Archive for May, 2014

May 30, 2014

Introducing… DIC’s Olathe Clinic!

photoUnknown-4Walking into Diagnostic Imaging CentersOlathe Clinic is… shiny and new!

 

With a recent move, everything is upgraded and new – a complete overhaul of equipment brought us to the most recent and state of the art technology available today. There’s even a thoughtfulness to the equipment – we made equipment upgrades with our patients in mind.

 

Our new CT scanner has low dose technology and can do amazing 3D imaging.  Our MR scanner is open technology with high strength imaging a combination that says you’re comfortable and we are getting the best possible images you. This MRI also does high quality imaging of joint replacements, that’s great news to many people with pain after joint replacement. This is a full service imaging clinic, performing everything from ultrasounds to digital mammograms, MRIs to CTs to x-rays, fluoroscopy and bone density scans. In short – it’s all there!

 

You will love our staff too. This is a diverse and educated group. They are passionate, too.  We asked them what groups they like to support, and we thought we’d give a shout-out to (just to name a few…) Made to Serve, NASCAR Foundation, March of Dimes, Wayside Waifs, American Diabetes Association, Ozanam, Autism Society and PurpleStride Awareness Walks! In short, we have dog-lovers, healthcare nuts and children’s health fanatics. This is addition to their greatest passions – for people.

 

When asked what they loved best about their jobs, everyone jumped in with exclamations about interesting patients and great co-workers. They are truly lovers of human beings. Also, they’re pretty thrilled about the new location. The Olathe clinic was thoughtful put together – and thanks to an amazing staff it is thoughtfully held together too!

When you need us our what you see us we can be found at 13795 S. Mur-Len Road in Olathe, KS, just across the road from Mid-American Nazarene University. Come on by sometime.

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!

 

May 28, 2014

Introducing… Overland Park Women’s Center!

Dancing by Katri Niemi via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)Ever heard of the Mammogram Dance? Neither had we… until we did it. Just another day at the office at Diagnostic Imaging Centers’ Women’s Center.

 

How does such a thing happen? It starts with people. Not just patients, not just staff… but people. Friendly people, nervous people, excited people – we have all kinds of people walk in the doors of the Women’s Center in Overland Park.

 

The Women’s Center is part of our Overland Park office – this imaging suite in the big building at the corner of College Blvd and Nall is dedicated to mammography, breast ultrasound and DEXA (bone density) scans. We will see men at this office – men sometimes need breast imaging or DEXA studies.

 

Our front desk works to put you at ease. Our technologists are trained to not only be specialists in their chosen fields but also in their bedside manner. And our patients aren’t just a number. We strive to tailor the exam to whatever it is you need most. Which brings us back to the dancing and the day of our mammogram dance.

 

There was no music, no disco balls or strobe lighting. There was a woman, dutifully coming in for her annual screening mammogram. There was her toddler grandson. And then there was a quiet, empty waiting room. How else to kill the time and shake off a little nervous energy? We danced.

 

WE danced – first the little boy started bopping about, then his grandmother got in on it, next thing you know, the DIC staff was shakin’ it up like the best of ‘em. Surely, a sight to behold if anyone had walked in on us – but nevermind that. Everyone laughed and felt better about their day from that point forward.

 

Magic happens when people care about each other. And magic happens everyday at the Women’s Center at Diagnostic Imaging Centers. If you want to see for yourself, head on down to suite 110 at 5520 College Boulevard in Overland Park, KS. We provide mammograms with immediate results, and follow-up imaging (such as ultrasound) the same day if needed. We can’t promise a dance every day – but you never know!

(Image credit: Dancing by Katri Niemi via Flickr Copyright Creative CommonsAttribution-ShareAlike 2.0 Generic (CC BY-SA 2.0))

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!

May 23, 2014

Case of Note: Herniated Disc

herniated lumbarAs we worked through spinal conditions and imaging this week, we found a useful and not entirely uncommon case study: A patient with low back pain.

 

This patient presented with severe lower back pain and pain extending into both lower legs.

