Participants: Dr. James Marcum (Host), Brent Barrow
Series Code: BRX
Program Code: BRX00011A
00:01 Are you confused by the conflicting health reports
00:04 in the news today?
00:05 In this well marketed world it is hard to know who or
00:08 even what to believe, but there are answers
00:10 you can depend on.
00:12 Hi, I'm Dr. James Markham.
00:14 Join me for Bible RX, a program exploring the
00:18 healthcare world.
00:19 Looking at all aspects of healing, using the Bible
00:23 and biblical prescriptions as the ultimate
00:26 source of truth.
00:49 Today's program we are going to be talking about
00:51 how to make it a diagnosis.
00:53 How do we know when something is wrong in an individual?
00:56 We have a radiologist who is going to help us make some
00:59 diagnosis today, that's Dr. Brent Barrow.
01:01 We are so glad he is here as we talk about,
01:04 how to make the correct diagnosis.
01:09 In the medical community, sometimes making a diagnosis
01:13 can be very difficult.
01:15 We are lucky that we have
01:17 a bevy of professionals
01:19 making a diagnosis.
01:20 One of those that helped me make a diagnosis every
01:24 day is the type of doctor called a radiologist.
01:27 Some people do not even know what a radiologist is
01:30 and we are going to explain that today,
01:32 and also how to make a correct diagnosis.
01:34 We have one of the best radiologist's, that I know,
01:37 join us today and we would like to welcome
01:39 Dr. Brent Barrow today.
01:41 Brent we are glad you are here.
01:43 Tell us how did you get interested in the
01:45 field of radiology?
01:47 Well it started when I was
01:49 actually in nursing school,
01:51 knowing that I was going
01:52 to go into medicine,
01:54 I became somewhat acquainted with radiology and
01:57 then practicing nursing in a emergency room setting
02:00 while I was finishing my masters degree.
02:03 I was able to see radiologist from looking at
02:07 an x-ray or looking at a x- ray exam that was done
02:11 and be able to tell the ER physician,
02:14 what is wrong with the patient and
02:17 what do we need to do next?
02:18 I was fascinated by that, and that was compounded in
02:21 medical school, in the third year medical school.
02:23 I made that decision to do the diagnostic
02:26 interventional side of radiology.
02:28 Well for our listeners today, what is radiology anyway?
02:31 It is a big word, radiology, what does that encompass?
02:35 With technology changing so much,
02:37 I'm sure that you have seen a lot of changes.
02:38 It has changed a lot over the years.
02:40 Radiology, years ago was just regular x-rays and maybe
02:45 the barium studies of upper GI's.
02:47 The dreaded barium enemas, those kind of things.
02:49 That stuff you put inside a person?
02:51 The stuff you put inside of the person and shoot an
02:53 x - ray through the person to make a diagnosis.
02:55 Chest x-rays, but then as computers became
03:00 more prevalent, ultrasound.
03:02 People have now heard of CAT scans, or CT scans.
03:05 MRI scans, pet scans, all are different kinds of
03:09 technology that are able to image the person's body
03:13 and as a diagnosis radiologist we then use that
03:17 information to make a diagnosis and determine
03:20 what is normal and what's abnormal.
03:21 What may be causing the patient's problem.
03:23 But I understand now that radiology has changed,
03:26 not only do you make a diagnosis, but now actually
03:29 you are able to intervene on people.
03:30 We do, in concert of being able to do the diagnostic part.
03:35 Then the interventional side of radiology using those same
03:40 tools, whether it is a CT scan, fluoroscopy or ultrasound
03:45 or other diagnostic means.
03:48 They will either use catheters, needles, wires,
03:51 different things to be able to make a diagnosis,
03:55 biopsy, do it an Arteriogram, doing angioplasties
03:58 and some of those things.
03:59 So the field of radiology seems like it is growing
04:01 by leaps and bounds? - it is!
04:03 The technology has grown? - it has and as computers
04:06 have gotten faster and faster, the ability to manipulate data
04:10 has gotten better and it has allowed us to do the
04:15 kind of 3-D multi-planar imaging that we now can do
04:19 that just a few years ago was a concept
04:22 on a blackboard somewhere.
04:23 Now the other day I sent a patient over and he
04:26 had Abdominal Aortic Aneurysm.
04:29 Not only did you guys help make the diagnosis of this,
04:33 but you also provided treatment.
