Sally Adams

I'm claustrophobic. That's how I can talk people to get through it, because I know what my fears are. I'm extremely claustrophobic. I know that that machine's not gonna hurt me, I know it's not gonna last forever, I know that there's air being blown through there, I am in control of the test. However, I do not like being in there!

Aryana Misaghi

I'm Aryana Misaghi and this is Appalachian Care Chronicles, a podcast bringing you stories from every corner of West Virginia's health sector. Join me as we journey alongside a variety of problem solvers, change makers and daily helpers, who are all working behind the scenes and on the front lines to care for our communities. Together, we'll explore what they do day-to-day, the steps that got them there, and the why’s that continue to draw them back. How in the face of some of the most challenging situations possible, do they manage to keep themselves and the rest of us from falling apart? Far from predictable, the paths they've walked are full of twists and surprises, discovery and purpose. This podcast is for anyone who's ever even thought about going into the healthcare field or has a passion for caring for others in times of need.

We're spending the day with MRI technologist Sally Adams. Millions of people get MRIs every year, and a technologist's job involves way more than just operating the machine. These images help physicians diagnose and monitor a wide range of conditions. By the way, if you've had an MRI, you know, it's a noisy machine, so just a heads up that you will hear a lot of it in this episode.

Sally Adams

We do livers, pancreas, gallbladder, so those are all separate, so in CT, you do an abdominal scan. Here we do body parts. You know, we've done a thumb before. I've scanned a tongue for cancer in the tongue. I mean, there's just—we can specify what we're looking at.

Aryana Misaghi

We couldn't go into the actual MRI room because our production crew learned that the magnet can interfere with the audio recording devices. And if we got too close, the machine can wipe digital memory cards clean! So we safely and respectfully watched a scan of a woman's lower back from outside the room.

Sally Adams

So they're positioning the patient, making her very comfortable. It looks like maybe we're going to be doing probably a low back because she's laying on the piece of equipment, nothing restricting her, giving her pillow underneath her legs. They are giving her earplugs because of the pounding noise and damaging the ears. Yes, they can still hear us with those earplugs, but it is safety recommended with the machine, with the decibels that those cover. And they're going to give her a blanket for comfort. Some things we can't give blankets for, like people with stimulators. They say, do not cover them because you don't want the internal heat. But apparently, she has no implants. She's getting a blanket, and they're going to give her that ball to hold on to if she needs us for anything. They are staying with the patient, talking her through, going in the scanner, as you can see, and whatever we scan goes to the center of the scanner, so they're lining her up now and now she's going in, making sure she's okay, kind of giving that hand on the shoulder. We're right here. Just, are you okay? Coming out. And then they can talk to her on the microphone here, as she can talk to us as well. And she's on the monitor, and you can scan. Start the scan!

Aryana Misaghi

Basically an MRI is a bunch of images of a body part that are taken in sequence, one after another, only millimeters apart. Each image slice provides a ton of information about the tissues in the body without having to cut anything open.

Sally Adams

It's like a loaf of bread. We would consider that like an axial image, and we go like a slice of bread. And each of those slices is going to be a picture we take. Now, if you want to do it, let's say in a, what we call a sagittal image, you're going to go perpendicular to that loaf, and go down the long ways. And now, each time we slice the loaf of bread that way, we're taking the picture.

Aryana Misaghi

The actual science of how MRIs work is fascinating—and honestly, a little hard for my mind to wrap around! In short, MRI machines take advantage of the natural properties of hydrogen atoms in the body. When placed in a magnetic field created by the machine, the hydrogen atoms align themselves along the direction of the magnetic field. Radio waves are then used to disrupt this alignment, causing the hydrogen atoms to produce signals that are picked up by receivers in the MRI machine. These signals are then processed by a computer to create detailed, cross sectional images of the body. Doctors might choose MRI over a CT scan or an Xray in cases when they need highly detailed images of soft tissues, or if a patient cannot receive radiation for whatever reason.

Sally Adams

The first part of that pounding noise you heard, it went through different pause, different pause, different pause, and then it went quiet for a second—that was the machine tuning itself to what body part was in there. This machine automatically tunes. When I first started, you actually had to go at the end of the machine, and whatever body part we scan goes in the center of the tube. Let's remember that. Most things from waist down can go in feet first. Most things from waist up need to go in head first. So a cervical on the first scanner in the valley that we worked on, they had these long rods that you had to reach in there and it was like a screw at the end that you had to get these long screwdrivers stuck into, and you had to turn them back and forth different ways with each hand to make sure you get it zero—in tuned—to that body part. That's how far MRI has come! We the machine is doing that now for us.

