A Blog for Healthcare Consumers

X-rays are frequently used to evaluate the bones of the shoulder. If you've injured your shoulder, have chronic shoulder pain, or are going to have shoulder surgery, your doctor will probably order an x-ray. On your doctor's order for the X-ray you might see:

"r/o fracture" -  a fracture is a break in the bone.

"r/o tendinitis"- tendinitis refers to inflammation or injury to the ligaments and tendons around your shoulder.

"r/o djd" - djd is short for degenerative joint disease. It is a generic term that is used to describe bone spurs, joint narrowing, etc.

(FYI - "r/o" is short for "rule out")

An X-ray  of the shoulder will evaluate:

Bones

A shoulder X-ray will include the shoulder joint which includes the humerus bone, scapula, and the clavicle. Parts of the chest are also seen in a shoulder x-ray. An x-ray can detect bone fractures, tumors, infection and evaluate post-surgical changes. The x-ray can also determine the extent of degenerative changes (arthritis) and be used for pre-operative planning for surgery.

Soft Tissues

X-rays are not very good at evaluating the soft tissues around your shoulder in detail. For example an x-ray will not be able to look at the tendons and ligaments that make up the rotator cuff. However, it can pick up indirect signs of tendon injury such as calcium deposits.

Your Shoulder X-ray

A shoulder X-ray generally takes about 5-10 minutes or so to complete. You'll probably be asked to change into a gown. If you are going for one, wear loose comfortable clothing and remember to remove all metal near your shoulder (eg necklaces) before going into the X-ray room.  Shoulder x-rays may include views which require you to move your arm. X-rays do not require preauthorization from your insurance company but you do need a valid doctor's prescription.

Have you had a Shoulder X-ray? What was it like? Please leave your comments below.

CT scans are frequently used to evaluate the temporal bones.  Temporal bone CTs, also known as mastoid bone CTs are typically ordered to evaluate the outer ear, bones of the ear and inner ear structures for infection, tumor, injury or congenital or acquired hearing disorders.  Below are a few common diagnoses that a CT scan of the temporal bones detect.

Mastoiditis - This is an infection of the air filled parts of the temporal bone, located just behind your ear. The infection can be aggressive and erode the bone. Symptoms include dizziness, hearing loss, and pain for example. In extreme cases the infection can extend to the nearby brain. This can cause seizures.

Tumors - Tumors can be from the temporal bone itself or arise in and around the ear structures. These tumors can be either benign or malignant. Some tumors that affect this area include basal cell carcinoma, cholesteotomas, schwannomas, neuromas, and cholesterol granulomas. Symptoms vary but can include pain, hearing loss, and dizziness.

Trauma - In severe head injuries, the temporal bone can fracture and injure the bones of the ear, the nerves that carry sound or damage the facial nerve (and cause facial paralysis). 

An CT scan of the temporal bones will evaluate:

External ear

The outer ear, nearby tissues and the ear canal are well seen and part of the evaluation of the temporal bones. A temporal bone CT can evaluate a severe swimmer's ear infection - otitis externa. Surfer's also develop a bony growth in the ear which can lead to hearing impairment. This is called Surfer's ear.

Middle ear

This includes the ear bones (ossicles) and bone cavities that are involved in transmitting sound. Otitis media is an infection centered in the middle ear.

Inner ear

Sinuses

Portions of the sinuses are seen in a temporal bone CT and sinus disease may be detected.

Skull base

The skull base is a complex set of bones that protect and surround parts of important vessels and nerves. Erosion or injury to the bone can damage these structures. The carotid arteries which feed parts of your brain travel through the skull base.

Your Temporal Bone CT Scan

A temporal bone CT scan generally takes about 5 to 10 minutes or to complete. If you are going for one remember to remove hair pins, nearby piercings, earrings and necklaces as these metallic objects can interfere with the scan. These scans are done without IV contrast.

If you're insured, you may need to have your test authorized (approved) by your insurance company first. If you're uninsured and need to look up prices and buy an CT scan of the brain, you can use our website to look up CT scan costs and then purchase with your credit card.

