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Early Screenings for Early Lung Cancer Detection

Early Screenings for Early Lung Cancer DetectionGenerally, chest x-rays are used to diagnose patients who already show signs of lung cancer. Many times, the disease has already reached an advanced stage by the time it is discovered. However, patients at high risk for lung cancer can now get early detection screenings which will help discover any signs of lung cancer before symptoms develop.

Who Is High Risk?

There are a few factors that come into play when deciding who is a candidate for lung screenings. In order to be considered, the patient must meet the following requirements:

  • Current or former smoker
  • AND in the age group from 55 to 74 years
  • AND with a smoking history of at least 30 pack-years (this means one pack a day for 30 years, two packs a day for 15 years, etc.)

Other factors may come into play, and the risk of lung cancer is different for every person, so be sure to discuss early screenings with your doctor.

The Process

The screening process is fast–just a few seconds is all it takes. In order to acquire the most accurate image, patients are asked to hold their breath while the x-ray is taken. Following the x-ray, the patient will meet with a specialist to review the screening. If the result is negative, it is recommended to go in for another screening once a year for the next two years. Also, it is highly recommended to quit smoking during that time (or before, for that matter). If the result of the screening is positive, additional tests or follow-ups will be required to determine if it is lung cancer or another problem altogether.

Screening is not a substitute for quitting smoking. The most effective way anyone can reduce their risk of lung cancer is to avoid tobacco. Riverside offers Smokeless®, a program to help people quit smoking on the Peninsula. For information and help to quit smoking, call Holly Hicks at (757) 875-7533.

 

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Ultrasounds: What They Are and When You Should Get One

Ultrasounds: What They Are and When You Should Get OneUltrasounds are used for more than just pregnancy, although that tends to be what most people associate it with. Here, we will discuss ultrasounds and learn what they’re used for, and when we may or may not recommend one.

The ultrasound scan

Sonography (more commonly known as an ultrasound scan), captures images of what is inside a person’s body. Consider a bat or dolphin that uses echolocation to “see” their surroundings. In similar fashion, an ultrasound emits a noise too high pitched for humans to hear, and then records the echoes to determine the shape of organs and soft tissues. This allows for a clear look inside the body without needing an incision.

What do doctors use ultrasounds for?

Ultrasounds look for a variety of things. One of which is pregnancy, of which you’re most likely already aware. During pregnancy, the doctor can see how an unborn baby is progressing. Also, some health issues can be discovered in this manner. For many parents, the sex of the baby can be discovered through use of ultrasound.

But it’s more than just for pregnancy, as mentioned. An ultrasound can detect health problems in a host of internal organs, including:

    • gallbladder
    • kidneys
    • liver
    • ovaries
    • uterus
    • pancreas
    • spleen
    • thyroid
    • testicles
    • bladder
    • eyes
    • heart
    • blood vessels

Some medical procedures also use ultrasound to help in precision, such as needle biopsies.

Advantages of ultrasound imagery

One of the biggest advantages of ultrasounds is that they allow the doctor to see inside a patient without having to make an incision. Ultrasounds are also safe, and do not emit radiation. While x-rays excel at capturing images of bones, they struggle in detecting soft tissues. Ultrasounds do well at capturing images of soft tissues, which is another perk. Finally, ultrasounds are less expensive than other imaging techniques.

Disadvantages of ultrasounds

As with most things, there are a few drawbacks to using an ultrasound. For example, certain areas of the body cannot be imaged using this process. This includes bones and organs where gas is present, such as the lungs. While ultrasounds are great at getting images where x-rays cannot, these images aren’t as detailed, and can sometimes lead to misleading images due to this. The disadvantages are minimal, however, and your doctor will be able to help you understand if this method is best for you.

 

In conclusion, ultrasound scans allow doctors to see organs and soft tissues without being invasive. This is useful for pregnancies and many other medical conditions. Medical technology continues to advance, giving doctors more and more options to diagnose and treat their valued patients safely and effectively. Visit us online for a map to one of our seven locations.

Merry Christmas and Happy Holidays!

What are the Differences Between a CT Scan and MRI?

What are the Differences Between a CT Scan and MRI?If your doctor requests an advanced imaging scan to aid in making a diagnosis, two of the most common tests requested are the CT Scan and MRI. Let’s take a look at how each of these tests show cross-sectional pictures of the body using different techniques.

