Triad Radiology Associates

National APP Week 2025

admin — Tue, 02 Sep 2025 23:18:38 +0000

National Advanced Practice Provider Week

Racing Toward the Future: Celebrating APPs

September 22-26, 2025

The Essential Role of Advanced Practice Providers

Advanced practice providers (APPs) are integral to the healthcare system, delivering comprehensive, patient-centered care. APPs are highly trained medical professionals who assess, diagnose, treat, prescribe medications, perform procedures, and engage in clinical research to improve patient outcomes. APPs elevate both medicine and nursing, ensuring safe, high-quality, evidence-based care for communities nationwide.

Advanced Practice Providers Include:

Nurse practitioners
Physician assistants
Certified registered nurse anesthetists
Certified anesthesiologist assistants
Certified nurse midwives
Clinical nurse specialists

Visit https://nationalappweek.com/events/ for more information.

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JULY IS SARCOMA AWARENESS MONTH

admin — Wed, 06 Jul 2022 05:35:51 +0000

JULY IS SARCOMA AWARENESS MONTH

By TRA Radiologist
Michael Chester, MD

WHAT IS SARCOMA?

Sarcoma is a rare, malignant tumor that arises from a variety of soft tissues such as bone, fat, muscles, blood vessels, nerves, and joints. They can occur anywhere in the body but are most common in the arms or legs (60%) and torso/abdomen (30%). Bone and soft tissue sarcomas are the predominant types of sarcoma.

Sarcomas arise in both children and adults and account for approximately 1% of all adult cancers and 15% of all childhood cancers. There are approximately 17,000 new cases of sarcoma diagnosed in the United States each year.

SYMPTOMS

The first sign of sarcoma is usually a palpable lump underneath the skin.
In some cases, the lump hurts when touched or causes pain with movement.
Ewing sarcoma may cause unexplained fever or weight loss.
Weakened bones may fracture.
Not all lumps are cancer. However, a lump that increases in size or becomes painful warrants a visit to the doctor.

CAUSES

The cause of most sarcomas is unknown. There are a few risk factors which include: radiation exposure to treat other cancers, family cancer syndromes, and exposure to certain chemicals such as herbicides.

DIAGNOSIS

If a concerning lump is found by a patient or doctor then imaging should be obtained for further evaluation. If imaging is consistent with a soft tissue or bone tumor the next step is a biopsy to determine if the tumor is benign or malignant.

IMAGING

Imaging plays an important role in the diagnosis and pre and post operative management of patients with soft tissue sarcomas. No single imaging modality is ideal for every tumor. Therefore, a multimodality approach is necessary. Often, radiographs are initially obtained and are very helpful in diagnosing and characterizing bone tumors. Radiographs, while less helpful for soft tissue tumors, can still reveal certain patterns of soft tissue calcification that can be characteristic for certain tumors, such as hemangiomas.

CT, US, MRI, and PET-CT can all be used for diagnosis and staging of a sarcoma. MRI is usually the next imaging exam obtained after radiographs because it provides information about both bones and soft tissue. It can help characterize the tumor, stage the tumor locally, and provide the surgeon an idea of the tumor’s relationship to important surrounding structures such as nerves and arteries prior to resection. In addition, MRI is also used after resection and treatment to evaluate for tumor recurrence.

PET-CT and/or contrast enhanced CT are the modalities used to evaluate for metastases in other parts of the body. In some cases, bone scan will also be obtained to look for additional bone lesions.

In addition, CT and US are important to tools to assist in image-guided biopsies for the initial diagnosis of sarcoma.

TREATMENT

Treatment of sarcomas typically depends on the stage of the cancer. Staging is based off of the pathology, size and grade of tumor, and whether the cancer has spread (metastasized) to lymph nodes or other parts of the body.

Surgery is the most common treatment for sarcomas. As much of the tumor is removed as possible. Radiation therapy may be used either before or after surgery to help shrink the tumor or kill tumor cells that could not be removed at surgery. Chemotherapy may be used with radiation therapy to shrink the tumor and to shrink tumors or reduce pain if the tumor has spread to other parts of the body.

