Nurse Practitioner and Image Interpretation

[cbott1]

Trying to implement a role for Nurse Practitioners and image interpretation at my hospital, currently not allowed to interpret chest x-rays but just request them, anyone experienced similar problems/opposition? How did you overcome it?

[Corey Narry, MSN, RN, NP]

I'm sure many others will offer their ideas. My take on it is that if the Scope of Practice for NP's in your state has no written limitations on NP's interpreting radiographic studies, I think it's a matter of convincing the Credentialing Board in your hospital to agree to allow NP's to function in this role. You may need a strong physician advocate on your side for this to happen. Medicare has no expressed limitations on NP's performing services that are considered physician-related as long as there is a mechanism in place to prove that the NP has a collaborative relationship with a physician who will serve as a back-up if situations arise that are out of the NP's expertise.

[jer_sd]

The issue is final interpretation, in the hospital even fils that the ER docs read get a final read by a radiologist. You can order and act upon findings before it has been read by a radiologist.

Now if a NP were to interprete imaging studies you are held to the same standards as a physician/radiologist. You can find the minimum # of studies to be read for recomondations for privilages, if you have documetation meeting teh requirements of guidelines you might be able to read studies in an outpatient center. At a hospital it would be doubtful that you will ever provide final image intepretation.

Jeremy

[Corey Narry, MSN, RN, NP]

I'll have to say that image interpretation to guide clinical decisions should be part of the NP's role. For instance, you have to be able to interpret chest films independent of the radiologist's reading if you are the provider caring for the patient directly. The radiologist has no idea what the clinical presentation is like and the diagnosis is based on the film alone. You, on the other hand, can tie your assessment with the radiology film. Most instances, we have to interpret our own CT films with our attending CT Surgeons especially when we are lookig at the mediastinum.

I had the impression that the OP was probably employed in a Radiology-type role where the intent was for the NP to interpret diagnostic films. I would have to agree with jer_sd that this is an uphill battle that the NP may not win especially if the NP is asking for priviledges as the "final reader".

[NurseKJ]

I have found in my RN experience as well as clinicals as an NP in the ED, that even the most experienced and knowledgeable ED physicians read their own images; however, that said, they ALMOST ALWAYS wait for the final read from the radiologist before discharging, admitting, ect... (for obvious or emergent cases, they of course, act upon their own reads before the final read).

For what it's worth, in my opinion, NPs should act in the same manner-- certainly an NP can wet read an image, but in the hospital setting, the radiologist should do the final read. Aside from the knowledge and experience that the radiologist has, you should also remember, that in the radiology department, the images are being read on monitors that cost thousand and thousands of dollars (ie, better picture, easier to read, ect). If you find it hard to believe that the picture could be better, look at an image on the computer on the floor, then go to the radiology room and look at the same image... it is remarkable, and one of the first things my preceptor showed me...

[APNgonnabe]

So in summary: as long as the state BON doesn't explicitly say that a APN can't read a film and the hospital credentials you to do so the APN should be able to do the prelim read, final by radiology.

[zenman]

And remember the first question you ask when you slap that film on the lightbox is, "Is this a quality film?

[ANPFNPGNP]

And remember the first question you ask when you slap that film on the lightbox is, "Is this a quality film?

I interpret x-rays at an urgent care clinic and everything is sent for radiology review the next day. I can tell you this, be very careful about reading chest x-rays, I still have problems reading them. I've seen experienced physicians misread chest x-rays and if they're making mistakes, then I certainly don't feel comfortable reading them.

When I have time, I pull x-rays and compare my findings to the radiology report. I'm good friends with one of the x-ray techs and we review the x-ray together before looking at the report. Another thing, I've seen radiologists make mistakes too, so make sure you always rely on your assessment of the patient!

[ruralnurs]

Another thing, I've seen radiologists make mistakes too, so make sure you always rely on your assessment of the patient!

This is so true. The PA I work with (in a small rural clinic that has an MD come a couple times per month) x-rayed a guy with suspected pneumonia. The radiologist read it as having a "rounded pneumonia." The PA did not buy it, he has been a PA for 16 years and was an x-ray tech and respiratory tech in the Army prior to becomming a PA. He CTed the guy and found a big ole tumor!

I aksed him what would have happened if it had been me (pretty new and way less experience) I would not have caught that and that tumor would have grown for who knows how long. And he told me "No, you would have re-xrayed him." He taught me that if you make the decision to x-ray someone once you are making the decision to repeat the x-ray on them later.

We have the old equipment and real films that we process in the clinic (our RN is our x-ray tech) and send them via UPS to a radiologist. I just did an x-ray on a 6 year old with a leg injury from jumping off a bed, nice spiral fracture of the tibia (off to the ortho she went). If I had done nothing and waited for a radiologist to read it no telling how much damage that kid could have had. Our radiographs are always final read by a radiologist but may take quite a while.

[marty6001, EdD, EMT-P, APRN]

I also interpret all the Xrays that come through the ICU off shift, as we have no radiologist on to do it. the CT scans get read off site and I get the report, but I also first look them before getting the read. I agree that if it's not listed as outside your scope, and your Collaborating doc agrees to it, it should be allowed...

[Aymese]

I am in the ACNP program at UAB. They are no longer offering the online course Radiology for the APN. I want to take this course somewhere and transfer the credit to UAB. I've been browsing some universities course catalogs and have yet to find an online option. Any of you know of a school that currently offers this?

[PICUPNP]

He taught me that if you make the decision to x-ray someone once you are making the decision to repeat the x-ray on them later.

THis is NOT a good practice to carry on with in your career. A single xray does not mean that it needs to be repeated. I almost never repeat cxr's on pedi patients unless there are extenuating circumstances. Even our intensivists and pulmonologists don't routinely repeat cxrs unless medically necessary.