THE BEAM - Mississippi Society of Radiologic Technologists

Transcription

THE BEAM
Winter 2009
Affiliated with the American Society of Radiologic Technologists
Letter from the MSRT President:
Dear Fellow MSRT Members,
First I would like to thank everyone for granting me the opportunity to serve as
MSRT President again. This will be a busy year, and the Board is working hard.
Strategic Planning, Licensure, our website - it will be a full year.
Inside this issue:
President’s Letter
1
Editor’s Letter
1
A Tribute to Kathy Stegall
2
Special note from the
Technologist of the Year
2
Directory—MSRT Board of
Directors / Committee
Chairpersons
3
Business Meeting Minutes
6
Student Exhibit
Competition
11
Student Manuscript
Competition
13
Jim Wood Award
14
1st Place Student
Manuscript
15
Student Paper
19
Change of Info Form
24
Membership Application
25
Random Pictures from
Conference 2009
26
Conference on the Coast was great! The student papers and exhibits were
excellent, and continue to impress. Congratulations to all winners! It appeared
that all had a great time. I know I speak for all MSRT in giving a big “Thank You”
to Chuck, Penny Spivey, and to all who were involved in the preparation and
planning.
I have heard many comments regarding the MSRT this past year. After all is
said and done, the MSRT is our only state organization that is valiantly
attempting to secure a place in the educational and legislative realm for our state
technologists. In comparing Mississippi, what makes
other state societies strong is membership, and active
participation and volunteer work. MSRT will see many
changes this year. I encourage you to volunteer to share
your vast knowledge by possibly speaking during a
presentation, or support our membership and be a part
of the future for the MSRT.
Thank you again.
Deborah Shell
Letter from the Editor:
I am extremely excited about
serving as Editor of THE
BEAM! I would like to
personally
thank
Kathy
Stegall for her dedication and
hard work as editor for the
past 19 years! Please be sure
to read the special article
honoring Kathy in this issue
of THE BEAM.
Conference 2009 in Gulfport
was awesome! Penny, Chuck
and their crew helped coordinate another memorable Conference! In this issue of THE
BEAM, you will find a report
from Conference 2009, an
updated directory of the
MSRT Board of Directors and
Committee Chairpersons, and
a couple of excellent student
papers. I also included some
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great pictures from our
time in Gulfport!
The next deadline for THE
BEAM is tentatively set for
February 20, 2010.
Please have a wonderful
and safe holiday season!
~Kristi Moore
THE BEAM
ATTENTION!!!
Please make note that Nancy Adams has retired as Executive
Secretary. Christy Thomas now serves in this capacity. All
correspondence regarding MSRT membership and
Conference registration needs to go to Christy Thomas.
A Tribute to Kathy:
Kathy Stegall graduated
from the University of
Mississippi in 1985 with a
Bachelor of Business
Administration degree. She
received EMT - Basic in
1987 from Ittawamba
Community College; EMT Intermediate in 1988, and
graduated from the ICC
Radiography Program in
1990. Kathy has been
employed in Computed
Tomography (CT) since
1991. She has been employed at North Mississippi
Medical Center since 1986.
editor and Joanne Gregory
served as editor. In 1996,
Kathy was elected editor
again, where she remained in
this position until resigning
in 2009.
Kathy has also served MSRT
in other capacities. In 1992,
she took over as secretary of
MSRT because the elected
secretary had moved out of
state.
Kathy reflected on early
duties as co-editor and editor
of THE BEAM: She said, “To
support mailings and printKathy Stegall was elected
ing, we sold advertising for
co-editor of THE BEAM in THE BEAM. I remember havOctober 1991 at the Biloxi ing to hand sort by labels into
Conference. Rita Fraser
different zip codes and taking
served as editor at that
it to the post office for mailtime. In 1992, Kathy was
ing, where we paid for postelevated to editor. She was age out of our own pockets
re-elected editor until 1995, until we were reimbursed by
where she served as coMSRT. We had to rely on the
U.S. Postal Service for letters, articles and other entries for THE BEAM, and
used graphics from other
publications for a little
variety. We used typewriters to correct any errors in
articles or letters or to create an article. We literally
hand cut and pasted pictures and writings for THE
BEAM and discovered that
black and white photos
printed better than color.”
Kathy loves to travel. She
also enjoys helping raise
her nieces and nephews,
cooking, and decorating
cakes for all occasions,
including weddings and
birthdays.
Kathy, thank you for
dedicating your time for
the past 19 years to the
MSRT BEAM!
Technologist of the Year:
Being chosen as Technologist of the Year is an interesting experience. You
know that being honored in this way is a reward for your doing a good job
for the society and its members. However, at the same time you know that
there are those who have given to the MSRT over the past year also. I am
so thankful to be honored this way and am grateful to my fellow members
and board members for allowing me to do the things I do and grateful for
everyone who works so hard for the MSRT. Thank you for this award and
a special thank you for the selection committee for choosing me.
