time to vent frustrations

papa

ok guys, i got an issue, and i'm not quite sure how to tackle this. what better place to vent this out that with people that i know are high quality techs.

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past couple weeks, i've been filling in over in diagnostic x-ray, as my CT schedule hasn't been all that great. we've got CR, and everything is filmless.

i was always taught to colimate as tightly as possible. you get better films image quality wise, and you don't expose the entire patient to radiation. that's just the way it was, that's how i was "raised" you could say. it also seems that nobody knows what "room ready" is, but that's for another day.

a number of the technologists are using the automask to a great disadvantage. this is driving me nutz. they're exposing huge parts of the patients, then using the CR system to cone down to what they want to send through. i personally don't feel "safe" working around these guys. i know the legal issues with this kind of practice, and my wife and 4 kids can not handle me being out of work because of a lawsuit. will it ever get to that point? probabally not. i still don't like associating myself with these technologists simply because of this practice.

for instance, this happened yesterday on a 3 year old chest. i started by assisting this technologist, because i'm good with kids. tech had mother in room, lead and all, kid was shielded (thank god), 14 X 17 cassette with colimator wide open.

me: "ok, why do you have a 14 x 17 film?"
her: "so i know i can get it in one shot". exposes AP. "i don't want to repeat it." changes film, positions lateral, again colimator open.
me: "don't you want to cone that down a little?"
her: raising eyebrow as if i had a chicken on my head "what if she moves? that's an extra exposure" and went on explaining herself.

ran the films through the CR, and of course, everything on this poor child was exposed. went under options to the auto mask, boxed in just the lungs on both films, and sent them through. when she turned to dismiss the patient, i just put my hands up and walked away.

if this was a one time thing, or a new student (not to hate on you guys, but some students just haven't learned that yet), or above all, one tech, i would not be as upset and angry as i am now.

i am at a loss for what to do. i'd go to the lead tech, but she's one of them. i'd go to the office manager, but she knows absoluetly nothing about radiology itself, and diverts all those issues to the lead technologist. i feel like i'm the only one who actually gives a damn about the quality of my work.

i'm also planning on leaving in the next couple months. i got an inside line to one of the last places that i worked, who really wants me back, and was very upset when i left.

i don't know wether to just bite the bullet and keep my mouth shut, or take this higher up the corporate ladder.

any ideas?
_________________
Mr. Green

papa RT(R)(CT) Mr. Green

Delusional Radiology
never meddle in the affairs of a dragon, for you are crunchy, and taste good with ketchup

wvaio · Joined: 22 Sep 2007 Posts: 82

Papa,

I feel for your situation. Unfortunately, technology has not changed the chain of command. Even though the lead tech may be one of the culprits in the unethical patient care, the chain of command dictates that you address them first with the issue.

I found this on the ARRT website regarding violations of the Code of Ethics:

The ARRT states: "First, you should report the violation to your supervisor. As an employer, your facility has a responsibility for the quality of patient care being provided by the staff."

"Second, you should report the incident to the ARRT. Rule #21 of the Standards of Ethics, states that it is a violation of the Standards if you are aware of a violation and fail to report it to the ARRT."

What you described is a direct violation of rule 7 of the Standards of Ethics, "The radiologic technologist uses equipment and accessories, employs techniques and procedures, performs services in accordance with an accepted standard of practice, and demonstrates expertise in minimizing radiation exposure to the patient, self, and other members of the healthcare team."

You have the unfortunate position of being between the rock and a hard place.

...part of the problem or part of the solution.

I am sure you will do the right thing.

