iRADiX

Did you identify any training needs for yourself in this exercise of reflecting on scanning protocols ? In previous entry we saw some issues relating to abdomen imaging.

As we jogged down the different systems we identified other areas where people are hesitant.

A relook at the Musculoskeletal system Protocols

I remember a talk given over a decade ago. The speaker asked how many of you do knee MRI. Many hands went up. Then he asked, how many of do more than 50 knee MRI cases in a month. Very few hands went up.

If one asks a question in the same frame, how many of you will be confident in reporting the postoperative shoulder or postoperative knee. For our technicians who start telling that we too can do the scanning “I too am a ‘technologist’” we had a relook at the musculoskeletal system scanning protocols.

(A feedback: The same technicians who were a bit cross at them not being made as a frame of reference “I too am a ‘technologist’” backed out when we started exercises in quantitative assessment of fatty liver or chemical shift imaging for adnexal masses… see previous entry)

To those who are happy to scan the shoulders, knees, wrists, one has to have a relook at the elbow imaging protocols. How many elbow MRIs have you done in past six months?

Plane selection for the elbow

Plane selection is important in evaluation of the elbow –especially the common flexor and extensor tendons. Axial images are obtained perpendicular to the long axis of the humerus at the elbow. The prescribed coronal plane is oriented parallel to a line drawn along the anterior surface of the condyles in the axial plane, and the sagittal plane is perpendicular to that coronal plane.(1)

Wrong plane selection and the resultant image. After this all the planning will be wrong as the sagittals are based on the coronal plane planning which was chosen incorrectly.

Result: We cannot see the common flexor and extensor tendons.

Correct coronal plane selection leading to proper visualization of the common extensor and flexor tendons, shows normal appearance of common extensor tendon at the attachment in the lateral condyle

Patient presenting with Posterolateral rotatory instability (PLRI)

Capsular injury with thickening and tearing of the lateral ulnar collateral ligmant (LUCL). The lateral collateral ligament complex consists of the Radial collateral ligament (RCL), annular ligament, accessory lateral collateral lgiament and LUCL.Common extensor tendon tear involving the Extensor Carpi Radialis Brevis (ECRB). Contusion and edema in the lateral condyle.

The correct scanning plane played an important role in identifying the complex injury.

Job sculpting

Job sculpting begins with identifying deeply embedded life interests. One should have an interest in the motivational psychology of one’s colleagues. In these conversations with the new technician I asked him what was it that he was doing differently now as compared to two years ago. This question made him reflect on what he will be doing differently two years from now, if he changes course.

Beyond identifying the need to get the plane selections right, and the parameters to decrease motion artefacts, or chemical shift techniques I saw the need for proper communications.

In private non-academic settings, another challenge I find is to make the persons being trained keep to some disciplined curriculum. This also made me reflect on the state of advanced medical teaching in our institutions (a bit depressing..).

Application of technology: How the clock works

Whether or not they are actually working as-or were trained to be –engineers, people with the life interest application of technology are intrigued by the inner workings of things. They are curious about finding better ways to use technology to solve problems. The signs are subtle. Application-of-technology people often approach problems with a ‘let’s take it apart and solve it” mind-set. And when introduced to a new process at work, they like to get under the hood and fully understand how it works rather than just turn the key and drive it. In a snapshot, application-of-technology people are the ones who want to know a clock works because the technology excites them-as does the possibility that it could be tinkered with and perhaps improved (2)

In finding joint answers we started tinkering with the numbers of TE. If you raise the TE the parenchyma will be better seen.(Better look at the pancreas). If you decrease the TE the fluid will be better highlighted-(better MRCP ).

How many numbers can we start changing together?

Regarding communications: The questionnaire tool

In informal teaching, the need to establish a curriculum or program may be difficult. Then there are organisational dynamics. If you want to change the way a person behaves, give him a tool.

As it was for fire, the sling, the wheel, in remote times, so it is with the coming of advanced MRI/CT imaging and the need of technologists to carve a niche for themselves by knowing their numbers and planes well.

It can be a challenging and frustrating exercise to train persons in informal settings where the teacher-trainee relation is not clearly established.

For them we can have a questionnaire tool. The first question could be:

Did you identify any training needs for yourself in this exercise of reflecting on scanning protocols?

References

1.Walz D, Newman JS, Konin GP: Epicondylitis: Pathogenesis, Imaging, and treatment.

2.Butler T,Waldroop J: Job Sculpting: The Art of Retaining the best people

Harvard Business Review on appraising employee performance:pages 111-136