Well
As the phrase goes "Time flies when your having fun" this three weeks has been an eye opener to the world of a qualified Radiographer and I want to get there more than ever.
Today has been quite sad, I feel that ive learned so much and devloped skills I did not have on going here, ive picked up positioning tips which never fail! Ive developed skills in areas I felt I was lacking on my placements because I was allowed to develop without being pushed.
This morning was quite quiet to begin with so I booked appointments for future ultrasound patients and printed off the letters to inform them of such, sound simple but its not. To do this apparently simple task there are five stages of processing in five diffent areas of CRIS, amazing how something so simple can become so time consuming, and its all done by the Radiographers there is no Admin staff in a backroom.
As the Sonographer reported on the morning pataints its the Radiographers role to report the finings into CRIS reporting, I was allowed to do this under close supervision on a few of the reports.
It was suggested thta during my third year I would like to spend some time in Ultrasound, this I hope to achieve before completion of my third year.
As for the rest of the day i stayed in general X-Ray I learnt about "Harris Lines"
these are linear markings across the bone and are indictaive of serious infections during childhood, such as whooping cough or measles. They are caused by the ceasing of bone growth as the body fights infections, when the bone starts to grwon again these line develop as a mark on the bone which remains forever. - Amazing
Anyway thats the end for me at this Hospital, even though I can not mention all the people I have worked with I just want to say THANK YOU for giving me the chance to com ehere and work with you all, and the University for giving me the chance to complete a Practice Based Module.
Thanks
Saturday, September 22, 2007
Thursday 20th September 2007 - Working with the Nurses in M.I.U
In training we had a session where a nurse practitioner cam into us as a group and discussed patient assessment before imging refferal, this was fine and i learnt a lot but this was to be my cahnce to work with and observe the nursing staff in this busy department.
I had arranged with the Radiographer in charge to watch the assessment, watch them justify the request and then grab a Radiographer to obvserve then procedure as I positioned and took the image then diagnosed the film.
Then took the film back to M.I.U with the patient to explain my findings, such fun! I soon learnt in here that patience is a virtue, some patients will tell you anything to get an x-ray to aid in convincing themselves a sprain is a fracture.
Throughout the day I was able to work through about ten patients who required imaging and plenty more who were told no!, this was an experience working in here. More importantly I realised again the importance of a diagnostic image and the ability to be able to describe an fracture and point it out to thoise who have a limited training course on the subject.
I have highllighted an area which I would like to develop in my third year the ability to report in simplictic but accurate terminoilogy, my mentors tell me this will develop in time but theres no harm in pushing yourself a little harder.
Its a shame the three weeks are coming to a close!!
I had arranged with the Radiographer in charge to watch the assessment, watch them justify the request and then grab a Radiographer to obvserve then procedure as I positioned and took the image then diagnosed the film.
Then took the film back to M.I.U with the patient to explain my findings, such fun! I soon learnt in here that patience is a virtue, some patients will tell you anything to get an x-ray to aid in convincing themselves a sprain is a fracture.
Throughout the day I was able to work through about ten patients who required imaging and plenty more who were told no!, this was an experience working in here. More importantly I realised again the importance of a diagnostic image and the ability to be able to describe an fracture and point it out to thoise who have a limited training course on the subject.
I have highllighted an area which I would like to develop in my third year the ability to report in simplictic but accurate terminoilogy, my mentors tell me this will develop in time but theres no harm in pushing yourself a little harder.
Its a shame the three weeks are coming to a close!!
Tuesday 18th September 2007 - After a night "On Call" the show must go on!
Well
As reported yesterday was a very busy day and it didnt stop, curious to find out how On Call worked i asked if I could experience it first hand and the Radiographer on call was all too glad to say yes.
On Call is lonely, its probably the only time I would feel vulnerable in the department. Why? well you are on your own, nobody to refer too, its just you and the patient out of normal hours. When im qualified im sure it would be a case of just getting on with the job regardless, from a student perspective it was quite intimidating.
