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Prostate Artery Embolization: A Minimally Invasive Option to Treat Benign Prostatic Hyperplasia

January 18, 2021 in 2020 Learn Posts, Dalal Blog Post

Prostate Artery Embolization:
A Minimally Invasive Option to Treat Benign Prostatic Hyperplasia

A common condition among most aging men is benign prostatic hyperplasia (BPH), a noncancerous condition where the prostate becomes enlarged and urinary issues start to take hold.

In fact, approximately 50 percent of men who are 50 and older and 80 percent of men who are 80 and older struggle with BPH, symptoms of which include urinary urgency, frequent urination, straining to urinate, urinating multiple times in the night, incomplete emptying of the bladder, and sexual side effects. BPH can have a deeply negative impact on a man’s quality of life and leaves most searching for relief.

 

Why Does Urination Become a Problem for Some Men?

The prostate gland sits below the bladder, between the bladder and the penis. Running through the center of the prostate is a vessel or tube called the urethra, which allows urine to flow out of the body. When the prostate becomes enlarged, pressure is placed on the urethra and a man cannot urinate properly or efficiently. The goal of treatment is to remove this pressure.

 

Traditional Complex & Invasive Treatment Options for BPH

Treatment of BPH involves medication as well as several procedural options, some of which require invasive surgery, an inpatient hospital stay, and the potential for unpleasant side effects. Additionally, a patient must meet certain requirements to qualify. Treatment options include:

  • Transurethral resection of the prostate (TURP) – The urologist essentially removes the parts of the prostate gland that are causing problems. While TURP is the “gold standard” and essentially eliminates BPH, it is also major surgery that involves an overnight hospital stay, blood loss, and many potential side effects. Additionally, if the prostate is too large, TURP is not an option.
  • Prostatectomy – This procedure is a partial or complete removal of the prostate, and is widely used for men who have a very enlarged prostate. This treatment option presents the best overall improvement of symptoms, but also involves surgery, a hospital stay, and potential side effects.
  • Laser treatment – Lasers are used to kill the prostate tissue and reduce the size of the gland.
  • UroLift® system – A permanent device is implanted to lift and hold the enlarged prostate tissue, preventing it from blocking the urethra.
  • Rezum™ Therapy – This minimally invasive treatment option uses hot steam to attempt “burning out” the parts of the prostate that are squeezing the urethra.

 

Benefits of Minimally Invasive Prostate Artery Embolization (PAE)

Dr. Ravi Dalal, an interventional and vascular radiologist with Raleigh Radiology, reports that there is a different way to approach treatment of BPH that does not involve burning or removing the prostate, is minimally invasive, and presents relatively few side effects. Prostate artery embolization (PAE) is a newer, intravascular treatment, introduced more widely within the past ten years. It has grown in popularity due to the benefits mentioned above and its success rate. Additionally, the patient receives moderate sedation, so general anesthesia is not necessary. The procedure takes anywhere from one and a half to three hours.

 

“The idea is that if we shrink the prostate by getting rid of the blood supply on both sides, it will have the same effect as other treatments, but it is safer,” said Dr. Dalal. “Without a blood supply, nutrients can’t reach the prostate, and the cells will die. This is called necrosis. The body’s immune system will then remove the cells and create scar tissue, the prostate will shrink, and the tissue around the urethra will open up allowing urine to flow freely and reducing many symptoms.”

Performed in the hospital by an interventional radiologist like Dr. Dalal, PAE is a technical procedure that requires precision and expertise. Dr. Dalal has had extensive training for PAE during his interventional radiology fellowship.

 

Depending on the patient’s height (shorter than six feet, due to the catheter length), the radiologist may decide to perform the procedure trans-radially, through the patient’s wrist. This method is easier on recovery, but is only available for patients shorter than 6 feet tall due to the catheter length. Otherwise, the radiologist goes in through the groin. Either option creates no more than a 2 mm incision and requires no stitches.

 

The radiologist will then inject microscopic beads into the artery that runs to the prostate. These beads will ultimately block the blood supply. Multiple techniques are employed during the procedure to ensure the beads are inserted into the correct artery.

 

Positive Results & Improved Symptoms

Before PAE, most men report a variety of negative symptoms that impact their quality of life using a symptom tracking score methodology known as the International Prostate Symptom Score (I-PSS) rubric. The I-PSS is an eight-question screening tool that tracks and assesses symptoms of patients with BPH. The questions determine a man’s difficulty with urination and also help select the best treatment options. Whether it’s sexual dysfunction or urinary symptoms – men want relief and to live their lives to the fullest. Interventional radiologists like Dr. Dalal determine their success rate based on patients’ improved I-PASS scores after the procedure.

 

“After a PAE, we want to see those scores trending in the right direction. Fortunately, we typically see a significant impact,” added Dr. Dalal. “In fact, 75 to 80 percent of men say they experience an improvement in symptoms after this procedure.”

 

Patients also appreciate that PAE comes with few side effects. While there may be pain with urination or blood in the urine afterward, symptoms are usually mild and improve within a few weeks. A patient spends about two hours in recovery and is then sent home. The patient is prescribed antibiotics and NSAIDs to help with any inflammation or pain.

 

Rarely, post embolization syndrome can occur after PAE (low-grade fever, nausea, chills, discomfort when urinating), but this is temporary and resolves within a week. After the procedure, a patient should meet again with his radiologist to assess progress.

 

Helping High-Risk Patients Face BPH

Interventional radiologists and urologists are very selective when choosing patients for PAE.

They will assess each patient via CT scan prior to the procedure so they can map out the prostate’s anatomy and ensure the blood vessels are healthy enough for a successful PAE. PAE is most helpful in patients who have a large prostate of 150-200 grams. It is also a good option for patients for whom medical therapies have failed and/or who have pre-existing medical conditions such that surgery is not an option (i.e., heart disease and chronic obstructive pulmonary disease).

 

PAE can also help patients who have chronic indwelling foley catheters by shrinking the prostate and removing the catheter, as well as men who have hematuria, or bleeding from the prostate. By blocking the blood supply, the radiologist can use PAE to help heal the hematuria and shrink the prostate.

“Urologists prefer to avoid surgery with their high-risk patients, making PAE a good option. The risk is less for PAE since it only requires moderate sedation and it is not a surgical procedure,” explained Dr. Dalal. The interventional radiologists at Raleigh Radiology will consult with your urologist to develop a multidisciplinary approach and develop the best treatment option for each patient.

 

“PAE takes a lot of skill and experience; we use all the tools and training we have. Every patient is different, but I enjoy the challenge,” reflected Dr. Dalal. “Patients report a significant improvement in their symptoms – I’ve actually had men tell me they feel like they are 20 years old again.

