A recent article published in Health Imaging discusses a study done by researchers who found that, with the help of MRI, ADHD is a disorder of the brain. With MRI technology being used to showcase how neurological disorders affect brain development, it also serves as a vital resource for helping combat mental health stigmas.
Radiology Business spoke with Barry Southers, MEd, associate professor and MRI program director and faculty instructor in the University of Cincinnati Advanced Medical Imaging Technology (AMIT) Program, who shared his 20 years of experience in the medical imaging field and how he believes brain imaging can fight the stigma associated with mental health.
Radiology Business: What prompted your interest in this field?
Barry Southers, MEd: Initially, I actually wanted to get into radio. Once I started taking the classes, I realized it wasn’t something I was interested in as much as I thought, so I started looking around for things in Lexington, Kentucky. I went to do some tours and I found radiology technology and x-ray to be really interesting because it had a pretty good pay. But more than that, I thought it was fascinating how you can be a part of a diagnostic process [and] be a part of a healthcare team in such a unique way. Once I got into the field, it opened my eyes to the fact that there were so many branches in medical imaging that ranged from tomography to interventional MRI—and MRI was just one of those things that I was always drawn to once I got into the field. I was just fascinated with how it work. It was just the physics of it; it was just so different with the ability to image soft tissue so well. There’s always new techniques coming out and new ways to use artifacts that were actually something we would try to get rid of in previous years. It’s just a fascinating field, and it’s really rewarding because we get to see so many patients. This is what I tell my students: "We get to see 15, 20, or even more patients a day in helping them figure out what’s going on, with how they’re doing or trying to diagnose a problem. So I think the impact in our field is pretty profound because we can touch so many patients and be a part of them all in the course of one day."
What do you tell your students when it comes to learning about this field?
I’ll show a picture of the first MRI scanner back in the 1970s, and then I’ll show a picture of todays scanners. I’ll ask them, "What do you think is different and what do you think is the same?" And then I tell them that physics is always going to be the same, so the physics of MRI can’t be changed. But the technology is always advancing. I talk about how when I first started, we would do some scans in maybe seven or eight minutes that we can now do in two minutes and they look twice as good because our technology and techniques have improved.
How is MRI used to explore the effects of neurological disorders on overall brain development?
When I first started in research MRI, back in the early 2000s, our center was led by a psychiatrist. His focus and a lot of his colleagues focus was mental health, which included ADHD, bipolar disorder, schizophrenia, depression, so I got to see a lot of how we can use MRI to better find out and learn more about these brain disorders. One thing that I noticed that has been proven on a lot of these studies is that we can use several different techniques with MRI. The two techniques we could use is functional MRI and MR spectroscopy.
We found that patients with bipolar disorder or ADHD had areas in the amygdala or the prefrontal cortex—which are responsible for emotional processing and regulation—that were not functioning as well as a healthy control.
Patients with ADHD are given a medicine, Theraquil, and they’ll get a baseline functional MRI and a baseline scan. Then we’ll repeat the same study a week later, and then we'll repeat the scan a few weeks later, so they’ll have a total of about two or three scans. As you go you can see, especially when they’re given behavioral or cognitive tests, we can compare the differences between the first scan, the next scan and then the final scan for a total of eight weeks. We can see if their brain function has improved and if their neuro-metabolic activity has improved. Then, as a good measurement, we can see if the medicine they’re on is effective in treating this disorder.
How can MRI technology be used to fight mental health stigma?
I’ve seen a lot of time people making comments about patients being "crazy." You hear that all the time—things like that where it's their fault for how they are handling certain situations. In reality, a lot of times these patients have a neurological disorder that is affecting specific areas of the brain that regulate emotion, that regulate the pleasure center of the brain. There are lots of areas that are being affected by a disorder, by these neuro-metabolic activities. We’re still kind of scratching the surface as to why. When you do studies, when you actually take a look at an ADHD patient, you see differences in behavior, in brain chemistry and in brain function. This work starts to prove that it’s more of a neurological disorder as opposed to simply a person who can't deal with their problems. I think that tackling that stigma can be done by putting this information out there. There are a lot of specific areas in the brain that are affected by these disorders. It's not just something that people want to have. I can ensure you that no one in this world would say, "I want to have bipolar disorder or schizophrenia," so showing specific areas of the brain that are affected by these diseases is helpful.
Can you share an example?
When a person has a physical injury, if they get hit in the head or a car wreck, we do a routine MRI. We might not see something physically like a bleed, a stroke or something that is a result of this impressive event. I think it really goes back to when we look at ADHD or bipolar, there is not anything specific that has happened to the person, such as a physical trauma or a tumor—and I think that’s really one of the big issues. I see people come in with a concussion after they experienced trauma. But when you see a person with a mental health disorder, like a schizophrenic patient, there wasn’t a physical event that happened; they didn’t get hit in the head. But if you look at patients who have had some severe head trauma, there are studies that have shown they can exhibit psychotic behavior. There are disorders that can be diagnosed as psychotic disorder secondary to a post traumatic event. I think the big issue is that they do exist, even if nothing physically is the root cause. The majority of the population is unaware of this information. It’s a big battle, but a lot of it is shedding light on the research. This isn’t something that can be physically attributed to something. Sometimes it just happens. Whether its genetics or not, it still exists—and it's complex and not a easy thing to diagnose.