Sunday, February 24, 2008

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.

Thursday, February 14, 2008

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.

Sunday, February 10, 2008

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.

Sunday, February 3, 2008


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.