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Diagnonistic Test

Back X-Rays (Spine X-Rays)

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Alternative Names:Vertebral radiography; X-ray – spine; Thoracic x-ray; Spine x-ray; Thoracic spine films; Back films

Definition:
Doctors have used x-rays for over a century to see inside the body in order to diagnose a variety of problems, including cancer, fractures, and pneumonia. During this test, you usually stand in front of a photographic plate while a machine sends x-rays, a type of radiation, through your body. Originally, a photograph of internal structures was produced on film; nowadays, the image created by the x-rays goes directly into a computer. Dense structures, such as bone, appear white on the x-ray films because they absorb many of the x-ray beams and block them from reaching the plate. Hollow body parts, such as lungs, appear dark because x-rays pass through them. (In some other countries, like the United Kingdom, the colors are reversed, and dense structures are black.)

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Vertebral radiography; X-ray – spine; Thoracic x-ray; Spine x-ray; Thoracic spine films; Back films. Doctors use back x-rays to examine the vertebrae in the spine for fractures, arthritis, or spine deformities such as scoliosis, as well as for signs of infection or cancer. X-rays can be taken separately for the three areas of the spine: the cervical spine (neck), thoracic spine (middle back), and lumbar spine (lower back). Occasionally, doctors x-ray the pelvis to help diagnose the cause of back pain.
How do you prepare for the test?
You have to remove all clothing, undergarments, and jewelry from your upper body. You may be asked to wear a hospital gown.
Inform the health care provider if you are pregnant.

How the Test is Performed

The test is performed in a hospital radiology department or in the health care provider’s office by an x-ray technician. You will lie on the x-ray table and assume various positions. If the x-ray is to determine an injury, care will be taken to prevent further injury.

The x-ray machine will be positioned over the thoracic area of the spine. You will hold your breath as the picture is taken, so that the picture will not be blurry. Usually 2 or 3 views are needed.

What happens when the test is performed?
You either stand or lie down while a technician takes the x-rays. He or she positions you against the photographic plate (which looks like a large board) to get the clearest pictures. A front view and a side view are usually taken.

For cervical spine x-rays, the technician tells you to open your mouth as wide as you can before taking some of the pictures; this is done to avoid having your teeth block the view of the bones at the top of your spine.

The technician leaves the room or stands behind a screen while controlling the x-ray camera. To avoid a blurred image, he or she tells you to remain as still as possible, including holding your breath, before taking each picture.
Th test causes no discomfort. The table may be cold.

Why the Test is Performed?
The x-ray helps evaluate bone injuries, disease of the bone, tumors of the bone, or cartilage loss.

What risks are there from the test?
There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits as The amount of radiation from x-ray tests is too small. Pregnant women and children are more sensitive to the risks of the x-ray as the radiation may be harmful to a developing fetus.

Must you do anything special after the test is over?
Nothing.

How long is it before the result of the test is known?
Although digital images are often available immediately, it may take additional time for a doctor to examine them. You’ll probably get the results later in the day.

Considerations:
The x-ray will not detect problems in the muscles, nerves, and other soft tissues, because they can’t be seen well on an x-ray.

Resources:
https://www.health.harvard.edu/diagnostic-tests/back-x-rays.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003806.htm

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Myelography (Myelogram)

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Definition:

A myelogram is an x-ray test in which dye is injected directly into your spinal canal to help show places where the vertebrae in your back may be pinching the spinal cord.It is utilized to diagnose disorders of the spinal canal and cord, such as nerve compression causing pain and weakness.It is sometimes used to help diagnose back or leg pain problems, especially if surgery is being planned.

The test is usually performed on an outpatient basis at a hospital or other medical facility by a neuroradiologist. Neuroradiology is a sub-specialty of radiology that conducts studies of the central nervous system.
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A myelogram requires introduction of radiographic contrast media (dye) into the sac (dura) surrounding the spinal cord and nerves. The patient lies on their stomach during the test. After the skin area has been numbed, the dye is injected into the spinal sac followed by x-rays, CT, or MRI scans. After the images are processed, a neuroradiologist interprets the results and sends a report to the referring physician.

