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

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

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

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

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

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

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.