Road to Radiography

Monday, I went back to an orthopedic office for my clinical rotation. This particular ortho office is different in many ways from my previous ortho rotation. Instead of one tech and one x-ray room, this office has four techs and two x-ray rooms, and the volume of work being done is significantly higher. The actual work being done is very similar, but I’m seeing a greater variety of things being done at this site. Unlike my last ortho rotation, I’m seeing weight-bearing feet and ankle exams, and a variety of different positioning techniques.

Clinical rotations in ortho offices have advantages and disadvantages. I’m not sure that I’m really ready to call them disadvantages, but they are peculiarities that are difficult to get used to.

Advantages:

Lots of exams… it’s almost non-stop on most days.
A majority of the patients are mobile and conscious :)
You get a good opportunity to work on your speed and proficiency

Disadvantages:

There is no standard technique for a specific exam. If you are dealing with several different doctors, each of them will likely want some exams done differently.
You won’t see the overall variety of work that you see in an outpatient or hospital environment.

Since school started back in the area this week, I have seen athletes from several of the local schools in for sports-related injuries. Since I’m a sports photographer for the local newspaper, I know a lot of these kids. This is one of the reasons I’m leaning towards working in orthopedics when I graduate from this program. I plan to continue my work as a sports photographer, and I would like to work in an environment where I’m providing imaging for those athletes if at all possible. I will, of course, be at the mercy of whatever jobs are available when I get ready to graduate though.

I don’t have another special rotation until late september. I’ll be spending two weeks working a second-shift rotation in a hospital. That should provide some excellent trauma experience. When I start that rotation, I hope to blog those experiences each night after clinical…

Tags: 4th Semester, Clinical by John Setzler
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I guess I have been getting slack on my Radiography blog. I haven’t done this intentionally. I just didn’t post much during my two-week break, and my first week back in class was very busy.

I started out my clinical this week with a three-day rotation in special procedures, which is primarily cath lab work. This rotation consisted mainly of PICC lines, left heart caths, and abdominal aortograms. I did get to watch one discogram too. That procedure intrigued me more than the others. I got the opportunity to talk to a radiologist about that exam later in the day, and he told me that he hated doing discograms. This exam is designed to create pain in the patient. It’s objective is to reproduce the pain the patient is experiencing in order to determine the exact source of the pain in the vertebral column. The radiologist will insert injection needles into multiple disk spaces where he will inject contrast. The pressure created by the contrast will help locate the source of the pain in the patient. I also watched several heart caths, one of which involved the installation of a stent. Another of those exams resulted in the recommendation of a quadruple bypass because the strictures were not stentable.

I like my schedule this semester. I’m in clinical Monday through Wednesday and have class/labs on Thursday and Friday. Hopefully my weekends will show me a little more free time this semester. I can do my studying for tests on weeknights now rather than over the weekends. THAT will be a relief!

My next four weeks of clinical are in an orthopedic office. My next special rotation this semester is two weeks of 2nd shift in a hospital, but that doesn’t start until September 22…

Tags: 4th Semester, Clinical by John Setzler
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I finished up my summer semester in clinical today. All I have left to do this semester is go to my clinical conference with my instructor tomorrow at noon, and then I get to kick back for two weeks off. Today was another one of those painfully slow days at clinical, but I did manage to collect the Simmer’s T-Spine comp. I finished the semester with 7 extra comps that roll over to my 15-comp requirement for the fall semester, so that’s a good start. I will only need 8 comps during the fall to meet the requirement for the top grade.

Tags: 3rd Semester, Clinical, RAD-131 by John Setzler
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I can’t believe I haven’t posted much here lately, but I have been rather busy. We’re almost to the end of the summer term. This is the last week of class and clinical before I get a nice long two-week break before digging back in for the fall semester. I’m busy this week preparing for my physics (RAD-131) final exam that is a combination of two tests rolled into one. We’re having the 5th test of the term and the final all on a single test, so it’s worth two separate grades. That test is at 10am on Wednesday morning. I have clinical on Tuesday and Thursday, and then my clinical conference on Friday.

Overall, clinical has gone well this semester. I have not gotten the number of comps I had hoped to get, but I still have met the requirement for the best possible grade. I’m currently six comps ahead of schedule, so that means I already have six out of the 15 I need for the fall semester. I got my Upper GI comp last Friday, but it doesn’t look like I’ll get the barium enema comp this week. I’ll have to save it for the fall semester. I know where I’m going to be for my clinicals this fall and I’m confident that the barium enema comp will come from the second of my two rotations.

I’ll post again later this week after the exams are over unless something interesting comes up in clinical…

Tags: 3rd Semester, Clinical, RAD-131 by John Setzler
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I would like to propose to the powers that be, a new competency requirement for aspiring radiologic technologists during their course of study. Since I have completed this competency many times during my clinical experiences, I also want to be the first student to claim proficiency in this procedure. The title of this master competency will be Babysitting.

