Other Side Of The Coin

DMike

MedScanMan said:

Yes. Non contrast films of
Yes. Non contrast films of the abdomen are very important to compare. The Thorax as you say would be a CT scan of the chest (Lungs). A CT of the Abdomen alone would stop at the top of your hip. Usually 2-3 cm below the iliac crest. The bone you feel on your side about inline with your belly button. If that's where the scan stopped then you did not have the pelvis done. The pelvis would have taken the pictures past the bladder filled with contrast to the end of the pelvic bone. Not going to get fancy here with anatomy. Can I ask you how you know that the technologist stopped at the top of your hip....as you call it? If it's because he or she was poking you there before the scan, it's a place we use to measure. It's a place the laser light goes so we know where you are.
Jeff

Pelvis
Jeff,
The doctor told me that's where it stopped while scrolling/zooming through the image. So, it sounds like I didn't get the pelvis CT scan.

It was a confusing day because my doctor was leaving and it was his last day in the clinic. I was upset to learn that that day and I was looking at the scan with his resident at the time I learned they stopped at the top of the hip.

Thanks for the info and welcome to the group again!

--David

MedScanMan

DMike said:

Pelvis
Jeff,
The doctor told me that's where it stopped while scrolling/zooming through the image. So, it sounds like I didn't get the pelvis CT scan.

It was a confusing day because my doctor was leaving and it was his last day in the clinic. I was upset to learn that that day and I was looking at the scan with his resident at the time I learned they stopped at the top of the hip.

Thanks for the info and welcome to the group again!

--David

Pelvis
David, you might want to check with the center that did your scan. Could be that the tech didn't send all the images to the radiologist. When the scan is over, the images are sent from one computer to another. For all you know the pelvis images are right there on the computer in the scanner. If that was the case those images would simply be sent to the radiologist and your report would have an adendum added. I would check. I've seen it happen and it takes only seconds to send the images.
Jeff

brea588

MedScanMan said:

My recovery time was three
My recovery time was three days. Normal surgical pain. Second night, after dinner.....two vicodin and an hour later walking around the nursing station with the Ivac. Minimal post op antibiotics, nothing fancy and home at the end of the third day, not counting surgery. With all these extra doctors monitoring you, you'll do fine. You're an RN..............Who's better than you!

rcc
Thank u so much u have relieved a lot of my fears. So glad i met u here tonight. You are a blessing to this web site. Doc said surgery would be about 5 hours and 3-5 days in hospital. Yes I will be fine. Thanks for encouragement. You know when noone you know has been through this it is hard for others to understand what ur feeling and thinking.

DMike

MedScanMan said:

Pelvis
David, you might want to check with the center that did your scan. Could be that the tech didn't send all the images to the radiologist. When the scan is over, the images are sent from one computer to another. For all you know the pelvis images are right there on the computer in the scanner. If that was the case those images would simply be sent to the radiologist and your report would have an adendum added. I would check. I've seen it happen and it takes only seconds to send the images.
Jeff

Thanks
Will do, Jeff. Thanks!

sunlover_56

MedScanMan said:

Thanks for the welcome Fox.
Thanks for the welcome Fox. I've been reading your posts for a couple of weeks now. Everyone actually. I didn't just jump in. The interaction here was great and I wanted to be a part of it. Glad you're doing well!

MedScanMan
Wow, How fortunate are we to have you join our group. (Not so fortunate for you, though, I'm sorry) Dare I jump in with a question? I am due for my very first 3 month scan this August. A lower abdomon and pelvic was ordered along with an upper chest xray. My concern is the chest xray. I wondered why they dont just do a full body scan which is more likely to pick up any thing that has spread to my lungs etc? (By the way I had a full lap scope nephr in April taking out a 7.5 RCC tumor which was contained to the kidney)

MedScanMan

sunlover_56 said:

MedScanMan
Wow, How fortunate are we to have you join our group. (Not so fortunate for you, though, I'm sorry) Dare I jump in with a question? I am due for my very first 3 month scan this August. A lower abdomon and pelvic was ordered along with an upper chest xray. My concern is the chest xray. I wondered why they dont just do a full body scan which is more likely to pick up any thing that has spread to my lungs etc? (By the way I had a full lap scope nephr in April taking out a 7.5 RCC tumor which was contained to the kidney)