The fact that we can treat these patients with a minimally invasive approach and have such a significant impact on their symptoms, meanwhile enhancing quality of life, is very exciting and satisfying.”

 

To learn more about Dr. Dalal and Raleigh Radiology, visit www.raleighrad.com.

Ravi Dalal, MD, Vascular & Interventional Radiologist Raleigh, NC

Ravi Dalal, MD

Interventional and Vascular Radiologist

  • BS: Cornell University
  • MD: University of Miami Miller School of Medicine
  • Radiology Residency: Jackson Memorial Hospital/University of Miami
  • Vascular and Interventional Radiology Fellowship: Jackson Memorial Hospital/University of Miami
  • Member, Society of Interventional Radiology
  • Member, American College of Radiology
  • Member, Radiological Society of North America
  • Interests: Prostate Artery Embolization
  • Native of New York State

Joined Raleigh Radiology in 2017

Ending the Monthly Cycle of Fear: Treating Uterine Fibroids with Uterine Fibroid Embolization

January 18, 2021 in 2020 Learn Posts, Doster Blog Post

Ending the Monthly Cycle of Fear:
Treating Uterine Fibroids with Uterine Fibroid Embolization

For many women, uterine fibroids can have a significant impact on quality of life. They find it difficult to go to work or leave their homes on certain days of their menstrual periods for fear of excessive and uncontrollable bleeding. While there are numerous treatment options, most require major surgery that isn’t ideal for most women.

What are Uterine Fibroids?

According to the National Institute of Environmental Health Sciences, 70 percent (or more) of women have uterine fibroids by age 50. Uterine fibroids are noncancerous tumors or growths that appear in a woman’s uterus during her reproductive years. They can cause heavy menstrual bleeding, severe cramping pain, periods that last longer than normal, breakthrough bleeding between periods, and even abdominal pain and pressure, bloating, constipation, frequent urination and pain during intercourse.

Surgical Methods to Treat Uterine Fibroids

The only way to resolve uterine fibroids with 100 percent efficacy is via a hysterectomy, or the surgical removal of the uterus. A hysterectomy will end a woman’s menstrual periods – meaning pregnancy is no longer an option. This procedure requires a complex, invasive surgery with a long recovery time.

Another surgical option is the myomectomy, where the surgeon makes an incision in the lower abdomen and goes through the uterus to cut out portions of or remove entire fibroids. However, because women can have many fibroids at once and they can grow on multiple areas of the uterine muscle, this procedure cannot guarantee the complete removal of all fibroids. Recovery for this procedure typically takes 2-4 weeks.

Uterine Fibroid Embolization as an Alternative Treatment Option

Uterine fibroid embolization (UFE) is a minimally invasive, non-surgical option available for treating uterine fibroids. According to Dr. Jamie Doster, chair of Interventional and Vascular Radiology at Raleigh Radiology, this common, alternative treatment option is successful for about 90 percent of patients, helps patients avoid major surgery, and allows for a much shorter recovery time. Dr. Doster was specifically trained to perform UFE during her interventional radiology fellowship.

“UFE works because we take away the blood supply to the fibroids, which then causes them to shrink and die off (necrosis),” explained Dr. Doster. “When they shrink, they are no longer hormonally active, which helps eliminate the heavy and breakthrough bleeding. Meanwhile, the shrinkage helps resolve the bulk of the patient’s other symptoms. After this procedure, patients can go back to work much sooner and the procedure is often more affordable than surgery as well.”

How Does UFE Work?

Interventional radiologists perform UFEs in the hospital, including at both WakeMed Raleigh Campus and Cary Hospital. As part of the treatment process, the patient will first receive an MRI to ensure she is a candidate for UFE – to check the anatomy of the fibroids, determine where they are located and ensure no other complications (i.e., malignancy) are at play. After this MRI and a pre-planning consult, where the MRI results and details of the procedure are discussed, the patient is scheduled for her UFE.

During this very technical and precise procedure, the radiologist uses a catheter inserted through the uterine artery to inject tiny beads into the blood vessels that feed the fibroids. Hence, the blood flow to the fibroids is blocked, and they will all begin to shrink. For 90 percent of patients, UFE can be performed trans-radially, or through a tiny incision in the wrist. For the other 10 percent, the procedure is performed through the groin, also just a tiny incision. This is based on the patient’s height (the size of catheter will not allow trans-radial on taller patients) and blood flow. With the wrist incision, a patient can get up and walk very soon after her procedure. In total, UFE takes about one to two hours. When the procedure is finished, patients either stay overnight or in some cases, may be able to leave the hospital on the same day.

What is Recovery Like?

According to Dr. Doster, the first 24 to 48 hours after UFE are the most difficult. A patient will typically remain in bed for that time and may experience pain, abdominal cramping, fatigue or vomiting. These symptoms usually resolve within a week, and patients are then able to return to work or their normal daily activities. Patients do not experience the total loss of their menstrual periods (amenorrhea) after UFE; however, a smaller and less impactful period remains. Some patients may continue to have slight discomfort and spotting for two to three menstrual cycles before they report a complete improvement.

“The complete resolution of symptoms is our ultimate goal, and most patients come back to tell us their symptoms are gone or significantly improved,” said Dr. Doster. “It’s remarkable and very rewarding when we can help these women take back their quality of life.”

Each patient should have a follow-up appointment with her radiologist one to three months after the procedure. Meanwhile, Dr. Doster’s office will call the patient one week later to check on her during recovery. Based on age, a small subset of women may have a recurrence of symptoms within five years, possibly due to the growth of new fibroids. However, these patients are typically younger women (around age 30) who are years away from menopause, and having a second UFE will help. For all women, the symptoms of uterine fibroids will typically resolve with menopause.

“At Raleigh Radiology, we are proud to offer UFE for women who suffer from uterine fibroids. We can help them stop living in fear of their menstrual periods and give them more freedom to enjoy their lives again,” added Dr. Doster. “We are also proud to offer same-day discharge as well as the trans-radial (wrist) option for a minimally invasive and safer treatment experience.”

To learn more about Dr. Doster and Raleigh Radiology, visit www.raleighrad.com.

