MiWord of the Day Is… Cinemaradiology!

Yes, it is Halloween today and my kids could barely contain themselves getting ready for school. I suspect today will not be very productive as they count down the minutes before heading out to terrorize my neighbors.


Anyway, how about this for a scary thought: cinemaradiology! In the late 1800’s John MacIntyre at the Gasgow Royal Infirmary experimented with producing X-ray motion pictures. What!!!? He tried exposing film by passing it between the screen of the fluoroscope and the x-ray tube and by simply filming the fluoroscopic screen. This latter method was very difficult because, as all of you budding radiologists know, the images viewed on the fluoroscope screen were dim and of poor resolution at the time.


For years researchers worked on perfecting cinemaradiology. However, during those early years of discovery they lost interest when they realized that sharper images were possible when BOTH patients and investigators were exposed together AND that excessive radiation was a bad thing – duh! 


It would only be many many years later that fluoroscope screen technology would be improved to allow for brighter and higher resolution images (and without frying the patient and everyone around!). 

Fluoroscopy is a study of moving body structures – similar to an x-ray “movie.”  A continuous x-ray beam is passed through the body part being examined, and is transmitted to a TV-like monitor so that the body part and its motion can be seen in detail. As an imaging tool, Fluoroscopy is used in many types of examinations and procedures.

To my knowledge, no actors from the cinemaradiology era ever became successful stars in Hollywood…


No need to use the MiWord of the day in a sentence today (see rules here) as I realize you are busy getting ready for Halloween and need a break!


Decompress listening to the classic song Thriller by the King of Pop Michael Jackson and I’ll see you in the blogosphere…






Pascal Tyrrell

 

MiWord of the Day Is… Cuckoo!

One of my favorite more serious films is One Flew Over the Cuckoo’s Nest. What does Jack Nicholson’s portrayal of a bad guy hoping for easy served time in a mental institution have to do with medical imaging? Well it all starts with the lobotomy. Not to spoil the story, suffice it to say that the movie broaches the topic of lobotomies and how ridiculous they were. Lobotomy was a form of neurosurgery that involved damaging the prefrontal cortex in order to “calm” certain mentally ill patients. Needless to say the procedure was controversial from the beginning (1935 to the early 1970’s) but the author of the discovery, Egas Moniz, was awarded the Nobel Prize in 1949. Maybe not the most sound of decisions by the committee. However, for the time, it was considered progress in a very challenging area of medicine – mental illness. 


OK, medical imaging? Well as it turns out Moniz (do not confuse with St-Moriz, ahhh skiing…) is also known for developing cerebral angiography – a technique allowing the visualization of blood vessels in and around the brain. 



Moniz was interested in finding a non-toxic substance that would be eliminated from the body, but would not be diluted by the flow of blood before the x-ray could be taken. Another requirement is that the substance could not cause an emboli or clot as this would be a bad thing. Moniz played with salts of iodine and bromine and settled on iodine because of its greater radiographic density. And voila, birth of iodinated radiocontrast agents still in use today. Cool.




Supposedly it took him 9 patients to perfect his angiogram technique. Don’t ask about the first 8…

Moral of the story is: lobotomy bad and cerebral angiography good.



Now for the fun part (see the rules here), using Cuckoo in a sentence by the end of the day:

 
Serious: Hey Bob, when I was visiting my aunt in Australia I spied a little bronze cuckoo in her backyard! This could be my “big year“…


Less serious: Someone won a Nobel Prize for developing the lobotomy? Are you cuckoo?
 
 
Listen to Los Lobos (not short for lobotomy but “the wolves” in Spanish) singing La Bamba to decompress and…
 
… I’ll see you in the blogosphere,
 
 
Pascal Tyrrell

MiWord of the Day Is… Fluoroscope!

It is hard to believe that the fluoroscope (essentially an x-ray machine used to produce real-time moving images viewed on a screen of the internal structures of a patient) was used to “help” better fit shoes to your feet! From the 1920 to about 1970 you were able to irradiate your feet with x-rays in order to see if you had enough “wiggle-room” in your new shoes! Crazy. 
 
So, the whole concept of Fluroscopy dates back to you know who, Wilhelm Röntgen. We chatted about him here in our blog. He is also responsible for discovering the interesting phenomenon of barium salts fluorescing when exposed to x-rays (see here in our blog). 
 
