1. society
2. welfare
3. healthcare
4. hospital

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City College San Francisco
RadTimes
July 2014 | Volume 3, Issue 4
DIAGNOSTIC IMAGING PROGRAM NEWSLETTER
CONTENTS
1 Student Life
3 How we survived second semester
4 First Day San Francisco General
5 Graduation Photos
6 Tuberculosis: A Newbie’s Guide on
How to Protect Yourself and Others
8 Inter-Professional Education: DMI
and RN’s New Frontier
9 Children or School
10 #studentradiographer
11 My Clinical Rotation Experience
12 A Lesson Learned
13 Let’s go BACK to the FUTURE!
14 HOLD YOUR BREATH ... BREATHE
15 Migration South for Vacation
16 Diary of a 4th Semester Student
18 MRI Contrast Complications
19 Student Meets Incident
20 Why DMI?
Graduation Day: Members of the December, 2014 class joined
the July, 2014 class for a day of celebration and ceremony
Recognition for a Job Well Done!
Recognition For a Job Well Done! This issue is dedicated
to the DMI instructors and students for working together
to achieve success. The student success rate which had
decreased below 70% in recent years, increased to 76%.
Included in this figure are the seven graduates of July,
2014. Don't miss their class picture on page 5 of this issue.
This program does not involve luck. It requires hard work.
The staff and students have proven that they are
motivated to do what it takes to progress to the next
level. Way to go!
21 Second Semester Students
Explore the 15% Rule
Student Life By Kenny Yip
As an immigrant to the United States without too much educational
background, there weren’t many opportunities for me to choose what
I wanted to do once I arrived here. Moreover, education wasn’t an
option for me previously because of my financial situation and
therefore, I went to work in a restaurant shortly after moving to the
United States. After working in the restaurant business for over fifteen
years, everything in my life was pretty much on track, however, I felt
lost. I kept asking myself if I was destined to work in a restaurant for the
rest of my life. Should I be doing something else? Should I be doing
something more meaningful? With my limited education and skills, I
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didn’t know what I could do
besides working in food service.
Fortunately, a friend of mine is a
radiologic technologist and he
guided me into this field and I
discovered the Diagnostic
Medical Imaging program at City
College of San Francisco.
In order for me to apply to
the DMI program, I needed to
take some prerequisite classes
so I embarked on my educational
journey in 2007. It took me three
years to finish all the prerequisites
while I was still working full time
and in 2010 I was finally qualified
to submit an application for the
program. However, spaces are
limited due to the number of
students who apply to the
program. For this reason, not every
applicant is accepted despite
having fulfilled all of the
prerequisites. Instead, everyone
has to go through the lottery
process. Unfortunately, my name
didn’t get chosen in the first round
so I had to wait for another year
and resubmit my application.
Luckily, I was accepted to the
program the second time around
and this is how my story starts.
Since the DMI program is a
full time program, I was unable to
work full time. I had to change my
life style and change my spending
habits because I would now have
to live on my savings plus a limited
income for the next three years. It
was a little difficult at first since I
had to reduce expenditures on
just about everything. Fortunately,
I was able to lower the monthly
mortgage on my house which
helped. I had to make sure that I
didn’t gain or lose more than a
few pounds because that would
mean buying new clothes which
wasn’t an option. My eating
habits had to change a bit and
some of my favorite foods
wouldn’t be on the menu
anymore. For instance, I wouldn’t
be dining out as much, but rather
cooking at home. Finally, I had to
sell my six cylinder car and
exchange it for a smaller four
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cylinder car in order to save
money on the gas and
insurance. These lifestyle
changes are just one piece of
the puzzle that would now
define my life.
After squaring away the
financial changes and lifestyle
changes, I then needed to
work on the emotional
changes. After the program
started, I was no longer able to
spend much quality time with
my wife and my family. My time
was occupied by class, clinical,
and work. Even when I had a
day off I would still need to
keep up with studying and
homework. I felt like nobody
could understand how stressful
my life had become including
my wife. Furthermore, the
program required a 75%
passing grade in every class. If I
received a grade lower than
75% in a class I would need to
start all the program over from
the beginning assuming I could
even get into the program
again. A spot was not
guaranteed. For this reason, I
felt incessantly anxious and
worried. As the saying goes,
“I’m not getting any younger”
so I had to make sure I passed
all the classes because I don’t
have time to start all over
again. I don’t want to waste six
years of hard work. After all, I
am nearing the end of this
program.
Besides the didactic
activities, the clinical component
is the other part of the DMI
program. Everything went well
for the first two clinical semesters
until the third clinical semester.
The third semester is the rotation
semester where students rotate
to a new hospital. Everything is so
different from the hospital that I
was based at and it took me a
little over a month to get used to
new equipment and new
protocols. I also had to get used
to new people including the
technologists and the types of
patients. I was so nervous at the
beginning when I rotated to the
new hospital because of the
new surroundings. Meanwhile, I
was also trying to prove myself
and gain the trust of those
around me. I found out that the
more I pushed myself, the more
mistakes I made. Luckily, one of
the technologists noticed my
honest efforts and told me to
slow down and not try to rush
everything because this is how
we make mistakes. In all honesty,
that was the best advice I had
received so far because I didn’t
realize I was pushing myself so
hard.
In short, the DMI program
at CCSF is a great program for
people who want to work in the
medical field because of the
bright future; moreover, it is also
great for people like me who
want to change their career and
do something more challenging.
As a final suggestion for those
who want to be a future
technologist, be prepared
financially and emotionally as
you enter the program. You
won’t be able to work full time
and you won’t see your friends or
family often. One final thought
for future students is that I can
attest to the fact that we are
most certainly not just “button
pushers”!
CCSF RadTimes July 2014
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NEWSLETTER SPOTLIGHT:
How We Survived
Second Semester
By Michael Ng
Since the 2nd semester of (DMI)
Diagnostic Medical Imaging
Program has been touted as
one of the most difficult of all
the semesters, I thought it would
be interesting to do a survey of
my class to share how so many
of us are progressing through.
The objective was to figure out
the study habits and the
different ways people were
coping with the workload while
trying to de-stress and maintain
some sort of sanity. Kyle
Thornton, Department Chair,
and Diane Garcia, Clinical
Coordinator, have stated that
as a group, this class, in
particular, has been one of the
most stressed out classes in a
while. Kyle has also stated that
he expects a larger than usual
number of students to continue
on to the 3rd semester, making
it more challenging for Diane to
place us in clinical sites. I
conducted this survey with
various questions such as
educational background, work
balance, study habits, and stress
management.
The first couple of questions
were aimed at trying to
understand the background of
the class to see if there was any
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correlation between previous
schooling and our success. Of
the thirteen people in the class,
most were working and held
jobs that varied from
bartending, retail, and even
graphic design. Some of the
younger classmates were still in
school doing prerequisites for
the DMI program or trying to
finish their degrees. Seven
students in the class already
had degrees that varied from
kinesiology, fine arts,
microbiology, and even
business. Three students had no
degrees and three others had
associate degrees. Most felt
that their degrees have not
helped much with the program
since they were in different
subjects, but some feel that
the study habits that they
obtained while in school have
been useful.
Because the workload for
the second semester is
significantly more than the first,
it was important to inquire
about the number of hours per
week the working students
were putting in. It would be
difficult to study three hours for
every one hour of class
recommended by our teachers
if we were working too much.
The results found that nine out
of thirteen classmates worked
an average of 12 hours per
week. Ricky Ng shockingly
worked the most during the
week with about 33-36 hours.
Working during this semester
can be done, however making
it much more challenging. My
classmates said they would
consider cutting back hours if
necessary.
Also, because the workload
has increased I wanted to find
out if my classmates were doing
anything different compared to
the first semester to
compensate. The results were
quite varied here but the most
common accommodations that
took place 2nd semester were
studying harder, not
procrastinating, and working
less. Some also suggested
having more study group
sessions or giving up Saturdays
to practice positioning at
school. Vanessa Aycock's
answer was interesting because
she "treated school like a full
time job" during the 2nd
semester.
No doubt the study time has
increased but everyone studies
differently. It was important to
know how people were studying
and to see what is working for
our class. The majority of the
class said their preferred
method of studying was a
combination of individual time
mixed with study groups. Most
everyone preferred to study by
themselves until they grasped
the information and understood
it before joining study groups.
However, some preferred only
doing study groups, for constant
dialogue to help understand
the information as well as an
opportunity to ask questions.
Group study also provided a
forum for testing one another.
Because meeting up isn't always
easy and convenient for
everyone, a common tool used
by my peers was Skype.
Studying individually is essential,
but studying in groups is
essential as well. For example,
you can't practice positioning
by yourself. Other tools that
were useful throughout the
semester were the notes and
study guides that classmates
passed around. We were lucky
enough to have students who
made PowerPoints and
Quizlettes that were used to test
each other.
Not only is the workload
immense, but the stress that
goes along with it is evident as
well. Everyone will have their
own way of coping and
dealing with stress. My peers all
had different ways of coping.
Some said that keeping up
with the work helped them feel
less stressed because they
didn't feel behind in their
studies. Others went out with
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friends once in awhile to
get away from the daily
grind. Some listened to
music while others ate food
to distract themselves.
Another common answer
was to empathize with your
peers. Luis Moran utilizes a
light hearted method of
stress relief by tuning into
Comedy Central everyday
because "laughter cures all".
In the end, the best
advice we can give to
anyone coming into this
program is to take
ownership of your learning
and do what works for you.
Don't fall behind and have
fun with the opportunity you
have been given! Talk to
the classes ahead of you
and let them instill some fear
in you. Hearing all the horror
stories made us work that
much harder. Another key
component is that
cooperation is vital. Every
Remember that
“laughter cures
all” for students
during second
semester!
person in the class was a
key contributor to the
success of the group. Even
though we, unfortunately,
lost a couple of people, our
class is tight knit. We have
each other's back and are
each other's motivators. No
one else understands the
stress you go through but
the people who fill those
classroom chairs each and
every day. So, be there for
each other and support
one another.
Lastly, ENJOY THE RIDE!
FIRST DAY:
San Francisco
General Hospital
By Jalil Kawas
It was the last week of our finals after a brutal second semester in
the Diagnostic Medical Imaging Program at City College of San
Francisco and with just a couple days to unwind, the grind of internship
consisting of 8 hours a day for 5 days a week was just around the corner
for my classmates and me at San Francisco General Hospital (SFGH). We
had often talked about where we wanted to be placed even though
the decision was out of our hands. I was one that said, “I hope I go to the
General. I want to be a part of that mayhem”. When the day came that
we got our clinical placement e-mail, my placement was at SFGH.