CONCLUSION

Sarcoma is a rare cancer that has been called the “forgotten cancer.” Sarcoma awareness month presents an opportunity for the public to better understand the disease and encourage research and drug development. Patients and families often face immense challenges over the course of treatment of sarcoma. You can help by raising awareness on social media platforms and by donating at curesarcoma.org.

sarcomaalliance.org

acco.org

https://www.cancer.org/cancer/soft-tissue-sarcoma.html

B.J. Manaster. Soft-tissue masses: optimal imaging protocol and reporting. American Journal of Roentgenology. 2013;201:505-514.

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Kidney Cancer Awareness Month

admin — Thu, 17 Mar 2022 06:12:16 +0000

Kidney Cancer Awareness Month

By TRA Radiologist
Eli Tate, MD

March is Kidney Cancer Awareness month and our team at Triad Radiology wanted to take the opportunity to shed some light not only on a disease that is on the rise the United States, but also on what our radiologists offer both in terms of diagnosis and treatment.

Our kidneys are the janitors, so to speak, of our body. Functions include:

Removing waste products, drugs, and toxins from our blood
Maintaining the balance of electrolytes and fluid to keep us healthy
Releasing certain hormones which regulate blood pressure
Signaling the body to make more red blood cells
Producing vitamin D for healthy bones and teeth.

It is hard to believe, but our body can maintain all of these things with just one kidney if necessary.

Kidney cancer is a group of malignancies that will account for over 79,000 cases in the US this year and is among the top 10 cancers in adults. It affects men slightly more than women and mainly in adults over the age of 45, however kidney cancer also accounts for 6% of pediatric malignant tumors. Most cancers occur spontaneously with risk factors such as cigarette smoking, obesity, and high blood pressure, but there are some hereditary syndromes which increase the risk, such as Von Hippel-Lindau disease.

About 25% of kidney tumor growths are benign, including oncocytoma and angiomyolipoma, and the most common kidney lesion is a benign cyst which can be simple or complicated. Distinguishing between these benign lesions and true cancer is incredibly vital and where radiology plays a key role.

There is no set screening test or age for kidney cancer unless a patient has a hereditary/genetic predisposition. Physical symptoms that lead to further investigation include:

hematuria (bloody urine)
Abnormal lab results
Flank pain/abdominal fullness
Fatigue, weight loss, fever
Paraneoplastic syndromes

That is why it is important to see your doctor regularly. After seeing a primary care provider or Urologist, they can order a CT scan of the abdomen with contrast or an MRI if CT contrast isn’t an option for the patient. These studies are interpreted by our sub-specialist radiologists here at Triad Imaging. If the screening scan is positive, additional scans may or may not be recommended.

Imaging is often definitive in diagnosing Renal Cell Carcinoma (RCC). In instances where the imaging is inconclusive, but suspicious, our team of interventional radiologists can perform an outpatient biopsy of the lesions using imaging guidance (ultrasound or CT) to obtain tissue to confirm or refute the diagnosis.

Following a diagnosis of RCC, an individual plan of action will usually be formulated by a team of physicians including a Urologist, Oncologist, Surgeon, and Radiologist. This team approach offers the highest level of care to address each individual patient.

Treatment options include:

Ablation for local tumors (radiofrequency/cryotherapy) performed by interventional radiologists
Active surveillance/conservative management
Partial nephrectomy or removal of a part of the kidney
Total nephrectomy
Systemic immunotherapy

Of note, RCC is not responsive to radiation oncology or traditional chemotherapy in most cases.

As with most cancers, early discovery and active management are keys to improved results. Don’t hesitate to contact your PCP or our team at Triad Radiology for any questions

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CT Angiography of the Heart (CTA Coronary)

admin — Fri, 04 Feb 2022 20:31:46 +0000

CT Angiography of the Heart (CTA Coronary)

By TRA Radiologist
Jeanette Hemp, MD

“The best preparation for tomorrow is to do today’s work superbly well.” – Sir William Osler

The coronary arteries are the small arteries that supply blood to the heart muscle. When these small arteries become blocked, the heart muscle can become stressed and even die, otherwise known as myocardial infarction (MI) or a heart attack. Coronary artery disease is the build up of atherosclerotic plaque that can cause blockages in these small arteries. Common risk factors for coronary artery disease include smoking, poor diet and sedentary lifestyle. Coronary artery disease can cause chest pain, heart failure, irregular heart rhythms, and death from acute MI. Fortunately, for many people coronary artery disease can be detected and treated before it causes serious damage. For certain patients experiencing atypical chest pain coronary CT angiogram (CTA) is an important type of imaging test that does not involve undergoing a procedure or surgery.

