Types of Services

Bon Secours performs comprehensive diagnostic imaging studies for adults and children that assist physicians with diagnosis of conditions. These imaging services are:

3-D mammography is a new screening and diagnostic tool designed for early breast cancer detection. It is a three-dimensional imaging technology that uses a low-dose short x-ray sweep over the compressed breast. A computer produces a 3-D image of the breast tissue in one millimeter slices, providing greater visibility for the radiologist. This imaging technique is designed to separate the tissues and to reduce the overlapping of structures. The radiologist can scroll through these images of the entire breast like the pages of a book.

What are the advantages of a 3-D mammography exam?

  • Potential for fewer callbacks for additional views
  • May help with faster detection as thin layers of tissue appear separately and suspicious lesions from traditional 2-D images can be ruled out as benign
  • Improved imaging for patients with dense breast tissue

Recent studies* suggest that 3-D mammography provides:

  • a 40% increase in the detection of invasive cancers
  • a 27% increase in detection of all cancers
  • a 15% reduction in false positive rates
  • a 40% reduction in patient recall rates

* Radiology Today, Vol. 14 No. 6 P. 26. See more at http://www.radiologytoday.net/archive/rt0613p26.shtml#sthash.tB2M1fTL.dpuf

Who benefits from a 3-D mammography exam?

Patients who benefit from 3-D mammography include:

  • Patients with a high risk of breast cancer
  • Patients who have a history of breast cancer
  • Patients with dense breast tissue

In general, this technology benefits everyone. Have a conversation with your physician to see if a 3-D mammogram is right for you! Please remember, regular mammograms are still a very good screening tool and the standard of care.

What should I expect during the 3-D mammography exam?

  • A 3-D mammography exam is very similar to a traditional mammogram. Just as with a digital mammogram, the technologist will position you, compress your breast under a paddle and take images from different angles.
  • During the 3-D mammography part of the exam, the X-ray arm sweeps in a slight arc over the breast, taking multiple breast images.
  • No additional compression is required with 3-D mammography, and it takes only a few seconds longer for each view.

Bone densitometry or DEXA scans (short for dual-energy X-ray absorptiometry) identify a decrease in bone density and a loss of bone strength. DEXA scans determine the risk of fractures (broken bones) and can confirm a diagnosis of osteoporosis (or osteopenia). DEXA scans can provide physicians with an early diagnostic tool by which to determine whether osteoporosis treatment is needed.

Who should get a Bone Density scan?

  • Women age 65 and older, men age 70 and older
  • Postmenopausal women under the age of 65 with one or more risk factors
  • Family history of osteoporosis (mother or sister)
  • History of cigarette smoking, excessive alcohol or caffeine consumption
  • History of diabetes, hyperparathyroidism, or hyperthyroidism
  • Premature menopause or late onset of menstrual periods
  • Vitamin D deficiency
  • Long term use of medications known to cause bone loss (i.e., prednisone, seizure medications, diuretics and Depo-Provera contraceptive injections).

What to Expect

During a comprehensive examination with DEXA, you will lie comfortably still on a padded table while the DEXA unit scans two or more areas, usually the hip and spine. Unlike typical X-ray machines, radiation exposure during bone densitometry is extremely low, less than the radiation exposure during a coast-to-coast airline flight. The entire process takes only minutes to complete, depending on the number of sites scanned. It involves no injections or invasive procedures, and you may remain fully clothed.

Preparing for Bone Densitometry

Unless instructed otherwise, eat normally on the day of the exam, but avoid taking calcium supplements for at least 24 hours prior to your appointment. Wear loose, comfortable clothing. Sweat suits and other casual attire without zippers, buttons, grommets or any metal are preferred. You should not have had a barium study, radioisotope injection, oral or intravenous contrast material from a CT scan or MRI within seven days prior to your DEXA scan.

QCT

In certain patients, quantitative computed tomography (QCT) may be more sensitive than DEXA. Contact your physician if you have any of the following conditions to determine if QCT is a better alternative for you: severe aortic calcifications, degenerative spine changes, scoliosis, prior kyphoplasty, lumbar hardware, IVC filter, bone lesions, or morbid obesity (to 450#).

