New state-of-the-art GE Revolution EVO 64-Slice CT scanners were recently installed at RAI’s Town Center Imaging and Twin Lakes Imaging. Revolution EVO allows RAI to provide higher resolution CT scans to referring physicians. Its Clarity Imaging System provides up to 100% better spatial resolution over previous GE CT scanners. In addition to making low dose radiation routine, it enables RAI to serve the widest variety of patients and applications in the industry. With more intelligence and automation from patient preparation through post processing, this state-of-the-art CT performs more studies in less time. GE Revolution EVO 64-slice CT scanners yield powerful, reliable, and accurate results.
Written by Stephen Sevigny, M.D.
Mammography is not just for Breast Cancer Awareness month or October as it was previously known. Throughout the year mammography saves lives in our community. One of the most common questions I receive is when to start and what kind do I need.
There are essentially two different types of mammograms performed, screening and diagnostic. A screening mammogram is for the routine detection of breast cancer, typically beginning when a woman turns 40 years old. Screening mammograms consist of 2 views of each breast, with or without 3D tomographic imaging. The patient receives results a few days later. Diagnostic mammograms are more involved with routine views and numerous special views for different indications. Often a diagnostic mammogram will include a diagnostic breast ultrasound to further investigate an area. Indications for a diagnostic exam include a palpable lump, focal breast abnormality or to further investigate an abnormal screening exam. The patient receives final results that day.
For decades, medical organizations were nearly unanimous in regards to the practice of screening mammography. Routine screening for the detection of breast cancer typically began at age 40 and continued yearly until it made medical sense to stop. Numerous studies proved a 15-29% reduction in breast cancer mortality for screening women in their 40’s and 50’s. As screen film mammography progressed to current digital mammography, the radiology community expects that number to increase. Now that 3D tomography technology has been added, the quality of mammographic screening has grown substantially.
However in 2009, the independent US Preventative Services Task Force (USPSTF) recommended biennial screening for women between the ages of 50 – 74, and to only begin before 50 after consulting with her physician. The USPSTF concluded that “screening seems equivalent for women aged 40-49 and 50-59 years” but screening the younger population caused increased anxiety, additional testing, and unnecessary biopsies. The same study recommended AGAINST teaching breast self-examination to women. Numerous organizations including the American College of Radiology (ACR) and Society of Breast Imaging were quick to point out numerous flaws in their recommendations. One main criticism of the USPSTF position is based on the “over” diagnosis of ductal carcinoma confined to the duct. It is clinically unknown how many of these would have progressed to invasive cancer and put the patient at systemic risk versus remaining within the duct. Of course to judge its biological activity it must be biopsied or removed AFTER its detection with mammography. I prefer the earliest detection to allow for earliest treatment. Improving patient anxiety levels is an important part of the mammography examination. Our technologists and staff work every day guiding patients through their tests and what they can expect both that day and afterwards.
The ACR and our practice continues to recommend yearly screening mammography beginning at age 40 unless clinically warranted earlier. If the patient is breast cancer gene positive, alternating a Breast MRI exam every six months with yearly screening 3D mammography is the current recommendation. An informed patient makes the best patient. Discuss your screening options with your physician. Currently the Affordable Care Act or “Obamacare” mandates screening mammographic coverage at age 40, at NO charge to the patient.
Note: This article appeared in The Daytona Beach News-Journal and was written by Stephen Sevigny, MD, Board Certified Radiologist.
Written by Stephen Sevigny, MD
Lung cancer is the third most common cancer among men and women and is the leading cause of cancer-related deaths. It currently accounts for nearly 27 percent of cancer deaths in total. Current estimates suggest that almost 7 percent of persons born today will be diagnosed with lung cancer in their lifetimes.
Seventy-five percent of patients with lung cancer present with symptoms due to incurable advanced local or metastatic disease. Such a common disease, which presents so late with such significant mortality, should leave itself amendable to a successful screening exam to allow for early detection, and hopefully, treatment.
Medicine has been in search of a lung cancer screening test for decades. Numerous studies had previously concentrated their efforts on chest radiographs, or chest X-rays (CXR), as they are commonly known. Unfortunately CXR’s proved to be too insensitive for lung cancer detection. Although successful in finding many cancers, the cancers found were often too advanced to change the patient’s prognosis and outcomes. Recently a new study, a low radiation dose CT scan of the lungs, has proven very successful in finding cancers early enough to allow for treatment and cure.
