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Assessment

One of the first tasks a computed tomography (CT) technologist encounters is patient assessment. From the moment a CT technologist meets the patient, they should be visually assessing the patient's current state (e.g. skin coloration, respiratory rate, dilation of the eyes, and overall health) and watching for any changes while the patient is in their care. This monitoring often incorporates both visual and verbal assessment. Aspects of assessment include obtaining a medical history and consent, monitoring vital signs, transferring patients, documenting, and communicating with other members of the healthcare team.

Obtaining Medical History and Consent

• The technologist must have good communication skills to obtain a thorough medical history and consent from patients.
• Communication with patients should be professional, respectful, attentive, and focused.
• Interactive communication allows the patient to feel safe, valued, and involved in their care.
• The technologist should aim to personalize care to the specific needs of the patient.
• Effective communication enables technologists to work efficiently while fostering a safer, more trusting environment that reduces risks and enhances patient's perception of care.1-3

Verification

• When obtaining a medical history, it is imperative to verify the patient's identity before starting the exam. Identify the patient using two forms of unique information:
  • Name
  • Date of Birth (DOB)
• Review the physician's order and ensure it aligns with the patient's medical history.
• Obtain verbal or written consent depending on the invasiveness of the exam (consent).

Medical History

Providing the interpreting radiologist with a detailed medical history offers essential context for the patient's images, aiding accurate image interpretation.

• Use focused questions to help the patient provide relevant information.
• Review previous imaging in the area, if available. Matching previous protocols for reoccurring issues allows for reproducibility and easier comparison between previous and current images.
• Prior surgeries should be noted in patient history and communicated to the radiologist.
• Ask about any history of primary cancer or metastatic disease.
• If contrast is to be administered, verify the patient does not have any contraindications for contrast media (Chapter 2).

Consent: Informed Consent

Studies have a well-established link between effective communication and reducing medical malpractice claims.3,4 Patients feel more satisfied with their care when they are fully informed. Effective communication helps reduce the likelihood of a malpractice claim because it reduces misunderstandings, builds trust, enhances team coordination, encourages transparency, and provides a means to document key interactions and informed consent.

• Types of Consent
  • Verbal: An agreement given by the patient's word. Also referred to as basic consent; the technologist explains the procedure to the patient and asks if they agree.
  • Written: A more formal type of consent in which a form must be signed (usually with more invasive procedures, contrast administration, etc.).
  • Implied: When a patient needs lifesaving care and there is no "do not resuscitate" (DNR) order in place. It is primarily utilized in trauma situations.
• Requirements for Informed Consent
  • The patient must be of legal age and deemed mentally competent. If not met, then a parent or legal guardian must provide consent.
  • Consent must be voluntary. The patient cannot be forced or coerced.
  • All risks and alternatives of the procedure must be discussed.
  • Allow the patient time to ask questions prior to signing or providing their decision.

Monitoring Vital Signs

A CT technologist requires knowledge of vital signs and how to accurately assess them on patients. Vital signs are key early indicators of significant physiologic changes in the patient, making it important to know how to measure, recognize when they should be recorded, and distinguish them as normal versus abnormal.

• Blood Pressure
  • Blood pressure measures the pulses of heart systole (ventricular contraction) and diastole (atrial contraction/ventricular relaxation) and is reported in millimeters of mercury (mmHg).
  • Blood pressure is measured using a sphygmomanometer. If measuring blood pressure manually, a stethoscope is also necessary.
  • Hypertension refers to high blood pressure.
  • Hypotension refers to low blood pressure.
  • Blood pressure can vary based on age and sex (Tables 1.15, 1.2,6, and 1.3,6 for adult, age, and gender blood pressures, respectively).

• Pulse
  • Pulse (heart rate) is the measurement of arteries expanding and recoiling, assessed by counting the number of heart beats per minute (bpm). A variety of arteries can be accessed for this measurement, but the most commonly used are radial and carotid arteries.

    Table 1.1 Adult Blood Pressure Values

    Category Systolic (mmHg) Diastolic (mmHg) Normal <120 <80 Elevated 120-129 <80 Hypertension Stage 1 130-139 80-89 Hypertension Stage 2 140+ 90+ Hypertensive crisis >180 >120 Hypotension <90 <60

    Table 1.2 Normal Blood Pressure Ranges by Age

    Age Systolic (mmHg) Diastolic (mmHg) Newborn-1 month 60-90 20-60 Infants (1-12 months) 87-105 53-66 Toddlers (1-5 years) 95-105 53-66 Children (6-13 years) 97-112 57-71 Adolescents (14-18 years) 112-128 66-80 Adults (18-39) 95-135 60-80 Adults (40-59) 110-145 70-90 Adults (60+) 95-145 70-90

    Table 1.3 Normal Blood Pressure Ranges by Sex as Assigned at Birth

    Age Female (Systolic/Diastolic) (mmHg) Male (Systolic/Diastolic) (mmHg) 18-39 years 110/68 119/70 40-59 years 122/74 124/77 60+ years 139/68 133/69
  • Other arteries used for measuring pulse include the temporal, brachial, femoral, popliteal, tibialis posterior, and pedal (dorsal pedis) arteries.
  • In addition to the pulse rate, rhythm can indicate a normal or abnormal heart function (arrhythmias), which are typically diagnosed with electrocardiograms (ECGs).
  • An adult heart rate above 100 bpm is tachycardia.
  • A heart rate below 60 bpm is bradycardia.
  • Heart rate varies based on age (Table 1.4).

• Respiration Rate
  • Respirations refer to the number of breaths taken per minute.
  • One respiration is noted as the rise and fall of the chest or abdomen.
  • Respirations can be manipulated by the patient, so best practice is to assess without the patient's awareness.
  • When recording respirations, also note the descriptive nature of the breathing (i.e. labored, shallow)
  • Respiration rates vary based on age (Table 1.5).

    Table 1.4 Normal Heart Rates by Age

    Newborn 100-205 bpm 0-1 year 100-180 bpm 3-5 years 80-120 bpm 5-12 years 75-118 bpm 13-18+ years 60-100 bpm Athletic 45-60 bpm ...