Road to Radiography

I completed my third test of the week today, and I’m confident that I made an A on it.  After this week, my confidence is high as far as my grades are concerned.  As I mentioned earlier, I have a 4.0 grade point average coming into this program.  Finishing this program with a 4.0 grade point average would certainly be nice, but I’m going to have to quit worrying so much about that.  I’m doing the best I can under my own circumstances.  Working and being a full-time student is not an easy task.  I have to make trade-offs constantly to balance the time I have.

We started the next section in our positioning class today, but we did not dive directly into the humerus and shoulder girdle like I thought we would.  We are looking at some more anatomy first.  Today’s lecture discussed bone and joint types in detail, which we’ll have to know for the test.  Everything I saw today was review of what I learned in Anatomy & Physiology last year, but I’ll still study hard for the next test. 

I have clinical at a new site tomorrow, and I have just finished up a huge stack of paperwork that’s required at that site.  I’ll be in a hospital environment for the next 8 weeks.  In an effort to keep myself focused on my objectives in clinical, I have added a “Goals & To-Do List” section to this blog on the right menu.  I have listed my requirements and goals for the remainder of the semester.  After closely examining my comp requirements, I made a list of things that I can comp now, and I’ll add to that list as the comps become available to me.  I need 4 comps this semester and I only have one so far, but I have set a goal of 6 for this semester, which may be out of my reach, but I’m going to give it a try.  I’ll be the only student in my clinical environment for the remaining 8 weeks of the semester, so I won’t have to share my comp opportunities with someone else. 

I’m looking forward to this week being over.  I’m still enjoying everything, but this particular week has been rough with three tests on the schedule.  At least that part is over :)

Tags: 1st Semester, Clinical, RAD-111 by John Setzler
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We are experiencing drought conditions here worse than anything I have ever seen in my lifetime of living in this town.  The lake is 5 or 6 feet below normal.  I would have been standing in about 3 feet of water to make this photo if the lake was at normal level…

I don’t understand what happened to me today during my positioning test.  I made a simple stupid mistake.  Luckily, my instructor didn’t penalize me much for it, and I made a 98 on the test.  For this test, we drew a card out of a bag.  The card had three positions that we had to execute.  My card had PA 2nd digit, AP forearm, and Lateral elbow, all on the left upper limb.  Simple enough… actually much simpler than I expected.  These are all very easy positions.  For some unknown reason, I x-rayed my patient’s third digit rather than the second.  I have no idea why, and can’t come to any conclusions other than possible nervousness in the testing environment.  The good news is that I did the third digit properly and made no errors on the other positions.  I had full confidence prior to this test and I didn’t feel nervous during the test.  I know I read the card properly, because when I was explaining the procedure to my classmate patient, I told her that we would be making an x-ray of her index finger.  I’m just at a loss as to why this happened.  I’m too young to be experiencing senility :)

The other good news is that I made a 98 on my written test for this unit.  I was NOT highly confident after finishing this test, because I thought the test was very difficult.  When I find myself thinking that, I usually don’t do as well.  It took me the full hour of class to complete the test also…

Tomorrow we’ll start the humerus and shoulder girdle.  These are still part of the upper limb, but our instructor agreed to split this section into two separate positioning tests so we could start working on pre-comps and comps a little sooner…

Tags: 1st Semester, RAD-111 by John Setzler
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While I could have been preparing for my upcoming tests this weekend, I chose to spend my time at Oktoberfest where I saw The Alabama Blues Brothers and The Little River Band on Saturday night :) 

We got our tests back from the Patient Care & Intro to Radiography test that we had last Wednesday, and I made a 95.  I actually thought I did better, but I’ll take a 95 any day.  We spent our hour in the positioning class studying for tomorrow’s tests.  We have a written test on the upper limb and positioning tests from the fingers up to the elbow on the upper limb.  I still have a good bit of studying to do for that written test, but I’m ready for the positioning test.  The upper limb positioning isn’t too complicated as long as I can remember to angle the tube 10-15 degrees for the ulnar deviation projection of the wrist.  I actually think it’s simpler to angle the wrist with a foam block for that procedure, but I think the instructor just wants to make sure we know how to angle the tube.  Chances are slim that I’ll have to do that procedure anyway.  We won’t have to actually peform each procedure on this test.  We will be drawing a card with three procedures on it that we’ll have to demonstrate for this test.  That being the case, we still have to be prepared to do any of them. 

