Saturday, April 19, 2008

Chest Pathology

Take a look at the image. See if you can identify the pathology. The answer is at the bottom.

Here's a portable cxr image I took the other day. It has been stripped of any pt info. I thought it would be a good education tool.

First let's critique the image itself: the clavicles are some what high, I could have shot more caudally. The pt seems some what rotated - the distance in the sternoclavicular joints is a little asymmetrical. The heart is under penetrated - I could have brought up the mAs by 50%. While it true that you can window images that are done with computed radiography, film is a different story.

You're always fighting a battle between too much exposure time or not enough penetration. High mAs with a large pt or high density pathology and you might get motion on the film. In-pt's tend toward involuntary motion. So then you might end up shooting high Kvp and low mAs. Two things happen, you contribute to higher dose if you use a grid. I have nothing against grids. They're necessary. But if I can, especially in the ER with young pt's, I don't use a grid. The other thing that happens is you risk quantum mottle, which is happening more with faster systems.

Now for the pathology: a large subcutaneous pneumothorax can be seen on the pt's right side. There is ample tissue affected with neoplasm (cancer) in the lungs. I'm sure other pathology is evident.

Sunday, April 13, 2008

More News From The Front

How do you sum up four months? I'm doing very well. I've had one job interview and another may be on the way. Both are happening and I'm not really trying to find a job just yet. Guys and gals, it pays to network. Buy a box of thank you cards. And be yourself.

I'm in my last quarter of school. Clinical is past the point of being very difficult. I know the protocols and blaze through them. I'm well liked by those around me. I guess one reason I haven't posted is that few like to read about how well things are going.

One area of growth has been in-patients. Often you try to get your 90 degree difference in views in situations less then optimal. I'm to the point where I plan how I'm going to do the exam as I'm wheeling the pt to the department. Sometimes the part of interest is flopped over. Case in point is a broken femur. You have to get very good at visualizing what you’re getting when you angle that tube in respect to the part and receptor; Like shooting a stretcher trans-shoulder t-spine: you try getting c7-t1 through Godzilla sometime.

Classes this quarter include review. I like learning new stuff more! I'm find I need a swift kick to the butt. I like school and clinical. The education coordinator at my hospital reminded me that the other students are impatient. Okay. I'm ready to slam the door on this sucker

I'm so grateful for the hospital experience I've had. It's been all inclusive and very comprehensive. I've seen the best and worst that humanity can bring to bear. Patients that in spite of the pain thank you for your effort on their behalf. I love my work.