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

What Is a PET Scan?

PET ScanPeninsula Radiology offers multiple diagnostic tests that are intended to diagnose diseases that are hidden from the naked eye.  While many people know the names of the different types of tests and scans, most do not know what the scans are intended to do.  One of the types of tests that is commonly performed at Peninsula Radiological Associates is a PET scan.

What is a PET scan?

A positron emission tomography, more commonly known as PET, is a type of procedure used to scan for possible diseases inside of your body. It uses gamma rays given off by a tracer to make a 3D image of the interior of your body possible. The way this works is that you are given the tracer, which is swallowed or injected, and it gives off low levels of radiation that the machine can pick up on, allowing it to map the inside of your body. It is a painless procedure, and has few risks associated with it. At the longest, the radiotracer will be out of your system within a day.

Why get a PET scan?

It’s an easy procedure that can detect and measure numerous things about the body, with the most important and often the most relevant being your oxygen use and blood flow. The scan is simple and non-invasive.

Why a PET scan over something else?

A lot of very dangerous diseases can be detected earlier with the aid of a PET scan, from cancer to brain disorders. The test can give you early warning for life-threatening diseases.  It can also detect the stages of heart disease, and can prevent stroke and heart attacks if the disease is found early.

In short, a PET scan is a relatively easy test to perform that can help to diagnose life threatening health situations. If your doctor recommends it, then it is a procedure that could very well save your life.

If you have been advised or referred for a PET scan, contact our office for an appointment with one of our radiology professionals.  Our team of providers has the experience and skill to provide outstanding health services in a compassionate, caring environment.


March is DVT Awareness Month

DVT logoDid you know that March is Deep Vein Thrombosis Awareness Month? This campaign is aimed at raising awareness among consumers, healthcare professionals, and policy-makers about DVT and pulmonary embolus (PE) blood clots on national, as well as local levels. For those of you who don’t know, DVT is a serious medical condition that results from a blood clot in the vein. These kinds of blood clots are normally found in the lower leg, but they can also occur in the arm and shoulder veins as well. The biggest risk of DVT is that a piece of the clot could break free and directly enter the blood stream. Since the blood in your veins travels straight to your lungs in order to exchange carbon dioxide for oxygen, the clot (now called embolus) will cause the vein to enlarge until it reaches your lungs, where the passageway narrows. PE can result when the blood clot blocks the vein and sufficiently stops further blood flow through the lung.

DVT mainly affects the larger veins in the lower extremities (like the lower leg, thigh, or calf). Normally, they are only on one side of your body. Symptoms include sudden loss of breath and dizziness. The blood clot can also cause noticeable redness and warmth on your skin, leg pain, and swelling.

According to the American Heart Association, DVT occurs in about 2 million Americans every year. Since they can be so immediately fatal, pulmonary embolus clots are responsible for an estimated 300,000 deaths in the U.S. per year, which is more than breast cancer and AIDS combined. With such frightening statistics, it is important to learn and spread the word about DVT and PE.

Although this condition can be prevented and treated with anticoagulant medications, our staff specializes in catheter-directed thrombolysis (CDT), which is a minimally invasive treatment that dissolves these troublesome blood clots directly in the blood vessel. By this procedure, x-ray imaging allows the physician to insert a specialized catheter into an affected vein in order to guide it to the blockage site. Once contact is made, the blood clot can then be dissolved by delivering either medication or a mechanical device to the affected area in order to break up the clot.

In addition to this process, we can also easily diagnose DVT by performing a duplex ultrasonography exam, which is a non-invasive procedure that allows us to visualize the flow of blood within an artery using color-doppler imaging.


What Is a Catheter Embolization?

iStock_000006042109Large-revAt Peninsula Radiology Associates, we believe patient education is an important facet of our services. We know that many of our patients like to familiarize themselves with procedures before we meet them. One of the procedures frequently performed is called catheter embolization.

What Is a Catheter Embolization?

Embolization, also known as catheter embolization, is a radiologic procedure used to introduce medications or synthetic embolic agents into a blood vessel to occlude — or block — blood flow. This procedure is often indicated to:

  • Stop abnormal bleeding, particularly gastrointestinal or pelvic bleeding.
  • Eliminate abnormal connections between arteries and veins, including AVMs (arteriovenous malformations) and AVFs (arteriovenous fistulas).
  • Cut blood supply to a tumor, including benign (non-cancerous) uterine fibroids in women and cancerous tumors in both men and women. Following embolization, a malignant tumor may shrink or grow more slowly, making chemotherapy and/or surgery more effective patient options.
  • Treat aneurysms, which are bulges or sacs formed in weak artery walls.
  • Treat varicoceles — enlarged veins — in the scrotum, which may contribute to infertility.

Embolization is a highly effective procedure, which can be performed on an outpatient basis. It helps you avoid more invasive surgical treatments or interventions for these and other common conditions when used alone. Catheter embolization may also be combined with other treatments such as surgery or radiation.