CT stands for computerized tomography. This scan uses multiple x-rays that are taken at different angles in order to produce a cross-sectional image. 

MRI stands for magnetic resonance imaging. Here a combination of magnetic fields and radio frequencies are used, so the MRI scanner can generate a 3D image of the part of the body being examined. 

Both of these techniques can be used to examine the same parts of the body, and the choice of which one should be used is based on the possible diagnosis. In general, CT scans are used for diagnosing serious injuries to the head, chest, spine, abdomen, and pelvis, and are helpful when trying to determine if fractures are involved. In contrast, the MRI does a better job of diagnosing issues in joints, tendons, ligaments, and soft tissues. MRIs are often used to scan the brain, spine, neck, breast, abdomen, and muscles. 

 

Differences between a CT Scan and MRI

  • Radiation – CT scans use X-ray technology so minimal radiation exposure is present. CT scans are not usually used during pregnancy for this reason. MRI’s do not involve radiation.
  • Cost – CT scans are usually less expensive than MRI tests.
  • Time for Procedure – CT scans are done fairly quickly. Most CT scans take around 5 minutes to complete. MRI’s can range from 15 minutes to 2 hours depending on the part of the body that is being examined.
  • Patient comfort – CT scans are done in an open machine so concerns about being in a small space are rarely an issue. MRI’s are traditionally done in a narrow tube, and can sometimes cause anxiety. Hampton Roads Orthopaedics & Sports Medicine has an open MRI machine to help with concerns about anxiety if MRI is the best choice for the diagnosis. 
  • Limitations – The table used in CT scans accommodate approximately 300 pounds, so if a larger table is required, a patient may need to go to a facility with appropriate equipment. MRI machines with the conventional tube design may also have limitations based on the size of the patient. Open MRI machines would be an alternative option. In addition, MRI machines utilize magnetic fields during the scan so patients with certain metal objects implanted in the body (e.g. pacemakers, rods, some prosthetic joints, and even certain tattoos) may prevent the use of MRI tests.

 

Your doctor will discuss the type of test that they are considering to make the diagnosis. If you have any questions or concerns please share that with your specialist. Schedule an appointment at one of our seven locations!

Breast Cancer Awareness Month

breast-cancer-awareness-monthIt’s that time of year again – Breast Cancer Awareness Month (BCAM)! This annual campaign was created to increase awareness of the disease. These days most people are aware of breast cancer, but many forget to take the steps to have a plan to detect the disease in its early stages and encourage others to do the same.

At Peninsula Radiology we want to encourage women to get their yearly mammograms, and invite others to do the same. Breast Cancer is the most common cancer, and the second leading cause of cancer-related deaths in women in America. Before the onset of mammography screening, the death rate from advanced breast cancer remained unchanged for 50 years. However, since 1990, this rate has decreased by 30 percent, and recent studies suggest that mammograms may even be more effective than previously thought, reducing breast cancer mortality by more than 30 to 60 percent.

It is important for physicians to educate their patients on the benefits of mammography, and to provide them with the proper resources, so that they may make the best decisions for their well-being.

We make it easy and convenient for you to schedule your annual Mammogram. Thanks to Riverside’s Self-Scheduler, you can now schedule your screening mammogram from any computer, at any time. The Self-Scheduler is simple and quick to use. You will first need to create and account by selecting a user name and password. Once your account is set up, you will be able to schedule, re-schedule or cancel your appointment at your convenience.

Another great feature about the Self-Scheduler is that it provides instructions on how to prepare for your appointment. Following these guidelines will help to ensure that you will get the most out of your breast cancer screening appointment.

What to Expect with Nuclear Medicine Imaging

Radiology Services Virginia Nuclear medicine imagingWhen you hear the term nuclear medicine, there’s a chance you may be a bit concerned with the treatment. After all, nuclear fallout, nuclear weapons, and nuclear meltdowns all have a negative connotation. When it comes to nuclear medicine imaging, however, there is no danger in it.

What is Nuclear Medicine

Nuclear medicine isn’t something you take, like a pain reliever or antibiotic. Rather, it’s simply an imaging process, or a scan. What happens during this scan is a small amount of radioactive material is used, alongside a special camera and computer, to capture images of the insides of your body.

