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Mammography

What is Mammography?
Mammography is a specific type of imaging that uses a low-dose x-ray system to examine breasts and is used to aid in the early detection and diagnosis of breast diseases in women.

Screening Mammography
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 when breast-conservation therapies are available.

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 as well as the frequency of screening.

Diagnostic Mammography
Diagnostic mammography is used to evaluate a patient with abnormal clinical findings. Example: breast lump, nipple discharge, change in skin colour or texture, retraction of the nipple etc.

Diagnostic mammography may also be done after an abnormal screening mammogram in order to evaluate the area of concern on the screening exam.

How is the Mammogram procedure performed?
Mammography is performed on an outpatient basis. During mammography, a specially qualified radiographer 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). The radiographer will gradually compress your breast.

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 are less likely to 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 minimize 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. Routinely two views of each breast are taken. They are a top-to-bottom view and an oblique side view. You must remain very still and you may be asked to hold your breath for a few seconds while the x-ray image is taken to reduce the possibility of blurring.

The images are then interpreted by a radiologist who may require further views or an ultrasound of the breast, if there is an area of concern. The ultrasound compliments the mammogram, and can pick up abnormalities that are not seen on mammogram, eg, cysts or small masses.

The examination process should take about 30 minutes but there may be a waiting period for the ultrasound.

Contrast-Enhanced Spectral Mammography
In our commitment to diagnostic excellence in woman’s health, Jackpersad & Partners Inc is proud to be the first practice in the country to offer Contrast-Enhanced Spectral Mammography.

Description and Overview
This study is performed as an adjunct to inconclusive mammography and ultrasound studies. SenoBright Contrast-Enhanced Spectral Mammography (CESM) from GE Healthcare can help physicians by providing answers regarding the presence or absence of breast cancer quicker. It can help to minimize the waiting time and anxiety to get test results. Using an iodine contrast agent, SenoBright takes two images per view at different X-ray exposures. It then combines these two images to highlight contrast-enhanced areas of unusual blood flow patterns which may be cause for increased suspicion.

Patient Benefits
  • Simple, quick, five-to-ten-minute procedure is much like a regular mammography exam
  • Helps minimize the wonder and the worry of waiting for results
  • Exam can be performed with the same mammographic equipment.

Physician Benefits
  • Reach decisions sooner regarding the presence or absence of breast cancer
  • Cuts the critical patient waiting time from detection to diagnosis

Relevant Statistics and Trends
  • Currently, 20% of all cancers are missed by routine screening mammography
  • Of every 1,000 women who undergo routine screening mammograms, 10%, or 100, will be called back for follow-up ultrasound, MRI, or mammographic imaging
  • Of those 100 women, 10 will undergo biopsy
  • 70% of those biopsies will be negative, with three confirmed cases of cancer

What if you require a biopsy?

  • If there is an area of concern, the radiologist may suggest a biopsy to exclude underlying cancer.
  • This is a special procedure and may be booked for another day.
  • The biopsy may either be done under ultrasound guidance or stereotactic guidance.
  • The ultrasound guided biopsy is done under local anaesthetic in the ultrasound room.
  • The radiologist uses the ultrasound probe to guide him to the lesion and he can actually watch the needle to confirm that he has biopsied the lesion.
  • The stereotactic biopsy, requires a special biopsy apparatus attached to the mammogram unit and is currently only done at our Mediclinic, Westridge, Chatsmed and Hillcrest branches.
  • The patient is seated for this procedure X-rays of the area of interest is taken , the area of concern is pin pointed and localized using special techniques and the exact position is determined by the computer and set for the radiologist to biopsy.
  • The procedure is quite accurate.
  • The specimens are then sent to the laboratory for analysis(Histology).

If on blood thinners: stop for 3 days prior to biopsy
Do INR + platelets either the morning of biopsy, or the day before.

Tomosynthesis

Tomosynthesis is an imaging technique in which multiple X-rays of the breast are taken from a discrete number of angles. These cross-sectional images are used to reconstruct 3-D images of the breast being imaged. Tomosynthesis differs from computed tomography because the range of angles used is less than 360°, which is used in CT. Tomosynthesis is performed in addition to 2D mammography, and aids in further detection of breast lesions.

Breast Biopsy

A Breast Biopsy is where a special needle is inserted into the breast to take a small sample of breast tissue from an area of concern so that it can be sent to a laboratory for testing. An abnormality may have been identified on a scan or X-ray image or may have been felt as a lump.

The radiologist performing the biopsy will insert the needle using guidance from ultrasound or mammogram images. This ensures the tissue sample is taken from the area where the abnormality has been identified.

You should bring recent breast imaging (mammograms and/or ultrasounds) and reports for the doctor performing the procedure to review before doing the biopsy. It is advisable to have someone drive you home after the procedure.

Do not wear talcum powder or deodorant on the day of the biopsy as these can mimic or imitate calcium spots in the breast which makes it harder for the radiologist to identify the abnormality that requires biopsy. You might consider the clothes you wear on the day so you only need to remove clothes from the upper part of your body.

The skin of the breast is swabbed with antiseptic and then a very fine needle is used to administer local anaesthetic to numb the area of the breast for biopsy. The local anaesthetic stings for only a few seconds when it is being administered, and after this the area will be numb.

