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Last night in Chat, we blamed Kara, but I'd rather blame someone who can't kick my butt. 
At this particular hospital, we have three scanners: one for general stuff, one for cardio, and one demon possessed machine for overflow (seriously, it's the finikiest scanner I've ever seen). The one saving grace we had was that cardio wasn't very busy so D was able to help us out with general stuff. Otherwise, I don't know how we would have made it.
Lung Scan Part 1
On top of a full outpatient schedule, we've got a STAT lung scan. So I call up to the floor for info. The doctor wants to take a look at the patient to decide if he even wants the scan now and he's not there yet. Ok, we'll wait for the floor to call when the doctor gets in. In the meantime, we'll squeeze in another scan.
Doc eventually wanders in, says yes, he wants the scan. Super. Oh, patient is on a ventilator. Which means respiratory therapy needs to come with them. Alrighty. It's gonna be a bit cramped, but we'll manage. Something to keep in mind here is the lung scan involves breathing in a radioactive aerosol --> pictures --> inject tracer for blood flow --> pictures. This will be important later.
Poor Student
Yesterday was Student's second day at our facility. With so much craziness happening, we didn't get to teach her much. We ended up having her sit with the back camera doing HIDAs since we were dealing with the lung scan.
Lung Scan Part 2
Second lung scan of the day, call for tracers. This guy literally had tests scheduled in every department on our floor, which we found out piecemeal. Interventional wanted him when we were done, then echo, then ultrasound. Somehow he ended up back with us after all his other stuff and it took transport nearly an hour to come to take him back upstairs. Family was understandably annoyed. I was annoyed.
Well, that would have been nice to know an hour ago
Inpatient HIDA added on. Patient had a prior HIDA scan less than two weeks ago. Another call up to the floor to see if the ordering doc knew that. After a couple hours of phone tag with a particularly nasty nurse, we find out this is supposed to be a post-op scan. The patient had her gallbladder removed and they want to check for a bile leak. The previous scan was for pre-op. Now that makes sense, and if the floor had told us so in the first place, we could have done the test earlier.
Lung Scan Part 3
Another one?! *&^)@(*#$(#%^!!!
Ahahahaha....no
Near the end of the day a STAT gastric emptying scan came through. Um, no. That is not a STAT scan. Calling the floor (yet again) revealed the order was written 2 days before and someone forgot to put it in. That same someone tried to cover their mistake by putting it in STAT. At the end of the day. Normally we can't refuse a scan, but this is an exception: We cannot do GES's after 930 when the cafeteria stops serving breakfast (we put our tracer in the eggs). Company policy states the cooks cannot crack eggs (due to botulism prevention) and have to use the liquid kind. I think they toss the leftovers at the end of breakfast and can't make anymore until the next morning. So no gastric for you!
I suspect this is going to become a huge ordeal
Alright, this one requires some background. We do a scan to look for infection in bone. It's a dual-isotope study with Technetium (Low Energy) and Indium (Medium Energy). The indium is tagged to the patient's white blood cells and then reinjected. The tagged WBCs will go to the infection site, and when we subtract out the technetium images, whatever's left will be indicative of an infection. There are only two hospitals in the area that do the scan this way. It is a 2-3 day test and all images MUST be done on the same scanner.
Our scanners have what are called collimators. They act as filters to only allow part of the radiation through to the camera's crystal and block what's extraneous. They are rated for Low, Medium, and High energies. As mentioned earlier, Tc is a low energy and In is medium. So for this scan, we needed to use the medium energy collimators.
Remember that lung scan we did on the vent patient?
Yeah....
Because there wasn't a good seal around the vent patient's mouth, radioactive aerosol got breathed out into the room. Unbeknownst to us (since radiation is invisible), the aerosol caught the air current from the heating vent and ended up all over the collimator cart. If spills are cleaned up right away, we can usually get all the contamination. But if it sits for several hours (like this spill did), even four people scrubbing with Radiacwash isn't going to get it up. With contaminated collimators, we can't complete the scan. I missed this part of the tale because I was in the back doing the aforementioned bile leak so Student could go to lunch.
When C broke the news to the patient, he went--pardon the pun--nuclear. It sucks, believe me I know. Since something on our end caused it, chances are the costs would have been on us. And yes, we have to do the whole thing over again. And due to the half-life of indium (2.8 days), we have to wait until sometime next week--both to let it decay off our equipment and to let it flush out of the patient's system.
Patient: Well, I'll just go to <home location> and do it there.
C: It doesn't work that way. I don't think <home location> has the software to do it.
Patient: I'm gonna call <doctor> then, because I'm not doing this again.
C: Well, that's between you and your doctor, but all the pictures have to come from the same camera and the department has to have the right software.
Patient: I always have problems when I come here. I'm going somewhere else.
C: That's fine, but you're going to have to start the test over.
And on and on, round and round. He walked out, C went to give the supervisor a heads up and call <doctor>. We thought that was the end of it.
Oh no.
He called back and harassed D trying to get an answer he liked better. D told him the same thing C did and C had to explain it to several other people. I have a feeling we haven't heard the end of this.
Seriously?!
In the midst of all this, the floor added another STAT HIDA.
This guy was....off. He thought he'd had a cheeseburger a couple hours prior, nurse on the floor said he hadn't. Ok, fine. We'll go with the nurse. Halfway through the test, C gave me the chance to go home and I took it.
I'm a little scared to go in tomorrow....
