Radiology

The Radiology Department provides a wide variety of imaging modalities, both inpatient and outpatient, including diagnostic, CT, nuclear medicine, ultrasound, interventional, non-invasive, vascular ultrasound, and MRI, performed by highly skilled certified technologists.

The Radiologists who interpret these procedures are all board-certified by the American College of Radiology. 


MRI (magnetic resonance imaging)

Magnetic resonance imaging (MRI) uses radiofrequency waves and a strong magnetic field rather than x-rays to provide remarkably clear and detailed pictures of internal organs and tissues. The technique has proven very valuable for the diagnosis of a broad range of pathologic conditions in all parts of the body including cancer, heart and vascular disease, stroke, and joint and musculoskeletal disorders. MRI requires specialized equipment and expertise and allows evaluation of some body structures that may not be as visible with other imaging methods.

How is the MRI performed?

The patient is placed on a sliding table and positioned comfortably for the MRI examination. Then the radiologist and technologist leave the room and the individual MRI sequences are performed. The patient is able to communicate with the radiologist or technologist at any time using an intercom. Depending on how many images are needed, the exam will generally take 15 to 45 minutes, although a very detailed study may take longer. You will be asked not to move during the actual imaging process, but between sequences some movement is allowed. Patients are generally required to remain still for only a few seconds to a few minutes at a time.

Depending on the part of the body being examined, a contrast material (usually gadolinium) may be used to enhance the visibility of certain tissues or blood vessels. A small needle connected to an intravenous line is placed in an arm or hand vein. A saline solution will drip through the intravenous line to prevent clotting until the contrast material is injected about two-thirds of the way through the exam.

When the exam is over the patient is asked to wait until the images are examined to determine if more images are needed. A radiologist experienced in MRI will analyze the images and send a report with his or her interpretation to the patient's personal physician. This should take only a few days or less.

What will I experience during the MRI procedure?

MRI causes no pain but some patients can find it uncomfortable to remain still during the examination. Others experience a sense of being "closed in," though the newer MRI systems have done much to reduce that reaction.  Stereo headphones are provided to calm patients and reduce anxiety. You may notice a warm feeling in the area under examination; this is normal but if it bothers you the radiologist or technologist should be notified.

If a contrast injection is needed, you may have a cool sensation at the site during the injection. Most bothersome to many patients are the loud tapping or knocking noises heard at certain phases of imaging. Patients are provided ear plugs to reduce the noise level.

Ultrasound

Ultrasound imaging, also called ultrasound scanning or sonography, is a method of obtaining images from inside the human body through the use of high-frequency sound waves. The reflected sound wave echoes are recorded and displayed as a real-time visual image. No ionizing radiation (x-ray) is involved in ultrasound imaging. Obstetric ultrasound refers to the specialized use of sound waves to visualize and thus determine the condition of a pregnant woman and her embryo or fetus.

Ultrasound is a useful way of examining many of the body's internal organs, including but not limited to the heart, liver, gallbladder, spleen, pancreas, kidneys and bladder. Because ultrasound images are captured in real time, they can show movement of internal tissues and organs and enable physicians to see blood flow and heart valve functions. This can help to diagnose a variety of heart conditions and to assess damage after a heart attack or other illness.

How is the ultrasound performed?

The patient is usually positioned on an examination table. A clear gel is applied to the patient's body in the area to be examined to help the transducer make secure contact with the skin. The sound waves produced by the transducer cannot penetrate air so the gel helps eliminate air pockets between the transducer and the skin. The technologist or radiologist presses the transducer firmly against the skin and sweeps it back and forth to image the area of interest.

When the examination is complete the patient may be asked to dress and wait while the ultrasound images are reviewed either on film or on a TV monitor. Often though, the technologist or radiologist is able to review the ultrasound images in real time as they are acquired and the patient can be released immediately.

What will I experience during the ultrasound?

Most ultrasound examinations are painless, fast and easy. You will lie on your back on an examining table. The technologist or doctor will spread some warm gel on your skin and then press the transducer firmly against your body, moving it until the desired images are captured. There may be varying degrees of discomfort from pressure as the technologist guides the transducer over your abdomen, especially if you are required to have a full bladder. The examination usually takes less than 30 minutes.
 

CT  (Computed Tomography)

Computed tomography (CT) scan, sometimes called a CAT scan, uses special x-ray equipment to obtain image data from different angles around the body and then uses computer processing of the information to show a cross-section of body tissues and organs.

CT imaging is particularly useful because it can show several types of tissue—lung, bone, soft tissue and blood vessels—with great clarity. Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as cancers, cardiovascular disease, infectious disease, trauma and musculoskeletal disorders.

How is the CT scan performed?

The technologist begins by positioning the patient on the CT table. The patient's body may be supported by pillows to help hold it still and in the proper position during the scan. As the study proceeds, the table will move slowly into the CT scanner. Depending on the area of the body being examined, the increments of movement may be so small that they are almost undetectable or large enough that the patient feels the sensation of motion.

