"We can't x-ray him, he's too big!"...This was a statement I had from a radiology student earlier today when approached with an abdominal x-ray on a morbidly obese patient. My answer? "Too bad, figure it out". Yes, the patient was on the upper end of 400 pounds, and yes, he was extremely difficult to radiograph, however, it had to be done. All too often a student (or even a seasoned technologist for that matter) will come to wits end on a proper approach to imaging the morbidly obese, and sadly, sometimes the patient's life can depend on the quality and, in turn, the interpretation of that radiograph. This is becoming a looming issue in our field and unfortunately the issue isn't going away.
According to the CDC, about one-third of U.S. adults (33.8%) are obese and approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese. During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2010, no state had a prevalence of obesity less than 20%. Thirty-six states had a prevalence of 25% or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30% or more.
The problem with having an obesity epidemic is having obesity-related diseases. Obesity-related morbidity encompasses a large number of disorders, including: type II diabetes, dyslipidemias, hypertension and cardiovascular disorders, hepatobiliary disease, osteoarthritis, sleep apnea,and even certain malignancies (endometrial, breast, and colon cancer). This is where our job comes into play. We are continuously required to image these people, and sometimes we don't have a clue on how to approach it. I typically try to appeal to the general public on this blog, but this is where I may lose you. If you don't know the difference between a KUB and kVp, you may continue reading, but you'll probably want to pick up an issue of Bontrager's Positioning for Radiography book. If you're a seasoned technologist, this might not be a bad "refresher" course. If you are a student, this should be considered required reading. Enjoy.
The biggest issue we have as an x-ray technologist is simply getting the patient on the imaging table. The key is to have a lot people for "lifting help" and to use an ergonomically practical approach. If gathering a few people to give you a hand isn't realistic, your imaging facility needs to have some sort of protocol for transporting heavy patients, whether it's using a lift of some sort or taking an alternate approach. If you're simply unable to transport the patient to the imaging table, an all too often used solution may be to image the patient with a mobile x-ray machine in their bed.
Once the transport issue has been resolved, another question typically arises. How do we radiograph someone that we simply can't penetrate? Well the answer to that question is a basic step that we learned in the very beginning of our training. Out of all the factors utilized in performing a radiograph, the most important for improving penetration is to increase our kVp. Obviously increasing our kVp will have extenuating circumstances with risks that we must carefully weigh against the rewards of a diagnostic image. With a higher kVp comes MUCH more scatter photons that will dramatically lower the image contrast. Remember to implement a grid if the subject thickness is greater than 10 cm and when using a kVp greater than 70 (which will typically be the case when imaging larger patients).
Once an adequate kVp has been determined, the mAs will most likely also need to be increased. Due to increased subject absorption and attenuation of the x-ray beam, the "quantity" of the x-ray beam will need to be compensated for. The compromise of having a long exposure time will also require you to increase your mA. The goal should be to use the shortest exposure time possible...because it's still going to be long (we just don't want it to be THAT long). If we can cut down on the motion artifacts caused by a long exposure, we can dramatically improve an already inferior image quality.
A couple other quick tips that might help are to increase your film-screen speed (if that's an option), make sure to be on your game with collimation and consider decreasing source-to-image distance. An increased film-screen speed can dramatically decrease the amount of mAs required which will make your life a million times easier (this may not be an option in a digital imaging setting). You will increase image contrast, lower your exposure time, and limit your motion artifacts. Once again, image resolution will be the expense but chances are, if you're resorting to using a higher film-speed screen, image resolution will be one of your lower priorities.
As with any radiograph, tight collimation is essential to producing a quality image. When imaging an obese patient, the importance of good collimation cannot be overstated. We all know that the larger the patient, the more scatter photons are produced. The easiest way to avert that is to limit the field of view in which the photons are being emitted. This will increase your image contrast considerably, especially with the use of a grid. Your image density will be compromised a little, but the density you get from scatter radiation is only deteriorating the quality of the image anyhow. This is a very good tip that is typically an oversight when imaging "in a hurry".
The next step, and hopefully the last one is to decrease your source-to-image distance. This is something that you'll NEVER see recommended in a text book and this is something that a radiography instructor would scoff at, however, I'm looking for real world solutions, and it works. Yes, bringing the tube closer to the patient WILL increase absorbed dose, and yes, you WILL be going against everything you ever learned by the "never shoot anything at less than 40 inches" rule that's been ingrained in you since you donned your first pair of brand new scrubs, BUT...IT WORKS. When making this recommendation to the student today he responded, "That doesn't quite follow ALARA radiation (As Low As Reasonably Achievable) principles". I responded with "Well let's repeat these x-rays 4 or 5 times at 40 inches and calculate the absorbed dose versus one exposure at 34 inches...I'm pretty sure an RSO (Radiation Safety Officer) would be proud of my defiance of your ALARA principles." By following the inverse square law, you will increase your image density considerably, which may be limited depending on the type of x-ray machine you're using. Just a quick disclaimer, this would absolutely be your last resort.
