Diagnostic Imaging / X-ray

• What is a Diagnostic X-Ray?

Diagnostic X-ray (radiography) is an examination using electromagnetic energy beams to produce images onto film or computer.   X-Ray imaging is one of the fastest and easiest ways for a physician to view the internal organs and the conditions of bones. Because X-Rays are inexpensive and useful they comprise a majority of all diagnostic procedures done on a worldwide annual basis.

• Common Uses

X-Ray imaging is essential tool for assessing skeletal trauma and capturing a comprehensive snapshot of the status of your lungs, heart and blood vessels.   Also commonly used for diagnosing the digestive tract, for high resolution diagnostic imaging of the breasts.  X-Ray imaging is also available for imaging the kidneys, teeth and jaws, and the fine structures of the ear, nose and throat.

• Safety

 x-rays are safe when used with care. Radiologists and x-ray technologists have been trained to use the minimum amount of radiation necessary to obtain the needed results. The amount of radiation used in most examinations is very small and the benefits greatly outweigh the risk of harm.

Women should always inform the physician and technologist if there is any possibility that they are pregnant so that the necessary precautions can be taken.

• What should I expect BEFORE my Diagnostic X-Ray?

Medications
Continue taking your current medications as normal unless specified by your physician.

Food and drink
For most X-ray exams there are no restrictions on what you may eat or drink. Exceptions will be specified by your physician.

When to arrive
Please arrive 15-20 minutes before your appointment.

What to wear
Wear comfortable clothing, preferably clothes with no zipper or buttons, such as a sweats. You may also be asked to remove jewelry, eyeglasses and any metal objects or clothing that might interfere with the images. Gowns are available if needed.

What will I experience DURING my Diagnostic X-Ray

Scanning
The patient is positioned by the technologist so that the anatomy of interest is in the proper field of view between the X-Ray tube and film or image intensifier. The technologist will leave the room and ask you to remain perfectly still for a few moments, or hold your breath (for a chest X-Ray) while the X-Ray picture is taken.

Some X-Rays, such as an upper gastro-intestinal series, will require the patient to drink a barium solution immediately before the X-Rays are taken to help delineate the internal structures.

Length of Diagnostic X-Ray
Depending on the type of X-Ray, it can last from 5 minutes to 60 minutes.

Contrast Medium
An iodinated based contrast medium may be used with certain types of X-Rays; amounts differ depending on patient condition and type of exam performed.

What should I expect AFTER my Diagnostic X-ray

You may resume your normal activities, diet, and medications unless instructed otherwise by the technologist or your doctor.If you receive an injection of contrast medium before your X-rays, call your doctor if you experience pain, swelling or redness at the injection site

Diagnostic X-Ray Results

We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you.

top of page
Fluoroscopy

• What is a Fluoroscopy?
Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed. However, modern fluoroscopes couple the screen to an X-ray image intensifier and CCD video camera allowing the images to be recorded and played on a monitor. The contrast agent is needed to enhance the soft tissue which doesn’t show under normal X-Ray use.  The technologist uses a switch to control an X-Ray beam that is transmitted through the patient. The X-Rays then strike a fluorescent plate that is coupled to an “image intensifier” that is, in turn, coupled to a television camera. The Radiologist can then watch the fluorescent screen and see a dynamic (moving) image of the patient’s body, for instance, the beating heart.

• Common Uses

• Small Bowl Series ; evaluation of the small intestine.
• Galactogram ; evaluation of breast glandular ducts
• Intravenous Pyelography ; evaluation of the kidneys, ureter, and bladder
• Upper Gastrointestinal Series ; evaluation of esophagus and stomach
• Barium Enema ; evaluation of the large intestine
• Gall Bladder Series ; evaluate presence of gall stones
• Hystersalpingogram ; evaluation of the fallopian tubes
• Arthrogram ; evaluation of major joints
• Venogram ; evaluation of veins
• Sailogram ; evaluation of the parotid gland

Another common procedure is the modified barium swallow. The patient will ingest barium-impregnated liquids/solids, and a radiologist and speech pathologist interpret the results. The test is taken to diagnose oral and pharyngeal swallowing dysfunction.       

• Safety

x-rays are safe when used with care. Radiologists and x-ray technologists have been trained to use the minimum amount of radiation necessary to obtain the needed results. The amount of radiation used in most examinations is very small and the benefits greatly outweigh the risk of harm.

Women should always inform the physician and technologist if there is any possibility that they are pregnant so that the necessary precautions can be taken.

What should I expect BEFORE my Fluoroscopy?

Medications
Continue taking your current medications as normal unless specified by your physician.

Food and drink
Depending on the patient and procedure, you may be asked not to eat or drink anything for several hours before your procedure. Please contact the facility where your exam is scheduled to see if this applies to your exam.

Please refrain from smoking or chewing gum prior to the exam.

When to arrive
Please arrive 15-20 minutes before your scheduled exam.

What to wear
Wear comfortable clothing, preferably clothes with no zipper or buttons, such as sweats. You may also be asked to remove jewelry, eyeglasses and any metal objects or clothing that might interfere with the images. Gowns are available if needed.

What will I experience DURING my Fluoroscopy?

Scanning
You will be given a contrast agent to enhance the tissue that isn’t normally seen with a normal X-ray.  A technologist will position you to best capture the area of interest.

Length of my Fluoroscopy
The length of the exam is varies on the type of exam being performed.

Contrast Medium
The contrast agents used are administered through injection, ingestion or an enema

What should I expect AFTER my Fluoroscopy?
 
You may resume your normal activities, diet, and medications unless instructed otherwise by the technologist or your doctor.

Fluoroscopy Results

We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you. 

top of page 
Nuclear Medicine


What is Nuclear Medicine?

