Imaging Services/Modalities Mission Health provides ambulatory and inpatient imaging services including: Bone Density What is a Bone Density exam? It is a test like an X-ray that quickly and accurately measures the density of bone. It is used primarily to detect osteopenia or osteoporosis, diseases in which the bone's mineral and density are low and the risk of fractures is increased. How to prepare for a Bone Density appointment? No diet restrictions Do not take calcium supplements on the day of the exam Wear clothing that does not have zippers, buttons, or metal studs. Bring a list of current medications with you. No barium studies or nuclear medicine studies 7 days prior to Bone Density appointment What is a Bone Density exam like? You will lay still on the table for 30 minutes, no breath hold, no changing if dressed appropriately. How long will the exam take? 30 minutes. Computed Tomography (CT) What is a CT Exam? Mission Health offers a full range of CT examinations utilizing the latest technology along with licensed radiologic technologists and board-certified radiologists. CT scans involve a special form of X-ray that uses computer technology to produce cross-sectional images. These images allow providers to see ”inside the body,“ providing information to help you and your doctor make better decisions about your healthcare. A CT scanner looks like a large ”doughnut” with open ends in which a table moves in and out as it takes images and makes a swirling noise. There is an intercom system in the machine so you and the technologist can communicate. A CT scan is a low-risk procedure. Generally, most CT exams take approximately 5-15 minutes. How do I prepare for my appointment? For certain CT examinations, your doctor may request contrast agents. One or two agents may be ordered. Oral contrast is an agent that allows your digestive system to be more visible. In some situations, your doctor may request an injection of IV contrast that ”highlights” blood vessels and organs. If you meet certain criteria, as determined by our radiologist, we may perform a blood test to check your kidney function before you receive IV contrast. Your daily medications may be taken as usual. Detailed information will be provided before your examination. What should I wear? A CT scan can be done wearing everyday clothes. It is helpful to avoid any type of metal in the area that is being scanned. What happens after the exam? There are no restrictions or limitations placed upon you after your CT examination. You may eat, drink and take medications as normal. If you take certain medication for diabetes, you will receive instructions at the time of your exam. You may drive as normal. Also, if you receive oral or IV contrast, we will ask you to increase your fluid intake afterward. How do I obtain results? Your images will be reviewed and read by our board-certified radiologists, and a report will be sent to your doctor. This generally takes 24 to 48 hours. Your doctor will inform you of the results. What are the common exams? CT abdomen and pelvis with contrast. You may be asked to drink oral contrast and receive IV contrast. Do not eat 2 hours before or drink 1 hour before your exam. CT chest with contrast. You will receive IV contrast during your exam. Do not eat 2 hours before or drink 1 hour before your exam. CT head without contrast. You will not receive any contrast for this exam. There are no restrictions before the exam. CT chest without contrast. You will not receive any contrast for this exam. There are no restrictions before the exam. Interventional Radiology What is Interventional Radiology? Interventional radiology (IR) is a medical specialty that performs minimally invasive treatments, using radiologic imaging for guiding the procedure. Interventional Radiology treatments have become the primary method of care for a variety of conditions, offering less risk, less pain, and less recovery time compared to open surgery. Interventional radiologists are board-certified and fellowship trained physicians whose area of expertise is minimally invasive, targeted treatments. How to prepare for an Interventional Radiology appointment? NPO (nothing to eat or drink) after midnight, on the night before your procedure. You will need a driver who can bring you to the hospital or outpatient center before the scheduled time of the procedure. During this time, you will register in admitting, have lab work completed, then have your IV started, and history taken by the nurses in Radiology Recovery Unit. What to wear? You will be asked to remove any clothing or jewelry that may interfere with the exposure of the body part being examined. You will also be required to change into a patient gown. All necessary items will be provided. What is an Interventional procedure like? You will be positioned on the examination table and cleaned with an aseptic solution. Depending on the type of procedure, you may be asked to hold your breath for brief periods of time while the fluoroscopy is being performed. Motion interferes with obtaining good X-ray images. Contrast dye may be injected into the IV line in order to better visualize the organs or structures being studied depending on the type of procedure. How long will the exam take? Depending on what type of procedure you are having performed, the time may vary. Forms: Patient consent, Medication list and other forms will be completed prior to the procedure. Magnetic Resonance Imaging (MRI) What is a MRI exam? An MRI exam is an