04:35 He was not a candidate to have an open procedure but
04:38 he had something called a Stent Graph.
04:40 Can you explain what that is all about?
04:42 Sure! I sure can it actually brought an example of this
04:45 Stent Graph with me today.
04:46 This is a flexible piece of fabric material that has...
04:53 - that is real? - and this is real.
04:55 This is not a model this is what could be used
05:00 inside of a patient.
05:01 One of several different kinds of manufacturers.
05:05 When this goes in the patient, instead of having as
05:08 you are describing, the traditional approach
05:11 for Abdominal Aneurysm.
05:12 It is an abdominal incision, major surgery.
05:15 We are talking about fixing a weak spot in
05:19 the blood vessel.
05:20 Where an Aneurysm is where the blood vessel,
05:22 for what ever reason, it starts to weaken
05:25 and starts to dilate.
05:26 In the abdominal aorta, that many times is silent
05:30 until the patient has symptoms of that sudden
05:34 dilitation or the rupture.
05:35 But in treating those patients, previously it had
05:39 been surgery, now with stent graphs these patients
05:43 can potentially have a...
05:46 This goes on a catheter so it is about the size of
05:50 a pencil when it goes in and it is flexible.
05:53 Little incisions are made in the groin region
05:55 on both sides - you do not have to be cut open?
05:57 They cut little incisions in the groin, like doing
06:00 a heart catheter arteriogram, just a little
06:02 bit bigger incision.
06:03 This gets precisely localized using the x-ray machine,
06:09 we have in a special procedure lab.
06:11 Then it is deployed - Wow!
06:14 Sometimes you have to add a second limb to one side,
06:17 this would be a graft - and that will keep the
06:20 vessel from breaking open?
06:21 This will keep, this will allow the blood to travel
06:24 through the stent graft, keep it away from the wall of
06:28 the Aneurysm so that hydrostatic pressure, pressing on that
06:31 Aneurysm to cause it to expand is now reduced.
06:35 The risk of rupture goes away and the patient can
06:38 go home the next day.
06:39 You know that is incredible!
06:40 You know there are blood vessels throughout the whole
06:42 body and who knows where next,
06:43 there are Aneurysm's in the legs.
06:45 And you can treat all those with radiology.
06:48 Whether it is a stent graft procedure or a cover stent
06:52 for a brain aneurysm's now, neuro interventional radiology
06:56 are putting flexible metallic
06:59 coils into those to stop those up, it is really amazing.
07:02 How do they radiologist keep up with all this?
07:04 I mean, for instance if you just start out looking
07:07 at x-rays and other types of test then all this
07:10 technology, I guess you have to stay up with things?
07:14 Well like many other areas of medicine, radiology is
07:17 specialized so there is a vascular interventional,
07:21 there's muscular skeletal, neural pediatrics.
07:26 Most of us, in my case I practice pretty much
07:29 general radiology and also to the interventional
07:33 side of radiology.
07:34 I have other partners that do the general radiology
07:40 as well, but then they make you more MRI,
07:42 or more neuro intervention, or muscular skeletal.
07:45 So as a team we all try to cover all the bases,
07:49 but individually we don't have to do everything as
07:52 well as a regional expert.
07:55 It shows how medicine is specialized,
07:56 and everybody does what they do best.
07:58 Well what we have done Dr. Barrow, is we have collected
08:01 questions from all over the United States regarding
08:04 radiology and some of those questions we will be able to
08:07 answer and some of them I we will not be able to
08:09 answer, but hopefully we will
08:11 point people in the right direction.
08:12 The first question comes from Max in Kentucky.
08:16 Max says:
08:42 So Max is having breathing problems, got a cough,
08:45 has lost some weight and they want to screen his lungs.
08:47 What would be a good radiologic test
08:48 to get some more information?
08:50 Well there is actually a National Cancer Institute
08:53 study going on right now to try and answer Max's question.
08:58 He wants an answer today, this study will take
09:01 many years to answer.
09:03 That study is trying to determine is a CT scan
09:07 verses a chest x-ray.
09:09 Now what is the difference between a CT scan
09:11 and a chest x-ray?
09:12 Well many patients have seen or have family members
09:16 that have had this CAT scan or CT scan.
09:18 That is where there is a x-ray table that has an
09:21 associated machine, or Gantry as we call it.
09:25 But the donut in it is very small, and the table goes
09:29 through the Gantry while it is spinning around
09:33 and it actually has, as it spins an x-ray tube and shoots
09:37 an x-ray beam through the patient.
