PET/CT IMAGING
Dearborn County Hospital is
pleased to be one of only a small number of facilities in the
Tri-state to have an in-hospital, dedicated PET/CT scanner.
This form of medical imaging is the gold standard in the detection
and staging of cancer.
DCH’s dedicated PET/CT scanner, the General
Electric Discovery ST, allows the hospital to perform specific scans
to diagnose almost all common forms of cancer. In numerous
instances, PET/CT is able to detect cancerous activity in areas that
appear normal on a CT or an X-ray. It is valuable not only in
detecting an initial lesion but also in identifying secondary
lesions and determining if the cancer has metastasized and into
which areas of the body.
Statistics show that the results of a PET/CT
scan will alter a cancer patient’s intended course of treatment in a
significant number of cases. That’s because the physician has an
abundance of information including the size, shape, location, form
and density of the tumor and any metastatic activity or additional
cancers.
A PET/CT scanner combines the image derived
from a dedicated PET scan with that of a CT scan in a single
examination. PET scans distinguish normal from abnormal metabolic
activity while CT scans identify the body’s anatomy. The union of
these two modalities makes PET/CT scanning ideal for use in the
diagnosis and staging of cancers.
A radiopharmaceutical tracer, FDG
(fluorodeoxyglucose), is used in conjunction with PET scans to
“light up” cancerous lesions or other suspected abnormalities in the
body. Abnormal cells use or metabolize a greater amount of this
oxygen-sugar product than normal cells so more of the tracer is left
in the abnormal cells. This in turn causes these abnormal cells to
“light up” on a PET image. A CT scan utilizes a sequence of X-rays
to create highly detailed, computer generated images that show
location, size, shape, form and density.
For additional information on Dearborn County
Hospital’s PET/CT imaging program, please call the DCH Nuclear
Medicine Department at
812-537-8104 or 800-676-5572, ext. 8104.
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4D MRI OF THE BREAST
The latest diagnostic tool for use in detecting,
classifying and staging breast cancer, 4D MRI (magnetic resonance
imaging), is now available at Dearborn County Hospital.
MRI of the breast is able to detect lesions that may not be visible
on mammograms due to the size or location of the tumor or other
factors. It also better allows for the early detection of multiple
lesions in the same or other breast.
Some of the more common clinical
indications for the use of MRI of the breast include:
-
problematic mammograms with equivocal or
suspicious findings
- after diagnosis/before surgery assessments
to more accurately classify or stage the cancer
- examination of a new lesion detected in a
former breast cancer surgery patient to determine if the new
lesion is a recurrence of cancer or a post-operative scar
- multiple suspected cancerous lesions in one
breast or one or more suspected cancerous lesions in both
breasts (bilateral)
- to evaluate the success of treatment, such
as chemotherapy or brachytherapy (seeding), administered over a
period of time in advance of surgery and to assess the current
size and stage of the cancer
-
to determine or verify surgical margins
prior to or following a lumpectomy
DCH’s scanner, the General Electric 1.5T EXCITE HD
(high definition) VIBRANT Breast Magnetic Resonance Imaging System
is equipped with numerous features that provide for exceptional
quality images including both sagittal (side) and axial (horizontal)
views. It also is capable of simultaneously imaging both breasts.
Currently DCH offers MRI of the breast as a diagnostic examination,
meaning it is not used for the routine screening of healthy,
asymptomatic women. The hospital is working to develop a screening
program to be available in the near future.
DCH works in conjunction with the
Breast MRI Institute of Flint, Michigan. The raw data derived from
a breast MRI scan at DCH, consisting of approximately 900 images, is
sent to the Breast MRI Institute. There the data is processed
through specialized computer aided detection systems to produce
approximately 4,000 images. Radiologists at the Institute who
specialize in Breast MRI use this extensive collection of images to
formulate an interpretation. This interpretation is then provided
to the ordering physician (your doctor) for follow-up.
For more
information please call the DCH Imaging/ Radiology Department at
812-537-8105 or 800-676-5572, ext. 8105 and ask to speak to an MRI
technologist.
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ENDOSCOPIC ULTRASONOGRAPHY (EUS)
Endoscopic
Ultrasonography (EUS) is a new, minimally invasive gastroenterology
procedure used to diagnose possible abnormalities in the digestive
tract and certain adjacent or nearby organs.
