#radley irradiates people

[radioactiveradley]

What would you consider the hardest imaging modality to work with? Any tips on how to get my eyes adjusted to the different images/radiographs they’re producing? I’m a student struggling with the different modalities and machines and the radiographs are just starting to look like blurry black and white and gray swirls in my eyes. 😵‍💫

Oh goshhhh, best of luck to you!

I'm going to give an annoyingly honest answer to 'which is the hardest imaging modality to work with'. It depends a lot on what you're looking at, and how you're looking at it!

In general, I would say that MRI is the easiest for discerning anatomy. Those are our crisp, clear, pretty images, which differentiate the soft tissues of the body beautifully. Especially when seen in the coronal plane (aka: the view you typically find in anatomy diagrams), it's suuuuper easy to discern different organs.

The only problem is.... it's kinda hard to express that on tumblr, when you can only post one image! MRI and CT produce 2D 'slices' of a 3D image in every plane, meaning that you're supposed to scroll through them to get the whole concept of the anatomy, rather than visualising a single image.

Here is a static normal abdomen MRI image, taken of a pregnant person, courtesy of radiopaedia. But I would enocurage folks to follow the link and scroll through the whole series!

The hardest modality to interpret (and, I would argue, use) in most cases would, in my opinion, be Ultrasound. Ultrasound is a cheap, fast and accessible imaging modality, which is incredibly useful as it can take 'dynamic images' (i.e., video, basically) without incurring a massive radiation dose. The pay-off is.... it's all fuzzy grey blobs.

Guess what this is! Go on, guess! Dingdingding, it's prostate cancer

You can get an awful lot of information out of those grey blobs, but you need a skilled Sonographer with a lot of wrist strength to be performing the exam and interpretating the images. My limp-wristed ass could never.

Ultrasound can be incredibly clear though! Some structures within the body are very difficult to image using MRI or CT, as they are in constant motion - your heart is the classic! We can compile 3D images of these structures by using ECG Gating - we trigger the CT scanner to only take 'pictures' (with radiation) when the heart is in diastole. This results in a gorgeous clear 3D image of the heart! But depending on the stage of diagnosis/suspected pathology, it can honestly be... just a lot quicker, cheaper and easier to whip out the ol' Ultrasound and do some good ol' echocardiography.

Check out this beautiful transthoracic view of the heart, taken using Ultrasound, showing clear differentiation between the four chambers!

Courtesy of Radiopaedia

But what this image can't show you is how this structure is moving, which is the key benefit of Ultrasound. The cardiologist taking this echocardiagram would be watching the motions of the muscle and assessing the function of the valves, not just looking at the static anatomy. Ultrasound might not be the best at creating detailed anatomical images, but it performs very well as a dynamic device, allowing the sonographer to watch various mechanisms at work within the body or, say, find a Deep Vein Thrombus by activating the Doppler and locating the point where the blood has clotted in someone's leg.

As for advice.... my best advice is to develop a three-dimensional model of human anatomy in your head, which you can spin around and rotate as you please to orientate yourself along the different planes used in imaging. Then you can just visualise where you are within your model as you scroll through the images, and figure out the blobby greyness using your knowledge of anatomy!

That sounds WAY easier said than done - and may take serious effort, depending on how good your individual brain is at thinking spatially and reconstructing images in 3D. I'd recommend accessing a resource like Anatomy TV, which lets you basically put human anatomy in the Horse Plinko Machine and twist it about and play with it and prod it from every angle. There are some free versions as well, but I'm afraid I can't vouch for their quality!

Again, best of luck, and keep practicing! It gets easier (and less confusing) I promise you! I am always here if you wanna yell.