Aryana Misaghi

Sally has been working in this field for as long as MRIs have been used around Charleston. In fact, she says she operated the Kanawha Valley's first machine back in the 90s. So she's seen the development of the technology in real time. It's honestly amazing to see how far we've come.

Sally Adams

So the timeframe of the scan was like an hour—that we could do like 15 minutes now! I mean, the time has really changed—the bore of the scanner, which means the center of the scanner, and how long the scanner is—has been compacted down now so they're not near as long as what they used to be. Things have just changed so much. With the quality that we have now the new softwares that come out, which are being updated frequently. The images are fantastic. We have a mobile unit also that's kind of built in permanently at the hospital, as in, there's a ceiling, you know, we have a hallway. It's just like, really built in, but you're still on a trailer when you walk in. And those images as well are pretty awesome. We're doing breast MRIs now, prostate, we do rectal staging for cancer. There's just things that I never dreamed when I first started that we were doing now because when I first started, we do knees, brains, spines, occasional foot or an occasional shoulder. That's when I first started. And now we're doing all kinds of stuff!

Aryana Misaghi

Getting an MRI is painless, but it can be an intense experience. Patients typically lay flat on their back with a pillow under the knees for comfort on a motorized bed that moves into the scanner either feet or head first, depending on what exam you're getting. The tech will provide headphones or earplugs to protect your ears and then off you go. People sometimes struggle with a small space or loud noises, so doctors may prescribe anxiety medication to take beforehand.

Sally Adams

Some of the techniques we use with patients is “Close your eyes, go to your happy place, if you like, the beach. Think you're outside. The wind's blowing…” (because we do have a good air system in our scanner) “...the wind's blowing. You're watching the birds. You're here in the ocean. You're watching your kids fly the kites. You're in a big open space.” It's a mind game. Mind over matter. There's times that people say, “Just put a blindfold on me.” We do that. If you want to be blindfolded, you can be blindfolded. There's been times that there's been a technologist, because we know patients really need their tests, they really need it to finish out a test or something, techs go in there and hold patients' hands to get them through. “Just give me two more minutes. Just two more minutes we can do this.” You know, it takes a team sometimes to get these patients through.

There's some people just look at the machine, turn around, walk right back out. So we're walking down the hallway chit-chatting. And it's like, and if I can just get them in the room, show them the equipment, let them lay down on the table, and they're popping right back. I was like, “No, just, just lay here for a minute. We're not going to do anything.” You got to earn that trust with that patient and then say, “Hey, even if we don't do this today, let's see if you can just go where you're supposed to be. Because what knowledge is power, right?” So if they have the knowledge of what's getting ready to happen, they have the power to go through the test. Sometimes that works, and we can continue to do the test. Sometimes they still need to leave and maybe get some type of sedation and come back. And you can talk to patients in between. You can pause the scanner too. Your mind's going a mile a minute. And what are you thinking about? Anything that could happen. So what do we do? “Hey, are you in Hawaii yet?” “Are you on that cruise?” We had one lady. We've taken Hawaii trips with her a few times. We've had people say that they baked us a chocolate cake inside the scanner because they go through recipes. They go through Bible verses. If they're not singing songs and tapping their toes—we have to remind them that they can't do that because of motion. But there's people that just recite things in their mind, or make their grocery list out, or if it's close to Christmas, “Have you done your Christmas list yet?” Try to think of things. Anything to keep their mind off of having the MRI scan.

Aryana Misaghi (Show Information Break)

Appalachian Care Chronicles is made possible thanks to the West Virginia Higher Education Policy Commission. West Virginia Invests is the state's tuition free community college program covering tuition and mandatory fees for certificate or associate's degrees in in demand fields, including nursing and other healthcare careers. Find out if you qualify and apply at collegeforwv.com. That's College For WV dot com.

Aryana Misaghi

Not everyone can get an MRI. Sheet metal workers, for instance, should be careful, because there may be small pieces of metal stuck in the eye that they didn't even know about. Some ink and tattoos can contain trace amounts of metals. It's part of the technologist's job to watch scans as they're being generated, in case unexpected metal is detected. Sometimes they may choose to proceed with the scan, since it may still be safe, as long as the patient doesn't feel discomfort. Surprisingly, implanted orthopedic devices like pins, rods and plates are okay, as well as IUDs and wire mesh.

