My Immersion in Radiology Department

This is already the third week of my immersion in radiology department. I find my life here is very different from my classmates: no scrubs, no rounds and no tears. I am not sure whether someone will think this can be called "not immersed yet". However, I actually feel very happy to experience this aspect of the life in hospital. Perhaps I missed many moving stories in ICU, but I learned a lot of episodes "behind the scene". I will talk about this starting from three biopsy cases to which I have been.

Case 1: X-ray-guided Transjugular Hepatic Biopsy. This is a case done at Columbia. Patient is one more-than-seventy-year-old male. The whole biopsy lasted about one hour. Sampling amount is small. There is no too much pain and bleeding after biopsy. Basically the patient didn't suffer a lot from this biopsy. Biopsy report unknown.

Transjugular hepatic biopsy is actually one of the newest technology among all hepatic biopsy methods. In US, the death rate of doing hepatic biopsy is about 1/1000. Most of them are due to the massive bleeding and collapse of diseased liver after biopsy. Considering this patient is old and his diseased liver may be too frail in this situation, this method is definitely a great choice.

Case 2: MR-guided Breast Biopsy. This is a case done at the MRI center on 55th street. Patient is one around-fifty-year-old female. The whole biopsy lasted about forty minutes. Sampling amount is relatively big. The suspicious lesion is very close to some big blood vessels, so the patient bled some after biopsy. Two samples were taken here because the patient accidentally moved her head during imaging, the location of the lesion was then changed. Because of this, patient had some small complains, but in general this biopsy was very successful. Biopsy report unknown.

MR-guided breast biopsy is better at maintaining the natural shape of breast than X-ray imaging. And it is more accurate at telling the location of lesions with the help of the guiding gird.

Case 3: CT-guided Lung Biopsy. This is a case done at Weill. Patient is a seventy-two-year-old female who had an incision of the right breast because of breast cancer ten years ago. Now a nodular solid lesion was found in her right lung. The whole biopsy lasted about half an hour. Sampling amount is very small. This is perhaps the easiest biopsy case among the three - very quick and causes very small cut. However, because of the structure and composition of lung, about 20%~25% of patients may suffer from lung collapse after biopsy. The severity and recovery of collapse vary among different patients. A quick H & E staining was done right after the biopsy. Flower-like cell clusters were found in the specimen, indicating a cancer-like lesion in the patient. More biopsy samples would be sent to Papanicolaou stain and making wax-embedded slides, so that more convincing characterizations of the biopsy sample can be made.

Although no confirmative conclusion about this patient can be made then in this case, I still felt very sorry for this lady when I was watching the biopsy. Ten years ago, she came into the hospital and lost one breast because of cancer. Ten years later, the same disease came back and might jeopardize her life and happiness again. Everything is so tricky when the moment came that as a radiologist, one learned about the coming of a horrible disease earlier than the patients and physicians. However, this radiologist must give comfort, possibility and hope to the patient when everything was not sure yet.

In this small scanning room, drama seldom happens. But all kinds of delicate struggles of inside world are going on. I can feel this on the patients by observing their move and words before and after learning about the scanning results. I can also feel this on the radiologists when they think very hard to give the most likely right conclusion on some cases to the clinicians. Here, no bloody "fighting" happens. But the things happened here give the most important support to the most thrilling surgery in ORs.