X-Ray & Diagnostic Ultrasound Consultants
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  Women's Health

From mammograms to overcoming infertility, X-ray & Diagnostic Ultrasound Consultants Ltd provides the latest care to help ensure your health as a woman.

The special diagnostic needs for women's health are met through the imaging capabilities at XDUCL. Here, our staff makes every effort to provide comfort and accuracy in women's diagnostic imaging.

Breast cancer is the second most common cancer among Jamaican women and we know that while most breast tumors can be located and identified with mammography, some 15% can be missed by this procedure.

That's why in addition to traditional mammography and ultrasound, we also offer digital mammography which is more sensitive than analog Mammography and exposes the patient to less radiation.

In addition to Mammography, XDUCL uses one of latest tools in the fight against breast cancer, Breast Specific Gamma Imaging (BSGI). BGSI is a nuclear scan of the breast (molecular imaging) which can be used to identify breast cancers that mammograms may miss.

Mammography, ultrasonography and BGSI are the tools we employ for breast Cancer detection. Furthermore, once a diagnosis of breast cancer is made we are able to perform the necessary nuclear scans and CT Scans for staging -
comprehensive care.

Read more about detecting cancer of the Breast:

Ultrasound for women
Additionally you’ll find that we offer a full range of OB/GYN ultrasound procedures.

If you are having trouble conceiving XDUCL offers a range of imaging tests to determine the possible causes of infertility allowing for a visual examination of the complete female reproductive system.

With ultrasound, abnormalities of the uterus and ovaries are easily detected. We have also incorporated ultrasound exams in the Hysterosalpingography to evaluate the cavity of the uterus in detail.

If you are pregnant, XDUCL works with many local obstetricians and general practice physicians to provide ultrasounds throughout your pregnancy to help ensure the health of your baby. Read more about evaluation of infertility.

And finally, ultrasound is used to locate and identify fibroids, cysts and tumors that can affect your health as a woman.

Read more about cancer of the Uterus and Ovaries

Your comfort is a top concern.

Of course we want you to feel comfortable through every step of your care while you are at our facility. That’s why we always make the time to fully explain any test or procedure you may need and answer all your questions.  We also designed all of our examination rooms for your comfort and a high level of privacy.

For more information, please visit our Frequently Asked Questions page.

 

Detecting Cancer of the Breast

Breast Specific Gamma Imaging

Cancer of the breast is the second most common cancer among Jamaican women and although much less commonly seen, it also affects older men as well. 

Most cases of cancer of the breast can be detected with a mammogram. However approximately 15% of breast cancer cases are missed by mammograms. Breast Specific Gamma Imaging (BSGI) or an MRI can identify cancer, which mammograms miss. BSGI is the latest tool in the fight against breast cancer.

What is Breast Specific Gamma Imaging (BSGI)?

Breast Specific Gamma Imaging (BSGI) is a functional or molecular breast imaging procedure that creates an image of cell activity (metabolism) and can differentiate cancerous cells from non-cancerous. Whereas mammograms are x-rays that depict tissue densities, BSGI done with the Dilon 6800 uses radiotracer uptake to detect cancer independent of tissue density.

Ultrasounds like mammograms show breast anatomy (structure) while BSGI captures the cellular function of the breast tissue and provides for improved diagnostic sensitivity and specificity. This is comparable to and in some situations betters the MRI.

How is the BSGI performed?

As a patient you are intravenously injected with a small dose of radioactive Isotope - Technetium 99m Sestamibi and the cells absorb this. This tracing agent emits invisible gamma rays, which are detected by the Dilon 6800 Gamma Camera on which your breast rests and translated into a digital image of your breast.

Due to the higher metabolic activity of cancerous cells, these cells absorb and consequently emit a greater amount of the radiation than other tissue.  BSGI highlights these cells, thus indicating diseased areas. Hence cancers as small as 3 mm in diameter are readily detected with this technology.

Once injected imaging can begin immediately. Generally four views are taken- two for each breast. Each view takes between 6 - 10 minutes to acquire so the entire procedure lasts about 45 minutes to an hour.

Is the procedure comfortable?

Throughout the imaging process you are seated comfortably. The procedure is more comfortable than a mammogram. Only moderate pressure is required to help form and stabilize the breast.

When is BSGI used?
BSGI is a valuable tool for situations where mammography fails and further evaluation is needed, for example when patients have:

  • Dense breast tissue;
  • Multiple suspicious lesions or clusters of micro-calcifications;
  • Palpable lesions not detected by mammography or ultrasound;
  • Post-surgical or post-therapeutic masses;
  • Breast Implants;
  • Taken Hormone Replacement Therapy.

And from surgical and treatment perspectives, BSGI may provide valuable information for the following scenarios:

    • Determining the extent of the primary lesion;
    • Detecting occult secondary lesion;
    • Evaluating the axillary region for node status in breast cancer patients.