Have you had a Temporal Bone CT scan? What was it like? Please leave your comments below.

CT scans are frequently used to evaluate the brain (head).  Brain CTs are typically ordered for many different symptoms such as headaches, weakness, seizures, confusion, etc to exclude a tumor, aneurysm or infection.  They are also used as a follow up test for patients with strokes, bleeds or surgery. Below are a few common diagnoses that a CT scan of the brain detect.

Aneurysm - Aneurysms are ballooning of vessels that risk rupturing. If blood leaks from the aneurysm patients describe the headache as a thunderclap and sharp/shooting pains. Patients can also have stroke-like symptoms with weakness, slurred speech and confusion. A Brain CT scan is the first test done to evaluate for a bleed.

Tumors - Tumors can be primary (from brain tissue) or secondary (from other sites, eg breast cancer). These typically present with headaches, weakness, and seizures. Head CT scans can be done without or with IV contrast to detect tumors.

Bleeding - Hemorrhage, aka bleeding, in the brain can be from trauma, ruptured aneurysms or tumors that bleed. CT scans are very sensitive to recent bleeds (especially within a few hours).

Stroke - Also known as a "brain attack", stroke refers to a blocked artery that deprives a part of the brain of blood (and therefore oxygen). This part of the brain loses it function and patients present with weakness, slurred speech, difficulty walking and on occasion, headaches. Head CT scans are a good first test to detect a stroke or determine if the symptoms are caused by another factor such as a bleed or a tumor.

An CT scan of the brain will evaluate:

Sinuses

A CT scan of the brain will include parts of the sinuses. Though not used to primarily look for sinus disease, the brain CT can pick up thickening of the sinus tissue (mucosa) or fluid in the sinuses.

Orbits

Brain CT scans can include parts of the orbits. It can pick up injury to the orbit and  diseases of the orbits such as large tumors, bleeds, inflammation, etc.

Bones

Brain matter

The white and gray matter of the brain are well seen. CT can detect tumors, infection, bleeds, stroke and congenital defects. Part of the pituitary gland, optic nerves and upper brainstem are also evaluated. A "routine" head CT is done without contrast.

Ventricles

These are the fluid filled structures inside the brain that help circulate cerberospinal fluid. Tumors and bleeds can extend into these structures and cause blockage which can lead to headaches, confusion and problems with walking for example. 

Your Brain CT Scan

A brain CT scan generally takes about 5 minutes or so to complete. If you are going for one remember to remove hair pins, piercings, earrings and necklaces as these metallic objects can interfere with the scan. Most scans are done without IV contrast. But if your doctor is looking for a tumor or infection this may be done with contrast.

If you're insured, you may need to have your test authorized (approved) by your insurance company first. If you're uninsured and need to look up prices and buy an CT scan of the brain, you can use our website to look up CT scan costs and then purchase with your credit card.

Have you had a Brain CT scan? What was it like? Please leave your comments below.

CT scans are frequently used to evaluate the chest. A chest CT scan is frequently ordered to look at the lungs, heart and nearby tissues. It may be ordered after a chest x-ray shows a lung nodule or to evaluate pneumonia and other lung diseases such as emphysema. Some chest CT scans are tailored to look for heart disease, aneurysms of the aorta or pulmonary emboli. Chest CT scans are also used to look for the spread or recurrence of cancer.

If you've been in an accident, a chest CT scan can detect a pneumothorax (air leak), fractures of the bones of the chest or bleeding.

A CT scan of the chest will evaluate:

Lungs

A chest CT scan will detect pneumonia, emphysema, lung scarring, pleural effusion (fluid on the lungs), pneumothorax (air leak), and lung cancer.

Mediastinum

The mediastinum refers to the part of the chest that contains your heart, vessels and the esophagus.  The chest CT will detect lymph nodes, tumors in the chest, heart disease, pericardial effusion (fluid around the heart), aneurysms of the aorta and pulmonary emboli (these cause sudden shortness of breath). It can also detect tumors or inflammation of the esophagus.

