Tuesday, August 2, 2011

Ultrasound and Evolution: A personal retrospective (Part 1)

I started life as a Medical Radiographer.  I graduated in the late 70's with a degree in radiologic health science, and proceeded to go to work in the hospital where I trained, a 320 bed hospital in north Texas.  Back in the 70's it was hard on people who were sick.  Going to X-Ray was a trip to the torture chamber some patients would recall.  Pain in the tummy?  Well, let's see:  We can give you an oral cholecystogram, and IVP, a barium enema, and an upper-GI to start with.  Headache?  We can really make your day with a pneumoencephalogram (a procedure whereby we insert a needle into the neural tube in your back, then inject room air to see how it behaves in the ventricles of the brain).  These patients would scream in pain due to the pressure of the air in their head.  If these examinations failed to find the problem the surgeon would wander into the room and confess that it was time to perform a diagnostic laparotomy (belly cases) or another surgical procedure.  For those of you reading this, be patient.  What I am relating to you are my personal experiences starting from over 30 years ago.  Call this a personal retrospective.

When I went to work F/T at the hospital, I was trained to perform special procedures.  Angiography before digital imaging involved something called "film". We were trained to load and process film in a dark room.  The angiogram was performed by exposing several sheets of film loaded into a film changer to x-rays.  In the cases of a cerebral angiogram, films were bi-plane.  In other words, the films were rapidly taken from two perspectives:  AP and medio-lateral. I usually scrubbed in and assisted the radiologist with the surgical portion of guiding a catheter into an artery in the brain, then injecting meglumine (Conray or Reno-76).  The surgical procedure has not changed much over the years, with the exception that I no longer give valium and demerol to the patient to control pain and anxiety.  This is now handled by an RN or anesthesiologist  Yes, you read correctly.  Part of my job was to administer medications to the patient during the procedure (though I was poorly trained to do this part).  Scope of practice for many health care professionals were poorly defined at this time.

The late 70's were a period of Renaissance in medical imaging. I am fortunate to have been fresh out of school when the CAT scanner and B-scanner ultrasound machines were being purchased by the progressive hospitals of the day.  Radiologists who were never trained in cross sectional anatomy were pulling their hair out trying to correlate what was shown on the CT and what anatomy they were seeing.  Ultrasound was even worse on the Radiologist.  One guy I worked for compared ultrasound to looking at post modern art made by elephants with  buckets of black paint and brushes in their trunks.

It all changed for me one day when the administrator of the hospital asked me to accompany him to a storage room in the bowels of the hospital.  We opened a huge wooden crate and inside there was a contraption that could have been the Doppelganger of Keith Emerson's Monster Moog music synthesizer.  As I was a keyboard musician I excitedly asked the administrator if this was a musical instrument.  He replied that it was a sound wave machine for medical purposes and the chief of staff had asked him to purchase it for the X-ray department.  He continued by asking me if I was interested in attending a three day seminar on the use of the instrument (Unirad B scanner Johnson and Johnson Corporation). He offered me my own department if I succeeded.  Since I was young and energetic I agreed (Knowing full well that an 18 year old new X-Ray graduate with his own department in a large hospital with a nursing program may very well become a chick magnet).

I was off to Denver on a mission!

To Be Continued...

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