to the various dose ranges. The referring medical practitioners are responsible for keeping their knowledge about radiation up to date. In support of this, they should be provided education in radiation protection during their medical studies.

    » How should justification be practiced and what knowledge is required for proper justification of a radiological procedure?

    According to the BSS, the justification of medical exposure for an individual patient shall be carried out through consultation between the radiological medical practitioner and the referring medical practitioner, as appropriate, with account taken, in particular for patients who are pregnant or breast-feeding or paediatric, of:

  • The appropriateness of the request; 
  • The urgency of the procedure; 
  • The characteristics of the medical exposure; 
  • The characteristics of the individual patient; 
  • Relevant information from the patient’s previous radiological procedures. 
  • Justification should be patient specific. The referring medical practitioner should take into account all clinical aspects regarding the management of every patient separately. Other possible procedures with lower or no exposure, such as ultrasound or magnetic resonance imaging, should be considered, if and when appropriate, before proceeding to radiological procedures.

    » Is the acquisition of patients’ consent important?

    According to the BSS, in order for a symptomatic or asymptomatic patient to undergo a medical procedure that involves ionizing radiation, the patient or the patient’s legally authorized representative should be informed in a timely and clear fashion, of the expected diagnostic or therapeutic benefits of the radiological procedure as well as the radiation risks. Thus, the emphasis is on provision of information.

    » When is an investigation useful and what are the reasons that cause unnecessary use of radiation?

    According to the guidelines published by the Royal College of Radiologists (RCR),  a useful investigation is one in which the result, either positive or negative, will alter a patient’s management or add confidence to the clinician’s diagnosis. According to the RCR guidelines, there are some reasons that lead to wasteful use of radiation. With emphasis on avoiding unjustified irradiation of patients, the RCR report has provided a check list for physicians referring patients for diagnostic radiological procedures:

  • HAS IT BEEN DONE ALREADY? It is important to avoid repeating investigations which have already been performed relatively recently. Sometimes it is not possible to accurately track the procedures history of patients. Furthermore, patients may not be able to inform the practitioner that they had a similar procedure recently. It is important to attempt retrieving previous patient procedures and reports, or at least procedure history when possible. Digital data stored in electronic databases may help in that direction; 
  • To help in avoiding repeating investigations, it is necessary to establish a tracking system for radiological examinations and patient dose. The IAEA has taken steps towards that direction by setting up the “IAEA Smart-Card” project;
  • DO I NEED IT? Performing investigations that are unlikely to produce useful results should be avoided, i.e. request procedures only if they will change patients’ management. It is important for the practitioner to be sure that the finding that the investigation yields is relevant to the case under study;
  • DO I NEED IT NOW? Investigating too quickly should be avoided. The referring medical practitioner should allow enough time to pass so that the disorder or impact of management of the disorder may be sufficiently evident; 
  • IS THIS THE BEST EXAMINATION? Doing the examination without taking into consideration the optimal contributions of safety, resource utilization and diagnostic outcome should be prevented. Discussion with an imaging specialist may help referring medical practitioners decide on proper modality and technique; 
  • HAVE I EXPLAINED THE PROBLEM? Failure to provide appropriate clinical information and address questions that the imaging investigation should answer should be avoided. Deficiencies here may lead to the wrong technique being used (e.g. the omission of an essential view); 
  • ARE TOO MANY INVESTIGATIONS BEING PERFORMED? Over-investigating. Some clinicians tend to rely on investigations more than others. Some patients take comfort in being investigated. 
  • » What are the reasons for over-investigating?

    There are various reasons that may lead medical practitioners to refer patients for more procedures than needed. Practitioners should be aware of that and take action to avoid such situations. Some of the reasons that lead to over-investigation are the following:

  • Patient wishes. Patients feel more reassured when they are sure that their practitioner has thoroughly investigated their health condition. Some of them connect the quality of care with the number of procedures they undergo and ask their practitioner to subject them to more procedures. There must be a careful balance between informing patients of risks and benefits and the importance of considering patient desires and needs in the decision making process;
  • Financial. Some organizations or doctors get a direct financial benefit related to conflict of interest (also known as self-referral) from subjecting the patients to various procedures mainly because the services in question are provided by these health care professionals. Such practices are unethical and should not be accepted. Financial reasons may also influence a referring medical practitioner’s equity and also equal access to health services; 
  • Defensive medicine. Some professionals rely far more heavily on investigations including radiological procedures than others, possibly to avoid litigation. In the case of radiological procedures, the risk should also be taken into account and exposure limited to the minimum required for a correct diagnosis;
  • Role of media. The opinion of the public on a subject is shaped by many parameters in a society. Media is one of them. For instance, exaggerated publicity in reporting a medical mistake may lead to increased public sensitivity about the subject. Publicity and increased sensitivity are good things and should be encouraged, but when reporting is not scientific but emotion-driven for audience reasons, as is often the case in mainstream media; this may lead to practitioners practicing defensive medicine and patients refusing indicated procedures; both of these scenarios undermine the appropriate practice of medicine; 
  • Role of industry. The medical industry comprises large corporations that compete with each other for market-share. However, one large problem is that time is needed for new or improved technology, and this must be understood and assessed by the scientific community with regard to the cost-benefit ratio. Studies have to be done and sometimes results take time to come. This creates a window of time when misuse of equipment due to knowledge deficiency is possible;
  • Convenience. Sometimes a practitioner may subject a patient to a procedure that the patient has already undergone when imaging films or discs are unavailable, in order to save personal time, instead of checking the patient’s record. This is not relevant with the specific patient’s well-being, and similar convenience driven prescriptions should be avoided. Such practices are also unethical. 
  • » Is there any guidance available?

    During the last 20 years international and national organizations published guidelines for proper justification of radiological procedures. The UK Royal College of Radiologists (RCR) publication "Making the best use of clinical radiology services " has been in print since 1989. The American College of Radiology (ACR) published its guidelines as Appropriateness Criteria. Similar efforts have been undertaken by the Department of Health of Western Australia in Diagnostic Imaging Pathways. 

    For references of publications from national societies in Europe, Oceania, and other regions please see publication from Remedios. These publications constitute guidelines and aim to guide referring medical practitioners in the selection of the optimum procedure for a certain clinical problem. In case there are alternative procedures that do not utilize radiation but yield results of similar clinical value, these guidelines encourage the avoidance of radiological procedures.The cited publications give very specific guidance to help practitioners perform justification properly. 

    » What is the role of radiation protection experts?

    A medical physicist with experience and expertise in radiation protection will be able to provide information and guidance on radiation doses and risks in radiological procedures. In case you do not have an access to the help of radiation protection experts, referring medical practitioners may address their questions to their colleagues who work in radiology departments. However, staff specialized in radiation protection is more likely to provide complete, responsible and up-to-date information for the specific clinical problem. Radiation protection experts are comfortable with dose measurements and quantities which come from the domain of natural sciences and are usually hard to conceive for people outside the field. 

    » Which procedures are responsible for the highest doses to the patient?

    The referring medical practitioner should be aware about procedures which impart high radiation dose to patients in order to be more cautious in such cases. This does not mean that other procedures should be written without proper justification. A quantitative knowledge of doses of various procedures is useful for the referring medical practitioner. Data given below will help the practitioner in that direction. In diagnostic radiological procedures, dose depends on the modality used. Computed tomography (CT) exposes patients to relatively high doses in comparison to other diagnostic imaging modalities.

    Interventional diagnostic and therapeutic procedures that utilize fluoroscopy may also be a source of high radiation doses. Such procedures carry the risk of causing erythema  to patients that receive high dose in single or repeated procedures. Some nuclear medicine procedures are also responsible for high radiation doses to patients.

    » What if the patient whom I refer for a radiological procedure is pregnant?

    The responsibility to identify patients that might be pregnant and are unaware of it is shared by the patient, referring medical practitioner and the imaging service providers. Safeguards to avoid inadvertent exposures of the foetus should be observed at all times. The “ten day rule” was postulated by ICRP for women of reproductive age. The more recent “28-day rule” allows radiological procedures throughout the complete menstrual cycle unless there is a missed period. When a woman has a missed period, she is considered pregnant unless proven otherwise. 

