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A Short History of Medical Imaging – Part Two

Continuing from our last post on the history of medical imaging…

Soon after x-rays were discovered, French scientist Henri Becquerel discovered naturally occurring radioactivity. He found, while investigating the properties of fluorescent minerals, that certain atoms self-disintegrated; he used photographic plates to record this fluorescence. When storing uranium with photographic plates in a closed drawer, he was shocked to later find they had been exposed by the uranium.

Becquerel’s discovery did not create much scientific interest, until the Curies discovered radium a couple of years later, in 1898. Radium was to become the initial gamma ray source (which would be commonly used in industrial radiography and for therapeutic purposes).

On May 9th, 1913, American physicist William Coolidge invented the hot cathode x-ray tube. It was known as the Coolidge Tube; it had an improved cathode which allowed for superior visualization of anatomy deep within the body, and also for better imaging of tumors. This was a major development in radiology; the basic design of Coolidge’s invention remains in use to this day.

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X-rays were used from the earliest times, not just for diagnostic purposes, but also for therapeutic concerns. Skin lesions were treated with some success, and deeper tissue conditions were soon treated with stronger x-ray apparatus and radium. While ionizing radiation is today of extreme value and importance in treating cancer and certain other conditions, one hundred years ago there was no understanding of the dangers posed by radiation – that discovery was yet to be made. Marie Curie actually worked to have radiography used to treat soldiers who were wounded during World War I.

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Curie Radium Therapy – Picture courtesy of www.aip.org

It was inevitable that indiscriminate exposure to ionizing radiation would be harmful in these early days. Some health implications were noted early; however there was no reason for experimenters to see the link between side effects and x-rays at that time. Symptoms like skin burns had a slow and gradual onset. The first real warning came from Thomas Edison, Nikola Tesla, and William Morton, who each experienced and reported eye irritation after experimenting with x-rays and fluorescent minerals. (We will later look in depth at the developments in radiation protection to the standards we have today).

In the early 1900s, many members of staff took x-ray images and used x-rays for therapy in hospitals – everyone from doctors, to physicists, nurses, engineers, and photographers. Prior to 1918, the word used for one who took x-rays was “skiagrapher” (from the ancient Greek words for “shadow” and “writer”).

(Thereafter, the term “radiographer” has been used; in the USA, these professionals are called “x-ray technicians”. The medical doctor who is specialized in the field is called a “Radiologist”).

Until the 1930s, doctors in hospitals used x-rays for both imaging and therapeutic purposes. From the mid-1930s, however, those who worked with radiation were appointed to a specific interest in either diagnosis or therapy.

Next time – Part Three – Medical imaging developments from 1950.

FAQ

How much will my exam cost?
Exam prices vary by procedure but you will be happy to know EPIC Imaging is one of the most cost effective centers in the region. Our pricing is consistently lower than every major hospital and other outpatient facilities. Our staff will gladly provide you with a cost overview of your specific exam prior to your study.

What insurance plans do you accept?
EPIC accepts virtually all insurance plans, however, we may not be preferred providers for all plans. Our billing and insurance personnel are available to assist you with any questions. Please call the center with the information on your insurance card. If we are not a preferred provider for your plan, we will match the in-network benefits of any plan the law allows.

Do you accept payment plans?
Yes. Our onsite financial counselors will be happy to discuss payment plans. EPIC also works with a financing company specializing in medical expenses.

How accurate is the equipment used?
EPIC Imaging maintains the most technologically advanced facilities in Oregon. All equipment is state-of-the-art and undergoes rigorous, daily quality control checks to yield the highest degree of accuracy. In addition, we conduct frequent and regular preventive maintenance checks. Many of our departments are individually accredited by the American College of Radiology. To achieve this accreditation, an ACR board of experts regularly reviews our images and monitors our quality control efforts.

What exactly does a radiologist do?
Radiologists are medical doctors who have chosen to specialize in the field of imaging for the diagnosis and treatment of disease. The most important task of the radiologist is to interpret the data from your procedure and combine that information with the clinical findings of your doctor. We commonly refer to this process as a “reading.” The goal of the reading is to provide your physician with a clearer picture of what is happening inside your body.

Do radiologists have special credentials?
Yes. All EPIC radiologists are board certified by the American Board of Radiology which means they have completed a radiology residency and examinations as well as maintaining ongoing educational programs. In addition many of our radiologists hold fellowships in subspecialties like neuroradiology, musculoskeletal imaging, abdominal imaging, women’s imaging, head and neck, etc.