Hi Sun
I think the normal follow-up for RCC is a chest x-ray to look for nodules....as we all know RCC can go to lungs and either a renal ultrasound or a CT Abdomen the keep an eye on the other kidney as well as to make sure nothing shows up in the liver. Mine was only 2cm and I simply had the Ultrasound at 3 months and an in office Cystoscopy for the bladder tumor which seems to be completely gone.....for now. Your doctor is thinking why expose you to that extra radiation that you'd get with the CT Chest when nodules can be seen pretty well on a simple chest x-ray. Not to make everyone run away from the CT machine but the amount of radiation you receive during a Chest Abdomen and Pelvis with and without contrast is probably close to a few thousand chest x-rays. We think about radiation as a bad thing, but when medically necessary the best way to think about it is "If you can't see it....it can't hurt you". At 7.5cm I would much rather my follow up be the CT scan rather than the ultrasound. Good luck with the results.

adman

MedScanMan said:

Hi Sun
I think the normal follow-up for RCC is a chest x-ray to look for nodules....as we all know RCC can go to lungs and either a renal ultrasound or a CT Abdomen the keep an eye on the other kidney as well as to make sure nothing shows up in the liver. Mine was only 2cm and I simply had the Ultrasound at 3 months and an in office Cystoscopy for the bladder tumor which seems to be completely gone.....for now. Your doctor is thinking why expose you to that extra radiation that you'd get with the CT Chest when nodules can be seen pretty well on a simple chest x-ray. Not to make everyone run away from the CT machine but the amount of radiation you receive during a Chest Abdomen and Pelvis with and without contrast is probably close to a few thousand chest x-rays. We think about radiation as a bad thing, but when medically necessary the best way to think about it is "If you can't see it....it can't hurt you". At 7.5cm I would much rather my follow up be the CT scan rather than the ultrasound. Good luck with the results.

Agreed....

I just had a 5.0cm ( path - stage 1/ grade 1 ) right radical a few weeks ago.
Pre tests were cyst, CT abd/ pelvis w/ wo contrast, MRI abd, MRA abd, Nuc Med bone scan, mag 3 renal, chest X-ray, PSA.
- All negative

I had a small cyst on my remaining left kidney which obviously needs to be very closely watched.
Surgeon just told me my 3 month is blood work & a ultrasound.

I've been wondering if this is aggressive enough.

love_of_my_life

Thank You!
Thanks for joining this board.

I have a feeling that your insight will be extremely valuable for many.

Tom

MedScanMan

adman said:

Agreed....

I just had a 5.0cm ( path - stage 1/ grade 1 ) right radical a few weeks ago.
Pre tests were cyst, CT abd/ pelvis w/ wo contrast, MRI abd, MRA abd, Nuc Med bone scan, mag 3 renal, chest X-ray, PSA.
- All negative

I had a small cyst on my remaining left kidney which obviously needs to be very closely watched.
Surgeon just told me my 3 month is blood work & a ultrasound.

I've been wondering if this is aggressive enough.

Hi Adman
I'm guessing that your follow up blood work will always be Bun, Cratinine and GFR. Just to make sure that the kidney you have is functioning well. For that small cyst, I think Ultrasound is fine for three month follow up. I have a question for you though. Looking at your pre tests.....if you were in my diagnostic center you would have made the rounds of every department other than Mammo. I'm not getting the MRA. I've done many MRA's of the abdomen, but they were anatomy specific. Most of them were for renal artery stenosis. Were your numbers so high that a stent was being considered? Just wondering why you had to have the MRA. Good to meet you.

Jeff

adman

MedScanMan said:

Hi Adman
I'm guessing that your follow up blood work will always be Bun, Cratinine and GFR. Just to make sure that the kidney you have is functioning well. For that small cyst, I think Ultrasound is fine for three month follow up. I have a question for you though. Looking at your pre tests.....if you were in my diagnostic center you would have made the rounds of every department other than Mammo. I'm not getting the MRA. I've done many MRA's of the abdomen, but they were anatomy specific. Most of them were for renal artery stenosis. Were your numbers so high that a stent was being considered? Just wondering why you had to have the MRA. Good to meet you.

Jeff

Follow up - tests
Jeff,

Not sure why the MRA was ordered to be honest. I don't recall any 'pre-surgery' mention about needing any stents.

Thanks for the valuable input & perspective.

