Smile for Second Year!

How I currently feel in specialised modality departments.

Stardate: 92458.79

I realise it's been a while since I posted anything, but I've been ridiculously busy, so I decided to wait until my first block of second year placement as a student radiographer had begun before making anything worthwhile reading... that and I've been using precious hours as nap time...

The first set of lectures were just a bombardment of anatomy, and believe me when I say we learn a good deal more than just bones! Thankfully, it's my strong subject, but alongside Anatomy is Imaging Science (or Physics), Imaging Technique and Research Methods (queue the 'Psycho' theme). I've suddenly realised that my home away from home is the Healthcare Library, and copious note-making (seriously, it's ridiculous how tall my pile of notes is) accompanied by rivers of green tea is helpful. And as that wasn't challenging me enough, attending four martial arts classes a week while being captain of the university Taekwondo club certainly assured I learned to appreciate weekends in a whole new light. I've forgotten what sleep is.... again. 

This year, I'm in a completely different Trust for placement, so aside from getting used to new radiographers, specialised modality departments (such as CT), different shift times and learning which direction I'm supposed to be going in, I've also had to brush off the cobwebs cluttering my radiographically-trained brain in order to not look completely useless!

For my first week, I was placed in Vascular, which involves angiography, an imaging technique that visualises the blood vessels using contrast agents. You also get to live in scrubs for a week. One of the examinations I saw this week was a cerebral angiogram (within the brain's vessels), that displayed 6 aneurysms in the patient's brain. These were treated with endovascular coiling, which involves inserting a guided catheter (small wire) into the femoral artery (in the thigh/groin area), which aids a microcatheter into the aneurysm. This coiling promotes blood clotting within the aneurysm, eventually sealing it and reducing the pressure.

But my favourite experience this week, happened to be during an endarterectomy, which is the surgical removal of plaque from an artery. This examination can be quite slow for radiographers, as they are only needed for a small part of the procedure. Luckily, my supervisor knew the surgeon taking the case, asked if I could observe the procedure. The surgeon agreed and basically explained everything to me as if I were his student. 

Throughout this procedure, patients stay awake but are anaesthetised. An incision is then made over the blockage site (in this case the femoral artery), and the blood flow is re-routed using clamps. The artery is then opened, and the plaque removed. As student radiographers don't go into dissection rooms, I was amazed to see how big the femoral artery is in 'real life'; about the thickness of your little finger. It was brilliant to be able to understand what was actually going on, instead of just aiding the radiologist, who inserted a shunt further up the artery, to 're-inflate' the artery, to prevent the artery staying narrowed.

Overall, this week was really interesting, although I've been told many students find Vascular placement quite boring. I think it is what you make of it, and I did my best to get involved as much as possible, for example changing contrast, patient moving and handling etc. It's also a good time to learn some vascular anatomy, such as the various branches of the internal carotid artery. You also get to see a 3D spin, which is a pretty cool radiograph of the skull that does almost a 360 view, with contrast to help visualise the cerebral vessels. Check out this Youtube link for an example: http://www.youtube.com/watch?v=0gWmehOhRGs

Next week I'm in Main X-Ray again, so I'll get to refresh what I learnt from first year (and maybe get a head-start on my portfolio). Hopefully I'm not too rusty!

LLAP guys!

My First Conference - IAFR Annual Conference 2014

A look into the pack we were given today at the conference.

Stardate: 92305.32

Prepare for a long post...

I have to admit it, I am knackered. Due to a 5.20AM start to get a train at 6.34AM to Middlesbrough, and getting home at 7.40PM, I have had one heck of a long day, but I think it has definitely been worth my time. I don't know many undergrad students who attend conferences, but I certainly think that we should. I met so many new people, gained a lot of information from qualified radiographers, their views and advice, and I also learnt a good deal about the new and upcoming future developments in radiography (mainly forensic imaging). It's definitely motivated me to attend more conferences in the future! 

The morning started with a talk from Her Majesty's Senior Coroner in Sunderland, Derek Winter, who spoke about the role of a coroner and the role of post-mortem CT. For those of you who are unsure, a coroner is an independent judicial office holder appointed by a local authority, that investigates deaths that have been reported to them, if they have reason to suspect the death was violent or unnatural, has an unknown cause, or the deceased died in prison, police custody or another type of state detention (Ministry of Justice, 2013). His presentation explained that CT imaging is considered to be one possible way to reduce the number of autopsies in Britain, which is 2-3 times the rate of comparable countries. Post-mortem CT (PMCT) is also more cost-effective than an autopsy, but is a developing field, and has certain limitations. Certain faith groups are keen to avoid autopsy, as are bereaving families, in these cases CT virtual autopsies would be favourable.

Our next talk was then on Multi-Phase Post-mortem CT Angiography, which has been a major research project at the University Centre of Legal Medicine in Lausanne-Geneva. This presentation informed us of courses available to radiographers, as well as the current developments and benefits of MPMCT Angiography. In Lausanne, the forensic radiographers carry out examinations and cases themselves, including incisions and cannulations, which usually requires training, but gives these radiographers more autonomy in their practice.

