A Tough Week

I know I have been busy when I haven’t had time to write a blog entry.  This week has been busy.  We had our first test in the positioning class today, and it only covered the spinal anatomy.  I made a 97, so I’m quite happy with my first grade of the new semester.

We had an interesting lab in our imaging class yesterday afternoon.  We had to do a demonstration of the relationship between mAs and density on radiographic film.  Our experiment consisted of five x-rays, all shot at 40″ SID and a kVp of 55.  We used a phantom hand and a step block as subjects and shot 5 images starting at 1.2 mAs, and doubling the mAs each time up to a mAs of 22.  As we expected, each consecutive radiograph got darker, but we used the densitometer to measure the actual density on one of the step block steps for consistency purposes.  What we discovered is that the data points we collected created an S curve on the graph rather than a linear relationship.  What this showed us is that doubling the density won’t continue to increase the ‘blackness’ of the film noticeably after you reach a certain point.  In theory, it would continue to get darker, but the film’s responsiveness falls off at a certain point.  The same holds true on the lower end of the mAs range, but we didn’t really have a way to demonstrate that part of it since our controller won’t let us shoot at a mAs of less than 1.0.  If our controller would let us set mAs to .1, .2, and .4, we would not have seen a dramatic change in density between those images.

There is a possibility of frozen precipitation here in the foothills of the western North Carolina mountains late tonight and tomorrow, so there is a possibility that I won’t have clinical tomorrow.  Our department head instructed us NOT to go to clinical if school is closed for bad weather, and to go on a delayed schedule if the school operates on a delay.  This is no big deal, but I would rather go to clinical if my clinical site is up and running.  In an orthopedic office, I’m not sure how busy they would be if they were open during bad weather.  I expect that a lot of appointments would probably call in and reschedule.   We are allowed to miss two of the 32 scheduled clinical days this semester, but I don’t want to miss any.  I need those comps!!  One of the other things I’m starting to notice during my clinical time is that my confidence is rising more quickly.   I feel more comfortable with the patients and doing the exams than I have in the past.  I guess that’s a good sign :)

I also finished my spinal series videos, and they are all online now.  The RADIOGRAPHIC POSITIONING link on the right will show those if you want to take a look.  They are not professionally produced, but I think they are fairly effective, and they are free :)

Another Successful Day

I had another very successful day in clinical. I really think the orthopedic office is where I’m going to get a lot of work done this semester. I’m in the ortho office for the first 8 weeks and then back in a hospital for the second 8 weeks. As I mentioned earlier, I need to log 300 procedures and shoot for 22 master comps this semester. After two days in the ortho office, I have logged 63 procedures and added three comps. There are 8 or 9 more exams on my list where I have completed all the pre-comps, so I should be able to knock down quite a few more master comps next week. In addition to that, I should be able to get a lot of my spine series comps during this first 8 weeks also. We will pass those off in lab at school in a few weeks and then I’ll be able to start working on my pre-comps and master comps on those before the end of the first 8 weeks.

What I have realized today is that I’m tired. This first week back to school has been a long one. The two days of clinical work wasn’t physically tiring, but my mind is tired. I know all these exams are routine for a working tech, but in my current state of learning, I’m probably over-thinking everything I do, and it makes me mentally worn out by the end of the day.

I also got slightly embarrassed at clinical today. One of my patients one of my classmate’s mother. I had to do several exams on her, one of which was a very new technique to me. It was a view that isn’t in our books and one I had never seen before until yesterday. I didn’t get the patient positioned quite properly and had to repeat the exam. The tech who was working with me did not catch my error in positioning either, so it wasn’t entirely my fault :) I’m sure I’ll hear about my ‘mistake’ from her daughter on Monday :)

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Best Day Yet

Old Glory

I had a phenomenal day in clinical on my first day at a new rotation in an orthopedic office.  This semester, I have to log 300 procedures and complete 22 master comps in order to receive a grade of 100 in those sections.  It seemed daunting at first, but it was busy in the ortho office today.  I set a personal record by completing 39 procedures in a 7.5 hour day.  I have never completed more than about 14 or 15 procedures in a single day of clinical in the past.  We had a fairly steady stream of patients in the office today. 

