Emergency Radiology Day 1

On Monday of this week I arrived back home from my holiday to the middle east but due to time restraints I had to book my work experience on the same week in order to get all my plans for this summer completed. Though this meant I have been very jet lagged for the past couple of days, it does not take away from the amazing experience I have had at the Radiology Departments, both outpatients and emergency, at Wythenshawe Hospital!

DAY 1: Head and Neck Clinic at Wythenshawe Hospital is next to A&E for emergency referrals. In the morning I saw ultrasounds of the neck and mouth alongside small procedures of ultrasound guided biopsies. The first patient was a women with supposed stones in a duct in her neck, however as identified by the scan, the thyroid gland and the duct were both of the same size. Normally if there was a blockage one of the glands would swell. Hence despite of complaints of swelling around her neck, the radiologist concluded that it was probably referred pain from elsewhere. In order to better understand the common problems faced in the thyroid, the consultant explained to me the function of the parathyroid gland and some of its malfunctions – it controls the calcium levels in the body and has a negative feedback mechanism, resulting in no calcium being detectable in the blood. However if calcium Is detected this suggests that the parathyroid gland is hyper active. A patient came in after blood tests presented calcium in her blood despite having her parathyroid glands surgically removed earlier this year. However she had no evidence of the glands therefore she was referred for a nuclear medicine scan which can better pick up the parathyroid glands.

So short into my stay at radiology and I was already astounded by the great range of data the radiologists, radiographers and specialist nurses work with on a daily basis. They know their anatomy exceptionally well in order to be able to identify the different body parts on multiples scanners. As a simple example they need to know in a heartbeat the normal and diseased appearance of a parathyroid gland under an ultrasound, MR, CT and nuclear medicine scan, which will all appear differently. Whilst also understanding that the glands do not appear on a normal x-ray scan. This level of perception and analytical skill to diagnose illnesses is admirable.

Those with a parathyroid gland containing supposed stones (calcification) in their duct present a dilated duct and swollen, rough-surfaced gland when using an ultrasound. This was the case with the following patient, a middle-aged man with a swollen neck. The ultrasound presented no stones but his duct was full of sludge. The patient had had surgery to remove stones in the kidney however it is very unlikely that it was from the same cause. The patient claimed that when his neck would swell from eating he would massage the area but in doing so he once found grit in his mouth therefore the radiologist concluded that he has probably removed his stone on his own hence ended his consultation. This indicated to me the importance of communicating well with the patient to allow them to confide in you. A simple question of ‘how have you been doing recently?’ will instantly create a more friendly and comfortable relationship which in turn could lead to information that makes clearer the patient’s situation for example home life and symptoms.

Moreover nodules found on the thyroid gland cannot be identified as cancerous or benign until a biopsy has taken place. This is most commonly found in women and the chemical tested for is colloid which only presents itself in benign nodules. The procedure was guided by the ultrasound and is taken by a very fine needle. Generally speaking however cancer of the thyroid is very uncommon. In all I thoroughly enjoyed my first day at radiology and anticipated the remaining week. The following day (hence in my next post) I visited the general department of radiology and as wythenshawe is a chest specialist hospital, I will speak about my visit to the chest X-ray rooms alongside the other departments of CT, Nuclear Medicine, fluoroscopy and general scans.

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