Road to Radiography

I got my first opportunity to work on a voiding cystourethrogram in clinical today. I was glad to get the opportunity, but the experience overall was one of the most difficult I have had so far. The male patient was just under three years old. For those of you who are in your own clinical environment, you know that children this age can be difficult, especially in fluoro exams. We made it through the fluoro portion of the exam without too much trouble, but the real problems set in when we needed to have the child completely void himself for the final empty bladder image. The child’s bladder was definitely full of contrast, but the child refused to empty it for us. The frustrating part of the situation was that the child would tell us that he needed to pee, but when we took him to the restroom and put him on the stool, he always claimed that he couldn’t go. We decided to get him to drink some to help this process along, but the success was not so great. This child drank an entire 20oz Pepsi, and a 20oz Sun Drop, and still would not go. We gave him a 12oz cup of water and got him to go just a little bit after that, but not enough to void the contrast from his bladder. This process of getting him to completely void started at about 10am this morning, and when I had to leave clinical at 2pm, he was still not voided enough for the final image in the series. By this time, the child was visibly tired and just worn out. To me, it looked like he would go to sleep at any minute. I’m not sure how this exam ended, but I’ll find out in the morning. The tech who was working with me during this exam was completely frustrated with the situation, but I had to let him have it back when I had to leave. I’m sure I’ll hear the result first thing in the morning when I go back.

On a good note, this exam does count as a pre-comp for me, and I also picked up a pre-comp I needed for a pediatric abdomen on another exam today…

Tags: 3rd Semester, Clinical by John Setzler
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We dove into RAD-131 (Physics) today. We had about 6 hours of lecture. This first physics class doesn’t have a lab associated with it, so we’ll be having lecture on Monday and Wednesday for the next 5 weeks from 9am to 4pm with a lunch break in the middle somewhere. The good thing about today’s lecture is that I haven’t seen anything I don’t really know yet. Most of what we covered today was basic math review, units of measurement, and we started into the physics fundamentals segment as well. One advantage that I may have in my favor is that I have had college level general physics in the past. Our instructor mentioned today that nothing we would cover would require any more math than the algebra level. My last physics class used algebra for some stuff but it also dug into trigonometry and calculus as well for a lot of the problems we solved. This stuff can’t be too mathematically complicated if algebra will cover it all. He even told us that we could make a list of formulas that we would need on a 5×7 index card and use it on the tests. That will take a lot of the work out of it, but most of the formulas I looked at today were familiar anyway.

We have our mid-semester clinical conference tomorrow afternoon, so I’ll get to leave clinical a little early. I have all my paperwork in place for that. I took the mid-semester film test online this afternoon and made a 93 on it.

It won’t be too long until we are welcoming in a new set of first-year students. They should have an orientation day sometime in July, and we will get to meet all of them.

Tags: 3rd Semester, Clinical, RAD-131 by John Setzler
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An interesting milestone passed on Friday… Friday marked the half way point in my Radiography program. I hit the 5-week mark in the 10-week summer semester (third semester out of five). Right now, I’m sitting in an empty classroom while everyone else has left for lunch or whatever they want to do. We had a final test in our RAD-122 (Imaging) class this morning and we have a final lab test for that same class at 1pm. My grades look good so far in this class, and I should get an A for the semester unless I totally botch my lab test after lunch. We will come back to class on Wednesday and dive into the RAD-131 class (Physics). I think I am going to enjoy the Physics. I’m good with math and I enjoyed Physics during my first trip through college. This round of Physics won’t be as complicated as general college physics, but it will be more in the realm of practical application.

I don’t have clinical tomorrow. It’s an advising day at the school, so there are no classes or clinical. Some of my classmates will be making up missed clinical time tomorrow, but I’ll be sleeping late and not doing much of anything :)

Tags: 3rd Semester, Miscellaneous by John Setzler
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Today was one of the first really productive days I have had in clinical lately. My spinal comps have been slow in coming for various reasons. Maybe I’m just a little too picky, but probably because I haven’t been in any great hurry to get them done. There are plenty of opportunities for them at my current clinical site, so I have just basically been doing them and trying to learn more about them as I go. It’s really amazing at how different the real world is as compared to the lab in school :)

My first exam this morning was a comp opportunity for the cervical spine series, so I decided to attempt it. I haven’t been having any particular difficulty with the cervical spine series with the exception of the odontoid. The odontoid is the only shot in this series I ever miss on the first try. I finally decided to re-read the book section and talk with the techs at my clinical site. I got some good advice on how to get more consistent with this exam, and it seems to have paid off quite well. The last few odontoids I have shot have been near perfect. Patient motion has also been an issue with the odontoid exam. I can position the patient exactly right and they often won’t be able to hold it until I can get to the control panel to make the image. It’s not the easiest position to hold as a patient either.

That first cervical spine exam today was followed by three lumbar exams, so I decided to go ahead and attempt the comp on that as well. On my first attempt, I had a patient with some rather serious scoliosis. It was so bad that I could see pedicles on the AP view, so my first oblique was rather off target. I actually had to get one of the other techs to help me position this patient to get the obliques right. My second patient was actually a perfect patient for a comp. She was average in size, maybe even a little on the small side, so positioning was quite easy.

