Week 5 - Jiahao

Neuro Core this week for the noon radiology lectures. This week's topics covered mainly categories in neuroradiology, including vascular imaging for angiography such as MRA and CTA, stroke, brain&spine trauma for adults and pediatrics, head&neck basics and emergency, etc. Since I am also working on neuro imaging involving MRI, this week's lectures are extremely helpful.

Although I've already looked at many neuro images, mostly of them are MRIs, it is still of great importance for me to understand how radiologist examining and making out any image findings, especially for how they look through noise for searching any abnormality in specific area and trying to explain the pathology or give any differential diagnosis. For example, head&neck imaging can be a very complicated part and difficult to interpret. Dr. Phillips gave an impressive educational lecture on how to interpret these images by assigning radiological spaces, knowing what should live normally in and then finding imaging features in those lesions. He went over each space in turns, from pharyngeal mucosal space (PMS), parapharyngeal space (PPS) to neck areas like retropharyngeal space (RPS), which made the reading a lot easier. What I got much surprised is about the tumor diagnosis in parapharyngeal space. The anatomy of this space basically consists of fat. Based on this, pseudomasses can be differentiated for primary tumor which is surrounded by fat and which is normally benign mixed tumor (BMT), and secondary one which is from any contiguous spaces and which is usually malignant. Another interesting during this lecture is about all kinds of MRI features for tumors in parotid space. For different tumors, they can appear differently and even change their radiological features on same protocols only due to their development, which makes the diagnosis hard. In this case, Dr. Phillips mentioned the significance of follow-up examination for the disease diagnosis and corresponding management plans, which is a very important step for how radiologists work together with clinicians to provide quality healthcare.

The other thought comes from the whole observation during my experience in reading room, scanning room as well as these specific lectures, which is about the emphasis on protocols. I may mention about protocoling and its great role for radiologists in the whole hospital setting in terms of medical imaging. As Dr. Gupta's lecture on vascular imaging, he firstly gave the hospital statistics on the whole callbacks on radiology and pointed out that nearly 1/3 errors came from vascular imaging from neuro subspecialty and for those erroneous cases, MRI took approximately half of them. On the one hand, this could be resulted from the complicated condition in neuro imaging reading, especially for MRI. On the other hand, it also shows radiologists are making great efforts in the neuro. For instance in MRA, first radiologists need to know the procedure for MRA reading by source MR brain images on axial view, then whole brain maximum intensity projection (mIP) for overview of vasculature, and finally those vasculature cutoffs by technologists removing background to outstand vessel images. Besides these steps, they are also required to make appropriate protocols for vascular imaging in order to get most useful image information. Taking the example of MR, the protocol often involves with whether using contrast or not, which parts need to be imaged, how much time needed and whether the imaging process suitable for specific patients. Then radiologists should consult patient's primary clinicians for any related issues such as which part would be clinicians' expectations for imaging. After image reading, radiologists also need to make any possible follow up protocols in order to get a clearer picture for pathology. To me, protocols used to be represented for which MRI sequences using in the case. However, now I would regard it more as an experienced imaging methods that is needed for individuals. Just as medicine is slightly different from pure science, protocoling is also slightly different from total engineering view. It is like a local minimum solution for an optimization problem, which is hardly regarded as best globe solution rather the best choice with most economy approaches.