A small cut is made in the skin and the biopsy needle is gently inserted into the breast. Several samples are taken. When each sample is taken there is a clicking noise, and you may have a feeling of pressure in the breast where the sample is taken. The biopsy procedure may sometimes feel uncomfortable but is not usually painful because of the local anaesthetic used.

After the samples have been taken, the biopsy area will be pressed on firmly for a few minutes to reduce bleeding, and then covered with a sterile dressing.

The area that has been biopsied may feel a little tender for several days and there is usually some bruising. If the biopsy area is painful you can take paracetamol. Aspirin is not recommended because it thins the blood and can increase bruising or bleeding at the biopsy site. You should avoid vigorous physical exercise or heavy lifting for 24 hours after the procedure as this may cause a bleed.

The small nick or cut that was made for the biopsy usually heals over in a few days and you will have a tiny scar that will be barely visible once healed. There is a very small risk of infection. In the very unlikely event that the biopsy site becomes infected, a course of antibiotics may be required from your doctor.

Contact your doctor if you experience excessive swelling, bleeding, have fluid draining from the wound, redness or heat in the breast after the biopsy.

The time taken for the procedure varies according to how the biopsy is done. For example, an ultrasound guided core biopsy may take only 20 minutes. A mammographic guided core biopsy (also called a “stereotactic”) may take up to an hour.

Doing a biopsy of tissue, especially if it is 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 complication is a rare occurrence and is called a pneumothorax.

A Breast Biopsy is a way of getting accurate information without needing an operation to surgically remove the tissue for testing.

Stereotactic Breast Core Biopsy

A Stereotactic Breast Biopsy is a minimally invasive procedure, which uses x-ray imaging techniques to gather tissue samples from a breast abnormality. Sometimes these abnormalities turn out not to be a problem. If there is a potential problem, early detection is essential and increases treatment options and the likelihood of successful recovery.

For your Stereotactic Breast Biopsy appointment, you should plan on being at Jackpersad for a couple of hours, which will include all pre- and post-procedure care. The procedure itself will take about 60 minutes. The breast being biopsied will be compressed (similar to a mammogram), while x-ray imaging is used to help locate the abnormality.

Once the abnormality is located, the area will be sterilized. A radiologist will inject a local anesthetic into your skin and deeper tissues to numb the area. A very small skin incision will be made. Most patients experience some minor discomfort during this procedure.

The radiologist will then use imaging techniques to locate the abnormality and extract several tissue samples to be sent to and interpreted by a pathologist. After the tissue is removed, a small metallic marker will be placed in your breast. This marker is a reference point for future imaging, and confirms that the area of concern has been biopsied.

Following your Stereotactic Breast Biopsy, you will need to wear a supportive bra and keep the sterile dressing that covers the incision clean and dry for the first 24–48 hours. You should apply an ice pack over the biopsy site following the procedure. Detailed self-care instructions will be provided to you immediately following your biopsy.

Avoid any strenuous activity for 48 hours following your procedure, especially activities that involve repetitive movement of the chest and arms, such as lifting, vacuuming, swimming and exercising.

Ultrasound Guided Breast Core Biopsy

An Ultrasound-Guided Breast Biopsy is a non radiation, minimally invasive technique used to gather tissue samples from a breast abnormality discovered during a diagnostic mammogram and/or breast ultrasound. Sometimes these abnormalities turn out not to be a problem. If there is a potential problem, early detection is essential and increases treatment options and the likelihood of successful recovery.

For your Ultrasound-Guided Breast Biopsy appointment, you should plan on being at Jackpersad for approximately an hour, which will include all pre- and post procedure care. Most diagnostic procedures are simple to prepare for and have a quick recovery time. With a few easy steps you will be ready for your procedure.

Once the abnormality is located, the area will be cleaned. A radiologist will inject local anesthetic into your skin and deeper tissues to numb the area. A very small skin incision—approximately 1/4 inch— will be made. Most patients experience some minor discomfort during this procedure. Some experience no discomfort at all.

The radiologist will then use imaging techniques to locate the abnormality and extract several tissue samples to be sent to and interpreted by a pathologist.

Most diagnostic procedures are simple to prepare for and have a quick recovery time. With a few easy steps you will be ready for your procedure.

Following your Ultrasound-Guided Breast Biopsy, you will need to wear a supportive bra and keep the gauze dressing that covers your incision clean and dry for the first 24–48 hours. Avoid any strenuous activity for 48 hours following your procedure, especially activities that involve repetitive movement of the chest and arms, such as lifting, vacuuming, swimming and exercising hours. You should ice the biopsy site following the procedure. Detailed self-care instructions will be provided to you immediately following your biopsy.

Ultrasound

Ultrasound includes sound waves in the frequency range of Twenty Thousand hertz or cycles per second, which cannot be heard by the human ear. Ultrasound in medical imaging uses frequencies in the 2-12 million hertz range.

Ultrasound imaging produces detailed images of the internal structures and organs of the body. A hand held device called a transducer transmits a series of sound waves through the body. Sound waves that are reflected by internal structures and organs are also received by the transducer, transmitting them to a computer, which converts the data into an image displayed on a monitor.