Nuclear Medicine is a safe, painless process in which small amounts of radioactive materials, called radiopharmaceuticals, is ingested by the patient. These radiopharmaceuticals are attracted to specific organs, bones or tissues, which in turn are detected by special types of cameras. Nuclear Medicine imaging offers early detection and is used in the diagnosis, management and treatment of serious disease, which may result in a more successful prognosis.

Common Uses

Nuclear medicine images can assist the physician in diagnosing diseases. Tumors, infection and other disorders can be detected by evaluating organ function.

Specifically, nuclear medicine can be used to:
• Scan lungs for respiratory and blood flow problems
• Identify inflammation or abnormal function of the gallbladder
• Evaluate bones for fracture, infection, arthritis or tumor
• Stage cancer by determining the presence or spread of cancer in various parts of the body
• Identify bleeding into the bowel
• Locate the presence of infection
• Measure thyroid function to detect an overactive or underactive thyroid
• Analyze kidney function

Safety

The amount of radiation in a typical nuclear imaging procedure is comparable with that received during a diagnostic x-ray, and the amount received in a typical treatment procedure is kept within safe limits. Nuclear medicine has been used for more than five decades, and there are no known long-term adverse effects from such low-dose studies.

Please tell the technologist if you are, or might be pregnant. In certain cases you may not be able to have an exam and will need to discuss alternatives with your doctor.

Preparing for your Nuclear Medicine

What should I expect BEFORE Nuclear Medicine?

Medications
Restrictions for discontinuing medications depending on the exam and/or patient. Please check with your physician or the nuclear medicine department at the facility where your exam is scheduled prior to your appointment.

Food and drink
These exams are very specific, each requires different food and drink restrictions. Please be sure to ask your physician before the exam, or call the Nuclear Medicine Department.

When to arrive
Please arrive 15 minutes prior to your scheduled exam.

What to wear
Wear comfortable clothing, preferably clothes with no zipper or buttons, such as a sweats. You may also be asked to remove jewelry, eyeglasses and any metal objects or clothing that might interfere with the images. Gowns are available if needed.

What will I experience DURING Nuclear Medicine?

Scanning
You are given a small dose of radioactive material, usually intravenously but sometimes orally, that localizes in specific body organ systems. After you are given the dose of radioactive material, you will lie down on a scanning table. It is important that you remain still while the images are being recorded. Though nuclear imaging itself causes no pain, there may be some discomfort from having to remain still or to stay in one particular position during imaging. A camera positioned above and below you then measures and takes pictures of the radioactive material that is being given off from your body. The amount of radioactive material you are given is very small and the radioactivity wears off very quickly within a matter of a few hours.

Some exams, such as bone scan require you to receive the injection and return a few hours later for the imaging portion.

Length of Nuclear Medicine
The exams average from 1-4 hours. Many times the patient is injected with a radioisotope and then returns a few hours later for the imaging.

What should I expect AFTER Nuclear Medicine?

You may resume your normal activities, diet, and medications unless instructed otherwise by the technologist or your doctor.

Through the natural process of radioactive decay, the small amount of radiotracer in your body will lose its radioactivity over time. It may also pass out of your body through your urine or stool during the first few hours or days following the test. You may be instructed to take special precautions after urinating, to flush the toilet twice and to wash your hands thoroughly. You should also drink plenty of water to help flush the radioactive material out of your body.

Nuclear Medicine Results

We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you.

top of page

Ultrasound


What is an Ultrasound?

A Ultrasound is an ultrasound-based diagnostic medical imaging technique used to visualize muscles, tendons, and many internal organs, to capture their size, structure and any pathological lesions with real time tomographic images. Ultrasound has been used by sonographers to image the human body for at least 50 years and has become one of the most widely used diagnostic tools in modern medicine.

• Common Uses

Ultrasound examinations can help to diagnose a variety of conditions and to assess organ damage following illness. Ultrasound is a useful way of examining many of the body's internal organs.

Ultrasounds help physicians evaluate symptoms such as:
• pain
• swelling
• infection
• hematuria (blood in urine)


Ultrasound is regarded as the Gold Standard diagnostic exam for monitoring pregnancy.
 
Safety

For standard diagnostic ultrasound there are no known harmful effects on humans. Ultrasound imaging uses no ionizing radiation.

Preparing for your Ultrasound

What should I expect BEFORE an Ultrasound?

Medications
Continue taking your current medications as normal unless specified by your physician.

Food and drink
If you are having an abdominal ultrasound, you should have been instructed not to eat or drink anything 8 hours prior to your exam. Other ultrasound exams such as pelvic, thyroid, scrotal, and vascular studies do not require any preparation.

When to arrive
Please arrive 10 minutes prior to your scheduled exam.

What to wear
Wear comfortable clothing, preferably clothes with no zipper or buttons, such as a sweats. You may also be asked to remove jewelry, eyeglasses and any metal objects or clothing that might interfere with the images. Gowns are available if needed.

What will I experience DURING an Ultrasound?

Scanning
Ultrasound examinations are painless, fast and easily tolerated by most patients.
A sonographer, a health care professional specially trained in the use of ultrasound, will apply a gel to the skin over the area being examined. The gel maximizes contact between the transducer and the skin, thereby producing high quality images. The transducer is moved over the targeted area and obtains the desired diagnostic data. If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.
Transvaginal and transrectal ultrasound are specialized tests that can provide better images than traditional Ultrasound or other diagnostic methods. For these exams a smaller, specially designed transducers may be inserted into the vagina or rectum


Length of an Ultrasound
Depending on the exam being preformed Ultrasounds average between 10 and 30 minutes.

What should I expect AFTER an Ultrasound?

After an ultrasound examination, you should be able to resume your normal activities immediately.

