IN-DEPTH RADIOLOGY TESTING

Every patient today who may have a signficant medical condition (such as cancer) will be subjected to at least some "Diagnostic Radiology Testing". The names and meanings of these tests are often bewildering to the patient and their apprehensive families. Since the discovery of X-rays by Dr. Roengen in the late 19th century, there has been a veritable explosion of new "imaging techniques" developed. These techniques allow us to view parts of the body which previously would would required open surgery to visualize. Operating on a patient and directly seeing exactly what is (or is not) going on is called an "open procedure", and risks side effects. The exact nature of the side effects depends upon the area being opened, the medical condition of the patient, and the skill of the surgeon. Obviously, performing a surgery for the purposes of diagnosing disease is very "invasive". Often it is essential that we perform invasive surgery to have the best chance of controlling disease. In fact, every diagnosis of cancer will require some sample ("biopsy") of the suspicious area to be examined under the microscope. This may require an invasive surgery to secure a piece of body tissue. However, a if we can glean the necessary information in a less damaging way to the body, with less potential side effects, we should. Diagnostic Imaging is the science developed to view what is happening inside the body from outside of it. It can help diagnose disease, confirm the extent of disease, "rule out" (obviate) disease in a particular area, and help guide a biopsy (as by using a fine needle) so that it is minimally dangerous and uncomfortable. Also, it can help tell the surgeon just what to expect should an invasive operation prove necessary. Information from Diagnostic Imaging has become integral to today's proper management of the cancer patient. Used properly, it is a hallmark of modern medicine.

Doctors of the past centuries undoubtedly would have wished they have some way of looking deep into the body without cutting into it, and today we do. There are basically two ways that we can "image" what is happening within the body - directly or indirectly. Direct visualization means the interpreter is using some device which acts as an extension of the human eye, while indirect visualization uses some other means (such as radiation, magnetism, or sound waves) to reconstruct an image to be seen.

The greatest advance in "direct visualization" has been Endoscopy - that is inserting a lighted tube into a body orifice (or a surgical opening) and steering it to look around. Biopsy samples can be taken with a small scissors at the end of the endoscope. Endoscopy is performed by the physician specializing in whichever part of the body is being examined - a gastroenterologist commonly examines the intestines, a pulmonologist the lungs and a urologist the bladder with their specific "scopes". The particulars of these direct studies will be later discussed, but note that they are all highly "operator dependent". This means that what is or is not seen and biopsied will be most influenced by the skill of the person performing the test. Even though pictures can be taken with camera attached to the endoscope, there are no "standard setups" as with direct imaging below, so the angle of any pictures taken will be unique for each patient. Nonetheless, endoscopy is indispensable for performing small internal operations (such as polyp clipping in the colon) in a minimally invasive way.

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