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!

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!