About Skeleton Crew

Skeleton Crew is the show for current and prospective techs in radiography and related modalities, exploring career options, life as a practicing tech, and the future of the practice. Each week, host Jen Callahan, ARRT interviews practicing rad techs, educators, business and industry leaders who are shaping radiology now and in the future.

Episode Transcript

[00:00:04] Jennifer Callahan (JC)

Welcome to the Skeleton Crew. I’m your host, Jen Callahan, a technologist with ten plus years experience. In each episode, we will explore the fast paced, ever changing suburbs. Completely crazy field of radiology. We will speak to technologists from all different modalities about their careers and education. The educators and leaders who are shaping the field today and the business executives whose innovations are paving the future of radiology. This episode is brought to you by X-ray technician Schools.com. If you’re considering a career in X-ray, visit X-ray technician Schools.com To explore schools and to get honest information on career paths, salaries and degree options. We’re here today with our long time friend and colleague, Ashley Marciano. She worked with me previously at a hospital in x ray. And then from there, she transitioned into interventional radiology as a technologist and has been working at Riddle Hospital for the past few years. Today, she’s joining us to talk about what an interventional radiology technologist does, how she came to that point in her career. And we’re going to cover what she does for her job. If she knew then what she knows now, would she choose to do anything differently? And then in part three, we’ll wrap things up just by asking her some fun questions about herself and what she thinks about the path that she chose. So welcome, Ashley. Thank you so much for being here with me.

[00:01:37] Ashley Marciano (AM)

It’s such an honor.

[00:01:38] JC

So, Ash, if you could just give our listeners here like maybe like a one minute synopsis of what an AR tech does.

[00:01:48] AM

Okay. So an AR tech is meant to be the assistant to the doctor doing the procedure. It’s kind of what we call a first scrub to the doctor. When we say scrub, that means us getting our sterile gown and gloves on, our mask on and helping them with the procedure by handing them the tools that they need to do that procedure. Basically, it is our job to try to know what their next step is so that we can kind of work like a well-oiled machine together. You know, typically that’s like learning on the job. You know, you typically get cross- trained into that, so you start to learn all the different procedures like line placements and ports and drains and internal bleeding to stop that. So you’re basically just there to help the doctor with the case in terms of making sure that they have the proper equipment. You know, sometimes you’re like holding pressure for them or you’re getting everything ready for them that they need for the case. So that’s basically what you do as a scrub tech.

[00:02:54] JC

And just to back up for a second, for people who might not know, interventional radiology is used for a less invasive way to do things with inside the body. Patients are usually awake during these procedures.

[00:03:07] AM

They are given conscious sedation, which is sometimes they’ll consider it like Twilight, where they give you like a pain meds and sedation. Right?

But just so that they’re like relaxed enough that they’re not going to.

Be like, that’s so they can’t feel any pain. They kind of relax. A lot of people do end up falling asleep, but it’s not general anesthesia where that is a tube down the throat and you’re giving Propofol for that.

And so they’re using x ray in these procedures to guide them through the body without having to open the body up to do things like place like a port for chemo.

Or a place, as you were saying, like a line into one of like the veins or arteries to administer like medication or something just for people who might not know.

It’s definitely a like another world that people don’t really know too much about. I think when people hear like, surgeries or procedures, they just think it’s the same thing where it’s like a basic like you’re given anesthesia and you’re getting cut open. You know what I mean? In this case, we don’t like to cut people open. So yeah, it’s just another route to take versus doing something very invasive, which is to actually cut somebody and get in there.

[00:04:21] JC

So since you and I have worked like initially with each other excuse me, as you and I were in x ray with each other and when I was leaving and you were kind of leaving at the same time because you were going to be transitioning into at like another hospital. So since you and I have worked with each other since, jeez, 2016, so crazy, so long. I know. Can you tell me like, have like, where have you gone? Like, so we were at Brandywine with each other and since then I’m pretty sure you’ve gone to two different hospitals doing right?