Ultrasound Results

We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you.

top of page

CT- CAT SCAN


What is a CT Scan?
A CT (computed tomography) is a study that uses a series of X-Rays to create image "slices" of the body. This type of study is commonly called a CAT scan. The "A" in CAT refers to "axial," or computed axial tomography. Axial is an orientation of images, but with other orientations available, the study is referred to as a CT scan.
In the CT scan, the patient is on a table that has a doughnut shaped device at one end. This device contains an X-ray that takes images of the body from different orientations. A computer integrates these images to create a two-dimensional image of the body. The images represent slices of the body, and are usually completed in a series with about one slice per centimeter.
CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity than conventional x-ray exams.
 
Common uses
CT scanning of the head is typically used to detect:
• bleeding, brain injury and skull fractures in patients with head injuries.
• bleeding caused by a ruptured or leaking aneurysm in a patient with a sudden severe headache.
• a blood clot or bleeding within the brain shortly after a patient exhibits symptoms of a stroke.
• a stroke, especially with a new technique called Perfusion CT.
• brain tumors.
• enlarged brain cavities (ventricles)
• diseases or malformations of the skull.


Safety
CT examinations improve health care and are an essential part of diagnosis and treatment planning. However, there are some risks associated with the level of radiation exposure during a CT. Women should always inform their physician and x-ray or CT technologist if there is any possibility that they are pregnant. The risk of serious allergic reaction to contrast materials that contain iodine is extremely rare, and radiology departments are well-equipped to deal with them.
 Because children are more sensitive to radiation, they should have a CT exam only if it is essential for making a diagnosis and should not have repeated CT exams unless absolutely necessary. CT scans in children should always be done with low-dose technique.      

What should I expect BEFORE my CT Scan?

Medications
It is important for you to keep to your regular medication schedule, however please check with your physician or CT department at the facility where your exam is scheduled prior to your appointment. If you have a known allergy to contrast material, or "dye," your doctor may prescribe medications (usually a steroid) to reduce the risk of an allergic reaction. These medications generally need to be taken 12 hours prior to administration of contrast material. To avoid unnecessary delays, contact your doctor before the exact time of your exam.

 Food and drink
Unless you are told specifically by staff or your physician, you should not eat or drink for six to eight hours prior to your test. If you are not on an NPO status then we encourage you to drink plenty of clear fluids before your exam.

When to arrive
If you are having a CT scan of your abdomen or pelvis, you need to arrive one hour before your scheduled appointment. This is to allow time for you to drink oral contrast material before your exam and to ensure that the contrast material completely coats your gastrointestinal tract. The contrast material helps to highlight body areas for the CT scan. If you are having a scan other than the abdomen you should arrive 10 mins prior to your appointed time.

What to wear
Wear comfortable clothing, preferably clothes with no zipper or buttons, such as a sweats. You may also be asked to remove jewelry, eyeglasses and any metal objects or clothing that might interfere with the images. Gowns are available if needed.

Diabetic conditions
If you are an insulin-dependent diabetic, please continue to take your insulin as prescribed, but drink extra fruit juices to make up for the fasting of solid foods for the 2-3 hour period that your stomach is empty. Patients who are taking diabetic medications, such as Glucophage (Metformin) should take the prescribed dose as normally done on that day, but discontinue the next doses for 48 hours AFTER their CT exam. Patients should notify their Primary Care Physician (PCP) that they were instructed to discontinue their medication for 48 hours. If you need a substitute medication, please consult your doctor.

Intravenous preparation
Many patients receive a contrast agent intravenously (IV) during their CT test. If your doctor or the radiologist has determined that this procedure will enhance your CT scan results, the technologist will place an IV in your arm or hand prior to going into the test.

Pacemakers
You should inform the technologist if you have a pacemaker. Pacemakers do not hinder the use of CT as in MRI as long as the scanner will not be taking images repeatedly over the area of the pacemaker device in the upper chest. This is usually not an issue for cardiac CT exams.

What will I experience DURING my CT Scan?

Scanning
The technologist will help position you on an exam table. The table may have straps, pillows, or a special cradle for your head to hold you in place. You will probably lie on your back, although you may be asked to lie on your side or your stomach, depending on which part of your body is being scanned, especially if you are undergoing a biopsy. If the scan is done as part of radiation therapy treatment planning, there may be special devices such as masks or body casts to keep your body in the same position that will be used for the radiation treatment.
During the scan, the technologist who monitors the procedure will be in an adjoining control room. However, he or she will be able to observe you through a window and you will be able to communicate through an intercom system.
The CT scanner resembles a large donut. The exam table will slide back and forth through the large hole in the center of the machine as the scanner rotates around you. At first, the table will move through the scanner quickly, which helps the technologist confirm that your body is in the right position. After that, the table will move more slowly.
CT scans are not painful. However, you will need to lie still for the entire scan, which may become uncomfortable. Since the scanner is shaped like a donut, you will not be enclosed in the scanner at any time. You can also expect to hear whirring or clicking sounds from the machine.
You may be asked to hold your breath during part of the scan because the motion created by breathing can blur the images. The exam table may be raised, lowered, or tilted to create the correct angle for the x-rays;

Length of scan
Each CT scan is individualized and tailored to each patient's needs. In general, the actual image-taking is only a few mins and most examinations last approximately 15 minutes in total.

Contrast medium
Depending on which part of your body is being scanned, you may be given a contrast medium. This dye may be given orally (as a drink), through an intravenous (IV) line, or through an injection (shot). Then it will travel through your bloodstream and help create a clearer picture of specific parts of your body. Contrast mediums, or contrast agents, highlight your organs and blood vessels and help the radiologist see them better. In the past, most contrast agents contained higher levels of iodine. The new contrast agents available today have lower iodine content, which greatly reduces the chance of an allergic reaction and most of the discomforts associated with the injection.
What should I expect AFTER my CT Scan?
You have no restrictions after having a CT scan and can go about your normal activities. To help eliminate the contrast medium from your body, drink plenty of decaffeinated or non-alcoholic beverages. Water and juices also work well. The kidneys help filter the iodine that is in the contrast out of the body. If you have kidney disease or diabetes, you should be closely monitored for kidney problems after this test. If you have diabetes or have kidney disease, talk to your health care provider before the test about your risks.

