implementing a computed tomography cross-training program

Running Head: IMPLEMENTING A CT TRAINING PROGRAM 1

Implementing a Computed Tomography Cross-training Program

Veronica Vallejo

Presented to the Management Department Faculty

of Oregon Institute of Technology

in Partial Fulfillment of the Requirements for the Degree

Bachelor of Science in Management

Implementing a CT Training Program 2

Business Management Department

Table of Contents

Abstract………….........................................................................................................................4

Introduction...................................................................................................................................5

Project Overview..............................................................................................................5

Assumptions.....................................................................................................................5

Scope.................................................................................................................................5

Impact................................................................................................................................5

Project [Research] Methods ...........................................................................................................6

Timeline & Milestones........................................................................................................6

Project Success Metrics.......................................................................................................6

Organizational Background..............................................................................................................7

Stakeholders........................................................................................................................7

Resources............................................................................................................................7

Literature Review............................................................................................................................7

Discussion of Research....................................................................................................................8

Analysis of Data..............................................................................................................................8

Results..............................................................................................................................................8

Summary and Conclutions..............................................................................................................8

Recommendations and Future Work...............................................................................................9

References.......................................................................................................................................10

Appendix.........................................................................................................................................11



Abstract

As Pacific Mobile Diagnostics’ clientele grows, the demand for more Computed Tomography

coverage increases. The purpose of this project was to develop and implement a cross-training

program for all current Pacific Mobile Diagnostics employees. This program included research

on both online and hands-on training that would help employees become proficient in

performing Computed Tomography exams. After careful research and employee input, a training

program was developed that included an online training module, a protocol reference manual,

two equipment use presentations, and a hand-on training schedule. These tools along with a

competency checklist helped cross-train employees so that the company could keep up with their

clients’ demands by increasing both day and call availability.

Keywords: Computed Tomography, Training, Program, Increase, Demand



Implementing a Computed Tomography Cross-training Program

Pacific Mobile Diagnostics was founded in 1987. It began providing services in Arizona

with one simple idea – bring radiology services directly to the patient rather than vice versa.

Pacific Mobile Diagnostics is an established leader and pioneer in proving mobile diagnostic

services, including digital x-ray and Ultrasound, as well as EKG’s and ABI’s. With over a

quarter century of experience in the mobile market, Pacific Mobile Diagnostics provides

exemplary service and keeps costs low for its clients in their homes, or at long-term care

facilities from their local offices in Phoenix, Tucson, Salt lake City, Denver, and Colorado

Springs.

Pacific Mobile Diagnostics provides portable x-rays, ultrasounds, echocardiograms,

EKGs, and Computed Tomography exams to facilities that do not have their own radiology

department. As the company’s clientele grows, facilities are demanding 24-hour Computed

Tomography coverage. With only three full-time Computed Tomography techs, Managers are

looking to hire on-call techs to provide more Computed Tomography availability. On-call techs

have high turn-around rates and it is very difficult to find techs that would be willing to work the

hard hours, plus work their other jobs.

As a true innovator in the mobile industry, Pacific Mobile Diagnostics provides all its

clients with a reliable, professional and proactive company that will always be there to provide

top-tier service. Their team of support staff and technologists work tirelessly to provide a

customer-service friendly experience from start to finish. Their team is more than able to take

their clients through the process with a sense of professionalism and care that is unmatched in the

entire mobile industry. Pacific mobile Diagnostics is privately owned and operated and makes



itself available to any staff and residents 24 hours a day, seven days per week, 365 days per year–

and all without one single “stat”, “after hours” or “holiday” fee.

Project Overview

The objective of this project was to develop a cross-training program that will be able to

train all current radiology techs on Computed Tomography. Since all rad techs already rotate on

the xray on-call schedule, the goal is that they will be able to perform Computed Tomography

exams as well. This will align with the company’s strategic plan by providing fast and

exceptional service and exams to patients. It will also save facilities a lot of money because they

will no longer have to transport them to hospitals when the company is not available to perform

Computed Tomography exams.

