Ectopic pregnancy is a life-threatening condition that warrants immediate treatment due to the risk of rupture and resultant hemorrhaging. Less than 1% of all pregnancies are ectopic; of these, 90% or more are located in the fallopian tubes. In a clinical setting, sonography can diagnose an ectopic pregnancy in conjunction with beta-human chorionic gonadotropin (B-hCG) levels above 1500 mIU. A case is presented in which the diagnosis of ectopic pregnancy was supported through sonographic features. Medication was given to terminate the ectopic pregnancy; however, surgery was later needed when the ectopic ruptured.
An ectopic pregnancy is a pregnancy that does not occur inside the uterus, most commonly occurring in the fallopian tubes, but it may also occur in interstitial, cervical, and abdominal areas.1 Ectopic pregnancy can be life threatening if not diagnosed in a timely manner. Ectopic pregnancy requires immediate intervention through surgery or medication. The ectopic pregnancy can rupture, and shock and internal hemorrhage can lead to an emergency situation.2 Sonography is a key imaging modality used in diagnosing ectopic pregnancy since it can determine whether the pregnancy is an intrauterine or extrauterine gestation. With the advance of transvaginal sonography, clearer and more detailed images can be obtained when evaluating the uterus, and especially the ovaries, because of the ability to use higher transmit frequency probes as compared to transabdominal sonography.
Case Report:
A 28-year-old female presented to the emergency department with concern for an ectopic pregnancy. Blood work was ordered that revealed her serum quantitative beta-human chorionic gonadotropin (B-hCG) level was 15 248 mIU/mL. (Normal values in nonpregnant females are < 5 mIU/mL.) She displayed no emergent physical symptoms and had no medical history to increase her risk of having an ectopic pregnancy.
A sonogram was performed and demonstrated an anteverted uterus that measured 9.9 × 3 × 5 cm with an endometrial measurement of 1.8 cm (Figures 1 and 2). No evidence of an intrauterine gestation was found. As shown in Figures 3 and 4, the left ovary measured 2.9 × 2.9 × 2.2 cm with an irregular cystic component that displayed increased vascularity surrounding the ovary (Figure 5). Figures 6 and 7 show a left adnexal mass measuring 2.2 × 2.2 × 1.8 cm that was highly suspicious of an ectopic pregnancy. The right ovary demonstrated normal flow and measured 3.1 × 1.8 × 2 cm with a 1.3 × 1.2 × 1 cm septated cyst (Figure 8). No free fluid was found in the cul-de-sacs. These results were called to the emergency department physician by the reading radiologist as soon as the sonographic examination was completed.
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Figure 1.
A transabdominal longitudinal midline image showing an anteverted uterus measuring 9.9 × 3.0 cm; no gestational sac was seen inside the uterus. Note was made of a thickened endometrium.
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Figure 2.
A transabdominal transverse image of the uterus, which measured 5.0 cm across.
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Figure 3.
A transabdominal image of the left ovary shown in a longitudinal plane, measuring 3.0 × 2.8 cm.
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Figure 4.
A transabdominal image of the left ovary in a transverse plane, measuring 3.0 cm.
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Figure 5.
A transvaginal image of the left ovary in a longitudinal plane with color Doppler demonstrating the “ring of fire” appearance.
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Figure 6.
A transvaginal longitudinal image of the ectopic pregnancy next to the left ovary measuring 2.9 × 2.9 cm.
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Figure 7.
A transvaginal image showing the transverse measurement (2.2 cm) of the ectopic pregnancy next to the left ovary.
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Figure 8.
Longitudinal and transverse transvaginal images of the right ovary showing a 1.3 × 1.2 × 1.0 cm cyst.
Options for termination of the ectopic pregnancy were discussed with the emergency department physician and the decision was made to use the medication methotrexate, an inhibitor of the metabolism of folic acid, thus producing a toxic effect on rapidly dividing cells. Four days after this initial diagnosis of an ectopic pregnancy, the B-hCG level remained elevated at 17 608 mIU/mL, despite taking methotrexate. Three days later the level began to decrease to 14 760 mIU/mL. Eleven days after the initial diagnosis, the B-hCG levels continued to decrease to 8313 mIU/mL. One week after this measurement of the B-hCG level, the patient presented again to the emergency department with complaints of increasing lower abdominal pain. She appeared pale, diaphoretic, and was hypotensive; her serum hemoglobin was 10. These findings supported the diagnosis of a possible rupture of the ectopic pregnancy. A bedside sonographic examination was performed and demonstrated a large amount of echogenic material in the pelvis consistent with blood or a hematoma (Figures 9and 10). The surgeon and emergency department physician were present during the sonographic examination, and the patient was immediately rushed to the operating room for a ruptured ectopic pregnancy with hemolytic shock. At surgery, 2500 mL of bright red and clotted blood was found in the peritoneal cavity. Evidence was found of a ruptured left tubal pregnancy. An area in the left broad ligament and left round ligament was actively bleeding, as well as the cornua of the uterus. The left ovary and fallopian tube were densely adherent into the left ovarian fossa; however, the left ovary could be palpated but never completely visualized. Laboratory evaluation found immature chorionic villi; some were hydropic, and there was minor trophoblastic proliferation. A drain was placed in the posterior cul-de-sac and a large amount of fluid was suctioned out before closure. The patient continued to be hypotensive and was infused with two units of blood in the operating room. The patient was then transferred to the intensive care unit to recover. On the day of the surgery her hematocrit was 33.5 g/dL; it continued to remain low for the next four days at a level of 28.8 g/dL. Her platelet count also remained low for the four days postoperative, ranging from 7.1 fL to 7.4 fL. The patient was discharged seven days after her surgery with no special instructions. The patient returned three days after discharge for blood work where her hematocrit was 34.7 g/dL and the platelet count was 7 fL; no further follow-up was deemed necessary.
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Figure 9.
A longitudinal transabdominal image of the uterus following the rupture of the ectopic pregnancy.
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Figure 10.
A transabdominal image of the left adnexa showing the echogenic remains of the ruptured ectopic pregnancy consistent with blood and/or hematoma.
The exact etiology of an ectopic pregnancy is unknown and can happen to any female; however, those who have had previous pelvic infections, an IUD, fallopian tube surgery, infertility treatments, or a history of ectopic pregnancies are at increased risk for ectopic pregnancies.3 The most common site for an ectopic pregnancy is the fallopian tubes; tubal pregnancy occurs with the invasion of trophoblastic tissue within the fallopian tube mucosa.3 However, ectopic pregnancies also can be located in the ovaries, cervix, or abdominal cavity.2 The sonographic diagnosis of ectopic pregnancy has improved significantly over the past 15 years as the instrumentation has improved, and it is now the first diagnostic modality used in suspected cases.4⇓-6 Transvaginal sonography has a reported sensitivity of 73% to 93%, with results primarily dependent on gestational age and the experience of the Sonographer.7,8 In the case presented, the Sonographer showed proper visualization of the ectopic pregnancy, for example, the vascular “ring of fire” surrounding the gestation. The Sonographer also showed good visualization of the ruptured ectopic and free blood in the pelvic cavity on the later examination.
The treatments for an ectopic pregnancy are limited; either the patient takes methotrexate if early enough in the pregnancy or has surgery to remove the ectopic and any tissues that may be involved. When detected early, an injection of methotrexate is given to halt the growth of new cells. B-hCG levels are monitored for response, and if the B-hCG level remains high, an additional injection of methotrexate can be given.9,10 Single- or multidose regimens of methotrexate may be used, but multidose regimens have been shown to be significantly more effective in cases of elevated baseline B-hCG levels > 5000 mIU/mL and/or in the presence of fetal cardiac activity.11 The commonly used criteria for single-dose methotrexate use are a hemodynamic stable patient, an unruptured ectopic mass less than or equal to 5 cm at the greatest dimension on transvaginal sonography, B-hCG level less than or equal to 5000 mIU/ml, no cardiac activity seen, a wish for future fertility, and proper informed consent.12 Monteagudo et al13 have shown success with direct ultrasound-guided methotrexate injection, though in a very small series of four tubal pregnancies. More and more women are choosing methotrexate instead of surgical intervention as a way to preserve fertility, though Krag-Moeller et al14 showed equivalent success rates and subsequent fertility in a randomized, multicenter trial comparing single-dose systemic methotrexate with laparoscopic surgery.
