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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) in the past 15 years. The American College of Radiology and American Cancer Society recommend that annual screening mammography beginning at the age of 40 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.

3D Breast Tomosynthesis is particularly useful in patients with dense breasts, allowing overlapping structures of the dense breast to be separated. Only structures within the plane of interest remain in focus. This 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 at an 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. 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.
Zilkha Radiology also offers stereotactic breast biopsy, ultrasound guided breast biopsy and MR guided breast biopsy.  Arrangements can be made to have biopsies performed on certain evenings and weekends.

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.

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.

Zilkha Radiology acquired Clarity, an 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%.

Zilkha Radiology often sees patients who have had CT scans at other offices or hospitals.  Patients request 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.  In the other office, 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 IV sedation
for adults and children by Board Certified Anesthesiologists.

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

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