3D Breast Tomosynthesis at Zilkha Radiology

Breast cancer is the most common form of cancer and the second leading cause of cancer-related death in the U.S in women. Mammography screening has dramatically reduced breast cancer death particularly after the introduction of digital mammography (2D) at the beginning of the 21st century. The U.S. Preventative Services Task Force agrees that annual screening beginning at the age of 40 years saves the most lives.

Digital Breast Tomosynthesis is a 3D imaging modality used in conjunction with 2D digital mammography for breast cancer screening. It is acquired by low dose exposure of a rotating x-ray tube. The obtained 3D images are reconstructed at 1.0 mm thick slices.

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3D Breast Tomosynthesis is particularly useful in dense breast, allowing overlapping structures of the dense breast to be separated. Only structures within the plane of interest remain in focus. The technology improves the ability to detect more cases of breast cancer at a smaller size and at earlier stage. Lives can be saved when breast cancer is found and treated at a smaller size and earlier stage.

3D Mammography detects cancer that may be overlooked at 2D Mammography. The rate of diagnosis of cancer increases 27% when 3D is added to 2D mammography. There is a 40% increase in detection of invasive breast cancer when 3D is added to 2D. 3D reduces the need for recalls for additional images. Less recalls decreases radiation to the breast. 3D mammography reduces false positives, leading to less biopsies. There is less breast compression with 3D particularly important in patients with tender breasts.

Zilkha Radiology has the most technically advanced, up-to-date 3D Mammography. All patients scanned for mammography will have the 3D portion of the exam regardless of their policy’s coverage or ability to pay for the remainder of 2014. While certain insurance companies have not yet updated their reimbursement policy, at Zilkha Radiology there will be no added out of pocket expenses for the 3D examination in 2014.

Zilkha Radiology also offers stereotactic breast biopsy, ultrasound guided breast biopsy and MR guided breast biopsy.

TRAUMATIC BRAIN INJURY AND DIFFUSION TENSOR IMAGING, AN MRI TECHNIQUE

The brain is a highly complex organ. The most important cell of the brain is the neuron. Neurons connect with each other via the axons. A group of axons traveling together is called a fiber tract. Fiber tracts are like cables. They help connect the important structures in the brain.

In a traumatic brain injury (TBI), MRI may detect traumatic brain lesions such as intracranial hematomas, brain contusion, etc. MRI cannot detect injury to the fiber tracts. This injury is called diffuse axonal injury (injury to the cables). Diffuse axonal injury manifests little or no apparent abnormality on MRI.

Diffuse axonal injury can lead to disruption of critical cortical and subcortical pathways in the brain and may lead to cognitive dysfunction and functional impairment. DTI is an MRI technique that evaluates the microstructures of white matter and fiber tracts. It has the ability to evaluate the integrity of the axons.

Multiple parameters are used to measure DTI. The most commonly used parameter is called Fractional Anisotropy (FA) which is a quantative measure of fiber tract density (thickness). FA is decreased when fiber tracts are disrupted. Disease severity correlate with FA. DTI measurements are obtained at different levels of the brain, and at times in areas of interest when indicated.

The following example is that of a young man with history of MVA and brain concussion. Following the accident, the patient had a brief loss of consciousness and memory loss. The patient complained of left sided headaches. A brain MRI was normal. DTI (Figure 1 and 2) showed decreased FA in the left anterior frontal white matter indicative of traumatic axonal injury and disruption.

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Beside TBI, there are other brain diseases that can benefit from DTI. They include, multiple sclerosis, strokes, Alzheimer’s disease, amyotrophic lateral sclerosis, etc. DTI is also used in neurosurgical planning of tumor resection. The technique is called Fiber Tractography (FT). There is improved clinical outcome when FT is incorporated in presurgical planning.

At Zilkha Radiology, DTI and Fiber Tractography are performed on a 3.0 Tesla MRI scanner, the highest magnet strength available on the market.

ZILKHA RADIOLOGY has low dose CT scanners in the West Islip and East Islip offices.
All patients undergoing CT scans need to be concerned about radiation dose exposure.  This is especially true for children and patients who require follow-up CT studies.  There is a need for radiology groups and hospitals to reduce the dose of your CT scan while maintaining or improving imaging quality and higher diagnostic confidence.
Zilkha Radiology has taken the lead to lower radiation dose by implementing a newly developed technology that achieves excellent images while using a significantly lower dose of radiation. We optimize diagnostic quality while keeping patient safety our number one priority.