After a well-needed coffee break (I was beginning to nod off from being tired!), the subject turned to Non-Accidental Injury and Physical Abuse cases in children. I had the chance to actually meet one of the speakers (Dr. Amaka C Offiah) prior to her talk, as I took the same train as her from Darlington to Middlesbrough, and we also shared a taxi. A national expert in radiological research into child abuse, and the first woman to be appointed as the Royal College of Radiology Roentgen Professor, she is well-known within her field and her talk was excellent and incredibly informative about the pitfalls in radiological diagnosis of physical abuse in children. Her presentation highlighted many key areas within this subject, and how to avoid future issues from arising within departments.

Our final talk was on ballistics, which highlighted and identified different bullet types, gun 'anatomy', trajectory and basic witness statements on forensic radiography ballistics. It was quite an interactive and entertaining way to end the day!

The members of the IAFR (International Association of Forensic Radiographers) were all very welcoming, and happy to answer questions, and I also got to speak to a few recent graduates of the Masters course at Teeside.

Overall, I thoroughly enjoyed my day, gained a CPD (Continuing Professional Development) certificate, and got to speak to the Forensic Radiography Masters course co-ordinator, who re-assured me about the content, and applications process.

For anyone interested, I've posted a link to the IAFR website for you to have a look at :3

An added bonus: I even managed to watch Doctor Who without nodding off. So now, I'm off to read my Stephen King book until I fall asleep! I'm too tired to pay attention to 'Once Upon a Time' tonight...

LLAP guys! Told you it would be long....

The IAFR website: http://afr.org.uk/

Through the Looking Glass: A Patient's Perspective

A phrase that makes hospital stays a little more hopeful.

Stardate: 92288.3

I've noticed that in all the posts I write, they're all from the imaging department's perspective, and none helping to understand how a patient really feels when in hospital, either as an outpatient or an inpatient. Let me tell you, after working in a hospital myself, it felt incredibly strange being a patient, as you do absolutely nothing! Resisting the urge to ask staff if they needed help felt lazy and weird!  So, I decided that I would just  give you all an insight into what it's like to be a patient, rather than a healthcare professional.

Recently, and a few times in my youth, I've felt first-hand what it feels like being a patient. To cut it short, I randomly collapsed one morning while running (and they say it's supposed to be good for you), and after waiting for 6 hours in A&E, was admitted, and even then, I wasn't sure whether I was staying overnight or going home. 

I had my blood pressure taken a good total of 8 times in those first 6 hours, a blood test done, and initial assessments from both a nurse and a doctor; all the while I was still wearing my muddy running clothes, and in desperate need of a shower... no-one gets up to go running and expects to be rushed to hospital! I was then taken to the second hospital, where I was to stay overnight for observation on the cardiology ward, due to the unknown cause of my collapse. Here is where I say, I wasn't told a single thing about why I was being admitted, until another doctor did another assessment, then told me why I was staying... at nearly 10 o'clock in the evening, almost 12 hours since I'd first gotten into an ambulance! Talk about speedy...

Staying overnight is difficult, and slightly scary, especially on a cardiology ward, as everyone is hooked up to a heart monitor, so there's machinery constantly beeping through the night (I still have sticker marks on my skin even now). Nurses wake you up at 6AM (more blood pressure readings), and the doctors do their rounds around 8AM, so you have the rest of the day to fill with TV or reading. The hardest part, is all the waiting you have to do, and that you're mostly alone. I believe the best part of a patient's day is visiting hours. And that can be tough if no-one is actually visiting you. Well, you're not called a patient for nothing... 

I'd been told I was in need of two examinations: an echocardiogram and an exercise test. This was to rule out the possibility of Wolff-Parkinson-White syndrome, a condition that affects my younger brother. Sunday and Monday were spent being visited by my very good friends and my boyfriend's mother, all the while my mother sent me texts constantly, trying to find out if I'd escaped.

After a truly difficult exercise test (which I aced at an above average athletic level), and a quite relaxed echocardiogram, (where you get given a chest ultrasound while being hugged), I was deemed fit and healthy, and sent home!

For me, it was just a long waiting game, to eventually be told after 3 days there was nothing they could find that was wrong. But it's a lonely ordeal, and you're not always told what's exactly going on, or when you're going home... which is why I may or may not have peeked at my notes... shhh. Overall, I learnt (but already knew) that patients go through quite a lot... so always be that person who gives them a smile and talk to them. You never know, it might just make their day :3

Only one more day until I get up at 5AM to get the train to my conference!

LLAP guys! 

Radiographers to Gain Prescribing Rights?

Could prescribing rights be on the horizon for radiographers?

Stardate: 92257.58

So, I was browsing the SoR's website last night, and came across one of their news posts that caught my eye, regarding radiographers and prescribing medication.

In July 2009, a report was published presenting the findings of the Allied Health Professions (e.g. radiographers, physiotherapists, podiatrists etc.) prescribing medications. Currently, there is 'supplementary' prescribing training available to experienced and expert radiographers. These radiographers use PGDs (Patient Group Directions) - specific written instructions for the supply and administration of medicines - for analgesics and anti-emetics that may be required before, during or after procedures. Contrast agents are also managed with PGD.

In order for a radiographer to undertake supplementary prescribing training, they must already be highly advanced, and their employer must have identified a need for a supplementary prescribing role. They undertake the same training as nurses and pharmacist independent prescribers.

There a few arguments raised that back up the need for independent prescribers within the Allied Health Professions, for radiography:

• radiographers are experts in drug interactions with imaging contrast media
• they could manage unexpected side effects, and only liaise with other medical professionals if clinical emergency
• invasive procedure patient need could be better supported by independent prescribing

The report concluded there is strong evidence supporting a progression to Independent Prescribing for radiographers, but less than for physiotherapists and podiatrists. You can read the full report below (link in references list).

