Image Makeovers




Have you hugged a radiologist today? You might want to, if you think about how much radiology contributes to health and medical treatments. Radiology is often a driving force behind improved, less invasive health care that involves lower risk and shorter recovery time than traditional methods. It enables some patients whose conditions in the past would have called for major surgery to now opt for outpatient procedures that require the patient to be in the hospital only one day. Radiology can serve as a diagnostic tool, helping doctors figure out what's wrong with patients, or it can be used as an interventional aid, from sophisticated 3-D imaging that guides physicians during surgical procedures to radiation therapy that destroys cancer cells. Here's a primer on some of the important new radiological techniques currently used at Granite State hospitals: PET/CT To understand this batch of alphabet soup, first we must take a quick look at the ingredients. PET stands for Positron Emission Tomography and is a type of nuclear medicine imaging, meaning that it uses small amounts of radioactive material to diagnose or treat disease. CT, or Computed Tomography (often called a CAT scan), is an imaging procedure that uses special x-ray equipment to produce detailed images of the inside of the body. Some hospitals now offer PET/CT, which is a fusion of the two techniques that provides greater detail, makes it easier for experts to correlate and interpret image information and tends to provide more accurate information than when the two scans are performed separately, according to the Radiological Society of North America. Plus, it's more convenient for patients, allowing them to undergo two tests at one sitting. PET/CT is often used to examine heart and brain function, and can also help cancer patients by enabling physicians to determine the extent of cancer and thereby better plan a treatment approach. It is "very effective at evaluating or staging cancer," says Fred Riester, M.D., chairman of the Department of Radiology at St. Joseph Hospital in Nashua. "Various cancers have various stages depending on where the cancer is distributed throughout the body. This is very critical in terms of treatment," he says. PET/CT can reveal many types of cancer, including that of the breast, lung and brain, and can help cardiac patients by showing blood flow to the heart and heart wall damage following a heart attack. Stereotactic radiosurgery Stereotactic radiosurgery is a type of radiation therapy that is most commonly used to treat brain abnormalities and tumors. Its name is a misnomer since stereotactic radiosurgery does not involve surgery, but instead uses highly focused x-rays to treat some conditions that previously would have required major surgery, says Richard Frechette, director of Diagnostic Imaging at Elliot Hospital in Manchester. Stereotactic radiosurgery can shrink tumors, and patients can often go home after receiving treatment the same day. Electronic brachytherapy Electronic brachytherapy offers a new choice for breast cancer patients. Traditionally, treatment of breast cancer that aims to preserve the breast involves a lumpectomy, which is usually followed by radiation therapy five days a week for six weeks, says Diane Palladino, M.D., a general surgeon with special interest in breast surgery and medical director of Women's Health at Exeter Hospital. In contrast, electronic brachytherapy patients receive treatment twice a day for five days - much less time-consuming than traditional therapy, especially for patients who do not have a radiation unit facility close to home. Electronic brachytherapy offers other benefits as well. Unlike traditional radiation therapy, there are no radioactive isotopes involved in electronic-based brachytherapy, so patients do not have to be isolated in a lead-lined room while they receive the therapy, Palladino says. And, there's less chance of injury to other organs during treatment. Kyphoplasty Kyphoplasty offers promising results to osteoperosis patients who suffer acute compression fractures of the spine, which can occur when osteoperosis causes bone to weaken to the point that a spontaneous fracture occurs - sometimes as a result of the patient simply walking around, Riester says. In the United States, there are an estimated 700,000 spinal fractures per year, according to the American Academy of Family Physicians, with the majority being caused by osteoperosis. Using imaging guidance and minimally invasive techniques, a doctor inserts a special cement mixture into the fractured bone to harden the bone and alleviate pain. No surgical incision is needed - only a small nick in the skin - and the procedure provides almost immediate relief, Riester says. Prior to development of kyphoplasty, there wasn't really any treatment for osteoperotic compression fractures other than pain control through medication. Seeing in 3-D Another radiological advancement that is bringing welcome change in health care is software that renders three-dimensional images. Three-dimensional cardiac ultrasound already exists and other 3-D applications are greatly anticipated, Frechette says. "3-D ultrasound in general is on the horizon as something that's going to be revolutionary," he says. Three-dimensional guided surgery has already been adopted by some local hospitals and has been used in the operating room by physicians for spinal surgery and brain surgery, Frechette says. "It allows surgeons [operating on the spine] to synchronize 3-D images with instruments that the surgeons use," Frechette says, and offers a visual dry run by enabling a surgeon to advance a surgical tool on a video image without actually cutting into the patient. The surgeon can see what the outcome of his or her action will be without actually doing it, says Frechette. NH
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