Following the myelogram, the patient is taken to a recovery area where they rest lying down with their head elevated for several hours. Once at home, quiet non-strenuous activities are recommended for 24 hours to allow the puncture site to heal. Plenty of fluids (e.g. water, juice) should be consumed to clear the dye from the body.

Important Considerations :-
Certain medical conditions, drugs, or allergies should be discussed with the referring physician prior to the myelogram. Some of these topics are listed below.

1. Metallic components such as a pacemaker, aneurysm clip, or other metal implants prohibit the patient from an MRI scan.
2. Allergies to an IVP (intravenous pyelography) or other contrast dye should be reported. Adverse reactions include hives, swelling, and difficulty breathing. Fore knowledge of an allergy can often be controlled by pre-medicating.
3. Epilepsy or seizure disorder, and if medication is taken to control episodes.
4. Angina or kidney disorders.
5. Diabetic patients who control their disease with medication need to discuss this with their physician. Certain drugs may need to be discontinued for 48 hours prior to the test.
6. Blood thinners may need to be discontinued prior to the test.
7. Difficulty lying flat on the stomach or inability to remain still.

How do you prepare for the test?
Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office, or to x-ray dyes. You should also tell your doctor if you might be pregnant.

1. The patient will need someone to drive them home following the test. This should be prearranged in advance of the scheduled test day.
2. Leave valuables at home.
3. Bring prior relevant x-rays, CT or MRI scan for the neuroradiologist’s review.
4. Do not eat anything after midnight the night before the myelogram. Some patients experience side effects such as nausea and vomiting. Clear liquids are acceptable.
5. Take scheduled medication with clear liquid, unless the referring physician has instructed otherwise (e.g. diabetics).
What happens when the test is performed?
Patients usually wear a hospital gown. Typically, you lie on your side with your knees curled up against your chest. In some cases, the doctor asks you to sit on the bed or a table instead, leaning forward against some pillows.

The doctor feels your back to locate your lower vertebrae and feels the bones in the back of your pelvis. An area on your lower back is cleaned with soap. Medicine is injected through a small needle to numb the skin and the tissue underneath the skin in the area. This causes some very brief stinging.

A different needle is then placed in the same area and moved forward until fluid can be injected through it into the spinal canal. This fluid is a type of dye that shows up on x-rays; this allows your doctors to get a clear picture of the fluid space around your spinal cord and to see places where the space is narrowed by bones around it. Because the needle must be placed through a small opening between two bones, the doctor must sometimes move the needle in and out several times to locate the opening. Because of the numbing medicine used in this area, most patients experience only a feeling of pressure from this movement. Occasionally some patients do get a sharp feeling in the back or (rarely) in the leg. Let your doctor know if you feel any pain.

Once the dye has been injected, the needle is removed and several x-ray pictures are taken of your back. Sometimes a CT (computed tomography) scan picture is taken instead.

The process usually involves lying face down on a table, and your feet are secured tightly with straps to the table itself. The Radiologist will perform the spinal tap, introducing the contrast medium. The table is then slowly rotated in a circular motion, first down at the head end for approximately 4-6 minutes, then rotated up at the head end for the same duration. Several more minutes lying flat and the process is complete. This movement insures the contrast has sufficiently worked its way through the spinal cord.

It is very important to not lift anything for at least 24 hours following this procedure, and to lie flat for at least the same amount of time. There is a high chance that excessive movement or any lifting will release the ‘plug’ at the site of the spinal tap, and CSF will then drain from your brain and cause very severe headaches. This can be corrected by returning to the medical facility and having them perform a ‘blood patch’, a small amount of blood from your arm, injected into the exact spinal tap location, to stop the leaking of CSF.
What are the benefits vs. risks?
Benefits:-

* Myelography is relatively safe and painless.
* When a contrast material is injected into the space surrounding the spinal cord, it allows the radiologist to view outlines of the different areas of the spine that usually are not visible or distinguishable on x-rays.
* No radiation remains in a patient’s body after an x-ray examination.
* X-rays usually have no side effects in the diagnostic range*Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the technique standards used by radiology professionals.

