Ultrasound - Not Just Babies!

  An ultrasound scan for the thyroid gland.

Stardate: 92672.31

Last week saw me in the hospital's various ultrasound departments: general, obstetric, paediatric and vascular. Despite my initial reservations and disinterest in ultrasound, I actually really enjoyed my week there. At first, I tried to read up on basic anatomical appearances, and how ultrasound images were produced, including the physics and which transducers (probes) were used for which examinations etc. But I'm going to leave that for another post... 

From my basic understanding, I started to get the hang of it all, and could get my head around what position the transducer was in when I observed examinations. I even got to have a go in some departments, where I managed to scan a kidney, my own thyroid gland, and finally an abdominal aortic aneurysm (AAA).

In the general department, the examinations are mainly musculoskeletal and some gynaecological procedures. Obstetric is the most famous ultrasound department, as it's where a multitude of women go for their pregnancy dating, 12-week and 20-week scans. Usually the 20-week scan is an anatomy check, as well as to check the sex of the baby (if the parents want to know what they're having). Paediatric is of course the children's department of ultrasound. And finally, Vascular is where all the circulatory system investigations occur.

Anatomy on ultrasound scans takes a little bit longer to get your head around than general x-ray anatomy, but once you've witnessed a few scans, you start to recognise certain structures and their appearances. If I do take anything away with me from my week, it is that fluid always look black and veins, in comparison to arteries, are compressible. Which is how sonographers test for DVT (Deep Vein Thrombosis).

As ultrasound has such a wide range of examinations and procedures, I couldn't really pinpoint one I wanted to talk about in detail that would fit into this post nicely, so I'll possibly put one up soon after some serious consideration! There were plenty I witnessed where I wouldn't mind looking further into them.

Out of all the departments I visited, the most interesting I found to be was Vascular, but each department has its own intrigue. Being placed in ultrasound has certainly changed my attitude towards the modality, and I actually wouldn't mind going there again. Some students find it boring, but if you ask plenty of questions and try to look into image production and anatomy before you go, there's less chance you'll be confused, and will be able to identify what you're actually looking at!

This week I'm in A&E, but I'm working alongside the first-years, so now I have to look like I actually know what I'm doing! I've also started my radiography assistant job, so you may start seeing posts about doing part-time work alongside the course cropping up!

LLAP guys!

References

1. Diagnostic Ultrasound Scan, n.d. photograph, viewed 25 January 2015 <http://www.ultrasoundnow.co.uk/wp-content/uploads/2012/01/shutterstock_82853839.jpg>.

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! 

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!