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.
Monday 10th September 2007 Week Two - Bariums and Ortho Clinics
Another week begins and as every Monday its Barium Studies all morning, couple this with the Orthopeadic Clinics and a vast array of M.I.U injuries that have been sent back over the weekend and reffered for x-ray today its going to be very busy.
I spent the morning between watchging Enemas and accompanying the Radiographer who was working in Room 2, this was great as I managed to do a bit of both. Monday Mornings in the general room is mainly hand, FOOSH and Facila Bones and the reasoning for this was Saturday Fight Night in town, the advice i wa sgiven prooved to be correct as a wave of injuries passed through the door with ?# many hands, phalanx and wrists and a fiew facial bones investigating #zygomatic arch.
With this hopsital having no CT scan facility all refferalls from MIU go here for plain film imaging, a great opportunity to learn in more detail the positioing and evaluation of plain film facial bones, something in a large City hopsital is lacking.
I did not spend a lot of time in enemas today as i felt it was more beneficial to learn more in plain film M.I.U cases, and I did a morning well spent.
There was also an offer to spend a morning with the visiting Radiologist in Reporting films and then the mornings Ultrasound list as this is an area where I need to gain a n understanding of the images and there acquisition, this is will take place next Monday 17th.
The afternoon was spent with a variety of Orthopeadic patients from two consulting clinics, many pre/post op knees, unusually there were a couple of shoulders and one failed ORIF where the screws had sheared and left metallic fragments within the soft tissue.
The most insteresting sight on an image was that of radiocative probes placed within the prostate as a means of curing prostate cancer, a basic plain Film AP Pelvis was acquired and placed on the light box, to my horror I thought there was artefact on the image. This was followed by the Radiographer asking what is in that area and I was told they are radiocative probes which are placed in the prostate to cure the cancer. Quite fantastic to view on an image.
I spent the morning between watchging Enemas and accompanying the Radiographer who was working in Room 2, this was great as I managed to do a bit of both. Monday Mornings in the general room is mainly hand, FOOSH and Facila Bones and the reasoning for this was Saturday Fight Night in town, the advice i wa sgiven prooved to be correct as a wave of injuries passed through the door with ?# many hands, phalanx and wrists and a fiew facial bones investigating #zygomatic arch.
With this hopsital having no CT scan facility all refferalls from MIU go here for plain film imaging, a great opportunity to learn in more detail the positioing and evaluation of plain film facial bones, something in a large City hopsital is lacking.
I did not spend a lot of time in enemas today as i felt it was more beneficial to learn more in plain film M.I.U cases, and I did a morning well spent.
There was also an offer to spend a morning with the visiting Radiologist in Reporting films and then the mornings Ultrasound list as this is an area where I need to gain a n understanding of the images and there acquisition, this is will take place next Monday 17th.
The afternoon was spent with a variety of Orthopeadic patients from two consulting clinics, many pre/post op knees, unusually there were a couple of shoulders and one failed ORIF where the screws had sheared and left metallic fragments within the soft tissue.
The most insteresting sight on an image was that of radiocative probes placed within the prostate as a means of curing prostate cancer, a basic plain Film AP Pelvis was acquired and placed on the light box, to my horror I thought there was artefact on the image. This was followed by the Radiographer asking what is in that area and I was told they are radiocative probes which are placed in the prostate to cure the cancer. Quite fantastic to view on an image.
Friday 7th September 2007 Podiatry Clinics
I was told that Fridays traditionally are a quiet day in regard to Pre Booked appointments and Clinics.
There was a wave of M.I.U. Patients throughout the day with a variety of injuries, some fractures some not. This was to be a day where I was to develop my skills at plain film imaging, the great thing with a hospital like this is you never know what patients will be walking through the door and what prospective injurie they may appear with. Very simillar to an A/E department but you have alittle more time to think about positioning, and exposure factors something I have never really concentrated on until coming to work here.
From the M.I.U patiants there were two I shall discuss two;
The first had presented on the request slip with ?# Proximal phalanx or Querry Fracture of the proximal phalanx, what the slip did not say was very large open wound. The patient had severed the tendon and the incision had passed through, this incision wa so large that it ended I would assume at the distal radius right across the palmer aspect of the hand.