With any disease, prevention is the best cure. Eighty-five percent of lung cancers in the US are directly related to smoking and the risk continues even after the person stops smoking. Although the government has done its best job to educate the public to the harms of smoking, current estimates are that 20 percent of American adults still smoke.
In 2013, the US Preventative Task Force (USPTF) came out with a recommendation of low dose CT scans for the early detection of lung cancer. Numerous studies were accumulated and evaluated for patient benefit. Patients who received low dose screening CT scans showed a 20 percent decrease in lung cancer mortality. Based on collected study data, the USPTF suggested that low dose CT screening begin at age 55 and continue until age 80. Screening should be limited to patients who have a 30 pack-year smoking history and currently smoke, or patients who have smoked in the past 15 years. To calculate your pack-years, multiply the number of packs smoked per day times the number of years smoked. For example, 1.5 packs a day for 20 years would equal 30 pack-years.
Low dose CT scans can only be ordered by your doctor. Medicare and many insurance companies will now cover the costs of a low dose CT scan. For the patient to qualify, the patient needs to be asymptomatic, i.e. no symptoms of cancer; be between 55-77 years of age; and have the minimum of 30 pack-years. The scan requires no contrast typically found with many CT scans. The patient simply lies on a table and gets scanned during a 4-6 second breath hold. The study will then be read by a board-certified radiologist and results given to the patient’s doctor.
Tiny nodules may need to be followed up with a follow-up scan in six months.
In addition to lung cancer, the test may also detect other diseases such as atherosclerotic disease or other lung diseases. People who smoke are at higher risk for coronary artery disease, pulmonary fibrosis, and COPD.
Occasionally the test may detect benign entities that will need additional scans.
Note: This article appeared in The Daytona Beach News-Journal and was written by Stephen Sevigny, MD, Board Certified Radiologist.
Radiology Associates Imaging welcomes Jacqueline Bernard, MD, the newest physician to join our staff of highly qualified, board certified radiologists. She recently retired from a career with the US Navy, where she served as a staff radiologist at various U.S. Naval hospitals and was also the recipient of 6 Naval Commendation Medals. Dr. Bernard completed a fellowship in breast imaging, which complements RAI’s superior expertise in women’s healthcare.
Step up with Radiology Associates Imaging (RAI) in the fight against breast cancer during Breast Cancer Awareness Month 2016 for a fundraiser called “Real Men Wear Pink.” Roy Siragusa, M.D., President of RAI, and Medical Director of Palm Coast Imaging and Town Center Imaging, was selected to join Volusia County community leaders in raising awareness and funds by wearing pink throughout the month of October. The program, a brainchild of the American Cancer Society, seeks donations online. “Every day, the American Cancer Society helps people take steps to reduce their risk of breast cancer or find it early, when it’s small and easiest to treat,” said Siragusa. “They provide free information and services when and where people need it. They are funding groundbreaking research to find, prevent, and treat breast cancer, and are working to ensure access to
mammograms for women who need them.”
3D mammography is now being offered at our imaging centers listed below in St. Johns, Flagler and Volusia counties:
- St. Augustine Imaging
- Town Center Imaging, Palm Coast
- Twin Lakes Imaging, Daytona Beach
- Port Orange Imaging
Area women are now provided with this new, state-of-the-art tool for monitoring breast health. Its benefits include the following:
- A 3D view provides a clearer look at breast tissue that is computer generated from 24 layered images of breast tissue at different depths.
- Enhanced ability to find small, early-stage breast cancers when they are much easier to successfully treat.
- Fewer false positives, fewer callbacks for additional imaging, and fewer unnecessary biopsies.
- Especially beneficial to women with dense breast tissue, which makes cancer more difficult to detect in 2D mammograms.
3D mammograms are fully covered for Medicare patients. Coverage by other insurers may vary. For patients whose insurance reimburses only for the cost of a 2D mammogram, a nominal copay is charged.
The advanced early detection provided by a 3D mammogram could make a lifesaving difference by finding breast cancer earlier. If it’s time for your annual mammogram, please call (386) 274-6000 to schedule an appointment.
To learn more about our revolutionary new Genius™ 3D MAMMOGRAPHY™ exam, please visit myGenius3D.com
Dimension, Detection, Detail. St. Augustine Imaging Launches 3D Mammography for Early Detection of Breast Cancer – Which Means a Better Chance of a Cure for Area Women
St. Augustine, FL – St. Augustine Imaging, one of six imaging centers operated by RAI in East Central and Northeastern Florida, is the first provider in St. Johns County to offer 3D mammography. The radiology practice selected a Hologic Selenia Dimensions Genius 3D MAMMOGRAPHY™ system.
