... not that I was ever gone ...

[James Snover]

I'm back. Sort of. Not that I was ever gone, per se, but, y'all know how it goes, trying to keep the planet spinning along in its mutually barycentric Earth/Moon/Solar orbit, at 67-68K miles per hour, 24x7x365.25. And fix the occasional x-ray machine.

Speaking of which: Holy freaking Carp on methamphetamine on steroids and pogo sticks: they went and trained me on a freaking robotic catheterization system, I kid you not! And as if that weren't enough? A robot that inserts wires in your femoral artery and goes into your heart and does all kinds of good stuff for you? NOW this thing is in FDA trials for neurology procedures! The wire goes in your femoral artery then goes way in the hell past the heart, into the brain! No fooling, they can fix brain aneurysms with this, among other things, that are otherwise inoperable!

And .. the writing has sort of taken off, too. At this point, though, if I do hit it big, like Tom Clancy big? I might just have to stick with the fixing x-ray stuff for a while longer, still. Just because.

Don't ask me how I got here. I lived it, and I still can't believe it. So, I don't think about it. I just keep fixing what they put in front of me. The rest will take care of itself.

Still ... not bad for a guy who only ever wanted to be a brick-layer, in the '80's. Only he couldn't stay awake on the job because he was so bored, even with a brick in his hand, on a scaffold.

 

[VegasMichael]

.

 

[1 Alibi 2]

Welcome back..
.

 

[CompOrange04GT]

@03cobra#694

He wasn’t building a nuke


Yet

 

[72MachOne99GT]

It amazes me still that we can just take stuff, run it through some inside-you-tubes, and get inside your heart, grab a clot, and pull it out.

 

[Double"O"]

Ill stick to the old school way of circulating AAAs and Cardiac caths thanks...f that robot lol

Is it a divinci?

Also come fix me archaic C arm that gives me shit weekly lol...my mini c arm is being dumb too...boots up and wont let take an image often

 

[James Snover]

Ill stick to the old school way of circulating AAAs and Cardiac caths thanks...f that robot lol

Is it a divinci?

Also come fix me archaic C arm that gives me shit weekly lol...my mini c arm is being dumb too...boots up and wont let take an image often

Is it an OEC9800? I can tear those things down to the base wheel assembly, and put them back together again. I used to replace the lift column in those when they would squeal, and GE/OEC would only offer low-buck trade-in value on them.

 

[James Snover]

It amazes me still that we can just take stuff, run it through some inside-you-tubes, and get inside your heart, grab a clot, and pull it out.

As well as all kinds of other repairs to the heart and vasculature, as well! My job has gone full-blast sci-fi.

 

[wizbangdoodle]

When this thing is navigating your arteries, are there road signs that mark the way? Like "1000mm to the heart this way", or maybe "ballsack ahead"?

Your government is lying to you

 

[offroadkarter]

Hey James, I'm curious, do you work for a third party or an OEM for all the medical equipment you service? I have a friend who works for Hologic doing what you do. Considering you're getting trained on cutting edge tech, I figure you must be working for GE or something.

 

[James Snover]

Hey James, I'm curious, do you work for a third party or an OEM for all the medical equipment you service? I have a friend who works for Hologic doing what you do. Considering you're getting trained on cutting edge tech, I figure you must be working for GE or something.

I've done both third party and OEM. I hired on with Siemens, in 2017, and it's been tech-geek x-ray imaging heaven ever since. When I was third party I worked on everything, from general rad rooms and ultrasound, portable C-arms, etc. (Love the OEC 9800's! So easy to work on, and they're such workhorses!)

Siemens hired me, stuck me in the cath lab in a major institution in the Houston Medical Center, and they aren't ever going to let me out, it seems. Yes, they are using the six-axis Kuka robot c-arms (Pheno) in cath labs and OR's, these days.

The other thing they trained me on is a patient monitoring system for real-time vital signs acquisition. It's nowhere near as much fun as the x-ray and the robots. It's just a PC with some funky peripherals, seriously. But if you can't get an EKG, you might as well not even turn the x-ray machine on, in a cath lab or EP lab.

I got my start in xray on Lorad M-IV Platinums. Mammo is insane. It uses soft-xray, for the contrast, and the imaging QC requirements were off the charts tight compared to any other x-ray modality. There are only three types of tissue in the human breast: adipose, glandular and connective. And to most x-ray system above 38KV, they all look the same: like clear glass. But the softer the beam, the higher the contrast, so the M-IV's used 25-28KV techniques and and that provided enough contrast in the breast to provide an image a radiologist can make a diagnostic reading from. The breast had to be compressed though, because soft x-ray does not penetrate to the depths 50KV-150KV can go. Everything in x-ray is a trade off of compromises to get a useable image.

I got out of mammo about the time it went digital, in 2007-ish. That's when I got into the cath labs.

 

[James Snover]

When this thing is navigating your arteries, are there road signs that mark the way? Like "1000mm to the heart this way", or maybe "ballsack ahead"?

Your government is lying to you

Ironically, yes. The x-ray systems I work on have features called subtraction, roadmap, and clearstent.

Subtraction: you take an image. Then you add contrast to the patient's blood, and take the same image again. The software subtracts out everything except what has changed from the first image. This eliminates all the surrounding anatomy of the body, and lets the surgeon see the vasculature in clear relief.

Roadmap: the software then takes the subtracted image, catheters are inserted, and you see only the catheter itself moving in real time, superimposed over the contrast image taken, above.

Clearstent: building on the same principles above, the software illustrates only the position of the stent, as it moves through the vasculature, and is placed with sub-millimeter precision, by the surgeon, exactly where he or she determines it should be.

