Medical Ethics

Learning objectives

• By the end to the session the students will be able to;

List the Examinations requires the presence of chaperone Outline the circumstances under which a chaperone is required during an ultrasound / x-ray examination Explain the roles of chaperone

Definition of terms

A healthcare practitioner; is a person who has undergone appropriate training in providing any form of healthcare. This would include but not limited to; radiographers and nurses and

Chaperone

Definition

A chaperone is a person who stands in as a witness for a patient and a medical staff during a procedure or assessment.

Typically, a chaperone should be a medical practitioner / health professional

Examinations requires the presence of chaperone

• Many examinations, especially those affecting anatomical areas of the

chest (female),

pelvis and upper thigh are potentially stressful or embarrassing /uncomfortable to the patient.

Examinations involving the

breasts, genitalia, anus or rectum are particularly intrusive /disturbing and may make the patient feel vulnerable /defenseless.

Patients should be offered a chaperone of their gender, present during the examination,

The chaperone would normally be another healthcare practitioner* and, in most cases, will act as a witness to verbal consent.

and this applies whether or not the examination operator is the same gender as the patient.

List circumstances under which a chaperone is required

Circumstances under which a chaperone is required during an ultrasound / x-ray examination

• Breast ultrasound
• Intra cavitary ultrasound
• HSG, Urethrography, contrast enema
• Testicular ultrasound
• Possibly, on call ultrasound
• Ultrasound examinations outside of normal business hours
• Mammography

The process for obtaining chaperones.

Chaperone roles

• Be familiar with the procedure involved
• Be sensitive and respect the patients dignity

Reassure the patient if they show signs of distress or discomfort Stay for the whole examination and be in a position to observe the examination if practical Be prepared to raise concerns if they feel the behavior or actions of the examination operator are inappropriate

Informed consent is mandatory to all intimate/private radiological procedures

• Verbal consent in the presence of the chaperone, are required at the time of procedure

The offer of a chaperone is for the protection of both the patient and the doctor

Medical Ethics concepts in maintaining patient medical legal requirement;

Diagnostic errors and negligence

Learning objectives

• By the end to the session the students will be able to;
• Describe errors in diagnostic radiography

Explain on how to reduce errors in diagnostic radiography

Imaging cycles phases

• The imaging cycle represents the phases involved in medical imaging care.

Three procedural phases are;

Pre procedural (from time an image was requested until the time when the patient presented to have the image taken) Procedural (during taking the image), and Post procedural.

Effects of errors in diagnostic radiography

• Errors that occur in medical imaging contribute to;
• increased radiation dose,
• compromised patient safety,
• wrong diagnosis,
• delayed treatment, and

decreased efficiency

Impact of errors in radiography

• Errors have significant impact on
• patient outcomes,
• health care workers' wellbeing, and

the public's trust in the health care system

Category of errors

• The majority if errors produced can be categorized into there groups
• Technique and projection errors
• Exposure errors

Processing errors – chemical errors, film handling errors

Technique errors

• Patient preparation error
• Radiopaque artefacts
• Blurred images
• Technical aspects
• Under or overexposure,
• Off centering
• Patient rotation,
• The use of one only projection,
• The presence of artifact
• Errors in interpretation
• Projection errors

Incorrect angulations

Processing errors

• Film placement artefact
• Double image

Area of interest not shown

Summary

• Diagnostic radiography errors
• Effect of errors in diagnostic rdiography

Impact of errors in radiography

Use of health sector Reforms and strategies in implementing radiology activities

Learning objectives

• By the end to the session the students will be able to;
• Explain the levels of radiology and medical imaging in Tanzania
• Explain Medical Radiology Services Background in Tanzania
• Describe Advancements in the field Radiology

Explain the Service arrangement in Medical radiology and imaging section

Radiology services Hierarchy

• There are six levels of radiology and medical imaging in Tanzania
• Dispensary
• Health center
• District
• Regional
• Zonal

National

MRIS Background in Tanzania

1940 Ocean Road Cancer Institute started to provide X-Ray services After the second world war (1946) many hospital were built and /or were upgraded and were given x-ray facility Before and shortly after independence x-ray units were operated by Europeans and Asians who left he country there after

Training in the field of radiology

At the beginning of the independence few Tanzanians were sent to London o train as radiographer Few years later few Tanzanians were trained in German, England and Kenya They graduated as radiologist and radiographer Radiotherapy services started in the late 1960 Services of medical physicists and radiation oncology were started in 1970 at MNH

Local training programs in the field of radiology

• Radiographic auxiliaries school at princes Margaret Hospital (now MNH) 1964-1971

Radiographic auxiliaries school was transferred to KCMC 1972-1972 – 1yr training Radiographic auxiliaries school was upgraded to two years training and transferred from KCMC to Bugando medical center in 1980 School of Radiography started in 1972 at MNH to date

Local training programs in the field of radiology

The second school of radiography started in 2003 at Bugando Medical Centre by phasing out the previous school of radiographic assistant The quality of the health services were improved from time to time by equipping the hospitals equipment required (modern imaging equipment).