[00:04:51] AM

Yeah. So after Brandywine Hospital, I stayed. Well, I was also with Hahnemann Hospital and I was there for a very long time, like I think at least a decade or something like that. That’s where I started my cross training in Er. I got very lucky at that time. I was not typically keen on cross training people, even though technically that was the way to get in. But a lot of people who had started in there got it right from x ray graduation. So you have to be an x ray tech first before you can work in interventional radiology, which I was. There just happened to be an opportunity where they said we are willing to cross train. And I jumped at the opportunity because I did a rotation during my x ray school program and I really found it very interesting. And then with my experience from Hahnemann, I got a job. Riddle Hospital Mainline Health system. In Butler County and did air there as well. Still do. So now I’m solely doing interventional radiology at Riddle Hospital.

[00:05:58] JC

So what was it about E.R. that attracted you? Like you said, doing the rotation, like through X-ray school. What was it about that drew you in?

[00:06:07] AM

I think what drew me into it was in interventional radiology procedures. You use a donated contrast that people know from, like if they had a Cat scan and it went through their IV or something like that. It’s the same thing that we use in interventional radiology, and it basically lights up either your arteries or your veins or your organs. And I thought that that was just so fascinating that you could see with just a quick picture what was going on in a person’s body, good or bad, and the way that they use that technology and the contrast to fix the issues in that problem minimally like invasively, that just impressed me. And I was like, I would love that, you know, just learning. So many things about the body because all the systems in our body are all connected and that job makes everything come together in one picture. And that just fascinated me. It’s incredible. And I’m still learning things today. I mean, there’s still things that I’ll see in a body in terms of maybe like a past surgery that they had and the whatever is in there, like a certain kind of stent or what have you. And I’ll be like, What is that? And they’ll be like, Oh, that’s this kind of stuff. And I’m like, What? I’m like, It’s mind blowing. Like to know that they had they have these resources and, you know, medicine obviously has just become so advanced. So it’s just you’re learning all the time.

[00:07:29] JC

So since you transitioned into I.R. and you’ve been now working in the field for like probably close to seven years, x ray were required at this point to, you know, you have to sit for your registry after you’ve graduated from a program that offers you an associate’s degree at this point. As far as it goes for I.R., are you required to sit for like an additional certification? Is it required, I guess, like maybe or is it like hospital based, you know, based by base, I should say.

[00:08:00] AM

So this is actually very tricky because according to the art, they had actually told me that it is hospital based, that it is not a state law, at least in the state of PA to be certified. However, there are interventional radiology boards that you can take that you can study for. Obviously, it’s better if you’re working in the field on because you do have to have a certain amount of procedures done and proven and signed off before you take your boards. But no, it is not required, at least in the state of PA, so you can take it yourself, which I haven’t yet and I would like to and I’ve been in and out of studying for it, but it’s so much information, it’s so hard. And if you don’t do certain procedures all the time, it’s hard to remember everything about it. But it is a goal of mine to do.

[00:08:55] JC

Did you have to take the ten year research certificate?

[00:08:59] AM

Did it last year. Right.

So the tough thing is this.

Like if it’s not required by your hospital for you to have the additional registry.

I.r., because if you took it now in ten years, you’re going to have to redo your x ray. And then also to the I.R.. Yeah, if you’re listening currently and you’re a prospective student and you think that this might be something that you’re interested in, listen up. Or if you are currently working in x ray or another modality and you also do think that you might be interested in transferring or looking into I.R. as another career path for you, listen up as well. So Ash, if you could like walk me through like an average day of what your department looks like, you know, like you coming in and then to the end of the day.

[00:09:49] JC

Like, what’s your day look like?

[00:09:50] AM

So basically when you come into work, you’re looking at your cases for the day. So the procedures that are on the agenda, you go ahead and you look at the procedures for the patient’s chart, you’ll look in the patient’s chart to see what they’re having done and why they’re having done. Typically in a interventional radiology lab, there is a charge person who it could either be a tech or a nurse who basically is running the day saying, we’re going to be doing this case today, or I got to talk to the doctor about this, see if he wants to do this case and so forth. So typically, you go to that person sometimes just to see what kind of the day is going to be like in general. When it gets to the point where they’re like, okay, these are your cases. You look at your cases, for example, say like someone’s getting a port, a cath, a port for chemotherapy, and you want to look up what kind of cancer they have because then that alters where you’re going to be putting the port, whether it be on the right or the left side. So, for example, if I’m getting ready to get this port on the table, I want to know, typically they like to put lines, any type of line placement on the right hand side because it’s a shorter route, if you will, from the all the way to the the junction of your right atrium.

