Short but Sweet

I'm finished with classes until August. I have learned the entire skeletal system and also the urinary, biliary, upper and lower GI systems. I'll be in clinicals 40 hours a week this summer and I'll be practicing all of that as well as getting introduced to the OR. In that area, we're allowed to work on choles, retrograde pyelograms and ERCPs.

I am eligible at this point to take the practical technologist exam. I was waffling on whether or not to take it but one of the techs at my site encouraged me to go ahead and do it. He said that it's good practice for taking the RT and also with having the PT license, there is a potential to find a job and get some experience. I have all the paperwork together and I'll be sending in my application tomorrow.

Man, don't you hate it when you visit a blog and it looks like it's been abandoned? Me too! Sorry to leave things hanging ... I kept thinking I should post something and then I would get busy.

So, last episode I was ready to start classes again. I finished a 6 week session and next week will start another 6 week session. This past 6 weeks we covered the shoulder girdle, bony thorax and pelvic girdle/hip in positioning, and the upper and lower GI systems in contrast class. The next 6 weeks in positioning will be skull and spine and contrast starts with the urinary system and I'm not sure where we're going to go from there.

It's been quite challenging balancing school and clinicals - I'm looking forward to later this summer when we'll have another stretch of nothing but clinicals and I can let my brain rest and just concentrate on putting into practice all that's just been crammed into it. I think part of what I'm finding so hard is the pacing. Last semester we had about a month to learn each section: chest, upper extremity (elbow down) and lower extremity (knee down). This semester, it's all going by so FAST. I don't feel like I've really absorbed it all yet.

Once I'm able to cert on my shoulder, then I will be eligible to take the limited scope radiography exam. I wasn't sure if I wanted to do that. My site does not hire PTs and I don't know if I want to try to hold down a part time PT position elsewhere because it seems like it would be a lot on my plate, with clinicals and classes. However, one of the techs at my site thought I should go ahead and take it. He said that it gives you a feel for what the "real" registry exam will be like and that it could be beneficial, as far as getting that first RT job, if you are already a PT.

So I think that brings everything up to date!

Today was an awesome day at clinicals. I was able to go down to the ER, where I haven't been for the past couple of weeks. I got several abdomen/KUBs and I'm ready to cert on the next pelvis that comes my way. Also got to brush up on some extremity skills. Tib/fibs don't come by very often but a combo tib/fib-knee exam came up so I was glad to have the opportunity to practice on that.

I'm looking forward to tomorrow. One of the community colleges has started a new rad program - this is their first class and one of their students will be starting at my clinical site. I know of her from someone else I exchange messages with on a radiography forum so I'm eager to actually meet her in person!

Hippity Hop

Next week is our last week of the semester and I have one more upper extremity comp to get. Then I need to go back and cert on a forearm but those don't come through during the day very often.

While waiting for my needed comp exams to come up, I also managed to cert on a portable pediatric chest and a patella.

After next week, I'll be splitting my time between class and clinicals. Two days a week I'll have to drive down to the college (about a 20 mile drive and I'll be getting out of classes just as rush hour picks up steam) and the other three days I'll be at my site (a very easy 4 mile zip down the freeway from my house!). My classes this semester will be positioning (everything we haven't done yet) and a lab to go with that class and contrast media. As much as I'm not looking forward to the drive, it will be nice to switch up my weekly routine a little bit.

Hands Down

This was a good week for me! I got my elusive hand cert. I also had a tib-fib and elbow come in this past week which I was able to cert on. I'm now ready to start comping in both upper and lower extremity and I finished off my week by getting my ankle comp. By the end of the month I need 7 more comps and I may actually end up making it.

I feel like I've done more portables this week than I have in a while. Before I would have said that I could do them, but I'm not comfortable with them. Now, though, I feel like I have a better idea of what I'm doing and it's becoming easier to figure out the angle of the tube in regards to the patient position. And it's also getting easier to manhandle the tube into place! Another thing I feel I'm getting better at is picking which technique I'm going to use.

