Medical Imaging Senior Posters showcase innovative research by Misericordia University Medical Imaging winter graduates.
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Percutaneous Renal Cryoablation
Shauna M. Aiena
This research topic discusses how safe and effective the use of cryoablation is to treat a renal tumor. Cryoablation is a procedure performed in the Interventional Radiology department to kill cancer cells using very cold temperatures. This procedure is done when the patient cannot have surgery to remove the tumor itself. Although the tumor is not removed during cryoablation, the treatment is performed to freeze the tumor to prohibit growth while releasing antigens from the tumor which triggers an immune response. To see if cryoablation is as effective as some say, a qualitative study was conducted which used 174 renal tumors that were treated by computed tomography (CT) guided cryoablations done between February of 2011 and June of 2020. Procedural success, effectiveness and complications were evaluated for each procedure. The results of this study were that in 98.3% of tumors (171/174), procedural success was achieved. The effectiveness of treatments was 95.3% which then increased to 98.2% after retreats. Overall, there was a complication rate of 29.8%. At 1 year after the procedure there was 100% recurrence-free survival, at 3 years there was 95.3% recurrence-free survival and at 5 years there was 88.6% recurrence-free survival. From this study one can conclude that cryoablation is a safe and effective procedure even years after it is performed. This technique is able to treat small renal tumors without any major complications. Possible implications from this research could be used while working in the interventional radiology department to ensure patients understand that this procedure is safe and effective.
Keywords: cryoablation; renal tumor treatment; renal cryoablation; interventional radiology
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Transcatheter Aortic Valve Replacement (TAVR)
Ashlee Blannett
Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Treatment of Aortic Valve Stenosis
Ashlee Blannett
Faculty Mentor: Lorie Zelna, M.S., R.T. (R)(MR)
Abstract
The purpose of this project is to explore the benefits and risks of the transcatheter aortic valve replacement (TAVR) procedure compared to the surgical aortic valve replacement (SAVR) procedure in the treatment of aortic valve stenosis (AS). TAVR is a lifesaving procedure for patients who are unable to undergo the surgery to fix their aortic valve stenosis. Aortic valve stenosis is a narrowing of the aortic valve of the heart that causes the valve to not open fully. When the aortic valve does not open fully this causes a reduction or blocking of blood flow from the heart into the aorta. The equipment and technology used for TAVR procedures is becoming more advanced and safer to ensure postoperative outcomes are positive and recovery is quick. This project focuses on a male, 78-year-old, patient that underwent a TAVR procedure on October 14, 2021. The patient was diagnosed with severe aortic valve stenosis and had a TAVR procedure done previously in May of 2019. There was a history of cancer, obesity, kidney failure, and being a former smoker. Initial visit to the hospital’s emergency room was chest pain and a syncope episode. Without another TAVR procedure the patient had a 50% chance of mortality in 6-12 months. Keywords: aortic valve stenosis (AS), transcatheter aortic valve replacement (TAVR), surgical aortic valve replacement (SAVR)
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Low-Dose Lung Cancer Screening Computed Tomography
Makalie Blazick
Abstract
Low dose Computed Tomography (CT) screening is essential when finding and treating suspicious lung nodules. A CT machine uses a highly advanced detector assembly that measures the amount of radiation exiting the patient and records data. A CT machine also conducts three-dimensional reconstructions of images that is used for surgical planning, CT angiography (CTA), radiation therapy planning, and virtual reality imaging. The low dose lung cancer screening is usually reserved for older patients with the greatest risk of lung cancer, including former or current smokers. To determine if someone is eligible for low dose CT screening, the pack years are calculated by multiplying the number of packs of cigarettes smoked per day and the number of years someone has been smoking. Researchers conducted a study using 50 milliamperes-second (mAs) for a low dose CT screening instead of 150 mAs for a standard dose CT screening. The results reveal that in comparison, the low dose and standard dose offer the same diagnostic performance and characterization capabilities when searching for lung cancers. Unfortunately, low dose lung cancer screening is heavily underutilized at a rate of only 2% in the United States. Discussing the risks and benefits from a low dose CT screening is highly recommended, especially for people around the age 70.
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MRI-Guided Breast Biopsy
Makayla Franko
This project explains the role MRI has in performing breast biopsies. MR imaging is used along with mammogram and ultrasound to detect and monitor lesions. Traditional imaging of the breast is explained to understand how images of the breast are obtained. The grade of the lesion and how the lesion is found indicates the type of biopsy performed. MRI provides superior visibility for lesions within the breast. MRI-guided breast biopsies are indicated in patients with lesions only visible on MRI. The equipment required for an MRI-guided breast biopsy includes the breast coil, grid, and vacuum-assisted breast biopsy apparatus. Experienced breast radiologists and MR technologists identify the lesion to be biopsied on axial images of the breast using special computer programming. A case study is also included within the research to provide a better understanding of a patient’s experience with MRI-guided breast biopsy. Following the biopsy, the patient receives a soft compression mammogram and has follow-up MR imaging of the breast. A summary of new technology is also included. The new technology would lead to future research that compares different MRI procedures of the breast.
