Archive for April, 2014

April 29, 2014

Case Study: Pyloric Stenosis or “Why Babies Get Ultrasounds”

pyloric stenosis

pyloric stenosis

We don’t like to expose infants to radiation, however sometimes we need to take a look inside. (Cue celebratory music…) This is why ultrasound is so fabulous! It’s real-time, harmless, noninvasive, short-lived and highly helpful.

 

Today’s case study covers an instance of an 8-week-old male infant with pyloric stenosis. Classically this disorder occurs at 2-8 weeks of age in male infants. The disorder is most common in Caucasian males and can run in families. The infants present with forceful projectile vomiting that can get progressively worse. Poor weight gain often results. Such was the case with this little one.

 

Today, we use ultrasound to image kids that are suspected of having pyloric stenosis (back in the old days we made the diagnosis with an upper GI exam done with fluoroscopy and X-rays – no longer necessary for the majority).  With ultrasound we use a probe gently placed on the baby’s abdomen to image the pylorus, a muscle which sits at the connection between the stomach and the small intestine. Ultrasound allows us to see the overdeveloped muscle that causes blockage between the stomach and the small intestine, impeding the progress of milk out of the stomach – vomiting and weight loss follow!

 

This condition is highly treatable after the diagnosis is made. Most often, simple surgery to open the muscle is used to put an infant back on track to weight gain and health. Here’s one more example of how ultrasound has impacted little lives. We love to image soundly!

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

 

April 24, 2014

Ankles: Sprains and Pains

Image

For any building to be upright, it requires a solid foundation. Such is true for the human body: if what’s below the knees goes wonky it can have an effect on the body as a whole. Ankles are incredibly resilient joints but when they take a hit (or a fall or a twist) they can be problematic.

 

Ankle sprains are common, and can be seen in athletes and nonathletes alike. Sprains can result from the ankle turning from a misstep, from stepping down at an angle or from sideways movements. There are clinical rules which help determine who needs imaging- mild sprains may not need to be imaged.

 

Sprains typically result in injury to the ligaments, those soft tissue bands which connect bone to bone. If the ankle is unstable or if symptoms do not improve as expected, imaging with an MRI may be needed. This allows assessment of the bones of the ankle as well as the soft tissues, including the ligaments.

 

A fall from a height may lead to fracture or dislocation (ouch). Plain films of your ankle will be the starting point if fracture is suspected.  If a fracture is complex, CT is excellent at showing the anatomy and helping your surgeon plan treatment.

 

Achilles tendontears are often an event with a distinct injury, sometimes related to a sudden movement and abrupt tensing of the calf muscle (Remember those replays of Lebron James’ injury? Ouch!). Physical exam will often reveal a focal defect in the tendon your doctor can feel. We may want to image to see if the tendon is completely torn and the distance between the torn ends to help with surgical planning. Ultrasound can show this nicely, as can MRI.

 

Tendons about the ankle other than the Achilles can also be injured, torn or inflamed. Injuries to other ankle tendons can also be evaluated with ultrasound, although MRI is more commonly used. Tendons about the ankle include the peroneal tendons on the outer side of the ankle and the posterior tibial tendon on the inside.

 

It’s important to treat ankle injuries, because as a foundation for the body, adding a limp can lead to other problems including back pain (double ugh). If left untreated, ankle sprains can lead to chronic instability.

 

As ever, prevention is the best medicine. Some ankle strengthening exercises can be found here.

(Photo credit: Broken ankle Cast detail by FiDalwood via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

April 22, 2014

Knees: Scrapes, Twists and Tears

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Knees are famous for scrapes (and bees). Little kids play rough and tumble and when they do, they land on ‘em. Little band-aids on a child’s knees are almost – dare we say – cute. They remind us of learning to ride bikes and popsicles on summer days and swingset leaps. Luckily, kids’ knees are resilient.