These are all my tips and tricks on how to get a quality image on a very large patient. This particular patient habitus seems to be increasing in the population faster than the technology to image them is produced. Until an x-ray machine manufacturer comes up with a more practical approach, this is the one I'll use. I hope I've helped solve one of the "big" problems in our field.
Curtis J. Carpenter R.T. (R)(CT)
Wednesday, November 2, 2011
Sunday, May 8, 2011
Why we need to CARE now!
First I'd like to say that I try to steer away from politics on this blog. This blog's primary purpose is for education and I don't think creating a segregation of our political dichotomy is a smart way of encouraging readership. With that said, we have a major problem in Washington. Sure, there are differing views on how to improve the economy, lower unemployment, how to conduct our defense department, so on and so forth. However, one thing that I think most people would agree upon, if presented, is the CARE Bill.
The CARE Bill, known as the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Bill, will amend and enforce the Consumer-Patient Radiation Health & Safety Act of 1981, which would essentially regulate the certification requirements for people who perform medical imaging examinations and who plan and deliver radiation therapy treatments.
Now, "why is this important?" you might ask. Let's ask a few questions first. Would you go to a physician that wasn't certified by the AMA? Would you go to a mechanic that wasn't ASE Certified? Would you let an unlicensed electrician in your home? My personal answer to all three is a resounding "NO!". Why then, would you let an unlicensed radiation therapist plan your chemotherapy treatment? Or why would you let an untrained Nuclear Medicine Technologist inject you with a radioactive isotope? Or let an unregistered Radiologic Technologist emit ionizing radiation to your body? The truth is, you may not know that this is occurring!
39 states require that a Radiologic Technologist be registered with the American Registry of Radiologic Technologists (ARRT), the gold standard for the field. This means that 11 states do not require national licensure. Those states are Alabama, Alaska, Georgia, Idaho, Michigan, Missouri, Nevada, New Hampshire, North Carolina, North Dakota, and South Dakota. This means that if you want to be a Radiologic Technologist in Atlanta, you can literally have ZERO experience in the medical field, submit an application, and be taking radiographs the next day. To put this in perspective, I don't know a ton about prescription medications but if I were to find a state that didn't require licensure as a pharmacist, I could apply for a job at Walgreens and deliver meds the next day. Scary, isn't it?
A common question is, "Why isn't the Consumer-Patient Radiation Health & Safety Act of 1981 being enforced?" When the bill was presented, there were no legally enforceable penalties for states that choose not to comply, therefore it's as if the bill doesn't even exist. The CARE Bill would simply enforce the laws put forth by this act.
The CARE Bill requires what you would expect, that the person treating you has been through proper training, has been tested, and has proven that they can operate within their scope of practice. This would follow similar guidelines as the Mammography Quality Standards Act that was enacted in 1994 to regulate the quality of care in Mammography. A few examples of the regulations put forth in the MQSA are that under the law, all mammography facilities must: 1) be accredited by an FDA-approved accreditation body, 2) be certified by FDA, or its State, as meeting the standards, 3) undergo an annual MQSA inspection, and 4) prominently display the certificate issued by the agency. These examples are not necessarily proposed in the CARE Bill and pertain to the facilities only, however there are plenty of patient safety issues at risk by not complying to these MQSA standards.
The CARE Bill would ensure that quality information is presented for diagnosis and that quality radiation therapy treatments are delivered, leading to accurate diagnosis, treatment and cure. Poor quality images can lead to additional testing, delays in treatment and needless anxiety for the patient. It would also reduce health care costs by lowering the number of radiologic examinations that must be repeated due to improper positioning or poor technique. Repeated radiologic examinations cost the U.S. health care system millions of dollars annually in needless medical bills. In addition, it would improve the safety of radiologic procedures. Administered properly, radiation is an invaluable tool in the diagnosis, treatment and management of disease. But most radiologic procedures also carry a potential health risk, and radiation can be harmful if misadministered(1).
On September 29, 2009, 135 members of Congress introduced H.R. 3652 with the official title being: To amend the Public Health Service Act and title XVIII of the Social Security Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly. This bill got passed along to the Senate. On August 5, 2010, 9 senators cosponsored this bill, it was read twice and referred to the Committee on Health, Education, Labor, and Pensions, however it sat in the 111th Congress until the elections of November, 2010 and never saw the light of day afterward.
The passing of this bill would open up the job market for a ton of out of work, licensed, radiation workers. It would reduce the operating costs of hospitals, radiation therapy facilities, and outpatient clinics. It would also increase safety to unprecedented levels. The ASRT has also performed a study in South Carolina and Arkansas to predict salaries for registered Radiologic Technologists and results showed that salary levels did not increase above the national norm, meaning costs will not rise to compensate for employing registered technologists. I have yet to find a single negative effect that the health care industry would encounter if this bill were to be passed. All I see is highly qualified, registered technologists seeking optimal, diagnostic imaging while ensuring the safety of all individuals involved. I think that's a good thing, and I hope you do too. If you would like to get more information or get involved, you can check out http://www.asrt.org/ or email governmentrelations@asrt.org.