 

This imaging was done using MRI technology. He was prescribed the procedure due to the severity of pain in his lower legs, a symptom called radiculopathy, which is a shooting pain distributed through the nerves in the legs. You can see a disc has protruded from the normal position between the lumbar vertebrae and presses on the spinal canal (between numbers 3 and 4 the black gap between vertebrae seems to “spill” out in the back). This MRI exam was extremely useful in identifying the level of patients abnormality and and the extent of abnormality.

 

Initially, the patient elected a conservative route for treatment and had an epidural pain injection. Pain medicine is injected to the area around the herniated disc for relief of pain. This procedure resulted in temporary partial pain relief. After that treatment and a course of physical therapy he was referred for a surgical consultation as his pain continued. A microdiscectomy gave relief and has allowed him to return to normal activity.

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!

May 21, 2014

MRI Case Study: “Thoracic Cord Syrinx” or “Some new vocab words for today”

SAG t2 8Here is an example of an MRI of the thoracic spine. The image on the left is taken as if the body were being sliced from head to toe (sagittal image) and the image below is as if the body were being sliced across the middle like a loaf of bread (axial image).

 

The image to the left shows the vertebral bodies as blocks and the spinous processes back behind the spinal canal as obliquely oriented blades. The spinal canal on both contains the spinal cord which is mostly black surrounded by the normal cerebrospinal fluid which is white. The thoracic cord normally has a little bit of a bulge as it ends in the upper lumbar spine, seen on the sagittal image towards the bottom.

 

This patient presented for evaluation of mid-back pain. On the left side sagittal image, the cord has an area of white running through it centrally from top to bottom. This is seen as the central spot of white within the normally dark cord on the axial image. The signal of this area matches the signal of the cerebrospinal fluid surrounding the cord.

 

This area of white is one example of cord pathology that might be picked up on an MRI. This is known as a syrinx (or syringohydromyelia – how’s that for a long name!) and is an abnormal buildup of fluid in the central canal of the cord. Over time, this fluid buildup can enlarge and start to affect the nerves running through the cord, sometimes resulting in symptoms like muscle weakness.

 

Remember, most patients with back pain will find their symptoms resolve within 4 weeks. If symptoms do not improve or are accompanied by other changes like muscle weakness, evaluation by your doctor is warranted.

 

 

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!AX t2

May 19, 2014

Introducing Diagnostic Imaging Centers’ Overland Park Location (Part 1)

It’s Monday! Back to work and time to introduce you to our office in Overland Park, Kansas, just off the highway at College and Nall.

 

photoIn Overland Park, our office has grown over the years, and we have three separate office suites at the same site capable of fulfilling all of your imaging needs. In the multi-story building we have a general radiology center and a women’s health suite;  the adjacent one-story building is the site for MRI, open MRI and CT exams.

 

The general radiology suite (#100) is home to a team of 13 employees, ranging in specialities from fluoroscopic imaging to ultrasound, to nuclear medicine. Our front desk staff will greet you with a smile. If you have need to speak with our medical records staff, this is the office where they are located – although they can be reached by calling any of our offices.

 

What’s really great about this team of employees isn’t just their expertise in their fields of work but their attitude as a team.

 

First off, they are a team – truly working together to help each other out. This attitude of togetherness is focused on taking care of our patients as expertly and quickly as possible. From the moment someone walks in the door, our Overland Park staff aim to put people at ease and bring comfort to a procedure which may be stressful. The Overland Park office is comfortable with and has experience imaging patients of all ages – children needing imaging tests and their parents will be reassured to know we can handle children’s special imaging needs. We perform lots of fluoroscopic procedures at this office, including barium studies of the GI tract, arthrograms (special studies to look at the joints) and hysterosalpingograms or HSGs to help look for patency of the uterine tubes in women trying to become pregnant. Many of our patients are comforted to know that results can be phoned to their doctor’s office immediately.

 

Our employees are not only talented and well- educated – they are genuine people with passions for great causes (everything from the ASPCA to the Humane Society to Miles for Melanoma Research Foundation). They enjoy their part in meeting your health care needs and are passionate about caring for people as individuals. If you need a hand to hold during a procedure (don’t worry – many do!) or are so happy when you’re done you need a hug (don’t be surprised – many do!) our technologists are the folks there to help you out!

