Magnetic Resonance Imaging is a powerful tool in the war against cancer. An MRI is used to trap structural changes, such as those brought on by tumor growth or the effects of radiation. PET scans produce images that are shaded as a function of glucose uptake. The MRI procedure involves the removal of all metal from my person, such as glasses, cell phone, rings, watch, wallet and my prayer pager. I then mount the table, and a number of straps and pads are placed around my head to help secure a static position during the scan. Ear plugs are used to attenuate the noise of the machine, and blankets mitigate the room's glacial temperature. The challenge is to be still during the 25 minutes of the first part of the MRI, which is complicated by the fact that my face always demands to be scratched during a MRI. I just have to ignore these interrupts. The "open MRI" configuration is a preferred alternative to the full torpedo enclosures of the past.
The clanging noise begins, and after the magnetic percussion stops, the technician enters the room and administers the Magnevist contrast agent. A skilled tech can compensate for persons who have covert veins (such as I do), with the use of a small needle and a slow injection of the Magnevist over about a four minute period. Reinsertion into the machine follows and the MRI concludes after 15 minutes or so. Next, I return to the lobby where the film is delivered to me straightaway. Images are also available on CD.
It is important to establish and maintain continuity by staying with the same imaging facility, same MRI equipment and same radiologist. The goal is to generate a database of scans and reports that can be utilized by the doctor familiar with your situation to connect the dots much more quickly that someone who is not aware of the fine details of your case. My MRIs are accomplished on a bi-monthly basis, and my radiologist conducts a study following each MRI, looking back in time with a fully briefed eye to trap any changes that might represent a tumor recurrence. All of this is a major lesson learned.
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Sometimes continunity cannot be maintained, due to circumstances beyond our control. The latter part of 2008 found me at three facilities over a six month period. My scans were performed at ISI in Flower Mound for several years; same equipment, same radiologist, for the most part. Then ISI went out of business, so the September 2008 MRI was executed at a nearby Touchstone Imaging location. Touchstone purchased the bankrupt ISI, so getting a scan at the Touchstone facility in Lewisville made sense because Touchstone would have easy access to all of my medical records from ISI. The goal, as previously stated, is to maintain continuity from scan to scan. The preferred scenario is the same facility, same MRI machine, same radiologist for each MRI. Moving to Touchstone provided a historical data bridge, but with different equipment, an opportunity for error was created. That is, changing MRI machines could yield results that are not truly indicative of a problem. The radiologist's thread was definitely broken when changing from ISI to Touchstone. The Doctor who had been reviewing my film at ISI did not read scans for Touchstone, so I took the film, plus older scans and studies (reports) to his office for an unofficial, informal report. The Touchstone radiologist provided the official MRI report, but my legacy radiologist supplied the informal report to preclude any over reaction should the Touchstone doctor identify an area of concern that we already knew was okay from past scans.
The MRIs from November 2008 and January 2009 were performed at Blue Star in Irving. I remembered to bring my MRI films from July 08, Sep 08 and Nov 08 to Blue Star for use by their radiologist (to compare older scans to the January scan, looking for subtle changes), but I failed to bring copies of the MRI reports. I returned home to retrieve these important documents. But instead of driving back to Irving from Argyle, I scanned each report, created a pdf for each report and then emailed these files to Blue Star. My legacy radiologist does read film for Blue Star, and this company opened a new site in Flower Mound in February 2009, thereby restoring my groove will have been restored. I am now returning to the same area (local) to get my MRIs at the same facility, using the same machine and the same radiologist.
All of this illustrates an aspect of taking charge and retaining charge of your own medical care. Keep copies of your medical records; build your own data warehouse. If you see a gap, bridge it. If you find a hole, plug it. If something is missing, provide it. If you see a problem, fix it. Work with medical team around you, but lead the charge, rather than waiting for something to happen.
The MRI from February 2010 was probably the last time I will exit an imaging facility carrying a packet of film. I have been receiving all scans on CDs for some time now, but my oncologist has requested a hardcopy accompany each CD up to this point. Now that computers populate all of the examination rooms at the oncologist's office, I do not think the film will be required. I have been told that the film will fade over time, whereas the images on a CD will not. Another item of interest was discovered today. The most recent MRI machines do not skip as they scan. "What you see is what you get," according to the radiologist. This is a major step forward, since very small tumors could be missed if the MRI machine's skip is larger than the tumor.
I have noticed a dramatic decrease in the time required to perform a scan since 2004. Back then, about 45 minutes were needed to perform the MRI, and the machine used 4 or 5mm skips, so the entire brain was not covered. Today in 2010, the same scan takes about 15 minutes or even less, and there are no unmapped regions! I am grateful for this 66% reduction. I am in and out in no time with better scans.
There is a certain amount of anxiety associated with each MRI. How do I deal with it? I send emails to those who have been with me throughout this adventure - to the prayer teams at my church, at my work place, family and other survivors. The pending date of the MRI is noted in these emails, and I solicit prayers for a clean scan. I tell myself that there is no reason why the tumor must come back. This is up to God, not me. Worrying is not going to change the situation, at least not for the better. Worry can literally make a person sick, so I therefore try not to be consumed by the MRI results - easier said than done. I typically pray all during the MRI, while the scan is in progress. When I receive the film following the MRI, Kathy and I perform our own review, courtesy of the light shining through the windows in the lobby of the MRI facility. We are not formally trained in these matters, but we do know my brain, where the tumor was, where the recurrence was located, and we could spot any obvious major changes. We have a good idea what the report is going to say even before the report is published.