The first coronary CTA was performed in 2004, and technology has rapidly improved since that time. Because the heart is always beating, there are several technical factors that must be addressed in order to obtain an excellent scan. Today’s CT scanners are able to detect small vessel size, correct for motion, discriminate between two adjacent structures and evaluate a curved vessel course. They are able to do this by infusing contrast through an IV and using many cameras that image at exact times dictated by the patient’s heart rate and cardiac cycle. When undergoing a cardiac CTA, the patient is typically given a medication to slow and even the heart rate and another medication to dilate the arteries. An echocardiogram (ECG) is obtained which is sent to the CT scanner in real time. Together, these techniques are able to generate very clear pictures of the coronary arteries in a few seconds. These pictures are evaluated specifically for coronary artery disease that can be repaired.

Not everyone is a candidate for coronary CTA and some patients will need to go directly for a procedure at the discretion of their cardiologist. But for many, this impressive technology can help detect coronary artery disease without the need for an invasive procedure.

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Lung Cancer Screening Eligibility Expanded

admin — Fri, 29 Oct 2021 20:28:34 +0000

Lung Cancer Screening Eligibility Expanded

By TRA Radiologist
Bradley VanDyke, MD

November is designated lung cancer awareness month, and greater awareness of cancer’s top killer is sorely needed in the United States. The numbers tell a staggering, and perhaps underappreciated tale of lives lost annually. Most, if not all, of us know someone who has been taken too early by breast, colon, or prostate cancer, which are all too common and deadly. However, lung cancer is in a league of its own and kills more than these 3 combined each year.

Prevention is best, no doubt about it. But a brief, painless, noninvasive CT scan to look inside the lungs of patients and find lung cancer early is a great option too… right? Well, nearly a decade after first recommended for the detection of lung cancer, CT screening rates in the population remain stubbornly low. The American Lung Association reports that in 2019 only about 5.7% of the eligible population was screened. While the trend is in the right direction, there remains a vast population of high risk, unscreened patients.

However, a recent development could push the trend further in the right direction. In March 2021 the United States Preventive Services Task Force (USPSTF) revised its original 2013 guidelines for lung cancer screening to include a broader group of at-risk individuals. Eligibility was expanded to include adults aged 50-80 with a 20-pack year history of smoking (previously age 55-80 and 30 pack years). Estimates suggest the new guidelines could increase eligibility by greater than 80%. This is welcome news for patients and providers looking to detect deadly lung cancers at an earlier stage and with better outcomes. If greater awareness and eligibility translate into more lung screening action then we could see some real improvements.

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Breast Cancer and Covid-19: The Importance of Returning to Screening

admin — Sun, 19 Sep 2021 15:18:58 +0000

Breast Cancer and Covid-19: The Importance of Returning to Screening

By TRA Radiologist
Lauren Golding, MD

Early in the pandemic, non-elective medical procedures and screening exams were delayed, including annual screening mammograms. But as it became clear COVID-19 was going to be with us for a while, the risk of delaying breast cancer diagnoses could not be ignored. We know from multiple studies that regular screening mammograms help detect breast cancer early and women who undergo screening mammograms are less likely to die from breast cancer (1).

A recent large-scale study showed that even missing one scheduled mammography screening before a breast cancer diagnosis results in a significantly higher risk of dying from the cancer (2). These results are especially alarming given the staggering number of women who have missed their regular mammogram over the past 12-18 months due to the period when screening services were suspended as a result of the pandemic, as well as enduring fears and barriers caused by the COVID-19 pandemic. According to the Prevent Cancer Foundation, an estimated 35% of Americans missed routine cancer screening due to COVID-19-related fears and service disruptions early in the pandemic. Additional studies have suggested that this impact has disproportionately impacted women of color (3).