Paula Young, BS, RT (R) (M)
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MISSISSIPPI SOCIETY OF RADIOLOGIC TECHNOLOGISTS
BOARD OF DIRECTORS 2009-2010
President
Deborah Shell
602 West Hill Street
Fulton, MS 38843
(H) 662-620-1450
(W) 662-862-8345
Email: [email protected]
Vice President
John Melvin
5857 Cypress Trail
Jackson, MS 39211
(H) 601-573-6853
Secretary
Kristi Moore
252 Moore Road
Vaughan, MS 39179
(C) 601-842-1738
(W) 601-984-6368
Treasurer
Paula Young
104 Nolan Lane
Brandon, MS 39047
(H) 601-829-2132
(W) 601-984-2604
Editor – THE BEAM
Kristi Moore
252 Moore Road
Vaughan, MS 39179
(C) 601-842-1738
(W) 601-984-6368
Executive Secretary
Christy Thomas
108 Begonia Lane
Madison, MS 39110
(H) 601-842-6973
(W) 601-984-6973
ASRT Delegate
Mike Ketchum
7 Dark Corner Road
Yazoo City, MS 39194
(H) 601-746-7619
(W) 601-984-6355
ASRT Delegate
Paula Young
104 Nolan Lane
Brandon, MS 39047
(H) 601-829-2132
(W) 601-984-2604
Board Member
Kelly Smith
1026 Bondurant Street
Wesson, MS 39191
(H) 601-643-8894
(W) 601-835-9442
Board Member
Sherrill Wilson
322 Martin Road
Brandon, MS 39041
(H) 601-825-6164
Conference Coordinator
Chuck Busby
302 Wildwood Blvd
Jackson, MS 39212
(H) 601-372-3615
(W) 601-894-4541
Chairman of the Board
Mike Ketchum
7 Dark Corner Road
(H) 601-746-7619
(W) 601-984-6355
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BOARD OF DIRECTORS 2009-2010 (CONTINUED)
Student Delegate
Allison Bennett - UMMC
738 North Oakridge Drive
Brandon, MS 39047
601-214-8397
Student Delegate
Chris Burleson - ICC
102 Mulberry Drive
Tupelo, MS 38801
662-213-7629
Alternate Student Delegate
Tyler Counts - UMMC
3975 Interstate 55 North, Apt. F3
Jackson, MS 39216
(C) 662-897-0055
Alternate Student Delegate
Antonio Maymon – Co-Lin
1004 Sinclair Street
Hazlehurst, MS 39083
601-669-6005
DISTRICT PRESIDENTS
District 1
District 5
Kelly Smith
1026 Bondurant Street
Wesson, MS 39191
(H) 601-643-8894
(W) 601-835-9442
Inactive
District 2
Rita Fraser
339 Hwy 348
Guntown, MS 38849
(H) 662-869-1369
District 6
Hope Husband
336 Oral Church Road
Sumrall, MS 39482
(W) 601-554-5510
District 3
Christy Thomas
108 Begonia Lane
Madison, MS 39110
(H) 601-842-6973
(W) 601-984-6973
District 7
Inactive
District 4
Marsha Mitchell
2204 Valley View Drive
Meridian, MS 39305
(H) 601-485-0445
District 8
Inactive
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MSRT COMMITTEE CHAIRS, ETC. FOR 2009-2010
Historian
Sherrill Wilson
322 Martin Road
Brandon, MS 39041
(H) 601-825-6164
Membership Committee
Christy Thomas
108 Begonia Lane
Madison, MS 39110
(H) 601-842-6973
(W) 601-984-6973
Conference Committee
Christy Thomas
108 Begonia Lane
Madison, MS 39110
(H) 601-842-6973
(W) 601-984-6973
Education Committee
Mark Gray
188 Fairchild Road
Morton, MS 39117
(H) 601-732-1929
(W) 601-984-6364
Nominations Committee
Penny Spivey
10800 Jim Ramsey Road
Vancleave, MS 39565
(H) 228-826-4991
Legislative Committee
Mike Ketchum
7 Dark Corner Road
(H) 601-746-7619
(W) 601-984-6355
Rules/Bylaws Committee
Asher Beam
167 Trace Ridge Drive
Ridgeland, MS 39157
(W) 601-984-2645
Parliamentarian
Tracie Jordan
Post Office Box 686
Quitman, MS 39355
(C) 601-480-0575
Student Liaison
Julie Gaudin
1010 Fair Oaks Drive
McComb, MS 39648
(C) 601-248-5260
(W) 601-643-8454
Training Session Coordinator
Rita Fraser
339 Hwy 348
Guntown, MS 38849
(H) 662-869-1369
Sargeant-at-Arms
Co-Editor – The Beam
Pending
Pending
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Mississippi Society of Radiologic Technologists
Affiliated with the American Society of Radiologic Technologists
The MSRT Business Meeting for the 68th Annual Conference was held at Courtyard Marriott in Gulfport, MS,
on October 29, 2009. Deborah Shell welcomed those present and thanked everyone for attending Conference.