Anyway back to On Call, after leaving at Five last night (Monday), the Radiographer got a call at 18:15 from M.I.U asking them if they could come back to department for a couple of important requests, he then called me and we met at the department.
The routine is slightly different to daytime hours as patients are all in bays in M.I.U, usually when M.I.U is full we shout the patient from the normal waiting area. A busy hospital in the evening becomes very quiet as the only people there are those visiting wards or patients for casualty.
Before meeting any patients the room has to be turned on, this includes the tube, control panel, DAP meter and all the computer systems which enable us to label the cassettes and the processor. This is very time consuming and energy intensive the processor unit alone takes 15 minutes to warm itself up to be able to work effectively.
When we enter M.I.U we collect all requests to get an idea of our workload and plan accordingly, usually mots of the work is extremity so its not too difficult to move the patiants through as a production line, there may be an occasional facial bone thrown in but mainly extremity. The evenings work was finished by 19:15 and we powered off and went back home only to be called out again at 20:15 and finished again at 21:30, apparently the Radiographer on call was called out once more after that and decided not to ring me again-shame but now I know what its like On call.
Today I feel tired! Having your evening interrupted is something which is not pleasent, being in a large city hospital you work evening shifts so you can plan when your on late and work your week around it. It feels as though you have not been away from department you come back in at 09:00 and start all over again and its hard to do.
On call is a whole different game, you are stuck near a phone until it calls if it doesnt its a quiet night, if it does you are at the mercy of the department until the work is done. Its an interruption which is not wanted especially if you are unfortuntae to be presented with an aggressive patient in the early hours.
The staff here work on an on call rota which include a seven day week on a one on four week basis.
Today has been a challenge and last night into today ahs been an experience which i will never forget, thankfully its only one night.
I was told by those who work on call that eventually you dont mind you become used to getting call outs and just get on with it.
As reported yesterday was a very busy day and it didnt stop, curious to find out how On Call worked i asked if I could experience it first hand and the Radiographer on call was all too glad to say yes.
On Call is lonely, its probably the only time I would feel vulnerable in the department. Why? well you are on your own, nobody to refer too, its just you and the patient out of normal hours. When im qualified im sure it would be a case of just getting on with the job regardless, from a student perspective it was quite intimidating.
Anyway back to On Call, after leaving at Five last night (Monday), the Radiographer got a call at 18:15 from M.I.U asking them if they could come back to department for a couple of important requests, he then called me and we met at the department.
The routine is slightly different to daytime hours as patients are all in bays in M.I.U, usually when M.I.U is full we shout the patient from the normal waiting area. A busy hospital in the evening becomes very quiet as the only people there are those visiting wards or patients for casualty.
Before meeting any patients the room has to be turned on, this includes the tube, control panel, DAP meter and all the computer systems which enable us to label the cassettes and the processor. This is very time consuming and energy intensive the processor unit alone takes 15 minutes to warm itself up to be able to work effectively.
When we enter M.I.U we collect all requests to get an idea of our workload and plan accordingly, usually mots of the work is extremity so its not too difficult to move the patiants through as a production line, there may be an occasional facial bone thrown in but mainly extremity. The evenings work was finished by 19:15 and we powered off and went back home only to be called out again at 20:15 and finished again at 21:30, apparently the Radiographer on call was called out once more after that and decided not to ring me again-shame but now I know what its like On call.
Today I feel tired! Having your evening interrupted is something which is not pleasent, being in a large city hospital you work evening shifts so you can plan when your on late and work your week around it. It feels as though you have not been away from department you come back in at 09:00 and start all over again and its hard to do.
On call is a whole different game, you are stuck near a phone until it calls if it doesnt its a quiet night, if it does you are at the mercy of the department until the work is done. Its an interruption which is not wanted especially if you are unfortuntae to be presented with an aggressive patient in the early hours.
