Road to Radiography

We had a really fun lab today in our Patient Care & Intro to Rad class.  We x-rayed some phantom hands to demonstrate density maintenance and the inverse square law.  Our first test was a standard hand x-ray at a 40″ SID with the kVp set to 55 and the mAs set to 1.2.  We did the same x-ray at a mAs of 2.4 and 5.1 to demonstrate the changes in film density.  In this demonstration, the penetration of the beam did not change.  We measured the density of the films with a densitometer, and the results were what we expected.  The density approximately doubled on each consecutive exposure.  The next set of three exposures were all at a mAs of 2.4 with kVp settings of 46, 55, and then 64 (using the 15% rule.)  The results of these images were interesting.  We have studied the idea that mAs is the controlling factor of density, but we got to see here that kVp affects density as well.  In the second set of images, we did not change the mAs settings, just the kVp, yet our density readings on the three films gave us the same results as the first three where we manipulated the mAs.  Increasing the kVp increases the penetrating ability of the x-rays which, in turn, adds exposure to the film because more x-rays are penetrating the body part.  However, changing the kVp also changes the penetration of the body part, which may or may not be the desired solution. 

We did another set of three images at 20″, 40″, and 80″ to demonstrate the inverse square law.  The 80″ image was a challenge.  We had to put the image receptor on the floor because the tube would not go up 80″ above the table, and even if it would, we would have needed a ladder to get to it :)

I’m off to clinical in the morning.  I hope I can pick up some more pre-comps this week.  I have 6 clinical days left this semester and I only have one master competency so far.  I need three more to get a grade of 100 on that section of the class.  Three master comps gets me a 93 in that section, but I would prefer to get four.  Adding the humerus and shoulder girdle to my opportunities may help out, but I haven’t seen many shoulder and/or humerus exams performed during my previous clinical days.  What I see the most of that I can’t pre-comp yet is C-spine, T-spine, and L-spine exams.  We start the spinal series in January.  We’ll finish this semester with the lower limb and pelvis.  Pray for pre-comp opportunities for me tomorrow! 

Tags: 1st Semester, RAD-110 by John Setzler
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We had an interesting turn of events in our positioning lab today.  We were scheduled to learn the clavicle, AC joints, and scapula positions, which we did.  We decided to ask our instructor to go ahead and test us on these positions because we weren’t scheduled to take that test for two more weeks, and we wanted to get them out of the way before we dive into the lower extremities tomorrow in class.  So, we tested and now have a few more pre-comps we can start working on in clinical this week.  Just like last time, this was a hat draw method of testing, so we didn’t have to demonstrate each position.  We had to know them all because we didn’t know what we would draw, and I got the most difficult one of the bunch I think.  The superoinferior axial shoulder view is what I came up with from the hat.  I knocked it out though… perfect score on the positioning test.  This is the only shoulder view that uses an angled tube, and it’s a table-top exam rather than at the wall bucky.  So tomorrow, we start lectures on the lower limb anatomy and positioning.  There are a lot of positions to learn here, so getting a head start will be nice…

Tags: 1st Semester, RAD-111 by John Setzler
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My written test in my positioning class today was a disaster.  I spent a lot of time studying for it, but apparently it wasn’t enough.  I made an 84, which is my lowest grade of the semester in any of my classes.  After taking the test, I realized that my study approach was simply not the right one, so this mistake won’t happen again.  I’ll be much better prepared for my next test.  I’m simply not good at memorizing long lists of information, which is what I really needed to do for this test.  All of the shoulder girdle positions, including the alternate and obscure, were included on this test, and I needed to know everything from patient position and central ray angulation to what the resulting radiographs look like.  I’ll do better next time…

In the RAD-110 class, we started discussing “MedicoLegal” talk.  We covered things like assault and battery and slander and libel.  Healthcare facilities and the people who work in the industry are too often targets of lawsuits, so being aware of proper procedure is very important.  If you aren’t familiar with “Res Ipsa Loquitur” you might want to look it up…  This is where innocent until proven guilty doesn’t necessarily apply…

Tags: 1st Semester, RAD-110, RAD-111 by John Setzler
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This is the group of people I spent 11 days with in early May as we toured the four-corners area of New Mexico, Arizona, Colorado, and Utah…

Yesterday’s clinical was fairly productive.  I picked up two more pre-comps on the KUB, and I also learned how to operate the portable x-ray unit.  I got a lot of procedures on Thursday, but I could have had even more.  During my process of becoming a radiographer, I have discovered one interesting (but useless) fact.  I’m glad I’m not in Human Resources.  When I arrived at my clinical site yesterday morning, I was told I had to go take a drug test.  That’s not a big deal, but we had to be drug screened before we started this program.  I don’t guess that one bit of information like that can be transferred to someone else.  I was also told that the huge stack of paperwork they gave me to complete for this site was the wrong stuff.  They handed me another stack of paperwork to do.  As I started looking at that stack, I noticed that it was part of what I had already done.  The packets they gave me were even the SAME ones I turned in previously, complete with the completed tests and everything.  I took it back to the HR department and turned it in.  I can’t imagine what it would be like to have to manage and maintain all that paperwork.  Anyway…