Curtis J. Carpenter R.T. (R)(CT)
Curtis Carpenter is the founder and president of Reliable Radiography based in Vero Beach, Florida.
(1) https://www.asrt.org/content/GovernmentRelations/CAREBill/CAREBillPositionStatement.aspx
The CARE Bill, known as the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Bill, will amend and enforce the Consumer-Patient Radiation Health & Safety Act of 1981, which would essentially regulate the certification requirements for people who perform medical imaging examinations and who plan and deliver radiation therapy treatments.
Now, "why is this important?" you might ask. Let's ask a few questions first. Would you go to a physician that wasn't certified by the AMA? Would you go to a mechanic that wasn't ASE Certified? Would you let an unlicensed electrician in your home? My personal answer to all three is a resounding "NO!". Why then, would you let an unlicensed radiation therapist plan your chemotherapy treatment? Or why would you let an untrained Nuclear Medicine Technologist inject you with a radioactive isotope? Or let an unregistered Radiologic Technologist emit ionizing radiation to your body? The truth is, you may not know that this is occurring!
39 states require that a Radiologic Technologist be registered with the American Registry of Radiologic Technologists (ARRT), the gold standard for the field. This means that 11 states do not require national licensure. Those states are Alabama, Alaska, Georgia, Idaho, Michigan, Missouri, Nevada, New Hampshire, North Carolina, North Dakota, and South Dakota. This means that if you want to be a Radiologic Technologist in Atlanta, you can literally have ZERO experience in the medical field, submit an application, and be taking radiographs the next day. To put this in perspective, I don't know a ton about prescription medications but if I were to find a state that didn't require licensure as a pharmacist, I could apply for a job at Walgreens and deliver meds the next day. Scary, isn't it?
A common question is, "Why isn't the Consumer-Patient Radiation Health & Safety Act of 1981 being enforced?" When the bill was presented, there were no legally enforceable penalties for states that choose not to comply, therefore it's as if the bill doesn't even exist. The CARE Bill would simply enforce the laws put forth by this act.
The CARE Bill requires what you would expect, that the person treating you has been through proper training, has been tested, and has proven that they can operate within their scope of practice. This would follow similar guidelines as the Mammography Quality Standards Act that was enacted in 1994 to regulate the quality of care in Mammography. A few examples of the regulations put forth in the MQSA are that under the law, all mammography facilities must: 1) be accredited by an FDA-approved accreditation body, 2) be certified by FDA, or its State, as meeting the standards, 3) undergo an annual MQSA inspection, and 4) prominently display the certificate issued by the agency. These examples are not necessarily proposed in the CARE Bill and pertain to the facilities only, however there are plenty of patient safety issues at risk by not complying to these MQSA standards.
The CARE Bill would ensure that quality information is presented for diagnosis and that quality radiation therapy treatments are delivered, leading to accurate diagnosis, treatment and cure. Poor quality images can lead to additional testing, delays in treatment and needless anxiety for the patient. It would also reduce health care costs by lowering the number of radiologic examinations that must be repeated due to improper positioning or poor technique. Repeated radiologic examinations cost the U.S. health care system millions of dollars annually in needless medical bills. In addition, it would improve the safety of radiologic procedures. Administered properly, radiation is an invaluable tool in the diagnosis, treatment and management of disease. But most radiologic procedures also carry a potential health risk, and radiation can be harmful if misadministered(1).
On September 29, 2009, 135 members of Congress introduced H.R. 3652 with the official title being: To amend the Public Health Service Act and title XVIII of the Social Security Act to make the provision of technical services for medical imaging examinations and radiation therapy treatments safer, more accurate, and less costly. This bill got passed along to the Senate. On August 5, 2010, 9 senators cosponsored this bill, it was read twice and referred to the Committee on Health, Education, Labor, and Pensions, however it sat in the 111th Congress until the elections of November, 2010 and never saw the light of day afterward.
The passing of this bill would open up the job market for a ton of out of work, licensed, radiation workers. It would reduce the operating costs of hospitals, radiation therapy facilities, and outpatient clinics. It would also increase safety to unprecedented levels. The ASRT has also performed a study in South Carolina and Arkansas to predict salaries for registered Radiologic Technologists and results showed that salary levels did not increase above the national norm, meaning costs will not rise to compensate for employing registered technologists. I have yet to find a single negative effect that the health care industry would encounter if this bill were to be passed. All I see is highly qualified, registered technologists seeking optimal, diagnostic imaging while ensuring the safety of all individuals involved. I think that's a good thing, and I hope you do too. If you would like to get more information or get involved, you can check out http://www.asrt.org/ or email governmentrelations@asrt.org.
Curtis J. Carpenter R.T. (R)(CT)
Curtis Carpenter is the founder and president of Reliable Radiography based in Vero Beach, Florida.