Of course, there are other imaging techniques, so why use nuclear medicine for imaging? Simply stated, because nuclear medicine imaging is able to detect molecular activity with precision, and can discover diseases in their earliest stages, during which time they’re easier to treat.

Preparing for the Exam

Generally speaking, there isn’t a lot you need to do to prepare for a nuclear medicine scan. If, however, the scan will be looking at the stomach, you may be asked to not eat food before coming. Likewise, if the scan is for the kidneys, you may be asked to drink lots of water beforehand. Whatever the case, your radiologist will let you know what you should do before you come in.

What You Should Expect

Most scans will have you lie down on a table. The camera may look like a CT scanner, however it may also be positioned above the table or below the table. While the images are being taken, you must stay as still as possible so as to get the most accurate image. Don’t worry about the radioactivity lingering in your body, either. The majority of it leaves your body through urine and stool. The rest disappears over time, so if you were hoping to gain superpowers like Spider-Man from nuclear medicine, you’re out of luck.

 

If you need nuclear medicine imaging or other radiology services, please schedule an appointment with us at Peninsula Radiology by giving us a call at (757) 989-8830.

The Importance of Regular Breast Cancer Screenings

breast cancer screenings

Cancer is a heartbreaking illness that is very difficult to treat and incredibly painful to go through. Based on 2010-2012 data, 39.6% of Americans are diagnosed with cancer at some point during their lifetime. There are several forms of cancer that can develop many different ways, and a few ways to take breast cancer screenings.

Breast cancer is a form of cancer that develops from breast tissue. It is most common in women over the age of 40 but also affects younger women as well. Men also have a risk of developing breast cancer, although the rate of breast cancer seen in men is far lower than the rate of breast cancer seen in women. In the United States, less than 5 percent of women with breast cancer are younger than 40. Breast cancer rates are highest among women over the age of 70. With any form of cancer, it is better to detect the problem earlier on before it escalates further and becomes harder to treat.

There are several ways to check if breast cancer is present. One way to check yourself for breast cancer is to do a self-examination once a month. Self-examination is the process of an individual looking for physical or visual changes in the breasts. To do a self-examination, your breasts should be dry and there should be no lotions or other similar products on your fingers. Find a comfortable couch or bed and lay down flat on your back. Use the pads, not the tips, of your index, middle, and ring fingers. Start from the outer areas of the breast and work your way towards the center, carefully feeling for any lumps that might exist. If you feel anything, do not panic, for many of these lumps turn out to be non-cancerous.

Self-examinations are just one way to check for breast cancer, but the best and most effective way to screen yourself for breast cancer is by making an appointment with your doctor and scheduling a mammogram or breast ultrasound. Even if no lumps are felt by the self-examination, women over the age of 40 should schedule these breast cancer screenings regularly. Always keep an eye on your health and be sure to check with your doctor if you come across anything concerning. The best way to fight cancer is to detect it early.

Peninsula Radiology urges you to do a monthly breast self exam.  If you or a family member require guidance to find a qualified breast health specialist in your area, please contact one of our seven locations for help.  

Bone Density Testing: What is it and Why is it Important?

bone density testing at Peninsula Radiology

What is bone density testing?

Bone density testing—also known as dual-energy x-ray absorptiometry (DEXA or DXA)—uses x-ray images to assess bone mineral density (BMD). The absorption of dual x-ray beams by a patient’s bone is measured to determine the overall strength of the bone and the risk of fracture. The test is typically performed on the lower spine and hips.

What does bone density testing discover?

A bone density test is currently the only way to diagnose osteoporosis, a disease characterized by decreased bone density and quality. Osteoporosis and low bone density (osteopenia) increase the risk of bone fracture. Therefore, DEXA can be used to:

  • Diagnose osteoporosis, either before or after a bone fracture
  • Identify decreased bone density before you break a bone
  • Assess your risk of bone fractures
  • Monitor the success of osteoporosis treatment

When is bone density testing recommended?

