First Day of Clinicals 12/13/2010

Today was the first day of my clinicals.  A day that I was both dreading and excited for.  Dreading because I am a bit of a shy person and am very uncomfortable in new situations.  Plus I had a pretty poor experience doing my clinicals for xray.  I was obviously excited though because this would be the beginning of real world scanning, which would be much different than the lab scanning.  On the first day I met with my clinical instructor who began my new student orientation.  I got to sit in on a few outpatient exams.  We then did a tour of the hospital and some boring paperwork to get things started.  She appears to be very helpful and eager to share her knowledge with me.  This is a huge change over what I had experienced doing my xray clinicals at Banner Mesa/Gateway.  The CI was for the most part very unhelpful and uninvolved. 

It was crazy watching her scan her first patient.  I believe that I watched her do venous doppler on lower legs.  She was ridiculously fast at scanning and controlling the machine.  It was very impressive for me and gave me something to strive for in the future.  During her scanning she also took time to explain some of what she was doing.  This I found to be both very interesting and helpful to me. 

I also got a chance to meet some of the other sonographers, who all appear very friendly and helpful.  I am hoping this will be a much better overall experience than I have had in the past.  I can't wait until I am able to get more hands on experience. 

Last Lab 12/02/2010 Thyroid

Long Rt Thyroid with small nodule

In this lab we learned how to scan a thyroid.  Luckily it was somewhat easy.  It is not large, and not surrounded by any gas.  This definitely made it easier for me to see and image.  I am including 2 images on this weeks blog.  My patient had a small nodule on her right side.  The following pictures show the nodule measurements, as well as the blood flow. 








In this image you can see the nodule as well as the measurement showing the size of it.  It is a .26cm mass with bloodflow surrounding it, but not inside of it.  This is shown in the image below. 


Long Rt Thyroid with doppler



















Lastly, I will include a transverse image of the rt thryoid that demonstrates the nodule. 

Trans Rt Thyroid with Nodule

I had no trouble locating this nodule in transverse.  It was really hard to locate it and then turn on it to show it in the longitudinal.  I believe that I finally was able to do so.

Week 11 November 18

In this lab we were asked to complete an abdomen series focusing on the acoustic windows, breathing, exploring the ultrasound machine in the abdomen with emphasis on the abdomen. 

While doing this lab, I was not working fast enough to fully complete my whole abdomen scan.  I need to get myself in there and practice to make it go much quicker and smoothly.  I also need to spend some time focusing on scanning the pancreas.  This is the organ that I am having the most trouble with so far. 

Overall I am feeling pretty comfortable with the kidneys, liver, great vessels, gall bladder and spleen(except Hulda's).  I am attaching one of the images of the pancreas, just because this is my problem organ.  I felt that I should take a closer look at it.  I feel that this is a good image of the pancreas. 

During this lab I did spend more time focusing on using my gain, focus, breathing and TGCs.  I feel that I am doing a better job at producing images that are pleasing to the eye, well I suppose I should say my eye.  It can be a lot to remember making sure that you adjust everything on every image, but slowly I am getting better. 

October 28 Week 10

In this lab we were asked to complete a set of images using spectral doppler.  I find this to be pretty neat.  I like that it allows you to see the blood flow within the organs.  I did have a bit of trouble getting just the right amount of color.  I always felt that I was not getting enough or turned the gain up to high and ended up with too much noise.  From what I know this picture that I have posted today has a pretty good amount of color.  There is not very much excess noise visualized around the organ.  You are also getting a pretty clear picture of the blood flow that is entering and exiting the spleen.  I feel that once we learn more about the physics and all that goes into producing and using the correct amount of color will make this process much easier.  It will also make me much more aware of just what it is that is expected of me when using the spectral doppler. 

Overall I did enjoy this lab.  I was not fully aware of all the stuff that we are able to do with ultrasound until I started this program, and am excited to learn about all the other stuff that we can do. 

What could it be? 10/28/2010



What is this?

What do I have?