The success of methotrexate has been shown in part to depend strongly on the level of B-hCG when beginning the medication. Lipscomb et al4 found that 91% of women with ectopic pregnancies who took methotrexate successfully terminated the pregnancy. They found the success rate to be high with B-hCG levels up to 15 000 mIU/mL; above this level the success rate fell to only 68%. Current guidelines suggest a B-hCG level of 5000 mIU/mL as an upper cutoff point for a single-dose methotrexate regimen.12 In the case presented, the patient’s B-hCG was above this cutoff point for optimal success, and after the initial injection the B-hCG level continued to increase. This case demonstrates a methotrexate failure secondary to elevated levels of B-hCG and illustrates the importance of continued monitoring for complications that may become life threatening, such as rupture, which can lead to shock and hemorrhage.
CONCLUSION:
In the presence of proper clinical history, a definitive diagnosis of an ectopic pregnancy can be based on sonography and a B-hCG blood test. An accurate diagnosis is essential for proper treatment. This case study supports sonography as an indispensable diagnostic imaging modality in gynecologic and obstetric studies.
Specialized Ultrasound Used to Detect Cancer
This principle led UNC scientists to a new method of using a high-resolution ultrasound to identify early tumors in preclinical studies. The method, based on vessel bendiness or "tortuosity," potentially offers an inexpensive, non-invasive and fast method to detect cancer that could someday help doctors identify cancers when tumors are less than a centimeter in size.
Their findings were published in the July 6, 2012 online issue of the journal Radiology.
Paul Dayton, PhD, associate professor of biomedical engineering explains, "The correlation between vessel tortuosity and cancer is well-established. What's new about our finding is that we can visualize these vessels in minutes with a very quick scan, using very inexpensive imaging methods." Dr. Dayton is a member of UNC Lineberger Comprehensive Cancer Center.
The UNC team used a new high-resolution ultrasound method, called "acoustic angiography," with an intravascular contrast agent that allowed them to acquire images of only the blood vessels. "Unlike current clinical 'grayscale' ultrasound, this method filters out all tissue signals, so we can see small blood vessels clearly." says Dayton.
"Our results showed a definitive difference between vessels within and surrounding tumors versus those associated with normal healthy vasculature. The limitation that we must now address is that our method works only for tumors at a shallow depth into tissue, such as melanomas or thyroid cancer. Our next studies will focus on this imaging-depth issue as well as evaluating the ability of this technology to determine a tumor's response to therapy.
"We know from several clinical and preclinical MRI studies at UNC by Elizabeth Bullitt, MD, and others, and at other institutions that vessels can unbend, or "normalize," in response to effective therapy. We need to see if our inexpensive ultrasound-based method of blood vessel visualization and tortuosity analysis can detect this normalization prior to conventional assessments of tumor response to therapy, such as measurements of tumor size.
Simple Ultrasound Test to Identify People at Stroke Risk
A simple ultrasound test to identify people at high risk of stroke who have a condition called asymptomatic carotid stenosis, has emerged from a study.
Asymptomatic carotid stenosis is a narrowing of the carotid artery found in the neck, in which few or no symptoms are present. The research is published in the August 17, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"There is debate over how to best treat people with asymptomatic carotid stenosis. A procedure called carotid endarterectomy can reduce the risk of stroke, but there are risks and costs involved with the surgery. Identifying people with asymptomatic carotid stenosis who are at higher risk of stroke would help determine whether carotid endarterectomy is needed," said study author Raffi Topakian, MD, of the Academic Teaching Hospital Wagner-Jauregg in Linz, Austria.
The surgery removes the plaque buildup in the carotid artery, which is the main artery from the heart to the brain.
For the study, 435 people with asymptomatic carotid stenosis were followed for two years. They underwent ultrasound of the carotid artery and of blood vessels in the brain to determine whether two markers for high risk of stroke were present. The markers were signs of blood clots passing into the brain, and a type of carotid plaque called echolucent plaque, which has a higher fat content than other plaque.
Of the participants, 164 people had echolucent plaque, or 38 percent, and 73 people, or 17 percent, had at least one sign of a blood clot. Six percent, or 27 people, had both markers. During the study, 10 people had strokes and 20 people had transient ischemic attacks, or mini-strokes.
The study found that people with the echolucent plaque in their carotid artery were more than six times more likely to have a stroke than those people without the plaque. People who had the plaque and signs of blood clots were more than 10 times more likely to have a stroke than those without both markers. The results remained the same regardless of high blood pressure, diabetes, smoking and vascular disease.
"With further study, our results may lead to a simple, clinically applicable method for predicting future stroke in people with asymptomatic carotid stenosis and help to determine the best way to treat people with the disorder, such as selecting patients with asymptomatic carotid stenosis for carotid endarterectomy," said Topakian. "This method identifies a high risk group with an annual stroke risk of about nine percent and a low risk group with an annual risk of less than one percent.
In an accompanying editorial, Lars Marquardt, MD, DPhil, of the University of Erlangen-Nuremberg in Germany noted that the overall risk of stroke among people with asymptomatic carotid stenosis is relatively low and has decreased in recent years due to better management through cholesterol and high blood pressure drugs. He also said that incorporating screening for plaque and blood clots in people with no symptoms may be difficult and costly.
The CARE Bill in the 113th Congress
Key congressional offices have reported that the “Consistency, Accuracy, Responsibility and Excellence” (CARE) bill will be re-filed in the current congressional session within the next month. The 113th Congress convened in January and will run for two years through the 2014 elections. The CARE bill, if enacted, would establish federal minimum standards for certification and education of non-physician providers of medical imaging services, including sonographers. The fundamental question related to any proposed federal legislation, including the CARE bill, is “why?” Why is this legislation needed? What problem would the enactment of this proposed legislation address? How would this bill serve the public good?
All of the questions above reflect public policy issues that deserve comprehensive and coherent answers by our elected officials, who are responsible for considering and ultimately deciding which of the multitude of bills that are filed in Congress will survive the legislative gauntlet and be made into law. Over 95% of the bills filed at the federal legislative level fail to make it into law. The CARE bill has been introduced in every congressional session since the 106th Congress, a protracted history of over fourteen years.
For the CARE bill, the answer to the question of “why?” has been consistent over its entire history: because the CARE bill would result in patients receiving better care, it would provide for greater patient safety, and ensure a more cost effective delivery of care. In summary, the CARE bill is good public policy. As then Chairman of the Health Subcommittee of the House Energy and Commerce Committee, Mr. Frank Pallone (Democrat - New Jersey), said during congressional hearings on the safety of medical imaging, “Passing the CARE bill is a no-brainer.” However, that having been said, the CARE bill still failed to make it out of that congressional session.
The American Society of Radiologic Technologists (ASRT) was the driving force behind the original CARE bill and supported its passage in every congressional session through 2012. The ASRT was the professional association that helped form the Alliance for Quality Medical Imaging and Radiation Therapy (the “Alliance”), a coalition of over twenty medical imaging related organizations supporting the CARE bill effort. In 2008, the Society of Diagnostic Medical Sonography (SDMS) was the first sonography professional association to join Alliance efforts to pass the CARE bill. Subsequently, several other sonography related organizations, including the Society for Vascular Ultrasound (SVU), joined the Alliance in support of the CARE bill.
