Final Clinical Post

As I was preparing to write this blog I was thinking about how far I have come in the past year. Last year at this time I was preparing to start my clinicals. I was nervous and unsure if I would really be able to learn it all. I had many frustrating days when I thought I would never be able to remember it all. Now I am able to scan on my own confidently. Even exams I have not done before I am able to understand the concept of the planes and ask questions prior to the patient arriving so I am able to scan confidently on my own. I never thought this would have been possible. I feel that I have learned a great deal and know that I will continue learning every day. I would still like to be able to identify pathology a better as well as recognize what additional scans our radiologists would like with certain pathology, but I know this will come in time. I am anxious now to take my boards in a few months!

Clinical Experience

I made my first large mistake in MRI this week. I have scanned my first post arthrogram knee on Monday. I could tell there was fluid in the knee, and assumed that it was contrast. I scanned to entire protocol and let the patient go. The patient was a STAT read and had an immediate follow up appointment with his ordering doctor. I sent the images to the radiologist reading and called to let him know that I was sending him a STAT case. I changed the table coil and got my next patient dressed and positioned for their scan. When I came back to the scan computer I had a message. I listened to it and it was from the radiologist reading stating that there was no contrast in the knee and to call him back. He seemed irritated. I went and got the lead tech, asking that she come look at the images and explain how their wasn't contrast in the knee. She looked at the images and explained that on 3 of the series the fluid was not quite as bright at it should be, but that it was a tough one to tell because there was definitely fluid in the knee joint. I called the radiologist, and by this point he had already contacted the reffering office to let them know. He informed me that it was still a diagnostic exam and there was no need for the patient to return for additional imaging or re-injection. He wanted me to know that for future arthrograms what to look for. I was fortunate that he was very friendly and explained the situation without getting upset with me. I will definitely learn from my mistake!

MRI CLINICALS

I had my first experience with a contrast reaction this week. Luckily it was not very severe, but it was still very scary. I had a patient in her early seventies for an ankle without and with contrast. I had to do several scans on her prior to contrast. I also had to do a GFR check on her to confirm her kidneys were function appropriately, and that she could have contrast. Her GFR came back within normal range. I injected 19cc of omniscan. During and immediately following the injection she stated she felt fine. I advanced her back into the scanner and left the scan room. After the first post contrast series ran, the patient squeezed the emergency ball. I asked her if she was alright, she said she was having trouble breathing and started coughing uncontrollably. I rushed into the room. I sent a co-worker to get out lead tech immediately. I brought the table to ground level and had to patient sit up. She said she felt her throat was swelling and she was having trouble breathing. At this time the lead tech, along with the other four techs in the building and the doctor entered the MRI area. The doctor said to bring the patient out of the scan room and he would evaluate her. He listened to her heart and breathing and said she was most likely having anxiety because she sounded fine. Even with this said we monitored her pulse and oxygen, and started an IV. We had oxygen ready next to her. The doctor administered 25mg of benadryl. The patient continued to feel swelling of her throat on and off. The radiologist reading the images was contacted because he was at a different center. He stated that he did not want us to finish the scan, he had adequate information to make a diagnosis. We continued to monitor the patient for 35 more minutes. We had her call a friend to drive her home and stay with her for several hours following her reaction. The patient felt fine but had slightly elevated blood pressure when we released her. I had to document everything as a patient incident report and send it to our HR department. While this was a minor reaction, it is very rare to even see a reaction in MRI. My lead tech has been scanning in MRI for over 10 years and this was only her second reaction she has seen. I hope that I will not see another one for at least 10 years, never again would be preferred.

MRI CLINICALS

I scanned a brachial plexus yesterday. The patient received contrast for this exam because he had a history of a tumor removed from the lateral axillary area one year ago. Because of the location of the area of interest we had to increase our field of view, change our centering to lower and more lateral, and also increase the slices of many of the series. Our routine brachial plexus has very long scans to begin with, so when we began changing parameters the scans became even longer, some over six minutes. The patient was very cooperative. After contrast we ran scans in all three plains with additional fat saturated images in the coronal plane. From what I could tell the tumor had not returned. This was a good learning experience because it was not a typical brachial plexus. I had to use critical thinking to modify the scans to meet the needs of the radiologist, so that he could give an accurate diagnosis.

Clinical Experiences

Thinking back over the past few weeks, two exams stick out in my mind as memorable learning experiences. Those are elbow and soft tissue neck. Seems that in my past several months of clincicals I have not seen very many elbow exams. However, in the past month I have been able to scan several elbows. I have been fortunate enough that all my patients have been able to lay in the preferred position, on their back with their arm extended over head in a knee coil. With that said, just because their arms have all been in the same general position, the actual position of the elbow has varied in each exam. This is due to the ability to rotate the arm comfortably and also the individual anatomy of the patient. I always think back to my original learning experience with elbows- scanning an apple. This allows me to remember that just because my localizer may say that the anatomy is in a specific plane may not really mean it truly is in that plane. I have become comfortable differentiating the planes and setting up accordingly for each scan. I actually am starting to enjoy elbow scans and not be so nervous about them. Soft tissue neck was an exam that I had not seen or scanned in MRI until two weeks ago. I was able to review the scan set up and protocol with two experienced technologists the evening prior to the scan. While doing the scan I was the only MRI technologist in the building, which made me slightly nervous. Luckily because the patient received contrast, the radiologist was in the building, which happened to be the radiologist reading the exam. He was very friendly and willing to teach me about the lymph nodes and blood vessel being imaged and how to differentiate between them. He watched me set the scans up and explained why they were set up that way. I am grateful for his patience and his willingness to help me understand the scan.

Summer Clinicals Introduction

Hello. Looks like there is a combo of new and existing clinical students in this class. This is my final semster of clinicals. I work as a MRI tech and a special procedures tech at an outpatient imaging center in Greenwood. I am looking forward to finishing up my clinicals and taking my MRI registry this fall. As a requirement for my work I must take it by December. I wish everyone luck this semester!

Clinical Experience

Looking back over this semester of clinicals, I realize how much I have learned and how my skills have developed. I am comfortable scanning a large variety of exams. I have learned to identify most anatomy and some pathology. I feel that because of my time spent scanning and the knowledge I have from procedures, I will be able to confidently take my MRI registry by the end of this year.