Mary Bruno, BS, RT, is an advanced practice specialist in the Department of Radiology at NYU Langone Health. Advanced practice specialists are MRI technologists who work on interdisciplinary teams that include radiologists, imaging scientists, medical device industry partners, and clinical administrators. These teams improve and optimize imaging care by combining expertise from every link of the imaging chain. Ms. Bruno’s role also extends to imaging research. She is a coauthor on scores of peer-reviewed studies that span all aspects of MRI development and has presented research as lead author at meetings of the International Society for MR Radiographers and Technologists. Our conversation was edited for clarity and length.
You’re an MRI technologist with a special interest in research and a special role in the radiology department. But before we get to those unique responsibilities, can you talk about what an MRI technologist does?
An MRI technologist takes care of patients. A patient comes in and they need imaging care in order to go on to get treatment. The MRI technologist meets and greets, makes sure that the patient is safe to go in, which can be complicated if the patient has implants. The technologist has to understand basic anatomy to know what to cover and basic MR physics in order to properly set the scan parameters. Those are the basics.
But in practice, when we’re at the scanner, we notice things. For example, maybe the scan is too long—let’s say that someone comes in every three months for a combined brain and spine exam, and the scan adds up to two hours. We then go to the radiologist and request they shorten scan times by cutting out a sequence or work with us on finding advances that can make the scan shorter. That’s also the technologist’s role.
And there are other things, too. For example, if there’s a brand new MRI sequence that everybody loves but the image takes five minutes to come up on the console because of all the computation required, the technologist would raise that. In some cases, it might be okay—with a short scan, there’s less probability that the patient will move and so there’s lower likelihood of motion artifacts. But if we have to wait five minutes to see the images, that’s when we would say to the patient, hey, the machine is taking a few minutes to create an image. Are you comfortable? Would you like any music? Some people have claustrophobia, and I’ll take them out of the scanner. Once the picture is up, I’ll go check it and if it’s good, I’ll take them off the table. So it’s all about taking care of the patient.
And why is it important that you see the images before dismissing the patient?
We need to see the pictures before the patient leaves because if there’s an issue, it doesn’t just affect a whole new booking—it affects their follow-up appointments or maybe whether or not they’re staying in a drug trial. If they’re on a schedule where every three months they get an MRI and see a surgeon right after who goes over their pictures, if the pictures are not of good enough quality for the radiologist to dictate the report, that could result in delayed care, which would be a big problem.
So, on the one hand, your job is very much about what’s happening then and there during a patient’s visit for an imaging exam, but on the other hand you have to stay aware of the much broader context of their care.
Yes, and that’s true for all the technologists.
And your role is bigger than that. You’re on the advanced practice team, and part of the team’s mandate is continuous quality improvement. How does that work?
That’s the fun part of my job and one of the beautiful things about the advanced practice specialist position—there are nine of us in the whole system. Let’s say that an MRI sequence is too long or too blurry or has an artifact that we need to clear up. Those are the three big things: too long, needs to be sharper, or there’s an artifact. A radiologist who notices this would email the team—hashtag MRI advanced practice team—and ask, can you help? And one of us will pick up the request.
To start, we usually meet with the radiologist and a Siemens scientist [most MRI scanners in NYU Langone’s system are made by Siemens], and then if we need further expertise, we bring in an NYU Langone imaging scientist. Sometimes the industry partner will give us pointers or take the issue back to the engineers who build the scanners and the software. Or, for example, if we’re trying to shorten the scan, they may have a license that’s not in production yet but we could become a collaborator on, and then we may do research with phantoms or volunteers on a technique that’s potentially shorter.
In the operations of an imaging clinic, efficiency is a huge factor. Every moment a scanner is not being used to deliver a medical exam, it’s costing something. When do you find the time to investigate things like artifacts, run phantom scans, and experiment with scanner settings?
