At the end of my second week in clinicals 12-23-2010

I spent two weeks without Kim at my clinical site and I have worked with many techs. I am ready to work with my clinical instructor, Kim, and work at perfecting my abdomen scanning routine. Many patients have gas, and it is hard to find the perfect window for the liver and great vesels. I will try to enjoy my week off, and return to the site on January 3rd, after spending some quality time with my family. Merry Christmas and Happy New Year!!!

After one full week of clinicals

I spent one full week at my clinical site. I rotated from the suite 100, to the women center and even to the vascular lab, suite 201. It has been interesting and I am ready to start scanning myself soon.

My first day of clinicals 12-13-2010

Today I started my clinical rotation. I am assigned to SMIL, Desert Mountain office, on Shea and 101. It is a long drive and I left one hour and a half prior to my starting time. I got there on time, and found where to go to sign in on the computer. I met Kim and I was introduced to all the other technologists. I spent my first day with Stephanie Flores, following the techs and observing their routines and preferences.

DMS 110 lab 12-2-10 Thyroid

After one week off ( Thanksgiving week) we returned to DMS 110 lab.
Today we scanned for the first time the thyroid, both in trans and long. I measured the gland in long. We also used for the first time the dual screen, or extended view. We used color Doppler to see the blood flow, in longitudinal view.

DMS110 lab 11-18-10

Today we practiced scanning the entire abdomen in one hour. I took images of GV, liver, GB, CBD, both kidneys, and spleen. I was not able to see the pancreas due to a large amount of gas in my patient's bowel. The focus in this lab was optimizing the images, by breathing techniques, adjusting gain, depth and focus. I also changed my pre-sets and used the auto optimize button. I liked the renal pre-set for the kidneys. Also finding different windows helped me see the left kidney and the spleen.

DMS 110 lab 11-4-2010 Spectral Doppler

Today we learned how to use spectral Doppler, combined with color Doppler. We did not change the angle of insonation, at least not on all the images. I obtained images of right kidney in long and trans with spectral arterial and venous waveforms. I found that in long I got better arterial waveform, and in trans I got better venous waveform.
We also imaged portal vein with spectral flow, and the aorta, at the celiac axis, and at the proximal and distal location. We practiced more finding the CBD, and we measured it at the pancreatic head. I liked this lab because I learned hands-on about the spectral Doppler, and I learned about how different the velocity of the blood is in different spots of the body. For example the velocity in the celiac axis was about 100cm/s, and in the portal vein was 20 cm/s. The part that I found challenging was finding the optimal angle, and position in order to obtain an accurate velocity. I am sure that this will come with more practice and knowledge of physics.

10-28-10 lab DMS 110

Today we scanned both kidneys and the spleen, and we put color Doppler on the image to visualize the blood flow. We adjusted the velocity ( the ideal one was around 9 or below), the doppler gain, and the frequency. The attached image represents the spleen with color Doppler. We can see the blood vessels well.
I enjoyed this lab better than the previous ones, because I feel more comfortable finding the ideal window for the kidneys. I tried different windows, including the intercostal and posterior. The posterior window is difficult to see due to the muscles, ribs and fat that got in the way, but the kidney is closer to the surface, so the color Doppler will show more blood flow. The intercostal window was the one I used the most, combined with deep inspiration. What I found more difficult today is using the Doppler succesfully. I am not sure if the U/S machine was too old, or the organs were too deep, but I was not able to see the blood vessels too clearly.

10-21-10 DMS 110 lab

Today we scanned the pancreas, great vessels, liver, gall bladder and the commom bile duct in one hour. For the gall bladder, we had the patient in two different posotions: supine, and left lateral decubitus. The included image was obtained in the decubitus position, following the long axis of the gall bladder. I helps a lot to interrogate and obtained gall bladder images in two different positions, in case we need to asses for stones, polyps or sludge. Stones and sludge will be gravity dependent, while the polyps are not.

DMS 110 lab 10-07-10 Abdomen US pictures

Today we scanned the pancreas ( for the first time), GV, and the liver all in one hour. I was able to complete all the required images, but not without help from my instructor, especially when looking for the pancreas. I found it harder to visualize, than all the other organs, since it does not have a capsule, and it varies from patient to patient. I can improve the speed of my study, over time, as I get more practice imaging a large number of people, and my eye gets used to recognizing where the pancreas lies.

DMS 110 lab 09-30-2010

Today we scanned the biliary tree and we adjusted the brightnes gain, TCG's and the power knobs. I was able to find the CBD in the left decubitus position, and it measured 3.6 mm. My patient had a lot of gas, so I had to place her on the left side and use an intercostal window.