EUS can be used to
gain ultrasound images of the digestive tract including the
esophagus, stomach and intestines (intestinal wall, gastric folds
and colon). In addition, EUS can obtain internal ultrasound images
of nearby organs and anatomic structures such as the liver,
gallbladder, bile ducts and pancreas. While EUS has multiple
applications, it is most commonly used to diagnose or stage lung,
esophageal, pancreatic, bile duct, gastric and rectal cancers. It
is also used to diagnose and biopsy bile duct lesions and cystic
masses in the pancreas.
In many cases, EUS
can be combined with fine needle aspiration to determine if a
questionable mass or lymph node is malignant. By using this
low risk procedure, patients may be able to avoid more invasive
exploratory surgery. This in turn, decreases the risk from
infection and other complications and greatly reduces recuperation
time.
Endoscopic ultrasonography is the result of combining two
technologies, ultrasound and endoscopy. In EUS, an endoscope which
contains a very small camera, much like those used for an EGD or
colonoscopy, is enhanced by adding an extremely small embedded
ultrasound transducer.
This
procedure results in ultrasound images gathered through the embedded
transducer. Because the transducer is utilized inside the
body, it is able to provide a much higher quality image of certain
organs and structures than traditional ultrasound used on the body’s
exterior. This advanced technology provides valuable information
regarding the density and size of the mass, in addition to a higher
quality visual image. The more data and imagery a physician has
available, the better that physician is able to develop a targeted
plan of care for their patient.
Only a limited number of hospitals in the
Greater Cincinnati area have this technology.
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CAPSULE ENDOSCOPY
The M2A Capsule Endoscopy Given Diagnostic System utilizes a camera so small it fits inside a capsule. After swallowing the capsule the device travels throughout
the patient's digestive tract while transmitting full color video images to a receiver for future examination by
their physician. This noninvasive imaging device is primarily used for viewing the small intestine.
Traditional endoscopic procedures do not reach the small intestine. Esophagogastroduodenoscopy (EGD) examines the esophagus, the stomach and the upper tip of the small intestine. Colonoscopies examine the rectum, the large intestine/colon and only the very lower portion of the small intestine.
Without the use of capsule endoscopy, the majority of the small intestine
is left unexamined by endoscopic means.
Before capsule endoscopy, the most common nonsurgical ways to examine the small intestine were through CT or through radiography or fluoroscopy in which the patient consumed a barium sulfate solution. These types of procedures provide information regarding the size, contour and position of the bowel. While valuable, they do not provide the high quality full color images of the interior of the intestine that are available through capsule endoscopy.
In some instances, abnormalities of the small intestine went undiagnosed because a surgical procedure was needed to make a definitive diagnosis. In many cases, the risks posed by exploratory surgery outweighed the perceived benefit to the patient.
Because capsule endoscopy is noninvasive, it is easily tolerated by most individuals and involves no radiation. More importantly, it requires very little effort on the part of the patient.
The capsule endoscopy procedure, which is performed on an outpatient basis, begins at home with the patient fasting for a specific period of time. Upon arriving at the hospital, the patient is asked to swallow the M2A capsule with a small drink of water. Next, small sensors with an adhesive backing are secured to the patient’s abdomen. These sensors are connected to a DataRecorder stored in an adjustable belt. The belt is then worn around the patient’s waist, on top of clothing, much like a fanny pack.
Once the capsule has been taken and the belt is fitted, the patient is free to return home. Approximately eight hours later, the individual returns to the hospital for a very brief time to have the sensors and belt removed. At this point the video data is retrieved for the physician’s review and the procedure for the patient is concluded. The encapsulated camera passes naturally out of the patient’s body.
Capsule endoscopy isn’t for everyone. It is not for routine screenings or for examining areas readily available through other means of endoscopy or radiography. It is, however, an excellent tool in helping physicians diagnose undetermined abdominal pain, obscure bleeding, Crohn’s disease, celiac disease, multiple polyps, intestinal tumors or other abnormalities of the small bowel. Depending upon the outcome of the procedure, surgery may still be required to treat the abnormality.
ENDOVASCULAR REPAIR
Life threatening abdominal aortic aneurysms, in many cases, can now be treated using a new procedure known as endovascular repair. The procedure utilizes the Zenith AAA Endovascular Graft System by Cook Incorporated.
Aneurysms occur when the walls of a blood vessel become weakened allowing a pocket of blood to build up in the affected area. As this pocket expands, the walls of the vessel become thinner, much like a balloon that is being blown up. Over time, the walls of the vessel may become unable to support the blood flow causing the aneurysm to leak or rupture. This may result in severe internal bleeding.
