Radiologist Dr. W. Fin Hodge examines an image from a patient at the Jim Pattison Outpatient Care and Surgery Centre.

Radiologist Dr. W. Fin Hodge examines an image from a patient at the Jim Pattison Outpatient Care and Surgery Centre.

HIDDEN HEALTH – PART 2 – The interpreters

A small group of doctors, rarely seen and often dimly lit, make the critical diagnostic evaluations of medical scans – and more.

X-rays, CT scans, MRIs, mammograms and ultrasound images are well-known diagnostic tools for health care professionals.

But when scans are taken of patients and sent off, where do they go, and who makes a diagnosis?

The answer often happens in a dark room with the overhead lights turned off.

In his tiny office, his face lit by three screens, flickering grey images bounce off the eyes of Dr. W. Fin Hodge as he examines a section of a patient’s anatomy by scrolling the wheel of his computer mouse.

With each click, different slices of the man’s leg appear in anatomical detail.

At times, the layers move so fast, it looks like stop-motion video of a slithering primordial creature.

He sifts through different angles from an MRI and settles on one picture.

Hodge adjusts the contrast and begins to explain the situation.

The patient is a man in his early 50s. His history: Knee pain.

He examines several ligaments (dark fibres, all intact), before focusing on a too-thin layer of cartilage near the medial femoral condyle.

Hodge explains.

“This person has a tiny little fragment of (loose) bone that’s sitting in this joint space, and so every time he walks on that, it’s moving around in there and it does damage to the cartilage.”

There are also indications of osteophytosis, outgrowths of bone tissue that forms around damaged joints.

Though the image looks big on the screen, the area of damage is actually just one to two millimetres in length.

“As a radiologist, you need to know the anatomy of the structures you’re looking at because you need to know what normal looks like, and you really need to know the physics of the modality you’re using.”

Although the osteoarthritic degeneration of the patient’s knee is advanced for his age, Hodge says that there are injection and surgical treatments that will be used long before a knee replacement would be considered.

Hodge, based in the Jim Pattison Outpatient Care and Surgery Centre in North Surrey, is a type of doctor some patients will never see – an interpreter of medical imaging.

He has 13 years of post-secondary education, including four years for a science degree, four years of medical school and a further five years (one intern) specializing in radiology.

He’s also got a battery of different imaging modalities – a term that pops up repeatedly when you talk to radiologists – to help with his diagnoses.

X-rays, most often of the chest, are the bread-and-butter work for radiologists.

The process hasn’t changed much since the late 19th century, where ionizing radiation is sent through the body onto detectors. (At times, film is still used at the SMH, but radiologists mainly use Digital Radiography (DR), where the picture is created on a phosphor plate and then digitized by a laser image reader before being sent to a computer screen).

The ghostly images are familiar, with a gradient of increasing darkness as the matter gets less dense: Bones in white (they’re too hard for the weak X-rays to pass through to reach the “film”), muscle in light grey, fat in dark grey and fluids or air (such as lungs) in black.

CT scans (computed tomography) also use X-rays, but produce multiple images from different angles. Hodge describes it as a fan beam of X-rays that captures a larger volume of information as it spins around the patient.

Ultrasound scanners use high-frequency sound waves to produce images. Results-wise, the same rules apply for ultrasound as for X-rays.

“Bone reflects sound, whereas fat absorbs sound,” making bones lighter in the images,” Hodge explains.

Then there is the most modern of modalities, the MRI, which stands for Magnetic Resonance Imaging.

“I won’t go into too much detail,” Hodge begins without irony, “but essentially we align the protons of the body in one direction along the main magnetic field and then we can manipulate those with radio frequency pulses. And the radio frequency signal that is emitted by those protons as they relax back to their state, we can record, and through some complex transformations that are done by the computer, we end up with MRI images.”

Heady stuff.

Each modality has its strengths and weaknesses, and part of a radiologist’s job is to determine which modality would be best suited for the patient’s problem – though usually X-rays come first, especially in emergency cases.

There are 10 radiologists shared between the Surrey Memorial Hospital and Jim Pattison Outpatient Care and Surgery Centre – scans at the latter are given to more mobile patients.

 

The interventionists

 

Radiology was always a diagnostic specialty, but imaging interpreters are getting more involved in the therapeutic side of medicine.

With the increasing sophistication in imaging, they can now see and do more.

“In some cases, we can provide treatment,” says Dr. Del Dhanoa, a radiologist specializing in interventional therapy in his office at SMH.

He gives some common examples of image-guided treatments he performs:

• Guiding targeting markers (metallic beads) put into prostate glands for radiation treatment;

• Inserting stents or tubes to help cancer patients bypass obstructions, often in the liver;

 

Photo by Boaz Joseph: Dr. Del Dhanoa, seen through a CT Scanner at SMH.

