A TECHNICAL REPORT

ON

STUDENT INDUSTRIAL WORK EXPERIENCE SCHEME (SIWES)

UNDERTAKEN AT
LAGOS UNIVERSITY TEACHING HOSPITAL (LUTH),
IDI-ARABA,
SURULERE, LAGOS.

BY

EKOISO EFFIONG ANIEFON

MATRIC NUMBER: 170707502

DEPARTMENT OF RADIOGRAPHY AND RADIOLOGICAL SCIENCES,

FACULTY OF CLINICAL SCIENCE, UNIVERSITY OF LAGOS
FROM
MAY 2021 TO OCTOBER 2021
 DEDICATION

This report is dedicated to my beloved parents Mr and Mrs Effiong Ekoiso for their
unconditional love and support in my life.

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 ACKNOWLEDGEMENT
I wish to register my profound gratitude to God Almighty for the guidance and grace
throughout my life.
I’m grateful to the entire staff of the department of radiodiagnosis Lagos University
Teaching Hospital (LUTH) for making my industrial training interesting, educative and
worthwhile.
Special gratitude goes to the HOD radiodiagnosis department, Lagos University Teaching
Hospital (LUTH), Dr O. Soyebi, deputy directors of radiography, Mr. Olaleye Abioye,
Mr. Olalekan, for their constant care and tutorship. The chief radiographers, Mrs.
Ibrahim, Mrs. Kalejaiye and Miss Utitofon for their warmth, affection and patience in
teaching me, the radiographers, Mrs. Nkem and Mr. Nifemi and the intern radiographers
who assisted my learning during this programme.
My regards to my amazing parent and siblings for the constant moral and financial
support. I love you all.

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 ABSTRACT
The Student Industrial Work Experience Scheme established by the Federal Government
of Nigeria was aimed at exposing students of higher institution to acquire industrial skill
and practical experience in their approved courses of study and also to prepare the
students for the industrial work situation which there are likely to meet after graduation.
The technical report is based on the experiences gained during my six months of
industrial training at the Lagos University Teaching Hospital, Idiaraba, Lagos state.

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 TABLE OF CONTENT
Title page………………………………………………………………… 1
Dedication………………………………………………………………… 2
Acknowledgment………………………………………………………… 3
Abstract…………………………………………………………………… 4
Table of content…………………………………………………………… 5

CHAPTER ONE: INTRODUCTION

1.1 About SIWES 6
1.2 Aims and objective of SIWES 6
1.3 Brief history of the radiodiagnosis department in LUTH 7
1.4 Organogram Of Lagos University Teaching Hospital (Luth),
Radiodiagnosis Unit 8
1.5 Orientation programme 9

CHAPTER TWO: CONVENTIONAL RADIOGRAPHY 14

CHAPTER THREE; FLUOROSCOPY UNIT 22
CHAPTER FOUR: COMPUTED TOMOGRAPHY UNIT 25
CHAPTER FIVE; MRI UNIT 31
CHAPTER SIX: CONCLUSION 34

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 CHAPTER ONE: INTRODUCTION

1.1 ABOUT SIWES

The students industrial work experience scheme (SIWES) is a skills training

programme designed to expose and prepare students of Universities,
Polytechnics/Colleges of Technology/Colleges of Agriculture and Colleges of
Education for the industrial work situation they are likely to meet after graduation.
The scheme also affords students the opportunity of familiarizing and exposing
themselves to the needed experience in handling equipment and machinery that are
usually not available in their institutions. It is a cooperative industrial internship
program that involves institutions of higher learning, industries, the Federal
Government of Nigeria, Industrial Training Fund (ITF), and Nigerian Universities
Commission (NUC).
The student industrial work experience scheme (SIWES) was established as a result
of the realization by the Federal Government of Nigeria in 1973 of the need to
introduce a new dimension to the quality and standard of education obtained in the
country in order to achieve the much-needed technological advancement. The scheme
was solely funded by Industrial Training Fund (ITF) during its formative years. But
due to the increased rate of financial involvement, it was withdrawn from the scheme
in 1978. In 1979, the Federal Government handed the scheme to both the National
University Commission (NUC) and National Board for Technical Education (NBTE).
In November 1984, the government changed the management and implementation of
SIWES fund to ITF. It was effectively taken over by ITF, in July 1985, with the
funding being solely bear by the Federal Government. The Federal Government, ITF,
the supervising agencies – NUC, NBTE, NCE (National Commission for Colleges of
Education), Employers of Labour, and the Institutions each contribute one quarter in
the management of SIWES.

1.2 AIMS AND OBJECTIVES OF SIWES

(i)  Provide avenues for students to acquire industrial skills and experience during
their course of study.
(ii) Prepare students for industrial work situation they are likely to meet after
graduation.
(iii) Expose students to work methods and techniques in handling equipment and
machineries that may not be available in the university;
(iv) Provide students with the opportunities to apply their educational knowledge in
real work situations, thereby bridging the gap between theory and practice.

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 (v) To make the transition from the schooling to world of work easier through
enhancing students’ contact for later job placement.

Roles of the Federal Government

1. Make adequate funds available to the Federal Ministry of Commerce and Industry
to fund the scheme.

2. Make it mandatory for all Ministries, companies and government parastatals, to

offer attachment places to students.

3. Make it a policy to include a clause in every major contract lasting over six to nine
months being awarded for contractors to take students on attachment.

Roles of the Industrial Training Fund (ITF)

1. Provide logistic materials needed to administer the scheme.

2. Compile lists of employers and available training places for industrial attachment
and forward such lists to the coordinating/ regulatory agencies (NUC, NBTE, and
NCCE)

3. Organize biennial SIWES national conferences and SIWES review meetings.

4. Provide insurance cover for students on SIWES attachment.

5. Disburse supervisory and student allowances.

Roles of the supervising agency/regulatory body (NUC)

1. Establish SIWES coordinating units.

2. Appoint full-time industrial coordinators to operate the scheme at Agency level.

3. Evolve a minimum national guide programme for supervised industrial attachment

activities for approved SIWES courses.