My next goal is to try to speed up my exams. I tend to futz around with my positioning a lot longer than I need to and, honestly, I think all my futzing isn't really enough to change the image I'm going to get. I have noticed this week that one of the techs will start rotoring when he feels I've been in there long enough. One of the speakers at the ACERT conference I attended last month referred to the rotor as a "student motivational device" and I have to laugh because it's true. I hear the rotor go and BAM I'm out of the room.

In Like a Lion...

I hate subject/title lines. When I email, I usually use some variant of hello, hey, hi. Now I have a blog and a never-ending series of "hello, hey, hi" titled posts just aren't going to cut it! I had toyed with the idea of numbering the days but I think that would come too close to that "excerpt from a cat's diary" that's floating around on the net. You know, the one that starts:

Day 752: My captors continue to taunt me with bizarre little dangling objects.

Anyway....

I wasn't able to cert on anything last week but I did manage to comp on everything in the chest category and I'm finished with that. I'm still waiting to cert on a tib-fib, patella, hand, forearm and elbow.

I was having great difficulty the week before with my hand images. One hand come through last week and I asked to go down to the ER to do it. My images were absolutely beautiful with no retakes necessary. So, as I thought, for some reason I was just psyching myself out. Now I'm ready to cert on that and hopefully another one will come through this week.

Tib-fibs don't come through very often (while I'm there, at least) but one did come through the ER and I thought I was going to be able to get some experience with positioning. Unfortunately for both me and the patient, it was a pretty severe break (spiral fracture to the distal tibia and a fracture of the proximal fibula) and the tech had to stay in the room holding the leg in place while I went to the controls and shot the images. While I didn't actually get to position or assist, it was a good exercise in thinking outside of the box and how to compensate for the inability of your patient.

Other than that, it was a pretty quiet and slow week.

Goals for this week are to work on getting those remaining certs. Although I need to cert in everything I have left on my to-do list, once I have 4 in each extremity category, I can start comping in that category. In each category, I need 2 more certs before I can start comping. Hopefully I'll be able to do that soon. This clinical rotation is finished at the end of the month and we're supposed to be done at that time with all certs and comps. We've been told, though, that something will be worked out should we be missing any because our site is slow. I'd rather not have to go there, though!

Hands and Knees

I certed on my knee this past week and also re-certed on my AP cart, since I had to give that up in favor of keeping my finger cert (since I got them both on the same day and only one cert per day is allowed in my program).

I impressed myself with my knee images - I had been worrying about the tunnel and sunrise because the knee routine we practiced in school was AP, Oblique and Lateral. But mine came out pretty good! The only thing I don't like is the positioning used. For tunnels, every single tech uses the Beclere. In class, we learned that was one of the least desireable positions because of the OID. When using the DDR system, there isn't even a cassette to build up with towels or sponges. And for the sunrise everyone uses the inferosuperior position. I hate aiming the tube right at the patient. Even though I have the patient wear lead and I collimate down, it almost feels like pointing a loaded gun at someone. My positioning teacher is somewhat appalled and said there were so many other better ways to do the sunrise but when I brought that up at my site, I was told to get my license and then I could get the images however I wanted.

I've done hands before and they seem pretty straight forward, so I thought I was ready to cert on them this past week. I tried *5* times and messed up every single series. Mostly what I'm having trouble with is the oblique. I know I tend to overrotate any obliques and I really try to watch that. But I switched back and forth between over and under rotating, even with using sponges and wedges. And then I started getting frustrated and my fan laterals came out sloppy, too. By the end of the day, I swear, Bontrager himself could have come in, sat himself down and positioned his own hand and I probably still couldn't have gotten it then! I know I can do these - I just psyched myself out.

I can start comping on my chest category but I still need some certs to finish up the upper and lower extremity categories before I can start comping in those: hand, forearm, elbow, tib-fib and patella. This week's goals will be to conquer the hand and start the chest comping.

Happy Valentine's Day!