The invocation was given by Mark Gray, with the pledge of allegiance following.
A quorum was established and the meeting was called to order by President Deborah Shell at approximately
8:10 a.m. She stated that the minutes from Conference 2008 will not be read “due to circumstances beyond our
control.”
The following reports were given:
I. District Presidents: No report given.
II. Historian: No report given.
III. Nominations: No report given.
IV. Student Liaison:
1. Tyler Counts from UMMC and Antonio Maymon from Co-Lin Community College were elected as
alternate student delegates.
V. Editor of THE BEAM:
1. A total of 2,640 copies of THE BEAM were printed.
2. The total cost of printing was $4,914.60.
VI. ASRT Affiliate Delegates:
1. The full ASRT Affiliate Delegate Report was published in the Fall 2009 issue of THE BEAM. Paula
Young responded to questions from members.
VII. Student Delegates: No report given.
VIII. Treasurer:
1. Please refer to Appendix A for the MSRT Annual Financial Report that was presented at the
business meeting.
IX. Operating Budget:
1. Mike Ketchum presented the operating budget that was approved by the Board so the membership
could vote on it. (see Appendix B)
2. Several questions were posed by MSRT members:
a. Question:
¬ How much does MSRT get annually just from membership dues?
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b. Question:
¬ Technologists want to know what does being a member of the MSRT get them? What does
the MSRT do for them? A suggestion was made to create incentives for RTs, such as having
a drawing for a member to have a choice between an all expense paid trip to ASRT (for
registration and travel) or $500 cash.
c. Response:
¬ Mike Ketchum responded to these questions by stating that MSRT membership dues have
not been increased since 1994. The dues are not sufficient enough to cover all expenses
proposed in the operating budget. He stated that the Board had an intense workshop with
Dana Aragon from the ASRT on Wednesday during Conference to discuss working on a
strategic plan for recruitment and retention of RTs. Updating the website and offering
incentives were items discussed in the workshop. He said, “In January 2010, we will have a
strategic plan ready. The 70th anniversary of the MSRT is in two years and it would be a
great time for the MSRT to rebuild. We have to fight for the MSRT and we are getting help
from the ASRT concerning this.”
3. The operating budget (Appendix B) was approved by the membership.
X. Conference Coordinator/Conference Chair:
1. 168 Conference attendees had preregistered.
2. Chuck Busby opened the floor for any ideas to make Conference better.
a. The following question was asked from a second year student:
¬ “What can we do about jobs when we graduate? Is there anything in the works to re-amend
the state law?”
b. Response:
¬ Diane Mayo gave an update on the Care Bill. She said that the Care Bill was submitted on
September 25 to the House of Representatives in Congress. She said, “We are trying to get
cosponsors on this bill. They are waiting to get a budget score to see how much passing the
Care Bill will save the federal government. We had 160 representatives sign on last time in
Congress. We know it will save between $50- and $100 million dollars in medical bills.”
XI. Vice-President: No report given.
Old Business:
1. Legislative update:
a. Mike Ketchum stated in response to a student’s question, “There is nothing we can do about OJT’s
taking our jobs. We don’t have the numbers. You have to have money and power and this comes in
numbers.” Mike has been working especially hard with Beth Clay’s firm revising the state law and all
has been going well so far. There has been no major opposition. Mike said, “The membership decided
at Conference last year to let the bill sunset. Little did we know…we don’t have control. The
Mississippi State Department of Health has control. It was suggested that we make revisions if we need
to because it will not sunset.”
b. Mike presented a short slide show that included the following information:
i. According to the current state licensure, we can’t legally inject contrast media. We had to make our
scope of practice match what it is nationally. If it applies to the exam we are performing under the
direction of a Radiologist, we can do it.
ii. OJT’s pay their licensure fees to the Board of Medical Licensure. We added a category for the
LXMO for these people so everyone is operating under the same rules.
iii. Exemptions have been revised to include only dental hygienists, chiropractic assistants, and x-ray
students.
c. Mike has met with our legislative monitor and a legal representative from the State Department of
Health regarding the revisions. They believe it has been written well. Mike also said that the
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Mississippi Department of Health is behind us and that they will be presenting these revisions for the
MSRT if no issues arise and they are in agreement.