The staff here work on an on call rota which include a seven day week on a one on four week basis.
Today has been a challenge and last night into today ahs been an experience which i will never forget, thankfully its only one night.
I was told by those who work on call that eventually you dont mind you become used to getting call outs and just get on with it.
Thursday, September 20, 2007
Wednesday 19th September 2007 - Podiatry Clinics
The foot stand used in Podiarty cases, a far cry from displacing a cassette on a chest stand!
An unusual day spent with the team in Podiatry, these clinics look at Pre-Op and Post Op patients of a variety of ages with conditions affecting their feet.
Feet are a part fo the antomy as a student which are possibly the most unattractive area of teh body, I however quite enjoy imaging feet and bariums too??
Feet are a part fo the antomy as a student which are possibly the most unattractive area of teh body, I however quite enjoy imaging feet and bariums too??
Possibly a bit weird but hey ho
Anyway back to Podiatry, the clinic runs from 10:00am till 15:00 and during this time the clinics consultant podiatrist looks at around thirty patients, of these patients around 15 of them will be sent for imaging.
All images for this clinic are weight bearing and usually the projexctions required are a DP and Lateral, the DP is acquired with the aptient standing on the plate and the lateral with the patient stood on a specially made box with the cassette inserted.
This box has a lead insert so that only half of the cassette can be exposed by the primary beam, I have been taught to image the lateral first using the box, and place the correct marker on the lateral and dont move the marker, that way you know when the cassette is placed on the fllor which side is unexposed. It is simple when you know how!
I spent the whole day working with the podiatrist and followed the patients from entering to leaving, the images reproduced were done by me so if they were not right I was to blame, in this situation you can see how your role affects the consultants and therefore accuracte imaging is essential.
The Radiographers involvement however is not to repeat the image but to pull a films list first compile the days films packets from storage and prepare them for collection by the poditarist nursing team, then put them all away again when the clinic ends once the records are updated.
This situation was particularly good for developig my skills in reporting the podiatrist spent an incredible amount of time taking me through the images nad explained why accurate imaging was of the upmost importance in Pr and Post Op surgery cases.
When the clincs were over I went back to start working on the casualty patients, for the last two hours.
A thouroghly enjoyable day
Anyway back to Podiatry, the clinic runs from 10:00am till 15:00 and during this time the clinics consultant podiatrist looks at around thirty patients, of these patients around 15 of them will be sent for imaging.
All images for this clinic are weight bearing and usually the projexctions required are a DP and Lateral, the DP is acquired with the aptient standing on the plate and the lateral with the patient stood on a specially made box with the cassette inserted.
This box has a lead insert so that only half of the cassette can be exposed by the primary beam, I have been taught to image the lateral first using the box, and place the correct marker on the lateral and dont move the marker, that way you know when the cassette is placed on the fllor which side is unexposed. It is simple when you know how!
I spent the whole day working with the podiatrist and followed the patients from entering to leaving, the images reproduced were done by me so if they were not right I was to blame, in this situation you can see how your role affects the consultants and therefore accuracte imaging is essential.
The Radiographers involvement however is not to repeat the image but to pull a films list first compile the days films packets from storage and prepare them for collection by the poditarist nursing team, then put them all away again when the clinic ends once the records are updated.
This situation was particularly good for developig my skills in reporting the podiatrist spent an incredible amount of time taking me through the images nad explained why accurate imaging was of the upmost importance in Pr and Post Op surgery cases.
When the clincs were over I went back to start working on the casualty patients, for the last two hours.
A thouroghly enjoyable day
Tuesday, September 18, 2007
Monday 17th September 2007 - What a Busy Day!
Well as mentioned in previous weeks Mondays are renouned for bieng busy, you have a wave of Friday and Saturday Night Out injuries followed by the Sunday morning football injuries just to start the day off.
