Archive for February, 2014

February 25, 2014

Task Force Guidelines on Aorta Screening in Smokers

Vincent Willem van Gogh (self portrait) Copyright Public Domain

Vincent Willem van Gogh (self portrait) Copyright Public Domain

This is a call to older male smokers. As a smoker you are at risk for many health issues. While heart and lung conditions are the more commonly known diseases for smokers, vascular diseases are another. Abdominal aortic aneurysm, or “AAA,” is yet another significant health issue that may be seen with higher frequency in smokers. An aneurysm is an abnormal ballooning or dilatation of a blood vessel. In this case, the aneurysm involves the aorta – the main artery carrying blood to the abdomen and lower body. As the aneurysm gets bigger, there is a risk of sudden death from rupture.

Recently the USPSTF, a task force that reviews guidelines and screening studies, came forward with a recommendation with the intention of saving lives. The Task Force has issued a recommendation for ultrasound screening of male smokers over the age of 65 for the presence of an abdominal aortic aneurysm. Further research is needed to determine the usefulness of the screening test both in women who smoke and in older male non-smokers.

Making use of the simple non-invasive technology of ultrasound, one-time screenings for men in the high risk category will help improve survival from complications of abdominal aortic aneurysm. For more on the recommendation, we recommend this resource.

February 25, 2014

What Is Ultrasound?

Philips - Ultrasound EPIQ - Abdominal by Philips Communications via Flickr Copyright Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0)

Philips – Ultrasound EPIQ – Abdominal by Philips Communications via Flickr Copyright Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0)

Today we will focus on another imaging technique that has revolutionized the practice of medicine in the past 3 decades. Ultrasound is a noninvasive form of imaging which uses sound waves to create images of the body. That’s right – sound waves!

An ultrasound technologist, also known as a sonographer, uses a transducer (probe) on the surface of the skin, connected to a computer. The transducer transmits sound waves into the body and then receives the sound waves as they come back to the transducer after they travel through and are reflected in the body. DIfferent tissues reflect and transmit the sound waves differently, allowing images to be created. A warm gel is applied to avoid air between the probe and the skin which can interfere with transmitting the sound waves.

How does it differ from other imaging techniques?

  • Firstly, ultrasound uses no ionizing radiation. It is a safe technique when performed properly with little risks to the patient, making it ideal for use in the young or pregnant patient.

  • Ultrasound can be used real-time, meaning images can be obtained while the patient is moving. This is particularly useful when studying things like joints or in directly assessing the exact site of symptoms.

  • The patient can be examined in different positions – for evaluating some structures, like leg veins, it may be helpful to examine the patient when they are upright. Joints may also require changes in patient position.

  • The machines are small – and getting smaller. For patients in the hospital, this means that the machine can be brought to the patient, rather than requiring the patient to move.

  • Doppler is an ultrasound technique which allows the study of blood flow, helpful in assessing many parts of the body, from the arteries in the neck to blood flow in the kidneys.

If you hear ultrasound and conjure images of pregnant women getting ultrasounds, you are not alone. Many are unaware of the number of applications of the technique in the body. With ultrasound, we can image most any part of the body – from the head to your toes and all parts between.

February 20, 2014

A Day in the Life of a Radiologist

LH at station

Let’s take a post to introduce ourselves. This will not be an introduction of us individually but rather a collective introduction. We are radiologists. We are medical doctors with 5 years of specialty training in radiology after medical school. That’s where we could have finished, but many of us did additional subspecialty training in different aspects of radiology like neuroradiology, ultrasound, body imaging, musculoskeletal imaging or breast imaging. So clearly we love schooling, training and practicing in radiology.

It is an exciting field where we have the pleasure and privilege of ‘looking inside’ our patients every day. This is how we take care of you. We carefully and thoughtfully examine imaging studies including CT, MRI, nuclear medicine, ultrasound, X-rays, mammography and fluoroscopy. In radiology we scrutinize images for both normal and abnormal findings in an attempt to detect causes for patients’ symptoms. Our interpretations help the referring doctor or clinician to care for patients. Often, imaging is the key to a diagnosis, from appendicitis to Zenker’s diverticulum.

