Radiologic confidential

2008-10-14T10:31:00.000-07:00

Hey! I've been doing quite well. I enjoy my job very much. Not a lot for me to relate here. It's largely ortho in exam types. I also do a truck load of CXRs and a fair amount of head work. I've gotten automatic on those.

The Goal Has Passed

2008-06-24T18:50:00.000-07:00

The torch lit - I gained .75 employment and full benefits two weeks out from graduation. I took my boards and got a 91%. (It's pretty easy, Kids.) The student blog is over. Thanks for reading.

Chest Pathology

2008-04-19T13:33:00.000-07:00

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.

More News From The Front

2008-04-13T16:21:00.000-07:00

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.

The light at the end of the tunnel

2008-01-24T11:14:00.000-08:00

Weeks of: 2007-11-04 - 2008-01-20

Abstract: The light at the end of the tunnel

Mood: Ill, but ok.

What went well: I cleaned up on the comps.

What needs work: I need to be faster.

Elucidation: I skipped class today because I woke up with a sore throat. I thought I'd post as I lay on the couch. I'm the prodigal blogger, the one who lets weeks and months go by between posts. School and clinical is much the same now as my earlier posts.

I do exams skillfully and with efficiency. I'm enjoying the process. Yesterday I did a sinus series. I slamm dunked it. I was pleased because the tech said my films were pretty. I did the series from memory. It made me feel good that I was able to pull views out that I did in practical last year. At my hospital, all head work goes to CT. I've been doing an outside rotation. It's been nice because they get a lot of views and exams that I don't see at my hospital. My last day is tomorrow.

Can you believe I'll be done is less that six months. I enjoy school. But it will be nice to make money as a tech. I'm still working at the hospital. I do a lot of inpatient spines which is challenging. This is one of the reasons I don't post often: I'm working 50-60hr weeks.

Goals for next week: Post to the blog. Get all caught up with school. At this point I'm nearly done with the comps I need.

My Children's Rotation

2007-11-04T19:51:00.000-08:00

Weeks of: 2007-10-21, 2007-10-28

Abstract: My rotation through a Children's Facility

Mood: Happy

What went well: I learned a lot by observation

What needs work: Assertiveness

Elucidation: The last two weeks have been a mixed bag of my usual clinical site and the children's facility I rotated through. One day I worked in fluoro with pediatric patients. It was difficult because toilet trained children take great exception to having a catheter inserted. The VCUG (voiding cystourethrogram,) a common pediatric fluoro exam done to test for urethral reflux, has got to be one of the more challenging because of patient reaction. It wasn't the most fun I've ever had at clinical. But I learned a lot.

The tech I was with had strong skills in calming the patient and alieviating their concerns. She was successful for the most part in explaining the exam in a way that a child could understand. It's possible to over prepare a patient though.

It's often helpful to give patient and the family a pamphlet explaining the procedure. For adults this can be good because many will imagine the worst. But I can say for one eight year child, reading the pamphlet again and again caused her great duress. She was almost airborne at certain points, trying to buck off the table. Eventually she was calmed down and the contrast administered.

I can honestly say I would think long and hard before accepting a position in fluoro with pediatric patients. I love children. I have many nieces and nephews. In medical it's hard to listen to child's scream for minutes on end. The pain of child is hard to wittiness.

Another day I worked in the children's ortho clinic. It was a good experience and a reprieve after fluoro. An eleven month infant was positioned for a tib-fib and a toddler for bone length study. It was good to learn some positioning skills. You can throw out much of your ideas with adults; it's quite different. You can't position a toddler the same way you'd position an 11 year old.

The total rotation was three days. It wasn't sufficient length to start comping. I did a lot of observation which really isn't how I learn. I do best by doing.

The hospital had a lot of modern equipment. Everything is computerized and uses direct radiography. I like the visceral sense of placing a cassette into a reader is gone. But the processing time is very fast.

Back at my hospital I received two instances of feedback. After a myelogram (spine x-ray with contrast) the patient said, “Thank you for your compassion. You have an excellent team.” That felt nice as I conveyed it to the staff. I comped an arthrogram (joint x-ray with contrast.)

My clinical instructor emailed late Friday to say, “I was just stopped by a Tech who told me what a great job you did today and she saw your enthusiasm shine. She was impressed and wanted to give this feedback,” “Keep up the good work and have an excellent weekend.” I have. I'm smiling now.

I did well in my first pair of exams. I'm doing well this quarter. Stay in touch, y'all.

Goals for next week: I'm back at my hospital. I need more fluoro comps.

Asteroids and Renal Stones

2007-10-21T09:48:00.000-07:00

Week of: 2007-10-14

Abstract: I complain and I give thanks.

Mood: I'm just Ok

What went well: I did several cases in the OR solo.

What needs work: I need to fine tune my systems of approaching each case.

Elucidation: I've been in the OR at clinical. It was a successful week. I did several exams solo: cysto, laparoscopic cholangiogram, patella and a lot of hands and wrists.

The cystogram case was interesting for the use of lasers to burn out renal stones. I was able to watch it happening on a live color monitor. It reminded me of the Asteroids video game as shards of stone went tumbling around in the calices.

The doc requested live fluoro during the cholangiogram. He asked me to save some of the images. I repeated his requests as he made them communication is key in the OR. You need to repeat the request as you comply.

I had exams this week in both of my lecture classes, Pathology and Biology: Evaluating radiographs for their diagnostic capacity and learning how radiation effects human tissue. The pathology test seemed to very well. There was no ambiguity in the questions of either exam. I'm eager to see how my study skill are shaping up.

We experienced turnover in a instructor position this year. I can say that it's nice to have the same instructor for the program because you can easily do well. Predicting a result is harder when you are breaking in a new instructor. The change is universally positive as she is a good educator. Up till now we've had very good stability in staff. That said it's challenging to see how a new instructor will lectures and study materials to tests.

I'm beginning to see how spoiled we are. Up till now, instructors have been willing to release an outline and power point to the lecture. We were tested to those. It made it a breeze to study. One of the instructors still does it that way.

A thousand apologies for people who read the blog. I'm just about overwhelmed with school. I can tell you that after three months of full-time clinical I wasn't in the mood for lectures, studying and tests. Tough, you may say, just do the blog. Well it's been challenging in the least to get into the flow but I'm almost there. I'm experiencing many of the ins and outs of being a student.

Getting back into routine has proved challenging. I'm an artist. During the Summer I was able to explore my interests in photography, song writing and poetry. For the past three weeks it's been back to grind.

I told my instructor how thankful I'm am to be in this program. How I feel gratitude for the superlative instructors and associative staff. I'm also grateful for the lead techs in my hospital. I love where I am at.

Goals for next week: I'm doing an outside rotation at a children's facility. I want it to be productive.

Oh Summer, You're now just a memory

2007-09-23T16:28:00.000-07:00

Quarter of: Summer 2007

Abstract: Summer Quarter Wrap Up, Happy Autumn to all!

Mood: Alert and Cheerful

What went well: I really got a handle on the big picture.

What needs work: Efficiency. Making exams quicker.

Elucidation: I worked very hard during Summer quarter. I want to remind everyone that I was in clinical for eleven 40 hour weeks. Working for free is always easier if you think in terms of offering in an attitude of service. See an earlier post for more.

There was no scholastic material to memorize. The time consisted of bringing up my skill and professional behavior to the next level. I started more multiple exams: where I might to c-spine, fingers to shoulders, & feet to hips.

I sped the time up for exams, increased my accuracy, and took on more responsibility with portables. Personalities played less of a role for me because I was able to raise the level of independent work.

In short, I felt the distance to the goal shorten. Summer was a watershed experience, one I will remember for the rest of my life. Fall quarter starts tomorrow.

Goals for next quarter: Continue my development on all fronts.

Summer Wonder

2007-08-19T14:41:00.000-07:00

Week of: 2007-08-13

Abstract: A flood in the MR room, Notes on techniques.

Mood: Upbeat

What went well: Gaining confidence and self-initiative.

What needs work: Reduce retakes.

Elucidation: As I increase my skills there's more opportunity to learn more about how to set techniques. For example, with a Lateral thoracic spine, you have the pt raise their arms above the head – this helps the radiologist gain a view of the upper T interverbral formaina. Also, a longer exposure time, up to five seconds. Exposure is divided into Milliamperage and time (Milliamperage seconds mAs.) As you increase the time the millamps go down to maintain the exposure.

As I gain experience I find increasing or reducing the kilovoltage peak (kvp) allows me to increase or reduce time. In the case of the Lateral T spine (5 seconds) it blurs the lungs – the pt must remain still, seated or supine is best. You need more technique than a CXR.

In a chest x-ray, CXR you deliberately increase KVP and reduce time to create a snap shot of the lungs. Of course I leaned this in the classroom last year. But there exists a separation between learning it and knowing it as applied to the clinical experience.

I did a larger amount of retakes last week. I'm not sure what to attribute this to but I will ensure to make this week different. This said, my confidence increased.

Things were incredibly busy on Tuesday, as usual. I did five AP pelvis exams and other exams. A bit more of a crazy day. What's neat is how I'm handling it and putting out good work.

Wednesday I talked to a pt who got run over by a land-mover. I looked at the comparison films, ER and OR to post OP and beyond. It was night and day, His maleoli were completely smashed in the ER films. He's able to walk now. Very gratifying to hear how our ortho department is improving quality of life. And nice to see how my contribution helps.

My clinical site is expanding into an additional MR room. On Friday, I was greeted by flashing light and a recording, “ALL NON-ESSENTIAL PERSONELL MUST LEAVE THIS LEVEL.” I assumed that meant me. But how to best achieve that objective. It turned out the my lateral path put me in the center of the “emergency.” An electrician in the MR construction site had inadvertently cause the sprinkler system to engage, thus signaling the fire response team. The emergency amounted to a fleet of shop vacs and push broom wielding hardhats attempting clear the site of 2-3 inches of standing water. The fire fighters were chuckling.

Goals for next week: Continue cleaning up on comps in Ortho.

Where the Rubber Meets the Road

2007-08-12T17:43:00.000-07:00

Weeks of: 2007-08-06, 2007-07-30

Abstract: Not much to report

Mood: Happy

What went well: I'm putting it all together.

What needs work: Work on internalizing and synthesizing my experiences and education.

Elucidation: I've spent the last couple of weeks in the Ortho department. I've received several complements on my growth as a tech. I continue to work 10 hour shifts in the ER. This means fifty hour weeks are the norm.

Summer quarter is what my program would suggest is the “rubber meets the road” kind of experience. Where you take your education and experience and internalize and synthesize skills from it. I've worked very hard. I'm not going to write much this post as I need to devote my free time to fun stuff. More of a post next time is offered.

Goals for next weeks: Fill out my comps.

Pizza, The OR and a Skull Series

2007-07-28T11:17:00.000-07:00

Week of: 2007-07-23

Abstract: Pizza, The OR and a Skull Series.

Mood: Happy

What went well: I showed a high level of independence.

What needs work: Speed and accuracy in moving in and out and centering on the affected part with the C-arm

Elucidation: Monday was a slow starter but ended big. Early on a spent I lot of time sitting around in the dispatch office waiting for exams to come up. I thought I was going to do a Lap Chole, but the docs didn't request a C-arm for the procedure. I was somewhat disappointed because I wanted to comp it but I know it will come up soon. I waited most of morning for this exam so it was a waste of time. I made up for it by doing a wrist.

Later, I had the good fortune of participating in an exam that was termed speed surgery. The surgeons inserted the plate quickly due to the poor health of the patient (although cram would be a better descriptive verb.) It was interesting because the team worked like thieves in the night: quickly drilling holes and turning screws around the shattered portion of the femur. The patient's EKG demonstrated a very irregular heart beat, often slowing to the point of stopping for a count or two. The anesthesiologist was working constantly at a fevered pace to stabilize the patient, pushing drugs into the IV. The surgeons began closing before they had even put in 60% of the screws, something you don't see everyday.

Other days were rewarding on many counts as I showed a high level of independence. I was assigned a tibial plateau reduction and reconstruction. The patient's proximal tibia was in pieces. The axial MR images showed the pathology plainly. I observed as the surgeons placed plates in the medial, lateral and anterior aspects. I provided the images for the placement and anchoring of the hardware. The surgery stretched from 08:30-14:00. It was a nice step for me because I did it solo.