(1) https://www.asrt.org/content/GovernmentRelations/CAREBill/CAREBillPositionStatement.aspx
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Tuesday, March 22, 2011
I am NOT a Doctor!
How many times have you been asked, "Are you a Doctor?", or after a radiograph is taken a patient asks, "So is it broken?", or even when it's explicitly stated that you are not a physician, a patient says, "Come on, you've seen enough of these. Do I have cancer?". I'm sure the answer to the number of times you've heard these questions is anywhere from once to hundreds of thousands. A lot of times it's very tempting to answer these questions in order to prevent confrontation with a patient or to sound intelligent, however, regardless of the amount of times you have to repeat yourself and explain to the patient that you are unable to assist them in the diagnosis of their images, it's imperative that you are stern in your position.
The ARRT code of ethics states, "The radiologic technologist acts as an agent through observation and communication to obtain pertinent information for the physician to aid in the diagnosis and treatment of the patient and recognizes that interpretation and diagnosis are outside the scope of practice for the profession." Every technologist is aware of this statement. The code of ethics is drilled into your head from day one of x-ray school until you take your national registry after graduation. However, not every patient knows this. Believe it or not, a lot of patients that I've dealt with have zero knowledge of the examination being performed, nevertheless who reads it, diagnosis it, and plans treatment or therapy afterward. All this information can be very confusing to the average patient but there are ways to educate the patient and to put their concerns at ease, IF you communicate with your patient properly.
One way to help prevent any confusion is to be 1oo% honest from the very second you meet your patient. For instance, when introducing yourself tell them, "Hello, my name is (fill in the blank). I will be the technologist performing your examination today." A lot of times, introducing yourself as the technologist will alarm the patient that you are NOT the physician and can avoid future confusion. Sometimes a patient is under the impression that a physician will be performing their exam. If this is not the case, explain to them that you have been trained and are licensed to perform their examination and that this is the sole purpose of your profession. This should help to inform the patient of your position.
If this doesn't work and the patient is still under the impression that you may be a physician performing their examination, they will generally have questions for you during the exam. For instance, a patient may ask "Will you read these right away?" or "Can you tell me if anythings wrong?". At that point, a typical response should be, "All of the images will be given to our radiologist who will send a report to your referring physician within (time frame here)." This often will put their concerns at ease about who's reading their films.
Once in awhile however, you'll have a patient that will insist you give them a diagnosis even though they know you are not licensed to do so. A common statement will be "I really need to know if there's something wrong, can you tell me?" or "I know you can't tell me if there's anything wrong but can you give me a hint?". Patients will come up with many different reasons as to why they need an answer quickly, however your response needs to always include the phrase "I am not a physician" or "it's beyond my scope of practice". This can get very old and annoying, however I cannot stress the importance of communicating this fact to the patient.
There will be times when you want to inform the patient of something you see on the images just to put their minds at ease and there are definitely times in which you should inform the radiologist of something you might see prior to the discharge of a patient. I'll never forget one particular instance when I had a patient at an outpatient facility that came from a primary care physician with a prescription for a chest x-ray because he had acute shortness of breath. I took the chest x-ray a saw a HUGE pneumothorax in the patient's left lung. I calmly informed the patient that they should have a seat while I showed the radiologist the film. The radiologist interpreted the film immediately and sent the patient to the Emergency Department. It would have been very easy for me to tell the patient prior to showing the film to the radiologist that I knew he had a pneumothorax and that he needed to stay there for a few minutes, but what if I was wrong? Then what? The patient would've been upset without question and if a complaint were to be filed, I would have probably lost my job and possibly my license. It's much easier to be honest with the patient about your position and to abide by your skill set.
The bottom line is, when the patient questions you, always answer within your scope of practice. You will often be certain of a diagnosis after imaging a patient and be completely wrong. So whenever you want to inform the patient of a possible ailment, just remember the old Mark Twain quote "It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt."
Curtis J. Carpenter R.T. (R)(CT)
Curtis J. Carpenter is the founder and president of Reliable Radiography, based in Vero Beach, FL.
The ARRT code of ethics states, "The radiologic technologist acts as an agent through observation and communication to obtain pertinent information for the physician to aid in the diagnosis and treatment of the patient and recognizes that interpretation and diagnosis are outside the scope of practice for the profession." Every technologist is aware of this statement. The code of ethics is drilled into your head from day one of x-ray school until you take your national registry after graduation. However, not every patient knows this. Believe it or not, a lot of patients that I've dealt with have zero knowledge of the examination being performed, nevertheless who reads it, diagnosis it, and plans treatment or therapy afterward. All this information can be very confusing to the average patient but there are ways to educate the patient and to put their concerns at ease, IF you communicate with your patient properly.
One way to help prevent any confusion is to be 1oo% honest from the very second you meet your patient. For instance, when introducing yourself tell them, "Hello, my name is (fill in the blank). I will be the technologist performing your examination today." A lot of times, introducing yourself as the technologist will alarm the patient that you are NOT the physician and can avoid future confusion. Sometimes a patient is under the impression that a physician will be performing their exam. If this is not the case, explain to them that you have been trained and are licensed to perform their examination and that this is the sole purpose of your profession. This should help to inform the patient of your position.
