Road to Radiography

We are experiencing drought conditions here worse than anything I have ever seen in my lifetime of living in this town.  The lake is 5 or 6 feet below normal.  I would have been standing in about 3 feet of water to make this photo if the lake was at normal level…

I don’t understand what happened to me today during my positioning test.  I made a simple stupid mistake.  Luckily, my instructor didn’t penalize me much for it, and I made a 98 on the test.  For this test, we drew a card out of a bag.  The card had three positions that we had to execute.  My card had PA 2nd digit, AP forearm, and Lateral elbow, all on the left upper limb.  Simple enough… actually much simpler than I expected.  These are all very easy positions.  For some unknown reason, I x-rayed my patient’s third digit rather than the second.  I have no idea why, and can’t come to any conclusions other than possible nervousness in the testing environment.  The good news is that I did the third digit properly and made no errors on the other positions.  I had full confidence prior to this test and I didn’t feel nervous during the test.  I know I read the card properly, because when I was explaining the procedure to my classmate patient, I told her that we would be making an x-ray of her index finger.  I’m just at a loss as to why this happened.  I’m too young to be experiencing senility :)

The other good news is that I made a 98 on my written test for this unit.  I was NOT highly confident after finishing this test, because I thought the test was very difficult.  When I find myself thinking that, I usually don’t do as well.  It took me the full hour of class to complete the test also…

Tomorrow we’ll start the humerus and shoulder girdle.  These are still part of the upper limb, but our instructor agreed to split this section into two separate positioning tests so we could start working on pre-comps and comps a little sooner…

Tags: 1st Semester, RAD-111 by John Setzler
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While I could have been preparing for my upcoming tests this weekend, I chose to spend my time at Oktoberfest where I saw The Alabama Blues Brothers and The Little River Band on Saturday night :) 

We got our tests back from the Patient Care & Intro to Radiography test that we had last Wednesday, and I made a 95.  I actually thought I did better, but I’ll take a 95 any day.  We spent our hour in the positioning class studying for tomorrow’s tests.  We have a written test on the upper limb and positioning tests from the fingers up to the elbow on the upper limb.  I still have a good bit of studying to do for that written test, but I’m ready for the positioning test.  The upper limb positioning isn’t too complicated as long as I can remember to angle the tube 10-15 degrees for the ulnar deviation projection of the wrist.  I actually think it’s simpler to angle the wrist with a foam block for that procedure, but I think the instructor just wants to make sure we know how to angle the tube.  Chances are slim that I’ll have to do that procedure anyway.  We won’t have to actually peform each procedure on this test.  We will be drawing a card with three procedures on it that we’ll have to demonstrate for this test.  That being the case, we still have to be prepared to do any of them. 

The written test is going to be a little more challenging.  Part of it will be to identify the projection used for various radiographs that we’ll be shown.  I have most of those down pat, but there are still a few that confuse me for some reason.  This early in my studies, they aren’t second nature to me yet.  I’ll also have to label diagrams of the skeletal anatomy of the upper limb.  There are still a few condyles, epicondyles, fossae, and tuberosities that I need to sort out in my mind :)  I should be ok, but we’ll see :)

Tags: 1st Semester, RAD-111 by John Setzler
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I had a successful day.  I completed my first master competency this morning.  I can now perform chest x-rays on my own without supervision.  Everything was perfect on my PA and Lateral views on this exam, so my first competency is complete!  I need three more master competencies this semester.  Hopefully I will be able to knock those down soon.  Any additional comps that I collect this semester (above the 4 I need) will roll over to next semester’s requirements, so hopefully I can get ahead of the game just a little. 

We had our midterm conference today to let us know where we stand.  I’m ahead of the game in most areas and at par in others.  I’m not behind on anything.  I got a 95.5% rating from my clinical preceptor on my evaluation.  I’m happy with that and I’m looking at some areas where I can improve during the second half of this semester.  I’m moving to a new clinical site starting next Thursday, so I’ll be meeting some new people and working on different equipment.  Hopefully this will be a smooth integration into a new environment. 

Tags: 1st Semester, Clinical by John Setzler
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We had a test in RAD-110 (Patient Care & Intro to RAD) this morning.  The good thing is that I was, once again, over-prepared.  I don’t know my grade yet, but I’m confident that I made an A. 

Tomorrow is my last day of clinical at my current location.  We’re having our mid-semester conferences to find out how our instructors think we are progressing and review that information.  I hope to get my chest master comp done tomorrow if the opportunity arises, but we’ll just have to see how that goes.  I may or may not get a chest opportunity tomorrow before the end of my clinical day at 11:30am. 

I have 3 tests next week.  The first test will be the written test for my current unit in positioning.  That same day, we’ll be tested on positioning of the fingers, hand, wrist, forearm, and elbow.  This test will open up a new group of competencies that I can work on in clinical.  The third test will be a lab test in the patient care and intro to RAD class.  It’s gonna be a busy week…

Tags: 1st Semester, Clinical, RAD-110 by John Setzler
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Some of my classmates were discussing the possibility of having some T-shirts made for the members of our class.  Our instructors told that if we showed them some good ideas, we could possibly get some made, so I’m submitting this idea.  My sister owns a tattoo shop, so I talked one of her tattoo artists into drawing this hand for me to use on this project.  This particular design would be for the back side of the t-shirt.  I’m thinking that the hand and maybe either “Class of 2009″ or “Radiologic Technology” as a smaller image on the front pocket or chest of the t-shirt…  What do you think?