“Hologic was the first manufacturer to obtain FDA approval for 3D digital breast tomosynthesis, so we view them as the technology leader whose equipment was the best choice for area women,” said radiologist and St. Augustine Imaging Medical Director John E. Agles, M.D. “As the first provider to bring the benefits of 3D mammography to St. Johns County, we’re pleased to be partnering with Hologic.”
What are the benefits of 3D mammograms, and who should consider having a 3D mammogram at St. Augustine Imaging instead of a conventional two-dimensional (2D) mammogram?
“It’s easier to understand when you think of 3D as standing not only for ‘three dimensional’ but for three words that start with the letter D: dimension, detection, and detail,” Dr. Agles said.
“Conventional mammograms usually take four two-dimensional images of the breasts at different angles,” he said. “But a 3D mammogram takes 24 images of the breast tissue at different depths. A computer puts those pictures together, creating a three-dimensional image that lets us see inside the breast much more clearly. That makes us more confident when a mammogram appears normal and when we see abnormalities, which means fewer false positives, fewer callbacks for additional imaging, and fewer unnecessary biopsies. 3D mammograms also make the smallest abnormalities easier to find. That’s vitally important because, when a small abnormality proves to be early-stage cancer, it can be cured—the treatment success rate is virtually 100 percent. So 3D mammograms are beneficial to all women, but especially to those with dense breast tissue, which makes abnormalities harder to find in a conventional mammogram.”
Dr. Agles added that a 3D mammogram takes virtually the same amount of time to complete as a conventional 2D mammogram, and feels essentially the same to the patient.
Currently, 3D mammograms are fully covered for Medicare patients who are within Medicare guidelines for screening mammograms. However, not all private insurers have followed suit.
“I do expect that most insurers will eventually get on board with Medicare in covering 3D mammograms,” Dr. Agles said. “But for now, patients can expect variations depending on their insurance plan. In the meantime, we’re offering patients who are covered only for 2D mammograms the option of a 3D mammogram for a nominal copay. We hope that will help more women benefit from this latest advancement in early detection of breast cancer until private insurers update their coverage policies.”
The American College of Radiology (ACR) recognizes each of our 6 imaging centers as ACR Designated Lung Cancer Screening Centers. It signifies that the Radiology Associates Imaging (RAI) lung screening program and protocol meet requirements set forth by the ACR Committee on Lung Cancer Screening.
“We are able to detect lung cancer at its very early stages, which significantly improves the survival of
our patients,” said RAI President Roy Siragusa, MD.
The ACR Lung Cancer Screening Center designation is a voluntary program that recognizes facilities committed to practicing safe, effective diagnostic care for individuals at the highest risk for lung cancer. In order to receive this elite distinction, facilities must be accredited by the ACR in computed tomography (CT) in the chest module, as well as undergo a rigorous assessment of its lung cancer screening protocol and infrastructure. Also required are procedures in place for follow-up patient care, such as counseling/smoking cessation programs.
Lung cancer screening with low-dose CT scans and appropriate follow-up care significantly reduce lung cancer deaths, which total more each year than those related to breast, colon and prostate cancers combined. In December 2013, the United States Preventive Services Task Force recommended screening of adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit smoking within the past 15 years.
Did you know that the latest statistics from the American Cancer Society demonstrate a dramatic reduction in breast cancer deaths over the past 20 years?
The data shows that the death rate has declined by 34% between 1990 and 2011 (figure 1). This means that more than 200,000 deaths have been averted! This decrease is likely the result of greater awareness, better treatment, and improvements in mammography screening. We should all be very proud of this accomplishment and continue to improve awareness and promote breast cancer screening.
The research also shows us where there is room for improvement. Over the past 2 years, the percentage of women who should be having screening mammograms (women 40 years of age and older) has leveled off at approximately 67%. That means that about 1 in 3 women are not getting screening for cancer. The American Cancer Society data shows that these women who are not getting screened are more likely to be uninsured and less educated (figure 2). So spread the word and share this information with your friends and family. Hopefully, we will improve screening rates with better awareness.
Please note that this information and graphics are provided by the American Cancer Society and is copyrighted material. This information is from “Breast Cancer Facts & Figures 2013-2014.” For more information, please visit their
website at www.cancer.org.