Will the radiologist meet with me during my test?
Generally not. Your primary contact is most often with the technologist who administers your exam. It depends on the exam. Some require the direct supervision of a radiologist while others are performed completely by the technologist and reviewed afterwards by the radiologist. However, if you’d like to speak with the radiologist, we will make every effort to accommodate your request.

What is a technologist?
A technologist is a person specially trained to operate the diagnostic imaging equipment and to position patients to achieve the clearest images possible. While technologists are not medical doctors they do work closely with the radiologist reviewing patient histories, presenting histories and preliminary films to the radiologist and making sure all patients are as comfortable as possible.

Do technologists have special credentials?
Yes. EPIC employs only registered technologists who specialize in a particular area (or modality) such as MRI, Mammography, Ultrasound, CT, etc.

Will I know the results of my exam before I leave?
Generally not. Your results are forwarded to your physicians within 24 hours. It is very important for your physician to compare our conclusions with his or her clinical findings in order to present you with a complete diagnosis.
The exception to this is routine mammogram screenings. If you are having a mammogram and want to know your results before leaving, please let us know.

Can my study go to more than one physician for review?
Absolutely. We respect the desire of patients to seek second opinions in their care. Simply call our Medical Records department with the name and address of the physician.

EPIC Imaging

Combining all major medical imaging technologies with compassionate and professional staff makes EPIC Portland’s leading outpatient practice.

Unlike many other facilities in the area, EPIC is independently owned. The doctors who refer to us have absolutely no financial interest or ownership in our center and do not profit by referring you to us for care. Exam costs at EPIC are also consistently lower than area hospitals and other imaging centers.

We offer all the major imaging technologies at EPIC Imaging. This provides our patients with the unique ability to move immediately from one technology to another if diagnosis would be better served with a different procedure or if one test reveals the need for a more targeted study.

Our Patient Services are built upon the principle that each of our patients is an individual with unique needs and concerns.

  • You can expect to be treated with respect and courtesy.
  • You can expect a clear explanation of your exam.
  • You can expect to have your concerns and questions thoroughly addressed with patience and compassion.

We want to be your partner in health care and we take that trust seriously. Our staff is available by phone throughout working hours to answer any procedural questions you might have before your visit. Translators are available for Russian and Spanish speaking patients. Insurance and billing specialists are on staff to help you with financial issues. Our medical records staff will be happy to track down films done at other facilities for comparison with your exam at EPIC.

If you have a unique need let us know. Whether it be a specific scheduling request by your doctor’s office or simply getting help from your car to the center, our staff is ready to make all the necessary arrangements prior to your visit. We know that diagnostic tests can be very stressful and we want to make very sure everything is done to make you comfortable. If you have had a bad experience with a test in the past, please tell your technologist. Don’t hesitate to ask questions and take advantage of our online resources like exam preparations, frequently asked questions and pre-registration.

EPIC Imaging is a family of outpatient centers whose only focus is diagnostic imaging. We understand your needs and the needs of your physician. Your care does not stop when you leave the center. We will deliver your images and report directly to your physician in time for your next appointment as well as any other physician or specialist involved in your care. There is always a radiologist on the premises to consult with your doctor or answer any questions that may arise from your test.

MRI

MRI Defined
Magnetic Resonance Imaging, commonly referred to as MRI, provides a remarkable window to the body’s internal structures. It has become an invaluable diagnostic tool replacing many invasive surgical procedures. Unlike other techniques, MRI does not use radiation. It combines a powerful magnetic field, radio frequency pulses and a computer to generate highly detailed images of soft tissue structures near and around bones, blood vessels, organs and the brain.

All MRI machines produce images as a result of the interaction between a strong magnetic field, the behavior of water molecules in the human body when exposed to this field and radio waves, but not all MRI scanners are the same. Generally what makes one machine different from another is the strength of the magnet. This strength is measured in a unit called teslas. The stronger the tesla strength, the better the image and the faster the exam.

Today, a number of different MRI scanner types are in use. The difference between them revolves around magnet strength and the configuration of the bore (or tunnel). Technological advances continue to open possibilities for machine refinement. Each scanner type serves a definite purpose in imaging. The EPIC Imaging family of centers maintains all important scanner types. Our 1.5 Tesla and 3 Tesla scanners feature large, roomy short bores. No long tunnel scanners are in use at our centers. We also feature a fully OPEN MRI. Our highly skilled staff is always on call to help you and your physician determine which scanner type is most appropriate for your diagnostic need.

