Radiology- March 6th, 2015

Report

What were your responsibilities or duties this week? 
  My responsibilities included being professional and observing the radiologist I was following. I was to be respectful and considerate to the staff and patients.
What new knowledge or skill did you learn this week?
   I observed a lumbar myelogram with full explanation as to how you can tell the fluid is working, the differences in spinal procedures, and how pain correlates with finding the right entry in the spine. I also got to see the procedure for a chest x-ray.
What was the best thing that happened at the unpaid work-based learning site this week?
   I loved that the lumbar myelogram was explained to me as the procedure went on. I was able to get tons of notes on the procedure and I wasn't as confused on why things were happening.
What was the worst thing that happened at the unpaid work-based learning site this week?
   The only complaint I would have is that the chest x-ray wasn't really explained to me, but I mean it was self explanatory. There was few acronyms that I didn't get, but I wrote them down to look up later.
If the "worst" was a mistake, how was it corrected?
   I should have asked questions after the X-ray was over, but I think the writing down of terms I didn't know was pretty useful. I couldn't do much due to the privacy of the patient. 
This week was GOOD. Why?
    Radiology got me thinking and got me interested. I thought the X-rays were so interesting and there wasn't really much down time when I was there which I enjoyed; gave me more time to observe. Also, it was nice to have something explained rather than just stated to you like some of the other rotations.

Record

Technology observed: I saw the computer where the X-rays would come up. Also, I observed the camera that they use to do the imaging along with the special table/bed where the patients lays; it tilts up and down and in all sorts of directions for the purpose of effective imaging. I didn't ask for any of the names of the technology, which I'm not punching myself in the face for.

Diagnostic procedures observed: When evaluating the patient, the doctor checked the previous CTs to make sure he was entering the spine at the correct point. The patient had an extreme narrowing in this L3 and L4, causing the route to injected the contrast for the CT so the spine really shows up and isn't as vague. 
Therapeutic procedures observed: During the chest X-ray, the radiologist acted as if she had known the patient for years. She was so kind and sweet and supportive to the patient, and then in the myelogram comfort was always one of the main concerns of the radiologist during the procedure.
Diseases/disorders observed: The narrowing of a the spine in the lumbar section on an elderly patient was the main disorder observed. The chest x-ray was taken for a woman with almost deformed looking lungs; could have been an smoker, but the lungs didn't look in too great of condition. 
Medical terminology/abbreviations encountered: Myelo-  any part of the spine, and always entered through lumbar. 
BE- barium enema
IVP- intravenous pyelogram
UGI-upper gastrointestinal 
MRI-magnetic resonance imaging

Journal

   Imaging is dark. The lights are dimmed and there are maybe 4 computers open that aren't in the 4 screening labs, with two of the radiologists in there; both women. The radiology department does a lot of the screening including X-rays. Special cameras, tables that are able to tilt, PPE, sterile gloves/syringes/masks, and previous testing results are used. All the stations are extremely dark which I'm guessing because of the harsh light and special cameras they use. The doctor was in a gown, mask, gloves, goggles- the whole 9 yards of PPE and the nurses were just in scrubs. Probably because they weren't directly touching the patient in any way, other than in the chest x-ray where she was turning the lady because the patient was unable to do so on her own. 
   Communication skills between the imaging nurse and the doctor were frequent and efficient due to the nurse being in control of how the doctor views the spine and the body. During the Myelogram, the doctor was fully gowned because of harsh lights and possibility of spinal fluid coming out of the tube being entered into the lumbar while injecting contrast. The nurse had the man on his side because it was painful to be on his stomach for a long period of time while the nurse in the chest x-ray had to physical turn and help the patient because she was unable to stand against the camera without getting weak in the knees. 2nd hand opinion was used during the myelogram; the doctor was super sketchy about how he was going to inject the fluid into the spine due to how small of an opening was (narrowing). 
   During myelograms of any sort, personnel always go through the lumbar part of the spine. If it's the cervical portion of the spine, the doctor will inject the fluid into the neck then tilt the table forward so the fluid runs to where it needs to be. Also, I thought it was really weird that the staff used just a pair of surgical scissors for alignment and the numbing medicine they use is the same as the one you receive at the dentist. When the doctor started the myelogram, it looked like he was just poking a needle into the patients spine and the patient started complaining about a shooting pain in his right leg, signaling that the doctor had hit a nerve. I learned that if spinal fluid comes out of the syringe then you're in the spinal canal. The patient also had to be moved during the procedure because he was too far up the table when trying to tilt him and then the doctor had to stop. Something to do with how narrow the spine was and how he was now pushing into L5; stenosis essentially. Most of the problems during the procedure had to do with flow and narrowing, but nerve endings and spinal fluid not coming out also became a problem.
   I loved imaging because of how most of the procedure was explained to me and how the nurses were willing to teach. You don't get that a lot in the hospital, which is kind of disappointing. It allowed me to view what the staff does on a daily basis while also getting a close view of procedures going wrong. The nurse seemed pretty impressed with the amount of notes I had taken and they were all really laid back. I gained a lot of new medical terminology and insight on the profession while I was there, along with getting a good understanding of why things are done during procedures which kept me interested. I would love to go back and view what else imaging does; the rotation got me very curious in the profession.