Los Rayos Equis

This is a picture of my cute little ray-gun, with which I made bone pictures today.  It’s a basic machine, and unlike most x-ray machines in current use it’s set up to shoot films. That means you need a darkroom and chemicals, and to re-load the cassettes, and develop the films in a processor.  We trained on these kinds of machines in school, but the only place outside of school I saw any were in clinics for the poor, usually frequented by Latino patients.  Hospitals and imaging centers either use cassettes that hold a sensing plate read in a computer scanner or the tables have a digital sensor interface that ports the images directly into a computer.  Yet, here it is, La Machina Basica, way up North in an old port town.

Medical professionals perform procedures on patients that involve risk.  If you do things the wrong way, you can hurt someone.  That’s why you have to go through long processes to get State-provided permission (licenses) to take X-Ray images.  It isn’t because of how hard or easy it is to learn or do the job.  You have to go through accredited training and work full-time for FREE (under supervision) for about nine months before you qualify to take the licensing tests.  If you pass, you can join a national registry.  Your State will grant you a certificate stating they trust you not to screw up.  Then you have to take a certain amount of hours of continuing education to retain and renew your license.  When I worked for free, I worked only at places with digital systems.  Some of my old classmates would be laughing if they saw this machine, but I respect it because it still works.  It’s in good repair and it makes decent images.

Shooting on film is for manly-men, even if you are a woman.  Any qualified tech can shoot on a digital system.  You only have to get your exposure settings inside the ballpark.  The computer will give you the leeway to adjust the contrast and borders of the image so it will always be ideal.  On film, you can’t adjust anything once you take the shot.  It is what it is.  There’s little latitude.  You have to get it right first time, every time.  It’s kind of like photographing for Sports Illustrated.  You can’t ask the home run hitter to swing over again because you were underexposed.  Also, every tube is different.  They wear out over time.  That’s why you need an accurate technique chart for the machine you are working with.

It turned out the chart for this machine wasn’t accurate.  I don’t know why.  However, a good tech knows how to adjust after seeing a single exposure.  Because film is unforgiving of mistakes, it’s preferable to develop and view the first film before shooting the rest of an exam.  The first image I took was acceptable, but not ideal.  The later shots were better, because I compensated for what wasn’t as good on the first one.  I also made sure to take the least important pose first, so the ones illustrating the patient’s injury best would be clearer.  X-Rays can’t be focused.  They must be corralled and filtered, so the best wavelength rays get through the patient to the film.  Proper exposure technique, good positioning and closely framing the intended target area all add to an image’s value for diagnosis.

I can’t tell you any specifics about the cases.  Part of being a tech is that you swear to protect the privacy of any information that might identify a patient to someone not involved in their care.  I can say that people who show up at an Urgent Care are suffering from minor emergencies.  They may be wounded or have fractures or have been in a car accident, but they aren’t brought in unconscious and close to death as they may be at hospitals.  Usually they can assist in their own exams, and can cooperate by shifting, holding their breath etc.  The tables in hospitals must move, since sometimes the people can’t.  I don’t have a floating table.  I do miss that.  However, my X-Ray tube changes angle, height and distance nicely.  The controls that corral the rays into the desired rectangular shapes work well.

It took five months to take the tests and get the licenses before I could even apply for this part-time job.  That’s how much of a privilege it is to be doing it.  It’s patient care.  It’s something I can do to make a direct difference for the better in the lives of people in need.  It’s a way of closing the circle for me.  When I was a teenager, I was a trained volunteer counselor at a Crisis Intervention Center.  I did that for almost a decade, from high school through the time I worked in that film manufacturing factory (Oddest Jobs Ever Pt. 2).  The center had some management crises of its own, and I quit doing it when I went back to college.  I’ve done short stints of volunteering since, but I wasn’t involved in patient care from 1978-2005.  Now the Wheel has brought me back where I began, into the river where wounds are washed.