PS
After speaking to my family doc yesterday - ( post surgery ) I have made a decision to be treated by a nephrologist moving forward.
I feel I want their perspective on future blood work, diet, meds, etc.
I will also see my surgeon as well.

Thanks.

garym

MedScanMan said:

Hi Sun
I think the normal follow-up for RCC is a chest x-ray to look for nodules....as we all know RCC can go to lungs and either a renal ultrasound or a CT Abdomen the keep an eye on the other kidney as well as to make sure nothing shows up in the liver. Mine was only 2cm and I simply had the Ultrasound at 3 months and an in office Cystoscopy for the bladder tumor which seems to be completely gone.....for now. Your doctor is thinking why expose you to that extra radiation that you'd get with the CT Chest when nodules can be seen pretty well on a simple chest x-ray. Not to make everyone run away from the CT machine but the amount of radiation you receive during a Chest Abdomen and Pelvis with and without contrast is probably close to a few thousand chest x-rays. We think about radiation as a bad thing, but when medically necessary the best way to think about it is "If you can't see it....it can't hurt you". At 7.5cm I would much rather my follow up be the CT scan rather than the ultrasound. Good luck with the results.

You hit the ground running...
MSM,

I had a feeling you we're going to be a popular guy, but WOW! I have a question related to Sunny's, I'll be having my 3 year CT in December and I won't have had a chest x-ray for 2 years. As i understand it a CT usually catches the bottom of the lungs so my question; is the CT sufficient or should I request an x-ray as well?

Thanks,

Gary

MedScanMan

garym said:

You hit the ground running...
MSM,

I had a feeling you we're going to be a popular guy, but WOW! I have a question related to Sunny's, I'll be having my 3 year CT in December and I won't have had a chest x-ray for 2 years. As i understand it a CT usually catches the bottom of the lungs so my question; is the CT sufficient or should I request an x-ray as well?

Thanks,

Gary

Garym
Gary

I surely can't say how often your doctor feels it necessary to have the f/u chest x-ray. That would vary by physician. I can tell you that the base of the lungs that show at the beginning of the CT Abdomen is small. Maybe 3-4cm. Just enough for the technologist to know that he gets a running start to the Abdomen. If you take a big breath on the first pass, more of your lungs will show. The lung seems to move down (as scans go) when a real deep breath it taken.

Jeff

NewDay

love_of_my_life said:

Thank You!
Thanks for joining this board.

I have a feeling that your insight will be extremely valuable for many.

Tom

Thank you too
You only thought you had retired. It is so good to have your expertise here. I hope we don't run you off with all of our questions.

Thanks,
Kathy

MedScanMan

NewDay said:

Thank you too
You only thought you had retired. It is so good to have your expertise here. I hope we don't run you off with all of our questions.

Thanks,
Kathy

Kathy
You're very welcome. If I can help I will. If I don't know......I'll say so. I did that once today. I almost felt bad that I had no answer but I'm not going to snow anybody here. I'll do my best. It's the only place I can type where I don't get political. You have to come to a place like this to get your faith in humanity restored.......but I had to get cancer to get here...........Funny

Jeff

pjune127

MedScanMan said:

Kathy
You're very welcome. If I can help I will. If I don't know......I'll say so. I did that once today. I almost felt bad that I had no answer but I'm not going to snow anybody here. I'll do my best. It's the only place I can type where I don't get political. You have to come to a place like this to get your faith in humanity restored.......but I had to get cancer to get here...........Funny

Jeff

Welcome Jeff
You are a good man! We are lucky to have you with us for this awful ride. My oncologist believes he can get all the information he needs with a chest/abdomen CT with no contrast. He says it is not necesssary to stress out my remaining kidney. While this makes me happy to not have to drink that disgusting stuff, I worry that he might be missing something. I had a 10 cm tumor that had invaded my VC and some mets in my lungs at diagnosis. RCC Stage 4 Grade 4... My scans are every 2-3 months, next one the beginning of September. Am on Inlyta now after Sutent for 10 months. Can't wait to have you interpret my next scan. Welcome aboard. Hope you won't get tired of us.

