Friday, 24 June 2016

Radiology: The "Eyes of Medicine"

The "Eyes of Medicine"

Wessam Bou-Assaly,  MD

Radiology is a branch of medicine that uses different imaging techniques to diagnose and treat diseases.
Many modalities, including X-ray/radiography, ultrasound, computed tomography (CT), nuclear medicine (including positron emission tomography, PET), and magnetic resonance imaging (MRI) are used by the Radiologist to diagnose and/or treat diseases.
Radiology is crucial in healthcare system since it provides a major step in treating patients, putting the finger on where the problem is and producing images of the internal organs of the body, which clinicians, of medical and surgical specialties, cannot see and evaluate.
The Radiologist, a physician and medical imaging expert, with specialized training in obtaining and interpreting medical images, works as part of the clinical team taking care of patients and participating actively in decision making to treat them.
For abdominal pain, signs of stroke, trauma after an accident, knees, neck and back pain, pregnancy and fetus evaluation, concern for surgical emergencies, screening for cancers such breast cancer, diagnosing tumor and evaluating their spread; the clinicians find no way around the Radiologist to obtain an as much accurate diagnosis as possible, with highly advanced imaging modalities, before planning any treatment for their patient.
Like the eyes for our bodies, shedding light on the external world around us, guiding our steps, coordinating our action, managing our reflexes, planning our moves, maintaining a safe environment for us, Radiology is the Eyes of Medicine, opening the body for us, shedding light on our internal world, without a single skin cut, and painting an image of our internal organs, showing what went wrong inside our bodies, and helping us plan an accurate treatment for our disease.
After all, who wants to drive a car blindly with closed eyes!

Wednesday, 22 June 2016

Tuesday, 21 June 2016

Wessam Bou-Assaly - How to Earn a Spot in a Fellowship Program

Fellowship programs are a prestigious form of medical training. Wessam Bou-Assaly earned a spot in a neuroradiology and head and neck imaging fellowship program at the Indiana University, School of Medicine. After completing that program, he enrolled in a second fellowship program to train in nuclear medicine. Medical training requires a lot of time and study. A fellowship program provides doctors with specialized training in a subfield of medicine.

The first step to earning a spot in a medical program is to excel in medical school. You will need to get excellent grades in medical school in order to earn a spot in a top residency program. In order to earn a spot in a fellowship program, you will need to have an excellent educational history. That history will need to begin in your medical program and continue throughout your residency program.

It may take some doctors several years to earn a spot in a fellowship program. Some of the more prestigious programs require an excellent educational history as well as a few years of work experience. Applying to a fellowship program is a difficult and time consuming process. However, the training is often worth the work and the wait.

A fellowship program can help a doctor obtain a specialized training and a prestigious position. After earning his medical degree in France and completing his residency at Caen and Lille, he earned a spot at the Indiana University, School of Medicine. He successfully completed two fellowship programs in radiology subfields.

Saturday, 18 June 2016

Wessam Bou-Assaly: The Risks of X-Rays

X-rays are produced when charged particles (electrons or ions) of sufficient energy hit a material and are suddenly decelerated upon their collision.

X-ray images are produced when a patient is placed in front of an X-ray detector and is then illuminated by short X-ray pulses. X-rays are absorbed by dense material with high atomic number such as bones, which are rich with calcium, and appear white on the resulting image. In the other hand, material with low or no atomic number, such as air in lungs, show up as dark patches on X-ray images because of their low absorption rates.

Type of X-Ray:

There are mainly 3 types of clinically used X-ray:

Radiography is the most familiar type of X-ray imaging. It is used to image mainly bones and the chest. Radiography also uses the smallest amounts of radiation.

Fluoroscopy is continuous live use of X-ray, and cane considered as a movie equivalent. The radiologist can watch the X-ray of the patient moving in real-time to watch the activity of the gut after a barium meal or intravascular contrast. Fluoroscopy uses more X-ray radiation than a standard X-ray, but the amounts are still tiny.

During Computed tomography (CT), the patient lies on a table and enters a ring-shaped scanner. A fan-shaped beam of X-rays passes through the patient into detectors placed across the patient’s body. The patient moves slowly into the machine so that a series of slices can be taken. This procedure uses the highest dose of X-rays because so many images are taken in one sitting.