On Tuesday, The education coordinator celebrated our transition to second year status. By ordering two large pizzas and watching us stuff our faces. We got to leave early: bonus!

I witnessed a distal ulnar dislocation from the carpals. It clearly projected at right angle and one could see the articular cartilage after the part had been dissected. It was challenging for me because I was moving the C-arm base a lot. The tech observing me noted, "We need you to build some strength." He's right, I'm the 170 pound, under-muscled tall dude.

I also participated in a distal femur case involving a 14 year old child. The fracture was quite large and extended from knee to mid femur in one way or another. I watched and provided images as the surgeons reduced the fractures and put an ginourmous articulated plate into the area. The leg was rolled medially and the C-arm had angle to match this rotation rolled toward the base. I did several plain films which are numbered to demonstrate timed placement of hardware. Both residents commented on the serious aspect of the fracture.

The first exam on Thursday was very interesting. It was a pilon fracture. In the case, I ended up getting a C-arm with a lot of artifacts showing in the images it rendered. The doc was a real type-A. She's definitely intelligent and articulate but somewhat abrasive and aggressive in her manner. And I do appreciate the she speaks up. Many docs mumble. She made it clear that a tech needed to come in to help with the C-arm.

When she saw my ID she said, “Why did they send a student here.” And Later when I was rolling the c-arm over for a lateral, “Come on,” She said while tapping her toes impatiently, “Step it up; we're on a tight time line.”

I was able to develop skills as I progressed in spite of the imposed pressure these statements induced. I want to comment that this is a sign of growth as I'm learning how to perform well in those situations. I throughly enjoyed myself in the case because my images improved as the case progressed. One of the residents gave me an OK sign as her eyes smiled.

Skull, facial and sinus series exams are few and far between in standard radiography. This is because CT has taken over much of it. For those exams we rarely see we do a mock, where the student demonstrates skill in producing the images requisite in a series. I did a mock comp of a skull series on Friday.

Week 3/3 in the OR ends Friday, Ortho rotation follows.

Stay cool and in touch.

Goals for next week: Continue to develop skills and confidence in the OR. Do a tibial nail case solo.

Selfless Service: A Manifesto

2007-07-23T19:53:00.000-07:00

Week of: Supplemental

Abstract: I expound on Acts of Service

Disclaimer: What follows is philosophy and contains no information about x-ray school or radiologic technology.

Elucidation: I want to see what I do during the day as more than the typical, “I punch in, I punch out for lunch, I punch in, I punch out and go home.” I want to see work as the pure expression of acceptance and offering of sharing and listening of giving and taking. Work is, in large part, what makes us human. It helps me to think of what I do during my shift as service.

I want to see the people I serve: patients, families, other staff, doctors – as the truest expression of what I aspire. I try to see them as wonderful contributions to humanity. I lend my best listening. I offer my heart of compassion. But I don't feel their pain. Instead, I open my eyes to their beauty and truth. I listen, through intuition, to the meaning behind their words. I've seen many people wracked with pain, beset with injury, but I always look for the unique aspect of the individual. And often I find that they have something to offer me even though I wasn't looking for it.

How do we bring the spirit of service to are lives? Methods will differ. For me, it always comes down to introspection. It comes down to several questions. How can I see this patient in their best light? How do I involve myself in a more deeply held involvement and commitment to Quality work? How can I learn to see my work as service?

Many of us will remember times when we gave selflessly. Mothers and Fathers do it everyday with their children. Selflessness refers to a removal of attachment to the fruits of our labors. When I get a paycheck I see it as a gift. I know full well that I worked very hard for the money. But I aways want to feel gratitude in my heart. It's possible to give generously with out spending a cent.

I remember one day I stood at one of the most busy intersections in which the city I live. An older man stood, leaning on this walker. “Sir, Will you be OK crossing the street,” I asked. His appearance was infirm. He indicated that he could cross with some difficulty but would like some assistance. I offered my arm to him and carried his walker. I told him to hold on. His grip was like iron. We walked at his pace: slow. The light changed before we had made it half-way across the four lanes. No drivers blew their horns or yelled as I feared they might. We crossed the street safely after some time.

On the other corner he smiled and with a bright presence in his eyes said, “You Sir are a gentleman and a scholar.” I know I could have left him in the dust. My purpose is to offer an illustration of how we can be unconditionally selfless in the way we approach action. Selflessness does not mean we loose a sense of self. Rather, we gain a sense of self. Each action that helps someone else can be an opportunity of selflessness. I believe seeing our daily occupation as service allows us to experience, as Abraham Lincoln said in a different context, “the better angels of our nature.” It's liberating. It also helps us avoid burn out; selfless service recharges our batteries. When we sustain it, the act of it sustains us.

Those of you who are still reading will ask, “Well fine, how does this apply to imaging technologists and the larger medical field.” I say, there's no finer field for it to be applied. As we well know, the people we see professionally are in many stages of life and health. Suffering runs across social and economic boundaries. How better to affirm then why many of us go into the medical field in the first place: to help people. And for that matter why limit it to patients. I try to say mentally, I offer this action to the individual I see before me. We all want to love what we do. Selflessly offering our actions in the form of service is one method of maintaining a high level of satisfaction and a love for our work.

I will never be able to say this as well as others more involved than I in the expression of selfless service. I have found this book helpful:

How Can I Help

Das and Gorman

Paperback: 256 pages

Publisher: Knopf (March 12, 1985)

Language: English

ISBN-10: 0394729471

I Rock the OR

2007-07-21T22:29:00.000-07:00

Week of: 2007-07-16

Abstract: An amazing first week in the OR passes in a flash. I get paid as technologist for the first time.

Mood: Somewhat tired but optimistic

What went well: I rocked in the OR. I did many cases solo.

What needs work: Speed with turning equipment over after cases. Changing the views in the rooms.

Disclaimer: Some descriptions of cases are graphic in nature and not suitable for all audiences.

Elucidation: I've had a delightful week in the OR. Something just clicked for me: I'm doing exams on my own. Crazy Uncle, the OR lead tech remarked to the visiting instructor of my program how I just go out and grab a req off the board and do it from start to finish. And how he can throw me into a room with the expectation that I will pick up where the previous tech left off. As I left on Friday, I remarked to a group of techs, “Thanks for helping me feel so successful.” One of them said, “You're doing exams on your own. Keep up the good work.” I feel so lucky to be in this program.

On Monday I did a procedure where involving a patient who's epidermis had been completely pulled away from the underlying tissue of his hand. This is called degloving. In this case, his hand had received the blunt force of a falling cinder block, sufficient to pull the skin away from the muscle, tendinous, connective, nervous, and osseous tissue of the hand.

I watched as they flushed his hand which was missing a couple of fingers. This was a difficult exam to see. But if I do say so, I maintained a clinical attitude of professionalism throughout. As one tech said, “Humpy Dumpty.” Meaning the docs would put the hand back together bit by bit. At the same time I felt my heart swell not in resonance of the pain, but in expression of kindness: seeing the true nature of the individual as a whole healthy person, seeing the person well.

I also so a degloved leg procedure. This one was more interesting, again the epidermis had been completely pulled free from an areas stretching from mid-thigh to mid tib-fib. The dermal tissue had been completely destroyed. There were muscle groups hanging loosely from a bloody mess. They had put in antibiotic beads to assist in fighting infection. To close, I'm sure they used grafted tissue to surround the enormous wound.

During my first two terms, the lead tech tried to shield us from such extreme cases. I appreciated that. I'm telling you this because this is my blog. Yo. I've kinda snuck into the last one. I need to let Crazy Uncle know that I'm sufficiently hardened to observe this type of case. I don't resonate with the pain or the injury, I resonate with viewing the patient as healthy and whole as the process I'm participating in. I see myself as a participating member of the team, headed my the physician, bring the pt back to health.

There's a counterpart program to my program that is across the State from us. They live an area of the state with a farm based economy and low population density compared to ours. We've been sharing our classes with then via internet link as I'm sure I mentioned earlier.

They've been visiting our sites this week. It was a wonderful experience because I was able to demonstrate my knowledge of the C-arm: the controls, sending images to PACS, how you line up the C-arm to the axial line of the part. If the pt is rolled up so the affected part is higher, you might need to incorporate multiple angles to achieve an AP and Lateral to adjust to the rotation of the pt, to explaining how increasing kilovoltage increases apparent brightness of an image. It was fun to meet these students.

I participated in a couple of Cystography exams. this week. One included lithotripsy and associated basketing of the stones. It was interesting following the scope up the ureters to the kidneys. Also of interest was viewing the scope feed on an LCD monitor next to the spot films of the c-arm.

For my part, it was very simple: follow the scope from the bladder to the right kidney, then from the bladder to the left kidney, as they flushed contrast into the renal tissue providing shape of those structures. They inserted a basket through the ureters to grab the stones broken up by the lithotripsy. It was wonderful to do the procedure solo all the way through. And I liked the feeling of being an integral part of the OR: providing diagnostic images for the physicians.

I worked my first paid shift as a Imaging Technologist Trainee on Saturday. I did at least six CXR portables today solo. I enjoy ports. I think there's something very calming about walking the corridors of a big county hospital as portable machine rolls noisily along. Even though I've been at the same hospital for a year I haven't spent a day doing them. It helps in learning the layout of the floors.

I like when patients talk back or ask me questions. One woman asked about the large body of water she saw from the sixth floor window. I went from floor to floor, introducing my self to nurses. I suggest playing nice with nurses; they're there to help the patient and by extension the technologist.

There were a lot of trauma cases. Nothing really to write about. Except for one fellow who was brought in from a high-speed motorcycle wreck. In a situation like this you do about 50 images. We worked quickly. But multiples take time.

Goals for next week:

Pick up prescision in lining up the C-arm with the affected body part.

Start, work and finish an ankle case.

Pick up my overall speed.

OR Ratation, here I come

2007-07-14T16:35:00.000-07:00

Weeks of: 2007-07-01 & 2007-07-09

Abstract: Summer quarter is a sweet reprieve from the rigors of scholasticism yet amidst a marine heat wave.

Mood: Cheerful and even minded

What went well: I concentrated primarily on fluoro. My comps are rolling in.

What needs work: Fluoro demands detail oriented work

Elucidation: Wow! This quarter is interesting. It feels like a full time job only I'm not getting paid. I am learning about the flow of patient care from the time the EMTs roll 'em in, until their discharged. It's reassuring that I'm having fun.

The program director has visited us twice. He reminds me of a charismatic but unknown rock musician. I'll call him Perkins. He's been throwing our understanding of the rationale for exams under the wheels. It's cool. I know that real learning always need to start with some mental dissonance.

He often asks us questions an then watches with amusement as we struggle to answer. Example: Why center slightly medial on a lateral scapula? Answer: it throws the scapula slightly away from the ribs because of divergence. If you center right on the scapula divergence will project the scapula over the ribs.

Another fun one: What's another name for the talus? It rhymes with asparagus. Someone guessed asperger's to general laughter. Answer: Astragalus. We should have known that one.

Being in the hospital 40 plus hours a week really makes it easier to rake in the comps. I comped a cross-table hip. I'm happy about that one because, for me at least, it's that culmination of a lot skills from the past year.

Line the tube up with the grid to avoid cutoff. Quadruple your mAs because it's a axial projection to produce a lateral. This through a lot of tissue. Multiple positioning criteria including: Place the affected hip on a pad. Raise the unaffected leg out of the way. Angle into the joint space. What comes out is a pretty film of the femoral neck, without the foreshortening that a frog view creates. What is demonstrated is a true lateral showing the ball of the femur in the acetabulum.

I'm able to call back to the tech at the panel what technique I want. I apologize that this is turning into another self-congratulatory post. But yo, this be my blog. I'm particularly pleased because this happened most recently during a trauma case involving a post-fall 85 yo female. It pulled three comps from that case alone.

My level on independent work is on the rise as well. I've been running the fluoro exams on my own for significant periods. I've taken initiative more often in regards to patient care.

It's important to me for my service to others be done with the right attitude. I'm trying to see each patient as an individual whether or not they're out cold or raving mad.

