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Breast Specific Gamma Imaging (BSGI) Soon Available At The Comprehensive Breast Center
BSGI is a nuclear medicine technique that uses a high resolution, small field-of view gamma camera to obtain breast-only images which can be oriented identically to the standard mammographic views. Northwest Community has purchased the Dilon 6800 breast specific gamma camera, and we will begin imaging patients in May.
 
As shown on the left, the Dilon 6800 is small and portable. Patients can be positioned identically as for mammography, an MLO view being acquired on the right.
BSGI is not a substitute for mammography, but it has been shown to be a very useful problem-solving modality. Image quality and diagnostic accuracy are not affected by breast tissue density, prior surgical scarring, or the presence of implants. When compared with breast sonography and MRI, BSGI is more specific than both, more sensitive than sonography, and of similar sensitivity as MRI. BSGI sensitivity decreases when lesions less than 1 cm in size are assessed, and it cannot be directly utilized for biopsy guidance purposes.
 
47-year-old woman with two synchronous left breast malignancies. The CC mammographic image on the left demonstrates one of the cancers as a spiculated mass (red arrow). The corresponding BSGI on the right demonstrates the mammographically visualized cancer as an area of increased tracer uptake (red arrow) as well as the second malignancy which was mammographically occult (yellow arrow).
Nephrogenic Systemic Fibrosis (NSF) And MRI Contrast: What You Should Know
NSF is a rare acquired condition initially identified in patients with renal disease who presented with firm, erythematous, and indurated skin plaques. While predominantly a cutaneous disorder, NSF is more accurately termed a "scleroderma-like" fibrosing disease. NSF is progressive and may result in death, and there currently are no effective treatments.
First described in the United States in 1997, over 200 cases have been reported worldwide to date. While a cause and effect relationship has not been clearly established, a history of exposure to the gadolinium (Gd)-based contrast agents utilized for MRI and MRA examinations has been identified in nearly every proven case. While the majority of NSF patients had been given one particular brand of contrast, Omniscan™, all Gd-based agents are considered to be of potential risk.
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Image from the literature (Sadowski, Radiology 2007; 243:148) of the arm of a patient with NSF.
In response to FDA recommendations, Northwest Community has adopted a protocol which is similar to others currently being instituted throughout the United States and Europe. We will not give Gd-based contrast agents to any patients who are pregnant, under 1 year of age, or on peritoneal dialysis, and we advise against their use in all patients with known renal disease. For hemodialysis patients who do receive Gd-based contrast, dialysis needs to be performed within 3 hours of the MRI or MRA study. Northwest Community does not utilize Omniscan™..
Interventional Radiology (IR) Service Update
The IR section performs the entire gamut of image-guided invasive procedures. Our three IR radiologists - Drs. Brad Melliere, Jonathan Barker and Evan Oblonsky - all have IR subspecialty certification from the American Board of Radiology. The IR service sees patients for clinical consultation in both the inpatient and outpatient settings, with all IR physicians having hospital admitting privileges.
Services offered include - but are not limited to - vascular procedures (eg, angioplasty, stenting, IVC filter placement/retrieval, and central venous access such as PICCs and ports), uterine artery embolization to treat fibroids, and various interventions involving the hepatobiliary tree, genitourinary tract, and spine. With regard to the specific spine interventions of kyphoplasty and sacroplasty, Dr. Barker relates, "Many of these patients have been relatively inactive for weeks resulting in general debilitation. Their pain medications make them dizzy and unsteady, and they frequently become quite constipated. They really feel miserable."
 
Prone CT images obtained during sacroplasty on a 71-year-old woman with bilateral sacral insufficiency fractures. The image on the left demonstrates needles being placed into the bilateral sacral ala fracture sites (red arrows). The image on the right was obtained after bone cement injection and needle removal (yellow arrows).
From initial consultation to follow up, the IR service provides complete patient care. Dr. Barker adds, “The interventional radiologist will admit patients to his own service and care for them while in the hospital. Patients are usually discharged home on the same day. When they do have to stay overnight, we always keep the primary care physician informed and apprised." If you have a specific IR question or need, please call Special Procedures at 847/618-5890.
Thanks to Dr. Jonathan Barker for the information on the IR service at Northwest Community.
For more information about Northwest Radiology Associates, the services we provide, and how to contact individual radiologists, please visit our web site: northwestradiologyassociates.com.
If you wish to be added to our distribution list, please contact: ckalbhen@northwestradiologyassociates.com . We also welcome your questions and comments.
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