The written test is going to be a little more challenging.  Part of it will be to identify the projection used for various radiographs that we’ll be shown.  I have most of those down pat, but there are still a few that confuse me for some reason.  This early in my studies, they aren’t second nature to me yet.  I’ll also have to label diagrams of the skeletal anatomy of the upper limb.  There are still a few condyles, epicondyles, fossae, and tuberosities that I need to sort out in my mind :)  I should be ok, but we’ll see :)

Tags: 1st Semester, RAD-111 by John Setzler
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I have opened my new online store for my photographic prints.  The above image is a sample from that collection.  Click on the image to visit the store…

Today’s lab in the positioning class was excellent.  We spent the entire lab practicing positioning of fingers, hand, wrist, forearm, and elbow.  Our next test is going to split the upper limb into two sections rather than having them all on a single test.  The humerus and shoulder will be on the second of the two tests, and the rest will be on the first test.  We are out of school next Monday and Tuesday, so I won’t have another lab period before we have this positioning test. 

I spent the entire lab period today working with another student on these positions.  She had missed part of the first lab on upper limb, so we spent the period practicing on each other.  I’m still thinking about my ‘personal’ positioning guide, but I haven’t started on it yet.  I’m actually going to ditch that idea after thinking about making photos to go with it.  Photos are important for that, and I don’t want to drag my camera gear to school to do it. 

In regards to the positioning we practiced today, I found a couple of them to be particularly difficult for the patient.  The AP thumb wasn’t particularly easy.  A patient with arthritis might find this to be a nightmare.   The AP Lateral Oblique position for the elbow is also a bit challenging. 

Our positions for this segment are:

** The 2nd digit oblique and lateral are done with a medial rotation rather than lateral.  The thumb (1st digit) is done AP instead of PA under normal circumstances. 

Tags: 1st Semester, RAD-111 by John Setzler
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We continued our study of the upper limb positioning today with the forearm, elbow, and humerus.  After looking at these, I think I want to create my own positioning guide.  I mentioned this earlier, but I think I’m going to start working on it so I don’t get too far behind my studies.  Since photography is my hobby and bread and butter while I’m in school, I might even make photographs to go along with the positioning techniques.  I know it’s sorta like re-inventing the wheel, but I think it will be a decent study aid also…

Several students showed up this morning with big grins because they had completed their comps on the CXR.  I hope to finish the chest on Thursday and at least get started on my abdomen stuff too.  We have to complete four comps by the end of the semester, which shouldn’t be too difficult.  We are going to test on the hand, wrist, forearm, and humerus in about two (or maybe three) weeks, so that will open a few more doors.  We’re saving the shoulder girdle for a little later.  We’ll see how that goes :)

Tags: 1st Semester, RAD-111 by John Setzler
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The dive into the upper limb has been interesting so far.  In reality, I’m re-learning a lot of skeletal anatomy that we covered in Anatomy & Physiology last year.  A bone is a bone, right?  Not hardly.  The humerus is a bone.  I can identify it when I see it.  I can even tell you if it’s a right or left humerus and whether I’m looking at the anterior or posterior view of it.  I remember studying the skeletal system in Anatomy & Physiology last year.  Going into it, I though for sure I could learn the names of all the bones and where they were located.  Too bad it didn’t end with that!  I think I’ll use this blog post to make some notes for myself.  I’m going to have to re-learn a lot about bones.  In the A&P class, we had to learn all of it in one unit… all the bones, and everything about them.  I think that short timeframe didn’t stick with me very well…

Tuberosity - an elevation or projecting part - also called a tubercle

Fossa - a trench, channel, or hollow place (groove)

Condyle - a rounded projection on a bone

Epicondyle - an eminence upon a bone above the condyle (a condyle on a condyle!)

