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!!

My Week

Well, I didn't get a whole lot of time in CT this week and therefore didn't really see anything of great interest. I am amazed however, at how much more comfortable I am getting when working down there! For instance, I had a trauma patient last night that had a head and c-spine without and a chest/abdomen/pelvis with IV only. A few months ago I would have scared been to death to be doing it on my own but it turned out really well! Though I did see an odd mass like thing (can't think of a better word to describe it) surrounding the right kidney. I never got a chance to check the report but I'm definitely going to follow up and find out what it was!

Last week I had to do a stat AIF which was pretty interesting. The patient was 4 days post op from a left hip pinning and had diminished pulses in his left leg, the nurse was barely able to find a pulse in his foot even when using a doppler! I did the study which I thought looked a little odd and come to find out the next day after reconstructions he had almost no blood flow to his lower legs! It was a very stressful situation all around because the ordering doctor was calling and yelling because it wasn't getting done quickly enough for his liking, we were down to one scanner thanks to PM's on our other one, and it took almost 30 minutes for all of my images to cross over to synapse! I was very glad to be finished with it!

Hopefully this coming week some more interesting things will happen!

First Week of Clinicals

This week has flown by for me! We were extremely busy in Cat Scan every night this week and while I can't seem to remember all the cool stuff I saw, one thing sticks out in my mind.

An order for an abdomen/pelvis with contrast on a 70 something year old woman complaining of abdominal pain came across and upon taking the patient's history, I found out that she had a history of breast cancer with a left mastectomy. At the time I didn't think to ask her how long she had been cancer free but now I wish I had. Anyway, I scanned the patient and was very dismayed to see her liver. It was absolutely eaten up with what looked like mets. It was so awful to walk back into the scan room and talk to the patient like absolutely nothing was wrong. I checked the report later that night and according to the Rad, there were too many spots to even count them correctly and they were HUGE. I have never seen mets this bad before. But that wasn't even the worse part, aside from the liver, there was also question of pancreatic and uterine masses in this patient. This all happened on Wednesday night and I found out on Thursday afternoon that this same patient was scheduled for a liver biopsy the next day. I feel so horrible for that patient and her family.

I have to say that's the worst part about this job. At least I know I got a good scan and hopefully made that patient feel as comfortable as possible.

Wow

I honestly can't believe that the semester is almost over!! It seems like I just got started!!

So I've been working dayshift in CT this whole week and I'm feeling pretty good about things. The more I work, the more confidence I gain. (Duh!) Yesterday I got to do an AIF which is something that I hadn't done in probably 3 months (at least) and I remembered everything I needed to do and had a great study! Earlier in the week I did a dreaded head angio and got a compliment from the vitrea tech who does the reconstructions about how great it was! Yay me!! Today I got to do a chest angio which I think is probably my favorite exam. It's the only angio study that we get to reconstruct ourselves and I love to do it!! All the other angios are sent to the vitrea and there are only 4 people in our department trained on that equipment. Thanks goodness I'm not one of them!

We also have a new protocol that started this week concerning a soft tissue neck with contrast. We are supposed to start the scan above the ear and end it at approx. the level of the carina. Well, when I trained in CT over the summer the protocol was that the scan ended at the sternal notch. I will remember that for the rest of my days because the very first soft tissue neck I did, I did not get all the way to the sternal notch, a fact which the two techs supervising me did not notice, and our head radiologist called to point it out to me. I was so embarassed and wanted to crawl in a hole. You would have to know and work with this doctor in order to understand just how small and insignificant he can make you feel! Though technically it wasn't my fault since at the time I didn't really know what I was doing anyway! Anyway, back to the new protocol, I did a neck with contrast today and luckily just happened to get down far enough because I thought I only had to go to the sternal notch! Sternal notch is forever drilled into my head and it's gonna be hard to change! Oh well... live and learn I guess! The study was beautiful though!

I am loving dayshift because there is such a huge variety of exams being done. It seems like the last few times I worked in CT on seconds that all I ever did was stone protocols and heads! Not that I mind those, just gets a little monotonous sometimes!

Well, hope everyone has had a great semester!!! Merry Christmas and Happy Holidays!!

Dayshift!!! Yay!!