I start my employment as a Radiologic Technologist Trainee next Saturday. I'll be working in the ER department 08:30-19:00 to start.

I'm a happy camper. Let me know what you're thinkin'.

Peace out.

Goals for next week:

Next week I'm back in the OR. I plan to take it one day at a time.

I'd like to be doing femoral nails by the end of the rotation.

For next week I want to complete an ankle procedure.

Happy July!

2007-07-01T17:35:00.000-07:00

Week of: 2007-06-25

Abstract: The first week of the, 40hr/wk clinical only, Summer Quarter

Mood: Chipper

What went well: I got in and started and ended fluoro exams. It took control of my experience.

What needs work: Being open to new experiences and as usual, taking initiative.

Elucidation: It was quite a week I think. I was able to spend the entire 40-hour first week in fluoro. I learned a lot, from setting up exams to the flow of spots (which the radiologist takes) to overheads (standard radiographs) which are the responsibility of the technologist.

The setup consists of setting out various materials including contrasts dyes, other compounds to be injected. I observed the checks and balances that go into securing a safe experience for the patient.

I was involved in one exam called a Myelogram. In this exam contrast is injected using a long needle inserted into the nerve roots of the spinal column near L5-S1. The patient experienced a mild form of shock. She was in extraordinary pain and sat up quickly which caused the situation to become worse. I talked to her calmly while holding her hand. I asked her about her family. I patted her shoulder.

She had expressed fear when I brought her back from the holding area before the exam. I told her when I have a medical procedure in which I'm afraid I always take deep breaths and imagine it's happening to someone else.

When the episode started I got down to her level as said, “This would be a good time to do some deep breathing.” She took it well. But her pain was stupendous.

She calmed down after getting an injection of pain meds. We were able to complete the study. The radiologist explained the pain as being caused by truncated nerve roots. The contrast was forced farther into the area by her insistence of getting up. I can't blame her. I'd be jumping up too if my butt and legs seemed to be on fire.

I seem to be doing well. I made six comps last week I want to finish them all up during the 440 hours this quarter.

Just a reminder to take not to take anything personally if you can help it. It always seems like there's a type-A in the department. And fluoro is no exception.

I had fun last week. It nice not to have to worry about exams.

Keep in touch.

Goals for next week: Comp two fluoro exams. Continue knocking down other comps.

Spring Wrap Up

2007-06-24T18:47:00.000-07:00

Quarter of: Spring 2007

Abstract: I finish my first year successfully.

Mood: Relaxed, I had six continuous days off.

What went well: My clinical experience provided many areas of growth.

What needs work: Assertiveness and speed.

Elucidation: Spring quarter was successful on my many counts. And I'm sorry if this is going to be a self congratulatory sounding post. But I managed a sweet GPA for the quarter.

I got a glowing evaluation from the education coordinator of the hospital. She's noted growth in all areas. It was interesting to me that I pretty much led the evaluation.

Wow! My second year starts tomorrow. I'm feeling a little apprehensive as usual. Read my last few posts if you're wondering why. This is a different set-up because there are no classroom hours. It's all in the hospital 07:30-16:00 M-F. I know I'm going to learn a lot.

Goals for next Quarter: To gain self proficiency in triage & in-patient portables. To gain speed and accuracy in the OR. To continue to integrate and synthesize concepts and methods.

Crazy Uncle, Tough Love and The OR Queen

2007-06-10T18:55:00.000-07:00

Week of: 2007-06-04

Abstract: OR Rotation Ends

Mood: Nervous, cause I drank to much coffee while studying for the exams I have tomorrow.

What went well: My level of independent work in the OR has shot up.

What needs work: I still need to improve my speed in the OR.

Elucidation: I find that I am reflecting on the events of last Tuesday. I had scheduled a case in the OR. Two other techs had joined me to set up the room for the case. One tech, I'll call her, OR Queen, was asked, “Why does the schedule say upper extremity when its a lower extremity case?”

“Because it was an idiot who scheduled it,” OR Queen said to the tech who had asked.

Upon hearing the last I asked, “That would be me. I didn't quite catch the gist. Is there a problem?” Without batting an eyelash she told me in no uncertain terms what my transgression was. OR Queen does blow everything, around my experience, out of proportion. She is a type-A female. She's often overbearing in the middle of cases.

Upon reflecting on the events I share these thoughts: It doesn't pay to take anything personally, even when you've been insulted as much as that. Life is full of joys as well as jabs.

I would never personally say something about another person being an idiot. That's my nature. I tend to be PC to the hilt. In a similar situation I'd say, “That person had a clueless moment.” OR Queen's example is certainly more direct.

I told the lead tech, Crazy Uncle about this. And he said it was no big deal. That I could change the exam type when I ended the case.

Crazy Uncle also has noted that I'm not assertive enough for the maximization of the experience. He said, “I'm going to push you into things outside your comfort zone.” I thanked him and said that I need that push. One thing I need to caution my readers who have yet to start your programs: I don't harp on assertiveness for nothing. It is critical to get your experiences in. I feel that I am improving.

It was a successful week in many ways. First though I want to continue my rants about “hard love.” Being in such a intensive program, unlike many stand alone classes at the college level, often there is a race to the finish line at each quarter. What this final week entails is a feeling of being overwhelmed.

Many new concepts related to fluoro and advanced procedures have been introduced. It's been exceedingly difficult to retain everything. I have two exams tomorrow! The last several days have been fat with study. I find the best thing to do is to study when I'm relaxed.

That said, I'm feeling somewhat resentful to the process because so much new material was dropped in our laps. Getting so much new material makes it hard to assimilate everything.

I was able to complete several exams this week. My level of independent work in the OR has increased. And despite what I said about OR Queen, I like her and the other techs quite a lot. And I feel respected in return. This feels like a good way to end my account of the rotation.

In real news: A supervisor for the radiology department spoke with us last week about summer employment. I'm looking forward to getting paid. The jobs are contingent on good grades, strong performance in the hospital setting and comps.

Tuesday is the last day of Spring Quarter for me and the last of my first year!

Do say, Hi.

Goals for next week: Next week I'm in the Main Department. I will round out some of the spine comps that I missing.

Getting Over the Jitters

2007-06-05T05:35:00.000-07:00

Week of: 2007-05-28

Abstract: OR Rotation Continues

Mood: Tired

What went well: I got into the rooms: started and completed exams.

What needs work: I need to get over the jitters and bring up the speed.

Elucidation: Working in the OR requires a skill set that is hard to acquire if you're not in the department all the time. My OR hours to standard radiography hours are 3/11. Next quarter, my clinical will be 40 hrs/wk Monday-Friday. It will be productive to a better grasp of all the departments including the OR.

It's easy to understand why a student might feel nervous. I remember an early situation, during a flustered moment, when I moved the c-arm proximal when the surgeon asked for distal. Most surgeons have no time for students who take extra time. I need to bring up my speed.

Surgery is really a race. Everyone has limited time: for the patient to be under anesthetic, before the next scheduled exam.

Goals for next week: Be more proactive. Speed up my movements.

Adventures with the C-Arm

2007-05-27T10:18:00.000-07:00

Week of:
2007-05-21

Abstract:
OR Rotation Begins

Mood:
Upbeat

What went well:
I did my first solo OR case.

What needs work:
As usual, assertive behavior is key to success.

Elucidation:
As I was leaving at the end of the week, the lead tech clapped me on the shoulder and said, “You need to lighten up. This place can eat you alive if you take it too heavy.”

The OR is very stressful. But one thing you notice is how close knit the people are. That includes X-ray of course. Talk is very relaxed.

My first solo case was a scaphoid fx. Not a lot to it most of the experienced people might say. I forgot that with c-arms are basically fancy fluoroscopy machines. So when I was asked by the surgeon to lighten the image on the monitor I couldn't figure it out. “The KV is at the bottom of the scale,” I said.

What I forgot is that every thing is backward with c-arms and fluoro. The tube is under the table with fluoro and increasing kv makes the image lighter! Surprise, the doc was very gracious about it. He referred to me by first name through out the case.

When I mentioned this to the lead tech he said, “Why did you think I put you in there; he's very good with first year students.”

By the way. In three weeks my first year will be over. In five weeks I'll begin my second year with an 8x5 eleven week clinical experience.

Goals for next week:
Be more assertive.
Ask for experiences.
Complete an exam from start to finish: solo.

In the Court of the Ortho Queen

2007-05-20T16:32:00.000-07:00

Weeks of:
2007-04-30
2007-05-07
2007-05-14

Abstract: I've been busy. Exams every week. Ortho ends OR next week.

Mood:
Cheerful

What went well:
I managed 10 comps during my ortho rotation,

What needs work:
Confidence around techs with strong personalities.

Elucidation:
I'm writing this a study for my practical and exam on UGI and BE. I'm still excited about the process.

I got a huge compliment from the ortho lead: “You do knees exams as well as anyone. You act with confidence and accuracy. You work hard and it shows." I really needed that statement. It's good to hear.

Not all my interactions were that easy. As many students know, there comes a time when you can do many exams with confidence. One tech, I'll call her the Ortho Queen was interested in teaching me her way of every exam I attempted. She might say, “No. No. You must do it like this.” I wanted so badly to scream to the sky, “Hello, I already know how to do axillary shoulders!

I missed the point however, I can learn something from every tech. I'm too the point now where I know how to nail most ortho exams. But it's important to let go of that, and to some extent, embrace the opportunity for growth. I feel like the willful-spirited teen.

OR here I come.

Goals for next week:
Kick butt in the OR: do multiple exams.

The Dog Days of Spring

2007-04-29T19:26:00.000-07:00

Weeks of:
2007-04-14
2007-04-23

Abstract:
Things find their own level like water in a basin. The dog days of spring.

Mood:
Scattered - after studying electrical theory for three hours.

What went well:
I've made very few comps, but I've learned a lot about myself

What needs work:
I need to improve my skills in dealing with sarcastic and condescending criticism.

Elucidation:
I've felt more focused in my school work. I've done very well in the tests so far. It's interesting how each facet of life is experienced as ebb and flow. It's helps to be assertive and work hard, but to also accept what the world sends you.

I've spent the last three weeks in the ER, something I enjoy doing very much. The vibe, and energy combine for exciting work. Helping people in various stages of life and injury.

But I think we all can agree that who your tech is for the day can dictate how you perceive your developmental self esteem. Call me a wimp. But I don't do well when someone in a supervisory roll uses me as their cat toy, to bat around. A tech, I'll call her Casper, would smile as she said, “You've been here long enough to know better.” The tone of voice was like acid. There were several moments like this.

For most of them I remained silent, Nodding in agreement. But it's difficult when you know down to your socks that there are many ways to look at the issue. I didn't take it well. Primarily because I feel that there's good teaching and not so good. I've said this before: What needs to understood is that these people, the technologists, aren't trained teachers. I would never act like that to a student.

The clinical coordinator at the hospital said as much after she asked who the individual was. She said things that I knew but it helped to hear them, “Casper is a real bitch.”
“I don't use that word.” I said.
“But it's true. She is a very moody person. You need to realize that this isn't about you. She's having her moment of dominance at your expense. But if it wasn't you, it would be some one else. So don't take it personally.”

I agreed to let it go. That decision is where my power is. I spoke to one of my buddies and she said to let in fall off my back, to not take it personally. I'm good at doing that sort of thing. I never looked at the tech's comments like attacks.

This week reminds me of something a student told me before I was in an x-ray program. This in response to my question: “What are the keys to clinical success.”

Show up
Be honest
Be humble
Take direction
Be Assertive
Learn from past actions

I'm in ortho next week. Every one: stay in touch.

Goals for next week:
Improve my interactions
Earn Eight comps.

Spring quarter starts with a bang, I mean a rush

2007-04-15T18:25:00.000-07:00

Weeks of:
2007-04-02
2007-04-09

Abstract:
Spring quarter starts with a bang, I mean a rush.

Mood:
Stressed, yet happy

What went well:
I feel my confidence level soaring

What needs work:
I need to be better with techniques.

Elucidation:
Does it seem like I say the same thing every time in the intro segments? I think so. Anyway, I've been finding the new quarter to be the one where I find my feet. The development seems agonizing slow at times and I'm quick to loose patience with myself.