MedScanMan

pjune127 said:

Welcome Jeff
You are a good man! We are lucky to have you with us for this awful ride. My oncologist believes he can get all the information he needs with a chest/abdomen CT with no contrast. He says it is not necesssary to stress out my remaining kidney. While this makes me happy to not have to drink that disgusting stuff, I worry that he might be missing something. I had a 10 cm tumor that had invaded my VC and some mets in my lungs at diagnosis. RCC Stage 4 Grade 4... My scans are every 2-3 months, next one the beginning of September. Am on Inlyta now after Sutent for 10 months. Can't wait to have you interpret my next scan. Welcome aboard. Hope you won't get tired of us.

Thanks for the Welcome
It's not always necessary to drink what you call (that disgusting stuff).....I've heard other words for it, not suitable for this board. But it is simply barium. The same barium you drink when having a G.I. series for a look at your stomach. Just a different consistency. There's one called Scan-C that is made in Canada and tastes a lot better than EZ Cat used by most. I used to order that for my patients. The people I worked for never realized the difference in cost so the hell with them. Patients used to say "this ain't half bad". There are other things to drink but usually only if you're being considered for Gastro surgery. Now that stuff is icky. If your creatinine is lower that 1.4 and your BUN under 20, I wouldn't think your doctor should be worried about the other kidney excreting the injection of nonionic iodine quickly. Since you already have your diagnosis, he's probably right. If all he needs are measurements of the remaining kidney, as well as checking for lung nodules, IV contrast wouldn't be needed. If he (or you) are worried about anything else.......liver, pancreas, anything in the pelvis.....lymph nodes.....etc., then IV contrast is definitely needed. I look forward to hearing what the radiologist dictates in his impression at the bottom of your next CT report. I hope I can help you make sense of it all.

Be well,

Jeff

DMike

Oral Contrat Material
Hi Jeff,
I did check on my pelvis CT and it was done. It seems they're working in 2 computer systems at the moment and my doctor was trying to view it on the old system. Anyway, I have the radiology report and it's good!

I noticed on the reports for chest, abdomen and pelvis it states:
"Technique: Axial images of the abdomen were obtained following the administration of oral contrast material. Next, axial images of the abdomen were obtained in the arterial and portal venous phases following intravenous injection of contrast medium per protocol. Coronal reformatted images were reviewed. IV Contrast: Omnipaque 350, 120ml, per protocol. Oral Contrast: Gastrografin, diluted per protocol, 32 oz. IV contrast injection rate: 3 ml per sec. Scan delay: 35/100 sec. Scan field of view: 330mm."

I did not take oral contrast material. Isn't this saying I did? I did have IV contrast. Just trying to be well informed for the next round of CT scans. Thanks so much for your help. --David

MedScanMan

DMike said:

Oral Contrat Material
Hi Jeff,
I did check on my pelvis CT and it was done. It seems they're working in 2 computer systems at the moment and my doctor was trying to view it on the old system. Anyway, I have the radiology report and it's good!

I noticed on the reports for chest, abdomen and pelvis it states:
"Technique: Axial images of the abdomen were obtained following the administration of oral contrast material. Next, axial images of the abdomen were obtained in the arterial and portal venous phases following intravenous injection of contrast medium per protocol. Coronal reformatted images were reviewed. IV Contrast: Omnipaque 350, 120ml, per protocol. Oral Contrast: Gastrografin, diluted per protocol, 32 oz. IV contrast injection rate: 3 ml per sec. Scan delay: 35/100 sec. Scan field of view: 330mm."

I did not take oral contrast material. Isn't this saying I did? I did have IV contrast. Just trying to be well informed for the next round of CT scans. Thanks so much for your help. --David

Hi David
First of all let me say that you really did get a great scan. You had non Ionic Contrast (Omnipaque....best stuff), probably made you warm down below for about 15 second and maybe a little warm in the throat but no nausea. Years ago everybody got nauseous. The technologist not only did a venous and an arterial phase (meaning they were able to measure delayed iv contrast images, but he had the scanner reformat the axial images into a coronal view. That’s like stacking all the images on top of each other to get a complete view of your body from front to back. As far as the oral contrast, it does say that before the non contrast films you drank Gastrografin. This contrast takes the place of Barium.....tastes very bitter and for an Abdomen and Pelvis you would have had to drink two glasses.....then sit for a while and then a final glass before lying down. If you don't remember drinking that stuff (and you would, believe me), then the radiologist made a mistake in his reading. I'm glad they found your pelvis images. I told you they were in a computer somewhere. Hope you're having a good week-end.

