Wessam Bou-Assaly: Disc Disease and Radiology

                 

                         

                                   

Disc Disease and Radiology

          Wessam Bou-Assaly, MD

　

The intervertebral discs are spongy cushions elements, formed by strong connective tissues that separate the vertebral bodies of the spine. These have many important functions including shock absorption, stability of the vertebral column and giving the vertebrae pivot points for its movement.

　

A disc is made of two parts: the annulus fibrosis, an elastic outer shell and nucleus pulposus, a jelly-like central content.

With age and with certain types of pressure the annulus fibrosis can be damaged and the nucleus bulge through it.

Risk Factors:

　

Some people are more susceptible to disc problems than others. Risk factors include:

-Obesity

-Poor muscle tone

-Lack of exercise.

-Cigarette smoking

-Advancing age

-Poor posture

-Incorrect lifting techniques.

　

But often, there is no recognizable risk factor present.

Symptoms:

　

The symptoms of disc problems vary according to its location, its severity and its compression on the adjacent structure, mainly the spinal cord or nerve roots. Many people with disc herniation on MRI have no symptoms.

　

Symptomatologic disc problem complains may include:

　

-Back pain with or without radiation down the legs.

-Worsening pain associated with bending over or sitting down for a long time.

-Pain associated with activities like coughing or sneezing.

-Numbness or pins-and-needles in an arm or leg.

-Weakness.

-Loss of bladder or bowel control.

Diagnosis:

　

Diagnosis is of course suspected during taking medical history and when performing physical examination.

　

Radiology plays crucial role in diagnosing disc problem. The X-ray, even though limited in visualizing and evaluating the intervertebral disc, can shows signs of degenerative changes in the spine, which can be associated with underlying disc disease.

　

Signs of degenerative changes on X-Ray includes disc space narrowing, endplates sclerosis and presence of osteophytes.

MRI is the modality of choice in diagnosis disc degeneration and its effect on adjacent structure such as spinal cord and nerve roots.

MRI can precisely evaluate the type of herniated is material.

　

1- Diffuse disc bulge: Herniated disc tissue "circumferentially" (50–100%) beyond the edges of the vertebra. It is not considered a form of herniation.

　

It could be Symmetrical:

Or Asymmetrical:

2- Broad based disc herniation: Herniation between 25% and 50% (90 –180°) of the disc circumference.

3- Focal herniation: Involves less than 25% or 90° of the disc circumference.

Focal disc herniation versus Broad base:

Focal disc herniation can also be classified as protrusion or extrusion, based on the

shape of the displaced material.

　

Protrusion is present if the greatest distance, in any plane, between the edges of the herniated disc material beyond the disc space is less than the distance between the edges of the base, in the same plane.

　

Extrusion is present when, in at least one plane, any one distance between the edges of the disc material beyond the disc space is greater than the distance between the edges of the base, or when no continuity exists between the disc material beyond the disc space and that within the disc space.

A sequestration is present when there is discontinuity between the herniated disc material and the parent disc

Wessam Bou-Assaly, MD is a Neuroradiologist. He has many years in experience in medical Imaging fields.

Radiology: The "Eyes of Medicine"

Radiology:
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!

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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.

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.
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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.


Sources: http://interactive.snm.org/docs/whatisnucmed2.pdf