Last Post for Clinicals

I hope everyone has had a great semester! I know that I am glad to get a little break for a couple of weeks!

I am attaching a CT head image after administration of 75 cc Omnipaque 350. We use a 3 minute delay for our heads. This patient, a 56 year old male, first came initially for a CT chest in March. He had been having some hemoptysis with little to no shortness of breath. The CT showed a left lung cavitary mass. We biopsied this mass in March and it came back positive for Stage IV adenocarcinoma. In April, we scanned him again and we found bone mets in his pelvis. In May, we repeated the scan and found bilateral metastatic adrenal lesions. Now, the patient presents back to us while undergoing radiation and we perform the CT head and find mets to his brain. The report reads that there is a 2.5 cm left cerebellar mass with moderate effacement of the fourth ventrile. No hydrocephalus.

This is the great thing about working in CT, and also the hardest. These patients once they keep coming over and over become like family. It's hard to see them deteriorate and then pass. But, we have such an ability to impact their last days in making more tests easier to bear. We have an opportunity to ask them about their family and fun things they would like to do. Once, one of our cancer patients brought back seashells from the beach. This trip to Florida was her last wish that her family fulfilled. It meant so much to the staff that she shared that with them. We, as healthcare workers, often don't realize how much we can impact a patient's outcome just in helping keep spirits up.

I hope everyone enjoys the rest of their classes, this is my last clinical class.

Susan Brumley

CT Radiation Dose

As everyone is aware, CT dose is a hot topic in the layperson media along the ACR and other Radiology journals. At Deaconess, we try very hard to keep up with current best practices. Recently, the CT Team Leader and myself listened in on a webinar regarding CT dose and how to reduce it. We actually realized during this national webinar, that we...in little Evansville, IN are doing what many larger institutions are doing. We've done alot surrounding radiation safety to ensure the public is safely receiving adequate CT studies.

We have done recently:

*Looked at all of our protocols-per scanner. One particular Radiologist has taken ownership and we run all of our protocols through him.

*Developed a CT Dose Audit tool. We actually take this audit tool and place it at the controls for the scanner and the technologist must record the dose from the CT Dose report that is attached to every CT exam and sent to PACS. This makes the technologist think about radiation dose as they audit.

*Radiologist helped determine "normal ranges" for the dose audits. In doing our audits, we found that our CT Sinus/Face protocol could be realistically tweaked down a bit on one particular scanner without sacrificing quality images.

*We've made a huge stride to shield as much as possible. Attached you will see an image using a breast shield. The breast shields are great and they cause very little artifact while saving the female breast tissue a huge dose.

*Radiologist is going to do a "Grand Rounds" at Deaconess for Medical Staff so that MD's are educated on CT Radiation dose and what exams are best for what diagnoses.

All of these things are actually reported out to our Radiation Safety Committee quarterly so that they know at what lengths our department is going to keep our patients safe!

Deaconess Update

We've had a very busy start to our work week...or at least it felt that way! Our scanner went down overnight and today was a bit chaotic to start. It turns out that we've had some air conditioning problems in our VCT room. This is our 64 slice scanner and it puts some heat out! We use it all the time and it just doesn't really get a break, even at night. So, we had to call engineering and maintenance and get it taken care of. Apparently, the ducts had not been cleaned out for quite some time causing the air conditioning to not work the best. But, by 1030 am we were all cooled down and running smoothly again!!!

Clinicals Update

We've been really busy the past few weeks in the CT department at Main and Gateway. Yesterday we were hopping from the ER all day! We had a gentleman with a history of a fall come over for a CT chest, abdomen and pelvis. Of course, we were looking for trauma related pathology, but unfortunately, the patient ended up with an abnormal lesion in his chest. The fall of course is bad, but it could have saved his life! He was asymptomatic and had no cancer history. The radiologist recommended a biopsy so I am sure that we will be seeing him back in a few weeks once he has healed up from his fall.

Clinical Update

Hello all! I hope everyone is having a great semester. Things are moving along for me. Our hospital is beginning to ramp up for our HFAP survey. HFAP is a hospital accreditation similar to JCAHO. Many hospitals are moving to this type of survey. Right now we are really working hard on our Stroke Indicators. With our Stroke Certification we must do alot of PI (performance indicators) to show what our turn around times are. I am given a list of patients that coded out as a stroke and then must audit their charts for their CT head or CTA head results and then also their CXR's. We are supposed to have results to the ordering physician in 45 minutes. For the most part, we are very good at what we do. CT is a well-oiled machine in most cases. Of course, there are always an outlier or two that needs a little research. It helps alot that I still go back and watch staff and scan. It is a huge help to get buy in from staff and also to develop policies that actually work.

Hello All

Happy Clinicals! My name is Susan Brumley for those who may not know me. I am the department manager for Deaconess Hospital, Gateway Hospital, and Deaconess Clinic. I have been a CT technologist for about 13 years now. I passed my boards finally last April...just decided I needed to do it! I can't expect my CT staff to take a board exam if I don't.