Ultrasound images are captured in real time, showing the structure of organs as well as blood flow through the vessels. It produces detailed images of soft tissues that are not well shown on X-rays. No ionizing radiation is used to produce the image therefore ultrasound is a safe procedure.

Depending on the nature of the clinical query, ultrasound imaging can be used to assess various organs and structures in the body. Ultrasound can also be used as a guide to direct biopsy procedures and needle placements for cyst aspirations.

How is the examination done?

  • You will be asked to undress and wear a gown or your clothing will be moved away from the region to be examined.
  • You will lie on an exam table, warm gel will be applied to the area of examination.
  • A sonographer presses the transducer against your skin and moves it back and forth to obtain the necessary images.
  • The radiologist may obtain more images after the sonographer has completed the examination.

Interpretation of images and results

A radiologist who specializes in ultrasound will review the images and issue a report to your referring doctor. The radiologist may discuss early findings with you when your exam is over.

Abdominal Ultrasound

The organs most often examined include the liver, gallbladder, biliary system, spleen, pancreas, kidneys, aorta and urinary bladder.

  • For ultrasounds of the abdomen you must fast for at least 8 hours before the exam.
  • For evaluation of the urinary bladder, a full bladder is required and you will be asked to drink 4-6 glasses of water at least 30 minutes prior to the examination.

Pelvic Ultrasound

Pelvic ultrasound in women is used to examine the uterus, ovaries, fallopian tubes, and nearby structures such as blood vessels and lymph nodes.

In men, the pelvic ultrasound is used to examine the bladder and the prostate gland. A full bladder is required for all pelvic ultrasounds.

Musculoskeletal Ultrasound

With advances in technology and image quality the use of ultrasound to assess the musculoskeletal system has increased considerably.

Muscles, tendons, ligaments and soft tissues lining the joints can be evaluated. It is a painless, non invasive method to assess joint problems due to injury, degeneration or arthritis.

Vascular Ultrasound

Vascular ultrasound is a useful method to examine the arteries and veins in the body. Not only are the structures of blood vessels assessed, but using a special technique called Doppler, measurements can be done to determine direction, speed and pressure of blood flow in the vessels.

It is a useful investigation to help diagnose conditions such as:

  • Detecting blood clots (thrombosis) in the veins.
  • Determining the location and severity of varicose veins, by locating poorly functioning valves
  • Identify and characterise blockages (stenosis) in the arteries of the neck and legs causing decreased circulation
  • Determine if there is enlargement of an artery (aneurysm)
  • Evaluate the success of procedures such as bypass grafts.
  • Evaluate the circulation in tumours.
  • No special preparation is necessary
  • Depending on the region to be examined you may be asked to undress and wear a gown during the procedure.
  • For non emergency examinations booking an appointment is essential as some examinations are time consuming

Obstetric Ultrasound

Obstetric Ultrasound is the use of ultrasound imaging in pregnancy. It is a safe, non-invasive, accurate and a cost-effective investigation of the foetus. It has proven to be a useful diagnostic tool in obstetrics, playing an important role in the management of every pregnant woman. With effect from 1 October 2013, antenatal obstetric scans will no longer be offered beyond 13 weeks gestation i.e. beyond the 1st trimester. First trimester scans will continue to be done for diagnosis of pregnancy, location and gestational age only. See circular below for further explanation:

Small Parts Ultrasound

Ultrasound imaging is a useful way of evaluating many superficial organs of the body such as the thyroid gland, the salivary glands, the eye, breast, scrotum and testes.

Thyroid ultrasound
Is used for diagnosing suspected thyroid disease. The ultrasound can establish if the thyroid gland is enlarged, has solid or fluid filled nodules as well as determine its vascularity.

Testicular ultrasound
Is the primary imaging method used to evaluate problems in the testicles and surrounding tissues. Indications for an ultrasound scan include pain or lumps in the scrotum, testicular torsion (twisted testis), an absent or undescended testicle, fluid collection, or abnormal collection of blood vessels.

Breast ultrasound
Is used as a primary examination in young females who present with breast lumps to differentiate between a solid and fluid filled lump. Generally it is a supplementary investigation to mammography to further clarify the nature of lumps seen on mammogram. Ultrasound is also used for direct biopsies or as a guide for needle placement to aspirate cysts.

Orbital ultrasound
Is also a useful method to detect eye abnormalities. These include locating foreign bodies, the eyeball and its contents, and the retina.

Salivary gland ultrasound
Is helpful in determining the nature of lumps in the glands, as well as detecting stones in the duct

Bone Densitometry (BMD)

Bone densitometry, also called dual-energy x-ray absorptiometry (DEXA) uses low dose xrays to produce images of the bones. It is most commonly performed on the lumbar spine and hips but sometimes also includes the distal forearm. There is good correlation between the amount of bone measured, and bone strength. DEXA is an established standard for measuring bone mineral density (BMD). By measuring BMD, it is possible to predict fracture risk in the same manner that measuring blood pressure can help predict the risk of stroke. A whole body scan can also be performed depending on the indication.