There was extensive planning and organizing to produce a training program that will

cover everything that needs to be known plus training. The results will be that every rad tech in

the company will feel comfortable performing exams and can be available to rotate in the CT on-

call schedule.

Resources

Resources for this project include purchase of the online training modules costing $320,

$100 in printing supplies for the training brochures, and any employee pay due to overtime or

additional training days.

Assumptions

By implementing a cross-training program for current Pacific Mobile Diagnostics

employees, they will be comfortable enough to perform Computed Tomography exams

independently and be able to be on-call for CT. They will also be able to provide CT relief during



day hours. Project assumptions include extensive planning and organizing the training program.

There will be research on books, online classes, and modules that can be taken by employees to

better train them. There will be CT training that will include both hands-on and virtual classroom

classes. It will require a finalized training schedule that must be approved by management. There

will be a lot of overseeing on employee progress.

Scope

The Scope of the project includes:

Goals: To plan and execute a CT training program

Costs: Costs will include a $300 on-line introduction module and any over-time that

employees may require due to training.

Any training or teaching of the history of CT and the physics of how a CT image is made

will be excluded. Although these things are required for a tech to know to pass the registry exam,

the purpose of the training program is to have an employee be comfortable in performing CT’s

independently. A tech can legally perform exams without being registered in CT, he/she just

needs to be registered in radiography. If an employee wishes to take the registry, he/she would

need to take the additional learning/training manuals on their own time.

Impact

The impact of this project will be greater workflow, increased competitive advantage, and

increased efficiency. Workflow will be increased due to more availability for technologists to

perform Computed Tomography exams. Pacific Mobile Diagnostics will gain a competitive

advantage due to the increase in availability and therefore, attract new facilities. Efficiency will

increase due to there will be no need to hire more techs since the rad techs that are on-call can

take care of the CT exams as well.



Project and Research Method

Primary research includes an employee survey along with follow up question and answer

emails. This will bring up any concerns and questions from both employees and supervisors.

Secondary research includes finding the right online training modules and developing the

Computed Tomography protocol manual and hands-on training schedule.

Timeline and Milestones

The following provides an overview of the project timeline and milestones (Figure 1):

Figure: 1

Tasks & Deadlines: Fall: WEEK 1 Research and organize all materials needed for

training manuals and presentations WEEK 2 Develop and deliver surveys to employee with

questions they might have. Change or develop changes in training material appropriately WEEK

3 Develop training manual WEEK 4 Training manual due. Present to employees WEEK 5

Presentation due. Present to employees WEEK 6 Take any questions or concerns WEEK 7

Answer employee questions and understanding of materials WEEK 8 develop and collect sign-

GANTT GRAPH PAPER (WEEKLY)S S S O O O O O O O O O O O O O O O O O O O O O O

Mon Sep 28ISO WEEK NUM W40 W41 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W53 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12

MONTH Sep October November December January February March

(MON)DAY 28 05 12 19 26 02 09 16 23 30 07 14 21 28 04 11 18 25 01 08 15 22 29 07 14 21

Research and Organization

research materials

Develop Training Manual

Develop Training Presentation

Progree Report to Manager

Online Training

Present Training Manual

Present presentation

Make Hands-0n Training Schedule

Progress Report to Manager

Hands-on Training

Saftey Training

Injection Training

Exam Training



ups on hands-on training. WEEK 9 Develop hands-on training schedule WEEK 10 Present

schedule with supervisor. Make appropriate changes Winter: WEEK 1 Answer and questions or

concerns from employees and supervisor before hands-on training WEEK 2 1st week of hands-

on training: Patient safety, registering, and injections WEEK 3 2nd week of hands-on training:

setting up, Protocols, and patient exams WEEK 4 3rd week of hands-on training: advanced

protocols and exams WEEK 5 Monitor employee training results and check up with their

progress WEEK 6 Make report on any corrections that need to be done and work on progress

report WEEK 7 talk with employees, answer questions, and schedule additional training if

needed WEEK 8 Talk with facility managers and make sure they are happy with our services.

WEEK 9 Present progress report to supervisor.