09:39 You still get an x-ray?
09:40 You still get an x-ray!
09:41 The ability though to see all the internal structures
09:46 in a CT is tremendous.
09:48 So in and of itself probably a CT scan a better way
09:55 to fully evaluate the lungs.
09:56 As a screening test, that is what is being studied by
10:00 the National Cancer Institute and this is specifically in
10:04 patients who are known smokers, and a screening test to
10:08 determine whether or not CT verses a chest x-ray.
10:12 Which is more beneficial in finding those early
10:16 lung lesions that can be cancerous before they
10:20 spread out in the lung.
10:21 If we can find early lung cancer,
10:24 98 percent survival of 5 years.
10:27 He is already having some symptoms, he has had a cough
10:31 and has lost weight.
10:32 I think if it was me I would just recommend if he could to
10:35 have the good test, the big test the CT scan.
10:37 It's probably and that would be instinctively what everybody
10:40 would want to do.
10:41 I still think, because the chest x-ray,
10:44 he may have had previous chest x-rays - oh right!
10:47 So being able to, if he is feeling bad,
10:49 this may just be pneumonia - okay!
10:52 So I would recommend to have a chest x-ray either in
10:55 the same place, or get a copy of the film he had
10:58 from a previous place, get that and have those
11:01 compared side-by-side.
11:02 If there is a question or concern, follow it up with
11:05 a CT scan, and if it comes back negative and he is still
11:08 feeling bad that I would move on to that more expensive,
11:10 but also more thorough follow-up test.
11:13 I hope that helps you out Max.
11:15 The next question is coming to us Dr. Barrows from
11:18 Camden Maine, on the coast.
11:20 And this gentleman says:
11:31 okay! Well we just mentioned the CAT scan and how
11:35 that is an x-ray test, it uses an x-ray beam
11:39 to image whatever part of the body and in his case
11:43 it would be the spine.
11:45 An MRI looks very similar, maybe a little bit more
11:49 daunting actually then a CAT scan in the point that
11:54 is usually a bigger machine that the patient
11:57 has to get inside of.
11:58 And the reason for that is that it is actually
12:01 a combination of the extremely high powered
12:03 magnet and a radio.
12:06 Both radio, it actually sends radio waves into
12:10 the patient and then receives radio signals
12:13 back from the patient.
12:15 There is no radiation with this type?
12:16 No radiation at all in an MRI.
12:18 It is a little more daunting, or claustrophobia tends
12:22 to be a concern, if that is something, you usually
12:24 can get sedation for that.
12:26 But an MRI is incredibly helpful for us in trying to determine
12:30 what is going on in somebody's spine, whether
12:33 there is a fracture that we are not aware of, or there is a
12:35 herniated disc, or there is just a degenerative spurring
12:40 and degenerative changes, it is probably the best
12:45 single test to evaluate for low back pain.
12:49 He has back problem so this is a pretty good test?
12:51 I would think so.
12:52 I think that it is fascinating that you can use these
12:55 waves to reconstruct what is inside of you.
12:58 It is this interesting technology and the MRI can be
13:03 very intimidating to the patient.
13:05 Relaxing techniques may be necessary or more than worth
13:10 it because that test gives us more information for his
13:14 particular problem than any other test that we have.
13:17 I had one person that was in one of those who said it
13:19 was a little bit noisy, is that true?
13:22 It is! - What makes it noisy?
13:23 Well it again is the combination of the magnetic field,
13:28 and within that magnetic field we have a series of what
13:32 is called gradient, so essentially every millimeter
13:36 across the body the magnetic field is slightly different.
13:40 Then you have a combination of the machine making noise
13:43 because it is sending radio impulses into the body and
13:46 receiving those impulses from the body.
13:48 The coils within the machine are interacting and nothing
13:52 touches the patient, but it can be fairly noisy.
13:56 Hopefully they will have at least earplugs in some
13:59 places they will even have music that you can listen to.
14:01 All this information is fed to computers and reconstructs
14:04 - reconstructs the body parts we're imaging and gives us
14:07 really a tremendous amount of information.
14:10 An MRI is a way that you can make a diagnosis.
14:13 A CAT scan and a chest x-ray, wow, these are great ways
14:16 to make a diagnosis.
14:18 We are going to come back and answer a few more questions just
14:21 after this short break!