Road to Radiography

I worked four Barium Enema exams in clinical today, and luckily, each of them went smoothly. All four exams were single-contrast. I used two of these exams to complete my required three pre-comps and I used the other two just as simple practice. These exams aren’t that difficult usually, yet the barium enema seems to be one of the most feared procedures by students. I think that it’s just the nature of the exam that makes people shy away from it. I think the key to being successful with this exam is to make sure the patient knows what to expect. I have participated in several of these exams where the patient didn’t really understand what was going on, and that made it a lot more difficult for them.

This entire procedure isn’t so complex. Tipping the patient is probably the most complicated part of it, and that just takes a little practice. The breathing technique is important for the patient’s comfort. So as far as the tech and/or student are concerned, prepping the room, mixing up the contrast, and tipping the patient is the majority of the work to be done. There is always a scout KUB taken before the exam to make sure the patient is cleaned out properly, and then there are spot films taken after the procedure. The spot film requirements are not always the same. Different radiologists want different images. In my exams today, the radiologist on staff only wanted a PA and a post-evac AP, so there were only two additional images to be made. The double-contrast studies usually have a longer list of images after the exam, but I haven’t had the chance to do all of those yet. Some of the staff radiologists also require that the spot images be taken via the fluoro tower, which is something I’m not allowed to do for obvious reasons. I’ll have to cross that bridge when I come to it. It may involve asking the radiologist if I can provide regular images since I’m a student trying to achieve a master comp on the exam.

Another interesting thing I learned today during these exams is that when the colon is filled with barium, it will often spread out wide enough or long enough that you can’t get it all on a single 14×17 image receptor. On the first PA spot film I shot, I had the colon clipped on the left, right, and top of my IR, and the base of the image was perfectly located at the symphysis pubis. That’s something we need to pay attention to as the radiologist is running the fluoro tower. You can get an idea of where the anatomy is going to be if you watch what’s happening on the fluoro screen during the exam…

Anyway… I’m gonna try to enjoy some relaxation this weekend. I do have some studying and reading to do, but not so much that I won’t have any free time…

Until next week…

Tags: 3rd Semester, Clinical by John Setzler
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I think I will probably comp my C-spine and L-spine on my next attempts at clinical. I changed up the way I’m placing my markers and it seems to work very well. I shot one of each of these exams in clinical today, and they both looked good, but I didn’t turn them in as comps. I want to shoot each of them one more time before I claim the comps. It may sound odd to some, but I don’t always claim a comp right away. When I know I’m going to have plenty of opportunities on certain exams, I get any required pre-comps logged and then start looking more critically at what I’m doing. On exams that don’t come up so frequently, I don’t take this approach. I make sure I get them as soon as possible. Those exams that don’t come up as often don’t seem to be the really difficult ones though, so there isn’t much to worry about when it comes to actually being competent. I bet I shot 30 or 40 4-view knee exams before I ever claimed my comp. I still don’t feel 100% competent with the lateral knee. It’s definitely not particularly easy with certain patients. Extremely large patients are the most difficult. It’s nearly impossible on some to tell when the knee is perfectly lateral. Knee exams are not hard to come by, so the opportunities are abundant.

Tomorrow morning, there are four barium enemas scheduled, so I might finish out my pre-comps (I only need two more) and then use the other two as confidence and competency builders. The barium enema is a common exam at my current clinical rotation, and I expect to see at least 20 more of them, if not more, during this rotation. I also have a fluoroscopy objective to complete this summer, so I will start working on that as well.

My clinical instructor stopped by for a visit today. I don’t get to see her that often, so it’s always nice when she stops by. I wasn’t spot tested on anything today, but that will be coming soon enough…

Tags: 3rd Semester, Clinical by John Setzler
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That will never happen to me… I’m always careful… We’re all careful all the time. One of my classmates got stuck with a dirty needle at clinical on Friday. It obviously happens when you least expect it, but it involved testing of the student and the patient for potential infections. Please be careful!

