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!