I’m trying to start something a little different with my procedure log.  In an effort to gain a better understanding of technique, I’m trying to note the kVp and mAs settings that the console is showing for the exams I’m participating in.  When we are using automatic exposure control, which is most of the time, there are presets for the kVp, but the actual mAs that gets used will vary from patient to patient based on their size.  Since all of my clinical experience so far has been with AEC consoles, I’m not getting a good grip on the technique used for most exams.  I want to build a technique chart that will help me get a better understanding of this.  The rest of my weekend, besides work, will be spent studying for my test on Monday…

Tags: 1st Semester, Clinical by John Setzler
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My RAD-110 test today seemed way too easy.  It could possibly be the first test where I get a perfect score this semester.  I knew all the answers, so unless I made a stupid mistake or mislabeled the scantron test sheet, I think I did really well on this one.  My weekend is going to be spent studying for the next positioning written test.  The anatomy won’t be too difficult, but the long list of positions of the proximal humerus and shoulder girdle is going to take a lot of work to learn.  In the actual positioning lab, I only have to be able to demonstrate these positions:

Humerus: AP

Humerus: Lateral

Humerus: Transthoracic Lateral

Shoulder: AP Internal Rotation

Shoulder: AP External Rotation

Shoulder: Superoinferior Axial

Shoulder: Scapular Y-Lateral

For the written test, I have to know these special views in addition to the others:

Shoulder: Lawrence Method (Inferosuperior Axial)

Shoulder: Neer Method (Supraspinatus/Outlet View)

Shoulder: West Point Method (Inferosuperior Axial)

Shoulder: Grashey Method (Posterior oblique / AP projection)

Shoulder: Garth Method (Posterior oblique / AP Axial projection)

Shoulder: Stryker Notch (AP Axial)

I have a lot of studying to do.  On the written test, it’s hard to guess at what the questions will be like.  They are usually multiple choice where a situation is described where we need to look at something specific, and we are asked to choose which method.

Tomorrow, I’m back to clinical.  I hope I’ll get a few more pre-comps completed, and if I’m lucky, I’ll comp something, but I’m not expecting it tomorrow.  The closest I am to another comp is on the hand.  I need two more pre-comps before I can comp that one.  Maybe I’ll get some more pre-comps on things I don’t have yet…

Tags: 1st Semester, RAD-111 by John Setzler
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We started digging in to the humerus and shoulder positioning techniques in lab today.  The positions we studied are:

AP Humerus

Lateral Humerus

Transthoracic Lateral Humerus

AP Internal Shoulder

AP External Shoulder

Superoinferior Axial Shoulder

Scapular Y Lateral Shoulder

All of these views are 40″ SID with the CR perpendicular to the image receptor, except for the suproinferior axial shoulder, which uses a 40″ SID with a 5 to 15-degree angle on the tube towards the elbow.  The AP and Lateral Humerus views use a 14×17 image receptor in most cases, while the rest can use 10×12 (or possibly 8×10 depending on the patient.)

These positions aren’t too difficult.  The transthoracic lateral humerus requires an interesting breathing technique, because it’s a rather long exposure at 4-5 seconds.  The technique is rapid and shallow breathing to blur out some of the anatomy in the picture.  The patient positioning for the AP and Lateral Humerus is practically identical to the positioning for the AP Internal and External shoulder.  The only difference is where you are centering your beam and what you are actually looking at.  We spent about two hours in lab practicing these positions.  Each student took a turn at positioning another student for these routines. 

I really wish we were actually able to make some radiographs.  Our instructor is watching what we do and telling us where our problems may be, but executing a positioning routine and then not having a radiograph to see afterwards still feels strange to me.  We don’t really know how good our positioning technique is without being able to see a resulting image.  I do realize that we can’t radiate each other all semester :) 

I’m having a test in the morning on imaging concepts.  This test is covering a lot of general topics such as the inverse square law, density maintenance formula, mAs calculations, photographic and geometric properties of images, contrast, density, film (what it’s made of and how it works), intensifying screens, grids, grid ratios, grid frequencies, et cetera.  I don’t think it’s going to be too difficult, but I’m going to spend an hour or two studying anyway.

Tags: 1st Semester, RAD-111 by John Setzler
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In today’s positioning class, we started looking at the humerus and shoulder girdle.  The humerus is quite simple with just two primary views.  The AP and Lateral views of the humerus seem simple enough.  The shoulder, however, is going to be quite a bit more complex.  My book is showing 17 views in the shoulder girdle area.  I know some of these are special views, but there is going to be a lot of work here.  We looked at a lot of these in class today via a powerpoint presentation, but we’ll start on them in lab tomorrow.  I think this will be the first really detailed section of the body we have studied so far.  There is a lot of anatomy and bone detail in this area. 