At EPIC, MRI is used to examine such diverse things as:

  • Spinal and joint problems
  • Small tears to tendons and ligaments
  • Sports injuries
  • Work-related disorders from repeated strain
  • Arthritis
  • Stroke
  • Reproductive organs
  • Organs of the chest and abdomen

How MRI Works
The human body is made up predominantly of water or H2O. MRI is based on the behavior hydrogen protons (the H in H2O) exhibit when subjected to radio waves within a magnetic field. The magnetic field of an MRI scanner causes the randomly positioned hydrogen protons of the human body to align and spin in the same direction. The machine then directs a radio frequency pulse toward the area of the body being examined. The pulse causes the protons to spin in a slightly different direction while simultaneously absorbing some of the energy from the pulse. The protons gradually release this absorbed energy which is measured by the MR machine and mathematically reconstructed on a computer to form highly detailed images.

MRI gives us minutely thin, cross-sectional views or “slices” of anatomic structure seen in a variety of planes. And because of its unique principles, magnetic resonance imaging has the ability to be tailored to answer specific diagnostic questions. The technology is capable of revealing even the most subtle differences in body tissues.

X-ray

X-Ray Exam Overview
X-ray technology today is more commonly referred as general radiography. It uses a controlled beam of energy to produce digital images of the body’s internal structures. It is commonly used to assess broken bones, bone health, pneumonia or other lung ailments, joint space ailments and to locate foreign bodies.

There are no required preparations for general x-ray exams.

The Procedure

General radiography exams usually take between 10 to 30 minutes depending on the type of procedure ordered by your physician. You may be asked to change into a gown if this would help us to obtain a detailed image free from metal snaps, zippers, jewelry or other items that might prevent a clear picture. A safe, controlled beam of energy will be passed through the area being examined. Because our bones, organs and tissues are composed of differing densities, x-ray beams move differently through them. Bones for instance will absorb more of the beam than an organ or soft tissue making them appear white or gray on x-ray image while tissue appears darker.

After the Exam

There are no restrictions following an x-ray and you can return to work or normal activity immediately. Your images will be reviewed and interpreted by one of our staff radiologists. Any previous studies are compared against your new exam and the results are sent directly to your physician. Our goal is to provide your physician with a report within 24 hours of the examination. Having all your outside films at the time of your exam helps ensure your results within that time frame.

The actual results of your exam will be given to you by your doctor who will compare your test results against his or her own clinical findings to provide you with a clear picture of your overall health.

Upper GI

Upper GI Exam Overview
An Upper GI exam is a digital fluoroscopy (x-ray) procedure that evaluates the structure and function of the upper portion of the digestive system. It is commonly used for the diagnosis and assessment of stomach ulcers, difficulty swallowing, stomach pain or heartburn and unexplained vomiting.

The preparations for an Upper GI are very important and must be followed exactly to ensure that your exam is accurate.

  • Please do not eat, drink, smoke or chew gum after 10:00 p.m. the evening prior to your exam.
  • If you have a prescribed medication that needs to be taken in the morning or are diabetic, please let our scheduling staff know so that we may accommodate you with the earliest possible appointment time.

The Procedure

The procedure takes from 15-30 minutes to complete. You will be asked to change into a gown and to remove jewelry or other items that could obstruct a clear view from your mouth to your stomach. Your technologist will ask a series of questions about why you are having the exam. This background information provides very important historical reference to the radiologist who will be supervising your procedure and later interpreting your exam. If there is any possibility that you are pregnant, please be sure to tell your technologist.

While standing next to a movable table, you will be asked to drink barium from a cup. Barium is a radio-opaque liquid that provides a white appearance on x-rays. The radiologist is able to view the barium as it moves down your esophagus and into your stomach providing a real-time view of the function of your upper digestive tract. You will be asked to turn several times and the table may be reclined to coat the stomach and obtain different views.

The procedure should not be uncomfortable for you. The barium used for an Upper GI is lightly flavored to make it more palatable.

After the Exam

There are no side effects to the procedure and you can return to work or normal activity immediately. It is important to drink extra fluids over the next several days to flush your system of the barium.
Your images will be reviewed and interpreted by one of our staff radiologists. Any previous studies are compared against your new exam and the results are sent directly to your physician. Our goal is to provide your physician with a report within 24 hours of the examination. Having all your outside films at the time of your exam helps ensure your results within that time frame.