Follow-up 

Similar to household scales, each DEXA machine has different calibration and sometimes different physics. Patients benefit from follow-up on the same unit.

Screening Breast MRI Criteria:

High-Risk Patients (per American Cancer Society (ACS) criteria)

  • Breast cancer gene carrier
  • First-degree relative with breast cancer gene
  • Prior radiation to the chest between the ages of 10 and 30
  • Lifetime risk of breast cancer 20% or greater using a model such as National Cancer Institute’s (NCI) Gail model
  • Implants (for cancer detection and rupture)
  • Dense breasts identified on mammography are not yet recommended for MRI screening per ACS, but may benefit if other tests are uncertain or questionable.

Diagnostic Breast MRI Criteria:

Pre-op Screening for Patient with New Positive Breast Biopsy per the American College of Radiology Network (ACRIN) recommendations N.E.J.M. 3/28/07)

  • Close or Positive Surgical Margins
  • Lobular Carcinoma
  • Lobular Carcinoma In Situ, Atypical Lobular Hyperplasia, Atypical Ductal Hyperplasia
  • Neoadjuvant Chemotherapy
  • Postoperative Scar vs. Tumor Recurrence
  • Axillary Node Cancer, with negative mammogram
  • Suspected Inflammatory Breast Cancer

FAQs:

Can breast MRI replace mammography?

No, only mammography can show microcalcifications, the most important sign of ductal carcinoma in situ (early cancer). Having a breast MRI does not replace your annual mammogram. It is very important to continue to have a yearly mammogram, as well as any breast imaging recommended by your physician.

Is breast MRI appropriate for general screening?

No.

What to expect when having a Breast MRI:

The MRI machine is loud and you may hear banging, buzzing and beeping noises throughout the exam. The technologist will explain the various noises. We will provide earplugs or headphones with music for you during your exam. The breast MRI usually takes between 25-45 minutes. If you have breast implants, the exam may take a little longer because the technologist may need to obtain additional images.

The most important part of the breast MRI is keeping very still so that the technologist is able to acquire the best possible images. You will be able to communicate with the technologist during your exam through the intercom.

If you feel you need sedation, you will need to speak to the nurse at the facility where you are having the breast MRI prior to your exam. Sedation needs to be ordered by your physician. If you have any questions about sedation, please call the contact person at the facility.

For the exam, an IV will be started in your arm so that MRI contrast agent can be given to you during the test. The contrast agent is an extremely important part of the breast MRI exam and must be done in order for the radiologist to provide an accurate, thorough reading of your exam and to screen for abnormal tissue. The technologist and/or nurse will assist in positioning you on the MRI table for the test. You will be lying on your stomach with your breasts suspended into two holes formed especially for them. The technologist will make you as comfortable as possible. Your breast MRI will be reviewed by one of our specialized breast MRI radiologists and a report will be issued to your physician.

What to bring with you when having a breast MRI:

The radiologist reading your MRI will need to compare the images with your prior mammograms. If your prior mammograms were not done at a Bon Secours facility, you will need to bring copies of the mammogram images (CD or film) and reports with you. If you are unable to do so, we can get your prior images after your appointment, but it will delay the results of your breast MRI exam. Please bring a list of your current medications when you come for your breast MRI.

Please wear comfortable clothes with no zippers and try not to wear jewelry or metal hair pins when you come for your exam. Competent staff will assist you with a breast MRI screening form. A brief visual exam of your breasts for any scars, surgical wounds, moles, etc., is also necessary. The radiologist will need to be aware of these when interpreting your breast MRI.

Points of Contact:

A CT exam is sometimes referred to as CAT scan. CT is a diagnostic tool that uses X-rays to produce a series of computerized images of your body that are useful in detecting many medical conditions that do not appear on traditional X-rays. Similar in appearance to an MRI scanner, the doughnut-shaped CT scanner houses an X-ray tube that moves rapidly around a specific anatomical area, sending signals to a computer. The computer reconstructs these signals to form a cross-sectional image of your internal anatomy, including bones, organs and blood vessels. During your CT exam, you will be asked to lie very still and quiet on a padded table for approximately 15 minutes.