 

We like to share on our blogs what to expect when it comes to medical imaging, but we also like to share what to expect when you meet us. We want you to feel safe and comfortable. We often say we work for your best possible health, and our Overland Park Kansas team hopes to meet your imaging needs completely. Thanks for letting us help you.

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!

May 14, 2014

What’s Up with Your Neck? (and just below…)

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Have pain in your neck or upper back? You are not alone! While less common than low back pain, pain in the neck is a common complaint leading to doctor’s office visits. Pain in the upper back is somewhat less common, but we will include it in our discussion for completeness.

 

In a recent post we talked about imaging of the lumbar spine, the lower portion of the spine which sits behind your belly.  Much of the imaging for the rest of the spine is similar to what is done for the lumbar region.

 

The cervical spine (coming from the Latin word for neck) is sometimes referred to as the C spine. It consists of the first seven vertebrae (from the skull) and the cartilage discs between them, in addition to adjacent ligaments and muscles. A lot of motion (up,down, around!) occurs in this part of the spine during the day, so this is a common spot for symptoms of overuse or muscle strain to occur.

 

Patients with cervical spine problems may have pain in the neck with or without symptoms in the upper arms/shoulders – this can be pain or can be nerve type symptoms like numbness or tingling. How far the symptoms go down your arm can help indicate the level of involvement in the cervical spine.

 

The T Spine is the thoracic spine consisting of the 12 vertebral bodies, discs, adjacent muscles and ligaments at chest level. There is less movement of the spine at this level, so symptoms here are less common. Symptoms of thoracic spine problems may include pain in the upper back, shoulders, arms, or to the sides of the chest. Nerve symptoms like numbness, tingling or weakness may also be present.

 

As in the lumbar spine, there are a lot of age-related changes involving the discs and/or the adjacent bones; these may or may not be related to the patient’s symptoms. Imaging of the cervical and thoracic spine is generally performed after careful history and physical examination, and may be delayed to see if a trial of conservative treatment improves symptoms. Imaging immediately may be warranted if there are serious symptoms such as major trauma, weight loss, or nerve symptoms, particularly weakness of the arms or legs.

The spectrum of problems in the cervical and thoracic spine is similar to that in the lumbar spine and can include disc displacement, fractures, and muscle strain. Less common causes of neck and upper back symptoms include disease in the spinal cord itself, spinal cord tumors and things like multiple sclerosis. Note that the spinal cord ends at approximately the upper lumbar level; therefore, these problems do not directly affect the lumbar spine.

 

Imaging of the cervical and thoracic spine is similar to that for the lumbar spine. X-ray, CT and MRI can all be used to diagnose problems.Plain films or x-rays may be the best starting point as they can show alignment and fractures. X-rays can also show any narrowing in the spaces between the vertebra indicating disc disease. A CT shows bones and adjacent tissues and is the test of choice if we are concerned about fractures. CT can see the cord and nerve roots if we do it after a myelogram (more commonly done with C spine than with the T spine). Last, an MRI can show the spinal cord, nerve roots and discs and how they relate.

 

Ultimately, imaging of the neck and upper spine may be helpful to determine the proper course of action to get you on the road to your best possible health!

(Image credit: Illu vertebral column via Wikimedia Commons Copyright Public Domain)


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!

May 12, 2014

Diagnostic Imaging Centers: We’d Like to Introduce Ourselves (ALL of Us!)

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Over the past year, we’ve put a lot of love and energy into providing the best imaging information for our growing readership. We blog at mammographykc.com about breast health and not just cancer but overall breast health. Then we write here at diagnosticimagingcenterskc.com to discuss more general radiology topics from when, to what, to why we image the human body and how we keep you safe and healthy.  

 

We’ve introduced the types of imaging we use (MRI, CT etc.) and introduced many of our radiologists at Diagnostic Imaging Centers. We’ve raved about our love for our whole team (techs and all of our staff are awesome people!). Our jobs revolve around people, our jobs involve working together, our jobs are our pleasure and a labor of love. We strive to offer the best in outpatient imaging care.