Radiology services expansion/ reforms

• Improve and expand access to radiology services in Tanzania.
• expand physical infrastructure of health care facilities.
• Construction of many new hospitals
• Renovate other facilities and equip them with more modern radiology equipment.

Training in the field of radiology

Education in the field of radiology

• Academic centers
• The Muhimbili University of Health and Allied Sciences (MUHAS)
• The Catholic University of Health and Allied Sciences (CUHAS)
• The Kilimanjaro Christian Medical Centre (KCMC) – 1971

The Benjamin Mkapa Institute of Health Allied Sciences (BMIHAS) – 2022

Academic centers around the country that provide educational opportunities in the field of radiology

The Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam has a department of Radiology & Diagnostic Imaging. This department teaches a Masters in Medicine (MMed) in Radiology, a Diploma program in diagnostic radiology, and the country’s first MMed in Interventional radiology

The Catholic University of Health and Allied Sciences (CUHAS) in Mwanza also offers a

• diploma course in diagnostic radiology and has started to deliver the country’s first

Bachelor in Diagnostic Radiology.

The Kilimanjaro Christian Medical Centre (KCMC) was founded in 1971 and also runs

a MMed in Radiology. It also offers certificate courses in diagnostic ultrasound to nurses, midwives and other health care providers.

Moreover, they offer a unique diagnostic ultrasound program for working Assistant Medical Officers, to address the need of such services in rural and underserved areas.

Advancement in Radiology field

An increasing interest in providing high quality care and diagnostic exams has pushed the government and the private sector to increase funding to hospitals and health care centers. As such, advanced imaging technologies such as CT and MRI, PET/CT, Radiotherapy, are taking a forefront in radiology services in Tanzania.

Service arrangement in Medical radiology and imaging section

• Currently the MRIS to the clients include the following;
• Arrangement of requisitions
• Choice of correct imaging technique
• Client information, client consent
• Client identification, client preparation
• Performance of imaging procedure
• Interpretation and reporting

Consideration of safety and ethics in imaging services

TNX

Medical Ethics concepts in maintaining patient medical legal requirement;

Intentional and unintentional Misconducts

Learning objectives

• By the end to the session the students will be able to;
• Define professional misconduct, abuse and neglect
• Describe and explain the groups of abuse

Describe and explain the groups of professional misconduct

Definition of terms

• Anguish; extreme pain, either of body or mind: excruciating /causing distress

Corporal; Pertaining to the body, especially the human body

Definition of Misconduct and an abuse

Professional misconduct encompasses actions that deviate from benefit for the client and society at large Abuse; is defined as the willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain, or mental anguish.

Misconducts

Abuse

“Abuse” is defined as the willful infliction of injury, unreasonable confinement, intimidation /threats or punishment with resulting physical harm, pain, or mental anguish.

This includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being.

Medical Ethics

Verbal Abuse involves the use of speech, sound, writing, or gestures when communicating with patient/client or their families or when within their hearing or sight, regardless of their age, ability to comprehend, or disability Sexual Abuse is the non-consensual sexual contact of any type with a patient /client. Sexual abuse includes, but is not limited to sexual harassment, sexual coercion, or sexual assault

Medical Ethics

Physical Abuse includes, but is not limited to hitting, slapping, punching, biting, and kicking. It also includes, controlling behavior through corporal (human body) punishment.

Mental Abuse is the use of verbal or nonverbal conduct which causes, or has the potential to cause, the patient / client to experience humiliation, intimidation, fear, shame, agitation, or degradation.

Examples of abuse include but not limited to;

Physical Abuse – Hitting, slapping, pinching, kicking, or intentionally causing harm Sexual Abuse – Harassment, inappropriate touching, or assault. Accordingly, sexual relations or any other type of physical relations are strictly forbidden.

Verbal Abuse – Threats of harm, saying things to intentionally frighten a client

Mental Abuse – Humiliation, harassment, and intimidation with threats of punishment or threats of depriving care or possessions

Neglect

“Neglect” is defined as the failure of the facility, its employees, or service providers to provide goods and services to a patient / client that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.

