iDEXA SCAN

A Bone Mineral Density test determines whether you have osteoporosis or are at risk of osteoporosis. Osteoporosis is a disease that causes bones to become more fragile and more likely to break. A bone density test uses X-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone. A bone density test is a fairly accurate predictor of your risk of fracture.

 

 

Why it is done?

Doctors use bone density testing to:

decreases in bone density before you break a bone

Determine your risk of broken bones (fractures)

Confirm a diagnosis of osteoporosis if you've experienced broken bones

Monitor osteoporosis treatment

It is recommended to take this test if,

You're a woman age 65 or older

You're a postmenopausal woman under age 65 with one or more risk factors for osteoporosis

You're a man age 70 or older

You're a man between age 50 and 70 with one or more risk factors for osteoporosis

You're older than age 50 and you've experienced a broken bone

You're a postmenopausal woman and you've stopped taking estrogen therapy or hormone therapy

 

How to Prepare for Bone Mineral Density

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.

Ultrasound-Guided Breast Biopsy


An ultrasound-guided breast biopsy uses sound waves to help locate a lump or abnormality and remove a tissue sample for examination under a microscope. It is less invasive than surgical biopsy, leaves little to no scarring and does not involve exposure to ionizing radiation. Tell your doctor about any recent illnesses or medical conditions and whether you have any allergies, especially to anesthesia. Discuss any medications you’re taking, including herbal supplements and aspirin. You will be advised to stop taking aspirin or blood thinner three days before your procedure. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown. If you are to be sedated, plan to have someone drive you home afterward.

What is Ultrasound-Guided Breast Biopsy?

Lumps or abnormalities in the breast are often detected by physical examination, mammography, or other imaging studies. However, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous.

A breast biopsy is performed to remove some cells from a suspicious area in the breast and examine them under a microscope to determine a diagnosis. This can be performed surgically or, more commonly, by a radiologist using a less invasive procedure that involves a hollow needle and image-guidance. Image-guided needle biopsy is not designed to remove the entire lesion.

Image-guided biopsy is performed by taking samples of an abnormality under some form of guidance such as ultrasound, MRI or mammographic guidance.

In ultrasound-guided breast biopsy, ultrasound imaging is used to help guide theradiologist's instruments to the site of the abnormal growth.

 

What are some common uses of the procedure?

An ultrasound-guided breast biopsy can be performed when a breast ultrasound shows an abnormality such as:

A suspicious solid mass

A distortion in the structure of the breast tissue

An area of abnormal tissue change

There are times when your doctor may decide that ultrasound guidance for biopsy is appropriate even for a mass that can be felt.

Ultrasound guidance is used in four biopsy procedures:

fine needle aspiration (FNA), which uses a very small needle to extract fluid or cells from the abnormal area.

core needle (CN) which uses a large hollow needle to remove one sample of breast tissue per insertion.

vacuum-assisted device (VAD) which uses a vacuum powered instrument to collect multiple tissue samples during one needle insertion.

wire localization, in which a guide wire is placed into the suspicious area to help the surgeon locate the lesion for surgical biopsy.

 

How should I prepare?

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.

You may be asked to wear a gown during the procedure.

Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anesthesia. Your physician may advise you to stop taking aspirin or a blood thinner three days before your procedure.

Also, inform your doctor about recent illnesses or other medical conditions.

You may want to have a relative or friend accompany you and drive you home afterward. This is recommended if you have been sedated.

 

What does the equipment look like?

Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to do the scanning. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. Some exams may use different transducers (with different capabilities) during a single exam. The transducer sends out inaudible, high—frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.

The ultrasound image is immediately visible on a video display screen that looks like a computer or television monitor. The image is created based on the amplitude (loudness), frequency (pitch) and time it takes for the ultrasound signal to return from the area within the patient that is being examined to the transducer (the device used to examine the patient), as well as the type of body structure and composition of body tissue through which the sound travels. A small amount of gel is put on the skin to allow the sound waves to best travel from the transducer to the examined area within the body and then back again.

One of four instruments will be used:

A fine needle attached to a syringe, smaller than needles typically used to draw blood.

A core needle, also called an automatic, spring-loaded needle, which consists of an inner needle connected to a trough, or shallow receptacle, covered by a sheath and attached to a spring-loaded mechanism.

A vacuum-assisted device (VAD), a vacuum-powered instrument that uses pressure to pull tissue into the needle.

A thin guide wire, which is used for a surgical biopsy.

