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Diagnostic Imaging for Inflammatory Breast Cancer Patients:

Most IBC patients will initially receive a diagnostic mammogram and usually an ultrasound of the breast. They will also usually receive a MUGA scan to test their heart function, and a chest x-ray, a bone scan, and a CT scan to determine the Staging of their IBC (if they have metastasis (spread) of the cancer). Occasionally, a PET Scan or MRI will also be prescribed.

Diagnostic Mammography:

A diagnostic mammogram is an x-ray of the breast that is used to diagnose unusual breast changes, such as a lump, pain, thickening, nipple discharge, or a change in breast size or shape. A diagnostic mammogram is also used to evaluate changes detected on a screening mammogram which is a mammogram used in women who have no signs or symptoms of breast cancer.

The diagnostic mammogram of the IBC patient will be compared to their screening or baseline mammograms of the past if the patient had a previous mammogram. A diagnostic mammogram involves more x-rays to obtain views of the breast from several angles. The technician may magnify a suspicious area to produce a detailed picture that can help the radiologist make an accurate diagnosis.

Digital (computerized) mammography records x-ray images in computer code instead of on x-ray film, as with conventional mammography. The digital mammogram is stored on a computer, and the magnification, orientation, brightness, and contrast of the image may be altered after the exam is completed to help the radiologist more clearly see certain areas and makes long-distance consultations with other mammography specialists easier. The procedure for having a mammogram with a digital system is the same as with conventional mammography.

If an abnormality is detected with diagnostic mammography, follow-up may include additional breast imaging, such as ultrasound, or biopsy. Since IBC often does not form an obvious tumor, it is often not detected by mammography. Suspicious thickening of the skin may be the only indication of IBC through mammography. Most IBC patients will require a biopsy or biopsies to definitively diagnose their IBC.

Breast ultrasound, also known as sonography or ultrasonography, creates images of the breast via high-frequency sound waves which are transmitted from a transducer (a device that resembles a microphone) through the breast. The sound waves make echoes as they bounce off various types of tissue. A computer converts the echoes into an image that is displayed on a video monitor.

Receiving an ultrasound is painless. While lying on a table, the ultrasound technician will cover the part of the breast to be examined with a gel. This lubricates the skin and helps to transmit the sound waves. The technician will then guide the transducer back and fourth across the breast until clear images have been generated and captured for analysis.

While ultrasound provides an effective and painless way to identify many breast abnormalities, unlike a mammogram, an ultrasound does not have good spatial resolution and therefore does not provide as much detail for deeply located breast abnormalities. It is also unable to reliably detect microcalcifications which are tiny calcium deposits that can often be the first indication of breast cancer.

Ultrasound is excellent at imaging cysts and can often quickly determine if a suspicious area is in fact a cyst or a dense mass which may require a biopsy to determine if it is cancerous.
MUGA Scan:

The MUGA Scan (Multiple Gated Acquisition Scan) is a noninvasive test that is performed by attaching a radioactive substance to red blood cells, then injecting the red blood cells into the patient’s bloodstream. The patient is then placed under a special camera (a gamma camera), and with computer manipulation, a moving image of the beating heart is made. From this image, the MUGA scan gives an accurate and reproducible way to measure the left ventricular ejection fraction (LVEF) which is an excellent measure of overall cardiac function. The ejection fraction is simply the proportion of blood that is expelled from the ventricle with each heart beat. (A normal LVEF is 0.5 or greater.)

Adriamycin (generic name - doxorubicin) is a chemotherapeutic drug that is commonly used in the treatment of inflammatory breast cancer. Adriamycin can be toxic to the heart muscle. To minimize the risk of damaging the heart muscle with Adriamycin, physicians monitor the patient’s cardiac function by means of the MUGA scan. Before a patient receives their first dose of Adriamycin, a MUGA scan is usually performed, both to establish a baseline LVEF, and to rule out pre-existing cardiac disease.
Chest X-ray:

Chest x-ray (also known as Chest Radiography) is done for the evaluation of the lungs, heart and chest wall. IBC patients will have chest x-rays to determine their Staging and their ability to receive certain chemotherapy agents like Adriamycin which can be damaging to the heart.

Tumors that spread to the lung (lung metastasis) may be visible on the chest x-ray. However, lesions that are small or superimposed on normal structures may not always be visible. Heart irregularities, such as fluid around the heart (pericardial effusion), an enlarged heart, or abnormal heart anatomy or congestive heart failure may also be visible on a chest x-ray. Pleural effusions (fluid around the lungs) on one or both sides can be detected.

Radiography involves exposing a part of the body to a small dose of radiation to produce an image of the internal organs. When x-rays penetrate the body, they are absorbed in varying amounts by different parts of the anatomy. The ribs and spine, for example, absorb much of the radiation and appear white or light gray on the image. Lung tissue absorbs little radiation and appears dark on the image. Depending upon the type of image-recording medium, chest x-rays can be maintained as hard copy film for filing or as filmless digital images that are archived electronically.
Bone Scan:

A Bone Scan (also known as radionuclide scan) can reveal if the cancer has spread (metastasized) beyond its primary site and developed secondary cancer growths in the bones. On an x-ray one might see that the bone is not broken, but on a bone scan, physicians can see metabolic changes caused by fine fractures, small tumors, or degenerative diseases such as arthritis.

A bone scan is usually done in the 'Nuclear Medicine' Department of the hospital. For cancer diagnosis, the entire body is usually scanned. The scan involves one injection, but, otherwise, is painless.

The scan uses a large camera called a 'gamma camera.' that picks up radioactivity. To have the scan, you must first have a radioactive substance called a radionuclide injected into your blood stream, but this substance is harmless. The radionuclide travels through the blood and collects in your bones. More of it tends to collect in areas where there is increased activity in the bone, and this activity means the bone is breaking down, or repairing itself. These areas of activity are commonly called 'hot spots.'