 

Sources:

National Institute of Environmental Health Sciences: www.niehs.nih.gov

Office on Women’s Health: www.womenshealth.gov

Mayo Clinic: www.mayoclinic.org

Jamie Doster, MD Vascular & Interventional Radiologist Raleigh, NC

Jamie Doster, MD

Chair, Interventional and Vascular Radiology, Interventional and Vascular Radiologist

  • BS, Florida State University
  • MD, Florida State University College of Medicine
  • Internship, Greenville Memorial Hospital, Greenville, S.C.
  • Residency, University of Virginia, Charlottesville, VA
  • Fellowship in Vascular and Interventional
  • Radiology, University of Virginia
  • Member, Society of Interventional Radiology
  • Member, American College of Radiology
  • Member, Radiological Society of North America

Expertise in Interventional Radiology

Joined Raleigh Radiology in 2016

Clearing the Congestion: Ovarian Vein Embolization as a Treatment for Pelvic Venous Insufficiency & Chronic Pelvic Pain

January 18, 2021 in 2020 Learn Posts, Doster Blog Post

Clearing the Congestion:
Ovarian Vein Embolization as a Treatment for Pelvic Venous Insufficiency & Chronic Pelvic Pain

Pelvic pain and pressure are common symptoms for women that too often just become part of her daily life. Since there are many possible causes of pelvic pain, pelvic venous insufficiency, also known as pelvic congestion syndrome, can often go undiagnosed or ignored – leaving women stuck with constant feelings of general discomfort, painful pressure in the pelvic area, difficulty standing for long intervals, and a constant feeling of heaviness or fullness in the abdomen or pelvis. She may even suffer from hemorrhoids (swollen veins in the lower rectum) as a result.

“Because there are so many different sources for chronic pelvic pain, many providers shy away from treating it,” explained Dr. Jamie Doster, chair of Interventional and Vascular Radiology at Raleigh Radiology. “It’s a hard condition to diagnose and therefore, patients are often left without answers or options.”

However, Dr. Doster and her interventional radiology colleagues at Raleigh Radiology are committed to helping women who suffer from chronic pelvic pain find long-term relief.

Pelvic Venous Insufficiency as a Cause for Chronic Pelvic Pain

Pelvic congestion syndrome (PCS), medically known as pelvic venous insufficiency, can often be the cause for chronic pelvic pain. PCS is an abnormality in some women where the veins that drain blood from the pelvis are dilated and create blood flow in the wrong direction (away from the heart). This results in increased pressure and swelling in those pelvic veins, much like the varicose veins some women suffer from in the legs.

The only way to know for sure if a patient is suffering from PCS is through an imaging study such as a CT scan. The challenging part is that approximately four out of 10 women who have PCS don’t have any symptoms.

“To accurately diagnose PCS, you have to confirm that both the patient has symptoms and the imaging study must determine the condition is present,” explained Dr. Doster. “Our success in improving a patient’s symptoms is based on our ability to prove both. In other words, treatment will not work if PCS is not the source of the patient’s pain.”

Diagnostic studies offered by interventional radiologists like Dr. Doster greatly increase the chances that treatment will be effective. Often, a patient with pelvic pain will see a radiologist when her gynecologist has been unable to find the reason for her discomfort using other tests or assessments, such as hysteroscopy, a procedure where a gynecologist looks inside the uterus to investigate abnormal bleeding or check for endometriosis.

“Many patients are not even referred to us by their gynecologist,” added Dr. Doster. “They have often done their own research online and feel PCS could be affecting them.”

Ovarian Vein Embolization: A Minimally-Invasive Option to Treat PCS

Treatment options include ovarian vein embolization, a minimally invasive, non-surgical procedure performed in the hospital, where a radiologist uses a catheter to close off the faulty or abnormal veins. Locally, it’s performed at both the WakeMed Raleigh Campus and WakeMed Cary Hospital. This procedure essentially removes the abnormal veins from the circuit of pelvic blood flow, and the blood is then rerouted through the healthy veins. The abnormal veins are coil embolized using image guidance, contrast fluid and a catheter. Through the catheter, an embolic agent is inserted to treat the veins. All of this is performed through a tiny incision in the patient’s neck or groin.

However, before a patient can receive ovarian vein embolization, she must first complete a series of other steps for PCS diagnosis. She will start by meeting with a radiologist for a pre-procedure consultation where her symptoms and quality of life are assessed. From there, an imaging study, such as a CT scan, will help the radiologist examine the anatomy of the patient’s pelvis and pelvic veins.

Finally – prior to the ovarian vein embolization, a pelvic venogram is required. This is where a catheter is inserted into the pelvic veins with a wire, and contrast fluid is used to confirm the diagnosis and help the radiologist get a better look at the veins prior to the embolization procedure. It is a same-day, minimally invasive procedure using a tiny incision in the neck or groin that allows the radiologist to take pressure measurements of the pelvic veins. The venogram and the ovarian vein embolization can be done together or separately, depending on the patient’s preference and/or insurance coverage. This will also be discussed during the pre-procedure consultation.

Recovering from Ovarian Vein Embolization & Enjoying the Results

After an ovarian vein embolization, a patient is typically discharged on the same day. Patients may experience mild discomfort, nausea, low-grade fever and/or cramping in the days after the procedure, which can typically be treated with ibuprofen. According to Dr. Doster, about 80 percent of patients can experience significant improvement in pelvic pain after undergoing an ovarian vein embolization.

“It’s remarkable that we can treat our PCS patients with an option that doesn’t require surgery. They can potentially be home recovering on the same day and then experience long-term benefits and symptom relief from this innovative non-surgical procedure,” added Dr. Doster. “It’s so rewarding to know we can help women suffering from pelvic congestion truly improve their quality of life.”

To learn more about Dr. Doster and Raleigh Radiology, visit www.raleighrad.com.

Source:

RadiologyInfo.org: www.radiologyinfo.org

Jamie Doster, MD Vascular & Interventional Radiologist Raleigh, NC

Jamie Doster, MD

Chair, Interventional and Vascular Radiology, Interventional and Vascular Radiologist

  • BS, Florida State University
  • MD, Florida State University College of Medicine
  • Internship, Greenville Memorial Hospital, Greenville, S.C.
  • Residency, University of Virginia, Charlottesville, VA
  • Fellowship in Vascular and Interventional
  • Radiology, University of Virginia
  • Member, Society of Interventional Radiology
  • Member, American College of Radiology
  • Member, Radiological Society of North America

Expertise in Interventional Radiology

Joined Raleigh Radiology in 2016

The Bright Future of PET Imaging

December 16, 2020 in 2020 Learn Posts

The Bright Future of PET Imaging
– Using Hybrid PET/CT Scanning to Target & Treat Specific Types of Cancer

A critical weapon in the fight against cancer is having a detailed and accurate diagnosis.  Therefore, it’s not surprising that hybrid PET/CT (positron emission tomography/computerized tomography) scan technology is now essential to detecting and diagnosing different types of cancer.  Radiologists can see things on a PET/CT scan that typically cannot be found using traditional CT scan or MRI imaging alone. While CT shows the location, size and shape of a potentially cancerous growth, PET scan can actually show if a tumor or growth is malignant.  This is credited to the use of radioactive imaging agents, such as fluorodeoxyglucose F 18, or FDG, which can detect metabolic activity indicative of cancer.

