Claustrophobia

My clinical site, also my employer, has to turn away numerous patients due to them being claustrophobic or too large. We only have one magnet and it is a short bore Philips MRI, but for the true claustrophobic it doesn't matter how short the bore is. This summer we are finally getting an open MRI and are so excited about it, hopefully it will increase our volumes and productivity tremendously and will be very convenient for our patients. One thing I thought was above and beyond when I started at Lourdes was what the MRI techs do to help a person get through their exam in the closed MRI when they are claustrophobic. It is amazing how much it helps calm a person just to know someone is right there with them. The techs will stand in the magnet room with a patient either holding their hand or just patting them on the leg every now and then just to let them know they are not alone. It relieves some patients claustrophobia just to know that someone is there to get them out right when they need out and that they will be able to speak to someone at any time. I thought this was very compassionate of the techs by making sure they got the test they needed without rescheduling the exam or delaying the patients treatment.

Baker's Cyst

This patient had a large palpable area on the back of his knee that you really didn't even have to palpate to know it was there. You could see it sticking out the back of his knee. The radiologist read this as a large Baker's cyst. We get patients all the time with Baker's cysts but I thought this one would be something different because of the size of it(even though I could see that it was fluid filled), but guess I was wrong. This patient also had osteoarthritic changes and a tear of the posterior horn of the medial meniscus. I posted a picture of the Baker's cyst so you can see how large it was on the images.

Syrinx and Chiari Malformation

This sagittal image is from a MRI of the cervical spine with and without contrast. In this pre contrast T2 image you can see a couple abnormalities, one being a Arnold-Chiari malformation. A Arnold-Chiari malformation is a downward displacement of the cerebellum through the foramen magnum. Another abnormality is that the patient has a large cervical syrinx that extended all the way to the margin of the field of view. We later found out the syrinx was the entire length of the patients spinal cord. A syrinx is a rare, fluid-filled neuroglial cavity within the spinal cord or brain stem. I have seen a syrinx on a patient before but it was only the length of one cervical vertebrea so this one definately stands out to me. The patient's symptom was occipital headaches. I wish I could follow-up on patients and see what kind of treatment is used and if it helps for different pathologies I see! And the image I posted isn't the best, it is a picture of the computer screen with my digital camera so not the best quality but you can see the pathologies I'm mentioning.

Large Aneurysm

This is an image from a MRI of the brain done on a 71 yr old patient that complained of visual disturbances and hypertension. This axial image shows a very large aneurysm measuring 2.4 x 2.3 cm. It is causing mass effect on the patients right optic nerve which would be a cause for the visual disturbances the patient is having. The doctor recommened MRA or CTA evaluation of the head to better evaluate the area. The lead tech saw this area while doing the MRI of the brain and after consulting with the radiologist called the ordering doctors office and had them send us an order for a MRA of the brain. The images were read as a stat call results priority. This is the biggest aneursym I have seen in the head and thought it would be a good exam to share.

30yr old with brain lesion

Above are axial MRI images of a 30yr old female brain, one being a T2 axial and the other a T1 axial post contrast injection. The patient came into the ER this day because her husband said she had a possible seizure while she was sleeping and the patient stated her body was really sore and weak feeling. A CT of the brain was performed through the ER showing an abnormality. The patient was admitted to the ICU and given meds to prevent another seizure then came to us for her MRI. I felt so sorry for her because as I was screening her I found out her only medical background was the birth of her daughter who was now 18 months old. You could tell she was scared and nervous. I made sure I explained everything that would happen during the MRI since she had never had anything like this done in the past. The thing I thought was unique about this exam is that the area of interest was dictated as being a lesion yet it did not enhance with the contrast injection. I think every mass or lesion I have ever seen has enhanced so this was a note-worthy exam for me to share. The radiologist suggested a differential diagnosis for this finding to be neoplasms with a propensity for the temporal lobe resulting in seizure activity, such as a dysembryoplastic neuroepithelial tumor (DNET). The radiologist also gave several other possible types of lesions the area could be. You can also see in the images that the lesion was causing a mass-effect midline shift in the patients brain.

Spring 2010 Introduction

Hello! My name is Ashley. I am now in my last year of school ever hopefully! I plan on graduating in December with my Bachelor's in Radiologic Sciences. I live in Western Kentucky and take all my classes at USI online through the distance education programs. I love that USI gives me the opprotunity to do this because being a single mom, owning a home, and having to work full time there is no way I would have the time to actually attend class. I graduated from a college here in western Kentucky in 2005 with an Associates Degree in Science from the Radiography Program and decided to go back to school to get my Bachelors in 2009. I work at Lourdes Hospital in Paducah, KY as a CT/MRI tech. I currently only have my R.T. (R) but plan on getting my MR and CT certification when I finish school. Wish me luck! I am doing my clinicals in MRI again this semester so hopefully I will see more interesting exams to post about.