Preparing for a CT

If your CT exam requires the use of a contrast agent, the technologist may start an IV, and/or you may drink an oral contrast agent. These contrast agents greatly enhance the CT images. Please plan to pick up your oral contrast agent in advance of your appointment at the Bon Secours facility where your scan will be completed. You will be given instructions on when to drink the contrast, otherwise you must arrive two hours ahead of your scheduled appointment time to drink the contrast. Continue taking your daily medications prior to your scan unless otherwise instructed. If you have ever had a previous allergic reaction to a contrast agent, or have multiple allergies or suffer from asthma, it is very important that you notify the technologist prior to your visit. Patients may not eat for four hours prior to any CT scan if you will be receiving IV contrast. Patients are encouraged to drink plenty of clear liquids. Patients may take medications except Ibuprofen (i.e., Advil, Motrin, etc.) and Naproxen Sodium (i.e., Aleve, etc.).

  • If you are 65 or older and your physician has ordered your CT with IV contrast, you will need lab work for kidney function before you have your scan.
  • If you are having an abdominal or pelvic CT scan, you may not eat or drink in the four hours prior to your scan.
  • If you are having a CT of the brain, head or chest, you may drink only clear liquids in the four hours prior to your appointment.
  • Wear warm, comfortable clothing.

Fluoroscopy is an imaging technique that uses X-rays to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. Fluoroscopy makes it possible to see internal organs in motion. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed.

Types of fluorscopy:

  • An Arthrogram is a procedure using fluoroscopy to obtain a series of images of a joint after a contrast agent has been injected into the joint. This allows the radiologist to see the soft tissue structures of your joint, such as tendons, ligaments, muscles, cartilage and your joint capsule. An arthrogram is used to check a joint to find out what is causing your symptoms or problem. An arthrogram may be more useful than a regular X-ray because it shows the surface of soft tissues lining the joint as well as the joint bones. This procedure can be performed on your hip, knee, ankle, shoulder, elbow, wrist or jaw.

    Other imaging modalities, such as magnetic resonance imaging (MRI) and computed tomography (CT) provide different information about a joint. They may be used with an arthrogram or when an arthrogram does not give a clear image of the joint.

  • A Myelogram, also known as myelography, is a diagnostic imaging procedure performed by a radiologist. It combines the use of a contrast agent with fluoroscopy or computed tomography (CT) to evaluate abnormalities of the spinal canal, including the vertebrae and intervertebral discs, spinal cord, nerve roots and other tissues. The contrast agent is injected into the spinal canal before the procedure. This contrast agent enhances the tissue being examined. After the contrast agent is injected, it allows the radiologist to view the spinal cord, subarachnoid space and other surrounding structures more clearly than with standard X-rays of the spine. The radiologist will also use a CT scan when performing a myelogram. A CT scan is a diagnostic imaging procedure using a combination of X-rays and computer technology to produce cross-sectional images of the body. These images, called slices, show detailed images of the spinal canal. CT scans provide more detail than standard X-rays.

  • Gastrointestinal Fluoroscopic Exams

    An Upper Gastrointestinal tract exam, also called an upper GI, is a fluoroscopic exam of the pharynx, esophagus, stomach and first part of the small intestine (also known as the duodenum) that uses fluoroscopy and a barium contrast agent. When the gastrointestinal tract is coated with barium, the radiologist is able to view and assess the anatomy and function of the pharynx, esophagus, stomach and the duodenum.

    An Air-Contrast or Double-Contrast Upper GI is an exam that includes drinking both barium and effervescent crystals to further improve the images of the pharynx, esophagus, stomach and first part of the small intestine.

    A Barium Swallow is a fluoroscopic exam that evaluates only the pharynx and esophagus. A Lower GI or Barium Enema (BE) exam, also called a lower GI, is a fluoroscopic examination of the large intestine, also known as the colon. This includes the right or ascending colon, the transverse colon, the left or descending colon, and the rectum. The appendix and a portion of the small intestine may also be visualized. When the lower gastrointestinal tract is filled with barium, the radiologist is able to view and assess the anatomy of the rectum, colon and part of the lower small intestine.

