Posts tagged ‘contrast’

October 29, 2014

Donuts, Bagels, Claustrophobia and MRIs

1024px-Plain-BagelFor people with severe claustrophobia, MRIs can be intimidating. Even people who are only mildly claustrophobic may find MRI exams stressful – but they don’t have to!

 

The best imaging technologists and radiologists will always work with patients to provide feelings of safety and comfort during MRI procedures.

 

The first step in managing stress and claustrophobia comes in arming yourself with information. Information on how long the exam will take and how you will be positioned in the magnet can help prepare you.

 

Here are a few tips and tricks for the time you may find yourself in a donut-shaped machine:

 

  1. For many with mild claustrophobia, two things will help the most: covering your eyes and practicing visualization exercises. While this may sound “new age”, these sorts of mental exercises have been shown to get people through their MRIs. The best thing is to concentrate on breathing and on visualizing in your mind a calm, open space – one you find restful. Get that picture in your mind – a beach, a meadow, a mountain slope – someplace wide open. Get the smells and sounds in your mind as well. Keep coming back to it – it will work! This in conjunction with talking with the technologist throughout the study will get you through the test in no time.
  2. Because MRIs are loud, ear protection is provided. Some clinics offer music as well, which can be calming.
  3. If the above isn’t working, consider asking for a procedure done on an open bore magnet – the latest in technology is a more open cylinder design, still with a high field strength magnet (our Olathe clinic has such a machine!). True open MRI units may be an option as well, but those may be lower strength magnets and imaging times can be longer!
  4. If claustrophobia is still an issue, you may need to seek some help from your doctor or the radiologist. Some doctors who refer patients with claustrophobia for an MRI will write for a prescription for an anti-anxiety medication, like valium, to be taken prior to imaging. At some facilities, your radiologist will be able to provide medication, often Xanax, but make sure this is discussed with the facility beforehand as it may mean changes in how your prepare for the study, and it will require you to have someone available to drive you – no machine operating after these types of anti-anxiety meds!

 

Armed with this knowledge and the help of caring technologists and staff, you can survive the MRI experience. And with medical imaging comes the ability to diagnose and get you on the road to your best possible health!

Plain Bagel by Evan-Amos (Own work) [Public domain], via Wikimedia Commons

 

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!

 

October 9, 2014

MRI: Not If You’re the Tin Man

Tin Woodman by William Wallace Denslow via Wikimedia Commons Copyright Public DomainWhat are the risks of an MRI?

The main risks of MRI come from the fact that the machine is made up of a giant magnet – which is never turned off.

 

Safety for MRI studies relies on removing any metal on your body and fully understanding the impact of any metal within your body. Many types of metal implants, like joint replacements, are not a problem and patients with them can safely undergo MRI.

 

Some battery operated implants, like most pacemakers and many neurostimulators, can be adversely affected when exposed to the magnet. The safety of any implanted surgical device or metal should be thoroughly discussed before the exam – preferably at the time of scheduling.

 

On the day of the procedure, removing all metal (all hairpins included!) prior to entering the MRI suite is important for the safety of you, the technologist and the machine. No metal in clothing, no metal in pockets, no watches or phones!

 

The other main risk of MRI comes from those studies that require the injection of IV contrast. This allows us to evaluate blood vessels and the vascularity of organs and masses. This contrast contains gadolinium which is a heavy metal. Allergies or reactions can occur, although rarely. Gadolinium contrast materials should be used with caution in those at risk for kidney disease. You will be screened for the possibility of kidney disease, and your kidney function may be evaluated with a simple blood test before we give you the contrast if you have risk factors.

 

MRI is an amazing technology but requires strict safety precautions for everyone. We’ll be writing more about MRIs and the claustrophobic patient in our next post – stay tuned!

(Image credit: Tin Woodman by William Wallace Denslow via Wikimedia Commons Copyright 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!

 

October 6, 2014

MRI: It’s a Magnet!

