Jennifer L. Benjamin

I suppose anything used incorrectly can cause pain. If you were receiving a high frequency sequence it could cause heating of tissue that might hurt. But in general the usual sequences used for diagnostic MR do not cause pain.

No

It depends on what nerve up are trying to see. The spinal cord is easily visible and parts of cranial nerves are visible on MR imaging usually. The strength of the magnet also determines what can be seen. A 3 Tesla magnet is better than 1.5T. Smaller nerves are difficult to see.

A shadow just means that the sound waves were reflected. Many things can cause shadowing, such as calcifications, air and very dense tissue or masses. You need a CT of the abdomen (and pelvis) with and without contrast and with delayed post contrast images (aka triple phase liver study)to best understand what is truly causing the shadowing on ultrasound. MRI may also be helpful for clarification if there is some question after doing the CT. However, CT is the best next step. MR is not better. It’s supplemental if a question remains after CT.

Yes, there is a tremendous difference in image quality. Closed MR image quality is superior. The stronger the magnet strength, the better the image quality. 3Tesla closed magnet is best. Get a prescription of Xanax and give him a dose of Benedryl to manage the claustrophobia.

Yes. Sometimes fibroids are treated with embolization of the vascular supply by an interventional radiologist.

Let the educated professionals order the correct test. You have a good doctor who knows what she is doing based on what little you have said in your question. There is no perfect test that finds every cancer. However, there is a methodical way of going about finding breast cancer that gives you the best chance of finding it. To do things in the wrong order puts you at risk for unnecessary biopsy. Mammography is the first step.

Ultrasound is good for looking at some things (determining if something is cystic (usually benign) or solid (higher risk for cancer) but ultrasound is not good at finding cancer as an initial test. It can miss a lot. If a lump is detected on a mammogram ultrasound can then determine if it is at risk for being cancer. However, a lot of densities that aren’t cancer may look similar under ultrasound. You wouldn’t want to chase every density on ultrasound unless it had a corresponding worrisome characteristic on a mammogram. You’d be biopsied unnecessarily. That is no picnic and not good practice. Additionally, ultrasound can miss cancers that present as a cluster of micro calcifications. For many reasons, ultrasound is a suboptimal screening tool for breast cancer.

MR can be used for screening if you are in a high risk category but it is not a good screening tool for a large group of woman at low risk for breast cancer. It is costly, may find false positives that are then biopsied unnecessarily.

There is no perfect test but you can select the best test for you based on your history. It sounds like your doctor has made good decisions on your behalf so far. Many health decisions you can and should make for yourself like diet, exercise and supplements. You should definitely discuss things with your doctor if you have questions, but LISTEN to their recommendations. Physicians dedicate years of their lives studying how to best help people preserve and manage health. Most physicians do not take that responsibility lightly. Sounds like yours is a keeper.

It’s possible but unlikely that contract would cause headaches. IV Contrast should clear from your system in 48 hour the very latest. (Unless you are on dialysis.)

Depends on where you are having it done. I would avoid having an X-ray done in a doctor’s office or Chiropracter’s office. Hospitals or imaging centers are better choices. They are more regulated than a small office and must adhere to strict safety guidelines. Offices are supposed to but the oversight may be lax.

No dose of radiation is considered “safe” since we don’t ever know which interaction will damage a cell irreparably. However, we live on planet earth and are bombarded by radiation from the sun daily. Do you fly in airplanes? You can get the equivalent dose to a chest X-ray every time you fly a few hours. Will you get cancer from it? Probably not. But no one can say for sure.

The dose of radiation to the ankle will be minimal. Not something to worry about if there is appropriate benefit of gaining medical information. However, if you are looking for soft tissue injury, an X-ray radiograph cannot tell you much in that regard. It is excellent for evaluating bones and seeing fractures. For soft tissue pathology MRI is far better. I hope that helps.

Chest CT may be helpful. Echocardiogram may also be helpful.

A radiologist specializing in mammography interprets mammograms, ultrasounds and MR of the Breast. They also do biopsies or sampling of tissue suspicious for malignancy. (There are different kinds of sub specialties in radiology- for example, I sub specialize in Neuroradiology and trauma radiology/ emergency imaging.) A radiologist with subspecialty training in breast imaging is also called a mammographer. There are also general radiologists who usually practice in smaller hospitals where they have to do a little bit of everything. Sub specialists, such as mammographers, only practice their subspecialty and nothing else. They are experts and are usually found in large tertiary care hospitals, where there is enough volume for them to fill their schedule, typically at universities or the Cleveland Clinic for example.

An oncologist decides what treatment is appropriate for patients with breast cancer. There are different types of treatment. An oncologist will help determine what treatment is best based on the type of cancer and what kinds of treatments are available in your community. You may want to explore options at other institutions if you are not happy with the options provided. You should be aware that there are oncologists that specialize in radiation treatment. But you will usually not see that doctor first. A radiation oncologist is not a “radiologist” though, even though they plan the dose of radiation therapy. The terminology can be confusing.