Basic function of a fluoroscope
Soon after Rontgen’s discovery was announced, Thomas Edison (the light bulb guy) decided he could improve on this whole x-ray thing as these rays were produced by a “glass tube apparatus” – something he knew a lot about. After setting his team to work – he had a team as he was a very successful man in those days following his 1879 patent of the light bulb – they soon discovered the risks of working with x-rays. Edison decided to remove himself (literally!) from x-ray research. But before he did he developed one of the first (and arguably the most advanced in it’s time ) fluoroscopes along with a full line of x-ray kits. He also coined the term “Fluoroscope”. Interesting man…
Fluoroscopes have come a long way over the years and are still used today in areas such as orthopedic surgery, gastrointestinal investigations, and angiography but, of course, the dose of x-rays a patient receives is minimized and closely monitored. Have a look at this machine from Siemen’s. “Beam me up Scotty!”. 
So how did all of these machines suddenly flood the shoe retail industry? Good question. As it happens, following the development of the high vacuum, hot cathode, tungsten-target x-ray tube by William Coolidge in 1913 the interest for a portable and reliable machine increased dramatically with the advent of the First World War. The successful deployment of numerous machines during the war to aid army physicians spurred the manufacturing industry to mass produce them. After the war, the impact the fluoroscope had on army medicine flowed into community practice. 
 
Due to the enormous supply of portable x-ray machines at the time following the end of the war, Dr Jacob Lowe introduced the idea of using a modified portable x-ray machine in the shoe retail industry. Voila, fried feet fricassee for the next 50 years!

Now If were to be interested in using a fluoroscope to look at my feet I may be inclined to use a suit like this gentleman below is sporting…

WW I x-ray protection suit

Now for the fun part, using Fluoroscope in a sentence by the end of the day:


Serious: Bob, did you know that the foot-o-scope was a modified fluoroscope used to view ones feet when fitting new shoes which delivered on average 13 Roentgens for every 20 second exposure?


Less serious: I heard grampa grumbling he can never find shoes that fit right anymore since they banned fluoroscopes in shoe stores. What is a fluoroscope mommy?




Listen to High Heels to decompress and I’ll see you in the blogosphere.




Pascal Tyrrell

MiWord of the Day Is… Radio!

Easy one today! I thought I would give everyone a break as you have all been working very hard on the MiWord of the day in the past weeks. 


So, what does radio have to do with medical imaging? What a great question! The origin of the root word “Radio” is radiant energy. The radio you immediately think of is the one that is attached to your ear most of the time and has a DJ who selects music to play for your entertainment – along with ads to pay for the station’s bills! The use of “radio” to describe this form of wireless communication comes from the word radiotelegraphy


How about if we were simply interested in a medical picture produced by radiant energy? Well you would end up with a radiograph AKA an x-ray! We talked about that word here. Do you see the trend? How about a picture produced by radiant energy in the visible light range of the electromagnetic spectrum? A photograph. Cool.


OK now suppose you are an MD working in the emergency department and someone presents with a lung disorder. What do you do? Generally, you order a chest radiograph. As you zap your patient with x-rays you expect that most of them will pass through the chest area – that is mostly filled with air – unchecked and will proceed to expose the film (or trigger the detector) resulting in a dark area. However, if the lungs become filled with abnormal substances more of the x-rays are blocked and result in a lighter (whiter) radiograph. What would you be looking for?





1- Pus – a combination of bacteria and white blood cells as seen with pneumonia.
2- Edema – fluid that leaks into the lungs as seen with heart failure.
3- Hemorrhage – bleeding into the lung cavity as seen with trauma.
4- a solid mass – as seen in lung cancer.



Today, we have to use “Radio” in a sentence (see rules here). Easy! Here are two examples to help you along:


Serious: Bob, you will need to remove your radio from your person before entering the MRI. No metal objects are permissible in the room.


Less serious: I went for a radiograph today and all they did was have me stand in a room by myself and that was it! What a relief. I thought for a moment I was scheduled for a radio-graft…!



Have a listen to my favorite Radiohead to decompress and…


… I’ll see you in the blogosphere,




Pascal Tyrrell

MiWord of the Day Is… Ionizing!

So what the heck is ionizing radiation? Well consider the following conundrum about x-rays. They can:


1- cause cancer
2- be used to detect cancer.
3- be used to treat cancer.


