Medical Imaging and Radiologic Technology

01Purpose and scope

• This manual supports the course Medical Imaging and Radiologic Technology. It describes how imaging examinations are actually carried out in a clinical department, from the order that arrives in the queue to the images that a radiologist reads and the record that stays in the chart. It is written for students in training programs, newly credentialed technologists, and experienced staff who move between modalities or sites.
• The scope covers conventional radiography, fluoroscopy, computed tomography, magnetic resonance imaging, ultrasound, and nuclear medicine at the level of daily practice. It does not teach anatomy, pathology, or image interpretation, which belong to other courses and to the radiologist's role. It also does not set dosing protocols for any specific patient population.
• This guidance does not replace qualified professional judgment, approved departmental procedures, or required authorization. Radiation safety rules, licensure, and scope of practice depend on jurisdiction and employer policy, so check the current requirements with your state or national regulator, your medical physics team, and your facility's governing documents before acting on anything here.

02Core principles

• Every examination should answer a clinical question with the least radiation or magnetic exposure needed to do so. Radiation protection practice commonly refers to the ALARA principle, which asks that doses be kept as low as reasonably achievable while still producing a diagnostic image. In daily work this means choosing the right projection, collimating tightly, and repeating an image only when the first one truly fails.
• Patient identity and the correct examination come first. Two identifiers are checked against the order before any exposure, and the laterality, body part, and contrast status are confirmed with the patient rather than assumed from the requisition. Most serious imaging errors trace back to a mismatch at this stage rather than to a technical failure at the console.
• Image quality is a function of positioning, exposure settings, equipment condition, and patient cooperation together. A technically perfect setting cannot rescue a motion-blurred image, and a well-positioned patient cannot compensate for a detector that has drifted out of calibration. Treat quality as a system property rather than a single skill.
• Communication is part of the procedure. Patients who understand breath holds, the need to stay still, and what a contrast injection feels like move through the exam faster and with fewer repeats.

03Planning and preparation

• Before a shift or a scheduled block, review the modality worklist, the protocol list, and any open equipment alerts. Confirm that the room, the detector, and the injector or contrast supplies are ready. A five-minute check at the start of a session prevents the common problem of discovering a failed detector halfway through a patient's exam.
• Review each order for the clinical indication, prior imaging, pregnancy screening status where applicable, renal function when iodinated contrast is planned, and any implanted devices for magnetic resonance work. Many departments set these screening questions in the scheduling system, and the technologist's job is to verify the answers at the point of care instead of trusting that they were asked correctly.
• Plan the patient flow. Mobility, sedation needs, language support, and the need for a chaperone or family member affect the room assignment and the time you allow. For portable exams, plan the route, the shielding, and the people who will need to step out of the room before the first exposure.
• Resource decisions involve trade-offs. A high-throughput outpatient radiography room can run quickly with standard protocols, while an inpatient bedside exam may take longer because of lines, drains, and limited positioning. Scheduling a complex CT angiogram immediately before a routine chest film can cause delays, so many departments separate those sessions or assign a second technologist.

04Recommended workflow

1. 1
   : Verify the order and the patient. Confirm two identifiers against the requisition and the electronic record, check the exam name, laterality, and priority, and note any allergy or contrast warning. If the order and the patient do not match, stop and resolve the discrepancy with the ordering clinician before continuing.
2. 2
   : Screen for safety risks. Ask about pregnancy or possible pregnancy when required by local policy, prior contrast reactions, kidney disease, implanted metal or devices, claustrophobia, and the ability to hold still. Record the answers in the examination record so the next person does not have to repeat the questions from memory.
3. 3
   : Prepare the patient and the room. Explain the procedure in plain language, remove metal and clothing that will degrade the image or cause burns, and provide gowns or shielding according to the protocol. Set up the room with the correct protocol loaded, the table and detector positioned, and the collimation and immobilization aids ready.
4. 4
   : Position and select technique. Use the correct projection and centering, confirm that the anatomy of interest is within the field, and select exposure or scan parameters from the approved protocol rather than from memory. For fluoroscopy and interventional work, document the fluoroscopy time and the dose metrics the system provides.
5. 5
   : Acquire and review images. Take the first image, then review it on the display for position, exposure, motion, and artifact before the patient leaves the table. If the image is repeated, record the reason in a standard code such as motion, positioning, or exposure error so trends can be reviewed later.
6. 6
   : Complete the contrast or special steps. For iodinated contrast, confirm the dose, injection rate, and timing against the protocol, watch for reactions, and keep emergency equipment and trained staff available. For magnetic resonance, confirm screening again before entering the scanner room and use the approved hearing protection and monitoring.
7. 7
   : Close the exam and transmit the record. Confirm that all required images are sent to the picture archiving and communication system with correct patient and study identifiers, that the dose and technique data are stored, and that any incident or unusual event has been reported. Give the patient post-exam instructions, such as hydration after contrast, if the protocol calls for it.