• Inserting catheters used to treat infections;

• Guiding renal access for catheters in dialysis patients; and

• Hybrid diagnostic and interventional therapies (including guiding for biopsies) at the Breast Health Clinic, where a new system aims to provide triple assessment (mammogram and/or ultrasound, physical exam and tissue sample) in one visit.

“Generally (the modalities are) a combination of fluoroscopy and CT scanners, but we can also use ultrasound – it depends on the situation,” says Dhanoa.

(Fluoroscopy sends X-rays through the patient onto an image intensifier that allows real-time visuals on a screen. It allows radiologists to watch, for example, the actions of a patient’s esophagus and stomach as they swallow a liquid).

Dhanoa says interventional radiology has blossomed recently, making for less invasive treatments for patients.

“Rather than having a six-inch scar from a surgery, you have a three- or four-millimetre puncture hole.”

The result: Shorter stays and lower costs to the medical system – as well as more interaction with patients.

bjoseph@surreyleader.com

 

Next week: Box therapy

How a wrist was saved by the simplest of tools

 

More in the series:

Culture Club

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Preparations are made for a video recording at White Rock Baptist Church that will be part of this weekend’s Christmas on the Peninsula online event. (White Rock Baptist Church Facebook photo)
Christmas on the Peninsula moves online due to COVID-19 restrictions

Annual event – normally held in uptown White Rock – set for Saturday, Nov. 28

Jack Herring, 3, met Santa at a 2017 ‘Cram the Cruiser’ event held by White Rock RCMP. This Saturday (Nov. 28), the detachment will host a drive-thru collection drive as part of its month-long children’s clothing drive. (File photo)
Children’s clothing, winter wear sought at White Rock RCMP ‘main event’

Drive-thru collection day set for 9 a.m. to 3 p.m. Nov. 28

Lisa Werring, Surrey Christmas Bureau boss, inside the charity’s new home. (Submitted photo)
‘Toys, toys, toys, we need toys’: Surrey Christmas Bureau calls for donations

‘It’s been a challenging season to say the least. Every day is a new adventure,’ says bureau boss Lisa Werring

(report.deltapolice.ca screenshot)
Delta police launch online reporting tool

Site for reporting non-emergencies such as vandalism, fraud under $5K, lost property, traffic incidents

People wearing face masks to help curb the spread of COVID-19 cross a street in downtown Vancouver, on Sunday, November 22, 2020. The use of masks is mandatory in indoor public and retail spaces in the province. THE CANADIAN PRESS/Darryl Dyck
B.C. reports 17 COVID deaths, 1,933 new cases as hospitalizations surge over the weekend

There are 277 people in hospital, of whom 59 are in ICU or critical care

(Black Press Media files)
B.C. to test emergency alert system on cell phones, TVs, radios on Wednesday

The alert is part of a twice yearly test of the national Alert Ready system

Prime Minister Justin Trudeau speak to the media about the COVID-19 virus outside Rideau Cottage in Ottawa, Friday, Nov. 20, 2020. THE CANADIAN PRESS/Adrian Wyld
Canada’s inability to manufacture vaccines in-house will delay distribution: Trudeau

First doses of COVID-19 vaccine expected in first few months of 2021, prime minister says

Phillip Tallio was just 17 when he was convicted of murder in 1983 (file photo)
Miscarriage of justice before B.C. teen’s 1983 guilty plea in girl’s murder: lawyer

Tallio was 17 when he pleaded guilty to second-degree murder in the death of his 22-month-old cousin

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

Join Black Press Media and Do Some Good
Join Black Press Media and Do Some Good

Pay it Forward program supports local businesses in their community giving

This undated photo issued by the University of Oxford shows of vial of coronavirus vaccine developed by AstraZeneca and Oxford University, in Oxford, England. Pharmaceutical company AstraZeneca said Monday Nov. 23, 2020, that late-stage trials showed its coronavirus vaccine was up to 90% effective, giving public health officials hope they may soon have access to a vaccine that is cheaper and easier to distribute than some of its rivals. (University of Oxford/John Cairns via AP)
VIDEO: How do the leading COVID vaccines differ? And what does that mean for Canada?

All three of the drug companies are incorporating novel techniques in developing their vaccines

An aerial shot of Cedar Valley Lodge this past August, LNG Canada’s newest accommodation for workers at the project site in Kitimat. This is where several employees are isolating after a COVID-19 outbreak was declared last Thursday (Nov. 19). (Photo courtesy of LNG Canada)
Forty-one positive COVID-19 cases associated with the LNG Canada site outbreak in Kitimat

Thirty-four of the 41 cases remain active, according to Northern Health

7-year-old Mackenzie Hodge from Penticton sent a hand-written letter to premiere John Horgan asking if she’d be able to see her elf, Ralph under the new coronavirus restrictions. (John Horgan / Twitter)
Elf on the shelf an acceptable house guest, B.C. premier tells Penticton girl

A 7-year-old from Penticton penned a letter asking if she’d be allowed to see her elf this year

Most Read