Roles of the Institution.

1. Organize orientation courses in collaboration with ITF.

2. Assess students’ performance and award grades accordingly.

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3. Supervises students on attachment and sign their logbooks. A minimum of two
visits should be made to the students by the Institution’s supervisor during the
attachment.

4. Establishing SIWES coordinating units and appoint department/Faculty SIWES

coordinators within the institutions.

5. Prepare and submit master and placement lists to the respective coordinating
agency and ITF.

6. Submit comprehensive reports on the Scheme to the ITF after the programme.

Roles of the students

1. Be regular and punctual at respective places of attachment.

2. Comply with employers’ rules and regulations.

3. Keep proper records of attachment activities and other assignments in the logbook.

4. Submit to ITF through their institution the evaluation Report Form 8 duly
completed by the students, employers and the institution.

5. Submit to ITF through their employer placement form SPE-1.

Roles of the Employers

1. Accept students and allow them access facilities relevant to the job training.

2. Attach experienced staff to students for effective exposure and supervision.

Supervisors should not handle more than ten students at a time.

3. Control and discipline students like permanent staff.

4. Grade students, as provided in the Assessment form and the ITF form 8 at the end
of the programme and submit same to the institutions.

5. Permit representatives of ITF and institution Based supervisors to visit the

students on attachment.

1.3 BRIEF HISTORY OF THE RADIODIAGNOSIS DEPARTMENT IN

LUTH

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The Department of radiology is made up of 4 main units, namely Radiation Biology,
Radiotherapy, Radiodiagnosis and Radiography. The combined two units of Radiation
Biology and Radiation Therapy and the unit of Radiodiagnosis which formerly
constituted separate Departments were merged into one department in December
1997.  The Radiography unit was incorporated into the department during the
2005/2006 academic session with the commencement of the 5-year BSc. Radiography
programme of the University of Lagos was incorporated into the department during
the 2005/2006 academic session with the commencement of the 5-year BSc.
Radiography programme of the University of Lagos.
The Radiodiagnosis unit of the department has been a service department to all the
clinical departments of the Lagos University Teaching Hospital since the inception of
the University in 1962.  It also serves other secondary and tertiary teaching hospitals
as well as private clinics and hospital in the south west region of the country.  It has
facilities for conventional general and special radiographic investigations and
ultrasound examinations.  Other modern equipment acquired through the Vamed
project included digital mammographic machines, mobile machine for ward
examinations and a spiral GE Computerized Tomography machine. Magnetic
resonance imaging (MRI) machine is also available through public-private-
partnership (PPP) initiative arrangement.  Availability of these facilities has thus
raised the status of the radio diagnostic unit to international standard.
The Radiography unit of the department was established in the University of Lagos in
2004 following the assimilation, by the University, of the former Federal School
Radiography, Yaba into the College of Medicine for the purpose of running a 5-year
B.Sc program in Radiography.  The programme is currently at 500 level of training. 

1.4 ORGANOGRAM OF LAGOS UNIVERSITY TEACHING

HOSPITAL (LUTH), RADIODIAGNOSIS UNIT.

CHIEF MEDICAL DIRECTOR

MANAGER

ASSISTANT MANAGER

HEADS OF DEPARTMENT

RADIOLOGY 9 ACCOUNTING AUXILLARY

DEPARTMENT DEPARTMENT WORKERS
 STUDENTS

1.5 ORIENTATION PROGRAMME

On my arrival at the Radiodiagnosis department of Lagos university teaching hospital

Idi-araba, Surulere Lagos on the 18th day of May 2021, I handed over my acceptance
letter for SIWES from the Director of Administrative to the Assistant Director of
Radiography in the person of Mr. Peter Odedayo. He took me to one of the interns to
take me round the department and show me the infrastructures and units in the
department. These include
1) The reception with a spacious patient waiting area
2) Two conventional Xray units, a ceiling mounted and floor mounted
3) Computed tomography (CT) suite
4) Ultrasound unit
5) Magnetic resonance imaging (MRI) suit
6) Fluoroscopy unit
7) Mammography unit

1.6 STAFF PROTECTION

1. Personal monitoring badges should be issued every week.

2. Workers should wear personal monitoring device (dose meters) at all times while
working in controlled areas.
3. When wearing a lead apron, badges should be worn underneath the apron (or as
indicated).
4. The radiation protection officer (RPO) should inform the staff of radiation monitoring
results. This should be posted on the staff notice board if available.

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1.7 MAINTENANCE AND SAFETY MEASURES IN USING THE
RADIOLOGICAL EQUIPMENT

I was told by the Head of Department and Chief Radiographers that the equipment was
maintained by service engineers. They then told me the various safety/precautionary
measures I should adhere to, which include:

• Do not operate any equipment which you are not fully aware of except a
radiographer is there with you. .

• Do not operate the machine with wet hands to avoid electrocution.

• Adhere strictly to the warning notes on the walls of the different imaging
suites.

• Remember your Radiation protection measures As low As Reasonably

Achievable (ALARA) and avoid repetition of exposure to reduce absorbed
dose.

• Remember your patient care techniques; also maintain your patient’s

privacy.

• Remember that there is division of labour in each unit but be inquisitive.

• Always ask women of child bearing age if they think they might be
pregnant, and ensure that the examination is justified.

• Don’t keep an old patient standing for too long for an examination.

• Give new changing gown to paediatric patients, because they have a

delicate immunity.

• Radiographers are to use their film badges when working in the controlled
area.

• Remember to wear hand gloves when handling patients and washing of

hands in between patients.

• Use of face mask when handling patients with contagious diseases like
Tuberculosis. Patient should be well positioned and the radiation beam
should be collimated to the area of interest.