FDG – The Workhorse of PET Scan Technology
Known as the workhorse of PET imaging, FDG was the first imaging tracer to receive approval from the U.S. Food & Drug Administration (FDA) and is widely used for oncology imaging.  FDG is a radioactive molecule that is similar to glucose.  It is injected into the body and travels to areas of highest metabolism, helping radiologists discern metabolic abnormalities when the body is scanned.  This is important because cancerous growths and tumors have a very high metabolic rate.  FDG accumulates in the body’s neoplasm (new or abnormal tissue growth) and then provides a map to where a primary tumor is located as well as areas of metastatic disease.

“It’s a tremendously exciting time to be part of a new PET/CT practice,” shared Dr. Andrew Moran, chair of Nuclear Medicine and a nuclear medicine/PET imaging radiologist at Raleigh Radiology.  He and his team have worked tirelessly to bring hybrid PET/CT to the practice.  “Combined PET/CT scanning is an incredible tool to support oncologists in making sound treatment decisions for their patients. Playing a role in helping cancer patients get the best care possible is very rewarding.”

New Radiopharmaceuticals Emerge to Image Specific Cancers
PET/CT can be used to help diagnose many different types of cancers, including neuroendocrine cancers, prostate cancer, lung cancer, breast cancer, gastric cancer, and cancers of the head and neck.  According to the American Cancer Society, a PET/CT scan with FDG, most often used for diagnosing lung cancer and detecting if the cancer has spread.  However, over the past six-plus years, radiopharmaceutical scientists have also been working to develop new PET imaging agents that are specifically targeted for detecting certain types and sub-types of cancer.

“PET imaging is really just in its infancy stage now,” explained Dr. Moran.  “In 20 to 30 years, the field is on target for a revolution that will introduce many new, more specific radiotracers – we will be able to track tumors and metastatic disease better than we ever have in the past.”

For example, gallium-68 DOTATATE is being used to diagnose neuroendocrine cancers with great sensitivity and specificity.  Meanwhile, Axumin® (fluciclovine F 18) has already received FDA approval in the United States for metastatic prostate cancer by tracking rising prostate-specific antigen (PSA) levels.  Additionally, gallium-68 PMSA (prostate-specific membrane antigen) just recently received FDA approval, although it isn’t yet commercially available.  It’s an even more specific tracing agent for metastatic prostate cancer.

“Urologists are really excited about these new tracers and the opportunity to order these scans when they become available,” explained Dr. Moran. “Historically, no good imaging method for metastatic prostate cancer has ever been available, we’ve been relying on bone and CT scans.” 

For breast cancer imaging, the radiopharmaceutical Cerianna™ (fluoroestradiol F 18) just recently received FDA approval and can be used specifically for patients with estrogen receptor positive cancer; looking for the metastatic or recurring disease in these patients.  

“It’s amazing that a radiotracer can be targeted for this specific sub-type of breast cancer.  It will have an immense impact on detection and treatment decisions for breast cancer patients,” added Dr. Moran.  “Additionally, new tracers will be developed in the next several years for specific sub-types of lung cancer and GI tract cancers, making the process to track these diseases even more sophisticated as well.”

Theranostics – Using Radiotracers to Treat Cancer
Meanwhile, to peek further into the future, a new field has developed within PET imaging called theranostics.  In addition to being able to image tumors with PET imaging agents, radiologists will soon be able to use those tracers to treat cancer as well.  This will be done by attaching a radioactive particle to the imaging agent.  For example, a radiologist will use gallium-68 DOTATATE to image a patient and detect metastatic disease, then will follow up with an IV injection of lutetium (radioactive element) DOTATATE and actually ablate the tumor.  Currently, scientists are developing approximately 25 different theranostics agents to pair with PET imaging agents for cancer treatment.

“Actually being able to treat cancer based on the imaging agent is a real gamechanger,” said Dr. Moran.  “It’s a fascinating time in the field of PET because of the future and where all of this is headed for patient care.” 

Raleigh Radiology and WakeMed Health & Hospitals introduced a new hybrid PET/CT scanner in February 2021. 

References

Stanford Health Care: Advantages of a PET/CT Scan

National Cancer Institute: Radiopharmaceuticals – Radiation Therapy Enters the Molecular Age

Physics World: New PET tracers show immense promise in cancer imaging

American Cancer Society: Tests for Lung Cancer

Andrew Moran, MD Nuclear Medicine, Chair & Radiation Safety Officer Raleigh, NC

Andrew Moran, MD

Chair, Nuclear Medicine, Radiation Safety Officer, Nuclear Medicine/PET and Abdominal Imaging Radiologist

  • BS, Idaho State University
  • MD, Utah School of Medicine
  • Residency, Duke University Medical Center
  • Fellowships in body imaging and nuclear radiology, Duke University Medical Center
  • Member, Society of Nuclear Medicine
  • Native of California

Expertise in abdominal imaging, oncologic imaging, nuclear medicine and PET/CT

Joined Raleigh Radiology in 2006

Too Much Elbow Grease? The Causes, Treatment & Rold of MRI for Elbow Pain

December 8, 2020 in 2020 Learn Posts, Pendergrast Blog Post

Too Much Elbow Grease?
The Causes, Treatment & Role of MRI for Elbow Pain

“Just give it a little more elbow grease!”  We’ve all heard this expression before as a playful way to refer to hard work.  But as we get older, many of us realize how much sense it actually makes.  We use our elbows for all sorts of activities, work-related and recreational.  Therefore, it’s no surprise that elbow pain is a common condition found in adults who are 30 to 40-plus years of age, due to repetitive overuse.  Sports like golf, tennis and other racquet sports, and occupations such as painting, carpentry and plumbing are usually the culprits. 

Elbow Pain and Epicondylitis
The common cause of elbow pain is medically referred to as epicondylitis, and there are two types that occur.

  • Medial epicondylitis – or golfer’s elbow – occurs on the inside of the elbow and affects the common flexor tendon and muscles in the forearm that contribute to moving the wrist and fingers.
  • Lateral epicondylitis – or tennis elbow – occurs in the outer elbow, where the common extensor tendon attaches the forearm muscle to the elbow bone.