Whaaat? How does that work?  We use the term ionizing  when the radiation has sufficient energy to detach electrons from molecules causing them to become chemically reactive ions




The name atom means “indivisable” and are incredibly small. They are made up of protons, neutrons, and electrons with about 99.9% of its mass concentrated in the nucleus that holds a positive charge. A surrounding negatively charged cloud of electrons makes up the difference and the atom stays together due to the attraction between the two. 


OK, so here is the rub: if an atom gains or loses an electron it becomes an ion and generally results in a very chemically reactive substance. This process to produce an ion can be achieved by many ways but one of the most important is electromagnetic radiation (we’ve talked about this already here). Radioactive materials such as radium emit ionizing radiation as does x-ray tubes. There is even such a thing as cosmic radiation (Yup, we talked about that here!). 


Now x-rays produce photons which are the same particles that make up visible light but at a much shorter wavelength and higher energy. When they penetrate through a solid object they will most often simply pass through. However, if they pass by close enough to an electron they can transfer their energy and in the process knock it out orbit producing an ion. Also, the more dense the object the more often the photons are blocked from travelling through resulting in a differential effect on a film or sensor placed on the opposite side. This is how we are able to see inside the body using x-rays.


The problem about ionizing radiation is that the resulting chemically reactive ions can result in DNA damage. Often the cell can repair itself resulting in no permanent damage. Other times, however, permanent damage occurs and can result in cell death (a good thing if they are cancerous cells) or DNA mutations that can in turn lead to the promotion of cancer – bummer.


Now on to using ionizing in a sentence today (not sure about the rules? See here):
Serious example – Bob, don’t stand too close to the x-ray machine. You wouldn’t want to be exposed to ionizing radiation that could damage the DNA in your cells…


Less serious – You wouldn’t believe what happened to me at work today! I was at the photocopy machine getting ready to change the toner cartridge and Bill from sales said:”Let me do that for you, Honey”. He is so ionizing or patronizing or whatever. He makes me mad… 




Listen to Just Because by Raygun to get ready for the weekend and I’ll see you back in the blogosphere soon.




Pascal Tyrrell

MiWord of the Day Is Something to “Bragg” About…


OK who hasn’t made rock candy as a kid? No? Give it a try. Maybe you have a little brother or sister you can impress. All you need is a super saturated solution of sugar, a surface for crystal nucleation (string), and lots of time…


Now what if you were to apply this technique to obtain crystals of DNA? I don’t suggest that you eat it as a treat but you could possibly try X-ray crystallography.


The challenge is that DNA, unlike proteins, is an exceedingly large molecule which does not lend itself to crystallisation. The result is a highly viscous suspension of spiderweb-like filaments. However, it is this very suspension that the DNA molecules were deduced to be neatly aligned alongside one another by studying the X-ray diffraction patterns. This initial challenge was successfully overcome by Rosalind Franklin. Her hard work then laid the ground work for Watson and Crick to piece together the puzzle of DNA structure (winning the 1962 Nobel Prize along with Wilkins).


Now the x-ray crystallography imaging technique is no pic-nic! It was first described by the Australian father-and-son duo William Henry Bragg and William Lawrence Bragg. Essentially x-rays are projected onto a crystalline solid and when analyzing the diffraction patterns it is possible to determine how its molecular atoms are positioned in relation to one another. This is due to x-rays having very short wave-lengths (see x-rays in the blog) and the mathematical analysis of predictable diffraction from the three dimensional structure of the crystal. It was Lawrence Bragg who developed the equation to describe this diffraction and is now known as Bragg’s Law. He and his father won the Nobel Prize for this work in 1915. 


I used to listen to New Order back in the day and they are still singing (and dancing?) with a more recent release of Crystal by New Order. So, listen to the song while making rock candy and maybe you too will come up with a brilliant idea worthy of a Nobel Prize by the time the crystals are big enough to eat.




Now if you remember the rules:


1- I introduce and discuss a word.
2- You have to use the word in a sentence by the end of the day. No need to use it in the correct context – actually out of context is more fun and elicits a more entertaining response!