Osteoporosis
Osteoporosis is a disorder of the skeleton resulting in compromised bone strength, leading to an increased risk of fracture. A reduction in bone mass and strength make bones fragile, thereby fracturing easily. Fractures usually involve the hip, spine and wrist, and are a major cause of suffering, disability and death in the elderly population.

Worldwide osteoporosis affects 1 in 3 women and 1 in 5 men over the age of 50 years. Individuals with risk factors are more likely to develop osteoporosis.

Risk factors

  • Early menopause ( before the age of 45 or hysterectomy)
  • Family history of osteoporosis
  • Long term use of corticosteroid medication
  • Primary or secondary hypogonadism in men and women
  • Chronic diseases such as
    • Intestinal Disorders: inflammatory bowel disease, chronic liver disease, Malabsorption syndrome.
    • Hormonal Disorders: primary hyperparathyroidism, hyperthyroidism, Cushing’s syndrome.
  • Malignant diseases
  • Osteodystrophy in paediatrics
  • Renal disease

Risk factors that cannot be altered include:

  • Age
  • Gender
  • Ethnicity
  • Family History

Modifiable risk factors that can be altered by lifestyle changes are:

  • Smoking and alcohol intake
  • Low body mass index
  • Poor nutrition and eating disorders.
  • Insufficient exercise
  • Low dietary calcium intake.

General X-Rays

An x-ray (radiograph) is a non invasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce images of the body. X-rays are the oldest and most frequently used form of medical imaging.

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

The equipment typically used for bone x-rays consists of an x-ray tube suspended over a table on which the patient lies. A drawer under the table holds the x-ray film or image recording plate. Sometimes the x-ray is taken with the patient standing upright, as is the case with chest x-rays.

A portable x-ray machine is a compact apparatus that can be taken to the patient in a hospital bed or the emergency room. The x-ray tube is connected to a flexible arm that is extended over the patient while the x-ray film holder or image recording plate is placed beneath the patient.

Different parts of the body absorb x-rays differently. Dense bone absorbs more radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of grey and air appears black.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.

The radiographer, an individual specially trained to perform radiology examinations, positions the patient on the x-ray table and places the x-ray film holder or digital recording plate under the table in the area of the body being imaged. When necessary, sandbags, pillows or other positioning devices will be used to help to maintain the proper position. A lead apron may be placed over your pelvic area to protect from radiation.

You must remain very still while the x-ray is being taken. You may be asked to hold your breath for a few seconds, to reduce the possibility of a blurred image.

You may be repositioned for another view and the process is repeated. Two or three images (from different angles) will typically be taken.

An x-ray may also be taken of the unaffected limb, or of a child's growth plate (where new bone is forming), for comparison purposes.

When the examination is complete, you may be asked to wait until the radiologist determines that all the necessary images have been obtained.

A bone x-ray examination is usually completed within 15 to 30 minutes.

Computerised Tomography (CT)

A CT scan is a diagnostic imaging procedure that combines x-ray technology and computer-generated cross-sectional images or "slices" of the body. A CT scan shows detailed images of any part of the body, including bones, muscles, fat, blood vessels and organs.

In CT, an x-ray beam moves in a circular motion around the body. This allows many different cross-sectional views of the same organ and provides much greater detail for a more precise interpretation. X-ray information is then processed to display the 2-dimensional computer generated image. In some instances, the data is processed to display three dimensional (3D) images. The common procedures are listed below:

Indication for a CT Scan
CT scans may be performed to help diagnose tumors, evaluate or assess blood vessels, determine calcium "scores" of the coronary arteries or check for other internal disease, injuries or damage.

For all CT scans that require a contrast injection, a U+E, creatinine and eGFR test will be required before the scan is done. Please let the medical secretary know at the time of booking about any allergies, diabetes, and kidney problems that you could possibly have.

CT ABDOMEN/ PELVIS

Indication
CT scanning provides detailed evaluation of abdominal and pelvic structures. There are many indications and examinations are usually tailored according to the indication.

CT BRAIN

Indication
This procedure provides a detailed examination of the brain and ventricular system (the fluid containing spaces in the brain). There are many indications but the most common are headaches, trauma, strokes and other neurological events.

CT CHEST

Indication
Chest CT scanning provides a detailed assessment of the lungs, chest wall and central hilar structures. Common indications include assessment of abnormalities seen on a chest X-ray, staging of tumours, presence and extent of enlarged lymph nodes as well as detailed evaluation of lung parenchymal disorders.

CT SINUSES

Indication
Sinus CT scanning is considerably superior to conventional x-rays for evaluation of the paranasal sinuses. Detailed anatomy and pathology of the sinuses is required for pre-operative planning.

CT Neck

Indication
Provides information on the neck structure including soft tissue, vasculature and airways.

CT Angiography

Indication
This is a procedure used to demonstrate the different blood vessels in the body. This scan shows any abnormalities such as calcifications, strictures, and decreased blood flow.The scan takes between 20 to 30mins. After the scan is completed the radiographer will then begin post processing the images. This can take up to 2 hours to complete as the images are very detailed and take a long time to process.