Sally Adams

We're really concerned with soft tissue things, whereas I think she also has maybe a stent in her leg. This was researched because now a stent in the leg that's not in the bone, that's a soft tissue. We have to research that. And as we talked about over here, the gauss lines, it met all the parameters that we needed and for what we were scanning. So that was something that had to be researched on the fly.

Sometimes they have cards that they bring with them, which is a godsend if they do, because it makes life so much easier on us that we know the make the model and we can research it that way, if they don't give the particulars on the card, makes it so much faster. If they don't have the card, we have to get the OP reports of when they were put in and research the Op Report, take time out to get it from the facility, once our computer systems fully change over, that may not be an issue. At that point, we can go directly to and get the reports.

Aryana Misaghi

All of this can take a bit of detective work to figure out.

Sally Adams

Years ago, in one of our professional magazines that we had, they mentioned the MRI techs were like air traffic controllers, because we have a short, minimal amount of time to know everything about that patient. We got to know if they're claustrophobic, we got to know how to read them. We got to know what's in them. We got to know what exam they're for. How are we going to get that exam appropriate for the doctor and what the doctors are wanting. Make sure the patient is comfortable and safe. While as we're scanning, the patient may be squeezing the ball, we're having to, you know, take care of them, but we're setting up the next stuff on the computer, and it's just go, go, go.

Aryana Misaghi

The four MRI machines in Sally's office are intricate and costly. She and her colleagues are always monitoring them. They start their day with a detailed review of the equipment and its performance.

Sally Adams

We check out the equipment, we make sure the levels are on, we do a test run with the equipment and test or check all of our refrigerators with things that we have in and our equipment to do the blood test to make sure the contrast can flow through the kidneys. After that, our patients start arriving, and we greet them and start going through safety questions and make them comfortable for their test and getting them through the test. Some patients are, of course, are much more claustrophobic than others. Some people say, “Oh, I've had a million of them, I'll be fine.” And some we have to research. You never know what you're going to get. We also see patients that don't even think twice about it.

Sally Adams (to Patient)

How are you doing today? Fine. Thank you. You have a seat right here. My name is Sally. I'm going to be doing your test today, or at least assisting with your test. She's already taken her jewelry off. She knows, all right, so, and we're looking at your head today. Is that correct?

Patient (to Sally)

Correct?

Sally Adams (to Patient)

Okay, what's going on?

Patient (to Sally)

Hopefully, nothing.

Sally Adams (to Patient)

(Laughs)

Patient (to Sally)

I had a craniotomy in 2013 for a benign meningioma. It was a full craniotomy with about 47 staples you can feel in my forehead where they took a piece of the skull out, and there's titanium screws there to keep my head together.

Sally Adams (to Patient)

All right, so you know these questions we have to go through. How about pacemaker? No PACE wires? Drug pump? neurobo stimulator, insulin pump, insulin sensor, the shunt or heart valve? No metal in your eyes or eye surgery? How about hearing aids or tubes in your ears?

Patient (to Sally)

Hearing aid, but I took it out.

Sally Adams (to Patient)

Okay, great, and you said family history of aneurysm, any reason…?

Patient (to Sally)

My mother, just at 55 years old, she had a cerebral aneurysm and just dropped and died.

Sally Adams (to Patient)

Oh my goodness, yeah. Oh my goodness, yeah. I bet it was. They have ordered contrast on you, and that will be an injection into your vein.

Patient (to Sally)

I've had that several times. Sometimes it makes me feel a little squirrely.

Sally Adams (to Patient)

Well, in this one, we're going to come in the room and actually give it to you bedside there and be there with you. Okay, and if you feel any discomfort or feel anything you just let us know, okay?

Patient (to Sally)

and you'll quit. (Laughs)

Sally Adams (to Patient)

You just want to wash it out of your system. It can cause thickening of like the skin or organs, hence getting it out of your system. And that's the best way to do that. My guess is you're going to be good.

Patient (to Sally)

Well, thank you. You're a good technician.

Sally Adams (to Patient)

You’re going to be fine! All right, so this one right here talks about…

Aryana Misaghi

We were with Sally the day after a tornado warning in Charleston, knocked out phone and power for 1000s of households and dozens of businesses. She had to figure out how to confirm one important detail of this patient's story, and that proved to be a little challenging, since she couldn't access records on the computer, she tried the doctor on her cell phone instead.

Sally Adams (to Patient)

I can't get hold of your doctor's office right now. They're closed for lunch. Mother Nature rolled over us. Yeah, yeah. Well, anyway, we will try to get that, and if we get it, we're good.