# Minimizing Radiation Exposure:State-of-the-art x-ray systems have tightly controlled x-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures that those parts of a patient’s body not being imaged receive minimal radiation exposure.

Risks:-

* There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
* The effective radiation dose from this procedure is about 4 mSv, which is about the same as the average person receives from background radiation in 16 months. See the Safety page for more information about radiation dose.
* Although it is uncommon, headache due to the needle puncture following myelography is one risk. The headache, when it occurs, usually begins when the patient begins to sit upright or stand. One of the common features of this type of headache is that it is improved when the patient lays flat. When present, the headache usually begins within 2-3 days after the procedure. Rest while laying on one’s back and increased fluid intake readily relieve mild headaches, but more severe headaches may call for medication. In rare circumstances some patients continue to experience spinal headaches, which may necessitate a special procedure to stop leakage of cerebrospinal fluid from the puncture site.
* Adverse reactions to injection of contrast material during a myelogram are infrequent and usually mild in nature, including itching, rash, sneezing, nausea, or anxiety. The development of hives or wheezing may require treatment with medication. More severe reactions involving the heart or lungs are rare.
* Other rare complications of myelography include nerve injury from the spinal needle and bleeding around the nerve roots as they enter or exit the spinal cord. In addition, the membrane covering the spinal cord may become inflamed or infected. Seizures are a very uncommon complication of myelography.
* There is a very small risk that contrast material will block the spinal canal, which can make surgery necessary.
* Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

If symptoms persist 48 hours, contact the referring physician and/or medical facility.

Must you do anything special after the test is over?
Nothing. Usually a Band-Aid is the only dressing necessary for your back.

How long is it before the result of the test is known?
It takes about an hour to have your x-rays or CT scan developed and some time for the films to be reviewed by a radiologist. Usually your doctor can get the results within a day.

Limitations:–

* The most significant limitation of myelography is that it only sees inside the spinal canal and the very proximal nerve roots. Abnormalities outside these areas may be better imaged with MRI.
* Myelography usually is avoided during pregnancy because of the potential risk to the baby.
* The findings may not be accurate if the patient moves during the exam.
* It may be difficult to inject contrast material in patients with structural defects of the spine or some forms of spinal injury.
* Myelography cannot be done if the injection site is infected.

Resources:
https://www.health.harvard.edu/diagnostic-tests/myelography.htm
http://www.spineuniverse.com/displayarticle.php/article249.html
http://en.wikipedia.org/wiki/Myelography
http://www.radiologyinfo.org/en/info.cfm?pg=myelography

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Diagnonistic Test

Computed Tomography (CT Scan) for Back Problems

The prototype CT scanner
Image via Wikipedia

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Definition:
Computed tomography (CT) scan, also called computerized axial tomography (CAT) scan, is used to create cross-sectional images of structures in the body. In this procedure, x-rays are taken from many different angles and processed through a computer to produce a three-dimensional (3-D) image called a tomogram.

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CT scans are pictures taken by a specialized x-ray machine. The machine circles your body and scans an area from every angle within that circle. The machine measures how much the x-ray beams change as they pass through your body. It then relays that information to a computer, which generates a collection of black-and-white pictures, each showing a slightly different “slice” or cross-section of your internal organs. Because these “slices” are spaced only about a quarter-inch apart, they give a very good representation of your internal organs and other structures. Doctors use CT scans to evaluate all major parts of the body, including the abdomen, back, chest, and head.

A CT scan is not a very common test to have done for back problems. It does a better job showing the abdominal internal organs than showing details of the bones in the spine. But some back pain is caused by problems in these internal organs, such as the pancreas or the kidney. The CT scan is an excellent way to examine these organs. Also, the CT scan can be combined with a test called a “myelogram” (discussed separately) to give a clear view of the spinal cord and places where the vertebral bones might be pinching it.

Why It Is Done
A CT scan of the spine is done to:

*Look at the bones of the spine (vertebrae).

*Find problems of the spine, such as tumors, fractures, deformities, infection, or narrowing of the spinal canal (spinal stenosis).

*Find a herniated disc of the spine.

*Check to see if osteoporosis has caused compression fractures.

*Check on problems of the spine that have been present since birth (congenital).