Project Success Metrics

Success will be when all of the employees are deemed competant with performing CT exams,

all of the project information and progress is documented, and the company supervisor and facilities

are happy with the outcome. The success factor will be the successful hands-on training. A tech

learns better when the exams are performed in front of them and they can get to practice them. This

will be measured by number of exams a tech is comfortable doing. There will be checklist that needs

to be signed off for every exam. When an employee can perform an exam independently three times,

the tech is deemed an expert on performing that certain exam.

Organizational and Industry Background

Pacific Mobile Diagnostics is a privately owned company. It is in the Health Care

industry in Phoenix, Arizona. The health care industry, or medical industry or health economy, is

an aggregation and integration of sectors within the economic system that provides goods and

services to treat patients with curative, preventive, rehabilitative, and palliative care. It includes



the generation and commercialization of goods and services lending themselves to maintaining

and re-establishing health. The modern healthcare industry is divided into many sectors and

depends on interdisciplinary teams of trained professionals and paraprofessionals to meet health

needs of individuals and populations.

The healthcare industry is one of the world's largest and fastest-growing industries.

Consuming over 10 percent of gross domestic product (GDP) of most developed nations, health

care can form an enormous part of a country's economy (Cortera Business Index).

Pacific Mobile Diagnostics currently has approximately 20 to 30 employees and annual

sales of $1,000,000 to $4,999,999 (Cortera Business Index).

Pacific Mobile Diagnostics is a newer company but has great growth potential. It is

important that the company takes advantage of this growth and becomes more available to accept

more contracts and be more available to provide services to clients. As the company continues to

grow, so should the employees’ ability to provide exceptional service. This project will help the

company grow by furthering employee availability and capability when it comes to diagnostic

imaging.



Stakeholders

The consumers are the most important stakeholders of Pacific Mobile Diagnostics. These

consumers include rehab centers, retirement homes, county jails, prison, behavioral hospitals and

long-term care hospitals. Although patients mostly include a community of older residents, some

of our patients are younger patients as well. The company employees consist of radiologic,

ultrasound, EKG, and echocardiogram technologists. The only social responsibility the company

currently has to is keep radiation levels as low as reasonably achievable when performing exams.

Literature Review

Business organizations like Pacific Mobile Diagnostics are constantly seeking ways to

enhance their performances in order to compete actively and aggressively in the market. Profit-

seeking organizations have long recognized the importance of creating value in the services they

offer to the customers. Aside from inculcating loyalty among the members of the clientele,

Pacific Mobile is aware of the need to widen and extend the reach of the company’s services to

new markets in order to increase its share on clients and customers. In order to increase their

target market, Pacific mobile has expanded their services they provide to include Computed

Tomography exams. This has not only increased their customer base, it has also increased their

demand for services. To keep up with this demand, Pacific Mobile will offer 24-hour CT

services, but to do that, a new cross-training program will be introduced to current employees.

This paper aims to present a discussion that illustrates arguments and debates regarding the

importance of the concept of radiation and patient safety in the Computed Tomography.

Medical imaging exams — including Computed Tomography scans — have been directly

linked to greater life expectancy and declining cancer death rates. Medical imaging exams are

also generally less expensive and safer than invasive procedures, such as exploratory surgery. CT



examinations provide valuable information about your health and play an important role in

helping doctors make an accurate diagnosis. In some cases x-rays are used to assist with the

placement of tubes or other devices in the body or with other therapeutic procedures. CT scans

have various purposes. They include helping to diagnose a condition, guiding medical

procedures, such as needle biopsies, and monitoring the effectiveness of certain treatments, such

as cancer treatments.

The use of CT has increased rapidly over the years. The increase in CT use and in the CT-

derived radiation dose in the population is occurring just as the understanding of the carcinogenic

potential of low doses of x-ray radiation has improved substantially, particularly for children. CT

use can be categorized according to the age of patients and the purpose of imaging (diagnosis in

symptomatic patients or screening of asymptomatic patients). CT-based diagnosis in adults is the

largest of these categories. About half of diagnostic CT examinations in adults are scans of the

body, and about one third are scans of the head, with about 75% obtained in a hospital setting

and 25% in a single-specialty practice setting (Brenner, 2007). However, the largest increase in

CT use, has been in pediatric studies and adult screenings (Brenner, 2007).

