When life throws wheel chairs at you what do you do?

Well, I know some of you out there are well aware of the safety concerns involving MRI. We take every precuation at our hospital to ensure the saftey of our patients, and yet still there is room for improvement. Take for example, The day I scaned a pateint who needed quite a bit of assistance. His wife was his only caretaker and knew how to help him in every way. She was fantastic. Unfourtounately, becuase he was in such bad condition, we decided to use his own wheel chair and stop at the end of the table outside the magnetic field. We moved his chair over to the back of the room, far, far, away. When the scan was done I went in the room to help him get up his wife came into the room to help her husband and she grabbed the chair and moved closer to the magnet. I did not see her becuase my back was turned and I was lifting the patient up from the table. When she eventually got too close the wheel chair flew out of her hands and slammed against the magnet. I can only describe the sound as an aluminum baseball bat hitting a stopsign. I was so scared I had been standing about two feet away from where the wheel chair flew by. It could very easily hit me in the head or the patient. I was lucky. This Is why SAFETY in MRI is ALWAYS FIRST!!!!

Rare and unusal cases (Erdheim-Chester Disease)

Recently, I had a patient come in for a Brain MRI. She had Erdheim-Chester disease. It is a type of histiocytosis. This disease is a rare non-Langerhans cells histiocytosis affecting multiple organ systems . Symmetric sclerosis of the long bones is usually reported, but the central nervous system and sinus can also be affected. Among patients with central nervous system involvement, the most frequent manifestations are diabetes insipidus, cerebellar syndromes, orbital lesions, and extra-axial masses involving the dura . The patient is coming in to be scanned about every 6 months. She is on cobalt and it seems to be helping. Her chemotherapy looks like it is making her very weak, but seems to be helping the disease. I was supprised at how little information there was about this disease on the web when I started looking. I did find one source of information that recomended doing a T2 flair cor in addition to the T2 flair ax. I am glad I did because the lesions in her brain show up better on the flairs than anything else.The lesions enhanced post gad but in a fuzzy sort of way. The flairs offer the best images in the study. Just my $.02.

Erdheim-Chester disease (ECD) is a rare multisystem disorder of adulthood. It is characterized by excessive production and accumulation of histiocytes within multiple tissues and organs. Histiocytes are large phagocytic cells (macrophages) that normally play a role in responding to infection and injury. (A phagocytic cell is any “scavenger cell” that engulfs and destroys invading microorganisms or cellular debris.) In those with ECD, sites of involvement may include the long bones, skin, tissues behind the eyeballs, lungs, brain, pituitary gland, and/or additional tissues and organs. Associated symptoms and findings and disease course depend on the specific location and extent of such involvement. The specific underlying cause of ECD is unknown.

56-year-old woman with progressive chronic cardiac failure who was followed up for 5 years. Erdheim-Chester disease diagnosis was made on basis of typical bone involvement on femurs and perirenal biopsy. Cardiac-gated T1-weighted spin-echo chest images reveal extent of mediastinal infiltration sheathing aorta, superior vena cava, and right pulmonary artery. Infiltration appears as soft-tissue of low intensity (E and F). Pericardium is not visible because it is probably obscured by mediastinal tissue infiltration. Right atrium is obscured by wall thickening and lumen distortion (asterisk, G) associated with presence of pseudomass appearance in anterior and lateral walls (black arrow, G). Another pseudomass is also visible on interatrial septum (white arrow, G). Note dilatation of left ventricle.

48-year-old man with Erdheim-Chester disease presenting with flank and extremity pain. Contrast-enhanced axial CT image shows left perinephric hypovascular mass (arrow) associated with fat stranding. Note moderate hydronephrosis (asterisk). Appearance is nonspecific.

68-year-old woman with Erdheim-Chester disease involving both lower extremities. Coronal T1-weighted MR image (TR/TE, 520/25) of both lower extremities shows diffusely invasive bone marrow masses destroying cortical bones in both tibias.

M. D. Anderson physicians are encouraged by the results of interferon therapy used to treat complications of Erdheim-Chester disease, a rare disorder that attacks the body’s connective tissue. Two patients have experienced significant symptom improvement after receiving interferon alpha treatment at M. D. Anderson.
Erdheim-Chester disease, or ECD, is a potentially fatal disorder caused by the overproduction of histiocytes, which are large cells that help the body respond to infection or injury. These rogue histiocytes accumulate in the loose connective tissue, causing it to become thickened and dense. ECD can affect many areas of the body, including the eye cavity (orbit), skin, brain, long bones of the arm and leg and the lungs.