The day after Memorial Weekend 2013 was the first day of
clinical at SFGH. I started to prepare for what would be my daily routine
for the next seven weeks of “summer school”, as I thought of it. I was as
nervous as a child on his first day of school. SFGH requires us to start at
7:30am. My classmates and I arrived at different times but all of us arrived
at the radiology department by 7:30. As I entered, I started to introduce
myself to the radiologic technologists that were also arriving to start the
day. Some were approachable and some gave you the feeling that they
were thinking, “great, a new batch of students to babysit”. Since this was
my first clinical assignment, I felt like I was coming in “wearing diapers”.
Not too long after introductions, we met our assistant clinical instructor
whom we followed to the break room for our orientation to our new
home for the summer. We were given an introduction to the hospital and
what was expected of us while we were here.
During my second week at SFGH I was shadowing the different
techs and accompanying them during exams to observe and assist so
that I could become acclimated to the radiology department. One
afternoon a tech approached me and asked if I wanted to “check
something out.” I was all about being busy and I didn’t want to stand
around so I took a walk with the tech. As we walked I asked him where
we were going and what was going on. He turned and told me,
“gunshot victim”. My eyes, at that moment lit up with excitement, this
was my first trauma patient. We entered Room 64 which connected to
Trauma 2. Each x-ray room is connected to a trauma room. There are
windows to observe not only the patient but whatever medical
emergency happens to come through the hospital. Looking through the
window, the victim was a male who was shot in the chest. Most of the
personnel in the emergency department converged on the room like a
swarm to help this individual who was lying on the gurney in a motionless
state. They cut his clothes off, started IV’s, and intubated him with the
quickness of a cheetah chasing down its prey. I couldn’t move away
from where I was standing because my eyes were glued to the action.
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CCSF RadTimes July 2014
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Looking at the victim, I could see where the bullet
penetrated him in the chest. The hospital staff was
relentless in their efforts to keep this person alive.
After a few minutes of chest compressions and
other life saving techniques, the chief surgeon showed
up with two other doctors to assess and assist in trying to
save this man’s life. As I studied the scene, the doctor
made a lengthy incision down the side of the victim’s
chest. In the brief moment that I turned my head away
to sneeze, the patient’s chest had been cracked open
with rib splitters. The scene was surreal; one second his
chest looked normal and the next second his ribs were
protruding through his skin. The doctors then proceeded
to work their hands, one at a time, into the victim’s
chest. The tech explained that “the doctors were in the
chest cavity massaging the heart to keep it beating
while they tried to save him.”
After another few minutes of doing everything
they could to revive the patient, the medical team’s
actions came to a halt. The patient was pronounced
dead. I then saw others entering the trauma room. It
didn’t dawn on me at first why these people came in,
but then I remembered that SFGH is a teaching hospital
for new residents. These people were doctors in training
and they were in the trauma room getting a lesson from
the seasoned doctors. You could see them examining
the victim from every aspect as if experiencing
something fascinating for the first time.
After all the residents left, I remained transfixed
on the patient. I stayed and watched a female doctor
stitch the victim’s chest back together. Looking at the
aftermath, my eyes fell upon the victim’s dead stare. This
made me reflect on how precious life is how easily life
can be cut short in the face of a tragedy. I finally peeled
myself away from the trauma window with a whole new
perspective and respect for what I would be
experiencing in my daily life as a tech. Later that night I
received an e-mail from my clinical coordinator asking us
how our day in the hospital went. I summarized the
shocking scene that unfolded before my eyes earlier that
day. She responded back by explaining that situations
like the one I witnessed are a part of life and not to let it
bother me into the night. I wrote back and told her that it
didn’t bother me. The events of the day made me think
about my own life. I thought about the patient as well.
He will never see his family again and his family will be
grieving the loss of their loved one indefinitely. All of the
lives he touched would be affected by his passing. It was
an important reminder that death is a part of life.
I would never have imagined that my first day in
the clinical environment would begin with that
experience. Though shaken, I was equally excited to get
back to SFGH the next morning and continue my
education. I want to be a technologist who makes a
difference by performing my job well. I have always
taken my education seriously but now I have a new
appreciation for the role of radiographer. This is serious
work and I am determined to do the very best I can to
aid the healthcare team in our mission to care for
patients … and perhaps even save a life.
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Congrats to our Grads!!!
Did you know that you can support
patient safety and help to protect the
future of your career at the same
time? Join the CSRT today!
It’s your future.
CCSF RadTimes July 2014
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TUBERCULOSIS:
A Newbie’s Guide
on How to Protect
Yourself and Others
By Chelsea Christopher
Tuberculosis.... I remember before I lived in San Francisco, I had learned about tuberculosis in school. I vividly remember the
image of the Iron Lung shown in class and I remember mentally categorizing tuberculosis with other diseases, such as polio,
as a condition of 1950s America; a thing of the past. I knew that tuberculosis was rampant in other areas of the world, but I
never thought I would have to worry about this “old” disease in my lifetime. That all changed when I started my clinical
rotation at a major San Francisco hospital as a student technologist. The first time I encountered a patient’s requisition that
read “TB+,” I panicked. I had no idea what to do or how to protect myself. I realized I knew very little about the disease and
what to do when performing an examination on a patient with suspected or confirmed tuberculosis. After talking with some
seasoned technologists and doing a little research on my own, I now feel confident as to what to do when encountering
this type of patient demographic. In this article, I hope to provide a background and a simple how-to guide as to what to
do to protect yourself and others against the spread of tuberculosis.
Chances are, if you work in the health profession, you have encountered a patient with suspected or confirmed
tuberculosis. This is especially true in the city of San Francisco. According to San Francisco Health Partnership (SFHIP), 13.1
cases of tuberculosis per 100,000 people were recorded in 2011. This makes San Francisco County the highest of all
tuberculosis rates in California, with 118 new recorded cases in 2011 alone.
San Francisco is also home to a number of tuberculosis care facilities, making the possibility of exposure that much
more probable to health care workers in this area. Since radiologic exams are often used to diagnose or rule out
tuberculosis, technologists are often subjected to the potential tuberculosis infection. Since the likelihood of coming into
contact with tuberculosis is high, it is important to recognize when a potential exposure is likely to occur in order to reduce
the possibility of infectious transmission.
So how can you recognize a situation where you might be exposed to tuberculosis? Unfortunately, these situations
are not always obvious. A person with tuberculosis may or may not be showing any signs of infection and might not be
wearing a mask to avoid infectious transmission. Luckily, in the world of radiology, a patient’s requisition can tell us a lot
about the patient before we come within contact. This gives us an opportunity to prepare for potential exposure to
tuberculosis and other infectious diseases requiring special protective measures. A patient’s requisitions may state that the
patient has a history of positive (+) PPD or QFT. These two abbreviations stand for purified protein derivative, also known as
the tuberculin skin test, and the QuantiFERON tuberculosis blood test respectively. Although a positive test finding does not
always mean the patient actually has the disease, the same precautions should be exercised as if the patient had
tuberculosis to minimize potential infection. Other indications of potential tuberculosis exposure include a requisition that
reads “R/O TB,” or “positive (+) TB.” As a health care employee, knowing what tuberculosis is and how it spreads will help
you to take the appropriate precautions in protecting yourself and others from potential infection.
So, what is tuberculosis and how does it spread? Mycobacterium tuberculosis is the bacteria responsible for
tuberculosis. Once a person is infected with mycobacterium tuberculosis, they will always possess the disease in either an
active form or a dormant form. This bacterial disease predominantly affects the lungs, but can spread to affect other areas
of the body. When this bacterium enters the lungs it wreaks havoc on the delicate lung tissues. The body attempts to
protect itself by walling off the infiltrative organism, limiting its spread to adjacent tissues in a process that results in necrosis
of lung epithelial, and eventually scarring. Scarring can lead to further respiratory
complications in an infected person. Although primary tuberculosis occurs in the
apices of the lungs, secondary infections and other types of tuberculosis can occur
in any part of the lungs. When a person is infected with mycobacterium
tuberculosis, he can spread the disease to others by transmission through air. This
disease is considered airborne and a person can catch the disease by being in
close proximity to an infected individual when they cough, sneeze, or even talk.
According to San Francisco Health Partnership (SFHIP), a person with tuberculosis is
contagious until she has been on the appropriate treatment and has completed
the intended course of medications. One thing that makes tuberculosis especially
dangerous is that research on its transmission is incomplete. The CDC states on their
website ( HYPERLINK "http://www.CDC.org" www.CDC.org) that, “... the smallest
infectious dose of M. tuberculosis nor the highest level of exposure to M. tuberculosis
From left: Hui Shan Su, Jalil
at which transmission will not occur has been defined conclusively.... Furthermore,
Kawas, and Chelsea Christopher
the size distribution of droplet nuclei and the number of particles containing viable
chill out before a tour of the MRI
Continued on page 7
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CCSF RadTimes July 2014
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M. tuberculosis that are expelled by infectious TB patients have not been defined adequately, and accurate methods of
measuring the concentration of infectious droplet nuclei in a room have not been developed.” This statement should raise
significant concern. What is to be done to limit the spread of tuberculosis if the means of infectious transmission are not well
defined?
It is crucial to use standard precautions when working with all patients. Standard precautions assume every patient is
infectious and requires health care providers to exercise minimum infection prevention measures with all patients, regardless
of suspected or confirmed infection (www.CDC.org). Hand washing is of particular importance. Although standard
precautions minimize the risk of infection for most communicable diseases, tuberculosis requires efforts beyond the use of
gloves and frequent hand washing due to its aerosol, or airborne nature. In the case of tuberculosis, transmission-based
precautions should be used. Under the larger umbrella of transmission-based precautions, tuberculosis is considered an
airborne communicable disease, and requires the use of airborne precautions. This means that when coming within contact
with an infected patient, we follow the following guidelines according to the CDC:
Try to isolate the patient as much as possible. This means not placing the patient within close contact with
yourself, health care workers, or other patients.
Provide a procedure or surgical face mask to the patient. Obtain an exam room as soon as possible and instruct
the patient to keep their mask on for the entire exam, or while visiting the hospital, and to avoid close contact
with other individuals. Ideally, an airborne infection isolation room (AIIR) should be used to perform the exam in,
if available at your care facility.
If at any time you need to leave the room, make sure the exam room door is closed, and personnel are notified
of the patient’s condition if they attempt to enter the exam room. Make sure to wear personal protective
equipment appropriate for airborne precautions before coming within contact with a suspected or confirmed
tuberculosis patient. This included the use of an N-95 respirator or higher (i.e. N-99 or N-100 respirator) to be
worn by the health care worker. According to the FDA and CDC, N-95 respirators are approved for use, and
measure over 95% effective against the spread of tuberculosis, when properly used. The effectiveness is a
measurement of filter efficiency of the respirator’s ability to filter particles of a size of 1 µm at a rate of 50 L/min.