What To Expect During the Catheter Embolization Procedure?

During catheter embolization, a physician called an interventional radiologist will use fluoroscopy — an imaging process that is similar to X-rays, but provides live, real-time moving images of your body — to carefully guide a catheter to the area within your body requiring treatment. A catheter is a long, thin plastic tube measuring about one-eighth of an inch in diameter that can be threaded safely through your arterial system.

Once your catheter has been placed, your physician injects a contrast material with iodine through it so that X-rays can be taken to indicate the precise site of your bleeding or abnormality. Then your interventional radiologist inserts the appropriate embolic agent through the catheter. The precise agent placed depends on the condition for which you are being treated. Common embolic agents include:

  • Acrylic polymer spheres, which are used to permanently block small blood vessels.
  • Small metallic coils, which are frequently used to permanently stop abnormal bleeding.
  • Liquid sclerosing agents, which are chemicals designed to cause scarring in a blood vessel that permanently seals the vessel.

Post Procedure Recommendations

You are normally sedated, using either a moderate or general anesthetic, and fitted with an IV (intravenous) drip and monitors for your vital signs at the start of the procedure.

Since arteries have no sensation, you should not experience any discomfort from the catheter once it has been inserted. You may experience a warm feeling from the contrast dye or other sensations when your embolic agent is administered, depending on your level of sedation. X-rays are taken to verify the success of the procedure.

Bed rest is recommended for at least six to eight hours following your procedure. You may experience some side effects after catheter embolization. Pain is a common one and is controlled by either oral medication or medication administered through your IV.

To schedule an appointment at Peninsula Radiology Associates, please call (757) 989-8830. We are proud to be affiliated with the Riverside Hospital system and have seven locations throughout Hamptons Roads to serve you. Please contact us with any questions about catheter embolization or the many other procedures and services our board-certified radiologists and experienced team expertly and compassionately provide.


concussionA concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. Concussions are a concern for young athletes in sports that involve contact. Signs and symptoms generally show up soon after the injury. However, you may not know how serious the injury is at first and some symptoms may not show up for hours or days. Monitoring an injured child or adult is essential to recognizing symptoms that require medical care.  Diagnosing a concussion through the appropriate imaging testing, such as those done at Peninsula Radiology, is the most accurate form of diagnosis.


Common Causes of Concussion

There are many ways to get a concussion. Some common ways include

  • fights
  • falls
  • playground injuries
  • car accidents
  • bike accidents
  • Participating in any sport or activity such as:
    • football
    • soccer
    • boxing
    • hockey
    • skiing
    • snowboarding


Symptoms of a Concussion

It is not always easy to tell if you have a concussion. You don’t have to pass out (lose consciousness) to have a concussion. Symptoms of a concussion range from mild to severe and can last for hours, days, weeks, or even months. If you notice any symptoms of a concussion, contact your doctor. Physical symptoms of a concussion include:


  • Nausea and vomiting
  • Headache and pressure in head
  • Fuzzy or blurry vision
  • Dizziness
  • Sensitivity to light or noise
  • Balance problems
  • Feeling tired or having no energy


How is a concussion diagnosed?

You need to see a doctor if you have sustained an injury or blow to the head and are showing symptoms of a concussion. If a doctor thinks that you have a concussion, he or she will ask questions about the injury. Your doctor may test your reflexes and order a CT Scan or an MRI to make sure the brain is not swelling, bleeding or bruised.


Treatment for a Concussion

The treatment for a concussion involves resting and abstaining from all physical activity until your doctor has determined it is safe. Rest is the best way to recover from a concussion. Getting plenty of sleep and avoiding activities that are mentally and physically demanding will hasten your recovery rate.


Preventing Concussions

Experts agree that the best ways to prevent concussion are to:

  • Play by the rules. Teaching young athletes to respect and follow the rules of their sport is part of good coaching.
  • Wear the appropriate equipment for your sport and wear it properly. Always close a chin strap if your sport requires a helmet; many concussions occur during practice.
  • Examine the playing field for uneven areas or holes.
  • Make certain that goal posts are padded sufficiently.
  • Practice good sportsmanship. Teaching good sportsmanship is part of good coaching and good parenting; minimizing unnecessary aggression on the field.
  • Learn and use proper technique for your sport. Some sports organizations have taken additional action to minimize the risk of concussion by limiting the number of contact practices allowed during the season.

If you’ve suffered any of the above causes of concussion and are showing symptoms, it is vitally important to seek medical care.  Peninsula Radiology’s team of highly trained imaging professionals and medical providers are able to diagnose concussion after a thorough review of imaging tests.  Contact us at (757) 989-8830 for more information.


Happy Holidays From Peninsula Radiology Associates!