Medical Ethics

Neglect is the intentional carelessness, negligence, or disregard of policy or care plan, which causes, or could be reasonably expected to cause pain, injury, or death

Carelessness or neglect

Through substantial carelessness or negligence, does any of the following:

Causes or could reasonably be expected to cause pain or injury to a client or the death of a client Substantially disregards a client’s rights

Medical Ethics

Causes or could reasonably be expected to cause mental or emotional damage to a client, including harm to the client’s psychological or intellectual functioning that is exhibited by anxiety, depression, withdrawal, regression, outward aggressive behavior, agitation, fear of harm or death, or a combination of these behaviors

Professional misconduct groups

Failure to maintain standards of practice Radiographer are expected to adhere to the standards of practice in carrying out their professional responsibilities. These standards are the reasonable to ensure that radiographer provide responsible, safe and adequate care to clients. Professional misconduct occurs when these standards are breached.

Working while impaired

Mood-altering substances can impair the judgment and ability of nurses and jeopardize client and public safety.

Clients trust that they will not be exposed to health care providers whose abilities may be impaired by drugs or alcohol.

Abusive conduct

Any abusive conduct by a radiographer toward a client is inconsistent with the fundamental professional obligations of the Radiographer. Such conduct is not tolerated by the public, the Hospital/Institution or the profession

Theft

Trust is one of the cornerstones of the radiographer – client relationship. Honesty is an essential ingredient in ensuring that client trust is maintained and that the client’s vulnerable position is not abused by the radiographer. In addition, radiographer are in a position of trust with their employer. It is important that radiographers not abuse this trust.

5. Failure to obtain informed consent and breach of confidentiality

Failure to obtain client consent

For a client to give informed consent, he/she must be given information that a reasonable person in the same circumstances would require to make a decision about the treatment, alternative courses of action, the expected effects, risks and side effects in each case, and the consequences of not having the treatment Consent must be given voluntarily and can be withdrawn at any time.

Failure to share information with client

Clients need information about their treatments or proposed treatments to make appropriate and informed health care decision Breach of confidentiality

Client health information is held in confidential by health professionals. Disclosure of this information can occur only with the consent of the client or the client’s representative, or when authorized by law

Inadequate documentation and record keeping

Clients have the right to expect that accurate and adequate records about their health care are kept by their health care practitioners.

Health records are the means by which information about the client is communicated and continuity of care is maintained.

Misrepresentation

It is the responsibility of the individual Radiographer to represent the truth about her/his qualifications and abilities.

Clients must be able to identify and distinguish among various health care providers, as well as between regulated and unregulated health care practitioners.

Failure to meet legal /professional obligations

To continue to deserve this respect, Radiographer have a duty to participate in, and promote the growth of, the profession; to uphold the standards of the profession and to conduct themselves in a manner that is becoming to the profession.

Conflict of interest;

The primary focus of the radiographer’s relationship with clients is meeting the clients’ health care needs.

A conflict of interest exists when a radiographer’s personal interests could improperly influence her/his professional judgment or conflict with her/his duty to act in the best interest of clients

Fraud

• Falsifying a record related to MRICP
• trying to influence a patient to change his or her will or any other testimony document

signing or issuing a document that you knows it contains false or misleading statements

Medical Ethics concepts in maintaining patient medical legal requirement;

Radiographer clinical and legal responsibilities

Learning objectives

• By the end to the session the students will be able to;
• Describe and explain radiographers legal responsibilities

Describe and explain radiographer clinincal responsibilities

Radiographer

Radiographers are the technicians who deals with patients and operates the equipment Radiographer perform various functions in their effort to perfectly diagnose patient’s disease

Major duties, tasks and responsibilities of radiographer

Evaluate patients’ medical condition and history to determine most suitable radiographic technique for diagnosis.

• Interact with patients to offer them psychological support and address their concerns regarding an imaging procedure.

Adjust diagnostic equipment to deliver accurate amount of radiation to patients.

Operate complex medical instruments such as MRIs, CT scanners, X-ray, ultrasound, and several other imaging devices.

• Liaise with oncologists and physicians to plan treatment for cancer patients.

Direct and supervise the activities of radiography trainee radiographers.

Maintain proper records of patient details ensuring confidentiality of sensitive information.

Follow up on patients after treatment to track the progress of recovery and ensure patients show no signs of radiation side effect.

Explain to patients and their family the details of a procedure and ways to manage possible side effects.

Regularly inspect diagnostic equipment to ensure they are functional and operate efficiently.

Assist oncologists and physicians during complex radiological examination

Ensure compliance with health and safety guidelines to minimize risk of exposure to ionizing radiation.

