R.T.s in D.C. Urge Congress to Support CARE Bill Cosponsors Sought for House Resolution 1214

By Robin Anderson,
ASRT Scanner Managing Editor

R.T.s in Washington, D.C., on April 1 worked their way through hundreds of protesters between the House and Senate buildings to press their message about the Consumer Assurance of Radiologic Excellence (CARE) bill recently reintroduced in the House by Rep. Heather Wilson, R-N-M. This year’s “R.T. in D.C.” event was conducted against the backdrop of an affirmative action protest in front of the Supreme Court building and amid concerns about safety due to the war in Iraq.

Despite the challenges and concerns, more than 100 R.T.s walked for miles and talked for hours about the importance of the CARE bill in assuring all patients access to quality imaging and therapy services. They answered concerns about states’ rights and when the Senate version might be introduced, and they encouraged the representatives who signed on before to honor their prior commitment.

Overall, the R.T.s who spoke after their visits were enthusiastic about the opportunity to encourage more representatives to cosponsor House Resolution 1214 and to gain support when the Senate version of the bill is introduced. They went into the lobbying effort buoyed by a full day of information and role playing, organized and executed by ASRT government relations, and with additional knowledge provided by two professional lobbyists retained by the ASRT to promote the legislation in the House and Senate.

But it was the R.T.s who made the appointments and the pleas to legislators and their staffs. Almost three-quarters of the radiologic technologists who attended were veterans, having attended at least once out of the past five years that the ASRT has sponsored the event. As part of a strong alliance of organizations supporting the CARE bill, the Society of Nuclear Medicine Technologist Section joined the effort.

On the House Side

At one House visit, the Mississippi delegation showed Ryan McBride, a radiologic technology student, how to promote the bill, along with encouraging him to add his own observations. The R.T.s talked with Jason Dedwylder, a legislative aide with Rep. Chip Pickering, R-Miss. The representative was one of 54 who had signed as a co sponsor on last year’s bill.

Rep. Wilson has sponsored the CARE bill for the past two years, as H.R. 1011 last year. In March, she referred H.R. 1214 to the House Subcommittees on Health and Environment and the House Committee on Energy and Commerce. The committee, consisting of 57 House members, will be the next step for the bill. If H.R. 1214 reaches committee and is considered to have a substantial public impact, the committee will hold hearings.

The House has 435 members, with a simple majority needed to pass legislation that makes it through committee and onto the House floor.

On the Senate Side

ASRT members approached the Senate with a draft bill that Sen. Ted Kennedy, D-Mass., is expected to introduce after Congress reconvenes following an April district work period. A Senate sponsor is needed to champion the legislation into the committee hearings with the Senate Committee on Health, Education, Labor and Pensions (HELP) and on the Senate floor if is approved by a majority of the HELP committee and is referred to the full body. To become law, the bill must be voted in both the House and Senate.

A Tennessee constituent breakfast sponsored by the offices of Senate Majority Leader Bill Frist, R-Tenn., and Sen. Lamar Alexander, R-Tenn., offered Cathy Parsons, R.T.(R)(M)(QM), ASRT secretary-treasurer, the opportunity to speak to Sen. Frist’s staff. In phoning his office, she was told that the breakfast would be her best chance to tap the majority leader’s staff.

Later that morning in another Senate building, Jo Piccone, R.T.(R), and Diane Kosenko, R.T.(R), of Connecticut met with an aide in a small room separated from the main office of Sen. Christopher Dodd, D-Conn. They pressed their case for the bill with a statement that everyone should be ensured quality care by setting minimum standards for anyone taking an x-ray. The R.T.s were questioned about the availability of qualified personnel if the legislation passed, to which they replied that MQSA had not shown a decrease in mammographers, despite a requirement that practitioners be registered mammographers.

Wrap-up

Following the long day of visits on the Hill, participants expressed their optimism about getting House cosponsors.

Some of the R.T.s’ optimism about cosponsors war realized shortly after the R.T. in D.C. event, with 16 representatives signed on as cosponsors of the CARE bill. The cosponsors as of April 9, listed in alphabetical order, include Rep. Spencer Bachus, R-Ala.; Rep. Lincoln Davis, D-Tenn.; Rep John J. Duncan Jr., R-Tenn.; Rep Harold E. Ford Jr., D-Tenn.; Rep. Barney Frank, D-Mass.; Rep Jay Inslee, D-Wash.; Rep Steve Israel, D-N.Y.; Rep. Dale E. Kildee, D-Mich.; Rep. Peter T. King, R-N.Y.; Rep. William O. Lipinski, D-Ill.; Rep. Carolyn McCarthy, D-N.Y.; Rep. Donald Payne, D-N.J.; Rep. Earl Pomeroy, D-N.D.; Rep James T. Walsh, R-N.Y.; and Rep. Melvin L. Watt, D-N.C.

