Archive for March, 2014

March 27, 2014

Ultrasound and Pregnancy: The Third Trimester

Whoa. Third trimester!

Whoa. Third trimester!

The third trimester of pregnancy can be a kick in the ribs – literally! As the newest member of your family grows and moves, the closer the crown of the head moves toward the birth canal. This is something of a slow somersault. Often times, it’s noticeable by the kicking-in-new-places.

But sometimes it’s not readily obvious. This doesn’t necessarily mean anything is wrong, but that may be a moment when your doctor would order a third trimester ultrasound.

Here’s What To Expect:

Third trimester ultrasounds are less common but not unheard of. Just as during the first or second term ultrasound, measurements can be taken to confirm size and due date.

Here’s What You’ll See:

This ultrasound can be used to look for fetal development, size, fluid and position.  The examination is typically performed by scanning with the probe on mom’s abdomen.  It is uncommon to perform transvaginal fetal ultrasound during the third trimester.

So, if you don’t need a third trimester ultrasound – that’s totally fine. As doctors we try to be judicious about the use of imaging. Again, while an ultrasound is harmless, why go in for unnecessary tests? If your doctor does recommend a third trimester ultrasound, again – don’t worry. We simply want the best possible health – for all!

If you’d like some really comprehensive further explanations of ultrasound and pregnancy, we recommend this link.

 

Diagnostic Imaging Centers blogs regularly about women’s health at www.mammographykc.com and general radiology here at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

March 25, 2014

Ultrasound and Pregnancy: The Second Trimester

Normal 28 week fetus on second trimester ultrasound. We're getting bigger now Mom!

Normal 28 week fetus on second trimester ultrasound. We’re getting bigger now Mom!

While the first ultrasound of a pregnancy is necessary to confirm pregnancy and initial health of the fetus and the mother, there’s more to come!

Ultrasound: 2nd Trimester Pregnancy

The second trimester ultrasound is a fun one! Now, ultrasounds are not entertainment – they are a medical screening and we doctors take them seriously for the sake of the health of all.

Luckily, ultrasounds do not involve radiation so they are safe and non-invasive. Whereas a first trimester ultrasound requires what is known as a transvaginal probe, the second trimester is done entirely externally unless there are special circumstances with mom or the baby.

What to Expect

You will be asked to come to the exam with a full bladder – we actually use the full bladder as a “window” through which we can view the pregnancy.

The exam with the bladder full will be done using a transducer across your belly to get a good evaluation of the uterus and your pelvis. This is most helpful in demonstrating the pregnancy location and fetus position.

The whole process will take about half an hour.

So… what’s the fun? Want to know if it’s a boy or girl? Want to see a clearer picture of the fetus? Now’s the time! Because most people wait until the second term to announce their pregnancy to friends and family, these images often appear on places like Facebook as the first introduction of who’s-to-come. That’s a lovely bonus.

What We Can See

But the serious side of a second term ultrasound is to determine a few important things. First, we want to confirm size and due date for this pregnancy making sure the fetal size and expected due date match up. We also want to confirm overall fetal health while performing a fetal anatomic survey. This means we can see development of the fetus and detect any possible problems. If there is any point of concern by second trimester ultrasound study often more detailed ultrasound, fetal echocardiography or other imaging can be planned to further evaluate any potential problem.

Ultimately, the second ultrasound is something to look forward to. Great information comes from the second trimester ultrasound regarding the health and welfare of mom and her baby. And, ok, it’s a little fun too.

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health here at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

March 20, 2014

Ultrasound and Pregnancy: The First Trimester

Normal 12 week fetus on first trimester ultrasound. Hi Mom!

Normal 12 week fetus on first trimester ultrasound. Hi Mom!

When most people hear the term “ultrasound” one particular thought comes to mind: pregnancy. Every expectant parent loves a glimpse of who’s-to-come – and finding out which color to paint the nursery is a bonus for many!

However, ultrasound is far more powerful than simply providing in utero baby snapshots. Ultrasound has revolutionized the approach to pregnancy, giving information which can save lives – the baby’s or the mother’s or sometimes both. Ultrasound uses sound waves – not radiation – to produce images, so in trained hands it is safe to use at any time during pregnancy.

During the first trimester, ultrasound is used most frequently to confirm pregnancy (along with a blood test), to confirm the location of the pregnancy and to evaluate bleeding. In the first trimester, the ultrasound will likely involve images obtained through a distended bladder and a transvaginal exam.

Here’s what to expect:

First, you will be asked to come to the exam with a full bladder – we actually use the full bladder as a “window” through which we can view the pregnancy.