Both types of epicondylitis develop gradually and create a dull and achy type of pain or soreness in the elbow.  Dr. Thomas Pendergrast, a musculoskeletal radiologist with Raleigh Radiology, is well-acquainted with elbow pain, both as doctor and patient. 

“I have golfer’s elbow myself … from playing tennis,” he shared.  “Back in the 1800s [when they coined the phrase], different equipment was used for tennis which affected the lateral tendons and muscles.  In today’s game, tennis is more stressful on the medial elbow.”

Conservative Measures Come First in Treating Elbow Pain
Regardless if you are a tennis player suffering from golfer’s elbow, or a golfer suffering from tennis elbow, medical intervention is probably needed to relieve the pain, especially if your elbow is feeling tender to the touch. 

A good first step is to visit your primary care physician or orthopaedist where your condition can be evaluated based upon a physical exam and an understanding of your activities and history.  Dr. Pendergrast explained that if the symptoms and exam fit epicondylitis, your doctor will likely first recommend three to six months of conservative measures for the cessation of pain. 

Conservative measures include:

  • Anti-inflammatory medications
  • Icing after activity
  • Corticosteroid injections in the elbow, given by an orthopaedist
  • Activity modification
  • Physical therapy exercises, which can be done at home

Using MRI to Evaluate Persistent Elbow Pain
If conservative treatment measures are not successful and the symptoms of elbow pain continue, an MRI (short for Magnetic Resonance Imaging) is likely the next step. The elbow MRI is relatively simple and is a highly effective method for diagnosing elbow pain.  The scan takes approximately 20 minutes and can be done without contrast fluid. After interpreting the images, a radiologist will report back to the patient’s referring physician.

“The sensitivity of MRI for detection of epicondylitis is nearly 100 percent,” explained Dr. Pendergrast.  “With elbow pain, MRI findings and clinical findings tend to correlate nicely, making this condition readily identifiable – which is very helpful when it comes to determining the best treatment plan.  I find it very satisfying to be able to use MRI to give patients a clear answer about their pain.”

MRI can determine the severity of epicondylitis, for example, whether the tendon is thickening or inflamed, or if there is a tear in the tendon.  Tears can even be quantified using MRI to determine if surgical repair is needed.  MRI can also identify other abnormalities associated with elbow pain, such as nerve entrapment syndrome (when the nerves around the elbow are being compressed or squeezed) and osteoarthritis.  To an orthopaedic surgeon, a patient’s MRI results are often critical for surgical planning.

Does an MRI Always Mean Surgery?
Receiving an MRI for elbow pain does not always mean surgery is necessary.  As Dr. Pendergrast also explained, “The severity of a tendon tear can be present on a spectrum, from low-grade to more severe.  For example, I have tendinosis, a lower grade condition, and can keep it under control myself with the correct exercises.”   

Tendinosis is a chronic, degenerative condition that can occur in the elbow tendons, typically due to overuse.  This can increase the risk of a higher-grade tear but can also be managed with conservative measures such as activity modification, wearing a brace, consistent and correct exercises, strength training, nutrition and even massage. 

However, high-grade tendon tears may require surgery, especially if there is associated ligamentous injury, which can also be seen on MRI.  For this reason, it is important to see your doctor if you are experiencing elbow pain that is affecting daily activities.  Proper treatment is needed to help resolve the pain and prevent further deterioration. 

To learn more about Raleigh Radiology, visit https://www.raleighrad.com/.

Resources

Healthline

https://www.healthline.com/health/nerve-compression-syndrome

https://www.healthline.com/health/tendonosis#outlook

OrthoInfo – American Academy of Orthopaedic Surgeons

https://orthoinfo.aaos.org/

Thomas Pendergrast, MD

Musculoskeletal Radiologist, MQSA-Certified Breast Radiologist

  • BA – Chemistry: Wake Forest University
  • MD: Wake Forest School of Medicine
  • Internship – Internal Medicine: University of Tennessee Health Science Center
  • Residency – Radiology: Wake Forest Baptist Medical Center
  • Fellowship – Musculoskeletal Radiology – Wake Forest Baptist Medical Center
  • Member: American College of Radiology, American Medical Association, Radiological Society of North America, Society of Nuclear Medicine
  • Native of Wilmington, North Carolina

Interests: Diagnostic musculoskeletal imaging, image-guided musculoskeletal procedures

Joined Raleigh Radiology in 2020

A Joint Effort for Effective Pain Relief

December 7, 2020 in 2020 Learn Posts

A Joint Effort for Effective Pain Relief

Image-Guided Steroid/Anesthetic Injections to Treat Chronic Joint Pain
Osteoarthritis and chronic joint pain impact more than 25 million Americans. If you’re a sufferer, you know how this pain can hinder your daily life – holding you back from your normal, daily activities.  Maybe you’ve had to give up walking or golfing with friends because your ankles or knees won’t allow you to keep up.  Maybe it has become too difficult to play with your children or grandchildren because your joints continue to ache.  Or maybe your yard and garden have suffered because mowing grass, weeding and trimming hedges are impossible with pain in your shoulders, elbows or wrists.

Acute and chronic joint pain are common conditions that can certainly put a damper on life.  Often this type of pain is caused by an acute inflammatory process or trauma – such as a sports or overuse injury – or a chronic, degenerative disorder such as rheumatoid arthritis or osteoarthritis.  It may be that you have already tried conservative therapy for your pain, such as over-the-counter medication, physical therapy, massage, heat packs, stretching and/or even acupuncture, but nothing seems to work.  Fortunately, there is another option that doesn’t involve having surgery.

The Benefits of Image-Guided Steroid/Anesthetic Joint Injections
For chronic joint pain sufferers, steroid injections can provide fast and long-lasting relief. These injections typically comprise of a short-acting anesthetic and long-acting corticosteroid – which allows patients to feel relief almost instantly.  It’s a safe and effective pain relief method that comes with minimal side effects. While these injections are often given by orthopedic doctors, rheumatologists or even in some cases, primary care physicians – there are benefits to having the treatment administered by a radiologist who has image-guided technology at their fingertips.

Using ultrasound or low dose real time x-ray imaging called fluoroscopy, a radiologist can see directly into the joint to ensure the treatment is placed correctly every time. Image-guided joint injection therapy can also be used to diagnose the site of pain, control pain in non-surgical candidates, diminish pain to allow patients to begin physical therapy or exercise, and eliminate or delay surgical intervention. 