Magnet by AJ Cann via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)Radiology can be confusing. How these exams work can confuse the smartest people. As radiologists, we get lots of questions. Which exams use radiation and which do not?  How safe is the exam?

 

Today we will attempt to answer some of your questions and concerns about magnetic resonance imaging or MRI.

 

MRI – how do we make images?

MRI or magnetic resonance imaging, is one way of viewing the body that uses NO radiation (a plus!). We can create amazing images of all parts of the body with… a magnet! MRI machines are loud, clunky-sounding machines made up of a giant magnet. The noise comes from the second part of the name – resonance, or radiofrequency waves. This combined with computers creates images of the body. And, oh, the things we can learn about you with this technology.

 

The MRI Experience

Having an MRI involves being positioned on a table and moved inside the MRI unit. The inside of the MRI is called the bore and is basically a long tube the size of which varies. We center the body part being evaluated within the bore.  Bore sizes and configurations vary depending on the magnet strength and configuration of the MRI unit.

 

“Open MRI” units have a more open environment for imaging.  They are often used for the claustrophobic patient or larger patients.  The open MRI units can have limitations of longer exam times and lower quality of images. This is because the signal created and used to make the images is directly related to the magnet strength – which is lower for some open magnets.

 

High field magnets or traditional MRI trump an open magnet when we want imaging speed and precision, so it’s highly encouraged when at all possible. It can be done! There are many ways we can help our patients be comfortable while getting the highest possible quality images.

 

Over the next few days we’ll talk more about MRI safety as well as limiting patient discomfort in the machine.

 

In the mean time, cheers to your best possible health!

(Image credit: Magnet by AJ Cann via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 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!

 

September 26, 2014

Save a Man’s Heart!

Obesity-waist circumference by Victovoi via Wikimedia Commons Copyright Public DomainHaving seen enough episodes of Grey’s Anatomy (or ER or any of a dozen other TV shows about medical practitioners) you may well know the amount of work a doctor can put in to save a man’s heart. OK, that is television and not real life.  As doctors, we love to save lives! We prefer to do it preventatively and proactively.

 

So… what does it take to save a man’s heart? It is easy; exercise, limited alcohol consumption, no cigarettes and a healthy BMI are the keys. The more items a man follows from this list, the better protection for the heart.

 

Here’s what blew our collective mind:

 

80% = the number of heart attacks in men that are preventable with a healthy lifestyle. Eighty!

36% = the risk reduction of heart attack by not smoking

12% = the risk reduction of heart attack by keep a waist measurement below 37”

3% = the risk reduction of heart attack by exercising on a regular basis

 

These numbers come from a recent study in The Journal of the American College of Cardiology. And also from the land of amazingly great news.

 

Get yourself or your man on the road to your best possible health by engaging in a healthier lifestyle and make those numbers work in your favor!

 

 

(Image credit: Obesity-waist circumference by Victovoi via Wikimedia Commons Copyright 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!

 

August 4, 2014

We Love… Get Your Rear In Gear!

Katie Couric VF 2012 Shankbone 2 by via david_shankbone Flickr Copright Creative Commons Attribution 2.0 Generic (CC BY 2.0)To end this series on GI imaging, we thought we’d shine a light of hope and health by talking about an organization we love… Colon Cancer Coalition!

 

This is an amazing group of people dedicated to the knowledge that early detection of colon cancer saves lives! Their mission?

 

“Empower local communities to promote prevention and early detection of colon cancer and to provide support to those affected.”

 

Katie Couric, through her own personal loss and resilience, has helped make colorectal cancer a nationally known and talked about  issue (and for this we are grateful). The Colon Cancer Coalition reminds us to Get Your Rear In Gear! This program in cities across the US funnels money back into the participating cities, supporting local education and screening efforts. Check for events in your community here.