Bones

Your chest is protected by your ribs, sternum and the spine. A chest CT scan can detect fractures of these bones, tumors, infection or degenerative changes.

Other structures

A chest CT scan also includes parts of the upper abdomen and can pick up abnormalities of the liver, spleen and stomach.

Your Chest CT Scan

A chest CT generally takes about 5 minutes or so to complete.  Many chest CT scans are done with IV contrast.

If you're insured, you may need to have your test authorized (approved) by your insurance company first. If you're uninsured use our website to look up Chest CT scan costs, find a certified imaging center and buy your test with a credit card.

Have you had a Chest CT scan? What was it like? Please leave your comments below.

MRA stands for Magnetic Resonance Angiography. It is an MRI technique that specifically evaluates vessels such as arteries. Renal artery MRAs evaluate the vessels that supply blood to the kidneys to look for narrowing and blockage of the vessels, evaluate a suspected aneurysm, or look at the the blood supply of a kidney tumor.

(FYI: "renal" is another word for kidney).

Renal MRAs are typically ordered for the evaluation of hypertension and kidney failure that can be caused by blockages and narrowing of the arteries. If a kidney receives less blood flow it may "act" as if there is not enough blood in the body and release hormones that try to raise the blood pressure. If one or both kidneys has low flow, over time the kidney tissue becomes damaged and is unable to function leading to renal failure.

Renal MRAs can diagnose:

Plaque - Renal MRAs can detect plaque deposits that overtime can narrow the vessel leading to reduced blood flow to the kidneys. Some plaque can abruptly "tear" off sending bits of plaque into the kidneys, blocking vessels and causing a "stroke" of the kidneys. This can lead to kidney scarring.

Dissection - This refers to a tear in the wall of the vessel. Think of it as a tear of the inner lining of the sleeve of a jacket. If you filled the inner lining of your jacket with down it would block the real opening for your arm.  In the artery the blood goes into the opening of the tear of the dissection, expands the false channel, potentially blocking the flow of blood to the kidney and resulting in low flow to the kidney and damage to the tissue.

Aneurysms and Vascular Tumors - Aneurysms are ballooning of the vessels that can either disturb normal blood flow, press on nearby tissue or rupture. Renal vascular tumors may be picked as the vessels that feed them are large enough to be seen on the MRA.

An MRA of the renal arteries will evaluate:

Renal arteries

Each kidney has between 1 to 2 arteries that come off the sides of the abdominal aorta (see the picture to the right). These short and relatively small vessels can be narrowed by plaque, become inflamed or be affected by dissections and aneurysms.

Abdominal Aorta

The abdominal aorta is the main feeding artery for your body below your diaphragm. A renal MRA will include this vessel and can detect major abnormalities like aneurysms, dissection, plaque and blockages.

Abdominal Aorta branch arteries

In addition to seeing the renal arteries, the MRA will also see the other branch vessels which include the celiac artery, superior mesenteric artery and inferior mesenteric artery among others. These vessels supply other organs including the liver, gallbladder, pancreas, spleen, adrenals, stomach, etc.

Your Renal artery MRA Scan

A Renal artery MRA generally takes about 15-30 minutes or so to complete. If you are going for one, wear loose comfortable clothing and remember to remove all metal (jewelry, phones, rings, etc) before going into the MRI scan room.  This test is occasionally done with IV MRI contrast.

If you're insured, you may need to have your test authorized (approved) by your insurance company first. If you're uninsured and need to look up prices and buy an MRA scan of the renal arteries, you can use our website to look up MRA scan costs and then purchase with your credit card.

Have you had a Renal MRA scan? What was it like? Please leave your comments below.

MRI scans are frequently used to evaluate the internal structures of the ankle (you can read more about MRI here). A variety of trends have increased the use of MRI in evaluating our joints - more sports activity, increase in obesity rates, diabetes, and we've remained much more active into our later years than previous generations.