“Radiologists will always use image guidance to confirm that the injection is going directly into the affected joint – where it will have the greatest impact,” explained Dr. Jeffrey Browne, a musculoskeletal radiologist with Raleigh Radiology.  “X-ray guidance allows us to see inside the body in real-time, leading directly to the appropriate treatment location. This more exact science has been shown to have better outcomes compared to blind injections.  It’s quick, more accurate, more effective and reduces risk of complications.”

The Joint Injection Appointment – Quick and Easy
From start to finish, a patient having joint injection therapy will likely spend less than 30 minutes in the radiology office.  He or she will lie down on a table and be prepped for the procedure by a radiologic technician.  A musculoskeletal radiologist, like Dr. Browne, will then enter the room and discuss the procedure with the patient.  He or she will confirm the correct joint for treatment and also explain the risks and benefits of the injection, before sterilizing and draping the injection site and applying a local anesthetic. 

Once confirming the needle is in the correct location by ultrasound or fluoroscopy, the radiologist will inject a short-acting anesthetic and an intermediate to long-acting corticosteroid into the joint.   Complications are infrequent.

Immediate Pain Relief and Long-Term Results
In general, a patient will feel immediate relief of his or her symptoms but may be sore for one or two days after the injection until the long-term steroid becomes effective.  Patients with an acute inflammatory condition or trauma may only need one injection, however, patients with arthritis or chronic conditions may need multiple injections.  Three to four injections can be given per year and they typically provide three to six months of pain relief.

“As musculoskeletal radiologists, we are well-trained in performing these injections for multiple joints, including shoulders, elbows, wrists, hips, knees, ankles and feet,” added Dr. Browne.  “During each appointment, I enjoy the opportunity for facetime with my patients as well as the ability to relieve their pain using such a simple procedure.”

If you have been experiencing persistent joint pain and feel image-guided injections may be the right option for you, speak with your primary care physician, orthopedist or rheumatologist, or contact our office directly today: (919) 781-1437.

Jeffrey Browne, MD, Raleigh Radiology MSK Chair Raleigh, NC

Jeffrey Browne, MD

Chair, Musculoskeletal Imaging, Medical Director Raleigh Radiology

  • Medical Director, Raleigh Radiology
  • BS, Boston College
  • MD, University of Connecticut School of Medicine
  • Internship, St. Raphael’s Hospital
  • Residency, Duke University Medical Center
  • Fellowship in musculoskeletal radiology, Duke University Medical Center
  • Member, American College of Radiology, Radiological Society of North America and American Roentgen Ray Society.
  • Native of Connecticut

Interests: Musculoskeletal imaging

Joined Raleigh Radiology in 2008

Shoulder Ultrasound: Key to Diagnosing a Shoulder Injury

November 6, 2020 in 2020 Learn Posts, Bardini Blog Post

Shoulder Ultrasound:
Key to Diagnosing a Shoulder Injury

Raising, reaching, lifting, playing, painting, building and fixing…we use our shoulders every day, mostly without thought, for many significant activities. Therefore, any type of shoulder pain can quickly become difficult to ignore.

Most Common Reasons for Shoulder Pain
The three most common causes of shoulder pain include an injury or tear to the rotator cuff, a condition called bursitis, and an injury to the biceps tendon.

  • Rotator cuff tear or injury – The rotator cuff is made up of the four tendons and muscles that surround the shoulder joint. The upper arm bone depends on the rotator cuff to stay attached to the shoulder. Tears can be full or partial. Typical symptoms of this injury include a dull, deep ache in the shoulder, difficulty reaching up or behind, and arm weakness.
  • Bursitis – Bursae are small sacs of fluid that help cushion the bones, tendons and muscles near the shoulder joint. When these sacs become inflamed, pain will occur. Symptoms include swelling, redness, warmth/tenderness around the shoulder, or feeling achy or stiff. Sometimes even fever can develop.
  • Biceps tendon injury – The biceps muscle in the front of the upper arm. Symptoms of a tendon tear include warmth at the injury site, swelling, bruising, pain or ache at the injury site and throughout the arm, arm weakness, and pain when rotating the palm.

Often, these injuries can be attributed to repetitive microtrauma (frequent repetitive motion), but they can also be caused by a distinct, traumatic injury. Additionally, as people age, they become more susceptible to shoulder pain due to normal wear and tear. However, anyone, at any age or activity level, can injure a shoulder and experience shoulder pain.

Why Shoulder Pain Needs Ultrasound
When it comes to shoulder pain, diagnosis is complicated – the actual problem does not always correlate with where the patient hurts. Therefore, a physical exam is not enough, and an x-ray can only be used to see bones, not tendons.

Within the past 10 to 20 years, shoulder ultrasound has emerged as a critical method for investigating and diagnosing shoulder pain. For example, it can reveal with 100 percent sensitivity a full thickness tear of the rotator cuff, and a partial tear with 90 percent sensitivity. If you are experiencing shoulder pain, it is important to visit your primary care doctor or orthopaedic surgeon, who can order a shoulder ultrasound for a definitive diagnosis

“With shoulder ultrasound, we can look at many important structures,” explains Dr. John Bardini, a musculoskeletal radiologist with Raleigh Radiology. “The ultrasound probe can be angled wherever we need it to go, so we can evaluate each tendon at different angles and hone in on the reason for the pain. Shoulder ultrasound is alternative to shoulder imaging in patients who can’t undergo MRI . It is cost effective and can be scheduled and performed quickly.”

What to Expect During a Shoulder Ultrasound
An ultrasound of the shoulder should take approximately 10-15 minutes. Because the shoulder anatomy is complex, the accuracy of the exam is very dependent on technique. Therefore, a musculoskeletal radiologist will be present in the room, with patient and technician, to perform the exam.

“I try to make it interactive, educating the patient on what we’re doing and why we’re doing it,” explains Dr. Bardini. “At the end of the exam, I will talk with the patient about what I saw and give them a general idea of my findings, often showing them the images.”

During the ultrasound exam, the patient will wear a gown and remain seated. He or she will expose the injured shoulder and upper arm while putting the shoulder in different positions so the tendons can be revealed for imaging. Within a couple of hours, the radiologist will read the images and report final results to the referring doctor.

While shoulder anatomy is complicated, getting a shoulder ultrasound is a quick and effective tool that can help accurately diagnose a patient’s reason for shoulder pain. A quick and accurate diagnosis is the key to moving forward with a treatment and recovery plan to get patients feeling better and back to their lives.

John Bardini, MD is a musculoskeletal radiologist with Raleigh Radiology. To schedule a shoulder ultrasound, click here.

