Interpreting Radiological Images for Advanced Practice Providers

00:01 Hello. It's Glenna here, and I'm so excited to show you some radiology images and give you a framework on how to use these in your advanced practice.

00:10 Advanced practice students tell us that they don't get enough time and feedback on this skill, and wanting to hear from a working provider.

00:18 As an advanced provider, especially in specific areas of practice, you will need to know how to interpret radiological images.

00:26 The images in most cases will be sent to the radiologist for formal review, but your initial judgment is important so treatment can begin.

00:36 I know this can be intimidating, and I am going to help you build your confidence in this area.

00:42 In this video, I'm going to talk about evaluating image quality.

00:46 Importance of using a system to analyze images.

00:50 Some basic radiology terms.

00:52 Common mistakes. Knowing when to refer and to collaborate with other providers, as well as implications of coding and billing.

01:01 It may seem obvious, but the quality of the image is really important.

01:06 The density of the material being X-rayed shows up differently and therefore tells you what you are looking at.

01:12 So let's review. Air is going to appear black on radiographs whereas fat is going to appear dark gray. Soft tissue and fluid will be light gray.

01:24 Bone will be white. And of course metal will be your brightest white.

01:31 When thinking about image quality, remember that the higher the quality of the image you can achieve, the less likely you or the provider will make an error in your reading.

01:43 Images that are under or overexposed will make it harder for the provider to differentiate body structures, and more likely for you to miss subtle fractures or foreign objects.

01:55 If the patient isn't aligned properly when images are taken, then it is hard to judge whether the key body parts are deviated or displaced.

02:04 Another quality issue to consider is if the patient is moving too much when the image is taken, then this will cause blurring.

02:13 This makes it harder to see the margins of body parts and tell if there is any damage.

02:18 I encourage you to review our video content on the basics of radiology and computed tomography for more information on these concepts.

02:28 Depending on your area of practice, the specific radiological images are going to be different. But the human skeleton, of course, is consistent. Begin with a structured approach specific to each body region.

02:41 For example, in a chest x-ray , you would start at the trachea and follow downward, looking specifically for tracheal position, carina, mediastinum, borders, cardiac silhouette or aortic arch, and so on. Use anatomical landmarks as reference points and follow the same pattern every time. This way you avoid making mistakes when you document your interpretation, chart your normals as well.

03:10 Not documenting your normal findings is a common mistake you can avoid by being thorough and knowing your terms.

03:17 When describing the density of structures, remember to use the following terminology.

03:22 Radiopaque appears to white and bright on the X-ray, which is going to be referring to your bone and metal.

03:29 Radiolucent appears dark and black on X-rays.

03:33 This would be your air.

03:35 Opacification is the area appearing wider than expected, and this could be related to like infections such as pneumonia, blood or gallstone process.

03:46 Lucency is area appearing darker than expected, and this could be due to a cancerous process, osteoporotic or obstructive process.

03:57 Documenting the shape and border of the body parts you will use similar terms to the ones you use in nursing assessment documentation.

04:06 Anterior and posterior, referring to front and back.

04:10 Superior and inferior referring to upper and lower.

04:14 Medial and lateral meaning toward the middle or toward the sides.

04:19 Proximal versus distal, closer to or farther from the center.

04:25 Contralateral or ipsilateral, opposite side or same side.

04:30 When you start to document abnormalities, these are the reference terms you want to use. Midline referring to the central reference line, deviation will be movement away from your normal position.

04:43 Displacement will actually mean abnormal positioning.

04:47 Herniation will mean protrusion through the normal boundary, and migration will be movement from normal position.

04:55 These are just some of the many radiological terms you will need to become familiar with when you're interpreting X-rays.

05:02 I recommend that you read as many image reports that you can get your hands on.

05:07 When you encounter unfamiliar terms, be sure to look them up and ask questions.

05:13 This will only increase your confidence and skill.

05:16 Speaking of knowing when to ask questions, it is crucial that all providers, not just nurse practitioners, recognize when having someone with more training and experience look at an image when it is needed, especially as a beginner.

05:32 There are some specific situations where you will want to consult a radiologist if you suspect any of the following acute diagnoses: aortic dissection, intracranial hemorrhage, pulmonary embolism, bowel perforation or ischemia, cord compression, carotid dissection, arterial occlusion, and any time it's a complex case like a trauma case. Coding and billing for radiological interpretation for advanced practice providers is complicated for several reasons.

06:05 A primary consideration is avoidance of double billing.

06:09 It would be inappropriate for both you and the radiologist to bill for the same interpretation of the same image.

06:16 However, in an emergency situation, it is appropriate as an advanced practice provider to code and bill for a preliminary read, and there is a special code for that particular situation.

06:28 As with coding for other medical services, there is a primary interpretation code and a modifier code depending on your situation.

06:36 Choosing the right code and documenting your findings thoroughly and accurately is essential. It is also important to document follow up recommendations and communication of any critical findings.

06:50 Coding and billing requirements change regularly and are a significant part of medical practice, as many of you already know.

06:58 I encourage you to review our video content on these concepts, as well as exploring resources that are available at the centers for Medicare and Medicaid Services. That was a lot of information and we haven't even looked at an image. Don't worry, we will.

07:14 I want to sum up a few things that you might want to review.

07:18 First, the quality image is very important.

07:21 If you can't see well, you might need to get another picture.

07:25 You want to use a systematic approach to review your image.

07:29 Your teacher and mentors will likely show you one, and I will too. Find the one that works best for you and make sure you use it.

07:38 Yes, always new words to learn and use in documentation.

07:43 Failure to document carefully is a common mistake.

07:46 So when in doubt, document everything, but make sure you're being objective, of course. When unsure, ask for help.

07:54 At last, coding and billing is complex and will take time to learn, but it has a structure to follow, so pay attention.

08:03 Ready to take a look at some of those images and see how it works? Let's go.