• For an unconscious or unstable patient, the relative should be provided with

lead apron during the examination.
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 • Stay behind lead cubicle (lead glass) during radiation exposure.

• To remember my patient’s care procedure and to be careful while attending

to RVD (retroviral disease) patients

1.8 PROTECTION AND SAFETY MEASURES TO THE PATIENTS AND

PUBLIC

 Lead apron and gonad shield are used to protect radiosensitive organs such as the
gonads especially in males and premenopausal females.

 Infants and children presenting for examination of the hip have the first series
without any protection and all progress examination with shielding.

 Any unnecessary person accompanying the patient is not allowed to be in the

room during an examination.

 Persons (staff or helper/comforter) aiding examination should wear a lead apron

and avoid the primary beam.

 Parent whose children require assistance during examination should be

encouraged to assist. They are given a lead apron and instructed clearly.

 The application of ALARA principle by the radiation worker is of great

importance in reducing occupational exposure dose.

1.9 PROTECTION AND SAFETY MEASURES TO VISITORS

1. Staffs other than x-ray departmental staff and service engineers do not enter the
controlled area without the knowledge of a member of department staff.

2. Visitors do not enter the controlled area when the warning lights outside the door
are illuminated.

3. The entrance of the X-ray room is always closed.

4. X-ray room doors are always close during radiography and no one must enter
when the red warning ‘Do not enter’ lights are illuminated.

5. X-ray beam must not be directed at the door or to the control panel.

6. Exposure factors and field sizes used should always be the minimum compatible
with purpose of the exercise.

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1.10 SAFETY MEASURES IN CASE OF PREGNANCY

Female patients of the reproductive age are asked if they are pregnant. If yes, the patient
is referred to the referring clinician to know if the examination should proceed, otherwise
an alternative examination that does not involve the use of ionizing radiation is done. If
no, then care is implored when performing a radiological examination which involves
irradiating the lower abdominal and pelvic organs of women of reproductive capacity to
make sure the radiation dose is as low as practicable.

Finally, my senior Radiographers explained the departmental protocol for attending to a

patient to me which is as follows:

1. Each Patient with his/her request form for the examination is taken to the
Customer Services first to inquire about the price.

2. The patient or relative goes to make payments at the Cash Department after which
an “FMRN Number” is written on the form with the receipt attached to it.

3. Patient or the relative after payment, presents the request form to the Receptionist
at the CS and the forms are sent to their relevant units

4. The Radiographer calls the patients in for their examination according to their full
names on their forms, however, emergency cases are attended to as they come in.

5. The Radiographer then detach the receipt & give to the patient or the relative as
the evidence of payment to collect their results.

6. Patients are told to come after 2-4 hours for their results in a typed document, a
film and an image burned into a Compact disc is also given to them depending on
what Examination was carried out

1.11 SAFETY PROCEDURES IN THE DEPARTMENT

The Department of Radiology, LUTH adheres strictly to all radiation safety rules and
regulations. The following methods are used:

i) The conventional unit is properly lead lined.

ii) Radiation warning lights and signs are mounted at strategic places.

iii) Use of lead apron by patient and staff when necessary.

iv) Strict observance of restricted areas.

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 v) The use of ALARA principle which states that radiation dose should be given
‘as low as reasonably achievable’, to get a radio-diagnostic image.

vi) Collimate to the area of interest to avoid irradiating the patient unnecessarily

CHAPTER TWO: CONVENTIONAL RADIOGRAPHY

2.1 INTRO TO THE XRAY UNIT

The radiodiagnosis department in luth has two units dedicated to conventional
radiography. Both units use the digital x-ray machines. However, one is floor mounted
(fig.2.0) and the other is ceiling mounted (fig.2.1). Each unit has two changing rooms and
a control station
Conventional radiography involves the use of x-rays; the term “plain x-rays” is
sometimes used to distinguish x-rays used alone from x-rays combined with other
techniques (e.g., CT).
For conventional radiography, an x-ray beam is generated and passed through a patient to
a piece of film or a radiation detector, producing an image. Different soft tissues attenuate
x-ray photons differently, depending on tissue density; the denser the tissue, the whiter
(more radiopaque) the image. The range of densities, from most to least dense, is
represented by metal (white, or radiopaque), bone cortex (less white), muscle and fluid
(gray), fat (darker gray), and air or gas (black, or radiolucent).

2.2 PRINCIPLE OF DIGITAL RADIOGRAPHY

Digital radiography (DR) is an advanced form of x-ray inspection which produces a
digital radiographic image instantly on a computer. This technique uses x-ray sensitive
plates to capture data during object examination, which is immediately transferred to a
computer without the use of an intermediate cassette. The older Computed Radiography
unit uses cassette-based phosphor storage plates (PSP) to capture images, which are then
scanned by the computerized system into a digital format for image processing,
archiving, and presentation. However, with DR, the whole procedure is digitized from X-
ray detection onward.

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Figure 2.0 floor mounted digital x- machine ray Figure2.1 ceiling mounted

2.3 DESCRIPTION OF THE GENERAL UNIT

The conventional x-ray unit in LUTH is made up of two large rooms housing the
machine with three compartments which are;

 Diagnostic Rooms

 Control Room

 Changing Rooms

The diagnostic rooms house floor and ceiling mounted x-ray machine and also in the
rooms are; vertical Bucky, x-ray couch, foam pads, sandbags, pillows etc. This is where
the positioning and examinations of patients take place. To prevent exposure to the
operator and to prevent the unnecessary leakage of x-ray radiation to the rest of the
facility where x rays are performed, the x-ray unit is enclosed in a room that has walls
made of, or reinforced with, a dense material (lead) that absorbs any x rays that are
scattered during the x-ray process.