But recently, the Society of Radiographers has posted a news update (19th August) stating that ministerial approval has been received, meaning that proposals put forward by the movement (AHP Medicines project) will be taken to public consultation later this year.

One of the Society's professional officers, Christina Freeman, is highly involved in the project, and stated that independent prescribing would "bring radiography in line with other AHP, like physiotherapy, and increase opportunities to develop practice in areas such as emergency, unscheduled and cancer care."

I believe it would be a great opportunity to advance a radiographic career, and give insight into other clinical areas of expertise that radiographers rarely experience, and give the profession more autonomy with patient management. There is a long way for the project to go, but it is currently big news within the profession's future!

Who knows, in 10 years time I could be prescribing people medication... jeepers!

LLAP!

References

1. Department of Health. (2009). Allied health professions prescribing and medicines supply mechanisms scoping project report. Available: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_103949.pdf. Last accessed 27th August 2014.
2. Society of Radiographers. (2014). Radiographers move a step closer to gaining independent prescribing rights. Available: https://www.sor.org/news/radiographers-move-step-closer-gaining-independent-prescribing-rights. Last accessed 27th August 2014.

First Year Finale

That feeling when you've finished your first year successfully.

Stardate: 92252.42

It's been a while since I wrote a post, but let's just blame that on trying to finish my case study! So, after a good 11 months, my first year as a student radiographer is finally over! There's been stress-fuelled all-nighters cramming for exams, early mornings waiting for the bus to placement in the rain and piles and piles of lecture notes and textbooks to hike through. It's been a whole new experience. The course is definitely intensive, but it'll be worth it in the end.

In two weeks I'm off to the IAFR's Forensic Radiography conference in Teeside, and I know it sounds a little sad, but I'm actually excited for it, seeing as it's my first conference. I've even planned a smart-casual outfit, so I don't look like an out-of-place student.

But for now, I'm just enjoying my time off, spending time on my PS3, participating in Parkrun's and earning a little extra money from my part-time job here and there.

Here's looking forward to the new academic year!

LLAP!

Cerebral Shunts and a Growing Cello Obsession

What I would give to be playing that cello in this current heatwave!

Stardate: 92179.63

This week is a mixed department week for me, due to the second years still being on their assessment. I've been in both general and screening. I'm actually welcoming the radiology department's low temperature! It's well-known I don't do well with heat or sunshine. I want Summer to hurry up and give way to Autumn; or at least for the sun and heat to give it a rest. Also, for those of you who can hear it, I've added an audio-player to my blog, not because it's important, but the song is that beautiful, I want everyone to hear it! If I could afford one, I'd buy a white cello right this minute... but alas, without including money for rent, travel and food, I have about £20 to my name. Such is the life of an NHS student!

Recently, I was witness to a type of examination I rarely get to see. It was an x-ray examination regarding a cerebral shunt. Cerebral shunts are commonly used to treat hydrocephalus, swelling of the brain due excess cerebrospinal fluid (CSF), but they can be used in cases of brain tumours, meningitis, head injury etc. These shunts are thin tubes placed into the brain's ventricle and tunnelled beneath the skin to the peritoneum (abdominal cavity membrane). The shunt reduces the intracranial pressure caused by the CSF by draining it into the peritonial cavity.

In Radiology departments 'shunt series' are simple sets of x-rays (skull, chest and abdomen) that may reveal any breaks in the shunting. In comparison, a 'shuntogram' uses CT and involves a radioisotope being placed into the shunt reservoir in the patient's head and measuring the speed it travels to the abdomen. Any delay implies a problem with the shunt. It was interesting to see, and also to help, as when you feel for the shunt locations, they feel like large lumps beneath the skin. I was worried I'd press a little too hard, but apparently they don't hurt! 

Aside from that, all I've been focusing on is just getting my case study done, but it's so laborious after a long day on placement! So far, I've managed to write 1,000 words, read it through, delete about 900 of them, and stare at the now rather blank Word document, hoping for either inspiration, or for the words to magically write themselves. So alongside making plans and drafts for my case study until the wee hours of the morning, I've been downloading sheet music for my violin, listening to The Piano Guys (the people who perform the song being played), scoured the internet drooling over cellos, and playing Pokémon while watching Star Wars. Because I'm ever so organised and practical, you see.

Next week, I'll be in general x-ray, so I'm sure there'll be plenty to do... including the dreaded 2,000 word case study! Maybe after the next two weeks, for the first time in nearly five years (possibly longer), I might sleep before one in the morning!

LLAP guys!

Cardiac, Cages and Conferences

An example of an Ilizarov apparatus on the tibia and fibula.

Stardate: 92138.26

So, this week I'm in Cardiac, Mobiles and Theatre. For a Monday, the cardiology department on the x-ray front was pretty slow. I helped out on some portable x-ray examinations in (surgical) recovery and also on the ICU. As the focus (funnily enough) in Cardiac is of course, the heart, you see chest x-rays in abundance here. 

But for the majority of the week, I have been placed on mobiles and theatre, and one thing I finally got to see, was a surgical procedure involving the fixing of an Ilizarov apparatus to a patient's lower leg, due to bone bowing caused by osteogenesis. After seeing so many in A&E clinics, it was interesting to see how they areactually done. 