The risk of X-Ray:

X-rays can cause mutations in the patient’s DNA and, therefore, might lead to cancer later in life. For this reason, X-rays are classified as a carcinogen by both the World Health Organization (WHO) and the US government. However, the benefits of X-ray technology far outweigh the potential negative consequences of using them. It is estimated that 0.4% of cancers in America are caused by CT Scan and this level is expected to rise in parallel with the increased usage of CT scans in medical procedures.

Each procedure has a different risk associated with it, depending on the type of X-ray and the part of the body being imaged. In example:

  • Chest X-ray is equivalent to 2.4 days of natural background radiation

  • Lumbar spine is equivalent to 182 days of natural background radiation

  • Upper gastrointestinal barium exam is equivalent to 2 years of natural background radiation

  • CT head is equivalent to 243 days of natural background radiation

  • CT abdomen is equivalent to 2.7 years of natural background radiation.

Even though the X-ray has been associated with risk of cancer, their benefit if used properly surpass their claimed danger: the importance of making the right diagnosis and choosing the correct course of treatment makes X-rays far more beneficial than they are dangerous.

Whether there is a small risk or no risk at all, the X-rays are here to stay.

Wessam Bou-Assaly is a highly experienced radiologist in Michigan with long years of practice.

Tuesday, 14 June 2016

Wessam Bou-Assaly - 3 Tips for Succeeding as a Doctor

Doctors have one of the most difficult professions. Wessam Bou-Assaly graduated from medical school in 2000. He completed a radiology residency as well as a neuroradiology fellowship and a nuclear medicine fellowship. He is a dedicated doctor who has conducted research in radiology, neuroradiology, and nuclear medicine. In order to succeed as a doctor, you need to be dedicated, hard-working, and always willing to learn.

Doctors should be dedicated to their patients and to their professions. Many doctors are charged with diagnosing and then treating their patients. They need to be able to accurately diagnose an injury or and illness, and then be able to choose the best course of treatment for their patient.

Medical professionals also need to be hard-working. The medical field is demanding and difficult. Doctors are responsible for their patients’ health and lives on a daily basis. These doctors need to be willing to put in the hours needed to help diagnose and treat their patients.

The medical field is constantly advancing. A successful doctor pays attention and be updated to the research in his or her field. Doctors need to be current on state of the art treatments and cutting edge research. Doctors need to regularly take classes and read their colleague’s research in order to provide their patients with accurate diagnoses and effective treatments.

Wessam Bou-Assaly is a doctor and a radiologist located in Ann Arbor, Michigan. He studied neuroradiology as well as nuclear medicine at the Indiana University, School of Medicine after he earned his medical degree.

Sunday, 12 June 2016

What is Nuclear medicine

What is Nuclear Medicine?

Nuclear medicine refers to medications that are attached to a radioisotope (radioactive material); the drug is called a radiopharmaceutical. Several different radiopharmaceuticals are available today to study various parts of the body and treat some conditions and diseases.

The radioisotope which is attached to the drug is usually called a "tracer". The most common tracers used in nuclear medicine are thallium-201 and fludeoxyglucose (18F) (18F-FDG), gallium-67, indium-111), iodine-131, iodine-123, and technetium-99m.

The radiopharmaceutical is administered either by injection, orally (swallowing) or as an inhalation. It is designed to target a specific part of the body where there might be some abnormality or disease. The radioactive part of the drug emits gamma rays which are detected using a gamma camera. The doctor can then see what is happening inside the body.

Nuclear medicine is commonly used to evaluate the gallbladder, liver, thyroid, lungs and heart. Physiological function can be determined well using nuclear medicine, rather than anatomical detail.

Nuclear medicine can, for example, be used to identify lesions deep inside the body without having to open up with patient (surgery). It can also determine whether certain organs are working properly; it can determine whether the heart is pumping blood adequately, or whether the brain is getting enough blood, and whether the brain cells are functioning properly.

After having a heart attack, nuclear medicine procedures can help accurately assess the damage to the patient's heart.

Nuclear medicine is useful in locating the brain sites of seizures (epilepsy), Parkinson's disease and Alzheimer's disease.

Nuclear medicine can also be used to treat patients. Thousands of people with hyperthyroidism are treated every year using radioactive iodine. Certain types of cancers, as well as bone pain resulting from cancer can also be treated.

With the most advanced equipment, nuclear medicine images can be used almost simultaneously with CT scans, making detailed anatomical studies possible.

