The origin of cancer is often obscured by metastases – tumors that have already spread to other tissues. This is especially the case for neuroendocrine tumors (NETs), a malignancy of nerve cells scattered throughout various organ systems that are sensitive to the signaling of neurotransmitters and hormones. An investigational molecular imaging technique could be the key to finding the elusive primary tumor, say presenters at the 2015 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
MRI, CT and PET Scans are Critical to Successful Patient Outcomes
This year, the focus of IDoR was brain imaging and radiation, which plays a critical role in diagnosing and treating brain disease and brain injuries. Continue reading
Diagnostic imaging plays a very important role in modern medicine. It allows physicians to diagnose and treat many different health conditions, injuries, and diseases more accurately and easily.
A CT (computerized tomography) scan is used to enable doctors to see clear images of the structures and tissues of your body. This type of scan may be ordered for a number of reasons, from detecting a joint problem to assessing a tumor for changes. If you are due to have a CT scan, it can be beneficial to know exactly what to expect in order to prepare yourself in advance.
Preparing for a CT Scan
Your physician will give you instructions prior to your appointment, outlining exactly what you will need to do to prepare for your CT scan. Depending on the type of CT scan you will be having (i.e., which part of the body will be scanned), preparation may begin up to 24 hours prior to your scan.
Some CT scans, such as abdominal and pelvic scans, will require a contrast dye so the doctor can better assess certain structures and soft tissues. The contrast usually consists of iodine or barium sulfate and can be administered orally or by injection.
What Happens During a CT Scan Procedure?
Before the scan you will be asked to remove any metal objects, such as jewelry, and you may need to wear a hospital gown. A radiologist will perform the scan, and it generally takes about 30 minutes (or less) depending on the specific type of scan requested by your physician.
During the test, you will need to lie down on a bed-like table, which will slowly move through the large doughnut-shaped CT scanner. Low-dose X-rays will be taken as it rotates around your body as you travel through it.
You may hear a buzzing or whirring sound as the scan is being done, which is completely normal. You will need to remain very still during the scan in order to prevent any blurring of the images. You may even be asked to hold your breath briefly at times during the scan; full instructions will be given beforehand so you will not have any surprises.
The Results of a CT Scan
After your scan, a certified CT technologist will prepare your images for the radiologist, who will then interpret the images and report the results back to your doctor. Results are usually back with your physician within 24-48 hours.
A new report in tomorrow’s issues of the New England Journal of Medicine raises serious concerns about the use, and overuse of CT scanning. While individual risks of developing cancer from a CT scan are relatively low, the researchers ventured that repeated exposure to radiation from diagnostic imaging could potentially threaten patient populations if left unchecked.
How can you tell if it is time to get a CT scan?
In a traditional X-ray – a chest X-ray, for example – radiation goes through you from one side to the other with 3-D information ultimately projected onto a two-dimensional picture. With a CT scan, an X-ray tube rotates around the patient and presents the results to you as a three-dinensional picture. The advantage is that it’s much more sensitive, is high resolution, and offers much more anatomically specific information with great detail.
When should you get a CT scan?
If you think something is desperately wrong with you and you need an immediate answer. For example, if you have sudden severe abdominal pain or an intense headache that came out of nowhere.
CT scans are incredibly accurate, and can help you determine the source of your pain. For instance, CT scans can prevent false-diagnosis of appendicitis, having reduced false positives by nearly 20%.
Are their risks involved in CT scanning?
There is very minimal risk in CT scanning. For children, the risk of developing a fatal cancer from radiation exposure is somewhere around 1 in 500 or 1 in 1,000 – the older you get, the lower the risk becomes. For an adult, the risk is around 1 in 2,000. At this point, people believe there is a linear relationship between the dose and risk in half.
Are there alternatives to CT scanning that patients should know about or ask their doctors?
You can always ask if there are ways to find out the answer without using radiation. Using ultrasound, for example, or doing an MRI scan. Those don’t use ionizing radiation, so there is virtually no risk. If a child is getting a scan, the parent can make sure that the radiology technician is using the correct pediatric doses.
