Posts tagged ‘New’

December 31, 2014

Wishing you a safe and happy new year!

DIC blog new years eve

August 22, 2014

Head Aches and Head Issues #4: Head MRI – What To Expect

MRI of headIf you are experiencing headaches and your evaluation by your doctor suggests the need for imaging, you may be sent for either an MRI or CT scan. CTs are quick and valuable in the evaluation of patients presenting with headaches after trauma. MRI is an alternative means of imaging the brain and adjacent tissues.

CT vs. MRI

The main differences in the two technologies are as follows. The decision as to which test is needed is based on your history and findings, as well as the following:

 

CT:

  • uses ionizing radiation (avoided in pregnancy unless there are significant findings or significant trauma) in conjunction with computers to generate images
  • takes 10 minutes or less
  • may or may not use IV iodinated contrast material
  • great in looking for blood in and around the brain, which can be traumatic or non-traumatic in origin
  • uses a short bored tube

 

MRI:

  • uses magnets and radiofrequency waves in conjunction with computers to generate images – no radiation
  • can be used in pregnancy after the first trimester and without IV contrast material
  • may or may not use IV gadolinium contrast material
  • takes 30 minutes or more
  • uses a long bore tube (can seem confining although there are ways of treating this sensation!)
  • shows anatomy in greater detail than CT
  • some pathologies such as multiple sclerosis are best visualized on MRI
  • must hold still for longer time periods – may be difficult for younger children

 

 

What To Expect

Before an MRI of the head, no special preparation is necessary. However, metal is a big issue (seriously, the machine is one giant magnet and any metal on your body can become a hazardous missile with potential for harm to you, the technologist or the machine). So – extreme care is used to ensure that you have no metal on your body. Also, metals in things like artificial joints and pacemakers can create problems so full disclosure is needed.

The procedure takes approximately 30 minutes with only the head moving through the machine.

Holding still during the imaging is key to getting good pictures. Images are taken without contrast to begin with and then if needed (and patient is not pregnant) additional series may be run after an IV injection of a contrast material containing the heavy metal gadolinium. This should be used in caution in certain patients with kidney problems, so we always obtain a full history prior to giving this, and may check your kidney function before giving it. The injection may cause a cooling sensation.

What Happens Next

After your exam is completed, the images are studied by your radiologist for interpretation and reporting. The results are then shared with your referring doctor to integrate the new information gained from your head MRI with clinical symptoms for a specific diagnosis. After the test, we recommend drinking extra fluids to help flush the contrast from your system if it was used.

On Your Way!

Headaches can be a vexing issue, and getting you on the road to being headache-free is the goal of the medical team, including the radiologist carefully analyzing those images. As ever, we hope to help to get you on the road to your best possible 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!

 

August 21, 2014

Head Aches, Head Issues #3: CT Scan of the Head

CT scan by NithinRao via Wikimedia Commons Copyright Public DomainSo if you’ve had a good wallop to the head (or it just feels like you have) your doctor may direct you to a head CT.

 

Like all CTs, a modifiable dose of radiation is used to image the body in “slices” which are then reconstructed into images. Use of radiation in pregnancy should be reserved for special cases, so let the technologists know if you are or could be pregnant.

 

What To Expect

 

Before a CT of the head, no special preparation is necessary. However, metal interferes with the images, so jewelry, hairpins and the like will need to be removed from the region of the head.

 

The procedure takes approximately ten minutes with only the head moving through the machine. Persons with claustrophobia typically do well with CT because the exam is fast and the machine itself is not too confining. Holding still is important – as with all images, motion causes blurring.

 

CT of the head is often performed without contrast. For cases following trauma or in an evaluation for headache a non-contrast examination may be sufficient.  There are times when IV contrast injection is necessary. This additional part of the study can be very helpful to evaluate the blood vessels in the head and for assessment of the brain tissues and its enhancement. The iodinated contrast material will be given thru an IV which may cause a feeling of warmth. Images are then taken in the same manner as the initial non-contrast series.