 

Early detection is the key to saving lives from colon cancer which is a largely preventable disease – in most cases, colon cancer starts from small growths called polyps. If these are found early, no colon cancer will develop! From a healthy diet and exercise to regular check-ups and knowing the signs of colon cancer, we can all make a difference. Regular screening with colonoscopy at age 50 for folks of average risk can and will make a difference.

 

Catch up with the Coalition on Twitter. (We follow them too.)

 

Time to celebrate life – and kick cancer’s butt!

 

 

(Image credit: Katie Couric VF 2012 Shankbone 2 by david_shankbone 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!

 

July 30, 2014

MR Enterography

MR enterographyWhen investigating issues of the abdomen and intestines, there are multiple options, including small bowel series, small bowel enteroclysis and CT or MR enterography (entero- meaning intestine, our linguistic lesson for the day!).

 

Why would you need MR enterography?

 

MR enterography is performed for many of the same reasons as CT enterography. As with each imaging modality, there are nuances and benefits from the different techniques.

 

One of the reasons a patient may come in for MR enterography is due to an iodine allergy (iodine is the IV contrast agent for CT). MR technology uses a different IV contrast agent, one containing gadolinium.

 

Additionally, MR technology uses no radiation. This can be beneficial when the patient is pregnant (although only done in pregnancy after the first trimester). It is an ideal means for assessing younger patients with inflammatory bowel disease who may face the need for frequent, repeated imaging of the intestine.

 

How does a patient prepare for MR enterography?

 

Preparation for MR enterography is done similar to the CT version – fasting for up to 4 hours before the examination.

 

What can be expected when you have MR enterography?

 

As always, remember your basic MRI safety – no metal can enter the MR suite – this means all clothing with metal must be removed.

 

MR enterography relies on adequate distention of the small bowel, usually using the same oral contrast agent containing iodine as for CT enterography. Images of the abdomen and pelvis will be obtained while IV contrast containing gadolinium is injected. The imaging time is longer for MRI than for CT, usually close to 30 minutes total for MR. Holding still is important as any motion will cause loss of detail.

 

What can we find with MR enterography?

 

This can show vascular lesions of the wall of the GI tract, masses and mucosal lesions as can be seen with inflammatory bowel disease. It also allows us to see detail in the bowel wall and in the adjacent soft tissues. Fistulas (abnormal communications from bowel loops), strictures and blockages, and abscesses can be seen in patients, often in those with inflammatory bowel disease. Problems with the blood vessels going to the bowel will be shown, such as narrowings or aneurysms.

 

And after the exam?

 

To flush the excess contrast from your system – drink lots of water!

 

MR enterography is one more tool in the arsenal for imaging the small intestines able to produce beautiful images helping us keep you on the path to your best health.

 

 

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!

 

July 23, 2014

CT Ent-enter-entero-enterography! Whew!

Screen Shot 2014-07-23 at 2.52.56 PMWhen investigating issues of the abdomen and intestines, your doctor may order a small bowel series or enteroclysis. However, CT technology is also an excellent noninvasive way of looking at internal organs. It also allows us to better see the tissues adjacent to the small bowel. If a dedicated view of the bowel and adjacent soft tissues is needed there is a special procedure called CT enterography which may be used.

 

Why would you need CT enterography?

 

There are many potential reasons why a patient may come in for CT enterography, with the goal of precisely defining anatomy and potential causes of symptoms. Symptoms can include:

 

  • Abdominal pain (especially in the left or right lower quadrant)
  • Blood in stool
  • Possible bowel obstruction, usually partial blockages of the small bowel which can be difficult to diagnose and difficult to find the cause of
  • Inflammatory bowel disease – with CT enterography we can see not just the disease of the bowel, but any complications in adjacent tissues which are frequent
  • Hernias
  • Masses
  • Narrowings or strictures
  • Infections
  • Masses in the mesentery or adjacent organs that can affect the GI tract

 

How does a patient prepare for CT enterography?

 

Patient prep for this type of imaging is fairly basic: fasting (no food or drink) for 4 hours before the CT may be requested. At times the study may be done without preliminary fasting.