If they have right breast cancer, I would not want to put the port there because typically they would want to do radiation in that area. And so you would want to put the port on the left hand side. So that’s very important when you are looking at a port and seeing, okay, well, what kind of cancer is it? Am I going to be setting it up on the proper side? So when I’m getting ready for that port, I scrub. Now I’m when I say scrub, I mean, you’re doing the surgical scrub, you’re going to the sink outside the lab. You’re scrubbing, you know, for at least two minutes and there’s a surgical scrub and it’s got a sponge. And then it’s got things like bristles for under your nails. You do that for about two minutes and then you go into the into the lab without touching the doors. So you kind of back in like if you’ve ever watched E.R. or maybe some people watch Grey’s Anatomy. I don’t know. I’m aging myself here, but, you know, you’re back into the doorway. Then you go ahead and you dry your hands with a sterile towel that is there and there’s sterile gown and gloves.

You put all that on, there is somebody else in the room to help you tie up because anything behind you is considered non-sterile. So after that, you’re going to go ahead and set up your tray with all the proper tools there. Okay. Obviously, before I mean, I’ll backtrack a second before I scrub in, after I figure out what the case is and what I’m doing, I will grab the supplies in the lab to see to to have ready so that I can just dump on my tray and then get ready to do get ready to set it up At that point, since I’m scrub now, I’ve got my sterile gown and gloves on now. I set the tray up. Then after all that’s done, I cover my tray up with the sterile cover and I wait for the patient to come in the room. When the patient comes in the room with the nurse, you know, we get the patient on the table, we hook them up to the vitals, such as like EKGs, pulse, ox oxygen. Always going to give oxygen. Obviously, when you’re planning to do conscious sedation for the main reason of sedation because it can suppress your breathing. After we get the patient all set up, I go ahead. I scrub again at the sink, I scrub again, and then I walk back in without my hands touching the door, put my sterile gown and gloves on.

I prep the patient with a sterile prep stick like chlorhexidine prep stick. After I’m done prepping the patient and my tray is ready, we call the doctor in. Okay? And then the doctor comes in and we do what’s called we call it a safety check, a time out, basically stating what we’re doing today, who the patient is, make sure all of our ducks in a row. And before we sedate the patient, we make sure the patient tells us their name and their date of birth and so forth. At that point, then we get started to do the procedure, which then I will first assist, first scrub the doctor. So I will be giving him the lidocaine, I’ll be giving him the scalpel. I’ll be giving him everything that he needs to finish the procedure. So basically that is what you do from start to finish. So you figure out what your cases are, what cases you’re going to be doing, and you look up the history on the patient, figure out what supplies you need moving forward. Obviously, every doctor is different. They all like different supplies. So it’s going to totally depend on where you’re working. Each lab is run differently. That’s pretty much what your day is like as an interventional technologist.

[00:14:46] JC

So since you’ve been in this department, I mean, besides like the actual like equipment that is used x ray wise also to use ultrasound to view the different arteries or veins, sometimes even different body parts that you’ll use, ultrasound or guided access. Looking at those two computer based equipment, do you feel like in the seven or so years that you’ve transitioned into, have you seen like, advancements?

[00:15:13] AM

I have seen advancements, yes. I have worked with older equipment and newer equipment. The advancements that I have seen is that they have just made the screens bigger for doctors to see. They have made different like kind of features. So, for example. Well, when we’re doing like an internal bleed and there’s you know, your body is just full of vessels, especially when it comes to organs and such. There’s a really easy feature. It’s kind of like a roadmap. And I’ve seen the old school roadmap where it’s like you got a fluoro and then inject contrast and then your roadmap comes up. Now it’s like you can you can do that, but then it can take away like the it can take away the roadmap and put it back on. And I’ll kind of explain to you what I mean. So when you step on the fluoro and you inject contrast. The computer will make a road map that looks like the vessel, but it’s like the color white in the contrast of like, gray. And. Back when I was working at Hahnemann, one of the machines that they had. Any time you wanted to take the roadmap off, meaning you were like, Well, I don’t want to see just the white anymore.