I got the T-Spine comp a while back, and I got the cervical and lumbar flexion/extension comps last semester, so the only piece I lack on the spinal stuff is the Swimmer’s, but I’ll probalby shoot that one on my next opportunity also.

I’ll spend the rest of the summer semester (next 5 weeks) working on my fluoro comps…

Tags: 3rd Semester, Clinical by John Setzler
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At my current clinical site, I am seeing an unusually large number of Barium Enemas being rescheduled because the patient is not properly ‘cleaned out’ for the procedure. I perform quite a few scout x-rays for this exam every week just to have the radiologist reschedule the patient for another day of prep. Some patients come in for the exam and have only been preparing for less than 24 hours, which is rarely enough time for the large intestine to be cleaned out. It also seems that some doctors are not in tune with the nature of the prep procedure. I’m hearing stories from patients where the doctor has told them they could eat certain foods that are not clear liquids. I’m fairly confident that it’s true because multiple patients have told me that this doctor said they could eat cottage cheese, which is certainly not a clear liquid. I can’t really understand why this is happening. It’s a waste of time for the patient and the imaging center…

Tags: 3rd Semester, Clinical by John Setzler
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I got my first opportunity in clinical on Tuesday to do the small bowel exam. I have to get two pre-comps (one more now) before I can comp this procedure. It’s rather easy to perform, but this was the first one I have seen in this clinical rotation. Hopefully I’ll see some more before the end of the summer. The site was rather slow on Tuesday, so I didn’t get to log but five procedures, but I did miss quite a few procedures while I was doing the small bowel. That exam ran for a little over three hours in total.

We had a rather difficult test in RAD-122 today, and apparently the entire class scored below normal. Our instructor gave us the tests back and told us to take them home, re-write the questions we missed along with the correct answers and an explanation of the answer. When we turn that in on Monday, he will be giving us half credit for the questions we missed. I made an 83 on the test and should end up with a 91.5 after I get credit back, which will be ok. That will put my current average at a 93, so it looks like I’m going to have another course where I’m borderline between the A and B mark. We’ll see how it goes…

Tags: 3rd Semester, Clinical, RAD-122 by John Setzler
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Today was a rather interesting day in clinical. I had my share of challenging patients today. I definitely x-rayed my largest ever patient today. This patient weighed every bit of 450 lbs, and I had to do a chest x-ray. The patient had a difficult time standing for obvious reasons. The patient was in for diagnosis of a severe cough. I did not go back to look at the radiologists notes on these x-rays, but I did notice compression fractures in the thoracic vertebrae. I’m not sure if that was a known problem or not, but there were three vertebrae with definite problems.

Another interesting case came up this afternoon. I was sitting by the printer waiting for some orders to show up when one finally printed out. I grabbed it and it was a bone survey for metastases. These procedures usually take a while because of the number of images they require. As I looked at the order closer, the patient was a 5-year-old female. I couldn’t imagine metastatic cancer like that in a child that age, but I suppose it’s possible. I went to the lobby to get the patient and grab her doctor’s oder. When I picked up the order, the doctor had ordered a bone age study. I guess the person at the front desk had keyed the order in improperly. When I read the doctor’s order further, I noticed that the reason she was coming in for the bone age study was listed as precocious puberty. This was a completely new concept for me. I’m gonna have to look it up and see what that’s all about because I’m in the dark…

Tags: 3rd Semester, Clinical by John Setzler
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Today was another rather slow day in clinical. I only logged 10 procedures today, which isn’t bad, but it’s not enough to keep me busy. There were four barium enemas on the schedule again today, so I was looking forward to getting some more experience in that exam. The funny thing about them was that the first three were not performed. I did the KUB scout x-ray on each of them, and the radiologist sent each of them home for another day of prep because they weren’t cleaned out properly. One of the patients told us that her doctor said she could eat cottage cheese during the prep process, so she had eaten plenty of it. I asked one of the other techs about this and she told me that this particular doctor had a reputation for that. I find that to be quite unfortunate for the patient. One of the other patients had followed all the provided instructions for the cleansing process except the one about not eating. He had used the proper laxative regimen, but kept right on eating during the process. I can’t remember what the third patient’s reasoning was. We did get to do the fourth one though, and it went without a hitch. The patient wasn’t completely cleaned out, but the radiologist wanted to do the exam anyway.

I had another shot at an L-Spine today, and I missed it yet again. One thing I do know is that my marker placement is no longer an issue. This particular patient had trouble with the LPO. My RPO was perfect and I’m not entirely sure why I couldn’t get him in the LPO position. I thought I had him positioned properly and I suppose there is the possibility that he could have moved after I positioned him. He was over rotated, so that image had to be taken over again. Maybe I have been spoiled by my lab at school. When we were learning the L-Spine routines, I had a 45-degree foam block wedge that I could use to get this position. I don’t have that luxury in this clinical site.

We have a test in RAD-122 in the morning that covers film processing and sensitometry, so I gotta get back on that now…

Tags: 3rd Semester, Clinical by John Setzler
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