 

As we get older – not so much. Knees take a beating and unfortunately they’re really only meant to bend in one direction. We could go on and on about knee maladies (arthritis anyone?) but let’s pick one: sports injuries.

 

As we graduate from learning to ride bikes to learning to ski and more, we introduce a lot more opportunities to scrape, bang, twist and torque our knees. Knee injuries are incredibly common, especially in sports. There are a variety of tissues to damage – from bone to muscle to tendons to ligaments. Imaging may be needed to see all of the complex structures.

 

With sports injuries, damage to ligaments may occur, especially with twisting or blows from the side – ligaments (connecting bone to bone) include the anterior cruciate (ACL) and posterior cruciate ligaments which cross (cruciate comes from the Latin for “cross”) the center of the knee. The medial and lateral collateral ligaments stabilize the inner and outer aspects of the knee respectively.

 

Sometimes with a twisting motion, multiple structures will be involved in the injury. MRI is an excellent means of imaging the knee, allowing us to look at bone, soft tissue and cartilage all at the same time. You can even give a good estimation of the way a knee was injured based on the pattern of injuries present on the MRI. Injury to the ACL happens in athletes of all ages. The ligament can be torn partially or completely, and knee instability in a classic pattern will often be found on clinical exam of the knee.  ACL tears are often associated with bone bruises in classic places, and may be associated with damage to the other soft tissue structures, from other ligaments to meniscal tears.

Tendons (which connect muscles to bone) may also be injured – either the quadriceps tendon  coming to the top of the patella (kneecap), or the patellar tendon, coming from the bottom of the patella.  Often the tears can be felt by your doctor on exam. Imaging, often with MRI or with ultrasound, may be necessary to see if the tear is complete and look for other injuries. Muscle injury can also occur, and is well-imaged by MRI.

The menisci are discs of cartilage between the femur and tibia which provide cushioning and which can get torn. This can cause a sensation of something locking in the knee with motion (although other things can also do that) or may just cause pain. Meniscal tears are well-seen on MRI, and may also be evaluated with arthrography.

 

As with shoulders – you want to take care of your knees and keep ‘em strong. This doesn’t mean don’t play – it just means play smart. Other things you can do to help protect your knees can be found here.

(Photo credit: trufflekneehighs by boocub via Flickr Copyright Creative Commons Attribution- NonCommercial- NoDerivs 2.0 Generic (CC BY-NC-ND 2.0))

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

April 17, 2014

Shoulder Pain: When You Can’t Shrug It Off

Shoulder joint by National Institute Of Arthritis And Musculoskeletal And Skin Diseases (NIAMS) via Wikipedia Copright Public DomainThe shoulder is a complex joint of mythical strength (at least if your name is Atlas and you’re carrying the weight of the world on it).

 

From baseball pitching to carrying little kids to lifting overhead, the shoulder gets quite the workout. It’s important to take care of this joint – especially if it’s been injured. One of the most common injuries is to the rotator cuff tendons.

 

There are four tendons surrounding the shoulder to provide stability and assist in the normal range of motion. Pain and limited range of motion are often the first indicators that something could be wrong with those tendons. They can be inflamed, torn partially or torn full-thickness.

 

After an initial evaluation with your primary healthcare professional, you may be sent for imaging. Typically, this area can be evaluated with MRI or an  ultrasound. Some shoulder injuries are difficult to see without some fluid in the joint – this is when an MR arthrogram might be performed. MR arthrograms can evaluate partial tendon tears and provides an excellent evaluation of the labrum or cartilage lining the joint. Labral injuries may be seen in patients who have had a dislocation of their shoulder joint as well as in athletes.

 

Some of the rotator cuff tendons sit underneath the acromioclavicular joint – the smaller part of the joint on top of the shoulder. Changes in the acromioclavicular joint, either differences in the shape of the acromion or degenerative arthritis, may predispose you to problems with the rotator cuff tendons or may lead to chronic tendon irritation or tears.