The growth of CT use in children has been driven primarily by the decrease in the time

needed to perform a scan thusly eliminating the need for anesthesia to prevent the child from

moving during the exam. The major growth area in CT use for children has been pre-surgical

diagnosis of appendicitis, for which CT appears to be both accurate and cost-effective. Estimates

of the proportion of CT studies that are currently performed in children range between 6% and

11% (Brenner, 2007). With this continuing increase for the demand of CT, technologists must not

only be confident in their ability to perform the exams, but they need to adhere to the safety

policies and always perform the CT’s with their patients’ safety in mind. Protecting the patient



and ensuring that they absorb the least radiation possible is part of being a competent and safe

CT technologist.

CT delivers much higher radiation doses than do conventional diagnostic x-rays. It is

known that a chest CT scan typically delivers more than 100 times the radiation dose of a routine

chest radiograph (Smith-Bindman, R., Lipson, J., & Marcus, R., 2009). For this reason, it is very

important that the CT technologists follow proper safety protocols when examining a patient.

This includes using protective shielding when applicable. This also includes using the least

amount of radiation without compromising the image. Since the eyes, breasts, thyroid, and

gonads are the most radiosensitive organs in the body, the CT technologist must always shield

those areas whenever possible (Sensitivity of Body Organs to Radiation, n.d.). If the technologist

is performing a head CT, he or she should shield a patient completely with a full-body apron and

a thyroid shield. This way, the area of interest is still uncovered and the patient is protected.

When performing a chest CT, the technologist will be able to protect the patient with a half apron

or gonadal apron. This way, the patient’s chest in uncovered leaving breast tissue unprotected,

but the gonads are still shielded. Unfortunately, the more areas that needs to be imaged means the

less protection that can be offered. For example, if the patient needs a CT abdomen-pelvis, the

only thing that can be protected is the thyroid and eyes. Everything else needs to be exposed to

get the best visualization of the organs. Technologists need to make sure to use as much shielding

as possible without interfering with the organs that are being imaged. Radiation safety shields

include leaded aprons, thyroid shields, and gonadal shields. Gowns, aprons and thyroid

protectors are made of lead or other high Z material that is lined with vinyl. Gonadal shields are

not lined with vinyl. Aprons and shields used should be equivalent to at least 0.25 mm Pb(lead) if



the X Ray equipment operates up to 100 kV and 0.35 mm Pb if it operates above 100 kV

(Radiation Protection in Diagnostic and Interventional Radiology, n.d.).

CT scans expose you briefly to a targeted amount of ionizing radiation, which helps

create an image of structures inside your body. CT scans provide more-detailed images of more

types of tissue than traditional X-rays do, which allows doctors to detect and locate many

medical conditions. Because different tissues and organs have varying sensitivity to radiation

exposure, the actual radiation risk to different parts of the body from an x-ray procedure varies.

At the low doses of radiation a CT scan uses, the risk of harm from it is so small that it can't be

reliably measured. Because of the possibility of an increased risk, however, the American

College of Radiology advises that no imaging exam be done unless there is a clear medical

benefit (Farley, 2009). This is why performing a CT or any other radiology exam is only done

when the benefits outweigh the risks.

Training Product

The first part of the project involved research on reliable training modules that the

technologist could learn how to perform computed tomography exams from. A very promising

module came from the Phillips Online Learning Center online. The Phillips Online Learning

Center offers over 1,200 continuing medical and healthcare education and medical CE learning

activities for nurses, radiologic technologists, sonographers, and other healthcare professionals.

Over 600,000 healthcare professionals have actively participated in online modules to meet their

educational requirements (Philips Online Learning Center for Continuing Medical Education and

Medical CE). The Philips Learning Center offers an innovative and engaging online environment

for healthcare education. It is an online catalogue offering online and onsite healthcare education

courses from around the world. It contains courses offered by Philips and their network of



physicians, clinicians, key opinion leaders, and professional associations (Philips Online

Learning Center for Continuing Medical Education and Medical CE). Phillips is a very renowned

medical technology company that creates medical equipment including CT machines. In the

Online Learning Center, an introductory CT training module can be purchased and technologist

can learn about how to perform basic CT exams.

