Shielding Issues

Greetings...

I have had a rough weekend.  I have been sick with a rather ugly cold, but I still had to work my two 12-hour shifts at the hospital.  I suffered through it though and will hopefully get to sleep it off tonight and tomorrow so I can get back into full swing before my next rotation starts on Tuesday...

I ran into an interesting situation today with a patient in the ER.  I had a female patient in her mid 20's, so I followed the standard protocol of finding out if she could be pregnant.  I asked her if there was any possibility she could be pregnant.  She simply responded with YES.  It turns out that she's a week late on her menstrual cycle.  She was in for a chest x-ray, so I stopped what I was doing and went back to visit the ER doctor who had ordered her x-ray.  He told me to shield her really well and make the images, so that's what I had to do.

I have issues with this decision.  In my humble opinion, shielding a patient for a chest x-ray has only minimal effect of keeping radiation away from the places you don't want it to go.  The central ray is not passing through the pelvic region, but a lot of scatter is.  The shielding I provided would have little or no effect on that scatter radiation passing from the chest region down through the pelvis.  I know that this scatter has changed direction at least 90 degrees for this to happen, and it loses a lot of energy in that process.  Losing energy in that direction also means that a larger majority of that scatter will be absorbed in the body rather than passing on through.  So what effect does the front, side, and rear shielding I provided for my potentially pregnant patient have since the radiation is coming from directly above? 

Lateral Knee X-ray

Here's one of my more common imaging errors in the world of x-ray. The lateral knee requires a lot of attention in the area of tube angle because of body habitus. When the patient has wide hips, more tube angle is required to get the knee perfectly lateral. In this image, I had the central ray positioned properly but not quite enough tube angle to get the joint space completely opened. The medial epicondyle should be almost perfectly superimposed over the lateral epicondyle. In my example here, it is not...

This image was also posted on http://www.xrayforum.net for discussion.  If you haven't stopped by there yet, give it a look!

iRadTech

 

CLICK HERE to go to the iRadTech Website

If you are a Rad Tech and own an iPhone or a Droid, you might wanna check out this nifty little app called iRadTech.  This is a cool little electronic pocket guide for radiographers that has all the positioning information you need for various x-ray exams in a touch-screen format.  Each exam listed in this software includes information such as patient positioning (with images), position of body part, breathing instructions if required, image receptor selection, central ray placement and angle, a list of image quality checkpoints, list of structures to be demonstrated, and a sample x-ray image.  You can also make and save notes with each exam such as technical factors or any additional notes you might want to include with a particular exam.

I purchased this software on my Droid last summer and I'm quite happy with it.  I have actually used it several times when I have come across orders for exams that I haven't done in a long time.  Since my phone is always in my pocket, I always have a positioning guide with me.

Stop by http://www.xrayforum.net for a visit!

X-ray Tube in a Nutshell

I stumbled across this interesting little video on YouTube through a link someone posted on Twitter this morning... This is a very good 'nutshell' description of how an x-ray tube works without getting into too many details...  As I watched this video, I remembered how much physics and electronics actually go into this process... Brings back memories of late nights studying :)

Please visit http://www.xrayforum.net when you get a chance... I'm trying to get a new x-ray student/professional discussion forum off the ground!

XrayForum.net

Greetings...

I have created a new online forum for imaging professionals and students.  It's free and ready to go live as we speak. 

http://www.xrayforum.net

When decided to go back to school for a degree in Radiographic Technology, I could not find a resource like this, so I created one through the Ning network online.  Before that site had to close down, it had over 2000 registered users on the Radiography Student Network.  Unfortunately when Ning discontinued their free service, I felt that paying for access was not in my best interest financially since they wanted a significant fee for hosting a social network of over 2000 members. 

Hopefully this new effort will be as successful since I'm hosting it myself.  The site is brand new as of today, so it will take a little time to get the ball rolling.  Stop by and have a look around!

Minimizing Repeats

The cervical spine Odontoid exam is one of my most repeated procedures...

Now that I'm out of school and working fairly regularly in the world of x-ray, I have been focusing on continually improving my skills as a technologist.  I keep a Moleskine notebook in my pocket along with a pen for making notes to myself during my work day.  The main theme of the notes I make during any given day is a repeat log.  I typically don't have to repeat very many exams, but one that I find myself repeating more than any other is the cervical spine odontoid view.  In the above image, you might notice that my patient had no teeth, which can make this exam a little easier.  But toothless patients are not the norm.  I have learned to always ask my patients if they have dentures, and when they do, I always have them removed for this view.  The odontoid view is also quite difficult to get when your patient arrives in the emergency room wearing a neck brace and strapped to a back board.  This is where you MUST know your anatomy. 