For the last five years, SDMS has partnered with the ASRT and other medical imaging groups (including SVU) in providing significant support to push the CARE bill through Congress and into law. In more than one congressional session, these efforts have come exceptionally close to succeeding; in the 111th Congress, the CARE bill was passed in the US Senate on the “Unanimous Consent” calendar only to falter in the waning hours on the House side as time expired.
Congress convened hearings when The New York Timespublished front page articles related to patient harm in medical imaging environments. SDMS, along with several other professional associations, have secured noted lobbying teams,
which are dedicated to passing the CARE bill. Substantial resources, including money, time, and energy have been invested in CARE bill efforts. Despite these resource outlays, the CARE bill again fell short during the last congressional
session in 2012.
The CARE bill was among a raft of pending congressional legislation that was mired in a legislative logjam in December as the country’s economic challenges took center stage and consumed the attention of legislative decision makers. Unfortunately, these same issues remain unresolved today and in the media spotlight. The “fiscal cliff” is real and looms on the immediate horizon. Until the country’s pending economic matters, including the U.S. debt ceiling, the sequestration cuts, the sustainable growth rate, entitlement reform, and the government’s operational funding are addressed, it is unlikely that law makers will turn their attention to other public policy concerns.
There was another development related to the CARE bill that recently generated interest among the medical imaging community. On February 15, 2013, ASRT Chief Executive Officer (CEO) Sal Martino distributed a memo to Alliance members and other interested parties announcing that the ASRT decided “...to set CARE aside and pursue new tactical strategies toward achieving our goal,” that goal being the establishment of federal minimum standards. Mr. Martino went on to say that “ASRT will no longer be an active participant in the Alliance.” The SDMS acknowledges and appreciates all that ASRT has done over the years to bring attention to the need for national certification and education standards for non-physician providers of medical imaging services. Our organizations remain committed to achieving the same goal—federal minimum standards—though our respective strategies for accomplishing that outcome may differ in approach.
SDMS remains strongly committed to attaining federal minimum standards for certification and education of sonographers—the patients served by our sonographer members deserve nothing less.
In Pregnant Women, Ultrasonic Testing With Doppler Imaging can Rule Out Blood Clots
To rule out blood clots in the legs of pregnant women, the use of serial compression ultrasonographic testing together with Doppler imaging appears to be a reliable method
This is according to a study published in CMAJ (Canadian Medical Association Journal). Physicians can likely safely withhold anticoagulation therapy based on the results.
This technique, recommended in women who are not pregnant to determine if there is deep vein thrombosis (DVT) in the legs, is also used in pregnant women but its safety has not been validated in this cohort. Anticoagulation drugs are used to treat blood clots during pregnancy and are safe for the fetus; inappropriately diagnosing blood clots during pregnancy can result in unnecessary risks to a woman during and after pregnancy. It is therefore important to establish whether there is a clot.
Researchers studied data for 221 women who had symptoms of DVTs over an 8-year period from August 2002 to September 2010 to determine whether compression ultrasonography with Doppler imaging is a safe diagnostic approach. They found that 7.7% of pregnant women with symptoms had deep vein thrombosis; 94% of these diagnoses were detected using serial compression ultrasonography with Doppler imaging of the iliac veins. These women were subsequently treated with anticoagulants. One patient with normal test results was found to have a pulmonary embolism 7 weeks later. The incidence of DVTs during follow up was less than 1% (0.49%).
"Our strategy of serial compression ultrasonography combined with Doppler imaging of the iliac veins appears to reliably exclude clinically important deep vein thrombosis," writes Dr. Wee-Shian Chan, who is now at Department of Medicine, BC Women's Hospital and Health Centre, with coauthors.
"Our study highlights the importance of iliac vein visualization in symptomatic pregnant women. Because all of our cases of deep vein thrombosis were identified by initial imaging with compression ultrasonography and Doppler studies, it is unclear whether serial testing over a 7-day period is necessary," write the authors. More studies will be needed.
Using Ultrasound to Get Rid of Painful Kidney Stones
Space scientists are in the process of using ultrasound to get rid of kidney stones through a process called 'twinkling artifact'.
The risk of kidney stones developing in space is aggravated by environmental conditions, scarcity of resouces and the distance from the earth, which could restrict treatment options.
The project is led by National Space Biomedical Research Institute (NSBRI) Smart Medical Systems and Technology Team principal investigator Lawrence Crum and co-investigator Michael Bailey.
Bailey said the technology is based on currently available equipment . "We have a diagnostic ultrasound machine that has enhanced capability to image kidney stones in the body," said Bailey, according to an NSBRI statement.
"We also have a capability that uses ultrasound waves coming right through the skin to push small stones or pieces of stones toward the exit of the kidney, so they will naturally pass, avoiding surgery," added Bailey.
Currently, the preferred mode of removal is to drink water to encourage the stones to pass naturally, but this does not always work, and surgery is often the only option. In space, the threat from kidney stones is greater due to the difficulty of keeping astronauts fully hydrated.
Another factor is that bones demineralize in the reduced-gravity environment of space, dumping salts into the blood and eventually into the urine. The elevated concentration of salts in the urine is a risk factor for stones.
Crum, who is a physicist, said kidney stones could be a serious problem on a long-duration mission.
Simple Ultrasound Test to Identify People at Stroke Risk
A simple ultrasound test to identify people at high risk of stroke who have a condition called asymptomatic carotid stenosis, has emerged from a study.
Asymptomatic carotid stenosis is a narrowing of the carotid artery found in the neck, in which few or no symptoms are present. The research is published in the August 17, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"There is debate over how to best treat people with asymptomatic carotid stenosis. A procedure called carotid endarterectomy can reduce the risk of stroke, but there are risks and costs involved with the surgery. Identifying people with asymptomatic carotid stenosis who are at higher risk of stroke would help determine whether carotid endarterectomy is needed," said study author Raffi Topakian, MD, of the Academic Teaching Hospital Wagner-Jauregg in Linz, Austria.
The surgery removes the plaque buildup in the carotid artery, which is the main artery from the heart to the brain.
For the study, 435 people with asymptomatic carotid stenosis were followed for two years. They underwent ultrasound of the carotid artery and of blood vessels in the brain to determine whether two markers for high risk of stroke were present. The markers were signs of blood clots passing into the brain, and a type of carotid plaque called echolucent plaque, which has a higher fat content than other plaque.
September is National Prostate Cancer Awareness Month and Gynecologic Cancer Awareness Month. Both observances are aimed at increasing public understanding of these cancers.
Five main types of cancer affect a woman's reproductive organs: cervical, ovarian, uterine, vaginal, and vulvar. As a group, they are referred to as gynecologic cancer. (A sixth type of gynecologic cancer is the very rare fallopian tube cancer.)
Each gynecologic cancer is unique, with different signs and symptoms, different risk factors (things that may increase your chance of getting a disease), and different prevention strategies. All women are at risk for gynecologic cancers, and risk increases with age. When gynecologic cancers are found early, treatment is most effective.
-The most challenging and difficult group of women’s cancers to diagnose and treat are ovarian, fallopian tube and peritoneal cancers. These conditions often present with gastrointestinal symptoms, such as abdominal bloating, and can be confused with more common conditions such as irritable bowel syndrome or diverticular disease. Two-thirds of the women who are diagnosed with these conditions are already at Stage III or Stage IV of the disease, when it has already spread extensively throughout their abdomen or into the liver or chest. Being watchful for the signs and symptoms of these cancers could lead to earlier diagnosis and intervention.
Imaging studies
Imaging methods like computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and Ultrasound studies can confirm whether a pelvic mass is present. These studies cannot confirm that the mass is a cancer, but they may be useful if your doctor is looking for spread of ovarian cancer to other tissues and organs.
Ultrasound
Ultrasound (ultrasonography) is the use of sound waves to create an image on a video screen. Sound waves are released from a small probe placed in the woman's vagina or on the surface of her abdomen. The sound waves create echoes as they enter the ovaries and other organs. The same probe detects the echoes that bounce back, and a computer translates the pattern of echoes into a picture.