CT Coronary Angiography

The heart scan is a non-invasive, painless procedure used for early detection of coronary artery disease. Multiple images of the heart are acquired, between each heart beat while the heart muscle is at rest. An iodine based contrast media is injected intravenously in the arm which opacifies the coronary arteries. A radiologist will analyse these images to determine the degree of narrowing of the arteries. This also allows the radiologist to determine the amount of calcified plaque present in the arteries.

CT Virtual Colonoscopy

A CT Colonography is an examination done to visualize abnormalities of the colon.

The patient undergoes bowel preparation before the examination in order to clear the bowel of any faecal matter. A small Foleys catheter is inserted into the rectum and air is introduced to fill the colon. This examination is done to screen for polyps and other lesions in the large intestine.

Indication
This is examination to detect colonic abnormalities. CT colonography is a much less invasive procedure than a traditional colonoscopy or a barium enema and requires neither sedation nor admission to hospital. The preparation for the procedure is also less unpleasant.

After the scan the computer generates an image of the colon allowing the radiologist to do a virtual tour through the colon. It is highly accurate in detecting significant polyps, diverticular disease or tumours.

Interventional Radiology

Interventional Radiology (abbreviated IR or sometimes VIR for vascular and interventional radiology) is a subspecialty of radiology in which minimally invasive procedures are performed using image guidance. Some of these procedures are done for purely diagnostic purposes (e.g., angiogram), while others are done for treatment purposes (e.g., angioplasty). Images are used to direct these procedures, which are usually done with needles or other tiny instruments like small tubes called catheters. The images provide road maps that allow the Interventional Radiologist to guide these instruments through the body to the areas containing diseases.

Imaging Modalities: Common interventional imaging modalities include fluoroscopy, computed tomography (CT), ultrasound (US), and magnetic resonance imaging (MRI). Fluoroscopy and computed tomography use ionizing radiation that may be potentially harmful to the patient and the interventional radiologist. However, both methods have the advantages of being fast and geometrically accurate. Ultrasound suffers from image quality and tissue contrast problems, but is also fast and inexpensive. Magnetic resonance imaging provides superior tissue contrast, at the cost of being expensive and requiring specialised instruments that will not interact with the magnetic fields present in the imaging volume.

Procedures: Common IR procedures are:

  • Angiography: imaging the blood vessels to look for abnormalities with the use of various contrast media, including iodinated contrast, gadolinium based agents, and CO2 gas.
  • Balloon angioplasty/stent: opening of narrow or blocked blood vessels using a balloon; may include placement of metallic stents as well (both self-expanding and balloon expandable).
  • Drain insertions: placement of tubes into different parts of the body to drain fluids (e.g., abscess drains to remove pus, pleural drains)
  • Embolization: blocking abnormal blood (artery) vessels (e.g., for the purpose of stopping bleeding) or organs (to stop the extra function e.g. embolization of the spleen for hypersplenism) including uterine artery embolization for percutaneous treatment of uterine fibroids. Various embolic agents are used, including alcohol, glue, metallic coils, poly-viny alcohol particles, Embospheres, encapsulated chemo-microsphere, and gelfoam.
  • Thrombolysis: treatment aimed at dissolving blood clots (e.g., pulmonary emboli, leg vein thrombi, thrombosed hemodialysis accesses) with both pharmaceutical (TPA) and mechanical means. This procedure is also used for stroke patients.
  • Biopsy: taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transjugular approach
  • Radiofrequency ablation (RF/RFA): localized destruction of tissue (e.g., tumours) by heating.
  • Line insertion: Vascular access and management of specialized kinds of intravenous devices (IVs) (e.g. PIC lines, Hickman lines, subcutaneous ports including trans-lumbar and trans-hepatic venous lines)
  • IVC filters: - metallic filters placed in the inferior vena cava to prevent propagation of deep venous thrombus, both temporary and permanent.
  • Vertebroplasty: percutaneous injection of biocompatible bone cement inside fractured vertebrae
  • Nephrostomy placement: Placing a catheter directly into the kidney to drain urine in situations where normal flow of urine is obstructed. NUS catheters are nephroureteral stents which are placed through the ureter and into the bladder.
  • Dialysis access and related intervention: Placement of tunneled hemodialysis catheters, peritoneal dialysis catheters, and revision/thrombolysis of poorly functioning surgically placed AV fistulas and grafts.
  • Biliary intervention - Placement of catheters in the biliary system to bypass biliary obstructions and decompress the biliary system. Also placement of permanent indwelling biliary stents.

MRI

  • MRI has revolutionised imaging of the human body, especially the cerebro-spinal axis and musculoskeletal system.
  • High-resolution M.R. images are obtained in any orthogonal plane without patient repositioning and there is no hazard of ionizing radiation.
  • To date, no side effects have been reported.

Jackpersad and Partners Inc have several MR scanners – Chatsmed Garden Hospital , Westridge Medical Centre, EThekwini Heart hospital, City Hospital, Hillcrest Private Hospital and Mediclinic Hospital in Pietermaritzburg.

We have highly trained and experienced M.R. technicians and radiologists.
With this sophisticated equipment at our disposal, we can ensure that patients are imaged as swiftly as possible, and an expert MR radiologist is always at hand to provide the patient with reassurance and explanation of how the scan is progressing.