Additionally, in the control room, the operator of an x-ray unit turns the x-ray equipment
on and off from behind a protective wall that is lined with lead. Lead is extremely dense
to x rays and even a one-quarter inch thickness of lead will prevent all x rays emitted
from current x-ray machines from being able to pass. A lead-impregnated apron is also
provided to the relative (if their presence in the room is needed) or patients while they are
being x-rayed to prevent unwanted exposure of their bodies to x rays

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The changing room is a small compartment in diagnostic rooms, where the patient can
comfortably change into the hospital gown, and also serve as a safe to keep his/her
personal belonging during the period of his/her stay in the x-ray room.

2.4 PRINCIPLE OF XRAY PRODUCTION

Visible light is electromagnetic energy that has characteristics that allow it to be seen by
humans. There are many other familiar forms of electromagnetic energy that are not
visible to humans. These include radio waves, which permit the transmission of radio
signals and the operation of cellular phones; microwaves, which are often used to heat
food; and x rays. Each of these forms of light has a characteristic size (wavelength) and
speed (frequency) range that defines it. An x-ray beam is an invisible form of light that
has a wavelength that is much smaller than visible light and a frequency that is much
faster than visible light.

There are two processes by which these x-rays are produced;

1. Bremsstrahlung Process (continuous energy spectrum)
2. Characteristics Process (discrete energy spectrum)

Bremsstrahlung Process: These are x-rays that are produced by conversion of the
incident electron into electromagnetic radiation. X-Rays are formed in this process when
the negatively charged electrode (cathode), produces electrons by thermionic emission
which are attracted to the positively charged electrode (anode), by gaining kinetic energy.
The nucleus of the target (positive charge) attracts an incident electron, and thus
deceleration of an incident electron occurs in the proximity of the target nucleus then
conversion of kinetic energy of electron to electromagnetic radiation thus radiation is
produced.

Characteristics Process: Characteristics x-rays are produced when the kinetic energy of
the incident electron exceeds that of the target atoms binding energy, thus causing a
collision interaction to eject the bound electron and ionize the atom. The unfilled inner
shells are energetically unstable, and then an outer shell electron with lesser binding
energy fills the inner shell vacancy. As the electron transitions to a lower energy state
occurs, the excess electron energy is released as characteristics x-rays.

2.5 INTERACTION OF THE X-RAY BEAM WITH THE PATIENT

When visible light from a flash bulb strikes the skin of a human arm, that light is
reflected back to the lens of the camera to which the flash bulb is attached, producing an
image of a human arm on the film within the camera. Because x rays travel much faster
than visible light, and because they have a much smaller wavelength, they have more

16
"penetrating power" than visible light. This means that when x rays strike the same
human arm, they are not stopped (reflected) by the skin and soft tissues. Instead, these x
rays continue to travel through the skin and soft tissues until they meet a relatively dense
material, such as bone. It is the "penetrating power" of light in the x-ray range that allows
an x-ray image to "see inside" the human body.
An x-ray beam passes through sparse materials and only interacts with (becomes
reflected by) dense materials. For this reason, x rays are most often thought of as being
useful for the observance of dense tissues, such as bone. But, because an x-ray bulb is
tunable in that only x rays with the exact wavelength and frequency characteristics
desired for the production of the radiograph are allowed to contact the patient, what is
"sparse" and what is "dense" can often be defined by the particular type of x ray used. For
instance, x-ray imaging of the breast (mammography) does not rely on a very large
discrepancy in densities between the tissues being imaged and the tissues being ignored.
The breast is largely composed of fat tissue and vessels of the circulatory and lymphatic
systems, which are relatively dense when compared to skin and other non-fatty tissues. It
is possible to tune an x ray to image the fatty tissues, blood vessels and lymphatic vessels
of the breast in preference to the non-fatty tissues of the breast. Also, because abnormal
growths (tumors) in the breast are denser than the typical breast tissue, radiographic
mammography is an excellent diagnostic tool for the discovery of such breast
abnormalities.
Often it is desirable to selectively image certain structures that are not sufficiently denser
than their surrounding tissue. This may often be accomplished through the use of a tracer,
or dye, material that is dense that is administered to the type of tissue that is to be imaged.
Examples of this type of x-raying include the use of barium to coat the lower
gastrointestinal tract (barium enema) and the use of iodine compounds to coat the linings
of blood vessels (angiograms). The introduction of barium or iodine tracers makes the
gastrointestinal tract or the blood vessels appear to be denser than the surrounding tissues.

2.6 EQUIPMENT

The conventional x-ray machines are ceiling and floor mounted equipment with a floating
x-ray couch. It is a full wave rectified unit and it has a digital control panel where KV,
mA, and time can be selected separately. All the normal routine radiographic procedures
are carried out in this unit using this machine.
The X-ray Generator
The principal function of the x-ray generator is to provide current at a high voltage to the
x-ray tube. Two sources of electrical energy are required and are derived from the
alternating current (AC) mains of transformers. Transformers are principal components
of x-ray generators; they convert low voltage into high voltage through a process called
electromagnetic induction.
The transformer here has three major parts which are the autotransformer, the high
voltage and the low voltage transformers.

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A switching autotransformer consists of a single coil of wire wrapped around an iron
core. It operates on the principle of self-induction. A switching autotransformer has a
number of taps on the input and outsides, to permit small incremental increases or
decreases in the output voltage. The switched autotransformer is used to adjust the kVp
produced by an x-ray generator. Both the high voltage and low voltage transformer are
connected to the output side of the autotransformer. The high voltage increases the
voltage to a desired value from the line voltage to be applied across the x-ray tube. The
low voltage transformer is the filament transformer that provides the energy for heating
the filament (the filament heating voltage is about 10V and current of about 10A). Both
transformers are enclosed in one assembly called the high voltage assembly.
The control console selects the desired voltage for the filament, anode-cathode as well as
exposure time with the timer circuitry.
The X-ray Tube

Figure2.2 diagram of an x-ray tube

The x-ray tube is made of a Pyrex glass enclosed vacuum and contains two electrodes.
The tube contains the cathode, anode rotor assembly and support structure sealed in a
glass under a high vacuum. The high vacuum prevents electrons from colliding with gas
molecules. The x-ray tube has a rotating anode in which the anode in form of a disc that
rotates 2800rev/sec. X-rays are emitted in all directions from the focal spot; however, the
x-rays that emerge through the tube port constitute the useful beam. The x-ray tube
housing supports, insulates and protects the x-ray tube from the environment. It also
contains oil, which provides heat conduction and electrical insulation

Also in the x-ray tube is the filter for filtration. Attenuation of the x-ray beam occurs
because of both the inherent and added filtration. In general diagnostic radiology, added
filter attenuates the low-energy x-rays in the spectrum that have virtually no chances of
penetrating the patient and reaching the x-ray detector.
Collimators adjust the size and shape of x-ray field emerging from the tube port.

