Radiology (X-RAY VISION) with Varshana Gurusamy

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It's your uncle's ex wife who collects wind chimes, Ali Ward. So you, fine listener, are a bag of chaos. Just organs and tubes, fluids, benign lumps, squishy miracles. Let's get to know what's inside you and me and me. I've got all of that too, But first, thank you. Thank you so much for listening to ologies, and thanks for telling your friends and co workers and your tax preparators about the show. So many new people listening lately, and it's all thanks to you guys for yacking about it.

Yes, I live in Houston.

Are you from Texas?

So I grew up in Keller, which is a small town north of Fort Worth.

Doctor Varshauna Ghirosami went to Baylor College of Medicine in Houston for her undergrad and then she got a master's in Texas. She went and did grad school and med school in Philadelphia, and then she headed back to Texas, back to Baylor. Were you excited to go back to Texas.

Yes, I really wanted to come back to Texas. My parents live here. I just wanted to come back, and I want to do interventional radiology and Baylor has a really strong reputation for that. So that's why I chose that program. But I always thought about coming back to Texas.

At what point did you know you wanted to do radiology?

So this is really interesting because I never wanted to do a radiology what it sort of happened by accident. So I went into medical school wanting to be a general surgeon. I was gung ho general surgery. I did all the things for surgery, and I remember it was my very first clinical rotation as a third year med student. I was on my pediatric rotation and we get to

And I was like, oh man, it's going to be so boring. I don't want to watch people.

Read these CT scans and X rays is going to be terrible. So I sat down at this workstation and there was a resident there and he'd saved all these interesting cases, so rather than have me watch him read scans, he let me work through these on my own, which was really interesting. And I should say, like watching someone read or do radiology is kind of boring. It's like, okay, watching someone write a paper, so they're going through the scan. You might not understand what they're doing, so it can

And it was awesome. So that kind of hooked me.

But I kept thinking about surgery and then I noticed on every clinical rotation I did like Obgyn. I really liked looking at the ultrasounds, and when I was on surgery, I love that rotation. But we'd always go down to the radiology reading room and ask the radiologists about the scans and you know, in preparation for surgery. And I loved how the radiologists were such good teachers and they always took the time to.

Go through everything, and I knew I wanted to teach.

I really liked that aspect of their medicine, but I knew I wanted to do something with my hands. Sorry, it's like a long So someone told me, maybe you should think about interventional radiology, which where we use image guidance to do procedures. So that would marry the two things, like I liked looking at images and I want to work with my hands. So then I did a rotation in interventional radiology and I totally fell in love with it.

Can you explain two things? What is radiology and what is interventional radiology? I know that you handed me a pamphlet with an old white dude on the front, but I'm going to have you explained instand. I was sitting in bed writing this episode. It's a Saturday I'm not wearing pants. I haven't worn them all day. I wanted to describe the pamphlet that doctor Garasami brought me, but it was in the other room, which was approximately fifteen

There you go.

All of that just to tell you that, Okay.

So radiology is the study of like images and making diagnoses based on images and then using that to do procedures. So not all So there's sort of a misconception that radiologists just sit in a reading room and look at their computers all day and they don't ever see patients or other doctors. That's not true. They all do some kind of procedures. So that we look at four different types of imaging, mostly ultrasound, X rays, CT.

Scans, and MRIs.

Those are like the four main imaging modalities, and there's many different subsets of radiology. So people specialize in neuroradiology where they may read, you know, brain cts and brain MRIs.

They specialize in that or body.

Imaging, which is everything from like the neck down to the pelvis.

Is there a weird line in your neck where it stops being the head and.

It starts being the body?

You know, there's definitely some overallap Yeah, I know, it's a little like, oh I can't do that.

That's below of the classical.

Right, yeah, no, Like what's the thyroid that?

I was like?

What am I aside?

So?

I guess your head is just your skull and face and jaw, and your neck is part of your body. But then the whole thing is really part of your body. But if you think about your body, like where does your body really end? Given like air and space in your microbiome? What is your body? Honestly? You know what? These thoughts are starting to spiral into things that a college sophomore is staring a black light poster would say, So let's just move on.

I mean, basically, we use images a real time X ray, ultrasound or to guide whatever procedure we're doing. So there's lots of different procedures.

Like gallbladder removal and tumors and stuff.

We don't do gallbladder removals because that would be surgery. But we do put drains in gallbladders and patients that can't aren't you know, healthy enough to go through a surgery, So we might divert their gall butter and have that like drain outside.

But we do I'm so sorry.

Into a bag.

That's it?

Really?

Yeah?

Yeah, if they're obstructed and they need to like you know, and they can't have their gallbladder remove, maybe they have gallstones, but they you know, maybe it's like a really sick eighty five year old and she can't get surgery or something. We might put a tube or a colla sestos to YouTube and earn.

Is it like tapping a caprice son kinda?

I A should think about it that way. Can we make it more satisfy.

Just a bile flavored capris Son delicious? Tap it, drain it? Yeahbing on, Let's backtrack. Take a closer look at those four main imaging modalities, or the dark wizardry that radiologists used to stare into solid objects, including your brain and butt. Can I make you tell me run through the four different modalities ultrasound, MRI, CT scan, X X ray. I know that those are like just a big breathing for you. But I only found out the difference between as CT scan and MRI like a year ago.