Keywords: MRI, MRI-guided breast biopsy, breast lesions, case study
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White Blood Cell Scintigraphy in Nuclear Medicine
Kaitlyn Gurnari
White Blood Cell Scintigraphy in Nuclear Medicine
Kaitlyn Gurnari and Lynn Blazaskie M.S.,R.T.(R)
Abstract
Nuclear medicine is an imaging modality that utilizes the use of radiopharmaceuticals to evaluate the function of various structures in the body. These procedures introduce radioactive isotopes into the body via injection, inhalation, or ingestion. One specific procedure performed in nuclear medicine is white blood cell scintigraphy. During this exam, a patient’s blood is drawn and labeled with a radioactive isotope before being reinjected back into the patient. The white blood cells are tagged because their function is to fight infections, and thus they will travel to any infected or inflamed areas of the body. This capstone project studies the various ways radiolabeled pharmaceutical Tc99m-HMPAO tags white blood cell samples to detect areas of infection and inflammation. Articles published in various journals, such as Blood Cells, Molecules and Diseases and The Journal of Nuclear Medicine Technology provide evidence of the importance of white blood cell scintigraphy in nuclear medicine. This project discusses the process of tagging the patient’s white blood cells, and also discusses the importance of the gamma camera that is required. This capstone project then focuses on three different case studies that support both the significance and accuracy of white blood cell scintigraphy.
Keywords: ceretec, leukocyte scan, infection, Tc99m-HMPAO, blood cell labeling, diagnostic accuracy
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Low-Dose Computed Tomography & Lung Cancer Screening
Brandon Kessler
Lung cancer is the most common cancer in the world, and could have devastating effects to one’s health if not caught early enough. In order to combat this, the implementation of low-dose computed tomography (LDCT) lung cancer screenings can be used to help detect the cancer early. Questionnaires are used in order to determine if people are high-risk for developing lung cancer and qualify for this scan. Physicians have been reported to believe in these screenings and feel they help improve survival rates and early diagnosis of lung cancer. Although there are many positives with LDCT, there are also some problems. The continued radiation dose is of concern along with how the radiation can also influence future developments of radiation induced lung cancer. Another problem with LDCT lung cancer screenings is the false positive rate on diagnosis of lung nodules, which has been high in some of the studies conducted on this topic. Although LDCT lung cancer screenings have had these problems, the future looks promising with the advancement of technology and more studies done on the topic.
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Diagnosis of Triple Negative Breast Cancer (TNBC) Using Mammography
Sarah Mihalka
Triple-Negative Breast Cancer (TNBC) is a malignant, aggressive cancer that can affect men or women. Mammography is very helpful in diagnosing this type of cancer. The only option at this time for treatment for TNBC is cytotoxic chemotherapy. There is research being conducted to obtain more treatment options for patients. This is proving to be difficult because TNBC is negative for all hormone receptors. On a mammogram, this cancer may present as a lobulated mass with or without calcifications. This comes as a surprise because most masses present on a mammogram tend to be spiculated. This proves for an easier diagnosis of TNBC, however since it is aggressive, it tends to be in a later stage in the staging process.
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Invasive Mammary Carcinoma in Young Women
Jessica Ravert
Invasive Mammary Carcinoma in Young Women
Jessica Ravert
Gina Capitano Ed.D.,R.T. (R)
Abstract
This research is a case study of a 34-year-old patient that presented with a right breast lump measuring 1.9cm found to have invasive mammary carcinoma. Diagnostic mammogram and ultrasound were followed by ultrasound guided breast biopsy to make the diagnosis.
Breast cancer is the leading cause of cancer-related death in women between the ages of 15-39 inthe United States. Annual mammograms are recommended to begin at age 40, therefore younger women often do not have mammograms or breast ultrasounds unless they have symptoms. As a result, younger women are often diagnosed with breast cancer at a later stage with a poor prognosis. In many cases, the diagnosis an invasive breast cancer. Invasive breast cancer is a term that is used to describe a cancer that has invaded or infiltrated the surrounding healthy tissue. Patients with this diagnosis undergo more aggressive treatments to improve outcomes. Invasive mammary carcinoma is breast cancer that has features of both ductal carcinoma and lobular carcinoma; thus is considered a mixed tumor. Invasive mammary carcinoma typically begins as a ductal carcinoma that has spread to the surrounding lobules of the breast.