This is often the first test done to if a problem with the ovaries is suspected. Ultrasound can be useful to find an ovarian tumor and see if it is a solid mass (tumor) or a fluid-filled cyst. It can also be used to look better at the ovary to see how big it is and how it looks inside (the internal appearance or complexity). These factors help the doctor decide which masses or cysts are more worrisome.
At EDS, our technologists perform the ultrasound testing right in your doctor's office, and a board certified reading physicians will interpret your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
What is Aphasia?
Aphasia is an acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence. Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty reading and writing.
What Causes Aphasia?
The most common cause of aphasia is stroke (about 25-40% of stroke survivors acquire aphasia). It can also result from head injury, brain tumor or other neurological causes.
There are many types of aphasia which correspond to the location of the brain injury and the parts of communication that are affected.
• Global aphasia is the most severe form and patients can produce few recognizable words, understand little or no spoken language, and cannot read or write.
• Broca’s aphasia, also called non-fluent aphasia, is where speech output is severely reduced, mainly consisting of short utterances of less than four words.
• In mixed non-fluent aphasia, patients have limited and effortful speech, similar to Broca’s aphasia.
• Wernicke’s aphasia (fluent aphasia) patients have an impaired ability to grasp the meaning of spoken words but their own ability to produce connected speech is not much affected.
Ultrasound:
Carotid Duplex Scanning: This is a noninvasive study to diagnose blockage in the carotid arteries. This technology involves recording sound waves that reflect the velocity of blood flow.
Transcranial Doppler (TCD): Since carotid Doppler can only look at the carotid artery in the neck, before the artery enters the brain, another ultrasound technique was developed to look at the blood vessels in the brain. A TCD probe is placed either over the eye, at the back of the neck or on the temple to look at various arteries. The TCD measures the speed of the blood flow, which can help determine the status of the underlying vessels.
At EDS, our technologists perform the ultrasound testing right in your doctor's office, and board certified reading physicians will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
What is Aphasia?
Aphasia is an acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence. Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty reading and writing.
What Causes Aphasia?
The most common cause of aphasia is stroke (about 25-40% of stroke survivors acquire aphasia). It can also result from head injury, brain tumor or other neurological causes.
There are many types of aphasia which correspond to the location of the brain injury and the parts of communication that are affected.
• Global aphasia is the most severe form and patients can produce few recognizable words, understand little or no spoken language, and cannot read or write.
• Broca’s aphasia, also called non-fluent aphasia, is where speech output is severely reduced, mainly consisting of short utterances of less than four words.
• In mixed non-fluent aphasia, patients have limited and effortful speech, similar to Broca’s aphasia.
• Wernicke’s aphasia (fluent aphasia) patients have an impaired ability to grasp the meaning of spoken words but their own ability to produce connected speech is not much affected.
Ultrasound:
Carotid Duplex Scanning: This is a noninvasive study to diagnose blockage in the carotid arteries. This technology involves recording sound waves that reflect the velocity of blood flow.
Transcranial Doppler (TCD): Since carotid Doppler can only look at the carotid artery in the neck, before the artery enters the brain, another ultrasound technique was developed to look at the blood vessels in the brain. A TCD probe is placed either over the eye, at the back of the neck or on the temple to look at various arteries. The TCD measures the speed of the blood flow, which can help determine the status of the underlying vessels.
At EDS, our technologists perform the ultrasound testing right in your doctor's office, and board certified reading physicians will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
May is National High Blood Pressure Education Month and this year's theme highlights the threat of uncontrolled Hypertension.
High blood pressure affects about 50 million--or one in four--American adults. Of those with hypertension, about 68 % are aware of their condition--but only 27 % have it under control. The reasons for this include not taking drugs as prescribed and/or not taking a medication that sufficiently lowers blood pressure.
Hypertension can lead to stroke, heart failure, or kidney damage. To help prevent that, blood pressure must be lowered to less than 140/90 mmHg (millimeters of mercury). Normal blood pressure is less than 130/less than 85 mmHg.
High blood pressure can cause ischemic heart disease. This means that the heart muscle isn't getting enough blood. Ischemic heart disease is usually the result of atherosclerosis or hardening of the arteries (coronary artery disease), which impedes the blood flow. This can progress to a heart attack.
An Echocardiogram is used to show a detailed moving picture of the heart. It is used to evaluate the functioning of the heart valves and chambers, assess heart pumping, and check for heart murmurs. An Echocardiogram is commonly used to check for heart disease and evaluate the heart functioning of people that have had heart attacks.
The lifestyle changes to control high blood pressure are: lose weight, if overweight; become physically active; choose foods lower in salt and sodium; and limit alcohol intake.
At EDS, our technologists perform the Echocardiogram testing right in your doctor's office, and board certified Cardiologists will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
What is cancer?
Cancer is a group of many related diseases that begin in cells, the body’s basic building blocks. To understand cancer, it is helpful to know what happens when normal cells become cancerous.
Cigarette smoking and cancer:
Cigarette smoking causes 87 percent of lung cancer deaths. Lung cancer is the leading cause of cancer death in both men and women. Smoking is also responsible for most cancers of the larynx, oral cavity and pharynx, esophagus, and bladder. In addition, it is a cause of kidney, pancreatic, cervical, and stomach cancers, as well as acute myeloid leukemia.
The body is made up of many types of cells. Normally, cells grow and divide to produce more cells as they are needed to keep the body healthy. Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. The extra cells form a mass of tissue called a growth or tumor. Not all tumors are cancerous; tumors can be benign or malignant.
Benign tumors are not cancer. They can often be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.
Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. Cancer cells invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumor and enter the bloodstream or lymphatic system.
Ultrasound - The use of high frequency sound waves to create an image of the inside of the body.
Involves spreading a thin coating of jelly over an area of the skin, then bouncing high frequency sound waves through the skin onto internal organ.
Pelvic Ultrasound: A pelvic or gynecologic ultrasound is an ultrasound of the female pelvis. It examines the female pelvic organs including the uterus (commonly called the “womb”), the endometrium (the lining of the uterus), the cervix and the ovaries.
Testicular ultrasound test uses sound waves to create an image of the scrotum and testicles.
An ultrasound test can help determine the nature of any testicular lumps, such as if the lumps are solid or fluid filled. Ultrasound also tells you whether lumps are inside or outside of the testicle. Your doctor uses this information to determine whether a lump is likely to be testicular cancer.
At EDS, our technologists perform the ultrasound testing right in your doctor's office, and board certified reading physicians will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
Did you know that heart disease is the leading cause of death in the United States? That’s why the month of February is dedicated to raising awareness about heart disease. Educate yourself on the dangers and stay on track to better, healthier heart! The first step to preventing heart disease understands the most common types and the warning signs:
Heart Attack
- Pressure, a feeling of fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
- Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
- Prolonged pain in the upper abdomen
- Shortness of breath
High Blood Pressure
- Severe headache
- Vision problems
- Chest pain
- Difficulty breathing
- Irregular heartbeat
- Pounding in your chest, neck, or ears
Echocardiogram Ultrasound:
What is it? An echocardiogram is a moving ultrasound picture of the heart. It allows the doctor to test how well the heart pumps out blood and whether it has structural problems.
Does it work? While the test might help doctors diagnose conditions like heart failure and atrial fibrillation, it hasn't been proven to help people without symptoms. One recent study found screening for heart disease with echocardiography and other tests didn't change what drugs doctors prescribed, nor people's diet and exercise habits or whether they smoked.
At EDS, our technologists perform the ultrasound testing right in your doctor's office, and board certified reading physicians will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
It is estimated that up to 59 million American have experienced thyroid problems at some point and many more may be suffering from thyroid problems and not even be aware of it and, as a result, are not receiving any treatment.