Does like most radiologists probably when they started training, like I didn't know.

I was like, which one uses X rays? I thought radiology was only to do with X rays. But MRIs and ultrasounds don't use actual X rays, right, so what is like? What's the difference?

Oh?

And also CT scans used to be called cat scans.

Yeah right, people still call them cat scans.

What's the difference?

Nothing, That's just like an easy way of saying CT scan, Okay.

Side note, CT stands for computed tomography and cat CT stands for huted axial tomography. The axial it just refers to the way that the machine spins around you, taking a bunch of X rays as it goes. So CT scan it's the up to date wave of saying cat scan. It's a new easier phrase with more syllables. CT cat one's got two syllables. Anyway, Pay attention, because this is radiology in a nutshell. This is how it works.

I guess within all the different specialties we probably use some variation, maybe use more CT or MRI in certain specialties, but I mean I can go through like how we generate those images. Yeah, so ultrasound basically is sending a sound wave and measuring the echoes back. Then different tissues will send those sound waves back at different speeds, and then we use that to construct an image. So that's

X rays pass through it.

Then those all those X rays are sent to a detector and then an image is generated from that. And CT scan is like an X ray, but it's like a moving X ray and it's two dimensional. So that's how they reconstruct that image.

Oh, so they a CT scan kind of revolves around you, so it's like an X ray that does loop d loops in a spiral around you, and then it creates kind of like almost like a three D image of your inside.

Yeah, Like that's a two D image that we can get. We can scroll through or step through, like looking through your feet up through your.

Body in an MRIs or magnet. Yeah.

So an MRI so most tissue, most tissue in our body is made up of water, which in water has a lot of hydrogen atoms. So an MRI generates a magnetic field and we measure how the hydrogen atoms spin and what's their angle relative to this field, and we use that to generate an image. So that's different from CT and X ray and that it's not ionizing radiation. It's not you know, causing radiation. It's just a magnet that's sending a pulse, which.

Is crazy to me. I had to learn what an MRI, the difference between a CT scan and MRI for a shoot, and I I was in the hotel room the night before and I remember being like, wait, wait, wait, all of your hydrogen atoms in your body line up?

Yeah, we send a pulse to line them up and then we see how they like fall down or the you know speed or angles at which they fall down.

How come you can be in the MRI tube all of your hydrogen atoms are lining up like soldiers, and it just is like doop de doop. Do you know that?

Yeah, I don't really understand the physics of that yet.

That is something that I'm still learning in my training.

So essentially, your body has tons of hydrogen atoms like water fat lots of hydrogen, so we're made up of maybe sixty percent hydrogen, and hydrogen has an unpaired proton, which also has a magnetic spin. So when you have a strong magnetic fiel around you, like an MRI machine,

Yeah, I have.

I've I tore both on my ACL, so I've That's probably why I used that as an example earlier.

Yeah, dude, happened dumb stuff.

What kind of dumb stuff?

I played like intramural basketball in college and I tore my right ACL then and then I played flag football in med school for like five minutes and tourn ACL.

I thought people in college who played flag football were only in Zema commercials, like they were only in like deer commercials, you know, like of like a happy, amazing group of college people just being just having fun out on the field.

Yeah.

I had to hang up the cleats after that, man, So I've had but yeah, I've had those MRIs done. And yeah, the magnet's noisy, And even for someone who was I wasn't in radiology residency at the time. I was in medical school, but even someone who is medically literate, it was kind of scary and like it's weird, it's noisy, you don't know what's going on. You're in there for

Yeah, have what kind of tools do you have to have in your pocket, like psychologically to help patients, because I mean TMI, but I had to get a brain AMRI last year and my mom has a mess so like I'm familiar with like brain imaging and it's kind of scary. But I had to go in because I thought maybe I had a brain tumor, just like a pituitary tumor. They're like, let's check it out. So I was like, Okay, well, I'm just going to go by myself. It's fine. And I got to the hospital. As soon

It all the time?

And I'm so glad to hear that a radiologist was, you know, able to comfort you before you know, getting the scan done and everything. And when we can, for people who are really anxious, we can sedate them. We can give people value and help them relax. But I think just talking to someone and explaining, you know, what's going to happen and how we're doing the how we're doing the the MRI.

Is really helpful.

And a lot of times people will give you headphones to listen to They may they probably didn't do that because you were getting a brain MRI, but yeah, with my knee, I remember they did. So it helps drown out the sound of the magnet. And in pediatrics sometimes they give kids these little glasses where they can watch a movie, oh, to help distract them. Yeah, so we have those kinds of tools to help, you know, patients go through these scans.

If you have some shit going on that's not good, particularly with like neuroimaging. Do you ever have to have a poker face where you're like, Okay, I see you later, missus Wilson And then you're like, oh, Wow, she's screwed or do you like the Because I think that's always what's so scary when you're when you're getting diagnostics down as a patient is how long till I find out? And if it's something's wrong, will I find out now? Or will I just go about my business for two days?

Like, so typically when we're reading the scans, we're in a reading room that's like dark with these huge monitors, and we're far away from the patient, so we don't always get to I mean, we usually don't get to tell the patient like, oh, I saw.

This, and I can tell you immediately.

We read it, and we dictate a report and it's sent to the electronic medical record and then your primary physician may tell you.

But when we're in the er, we're reading.