2. Bylaws:
a. Suzanne Fisher, Bylaws Chair, was unable to attend Conference. Sherrill Wilson presented the
following information:
i. Two (2) years ago a task force was created to establish criteria for Life Membership (which was
published in THE BEAM).
ii. Currently, the entire Board has to approve nominations for someone to be a life member.
iii. If this is passed, the bylaws will read: “…Board members present at the summer board meeting”. If
this is not passed, it will read: “…the unanimous vote of the Board of Directors.”
b. The proposed bylaws were passed. Criteria will be placed in the Policy and Procedure Manual
regarding Life Membership.
New Business:
1. A member asked if a motion could be made that an ASRT representative formally contact ARRT and ask
for them to recognize category B credits. This was brought forward because of a concern about RT’s
copying category A CE credits. It was stated that “when we had category B CE credits they had to formally
get 12 of them.” Jeff Crowley with the ARRT stated that anyone copying CE credits should be reported
because they are violating the code of ethics. He said that if you are caught, you can have your license revoked either permanently or up to a three (3) year period. He said, “CE is about keeping your education
current in this ever-changing world. If you are caught, you will be punished.” Diane Mayo, the ASRT
President, said that she will go back to the ASRT Board and staff and present this request to recognize
category B credits.
2. THE BEAM:
a. Kathy Stegall resigned as Editor of THE BEAM (effective October 31, 2009).
b. Kristi Moore has volunteered to serve as Editor of THE BEAM.
c. The new BEAM will be electronic and will be posted on the MSRT website. A postcard will be mailed
to all MSRT members informing them that the new issue has been posted to the website.
3. Nominations:
a. Nominations were opened up and closed. Since only one person was nominated for the offices of
President, Secretary, and ASRT affiliate delegate, a motion was made to unanimously approve these
positions.
b. Voting took place for the office of Vice President.
c. The elected positions for the upcoming year are as follows:
i. President – Deborah Shell
ii. Vice President – John Melvin
iii.Secretary – Kristi Moore
iv. ASRT Affiliate Delegate – Paula Young
With no further business to be discussed, the meeting was adjourned at approximately 9:40 a.m.
Respectfully submitted,
Kristi Moore, M.S., R.T. (R)(CT)
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10
1st Place - Defecography
Students: Ruthie Gant & Dana Knight
(UMMC)
2nd Place - Fractures
Students: Christina Wilson, Kali Ford,
Leah Smith & Leslie Waldrop
(Co-Lin)
3rd Place - Radiography of Exotic Animals
Student: Simira Nazir
(UMMC)
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People’s Choice Award - X-Ray Interactions
Students: Melana Woods, Cary Anne Rake,
Robyn Breakfield, Alex Davis & Richard Panzica
(Co-Lin)
iScatter
Student: Dana Holeman
(UMMC)
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A total of 43 student papers were mailed to three (3) out-of-state judges for the student
manuscript competition. Pictured below are the six (6) students whose papers were
selected for manuscript competition.
Jason Cloud — Forensic Medicine: Dead Men Do Tell Tales - (2nd Place)
Caroline Scott — Shaken Baby Syndrome - (3rd Place)
Domenick Addison — Sirenomelia “Mermaid Syndrome” - (1st Place)
Michele Harris— Stereotactic Breast Biopsy
Cary Anne Rake — Turn Your Face to the Sun and the Shadows Fall Behind You
Justin Hanks — Understanding and Identifying Child Abuse
Pictured from left: Jason Cloud (Co-Lin), Caroline Scott (UMMC), Domenick Addison (UMMC),
Michele Harris (Jones CC), Cary Anne Rake (Co-Lin), and Justin Hanks (UMMC).
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Chris Hatt is currently a senior Radiologic Technology student enrolled at the
University of Mississippi Medical Center (UMMC). He started working to earn
points in October 2008. He entered an exhibit for competition at the MSRT 67th
Annual Conference, attended District Meetings, wrote papers to be published in
the Beam, made presentations at the District Meetings, and submitted a paper for
the student manuscript competition for this year’s conference. Chris Hatt was
presented the Jim Wood Award in recognition of outstanding performance.
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Student Manuscript: 1st Place Recipient—Domenick Addison (UMMC)
Sirenomelia “Mermaid Syndrome”
Back in the day as a young kid running around the mean country streets of Bogue Chitto, Mississippi, I
remember watching a Walt-Disney movie called “The Little Mermaid.” At that point in time, I knew there was
no such thing as a real life mermaid. Little did I know, mermaids somewhat actually existed. A pediatric pathologist describes mermaid-like humans as having Sirenomelia, also known by “Mermaid Syndrome.” It is a
lethal birth defect of the lower body characterized by complete or incomplete fusion of the legs into a single
lower limb that simulates a mermaid. It is a severe form of caudal defect with an incidence of 1 to 4 in every
100,000 births. The presence of chromosomal abnormalities and family inheritance has been thought the reason in almost all cases. Other birth defects are always associated with Sirenomelia, most commonly abnormalities of the kidneys, large intestines, and genitalia.
