A moveable feast.

As a part of the health care team, radiologic technologists must be prepared for any patient condition. Even so, this technologist was taken aback by the smell that greeted him when he began imaging the patient's foot.

He soon realized that the smell was not the only issue (see Figure, a lateral radiograph of the right foot). The patient had pockets of live maggots crawling out of his foot.

Maggots are fly larvae. Flies lay their eggs in decaying flesh or any moist area with an ample supply of dead tissue. After 8 to 20 hours, the eggs hatch and the flies enter the maggot stage. Maggots are remarkable eating machines and can feed 24 hours a day until they are ready to enter the pupal stage.

It is true that maggots can be dangerous. Apart from the fact that they turn into flies and start the life cycle over again, some maggots cause damage to agricultural crops. However, centuries ago, before the discovery of antibiotics, maggots were used to clean necrotic tissue from wounds and promote healing because they eat dead tissue and leave healthy, living tissue alone. They also excrete substances that inhibit and possibly kill bacteria.

In recent years maggots have gained respect in the medical world. Maggot therapy, also known as maggot debridement therapy (MDT), uses live disinfected maggots to help heal soft-tissue wounds and promote faster healing. These are sterile, farm-bred maggots, called Phaenica sericata. Because the maggots do not multiply in the wound and must leave the wound to pupate or they will die, physicians simply flush them out when they have completed their job, usually in about 3 to 4 days. Only maggots that do not eat healthy tissues and do not burrow under the patient's skin can be used in medicine.

However, this patient was not undergoing MDT and these maggots had to be removed.

Technical Query is a troubleshooting column that covers image acquisition and processing. This issue's column is edited by Olive Peart, M.S., R.T.(R)(M), a clinical instructor at the Stamford Hospital School of Radiography in Connecticut. Ms. Peart is the author of Spanish for Professionals in Radiography, Appleton & Lange Mammography Review and Mammography and Breast Imaging: Just the Facts.

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Thanks to Minh Pham, R.T.(R), a radiologic technologist at Stamford Hospital, for this month's Technical Query radiograph.