If this doesn't work and the patient is still under the impression that you may be a physician performing their examination, they will generally have questions for you during the exam. For instance, a patient may ask "Will you read these right away?" or "Can you tell me if anythings wrong?". At that point, a typical response should be, "All of the images will be given to our radiologist who will send a report to your referring physician within (time frame here)." This often will put their concerns at ease about who's reading their films.
Once in awhile however, you'll have a patient that will insist you give them a diagnosis even though they know you are not licensed to do so. A common statement will be "I really need to know if there's something wrong, can you tell me?" or "I know you can't tell me if there's anything wrong but can you give me a hint?". Patients will come up with many different reasons as to why they need an answer quickly, however your response needs to always include the phrase "I am not a physician" or "it's beyond my scope of practice". This can get very old and annoying, however I cannot stress the importance of communicating this fact to the patient.
There will be times when you want to inform the patient of something you see on the images just to put their minds at ease and there are definitely times in which you should inform the radiologist of something you might see prior to the discharge of a patient. I'll never forget one particular instance when I had a patient at an outpatient facility that came from a primary care physician with a prescription for a chest x-ray because he had acute shortness of breath. I took the chest x-ray a saw a HUGE pneumothorax in the patient's left lung. I calmly informed the patient that they should have a seat while I showed the radiologist the film. The radiologist interpreted the film immediately and sent the patient to the Emergency Department. It would have been very easy for me to tell the patient prior to showing the film to the radiologist that I knew he had a pneumothorax and that he needed to stay there for a few minutes, but what if I was wrong? Then what? The patient would've been upset without question and if a complaint were to be filed, I would have probably lost my job and possibly my license. It's much easier to be honest with the patient about your position and to abide by your skill set.
The bottom line is, when the patient questions you, always answer within your scope of practice. You will often be certain of a diagnosis after imaging a patient and be completely wrong. So whenever you want to inform the patient of a possible ailment, just remember the old Mark Twain quote "It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt."
Curtis J. Carpenter R.T. (R)(CT)
Curtis J. Carpenter is the founder and president of Reliable Radiography, based in Vero Beach, FL.
Tuesday, January 11, 2011
Think You Want To Be An X-Ray Tech? Read This First...
Wanna be an RT? Think it's a quick 2 year degree? Simple...Right? I'll let you in on a little secret...It's not as easy as it sounds.
As a Clinical Instructor for a local university, I can't tell you how many times I see a prospective student come into my place of employment with that silly smirk on his or her face thinking, "This will be a fast way for me to make some easy money!" Ummmm...Not so fast. I ask every single prospective student the same thing, "Why do you want to be an x-ray tech?" Their answer usually consists of, "It looks cool", or "I want to be in the medical field", or "I want a clean, inside job", or, my favorite one so far, "I know a guy who knows a guy that says I can make $(Insert ridiculous figure here) a year by doing this." With all these hilarious answers, I'll give you this. Here are realistic expectations of what to expect from a bonafide Radiology Technology program. I hope every person that wants to enter the field gets a sneak peak at this.
A typical Radiologic Technology program offers you an Associates Degree and is typically a 2 year program. However, for most programs, prerequisites are required to be taken prior to application to said program. I personally attended college for three part time years before I even applied to my program. Once your prerequisites are acquired, you may then apply to the program.
When I applied, I had a 3.4 GPA and I scored over 90% on my Health Occupations Basic Education Test (the standard testing procedure at the time), I had over 5 years experience in the field of Radiology as a report filer, secretary, scheduler, PACS Administrator, and even as an X-Ray Tech (I acquired a state license allowing me to perform basic radiologic procedures a year prior to applying). The program I attended only accepted 18 applicants and 2 alternates and I was lucky enough to be one of the two alternates, (for the record, the other alternate and myself both slid into the program and graduated, while only 12 others did so).
I don't mention this to brag, gloat, or toot my own horn. I mention this because I want to make a point...this program isn't a cake walk. Once you are finally accepted into a program you will be expected to work, for free, performing clinicals at a hospital or free standing clinic, anywhere from 24 to 40 hours a week, while attending classes full time as well. While attending clinic and school, you are inundated with homework, projects, lab work, and research assignments.
While at your clinical site, expect to be treated like a slave. You clean everything, stock all the linen, do all the examinations, and are held accountable for each and every breath you take. You have to put up with a lot of sick people, and the patients as well. Every x-ray technologist you meet has a preconceived notion that you were born yesterday and that you can't figure out a chest x-ray from a KUB, and sometimes they're right. You are repeatedly asked to go get "sterile oxygen", or my personal favorite, "Go to Medical Supplies and grab me a dozen filopian tubes"...All this occurs while you are trying to learn how to do your job.
