Courtney Nance

1
Modality Assessment

For the special modality week I assisted in Magnetic Resonance Imaging (MRI),
Ultrasound, and Radiation Therapy. MRI uses three main body plane slices which are coronal,
axial, and sagittal. What I learned most was how to identify which slice was being used. Each
plane can be related to x-ray terms: coronal is AP, axial is transverse, and sagittal is the lateral
image. The machine takes these images by a large magnet aligning the hydrogen atoms in the
body. The energy released by the atoms retreating back to normal state is captured by radio
frequency coils wrapped around the patients body part displaying the image. The caution with
MRI is removing all metal from yourself and the patient before entering the room due to the
magnetic force of the machine; objects like pacemakers, spinal stimulators, hearing aids, and
bobby pins. The SAT Band is a useful setting for removing image blur wave effect by placing the
band over areas of movement such as the heart and lungs. I enjoyed creating images of detailed
cross sectional anatomy and learning the physics of the MRI machine. Learning more about the
machines capability to image anatomy slices would be beneficial. It is nice to not worry about
keeping the patient in a specific oblique position or angling the tube to image. However, I did not
like how little patient interaction there is.
The next day I observed in Ultrasound which works through an electrical signal sent
through the transducer which rapidly vibrates crystals located inside. The vibration sends sound
waves into the body which comes back to the transducer in amplitudes producing an image.
Contrary to x-ray, fluid is black on sonography images resembling blood, urine, etc. Ribs and
other bones show as shadows. Positioning the transducer on the patients side will visualize the
kidneys and no rib overlapping. Doppler is a sonography program used to view the blood flow
during the exam. Angling the transducer obtains different views needed like linear and

Courtney Nance

transverse. Also, different shapes of transducers can image better with different body parts. Air is
the enemy of ultrasound so the jelly acts as a liquid to allow easy passage of ultrasound waves. I
learned mainly about identifying anatomy better and that the hard part is the ability to angle the
transducer to find the needed structures. I enjoyed performing the invasive procedures and being
able to work with RAs, radiologists and other doctors. I would like to learn more about how to
angle the transducer appropriately when identifying anatomy. It was nice to have direct patient
interaction during the exam however that could be a negative at times with certain procedures.
Also, it is intimidating to think you are the one finding the pathology.
Radiation therapy was my last observation site at Gamma West Radiation Therapy where
a tomotherapy machine is used rather than a linear accelerator. Both use multi leaf collimators,
but tomotherapys collimator overlaps where the radiation to surrounding structures can be
blocked or allowed. It works similar to a CT machine with detectors circling around the patient.
A Linear Accelerators collimator positions into the shape of the structure being treated, but isnt
able to block unnecessary areas in the middle. This method is effective by only giving extra
radiation to immediate surrounding structures to the area of interest; however the radiation is a
high dose. A tomotherapy machine circles around the patient treating from all different angles
and irradiates a greater diameter of surrounding structures, but at a much lower dose. I learned
most about dosimetry and its give and take aspect. When coming up with a radiation therapy plan
many factors are taken into account such as the amount, where the radiation enters and exits, and
prioritizing radiosensitive structures. A Dose Value Histogram is used for the optimization of
radiation dose to the target area and surrounding structures. Radiation to only the target area
would be preferred, but is not possible with human anatomy. Sometimes a PET scan and CT
image are sent to the dosimetrist where they can overlap the exams to better identify pathology

Courtney Nance

using hotspots. Tattooed dots in 3 different areas are given to the patient at the first appointment
to precisely treat the same area every time. A scout CT scan is used and compared to the very
first image taken to make sure of its accuracy. The Radiation Therapists then realign the patient
and continue with the treatment. I enjoyed talking with the dosimetrist and seeing the advanced
technology to treat cancer. I would like to learn more about how the machine works with getting
rid of the cancer cells and about dose allotments. I liked the cause behind Radiation Therapy and
the ability to help patients with a life threatening disease. With new technology the Radiation
Therapist doesnt seem to have a lot of responsibility, which could get boring.
This week was beneficial in gaining a better feel for other modalities. The imaging
profession has many routes of specialization with continuing change in technology which makes
this field great to work in. I am glad to have chosen a career path that helps others and is very
self-rewarding. Each modality presents a new learning curve where I am able to expand my
knowledge further.