I did quite well over the last two weeks. I already have as many comps this quarter than for all of Winter. I started and ended a full trauma Cervical and Thoracic spine series. It's more challenging because you can't use the bucky since the pt is on a backboard. The oblique radiographs are ugly as sin, because the vertebral bodies are all stretched out laterally. I nailed every shot!

And I would have been happy as I thought I was making pretty good time. But the pt's nurse came in and asked, “What's taking so long?” She smiled when she said it. I told her that I'm a student of radiography and the seemed to satisfy her. It may see like a modest step but I feel it's a leap mentally.

What predicated this was a moment with a supervisor week one. He asked me if I'd seen anything interesting. I said I'd seen a RUG, Retrograde Uerethrographic exam.

He said, “See, Did Do!”

What he meant is this clinical experience is what I make of it. I need to go into every exam with the thought that I'll make some contribution. It might be setting up the supplies including contrast. So I've taken the concept to heart.

I took it upon myself to do several portable exams solo. This was a little stressful as I didn't have the usual support. I had to CXR a 500 pound guy! But I asked the nurse for help and got it going and nailed the shot.

I slipped over to CT during a slow moment in trauma. They were doing an abdomen scan on a young man. I overheard the words, “multiple gun shot wounds” and “multiple surgeries.” The scout lateral of his addomen was aquired and the tech said, “When is he expecting?” Because of how distended the man's abdomen was it looked like a pregnancy.

What really flipped me out was seeing the axial image of what was causing the distention. His colon was completely external to the peritoneum. Sheesh! Not a good thing. Can you say massive histamine reaction? Loop upon loop, layer upon layer laid to waste.

Thursday was a tough day. I'm a feeling kind of guy. One woman was D.O.A and I happened to observe. I need to look at my emotional reactions that is, don't react emotionally to extreme cases. It's no wonder the people in those areas are cracking jokes all the time.

I need to regain my sense of urgency for school work. Clinical is great, show up, work hard, kick ass. School is harder to stay motivated. But I'm trying to get into labs and groups more often. I'll let you know.

Goals for next week:
Stay more physically and emotionally balanced.
Continue to work on techniques and confidence

Winter quarter Wrap Up

2007-04-06T15:24:00.000-07:00

Abstract: Winter quarter ends in a blaze comp collecting fury, sort of...

Mood: Silly, slightly guilty

What went well: I gained confidence in most areas. I found new confidence in standard radiography.

What needs work: My selection of techniques to limit patient exposure.

Elucidation: Has this blog faded? No, at least not intentionally. I've very busy with school. I became ill with some brand of flu. My computer died. Getting sick the last two weeks of the semester will adverely affect your GPA.

In any case, Winter was a process. I burned out because of lack of sleep. I'm doing okay now.

A process because I began to see my self as tech. I built on knowledge of techniques and postioning.

Goals for Spring Quater:
Work harder; rest more
Become more proactive: go into new experiences with the intent to participate fully
Act with more confidence

Wicked Snowstorm

2007-03-04T15:32:00.000-08:00

Week of: 2007-02-26

Abstract: A wicked snowstorm invades the convergence zone; OR rotation: Week Two

Mood: Happy, yet pensive

What went well: Nearly everything

What needs work: I suppose I'm right where I should be but I could be more proactive.

Elucidation: It snowed all evening Wednesday. The commute home from school was time consuming. All the area streets were clogged with spin outs.

On Thursday day morning I awoke to easily the most snow I've seen all season. I had drifts that were over eight inches high. Some of you will think: so what's the big? Yo, I live in a marine area. Fortunately the phenomenon was isolated to the county in which I live. So the greater area was not adversely effected. Which meant of course that my school was open; I need to get to clinical or make up the day. Yuck.

The commute was difficult to say the least. It took nearly three hours. Everyone was gracious about my tardiness. My feelings of stress dissipated quickly. So did the snow so I was able to get home from clinical quickly.

I did my first wrist exam in the OR. I was pretty nervous. I've been trying to learn the locks on the C-arms during the quiet moments. But you know how first timers sometimes get when their on stage. My advice: calm down. The tech I was with made subtle adjustments to my technique and positioning.

My positioning instructor has pointed out that OR techs should wear leaded glasses. She qualified this with no numbers but suggested the the longer duration and lack of shielded area creates higher rad exposures. She said, "The cornea is exceptionally sensitive to radiation."

I've noticed the glasses I want cost about $200. Hey, it costs money to look cool. These expensive specs seem prudent as I'll be working in the OR for 40 hour weeks at times this summer. Maybe I can talk to financial aid about funding a pair of leaded glasses.

We covered bony thorax positioning and grids in lecture. Next up, the skull.

Everyone have a great week!

Goals for next week:
Relax into being more proactive.

Take the opportunities the techs present and ask more often to practice during procedures.

My First OR Rotation: Week 1

2007-02-25T13:56:00.000-08:00

Week of: 02-19-2007

Abstract: I begin my OR rotation

Mood: Cheerful, calm & quiet

What went well: I integrated many of the dynamics of the OR.

What needs work: There's still a lot to learn. Strong personalities in the department.

Elucidation:
Imagine your favorite crazy uncle who always is cracking jokes and you have a good picture of the lead tech in the OR. He's a real hellion but a lot of fun. His first words Tuesday were, “Why don't you go to the cafeteria to get some breakfast.” Which certainly sounds tame enough. I won't describe the other things he said, yet.

My first day in OR rotation started with a feeling of trepidation. I often get the jitters during any activity that is new. What makes it different of course is that the area around and between tables is considered sterile.

It's critically important that no one other than the scrub nurse/tech and docs touch the area. I've always been some what spatially challenged. Case in point was my short football career in high school: unmitigated disaster. I've improved in this regard since my ungainly years as a youth.

So what happened? I nearly touched the field twice in one 30 second period. The tech, a woman, pulled me by my scrubs and whispered sharply, “NEVER TURN YOUR BACK TO THE STERILE FIELD.” Wow. On Thursday, the lead tech (Crazy uncle) said something similar when we walked to a room. “If you touch the sterile field your ass is grass.” He needn't have said this.

But you know it worked. From then on I'd look in the window of the suite to assess the position and best approach to bring the equipment in.

The first tech was an encyclopedia. She explained just about everything she did during a capitulum reconstruction. She talked about the controls of the C-arm, technical factors, and who all the personnel involved were.

I found it all fascinating to say the least. Looking into an open abdomen for example, really leaves a mark on a young tech. I saw a surgeon draw a strand of the tricep upward during the capitulum reconstruction.

But I must say it brought me pleasure at the end of my shift on Thursday when the lead tech said, “You did a good job today.” I smiled. I'm smiling now.

Goals for next week:
It's all very basic for now:
Just get in to the rooms and watch, observe and take notes.

No More Moaning, Well...

2007-02-19T17:42:00.000-08:00

Week of: 02/12/2007

Abstract: My three weeks in ortho ends. I begin surgery rotation for the first time this week.

Mood: Apprehensive yet optimistic

What went well: I did well in my classroom exams. Clinical was enjoyable.

What needs work: Same as last week

Elucidation:

Well I'm through being hard on myself. I will continue to assertive but balance that with acceptance. I'm doing the best I can and I sticking with it. What does that mean?

I got two comps last week and I'm okay with that number. I'm not going to jump down my own throat when I do badly in an exam. I'm going to chalk it up as a learning experience. Note that I not taking about negligence. I plan to get in and get out. I do like to interact with the patients if possible but not to the point of distraction.

That's one thing different about OR. No patients to chat with. I'm a newbie in the department, so I'm a little nervous. Well I'm gonna be brief and wish you all a fantastic week!

Goals for next week:

Use initiative. Get into OR Rooms and observe.

Take notes of the procedures.

It's the Quality Not the Quantity

2007-02-11T15:21:00.000-08:00

Week of: 2007-02-08

Abstract: Things are progressing much the same...

Mood: Uninspired, overworked, grouchy

What went well: I internalized much of the new material and brought it to clinical

What needs work: I need to do more mock work. Get into the labs.

Elucidation: No fun. Well, not exactly. I finished up my second week in ortho with only two comps. My feeling about the situation is that it's quality not the quantity that counts. The education coordinator said much the same. “You need to act like a sponge. Gain all you can from the techs.”

Class room work is somewhat overwhelming, which is okay. I just need to buckle down. I just would like more time. Blah. We've begun our second unit on spines which I'm really excited about. It's not an understatement to say that I've been waiting two years to get into this stuff.

I love the people. Which is nice to be able to say since the medical field is all about people. I think my patients sense that vibe on some level. I enjoy interacting with techs and fellow students. I find I enjoy my interactions with the docs too.

Goals for next week:
Get several comps in ortho.
Get into the labs at school.
Get some counseling on campus regarding anxiety.

More Self-Indulgent Blather

2007-02-02T13:37:00.000-08:00

Week of: 01/29/2007

Abstract: I begin my ortho rotation; Five major assessments in seven days.

Mood: Quiet - introspective

What went well: I received an excellent grade on one of my exams and did well on others. I felt more at ease with my skills in clinical.

What needs work: I need to improve my organization before each exam: reduce retakes.

Elucidation: As I write this I'm studying for a Positioning and Related Anatomy exam slated to occur on Monday. First, before I continue I want to say, I know how lucky I am to be where I am, doing what I doing.

But golly, five big tests in seven days? It makes you wonder why the instructors couldn't get together a spread sheet calendar to show how the exams overlap. Grrrrr. Okay, now that I said it. Was it tough? You bet: I studied and worked and studied and worked some more. Everyone said the first Fall quarter is the toughest. We're taking ten didactic credits – in addition to being in clinical fifteen hours a week.

This week in ortho was fun. Although I had some family issues that provided heavy distraction, I pulled through with four comps: hand, pelvis etc. More importantly, I had a positive experience. The lead tech in orhto is very good with students. He challenges us within our abilities. For example, before assigning us an exam he'll say, which part of this exam do you feel comfortable trying to comp? I'm usually eager to do all of the projections, but I always want supervision, that is, until I double comp each one.

The problem is such supervision isn't always available. On a busy day, the techs are running around. I began a Os Calsis exam with out my usual routine to getting organized before beginning. I don't mean I didn't flash the proper size cassettes and think about technical factors, (mAs, kvp, sid, and collimation,) and positioning criteria. I did. I just didn't stop and put it all together mentally. Through this failure, I was able to see what is called for. Slow down, don't try to be a seasoned technologist after your first semester. Try to increase your speed at the things you feel confident.

Radiography is hard to learn. It's like riding a bike for the first time, while talking on the cell phone, and reading a newspaper. Don't believe me? The tech must take into consideration the girth of the pt, how rad (hot) the room is, how dense the tissue being imaged is, how much to collimate, how all the factors affect density and contrast, what is the CR angle in relationship to the IR, how will the source image distance produce a diagnostic image, what is the physician really requesting, ensure that the right pt and part are being imaged, & how does pt history affect the current exam? I could go on and fill a page, but that would be tedious.

I must somehow keep all those things organized in my mind before the exam. I don't want to appear hesitant with the patient. How do I do that? By being a sponge: asking the tech questions, imitating my role models, referring to my notes and taking notes in clinical, practicing in the lab at school. Doing everything with defined intention and attention. In short, increasing my confidence by acting like a good tech; one who pursues knowledge and skill in order to improve steadily.

Goals for next week:
Since I dropped two comps last week, I'm setting the goal to eight comps this week.
Work on all my interactions with patients, staff and fellow students.

Oh the horror; Oh the joy!

2007-01-26T20:35:00.000-08:00

Week of: 01/22/07

Abstract: What a mixed bag; oh the horror; oh the joy! My trauma rotation ends.

What went well: I was provided with plenty of opportunity to select techniques.

What needs work: You ever feel like a deer in the head lights?

Mood: Discouraged yet hopeful, chatty.

Elucidation: How did the week go? I'm trying to be the optimist here and say, pretty good. I'm getting better at predicting what the tech needs and expects. You need to be good at dealing with strong personalities. If you wilt under pressure, then your up for some rough days, sister. I was more proactive in my own eduction by asking if I could attempt a comp of parts of many exams. Sometimes those ended in abject failure. Most of the time, they ended in a lovely learning experience.

