Last One!!

Just thought I'd share one last set of images from a patient I scanned....

This patient is suffering from ischemic bowel disease. This is the first time I had ever seen anything like it. The radiologist I spoke with about the exam said that this patient would not live much longer... due to HIPAA, I didn't go snooping to find out what actually happened to him but once again, it's hard to walk back into a room and speak to a patient knowing that something is really really wrong with them.

On a better note, for the first time last week I scanned the abdomen/pelvis of a 56 day old baby. Earlier in the week I had done this same baby's chest x-ray and his symptoms included a fever of unknown origin, lack of appetite, and constant fussiness. The patient apparently had had a KUB done earlier in the day and it was suspected that he had a small bowel obstruction. The patient was to receive IV and oral contrast. He drank 4 oz. of oral contrast on the floor and then I gave him a little more through a bottle when he arrived in the department. I spoke with the radiologist before beginning the exam and it was decided to do one scan straight through about 60 seconds after injected of IV contrast. No delay kidneys to save the patient from excess radiation.

So, after the patient took the bottle with oral contrast, I did the scout images and then injected 9mL of contrast through a 24 gauge in the left side of the patient's skull! I was extremely nervous about this but everything went really well. The mother and grandmother did an excellent job of keeping the patient still and it went off without a hitch. Our head radiologist even came out to tell me how good of a job I did! All in all a great scan!

Hope everyone has had a great summer! I am so glad to be finished with school!!! Woo hoo!

This Week

Yesterday I worked dayshift in CT which is a totally different experience from 2nd shift. For one thing, there are at least 4 techs there during the days whereas on 2nd shift there are only 2. This makes such a huge difference! It's nice to be able to finish an exam, get all your paperwork completed and get the study sent to the radiologist without having to worry about taking care of the next patient to come in the room. Overall it was a very good day! My patients were great, no one complained and I got to take a real 30 minute lunch break... not eat my food while sitting at the scanner! It was awesome!

Which was great compared to last Tuesday when the two of us techs plus the tech aide that was there between 3-11 never got to eat at all! We were so super busy, a scanner was down due to PM's and it was just a mad house!

This past Monday was also interesting.... Due to an upgrade to Synapse, we had to print out dictation forms, print previous reports and take them to the radiologist to be read... thankfully we have a test environment so our studies could still be looked at digitally but the whole running up and down the hallway every time something needed to be read got old really quickly! It's funny how fast we get spoiled to being completely digital... I remember when every exam had to be taken to the radiologist to be read and we had to sit in the reading room to take reports for stat exams! On top of all the extra hassle, the Lanier dictation system went down in the ER reading room so everything had to be moved to the MRI reading room in order for the doctor to have access to anything! It was crazy!

All in all, I'll be glad when this week is over!! Too bad I have to work the weekend though!

This Week-PE's!!

Well, thanks to someone being off due to a back injury, I am working 3 or 4 days per week down in CT... this could not have come at a better time for me clinical wise!

I saw an interesting case this week that I wanted to share! We do A LOT of chest angios and they always seem to come in spurts... we never just do one, we do 15 in a day. I have been working in CT for just over a year now and for the first time I was able to diagnose a PE on my own. I was doing the oblique reformats that are part of our protocol and there they were!! The patient didn't have just one but multiple, bilateral PE's! Here are some of the reformatted images that I did:

I was really proud of myself for being able to identify the PE's on my own. I feel bad that the patient is obviously sick but I was almost giddy! That sounds awful doesn't it?

Of course this was the same day that I did another PE study on a 37 week pregnant patient, totally missed the bolus and ended up with a mediocre study at best. I got chewed out by the radiologist but there was absolutely nothing I could do. I waited an extra MAYBE 2 seconds to start my tracker image to spare the patient and her baby a little radiation, and apparently that was long enough for the contrast to all ready be making her aorta nice and bright. The study was read as "no gross PE" but a limited exam. I feel awful about it still and that was 4 days ago!

This is the end of a really really long stretch of work. Today is my first day off since the Sunday before last and boy do I need it! 3 whole days off sounds like a great treat to me right now!

It's Been a While...

Wow, time flies, I hadn't realized that I haven't written anything on here in like a month. Things have been super busy for me lately.

CT wise it's been interesting at OMHS... We are testing out a new protocol for patient's with Crohn's, among other disorders which I can't remember right now where we inject the contrast at 4 mL/sec as opposed to 2 mL/sec like a normal. I'm still not sure the purpose of this as I have yet to do one but according to our medical director it makes a "huge" difference! Oh well, I don't pretend to understand why our protocols change so much... it's better just to go with the flow!

We're having trouble with one of our scanners causing artifact on all head scans. This has been an intermittent problem with this same scanner ever since we got it. What's weird is that it always seems to show up after we get a software upgrade. Also strange is that our other scanner which is exactly the same as the one with the artifact only 2 year newer has never had this issue. Supposedly it's fixed now but two weeks of only being able to do head scans on one scanner was getting really really old!