John Bardini, MD

Musculoskeletal Radiologist, MQSA-Certified Breast Radiologist

  • BS: University of Massachusetts at Amherst
  • MD: Rutgers New Jersey Medical School
  • Internship: Jersey Shore University Medical Center
  • Residency – Diagnostic Radiology: The University of Chicago Medical Center
  • Fellowship – Vascular and Interventional Radiology: University of Chicago Medical Center
  • Fellowship in Musculoskeletal Radiology: The University of Michigan Medical Center
  • Member: American College of Radiology, American Roentgen Ray Society, North Carolina Medical Society, North Carolina Radiological Society, Radiological

    Society of North America, Society of Skeletal Radiology

Interests: Musculoskeletal ultrasound,
Musculoskeletal ultrasound-guided procedures

Joined Raleigh Radiology in 2017

Getting to the ROOT of Knee Pain: Posterior Horn Medial Meniscus Root Tears

November 6, 2020 in 2020 Learn Posts, Shah Blog Post

Getting to the ROOT of Knee Pain:
Posterior Horn Medial Meniscus Root Tears

As we age, it’s common to feel more aches and pains, especially pain or discomfort in the knees while walking, jogging or squatting. Sometimes, a sports injury or other acute trauma can hurt the knee. There are many different causes of knee pain, but a tear to the knee’s meniscus root should not be taken lightly – as repair is often necessary to avoid the progression of osteoarthritis.

What is a Posterior Horn Medial Meniscus Root Tear?

The meniscus is a thin, fibrous cartilage in the knee that softens the contact between the leg’s tibia and femur bones – it attaches to ligaments of the tibia. It plays a key role in absorbing the shock and stress your knee takes doing regular tasks throughout the day.

While many have heard of a torn meniscus, there are many different types – and they’re not all treated the same way, which is why proper diagnosis is critical. The three “zones” of the meniscus are called the (1) posterior horn, (2) body, and (3) anterior horn. The meniscal root connects each horn to the bones. Root tears occur within a centimeter of the meniscal attachment and prevent the meniscus from doing its job of converting loading forces into hoop stress. Cartilage defects are bad news because they can lead to total cartilage loss, which occurs when the bones rub together. The result is altered movement and an increased risk of osteoarthritis.

“Reflecting up to 25 percent of meniscal root tears are tears of the posterior horn medial meniscus root,” explained Dr. Kesha Shah, musculoskeletal radiologist with Raleigh Radiology. “These tears are degenerative and most common in middle-aged women with an elevated body mass index (BMI). They are also six times more likely to be associated with cartilage defects.”

Symptoms & Diagnosis of a Posterior Horn Medial Meniscus Root Tear
Someone who experiences a posterior horn medial meniscus root tear may feel joint line pain (located horizontally from inside to outside knee along where the joint sits) or even hear a popping sound. They may also feel pain with full flexion of the knee and have a positive McMurray test after visiting an orthopaedic surgeon. The McMurray Test is an orthopaedic assessment used to detect tears in the knee joint that requires a physical exam.

Comprised of many different tendons and ligaments, as well as the meniscus, the knee can be deceptive when signaling pain. Therefore, it is quite difficult to diagnose the reason for knee pain after a physical exam alone. Someone who has visited an orthopedic surgeon due to knee pain will most likely receive an MRI. Most orthopaedic surgeons deem the MRI as critical to finding the reason for knee pain and determining the best treatment plan for a patient. MRI results will be read and interpreted by a musculoskeletal radiologist like Dr. Shah.

“The MRI can tell us the exact type of tear,” added Dr. Shah. “Specifically, with the posterior horn medial meniscus root tear, MRI really helps because this tear does not present as an acute trauma. It’s a slow, degenerative process. Proper diagnosis can help guide treatment and management, which can make a big difference in delaying the progression of osteoarthritis.”

Treatment of a Posterior Horn Medial Meniscus Root Tear
Surgery is often required to repair a posterior horn medial meniscus root tear and slow down any progression of osteoarthritis. The two most common surgical procedures are suture anchor repair and transtibial pullout repair. Both are performed arthroscopically and are done by either suturing the meniscus root back in place or tunneling through the bone to tie the meniscus back to the tibia. Another surgical option is to partially or completely remove the meniscus. However, this option can lead to an increased risk for osteoarthritis in the long-run.

For patients who already have osteoarthritis, surgery is much less helpful. Non-surgical treatment options include:

  • Analgesics or topical pain relief ointments
  • Activity modification
  • Wearing a brace

The moral of this story is: don’t ignore knee pain. Be seen by a doctor as soon as possible so that the exact cause can be determined and appropriate treatment plans can be put into action. Especially with a posterior horn medial meniscus root tear, surgery is essential in preventing further issues and getting back to a pain-free lifestyle.

Kesha Shah, MD is a musculoskeletal radiologist with Raleigh Radiology. To schedule an MRI, click here.

Sources:

Kesha Shah, MD

Musculoskeletal Radiologist

  • Emory B.A. in Psychology
  • USC-School of Medicine M.D.
  • Preliminary year in Internal Medicine, Greenville Memorial Hospital System
  • Chief Resident in Diagnostic Radiology, Maimonides Medical Center
  • Fellowship in Musculoskeletal Radiology, Duke University Hospital System
  • American College of Radiology, Member
  • Radiologic Society of North America, Member
  • American Roentgen Ray Society, Member

Interests: Musculoskeletal imaging with bone
and joint intervention

Joined Raleigh Radiology in 2017

An Ounce of Prevention is Worth a Pound of Cure

October 9, 2020 in 2020 Learn Posts, Shekleton Blog Post

An Ounce of Prevention is Worth a Pound of Cure

Women in the US have a one in eight risk over the course of their lifetime of being diagnosed with breast cancer. Most women know that getting an annual mammogram at age 40 and beyond can help detect breast cancer in its earliest stages when it’s most treatable.  Yet still, approximately 30% of women fail to get their routine mammogram screenings.  A 2009 study demonstrated that three-fourths of breast cancer deaths occur in women who don’t undergo yearly mammograms.  So, what’s holding women back from getting screened? Whether it’s the fact that 40-year old women tend to be too busy taking care of everyone else or other factors – the evidence is clear that getting a routine mammogram can save lives.  

Raleigh Radiology breast imaging radiologist Dr. Daniel Shekleton has a long history of promoting breast cancer screening – and for good reason.  He lost his mother to breast cancer at the age of 14, so it’s a topic near and dear to his heart. “Like most of us, I’ve been touched personally by the devastating effects of breast cancer. Today, as a radiologist, every day that I make a diagnosis of breast cancer is a good day. That’s because if I find cancer early enough, I know the patient can be a survivor and can go on to live a completely normal and healthy life,” he concludes. An ounce of prevention – or in this case, early diagnosis – really is worth a pound of cure.   