I am doing an extra blog for this lab, because I thought that this was something interesting.  While scanning my kidney we found something that appeared abnormal.  We were unsure what it was at the time.  After further research we believe we have figured it out.  It was found that I have a duplex kidney, this means that I have an extra renal pelvis.  This is a normal anatomic variant which can easily be mistaken for a cyst.  The cyst like structure we are seeing is actually where my collecting system sits.  It is outside the kidney, medial to the hilum.  Now it will be interesting to see if I have double ureters.  Can't wait for the pelvis scanning to see if I do.  I am including a picture showing my duplex kidney, one without color and one with color to proof that there is no blood flow within the collecting system.

I will also include the picture of a normal right kidney, for those of you that do not know what one looks like ever.  Unfortunately, my picture may not be as good as the one to the left because I was using a different system.  You should still be able to see the difference though.

Normal Rt Kidney at hilum                                                                Rt Kidney at hilum with duplex kidney

October 28 Week 9

In this lab we were asked to start playing around with color doppler.  I am still having a bit of trouble understanding the whole concept, but as Bryan said this will all become much clearer when we get to physics.  Boy I can't wait for that.  Sorry that is a bit of sarcasm, I am not much of a physics student. 

Well, I am including a picture of the kidney were I have placed the color doppler to show the blood flow and vasculature of the organ.  I am not sure if I adjusted the gain to an acceptable level.  I do know that I did not go too far, because we do not see a lot of noise.  We are only seeing the flow within the kidney.  I have seen pictures where this has been used correctly, and I think that it makes for very neat images.  I can't wait until this all becomes a bit clearer to me.  I did enjoy the practice of scanning the kidney. 

October 21 Lab Week 8

In this lab we were required to interrogate and image the great vessels, liver and pancreas in an hour.  This was a bit rough.  It was hard to remember all the images that were needed, as well as all the different interrogations.  The liver has so many sweeps, it is hard for me to remember which one and pay attention to every aspect. 

I am including a picture of the gallbladder in transverse in both the supine and left lateral decubitus position.  Luckily with the other people in my class so far scanning the gallbladder has been pretty easy.  Probably my favorite organ to scan so far.  Mainly for how simple the interrogations and scans are.  I am sure that after more practice the rest will come more easily and I will definitely feel more comfortable with all the other abdominal scans. 

I think the picure that I took with the patient in the left lateral decubitis picture looks a bit clearer.  You get a nice round anechoic image of the fundus of the gallbladder.  The decubitus position does sometimes make it easier to clearly view the organ you are looking for because some of the gas may shift making everything more easily visualized.  With this patient however, both positions produced a nice image of the gall bladder.  Also lucky for her there does not appear to be any pathology affecting her gallbladder.  No wall thickening, no stones or polyps are present. 

 

October 7th Lab

Again I had to miss this lab, trust me would have much rather been in class than dealing with everything else.  In this lab all the parts of the abdomen we have been dealing with were supposed to be scanned and imaged.  I chose to attach two pictures of the GB I was able to take in another lab.  I have attached a picture of the gallbladder in long taken both with the patient in the supine and left lateral decubitis position.  In my opionion the picure I took with the patient in decub is a better image of the gallbladder in its true long.  You really get a good look at the length of the gallbladder.  Also from what I remember it was an easier image for me to acquire.  In the supine position you don't really get the length that you do in the decub.  Plus there are times you have more gas to contend with, depending on your patient. 

     I do like how easy it is to locate and scan the gallbladder.  Well, I guess I should say as of now it is easy.  Of course we have been dealing with pretty easy patients.  I have not had to deal with any obese patients, or hard to scan patients based on pathology or anything.  I do feel comfortable about obtaining these issues. 

September 30th Lab

Unfortunately I was unable to attend this lab, but have had a chance to scan the billiary tree since then.  In this picture you can see the common bile duct.  This is probably my least favorite thing to scan at this time.  I have had some trouble locating it, and I know that others have had trouble locating it on me.  I believe when we did this lab in order to distinguish this as the CBD we used doppler to prove that there was no blood flow.  I do like the challenge of locating it, but can't wait until the time that it comes a bit easier. 