This was the first time I had to think about the exposure to blood and protecting myself and the room from and more importantly the patinet from any infection, before even taking the image.
All the relevant cleaning measure were implemeented and the patint went back ti M.I.U. it turned out there was an fractured distal, and proximal fractures with the middle phalanx being displaced on the 2nd metacarpal following by a dislocation of the 1st Metacrapal at the MCP Joint. This patient was refferred to clinic at the large city hospital nearby.
I had learnt that by taking my time and really thinking about situation before carrying out any part of imaging or positioing will help me keep my composure and acquire a diagnostic image.
The second patient was admitted after a fall at home, the patinet had been lay for three days on her side unable to move, after being found by her neighbour the paramedics rushed her to us for immediate imaging before possibly being sent to the City Hospital. The need for smaller community hopsitals are vital in caring fpr patients with urgency when a longer ambulance ride to a City Hospital is not suitable.
The request slip required AP and Hztl Beam Hip Left and Left Knee and Ankle, additionally there was a request for left Shoulder and Wrist, quite a checklist of images all related to the fall.
The only problem was the patients size and the problem of her being on a chair and not a trolley.
This was to be the first time I had attempted to use a Hoist (under a lot of Supervision), and was asked how I would adapt the traditional techniques around this patient, it was quite interesting to be asked and to attempt what I had suggested (only if it were correct though), the shoulder AP and Lateral, and the Wrist images were done in the chair.
After leraning how you set up a hoist I was allowed to help in placing it under the patient, this was not satisfactory as the patients hevaily swollen knees would not move and any movement around this area resulted in discomfort.
We eventually managed to lower the table to chair hieght and slide the patinet across onto the table top, using an old 35/43 cassette as the sliding board wouldnt withhold the pressure, an all new version of adapted techniques!!
Eveentually the images were acquired and there fractures so the patient was refferred to the City Hospital for further treatment.
All in all an extremely hard week with a variety of cases and a lot of learning, its amazing to think that Radiography used to be so intensive when away from the patient, the image acquisistion is actually the easier bit.
Oh well Weekends upon us and another week about to begin, and too be honest im looking forward to going back.
There was a wave of M.I.U. Patients throughout the day with a variety of injuries, some fractures some not. This was to be a day where I was to develop my skills at plain film imaging, the great thing with a hospital like this is you never know what patients will be walking through the door and what prospective injurie they may appear with. Very simillar to an A/E department but you have alittle more time to think about positioning, and exposure factors something I have never really concentrated on until coming to work here.
From the M.I.U patiants there were two I shall discuss two;
The first had presented on the request slip with ?# Proximal phalanx or Querry Fracture of the proximal phalanx, what the slip did not say was very large open wound. The patient had severed the tendon and the incision had passed through, this incision wa so large that it ended I would assume at the distal radius right across the palmer aspect of the hand.
This was the first time I had to think about the exposure to blood and protecting myself and the room from and more importantly the patinet from any infection, before even taking the image.
All the relevant cleaning measure were implemeented and the patint went back ti M.I.U. it turned out there was an fractured distal, and proximal fractures with the middle phalanx being displaced on the 2nd metacarpal following by a dislocation of the 1st Metacrapal at the MCP Joint. This patient was refferred to clinic at the large city hospital nearby.
I had learnt that by taking my time and really thinking about situation before carrying out any part of imaging or positioing will help me keep my composure and acquire a diagnostic image.
The second patient was admitted after a fall at home, the patinet had been lay for three days on her side unable to move, after being found by her neighbour the paramedics rushed her to us for immediate imaging before possibly being sent to the City Hospital. The need for smaller community hopsitals are vital in caring fpr patients with urgency when a longer ambulance ride to a City Hospital is not suitable.
The request slip required AP and Hztl Beam Hip Left and Left Knee and Ankle, additionally there was a request for left Shoulder and Wrist, quite a checklist of images all related to the fall.
The only problem was the patients size and the problem of her being on a chair and not a trolley.
This was to be the first time I had attempted to use a Hoist (under a lot of Supervision), and was asked how I would adapt the traditional techniques around this patient, it was quite interesting to be asked and to attempt what I had suggested (only if it were correct though), the shoulder AP and Lateral, and the Wrist images were done in the chair.