Preparation for fluoroscopic examinations requires an appointment, as well as a written order from your physician. If you are pregnant or nursing, you must notify your technologist. Depending on the area of your body being examined, you may need to change into a gown upon arrival. In addition, you will be asked to remove jewelry, eyeglasses and any other objects that could obscure the images. Many fluoroscopic procedures require specific preparation prior to the procedure. Scheduling personnel will provide you with special diet and procedure preparations when making the appointment.

Digital X-rays are the most common examination performed in radiology. A small column of radiation passes through the body and strikes the digital sensor on the other side. Similar to digital photography, the image can be adjusted. The radiologist can magnify, rotate, lighten/darken, or measure on a workstation to better answer clinical questions. X-rays of the chest, abdomen, spine, sinuses and extremities are the most common types of exams performed. At least two images are taken, but additional images may be required depending on the body part being examined. You may be asked to wait if your physician has requested that the result be called to their office prior to your departure from the facility.

Preparing for an X-ray

There is no special preparation. You may need to change into a gown upon arrival. Typically, these exams require 5 to 15 minutes to complete. An X-ray exam is offered on a walk-in basis, with no appointment necessary. A written order from your physician is required. If you are pregnant, you will need to notify the technologist prior to your exam.

Interventional radiography is the use of imaging to highlight a specific body system for diagnosis and treatment. The procedures are minimally invasive and are an alternative to surgery; generally, interventional procedures involve less risk, pain, recovery time and expense. IR includes the following procedures: kyphoplasty, vertebroplasty and steroid injections. Intravascular procedures include uterine fibroid embolization, stroke intervention, venous access and angioplasty/stenting. This specialty also includes needle-directed biopsies, embolization of arteries to control bleeding or treat malignancies, and radio frequency ablation (RFA) of tumors. Interventional radiography is a rapidly growing area of medicine.

  • Uterine Fibroid Embolization (UFE): Fibroids are common benign tumors of the uterus that affect up to 40% of women over the age of 30. Although the majority of women may not know that they have fibroids, many women may suffer from a variety of symptoms including heavy menses (menorrhagia), heavy and frequent menses (menometrorrhagia), pelvic pain, frequent urination or painful intercourse (dyspareunia). UFE is a minimally invasive treatment that may avert the need for surgical hysterectomy.

    UFE treatment is performed by an interventional radiologist using catheters and embolic material under fluoroscopic guidance. Via a small incision in the inguinal region, a catheter is used to select the uterine arteries which supply the fibroids. Small embolic particles are then delivered to cut off the blood supply to the fibroids while retaining the viability of the uterus. UFE is performed at the hospital under conscious sedation. Recovery is relatively short and some patients may be admitted overnight for observation and discharged the next morning. UFE procedures are safe and provide excellent results for relieving heavy menses and/or pelvic pain.

    Contrast-enhanced MRI pelvic exams are performed before and after UFE. Typically the treated fibroid should significantly decrease in size after three months.
  • Y-90 is an interventional procedure that uses yttrium-90 radioembolization to treat liver cancer. Studies show that treating liver tumors with doses of Y-90 is safe, provides results when chemotherapies have failed, preserves the patient's quality of life, and can be done on an outpatient basis. The treatment combines the radioactive isotope Y-90 into microspheres (small beads about the width of five red blood cells) that deliver radiation directly to a tumor. The microspheres are injected through a catheter from the groin, and the beads become lodged within the tumor vessels where they cause the cell to die. This technique allows for a higher, local dose of radiation, with no danger from radiation to the healthy tissue in the body.
  • Kyphoplasty: Over 700,000 new cases of vertebral compression fractures (VCF) occur each year, typically affecting elderly men and women with osteoporosis. Younger patients may also suffer from VCF due to fragile bones from chronic steroid use. For many elderly, VCF typically means debilitating constant pain, reduced mobility, narcotic pharmacotherapy and reduced quality of life. Although surgical options exist, spinal surgery is invasive, difficult and risky and therefore is not typically applicable, except as a last option.