Emergent scans in the EER, if we see something emergent, we'll call the physician immediately and they'll tell the patient. But when we're in that diagnostic reading room, we don't get to communicate that to the patient.

Right because there's so mighty protocol steps that I'm sure it has to go through.

Yeah, and there's just so many studies, like we're just crushing studies.

Oh my god, you can't pop up like a gopher and be like.

Hey, whoa, yeah, exactly.

Go to Disneyland tomorrow, man, serious, live it up. Do you have friends that text you pictures of the inside of their guts and be like.

Hey, have a look at that whole time, really all the time, and not just like the inside of their guts, but like rashes and stuff. And I'm like, man, I'm not a dermatology just or like, you know, just my family member has this like weird you know, she's getting nauseated every time she eats chips.

I'm like, I don't know, Like that's not my job.

Do you ever see someone like out and about, like in line at the grocery store or like on a plane or something, and you're like, oh, I could definitely tell that they have like a certain condition that they may or may not know about.

Yes, really yeah, Like you know, sometimes we'll see people that are like really like short of breath and they have like really ademitous legs.

Yes, ademitis means casually kin squishy because of retained water. So next time you feel bloated, just say mine, my mi, I am an adematist Fox today. Also, that's not really a joking matter, because please take care of yourself for real.

So I'm like, they probably have congestive heart failure or something, you know, just like stuff that we saw a lot of in medicine.

Would you ever tell someone No, I don't think I could. Yeah, that's not really legal.

Huh yeah. Someone's like it's probably crossing some line.

Soone's like, I'm just here to watch the boat show, Like what are you doing?

Just let me live my life.

So what else does doctor Gerasami working as an interventional radiologist do?

So I'm so excited about like the neuro interventional radiology that we do.

It's awesome.

We do a lot of spine injections like I was talking about, but we do endovascular work, which means we work in the blood vessels, which is a lot of what interventional radiology is.

So I can just give you.

An example of a really interesting case. We had a lady that came in about sixty something, came in with a cute left sided arm and leg weakness and like left sided facial troop. So she's probably having a stroke stroke. So she comes into the er, she gets a head CT like, that's what we would do right off.

The bat, and they ordered a CT scan where they injected contrast to look at the blood vessels to see if there's a clot causing her stroke, and one of the diagnostic radiologists saw something that looked a little funky.

I was on call that night, and I called my attending, the neuro interventional radiology attending, and we brought this patient into the interventional radiology suite. We went in through an incision in her groin, which is what we do for a lot of interventional procedures.

So back in the.

Day when you did surgery, we would open the patient totally up. But interventional radiology is going through vessels, making a small incision and using X ray guidance to know where you're going. So we go on through her right femeral artery. We're going up to her aorda, up to her internal carotids and looking at the vessels in her brain by injecting contrasts and taking real time X ray.

Right.

So we put another catheter up through the vessel all the way up there and it's kind of attached to a little vacuum.

Whoa, and you sucked the clot out.

And right after the procedure, we asked her to like move her.

Left arm and leg and she could whoa. It was so cool.

That was like one of those moments where I was like, this is why I'm a doctor.

Oh my god, it was so.

Badass's that's like the most heroic version of unclogging a drain ever, you know what I mean? Like, got it?

Now?

Where are you while all this is going on? Are you six feet away? Are you cross the room? Are you operating a robot? Like? How are you imaging while operating?

We're right there, so you know, we're standing right by her groin where we're using that access to manipulate wires and catheters up to her brain. And there's an X ray and that's like over her head wow neck.

So it does seem like surgery as well as radiology, Like how is it not in terms of the nomenclature. How is it not radiological surgery as well? You know what I mean?

Yeah, I think it's not surgery because we aren't cutting the patients open and we're just making a small incision.

So I mean, I like to think.

Of it as image guided, minimally invasive procedures. Okay, because when this woman came out of her procedure, she just had a little band aid on her ground, like a one centimeter incision, and we were like, we were just up in your brain something clought out.

That's nuts.

Yeah.

I just feel like if the guy that like trims your gums is an oral surgeon, like what you do is surgery, you know what I mean, Like you're up in there through the brain. Just like when you were a kid, were you ever fascinated with like X ray glasses or invisibility cloaks or anything sci fi like that.

No, I don't think I was. That's so interesting. I was really into blocks and building, huh. And my mom said that they never bought me barbies because I was never interested and people would come to visit and like I got like one or two as a child growing up, and I took their heads and like legs off and she was like all right, like Jeffrey Dahmer, like no, or Barbie's for you, it may make you.

Feel any better.

We had Barbies and once my sister and I read about Joan of Arc and we're so inspired that we cut off our Barbie's hair and burned her at the stake in the yard. I remember my mom came out to be like Rice Ronies, what are you jo We're like, she's Barbie of Arc.

But that's awesome.

We took a ken head and put it on a snake's body once, put it in a crazy I don't know. The eighties were a weird time.

They were a weird time.

But do you feel a little bit like a detective? Like do you like puzzles and mysteries? Yes?

That was like what I what really attracted me to radiology is I loved the puzzle. Every scan, every X ray is a puzzle and you just do that all. I thought it was so fun. It's also mentally exhausting, really yeah, Like I leave every day feeling like I just took like the boards or ly Sam because it's so tiring, but it's so fun.

It's just never boring, and.