After leraning how you set up a hoist I was allowed to help in placing it under the patient, this was not satisfactory as the patients hevaily swollen knees would not move and any movement around this area resulted in discomfort.
We eventually managed to lower the table to chair hieght and slide the patinet across onto the table top, using an old 35/43 cassette as the sliding board wouldnt withhold the pressure, an all new version of adapted techniques!!
Eveentually the images were acquired and there fractures so the patient was refferred to the City Hospital for further treatment.
All in all an extremely hard week with a variety of cases and a lot of learning, its amazing to think that Radiography used to be so intensive when away from the patient, the image acquisistion is actually the easier bit.
Oh well Weekends upon us and another week about to begin, and too be honest im looking forward to going back.
Thursday 6th September 2007 Curved Cassettes?? Yep Curved Cassettes
Images of a Curved Cassette.
Thursdays begin with an Enema list and continue with constant work from the Minor Injuries Unit (M.I.U) and a variety of Orthopeadic Clinics from visting consultants.
The list starts at 9:00am and finishes at 13:00 and today would be solely Barium Enemas in Room 1 which has a Flouroscopy tube levaing the General work from the Orthopeadic clinics and M.I.U to be carried out in Room 2.
Their is an Enema trained Radiographer who is assisted by a Senior I grade and together they operate the room, from preparation to screening through to the final plian film images.
The difference with this hopsital is they complete a four view series as a completeion to procedure a Prone Film (Hamptons View), Prone 30, and RAO and LAO Decubitus Views, once these have been completed there will be an additional four imgaes grabbed by Flouroscopy.
These final images are acquired if there has been an area demonstrated of consistent spasm, if there is an area of abnormality, also the final images demonstrate an better view of the caecum with a small amount of air in it.
I was alos told that you know when you have the caecum when you reach the terminal ileum entering the small bowel then move the tube down a little further and the domed area is the caecum, look a little harder and the appendix will become clear. I hope to download an image to demonstrate this later in the blog.
The mornings list continued to include a total of six patients all of varying degrees of condition, as there were two Rdaiographers on duty I was working as the assistant role during each procedure and then completed the final set of images, a role I thought would be very helpful with Third Year assessments looming and one which involves Flouroscopy.
This role did not really teach me anything I did not already know about preparation but I learnt a lot about the imaging, parcticesed the final sequence of plain films and practiced my Image analysis skills, developing methods of remembering where to look and what you are looking at.
After lunch I returned to start work on Orthopadeic Clinics many of the images acquired where for Knees and Spines the majority of patients all had pre-post operative imaging to check the condition of the joints pre-post op.
I spent the reamining three hours developing my techniques on knees and showed the Radiographers here how we do Intercondylar Notch Views at the training placement, Why?? You may ask.. Well I was shown the old fashioned plain film method of a Curved Cassette! Yep an actual cassette that is curvedand its amazing. ive never seen one before and its quite unlikley I'll ever see one again. For those who are interested I'll be posting an image on this blog.
So how does it work? The Curved cassette has a normal flat plate placed in the curve cassette in the dark room, it is then placed under the knee withj the patinet sat up and the image is acuired, the cassette is then taken to the dark room and placed in a flat cassette and placed in the processor, the resultant film is as though it were an adapted technique from a text book.
And that concludes todays Blog
The list starts at 9:00am and finishes at 13:00 and today would be solely Barium Enemas in Room 1 which has a Flouroscopy tube levaing the General work from the Orthopeadic clinics and M.I.U to be carried out in Room 2.
Their is an Enema trained Radiographer who is assisted by a Senior I grade and together they operate the room, from preparation to screening through to the final plian film images.
The difference with this hopsital is they complete a four view series as a completeion to procedure a Prone Film (Hamptons View), Prone 30, and RAO and LAO Decubitus Views, once these have been completed there will be an additional four imgaes grabbed by Flouroscopy.
These final images are acquired if there has been an area demonstrated of consistent spasm, if there is an area of abnormality, also the final images demonstrate an better view of the caecum with a small amount of air in it.