Wednesday, 8 June 2016

Wessam Bou-Assaly - The Different Types of Strokes

A stroke can occur in different parts of the brain, and each type of stroke affects the brain in a different way. Wessam Bou-Assaly is a radiologist who studied neuroradiology as well as nuclear medicine. Both of these sub disciplines can be used to study, diagnose, and treat the brain. Neuroradiology can be used to identify the signs of a stroke. It is important to know about the different types of strokes, and their causes.

There are mainly three types of strokes :

  • ischemic stroke (caused by blood clots)
  • hemorrhagic stroke (caused by ruptured blood vessels that cause brain bleeding)
  • transient ischemic attack (TIA) (a “mini-stroke,” caused by a temporary blood clot)

  • Ischemic Stroke
    About 80 percent of strokes are ischemic. An ischemic stroke is most frequently caused by a blood clot that lodges in an artery and blocks the flow of blood to a part of the brain. High blood pressure and atherosclerotic disease are the most important risk factor for ischemic stroke.

    Ischemic strokes are typically preceded by symptoms or warning signs that may include loss of strength or sensation on one side of the body, problems with speech and language or changes in vision or balance.  They usually occur at night or first thing in the morning. Symptoms develop over a few minutes or worsen over hours.

    Often a TIA (transient ischemic attack) [see below] or “mini-stroke” may offer some warning of a major ischemic stroke.

    There are three types of ISCHEMIC strokes:
    • Thrombotic strokes are caused by a blood clot (thrombus) in an artery going to the brain.  
    • Embolic strokes occur when a clot that’s formed elsewhere (usually in the heart or neck arteries, such as carotid artery ) travels in the blood stream and clogs a blood vessel in or leading to the brain.
    • Systemic hypoperfusion (low blood flow) is caused by circulatory failure of the heart.
    Hemorrhagic Stroke
    A hemorrhagic stroke occurs when a blood vessel ruptures within the brain. About 15 to 20 percent of strokes are hemorrhagic. There are two kinds of stroke due to ruptured blood vessels:  subarachnoid hemorrhage due to ruptured aneurysms and intracerebral hemorrhage due to ruptured blood vessels.   In both types of hemorrhagic stroke, blood flow is disrupted to part of the brain.
    • Subarachnoid hemorrhage most commonly occurs when an aneurysm ruptures and bleeds into the space between the brain and the skull. Most aneurysms are congenital and rupture due to high blood pressure.  
    • Intracerebral hemorrhage occurs when a blood vessel bleeds into the tissue deep within the brain.  The main causes are chronically high blood pressure and aging blood vessels. Arteriovenous Malformations (AVMs) are also congenital malformations of blood vessels in the brain which can rupture into brain tissue as they get larger.
    Victims of hemorrhagic strokes are often younger and the fatality rate is higher than for ischemic stroke.  Overall prognosis is also poorer for those who have hemorrhagic strokes. The symptoms of a hemorrhagic stroke usually appear suddenly and often include:
    • very severe headache
    • nausea and vomiting.
    • partial or total loss of consciousness 

    Wessam Bou-Assaly is an experienced radiologist in the neuroradiology subfield.


    Wednesday, 1 June 2016

    Wessam Bou-Assaly - Nuclear Medicine versus Radiology

    Nuclear medicine is a sub discipline of radiology. Wessam Bou-Assaly is a radiologist who specializes in nuclear medicine. In 2007, he completed a fellowship program in nuclear medicine. He is a member of the Society of Nuclear Medicine, and he has conducted a large amount of research in the field. Nuclear medicine is different from radiology.

    Radiology involves using X-ray imaging to diagnose and treat diseases, injuries, and illnesses. Radiologists use a wide array of imaging techniques including computed tomography (CT), ultrasound, MRI and X-ray radiography. These professionals create images by projecting X-rays, ultrasound waves or large magnet, over the body. Machines measure where the X-rays pass through the body, or the reflection of ultrasound waves from body organs or proton spinning characteristics when inside a strong MRI magnet to create an image of the human body.

    Nuclear medicine is a type of radiology, however, it uses a very different method to create images. Professionals introduce small amounts of radioactive substances into their patients’ bodies. These substances are either injected or ingested. The radiologist will then use gamma cameras to form images based on the radiation that is emitted from the body.

    Nuclear medicine is different from other types of radiological images, because the images show physiological functions. In example, radiologists can use nuclear medicine to study the flow of blood to the brain or the function of the kidneys. Other forms of radiological imaging, such as CT scans or MRI scans, only create an image.

    Wessam Bou-Assaly is a radiologist who has studied neuroradiology and nuclear medicine.