Radiology - Medical Radiation Technologist - Case Study Assessment Answer

Radiology Assignment

Assignment Task

Case Scenario:

You are on duty at 9pm as a medical radiation technologist (MRT) in the department and your partner who is an emergency department registrar and who is coincidently also on duty that day.

You are working with Dr. B an intern in the department. He is helping you to review images to develop your recognition skills. She is called by the triage nurse to attend to Ms. Z who has presented with a 6 months’ low back pain.

The 80-year-old female who presents to the department of radiology with mechanical low back pain left L3 radiculopathy and neurogenic claudication. Ms. Z presented with a 6 months’ history of progressively worsening left leg pain. she complains of left buttock pain that radiates through his thighs and calves. Pain is exacerbated by standing and ambulation. she is hard to walk for more than 20 minutes or 2 to 3 blocks due to pain. She considers lower extremity pain to significantly affect her quality of life and has recently experienced weight gain due to inability to remain active. Before she gets retired she was working in the transport industry and sitting 8 hours a day in the chair and did not have an active life. her husband was died as kidney cancer 8 years ago. She lives alone and sometimes feeling lonely and get depressed. Her son lives in another city because of his work and he sometimes visit her. She has a personal care assistant who can cook, clean the house and take her to an appointment.

Prior Treatment Previously, Ms. Z has tried basic non-operative treatments (mainly physical therapy), chiropractic treatment, massage, and epidural steroid injections (ESIs). but she has not found relief.

Examination Ms. Z gives a note from physical therapy to Dr. B which asked a doctor a series of lumbar spine x-ray plus flexion and extension projection for a checkup of her progression. Dr. B says that The physical exam reveals that she is neurovascular intact. Dr. B orders a series of lumbar spine x-ray plus flexion and extension projection.

You take the patient into the x-ray room and positioned her correctly and prepare her for an x-ray. When it is completed you make sure she is taken back to the waiting room by her personal assistant and archive the images, check them for quality and then send them on for review and reporting.

Her x-ray Images

2 days later Ms. Z comes back to the department for her report result. The Dr. B explained that the report, the examination we conducted it looks like you have degenerative lumbar scoliosis with spinal stenosis.

There are some other things to think about, ‘says Dr. B.’ I have sent a note to the neurology and orthopedic department registrar for an appointment for you. You need a specialist consultation. They will call you as soon as your name come on the waiting list. Can you give me a contact number?

Ms. Z personal assistant gives her mobile number.

Task:

This individual PBL case study extension activity is designed to allow you demonstrate an advanced knowledge and integration of the processes that contribute to the medical imaging case management of a chosen PBL Case scenario.

This assessment task is an introductory level case study report, which is to be based on your individual analysis, and interpretation, of One of the PBL case study scenario’s. This is to be selected from any of the first four cases that we will complete.

* Note: Title page, section headings, and references that are used in-text, or as a bibliography, do not count toward the 2,000 words!

Remember: Concise & clear writing that covers what is expected in the rubric below is what is required to get marks, so spend your time on this, rather than writing things we have not asked for!

Drawing on the experience and content themes that you have assimilated from PBL case discussions in your PBL Group – Develop an individual Case profile, and integrated review of the case from your own individual perspective, using the following response rubric (next page) as a framework for structuring, and completing, your report:

RADIOLOGY

Introduction

The patient in this case report, Ms. Z, is an 80 year-old female experiencing mechanical low back pain, left L3 radiculopathy, and neurogenic claudication. Her medical history shows 6 months of a progressively worsening left leg pain. In addition, the patient complains of pain in the left buttock, that radiates through her thighs and calves, and standing as well as ambulation exacerbates this pain. The patient can hardly walk a distance of 2 to 3 blocks or for more than 20 minutes due to the pain. The inability to remain active has caused the patient to experience weight gain, and she considers that her general quality of life is significantly being affected by lower extremity pain. Ms. Z’s prior treatment shows that she previously been treated with basic non-operative treatments, massage, chiropractic treatment, and epidural steroids injection but non of these treatments has found her relief. Her current physical examination shows that she is neurovascular intact and the x-rays shows that she has degenerative lumbar scoliosis with spinal stenosis. I chose this particular case study of degenerative lumbar scoliosis with spinal stenosis since it is a common health problem that affects most individuals and requires the expertise of radiology in order to diagnose. Radiology is central to the clinical practice of medicine across a wide range of disciplines, and the primary theme of this case involves the use of x-rays, a common imaging test that has been employed for decades to help and is specifically relevant in my own medical imaging practice.