The first part of the exam with the bladder full will be done using a transducer across your belly to get a view of the uterus and your pelvis. This is most helpful in demonstrating the pregnancy location. Once these images are obtained, you will be able to empty your bladder and return for what is called a transvaginal ultrasound. This involves a small probe being placed into the vagina to image the pregnancy and pelvic structures. This transducer allows better depiction of the pelvic structures and will allow more detailed evaluation – this is used in the first trimester and occasionally later in pregnancy. In the first trimester when the pregnancy is so small, the transvaginal part of the study is often key. There is usually little or no discomfort with the transvaginal study.

The whole process will take about half an hour.

What can we see in the first trimester?

It depends on the age of the pregnancy. When first visualized, the pregnancy will be a small fluid filled sac. At around 6.5  weeks, the embryo is often seen as a small peanut shaped structure – heart beating away. By the end of the first trimester, you can distinguish the head, trunk and the limbs. Everything is small, so in general gender will not be determined. We will evaluate the age of the pregnancy and compare to what you should be; confirm that the pregnancy is in the uterus; count babies – twins anyone? – look for the heartbeat, which we can only see once the embryo is big enough (7 mm is the key embryo size to expect to see a heartbeat!); and look at the pelvic structures. Fetal anatomic detail is limited by the small size, but it is amazing what you can see!

We know having babies is stressful – and not always easy! We wish you all the best, and hope this helps explain the process of the first trimester obstetric ultrasound.

March 18, 2014

Radiation Risk Management

Everyone is exposed to radiation in daily life. It’s a part of living on our planet. As radiologists, we are schooled in managing radiation in the imaging of patients.

There are many indications for the use of imaging studies using radiation to image the body – from finding fractures to finding cancers. Your referring clinician and your radiologist constantly weigh the pluses/minuses of using radiation in order to answer a clinical question. There are imaging techniques such as ultrasound and MRI which do NOT use radiation. As radiologists, one of our jobs after it has been determined that an imaging test is necessary is to make sure the radiation dose is appropriate – using the least possible dose to answer the question.

Radiation Exposure Is Measured and Focused

The pioneers of radiology faced the dangers of radiation without knowledge of its strength – many of those pioneers died from the effects of the radiation on their bodies . As the field of study evolved, radiation was over-used to treat benign conditions, like acne… and even initially for non-medical things like shoe-sizing (no kidding). The negative effects of large doses of radiation were soon recognized, and management of radiation dose is an integral part of the training of today’s radiologists and radiology technologists.

Radiologists regularly work with physicists to assess and address dose. Together, we wrote this: What Does Radiation Safety Mean to DIC?

Exposure Doesn’t Always Mean Cancer Risk Increase

Modern techniques focus on limiting radiation to the area being examined and using the lowest dose possible to get the images needed to make the diagnosis. These principles govern our use of radiation in imaging. For almost all, imaging tests and the radiation from them will NOT have a detrimental effect. The risk of developing cancer from radiation related to medical imaging is theoretic – and most of the information has been extrapolated or guessed at from dose and information related to survivors of the atomic bombs.

Radiation Therapy Is a Different Story

Radiation therapy to the body to treat malignancies is a different story – here larger doses of radiation are being used to destroy a cancer -and save a life. Radiation oncologists make every effort to limit the field of radiation to the area of cancer, sparing adjacent tissues whenever possible.  Some sensitive tissues may be in the field of view. For example, if the breasts are in the field of radiation, there may be an increase in the risk for breast cancer. This is why patients with Hodgkin’s lymphoma with treatment with radiation to the chest are recommended to screen with breast MRI 10 years after completion of radiation therapy. This will supplement mammographic screening (starting at the usual age) in these patients. Other sensitive tissues and the risks of radiation therapy to them should be discussed with your physician and radiation oncologist.

In summary, radiation is never used lightly. As radiologists, we work carefully with a dedicated team and look at the big picture of your overall good health. Your best possible health is our number one priority.

March 13, 2014

Self-Exams for Men (and Women)

Operation Truck Nuts - Successful by The359 via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0) Cropped

Operation Truck Nuts – Successful by The359 via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0) Cropped

Okay, we’re slightly nerdy.

Aside from being fans of thought-gems on TED.com you may have noticed on our other blog, MammographyKC.com that we’re also fans of Lifehacker. We can’t help it – there are thought-gems there too. Recently, they did a report on Three Self Exams Everyone Should Perform. Because early detection saves lives, and we as radiologists have the capacity to assist in early detection, we are great fans of self-exams.

But there’s so much to learn!