    Kyphoplasty is a relatively new treatment available for painful compression fractures. Using fluoroscopic guidance, an interventional radiologist first expands the vertebral body with a balloon, and then delivers a bone cement mixture (PMMA) into the broken vertebra percutaneously without a surgical incision. Kyphoplasty is an outpatient procedure and often performed in under one hour. Typically, pain is resolved within a few days, allowing patients to return to daily activities.
  • Vertebroplasty is also a procedure to repair spine fractures typically caused by osteoporosis. The procedure involves placing a small needle into the fractured bone. Bone cement is injected into the bone to secure it. Several fractures can be treated at the same time. The interventional radiologist guides the needle into position using fluoroscopic equipment, thus avoiding open surgery. The procedure takes about one hour and is usually done using only numbing medication. Vertebroplasty is safe and patients can usually leave the hospital a few hours after the procedure is completed. The bone cement used to secure the broken bone is safe. Patients with tumors on the spine may be at slightly higher risk of complications.

Preparing for an Interventional Procedure

You should inform your physician of any medications you are taking and if you have any allergies, especially to contrast material. Depending on the severity of a contrast allergy, medication can be administered to mitigate a reaction. Also, inform your physician about recent illnesses or other medical conditions.

You may be asked to remove some or all of your clothes and wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the X-ray images.

Women should always inform their physician or X-ray technologist if there is any possibility that they are pregnant or if they are nursing.

If you are going to be given a sedative during the procedure, you may be asked not to eat or drink anything for four to six hours before your exam. If you are sedated, you should not drive for 24 hours after having your exam and should arrange for someone to drive you home. Because an observation period is necessary following the exam, you may be admitted to the hospital for an overnight stay if you live more than an hour away.

MRI is an advanced medical imaging technique that uses a magnetic field and radio waves instead of X-ray to image different parts of the body. It is an easy, safe and comfortable exam. It provides an excellent way to diagnose diseases of the brain, spine, skeleton, chest, abdomen, pelvis and blood vessels.

The MRI exam requires you to lie very still on a table that moves into a scanner housing a large magnet. During the procedure, you may communicate with your technologist by intercom, and they will explain the various noises that you will hear. The procedure lasts 20–60 minutes, depending on the number and types of images needed. In some cases, your physician may order the administration of intravenous contrast agent to enable visualization of some specific images.

Preparing for an MRI

  • If you have ever had any medical implants, please bring a device ID card or physician note about the implant.
  • Eat normally. Take your usual medications unless your physician gives you other instructions.
  • If you have had previous exams (CT, MRI or X-ray) performed at a non-Bon Secours facility, please bring those images with you to your appointment.

MRI is very safe. There are no known health risks associated with the magnetic field or the radio waves used by the machine. However, some special circumstances limit the use of a magnetic field, so it is important for you to tell us if any of the following apply to you:

  • cardiac pacemaker or artificial heart valve
  • metal plate, pin or other metallic implant
  • intrauterine device, such as Copper-7 IUD
  • insulin pump or other infusion pump
  • aneurysm clips
  • previous gunshot wound
  • inner ear implant
  • ever been a metal worker (had metal in eye)
  • if you are pregnant

Any metallic substance, on or in you, can affect the quality of the diagnostic images. It can also cause discomfort or injury when placed in the magnetic field and may exclude you from the exam.

Mammography is a specific type of low-dose, noninvasive X-ray used to examine breast tissue, commonly searching for breast tissue irregularities. All Bon Secours facilities offer digital mammograms which allow the radiologist to focus on areas of concern by enhancing readability and improving the interpretation of the images. Medical experts agree that successful treatment of breast cancer is often linked to early detection. The American Cancer Society recommends a screening mammogram every year for women beginning at the age of 40. Women who have had breast cancer or those with a family history of breast cancer should talk with their physician regarding individualized recommendations for age and screening frequency.

A typical mammogram consists of two views of each breast. In all four views, the breasts are compressed firmly between plates. The breast compression and positioning that occurs during imaging is necessary in order to acquire the best possible visualization of breast tissue. Mammograms make it possible to detect tumors that cannot be felt. Mammograms can also find microcalcifications (tiny deposits of calcium in the breast) that sometimes indicate the presence of breast cancer. Mammography can be used either for screening or diagnostic purposes.