Professionalism, patient care and ethics

The patient in this case study is an elderly patient that is experiencing a lot of pain from degenerative lumbar scoliosis with spinal stenosis. In addition, the patient is affected psychologically since her mind is set to the fact that her quality of life is deteriorating with her inability to remain physically active for a longer time. Since the patient is suffering both physically and psychologically, it is important for a Medical Imaging Technologist (MIT), to have both the professional as well as care focused skills essential for them to demonstrate both patient to practitioner and practitioner to practitioner interactions.

There are several essential skills that a competent MIT must possess in order to interactive with both patients and fellow practitioners in a productive manner in this scenario. One essential skill is communication. As an MIT in this case, in order to communicate efficiently, it is important to respect the patient suffering from degenerative lumbar scoliosis with spinal stenosis, as well as other practitioners attending to the needs of this patient. Interpret information, utilize appropriate communication, demonstrate appropriate staff interactions as well as interactions with others during the diagnosis and treatment process of this patient. (Queen & Bagwell, 2013). An MIT working with a degenerative lumbar scoliosis with spinal stenosis patient should also be able to apply professional standards by using protocols, policies and procedures, applying the codes and ethics of the Board, and also applying regulations and guidelines. In this case, the MIT is also expected to be able to provide the patient with holistic care. This is by assessing and providing for the patient’s physical and psychological needs, demonstrating basic patient care skills, and ensuring patient care. In addition, an MIT in a case of degenerative lumbar scoliosis with spinal stenosis should be able to operate equipment, since the efficient use of equipment is a fundamental aspect in the practice of radiology. More importantly, an MIT in this case is expected to be able to produce a diagnostic image by selecting the appropriate equipment, appropriate technique, be able to acquire image, process and evaluate image.

Since an MIT is considered a significant member of the diagnostic health care team due to their responsibility for producing high quality images and assisting in the diagnosis made by doctors on a patient’s injury or illness, it is important for an MIT attending to a degenerative lumbar scoliosis with spinal stenosis case to possess these important skills. In this case the patient is suffering both psychologically and physically. It is, therefore, very important for the MIT to demonstrate care, compassion, and empathy. Despite their role being highly technical, it is significant they focus their efforts on the care and welfare of the degenerative lumbar scoliosis with spinal stenosis patient to ensure positive patient experiences. Moreover, in this case involving a patient with degenerative lumbar scoliosis with spinal stenosis, they require an extremely thorough comprehension of the human anatomy and how injury can be affected by the body as well as the causes and effects of disease when taking x-ray images.

Pathology and pathophysiology processes

Acute and chronic lower back pain causes a major health care challenge globally. Elderly patients present with more recurrent or chronic symptoms of degenerative spinal disease. Degenerative scoliosis which can also be referred to as adult scoliosis is a side to side curvature of the spine as a result of the degeneration of the facet joints. It is a condition that more often occurs in individuals over the age of 65 years. The scoliosis curve which is located in the lumbar spine typically forms a ‘C’ shape. As mentioned, a gradual deterioration of the facet joints causes degenerative scoliosis (Pritchett & Bortel, 2003). Although this is a similar process to that that causes osteoarthritis, in degenerative scoliosis, the pressure of these deteriorating facet joints results to a straight spine as viewed from the back, to start to shift in order for the spine to curve to one side. With degenerative scoliosis, the patient may experience stiffness and pain in the mid to lower back or numbness, pain, and weakness in the legs and feet. When the patient is experiencing severe pain, the physician is expected to determine whether the degenerative scoliosis itself is the source of the pain or whether or not other conditions may be the source of the pain, and the scoliosis is incidental (Pritchett & Bortel, 2003).

The boundary between the nucleus during growth and skeletal maturation becomes less obvious, and with increase in age the nucleus practically becomes more fibrotic and less gel-like. Increase in age and degeneration leads to morphological changes of the disc, as it becomes increasingly disorganised. Often, there is a cleft formation with fissures forming within the disc, especially in the nucleus. Cell proliferation takes place leading to formation of clusters especially in the nucleus. This is followed by cell death with the presence of cells with apoptotic and necrotic appearance.