Fit testing is necessary for the N-95 respirator to be considered effective. Proper fitting requirements will be
explained later in this article. The N-95 respirator should be removed promptly whenever exiting an exam room.
Proper disposal of the N-95 respirator is crucial to contain any potentially infectious particles that might be
present on the respirator. All FDA-cleared N-95 respirators are designed for single-use only, and are considered
disposable devices. If your N-95 respirator becomes damaged, wet, soiled, or if breathing becomes difficult, the
N-95 respirator should be replaced immediately.
Make sure to wash your hands before and after coming into contact with an infected patient or contaminated
objects. Properly dispose of contaminated objects such as gloves, masks, respirators, and other materials.
Finally, proper cleaning of the exam room should be done once the patient has left. This includes any surfaces
the patient may have touched or been near (i.e. chest stand for chest x-ray, etc). The room should be well
ventilated and left vacant for as long as possible to reduce the risk of inhaling residual mycobacterium
tuberculosis particles.
As stated above, proper N-95 respirator fitting is required to ensure protection against tuberculosis. Without proper fit testing,
an N-95 respirator is considered ineffective. So, how do you go about getting fit tested? Check with your facility to see where
to get fit tested. They must provide the means to do so as part of their infection control program. The goal of fit testing is to
provide an adequate seal and this is achieved when there is a N-95 respirator leakage under 10% (NIOSH guidelines). In
general, a proper fitting N-95 respirator should fit tight to the face without feeling uncomfortable. It should provide a seal to
the wearer’s face to improve protection from mycobacterium tuberculosis particles. It is important to note that fit testing is
model specific and whenever switching from model to model, you must be fit tested again to ensure protection. An
improperly fitted N-95 respirator poses the risk of infectious particles being inhaled and this is particularly of concern around
the periphery of the respirator where there is poor contact or lack of a seal to the wear’s face. N -95 respirators are not
designed for children and are not appropriate for people who have facial hair or wear excess makeup, because a proper
seal cannot be achieved. Once you have been fit tested and the make/model and size has been determined appropriate
for you, you can now follow the guidelines detailed above when coming into contact with patients that have suspected or
confirmed tuberculosis to reduce the spread of infection. Reducing the spread of mycobacterium tuberculosis through the
use of airborne precautions allows a technologist to provide a safe environment for all patients. Knowing what to do in the
case of potential tuberculosis infection will enable a technologist to perform the necessary diagnostic images while
maintaining professional. A professional technologist should concentrate on providing exceptional patient care without
showing signs of anxiety or fear that might otherwise alarm a patient. It is our responsibility as technologists to support to our
patients in times of uncertainty. Personal confidence in caring for patients with suspected or confirmed tuberculosis and
other communicable disease not only allows patient care to become a priority, but enables a technologist to protect
themselves and others from the spread of tuberculosis.
References:
"TB Respiratory Protection Program In Health Car Facilities- Administrator's Guide." Centers for Disease Control and Prevention. DHHS (NIOSH) Publication Number
99-143 . (1999): n. page. Web.
"Basic Infection Control and Prevention Plan for Outpatient Oncology Settings." Centers for Disease Control and Prevention. (2011): n. page. Web. 26 Feb. 2014.
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Inter-Professional Education: DMI and RN’s New Frontier
By Kyle Thornton
Registered nurses and imaging
technologists must often
collaborate in order to conduct
imaging studies on patients.
Communication is an essential
element to ensure the success of
the students. Interaction,
collaboration, and professional
conduct in a stressful and rapidly
changing environment are also key
factors.
The DMI students participating in the
activity were fourth semester
students. Many of them had
observed technologists and other
medical professionals caring for a
trauma patient, but had not actively
participated in the event. Thus, the
objective of this skills laboratory
activity was to create a situation as
true to an actual clinical experience
as possible.
Using a patient simulator, the skills
lab was set up to resemble a
trauma room.
The patient was involved in an
explosion. He sustained severe burns
to most of his body, along with an
open, compound femoral fracture.
Upon arrival to the trauma center,
RN students were required to assess
his condition, stabilize him, and
provide appropriate care.
Part of their assessment and care
included ordering a number of
appropriate diagnostic procedures.
Among them were X-ray studies of
the chest and femur. DMI students
were requested to provide an X-ray
examination of the affected areas
in the trauma room, with mobile
imaging equipment.
DMI Intern Natalia House assesses
the trauma patient while DMI
Intern Harry Jufri moved the
portable X-ray machine in place.
The examination was conducted by
students, Natalia House and Harry
Jufri, while the other members of the
class observed. Prior to the event,
These skills are often learned in the
“real-time” clinical environment in
which there is not always time for
evaluation, comment and
reflection. Therefore, the Registered
Nursing and DMI programs
collaborated to implement a skills
laboratory activity in which the two
disciplines could interact and
participate in a simulated
environment with guidance and
feedback before students
encountered the experience in
“real-time.”
DMI Intern Natalia House discusses
the examination with the RN students.
8
the students were briefed on
expectations of what they might
encounter, and what their duties
would be once they entered the
trauma room.
When the students entered the
environment, the atmosphere was
one of managed chaos. The
patient was screaming in pain,
nurses were rushing to stabilize
him, and the DMI students had to
determine where they fit in to this
scenario. For a simulated
environment, the stress level was
high, but that was to be
expected. The purpose was to
create as true a scenario as
possible.
Natalia and Harry communicated
their needs with the RN student in
charge, and proceeded to
conduct the examination.
For a first time effort, this event
was considered successful.
Following the event, the group of
students indicated this activity
had educational value, and felt
more confident in their ability to
participate in the imaging needs
of a trauma patient, as well as
their ability to communicate with
other personnel while conducting
an exam.
Effective patient care is the result
of a collaborative effort of
multiple individuals, each
providing their own level of
expertise. Interdisciplinary
activities such as these have
excellent potential to improve the
educational experiences of
students and their ability to
provide better patient care.
Dr. Kyle R. Thornton, RT(R), (CT), CRT
Radiologic Sciences Department Chairperson,
Diagnostic Medical Imaging Program Director
CCSF RadTimes July 2014
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2
Children
or School
By Hui Shan Su
I feel so lucky that I
could start the
Diagnostic Medical
Imaging (DMI) program
in Fall of 2012. The
education system in
the United States will
lead me to a better
way of life. My dream,
to be a radiologic
technologist, will come
true with this treasured chance. I have two sons who are
four and two years old and a one-month old daughter. As a
full time student and part time employee, my biggest fear is
that I won’t have the time to give my children the care they
need. I really want my children to have the best upbringing
possible.
I love my children without any reservation but I also
enjoy my student life very much. This paradox causes me to
ponder whether I should drop school and stay home with
my children or continue. After thoroughly pondering this
burdensome decision, I strongly believe that I should not
drop out of the program. I am eager to be a radiographer
one day soon. I am ready to reach my dream so I must
complete the Diagnostic Medical Imaging Program. The
decision has been made.
Students entering this field of study need strong
mathematics and communication skills. They need a
background in chemistry, physics, english, and health
education. Luckily, I am good at science but I am
struggling with my English skills as I am an ESL student which
adds an extra burden to my learning.
One challenge I have is convincing my friends that I
want to continue in school because they are trying to
convince me to drop. They think that I should spend some
more time with my children. I agree that it is not easy to
take care of three children as a full time student. My
daughter is only one-month old! She is demanding much of
my attention. She does not always sleep when I need to
sleep and cries during the night and I have to comfort her.
Her needs come first so I must often sacrifice sleep for
myself. She sleeps during the daytime, but I cannot. I have
to go to school and go to work. My sons are also very
young and demanding of my attention. They are at an age
where they fight with each other, often over toys. I must be
there to help them learn.
On top of the daily pressures, I must also squeeze in
enough time to take my children to the doctor for checkups and other issues. I must also have time to see the
counselor of the Women, Infants & Children Supplemental
Nutrition Program……and there is so much housework that is
always waiting for me. The fact that English is not my native
language causes me to spend a lot of time reading and
understanding what is required before I can even begin
doing the work. To communicate well, I have to have time
to talk in English with my classmates and teachers in
order to understand the information to pass all of the
courses. My friends fear that I will be too tired and not
have enough energy to effectively and successfully
care for so many things at the same time.
I understand that it is extremely difficult for me
to be a radiology student as well as to care for my
children and also have a part-time job but everything
in life is a choice and these are the choices I have
made. I know I can take care of them all.
This is how I do it….. I have a wonderful
husband who supports me. He cares for the children in
the early morning so I can leave by 6:00 am for the
hospital. He takes our eldest son to preschool from 9-5
pm and my mother helps by taking care of the
younger boy and my baby girl during the afternoon
so my husband can go to work. My sister helps me by
picking up my son from preschool and brings him
back home. She then gives the children a bath so that
I can attend the evening courses that are required.
My husband finishes his job and gets home around
7:30pm. He takes care of the kid’s dinners, teeth
brushing, storytelling, and more. Family support is so
important. It would be impossible for me to be a full
time student without help from my family.
The trick to juggling all of my responsibilities is
my ability to manage my time well. Time
management is one of my specialties! I arrange all
appointments with the doctor and counselor in the
same afternoons. I do my homework in the evenings
after my family goes to sleep. I write down all of my
appointments and school assignments on the
calendar and check it every day so I will not miss any
of them. If you have responsibilities that demand your
time the way I do, you become an expert in time
management very quickly!
I have a part-time job as a medical clerk at a
clinic eight hours per week. This only allows me to
earn a few hundred dollars per month to supplement
the household income. My husband also has a parttime job. The amount of money that we earn is barely
enough for our daily living and educational expenses
but I am grateful for what we have and especially
grateful for the W.I.C. program and food stamp
programs that help us. This help is instrumental in
helping me to finish the DMI program.
So, as I think about this more clearly as I am
writing, I absolutely will not drop out of the radiology
program, it is my dream and I will make it come true.
My educational goals are important to me and I will
not let anything get in my way. I will follow my dreams
for a higher paying career, better benefits and the
opportunity to be financially independent. Along with
this, I vow to give my children the best education and
upbringing that our lives will allow. Thinking about this
choice I realize that to be a DMI student doesn’t
mean that I love my children less, on the contrary,
being a DMI student means that I love them more and
without any reservation!
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#studentradiographer
By Steve Carreon
I can still remember receiving my letter of
acceptance to the DMI program at CCSF. It seemed
too good to be true after not being accepted the
previous year. It took a moment for me to realize that I
was, in fact, accepted this time around and I needed
my wife to reread the acceptance letter for me. Upon
DMI program commencement, the director, Kyle
Thornton, gave us clear expectations as to what lies
ahead. He provided us with meaningful advice to help
us succeed. Congruently, our clinical coordinator, Diane
Garcia, provides the similar advice up to the present
day.
