Ever watch House or get an MRI?

So this week I draw inspiration from the great Dr. Gregory House.

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But really, this is just an excuse to reminisce back to my high school days, when I made time to watch House with my mom…and laugh at House’s sarcasm, of course.

So I’ll be sharing some House quotes, then dissecting his words with my newfound neuroscience knowledge. Read on.

Dr. House: MRI show anything?

Dr. Foreman: CT scan was negative.

Dr. House: CT… that’s like, short for MRI, right? Excellent, well I guess that saves us a lot of time.

Dr. Chase: We’ve got an MRI scheduled in twenty minutes. Earliest Foreman could get the machine.

Dr. House: I teach you to lie and cheat and steal…and as soon as my back is turned, you wait in line?

First of all, CT scans are not short for MRI. CT stands for computerized tomography. MRI stands for magnetic resonance imaging. These are two completely different techniques used to study the brain in vivo.

Here’s what a CT procedure might look like in your local hospital:

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CT scans use X-rays to beam your head from all angles (hence the doughnut shape of the machine). The X-ray detector measures how much radioactivity gets through. A computer then takes these numbers from the detector and creates images of your brain!

Technology is amazing. I mean, before advances in imaging techniques, scientists were stuck with lesion studies. By lesion, I mean deliberately damaging a part of a rodent’s brain to see how their behavior might change. You can’t exactly ask a human to let us crack their head open with a drill and mess around for the sake of research.

On the other hand, with imaging techniques like MRIs or CT scans, we avoid drilling holes in skulls altogether and directly see the human brain’s nooks and crannies.

And what about MRIs?

MRI scans are even more detailed than CT scans. Instead of beaming X-rays at your brain, the MRI passes a strong magnetic field through your head. Nuclei from hydrogen atoms align themselves at an appropriate angle to the magnetic field. A radio frequency wave then pulses through the brain. As this happens, the poor nuclei are bounced at a different angle as they absorb energy from the radio frequency wave. After the nuclei swing back to their original positions, the energy is released and quantified by a detector.

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The amounts of water in different tissues of the brain vary, thus the amount of hydrogen atoms vary…So the amount of released energy varies. The computer picks up all these numbers and creates a picture.

The picture below shows a CT scan (left) and an MRI (right). MRIs are better at looking at softer tissues with more water, while CT scans are better for visualizing bleeding.

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Now that we’ve dissected the technological aspects of MRI and CT scans, I’d like a quick reality check. Back to House.

Dr. Taub: You’re risking our patient’s life, just to get back at Cuddy?

Dr. House: Whaaaaaaaaat? No. That would be childish. This is what I’m doing to get back at Cuddy. [in the clinic waiting room] Who here doesn’t have any health insurance?[many people raise their hands] Michael Moore was right. MRI’s, PET scans, neuro-psych tests, private rooms for all these patients. Fight the power!

Note: Michael Moore is a liberal documentary filmmaker — House is probably referring to Michael Moore’s film “Sicko”, which compared U.S. for-profit non-universal healthcare with foreign non-profit universal healthcare systems (e.g. Cuba, UK, France, and Canada.)

MRIs scans are expensive. MRIs cost anywhere from $400 to $3500 without insurance. So undocumented immigrants — sorry, you have a brain disorder, or a tumor, too bad.

House didn’t mention a CT scan, but those can cost you anywhere from $50 to $1000 without health insurance. It depends if you’re getting an angiography of the heart or a less invasive (less expensive) calcium scoring of the heart.

So all this talk about MRIs makes me wonder how feasible brain imaging is for the lay person. After chatting with my roommate, I found out that although he knows he has a neurological disorder, he has never gotten an MRI because of a perceived waiting list. His doctor dissuades him from getting one, since they already know what’s causing most of the problems anyway. My roommate suspects, however, that the waiting list for an MRI is long.

After doing some research on the net, I’ve found a theory that well-renowned university medical centers charge more for their procedures because they’re well marketed. Your pockets might stay heavier if you try the stand alone imaging centers.

Well, that’s this week’s musings on imaging. And House. Never forget House.

Dr. House: As I suspected, you have significant losses in the upper right quadrant of your visual field.

Evan Greer: Are you serious?

Dr. House: No, it’s a joke. Two guys go into a bar and one has significant losses in the upper right quadrant of his visual field. And the other one says, ‘You’re gonna need an MRI to confirm the type and location of the tumor.’

If you didn’t laugh, maybe something’s wrong with you. Get a CT scan!

On that note, is there a part of the brain responsible for your sense of humor? To be continued next week.