 

What Happens Next

 

After your exam is completed, the images are studied by your radiologist for interpretation and reporting. The results are then shared with your referring doctor to integrate the new information gained from your head CT with clinical symptoms for a specific diagnosis.

 

On Your Way!

 

That’s it! A CT head is a quick, simple procedure which can be invaluable in looking at your brain and surrounding tissues. It can help get you on your way to being headache- and anxiety – free!

 

 

(Image credit: CT scan by NithinRao 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 19, 2014

Headaches and Head Issues #2: Looking Inside Your Head

800px-Brain_MRISo… there will be times when a headache prompts further evaluation. Imaging can be used to study the brain and its surrounding tissues. CT and MRI are both common imaging techniques for evaluating the brain and adjacent tissues when imaging for headaches is indicated.

 

For sudden onset headache, thunderclap headache, and headache following trauma in the past 48 hours, we often start with CT of the head.

 

CT Scans

The initial CT imaging is done without contrast; images are obtained through the skull while the patient lies still. This takes only a few minutes.

 

From this we can see hemorrhages in and around the brain – one of the serious causes for headaches that can be seen from both traumatic and non-traumatic causes.

 

Occasionally, the noncontrast study will be followed by postcontrast imaging after an IV injection of iodine-containing contrast – this highlights the vessels and demonstrates abnormal enhancement in the brain, such as masses.

 

CT uses radiation to make its images – therefore, use in pregnant patients will generally be reserved for special indications and circumstances.

 

MRI Scans

If there are any neurologic changes associated with your headaches (things like numbness, loss of strength or confusion) imaging with MRI may be requested. An MRI shows the internal structure of the brain in great detail. Masses and areas of abnormality from things such as strokes and multiple sclerosis are well shown with this modality. Because the procedure takes about 30 minutes to fully image the head, it does require the ability to lay on your back for a length of time. Images can be obtained both without and with IV contrast containing gadolinium, often times with both. Gadolinium contrast helps us look at vascular structure and for abnormal enhancement.

 

MRI can be used in some instances during pregnancy, but only after the first trimester is complete. No IV contrast is used for MRI in pregnancy.

 

Patients with pacemakers and other implanted surgical devices may not be able to undergo MR imaging. Let your doctor know of all surgeries and procedures prior to scheduling your MRI.

 

These exams can shed amazing light on the brain and its functions (or malfunctions). While we always work to image wisely, we can also image exquisitely. From the finest of endings to the largest of masses, we are able to have a noninvasive peak inside the inner workings of the brain. Through this we are able to get our patients on the road to their best possible health!

 

 

(Image credit: Brain fMRI 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 13, 2014

Headaches and Head Issues #1: When NOT To Image

headache by Pierre Willemin via Flickr Copyright Creative Commons Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)Headaches are a common complaint and come in different forms. Most headaches, though they may not feel like “nothing” at the time, are often simple and solvable problems.

 

As radiologists we have a special role when it comes to headaches. Ready for this? Most times patients with headaches need not visit their friendly radiologists. The brain (and even the musculature around it) is a complex and honestly beautiful thing. We are advocates of imaging carefully – and there are times when that means no imaging at all.

 

The crux is this: it can be hard to know when a headache should prompt medical evaluation. Rules have been developed helping medical professionals determine when imaging will be most beneficial. if a headache has other symptoms associated with it (such as nausea or vomiting) or is new, significantly worse or comes on suddenly, medical evaluation is warranted and imaging may be needed.

 

According to a recent article published in the Journal of the American College of Radiology:

 

“Most patients presenting with uncomplicated, nontraumatic, primary headache do not require imaging. When history, physical, or neurologic examination elicits “red flags” or critical features of the headache, then further investigation with imaging may be warranted to exclude a secondary cause.”

 

What are the “red flags” that mean imaging may be necessary?