imaging procedure that utilizes a very strong magnetic field, radiofrequency pulses and a very specialized computer to create detailed images of organs, muscles, nerves, soft tissues and bones within your body. There is no ionizing radiation with MRIs. Generally most MRI exams take approximately 30-45 minutes and are performed by registered Radiologic Technologists licensed in Magnetic Resonance Imaging. Board certified radiologists will review and interpret your MRI. All MRIs are very loud due to the inherent nature of the machine. Hearing protection is required for all exams. Ear plugs/headphones will be provided by the technologist during your examination. How to prepare for a MRI appointment? There is typically no preparation for an MRI examination. However, if your MRI exam is of the abdomen more than likely you will be asked to withhold food/drink for 4 hours prior to your test. Water is allowed and prescribed medications should be taken as normal. What to wear? Since you are going into a large magnet, we need to protect both you and our staff. For this reason, you will be required to change into hospital clothes (scrubs/gowns) prior to you MRI exam. You must remove all jewelry and body piercings, even if they are not in the area beingscanned. All bobby pins, hearing aids, insulin/medication pumps, drug delivery patches, etc. willneed to be removed as well. Dentures will need to be removed for exams above the shoulders. We ask you please leave valuables at home. A locker will be provided for you to lockyour belongings in. The MRI staff will assist you to make sure that you are prepared properly for your MRIexamination. Contraindications You will be asked to fill out a Safety Screening Questionnaire every time you have an MRI exam. The MRI staff will review this with you once completed to determine if an MRI is safe for you. More information may be required before having an MRI for some implants before we can proceed. Most surgical implants such as joint replacements, sutures, pins, screws, etc. are fine. The MRI staff will determine on an individual basis if there are any safety concerns for you. We ask if you have any information regarding your surgical implant (ID card, surgical notes) to please bring it with you on day of appointment for the technologist toresearch and confirm that you can safely proceed with the MRI. How long will the exam take? Typically 30-45 minutes for the MRI examination. We do ask for you to arrive earlier for registration and to fill out the necessary paperwork prior to your MRI. Contrast agent disclosure Some MRI examinations may require an injection of an IV contrast agent (Gadolinium) during the procedure. This gives the physician more information for certain things. Please let the MRI staff know if you are pregnant or have allergies if receiving contrast. Please bring a list of medications with you to your appointment. What about claustrophobia? Every effort will be made to ensure your comfort. Most MRIs you will lie on your back and the table will move you in slowly into the MRI. Our wide bore MRI (70cm) is open on both ends with a fan blowing air through it. You will be given an alert button to hold in your hand. If you need assistance just squeeze it and the technologist will stop the test immediately. There is also an intercom that the technologist will speak to you every few minutes to check on you or give you instructions during the examination. If you are claustrophobic or anxious about being in the MRI machine you should discuss this with your ordering physician and see if they can prescribe medication to help you relax. The MRI department is not able to prescribe medication for you. Mammography What is a mammography exam? A mammogram is an X-ray of the internal breast tissue. It uses low-dose radiation to create images that allow radiologists to detect changes in breast tissue that could indicate a medical condition. The primary use of mammography is to detect cancer, however, mammography can also detect other, more common, benign conditions such as cysts and benign masses called fibroadenomas. Studies have shown that mammograms can detect some changes years before they can be felt during a breast exam. A screening mammogram is done regularly on women who have no symptoms. This means you do not feel a lump or aren’t having any breast problems. You can schedule screening exams by calling 828-213-9729. A diagnostic mammogram is done when a woman is experiencing symptoms such as a palpable lump or spontaneous nipple discharge. A referral from your healthcare provider is required for a diagnostic mammogram. What is a 3D mammogram? 3D mammography, also known as tomosynthesis, is a breakthrough in breast imaging that provides a clearer, more accurate view compared to 2D mammography alone. Research on breast tomosynthesis in large populations consistently shows improved breast cancer detection rates, especially of earlier invasive cancers. It also shows a 40 percent decrease in callbacks for additional imaging, which may lessen anxiety for patients. 