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>

Return of the Placement!

As insane as it sounds, it's slightly true.

Stardate: 91659.59

So, I'm back out on placement already, and my first day started off in a bit of a panic. Why? Well, because I thought it was okay to not check the TLD (Thermoluminescent dosimetry) I was handed before getting the train to placement. As a result, I found out I had the wrong TLD, which brought forward the looming possibility of not being able to go on placement until I had the correct one, which could take up to 3 days...

Luckily, the Radiation Supervisor and my clinical tutor said that one not having a TLD for a couple of days wouldn't be a major risk... unless something drastic happened. So I decided to risk it and get on placement anyway.

I was glad that I did. I managed to get lots of examinations for my portfolio signed off, mainly chest x-rays, because there weren't many portable examinations being requested. I saw some interesting departments like Oncology and ICU, and was glad to find out I hadn't forgotten everything since last year, which I consider to be a bonus. There were one or two situations that happened involving fainting patients and the like, but it was all good experience, and you learn from them quickly. Being in the department with other students can be helpful as looking at each others x-rays is fun, and good practice, as you get to see some pretty amazing things, and wince in unison at some painful ones.

I'm hoping that tomorrow I get to go into theatre, because tomorrow happens to be my birthday, and I want it to be interesting. I don't tend to make a big deal about them, but being the strange person I am, I think it'd be great fun to get some time in theatre to learn how the techniques are adapted to different cases. And who doesn't like a bit of gore now and then?

As for spare time, in between what little sleep I tend to get and now being out on clinical, I've started doing an online Forensic Science course, which entails studying the field using a 'Murder on the Loch' case study, while I sit happily listening to Mozart. It's fascinating, and as it's linked to what I want to do in the future, some of the material slots in nicely. It seems one has gone back into her geeky-recluse mode once more...

LLAP and the game is now most definitely on.

References

1. Sherlock and Violins, n.d. photograph, viewed 20 January 2012 <https://i.chzbgr.com/maxW500/6564377344/hBA076E54/>

Happy Belated Christmas and New Year!

This is how my Christmas and New Year holiday generally looked. Except I had piles of textbooks around me...

Stardate: 91629.78

As the title says, despite their belatedness, Happy Christmas and New Year!

Well, it has been a while since I wrote an entry, but I am putting that down to three things:

• an incredibly evil essay my year had to write for the Learning Together, Working Together module (3,000 words of pain)
• part-time work (Boxing Day sales how I loathe thee!)
• and finally fatigue and anti-social tendencies

Yes, it's true, when an essay rolls around, I tend to either disappear into the ether until it's finished, or I pretend it doesn't exist and leave it until I have around three weeks left to complete it. I managed to hole myself up in my living room with piles of textbooks and handwritten notes surrounding me, with a vast quantity of tabs in Chrome detailing journal articles open on my laptop. But, it is done and I can breathe once more. Well, this is me we're talking about, so probably not. As I'm writing this I've got a textbook on 'Comprehensive Radiographic Pathology' open next to me, with post-it notes stuck everywhere. Hey-ho.

So, how do I summarise my first semester with the University of Leeds? Overall, it was highly enjoyable and eye-opening, and I'm looking forward to some new course material to return to. I survived my first three week placement block (just about), and I feel like I learnt a great deal. I applied to be a student rep alongside another student, so the pair of us will try our best to get our cohort's concerns and thoughts heard. What else... oh yes, I definitely decided I want to become a Forensic Radiographer. We all know how I like a good challenge (or that mind-numbing boredom sets in), and I believe this will be the perfect one for me.

We received a whole year rota for our clinical placement blocks (well, the students at my placement did anyway), and I have a nice mix coming up. For my two-week January placement (on my birthday! Woe is me!) I'll be in Mobiles & Theatre in week one (hopefully I won't faint this time), and general X-ray for week two, so that'll be a nice opportunity to get the clinical experience portfolio filled in. Roll on early morning starts, cafeteria food and waiting for ages in the cold for a bus.

Semester 2 technically starts again on Monday, but it's our assessment week, and as we only had that one essay from Hell, we're hoping for an extra week off. So our real semester starts the week of my birthday, from January 20th. Which begins with two weeks of placement.

Hopefully this semester is even better than the first.

The game is on! (LLAP)

References

1. Festive Sherlock, n.d. photograph, viewed 9 January 2014 <http://31.media.tumblr.com/tumblr_mde23g8rXR1rnw4hro1_500.png>.

First Placement Week 101

When you've been sat around for a good hour with no request cards, this is your face when a patient appears.

Stardate: 91484.54

Well, first off, my placement's okay. It's a little boring at times (probably because nobody knows where anything is except the hospitals, chip shop and the Sainsbury's Local) but everyone staying there has become part of the 'Family' (and we've all just been watching 'I'm a Celebrity' together after coming back from our homes). I'm even making an effort at socialising like a normal person, you'll be pleased to know. Completely out of character for a geeky recluse like myself, I know! 

Our rooms are a little basic, and we can only use the internet for e-mail and studying (hahahaha)... even though I was sneaky and watched 'Dexter' on Netflix... because otherwise I'd have died of boredom. I'm missing vegetables, so made sure I'd eaten a load this weekend before coming back. The previous week I was surviving on cheap ready meals and noodles, as after placement no-one can be bothered to cook anything real (I mean come on, we're students).

