Latest / Cat Scan Guru Podcast / EP. 74 CT Workflow: Steps That Actually Works

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EP. 74 CT Workflow: Steps That Actually Works · Cat Scan Guru Podcast

• 0:00
  Hello, hello everybody, Welcome back to the podcast.
• 0:03
  Hope you guys are having an amazing freaking week.
• 0:07
  So it is spooky season, one of my favorite times of all time
• 0:13
  considering that we are, you know, radiologic, radiologic
• 0:16
  technologists and tech week is like around the corner.
• 0:20
  Can you believe it? I think we kind of like breeze
• 0:22
  through summer because summer is one of my favorite times.
• 0:24
  I mean, I like fall because I love Halloween, Christmas.
• 0:27
  I do like Christmas. Ever since my dad passed away,
• 0:30
  Christmas has always been a very challenging time because he was
• 0:34
  a lover of Christmas and there's somebody else that I know that,
• 0:38
  you know, absolutely loves Christmas.
• 0:40
  And so I'm starting to kind of get back into that because I
• 0:44
  used to do a lot of activities with my kids, and then Kovic
• 0:47
  kind of killed it, and now I'm getting back into the swing of
• 0:49
  things. So yeah, so lots of great stuff
• 0:54
  happening with, you know, fall and pumpkins and all that good
• 0:58
  stuff. I'm a horror movie junkie, so
• 1:00
  this is right out Matt alley. So got some updates for you
• 1:03
  guys. Sorry, yes, I don't like the
• 1:06
  stutter. So I have some some things to
• 1:09
  kind of catch up. So this week I'm going to if you
• 1:12
  didn't check out last podcast episode, I released a YouTube
• 1:17
  video on patient positioning. So make sure you guys check that
• 1:20
  out. So the link is in the show
• 1:21
  notes. Check that out.
• 1:23
  OK. It is really good and I do a
• 1:25
  deep dive on patient positioning and why that matters.
• 1:28
  OK, So make sure you check that out and also give me a follow on
• 1:32
  TikTok and Instagram. So you know, I post a lot of
• 1:36
  educational stuff on TikTok. It is my main platform because I
• 1:39
  love TikTok, love TikTok. So but I'm making sure that I
• 1:43
  also show up to Instagram, even though Instagram sometimes
• 1:46
  really makes me mad because you know, it's sometimes it's a hit
• 1:49
  or miss with that one, but I tend to post at least three
• 1:52
  times a week on Instagram. So make sure you guys, you know,
• 1:55
  follow along there and check those things out and make sure
• 1:59
  you subscribe to the podcast if you're new here.
• 2:01
  So I give you all the CT educational content, whether
• 2:04
  you're new, seasoned, retired, doesn't really matter.
• 2:07
  This podcast is for everybody, OK?
• 2:10
  But I do talk a lot about, you know, educating the new
• 2:12
  technologies coming into our mobility that have interest
• 2:15
  travelers that need help. All the things we talk about it.
• 2:18
  We talk about all the CT things here, OK?
• 2:20
  So make sure you like share, subscribe, send it to somebody
• 2:24
  that needs to hear it too. OK, So and also if you want to
• 2:27
  get on my e-mail list to know when I'm dropping episodes, when
• 2:29
  I'm dropping trainings, when I'm dropping anything, make sure
• 2:33
  that you check out my free eight week checklist so you can get on
• 2:36
  the e-mail list. And then I do have courses
• 2:38
  available that you can purchase. It's very affordable for
• 2:41
  everybody where I do more of a deep dive on the CT basics.
• 2:45
  So I do the most common CT exams.
• 2:47
  I do a rundown of A through Z on a crash course, 101 on CT, and I
• 2:53
  do a contrast course. So make sure you guys check that
• 2:55
  out. Everything will be in the show
• 2:56
  notes. All right, let's dive into in
• 2:58
  today's episode. So in today's episode, we're
• 3:01
  going to be talking about CT workflow that actually works.
• 3:04
  We know that RCT workflow is a shit show and it's a hot mess,
• 3:08
  OK? COVID has really changed the way
• 3:11
  we operate and the way our workflow is, and it's been like
• 3:14
  that for the last five years or so, OK?
• 3:17
  So the way most radiology departments operate nowadays is
• 3:21
  a little bit different and it's not the same pre COVID.
• 3:24
  OK, so there's a right way to run ACT exams and it's not how
• 3:30
  most techs are doing it nowadays.
• 3:32
  OK, And I'm going to get into the nitty gritty about that.