3D mammography is approved for all women undergoing a standard screening or diagnostic mammogram regardless of age or breast density. A 3D mammography machine creates both 2D and 3D mammograms. You stay in one place while all the images are taken on the same machine. A 3D mammogram takes a few seconds longer than a 2D mammogram because more images are taken, but you likely won’t even notice a difference. At our centers, 3D mammography gives the same or slightly more radiation than 2D mammography. By North Carolina law, insurance covers 2D screening mammograms. Most insurance also covers 3D mammograms. Still, it’s best to confirm with your insurance provider before going for 3D mammograms. What is whole breast ultrasound? Whole breast ultrasound, otherwise known as ABUS, enables radiologists to look through hundreds of image slices to find breast cancers that may have been missed on a mammogram. It is recommended that women with dense breasts obtain whole breast ultrasound in addition to their regular screening mammogram. This technology uses nonionizing soundwaves and increases the chances of diagnosing invasive breast cancer at an earlier, more treatable stage. Why is breast density important? Breast density is determined through a women’s mammogram and is described as one of four categories depending on the amount of breast tissue in comparison to fat in the breast. The categories are fatty, scattered fibroglandular, heterogeneously dense or extremely dense. Forty percent of women over age 40 have heterogeneously dense or extremely dense breasts. Because both cancers and dense breast tissue appear white on a mammogram, diagnosing cancer on dense breasts can be more difficult. Whole breast ultrasound, interpreted with a screening mammogram can increase the detection of cancers that may be hidden on a mammogram. How do I prepare for a mammography appointment? If your previous mammograms were not performed at a Mission facility, please obtain a copy of your images and associated report, and bring it to your appointment. The radiologist will compare these images with your new images to look for changes in the architecture of your breast. Do not wear perfumes, powders or deodorant on the day of the exam. These substances can be seen on a mammogram and can interfere with an accurate interpretation of the exam by the radiologist. Wear a two-piece outfit. You will be asked to change into a gown. Please arrive at least 15 minutes before your scheduled appointment to allow time for parking and registration. What is a mammography exam like? The technologist will position your breast on the platform of the mammogram machine and then gradually compress the breast with a special paddle. Compression is necessary in order to: Even out the breast tissue so that any abnormalities will not be hidden Decrease the amount of radiation used by making the tissue thinner Hold the breast still to avoid a blurry image caused by motion It takes approximately 5 minutes to obtain the necessary images. What is a ”call back”? If the radiologist identifies an area of interest on a screening mammogram, you will be contacted to return for additional images. Less than 10 percent of screening mammograms are called back for additional imaging. 'Receiving a call back does not necessarily mean that something “bad” has been found. Mammography detects many benign conditions along with the more worrisome ones such as cancer. Sometimes the changes seen on a mammogram are merely the result of the normal aging process or changes in weight, but any change needs to be addressed to obtain a definitive diagnosis. Be prepared to spend an hour or more with us when you return for more imaging. Additional mammographic views are taken and sometimes an ultrasound is performed to provide additional information for the radiologist. If you are called back, the radiologist will review your images while you wait and you will receive your results at the time of your appointment. You may want to contact your insurance company to check your coverage for this additional diagnostic mammogram and possible ultrasound. How do I obtain my mammogram results? There are several ways to obtain mammography results: Access your report via our patient portal usually within 1-3 days after your exam. Click here to access the portal. Opt to have your results sent to you via secure email. You will typically receive an email within 1-3 days. Elect to receive your results via the US Postal Service. This may take a few days longer. If we are waiting for your images from an outside facility for comparison, there could be a longer delay. Regardless of which option you choose, a copy of the report sent to your provider will be accessible in your patient portal. Patients having a diagnostic mammogram or who are called back for additional images will receive their results at the time of their appointment. A letter will also be sent to you, and a report will be sent to your provider. If you have not received your results in the expected time frame, call 828-213-0811. Why do I need to complete the history questionnaire? When you arrive for your mammogram, you will be asked to complete a detailed history form. These questions will help us determine your lifetime risk of breast cancer. If based on your answers it is suspected that you may have a lifetime risk greater than 20 percent, you and your provider will be notified. You may then choose to have a more comprehensive risk evaluation at a high-risk clinic where they will make personalized recommendations for risk-reducing strategies. Nuclear Medicine What Is a Nuclear Medicine Exam? Nuclear medicine provides safe and useful methods of obtaining functional information about various organs of the body. It involves the introduction (usually by IV injection) of a radioactive tracer into the patient. The location of the tracer can be detected using a gamma camera. The gamma camera does not emit any radiation, but