When you’re listening to the advice given, you
hear everything that is being said but, you really need to
experience the program in full swing to put the advice
into action. It seems that when you reach a certain age,
your ability to evolve tends to diminish. I know that I
have the capacity to change and adapt, but
sometimes I’m unsure of how to implement that change.
My perception of myself isn’t quite realized yet. This
experience is quite different compared to previous
learning situations. So, this road is definitely not an easy
one. That truth doesn’t hit you until later while immersed
in the program.
Summer of 2009, our first child, Addison was born
while I hammered out my prerequisites in a timely
manner. I say “timely manner” because I wasn’t getting
any younger and my wife doesn’t want to be the sole
bread winner. Nor did I want her to be. I was already
practicing how to have a young child, but not be fully
present with him because I was studying. Thank you,
Grandmas and Grandpa.
A year later, while achieving the completion of
my volunteer hours, we had our second child, Bryce
Marie. Unfortunately, we had to make a decision that I
wish no parent should have to make. We withdrew life
support. She was born almost four months premature
and suffered an injury to the blood vessels of her brain.
So, when the program acceptance letter came, it was a
blessing to my family and me after a very difficult few
months subsequent to the loss of our second child.
Maybe someone “up there” was advocating for me. I
figured that this experience would allow me to become
a true professional in the healthcare field. We shall see.
We did receive an additional blessing with our
third child. Grayson was born a year after Bryce’s
passing. I know what you’re thinking … and yes, I was
told not to have any major life events during the
program. But again, my wife and I are not getting any
younger and, for now, they have grandparents to
partake in their upbringing. Later that fall (of 2012), I
began the rigorous DMI program at CCSF.
10
As the first semester began, my family and I
grappled with the uncertainty of my father’s health. He was
cared for in a rehab facility after suffering from multiple
strokes. We still regularly checked on the quality of his care.
But, his condition became increasingly bleak as the
semester drew on. Ultimately, he passed away half way
through the first semester. I needed to mourn quickly and
get back on track. I heard some feedback from students
ahead of me about the challenges of the second semester.
It seemed as if my dad sensed that. Apparently, he was
determined that his poor health would not be a burden to
me while I was in the DMI program. He was leaving that
duty to his grandkids that are now age four and two.
With my wife working twelve-hour shifts at the
hospital and additional per diem shifts at a clinic, it leaves
me to pick up the balance of the household duties. Despite
my packed schedule, I’ve found myself thinking about our
personal losses and they sometimes weigh heavy on me.
There are no extravagant birthday parties for the kids. We
are content with small family gatherings to celebrate the
milestones. Weekly ballet practice for my daughter takes
up a little valuable study time. Every now and then a
parent or teacher will dole out some guilt to my already
heavy conscience. Preschools do their part in helping to
develop some important skills, but parents are leaned on to
fill in the blanks and work with their children when they are
not in school. I have to pick and choose what’s most
important for my family and me. In other words, I don’t
read books to my daughter EVERY night but, dinner is on the
table. My son’s speech was described as
“underdeveloped” compared to other kids his age. So
what? He’s two! He doesn’t have to take the SAT’s for a
little while longer. Sometimes, my brat pack would be lucky
to have as many as three baths in the same week. I was
fortunate enough to be present for their first steps, first
words, and first acts of defiance. Otherwise, that is what
smart phones with cameras are for. My Minions tax me for
the energy that I wish I had. I’ve managed to still stop and
wipe a few runny noses and then continue studying.
I am not saying that the road I have traveled is
more difficult than the next student’s but, it has not been
one of the easiest either. I am only one shade of gray from
a box that contains many more shades. There are benefits
of embracing these challenges. There are no excuses for
the poor exam results or missed homework assignments.
Sometimes it is necessary for me to have a longer exposure
time to a particular subject before achieving the desired
knowledge. Pun intended. But the instructions are clear.
Do the work. Put in the time. The goals are in plane sight.
The “goals” being to graduate, become licensed, become
employed, and make the family proud. Allow me to
introduce myself… Steve Carreon, student radiographer.
CCSF RadTimes July 2014
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My Clinical
Rotation
Experience
by Dallas Fair
First day on the job is always
nerve wracking and my first day of
clinical rotation was no different. I
tried not to let the butterflies in my
stomach get the best of me. I gave
myself extra time to get to the
clinical site, as I was not familiar with
the location of the hospital and the
surrounding area. I also wanted to
allow myself time to look for parking. I
did a trial drive through a few days
before, but I was completely lost and
had to rely on my GPS to guide me.
My trial drive was during the
afternoon and the scenery was
different compared to the 6:00am
darkness. I drove back and forth on
one particular road a few times and
thought I had better call the
radiology department at the hospital
to inform them that I got lost and will
be late. Then I saw the hospital’s
emergency sign. I managed to get
to the radiology department at the
hospital fifteen minutes before my
start time. I felt like a wreck but
managed to put on a brave, smiling
face and I introduced myself to
some hospital employees. I received
lukewarm hellos following awkward
moments of silence and the
technologists went on with their
routines. It seemed like everybody
had a job to do and I had better find
one quick if I was going to be a part
of the team.
Since I was a new student, I
was expecting an orientation around
the radiology department and
maybe a description of the hospital
layout upon my arrival, it seemed a
tour might not happen today. It was
every clinical student’s nightmare,
standing around not knowing what
to do or where to go or who to talk
to. It was only 7:30 in the morning
and I could not wait until 3:30pm
when I would get to go home. I
decided right at that moment that if I
was going to make it through that
day, I had better attach myself to a
technologist and shadow him/her
11
during exams. I asked to shadow
one of the technologists who was
about to do the morning portable
rounds. We made small talk as we
wheeled the portable x-ray
machines to the patient rooms.
When we got to the first patient’s
room, I went into this automatic
mode of introducing myself as well
as the other technologist, asked the
patient for her birthday, and
reconfirmed her last name for
identification. I proceeded by letting
the patient know that we were there
to take her chest x-ray. Next, I
continued on by positioning the
patient upright for an AP Landscape
portable chest x-ray. The other
technologist assisted me and we
took the exposure. It was not until we
had finished the portable round
while heading back to the radiology
department that the technologist
made a comment that I was not
new to doing portable x-rays and my
work was good. I had forgotten that
I was a new student and had not
earned the trust of the technologists
yet. At least I had earned the trust of
one technologist that morning. One
tech down and how many more to
go?
When we arrived back in
the radiology department, my
clinical instructor welcomed me with
open arms. She was just arriving at
the hospital. There were more
employees arriving now and I was
introduced to all who were there. As
it turned out, the staff I encountered
earlier were from Ultrasound and
Interventional Radiography. The
technologists I was now meeting
turned out to be very nice and
friendly people. My clinical instructor
was called into surgery so the
assistant clinical instructor gave me
an orientation tour of the radiology
department, the emergency room,
and the general hospital floor plans.
He was extremely helpful in
explaining department procedures
and protocols. We got called back
to radiology as the cases were piling
up. The technologists were busy
taking exams and I offered to help
but was told to just stand aside and
observe. Observe I did.
Standing aside and
observing the orderly chaos of the
activities around me, I noticed a lot
of foot traffic between of the x-ray
room and the cassette reader which
is located in the hallway. That’s
when I realized the system they use
at this hospital is the CR system and
not the digital system. I thought of
the inconvenience of having to run
out of the x-ray room to process a
CR cassette after each exposure,
not to mention the inconvenience of
having the patient wait in the x-ray
room alone while the cassette is
being processed. It took longer to
finish one study in my new clinical
site than at my home base hospital
because of digital system efficiency.
With the digital system the
technologist does not need to leave
the room because the image is
displayed on the screen shortly after
the exposure is taken. The
technologist is in the exam room
with the patient the entire time,
which is important for patient safety.
In spite of having to process each
cassette in between, the
technologists moved quickly and
efficiently.
I was very impressed with
how well the technologists set
manual techniques. Their exposures
always fell within the acceptable
exposure range. I cannot say the
same for me. As I was observing, I
took out the technique chart that I
previously made for myself and
would try and remember the
techniques for the study of a body
part at a certain kVp and a certain
mAs. To my surprise, the levels that
rendered diagnostic quality images
at my home hospital were far less
Continued on page 12
CCSF RadTimes July 2014
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1
2
3
than what was used at my current
hospital. My setting for kVp was
always acceptable but my setting
for mAs would have consistently
been underexposed had an
exposure been taken. I was told I
would need to use more mAs. It
was not uncommon to see a lateral
L-spine study with 80kVp at 250mAs.
The thought of using a technique
with such high mAs scared me, but
the image came out within the
acceptable exposure range. I had
to train myself to change my way of
thinking about utilizing more mAs.
Within the first week I was
given studies to do on my own. I
made another technique chart to
use on the machines for this
hospital. They said that every
machine has its own personality. I
soon found out what they meant.
The center marked line of the x-ray
field is not always in the center. The
detent track squeaks loudly and the
detent indicator light is not always
illuminated. These are just a few
quirks of the machines that I had to
learn to maneuver. Now one month
later, I still feel uneasy sometimes
when setting a higher mAs when I
know that much less mAs can still
render diagnostic quality at other
hospitals. I kept reminding myself
that I am working with the CR
system, which requires more mAs
than the digital system. The
technologists all seem to be
comfortable with higher techniques.
I’m still learning to be a
technologist, so for now I just have
to put my apprehensions aside and
follow their lead. My CT and MRI
rotation is not for another four
weeks. With what I have learned so
far in CT class, I feel that I will
understand more when I do my CT
rotation at clinical. For now, the
workload is more than enough for
me to handle as I’m only in clinical
two days a week. I’m still trying to
learn about the hospital billing and
processing computer system. I’m in
a whole new hospital with a whole
new computer system to learn.
Although I am stressed out at
clinical, I am grateful for the
opportunity to work with the CR
system, which requires me to master
my manual techniques. I am not
there yet but each day at clinical
brings me closer to a working
confidence level.
12
A Lesson Learned
By: Sandy Zhou
It all happened so fast. I stood
there, not knowing what to do. I just
stood there.
“Call a code,” the anesthetist
shouted.
Someone, I can’t remember who,
asked, “What’s the code number?”
“555… dial 555, code blue,” the
attending technologist answered.
“Go get the crash cart, the pediatric
crash cart. Location of code blue at
XXX hospital XXX campus, CT
department, first floor, 8 month old
male.”
On the overhead: “Code blue,
CT.” Again, “Code blue, CT.”
A doctor rushed in, asking, “What
happened?”
Then the anesthetist shouted,
“Cancel code, cancel code. He’s
breathing.”
