Peripheral Artery Disease (PAD) is a narrowing of the peripheral arteries which supply blood to the legs, arms, stomach, and heart. This narrowing occurs due to atherosclerosis, which is the buildup of plaque or fat on the walls of the blood vessels. Atherosclerosis results in the restriction of blood flow to the desired site, which is most often the legs. The most common symptoms for PAD are cramps or pain in the leg when walking, which subsides during periods of rest. A brachial-ankle index test can be administered to monitor the blood pressures in the upper and lower limbs to evaluate any abnormalities. The most likely risk factors for being diagnosed with PAD are smokers, diabetes, and high blood pressure or high cholesterol. PAD is diagnosed through a lower extremity angiogram, typically through the femoral or iliac arteries. Contrast is administered through the vasculature to identify areas that are blocked or narrowed. Balloon catheters are inserted into blood vessels to open blockages and stenting can be placed to ensure further issues do not occur. Prevention of PAD includes frequent exercise to reduce claudication, dietary changes to reduce cholesterol, administration of medications, and quitting smoking.
This project explains reverse transcription polymerase chain reaction tests (RT-PCR), how they are used to test patients for coronavirus disease (COVID-19), and how chest computed tomography (CT) imaging can assist in diagnosis. False negatives in RT-PCR testing, ground glass opacities (GGOs), pros and cons of using CT and RT-PCR tests together for diagnosis, and the use of artificial intelligence to diagnose COVID on a CT image are also discussed. COVID is a respiratory disease discovered in December of 2019 in Wuhan, China and has spread to the entire world. RT-PCR tests are the main form of diagnosis of COVID and chest CT imaging can show the damage the virus can cause to the lungs. Chest CT can show signs of COVID in the lungs in the case of a false-negative RT-PCR test, but COVID may also appear similar to other lung diseases on a chest CT. New artificial intelligence technology may have the ability to differentiate COVID from other lung diseases on a chest CT image, allowing for the possibility to rely on CT for COVID diagnosis.
This poster project explains an interventional radiology (IR) procedure called Balloon Kyphoplasty (BKP). BKP is a procedure that involves the insertion of cement into the vertebral column due to vertebrae fractures throughout the spine. Vertebral fractures can happen due to a number of reasons, however, multiple myeloma is the main focus of this project. Multiple Myeloma (MM) is the second most hematological malignancy and there is no cure. MM affects several parts of the body but the most common are the skull, vertebral column, long bones, and the hip and pelvis region. There are several advantages to having BKP done. The advantages of an improved quality of life, reduced pain, and slows the progression of the disease are just a few. There are drawbacks to having this procedure done. For example, possible future fractures due to the pressure of the cement in the spine or just simply not being a candidate for this procedure due to other medical conditions and not being able to tolerate anesthesia, The poster also discusses how the COVID-19 pandemic has affected specials procedures, this being one, and how things have been handled.
When the COVID-19 pandemic began, hospitals became overwhelmed. There was a lack of personal protective equipment (PPE) and a lack of capacity within emergency departments, which caused a panic amongst medical facilities. Facilities were forced to prioritize patients and cancel appointments that were not urgent. Many doctors’ appointments were switched to tele-visits to limit exposure to the virus and to allow priority to COVID-19 patients. Not only were diagnostic testing and treatments postponed or canceled, but news was published that those who were immunosuppressed need to take extra precautions because the risk of fatality is greater for those with preexisting conditions. The combination of the delay in care and the fear that has been introduced among the people has caused a significant impact on the overall health status of patients. Delayed diagnosis and treatment had led to premature death and progressed disease.
Madison L. Keegan
Breast Lesion Localization: Savi Scout
Faculty Advisor: Dr. Elaine Halesey, Ed.D., R.T.(R)(QM)
The Savi Scout is a localization procedure used to help identify non-palpable breast lesions under mammographic or ultrasound guidance, by way of placement of a non-radioactive reflector through a delivery system. The modality of mammography uses screening and diagnostic exams by creating images of the breast to better visualize anatomy as well as possible lesions. The radiographic detail determines the type of breast tissue such as fatty, dense, or extremely dense and with age the tissue type can change. Non-palpable breast lesions are identified with imaging of the breast, using procedures other than the Savi Scout such as: wire guided localization, radioactive seed, magnetic seed, radiofrequency identification, and hematoma ultrasound guided. The Savi Scout localization procedure can be completed up to 30 days prior to surgery, and is located after placement using a hand piece and guidance system. Location is determined by the reflector emitting a certain frequency based on proximity to the reflector, and when compared to the more common procedure of wire guided localization, there is no statistical difference as the mean tumor volume, negative margin rate, and re-excision rate. The Savi Scout is an FDA approved procedure that is efficient and is becoming more commonly used.
Keywords: Savi Scout, Non-palpable Breast Lesions, Mammography, Reflector, Localization, Procedure, Wire Guided localization
Digital breast tomosynthesis (DBT), also referred to as three-dimensional digital mammography provides a new technique that can aid in dense breast imaging. Mammography is the process of creating images of the breast for screening and diagnostic purposes by using low dose radiation. Screening mammograms are performed once a patient is age forty and then annually after that. It is used to provide an earlier detection of breast cancer for a better chance of survival. Diagnostic mammograms are performed when a patient has a strong family history of breast cancer or clinical evidence, such as, a breast lump. Most cancerous lesions found in the breast have irregular boarders that appear spiculated and as architectural distortions. Dense breast tissue can mask these spiculations. DBT reduces masking and resolves superimposition of breast tissue allowing better discrimination of tissue structures and improves visualization. DBT offers many advantages including improved breast cancer detection, dense breast imaging, and reducing the frequency of false-positive results and recalls.