So I just found out yesterday that for the next month or so I'm going to be working some dayshift!!! Yay!! I'm a full time second shifter but thanks to someone on first shift having surgery I get to fill in AND be in CT full time!! Well, for a little while anyway!! I don't care though... I'll take what I can get! And I'll get to finish up my clinical time without having to stay late!

By the way, I ROCKED a head angio tonight!! They still make me super nervous and I almost threw up after I finished it but everything turned out great!! I'm getting more and more confident which is great! I still sometimes feel like I have mush for brains when I leave work because I'm thinking so much!! But it's great... I'm really glad I let my supervisor talk me into cross training!

Not too exciting...

So it's been a while since I've posted anything new and that's only because I haven't done anything too interesting in quite some time. I did have a patient that I had to chase down through the hospital and into the parking lot because his IV had not been removed! It was pretty interesting to say the least!

It seems like the only exams I've done in the past few weeks or so are heads and abdomens! I had just gotten really comfortable with chest angios and now it's probably been a month since I've done one! Oh well. I'm getting ready to get a lot of time down there because the regular 2nd shift CT tech is going on vacation and I'm filling in for her. Yay! Sometimes I feel like I'm going to drive someone crazy asking a million questions but I guess I would rather do that than screw something up!

I'll write again soon when I have more interesting things to talk about!

Head Angios

Okay, so I'm not sure how everyone else feels about them, but basically, I LOATHE head angios. I know, I know, they are a relatively short exam to performed but for some reason, I just don't like them. Here's my reasoning behind this.

Two weeks ago on a Friday night, it's about 10 p.m., almost time for me to go home and a Head Angio pops up. Okay, so I haven't done one of these since I was still in training which had been more than two months prior to this night. Well, I got the patient, started the exam, everything was fine. I don't know how everyone else was trained but I was taught to set my ROI tracker in the ascending aorta and set my HU to 120 and let the scan start on it's own when the contrast reaches this point. Well, I did this and for some reason, I don't know if it was because the woman was absolutely tiny or what the but tracker actually read some streak artifact from the contrast that I think was actually in the vena cava and started the scan waaaaaayyyyy too early. There was absolutely no contrast whatsoever anywhere in the brain. The only thing I could do was restart the scan. There was probably about a 15 second timespan between the end of the first scan and the start of the second one but it was enough that the entire scan was contaminated. I was very disappointed. Though I didn't receive a call from the radiologist and the girl who did the recons the next day said it was fine. I was still mad because it wasn't an ideal scan. Oh well.

So, needless to say after that experience, I was none to keen on doing any head angio that popped up. Well, low and behold, Tuesday night an ER doctor orders one!! EEEKKK!! I had the other CT tech that was with me, who I graduated from x-ray school with, show me how she does them. Instead of using the tracker system, she sets the ROI between C3-C4 and watches for the internal carotids to blush. Once this happens, you manually start the scan. So this is what I did and after a few seconds of panic when I didn't see the blush as quickly as I thought I should, I got a beautiful scan! Yay!!

I still hate them though!! About the only angio study I feel fairly secure in doing is a chest!! I guess that just comes with time!

This Week

I saw something I'd never seen before last night and thought it was worth mentioning. I went to get a patient for a chest without last night. It was ordered on a 30 something year old woman in the ER who hadn't even had a chest x-ray yet so I was a little curious as to why we were doing the exam in the first place. Her history only said shortness of breath. I don't know how it is at other facilities but MOST of the time at ours, a chest x-ray is the first step. Well, it turns out the exam was actually ordered on the wrong person! This happens at least once a day in our ER and we techs spend a lot of extra time hunting down correct patients and orders!

Anyway, it turns out the exam was actually supposed to be ordered on a 50 something year old man who was complaining of pain in the center of his chest. He had in fact had a chest x-ray prior to the ordering of the CT and the report mentioned a peritracheal and hilar fullness and recommended a CT chest with contrast. It turns out the patient was allergic to contrast! When I finally got the correct patient scanned I saw a pericardial effusion! It looked huge to me!! I have never seen one before! The CT report stated that it should be checked again in 3 months so I assume it wasn't too bad... but I think that explains why the patient's chest was hurting so much!

Can't believe September is almost over!