“Our fifth ‘R.T. in D.C.’ showed that ASRT members are becoming skilled lobbyists and have made excellent contacts on Capitol Hill,” said Christine Lung, ASRT director of government relations. “However, to ensure that their visits are successful, they need to mobilize their colleagues back home to follow up with the legislators they met with.”

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MR CLAUSTROPHOBIA: R.T.s GUIDE PATIENTS INTO THE BORE

By TOM SANCHEZ,
ASRT SCANNER LEAD WRITER

When magnetic resonance imaging first was used on a human being more than 25 years ago, it took five hours to produce a single image. Today, MR imaging is a sophisticated diagnostic technique that produces better soft tissue images than x-rays can. With a static magnetic field up to tens of thousands of times stronger than the earth’s own magnetic field, the MR procedure is not without its caveats. The unit remains unchanged in that it is noisy and, for most patients, confining. While most pediatric patients are mildly sedated or given melatonin to make them sleepy, many Radiologic technologists are not always sure what to expect when adult patients are slid into the bore on the unit’s special table.

Jessica L. Shull, R.T. (R) (MR), who works for White County Medial Center, Searcy, Ark., remembers one memorable MR procedure she performed.

“I had one lady who started jumping around as soon as she was placed in the magnet, and shortly after, she was banging her head on the sides of the tunnel. I couldn’t get her to lie still while I moved the table out, so I had to move it amid all her excited movements. She was so scared she couldn’t speak. When I had the table all the way out, she leaped out of the bore and ran to the dressing room with me chasing after her.”

On another occasion, Ms. Shull was scanning a patient’s lumbar spine when she noticed that as the images reconstructed, the spine was in a different place on the screen at every image.

“The patient was in her 60s, and I had one scan left to do for the exam,” Ms. Shull said. “The patient had been fine up until that point, and had never mentioned being claustrophobic. I looked at the computer screen and saw her trying to crawl out the other end of the magnet. I ran into the room, hollering at her to be still while I removed her from the bore. When I got her out, she was crying and visibly shaken. I asked her what was wrong, and she said she had gotten scared. I asked why she didn’t use her call button, and she asked, ‘What call button?’ I looked down and said, ‘The one in your hand.’ She started crying and apologizing. In her anxiety she had completely forgotten that she had the button and that I had told her to push it if she needed me for anything.”

Claustrophobia is a morbid dread of enclosed spaces. “Claustrophobics sometimes describe it as a fear of closed spaces or fear of being closed in and some say it feels as if the walls are closing,” reports Phobias Cured, an online organization that helps people overcome their phobias, fears and panic attacks. “Fear of enclosed spaces can first become apparent when certain medical procedures are performed. An MRI requires that a person be in a small enclosed space for a period of several minutes. Anxiety levels for claustrophobia sufferers can reach panic levels during an MRI procedure.”

Claustrophobia ranges from nervousness to patients who cannot pass through an MR scanner, said Doug Venable, R.T. (R) (MR), who works for Alliance Imaging, Birmingham, Ala.

“The extreme claustrophobic patients will have to try an open MR or go under sedation to be scanned,” he said. “Patients who are less claustrophobic can receive a lot of help from R.T.s. I’ve offered washcloths to cover the eyes of patients, talked to them after each sequence or had a family member stand next to the scanner and hold their ankle or foot.”

Trying the “initial scout sequence: is the most effective technique for helping patients overcome their initial fear, said Mr. Venable.

“The imaging sequence often is only a minute long, and then I ask patients how they are doing. Many patients realize quickly that the procedure is not so bad,” he said. “It also helps patients if their physicians can prescribe a mild sedative, such as valium, for them---provided, of course, that they have someone to drive them home.”

Mr. Venable believes that most patients do better if R.T.s communicate and assure them that the R.T. is there to help.

“Just giving the patient the squeeze bulb to audibly alert the radiologic technologist gives them a measure of control over their fear,” he noted.

Open MR units are becoming more common in large cities across the United States, he said.

“The best possible scanning environment, in my opinion, would be a high strength magnet and an open magnet,” Mr. Venable said. “This would help very claustrophobic patients as well as extra-large patients who cannot fit in a high-field magnet. The image quality is much lower with an open magnet, but it has improved in some of the newer scanners.”