Ilizarov cages (as I call them), are used to lengthen or reshape limb bones, to treat complex fractures, or non-unions of bone. They are named after the orthopaedic surgeon, Gavriil Abramovich Ilizarov.

The top rings are fixed to healthy bone by tensioned wire (Kirschner wires), allowing weight-bearing force to be transferred through the external frame, to bypass the fracture/injured site. The force is then transferred back to the healthy bone through the bottom ring. The structure therefore acts as a 'bridge', where the middle rings hold the bone fragments in place.

For bone lengthening/reshaping, the affected bone is surgically fractured, and the cage is attached. During recovery, the fractured bone will begin to heal. This process is slow, and the rings is adjusted using the network of nuts, increasing the spaces between rings. The adjustment is done four times a day, moving the fracture apart 1mm per day. This allows significant lengthening. 

The procedure I was present for was quite short (2 and a half hours in all), and the only thing that bothered me was probably seeing the wires about to come through, due to the wires pushing the skin outwards. The rest was fine. The sound of drills doesn't bother me, nor does blood or the sound of a mallet breaking a bone... on purpose (with good reason)!

Aside from that, mobiles has been quite quiet, so while surfing the internet, I came across an event that caught my eye: the International Association of Forensic Radiographers Annual Conference that's being held at Teeside University. Luckily for me, this event was open to students (with a student discount!), and after a long look at my funds, I decided I was definitely going. I've been told by friends on other courses who attend conferences that they're good for networking and experience, so how could I say no?! The topics that are going to be included on the day are:

• Update to the new Coroner & Justice act
• Post Mortem CT Angiography 
• The radiographer as researcher
• Pitfalls in NAI and follow-up imaging
• Radiological detection and interpretation of internally concealed illicit drugs
• and Ballistics

So on September 13th, watch this space! It might actually be interesting!

Next week is my guided study week, so unless something incredibly life-changing happens, I'll post again when I'm back on placement in screening. Due to me only having my case study to be getting on with now most of my portfolio is complete, I'm off to London for a few days to see my grandfather, and hopefully sit in on some cases at The Old Bailey. Murder trial anyone?

LLAP!

References

1. Ilizarov Apparatus, n.d. photograph, viewed 17 July 2014 <http://upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Ilizarov2.jpg/640px-Ilizarov2.jpg>.

Post-Exams Placement... And Prescriptions?!

This is definitely how I'm feeling thus far into my placement due to lack of sleep....

Stardate: 92102.82

It's been a long while since I last wrote a post, but in all fairness, I've had a lot going on to actually really think about my blog! I've completed all my first year exams (and passed them all, and gained an overall high 2:1 grade; one shall work harder next year), moved into my new house for second year, undertaken and passed 4 out of my 5 clinical assessments (1 more to go), and have also been going back and forth to placement sites.

I'm six weeks into my 11-week long Summer placement, and I'm getting to that stage where my brain is on the verge of going on auto-pilot from early starts, input overload and circuit overuse. I've done lots of general x-ray, some in my base hospital site, and some in the 'satellite' hospitals. I've been on Mobiles & Theatre, next week I'm in A&E, and the week after that I'll be placed in Cardiac for the first time. I think Cardiac is like mobiles, but I'm actually not sure. I'll find out soon enough!

Although the exams are over, I've still got work for the portfolio to finish, which includes a 2,000 word case study and various forms. The case I've chosen is about atelectasis. But more about that to follow, as I am still researching into the condition... well, enough to sound coherent and knowledgeable on the subject, anyway. 

You'd think with all that's going on, my body would at least try to function on at a normal human standard. But no, mine has other ideas. Upon visiting a GP with some worsening thoracic (upper back) pain, I found out I am now possibly suffering with Myofascial Pain Syndrome. In other words, my back muscles have knotted up in a specific point to the right of my left scapula and are making life much less fun than before. I'm managing, but I've now been prescribed a tube of Ibuprofen gel, and the strong painkiller Codeine. Yesterday, I was fine, but today, the codeine made me feel completely drowsy and a little more mellow than usual. I didn't fall asleep at lunch... honest.

One other thing you have to get used to, and has finally made an impact, while being a student radiographer, is being almost completely poor for the majority of your degree course. With all the travelling to placement, secondary accommodation, paying for food, rent and bills, and then waiting for the NHS to pay the claim money back into your account, it's no wonder I hide in my room cuddled up with a book! Holiday to Middle-Earth anyone?

I've only one more assessment to go, which is my spine assessment. I'm prepared and ready to get it over and done with. It's just a shame there are never many spines to x-ray on a general x-ray department. There's always the odd one or two, but it figures that when they do come through, there's always at least 5 other examinations to do, and the assessors are too busy to actually assess you!

But once that's done, I will be able to have 5 glorious weeks of doing as little as possible to enjoy. Shall I re-watch all of Sherlock, or catch up on all the video games I haven't finished playing? Oh, choices, choices! What's that you say? Go outside and enjoy the sun? I don't even know what that is anymore...

LLAP!

'Just Another Mobiles Monday'...

"Have you seen what this examination here is called? A 'proctogram'... it sounds disgusting!"

Stardate: 92023.29

This week I'm placed in Mobiles and Theatre, and today was actually quite eventful for a Monday. I didn't do any portable x-rays, as none were requested, but I did get to assist in a urology theatre case in the afternoon.