BSGI should therefore be recommended for everyone with a diagnosis of breast cancer prior to definitive treatment - surgery.

Who should get BSGI Done?

From our experience all women who have first-degree relatives with breast cancer should have BSGI once every 2-3 years.

 

Our Comprehensive Services for Breast Examinations

X-Ray & Diagnostic Ultrasound Consultants Limited offers a comprehensive range of imaging and diagnostic modalities for breast disease detection. These include:

  • Digital & Analog Mammography
  • Breast Ultrasonography;
  • Ductography;
  • Guided Breast Biopsy;
  • Breast Cyst Aspiration;
  • Ultrasound & Mammography Hook Wire localization of Non Palpable Breast Lesion.

Mammography

What is Mammography?
Mammography is simply a form of low dose X-ray used to create an image of your breasts. As a diagnostic tool, mammography is generally used if you have signs such as lumps, tenderness, discharge from the nipple or any breast changes.

Routine screening exams are also recommended for women by age 40, even if you are healthy and have no symptoms. Women age 40 to 50 should have a mammogram every two years and annually after age 50.

How is a Mammogram performed?
The mammography exam is performed with special X-ray equipment that enables the radiologist to view the thickness of your breast tissue on X-ray film.

You will be positioned in front of the machine and be asked to stand for the exam, if possible. Your breast will then be positioned on the mammography equipment, and firm pressure will be applied. Each of your breasts will be X-rayed from above and from the side. Both breasts are X-rayed so that we are able to compare the images.

Your mammogram is performed by a certified radiologic technologist. The radiologist, who specializes in reading mammograms and making medical diagnoses based on X-rays, will carefully examine the images.

Is Mammography comfortable?
Since pressure is applied to your breasts you may find the exam a bit uncomfortable, but rest assured, any discomfort will last only as long as it takes for the X-ray, which is generally less than a minute.

Digital Mammography
Unlike Analogue mammography, which provides images of breasts on x-ray films, Digital Mammography provides the images on computer monitors. These images can be easily manipulated to view them darker, brighter or sharper as well as magnified resulting in a far more accurate exam than the analogue form. Moreover, Digital Mammography results in a lower dose of radiation to the breasts than with analogue mammography. X-Ray and Diagnostic Ultrasound Consultants Ltd is the only facility which currently offers digital mammography in Jamaica.

We recommend Digital Mammography as the ideal imaging technology for screening for Breast Cancer.

Breast Ultrasound
The Breast Ultrasound examination enables the Doctor to further evaluate abnormalities seen on the Mammograms or lumps felt. This technology is also employed to direct needles into areas of concern and obtain tissue (Biopsy) so as to have the pathologist establish a diagnosis.

Hookwire Localization
Ultrasound can also be used to direct a hook-wire into a suspicious focus which cannot be felt, thus enabling the surgeon to remove that focus for further testing by the Pathologist. The Hook-Wire Localization procedure is also performed under the guidance of Digital or Analogue Mammography.

Ductography
In situations where there is a spontaneous and profuse bloody discharge from the nipple, iodine containing fluid is introduced into the offending duct and mammographic films are taken to detect a possible tiny tumour in the duct (papilloma) which could then be removed.

 

 

Evaluation of Infertility

Often times abnormalities of the uterus, diseases and blockages of the fallopian tubes result in infertility. Hysterosalpingography & Hysterosonography are two radiological tests, which are used to evaluate the female reproductive system-uterus, ovaries and fallopian tubes and thereby determine fertility.

What is hysterosalpingography?
Hysterosalpingogram, or HSG is an X-ray test that looks at the uterine cavity and the fallopian tubes.

What is Hysterosonography?
Hysterosonography is an ultrasound examination, in which a special probe is employed to provide detailed views of the uterus, fallopian tubes and ovaries, once the uterine cavity is filled with fluid e.g. saline.

How is a hysterosalpingogram performed?
During a hysterosalpingogram, a thin tube is passed through your vagina and cervix and into your uterus. Then iodine containing fluid is introduced through the tube and into the uterus.

The uterine cavity as well as the fallopian tubes normally fill with this material, which is identified on x-rays. If your fallopian tubes are open this fluid would be noted to spill into the pelvic cavity where it will be absorbed naturally by the body. If a fallopian tube is blocked, it may not fill and no spill would be observed.

A special x-ray machine called a Fluoroscopic machine enables your radiologist to observe the outline of the uterine cavity and the fallopian tubes. The pictures can show problems such as an injury or abnormally structured uterus or fallopian tube, or a blockage, which prevents an egg moving through a fallopian tube to the uterus.

