Looking inside

Two radiology department staff members arrive at 7 a.m., every weekday morning without exception. The radiology technologists go to each of the seven different radiology modalities, turn them on and make sure they are working properly.

It is not much longer until the rest of the radiology technologists, radiologist and clerks arrive. When they get there, there’s a list of patients to be seen.

“There are some days that it can be really busy,” Linda Labatte, co-manager, said. “There are seven different modalities and sometimes we are stretched in seven different directions.”

The seven different sections or modalities in radiology are: mammography, CT, nuclear (which is when radioactive substances are injected into the blood stream), densitometry, diagnostic radiography, ultrasound and magnetic resonance imaging [MRI].

Currently there is no MRI machine at the health center, however, the Montana Health Network owns a machine that stops at several different health centers every week. Tuesday night and all day Wednesday, the machine is at the Sidney Health Center.

I arrived at 9 a.m., after the technologists had already worked with surgery. Rance Haralson, co-manager, went into ultrasound to do an echo cardiogram of a woman’s heart. Haralson looked at the four valves, measured them and listened to the sound of each valve as it pumped blood.

“The mitral valve has its own unique sound,” Haralson said. We listened. By the sound the valve makes, a leak can be detected.

The ultrasound cannot penetrate through air. “Right now, the image looks grainy,” Haralson said. The grainy image was a result of air.� � � 

“Patients won’t see film X-rays much longer. The film is still used, but the image is printed once it is digitally uploaded to a Fuji computerized radiography (CR) machine. This allows someone to be with the patient at all times,” Haralson said. There are currently four Fuji CR machines in the radiology department, most located right outside of the room where the X-ray is taken. The patient does not have to be alone, while the technologist runs the film to a room to develop it and bring it back. “This system has enhanced patient safety,” Haralson said. � � � 

The digital imaging is part of Sidney Health Center’s goal to be film free, and near paperless, by this November. The system is known as PACS, Picture Archiving and Communication System. When the system is completely installed, doctors will be able to bring up patient’s files, including their X-rays and special procedures, onto the computer screen in their office.

As I walked out of the ultrasound room and into the main office, where orders are printed, telephones ring, faxes are sent, images are printed, and I noticed two large holes in one wall. The staff explained to me, that this used to be the X-ray film developing room. Now, it is no longer needed.

I then went to work with Melyssa Bauer, who has been in the health center's radiology department five years. This patient was having an Intravenous Pyelogram (IVP) done. Bauer has already taken one scout picture and another Tomography scout picture.

“Tomography is the ‘old CT’,”�  Labatte said. “CT stands for computerized tomography. Like a CT this way of imaging cuts the kidneys in half and moves while it takes the picture.”

“What I’m doing now is inserting an IV,” Bauer explained to both her patient and me. Conversation remains explanatory and upbeat. The IV is successfully inserted. Bauer explains to me that she has asked the patient several questions to find out whether or not he would be allergic to the contrast inserted for this test. There is also medication available in the room that will counteract an allergic reaction.

“Before I can inject the contrast, I have to wait for a doctor to be here,” Bauer said. That doctor would be Dr. Faul, a radiologist. The doctor is in the department, and the patient is not allergic, so Bauer injects 100 cc of Omnipaque �“ the IVP contrast. “It’s very thick and sticky,” Bauer said. The Omnipaque appears on the images in the kidneys.

After one minute of injection, Bauer and I step behind a divider.

“Hold your breath,” Bauer tells the patient. The machine whirs as she presses down the button. “Now, breathe.” The patient is told to hold their breath to decrease movement.

The cassette is taken from the table and inserted into the CR machine. In mere seconds, an image appears on the screen, is labeled and printed. Five minutes after the dye injection, another image will be taken, then another will be taken at 10 minutes after. As the dye moves through the patient, the kidneys are highlighted, and then the bladder.

As the patient waits on the table, Bauer shows the images to Faul. “The patient”, Bauer says, “can't be released until the doctor has looked at the images because he might call for more images to be taken.” In this case, he wanted two more images.

As we waited for the additional images, Faul explained a large portion of what is done in the mammography department is screening, especially for cancer. On a normal day, around seven mammograms will be scheduled. If there is a lesion or a suspicious lump, a follow-up biopsy will be ordered by Faul. The most common biopsies consist of a needle entering the area and extracting part of the suspicious matter. This day, though,Faul was going to perform a more technical biopsy requiring a CT scan. The patient had a mass in a lung. I shuddered as Dr. Faul explained the procedure due to my inexperience in the medical field, but he assured me, it was nothing that bad.

Relief is also given in the radiology department. For those with arthritis, steroids may be injected near the joints. “For those that could barely walk because of the pain, it gives them a new lease on life,” Faul said.

Bauer has taken the two other pictures, and Faul looks at them and does not require more. The patient was released and Faul is needed in another section of the department.

Though the work day technically ends at 5:30, someone from the department must always be on call 24 hours a day in case of emergency.