Congratulations to Jeanine in Florida for winning the TiR Newsletter giveaway. She will be receiving a copy of "I'm Sorry to Hear That" in the mail. Thank you to everyone who has signed up for the newsletter. The first one should be sent in early April, and please feel free to subscribe from the blog if you would like to receive the newsletter and have not subscribed already.
Thursday, March 15, 2012
Saturday, March 10, 2012
Modified Barium Swallow and Dysphagia Studies
It took me quite a few modified swallow studies with the Speech Therapist in order to visually witness what they were looking for. This clip (played three times) shows exactly what they are looking for:
This video shows aspiration - I allowed it to play twice before adding an arrow pointing out the aspiration on the third loop. Watch the patient finish chewing... observe the black bolus travel from the oropharynx, down to the laryngopharynx, then the epiglottis closes off the trachea. The majority of the bolus travels down the esophagus (parallel to the spine, but posterior to the trachea). The arrow indicates a small amount of contrast getting around the epiglottis and dripping down the trachea. Notice that the patient does not seem to have a cough reflex, which is not quite as common.
Tuesday, March 6, 2012
Radiograph of the Week
This shotgun wound just goes to show that it doesn't exactly happen like you see it in the movies. This is actually a set of radiographs on plain film from many years ago that I recently digitized.
Sunday, March 4, 2012
Introducing the Topics in Radiography Newsletter
I am pleased to announce the launch of the Topics in Radiography Newsletter. I will be sending out a monthly newsletter to subscribers with updates on the latest TiR material, some upcoming CEU opportunities, and there will even be a few give-aways from time to time.
Why wait? Let's start now... I will randomly select one of the first 50 subscribers for my first give-away:
Subscribe now and you could receive a new copy of "I'm Sorry to Hear That", a great resource for patient care providers to understand the 101 most common complaints from patients about health care (and how to effectively respond to them).
Saturday, March 3, 2012
Effects of Collimation on Radiographic Density and Contrast
One of the most interesting experiments for first-year radiography students is the effect of collimation on density and contrast. If you have not had the privilege of performing this with film/screen imaging, it's probably not going to yield as much of a profound result. The idea is to take two radiographs. The first one (we did ours on an abdomen) was taken with the collimation open to the entire phantom, and the second was taken with a 5" x 5" field size. We used the same regular 8x10 film for each, as well as the same technical factors. For best results, we did both exposures without the added variable of a grid - so table-top. Here's what we got:
The film with the open collimation on the left is overall higher in radiographic density. This is due to the increased amount of scatter radiation due to a larger volume of tissue (or phantom) being radiographed. This causes fog, or unwanted density to a greater degree than with a well-collimated view. The scatter also reduces contrast.
We measured two adjacent shades of gray on each radiograph. Contrast can be defined as the difference between two shades of gray. The densitometer had readings of 0.87 and 0.99 for the non-collimated exposure, and 0.36 and 0.54 for the collimated film. The lower density difference means there is lower contrast.
Sometimes, if anyone has a hard time visually seeing the difference between the two radiographs prior to taking optical density readings, you can take a pair of scissors and cut out the exposed field in the 5" x 5" exposure, and use it as a template to cut the same size piece with the same anatomy in the other image. Since I don't have to do that on my blog, I just did it digitally... here's a closer look:
So the results concluded that an increase in collimation (increase in beam restriction and decrease in field size) will reduce radiographic density and increase contrast. You can perform the same experiment with CR or DR, but the contrast effect will not be so pronounced due to the software compensation on the image. You will, however, see exposure indicators affected in the same manner.
Looking for tips on success through Radiography school? Check out my book!
The film with the open collimation on the left is overall higher in radiographic density. This is due to the increased amount of scatter radiation due to a larger volume of tissue (or phantom) being radiographed. This causes fog, or unwanted density to a greater degree than with a well-collimated view. The scatter also reduces contrast.
We measured two adjacent shades of gray on each radiograph. Contrast can be defined as the difference between two shades of gray. The densitometer had readings of 0.87 and 0.99 for the non-collimated exposure, and 0.36 and 0.54 for the collimated film. The lower density difference means there is lower contrast.
Sometimes, if anyone has a hard time visually seeing the difference between the two radiographs prior to taking optical density readings, you can take a pair of scissors and cut out the exposed field in the 5" x 5" exposure, and use it as a template to cut the same size piece with the same anatomy in the other image. Since I don't have to do that on my blog, I just did it digitally... here's a closer look:
So the results concluded that an increase in collimation (increase in beam restriction and decrease in field size) will reduce radiographic density and increase contrast. You can perform the same experiment with CR or DR, but the contrast effect will not be so pronounced due to the software compensation on the image. You will, however, see exposure indicators affected in the same manner.
Looking for tips on success through Radiography school? Check out my book!
How Many Hours do You Work?
I know the job market is still in the dumps, but I'm finding it somewhat ironic that everyone I know who is employed happens to be working 2 or 3 jobs, and a lot of times are being asked to work overtime. Why is this? As my shortest blog post yet, I simply wanted to ask those of you who are actively employed as a Technologist how many hours you work... feel free to comment here, on my Facebook page, or my Twitter.
