What's New

CCTA As Seen On Oprah   Directions to East River Medical Imaging at Sutton Place   
Coronary CT Angiography   PET/CT   Virtual Colonoscopy    GE 1.5T EXCITE MRI    Light Speed CT   
New Studies of FDG-PET for the Diagnosis of Alzheimer's Disease

64-Channel CT
For the detection of coronary artery disease

As seen on "Oprah" October 19, 2005

Please call Katie Joanne Lovaas on our Coronary CT Angiography team  
to schedule an exam

212.288.1575

EAST RIVER MEDICAL IMAGING AT SUTTON PLACE

November 2005 – East River Medical Imaging is proud to announce the opening of our new facility, East River Medical Imaging at Sutton Place.  The office is conveniently located at 430 East 59th Street, New York, NY 10022, adjacent to the Queensborough Bridge [59th Street Bridge] in Manhattan.

Our new office currently offers high-field MRI imaging studies on the latest General Electric HDMR platform.  In the upcoming months, we will add CT and Ultrasound to the list of diagnostic services offered at this new location.  The Sutton Place office will allow us to extend the same exceptional service we strive to deliver to our patients and their physicians.

If you would like to schedule an appointment at any of our offices, please call our Scheduling Department at (212) 288-1575.

Driving
Our office is located at 430 East 59th Street, New York, NY 10022, between First Avenue & Sutton Place (York Avenue).  Parking is available in the garage by entering either the 58th Street or 59th Street side of the Sovereign Apartment building.

Mass Transit
Nearby buses included:  M31, M57, M98, M101, M102, M103, Q32.

The following subway lines are available at 59th Street & Lexington Avenue station  ( with MetroCard).

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

               OR

• 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.  

Click To View More Coronary CTA Pictures

Read an article by Dr. Benjamin Roach “How 64-Slice CT Saved My Life”

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

PET/CT

East River Medical Imaging Associates is proud to announce the addition of our GE Discovery LS PET/CT to our comprehensive list of services. We are the first in the tri-state area to acquire this new premier scanner.

Our Discovery LS PET/CT scanner fuses the technology from the highest resolution Light Speed Multislice CT and the superior imaging capability of a dedicated PET/CT scanner. The combination of these two state-of-the-art scanners greatly improves the ability detect and localize malignant tumors.

This exciting integrated technology enables us to perform both the PET/CT scan and CT scan in one sitting, without the patient changing position. The PET/CT and CT images are fused together allowing the radiologist to see malignant activity at a metabolic level and pinpoint its exact location. The PET/CT will enable the physician to determine if an abnormality seen on a CT or other traditional imaging scan is malignant or benign. Additionally, it will assist the physician in determining if there are distant metastases in patients who already have a known malignancy.

Positron Emission Tomography (PET/CT) is a non-invasive, functional imaging modality that provides diagnostic information regarding biochemical and physiologic processes in patients. Many disease states manifest these metabolic changes before anatomic changes are noted, PET/CT can play an important role in evaluating and managing patients. PET/CT is often used clinically to complement other anatomic imaging modalities, such as computerized tomography (CT) or magnetic resonance imaging (MRI), when anatomic information alone is not specific.

Another advantage of the PET/CT over our existing PET/CT scanner is that the scan time is reduced by about half which increases patient comfort. We will of course continue to work very closely with both physician offices and patients to ensure that your patient will have a positive experience at East River Medical Imaging.
PET/CT can differentiate scar or radiation necrosis from active tumor
PET/CT can determine if a mass/lesion is malignant or benign
PET/CT can characterize enlarged lymph nodes as malignant or benign
PET/CT can detect malignancy in normal-size lymph nodes or normal-appearing tissue
PET/CT can evaluate early tumor treatment response
PET/CT has been widely investigated in the assessment of dementia. Alzheimer's Disease and Multi-Infarct Dementia are readily diagnosed and differentiated.
PET/CT provides the ability to identify focal lesions, aiding in the diagnosis and treatment of epilepsy.

PET/CT scans can also be used to measure the brain’s metabolism. Studies have shown that it is possible to spot Alzheimer’s through metabolism patterns on PET/CT scans and may detect Alzheimer’s even before significant symptoms emerge. This study can be used in combination with other tests to distinguish memory loss, behavioral changes and other early symptoms from those of other conditions. Detecting Alzheimer’s early is important because new treatment options have recently emerged which have been found to slow the progression of disease in some patients. Click here to learn more

Medicare has recently approved payment for many PET/CT scan indications. Most private and managed care insurance companies pay for all or part of the procedure. Insurance coverage differs depending on the type of study and the reason the test is performed. We recommend that the patient contact their insurance carrier for details on their specific coverage. Precertification is quite often necessary.
Please feel free to contact our office for additional information.

Medical Literature

Virtual Colonoscopy

What is Virtual Colonoscopy?

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.

How is it done?

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.

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.

Is it painful?

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.

What are the Advantages over Conventional Colonoscopy?

-No Sedation
-Immediate Resumption of normal activities
-Rapid, Safe, Accurate

What are the Disadvantages compared to Conventional Colonoscopy?

-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

How Accurate is it?

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.

Is Virtual Colonoscopy covered by Insurance?

Virtual colonoscopy is not currently reimbursed by most insurance companies. The patient must therefore cover the cost of the procedure which is $750. Medicare patients will be required to sign a waiver stating it is a non-covered service and you will accept responsibility for payment.

Why is screening important?

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.

What are the options to detect polyps?

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.

What are your feelings as a radiologist?

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.

GE 1.5T EXCITE MRI

East River Medical Imaging is pleased to announce the addition of a third high field strength 1.5 Tesla magnet with echo speed gradients and the new EXCITE platform. The first in Manhattan, East River Medical Imaging commits to Leading the Way in new technology. This new high field strength magnet was designed to optimize patient comfort. Its wide bore configuration and creatively designed exterior has enabled a larger population of claustrophobic patients benefit high field imaging.
The GE EXCITE 1.5T system provides the most extensive range of leading-edge imaging technologies in the industry. The EXCITE platform reduces scan time, improves image quality and allows breakthrough imaging techniques such as peripheral vascular imaging, spectroscopy and MRA. The reduced scan time decreases motion artifact, reduces the length of a breath-held exam and increases patient comfort because of its high speed capability.
East River Medical Imaging can provide same day scheduling for your MR patients. As always, our goal is to provide your patients the highest level of diagnostic imaging in a pleasant and professional environment.
For patients who are unable to tolerate this "open" high field strength magnet we continue to provide a traditional open magnet as an alternative.
Please call our office if you have any questions or need further assistance.

Lightspeed 16 CT Scanner

East River Medical Imaging is the first free standing imaging center to acquire the new GE LightSpeed 16. This new 16-Channel Multidetector CT scanner adds a new dimension to diagnostic imaging with higher resolution and quicker scan time.

The 16 Channel Lightspeed CT Scanner has the ability to scan faster with sub-millimeter resolution and dose optimization. The Lightspeed16 obtains diagnostic quality images at minimum patient dose. Multiplanar reformatting (MPR) and advanced 3D applications are enhanced by cubic voxels.

Advanced clinical applications of the Lightspeed16 include:
·  CT angiography with advanced vessel analysis
·  Cardiac Functional Analysis
·  Coronary artery calcium scoring
·  Coronary artery vessel analysis (including patients who have undergone bypass grafts and stents)
·  CT Perfusion
·  CT Virtual Colongraphy
·  3D Volume Rendering

3D volume rendering allows the user to take full advantage of 3D analysis. With the integration of the new Advantage Workstation; one is able to generate 3D images rapidly and precisely.