There’s very little downtime, but the advanced practice specialist position has some flexibility and includes academic time, which can be used to study, read research articles, prepare monthly educational presentations, and you can use it to meet with doctors and for scanning purposes. The research scans usually have to be after hours. I’m lucky that on the machine I often use the clinical schedule ends at five o’clock and not, for example, at 10:00 p.m.
Working with patients all day only to investigate MRI sequences and image quality after the clinic closes must make for a long workday. When you talk about MRI, your enthusiasm is palpable—what keeps you motivated?
You have to think of it as a hobby. It has to be something you enjoy. It’s always fun in the beginning and great at the end when a problem is solved—just not in the middle. The middle is the hardest, because you don’t want to give up, but you also do really want to give up. But you don’t.
How did you get into this line of work?
My father is an MRI tech—he’s retired now—so I grew up knowing about MRIs and X-rays, but I never thought it was that fascinating when I was younger. My father worked six days a week, so my three brothers and I would sometimes be at his office on Saturdays and mess round in the hall while he worked. It was a private MRI practice on Long Island. Now it’s actually a part of NYU Langone’s network—but it looks completely different: you know, redone, with new machines, new everything, it’s fabulous.
When I was in high school, I started talking to one of the neuroradiologists that my father was friends with, Dr. Joseph Louis Zito. He would bring a neurology book and sit at the scanner with my father at the end of the shift and he’d be showing my father things in the book and relating them to the images my father was taking. That’s the first time I thought that being able to see a person’s anatomy through this machine was cool.
It was also the collaboration and the friendship between them. Dr. Zito would say, I want to see this better, and my dad, who knew physics really well, would basically optimize things at the scanner. I found that to be really incredible. They were working together to see something that this smart guy wanted to see, almost like a director working with a cinematographer.
How did that early experience later lead to your following in your dad’s footsteps?
That was a little bit of a journey. Not everyone wants to do what their parents do, and in college I went through different majors: I wanted to be a teacher, and I wanted to be a chemical engineer, and then I wanted to do forensic science. When 9/11 happened, I was at John Jay College of Criminal Justice studying forensics. There was a huge effort at the time to try to identify the remains of people who died in the attacks, and my father said to me, you’re not going to want to be in a lab testing body parts for DNA. You’re a people person and you love science—just go to rad tech school. And if you hate it, then go back to college and be an eternal student, but you’re going to love it.
Was he recommending the profession to your brothers, too?
No, just to me. I think it was because of how interested I was when I would see him working with Dr. Zito. I found it to be really amazing. So I enrolled in LIU Post and really enjoyed it. I was working full-time as a waitress, going to school, doing clinicals, and moonlighting at my father’s MRI office. When I heard about NYU Langone coming on campus to recruit students to be technologists, I was like, that’s in New York City, and I need to be there!
How did you become involved in imaging research?
Within my first year at NYU Langone, my cousin, who was a senior in high school, had a seizure and it turned out that he had brain tumor and needed surgery. I went to my father’s office, Dr. Zito was there, and they were in the very early stages of using functional MRI equipment to map out networks in the brain so that surgeons could better plan interventions. The fact that this technology could help my cousin—who later made a full recovery—was really eye opening to me, and that was my first experience with advanced imaging and research. That was almost twenty years ago.
You’re a coauthor on scores of peer reviewed studies that cover an astonishing variety of topics. Just to give some examples here, these include studies on advanced MRI of the brain, alternative motion sensors for low-field imaging, flexible radiofrequency coils, various contrast techniques, dynamic contrast imaging, artifact reduction in very specific applications like cochlear implants, and even the fastMRI dataset. In short, you have participated in investigations on everything from new techniques to applications to hardware to data. Can you talk about your role in some of these studies or any particular projects you’ve been especially fond of?