The actual results of your exam will be given to you by your doctor who will compare your test results against his or her own clinical findings to provide you with a clear picture of your overall health.

Ultrasound-Vascular

Vascular Ultrasound Exam Overview
Vascular Ultrasound is a safe and painless diagnostic procedure that uses high frequency sound waves to evaluate the circulatory system. It is non-invasive and no radiation is involved. Vascular ultrasound in commonly used to diagnose blocked arteries and veins.

You may prefer to wear loose, comfortable two-piece clothing for your exam. Otherwise, there is no preparation necessary for a vascular ultrasound.

The Procedure

Ultrasound procedure times vary with the particular area of interest, but usually take between 30 to 60 minutes. For some exams, you will be asked to change into a gown and recline on a padded table. The technologist will use some pre-warmed gel on your skin to create an area for optimal contact with the transducer, a wand-like piece of equipment that emits the sound waves. The technologist will firmly press the transducer against your skin and will move it back and forth to create very detailed images. These images will be displayed immediately on a monitor and you may hear “whooshing” sounds as blood flow is measured with the Doppler equipment. Your technologist will selectively capture images for review by the radiologist.

After the Exam

There are no side effects to the procedure and you may return to work or normal activity immediately. Your images will be reviewed and interpreted by one of our staff radiologists. Any previous studies are compared against your new exam and the results are sent directly to your physician. Our goal is to provide your physician with a report within 24 hours of the examination. Having all your outside images at the time of your exam helps ensure your results within that time frame.

The actual results of your exam will be given to you by your doctor who will compare your test results against his or her own clinical findings to provide you with a clear picture of your overall health.

Ultrasound-Obstetrical

OB Ultrasound Exam Overview
Ultrasound is a safe, painless diagnostic procedure that uses high frequency sound waves to
examine the fetus during pregnancy. Because no radiation is involved, it has become a particularly invaluable tool in obstetrics to confirm early pregnancy, check for heartbeat, evaluate baby’s overall health, confirm baby’s age and size, document multiple pregnancies and assess the placenta and amniotic fluid.

Since the sound waves used in ultrasound travel through fluids much more easily than through tissue or air, a full bladder becomes a “window” for more clearly viewing your baby and the internal structures that surround it.

  • If you are less than 30 weeks pregnant, you must drink 32 ounces of water one hour prior to your scheduled exam. Give yourself enough time so that you are finished with the full 32 ounces one hour before your exam time. Remember, once you begin drinking you must not go to the bathroom until your exam is completed.
  • If you are already 30 or more weeks pregnant, follow the same instructions above but you may cut your water volume to 16 ounces.
  • Wear a loose fitting, two-piece outfit for your exam since only the lower abdomen needs to be exposed during the procedure.

The Procedure

Ultrasound is a simple non-invasive technology that uses the same echo-locating principles of sonar technology employed for decades by ships at sea. No radiation is involved. Instead, sound waves move through the mother and baby’s tissues, creating echoes that bounce back and are recorded. These echoes are used to create images in real-time on a television-like monitor.

Obstetrical ultrasound exams usually take between 30 to 60 minutes, depending on the age of the fetus and the type of exam requested by your physician. Your technologist will ask several questions about your medical history that will provide important information for the radiologist interpreting your exam.

You will be asked to lie on a padded table. The technologist will use some pre-warmed gel on your skin. A wand-like piece of equipment that emits the sound waves (called a transducer) is then moved back and forth over your stomach to create very detailed images of your baby. These images will be visible on a monitor and are selectively sent to the radiologist for review.

Occasionally, it is necessary to acquire a higher level of detail in the images. This is achieved through a transvaginal scan. This is performed much like a gynecologic exam. You’ll be allowed to empty your bladder and a specially designed transducer is placed in the vagina. The closer proximity to the uterus reduces the distance the sound waves need to travel increasing the level of detail on the images. Other than a small amount of pressure, this procedure should not be uncomfortable.

After the Exam

There are no side effects to the procedure and you may return to work or normal activity immediately. Your images will be reviewed and interpreted by one of our staff radiologists. Any previous studies are compared against your new exam and the results are sent directly to your physician or healthcare provider.