Tags: 3rd Semester, Clinical by John Setzler
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I’m working on comping my L-spine and C-spine routines right now. My positioning technique is good, but I’m running into problems with marker placement. In my last clinical rotation, I learned one way to do it, but I’m being taught a different way at my new clinical site. Actually, in my last two clinical rotations, I have used the same marker placement technique for the L-Spine series. I had been taught to use my left marker on every image, which makes sense. My mind wants to use the right marker on the RPO, but consistency wants me to use the left marker, as do the people I have been working with in clinical. At my current site, they prefer that I use the right markers on the AP Sacrum, AP L-Spine, RPO, and LPO views and then switch to my left marker for the lateral and the L5-S1 spot. I had another shot at the L-Spine comp today, and the only error I had was a clipped marker. My positioning was fine, so I expect to get that comp completed this week. My positioning on the C-Spine routines has been good also, but I’m clipping markers there too. I have to get more aggressive with my marker placement on those. I always have my marker on the bucky, but I end up losing it when I collimate. I’ll get it sorted out :)

Tags: 3rd Semester, Clinical by John Setzler
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I survived my first week back to school for the summer term. My schedule this summer is the most difficult I have had so far where time is concerned. I’m going to have to make some changes in my personal routine to cope with the additional time in class and clinical. That will take a little getting used to.

The video clip here is from the fireworks show at the Hickory Crawdads (Single-A minor league affiliate of the Pittsburgh Pirates) baseball game on Friday night. I’m still having fun with the video camera :)

I have my first test in RAD-122 on Wednesday, and it covers a good bit of material, but I think I’m going to be ready for it… hopefully. This instructor is the department head and his test questions are often quite tricky. I got my first B since I started back to school in his RAD-121 class during the spring semester. I was close to an A, but didn’t quite make it. My average was somewhere between 91 and 93, but I don’t know exactly what it was.

I’m out of school today for the memorial day holiday, but I have my normal clinical rotation tomorrow…

Tags: 3rd Semester, RAD-122, Video Clips by John Setzler
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One of our areas of study during the first week of the summer semester is technique charts. One of my objectives this semester is to start building a reliable technique chart. In order to do this, I want to measure the thickness of some body parts that I’m imaging and record the exposure technique that goes along it whenever I come across exposures that I think are really good. This will start to give me a baseline to use whenever I’m not using automatic exposure controls. My first hurdles to this project were that no one knows for sure what the screen speeds or bucky grid ratios are at my clinical site. I discussed this with my instructor and he recommended making an assumption that we’re using 200 speed screens an 10:1 grids, which would fall in line with what’s in use at the other facilities I have be in so far. Today when I returned to clinical, I started looking for the calipers so I could measure some patients, and there are none to be found. Without those, I can’t begin to start making any real sense of techniques. I sent an email to my instructor to ask if I could borrow a set of our calipers from the lab for a couple weeks. Hopefully he’ll allow me to do that since we don’t use them in the lab. The thickness of our phantoms never change :)

I didn’t run into much of anything intriguing at clinical today. I did learn that refuse from a barium enema can smell particularly foul, especially when the patient’s large intestine was not cleaned out to an optimum level before the study was started. I had to clean up a floor in a dressing room where a patient had ’spilled’ some barium, and it about knocked me out.

I got my first precomp on a barium enema today. I’m looking forward to getting some fluoroscopy comped this semester…

Tags: 3rd Semester, Clinical by John Setzler
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Today was the first day in the new clinical site, and I hit the ground running with an 8am double contrast barium enema. There’s an old saying that I like to remember occasionally that says: “Eat a bullfrog first thing in the morning and nothing worse will happen to you for the rest of the day.” I guess the same holds true for getting the barium enema out of the way early…

I’m really going to like this clinical site. I worked with two techs today who were excellent, and they both seemed to be interested in helping me with my goals. That’s always a good feeling. I expect that I’ll be able to get a lot of work done here during the next 10 weeks.

I actually got my first opportunity to comp a T-Spine today. I made two perfect images to get the new semester’s comps rolling. The only thing I didn’t care for on this exam was that this site prefers T-spines to be done on the table rather than standing. When we learned the spinal routines in class and lab, we were taught that these exams could be done either way, but in my past experiences, even though they are limited, I believe that its easier to do T-spines erect, especially for the lateral. My T-spine patient today was in for a follow-up for a T12 compression fracture. I’m also curious as to why the doctor would not want a coned-down view of the T-11 / L1 area. I did several T-12/L1 junction images when I was in the ortho office last semester.

I’m planning to start getting my pre-comps and comps on the fluoro studies this week. They do a good bit of fluoro here, and I have a lot of that stuff left to get comped.