Process - A prominence or projection

These are the major items (not including the foramen) on the surfaces of bones.  There are plenty of these for me to learn while studying the ulna, radius, and humerus.  I’m thinking about starting my own collection of diagrams for study purposes.  Gray’s Anatomy is a great resource for them since those images are all public domain and there is no fear of copyright infringement.  They way they are labeled though is quite out of date.  Maybe a little touch-up work with photoshop and some modernized labeling will make some useful study material. 

The positioning that we studied today was for the fingers, hand, and wrist.  The hand has three primary positions: PA, PA Oblique at 45 degrees, and lateral.  The wrist has four: PA, PA Oblique at 45 degrees, lateral, and ulnar deviation.  The fingers get a little screwy since the thumb doesn’t like to cooperate.  Fingers 2 through 5 use the PA, Oblique, and lateral also, but there is some deviation in fingers 3-5 that I don’t fully understand yet.  I’m gonna have to ask some questions.  They use the PA, lateral oblique, and some other deviation of a lateral view.  I think this is a 90 degree lateral rather than a 45 degree view.  Finger number 2 uses a medial oblique and a medial lateral view.  Like I said, I’m a little hazy on these.  I’m going to look up some detail in the Merrill’s Atlas shortly.  I really should start developing my own positioning guide.  I think RTWANNABE was working on one of those but I haven’t heard her mention it lately.  I’m not too far into the semester to start on this unless my instructor says NO to me bringing my camera into the lab… I think it would be a useful tool to actually write documentation on positioning technique.  It could be easily made into a PDF document and used by future x-ray geeks.  I know it would be a re-invention of the wheel, because the Merrill’s Atlas is excellent and my existing textbook is great also, but it would be a good learning experience and it would be FREE! 

In reality, I really don’t need to put time into something like that.  This blog is something that takes enough time :)

Tags: 1st Semester, RAD-111 by John Setzler
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I had to photograph an extreme paintball event Saturday morning for the newspaper if you are wondering what sort of strange photo this is :)

As I mentioned last Wednesday, one of my instructors was absent from class and lab that day.  He returned today and had our tests that we took two weeks ago in his hand.  I’m happy to report that I made a 101 out of a possible 104 on that test.  I’m happy about that!  He was out last Wednesday though, and all of us were there at 10am just to find a note on the door that we wouldn’t be having class.  After he gave us our tests back, he dropped the bad news on us.  We have to arrive at class 15 minutes early for the next four class periods to make up that time that he missed… lol… We were THERE!  I thought it was a little obnoxious that he would ask us to do that, but I suppose it will help him maintain his schedule, and since he’s the Radiography department head, we really don’t want to piss him off :) 

In our positioning class, we started looking at the upper limb stuff today.  We didn’t get much above the wrist though.  We talked about every bone in the wrist and hand, starting with the carpals and working our way out to the distal phalanges.  Since there are 27 bones in the hand and wrist, there isn’t much left in the upper limb!  I guess the radius, ulna, and humerus are all that we have left until we hit the shoulder. 

I can’t be too sure about this until after my lab tomorrow, but I have a feeling that the positioning for the upper limb are gonna be rather simple.  I’ll report back on that tomorrow after we get started on them in lab…

Tags: 1st Semester, RAD-110, RAD-111 by John Setzler
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As I’m studying for my Wednesday morning test, I’m finding myself a bit lost on a couple terms.  I understand the simple definitions of additive and destructive pathology.  Destructive pathology is easier to penetrate and takes advantage of a lower kVp setting for a decreased exposure.  Additive pathology is harder to penetrate and requires a higher kVp for more penetrating power.  Air and gasses are destructive pathologies while fluids and blood are additive.  The part I’m having trouble understanding is the list of pathologies that I’m studying as additive or destructive.  Some of them are more obvious to me than others.  Ascites, by definition, is an abnormal accumulation of fluid in the abdominal cavity.  That fluid creates an additive pathology.  I can understand that easily.  A pneumothorax, by definition, is a collapsed lung cause by air or gas in the pleural cavity.  That air or gas creates a destructive pathology.  Where I’m running into trouble is some of the other pathologies where I can’t understand why it’s additive or destructive. 

