"Mistakes cause frustration, frustration causes more mistakes!"

1. You forgot to use them!

2. Used one, but put the wrong marker on wrong side! (you are in big trouble!)

3. Used correct marker, but placed it in body part. (this is really not your day!)

4. Used correct marker, but placed it outside collimation area (there is no guarantee that scatter will pick it up).

5. Used correct marker, but put it on the table top instead of the cassette, and it was projected off by the diverging beam (common on skull x-ray )

6. Marker is upside down or backwards (not a mortal sin, but sloppy!)

7. Marker scrapped off cassette when pushing in bucky (it can happen) or scrapped off when you pull the tray out (gone to marker heaven inside table)

8.  Marker scraped off cassette when pushing in bucky mysteriously appears right smack in the area of interest on an  image five pt.s later.  (Proof of reincarnation!)

9.   You used markers with somebody else’s initials on them.

10. Somebody else used your markers and took really lousy images, which they turned in!

11. Used correct marker, but the marker area was overexposed and didn't show up.

12. Scotchtape gives out- marker falls to floor (don’t you hate that!!)

13. Scotchtape gives out just enough to flop over into area of interest (Cross-table feet).

14. Can’t find your markers when you need them (stuck to gown of last pt. Bye-bye marker)

15. Child or baby grabs marker and rips it off, or puts it in area of interest.

16.  Pt. has situs inversus (1 in 10,000 people) You better hope you used correct marker on this one!

1. Forgot to use one when you were supposed to!

2. Used one when you shouldn’t have (elbow?!)

3. Put grid in backwards (almost total grid cut off!)

4. Angled against the grid (used grid crosswise for clavicle, but angle up 25 deg. (almost total grid cut-off)

5. Used 40 inch grid for 72 inch SID, or vice versa

6. Used grid ratio different than required and didn't compensate with increased or decreased technique.

7. Grid tilted (Smith-Pete. – grid cut-off)

8. Angled correctly along grid axis, but too much (Smith-Pete. when cassette isn’t parallel to face of collimator.

9. Not centered to line running vertically down center of cassette (grid cut-off)

1. Didn’t turn on bucky switch if required on your unit, or didn’t turn off for table top exam.

2. Didn’t push bucky all the way in.

3. Didn’t align bucky to CR.

4. You got a grinding noise when you move the bucky (unlock it before you move it! Its the sound of your grade going down if you are a student!)

5. Didn’t lock film in bucky. (Slides around when you push in bucky)

6. Didn’t lock bucky in place horizontally (won’t generally move but it will those times you have to get it right in one shot)

7. Didn’t lock bucky horizontally as you raise table vertically (crash).

8. Didn’t raise counter-balanced vertically bucky to ceiling before turning off power. (BIG crash)

1. Wrong size (too small -cut off anatomy  too big- more expensive, more developer cost, looks sloppy)

2. Wrong speed (used Extremity cassette instead of regular speed, vice versa)

3. Didn’t use one at all (you thought you had put one in the wall bucky)

4. Cassette in wrong direction (did a KUB with cassette crosswise)

5. Cassette placed upside down in bucky.

1. Used wrong pt. ID card

2. Flashed too quickly- blurred

3. Managed to get flashmarker in area of interest (I told you to put the FM up on a "pelvis for hips" image!)

4. You just flashed a film two seconds ago, no one could have possibly had a chance to switch ID cards (but they did)

5. Flashcard in backwards or upside down (blank space on film).

1. Pt. answers to similar sounding name (ask for birthdate)

(one day in fluoro there were 4 Johnsons, one Wilson, and one Nelson- I still don’t believe that one).

2. Multiple family members need x-rays (Twins-Yikes!)

3. Person answers to any name just to get out quicker (ask for BD!)

4. Pt. doesn’t speak English- answers to wrong name but they fit description so you go with it!

5. You are really stressed or in hurry, you use ID that sounds familiar (because it’s the last pt. you did!)

6.  Father and son have same name and you flash all radiographs with the wrong one's ID because you forgot to ask their birthdate.  (John Smith, Sr and John Smith Jr.)