• 3:35
  So I want you to remember this. CT is not about pushing buttons
• 3:40
  because I know there's texts that feel that way, that it's
• 3:43
  just about pushing buttons and you don't have to care about
• 3:45
  anything else. And that mentality really grinds
• 3:49
  my gears and it's one of my pet peeves.
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  It's about flow. It's about making sure that you
• 3:55
  aren't flow on how you're supposed to be doing things.
• 3:58
  So let me give you some prime examples like verifying your
• 4:01
  orders because we have a list whether you use Cerner, you use
• 4:05
  Epic, you know, you have a order list of, you know, that's
• 4:09
  labeled by priority, the stats versus the routines, OK, and the
• 4:13
  AM stuff. So making sure that before you
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  bring those patients over, you're verifying orders, making
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  sure there's labs, making sure you're checking allergies,
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  making sure that the diagnosis correlates with the order that
• 4:26
  is ordered. OK, the exam that's ordered.
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  Because a lot of times we get some really wacky orders that
• 4:31
  make no freaking sense. And then we have to start
• 4:34
  calling doctors and clinics to figure out exactly what it is
• 4:37
  that they want. Because not 9 times out of 10,
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  they don't even know what they want.
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  They're just, you know, pulling straws out of a hat.
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  So making sure that you verify orders is super duper important.
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  And then your patient care and education.
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  So when you get your patient in the room to, you know, do proper
• 4:54
  patient care, get them prepped and ready for the exam, educate
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  them about contrast, about the effects of contrast and how
• 5:02
  maintaining, still holding your breath if they're able to, you
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  know, giving patients instructions and education in
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  terms that they can understand. Listen, patients don't
• 5:12
  understand all that medical jargon and all the mumbo jumbo
• 5:15
  that us and doctors and nurses tell them.
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  If we explain it to them in simple terms, trust me, they
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  will get it. If they are alert and oriented,
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  they will get it. OK, So making sure you educate
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  them and then ask them if they have any questions because
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  sometimes patients do have questions.
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  So it's important for us to make sure that we answer their
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  questions to the best of our ability.
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  And it's OK to say, you know what, I'm not sure what that
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  answer is. Let me find out for you because
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  at least they trust you that you will at least try to attempt to
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  answer their question. So patient care and education is
• 5:51
  super important. OK, now I'm going to give you a
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  model here that I want you to remember.
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  So Scout, plan, scan and review. I'm going to go over these.
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  OK, so scout making sure you're centering in positioning your
• 6:07
  patient properly and use the damn laser light.
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  I can't I can't fathom on how many texts do not do this.
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  And I don't know where you guys are learning this.
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  Stop it. OK, do it properly.
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  That's why it exists. OK, so planning, making sure
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  you're scouting your patient correctly with proper
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  positioning, proper centering using the laser light and
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  centering to the Z axis of the patient on whatever body part
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  you're scanning. And then once you get your scout
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  to plan your exam, making sure you know where you're starting
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  and ending points are, making sure that you have correct scan
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  field of view, OK? Making sure that you you know,
• 6:41
  are if if you're using a volume, a certain volume of contrast,
• 6:45
  making sure you have that ready, making sure you double check all
• 6:48
  your recons before you hit that button, OK?
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  Making sure that all the lines are pertinent to where they need
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  to be. So planning your scan is very
• 6:56
  important. And then your scan itself,
• 6:58
  making sure you've gotten the covered areas, the correct field
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  of view, correct contrast enhancement, correct everything.
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  OK, correct reconstructions, all that.
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  OK. And what I mean by
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  reconstructions, it's not what we do after the fact because a
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  lot of protocols have, you know, different window levels that are
• 7:16
  built into the protocol. So making sure that those are
• 7:19
  done correctly. And then you're going to review
• 7:22
  before you get off that patient, off the table, you're going to
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  take a quick, what, 1015 seconds to just flip through those
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  images, making sure you've got everything you need.
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  There's no movement. There's proper contrast
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  enhancement, making sure you have everything.
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  You're going to review all that stuff to make sure everything is
• 7:38
  there before you take the patient off the table.
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  Because let's say if Susie Q moved and you have to just go
• 7:44
  back and scan those few slices, that's what you need to do.
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  So scout, plan, scan, review. OK, Remember that acronym?
• 7:52
  OK, now documentation, OK, yes, it can be annoying, but it
• 7:57
  doesn't have to be annoying. But I'm going to tell you this
• 8:00
  documentation will save you a lot of headaches and save you
• 8:03
  from litigation. Let me say that again.