The thyroid a small butterfly-shaped gland located in the neck, but the hormones it produces are essential; they deliver oxygen and energy to every cell in the body. The most common thyroid problem is insufficient thyroid hormone, known as hypothyroidism, "low thyroid" or an underactive thyroid. Hypothyroidism causes metabolism to slow down, and can result in fatigue, depression, weight gain, hair loss, infertility, low sex drive, memory and concentration problems, and a host of other symptoms.
Sometimes, the thyroid can go into overdrive, and produce too much thyroid hormone, a condition known as hyperthyroidism, or an overactive thyroid. When too much thyroid hormone floods the body, it's common for heart rate and blood pressure to go up, and an overactive thyroid can cause anxiety, tremors, panic attacks, diarrhea, muscle weakness, eye problems, insomnia, and rapid, debilitating weight loss.
The thyroid can also get enlarged (known as a goiter), develop lumps (known as nodules), and in rare cases, those lumps can be cancerous. Thyroid cancer is, unfortunately, one of the fastest growing cancers in the United States.
Ultrasound:
An ultrasound of the thyroid is typically used:
• to determine if a lump in the neck is arising from your thyroid or an adjacent structure
• to analyze the appearance of thyroid nodules to determine if they are the more common benign nodule or if the nodule has features that warrant a biopsy
• to look for additional nodules in patients with one or more nodules felt on physical exam
• to see if a thyroid nodule has substantially grown over time
Because ultrasound provides real-time images, images that are renewed continuously, it also can be used to guide procedures such as needle biopsies, in which needles are used to extract sample cells from an abnormal area for laboratory testing. Ultrasound may also be used to guide the insertion of a catheter or other drainage device and helps assure accurate placement and fluid drainage for diagnosis or relief of patient discomfort.
At EDS, our technologists perform the ultrasound testing right in your doctor's office, and board certified reading physicians will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
"Why Should You Care About Diabetes?"
It is the leading cause of kidney disease, blindness, and amputation, yet nearly 25% of people who have it don't even know it.
Nearly 24 million children and adults in the United States, have diabetes. The death rate for diabetes has continued to grow since 1987, while the death rates due to heart disease, stroke and cancer have declined.
Having diabetes places a person at increase risk for a number of serious, even life-threatening complications, including:
• Heart disease and stroke - Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
• Blindness - Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year making diabetes the leading cause of new cases of blindness in adults 20-74 years of age.
• Kidney disease - Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005.
• Amputations - More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
Ultrasound:
Carotid Duplex Scanning: This is a noninvasive study to diagnose blockage in the carotid arteries. This technology involves recording sound waves that reflect the velocity of blood flow.
The major goal of carotid ultrasound is to screen patients for blockage or narrowing of their carotid arteries, family history of stroke, heart disease and diabetes.
Arterial Doppler: This procedure uses color to map the arteries in your leg(s) to identify narrowing of your vessels that may be causing leg pain when walking, resting leg pain, foot, ankle, heel or toe ulcers, or skin discoloration.
Peripheral arterial disease (PAD) -- also known as peripheral vascular disease, atherosclerosis or hardening of the arteries - is a disorder that occurs in the arteries of the circulatory system.
What are the risk factors for PAD?
An individual is at risk for developing PAD when one or more of these risk factors are present:
• Smoking
• Diabetes
• History of heart or blood vessel disease: A personal or family history of heart or blood vessel disease may be an indicator for PAD
• High blood pressure (hypertension)
• High cholesterol (hyperlipidemia)
At EDS, our technologists perform the ultrasound testing right in your doctor's office, and a board certified reading physicians will interpret your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
Tired of hearing your Dr. say “On a scale from 1 to 10, where is your pain level”? Well this new diagnostic tool may help:
Researchers at Stanford University School of Medicine in Palo Alto, California are working on developing a diagnostic tool that will eliminate the need for your doctor to ask you “On a scale from one to ten, where is your pain level?”
wwww.medicalnewstoday.com
A new study shows a link between long-term painkiller usage and kidney cancer:
In a study published through the Archives of Internal Medicine has shown that long-term use of non-aspirin anti-inflammatory painkillers like Advil ® and Aleve® has been linked to kidney cancer:
www.medicinenet.com
Never underestimate the power of natural remedies:
It’s amazing what can be discovered; even things that may be living in your own backyard:
www.dailymail.co.uk
In Baltimore, Md. Sinai Hospital has implemented the use of the AccuVein AV300, an innovative device that will make drawing blood and inserting IVs less painful. The device is small lightweight and handheld that ‘paints’ veins in a high-visibility patter utilizing infrared light.
Sinai Hospital in Baltimore, Md. has begun using a new device that makes drawing blood & inserting IVs less painful:
www.medicalnewstoday.com
(Extra post) Andy Whitfield died Sunday in Sydney, Australia, 18 months after he was diagnosed with non-Hodgkin lymphoma
www.huffingtonpost.com
If you suffer from chronic pain this is a must read. Scientists may have found a gene that could be responsible for regulating chronic pain. Their focus is on the gene called HCN2 that is located at the pain-sensitive ends of the nerves:
There’s a gene that causes chronic pain?! Yes, you read that right:
www.ctv.ca
10 years, even 5 years ago, this would have been received with more
criticism but with last week's announcement that scientists have used a
harmless form of the HIV virus to treat and cure chronic lymphocytic
leukemia (CLL) the most common form of leukemia.
Link
The new school year is just around the corner...as is every parent's
nightmare of cold and flu season. Teaching our children to regularly wash
their hands is a great start! What are you doing to help your child stay
healthy this year?
If your doctor is wearing a necktie you should request they remove it.
Neckties can harbor germs from other patients as they are not cleaned on a
regular basis.
With new diseases and conditions being discovered all the time it is
important to visit your doctor not only when you are sick but also for an
annual checkup when you feel fine. When you're fighting off another sickness
your doctor may not see another existing condition.
Seemingly there seems to be an epidemic of women and men being diagnosed
with HPV the Human Papillomavirus. Get the real facts about this common STI
here: http://www.cdc.gov/std/hpv/stdfact-hpv.htm
May is National High Blood Pressure Education Month and this year's theme highlights the threat of uncontrolled Hypertension.
High blood pressure affects about 50 million--or one in four--American adults. Of those with hypertension, about 68 % are aware of their condition--but only 27 % have it under control. The reasons for this include not taking drugs as prescribed and/or not taking a medication that sufficiently lowers blood pressure.
Hypertension can lead to stroke, heart failure, or kidney damage. To help prevent that, blood pressure must be lowered to less than 140/90 mmHg (millimeters of mercury). Normal blood pressure is less than 130/less than 85 mmHg.
High blood pressure can cause ischemic heart disease. This means that the heart muscle isn't getting enough blood. Ischemic heart disease is usually the result of atherosclerosis or hardening of the arteries (coronary artery disease), which impedes the blood flow. This can progress to a heart attack.
An Echocardiogram is used to show a detailed moving picture of the heart. It is used to evaluate the functioning of the heart valves and chambers, assess heart pumping, and check for heart murmurs. An Echocardiogram is commonly used to check for heart disease and evaluate the heart functioning of people that have had heart attacks.
The lifestyle changes to control high blood pressure are: lose weight, if overweight; become physically active; choose foods lower in salt and sodium; and limit alcohol intake.
At EDS, our technologists perform the Echocardiogram testing right in your doctor's office, and board certified Cardiologists will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
April is National Foot Health Awareness Month! Your feet, like other specialized structures, require specialized care. A doctor of podiatric medicine can make an important contribution to your total health, whether it is regular preventive care or surgery to correct a deformity. In order to keep your feet healthy, you should be familiar with the most common ills that affect them. Remember, though, that self treatment can often turn a minor problem into a major one, and is generally not advisable. So, are you taking care of your feet? If you're experiencing any pain or discomfort, visit one of our podiatrists at Foot Healers before a small annoyance becomes a big problem.