Do you do a lot of it real time while the patient is kind of in the bay getting the scan, or do you get it and then spend two hours looking at everything slice by slice.

It depends.

So if it's something not urgent, like an outpatient you know, shoulder hip MRI, we may do that you know later, and may take a couple hours. For things that are emergent, like someone comes in a motorcycle crash and they get a head to toe CT, we're reading that very quickly, within minutes. So the patient will come in, they'll get scanned in the er scanner, and the trauma team will walk in as the CT is being done.

Oh wow, And.

So they'll expect you to go through it real time with them very quickly, And that's kind of where you grow up in radiology. I remember doing that rotation as a first year resident and I was like, oh no, I don't want to look stupid in front of the whole trauma team for real. It's and it's like time's a ticken, Yeah, exactly, times ticken, And what you say

So have you, based on your work and imaging, decided like that you're never going to ride a motorcycle.

Yeah, I can never ride any motorcycle. Like this is crazy. These people come in with the worst of pelvic fractures, but we're always like, why do people keep doing this?

Oh? Why?

It's like I I would not sit on the top.

Of a car, Yeah, why would I?

Just why? It's like driving a car but without the car. I get it. It's quick, it's the fuel economies top of the line. But I just had a boyfriend that rode a motorcycle and I was like, every time it'd be like, well if you die by now, like it's so dangerous.

They get and just gnarly pelvic fractures. We had one.

Guy who we were doing an embolization on for his pelvic bleeding, and he also had a very like severe de gloving injury of his little thigh, which, if you don't know what degloving is, it's like kind of what it sounds like, but it's like your skin and your muscles being like, you know, just peeled off.

Oh that's gonna be no for me. Yeah, So do you have a strong stomach, because if you went into if you were willing to go into surgery, like I can't. I can barely salt raw chicken without like breaking down and crying, Like how do you what kind of stomach or what kind of resolve do you have to have in order to put someone who might be hamburger meat ye on a slab?

Yeah. I think a lot of us have really strong stomachs. I think a lot of surgeons do. And there's only one thing that grosses me out. And it's a sound of like spit in your mouth. So like when someone's like intubated and they make the like spit noise. I'm like, that's the old that's the only thing you could pri sugn a gallbladder, but like saliva grosses alima grows me out. Like I can deal with poop and pee and blood just like blood everywhere, and I can't handle spit.

Yeah exactly, is like my bye, I did ever matter?

By?

Oh my god?

Oh I had another question. I'm gonna have to cut this out because I can't remember. Oh yeah, so I had a boyfriend. He was telling me the story before I met him. He got into a car accident okay, rear ended and he had to go in. He was messed up, like he lost a tooth. His neck and back were all messed up, right, So he went in.

The machines are very expensive. They cost like millions of dollars, and the time that we use the machines is very valuable.

So that's why.

I mean, I don't know why, like an MRI costs like I have five thousand dollars or ten thousand dollars, like, I don't know how it gets assigned that number.

I think it seems worth it just to purchase your own MRI, just in case you need it. Let's talk about ultrasound goop. Okay, the hell is that stuff?

The gel?

Yes, the gel helps create an interface between the ultrasound transducer and your body because air doesn't let sound travel very well through it, so we use the gel to help the sound waves like go to the body and like come back.

What is the gel? I don't know what it's made out of?

Them, I should look that upoud.

It's made out of elf tears. You always see that in TV shows. Were like this like big yeah, this big party goop of like like on a pregnant bill.

Yeah, and it's always cold.

Always freezing. I've gotten an ultrasound of my thiraid before and they're like you're like, oh, goop it up. What is the goop? What is the goop? So she emailed me later to say quote, I asked like four radiologists what this was made of, and no one knew. So I felt better about myself. So then I went I did a little more digging your buddy, your pop's aw here. I found out that ultrasound gel is polyecrylamide and it's made up of glycerin and propylene glycol a bunch of stuff.

Oh.

I have a question. You know those airport X ray machines. Oh yeah, they're always like, don't worry, it doesn't do anything to you. And I'm like, you're looking inside of my body to see if I'm smuggling any like drugs or weaponry. How much radiation do those airport scanning machines have?

That is such a good question. Yes, I love this question about radiation dose. So the back ground radiation that you're exposed to just by living and doing your daily activities is about three milli siverts. And a severt is like an SI unit that we use to say, like if one sivert is like equal to a five point five percent chance of getting cancer.

Okay, so now we're.

Talking about milli sivertsh So three milli siverts is just your background exposure to radiation, just like walking around doing what you do.

Quick aside, what exactly is radiation and where does it come from? So it's defined as the emission of energy as electromagnetic waves or as high energy particles that cause ionization. What is ionization? I looked this up and I'm reading it verbatim. It's when an atom or a molecule acquires a negative or positive charge by gaining or losing electrons to form ions. So do what you will with that information.

And something like a mammogram would be like zero point four milli siverts, So like the equivalent to like six or seven weeks of just daily radiation, which is nothing. I know, Like people always worry about getting exposed to radiation when they get a chest X ray or a CT scan, But when you think about what you're exposed to daily, it's not that much. And we're talking about milli siverts and one severt would be a five point five percent chance of getting canccer what if I.

Travel a bunch, Yeah, and I'm going through those things all the time and on airplanes all the time.