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  Documentation will save you from headaches and litigation because
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  when you document, that is very, very important because you don't
• 8:13
  want anything to come back on you.
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  If something happens during that interaction with the patient,
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  something happens with that scan, something happens with
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  contrast, document, document, document.
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  It'll save your ass. Now, the one thing, the last
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  thing that I'm going to talk about in this podcast episodes,
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  because I'd like to make these podcast episodes nice and short
• 8:31
  and digestible so that you can get all the information that you
• 8:34
  need. How to handle chaos.
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  OK, so when I talk about chaos, I'm talking about bad Ivs.
• 8:41
  You know, positional Ivs. They're very iffy when we're
• 8:44
  dealing with nursing when it comes to delays and you know the
• 8:50
  patient's not ready or if the patient's intubated or if the
• 8:54
  patient has medications running and the nurse can't bring them
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  over. When we're running into issues
• 8:59
  with the scanner, when there's issues with the table, issues
• 9:04
  with the X-ray tube, issues with image quality, ring artifacts,
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  things like that. Now, how do you handle these
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  chaotic situations #1 take a breath, take a breath, okay?
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  Because you cannot just calm yourself in the amount of chaos
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  when you're anxious and and you are just in this fight or flight
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  mode. OK, So you can't be chaotic in a
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  situation of chaos. You have to be home and kind of
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  take a step back so that you can handle the situation.
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  OK, OK, perfect example, bad Ivs, OK, you know and I know
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  that we should flush those Ivs before we even power inject
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  them, OK, And then checking them with with a power injection of
• 9:49
  saline, a test injection is always good practice.
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  What I always tell technologists if the IV is very iffy and you
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  are not comfortable and it is not flowing well, make sure that
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  they start a new IV or if you're able to restart it yourself, OK,
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  I can't tell you how many times I've done that, I've restarted
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  Ivs where I'm like no, this is not good.
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  Or get one of your Co workers to do a check on an IV.
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  We do this a lot in our department where different
• 10:17
  technologists will say, hey, can somebody check an IV for me in
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  room 4? Whatever we will do, do that
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  just to make sure because two people checking it is better
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  than one person. So when you have delays with
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  nurses, you know, nurses that say the patient's not ready and
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  this and that, take it with a grain of salt because a lot is
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  happening, you know, behind the scenes, especially when patients
• 10:38
  are critical and the reason there's a delay and things like
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  that. And I know turn around times are
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  a very big thing in almost every institution.
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  I know they're harping up on us about turn around times, OK?
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  So what I would say to that is document the delays.
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  That's what we started doing and that's how we were able to
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  improve the process to make sure that the patients come over when
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  they're ready to go and they have everything in mind, OK.
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  There are certain sentences, you know, those outliers where the
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  patient gets intubated, the patient's really sick and they
• 11:10
  don't want transport them. So you have to take those into
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  consideration as sometimes that is going to delay the exam.
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  Okay, So if patients not able to come, especially trauma and
• 11:21
  they're really critical, I mean, the last thing you want is a
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  trauma patient dying on the CT, which that has happened a lot in
• 11:27
  my career or we're even coding them and yeah, that's not a good
• 11:31
  situation. So sometimes we do have delays
• 11:33
  when it comes to that, but every situation is different and we
• 11:37
  just have to be mindful and aware on how to handle them.
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  And then there's issues with scanners delays, you know, there
• 11:42
  could be an issue with the table, issue with the detector
• 11:45
  ring artifacts, problem with the X-ray tube, you know, and
• 11:48
  exposure, no problem with the computer.
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  So all those things can be sometimes they're an easy fix
• 11:54
  with an Aircal or or a reboot where you should bring the
• 11:58
  scanner all the way down and reboot the scanner.
• 12:00
  So, you know, use your best judgment on that.
• 12:02
  Sometimes we have to call service.
• 12:04
  So those are some of the things that we can do to handle some of
• 12:07
  that chaos. OK, so that is it for this
• 12:09
  episode. I hope this episode was
• 12:11
  insightful. So like I said, share it with
• 12:13
  somebody that needs to hear it. Subscribe to the podcast, make
• 12:15
  sure you check out the show notes for courses that ioffer
• 12:18
  links to socials and link to the patient centering video that I
• 12:23
  did do on YouTube. So make sure you guys get in on
• 12:25
  the action on that, OK? So thank you so much for joining
• 12:29
  me on this podcast episode and I will chat with you guys next
• 12:33
  week.