Importance of Imaging in Low Back Pain

Radiologists utilize imaging studies to accurately diagnose a variety of causes of low

back pain. In primary care, the most commonly used imaging modalities are X-ray, MRI, CT, and

nuclear medicine bone scan. Sometimes, more advanced imaging techniques are used in

anticipation for surgery and that includes CT myelography and PET scans.

By having specialized training with these techniques radiologists are able to provide

assistance to surgeons and other medical practitioners. X-rays are helpful for evaluation of

fracture, bony deformity including degenerative changes, sacroiliitis, disk and vertebral body

height, and assessment of bony density and architecture. MRI or CT is recommended in

patients with severe or progressive neurologic deficits or with serious underlying conditions,

such as vertebral infection, cauda equine syndrome, or cancer with spinal cord compression.

MRI does not require radiation exposure and provides better visualization of soft tissue and

spinal canal, and thus preferred over CT. Computed tomography (CT) has superior depiction of

cortical bone than MRI. It may be better in visualizing fractures and detecting facet

degenerative changes. Bone scans are used mainly to detect occult fractures, stress fractures,

infections, or bony metastases and to differentiate them from degenerative changes.

Radiologists can take patient findings and correlate them with the appropriate imaging

studies to provide diagnoses, further diagnostic studies if needed, and possibly a treatment

plan.

Author 1: Braden Stoeger UWSP Biology Major

Author 2: Kunal Patel, MD

References

Harwood MI, Smith BJ. Low back pain: a primary care approach. Clin Fam Pract.

2005;7(2):279–303. doi: 10.1016/j.cfp.2005.02.010.

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK, Clinical Efficacy

Assessment Subcommittee of the American College of Physicians., American College of

Physicians., American Pain Society Low Back Pain Guidelines Panel.

Ann Intern Med. 2007 Oct 2; 147(7):478-91.

Jarvik JG, Deyo RA. Ann Intern Med. 2002 Oct 1; 137(7):586-97.


The Effect of Low Back Pain

      Lower back pain is a serious issue faced by many individuals in the United States. Low back pain is the fifth most common reason for all physician visits, and is the second most common symptomatic reason (upper respiratory symptoms are first). As these patients are attempting to find a solution for their low back pain they are likely to have to pay medical bills and have decreased productivity at work.  The estimated annual national bill for the care of low back problems is $38 to $50 billion. Low back pain can be a symptom of a wide array of mechanical and nonmechanical conditions. The mechanical conditions typically include muscular or ligament strains/sprains as well as degenerative disk disease, spondylolysis, spondylolisthesis, or osteoporosis. Radiculopathy is another large contributor to low back pain and is often identifiable as a sciatica, herniated intervertebral disk, as well as fractures, tumors, infection, or a vascular compromise. Nonmechanical spine disorders are less common but include neoplasia, infection of the low back, and inflammatory arthritis. Low back pain is located, managed, and treated by family practice providers, internists, neurologists, rheumatologists, radiologists, emergency physicians, and orthopedic and neurological surgeons. Nonallopathic providers of back care include osteopathic physicians, chiropractors, physical therapists, acupuncturists, and massage therapists.

Author 1: Braden Stoeger ,UWSP Biology Major

Author 2: Kunal Patel, MD

 

                                            References
Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical
evaluation, and treatment patterns from a U.S. national survey. Spine. 1995; 20:11–9.
Frymoyer JW, Durett CL. The economics of spinal disorders. In: Frymoyer JW, Ducker TB, Hadler NM, Kostuik JP, Weinstein JN, Whitecloud TS, editors. The Adult Spine: Principles and Practice.Philadelphia, PA: Lippincott-Raven; 1997. pp. 143–50.
Frymoyer JW. Back pain and sciatica. N Engl J Med. 1988; 318:291–300.
Atlas, S. J., & Deyo, R. A. Evaluating and Managing Acute Low Back Pain in the Primary Care Setting. N Engl J Med 2001; 120-131
 

 


Breast Cancer – Current Issues and Promising Techniques

Currently, thirty-five states have either put laws into effect or are in the process of passing laws that require breast density information be given to patients with their mammogram results. Wisconsin is not one of those states.[1] Additionally, research has shown that women with dense breasts may be up to six times more likely to develop breast cancer,[2] so it is important there are adequate means of screening these patients and ways of being proactive regarding breast cancer. Fortunately, a new technology, SoftVue, is being investigated locally. Led by Delphinus and in joint collaboration with Radiology Associates of the Fox Valley, St. Elizabeth Hospital, and the LivingWell Foundation, SoftVue is a new style of breast imaging that incorporates the attenuation of conventional mammography with the acoustic properties of ultrasound scans.[3] It is seeking FDA approval in hopes of proving its capability of finding more cancers and reducing false-positives and -negatives, particularly in women with dense breasts.[4]

 

1st Author: Tessa Miller

2nd Author: Rudy Lin, MD

 

[1] Durning, M. (2016, May 26). Breast Density Notification Laws by State – Interactive Map. Retrieved January 01, 2017, from http://www.diagnosticimaging.com/breast-imaging/breast-density-notification-laws-state-interactive-map
[2] Adding 3-D Mammography or Ultrasound to Regular Screening Finds More Cancers in Dense Breasts. (2016, March 18). Retrieved January 01, 2017, from http://www.breastcancer.org/research-news/add-3d-mammo-or-ultrasound-to-dense-breast-screening
[3] Delphinus. (2016). SoftvueTM System. Retrieved January 01, 2017, from http://www.delphinusmt.com/technology/
[4] Ibid.

Breast Cancer – How do we Detect it?

     Owing to the fact that mammograms are not always fully reliable when it comes to detecting breast cancers, many alternative screenings in addition to regular mammographies have been researched. The most popular researched studies are breast MRI and Ultrasounds. Also, although Ultrasounds finds a couple more cancers than mammography alone when used together, the PPV is only like 10%- very poor. Hopefully with the additional impedance data, Ultrasounds will become more specific.[1] When administered in conjunction with mammography, breast ultrasounds detect more cancers in dense breasts than in mammography alone.[2] Ultrasound sends high frequency sound waves through the tissue which produces an image of the tissue, and it does not use radiation, making adverse effects virtually none.[3] Rather than using attenuation like x-rays, ultrasounds use acoustic properties of tissue to detect abnormalities. Since mammograms and ultrasound use different methods of detection, they can pick up different types of masses. Therefore, they are best paired together, particularly in women with dense breasts. 

 

[1] Adding 3-D Mammography or Ultrasound to Regular Screening Finds More Cancers in Dense Breasts. (2016, March 18). Retrieved January 01,2017, from http://www.breastcancer.org/research-news/add-3d-mammo-or-ultrasound-to-dense-breast-screening
[2] Ibid.
[3] Johns Hopkins. (2016).Breast Ultrasound. Retrieved January 01,2017,from http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/breast_ultrasound_92,p077641/
[4} Ibid.

 

Author 1: Tessa Miller

Author 2: Rudy Lin, MD