If you've injured your ankle or have ankle pain, your doctor will probably first order an x-ray. After an x-ray, an MRI may be needed to evaluate the tendons, ligaments and bones of the ankle. On your doctor's order for the MRI you might see:

"r/o stress fracture" - this refers to a "hairline" fracture of a bone that is not seen on an x-ray.

"r/o ligament injury"- there are many tendons and ligaments which pass through the ankle area and can be injured or degenerate.

"r/o osteochondral defect" - this is a defect of the bone and cartilage that can cause chronic pain.

(FYI - "r/o" is short for "rule out")

An MRI of the ankle will evaluate:

Bones

An ankle MRI will include parts of the lower tibia, lower fibula and the ankle bones which include the talus, calcaneus and some of the forefooot bones. An ankle MRI can detect bone bruises, fractures, cysts, tumors, infection and dislocations. An MRI can also determine the extent of arthritis and assist in pre-operative planning.

Cartilage

Ankle MRIs are very good at looking at the cartilage. MRI can detect cartilage fraying (like frayed edges of jeans), fissuring (cracks, similar to a dry river bed), and defects (the cartilage is missing). Damaged cartilage can lead to chronic pain and arthritis.

Tendons and Ligaments

Your ankle has a complex set of tendons and ligaments that an MRI can evaluate. The Achilles tendon is the large tendon at the back of your ankle. This can develop internal tears and cause pain. Tendons along the sides of your ankle can also develop tears and cause pain and a flattened arch for example. Ligaments like the deltoid ligament help suport your ankle. Any of these tendons and ligaments can be injured and the injury may only be seen on MRI.

Soft Tissues

This refers to the muscles and tissues around your ankle. An ankle MRI scan will show parts of the lower leg and foot muscles. An MRI can detect muscle tears, strains, tumors and infection. It can also detect fluid collections in the joints.

Your Ankle MRI Scan

An ankle MRI generally takes about 30 minutes or so to complete. If you are going for one, wear loose comfortable clothing and remember to remove all metal (jewelry, phones, rings, etc) before going into the MRI scan room. If you're insured, you may need to have your test authorized (approved) by your insurance company first. If you're uninsured and need to look up prices and buy an MRI scan of the ankle, you can use our website. Click here to see MRI scan costs.

Have you had an Ankle MRI scan? What was it like? Please leave your comments below.

X-rays are frequently used to evalaute the bones of the knee (you can read more about X-rays here). If you've injured your knee or have chronic knee pain, your doctor will probably order an X-ray.  On your doctor's order for the X-ray you might see:

"r/o fracture" - a fracture is a break in the bone.

"r/o DJD"- DJD short for degnerative joint disease. Your doctor is looking for joint narrowing, bone spurs and fluid on the knee.

(FYI - "r/o" is short for "rule out")

An X-ray of the knee will evaluate:

Bones

A knee X-ray will include parts of the lower femur, upper tibia, upper fibula and the patella. The knee X-ray can detect bone fractures, cysts, tumors, infection and dislocations. An X-ray can also determine the extent of arthritis and assist in pre-operative planning. X-rays are frequently done to evaluate knee replacement hardware as well.

Soft Tissues

This refers to the muscles and tissues around your knee. A knee X-ray scan will show parts of the thigh muscles and muscles of the upper calf area. The X-ray can see foreign bodies (for example metal) that are in the skin or large tumors and joint effusions.

Your Knee X-ray

A knee X-ray generally takes about 5 to 10 minutes or so to complete. If you are going for one, wear loose comfortable pants or shorts. If you're uninsured expect to pay between $75-$250 for an x-ray. Prices vary depending on location and number of images taken.

Have you had a Knee Xray? What was it like? Please leave your comments below.