Self-exams put the power in your hands. You are the first line of defense when it comes to taking care of yourself, from eating right to exercise to noticing unusual changes in your body. But you have to pay attention! This is why we loved the article so much – it encourages you to pay attention.

We’ve written about breast self-exams on our MammographyKC blog (here) so today we’d like to use the Lifehacker article as a jumping-off point to talk about men’s health and the scrotal self-exam.

Men’s health is something we care about too.

The Lifehacker article gives good tips on how a man can perform his own scrotal self-exam. Knowing how to do it and what to look for are step one!

Testicular cancer is a leading cancer type in young men – and if found early, most testicular cancers respond well to treatment. Scrotal self-exam after puberty is one of the ways of finding scrotal changes that may be a sign of this cancer. Testicular cancer will often present as a firm or hard persistent lump in the testes.

If you find a scrotal lump on self-exam, step one is to get in to see you doctor. He will perform a careful physical exam and may also evaluate blood work. Depending on the results of those tests, you may be referred to a radiologist for a scrotal ultrasound.

Earlier on this blog, Dr. Sid Crawley talked about scrotal ultrasound and what to expect. It’s a non-invasive and relatively quick procedure. Besides masses or lumps what other symptoms may prompt a request for a  scrotal ultrasound? Pain, feeling of heaviness/fullness, infertility and scrotal trauma are also reasons men may be referred for scrotal ultrasound. Remember any persistent scrotal changes should not be ignored!

What can we see on scrotal ultrasound?

Scrotal ultrasound examines the scrotum and contents including the two testicles, spermatic cords, and each epididymis. The exam evaluates for the presence or absence of masses within or outside the testes, infection, trauma, fluid accumulation (hydroceles) and testicular torsion (an abnormal twisting of the testes which causes blood circulation to be impeded and can lead to permanent damage or loss of the testes). The sonographic evaluation will help guide your clinician to the appropriate course of treatment.

Just as we talk about in the breast, all lumps are not cancers. Many benign cysts and other benign masses may feel like a lump or knot. The beauty of scrotal ultrasound is being able to examine right where you are having symptoms, and answering the question of what is this lump!

A quick word about scrotal trauma – many times, trauma to the scrotum prompts a first scrotal self-exam. If you feel a lump do not assume the lump must be from the trauma – one of the most common scenarios for finding testicular cancer is the patient who first feels a lump after an episode of trauma.

Take a breath.

Most often, the scrotal ultrasound will reveal benign, treatable conditions. A monthly scrotal self-exam is an excellent means of keeping aware of your body and finding changes early. So breathe easy and take care of yourself with a simple monthly self-exam.

March 11, 2014

HSG and Reducing Anxiety

A health HSG

A healthy HSG

If your doctor orders an HSG (which is much easier to say than hysterosalpingogram) you may have heard stories from friends who have had them – or perhaps you’ve read some (scary) accounts on the internet. These may make you hesitate before scheduling that procedure! But we’re here to tell you, while not a cakewalk, the procedure is really not so bad – and lest you think we speak without knowledge, know that both your blogger docs have had the procedure and survived.

The HSG is one of those tests where it truly is hard to predict the level of discomfort. Experiences are individual – just as some have passing menstrual cramps and others have pain that keeps them in bed, some will say of an HSG, “Meh.” Some will say, “Ugh.” Others may truly experience pain. Your experience may fall anywhere on that spectrum, but there are things you can do to make the experience more comfortable. Communication is, as so often is the case with comfort, key.

In the past we’ve covered the specifics of what goes on in the procedure (here), but to briefly reiterate: an HSG involves injection of a contrast material into the uterus and uses x-ray technology to obtain images of the uterus and the Fallopian or uterine tubes, looking for any potential blockage.

Almost ALL of our patients express post-procedure relief that it wasn’t as bad as they feared. The most common comment – that wasn’t nearly as bad as I thought it would be – wish I hadn’t read all those stories on the internet! This made us think, how can we help to reduce your fear?

An HSG involves a lot of setup. The initial part of the study is about visualizing the cervix and getting the instruments in place so that the contrast material can be injected in your uterus. This is similar in discomfort to your routine pelvic exam- no picnic, but tolerable. The next part of the procedure is filing the uterus with the contrast material and getting our images. This is the part that will produce cramping from contrast filling the uterus, similar to menstrual cramps at their most intense. This part is fairly brief, usually 10 minutes or less. The discomfort ends when the procedure does -so breathe, relax and remember it will all be over in short order.