Tags: 1st Semester, Miscellaneous by John Setzler
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I had a disappointing day in clinical today.  I was stoked about having the opportunity to complete my master competency on the CXR.  I got my final pre-comp, and immediately following that, I had the opportunity to do another for my master competency.  I got my patient and made the PA and Lateral view x-rays, and then went to look at the images.  I had a hypersthenic patient, so I had to shoot the PA view with the IR mounted crosswise in the bucky.  That X-ray was, by far, the best image I have made on my own so far.  Everything was perfectly centered, with no rotation, and everything was in place.  I did NOT collimate any with this patient because of his size.  When I pulled up the lateral view, I was discouraged immediately.  First of all, the image was good.  Everything that I needed for a good x-ray was in place, except for my marker.  I had placed it too close to the edge of the image receptor.  When I’m doing erect exams, I always place my marker on the outside of the board rather than directly on the image receptor.  I placed this marker in the light, but apparently, it was not good enough.  About 20% of my marker was cut off the edge.  I also did not collimate any on the lateral view when I probably could have.  Our instructors want to see visible collimation on all x-rays.  With the size of this patient, I didn’t want to collimate on the PA view for fear of having to re-take it.  I should have collimated on the lateral view though.  During my five pre-comp exams, I collimated on every view… even if it was just a little bit, just to show collimation on the image. 

What Have I Learned Today?

The main thing I learned today is that an image that I submit as a master competency image must be perfect in every way.  I understand the reasoning for this and I will make it happen on my next attempt.  I think part of my problem with collimation on chest x-rays is the fact that the positioning light is smaller on the patient than the size of the image receptor.  The light is representative of the x-ray primary beam though.  But as the beam travels closer to the image receptor, it continues to spread.  Since the light I see is smaller than the image receptor, I have less confidence that I’m not going to clip something that is an important part of the view… such as the costaphrenic angles.  I need to work with what I KNOW on the chest and abdomen views rather than what I see :)

Ok… I’m ready for a long weekend now.  We’re out of school Monday and Tuesday, but I still have a test to study for coming up on Wednesday morning…

Tags: 1st Semester, Clinical by John Setzler
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Our mid-semester conferences have been scheduled.  Mine is scheduled for 12:30pm on October 11th.  This is normally a clinical day, but we will get out of clinical at 11:30 instead of 2pm so we can have these conferences.  The purpose of this conference is to evaluate our progress towards our goals for the semester in clinical.  My semester goals for the RAD-151 Clinical class are as follows… I still have two more clinical days before the mid-semester point:

I’ll have a new number of procedural observations required for next semester, and it will be a lot more since our clinical will be two days per week instead of just one.  I should get my first master comp on the chest x-ray tomorrow.  I got 4 pre-comps last week and just need one more before I can complete that.  I would like to get a couple KUB and erect abdomen pre-comps tomorrow as well if at all possible.  I need 5 pre-comps on the KUB and just 3 on the upright abdomen.  Currently, these are the only procedures I’m allowed to pre-comp and comp, so getting 4 master comps right now is an impossibility.  We have to pass our lab test on the procedure before we can pre-comp the procedures in clinical.  I’ll be testing on fingers, hand, wrist, forearm, and elbow in lab on October 16th, so that will offer me up some more opportunities in that arena.  In theory, there actually are two more exams that I can pre-comp and comp.  They are the pediatric chest and abdomen.  In my clinical site, I haven’t seen a pediatric patient yet having those exams, so it may or may not be a possibility.

We’re out of class on Monday and Tuesday of next week, but I will return to a test in the Patient Care and Intro to Radiography class that’s gonna require a lot of study time.  I’m going to dedicate Monday and Tuesday to studying for that test and I’m gonna relax all weekend (or as much as possible.) 

Tags: 1st Semester, Clinical by John Setzler
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I have opened my new online store for my photographic prints.  The above image is a sample from that collection.  Click on the image to visit the store…

Today’s lab in the positioning class was excellent.  We spent the entire lab practicing positioning of fingers, hand, wrist, forearm, and elbow.  Our next test is going to split the upper limb into two sections rather than having them all on a single test.  The humerus and shoulder will be on the second of the two tests, and the rest will be on the first test.  We are out of school next Monday and Tuesday, so I won’t have another lab period before we have this positioning test. 

I spent the entire lab period today working with another student on these positions.  She had missed part of the first lab on upper limb, so we spent the period practicing on each other.  I’m still thinking about my ‘personal’ positioning guide, but I haven’t started on it yet.  I’m actually going to ditch that idea after thinking about making photos to go with it.  Photos are important for that, and I don’t want to drag my camera gear to school to do it. 

In regards to the positioning we practiced today, I found a couple of them to be particularly difficult for the patient.  The AP thumb wasn’t particularly easy.  A patient with arthritis might find this to be a nightmare.   The AP Lateral Oblique position for the elbow is also a bit challenging. 

Our positions for this segment are:

** The 2nd digit oblique and lateral are done with a medial rotation rather than lateral.  The thumb (1st digit) is done AP instead of PA under normal circumstances. 

Tags: 1st Semester, RAD-111 by John Setzler
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We continued our study of the upper limb positioning today with the forearm, elbow, and humerus.  After looking at these, I think I want to create my own positioning guide.  I mentioned this earlier, but I think I’m going to start working on it so I don’t get too far behind my studies.  Since photography is my hobby and bread and butter while I’m in school, I might even make photographs to go along with the positioning techniques.  I know it’s sorta like re-inventing the wheel, but I think it will be a decent study aid also…

Several students showed up this morning with big grins because they had completed their comps on the CXR.  I hope to finish the chest on Thursday and at least get started on my abdomen stuff too.  We have to complete four comps by the end of the semester, which shouldn’t be too difficult.  We are going to test on the hand, wrist, forearm, and humerus in about two (or maybe three) weeks, so that will open a few more doors.  We’re saving the shoulder girdle for a little later.  We’ll see how that goes :)

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