Technique Problems

1. Too much kVp- film gray-lacks contrast.

2. Not enough kVp- not enough penetration, can't see through body part.

3. Not enough kVp- too much contrast (can't see lung detail on CXR).

4.  You mis-read technique settings (you thought  .1 seconds was .01seconds- you just gave the pt. 10 times the radiation dose for each exposure you made at this setting) or just the opposite-you thought .01 seconds was .1 seconds, now all your images are 10 times too light.  Even Digital Radiography can't save you now!)

Photocell problems

1.  Body part isn't correctly over photocell. (Too light or too dark image-Shoulders can be tricky)

2.  You choose wrong photocell, or forget to switch it when you do the next position (Pelvis, frogleg)

3.  Photocell burns out, thus exposure continues to backup time.

4. You don't choose enough backup time.  (Film too light).

5.  Photocell underneath gonad shield (Crispy Critter!)

6.  Photocell under large metal prosthesis (sometimes its better to use manual techniques).

7.  You use photocell for wall bucky when using table bucky.  (Another crispy critter)

1. Film outdated (check the expiration date, rotate newest boxes to back of storage)

2. Loaded wrong speed of film in cassette.

3. Put wrong size film in cassette ( 11x14 in 14x17 cassette- it will happen to you!)

4, No film in cassette (always when you have just done a difficult portable!)

5. Double loaded cassette.

6. Film black (oops, somebody fogged the bin- blame it on a student).

7. Film is double exposed (you forgot to change cassettes for next exposure)

8. Film is double exposed (somebody in darkroom mistakenly thought they had already run it, put exposed cassette in "out" passbox- just your luck!

9. Cassette gets caught on something and pops open exposing film (Gee Willikers! Always on that repeat shot you have taken 3x already)

Central Ray

1. Forgot to angle, or angled wrong direction.

2. Forget landmark CR is supposed to enter or exit.

Dark Room and processor problems

1. Door not locked, somebody walks in, exposing films.

2. Safelight too bright or too close to work area (fogging).

3. Safelight so weak or burned out, can’t see what you are doing- (good time to drop film on floor!)

1. Hidden jewelry (Necklaces-guilty until proven innocent!)

2. Safety pins (usually ladies over 70)

3. Wadded up Kleenex in pocket (can look like some strange soft tissue problem), keys, coins.

4. Buttons, zippers, snaps - (if you change them correctly, this shouldn’t be too big of a problem)

5. Bra’s- either the hooks in the back, or the metal adjusting clips on shoulder top – bras are no friend to x-ray techs! (For some reason some women think-take everything off from your waste up, does not mean their bra! Always pat’em down in back)

6. Dirty screens (can mimic calcifications or foreign body)

7. Piercings (genital, nipple, tongue, nose etc.)

8. Cable from equipment gets in image.

9.  Even breasts can be an artifact!  Like when doing a chest x-ray or decubitus,   or axillary view of shoulder- sometimes you have to ask the pt. to move 'em. Don't do it yourself- unless you are tired of working at your job.

10.  Don't forget the penis!  Better to not have it over the hip joint when doing a frogleg position. (Eh, excuse me sir...)

11.  Instead of taking off necklace, pt. offers to just put it around in back of chest.

12.  Instead of putting hair up (like on CXR), pt. wants to put hair on front of body.

1. You forgot to use it!

2. You used it, but keeps falling or sliding off

3. You used it, but pt. keeps grabbing it and putting higher up than you want!

4. You used it, but covered the area of interest (male shield covering pubic sym. or acetabulum)

5. Pt. wants face shield, thyroid shield , full lead apron even though it will completely block area of interest (radiation won’t hurt my new shoes will it?)

6. You decided to really practice radiation safety and shield a woman's ovaries when you were x-raying her pelvis (or KUB or sacrum, etc.)

1. Often isn’t Dr., but aide or nurse ordering x-rays (looks at chart and takes a guess)

2. Dr. doesn’t know how to order- (everything is AP/lateral)

3. Dr. from "somewhere else" orders a projection, but you are unfamiliar with the name he uses (but know it quite well once you establish what name you know the exam by.

