The Power of Imaging

Carly Carey (00:11) We can't expect the best doctors and nurses if we're not providing them opportunity to be the best. And to be the best, they need equipment to do all the cutting edge kind of work that they deserve to do. Barney Ellis-Perry (00:34) Welcome to Harboring Hope. podcast brought to you by the Nanaimo District Hospital Foundation. I'm Barney Ellis-Perry, CEO of the foundation and your host for this series. We're on an exciting journey with our dedicated donors who you will hear from throughout this series as they share why it is in our nature to give and their collective vision for improving health across central and north Vancouver Island. In each episode, we'll take you behind the scenes at the Nanaimo Regional General Hospital, Oceanside Health Centre and other facilities supported by our foundation to explore the many departments, innovation, and dedicated professionals who keep our healthcare system running from doctors and nurses to administrative leaders and patients with lived experience. We'll hear powerful stories that reveal both the challenges and the triumphs within our hospital walls. Most importantly, we'll shine a light on the critical role our community plays because behind every success story is a network of generous supporters helping to make it all possible. Today we're joined by Dr. Rob Johnson, the head of radiology at NRGH, as well as Carly Carey, a two-time cancer thriver and friend of the foundation to talk about all things imaging. So let's get into the conversation. Imaging is a very essential service in healthcare. It includes x-rays, CT scans, MRI, ultrasound, and the list goes on. These technologies help doctors diagnose countless ailments and are constantly being used to save lives. However, as with any technology, what once was revolutionary slowly becomes out of date each year. Today, we want to share the importance of this technology and how you can help support this department. Let's meet Dr. Johnson first. Dr. Johnson grew up in Vancouver and his education took him from UBC to Montreal to Toronto and to Calgary. Then, luckily for us, in 2000 he settled in Nanaimo and has been here ever since. Before we dive into the imaging department at NRGH, I asked Dr. Johnson to give us a Radiology 101 lesson. Dr. Rob Johnson (02:27) Yeah, most people at one point in their life are going to come through a medical imaging department for one thing or another. The other modalities that we use in medical imaging like x-rays, if you twist your ankle or you have a wrist that you're worried about a fracture, you'll have an x-ray. Or if you have abdominal pain and you need a CT scan, both of those modalities use x-rays. A normal x-ray just passes x-rays through your hand or whatever we're imaging to get structural detail, structural information about the part of your anatomy that we're interested in. CAT scans are the same. It uses an x-ray tube that's spinning around you to create a slice image that computers are used to make a three-dimensional image or a slice image through whichever body part we're interested in. Ultrasound uses ⁓ sound waves that we pass into the patient and that same probe that the technologist is holding receives the reflection of that sound wave back again to make a structural image. MRI uses radio waves inside a fixed magnetic field. The radio waves go into the patient, radio waves come back out and we use those radio waves to make an image. All of those modalities are giving you a structural image of whichever body parts you're interested in. Barney Ellis-Perry (03:42) Another interesting type of imaging is nuclear medicine, which is very different from other types of imaging. Dr. Rob Johnson (03:48) Nuclear medicine is different in that it's a functional thing. Instead of seeing the structure of whatever organ we're interested in, we're looking at the function of that organ. And by changing which chemical we give to the patient, we will see the function in different organ systems. Barney Ellis-Perry (04:06) So let's talk a little bit more about nuclear medicine, specifically at NRGH. Dr. Rob Johnson (04:11) When I came here in 2000, there were two nuclear medicine cameras in the department. The foundation at the time was very generous and helped at that point, It wasn't called Island Health, but the Regional Health Authority at the time helped us acquire a third nuclear medicine camera. And as of 18 years ago anyway, we had a three camera department that was very up to date. All of the cameras that we had were state-of-the-art. But then, as is the case in a lot of healthcare over the course of years and years, camera's age or equipment ages, as of three years ago, we still had those same three cameras that were state of the art 20 years ago and were no longer state of the art. Starting a few years ago, I'm going to say seven or eight years ago, the replacement of our oldest camera was number one on the capital list for a number of years in a row. But as is the case with healthcare, there are frequently fires that have to be put out. And if something is more urgent, some piece of equipment is deemed to be more necessary at the time, it changes where your piece of equipment falls in the capital list. And so a number of years in a row, the gamma camera that we had anticipated getting was put off one more year, one more year, one more year, and to the point where we were really starting to struggle with camera downtime and not being able to put as many patients through the nuclear medicine department as we should have. When we got the third gamma camera about 20 years ago in the department, we had three cameras. So we were able to image a lot of people in nuclear medicine. Over the course of the years, as capital budgets have fallen and as healthcare costs have gone up and our availability to new equipment has... diminished. We've had to change the department to become a now it's a two camera department. At the same time the workload is going up and the population of the central island is going up. Barney Ellis-Perry (06:07) One of the things that Dr. Johnson is very proud of is his team's track record for the early detection of breast cancer. Dr. Rob Johnson (06:13) We just got a new mammogram machine at NRGH as well that instead of just doing two-dimensional mammogram images, now does three-dimensional slice images, which will also help us find cancers earlier and find them more accurately and localize them more accurately. Barney Ellis-Perry (06:31) We at the Foundation were thrilled to pay for the new SPECT-CT CT machine at NRGH. On the topic of cancer, I was able to chat with a two-time cancer thriver, Carly Carey, who is a friend of the Foundation. She has long been involved with the Foundation and even ran an incredibly successful campaign for the new SPECT-CT CT for the hospital. Let's meet Carly now. Carly Carey (06:50) I have been a long-time volunteer and I worked as a volunteer for a different organization for about eight years and that tenure