Most of the techs treat me like an peer. Others, at times, treated me like a idiot. I still think of my self as a beginner and I tend to use that as an excuse. The techs in trauma sometimes confuse first year students with second years. Second year students have many hundreds of hours of experience. I'm getting there.

I work in the hospital fifteen hours a week. Maybe I won't know exactly how to position a T-spine, because we haven't gotten the examples. I don't take it personally though, because I know it's needful to get the exam done in a timely manner.

I want to give you a real situation. One of the techs screamed at me, “You should know what size cassette to use for a T-spine!” Her point is that I've observed the exam many times. My point is that with out covering the exam in lecture and lab, I don't have handle on doing it; I might be able to think it through, but it's not yet automatic. In retrospect, maybe I should. But it my own defense, I'm more of kinesthetic learner; I learn by doing. And I haven't done much. This week offered plenty of opportunity.

If the patient is injured grievously, than it's helpful when the nurse gives them meds. that wasn't the case when we began an exam that included every extremity possible and imaging the whole spine. The hard part was that the patient couldn't lay still because she was in so much pain. The exposure times are such that any motion causes blurring.

The patient wasn't able to objectify anything that was happening during the exam because of her dementia. I have to admit that I was wowed by her charm. She was so precious with her plaid dress and gentle child-like manner and words.

It's not realistic in this context to expect a patient to lie still and understand the situation is temporary. And it's not realistic to expect a second quarter student to always pick the right size cassette and technique. How realistic is it for me to expect a trauma tech to be patient with my learning process in an acute situation?

Not very, these people aren't trained teachers. I come from an educational background. When I'm a tech I will be honored to be part of the student process. At the same time, I'll need to step in at times and say, “Do you mind if I take over here in the interest of time. Patients are waiting.” I expect that I'll always treat students with respect. I haven't earned it yet.

I think though my expectations are high of myself and the experience. I don't come across as competent as I would like. It's an issue; how do I become more able. I am proud that I didn't wilt under pressure. I showed heart when it counted. Another cliché comes to mind: If it were easy to accomplish, would it be worth it? I'm having fun in spite of all that.

I had the experience of imaging a six hundred pound patient. Wow, talk about scatter: Nothing but a blob of white and a few suggestions of lung on the image.

Have a great week.

Goals for next week:
Ortho is Disney Land for fist year students: Six comps.
A continuation of previous weeks goals.

No Clever headline

2007-01-21T21:14:00.000-08:00

Week of: January 15 2007

Abstract: We end the pelvis unit and begin the spine. My clinical experience improves.

What went well: My didactic studies feel focused.

What needs work: I'm still slightly out of sync with clinical

Elucidation: I enjoyed this week. I didn't fulfill my goal for two comps. But I do feel I've gotten closer to where I want to be: better familiarity with equipment and protocols; a willingness to ask questions and learn from mistakes. I continue to feel challenged by the many aspects of a successful exam. An example? I put an extremity cassette in the bucky for a foot exam.

I try to go through my mind with ideas on how to improve performance. What did I do well? What did I learn from the experience? How will I improve next time.

All this to say; I had much more fun. I'm starting to feel like the hospital is one my homes. When I relax I tend to perform better. Here's hoping that hold true for next week.

I did gain progress in two of last weeks goals: Continue to be proactive in the learning process in clinical and synthesize information from the classroom to clinical experience.

Goals for next week:
All of last weeks goals.

Week of Ice

2007-01-12T13:58:00.000-08:00

Week of: January 8, 2007

Abstract: I work in my trauma rotation. School closes for two days due to snow/extreme black ice.

What went well: Overall I'm pleased with how I'm doing in my didactic studies.

What needs work: I'm still a little off in my clinical.

Elucidation:
What a weird week. I don't know weather to cheer or cry. Since the ice storm, I missed a clinical day. I really wanted to go, but I heeded the meteorologist's advice and stayed home. It was an excused absence, seeing how the college was closed. I'm feeling caught up in my studies, which rocks.

My one day of clinical went well. I fulfilled my goal to be more proactive in my approach and found myself becoming integral to many of the exams. I followed the techs to the exams and found that I was able to help. I'm starting to feel my legs again in clinical. My comp attempts were off, but more solid than last week.

We received a lecture and practice problems on the inverse square law as well as the 15% rule. I followed it fine but I'm practicing the math as I go. It's been several months since my last math class.

Goals for next week:
Work harder in clinical and succeed more in my objectives
Comp two exams
Continue to be proactive in the learning process in clinical and synthesize information from the classroom to clinical experience.

First Week of Winter

2007-01-06T22:10:00.000-08:00

Week of:
Monday, January 1 2007

Abstract:
I begin Winter quarter 2007

What went well:
I was more assertive in my own process. I received a orientation in surgery radiography.

What needs work:
Coming back after nearly a month off leaves a lot to be desired.

Elucidation:
Well, the first week was not especially sterling. I had difficulty getting back into the groove. For example, I totally mixed up the angle of a foot x-ray. My timing was off. And my feet were sore, unaccustomed as they are to standing for long periods. But it was temporary; I started to get my legs late Thursday.

Overall though, I had an enriching experience. I was able to integrate much of the concepts that are new to me. I was able to acquaint myself was several new faces in the O.R. A fine start I feel to the quarter.

Goals for next week:
I want to be proactive in my approach to my own learning.
I want to gain useful skills in my trauma rotation next week

Fall Quarter Wrap Up

2006-12-13T18:07:00.000-08:00

What went well:
Overall, the quarter went well. I achieved most of the objectives I set up for myself. My quarterly GPA is around 3.8. I archived most of the objectives set up for me by the school. I began to feel that I was participating on a higher level with some techs.

Patients and techs told me privately that I have good patient care skills. One of my instructors noted that my comfort and confidence level seemed to be getting better with techniques, exams and patients.

I enjoyed clinical. I put a lot into it. I got what I put in. I set my goals high and I was able to reach most of them. I always tried to inject a high level of enthusiasm.

What didn't:
Due to my reserved nature I tended to sit on my hands occasionally. This isn't really a problem as I made a conscious effort to compensate. Just something I need to pay attention to. I need to be more proactive in my approach to learning.

I didn't have many personality conflicts with anyone. But I did fail to speak up for myself.

Elucidation:
Again, overall I did very well. If I had to do it all over again I would chose to be a little more assertive in my own learning process.

RT students live in glass houses. We really don't find a benefit in correcting techs when they do things that are different or in conflict to what we were taught. What you find is that there are multitudinous ways to successfully complete an exam. However when it comes to patient safety we need to speak up.

I talked to my education coordinator about this issue and she was quick to offer her support as mediator to staff technologists when needed. Hopefully that will never happen.

Some Goals for Winter quarter:
Increase my level of confidence.
I want to take more initiative in my learning process.
I want to improve my anticipation of patient care and comfort.
Improve the selection of techniques.
Increase my level of independent work.
Reduce the number of retakes.
Increase speed during exams.
I want to stand up for my self when appropriate.
Improve interpersonal skills with patients and staff.

Sex, Teasing and Adhesive Tape

2006-11-21T21:31:00.000-08:00

Gosh, what a morning. I felt like I was making dumb mistakes. The day started out with me misaligning the tube and the bucky. Dosing the patient and not getting the image. And later when trying to comp exams, while my positioning was competent, my confidence was shaken.

I was able to pull out it though, by virtue of the sheer volume of exams. I think I was personally involved with twenty exams. So it was very busy. I like that because the day flew by.

Today I had experience which I'll relay here. I was doing a spine series consisting of cervical and lumbar exams. The patient was a female of advanced years. I noted when I checked her condition that her skin was extremely brittle. I took care then, when a tech asked me to immobilize her arms with tape, not to stress her skin. I put tape on the clothing. The difficult thing was that we didn't get a diagnostic image the first two times due to osteopenia.

So another tech came in. She was very brisk and put the tape directly on the patient's skin. -- The first thing I learned in nursing class was not to put tape on the skin of the elderly-- I removed the tape after the exam with great care. The tech had put tape directly on a shoulder abrasion. It was like pulling tape from paper. Ouch.

I was very upset by the experience. But I felt that I couldn't go to the female tech about it. Why? Because I'm not by nature confrontational. Also, I'm a first year Ratec student. For me to talk about it wouldn't wash. I felt voiceless and frustrated.

I will however, bring it up with the clinical instructor. I need to know how to deal with situations like this. I also need to know what my responsibility is when I see something like that.

In other news:

Teasing is a double edged instrument of bluntness. One side can be fun – the other side of teasing can be hurtful and/or harmful and I've seen it get people fired.

At lunch, my fellow RT students were taking about the Christmas party. One of the women asked, “Is anyone going to the party.” I said, “I'll go if you go,” Meaning “Y'all” in the group. One of the men said, “Oh, he's asked Loren out.” Everyone laughed but me. I attempted to clarify. I did not intend for it to sound that way. I didn't mean it that way. Moreover, I said, teasing of this nature has no place in a healthy work environment. I had to pull the man aside and explain how I was affected.

We need to ask, Is what I'm doing going to build a strong working relationship. If the answer is not an unequivocal “Yes,” than we need to reevaluate what we're doing. If it's not appropriate: don't do it; don't think it. Anything a romantic or sexual nature, that is unwelcome, is poison to the coworker experience.

I enjoy teasing, But I don't take teasing well so I've tried to reduce that amount that I do. This was good for me to see how it feels.

To close on an upbeat note: I've been dong very well in comps. I've got four times the minimum.

That Boy's Allright.

2006-11-16T19:41:00.000-08:00

I know it's been a while since my last post. Things have been moving a fast pace. I've been trying to work during the program and while it's doable, it's not that fun.

I had a practical exam on Monday on shoulders and the lower extremities. I seemed to do well on it. I was shown a radiograph. And it was my job to say which exam it was. I then did my best to demonstrate my ability to position each of them. I did a grashey, bilateral ac joints and medial oblique foot. I also was told to identify anatomy from a radiograph. I breezed through that portion.

Lately I've been doing clinical in the ortho department at my placement hospital. What a blast! Ortho really is a fantastic place for beginning students because all the exams are requests for the extremities. I was able to get ten comps during my brief time there. The minimum for the quarter is four.

Hard at Work

2006-10-31T20:41:00.000-08:00

And this is when the class work takes over. I'll have had three intense exams in a weeks time by this Wednesday. I'm studying the shoulder, clavicle and AC joints as I write this.

I want to say that last Thursday in clinical was much easier to take. I'm getting better at not investing my emotions into the experiences with patients. I provide the care as quickly and efficiently as possible. Again, I do try to leave them with something: a smile, an ear for the their concerns, ect. I got three comps today.

Of Suffering and Empathy: Trauma Rotation Part 2

2006-10-21T23:11:00.000-07:00

What a week. That seems to be my refrain. Last week in clinical was extremely demanding for me. I tend to a little on the sensitive side: I haven't completely learned how to separate my emotions from the trauma that's in front of me. Going in to the program I knew it would be an issue for me.

I've journaled extensively about the difference between sympathy and empathy. I'm working on being more inclined toward empathy which is the intellectual identification with or vicarious experiencing of the feelings or thoughts attitudes of another. More about this later.

On Thursday, I saw a lot of difficult cases: young children with broken bones, men and women returned from the scene of MVAs. When we get the call, TRAMA IN RESSUSATION ROOM 8,” for example, we roll in a portable machine and proceed to shoot a trauma series: CXR, pelvis and cross table cervical spine.

I'd have to say that my tendency during those exams was more toward sympathy: the emotional identification with the suffering of others. For me this is especially true when it comes to pediatrics. I won't go into any particular detail on the trauma itself except to say that in several cases it was grievous.

My mentor, J. has counseled me on this topic and I paraphrase here: It's important to mentally observe suffering. Don't allow your emotions to come into it. Do your job as a Radiologic Technologist never allowing the suffering of others to penetrate your shielding.

Understand suffering with your intellect but don't go beyond that. Be a professional and observe the ethics and guidelines of your field. Give people a voice. Be a good listener. They need to be heard. It's never helpful to the patient or yourself to internalize their suffering.

