HighResolution Consistent and Reliable Results from Baylor Diagnostic Imaging Centers

Transcription

1 HighResolution Consistent and Reliable Results from Baylor Diagnostic Imaging Centers Interventional Radiology Often Proves Effective Alternative to Surgery Baylor University Medical Center at Dallas offers comprehensive interventional radiology services. Through research and the application of advanced endovascular techniques, interventional radiologists on the medical staff of Baylor Dallas are developing innovative methods to treat complex cases, many once thought to be fatal or inoperable. Volume 1 Number 2 In This Issue Interventional Oncology Improves Treatment for Liver Cancer We are essentially a full-service center for any vascular and interventional procedure, both body and neuro, said Joseph Hise, MD, chief of the Department of Radiology at Baylor Dallas. The procedures we perform range from diagnostic angiography, vascular stent placement and percutaneous-directed biopsy to coiling of a ruptured aneurysm. Baylor Dallas is one of only two medical centers in Dallas that offers comprehensive interventional stroke therapy, including microcatheter thrombolysis and mechanical retrieval of clots, 24 hours a day, seven days a week. Board-certifi ed radiologists on the medical staff of Baylor Dallas also provide treatment for a full range of complex neurovascular conditions. Among the numerous conditions treated are ruptured and unruptured intracranial aneurysms, head and neck tumors, carotid-cavernous fi stulae, dural arteriovenous fi stulae, extracranial (brachiocephalic) atherosclerosis, extracranial and paraspinal vascular malformations. Quality of Interpretation Key to Neuro MRIs PET/CT Imaging: Case Histories Baylor Dallas is participating in a National Institutes of Health-sponsored multicenter national trial to look at the effi cacy of intracranial angioplasty and stenting vs. best medical management for the treatment of symptomatic intracranial stenosis. Another clinical trial is comparing the effi cacy of kyphoplasty versus vertebroplasty for the treatment of painful osteoporotic compression fractures. We believe that if patients are selected correctly, vertebroplasty does offer better treatment than medical management, Dr. Hise said. Interventional radiologists on the medical staff at Baylor Dallas perform radiofrequency ablation of solid organ tumors with CT guidance. Tumors treated are primarily hepatic and renal, but RFA is occasionally used for bone tumors as well. Physicians also are using chemoembolization (chemo beads) as a treatment for hepatic tumors. See story on page 2. Quality Staff and Equipment Make a Difference Patient Satisfaction Tops 90 Percent Prompt Appointments Baylor Dallas also offers uterine artery embolization to treat fi broids without surgery. During the procedure, the blood supply of the fi broids is cut off, causing the fi broids to shrink. This can be a very effective treatment if the patient is a good candidate, Dr. Hise said.

2 Interventional Oncology Improves Treatment for Liver Cancer A collaboration among interventional radiologists, surgeons and medical oncologists on the medical staff of Baylor University Medical Center at Dallas is leading to improved outcomes for patients with liver cancer and metastisis to the liver. In chemoembolization, an interventional radiologist introduces microscopic beads coated with chemotherapeutic agents into a tumor through the artery that supplies the tumor s blood flow. The beads then elute the drugs directly into the tumor. Images Society of Interventional Radiology There is a remarkable difference between using chemo beads and chemotherapy delivered systemically through the veins, said J.D. Meler, MD, an interventional radiologist on the medical staff of Baylor Dallas. Patients experience fewer side effects such as no hair loss, and less fatigue and nausea. We can safely give patients much higher doses than with traditional chemotherapy. At Baylor Dallas, chemoembolization may be used to treat primary liver cancer, as well as metastases to the liver. In the liver, chemoembolization has been found to effectively shrink many tumors that are too large to meet transplant criteria. The chemobeads may reduce the tumor to a size that allows the patient to undergo a liver transplant or traditional resection. In some cases, the beads control the cancer, prolonging and improving the patient s quality of life. In terms of patient volume, Baylor Dallas is among the top three medical centers in the United States that uses this method of chemoembolization for the treatment of primary liver cancer, as well as metastases to the liver. The collaboration among the three specialties developed when Dr. Meler, liver surgeon Robert Goldstein, MD, and medical oncologists Mark Walberg, MD, and Douglas Orr, MD, began meeting regularly to discuss the care of patients with liver cancer. Today, the meetings draw almost 20 physicians on the medical staff. We realized early on that by meeting and talking with each other, we would deliver better care for more patients and be more coordinated in the process, Dr. Meler said. For patients with liver cancer, we all agree on the basic tenets. The first choice is always surgical resection or transplant because those are curative, he said. But for patients with an inoperable tumor, treatment with chemo beads may shrink the tumor enough that they may become a transplant candidate. We all participate to try to get the patient to surgery or transplant. Educational Brochures Available in Spanish Patient education brochures about MRI, CT and PET scanning are available in Spanish. To receive a supply, please contact Linda Blue at or lindab@baylorhealth.edu. Dr. Meler said chemoembolization also may secure a patient for transplant, i.e. control the tumor until the patient can meet the sobriety guidelines for transplant. For a patient that is outside the transplant criteria but who receives treatment, projected survival is one to three years, he said. With a transplant, five-year survival is in the 90-percent range. With chemoembolization, we re seeing excellent results, both in prolonged life and prolonged quality of life.