In the morning, I had to give myself a celebratory clap. I was processing one of my x-rays, when I noticed the trabecular pattern was off on the AP (anterior-posterior) projection (the projection that shows the "front"), so once the lateral (the "side-on" view) had gone through, I saw a definite break on the radiograph. So, I grabbed my supervising radiographer to let them look, and pointed it out. We then tracked down a radiologist to see what they thought. Luckily, I was right. Turns out it was a 3-week old fracture that hadn't been seen to! Seems that commenting does come in handy sometimes...

Following that, I did some other general x-rays, as our morning urology case had been cancelled. I also produced an absolutely beautiful lateral horizontal beam knee (according to my supervisor; it's something to be proud of and show off all day on the screens) at some point during the day before lunch. I was also told to look up about 'proctogram' examinations... I'll leave Google to explain that one! 

When I got back from lunch, I filled out some commenting forms to pass the time until we were called to theatre. I managed to spot osteoarthritis, a comminuted fracture, and a lung abscess on the radiographs I'd chosen (don't worry, I checked against the radiologist reports, too! I did manage to completely miss a rib fracture on one.). Not bad for me, especially on a Monday! 

After eventually getting changed into scrubs, a hat and leads, I realised that I had picked the one pair of clogs that made me sound like a horse. Not only that, my scrub trousers kept falling down, as I apparently can't tie them up properly... Never mind!

Our case in theatre was a Bilateral Retrograde Stents Pyelogram. This is a urologic procedure where contrast is injected into the ureter to visualise the ureter and kidney. It requires cystoscopy, and a small tube (ureteral stent) being placed into the lower ureter. The 'retrograde' is due to the contrast flowing in the opposite direction to the usual flow of urine.

I watched my supervisor use the C-arm first (as it was a little different to the ones I'm used to), and then once I felt confident enough, I took over, and managed to get a good view of the guide wire and kidney slap bang in the middle of the image... just how they like it! To be honest, I was a little sketchy at first, but after a little while I'd gotten the hang of it.

So all in all, it wasn't so bad a day! I spotted a fracture, took a nice lateral knee, got to wear scrubs, and assisted in a case! I even had a nice lie in this morning for once, and got to watch Doctor Who!

Now to carry on it that same vein and enjoy some jelly babies...

LLAP guys!

First Year Commenting

Bone metastasis of a bronchial carcinoma in the tibia.

Stardate: 92012.11

Today was my spinal tutorial session with my lecturer practitioner/clinical tutor, which ended up turning into a general tutorial session, giving us the opportunity to ask questions on anything we need help with. In the first half we took some x-rays, mainly lumbar spines and pelvic examinations. In the second half, we talked about image commenting, which was one of our final exams, and also makes up part of our clinical portfolio.

Basically, we take an image, any image, and describe what we see. Easy, right? Well, not always, but the process seems simple enough, which goes a little something like this:

• Check the patient's clinical details - how old are they? What are their symptoms? 
• Is the image, abnormal, possibly abnormal or normal?
• Examine the general appearance of the bone
• Trace the bone's cortex and density for any irregularities
• Has the trabecular pattern been disturbed?
• Give a detailed account of the abnormality seen
• Examine the joint spaces and soft tissue
• Are there any artefacts on the image?

I'll use the above image as an example, although I don't know the clinical details. Let's say the patient is a 29 year-old male, with severe pain around the tibia, for 3 months.

- The above image is definitely abnormal.

- The bone's cortex has not been disrupted, and the bone density appears normal. The trabecular pattern has not been disrupted.

- There are two radiolucent (the dark patch within the bone) area on the proximal end of the tibial shaft, visible on both projections, on the posterior and anterior tibial aspects.

- The joint space appears within normal limits, and the there is no soft tissue swelling

- There are no artefacts on the image.

This is a basic "comment", and as I found out, this image displays bone metastases.

Bone metastases, is a class of cancer metastases that is the result of primary tumour invasion of bone. Metastasis is the spread of cancer from one organ or part to another. Bone-originating cancers like osteochondroma for example, are rare. These metastases form solid masses, and bone is one of the most common metastasis location. 

Bone metastases can cause severe pain, bone fractures, spinal cord compression, and other major clinical concerns. These symptoms are caused by:

• acidosis - increased acidity. Osteoclasts (bone cells that reabsorb bone tissue) generate extracellular protons, which lower the pH level.
• bone restructuring - the uncoupled regulation of osteoclasts and osteoblasts (bone cells that form bone tissue) leads to bone malformation. Malformed bones are unable to withstand normal day-to-day mechanical stresses (e.g. weight bearing), leading to fractures, spinal cord compression and instability.

Anyway, this is post is getting long enough, and I've got dinner to make for myself. I hope this post has given you some insight into how we "examine" an image, in it's most basic form, and it's actually one of the fun parts of being a radiographer. True, there is a lot of terminology to get your head around, but once you have, everything sort of clicks into place! Tomorrow's my half-day and I'm once more in general, so hopefully I'll get the rest of my unaided examinations signed off.

LLAP guys!

References

1. Bone Metastasis of a Bronchial Carcinoma in Tibia, n.d. photograph, viewed 29 May 2014 <http://www.mevis-research.de/~hhj/Lunge/imabc/BCKnMetb41_2.JPG>.

The 11-Week Stint

"How was your first day back in clinical?" "Great!"

