East River Medical Imaging, PC

On July 9th 1999, the New York Times published an article regarding helical CT scans of the lungs for cancer screening.

As reported in this article, CT scans are preferred over X-rays as a screening test for lung cancer as CT scans are significantly more successful in identifying early tumors.

East River Medical Imaging has two of the newest state-of-the art helical CT scanners available today which are identical to those used in the above study at New York Hospital. Our radiologists are considered experts in the field and have been interpreting CT scans, including lung scans, for over 20 years.

We would like to take this opportunity to remind you that East River Medical Imaging performs helical CT scans of the chest for lung cancer screening. No intravenous contrast material is administered. The fee for this screening procedure is $300.00 and, at this point, is not covered by any insurance.

If you would like to refer your patient to us for this procedure, please be sure to inform our appointment desk that it is a Screening CT of the Lungs. If you have any questions or considerations, please do not hesitate to contact us.

Virtual colonoscopy is a new method that allows radiologists to evaluate the lining of the colon (large bowel) to detect polyps and cancers. Polyps are growths in the colon that may become cancerous if they are not removed. Utilizing a high-speed multidetector CT scanner and specialized computer software images are obtained that “visualize” the surface contour of the colon. Images are evaluated in both two and three dimensional projections as well as endoscopic views similar to those seen during conventional colonoscopy.

The first and most important part of the Virtual Colonoscopy, as with conventional colonoscopy, is the proper preparation. In order to perform an accurate evaluation of the colon a thoroughly cleaned colon is necessary. To achieve this, a clear liquid diet, a bowel cleansing kit and use of a tagging agent (Tagitol), which is used in opacifying residual stool, are each required to be completed 24 hours prior to the exam. An inadequately cleaned colon can lead to a non-diagnostic study and even erroneous results.

The day of the examination the patient comes to the office and Virtual Colonoscopy is performed with high-speed multidetector computed tomography (CT or CAT scan). The patient lies on the CT table and a small flexible enema tip is placed in the rectum so that air can be introduced to distend the colon.

A scan of the colon is performed with the patient lying on their back and then repeated with the patient lying flat on their stomach. Each scan takes about 20 seconds with the total time for the procedure approximating 15-20 minutes.

Since there is no sedation or anesthesia the patient may leave shortly after the procedure and resume normal activities and can eat, work and drive without a delay.

After reconstruction of the data the radiologist will evaluate the images to detect colon polyps or cancers. Since hundreds of images are generated careful review is time consuming and rapid analysis is not in the best interest of the patient. Pertinent images of the virtual colonoscopy are recorded on film and sent to your physician. Digital images are stored at our facility.

The most difficult part of the procedure for most patients is the preparation the day before the examination. During the examination some patients experience “gas pains” or cramping with the introduction of air into the colon. This is usually temporary and rarely results in terminating the study. Proper distention is imperative to visualize the entire colon adequately. The introduction of air can be performed by the radiologist; however, it sometimes is more relaxing for the patient to insufflate the air themselves.

- No Sedation

- Immediate Resumption of normal activities

- Rapid, Safe, Accurate

-Mucosal detail and color is not visible which limits characterization of lesions

-Detection of small polyps (less than 1 cm) is inferior

-Polyps if detected cannot be removed and would require follow up colonoscopy and second preparation

-Ionizing Radiation – Approximately 20% less than a Barium Enema

Studies suggest a very high sensitivity for detection of polyps 1 centimeter or greater approaching that of conventional colonoscopy. These are the ones that have significant malignant potential. Smaller polyps are more difficult to detect. As with any procedure, including conventional colonoscopy, both polyps and cancers can be missed.

Virtual colonoscopy is not currently reimbursed by most insurance companies. The patient must therefore cover the cost of the procedure which is $900. Medicare patients will be required to sign a waiver stating it is a non-covered service and you will accept responsibility for payment.

Colorectal cancer is a leading cause of cancer related death in the United States. Colon cancer can be prevented if polyps are discovered and removed early before they become cancerous. It is believed that tumors take years to develop and typically form from a benign non-cancerous polyp. If these are removed progression to malignant disease can be prevented. Nevertheless, individuals remain largely under screened, in part due to poor public awareness and reluctance to current screening procedures.

The American Cancer Society recommends that patients undergo a test that allows the entire colon to be visualized at the age of 50 and then every 3 to 5 years. The two currently accepted methods include Conventional Colonoscopy and Barium Enema. Although both visualize the entire colon, barium enema is a less sensitive examination and is considered an inferior test. Colonoscopy, which is more sensitive as a screening procedure, is more costly and requires sedation and anesthesia. The introduction of a safe, non-invasive, and affordable procedure for detecting polyps has appeal for the individual and society as a whole. Virtual Colonoscopy is felt by several institutions including Boston Medical Center and The Mayo Clinic to fulfill many of these requirements. Multi-institutional studies are being performed to compare these techniques.