Patient (to Sally)

So you're just wanting the report that says this coil is out.

Sally Adams (to Patient)

Yes, ma'am.

Sally Adams (to Colleague)

Hi. This is Sally an MRI. I've got a question for you. There's a patient that's going to be a mutual patient of ours. She is from Nebraska, and I think she had her record sent to you. We're trying to do an MRI on her today, and with the computer systems are down, phone lines are down here, and we are trying to get her scan done. Wondering if you had any of that information?

Sally Adams (to Patient)

Another dead end, they don't have those records, so don't think we can do this today. I'm going to let you get dressed.

Patient (to Sally)

We'll reschedule?

Sally Adams (to Patient)

When would you like to come back?

Patient (to Sally)

I want to get it out of the way so I quit worrying about it.

Sally Adams (to Patient)

Let me see what we've got for you. Okay, yeah…

Aryana Misaghi

Sally's path to becoming an MRI technologist started before MRI machines were available in our area. After high school, Sally considered becoming a state trooper. One day, her mom mentioned an X-ray Technologist Program at the University of Charleston.

Sally Adams

I didn't know there was a whole field in that, and it has grown now to ultrasound, CTs, MRIs, even narrowed down to even more aspects of it. So she got me an interview to the school. I went into the program at the time, and pretty interesting stuff. I realized it just wasn't hands and elbows that you take pictures of, you can do the inside of bodies too.

Aryana Misaghi

Sally got trained in X-ray and learned MRI through continuing education. All radiology technologists start with X-ray school, which is two years long. The first year school teaches the operations and positioning of the devices, and the second year covers physics and safety. Rotations in second year help you choose if you want to branch out from X-ray, and most of the specializations get to be taught on the job. All texts require board certification. After that, the US has a shortage of radiology technologists, but it's also a growing field. Overall employment of radiologic and MRI techs is projected to grow 6% from 2022 to 2032 which is faster than the average for all occupations. Sally got her first job while still a student as a technical assistant.

Sally Adams

I was already on the career path. I was already in school. There was no turning back at that point, and from that I worked trauma, from there, went into computer tomography, CT, did CT for a little bit, and from CT, I went into MRI. Most people in high school want to go when they think of a medical field, they think nurses, or they think PA, doctor. They don't think that supporting staff. That supporting staff, is the ones that keep those people going. Okay? So we're down here, we're doing these exams for you so you can make a diagnosis for your patient. I had a family and still could do this job.

Aryana Misaghi

The job also requires restraint. Sometimes Sally sees things on a scan that are concerning, but she can't diagnose conditions or even reveal findings, even if a patient asks her directly.

Sally Adams

A lot of small cell lung cancers can metastasize to the brain. So we follow up a lot of times with brain scans and where they've had chemo and stuff. So we get repeated patients to see, you know, if anything's developed or anything. And you get to know these patients, and you know if they have a vein or not, because we’ve got to inject them, and they're so sweet. And you your heart breaks for them. So the TLC comes in at that point as well. But yes, we also know when somebody comes in, they've just had a headache, that they think it's just a migraine. It may not be. Can we disclose that to them? No, that's malpractice. We can't say anything to them. That's where we have to have a strong soul, person, and keep our smile on our face and say, “You know, your doctor will get this report.” Or we're holding them here and saying, “You know, we just want the doctor reviewed this.”

Vas Scouras (Production Crew Member Interviewing Sally)

Is there one moment that stands out that you were just like, “This is why I do this”?

Sally Adams

Maybe the patients that have been recurrent and they beat cancer. They beat it. They're in remission. They've come back, maybe for something else. They're like, “Yeah, I had cancer. Y'all scanned me here several times.” And I'm like, “How you doing with that?” They’re like, “Oh, it's gone.” What a cheer moment that is! Yeah. So yeah, they're doing great. So those moments make it worth the while.

Aryana Misaghi

Appalachian Care Chronicles is a production of the West Virginia Higher Education Policy Commission, Health Sciences Division, which is solely responsible for its content. Guest opinions are their own.

Special thanks to WVU Medicine Thomas Hospitals.

For more information about educational opportunities related to healthcare in West Virginia, visit appcarepod.com that's A PP Care Pod dot com.

I'm Aryana Misaghi and you’ve been listening to Appalachian Care Chronicles.

Next time, in the final episode of Season Three, we'll be joined by Jordan Dennison, a Peer Recovery Support Specialist who helps vulnerable and at-risk populations by making sure they have access to life saving and life changing resources, ensuring that they know someone is in their corner.

See you then!