Posts tagged ‘smoking’

June 13, 2014

Vascular Series Part 3 – MRA

MRAAs part of our continuing series on vascular health and imaging, we’d like to talk about another way of seeing into your body and imaging blood vessels: MR angiography, or magnetic resonance angiography.


MR angiography is different than CT angiography in that it uses MRI or magnetic resonance imaging with no radiation. This is a benefit of MR angiography.  MR angiography may or may not require use of an IV injection. When needed, MR angiography uses a different type of contrast material for injection – gadolinium-based instead of iodine-based. This is particularly helpful for people with iodine-contrast allergies or poor kidney function.


MR angiography can be used to image the blood vessels and blood flow. The procedure can produce some truly beautiful pictures of blood vessels (the physics behind creating those images is fascinating – and complex!). The vessel walls and adjacent tissues can be seen, as opposed to traditional angiography which shows only the vessel lumen or the inside of the vessel. CTA is the best tool for showing the walls of the vessels themselves.


So, what do we use MRA for?


We can use it to evaluate almost any artery or vein in the body. For example, MR angiography of the head (usually done without contrast) is helpful when looking for aneurysms (saclike outpouchings arising from blood vessels which can be deadly or disabling if they bleed) or areas of artery narrowing. To evaluate the abdominal aorta, we can look for aneurysms (abnormal dilatation) or dissection (when there is a tear in the vessel creating two channels). We may be asked to evaluate the renal arteries for narrowings- renal artery stenosis is one of the treatable causes of high blood pressure.  MR angiography can also be used to examine the leg arteries when needing to evaluate for causes of pain when walking.

As we have discussed, there are lots of ways of imaging the blood vessels. Often, ultrasound with Doppler is used first to see if there is a need for further investigation. CT angiography or MR angiography can further define the vessels and identify problems that may need to be addressed either surgically or with interventional radiology procedures (angioplasty, stenting). Traditional catheter angiography is often reserved for those cases that will benefit from vascular intervention.

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


June 11, 2014

Vascular Series Part 2 – What Is CT Angiography (CTA)?

CTACT angiography, or computed tomography angiography, (now you see why we like to call it CT angiography- such a mouthful!) is a way of imaging the blood vessels and surrounding tissues.


Why would we do that? CT angiography is a noninvasive way to exquisitely evaluate blood vessels within the body. With a simple venous injection of contrast we can quickly and elaborately evaluate the artery, the wall of the artery and the surrounding tissues.  Let’s look at an example. Say we need to evaluate patients with suspected narrowing in the neck arteries – CT angiography may follow an abnormal carotid Doppler to confirm how narrow the vessel is and to see if surgery will be necessary. It will show calcifications and noncalcified plaques and show how they affect the lumen (inside of the vessel) of the artery. This test is helpful in planning any necessary surgeries.


CT angiography can also be used to look at the arteries in the head for patients with strokes from bleeds. Aneurysms  (focal outpouchings) and their relation to the vessel are well seen and this procedure can help plan interventions needed to address them.


So now we know why we need to perform CT angiography, it begs the question, why is this modality of imaging the best choice for a situation? In the past, catheter angiography was the traditional way of imaging blood vessels of all types. However, it involves  putting a catheter through the skin into vessels, usually with an approach through the groin or in the arm. This creates beautiful images of the insides of the vessels, but is associated with some risks related to the catheter and the arterial puncture.


CT allows us to get exquisite images of the vessels with an injection into a vein in a less risky fashion while also allowing us to see the blood vessel wall – not just the lumen as is seen in traditional angiography. CT angiography can be used to evaluate blood vessels from the head to the toes and most parts in between.

In some cases, CT angiography has replaced or nearly replaced the need for catheter angiography (CT angiography chest to evaluate for pulmonary emboli or blood clots in the vessels in the lungs is one example). Other times, CT angiography will identify those patients that will benefit from catheter angiography – often this is used when interventions like angioplasty (ballooning narrowed areas in the arteries) or stenting (putting in metal or mesh stents to open up narrowings) are needed.


All told, CT angiography may be a lot of syllables but it can save a lot of lives.

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


June 6, 2014

Vascular Series Part 1 – Carotid Doppler Screening

Carotid ultrasound by National Heart Lung and Blood Insitute (NIH) via Wikimedia Commons Copyright Public DomainEveryone’s heard of cardiovascular disease, which is the leading killer of men and women in our country, but for many the term brings to mind only heart disease.


Being heart-health focused is great! But having healthy arteries is also critical to health and longevity. There are 795,000 US citizens affected by stroke each year. Strokes can be caused by blockage of blood flow in the vessels leading to or in the brain or bleeding from vessels in the brain.