Yeah, So I like across country flight and an airplane is like point oh three milli siverts or something like that.

That's like the background radiation that you would get.

So all this radiation, I mean you have to get exposed to a certain amount of radiation before you would you know, maybe get something.

Start to cook your own body.

Right.

What happens when you're exposed to radiation? Like what's the risk here? Is it changing your gene expression? What's going on?

So radio ionizing radiation or like UV radiation, what causes breaks in the DNA? And your body has ways, your cells have ways of repairing that DNA, but sometimes it doesn't.

The DNA just gets wonky and it's on it's.

Replicated in this like wonky state, and that's how you get cancer.

So that's how radiation would cause cancer.

Okay, but you'd have to get, you know, exposed to a significant amount for that to happen.

Okay, good to know. That puts me at ease a little bit.

Good.

And the other thing is about the airport scans is you can always opt out and then you get like a free Yeah, you get the full you get the massage.

Yeah.

Someone And if you've been traveling and you're a little lonely and then someone just comes and caresses your back looking at her weapons.

I didn't refuse a scanner.

They just were like, you're getting the pack down and I was like, all right, whatever.

I saw a guy get a pat down the other day and he just willingly dropped his pants and they were like, sir, sir, you can keep them on. And he was like he was so like indignant that he was getting patted down. He was like, have a look, look at everything, and they're like, sir, please.

I like how they do the back of the hand like it's less invasive when they're like rubbing your vagina.

We're like, okay.

They're like, I can sense less, but just enough.

I feel slightly less violated.

I guess if you listen to the gynocology episode right now, you're thinking about vulva taxonomy, and I'm proud of you for that. Kiddo, on a first or second date, I only let someone touch me with the back of their hands, giving me.

That front hand.

No front hands till marriage. Okay, I have questions from listeners. Okay, are you ready for a rapid fire? Oh my goodness, you can take as long as you want to answer these. I call it rapid fire.

Man.

I never hold anyone a good but before we take questions from you, our beloved listeners. We're going to take a quick break for sponsors of the show. Sponsors. Why sponsors, You know what they do? They help us give money to different charities every week. So if you want to know where Ologies gives our money, you can go to Aliward dot com and look for the tab Ologies gives back. There's like one hundred and fifty different charities that we've

That's a good question.

Good question.

So being exposed to radiation is a occupational risk, especially in a field like interventional radiology, where you are exposed to more radiation than a diagnostic radiologist.

Why is that?

Because you're using.

Real time X ray like I was saying, and so you're standing next to the machine that's producing the X rays.

Okay, so we wear lead suits.

Oh so we wear like a lead thyroid collar, whoa a lead vest, and like a lead skirt and that helps reduce some of the radiation.

We wear leaded glasses.

Wow, so we all let it up. What about lead poisoning? I wasn't sure if I was just being paranoid, So I looked into it and last year the American College of Radiology published a paper that minced no words. This was the title quote, lead aprons are a lead exposure hazard. Dang. Okay. So they collected one hundred and seventy two lead garments worn by radiologists, and they took down the age and

Oh it's so like heavy, I know.

Ever, like they sell those anxiety blankets when you're like, oh yeah, I could just go to the dentist and hang out there all day.

I find the lead very comforting too, because it's just like you know, isn't It's just fitted to you. But when you're in these procedures for really long and you're wearing a sterile gown, mask and gloves and everything over it, you can sweat.

A lot, so you might get stinky, but nut sterile. Yeah, So do radiologists worry about that or do you feel pretty well protected?

I feel pretty well protected.

But we wear radiation badges that measure how much radiation we're exposed to, so you'll get a warning if you've you know, been exposed to too much radiation, and we can reduce used to amount of radiation we're exposed to, not just by wearing the lead by, but by also imaging smaller parts of the body, so you take a.

Lot of percussions.

We do.

Okay, good Megan. See great question, Meghan. Weirdest thing they have seen inside someone?

Man, this is such a good question. We actually.

People like to talk about the things that patients put in their butts. I think the weirdest thing I've not seen anything super weird. Someone had a rolled one of those like old school rolling deodorant things.

A roll on, Yeah, like a wet like a band roll on.

Yeah for butt stuff.

Now, whoa, that's a butt stuff?

Yeah, but I mean people, I heard about someone who put a beer bottle in there, like a corona.

Man, you can Amazon Prime anything you need these days pretty anonymously. So after this interview, the doc and I exchanged a series of text messages from radiology textbooks, and I honestly I don't know where to start. I will say PSA, if you would like to experiment with pleasures involving forbidden orifices, to hit up Amazon Prime free shipping,

You know what I mean.

So the most common improvised rectal foreign body, as medicine politely demurrors seem to be containers that once held alcohol. What are the chances gatorade bottles? Two leaders of mister Pibb. They just don't seem to incite insertion experiments quite in the same fashion. But still One X ray image entry on a radiology site, and yes, I googled some one was called Radiopedia reported that aerosol cans are a relatively common improvised rectal foreign body and in this one just

Exactly.

I have to deliver beer to your mouth. Have you ever seen anyone swallow anything weird like car keys.

Or Yeah, we did extrays on a patient that swallowed razor blade.

She's swallowed like parts of a spoon.

So first intervention is getting those things out.

Right, Yeah, especially like something like a razor that's gonna, you know, be getting things on its way down.