At this particular hospital, we have three scanners: one for general stuff, one for cardio, and one demon possessed machine for overflow (seriously, it's the finikiest scanner I've ever seen). The one saving grace we had was that cardio wasn't very busy so D was able to help us out with general stuff. Otherwise, I don't know how we would have made it.
Lung Scan Part 1
On top of a full outpatient schedule, we've got a STAT lung scan. So I call up to the floor for info. The doctor wants to take a look at the patient to decide if he even wants the scan now and he's not there yet. Ok, we'll wait for the floor to call when the doctor gets in. In the meantime, we'll squeeze in another scan.
Doc eventually wanders in, says yes, he wants the scan. Super. Oh, patient is on a ventilator. Which means respiratory therapy needs to come with them. Alrighty. It's gonna be a bit cramped, but we'll manage. Something to keep in mind here is the lung scan involves breathing in a radioactive aerosol --> pictures --> inject tracer for blood flow --> pictures. This will be important later.
Poor Student
Yesterday was Student's second day at our facility. With so much craziness happening, we didn't get to teach her much. We ended up having her sit with the back camera doing HIDAs since we were dealing with the lung scan.
Lung Scan Part 2
Second lung scan of the day, call for tracers. This guy literally had tests scheduled in every department on our floor, which we found out piecemeal. Interventional wanted him when we were done, then echo, then ultrasound. Somehow he ended up back with us after all his other stuff and it took transport nearly an hour to come to take him back upstairs. Family was understandably annoyed. I was annoyed.
Well, that would have been nice to know an hour ago
Inpatient HIDA added on. Patient had a prior HIDA scan less than two weeks ago. Another call up to the floor to see if the ordering doc knew that. After a couple hours of phone tag with a particularly nasty nurse, we find out this is supposed to be a post-op scan. The patient had her gallbladder removed and they want to check for a bile leak. The previous scan was for pre-op. Now that makes sense, and if the floor had told us so in the first place, we could have done the test earlier.
Lung Scan Part 3
Another one?! *&^)@(*#$(#%^!!!
Ahahahaha....no
Near the end of the day a STAT gastric emptying scan came through. Um, no. That is not a STAT scan. Calling the floor (yet again) revealed the order was written 2 days before and someone forgot to put it in. That same someone tried to cover their mistake by putting it in STAT. At the end of the day. Normally we can't refuse a scan, but this is an exception: We cannot do GES's after 930 when the cafeteria stops serving breakfast (we put our tracer in the eggs). Company policy states the cooks cannot crack eggs (due to botulism prevention) and have to use the liquid kind. I think they toss the leftovers at the end of breakfast and can't make anymore until the next morning. So no gastric for you!
I suspect this is going to become a huge ordeal
Alright, this one requires some background. We do a scan to look for infection in bone. It's a dual-isotope study with Technetium (Low Energy) and Indium (Medium Energy). The indium is tagged to the patient's white blood cells and then reinjected. The tagged WBCs will go to the infection site, and when we subtract out the technetium images, whatever's left will be indicative of an infection. There are only two hospitals in the area that do the scan this way. It is a 2-3 day test and all images MUST be done on the same scanner.
Our scanners have what are called collimators. They act as filters to only allow part of the radiation through to the camera's crystal and block what's extraneous. They are rated for Low, Medium, and High energies. As mentioned earlier, Tc is a low energy and In is medium. So for this scan, we needed to use the medium energy collimators.
Remember that lung scan we did on the vent patient?
Yeah....
Because there wasn't a good seal around the vent patient's mouth, radioactive aerosol got breathed out into the room. Unbeknownst to us (since radiation is invisible), the aerosol caught the air current from the heating vent and ended up all over the collimator cart. If spills are cleaned up right away, we can usually get all the contamination. But if it sits for several hours (like this spill did), even four people scrubbing with Radiacwash isn't going to get it up. With contaminated collimators, we can't complete the scan. I missed this part of the tale because I was in the back doing the aforementioned bile leak so Student could go to lunch.
When C broke the news to the patient, he went--pardon the pun--nuclear. It sucks, believe me I know. Since something on our end caused it, chances are the costs would have been on us. And yes, we have to do the whole thing over again. And due to the half-life of indium (2.8 days), we have to wait until sometime next week--both to let it decay off our equipment and to let it flush out of the patient's system.
Patient: Well, I'll just go to <home location> and do it there.
C: It doesn't work that way. I don't think <home location> has the software to do it.
Patient: I'm gonna call <doctor> then, because I'm not doing this again.
C: Well, that's between you and your doctor, but all the pictures have to come from the same camera and the department has to have the right software.
Patient: I always have problems when I come here. I'm going somewhere else.
C: That's fine, but you're going to have to start the test over.
And on and on, round and round. He walked out, C went to give the supervisor a heads up and call <doctor>. We thought that was the end of it.
Oh no.
He called back and harassed D trying to get an answer he liked better. D told him the same thing C did and C had to explain it to several other people. I have a feeling we haven't heard the end of this.
Seriously?!
In the midst of all this, the floor added another STAT HIDA.
This guy was....off. He thought he'd had a cheeseburger a couple hours prior, nurse on the floor said he hadn't. Ok, fine. We'll go with the nurse. Halfway through the test, C gave me the chance to go home and I took it.
I'm a little scared to go in tomorrow....
Especially since I had a terrible cough, and kept trying not to move. 
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