Clinical Experience

I have seem quite a bit of pathology in the past few weeks. One lady had severe discitis in her lumbar spine. She complained of low back pain for a few months and was sent to us by a chiropractor. The study was ordered without contrast, but after consulting with the radiologist we gave the patient contrast. I followed up with the radiologist to see what the next step would be to treat something like this. He said that she would definitely have to see back specialist instead of her chiropractor, and most likely would be put on oral medications or could have a biopsy to confirm the discitis before treatment was made.
Another case that I saw imaging from, but did not scan myself , was a 33 year old female who came in to have her hip scanned. She had been complaining of low back pain radiating into her hip since shoveling snow. She was seeing her chiropractor for her symptoms. The chiropractor sent her for an MRI of her lumbar spine (not at my facility) a few months ago when the symptoms started. This facility only ran T1 and T2 sagittal images. The MRI was dicatated as normal, negative for any pathology. Once the tech and my facility started scanning, she was seeing highlighting in the hip area. She contacted the radiologist on call to take a look at the imaging. The radiologist asked the technologist where the primary was, meaning primary cancer. The tech said that there was no primary known. I later spoke with the radiologist who showed me the images and explained that this women with no known history of cancer has mets in her spine, acetabulum, liver, and uterus. The worst part of this whole thing is that if the facility that imaged her originally would have run a flair, they would have been able to diagnose her several months ago, and maybe treated her before she has so many mets.

Clinical Experience

Treatment planning scans are something that my facility does for a local cancer center. The type of treatment the patients receive is called cyberknife. The majority of the scans that we do are brains, but sometimes we scan spines or abdomens for treatment planning as well. These cases make me very anxious. They are not hard scans, one sag for our radiologists benefit and then pre and post contrast T1 axial scans. Everything must be exact so that the treatment can be set up appropriately. We have done quite a few in the past few weeks. I am becoming more comfortable with the brain scans. The spine and abdomens I have only seen a few of. One patient this week had primary breast cancer with spine mets in the thoracic and cervical spine. She also had a syrinx. This was one of the worst cases of pathology that I have seen in MRI.