After the three tests I had last week, I thought I was gonna be test free this week, but we’re having a test in the Intro to Rad and Patient Care class on Wednesday.  This test is on basic concepts of imaging, and I don’t think it’s gonna be too difficult.  I’ll have a written test in the positioning class on Monday on the shoulder girdle anatomy and positioning concepts, so this weekend will be spent studying quite a bit. 

Tags: 1st Semester, RAD-111 by John Setzler
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I got an invitation to join Phi Theta Kappa today.  I know what it is, but I’m having a hard time understanding the benefit of me joining this organization.  There is a lot of scholarship money that they offer their members, but it looks like a large majority of it is for two-year college students who are planning to transfer to a four-year school immediately after graduation.  Can someone tell me if there is any benefit for me beyond being able to put it on a resume?  That alone may be worth the membership…

Tags: 1st Semester, Miscellaneous by John Setzler
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I had my first day of clinical at the new site today.  The new site is a hospital, so the ’scenery’ is a little different from the outpatient setting I have been in for the last eight weeks.  I was involved in 10 procedures today, and 5 of them were chest x-rays.  I did those myself with the help of a tech on a wheelchair exam.  The wheelchair PA chest is a separate comp, so I got one of my required pre-comps on that exam.  One of my chest x-rays was on an 8-year-old girl, and I think my cut-off for the pediatric chest is age 6, so I emailed my instructor to ask if I can use that as a pre-comp or not… I don’t think I can.  I picked up a pre-comp on a hand exam and another on a KUB, so the day was productive.  I have to participate in 125 procedures this semester for a grade of 100 in that section, and I have completed 89 of those already.  I need 4 master comps for a grade of 100 in that section, and I still only have one of those, but I feel confident that I’ll get at least 4 comps by the end of the semester.  My personal goal is 6, so we’ll see how that goes.

In the new clinical site, I quickly encountered a couple differences in the way we are taught and the way things are actually done.  I have been expecting this, but I didn’t see that much of it at my last site.  The tech I worked with this morning on the chest x-rays doesn’t like to make the image on the second full inspiration.  She wants it done on the first in an effort to save time.  I’m not particularly happy with that, but I suppose I have to ‘be like the Romans’ in this instance.  I was also told that if I do a finger exam that I should include the entire metacarpal all the way down to the wrist.  I’m not sure if this is a radiologist requirement or what, but it’s different than what I have been taught. 

Two of the techs I’m working with at the new site graduated from my program last may, so that is sorta interesting.  Both of them will be helpful to me in understanding lots of details about my instructors and their expectations since they have already been down this road. 

Now… I’m glad this week is over.  I aced three tests and had a first day at a new clinical site.  I don’t have a lot of studying to do before Monday other than to look over a few lecture notes and possibly complete my next unit in Medical Terminology.  I can’t remember if I have mentioned it here before, but “Medical Terminology” is a self-study portion of my Patient Care & Intro to Rad (RAD-110) class.  The tests that we take are online and the book is broken up into 12 units.  If we stay on schedule with that part of the program, we will finish with 4 weeks leftover in the semester.  I’m currently on schedule.  I have taken 9 of the 12 tests.  I’ll probably try to get prepared for the next test over the weekend. 

Tags: 1st Semester, Clinical by John Setzler
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I completed my third test of the week today, and I’m confident that I made an A on it.  After this week, my confidence is high as far as my grades are concerned.  As I mentioned earlier, I have a 4.0 grade point average coming into this program.  Finishing this program with a 4.0 grade point average would certainly be nice, but I’m going to have to quit worrying so much about that.  I’m doing the best I can under my own circumstances.  Working and being a full-time student is not an easy task.  I have to make trade-offs constantly to balance the time I have.

We started the next section in our positioning class today, but we did not dive directly into the humerus and shoulder girdle like I thought we would.  We are looking at some more anatomy first.  Today’s lecture discussed bone and joint types in detail, which we’ll have to know for the test.  Everything I saw today was review of what I learned in Anatomy & Physiology last year, but I’ll still study hard for the next test. 

I have clinical at a new site tomorrow, and I have just finished up a huge stack of paperwork that’s required at that site.  I’ll be in a hospital environment for the next 8 weeks.  In an effort to keep myself focused on my objectives in clinical, I have added a “Goals & To-Do List” section to this blog on the right menu.  I have listed my requirements and goals for the remainder of the semester.  After closely examining my comp requirements, I made a list of things that I can comp now, and I’ll add to that list as the comps become available to me.  I need 4 comps this semester and I only have one so far, but I have set a goal of 6 for this semester, which may be out of my reach, but I’m going to give it a try.  I’ll be the only student in my clinical environment for the remaining 8 weeks of the semester, so I won’t have to share my comp opportunities with someone else. 

I’m looking forward to this week being over.  I’m still enjoying everything, but this particular week has been rough with three tests on the schedule.  At least that part is over :)

Tags: 1st Semester, Clinical, RAD-111 by John Setzler
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