3 Quality of Interpretation Key to Neuro MRIs The value of neuro MRI magnetic resonance imaging of structure and function of the brain, spine, head, and neck is enormous. MRI in general has become an integral part of health care, offering a non-invasive procedure that provides detailed images. According to Manu Gupta, MD, a neuroradiologist on the medical staff of Baylor University Medical Center at Dallas, there are numerous indications for neuro MRI. Neuro MRI is indicated for any symptoms related to the brain or spine, Dr. Gupta said. Beyond the central nervous system, neuro MRI also may be used to identify the source of peripheral symptoms, such as pain in the fingers or numbness in the toes, which could be caused by something more centrally located. Because MRI is widely available, the key difference among imaging centers is the quality of interpretation, Dr Gupta said. At Baylor University Medical Center at Dallas, Baylor Diagnostic Imaging Center at Junius and Baylor Diagnostic Imaging Center at North Dallas, board-certified neuroradiologists on the medical staff read all neuro MRI results. This team of 10 neuroradiologists is specially trained and experienced in neurological conditions, as well as conditions related to the head and neck. Dr. Gupta said another key consideration is the quality of the magnet. All MRI machines within Baylor Health Care System are high-field, updated magnets that utilize current technologies. All of our machines have a strong magnetic strength and technologically advanced updates, said Joseph Hise, MD, chief of the Department of Radiology at Baylor Dallas. The better the magnet, the better the quality of the images, which makes it more likely we can make the correct diagnosis. In addition to its main function in diagnosing various pathologies, neuro MRI can be used to guide certain therapeutic procedures, such as biopsies or radiofrequency ablations. Neuro MRI is indicated for any symptoms related to the brain or spine. Beyond the central nervous system, neuro MRI also may be used to identify the source of peripheral symptoms, such as pain in the fingers or numbness in the toes, which could be caused by something more centrally located. Quality Staff and Equipment Make a Difference The images produced at Baylor Dallas, Baylor Diagnostic Imaging Center at Junius and Baylor Diagnostic Imaging Center at North Dallas are interpreted by a highly skilled team of radiologists on the Baylor Dallas medical staff. In addition, more than 50 radiologists on the medical staff of Baylor Dallas have subspecialty training in breast imaging, musculoskeletal radiology, neuroradiology and nuclear medicine. Each facility has an experienced radiology and medical imaging staff who have dedicated licensures and credentials for their specific area. All equipment at Baylor Diagnostic Imaging Center at Junius and Baylor Diagnostic Imaging Center at North Dallas is certified by the American College of Radiology (ACR). Quality guidelines are met in accordance with Baylor Health Care System, ACR, Texas Department of State Health Services, American Registry of Radiologic Technologists, American Registry for Diagnostic Medical Sonographers, and for Junius, the Nuclear Medicine Technology Certification Board for certified nuclear medicine technologists.

4 PET/CT Case History: Biopsy Localization Background: A 61-year-old man with prior history of resection and radiation of rectal carcinoma returns for follow up. A CT had shown presacral mass, and a routine CTguided biopsy had yielded necrosis and inflammation. Sites of Needle Biopsy PET/CT Findings: The PET/CT showed exactly where to biopsy, and the patient was then treated accordingly. PET/CT Case History: Staging of Metastatic Lung Cancer Background: A 53-year-old man presents for PET-CT staging of adenocarcinoma of the lung. Previous CT scans and a bone scan were negative. PET/CT Findings: The PET/CT showed a very small lung cancer, as well as two very small bone metastases that did not show up on bone scan or CT. Any case study presented is for informational purposes and is not meant to substitute for clinician judgment in how best to use any medical devices. Patient Satisfaction Tops a Mean of 90 Patient satisfaction is a top priority at Baylor University Medical Center at Dallas, Baylor Diagnostic Imaging Center at Junius and Baylor Diagnostic Imaging Center at North Dallas. From ease of registration to the comfort of patients while they wait and during procedures, all staff members work to create a positive experience for patients. During July through September 2009, the mean score from patient surveys reporting the likelihood of recommending these facilities exceeded 90. Baylor University Medical Center at Dallas: 93.9 Baylor Diagnostic Imaging Center at Junius: 92.4 Baylor Diagnostic Imaging Center at North Dallas: 90.3 Baylor University Medical Center at Dallas 93.9 Baylor Diagnostic Imaging Center at Junius 92.4 Baylor Diagnostic Imaging Center at North Dallas 90.3