Wvaio
_________________
“Whether you think that you can, or that you can't, you are usually right.” --- Henry Ford

papa · Posted: Fri Feb 13, 2009 4:19 pm Post subject:

rock and the hard place...... you have no idea

i'm torn between letting it go or making a big stink (aka reporting to supervisor and/or arrt).

on one hand, i know as a technologist that this needs to stop. radiating whole bodies just to get an adequate chest image is absurd. how they passed the boards with that kind of mentality, i'll never know. i don't want my name anywhere near any kind of work like that. i'm proud of my RTRCT, what it means, and what it stands for. i work hard every day to personally live up to those standards, achieve them, and excede them if at all possible. that's probabally why i'm so flustered about this in the first place. it's not like they're super busy (as if that were an excuse), or all new techs not knowing what they're doing (no offense to the new techs in the area).

on the other hand, georgetown wants me back. they've installed a third scanner, and have told me that a dayshift position is waiting for me if i want it, which i do. they haven't completely signed off on the paperwork for that position, because they're also replacing scanner 2, and don't want to have too many people around sitting on their thumbs, which i understand. i've been told that it'll most likely happen mid to late march, which isn't that far away.

i just don't know if it's worth the effort to try an change at least 4 tech's methodology in an office where i'm most likely going to be leaving in 4 - 8 weeks. am i obligated by arrt to report this? am i required, as a technologist and radiographer, tested and registered, to better the technologists around me, when i'm outnumbered, and am the only multimodality tech in ct, where i spend most of my time? i'm usually just cover lunches, or if somebody calls out sick.
_________________
Mr. Green

papa RT(R)(CT) Mr. Green

Delusional Radiology
never meddle in the affairs of a dragon, for you are crunchy, and taste good with ketchup

hjhogle · Posted: Fri Feb 13, 2009 7:09 pm Post subject:

papa, we've had other similar, open conversations in the time we've known each other - you know how I feel about this.

Report it. Report it. Report it.

But only you can measure the cost of doing the right thing (which is almost never convenient or popular, by the way and always costs us something).

Aaah, but I'm happy you know what the right thing IS.

Many out there who claim to be professionals do not even understand that what they're doing is unethical and unprofessional.

Ye Gods.

hjh, RT

mrbzero923 · Joined: 19 Feb 2009 Posts: 1

As a student about to graduate and an extern, I have been able to go through lots of clinical sites and watch how other techs do their job. Some are 100% by the book, and some are sloppy and do not seem to care. I have seen many techs using that masking feature to make the images look better without actually collimating properly (or at all). Use of this feature used to be rampant but it is no longer tolerated.

How did they manage to get the techs to stop using it improperly?

The Chief Radiologist found out that techs were doing this crap and he very firmly let it be known that they could tell a difference between actual collimation and masking the images, and that this practice was to cease immediately. Now they want to see real collimation on every image unless it is not feasible due to patient size, etc... They don't mind if the masking feature is used, as it aids them in reading images to some extent, but he brought down the hammer on techs that were not practicing proper ALARA. Hospitals around here are very tight on image quality and most of the rads will not hesitate to call you personally on the phone and tell you "what the heck is this you are sending me?! Do it right!" And you better believe the peds radiologists will not hesitate to verbally slap you around or report it to management if they catch you not shielding children properly or doing a chest xray that includes half the child's skull all the way down to the symphysis pubis.

If I were you, I would mention this discreetly to your radiologist. Don't point the finger at particular people. He/she may be able to help or even be unaware that this is going on. I have found that usually they will be behind you 100% when it comes to anything giving them the benefit of better images to read and less chance of making their malpractice go up!

LisaXXII · Joined: 20 Aug 2008 Posts: 5 Location: Upstate New York

At the risk of sounding like an idealistic newbie I just want to say I'm thrilled and relieved to know that some people out there are not willing tolerate such behavior. I think techs that shirk off the responsibilities of properly shielding and collimating and just overall radiation protection really cheapen our profession and it's embarrassing. I am just a student and I haven't been out there long and already I've seen and heard about things like this happening far to often.

When you start to not care enough to even bother attempting to do your job right, please find another, you are dealing with people lives.

Sorry if this came off a bit too supercilious...i think maybe i just had a bad day.
_________________
Live as though the world is what it should be and you will show it what it can be.

hjhogle · Posted: Thu Feb 19, 2009 8:47 pm Post subject:

Lisa, I hope you have lots of 'bad' days. Keep your sense of professionalism - when others act as though you're overzealous ... just smile.

Welcome aboard

hjh, RT

Calvin7711 · Joined: 28 May 2009 Posts: 1

who cares....

CigarPete · Power User Joined: 21 May 2007 Posts: 118