I haven't had any interesting cases lately... I did do another head angio (ICK!!!!) the other night. I was not proud of it at all. Ever since my bad experience with setting an ROI in the ascending aorta I do a manual scan where I watch the carotids blush and most of the time this works out well for me. Well this time for whatever reason when I hit "next scan" there was like a 5 second delay. Well as those of you that do CT know, this is a huge deal when it comes to angios, especially head angios! I still hate them... I would rather do just about any other exam! Other than one that involved rectal contrast I guess!!

Summer Clinicals

Wow, it's hard to believe this is my last semester!! I'll officially have my Bachelor's Degree in August!

In other news, my husband and I are expecting our first baby in October! School really couldn't be ending at a better time!! I am so glad I decided to do this.

Things in CT at OMHS are pretty much the same. I am still working 1 or 2 days a week in CT and spending the rest of my time in x-ray. I think that's pretty much how I would like for it to stay!

Anyway, I recently saw a very interesting case, that's what the images above are from. I had a patient come in who was complaining of pain in her left pelvic area. No symptoms other than that. When I was getting the patient's history she told me that she had just had an ultrasound in which they had found a cyst on her right ovary. Well, I didn't think anything about it since this is fairly common for most women. I did her scan, abdomen/pelvis with, and sent her back to the ER. As I was looking over the scan before sending it to the doctor I was surprised by what I saw, the cyst was taking up almost her entire pelvic cavity and her bladder was completely compressed by it. I have never seen anything like it. I can't remember the reading exactly but the gist was that it was way too big to be a simple cyst and was probably some sort of neoplasm. I found out later that week that the patient ended up having a completely hysterectomy the next day. Crazy! I just hope that she's okay!

Well, hope clinicals are going well for everyone else! I have another cool case that I want to get some images of on here but I haven't gotten the chance to do it yet. I'll save it for next time!

It's Been a While... again!

Suffice it to say that it's been a pretty interesting past few weeks for me. My CT time has been a little limited but I have managed to have some interesting experiences.

It all started when one of our machines (we have two Toshiba Acquilion 64 slice) blew it's tube! That made for an interesting night! Especially when the next day, the other machine went down for some odd reason and we had no scanner whatsoever. ER patients were being taken next door to our outpatient facility that has a machine that most of us have never used, myself included! One of our ER doctors in particular was having an absolute fit over the situation and I heard him yelling and complaining about it to anyone who would listen for over two hours! Because it was our fault you know!

Anyway, once the tube was replaced in one scanner and the other was up and running again, I had an interesting experience while doing a chest angio on a woman who was approximately 29 years old. Everything was going fine, she had great IV access and I was having no problems. I did both of my scout pictures and when I FINALLY found her pulmonaries after about 6 sure exposure pictures, my dot for my ROI was nowhere to be found!! I had no idea what to do. I tried everything I could think of. Absolutely everything. I called three different techs, only managing to get ahold of the 3rd one I tried, and found out that I was pretty much on my own and would have to manually watch the contrast in her pulmonaries and start the scan based on my own judgement. My hand were shaking so bad as I did her test injection and then as I started her contrast. Luckily, the patient was young and her body cooperated with me. Her pulmonaries lit up nice and bright, I hit the scan button, and everything was beautiful!! I have never ever had to do that before! It just goes to show me how spoiled that scanner has us all!!

The other interesting experience I had was on this past Friday night. A two year old girl had fallen approximately 5 feet from the top of a slide and was having severe pain any time her parents tried to pick her up. The ER physician had ordered a head and c-spine without and then a chest, abdomen, pelvis with IV only. Of course we're all dreading getting this patient because it's hard enough to just do a head on a child this age, let alone give them contrast and try to get them to hold still long enough for a scan of their entire body! Well the patient was great!! She was of course scared to death, but I had the mom lay on the scanning couch with her for the head and c-spine which seemed to help, and then we spun the patient around so she was feet first in the scanner and could easily see both her parent for the C/A/P scan. The patient's weight was 25 pounds so I hand injected 20mL of contrast and we started the scan. There was a little bit of respiratory motion because of course, a two year old is not going to hold her breath, but other than that we got a great scan! I didn't get to see the report because when we finished it was time for me to go home but I am interested to see if anything was wrong with her.

Bad Week

So due to a lot of people being out sick lately I've gotten a lot of time in Cat Scan. Though I have to say it has not all been good! For three days in a row I had major problems. The first day, a patient threw up all over me, the next day, contrast exploded in my face and hair, and then the day after that, as I was scanning a patient and their IV pulled completely out of their arm and contrast spewed all over the patient, the scanner, the room and me. After all of that I told the other girl I was working with that I was DONE with contrast of any type because I was tired of going home with half of it on my person!!!

I haven't really seen any interesting cases lately. Just your usual abdomen/pelvis and heads. Though on one good note, I did do another head angio by myself and it turned out great!! Still doesn't mean I like them though!!