4. Dr. from "somewhere else" –orders a position not even in Ballenger’s, that he orders at another hospital.

5. Dr. orders wrong side (left instead of right! (Somehow this is your fault- you knew what he meant!)

6. Dr. orders C spine, but his handwriting is so bad, its looks like L spine!

7. Handwriting is so bad, no one can figure is out what he wants (but he gets annoyed when you ask!)

8. Dr. is new, so over-orders (child skins elbow- better get humerus, shoulder, elbow, forearm, wrist and hand just in case! Better get the other side too for comparison.)

9. Dr. orders impossible x-rays (sunrise on pt. with no patella, weight bearing knees on double amputee, standing hips-to-ankles on quadriplegic).

10. Dr. has lapse of consciousness (or didn’t know any better)- orders wrong exam (you should have known he meant ankle when he ordered foot!)

11. You just turned off all equipment and computers, took out garbage, wiped down tables- knock, knock- I have one more pt.

12.  Dr. orders "Y" view on hip x-ray. (Somehow you have got to get the pt. to bend over far enough to get that shoulder in the picture!)

1. He wants just one more film right after you just let the pt. go because he OK’d the exam. (better run down the stairs to catch them, the elevator is too slow!)

2.  Lack of appreciation by Radiologist how hard it will be to get that extra view "just rotated 5 degrees" (especially when pt. has already told you they absolutely do not want any more exposures.

1. You cut-off body part! (pt. must have reached up and twisted collimator knob while you were walking back to console!)

2. Included too much area (looks sloppy, extra pt. exposure, some Radiologists hate this because they are legally responsible for reading everything on image, even if  extra area not is requested by ordering Dr.

3.  The collimator light out of adjustment -does not cover the same area as the x-ray beam.  (One side of the image is cut-off, the other side has lots of unnecessary exposure)  Its a poor workman who blames his tools, but in this case its true!

4.  Next time you use that equipment, you try to compensate for collimator light that is out of adjustment, but you forget which sides are "off", and make the situation even worse.

1. Bucky cable broken (grid lines because the grid didn’t blur out of way).

2. Equipment was just re-calibrated, so now all your techniques no longer work.

3.  You didn't put the footboard on bottom of table correctly before you raised table vertically- footboard comes loose, pt. falls. (can you spell LAWSUIT?)

4.  Collimator light burns out. (of course you don't have an extra one lying around)

5.  Dept. switches to new cassettes of which are of a different speed than you have been using for years.     (Now none of your techniques work!)

6.  You raised the table from horizontal to vertical, and didn't notice you moved a chair under table as you lower it down.  (Count yourself really lucky if only the chair breaks!)

7.  You have the kind of table that will rise up vertically (kind of like a magician levitating someone).  You don't notice when you lower the table that a stool is now under the table. CRAACK!!! Oh, well, how much can a new tabletop cost- a couple hundred bucks?  (Try $7,500)

8.  A year later you do exactly the same thing! (Now its $9,000!-inflation you know!)

9.  A few months later, a student does the same thing. (Now you know one reason why the new tables have alarms built into them...some people will think their cellphone needs recharging when they hear it go off!)

10.  You hear grinding noises and smell something burning when you try to raise table to vertical position (Sounds like the motor is going out)

11.  There are no  more clean sheets or pillow cases.

Portables

1.  You have to wait forever for an elevator (you and the machine have last priority when elevators are busy).

2.  Various bars on the bed are right between your tube and the cassette.

Common postioning problems (this could be a lengthy one!?)

1. Cut off angles on chest x-ray.

2. Foot not true lateral

3. Mortise view of ankle obliqued too much, or not enough.

4. Shoulders not rolled forward enough on CXR, so scapulas cover part of lung field.

5. Forgetting to turn feet inward on a pelvis exam.

1. Pt. wants you to x-ray another body part that their Dr. didn’t order, as long as they are here anyway.

2. Pt. expects you to call their Dr. and ask for permission to do the added exam.

3. Dr. gets mad if you call them and interrupt what they are doing to ask if you can do the requested exam.

4. Pt. wants to be cut to front of waiting line because they have a plane to catch (its usually the same guy every time).