Your healthcare provider will conduct a thorough health assessment to determine if you’re at risk for osteoporosis or decreased bone density. A bone density test may be considered if:

  • Further bone testing is recommended based on the results of a screening test such as a peripheral dual x-ray absorptiometry (pDXA), quantitative ultrasound (QUS), or peripheral quantitative computed tomography (pQCT)
  • You’ve lost height of at least ½ inch within a year
  • You’ve lost a total height of 1 ½ inches
  • You’ve had a break or bone loss in your spine
  • You are a woman aged 65 or older
  • You are a man aged 70 or older
  • You break a bone after age 50
  • You are a post-menopausal woman not taking estrogen
  • You have risk factors such as rheumatoid arthritis, chronic kidney disease, liver disease, type 1 diabetes, or a thyroid condition
  • You use medications that can cause bone loss, such as corticosteroids, anti-seizure medications, or high-dose thyroid replacement medications

How is bone density testing conducted?

Bone density tests are fast, easy, and noninvasive outpatient procedures. You will lay on a padded table while a mechanical imaging device passes over your body. You will be asked to stay still and perhaps hold your breath for a few seconds to ensure a clear image. The amount of radiation you’re exposed to is very small.

How are bone density test results interpreted?

Bone density test results are reported in T-scores and Z-scores:

T-score

Your T-score measures your bone mass compared to the bone mass of a healthy young adult of your gender.

  • -1 and above: Normal bone density
  • Between -1.1 and -2.5: Osteopenia (low bone density)
  • -2.5 and below: Osteoporosis

Z-score

Your Z-score measures your bone mass compared to healthy adults of your age, gender, weight, and ethnicity. If your score is significantly higher or lower than normal, you may need further medical tests.

 

If you meet any of the above mentioned recommendations for considering bone density testing, give Peninsula Radiology a call at (757) 898-8830. We’d love to help!

The Role of a Radiologist

role of radiology Depending on the illness or injury that brought them there, people tend to walk into their doctors’ offices with several questions that will hopefully guide them onto the path of recovery.  As new technologies develop and diagnostic systems advance with ever-increasing accuracy, the discussions between doctor and patient can become complex.  In order to properly diagnose and treat all of the injuries and diseases that occur within the human body, it is important that patients have a clear understanding about radiological procedures and all of its benefits.

A recent study presented at the annual Radiological Society of North America meeting determined that more than 64% of respondents stated that they had little or no understanding regarding the critical role of radiologist.  To clarify, radiologists specialize in producing pictures of the human body using state-of-the-art imaging technology, such as X-rays, ultrasound, and magnetic resonance imaging (MRI).  These medical specialists are central members of the multidisciplinary clinical care team who play a vital role in the diagnosis and treatment of diseases and injuries within adults and children, including babies and unborn fetuses.

Since Peninsula Radiological Associates is affiliated with the esteemed Riverside Health System, patients are offered the following specialties and services:

•    CAT Scans, which display several different types of tissue
•    X-rays, which identify and treat bone fractures
•    DEXA Scans, which measure bone loss and density
•    Embolization, which stop blood supply to destructive tumors
•    MRI, which diagnose cancer, vascular disease, and neurological disorders
•    Musculoskeletal imaging, which pinpoint spinal disorders and arthritis
•    Nuclear medicine, such as PET scans, which evaluate respiratory problems and organ function
•    Radiofrequency Ablation, which locate and eliminate tumors using electrical energy

Of course, there are several other imaging procedures available through the dependable care of our board-certified radiologists Women’s Imaging, for example, includes a wide range of valuable services related to breast cancer, such as digital mammography and image guided biopsy.

Because these terms can appear confusing or overwhelming to some patients, we uphold the ideas behind the “Radiology Cares” initiative, which seeks to effectively promote effective communication between the patient and healthcare providers.  As a result, our patients are empowered to make informed decisions regarding their rehabilitative care.

Overall, direct communication is essential to improving our community’s awareness of the dynamic role radiologists play in healthcare. Even more importantly, direct interactions with these specialists will enhance patient understanding and maintain comfort regarding their undergoing tests and procedures. These are the goals that we strive to achieve on a daily basis in order to provide the best healthcare possible.

We strongly encourage patient education, and are always ready and willing to answer any questions regarding your health.

Tomosynthesis a.k.a “3D Mammography”

radiologist va

Dr. Benjamin Pettus

As the first Breast Center of Excellence on the Peninsula, Riverside is committed to providing the highest level of care available within the bounds of current technology.

Mammography remains the “gold standard” method, proven to detect the majority of cancers at the earliest stages.  The best data available supports a 30-60% reduction in woman’s chances of dying of this horrible disease (based on changes in the whole population including women not being screened – effect for screened women is likely greater). This means that 3-6 out of every 10 women with breast cancer in our entire population would not be alive if it were not for the advent of screening!