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The X-ray Table
The x-ray table is the flat top where the patient lies for all the supine and prone
examinations. In LUTH, the x-ray table present is a floating top which helps the
radiographer to position the patient and centre the beam easily. It has under it a Bucky
tray with movable grid which helps to reduce scatter radiation reaching the film cassette.

The Vertical Bucky

This is a Bucky tray where film cassette is being put for all the erect x-ray cases such as
CXR, shoulder, C-spine etc. This also houses a movable grid which is important in
reducing scatter radiation. It can be adjusted up or down depending on the height of the
patient.
The Control panel/Console
The control panel in LUTH Lagos is an automatic control panel, which has buttons which
the operator can select the kV, mAs, exposure time etc. There is a button hung by the side
of the control console, which is used for exposure, the button is first pressed to prepare
the x-ray tube for exposure before proper exposure is done.

Figure 2.4 control panel

OTHER ACCESSORIES
The Stationary Grid
This is used to interrupt scattered radiations. It has front (tube) side and back side. During
examination, the back side must be positioned in contact with the cassette while the tube
must be in contact with the patient.
The Lead Apron

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This is used as a shielding form of radiation protection. It is a protective lead like coat of
about 0.5mm lead equivalent which is used mostly during special radiological
investigation or worn by person that support patient who is unconscious or needs support.
The Foam Pad
This is used in a situation where the patient is uncomfortable with the positioning i.e., it
is used as a support. There are different types based on the shape.
Changing Gowns
These are used as part of the physical preparations to ensure that all radiopaque materials
are removed which may contribute to artefact and that patient’s privacy is ensured.
Other items found in the diagnostic room include disinfectant, hand gloves, wool,
cupboard and air freshener
The detector
In contrast to screen-film radiography, in which the film serves as both detector and
storage medium, digital detectors are used only to generate the digital image, which is
then stored on a digital medium. Digital imaging comprises four separate steps:
generation, processing, archiving, and presentation of the image. Patients are asked to
place the body part to be examined in contact with it or it is placed in the bucky tray
when moving grid is needed, then exposures are made. Images are then viewed digitally
on a computer workstation. Digital images can be manipulated during viewing 

Figure 2.5. 43 by 43cm detector

2.7 WORK DESCRIPTION

After registration of the patient at the reception desk, the request forms are sent to the
conventional unit. The patients are called upon according to the x-ray numbers, age and
condition. And when they answer in the affirmative, a short conversation ensues to
ensure that the right patient is being called.
After which changing instructions are given to the patient depending on the part of the
body that is to be examined. As soon as the patient is through, it is necessary to check
thoroughly to ensure that the patient had carried out the instruction correctly. The
examinations can now be carried out using a constant detector size of 43cm by 43cm (fig.
2.5) and the appropriate exposure factors, after which the cassette is taken for processing,

20
and if the radiograph is good enough to answer the necessary questions, and of good
diagnostic relevance, the patient can be discharged, and given a date to come for his or
her examination.

SOME ROUTINE CASES DONE IN THE XRAY UNIT

Various routine case done in this unit include; chest, upper limb, lower limb, skull, and
abdomen.

RADIOGRAPHY OF THE CHEST:

INDICATION: Tuberculosis, pneumonia, chest pain, emphysema etc.

PROJECTIONS: Posterior anterior and Anterior posterior.
PATIENT POSITIONING FOR POSTERIOR ANTERIOR:
1) The patient stands facing the vertical image receptor with the chest in contact with the
image receptor.
2) The patient opens the feet slightly for stability.
3) The chin is raised and placed on the top of the erect image receptor
4) The median sagittal plane is adjusted at right angle to the middle of the cassette.
5) The shoulders are rotated forward and pressed downward to come in contact with the
cassette/vertical image receptor and the dorsal aspect of the hands behind and below the
hip with the elbow brought forward.

CENTERING POINT: Centre at the midline at the level of the inferior border of the
scapula corresponding to the spinous process of T7.
N/B: EXPOSURE IS MADE AT FULLY ARRESTED INSPIRATION.

RADIOGRAPHY OF THE LEG:

INDICATIONS: RTA, swelling
PROJECTIONS: Antero posterior and lateral.
A.P POSITIONING:
1) The patient sits on the couch and extends the affected leg and places it on the detector.
CENTERING POINT: The vertical central ray is centred to the middle of the legs
LATERAL:
1) From the A.P position, the leg is rotated laterally.
2) The leg is further rotated until the malleoli are superimposed vertically.
3) The tibia should be parallel to the cassette

RADIOGRAPHY OF THE ABDOMEN;

PROJECTION; supine and erect
SUPINE POSITIONING;
1) The patient lies supine on the imaging table with the median sagittal plane at right-
angles and coincident with the midline of the table.

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 2) The pelvis is adjusted so that the anterior superior iliac spines are equidistant from
the tabletop.
3) The DR detector is placed longitudinally in the bucky and positioned so that the
region below the symphysis pubis is included on the lower margin of the image.
4) The center of the image receptor will be approximately at the level of a point
located 1 cm below the line joining the iliac crests. This will ensure that the region
inferior to the symphysis pubis is included on the image.
CENTERING POINT
The collimated vertical beam is directed to the center of the image receptor to include the
lateral margins of the abdomen.