I was alos told that you know when you have the caecum when you reach the terminal ileum entering the small bowel then move the tube down a little further and the domed area is the caecum, look a little harder and the appendix will become clear. I hope to download an image to demonstrate this later in the blog.
The mornings list continued to include a total of six patients all of varying degrees of condition, as there were two Rdaiographers on duty I was working as the assistant role during each procedure and then completed the final set of images, a role I thought would be very helpful with Third Year assessments looming and one which involves Flouroscopy.
This role did not really teach me anything I did not already know about preparation but I learnt a lot about the imaging, parcticesed the final sequence of plain films and practiced my Image analysis skills, developing methods of remembering where to look and what you are looking at.
After lunch I returned to start work on Orthopadeic Clinics many of the images acquired where for Knees and Spines the majority of patients all had pre-post operative imaging to check the condition of the joints pre-post op.
I spent the reamining three hours developing my techniques on knees and showed the Radiographers here how we do Intercondylar Notch Views at the training placement, Why?? You may ask.. Well I was shown the old fashioned plain film method of a Curved Cassette! Yep an actual cassette that is curvedand its amazing. ive never seen one before and its quite unlikley I'll ever see one again. For those who are interested I'll be posting an image on this blog.
So how does it work? The Curved cassette has a normal flat plate placed in the curve cassette in the dark room, it is then placed under the knee withj the patinet sat up and the image is acuired, the cassette is then taken to the dark room and placed in a flat cassette and placed in the processor, the resultant film is as though it were an adapted technique from a text book.
And that concludes todays Blog
Monday, September 10, 2007
Wednesday 5th September 2007 - High kV its all new to me
Wednesday is Chest Clinic Day
Chest X rays are the firts thing any training student develops until perfection and an image which is not that difficult to achieve using CR! as I found out.
The trust employs a high kV technique on all imaging this is used as higher kV imaging proves to be less aesthetically pleasing but contains a greater diagnostic quality through providing greater penetration.
This technique provides more penetratrion (high kV) with less contrast (low mA)
To compare the exposures with a Chest X-ray;
Training Hospital
Average Male 85kV and 2.5mA
Larger Male 92kV and 3.2mA
Local Hospital employing high kV
Average Male 101kV and 0.80mA
Larger male 107kV and 1.00mA
The use of high kV is difficult to grasp at first and is reliant a little more on Radiographer knowledge of plain film and adapting the exposures rather than the computer doing some of the work for you.
With contsnt supervision exposure to a variety of pataint sizes I was becoming able to judge the pataint size and calculate whether to oncrease or decrease the kV accordingly as well as judging whether to increase the standard 0.80mA with some pataints.
As a demonstration we acquired a diagnostic image using the exposures used on placement and produced a comparable image using the high kV technique, the reasoning behind this became apparent as the image clarity is far better allowing a more diagnostic appearance of any lesions, infections.
The Chest Clinic provided an afternoons work in particular one case involving a patinet who had been suffering with shortness of breath (SOB) and a repetitive chest whheeziness.
The exam requested aroutine PA CXR which was carried out the image demonstrtated that there were abnormalities along the bi-lateral walls of the pleura, this image although diagnostic was a little over exposed and I was aked to repaet the image but decrease the kV by four.
The resulting image demonstrated that the patient had bi-lateral plaques which I was told is indicative of asbestosis a condition which develops in later life if the patient has had repeated exposure to asbestos, the radiograph displays these plaques a dark furring within the bi-pleural lining. This furring is actually a calcification.
I was told to have a look at the image and look for something else abnormal apart from the plaques, there appeared to be a thickening of the vessels at the level of the hila, not knowing what this was I was told it may be a lesion which is associated with asbestosis.
To demonstrate this further I was asked to do a Lateral Chest a new projection in my training, which i had been practicing throughout the day, this is achieved using the bucky and the iontomat.
If a mass is seen in the left lung the patinet is placed with their right side to the bucky, and right sided mass left side to the bucky, and a central chamber selected.
The lateral chest projection confirmed that the patinet had a mass lesion at the site if the hila, this I was told is the start of cancer of the pleura or mesothelima.