Happy Holidays

The Musculoskeletal System Explained

musculoskeletalThe musculoskeletal system is the network of muscles and bones within the body. Injuries, conditions like arthritis, and other growth and degeneration problems can cause pain and disorders that cannot always be identified with a physical exam. It is a musculoskeletal radiologist’s job to conduct medical imaging of the problem areas to figure out what is happening to your body.

Musculoskeletal problems can be the result of anything from work accidents and sports injuries to genetics and lifestyle choices, and many other circumstances. Some of these problems include osteoarthritis of the knee, osteoporosis of the bones, and other joint or muscle issues.

In order to accurately diagnose and treat Musculoskeletal Conditions, Peninsula Radiology offers a full spectrum of imaging services. Our radiologist utilize CTMRI, musculoskeletal ultrasound, bone biopsies and bone mineral density studies to effectively look inside of a patient’s body. Since musculoskeletal disorders and injuries affect bones and muscles specifically, this is where these kinds of radiologists focus their attention. Thanks to these technologies and our expert staff, we are able to diagnose a wide range of disorders of the musculoskeletal system.

Our Musculoskeletal Imaging Radiologists work closely with our other departments to ensure that every diagnosis is accurate and that treatment plans for musculoskeletal conditions are the most effective available.

Conditions that fall in the range of Musculoskeletal Imaging include patients with the following:

  • Patients with disorders of the spine, upper & lower extremities
  • Arthritis
  • Cancers of the soft tissues & bones

For more than 50 years, Peninsula Radiological Associates has provided quality medical imaging services. Our team of board certified and fellowship-trained radiologists have over 200 years of combined experience.  As a team we deliver the most comprehensive range of medical diagnostic imaging and interventional radiological procedures available on the Virginia Peninsula.

At Peninsula Radiology, it is our goal to always utilize the least invasive technology for diagnosis. We only advance to more complex procedures when it is necessary. Call (757) 595-6363 or go online to schedule an appointment for imaging services.

Schedule your Annual Mammogram Online

mammogram scheduler Have you scheduled your annual Mammogram for 2018? The fact is that mammography is the best tool available to screen for breast cancer. Mammography has helped reduce the breast cancer death rate in the United States by 30 percent.

The American Cancer Society recommends women 40 years and older have an annual screening mammogram to aid in early detection of breast cancer. If you are under 40 years old, talk to your doctor to see what screening program will work best for you, especially if you have a personal or family history of breast cancer.

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.

Annual mammograms can detect cancer early — when it is most treatable. In fact, mammograms show changes in the breast up to two years before a patient or physician can feel them. Mammograms can also prevent the need for extensive treatment for advanced cancers.

To schedule your annual mammogram through Riversides’ state-of-the-art Women’s Imaging Center, visit the Online Scheduler today.

Once you have your appointment scheduled, you can visit the Peninsula Radiology website to find maps and directions to your breast imaging center.


National Prostate Awareness Month

imagesSeptember is National Prostate Cancer Awareness month and Peninsula Radiology Associates would like to encourage you to make prostate health a priority. The focus during Prostate Cancer Awareness month is education and prevention. Urologists recommend that men discuss prostate cancer with their doctors and get tested. Cancer screenings look for cancer before it causes symptoms.  Like any cancer, early detection can be life saving.

Our team of accomplished physicians at PRA have a wide range of sub-specialty, fellowship trained expertise, which allows them to provide our patients with outstanding care. Doctors recommend men get a prostate exam beginning at age 50, but if there’s a family history of cancer, they recommend getting tested at age 40.

During National Prostate Awareness Month, Healthline Networks empowers men to learn the steps they can take to protect their prostate:

  • Diet – research suggest the following foods should be included in your diet to reduce your risk factors
    • Tomatoes
    • Watermelon
    • Antioxidant known as Lycopene
    • Green Vegetables
    • Omega 3 fatty acid including fish and fish oil
    • Soybean – tofu, chickpeas, lentils
    • Replace animal fats with healthy plant based fats
  • Stop Smoking
  • Exercise regularly to reduce fat in the middle of the body
  • Talk to your doctor about prostate screenings and inform your doctor of any changes in urination or discomfort in your pelvic area.

Join PRA in recognizing National Prostate Awareness Month by taking these steps today! Make your prostate health a priority. And don’t forget to spread the word to your family and friends. Our team of board certified and fellowship trained radiologists have delivered the most comprehensive range of medical diagnostic imaging and procedures available anywhere on the Virginia Peninsula. Call Peninsula Radiology Associates today (757) 989-8830 for your medical diagnostic procedures.

Understanding Radiology

Screen Shot 2014-04-09 at 2.04.32 PMWhat is Radiology?

The field of radiology began with the discovery of X-radiation by Wilhelm Roentgen in 1895. Since then, radiology has evolved tremendously. These days, radiology is central to the clinical practice of medicine across a wide range of disciplines. It is the best practical way to diagnose, monitor treatment and detect progression or relapse of many important and common diseases in a minimally invasive manner.

What is the role of a Radiologist? 

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.

Radiological Procedures

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.

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