Low Dose Computed Tomography (LDCT) is frequently used for patients who have a high risk of developing lung cancer since it can visualize small tumors not identified on chest x-rays. There are two main types of lung cancer: non- small cell lung cancer and small cell lung cancer. However, smoking is the main cause of lung cancer. The patient must be between the age of 55-80 years old and have a 30 pack-year smoking history, currently smoke or have quit within the past 15 years to qualify for a LDCT scan. The main benefit of LDCT is that it can detect lung cancer early resulting in a greater survival rate. However, there are a few risks associated with undergoing a LDCT scan such as incidental findings, false positives, and radiation induced cancer. Incidental findings may result in additional testing for the patient but may be beneficial for their health. False positives can also result in unnecessary testing for the patient which can increase radiation dose and financial costs. Radiation induced cancer is a major concern with lung cancer screenings, but LDCT scans have a radiation dose of 1.5 mSv per annual exam compared to a standard chest CT which has a radiation dose of 8 mSv.
Breast fibroadenomas are common benign (non-cancerous) breast tumors made up of glandular and stromal (connective tissue) found in women of all ages. Fibroadenomas take on a solid lump feeling like a marble in the breast. They often cause no pain to the patient and are unilateral. There are four types of breast fibroadenomas: complex fibroadenoma, juvenile fibroadenoma, giant fibroadenoma, and phyllodes tumor. Each type has their own distinct characteristics. Fibroadenomas tend to shrink after a woman goes through menopause. While there is no medical treatment or medicine to decrease the lumps, surgical excision may be necessary if the lumps are increasing in size, becoming painful, and if there is any uncertainty between breast fibroadenomas and other health conditions. It is important for women who have breast fibroadenomas to participate in yearly mammograms to confirm the fibroadenomas are not growing. A case report showed the findings of a 26-year-old female with a lump measuring 6 x 3 cm in her right breast. Her left breast was normal with no problems and the axillary lymph nodes were evident. An ultrasound verified the diagnosis of a non-cancerous breast fibroadenoma. An excisional biopsy was arranged to remove the fibroadenoma.
The Complexity of Diagnosing Sclerosing Breast Adenosis
Dr. Elaine Halesey, Ed.D., R.T.(R)(QM)
This project explains the research conducted on the complexity of sclerosing breast adenosis and the specific findings that can lead to a misdiagnosis. Explanation of the disease, methods of diagnosis, case-studies, and risk factors are discussed. In addition, common presentations in misdiagnoses in imaging modalities such as MRI, mammography and ultrasound are included in this project. Sclerosing adenosis is dominantly found in women around the perimenopausal age and usually does not show any symptoms. When the breast is imaged through multiple modalities, the presentation of the disease can be mistaken as invasive carcinoma. If a patient has an unclear presentation of this disease, a biopsy may be done to verify the existence or nonexistence of a malignancy. A patient who has sclerosing adenosis is associated with a 1.7 to 3.7 times more risk for developing cancer. In most cases after the diagnosis of sclerosing adenosis, the patient does not need any special treatment options.
Keywords: Sclerosing Adenosis, Mammography, Breast, Carcinoma
Interventional breast imaging is essential in the diagnosis of abnormal findings in the breast tissue. Interventional breast imaging began as an open excision; the breast was biopsied through a surgical procedure that required the whole breast to be excised, thus allowing a sample of the breast tissue to be obtained. With this type of biopsy, the patient would have a longer recovery time, a higher cost, and, in some cases, unnecessary excisions. Image guided breast intervention, however, has led to the decline of open excisions. Biopsies performed under the guidance of an imaging modality allow breast interventions to be safe, accurate, and cost-efficient. Through literature review, breast interventions have shown the transition that the role of breast interventions has taken. Instead of the one biopsy, it has developed into a variety of biopsies that can be categorized into two types of palpable and non-palpable biopsies/ needle localization. Additionally, the image guidance can be done through three different modalities: mammography, sonography, and magnetic resonance imaging. Each modality has its advantages and disadvantages, but they tend to work with one another. In order to know which modality to use for the chosen biopsy, many factors of both the patient and abnormal findings are taken into consideration. Some biopsies have more than one modality that can be used as a guide, while there are other biopsies that can only use the one modality. Through the advancements in technology, many of the modalities are improving their methods of biopsy.
Keywords: Breast Intervention, Image Guidance, Breast Biopsies, Mammography, Sonography, Magnetic Resonance Imaging
Single Source Cardiac Computed Tomography (CT) Imaging for evaluation of the coronary arteries occurs in multiple formats; the most common being prospective sequential and retrospective spiral methods. The differences between the two methods include dose to the patient as well as the image acquisition process. Dual source CT or Flashcardiac imaging of the coronary arteries is an additional method currently utilized by many facilities via Siemens® equipment. Dual-source imaging has multiple advantages and few disadvantages. An in-depth comparison between flash (dual-source) imaging and traditional (single-source)cardiac imaging is the purpose of this research.