 

What can be expected when you have CT enterography?

 

Typically, CT enterography uses fairly large volumes of oral contrast agents which are iodine-based and iodine-based IV contrast. The oral contrast material helps distend the bowel, so that the wall is well seen. The blood vessels and any inflammatory changes are best seen with the IV contrast highlighting the vessels.  If you have allergies, let us know so we can plan ahead. CT uses radiation, so this exam in general is not done in those that are pregnant or who may be pregnant.

 

What might we see with CT enterography?

  • Inflammatory bowel disease – bowel wall thickening, abnormal enhancement of the wall of the bowel, strictures, fistulas (abnormal communication between bowel loops), adjacent abscesses all may be signs of inflammatory bowel disease and imaging with CT enterography can help assess its degree of activity
  • Masses – benign polyps and cancers
  • Vascular problems to the small or large bowel, including narrowings of vessels or aneurysms (small saccular outpouchings)
  • Blockages – we can not only see the site of obstruction but many times can find the cause of the blockage
  • Infections

 

 

CT enterography is a fusion of the best of CT technology, allowing us to see the soft tissues in the abdomen, and enterography which distends the small bowel, allowing us to best see the wall. With this technique, small bowel diseases are beautifully demonstrated.

 

 

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!

 

July 21, 2014

Intestinally Yours

small bowelIn our continuing series on gastrointestinal imaging, today we’re talking about the small bowel or small intestine. The small intestine is key in absorbing nutrients in our food.

 

Why would you need an imaging study of the small bowel?

 

The small bowel is a coiled tube in the abdomen up to 23 feet in length connecting the stomach and the colon.  In contrast to the stomach and colon which are easy to evaluate by endoscopy, much of the small bowel is beyond the reach of endoscopes.

 

Symptoms which might prompt a small bowel evaluation include:

 

  • diarrhea
  • blood in stools
  • abdominal pain
  • malabsorption
  • suspected partial small bowel obstruction
  • inflammatory bowel disease
  • anemia

 

There are two types of fluoroscopy exams a patient can have to evaluate the small bowel: a small bowel series or a small bowel enteroclysis.

 

How does a patient prepare for small bowel imaging?

 

The prep for these studies is simple: no food or drink by mouth for 4 hours. Clothing with metal will need to be removed. Radiation is used, so these studies are not performed in pregnant women. If you have an allergy or sensitivity to oral barium please advise the radiologist.

 

What can be expected of a small bowel imaging procedure?

 

Both exams will start with a preliminary film which is used to assess the gas in the intestine. Signs of obstruction or bowel perforation may lead to the exam being cancelled or modified.

 

1. Small bowel series

For this procedure, the patient will be given barium to drink. Sufficient barium is necessary in order to fill up the small bowel in order to image it. Next, we will take a series of x-rays to follow the barium through the entire small bowel all the way to the cecum (first part of colon). Additionally, we will take images with gentle compression of the small intestine including the  terminal ileum which is the point at which small bowel ends and joins the colon. Please note it can take up to 4 hours for the contrast to travel all the way through!

2. Small bowel enteroclysis

This procedure uses a tube placed through the mouth or nose until the tip is in the first part of the small bowel. This tube is used to instill a solution of barium at a rate which distends the small intestine and limits normal peristalsis (those normal contractions which move food along). Images are then taken in the same method as above. The entire study can take up to 3-4 hours to complete.

 

So, what are radiologists looking for? What can we expect to find?

 

Images from either method will allow a beautiful depiction of your small bowel anatomy and a little about how it is functioning. Imaging can find:

  • tumors – benign polyps and cancers
  • inflammatory bowel disease IBD (inflammatory bowel disease)
  • infections
  • strictures or narrowings which might partially block small bowel – frequent in patients with IBD
  • fistulas or abnormal communication between bowel loops – frequently found in patients with IBD
  • celiac disease

 

After a small bowel exam, drink lots of fluids! This will help flush out the contrast that was introduced for the exam.