The American Cancer Society estimates that this year:

About 276,480 new cases of invasive breast cancer will be diagnosed in women.
About 48,530 new cases of carcinoma in situ (CIS), a non-invasive and early form of breast cancer, will be diagnosed.
About 42,170 women will die from breast cancer.

Early detection has been key to helping to reduce the number of deaths related to breast cancer. The consequence of missing cancer screenings is that breast cancer will grow undetected—by the time a patient realizes she has cancer, it will be at a much more advanced stage and less likely curable. In a June 2020 editorial in Science, Dr. Norman Sharpless, director of the National Cancer Institute, predicted up to 10 000 excess deaths due to delayed diagnosis of breast and colorectal cancer in the United States over 10 years (4). In addition to a rise in cancer deaths, diagnosis of breast cancer at a later stage will result in the need for more aggressive treatments, including chemotherapy and mastectomy (rather than breast conservation surgery).

Of course, every patient’s circumstances and risk factors are different. But for most women, resuming routine annual screening mammography is the best way to detect breast cancer in its earliest stage. Patients can be reassured that breast imaging centers in the Triad are taking precautions to keep them healthy and reduce the risk of COVID-19 infection.

Some of these safety protocols include:

Screening patients and staff for COVID-19 symptoms at entrances
Universal masking
Limiting seating and spacing out appointments to allow for social distancing, including in waiting and dressing rooms.
Heightened cleaning/disinfecting

As a reminder, multiple societies (the American College of Radiology [ACR], the Society of Breast Imaging [SBI], and the American Society of Breast Surgeons [ASBrS]) prioritize the lifesaving benefits of screening mammography and advise women of average risk to begin screening mammography at age 40 and continue annually for as long as they are in good health.

Monticciolo DL, Newell MS, Hendrick RE, Helvie MA, Moy L, Monsees B, Kopans DB, Eby PR, Sickles EA. Breast cancer screening for average-risk women: Recommendations from the ACR commission on breast imaging. Journal of the American College of Radiology 2017;14(9):1137–1143.
Duffy SW, Tabár L, Yen AM, et al. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer. 2020;126(13):2971-2979.
Amram O, Robison J, Amiri S, Pflugeisen B, Roll J, Monsivais P. Socioeconomic and Racial Inequities in Breast Cancer Screening During the COVID-19 Pandemic in Washington State. JAMA Netw Open.2021;4(5):e2110946.
Sharpless NE. COVID-19 and cancer. Science. 2020; 368 (6497): 1290

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Pulmonary Fibrosis Awareness

admin — Wed, 08 Sep 2021 15:07:08 +0000

Radiology Imaging Role for Interstitial Lung Disease (ILD)

Idiopathic Pulmonary Fibrosis (IPF) is the most common ILD and carries a high mortality rate, so it is important to differentiate IPF from the remainder of the ILDs. It usually occurs in patients over the age of 50 years and is more common in men.

The treatment of IPF is different than the other ILDs and includes new antifibrotic medications and lung transplant, in addition to the traditional treatment of corticosteroids and immunosuppressive drugs.

The key role of radiologists is to identify patients with Usual Interstitial Pneumonitis (UIP), which is the radiographic equivalent of IPF because of the substantially poorer prognosis than the other ILDs.

The textbook UIP pattern on High Resolution Chest CT is lower lung predominant honeycombing, subpleural reticulation and groundglass opacity, as well as associated traction bronchiectasis.

The Diagnosis of IPF requires the exclusion of other known causes of ILD which are called Nonspecific Interstitial Pneumonitis (NSIP). Mimickers of IPF which could have different prognosis and treatment include: Collagen Vascular Disease, Hypersensitivity Pneumonitis, Desquamative Interstitial Pneumonitis which is smoking related, Occupational Exposure, and Drug reaction.

In all patients suspected to have ILD who do not show typical clinical and radiologic features of UIP, lung biopsy should be considered. These are the patients without honeycombing on their High Resolution Chest CT.

Nonspecific Interstitial Pneumonitis (NSIP) is an area of diagnostic uncertainty, and its diagnosis should be provisional until further workup and characterization are completed. This could include bronchoalveolar lavage, serologic workup for autoimmune Collagen Vascular Diseases (Rheumatoid Arthritis, Lupus, Scleroderma, etc), standardized questionnaire regarding occupational, precipitant, and drug exposure.

