Women’s Radiology

Osteoporosis Bone Densitometry Procedure

Bone Densitometry is a type of imaging examination that measures the bone mineral density or the strength of your bones.  During a bone densitometry test, density measures are taken of bones at specific areas of your body.  The measurements then are compared to a database of ÒnormalÓ individuals of your same age, sex and race.  The results show whether you have lost bone density.  The measurements also help determine the presence of porosis and can be used to estimate your risk of bone fracture.  This test assists physicians in making diagnosis, fracture risk assessments and monitoring response to therapy.

What is Osteoporosis?

Osteoporosis is a silent progressive disease characterized by decreased bone density with no symptoms until fractures occur.  Postmenopausal women are most prone to porosis.

Procedure

Before the examination, a technologist will ask you several questions about your medical history.  You will need to bring a list of all your medications and the dosage.  You will be allowed to stay in your clothes but it is recommended that you not wear clothing with a metal zipper or buttons.  The technologist will position you on a padded table and then scan your spine and hip area.  The procedure will take approximately 25 minutes.  A detailed report will then be sent to your physician after it has been interpreted by our radiologist.
Osteoporosis Risk Factors
¥ Female and older than age 50
¥ Family history of fractures
¥ Early menopause
¥ Diet low in calcium
¥ Thin and small framed

Why Is Screening for Osteoporosis in Postmenopausal Women Important?

Osteoporosis is a medical condition marked by thinning and weakening of bones and can lead to fractures, loss of height due to compression of the bones of the spine, and pain.

Risk for porosis increases with age, lower body weight, and a lack of estrogen.  Current recommendations would indicate that women 65 and older can be screened routinely for porosis.  For women at higher risk for fractures, that screening should begin at age 60. Dual energy x-ray absorptiometry (DEXA) is the most commonly used diagnostic tool specifically designed to measure bone density.

The test is painless, and requires no special preparation. It is often scheduled with mammography for patient convenience. The results from the screening test will be forwarded to your physician, who will then be able to discuss the potential risks and benefits of the various therapies currently available.

Osteoporosis: Risk Factor Assessment

Please answer all the questions below-The more ÒYESÓ answers you
circle, the greater your risk of fracture.

 1. Are you past menopause?  Yes  No
 2. Did or does your mother or sister have porosis?  Yes  No
 3. Have you broken a bone in your hip, wrist, or spine since the age of 50?  Yes  No
 4. Do you smoke cigarettes, or have you been a
regular cigarette smoker in the past?
 Yes  No
 5. Do you have a small thin frame?  Yes  No
 6. Are you Asian or Caucasian?  Yes  No
 7. Do you currently take oral steroids such as
Prednisone?
 Yes  No
 8. Does your daily diet include less than 1200mg of
Calcium, which is the equivalent of 1 quart of milk
 Yes  No
 9. Do you do weight-bearing exercise, such as walking
fewer than 3-4 times a week?
 Yes  No
 10. Do you consume alcohol in more than moderate
amounts?
 Yes  No

Bone Densitometry procedures are only performed at Patewood Campus in Building A.

We offer the only Breast Imaging Diagnostic work-up for the Greenville Health System. This is to include Screening and Diagnostic Mammography, Breast Ultrasound and Breast MRI. We offer Biopsies under Ultrasound, Stereotactic and MRI for the Diagnostic workup of breast lesions.
Bone Density is done Monday ÐFriday and can be accompanied with a screening mammogram. We also do male patients and females that  do not require mammograms.

What is breast ultrasound?

Breast ultrasound is a noninvasive (the skin is not pierced) procedure used to assess the breasts. Ultrasound technology allows quick visualization of the breast tissue. The examination is often used along with mammography.
Breast ultrasound uses a handheld probe called a transducer that sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the breast at certain locations and angles, the ultrasonic sound waves move through the skin and other breast tissues. The sound waves bounce off the tissues like an echo and return to the transducer. The transducer picks up the reflected waves, which are then converted into an electronic picture of the breasts.
Prior to the procedure, clear, water-based gel is applied to the skin to allow for smooth movement of the transducer over the skin and to eliminate air between the skin and the transducer.
Ultrasound may be safely used during pregnancy or in the presence of allergies to contrast dye, because no radiation or contrast dyes are used.

Reasons for the procedure

A breast ultrasound procedure is commonly performed to determine if an abnormality detected by mammography or a palpable lump is a fluid-filled cyst or a solid tumor (benign or malignant). Breast ultrasound is generally not used as a screening tool for breast cancer detection because it does not always detect some early signs of cancer such as microcalcifications, which are tiny calcium deposits.  Ultrasound may be used in women for whom radiation is contraindicated, such as pregnant women and women younger than 25 years. The procedure may also be used to guide interventional procedures such as needle localization, breast biopsies and cyst aspiration (removal of fluid from cyst).

Breast ultrasound follows this process:
¥ No preparation needed. You will be asked to undress from the waist up and will be given a gown to wear.
¥ You will be asked to lie on your back on an examination table and raise your arm above your head on the side of the breast to be examined. Alternatively, you may be positioned on your side.
¥ A conductive gel will be applied to the breast(s), and a hand-held transducer will be placed directly on the skin overlying the breast.
¥ The Technologist will move the transducer over the breast top acquire images needed for the Radiologists.
¥ After the procedure is completed, the gel will be removed from the breast(s).