 

The shoulder is a complex joint, and vital to many daily functions we don’t even think about, such as brushing your hair or lifting your groceries. So if you have an injury, pain or develop difficulty in moving your shoulder, don’t hesitate to see your doctor.

 

And remember – prevention is the best medicine! Stronger shoulders are less likely to incur injury, and strengthening the rotator cuff can be achieved. Here’s a Real Simple way to improve your shoulder health.

(Photo credit: Shoulder joint by National Institute Of Arthritis And Musculoskeletal And Skin Diseases (NIAMS) via Wikipedia Copright Public Domain)

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

 

April 15, 2014

Shoulders, Knees and Toes, Knees and Toes

Head, Shoulders, Knees, and Toes by james.swenson13 via Flickr Copyright Creative Commons Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0)

Over the next few posts we’re going to highlight some common injuries affecting familiar joints. As the title suggests, we’re starting near the top.

 

But before we get ahead of ourselves and start talking about these individual parts, let’s talk about how we image them…

 

There are many techniques for imaging the body, and the ones we use depend upon the type of injury and the most likely tissues injured. Here’s a gimme: broken bones? We’ll start with an x-ray – perhaps a CT if it’s complex. Here’s a not-so-gimme: soft tissue injury like torn ligament? Options here include MRI, ultrasound and arthrograms.

 

First off, not every injury is imaged. Why? Sometimes a careful exam by your doctor can answer the question – imaging in these cases is not done, unless symptoms do not improve in the expected manner. There are carefully developed rules helping your doctors determine who will benefit the most from imaging in the case of many of the common injuries, for instance ankle sprains.

 

After your doctor’s initial evaluation, you may be sent for imaging. In many cases this will start with conventional films (x-rays) to exclude fractures or other bony changes. Beyond that, a patient will be directed based on the clinical concern.

 

Imaging of patients who have multiple sites of injury from a fall or motor vehicle accident for instance may be done with CT. This allows quick evaluation of bones as well as some types of soft tissue injuries. Multiple structures can be evaluated at the same time with CT, such as looking for fractures in the lower back, while also assessing the abdomen for signs of damage to internal organs.

 

Soft tissue damage, such as torn cartilage or ligaments, will often not be apparent on a conventional film. Visualizing soft tissues can be done with ultrasound, MRI or an arthrogram (where contrast material or dye is introduced into the joint space). We may follow the arthrogram with imaging with MRI or CT.

 

So… we will start our journey of the joints with your shoulders! (See you Thursday!)

 

(Photo credit: Head, Shoulders, Knees, and Toes by james.swenson13 via Flickr Copyright Creative Commons Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0))

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

April 10, 2014

Bone Density: High Impact

Double Dutch Street Performance by Matsuri @ Vancouver City Centre Station by GoToVan via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0)And you thought jumping rope was just for fun… Well, it is! But it also might be good for the health of your bones. We’re not saying you have to hit 332 jumps per minute, but even at a leisurely pace, a little jumping can be good for your bones.

 

As it turns out, when bones receive a moderate impact (we’re talking a moderate impact from movement like running or jumping) bones make themselves stronger.

 

In a recent study (playfully titled Physical activity and bone: may the force be with you) it was discovered that young persons, whose bones are still developing, can increase bone density with physical exercise which included moderate impact activities. The hope is that building bone density in young people will help provide protection from future bone loss issues such as osteoporosis, although further research into long-term effects is needed. And these clever scientists weren’t the only ones to find such promising results from moderate impact exercise. In another study of premenopausal women, when bones were subjected to a moderate force from jumping, hip bone density increased.

 

As we age, the risk of bone loss and all its negative side effects increases. One of the best preventives for future problems with osteoporosis is to start with strong bones. These studies show we can improve bone strength over a relatively short period of time with purposeful, moderate impact activity.

 

Want to read more? Check out this article from the New York Times, here. Hop to it!