Intertwined into your clinical hours are your classroom hours. Unlike most medical professions, you are responsible for not only Anatomy & Physiology, Chemistry, and Patient Care, but you must also retain Physics, Radiographic Procedures, Advanced Anatomy, Pathology, and every radiology theory ever conjured up by any guy that thought he was smarter than the guy before him. You are tested on all of these subjects which are ironically disproven in your clinical setting. Therefore you must retain two sets of information, things you learned in class (for test purposes) and things you learned in clinic (for practical purposes).
While you are dealing with the book world vs. real world debate, you have to study for your national registry. This is a 240 question, 3 hour test that covers every single thing you've ever laid eyes on in the past two years. If you score a 74% or less, you've essentially wasted your time attending x-ray school. Pack your bags. Go Home. Do Not Collect $200. If you've selected the right program, this is the test that you have prepared for since you walked in the door on day one and you pass with flying colors (I scored a 94%). You still end up studying for countless hours hoping to catch that one question that you know you don't know. I literally had a study book in my vehicle, taking that last second peek before I walked into the testing center.
Once you graduate and pass your registry, you get to join the workforce and really learn how to take an x-ray. Here's a perfect quote that I heard from a technologist while I was in x-ray school, "You'll learn more in your first year out of school than you did in your two years in it."
How true that is.
Now...Do you want to be an X-Ray Tech?
Curtis Carpenter is the founder and President of Reliable Radiography, based in Vero Beach, Florida.
As a Clinical Instructor for a local university, I can't tell you how many times I see a prospective student come into my place of employment with that silly smirk on his or her face thinking, "This will be a fast way for me to make some easy money!" Ummmm...Not so fast. I ask every single prospective student the same thing, "Why do you want to be an x-ray tech?" Their answer usually consists of, "It looks cool", or "I want to be in the medical field", or "I want a clean, inside job", or, my favorite one so far, "I know a guy who knows a guy that says I can make $(Insert ridiculous figure here) a year by doing this." With all these hilarious answers, I'll give you this. Here are realistic expectations of what to expect from a bonafide Radiology Technology program. I hope every person that wants to enter the field gets a sneak peak at this.
A typical Radiologic Technology program offers you an Associates Degree and is typically a 2 year program. However, for most programs, prerequisites are required to be taken prior to application to said program. I personally attended college for three part time years before I even applied to my program. Once your prerequisites are acquired, you may then apply to the program.
When I applied, I had a 3.4 GPA and I scored over 90% on my Health Occupations Basic Education Test (the standard testing procedure at the time), I had over 5 years experience in the field of Radiology as a report filer, secretary, scheduler, PACS Administrator, and even as an X-Ray Tech (I acquired a state license allowing me to perform basic radiologic procedures a year prior to applying). The program I attended only accepted 18 applicants and 2 alternates and I was lucky enough to be one of the two alternates, (for the record, the other alternate and myself both slid into the program and graduated, while only 12 others did so).
I don't mention this to brag, gloat, or toot my own horn. I mention this because I want to make a point...this program isn't a cake walk. Once you are finally accepted into a program you will be expected to work, for free, performing clinicals at a hospital or free standing clinic, anywhere from 24 to 40 hours a week, while attending classes full time as well. While attending clinic and school, you are inundated with homework, projects, lab work, and research assignments.
While at your clinical site, expect to be treated like a slave. You clean everything, stock all the linen, do all the examinations, and are held accountable for each and every breath you take. You have to put up with a lot of sick people, and the patients as well. Every x-ray technologist you meet has a preconceived notion that you were born yesterday and that you can't figure out a chest x-ray from a KUB, and sometimes they're right. You are repeatedly asked to go get "sterile oxygen", or my personal favorite, "Go to Medical Supplies and grab me a dozen filopian tubes"...All this occurs while you are trying to learn how to do your job.
Intertwined into your clinical hours are your classroom hours. Unlike most medical professions, you are responsible for not only Anatomy & Physiology, Chemistry, and Patient Care, but you must also retain Physics, Radiographic Procedures, Advanced Anatomy, Pathology, and every radiology theory ever conjured up by any guy that thought he was smarter than the guy before him. You are tested on all of these subjects which are ironically disproven in your clinical setting. Therefore you must retain two sets of information, things you learned in class (for test purposes) and things you learned in clinic (for practical purposes).
While you are dealing with the book world vs. real world debate, you have to study for your national registry. This is a 240 question, 3 hour test that covers every single thing you've ever laid eyes on in the past two years. If you score a 74% or less, you've essentially wasted your time attending x-ray school. Pack your bags. Go Home. Do Not Collect $200. If you've selected the right program, this is the test that you have prepared for since you walked in the door on day one and you pass with flying colors (I scored a 94%). You still end up studying for countless hours hoping to catch that one question that you know you don't know. I literally had a study book in my vehicle, taking that last second peek before I walked into the testing center.
Once you graduate and pass your registry, you get to join the workforce and really learn how to take an x-ray. Here's a perfect quote that I heard from a technologist while I was in x-ray school, "You'll learn more in your first year out of school than you did in your two years in it."
