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!

Merry Christmas!

Well, I hope everyone had a great semester! I am ready for a little break before the Spring semester begins.

We've had a bit of a bad luck run on illness in CT. Several have been hit with the stomach flu. So, I figured it was my turn so I worked several hours tonight. I scanned several patients as the ER at Gateway was hopping! It's best to just think of that as job security. I scanned a elderly gentleman tonight that was s/p open heart surgery. He had a low hematocrit so there was some concern of hemorrhage. However, he also was having shortness of breath and some chest pain. The radiologist said that it was pleural effusions and had no mediastinal hemmorhage.

My other big time consuming patient was actually a 2 year-old. He had a cxr and it was normal. The other technologist wanted to call the radiologist and get the new CT chest order approved. I chose to take the other route and bring the patient/mom down and get a better history. I was able to use Epic, our new electronic medical record, to my advantage and checked the physician notes. There was no history that warranted scanning this child's chest. So, I called down and spoke with the nurse who then said that the order was entered incorrectly. As a technologist, we often feel unimportant..especially from nursing. Had I just performed the exam, I would have given the child unneccesary dose. Asking clarifying questions can save the technologist unneccesary work...but more importantly we must do what is right for the patient! The key here is treating the ER physician with some respect to make everyone's lives easier!

All in all, it was a nice change in pace. I worked last week at Main Campus, but was in charge so I didn't get to scan.

Merry Christmas to everyone!

CT Clinicals Update

I had no idea I would have something for everyone so soon! We had an interesting case that I got to follow through on beginning with the planning of the patient with the Radiologist's portion of the exam to the CT exam at the end. This patient was in the ICU and intubated and a request came down for a cervical myelogram. Most Radiologists perform their lumbar punctures with the patient prone so he wanted to have some senior tech involvement and the Team Leader for the area was off. So, I assisted. Below is a brief case study of the patient:


We received a 61 y/o male through the emergency room for a CT cervical spine among everything else ordered. He was alert and orientated and was responding to questions. However, he had tingling sensation to the nipple line, but was unable to feel anything from that point down. He suffered a 4 foot fall from a truck bed.

The exam was performed and it was noted that he had a significant C-3 fracture with significant offset. All other imaging studies were negative. After a short time in the emergency room, the patient's respiratory effort declined significantly and had to be intubated.

The following day a CT cervical myelogram was ordered. An attempt by the Radiologist was made, but due to equipment and patient condition a blind stick by the Neurosurgeon in the ICU was performed. The patient then returned to the CT suite to have post images performed.

I've attached the reformats performed and it shows a moderate to severe disc bulge. This certainly can be causing his paralysis.

Neurosurgeon re-evaluated patient and states he is ineligible for MRI due to pain stimulator implant. He will give the patient another day to recover and see him again to evaluate stability with flexion and extension movements. He also states that he has cord contusion that can resolve with some time.

Due to the numbness/tingling and inability to feel past that point the ED physician felt certain that there was a spine injury. These injuries can resolve on their own, with medications, or often require surgery to assist healing.

Update from Deaconess!

Well, things are very busy for me lately. Our new EMR has been implemented and like all new systems...there have been a few bumps in the road. I've had to spear-head collection of issues and assist in getting information out to staff. Lots of issues surrounding availability of reports in a timely manner.

Things are very busy in our CT and MRI departments after a brief lull. We are seeing flu symptoms of course, but have had a influx of trauma and broken bones as well. We have a new traumatologist at Deaconess and he is having us do lots of 3d images via our Tera Recon workstation now. So, we've been training everyone on those. Here is an example...

This was scanned at 2mm increments on our VCT 64 slice scanner. We then reformat an AP pelvis, and inlet and outlet views on every trauma for sure, but he'd like them for all ER pelvis exams. They are just a little time consuming so we haven't gotten that far yet. This particular patient had IV contrast for an abdomen as well and had a catheter in. It showed that really well! It's unbelievable the detail we get from our workstation.

I hope everyone has a great Thanksgiving!