This condition is common and is estimated to occur in 6 to 68% of the elderly population depending on how scoliosis is defined. Since spinal curvature is measured in degrees, some physicians consider a person with spinal curvature of just 10 % which is invisible to the untrained eye to have degenerative scoliosis. Pin primarily originates from the deterioration of the facet joints, which when healthy, are similar to hinges that assist the spine to bend smoothly. In some individuals, the cartilage that protects the joints is naturally eroded by aging. This process of erosion can result to the joints becoming irritated and inflamed by the bone of the vertebrae. This inflammation does not result to the curvature of the spine but the pain of the patient. Degenerative scoliosis has typical symptoms includes pain coming on gradually. The pain that results from degenerative scoliosis does not occur suddenly but worsen gradually over time, as it is linked with activity. This pain tends to worsen the first thing in the morning and tends to improve when the individual gets up and around for a while (Pritchett & Bortel, 2003). Later in the day, the pain worsens. With degenerative scoliosis, sitting feels better than walking or standing, since the facet joints generate majority of the pain and facet joints experience more pressure in the standing position, while sitting offloads the stress and weight off the joints. Another symptom is pain in one or both legs while walking or standing. Irritated facet joints become enlarged and as a result constrict the lumbar spinal canal in a condition referred to as lumbar stenosis. When walking or standing, this is even a narrower position causing blood enlargement around the nerve root. The nerve root that leaves the lower spine serves the leg and as a result the individual may experience leg pain. Sitting opens up the space and relieves the pain by allowing blood to flow out (Pritchett & Bortel, 2003).

Imaging

The type of imaging applied in this case is the use of x-rays. X-rays refer to a kind of radiation called electromagnetic waves. X-ray imaging develops pictures of the internal anatomy of an individual’s body by showing parts of the body in distinct shades of black and white. This is so because different body tissues absorb different amounts of radiation. X-ray is absorbed the most by calcium in the bones, so bones appear white. Less x-ray is absorbed by fats and other soft tissues and appear grey. The lungs appear black since air absorbs the least amount of x-ray. X-ray is at most of the time used for checking broken or curved bones, but can also be used in other ways such as spotting pneumonia. This imaging technique is usually carried out in x-ray departments in hospitals by trained specialists referred to as radiographers or MITs, although they can be also performed by various healthcare professionals such as dentists (Mower, Hoffman, Pollack, & Browne, 2001).

There is nothing special that needs to be done before performing an x-ray. However, when undergoing an x-ray that uses a contrast agent, one may be required to avoid taking such medications and avoid drinking or eating for a few hours. In addition, pregnant women are not usually recommended for an x-ray unless it is an emergency, and therefore, a patient is obligated to let the hospital know if they are pregnant. Moreover, it is advisable to wear loose and comfortable clothes as they can be worn during an x-ray, and one should try to avoid clothes that contain metals such as zips.

The use of x-ray played a significant role in this case involving a patient with degenerative lumbar scoliosis with spinal stenosis since it produced images that were critical in the diagnosis of the patient’s problem and, therefore, laying the foundation for the relevant interventions and therapy necessary for the patient’s treatment. This is because the use of x-rays will reveal the patient’s degree of spinal curvature and the spines overall alignment.

The use of x-rays has a number of benefits and limitations. In terms of benefits, x-rays are fast as the results are available during the same day and even within an hour in some simpler cases. They are painless and invasive. They require no special preparation and time of recovery is also not required. However, in cases where the mother is pregnant, x-rays can harm the unborn baby. In addition, ionizing radiation can result to cell damage, and being exposed to large amounts of radiation from x-rays may increase the chances of an individual developing cancer a decade or more in the future (Smith, 2013).

Future directions

In future, the patient might require a magnetic resonance imaging (MRI). This is a test that employs the use of magnetic field and pulses of radio wave length to make pictures of organs and structures inside the body. In most cases, MRI offers more and different information about the body’s structures that can be seen with an x-ray, computed tomography scan, or an ultrasound. The patients pain is expected to increase in future since this pain caused by degenerative scoliosis increases with aging. With patients experiencing minimal pain, MRI is rarely used. But since pain is expected to increase in future in this case, an MRI can be ordered since this imaging technique is usually applied when a patient experiences leg pain, their physician finds some subtle neurologic abnormalities, or if they experience significant pain or an atypical curve pattern (Green, Lawhorne, & Kepler, 2011). By using magnetic resonance for this patient with degenerative lumbar scoliosis with spinal stenosis in future to view the images of their spine, information about the discs of the spine, the spinal cord, as well as spinal nerves will be revealed. A large part of the human body is comprised with water molecules which consist of oxygen and hydrogen. At the centre of each hydrogen atom, there is a proton, and protons are minute magnets that are very sensitive to magnetic fields. The protons in the body align in the same direction when one is under a scanner in the same way the needle of a compass can be pulled by a magnet. When short bursts of radio waves are sent to certain areas of the body, the protons are knocked out of alignment. The protons realign when radio waves are turned off. This sends signals which the receivers pick out. These signals provide data on the exact location of protons in the body which assist in distinguishing the various types of tissues in the body since the protons in diverse types of tissues realign at different speeds and give out distinct signals (Green, Lawhorne, & Kepler, 2011).