As the radiologist was available the films were reported on immediatley and sent to the GP, the most emotiove part of the day was watching whilst the patinet was asked if he had worked with asbestos in the past and the reaction.
Chest X rays are the firts thing any training student develops until perfection and an image which is not that difficult to achieve using CR! as I found out.
The trust employs a high kV technique on all imaging this is used as higher kV imaging proves to be less aesthetically pleasing but contains a greater diagnostic quality through providing greater penetration.
This technique provides more penetratrion (high kV) with less contrast (low mA)
To compare the exposures with a Chest X-ray;
Training Hospital
Average Male 85kV and 2.5mA
Larger Male 92kV and 3.2mA
Local Hospital employing high kV
Average Male 101kV and 0.80mA
Larger male 107kV and 1.00mA
The use of high kV is difficult to grasp at first and is reliant a little more on Radiographer knowledge of plain film and adapting the exposures rather than the computer doing some of the work for you.
With contsnt supervision exposure to a variety of pataint sizes I was becoming able to judge the pataint size and calculate whether to oncrease or decrease the kV accordingly as well as judging whether to increase the standard 0.80mA with some pataints.
As a demonstration we acquired a diagnostic image using the exposures used on placement and produced a comparable image using the high kV technique, the reasoning behind this became apparent as the image clarity is far better allowing a more diagnostic appearance of any lesions, infections.
The Chest Clinic provided an afternoons work in particular one case involving a patinet who had been suffering with shortness of breath (SOB) and a repetitive chest whheeziness.
The exam requested aroutine PA CXR which was carried out the image demonstrtated that there were abnormalities along the bi-lateral walls of the pleura, this image although diagnostic was a little over exposed and I was aked to repaet the image but decrease the kV by four.
The resulting image demonstrated that the patient had bi-lateral plaques which I was told is indicative of asbestosis a condition which develops in later life if the patient has had repeated exposure to asbestos, the radiograph displays these plaques a dark furring within the bi-pleural lining. This furring is actually a calcification.
I was told to have a look at the image and look for something else abnormal apart from the plaques, there appeared to be a thickening of the vessels at the level of the hila, not knowing what this was I was told it may be a lesion which is associated with asbestosis.
To demonstrate this further I was asked to do a Lateral Chest a new projection in my training, which i had been practicing throughout the day, this is achieved using the bucky and the iontomat.
If a mass is seen in the left lung the patinet is placed with their right side to the bucky, and right sided mass left side to the bucky, and a central chamber selected.
The lateral chest projection confirmed that the patinet had a mass lesion at the site if the hila, this I was told is the start of cancer of the pleura or mesothelima.
As the radiologist was available the films were reported on immediatley and sent to the GP, the most emotiove part of the day was watching whilst the patinet was asked if he had worked with asbestos in the past and the reaction.
Tuesday 4th September 2007 NO CR!! How will we cope?
If you forget your markers this stamp must be used!
An image of the Developer and Fixer Tank leading onto the Rollers and Dryer Unit.
Filling up the fixer tank, all done by hand
Here there are five types of cassette
35/43-
30/40 - Lumbar Spine and Thoracic Spine
35/35 - Female Chest and Paediatric and the Hamptons View in a Barium Sequence
24/30 -
18/24
Curved Cassette - more on this to come - amazing!
Hamptons View is now refferred to as the PRONE 30 in a Barium sequence.
As with the standard CR the main cassettes used are those with no descriptions of use next to them, as reference I have listed the uses for those cassettes not used with CR imaging.
Warning!! There are different types of cassette too a T2 is an extremity cassette which is a faster speed and a T8 is an all other parts cassette this is a slower speed. As I have learnt look at the T number, if you use a T8 for an extremity the resultant image is darker, and you may risk having to repeat.
The cassette has a patient details window at the top of it, I soon learnt to always place this at the top as you can cut off vital parts off an image if you dont, an example being the bases of a PA Chest, therefore having to repeat all because of my not thinking. I now understand why we taught about traditional development methods.
With this window being on the left side of the cassette you are not able to use a Left PA marker, as it will be placed over the patients details, therefore a Right PA marker has to be used which is contrary to that taught in our training. This takes some time to get the hang of but has its advantages.