“This particular pattern of birth defects is associated with abnormal umbilical cord blood vessels. In
normal infants, the fetus develops two umbilical arteries, which pump blood from the fetus to the placenta, and
one umbilical vein, which returns blood from the placenta to the fetus. The umbilical arteries branch off the
iliac arteries in the pelvis. The iliac arteries supply the legs and pelvic organs such as the genitalia” (Valenzano). Most babies with Mermaid Syndrome have only one umbilical artery and one vein. Very seldom a baby with Mermaid Syndrome can have the typical two arteries and one vein without blockage of one
artery.
In Sirenomelia, it is explained as having one functional artery larger than normal and branches from the
aorta high in the abdomen. Below this umbilical artery, the aorta becomes abnormally narrow. “This type of
single umbilical artery is known as a vitelline artery because it is thought to arise from the primitive vitelline
arteries early in the life of the embryo. The vitelline arteries normally fuse a few weeks after conception to
form the arteries that supply the gastrointestinal system and genitourinary system. If the normal umbilical arteries do not form correctly as branches from the iliac arteries, then a vitelline artery might persist” (Stevenson). The vitelline umbilical artery steals blood and nutrition from the lower body and redirects it
15
to the placenta. This results in a small aorta and variable absence of the arteries that supply the kidneys, large
intestine, and genitalia. Because of the loss of nutrition and blood flow, the lower limbs fail to form as separate
limbs, the kidneys do not form or are malformed, the large intestine ends blindly in the abdominal cavity, the
anus is imperforate, and the internal and external genitalia are absent or either malformed.
Single umbilical artery occurs in about 1% of all live-born infants. In most of these infants the one umbilical artery is normally formed and not of vitelline origin. In these cases, the risks of other birth defects are
low, about 8%. All infants born with a vitelline umbilical artery will have other malformations, the most common being Sirenomelia. “Other birth abnormalities of the upper body involving the heart, lungs, spine, brain,
and arms can also be seen in this syndrome, however, not in every affected individual. It is unknown at this
time why a single umbilical artery could cause these changes” (Stevenson).
The typical malformation of the lower limbs seen in babies with Mermaid Syndrome consists of apparent fusion of the legs. There is a scale of severity with the most severe case is having one lower limb that narrows to a point with the absence of foot structures. In these severe cases there are only two bones present in the
entire limb, a femur and what is said to be a tibia. On the less severe end of the spectrum are babies with fusion
of the skin of the lower limbs only. In these infants the feet may be fully formed with fusion at the ankles. All
bones are fully formed and separate. Normally there are three bones in each leg, the femur in the upper leg and
the tibia and fibula in the lower leg.
All cases of Sirenomelia have occurred in families as isolated cases, and there are no known genetic
causes. “It is possible that Sirenomelia is an autosomal dominant condition and because it is lethal, all cases
represent a new mutation. Many doctors seem to think it might be a multifactorial trait where multiple genes
and environmental factors come together to cause this pattern of malformations” (De Silva). The fact that all
cases have been isolated does not support this possibility. This may give evidence to an environmental cause.
Abnormalities associated with Sirenomelia include absence of the kidneys or malformed nonfunctioning kidneys, blind ending colon and imperforate anus. Usually small, absent, fused, or poorly formed pelvic
bones along with internal and external genitalia are very common. There is the fusion of the lower limbs along
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the inner leg from skin only to complete fusion with the appearance of only one leg. “Sometimes there is death
from underdeveloped and immature lungs caused by oligohydramnios.” (Stocker).
Parents can find out if their child has “Mermaid Syndrome” during the second trimester of the pregnancy by an ultrasound usually between weeks 13 through 26 of a pregnancy. If this is not detected during the
ultrasound, it is obvious upon the child's birth. Conventional radiography is used after birth to obtain better
diagnostic images to further assess this disease. Scientists have studied this in any way genetically. No one has
been able to come up with something that can cause a baby to be born with defect, but they have noticed that it
is more frequent in twins.
Babies born alive with functioning kidneys may survive with appropriate surgical management. Operations to reconstruct the urinary and gastrointestinal outlet tracts are almost always needed. Other procedures
and treatments depend on the extent of other birth defects. It appears that if a baby does survive, he or she will
not have any mental delays. Because of the birth defects involving the gastrointestinal tract and kidneys,
sirenomelia is almost always fatal. “About 50% of babies are stillborn (the baby has died before delivery) and
50% are live-born with survival lasting a few minutes to a few days. There have been at least two reported
cases of sirenomelia that have survived beyond the first month of life. These infants had normal functioning
kidneys during their development” (Stocker).