Additionally theres a Barium List and a Consultant Radiologist all in the department, I was spoilt for choice today with where I wanted to go and decided i would float between Barium and Casualty patients, as I woudl get chance to go into Ultrasound later in the week.
The day was busy and the pataints visiting were relentless the normal FOOSH and metatarsal injuries with a far few querry fracture requests, many of the images producing no fractures or dislocations later in the morning.
However the first six images were fractured and this gave me an opportunity to have a go at reporting the image, the Radiographer watched me position, acquire and develop the image, she then asked me to find a fracture and demonstrate where the site is (if there was one) and tell her in reporting language.
As soon as I was asked this the feeling of panic appeared and struggling became the chosen word! The fractures were demonstrated and i managed to talk through some of the images alright, but my descriptions were just too long.
Too trya nd understand how a simple effective report is wrote i sat with teh visiting consultant and watched as he described the fracture site and the result it had on the joint, in this case it was an ankle with a comminuted fracture of the lateral malleolus which had produced a talar shift medially suggestive of ligament disruption or something along those lines. It is pretty amazing to sit there and watch as a consultant can report five or more films in a short space of time, this was an great chance to watch as the AABCs system or a variation of such is applied.
We knew that the afternoon was not going to slow down either with M.I.U (Casualty) refferring and a Ortho Clinic waiting to refer the hard work was only just beginning, as the bell started to ring the department went crazy. I decided that it wa stoo busy for me to be taught and offered to complete and admin role to help speed up the Radiographers at work.
As they brought their cassettes through I would label them and process the images, placing them on the light box and labelling them up, as well as this finding out when they had their last image and producing volume and attendance labels.
The workload did not slow down until four o clock when I was allowed to image a number for standing knees as it seems to be something i appear to have become quite good at. That was it for a very busy day.
Additionally theres a Barium List and a Consultant Radiologist all in the department, I was spoilt for choice today with where I wanted to go and decided i would float between Barium and Casualty patients, as I woudl get chance to go into Ultrasound later in the week.
The day was busy and the pataints visiting were relentless the normal FOOSH and metatarsal injuries with a far few querry fracture requests, many of the images producing no fractures or dislocations later in the morning.
However the first six images were fractured and this gave me an opportunity to have a go at reporting the image, the Radiographer watched me position, acquire and develop the image, she then asked me to find a fracture and demonstrate where the site is (if there was one) and tell her in reporting language.
As soon as I was asked this the feeling of panic appeared and struggling became the chosen word! The fractures were demonstrated and i managed to talk through some of the images alright, but my descriptions were just too long.
Too trya nd understand how a simple effective report is wrote i sat with teh visiting consultant and watched as he described the fracture site and the result it had on the joint, in this case it was an ankle with a comminuted fracture of the lateral malleolus which had produced a talar shift medially suggestive of ligament disruption or something along those lines. It is pretty amazing to sit there and watch as a consultant can report five or more films in a short space of time, this was an great chance to watch as the AABCs system or a variation of such is applied.
We knew that the afternoon was not going to slow down either with M.I.U (Casualty) refferring and a Ortho Clinic waiting to refer the hard work was only just beginning, as the bell started to ring the department went crazy. I decided that it wa stoo busy for me to be taught and offered to complete and admin role to help speed up the Radiographers at work.
As they brought their cassettes through I would label them and process the images, placing them on the light box and labelling them up, as well as this finding out when they had their last image and producing volume and attendance labels.
The workload did not slow down until four o clock when I was allowed to image a number for standing knees as it seems to be something i appear to have become quite good at. That was it for a very busy day.
Monday, September 17, 2007
Thursday 13th September 2007 - Copying Films without the "PRINT" Key
Agfa CURIX DUPLI Copier Machine
The copier plate of an AGFA curix copier
At this location theres no CR or DR just old fashioned plain film imaging, as discussed through the blog there are numerous differences in using convential plain film, these are mainly not beneficial to time saving as everything appears to be labour intensive.