5 Common Indications for CT and MRI Computed tomography and magnetic resonance imaging are not interchangeable. CT combines multiple X-ray images with the aid of a computer to produce cross-sectional views of the body. In contrast, MRI uses a large magnet, radio waves and a computer to produce images. Indications for a CT vs. MRI are outlined in the chart below: CT Brain Spine Body Chest Routine with or without contrast High Resolution primarily ordered by pulmonologists to identify subtle changes. CT Angio CT Angio aorta, coronary artery Chest Screening no contrast Abdomen Routine Abdomen Routine Abdomen/Pelvis Adrenal Mass Renal Mass Dual Phase Liver/Pancreas Hematuria Renal Stone CT Angiogram aorta MRI CT fi rst line MRI for questionable cases MRI is fi rst line unless trauma of spine; then use CT. First follow -up exam for abnormal chest X-ray Evaluation of diffuse pulmonary disease discovered on chest radiographs, conventional CT of the chest, or other CT examinations that include portions of the chest, including selection of the appropriate site for biopsy of diffuse lung disease. Evaluation of the lungs in patients with clinically suspected pulmonary disorders with normal or equivocal chest radiographs. Evaluation of suspected small airway disease. Evaluation of suspected bronchiectasis. Quantifi cation of the extent of diffuse lung disease for purposes of evaluating effectiveness of treatment. Pulmonary Embolus Can replace coronary angiogram CT better than MRI for abdominal pain, diverticulitis, appendicitis, bowel obstruction, renal stone CT fi rst to evaluate these areas. MRI follows to answer specifi c questions raised by CT. Aortic aneurysm Renal artery stenosis Brain for questionable cases Spine Body Chest Heart Abdomen Pelvis MSK Strokes Headache Brain tumors Therapy planning MRI is fi rst line To clarify certain mediastinal masses (not common) Examine wall motion perfusion, infarct imaging (in place of echo and stress thallium) Clarify liver, pancreatic, renal and adrenal masses Bile duct imaging Liver transplant workup Female: Uterus and adnexal abnormalities (fi rst line or after ultrasound) First line for cartilage, tendon and ligament tears Patient Orders Made Easy Patient education brochures about CT and MRI are available upon request. Please contact Linda Blue at or lindab@baylorhealth.edu. A Patient Order Form is enclosed with this newsletter. If you would like a pad of referral forms, please contact Linda Blue at or lindab@baylorhealth.edu.

6 3500 Gaston Avenue Dallas, Texas NONPROFIT ORG US POSTAGE PAID DALLAS, TX PERMIT #2650 Three Convenient Locations Baylor Dallas Campus 3500 Gaston Avenue Roberts Hospital, First Floor Medical Imaging Department Dallas, Texas Fax Outpatient Hours of Operation: Monday Friday, 7 a.m. to 5 p.m. Saturday Sunday, 7 a.m. to 7 p.m. Baylor Diagnostic Imaging at Junius Baylor Medical Pavilion 3900 Junius Street, Suite 100 Dallas, Texas Fax Hours of Operation: Monday Friday, 7:30 a.m. to 5 p.m. Baylor Diagnostic Imaging Center at North Dallas 9101 North Central Expy., Suite 100 Dallas, Texas Fax Hours of Operation: Monday Friday, 7:30 a.m. to 5 p.m. Prompt Appointments Often Available In many cases, same-day or next-day appointments are available for all modalities at Baylor Diagnostic Imaging Center at North Dallas and Baylor Diagnostic Imaging Center at Junius. All reports are faxed within 24 to 36 hours to the referring physician s offi ce. Both outpatient imaging centers share the same picture archiving and communication system (PACS) as Baylor Dallas, as well as the same managed care contracts. The North Dallas imaging center is located about 10 minutes away from Baylor University Medical Center at Dallas, just seven miles north of the main Baylor Dallas campus (south of I-635) on the northwest corner of Park Lane and Central Expressway. Parking is free. Baylor Diagnostic Imaging Center at North Dallas, Baylor Diagnostic Imaging Center at Junius and Baylor Dallas all have istat machines, so that stat blood work for creatinine levels may be performed before giving a patient CT and/or MRI contrast. PET/CT Referral Made Easy A PET/CT Physician Referral Form, which includes patient education information, is enclosed with this newsletter. If you would like a pad of referral forms, please contact Linda Blue at or lindab@baylorhealth.edu. High Resolution Newsletter Offered Electronically If you would prefer to receive this newsletter electronically, please send your address to Linda Blue at lindab@baylorhealth.edu. Physicians are members of the medical staff at one of the Baylor Health Care System s subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor University Medical Center, or Baylor Health Care System. Photographs may include models or actors and may not represent actual patients Baylor Health Care System BCIC_46_FY2009