|Three images of a woman with non-Hodgkins lymphoma over the course of her treatment show (top to bottom) extensive cancer, diminished cancer cells and, finally, complete resolution.|
It’s enough to make even the radiologists say “Wow” every now and then. The awesome ability to peer inside the human body is changing the practice of medicine in ways we could only dream about 20 years ago. In the Department of Radiology, the physicians — along with physicists and engineers who work alongside them — are passionate about taking the technology to new heights.
If you walk along the corridors of the University of Maryland Medical Center's Gudelsky Building’s first floor, you will see the radiologists in darkened rooms, sitting before oversized computer screens and manipulating three-dimensional images whose revelations determine the course of treatment for patients.
On the second floor of Gudelsky, interventional radiologists not only diagnose, but also treat disorders ranging from aneurysms to liver cancer and uterine fibroids.
The Medical Center is pioneering the latest generations of the most advanced modalities, investing more than $21 million in capital investment in diagnostic imaging during fiscal 2005 and 2006. The payoff: saving lives, preventing invasive procedures and giving patients the information they need.
The impressive array of machines includes a new 3-Tesla MRI scanner — the strongest approved for use in health care — as well as two new 1.5-Tesla scanners; two new 64-slice CT scanners — the highest resolution available — and two new 40-slice scanners.
Our Adult Emergency Department is one of the first in the world to use cardiac CT scanning to diagnose the cause of chest pain. For patients with pain and a slightly abnormal EKG, but no certain signs of a heart attack, our radiologists are evaluating cardiac CT scanning as a diagnostic tool that can be used instead of the more invasive cardiac catheterization.
“It will revolutionize how we evaluate chest pain,” says Reuben S. Mezrich, M.D., Ph.D., chief of radiology for the Medical Center, and chairman of the Department of Diagnostic Radiology and Nuclear Medicine at the School of Medicine. “With one scan, we get strikingly clear images and can detect or rule out a blockage in the coronary artery, a problem with the heart muscle, an aortic tear or a pulmonary embolism — in two minutes,” Dr. Mezrich says.
The slices from CT scanning are reconstructed and manipulated within minutes into 3-D color images that even patients and their families can appreciate. Radiologists assign colors to different densities, resulting in a realistic picture.
For some of the imaging enhancements, thank Hollywood. Technology used in movies such as “Jurassic Park” and “Terminator II” has led to 3-D modeling, also called “volumetric” reconstruction.
“It tends to make for a more compelling image to share with the referring physician, the patient and the family,” says Charles S. White, M.D., chief of thoracic radiology and professor of radiology and medicine.
Virtual colonoscopy involves a CT scan of the colon reconstructed as a 3-D moving picture, traveling through the colon, on the lookout for polyps that could later become cancerous.
If a polyp is found, patients would still need a colonoscopy to remove it. But only about 20 percent of patients will actually have a polyp, so the virtual version could help a majority of patients avoid the invasive procedure.
In the R Adams Cowley Shock Trauma Center, where every second counts in the “Golden Hour” of opportunity to save lives, a 15-second head-to-toe CT scan can reveal blood clots or weaknesses that, if undetected, could prove fatal.
Stuart E. Mirvis, M.D., director of emergency radiology/trauma radiology and professor of radiology, says the scan can provide enough information to yield countless images — all accessible from the physicians’ PCs.
“I got into radiology at a time when none of this existed,” Dr. Mirvis says. “When I talk to the new radiology residents, I say, ‘You have no idea how far we’ve come in the last 20 years.’ ”
Statscan, a quick, low-dose, whole-body X-ray takes just 13 seconds. No other center has Shock Trauma’s depth of experience with this tool.
The federal government has approached Dr. Mirvis about how Statscan might be used for disasters and mass casualty situations.
For patients and their families, the wait can seem endless to learn whether a course of chemotherapy or radiation was effective.
In PET/CT scanning, high-quality CT imaging shows detail of the anatomy and structure of the tumor, and PET scanning reveals whether the cells are active. Before the scan, patients receive an injection of a radioactive type of glucose. Because cancer cells are particularly high users of glucose, they show up distinctly.
“PET/CT is a primary technology for evaluating patients with cancer, both for staging and for following the response to therapy,” says Bruce R. Line, M.D., director of the division of nuclear medicine and professor of radiology. “It really comes down to having a more concrete way of visualizing the death of cancer cells after chemotherapy or radiation therapy, which may kill cancer cells without immediately changing the size of the tumor,” Dr. Line says.
“We routinely use high-quality diagnostic CT combined with PET,” Dr. Line adds. This gives patients the best diagnostic study to evaluate their conditions, manage their care and choose the best therapies.
Radiology has just begun to explore the potential for magnetic resonance imaging (MRI). Diffusion Tensor Imaging helps neurosurgeons plan how to cut into the brain. The new 3-Tesla machine will maximize use of this new modality.
Spectroscopy with MRI detects chemical differences of malignancy, especially useful for breast imaging. Mammography is still the gold standard for screening, but in women with dense breast tissue and high risk, MRI will pick up tumors that might have gone undetected in a mammogram.
“The 3-Tesla MRI, combined with spectroscopy, may be much more sensitive in detecting cancer,” says Helen Mrose, M.D., Ph.D., director of breast imaging and associate professor of diagnostic radiology.
The department will soon also have digital mammography, which allows immediate viewing.
Dr. Mrose says she and the other radiologists in breast imaging read every mammogram, perform every sonogram, and have streamlined the process for patients.
“If a woman calls in saying she has a lump, she can usually be seen within a day,” Dr. Mrose says. “We are part of a multidisciplinary breast evaluation team, and we will contact other members to arrange prompt follow-up.”
“Aneurysms — tiny bubbles on the vessels of the brain that can burst and kill — no longer need to be treated through a hole in the skull,” says Gregg Zoarski, M.D., director of diagnostic and interventional neuroradiology and associate professor of radiology and neurosurgery. “Instead, small platinum coils are inserted into the aneurysm through a very small catheter to make the bubble clot off.”
Sophisticated imaging equipment provides a virtual roadmap of the vessels of the brain, head and neck.
“This is the true ‘OR of the Future.’ We’re not going to take the CT to the OR. We’re going to bring the OR to the CT room,” Dr. Mezrich says.
By Anne Haddad