That's all a pretty basic, vastly over-simplified view.

And they'll shoot 3D images with superior resolution and lower delivered radiation dose compared to dedicated CT machines! But there are still lots of studies where dedicated CT machines excel.

Neat bit of trivia: a few years ago, some clever astronomy types figured out you could use the exact same technique of subtraction, to see changes in otherwise chaotic systems.

 

[wizbangdoodle]

Wow! I had no idea. That is incredible.

Your government is lying to you

 

[dwest731]

I do CT and worked interventional radiology for a few years. The IV suite stuff was mostly fistulagrams and diagnostic angio procedures plus some pain management. I loved doing that kind of stuff! I’ve always used GE equipment myself, with medrad injectors.

Good luck with that new robot!

 

[biminiLX]

I love my OEC 9800 C-arm!
100% interventional pain but I bet the vascular tech is getting good.
In this area (NW Ohio) we had one of the first mobile CT trucks that has a ‘doc in a box’ to rapidly diagnose stroke and brain bleeds.
Are you able to post any pics?
-J

 

[offroadkarter]

I've done both third party and OEM. I hired on with Siemens, in 2017, and it's been tech-geek x-ray imaging heaven ever since. When I was third party I worked on everything, from general rad rooms and ultrasound, portable C-arms, etc. (Love the OEC 9800's! So easy to work on, and they're such workhorses!)

Siemens hired me, stuck me in the cath lab in a major institution in the Houston Medical Center, and they aren't ever going to let me out, it seems. Yes, they are using the six-axis Kuka robot c-arms (Pheno) in cath labs and OR's, these days.

The other thing they trained me on is a patient monitoring system for real-time vital signs acquisition. It's nowhere near as much fun as the x-ray and the robots. It's just a PC with some funky peripherals, seriously. But if you can't get an EKG, you might as well not even turn the x-ray machine on, in a cath lab or EP lab.

I got my start in xray on Lorad M-IV Platinums. Mammo is insane. It uses soft-xray, for the contrast, and the imaging QC requirements were off the charts tight compared to any other x-ray modality. There are only three types of tissue in the human breast: adipose, glandular and connective. And to most x-ray system above 38KV, they all look the same: like clear glass. But the softer the beam, the higher the contrast, so the M-IV's used 25-28KV techniques and and that provided enough contrast in the breast to provide an image a radiologist can make a diagnostic reading from. The breast had to be compressed though, because soft x-ray does not penetrate to the depths 50KV-150KV can go. Everything in x-ray is a trade off of compromises to get a useable image.

I got out of mammo about the time it went digital, in 2007-ish. That's when I got into the cath labs.

Appreciate the response, I sent this thread to my friend and he got a kick out of it and sent me a response for you

When hologic bought Lorad it went digital through conversion of the tray first then they created the Selenia with a digital tray. Selenia went end of life two years ago almost (except for awful Kaiser) and was replaced by dimensions. 3d Tomography was added later. Now they run 20-49kv combo shots for both 2d and 3d images simultaneously. 3d is a stacked image in 1mm slices that can be scrolled through. Can also run cedm (contrast) and do biopsy directly on the machine.

And yes the physicist tolerances are brutal compared to what I dealt with on ct and petct.

 

[kazman]

I used a sewing needle to get a splinter out of my finger yesterday...

 

[James Snover]

I do CT and worked interventional radiology for a few years. The IV suite stuff was mostly fistulagrams and diagnostic angio procedures plus some pain management. I loved doing that kind of stuff! I’ve always used GE equipment myself, with medrad injectors.

Good luck with that new robot!

I've worked on Medrad injectors, tons of them, before I went full time to Siemens. Super tough, reliable equipment.

The first injector I worked on was for a CT machine, the saline/contrast type. I was just back from training on it. I get it all rebuilt, tested, calibration checked, put it back in the room. The tech asks if I want to hang out and observe it in action, and I said, yeah, sure.

They get the patient on the table. Do the scout scan, everything ok. Set him up for the injection scan, and as soon as the injector starts, the patient starts screaming like they are being slowly murdered. I'm standing there, having a heart attack, thinking, "Oh my God, I did something wrong! I've just killed this guy!" It was the worst moment of my entire life. The tech looks back at me, and says, "Jim! It's ok! This guy always reacts like this! He's fine! Sorry I didn't think to warn you."

Excuse me while I go find a defibrillator and get my heart re-started!

 

[James Snover]

Appreciate the response, I sent this thread to my friend and he got a kick out of it and sent me a response for you

I've read about how Hologic has been doing all kinds of research to harden the beam in mammo by using alternate materials for the anodes. That's great, if it's in use!

X-ray is usually defined as "soft," 0-39KV, and "hard, "40KV-150KV, typically, for medical. Ironically, soft xray is worse for you than hard x-ray. Becasue it can't make it's way through the body like hard xray, so much more of the dose used to make the image is absorbed by the body. But for ages, soft xray was the only way to get a useful image from the human breast.

So anything they can do to harden the beam means less absorbed dose to the patient. And maybe they can finally get rid of compression!

 

[James Snover]

I love my OEC 9800 C-arm!
100% interventional pain but I bet the vascular tech is getting good.
In this area (NW Ohio) we had one of the first mobile CT trucks that has a ‘doc in a box’ to rapidly diagnose stroke and brain bleeds.
Are you able to post any pics?
-J

That I can't do. Legal reasons. But you can find them on Youtube. Look for "Siemens Pheno," and "Siemens Artis Q," and "Corindus GRX."