CT Scan Results
We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you.

top of page
MRI

What is an MRI exam?
 
Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases MRI gives different information about structures in the body than can be seen with an X-ray, ultrasound, or computed tomography (CT) scan. MRI produces a series of cross-sectional pictures. MRI technology has advanced so much in recent years that it has greatly altered treatment courses. Physicians can detect many conditions in earlier stages, greatly optimizing patient outcomes.

Common uses
MRI provides good contrast between the different soft tissues of the body, which makes it especially useful in imaging the brain, muscles, the heart, and cancers.  Areas of the body that may undergo an MRI scan include the head, chest, abdomen, vital organs, joints, spine or extremities such as hands, wrists, ankles, and feet.

Safety
MRI scanners do not use X-rays. Instead, they use a very strong magnet and radio frequency. Because of this powerful magnet it is vital that you remove all metallic belongings in advance of an MRI exam, including watches, jewelry, and items of clothing that have metallic threads or fasteners. Please tell the technologist if you are, or might be, pregnant. In certain cases you may not be able to have an MRI and will need to discuss alternatives with your doctor.
Patients with any kind of metallic implant anywhere in their body should not have an MRI unless their physician is fully aware of the device and has approved the MRI procedure. Under no circumstances should a patient who has a pacemaker have an MRI.

What should I expect BEFORE my MRI exam?
Medications

Continue taking your current medications as normal unless specified by your physician. Let the MRI technician know what medications you have taken prior to your MRI Exam.

Food and drink
If you are having your abdomen scanned it may be necessary for you to fast for a few hours before the test and to drink some contrast when you arrive for your test. Contact the MRI department where your exam is scheduled and ask if your exam requires fasting. Otherwise there are no restrictions on what you may eat or drink.

When to arrive
You should arrive 15 minutes before your scheduled appointment.

What to wear
For MRI scans, you should wear comfortable clothing; however, you may have to change into a hospital gown. If you are wearing anything metallic, such as jewelry, dentures, eyeglasses, or hearing aids that might interfere with the MRI scan, we will ask you to remove them. You should not have your credit cards in your pockets during the scan because the MRI magnet can affect the magnetic strip on the card. Makeup and nail polish that contain metal particles should be removed if applied to the area undergoing the MRI examination.

Claustrophobia
Some patients who undergo MRI examinations may feel confined, closed-in, or frightened. Today, many patients avoid this problem when examined in one of the newer MRI units that have a more "open" design. If patients are properly prepared and know what to expect, it helps complete the exam without distress.

Intravenous preparation
Patients may receive a contrast agent intravenously during their MRI scan in order to give a clearer picture of the area being scanned. If your doctor has determined that this procedure will enhance your MRI scan results, the technologist will place an IV in your arm prior to your going into the scan.
 
What will I experience DURING my MRI exam?
Scanning

Your technologist will bring you into the MRI scan room where you will lie down on the patient table. The technologist positions the part of your body to be scanned in the middle of the large cylindrical magnet. The scanner does not touch you, nor do you feel anything. Because the scanner does make a loud knocking noise when it takes the pictures, the technologist will offer you headphones to listen to music or earplugs to lessen the sound. You may bring your own CD to listen to. The technologist leaves the room, but is in full view and communication with you through the observation window in the adjoining room. There is also voice communication at all times through an intercom. It is important for you to lie very still, and at some points you may be asked to briefly hold your breath as the picture is taken.

Length of MRI exam
Because each MRI scan is tailored to each patient's needs, scanning time varies. Contact the MRI department where your exam is scheduled to find out how long your exam is estimated to take.

Contrast medium
 If you are over 60 or have kidney disease, diabetes, lupus, or multiple myeloma, you may need a blood test beforehand to make sure the contrast will be safe for you.

What should I expect AFTER my MRI exam?
You should inform your radiologist if you are breast-feeding at the time of a scheduled MRI study if you may need to receive an MRI contrast agent. One option under this circumstance is to pump breast milk before the study, to be used until injected contrast material has cleared from the body, which typically takes about 24 hours. The radiologist will provide additional information to you regarding this matter.
Otherwise generally there are no restrictions after having a MRI exam and can go about your normal activities. To help eliminate the contrast medium from your body, drink plenty of fluids.

MRI results
We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you.

top of page
Mammography

What is a mammogram?
Mammography is a specific type of imaging that uses a low-dose x-ray system to examine breasts. A mammography exam, called a mammogram, is used to aid in the early detection and diagnosis of breast diseases in women.
Digital mammography, also called full-field digital mammography (FFDM), is a mammography system in which the x-ray film is replaced by solid-state detectors that convert x-rays into electrical signals. These detectors are similar to those found in digital cameras. The electrical signals are used to produce images of the breast that can be seen on a computer screen or printed on special film similar to conventional mammograms. From the patient's point of view, having a digital mammogram is essentially the same as having a conventional film mammogram.
Computer-aided detection (CAD) can be applied to mammography exams to help radiologists identify and mark regions of interest that are potentially indicative of cancer.. The computer software then searches for abnormal areas of density, mass, or calcification that may indicate the presence of cancer. The CAD system highlights these areas on the images, alerting the radiologist to the need for further analysis.
Breast tomosynthesis, also called three-dimensional (3-D) breast imaging, is a mammography system where the x-ray tube and imaging plate move during the exposure. It creates a series of thin slices through the breast that allow for improved detection of cancer and fewer patients recalled for additional imaging.

