My Shadowing Experience

Introduction
During my half day shadowing of Memorial hospitals radiologist, Dr. Armah, I was able to observe several studies. These studies included several CT scans, and three PET/CT 18F-FDG scans. During my shadowing experience I was able to obtain a better understanding of how the radiologist reads images, what makes for good diagnostic images, and what role I play in the quality of the images. The shadowing experience was one of great importance as it proved to be very informative. Such information included technology impacts, various pathologies, and personal reflection on my role.
Advancements in Radiology
In order to really understand where medical imaging is currently at one must have a basic understanding of where it came from. Twenty years ago radiologist would read and dictate the images on film. They were able to accomplish this by holding the film up to light boxes. This method provided no way for the radiologist to interact or manipulate the images

to get a different view. In turn there was a delay in doctors receiving the results and the patient obtaining treatment. With recent technology and images becoming digital radiologist have been able to decrease the time it takes to dictate the images, and decrease the time for the doctors to receive the results. Additionally, the radiologist is now able to provide earlier and more accurate diagnoses as a result of better quality images. The advancements also provide easier access to the images, a decrease in exploratory surgery, and ability to see metabolic functions.
Observed Pathology
In addition to discussing the impacts of technology I was also able to observe Dr. Armah dictate a PET/CT 18-F FDG scan that was performed to stage lymphoma. The PET/CT images obtained allowed Dr. Armah to locate the metabolically active lesions. He also explained and demonstrated how to obtain the standard uptake value (SUV). In addition to observing the lymphoma scan, I was able to gain an understanding of how acute sinusitis, diverticulitis, degenerative disease, and hydro-metabolic nodules appear on the images. Furthermore, Dr. Armah showed me the importance of observing the images in several different window ranges in order to accurately dictate the images and not miss something that could be of great importance. While I was gathering a basic understanding of the PET/CT images, I was greatly surprised by the fact the liver is a huge blind spot for radiologist. The blind spot is caused by the increased amount of noise through out the image. As a result, there is a great chance of radiologist missing important information in that area of the image.
Results of the Experience
Since my shadowing experience I have been able to do a bit of personal reflection and examine how I would be able to produce better images.

One of the ways I am going to implement into my routine is stopping and asking what could cause these images to have a reduced quality and in what ways will I be able to prevent that from happening. The thoughts already run through my head quickly, however, I want to really focus on the individuals and base my opinion off of their actions as to what could go wrong. For example, if I had a patient who suffered from memory loss I might want to remind them several times throughout the procedure to try and remain as still as possible. Additionally, I want to continue to focus on ensuring I am taking all steps possible to obtain a good quality image by doing routine things such as explaining the procedure well to the patient, ensuring any material objects are not causing artifacts, and practicing safe handling of the radioactive pharmaceuticals to eliminate

contamination.
Conclusion
As a result of the shadowing experience with the radiologist I have been able to obtain a much greater understanding of the information with in the image, the importance of high quality images, and what the radiologist is looking for when dictating the images. This experience has also allowed me to personally reflect on what role I play in the patient receiving the best health care. I will be able to continue to educate myself and possibly others as a result of the experience, and I am grateful for Dr. Armah for his time and patience.