Radiology: CT and MRI

Today I rotated through two departments: CT in the morning and MRI in the afternoon. The two CT techs, Claudia and Tina, were very nice; Tina and I spent a great deal of time talking about our pets (and animals in general) while Claudia talked about her daughter who wants to be a pediatrician. I remember wanting to be a pediatrician as a pre-med, but medical school changed all that =) It was cool getting to see how the CT worked and how patients prepare for their scans (i.e. drinking lemonade-flavored barium to visualize the stomach and later getting an iodine contrast injection after their non-contrast CT is done. Patients who have had allergic reactions to iodine in the past are put on a "13 hr prep protocol" in which they start taking measured doses of Benadryl and methyprednisolone thirteen hours before their scheduled scan. It works pretty well in most people, but some people require as much as a 3-day prep before the doctors decide to go without contrast from then on. Most patients get three scans: one "scout" scan where the entire chest/abdomen/pelvis (whatever you want to visualize) is scanned, one non-contrast scan, and one contrast scan (the latter two with cross sections). Sometimes, if there are suspicious cyst-like lesions in the liver or kidney, there is a "delayed" scan done to see if it takes up the contrast dye (cysts take up dye). Most of the CT scans I saw today were benign, which is good for the patients.

There was only one patient scheduled for MRI in the afternoon (but she needed two separate scans), so I went with Marcy, the MRI tech, to the waiting room to take the patient to the MRI. As it turns out, the MRI machine isn't even in the building; it's housed in one of those one-room temporary structures outside the building. The patient was a woman with stage II breast cancer (recently diagnosed) who'd undergone a bilateral mastectomy with metastasis to two nodes. She also had a history of falling, so in addition to a head/neck MRI she was also getting a lumbar MRI to assess for nerve compression. The MRI was a very loud machine with a tiny tunnel. The patient's head was covered with a cage-live device at one point; if that doesn't make one claustrophobic I don't know what does. Fortunately she was given Ativan before the procedure and handled it nicely. As we waited for the scans, Marcy told me about breast MRIs and how they can be used to detect breast masses that haven't been spotted yet. She said that just because only one breast has noticeable cancer doesn't mean the other one is cancer-free, and showed me several breast MRIs to make her point. That definitely makes me worried, since I don't think breast MRIs are the norm in cancer detection just yet and I'm sure there's many women out there who could benefit from it (but don't get them done).

After the MRI, Marcy took the patient around to all the other departments so she could see how small their tunnels were (CT, DEXA, PET scan) in case she got claustrophobic again. I sat in on the end of a PET scan before going back to CT, where Claudia proceeded to show me some of the more interesting scans they've had like an intussuseption, bone mets in the sternum (looks like a knob sticking out of the chest), and one where the peritoneal organs were totally riddled with mets. =( Cancer is nasty business.