There are two known survivors of “Mermaid Syndrome.” The oldest survivor is Tiffany Yorks; she is
an American and born in the late 1980s. She was born without a bladder and had many surgeries throughout
her childhood and had her legs surgically separated before she was a year old. Tiffany now lives a close to normal life. Milagros Cerron is the second long-term survivor of “Mermaid Syndrome.” She was born in Peru in
2004 and was born with one kidney and her digestive tract and genitals were a single tube. Her name, Milagros, means “miracle” in Spanish. She was born to a poor family and the Lima government paid for her
medical care. At the age of two she began to walk on her own.
Mermaid Syndrome is a rare condition that has been documented throughout many centuries and is
devastating to the families of the infants that it affects. Early detection of any fetal problem is an important
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first step in the management of the pregnancy. The technology today has given medical professionals ability to
give the parents early detection of problems. Continuing advancement of sonographic technology is improving
the visualization of fetal anatomy. These capabilities are not only limited to the second and third-trimester
sonographic examination. Even in the first-trimester sonographic examination, the fetus is capable of being
evaluated.
Works Cited
De Silva, M.V., and W.D. Lakshman. "Sirenomelia Sequence (Mermaid Syndrome)." Ceylon Medical Journal
44 (March 1999): 34-5.
Stevenson, Roger E., et al. "Vascular Steal: The Pathogenic Mechanism Producing Sirenomelia and Associated Defects of the Viscera and Soft Tissues." Pediatrics 78 (September 1986): 451-457.
Stocker, J.T., and S.A. Heifetz. "Sirenomelia. A Morphological Study of 33 Cases and Review of the Literature." Pespectives in Pediatric Pathology 10 (1987): 7-50.
Valenzano, M., et al. "Sirenomelia: Pathological Features, Antenatal Ultrasonographic Clues, and a Review of
the Current Embryogenic Theories." Human Reproductive Update 5 (January-February 1999): 82-6.
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Student Paper: Simira Nazir (Jim Wood Award Candidate)
Necrotizing Fasciitis
Introduction
Excruciating pain. Pockets of pus waiting to burst. Sloshing off of black and purple skin. Bones
feeling the outside air. What is happening? Zombies? No. Much worse. The flesh-eating bacteria are
coming! Does it sound like a myth? Possibly even a new Sci-Fi Channel movie? No, the existence of this
“monster” is very real and is called necrotizing fasciitis.
Necrotizing fasciitis, or NF, is a rare disease that can be fatal if left untreated. NF is characterized by
“extensive necrosis of subcutaneous tissue and deep fascia and usually accompanied by severe systemic
toxicity” (Schmid, Kossmann, & Duewell, 1998, p. 615). The soft tissue and fascia around the muscle is
attacked by toxin-secreting bacteria. Hippocrates described the earliest case of NF in the 5th century B.C.,
when he reported of flesh and bones falling away from the body in massive chunks (Feely, 1998). The first
time the disease was seen on United States soil was during the American Civil War, coined by the Parisian
venereologist, Jean-Alfred Fournier, as Fournier Gangrene in 1883 (Becker et al., 1997, p. 475; Santora, 2009).
Fournier Gangrene attacks the soft tissue of the genitalia in otherwise healthy men. It was not until 1952,
when Wilson discovered the same degrading of tissue could be found in other parts of the body, terming the
condition “necrotizing fasciitis” (Santora, 2009). Now, Fournier Gangrene is specifically used to describe the
affected scrotum or genitalia and seen as a type of NF instead of a separate disease.
Most authors break NF down into two types. Type 1 is polymicrobial, or a mixture of bacteria, that
usually includes anaerobic and aerobic bacteria, such as streptococci and E. coli. Type 2, or monomicrobial, is
causd by Group A Streptococcus (GAS). The major contributors to NF are GAS, Staphylococci, E. coli, and
Enterobacteria, accounting for 90% of all cases (Feely, 1998). Both types are contracted in the similar ways.
A person only needs a break or weakened spot in the skin to catch NF. This site could be as small as a pin
prick and can occur in otherwise healthy individuals. According the National Necrotizing Fasciitis Foundation
(2007), NF is most commonly transferred by “respiratory droplets or direct contact with secretions of someone
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carrying [GAS].” The most dangerous people are those who are carriers of Streptococcus and show no
symptoms of the disease. All it takes is an innocent sneeze or cough to spread the bacteria to a viable person.
