Road to Radiography

We continued our study of lower limb positioning today in the RAD-111 class.  We have covered from the toes to the distal and mid femur in the book so far.  We’ll start the physical positioning process on those tomorrow in lab.  I don’t think we are actually going to practice toe positioning in lab though.  We will need to know those for the written test though.  There are a lot of positions to deal with in the lower extremity, and I’m not exactly sure how I’m going to memorize all this yet.  We’ll be tested on Tuesday of next week and I’ll have to have ‘mental’ knowledge of all of it by then.  Our last written test in the positioning class was my worst grade so far this semester.  I got an 84 on that test, and I’m confident that it was because of the number of positions and detail we had to cover.  This unit has even more positions, so I guess I need to start working on my strategy for learning all of it with a high level of confidence.  I think I’ll make another chart of all the lower extremity positions and work from that.  I’ll probably try to post that list here over the weekend…

Tags: 1st Semester, RAD-111 by John Setzler
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My day in clinical got off to an interesting start.  Just as I came in and got my lab coat on, one of the techs told me to come to come with her for a portable chest.  I followed her to the ER and we just stopped.  I asked her where the patient was, and she told me that he was coming in an ambulance and would be here any minute.  When they rolled the patient in, I knew I was in for an experience, because the paramedics were still doing chest compressions on him.  The patient was flat lined and had been that way for 30 minutes or longer.  After they got him in the code room and had him tubed, we did our chest x-ray.  His eyes were open, his body was cold to the touch, his stomach was very bloated with air, and his skin was starting to show signs of cyanosis.  We left and went back to the radiology department…

About 45 minutes later, we got another call from the ER to come do a chest x-ray, so we went back.  The patient who had been ‘dead’ was now on a ventilator and had a heartbeat.  I was amazed.  Whether or not this patient survives is still up in the air.  If he does survive, I assume that some amount of brain damage will have occurred after being flat lined for that long.  The paramedics were not sure how long he had been down before they got to him.  The patient was air lifted to another facility for further treatment…

I guess this is a scenario that I’ll get used to eventually :)

Tags: 1st Semester, Clinical by John Setzler
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Well, I did not win the chili cook-off, but I ate some chili and a good time was had by all :)  Maybe next year…

We had a great lab today in our Patient Care & Intro to Rad class.  The clinical instructor from our school’s respiratory therapy program came to teach us about oxygen therapy and how to deal with patients who are on oxygen.  Rad techs often have to deal with patients who are on oxygen, so knowing how to connect and disconnect the oxygen, as well as the masks is rather important.  We don’t remove the oxygen masks and lines from a patient unless it’s absolutely necessary though.  We sometimes have patients come through the department that are on tanks that need replacing though, so being able to do that is critical.  So we learned about the various types of oxygen delivery devices and how they work, and how to install regulators on tanks.  The final item we learned is how to calculate how much time is left on a tank at a given flow rate.  I’m glad we had this instruction, and now I feel confident working with patients on oxygen. 

I’ll lose a little time in tomorrow’s clinical.  I’ll be leaving 90 minutes early because our instructors are taking us out for lunch.  I do hope to get at least one more comp tomorrow though :)

Tags: 1st Semester, RAD-110 by John Setzler
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I just spent the last few hours working up a large pot of some good red chili.  I sampled it and it’s not bad.  I love chili, but to be quite honest, chili doesn’t get REALLY good until it’s been frozen and reheated.  I’m not going to be able to freeze this batch for the chili cook-off because I have to take it to school with me tomorrow.  If I think about it, I’ll take my camera with me to school tomorrow and shoot some more photos…

Since we have no classes today, it was a good day to cook a little…

Tags: 1st Semester, Miscellaneous by John Setzler
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In honor of National Radiologic Technologist Week and some other Allied Healthcare week, we’re having a chili cook-off at school on Wednesday.  Somehow or another, I got myself roped into making a pot of chili for this event.  I haven’t made a good pot of Red in a long time, so I think I’ll knock that out tomorrow and then eat some good chili with my classmates on Wednesday.  We’re out of class tomorrow for ‘advising’ day, so it will be a good day to do a little cooking. 