The most important thing is that the patient be screened by some technique for colonic polyps and cancer. Since many deaths maybe prevented with early detection … no screening is the biggest mistake. The gold standard for detection and removal of polyps is still conventional colonoscopy. Not only is this the most sensitive procedure, in addition, if a polyp is found a therapeutic polypectomy can be performed during the same procedure. Since virtual colonoscopy is only a diagnostic procedure if an abnormality is detected another preparation and conventional colonoscopy will be needed. If conventional colonoscopy is contraindicated or you are unwilling to have the procedure than virtual colonoscopy would certainly be a viable and beneficial option. We would consider barium enema to be the last resort but still better than no evaluation at all.

East River Medical Imaging is proud to announce the installation of the first Light Speed Plus scanner specifically designed for CARDIAC IMAGING. This GE CT scanner is equipped with their fastest scan times and new prospective gating technology to allow both anatomical and functional imaging of the heart.

This CT will now enable us to perform coronary calcium scoring with the most current technology available. This can be performed on its own or in combination with other screening procedures. We have enclosed images demonstrating it unique abilities and motionless images of the coronary vessels.

Please feel free to call if you have any questions or need further information. As always we will provide prompt, courteous service to you and your patients.

In response to many inquiries we have had over the last several months concerning screening examinations we thought our prospective on the subject might be of value in helping you advise your patients.

PROTOCOL #1 (CT Chest – Lungs and Heart)
· CT Lungs and Heart– CT of lungs and heart evaluates for lung disease (cancer) and coronary heart disease.

Pros

· Most effective modality in evaluating the lungs and heart.
· No Claustrophobia
· All examinations done on single machine
· No preparation
· No risk of contrast reaction

· CT Lungs and Heart– CT of lungs and heart evaluates for lung disease (cancer) and coronary heart disease.
· MRI of Abdomen and Pelvis- MRI evaluates the intrabdominal and pelvic organs in the male and female.

· Most effective modality in evaluating the lungs and heart.
· Most effective modality in the abdomen and pelvis in men unless CT uses oral and intravenous contrast.
· Most effective modality in abdomen and pelvis in women even over CT with IV and oral contrast.
· No preparation necessary
· No risk of contrast

· Requires examination to be performed on two different machines which can be more inconvenient and more time consuming.
· Claustrophobic patients may have problems with MRI
· More expensive

· CT Lungs and Heart– CT of lungs and heart evaluates for lung disease (cancer) and coronary heart disease.
· CT Abdomen and Pelvis with Contrast- CT evaluates the intrabdominal and pelvic organs in the male and female.

Pros

· Most effective modality in evaluating the lungs and heart.
· Men - Effective modality in the abdomen and pelvis if IV and oral contrast utilized.
· Women - effective in the abdomen with IV and oral contrast but not as effective in the pelvis for evaluating the uterus and ovaries. Ultrasound may be utilized to cover these regions if an MRI is not performed.
· No Claustrophobia
· All examinations done on single machine

· Preparation required – Fast 12 hours and 1 hour drinking before exam
· Risk of IV contrast reaction (small)

· CT Lungs and Heart– CT of lungs and heart evaluates for lung disease (cancer) and coronary heart disease.
· CT Abdomen and Pelvis (No IV & No oral) - CT evaluates the intrabdominal and pelvic organs in the male and female.

Pros

· Most effective modality in evaluating the lungs and heart.
· No Claustrophobia
· All examinations done on single machine
· No preparation
· No risk of contrast reaction

· Significantly limited in evaluation of abdomen and pelvic pathology with low yield on finding early disease.
· Utility is of questionable value given limitations.

PET/CT SCANNING

Positron Emission Tomography is an imaging modality that detects changes in metabolism within the body. Where as other forms of imaging such as CT scanning and MRI look at the anatomy within the body, PET/CT scans look at the cellular level. Since most malignancies have higher levels of metabolism, a PET/CT scan locates these areas adding in the detection and evaluation of disease. This is currently used in the United States as a tool for cancer diagnosis and to evaluate for spread of disease. In Japan this has received some attention as well for a screening tool. As with any procedure again there are false positive (positive exam but no cancer) as well as false negatives (exam negative but cancer present).

REMEMBER - It is again very important to keep in mind that whichever protocol fits the patient and physician specifications that none of these exams are 100 percent effective in detecting disease. Just as important to remember is that many examinations will result in unexpected findings with ambiguous results often requiring additional follow up, examinations and procedures. Many of these findings may be inconsequential and after extensive testing and emotional stress probably would have been better off unfound. One must allows balance the risks and reward when ordering any screening examination.

We at East River Medical Imaging are able to provide all of the above services with the most advance imaging tools available. It would be our pleasure to discuss any of your questions or concerns in these matters.