The high cost of the procedure and equipment is justified by the diagnostic accuracy and image clarity. Intracranial, as well as, whole body angiography is performed non-invasively and without intravenous contrast injections. Varied orthopaedic indications include exquisite demonstrations of disc prolapse, soft tissue neoplasm, muscular strains and joint anatomy.

MRI of the breast is the latest imaging tool in the diagnosis and staging of breast cancer.
It is an important diagnostic tool in the screening of young patients with a strong family history of breast cancer , as mammography in these patients is not sensitive due to significantly dense breast tissue.

What is MRI and how does it work?

  • Magnetic resonance imaging, or MRI, is a way of obtaining very detailed images of organs and tissues throughout the body without the need for ionizing radiation
  • Instead, MRI uses a powerful magnetic field and radio waves , to construct images of the body.
  • A rapidly changing magnetic field and a computer are used to create images that show whether or not there is an injury or some disease process present.
  • For this procedure, the patient is placed within the MR scanner—typically a large, tunnel or doughnut-shaped encased magnet that is open at both ends.
  • The magnetic field aligns atomic particles called hydrogen atom that are present in most of the body's tissues.
  • Radio waves then cause these particles to produce signals that are picked up by a receiver within the MR scanner.
  • The signals are specially characterized using a changing magnetic field, and computer-processor to create very sharp images of tissues as "slices" that can be viewed in any orientation.
  • An MRI exam causes no pain, and the magnetic fields produce no known tissue damage of any kind.
  • The MR scanner may make loud tapping or knocking noises at times during the exam; using earplugs reduces the noise levels.
  • You will be able to communicate with the MRI radiographer or radiologist at any time using an intercom system or by other means.

Nuclear Medicine

  • Nuclear Medicine is a branch of medical imaging that uses the nuclear properties of matter in diagnosis and therapy.
  • Nuclear Medicine uses radionuclides / radioisotopes or radiopharmaceuticals that are either injected into the vein or intradermally, ingested with food or liquids or inhaled in gaseous form.
  • Nuclear Medicine exploits the way the body handles substances differently when there is disease or pathology involved.
  • Nuclear Medicine shows physiological function as opposed to anatomy.
  • The radionuclide introduced into the body is chemically bound to a complex that acts characteristically within the body. That complex is known as a tracer or ligand.
  • Most diagnostic radionuclides emit gamma rays, while the cell damaging properties of beta particles are used in the therapeutic applications.
  • It must be noted that the radiation delivered, presents a very small risk of inducing cancer. In fact, more radiation is absorbed by the body during a single short (1-2 hour) airplane flight than is taken by the majority of nuclear medicine studies.
  • Any increased physiological function, such as a fracture in the bone, will show as increased concentration of the tracer; termed a “hot spot”.
  • Some disease processes result in non-uptake of the tracer; called “cold spot”.
  • Vein viewer on site for venous canulation

Common Terminology

  • Planar - Provides a two-dimensional view of the process of function of the organ being imaged.(Also known as static images)
  • SPECT - (Single Photon Emission Computed Tomography) provides 3-D computer-reconstructed images measuring and determining the function or physiology in a specific organ, tumor, or other metabolically active site.
  • Tomography - From the Greek words "to cut or section" (tomos) and "to write" (graphein). A method of separating interference from the area of interest by imaging a cut section of the object.
  • Nuclear Medicine Scan - The images produced as the result of a nuclear medicine procedure, often referred to as the actual procedure, examination or test.
  • Radiopharmaceutical - Also referred to as tracer or radiounclide. The basic radioactively tagged compound necessary to produce a nuclear medicine image.
  • Gamma Camera - The basic instrument used to produce a nuclear medicine image.

Single photon emission computer tomography (SPECT)
SPECT is a scintigraphic technique in which a computer-generated image of local radioactive tracer distribution in tissues is produced through the detection of single-photon emissions from radionuclides introduced into the body that is able to provide true three-dimensional (3D) information. This information is typically presented as cross-sectional slices through the patient, but can be freely reformatted or manipulated as required.

SPECT camera may be combined with a computerised tomography (CT) unit to form a hybrid system and fusion imaging of the physiology and anatomy of the area/s being scanned. Combined SPECT/CT devices provide both the functional information from SPECT and the anatomic information from CT in a single examination. SPECT/CT acquisitions can include the whole body, a limited portion of the body, or an organ. (Mariani et al., 2008).

Gamma Probe
The gamma probe is a hand held device that is used to localise abnormalities that are taken up by Technetium 99m, F-18 and Iodine based pharmaceuticals. The probe is used before and during surgery for accurate localisation, following the administration of the above mentioned tracers. It is commonly used for sentinel lymph node localisation and parathyroid adenoma localisation.