I started to tear up - tears of joy,
of course!
What an experience! I never
thought I would actually experience
a code blue. As a student, I learned
what a code blue is and what
needed to be done when a code is
called, but I never paid too much
attention when these lessons were
given.
On the first day at the clinical site,
the lead technologist gives the new
students a tour of the radiology
department. The location of the crash
cart is always highlighted during the
tour. Now I know, being familiar with
the location of the crash cart is much
more important that one would think.
It is not something to just
acknowledge and then forget. The
students really need to pay attention.
This is serious business.
I am a 4th semester radiologic
technology student at City College of
San Francisco (CCSF). After this
semester ends I will become an Intern.
At CCSF that means that my didactic
education is complete and I will then
be in the hospital 40 hours per week
for 6 months. By the end of this
semester I will have been in the
program for almost two years but I will
not be done. CCSF is longer than all
the other programs in the Bay Area
and I’m sure glad that it is. I have so
much more to learn. By the end of
this semester I will have completed
about 810 clinical hours. I still have
about 1000 hours left but it will be
concentrated on perfecting
radiographic procedures not
bookwork.
Finishing up my 4th semester, I
should be a confident clinical
student at any hospital. Yet, when
the code blue was called, I stood
there, not knowing what to do. The
code lasted less than 10 minutes,
but it was one of the longest 10
minutes of my life.
This is how it started. A head CT
scan was ordered, and the child, a
boy, was to be sedated. When the
boy’s mother carried him into the
CT room, his eyes grew large as he
looked around the room. He must
have been wondering about the
big, scary-looking machines. His
mom then placed him on the CT
table, and a mask was placed over
his face by the anesthetist. He went
to sleep within seconds. After his
mother kissed him good night, she
went to the waiting room with the
child life support assistant.
What is amazing to me is how,
within a matter of minutes,
everything can change.
Most people who enjoy
hospital themed television shows
have probably seen a code blue
on television. However, unless you
have actually experienced one in
real life, you can never really
understand the intense stress and
desperation that is present during a
code. I certainly feel lucky that my
first experience was at a hospital
with a dedicated and intelligent
team of health care providers. They
brought the patient, a beautiful
baby boy, back to life and earned
my utmost respect. Wow! I am
actually part of this team. I just
learned a very valuable lesson…..to
be present at every moment – in
class, during orientation, and every
moment that I am in the clinical
environment – to pay attention to
every detail no matter how small.
There could be a life depending on
me and I intend to be sure I give
the best care possible. My advice
to all students is to PAY ATTENTION
to what you are learning.
Everything being taught is
important to your new career and
to quality patient care. Your
patients are depending on you to
know what to do. PAY ATTENTION!
CCSF RadTimes July 2014
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Let’s go BACK to
the FUTURE!
By Diane R. Garcia, MS, RT(R)(CT),CRT
The latest Radiologic Technology Certification
Committee (RTCC) Meeting was held in Los Angeles on
Wednesday, April 2, 2014. After approval of the previous
meeting’s minutes the agenda included the following:
•
•
•
•
•
•
•
•
•
Status of Prior RTCC Motions
Legislative and Regulatory Updates
Whole Body Composition & Scope of X-ray Bone
Densitometry Permit
Fluoroscopy Examination Update
QA/QC Regulation Inspection Experiences
Consideration of Eliminating Fluoroscopy Permit
for CRTs
Radiation Protection in the Cath Lab: 1950s
Technology Jeopardizes Today’s Medical
Professional
Agenda for RTCC Subcommittee Scope of
Practice for Radiologic Technologists
Consideration of RCIS Regulatory Fluoroscopy
Exception
The minutes of this meeting will not be available until
after they have been approved at the October, 2014
meeting.
The most important part of this meeting, from my point of
view, was the part of the agenda that had to do with
allowing non-radiology personnel the ability to operate
fluoroscopy equipment without being CRTs.
Deregulating radiologic technology is very disturbing to
me and many others including the radiologists on the
RTCC as evidenced by the way they voted on the
motions made at this meeting.
An important motion was made by Radiologist, Dr.
Bonna Rogers-Nuefeld, which was voted on and passed
by the RTCC to rescind the previous motion that was
passed in the October 23, 2013 meeting. This previous
motion made by committee member Dr. Dale Butler
(non-radiologist physician) and seconded by committee
member Dr. Todd Moldawer (non-radiologist physician)
stated the following:
“The committee members approved that the
RTCC support the development of a limited
permit, or an exception to existing regulation,
that would allow an individual, with specific
education and experience to be defined or
determined, the ability to position the patient or
the equipment under the personal immediate
supervision of the S & O, while x-rays are not
being generated.”
(Oct. 23,2013 RTCC meeting minutes)
Though this motion states, “…while x-rays are not being
generated,” it is well known that once the barrier is
lowered, operating the equipment with the beam on will
become common practice of those who obtain said
permit. It has even been said at the last few RTCC
meetings that currently Cath Lab personnel, specifically
Registered Cardiovascular Invasive Specialists (RCIS),
have been defying California Laws and operating
fluoroscopy equipment in many facilities. I am aware of a
few in the San Francisco Bay Area that, at present time,
do not even employ any CRTs in Cath Labs so who do
you think is operating fluoroscopy equipment (illegally) in
those departments? I wonder if the patients know that
they do not have qualified personnel potentially setting
technical factors and operating fluoroscopy during their
procedures.
As a matter of fact, it is widely known that most RCIS
personnel have only on the job training with little to no
radiology education at all. Even those from an
accredited program have only minor questions on their
board examination regarding radiation or fluoroscopy
and a person taking that exam can get all of those
questions wrong and still be qualified as an RCIS. Are
they qualified to operate and understand fluoroscopy
equipment?
Back in 1969, the Radiation Health Branch (RHB) made
the enlightened decision to create the Radiologic
Technology Act which specified that only those
educated in a particular way could operate radiology
equipment for the purpose of irradiating human beings.
To be exact,
“The Legislature finds and declares that the
public health interest requires that the people of
this state be protected from excessive and
improper exposure to ionizing radiation. It is the
purpose of this chapter to establish standards of
education, training, and experience for persons
who use X-rays on human beings and to
prescribe means for assuring that these standards
are met.” This comes from the Health and Safety
Code (HSC), Division 104. Environmental Health,
Part 9. Radiation, Chapter 6. Radiologic
Technology, Article 1 Declaration of Policy,
Section 114840. (RegsToday.com)
At the latest RTCC meeting on April 2, 2014, a motion was
passed to consider non radiologic technology personnel
to possess the ability to operate fluoroscopy equipment
in the surgical suite and the cardiac catheterization
laboratory (Cath Lab). During the discussion that ensued,
it was even suggested (though the motion did not
include this) that any person in the IR suite should also be
allowed to operate the fluoroscopy equipment. This
motion was voted on by the committee. The nonradiologist physicians all voted in favor of this motion
while the radiologic technologists and the radiologists all
voted against it. Unfortunately the non-radiologist
physicians outnumbered those of us (Radiologists and
CRTs) whose entire education revolves around radiology.
I now fear that the non-radiologists are trying to bring the
state of California back to 1969 when anyone was
allowed to operate radiology equipment with little to no
Continued on page 14
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CCSF RadTimes July 2014
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education at all. The argument
made by the non-radiologists is that
the physicians who supervise in
fluoroscopy are capable of
monitoring all aspects of the
fluoroscopy procedure and the other
personnel do not need to be licensed
CRTs. The physician will have
complete control over verifying all
technical factors and other important
elements of the procedure. In theory,
this may be true, but in my 35 years of
experience working in surgery,
general fluoroscopy, and IR, this is
absolutely not true in practice.
Though the Cath Lab traditionally
does only cardiac procedures, this is
not the case any longer. They are
also doing interventional procedures
which makes the deregulation even
more concerning.
To conclude, do we really want to
return to 1969 or do we want to go
back to the future? Do we want to
join the other states that have no
regulations regarding radiology? As a
technologist of vast experience both
in practice and in education, I
personally understand the risks
involved. Are we going to allow this
deregulation of our profession or are
we going to fight for our patients?
AND I remind you that YOU may also
become a patient one day!
Let’s go BACK to the FUTURE!
Diane encourages you to get
involved today!
Resources:
Approved RTCC meeting minutes of
October 23, 2013
RegsToday.com; California Law
http://ca.regstoday.com/law/hsc/ca.regst
oday.com/laws/hsc/calawhsc_DIVISION104_PART9_CHAPTER6.aspx
14
HOLD YOUR BREATH ... BREATHE
Eric Holmgren
There is a moment in many x-ray exams when you ask the patient to stop
breathing. Preparation is complete: you have identified the patient, confirmed
the order and its clinical indication, set the technique, shielded, angled, and
positioned. Now, just before you make an exposure, there is a pause as
breathing is suspended. Full stop in this moment allows you to capture a clear
image without motion. As I complete the City College of San Francisco
Diagnostic Medical Imaging Program, I find myself in a similar moment. In a
scant six weeks internship ends for me and my cohort. Our education will be
completed and then evaluated via the ARRT exam. Of course, we hope to
soon be working as radiologic technologists and we know that our education
will be ongoing. HOLD YOUR BREATH ... pausing in this moment to mark,
celebrate and reflect on this accomplishment - full stop before moving forward
- can add clarity to the picture of the path and our place on it.
Personally, it is clear that this accomplishment is not mine alone. Though I
dedicated myself and my hard work to this program, I know that the success I
enjoy is also due to the opportunities I have been afforded, the support I have
received and the friends I have made as a result. It is difficult to imagine a
more comprehensive preparation for this career than that which the CCSF
Diagnostic Medical Imaging Program provides. I am grateful to the entire
faculty for not just teaching radiologic science and technical proficiencies, but
also illuminating a more complex and integrated picture of modern health care
and compassionate patient care, all while shouldering the stress and
uncertainty of CCSF accreditation in a manner that minimized its impact on
students.
At City College, I was encouraged to acquaint myself with two of our
professional societies. My participation as a student member of the CSRT and
the ASRT has deepened my appreciation of the world I am entering, how much
there still is (and will always be) to learn, and issues that affect our profession
and our patients in an evolving health care environment. Being able to attend
meetings of the Radiologic Technology Certification Committee, I witnessed
lobbying to issue fluoroscopy permits to personnel other than CRTs to operate
fluoroscopy in the operating room, catheterization lab and interventional
radiology suite, without formal diagnostic medical imaging education. The
RTCC is the advisory body to the Radiologic Health Branch of the California
Department of Public Health. Their recommendations will affect the value of
our education and expertise, the necessity of RTs, and - most critically - the
safety of patients and health care workers. The CSRT is a countervailing voice in
California on this issue and it lobbies for educational and patient safety
standards locally. CSRT joins the efforts of the ASRT on a national level through
support of measures like the CARE bill. HOLD YOUR BREATH ... I know my future
includes ongoing membership in these two important organizations. Whether or
not we attend their continuing education conferences, our membership dues
support the work they do on our behalf.
