Now that spring break is over we are starting to pick back up. We are possibly starting a new contrast used just for MRA's. As of right now, we use a fluoro trigger method for capturing the exact moment when the contrast has filled the carotids or renal arteries. This is somewhat challenging depending on the patient. With this new contrast it actually clings to the red blood cells so the contrast stays in the arteries longer. This allows less venous contamination and allows a little more latitude when it comes to imaging. So, if my first scan doesn't quite capture the best image,then I have time to run another scan without venous contamination. I have been an MRI technologists for five years now and I still have butterflies in my stomach every time I do an MRA just for the reason alone you only get one chance! Now, maybe with this new product I will be more comfortable! I also was able to finish three more comps this semester and feel once again I have learned so much more about my modality. I feel with every class I take I become a better technologist!

It is spring break in my town! So, that means we are super slow! I am not going to lie, I kind of appreciate it. The last six days I worked I scanned 42 exams! I feel like that is a lot! This week, we have finally hired a massage therapist for the MRI suite. So, when I go get a patient I ask them if they would like a complimentary 15 minute massage before having their MRI scan. Right off my scan room we have a comfort suite with a massage table, chair, and all of the amenities of a spa! Research has shown patients who receive massages before MRI have less anxiety and are more relaxed for their procedure. We were finally able to hire a massage therapist and she started this week! She also helps with assisting the MRI tech and acts like a patient care tech. This has been very helpful since we work alone and we also have the movie goggles to utilize. I have told her already, just putting in the movie and fast forwarding through the previews has been helpful enough! Now that we offer this service I have become the bad guy in the whole MRI experience!

Thoracic Lesion

I have been getting quite a few interesting cases lately having to do with the spine! This 26 year old male came in with low back pain. He had his Lumbar done and we found the mass at the level of T12. We injected and it some what enhanced. The report reads: Consider cavernoma, cystic degeneration, schwannoma with cystic degeneration. The patient came back at the end of the week and had the rest of his spine and brain scanned. The rest of his scans were clear. His doctor told him that is probably not the cause of his back pain. On a side note, I also found out he married a girl from my hometown who went to school with me! Small world.

I had a 34 year old patient come in with lower back pain. I had asked him a series of questions about his history including have you ever had back surgery. He responded with "yes, I had a lipoma removed off my back". Many of times patients come in with lipomas on their back. Patients present with a palpable mass on their back side somewhere and they usually turn out to be just lipomas. So, imagine my surprise when I ran his scans to find this intradural lipoma. I have never seen one before, so I thought it was very interesting. I called one of my neuroradiologists and asked if they would need contrast and he said none was needed. He only asked I made sure to do a block of T1 Axials through the lipoma. I think this case made me realize how thorough I should be with a history. I assumed with him he was talking about something else, luckily I was able to see his pathology and do the proper images.

February-Spring Semester

It seems in the past month I have had so many patients come in who are claustrophobic. I always feel as if it is a challenge whenever someone comes in and initially can not do their test, but I am them able to convince them to do it. I feel I have an advantage because I too am very claustrophobic. My facility offers movie goggles and that seems to help a lot of people deal with the MRI. But, sometimes that is not enough. I am an advocate of putting something over the patient's eyes. Along with covering the paitent's eyes, I also give them a squeeze ball to get a hold of me; I also talk to them after every series to let them know how long each scan is programmed; and finally my favorite thing to do is to tape an oxygen tube to the paitent's chest so that it blows constant air on the paitient's face. Having the oxygen tube on blowing on my face is the only way you will ever get me into the MRI tube! My patients always get a kick out of me when I tell them, I have a hard time going into the scanner. I think this is a huge advantage because I gain the patient's trust and can emphasize with them when it comes to this disorder.

I felt going into this semester I would consider myself an experienced MRI technologist. After just taking one semester of classes, I have realized I have so much to learn! After one semester, I feel I am able to improve on my scans, have a better understanding of cross sectional anatomy and also provide better care for my patients. I have learned so much more about different pathologies and feel I will be able to recognize them and add extra scans to show the radiologist as much information I can provide while still having my patient on the table. I really enjoy spine work and after going through the procedures course I feel clinically I have improved on my scans. I have learned to see certain pathologies on my sagital scans which allows me to make sure when setting up my axial images I cover these particular areas. Learning the anatomy of the brain has also been a great help. When patients have previous head CT's I am able to read the report and am sure to set up my MRI scans with the best images possible depending on the are of interest mentioned in the report. I look forward to next semester and continuing on improving.

St. Vincent Health has decided to go with Eovist contrast for Liver MRI scans. We now have a new protocol where we inject early, run a few scans, but must wait at least 20 minutes before running our post Lava scans. There have been many of times where I would have to bring the patient out and sit in there with them hoping they don't move until the 20 minutes were up! This contrast is only for Liver MRI's and demonstrates the pathologies of the liver more clearly.
Today, I have a patient coming in for a Liver scan and I look forward to using the new contrast and protocol. What I am NOT looking forward to, is starting her IV. I guess she came in on Wednesday before Thanksgiving and no one was able to get her IV started. So, they must have all of the confidence in the world in me, because they re-scheduled her on a Saturday and I am the only one here!!!! I may or may not be doing her test! Luckily for me there is no one else scheduled after her!

I had a very interesting case the other night. I was scanning a 12 yr old girl's complete spine for scoliosis. While I was scanning her not only did she have the most drastic S curved spine I have ever seen, but then I realized she also had a synrinx throughout her entire spine. Each of my sagitals for the thoracic spine had to be done in two parts to stay with the alignment of her spine. My facility requires the technologist to scan each part of the spine in separate sections unless they are looking for metastatic disease. Also, since I discovered the synrinx I also had to inject. It is always a challenge to explain to any child and or parent the importance of the contrast for the exam without causing them to worry. I think even more of a challenge in this situation was trying to convince the young girl to lay still so I could just continuously scan without having to realign each scan up for her extreme curvature. She was watching a movie and didn't move at all during her test and injection. I was very lucky!

Clinical update

Since the school year has started we have had so many pediatrics coming in with sports injuries. We have had quite a few ortho cases including knees, wrists, shoulders, ankles, and feet. All patients were under the age of 17! These patients included football players, swimmers, soccer players, and runners. A lot of the knee scans showed torn meniscus and ACL tears. I have decided if I have children they are playing golf! We are just now starting to learn how to T2 mapping with our upgraded software. This program allows us to post process knee scans and with color determine where patients have good and or bad/damaged cartilage. This is very new and I will post more as we get more involved. What I have seen of it, I have been very impressed!

Just from our first few weeks of classes, I have already learned so much more about MRI! Especially the anatomy on the scans. This past week for me has been a very busy one! We run a 1.5 tesla strength magnet from 8:ooam until 8:30pm monday through saturday. The few days I was there, I averaged at least ten patients a day. One of my cases was a little different. I had to do a Brain MRI on a patient with nasopharangeal cancer. My radiologists have a specific protocol and it takes approximately one hour to do. This patient had his mandible removed due to the cancer and was extremely claustrophobic, so it was a bit of a challenge for me. He was sedated, but he still was having a hard time laying in the scanner. The axial scans start at the hyoid bone and need to cover through the pituitary. The coronals must begin posterior to the brain stem and anteriorly through the face. It was challenging, but also a very educational process.