In the book, The Secret Life of Bees by Sue Monk, the character, May is unable to separate the suffering of others from her own. She goes into fits of misery upon learning of the suffering of the world. What a wreck she was. When reading this, I wondered is she helping anyone by this identification? The answer is an emphatic no.

I need not wrap my emotions into the concern for the suffering of others. I'll use my intellect and understanding. I will employ heed and caution to always do the right thing for my patient according the the ethics and guidelines of my profession.

A healthy approach to the observance of suffering is toward understanding of the level of pain my patient is going through. Ask, “How would I want to be treated?”

So by now you must think I'm a mess of emotions. I say perhaps. I'm working on the above issues and I'm not exactly there yet. I'm close. But it's extremely rewarding to know that each time I produce an image of diagnostic value I'm contributing in a definite way toward the patient's recovery toward productivity.

Morning Portables

2006-10-19T21:02:00.000-07:00

I had a interesting experience with a technologist today. We were doing portable CXRs this morning. One patient we imaged was adamant that we avoid jostling his right side which was festooned with tubes. I put the cassette in on his left.

After we did a couple we returned to radiology do the paper work. The tech said, “That guy looked like a real gang banger.” He was referring to the young gentleman we had imaged earlier.

I replied to the tech, “I don't like to think that way.”
“Yeah,” said another, “isn't that profiling?”

We inspected the image on PACS. The tech pointed out that I clipped part of the anatomy. "And," the first tech said, “look at his lower right quadrant.” Lodged in his abdomen was a small, blunt radiopaque object. “A bullet. What I tell you?”

This exchange didn't make me feel very happy. I don't like to assume.

Worry Be Gone

2006-10-14T10:50:00.000-07:00

Some of my fellow students have encourage me to not be so hung up on getting my comps. But I feel it's important for me to be on top of it. We're only expected to get four comps Fall quarter.

One tech, I call her Wendy, Said, “I hope you don't feel like I'm pushing you.” Then she shoved me into a room and insisted that I grab a portable chest requisition and do the bugger myself. I did OK I guess. I pushed the cassette a little low and she corrected it. Then I set technique and that was a little hot. But at school our instructor is fond of quoting, “Better hot than not.” Seriously, she corrected my technique stab. My collimation and tube placement was good.

It's important to have initiative in clinical. I'm feeling very good about many aspects of my clinical experience. I'm very new with the hospital experience so I feel like a bit of sponge; trying my hand at various exams when it's appropriate; when not, I stand back and watch attentively. I try to remain on my feet at all time except to do paper work. When a tech seems to need help I step up. In short, I'm loving the experience as a whole. I try to ask periodically, "Is there something you need help with."

The area that I'm unsure about is comps. We need a minimum of four to get a satisfactory rating for Fall quarter. So far I have a double comp on CXR and a single comp on a wrist. I feel that I'm about to really pull in a bunch of comps now that we're cleared to do upper extremities. I want to be careful of mistaking being comfortable with an exam and being complacent. It can be a trap to say, I'm a beginner I'll sit out comping this one. That's easy to do for a beginner student in trauma because of how fast paced it can be there. I can be extremely reserved in new situations.

At the same time, Josh and Wendy, staff technologists have been taking upon themselves to push me saying, "Have you done a humerus before?" for example. And then allowing me to make my best effort at a trauma series. I love working with trauma techs because it does feel like an accelerated learning experience.

Trauma Rotation

2006-10-11T09:40:00.000-07:00

Yesterday was my first day in trauma rotation. What a blast. As you can imagine it was very fast paced. But what made it a good experience for me was that a couple of the techs let me do the positioning. I took my first AP shoulder xr yesterday. It was a trauma shoulder. I missed: I cut off the acromion. But it was like this, I'd position the patient in a way that my limited knowledge would permit and then the tech would make adjustments. What I found humorous was that sometimes I'd set up the patient and the tube perfectly, for a stretcher T-spine for example, and the tech would come in a make some adjustments. Several times they moved the tube and patient right back into the location I'd placed them.

It's amazing to me that I'm in such a terrific place. A graduate of my program introduced him self as an OR tech. He said you, meaning all the RT students in my program at this hospital, are going to be so far ahead of anyone else in your class, and by inference anyone in the entry level job market. That made me feel excited. I want to work there when I'm eligible

One of the techs, I'll call him Josh, typical of many trauma techs, told the two of us newbies stories to curl our toenails. One of the more tame stories involved a woman in small town beauty salon. Apparently she was sitting in a dryer chair. A significant distance away ,a boulder made its way crashing through the valley at a great speed. She was oblivious to the danger. The boulder crashed though the brick building of the salon a pinned the hapless woman still in the chair against the opposite brick wall.

Her upper leg was completely de-gloved; the tissue of the leg was completely removed. This conversation came under the category of things I learned not to do. My take on the story was that sometimes it just your time to have boulder pin you and your chair against a brick wall.

I know I'm so lucky to be where I am: A major metropolitan trauma center – the best community college RT program in the NW. I try to see both sides of every interaction. I don't always succeed, but it's my job to get in there. I try to give each patient something: a smile, a kind word, a brush of my hand to their brow when the pain is too intense, a warm blanket, and although I haven't tried it yet: a softly sung song. I have a calming countenance.

Many new RT grads go directly into CT, MR ect. Some of my fellow students entered this program because they weren't accepted to sonography school or med school. That burns me a bit as I had to wait a year for entrance. I can understand it, but it still bugs me. Radiography was my first choice field, my school was my first choice program, and my clinical was my first choice setting.

The key to successful patient interaction is communication and customer service. It helps the patient to explain the exam or ask if they have questions.

I know I'm being overly romantic not to mention hyperbolic, but I feel like ("like" is the key word here) I'm being initiated into a secret society entrusted to hold, maintain and share the chalice of sacred knowledge and the torch of illumination, as we, the ethical practicing acolytes, illuminate the darkness of the inner body with our diagnostic alchemy.

I'm smiling now. I've been smiling for a while now. Sure RT school is tough; I'm writing this as I prepare to for a five-hour study session; but I'm having much more fun than I could have imagined.

My Wrist Comp

2006-10-07T11:34:00.000-07:00

It's been a wonderfully active week. I had two exams and one practical in the didactic portion of my education. I managed to comp a wrist exam in clinical. I did well in all.

I spent a lot of time shadowing techs in fluoro. I observed techs setting up sterile trays for contrast injection. Usually the radiologist operates the equipment and the tech supports the doc.

My wrist exam was a challenge for me. I had read the department protocol book on upper extremities. It was difficult keeping straight what was textbook positioning and what is hospital protocol. I ended up dumping my first wrist comp attempt because I coned in to far vertically. What I'm finding is that every tech has their own way of doing things. I might have passed the first try with another tech grading me. This facilitated a learning situation.

Later, the tech who had initially failed my effort offered me a chance to re-comp. She spent time going over the protocols with me.

Our CR instructor told us that El Nino is becoming stronger. Our normal weather for Fall is rain until mid-December. Which translates into ski weather in the mountains. Snow means hours if you work in outdoor retail. El Nino casts this in doubt since it seems we can expect a warm dry winter.

Yesterday, my bus sideswiped another bus. The experience was startling but no one was injured. The driver for my bus is one of my favorites. I like his style because he whistles show tunes during the commute. Sometimes it can be distracting. But I always enjoy his good natured greetings.

The commute

2006-10-01T09:29:00.000-07:00

One thing that concerned me about going back to school was the commute. Because I live in the Suburbs:

Home to school is a 51 mile round trip.
Home to clinical is a 42 mile round trip.

It's a 237 mile commute each week. The area I live in has some of the worse traffic in the US. When you add up gas, maintenance and parking (there's a long waiting list at the clinical site) it's easy to see how using an alternate form of transportation could save a lot of money I don't have. And because of the way the school and clinical schedule is set up I commute during peak times.

I 'm not working very much outside of school. Even so, the amount of information communicated in class and clinical is fairly staggering. I don't recommend trying to work full-time while doing this. It's Just too much. So unless you consider sleep and occasional fun optional... BTW, I don't mean to be overly flippant about the situation. Several people in my class are trying to support themselves and perhaps children too. My situation is a gift.

Imagine my delight upon finding out that I could get a three-month regional transit pass for under $65. The retail value, if it were available, is about $500.00. My clinical site funds it and my work place will pay half. I can get around for about $11 a month. I live less than two miles from a major transit center where I can catch commuter buses to school and my sites. So far so good, if I stick to commuter trips the commute takes about the same or less time than if I were driving.

The Honey Moon is Over

2006-09-30T08:08:00.000-07:00

The honeymoon is over, this according to the main instructor. She was joking. But the statement is important because it shows that expectations are higher. She was referring to the natural acceleration of positioning practicals and the corresponding clinical comps, as it should be.

The way it works is you must show that you can do the exam with minimal help from the technologist. You must then show your ability on the same exam no less than one week later. Only then do you fully comp an exam.

This week I got my second comp on CXRs (chest x-rays.) I then flew solo with CXRs.

In positioning classes, we finished up the upper extremities and are into the shoulder girdle. On Monday I have a chapter quiz on the forearm, elbow and humerus. Later that day I'll have a practical on the whole upper extremities. I'm looking forward to it because I can then ask to comp those exams.

We finally dived deep into radio technique. The lecture on Friday began with an IT worker setting up the distance connection. I have to say that the link worked better than I thought. Call me a big baby, but I was initially a little put out that our class would be the distance element as the instructor is an employee of our campus. It's called sharing. The students at the originating end usually are the distance students. That's the way it should be. I signed up to this program because it wasn't a distance link. Okay, peeve relieved.

Yes, the technique portion was very basic. But I found that there were gaping holes in what I knew. No big surprise there, only I found I was having a hard time with mAs and the whole remnant beam thing. I'll see if I can meet with an instructor next week.

Clinical was a blast as always. I liked how the six view spine exam I observed a young tech do really served to cement my understanding. The standing t-spine a-p and lateral reminded me a lot of a CXR. The tech did something else that reinforced my experience. She did all her a-p's and then did all her laterals. That is helpful to the patient because you don't need to move them much between projections as they are already centered to the bucky. I wonder who showed me that concept first?

I also observed several Fluoroscopy exams. Fluoroscopy is a technique for creating "live" X-ray images of a living patient. The Radiologist presses a foot switch to control an X-Ray beam that is transmitted through the patient. What's interesting is that they're often video images displayed on a monitor. Occasionally the radiologist will freeze an image out of the video. I was told by an older tech to watch the exams carefully as I'll be doing them significantly later in the program. I found that watching the action was helpful.

My First Comp

2006-09-22T23:08:00.001-07:00

What a week! I've had fun just doing chest radiographs. I should say that I comped the chest PA and Lateral. My first comp ever, on the third week of September 2006. I love the sound of that.

I think I must have done about twenty chests this week. A lot of them are TB screens. I have to smile here because the techs like to hand the chest exams to me to make their load lighter. I'm okay with that, but I have other exams to comp as well.

As for the didactic learning, we covered a broad spectrum of topics. From the model of an atom, to the anatomy and positioning of the elbow and forearm, to computed radiography. This morning I awoke with a smile. I'm in love with this experience.

Overall, the hospital experience is growing on me. I feel like I'm at my third home. Seriously, I know it will pass, along with my infatuation with the classroom, but I love the hospital at which I'm fulfilling my clinical. My second home is my workplace in retail.

Nearly all the techs are women, which is great because I primary prefer to work with women. I like their temperament generally.

These techs in particular are personality plus types. One has been very helpful. I'll call her Mary. She treats me like an equal with respect and interest to my involvement in the process of acquiring the image. She understood when I explained that I am a kinesthetic learner, that I learn best by doing.

Two of the others are from eastern an European countries and speak in their lovely, lilting language to each other. One of them has a fantastic sense of the absurd; she's fun to be around. She clutched her ears during a particularly lively exam with a pediatric. The child had a healthy pair of lungs. The child was expressing her extreme displeasure at the indignity of being held down for each radiograph of a bone study.

I'm finding it difficult to submerge the impulse to say, “I know,” when a tech says something to me. I recognize I should just nod and say, “okay.” I'm here to learn first, and secondarily to demonstrate knowledge with comps. Just don't step on the toes of techs. The last thing I want is have tech say to me, “Just listen, Okay?”