Google Time 09-23-2010

In this lab we were supposed to enjoy some "Google" time.  This meant that we had the whole lab time to just play around with the machine and see what all the knobs and buttons do.  It also gave us a chance to practice scanning the GV and liver.  I found this lab pretty fun, because we got a chance to use some of the functions that we have not had a chance to learn about.  I got a chance to play with the doppler and PDI a little bit.  Unfortunately I forgot to save a picture of it so that I could show what it looked like. 

I got a chance to see that I do remember the images that are required for the liver, for the most part.  I did need some occasional assistance from my patient.  The picture that I attached is a picture of the liver rt kidney interface.  In this picture you get to view the lower portion of the rt lobe of the liver, the gall bladder, the renal vein and the IVC.  I chose this one because I felt that it was a good image of everything that is required. 

I can't wait until doing an interrogation of the liver and taking pictures is like second nature.  I want to get passed this time where I have to think forever about what landmarks, anatomy and probe position is needed for each sweep and picture.  I am sure it will happen eventually!

Lab 09-16-10

Gallbladder Long Decubitus

     This is an image of the gallbladder taken while the patient was in decubitus position, meaning they were lying on their side.  I found that I had some trouble originally locating the gallbladder.  Once I located it though, I found it every time I set the probe down.  It showed up very clear.  You can tell that my patient had not eating a fatty meal prior to her scan because the gallbladder is not contracted.  I do feel that it was a bit easier to obtain this picture with the patient lying on their side. It does help sometimes to move some of the gas out of the way that could possibly obstruct my image.

      

Transverse Portal Vein

In this lab we were asked to scan the liver using the ribs as the acoustic window.  I had a lot of trouble with this lab.  It was hard to figure out where everything was using a new area and new angles to obtain our images.  I do see how there were some advantages to using this window.  We were able to get some very good views once you got between the ribs. 

When your patient takes a deep breath everything moves down.  This makes some structures easier to see, or distinguish.  For example you can determine when you are looking at IVC as opposed to aorta because respirations do affect the IVC.  When you have the patient take a deep breath and hold it you are able to sometimes get a better image because the breathing is not causing movement on your pictures. 

This lab did make me very aware of how much I need to study my anatomy and landmarks so I am able to distinguish what I am looking for much faster.  Also I would have a better understanding of the relationships of organs and structures. 

I was supposed to obtain two images of the aorta, one using the harmonics feature and one without.  This first picture is the image that was obtained without using harmonics.  The aorta in this image has a lighter more grainy appearance.  In a way it blends with the surrounding structures more, making it harder to get a clear picture of the aorta by itself.  In the picture below where harmonics were used the aorta becomes darker and is more hypoechoic.  It makes the aorta stand out from its surrounding a bit better.  The harmonics also make everything posterior to the aorta much more hypoechoic as well.                 

       I am having a hard time choosing which picture I prefer.  The one with the harmonics does appear to make the aorta clearer and easier to focus on, but the one without seems to make the overall picture more pleasing to me. I suppose for diagnostic purposes the harmonics image would be better because you do get a clearer view of the aorta.   

  

1st Lab

I am posting two of my favorite pictures from our first lab.  The pickle turned out the best in my opionion.  I'm sure that I am not the only one that is posting this picture.  I was just very impressed on how clear it appeared.  I had a bit of trouble with some of the other objects, but no matter what this was always clearly the pickle.

I have not had much experience with ultrasounds in my life, and have never really been able to tell what anything was on the screen.  It is neat to finally realize that once you know what you are looking for it can become so much clearer.  I know I am only basing this on a pickle, but still very interesting the amount of detail that you are able to pick up when scanning.  

 

In this transverse image, it is neat that you are seeing the whole pickle just like it is in the jar.  Although, I am pretty afraid of what is to come in this program, I am excited for the outcome.