I’m back to lecture and lab tomorrow, so I’m signing off… I have a lot of reading to do :)

Tags: 3rd Semester, Clinical by John Setzler
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As the photo may indicate, I’m going to be tied up for the rest of the summer it seems. The way our summer semester works is just a bit outside of the norm. Instead of the regular 16 weeks, we have a 10-week semester. During this 10 weeks, I have two classes plus clinicals. Our RAD-122 (Radiographic Imaging II) is held during the first five weeks and the RAD-131 (Physics) is held during the second five weeks. In a nutshell, we’re covering 16 weeks worth of material in a five-week period twice during the summer term.

We jumped right into the imaging class today. We had nearly 6 hours of lecture covering technique chart development, automatic exposure control, and radiographic film. We didn’t quite finish the section on radiographic film, but we’ll be finishing that up in class on Wednesday and having our first test next Wednesday. Oddly enough, we’re out of class on Monday for Memorial Day.

I start my summer clinical session in an outpatient center tomorrow morning at 8am. Tomorrow is going to be another one of those really long days for me. My clinical runs from 8 until 3:30 and then I have to go to work around 4. I have one sports photography assignment at 4pm and another one at 7pm, so it will be around 10pm at the earliest until I find my way back home. Days like that make it very difficult to get any useful studying done. Luckily, I have a long weekend to make up for it before my first test.

As of this time, I haven’t organized my documentation for this clinical session yet, but I intend to do that this evening. In the next day or two I’ll have my goals list for the summer clinical in order. I already know that I’m hoping to get a majority of my fluoro comps completed. I’m very happy with the opportunity to be in an outpatient center at this point because we just finished up our fluoro stuff in lab at school at the end of the spring semester, and I’m ready to start working on comps for those procedures.

Hopefully I’ll be back tomorrow night at some point to post some preliminary thoughts on the new clinical site…

Tags: 3rd Semester, Clinical, RAD-122 by John Setzler
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I’m a little over half way through my two-week break before the summer semester starts. I have enjoyed the time off so far, and I’m looking forward to the rest of the week as well. Last week, I visited the Kangaroo Conservation Center in Dawsonville, Georgia. The above video clip shows some of that place. It was really interesting and there are over 300 kangaroos on site, as well as other Australian wildlife.

When I start back to class next Monday, I’ll be taking Radiographic Imaging II (RAD-122), Radiographic Physics I (RAD-131) and my third round of clinicals (RAD-171). My clinical rotation will be in an out-patient imaging center and I’ll be in from 8-330 on Tuesday and Thursday, and from 8-12 on Fridays for the duration of the 10-week summer session. I have all of my books ready to go. I purchased “Digital Radiography and PACS by Christi Carter and Beth Veale” on Amazon.com and saved about $8 from the school bookstore price. I also purchased “Radiologic Science for Technologists by Stewart C. Bushong” used on Amazon.com and saved about $50 from the school bookstore price. I purchased the workbook that goes along with this book new from the school bookstore earlier this week. Fortunately, my total book cost for the summer semester was about $110 with the savings I got from Amazon and buying a used book. I’ll probably start reading in these books tonight or tomorrow to get a jump start on the semester. I don’t have a syllabus for either class yet, so it would be hit and miss as to where I should start. Maybe I should just enjoy the break :)

Here’s another video clip from the trip to Georgia… This is the Fountain of Rings at Atlanta’s Centennial Olympic Park…

Tags: 3rd Semester, RAD-122, RAD-131 by John Setzler
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Friday is our last day of the semester. I loaned my camera to our head cheeze to snap this photo of my class when we attended the pinning ceremony for the graduates last night. One of our students played hookie from the pinning ceremony so there are only eight of us in the photo. One of our students in this picture is also playing hookie from clinical tomorrow so he can go fishing.

A little bit about this group…

First row - Left: Duggan - experimental remote controlled airplane pilot…

First row - Center: Amanda - hair dresser extraordinairre…

First row - Right: Wendy - YouTube model (my positioning videos) and she sucks cause she’s going to Mexico over the break…

Middle row - Left: Jason - hookie-player who is feared by fish in 5 counties…

Middle row - Center: Amber - Newlywed (i think during the break)

Middle row - Right: Chelsea - Elvis freak and the youngest member of our troop…

Back row - Left: Joan - The one everyone wants to sit next to at test time…

Back row - Right: John - by far, the sexiest member of this class, the best photographer, the best blogger, and an inspiration to all…

Not pictured: PAUL… he shouldn’t have played hookie :)

I’ll be back in a couple weeks…

Tags: 2nd Semester, Miscellaneous by John Setzler
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