Radiology Mid-Term

We had our radiology (x-ray) mid-term last week.  I think I did reasonably well, at least on the practical portion.  I’m not as confident about my performance on the evaluation of the x-rays and the other questions.  Our test was two pages – the first page was a checklist of things we needed to do on the practical portion and the second was questions about evaluating x-rays, positioning, technique, safety, and the like.

Before our test, I read through the checklist for the practical portion to see what exactly she was going to watch for and to remind myself of any little details I may have otherwise forgotten.  This sheet had to be handed to our instructor when we did our practical portion so she could check off whether or not we did each step.  To start, each of us had to draw (as in take a piece of paper out of a cup, not as in sketch with a pencil) a “view” (body part and position).  We then had to take an x-ray of whichever body part and view we drew.   I drew the lateral elbow, which made me a bit nervous (lateral means the image is taken with the animal on its side, as opposed to on its back or stomach).  I was hoping for a view I was more confident with, such as lateral chest.  Oh, well.  I did the best I could and I think I remembered my procedures pretty well.  I just couldn’t remember if the elbow was considered an extremity or part of the shoulder girdle for purposes of x-ray technique.  I finally determined (mostly hoped, actually) it should be considered an extremity, though I paused to think again before I actually shot the x-ray.

Whether or not the body part is considered an extremity is important for determing settings on the x-ray machine.  Shooting (taking a picture of) an extremity requires you to place the x-ray cassette between the x-ray table and the patient.  For most other body part, you to put the x-ray cassette in a tray below the table.  The location of the cassette determines the position of the x-ray tube (the part that produces the x-rays) and the settings used.

Developing the x-ray I took was a cake walk.  It’s a relatively simple process: make sure the regular lights are off and red lights are one, remove the film from the cassette, stick the corner in the photo-imprinter and expose it so it will be permanently identified, stick the film in the developing machine, then re-load the cassette.   After the image is done processing, in about three minutes, it will spit out your x-ray.  It’s peachy.

When I reviewed the practical portion with my instructor, she pointed out two things I missed: labeling which leg I was x-raying and measuring incorrectly.  While prepping, I had actually pulled out the little lead “R”, but I forgot to actually put it on the cassette.  When I measured the dog’s leg before taking the x-ray (to determine what settings to use), I measured the left leg then took a picture of the right leg.  Oops.  In this case, it ended up not mattering, but if I had a dog with a very swollen right elbow and adjusted my exposure settings for the non-swollen left elbow, I could have ended up needing to re-take the x-ray.

The “book smarts” portion of the test wasn’t too difficult but there were a few things I wasn’t confident about.  One question asked for the boundaries for a particular view – which body parts we needed to make sure we could see to ensure we had the entire body part of interest in there and the others were about technique.  There are a few different ways to change the quality of an x-ray and I’m still having trouble determining which setting needs to be adjusted when.  I’m not entirely confident that I did well on the technique evaluation portion.  There are two (well, three, but for purposes of technique we talk about two) settings you can adjust to alter your technique.  One setting adjusts how many x-rays the machine produces and the other adjust how fast they go.  The trick is determining which one needs to be adjusted if your x-ray doesn’t turn out as well as you needed it to.  It’s becoming more clear to me, but I still need some more practice evaluating x-rays and determining what should be changed to improve them.

I’m anxious to see how I did on the test.  I will get my grade next Friday, unless I remember to e-mail my instructor before then, in which case I’ll have it sooner.  Unless I completely screwed up on my technique evaluation, I don’t expect that I will get anything lower than a B (though I’m hoping for an A of some sort).  We shall see…

An just for fun, here’s an x-ray of an anteater I found while browsing xrays on flickr tonight (and I thought my Collie had a long nose!).  The round object you see around the anteater’s nose on the left side of the image is the mask for administering anesthesia and oxygen.  The white object above the nose is a lead marker used to identify which side or part of the animal was x-rayed, since you can’t tell which side is which when looking at an x-ray.

Image sources: ten safe frogs & lhooq38

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