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Advanced technology, accuracy and speed define radiology - 02/18/2010

A tractor-trailer truck driver for 18 years, Carey “Tim” Mason of New Britain loves the sense of freedom that comes with his job. “I’m out there making decisions on my own.” One of the biggest decisions he made probably saved his life. Early last spring, Mason, 48, noticed a quick-growing mass on his neck. Tiring more easily along routes, he sensed the growth was something that needed to be checked — and soon. “I knew something was wrong and it was time to make that call,” Mason says. He was referred to Hospital of Central Connecticut (HCC) otolaryngologist George Melnik, M.D., who diagnosed Mason’s head and neck cancer through a needle biopsy. A CT (computerized axial tomography) scan at HCC soon followed. In just minutes, the test was done and the radiologist’s report quickly available via a secure Internet connection to Melnik’s office. The 16-slice scanner at the Bradley Memorial campus captured detailed, 3-D digital X-ray views of his cancer. The images also helped Melnik devise Mason’s treatment plan. Whether it’s a CT scan, PET-CT, or X-ray, The Hospital of Central Connecticut uses advanced imaging technology and software that provide incredible views of tumors, bones, soft tissues and blood vessels within minutes. New technology also brings faster tests, easier access to results and tools that help doctors read those images.

Images now digitized

Just a few years ago, if you had a doctor’s appointment following an X-ray at HCC, you would bring a hard copy of the image with you. “We’re no longer involved in the film chase,” says Ted Lombardo, director of Radiology at HCC, explaining the hospital’s imaging tests are now digitized — immediately transferred to computer where they’re read by a radiologist. This picture archive and communications system also makes images available via the Internet to an operating room, for example, or a doctor’s office. Computerized technology sharply enhances images while reducing test time for patients and decreasing radiation exposure as much as possible, says Sidney Ulreich, M.D., HCC chief of Radiology. Patient advantages include quicker tests and results, including at HCC’s busy Emergency Department (ED). “When we need a CT scan done emergently, we can get it done within minutes,” says Jeffrey Finkelstein, M.D., chief of Emergency Medicine, adding that a radiologist can interpret findings within five minutes. Finkelstein says 60 percent of X-ray tests are done within 30 minutes and most within 60 minutes. The New Britain General campus ED has two X-ray rooms, a portable X-ray unit, a 32-slice-CT scanner and an ultrasound unit. ED radiology services are among those offered at the hospital and satellite facilities:

Ultrasound: which uses waves to obtain precise images of soft tissues (e.g., blood vessels, breast, abdomen, kidney, uterus, bladder).

CT-scan: a computer-enhanced X-ray that displays a particular body structure, either bone or soft tissue, in 3-D images (slices). Can be used to diagnose cancer, coronary artery disease and other conditions.

64-slice PET (positron emission tomography)-CT: allows separate or combined CT and PET scans. PET detects chemical (metabolic) activities in the body that can show heart, brain and nervous system conditions, and cancer. Other nuclear medicine tests, which use radioactive materials or isotopes, are bone, lung and thyroid scans; cardiac imaging; and cancer therapies.

MRI (magnetic resonance imaging):
a powerful magnetic field and radio waves produce clear images of body structures. MRI emits no radiation and is used for neurological, orthopedic and breast cancer studies.

Digital mammography: a breast X-ray especially valuable in penetrating
dense tissue.

‘Virtual fly-throughs’ with test
Not one for needles and tests, Mason says his CT scan was “pretty quick.” “They were very professional and did it very well,” he says, recalling getting a contrast dye before the test that provided 3-D digital X-ray views of his head and neck. Before Melnik surgically removed the cancer in June, Mason also got a PET-CT scan to determine cancer extent. A sugar-like substance was injected before the scan to highlight areas of unusual activity, characteristic of cancer. The scanner converted that energy into computerized images that appeared on powerful work stations, enabling views of the cancer from top to bottom in sequence “slices” or “stacks.” These slices can be reconstructed to enable measurements, create 3-D images and allow physicians to do “virtual fly-throughs” into the slices. The PET-CT’s 3-D images quickly provide more information to work with, says Ulreich. “We can manipu- late data in such a way as to maximize the information for increasing accuracy and specificity.” Mason was impressed with the technology. “To be able to scan and look at your whole body in the way these technicians do … I think that’s great. You have all this technology that can see the soft tissue.” For Mason, the PET-CT scan showed his cancer hadn’t spread. “The value of the PET-CT was highlighted by the fact that we were able to rule out distant metastatic disease, changing Mr. Mason’s status to potentially fully curable,” says Melnik. In June, he removed cancer from Mason’s neck and the primary tumor in both tonsils. His care plan continued under HCC medical oncologist Brian Byrne, M.D., with six weeks of concurrent radiation and chemotherapy at the New Britain General campus. Currently cancer-free, Mason says he wouldn’t have opted for treatment at any other hospital. “They were very good. I trusted them. I put my life in their hands. I would say to anybody, when you’re making a decision, look to home first.”