In addition to looking at images, we perform procedures that are based on imaging – some of these for diagnosis, like barium examinations of the gastrointestinal tract, and many for therapy, like drainage of fluid collections or dilating arteries. Here, we get hands on time with our patients, helping to find problems and to provide solutions.

Admittedly we spend a fair share of time “behind the curtain” in a darkened reading room where images are shared via computer for interpretation. Rest assured we are never bored. Time flies between image interpretations, dictating cases, sharing information with our referring doctors and performing exams such as fluoroscopy or other procedures. Complex cases are the norm, and often require consultation between us as radiologists and your referring doctor. We have a key role in consulting with doctors and patients in ensuring the appropriate imaging study is done in the appropriate manner.

Your radiology test may not involve direct interaction with your radiologist – you will not see us every time. But we will be there, focused on your images to help keep you in your best health.
We love what we do – that’s why we’re here.

February 18, 2014

Smoking kills – Seriously, In More Ways Than One!

Smoking Kills by Vanderloot ∴ via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

Smoking Kills by Vanderloot ∴ via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

We typically don’t go for sensationalized article titles (there’s plenty of that out there without having to drum up extra) but the recent word from the Surgeon General’s office is serious.

USA Today quoted Thomas Frieden, director of the CDC as saying, “Amazingly, smoking is even worse than we knew – even after 50 years we’re still finding new ways that smoking maims and kills people.”

In this year, the fiftieth anniversary of the Surgeon General’s office calling tobacco what it is – a killer, the report (which can be found here) enumerates the sins of the smoke. Most people know that tobacco contains known carcinogens, and is related to lung and other head and neck cancers. The damage of smoking to the lungs is widely known and acknowledged. The acceleration of vascular disease and the association between smoking and cardiovascular disease is well-studied and widely known.

The more widespread effects of tobacco are less well known, and new associations are increasingly being recognized. The surgeon general in this report concluded that smoking is causally-linked – many smoking can directly cause -diabetes, liver and colorectal cancers. These are fairly recent additions to the list of diseases and damage from smoking.

The body – from the top of your head to the bottom of your toes and all parts between – is harmed by tobacco and smoking. Did you know smoking is related to macular degeneration (a leading cause of blindness), erectile dysfunction, rheumatoid arthritis, growth problems in fetuses whose mothers smoke as well as cleft lips and palates? Amazing that after 50 years scientists are still uncovering more ways tobacco damages the body.

This is not intended as a public shaming campaign for smokers, but a call to health for all. We need to work together to educate and keep others from starting on the path to addiction and help those who are addicted. We know it’s not easy. Some resources for quitting can be found here.

February 14, 2014

Heart Health: CT Coronary Angio

Here is an image from a CT coronary angiogram showing the aorta (the main blood vessel coming out of the heart and bringing blood to the body) with the coronary arteries coming off the aorta and going around/to the heart – the heart has been removed from the image so we can see the vessel, much like is seen on a heart catheterization. These arteries show no significant narrowings.

Here is an image from a CT coronary angiogram showing the aorta (the main blood vessel coming out of the heart and bringing blood to the body) with the coronary arteries coming off the aorta and going around/to the heart – the heart has been removed from the image so we can see the vessel, much like is seen on a heart catheterization. These arteries show no significant narrowings.

Now that we’ve covered CT coronary calcium scores, we’d like to talk more about noninvasive heart imaging.

There are several ways of studying artery narrowing or blockages of the coronary arteries of the heart. Two common exams are the CT angiogram of coronary arteries and the coronary angiogram, also known as a heart catheterization or “heart cath.”