Today, we have to use “Bragg” in a sentence. Here are two examples to help you along:

Serious: “Hey Bob, did you know that if you used a saturated sodium salt solution of DNA instead of sugar to produce crystals we could then do some x-ray crystallography for fun and apply Bragg’s law to determine the molecular structure…”
 
Less serious: “Bob, I don’t want to Bragg but my crystals are way bigger than yours…”
 
 
 
 
See you in the blogosphere,
 
 
 
Pascal Tyrrell

MiWord of the Day is… Supernova!

So, what does medical imaging have to do with a Supernova? Well in the B-movie – Supernova a deep space medical ship responds to a distress signal from a nearby mining planet and gets too close to a Red Supergiant ready to go Supernova. Is your geek alert tingling?


Well, believe it or not Supernovas are explosions of giant stars. Nuclear fusion produces iron in the cores of these stars. Such dense matter at the core creates a tendency for the star to collapse on itself due to gravitational pull. This is kept in check by the massive amounts of energy the star is constantly releasing. But what happens when the star starts to run out of fuel? Yup, you guessed it. It collapses on itself and implodes. As the star rushes inwards, protons and electrons combine to produce neutrons that in turn collide with the core and produce a crazy big explosion. This sudden release of energy is accompanied by the production of x-rays. Yes, I am serious. What is left behind of the exploded star is either a neutron star or a black hole depending on the mass of the remains.


So, a supernova is essentially a giant x-ray machine? Maybe not. However, by studying these cosmic x-rays astronomers are able to help describe the structure of the universe (not Castle Greyskull). Cool. 


Question for you: should we be concerned with being exposed to cosmic x-rays?  No. Cosmic x-rays are pretty much completely filtered out by our atmosphere by the time they get to the surface. So, how do astronomers get readings? Good question. By placing their recording instruments on satellites and spacecraft, of course!



Now on to using supernova in a sentence today:
Serious example – So did you catch the last supernova in our galaxy? Happened about 400 years ago. No? The next one should be soon as it is overdue by about 300 years. 


Less serious – Growing up I always loved the Chevy Nova SS. Especially when it was customized. It surely was a super Nova…




Enjoy Ray LaMontagne – Supernova to recover from today’s post and  I’ll see you in the blogosphere.






Pascal Tyrrell

MiWord of the Day Is… Pentimenti!

What!!? Do you find it on pizza or in the middle of green olives? Well actually, it is a word of Italian origin and describes minor changes in a painting during its composition. So, similar to erasing some of your hand writing and then writing over it again with the corrected text. I guess for you younger folk it would be like pressing back-space and then re-typing! The difference of course is that there would NOT be any pentimenti as there would no trace of your previous attempt…


So what does this have to do with medical imaging? In our last Mi word of the day we talked about x-rays. Now, today we take x-rays and our ability to peer inside the human body for granted. So what else can we see with x-rays? Believe it or not x-rays can also help to reveal how a painting evolved from first brush strokes to finished product. X-ray analysis can help to describe the paint composition to the different layers that may exist in the painting.


Consider, for example, “Patch of Grass” by Van Gogh seen above. It was discovered by x-ray analysis that this 1887 painting completely concealed a portrait of a woman that Van Gogh had painted over. He often did this to save money on canvases (maybe to buy Absinthe – how naughty!). In this case, in addition to Van Gogh’s pentimenti is his habit of painting over previous works. All of this adds to a type of “fingerprint” that art appraisers use to identify works of art from forgeries… Cool.

Today, we have to use “pentimenti” in a sentence (see rules here). Here are two examples to help you along:

Serious: I wonder how Van Gogh’s pentimenti differs from that of Rembrandt. Maybe I should ask the Musee du Louvre’s curator for some insight.

 
Not so serious: Yes, I would like to order a large pizza with pentimenti, double cheese, and mushrooms. No pentimenti? Alright, pepperoni works just as well…




See you in the blogosphere,


Pascal Tyrrell

MiWord of the Day Is… X-Ray!

Yup! Want some of that. Not only is Superman cool but he has x-ray vision. Unbelievable. Or is it? Radiologists have the same x-ray vision but without the Spandex suit – or at least they don’t wear it to work that I am aware of.


The word of the day is x-ray. You have already successfully used “Roentgen” in casual conversation last week (don’t know what I am talking about? See Mi Word of the Day Is… Roentgen!) and today I will talk a little about what Roentgen was first in measuring and describing – x-rays.