How true that is.
Now...Do you want to be an X-Ray Tech?
Curtis Carpenter is the founder and President of Reliable Radiography, based in Vero Beach, Florida.
Sunday, January 9, 2011
Showing Compassion When It's Not Easy To Do
How often have you had a patient that you feel extreme sympathy for, you know is wasting your time, or you simply would like to strangle? Nearly every patient in a hospital, clinic, or doctor's office fits this criteria. The important thing is how you control yourself and react to every patient and his or her needs. The facility, the department, your staff, and yourself are all reflected on how you deal with every single patient and ultimately, how it's perceived that they're being treated.
There are many ways to quantify a patient's perception of how they were treated during their stay but perhaps the largest context in which patient satisfaction is currently measured involves hospitals using patient surveys to assess and improve their "hotel-motel" functions and do a better service job to maintain a competitive posture in their markets. The hospital industry's leading independent vendor of patient satisfaction measurement and improvement services - Press Ganey Associates, headquartered in South Bend, Indiana - specializes in producing tested and reliable surveys and national comparative databases. The firm's clients include 40 percent of the nation's acute care hospitals with over 100 beds and 30 percent of those with fewer than 100 beds.
Press Ganey uses patient discharge information to select a sample of recipients who receive mailed satisfaction surveys. Press Ganey's core surveys were designed by focus groups of industry experts who developed lists of topics important to various aspects of health care, which were then tested and refined in test surveys. The company currently offers 35 surveys designed for various health care contexts, including general inpatient, pediatrics, emergency department, outpatient medical practice, ambulatory care, behavioral care, long term care and home health care. The majority of surveys use a five-point scale of responses ranging from "very poor" to "very good."
Whether a patient marks their experience as a "very poor" or a "very good" may very well depend on the amount of compassion that the patient feels they have received. Research evidence suggests that compassion affects the effectiveness of treatment. For example, patients who are treated by a compassionate caregiver tend to share more information about their symptoms and concerns, which in turn yields more accurate understanding and diagnoses. In addition, since anxiety and fear delay healing and compassionate behavior reduces patient anxiety, it seems likely that compassionate care can have positive effects on patients’ rate of recovery and ability to heal.
As far as I'm concerned, the accuracy and expediency involved in getting a patient healed and back to a normal life is the absolute most important thing in the healthcare field. Nothing should take precedence over the patient's safety and recovery. While these are the most important things to focus on with a patient, sometimes it's easy to overlook how a patient feels when they are in a healthcare setting. It's extremely important to constantly remind the patient that you are there for them, that you understand what they are going through, and that you are doing everything you can to make their visit quick, accurate, and comfortable.
None of this is very difficult to do. We all learned in elementary school to treat everyone else the way you would like to be treated yourself, and every healthcare professional has taken a patient safety course in which you learn that every patient shall be treated equally. However, a lot of medical professionals get very comfortable with their jobs and begin focusing on other things rather than the patient. This happens to everybody but the important thing, once again, is how you react to it. Make sure when this happens to you to remember that the patient you are taking care of could possibly be somebody's grandparent, and to treat them with the kindness and respect that they deserve.
Curtis Carpenter is the founder and president of Reliable Radiography, based in Vero Beach, FL
There are many ways to quantify a patient's perception of how they were treated during their stay but perhaps the largest context in which patient satisfaction is currently measured involves hospitals using patient surveys to assess and improve their "hotel-motel" functions and do a better service job to maintain a competitive posture in their markets. The hospital industry's leading independent vendor of patient satisfaction measurement and improvement services - Press Ganey Associates, headquartered in South Bend, Indiana - specializes in producing tested and reliable surveys and national comparative databases. The firm's clients include 40 percent of the nation's acute care hospitals with over 100 beds and 30 percent of those with fewer than 100 beds.
Press Ganey uses patient discharge information to select a sample of recipients who receive mailed satisfaction surveys. Press Ganey's core surveys were designed by focus groups of industry experts who developed lists of topics important to various aspects of health care, which were then tested and refined in test surveys. The company currently offers 35 surveys designed for various health care contexts, including general inpatient, pediatrics, emergency department, outpatient medical practice, ambulatory care, behavioral care, long term care and home health care. The majority of surveys use a five-point scale of responses ranging from "very poor" to "very good."
Whether a patient marks their experience as a "very poor" or a "very good" may very well depend on the amount of compassion that the patient feels they have received. Research evidence suggests that compassion affects the effectiveness of treatment. For example, patients who are treated by a compassionate caregiver tend to share more information about their symptoms and concerns, which in turn yields more accurate understanding and diagnoses. In addition, since anxiety and fear delay healing and compassionate behavior reduces patient anxiety, it seems likely that compassionate care can have positive effects on patients’ rate of recovery and ability to heal.