Common uses
Screening mammogram versus diagnostic mammogram
A screening mammogram is an exam used to detect early breast cancer in women experiencing no symptoms. Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them. Current guidelines recommend screening mammography every year beginning at age 40. In addition, women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening.
Diagnostic mammography is used to evaluate a patient with abnormal clinical findings, such as a breast lump or lumps that have been found by the woman or her doctor. Diagnostic mammography may also be done after an abnormal screening mammogram in order to determine the cause of the area of concern on the screening exam.

Safety
State-of-the-art X-ray systems have tightly controlled X-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures those parts of a patient's body not being imaged receive minimal radiation exposure.
Although there is no radiation that reaches the uterus during a mammogram, it’s preferred not to perform routine mammograms on women who might be pregnant. If you are coming in because of a breast problem and you are or may be pregnant, please notify the mammographer so that we can decide the best way to evaluate your situation.

What should I expect BEFORE my mammogram?
Discussion
Prior to your mammogram, discuss any new findings, prior surgeries, hormone use, and family or personal history of breast cancer with your doctor.

What to wear
On the day of the exam do not use deodorants, antiperspirants, powders, or ointments since these can show up and be confusing on the mammogram. Since you will need to undress from the waist up, a two-piece outfit is recommended.
 
What to bring
If possible, obtain prior mammograms and make them available to the radiologist at the time of the current exam. You will be asked a number of important questions about your medical history so that we can assess your breast cancer risk.

What will I experience DURING my mammogram?
Preparation
You will be asked to remove your clothing from the waist up and will be given a gown. You will be escorted into the mammography room.
The mammographer who performs your exam is a highly trained individual who is board certified in breast imaging studies. She can answer most of your questions, but if she cannot, then she can ask a radiologist who specializes in mammography.
If you have not had a mammogram before, the mammographer will explain the procedure. If you have any scars on your breasts, breast implants or skin irritations, particularly underneath your breast in the fold where the breast attaches to the chest, please point them out to the mammographer.

Breast compression
It is very important that you work with the mammographer to insure that your breast is as far into the machine as possible so that the tissues deep in the breast can be examined.
Your breast will be placed on a special platform and gradually compressed with a paddle (often made of clear Plexiglas or other plastic).
You will feel pressure on your breast as it is squeezed by the compressor. Some women with sensitive breasts may experience discomfort. If this is the case, schedule the procedure when your breasts are least tender. Be sure to inform the mammographer if pain occurs as compression is increased. If discomfort is significant, less compression will be used.

Breast compression is necessary in order to:
• Even out the breast thickness so that all of the tissue can be visualized.
• Spread out the tissue so that small abnormalities won't be obscured by overlying breast tissue.
• Allow the use of a lower X-ray dose because a thinner amount of breast tissue is being imaged.
• Hold the breast still in order to eliminate blurring of the image caused by motion.
• Reduce X-ray scatter to increase sharpness of picture.

Scanning
You will be asked to change positions slightly between images. Routine views are a top-to-bottom view and an oblique side view. The process will be repeated for the other breast. The mammographer will walk behind a wall or into the next room to activate the X-ray machine. The X-ray beam will remain on for a few seconds at most. You may hear a whining noise that persists even after the X-ray is turned off. This is just a mechanical part of the tube that spins at high speed and does not stop immediately even though no more X-rays are being produced.

Length of exam
Your mammogram should take about 30 minutes.

What should I expect AFTER my mammogram?
When the examination is complete, you will be asked to wait until the mammographer determines that the images are of high enough quality for the radiologist to read. After that you will be free to go.

Mammogram results
We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you.


top of page
Breast MRI

What is a MRI of the Breast?
Magnetic resonance imaging (MRI) is a non-invasive way of viewing organs, soft tissues, bone and other internal body structures without the use of x-rays. MRI uses a magnetic field and radio waves together with a computer to create cross-sectional, three-dimensional pictures of the head and body. Detailed MR images allow physicians to better evaluate parts of the body for conditions that may not be visible with other imaging methods. MRI has proven very valuable in diagnosing a broad range of conditions, including cancer, heart and vascular disease, stroke and musculoskeletal disorders.
MRI of the breast is not a replacement for mammography or ultrasound imaging but rather is a supplemental tool for detecting and staging breast cancer and other breast abnormalities.

Common Uses
• Further evaluation of abnormalities detected by mammography
• Finding early breast cancers not detected by other tests, especially in women at high risk and women with dense breast tissue
• Examination for cancer in women who have implants or scar tissue that might produce an inaccurate result from a mammogram This test can also be helpful for women with lumpectomy scars to check for any changes.
• Detecting small abnormalities not seen with mammography or ultrasound (for example, MRI has been useful for women who have breast cancer cells present in an underarm lymph node, but do not have a lump that can be felt or can be viewed on diagnostic studies)
• Assess for leakage from a silicone gel implant
• Evaluate the size and precise location of breast cancer lesions, including the possibility that more than one area of the breast may be involved
• Determining whether lumpectomy or mastectomy would be more effective
• Detecting changes in the other breast that has not been newly diagnosed with breast cancer
• Detection of the spread of breast cancer into the chest wall, which may change treatment options
• Detection of breast cancer recurrence or residual tumor after lumpectomy
• Evaluation of a newly inverted nipple change
Without contrast material, an MRI of the breast can show:
• Breast tissue density
• Cysts
• Enlarged ducts
• Hematomas
• Leaking or ruptured breast implants
By comparing breast images taken before and after contrast material injection, an MRI exam can determine:
• If there are breast abnormalities
• Whether an abnormality looks benign (non-cancerous) or malignant (cancerous)
• The size and location of any abnormality that looks malignant
• The presence of enlarged lymph nodes
 
Safety
MRI scanners do not use X-rays. Instead, they use a very strong magnet and radio frequency. Because of this powerful magnet it is vital that you remove all metallic belongings in advance of an MRI exam, including watches, jewelry, and items of clothing that have metallic threads or fasteners. Please tell the technologist if you are, or might be, pregnant. In certain cases you may not be able to have an MRI and will need to discuss alternatives with your doctor.
Patients with any kind of metallic implant anywhere in their body should not have an MRI unless their physician is fully aware of the device and has approved the MRI procedure. Under no circumstances should a patient who has a pacemaker have an MRI.
What should I expect BEFORE my Breast MRI?