*Look at problems seen during a standard X-ray test.

*Check how well spinal surgery or therapy is working for a spine problem.

How do you prepare for the test?
If you are having an abdominal CT scan, you might have to fast 2–4 hours before your test. You also may have to drink a large quantity of oral contrast, a fluid that will show up on the CT scan and help define the lining of some internal organs. Tell your doctor if you’re allergic to x-ray contrast dyes, may be pregnant, or have diabetes and take insulin. Insulin can cause hypoglycemia after missing a meal.

What happens when the test is performed?
The test is done in the radiology department of a hospital or in a diagnostic clinic. You wear a hospital gown and lie on your back on a table that can slide back and forth through the donut-shaped CT machine.

During the test, you will lie on a table that is attached to the CT scanner, which is a large doughnut-shaped machine. The CT scanner sends X-rays through the body. Each rotation of the scanner takes a second and provides a picture of a thin slice of the organ or area being studied. One part of the scanning machine can tilt to follow the curve of your spine. All of the pictures are saved as a group on a computer. They also can be printed.

In some cases, a dye (contrast material) may be put in a vein (IV) in your arm or into the spinal canal (intrathecally). The dye make structures and organs easier to see on the CT pictures. The dye may be used to check blood flow and to look for tumors, areas of inflammation, or nerve damage.

The technologist moves the table with a remote control to enable the CT machine to scan your body from all of the desired angles. You will be asked to hold your breath for a few seconds each time a new level is scanned. The technologist usually works the controls from an adjoining room, watching through a window and sometimes speaking to you through a microphone. A CT scan takes about 30–45 minutes. Although it’s not painful, you might find it uncomfortable if you don’t like to lie still for extended periods.

How It Feels
You will not have pain during the scan. The table you lie on may feel hard and the room may be cool. It may be hard to lie still during the test.

Some people feel nervous inside the CT scanner.

If a medicine to help you relax (sedative) or a dye (contrast material) is used, an IV is usually put in your hand or arm. You may feel a quick sting or pinch when the IV is started. The dye may make you feel warm and flushed and give you a metallic taste in your mouth. Some people feel sick to their stomach or get a headache. Tell the technologist or your doctor how you are feeling.

Risk Factors:

The chance of a CT scan causing a problem is small. The contrast dye used in the test can damage your kidneys, especially if they are already impaired by disease.However, some newer dyes are less likely to cause kidney injuries. If kidney damage does occur, this is usually temporary, although in some rare cases it becomes permanent. If you are allergic to the dye used in the procedure, you may get a rash or your blood pressure may drop enough to make you feel faint until you get treatment. As with x-rays, there is a small exposure to radiation. The amount of radiation from a CT scan is greater than that from regular x-rays, but it’s still too small to be likely to cause harm unless you’re pregnant.
If you have diabetes or take metformin (Glucophage), the dye may cause problems. Your doctor will tell you when to stop taking metformin and when to start taking it again after the test so you will not have problems.You may have nausea or vomiting after the test.

There is a small chance of an infection at the needle site on your spine or bleeding into the space around the spinal cord.Intrathecal injections may cause a headache. On rare occasions, seizures may occur after an injection of intrathecal contrast material.

There is a slight chance of developing cancer from having tests that use radiation. The chance is higher in children or people who have many radiation tests. If you are concerned about this risk, talk to your doctor about the amount of radiation this test may give you or your child and confirm the test is needed.

Must you do anything special after the test is over?
Nothing.

Results
A computed tomography (CT) scan uses X-rays to make detailed pictures of the spine and vertebrae in the neck (cervical spine), upper back (thoracic spine), or lower back (lumbosacral spine).

The radiologist may discuss the CT scan with you right after the test. However, complete results usually are ready for your doctor in 1 to 2 days.

If you face any problem After the test is over
Call 911 or other emergency services immediately if you have a seizure.

Call your doctor immediately if you:

*Have pain, weakness, or numbness in your legs.
*Have a severe headache.
*Have a headache that lasts more than 24 hours.
*Feel extremely irritable.
*Have problems urinating or having a bowel movement.
*Develop a fever.