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Thursday, March 1, 2012
Improve your Exam Efficiency
While this post might apply more to beginners in the field, or students, I think even seasoned Technologists can make small tweaks to their routines, based on different places of employment, to improve their efficiency in the Radiology Department.
Place some forethought into your exams - develop a routine for performing exams that will remain the same every time you do it. This helps on two levels... first, it will make something that you originally had to put a lot of thought toward into a habitual routine that you will later realize that you may be performing subconsciously.
Example: When I do an outpatient chest x-ray, I bring the patient to the dressing room, and while they are changing, I will set up my control panel for my first exposure. I use AEC with the two outer cells on the wall bucky. I set the kVp to 120 and bump up the mA station as high as it will go. I then place a CR cassette into the upright bucky (pre-scanned), and then detent my x-ray tube to 72" and transverse to the wall bucky, and raise it far above head-level so the patient doesn't have any chance of collision. I also place the rolling lead apron near the wall bucky.
When the patient enters the room, they simply need to walk to the upright bucky for the PA view where I adjust bucky height, align my x-ray tube, and roll the shield behind them (less than 10 seconds) before giving breathing instructions. On an average patient, start to finish is from 5-10 minutes but the patient will feel like it's about 1 minute because that's how long they are in the exam room. You can be completing paperwork while they are getting dressed, and don't forget to keep an eye out for them leaving the dressing room so you can walk them out.
I always suggest to my students that you can start this practice simple with the ABC's of beam alignment once the patient is ready to be positioned. A - set your control panel... do this first so that if a position is uncomfortable or awkward, you can run quickly to expose, keeping the patient from having to hold the position very long. B - line up the tube with the image receptor (if using the table)... don't get carried away with palpating and aligning the central ray. A common student mistake is forgetting to line up your bucky/image receptor. C - position the patient... make sure the patient is in the position you need, then float the table top to fine-tune your positioning.
If you're performing multiple exams, do them in a sequence that requires the least patient movement. For example, if you're doing a C-spine, T-spine and L-spine, this is an example of how I would perform the exams:
1. upright lateral C-spine
2. upright obliques for C-spine
3. supine odontoid
4. supine AP C-spine
5. AP T-spine
6. AP L-spine
7. RPO L-spine
8. LPO L-spine
9. Lateral L-spine
10. L5-S1 spot film
11. Lateral T-spine
12. swimmer's view if needed
This might not sound efficient by switching the order of the different body parts you need, but think about the patient. How much time will you spend if you do the entire C-spine series, then the entire T-spine, then the L-spine. How many times will you roll the patient up on their side, and how much discomfort will you cause if they are in pain when they move? If you plan it out in advance it should be much quicker with the least amount of movement required from the patient.
Enlist some help... have someone process your images (if you're not lucky enough to have DR). Ask for assistance with sliding patients up in a gurney or leaning them forward to place a gridded cassette behind them. Someone else can be moving the patient out of the room while you complete your tracking and/or paperwork. It's true that it only takes a few seconds, but over the course of an entire day, the cumulative total of time saved could mean that you get to go to lunch on time or go home on time. Looking even more long-term, it will increase the productivity in your department, allowing your Manager to hire additional Technologists more easily. This also means that you should also be seeking opportunities to help your fellow techs too when you are not otherwise occupied with an exam. Good teams don't necessarily have to ask for help.
For portable exams, check to see if there are any pending portables on the way or near an exam that you are heading out to perform. If someone is already on a portable run and a STAT portable is ordered near where they are, take a cassette to the tech and offer to process their original images, or take the portable machine from them when they are finished with their original exam and perform the STAT procedure yourself. If your department has a mobile phone, it's a good idea to have the portable tech carry one with them to communicate STAT exams.
Fluoroscopic exams can be tedious to set up for. It's a great idea to try to have some supplies set up at the beginning of the day when you have a busy schedule ahead. Be mindful not to open any supplies that would need to be discarded if not used. Sometimes patients do not show, and you may have filled an enema bag already. It will have to be discarded if not used that day. I would recommend keeping an un-used enema bag around until the end of your shift, even the patient that you prepped it for does not show. You never know when you will receive an add-on enema due to an incomplete colonoscopy. You might just be saving some time later in the afternoon by hanging onto it.
Make the most of slow moments. The first thing that anyone wants to do who works on their feet all day when there is a lull in activity is sit down. If you can resist this urge for a few moments, it can pay off later in the day. Check linens and supplies to see if there's any stocking that may be needed. Make sure there's fresh sheets and pillow cases on your table, and that the rooms are clean. These things should only take seconds if regularly kept up with, and if you're totally exhausted, take turns doing this with your teammates. Nobody wants to have a BE blowout only to learn there are no towels in the room!
These are just a few examples of what I like to do to increase efficiency in my department. Everyone has their own system that works for them, and I'm sure there are endless variations from the way that I like to do things, which is okay. Regardless of whether you like my routines in this post or you are being shown a different way than you might go about things, try to keep an open mind. You need to spend some time to develop routines that work for you, as well as the team you are working with. You are all there for the common goal of providing quality care in an efficient manner to the patients you serve.