Diagnostic ultrasound is an amazing advance in helping to diagnose foot problems! In the foot bone problems are easily seen with x-rays. But what about everything else that's under the skin and that's not bone? What about the muscles, ligaments, nerves and blood vessels? Now with specially designed ultrasound we can safely see those parts of the foot that we could only guess about before! Ultrasound is completely safe and painless. It also has no contraindications. There is no problem in having the examination if you are pregnant, have a pacemaker, or other medical conditions that may prevent you from having a MRI or CT scan. Ultrasound also does not produce any radiation as with a CT scan or X-ray.
If you or your doctor feels that you are at risk for any Foot problem, or if one or more of the risk factors apply to you, a simple ultrasound can help the doctor evaluate the condition of your Foot.
At EDS, our technologists perform the ultrasound testing right in your doctor's office, and board certified reading physicians will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665.
March is National Kidney Awareness Month! The kidneys are a pair of
bean-shaped organs located behind the upper abdominal cavity. The kidneys
remove wastes from the blood and produce urine. A pelvic ultrasound
evaluates the organs in the lower abdominal area. It is done to find the
cause of abdominal pain and blocked urine flow. A kidney ultrasound may also
find the size of kidneys, investigate causes of recurring tract infections,
detect kidney masses and detect fluid surrounding the kidneys. If you have
diabetes, high blood pressure, or a family history, you can be at risk of
kidney failure.
If you or your doctor feels that you are at risk for any kidney problem, or
if one or more of the risk factors apply to you, a simple ultrasound can
help the doctor evaluate the condition of your kidneys. At EDS, our
technologists perform the ultrasound testing right in your doctor's office
and board certified reading physicians will read your exam usually within 24
hours. For more information about Empire Diagnostic Solutions, call us at
347-715-4665.
The American Heart Association (www.americanheart.org) has designated February as heart health month. In America, the number one killer is cardiovascular diseases. The heart supplies blood and oxygen to all parts of the body. Cardiovascular disease is more life threatening if you have diabetes or are obese. Heart failure, heart attacks, strokes, hypertension and cardiac arrhythmia are just some of the cardiovascular diseases that could threaten your life. An Abdominal Aortic Aneurysm (AAA) is a blood filled bulge or ballooning of the abdominal aorta. This artery carries blood away from the heart and towards the lower part of your body. The bulge over time can become weak and eventually erupt. This can lead to severe pain, massive internal bleeding, or even sudden death. AAA is known as the silent killer because many people do not experience any symptoms. The risk of AAA increases if you are over the age of 60, a man, have a family history of AAA, smoke, have clogged arteries, high blood pressure, and high cholesterol.
If you or your doctor feel that you are at risk for a cardiovascular disease, or if one or more of these risk factors apply to you, a simple ultrasound can help the doctor evaluate the condition of your heart. At EDS, our technologists perform the ultrasound testing right in your doctor’s office and board certified reading physicians will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665, or visit our website at www.edslive.com.
In October of 2010, Empire Diagnostic Solutions (EDS) was awarded a three-year term of accreditation by the prestigious American College of Radiology (ACR). That achievement, together with its existing accreditations by the American Institute of Ultrasound in Medicine (AIUM) and the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL), allowed EDS to become the only mobile diagnostic company in the NY area, and one of a select few in the nation, to achieve such distinction.
Taking excellence and quality to an even higher level, EDS has now earned yet another accreditation award by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). In doing so, EDS has once again set the standard, raising the bar on mobile imaging quality to a level unmatched by anyone in the industry.
Echocardiography is a complex imaging technique that relies on the experience and training of both the physician and sonographer. Their interpretive and technical abilities determine the diagnostic accuracy of the echocardiogram examination. The ICAEL has developed an accreditation program which evaluates the quality of these and other critical elements of an echocardiography laboratory. With this accreditation, EDS is again recognized for its commitment to high quality patient care and its provision of quality diagnostic testing, this time in the field of echocardiography.
The ICAEL was established with support from the American Society of Echocardiography (ASE), the American College of Cardiology (ACC), and the Society of Pediatric Echocardiography (SOPE) to encourage and recognize the provision of quality echocardiographic diagnostic testing and is dedicated to promoting and ensuring high quality patient care.
For more information about Empire Diagnostic Solutions, call us at 347-715-4665, or visit our website at www.edslive.com.
The American Association of Clinical Endocrinologists (www.aace.com)has designated January as National Thyroid Awareness Month. The thyroid is a small gland in the neck that regulates and creates hormones which control growth and metabolism. A growth can appear on the thyroid and is not uncommon. A doctor may discover an abnormal growth by feeling it with their hands or it may be seen when looking in a mirror. These growths or “nodules” can be small simple fluid sacs called “cysts” or something more solid. You are more likely to develop a thyroid cyst if you are a woman, over the age of 40, or if one of your parents or siblings has a thyroid cyst. The majority of thyroid nodules are benign in nature.
If your doctor wishes to evaluate you for a possible thyroid nodule, or follow-up on an existing nodule, he or she will most likely order an ultrasound exam. Ultrasound is a safe, easy, and efficient way to accurately examine thyroid nodules in total comfort. At EDS, our technologists perform the ultrasound testing right in your doctor’s office and board certified reading physicians will read your exam usually within 24 hours. For more information about Empire Diagnostic Solutions, call us at 347-715-4665, or visit our website at www.edslive.com
Empire Diagnostic Solutions (EDS) has been awarded a three-year term of accreditation in ultrasound as the result of an extensive review by the American College of Radiology (ACR).
The ACR gold seal of accreditation represents the highest level of image quality and patient safety. It is awarded only to facilities meeting ACR Practice Guidelines and Technical Standards, following a peer-review evaluation by board-certified physicians and medical physicists who are experts in the field. Image quality, personnel qualifications, adequacy of facility equipment, quality control procedures, and quality assurance programs are assessed. The findings are reported to the ACR Committee on Accreditation, which subsequently provides the practice with a comprehensive report they can use for continuous practice improvement.
The ACR is a national professional organization serving more than 34,000 diagnostic/interventional radiologists, radiation oncologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of medical imaging and radiation oncology and the delivery of comprehensive health care services.
EDS has always stood alone as the only mobile ultrasound company in the NY area accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) and the American Institute of Ultrasound in Medicine (AIUM). Now with accreditation by the ACR, EDS has truly set a new standard and brought mobile imaging to a level previously reserved for the finest medical centers and stationary imaging facilities.
For more information about Empire Diagnostic Solutions, call us at 347-715-4665, or visit our website at www.edslive.com.
As part of the ICAVL's newly redesigned website which went live on Monday, August 16th, four ICAVL accredited laboratories were chosen from across the country to be used as ideal examples of proudly promoting the ICAVL accreditation logo. After an extensive review, EDS was chosen to be part of that elite group and is the only mobile diagnostic company listed.
EDS is honored and thrilled to receive this special recognition by the ICAVL, just as it has always been proud to display the ICAVL logo.
As reported by the Society for Vascular Ultrasound (SVU): On August 5th the "Consistency, Accuracy, Responsibility and Excellence (CARE) in Medical Imaging and Radiation Therapy Act of 2010" (S. 3737) was introduced in the Senate by Senator Mike Enzi (R-WY), Ranking Member of the Senate Health, Education, Labor and Pensions (HELP) Committee. The CARE Act of 2010 is supported by the Alliance for Quality Medical Imaging and Radiation Therapy, a coalition of 22 medical imaging and radiation therapy organizations, including SVU. The House version (HR 3652) now has 117 co-sponsors.
The CARE Act will improve patient safety and health care quality by advancing national uniform standards for medical imaging certification of technologists.
