Seeing it through: Behind the scenes at Inpatient Radiology
A typical day for the Inpatient Radiology staff at Owensboro Health Regional Hospital isn't just about the patients they’ll see. It's about what they’ll see inside the patients.
Inpatient Radiology is the world of medical imaging where high-energy physics and ultra-modern technology are combined to produce outstanding diagnostic medicine. But there’s a lot more to it than buttons and fancy machines. It takes a human touch to really make it work.
It’s a huge field, with an impact on every area of inpatient treatment, said Inpatient Radiology Director Donna Ross.
“They're dedicated to their jobs and their patients. Everyone here knows they're here for the patients, and they're caring for the patients and each other,” Ross said. “We have inpatients, outpatients, emergency patients and surgical patients. We touch many areas all here at the hospital. That's where our staff has to be really flexible. They can deal with each of those patient populations and meet their needs.”
And Butch Reynolds, manager of Inpatient Radiology, said radiology is a part the hospital couldn’t function without. In a typical year, the 119 staff members of Inpatient Radiology will carry out about 119,000 procedures.
“We give the physicians one of the best tools to diagnose,” Reynolds said.
X-ray marks the spot
X-ray images are produced by firing small amounts of radiation through the body. The resulting image uses radiation to see through the body because of how it is absorbed (or not absorbed). Bones are mostly made up of radiation-absorbing calcium, preventing x-rays from passing through. If a broken bone is x-rayed, the fracture is visible because radiation can slip through the gap between the parts of the bone.
Certain substances also block x-rays, and by circulating them through a patient’s blood vessels or digestive tract, doctors can see the structure of these internal systems, including blockages or injuries.
Years ago, x-rays were produced using plates that worked like film in a camera. X-rays would be taken and then the images would have to be developed and processed before they could be read. Today, the entire process is done by computer, making it faster, more efficient and producing much clearer images.
“We see a lot of interesting things,” said x-ray technologist Kim Barnard. “We have a very physical job too, doing a lot of lifting and pulling every day.”
Because the process is relatively fast, Barnard said, they also see a large number of patients each day. Sometimes that means having to put difficult cases out of their minds so they can move on to the next person who needs them.
“It can be hard because you can get attached to the patients,” Barnard said.
Yes, we scan
Just a few rooms away is the CT section of inpatient radiology. A CT scanner also uses x-rays, but the scanning technique is computer-controlled. By fine-tuning the way the x-rays are directed, the CT machines can give much more detailed pictures than a standard x-ray.
CT scan images are made in “slices,” allowing a layer-by-layer examination inside a patient. Because CT scan uses X-rays, it’s extremely useful at imaging bones and joints, searching for cancer and looking for chest and lung problems like pneumonia. CT scans are also advantageous because they can be used on patients with metallic implants or pacemakers, unlike MRI machines, which use powerful magnets as part of the imaging process.
The CT scanners can also be used in real time, giving doctors a live view of the inside of a patient.
“It's a souped-up X-ray,” said CT Technologist Corey Owens, explaining that certain procedures can be done using live CT. “It's much less invasive (using live CT imaging as a guide). You'll be up and moving in two days.”
Owens said that CT functions a lot like the other areas in radiology when it comes to the people.
“(I especially enjoy working with) my patients and my co-workers,” Owens said. “I go do my job but I enjoy it so much that it doesn’t feel like work.”
A job that resonates
CT scans are great for analyzing bony structures, but when it’s time to look deep into soft tissue, MRIs have abilities that stand out. Using powerful magnets and radio waves, an MRI machine takes image “slices” layer-by-layer, similar to the method used by CT scanners.
Sara Butterworth, MRI supervisor, said that MRI is also a very technically demanding field. In order to get a clear, stable image, the patient must lie still for the duration of the scan. When a patient has an injury in a difficult-to-scan place, that may mean looking for an unconventional solution,” Butterworth said.
“There's always something to learn, whether it's about anatomy or about the way the machine functions. It always keeps you on your toes,” Butterworth said. “You have to get creative sometimes. Sometimes you've got to think outside the box.”
One major difference between a CT machine and an MRI machine is its structure. MRI machines typically require an enclosed space around the patient, and sometimes that can be unnerving for someone being scanned.
“We know how important these scans are and that's why we are willing to think outside the box or stay with them and hold their hand so they can get through this,” Butterworth said. “Sometimes it's just being near them with a hand on them so they know they aren't alone.”
Another tool available to providers for internal diagnostic imaging is ultrasound. By using high-frequency sound waves, which are well outside the range of human hearing, doctors can look inside a patient similarly to how sonar can see underwater. The ultrasound probe emits the high-frequency sound waves and the way the waves are reflected by internal structures is used to create an image of what’s inside.
Ultrasound is advantageous not only because it is less expensive, but because of how it works. It takes much less time than an MRI and uses equipment that is far less expensive. It also doesn’t use radiation like a CT or an X-ray. These factors make it perfect for a wide range of diagnostics, including cardiac and vascular diagnostics, as well as the most well-known use, sonograms on pregnant women. Ultrasound is also used to perform tissue biopsies, including those used to test for cancer.
For ultrasound technicians Judy Druen and Anita Bruggerman, it’s also a field that doesn’t lose its challenge or attraction with time.
“It's not something you learn overnight. You never stop learning,” Druen said. “When you find pathology, it's interesting, and it's like in any medical field, that helping somebody is rewarding.”
“Not all patients are like the textbook,” Druen said. “Every patient is a challenge in their own way.”
Over in nuclear medicine, the staff are learning about their patients from the inside out. Literally.
“We use radioactive drugs to study the functions of organs. (By giving a patient a dose of a radioactive substance) the patient emits the radiation and we use that to create the image,” said Nuclear Medicine Supervisor Daryl Reed. “You can see the function of the organ instead of just seeing the structure.”
The medicines they use take advantage of more stable radioactive substances, like iodine or technetium, and the organ needing examination often changes the type of substance used. Some studies are done quickly. Others take longer, Reed said.
“You have to be able to multitask,” Reed said. “Our procedures take a long time, anywhere from 30 minutes to three days, so you have to juggle multiple patients. You've got to be patient. You can't rush things.”
And working in this area means knowing physics in addition to medicine.
“You've got to be skilled. You've got to have nuclear medicine skills and nursing skills as well,” Reed said.
A glowing recommendation
With such a wide range of disciplines and methods, it takes a well-trained, professional staff to make a department like Inpatient Radiology successful.
And that’s exactly what they have, said Administrative Assistant Valerie Blackford.
“Everybody's really easy to get along with and everybody's a team player,” Blackford said. “They work here as a team and know what had to be done. They pool their resources to get it done. I don't think I've ever seen anyone back down in here. They jump in with both feet to get the job done and help keep the patient comfortable.”
Together, they’ve built an atmosphere of trust between providers, staff and patients, Ross said.
“Everyone here knows they're here for the patients, and they're caring for the patients and each other,” Ross said. “We see so many different patients in a day. In a short period of time, we try to make a positive impression.”
And Reynolds said he’s most proud of the attitude and the commitment from the staff.
“There's a lot of cross training in here, a lot of them have bachelor's degrees and a lot are in school to get their bachelor's. We're a department that pushes education because a better educated technologist is good for the organization,” Reynolds said. “This staff here is the best I've ever worked with. That didn't just happen. We worked hard to get to that point. You're going to get the best care you can get in radiology coming here. I can hold my head up and say that.”