Oddly enough, I knocked out two more master comps today on some exams that don’t require any pre-comps.  I picked up a tangential sesamoid comp and a bilateral weight-bearing knee.  Each of these exams was sorta ’special’ in a way.  The sesamoid exam turned up a three-sesamoid big toe, which I had never seen before.  I’m guessing it’s fairly rare since most adults only have two.  The bilateral knee exam taught me a new procedure that I had never seen, and it’s not in my textbook either.  It’s called the “Rosenberg View”.  It’s a PA projection where the patient stands facing the wall bucky with his knees slightly flexed.  The tube is angled about three degrees caudad.  I had never seen this view before but the x-ray is very nice.  I’m not actually 100% sure I’m going to be able to keep that comp though.  I emailed my instructor about it, because the comp manual describes the AP view on this procedure.  This ortho office doesn’t use the AP view on this exam…  We’ll see what happens. 

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The Videos

One of my goals this semester is to video tape make videos of our positioning labs when the instructor is demonstrating new positioning techniques.  It’s unfortunate that I couldn’t start this process at the beginning of our program, because we have already been through a lot of the positioning, including the chest, abdomen, upper, and lower extremities.  I don’t know if I can make it happen or not, but if I end up with extra time in lab on Mondays this semester, I may try to go back and make videos of some of those routines. 

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mAs vs Dose

We had an interesting lab in our Radiographic Imaging class on Tuesday.  We talked about the scientific method and we’ll probably be using that to write up lab reports for each set of experiments we do this semester. 

In Tuesday’s lab, our objective was to solve this problem:

What is the relationship between mAs and radiation intensity (quantity)?

We knew from previous classes that, with a given kVp and SID setting, doubling the mAs would also double the intensity of the radiation.  Our objective was to demonstrate and document this hypothesis.

Our instructor sent us on a bit of a wild goose chase before we got started on this experiment though.  We had no idea how we were going to measure the radiation output from the x-ray tube.  We were trying to figure out how we were going to demonstrate this idea by exposing film.  Any increase in density that we would be able to measure would not demonstrate a linear relationship between mAs and radiation output. 

After we spent about 30 minutes trying to figure out how we would measure the radiation output, our instructor popped back into the lab carrying an electronic dosimeter that would read radiation intensity in milliroentgens.  He had a nice chuckle as he watched us wipe the sweat from our brows…

After we got the proper equipment, we set up a little experiment.  We set the dosimeter on the x-ray table and colimated the beam over the top of it.  We set the SID to 40″, set the kVp to 80, and shot our first exposure with a mAs of 2.0.  This exposure gave a reading of 21 milliroentgens of radiation.  On our next exposure, we increased the mAs to 4.2 (our controller would not let us set to 4.0) and got a dose reading of 21 milliroentgens.  We did five more exposures, approximately doubling the mAs each time, and our dose readings approximately doubled each time also.  With this data, we were able to establish a linear relationship between mAs and radiation intensity. 

I know you are really wondering why there is no picture today :) 

I got my positioning videos started and posted to YouTube…

Cervical and Thoracic Spine Routines

I’ll be posting more videos as I collect them. 

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Cervical and Thoracic Spine

Power and Glory

Classes started again today, and we hit the ground running in our positioning lab with technique for the cervical and thoracic spine.  We covered AP, Odontoid, Lateral, and the Obliques on the cervical spine, and AP, Lateral, and Swimmers on the thoracic spine. 

This semester, I’m trying something a little different in my positioning lab.  I’m taking my video camera to lab with me and videotaping the positioning demonstrations so I can refer back to them later.  I was hoping to be able to post those video clips on YouTube to share, but one of the students who is in the video as our ‘patient’ doesn’t want to be on YouTube, so I still need to try to convince her to let me put the videos online.  Hopefully I’ll be successful.  We’ll see how that goes.  I really wish I had my video camera at the beginning of last semester so I could have recorded everything, but I didn’t get this camera until mid-December…

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Here we go…

From Above

Well, my break is almost over.  It’s always amazing how quickly time flies when we’re having fun…  I have had almost three weeks off, but I return to classes tomorrow.  I’m ready to dig in to my second semester of the Radiography program and see how things go.  I hope everyone else had a great holiday also :)

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