Week #3: Opposite ends of the spectrum
Another week in the trenches and a whole new set of cases that have been read in MRI. I think that my experience with Dr. Prince has been a bit different from everyone else's because my focus is on MRI, not speaking to patients and watching surgeries, but that doesn't make it any less interesting!
We're all engineers or at least aspiring to be engineers and MRI is a great example of how scientists and engineers can reshape the medical field. It can all be traced back to Raymond Damadian's original patent filed in 1971 and issued in 1974 (Pat. No. 3789832). Damadian's patent and several journal articles disclosed that he had discovered certain mouse tumors displayed elevated relaxation times compared to normal tissues. This Damadian hypothesized could be used in humans to identify diseased tissue from healthy tissue with much greater contrast than offered by X-ray and Ultrasound. This discovery combined with recent work in cryogenics made possible the construction of large super-conducting magnets necessary for MR-imaging in humans and thus MRI was born.
The story goes that Damadian and colleagues designed and built their own whole-body super-conducting magnet while at the State University of New York. Here is a diagram from Damadian's 1971 patent showing the MRI device that he had envisioned:
(Image taken from U.S. Patent and Trademark Office)
The first commercial scanner named 'Neptune' was installed at the Hammersmith Hospital in London and had a magnet strength of 0.15T (no that isn't a typo). The most common modern day scanner strength is 1.5T which provides many major improvements over the original 'Neptune'. With the involvement of large corporations like Siemens, GE, and Phillips, and collaboration in the medical research field, MRI has come a long way from the first human images ever reported.
As an interesting aside the 2003 Nobel Prize in Medicine was awarded to Paul Lauterbur and Sir Peter Mansfield for their contributions MRI (Lauterbur's contribution was the discovery that gradients in the magnetic field could be used to generate two-dimensional images and Mansfield analyzed the gradients mathematically). The Nobel committee snubbed Domadian, the pioneer and father of modern day MRI by not awarding him a Nobel Prize. Shortly after the committee's decision, Damadian took out expensive, full-page advertisements in major newspapers to protest their decision - the advertisement can be seen here.
The title of my post this week is "Opposite ends of the spectrum" and it comes from my experience last week of two different memorable cases. In the first case, the patient was 100% ignorant about his health and condition as well as why he was being subjected to an MRI. He had such a lack of interest in his condition and had no desire to help himself that he adamantly refused to be scanned. The second patient was the exact opposite, he was informed (both by the physician and through research he had done independently) and was eager to undergo the MRI to begin to fix the problems with his health.
It seems to me that the most difficult problem in the medical field is getting people to understand - and want to understand - their condition and treatment. From my experience in observing patients being scanned it seems that a majority of them have no clue what is being done or even why it is being done. I have found it rare that a patient has a firm grasp of their condition and treatment that they can have an intelligent discussion with the Radiologist or Physician about it.
In the first case, the patient initially agreed to the scan. The technicians setup the machine, put the patient into the scanner, and began to acquire images. Four minutes into the image acquisition the patient got agitated and wanted to get out the machine. While the cylinder inside the magnet is small, his movements were enough to ruin the images that were acquired. The technician operating the machine got on the speaker and tried to calm the patient down and convince him the lie still so they could finish the scan. The patient suprisingly agreed and they continued to scan.
One minute into the new scan the patient begins to move again and this time seems even more agitated than before. The technician gets on the speaker and tries to calm the patient down. Unfortunately this time he isn't successful. He seemed to have the opposite effect - upsetting the patient even more. The man became so agitated that he began to pull the inside of the scanner apart exposing the fiber-optic lighting system. At this point Dr. Prince decided to stop the scan and pull the patient out.
It took 15+ minutes and the assurance of the doctor, multiple technicians, a few residents and fellows, and some drugs to get the patient to agree to finish the scan. It took a lot of effort to convince one man to sit still for 5 minutes because it was going to benefit his health. After getting the coils realigned, and putting the patient back in the scanner, the technician was finally able to finish.
In contrast, the other case was as easy as it gets because the patient knew what is going on and also had a vested interested in following all of the technicians instructions. Unfortunately, most of the cases are more similar to the former than the latter.
I have learned that the sign of a good technician is someone who can communicate with the patient on a personal level to comfort them during the scan. This desired trait is opposed by the fact that operating a scanner is technically complex and generally best suited for someone who is computer savvy. In laymen's terms, the best MRI technician is a nerd with an amazing personality - this is a hard combination to come by. Sorry if that last comment offended anybody but we all know that nerds are generally socially inept and the inverse is true for socialable people.
Until next week, I hope you all had as good a time as I did observing patients and the weird things they do and say.