5. Pt. doesn’t want you to do all the exams their Dr. ordered (fine, save me some work).

6. Pt. argues and complains for ten minutes that they don’t want an exam, then as soon as they understand that you are not going to do anything they don’t want, suddenly they want the exam).

7. Pt. whines, "Isn't all this x-ray bad for me?" (think Roseanne Barr) Well, you may have a heart attack when you open the bill!

8. Pt. has major body odor, foot odor (and smell stays in room or clings to your labcoat or uniform).

9.  When is a Pt. not a Pt.?  When they are a sweater!  (big wet marks on cassette or table where body part contacted it.  Get out the cavicide! Actually, you should do wipe down the equipment even if you don't see anything.)

10.  Spontaneous erections can make for an awkward moment (try to take it as a compliment!).

11.  Some male pt.s have been known to pleasure themselves when the female tech leaves the room to check her films (now that is really a compliment!..even if you are a male tech..)

12. Never refer to male pt.s wife as his mother.

13. Pt. pulls out dentures or partial plates for odontoid view, and hands them to you with 3ft streamer of saliva trailing behind.

14. Forgetting to ask a female pt. if she could be pregnant.

15.  Asking a female pt. if she could be pregnant and she gets offended because she thinks you think she is fat....

16.  You're trying to do a difficult position like an axiolateral oblique mandible, and pt. says, "I'll put my head in position when you are ready to shoot.

17. Pt. is telling you how to do position, even when they have absolutely idea what you are doing.

18. Pt. wants to know why they have to have mammogram..they just had a CXR last year!

Super-size it!   (problems with extra large pts)

1.  Table starts beeping when pt. lies down on it. (special alarm in newer tables when pt. exceeds weight limit of table) Try to be tactful!

2. Large male pt. takes in deep breath for chest x-ray- both Apices and costaphrenic angles are cut-off, no matter if the cassette is turned vertically or horitzontally.

3.  Taking a KUB requires 4  14x17 cassettes because the pt. is so massive. (Image is generally poor because of the large amount of scatter).

4.  Trying to find the crest or other landmark on an obese pt.....

5.  Trying to see C-7 on lateral on C-spine series when pt. has huge shoulders that they can't relax down.

Pediatric Issues

1. Baby in serious need of diaper change.

2. Parent didn't bring extra diaper (of course, you  have one right there in your back pocket!)

3.  Parent mistakes child restraint as hurting the child (one parent threatened to beat the @#%& out of me!)

4.  Diaper is dumped in garbage can in room and continues to smell up room for rest of day.

5.  Child screams in your ear for the whole exam.

6.  Mother starts crying (you brute!)

7.  Mother and Father start fighting with each other.

1. Pt.’s films are misfiled.

2. Pt. checked out films and never brought them back.

3. Last Dr. looking at films didn't put them back in jacket (probably safe and secure in someone else's jacket!)

4. Comparison x-ray in jacket suddenly grew breasts, got 30 years younger and shoulder replacement went away. (Amazing what they can do with plastic surgery these days!).

1.  Tech is short-tempered and  rude to pt.s or other hospital staff because they haven't gotten lunch, or any other breaks.

2.  Hit you own head on tube head, especially when you are moving it (you gotta be really tired for this one).

3.  Drop cassette on your own foot, or pt.s.

4.  Don't see, or forget to do additional exams listed on X-ray request.

5.  Forget to wash hands and wipe down table after finished with Pt.

6.  You wipe everything down so well that someone almost (or does) slip on wet floor.

7.  You do the exam listed on the sheet that has been registered by the receptionist, instead of reading actual request. (Should be same, but often aren't.

8.  You don't do the correct exam series for a given part based on history (trauma cases often require a different routine than say, arthritis cases- read the history!)