(Photo credit: Double Dutch Street Performance by 祭 – Matsuri @ Vancouver City Centre Station by GoToVan via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

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

April 8, 2014

Bone Density: What Is DEXA?

Diagnostic Imaging Centers DEXA scanner

Diagnostic Imaging Centers DEXA scanner

Dual photon x-ray absorbtiometry? That sounds like something that happened to Bruce Banner (okay, those were gamma rays…). But we promise, you won’t turn green from what is more simply known as a DEXA scan.

 

A DEXA scan is also called a bone density scan. This test is used to test your bone density and determine your risk for future fracture.  This test involves a small amount of radiation and evaluates the density or strength of your bones. It can analyze different bones, but is most often used to evaluate the spine and hip.

 

An exam takes 10 minutes and is easy for most: all you have to do is hold still while lying on your back and our computers will do the rest. On the day of your exam you will be asked to avoid taking any calcium supplements as they interfere with the test. If you have metal in your back or hip like a spinal fusion rod or hip replacement your exam will be slightly different.  For these cases we use another bone for analysis, typically the forearm.

 

The test will calculate a score which estimates fracture risk. All sorts of data are taken into account, from age to gender to race, and your bone density will be compared to a healthy 30-year-old’s average.

 

Bone density results will fall into three ranges: normal, osteopenia or osteoporotic. Osteoporosis is the loss of bone mass often found in the elderly which makes bones brittle or weak and susceptible to breaking. Osteopenia indicates bone density less than expected but not yet reaching osteoporosis levels. While osteoporosis is serious with serious implications for future health, it is also treatable – and treat it is what we want for you! If you show signs of bone density loss there are a variety of medication options and lifestyle changes which can be considered.

 

While a DEXA can’t cure what ails, it can help target and identify what does so that treatment can be started to get you on the road to your best possible health!

(Photo credit: DEXA scanner at the Diagnostic Imaging Centers)

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

April 3, 2014

Brain Boost: Kids and Screens

Computer by yoshimov via Flickr Copyright Creative Commons Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)

Computer by yoshimov via Flickr Copyright Creative Commons Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)

Bringing children into the world brings organized chaos to your life. There are things they do on a regular basis, like eat and sleep – and things we cannot regulate at all, like moods, personalities and learning curves. There is one certainty – they will keep growing and changing, especially when you think you’ve figured them out.

 

As parents, we struggle to manage the unmanageable. We try to get them to go to bed at a certain hour, we try to get them to eat at dinner time and we try to get them to want healthy foods.

 

In the middle of all that trying comes another interruption to their cycles: technology. It entertains the cranky, exercises the brain and distracts, separating the user from the world outside the screen. It’s a gift and a burden.

 

Recently, the Washington Post wrote an excellent article on kids and screentime. In short, just as we carefully monitor their diets for a balance of good food and the occasional treat, absorption of a healthy media diet is in order too.

 

It doesn’t take a scientific study to know that there are times to turn off the television and go get some playful exercise outdoors (but there are many). But as iPads have turned into flipbooks for three year olds and texting is more than just a game to many teenagers, it can become hard to judge just how much time spent on these devices is time well spent.

 

The American Academy of Pediatrics has some great guidelines they’ve researched when it comes to the media intake of children. When it comes to hard facts and numbers, here’s what we learned from writer Kendall Powell:

 

Develop a family media plan and stick to it!

 

●Enforce consistent rules about screen time from the start.

●Keep all screens and Internet out of the bedroom.

●Impose meal time restrictions and bedtime curfews for everyone’s devices (yours too!).

●Watch or explore media content with children.

 

While wrangling the chaos of a household is hard (to put it mildly), managing a little more of what goes into the heads and hands of little ones can produce happier, healthier children. And that’s an effort well worth making.

