Seeing Inside the Body
Words by Maryann Brinley / photographs by John Emerson
sk two UMDNJ-School of Health Related Professions (SHRP) alums — nuclear medicine technologist Francesco Grippo, MS, ARRT, CNMT, RT (N), ’02, and vascular sonographer Garth Nanni, BS, RDMS, RVT, ’08 – to look inside the brave, new diagnostic world of medical imaging sciences and you are in for surprises. For job-seekers, the surprises are not all in the ingenious technologies being used to identify pathological conditions, congenital defects, physiological changes, organ functioning or fetal development.
This field of nuclear medicine, Grippo says, “offers the best mix of direct patient care, technology and clinical skill.” He explains, “You are with the patients for hours and sometimes over multiple days so you make that personal, direct connection. Yet, you also have the computer and technical aspects of the job. That unique combination is what appealed to me.” Grippo was a pre-med major in college at Rutgers-Newark when he first heard about the various joint Rutgers/UMDNJ-SHRP programs and he has never regretted his decision to change career directions. He finished his last year of undergraduate work at UMDNJ and was then able to complete a bachelor’s as well as his certificate in nuclear medicine in four years.
Grippo and Nanni are graduates of the SHRP Department of Medical Imaging Sciences. Once known simply as Radiation Imaging Sciences, this department now encompasses programs in Cardiac Sonography / Echocardiography, Diagnostic Medical Sonography / Sonography, Vascular Sonography / Technology, and Nuclear Medicine Technology as well as two advanced professional programs for licensed radiographers in Diagnostic Imaging Technologies (CT-MRI-mammography) and Radiologist Assistant. Make no mistake about what is possible through the wonders of imaging sciences. Even the New England Journal of Medicine once stated that imaging has “changed the face of clinical medicine” in the last millennium.
To see inside the body, these highly-skilled experts use magnetic resonance imaging (MRI), computed tomography (CT), mammography, radiography, ultrasound and nuclear medicine. “Dynamic, active and innovative,” this area of healthcare demands that students and professionals use their “image-ination,” to quote the department’s own website. As Garth Nanni, clinical coordinator for the Vascular Sonography program as well as a part-time sonographer for Holy Name Medical Center in Teaneck, says, “There is an art to this. It’s intuitive. We talk about the technology but it’s really a combination of art and technology.
“Ultrasound is very operator-dependent,” Nanni continues. “You produce a picture on a screen that someone else has to be able to interpret but just the slightest tweak of your hand can change that picture. And everything we see is in real time. It is happening right then.” CT scans, MRIs, or X-rays all produce still images which show what was going on but not what may be happening presently. Nanni explains, “I can see a gallstone move or blood vessels as sluggish or slow. The first few times I performed Venous Doppler exams to rule out fatal blood clots, I remember feeling absolutely horrified that a patient might die if I made a mistake. So I can’t emphasize enough the importance of the sonographer. Outside of radiologists, OB/GYNs and vascular surgeons to name a few, there are many physicians who aren’t able to interpret ultrasounds as well as sonographers. Becoming skilled is like learning to play a musical instrument. You have to be good with your hands and I do play the guitar. You also have to practice to stay true. So, you start with ‘Twinkle, twinkle, little star’ and with lots of practice, you are ready for the orchestra.”
Like ultrasound, nuclear medicine also allows the technologist to see functionally, at a molecular level, what may be happening inside the body. “With MRI and CT, you may be able to take really good anatomical pictures but you won’t be able to tell how the liver is functioning,” Grippo explains. His field is definitely technology-driven with a push toward the fusing of anatomical and functional images. “We use software to put CT scans together with the nuclear images. So, now we don’t have to say there is a tumor somewhere in the liver. We can pinpoint exactly where.”
However, both of these experts emphasize the need for people skills in their jobs. Grippo had one patient who was fearful of nuclear medicine because the testing relies on the use of radioactive material. “Her physician kept encouraging her to get tested but she was very afraid. So she came to speak to me about her reluctance. We established a bond and I spoke to her again later by phone. When she came in a week later, she was still scared but I was able to walk her through the test. It’s a blessing she did go through the diagnostic procedure because it led to some much-needed therapy. She’s doing very well now.”
Grippo believes, “You have to be able to comfort patients.” His warm, take-charge personality may also help account for the fact that he “took the express train” to his managerial role at UH. He was hired immediately after graduation in 2002 and got the job of acting chief just two years later , having been encouraged and recommended not only by his medical director but also by his supportive co-workers. “I was 25 and it was a big jump.”
Garth Nanni’s undergraduate degree is in psychology and substance abuse counseling and this background comes in handy. A great attitude and “the ability to really understand what the patient is feeling” are keys to success. “I revert back to my counseling training when patients are scared. There is no way to separate healthcare and psychology. They work together. And in this area, you can’t just focus on getting that picture of the liver or the gall bladder. If you do, you forget the whole person. As a sonographer, you are taking the medical history, asking where it hurts, and touching the patient. It’s very people-oriented. You can be with that person for up to an hour and a half. The doctors are accountable for the ultimate diagnosis, but they need us to function in a sense as their eyes and ears.” Brilliance or academic excellence alone won’t cut it. “If you would rather sit at a computer and look at slides, then you are better off in another field.”
Nanni, who fantasized about becoming a professor, was recruited back to his alma mater to begin teaching last year, just two years after completing the program. “I was truly honored.” A 2005 Ramapo College graduate at age 31, “I wasn’t a kid then and also didn’t know what I wanted to do. I thought of nursing but really liked the non-invasive aspect of this area.”
A secret to his success? While a student at SHRP during the 15-month program, Nanni completed the regular Diagnostic Medical Imaging program, specializing in abdomen, small parts, obstetrics/gynecology but also studied vascular technology on his own. “I jumped in with both feet, bought my own texts and went to every senior technologist and vascular surgeon to ask questions.” He also helped teach incoming students. His mentors, Department Chair Cynthia Silkowski, MA, RDMS, RVT, and Clinical Coordinator Karen Degli-Antoni, MA, RDMS, “who are both phenomenal,” he says, took notice. “I have a knack for conveying information and really getting people to learn. I’m new at teaching but I like to bring my clinical experience into the classroom and I like talking,” he laughs. He’s also empathetic. Nanni spent years working in restaurants before college. “I recently had a student say to me, ‘I’ve been a waitress for years. Should I bother to put this on my resume?’ So I answered, ‘Absolutely, this is a very people-oriented career and the skills you learn in any customer service position will show an employer that you’ll be able to focus on the health needs of future patients.” His classes are small, from 9 to 30 students, with an age range from 22 up to 60, and backgrounds from undergraduate to experienced MBAs and foreign-trained physicians aiming for new careers in America.
In medical imaging science, Nanni says, “You can make a living, feel good about yourself and sometimes it doesn’t come with a whole lot of stress.”