Close interaction between clinicians, radiologists, and pathologist is crucial in establishing the final diagnosis in ILD patients.

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What is Juvenile Arthritis?

admin — Fri, 16 Jul 2021 13:41:36 +0000

By TRA Radiologist
Michael Chester, MD.

What is Juvenile Arthritis?

Juvenile idiopathic arthritis (JIA) is a group of diseases that cause arthritis before the age of 16 years. It can cause persistent joint pain, swelling and stiffness. For some children symptoms only last a few months but others have symptoms that last many years.

Juvenile idiopathic arthritis can affect one joint or many. The most common type affects four or fewer joints. There are also polyarticular types that involve more than four joints and a systemic type that is more serious and causes abnormalities such as fever, lymphadenopathy, organ dysfunction, and rash.

Symptoms

Pain, which may or may not include joint pain. Instead of complaining of joint pain children may limp, especially in the morning or after a nap.
Joint swelling is common but especially noticeable in the large joints such as the knee.
Stiffness. Children may seem unsteady or have difficulty when they awake in the morning or after a nap.
Systemic symptoms such as fever, swollen lymph nodes, and rash.

Causes

Juvenile idiopathic arthritis is an autoimmune disease in which the body attacks its own cells and tissues. The cause is not known but genetics and the environment are both thought to play a role. The prevalence of the disease is approximately 16-150 per 100,000 children.

Complications

Eye inflammation which can result in cataracts, glaucoma, and blindness.
Growth disruption. Bone growth and development can be disrupted by JIA. In addition, corticosteroids, which are used to treat JIA, can also inhibit growth. In advanced cases bones can fuse (ankylose) and disrupt growth.
Permanent joint damage. Some cartilage damage can be repaired in children given the more vascular nature of their growing cartilage and cartilage caps (epiphyses). However, if the cartilage loss becomes greater than the body can repair then permanent cartilage loss ensues, leading to progressive joint space loss and in certain cases joint fusion.

Diagnosis

JIA remains a clinical diagnosis with varied manifestations. Clinical exam, blood tests to detect inflammatory change, and imaging all play roles in diagnosing JIA.

Imaging

Imaging is important to diagnose and monitor the course of the disease. Radiography (x-ray) is often the initial imaging exam but is insensitive for early findings of JIA. However, radiography is necessary because it can exclude other causes of joint pain such as tumors or fractures. It can also detect advanced changes of arthritis such as erosions, joint space loss, and joint effusions. Contrast enhanced MRI is the most sensitive modality to detect early changes of JIA such as inflammation of the lining of joints (synovitis), joint effusions, and bone marrow edema which is a precursor to erosive change. Ultrasound (US) is also more sensitive than radiography for early changes of JIA and can detect synovitis, joint effusions, and tenosynovitis (inflammation of the tendon sheath). Both MRI and US can used to monitor treatment response and progression of JIA.

Treatment

Treatment of JIA focuses on anti-inflammatory medications which range from common over the counter nonsteroidal anti-inflammatory drugs (NSAIDS) to powerful biologic agents which suppress the immune system. These medications help decrease pain, improve function, and minimize joint damage.

Conclusion

Although JIA remains a clinical diagnosis, imaging is key in excluding other causes of joint pain and swelling, aids in diagnosis, monitors disease progression and treatment response, and evaluates for complications of JIA. Given the new powerful therapeutics the goal of JIA treatment is suppression of joint inflammation before the development of irreversible cartilage loss.

https://www.mayoclinic.org/diseases-conditions/juvenile-idiopathic-arthritis/diagnosis-treatment/drc-20374088

Sheybani, Elizabeth et al. Imaging of Juvenile Idiopathic Arthritis: A Multimodality Approach. Radiographics 2013; 33 (5): 1253-1273.