How is a Hysterosonogram performed?
This technique involves the slow infusion of sterile saline solution into the uterus in the same way as the iodine material is introduced during a  hysterosalpingogram. In this test however, ultrasound is used to obtain the images.

Hysterosonography allows your doctor to evaluate abnormalities in the structure of the uterus, growths inside the uterus; abnormalities of the lining of the uterus (the endometrium); or disorders affecting the uterine muscle.

X-Ray and Diagnostic Ultrasound Consultants Limited, has the unique distinction of combining the Hysterosonogram and Hysterosalpingogram in every female patient referred for the evaluation of infertility. This is far more detailed than providing the Hysterosalpingogram alone. In this procedure the iodine containing material used for the Hysterosalpingogram is employed for the Hysterosonogram.

What is the best time of the month to do these tests?
This test should be done 2 to 5 days after the menstrual period has ended.

Benefits

  • These are relatively short, simple procedures that can provide valuable information on a variety of abnormalities that can cause infertility.
  • The introduction of the fluid  can occasionally open fallopian tubes that are blocked allowing the patient to become pregnant afterwards.

Risks

  • For the hysterosalpingogram, you may develop an allergic reaction to the iodine material used for the examination. Women doing this examination must inform the doctor if they have asthma, are allergic to any medication or have had serious allergic reactions in the past.

The Pelvic Ultrasound Exam For Detection of Cancer of the Uterus and Ovaries

Cancer of the uterus and ovaries are among the most lethal cancers and are often discovered late, resulting in premature death.

Cancer of the uterus usually develops in the lining of the uterus called the endometrium.

Cancer of the ovary is called the ‘Silent Killer’ – because this cancer is typically, not detected until late, when death is inevitable.

Who is at risk?
Women forty-five years and older are at risk, especially women in the menopause. Women in the menopause who are obese are at increased risk for cancer of the uterus. However, younger women who are concerned about their health can also get these tests done at intervals.

Screening for Cancer of the Uterus and Ovaries
The Endovaginal Pelvic Ultrasound and Hysterosonogram tests are used for the detection cancers of the uterus and ovaries. When detected early, appropriate treatment is feasible and could be life saving.

How are these tests performed?
The endovaginal pelvic ultrasound exam involves the introduction of a special probe called a transducer into your vagina which enables your doctor to see the detail of the endometrium (the lining of the uterus) the myometrium (the muscular wall of the uterus) as well as the ovaries.  An empty bladder is required for this examination. A protective cover is placed over the transducer, which is also lubricated with a small amount of gel for patients comfort and safety.

In the Hysterosonogram  a speculum is placed into your vagina (as is done for pap smear), a tiny tube is passed into the cervix and a small volume of saline is then introduced and the trans-vaginal ultrasound exam conducted.  This enables your doctor to evaluate the thickness of the uterine lining – endometrium. Thickening of the endometrium is an early sign of uterine cancer.

In these exams the images are then obtained from different angles to get the most detailed views of the uterus and ovaries.

Benefits

  • Ultrasound scanning is generally painless
  • Ultrasound is widely available, and is relatively inexpensive compared to other imaging methods.
  • Ultrasound imaging uses no ionizing radiation hence does not have the potential to cause tissue damage
  • Ultrasound scanning gives a clear picture of soft tissues which do not show up clearly on x-ray images.
  • Ultrasound causes no health problems and may be repeated as often as is necessary.

Uterine Fibroid Embolization For the Treatment of Uterine Fibroids

Uterine Fibroids are a major women’s health issue affecting thousands of Jamaican women. Fibroid tumours are usually benign growths that arise from the muscular wall of the uterus and can range in size from very tiny (a quarter of an inch) to larger than a breadfruit to even as large as an advanced pregnancy. In most cases, there is more than one fibroid in the uterus. Fibroids usually cause heavy menstrual bleeding, pain in the pelvic region, an abnormally enlarged abdomen, pressure on the bowel and pressure on the urethers, the bladder, resulting in urinary frequency and even kidney failure.

What is Uterine Fibroid Embolization?
Uterine Fibroid Embolization (UFE) is a minimally invasive and non-surgical interventional radiology procedure, for the treatment of fibroid tumours of the uterus. Embolization is the blocking of the artery (blood vessels supplying an organ), to stop blood flow. In the UFE procedure the blood flow to the fibroid is blocked, interrupting its growth and resulting in considerable reduction in its size.

It is a safe and effective treatment option for women to consider and most often prevents the need for the standard hysterectomy, which removes the entire uterus or myomectomy that removes the fibroids.

Is there any preparation required before the procedure?
Women who are being considered for UFE are required to do a Magnetic Resonance Imaging (MRI) Scan of the uterus to determine if the fibroids can be embolized, to detect alternate causes for symptoms and to identify unsuspected cancer. 
A special test that looks at the blood vessels (an angiogram), is also necessary. This can be performed on the CT Scanner or the MRI scanner.