Both cause death of cells in the brain if not treated promptly. Death of neurons can result in significant disabilities or death. Risks for the development of strokes include age, smoking, high cholesterol, diabetes, high blood pressure, family history, as well as heart conditions including atrial fibrillation, inactivity, obesity (just to name a few). One of the best things a person can do to fight this disease is to stay active!


Thickening of the arteries which go to the brain (atherosclerosis) can lead to strokes. Blood flow can become blocked by clot, or plaques lining the arteries can break off and travel to the smaller vessels in the brain causing blockages.


One noninvasive way of looking at these conditions of the carotid arteries in the neck is with Doppler.  This is an ultrasound technique which can show blood flow in vessels. Narrowing of vessels causes an increase in the velocity of flow through them (much the same as increasing the rate of flow through your garden hose by holding your thumb over and narrowing the opening).


Doppler will look at the velocities in the arteries in the neck allowing us to find areas of narrowing. Doppler can estimate the degree of narrowing by looking at the velocities. Ultrasound of the arteries also allows us to see the wall and plaques causing the narrowing.


Carotid Doppler can be indicated to evaluate patients with mini-stroke symptoms or those at high risk for strokes. Sometimes carotid Doppler is indicated in high risk patients who are undergoing surgery for preoperative assessment of stroke risk.


If you’d like to know more about how to stay (or get!) heart and vessel healthy, we recommend the American Heart Association’s website.

(Image credit: Carotid ultrasound by National Heart Lung and Blood Institute (NIH) via Wikimedia Commons Copyright Public Domain)

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

February 25, 2014

Task Force Guidelines on Aorta Screening in Smokers

Vincent Willem van Gogh (self portrait) Copyright Public Domain

Vincent Willem van Gogh (self portrait) Copyright Public Domain

This is a call to older male smokers. As a smoker you are at risk for many health issues. While heart and lung conditions are the more commonly known diseases for smokers, vascular diseases are another. Abdominal aortic aneurysm, or “AAA,” is yet another significant health issue that may be seen with higher frequency in smokers. An aneurysm is an abnormal ballooning or dilatation of a blood vessel. In this case, the aneurysm involves the aorta – the main artery carrying blood to the abdomen and lower body. As the aneurysm gets bigger, there is a risk of sudden death from rupture.

Recently the USPSTF, a task force that reviews guidelines and screening studies, came forward with a recommendation with the intention of saving lives. The Task Force has issued a recommendation for ultrasound screening of male smokers over the age of 65 for the presence of an abdominal aortic aneurysm. Further research is needed to determine the usefulness of the screening test both in women who smoke and in older male non-smokers.

Making use of the simple non-invasive technology of ultrasound, one-time screenings for men in the high risk category will help improve survival from complications of abdominal aortic aneurysm. For more on the recommendation, we recommend this resource.

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.

January 9, 2014

Smokers and CT Screenings

Smoking woman Kelsey by Kelsey via Wikimedia Commons Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0)

Smoking woman Kelsey by Kelsey via Wikimedia Commons Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0)

As a follow up to our post in July of this year on the United States Preventive Services Task Force’s (USPSTF or task force for shorter!) draft recommendation with regards to lung cancer and CT screening, the final report has been recently published with full recommendations just in time to start the new year.

While the recommendations for who should undergo what type of screening have not changed since the initially-released draft, putting the full voice of the USPSTF behind it does have an effect. Under new healthcare legislation, Task Force-backed cancer screenings will be covered without co-pays in the relatively near future. This means that those who need screening tests will have greater access to them.

So, who needs to be screened for lung cancer? The task force has specified who fits in the high-risk category for lung cancer.

  • Those who smoke at least a pack a day for 30 years (or its equivalent, such as 2 packs a day for 15 years), are between the ages of 55-80 or have stopped smoking less than 15 years ago fall into the high-risk, should be screened category.

  • Exemptions are made for those who have been smoke-free for 15 years or more or those who aren’t currently well enough to go through cancer treatment.

If you fall in a high-risk category, screening for lung cancer with low-dose CT can save lives by finding lung cancer when it is smaller and more treatable, offering hope for a disease which until now had a pretty dismal outlook. The CT scan is done in a matter of a few minutes, and differs from a routine CT in that lower than usual dose is used so that the study can be repeated annually as needed.

And because early detection saves lives, this new CT screening test holds the possibility of moving the approximately 10 million high risk individuals* on their way to better health.


*Yes there are that many who fall into the “high risk” category. Please give up the habit!

November 8, 2013

International Day of Radiology

Wilhelm Conrad Röntgen Copyright Public Domain

Wilhelm Conrad Röntgen Copyright Public Domain

Today, November 8th, is the International Day of Radiology — Let’s Celebrate Together!