Other sterile equipment involved in this procedure includes syringes, sponges, forceps, scalpels and a specimen cup or microscope slide.

 

How does the procedure work?

Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as the object's size, shape and consistency (whether the object is solid or filled with fluid).

In medicine, ultrasound is used to detect changes in appearance, size or contour of organs, tissues, and vessels or detect abnormal masses, such as tumors.

In an ultrasound examination, a transducer both sends the sound waves and receives the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images. Small loops of the moving real-time images may also be saved.

Using an ultrasound probe to visualize the location of the breast mass, distortion or abnormal tissue change, the radiologist inserts a biopsy needle through the skin, advances it into the targeted finding and removes tissue samples. If a surgical biopsy is being performed, ultrasound may be used to guide a wire directly into the targeted finding to help the surgeon locate the area for excision. With continuous ultrasound imaging, the physician is able to view the biopsy needle or wire as it advances to the location of the lesion in real-time.

 

How is the procedure performed?

Image-guided, minimally invasive procedures such as ultrasound-guided breast biopsy are most often performed by a specially trained radiologist.

Breast biopsies are usually done on an outpatient basis.

You will be positioned lying face up on the examination table or turned slightly to the side.

A local anesthetic will be injected into the breast to numb it.

Pressing the transducer to the breast, the sonographer or radiologist will locate the lesion.

A very small nick is made in the skin at the site where the biopsy needle is to be inserted.

The radiologist, monitoring the lesion site with the ultrasound probe, will insert the needle and advance it directly into the mass.

Tissue samples are then removed using one of three methods:

In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.

In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with 'cores' of breast tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated three to six times.

With a vacuum-assisted device (VAD), vacuum pressure is used to pull tissue from the breast through the needle into the sampling chamber. Without withdrawing and reinserting the needle, it rotates positions and collects additional samples. Typically, eight to 10 samples of tissue are collected from around the lesion.

After this sampling, the needle will be removed.

If a surgical biopsy is being performed, a wire is inserted into the suspicious area as a guide for the surgeon.

A small marker may be placed at the biopsy site so that it can be located in the future if necessary.

Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed.

A mammogram may be performed to confirm that the marker is in the proper position.

This procedure is usually completed within an hour.

 

What will I experience during and after the procedure?

You will be awake during your biopsy and should have little discomfort. Most women report little or no pain and no scarring on the breast.

When you receive the local anesthetic to numb the skin, you will feel a slight pin prick from the needle. You may feel some pressure when the biopsy needle is inserted.

The area will become numb within a short time.

You must remain still while the biopsy is performed.

As tissue samples are taken, you may hear clicks or buzzing sounds from the sampling instrument.

If you experience swelling and bruising following your biopsy, you may be instructed to take an over-the-counter pain reliever and to use a cold pack. Temporary bruising is normal.

You should contact your physician if you experience excessive swelling, bleeding, drainage, redness or heat in the breast.

If a marker is left inside the breast to mark the location of the biopsied lesion, it will cause no pain, disfigurement or harm.

You should avoid strenuous activity for 24 hours after the biopsy. After that period of time, you will usually be able to resume normal activities.

 

Who interprets the results and how do I get them?

A pathologist examines the removed specimen and makes a final diagnosis. Depending on the facility, the radiologist or your referring physician will share the results with you. The radiologist will also evaluate the results of the biopsy to make sure that the pathology and image findings are appropriate.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

 

What are the benefits vs. risks?

Benefits
  • The procedure is less invasive than surgical biopsy, leaves little or no scarring and can be performed in less than an hour.
  • Ultrasound imaging uses no ionizing radiation.
  • Ultrasound-guided breast biopsy reliably provides tissue samples that can show whether a breast lump is benign or malignant.
  • Compared with stereotactic breast biopsy, the ultrasound method is faster and avoids the need for ionizing radiation exposure.
  • With ultrasound it is possible to follow the motion of the biopsy needle as it moves through the breast tissue.
  • Ultrasound-guided breast biopsy is able to evaluate lumps under the arm or near the chest wall, which are hard to reach with stereotactic biopsy.
  • Ultrasound-guided biopsy is less expensive than other biopsy methods, such as open surgical biopsy or stereotactic biopsy.
  • Recovery time is brief and patients can soon resume their usual activities.
Risks
  • There is a risk of bleeding and forming a hematoma, or a collection of blood at the biopsy site. The risk, however, appears to be less than one percent of patients.
  • An occasional patient has significant discomfort, which can be readily controlled by non-prescription pain medication.
  • Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
  • Depending on the type of biopsy being performed or the design of the biopsy machine, a biopsy of tissue located deep within the breast carries a slight risk that the needle will pass through the chest wall, allowing air around the lung that could cause the lung to collapse. This is an extremely rare occurrence.