Finally, my clinical education has been rich and diverse. The encouragement
and mentoring that I received from scores of techs, radiologists and others at
the various campuses of my two clinical hospitals have been profound. All
have helped me hone my skills as I developed them. The tech I have become
is a reflection of their skill and innovation. In addition to general x-ray, my
internship has included rotations in surgery, trauma, ultrasound, fluoroscopy, MR
and IR. This has given me a clear sense of the profession and the opportunities
that await me. HOLD YOUR BREATH … I am fortunate that throughout this
journey I have remained certain that this is the right path for me. I embrace the
transition from student to colleague, knowing that my education continues and
we all can learn from one another. I welcome the day that I find myself working
with a new clinical student practicing their fledgling skills.
... AND BREATHE.
CCSF RadTimes July 2014
1
Migration South for Vacation by Rhonda Boulland
There’s no hiding from the truth. My friend and classmate, Dallas Fair, and I took our chances on scoring two standby seats
on a packed jet headed for LAX one Friday evening in early May of this year. We were after one thing: vacation days to
use during our internship. The deal presented to our class was three vacation days in exchange for making the journey
down to southern California for the CSRT Spring Seminar. I don’t know about you, but I’ve never worked for six months
straight without a vacation so I knew what needed to happen. Honestly, our chances of getting seats on the airplane were
not much better than finding parking in Union Square, but we headed into the pandemonium of SFO to try our luck. Score!
Big thanks to my travel partner for a trip down to the land of palm trees and Botox. The next day after a mere four and a
half hours of sleep, we fueled up on Starbucks and made our way to Northridge Hospital. I couldn’t stop thinking about my
only reference to Northridge. Earthquakes! Dallas and I arrived and tried to prepare ourselves to sit and listen for the
balance of the day. We were in the company of about fifty other attendees. Dallas and I were the only ones representing
CCSF.
The first speaker discussed how multiple regulatory agencies had visited his hospital and how unnerving their visits were. A
few of the agencies that dropped in were the FDA, RHB, and JCERT. And what do these agencies want radiology
managers to fill out? Surveys. After several lengthy questionnaires, the speaker was happy to report that there were no
findings. The entire department could breathe easy and get on with their busy workload.
Next we broached the incredibly relevant subject of overexposure in CT, particularly in perfusion scans done using a head
CT. This type of scan would be common for a stroke patient for example. At one particular hospital 40% of the patients
receiving this type of scan on a repeat basis had hair loss in the shape of a ring around their head. The overexposure
occurring with this particular type of scan went unnoticed for 20 months before changes were made. The “Ring Effect” is
happening to patients all over the country. Senate bill 1237 and Assembly bill 510 were passed to address dose reporting in
CT, but this is not an official policy that must be followed by all radiographers yet. The discussion moved to adjusting
protocols in CT for pediatric and pregnant patients and how the dose limits are not always followed. There were some real
life examples given of pregnant women and children being given dozens more times the dose they needed. One baby
boy, in particular, was given hundreds more times the necessary dose and his doctor anticipates that the boy will develop
cataracts as well as other unfortunate manifestations due to the high exposure of ionizing radiation. I could see everyone in
the room shaking their heads and shuddering at the thought of being the tech that made such a grave error. This is likely
the number one concern for most radiographers; making a mistake that has a negative impact on a patient. For the
hundredth time since I started this program, I vowed to be super-duper-exceptionally-unbelievably-astonishingly careful
both in my internship and beyond.
Dallas and I had not yet had the opportunity to give each other feedback about our thoughts on the seminar, but as the
speakers were making their presentations and sharing their ideas about how to help us become more accountable and
more knowledgeable techs, Dallas and I exchanged approving glances. I could see the element of delight and surprise on
Dallas’ face and he witnessed the same on mine. Maybe we would get more out of this jaunt to SoCal than a few vacation
days. The next subject was about the dangers of an MRI quench. A quench is often signaled by a loud bang and a hissing
sound from escaping gas. It occurs when the liquid cryogens that cool the magnet coils boil off rapidly, which results in
helium escaping very rapidly from the cryogen bath. The quench duct can reach temperatures of 470° below zero and will
freeze anything around it, including you or me. Techs need to be aware of where the quench duct is located at their
hospital. If the scanner quenches it is very dangerous to be within a few feet of the duct because the extreme low
temperatures of the helium gas could cause frostbite or burns. Hospital employees should be able to identify the duct’s
location and what type of barrier, if any, is around it. The white smoke-like gas that comes out of the vent could prompt a
visit from the fire department. If proper signage isn’t present near the quench duct then fire department employees could
be hurt if they go beyond the barrier. How does your hospital handle this potential hazardous situation?
As the day progressed I was increasingly able to identify with Pooh Bear and his rumbling tummy when my attention was
again turned to CT. It came as surprising news to me that CT techs don’t necessarily have to be certified or licensed at
present time in the state of California (aside from their diagnostic license), but that will be changing soon. CT scanners
have to be “accredited” in each location that they reside in because of the law passed in July of 2012 mandating dosage
reporting. It would follow that techs be required to pass a board exam and hold a license in order to run an accredited
scanner. The only appropriate response to the aforementioned next level of laws around CT licensing should be favorable
by the radiographer community. Why? Because nurses and physician’s assistants want to take over certain aspect of our
jobs. With every law that’s passed requiring CRT’s to obtain a specific license to run a specific piece of equipment then
hopefully we are solidifying the fact that education is paramount when working with ionizing radiation. Maybe one day
California will require CRT licensure to accompany a bachelor’s degree. Can you see why that would be a move in the
right direction for our industry? The speaker also discussed the Image Gently Campaign (imagegently.org) and how
educating radiology staff about how “one size does not fit all” can lead us to true patient care. Can we adopt the
philosophy that we are our patient? When we become every patient’s advocate than we, as a whole, are becoming
respected professionals that will not let other hospital employees take over our jobs.
Continued on page 16
15
CCSF RadTimes July 2014
1
2
Migration South for Vacation CONTINUED
Break time! Dallas and I took a few minutes to talk about the day’s topics and we were both brimming with enthusiasm.
Every speaker had made an impact on us. We were furiously taking notes and trying to absorb every nugget of information
that was presented. This seminar was turning out to be a rich surprise that fueled ideas and chatter amongst all who
attended.
As a testament to how important dose management is, we welcomed a new set of speakers to the podium and continued
the discussion about using appropriate protocols to avoid overdosing the patient. One of the speakers, Tim Gustafson, was
so determined to purchase a CT scanner for his department that administered the lowest possible doses to patients that he
brought a phantom torso on a business trip to visit various CT manufacturers. Mr. Gustafson showed up at companies such
as GE, Siemens, Zeam, OEC, and Toshiba with the phantom in tow. Like a teacher who administers a pop quiz, he sparked
quite a stir when he asked if he could do an unscheduled abdomen scan at each of the companies being considered.
One brand of scanner stood out as the low dose leader. For the type of scanner that he was in the market for, let’s just say
the winner’s name rhymes with “Neiman’s”. Enough said.
There were many more speakers, each with the background and devotion to their subject to keep the group fully
engaged. We learned about the ABC’s of a chest x-ray, acromegaly, Cushing’s syndrome, legislative trends that affect our
future, acute CT brain imaging, and finally cultural diversity within imaging departments. The diversity discussion ruffled a
few feathers and sparked more input from the group than any other subject. The speaker was trying to make a case that
the U.S. isn’t a melting pot, but a fruit salad and we should treat one another according to the type of fruit we are. In other
words: don’t treat every patient the same. Hmmmmmm. Doesn’t the fruit in a fruit salad always remain firmly an apple or
firmly an orange in salad after salad? From my perspective, with each generation we combine the characteristics and
traditions of far-away lands to unite and fuse into a new family unit. With all due respect, we are a melting pot and not a
fruit salad. That being said, I do agree that every patient should be treated differently, but always with one idea in mind: I
am my patient and I will do everything in my power to protect my patient.
The afternoon wrapped up and Dallas and I headed to LAX to try our luck at once again scoring a standby seat. We both
felt like the seminar was a total bonus and an unexpected bounty of pertinent information. And just when we felt like our
luck may have run out, we received a couple more gifts … the last two standby seats on the airplane. ☺
Diary of a 4th Semester Student
by Rhonda Boulland
It’s Thursday and my alarms both sound at 5:45am. I turn them both off and I’m surprised that
my alarms wake me up and not my kids. My hospital shift is 8:00am to 4:30pm and I’ve rotated to a new hospital this
semester so I’m learning new exam protocols, new equipment, and trickiest of all I’m learning how to work with a new set of
radiographers.
I’m tired on this particular Thursday because my four year old son is sick
and woke me up several times during the night. I wonder how my
husband can sleep through the coughing, night terrors, and crying from
my kids?! No time to ponder such absurd questions; I need to get ready
and go. An hour later as I’m packing my lunch and getting ready to
leave, my sons both emerge from their bedroom. I’m overjoyed that I
can spend a minute and thirty seconds with them before I race out the
door. I ignore their fussing and pleas for milk and television as I pat their
thin, blonde hair that’s sticking out in all directions. At one and four
years old, they both still view me as someone who can meet their every
need at every moment. At this moment I view them as the two most
precious little bundles of love I could ever imagine that are about to
make me late. Now my husband is emerging, eyes squinting, and still
half asleep. I tell him “we’re out of vegetables because I made a salad
for lunch so you’ll have to go to the store before dinner tonight. Don’t
forget, I have class tonight so you have to pick up the kids. Wait … Levi was up all night coughing and he feels feverish. On
second thought, you need to stay home from work because Levi’s preschool director will flip out if you drop him off in that
condition. Oh, and when you’re getting Henry ready for the nanny-share can you give her more diapers. She’s out. And
don’t forget to put applesauce in Henry’s lunch, he’s been constipated for two days. Also, check out Levi’s eyes. They look
so red. I think he has pink eye. Okay, bye babe, love you”. My husband gets back in bed and pulls the covers over his
head and pretends to cry as I walk out the door. (continued on page 17)
“When the
stress becomes
overwhelming I
exchange it for
gratitude.”
16
CCSF RadTimes July 2014
2
It’s now 7:05am and I’m out the door a few minutes later than I’d like. I debate whether to listen to NPR on my way to work
or to listen to a recording of my instructor’s voice to prepare for an upcoming quiz. I can feel my anxiety level rise. I know I
have a quiz coming up that I haven’t studied for so I listen to NPR for 10 minutes then listen to my instructor for the remainder
of the drive. I park 7 blocks from the hospital to save $7 on parking, but the $13 per day charge is another small added
stress to the huge financial burden of living off of loans and one income while in the program. I stuff the financial worries in
a mental file that I try not to open very often.