The patient details are labelled to the image plate by using a machine called an "Identification Camera" this device uses a camera (inbuilt) and photographs the barcode on the request slip and then transfers it to the unexposed area on the cassette (the window)
Like CR the image plate is within the cassette holder and is read by a reader within the processor, above the imput slot are the five trays which hold the five types of film, the reader autmatically slects the size of film and transfers the image onto the film.
Once the image plate is read the cassette is pushed back out of the processor and ready for the next patainet, unlike CR this process is time consuming and at this stage the film is still being processed.
Once the cassette is returned the processor produces a hissing noise and produces a lot of noise and heat, another thing I ahve noticed whilst here is the amount you perspire, traditional processors produce an unusual amount of heat, which is very dry and produces an uncomfortable environment in which to work.
After about three minutes wait there is a cracka nd the image appears from the dryer and rests in the tray, the initail feel of the film is warm and sticky as though someone has spilt lemonade over it, compared to CR the images appear try and as though they have been printed on paper.
Thats the end of the developing side of the image, now the dignostic quality is assessed, unlike CR which has the afcility to change the contrast and density, rotate the image, annotate, and label an image with Plain Film what appears is what you get, there is no computer software taht can alter the image.
Once the image is developed it is placed on the light box where the exposure is assessed first Are the contrast and density enough to provide a diagnostic image? with CR they can to a degree by altered in this setting they can not an over exposed or dark image is not diagnostic so there must be a repeat using a lower kV, how lower is something i ahve been told comes with experience but something I think im grasping as the day moves along.
Magnification of an image involves a Magnifying Glass! Yep a Magnifying Glass no image zoom function it relys on traditional methods and to a degree is interesting to see. What happens if you forget your marker? You stamp it on, there is a stamping machine which stamps L or R onto your film, no fancy legends which can be enlarged. And annotations? you write them on with a black pen. It truly is amazing there is so much to think about before, during and after taht after one patient you dont want the next one.
Once the image is complete and finished your still not finished, the films have to be taken to the correct area and only by checking the request slip do you know where to send them next;
GP Patients; Conatct your GP within 5-7 days to arrange an appointment for your results
Orthopeadic Clinics; Pataint returns back to clinic with their films
Outpataints; Contact your GP within 5-7 days to arrange an appointment for your results
Inpataints; Mobile X_rays or walking patiants have their films delivered to the ward after processing
M.I.U/ Casualty; Patients films are placed on the Lightbox in M.I.U for Nurse Practitioners to assess the next course of action.
Developer and Fixer Tanks
The first thing I noticed was the use of plain film using a traditional processor using Fixer, Developer etc.
The large City hopsital uses CR equipment and is basically easy to use, very quick and not noisy.
The large City hopsital uses CR equipment and is basically easy to use, very quick and not noisy.
Here there are five types of cassette
35/43-
30/40 - Lumbar Spine and Thoracic Spine
35/35 - Female Chest and Paediatric and the Hamptons View in a Barium Sequence
24/30 -
18/24
Curved Cassette - more on this to come - amazing!
Hamptons View is now refferred to as the PRONE 30 in a Barium sequence.
As with the standard CR the main cassettes used are those with no descriptions of use next to them, as reference I have listed the uses for those cassettes not used with CR imaging.
Warning!! There are different types of cassette too a T2 is an extremity cassette which is a faster speed and a T8 is an all other parts cassette this is a slower speed. As I have learnt look at the T number, if you use a T8 for an extremity the resultant image is darker, and you may risk having to repeat.
The cassette has a patient details window at the top of it, I soon learnt to always place this at the top as you can cut off vital parts off an image if you dont, an example being the bases of a PA Chest, therefore having to repeat all because of my not thinking. I now understand why we taught about traditional development methods.
With this window being on the left side of the cassette you are not able to use a Left PA marker, as it will be placed over the patients details, therefore a Right PA marker has to be used which is contrary to that taught in our training. This takes some time to get the hang of but has its advantages.
The patient details are labelled to the image plate by using a machine called an "Identification Camera" this device uses a camera (inbuilt) and photographs the barcode on the request slip and then transfers it to the unexposed area on the cassette (the window)
Like CR the image plate is within the cassette holder and is read by a reader within the processor, above the imput slot are the five trays which hold the five types of film, the reader autmatically slects the size of film and transfers the image onto the film.
