"Medicine Enters a New
Dimension", (c) The Montreal Gazette, July 21, 2008.
Florence Benjamin lay on a stretcher in the MRI room at the Royal
Victoria Hospital as a radiology technologist prepared her for a scan.
"What radio station would you like to listen to?" asked Denise
Blanchette.
"CFQR," Benjamin replied, shifting her body to make herself more
comfortable.
Blanchette covered Benjamin with a blanket, left the room and closed
the door behind her. In the control room, she switched the FM radio to
Benjamin's favourite light-rock station. Every Breath You Take, by The
Police, came on.
Blanchette sat down in front of a computerized console. The stretcher
slid into the hole of the giant, doughnut-shaped magnetic resonance
imaging machine. Only the top of Benjamin's head was visible.
For the next 45 minutes, Blanchette and Mohan Patel, the co-ordinator
of the MRI room, would be scanning the soft tissues inside Benjamin's body
using the latest in three-dimensional medical imaging technology.
They would be taking images of Benjamin's uterus, checking for
fibroids, which are benign tumours.
Medical imaging has come a long way since the X-ray was discovered in
1895 by Wilhelm Conrad Roentgen, a German physics professor. X-rays are
still widely used today, but they don't take good images of tissue, hence
the need for other imaging technologies like MRI and positron emission
tomography.
X-ray images show only two dimensions of space: length and width. That
might be fine to show a leg fracture, but radiologists often need to look
at images in all three dimensions to make better diagnoses.
Computed tomography, developed in the early 1970s, was the solution.
Many X-ray "slices" are taken of an area of the body to provide the third
dimension of depth. The X-ray slices are combined to construct a 3-D
image.
Back to Benjamin, who was relaxed and breathing normally inside the
$2.2-million MRI machine. An MRI camera uses electromagnetic fields and
radio frequencies rather than X-rays. For an X-ray, a patient must not
move. For an MRI scan, a patient must not move and be careful not to
breathe erratically, otherwise the images of the tissue and organs become
skewed.
Under Blanchette's guidance, the MRI machine took three scans of
Benjamin's body. The first scan was on the coronal or frontal plane. The
machine buzzed loudly, taking 20 image slices.
The second scan was on the sagittal plane, from one side of the body to
the other. The third scan, on the axial plane, was taken from the top of
Benjamin's torso to the bottom.
The computer screen showed three images: frontal, side-to-side and
top-to-bottom. A radiologist would later examine them in a 3-D
reconstruction.
Sitting next to Blanchette, Patel explained the advantages of 3-D
imaging technology. He pointed to another computer screen that displayed
ghost-like images of the inside of the body of an elderly man suffering
from artery disease.
A frontal image showed what appeared to be a healthy abdominal aorta.
But Patel then spun the image on the screen to reveal the side of the
body. The artery suddenly looked jagged, clear evidence of
arteriosclerosis. The blood supply to the man's legs was being choked off
by the hardening aorta and more images showed that the arteries in his
legs were clogged as well.
No wonder the man had found it painful to walk.
"Abnormalities can be missed if you can't see all the angles," Patel
said.
By making the proper diagnosis, doctors could pinpoint the exact spots
where the man's leg arteries had hardened and would be able to perform
graft surgery to restore proper blood flow.
Larry Stein, chief of radiology at the Royal Vic, said his specialty
has probably benefited from more technological advances than any other
field of medicine.
"Back in the early '70s, I was doing an ultrasound and trying to
convince people that what I was looking at was actually the gallbladder -
the images were so rough," he recounted.
"Today, there's CT, MRI and PET scanning and all the interventional
radiology."
Radiologists like Stein no longer only make diagnoses. The technology
has advanced to the point where they can intervene in the body, blocking
aneurysms in the brain or opening a narrowed artery with a balloon
angioplasty. None of this could be achieved without being able to view the
inside of the body in three dimensions.
But medicine is not content with the three dimensions; it's pushing
beyond to the fourth and even a fifth dimension.
As any physicist will tell you, there are four dimensions, three
spatial and one involving time. Hence, the concept of space-time. Four-D
medical imaging allows clinicians to view 3-D images of a fetus as it
moves in the uterus in real time. Four-D imaging is also useful to
evaluate a beating heart for coronary artery disease.
The fifth dimension, for medical purposes, is like a second dimension
of time. Three-D images are shown moving in the fourth dimension, and the
fifth dimension adds artificial colors to depict specific functions of an
organ.
Five-D imaging, however, is far from the norm today.
Benjamin's scan was over. If Blanchette or Patel saw something
abnormal, they didn't share it with the patient. They would confer with
the radiologist.
Still, she walked out of the MRI room smiling.
"I'm good," she said of the experience inside the machine. "Once you
close your eyes and relax, you're fine."