<p><a href="https://peterattiamd.com/rajpaulattariwala/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=230703-pod-rajpaulattariwala&utm_content=230703-pod-rajpaulattariwala-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=230703-pod-rajpaulattariwala&utm_content=230703-pod-rajpaulattariwala-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=230703-pod-rajpaulattariwala&utm_content=230703-pod-rajpaulattariwala-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj's unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you've ever wondered how any radiology tool works, this episode is for you.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>Raj's road from engineering to radiology [2:45];</li> <li>How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [13:00];</li> <li>Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [22:45];</li> <li>Ultrasound: Benefits and limitations, and a special use for the heart [36:00];</li> <li>Detecting breast cancer with mammography: When is works, when you need more testing, and defining 'sensitivity' and 'specificity' [46:15];</li> <li>Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [59:00];</li> <li>Brain aneurysms: Using MRI to find them and save lives [1:18:45];</li> <li>Raj's unique MRI technology [1:25:15];</li> <li>The risk of false positives in cancer detection, and how Raj's MRI can reduce the number of false positives (i.e., increase specificity) [1:38:45];</li> <li>The unique software Raj created to pair with his MRI machine [1:46:15];</li> <li>Comparing the radiation exposure of a whole-body PET-CT to Raj's equipment (DWIBS-MRI) [1:48:45];</li> <li>How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:50:15];</li> <li>Why a DW-MRI is still not a perfect test [1:54:15];</li> <li>The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [1:58:00];/li></li> <li>Are there any commercially available scanners that can match the resolution of Raj's images? [2:01:00];</li> <li>Machine learning: When and where might machine learning/AI impact the field of radiology? [2:03:45]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Consider Brain Aneurysm Screening
Given that nearly 1% of the population may have an intracranial brain aneurysm, consider an MRA (Magnetic Resonance Angiography) to detect them early, as treatment before rupture can be life-saving.
2. Family History of Aneurysms
If a family member is diagnosed with an aneurysm, encourage extended family members to consider screening due to a potential genetic component.
3. Combine Mammogram and DWI MRI
For comprehensive breast cancer screening, especially with dense breast tissue, consider combining a mammogram with a Diffusion Weighted Imaging (DWI) MRI, as studies suggest this approach is highly sensitive and unlikely to miss cancers.
4. Consider Prostate MRI with DWI
For prostate cancer screening, consider an MRI with Diffusion Weighted Imaging (DWI), which is becoming a standard in some countries, as it offers a non-invasive way to assess the prostate beyond PSA or 4K blood tests.
5. Monitor Prostate Changes
If you have prostate abnormalities, consider monitoring changes over time with advanced imaging to differentiate between aggressive cancers requiring intervention and slow-growing ones that may not impact your lifespan.
6. Understand False Positive Risks
Be aware of the potential for false positives in advanced imaging, which can lead to unnecessary biopsies, physical harm, and significant emotional stress, even if the finding is ultimately benign.
7. Minimize Radiation Exposure
Be aware that younger individuals and females are more sensitive to radiation; therefore, minimize CT scans and other high-dose imaging, especially in children and young women, when possible.
8. Know Breast Density
Understand your breast tissue density from your mammogram report, as dense tissue can limit mammogram sensitivity, indicating a potential need for additional imaging like ultrasound or MRI.
9. Supplement Mammography for Dense Breasts
If you have dense breast tissue, be aware that mammogram sensitivity can be as low as 55%, making it crucial to consider supplementary imaging like ultrasound or MRI.
10. Regular Mammogram Screening
Follow recommended mammogram screening intervals (one or two years) because comparing images over time significantly increases the sensitivity for detecting subtle changes.
11. Calculate Radiation Dose
Use online calculators to determine your radiation exposure, especially if you travel frequently by air or live at high altitudes, as recommended for pilots and flight attendants.
12. Understand Test Trade-offs
Recognize that medical tests involve a trade-off between sensitivity (not missing true positives) and specificity (not having false positives), and a test with extreme values in one often sacrifices the other.
13. Seek Optimized MRI
When considering an MRI, understand that higher Tesla (bigger magnet) doesn’t always mean better; an optimally tuned 1.5T magnet can offer superior penetration and detail for whole-body imaging.
14. Seek Experienced Sonographer
Recognize that the skill and experience of the person performing an ultrasound are invaluable for accurate results, especially in challenging cases or body types.
15. Prepare for Ultrasound
If undergoing a pelvic ultrasound, ensure your bladder is full as the fluid acts as a window, allowing the ultrasound beam to pass through and provide clearer images.
16. Understand Medical Imaging
Regardless of your medical practice, strive to understand the risks, benefits, and subtleties of patient scans to avoid being confused or intimidated by them.
17. Consider Imaging Type
When ordering a medical imaging test, always ask yourself if you need anatomical information, functional information, or both, to guide your decision.
18. Understand Radiation Units
Familiarize yourself with millisieverts (mSv) as the unit of radiation measurement to better understand and discuss radiation exposure from medical imaging.
19. Observe Patient Anxiety
In trauma settings, be wary of patients who become wildly anxious when laid down, as this could indicate a critical underlying issue requiring immediate attention.
20. Learn FAST Ultrasound
Surgical residents should learn and practice FAST (Focused Assessment with Sonography for Trauma) ultrasound to quickly detect fluid in the abdominal or pericardial cavity in trauma patients, as it is a critical skill.
21. Foster Interdisciplinary Collaboration
For medical professionals, actively seek to bridge the communication gap between physicists and radiologists to optimize imaging technology and interpretation.
22. Advocate MRI Standardization
Support efforts by organizations like QIBA (Quantitative Imaging Biomarkers Alliance) to standardize MRI signal-to-noise, ensuring consistent image quality across different facilities.
23. Embrace AI as Second Reader
For medical professionals, consider integrating machine learning as a ‘second reader’ in radiology to improve efficiency and reduce the chance of missing critical findings, especially in comparative studies.
24. Join Membership Program
Consider joining the podcast’s membership program for more in-depth content and to take your knowledge of health and wellness to the next level.
25. Listen to “The Qualies”
Tune into “The Qualies” podcast (Tuesday-Friday) for short highlights of key questions, topics, and tactics from previous episodes of The Drive, offering an efficient way to catch up.