CHAPTER THREE; THE FLUOROSCOPY UNIT

2.1 INTRODUCTION;
In this unit special investigations are done. Special investigations as the name implies is a
radiological examination, using contrast and special preparations given to the patient
before the examination. The special cases I witnessed in LUTH are:
hysterosalpingography (HSG), barium studies, intravenous urography (IVU) and
micturating cystourethrogram (MCUG). I also learnt patient positioning, machine
manipulation and after care of patient. These investigations require booking and adequate
instructions are given to the patient depending on the type of study they come for.

A) BARIUM STUDIES: These are the radiological examinations of the alimentary

system using contrast medium. These examinations include-
i) Barium swallow: it gives details of the esophagus.

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ii) Barium meal: it gives details of the stomach and small bowel.

INDICATIONS FOR BARIUM STUDIES: esophageal reflux, dysphagia, hiatus hernia,

strictures, diverticular, pyloric stenosis, gastritis, enteritis, volvulus, ulcer, halitosis,
tumors etc.
The contrast used in these studies is barium sulphate; it has a resulting solution of pH 5.3
which makes it stable in gastric acid.

i) BARIUM SWALLOW: This is the investigation of the esophagus using contrast. The
barium
Sulphate is mixed with water to form a thick paste.

PATIENT PREPARATION:
a) Nil per oral 6 hours prior to the examination.
b) The patient is asked to change into the gown for the examination. And to remove every
radiopaque material from the region of interest.

TECHNIQUE:
1) In the erect position the patient is rotated 90° to the right so that the median sagittal
plane is parallel to the table top and imaging receptor. The chin is slightly raised and the
shoulders depressed to permit maximum visualization of the soft tissue above the
shoulder.
2) The patient is given the mixed barium until the mouth is filled and is instructed not to
swallow until asked to do so.
3) Spot films are taken immediately the patient swallows the contrast.
4) This is repeated until the upper and lower esophagus is outlined.

B) HYSTEROSALPINGOGRAPHY (HSG)

This is the radiographic investigation of the female reproductive system (uterus and
fallopian tubes.) that involves the use of contrast agent. It helps in determining the
patency of the uterine tubes.
Patient preparation
1. The patient is instructed to abstain from intercourse between booking
the appointment and the time of the examination unless she
uses a reliable method of contraception, or the examination
can be booked within the first 10 days from the patient LMP.
with a regular 28-day cycle.
2. Apprehensive patients may need premedication

INDICATION

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1. Infertility (both primary and secondary)
2. To check for tubal patency
3. To outline cause for any obstruction.
4. To check the efficacy of ligation of the tubes for contraception.

CONTRAINDICATION
1. Pregnancy
2. Pelvic Inflammatory Disease (PID)
3. Recent dilatation and curettage or abortion
4. Purulent discharge from the vagina

CONTRAST MEDIUM
Water-soluble Urographine. Water soluble contrast medium is preferable due to its rapid
peritoneal spillage which ensures a short procedure time. 2:1 contrast is used ie 20mls of
contrast and 10mls of water
EQUIPMENT
1. Digital x-ray unit
2. Vaginal speculum
3. Vulsellum forceps
4. Sponge holding forceps
5. Uterine sound
6. Uterine cannula
7. Angle poise lamp
8. Savlon
9. Sterile gloves and cotton wool.
10. Buscopan injection

RETROGRADE URETROGRAPHY (RUG):

This is a radiological investigation of the urethra by the use of contrast media which will
be injected through the urethra.
Indication: Urethral stricture, fistulas and rupture of the urethra following trauma
when retrograde filling is essential.
Contrast media used: Urografin
Equipment: Foley catheter, K-Y gel.
Patient preparation: Explanation is given to the patient about the procedure; why and
how it will be done and probably how long it will last. The patient changes into the
hospital gown.
Preliminary film: A cone down RPO view of the bladder base and the urethra is done.
Technique: The patient lies supine on the X-ray table. The skin surface of the pubic
region and penis are cleaned with antiseptic (savlon). A K-Y gel (lubricating gel), is then
robbed on the tip of the Foley catheter and gently insert into the penis. Normal saline of
about 5ml is injected in the catheter to balloon the tip for injection stability. The patient

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lies supine on the imaging couch and the urethral catheter or small Foley catheter (14–
16F) is introduced into the meatus of the urethra with its tip within the fossa navicularis.
Images are acquired with the patient in the oblique position, to outline the entire length of
the urethra. Additionally, AP images of the penis may be acquired, although in this
position there is foreshortening of the urethra. Using a 20 ml syringe filled with contrast,
image acquisition commences under fluoroscopic control, immediately after 6–10 ml of
contrast
is injected. Further spot images may be acquired, if necessary, during the injection of
further contrast to demonstrate the extent of any filling defect.
Projections: RPO, AP, and LPO.

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 CHAPTER FOUR; COMPUTED TOMOGRAPHY (CT)

4.1 INTRODUCTION TO COMPUTED TOMOGRAPHY

Computed tomography is a procedure which creates images of sections through the
patient’s body. Computed tomography images are created by a computer from digitized
data obtained by exposing the patient to X-ray in a particular manner. It dispenses a very
high radiation dose than other modalities, and images are taken in slices. The computed
tomography machine at LUTH Lagos is a TOSHIBA 128 slices helical C.T machine
which takes images on axial, sagittal and coronal planes.