In todays compensation crazy society its not uncommon for departments of large City Hospitals to employ a person to pull out and copy old images to assist solicitors in legal proceedings, thsi too applies to the smaller hospitals! the only difference is here its the Radiographer who obtains the films and copies them and then posts them on.
Here we have to get the required film from the packet and copy it sounds simple? well in a large hospital Yes, just press print and they are reproduced, when using traditional methods its takes an age. I hope the following text will give some indication of how technology has simplified the administratiive side of our role;
Reproducing images the 20th Century Way.
Find the old films
Go into a darkroom, yes you read that bit right, at this site there are two darkrooms, the first is for loading films into the feeding cassettes the second is for reproducing copy images.
In this room there is a AGFA CURIX DUPLI copier to use this machine you will need some copy film once again by AGFA and it comes in two sizes the 35/43 and the .
Unlike normal film used in the processor which has a double emulsion this copier film has emulsion on only one side, this emulsion side is placed into contact with the original film and the copier lid is locked shut.
Once the lid is closed and locked there is a timer, thsi is set to forty seconds, whilst the timer counts down the copier is exposing the developed film to an ultraviolet light which is copying the image onto the copier film.
The image is then copied but undeveloped and has to be transported to the processor unit.
This is done by taking two cassettes from department and emptying the film from one into the other this means that one cassette has two unexposed and not copied images inside, then the copied but undeveloped film is placed into the empty tray.
This now means that all film is safe for transportation to the processor, the patient details and markers will be copied so the cassette will not be placed in the identification camera for labelling.
Care must be taken not to mix the cassettes up as there are two films in one cassette and one copy in the other, if you forget which is which then go into the darroom and feel across the top of the film at the top right hand corner are two notches these are indications of copier film.
Right processing the image. With normal images the cassette is placed in the feeder the film is released from the cassette and developed and a fresh film inserteded into the cassette, this is called "Load and Unload", as we already have the film from the cassette that contains the copy we dont want another film to drop into teh cassette"Load" we only want it to "Unload" so a selcation on the control panel must be made to "Unload" only.
After about four miuntes the image appears and is an exact reproduction of the original.
Its a hard life as a 20th Century Student Radiographer, time is of the essence and theres not enough of it.
In todays compensation crazy society its not uncommon for departments of large City Hospitals to employ a person to pull out and copy old images to assist solicitors in legal proceedings, thsi too applies to the smaller hospitals! the only difference is here its the Radiographer who obtains the films and copies them and then posts them on.
Here we have to get the required film from the packet and copy it sounds simple? well in a large hospital Yes, just press print and they are reproduced, when using traditional methods its takes an age. I hope the following text will give some indication of how technology has simplified the administratiive side of our role;
Reproducing images the 20th Century Way.
Find the old films
Go into a darkroom, yes you read that bit right, at this site there are two darkrooms, the first is for loading films into the feeding cassettes the second is for reproducing copy images.
In this room there is a AGFA CURIX DUPLI copier to use this machine you will need some copy film once again by AGFA and it comes in two sizes the 35/43 and the .
Unlike normal film used in the processor which has a double emulsion this copier film has emulsion on only one side, this emulsion side is placed into contact with the original film and the copier lid is locked shut.
Once the lid is closed and locked there is a timer, thsi is set to forty seconds, whilst the timer counts down the copier is exposing the developed film to an ultraviolet light which is copying the image onto the copier film.
The image is then copied but undeveloped and has to be transported to the processor unit.
This is done by taking two cassettes from department and emptying the film from one into the other this means that one cassette has two unexposed and not copied images inside, then the copied but undeveloped film is placed into the empty tray.
This now means that all film is safe for transportation to the processor, the patient details and markers will be copied so the cassette will not be placed in the identification camera for labelling.
Care must be taken not to mix the cassettes up as there are two films in one cassette and one copy in the other, if you forget which is which then go into the darroom and feel across the top of the film at the top right hand corner are two notches these are indications of copier film.