Mammography, Defined 

A mammogram is a low-dose x-ray of the breast that’s designed to help detect abnormalities in the breast tissue before cancer symptoms begin. This is beneficial because research clearly demonstrates that women who are diagnosed with breast cancer in its early stages are less likely to need a mastectomy and/or chemotherapy – and the cure rates are also higher for cancers detected early.  

While mammography screening for breast cancer has been around since the 1950s, it did not become the gold standard for screening until the 1980s. Since then, research has shown that mammography has helped reduce breast cancer mortality by anywhere from 35 to 50 percent.   

There are two types of mammography screening tests – either traditional 2D or newer 3D (digital breast tomosynthesis) mammography. Standard 2D mammography will take 4 images of the breast, while digital 3D screening obtains additional images using multiple angles. For women with dense breast tissue, a 3D mammogram can make it easier for radiologists to see around or through dense tissue to better detect abnormalities that could be pre-cancerous or cancerous.  

“When it comes to mammography, any screening is better than no screening,” explains Dr. Shekleton.  “Regardless of which option you choose, make sure you’re getting screened regularly – it just might save your life.” 

Screening Recommendations, Clarified 

While there are many organizations with varying recommendations for mammography screening, Raleigh Radiology follows guidance set forth by the American College of Radiology (ACR) and the Society for Breast Imaging (SBI) – which indicate that women of average lifetime risk (no family history, no genetic risk factors, etc.) should be screened with a mammogram annually starting at age 40. Quoting Dr. Shekleton, “Screening mammography saves lives, annual screening mammography beginning at age 40 saves the most lives.” Women deemed at high risk may start screening as early as age 25, and, in addition to mammography, screening breast MRI may also be recommended. 

Raleigh Radiology offers 2D and 3D mammograms throughout the region. To schedule a mammogram, call our office at (919) 781-1437. 

Daniel Shekleton, MD

Breast Imaging Radiologist, MQSA-Certified Breast Radiologist

Raleigh Radiology Chair of Breast Imaging
Vice Chair, Department of Radiology at WakeMed Cary

  • BS: United States Military Academy at West Point

  • MD: Southern Illinois University of Medicine

  • Residency – Radiology and Internal Medicine: Southern Illinois University of Medicine

  • Fellowship – Breast Imaging: Susan G. Komen Breast Center

  • Member: American College of Radiology, Radiological Society of North America, Society of Breast Imaging

Interests: Breast imaging and breast Intervention, PET, body MRI

Joined Raleigh Radiology in 2019

Cloudy Skies and Dense Breast Tissue – A Common Comparison

September 30, 2020 in 2020 Learn Posts, Crosby Blog Post

Cloudy Skies and Dense Breast Tissue
A Common Comparison

Imagine you’re looking at a sky that’s filled with thick, white clouds – looking for a tiny white bird. Now, imagine you’re looking at a clear, blue sky looking for that same tiny white bird. In which scenario do you think it would be easier to see the white bird?

This is the analogy that fellowship-trained, board-certified breast imaging radiologist Dr. Kenneth Crosby often shares with his patients when explaining what it means to have dense breast tissue. For radiologists whose eyes are trained to look for small white masses on a mammogram, it’s simply harder to detect abnormalities in women with dense breast tissue.

When talking about breast density, it’s first important to understand the various categories of density. Dr. Crosby explains there are four categories as follows:

  • Fatty breasts mean the breasts are made up mostly fat – this accounts for 10% of women.
  • Scattered areas of fibroglandular density mean some areas of the breast are dense, but most are not. This accounts for 40% of all women.
  • Heterogeneously dense means most of the breast tissue is dense in nature. This accounts for 40% of women.
  • Extremely dense means nearly all the breast tissue is dense. This accounts for just 10% of women.

Generally, those with heterogeneously dense or extremely dense breasts are those who are considered to have dense breast tissue.

In North Carolina, state law mandates that your radiologist include this information in their report. That’s because women with dense breast tissue are considered to be at a slightly higher risk for developing breast cancer, although doctors aren’t yet sure why this is the case.

With that said, dense breast tissue is extremely common – accounting for 50% of all women – most of whom will never develop breast cancer.

“When looking at mammogram results for women with dense breasts, it can be more difficult to see the white masses that may indicate cancer,” explains Dr. Crosby. “While we certainly don’t want these women to be overly concerned, we do often recommend these women opt for a 3D mammogram. 3D mammograms allow us to get more images of the various layers of tissue within the breast – making it easier to detect abnormalities that may not show up in a standard mammogram.”

Even so, Dr. Crosby reiterates that when it comes to breast cancer screening, the mammogram is still considered the gold standard. While other tests such as breast ultrasound or breast MRI are available for areas of concern, women who have a 2D mammogram or 3D mammogram and are not at an increased risk of breast cancer (due to personal/family history or other factors) don’t typically need another level of screening.

“While ultrasound and MRI imaging studies are helpful for looking at abnormalities identified on a mammogram, they may also often provide false positives that could result in costly biopsy procedures and a lot of unnecessary anxiety for women,” Dr. Crosby explains. “With that said, I never want to take the power of choice away from my patients.” In these cases, the patient’s referring physician will need to order a breast MRI in order for us to complete this secondary level of testing.

In addition, Dr. Crosby recommends that even during Covid-19, women should make sure to stay on schedule for getting an annual mammogram and have a yearly clinical breast exam from a primary care provider or OB/GYN. Furthermore, women are urged to conduct monthly self-breast exams as recommended by the American Cancer Society.

Dr. Kenneth Crosby is a fellowship-trained, board-certified breast imaging radiologist with Raleigh Radiology. He earned his medical degree from the University of North Carolina School of Medicine, where he went on to complete his residency in diagnostic radiology. He also completed his fellowship training in breast imaging from the University of North Carolina School of Medicine. He is a member of the American College of Radiology, the Radiological Society of North Carolina.

Kenneth Crosby, MD

Breast Imaging Radiologist, MQSA-Certified Breast Radiologist

  • BS: North Carolina A&T State University

  • MD: University of North Carolina at Chapel Hill

  • Residency – Diagnostic Radiology: University of North Carolina at Chapel Hill

  • Fellowship – Breast Imaging: University of North Carolina at Chapel Hill

  • Member: American College of Radiology, North Carolina Radiological Society, Radiological Society of North America

Interests: Breast imaging and breast Intervention

Joined Raleigh Radiology in 2017