An email was sent to the manager at Pacific mobile diagnostics informing him of the

training module along with module link and pricing of $320.00.

Although the Phillips learning module is easy to understand and each section is only an

hour long, it was hard to determine how long employees would take to finish the entire module.

This was expected to be finished during down-time hours at work and also at home and most

employees have families and other commitments outside of work. A timeline of completion of

only a week was expected to be extended.

An email survey was conducted asking all current Pacific Mobile Diagnostic employees

about their past experiences with Computed Tomography and what questions or concerns they

have regarding the upcoming training. A total of 19 employees were surveyed. Besides the two

CT technologists, only two current employees, one being per-diem, have past experience with

CT. All other employees only have general x-ray experience (see Figure 2). After reviewing their

questions or concerns regarding the upcoming training sessions, it was found that most

employees were intimidated performing CT’s involving contrast injections.

Figure: 2



Contrast agents such as iodine are often injected into a patient’s bloodstream during

certain CT examinations. These contrast agents allow better visualization of tissues in organs and

become a tool to identify lesions and masses in organs such as the liver (Baron, R. 1994).

Contrast is administered to a patient via a rapid speed automatic injector (Small, J., & Kyotae, B.

(Eds.), 2003). Contrast injections have also been widely accepted to evaluate the anatomy of

major blood vessels such as the aorta and pulmonary artery (Small, J., & Kyotae, B. (Eds.),

2003). With an automatic injector, bolus of contrast medium can injected at a high injection rate

(3-5 mL/s) to achieve a high degree of vascular contrast enhancement (Small, J., & Kyotae, B.

(Eds.), 2003). Typically, contrast medium is injected at a constant injection rate, i.e. a uniphasic

injection protocol is used. This injection scheme results in a steadily rising vascular contrast

enhancement profile with a single peak of enhancement occurring shortly after the completion of

the injection (Small, J., & Kyotae, B. (Eds.), 2003).

Considering that uniform vascular enhancement through the entire period of image

acquisition is highly desirable for the purpose of image processing and display, contrast

injections are often ordered by doctors. In addition to a uniphasic injection protocol, a biphasic



injection protocol is sometimes used as well. Typical biphasic injection protocol consists of two

phases: a short rapid-injection phase, followed by a longer slow-injection phase. A biphasic

injection protocol yields more prolonged enhancement than a uniphasic injection protocol, but it

generates two enhancement peaks with a valley of enhancement in between (Small, J., & Kyotae,

B. (Eds.), 2003).

It was noted that the main concern for employees was learning how to use the contrast

injector and being concern when administering contrast agents to patients. These concerns were

anticipated since it is normal for people to be intimidated by new technology. This is why

injector training was put first in the hands-on training schedule. The injector training not only

will include step-by-step training on how to operate it, but it will also include safety and

handling practices as well.

Analysis of Data

Employee surveys showed that most employees were intimidated by the new technology

they would have to learn, both the injector and the Computed Tomography exams themselves.

Since the online training modules would explain how to perform the exams, introduction to the

power injector was first in the hands-on training schedule. The online module provided step by

step explanations on how to perform a Computed Tomography exam including exam

preparation, patient positioning, and exam protocols. Pacific Mobile Diagnostics employees

seemed to be comfortable with learning from the online modules because they could play them

in the comfort of their own home, at their own time, at their own pace, and they can repeat them

as many times they want. The project coordinator was readily available to answer any questions

or to clarify any points that the employees may have trouble with. Employees finished the online

training modules at an average of two weeks. The fastest finishing time was one week and the



slowest time was three weeks.

Pacific Mobile Diagnostic employees were also sent via email two instructional

PowerPoint presentations. One addressed how to start up the CT machine and the computer

stations. It covered how to turn on the gantry, the computer, how to calibrate it for an exam, and

how to register a new patient. The second PowerPoint presentation instructed the employees on

the operation of the contrast power injector. It showed them how to start it, load it with contrast

and saline, and load it to an exam. Employees were free to replay the presentations, print them,

and ask the project coordinator any questions about them.

