Posts tagged ‘CAT’

June 2, 2014

Introducing… Overland Park Open MR/CT!

OPEN MR CTWe’re pretty sure by now that it’s clear we at Diagnostic Imaging Centers love caring for people. The third part of our Overland Park clinic (just across the parking lot from the Women’s Center and general radiology clinic building) is lovingly called “the little building”.  At this office we perform CT, MRI and Open MRI exams.

 

Who are we seeing at this office?

 

Ever see a linebacker with an ACL tear? We have. Ever try to put someone that size through a traditional MRI machine? To be honest, it’s a tight fit. We have a solution!

 

Know anyone with extreme claustrophobia? From time to time, we have patients who suffer from that. Sometimes MRI machines can be (a little) intimidating to those who don’t like tight spaces. It’s ok. We have a solution!

 

We are equipped with specialized technology like our open MRI machine. While the typical MRI machine looks like a donut with a table running through it, the open MRI looks more like a round table with a round disc suspended above. Instead of being open only on the ends (as with the donut), it is also open on the sides. This is great for fitting those who feel too constricted by typical MRI units or those who have trouble fitting in the standard machine.

 

Now, there is a trade off to these open MRI exams – they take a slightly longer to perform and get a slightly lower clarity because the magnet creating the signal is much smaller. This is why we steer people to the traditional machines first, and even offer oral sedation to the nervous. However, when the situation calls for a larger/more open machine, we’ve got it!

 

This center also has CT imaging available that uses low dose technology, keeping patient safety first. We have a bariatric table that allows for larger patients to be imaged safely and quickly.

 

Our high field MRI unit is state of the art.  It uses fast gradients and techniques to perform  all exams of the highest quality from MRI cardiac imaging to brain studies to injuries. If an MRI is what you need, we have got you imaged.

 

Not only does our MRI/Open MRI/CT facility treat those with special concerns with state of the art technology, we have a dedicated staff of technologists who are there to put our patients at ease. From the front desk to the exit door, we’re with you all the way.

 

A friendly conversation to take the edge off? We’ll talk about anything from mystery novels to being animal-lovers. We believe in treating patients and people and in that, we aren’t just techs and doctors but – wait for it – actual people too! We truly believe that the best way to help you is by being genuinely caring – it’s something we look for in hiring. We seek out the best and get the best: not just employees, but people.

 

So should circumstances call for it, we’ve got you covered – from larger machines to the kindest people around!

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 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 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 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!

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!

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 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.

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.