Jeff

Texas_wedge

MedScanMan said:

Hi David
First of all let me say that you really did get a great scan. You had non Ionic Contrast (Omnipaque....best stuff), probably made you warm down below for about 15 second and maybe a little warm in the throat but no nausea. Years ago everybody got nauseous. The technologist not only did a venous and an arterial phase (meaning they were able to measure delayed iv contrast images, but he had the scanner reformat the axial images into a coronal view. That’s like stacking all the images on top of each other to get a complete view of your body from front to back. As far as the oral contrast, it does say that before the non contrast films you drank Gastrografin. This contrast takes the place of Barium.....tastes very bitter and for an Abdomen and Pelvis you would have had to drink two glasses.....then sit for a while and then a final glass before lying down. If you don't remember drinking that stuff (and you would, believe me), then the radiologist made a mistake in his reading. I'm glad they found your pelvis images. I told you they were in a computer somewhere. Hope you're having a good week-end.

Jeff

CT practice
Jeff, I'm interested in the differences in practice in CT scanning. I'm confident that I'm in the very best of hands with a large, highly expert multi-disciplinary team, so I'm intrigued that I've had 3 CAP scans so far, with and without Omnipaque, but I've only had water to drink before and after the scans - nothing like barium or Gastrografin.

(Also, for my rad neph and subsequent open op for a recurrence, I wasn't required to drink anything beforehand, other than water to keep myself adequately hydrated. Do such practices - use of what I seem to remember Fox referring to as Drano - depend on the individual patient's health profile or habits?)

Your expert knowledge will yet again be much appreciated.

MedScanMan

Texas_wedge said:

CT practice
Jeff, I'm interested in the differences in practice in CT scanning. I'm confident that I'm in the very best of hands with a large, highly expert multi-disciplinary team, so I'm intrigued that I've had 3 CAP scans so far, with and without Omnipaque, but I've only had water to drink before and after the scans - nothing like barium or Gastrografin.

(Also, for my rad neph and subsequent open op for a recurrence, I wasn't required to drink anything beforehand, other than water to keep myself adequately hydrated. Do such practices - use of what I seem to remember Fox referring to as Drano - depend on the individual patient's health profile or habits?)

Your expert knowledge will yet again be much appreciated.

Oral Contrast/Water
Good morning.....Normally whenever you have IV contrast you'll be asked to drink water for a good 24 hours so as to be well hydrated and your veins will be easier to stick. As far as Water being used in place of Gastrografin or Barium.....The very hi speed (New scanners) are so fast that even without oral contrast very little is missed in the GI track. The oral contrast is only meant to show stomach, small bowel, large bowel, and recto/sigmoid. When contrast shows in the rectum then the Radiologist feels the exam was complete. Some people are called back for a delayed scan of the lower pelvis if no contrast reached the area. As for water as contrast.....there is a Dr. who knows more about CT scanning than anybody in the country. He's at Hopkins and his name is Dr. Elliott Fishman. I do all my continuing education with him He travels with a lecture team all over the country and does full week-end seminars. Radiologists and Technologists getting their education credits together. I go for my CEU's and the Doctors get their CME's all at the same time. Below is what he says about Water Contrast in place of the others. Also you might find of interest the web site CTisUs.com. It’s his teaching site from Hopkins. There is so much you can see there. Every disease…..every way to scan them……movies to watch. It’s truly amazing. Read below. It may help.

Jeff

Recent advances in computed tomographic (CT) technology and three-dimensional (3D) imaging software have sparked renewed interest in using CT to evaluate gastric disease. Multidetector row CT scanners allow thinner collimation, which improves the visualization of subtle tumors as well as the quality of the 3D data sets. When water is used as an oral contrast agent, subtle disease is easier to visualize, especially when a rapid contrast material bolus is intravenously administered. Adenocarcinoma is the most common gastric malignancy and typically appears as focal or segmental wall thickening or a discrete mass. Gastric lymphoma can have a CT appearance similar to that of adenocarcinoma. Both gastric adenocarcinoma and lymphoma may be associated with adenopathy. Gastrointestinal stromal tumors (GISTs) tend to appear as well-defined masses that arise from the gastric wall and may be exophytic when large. GISTs are usually not associated with significant adenopathy. In addition to gastric malignancies, CT can also help detect inflammatory conditions of the stomach, including gastritis and peptic ulcer disease. CT angiography is especially helpful for depicting the gastric vasculature, which may be affected by a variety of disease conditions.