 

What are the limitations of Ultrasound-Guided Breast Biopsy?

Breast biopsy procedures will occasionally miss a lesion or underestimate the extent of disease present. If the diagnosis remains uncertain after a technically successful procedure,surgical biopsy will usually be necessary.

The ultrasound-guided biopsy method cannot be used unless the lesion can be seen on an ultrasound exam. Clustered calcifications are not shown as clearly with ultrasound as with x-rays.

Very small lesions may be difficult to target accurately by ultrasound-guided core biopsy.

Breast Imaging Resource Information For Patient


Magnetic resonance imaging (MRI) uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the body's internal structures that are clearer, more detailed and more likely in some instances to identify and accurately characterize disease than other imaging methods. It is used to evaluate the body for a variety of conditions, including tumors and diseases of the liver, heart, and bowel. It may also be used to monitor an unborn child in the womb. MRI is noninvasive and does not use ionizing radiation. For the benefits and risks of a specific MRI procedure, how to prepare, and more, select a topic below.

Ultrasound – Breast(Sono Mammograohy)

 What is Ultrasound Imaging of the Breast?

Ultrasound is safe and painless, and produces pictures of the inside of the body using sound waves. Ultrasound imaging, also called ultrasound scanning or sonography, involves the use of a small transducer (probe) and ultrasound gel placed directly on the skin. High-frequency sound waves are transmitted from the probe through the gel into the body. The transducer collects the sounds that bounce back and a computer then uses those sound waves to create an image. Ultrasound examinations do not use ionizing radiation (as used inx-rays), thus there is no radiation exposure to the patient. Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.

Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions.

Ultrasound imaging of the breast produces a picture of the internal structures of the breast.

Doppler ultrasound is a special ultrasound technique that allows the physician to see and evaluate blood flow through arteries and veins in the abdomen, arms, legs, neck and/or brain (in infants and children) or within various body organs such as the liver or kidneys.

During a breast ultrasound examination the sonographer or physician performing the test may use Doppler techniques to evaluate blood flow or lack of flow in any breast mass. In some cases this may provide additional information as to the cause of the mass.

 

What are some common uses of the procedure?

Determining the Nature of a Breast Abnormality

The primary use of breast ultrasound today is to help diagnose breast abnormalities detected by a physician during a physical exam (such as a lump or bloody or spontaneous clear nipple discharge) and to characterize potential abnormalities seen on mammography or breast magnetic resonance imaging (MRI).

Ultrasound imaging can help to determine if an abnormality is solid (which may be a non-cancerous lump of tissue or a cancerous tumor) or fluid-filled (such as a benigncyst) or both cystic and solid. Ultrasound can also help show additional features of the abnormal area.

Doppler ultrasound is used to assess blood supply in breast lesions.

Supplemental Breast Cancer Screening

Mammography is the only screening tool for breast cancer that is known to reduce deaths due to breast cancer through early detection. Even so, mammograms do not detect all breast cancers. Some breast lesions and abnormalities are not visible or are difficult to interpret on mammograms. In breasts that are dense, meaning there is a lot of ducts, glands, fibrous tissue and less fat, many cancers can be hard to see on mammography.

Many studies have shown that ultrasound and magnetic resonance imaging (MRI) can help supplement mammography by detecting breast cancers that may not be visible with mammography. MRI is more sensitive than ultrasound in depicting breast cancer, but MRI may not be available to all women. If screening MRI is performed, then screening ultrasound is not needed, though ultrasound may be used to characterize and biopsy abnormalities seen on MRI. When ultrasound is used for screening, many more abnormalities that may require biopsy are seen than are seen with mammography or MRI. These abnormalities usually are not cancer (false positives), and this limits its usefulness.

Ultrasound can be offered as a screening tool for women who:

Are at high risk for breast cancer and unable to undergo an MRI examination.

Are pregnant or should not be exposed to x-rays (which is necessary for a mammogram).

Ultrasound-guided Breast Biopsy

When an ultrasound examination reveals a suspicious breast abnormality, a physician may choose to perform an ultrasound-guided biopsy. Because ultrasound provides real-time images, it is often used to guide biopsy procedures. An ultrasound exam will usually need to be performed before the biopsy in order to plan the procedure and to determine if this method of biopsy can be used.