Keywords: invasive mammary carcinoma, breast cancer, mammogram, young women
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New Dose Reduction Techniques in Computed Tomography
Andrew Taylor
The use of radiation reduction techniques in Computed Tomography (CT) is critical in reducing patient dose, and for establishing new standards in radiation monitoring and protection during imaging procedures. CT is used to obtain high quality image sets that contain more useful information than standard x-ray images for diagnostic purposes; however, it utilizes higher radiation dose. With the advancement of newer technologies and techniques, many CT procedures can be performed to achieve high-quality images while using less radiation, and in some cases, improve diagnostic quality as well. Assessing new dose reduction techniques for specific procedures in CT is useful for improving patient health and safety. As more research is performed concerning how radiation accumulated during procedures is slowly being reduced to more acceptable levels, CT may be considered for use in more diverse patient populations. This could greatly change public perception of imaging procedures involving the use of radiation, and could highlight the importance of researching and developing new reduction techniques. Keywords: Computed Tomography, Radiation dose, Dose reduction, Reduction techniques
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Hypofractionation Treatment of Favorable Intermediate-risk Prostate Cancer
Carlos Torres-Teran
This research-based project will demonstrate the efficacy of a moderate hypofractionated regimen for the treatment of favorable intermediate-risk prostate cancer. Prostate cancer is a major cause of disease and mortality among men. Research indicates that each year, 1.6 million men are diagnosed with it and 366,000 die from it. Diagnosis is based on rectal examination, serum prostate specific antigen (PSA) measurement, and when essential, transrectal prostate needle biopsy followed by a Gleason score obtained from it. When treating prostate cancer, identifying a Gleason score is the deciding factor in choosing from a wide spectrum of treatment options ranging from supervision to multimodal treatment. Upon completion of essential tests, the primary tumor is assigned a stage based on the American Joint Committee on Cancer’s (AJCC) 8th edition Tumor Node Metastasis (TNM) staging system for prostate cancer and the patient is placed in a risk group. If radiation therapy treatment is required, the patient will undergo a process consisting of a treatment simulation followed by treatment planning. The preferred External Beam Radiation Therapy (EBRT) regimen is moderate hypofractionation. This prospect focuses on a case study of a 54-year-old gentleman who successfully underwent pelvic radiation therapy using hypofractionation doses for the treatment of prostate cancer.
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Computed Tomography and Adrenocortical Carcinoma
Rebecca Witmer
Computed Tomography and Adrenocortical Carcinoma focuses on key statistics of adrenocortical carcinoma (ACC). The equipment used to diagnose ACC and the specific types of studies used to diagnose ACC is discussed. Symptoms of ACC and how they affect adults and children are outlined. The research outlines potential genetic defects/other cancers that are associated with ACC. Research discusses the treatment of ACC and the therapies associated with ACC. The research describes certain characteristics of an ACC that are found on a CT scan. Multiple CT tools for diagnosing ACC are also mentioned. The research discusses the survival rate of ACC based on what stage ACC the patient is in and their survival rate. Finally, a case study is analyzed in the research project that reiterates common symptoms of the patient, how the ACC appeared radiographically on the CT scan, how the diagnosis was confirmed, and the treatment plan for the patient with ACC.
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Diagnosis and Treatment of Peripheral Artery Disease (PAD) In Interventional Radiography
Evan Busher
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.
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Chest CT vs. Reverse Transcription Polymerase Chain Reaction Testing for COVID Diagnosis
Megan Chlebove
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.
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Interventional Balloon Kyphoplasty in Multiple Myeloma Patients
Mary Dziadosz
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.
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The Impact of COVID-19 on Radiation Oncology Treatments
Lauren Fink
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.
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Breast Lesion Localization: Savi Scout
Madison L. Keegan
Breast Lesion Localization: Savi Scout
Madison Keegan
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
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Digital Breast Tomosynthesis for Dense Breasts
Emily Kerbaugh
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.
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Low Dose Computed Tomography and Lung Cancer
Kayla Roman
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.
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Breast Fibroadenomas
Jessica Savage
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.
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The Complexity of Diagnosing Sclerosing Breast Adenosis
Lauren Sokirka
The Complexity of Diagnosing Sclerosing Breast Adenosis
Lauren Sokirka
Dr. Elaine Halesey, Ed.D., R.T.(R)(QM)
Abstract
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
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Interventional Breast Imaging
Agripina Torres
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
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FLASH Cardiac Imaging of the Coronary Arteries
Cierra Yonchik
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.