CORONARY CT ANGIOGRAPHY (CCTA)

East River Medical Imaging Offers Revolutionary Diagnostic Technique

New York, NY: June 17, 2005 – East River Medical Imaging, a diagnostic radiology practice on Manhattan’s Upper East Side is now offering Coronary CT Angiography utilizing the first 64-Channel GE Volume CT (VCT) in New York City.

20% faster rotation time than any other 64-Channel CT
Superior to any other 64-Channel CT scanner on the market
Superior temporal, spatial and contrast resolution improving vascular clarity and decreased artifact from calcium
Superior evaluation of post-op patients (stents & grafts)
Experienced Cardiac Radiologists

This exciting technology is a new technique giving a 3D, non invasive, 360° examination of the coronary arteries. CTA not only allows the assessment of the arterial lumen (or the channel within the artery) but is also used to visualize the walls of the coronary arteries, demonstrating the presence of calcified and soft plaque or critical narrowing which could lead to a myocardial infarction (heart attack).

While the findings of Coronary Artery Calcification Screening (CACS) are limited to calcified atherosclerotic plaque, Coronary CTA (CCTA) is a more comprehensive exam whose findings are comparable to invasive coronary angiography.

Patients eligible for this exam must have a risk factor for heart disease which includes:

Smoker or Former Smoker
Diabetes
High Blood Pressure
Post Menopausal
Sedentary Lifestyle
Family History of Heart Disease
Known Heart Disease
Known Vascular Disease

Atypical chest pain
Evaluation of bypass grafts and stents

“In 2000, 1,500,000 coronary angiography procedures were performed in the US, 50% which were diagnostic. Of those 50% required no additional procedure” – ACC/AHA Guidelines for Coronary Angiography, 1999, Scanlon and Faxon

“The rupture of a plaque will be the cause of death of about half of all of us in the United States.” - Dr. Steven Nissen, Cleveland Clinic

East River Medical Imaging, PC has been leading the way in diagnostic technology for more than thirty years. For additional information about Coronary CT Angiography (CCTA) offered at East River Medical Imaging on our 64-Channel Volume CT (VCT) please contact Katie Joanne Lovaas at 212.288.1575.

What to expect

The patient should be prepped as: no caffeine 12 hours prior to the exam (no caffeine in any form, including cola, black/green/white tea, and chocolate) and nothing to eat or drink (NPO) 4 hours prior. Please take required medication with a small amount of water as necessary. The patient should be prepared to list their medications. We will not scan a patient with “active chest pain”.

* Please see CCTA Patient Preparation section below for further details

The scan takes approximately ½ hour and is only done our 64-Channel GE Volume CT (VCT) scanner. We ask that the patient arrive ½ hour before their scheduled appointment time.

Upon arrival and completion of paperwork, the patient will be taken to the back office by the technologist who will go over the patient’s medical history. The RN/radiologist will determine if IV beta blockers will be administered in addition to the beta blockers the patient took the evening prior to the exam and 1 hour before the exam. An IV line will be inserted in the arm around the inner elbow to administer the nonionic contrast and/or additional beta blockers. The IV line is inserted prior to the patient going on the table to alleviate any added anxiety and increase in heart rate immediately before the study. The patient will be taken into the CT room and placed on the exam table. A 4 lead EKG will be attached to monitor their heart rate. After further instructions from the technologist the exam is performed.

After the study, the patient is instructed to drink plenty of fluids to help eliminate thecontrast from the body. As with other CT studies, if the patient is diabetic and taking Glucophage, it must not be taken for48 hours after the study. Also, patients who are breast feeding, allergic to iodine, have multiple myloma or have a history of kidney disease cannot have this study.

Click To View More Coronary CTA Pictures

Coronary CT Angiography (CCTA) Patient Preparation

Before the study:

No Caffeine (in any form) 12 hours prior to the exam
Nothing to eat or drink 4 hours prior to the exam, please take required
medication with a small amount of water if necessary
Prescription beta blockers may be given before arrival to stabilize the heart
rate during the procedure (discuss with your referring physician)

Upon arrival:

We ask that you arrive 1/2 hour prior to the study
An IV catheter will be placed in an appropriate vein as determined by the
nurse/radiologist

During the study:

We will attach a 4-lead EKG to monitor your heart rate
You will be given nonionic contrast via IV catheter
You may be given IV beta blockers in conjunction with the oral beta
blockers to lower heart rate

After the study:

Be sure to drink plenty of fluids

Alerts:

No Glucophage (diabetic patients) 48 hours after injection

Contraindications:

Atrial fibrillation/Arrhythmia
Reactive airway disease/COPD/Asthma
Low cardiac output
Pacemaker/Defibrillator
History of severe contrast allergy with failure of premedication
Impaired renal function