1. Two techs work together, not in sync, winds up looking like comedy show as they bump into each other.

2. One tech makes suggestions in front of the pt., making first tech look inept.

3. Last tech in room left it a mess.

4. It gets ugly when some techs feel other techs are not pulling their weight.

5. Certain techs to seem to take extended lunch breaks.

6. Certain techs mysteriously always have to go to the bathroom right when a particularly difficult case comes in (time to see a urologist?)

7.  Certain techs clock-in and then go have breakfast.

1. Pt in bathroom when you call their name.

2. Pt. complains how long they have been waiting, and then wants to go to bathroom.

3. Just get difficult pt. on table and they want to go to bathroom.

4. Pt. goes to bathroom on table!

5. Pt. passes gas in your face as they turn over for lateral lumbar spine.

6. Next tech who comes in room thinks YOU did it!

7. On the other hand, if YOU did do it, you can complain about what that disgusting last pt. did!

8. Pt appears to understand they are to hold their breath, then they blow it out just as you shoot!

9. Pt appears to understand what you are saying, but turns out they are deaf and were lip-reading, and don’t hold their breath because they can’t see you.

10. Pt. thinks take in a deep breath means to hyperventilate.

11. Pt. does not speak English (there is usually somebody around speaking Spanish or Mandarin or Cantonese or Russian, but I have never known a tech who speaks Inuit).

12. Family member with pt. who does not speak English complains that they should not have to help, and that all techs should be required to speak several languages.

13. .You have had a horrible day, its five minutes to closing time, in comes two patients needing several complicated exams right when you thought you were going home (and have to be somewhere that you can't be late to)

14. You are trying to finish  the Sudoku puzzle and pt.s keep coming in interrupting you!

15.  You give a pt. a front and back gown to change into, and they come out with either both gowns open in front or both open it back (its never the cute ones!)

16.  Pt. comes back after you have completed their exam, claiming they left their wallet or expensive necklace in the room, which you usually can't find.  (Isn't it hard to come across as not guilty, even though you have never stolen anything in your life?)

17.  Someone opens door to exam room right as you hit exposure button, terminating you exposure time too soon.

18.  You aren't certain if you heard exposure "beep" when you hit the button.  Do you just hit the exposure button again or immediately switch cassettes and reshoot it, or run the first one, and maybe have to do it again anyway? Do you feel lucky today? (Always fun in the OR or when doing a portable).

19.  Pt. needs to sneeze or cough and politely turns their head, right in your face! (Forgive me if I don't say "God bless you" this time.)

20.  Pt. sneezes in their hand, wipes off mucous  extra  from their face with the back of that same hand, then offers you that hand to help them get off the table.

21.  Call Pt., but they want to finish their cellphone call first (if you want to wait another 15 minutes, I have no problem with that).

22.  Pt. is worried that radiation will damage their cellphone (like erase all those phone numbers)

23.  When you ask the pt. to lie down on the table, they put their feet on the pillow and their head on the bare table at the foot end.

24.  Pt. is sure you know what is on x-ray and can't understand why you won't tell them (no doubt because you see a giant cancerous tumor and don't want to tell them)

Computer Radiography  Problems

1. Frequent breakdown of equipment and software problem (its a rare day when our computer repair guy isn't in the dept. fixing something! (I do remember one day we didn't see him-- oh, wait, its was a holiday and the dept. was closed that day.)

2. Cassette gets stuck in digitizer and won't come out (if you thought pt.s were backup before...)

3.  You accidently erase the cassette.

4.  You window and level an image, but forget to save it, so poor image gets sent.

5.  You repeat an image because it is suboptimal (stinks), and accidently send it anyway.

From our friend in England

Don't you it hate when:

1. You give the pt a gown with instructions to take everything off, and they only take off their coat and put the gown over the rest of their clothes.

2.  The pt. keeps falling asleep during a long exam.   zzzzzzzzzzz....

3. The pt. wants you to give medical advice on all their other symptoms and ailments (give  me another 12 years of medical training, and I will be happy to try)