We're all engineers or at least aspiring to be engineers and MRI is a great example of how scientists and engineers can reshape the medical field. It can all be traced back to Raymond Damadian's original patent filed in 1971 and issued in 1974 (Pat. No. 3789832). Damadian's patent and several journal articles disclosed that he had discovered certain mouse tumors displayed elevated relaxation times compared to normal tissues. This Damadian hypothesized could be used in humans to identify diseased tissue from healthy tissue with much greater contrast than offered by X-ray and Ultrasound. This discovery combined with recent work in cryogenics made possible the construction of large super-conducting magnets necessary for MR-imaging in humans and thus MRI was born.
The story goes that Damadian and colleagues designed and built their own whole-body super-conducting magnet while at the State University of New York. Here is a diagram from Damadian's 1971 patent showing the MRI device that he had envisioned:
(Image taken from U.S. Patent and Trademark Office)The first commercial scanner named 'Neptune' was installed at the Hammersmith Hospital in London and had a magnet strength of 0.15T (no that isn't a typo). The most common modern day scanner strength is 1.5T which provides many major improvements over the original 'Neptune'. With the involvement of large corporations like Siemens, GE, and Phillips, and collaboration in the medical research field, MRI has come a long way from the first human images ever reported.
As an interesting aside the 2003 Nobel Prize in Medicine was awarded to Paul Lauterbur and Sir Peter Mansfield for their contributions MRI (Lauterbur's contribution was the discovery that gradients in the magnetic field could be used to generate two-dimensional images and Mansfield analyzed the gradients mathematically). The Nobel committee snubbed Domadian, the pioneer and father of modern day MRI by not awarding him a Nobel Prize. Shortly after the committee's decision, Damadian took out expensive, full-page advertisements in major newspapers to protest their decision - the advertisement can be seen here.
The title of my post this week is "Opposite ends of the spectrum" and it comes from my experience last week of two different memorable cases. In the first case, the patient was 100% ignorant about his health and condition as well as why he was being subjected to an MRI. He had such a lack of interest in his condition and had no desire to help himself that he adamantly refused to be scanned. The second patient was the exact opposite, he was informed (both by the physician and through research he had done independently) and was eager to undergo the MRI to begin to fix the problems with his health.
It seems to me that the most difficult problem in the medical field is getting people to understand - and want to understand - their condition and treatment. From my experience in observing patients being scanned it seems that a majority of them have no clue what is being done or even why it is being done. I have found it rare that a patient has a firm grasp of their condition and treatment that they can have an intelligent discussion with the Radiologist or Physician about it.
In the first case, the patient initially agreed to the scan. The technicians setup the machine, put the patient into the scanner, and began to acquire images. Four minutes into the image acquisition the patient got agitated and wanted to get out the machine. While the cylinder inside the magnet is small, his movements were enough to ruin the images that were acquired. The technician operating the machine got on the speaker and tried to calm the patient down and convince him the lie still so they could finish the scan. The patient suprisingly agreed and they continued to scan.
One minute into the new scan the patient begins to move again and this time seems even more agitated than before. The technician gets on the speaker and tries to calm the patient down. Unfortunately this time he isn't successful. He seemed to have the opposite effect - upsetting the patient even more. The man became so agitated that he began to pull the inside of the scanner apart exposing the fiber-optic lighting system. At this point Dr. Prince decided to stop the scan and pull the patient out.
It took 15+ minutes and the assurance of the doctor, multiple technicians, a few residents and fellows, and some drugs to get the patient to agree to finish the scan. It took a lot of effort to convince one man to sit still for 5 minutes because it was going to benefit his health. After getting the coils realigned, and putting the patient back in the scanner, the technician was finally able to finish.
In contrast, the other case was as easy as it gets because the patient knew what is going on and also had a vested interested in following all of the technicians instructions. Unfortunately, most of the cases are more similar to the former than the latter.
I have learned that the sign of a good technician is someone who can communicate with the patient on a personal level to comfort them during the scan. This desired trait is opposed by the fact that operating a scanner is technically complex and generally best suited for someone who is computer savvy. In laymen's terms, the best MRI technician is a nerd with an amazing personality - this is a hard combination to come by. Sorry if that last comment offended anybody but we all know that nerds are generally socially inept and the inverse is true for socialable people.
Until next week, I hope you all had as good a time as I did observing patients and the weird things they do and say.
posted by Evan Spiegel at 3:54 PM
1 Comments:
An interesting anecedote from the scientific world: My MRI lecturer, Dr. Donald McRobbie (1st author of From Picture to Proton) was (mis)quoted by desperate Damadian for saying that he (Damadian) deserved the Nobel Prize drawing evidence from the book. Dr. McRobbie had to clarify to the press that he did not say that and furthermore, Damadian did not patent the MRI scanner - he just patented a 'blackbox' style drawing of a large cylinder with magnet, that can potentially be used to detect cancer. :p
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