CT scans are frequently used to evaluate the sinuses, also called the paranasal sinuses. This test is frequently ordered to look for sinus disease. On your doctor's order you may see "r/o sinus disease", "h/o sinus disease", "allergy, cough, rhinitis"

(FYI - "r/o" is short for "rule out" and "h/o" stands for "history of")

A CT scan of the sinuses is usually ordered for sinus infection but is also done as part of a preoperative evaluation for sinus surgery. Sinus CT scans can also pick up tumors of the sinuses as well.

A CT scan of the sinuses will evaluate:

Sinus cavities

These are the air filled boney structures that make up the sinuses.  They are called the maxillary sinus, ethmoid air cells, frontal sinus and sphenoid sinus. All of these ultimately communicate with the nasal cavity via various passages and channels. If these passages are blocked, the normally secreted mucus can't escape and builds up causing pressure and pain.

Sinus Mucosa

The sinus cavities are lined by a thin layer of tissue called "mucosa". This tissue produces mucus. The mucosa can become inflamed causing symptoms related to sinusitis - pressure, pain, and sinus discharge for example.

Nasal Cavity

The nasal cavity contains boney structures called turbinates which are lined by mucosa as well. This tissue can become inflamed and give rise to nasal polyps which can cause stuffiness and difficulty breathing (through the nose).

Other structures

Other parts of the bones and tissues near your sinuses are included in a CT scan of the sinuses. These include the eyes, jaw bones, mouth and parts of the skull.

Your Sinus CT Scan

A sinus CT generally takes about 5 minutes or so to complete.  This scan can be done either laying flat on your back or on your stomach with your chin propped up by a soft pad.

If you're insured, you may need to have your test authorized (approved) by your insurance company first. If you're uninsured  use our website to look up CT sinus scan costs, find a certified imaging center and buy your test with a credit card.

Have you had a Sinus CT scan? What was it like? Please leave your comments below.

Ultrasound tests use sound waves to create images of the internal organs. Abdominal aortic ultrasounds are usually ordered to evaluate the size of the aorta to look for aneurysms (enlargement). The aorta is the main artery from your heart that carries blood throughout your body - sort of like a main highway with many branches coming off of it. It is roughly divided into two parts:

Thoracic aorta - in your chest, can be evaluated with CT and MRI

Abdominal aorta  - in your abdomen, can be evaluated with US, CT, or MRI

In the abdominal aorta picture to the right, the aorta is the red tubular structure. The magnified picture shows a normal aorta and one with an aneurysm.

Over time your aorta can enlarge in size and form what is called an  abdominal aortic aneurysm. The walls of the aneurysm are weak and can rupture causing life threatening bleeding into your abdomen. Symptoms include a pulsing mass in the middle of your  abdomen, a bruit (noisy flow) heard using a stethoscope, pain or rectal bleeding, sudden loss of consciousness or cardiac arrest. Once the aneurysm gets to a certain size the risk of rupture becomes significant and the aneurysm is repaired.

Like any other arteries in the body, the abdominal aorta can develop atherosclerosis which can cause aortic stenosis. Stenosis simply means narrowing. Significant stenosis can slow the flow of blood in the aorta impairing circulation to your legs for example. Some patients with significant atherosclerosis of the abdominal aorta may need to have a bypass surgery to restore adequate blood flow to the legs.  

Your doctor's order may read "r/o aneurysm" or "pulsatile mass", "h/o atherosclerosis"

(FYI "r/o" stands for rule out, and "h/o" for history of)

Below are some common indications for abdominal aorta ultrasounds.

•  Screening for aneurysm for patients with medical conditions such diabetes, high cholesterol and high blood pressure  which increase the risk of developing an abdominal aorta aneurysm
• Evaluate for an aneurysm if a pulsatile mass is felt on a physical exam
• Known abdominal aortic aneurysm and the scan is being done to check for any change in size of the aneurysm
• Evaluate the aorta because of a bruit (rushing, whistling noise) of the abdominal aorta heard during a physical exam

Below is a brief outline of the procedure.