There are many projects I love. When my father told me that if I didn’t like being an MR tech, I could go back to school for the rest of my life? Well, every time I walk in the building, I’m in school. The coil projects really speak to my engineering interests, even if I can’t do the engineering myself. My role here is often to recruit study volunteers and run the research scans, making sure that everything’s properly set up, that the equipment is used safely, and applying what I would call a radiologist’s eye—but not at the radiologist’s level—to check that the image quality is up to standards. I also really love the cochlear implant study.
Tell me about it.
Around 2015, I started working with ex-vivo brain specimens with Dr. Timothy Shepherd, on research into sudden unexplained death in childhood, SUDC, a heavy topic. It was important because in a regular autopsy doesn’t look into the brain. But if we receive an ex vivo brain and do an MRI and find an abnormality, when a parent hears that, that can change their life, knowing that there could have been a medical cause. That was a very meaningful project and I’m still working with researchers who continue to use and study the data I collected all those years ago.
This research led me to other collaborations in brain imaging, and at one point I heard from referring physicians and surgeons who are implanting cochlear devices in children born with hearing deficits. These doctors know that patients with cochlear implants are likely to have at least one MRI exam during their life and they’re working with implant manufacturers to make sure the devices are safe and compatible with MRI, that they don’t shift or stop working in the scanner’s magnetic field. So, those surgeons reached out to me and asked if I’d be interested in working with them. They were getting a number of cadaver heads and implanting devices in certain locations to see which locations result in the least amount of artifacts on MR images, and they also wanted to improve the image quality of routine clinical MRIs of patients with cochlear implants.
A project like this brings so much together: scanning, research, improving image quality, and helping people see something new to ultimately help patients.
Yes, they all come together. I consider myself very fortunate for having these kinds of opportunities.
People who don’t work with MRI machines may not know this, but scanners have tons of settings and are quite complex to operate. It takes a lot of experience to get to really know them, and they’re frequently updated, too.
Recently, we were doing shoulder imaging and using an AI feature that makes an image faster and sharper. But the faster and sharper image had an artifact—it was not inhibiting the read, but it was bugging me. An artifact is something that’s not supposed to be there. During troubleshooting, we figured out that if we switched to another sequence, the artifact would disappear but the image was too noisy. Eventually a colleague from Siemens who was working with us found that turning on the other sequence parameters automatically turned off a different setting—in this case, phase correction. Deduction: the artifact was being caused by phase correction and all I had to do was turn it off by unchecking a box. And the thing is, it was all in a screen pop-up that would come up when we were changing the sequences. We’d been seeing it for months but we’d never read it. I really liked this project because the learning point was: read the pop-ups.
Your ability to contribute to research collaborations stems in part from years of experience you’ve earned at arguably the most essential time and place in the imaging process, which is the imaging exam. That’s a bit like being at the hub of a wheel every time it turns. Does hearing it described in this way ring true to you?
It’s true that it comes from years of experience. Techs like my father were doing similar work: sitting at the scanner with a radiologist and trying things to get a better picture. That is one essential element of what an advanced practice specialist does.
We’re a whole team, and there’s no shortage of projects. It’s not just science—the advanced practice team installs licenses, they oversee upgrades and new scanners coming in and make sure that everything that used to be on a scanner is back on it, converted properly. There’s so much work, it’s endless. I’m grateful for being at the hub, but I’m also trying to hand off the baton to—or better, share it with—team members who are interested and ready to start engaging in research. It has to be done correctly and in a graceful way. It’s not, here’s the work, see you later. And you don’t necessarily have a manual that tells you how to do that.
There are days when I walk to work in the morning and think, what am I doing? Am I in the right place? How did I get here? And then I’ll walk through the door and someone will say, Mary, I’m so glad you’re here—we have this case and we’re not sure what to do. And I’ll be like, okay, you can try this, and you can use this coil, and then someone else will say, hey Mary, this sequence just failed on me, can you help me get it running again? And I’ll be like, oh sure. And the phone will ring, and—you know, I’m on it. And then I’m reminded that God is telling me this is exactly where I need to be right now.