Slowly the certs are adding up. I scored both a finger and an AP cart the other day. Unfortunately, my program only allows students to have one cert per day. I had done the AP cart in the morning and then, in the afternoon, a finger came along. I've been at the site since the 2nd week of January and this is only the second or third time I recall seeing a finger order come in. So, since the fingers come along rarely and AP carts are almost every day, I chose to go with the finger.

Knees and elbows have been kind of scarce, too, but I had a chance today to practice on both. In school, we learned to do an AP, Oblique and Lat knee routine. At my clinical site, however, the routine is AP, Lat, sunrise and tunnel. I think I'm comfortable enough now with doing the sunrises and tunnels that I can try and cert on the next knee that comes along. Today's elbow was the first one I've done and it was pretty darn good. The lateral could've been better, but my patient was also limited in what they could give me.

As each week begins, I try to think of a weekly goal. This week my goal was to get my AP cart, which I did, and then didn't. Hopefully one will come through tomorrow. I'm also trying to really think about techniques - what to use and how to adjust for circumstances when doing portables and what to use in the rooms if the digital system didn't have techniques preset. I've gotten very comfortable with the digital system and, unfortunately, not really paying attention to the technique used. I don't want to be a button-pusher.

2008 ACERT conference

I spent part of this past week in Las Vegas for the ACERT (Association of Collegiate Educators in Radiologic Technology) conference. It was fabulous and I would love to be able to go again next year. There were 3 tracks of lectures: Faculty, New Educators and Student. We were allowed to attend any track session but I chose to stick with the Student track as that was what pertained specifically to me.

In order to receive full educational credits and not be charged personal time, students from my program were required to attend the opening lecture on Wednesday night, which was about clinical admission requirements. At first I didn't really understand why I had to attend since I was a student and have nothing to do with admission requirements. But the lecture ended up being very interesting and there was even an opportunity for students to speak up on certain topics, such as mandatory health insurance for students entering clinicals (not a requirement of my program but others do require it). There were also scenarios discussed regarding past felony histories and admission to programs/ability to take the ARRT exam. There's a lot more that goes into being accepted into a program/being eligible to work at a clinical site than you might think!

Thursday's lectures were:

Student Challenge - the one mandatory track session that we had to attend. Students were divided into groups and given multiple choice questions to answer. I was out on the first question. I don't remember it exactly but it was something like: You've taken a supine abdomen without contrast at a certain technique (75 kV, 400 mAs and I don't remember what all else) and the image is underexposed. Why might this be? We haven't studied the abdomen or contrast yet but I tried to reason out the question anyway. I chose for my answer that there weren't enough milliamps but the actual answer had something to do about a backup timer and I don't even remember backup timers from my coursework! Other questions had to do with technique, positioning, patient care, and other topics.

Patient Care Through The Eyes of the Patient - this speaker talked about his own experiences as a patient. I don't think we always realize what an impact we can have on patients and how a simple "Can I help you?" or bending down to speak to someone at their level (if they're in a bed maybe) can change their whole perception of their time in the health care facility.

Tips for Interviewing - I've been to many interviewing/resume courses and there was nothing new here but it just reinforced what we've been told over and over. Tailor your resume to the job, come to the interview prepared, don't chew gum/talk on the phone/wear heavy perfume, dress appropriately. It was a good refresher on what to and what not to do.

The Practice of Medicine in the Early 20th Century: Everyday Horrors in the Home - this was a fun lecture. The speaker owns several early medical texts and shared them with us. It seems that purging the bowels and carbolic acid played a big part in home health care!

Non-Neoplastic and Neoplastic Changes in the Skeletal System - the speaker gave us a quick review over bones in general and shared images of different pathologies. This was interesting because even though I've heard of some of them (Paget's Disease) I had never seen pictures of how they would present radiographically.

Friday's lectures:
Physics for the Fun of It - this was by far the best lecture of the whole conference. The speaker (William Calloway) was incredibly engaging and made physics fun at 8 in the morning. He went over basic physics and tried to cover topics that were likely to be asked on the registry exam. Some topics he went over included the various parts of the x-ray circuit, the differences between Brehmstrallung and characteristic x-rays, the difference between photoelectric and compton interactions and inherent and added filtration.