Are CT scans useful for asymptomatic patients?
CT scans are not necessary for asymptomatic patients. Scans should only be used when there is a suspicion of an illness or disorder. There are still studies determining the risk profile of scans on different populations.
A CT Scan (or CAT Scan) is best suited for viewing bone injuries, diagnosing lung and chest problems, and detecting cancers. An MRI is suited for examining soft tissues in ligament and tendon injuries, spinal cord injuries, brain tumors, etc. CT scans are implemented in emergency rooms and the scan can take fewer than 5 minutes. An MRI, on the other hand, can take up to 30 minutes.
Advantages of MRI over CT Scan
A CAT scan uses X rays to build up a picture. An MRI uses a magnetic field to do the same and has no known side effects related to radiation exposure.
MRI gives higher detail in soft tissues
Another advantage of MRI is the ability to change the imaging plane without moving the patient.
Advantages of CT Scan over MRI
CT is best for imaging bone structures
An MRI is contraindicated for patients with surgical clips, metallic fragments, cardiac monitors or pacemakers cannot receive an MRI.
Treatment time is shorter than an MRI
MRI cannot be done on claustrophobic patients as the patient has to remain inside a noisy machine for up to 45 minutes
CT scans are less expensive than an MRI. A CT scan costs $1,200 to $3,200; while an MRI can cost upwards of $4,000.
These machines can cost from several hundred thousand to millions of dollars – which explains why treatments are so expensive. A basic CT scan can cost between $ 85,000 to $150,000. A 16-slice scanner costs $145,000 to $225,000 and the top-of-the-line 64-slice CTs can cost up to $450,000. The machines may typically need annual maintenance, which can cost tens of thousands of dollars.
Intrinsic to working in radiology is working with radioactive materials. Although we will always be exposed to some level of radiation, we use the ALARA principal (As Low As Reasonably Achievable) to keep exposure to a minimum.
This principle assumes that there is no threshold for inducing “biological effects” and therefore any dose of radiation carries with it some risk. In other words, there is no level of “safe” radiation.
Using the strategies of Time, Distance, and Shielding, we can keep radioactive exposure as low as reasonably achievable. This maximizes efficacy for your treatment and keeps everyone safe, especially our patients. Below is a list of techniques we use to minimize radiation exposure:
- Safe delivery of radiopharmaceuticals – When the syringe is being held with the plunger or needle, we make sure that it is managed with the utmost precaution, and, we take advantage of remote injectors whenever possible.
- Transportation of Patients – How close to the back of the wheelchair are we standing when transporting a patient? Do we maintain appropriate distance when we are walking them out of the department or when we enter the scan room?
- Cleaning up spills (including patient blood or body fluids) – This relates to how quickly we isolate and remove fluids that could contaminate the scan room, or mitigate the effect of the treatment.
- Holding / Lifting Patients – We pay particular attention to where we stand in relation to our patients, especially if we have our radiation badge on.
- Radioactive Tracers – When using these in treatment, we make sure that the all the precautions are made, so that we can have a safe and efficient treatment.
- During PET/CT/MRI Scans – We drape our patient’s bodies with a radioactive shield, isolating the exposure to only the areas that need treatment.
These techniques are just a tiny sample of the ways we consider your wellbeing during our examinations. For diagnostic imaging services, including PET/CT Scans, MRIs, and Mammograms contact the Center for Diagnostic Imaging in Miami.
Recent Mayo Clinic research suggests that many pancreatic cancer patients whose tumors have grown around the pancreas to encompass critical blood vessels are candidate for surgery, even though conventional wisdom has suggested otherwise. The organization has been fine-tuning a protocol to treat this group – which accounts for roughly one-third of pancreatic cancer patients – and in two studies found survival now stretching into years.
“We’re definitely seeing a revolution,” said Mark Truty, M.D., a gastrointestinal surgical oncologist at Mayo Clinic in Rochester, Minn., who is first author of one abstract and senior author of the other. “A lot of this has to do with better chemotherapy drugs and use of what we call multimodal therapy: chemotherapy, radiation and then an aggressive operation. Now we can potentially offer these therapies to patients who previously were told they had no options.”