The next step of the training was to develop the hands-on training schedule. One week

was set apart for the introductory session. A group of two or three employees per each

introductory two-hour session. Employees were able to practice running the CT machine and the

power injector. They were able to practice simulating exams and ask any questions they might

have. After the introductory session, each employee was assigned a day of the week for four

weeks where they were to practice performing Computed Tomography exams on patients.

Results

The project coordinator was there to supervise every exam and to sign off on every

employee competency paper. The majority of employees were quick to learn and were eager to

perform exams on live patients, but there were other that were intimidated to perform exams.

These employees learned at a slower pace than the others and were needing more guidance and

supervision. These employees were also the ones that would email, call, or text the project

coordinator more often with questions and concerns.

After the four weeks, all employees had most or all their competency exams signed off

on. If an employee needed a certain exam to complete their competency paper, the certain exam



was saved and he or she would be accompanied by the project coordinator to perform it. After

the training course, employees were free to request more time with the project coordinator to go

over any exams they were still having trouble with.

Summary & Conclusions

After an employee had all their competencies signed off on, they were deemed able to

perform Computed Tomography exam independently. They were put on the day CT schedule

and the CT Call rotation as well. Each employee also received a raise in pay along with CT call

pay. The training has increased employee availability to take CT call and has helped alleviate the

workload for the starting CT technologists. It has also made Pacific Mobile Diagnostic clients

more comfortable when ordering Computed Tomography exams because they know employees

are readily available and the turnaround time will be very fast. For this reason, Computed

Tomography exam ordering has increased (see Figure 3). With so many employees available for

CT coverage, Pacific Mobile Diagnostics has received more offers for contract by new facilities

that have demand for Computed Tomography coverage.

Figure: 3



Recommendations and Future Work

One of the next steps recommended after completion of the Computed Tomography

training program is having the project coordinator conduct follow-up emails with both

employees and stakeholders. These emails should include updates on work-flow and should

invite the employees and stakeholder to voice any questions or concerns. Quality assurance is a

very important follow-up step after training. The project coordinator must make sure employees

are keeping up with continuing education and any changes in radiation therapy laws and

regulations. The project coordinator must also follow up with clients and doctors of facilities to

make sure they are happy with the services the company provides. Making sure all nurses are

updated and trained in Computed Tomography ordering and turnaround times will also be very

helpful. Keeping a good communication relationship with both employees and stakeholders is

very important to the program’s success.

References

Baron, R. (1994, August 1). Understanding and Optimizing Use of Contrast Material for CT of

the Liver. Retrieved October 19, 2015, from

http://www.ajronline.org/doi/pdf/10.2214/ajr.163.2.8037023

Cortera Business Index. (n.d.). Retrieved October 6, 2015, from

https://start.cortera.com/company/research/k2m5ktq0q/pacific-mobile-diagnostic/

CT Training Module. (n.d.). Retrieved from

http://www.theonlinelearningcenter.com/assets/powers/32/CT_Basics_Module_7.htm



Medrad® Stellant® CT Injection System. (n.d.). Retrieved October 23, 2015, from

http://www.radiologysolutions.bayer.com/products/ct/injection/stellant/

Pacific Mobile Diagnostics - Pacific Mobile Diagnostics. (n.d.). Retrieved October 12, 2015,

from http://www.pmdxray.com/

Philips Online Learning Center for Continuing Medical Education and Medical CE. (n.d.).

Retrieved October 9, 2015, from https://www.theonlinelearningcenter.com/default.aspx

Small, J., & Kyotae, B. (Eds.). (2003). US Patent Number 663503. Retrieved October 9, 2015,

https://docs.google.com/viewer?url=patentimages.storage.googleapis.com/pdfs/US66350

30.pdf

SOMATOM Emotion - Siemens Healthcare USA. (n.d.). Retrieved from

http://usa.healthcare.siemens.com/computed-tomography/single-source-ct/somatom-

emotion/features

implementing a computed tomography cross-training program

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