CI.F.2019 Produce images using fluoroscopy

Overview

This standard is concerned with the examination of anatomical structures using fluoroscopy. This will be undertaken as part of a diagnostic and/or treatment process. The outcomes will be of sufficient quality to assist diagnosis and or treatment. This standard should be undertaken within the scope of your own role. Key people are those involved in the individual's care and others involved in provision of services. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 2

Knowledge and Understanding

You will need to know and understand:

legal, organisational and policy requirements relevant to your role, the role of others in your organisation and the activities being carried out
the relevant national and local standards, guidelines, policies and procedures that are available and how and when they should be accessed
the importance of respecting individuals' culture, privacy, dignity, wishes, beliefs and decisions
the limitations of your own knowledge and experience and the importance of operating within your scope of practice
the roles and responsibilities of other team members
the importance of obtaining valid consent in line with national and local guidelines
clinical appropriateness of the examination request and the action to take when the request is not appropriate
gross anatomy of the area being examined
physiological and pathological processes relevant to the area being examined
the medical terminology relevant to the examination including abbreviations
when standard and additional views are required to aid diagnosis and to enhance the examination
the range and safe use of contrast media and medicines in fluoroscopic examinations
the behaviour of contrast media and medicines and how this may affect images obtained and their interpretation
the clinical conditions appropriate for fluoroscopic examination
the clinical implications of any allergies relevant to the examination
the recognition of the variations of normal anatomy demonstrable by fluoroscopy and contrast media within your scope of practice
the recognition of abnormal anatomy demonstrable by fluoroscopy and x-ray contrast media and the significance of such abnormality within your scope of practice
manifestations of individuals' physical and emotional status
production, interactions and properties of x-rays
the harmful effects of radiation to the human body and use of radiation protection equipment
ways in which images can be captured, processed and permanently stored
how to adapt communication styles, ask questions, and listen carefully in ways which are appropriate for the needs of the individual
methods of communicating difficult and complex information to individuals and key people
the importance of providing individuals and key people with opportunities to ask questions and increase their understanding
the information that should be given to individuals before, during and on completion of the examination
the inter-relationship between Kilo Volt Peak (kVp) and Milliamperage (mA) and Time (seconds)
variables affecting exposure factors and how to manipulate exposure factors for the examination and the individual as appropriate
the technical and diagnostic quality requirements of the image
recognition of artefacts and their impact
factors which influence the decision to repeat images
equipment capabilities, limitations and routine maintenance including the quality control processes required by the operator
image manipulation and post processing
the importance of timely equipment fault recognition and local procedures for reporting these
contra-indicators to the procedure
the preparation of the individual, equipment and environment for fluoroscopic examinations
orientation and appropriate use of anatomical legends and electronic annotation
the range of techniques that may be used to optimise image quality and dose for the individual, including selection and provision of suitable projections, appropriate use of collimation and strategies to reduce dose to individuals and staff
the role of other imaging modalities and diagnostic investigations
relevant emergency procedures and the types and use of emergency equipment available
procedures relating to recording, collating and preparing appropriate information, documentation and images for transfer or storage according to local protocols
how to keep full, accurate and clear records in line with organisational procedures

Performance Criteria

You must be able to do the following:

apply standard precautions for infection control and other appropriate health and safety measures
ensure all necessary preparations have been made by the individual and staff before starting the procedure
check and prepare the equipment required for the examination
ensure the environment is conducive to maintaining the privacy and dignity of the individual
check the identification details before commencing the procedure in accordance with local policies and procedures
communicate with the individual / key people to facilitate their understanding of and co-operation with the examination
establish the individual's capacity to understand the procedure with the help of key people if necessary
obtain valid consent for the procedure in accordance with national and local guidelines
respect the individual's privacy, dignity, beliefs and decisions
clearly explain the procedure and possible outcomes, including risk, benefits and limitations
check individuals of child-bearing potential for pregnancy or possible pregnancy, if appropriate to the examination, and take action in accordance with local protocols
confirm the status of key people before the examination and, where their presence is required, adhering to local guidelines
examine previous relevant images and clinical information, where available, to ensure that the correct procedure and techniques are employed
assess the individual's clinical and physical condition prior to the start of the examination with a view to proceeding
give the individual clear information on the possible after effects of the use of contrast media and medicines
position the individual and adjust their clothing according to the protocols for the examination to be performed in a manner which allows an optimal outcome to be achieved while:

recognising the individual's need to retain their dignity and self respect
ensuring his/her comfort as far as possible
preventing the appearance of artefacts

position the imaging equipment appropriate to the examination technique with anatomical legends or electronic annotation correctly placed
apply, check and adjust appropriate exposure factors, collimation and radiation protection devices to minimise exposure to the individual whilst optimising diagnostic image quality
ensure the details of the individual are accurately recorded in the fluoroscopic equipment or if previously entered, check for accuracy
check the room prior to making the exposure to ensure that only essential, protected persons remain with the individual and that all local protocols have been adhered to
administer appropriate contrast media and medicines in accordance with the local protocols for the examination
seek confirmation that the individual is ready before the exposure is made and maintain communication with the individual/key people to facilitate their understanding and ensure their co-operation throughout the examination
observe the individual's condition and well-being at all times and take appropriate action
ensure that all dose reduction/protection processes have been employed
adjust the equipment to optimise the images for the purpose of the examination
monitor and accurately record the individual's exposure to ionising radiation throughout the procedure according to local protocols and local rules
capture permanent images where required and according to local guidelines for the examination
recognise where equipment malfunctions during the procedure and take appropriate action
check the identification of the images against associated documents
examine the images to ensure that the anatomical coverage is consistent with the examination request, the clinical information provided and local protocols
ensure the images are:

correctly labelled with the individual's orientation and identification details
are processed and inspected for satisfactory technical and diagnostic quality according to local guidelines and criteria

make a decision with the regard to the need to repeat any images or to take additional images to enhance the examination
following the preliminary imaging examination, inform to the appropriate person if an abnormality is observed on the image which is likely to require further investigation or treatment, following departmental protocols
provide the individual with information relating to the procedure and aftercare where necessary
explain the process for obtaining results
record, collate and prepare appropriate information, documentation and images for transfer or storage according to local protocols
verify that the images have arrived/been stored according to local protocols
recognise where help or advice is required and obtain this from appropriate sources

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB6 Assessment and treatment planning