 

The small bowel series and small bowel enteroclysis are methods of viewing the elusive small intestine. The resulting images can be phenomenal. We love being able to see into the human body to get you on the road 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!

 

July 18, 2014

Imaging of the Lower GI

Barium and Air lower GIYou would probably not consider a barium enema an exam to add to your bucket list, but this imaging study of the colon has the potential to save lives and diagnose many different conditions of the large intestine. While not the most pleasant test we perform, it does create beautiful (ok – we think they’re beautiful!) images of the colon, allowing us to find problems and prevent future ones.

 

So, why would you need an imaging study of the lower gastrointestinal (lower GI) tract?

 

A barium enema shows the anatomy of the large intestine or colon. Colonoscopy allows direct visualization of the mucosal lining and the inside of your colon through a long endoscope, and is often the first study performed for evaluation of the colon. Barium enema is an alternative means of imaging the colon that is less invasive, but not as sensitive at finding some things (especially smaller polyps). Your doctor may recommend lower GI imaging if you have the following symptoms:

 

  • blood in stools
  • change in bowel habits
  • constipation
  • excessive or chronic diarrhea
  • inexplicable weight loss
  • irritable bowel syndrome (IBS)
  • pain in the abdominal region
  • to screen for colon cancer – colonoscopy or CT colonography are often the studies of choice; if colonoscopy cannot reach all of the colon, barium enema may be used to screen the part of the colon not seen; screening for colon cancer is important as most colon cancers start as small growths called polyps – if such polyps are removed, no cancer will develop!

 

How do you prepare for lower GI imaging? What’s to expect?

 

Tests of the lower GI are performed… carefully. In order to find masses or abnormalities of the mucosal lining, the colon must be completely empty. A preliminary prep to accomplish this is necessary for most studies. It will require fasting for a time period, around 24 hours. The prep will include a combination of laxatives and enemas with the goal that all particulate matter is eliminated from your system by the morning of the test. Any medications necessary should be taken with a small amount of water.

 

We occasionally do the study on children. Special preparations may or may not be necessary depending on the age of the child and the conditions being evaluated.

 

The test involves radiation, so will not be used on pregnant women or those who might be pregnant. Let your radiologist know if you have an allergy to latex.

 

We will start the procedure with a preliminary x-ray or film of your abdomen. This allows the radiologist to make sure the prep has worked and the colon is empty. It also allows us to assess for signs the test should not be done, such as when there is a possible obstruction or bowel perforation. The exam involves placing a catheter into the rectum, where a small balloon is inflated. Barium is introduced through the catheter into the rectum by gravity. Room air is then introduced. We use fluoroscopy to get the right amount of barium and air into and coating the colon. This will involve changing your position on the table (lots of rolling!) and changing the table position. Once the colon mucosa is coated with barium and distended with air, a series of x-rays in dedicated positions will be taken so that all parts of your colon will be seen.

 

It will help you tolerate the study if you concentrate on breathing – this actually relaxes the muscles in the wall of the colon, lessening any cramping you may experience.

What do we look for when imaging the lower intestinal tract?

 

We can find a wealth of information from the health of the mucosal lining to blockages. We will assess for normal anatomy and look for signs that all of your colon, from the rectum to the cecum,  is seen. We can evaluate for:

 

  • tumors – both benign polyps and cancers
  • diverticular disease – diverticula are saccular outpouchings from the colon wall which can become inflamed
  • inflammation as can be seen in inflammatory bowel disease or colitis
  • strictures or narrowings
  • blockages in children, as from Hirschsprung’s disease or from intussusception, which can also be treated and reduced with a barium enema

 

What happens after a lower GI exam?

Your radiologist will review all of the films. Once all areas of the colon have been well-seen, the catheter will be removed and you will be allowed to the restroom. Images after using the restroom may or may not be needed.