Anyway, with my notes about repeat exams, I browse through them periodically and go back to my textbooks when I need some additional review on certain procedures.  One thing you will discover rather quickly through your clinical studies and early work as a radiographic technologist is that the textbooks are a good baseline for instruction on performing procedures, but they are only a baseline.  Your patients will not normally look quite like that person who is modeling in your textbook :)

Early in my career in x-ray, I had difficulty with the oblique lumber views as well as the lateral knee.  Setting up the tube and patient positioning for these views changes a little more dramatically as the patient body habitus changes.  The amount of patient rotation for the LPO and RPO lumbar views is something that takes a bit of experience to master.  The amount of tube angle for the lateral knee also changes quite a bit with patient size. 

Since I work in several different environments, I get to see patients of all sorts.  In the hospital, I have everything from walkie-talkies (those who can walk and talk) to totally dead-weight patients who are unable to assist with the exam in any way.  Most of my patients in the outpatient imaging center and ortho office can walk and talk and help with the exam, but when trauma is involved, getting the position and view you want can take a lot of creativity.

Whether you are a student or a working technologist, spend some time focusing on your weak areas and overcome them as quickly as you can.

Men in Radiography

Post Evacuation image from a barium enema I performed on Saturday morning...

I had a rather uneventful weekend at the hospital.  Working the 12-hour shifts is becoming a lot easier.  I get along very well with my co-workers, which leads me into my topic of discussion for today's blog post. 

Men in Radiography

In my former life, I worked in a field that was dominated by men.  There were occasional women here and there but not many.  I worked in the world of computer programming, computer systems and network administration, and IT management.  When I decided to change careers and move into the world of radiography, I never really considered the change in demographics related to sex.  In fact, I never really even realized that I had been working in a world dominated by men.  However, when I started my program at school and got tossed immediately into the clinical environment, I realized right away that I was going to have to make some personality adaptations in order to survive in this brave new world.  The comments I am about to make are not to be taken as sexist or accusatory in any way.  I am just trying to share an experience that has changed me in a lot of ways...

In my previous world of information technology where I worked day in and day out with other geeks, break room and lunchtime chats, as well as off-topic chats during the workday, usually consisted of work-related themes with some occasional dives into the previous weekend's national sporting events.  Working with a staff of all women where I'm the only male brings a lot of new chat topics to the table.  The women I work with don't talk shop during downtime.  Everything discussed is usually of a personal nature.  It has taken me a long time to even feel comfortable participating in these types of discussions.  I had trained myself in my earlier career to avoid getting involved with coworkers on a personal level.  Whether that is good or bad, I'm not sure.  But the problems it has presented for me today have been difficult to overcome.  I'm working with a group of women right now who have made me feel more comfortable interacting at work on a personal level.  I'm not really sure how I allowed myself to make this change in my own personality, but I seem to be adapting slowly.

During my clinicals while in school I would rarely ever get into personal discussions with other technologists.  THAT probably hurt me more than anything when it came time to start job hunting.  It took me five months after I graduated to find my first PRN job.  I'm wondering if my lack of personal interest in the various staff members at my clinical sites played a big role in that.  Now that I'm working more and longer hours with a group of female techs, I think I'm starting to bond with them on a more personal level.  I feel accepted and they seem to like me.  I find myself listening to and participating in their personal discussions quite frequently.  The current flaw is that all of these discussions are ones that they start.  I have not yet let myself bring up personal topics for discussion within this group.  I get drilled regularly with a lot of questions about my personal life.  Sometimes I'll spill the beans and sometimes I won't.  I do believe that I'm probably sharing enough to keep them from finding me incredibly boring. 

I wonder how different things would be for me if I was working within a group of male techs?  Would I feel more comfortable?  Would I maintain my old style of keeping work and personal life separated?  Maybe I should have studied psychology instead of radiography :)

Who knows... I'll have to revisit this topic again at some point in the future...

Patella Fracture

The doorbell rings... You drop what you are doing and start running to answer it.  As you cross your living room at a trot, you catch your knee on the corner of a coffee table...  The result of that impact is shown above.  I didn't bother and ask who was at the door, because if it was an insurance salesman, I'd probably have laughed.  I guess this knee would have been a pre-existing condition at that point, huh? 

Oh well... today was rather uneventful with this little exception...

Welcome...

As an X-ray tech, I get to see and hear some interesting things through the course of my day.  I have decided to create a little blog to share some of that information and hopefully get to meet some other interesting people who work in my field.  I work in several different types of medical environments, so I get to see a good variety of situations.  I'll be posting x-ray images here along with some commentary.  I'll be telling a few fun stories as I collect them.  They come quite frequently, especially from the emergency room!