What Affects the Test
The following may stop you from having the test or may change the test results:

*Pregnancy. CT scans are not usually done during pregnancy.

*Barium and bismuth used for another test. These substances show up on a CT scan. If a CT scan of the lower back is needed, it should be done before any tests that use barium, such as a barium enema.

*Metal objects in the body. These items, such as surgical clips or metal in joint replacements, may prevent a clear view of the body area.

*You are not able to lie still during the test.

What To Think About
*Sometimes your CT test results may be different than those from other types of X-ray tests, magnetic resonance imaging (MRI), or ultrasound scans because the CT scan provides a different view.

*CT results are often compared to positron emission tomography (PET) results to help find cancer. Some new scanners do both scans at the same time.

*MRI may give more information than a CT scan about the spinal discs and spinal cord. For more information, see the medical test Magnetic Resonance Imaging (MRI).

*When a CT scan of the spine is done with a myelogram, it is called a CT myelogram. An MRI of the spine is often done in place of a CT myelogram. For more information, see the medical test Myelogram.

Resources:
https://www.health.harvard.edu/diagnostic-tests/ct-scan-for-back-problems.htm
http://www.neurologychannel.com/diagnostictests/CTscan.shtml
http://health.yahoo.com/nervous-diagnosis/computed-tomography-ct-scan-of-the-spine/healthwise–tu6220.html

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Bone Density Test for Osteoporosis

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Definition:A bone density test uses special X-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone.It measure the thickness and strength of your bones. Various scanners use different techniques, such as dual-energy x-ray absorptiometry (DXA) and radiographic absorptiometry. Quantitative ultrasound, which does not involve x-rays, may also be used.
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When bones are somewhat thin, the condition is called osteopenia; when bones become very thin, the condition is called osteoporosis. Bone density tests provide a precise measure of whether you have osteopenia or osteoporosis.Men, and particularly women, usually begin to lose bone thickness around age 50. Exercise and various treatments can help prevent and even restore bone loss; that’s why diagnosing thin bones is important.Many authorities now recommend screening for thin bones. Not only is this test used to help detect osteoporosis, but it is also helpful in monitoring your progress if you’re taking bone-building medications.

A bone density test is a fairly accurate predictor of your risk. The results from a bone density test can let you know how you compare with other people of your age, sex and other similar characteristics.

Why it is required?
The higher your mineral content, the denser your bones are. And the denser your bones, the stronger they generally are and the less likely they are to break.

Doctors use a bone density test to determine if you have, or are at risk of, osteoporosis.

Bone density tests are not the same as bone scans. Bone scans require an injection beforehand and are usually used to detect fractures, cancer, infections and other abnormalities in the bone.

The U.S. Preventive Services Task Force recommends routine bone density screening if:

You’re a woman age 65 or older
You’re 60 and at increased risk of osteoporosis
Research hasn’t yet determined the optimal interval for repeat bone density screenings, or the right age to stop screening. However, two or more years may be needed between tests to reliably measure a change in your bone density. Your doctor can recommend the best screening interval for you based on your personal medical history and osteoporosis risk factors.

The older you get, the higher your risk of osteoporosis because your bones become weaker as you age. Your race also makes a difference: you’re at greatest risk of osteoporosis if you’re white or of Southeast Asian descent, and African American and Hispanic men and women have a lower, but still significant, risk. Other risk factors for osteoporosis include low body weight, a personal history of fractures, a family history of osteoporosis and using certain medications that can cause bone loss.

Risk Factor:
The test doesn’t have any significant risks. Bone density tests that use x-rays expose you to about one-tenth the amount of radiation as in a single chest x-ray; this is too small an amount to be likely to cause any harm, except to a fetus in a pregnant woman.

Bone density testing is a valuable tool in the diagnosis of osteoporosis and is a fairly accurate predictor of your risk of fractures. Significant differences in the various testing methods do exist, however. Central devices are more accurate, but cost significantly more than peripheral devices do.

Not all health insurance plans cover bone density tests, so ask your insurance provider whether it provides coverage that applies to your situation.

A bone density test can confirm that you have low bone density, but it can’t tell you why. To answer that question, you need a complete medical evaluation, including a history and physical. This information can help your doctor better interpret the results of the bone density test.

