By Michele Pilon, MS, BSN, RN, NE-BC
Dr. Norris Crigler is Transylvania Regional Hospital’s Imaging Medical Director and was instrumental in getting our Interventional Radiology program up and running. “Within the two primary branches of radiology — diagnostic imaging and interventional radiology — each comes with its own subspecialties. Diagnostic imaging radiologists can focus on neurological, body, musculoskeletal, pediatric or women’s imaging, while interventional radiologists can specialize in either neuro interventional radiology (NIR) or peripheral interventional radiology. NIR clinicians perform nonsurgical brain and spine procedures, while peripheral IR specialists perform similar procedures in the rest of the body, except for the heart,” explains Dr. Crigler, adding that “IR procedures save the patient from undergoing surgery with general anesthesia.”
Dr. Crigler shares that the image-guided procedures performed by interventional radiologists are diverse. They include angiography (X-ray pictures of blood vessels), angioplasty and stenting (opening blocked blood vessels), thrombolysis and thrombectomy (dissolving or removing blood clots), catheter placements (such as ports for chemotherapy), needle biopsies, and spinal and joint injections. “TRH’s newly installed CT scanner with enhanced software allows us to now offer many CT-guided biopsies and drainage procedures, in addition to previously performed US guided procedures and Fluoro guided injections,” says Dr. Crigler. While many procedures are offered at TRH, other IR procedures, as well as all NIR procedures, are referred to Mission Hospital.
The two broad types of imaging technologies that radiologists use are those that use ionizing radiation and those that don’t. X-rays, Fluoro, CT and NM imaging expose patients to extremely small amounts of ionizing radiation, while MRI and US do not. Dr. Crigler explains that for radiation exposure to be considered dangerous, one would need to receive it in high doses. In the United States, the average person receives the same amount of background radiation from the earth and outer space, which is unavoidable, as from medical procedures. “There’s no scientific evidence to suggest that even repeated radiation exposures from radiology procedures, except cancer radiation treatments, result in increased cancer risk. That said, radiologists remain committed to performing procedures when only medically necessary and using the lowest amount of radiation necessary to provide needed results,” says Dr. Crigler.
Radiology is also a powerful tool in breast cancer diagnosis and treatment. TRH’s Regional Director of Imaging Services, Kelly McFarland, notes that the hospital now offers women 2D and 3D mammography, automated breast screening ultrasound (ABUS) and targeted diagnostic ultrasound as imaging modalities. “If a breast cancer is suspected, depending on the finding type, we can usually perform US-guided biopsy of the breast mass. Rarely, a stereotactic biopsy or MRI-guided biopsy will need to be performed in Asheville based on how the finding is best visualized on imaging. When a breast cancer patient undergoes surgery at TRH, we sometimes perform placement of a localization wire to assist the surgeon in finding the tumor and removing the minimal amount of breast tissue necessary,” she says. Nuclear medicine is also used in lymphoscintigraphy procedures, which help the surgeon find the patient’s “sentinel” lymph node in the armpit. If there’s no spread of cancer from the breast to this lymph node, it limits the extent of surgery necessary. “We’re happy to bring this state-of-the-art technology to our community in Brevard, allowing us to diagnose and treat breast cancer at an earlier and more curable stage,” adds McFarland.
The hospital’s breast imaging capabilities are part of a multi-pronged approach to make breast cancer screening as powerfully preventative as possible, according to Dr. Rachel McEachern, TRH’s Medical Director of Women’s Breast Health. “We are excited to now offer a complete risk assessment based on a questionnaire about breast density, as well as family and personal breast cancer history. This will help determine an individual’s lifetime risk of developing breast cancer and guide the type, frequency, and starting age of annual screenings recommended by the American College of Radiology and the Society of Breast Imaging,” she explains. These recent enhancements to TRH’s breast imaging and interventional radiology offerings are the result of the partnership with Asheville Radiology Associates.
With a newly installed MR scanner at TRH, our MRI capabilities have expanded, too. In addition to brain and spinal disorders, we’re also able to use MRI imaging to address many more conditions, including orthopedic, prostate and women’s pelvic imaging, and gastrointestinal system, gall bladder, pancreas and liver studies. New MRI software provides higher-quality images on patients with metallic surgical implants (though patients with pacemakers must go to Mission Hospital). Our large-bore MRI provides access for larger patients, and enhancements like software improvements that allow for shorter scan times and a soon-to-be-installed music system make patient comfort a top priority.
The combination of the expertise wielded by TRH’s highly skilled and caring radiology staff and board-certified radiologists, and our advanced technology have earned us both accreditation and Diagnostic Imaging Center of Excellence™ recognition from the American College of Radiology (ACR). TRH is one of just 13 facilities in the state to attain this honor, and the acknowledgement means that we consistently exceed the high bar that is set by the ACR in terms of clinical excellence, safety and patient comfort.
Continued advances in radiology allow our clinicians to see more of what was once invisible inside their patients and save these patients unnecessary risk, discomfort and time. There is no question that TRH’s more robust interventional radiology, women’s and MRI programs benefit our community members tremendously, whether they visit us for a routine health screening or for attending to acute and chronic medical conditions.
Michele Pilon, MS, BSN, RN, NE-BC, is the Chief Executive Officer and Chief Nursing Officer of Transylvania Regional Hospital.