Like, I want to see the whole picture. If you wanted a roadmap again, you had to step on the pedal again and inject. Whereas the one that we use today, you don’t have to keep injecting. You can just with like the touch of like the joystick on the controllers, you can actually take the white away and bring it back so that they don’t have to continue to give the patient contrast, because ultimately contrast can be toxic, toxic to the kidneys. So it was like Siemens, way of which probably Philips has the same thing. But I work primarily with Siemens as just a way of them saying, Hey, you don’t have to give the patient so much contrast. You can just have this feature and you can have the white of the roadmap or you can take it away. All in the same at the same time. So that I thought was very cool because, you know, once again, it’s patient safety ultimately. So it’s really nice to have that feature, right?

[00:17:38] JC

So you’re not like reinventing with more contrast and you’re not like reradiating just to get.

[00:17:43] AM

Exactly. Exactly. It makes a huge difference.

[00:17:47] JC

All right. So real quick, what’s your favorite procedure to do in IRR?

[00:17:53] AM

I think I’d like to do the Y 90, which is a type of chemo treatment that you give directly to the tumor in somebody’s liver. You basically see the tumor like light up with the contrast and and then, you know, you give like the medicine through that. And just that whole process is like, you know, you give the chemo through it. I think like just seeing. Right the eyes, right, Like right in front of you, just like seeing that there’s medicine going to this tumor to help shrink it. And it’s not exactly a cure for the patient, but it just helps them feel more comfortable and you just feel like better about it.

[00:18:27] JC

So you can do or x ray for this question. But what is probably one of the weirdest or craziest things that’s happened to you in your radiology career?

[00:18:37] AM

So there was a patient in the E.R. at Hahnemann. I had on this Reebok hoodie and there was a patient in the hallway who was being very difficult and not very compliant and just being very rude. And, you know, obviously the staff is there just trying to work their best with this guy. And he had like this nasty cut. And I think they were just trying to get it like clean and and, you know, so that it didn’t get infected or whatever. And I said to the guy, well, geez, I’m like, I hope they fix your leg so it doesn’t fall off or whatever. And he said, Screw you and your stupid shirt. And I just started laughing because.

And to this day, I always look back at that with with a laugh because I’m just like, yeah, it’s, you know, city folk It was the best, you know. And and they were you he said something else but you know to me.

[00:19:44] JC

But that’s it though. I mean like I have to say, it’s one of the reasons why like, I love this field, like because you get people and like their truest rawest moments. It half the time that you meet someone out in public, you know, they’re probably like that to say like you’re always on your P’s and Q’s. But, but he’s just like, Dude, I’m in pain. And if you had to do it all over again, do you think you would choose the path that you’ve chosen, like radiology x ray?

[00:20:08] AM

Yeah. So I’m definitely glad I chose what I chose. And and the funny story is I really wanted to get into ultrasound, and this is why it’s amazing. Like I’m allowed out of my house without supervision. But like, when I signed up for the Drexel program, I thought it was an ultrasound and an x ray program. I’m I’m out of control. So when I found out that it was just x ray, I stuck with it. And like, I’m glad I did because had I not, I would have not had the experience that I have today and the wonderful opportunities and gotten to meet the most awesome people in the world. So I definitely. I’m very lucky that I decided to stay in a program I didn’t even know I was in.

[00:20:59] JC

Ash, thank you so much for being with me. Dude, I really appreciate it that you took your your life to reconnect with me and to have this conversation. Oh, of course. You’ve been listening to the skeleton crew brought to you by X-ray technician Schools.com. Join us on the next episode to explore the present and the future of the rad tech career and the field of radiology.