How is the procedure performed?
Medications are given initially to sedate you and control pain. The area of the body (usually the groin) where the catheter is to be inserted will be shaved,  sterilized and covered with a surgical drape. Your physician will numb the area with a local anaesthetic. A very small nick is then made in the skin at the site.

Using x-ray guidance, a catheter is inserted into the femoral artery, which is located in the groin area. A contrast material provides a roadmap for the catheter as it is maneuvered into the uterine arteries. The embolic agent is released into both the right and left uterine arteries by repositioning the same catheter that was originally inserted. Only one small skin puncture is generally required for the entire procedure. At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. No sutures are needed. You are generally kept in bed for 8-12 hours after the procedure.

Benefits

  • Uterine fibroid embolization, done under local anesthesia, is less invasive than open surgery done to remove uterine fibroids or the whole uterus (hysterectomy).
  • Patients ordinarily can resume their usual activities within days- weeks earlier than if they had a hysterectomy.
  • Blood loss during uterine fibroid embolization is minimal, the recovery time is much shorter than for a hysterectomy, and general anesthesia is not required.
  • 90-95% of clients experience cure or significant relief of symptoms related to fibroids e.g. pain, excessive bleeding and pressure related symptoms such as frequent urination.
  • About 30% of women who are infertile because of the fibroids eventually succeed in becoming pregnant.

Risks and Other Facts to note

  • Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage or blockage of blood vessels, bruising or bleeding at the puncture site, and infection.
  • There is a minute chance that an embolic agent can be lodged in the wrong place and deprive normal tissue of its oxygen supply.
  • Occasionally a patient may have an allergic reaction to the x-ray contrast material used during uterine fibroid embolization. These episodes range from mild itching to severe reactions that can affect a woman's breathing or blood pressure.
  • Some patients experience early menopause as a result of this procedure.
  • Sometimes fibroids that are situated in close relation to the inner lining of the uterus, are eventually expelled via the vagina.
  • A vaginal discharge could occur and this could be related to an infection of the uterus warranting an hysterectomy.

 

Ultrasound Examinations  Necessary Throughout Pregnancy

Ultrasound in The First Trimester
In the first trimester (the first 3 months of pregnancy), ultrasound is often used to:

  • Confirm and date the pregnancy.
  • Ensure that it is in the uterus where it should be. If the fetus is outside of the uterus an ectopic pregnancy would be diagnosed. This is life threatening.
  • Identify the source of any abnormal bleeding.
  • Establish whether the embryo or foetus is alive.
  • Determine if a natural abortion has taken place.

A Trans-vaginal ultrasound exam is often done in the first trimester. Here a special probe/ transducer is passed into the vagina and this gives detailed images of the ovaries and uterus.

Ultrasound in The Mid Trimester
By the mid trimester, which is 12-24 weeks, checking the well-being of the foetus is of utmost importance and many health providers advise mothers to do an ultrasound exam between weeks 17 and 19 for this purpose.
The specialist is able to identify:

  • The growing foetus and verify the appearance of the  -limbs and organ formation such as the structure of the baby’s BRAIN, heart, arms and legs. Many abnormalities can be detected early.
  • Any signs of growth retardation, that is a failure of the foetus to develop and grow in accordance with the age of the pregnancy.

Ultrasound in The Third Trimester
In the third trimester, (the last 3 months) the brain, heart, kidneys, abdominal wall, spine, intestines and stomach are usually more developed ultrasound may be used to assess position, size and health of the foetus. Most abnormalities are identified in the third trimester.

Your physician can use ultrasound to check the circumference of the belly, the length of the femur (thigh bone) and the circumference and width of the head. Through these measurements the age and weight of the foetus can be determined.

There are valuable particularly when there is a concern about the foetus’s development.

In addition the state of health of the placenta is determined.

How is the ultrasound performed?
To conduct the exam, the specialist applies a warm gel on the exposed belly/abdomen. A probe (transducer) is moved across your abdomen. This transducer directs inaudible sound waves toward the uterus and the foetus inside. The echoes are processed creating an image, or sonogram, of the foetus that can be viewed on a computer screen.

Amniocentesis
The genetic composition of the foetus can be identified by examining the mothers amniotic fluid. It is well known that foetal abnormalities or genetic abnormalities are a real risk in pregnancies in women over the age of 35 years.

Amniocentesis is the procedure by which a needle is passed into the amniotic fluid in the uterus and a sample of the fluid withdrawn. This is then processed at the laboratory to determine the genetic composition of the foetus and to exclude certain major abnormalities of the foetus, for example Down’s Syndrome. This study is often done by the 16th week of pregnancy so that safe termination of pregnancy could be offered.

 

 
 

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