How do you prepare for the test?
Bone density tests are easy, fast and painless. Virtually no preparation is needed. In fact, some simple versions of the bone density tests can be done at your local pharmacy or drugstore.

If you’re having the test done at a medical center or hospital, be sure to tell your doctor beforehand if you’ve had recent oral contrast or nuclear medicine tests. These tests require an injection of radioactive tracers that might interfere with your bone density test.

Be sure to tell your doctor if you might be pregnant. A screening test that uses x-rays can’t be performed during pregnancy because it may increase the risk of birth defects.

What happens when the test is performed?
Bone density tests can be done in the radiology department of a hospital, a radiology diagnostic center, or a doctor’s office.You lie on a table that has an overhanging cover, resembling a tanning bed, while a radiologist or x-ray technician moves a scanner above your spine, hip, or wrist. The test takes 10-20 minutes. The test itself is painless, but you may experience some discomfort because you have to lie still.

The equipment for bone density tests includes large machines on which you can lie down (central devices) as well as smaller, portable machines that measure bone density on the periphery of your skeleton, such as in your finger, wrist or heel (peripheral devices).

Central devices
*DEXA scan. Dual energy X-ray absorptiometry (DEXA) scans measure the bone density at your hip or spine. This test offers very precise results and is the preferred test for diagnosing osteoporosis. During this test, you lie on a padded platform for a few minutes while an imager — a mechanical arm-like device — passes over your body. It won’t touch you. The test does, however, emit radiation, though your exposure during a bone density test is commonly about one-tenth of the amount emitted during a chest X-ray. This test usually takes five to 10 minutes to complete.

*Quantitative CT scan. This test uses a computerized tomography (CT) scanner combined with computer software to determine your bone density, usually at your spine. Quantitative CT (QCT) scans provide detailed, 3-D images and can take into account the effects of aging and diseases other than osteoporosis on your bones. QCT scans emit more radiation than DEXA scans do. For a QCT test, you lie on a movable table that’s guided into a large tube-like area where images are taken. It typically takes less than 10 minutes.

Peripheral devices
Peripheral devices are found in pharmacies and are considerably less expensive than are central devices. But these smaller machines do have limitations.

Measurements taken at your hip and spine generally are considered more accurate assessments of your osteoporosis risk because these are the locations where major fractures tend to occur — fractures that can severely limit the quality and even the length of your life.

A test done on a peripheral location, such as your heel, may predict risk of fracture in your spine and hip as well. But because bone density tends to vary from one location to the other, a measurement taken at the heel usually isn’t as accurate as a measurement taken at the spine or hip.

Measurements of bone density in your heel or finger still can be used to screen for osteoporosis, though. If your test is positive, your doctor might recommend a DEXA scan at your spine or hip to confirm your diagnosis.

How long is it before the result of the test is known?
You’ll get the results within a few days. The results will include two scores, the T-score and the Z-score. The T-score measures your bone density compared with the average values in young adults of the same race and sex. The Z-score shows how your bone density compares with that of people your own age, race, and sex. A positive T-score means your bones are stronger than the average in a young adult, and a negative score means that your bones are weaker. If you have a T-score that is between -1.0 and -2.5, you have osteopenia. If it is below -2.5, you have osteoporosis.

In general, the lower your bone density, the higher your risk of breaking a bone. Fractures of the hip are particularly disabling, and fractures of the spine are common and painful. Bone density measured at the hip and spine by DXA is regarded by most experts as the best predictor of hip and spine fracture. DXA also is excellent for diagnosing thin arm bones; wrist fractures occur more easily in people with osteopenia or osteoporosis. Fortunately, treatment options exist. Talk with your doctor.

Anything Must you do special after the test is over?
Nothing

Resources:
https://www.health.harvard.edu/diagnostic-tests/bone-density-test-for-osteoporosis.htm
http://www.mayoclinic.com/health/bone-density-test/MY00304/DSECTION=results
http://www.osteoporosisexpert.com/
http://www.nlm.nih.gov/medlineplus/ency/imagepages/17287.htm

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Imaging Way to Keep the Doctor Away

New diagnostic machines showcased at a global medical conference in Chicago are going to rewrite the future of medicine.