About 50,000 people are diagnosed with pancreatic cancer each year in the United States. Historically, only about 7 percent of pancreatic cancer patients have lived at least five years after diagnosis.
Because the cancer tends to spread before symptoms appear, it is found early enough to make surgery a clear-cut option in only about 15 percent of patients. In about half of patients, the cancer has spread throughout the body by the time it is diagnosed, ruling out surgery.
In one-third of patients, cancer hasn’t spread through the body, but has grown around veins and arteries in and around the pancreas. For decades, surgery was considered too risky and ineffective to be performed in most of those patients. The Mayo studies chronicle a transformation in treatment for these patients.
In the study presented at the Society for Surgery of the Alimentary Tract annual meeting, researchers analyzed surgical outcomes for the past 25 years among such stage 3 patients who had surgery requiring removal and reconstruction of arteries. They found that most of the operations on this group were performed in the past five years, since the advent of improved chemotherapy and radiation.
Although these surgeries carry more risk than operations not requiring removal and reconstruction of arteries, there appeared to be a significant long-term survival advantage in patients treated with chemotherapy and radiation followed by such aggressive operations. Those who had surgery without chemotherapy or radiation first didn’t do well long-term, while patients who had chemotherapy and/or radiation before surgery did significantly better long-term, the researchers found. Looking at short-term outcomes, they discovered that complication rates have decreased over time.
“All in all, it shows that these patients, who would typically not be offered an operation, can have good short-term and long-term results with the appropriate protocol and treatment sequence,” Truty said.
In the study presented at the Pancreas Club meeting, researchers analyzed modern surgical outcomes for stage 3 patients whose tumors involved blood vessels and who had a specific protocol of chemotherapy, radiation and aggressive surgery.
Eighty patients have now gone through the Mayo protocol with data available for review. The study found that the median survival time after patients complete the protocol is approaching four years, about four times that of patients who do not have surgery. The patients who do even better than that include:
- -Those who receive more chemotherapy before surgery;
- -People who have a particular tumor marker known as CA 19-9 that returns to normal after chemotherapy; and
- -Those whose tumors, when analyzed after removal, are found to have only minimal cancer left.
The study also found that in a majority of patients, computed tomography (CT) scans before surgery showed that their tumors didn’t shrink after chemotherapy. However, when the tumors were removed, it turned out most of the cancer was dead.
“We’re hoping that data from this analysis will now spread to the rest of the country, and now people will have a road map for how to treat these patients and how to choose which patients will benefit from such complex operations,” Truty said. He hopes patients feel a sense of optimism, that there are options.
“Not everyone wants to sign up for these big operations or these long protocols of chemotherapy and radiation. But they have the options available to them to make that educated decision about whether this is something that would benefit them,” Truty said. “We’re offering an additional bit of hope for a pretty substantial number of patients who had previously been ignored.”
Originally published by Imaging Technology News.
Over the past century, radiology has evolved into more sophisticated forms of medical treatment. One of these forms is nuclear medicine. Nuclear medicine features the ability to search for an array of diseases in multiple areas of the body. From heart, brain, lung and bone to different types of cancer, this new and improved medicine can correctly diagnose many diseases. Now, more and more medical professionals along with the Center for Diagnostic Imaging are adopting nuclear medicine for a painless and far more accurate scan.
Nuclear medicine is unsurpassed in accuracy by any other form of radiology, it is noninvasive and painless medical procedure used by physicians to help diagnose medical conditions. “During the first part of the test the patient will have to walk on a treadmill to increase the patient´s heart rate. Then, the patient will be injected with a thallium solution that will travel through the heart vessels and work as contrast. The heart will be scanned using a “gamma” camera that will track the injected solution and create a picture of the heart vessels. After the patient´s blood pressure has lowered, more images of the heart will be taken. The patient should expect to be in the office for at least four hours.” Says the Miami Center for Diagnostic Imaging.