A CT examination often requires the use of different contrast materials to enhance the visibility of certain tissues or blood vessels. The contrast material may be swallowed, injected through an IV directly into the blood stream or administered by enema, depending on the type of examination. Before administering the contrast material, the radiologist or technologist will ask whether the patient has any allergies, especially to medications or iodine, and whether the patient has a history of diabetes, asthma, a heart condition, kidney problems or thyroid conditions. These conditions may indicate a higher risk of reaction to the contrast material or potential problems eliminating the material from the patient's system after the exam.

A CT examination usually takes five minutes to half an hour. When the exam is over the patient may be asked to wait until the images are examined to determine if more images are needed.

What will I experience during the CT scan?

CT scanning causes no pain, and with spiral CT the need to lie still for any length of time is reduced. For different parts of the body the patient preparation will be different. You may be asked to swallow either water or a positive contrast material, a liquid that allows the radiologist to better see the stomach, small bowel and colon. Some patients find the taste of the contrast material mildly unpleasant but most can easily tolerate it. Your exam may require the administration of the material by enema if the colon is the focus of the study. You will experience a sense of abdominal fullness and may feel an increasing need to expel the liquid. Be patient; the mild discomfort will not last long.

A contrast material is commonly injected into a vein to better define the blood vessels and kidneys and to accentuate the appearance between normal and abnormal tissue in organs like the liver and spleen. Some people report feeling a flush of heat and sometimes a metallic taste in the back of the mouth. These sensations usually disappear within a minute or two. Some people experience a mild itching sensation. If it persists or is accompanied by hives (small bumps on the skin), the itch can be treated easily with medication. In very rare cases, a patient may become short of breath or experience swelling in the throat or other parts of the body. These can be indications of a more serious reaction to the contrast material that should be treated promptly, so tell the technologist immediately if you experience these symptoms. Fortunately, with the safety of the newest contrast materials, these adverse effects are very rare.

You will be alone in the room during the scan; however, the technologist can see, hear and speak with you at all times. For pediatric patients, a parent may be allowed in the room with the patient to alleviate fear but will be required to wear a lead apron to prevent radiation exposure.

Mammography

Mammography is a specific type of imaging that uses a low-dose x-ray system for the examination of breasts. A mammography exam, called a mammogram, is used as a screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain or nipple discharge.

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 from the U.S. Department of Health and Human Services (HHS), the American Cancer Society (ACS), the American Medical Association (AMA) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40. Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available.

How is the mammogram performed?

During mammography, a specially qualified radiologic technologist will position your breast in the mammography unit. Your breast will be placed on a special platform and compressed with a paddle (often made of clear Plexiglas or other plastic).

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 since 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.

The technologist will stand behind a glass shield during the x-ray exposure. You will be asked to change positions slightly between images. The routine views are a top-to-bottom view and an oblique side view. The process will be repeated for the other breast.

The examination process should take about half an hour. When the mammography is completed you will be asked to wait until the technologist examines the images to determine if more are needed.

What will I experience during the mammogram?

You will feel pressure on the 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. The technologist will gradually compress your breast. Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression will be used.

The National Cancer Institute (NCI) adds that 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.

The Mammography Department is accredited by the American College of Radiology and the Federal Food and Drug Administration. A certified technologist utilizing dedicated mammography equipment performs the exams.

Bone Density

Every day, physicians use radiography, or x-rays, to view and evaluate bone fractures and other injuries of the musculoskeletal system. However, a plain x-ray test is not the best way to assess bone density. To detect osteoporosis accurately, doctors use an enhanced form of x-ray technology called dual-energy x-ray absorptiometry (DXA or DEXA). DEXA bone density is today's established standard for measuring bone mineral density (BMD). DEXA is a quick, painless procedure for measuring bone loss. Measurement of the lower spine and hips are most often done. More portable devices that measure the wrist, fingers or heel are sometimes used for screening, including some that use ultrasound waves rather than x-rays.

How is the bone density performed?

The bone density test takes from 10 to 30 minutes, depending on the equipment used and the parts of the body being examined. You may be asked to undress and put on a hospital gown. Then you'll lie on a padded table with an x-ray generator below and a detector (an imaging device).  (see photo)

Most often, doctors focus on bone loss in the spine and hip where most osteoporosis-related fractures happen. During an examination of the spine, your legs will be supported on a padded box to flatten your pelvis and lower (lumbar) spine. To assess your hip, the technologist will place your foot 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.

What will I experience during the bone density procedure?

DEXA bone densitometry is a simple, non-invasive procedure. Once on the table you may be asked to hold an awkward position for a short time while the arm of the machine passes over your body taking measurements. It is important that you stay as still as possible during the procedure to ensure a clear, useful image. No anesthesia is required. The procedure is painless and radiation exposure is minimal.