came to a close and I was thinking about what I was going to do next and Janice Krall actually reached out to me on LinkedIn and she just kind of sent me a really lovely message, hey I would love to get to know you more, can we meet up? And funny story about this and Janice and I laugh about this a lot is my first initial reaction was no. I don't think I have anything to offer. ⁓ I had this preconceived notion about volunteering for hospitals that it was a little more conservative and maybe was a lot of board meetings and data and financials and none of that really fit with my type of volunteering and personality. But you and Janice were so great because you kept providing me opportunities over time that you thought I might think is fun or match my personality. I would say that my engagement with the hospital is largely in part because of how amazing you, Tina, and Janice are, because you've been really good at pairing what you think I might be good at with some of your initiatives. Barney Ellis-Perry (08:06) So let's hear more of Carly's story of her first diagnosis of cancer when she was 18. Carly Carey (08:11) Yeah, I was 18, my first year of university, not a care in the world, thought I was invincible, and then I got diagnosed with cancer. Honestly, being young is such a blessing. I really didn't even think it was a big deal. I'm like, okay, what do we have to do to resolve this? And then let's do it. So the Nanaimo Hospital was really, really a wonderful experience because I was able to get all my chemo treatments there, which meant every three weeks or whatever the cycle was, I would just go down the road and get chemo. Barney Ellis-Perry (08:40) Carly was born on a houseboat in Port Hardy with no electricity or running water. However, she and her parents made the move to Nanaimo just before her cancer diagnosis. Carly Carey (08:49) I often think about what my life would have been like had my parents not moved to Nanaimo and what the journey would have been when I was diagnosed with Hodgkin's lymphoma at 18 if I had to make my way from Port Hardy to the nearest cancer centre. And that would have totally changed my experience. ⁓ But I'm lucky that I did live in Nanaimo. Barney Ellis-Perry (09:10) The SPECT-CT-CT machine, the one that Carly ran a campaign for, is very important when it comes to cancer diagnostics. The SPECT-CT uses nuclear medicine, like we talked about earlier with Dr. Johnson. Dr. Rob Johnson (09:20) dealing with cancer, staging is incredibly important from a treatment planning point of view, knowing how far the cancer has gone, where it's gone, which organs are involved. Nuclear medicine plays a significant role in that, determining before surgery or shortly after surgery whether a tumor has metastasized to the bones or metastasized to other organs. They have to know that the treatment that they are giving is ⁓ appropriate for the stage of cancer. The type of cancer, and they also want to know whether the treatment that they're giving is working. So cancer staging and cancer follow-up is a huge part of our medical imaging department, particularly in nuclear medicine, to see whether the treatments we've put someone on, or the cancer agency has put someone on, whether those treatments are working, whether they are improving, or whether they are resistant to the treatments that they're getting. If those treatments aren't working, they may choose to go in a different direction. If they are working, they'll carry on with the treatment plan that they're using at the time. And ⁓ nuclear medicine certainly figures into whether something's working, whether something needs to be adjusted, and how well it's doing, that treatment regimen. Barney Ellis-Perry (10:37) With an increasing demand and decreasing availability, the doctors have to prioritize some requests over others. It's difficult on both the doctors and the patients. As I close out my conversation with Dr. Johnson, I ask him where he sees the department in the next five to 10 years and what his perfect future would look like. He says that PET scans are what's important. Dr. Rob Johnson (10:56) Perfect future? Well, actually we're in a significant transition point right now that we're on the verge of a number of new imaging agents coming online. Most of those will be PET. Most of nuclear medicine has a difference between the United States and Canada. PET has been a workhorse in the United States for a long, long time. It's very expensive and Canada has been relatively slow to pick it up mostly from a... ⁓ capital cost and cost of creating the chemicals and doing the imaging. We're discovering as health authorities across the country that it is an incredibly valuable resource and incredibly valuable to modern medicine. The cancer treatments that we give are incredibly dependent on knowing that you're giving the right one and knowing that it's working properly. And PET is very important for that. PET is on the verge of becoming mainstream. It's already mainstream, but it's on the verge of becoming much more widely distributed than it was in BC until not too long ago. It's been available in Vancouver, but it'll be available everywhere in the province in the next few years. And it'll be very important for proper staging and following cancer patients. Barney Ellis-Perry (12:14) So how can you help? You can donate to the Hospital Foundation, but you can also take inspiration from Carly's story and get involved with the Foundation through fundraising efforts. Every gift counts towards helping improve our healthcare here on Central Island. And if you don't believe me, here's Carly for the final word. Carly Carey (12:29) I'm a very regular person. I have a regular job, a regular family, and I have found a way to support my community through volunteer work. And I get busy too and I get stressed. But I think we all have it in us to just do a little something. And it doesn't have to be monetary. It can be the gift of time or getting involved in one way or another, you know, preferably with the Hospital Foundation, because I do think we're at a critical point, but if not even anywhere in your community, volunteering is such a reward to yourself and to your community. So if you've been going back and forth on whether you should, Janice and Barney and Tina are the most approachable people in the world. And I do think that your life will be enriched in so many ways if you can find your way to some kind of volunteer work. Barney Ellis-Perry (13:25) Thank you for joining us today on Harbouring Hope. To learn more about the Nanaimo and District Hospital Foundation, please visit nanimohospitalfoundation.com. I'm your host, Barney Ellis-Perry. If you are a current or future partner of the foundation, thank you. With your unwavering support, we are delivering a new standard of care for all who call this amazing region home. Together, it's in our nature to give. Carly Carey (14:03) Another Everything Podcasts production. Visit everythingpodcast.com, a division of Pattison Media.