Zilkha Radiology acquired this new FDA approved technology which is currently used in children’s hospitals around the country  where low dose CT is the highest priority. How does this technology work?  The amount of radiation generated by the CT source is significantly lowered.  A “noisy” image is produced.  A very powerful computer mathematically removes this noise making high resolution pictures.  Dose is consistently reduced on the order of 50-60% for patients scanned before and after the acquisition of this technology.
The following case is an example of how the new software has a significant impact in dose reduction.  A patient had a CT scan of the chest in December 2009 with a radiation dose of 5.20 mSv.  The patient had a follow-up CT on October 2010.  Using the newly installed low dose technology, the radiation dose was reduced to 2.52 mSv, a reduction of 52%.

Dosage Card - Front
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Zilkha Radiology often sees patients who have had CT scans at other offices or hospitals, and who want to have their follow-up CT scans in our office because of the new technology.  In one such instance, a patient had a CT scan of the chest at another facility on December 2011.  At that visit, the patient received a radiation dose of 12.36 mSv.  The patient came to our office five months later for a follow-up chest CT.  The radiation dose received at Zilkha Radiology was 3.69 mSv, a much lower radiation dose.  The 12.36 mSv is more than three hundred percent higher when compared to the dose at Zilkha Radiology.  We have encountered similar instances of patients with higher dose of radiation received at other facilities, including hospitals, hospital affiliated facilities and other radiology groups.  Zilkha Radiology believes so deeply in this technology that the patient’s dose is printed on every report sent to their doctor. If you want to have your follow up CT at Zilkha Radiology, bring in your prior study and we can tell you what your radiation dose was on your prior CT scan.

Zilkha Radiology is the first and only practice in the Northeast, New York State and Long Island to acquire and provide this new low dose technology in our West Islip and East Islip offices.  We optimize diagnostic quality while keeping patient safety our number one priority.           

The offices are accredited by the American College of Radiology.  

The facility is accredited to perform monitored anesthesia by Board Certified Anesthesiologists.

The facility is equipped to perform blood work analysis prior to contrast injection. 
 
 
 

Zilkha Radiology is open 7 days a week, weekdays until 10pm and Saturday and Sunday until 4pm.

If you have any questions, please call (631) 277-1600.

 


Zilkha Radiology is committed to providing you with high quality, personalized care using the most sophisticated techniques and state of the art equipment. Our offices are equipped to perform all radiological services including 3.0 Tesla MRI, PET/CT scan, 128-slice multi-detector helical CT scans, ultrasound, 3D Breast Tomosynthesis, Nuclear Medicine, DEXA scans, digital x-rays, fluoroscopic procedures, biopsy, anesthesia, therapeutic injections and more.

We have a 3.0 Tesla ultra high field MRI scanner in each of our offices.  This ultra high field MRI system has open bore technology and the shortest length of any 3.0 Tesla system on the market. The design facilitates scanning of claustrophobic patients and those who weigh up to 550 pounds. The wide space of the scanner and feet first positioning make lying inside the MRI system more comfortable and a pleasant experience for the patient.  Most studies are completed in 15 minutes or less. The 3.0 Tesla MRI system enables advanced clinical application including MR Tractography and Functional MRI.  It provides excellent imaging quality and superb diagnostic images.  The system represents a major breakthrough in technology and Zilkha Radiology is the first on Long Island and the NY metropolitan area to acquire the scanners.



DIFFUSION TENSOR IMAGING AND FIBER TRACTOGRAPHY OF THE BRAIN USING 3 TESLA MRI SCANNER AT ZILKHA RADIOLOGY

Technical advances in MRI have included Diffusion Tensor Imaging (DTI) and Fiber Tractography (FT) for the evaluation of white matter tracts integrity. White matter tracts help one area of the brain to communicate with another part of the brain as well as with the spinal cord. Fiber tracts disruption can lead to neurological deficits.

White matter tracts are not seen on a routine brain MRI. Diffusion Tensor Imaging can visualize and quantify the damage of white matter tracts. DTI can demonstrate pathological processes involving the white matter tracts and is useful for assessing several neurological diseases such as congenital anomalies, degenerative brain disease, multiple sclerosis, traumatic brain injury, intracranial hematoma, hydrocephalus, etc.