rather detects the radiation coming from the patient. Hepatobilliary Imaging (HIDA Scan) A diagnostic study that evaluates hepatocellular function and the patency of the biliary system. The radioactive tracer is injected intravenously and imaged as it is processed by the liver and biliary system. Normally, we visualize the liver, the biliary ductal system, gall bladder and the small bowel. Patient Preparation: Patients should be fasting a minimum of 4 hours prior to the examination. Pain medication should be discontinued 4 hours prior to the examination. We will also need any history regarding gall bladder surgeries. Examination Time: Varies between 1-4 hours patient to patient, with breaks after the first hour into the exam. Bone Scans A diagnostic study used to evaluate the distribution of active bone formation in the body. Whole body, limited, SPECT and three-phase imaging are all techniques that may be used. These techniques all require the intravenous injection of a radioactive tracer with imaging performed 3-5 hours post injection. The three-phase technique includes blood flow images and early images, which are completed within 10 minutes after injection. Patient Preparation: Patients should be well hydrated. They will be instructed to drink extra fluids between the time of injection and the time of delayed imaging. The patient will be asked to urinate immediately before delayed imaging is begun. Examination Time: Approximately 3-5 hours in total although a delay between injection time and scan time can be up to 5 hours in which the patient is allowed to leave the imagining center and go about their normal routine to return at the scheduled time to complete the exam. Gastric Emptying Study A diagnostic procedure performed to evaluate gastric motor function. The radioactive tracer is incorporated into a standard meal (oatmeal in most cases), and the stomach contents imaged over time. Computer analysis of the data can determine the percent of retained contents 1-4 hours and the T1/2 time (the time for the content to empty by one half). Patient Preparation: Nothing by mouth (NPO) for 6 hours. Patients will have to consume the meal provided within 10 minutes. Diabetic patients should bring their insulin. Please be aware that this study will not be finished for over 4 hours. If vomiting occurs during the examination, the examination is terminated and must be rescheduled. Examination Time: Consumption of the meal and initial imaging will take about 15 minutes. Follow-up imaging will take place at 1-hour intervals to the 4-hour mark. Each imaging session will take 5-10 minutes. Patients can wait in the waiting room between acquisitions. Lung Scan A diagnostic study to evaluate the air flow and the blood flow within the lungs. The exam is done in two parts. The ventilation is done first followed by the perfusion study. It is the combined result that leads to the final diagnosis. Patient Preparation: A chest X-ray should be taken within 24 hours prior to the lung scan. The isotope may be administered with the patient either upright or supine for the ventilation scan. The isotope for the perfusion scan should be administered with the patient supine. Examination Time: It will take approximately 30 minutes for the ventilation scan and 30 minutes for the perfusion scan. Thyroid Scan and Uptake I-123 (NOTE: This is a 2-day test) This diagnostic study is an imaging procedure examining the structure and function of the thyroid gland. Thyroid gland nodules, masses position, and function are all evaluated with this exam. Patient Preparation: Thyroid medications must be held before this exam will be started. Thyroxine 4 weeks. Triiodothyronine 2 weeks. Antithyroid medications including Propylthiouracil (PTU), Tapazole (Methimazole) 7 days. Patient who has received IV contrast must wait 6 weeks before having this exam. Examination Time: Day One will consist of patient registering and arriving in the Nuclear Medicine department to go over their medical history with a technologist. Once it is determined that the test will proceed, the patient will swallow an I-123 capsule that is the size of a standard medicine capsule. The patient will receive a return time for the next day. Day Two consists of the patient returning to the department and sitting in front of a machine that counts the I-123 that was absorbed by the thyroid gland in the 24-hour period. This will take only a few minutes. The patient will then lay on a table, and a camera will take four images of the thyroid gland, each image taking 10 minutes or less. PET Brain PET/CT Scan a) Assessment for Temporal Lobe Dementia (amyloid plaque) b) Assessment for seizures, progressive dementia and brain metastasis Whole Body Bone PET/CT a) Detection and evaluation of bone metastases Total Body PET/CT Diagnosis, staging, and restaging cancer Axumin Whole Body PET/CT Used to evaluate men with suspected prostate cancer recurrence based on elevated PSA levels following prior treatment Xofigo Ra-223 Treatment Indicated for the treatment of patients with castration- resistant prostate cancer, symptomatic bone metastases, and no known visceral metastatic disease. Ultrasound What is an ultrasound exam? Ultrasound uses sound waves to "see" inside your body. There is no radiation exposure during an ultrasound exam. Sound waves are produced by the ultrasound probe (also known as a transducer) and directed into the body where they bounce off organs and tissues, creating "echoes" that are reflected back to the