    Even if safeguards are observed, sometimes a pregnant patient may be exposed to radiation. Depending on the radiation dose and the gestation age of the foetus, radiation effects may differ. Radiation risks are most significant during organogenesis in the early foetal period, somewhat less in the second trimester, and least in the third trimester. 

    As a rule of thumb one can assume that properly carried out diagnostic radiological  procedures to any part of the body other than the pelvic region or when the primary X-ray beam is not passing through the foetus can be performed throughout pregnancy without significant foetal risk, if clinically necessary and justified. For radiological procedures where the primary beam intercepts the foetus, advice from the medical physicist should be obtained, who will calculate radiation dose to the foetus and, based on that, the practitioner and patient should make a decision. However, doses associated with radiotherapy procedures and interventional procedures are high and they require the attention of experts (including medical or health physicists, practitioners, and sometimes engineers and epidemiologists). In the case when a practitioner is responsible for a patient who has undergone a radiological procedure inadvertently and has subsequently been found to be pregnant, advice from the individuals listed above is needed. For more information, please click here where comprehensive information is provided not only for diagnostic radiology but also for nuclear medicine and radiotherapy.

    » Should pregnant patients undergo radiological procedures?

    Sometimes it is imperative that pregnant women should undergo radiological procedures. The referring medical practitioner and the imaging provider have to be mindful of risk and benefit and decide whether a radiological procedure should be asked for or if the medical problem may be solved by other non-radiological procedures. Generally, it is preferable that non-radiological procedures, or at least those that do not provide exposure to ionizing radiation, are used whenever possible. However, the use of radiological procedures is not prohibited and, when properly justified, they may be optimized so that these procedures may help to achieve the desired result for the patient while keeping dose to the foetus at low levels. The patient should be made aware about the possible impact of radiation exposure to the foetus. The need for consent must be determined based on individual practice standards, guided by more global professional or regulatory/legislative requirements.

    » Can radiological procedures cause acute radiation injury?

    Acute injuries such as skin erythema, blistering and hair loss have been recognized as a rare side effect of procedures guided by fluoroscopy. Similar injuries have been long recognized in radiation oncology, which uses much higher doses of radiation than diagnostic imaging. While radiation therapy is administered in fractions and the radiation-inflicted cells may recover in between sessions, fluoroscopy usually imparts a high dose to the skin in a short amount of time and with no dose fractionation. Referring medical practitioners could miss recognizing acute radiation injury resulting from interventional procedures. Such injuries may appear weeks after the interventional procedure and patients may not think of the procedure as being the cause unless they have been instructed accordingly by the interventional facility. Practitioners have often tended to attribute injury to many other causes, including insect bite and allergic reactions, but not to radiation exposure. Awareness about radiation through fluoroscopy being a possible cause can avoid mis-diagnosis and patient suffering. 

    Read more:

  • Report of a consultation on justification of patient exposures in medical imaging. Rad. Prot. Dosimetry 135 (2009) 137–144. 
  • Brenner, J.D., Doll, R., Goodhead, D.T., Hall, E.J., et al., Cancer risks attributable to low doses of ionizing radiation: Assessing what they really know. P Natl Acad Sci USA 100 (24) (2003) 13761-13766. 
  • Mettler, F.A., Huda, W., Yoshizumi, T.T., Mahadevappa, M., Effective doses in radiology and diagnostic nuclear medicine: A catalog. Radiology 248 (2008) 254-263. 
  • Shiralkar, S., Rennie, A., Snow, M., Galland, R.B., Lewis, M.H., Gower-Thomas, K., Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 327 (2003) 371–372. 
  • INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION, 2007. Recommendations of the ICRP, Publication 103, Pergamon Press, Oxford (2007). 
  • INTERNATIONAL ATOMIC ENERGY AGENCY. International Basic Safety Standards for protecting people and the environment. Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards. General Safety Requirements Part 3. No. GSR Part3 (Interim), IAEA, Vienna (2011). 
  • Royal College of Radiologists. Making the best use of clinical radiology services. Referral guidelines. Sixth edition, London 2007. 
  • Remedios, D., Justification: how to get referring physicians involved. Rad. Prot. Dosimetry (2011) Epub ahead of print, accessed 21 July 2011. 


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