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...