Your wife may have been referred to a radiation oncologist by the primary oncologist. He will typically work with a radiation oncologist and a breast surgeon. The primary oncologist will decide the course of treatment and what options are best (Chemo and/or radiation and/or surgery and or clinical trials.) You should ask the oncologist about what treatment options are best for your wife. I hope that helps. Good luck to you both.
Dr. Jennifer Benjamin

You should see a headache specialist. A CT scan and/ or MRI can determine if you have a mass or intracranial hemorrhage (bleeding) which can cause headaches. If those find no cause, then You may never find the cause. You should try Botox if you haven’t already.

A picture is worth a thousand words. You should Google chest CT and chest X-ray. You can see the difference. A chest X-ray projects radiation through your body to be captured by a film on the opposite side of your body. Whatever doesn’t make it, essentially leaves a shadow of your bones and organs. Some pathology can easily be demonstrated, some cannot.

A CT scan circles around your body and similarly captures the radiation that passes through, but it does so with greater capacity and detail. Allowing for more detailed imagery of the density of the different substances in your body. The “computed” part of “computed tomography” or “CT” computes or assembles the data collected into an image with greater detail than a single dimension chest X-ray. Also, the images acquired can be “windowed” to optimize the viewing of lung tissue, soft organs or bone to be more sensitive to pathology. The level of detail visible with a CT scan is much greater than that of a chest X-ray. Sometimes there is a hint of pathology on a chest X-ray that is better demonstrated on a more detailed CT scan. The reports for a CT will therefore be more detailed than for an X-ray since more of your body is demonstrated.

I hope that helps.

A radiologist is a human being, and as such is imperfect, and it is possible for a person to make a mistake. However, a radiologist is a person who cares so much about helping other human beings that they invest a great deal of time in learning their profession. Specifically, 4 years of college, 4 years of medical school, 1 year of internship, 4 years of radiology residency and then, if they subspecialize, another one or depending on the sub specialty (like Neuroradiology) two years of fellowship training. Radiologists are hyper focused on noticing every detail of your imaging study so as not to miss anything. It is our greatest fear, to miss a finding. However, depending on the environment where you get your care, a radiologist may be compromised by being asked to read your study in the middle of the night when they are exhausted. Or they may be asked to read such a high volume of cases that they must move very quickly - sometimes too quickly through studies.

If you have ANY question about your study, I’d encourage you to get a copy and take it to be read by another radiologist at another facility for a second opinion. You are entitled to do this.

Dr. Jennifer Benjamin

There is nothing you need to do unless you are having a CT colonoscopy. However, you would have already been given instructions for cleanout and prep for that.

An X-ray will give you no indication of kidney function. The creatinine and glomerular filtration rate (gfr) are best indicators of renal function. At 5.5 your mother is in acute, if not chronic, kidney failure. Dialysis should be discussed sooner rather than later.

Yes, an X-ray can detect some cancers. CT is better for screening high risk patients. PET-CT is best for known nodules larger than 8mm, as PET imaging detects metabolic activity, which is usually increased in cancer. If that is positive, then a biopsy may be appropriate to determine the specific type of cancer you are dealing with so the best treatment can be selected.

You can’t. Cancer cells are in everyone’s body. It’s your body’s ability to keep the overgrowth in check that keeps you well. Once you have one cancer you are at risk to form other types. The best thing you can do is alter your diet, reduce sugar, reduce meat, increase plant based foods, meditate and stay vigilant about changes. Go for your regular check ups. Think positively. Enjoy your life. Cancer is not a death sentence, just a disease to be managed. Educate yourself about proton therapy if you haven’t already, just in case....

No. Open MRI does not produce the same quality images. The images may be adequate to diagnose some pathology but generally the images are not as good as a standard MR. Magnetic Field inhomogeneities are greater with open MRI, degrading image quality. You’d have to study and understand the physics of magnetic resonance to understand why you’d want to reduce field inhomogeneities. Suffice it to say the fewer the better. A standard bore (donut) magnet reduces field inhomogeneities

There are different levels of image quality. You may not need the best to identify disc bulges which are easy to see. However, if you are looking for subtle nerve abnormalities you are going to want to generate the finest quality images with the ability to see great detail. Open MRs generate the lowest quality images. A 1.5 T (“T” stands for “Tesla” which is a unit of measurement that identifies the strength of the magnet) is better . A 3T magnet generates better quality images than a 1.5 T and a 7T magnet - usually only available in research facilities -gives even better image quality. 3T is the best commonly available. Open MR is designed for the claustrophobic- not best image quality though.

There is no amount of radiation that is “safe.” However, sometimes the benefits of gaining information about your condition outweigh the risks of a small dose of radiation - I think it would be important to know how displaced your broken bones may be. The most risky time for radiation during pregnancy is in the first 12 weeks when the fetus is still forming organs. At 6 months of pregnancy, all organs are formed and the fetus is just adding mass. Since I don’t know how bad your fracture is, it’s hard to say whether it is necessary. It is advisable to have a discussion with the doctor who is ordering it. If you don’t like the answers, talk with another physician until you feel comfortable.