Stardate: 92009.75

Heads up, True Believers! It's that time of term again.... placement! Bear in mind, this time round I'm here for 11 weeks, which followed on from our first year final exams (which I think went well, despite my original fears). What's that you say? I can relax now? Don't be ridiculous! I still have my portfolio, clinical assessments, an ALPS form, commenting forms, critique forms and a case study to produce yet! Does it make me miss Physics and Chemistry yet? A little...

This week (well, 2 and a half days), I'm placed in the General department, so I'll hopefully be seeing a good variety of examinations, get plenty signed off, and maybe, just maybe, get a chest assessment out of the way. It was strange going back into a clinical setting after being out for a while, especially seeing as I've been focusing so hard on revising for my exams. 

This morning happened to be a rather clunky one, (getting the 7:28 bus is too early), having stayed up late to iron all of my uniforms to save time. Getting ready with your eyes shut is never a good idea, by the way, even with my glasses on (there's a reason I keep my hair so short!) It also turns out, I forgot my placement notebook back in Leeds, which is what I attach my markers to (now jazzed up with Spider-Man stickers and polka dot patterns), so getting your images to the optimum standard, just isn't as easy. There's always something....

Once again, I felt like I'd forgotten everything, but after the first three pelvis x-rays, I was fine, considering the rest of my day consisted of... pelvis x-rays! Tomorrow is set to be my spinal tutorial, so I'll be practising spinal examinations (my favourite kind!) and critique. Finally, Friday is my half-day, so I'll be returning to Leeds for the weekend. A student radiographer's life is always busy!

I actually forgot how tiring placement is, no matter how much sleep you attempt to get beforehand. I got on the bus home and fell asleep! Luckily, I have the amazing knack to wake up just before my stop, and get off at the right one, so at least that's something. After forcing myself to make a healthy dinner, I traipsed into my room, I wrote this post, which will now be followed by a movie, a book and then bed!

Watch this space, it may get interesting...

The Finals Countdown!

"So Emily, do you feel you're ready for your final exams?"

Stardate: 91935.01

Well, I'm back in lectures again for two weeks, after returning from my short Easter break (I'd say holiday, but as I was mostly revising and working, I'll refrain from doing so!) My first-year final exams are now looming ever closer, and despite revising every day, passing all the mock exams, and even printing off an A3 skeleton, I still don't feel ready. 

We've only got four exams, the longest of which being Physics at two and a half hours, but luckily they're spread out over four days, so I don't have to cram for two subjects at once beforehand. We've got two exams for Musculoskeletal Anatomy, one for Imaging Technique and one for Physics. I'm feeling confident for the Anatomy exam, as this is the one that, for now, makes the most sense. Physics on the other hand (see above image), well... writing pages and pages of notes has helped, but as far as 12-pulse bridge circuitry and rectifiers are concerned, I'm done for! You cannae change the laws of physics Jim, unfortunately...

Thankfully, a good chunk of some exams are MCQs (Multiple Choice Questions), and as long as you've done some reading around and understood the basics of the module, you should get most of these right, which usually can get you to the 40% pass boundary. Following those are the long answer questions, which range from 10-20 marks. 10 mark questions apparently only need about a page of writing, and 20 is two pages (...Wha?) So, my aim is to write as much as possible (within the relevant parameters anyway), and hope for the best!

After the exams are done with, we're back off out on placement again, but this time it'll be for 11 weeks! How will I survive 11 weeks of no Taekwon-do, nor a constant internet connection?! Do I risk taking my PS3, or shall I take boxsets upon boxsets of DVDs? Oh, decisions, decisions...

Portfolio Pains

What it feels like when you finish an examination for your portfolio and you try to get the radiographer to sign it.

Stardate: 91875.79

So, I'm in my last week of placement for this block, and this week is my second one in clinical skills. This is basically a week where you can take on real examinations, just a little slower, and focus on assessment techniques, as you are with a lecturer practitioner, and not on a busy department. It's actually a really good opportunity to get examinations signed off for your portfolio, and brush up on what you know, which catches up on you really quickly.

It also allows you to work with students from other placement sites and see the variations, as every Trust has their own Local Rules and protocols regarding examinations and safety etc. For example, where I'm placed, we may do different routine projections for an examination to another site, or technique may vary. Again, it all depends on where you're placed, and what the radiographers there have shown you.

The realisation has pretty much finally dawned on me that being a student radiographer is actually really hard! Balancing 7 weeks of holiday, placements, lectures, travel and expenses claims, revision, portfolios "social life", hobbies and sleeping into one academic year is not an easy task. In fact, it's knackering. Especially for students like me, who are crazy enough to have a part-time job too!

Getting portfolios filled in can be difficult for some sections, especially ours, as where I'm placed, certain types of examinations are few and far between, e.g. spines. Sure, you see plenty of chests, knees etc, but when a spine comes in, everyone wants to do it! Luckily, I'm almost done with signing off my portfolio, I just need a few more unaided examinations, then I'll take on the assessment run! (Better not leave it until the last minute.)

It's amazing how quickly a year goes by, as although it feels like September was ages ago, it also feels like it was yesterday I was standing in General X-Ray getting in everyone's way! We've got two weeks of holiday for Easter (I don't have a clue what I'm going to do for two completely free weeks!), then two weeks of lectures, an assessment week, and then all placement weeks until Summer!