 

 

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

April 1, 2014

The Places You’ll Go, the Things You’ll See… Imaging in Other Countries

Guest blogger, Rebecca

Guest blogger, Rebecca

Rebecca is our guest blogger today, one of our many great employees who make DIC what it is, committed to service not only here but in areas of great need…

We are proud of Rebecca for what she brings to our patients here and for her commitment to sharing her knowledge and compassion with those in need around the world.

 

Oh, The Places You’ll Go (by Dr. Seuss)

“You have brains in your head

You have feet in your shoes

You can steer yourself any direction you choose…”

This book was, and probably still is, a very popular graduation gift.  As young adults, the path to the future is wide open and many times uncertain.  I can say that I never imagined going to x-ray school then to ultrasound school in Kansas would lead me to Guatemala and Haiti to share that knowledge.

Luckily with time technology is catching up with the human need for quality healthcare.  The generosity of the American Society of Radiologic Technology and Rad-Aid who sponsored our Haiti trip and the Emporia United Methodist Church who sponsored the Guatemala trip is greatly appreciated.

Diagnostic Imaging Centers is committed to:  Dedication, Innovation, and Compassion.  All three are brought to our local community, but we also can bring those attributes to people in need – even in other countries.

Dedication:  Promoting patient care and safety. In Guatemala and Haiti, the maternal death rate during childbirth is high due to lack of knowledge of placenta location (placenta previa) or fetal position in the womb.  I was able to help instruct a midwife to learn these critical skills with ultrasound imaging. The Guatemalan midwife told our group that we were helping bring her dream of quality heathcare to reality and advance them to a higher level of care.  The dedication of many radiology personnel has helped form organizations for radiology medical missions. (For more information: www.odimguatemala.org)

Innovation:  The progressive innovation of increasingly smaller and truly portable ultrasound machines has helped bring quality healthcare to the poverty stricken and remote areas of the world.  But now the need is for trained professionals to teach the local doctors and potential students to use this equipment to the benefit of their patients.

Since the Haiti earthquake four years ago, most all healthcare supplies have been made available through donations.  Medical schools are open, but education for critical support staff such as technologists is limited.  At my location in Haiti, Hospital Bernard Mevs, there is a radiologic technologist school, but only one book to share among 6 students.  There is not currently an ultrasound technologist school.

The Rad-Aid group I was with hopes to change that reality. During the week in Haiti, we were doing lectures and hands-on training for the 1st class of Haitian radiology residents in 8 years, surgeons, and a few medical students.  A week is not enough time for proficiency, but with self motivated practice, internet capability to learn, donated textbooks (thanks to DIC‘s Dr. Linda Harrison), and hopefully future medical mission groups, we see a bright future for Haiti and other areas in need.

Compassion:  Compassion, consideration for another person, and living a life of service for others helps me enjoy my job and helped motivate me to search out these medical missions.

In Haiti, I did an obstetrical ultrasound on a 38 yr. old woman that had been in a car wreck, had a head injury, and bilateral mandible fractures.  She was 22 weeks pregnant at the time, and had never seen or knew about ultrasound before that day.  Due to machine and bed position, she was unable to watch the monitor.  And, unlike the USA, there was no picture printing or CD availability to provide her with images of her baby.  So, I took screen pictures of the baby on my camera to show her.

Though she had some memory loss and confusion, she was able to recognize her baby’s face.  The love that showed in her eyes and the smile on her face, I will never forget.  In Guatemala, my translator and I were able to attend a home visit with the midwife of a new mom and her infant son.  We brought her a gift for the baby and thanked her for allowing us to visit.  She said she wanted to thank us for wanting to meet them and learn about their culture.

In conclusion, I would like to encourage everyone to get involved with a group that supports your passion and to take that leap of faith to broaden your horizons.  It’s not always going to be easy and what you experience may not be easy to comprehend, but it will help make a better you and a better world.  I never thought my love of ultrasound, travel and service could be brought together, but now I can’t imagine separating them.