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.

Aortic Dissection

I had a patient this week that was involved in an MVA last year, but was still having some back pain. She had an MRI T-spine that showed a fractured vertebra and a possible tear in the aorta. The referring physician wanted her to have a CTA of the abdomen and pelvis. The results were astonishing! She had a dissected aorta that went from the ascending aorta, down through the descending aorta, and even went through the bifurcation into the right common iliac artery. The study stopped right under the ischial tuberosity, but the dissection was still continuing! She is only in her 50's and I can't believe she is still living and not having too many problems with it!

The first week in February

I went to my hospital location on Monday and we didn't have a patient until 3:45 p.m. and I usually leave at 3 p.m. I was really upset at first, but because I didn't have any patients, I was able to play around with the scanner. I believe it helped me out a lot just learning how one factor can change another.
(For those of you who are wondering... I did end up staying and doing the one patient!)

My hospital clinicals

The new hospital that I have been going to is a smaller hospital (approx. 40 beds) but it has some of the latest MRI and CT scanners! I love being able to learn on newer equipment as well as older equipment. It helps me become more versatile! I'm hoping that I see as much as I can over the next year in MRI so I can become the best technologist that I can! I am also hoping to gain more CT knowledge so I don't lose my skills as a CT tech.

MRI comps

Yesterday was a pretty steady day. I received a thoracic spine comp, as well as a knee and a shoulder. I'm very excited to start my clinicals at the hospital! I hope I can see unusual exams to give myself more experience in the field.

Intro for spring semester 2010

Hello all! I hope everyone is ready to start the new semester. I know I am:) I'm excited to start a new clinical site at a local hospital!!

Chiari Malformation

On Friday, we had a patient that was complaining of headaches on the left side. When we scanned a brain with and without contrast the tech I was working with noticed a Chiari malformation, which is where the cerebellar tonsils are being pressed down by the brain. We went over what it was, when it happens (when the brain and skull are developing), and what can happen when you have one. An example is when the malformation presses on the spinal canal and causes a blockage of signals to the brain. It was really interesting to me to see an anomaly like this.

We also scanned orbits, pituitary, a wrist, a knee, a thoracic spine, and a lumbar spine. The thoracic spine was on a patient that had a very high pain tolerance!! His spine looked horrible! There were so many bulging discs and degenerative changes.

unique exams

My last clinical day was a very unique day. I had an MRI ST neck with, MRI ST pelvis to check for a mass/lesion in the uterus, and an MRI chest exam to check the attachment of the pectoralis muscle. These exams are pretty uncommon at the facility that I do my clinicals with the exception of the ST neck. The pectoralis muscle attachment exam was extremely difficult to do becuase of the air in the lungs and the motion of the heart. Despite the difficulty, the images turned out pretty well!

CT boards

I PASSED MY CT BOARDS!!!!!!!!

I was so nervous before taking the exam and even during the exam. There were a lot of questions that I had no idea what the answer was. I was definitely sweating before I pressed the next button after the exam.

I'm so excited that I have CT completely done and now I just have to worry about MRI and my Bachelors Degree.

Needle sticks

I am now beginning to feel a lot better with doing complete exams from start to finish including needle sticks! I thought it would take me a while to learn a technique in needle sticks, but I try to do stick every single person that comes in so I can get the practice. One of the techs that I work with told me that if I miss the vein to anchor the vein down hard, pull the needle out a little, then go to the right until you get blood return (I guess it's because I'm right handed). I really don't know how, but it's worked for me.

Monday clinicals

Monday clinicals were very busy, so I got to see and do a lot. Most of the cases were usual head, sinus, chest, abdomen, and pelvis studies, but we had two cases that were soft tissue necks!

This week I had to pick up hours at work and miss out on one day of my clinicals, so now I think I'm behind on my hours. I feel like there is not enough hours in the day!

Hopefully after next week my life will calm down a little so I can dedicate more time towards my education.

Update on MRI and CT clinicals

This past week I got a competency on an MRI C-spine. I am now understanding that a lot of the procedures are set up the same way, but I'm still trying to understand how to revise the protocols that are already in the computer if we have to do any additional views, etc. MRI is still extremely complicated, but I am slowly getting it.

I am still trying to study for my CT boards, so I'm still working on the Toshiba CT scanner on Mondays. The Toshiba scanner computer is not hooked up to the automatic injector so the delay times are not shown on the computer screen. I feel that having this feature challenges me to remember the delay times of each exam. I also feel that since I am working at an outpatient facility, I don't get to see as many exams as I would like. Most of the exams I see are basic chest, abdomen, pelvic, and head CT's with the occasional PE chest, extremity, and soft tissue neck.

My 1st MRI comp

This week I got my very first comp in MRI!! The comp was a knee and I did everything including filming. That may not seem like a lot, but It meant a lot to me. I might not know everything about MRI, but it is starting to make a little more sense the more and more I do exams.

MRI is difficult

I now have started MRI officially! MRI is a lot difficult then what I originally thought. It is starting to come to me, but there is so much to know. I am now working on the open MRI scanner where I have helped scan numerous extremities, spines, brains, and a couple abdomens. The abdomens I have seen have not been the best to watch. One study was to look at the liver and the other was to look at the kidneys. The protocol on the liver study had to be changed dramatically because the ordering physician also wanted to look at the adrenals, so I kind of sat back and watched because I had know idea what the MRI tech was doing!

About CT:

Unfortunately I haven't taken my CT boards yet, but I hope to learn more about anatomy and pathology before taking them. I find it very difficult to try to study for my CT boards, keep up in class, work, and understand MRI all at the same time. My goal is to take the CT boards in a few months and then I can primarily focus on MRI and my classes.