Functional MRI

Today I witnessed a functional MRI study. It was on a patient who was a hemophilia and had a brain tumor that was hemorrhaging. The patient will have to have surgery to remove the tumor, so the functional MRI was done to see how the patients speech will be effected after the surgery. The radiologist and surgeon will discuss the surgery options later today. This was a very interesting case, but also very sad because the patient is very young.

Lung issues

Lately, I have opened my eyes to many lung disorders. My father passed away two weeks ago with severe health problems, including emphysema and double pneumonia. In February, he was diagnosed with both, but it had been residing since November of last year. I watched him struggle for every breath he took until he finally decided to give up the fight. I watched the nurses interact with my father while he was in the hospital and the nursing home. Some of them were very kind and understanding, and others were rude and did not take very good care of him. Some even made him wait for hours for his medications. I wish that I could have done more to help him, but because of what happened to him I have learned so much about what to do to take care of patients that come to the radiology department. I thought that I was very considerate before and I have always put patients first, but now I have been super careful about how I treat them. When I do lung CT scans, I look carefully at the images to make sure I do not have to do thinner cuts through the lungs. I actually just had a compliment from one of my patients last week that greatly appreciated the care that was given to him by me because I was so throughout.
A little about MRI. It is still very tough for me to learn all the physics involved, but the scanning is going well. I have been trying to work on the open sided magnet, because I feel like it is more of a challenge than the 1.5T. When you are scanning in the open, you only have one localizer to set your scans off of. I feel like I learn not only how to scan, but also why you scan a certain way and how to manipulate the image to decrease time or to get a better quality image. The open sided is very slow, but between setting my exams up and reviewing my images, I get a lot of studying done. On the contrast, I also like working on the 3T, because it is the complete opposite. That machine is a lot quicker, but you have to really watch your SAR values and also be extremely careful with who is scanned in the magnet.

MRI comps

I finally have all of my comps in MRI, so now I am able to take my boards soon. I still have a lot of studying to do because MRI is probably the hardest subject I have ever studied. I love scanning. Each patient is different and I always learn something new, either about the scanner or about pathology. Yesterday I scanned a patient that had a cyrinx. I scanned an MRCP on another patient whose pancreas was enlarged, probably due to pancreatitis. (I have not read the report yet). This patient had recently had a gastric bypass surgery and a miscarriage. I have read recently that there are 5 most common reasons to have pancreatitis. They are alcohol, traumatic events, biliary disease, infections, and being congenital.

Critical patients

Recently, we have had numerous critical patients, but one that stands out to me the most is a younger man that was in the hospital with a known aortic dissection and chest pain. He had a follow up CT Chest/Abdomen/Pelvis scan that showed his aortic dissection went from the ascending, down through the descending aorta, all the way down to his pelvis. To make matters worse, he had pleural effusion around his heart. He was rushed to surgery to fix the dissection, but unfortunately he did not make it.

Another case that stands out to me, was a patient that came to MRI for a brain scan. She was having severe headaches. We scanned her head and as soon as the localizers showed up, we saw a huge brain tumor. The brain scan was ordered without contrast, so we had to call the radiologist to order it with and without contrast. We had to explain to the patient that we had to give her contrast and, of course, she asked why. We had to "lie" and say that it is required for most brain scans. She almost denied it because she was worried insurance would not pay for it, but we quickly told her that more than likely insurance would cover this particular scan. She also was worried that something was majorly wrong with her scan. Needless to say, there was something incredibly wrong with her. She was diagnosed with brain cancer. After she was given her diagnosis, she was emitted to the hospital.

It gets hard to explain to patients that we are unable to discuss any abnormalities. Sometimes I wonder if they can see the look on my face and know something is wrong. I am so thankful I do not have to give the bad news to patients, but is still awful seeing nice people be diagnosed with horrible diseases and disorders.

Another semester

Another semester has come! I have been trying to keep up with work and school. It sounds like this next month will be a little crazier than usual.
My MRI clinicals are going very well. I am seeing a lot of unusual scans and I have been getting to scan more. I try to go to my clinical site every chance I get. The light at the end of the tunnel is slowly getting larger. I cannot wait until I am finished!

Caput Medusae

I was talking with one of the Radiologists the other day and she gave me some information about various pathologies. One, in particular, was called Caput Medusae. This occurs when the inferior vena cava is blocked off and veins grow from the umbilical vein around the blockage to bypass it so that venous blood can flow back to the heart. In sectional anatomy it looks like Medusa's hair. (Medusa was a mythical creature with snakes coming out of her head. Caput Medusae often happens to infants or to people that have cirrhosis of the liver. I have uploaded some pictures. One of what Medusa looks like and the other two is what Caput Medusae looks like in a CT scan.

References:
Dr. Dugan, M.D.
vroma.org
scielo.br

Indy Hospital

Since my last post, I have received a PRN position in CT at a major hospital in Indianapolis and for the past 2 weeks I have started to do my clinicals there. I have seen several unusual cases, such as various tumors and lesions, extreme scoliosis, horrible fractures, and the list could go on and on. I feel so grateful to have this experience working at this hospital. It took a while for me to get here, but I have finally worked my way up.