Breast ultrasound Biopsy

A breast biopsy is performed on a solid breast lesion.
This is a semi-sterile procedure. The area is cleaned with betadine and then numbed with lidocaine 1%.
A small incision is made in the skin and a biopsy needle is inserted through to take multiple tissue samples.
In most cases, a small metallic clip is left to mark the biopsied site.
Following the procedure, small steri-strips are used to close the incision, and the area is then covered with gauze and tape.
Further instructions are given to the patient prior to leaving.
Preparation needed: no aspirin products or vitamin E five days prior to exam. Patient may eat and/or drink prior to procedure. No sedative is administered; therefore, the patient can drive to and from their appointment.
If the patient has had a prior mammogram and/or ultrasound done at a different facility, we would need to obtain copies and reports of these prior to the exam.

What is MRI of the Breast?

Magnetic resonance imaging (MRI) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. MRI uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of the Breast, MRI does not use x-rays. MRI of the breast offers valuable information about many breast conditions , MRI works in conjunction with other imaging modalities, such as mammography or ultrasound.
MRI of the breast is not a replacement for mammography or ultrasound imaging but rather a supplemental tool that has many important uses, including:

1. Screening in women at high risk for breast cancer: For women at high risk for breast cancer, typically because of a strong family history, MRI may be an appropriate tool to screen for breast cancer. A strong family history is usually a mother or sister who has had breast cancer before age 50. It can also be aunts or cousins, including those on your fatherÕs side. Relatives who have had ovarian cancer also increase your risk. Your radiologist or primary care doctor can look at your family history and determine if screening MRI may be appropriate for you.
2. Further evaluating hard-to assess abnormalities seen on Mammography or Ultrasound: Sometimes an abnormality seen on a Mammogram cannot be adequately evaluated by additional Mammography and Ultrasound alone. In these cases, MRI can be used to help determine if the abnormality needs biopsy or can safely be followed.
3. Evaluating lumpectomy sites in the years following breast cancer treatment : Scarring and recurrent cancer can look identical on mammography and ultrasound. If there is a change in a lumpectomy scar by either mammography or on a physical exam, MRI can help determine whether the change is normal maturation of the scar or a recurrence of the cancer.
4. Following chemotherapy treatment in patients getting Neoadjuvant Chemotherapy: In some cases, breast cancer will be treated with chemotherapy before it has been removed by surgery. This is called neoadjuvant chemotherapy. In these cases, MRI is often used to monitor how well the chemotherapy is working and to reevaluate the amount of tumor still present before the surgery is performed.
5. Evaluating breast implants: MRI is the best test for determining whether silicone implants have ruptured.
6. Determining the extent of cancer after a new diagnosis of breast cancer: After being diagnosed with breast cancer, a breast MRI may be performed to determine:
a. how large the cancer is and whether it involves the underlying muscle.
b. if there are other cancers in the same breast and whether there is an unsuspected cancer in the opposite breast.
c. if there are any abnormally large lymph nodes in the armpit, which can be a sign the cancer has spread to that site.

How is the MRI of the Breast performed?

¥ For an MRI of the breast, you will lie face down on a table specially designed for the procedure. The table has openings to accommodate your breasts and allow them to be imaged without compression.
¥ It is important to remain very still throughout the exam. This is best accomplished by making sure you are comfortable and can relax rather than trying to actively hold still tensing your muscles. Be sure to let the technologist know if something is uncomfortable, since discomfort increases the chance that you will feel the need to move during the exam.
¥ You will be given earplugs to reduce the noise of the MRI scanner, which produces loud thumping and humming noises during imaging.  MRI scanners are air-conditioned and well-lit. The scanner has music to help you pass the time, you can bring a CD from home if you would like.
¥ For this exam you will be given a contrast material injected into a vein in your arm or hand. MRI of the breast without contrast material is inadequate for identifying breast cancers. When the contrast material is injected, it is normal to feel a flushing sensation for a minute or two. T
¥ MRI exams generally include multiple sequences, some of which may last several minutes.
¥ The imaging session lasts between 30 minutes to 45 minutes and the total examination is usually completed within an hour.

Who interprets the results?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you.
New Diagnosis of breast cancer there is no wait period
All others: Patient should be scanned between 7-14 days from the first day of menstrual cycle. (If applicable)
If the patient has had a prior mammogram and/or ultrasound done at a different facility, we would need to obtain copies and reports of these prior to the exam.

Breast Imaging Services Provided

Mammography

Screening
Diagnostic
Stereotactic Biopsy
Needle Localizations

Breast Ultrasound

Breast Ultrasound
Ultrasound Guided Biopsy
Ultrasound Guided Aspiration
Ultrasound Guided Needle Localization
Ultrasound Guided FNA

BREAST MRI

Breast MRI
MRI guided Breast Biopsies
MRI guided Needle Localizations

Nuclear Medicine

Sentinel Node Procedure
Lymphoscintigraphy