Tags: 1st Semester, Miscellaneous by John Setzler
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I had a great day in clinical today!  My worries about getting my required 4 master comps this semester are gone.  I’m not sure why I was getting worried, but things started to come together today.  My day started out with a string of three portable chest x-rays, so I have completed my three pre-comps for that exam.  The next exam I do, pending the quality results, will complete my master comp on that.  I also managed to get a pediatric upper extremity by doing a 3-view hand series on a 3-year-old this morning for a pre-comp.  I am only required to have one pre-comp on that exam, so the next one of those that pops up should give me a master comp as well.  The pediatric stuff doesn’t seem to show up as often though, so I may not see that comp for a while.  I also got one of my three required pre-comps on a non-trauma shoulder exam.  My last exam of the day turned out to be a master comp though!  We had an 8-year-old girl come in for a bone age study.  There were no required pre-comps for this exam, so I got my master comp on that.  I now have completed two of my required four master comps for the semester, and several more are in sight, so I think I’ll be in excellent shape by the end of the semester.  I have also completed 117 of my required 125 procedures for the semester with 5 clinical days remaining, so I’m practically finished with that.

My most interesting experience today was with the 3-view hand exam on the 3-year-old.  This child was, in my opinion, a perfect patient considering his age.  We brought him into the exam room without his mother.  The child had absolutely no problem with that.  The child was in for the exam because he had gotten his hand caught in something (I can’t remember what) and there was a chance that a fracture had occurred.  My PA and oblique exams with this child went off without a hitch.  I used a 45-degree foam block to position his hand for the oblique.  Where I ran into problems was with the fan lateral.  I showed the child the “OK” sign with my hand and asked him if he could do that.  He quickly responded by showing me the OK sign, so I put his hand down on the IR and asked him to do it again.  He had a little trouble with it, but I helped him get his fingers in position.  As soon as I let go of his fingers, he kept moving them into an improper position for the exam.  He was more interested in the laser alignment light and the collimation lamp on the x-ray tube.  After several attempts to make this exam work, I had to ask for help.  One of the staff RTs had to come into exam room with the child, put on an apron, and stand with the child to hold his hand in position while I made the image.  I suppose this is a necessary evil sometimes, but I still felt a little incompetent not being able to sort this out.  I probably had no choice, but there must be a trade-off between time and skill here :) 

Today was also my first experience with the pigg-o-stat.  I had seen one before but never used it.  We had an 8-month-old girl who was in for a chest series, so I asked one of the more experience staff RTs to help me out with the pigg-o-stat.  Before we brought the patient back, we discussed what was going to happen so I would have a good understanding of what to expect.  The first thing she told me about using the pigg-o-stat is that it sometimes upsets the parents more than the children it’s designed to help.  She said that the parents sometimes can’t deal with the confinement aspect of the pigg-o-stat and they get a little frantic when the child starts screaming when they are placed in the device.  So our goal was to bring the parent and child into the exam room where we would show them the pigg-o-stat and tell them why we use it and demonstrate how it works before proceeding with the exam.  This seemed to work out well for this exam.  The young girl’s father accompanied her to the exam and he was quite receptive to the idea.  We also put an apron on him and let him hold his daughter’s hands up above her head while we did the PA and lateral exposures.  The child did scream and cry during her stay in the pigg-o-stat, but she stopped immediately when we took her out and handed her back to her father.  I was quite thankful for my RTs great assistance in this procedure.  Next time, I’ll probably be able to do it on my own.  This was an opportunity for a pre-comp that I need, but I elected to turn it into a learning experience for me instead of trying to slip in a pre-comp that I didn’t feel prepared for yet…

I feel good about today’s experiences and what I have completed.  My confidence in clinical is a notch or two higher today :)

I get to register for my spring semester classes online tomorrow.  Here’s what I’ll be taking:

RAD-112 - Rad Procedures II (Positioning class) - 4 credit hours

RAD-121 - Rad Imaging I - 3 Credit Hours

RAD-161 - Rad Clinical Ed II - 5 Credit Hours (15 clinical hours)

I’ll have two days per week in clinical next semester instead of one.  The learning experiences should better than double for me as I go :)

Tags: 1st Semester, Clinical by John Setzler
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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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