Once the image plate is read the cassette is pushed back out of the processor and ready for the next patainet, unlike CR this process is time consuming and at this stage the film is still being processed.
Once the cassette is returned the processor produces a hissing noise and produces a lot of noise and heat, another thing I ahve noticed whilst here is the amount you perspire, traditional processors produce an unusual amount of heat, which is very dry and produces an uncomfortable environment in which to work.
After about three minutes wait there is a cracka nd the image appears from the dryer and rests in the tray, the initail feel of the film is warm and sticky as though someone has spilt lemonade over it, compared to CR the images appear try and as though they have been printed on paper.
Thats the end of the developing side of the image, now the dignostic quality is assessed, unlike CR which has the afcility to change the contrast and density, rotate the image, annotate, and label an image with Plain Film what appears is what you get, there is no computer software taht can alter the image.
Once the image is developed it is placed on the light box where the exposure is assessed first Are the contrast and density enough to provide a diagnostic image? with CR they can to a degree by altered in this setting they can not an over exposed or dark image is not diagnostic so there must be a repeat using a lower kV, how lower is something i ahve been told comes with experience but something I think im grasping as the day moves along.
Magnification of an image involves a Magnifying Glass! Yep a Magnifying Glass no image zoom function it relys on traditional methods and to a degree is interesting to see. What happens if you forget your marker? You stamp it on, there is a stamping machine which stamps L or R onto your film, no fancy legends which can be enlarged. And annotations? you write them on with a black pen. It truly is amazing there is so much to think about before, during and after taht after one patient you dont want the next one.
Once the image is complete and finished your still not finished, the films have to be taken to the correct area and only by checking the request slip do you know where to send them next;
GP Patients; Conatct your GP within 5-7 days to arrange an appointment for your results
Orthopeadic Clinics; Pataint returns back to clinic with their films
Outpataints; Contact your GP within 5-7 days to arrange an appointment for your results
Inpataints; Mobile X_rays or walking patiants have their films delivered to the ward after processing
M.I.U/ Casualty; Patients films are placed on the Lightbox in M.I.U for Nurse Practitioners to assess the next course of action.
If a fracture is seen then a red dot (actual red dot) is placed on the film and sent across. Its not uncommon to be asked to explian the fracture to them as they have to ring the details through to a large City Hopsital fracture clinic before reffering the patinets on. the films must always be booked out if this is the case.
This has been a lurning curve and a real eye opener into a realm of radiography without the technology which most of us myself included have taken for granted for the previous two years.
This in my view places a greater emphasis on the need to get it right first time and to strive for a perfect image with correct annotations and exposures and that using this traditional method can only help to improve my acquisition and disgnostic skills.
This has been a lurning curve and a real eye opener into a realm of radiography without the technology which most of us myself included have taken for granted for the previous two years.
This in my view places a greater emphasis on the need to get it right first time and to strive for a perfect image with correct annotations and exposures and that using this traditional method can only help to improve my acquisition and disgnostic skills.
The Video below demonstrates the procedure from labelling the cassette in the identofication camera, the cassette being placed into the processor and the resultant image appearing to be being placed on a light box.
Monday 3rd September - Admin Day
A picture of the filing room in this room there are seven years of film packets.Having trained at a large City Hospital ive begun to think that we have got it easy, of course the volume of patients appear to be much higher (or is it?) and the workload appears relentless.
In the small community environment the demands on the radiographer and student seem to be far greater than those placed on the role in alarge City Hospital.
The first biggest difference has been highlighted today and that is dreaded administration role, which is not done in the larger hospitals by radiographers but by administration staff, the following blog will go some way to decifer how admin tasks are a part of the daily routine for those radiographers in a community setting.
P.A.S
Patients who are new to the hospital whether thatbe new to the area, toursits or visting clinics must be loacted on the P.A.S (Patient Administration System), this is a nationwide system which holds the details of any patient who has had any involvement with the National Health Service. In this setting it is used to obtain a patient number and the pataints NHS number.