I've got two more days to sign off as many things as I can, then I can relax for once (with revision sittings of course). If I can find the time, I may even go and watch the new 'Captain America: Winter Solider'!

Well, as I like to say... Geronimo and LLAP!

References

1. The Hobbit, n.d. gif, viewed 9 April 2014,<http://31.media.tumblr.com/60b475d6d7c7ece10f1cda53b21de510/tumblr_ms3tfrXwoW1r9hlt2o8_250.gif>.

A Week in Fluoroscopy

This is the equipment used in my placement hospital, the Siemens Artis Zee

Stardate: 91823.58

It's that time again: placement! And for week one, I was placed in Screening (AKA Fluoroscopy); I was supposed to be in A&E, but it was changed at the last minute. If you didn't already know what fluoroscopy is, it's basically an imaging technique that uses real-time moving images of the internal structures.

The equipment I got the chance to learn to use properly was the Siemens Artis Zee Multi-Purpose, and it's controls, although they look confusing, take very little time to get used to. It's used in various types of fluoroscopic procedures:

• Root nerve blocks - an injection that is given close to a nerve as it leaves the spine; usually for sciatica pain.
• Facet joint injections - an injection of local anaesthetic or steroid which can anaesthetise the facet joint to block pain. Facet joints are small joints between each segment of the spine.
• Barium enema - an x-ray examination of the large intestine to help diagnose any existing problems affecting that area. The colon is filled with a contrast material containing barium, which is done by pouring the contrast into the rectum.
• Barium swallow - an x-ray examination of the upper gastrointestinal tract, including the oesophagus, and sometimes the stomach. The patient is asked to drink a suspension of barium sulphate, and the x-ray images are taken during the swallow. This procedure is done in various positions: AP, oblique and lateral, for a 3D assessment.
• Myelogram - an x-ray examination that uses an injected contrast material to view the fluid-filled space (subarachnoid space) between the spinal vertebrae. 

I witnessed these examinations, and there are more that are carried out on the department. I certainly got used to wearing lead rubber aprons, and quickly learnt to check the apron first, as instead of picking up the lighter 0.25mm apron, I picked up a heavy 0.35mm apron, which made me feel faint after a while! I also started using the thyroid shield, just to be on the safe side.

Despite what everyone first believes about barium enemas, you barely see (or smell) anything, and nearly all fluoroscopic procedures are painless for the patient (the barium mixture patients have to swallow has a pretty nasty after-taste, mind). 

Overall, it was nice to see what the department does, and what this technique involves. It certainly lets you know if you want to go into that sort of speciality, and it does actually seem quite interesting. You certainly see a good variety of patients, too. It's made me start seriously looking into what I want to do post-graduation (still definitely Forensic Radiography) as there are so many options with Radiography!

Until next time guys! Next week I'm in Clinical Skills, so we'll see how that goes.

LLAP!

References

1. Siemens Artis Zee Multi-Purpose, n.d. photograph, viewed 22 March 2014 <http://usa.healthcare.siemens.com/siemens_hwem-hwem_ssxa_websites-context-root/wcm/idc/groups/public/@global/@imaging/@angio/documents/image/mdaw/mtc0/~edisp/artis_zee_multi_purpose-00068177/~renditions/artis_zee_multi_purpose-00068177~10.jpg>.

Mayhem in March

When people ask you about mock exams; applies to both preparation and execution!

Stardate: 91796.42

As you may have noticed, it's been quite a while since I last posted (and it has been ages, because I was on placement last time!) This is generally down to mock exams having been placed over the last two weeks. We had our exams in Musculoskeletal Anatomy, Medical Imaging Science, and Diagnostic Imaging Technique. 

I would like to say I was happy with my results, and I will, but I'm a picky human being with a funny little brain, and I know I definitely could have done better. So I'm happy, but not satisfied with them (to be fair, I haven't had one set of results back yet). I was surprised when I concluded that I found the physics exam the least terrifying!

They weren't so terrible in retrospect, but the only thing to remember about radiography exams is: write as much as you can that's relevant to the question! I lost marks for assuming I didn't need to write something down. If you've learnt it, write it down and talk about it! Also another handy tip is to definitely keep on top of your revision. It soon builds up if you don't!

Anyway, since I've managed to free myself from revision, as a 'reward', I've been reading some radiography journals to pass some time (when I'm not watching Star Trek, or Doctor Who). Two articles caught my eye in last month's (Feb 2014) issue of the journal Radiography. These were very different in content, but interesting reads.

The first was about using cross-sectional imaging in virtual post-mortem examinations. This appealed to me, generally because it's to do with Forensic Radiography, which is the field in which I want to continue my studies. The second was about professionals' experiences of imaging in the radiography process. I may have mentioned it before, but if you haven't already, signing up to the SoR is very beneficial for (prospective) radiography students, as you can access journals and articles, and loads of information which can give a nice scope of the field.

Soon you'll be hearing more from me again, as I'm back on placement next week! I'll be in A&E for one week, clinical skills for two, and a screening room for another. So there'll be plenty to get on with, and hopefully I'll have interesting things to feed back!

LLAP and reverse the polarity of the neutron flow!

References

1. Matt Smith Filming His Final Scene, n.d. photograph, viewed 11 March 2014 <http://static.fjcdn.com/comments/Matt+Smith+after+filming+his+final+scene.+Leaving+the+TARDIS...for+_76a0889eed211250bf3e27e7c154b0c1.jpg>.

