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07:30 pm: MRI Images

–UPDATE–

Re-posted since the pictures ought to stay put now.

–/UPDATE–

I got the raw data from my knee MRI on a CD. They gave me the full DICOM data, which is the Digital Imaging and Communications in Medicine standard. The vast majority of medical imaging devices produce DICOM formatted files … which means that, basically, there’s no need for the radiologist interpreting the results to be physically close to the machine. Now, there are still advantages to physically seeing, touching, and smelling the patient – but in terms of an upgrade from “ink on plastic,” it’s pretty awesome.

OSIRIX is a piece of software (for apple) that reads and displays DICOM data. Until yesterday, I had not realized quite how powerful this stuff is:

I put the CD in the drive, started OSIRIX, and pushed the button with a picture of a CD on it. This was what came up:

Of interest are the fact that I’ve got six “series,” each of which represents a different combination of view / weighting. On the left side, you see a summary slide of each series. Basically, they took slices front to back, right to left, and top to bottom. This is a pretty amazing technology. redmed tells me that the weightings are probably going to be tuned so that we see detail on either bones, or on soft tissues.

The picture I’ve got up there is (I think) a view of the inside (medial) part of my left knee. Note that my muscles look a lot like steak. Have I mentioned that I’m vegetarian, at least as it relates to mammals? The big white circle is the inside knuckle on my femur. The black triangles in the middle, just below the femur, are (I think) my “medial meniuscus.” From my readings on the internet, meniscuses are supposed to look like “well formed, solid triangles.” Torn ones have “deformation, or break in the triangle.” That, to me, sounds a lot like a description of the rear triangle.

As I clicked around, additional windows started opening up. It turns out that the software knows that these images are actually slices from three perspectives of the same physical object. I started clicking back and forth through the slices at the same time, seeing a little green line move back and forth to show what slice I was looking at. Here’s a picture of the middle of my leg. On the left you can see the front to back slice. On the right, there’s a left to right slice. The diagonal stripe towards the back of my leg is (I think) one of my major ligaments or tendons. As I click back and forth, I can see it swooping from top to bottom and inside to outside.

Okay, it’s major nerd time. Look at the picture above and note the button that says “2D/3D”. I clicked on that and got all kinds of crazy options. I selected “3d volume rendering,” I picked the defaults, and I got this picture of my leg … sitting there on the screen like a ham on the butchers block:

I clicked the “crop” button, and sort of casually sliced off the front of my knee … as well as the side. Here’s a view (I think) of that same ligament / tendon:

I really can’t express how amazing it is for me to just be able to explore this stuff. I have to imagine that for someone who knows what they’re doing it’s even more so.

I realize that I’m being a really annoying patient by even looking under the hood here. The good little patient would sit quietly, waiting for the mighty doctor to come and reveal the world to him. On the other hand, I’ve long since abandoned the idea that anyone except me is responsible for my health and well being. I expect a call tomorrow with an interpretation of these images. I intend to listen to what the doc says, and give him a lot of credit for knowing way more than me about these things. Perhaps the most important thing this doctor has is context … I’ve never hurt my knee before. He’s seen thousands. That said, I plan to ask questions based both on how I feel and on what I see here. If I get a lot of flak for being a bad patient and actually looking at my data – I will go elsewhere.

I want to work with a physician who is comfortable enough in their knowledge to explain things to me.

While I was typing this, the image of my knee started rotating on the screen. I think it did that just to show off.

Originally published at chris.dwan.org. You can comment here or there.



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