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The perfect picture: Radiological technologists produce the images for diagnosis

An entire department in CHI St. Alexius Hospital in Dickinson is devoted to capturing the clearest image possible--radiology. The radiology department is responsible for taking the images of different parts of the body to send to a radiologist, w...

Zach Hollingshead, an X-ray technologist at CHI St. Alexius in Dickinson, is responsible for taking a clear image of the patient's body part to send to the radiologist for diagnosis. Photo by Ellie Potter/The Dickinson Press
Zach Hollingshead, an X-ray technologist at CHI St. Alexius in Dickinson, is responsible for taking a clear image of the patient's body part to send to the radiologist for diagnosis. Photo by Ellie Potter/The Dickinson Press

An entire department in CHI St. Alexius Hospital in Dickinson is devoted to capturing the clearest image possible-radiology.

The radiology department is responsible for taking the images of different parts of the body to send to a radiologist, who diagnoses the injury or ailment.

Radiology consists of several different modalities including: X-ray, ultrasound, bone densitometry, nuclear medicine, CAT/CT scans and MRIs-all of which can be found at the hospital, said Zach Hollingshead, an X-ray technologist at CHI St. Alexius.

Each is geared toward specific purposes with different specialists as a result.

Hollingshead began his medical career in nursing school before realizing he did not want to be a nurse for the rest of his life. X-rays had always interested him, so he decided to pursue an associate's degree.

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"I worked at a desk job once, and I just like being around people," he said. "I just really like what I do. I enjoy helping people, and I like X-rays. I'm really interested in the body and bones and stuff. ... I love my job. I love coming to work."

His job is to position the patient in order to best X-ray a specific body part. He adjusts the amount of light from the machine in order to narrow its beam to the target area for a clean picture and to limit the amount of radiation the patient is exposed to. People in the room wear a lead vest to protect themselves from the scatter radiation as it bounces off the target area. He stands behind a small wall looking at a monitor to judge the resolution of the image and to determine how to improve it before sending it to the hospital's radiologist. A radiologist has a medical degree and thus is able to make a diagnosis.

Every day is different, every patient is different, every case is different. Sometimes patients come through radiology's doors who can barely move or straighten their limbs, which can make Hollingshead's job more challenging when trying to find the right angle to best see the source of their injury, he said.

"You see people that are in extreme pain who have been in car wrecks, or you can just tell they're really, really in pain," he said. "You just feel really bad because you can't ease the pain, but you have to get the X-rays."

Live X-rays show the body's innerworkings

Throughout the day, Hollingshead works with all sorts of patients, generally looking for fractures in the patient's bones. He also works with fluoroscopy-essentially a live X-ray. Fluoroscopy works when the patient ingests or is injected with some sort of contrast which shows up on the monitor. As the liquid moves through the body, the radiologist and the technologists are able to see how the body is functioning. The movement helps them identify problem areas which may shed light on the source of the ailment the patient is enduring.

For example, the patient may drink a liquid contrast in order for the specialists to watch it move throughout the digestive tract-observing its movement in the stomach folds and through the intestines. This can help identify where the patient may be having problems.

When women are having trouble getting pregnant, female technologists can also inject a contrast into their vaginas to see if there are any blockages in the fallopian tubes-an X-ray test called a hysterosalpingogram (HSG). Any blockages could be hindering her ability to get pregnant. Before giving a shot, such as an injection for pain, doctors may also use the contrast to ensure the needle is indeed in the joint, perhaps when numbing a shoulder or hip.

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Normal X-rays do not require any contrast. Once Hollingshead takes the picture, he can then rotate it or resize it for the radiologist.

Ultrasound: the most 'tech-dependent' modality

Each specialty within radiology is better at capturing images of specific parts of the body, so the tests' costs vary as a result.

MRIs usually cost between $2,000 and $3,000 compared with X-rays, which cost more in the range of $100 to $400, Hollingshead said.

Fabiano Portugal, an ultrasound technologist at CHI St. Alexius, said his modality is also less expensive, though MRIs are considered the "gold standard" of radiology because of the crisp pictures they take.

However, other specialties are more reliant on the equipment rather than the technologist to get a clear picture-something that is not the case for ultrasounds, he said.

"It's kind of the first line of defense when a patient comes in because it's not the most expensive exam," Portugal said. "It's very tech-dependent unlike the other bigger machinery that we have where the patient has to go in and the machine does everything. Ultrasound depends a lot on the tech."

Ultrasounds use sound waves that travel through a medium in the body-normally a tissue or a liquid-then hit the organ or vessel and bounce back to the machine creating a picture of what that structure looks like, he said.

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He said ultrasound is the most difficult modality within radiology because the technologists are more involved with the diagnostic side as well. He spends at least 15 to 20 minutes with each patient and can spend upwards of an hour.

Ultrasound technologists must be well-versed in anatomy as they identify and measure different parts of the patient's or baby's body, Portugal said. They must also know the normal measurements of the body at different stages in order to identify when something is amiss.

They need to be proficient in multiple parts of the body where ultrasounds are used as well, including: babies, abdomen, breast, vascular, muscular/skeletal among others. He said it can take five to 10 years in order to get proficient in all the areas of ultrasound and the technologist would need to be in a hospital where they are more regularly treating people in all these areas.

After the ultrasound, the technologist then writes up a report for the doctor offering their own diagnostics as "medical diagnostic stenographers," though they are not allowed to share any of these diagnostics with the patient, he said.

"Ultrasound, you are the radiologist's eyes because he is not there with the patient, so you have to get the history, you have to know your anatomy, you have to look at everything, make sure you annotate," Portugal said. "... The radiologist is going to get your report and go by what you say, so it's much more involved."

It can be difficult to get a crisp shot of the patient's body part sometimes, he said. Sometimes the technologist really has to fight for their images because the person may be overweight or gassy, among other reasons. If the technologist is unable to get a clear image, then he details why in his notes to the radiologist.

A need for radiological technologists

Dorothy Meduna, the director of the hospital's radiology department, said there is a demand for X-ray technologists across the United States.

The technologists can also go to school to specialize in one area and then cross-train to become specialized in an additional modality. At her facility they have a lot of on-the-job training in different areas after which the technologist can take a registry test with the American Registry of Radiologic Technologists to become certified in the new specialty.

The hospital has 16 radiological technologists on staff.

"We are a great resource for the physicians for helping with diagnosis," she said, "which ultimately helps with treatment."

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