So, what was I doing for my first week? Well, I spent a week in general x-ray... Yes, it can be a little slow, especially in the early morning, when there are no request cards coming through. You find yourself cleaning cassettes, surfaces, your hands, actually reading your textbooks and reading through the hospital policies to fill your time. But just around half nine, requests came flooding in, and the range I got to see was brilliant. Hands, feet, chests, spines, abdomens... everything, really! You see so many examinations, that you begin to memorise the routine and technique. That's when I felt that I wanted to get stuck in and have a go myself.

The hospital I'm based at is really nice and a good environment to be in. The radiographers teach us so much, and love showing us everything and let us have a go while they explain stuff, though one has a penchant for appearing out of nowhere and quizzing us suddenly. Patients are all really nice too when they find out you're a student, but you need to be confident, or they're less than enthusiastic. Some say "keep t'up, love, and you'll be 'reet" (as some people of the North tend to sound like, of course!)

I've done my first two formal x-ray examinations (not just practice ones): both hands at once, then the two thumbs (5 x-rays for one patient), and then two thumb x-rays (for one patient). My supervising radiographer was really pleased and told me to put them in my portfolio straight away. So I'm learning loads really quickly. I'm also now my year group's student rep, so I'm getting loads done involvement-wise, too. I have to go to meetings etc. Some may think I'm biting off more than I can chew... but I do enjoy a good challenge.

The only advice I can give about your first week of placement? Go prepared. Go through some basic positioning techniques, practice talking to patients, be ready to just get involved. Radiographers don't have the time for students who can't be bothered. Make them want to help you!

I'd better get off to bed, I'm in A&E this week, and I'm pretty sure I'll be needing all the sleep I can get!

LLAP and Allons-y!

Happy World Radiography Day!

Source: http://www.sor.org/about-radiography/world-radiography-day

Stardate: 91459.52

Firstly, as you may have gathered from the above picture, today is World Radiography Day. Today marks the anniversary of the discovery of x-radiation by Wilhelm Röntgen in 1895 `. The day is basically to help promote radiography as a career and to increase public awareness. It's also of course for radiographers to show how proud they are of their profession!

Because it was World Radiography Day, I decided it would be the opportune moment to ask one of our lecturers (who also works as a Forensic Radiographer) how you would go about getting into Forensic Radiography post-registration. Unfortunately, not many places allow it to be chosen as an elective, so I would need to start asking around and finding out about it now, in order to get as much information on it as possible. Membership to the IAFR (International Association of Forensic Radiographers apparently costs a bit now, and there aren't too many people to ask, but luckily I have my lecturer and one of the radiographers on placement who is also a Forensic Radiographer too.

As long as I can pick their brains and gain some hints and things to check out, I'll be okay. According to my lecturer, if you put brie, pork and liver in a box somewhere warm, leave it for a fortnight, then open it up, once you've stopped throwing up, you'll then know whether you want to be a Forensic Radiographer or not. But, despite that, the work is interesting and fun. I still like to think it is for me, even if that does sound unpleasant!

Aside from that, spread the love for Radiography! All of it thanks to Wilhelm Röntgen.

Two days until I move to my placement site...

LLAP!

References

1. Society of Radiographers, 2013, photograph, viewed 8 November 2013 <http://www.sor.org/sites/default/files/images/wrd_2013_logo_web.jpg>

A Day in General X-Ray

We've not even been on a full week of clinical placement yet, and this has become so true!

Stardate: 91457.12

Another week down, and I've had another clinical placement visit! Not only that, but as of Sunday, I'll be living away from Leeds for 3 weeks while the first full placement period comes up. Nervous, moi?

This time, I was on the rota for General X-Ray, which of course can only mean chest x-rays galore! Despite being under the impression X-Ray departments tend to be very busy, the morning was quite slow, and was definitely all chest x-rays, so you get used to positioning for them really fast. Everyone's body is different, but the technique very rarely strays from the norm.

I also witnessed a good variation of hands, knees, and spinal x-rays, but this was all mixed in with lots of standing around and looking completely clueless while the qualified radiographers chatted between one another and assessed each others images.

The two most exciting occurrences of the day turned out to be a doctor with a piece of wine glass left over in his finger, and a police-accompanied patient. Apparently, it's all in a day's work! To keep myself busy on the other hand, a classmate and I tried to ask as many questions to the radiographers as possible. This varied from "What does this abbreviation mean?" "Why have you increased the kV?" "What are these marks/spots/dots on the image here?" "Do you want me to process the cassette?" to "Do you need me to clean anything?" Basically, anything to prevent myself from standing around.

I've noticed that if you observe enough examinations, you quickly learn the standard kV and mAs (exposure) levels. Our clinical tutor's advice to us was to carry around a little pocket notebook, to keep on hand what we'd learnt that day that would relate to anything we'd need later on. Stupidly, I forgot mine, but I do remember that a standard average male chest x-ray exposure is 60kV at 10mAs, but a female's is 60kV at 8mAs (don't worry, it will possibly make sense one day), and I also remembered that SUFE stands for Slipped Upper Femoral Epiphysis. Not bad, I suppose!

Anyway, I did enjoy my second day, though it didn't exactly live up to my fainting first day! I can't wait to get to the full placement blocks, but I'm definitely worried about moving into another new home! I'm sure I'll manage, and hopefully finding my way to the satellite sites at some point will be smooth and not too difficult and frightening!

Also, the image above happens to be my own design... I'm quite proud of it did you know (despite it not being amazing)

LLAP!