Road to Radiography

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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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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