What Do You Mean I'm a Third Year?!

Definitely how I feel when it comes to university work!

Stardate: 93312.32

I realise I have been very non-existant on this blog as of late, but I've had a lot going on, and I completely forgot to write a post. After my mammography placement block, it was just a matter of getting my assessments completed and filling in our portfolio examinations, so I ended up returning to CT and similar departments. Following that, I had one exam resit (yay for reduced Summer holiday time) and lots of part-time work shifts. Oh, I also visited Dubai, too.

Now the realisation that I only have 10 months left until I graduate has finally dawned on me... I am terrified! That's barely any time, and soon enough, I'll be applying for jobs. I have suddenly lost the ability to do remember anything about x-rays... *sobs quietly in a corner*.

This year is when we have optional modules, as well as the compulsory ones:

• Our Research Project (AKA the dreaded dissertation)
• Professional Practice (the placement module)
• Diagnostic Imaging Technique
• Pathophysiology
• Preparation for Practice
• 2 optional modules, of which I chose a Focused Practice module and Advanced Medical Imaging Systems
•  and finally the elective weeks in June.

I have some idea on what my dissertation will be, but I'll try to avoid thinking about it again until it's mentioned in a lecture... just to be on the safe side. Especially after looking at how many essays we have to hand in this year, the above gif works wonderfully. This year is going to be... hard. As for my electives, I've been playing with the idea of going abroad, or spending some time in a CT department... as I can't do anything Forensic related until I graduate. I'm not ready to be a full-blown adult yet...!

Either way, I apologise for the lack of posting, I will pick it back up as soon as the semester starts next week!

LLAP!

How To Not Be Awkward in Mammography Departments

Fact: No-one enjoys having a mammogram. No-one!

Stardate: 93085.08

I've gone pink for this post, (I know it's not October, but for this post I wanted to give a quick nod to the Breast Cancer Awareness organisation, Pink Ribbon) so if you have trouble reading it, I do apologise! I have also dedicated this post to my amazing and brave Auntie Mich, who kept me motivated to keep this blog going way back when I was just starting out!

It was the one placement I was openly dreading. After already having done radiography for nearly two years, you'd think I was already okay with seeing humans undressed in most ways, shapes and forms. No matter how many times you tell patients they can keep their underwear on, there's always one who didn't hear you... Apparently, I was not fully prepared.

I have to admit, despite having heard and been taught about Mammography, I'd never taken an active interest in the modality, nor fully looked into it. But once I'd looked into (aka Googled) the basic physics of mammography equipment  to refresh my memory post-exams (e.g. ultrasound, mammography units), I started to warm more to the subject than I had previously. The other plus side post-graduation wise: men currently can't do the job, so there is less competition for job applications (although I don't agree with this, from a work gender-equality angle).

Mammography is basically low energy x-rays that image the breasts. It's most well-known for its being an early detector of breast cancer, by finding masses or microcalcifications. I spent time in both screening clinics, where women who fit the criteria are checked every few years for any changes; and assessment clinics, where women have attended their GP after having found a lump, for example. 

So last Monday after having arrived at the department and been shown around, I witnessed my first mammogram, and couldn't help but look everywhere in the room, except at the body parts being examined. Eventually, I had to buck up and pay attention, or last week's block was going to go pretty slowly for me.

Every patient I saw examined was happy for me to stand in the room and have everything explained to me, and some even explained instead of the mammographer, which was a new experience! But this did put me more at ease, as being a student I'm used to doing the 'Student Shuffle' (basically constantly moving out of everyone's way) and being quiet when not in the general radiography or CT departments.

Once I'd followed a few women through from their mammograms to their ultrasound, I started to gain more interest and look in more detail at the images. I particularly enjoyed helping one of the consultant radiographers (yes, you read that correctly, we can become consultants!) with an ultrasound guided biopsy, where I was shown different types of tissue structures within the breast that would be going for testing.

I also got to spend one morning sitting with a doctor while he ran a clinic. It was interesting to see the other side, watching the pre-assessment, and then seeing how the imaging side was requested and for what reasons.

However, with Mammography, you will eventually come across sad news at some time or another. A number of the patients I saw examined at the department had already had a mastectomy (breast tissue removal surgery), and some images I was shown for comparison and to help me understand breast anatomy, displayed what were cancerous masses. For me, this was quite a tough experience (hence why I've never considered Radiotherapy), and it hammered home how beneficial Mammography is as a department. Even for a small number of men.