1. After you sign in to the Radiology office, you'll be taken to the ultrasound room.
2. An ultrasound technician will perform the test.
3. Once you enter the room, you will lie down on a bed/gurney.
4. The technologist will ask you to pull up or remove your shirt.
5. He or she will place a a warmed gel solution over the skin of your abdomen.
6. The technologist will use an ultrasound probe and glide it over the abdomen and take pictures.
7. The technologist may ask the Radiologist doctor to review the scan before you leave.
8. An official report is generated by the Radiologist in about 24-48 hours.

If you are insured abdominal aortic ultrasounds are covered. However, for uninsured patients these tests can be quite expensive. You can expect to pay anywhere between $300 and $700 for this test.

Have you had an abdominal aorta ultrasound? What was it like? Please leave your comments below:

CT scans are used to detect and monitor many types of diseases. CT Angiograms are a specific type of CT scan that uses dye injected a high rate to evaluate the arteries of your body. Carotid CT Angiograms evaluate the vessels of the neck to look for aneurysms, vascular tumors, narrowing and blockage of the vessels of the neck, among others.

This CT scan uses special software to create realistic 3D images and gives the Radiologist interpreting the test the ability to look inside the vessels.

CT angiograms of the carotids are typically ordered for the evaluation of stroke to detect blockages and narrowing of the arteries in the neck caused by plaque that ultimately supply the brain. Symptoms related to stroke include:

• weakness
• sudden speech difficulties
• confusion, erratic behavior
• vertigo, dizziness
• pain, tingling
  
• numbness

CT Angiograms can diagnose:

Plaque - CT Angiograms of the carotids can detect soft and hard plaque deposits that overtime narrow the opening of the vessel leading to reduced blood flow to the brain. Some plaque can abruptly "tear" off sending bits of plaque into the brain, blocking small vessels. Sometimes these tiny blockages can be completely unnoticed and other times cause the symptoms of stroke. In some cases the vessel can narrow to a point and cause a rushing sound in the neck called a "bruit." The sound is blood trying to get through the narrow opening.

Dissection - This refers to a tear in the wall of the vessel. Think of it as a tear of the inner lining of the sleeve of a jacket. If you filled the inner lining of your jacket with down it would block the real opening for your arm.  In the artery the blood goes into the opening of the tear of the dissection, expands the false channel, potentially blocking the flow of blood to the brain and resulting in stroke like symptoms.

Aneurysms and Vascular Tumors - Aneurysms are ballooning of the vessels that can either disturb normal blood flow or by their shape and size press on nearby tissues and cause related symptoms such as neck pain, pressure, nerve blockage, etc. Vascular tumors may be picked as the vessels that feed them are large enough to be seen on a CT angiogram.

A CT Angiogram of the Carotids will evaluate:

Internal Carotid Arteries

The carotid vessels arise from the aorta in the chest and travel up the neck along both sides. The vessels splits in the neck with the "internal" segments feeding roughly the front 2/3 of brain tissue. The "external" segments feed the face and parts of the scalp and skull.

Vertebral and Basilar Arteries

The basilar artery is made up by two vertebral arteries which arise from vessels in the chest and travel up along both sides of the neck near the spine. This vessel feeds the brain stem and approximately the back 1/3 of the brain.

Aortic Arch

Neck soft tissues

Parts of the soft tissues of the neck are seen in a CT angiogram of the carotids. Occasionally large tumors, inflammation or other findings can be picked up. 

Your CT Angiogram of the Carotids:

This CT scan generally takes about 15 minutes or so to set up and complete. This test is always done with IV MRI contrast. Keep in mind that the dye is injected at a much higher rate than a standard CT. Therefore a larger IV is used for this test. Many patients feel sudden flashes of heat and a metallic taste in their mouth. You may also feel sudden warmth in your bladder.

If you're insured, you may need to have your test authorized (approved) by your insurance company first. If you're uninsured and need to look up prices and buy an CT Angiogram of the carotids, you can use our website to look up CT Angiogram costs and then purchase with your credit card.

Have you had a Carotid CT Angiogram scan? What was it like? Please leave your comments below.