The first example is that of a patient who presented with clinical suspicion of Amyotrophic Lateral Sclerosis (ALS). DTI shows impairment of the cortico-spinal tract (CST), translated into decreased Fractional Anisotropy (FA) and increased Mean Diffusivity (MD) of the CST (Figure 1). Fiber Tractography shows thinning of the CST (Figure 2). These findings are in agreement with CST degeneration, present in patients with ALS.

Dosage Card | Zilkha Radiology
Dosage Card | Zilkha Radiology

Fiber Tractography is also useful in demonstrating the relationship of white matter fiber tracts to an adjacent brain tumor. This is particularly critical in surgical planning and maximizing lesion resection while avoiding the disruption of adjacent white matter tracts. FT usefulness is shown in this second example of a patient with a brain tumor seen on MRI (Figure 3). In order to define the white matter tracts location in relation to the tumor, fiber tractography was performed showing that the white matter tracts are displaced by the tumor and are not invaded (Figure 4). This information greatly helps the neurosurgical planning and appropriate approach for successful excision of the tumor while avoiding injury to the adjacent white matter tracts.

Dosage Card | Zilkha Radiology
Dosage Card | Zilkha Radiology

Diffusion tensor imaging and fiber tractography represent a major breakthrough in MRI technology. They assist in the understanding and identification of various neurological disease and are critical in planning successful surgical outcome. The images are exquisitely displayed on a 3 Tesla MRI. DTI and FT are available at Zilkha Radiology using a 3.0 Tesla Open Bore MRI scanner.


ZILKHA RADIOLOGY has low dose CT scanners In the West Islip and East Islip offices

We have low dose CT scanners in the West Islip and East Islip offices. There is a growing concern about radiation dose exposure during CT diagnostic imaging to patients, especially children and patients who need multiple follow-up CT studies. There is a need to achieve dose reduction while maintaining or improving imaging quality and higher diagnostic confidence.

Zilkha Radiology has taken the lead to lower radiation dose by implementing a newly developed software that helps achieve excellent diagnostic images while using a lower dose of radiation.

The new device is FDA approved and is currently used in children’s hospitals around the country where low dose CT is the highest priority. The technology uses post-processing algorithm after the CT scan has been taken. It provides improved signal-to-noise ratio and clarification of edges and structures of the images. It is similar to taking a lower resolution picture of an individual with a digital camera, then using a software method to enhance the image and sharpen the edges.

The following case is an example of how the new software has a significant impact in dose reduction. A patient had a CT scan of the chest in December 2009 with a radiation dose of 5.20 mSv. The patient had a follow-up CT on October 2010. Using the newly installed low dose technology, the radiation dose was reduced to 2.52 mSv, a reduction of 52%.

Dosage Card | Zilkha Radiology
Dosage Card | Zilkha Radiology

Only the dose that is clinically relevant to the patient is applied. Here is an example of an adult patient who has CT scan of the sinuses with a radiation dose of 0.30 mSv. A similar CT scan of the sinuses in an 11 year old patient has 0.17 mSv of radiation.

Dosage Card | Zilkha Radiology
Dosage Card | Zilkha Radiology

Zilkha Radiology is the first and only practice in the Northeast and New York State to acquire and provide this new low dose technology in our West Islip and East Islip offices. We optimize diagnostic quality while keeping patient safety our number one priority.

Imaging is performed by experienced, Board certified radiologists with subspecialty training in neuroradiology, musculoskeletal radiology, mammography/women’s imaging, cross section/body imaging, nuclear medicine, magnetic resonance imaging (MRI) and ultrasound.

Our PACS system allows referring physicians to view images of their patient's exams from their offices and retrieve patient reports on-line. Our PACS system has been provided by AGFA which is the leading manufacturer and installer of PACS worldwide.

From the time you call to make an appointment until your procedure is completed, someone will be available to answer your questions and help you. When you arrive at the center, our receptionists will help you with your paper work. When it is time for your exam, our technologist will explain the procedure and remain with you to answer any questions you have during the exam. You will probably have lots of questions. We are here to make sure you get the answers you need.

 

 

 

 
East Islip
(631)277-1600
West Islip
(631)669-1717