Fast Facts About Nuclear Medicine

  • Nuclear medicine procedures are unique, safe and cost-effective
  • There are nearly 100 different nuclear medicine imaging procedures available today
  • Nuclear medicine uniquely provides information about both the function and structure of virtually every major organ system within the body
  • Nuclear medicine procedures are among the safest diagnostic imaging tests available
  • The amount of radiation in a nuclear medicine procedure is comparable to that received during a diagnostic X-ray
  • Nuclear medicine procedures do not require anesthesia
  • Children commonly undergo nuclear medicine procedures to evaluate bone pain, injuries, infection, or kidney and bladder function
  • Common nuclear medicine applications include diagnosis and treatment of hyperthyroidism (Grave's Disease), cardiac stress tests to analyze heart function, bone scans for orthopaedic injuries, lung scans for blood clots, and liver and gall bladder procedures to diagnose abnormal function or blockages

Haemangioma

Purpose
A haemangioma is a benign hypervascular liver lesion. This study is performed to confirm/exclude a cavernous haemangioma within the liver.

GI bleed study

Purpose
This study is performed to localise the site of gastrointestinal bleeding (GI Bleed), in a patient who is actively bleeding. The bleeding can occur within the upper or lower GI tract. Sites of active bleeding are identified by the accumulation and movement of radiolabeled red blood cells within the bowel lumen.

Colonic Transit Study

Purpose
This study is performed to evaluate the gastrointestinal tract for a motility disorder.

Iodine Whole Body Scan

Purpose
It can reveal what one cannot see using traditional X-ray technology. This scan is performed on patients who have had an operation to remove cancer of the thyroid. It identifies how much thyroid tissue is left. By scanning the full length of the body it can be determined if the cancer has spread to other parts of the body.

I-123 MIBG Scan

Purpose
This study is performed for the localisation of a mass (phaechromocytoma) in the glands above the kidneys (adrenal glands) or any other site in the body that causes high blood pressure and some chemicals in the urine to be raised.

Tektrotyd Scan (Octreotide)

Purpose
The Tektrotyd scan is used to detect the existence of carcinoid tumours. These tumours interact with a hormone called somatostatin. The pharmaceutical tektrotyd, used for the scan in combination with a radioactive material (Technetium 99m), is chemically similar to this hormone. Whole body imaging allows for detection of the primary tumour as well as metastases. SPECT imaging assists in tumour localization

Glomerular Filtration Rate

Purpose
The purpose of a Glomerular Filtration Rate (GFR) Study is to assess how the kidneys get rid of the waste material.

Diuretic Renogram

Purpose
A Duiretic renogram is performed to assess kidney function and drainage.

Hida Scan

Purpose
To assess the function of the gallbladder and bile ducts

Baseline & Post-Captopril Renograms

Purpose
Normally requested for patients with high blood pressure who are suspected to have kidney involvement. To assess kidney function, drainage and if there is obstruction to the renal artery.

DMSA Scan

Purpose
To assess the percentage of kidney function, locate a kidney that is not in the normal position and to check for any damage or infection in the kidney tissue.

Thyroid Scan

Purpose
A thyroid scan is performed to identify any problems with the thyroid gland.

A thyroid scan may be performed to test for thyroid nodules, or to check how well the thyroid is working. Indications also include thyroiditis and thyrotoxicosis.

Parathyroid Scan

Purpose
The parathyroid glands, located above and below the thyroid gland of the neck, but separate from the thyroid in function, control calcium metabolism in the body. The parathyroid glands produce parathyroid hormone (PTH). PTH regulates the level of calcium in the blood. If too much PTH is secreted, the bones release calcium into the bloodstream. Over time, the bones become brittle and more likely to break. A parathyroid scan is acquired when the parathyroid appears to be overactive and a tumor is suspected. The gamma probe is used to localise the adenoma in theatre if it is seen on the parathyroid scan.

Lymphoscintigraphy

Purpose
To assess if there is obstruction in the lymphatic system in patients with swollen limbs.

Sentinel Node Imaging

Purpose
This is used to identify the first lymph node that the tumour drains into after administration of the radiotracer. This is used in patients with a lump in the breast or patients with melanoma. Once the sentinel node is localised using nuclear medicine imaging, the patient will go to theatre to remove those nodes. The gamma probe is then used in theatre to aid the surgeon in locating the sentinel lymph node.

Cardiac MIBI Study

Purpose
This study assesses the blood flow to the heart muscle as well as the amount of normal heart muscle the patient has. The indications for this study are to identify ischemic or infarcted cardiac tissue from normal cardiac tissue.

This examination may take the whole day.

Appointments
All appointments are made through the cardiologist.

Bone Scan

Purpose
A specialized scanner reveals the small amounts of infused radioactive material that move through the bloodstream and collect in the bones, especially in abnormal areas.

Bone scans are used for the detection and monitoring of bone disorders, including Paget's disease, cancer, infections, and fractures. Bone scanning is also useful in assessing joint diseases.

Muga Scan

Purpose
To assess the difference when the heart is full and when it has pumped out blood it assesses the Left Ventricular Ejection Fraction (LVEF).

The MUGA scan (Multiple Gated Acquisition Scan) is an extremely useful noninvasive tool for evaluating the function of the heart. The MUGA scan produces a moving image of the beating heart, which allows one to identify any abnormalities with the heart’s pumping mechanism.