I am running a bit late this semester! We've had a busy past few weeks at Deaconess in managment and staffing. We had a routine unnannounced inspection from the Indiana State Board of Health. I am happy to say that the Radiology department passed with flying colors! The surveyors complimented our staff on how helpful and knowledgeable they were. Then, as that was drawing to a close, the NRC walked in! Boy, was I nervous. I had not gone through this type of rigorous inspection before and our previous RSO had taken a new job not two months previous. So, needless to say I was nervous about how things would play out. But, again, our staff did a tremendous job. The surveyor was extremely detailed and interviewed every technologist and team leader including myself. But, we did a wonderful job and there were no citations or recommendations. This was a real test in leadership for me, and I feel like if I can go through an NRC and State inpection on the same day...I can probably handle anything!

Update to Clinicals

Well...this has been a crazy week, to say the least! CT at both Main and Gateway have been extremely busy. Thursday we had a code called at the Main campus in CT. He was a 72 year-old gentleman from a regular medical telemetry bed. He was getting a CT Head without contrast due to altered mental status. We noticed he was very uneasy and unsettled while we were transferring him to the table. He then just wouldn't hold still, but after repeating the first axial group, we got what we needed after we shortened the scan time. As we entered the room, we noticed he had turned gray and was not breathing. We knew that the family down here were discussing his code status, but with no official changes in the chart, we called the code. Immediately, we had much help. Due to the fact we had an ICU patient down in another room, the ICU nurse jumped right and started compressions. I think everyone was glad that she happened to be there! After some work, the team got him back and transferred him to ICU. As we were completing this...the trauma pager went off. I guess when it rains, it pours. The trauma was a 20 year old who was cutting limbs and a limb came back and hit him in the face and then knocked him off the ladder...he did some major damage to his face and caused a SDH.

Friday, our scanner at Gateway went down again. So, I went over there to help with any issues with the ER and to make sure service was on it. It went down during a bone biopsy, but luckily the needle wasn't placed. We had to move him and then work on the 6 ER orders that we had before we could get the biopsy going again.

The biopsy patient was a 56 year old male with hepatocellular carcinoma with metatstatic disease. He now presented with terrible pain and CT showed that the disease had infiltrated his bone. The radiologist was asked to perform a right iliac wing bone biopsy. Believe it or not, it went very well. He made 3 passes in to the bone and the pathologist said that we had an excellent specimen. I've included an image that shows the needle location while we were passing through.

Update to Clinicals

Well, thankfully, the pregnancy season is closely coming to an end in the CT department. We have had 4 maternity leaves all spaced about 3 weeks apart. The second technologist returned this past week and I have one more returning on April 5th. While it is stressful for all involved, it is nice to stay closely in tune with the department. CT at Main and Gateway are two of the busiest departments in the Radiology department. We average about 4000-4500 scans per month, and to be honest, that is down a little bit from last year. I worked this past Friday evening to give some relief to my Team Leader. As we all know CT dose is a hot topic. I had an OP present to the department for a CT stone protocol. When I went in to look at his record I noticed that he'd had 3 separate scans in the past 5 weeks. I thought that was odd that a urologist would order yet another scan only a week later. So, I phoned the physician. It puts the technologist in a precarious position to actually ask the practioner..."Are you sure you really want this?", but this patient was only 35 so I figured it was better to err on the side of caution. It turned out that the patient was scheduled in error. He was supposed to get it in 30 days after his lithotripsy! So, I was glad that I put a little time into it and saved the guy $2,000 and unnecessary radiation.

Clinicals Update

Here at Deaconess Hospital we have a Level II trauma certification. We had a category II come in while I was working. Category I activations are the most severe activations that require alot of accurate QA documentation. Category II's are a little lower level of trauma activation. Above are some images from a recent category II. This patient was a 70 year-old female who was a restrained passenger. The car was T-boned. She was airlifted to Deaconess from Illinois on March 1st.

She had multiple displaced rib fractures, a large right pneumothorax, and a hematoma to her RLQ anteriorly. She also had a Grade I liver laceration. Luckily, she had no head injuries or spinal injuries. The patient had chest tubes placed in the ER and was transferred to Trauma ICU. Her liver laceration was monitored while in the ICU as it was not deemed surgical at the time of admission.

Update to Clinicals

Things are going fairly well so far for CT at Deaconess. We are very busy with Inpatient work these days and of course Outpatients. We have several technologists that are off due to maternity leaves so that leaves us a little short handed. I have to say, the group has risen to the occasion and things are going just fine.

I helped out Saturday due to our physician order entry portion of our EMR going live. So, I assisted where needed and scanned at Gateway. I scanned an older gentleman who had an abnormal bone scan the day prior. So, we were looking for metastatic disease. An unfortunately, there were mets everywhere. The report showed a spiculated LLL lung nodule and also metastatic disease to the thoracic vertebral bodies and rib fractures...all which are pathologic in nature. I have attached a sagittal reformatted image of the lytic lesions to the vertebral bodies.

Welcome back everyone!

Hello!
For those of you new this semester, my name is Susan Brumley. I am a supervisor at Deaconess Hospital and Gateway Hospital. I passed my boards in CT this year...a long time goal for me! My next goal was to then finish my bachelor's degree. I manage the CT, MRI, and Diagnostic modalities at both campuses.

I am married and have 6 kids. Yes, I did say 6...I didn't give birth to them all, but I claim them! The four older kids are off in college or on their own. We have two younger children at home, age 7 and 2. Between work, school, and kids I really don't have much time for anything else. But, I love to shop, read, and watch movies. We also love soccer and spend a good amount of time on the field.

Have a great semester!