 

Your radiologist will evaluate all of your images and the final report will be sent to your referring physician.

 

Be sure to drink plenty of water following the procedure. This is needed to flush the remaining contrast agents from you system. You can resume your normal diet immediately.

 

The well-being of your gastrointestinal system is important, and the barium enema is an imaging tool which can provide valuable information, keeping you on the road 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!

July 16, 2014

Upper GI Pain and Imaging

UGI imagingEver wondered what happens when you swallow or what your stomach looks like? Upper GI (gastrointestinal) and esophagrams are tests used to assess  the first part of the gastrointestinal system and can be used to answer these questions and much more.

 

Why would you need one of these tests?

These exams may be used for a variety of symptoms including but not limited to:

  • Abdominal pain
  • Epigastric pain
  • Heartburn or other symptoms of reflux disease including chest pain or discomfort, a burning sensation, or excessive burping; more unusual symptoms of reflux can include sinusitis, anosmia (loss of smell), aspiration, and chronic cough.
  • Trouble swallowing
  • Choking
  • Vomiting
  • Blood in stools
  • Ulcers

 

Prior to the study:

It is very important that a patient coming in for an upper GI imaging procedure not eat or drink anything after midnight the day before the exam. In order to look at the structures and anatomy, the stomach and esophagus must be empty. Even a small amount of water can keep the contrast material from coating and sticking to the lining of the structures which would limit what the radiologist can see. Due to radiation exposure UGI imaging is not used in women who are or may be pregnant.

 

It is okay to eat and drink before an esophagram.

 

You will change into a gown, removing all clothing that has metal. We don’t want metal buttons, zippers or underwires hiding any of your lovely GI structures!

How are the tests done?

For an UGI we start with a preliminary x-ray or image of the abdomen- this makes sure there is no blockage before we begin the test. In order to optimally see your GI tract on x-ray using fluoroscopy, we have to give you a contrast material by mouth. General GI imaging can be done with contrast material such as barium and crystals of gas – the barium lines the esophagus (the connection from the mouth to the stomach) and the stomach; the crystals create gas which expands the organs, allowing radiologists to beautifully see the mucosal lining.

 

The contrast travels thru the pharynx, esophagus, stomach and duodenum; observing real-time with fluoroscopy allows us to see function as well as anatomy.

 

Images are obtained of all parts of the upper GI tract, usually starting with you positioned upright and then horizontal. fluoroscopy allows a real time look at what is happening.  X-ray images are also recorded for better detail.

 

For an esophagram, we focus on the pharynx and esophagus only, using oral contrast agents, gas and sometimes foods like crackers coated with barium paste.

 

What can be found using these tests?

  • masses- anywhere along the upper GI tract; these can be benign like polyps or cancerous;
  • ulcers (gastric or duodenal);
  • hiatal hernia (a condition where the stomach is positioned above the diaphragm predisposing to reflux disease and it’s complications like Barrett’s esophagus which is a pre-cancerous condition; this is one of the reasons to not ignore your reflux symptoms!);
  • reflux -we can see the barium going from the stomach back up into the esophagus- we will try different positions and maneuvers to try to elicit reflux;
  • esophagitis or gastritis-conditions of inflammation from many different causes;
  • congenital abnormalities-sometimes the upper GI tract is not connected normally or there may be congenital cysts or masses along the upper GI tract;
  • motility disorders- most often of the esophagus; imaging real-time allows us to see how your upper GI tract is functioning
  • swallowing disorders

What happens after the test?

The radiologist may be able to discuss some of your results at the end of the test. A final report will be made by your radiologist after reviewing all of the images, with the official report going to your doctor.

 

We will ask that you drink lots of fluids to help flush the barium out of the system! (Besides, drinking water is good for you no matter what!). You can resume your normal diet immediately.

 

Upper GI exams can result in amazing images and can be a key to diagnosis of a wide variety of conditions. Seeing your body in action helps us keep you on the road 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!