 

How should I prepare?

You will be asked to undress from the waist up and to wear a gown during the procedure.

 

What does the equipment look like?

Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to do the scanning. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. Some exams may use different transducers (with different capabilities) during a single exam. The transducer sends out inaudible, high—frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.

The ultrasound image is immediately visible on a video display screen that looks like a computer or television monitor. The image is created based on the amplitude (loudness), frequency (pitch) and time it takes for the ultrasound signal to return from the area within the patient that is being examined to the transducer (the device used to examine the patient), as well as the type of body structure and composition of body tissue through which the sound travels. A small amount of gel is put on the skin to allow the sound waves to best travel from the transducer to the examined area within the body and then back again.

 

How does the procedure work?

Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as the object's size, shape and consistency (whether the object is solid or filled with fluid).

In medicine, ultrasound is used to detect changes in appearance, size or contour of organs, tissues, and vessels or detect abnormal masses, such as tumors.

In an ultrasound examination, a transducer both sends the sound waves and receives the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images. Small loops of the moving real-time images may also be saved.

Doppler ultrasound, a special application of ultrasound, measures the direction and speed of blood cells as they move through vessels. The movement of blood cells causes a change in pitch of the reflected sound waves (called the Doppler effect). A computer collects and processes the sounds and creates graphs or color pictures that represent the flow of blood through the blood vessels.

 

How is the procedure performed?

You will lie on your back on the examining table and may be asked to raise your arm above your head.

After you are positioned on the examination table, the radiologist or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.

There is usually no discomfort from pressure as the transducer is pressed against the area being examined. However, if scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.

Doppler sonography is performed using the same transducer.

Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry to a powder. The ultrasound gel does not stain or discolor clothing.

 

What will I experience during and after the procedure?

Ultrasound examinations are painless and easily tolerated by most patients.

Breast ultrasound is usually completed within 30 minutes.

If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.

You may be asked to change positions during the exam.

When the examination is complete, you may be asked to dress and wait while the ultrasound images are reviewed.

After an ultrasound examination, you should be able to resume your normal activities immediately.

 

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician, or to the physician or other healthcare provider who requested the exam, and he/she will share the results with you. In some cases the radiologist may discuss results with you at the conclusion of your examination.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

 

What are the benefits vs. risks?

Benefits
  • Most ultrasound scanning is noninvasive (no needles or injections).
  • Occasionally, an ultrasound exam may be temporarily uncomfortable, but it is almost never painful.
  • Ultrasound is widely available, easy-to-use and less expensive than other imaging methods.
  • Ultrasound imaging is extremely safe and does not use any ionizing radiation.
  • Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
  • Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration.
  • Ultrasound imaging can help detect lesions in women with dense breasts.
  • Ultrasound may help detect and classify a breast lesion that cannot be interpreted adequately through mammography alone.
  • Using ultrasound, physicians are able to determine that many areas of clinical concern are due to normal tissue (such as fat lobules) or benign cysts. For most women 30 years of age and older, a mammogram will be used together with ultrasound. For women under age 30, ultrasound alone is often sufficient to determine whether an area of concern needs a biopsy or not.
Risks
  • For standard diagnostic ultrasound, there are no known harmful effects on humans.
  • Interpretation of a breast ultrasound examination may lead to additional procedures such as follow-up ultrasound and/or aspiration or biopsy. Many of the areas thought to be of concern only on ultrasound turn out to be non-cancerous.

 

What are the limitations of Ultrasound Imaging of the Breast?

Ultrasound is one of the tools used in breast imaging, but it does not replace annual mammography and careful clinical breast examination.

Many cancers are not visible on ultrasound.

Biopsy may be recommended to determine if a suspicious abnormality is cancer or not.

Most suspicious findings on ultrasound that require biopsy are not cancers.

Many calcifications seen on mammography cannot be seen on ultrasound. Some early breast cancers only show up as calcifications on mammography. MRI findings that are due to cancer are not always seen with ultrasound.

Many facilities do not offer ultrasound screening, and the procedure may not be covered by some insurance plans.

It is important to choose a facility with expertise in breast ultrasound, preferably one where the radiologists specialize in breast imaging. Ultrasound depends on the abnormality being recognized at the time of the scan as it is a "real-time" examination. This requires experience and good equipment. One measure of a facility's expertise in breast ultrasound can be found in its ACR accreditation status. Check the facilities in your area by searching the ACR-accredited facilities database

 

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