During scanning, pre contrast and post contrast scanning are done but the post contrast is
usually done depending on the patients’ history and subjective assessment of the scanned
slices. The post contrast helps to outline or enhance the hidden details. The intravenous
contrast used in C.T is contrapaque 300 or 350mg, omnipaque, scan lux, lek-pamidol.
The quantity of contrast given during the examination depends on its type and
concentration. For example, 50ml of contrast is given during brain C.T, while 80ml is
given during abdominal C.T and 50 or 60ml during chest C. T when scan lux is of usage.
4.2 PRINCIPLE OF OPERATION
The X-ray tube is fitted with a collimating device which limits its emission to a narrow
flat fan beam. The beam is accurately aligned to an array of small radiation detectors in
the form of an arc; each equidistant from the X-ray tube’s focal spot. In front of each

26
detector is a collimator which limits its measurement to the rays approaching the detector
along a line from the focal spot. The detectors are able to accurately measure X-ray
intensities. These measurements are digitized and fed to a computer.
If the beam is attenuated, the detectors measurement can be translated to indicate the
amount of attenuation which has occurred. The attenuation measurements can be
translated into data indicating the relative opacities of structures lying in the path of the
X-ray beam, between the focal spot and each detector.
C.T machines use very high radiation dose than in normal conventional x-rays. One C.T
exposure is equivalent to 25 chest x-ray exposures.
In the C.T suite there are three rooms:
a) The scan room, where all diagnosis and scanning take place.
b) The operating console, where all operating devices are situated.
c) Changing room for patients.
In the scan room, the following are situated:
The gantry, a couch, an immobilization foam pad, a head rest, strap or band, emergency
kits, automatic injector on which are two syringes containing water and contrast medium.

Figure 4.0 1automatic injector

In the operator’s console, there are:

The main computer, keyboard, gantry console, the CPU, the lead lined glass, the
automatic injector remote control.

27
Figure 4.1 CT control room

N/B: Before scanning commences for the day, tube warming is advised and the gantry
should be cleaned to rule out artefacts.
The common C.T examinations carried out in LUTH Lagos are:
a) Brain C.T
b) Abdominal C.T
c) Chest C.T.

4.3 BRAIN C.T

INDICATIONS– Hydrocephaly, Parkinson’s disease, optic atrophy, cerebrovascular

accident (CVA), encephalopathy, memory loss, intracranial haemorrhage.
PATIENT PREPARATION:
1) Explain the procedure and how long the examination is supposed to last.
2) Explain to the patient the necessity for immobility.
3) The patient should remove all opacity for the head to the abdominal region.
4) An intravenous cannula is used to set an IV line for contrast injection.

PROTOCOLS FOR ROUTINE BRAIN CT:

Patient Positioning: Supine, Head in head rest
Scout : coronal and sagittal
Start : Angle of mandible
End : Vertex of skull
KVP : 135
MA : 300
Rotation time: 1.0 second
IV contrast (if indicated): Ultravist 50mls

TECHNIQUE:

28
 1) The patient is asked to lie supine on the couch with head-in first.
2) Ensure the patient’s head is straight and properly immobilized.
3) Then strap the patient’s head to maintain the position firmly.

CENTERING POINT: Centre the horizontal line at the symphysis menti.

SCANNING SEQUENCE:
1) Type in the patient’s data into the system and click on protocol to select the region
to be investigated upon.
2) Press the gantry console to start the scanning, the first image that comes out is
called the scanogram.
3) The scanogram is the lateral aspect of the skull which is used to plan for the pre
and post contrast scanning.
4) The scan line should be out of the patient’s eye to avoid irradiating them.
5) After planning click on GO to start scanning.
6) Axial scanning is done first, then coronal and sagittal are reconstructed.
7) Save the image after scanning and post contrast scanning might be done depending
on the clinical indication or the subjective assessment of the scanned slices.
8) Scanning is done after the injection of the contrast (scan lux 50ml).
9) The C.T films are printed after being batched and also sent to the PACS system.
4.4 ABDOMINAL C.T
INDICATION: Aneurysm, lower urinary tract infection, obstructive jaundice, trauma, post
operative complications, abdominal sepsis.
CONTRAST MEDIUM:
a) Oral contrast (40ml gastrografin mixed in 1.5 litres of water)
b) Intravenous contrast (80ml contrapaque)
PATIENT PREPARATION:
1) The patient should be instructed not to eat 6hours before the examination.
2) 1.5L of water mixed with 40ml of gastrografin is given to the patient to drink 40-
50mins before the examination.
3) The oral contrast helps to outline the small bowel.
4) An IV line is set for the patient and the patient is asked to change.
TECHNIQUE:
1) The patient is asked to enter the diagnostic room and told to drink the remaining
contrast.

29
 2) Lay the patient supine on the couch in feet-in-position i.e the feet will be towards
the gantry and supported on the feet rest.
3) Ensure the patient is centered in the midline of the couch, and the feet are
strapped.
CENTERING POINT: Centre the horizontal beam of light at the mid axillary line and the
inner vertical line at the sternal angle (T4).
SCANNING SEQUENCE:
1) Scanogram is obtained and used to plan for pre and post contrast.
2) Click on GO to start pre contrast scanning for axial plane and then reconstruct for
coronal and sagittal planes.
3) Save after scanning.
4) An IV contrast will be given and scan 35secs from the start of contrast
administration for early contrast scanning.
5) 15mins after the injection of the contrast, late contrast scanning is done.
6) Abdominal C.T is done on an arrested expiration so as to avoid motion blurring.
7) The slice thickness is usually 5mm.
8) An IV contrast is injected to enhance the organ so as to see any pathology clearly.
9) In case of suspected malignancy in the lower part of the GIT, rectal contrast is
given to opacify the colon.