I arrive at the hospital and after cleaning and stocking are complete it’s time for the first x-ray. The tech on duty tells me to
get the order and the patient. I position the patient for an AP knee x-ray by angling the tube 5 degrees cephalad.
Collimation, marker, and lead are all in order. As I turn to dart behind the lead wall, I realize that my clinical instructor and
two senior techs have been watching my every move. Clearly, I’ve done something wrong. I’m staring at two puzzled
faces and one slightly annoyed face. Note to self: this hospital doesn’t want an angle on the AP knee. I erase from my
memory nine months of clinical instruction at my previous hospital along with what I’ve learned in my positioning class and
replace it with this new nugget of information. My mental hard drive is being reformatted with every move I make today
and for the rest of the semester.
It’s 9:00am now and I head over to fluoroscopy where I’m scheduled to be for the remainder of the day. I love fluoro
because it feels like I’m part of a little clinic. I enjoy working with the radiology residents who are also on a rotation as well
as the speech pathologists who come in for swallow studies. I always pick up new tidbits of information listening to the
residents talk to the patients. Our first patient will have a barium swallow study and an esophagram. The tech sets up while I
watch and I notice the similarities and differences in the set up procedure to my base hospital. The chatty speech
pathologist comes in and makes small talk with the tech while she sets up. Our patient comes in and the study begins. I try
to take in every detail in hopes of getting a competency signed off the next time this type of exam comes up during my
rotation. At this point I’m just trying to figure out when to put lead on, where to stand, and how not to be annoying to the
tech, resident, and speech pathologist. The esophagram is over and the doctor fills the patient in on what he has just
witnessed. I’m wondering if there will be overheads, but the tech motions for me to help the patient off the table and clean
the room. I guess the study is over!
Our last exam of the day is a hysterosalpingogram. A female tech comes in from the x-ray department to take over. I have
been signed off on this competency so I set up the room accordingly. The tech makes a few adjustments and we’re ready
to get the patient. I have a list of questions ready to ask the patient and I get her consent forms in order while she’s
changing into a gown. The patient nervously sits down. I make notes for the resident as I ask the patient several pointed
questions that will give the doctor some clues as to the patient’s condition when he arrives. I explain the exam and I’m
extra calm and warm in my demeanor in hopes that the patient will feel a little less anxious. During the exam I ask her
where she’s from and about her job to get her mind off the catheter that’s being inserted into her cervix. I rest my hand on
her shoulder and tell her to remember to breathe at certain times during the exam. At the end of the study the patient
thanks me profusely and tells me that I made the exam a “piece of cake”. This makes my day and is the equivalent of a
friendly reminder about why I went into this field.
The clinical portion of my day ends at 4:30pm and it’s time to commute to school for my night class. I’m exhausted. I call
my husband to check in. As soon as our kids realize that they don’t have dad’s undivided attention they begin to fuss.
Trying to talk is futile. I realize that I have a quiz in my class tonight. The wave of dread washes over me. I know this feeling
all too well. I’ve reviewed fifty pages of the hundred page chapter. For the remainder of the drive my thoughts vacillate
between my odds of passing the quiz and what I can find to eat at Whole Foods for less than $6.
With no time to change out of my scrubs, I arrive at 6pm on the dot for class. Two and a half hours go by and it feels like
ten. Now it’s time for the quiz. Why does the vascular system of the liver need to be
so complicated? The quiz is significantly more difficult than I anticipated, but the
“I’m always
end of the quiz means the end of class. It’s time to go home at last.
heartbroken when
another day has
gone by and I
haven’t done any of
the things a parent
longs to do with their
children.”
My husband is asleep on the couch when I walk in at 9:30pm. The house smells like
the dinner he prepared. There are clothes, shoes, toys, sippy cups, art projects, and
pieces of mail everywhere. I go into my son’s room. They are sleeping so perfectly.
I miss them so much it hurts. I kiss their foreheads and watch them breath. I’m
always heartbroken when another day has gone by and I haven’t done any of the
things a parent longs to do with their children. My husband is awake now and I fall
onto the couch next to him. He asks how my day was. I’m too tired to speak. He
already knows this and doesn’t press me for a response, but just rests his hand on
mine. I simply could not be in this imaging program without his support. He is the
reason it all works.
When the stress becomes overwhelming I exchange it for gratitude. Gratitude has never failed me during this journey. I
could say that I’m lucky, but luck doesn’t lend itself to the work that has been done so I’m just thankful each and every day
for my incredible husband, my two boys, and the strength to get up and do all over again tomorrow. ☺
17
CCSF RadTimes July 2014
1
2
Benjamin Franklin once said,
MRI Contrast
Complications
"The only things certain in life are death
and taxes." Although some people try
to avoid taxes, death is inevitable. Early
death, however, can be avoidable,
by Roel Atanacio
particularly the ones caused by
diagnostic procedures. Like anything
else that enters our bodies (food, water,
drugs), contrast used in MRI can also
cause our body to have some unkind reactions. The most widely used contrast for MRI is Gadolinium based
contrast agents (GBCA). Gadolinium is specifically used for MRI because of its magnetic properties. This agent is
introduced intravenously but can cause side effects and reactions ranging from mild to severe. In fact, GBCA
has been linked to many adverse reactions such as headache, nausea, and dizziness and in rare occasion
anaphylactic shock [8]. An even more rare but very severe adverse reaction, one that effects people with
impaired renal function and is a potentially fatal complication is called Nephrogenic Systemic Fibrosis or NSF for
short.
Nephrogenic systemic fibrosis is a rare disease that causes fibrosis of the skin and multiple internal organs
such as the heart, kidneys, and lungs. NSF causes patches of thick and hardened tissue [1]. Patients with NSF
have also experienced joint pains, tight muscles and yellow spotting in the whites of their eyes. This illness only
affects those with weak renal function and is usually paired with the introduction of gadolinium for MRI [2]. NSF
starts in the lower extremities and makes its way up through the thigh muscle, then to the abdomen and all the
way up to the thorax. Within weeks, many patients affected by NSF find themselves dependent on a
wheelchair. This disease has no cure and is progressive and can cause death. The most effective method in
controlling NSF is trying to improve the patient’s renal function [4].
Although introduction of gadolinium is not the only way patients end up with NSF, through the
increasing number of uses and requests for MRI studies, gadolinium has become one of the most common
ways of contracting NSF in patients with impaired renal function [3]. Patients who have had liver transplants in
the past are also at risk of developing NSF when given GBCA. The Food and Drug Administration has approved
the use of five GBCA’s and all five have been linked to reports of NSF. Although approved, the FDA does warn
the public of the risks [4]. It is important to note that although this is a very severe, life changing and potentially
life ending complication of this particular MRI contrast, it is very rare and uncommon for a patient to contract
this disease from GBCA due to lab screening and questionnaires that the patient must complete before they
are deemed acceptable to proceed with an MRI study with use of GBCA [6, 5,7].
Just like in many decisions that we make in life, we must weigh the risks and benefits. Gadolinium does
come with many complications including a major one in NSF; however, these complications including the minor
ones are not common. There are many tests patients must pass that limit risks of such reactions. As a student in
diagnostic imaging, I am learning that there are many things that can go wrong… especially in the hospital
setting. We, as technologists, have the responsibility to double and triple check everything that we need to
know about each patient before proceeding with an exam whether it is MRI or general x-ray because even if
we do not spend a lot of time with each patient we can still have a major impact on their future.
Work Cited
[1] Mayo Clinical Staff. June 17, 2013. Diseases and Conditions: Nephrogenic Systemic Fibrosis. Retrieved Feb. 23, 2014. From http://www.mayoclinic.org/diseases-conditions/nephrogenicsystemic-fibrosis/basics/definition/con-20036311
[2] Marie Cheour. Oct. 11, 2013. Side Effects of MRI with Contrast. Retrieved Feb. 23, 2014. From http://www.livestrong.com/article/178926-side-effects-of-mri-with-contrast/
[3] Jeffrey Schlaudecker MD. And Christopher Bernheisel MD. Oct. 1, 2009. Gadolinium-Associated Nephrogenic Systemic Fibrosis. Retrieved Feb. 23, 2014
http://www.aafp.org/afp/2009/1001/p711.html
[4] Questions and Answers on Gadolinium-Based Contrast Agents. May 2007. Retrieved Feb. 23, 2014. http://www.fda.gov/Drugs/DrugSafety/DrugSafetyNewsletter/ucm142889.htm
[5] Todd DJ, Kagan A, Chibnik LB, Kay J. Cutaneous changes of nephrogenic systemic fibrosis: predictor of early mortality and association with gadolinium exposure. Arthritis Rheum. Oct
2007;56(10):3433-41.
[6] Guidelines on the Administration of Intravenous Gadolinium-containing Contrast Media. Sept. 9, 2011. Retrieved Feb. 26, 2014 http://www.radiology.ucsf.edu/patient-care/patientsafety/contrast/gadolinium-policy
[7] Noah S Scheinfeld MD. Feb. 7, 2014. Nephrogenic Systemic Fibrosis. Retrieved Feb 22, 2014 http://emedicine.medscape.com/article/1097889-overview#showall
[8] Dr. Maurice Molan, Prof. Stacy Goergen. May 1, 2009. Gadolinium Contrast Medium (MRI Contrast Agents). Retrieved Feb. 23, 2014.
http://www.insideradiology.com.au/pages/view.php?T_id=38#.Uw6I__RdWFB
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CCSF RadTimes July 2014
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2
Student Meets Incident
by Joseph Carlisle
The life of a student in any medical imaging
program is likely to be full of obstacles and stress that
must constantly be dealt with and overcome.
Murphy’s Law basically states, “if anything can go
wrong, it will, accidents happen, that’s life as we
know it no matter how careful we are in avoiding
them.” When we are in the hospital that rule has no
exception. Despite knowledge, training, practice and
even the watchful eye of a supervising technologist,
accidents involving patients happen. As a student,
there are few situations more stress inducing than
having an incident involving a patient. However, it is
immensely important that one takes responsibility for
these accidents, learn from them and continue to
work after the fact. As students, we cannot let
incidents negatively affect our performance while in
the hospital.
My personal experience with this
circumstance was minor according to the supervising
technologist, but the patient didn’t think so and this
ultimately caused me grief. Imagine a clinic site in an
orthopedic / sports medicine facility with some of the
latest equipment you could imagine. The site is an
outpatient clinic and as one would expect, it is
extremely busy from day to day. Over the short span
of time I was there, I could see just how great the
pressure is that radiographers are under. The many
physicians at the facility have high demands from a
small department of technologists. These doctors
expect their radiographs to be done quickly and
given promptly back to them. While this concept is
not uncommon at other clinics, I could see that these
RTs were stretched a bit too far.