Do you have to go in and do like laparoscopic surgery? Where does that go? How do you escalate that case?

So?

I mean for us, we would read the x ray and we'd be able to tell the surgeons where it was, or maybe the GI physician who would go down and scope it and try to fish it out.

That seems what do you do put a magnet on a string?

I don't know.

Yeah, so don't swallow the stuff, guys nice says, really dumb question. Why do certain types of ultrasounds feel so uncomfortable, particularly abdominal and pelvic ones.

Because sometimes we have to push down really hard to get a better picture, So you might feel a lot of pressure when someone's pushing on your stomach or like on your kidneys.

And the other thing is if you're ultrasounding something, chances are there's something funky going on down there.

Yeah, there's something that brought you there. Also, like ultrasounding your bladder is like uncomfortable because it makes you feel like you have to peekes true, so.

Does anyone ever peed on a table?

Not with me, but I wouldn't be surprised. We also asked when we do pelvic ultrasounds, we ask patients to.

Have a full bladder, and we may give them.

Fluids or have them drink a lot of water because like it was, like we're talking about air is not a really good medium for like allowing sound waves to pass, so fluid in the bladder like gives us a good window. So that's like another trick or whatever. But it's really uncomfortable when we're looking at your uterus and we're pressing on this full bladder.

I've had a lot of patients who are like, I really need to be a need to be you need to be any like just a lot. Please.

You're like, that's the point. It's working out just as I wanted to. Yeah. Jennifer Buzz asks do you ever harness the radiation in your workplace for your own purposes? For example, leaving your pet tarantula next to it and then coaxing it to bite you, making rocks glow, et cetera. Also, do you ever wear the lead shield just for fun or for exercise?

Man, I should wear that lead shield for exercise, like go on like a little run with it.

Up and down the stairs in the hospital.

Yeah, that would be nice. No, I've never done that, And I mean, I don't think we.

Use enough radiation to do anything like really exciting.

To become a superhero or anything. No, I guess the kind of illegal probably rumph. Well, Jennifer Buzz, if she does do that, then she shouldn't get the idea from you. Bob wants to know what kind of fun cool things have you scanned after hours?

Ooh, I don't do that. We're not like allowed to.

Would they know? Would they be like, wait a second, this MRI has been used twelve times today, not eleven.

Oh yeah, they would definitely know. To do that, we'd have to like, you know, put it under a patient. That would be medical frauds.

Yeah, it's not like using the microwave.

Yeah, so I haven't done that. Sorry, that's not interesting.

You've also never been to jail, and that is true. Jack Keller wants to know why are we still using such old technology? Isn't there something more modern that's less dangerous? That is a little bit of shade thrown an X rays. I know it is debating here.

Yeah, I like it.

I mean they've been around forever, that's true. X rays have but I'm I mean they're still good. Yeah, you know, it's a little bit of radiation. Just getting a chest X ray gives us a lot of information about a patient and we can use that as like a screening tool to get more advanced imaging like a CT or an MRI, or decide if the patient needs a procedure, so this Yeah, these things have been around forever, but they work and they're safe.

What do you think about the history of X rays? Where didn't Edison try one on like an intern and ended up killing him? Like he tried it like a million times? Have you heard that story?

No?

I haven't. My probably should have.

But I know about like Renan who like invented the X ray in like the first X rays of his wife's hand.

And you can see a ring.

Oh yeah, that's cute. Was it cute?

Well?

William Rocken, the German Man whose name I probably just mispronounced in eighteen ninety five discovered and named X rays after X because it was an unknown ray for radiation, made the first medical X rays of his wife's hand and it looks kind of like a fuzzy X ray. You can see she's wearing a ring in it, and upon seeing it, she said, I have seen my death.

Oh hmm, yeah, I guess some people have like bigger or more dense bones.

I mean, you could find this out if you've got.

A DEXA or a bone scan. But whereas like you're just big boned, you're not fat. I don't know about that. Like this subcutaneous tissue doesn't lie, Like if there's a lot of tissue there, then it's not your bones.

I guess could you say I'm just ample with subcutaneous tissue?

Yes, I have an abundance of subcutaneous.

Tish, And that's why my bathing suit doesn't fit. You're welcome, which I'm in that. I mean both of us.

Why my pants split this week, That's why my pants split this hashtag diet stars on Monday, both of us.

I feel like we're speaking from a place of ripped pants, so we are not throwing shade.

I get it.

For the sake of transparency, I'm just going to come out with it. The week that we recorded this, both myself and doctor Garret saw me separately totally randomly had wardrobe malfunctions involving uh trouser ripping, So she as she got into an uber and nice slacks, and myself as I foolishly tried on jeans that I had not worn in some time, trousers zero points sabcutaneous tissue in the

Oh, I'm so glad he asked this because we were talking about AI artificial intelligence at this conference. So we use some computer aided detection or some form of artificial intelligence now, like especially in mammography, we use something called CAD or computer aided detection to help us find lesions in breasts like masses that we may not see just like little tiny things. And that's just a tool that the radiologist has to make sure they're being very thorough

Is it kind of like you can be a writer and and spell check helps, but that doesn't make you a writer. It's a tool, but not you can't rely on.

Yeah, something like that.

And I think those algorithms for recognizing, you know, findings and imaging are just getting better and better.

Do you have to consent to have your images put in that database?

I think so, I think they must. Yeah.