From what I've witnessed, being a mammographer, is a very intimate job. During the examination, you will be in the patient's personal space, and the procedure can be difficult and uncomfortable for patients. It's a difficult job to do, putting apprehensive and worried women at ease, and if they're upset, you have to be the type of person who knows how to handle that situation kindly and professionally. Not only that, nothing can be missed off the image, because something small could be hiding in that one area not included, so you have to be skilled enough to make sure you've gotten everything on the receptor. There is also a chance to be a breast sonographer, giving you a little more autonomy in your work.

Personally, I'm not completely sold on Mammography myself. If I had to say what I enjoyed the most, it would be the ultrasound examinations and biopsies, as I could 'see' more on those images, than on the plain film ones (a slightly odd situation for an undergrad radiographer). I wouldn't mind going back for another week, but right now, it's not something I could see myself going towards once I graduate. I can see why it's an appealing job to some, and don't get me wrong, I found the diagnostic side of it and the variation interesting, but all day and every day would be breasts. And I don't think I'm ready for that just yet!

This week I'm in the Paediatric department witnessing all sorts of examinations. But, more on that in my next post!

LLAP Guys!

Ps. I hope you've all gone to see Jurassic World... 

Managing Placement Assessments, and CT in (Dino)Nutshell!

How I feel handling all my different placements and assessments...

Stardate: 93066.03

I apologise, as this post is a few (ahem... five) days late. This is once again because of part-time work, and placement in a different hospital due to the department I'm in this week (more on that in my next post!)

As I'm now in my "Summer stretch" of placement blocks, second year clinical assessments are now creeping up on me, rather ominously too, as they're not easy to pick appropriate patients for! And as you have so little time in each department, due to rotations, every moment there is precious. No-one ever said second year was easy... Including me!

So far, I've passed my CT head and Extradepartmental Chest X-ray (Mobile/Portabe) assessments; so only three more to go! To celebrate passing my CT assessment, I decided to dedicate this post (briefly) on CT, and also went to see 'Jurassic World'... my inner child was incredibly happy (so was the grown-up, because Chris Pratt; 'nuff said.) It's amazing, I highly advise everyone to see it.

So, about CT, or Computed Tomography! Most people have heard of, or at least have had, a CT (or CAT) scan. For Leeds university students, CT is a department we visit, to further our understanding of extradepartmental modalities, that involve medical imaging. CT scans, use a 360-degree x-ray beam to create a 3D image, using a number of imaged slices taken from a large series of two-dimensional images, to visualise the internal structures of the body, without having to cut open the patient! CT has plenty of applications, including the detection of abnormalities, as well as diseases, such as cancer, inflammation and trauma etc.

There are a multitude of advantages to CT over the usual 2D medical radiography. It doesn't have the issue of superimposition (organs/tissues lying over each other), allowing structures to be assessed, and allowing the area of interest to be studied in detail. CT also has a high-contrast resolution, meaning that tissues with even the slighest difference in density can be distinguished from one another. Finally, CT images can be viewed in various ways, or "planes", allowing any exisiting pathology's position to be pin-pointed.

Non-medical uses of CT include discovering flaws in industrial parts before they are used, and to identify the existence of any oil, water or gas etc. in structures.

I find CT an interesting department to look into once I've qualified, as they're used quite often in forensic radiography for virtual autopsies, which I'm thinking of writing about for my final-year dissertation. Being able to see all the internal anatomy without it being superimposed onto itself is great, as it makes spotting abnormalities that little bit easier... but not by much for the inexperienced!

And that is basically CT in its barest form! This week I've been in the Mammography department, so I'll have a more in-depth post coming up regarding the Breast Screening process, and a little on the modified equipment.

Final Note: GO AND SEE 'JURASSIC WORLD'. Think I made that clear enough...

LLAP Guys!

So It's Been 5 Months, Eh? Let Me Tell You About Cardiac Cath Labs...

How I feel looking in the mirror now I have to get up early for placement...

Stardate: 92967.34

Well, aren't I just the worst blog owner? But in all fairness to myself, I have been entirely swamped by being a student radiographer. My placement in January got incredibly hectic, I've worked so many shifts at my part-time job, and then there's these evil little things our lecturers call 'exams' that recently came and went... But, finally I'm back on placement, so I'm going to be right back on track with this blog. I mean... I'm sure you've all missed it, right?

Now, if any of you readers are prospective students or currently a first year at the University of Leeds, let me give you another bit of advice... Second year is freaking hard. I have never felt so mentally drained in my life! And I've worked as a full-time supervisor in retail...  