Medications
It is important for you to keep to your regular medication schedule. Just let our staff know what medications you have taken prior to your MRI Exam.

Food and drink
There are no restrictions on what you may eat or drink before a typical MRI test.

When to arrive
Please arrive 15 minutes prior to your scheduled exam.

What to wear
For MRI scans, you should wear comfortable clothing; however, you may have to change into a hospital gown. If you are wearing anything metallic, such as jewelry, dentures, eyeglasses, or hearing aids that might interfere with the MRI scan, we will ask you to remove them. You should not have your credit cards in your pockets during the scan because the MRI magnet can affect the magnetic strip on the card. Makeup and nail polish that contain metal particles should be removed if applied to the area undergoing the MRI examination.

Intravenous preparation
Many of our patients receive a contrast agent intravenously during their MRI scan in order to give a clearer picture of the area being scanned. If your doctor has determined that this procedure will enhance your MRI scan results, the technologist will place an IV in your arm prior to your going into the scan.
What will I experience DURING my Breast MRI?

Scanning
You will be positioned face down on the moveable bed with your breasts hanging into the cushioned openings. The bed will then be moved into the magnet of the MRI unit. The technologist will leave the room while the MRI examination is performed. You will be asked to lie still while the machine acquires the images. Imaging is done in sequences, each lasting between one and fifteen minutes. In between sequences, you will be able to relax. You will know when images are being recorded because you will hear tapping or thumping sounds when the coils that create the magnetic field are turned on. It will be important for you to remain very still during the examination, as any movement could cause distortion and affect the quality of the scan. While the MRI procedure itself causes no pain, having to lie still for the length of the procedure might cause some discomfort or pain, particularly in the case of a recent injury or invasive procedure such as surgery. The technologist will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain.
After an initial series of scans, the contrast material is injected into the intravenous line. Additional series of images are taken following the injection.
When your exam is completed, you will wait a short time on the table while the images are evaluated to ensure no additional images are needed. Your intravenous line will be removed.

Length of my Breast MRI
The imaging session lasts between 30 minutes and one hour. The total exam will take approximately an hour and a half.

Contrast Medium
If you are over 60 or have kidney disease, diabetes, lupus, or multiple myeloma, you may need a blood test beforehand to make sure the contrast will be safe for you.

What should I expect AFTER my Breast MRI?
After a breast MRI examination, you should be able to resume your normal activities immediately.  To help eliminate the contrast medium from your body, remember to drink plenty of fluids.

Breast MRI Results
We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you.

top of page
PET-CT Scan

What is a PET-CT exam?
A PET-CT exam combines two types of scans to help pinpoint abnormal activity in the body.
A PET (positron emission tomography) scan creates an image of your body's metabolic activity and shows the rate at which your body's cells break down and use sugar (glucose). This is done by injecting a small amount of radioactive material (FDG) into your blood stream and waiting for it to disperse to the area of focus. A PET scan allows the physician to distinguish between living and dead tissue or between benign and malignant disorders
A CT (computed tomography) scan is a noninvasive medical test that uses special X-ray equipment to produce multiple images or pictures of the inside of the body and a computer to join them together in cross-sectional views of the area being studied. A CT scan is able to detect and localize changes in the body structure or anatomy, such as the size, shape and exact location of an abnormal growth, a sizeable tumor or a musculoskeletal injury
A PET-CT combines the functional information from a PET scan with the anatomical information from a CT scan. When a CT scan is superimposed over a PET scan, doctors can pinpoint the exact location of abnormal activity. They can also see the level and extent of that activity. Even when an abnormal growth is not yet visible on a CT scan, the PET scan may show the abnormal activity.

Common uses

• detect cancer
• determine whether a cancer has spread in the body
• assess the effectiveness of a treatment plan, such as cancer therapy
• determine if a cancer has returned after treatment.
• determine blood flow to the heart muscle
• determine the effects of a heart attack, or myocardial infarction, on areas of the heart
• identify areas of the heart muscle that would benefit from a procedure such as angioplasty or coronary artery bypass surgery (in combination with a myocardial perfusion scan).
• evaluate brain abnormalities, such as tumors, memory disorders and seizures and other central nervous system disorders.
• to map normal human brain and heart function.


Safety
CT: There are some risks associated with the level of radiation exposure during a CT. No direct data have shown that CT examinations are associated with an increased risk of cancer; extrapolations from studies of radiation exposure suggest there is a very small incremental risk.
PET: The dose of radiotracer administered is small, resulting in minimal radiation exposure. Nuclear medicine has been used for more than five decades, and there are no known long-term adverse effects from such low-dose exposure. Allergic reactions to radiopharmaceuticals may occur but are extremely rare.
Women should always inform their physician or technologist if there is any possibility that they are pregnant or if they are breastfeeding their baby. Some of the pharmaceuticals that are used for the study can pass into the mother's milk and subsequently the child will consume them. To avoid this possibility, it is important that a nursing mother inform her physician and the nuclear medicine technologist about this before the examination begins. Usually, you will be asked to discontinue breast-feeding for a short while, pump your breasts in the interim and discard the milk. Breast-feeding can often resume shortly afterwards.