CRIS (OLD)
This is an old version of the new CRIS system which is used in both types of clinic setting, in this hospital the old version is used to obtain the patients last attendance in this hospital before 2007, this will aid in the rerieving of film packets from storage.
CRIS (NEW)
This version is updated for 2007 and is used to access reports, write reports, previous history, and more importantaly to generate patient labels which are used on the request slips to place in a identification camera to labele the cassette, (more will be explianed regarding this later in the blog).
This software is also used to record patient exam type and dose, something I have noticed here is the different codes used here a code for a Chest X Ray carries the code XCXR, the city hospital has a code CXR, both sites record the dose although here an accumulative dose is recorded and not a dose per image.
Film Retrieval
As this site does not have PACS implemented the retrieval of previous images is done manually by the Radiographer, thsi is done by entering the CRIS number in the old system and finding out when the patinet last had an image e.g 2005 this year corresponds to a yellow barcode.
This code will be found in safe storage, the patints packet is located by birthday. Therefore you would look for previous films by going to the yellow barcoded packets and the pataints birthday.
In the small community environment the demands on the radiographer and student seem to be far greater than those placed on the role in alarge City Hospital.
The first biggest difference has been highlighted today and that is dreaded administration role, which is not done in the larger hospitals by radiographers but by administration staff, the following blog will go some way to decifer how admin tasks are a part of the daily routine for those radiographers in a community setting.
P.A.S
Patients who are new to the hospital whether thatbe new to the area, toursits or visting clinics must be loacted on the P.A.S (Patient Administration System), this is a nationwide system which holds the details of any patient who has had any involvement with the National Health Service. In this setting it is used to obtain a patient number and the pataints NHS number.
CRIS (OLD)
This is an old version of the new CRIS system which is used in both types of clinic setting, in this hospital the old version is used to obtain the patients last attendance in this hospital before 2007, this will aid in the rerieving of film packets from storage.
CRIS (NEW)
This version is updated for 2007 and is used to access reports, write reports, previous history, and more importantaly to generate patient labels which are used on the request slips to place in a identification camera to labele the cassette, (more will be explianed regarding this later in the blog).
This software is also used to record patient exam type and dose, something I have noticed here is the different codes used here a code for a Chest X Ray carries the code XCXR, the city hospital has a code CXR, both sites record the dose although here an accumulative dose is recorded and not a dose per image.
Film Retrieval
As this site does not have PACS implemented the retrieval of previous images is done manually by the Radiographer, thsi is done by entering the CRIS number in the old system and finding out when the patinet last had an image e.g 2005 this year corresponds to a yellow barcode.
This code will be found in safe storage, the patints packet is located by birthday. Therefore you would look for previous films by going to the yellow barcoded packets and the pataints birthday.
Once the films are retrieved they are brought to department and have the attendance year changed to a 2007 barcode colour which is silver as this is their latest image and will be filied accordingly.
The films are placed on top of the packet and placed on the Radiologists pile of work for reporting, another difference is the availability to a Radiologist as they only report from here twice weekly on the spot decisions are rarley made unless a GP from alocal practice is able to have a look at the images. Obvious Fractures for instance go straight to the fracture clinic at the neighbouring City Hospital.
Once the Radiologist has reported the film on a tape they are typed up by the Radiographer onto new CRIS and a report is printed of the radiologists findings, these are then placed in a patient information booklet along with the request slip, a copy of the findings are printed and posted to the pataints GP.
The films are placed in the fiilm packet along with the reports and request slip and the packet is then filed away.
Additionally there is the answering of the phone, in a city setting you only verbal conatct with the public is that of face to face , here you are required to answer the telephone.
The usual calls are those from pataints wanting to book an appointment for Ultrasound, Plain Film or questioning the time of an appointment.
The booking system is quite unique for plain film as the patrinets can pre-book appointments which suit thier time or call in at the department, and are advised that by doing this there may be a delay. M.I.U appointments take priority as there is a time limit on these pataints in line with teh patiants charter.
Ultarsound is alos pre-booked with teh Radiologist or a Sonographer who deals with the Pregnancy scans.
Diaries are used to check availability and make an appointment which are then keyed onto an online diary system.
All in all its quite a difference and thats only the admin side of radiography
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