 

During the next few weeks, we’ll be introducing each of our six facilities and our colleagues who make them so special. We will highlight many of our employees individually so you can get to know us better.    

 

So stay tuned and on Mondays we’ll be bringing you more of the great radiology information you’re accustomed to here and even more! From Overland Park to Olathe, from Lee’s Summit to Independence and the Plaza to the Northland, Diagnostic Imaging Centers is here for you – online and in real life too. Cheers to your best possible health!

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!

May 8, 2014

Imaging of the Lumbar Spine

Lumbar vertebrae anterior by Anatomography via Wikimedia Commons Copyright Creative Commons  Creative Commons Attribution-Share Alike 2.1 JapanTo continue our conversation about back pain, today we’re going to focus on the different imaging tests that may be requested to evaluate someone with back pain, specifically lower back pain. Imaging for lower back pain will likely focus on the lumbar spine. It’s the lower back region, usually the lower 5 vertebral levels – the series of vertebrae highlighted in the picture here.

 

There are several modalities we use to examine the lumbar spine, including (but not limited to) x-ray, MRI  and CT.

 

Conventional films or X-rays are often the starting point when evaluating someone with back pain. This allows an overall assessment of alignment and can look for signs of a more serious issue requiring additional imaging, like a fracture or an area of abnormal appearing bone. If the back pain follows recent trauma, is seen in someone with known osteoporosis or is in someone over the age of 70, conventional films may be the imaging study of choice and may be the only imaging needed.

 

MRI (magnetic resonance imaging) of the lumbar spine is the most common imaging test for back pain because of its ability to see details of the soft tissues, including the nerves as well as the bones.  As an added benefit, no radiation is involved. Remember with MRI the images are made with a large magnet and radiofrequency pulses (those are the loud sounds you hear). With MRI we can examine all of the following:  the structure of the discs (the cartilage cushions between the vertebrae) and look for how the disc relates to adjacent nerve roots; the bones that make up the spine including the vertebral bodies;  the conus (the lower end of the spinal cord); and the soft tissues surrounding the area. Imaging takes about 30 minutes, and remember – you can’t have an MRI if you have a pacemaker (most types anyway!) or some implanted devices like stimulators. Lastly for the safety of all you cannot bring metal of any kind into the room!

 

CT (computed tomography) is an additional means of looking at the spine. Images with CT are made with x-rays that are created in a ring around the body allowing the body to be imaged in thin slices. CT allows an excellent look at the bones making up the spine. It may be the study of choice for evaluation of acute trauma or fracture. Changes in the discs can be seen, but the nerve roots are not visualized in a routine CT. There are times when a CT of the spine is performed after a myelogram – this is a procedure where contrast material is put in the fluid- containing space surrounding the spinal cord and nerve roots. This then allows CT to better evaluate the nerve roots and soft tissues of the spinal canal. A CT scan may be used to help with planning before back surgery. A CT lumbar spine takes around 10 minutes. It should not be used in those who are pregnant unless it is an emergency (as with severe trauma).

 

All of these are straightforward procedures that can give an excellent anatomic evaluation. Remember imaging of the spine will often reveal age-related changes in the discs and bones, not all of which will be associated with symptoms. Imaging is not always needed for back pain – see your doctor to determine if imaging can help get you on the path to your best possible health!

(Image credit: Lumbar vertebrae anterior by Anatomography via Wikimedia Commons Copyright Creative CommonsAttribution-Share Alike 2.1 Japan)

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!

 

May 6, 2014

Oh! The Pain in my Back!

Low back pain by Harrygouvas via Wikimedia Commons Copyright Creative Commons Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0)Lower back pain is common. In fact, in the US it is a leading reason for a trip to see the doctor. There are many causes for back pain – some of them related to the spine and its components and others related to adjacent structures. Things like kidney stones and diverticulitis can present with back pain. There are also times when the source of back pain is never fully found.

 

When should you see your doctor and when is imaging for back pain appropriate?