By setting national education and certification standards for technical personnel who perform and plan imaging examinations and radiation therapy treatments in the Medicare program, the CARE bill will help ensure that quality information is presented for diagnosis, and that interventional care or radiation therapy leads to curative treatment for patients. It also will reduce health care costs by reducing the number of imaging or radiation procedures that must be repeated due to improper positioning or poor technique.
The CARE Act is co-sponsored by Senators Tom Harkin (D-IA), Richard Burr (R-NC) and Al Franken (D-MN).
According to the bill, standards prescribed under the CARE Act will be waived for states that have already established their own medical imaging certification standards under state licensure legislation.
EDS has always taken the training and proficiency of our technical staff very seriously knowing that the quality of our entire company starts with them. That’s why we created a strict Quality Assurance Program which closely monitors all of the exams performed by EDS and quickly addresses any deficiencies. In addition, routine staff meetings and educational sessions, including clinical case presentations, enhance staff knowledge and help maintain the excellence of our technologists.
Thank you to all the Medical offices who took the time to respond to our survey. We couldn’t have been more pleased with the feedback. Your input has brought to our attention areas where we can improve and grow, while overall confirming that the company is on track in providing the optimal ultrasound services needed in your offices.
Our goal is to continue bringing you the utmost excellence in all your ultrasound needs. We are taking your suggestions and comments seriously, and will use the information to fuel our efforts in providing you the best service possible.
Due to the considerable and constructive responses, we would like to share some of the results of our survey.
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We are pleased to share the outcome of the survey with you and want to express our appreciation to those who responded. We will use the feedback to improve overall as a company and provide superior service to you and your patients. Thank you for choosing Empire Diagnostic Solutions for your ultrasound needs.
The Cleveland Plain Dealer (5/25, Zeltner) reported that "even a small increase in the plaque that can build up on artery walls in the heart leads to more heart attacks, bypass surgery, angioplasty, and deaths, according to a study" published in the Journal of the American College of Cardiology. Cleveland Clinic researchers "examined results from six Clinic-led trials that used...intravascular ultrasound (IVUS) to measure plaque buildup in the arteries of 4,317 patients with heart disease." The data indicated that "plaque growth of less than one percent over an 18 to 24 month period predicted poor outcomes for patients, said Dr. Steven Nissen, the Clinic's chief of cardiovascular medicine and an author on the paper."
At EDS, we specialize in the painless, noninvasive detection of arterial plaque utilizing state-of-the-art diagnostic equipment from one of the most trusted names in healthcare technology, General Electric. EDS is dedicated to providing lifesaving diagnostic services of the highest quality.
Empire Diagnostic Solutions is constantly working on improvement of our
services. Right now we’re working on reconstruction of our automated
information system. This will enable additional functions for doctors and
staff and will ensure the best quality service for our clients!
In order to facilitate such major project, we will have a specialist in
automated systems on board beginning October, 1st, 2010.
You can find out more information by following the link!
LCA and Information
On Monday, April 19th, 2010, Empire Diagnostic Solutions will provide gold-level support for the annual Kings County Podiatric Association’s membership meeting. This year’s gathering will be held at the four-star Lai Yuen restaurant on 4th Avenue in Brooklyn. All area podiatrists are invited to attend and enjoy good food with informative presentations geared towards helping to improve your practice.
Lai Yuen is located at 10033 4th Avenue, Brooklyn, NY 11209
(718) 567-2300
March 30, 2010 - As a member of the PAD Coalition and a respected facility accredited by the ICAVL, EDS has always strived to be a strong player in the fight against cardiovascular disease. The results of a new study, described in the following article from “Medscape Medical News—a professional news service of WebMD,” describe how one of the vital vascular tests offered by EDS, has now been shown to have even more valuable and life-saving effects.
Please see the full article below:
Abnormal ABI an indicator of cardiovascular events in low-risk elderly.
MARCH 19, 2010 | Deborah Brauser
From Medscape Medical News—a professional news service of WebMD.
Tampa, FL - An abnormal ankle-brachial index (ABI) can predict an increased risk for future cardiovascular events in elderly people with low to intermediate Framingham risk scores (FRS), according to results from a new study presented here at SIR 2010: the Society of Interventional Radiology's 35th annual scientific meeting.
"This simple inexpensive test provides another way to identify those who may be at risk for future heart attacks," said principal investigator Dr Tim Murphy (Brown University Alpert School of Medicine, Providence, RI) during his presentation.
"Any methods to improve identification of individuals who are otherwise not considered at high risk for heart attack, based on Framingham risk factors, would have a significant public-health impact," Murphy said in a press release. With the help of this test, "thousands of lives can possibly be saved."
Examining PEDAL data
Almost two-thirds of coronary episodes occur in individuals not known to be at high risk for these events, according to the presentation.
The ABI test is a noninvasive blood-pressure reading in the ankle used to screen for peripheral artery disease (PAD). "It is a direct measure of fatty plaque buildup in leg arteries and an indirect gauge of plaque accumulations throughout the entire cardiovascular system," explained Murphy.
Although previous studies have examined the link between high ABI and increased risk for MI, this is the first trial to look at this association in an older population not otherwise considered at high risk.
Murphy and his team examined data from the Population-Based Examinations to Determine Ankle-Brachial Index (PEDAL) study, a trial conducted at 23 sites across the US organized by Legs for Life, a free public-screening program.
A total of 822 people (69.7% female; 89.7% white; mean age 64 years) were enrolled in 2007 and 2008 and screened for PAD with an ABI test. None of the patients evaluated had known cardiovascular disease or diabetes.
The FRS was used to determine 10-year risk for coronary heart disease, based on low (<6%), intermediate (6%-19%), and high (>20%) classifications. An ABI of less than 0.9 and/or more than 1.4 in either leg was considered abnormal.
10% of otherwise low-risk individuals identified
Results at the end of the analysis showed a 14.2% prevalence of abnormal ABIs among the participants (95% CI 11.9%-16.8%).
A total of 256 of the individuals had a low FRS, 414 had an intermediate FRS, and 152 had a high FRS (31.1%, 50.4%, and 18.5%, respectively).
Of those with a low FRS, 11.3% also had abnormal ABIs, as did 12.8% of participants with an intermediate FRS.
"Overall, 10% of the PEDAL participants had abnormal ABIs but were otherwise at low to intermediate [risk according to FRS] and would not be considered for aggressive risk-factor management," reported Murphy.
He added: "I think most people don't appreciate that the traditional, accepted way to evaluate risk in people is not very sensitive and [identifies], at best, about a third of the people who are going to have heart attacks." In contrast, "the ABI is a risk-free, noninvasive test that can be easily used to identify people who have no prior history of any events.
"People know their blood pressure and know their cholesterol because they know it's important for risk prediction, but those don't do a great job [of predicting risk]. Maybe everyone should know their ABI as well, although we'll need to do more research before making that recommendation overall."
However, he noted that if people are older than 55 years with no known risk, "it would be nice to at least consider getting the test because one out of 10 of those individuals will be found to have PAD, which is known as a high risk [factor] for heart attacks."
When asked about test costs, Murphy estimated that it would average between $100 and $200 but is often considered part of a normal physical exam. "It is not currently reimbursed as an independent test [except] for high-risk patients, who were not part of our study, but free screenings are often held across the country."
Test should become widespread
"With this very simple test, [the investigators] were able to identify PAD in 11% to 12% of patients [in whom] you wouldn't expect to have any problems," said Dr John Lipman (Emory Adventist Hospital, Atlanta, GA).
"This is really exciting because now you're shifting the focus more to the preventive side," added Lipman, who was not involved with the study. "Can we now identify people earlier before there's increased morbidity and mortality and more expensive intervention? If so, maybe we can get them early on and get them into medical management—like tobacco cessation, behavior modification, better diet, etc—early enough that it would affect them downstream.
"I thought this was just an excellent study, and the ease and simplicity of the test makes it something that I believe will become widespread. Or at least it should," concluded Lipman.
