Diagnostics Imaging

The O.U. is equipped with two Magnetic Resonance equipment:

1) Philips Ingenia 1,5 T located in VB: it is a latest generation high field machine (1,5 Tesla), equipped with a “big-board”, i.e. the diameter of the patient’s entry gantry is larger than on traditional equipment.

The magnetic resonance diagnostic room has been equipped with an intercom for music both in piped music and through the headphones that the patient wears, and with colored LED lights to make the environment more comfortable and the examination, lasting longer than other methods , more bearable. The exams that involve the use of paramagnetic contrast medium intravenously are carried out in sessions dedicated to the presence of the anesthesiologist.

2) Esaote 0,2 T located in VG: it is a low field open machine, dedicated to the study of joints, based on orthopedic diagnostic questions and it is specific for claustrophobic patients.

Studies are carried out both without and with contrast medium of all body sectors:

• MRI of the abdomen and the pelvis
• Joint MRI: all joints (pelvis, hips, knee, shoulder, wrist, elbow, foot, ankle)
• RMN Colangiopancreatografica
• Breast MRI
• Facial Massif MRI and ATM
• Neuro MRI: brain (including cranial nerves, ear, orbits), spine and spinal cord
• RMN prostata senza e con mdc

All diagnostic tomographs are of the latest generation and are equipped with low dose iterative statistical reconstruction systems: with this technology it is possible to reduce the patient dose up to 80% compared to the traditional technique. They are also equipped with optional systems for the reduction of artifacts due to metal components.

The O.U. is equipped with two CTs: one is in Villa Gemma for standard examinations of internal patients and the other one is in Villa Barbarano for both standard and contrast medium tests, for external and internal patients.

The tests involving the use of contrast medium are performed in Villa Barbarano in sessions dedicated to the presence of the anesthesiologist who assesses their feasibility on the basis of the patient’s suitability in order to carry out the examination itself.

CT exams are performed:

• CT examinations with contrast medium (Study performed with the use of intravenous iodinated contrast medium for diagnostic, follow-up and vascular studies)
• CT examinations without contrast medium (brain, spine, thorax, abdomen, pelvis, small and large joints, facial massif and dentascan)

Ultrasound scans of:

• Echo Complete Abdomen
• Echo Lower Abdomen
• Echo Upper Abdomen
• Echo Urinary system (kidneys, bladder)
• Echo-cardio
• Echo Neck and lymph nodes
• Echo small and large joints
• Echo prostate (transrectal echo at the Urology Clinic)
• Echo vascular system: Eco-color doppler TSA + lower limbs
• Echo soft tissue
• Echo Thyroid
• Echo Uterus and Outbuildings (Transvaginal Echo at the Gynecology Clinic)

Following the recent renovation and expansion of the clinic, the O.U. diagnostic imaging has fully digital technology for radiographic examinations of its patients: with digital technology it is possible to perform tests with very high spatial resolution with a very high level of image quality and a consequent reduction in both time execution of the examination and dose levels that are now optimized to the bare minimum.

Conventional tests are performed: non-contrast: chest x-ray, abdomen, spine, bone segments;
contrasting: digestive tract, study of swallowing, opaque enema.

• Abdomen X-ray
• Opaque Clisma X-ray
• Rachis X-ray
• Bone segments X-ray
• Swallowing study X-ray
• Chest X-ray
• Digestive tract X-ray

Bone mass in terms of skeletal density (BMD) can be assessed with various generically definable techniques such as bone densitometry (or computerized bone mineralometry, MOC).