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8 Comments

Filed under symbolism, Technology, Thinking about thinking

8 responses to “Los Rayos Equis

  1. Thanks for this post. It’s been enlightening hearing about these machines from your professional perspective. I have only encountered these kinds of machines from the patient’s point of view and unfortunately for me, it has had negative connotations. But, it’s lovely to hear from the person behind the machine!

    • It’s appropriate for you to be unhappy about being hurt, Tracy. Despite your exceptional achievements in adaptation and adjustment, it is (duh Captain Obvious) unfair that it happened. What changes over time is our perspective, since catastrophe can also open a door to new awareness, as it has in some ways for you. Every curse holds the potential to be a blessing.

      I develop reliance on the machines as useful tools, but it doesn’t compare to the importance of the relationships I establish with patients as we discuss their situations. I’m going to write some stories about previous patients in a manner that won’t compromise their identity. It’s possible, just stylistically challenging.

  2. Congratulations on the job, I look forward to it leading you places.
    I too thank you for the insight. I remember years ago having films taken and being asked to wait and then return for a re-shoot, now I understand why. I also recall a tech making a diagnosis that was missed by two surgeons, I was very thankful for that re-shoot, he saved me a world of hurt. I still have that film, and the tech’s report, but I think I told you that already during a conversation about dragons.
    My first “exposure” to digital was an eye-opener, the results making it back to the exam room before I did was down-right weird.

  3. Yes, you did tell me, but I remember it. That’s the gray area of our “scope of practice”. We can urge the taking of additional images, but we have to blame it on “technical problems” because we aren’t allowed to diagnose. Fortunately for all of us, films and computer sensors are so responsive now that even a lot of re-shooting on film or digital systems exposes patients to little radiation. Procedures like CTs require much more exposure, sometimes hundreds of times as much as a still image. It’s risk vs. benefit. You can map an active subdural hematoma on CT and save a life. Still images won’t show that. And of course, time’s important in hospitals. You want rapid diagnoses in dire situations. That’s why nearly every hospital has gone digital.

  4. Fascinating information. The (lead-lined) curtain rarely gets pulled back like this. It did pique my curiosity about a couple things, though:

    1. As I just made light of, how severe are the risks of exposure with these machines? Can faulty units be more dangerous?

    2. Is there any noticable malady in the image you provided?

    • I answered your first question in my answer to ShesBoxingClever. Very little radiation. Little risk. When the tubes wear out they just become unable to generate the rays at all. In rare cases, a tube’s glass could crack or explode, but the tech would be guilty of not allowing time for it to cool between exposures. It’s almost a theoretical case. These things used to happen more commonly in the early decades of the profession, before the 1940s.

      How could I have forgotten that! (I was tired. I posted late at night, that’s how.) The problem for this poor person is an obvious one. Spondylolisthesis. Look how much farther forward the rectangular bone at the top of the image is. It’s not aligned with the rectangle below it. Those are two vertebrae. They had a disc between them once, but that disc has been squeezed like toothpaste back into the spinal canal, in contact with the sciatic nerve which goes down the length of both legs. This one will have low back pain strong enough to prevent walking, standing, probably even make it hard to lie comfortably.

      Usual causes: MVA (motor vehicle accident), heavy lifting with bad body mechanics, and aging since we eventually lose water from the discs. They become less effective as shock-absorbers. Thanks for reminding me, Tim!

  5. lianamerlo

    Is it true that each x-ray you get is like taking a plane flight (in terms of radiation exposure)?
    Do you have to monitor how much radiation you’ve been exposed to everyday working with that kind of equipment?

    • Each commercial plane ride of 2 hours duration is roughly equivalent to an x-ray, which is still not much radiation, and yes, all techs wear badges that measure our exposure to radiation. The kind of badge is determined by the kind of x-ray practice you perform. Surgical techs wear rings. I wear one on my pocket. The badges are turned in to the state every 1-3 months and read to make sure we are following safe practices.

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