In 2005, the passage of United States Senate Resolution 56 officially recognized March as Deep-Vein Thrombosis Awareness Month. The effort was spearheaded by Senate cosponsors
Arlen Specter (R-PA) and Byron Dorgan (D-ND) and moved to raise public awareness of deep-vein thrombosis (DVT)—a condition that affects up to two million Americans annually according to the American Heart Association. Among the many victims was NBC News Correspondent David Bloom. While covering the war in Iraq, Bloom was stricken with a fatal pulmonary embolism (PE), a complication of DVT. “DVT strikes millions unknowingly each year," Senator Specter said. “With this resolution, we hope to raise public awareness for DVT, a serious yet preventable condition, so that others, like David Bloom, will not suffer at its hand.”
About DVT
Deep-vein thrombosis (DVT) is a common but serious medical condition that occurs in approximately 2 million Americans each year. DVT occurs when a thrombus (blood clot) forms in one of the large veins, usually in the lower limbs, leading to either partially or completely blocked circulation. The condition may result in health complications, such as a pulmonary embolism (PE) and even death if not diagnosed and treated effectively.
Learn the risk factors, signs and symptoms for DVT
The symptoms of DVT may be subtle and difficult to detect. When DVT is spotted early and properly treated, the risk of complications is reduced. When left untreated, it may cause severe complications, some even fatal.
At Empire Diagnostic Solutions, we can detect DVT by doing venous ultrasound. If you require an emergency DVT evaluation please call our scheduling department. We can have a technician in your office within two hours.
To learn more about DVT and even take a risk assessment, visit the Coalition to Prevent DVT website at www.preventdvt.org.
EDS has demonstrated its commitment to providing a high level of patient care and quality testing for the diagnosis of vascular disease by achieving accreditation by the Intersocietal Commission for the Accreditation of Vascular Disease.
Empire Diagnostic Solutions is now one of the growing number of vascular laboratories in the United States to meet or exceed the ICAVL standards for noninvasive vascular testing. During the accreditation process, every aspect of the laboratory’s daily operation and practice with respect to patient care is assessed and reviewed. Successful accreditation demonstrates patient care practices of the highest quality.
Cardiovascular disease is the leading cause of death in the United States, costing $83.7 billion each year in health services, medications, and lost time from work due to disability. Stroke, an interruption of blood supply to the brain, is the third leading cause of death and disability in the US, with 500,000 new strokes occurring annually.
One American dies every 32 seconds from some sort of vascular disease and each year, 2 million Americans develop blood clots in the legs or “deep vein thrombosis (DVT)”.
Early detection of these life-threatening vascular diseases is possible through the use of noninvasive vascular testing performed by qualified vascular laboratories.
The ICAVL is a non-profit organization established with the support of eleven medical societies including the American College of Cardiology, the Society for Clinical Vascular Surgery, and the Society of Diagnostic Medical Sonographers.
As a testament to our commitment of providing diagnostic patient services of the highest quality, Empire Diagnostic Solutions has received accreditation from the American Institute of Ultrasound in Medicine.
The AIUM is an association designed and dedicated to promoting the safe and effective use of diagnostic ultrasound. The review for potential accreditation is a long and highly detailed process in which all aspects of diagnostic, workflow, and processing procedures are evaluated for unwavering quality.
Receiving accreditation means that EDS has met nationally recognized quality standards and has demonstrated consistent excellence in patient care. Effectively and safely meeting the needs of our referring physicians and patients has always been our number one priority. This latest achievement truly validates our efforts as we continue striving to provide services of unmatched quality.
As part of our goal and desire to continuously improve the quality and level of service we provide, we are pleased to announce the expansion of our testing services.
To further enhance the care you provide for your patients, we are now pleased to offer you Ambulatory 24-hour EEG Monitoring.
Recreating the conditions that might trigger a patient’s seizures or syncopal episodes is difficult in a hospital or office setting. Also, the limited time of a routine electroencephalogram (EEG) may not produce an accurate documentation of seizure activity.
The diagnostic advantages of Ambulatory EEG are well documented. There is no question that obtaining a recording over a prolonged period of time enhances the ability to capture an abnormality or event. Couple this with the advantage of collecting this information while the patient resides in his own environment, and the advantages increase tenfold.
Some of the indications include:
Known seizures, need to r/o breakthrough seizures.
Fainting/near-fainting workup.
Unexplained dizziness.
Changes in mental status, memory loss, dementia.
Unexplained disorders of memory and cognition.
Any reason when regular EEG is indicated and is not revealing.
You will receive more information including a complete list of diagnosis codes shortly. In addition, the most common diagnosis codes will also be added to your referral sheets for ease of ordering.
If you have any questions or concerns, please do not hesitate to call us.
Glenn Erckert RT, CT(R)
Director, Clinical Operations
s.landa@edslive.com
On September 10th, 2009, in cooperation with respected podiatric specialists Andrew Shapiro, DPM and Michael Barkin, DPM, Empire Diagnostic Solutions sponsored a meeting of the Nassau County Podiatric Association entitled, “Diagnostic Testing in Your Office,” where they explored the legalities and benefits of outsourced in-office testing. While indulging their palates with savory prime-aged steaks and an award-winning wine list at Burton & Doyle’s Steakhouse in Great Neck, NY, attendees were treated to an informative and motivational presentation featuring Board-Certified Radiologists, Daniel Beyda M.D. and Mehrad Golzad M.D., as well as medical-legal expert Mathew Levy, Esq.
A similar meeting was held on September 17th in cooperation with podiatric specialists Michael Dellacorte, DPM and Richard Belli, DPM at nearby Morton’s Steakhouse, for members of the Queens County Podiatric Medical Association. Both events had great turnouts and ended with many satisfied, informed, and motivated attendees.
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We’re Opening a New Long Island Location!
To improve our services and better serve our clients and patients, Empire Diagnostic Solutions is pleased to announce the opening of a second office facility on the South Shore of Long Island. The new office, scheduled to open August 1st, 2009, will have all of the image processing and data transfer resources of our main office, providing a more accessible and convenient hub for technologists serving physician accounts in that area. This will result is less travel and stress on our staff, more efficient use of our resources, and faster turnaround times for exam interpretation and reports.
The office is located at: 103 School Street, Lindenhurst NY, 11757.
As part of our goal and desire to continuously improve the quality and level of service we provide, we are pleased to announce the expansion of our testing services.
To further enhance the care you provide for your patients, we are now pleased to offer you Transcranial Doppler Ultrasound (TCD).
TCD allows frequent repeated measurements and continuous monitoring of intracranial vasculature. With it, immediate and real-time detection of changes in cerebrovascular hemodynamics is possible. It can be utilized by any medical specialty to evaluate several neurovascular disorders.
In many places a "complete" stroke workup consists of carotid Doppler and two-dimensional echocardiogram. Unfortunately, this approach misses the important evaluation of intracranial vasculature. A TCD can be the inexpensive, convenient, and simple means to determine which of these patients should be referred for further evaluation. TCD may also be the only mean possible to evaluate intracranial vessels in cases when other radiographic means are contraindicated.
Some of the indications in which TCD can be utilized are:
Vertigo
Syncope
Lack of coordination.
Occlusion and stenosis of carotid arteries.
Generalized ischemic cerebrovascular disease.
Evaluation of occlusive intracranial vascular lesions.
To be used an accurate and effective diagnostic tool, we request that TCD exams be always paired with Carotid Doppler examinations. Subsequently, you will see no diagnosis code choices under “Transcranial Doppler” on the EDS referral sheet. Selection of a diagnosis code under “Carotid Doppler” will also satisfy the TCD diagnosis code requirement.
If you have any questions or concerns, please do not hesitate to call us.
Glenn Erckert RT, CT(R)
Director, Clinical Operations
s.landa@edslive.com