There are a number of bodily functions, diseases, and cancers that can be identified through the use of nuclear medicine. Abnormalities of the brain, respiratory health, and blood flow can be properly visualized inside out. Not to mention bone scans are made possible thanks to nuclear medicine. Additionally, transplants in the previous body parts can be identified for rejection.
Diagnosable diseases include coronary artery disease, metastatic bone disease, Parkinson’s disease and Alzheimer disease. Of course, cancerous tissue can be detected in nearly all parts of the body, even rare tumors of the pancreas and adrenal glands. Other evaluations for hyperparathyroidism, lymphedema, spinal fluid and possible bleeding in the bowls are achievable through nuclear medicine.
One significant advantage nuclear medicine can provide in the evaluation and diagnosis of the patient is the ability to fuse images from both full body CT and MRI scans in order to create more precise measurements of the patients systems. This is called a PET/CT scan. The precision and accuracy provided by these scans is unparalleled.
While non-invasive there is preparation on behalf of the patient that must be taken. This can sometimes be up to a week ahead of time for the patient to be ready. Preparation can include stopping a medication regimen in which it is patient responsibility to consult their physician before doing so. All in all, though the patient should not experience any discomfort from nuclear medicine.
For more information about CDI Diagnostic and Preventive Services please call 1.800.371.0002 or contact us.
Portable X-ray and CT scan devices are on the rise for patients with mobility issues. Portable X-ray and CT scan devices wirelessly communicate and share data, via cellular, WLAN, WMAN, WPAN, and WWAN (read: WIFI) communication networks. Furthermore, these devices act as intermediaries between patients and healthcare staff; monitoring patients and providing therapy, imaging, and diagnostics. The device is paired with a machine that allows it to transfer and store digital images almost instantly. Continue reading
Positron emission tomography (PET) scanning adds a whole new dimension to a radiologist’s ability to diagnose and directly treat disease. PET scans show metabolic function and abnormal molecular cell activity from anatomic structures. PET scans can detect very small cancerous tumors as well as subtle changes in the brain and heart.
It is a nuclear medicine imaging test used to diagnose a variety of diseases, including many types of cancers, heart disease, etc. In PET scanning, a patient is injected with a radioactive tracer infused with simple sugars. Cancerous cells and metabolically active organs metabolize these sugars much faster than normal cells. As these sugars are consumed, they begin to decay and emit positrons. These emissions collide with electrons, sending gamma rays out from the body. These rays are captured and processed by a computer to form “hot spots” on the images.
Since the disease process begins at a chemical level long before it presents structural changes, the information from a PET scan can provide radiologists a signal that there is a problem even before anything would show up through normal examinations.
PET scans are a valuable tool; PET scans have recently been combined with computed tomography (CT) scanning technology to increase results. CT imaging uses X-ray equipment to create detailed images of slices of the inside of the body. The PET-CT combination allows any abnormality on the PET scan to be precisely located within the body, allowing for more accurate diagnosis of any problems. Both types of scan are critical in diagnosing disease. Before the PET CT scan option, radiologists had to perform both scans separately and then compare images to determine the location of an abnormality within the body. Combined PET CT scanning provides the detailed information of CT with the “hot spot” information of the PET scan, offering more accuracy in targeting a disease site through only one exam.
These scans can often detect disease much earlier, allowing for treatment and cure with higher success. It can also show the “staging” of a disease, providing radiologists with invaluable information about the disease’s growth and progression. They can show whether a tumor is benign or cancerous and can also monitor the effectiveness of treatment.
PET scanning is a powerful diagnostic test that is having a major impact on the diagnosis and treatment of disease. It provides unique information which may assist in making a diagnosis, in determining treatment or providing the likely outcome of any disease.
Nuclear medicine tests, with a full body scan through the use of PET technology can provide information on how tissue or organs are working, which cannot be obtained from other imaging techniques. PET scans may detect disease earlier than other types of scanning by identifying early changes to tissue and organs.
Radiologists at the Center for Diagnostic Imaging use this advanced technology as their preferred choice to provide outstanding patient care with preventative and diagnostic purposes.