Cerebral Erdheim Chester Disease

Treatment

Numerous treatments have been attempted for this disease [2,6,13,14].
Corticosteroids are the traditional first-line treatment and are used to control
symptoms, but generally are either ineffective or only transiently effective [2,6].
Bisphosphonates are efficient in treating osteolytic lesions in Langerhans cell
histiocytosis but have only partial or temporary success in the management of bone
involvement in Erdheim-Chester disease [15]. Chemotherapy can induce transient
partial responses, but is often ineffective [2,16]. Cladribine has been used
successfully in adult Langerhans histiocytosis, but its application in Erdheim-Chester
disease is limited to two patients, one of whom responded [16,17]. Radiation,
methotrexate, cyclosporine and azathioprine have not yielded sustained clinical
response [3,18,19,20].
We describe the successful treatment of three patients suffering from Erdheim-
Chester disease with interferon-. The initial therapeutic dose of 3 to 6×106 units s.c.
three times per week, was reduced to 1×106 units three times per week because of
fatigue. This low dose was well tolerated and response was observed within one
month with dramatic reduction in the exophthalmos and recovery of vision in two
patients (case #1 and #3) whose vision was threatened by progressive disease while
on high-dose chemotherapy and/or steroids. Response was also manifested by
- 7 -
gradual improvement in diabetes insipidus (cases #1 and #2) and in bone lesions
(case #2) (Figure 2).
The mechanism(s) underlying the salutary effects of interferon- in Erdheim-
Chester are unclear but could be due to several of the diverse biological effects of this
agent: maturation and activation of dendritic cells [9,10]; immune-mediated (e.g. via
natural killer cells) destruction of Histiocytes; or direct antiproliferative effects [21].
There is also anecdotal evidence of clinical therapeutic benefits for interferon-alpha in
other histiocytic disorders (Langerhans cell histiocytosis [22] and Rosai-Dorfaman
disease [23]).
Erdheim-Chester disease is a rare and difficult-to-treat disease. All three of our
patients with this disorder achieved a long-lasting response (3+, 3.5 and 4.5+ years)
while receiving interferon-. Our observations suggest that this well-tolerated
treatment warrants further application and investigation in this disorder.(source)

MRI WHAT DOES THE FUTRE HOLD ;)

Ok, lets here them. worse case sceneriors. I’m listening.

I know you, “out there” have had a few run in’s with refering physicians, or maybe it was your local Radiologist, whoever the culprit I want to hear about it. Doesn’t every one? So tell me your worst story, and give me all the graphic details. We want to here from you!!

Pacemakers and internal defibrilators

Well, I guess we all knew the day would come but it is getting here much too fast for me. 10 patients in Isreal were done with pacers or defibrilators, all went off without a hitch. You know what this means guys and gals. I can see the order coming across the printer now from the nuerosurgeon, STAT stealth brain MRI, pt has pacemaker. Oh, what fun!!!!

MRI PHYSIC MADE EASY & REGISTRY REVIEW

I AM ALWAYS SEARCHING FOR GOOD PHYSICS SITES, TO HELP BETTER UNDERSTAND THE PRINCIPLES OF MR. IF ANYONE HAS ANY LINKS TO SHARE PLEASE FEEL FREE TO E-MAIL THEM TO ME.

HERE IS A GREAT BOOK ( amazon uk) (THAT HAS HELPED ALONG THE WAY.

HERE is MRI in Practice & MORE GREAT BOOKS CATHERINE WESTBROOK DOES AN AMAZING JOB OF EXPLAINING MRI. IF I CAN GRASP THESE CONCEPTS ANYONE CAN.

I AM USING THIS RIGHT NOW REVIEW QUESTIONS FOR MRI I LOVE THIS BOOK!!!!

ANOTHER BOOK I’D RECOMMEND IS BILL FAULKNER’S RAD TECH’S GUIDE TO MRI EVEN WHEN JUST STARTING OUT I COULD UNDERSTAND THIS BOOK BECAUSE OF THE VERY UNIQUE WAY BILL PRESENTS THESE VERY COMPLEX TOPICS.

THIS WEBSITE IS AN ONLINE TUTOR THAT IS VERY GOOD I ALSO RECOMMEND IT.

WILLIAM FAULKNER ALSO HAS A COURSE FOR REGISTRY REVIEW.

Here are a few good sites good luck!

medical student

Phillips Learning Center

Revise MRI

MRI Tutor

TRY THIS BOOK FOR NEUROANATOMY IT’S REAL CHEAP $20 NEW

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