Author Question: X-ray Anomalies

Barry Asks:

I have a character who is getting X-rays for headaches and vision problems. The X- rays show some kind of anomaly on or near the brain which requires a CT scan for further investigation. The CT scan needs to show something. I said a shadow, but any anomaly would work which cannot be biopsied due to the location.

For the development of the plot I need the doctors not to be able to ascertain immediately if the object on the scan is malignant or benign. Could this scenario work and would doctors wait to see what develops, or is there another course of action they would suggest in the absence of a biopsy?

Jordyn Says:

Very interesting question, Barry.

First of all, you're starting off with the wrong test. An x-ray (or plain film) is done merely to look at bones and is not the test indicated for your character's condition. A skull series would merely show fracture or bony tumors. It doesn't show brain tissue. Its primary indication is skull trauma-- looking for certain types of fractures that might indicate the need for neurosurgical evaluation. 

What your character really needs, ultimately, is an MRI. This might solve both of your problems. The concern for a patient with headaches and vision problems is that they could have a brain tumor. An MRI has the ability, in some cases, to distinguish between malignant and benign tumors. So, if the tumor location is in an inoperable area, such as the pineal gland or corpus callosum, then you could build your scenario around this.

If, as the author, you want to have a wait and see period, then your option would be to have the tumor not be differentiated on MRI but small in size. Then, the doctors could do serial MRI's every 3-6 months to see if the anomaly changes. 

However, the likely initial radiologic study of choice in the ER setting for your character's symptoms would be a CT scan of the head. The reason for this is that CT scans are very quick (less than five minutes.) An MRI of the brain can take anywhere from 30-60 minutes and are more expensive. What will show on CT is something bright white. Tumors and blood show up bright white on CT scan. Then, follow-up for the patient would likely be neurosurgical evaluation with an MRI scan. 

The term "shadow" is more reserved for ultrasound studies according to the doctor I spoke with. So I would adjust your terminology in that aspect.

Best of luck with your novel!