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Imaging Abroad: Part II

written by Matthew L. Hayes BSRS RT (R)(MR)(CT)
Adjunct Faculty | Radiologic Sciences| Online Learning
Adventist University of Health Sciences

This blog is contributed thanks to our very own Professor Matthew L. Hayes, an adjunct professor of CT and MRI at Adventist University of Health Sciences. Professor Hayes has spoken at events for the Radiological Society of North America (RSNA) and the American Society for Radiation Oncology (ASTRO) and brings more than 13 years experience in the field to ADU. He graduated from ADU with his associates and bachelors in radiologic sciences and has been fortunate to travel the world and learn from some of the brightest minds in the field. In this blog series, he will be contributing updates to his imaging work at ADU and abroad.

I’m heading to Columbus, Ohio. I lock up my 2005 Volvo station wagon and hope it’ll be safe without me in long term airport parking. I mean, what car thief wouldn’t want this thing? It has a terrific safety rating.

All in all, the trip was a success. I wasn’t strip searched while going through security and the turbulence was at a minimum in my normal sized plane. I was even able to catch up on some reading and grade a few papers. Upon landing, Columbus airport is bustling-surprising for a small city. My colleague Brian’s plane will be delayed again. He has terrible luck. Rather than wait around, I decide to meet him at our hotel later. I hail a cab. I wish I could whistle with my fingers.

On the way to the hotel that Ohio state has graciously put us up in, I find out from the taxi driver that Columbus is the 15th largest city in the U.S. For some reason, I was very surprised. Not as surprised as I was when the cabbie handed me a bill for 50$ for a 20 minute ride. “That’s it”, I thought. “I’m downloading Uber.”

My Siemens account executive always takes Uber wherever she goes. I call her and get some tips ( you know, because I’m old), then download the app. Brian arrived a few hours later, but he got upgraded to first class during his delay, so he’s smiling from ear to ear!

My brother used to live in Columbus, so he recommends the “short north” for food and to have a look around. I request an Uber and am automatically amazed. I can see what kind of car is picking us up. I can see the cab driver’s name! I can see where the car is en route to us on a map. Our driver is named Abdul. He came here from Lebanon 8 years ago. He spends the trip telling us about himself and briefing us on where to go and where not to go. He drops us off on high street and bids us farewell. First Uber ride was a success! I’ll never go back. I’m enlightened. How did I ever exist without this?

We walk around a little bit and, after consulting a few locals, ultimately decide on Wolf’s Ridge Restaurant. Brian orders the some chicken dish while I choose the lamb chops with a fennell salad and the white truffle risotto. Eat your heart out, Bourdain. It was a terrific meal, plus, I got to talk about MRI with Brian, which is one of my favorite things to do anyway! After dinner, we walked around the shops for a while, then called an Uber back to the hotel. I don’t remember this gentlemen’s name. He got us home, but I missed Abdul. We each grade papers and answer emails then call it a night.

We woke up to an email from Dr. Zhong-Lin Lu, the director for the Center for Cognitive and Behavioral Brain Imaging, Arts & Sciences department at Ohio State. He would like us to join him and his staff for lunch at the faculty club. Immediately I picture tenured professors smoking pipes in a building covered in ivy, so we of coarse write back and accept. I hope they make us wear standard issue blue sports coats embroidered insignias in order to gain access. That would be ideal.

I’d like to reiterate that since Alabama’s loss to OSU in last season’s college football playoff, I’ve been less than enthused to step foot on campus. My original plan was to accidentally leave a few banana peels in front of the dorm room doors of their best players. You know, just as an experiment-strictly for research. From our drive (thanks Uber) to campus, I see the stadium and can’t help but admire it’s design. Once on campus, I get the same feeling I did when visiting Penn State. This campus is beautiful and this place is special. Brian and I find our way to the faculty club. It actually has ivy, but no “sport coat only” dress code. You can’t have it all, I guess.

Dr. Lu is waiting for us with his colleagues, Xiangrui, Jingua and Deborah, the technologist. I order the Pad Thai, because Pad Thai always rules. Plus, Dr. Lu ordered it too. Probably best to not stand out and keep a low profile in the faculty club. Dr. Lu points out the provost of the university sitting at a nearby table. We all got along famously well and enjoyed each other’s company. What really stood out to me about Dr. Lu (apart from his hospitality and easy going demeanor) was how passionate he was in regards to making sure student athletes were protected and cared for in order to make sure they return to the classroom and obtain their degrees post concussion. This guy gets it. Student athletes are students first. Sometimes that gets forgotten in the hustle and bustle of college athletics.
It’s time for Brian and I to do our thing, so we head back across campus to the lab. We pass the quad. We pass the oval pond. I’m told that the entire campus was built to form the shape of an “O” in all aspects. I appreciate that kind of foresight.

Today we will be scanning on a Siemens Trio-the grandfather of all research magnets. With its’ longer bore design, it has maximum field homogeneity, not to mention a 30mT/M gradient design- the first of its’ kind. I know of plenty of these still doing cutting work at America’s top research institutions.

In addition to other sequences within the imaging protocol, we are utilizing Diffusion Tensor Imaging (DTI) . DTI is a variation of Diffusion Weighted Imaging (DWI) which are routinely performed in MRI to rule out various stages of stroke and/or a mass. While DWI measures the motion of randomly moving water protons (brownian motion) within the body, DTI uses multiple magnetic field gradients to go much deeper while still acquiring DWI images and maps. In essence, you get many different types of information by running a single sequence.

With conventional diffusion, gradients are applied in the X, Y, and Z directions to visualize water motion in between cells. These cells make up boundaries and structures. Water does not move through a nerve-rather, it goes around it. By using this concept, we can map white matter tracts’ structure and direction in DTI. Think of a straw inside of a glass of water. If you pour food coloring in the glass, the color will move and ultimately change the color of the water. The water within the straw however, will remain clear. In this analogy, the white matter tract is the straw and the food coloring is diffusion. If we know that diffusion is happening around a white matter tract, we can map the tract itself! We use multiple gradients applied in different directions to give us more specific trajectory of the tracts. We can grow specific tracts for structural analysis, or simply record the fractional anisotropy (FA) values of tissues, which helps us quantify the overall white matter health within the brain.

DTI is utilized in pre-surgical tumor planning to understand where the mass lies in relation to certain white matter tracts that control various motor and cognitive functions. Where a tumor lies and what neuronal pathways it disturbs is what determines if it is operable or inoperable. For our purposes, however, we utilize DTI for concussion is because it is sensitive to injury of the axons that is known to occur post trauma. FA values change post injury and DTI is sensitive to those changes. This will be a primary indicator as to whether or not a student athlete has sustained a concussion and when he/she is ready to return to the classroom and to the field. This is incredibly important to the universities, so you can see why this is such an important part of our examinations.

We load the protocols into the scanner and are each scanned twice. I rarely get to take naps, so I enjoy my time in the magnet. In between scans, Brian and I even get to help Deborah with some MRI physics questions she has. I love helping others grasp these concepts. They’re so important to our profession’s quality of work and also so gratifying when you grasp them. We thank Dr. Lu and his staff for the warm welcome and generous hospitality.
Ohio State has been terrific, but it’s time to head home. I request an Uber to the airport and shed tears of joy when I see Abdul’s car approaching. Columbus isn’t so bad. “To the airport, Abdul!”

*Writer’s note: UPDATE: I now require all guests in my home to wear a blue sport coat when entering.