Open MR units also have the endorsement of Robin R. Kinman, R.T. (R) (MR), who works for Southwest Alabama MRI Services, Mobile, Ala.

“We definitely have better results scanning claustrophobic patients in the open unit,’ she said. “However, we still get patients who have claustrophobia to such an extent that they feel too confined even in an open unit. I have found that the best way to help these patients are to spend time talking with them. We offer to let a family member accompany them into the scan room after explaining the test thoroughly so they know exactly what to expect. We let them look at the equipment before they begin the exam. Usually, these patients are embarrassed by their claustrophobia, but we don’t treat their fears lightly. Whatever happens, we make sure patients don’t leave feeling ashamed of their claustrophobia.”

Ms. Shull said that patients don’t like the MR unit right over their faces, and they prefer to come to the imaging suite medicated because their time in the machine seems shorter.

“We purchased a Philips ACS-NT 1.5 Tesla magnet because we felt this could better serve our patients,” she said. “It is not an ‘open’ magnet, but is considered a ‘short bore’ magnet, so the patient has the feeling of being in an open MR environment but we maintain a high quality scan. The diameter of the tube is much larger and the ends of the tube are flared open, so it gives the patient more room we get referrals most every week from smaller facilities whose MR machine cannot accommodate the larger patient or patients who are too claustrophobic to withstand the smaller machines.”

Recently, there have been health car articles suggesting that cucumber oil essence has a calming effect and can help with MR claustrophobia, said Cathy Smith, R.T. (R) (CT), an account executive with the ASRT Association Management Company who also works per diem at a university clinic and MR research center.

“We place a few drops of the cucumber oil on a cotton ball and put it on the pillow next to the patient’s head or have them hold it so they sniff it at will,” she said. “It’s supposed to help claustrophobia. We use this at our outpatient center and it seems to be fairly effective.”

Aromatherapy helps reduce MR assessment anxiety, according to Kim Albers, R.T. (R) (M), who works for Irvine Regional Hospital and Medical Center in Irvine, Calif.

“I thought that MR machines were scary for patients so I wanted to make the whole experience more relaxing,” Ms. Albers said in an article on the ASRT Web site.

After reading a story about how cucumber oil relieved anxiety, Ms. Albers decided to put some inside the MR scanner.

“It smelled wonderful, and patients loved it,” she told ASRT contributing writer Laurie Volkin, M.S. “They were so relaxed.”

Alternative stress-relief methods are finding support beyond Irvine, Calif. Researchers at Yale-New Haven Hospital in Connecticut is studying acupuncture and hypnosis to relive patient stress and anxiety.

In the long scheme of things, however, communication is still the key to helping patients complete an MR examination, Ms. Schull said.

“You must gain the patient’s trust at this point. I first show patients the scan room from the outside, and this alleviates a lot of anxiety at this point. Their mind has usually envisioned something much worse. I explain that the other end of the ‘tunnel’ is open. Even though they’re looking at it, they don’t realize it a lot of times. I explain that the system we have is much faster than others, and they’re relieved to find out that the scan is only 15 to 20 minutes, as opposed to the 45 to 60 minutes they were anticipating.”

An R.T. should get to know the patient, usually in a short period of time, she said.

“Patients must trust that you are going to do everything in your power to make the MR procedure a positive experience for them,” she said. “I let the patient know that I am a licensed radiologic technologist, and that I have my MR certification as evidenced by my credentials. I let the patient know that we have a commitment to quality, reflected by our recent accreditation by the American College of Radiology which our facility advertises. Patients have the right to know where they can receive the highest quality care in their area.”

Ms. Shull said it helps to let the patient get to know her.

“I tem, truthfully, of my own claustrophobic experience and it puts them at ease to know they’re not alone,” she said. “I tell them how I got through it, and explain to them that I’m gong to help them get through it, and explain to them that I’m going to help them get through it, too.”

Comfort is important for the patient, Ms. Shull said.

“I place the patient in feet first if the type of exam allows,” she said. “I find it helps a lot of patients, even if just mentally, to know their head is closer to the door than the back wall,” she said. “Our machine has a compact disc player for the patient, and our facility has a large selection of compact discs on hand just for the patient. We allow patients to pick their favorite types of music before they enter the MR suite. This ‘tailors’ the visit to the patient somewhat, and lets the patient know you care about their comfort. MR patients are even allowed to bring a favorite CD from home, if they desire.”

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