What should I expect BEFORE my PET-CT exam?
Medications
Continue to take prescribed medication, except insulin and diuretic, lasix (water pill) the day of exam.  No over the counter cough medicines.
If you are diabetic and your blood sugar has been consistently, above 200 the days before your PET/CT, please call 775.445.5500 and Radiologists will determine if it is safe to proceed with your exam. If you are a “brittle” (severe) diabetic please request to be scheduled at the first time slot.

Food and drink
Do not eat or drink anything for at least 6 hours before the exam, except water - drink several (2 to 6) glasses of water. 1 cup of Coffee is ok to drink, no cream or sugar. If your doctor has told you to take your regular medicine, take it with plenty of water. If you are diabetic, do not drink or eat anything for at least 4 hours prior to your scan. Take your diabetic medication as usual and read paragraph above. If your doctor has told you to take your regular medicine, take it with plenty of water. Avoid: candies, gum or beverages other than water.
24 hours prior to exam - follow a high protein, low carbohydrate diet (no sugar).


Foods to Avoid
• Cereals, breads, rice, pasta, or beans
• Starchy vegetables such as peas, corn, potatoes
• Fruit or fruit juices
• Sugar, candy, chocolate, honey, jam or jellies
• Gravy or cream based sauces
• Milk, including non-dairy milk products (cream)
• Alcohol
• Gum
• Mints


Exercise
Please do not exercise for at least 24 hours before the exam. Also, do not engage in any repetitive activity, including reading and chewing gum or eating mints.
 
When to arrive
Please check in 30 minutes before your appointment time. Please bring any x-rays you have of the body part being imaged to your appointment.

What to wear
Wear comfortable clothing, preferably clothes with no zipper or buttons, such as sweats. You may also be asked to remove jewelry, eyeglasses and any metal objects or clothing that might interfere with the images. Gowns are available if needed

Intravenous preparation
Many patients receive a contrast agent intravenously (IV) during their PET-CT test. If your doctor or the radiologist has determined that this procedure will enhance your PET-CT scan results, the technologist will place an IV in your arm or hand prior to going into the test. If you've ever had an allergic reaction to contrast, tell your doctor and the technologist. The doctor may prescribe special medicine for you to take before the exam and also while you are here for the exam. You should bring the last two doses of medicine with you.
 
If you are having your PET/CT with contrast, you must have additional lab work (BUN/Creatinine) prior to exam if you:
• Are over the age of 60
• Have diabetes and on medication for diabetes
• Have a history of renal failure, insufficiency or only one kidney
• Have hypertention (high blood pressure)
 
What will I experience DURING my PET-CT exam?
Scanning

It is important that you remain still while the images are being recorded. Though imaging itself causes no pain, there may be some discomfort from having to remain still or to stay in one particular position during imaging. You will need to be able to lie flat on your back for approximately 45 minutes.

Length of exam
You should plan to be here for approximately 2-3 hours. The actual scanning and preparation time varies with the type of scan you are having.

Contrast medium
If you are over 60 or have kidney disease, diabetes, lupus, or multiple myeloma, you’ll need a blood test beforehand to make sure the contrast will be safe for you.
The high speed of our state-of-the art scanners means we are able to produce high-quality images using less contrast than in the past;

What should I expect AFTER my PET-CT exam?
You can drive and resume normal activities immediately after leaving, unless you have taken medication to relax you. It is important that you drink as much water or fluids as possible for the rest of the day and empty your bladder as often as possible. This will result in a more rapid clearance of radioactivity and contrast from your body.

PET-CT Exam results
We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you.

top of page
Stereotactic Breast Biopsy


Overview of Stereotactic Breast Biopsy
What is Stereotactic Breast Biopsy?
Stereotactic breast biopsy is a safe and minimally invasive form of breast biopsy. It is an excellent way to evaluate calcium deposits or tiny masses that are not visible on ultrasound.  It is used to obtain tiny a sample of suspect breast tissue precisely located with a computer-guided imaging system for examination by a pathologist. Biopsies are the only definitive way to confirm that a breast abnormality is benign (non-cancerous) or not. The procedure is completed on an outpatient basis with a minimum of discomfort and recovery time.
No breast defect remains and, unlike surgery, x-ray-guided core needle biopsy does not distort the breast tissue and make it difficult to read future mammograms.

Common Uses

A stereotactic breast biopsy is performed when a mammogram shows a breast abnormality such as:
• a suspicious solid mass
• microcalcifications, a tiny cluster of small calcium deposits
• a distortion in the structure of the breast tissue
• an area of abnormal tissue change
• a new mass or area of calcium deposits is present at a previous surgery site.
Stereotactic breast biopsy is also performed when the patient or physician strongly prefers a non-surgical method of assessing a breast abnormality.

Safety
Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant
Because the vacuum assisted device removes large pieces of tissue there is a risk of bleeding and forming a hematoma, a collection of blood at the biopsy site. The risk, however, appears to be less than 1 percent of patients.
An occasional patient has significant discomfort, which can be readily controlled by non-prescription pain medication.
Any procedure where the skin is penetrated carries a risk of infection
Depending on the type of biopsy being performed or the design of the biopsy machine, a biopsy of tissue located deep within the breast carries a slight risk that the needle will pass through the chest wall, allowing air around the lung that could collapse a lung. This is a rare occurrence

What should I expect BEFORE my Stereotactic Breast Biopsy?
Medications

If you are allergic to a local anesthetic medication, notify the technicians. Additionally, stop taking aspirin, Vitamin E or Ibuprofen 3 days prior to the procedure. If you are on blood-thinning medication such as Coumadin please call the facility where your exam is scheduled and notify the mammography department.

Food and drink
Eat a light breakfast or lunch, limiting fluids.

When to arrive
Please arrive 15 minutes prior to your scheduled exam

What to wear
Wear a two-piece outfit, since you’ll be asked to undress to the waist. Wear or bring a comfortable bra that provides firm support. Bathe but do not use deodorant, talcum powder, lotion, ointment or perfume. They can leave a residue on your skin that can affect the quality of the imaging process.