For a CT angiogram, radiologists use CT technology and intravenous contrast to noninvasively image the arteries. A heart catheterization, usually performed by a cardiologist, uses a small catheter threaded through the blood vessels to the heart to inject contrast into the arteries.  The exam may require light sedation, and the use of catheters in the heart has risks including but not limited to blood vessel damage, arrhythmias, bleeding and stroke.

It has been shown that 40% of heart catheterization procedures in women and a smaller percentage in men are normal.  In those cases, nothing is wrong with the arteries and nothing requires treatment like angioplasty or stenting.  Having a less invasive, safer exam to evaluate people at risk for heart disease or symptoms of heart disease is a bonus – particularly for those patients with lower risk and potentially normal coronary arteries.

CT angiography of the coronary arteries uses CT, EKG, intravenous contrast and sophisticated 3D post processing techniques to create 3D images of the heart and heart arteries for analysis. Both soft plaques and calcified arterial plaques can be imaged and analyzed for severity. The determination for noninvasive or invasive treatments can be made from this study. The  procedure takes approximately 30 – 60 minutes, requires little preparation and the results are shared with the ordering physician for further review.

For patients at high risk for coronary artery disease, or those likely needing intervention such as angioplasty (treating narrowed arteries with a balloon) or stenting, a traditional heart catheterization is recommended. This allows diagnosis to be followed by immediate treatment.

CT coronary angiography can be considered for the following patients among others:

  • Patients with a strong family history of heart disease.
  • Patients with multiple risk factors for heart disease such as hypercholesterolemia, hypertension, diabetes.
  • Patients with atypical chest pain.

Talk to your medical provider if you have questions regarding this examination or questions regarding your personal risk for heart disease.

February 11, 2014

Heart Health: CT Coronary Calcium Score

One image from a coronary calcium  score showing calcifications (which show up as bright white, like the bones) in the wall of the coronary arteries at a level just above the heart.

One image from a coronary calcium score showing calcifications (which show up as bright white, like the bones) in the wall of the coronary arteries at a level just above the heart.

It’s heart month! We are joining with the American Heart Association in trying to raise awareness of the leading killer of women and men. In the past, we’ve explained the basics of a CT scan,  and today we’d like to talk about a specific use of the technology to obtain a CT Coronary Calcium Score.

A Coronary Calcium Score is a scan of the heart which evaluates the arteries for the presence of calcium. Calcium build up in the arteries is one part of coronary atherosclerosis – the process by which arteries are narrowed by buildup of plaque, both calcified and noncalcified (soft). Finding calcium in the arteries of the heart indicates coronary artery disease and is associated with an increased risk of future cardiovascular events, like heart attacks.

Obtaining a calcium score is a simple, quick, painless procedure. You will have EKG leads placed and then a quick scan of the heart will be done with the CT machine. No contrast is needed. Your study will be reviewed by your radiologist with computer assisted analysis. All calcium related to the coronary (heart) arteries will be identified, and a summation of the amount of calcium present will be reported. The score will be compared with others of the same age and sex.

The calcium score will give an estimate of the likelihood of significant coronary artery disease. It is important to remember that not all coronary artery disease will be calcified. Soft areas of plaque will not be found by this technique.

Coronary calcium score is a useful tool to consider for anyone in an intermediate risk category for heart disease or in some low-risk patients, especially those with a family history of early heart disease (before the age of 55 in a man or 65 in a woman).

What places someone in an intermediate risk category? Things like smoking, a family history of heart disease or high cholesterol can be factors. To determine your risk for heart disease, the Mayo Clinic has an excellent tool, found here. In intermediate and low risk patients, a calcium score can be an important independent predictor of the risk of future heart problems.

Recently, the American College of Radiology has reviewed the recommendations to determine the relative importance of getting a calcium score for different risk category patients. Their thorough statement and review can be found here.

For all, remember that cardiovascular disease is a leading killer. Take action to find out your risks and ways you can improve your heart health.

February 6, 2014

What is cirrhosis of the liver? – with Dr. Angela Noto