Place some forethought into your exams - develop a routine for performing exams that will remain the same every time you do it. This helps on two levels... first, it will make something that you originally had to put a lot of thought toward into a habitual routine that you will later realize that you may be performing subconsciously.
Example: When I do an outpatient chest x-ray, I bring the patient to the dressing room, and while they are changing, I will set up my control panel for my first exposure. I use AEC with the two outer cells on the wall bucky. I set the kVp to 120 and bump up the mA station as high as it will go. I then place a CR cassette into the upright bucky (pre-scanned), and then detent my x-ray tube to 72" and transverse to the wall bucky, and raise it far above head-level so the patient doesn't have any chance of collision. I also place the rolling lead apron near the wall bucky.
When the patient enters the room, they simply need to walk to the upright bucky for the PA view where I adjust bucky height, align my x-ray tube, and roll the shield behind them (less than 10 seconds) before giving breathing instructions. On an average patient, start to finish is from 5-10 minutes but the patient will feel like it's about 1 minute because that's how long they are in the exam room. You can be completing paperwork while they are getting dressed, and don't forget to keep an eye out for them leaving the dressing room so you can walk them out.
I always suggest to my students that you can start this practice simple with the ABC's of beam alignment once the patient is ready to be positioned. A - set your control panel... do this first so that if a position is uncomfortable or awkward, you can run quickly to expose, keeping the patient from having to hold the position very long. B - line up the tube with the image receptor (if using the table)... don't get carried away with palpating and aligning the central ray. A common student mistake is forgetting to line up your bucky/image receptor. C - position the patient... make sure the patient is in the position you need, then float the table top to fine-tune your positioning.
If you're performing multiple exams, do them in a sequence that requires the least patient movement. For example, if you're doing a C-spine, T-spine and L-spine, this is an example of how I would perform the exams:
1. upright lateral C-spine
2. upright obliques for C-spine
3. supine odontoid
4. supine AP C-spine
5. AP T-spine
6. AP L-spine
7. RPO L-spine
8. LPO L-spine
9. Lateral L-spine
10. L5-S1 spot film
11. Lateral T-spine
12. swimmer's view if needed
This might not sound efficient by switching the order of the different body parts you need, but think about the patient. How much time will you spend if you do the entire C-spine series, then the entire T-spine, then the L-spine. How many times will you roll the patient up on their side, and how much discomfort will you cause if they are in pain when they move? If you plan it out in advance it should be much quicker with the least amount of movement required from the patient.
Enlist some help... have someone process your images (if you're not lucky enough to have DR). Ask for assistance with sliding patients up in a gurney or leaning them forward to place a gridded cassette behind them. Someone else can be moving the patient out of the room while you complete your tracking and/or paperwork. It's true that it only takes a few seconds, but over the course of an entire day, the cumulative total of time saved could mean that you get to go to lunch on time or go home on time. Looking even more long-term, it will increase the productivity in your department, allowing your Manager to hire additional Technologists more easily. This also means that you should also be seeking opportunities to help your fellow techs too when you are not otherwise occupied with an exam. Good teams don't necessarily have to ask for help.
For portable exams, check to see if there are any pending portables on the way or near an exam that you are heading out to perform. If someone is already on a portable run and a STAT portable is ordered near where they are, take a cassette to the tech and offer to process their original images, or take the portable machine from them when they are finished with their original exam and perform the STAT procedure yourself. If your department has a mobile phone, it's a good idea to have the portable tech carry one with them to communicate STAT exams.
Fluoroscopic exams can be tedious to set up for. It's a great idea to try to have some supplies set up at the beginning of the day when you have a busy schedule ahead. Be mindful not to open any supplies that would need to be discarded if not used. Sometimes patients do not show, and you may have filled an enema bag already. It will have to be discarded if not used that day. I would recommend keeping an un-used enema bag around until the end of your shift, even the patient that you prepped it for does not show. You never know when you will receive an add-on enema due to an incomplete colonoscopy. You might just be saving some time later in the afternoon by hanging onto it.
Make the most of slow moments. The first thing that anyone wants to do who works on their feet all day when there is a lull in activity is sit down. If you can resist this urge for a few moments, it can pay off later in the day. Check linens and supplies to see if there's any stocking that may be needed. Make sure there's fresh sheets and pillow cases on your table, and that the rooms are clean. These things should only take seconds if regularly kept up with, and if you're totally exhausted, take turns doing this with your teammates. Nobody wants to have a BE blowout only to learn there are no towels in the room!
These are just a few examples of what I like to do to increase efficiency in my department. Everyone has their own system that works for them, and I'm sure there are endless variations from the way that I like to do things, which is okay. Regardless of whether you like my routines in this post or you are being shown a different way than you might go about things, try to keep an open mind. You need to spend some time to develop routines that work for you, as well as the team you are working with. You are all there for the common goal of providing quality care in an efficient manner to the patients you serve.
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