Ultrasound-General

General Ultrasound Exam Overview
Ultrasound is a safe and painless diagnostic procedure that uses high frequency sound waves to produce very detailed images of the soft-tissue structures, vessels and organs of the body. No radiation is involved. Ultrasound is commonly used to evaluate abdominal and pelvic pain, abnormal bleeding, liver disorders, gallstones, breast abnormalities, testicular pain or swelling, blocked veins and arteries and pregnancy.

The preparations for ultrasound exams vary with the type of test ordered by your doctor. Although a large number of exams don’t require any special preparation, those with particular instructions include:

  • Abdominal Ultrasound: Please do not eat, drink or chew gum after 10:00 p.m. the evening prior to your exam. Since the sound waves used in ultrasound do not penetrate air, it is important that you avoid the possibility of introducing air or gas into your stomach or bowel by eating or drinking.
  • Gallbladder: Please follow the prep for Abdominal Ultrasound above.
  • Pelvis: Please drink 32 ounces of water or other fluids one hour prior to your scheduled exam and do not urinate until the exam is complete. Since the sound waves used in ultrasound travel through fluids much more easily than through tissue or air, a full bladder becomes a “window” for more clearly viewing structures within the pelvis.
  • Obstetrical: Please see OB ultrasound exam preparations.
  • Other: No specific preparation is necessary for other ultrasound procedures.

The Procedure

Ultrasound procedure times vary, but usually take from between 30 to 60 minutes. For most exams, you will be asked to change into a gown and recline on a padded table. The technologist will use some pre-warmed gel on your skin to create an area for optimal contact with the transducer, a wand-like piece of equipment that emits the sound waves. The technologist will move the transducer back and forth over multiple areas to create very detailed cross-sectional, and in some cases, real-time images.

After the Exam

There are no side effects to the procedure and you may return to work or normal activity immediately. Your images will be reviewed and interpreted by one of our staff radiologists. Any previous studies are compared against your new exam and the results are sent directly to your physician. Our goal is to provide your physician with a report within 24 hours of the examination. Having all your outside images at the time of your exam helps ensure your results within that time frame.

The actual results of your exam will be given to you by your doctor who will compare your test results against his or her own clinical findings to provide you with a clear picture of your overall health.

Sonohysterogram

Sonohysterogram Exam Overview
A Sonohysterogram is an ultrasound procedure used to examine the inner wall of the uterus. It is commonly used to check for fibroids or polyps and to assess the thickness of the endometrium.

It is best if you schedule your procedure 6-10 days from the beginning of your menstrual cycle. Your exam will be performed using ultrasound which produces images by passing high frequency sound waves through the body. You must drink at least a quart of water, one hour prior to your coming to the center. Because sound waves travel through fluids much more easily than through tissue or air, a full bladder becomes a window to view the internal structures. We want your bladder to be fully extended for the first portion of the exam. You may not use the restroom until you have been directed to do so by one of our staff members. Our staff will be available for questions regarding your preparation if you need further assistance.

The Procedure

This examination will require an hour to complete. You will be asked to change into a gown. Your technologist will ask several questions about your medical history that will provide important information for the radiologist.

The first part of your examination will be an ultrasound of your pelvic area. The technologist will use some pre-warmed gel on your skin to create optimal contact with the transducer, the wand-like piece of equipment that emits the sound waves used in ultrasound. The technologist will be looking specifically at the uterus. Often they will take pictures during the scanning. Once this portion of the examination is complete, you will be asked to empty your bladder.

Next, the technologist will perform a trans-vaginal scan. This scan is done with a specially designed transducer that is inserted in the vagina. The closer proximity to the uterus reduces the distance the sound waves need to travel and produces clearer pictures.

The second part of the examination is done under a radiologist’s supervision. The radiologist will use a speculum just as your physician does to better visualize internal structures. They will insert a very small tube through the cervix and into the uterus. A small amount of water solution is then injected. This fluid is visible by ultrasound. The radiologist will take measurements of any fibroid or polyp structures that may be outlined after the injection. During the examination you may feel cramping similar to that of a menstrual cycle.

After the Exam

Some women experience some abdominal discomfort after the examination. This may last several hours but for the most part is gone by the time you leave. Patients may also experience spotting after the procedure. It is reasonable to assume that after the exam you can resume normal activity but if you are concerned, perhaps it would be best to schedule time off once the exam is done. Sonohysterogram examinations have minimum complications. In the rare event that you experience a prolonged period of pain or discharge, or a sudden onset of fever it is important to contact you physician for follow up care instruction.