As far as I'm concerned, the accuracy and expediency involved in getting a patient healed and back to a normal life is the absolute most important thing in the healthcare field. Nothing should take precedence over the patient's safety and recovery. While these are the most important things to focus on with a patient, sometimes it's easy to overlook how a patient feels when they are in a healthcare setting. It's extremely important to constantly remind the patient that you are there for them, that you understand what they are going through, and that you are doing everything you can to make their visit quick, accurate, and comfortable.
None of this is very difficult to do. We all learned in elementary school to treat everyone else the way you would like to be treated yourself, and every healthcare professional has taken a patient safety course in which you learn that every patient shall be treated equally. However, a lot of medical professionals get very comfortable with their jobs and begin focusing on other things rather than the patient. This happens to everybody but the important thing, once again, is how you react to it. Make sure when this happens to you to remember that the patient you are taking care of could possibly be somebody's grandparent, and to treat them with the kindness and respect that they deserve.
Curtis Carpenter is the founder and president of Reliable Radiography, based in Vero Beach, FL
Wednesday, January 5, 2011
Are There Really Too Many R.T.'s?
It seems to me that there is a preconceived notion in the "radiology world" that there are too many Radiologic Technologists in the so-called employment pool. The theory behind this is that there are tons of public and private educational facilities with radiology programs installed into their curriculum. A radiology program is fairly simple and cheap for an institution to implement and conduct, and the demand of students seems to continue climbing. Along with federal and state subsidies and low interest rates on student loans, a school can produce literally hundreds of Radiologic Technologists per year with limited immediate cost to the student.
There are currently no limitations on how many students an institution may accept although there are rumors and reports that the government is keeping an eye on it. And although there may be a time when the government begins to crack down on graduation numbers, the numbers are still relatively high. The ironic thing to me however, is that radiology continues to be an area with potential staffing shortfalls. While research shows that the shortage of radiologic technologists has eased, projections indicate that demand for radiologic technologists will continue to outpace supply. Recent U.S. Bureau of Labor Statistics reports predict the need for approximately 76,000 additional radiographers between 2004 and 2014. Recent ASRT enrollment studies report that an insufficient number of radiologic technologists will be available to meet the demand for additional staff.
Just as the general population is aging, so is the average age of radiologic technologists in the work force. A large segment of the profession is composed of baby boomers who are approaching retirement age. This demographic also will add to staffing problems. Currently, more than 35% of radiologic technology professionals have reached the age of 50, with the average age rising incrementally the past few years. In addition, the radiologic technology educator population is reaching retirement age quickly, which may represent a greater staffing problem than in other areas of the profession. Educational institutions will be challenged to replace retiring program directors and instructors while continuing to meet the growing demand for radiologic technologists.
The role of radiologic technology staff in the workplace is also shifting. As new career opportunities such as the radiologist assistant become available, organizations will use these advanced-level technologists to increase productivity and workflow. It is anticipated that advanced roles in nuclear medicine, ultrasound and radiation therapy will be developed in the near future.
So, my question is, are there really too many Radiologic Technologists out there? There seems to be thousands of new R.T.'s yearly but statistics show that these new graduates are coming out of school with jobs. How long will this last? I can't pretend to know, but as of now having R.T. credentials means you're working.
Curtis J. Carpenter is the founder and President of Reliable Radiography, a radiology staffing agency based in Vero Beach, Florida.
There are currently no limitations on how many students an institution may accept although there are rumors and reports that the government is keeping an eye on it. And although there may be a time when the government begins to crack down on graduation numbers, the numbers are still relatively high. The ironic thing to me however, is that radiology continues to be an area with potential staffing shortfalls. While research shows that the shortage of radiologic technologists has eased, projections indicate that demand for radiologic technologists will continue to outpace supply. Recent U.S. Bureau of Labor Statistics reports predict the need for approximately 76,000 additional radiographers between 2004 and 2014. Recent ASRT enrollment studies report that an insufficient number of radiologic technologists will be available to meet the demand for additional staff.
Just as the general population is aging, so is the average age of radiologic technologists in the work force. A large segment of the profession is composed of baby boomers who are approaching retirement age. This demographic also will add to staffing problems. Currently, more than 35% of radiologic technology professionals have reached the age of 50, with the average age rising incrementally the past few years. In addition, the radiologic technology educator population is reaching retirement age quickly, which may represent a greater staffing problem than in other areas of the profession. Educational institutions will be challenged to replace retiring program directors and instructors while continuing to meet the growing demand for radiologic technologists.
The role of radiologic technology staff in the workplace is also shifting. As new career opportunities such as the radiologist assistant become available, organizations will use these advanced-level technologists to increase productivity and workflow. It is anticipated that advanced roles in nuclear medicine, ultrasound and radiation therapy will be developed in the near future.
So, my question is, are there really too many Radiologic Technologists out there? There seems to be thousands of new R.T.'s yearly but statistics show that these new graduates are coming out of school with jobs. How long will this last? I can't pretend to know, but as of now having R.T. credentials means you're working.
Curtis J. Carpenter is the founder and President of Reliable Radiography, a radiology staffing agency based in Vero Beach, Florida.
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