What will I experience DURING my Stereotactic Breast Biopsy?
Scanning
You’ll be asked to undress from the waist up and put on a front-opening gown. In the biopsy room, you’ll lie on your stomach on a special table with a hole through which the breast is placed and aligned with the imaging unit beneath. You’ll be awake throughout the procedure. The physician performing the procedure will have studied your mammogram to become familiar with the location of the abnormal tissue in your breast. A confirming x-ray is taken to insure that the breast is positioned correctly. The skin on your breast will be cleansed; then a local anesthetic is injected with a very fine needle. You may feel a slight sting. Your breast will be slightly compressed, just as in a mammogram. A small nick is made in your skin and a thin, hollow needle is inserted through the nick. Because of the local anesthetic, most patients report only a small amount of discomfort. The doctor will use the computerized imaging system to precisely guide the needle to the biopsy area where several small samples will be taken. After the needle is removed, a sterile gauze bandage is placed on the skin to prevent bleeding. An ice pack may also be applied. This procedure requires no stitches.

Length of my Stereotactic Breast Biopsy
Exam time varies but average is little over an hour.

What should I expect AFTER my Stereotactic Breast Biopsy?
Before leaving the office, you'll be given instructions for biopsy aftercare that are specific to your individual needs. Your breast should heal quickly, leaving almost no sign of the procedure.

Stereotactic Breast Biopsy Results
We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you..

top of page
DEXA Scan

What is a DEXA Scan?
 
Bone densitometry scanning, also called dual-energy x-ray absorptiometry (DXA or DEXA) or simply a "bone density scan," is an enhanced form of X-ray technology that is used to measure bone loss. DEXA is today's established standard for measuring bone mineral densitometry.
An X-ray (radiograph) is a painless medical test that helps physicians diagnose and treat medical conditions. Radiography involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.
DEXA is most often performed on the lower spine and hips. Portable DEXA devices, including some that use ultrasound waves rather than x-rays, measure the wrist, fingers or heel and are sometimes used for screening purposes.

Common uses
DEXA bone densitometry is most often used to diagnose osteoporosis, a condition that often affects women after menopause but may also be found in men. Osteoporosis involves a gradual loss of calcium, causing the bones to become thinner, more fragile and more likely to break.
DEXA is also effective in tracking the effects of treatment for osteoporosis and other conditions that cause bone loss. The DEXA test can also asses an individual's risk for developing fractures.      

Safety
Special care is taken during X-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the technique standards used by radiology professionals.
State-of-the-art X-ray systems have tightly controlled X-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures those parts of a patient's body not being imaged receive minimal radiation exposure.

Preparing for your DEXA Scan
What should I expect BEFORE my bone densitometry exam?
Food and drink
On the day of your Bone Densitometry Scan you may eat normally. You should not take calcium supplements for at least 24 hours before your exam.

When to arrive
Arrive 15 minutes before your scheduled appointment time to.

What to wear
Wear comfortable clothing, preferably clothes with no zipper or buttons, such as sweats. You may also be asked to remove jewelry, eyeglasses and any metal objects or clothing that might interfere with the images..

Other information
Inform your physician if you recently had a barium examination or have been injected with a contrast material for a computed tomography (CT) scan or radioisotope scan. You may have to wait 10 to 14 days before undergoing a DEXA test.
Women should always inform their physician or technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy because radiation can be harmful to the fetus. If an X-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.

What will I experience DURING my bone densitometry exam?
Scanning

Bone densitometry scans are a quick and painless procedure, and usually done on an outpatient basis. You will lie on a padded table. An X-ray generator is located below you and an imaging device, or detector, is positioned above.
To assess your spine, your legs will be supported on a padded box to flatten the pelvis and lower (lumbar) spine. To assess the hip, your foot will be placed in a brace that rotates the hip inward. In both cases, the detector is slowly passed over the area, generating images on a computer monitor. You must hold very still and may be asked to keep from breathing for a few seconds while the picture is taken to reduce the possibility of a blurred image. The technologist will walk behind a wall or into the next room to activate the x-ray machine.

Length of scan
The scan is usually completed within 10 to 30 minutes.

What should I expect AFTER my bone densitometry exam?
You may resume normal activity immediately after your bone densitometry scan.

DEXA Scan results
We understand that quick results are important for our patients.  Exams are typically read within 24 hours and results will be sent to your physician who will go over them with you..

What is Interventional Radiology?
Interventional Radiology provides treatments and procedures that are minimally invasive using imaging guidance (X-ray, CT, Ultrasound and MRI).  These treatments and procedures are an advance in medicine that can replace open surgical procedures.  They are generally easier for the patient because they involve no large incisions, less risk, less pain and shorter recovery times. 

What is Interventional Radiology used for?
In an Interventional Radiology clinic patients can be seen for Venous Ablation (for venous insufficiency and varicose veins), angiography (for peripheral vascular disease), Fistulagram (for treatment of dialysis access complications), Uterine Fibroid Embolization (for treatment of symptomatic uterine fibroids), Steroid Epidural (for treatment of back pain and spinal stenosis) and Vertebroplasty (for pain management treatment of spinal fractures caused by osteoporosis).  Other services can include evaluation and consultation, Radiofrequency Ablation (for treatment of liver tumors), Regional Cancer Treatments and Vascular Radiology

Who is the Interventional Radiologist?
An Interventional Radiologist is a medical doctor who has completed four years of study in Radiology.  The physician is then eligible to take the board examination given by the American Board of Radiology.  Following g board certification, the Interventional Radiologist completes an Interventional Radiology fellowship training program.  Today, there are about 4,000 Interventional Radiologists in the US, mainly practicing in academic medical centers and in larger community hospitals.