 

The good thing about back pain is that the natural course for most is improvement of symptoms by around 4 weeks – whether you have specific treatment or not. If you have severe back pain, if it is associated with other symptoms like pain or nerve changes in one of your legs (numbness, burning sensation or tingling) or if symptoms are not improving, a visit to the doctor is in order.

 

There are published guidelines helping your healthcare provider decide if you will benefit from imaging of the spine. A careful history and physical are key.

 

Why not image everyone with back pain? Imaging the spine in the majority of us will show abnormalities – our discs (those cartilage cushions between the vertebral bodies) will begin to show changes as we get older. This is a natural age-related process related to being upright – the discs are only good for so many miles! The problem with imaging for back pain is we will often see abnormalities of the discs – some can even be large and impressive – but they do not always correlate with your symptoms. Imaging can lead to confusion and over-treatment, and for uncomplicated back pain will likely not affect how your back pain is managed.

 

When will imaging for back pain help most? Imaging is recommended for immediate evaluation of some patients with back pain with history or signs that might indicate a serious problem requiring immediate intervention. These include patients with history or signs that might make cancer (a RARE cause of back pain) more likely – things like a known cancer elsewhere in the body or significant weight loss. Signs that there might be an infection are important. Any symptoms that suggest there might be involvement of the nerves to the lower body may also warrant immediate imaging.

 

Imaging after a trial of physical therapy (usually after a 6 week period) may be indicated in patients who fail to show improvement or have worsening of symptoms. Imaging may also be performed if symptoms persist in patients with history of osteoporosis and concern for new fractures.

 

How do we image and which test do we pick? Those will be explored in our next post on back pain!

 

So, if you have low back pain remember that in the vast majority of patients, symptoms will get better – although it may take a few weeks. A visit to your doctor will help determine if imaging is needed and will help in the management of your pain.

Image Credit: Low back pain by Harrygouvas via Wikimedia Commons Copyright Creative CommonsAttribution-ShareAlike 3.0 Unported (CC BY-SA 3.0).

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!

May 1, 2014

Lung Cancer Screening and (New) Recommendations

smoking kills by André Hengst via Flickr Copyright Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)When it comes to cancer, lung cancer leads the list of the most deadly for men and women in the US. Fighting this disease has been an uphill battle, impeded by the fact that most patients are not diagnosed until late in their disease. Having an effective screening test to identify lung cancer when it is small and treatable has been a goal for years – the development of low-dose CT chest for the screening for lung cancer has brought hope.

 

We are therefore profoundly disappointed that the Centers for Medicare & Medicaid Services (CMS)’s Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) did not vote to recommend Medicare coverage of low-dose CT screening. Their primary concern is not that is does not find cancer, but that it will find too many things that are not cancer.

 

We disagree with the CMS, as do other (more important!) groups in the US. The United States Preventative Services Task Force (their statement can be found here) recently recommended coverage. This is critical, as those preventive services deemed appropriate by the Task Force are mandated to be covered under the Affordable Care Act. What does that mean? A double standard – those with health insurance will be covered, those with Medicare will not if the CMS acts on the recommendations of their advisory committee.

 

One of the (many!) advocates of low-dose CT screening is the American College of Radiology (their statement can be found here). The ACR supports the use of screening CT chests in those patients at the highest risk – in other words, heavy smokers or heavy former smokers. The National Lung Screening Trial found that there was a 20% reduction in deaths for heavy smokers due to screening (the trial report can be found here). That’s no small number. The ACR is working on developing uniform guidelines to help with interpretation and to reduce the number of false findings – those that seemed to concern the Advisory Committee.

 

Luckily, the CMS is not bound by the recommendations of MEDCAC and action based on the recommendation isn’t expected until late fall of this year. We hope that reevaluation of the data occurs between now and then, so that Medicare patients are covered.

 

If you’d like to know more about lung cancer and what you can do about it, we recommend checking out Free to Breathe. Eliminating the use of tobacco is a larger goal which will more profoundly affect lung cancer in the US – if you smoke, get help to stop.

Imagine attribution: smoking kills by André Hengst via Flickr Copyright Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)

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!