transducer. Because ultrasound images are captured in real time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels. A computer converts the echoes to electronic signals and processes those signals, creating images that can be seen on the ultrasound screen. When is ultrasound used? Your doctor may order an ultrasound exam to: Evaluate symptoms like pain, swelling and infection Examine internal organs Evaluate blood flow using Doppler ultrasound Guide a radiologist or physician assistant during an invasive procedure such as a biopsy Guide a surgeon during a surgical procedure Monitor an unborn baby during pregnancy When are ultrasound exams offered? Abdominal, to include evaluation of the following structures and surrounding area: Liver Gallbladder Kidneys Pancreas Spleen Aorta Bile ducts Vascular May be used to evaluate for DVT (deep venous thrombosis) in the upper or lower extremities Evaluate the carotid arteries Evaluate abdominal vasculature Evaluate some bypass grafts Preop vein-mapping studies Obstetrical/Gynecological 1st, 2nd and 3rd trimester OB ultrasounds Ultrasound of the female pelvis to include the uterus, cervix, ovaries and surrounding structures Small Parts Evaluation of the thyroid and parathyroid Scrotal/testicular ultrasound Invasive Procedures (some biopsies are performed at outpatient locations) What should you expect during your ultrasound? Your ultrasound will be performed by a registered diagnostic medical sonographer. All of the sonographers in the Mission Health system are highly trained and registered in specialty exams through the American Registry for Diagnostic Medical Sonography (ARDMS). Exam time may vary based on exam, anywhere from 30 to 90 minutes. You will be provided with a hospital gown or a sheet to cover up if necessary. You will lie down on the exam table, and the technologist will apply a warm, water-based gel to your skin. The gel allows the sound beam to penetrate your body as well as helping the probe to slide more comfortably over your skin. The sonographer will take multiple images according to the standard protocol for the type of exam you are having. The technologist may ask you to change your position (e.g., turn on your side, raise your arms, etc.) or to hold your breath from time to time throughout the exam. The images are then analyzed and interpreted by a board-certified radiologist. The radiologist will send a signed report to your referring physician, who will share the results with you. How do you prepare for your ultrasound? You do not need to wear any specific type of clothing. If you are required to change into a gown, one will be provided to you. Many exams require that you have nothing to eat or drink prior to the exam. Please see below for specific details: Abdominal ultrasounds: Nothing to eat or drink after midnight (your exam will be scheduled as early in the day as possible) You may take medications with a sip of water Please do not chew gum prior to your exam Pelvic ultrasounds: You must have a full bladder for this exam Please drink 32 ounces of liquid one hour prior to your scheduled appointment time Do not empty your bladder prior to your exam OB ultrasounds: For 1st trimester ultrasound, please follow the pelvic ultrasound prep detailed above If you are unsure of how far along your pregnancy is, please fill your bladder as described above For 2nd and 3rd trimester ultrasound, no prep is required Vascular and small parts ultrasounds: No prep is needed Invasive procedures (biopsies, thoracentesis, paracentesis): You may be asked to hold certain medications Specific instructions will be shared with you when your appointment is scheduled Frequently Asked Questions (FAQs) Who will read my exam? A Board Certified Radiologist from Asheville Radiology Associates will review your images and a report will be sent to your referring provider, typically within 1 business day. If you or another provider need a copy of your images or an additional copy of your report please call 828-213-0636. If you have registered for our patient portal, you can access your records at missionhealth.org/patient-portal. What if I have billing questions? You will likely receive two bills for your imaging services. One bill will be from Mission Health/Mission Imaging Services for the imaging exam. The other bill will be from Asheville Radiology Associates for the radiologist’s interpretation of the images. If you submitted insurance at the time of registration, we will file with your insurance company prior to you receiving an invoice from us. Mission Pardee Health Center patients will receive a third bill if urgent care services were provided. For billing questions or payments, please contact: Mission Health: 828-213-1500 or click here to make a payment. Asheville Radiology Associates: 1-800-475-6112 or click here to make a payment. How do I schedule or reschedule an exam? Scheduling or Rescheduling and Appointment 828-213-XRAY(9729) or have your provider fax and order to 828-213-XFAX(9329). Lung Cancer Screening patients call 828-213-2506. How do I share my experience? Our mission is to create an exceptional care and service experience for every patient and family. Your feedback is valuable and can give us an opportunity to improve care and services. If you have provided our team with an email address or cell phone number, you will receive a survey to complete within the next 90 days. You may also reach out to us at 828-213-0101 or email us at imaginginfor@msj.org to share your experience.