Well, I can't believe it's fall and September is almost over! How did everyone survive the windstorm? We had several HUGE branches fall in our driveway and on our garage but didn't sustain any major damage. We were without power for 72 hours though! I tell ya, you don't realize how much you take electricity for granted until you don't have it anymore!

Nothing very exciting has been happening in CT as of late. I got more time down there than usual this week, x-ray, for once, was well staffed and I got to spend a whole extra night down there making three days this week instead of just two! Yay! Though it seemed like the whole night was nothing but routine heads and of course the token really intoxicated guy who gave us all a good laugh!

The one really interesting case I did see took the form of a kiddo that was less than 2 years old. He had a huge mass on the side of his neck that was red and really horrible looking. A soft tissue neck with contrast was ordered and after 3 failed IV's and two trips back and forth between CT and the ER, I finally managed, with the nurse applying pressure to the IV, to hand inject 10 mL of contrast. The scan of course wasn't that great but it was enough to determine the mass was either an abscess or swollen/infected gland. Let me tell you I have never seen anything like it!! The knot was almost as big as the baby's head!

I have also been very frustrated lately about the fact that some patients don't feel it is their responsibility to inform health care professionals of their entire medical history. I personally feel that if I was allergic to CT contrast, and had horrible reactions to it, that I would let my doctor know as soon as I was told the exam I was going down for. Maybe that's just me though! I can't tell you how many people come down for exams, Chest Angios in particular it seems, that end up having to have a Lung Scan done instead. It just seems to me that a lot of time and trouble could be saved if perhaps the ordering physicans would ask about contrast allergies before ordering exams! Oh well.

Another gripe (I have quite a few this week) is that no matter what, it seems like nurses will argue with you about the size/location of IV's needed in order to power inject. I feel like a need to make a gigantic, neon, flashing sign! Though for some reason, I still feel like that wouldn't be enough! I really sometimes want to tell them we aren't arguing just for the sake of arguing, it's how things have to be done!

Well, I guess that's all for now. Hope everyone is having a great Fall so far!!

What a night!!!

Wow! Last night was a killer!! We were absolutely slammed from the time I walked in at 3:00 until I left (an hour late) at midnight! I worked most of the night in x-ray but did get in a few hours of time down in CT so I would mention the interesting case I saw.

I'm not sure how much we're allowed to say on here because of HIPAA and everything so I won't mention the circumstances surrounding this patient's injuries, but I got to see something I'd never seen before. The patient's orders were pretty routine... I guess you'd call it our "trauma panel", a head and c-spine without and a Chest, Abdomen, and Pelvis with. I did the head and c-spine with no problem and as I was watching my CAP images come up so I could do delays, something caught my attention. I don't know how other scanners are, but after our scans are finished the images flash by at the top of the screen and something funny in the liver caught my attention. I wasn't really sure what I was seeing, though to me it kinda resembled how atrophy looks in the brain. Well I called the other tech (who's been doing CT for about 8 years now) over to take a look and it turns out it was a lacerated liver! Pretty cool! Well, not for the patient I guess but definitely something I'd never seen before.

I'm back in CT tonight so we'll see if anything interesting happens!!

Let Me Introduce Myself...

Hi, my name is Brandy Johnson and I am starting my first semester here at USI. I graduated from Owensboro Community and Technical College's Radiography Program in May of 2006. I started working at Owensboro Medical Health System in 2005 as a Tech Aide in the Radiology department and was offered a full time job as a Rad Tech right before graduation.

I currently work 2nd shift and just completed cross training in Cat Scan. I have to say I like it so much more than I thought I would! Cat Scan is a completely different world than regular x-ray. It took me completely out of my comfort zone and threw me headfirst into a whirlwind of new information. For the first few weeks I was afraid my head was going to explode from everything I was learning! I feel pretty confident with most exams but I have to say Chest Angios still make my hands shake!! It's so great though because I feel like everyday I'm learning something new!

Now, some more about me... I've been married to my husband David now for two years. We have a black lab named Zoey who we treat like our baby. We bought our first house here in Owensboro almost a year ago and like to spend our free time hanging out with friends and family including our 7 nephews!! We also like to do home improvement projects, the next of which is going to be putting tile down on our bathroom floor! I say "we" but mostly it will be David doing the work!

Anyway, enough blabbering for now. I'm looking forward to getting started this semester and want to wish everyone the best of luck!