Despite this, only 6 out of 10 women choose to undergo recommended ANNUAL screening.  Sadly, the majority of women dying of breast cancer were not getting annual screening at the time of diagnosis.  While no test is perfect, mammography remains the only test proven to reduce the risk of dying from breast cancer.  One in eight women get breast cancer at some point in their lives, please get screened somewhere.

Among women getting screened annually, we believe in a personalized approach to care.  We believe in providing access to testing and we believe in education so women can make decisions with which they are most comfortable.  We are sympathetic to the tremendous anxiety generated by the process of screening and early cancer detection.  Part of this simply has to do with the nature of the disease.  As a progressive disease, a woman’s chances of survival are dramatically improved the earlier the disease process is arrested.  Cancer starts as normal tissue that then changes.  Every woman’s tissue is unique and not all cancers look the same.  Many cancers are difficult to detect until they look different from normal tissue.  This means that there is a threshold below which detection is possible.  Our efforts to detect very subtle changes can result in many “false positives” requiring additional workup i.e. “call backs”, and even biopsies.   This is particularly true with the more sensitive/more costly tests such as breast MRI which is why we use them judiciously and predominantly in the most high risk women most likely to obtain benefit. Read more.

Screen Shot 2013-10-17 at 11.30.44 AMBut we all still agree: this is not “good enough”.  The women under our care are precious.  We have to look them in the eye when we tell them the “news”.  We all want to know in our hearts that we provided every possible tool and the best care possible.  Who you trust to read your mammogram is every bit as important as the tool itself.

Of all the options under active investigation, Tomosynthesis holds the most promise and is increasingly available. But we do a tremendous disservice to women by overstating this promise.  A more honest assessment is necessary so that women can make an informed decision. Read more

Tomosynthesis is an imaging technique that has been used since the 1930s but only recently applied to the breast because of radiation exposure issues that required significant retooling.  It does not generate “3D” images in the strictest sense though that description has gained favor due to ease of description/corporate marketing.  An x-ray beam sweep generates an image “slice” in the tissue of interest by blurring surrounding tissue with the exception of the focal point of the arc.  As one of the difficulties with breast imaging detection is “superimposition” of tissue, this technique has the most theoretical potential for women with denser tissue.

Initial studies, however, failed to show an improvement over conventional “2D” mammography, particularly for detection of calcifications that often are scattered through imaging planes.  “Change from prior studies” is also more difficult to assess – as some cancers do not look “mass-like” or have “spiculations”, there is a risk that the readers may have even more trouble detecting some cancers if they over-rely on the “tomo” images. Read more

Subsequent research efforts since this initial set-back have focused more on using this test as a supplement to regular mammography.  When utilized in a “combo mode” both images are generated at a single compression such that women may feel that only one exam was performed, but in fact a supplemental test was added to their examRiverside breast cancer screening.

Newer advances have improved the technology such that an equivalent dose can now be expected and prior pitfalls avoided by use of reconstructed 2D images.

Several studies have shown an increase in cancer detection and some have shown a decrease in call-back rates when used this way, but these are not always the same study.

In our hands we are seeing a decrease in the call-back rates, further confirming this in an incremental step forward.

In summary:

1) Tomosynthesis is still mammography.  It does not replace mammography, rather it is a supplemental test acquired at the same time as a conventional “2D” mammogram.

2) It is not “more gentle” – compression is still required and if not performed will reduce the quality of the exam.

3) It is not “faster”- the length of time in compression is longer for both tests.

4) Secondary to recent advances including the ability to reconstruct 2D data from 3D data, it is now the “same dose” as a mammogram though possibly higher in women with larger breasts if additional pictures need to be taken for full coverage.

5)  It is not really “3D” people say that to make description easy.

6) Even if not a “revolutionary” step forward it is at least an “incremental” improvement.

7) It is sometimes covered by insurance so out-of-pocket expenses may be higher.

Read more here.

We believe this is an incremental step forward.  Consider choosing this option especially if you are a woman with dense tissue, complex breast pattern, and intermediate to high risk. 

Virginia mammography

To your health!

Benjamin J. Pettus MD, PhD Fellowship Trained Mammographer for Riverside