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.