05Quality checks, risk controls and compliance

• Equipment quality control is scheduled and documented. Typical programs include daily checks of image receptors, periodic output and alignment checks, and annual or periodic evaluations performed or reviewed by a medical physicist. The exact tests and frequencies depend on the equipment, manufacturer guidance, and the regulations that apply to your site, so use your facility's current quality control manual and confirm the interval with the physics team.
• Image quality reviews compare a sample of studies against established criteria. Reviewers look at correct positioning, collimation, exposure, and whether the anatomy requested is visible. Reject rates, repeat rates, and the reasons for repeats are the most common indicators, and a sudden rise in repeats often points to a specific room, detector, or protocol rather than to individual staff.
• Radiation dose monitoring includes personal dosimeters for staff where required, dose tracking for patients where the system supports it, and review of high-dose procedures. Pregnant staff members usually have a separate monitoring and reporting arrangement, and the rules for it vary by jurisdiction, so follow the radiation safety officer's instructions.
• Contrast safety requires a reaction protocol, emergency drugs and equipment that are checked on a schedule, and staff trained to recognize and respond to allergic-type reactions. Magnetic resonance safety requires zone controls, a screening process for every person entering the scanner area, and clear rules on what equipment may enter the room. The American College of Radiology publishes widely used practice guidance on these topics, and current versions should be consulted directly.
• Compliance means keeping the records that regulators, accreditors, and internal auditors expect to see. These include equipment logs, quality control results, dose records, training documentation, and incident reports. Retention periods are set by local law and institutional policy.

06Collaboration and documentation

• The technologist works most closely with the radiologist, the referring clinician, the nurse caring for an inpatient, the medical physicist, and the equipment service team. Good handoffs matter. If a patient cannot complete a study, tell the radiologist or ordering clinician what happened and why, rather than leaving the order open without explanation.
• Documentation should be accurate, timely, and specific. Record the exam performed, the views or sequences acquired, the contrast agent and dose if used, any adverse event, and the reason for any repeat. Vague entries such as completed without issues make it impossible to reconstruct what happened if a question arises later.
• Technologist notes may be used by the radiologist when interpreting an image, so avoid speculation about diagnosis. Describe what you observed, such as the patient moved during the second series or the patient reported pain at the injection site, and let the clinician draw conclusions.
• When a problem involves equipment, report it through the service ticket system and tell the supervisor if the room is affected. Document the time the equipment went out of service and the time it returned, since those data affect volume reports and quality reviews.

07Measures and continuous improvement

• Useful indicators include repeat rate by modality and room, the proportion of exams with documented safety screening, turnaround time from order to image availability, contrast reaction rate, and the number of image quality issues found in audits. Choose a small set of measures that the team can actually influence and review them on a regular schedule, such as monthly.
• Improvement works best with a specific change tested on a limited scale. If repeat rates are high for a particular projection, a short training session with a reference phantom and a review of the positioning steps may help. Measure the same indicator afterward and keep the change only if the result holds.
• Benchmarks differ by site, patient mix, and equipment age, so compare your numbers with your own past performance and with peers in similar settings rather than with a single published target. Be cautious about overinterpreting small counts, which can swing widely from one month to the next.
• Feedback from technologists is a valuable source of improvement ideas. Staff who work on the floor often notice workflow problems, such as a confusing order set or a frequently missing accessory, before the data show them.

08Common mistakes and how to prevent them

• Skipping identity verification under time pressure is the most consequential error. Prevent it by making the two-identifier check a fixed step before every exposure, including for patients who seem familiar, and by never accepting a verbal confirmation from a family member in place of the patient's own answer when the patient can respond.
• Using the wrong protocol or the wrong technique chart happens when a technologist assumes the default is correct. Check the protocol name on the screen against the order, and report any protocol that appears to be outdated so the physics team can review it.
• Overlooking a magnetic resonance safety screen is a serious hazard. Ferromagnetic objects can become projectiles, and implanted devices may heat or malfunction. Screen every person, including visitors and staff who only enter briefly, and do not rely on a patient's statement alone when the device is unknown.
• Failing to record a repeat or a dose event leaves a gap that makes trends invisible. Build the habit of logging the reason at the time of the event, not at the end of the shift.
• Assuming that an image is adequate because it was accepted once is a quiet error. Review each image before the patient leaves the table, and look at the full field and the annotations, not just the anatomy you expected to see.

09Practical checklist

• Confirm two patient identifiers and the exam, laterality, and priority against the order before any exposure.
• Complete the safety screen for pregnancy status where required, contrast history, kidney function when relevant, implants, and claustrophobia.
• Check the room, detector, injector, and emergency equipment before the first patient of the session.
• Load the approved protocol and verify the name matches the order.
• Position the patient, collimate tightly, and use immobilization aids to reduce motion.
• Review each image on screen for position, exposure, motion, and artifact before the patient leaves.
• Log the reason for every repeat using the standard code.
• Confirm that all images, dose data, and identifiers reached the archive correctly.
• Report equipment faults, contrast reactions, and any unexpected dose events through the required channels.
• Review quality indicators with the team at a set interval and act on one change at a time.

★Learning sources

• Micro Degree: Medical Imaging and Radiologic Technology
• Micro Degree: Healthcare Administration Practice
• Micro Degree: Physiotherapy Assistant Operations
• Micro Degree: Cardiac Care Support