Fluoroscopy Studies

Fluoroscopy is a type of medical imaging that depicts a continuous x-ray image on a monitor. Doctors use fluoroscopy to visualise structures inside the body in real-time during medical procedures. It is used to diagnose or treat patients by displaying the movement of a body part or of an instrument or dye (contrast agent) through the body example: Barium Swallow, Meal, Enema, Conventional Angiography, for embolisation and stenting of blood vessels. The most common fluoroscopy are listed below:

Barium Studies

Barium tests are used to visualise and outline the upper and lower parts of the GIT (gastrointestinal tract) such as the oesophagus, stomach, the small and large intestines.

Why is barium used during some X-ray tests?
The GIT (gastrointestinal tract) does not show up very well on ordinary X-ray images. Barium is a white liquid that contains a chemical called barium sulphate. The outline of the GIT show up clearly on X-ray pictures because X-rays do not pass through barium.

Depending on what part of your GIT is being looked at, you may have one or more of the tests listed below. In each test, the barium coats the lining of the GIT being tested. Therefore, abnormalities in the lining or structure of the git can be seen on the X-ray pictures.

The fluoroscopy unit is usually linked to a monitor. Still images, or a video recording taken in quick succession, can be acquired if necessary.

Barium Swallow

Purpose
The patient is required to swallow the barium liquid whilst positioned in front of the fluoroscopy tube, and images are acquired in real time. This test aims to look for problems within the oesophagus. These include a narrowing (stricture), hiatus hernia, tumour, reflux from the stomach, and any other disorders of swallowing. You will usually be asked not to eat or drink for a few hours before this test. A barium swallow test takes about 30 minutes.

Barium Meal

Purpose
This is similar to a barium swallow. This study aims to look for problems in the stomach and the small intestine. These problems may include ulcers, small fleshy lumps (polyps), tumours, etc. The patient is required to swallow a barium liquid during imaging of the oesophagus and abdominal area. As part of the study patients may be asked to swallow gas granules which aids in distention of the stomach for better visualisation.

The radiologist doing the test may do one or more of the following in order to get the barium to coat the lining of the stomach:

The radiologist may ask you to drink some ENO’s or Ez gas granules before swallowing the barium. You will as much as you can have to resist the urge to burp. The gas expands the stomach and duodenum and also allows for coating of the stomach lining with bariam. The lining of the stomach and duodenum. This makes the X-ray images much clearer. It is the shape and contours of the lining of the stomach and duodenum which need to be seen most clearly on the x-ray images.

The radiologist may ask you to turn over and lie prone (on to your stomach). Various X-ray images may be acquired whilst you are in different positions.

You may be given an injection of buscopan, which causes the muscles in the stomach to relax. You will usually be asked not to eat anything for several hours before this test. (Food particles can make it difficult to interpret the X-rays.) However, you may be allowed sips of water up to two hours before the test.

Barium Follow Through

This test is similar to a barium meal but aims to look for problems in the small intestine. Once you drink the barium liquid you then need to wait 10-15 minutes before any X-rays are taken. This allows time for the barium to reach the small intestine. You will then have an X-ray every 30 minutes or so until the barium is seen to have gone through and reached the large intestine.

Small Intestine Enema

This test is similar to a barium follow through. However, instead of drinking the barium liquid, a thin tube is passed down your gullet (oesophagus), through the stomach and into the first part of the small intestine. Barium liquid is then poured down the tube. This test is not commonly done but can provide additional information about the small intestine to the tests above.

Barium Enema

This procedure is used to visualise the large intestine. A small catheter is introduced into the rectum. This is used to introduce contrast media and air into the large intestine.

Intravenous Pyelogram (IVP)

The patient will be intravenously injected with a contrast media. This study detects abnormalities in the kidneys, ureters and bladder. The most common indication is for obstruction due to stones.

Voiding Cystourethrogram (VCU)

For this procedure a tiny catheter is introduced via the urethra into the bladder. Contrast media is used to visualise the bladder and urether. The common indications for this procedure include strictures and ureteric reflux. There is no specific preparation for this examination.

PET /CT

PET is an abbreviation for Positron Emission Tomography and is performed in the Nuclear Medicine department. It involves the use of a radioactive substance called F18-FDG (Fluorodeoxyglucose) which traces metabolic activity. The molecular and/or metabolic information provides essential contribution to the diagnosis, evaluation and prognosis of disease. This has impacted on effective patient management.

F18-FDG is produced in a cyclotron in Pretoria on the morning of the examination and is dispatched at 3.30 am to the airport. It usually arrives in Durban at about 8:00 am and is brought by a courier service to Westridge.

CT is an abbreviation for Computerised Tomography and involves the use of X-rays which are produced in the scanner and provides anatomical information. The PET/CT scan is a Nuclear Medicine examination with the added benefit of CT. This helps us to accurately locate the abnormal areas of FDG uptake.

The advantages of combining PET and CT include its superior lesion localisation in accurate anatomical/functional registration; a better distinction between physiological uptake and pathological uptake; consolidation of functional and anatomical imaging; and a benefit in shorter total scan time enhancing patient comfort and minimizing issues with claustrophobia and movement. The average radiation dosimetry for 350MBq is 7mSv for PET (FDG) and 3-5mSv for the low dose CT component. (Poeppel et al., 2009)

Patient Transport

Our courtesy vehicles are available for patient transport between our venues