Working in Theatre and ORIF Surgery

A scan of a Weber's Category B fracture.

Stardate: 91665.06

Day three of my placement, and luckily once again I was in theatre, and I have to say I'm really enjoying it. I saw one spinal examination today on the lumbar spine, and an ORIF (Open Reduction and Internal Fixation) surgery on an ankle.

The spinal examination required little screening, and these were few and far between, which meant half of the time was spent not being able to see anything and standing around waiting to be needed. 

This led me to think of what a student radiographer needs to know before going into theatre. My general thoughts were just tips on how to feel less overwhelmed by theatre situations, as it is a whole new environment:

• know the theatre rules and the theatre culture
• make sure you're wearing the right personal protection equipment - e.g. hat, mask, lead-rubber aprons
• once the patient's skin is open, assume everything is sterile - don't touch anything except the radiography equipment and you'll be okay!
• know how to use the image intensifier (C-arm - a portable C-shaped x-ray device used for imaging during surgical procedures), or observe it being used before undertaking it yourself
• know what is needed during the procedure, if unsure, ask your supervisor
• go to the toilet before surgery - you can be in there for a really long time!
• and if you feel faint, back up to the wall and slide to the floor

The second case was one I attended almost fully unassisted by my supervisor. I felt confident enough to handle the C-arm by myself, and the only hindrance I faced was the positioning of the patient on the table, as they were a little lower down than normal, which meant a bit of the table's metal framework was unavoidably in the image, but not obscuring it. This case was the ORIF ankle case. Open Reduction is surgery to set bones, and Internal Fixation is the fixing of screws and/or plates to facilitate healing. This surgery is used when casting or splinting a fracture alone would not assist repair.

This went well and I was quite impressed at my being pro-active with getting the imaging done and feeling that I could do the examination. The patient had a Weber's fracture (ankle fracture) on the medial malleolus (inner side) of the ankle, and the plates were being placed so the bone was able to heal correctly. I was given positive feedback, and I think I'm much more confident than I was before on placement, and I'm starting to get into the hang of working within different departments.

I think this has been my favourite week so far! Now to do a quick workout, eat a cookie and watch 'An Idiot Abroad' in bed!

LLAP!

References

1. Jeremy Jones, Radiopedia.org, photograph, viewed 22 January 2014 <http://images.radiopaedia.org/images/341127/186015a2d8111ae7f0232b0fb61ab9.jpg>.

Surprise Birthday Spondylosyndesis!

An example of a post-operative multi-level cervical fusion.

Stardate: 91662.61

Overall, I have to say, today wasn't a bad birthday. I wasn't knackered upon arriving at the hospital, I'd had a decent breakfast, and I got to spend pretty much all of my day in orthopaedic theatre! I saw three cases, all of them spinal surgery, and it was great! I saw two lumbar, and a cervical spine case, and the latter was just amazing to witness. (See, I told you my posts would hopefully get more interesting!)

The patient had been suffering with a cervical spinal disc herniation between the C4 and C5 vertebrae. This is basically where a tear in the outer fibrous layer (annulus fibrosus) of the inter-vertebral disc has allowed the central jelly-like portion (nucleus pulposus) to bulge out and cause mechanical compression (pressure) upon a nerve (in this case, the spinal cord). In order to relieve this patient of their pain, surgery was undertaken, and in this case it was a spinal fusion (or spondylosyndesis). 

The type of fusion used for this particular case was ACDF (Anterior Cervical Disectomy and Fusion). This is a surgical procedure where the surgeon enters the space between the two discs through a small incision anteriorly (from the front) and to either the right or left side of the neck. The affected disc is then completely removed, and the intervertebral foramen (the channel through which the spinal cord runs) is then enlarged by a drill to allow the nerve more room. A device is placed between the two vertebrae to maintain spine alignment, and is then fixed with a 'cage' using metallic pedicle screws made from titanium. This type of surgery can take 5 hours, and although I was only in for a few of them, I saw quite a lot.

The consultant surgeon was incredibly nice and explained everything as he went along, and why he was doing it. Before we properly started he showed me some of the patient's previous MRI scans, which helped me to understand what we were actually seeing and scanning. When he'd finished doing different stages, he even encouraged me to come over and have a good look at his work, and I felt quite privileged by it, as some of the surgeons I've seen are quite offish and uninterested.

When I wasn't in theatre, I was out on mobiles, so I got to visit the ICU (Intensive Care Unit) and Oncology. I finally put into practice what I'd learnt about moving and handling (how to move yourself and patients safely), as many patients on these wards find it difficult to get into position for their x-rays. One of the elder male Oncology patients made me smile, as he was fascinated by the mobile x-ray tube, as he thought we were coming to take him back to Main X-Ray (which is about a mile away from Oncology), and he asked quite a lot of questions, and praised the technology's speed.

To finalise this post, I really had a great day in theatre, and I'm looking forward to the possibility of going tomorrow! And, I didn't faint! I knew I wouldn't!

I'm off to spend the remainder of my birthday relaxing in bed with my Spider-Man pillow, some bicuits and 'An Idiot Abroad' DVDs...

LLAP!

References

1. Alexios Apazidis, spineuniverse.com, photograph, viewed 21 January 2014 <http://cloud2.spineuniverse.com/sites/default/files/imagecache/inline-content/images/2012/07/25/4-months-postoperative.jpg>