I wish I had a dollar for every time I have been involved in an exam where a mother or father showed up with ‘extra’ kids. As we all know, we don’t want anyone in the exam room that doesn’t have to be there for obvious reasons, especially in the case of children. At my clinical site on Tuesday, a mother brought in her one-month old son for a cystogram. We usually put a lead apron on the mother and let her stay in the room and assist whenever possible. This particular mother also brought her four-year old son along for the ride. I knew, as soon as I saw the situation, that I would not be assisting in the study in any capacity greater than sitting in the hallway with the four-year old.

In order to complete this competency, the student must show proficiency in the following:

1. Establish communications with the child by getting on your knees and introducing yourself at eye level.

2. Explain to the mother that you want to stay with her child somewhere outside of the examination room.

3. Successfully separate the child from his mother with minimal kicking and screaming (the child’s kicking and screaming should also be minimal).

4. Provide adequate entertainment for the child during his absence from his mother by finding something interesting for him to play with. (Items should not include enema tips, rubber gloves, empty contrast bottles, needles, lead markers, dosimiters, or any other items that could induce death in a small child.)

5. Allow the child to step all over your pristine white shoes without complaint.

6. Keep the child from wandering into any mammography exams.

7. When the mother returns, comfort her by telling her how much fun you had during your babysitting experience.

This comp isn’t as easy as it seems :)

Tags: 3rd Semester, Clinical by John Setzler
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Tags: 3rd Semester, Clinical by John Setzler
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This is a holiday week, so my only clinical day was on Tuesday since I’m out of class on Thursday and Friday. Tuesday was a rather busy day though. I managed to comp the small bowel study, and in the process, I set my personal best time on that exam. On my first pre-comp of this exam, the patient took nearly three hours to move the barium all the way to the terminal ileum. My second patient was a bit quicker at just over one hour. The patient I had on Tuesday got it all the way through in about 10 minutes. The barium had reached the terminal ileum on my film at 10 minutes, but I still had to shoot the second film since the radiologist needs the AP and PA images to work with.

I also got my final pre-comp on the ribs exam. The next time I see a ribs exam, I’ll be able to comp it hopefully.

The cruddy part of my day was that I missed out on a humerus exam when I went to lunch. I still need one pre-comp on the humerus before I can get the procedure comped, and I’m just not lucky enough yet to see many of these exams.

Comp System Rundown

Here’s a quick rundown of how our comp system works… We have a master list that we were given at the beginning of the program that lists the mandatory comps (36 total) and elective comps (30 total). We are required to comp all 36 of the mandatory comps and 15 out of the 30 elective comps. That being the case, there are 51 comps that we are required to have before we graduate. To get the maximum available grade in our clinical class, we ultimately have to get more than this. During our first semester, we were required to get 4 comps to get a grade of 100 on that section of the grade. During the second semester, we were required to get 22 comps to get a grade of 100. During this summer semester, we need 15 comps to get the maximum grade. During the upcoming fall and spring, we need 15 each semester for the maximum grade. The good news is that if you get extra comps during one semester, they carry over to the next semester. The following list shows our required comps and the elective comps. I have completed the comps that are in bold text:

Required Comps - Need all of these

Chest (routine)
AP Chest (wheelchair or stretcher)
Thumb or Finger
Hand
Wrist
Forearm
Elbow
Shoulder
Trauma Upper Extremity (non shoulder)
Foot
Ankle
Knee
Tibia-Fibula
Femur
Trauma Lower Extremity
Cervical Spine
Thoracic Spine
Lumbar Spine
Pelvis
Hip
KUB
Decubitus or Upright Abdomen
C-Arm Procedure
Portable Chest
Portable Orthopedic
Pediatric Chest
Ribs
Humerus
Trauma Shoulder (Scapular Y, Transthoracic, or Axillary)
Skull
Paranasal Sinuses
Trauma (cross table) Cervical Spine
Cross table lateral Hip
Upper GI Series
Barium Enema
Portable Abdomen

Electives - Need 15 of these

Lateral Decubitus Chest
Clavicle
Patella
Calcaneus
ERCP
Pediatric Upper Extremity
Pediatric Lower Extremity
Pediatric Portable
Small Bowel Series
Sternum
Upper Airway (Soft Tissue Neck)
Scapula
AC Joints
Toe
Facial Bones
Orbits
Zygomatic Arches
Nasal Bones
Mandible or Panorex
Sacrum or Coccyx
Scoliosis Series
Sacroiliac Joints
IVU
Esophagus
Cystography / Cystourethrography
Myelography
Arthrography
Surgical Cholangiography
Retrograde Pyelography
Pediatric Abdomen

Anything that isn’t on these lists are something we call “Candy” comps. They are comps that don’t require any pre-comps, and there are lots of them. I have 44 comps completed so far in the program. If you click on the MY GOALS link at the top of the page, you can see the list of stuff I have completed so far… I think I need to make some revisions to that page to help me focus on what I still need rather than what I have already. As far as this summer semester is concerned, I don’t expect to get many more comps. There are three that I expect to complete. I plan to comp the Barium Enema, the Upper GI, and the Swimmer’s C/T Spine. I may be able to get the Esophagus, but that exam is a multi-textured barium swallow, and I don’t see many of those.

Tags: 3rd Semester, Clinical by John Setzler
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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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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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