Let’s say you are in your lab and you are working with passing electrical discharges through vacuum tubes – a typical Saturday afternoon activity with friends. As chance would have it your little sister’s barium salts paintings happen to be drying near-by and you notice a faint glow emanating from them every time you run your experiments. No matter how much you try to block any light coming from your vacuum tubes the glow persists. What? That’s odd. How’s that happening? Well my friend, you have just crossed over into the Twilight Zone (awesome old tv series) and discovered a form of electromagnetic radiation.


Visible light is but a very small part of the electromagnetic spectrum. Moving from visible light to longer wavelengths and lower frequencies we find infrared (keeps food warm at restaurants), microwaves (to warm your pizza pop) and radio (not the one streamed through the internet!). 


Now if you move in the opposite direction from visible light you find shorter wavelengths with higher frequencies starting with ultraviolet (what helps you get that summer tan), x-rays (word of the day), and finally gamma rays (topic for another day!). So x-rays are about the size of atoms and radio waves the size of buildings. Crazy. I think what is surprising is that with the naked eye we “see” so little and yet so much (philosophy anyone?).


So, x-rays are short wavelength, high frequency, high energy electromagnetic radiation that is able to penetrate some substances more easily than others. For example, they penetrate flesh more easily than bone, and bone more easily than lead. Thus they make it possible to see bones within flesh and a bullet embedded in bone. The ability of X rays to penetrate depends on their wavelength and on the density and thickness of the substance being scanned.

 

 

Now if you remember the rules:

 

1- I introduce and discuss a word.
2- You have to use the word in a sentence by the end of the day. No need to use it in the correct context – actually out of context is more fun and elicits a more entertaining response!
 
 
Today, we have to use “x-ray” in a sentence. Here are two examples to help you along:

Serious: Hey Frank, did you know the radiation you received during your chest x-ray last week was actually “soft” x-rays? Ones with shorter wavelengths and more penetrating power are used for scanning archaeological artifacts.


Less serious: Frank! Dude, I got them! My x-ray specs just came in the mail. Let’s go the beach…

See you in the blogosphere,




Pascal Tyrrell

MiWord of the Day Is… Roentgen!

Welcome to the first Medical imaging Word of the Day! Here is how it works:


1- I introduce and discuss a word.
2- You have to use the word in a sentence by the end of the day. No need to use it in the correct context – actually out of context is more fun and elicits a more entertaining response!




OK, here we go. The word of the day is Roentgen – typically pronounced “Rent-gun”.

Wilhelm Roentgen was a physicist from northern Germany who in 1895 was the first to detect the now famous x-ray. Interestingly, he was not the first to produce them. The x-ray is part of the electromagnetic spectrum that contains shorter wavelengths (0.01 to 10 nm) than visible light (390-700 nm). We will talk about this in another post as today it is about Roentgen.

 
The interesting discovery was that it was a new kind of light – one that could not be seen but could be detected. Most importantly it gave physicians the ability to peer inside the body of a patient without having to cut it open – a camera that can see inside the body.
 
An interesting and maybe ironic fact is that Roentgen – the discoverer of a new way to “see” – was blind in one eye (from a childhood illness) and color blind
 
Here are some other interesting facts:
 
  • Following his discovery the “Roentgen unit” was described and used to measure x-ray exposure (one R is 2.58×10−4 C/kg). About 500 R over 5 hours is considered a lethal dose for humans.
  • Roentgen was the first scientist to receive the Nobel prize in physics in 1901. He refused to patent his discovery and gave the entire prize money to his university. Wow, what a guy!
  • He died of colon cancer in 1923.
 
So, now we have to use “Roentgen” in a sentence. Here are two examples:
 
Serious: Hey Frank, I see you just came back from having a chest x-ray. Did you know that you just received about 1/20 of a Roentgen? Oh, and I am glad to hear you don’t have pneumonia…
 
Not so serious: Hello, I will be travelling to Europe this summer and will need to exchange some Canadian dollars for Euros. Could you tell me the exchange rate? And while you’re at it, what is today’s rate on the Roentgen? Never heard of that currency? Really? It’s German I think…
 
 
OK, unbelievably I found a music link to Roentgen! Hyde produced an album named “Roentgen” and one of the main tracks is aptly called “Unexpected“. Yup, I’m serious…
 
 
See you in the blogosphere,
 
 
Pascal Tyrrell