The Value of Patient History in Medical Imaging

Glen Stancil M.Ed., RT(R)(CT)(ARRT) Director of Service GE Healthcare IT

LEGAL DISCLAIMER
The opinions expressed in this continuing medical education activities are those of the author and do not represent those of AboutImaging.com or its affiliates and subsidiaries. The information provided is for general education purposes only. The information is not warranted to be inclusive of all approaches to a medical issue or exclusive of other methods for obtaining the same result. The material is not meant to substitute for the independent professional judgment of a physician or other health care professional relative to diagnostic and treatment options for a specific patient's medical condition. The author does not warrant the completeness, accuracy, or usefulness of any opinions, options, advice, services, or other information provided through this educational activity. In no event will AboutImaging.com or its affiliates and subsidiaries be liable for any decision made or action taken in reliance upon the information provided through this activity. The participant acknowledges that case studies may be modified or changed from the actual case to protect the identity of patients.

Case Study: Joe

Age: 37 Years Gender: Male Chief Complaint: Right Flank Pain Scheduled Exam: CT Abdomen / Pelvis Provided History: R/O Renal Stone Exam was scheduled on the same day as Outpatient

Technologist History: None Additional Exam Performed: CT Abdomen / Pelvis W/O Only

Case Study: Joe

Radiologist Interpretation: No evidence of hydronephrosis No renal calculi identified in the renal pelvis or ureters Heavy stool in colon No abnormalities detected

Treatment: Antibiotics to treat Kidney Infection while awaiting C&S from Urinalysis Pain Meds
Patient outcome: Emergency surgery 4 hours later Initial hospital stay of 8 days Several follow up visits to hospital required

What Happened?
Can the primary blame for case mismanagement be placed on the technologist?
Was there anything that the technologist could do to prevent this situation?

Objectives
At the end of this lesson, the student will be able to:
Discuss the benefits and risks of providing patient history to the radiologist Describe the elements of a complete patient history

Why Obtain Patient History?

ASRT (2003) Code of Ethics states that Patient Diagnosis is outside the scope of practice
However, it further states:

The radiologic technologist acts as an agent through observation and communication to obtain pertinent information for the physician

Arguments For Obtaining Patient History

Technologists are physician extenders and often the only person to see the patient in the medical imaging setting Referring physician provided history may be incomplete or inaccurate May assist the radiologist in providing differential diagnoses to referring physician Critical for high risk exams, such as biopsies and MRI

Arguments Against Obtaining Patient History

Knowing patient history may skew the radiologists interpretation Technologists are not trained to examine patients and therefore it is out of scope for the profession Technologists dont have time to elicit a full patient history from all patients

Systematic Approach to Patient History

Radiologists must be SOLD on your patients medical history
Subjective History Objective History Laboratory Tests Deviations from Norm

Subjective History
What history is the patient providing that is unobserved by the technologist?
Last menstrual period Mechanism of injury Progression of symptoms What makes the pain worse (or better)? Personal medical history Family medical history

Objective History
What history can be gained from direct observation by the technologist
Cuts / Bleeding Discoloration Deformity Physical exam techniques
Palpation Range of Motion

Laboratory Tests
What pertinent lab tests were performed and what were the results?
Complete Blood Count Hemoglobin / Hematocrit BUN / Creatinine Urinalysis HCG D-Dimer Thyroid Panel (mainly NM and US) Pathology Results

Deviations from Norm

What is different from this exam compared with routine exam?
Patient Motion Unusual Positioning or Projections Patient Refusal to Continue Technical Issues

Case Study Follow-Up: Joe

Subjective: Pain started slowly 2 days ago Very dull when at referring physician mostly in the right flank Now sharp and in the Right Lower Quadrant (RLQ) of abdomen

Objective: RLQ Guarding Vomiting

Laboratory Tests: UA Clear / No RBCs present; Elevated WBC Deviations From Norm: None

Joes Diagnosis
APPENDICITIS
Without contrast, appendix was not visualized due to heavy stool Joes appendix ruptured due to delay in treatment Subsequent abscesses required several draining procedures

Review
Technologist has the duty to report all pertinent information to the physician Radiologist may review history before or after their initial interpretation due to their personal philosophy Radiologist must be SOLD on the patients history

Systematic Approach to Patient History

Radiologists must be SOLD on your patients medical history
Subjective History Objective History Laboratory Tests Deviations from Norm

References
American Society of Radiologic Technologists. (2003). Code of ethics. Retrieved from: https://www.asrt.org/media/pdf/rt/codeofethics.pdf