During one such day, I was working in the sports
medicine side of the clinic, and as expected, it was a
busy day and everyone was rushed to some degree
trying to get patients in and out as quickly as humanly
possible. A female patient comes in with a history of
bilateral knee replacement. She had surgery about a
year prior to this exam. The appointment was just a
standard follow up before seeing her physician.
After obtaining the standard patient
information, I proceeded with the known protocol in
the department for a bilateral knee examination. The
last view done for this protocol is a Merchant View
(Modified Knutsson method) to see the patient’s
patella. The position requires a supine patient on the
table with both knees flexed, the CR is angled and
directed through the patellofemoral joint space
19
towards the IR which is placed at the end of the table
beyond flexed knees and just in front of patient’s feet
in a lateral cassette holder. As I previously stated, the
entire staff and I were moving patients in and out of
the clinic at a pace that is faster than safely
recommended. In the course of placing the image
receptor (IR) into the lateral cassette holder and
securing it in place, I didn’t properly ensure that the
top bracket engaged. The IR seemed as if it was
secure and it didn’t move until the patient moved
slightly which shook the table and caused the top of
the cassette to fall forward and onto the patient’s
shins. The patient reacted instantly complaining of
great pain. The injury looked like a minor contusion, a
small bump and bruise was present, but the patient
began to claim that the bone had been broken and
she wanted to see her physician as well as have
additional images taken to prove it.
Both the tech and I stopped everything and
immediately assisted the patient, apologizing for this
accident and assuring her that the bone was most
likely not broken. The IR that fell forward was a GE
wireless digital cassette which weighs about nine
pounds. The full force didn’t seem to hit her shins
however she still continued to complain. The tech
and I both felt that the injury was minor and that the
IR didn’t even hit her shins all that hard, certainly not
enough to break a bone but that wasn’t for us to
decide. We proceeded with filing the patient
incident report as is required.
As it is with most service industry jobs, the
customer is always right and in the hospital the
patient is the customer. In short order, the tech and I
filled out the incident reports, explained everything to
the supervisor, the sports medicine supervisor, and the
patient’s physician then demonstrated what had
happened. This is the point at which my nerves
started getting to me because the stress and
concern about the situation grew. Not knowing the
outcome of what was to come felt overwhelming.
While we were filling out the reports, I could
hear the patient in the other room going on and on
about how the bone must be broken and that it was
the student (also saying my full name) who made the
error. I could hear the endless ranting and raving
about the whole mishap, which heightened my
anxiety. My heart was racing with concern. Luckily,
after the physician cleared the patient of serious
injury, he said, “the bone was not broken, it’s a minor
bruise and any further imaging is entirely
unnecessary”. The patient left the clinic shortly
following the physician’s verdict.
Continued on page 20
CCSF RadTimes July 2014
3
The entire situation took over an hour to resolve and
it wasn’t until the end of the ordeal that those in charge
could finally speak to me about the incident. In my mind, I
expected a scolding. Much to my surprise, that didn’t
happen. Instead I was told by everyone not to worry about
it. The error was an accident that had happened to other
techs in a similar fashion. All that was requested of me was
to learn from it, not to think much about it, and to move on
from the incident. I was also advised to slow down a bit. In
fact, everyone was extremely pleasant and understanding
about the calamity and not at all concerned with my
abilities. As much of a relief as this all was, I still had my own
anxiety about the whole situation. In the back of my mind I
was now worried about how the staff perceived me and my
aptitudes. Will they trust me for indirect supervision or are
they going to require me to go back to direct supervision on
exams that I have been deemed competent to perform?
What kind of example did I just make of myself? I felt terrible
that I injured the patient even though it was a minor
incident. The events started eating at me. The remainder of
that day was difficult mentally, to say the least, but I did
proceed with my job as was expected in spite of it all. The
rest of this day, I moved a little slower and more deliberately
but that was accepted and everyone understood. What an
extreme learning experience this was and one that I had
not expected to learn.
Later that day, the weight of the incident still on my
mind, I tried to do things that personally relieve stress for me.
Then after a good night’s sleep, I found myself feeling
better. I woke up with a new realization of what had
happened. I followed all the proper procedures and took
care of everything that was required and requested of me. I
had learned a valuable lesson.
"Why DMI?" by John Bates --Many people choose health care as a
profession because of the satisfaction
they get from helping others. From what I
have seen, many of those same people
gravitate toward nursing or various forms
of therapy rather than diagnostic medical
imaging. For me, DMI seems a better fit.
I have previously done volunteer
work with people recovering from
addiction. From that I learned that I
invested a lot of my own psyche in
patient’s outcomes. That’s not a good
thing, especially when a large majority of
those patients don’t recover from their
disease. Their failure to get well is often
messy for them as well as their loved ones.
I also have a friend who left her career in
Respiratory Therapy because so many of
her patient’s bleak prognoses took such
an emotional toll on her. I can identify
with her situation all too easily.
So that is why I am pursuing a
career in diagnostic medical imaging. It is
fulfilling to know that I am part of a team
that helps people have a better quality of
life. I usually won’t see the final outcome. I
am content to know in my heart that I
play a small role in the recovery of every
patient with whom I come in contact.
I find that life as a student is filled with studying,
homework, exams, and practicing positioning. This doesn’t
leave us much time to reflect on the bigger picture.
Dwelling upon the things we cannot change is useless. We
just have to take responsibility for our actions and learn from
our mistakes. We must be confident that we will learn from
our blunders and not repeat them. In the end, it is the
collection of experiences that will make us better techs.
Though this seems like something straight forward and
simple, not everyone can do it. Some students let their stress
and nerves shake them to the core and dwell on their
mistakes. Not advisable.
I will leave you with the moral of this story from my
point of view. Everything is a learning experience - the
good and the bad. As a student, I must learn from both
and advance to my goal of becoming a productive part of
the health care team. Though this was a difficult lesson to
learn, I am a better student because of it and will take this
part of my education with me into the future and not make
the same mistake twice!
20
DMI 62 Students prepare for summer clinical
during an all day orientation in May.
CCSF RadTimes July 2014
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Second Semester
Students Explore
the 15% Rule
By Vanessa Aycock
One of the things that I find
special about the Radiography
program at City College of San
Francisco is the hands-on labs
regarding the physics behind x-rays. It’s
one thing for a student to read about a
law in a book and it’s a very different
thing to be able to create an
experiment and see the results of that
law. In our case, eight students in the
second semester Physics Class (50B)
wondered if the 15% Rule could be
used as a dose reduction tool. This rule
is a guideline used by technologists for
their technique. It states that in the
diagnostic value range, as kVp is raised
15%, you can then reduce mAs by half
in order to maintain the same overall
exposure for a radiograph. This rule is
often employed as a way to reduce
time when the reciprocity law has
reached its limit, but it can also be
used to reduce patient dose by halving
the mAs value since mAs controls the
quantity of radiation being emitted by
the x-ray tube.
Our group project was inspired
by the work of Dennis Bowman,
educator and radiographer in
Monterey, CA who advocates the use
of technique charts with higher kVp
ranges for CR and Digital Radiography
in order to reduce patient dose. His
findings state that such techniques can
reduce dose by 66%. Intrigued by his
research, our group created an
experiment to compare patient dose
as kVp was increased for both film and
CR systems.
At first, the task seemed
daunting since we had to create an
experiment that was achievable. I
have to admit that our enthusiasm
made it hard for us to limit the
experiment to the one question,
“Would we be able to reduce patient
dose and still create images of
diagnostic quality?” Initially, our
biggest challenge was the complexity
of getting 8 radiography students to
take 25 x-rays in one hour. Our team
21
was comprised of four DMI students:
Allison Correia, Luis Moran, John
Bateman and Vanessa Aycock as
well as four Radiation Therapy
students: Liz Gonzalez, Charles Li,
Antony Appedu and Michaela
Nekovarova. For the experiment,
each student had an assignment of
either data keeping, film exposures,
CR exposures or reading the
dosimeter for the patient dose. Our
key tool in our experiment was our
beloved phantom, who proved to be
an excellent patient as we took our
25 AP Abdominal x-rays during our
experiment.
Being novices as both
radiography students and as
researchers, our experiment did
teach us to keep perspective as we
encountered hiccups in our
experiment. Some of these included
learning how to correctly use the
dosimeter, figuring out the best
technique to create an optimal
radiograph despite our phantom only
having “some” of its abdominal
viscera, and lastly, our natural ability
to recreate almost every film artifact
known to radiographers in our school
darkroom.
We also had some ideas
about the outcome of our
experiment. First, we expected a
visual difference with our film series of
exposures verses our computed
radiography exposures. We expected
both to become gradually
underexposed due to decreased
mAs but expected the film to
produce a smaller number of
diagnostic images as we increased
kVp. We also expected that patient
dose would decline as kVp increased
due to the increased penetrating
power of the beam, however, we did
not think we could recreate Dennis
Bowman’s results of 66% reduction in
dose.
Our experiment produced
both visual and numerical data. As a
group, we were able to analyze
the images for their diagnostic
quality and we were able to
calculate the absorbed patient
dose for each exposure. We
produced five images each for
film and CR, starting with our
baseline of optimal image and
increasing the kVp by 15% while
halving the mAs for each
successive exposure. Our results
were surprising to us — in the end
both film and CR produced
diagnostic images for the first
three “steps” of exposures in the
experiment and then the fourth
and fifth exposures were both
underexposed and nondiagnostic. Additionally, both film
and CR had a similar decrease in
patient dose, which was a 57%
decrease from the first exposure,
to the third exposure. In a nutshell,
a 30% increase in kVp resulted in
almost a 60% decrease in dose.
For our group, this exercise
became more than a school
project, it became a way to
actually see that the guidelines
and science behind x-rays really
exist. This is a great way to gain
understanding about the
foundations of our field as student
radiographers. Due to the
extended capabilities of postprocessing in CR and digital
systems, it has become easier for
radiographers to overexpose their
patients and not have the tell-tale
sign of an overly darkened film.
Recently, in starting my own
clinical rotation, I am very
fortunate to work with a group of
technologists who passionately
support ALARA. Even in the last
week, I had the real-world
experience of adjusting my hand
technique charts to utilize a higher
kVp with a lower mAs resulting in a
new technique chart that helps
me create diagnostic images
while lowering patient dose.
Without the opportunity at school
to be able to test the physics
behind the x-ray beam, I wouldn’t
have gained the knowledge of
how being smart about your
technique can make you a better
technologist for your patient.
CCSF RadTimes July 2014