Delivering the best care
U.S. Postal Service carrier Dora Gionfriddo enjoys the picturesque, rural surroundings of her mail route, sometimes chatting with customers. Her job has a certain amount of
routine, as does keeping up with her healthcare appointments, including annual mammograms. But she hit a bump in the road this past summer when her primary care doctor delivered a breast cancer diagnosis. Gionfriddo, 48, remembers sitting in her surgeon’s office before her lumpectomy. “I was blank. I didn’t hear a thing he said. All I could think was the word ‘cancer.’ It’s scary, the word.” The New Britain resident’s journey began with a screening mammogram last July at HCC’s Diagnostic Breast Center in New Britain. Like all of HCC’s mammography X-ray units, her exam was digital, offering advanced viewing with zoom technology to better detect abnormalities and emitting less radiation than a traditional unit. Each unit also has computer-aided detection (CAD) to help pinpoint areas of concern. “The digital mammogram is a huge advantage that has made a big difference,” says HCC radiologist Anita Bourque, M.D., noting its value for patients with dense breasts. Gionfriddo wasn’t alarmed when called for another mammogram, noting no family history of the disease; only 5 to 10 percent of such cancers are considered hereditary, according to the American Cancer Society. Because her second study confirmed very small tissue calcifications, she needed a stereotactic biopsy. Other breast biopsies offered at HCC are ultrasound core biopsy, and MRI-guided biopsy. Before biopsy, women with questionable mammograms may have an ultrasound to further image breast tissue; or breast-specific gamma imaging, which can distinguish non-cancerous or benign tissue from cancer and locate small lesions. During her biopsy, X-ray visualization was used to guide a needle into her breast, and tissue samples were taken. When her biopsy proved positive for early-stage cancer in the left breast, she had an MRI of both breasts to check for cancer elsewhere. Shortly after her diagnosis and before surgery, Gionfriddo got a call from Donna Boehm, R.N., M.S.N., M.P.H., nurse navigator for HCC’s new breast cancer program, which helps patients navigate through treatment. The program includes weekly reviews of newly diagnosed breast cases by a team of HCC physicians who make a collective treatment recommendation to the patient’s surgeon. “Instead of getting a second opinion, you’re getting a fourth and fifth opinion,” notes Lombardo. Boehm explained the diagnosis and treatment plan to Gionfriddo. “My brain was now focused on what I had to do and what was going to be my outlook for the rest of my life,” she says. Following surgery, Gionfriddo had radiation therapy at HCC; her treatment plan includes routine mammograms and clinical breast exams. She’s thankful for the new technology at HCC, noting her cancer was caught early. “It reassures me that they will take care of me.” (For more information about
radiology services, please visit www.thocc.org/services/radiology/.)


Interventional radiology: treatment without surgery
Instead of a hysterectomy, a woman with painful fibroid tumors can have the blood flow feeding the tumors halted or embolized, relieving symptoms. A patient with a small kidney tumor might opt for freezing vs. surgical removal. These are among several interventional radiology procedures, many of them outpatient, offered by The Hospital of Central Connecticut (HCC). This radiology subspecialty combines advanced imaging with minimally invasive procedures to diagnose and treat varied conditions. “We can provide treatment for certain diseases that would otherwise require surgery,” says Kevin W. Dickey, M.D., FSIR, the hospital’s chief of Interventional Radiology. An interventional radiology procedure typically means a quicker and less painful recovery, decreased complication risk, and less bleeding than surgery, according to Dickey. Among interventional radiology procedures offered at HCC are:

• Angioplasty. Opens a blocked artery by delivering, through a catheter, a balloon which inflates; a wire mesh device (stent) may be inserted to keep the artery open.

• Biopsies. CT scans and ultrasound guide a needle into a mass toobtain a tissue sample.

• Chemoembolization for cancer treatment. Chemotherapy drugs are injected into an artery that supplies a tumor with blood.

• Cryoablation for small kidney tumors. Destroys cancer cells by freezing them while not affecting surrounding tissue.

• Radiofrequency ablation. Kills diseased tissue while sparing healthy surrounding tissue. Tumors treated include liver, kidney, lung, adrenal gland and bone.

• Uterine fibroid embolization. Particles of a gel-like plastic are injected through a catheter to block blood flow to fibroids, shrinking benign fibroid tumors that grow in and out of the uterus.

• Varicose vein treatment. Laser treatment, using ultrasound guidance, closes varicose veins, relieving leg fatigue, aching and itching.

• Vertebroplasty to treat spinal compression fractures. Cements fractures, often caused by osteoporosis.