Now, here are some things you can do to help yourself. First off, ibuprofen is a minor miracle in preventing the cramping. You will be instructed to take some ibuprofen pre-procedure which will make the whole event more tolerable. Next, if you tense up, it is harder to insert the speculum and harder to get the instruments in the right position – so breathe. A few slow, deep breaths can go a long way in relaxing you and your muscles!

It’s helpful to know what your prior experiences are to gauge your potential HSG experience. For women with extremely painful periods, HSGs tend to be more uncomfortable. For women who have had children, HSGs are generally easier to tolerate. If it turns out that your fallopian tubes are blocked, the discomfort will be slightly more intense but will subside fairly quickly once the procedure is complete. And remember, blocked tubes are seen in only a small percentage of women.

If you have difficulty undergoing regular female pelvic exams, please do communicate this. Your radiologist will work with you to help make you more comfortable. Sometimes, it’s as simple as using a different speculum – they come in all shapes, just as we do.

All told, an HSG is an incredibly valuable form of imaging when pregnancy is your goal. We hope this brief discussion will help relieve some of the pre-procedure fright, and we have a feeling you too will be likely to say, “That wasn’t so bad.”

March 6, 2014

Ultrasound for Appendix

Here is an example of appendicitis by ultrasound with a tubular darker gray structure at the site of symptoms corresponding with the inflamed appendix.

Here is an example of appendicitis by ultrasound with a tubular darker gray structure at the site of symptoms corresponding with the inflamed appendix.

Appendicitis is pretty common – about 680,000 people – both kids and adults – will be affected by appendicitis each year – that’s about 1 per minute in the US! The appendix is a blind-ending tube with no apparent function that extends off the first part of the colon or large intestine, in the right  lower part of the abdomen, near the hip bone.

Appendicitis may be diagnosed purely on physical signs and symptoms (right lower quadrant pain, focal tenderness, fever and elevated white blood cell count) in some patients. If the diagnosis is questioned and imaging is needed, there are several options. Ultrasound is a great first step because it is noninvasive, quick, easy and involves no radiation. Imaging right where the patient is symptomatic is also quite helpful and easy to do with ultrasound.

With ultrasound, images with gentle, slow, graded pushing on the area of symptoms in the right lower quadrant are obtained with a transducer or probe. Appendicitis shows up as a tubular structure that does not push out of the way or compress, often with changes in the adjacent fat from the inflammation. This will often cause the patient to say, “Ouch, that is where it hurts.” If the symptoms are NOT related to the appendix, ultrasound can also help identify other potential sources of pain in the area, such as ovarian cysts, problems with the kidney or problems with the small bowel among lots of other causes.

If the ultrasound is inconclusive but symptoms persist, a CT scan is also an option for evaluation of the right lower quadrant.

There are many causes for pain in the lower right abdomen – if you have symptoms, see your doctor. Your doctor – with or without the help of your friendly radiologist – can work to determine the cause of your pain and treatment needed to get you back to good health.

March 4, 2014

Effective, Cost Effective, Life-saving CTs

Lung cancer is the leading cause of cancer deaths in the United States. The number of people dying from lung cancer in the US per year is greater that the number of deaths from breast, prostate and colon cancer combined. Despite the scope of the problem of lung cancer, early detection has been the subject of debate. Recent studies have shown that low-dose CT screening for lung cancer in high-risk smokers can reduce cancer deaths. The detection of small lung cancers before spreading outside the lungs has been shown to save lives.

According to a newly published study, there’s more good news about CT lung screening for smokers age 55-75. This study shows the success of CT screening out in the communities – not just in academic centers. Naturally, the best way to save lives from lung cancer is to never use tobacco or to stop using it. But as long as patients are fighting the uphill battle for lung health, it is keenly important to fight it on all fronts, from prevention to early detection.

For successful lung cancer screening, CT scans must be “low dose”, referred to as LDCT. We are always conscious of and try to limit radiation dose wherever possible in our practice. The principle of imaging is using the lowest dose possible to achieve the images we need. Studies have shown we can safely use LDCT for early detection of lung cancer. This study in particular shows that low dose CT programs can hit the trifecta of helpfulness: they are effective in finding lung cancer, can be performed cost-effectively and can save lives. There you have it.

The January recommendation from the US Preventative Services Task Force said that high-risk patients could benefit greatly from regular low-dose CT screenings. This is timely news as the US Centers for Medicare and Medicaid Services are currently determining coverage feasibility. This recent study shows that execution and efficacy are possible!

Hopefully, we will be seeing programs develop and expand as a result of these findings. For those at high risk, lung cancer screening with low dose CT and early detection can be life changing and life saving.