4.4 CHEST C.T

INDICATION: Cough, lung collapse, chronic chest pain, tuberculosis, rib fracture,
etc.
PATIENT PREPARATION:
1) The patient should remove all that he/she is putting on to rule out artefacts, and a
clinical gown is worn.
2) The patient’s name is registered in the system and protocol is clicked to get the
area of investigation.
TECHNIQUE: The patient is asked to lie supine on the couch in head-in- position.
CENTERING POINT: Switch on the laser beam and position the patient well by
centering the horizontal line just above the EAM and the vertical line at the chin.
SCANNING SEQUENCE
30
1. Scanogram is obtained and used to plan for pre and post contrast when possible.
The scanogram should include the whole lung
2. A pre contrast scan is done after the planning
3. A post contrast scan can be done, when necessary, by injecting 50mls of Scanlux
(an iodine base contrast). The scan is done 25secs from the start of contrast
administration

CHAPTER FIVE; MAGNETIC RESONANCE IMAGING

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 5.1 INTRODUCTION
MRI is a medical imagine technique that can produce detailed pictures of many parts of
the body. An MRI scanner contains a large magnet with a tunnel through the middle
where the patient lies on a movable bed. When the patient enters the magnet the hydrogen
atoms in the water of their body tissues line up along the magnetic field. Radiofrequency
pulses are then sent in, causing the atoms to ‘flip’ into another plane and then ‘relax’back
when the pulses are turned off. The repeated movement of the particles produces
electrical signals which are picked up by a receiver or coil, and then converted into an
image by a computer. As tissues such as fat, bone, and muscles have different densities
and water content, they produce different levels of signal. Similarly diseased tissues will
differ from healthy tissues and show up on the scan as brighter or darker than normal.
Some scan also requires the use of contrast dye which helps highlight certain tissues and
body structures.
INDICATIONS
Brain; tumor, stroke, aneurysm, multiple sclerosis
MRCP ; gallstones, bile duct obstruction, tumor
Spine; scoliosis, spinal cord constriction, spondylosis

PATIENT PREPARATION
1. Patient is to be remain fasted on the day of the examination.
2. Before entering the scan room, the patient should remove all
mechanical, magnetic or metal object.
3. Patient maybe asked to change into a hospital gown and is
told the duration of the scan which can last from 10 minutes
to an hour or more depending on the body part being
examined.
4. The patient is asked to lie on the couch and a coil may be
placed over the part of the body being scanned. A buzzer is
32
 also given in case the patient needs to call the radiographer
during the scan.
5. The patient is also informed about the noise the machine
makes during the scan. The patient is also told to remain still
during the scan to avoid movement artefact.
6. Claustrophobic patient or parent of children who are unstable
are asked to talk to their doctor who will may prescribe a mild
sedative to keep them through the scan.
5.2 COMMON MRI SCANS
1. BRAIN
Indications; tumor, stroke, seizures, headaches
Contraindications; electrical, metallic or magnetic implant
Patient positioning;
- head first supine
- position the head in the coil and immobilize with cushion
- center the laser beam localizer over the glabella
Protocols;
Axial T2, AX flair, AX T1, T2*,
SG T2, COR T1, DWI

Figure axial t2 image of the brain Figure axial T1 image of the brain

2. ORBITS
Indication; visual loss, vascular lesions of the orbit, optic nerve neuritis, orbital abscess
Patient positioning;
- head first supine
- patient head is positioned in the head coil and immobilized with cushions
- center the laser beam localizer over the glabella
Protocol ;
COR T1WI, COR T2WI fatsat, AX T2W1, AXT1WI fatsat, contrast enhance COR
T1WI, and AX T1W fatsat,
33
Figure axial, coronal and sagittal images and planning of orbit

3. WHOLE SPINE
This is basically the sagittal T2 or coronal stir (in cases of metastasis) images of the
cervical, thoracic and lumbosacral spine. It is done as a routine investigation in LUTH in
addition to whatever spine investigation that is requested by the referring doctor. The
whole spine procedure involves stitching the sagittal t2 or coronal flair of each part of the
spine.
Indication; spine TB, spinal cord tumor, compression or injury.
Positioning;
- Head first supine
- Patient is positioned on the spine and in the head coil.
- Beam localizer is centered over the thyroid gland
Protocols; 3 plane locator, SGT2 or coronal flair and coronal locator for each part of the
spine.

CHAPTER SIX

34
 CONCLUSION AND RECOMMENDATIONS

6.1 CONCLUSION
In summary, the experience and exposure gained within these six months of my SIWES
programme has been of tremendous importance to my professional career as a
radiographer. The relevance of this programme cannot be overemphasized because:

 It fully prepared me for the work situation I am likely to face after graduation.
 It helped me enhance my communication skills with patients as well as other
health practitioners.
 It improved my skill in image critiques and pattern recognition.
 I gained a lot of experience and self-confidence in clinical practice.
 It developed my professional ethics and patient care skill.
 I was exposed to ward and intensive care unit cases that improved my composure
and critical thinking skills in the face of emergencies.

6.2 RECOMMENDATION
Based on the level of experience this program has afforded me in my field of discipline, I
recommend that every student should be given an opportunity to participate in the
SIWES program. I also recommend that adequate management and supervision is done to
ensure that students remain in their place of attachment during the training.
Seminars, discussion forum and active participation of students in their place of
attachment should also be put in place to ensure that students not only acquire technical
experience but also have entrepreneurship, management and leadership skills.
I recommend this SIWES program to every university and institution of higher learning.
This is due to the fact that it bridges the gap between theories and the practical learnt in
the institution.
I also recommend that the SIWES unit liaises with the institutions of industrial
attachment to give stipends to the students, so as to support their transportation and other
daily expenses incurred in the course of the program.

35
REFERENCES
Stewart W. Charles S., Graham H., Adrian D., Chrissie W. (2005), Clark’s
Positioning in Radiography (12th) edition, published by Charon Tech Pvt. Ltd,
Chennai, India.
Roger .C. Sanders & Thomas .C. Winter (2007), Clinical Sonography- A Practical
Guide, 4th edition, Lippincott Williams & Wilkins.
Ball .J. & Moore .A.D. (1997), Essential Physics For Radiographers, 2nd edition,
Wiley Blackwell Publishers.
John Ball, Tony Price. Chesney’s’ Radiographic Imaging (6th edition), (1995).
Blackwell Science Ltd
Mrimasters.com
Lagos university teaching hospital (LUTH). Idi-araba Surulere Lagos.

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