Finally, I love the patients. Even the ones who are so out of it that all they can do is grunt when I ask them a question. It's a tremendous rush to produce a radiograph of diagnostic quality. I know I am adding to the total contribution in a positive way to the patient's recovery.

Thanks for reading and do add comments.

Fall has sprung, Uh.

2006-09-18T21:55:00.000-07:00

Gosh, I love my town in late September: clouds race by like pigs from a gun. Oops! Frazzled.

Today was the first day of Fall classes. First, what a gawd awful commute I had coming into school today. It seemed like everyone thought to get on the interstate at the same time. It took me two hours to go 22 miles.

Anyhoozle, we studied the positioning of the humerus, elbow and forearm. It was great fun. The lab was a farkin three ring circus. I have to smile here because it felt like high school: they Shepard us around from class to lab and back. We saw demonstrations of positioning and looked at films. I got to meet two new instructors. One teaches technique, the other computed radiography.

One of the newbies teaches my radio technique class and she had bad cold. She's also about 200 pounds over weight, which some of my readers will think is irrelevant, but it added to the overall affect. She seems nice enough. But she went though pages of power points with nary a pause. This won her little in the way of first impression points. But she's got personality and spunk. With the frequent smart ass comment.

The other newbie was in the military forever. And made a late career change. I really found him interesting and energetic. I like stories of mid-like career changes; any guess why?

I drank a cup of coffee this afternoon, which I not supposed to do, doctor's orders, so I feel a little wired, and the overall tendency to write run on sentences is somewhat overwhelming, so I should probably sign off. You've all been in my thoughts. Stay well and keep in touch. Wait, who does that remind me of.

Vacation

2006-09-12T19:22:00.000-07:00

Today I visted the college I wanted to take a look at all the clubs. I got a free burger and chips for my trouble. I took the image of down town Seattle.

One-Week Summer Vacation

2006-09-11T10:58:00.000-07:00

My one-week vacation has begun today. I appreciate that we only have a week off; it keeps what we learned over the summer from running out our ears like juice from a squeezer. Anyway, I'm not sure what I'm gonna do with myself. Some of you know that I'm an artist. Perhaps it time to create.

Fall quarter starts next Monday, September 18.

Yesterday, I picked up the book I'll need for my techniques class, RADIOLOGIC SCIENCE FOR TECHNOLOGISTS by BUSHONG.

By the way, I got a 3.88 GPA for Summer quarter.

Radiology File Room.

2006-09-02T10:46:00.000-07:00

Thursday and Friday I worked in records. They call it the file room. What's different about a hospital with a totally digital work flow? No paper.

As I've noted earlier, we've been rotating around the hospital learning how the various jobs relate to each other. The idea is to see all the departments that work as a group to support radiology. I had fun. The staff were friendly, patient, and they put us straight to work.

We digitized old films both days. I had fun knowing that it was only for a day or two. Although the full time records staff there have mountains of films to process.

I always approach data entry with a zen-like calm; I find it very relaxing. We imputed the patient information for each film or series of films. What made the experience interesting was that we looked at some very old films from the late eighties and early nineties. I made note of different pathology represented in the films. It was interesting to note how digital radiography really changed the image quality.

Someone brought in some tequila flavored chocolates. They were quite rich. We stated to talking about recreational alcohol consumption. We did so in hushed tones though.

I've been meeting several of the technologists that will likely be involved in my education. What I've noticed is how the HR values diversity. The technologists are from many backgrounds. They're all interesting people in their way.

My First Exam

2006-08-31T21:25:00.000-07:00

Transport was a blast. Imagine the largest hospital you've ever seen and you'll get an idea. The place is a maze of corridors. I felt like I was exploring. I don't want to give you the idea that it's cold, far from it; the staff are all caring individuals. But it is a county hospital so it's naturally comprehensive it scope. Radiology alone seems to occupy a city block of area.

We were assigned to shadow a transport staff. I'll call him Tim. Tim made it fun with invites to us to figure out how to get around the hospital. We went up to the Burn Intensive Care Unit (BICU.) We watched several trauma exams. I wish I had the time to fill you in on everything we saw. Suffice to say I feel at home here. It really is my element.

Today was my first exam. I didn't comp. it. But I was basically directed through the whole exam. It was done with a special machine intended for chest images. It's the only direct radiography (DR) machine in whole hospital. The bucky is the image receptor (IR.) The tube moves up and down with the bucky automatically. The definition of such a system is that no cassettes are used. The gonad shield is a lead curtain that closes like a door. The tech dragged me over and stepped me through the entire process. It was a special thrill.

It's late in my day. So I just want to ask for some feedback. I know it's easier just to read this. But, how about telling me what you think. This can't be a one way street. How about a little synergy? Thanks for reading Radiologic Confidential.

First Clinical Day

2006-08-28T17:53:00.000-07:00

Today was the first clinical day. I met many dymamic and friendly individuals. The day started with a review of expectations and locations. We talked at length on everything from a bus pass to personal leave. That part of it wasn't every interesting. But what made the it fun was talking with the education coordinator of the hospital.

She's really very much a people person. She arranges education for many hospital staff including doctors. Hearing her talk about her job made me realize how irreplaceable she is. I can't imaging trying find someone to fill her shoes. She coordinates continuing eduction for a lot of the staff.

We met up with the “seniors,” second year students who showed us around to all the x-ray rooms scattered through out the wing. And of course the ER, trauma, CT, and MR.

I simply don't know how to convey my excitement about the placement at this particular hospital. It really looks like a huge extended family. Of course, I could be projecting my expectations. I don't think so. I'm a rather reserved fellow and I was very much made to feel welcome.

I met a few techs. That's kinda where I didn't get an impression. But I'm sure I'll get one tomorrow. I'll be shadowing in transport.

Clinical Starts Monday.

2006-08-25T13:27:00.000-07:00

Clinical starts next week at the local trauma center. I'm feeling mixed emotions of elation, because it's finally time, and a sort of fear of how I'll adjust to working in a hospital. We'll be there for two 40-hour weeks starting Monday.

Last week was challenging, more so than I'd have thought going in. We had two exams that were fairly intense. What made them difficult is that we only had one day to study before being tested on some of the material.

I did fine but I should have asked for extra time off work. I need to work on the feeling of diminishing levels of return. Find that perfect balance. I've put a lot of work in these classes. I want to make it clear that being in RT school is more fun then I've had in some time.

We get to work with people of all walks of life. We use equipment in the ways it was intended. I could go on. I know the lines. I've read the ethics. I know how to behave and I have some idea what to expect out of clinical. Wish me luck.

These are some thoughts others have shared regarding clinical success:
Show up, act professionally and within ethical bounds;
Assume abilities of being humble and taking direction;
Asking questions and being assertive;
and learning from past actions.
Ask how you can help.
Keep areas well stocked.

My first Practical

2006-08-19T09:46:00.000-07:00

I'm doing well in all my classes. I had a written and practical exam on the same morning. Yike! It felt long. We had a 70 question written test and we identified anatomy on14 radiographs. I felt like a wet rag after that. I did fine though.

For the positioning practical I did a P-A and Lateral Chest, and a supine abdomen (KUB). I did OK on the positioning but I missed an important detail. I forgot the breathings instructions on the lateral chest. Doh!

We reviewed the anatomy of the wrist, and fingers last Tuesday. We'll have a positioning lab on that anatomy on Monday. I start my first clinical on Monday 28.

Acute Abdomen

2006-08-09T17:04:00.000-07:00

We've been working on the Acute Abdomen series this week. It started Monday with the positioning lecture and lab. I've had to work very hard.

I find the didactic lessons provide the biggest challenge. I'm a kinesthetic learner. I do well when I can learn experientially. Naturally I do well in labs then. I've been focusing in on the practical and written exams we have next Monday.

I pretty much have nailed the acute abdominal series: PA CXR, AP Upright abdominal, and supine abdomen. They're basic projections but I love 'em! Today I reviewed the anatomy of the bony thorax and the abdomen. Bring on clinical!

I've been hammering out the beginnings a study buddies. I study with a couple of fellow RT students in the cafeteria. We worked on anatomy.

Infection Control

2006-08-03T19:02:00.000-07:00

Today was review for me. I've been a care giver for many years. Our nursing class covered infection control.

I got 95% on my first test of the quarter. Ta ta.

Safety and Clinical Assignments.

2006-08-02T19:17:00.000-07:00

Today the discussion started with safety. We talked abut fire prevention and what to do in the event of a fire. We also covered proper body mechanics and patient skin care. Other topics were basic patient positions and assessments before moving a patient. Our lab involved patient transfer using a wheel chair or a stretcher.

What follows is a paraphrase of a discussion that occurred later today regarding clinical assignments.

“There's a lot of wonderful people out there. How you present yourself in the beginning is how others will perceive you. You need to help as much as possible. You need to ask, “how can I help.” You're the student and pretty much low man on the totem pole.”

Our program has a better reputation of treating their students better than other programs. Some people will resort to treating students poorly if they were treated poorly. They think of you as a really green student. Many people are reluctant to work with first year students because there's so much for the student to learn. If you go in overly cocky, they won't like that.”

Don't go in thinking, “Oh I know something about this.” Even if you have some experience that's not the way to approach it. You need to let them show you how to do things. There's lots of right ways of doing things. You're going to learn a different way from every tech you deal with.”

That's hard when you're a student that everything isn't consistent. There will be a tech who will say, “No you never put the flasher up in a chest x-ray. Even if what the tech teaches is opposite to what your didactic experience would suggest just go with it. Eventually you'll learn your own way and use the proper principles.”

It's really good learning experience to just get along with whom ever you're assigned to. Most people enjoy working with students. You don't correct the tech by saying, “My instructor told me this way was best.”

There's ways to get along with these people: prepare and clean the room, ask how you can help. Assume a basic good work ethic. When it's slow practice your skills and get to know the rooms and equipment. They'll give you respect if you clean the rooms and equipment. Put films in the bucky use another student for practice if appropriate.”

I would add that I have a sheet that I look at often. It reads in 30 point type: Clinical success: abilities of being humble and taking direction; asking questions, assertiveness and to learn from past actions.

Bony Thorax

2006-08-01T16:43:00.000-07:00

True to the schedule, we attacked the bony thorax. What I mean to say is I finally got the chance to do some real positioning. It started with Posterior-Anterior Chest and the corresponding left lateral. The instructor showed us some very bad chest x-rays. Seriously rotated or foreshortened, they were obviously of very little diagnostic value.

I like the very small lab ratio: one instructor to eight students. I really like this aspect of the program. The small ratio really allows for high interaction between the instructor and student.

At the start of second period I began by working the various locks getting used to the tube in that lab.

Our instructor walked in. “Since you're at the tube, P-F, why don't you position for an A-P stretcher chest. I did the well, considering I'd not been able to use my notes. I placed the cassette behind the “patient” and pointed the tube towards the cassette with a SID of 72 inches. I felt pretty good about it. I didn't put the requisite angle on the tube though.

The instructor corrected me. “What you've done is a good start. But you need to provide an angle that matches that of the patients sternum. I learned that an unintentional lordotic projection with out diagnostic value would have resulted.

Mind you, we're so green that every correction is a learning opportunity, And is offered with much patience.

Today we reviewed the anatomy of the bony thorax.

Nursing Procedures

2006-07-27T15:09:00.000-07:00

Well, I've finished the second week. As I've said it's nice how the beginning to this program is so leisurely. I've been having fun.

I hope my Nursing Procedures class picks up. We've been talking about ethics, legalities and guidelines all week. To be sure, those subjects are critically important. And I've taking them to heart. Today we covered the Patient's Bill of Rights and the civil legalities involving them. It's dry stuff. The instructor seems to know this when she looks up with a wry smile.

I'm more a hands on kind of person. The true nursing labs are coming. More positioning class next week too. It'll be that way through August 25. I start my first clinical on Monday 28.

scatological

2006-07-26T18:57:00.000-07:00

Defecogram: A fluoroscopy procedure in which the patient empty their bowels while seated.