You can show your support by changing your Facebook, Twitter or Instagram profile picture for the occasion… or just print yourself a mask. (Some people are already getting silly with this – on the other side of the world even!)

So… yesterday was Madame Curie’s birthday, which we love to celebrate for so many reasons, as she was an amazing scientist and an amazing woman. Today is the anniversary of the discovery of x-rays by Wilhelm Conrad Röntgen.

X-ray technology has revolutionized medicine, from conventional x-rays to check for broken bones to other modalities, such as CT scans and mammograms, which also use x-rays to form the images. These imaging techniques based on the x-ray allow an amazing view of the internal structure of our bodies, from our heads to our toes and every part in between. In short, medicine would not be what it is today without Röntgen’s discovery.

In a move of serendipity (perhaps not an accident…), November is also Lung Cancer Awareness Month, and this year’s International Day of Radiology has a focus on lung health. We’re fans of our lungs (yours too)! On both of our blogs, we’ve written about scientific progress in imaging and early detection of lung cancer, as well as how to kick the smoking habit for the sake of good health, including breast health. Using CT techniques with low-dose, we now have a way of screening for and finding lung cancer – a method which will hopefully enable us to find smaller, more treatable lung tumors in those at high risk. Reducing risk is key – we should not lose sight of that in our celebration of lung health and imaging.

We love our jobs, based on the discoveries of amazing individuals, and through our blogs hope to educate people on how radiologists can help you on your path towards better health. We can’t imagine our world without the discovery of Röntgen – we applaud him and all the researchers in imaging since him who have had such a tremendous impact on medicine and health. Cheers, radiology!

July 30, 2013

CT Scans for High Risk Lung Cancer Persons: Early Detection Saves Lives!

lung window, CT scanAs diagnostic radiologists, we have the unique capacity to help ensure best possible health for our patients, not via administering strong medicine to the sick, but with early detection of a disease, before one has symptoms. We say this all the time, because we experience this in our own practice all the time:  early detection saves lives.
We are excited to note that as of yesterday, the US Preventative Services Task Force (USPSTF) has made a draft recommendation for screening for lung cancer in high-risk patients. CT scans for this group of people can be  life-saving tool.
There have been decades of research dedicated to determining the best way to detect lung cancer and detection at a stage that is most treatable. Lung cancer is the #1 cause of cancer death in the US and causes more deaths than breast, prostate and colon cancer combined. Lung cancer is often caught late; with only a one-in-ten chance of survival. Patients detected early, before symptoms arise, may have a greater chance of a cure.
The USPSTF has researched methods of early detection and concluded that low-dose CT scans for certain portions of the population can be beneficial in terms of lung cancer. So, smokers and former smokers alike, listen to this please:
Together, we can help save lives. Please share this valuable information with those you care about. (And please care about yourself enough to stop smoking; there are resources available for that as well.) Please talk to your medical care provider to see if you are a candidate for CT lung screening. We’ll be cheering you on for your best possible health the whole way!
May 29, 2013

Take a Stand for Good Health

conference room stretching by synergy programs

Solution? Prevention:

As radiologists, we spend far too much time every day reading back injuries, so many of which are preventable. One simple solution: Take a break from sitting down so much!

It can seem nearly impossible to convert some sedentary jobs into standing ones based on office policies and equipment availabilities. In order to manage a situation that IS “unavoidable” there are some ways to fight back. As explained in a recent article in the LA Times, getting up and moving around on regular intervals can do wonders.

There are also workarounds for the seating issue: “I’ve been known to take a wrench to work and remove the arms of my chair so I could sit in lotus position at my desk. Luckily, I’ve had bosses who were either very kindly tolerant… or not too observant,” says a cubicle worker named Rachel, with a wink and a grin.

“Sitting is the new smoking.”

The list of painful results from a lifestyle of consistent sitting have lead to the expression “sitting is the new smoking.” That is to say, it’s too common and most people who do it somehow consider themselves the exception to the rule when they are, in fact, demonstrating the rule.

In a TEDx talk by Pack Matthews, Sitting Is the New Smoking (but You’ve Got Options), we learned a simple trick for measuring the impact of sitting on your life. On the ten point scale demonstrated in the video, can you raise and lower yourself to sitting cross-legged using your legs alone? Kudos to one of the radiologists here who scored a 10 in heels (ahem, show-off!) and another colleague who struggled is deeply motivated to correct her situation.


Armed with this knowledge about your legs, spine and general health, we hope you’ll rethink your sitting to standing ratio and enjoy better health. Give yourself a little test (but you don’t have to do it in heels) and make yourself a goal of ten. Happy standing to you!