 

SOME IMAGING EQUIPMENT PRESENTED AT RSNA 2008: (From left) High-resolution MRI system; a 4-D imaging ultrasound system ; the 1000-slice CT scanner

If you ask any knowledgeable person to name an area of science or technology that is set to revolutionise medicine, you will probably get “genomics” as an answer. Not many would say that “medical imaging” is the future. But this seemingly mundane technology is rewriting medical diagnostics and treatment like never before.

In the public mind, medical imaging is synonymous with three technologies: x-ray, ultrasound and magnetic resonance imaging (MRI). While these three still remain the basis of most initial diagnostic investigations, medical imaging has gone far beyond these techniques.

Variations of these three basic technologies now provide images of unprecedented accuracy, while new methods like molecular imaging are taking imaging to uncharted territories. Imaging techniques can point out cancer cells early, map far-flung crevices of the brain and show blood vessels and the flow inside them.

“Genomics has got all the publicity, but imaging has really transformed medicine in the last decade or two,” stresses T.S. Sridhar, professor of molecular medicine at St John’s Hospital, Bangalore.

It is no accident that the largest medical conference in the world is in the field of imaging, and is organised by the Radiological Society of North America (RSNA). The conference in Chicago, held between November 30 and December 6, presented some cutting edge research and imaging equipment that provided a glimpse into the future. One could see, among other things, computed tomography (CT) scanners that could take up to 1000 images of a body part in no time, MRI machines that could compensate for movement of the heart and provide clear images, and molecular imaging equipment that map tumours and their activity with great accuracy.

More and more clinical investigations are going to depend on imaging to provide clues to health problems. Traditionally, an image of the body is taken when you investigate symptoms of some disorder, but this practice is going to change soon. “Molecular imaging can tell you about risks for many diseases well before symptoms appear,” says Jean Luc Vanderheyden, molecular imaging leader at GE Healthcare.

Imaging is a technology that is already transforming medicine every day, as evidenced by the research presented at the conference. Here are a few samples. Scientists presented a new technique called magnetoencephalography (MEG) that maps small magnetic fields associated with brain activity. Among other things, it was used by scientists at the Children’s Hospital in Philadelphia to study abnormalities in the brain of autistic children.

Scientists from the University of California in San Francisco showed how CT scans could probe two diseases at once: colorectal cancer and osteoporosis (brittle bone disease). A new variant of mammography, called positron emission mammography (PEM), can point out those cancers in the breast that neither conventional mammography nor MRI can identify.

Advances in imaging technology are now promising to rewrite healthcare in at least one major way: by detecting diseases early, at a stage when treatment is very effective. Traditionally, early detection of disease was not under the purview of medical imaging, and doctors advised an ultrasound or an MRI only when there was some symptom. There were two reasons for this practice. First, random screening of patients was expensive and impractical. And second, imaging technology had not advanced enough to detect diseases before symptoms appeared.

Now advances in fields such as genomics are providing us with clues about risk factors. We know about many genes that could increase the risk factor for diseases like cancer, Parkinson’s and Alzheimer’s. In developed countries, such high-risk people are already being screened regularly to check for the presence of the disease. And in recent years, imaging technology has advanced enough for radiologists to detect diseases in their early stages, sometimes well before other techniques can detect them. Which is why imaging companies like GE are campaigning to detect diseases early.

Take breast cancer. Regular screenings fail to detect all breast cancers, and sometimes there are false alarms. This is because the density of the breast needs to be high (with less fat than glandular and connective tissue) for MRIs. Hormonal changes that occur during a woman’s menstrual cycle also interfere with the technique. In addition to these gla-ring exceptions, mammogra phy routinely misses minute tumours.

PEM, on the other hand, can detect tumours even in less dense breasts and is also less dependent on hormonal cycles. Also, mammography is now advancing at such a rapid pace that it will soon be able to detect cancers that are barely visible to the naked eye. It seems medicine has finally mastered the art of detecting critical ailments early.

Sources: The Telegraph (Kolkata, India)

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