Right processing the image. With normal images the cassette is placed in the feeder the film is released from the cassette and developed and a fresh film inserteded into the cassette, this is called "Load and Unload", as we already have the film from the cassette that contains the copy we dont want another film to drop into teh cassette"Load" we only want it to "Unload" so a selcation on the control panel must be made to "Unload" only.
After about four miuntes the image appears and is an exact reproduction of the original.
Its a hard life as a 20th Century Student Radiographer, time is of the essence and theres not enough of it.
Wednesday, September 12, 2007
Tuesday 11th September 2007 - An unusual day
Tuesday
Today was an unusual day in what is normally a busy department, the reason is there was hardly any patients until the days finale, a number of clinics which require imaging had small lists and a number of those patients were post op checks which didnt require imaging. Luckily the department was a little short on staff through holidays which compensated for a quiet day at least thats what we thought.
At around two o clock in the afternoon the bell started ringing and was relentless until quarter to five, in that small period of time there were around a half days worth of M.I.U cases for imaging, a large variety of cases where I was allowed to practice.
This situation meant that the Radiographer supervising allowed me to take control (whilst I was being watched), as though I was on my own, this was great for my confidence as there may come a time where I will be on my own in a department with nobody around. An example of a situation would be when "On Call" you get called out at any time in the night from six o clock until eight o clock the following morning. If the image is deemed neccessary you never know what you may get or the condidtion of the patient and you will be on your own as only one Radiographer is on call per week.
I found this a challenge which was extremely difficult to start with but one which in an afternoon has made me understand that I may not be in a department with others when working, and that confidence and being organised is the key to getting the task done.
I managed a littels ystem of work and stuck to it;
Select Cassette - Extremity or Other
Select Exposure - Adult or Pead and reduce kV accordingly
Pads and Protection at hand
Patient details - print off required labels and place on request slip
Bring patient through, ID and acquire image
Leave Patient in the room whilst you label the cassette and process
Assess the image (with a lot of help!)
Take the patient back through to M.I.U
Place films on M.I.U light box and point anything out.
Post Process and find out where the fim packet is
Set up the room for the next patient.
I managed a far number with a lot of assistance to speed the process along, what a learning curve!! Bring on tommorrow.
Today was an unusual day in what is normally a busy department, the reason is there was hardly any patients until the days finale, a number of clinics which require imaging had small lists and a number of those patients were post op checks which didnt require imaging. Luckily the department was a little short on staff through holidays which compensated for a quiet day at least thats what we thought.
At around two o clock in the afternoon the bell started ringing and was relentless until quarter to five, in that small period of time there were around a half days worth of M.I.U cases for imaging, a large variety of cases where I was allowed to practice.
This situation meant that the Radiographer supervising allowed me to take control (whilst I was being watched), as though I was on my own, this was great for my confidence as there may come a time where I will be on my own in a department with nobody around. An example of a situation would be when "On Call" you get called out at any time in the night from six o clock until eight o clock the following morning. If the image is deemed neccessary you never know what you may get or the condidtion of the patient and you will be on your own as only one Radiographer is on call per week.
I found this a challenge which was extremely difficult to start with but one which in an afternoon has made me understand that I may not be in a department with others when working, and that confidence and being organised is the key to getting the task done.
I managed a littels ystem of work and stuck to it;
Select Cassette - Extremity or Other
Select Exposure - Adult or Pead and reduce kV accordingly
Pads and Protection at hand
Patient details - print off required labels and place on request slip
Bring patient through, ID and acquire image
Leave Patient in the room whilst you label the cassette and process
Assess the image (with a lot of help!)
Take the patient back through to M.I.U
Place films on M.I.U light box and point anything out.
Post Process and find out where the fim packet is
Set up the room for the next patient.
I managed a far number with a lot of assistance to speed the process along, what a learning curve!! Bring on tommorrow.
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