Symptoms and Treatment
The leading reason of fatalities from necrotizing fasciitis is misdiagnosis. NF mimics symptoms of
other ailments, such as the flu and post-operative pains, which most patients readily ignore. The early signs
include nausea, fever, confusion, dehydration, dizziness, generalized pain around an injury, and pain
disproportionate to the injury, such as a paper cut hurting like a jab from a knife. However, timing is of the
essence in this disease. Every second that goes by, the bacteria are reproducing and spreading. Without
treatment, in three days, the site of pain will swell with a purple rash and blisters will form filled with black
fluid. After five days, blood pressure will drop, the body will go into toxic shock, and then loss of
consciousness will occur (National Necrotizing Fasciitis Foundation, 2003).
NF and cellulitis are often confused during diagnosis. Cellulitis is an infection of the dermis and
subcutaneous tissues only, while NF infects the deep fascia primarily and subcutaneous tissues secondary
(Fayad, Carrino, & Fishman, 2007, p. 1725). Each have different treatment plans; hence, the wrong diagnosis
could delay the correct care for the patient. Cellulitis is easily treated with antibiotics, and there is no need for
invasive surgery. The accepted management of NF includes two ways to attack the bacteria. The first is broad
range antibiotics, usually through an IV. The next step is surgical debridement, or complete removal of the
tainted tissues, and incisional drainage of any absesses. Intravenous immunoglobulin (IVIG) has been shown
to lower the mortality rate in NF patients who have reached the toxic shock level. The hyperbaric oxygen
chamber is another method used on a small number of patients. The patient is taking in pure oxygen, which
increases tissue oxygen tension and stops the bacteria from producing their toxin. In some cases, the chamber
assisted in closing up the wound faster (Cheung, Fung, Tang, & Ip, 2009, p. 48-49).
Prevention and Risk Factors
Currently there are no proven ways to prevent NF. The National Necrotizing Fasciitis Foundation says
keeping the skin intact and clean are good ways to lessen your chances. The Foundations encourages everyone
20
to use antibiotic ointment on every break in the skin, and to take caution around those with Strep infections
(National Necrotizing Fasciitis Foundation, 2003). According to the Centers of Disease Control and
Prevention (CDC), 9,000 to 11,500 cases arise each year in the United States, yielding 1,000 to 1,800 deaths
annually (2008). Although everyone can be susceptible to NF, there a few factors that are common in patients
and are now considered to be high risk for NF. Most experts believe diabetes mellitus, alcoholism, and
immunosupressed patients are leading causes, with diabetes showing up the most in cases (Feely, 1998;
Cheung, Fung, Tang, & Ip, 2009, p. 45). Other suspected history factors are drug use, malnutrition, vascular
disease, and old age (Feely, 1998). These factors have shown up in a few cases, but not excepted by the
science community.
Role of Radiography
Because of the time sensitivity of necrotizing fasciitis, it is very important to quickly determine if the
patient has NF. Radiography is one of most useful tools to verify NF without being invasive. Plain film was
initially used to exclude osteomyelitis, or infection of the bone. Instead, radiographers noticed soft tissue gas
in the form of bubbles mixed with the necrotic fascia. The gas is produced by anaerobic bacteria and aerobic
bacteria coming together at the fascial planes (Wysoki, Santora, Shah, & Friedman, 1997, p. 862). However,
a normal x-ray does not show any abnormalities until the disease is well advanced, and some patients may
never have gas in their tissues, such as the Type 2 recipients, causing doctors to rule out NF prematurely
(Feely, 1998; Schmid, Kossmann, & Duewell, 1998, p. 619).
Computed tomography (CT) scans have also been taken. In these scans, asymmetric fascial thickening
can be seen and corresponds to the location of the disease in the body. They also show the presence and extent
of the gas and fluid collections (Wysoki, Santora, Shah, & Friedman, 1997, p. 861). After initial surgeries,
follow up CT scans were extremely helpful in determining if all the infected tissue was removed. The scans
helped to pin point exactly where the surgeon had to go back into the body (Becker, et al., 1997, p. 476).
Magnetic resonance imaging (MRI) has become the popular method to distinguish between cellulitis
and necrotizing fasciitis. Characteristic markers include “thickening and fluid collections along the deep
21
fascial sheaths” for NF and subcutaneous thickening with possible fluid collection within the subcutis and
superficial fascia to determine cellulitis (Schmid, Kossmann, & Duewell, 1998, p. 619). MRI has a higher
sensitivity and specificity to NF as compared to CT. It provides a good starting point for surgeons to start
debridement procedures or drain unlocalized abscesses. However, patients with pacemakers and stents could
not be imaged. For a diagnostic MRI to be achieved, the patient has to be completely still, which could be a
problem for those in extreme pain. Also, MRIs sometimes over judge the extent of the NF (Feely, 1998).