I think that's nice though. Yeah, I mean, you know, if it can help someone else attribution, yeah, you know, put your put your guts in the library, and the gut the gut berry. Carolyn Steele wants to know. I had a hip arthrogram last year and found out afterwards about Chuck Norris's wife and the gadolinium toxicity thing. Is this madness or should I be concerned? I want you to know by the way ILI word don't know what most of those words meant.

Yeah, that's fine.

Gadolinium toxicity and a hip arthrogram. I do know what Chuck Norris is, but address that.

So gatolinium is the type of contrast that we use in MRIs. So we didn't talk about this earlier when we talked about imaging, but we use contrast to help opacify or make the blood vessels more dense, or the tissues that are being fed by blood vessels may look brighter on a scan. There are people that you know may not respond well to gattolinium. It's processed by your kidneys and eliminated by the body through your kidneys, So if you have kidneys that aren't.

Functioning well, that puts you at a greater risk.

And some people can get toxicity from gattolinium even though they didn't have problems with their kidney. So this is just a you know, like a very rare risk.

Chuck Norris and his wife Gina are suing. Get this. I just looked it up for ten million dollars. Also, then I went down a rabbit hole about Chuck Norris trivia Brazilian jiu jitsu black belts which he has, tooth veneers, which he also has mustache memes. But then I hit some stuff about political affiliations and a stopp being fun. Anyway,

No, they're not too worried.

I think that people just don't know, and I didn't really understand you know, I couldn't really quantify what was, you know, how much radiation I was being exposed to from an X ray versus how much I was being exposed to just by living my life. So I think that's a really valid question. And I like when patients ask that and we can explain it to them, and I feel like we can dispel some of the like fear and myths behind getting you know, imaging done.

So okay, So it's a valid questions, a valid question. Hillary Maser wants to know, how do you radiologist learn to read images that just look like fuzzy blobs to the uninitiated.

Man, it's really hard.

Yeah, So you're like, that's why my doctor.

Now, I mean, you know, uh, you kind of have some idea in medical school because you get exposed to some imaging. You look at a little bit of ultrasound and CT and MRI through medical school, so you have some framework and you know where the organs are relative to each other. So you have a little bit of an approach. So people tend to develop a search pattern. Maybe they start looking at the lungs and then the heart and then the bones or whatever on a CT scan.

I imagine it must be like if you don't know a language, well, it would be really hard to discern regional dialects. But if you have spoken it for years, you would be able to say, like, oh, are you from Philadelphia or you know what I mean? Yeah, little things, the more familiar wire or something, it must get easier to pick out abnormalities.

I'm so glad you use that analogy as language, because this is what I felt like it was when I was a first sure radiology resn't. I was like, I don't know the language. I don't know what you guys are talking about, like million sieverts, what's that?

Yeah?

And the physics of radiology is very complicated. So I feel like now I speak the language and I can understand what people are talking about.

Paulo Hanley wants to know, you know, if you're behind the scenes when a patient is getting a scan, do you have any stories of like good news where you where you saw something where you're like whoosh, all clear? Like are there any of those like feel good moments?

All the time we get, you know, scans for people where they're you know, have like vague abdominal pain.

You're like, oh no, like what's this gonna be? Be anything? And we're just happy when it's like not something terrible.

I would just like to take a moment to impart a family story. So my older sister Janelle used to get migraines and one day I went to visit her in Detroit and I asked her how her head was feeling. She got really serious and she told me she's glad. I asked she's been to the doctor and they discovered a growth, and she waited until I had tears on my actual face. Also, it was my birthday, to clarify that this was her way of announcing that I'd be getting a niece or nephew. The growth was a baby,

It is exciting when you see something unique that's like a learning opportunity, but usually something that's like fun and interesting for a radiologist is probably not good for the patient. So we try to like, you know, understand that or like remind ourselves of that.

You're like, you have a terotoma? Yeah, and they're like, fuck you exactly have you ever seen a tarotoma?

Yes? I have. They're so cool. They have like teeth and hair inside of them. They're awesome.

What do they look like? I mean, I've seen pictures. If you really want to say cut down on your snacking, well, all you have to do is google images are to tarotomas, and you will not the sound.

Of someone's secretions.

But like, what was the first time you saw a terotoma? Like, just to get you up. A tarotoma is a random ball of bones or teeth or hair or tissue. It's like a ball of hair that just grows inside some people for decades for no reason. They aren't even tax deductions, and no one gives you their seat on the bus. If you're growing one so.

It was like an ultrasound of it was a pelvic ultrasound.

Oh, so it was like on the ovary. Yeah, it was what are those called a den some kind of dermoid. Dermoid.

Yeah, so we saw a little bit of calcium and we saw this kind of like wavy pattern that was like the keratin or hair, and we're like, ooh, we give the MRI I have this, oh god, And then yeah we could.

Yeah, it was pretty neat.

Do those people get to keep the tarotomas if they want?

No, Oh you mean when they're removed.

Yeah, no, they we send them to pathology because the pathologists have to slide the tissue and make sure there's like no underlying kids or anything. So you never get to I know, people ask to keep weird things. They ask to keep everything.

I mean, if I grew teeth in my butt, I'd be like, I work seventeen years on that. I got an extra se seriously, like so gross. They come from the word for a monster, Oh they do, yeah, terotoma.