 

 

  • history of head trauma;
  • new, worse, or abrupt onset headache;
  • thunderclap headache;
  • headache with pain radiating to the neck;
  • one sided headache with facial pain;
  • persistent and positional headaches;
  • headache centered at side of head (temple) in older individuals.

 

 

It’s important to not ignore intuition. If something about your headache is unusual, or the circumstances predicating it are new, it is definitely worth seeing your doctor. However, if s/he doesn’t opt for imaging in the initial stages, that may be perfectly okay too. We love seeing our patients on the road to their best possible health!

 

 

(Image credit: headache by Pierre Willemin via Flickr Copyright Creative Commons Attribution-NoDerivs 2.0 Generic (CC BY-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 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!

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 18, 2014

Smoking kills – Seriously, In More Ways Than One!

Smoking Kills by Vanderloot ∴ via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

Smoking Kills by Vanderloot ∴ via Flickr Copyright Creative Commons Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

We typically don’t go for sensationalized article titles (there’s plenty of that out there without having to drum up extra) but the recent word from the Surgeon General’s office is serious.

USA Today quoted Thomas Frieden, director of the CDC as saying, “Amazingly, smoking is even worse than we knew – even after 50 years we’re still finding new ways that smoking maims and kills people.”

In this year, the fiftieth anniversary of the Surgeon General’s office calling tobacco what it is – a killer, the report (which can be found here) enumerates the sins of the smoke. Most people know that tobacco contains known carcinogens, and is related to lung and other head and neck cancers. The damage of smoking to the lungs is widely known and acknowledged. The acceleration of vascular disease and the association between smoking and cardiovascular disease is well-studied and widely known.

The more widespread effects of tobacco are less well known, and new associations are increasingly being recognized. The surgeon general in this report concluded that smoking is causally-linked – many smoking can directly cause -diabetes, liver and colorectal cancers. These are fairly recent additions to the list of diseases and damage from smoking.

The body – from the top of your head to the bottom of your toes and all parts between – is harmed by tobacco and smoking. Did you know smoking is related to macular degeneration (a leading cause of blindness), erectile dysfunction, rheumatoid arthritis, growth problems in fetuses whose mothers smoke as well as cleft lips and palates? Amazing that after 50 years scientists are still uncovering more ways tobacco damages the body.

This is not intended as a public shaming campaign for smokers, but a call to health for all. We need to work together to educate and keep others from starting on the path to addiction and help those who are addicted. We know it’s not easy. Some resources for quitting can be found here.

May 23, 2013

CT: A Better Way to Scan for Lung Cancer

In an article published by the New England Journal of Medicine on May 22nd, the National Lung Screening Trial had good news to report: Through the use of low-dose computed tomography, doctors were able to recognize lung cancer earlier and more often than through traditional chest x-ray.

The initial phases of the study, published in 2011, showed a 20% reduction in mortality among patients diagnosed with lung cancer. This is credited to the fact that twice as many early stage cancers were discovered using low-dose computed tomography (LDCT) than chest x-ray (CXR).

This most recent finding of the study specifically shows that LDCT discovers lung cancers more often than CXR. This is very good news for those at high risk for lung cancer – earlier and improved detection means expediting the process of healing and hopefully recovery.

The American Association for Thoracic Surgery recommends annual LDCT for specific high-risk groups, specifically North Americans meeting any of the following:

  • aged 55 to 79 years old with a history of 30 pack-years* of smoking

  • long-term lung cancer survivors up through the age of 79

  • those with a 20 pack-year history, starting at age 50 if there is an “additional cumulative risk of developing cancer of 5% or greater over the following 5 years.”

Doctor’s note: Please don’t smoke. Avoiding cancer is even better than discovering it early.

648px-X-ray_chest_cancer

Source: X-ray(Chest)Cancer.jpg: unknown
derivative work: Anassagora (talk)
Copyright: Public Domain

*A “pack-year” number is derived from multiplying the number of packs smoked per day times the number of years smoked – so 30 pack years could be smoking 1 pack a day for 30 years, or 2 packs a day for 15 years.