Having 'hot spots' doesn't necessarily mean that there is cancer in your bones. Bone can break down and repair for other reasons, for example, arthritis will also show up on the scan.
CT Scan:

A CT Scan or CAT Scan is the term used to describe a radiologic test known as computerized tomography (or computed axial tomography) that has the ability to image soft tissue, bone, and blood vessels. Unlike other medical imaging techniques, such as conventional x-ray imaging (radiography), CT enables direct imaging and differentiation of soft tissue structures, such as liver, lung tissue, and fat. CT is especially useful in searching for large space occupying lesions, tumors and metastasis and cannot only reveal their presence, but also the size, spatial location and extent of a tumor.

The CT scanner is a doughnut-shaped machine that uses advanced x-ray technology to take pictures of cross-sections of your body, called 'slices.' CT can examine areas that cannot be seen on regular x-ray examinations. CT scanners use x-rays, but the amount of radiation is kept to an absolute minimum.

IBC patients will usually be given a CT scan of the chest, abdomen and pelvis. The test itself is completely painless. You will be asked to lie quietly on the CT scanner's 'patient couch' during the study. Depending on the type of study being done, you may be injected with, or be asked to drink, contrast material. Many contrast agents contain iodine, which causes an allergic reaction in some individuals. Notify the staff if you have had an allergic reaction to iodine or a contrast agent in the past, or if you have any other allergies.

If you are having a CT scan of your abdomen or pelvis, you will be asked to drink barium, a fluid that helps mark your intestinal tract so that the radiologist may interpret your scans properly. You will then be asked to wait for one hour before the examination, because it takes that long for the drink to coat your stomach and small intestine. In fact, depending on your medical problem and the type of study that has been requested, you may be asked to drink one bottle of barium sulfate at bedtime the night before the study.

If your abdomen is being studied, a series of pictures will be taken from your lower chest down to the upper pelvis. During such a study, you will be asked to hold your breath so that the pictures will not be blurred. You may receive signals from the technologists (or from the machine) about your breathing. As part of your test, before or during the study, you may be given an injection of a contrast agent. This allows the radiologist to obtain clearer images of your organs.
PET Scan:

A PET Scan (also called a Positron Emission Tomography Scan or Imaging) uses a small dosage of a chemical called radionuclide combined with a sugar. This combination is injected into the patient. The radionuclide emits positrons. A PET scanner will rotate around a patient's body to detect the positron emissions given off by the radionuclide. Because malignant tumors are growing at such a fast rate compared to healthy tissue, the tumor cells will use up more of the sugar which has the radionuclide attached to it. The computer then uses the measurements of glucose used to produce a picture which is color coded.

Different colors or degrees of brightness on a PET image represent different levels of tissue or organ function. For example, because healthy tissue uses glucose for energy, it accumulates some of the tagged glucose, which will show up on the PET images. However, cancerous tissue, which uses more glucose than normal tissue, will absorb more of the substance and appear brighter than normal tissue on the PET images.

PET scans are used most often to detect cancer and to examine the effects of cancer therapy by characterizing biochemical changes in the cancer. A Pet Scan can differentiation between recurrent, active tumor growth and necrotic (dead) soft tissue masses in cancer patients.

PET is usually done on an outpatient basis. You should wear comfortable, loose-fitting clothes. You should not eat for four hours before the scan. You will be encouraged to drink water. Diabetic patients should ask for any specific diet guidelines to control glucose levels during the day of the test.

The PET scanner has a hole in the middle and looks like a large doughnut. Within this machine are multiple rings of detectors that record the emission of energy from the radioactive substance in your body and permit an image of your body to be obtained. While lying on a cushioned examination table, you will be moved into the hole of the machine. The images are displayed on the monitor of a nearby computer.

Because PET allows study of body function, it can help physicians detect alterations in biochemical processes that suggest disease before changes in anatomy are apparent on other imaging tests such as CT or MRI scans. The value of a PET scan is enhanced when it is part of a larger diagnostic work-up. This often entails comparison of the PET scan with other imaging studies such as CT or MRI.

An MRI (or magnetic resonance imaging or nuclear magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. These images can detect the difference between normal and diseased tissue.

MRI makes better images of organs and soft tissue than other scanning techniques, such as CT or x-ray. Breast MRI is excellent at imaging breasts with implants. MRI is also useful for staging breast cancer, determining the most appropriate treatment, and for patient follow-up after breast cancer treatment. MRI is especially useful for imaging the brain, spine, the soft tissue of joints, and the inside of bones.

The MRI scanner is a tube surrounded by a giant circular magnet. The patient is placed on a moveable bed which is inserted into the magnet. The magnet creates a strong magnetic field which aligns the protons of hydrogen atoms, which are then exposed to a beam of radio waves. This spins the various protons of the body, and they produce a faint signal which is detected by the receiver portion of the MRI scanner. The receiver information is processed by a computer, and an image is then produced.

The image and resolution produced by MRI is quite detailed and can detect tiny changes of structures within the body. For some procedures, contrast agents are used to increase the accuracy of the images. An MRI scan is a painless radiology technique which has the advantage of avoiding x-ray radiation exposure. During the MRI scan, patients lie in a closed area inside the magnetic tube. All metallic objects on the body are removed prior to obtaining an MRI scan. MRI scanning requires that the patient lie still for best accuracy.

After the MRI scanning is completed, the computer generates visual images of the area of the body that was scanned and these images are transferred to film (hard copy). This film is given to a radiologist, a physician who is specially trained to interpret images of the body reproduced on film.
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