It does sound really terrible.

Yeah, it comes from well, if you're like I grew a monster in my body anyway, awesome. Mike Milsheer wants to know, is it true that X rays are actually visible to the naked eye?

Uh?

No, okay good. Jennifer Overbe wants to know. Our dental X rays worse because radiation is shooting directly to your head. My mom told me this at some point. Now, every time I go to the dentist, I'm sure that it's taking off.

No, there are really low dose.

Krista Avanpato wants to know. I know there are so many mixed opinions about mammograms and ultrasounds for a woman. What's the right age to start them? And if someone has a risk factor like family history, should they start them earlier? So are there any new innovations in the works that might replace mammograms? And Christa, I'm gonna guess that you had an uncomfortable mamogram. Yeah, I've never had one myself. Have you ever had a mammogram?

I haven't.

No, they just squish your squish your boob.

I mean I've seen them. They look really uncomfortable.

Yeah.

So we typically start them at age forty unless they've had, you know, some risk factor. If they have like firstigree relatives that have breast cancer, we may start them ten years before okay, But people with like women who are thirty five or younger and have very dense breasts may not. They usually don't get mammograms, they'll get breast ultrasounds because your breast issue is so dense.

Do you think they're gonna have different modalities for imaging that doesn't involve like making a fruit roll up out of your boob. It does feel it does. I don't feel like they squish it into like fruit leather.

The reason that they do that is so they can spread out all the tissue and it's like less so it helps us.

Like scan through it and see things better.

Doctor Gurusami says that in higher risk patients, like those who might have the BRCA G mutation, a contrast enhanced breast MRI can detect breast cancer. Has a sensitivity of up to ninety percent with the MRI versus thirty eight percent for mimography or ultrasounds. So versus thirty eight percent, pretty good way to go. Contrast enhance it breast MRI. Tuck those stats in your breast pocket like a kerchief.

Yeah, that's I use that kind of message a lot.

This shit I've been through for one to two months of having a hair free face. You know what I mean, what's one thing about your job this sucks or about radiology that frustrates you?

Let me think. I mean it's tiring.

Like, so we sit a lot when I'm not doing interventional radiology stuff. When I'm not doing procedures and I'm doing the diagnostic part, I'm sitting a lot and I'm just like sitting for like fourteen hours and it's so busy, And I think sometimes people think there's a misconception that we just sit in that room all day and we don't talk to patients or we don't do procedures, and

What kind of jams do you pump?

Oh, all kinds of jams, Like on nights we were like old school bone thugs.

Really while you're diagnosing like all sorts of crazy stuff. Yeah, that's fantastic, actually, bone thugs is like kind of appropriate considering.

That it's not kind of quiet. Oh yeah, bone.

Bugs, Like you're looking at bones.

This is true. Never thought about that.

It's a little fun fact. Until radiology was developed, scientists had no idea that the busy bone was connected to the wishbone, and the wishbone was connected to the lazy bone, the lazy bone was connected to the crazy bone. The crazy bone was connected to the flesh and bone. So this societ is only going to matter to you if

I love that radiology is like so technological and so it's always changing, like with the artificial intelligence and with interventional radiology, we're always coming up with new techniques to like get in the brain or get to where we're going. And I just love that it's always changing. And I like the puzzle of reading the scan and I love working with my hands.

It's just for me, it's it hits everything.

So after the interview, doctor Karasami A. Rishanna emailed me some links. And at the very end, she said quote, we talked about my least favorite part of my job, which was when people thinking I was just relaxing listening to bone thugs rather than mainlining CTS, MRIs, et cetera. But I think what goes hand in hand with that is that radiologists really have an image problem. She goes on to say, I realize the irony in saying this,

No, but one of my co residents got a bunch of socks. What they were all like compression socks, which would have actually been really helpful because we're standing, but they were just like nice wool socks, and it was really sweet because it is cold in the angio sweet or or procedures.

That's really sweet. Yeah, So thank you radiologists. Honestly, some radiologists are the first line between like you and a box of Kleenex, Like I will never forget going in for the MRI and just that's nice crying and having someone be like it's okay, it's gonna be okay.

Like that's so good to hear.

It's almost like dealing with like shelter dogs or something where you're like they're going to be shivering and kind of scared.

And breast radiologists deal with this a lot because you know, like for women, I think sometimes we feel like our breasts are just taking time bombs and you know, you have to go on and get that mammogram, like you have to go get your kownoscoviy or whatever.

And when you know, may.

Need another study or an ultrasound, the radiologist is right there with you and they're explaining things to you. And I think that part of radiology that you know, real direct patient care is really helpful.

Yeah, meaningful.

I mean, it's crazy that you are a conduit to so much knowledge about someone's body, Like it's kind of true. You're like an interpreter between like me and my body. You're like, okay, let me let you know what's going on, Like that's pretty cool.

Your insides.

I know loog in my guts. Thank you for letting me ask you so many questionscome.

I hope I was helpful.

Next time I get any kind of body scan, I'm just gonna send it to you for sure. Don't send me yoursh so save the rashes for your dermatology friends people. Now for links from this week's episode, head to ali Ward dot com slash ologies or for super sensitive pictures. You can become a patron for as little as a dollar a month at patreon dot com slash ologies. That means you get to ask ologist questions and also see photos in this case that are too delicate for Instagram.