For example:

Atelectasis: collapsed lung usually due to an obstruction of a bronchus

This is listed in my course material as an additive pathology (hard to penetrate).

Atrophy: wasting or death of tissue

This is listed in my course material as a destructive pathology (easy to penetrate).

There are several other examples like these that I simply don’t understand.  I can’t understand why one is additive and the other is destructive.  My definitions of additive and destructive pathologies don’t give me enough differentiation between the two to apply them to cases where there is not distinct presence of fluids or gasses.  By the time anyone reads this, I’ll probably already have taken my test, but if you have information that will make this easier for me to understand, I would greatly appreciate it.  In the mean time, I’m just going to memorize which pathologies on my list fall into which category for the purpose of the test.  I would rather understand it though…

Tags: 1st Semester, RAD-111 by John Setzler
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We had our first lab exam in the radiographic procedures class today.  This test covered the actual positioning procedures for the PA Chest, Lateral Chest, Erect Abdomen, and KUB.  I was disappointed with my result.  My score was a 91, which was the lowest in the class.  This lab is split into two groups of 5 people, and everyone in my group scored higher than I did.  My errors were simple, and one of them was just a stupid mistake.  My most costly error was that I used the wrong side marker on the erect abdomen.  I put the L marker on the patient’s right side.  I was using the L marker on the two previous chest exams and just forgot to put it to the other side or switch it for the R marker on the abdomen exam.  The other place I was penalized was because I forgot to verbalize to the instructor that I had set the controller for the particular exam I was doing.  We don’t actually set a controller, so it was easy to forget to ‘tell’ her that we had set it. 

I’ll have to try to make up for this grade with my written test that we are having tomorrow.  I’ll be spending the evening studying, but before I can start that, I’m heading back to Bandys High School to photograph a volleyball match for the newspaper… Hopefully I’ll get home earlier tonight than I did last night :)

Tags: 1st Semester, RAD-111 by John Setzler
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 During today’s Rad Procedures class, we spent time reviewing for tomorrow’s written test, but somehow or another, this class talked her out of giving us the test tomorrow.  We were originally scheduled to have it on Wednesday, but last week, we all agreed to move it up a day and have it on Tuesday.  I guess everyone decided they weren’t ready and now that test has been moved back to Wednesday.  I’ll still be having a lab test tomorrow afternoon though.  I’ll actually get to demonstrate my Radiographic saavy by demonstrating the proper procedures for executing a PA Chest, Lateral Chest, KUB, and Erect Abdomen to my instructor.  Passing that test will allow me to start collecting competencies in clinical this week.  There is a series of pre-comps I have to perform before I actually do a final competency exam on those, but at least I can get started. 

Our department head mentioned that he would like for all of us to attend the 2008 Virginia ? Carolina Student/Educator Seminar in April, so that is something else I need to start stashing away money for in the near future.  I’m not sure of the details on that just yet, but it looks like it could be an interesting trip.

I have been eyeballing the Merrill’s Atlas of Radiographic Positions & Radiologic Procedures 3-volume set since late this summer.  I was a little hesitant about the $210 price tag on this set of books.  The 11th is the current edition, so I started shopping around for the 10th edition, which is only 4 years old.  I managed to get a set through a seller on Ebay for just under $60.00 with shipping included.  These arrived today, and I’m really excited about digging into those when I get home tonight.  I have to go photograph a high school soccer game this evening for the newspaper, so I probably won’t get home until 930 or so. 

Sports photography, as of yesterday, is going to be my only income for the remainder of my radiography school (hopefully.)  I quit my part time job in the custom framing department of A.C. Moore yesterday… or yesterday was the final day of my one-week notice.  I’m planning to expand my freelance photography work to include shooting team and individual photos of some local little league sports through the city and the YMCA.  I have made contact with both organizations, but I haven’t been given a green light to proceed yet.  I’m hoping that I can establish a good relationship with both groups, because those photo opportunities would be very profitable for me, and that type of work will fit into my school schedule very nicely.  Making ends meet while being a full-time student is going to be a challenge of its own…

Tags: 1st Semester, RAD-111 by John Setzler
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