Digital Radiography: Exposure Factor Selection - I was really looking forward to this lecture, especially since my facility is film-free and digital is radiography's future. But sometimes you get an interesting topic and a not so interesting speaker. This was the case here. I don't think he even turned to address my side of the room once during an 1 1/2 hour lecture! He spoke about dosage creep and how technique selections don't always transfer between film and digital. In digital imaging, kVp still controls subject contrast but not image contrast.

CT versus Radiography in Trauma and the Effect on Patient Dose - First the speaker talked about what trauma was, the different levels of trauma and gave some statistics. He talked about imaging in trauma situations and spoke about BERT - Background Equivalent Radiation Time (which equates the patient dose received to the background radiation equivalent) and the differences in patient dose between previous trauma protocols and current protocols. Basically, patients are getting hellacious doses because of the amount of CT scans they are subjected to. He said that in 1990, a trauma patient would get an AP CXR, AP Pelvis and 3-view C-spine which would equal 100mRem or 100 days worth of background radiation. CT would only be done if something on the films warranted it. Now that same patient would receive an AP Chest and a CT Head/C-Spine/Chest/Abd/Pelvis (total Pan Scan) and this would equal 3,710 mRem or just a little over 12 years of background radiation using the BERT method. Quite a difference, isn't it?

Take a Closer Look at Your Images - this was pretty much an image evaluation course and the speaker talked about proper ways of positioning, use of markers and what criteria you were looking for in images.

That was the last lecture of the day. If you're a rad tech student and you have an opportunity to go to a conference like this, I would highly recommend that you go. I picked up a lot of valuable information and really felt that this was well worth the time.

Update

It's hard to believe it's been a month since my last post. My intention was to blog regularly, not on a monthly basis! So, I'll see what I can do this coming month about checking in more often.

I actually had a comment on my last entry - that's so cool! And, you're so right - it's a world of difference between doing this in school with an instructor and doing this out in the real world.

The hospital I'm in is new - it opened last September. The ER has a Swissray and the core unit upstairs has one Swissray room and two rooms with Phillips equipment and a Fuji CR system. No film! We still have film at school, although we also have a Fuji CR and we also will be getting a Swissray, probably sometime later this year.

I think one of the hardest things for me to get used to was dealing with everything that comes attached to a patient - oxygen tubes, IV lines, catheters, wires and telepacks. Sometimes it's a challenge to get the patient disentangled enough so they can get up and get their images taken!

By the end of March, I'm supposed to have 11 certs and 9 comps. I don't know how other programs do it but in mine I have to cert in a certain amount of exams per category (chest, upper extremity, lower extremity) before I can start comping and then I need to comp 3 in each category. So far I've certed on the PA/Lateral chest, portable chest, ankle and foot. It's been somewhat slow-going - like I said, the hospital is new and even though the department is fairly busy, it's not always busy with the exams that I can do. But, I'll get there eventually!

Later this week I'll be heading to Las Vegas for the ACERT (Association of Collegiate Educators in Radiologic Technology) conference. There seems to be a wide variety of interesting topics that will be covered. I'm especially looking forward to Physics for the Fun of It and The Practice of Medicine in the Early 20th Century: Everyday Horrors in the Home.

Ready, Set .. Clinicals!

Tomorrow will be my first clinical day. I'm nervous and excited. I've gone through clinicals before - I'm a certified medical assistant and a certified unit health coordinator. For both of those programs I had to complete clinical hours although it was only around 200 compared to the 1800 that I'll have racked up by the end of my radiography program.

We did have a chance to meet with our clinical instructors last semester during an orientation. Some places throw you in right from the start - the site where I'll be at seems to be a bit more laid back. The CI talked about us having a whole week to get our toes wet, as it were, but he said that after that week, he expects to see progress! We learned about chest, upper and lower extremities (elbow down and knee down) last semester so those are the exams we'll be comping and certing on. We're also expected to observe the procedures we'll be learning about in future classes.