Summary
Necrotizing fasciitis is a life threatening disease. The mortality rate can be greatly reduced with the use
of radiographic modalities in early diagnosis. The earlier NF is concluded, surgery can be started immediately
to remove the “flesh-eating bacteria” and prevent the spread into other areas of the body. CTs and plain
radiography are reliable for gas detection. However, if there is no gas seen and doctors still suspect NF, an
MRI can be done to show the deep fascial involvement of the infection. The downside is that MRIs are the
most expensive form of radiography presented in this paper and may not be readily available in every hospital
or clinic. Since controlled laboratory testing for necrotizing faciitis is not possible, all tests reported were done
retrospectively and have small test groups. Further studies need to be done to confirm which method would be
best for early diagnosis of NF.
22
References
Becker, M., Zbaren, P., Hermans, R., Becker, C., Marchal, F., Kurt, A.-M., et al. (1997,
February). Necrotizing Fasciitis of the Head and Neck: Role of CT in Diagnosis and
Management. Radiology , 471-476.
Center for Disease Control and Prevention. (2008, April 3). Group A Streptococcal (GAS)
Disease . Retrieved October 30, 2009, from Centers of Disease Control and
Prevention: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/
Groupastreptococcal_g.htm
Cheung, J. P., Fung, B., Tang, W., & Ip, W. (2009). A Review of Necrotising Fasciitis in the
Extremities. Hong Kong Medical Journal , 15 (1), 44-51.
Fayad, L. M., Carrino, J. A., & Fishman, E. K. (2007). Musculoskeletal Infection: Role of CT in
the Emergency Department. RadioGraphics , 1723-1736.
Feely, E. A. (1998, December 1). Necrotizing Fasciitis: Diagnostic Modalities. Retrieved
October 26, 2009, from Wake Forest University School of Medicine:
http://intmedweb.wfubmc.edu/grand_rounds/1998/necrotizing_fasciitis.html
National Necrotizing Fasciitis Foundation. (2003, August 17). Retrieved October 26, 2009,
from National Necrotizing Fasciitis Foundation: http://www.nnff.org
Santora, T. (2009, march 19). Fournier Gangrene. Retrieved October 30, 2009, from
eMedicine: http://emedicine.medscape.com/article/438994-overview
Schmid, M. R., Kossmann, T., & Duewell, S. (1998, March). Differentiation of Necrotizing
Fasciitis and Cellulitis Using MR Imaging. American Journal of Radiology , 615-620.
Wysoki, M. G., Santora, T. A., Shah, R. M., & Friedman, A. C. (1997). Necrotizing Fasciitis: CT
Characteristics. Radiology , 203 (3), 859-863.
23
CHANGE OF INFORMATION OR ADDRESS FORM
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**** This form can either me mailed or return via email to the following ****
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MEMBERSHIP APPLICATION
CURRENT MEMBERSHIP (2009-2010) EXPIRES JUNE 30, 2010. IF YOU HAVE NOT SUBMITTED PAYMENT
WITHIN 30 DAYS OF THE DUE DATE, YOUR NAME WILL BE REMOVED FROM THE MEMBERSHIP ROSTER.
Please make checks or money order payable to MSRT and mail to:
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Annual Fees: Student -$7.00, RT -$25.00, Associate - $25.00
Complete the following form and return with payment.
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Primary Modality (Please Circle)
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Mammography
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RA
25
Bone densitomery
Nuclear medicine
RPA
Dana Aragon (left) from the ASRT directed the Refocus
meeting. She is pictured with the ASRT President...our
very own Mississippi girl, Diane Mayo.
Sherrill Wilson sporting the “Member Hat”!
26
27
MSRT President
Debbie Shell
Technologist
of the Year Paula Young
Installation of Officers:
Kristi Moore - Secretary
John Melvin - Vice President
Debbie Shell - President
Kathy Stegall receiving a plaque of
appreciation for 19 years of service
with THE BEAM
28
Penny Spivey receiving a gift basket
of appreciation for her hard work as
Conference Chair
After attending
all of the
meetings at
Conference, it
is good to let
loose one night
and have fun!!!
29
Yabba
Dabba
Doo!!!
30
Peace...Love...
and X-ray!
31
It doesn’t get
any better
than this!
32
Good Friends…
Good Times!!!
33
Let the Good
Times Roll!
34
Mr. Sims (Mark Gray)
Gone Green…
Recycle Barium Ya’ll!
35
Paula Young and Asher Beam…
enjoying the party!!!
36
Diane...wha
t’s got
your attent
ion?
37
Ron John (John Ron) & Nancy
Shake your
groove thang!
r
e
k
o
J
The
Granny got her groove on!!!
38
It’s a Bird…
It’s a Plane...
39
We hope you can
join us next year!!!
Fun Times!!!
40
Until we meet again…
Conference 2010
(Natchez, MS)
Please be sure to check out the MSRT
website in late March for the next issue
of THE BEAM!!!
Kristi
41

THE BEAM - Mississippi Society of Radiologic Technologists

Transcription

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