Don't get me wrong, I still love my university and the course, because I know it'll be worth it in the end. Our lecturers do an amazing job, but there is just so much to cram into your head, you'll be begging June to come faster so the May exams are over. And I thought the January exams were tough! Never have I been so wrong...

But it's not all doom and gloom! Hooray! 

So, what are Cardiac Cath Labs, you ask? Well, in the UK, a Cath(eter) Lab is an examination room containing diagnostic imaging equipment used to visualise the arteries and chambers of the heart for treatments or investigations. They're staffed by a multidisciplinary team such as cardiac consultants, cardiac physiologists, nurses and radiographers. 

Typical examinations that occur in Cath Labs include:

• Coronary catheterisation
• Coronary angioplasty or Percutaenous Coronary Interventions - used to treat stenotic (narrowed) coronary arteries
• Transcatheter Aortic Valve Implantations - the insertion of an artificial heart valve using catheters
• Pacemaker implantations
• Electrophysiological studies - e.g. mapping of the heart to locate heart abnormalities
• and Cardiac ablations - a procedure that is used to scar small areas in the heart that may be causing a heart rhythm problem.

I managed to see a good range of procedures this week, but the most interesting I saw was probably the PCIs, as radiographers have a large role in the team. PCIs usually use a femoral (leg) or radial (forearm) artery to access the coronary arteries of the heart. Then through a 'sheath', a guide catheter is pushed to the opening of the coronary artery; this allows contrast (x-ray dye) to be injected into the artery. The size of the artery is then assessed to select what size balloon catheter will be used. The guide catheter is moved to the stenosis (narrowing), so the balloon catheter can inflate, forcing any 'plaque' to compress, and the arterial walls to expand.

I also saw a TAVI which involved a large team, and plenty of contrast to check the valve's operation. I watched as the valve was prepped, and the one I was lucky enough to see was made from hand-sewn strips, and formed from pig pericardium (a double-walled sac that contains the heart)! It's amazing how small the valves become before they're inserted, and then you get to see them deploy to their full size around the old valve site. Seeing the valve outside the body made me appreciate how much magnification is used in fluoroscopic imaging!

Unfortunately, there isn't too much I can say, as I only went to Cath Labs for 3 days, and it went by so quickly! And as a radiography student, we can only do so much in that department with our basic training. It seems I need to get used to the early mornings and placement again!

Next week I'm working the Late shifts over the weekend, but this time, not as a radiographer assistant, but as a student. So I'll probably have plenty to talk about!

Once again, sorry for the long delay, but I'm hoping to keep on track once more!

LLAP!

The January Exams Episode

January exams are over it seems...

Stardate: 92647

I know, I know, it's been forever since I made a post... well, nearly two months anyway, if I'm not mistaken. But I do have an entirely reasonable excuse why. During this last week, I have been studying like a demon for my three January exams that snuck up on me over the Christmas period. Apparently, being a second year is hard. No, I mean it. Really hard.

We had three exams, one for Research Stats (this module, ladies and gentlemen, I kid you not, is pure evil. Sauron himself probably would have agreed), Chest Commenting and Anatomy. No matter how much I tried to get my head around Research Stats, it would not sink in, and I have the horrible, foreboding feeling that I've failed the exam. Commenting by far was the exam I was most confident for, and Anatomy I tried to write loads and draw as many diagrams as I possibly could! All that, and I also had a Physics essay to hand in at the start of the assessment week. So, with all that, I'm knackered.

But now that it's all over, I get a nice weekend to myself, (even after doing a quick shift in my new job as an radiography assistant - woo!) where I don't have to think about anything. That is until Monday rolls around, and the early mornings begin again... you guessed it, placement is here again!

This time around is a 5-week block. I'm in ultrasound, A&E, CT, fluoroscopy and finally orthopaedics. So yes, I'm going to be nice and busy. I'm looking forward mainly to CT, as it'll be a new experience for me. But I'm having to start thinking about the dreaded assessments, which will be:

• GI Tract with contrast
• Circulatory/Renal/fluoroscopy examination with contrast
• MSK non-ambulant
• Extra-departmental chest x-ray (e.g. a portable)
• CT Head without contrast 

We'll see how it all turns out. But at least ultrasound will be slightly more relaxed than some other departments anyway. Hopefully they're nice to me on my birthday this Wednesday...

I'd better start looking at how ultrasound actually works...

LLAP!

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! 

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...