Correctly position patients prior to X-ray imaging in order to obtain high quality films.

Use portable devices to conduct diagnostic scans on patients who can’t move to the radiology unit.

CLINICAL RESPONSIBILITY

TO CARRY OUT DAY WORK RADIOGRAPHER NEED

Some knowledge of practical procedure in the care of the patient Some knowledge of pathology and diseases process so that they do not worsen a diseases by uniformed handling of the patient Some knowledge of first aid and what to do in emergency situation so that they will be able to help the patient until the medical assistant arrive

Medical Ethics

We should not leave patient with unfavorable or depressing situation. It is necessary to surround the patient with right atmosphere To patient, it is very strange department so that the radiographer should be reassured first of all as to certain personal qualities and of professional capabilities Conform to the child protection

Make an easy relationship and reduce tension in the patient

• Handling of medical emergencies like allergies and other contrast reactions
• Assist Radiologist / physician during procedures
• Producing images / Process and evaluate radiographs

Observe principles of informed consent to the client / patient

Legal responsibilities

• Radiographer legal responsibilities can be considered under three heading
• Breach of professional conducts/conditions
• Negligence (breach the standards of patient care)

The process in the event of the accident

Procedures in the event of an accident

• Care of the victim
• Reporting of the accident (Done as soon as possible)
• Health and safety

Pregnant patients

Is responsible for continuous improvement of current practices

• Provide adequate information to individuals to that allows them informed choices

Practice healthful (conduct moral )behavior

Medical legal concepts in administering safe radiation to the patients

Legal requirements before practice

Learning objectives

• By the end to the session the students will be able to;
• Describe Qualification for Diagnostic Radiographer and licensing issues
• Describe radiographer professional duties and tasks

Describe Professional responsibility and accountability

Qualification for Diagnostic Radiographer

Must have obtained the necessary certified education, training, and qualification in their fields of practice from a nationally recognized and accredited institution in order to be considered competent in the diagnostic procedures they carry out.

Licensing

Licensing is the mandatory procedure for radiography. Registration aims at protecting patients by proving qualified radiographer The radiographer is responsible to obtain registration in the respective Council e.g. MRICP Radiographer may only perform diagnostic examinations after they registered by the council

Professional responsibility and accountability

• Maintain standards of personal conduct reflecting credit upon the professional
• Carries out responsibilities within the framework of professional boundaries
• Is accountable in maintaining practice standard set by MRIPC

Is accountable for own decisions and actions

Professional duties

Integrate patient history, supporting clinical data and imaging protocols with radiographic examination to obtain quality diagnostic results Be able to produce images with a high degree of accuracy, use diagnostic technology, and assess and analyze diagnostic images for technical quality or medical legal requirement

Medical Ethics

Need to possess critical thinking, problem solving and ethical decision making skills in order to practice as independent in healthcare professional Engaging in continuous professional development (CPD) to keep abreast of rapidly evolving advanced technologies and new healthcare practices

Medical Ethics

A sound knowledge of human anatomy, pathophysiology, medical terminology, science of imaging, patient care, human rights, ethics and health law and radiation effects as well as magnetic resonance imaging (MRI) electromagnetic effects, reinforces this professional

Practice within Scope of profession

General x-ray examination – conduct conventional diagnostic imaging of all anatomical regions according to prescribed protocols.

The above conventional diagnostic images include projections in AP, PA, lateral, oblique ore relevant modified planes dependent on the imaging request

Mobile radiography – perform relevant general examinations using mobile equipment in wards, ICU’s and emergency departments

Special precaution are to be used to prevent cross infection and protect health personnel and patient from radiation Fluoroscopy – work in collaboration with the radiologist or specialist medical practitioner to create real time image

C-Arm fluoroscopy unit may be operated by a diagnostic radiographer in the operating theatre and cardiovascular theatre

Angiography – produce images of cardiovascular system but, may not cannulate or administer contrast media Computed Tomography (CT) – produce cross-sectional images of the body but, may not cannulate or administer contrast media

Medical Ethics

Magnetic Resonance Imaging (MRI)- produce two or three or four – dimensional images of the body but, may not cannulate or administer contrast media Mammography

Bone densitometry – perform densitometry studies for bone mineral density assessment and associated criteria

Dental radiography

• Forensic radiography – perform forensic imaging studies for medical legal purposes.
• Preform limited ultrasound examinations

Diagnostic radiography tasks …….

Summary

• Qualification of the radiographer and licensing
• Professional responsibility and accountability
• Professional duties
• Practice within the scope of professional

Diagnostic radiography tasks