  • Screening mammography is used to detect breast changes in women who have no signs, symptoms or observable breast abnormalities. The goal is to detect cancer before any clinical signs are noticeable. They require two views of each breast.
  • Diagnostic mammography is used to investigate suspicious breast changes, such as a breast lump, breast pain, an unusual skin appearance, nipple thickening or nipple discharge. It's also used to evaluate abnormal findings on a screening mammogram, or follow up to breast cancer diagnosis. Additional images can be made from other angles or focus on areas of concern at higher magnification. A diagnostic mammogram takes longer than a screening mammogram because it involves obtaining additional views.

Preparing for a Mammogram

If your most recent mammogram was not at a Bon Secours facility, you will need to obtain your prior mammogram images and bring them with you to your mammogram appointment. Your prior mammogram images will assist the radiologist in providing prompt and accurate results. It is important to notify the scheduler at the time of scheduling your appointment, if you have breast implants.

On the day of your test, please do not wear deodorant, powder, lotion or jewelry around your neck. Wear a two-piece outfit, as you will be asked to undress completely from the waist up. The actual mammogram exam typically takes about 10 minutes. A radiologist will study your mammogram images and report the results to your physician.

Nuclear medicine uses a small amount of radioactive tracers to diagnose and treat a variety of diseases. Differing from X-ray, which demonstrates anatomy or structure, nuclear medicine provides information on how parts of the body function. The radioactive tracers are administered by IV injection, inhaled through a nebulizer or swallowed. The radioactive tracers are attracted to specific organs, bones or tissues in the body. The radioactive tracers will eventually concentrate in the organ of interest. A special camera called a gamma detector will be positioned close to the part of the body that is being scanned. The information is then sent to a computer that processes and analyzes the amount and distribution of radioactive tracers in your body. Depending on the test, the scan may be performed immediately or after a few days. Some scans may require multiple visits.

Nuclear medicine is safe and painless. The radioactive tracers used are quickly eliminated from the body through its natural functions. The dose of radiation is very small and the radioactive tracers lose their activity very quickly. Reactions to the radioactive tracers are rare. However, prior to the administration of any radioactive tracer, it is important to tell your physician and the nuclear medicine technologist if you are pregnant or nursing. Special precautions or a delay in performing your procedure may be necessary. You may be instructed to take special precautions after urinating, such as flushing the toilet twice and thoroughly washing your hands. You should also drink plenty of water after the exam.

Nuclear medicine scans can study any organ in the body, including the bloodstream. The most common tests are scans of the bones, heart, lungs, kidneys, gallbladder and thyroid. The purpose of these exams is to analyze kidney function; visualize heart blood flow and function; scan lungs for pulmonary embolism; evaluate the gallbladder for inflammation (cholecystitis) or poor function; evaluate bones for fractures, infection, arthritis and tumors; determine the presence or spread of cancer in various parts of the body; identify location of bleeding in the bowel; confirm and identify the location of infection; measure thyroid function in patients with symptoms of overactive or underactive thyroid; and localize abnormal lymph nodes before surgery in patients with breast cancer or melanoma.

Preparing for a Nuclear Medicine Test

Various procedures have different protocols, and therefore, will require specific instructions. It is likely that you will be advised not to consume food or drink for at least 4 hours prior to your appointment. If you are having a renal (kidney) function test, plan to drink plenty of water in advance of the procedure.

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Ultrasound uses high-frequency sound waves to create still or video images of soft tissue areas of the body. To capture these images, an ultrasound gel is first applied to the skin over the area to be viewed. A hand-held instrument called a transducer is then moved slowly across your skin as an image appears on the ultrasound monitor.

Ultrasound procedures are painless and safe. Ultrasounds usually take less than 30 minutes to complete. Ultrasounds make it possible for the radiologists to diagnose many diseases and medical conditions without any exposure to radiation.

Preparing for an Ultrasound

If your abdomen or pelvic regions are to be examined, you may be asked not to eat or drink after midnight prior to the exam, or asked to report with a full bladder. Otherwise, there is no special preparation required before your ultrasound.

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