Radiology: Ultrasounds and Mammos

Today I spent the day mostly with Cheryl, one of the radiology techs who specializes mostly in ultrasound and mammograms. We spent the morning in the U/S lab; among the cases I saw was a man with polycythemia presenting with a slightly enlarged spleen (and an incidental kidney cyst), a woman whose oncologist felt a breast lump (but U/S revealed nothing), and the lady from Iowa whose pet scan I saw yesterday. She needed her thyroid scanned b/c she had a family history of thyroid disease and currently has two nodules, of which one was biopsied this afternoon. (sadly I won't know the results). I also stopped by nuclear medicine to watch Mercedes prepare a patient (whose MRI I observed) for a MUGA scan, which measures ejection fraction. First you draw a sample of the patient's blood, tag the RBCs with isotopes, and then reinject it into the patient and follow the tagged RBCs to the heart. Then you measure the diameter of the left ventricle in systole and diastole to calculate the EF, which is great if it's above 50% (optimum). This is done prior to chemotherapy because chemo treatments have been known to cause heart disease, and the MUGA gets a baseline heart function to use as comparison later. This week is Radiology Tech week so we've been getting free breakfasts and lunches for the last few days. This morning the chef husband of one of the radiation therapy techs cooked custom omelettes for everyone, and lunch was Panera Bread. In the afternoon I was assigned to Marcy for mammography. The first patient was an 83-year-old lady with cancer of unspecified origin (though a note said it was bile duct cancer), and she had trouble getting to the machine b/c she was wheelchair bound. "Should I bring my husband in?" she asked, and we said we'd be okay (her husband's 85). Mammograms look painful; I'm not looking forward to those. Lauri actually commented that she doesn't want any of the current techs doing her mammos when the time comes. After her mammo, the patient had to wait in the hall for her bone scan, and I decided to keep her company by talking to her. We must have sat there for about 10-15 minutes just talking; the radiologists walked by a few times and I wondered if they thought I was slacking off by talking to patients instead of watching more mammograms (Marcy brought another patient to the room while I was talking). The patient was very nice though; she told me that her husband was a general surgeon with the US army and told me of all the places they traveled to, including Malawi (in Africa) where her husband was able to do all kinds of surgery he wouldn't have been permitted to do in the states (ortho, heart, etc). We had one more mammogram patient but when Cheryl asked if she was S.G., the woman somewhat rudely replied, "Yes." Then Tina pulled Cheryl aside to warn her that S.G. had caused some trouble at the front desk asking when she'd be seen after less than 5 min of waiting, and that she kept asking for a specific tech who just happened to be on vacation this week. It was agreed that I should not sit in on S.G.'s mammogram, and later Cheryl said that S.G. had once again asked for Nancy, the tech on vacation, but later grudgingly agreed to let Cheryl to her mammo. Tina flat-out called S.G. a b****, but Cheryl was more sympathetic. She said a majority of the mammo patients formerly had breast cancer, and every year they come to the center stressed and scared about the possibility that their cancer has returned. They wanted all variables (in this case, the lab tech) to stay the same so there'd be no room for error. Fortunately for S.G., her breasts looked fine. With that, my three-day tour around the departments has come to an end. I'm really glad I got to do this; since I understand the procedures better now, I think I'll be able to view each CT, MRI, and PET in a new light. I told Lauri that I enjoyed getting to spend time in each department (and meeting the techs), and she said she also wanted me to see understand that images take time to process, and that some doctors don't realize that when they complain about missing scans or XRs. She also told me that she gets at least one call a day from my classmates asking to do a rotation at the cancer center, but most spots are already full. January is a particularly popular month, and a friend was able to snag that spot several weeks ago. =) Tomorrow it's back to the dark rooms for me.