The point of the discussion was to emphasize communication skills. The instructor stated that often the doc does not inform the patient what to expect. So it falls on the technologist to explain. This works because there is very little prep. They're usually done on women, because of suspected prolapse of the rectum.

Chuckles began. The instructor told us, “Yeah, there's not a lot of pamphlets on it.”

“How does the technologist induce the bowel movement?”

“It's a mixture of instant mashed potatoes and barium,” we were told. “The way we put it in the patient is with a caulking gun.”

Laughter erupted.

“So you have to hide the gun. But when you start they look down and ask, “Is that a caulking gun?”

One of the students works in construction. He said, “I'm going to have to tell the guys about this!”

“It's a fairly common exam is this town,” we were told.

2006-07-25T19:52:00.000-07:00

The first days of positioning class were a real joy. I found that because of my volunteer experience (with J.,) I picked up the basic positions very quickly: RAO (right anterior oblique), LAO, right ventral decubitus ect. In fact, I was able to help out other students as they grasped the concepts. I have to admit that I was a bit a show off.

I know I'm bragging, but when I demonstrated the Right anterior oblique the instructor said, "excellent.” To my fellow students I'd say things like, “You need to keep the arms above the head so they don't obliterate the area of interest.” The instructor told me, “We aren't concentrating on the specific positions. We are learning the very general ones.”

She asked me if I'd done work in an X-ray department before. “Yes,” I said proudly, “I volunteered at X clinic with J.” It's occurred many times this week how much of a mentor J. was to my experience. And how I feel that the volunteering gave light to the concepts introduced this week, and ones to come.

One of the interesting thing about this quarter is that another community college is linking to our program. It's a little off putting to share the instructor's attentions with people that aren't even there physically. And the technology making this possible isn't without its many hickups and burps. It's funny to hear the distance learners reply in unison, “Yes.” When asked it they've grasped the concepts being presented.

I like how the quarter is being structured by introducing a little at a time. I probably wouldn't feel overwhelmed anyway, but it's nice that we're only taking eight credits to start. Fall quarter will be a full-time load, thirteen credits. One of the credits is a medical terminology course which I've already taken at another school. My credits matriculated so I'll have twelve credits for Fall.

Tomorrow I start the Nursing Procedures class.

In anticipation of Monday

2006-07-22T11:17:00.000-07:00

I expect what I feel now is beginner's jitters. I'm excited, and since so much of my life during the last 27 months has been spent in anticipation for the start of the program, I find I'm looking forward to Monday. Next week will start the two classes that will prepare me for the clinical that starts late August: Positioning & Related Anatomy and Nursing Procedures.

The director of the program told us on Monday July 17 that we could expect to do chest and upper extremities by the end of Summer quarter. Most of us sat in stunned silence. “Frightening prospect isn't it,” he said. We mutually agreed.

But that's just one reason I feel this is the best program. I don't think you can find that many programs in the nation that have you doing procedures the first quarter of the 23 month tour. Wow.

More on the first week

2006-07-20T08:31:00.000-07:00

It's an off day from school. I return to the Intro to Radiologic Technology class I have mostly finished. I've received one assignment: write a summary of an article from a medical imaging magazine. I chose an article about the new 64-slice Multi detector computed tomography system. It can acquire a large volume of images from the head to the upper femur in one data acquisition. This can save time in trauma situations and it reduces radiation exposure.

The subject of mammography came up. The instructor made the statement, “The female breast must be the most important part of the human anatomy.” This brought chuckles. He asked why we thought this might be so. One poor fellow said, “Because it provides food for future generations.”

Outright laughter erupted at this statement. We learned that it is a positive outcome of political lobbying in Washington DC. “What legislator in their right mind would vote against their key constituents by voting against women's health.”

First Week

2006-07-19T18:15:00.000-07:00

Photo from my dinner table.

After a delightful weekend of outdoor music and sweet repast with my beloved, I began my adventure in X-ray school. The morning began like most beginnings feeling of butterflys, transportation woes, getting lost on the campus, plagued my first day. I have to say, I'm not in love with the campus: a little cold and little large for my taste.

But I do like my class; I've struck up, and been struck up in conversation. Mostly it's revolves around the usual questions: how'd you get here ect. I do like the people. They seem a lively and inquisitive group.

We started very typically enough, with a review of school and program policies. It has to be done. The instructor starts by saying something about expectations and resources and talk about the ramifications of teaching. It's called house keeping and it needs to done.

For the past three days I've been immeshed in the class called, Introduction to Radiologic Technology. I guess it's been going fine. I feel like I've been through it all ready. I try not to let on that I feel that way. The instructor asked, “What is influenced by source to image distance?” I said, “It's involved in the inverse square law.” The instructor scolded me, “You're not supposed to know that yet.” The correct answer is – divergence.

One thing I do like is how leisurely this start seems. Just the one introduction class for the first week.

2006-06-06T21:56:00.000-07:00

Well, I've learned the job market for RT's has tightened a bit. Mind you, the reason why I wanted to go into RT is that I'll love the work and the contact with new technologies. Most of all I expect to have fun. And I expect the field to provide me with challenges.

All that said, I have the expectation of immediate employment upon graduation. I certainly expect it to work out that way. I'm curious what you think.

I'm In!

2006-06-01T16:38:00.000-07:00

I've just returned from the orientation for first year students granted acceptance. I start the BCC RT program in July. The program director made it clear that we should expect excellence from our program and he expected nothing less from us. Gulp. He divided us into two sections according to our residential locations in WA State.

I've been volunteering at an x-ray department for eighteen months. It was fun but hard because I wanted to do the positioning! I did get a lot of experience in patient interaction. I'm very excited to be finally Starting my program.

I wanted to follow up and say that I ended up taking College Algebra, Chemistry, and Physics. It was a blast. I kept sharp and learned valuable skills in problem solving.

I also have foundation courses under my belt that might help if I choose to pursue higher education than an AS degree. Thanks to everyone who's helped me along the way. Hi J!

2006-03-16T17:09:00.000-08:00

Do I every get tired of saying, "Not much to report?" Why, yes.

This blog is intended to portray what it's like to be a RT student. Seeing as I'm not in an RT program just yet, I can't have alot to say about it.

Of Friendship and Mentoring

2006-02-20T12:30:00.000-08:00

Have I told you how much it means to me to be a protege of a seasoned Radiologic Technologist. No? Then let me explain: I volunteer approximately once a week at an x-ray department in an inner city medical center.

It's been wonderful, working side by side, with an example of a complete professional of her field, J, the x-ray technologist. She's been in the field over forty years.

It's more than an educational experience. J. has taken me under her wing, so to speak: She's taught me how a medical center works, politically and logistically, including the dynamic of staff relations and how to listen to patients and coworkers. I've seen the big picture of interdepartmental interactions and the small picture of localized departmental work.

She's been able to give me a complete verbal description of a chest x-ray, for example, while doing it. This has been very valuable. Generally, I was her assistant in the room. It's been very exciting not just observing, but operating equipment under direct supervision, of course. I feel that I'll have a great advantage when I begin my RT program this July.

I was able to get into my RT program because of my volunteer work with J. What I've learned, is to trust yourself and your instincts. Mind you, I have little experience to base my instincts on; But I'll learn.

At times, I've said to patients and staff, “I'm just the volunteer.” J. says, “You're not “just” anything,” meaning that she values my contribution, how ever small. She introduces me as an x-ray student.

I've enjoyed working with her very much, not just because she is a massive figure, in my mind, of her art, but also because she's a fun person to be around. And she makes my experience enjoyable.

Moreover, any professional that seeks out opportunities to educate, train and mentor beginners in her field, has reached outside of herself, showing the highest examples of occupational altruism. We as students, often see the reverse in other clinical educators. In contrast, my observations show me that J. sees her work with students as a duty and a privilege.

It's been wonderful to be in this environment to listen and observe the art, practice and philosophy of patient care in the RT field. It's really a gift, one that I appreciate very much.

About this blog

2006-02-06T15:40:00.000-08:00

If you're new to the blog and X-ray, I suggest starting from the first posts and working your way up. That way you can read how my experience of school and the direction of x-ray started. I also assume the reader has read earlier posts and can understand related terminology.

What is this blog about? It's about me primarily, a student of Radiologic technology in the Pacific Northwest. I tend to have a dead pan manner, which is seldom overtly humorous.

Twenty months ago I realized I needed to make a change. But I asked myself often, “What combines my skills and experience with my passion for serving others?” I have a background in graphics including photography and design. I've worked in retail for many years. I also taught preschool classes to very young children. My finance made the suggestion that I look into Radiologic Technology.

This path started when I went back to school for my prerequisites. Anatomy and physiology was very enjoyable; I had a superlative educator in my professor. I think many folks in mid-life are concerned about going back to school. Questions abound: How will I make time for other things besides work and school? I'm an artist. I take photos, record music and write. Having time to play is important.

What is more important is finding work that is challenging and rewarding. I interviewed several technologists. They all recommended the school I've been accepted to. I'm very exited to be in this position. The only draw back is that I needed to wait for a year. During that time I ended up taking College Algebra, Chemistry, and Physics. It was a blast. I kept sharp and learned valuable skills in problem solving. I also have foundation courses under my belt that might help if I choose to pursue higher education than an AS degree.

I volunteered in an x-ray department for nearly two years. It was fun but hard because I wanted to do the positioning! I did get a lot of experience in patient interaction though which was wonderful.

See this post.

An Inner Celebration

2006-01-23T13:11:00.000-08:00

Today is a day of reflection, of solemn celebration. My late father, Charles, loved the Seahawks. He followed the team for more than twenty years.

The game of football was one of the factors in his life that brought joy to him among the many stresses of providing for family of six during the 1970s & '80s. People who have lived in Seattle since the early '70s will remember the dire effects the Boeing layoffs had the region; my Father was among those sacked at the time.

His team never won the championship. They came close once. I wish he was alive to see this. Although my Father has been gone for seven years, I hold the celebration in my heart for him. He's my hero.

2006-01-18T18:20:00.000-08:00

So there, I’m not sure if it rained today. I need to look at the paper. There are plenty of clouds so it still might let go.

Electrons are filling my mind lately. Words like valence, positive and negative charges ect. It’s all part of my general chemistry course. I’m taking the class to stay sharp scholastically as I wait to begin the radiologic technology program.

I’m also reading a terrific text, Principles of Radiographic Imaging: An Art and a Science. I’m reading about electronic theory.

Again, with the rain

2006-01-16T22:59:00.000-08:00

And the rain continues. I must be a native because I feel empowered by the rain. I work at a major outdoor retailer and snow in the mountains means hours for me. And so I'm happy.

Theres not a whole lot to report.

My own Headstart

2006-01-11T20:15:00.000-08:00

Seattle is such a beautiful city during the winter. The clouds race across the sky, gray and sodden. We’ve had a near record breaking string of rainy days.

I’m not even in the RT program yet and yet I’m studying. Today I took notes from the terrific book, Radiographic Imaging & Exposure 5th Ed.,pb,2000.

It really lays the concepts out in easy to follow side bars. I worked on the parameters controlling photographic factors like density and contrast. It turns out there’s quite a few. Miliamperage seconds, Kilovoltage peak and grid ratios to name a few.

My strategy is simple, knock out the basic understanding of the radiologic concept to ahead in the game. I’ve been told to expect an info dump early on.

What I really want to do is figure out some way to practice positioning techniques. I’ve got the books. It’d be very cool to put several competencies under my belt before the program even starts.

2005-12-13T11:44:00.000-08:00

I've been accepted to a Radiologic Technology program. I start the program in July. Today I called them to see what I could learn. It's a little early yet so they don't have info on what I'd need for the clinical work.

This path started when I went back to school for my prerequisites. I think many in mid-life are concerned about going back. Questions abound: How will I make time for other things besides work and school?

The effort of waiting

2005-12-12T17:54:00.000-08:00

I'm discovering that waiting is an art. The art is...don't wait. Life is too precious. Let me explain.

Twenty months ago I made the decision to make a career change. As usual the motivation is a better paying job.

But I asked myself often, “What combines my skills and experience with my passion for serving others?” I have a background in graphics including photography and design. I've worked in retail for many years. I also taught preschool classes to very young children.

My finance made the suggestion that I look into Radiologic Technology.