1) Vertebral / femoral DEXA: double photon beam bone densitometry (DEXA) is the technique of choice for assessing bone mass allowing the diagnosis of osteoporosis, the prediction of fracture risk and monitoring. The bone mineral content (BMD) is assessed for each segment; the femur and / or lumbar spine are usually examined. DXA is currently the preferred technique for evaluating bone mass, allowing for the diagnosis of osteoporosis, the prediction of fracture risk and monitoring. It is a dual energy X-ray absorbimetric technique that allows to evaluate, virtually for each skeletal segment, the bone mineral content (BMC, g / cm of bone segment) projected on a surface obtaining a parameter called BMD ( g / cm² of bone segment). BMD is correlated with the risk of fracture: The densitometric examination allows you to measure bone mass fairly accurately and precisely and remains the best predictor of the risk of osteoporotic fractures. The densitometric reporting of osteoporosis is based on the comparison between the BMD value of the examined subject, expressed in standard deviations (DS), and the average BMD value of healthy young adults (peak bone mass) (T-score). The BMD value can also be expressed in comparison with the average value of subjects of the same age and sex (Z-score). It should be remembered that for the WHO the threshold for diagnosing the presence of osteoporosis (T-score <<-2.5 SD) is applicable, today, only to the densitometric values obtained with DXA technique. WHO criteria for the diagnosis of osteoporosis are not applicable to women before menopause or to men before 50 years

2) The DEXA exam performed instead on the whole body (DEXA total body) allows the evaluation of the body composition by quantifying the lean mass and fat mass, both globally (throughout the body) and analytically (in the various districts, in particular the abdominal and glute- femoral) whose distribution is important for the risk of the onset of many pathologies. The D.E.X.A. also allows to evaluate the possible difference in muscle mass between the limbs as well as between the upper and lower portions of the body. Therefore it is useful during a nutritional or physical activity program aimed at reducing fat mass or increasing muscle mass
or for monitoring the effectiveness of a training or rehabilitation program in sportsmen of all levels, or after trauma and surgical interventions.
It is also useful in the presence of gastrointestinal pathologies with malabsorption, alterations of thyroid function, diabetes mellitus, eating behavior disorders (anorexia, bulimia), chronic renal failure and all pathologies characterized by high catabolism.

3) Ultrasound investigation: the Achilles ultrasound investigation conducted on the heel, uses an ultrasound technique and it is capable of providing two parameters (speed and attenuation) which are indirect indices of bone mass and structural integrity. Ultrasound parameters have been shown to predict the risk of osteoporotic (femoral and vertebral) fractures in a manner not inferior to lumbar or femoral DXA, both in postmenopausal women and men. Bone ultrasonography does not represent a direct measure of bone density. Discordant results between ultrasound evaluation and DXA are not surprising or infrequent and do not necessarily indicate an error, but, rather, that the QUS parameters are independent predictors of the risk of fracture being influenced by other characteristics of the bone tissue. Also for this reason QUS cannot be used for the diagnosis of osteoporosis according to WHO criteria (T-score <<-2.5). QUS can be useful when a lumbar or femoral DXA assessment is not possible and can be recommended for epidemiological investigations and first level screening, considering its relatively low costs, easy portability and absence of radiation. Therefore, in the impossibility of a DXA assessment, a low ultrasound value, in the presence of other clinical risk factors for fracture, may justify a therapeutic intervention, while a high ultrasound value, in the absence of risk factors, indicates a low probability of osteporotic fractures and therefore the futility of further investigations.

• X-ray bone densitometry (DEXA)
• X-ray bone densitometry – Fat/Lean Mass (DEXA)
• Ultrasound bone ultrasound (QUS)

It is a dedicated clinic inside the O.U. of diagnostic imaging and it consists of a digital mammography unit, specifically a Selenia tomologic equipment from Hologic, and a dedicated ultrasound system. Pre-operative mammograms and eco-mammaries, controls and follow-up are performed; for both affiliated patients with NHS and private patients.
The patient performs both mammography and ultrasound as well as any further investigations on the same day, as booked.
One session per week for biopsy investigations is dedicated to breast surgery: biopsy both under ultrasound and stereotactic guidance, cytological examinations and eco-biopsies.

In-depth diagnostic tests are also carried out, such as breast MRI and ATS Screening

• Mammography
• Breast ultrasound
• Needle aspiration / Breast biopsy
• Screening mammography ATS Brescia