Traditionally, abdominal aortic aneurysms or AAA were repaired using an open surgical procedure where an incision was made the full length of the patient’s torso. After reaching the aneurysm site, the surgeon would then open the aorta and sew a graft in place to prevent rupture. This major surgical procedure usually resulted in a six to 10 day hospital stay for the patient and an overall recovery period lasting up to three months. Now, by utilizing an endovascular repair technique, most patients will stay in the hospital less than 48 hours following the surgery with an overall recovery time of several weeks.
The endovascular repair procedure is performed by Dr. Michael McAndrew
and Dr. Mark McAndrew. This procedure requires two small incisions in the patient’s groin. This allows the physicians to insert a catheter into each femoral artery. The catheters are then guided through the arteries to the weakened area of the aorta. At the proper location, interlocking fabric-covered metal stents are opened to secure the artery wall and adjacent vessels, thus relieving pressure on the aneurysm.
Because the procedure is new, the surgeons must submit specific medical criteria to Cook Incorporated for their analysis. Their panel of experts reviews the case to determine if the patient is medically appropriate for the procedure. Patients may be deemed ineligible for the procedure for a number of reasons including the specific shape or location of the aneurysm or because of blockages in the femoral arteries.
Not all AAA patients are candidates for aneurysm repair. Surgery is usually not performed unless the aneurysm is four centimeters or larger in size and the patient meets the criteria for the endovascular graft.
Zenith AAA Endovascular Graft patients must have routine follow-up appointments with their surgeon. The schedule usually includes check-ups at one, six and 12 months following surgery with annual exams thereafter. Most appointments include routine blood tests, a CT scan, X-rays and a physical examination. At this time the surgeon will look for signs of leakage or movement of the graft or for growth or change in the aneurysm.
PICTURE
ARCHIVING AND COMMUNICATIONS SYSTEM (PACS)
In late 2004, Dearborn County
Hospital implemented a Picture Archiving and Communications System
or PACS. The system consolidates the results of imaging/radiology
and selected other healthcare modalities into an integrated online
patient file.
Images derived from traditional X-rays, CT, MRI, PET/nuclear
medicine, ultrasound, DEXA and cardiovascular procedures, such as
cardiac catheterizations, are formatted and stored digitally. With
the exception of mammography, film is no longer needed.
PACS allows physicians and other
healthcare professionals to access patient information in a faster
and more organized manner. Physicians no longer need to have
physical possession of an X-ray to view it. By using PACS,
physicians are able to request and view patient images and the
corresponding interpretation digitally.
PACS work stations featuring
computer monitors with extra large high-density screen resolution
are located in key areas of the hospital including the
Emergency
Department, ICU, Surgery and Radiology. Physicians can also access
PACS at the nurses stations and at their individual offices through
the hospital's Meditech system.
While PACS was developed primarily to facilitate the viewing and
storing of imaging files, it can also interface with other programs.
The PACS program acquired by DCH is compatible with the hospital's
Meditech computer network so it was able to be integrated into the
main hospital system. This allows physicians to not only access
imaging files but also by using Meditech; lab results, pathology
reports and other pertinent patient information...all without
leaving the PACS work station.
PACS makes a great amount of current and past patient information
available to the physician on demand. For example, a physician
utilizing a PACS work station in the ICU can view a patient's
current MRI scan, read the Radiologist's interpretation and review
previous scans or imaging procedures.
Also, by utilizing PACS, numerous physicians can obtain the same
image on their monitors simultaneously. Referring physicians,
Radiologists, Surgeons and other specialists can review images and
patient findings during a joint consultation without ever leaving
their individual PACS station.
In the future, it is anticipated that PACS programs between
various hospitals and systems will interface. This will allow
pertinent health information to be available to a patient's
physician, regardless of when or where the patient is in need of
care, such as following an auto accident or while vacationing.
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LUNG CANCER SCREENINGS
A 20 second, low-dose CT scan can help detect lung cancer before it is visible on a standard X-ray and usually before there are noticeable symptoms. This
noninvasive screening requires a physician’s order and is recommended for smokers and former smokers with a history of 10 pack-years or greater
or those who have been exposed to significant secondhand smoke. Ten pack-years translates to someone who has smoked one-half pack a day for 20 years, one pack a day for 10 years, two packs a day for five years and so forth.
The CT screening requires no advance preparation.
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