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June is National Cancer Survivor Month

admin — Fri, 18 Jun 2021 20:16:33 +0000

“In the fall of 2017 the healthcare facility in my community made the addition of 3D mammography in their breast center. As an imaging professional at this facility I wanted to be the first patient on our new equipment so I had my mammogram early that first day. I had been feeling something very small. The combined imaging technology of 3D mammography, ultrasound, and MRI breast would start my journey into early detection of breast cancer. With especially dense breast tissue, these imaging tools working together helped identify my breast cancer. Following several ultrasound biopsies, my pathology results helped guide the surgeon and treatment that would be necessary. My results were invasive ductal carcinoma, HR -, HER2 +. After undergoing a lumpectomy, I received 18 weeks of chemo, 20 radiation treatments, and one year of Herceptin treatment. I continue to celebrate being cancer free! I also continue to have follow up imaging each year with Mammography, Ultrasound and MRI. With the advancement in imaging, early detection is possible. “

Terrie Loflin, RT, R, BSHCA

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Abbreviated Screening Breast MRI

admin — Sun, 19 Aug 2018 17:41:49 +0000

Abbreviated Screening Breast MRI: Improving cancer detection in women with dense breast tissue

Triad Radiology Associates and Novant Health Imaging Maplewood are pleased to announce a new supplemental breast cancer screening option for women with dense breast tissue: Abbreviated Screening Breast MRI (ASBMRI). Although screening mammography is instrumental in reducing deaths due to breast cancer, mammography can miss some breast cancers─particularly in women with mammographically dense (“heterogeneously or extremely dense”) breast tissue. ASBMRI is especially beneficial for these patients. North Carolina, along with more than 20 other states, now requires notification of breast tissue density and suggests that these patients talk to their doctor about supplemental screening due to reduced ability of screening mammography to detect cancer.

What are the risks of having dense breast tissue?

There is a higher risk of breast cancer in women with dense breast tissue as compared to similar women with less dense breast tissue. There is also a higher risk of developing more aggressive breast cancers in such women. Because dense breast tissue can obscure the ability to see a breast cancer mammographically, there is reduced early detection potential with screening mammography. There is also a higher likelihood that a breast cancer will have spread to lymph nodes by the time it is detected mammographically or by physical or self breast examination.

Screening mammogram of a woman with dense breast tissue

What is ASBMRI?

Breast MRI has been shown to detect more cancers at a smaller size and a higher rate of detection before spread to lymph nodes. Breast MRI detects cancer differently than ultrasound and mammography, which rely on physical changes in architecture or density. The ability of breast MRI to detect cancers is based on tumor-related biological changes that cause blood vessel alterations and inflammation from biochemicals created by tumor cells. Breast MRI can detect tumors independent of the degree of tissue density by depicting alterations in contrast enhancement of intravenously administered contrast. ASBMRI offers the superior sensitivity of MRI for breast cancer detection, but is performed in ten minutes or less and for a fraction of the price of a traditional standard breast MRI.

ASBMRI images of the same woman in the above screening mammogram. Images are taken before and after an injection of intravenous contrast.

ASBMRI images are processed by digitally subtracting the before contrast images from the post-contrast images, which “removes” the normal dense breast tissue. This creates multiple 2-dimensional images and a 3-dimensional image of the breasts, which allows the radiologist to “see thru” the dense breast tissue.

Mammogram images showing breasts with dense tissue. Subsequent ASBMRI image showing a small 7mm breast cancer (small bright spot located along the inner portion of the breast on the right side of the image) that is not detectable on the mammogram.

How do I know if ASBMRI is right for me?

ASBMRI may be an appropriate supplemental (i.e. in addition to screening mammography) screening exam for breast cancer if you have dense breast tissue. Dense breast tissue includes breast tissue characertized mammographically as “heterogeneously dense” or “extremely dense.” Breast density will be reported on the letter you receive after undergoing screening mammography. Your doctor also receives a screening mammography report from the radiologist that includes an estimation of breast density, so he or she can also help determine if you are a candidate for ASBMRI.

Is there exposure to X-rays or radiation with ASBMRI?

There is no radiation involved in the use of any MRI. MRI uses strong magnetic fields and radio frequency pulsations to create images of the body.

Is ASBMRI painful?

The examination is painless. There is no compression of the breast as is necessary for mammography. The patient lies face down on the MRI exam table and care is given by the technologist to ensure patient comfort. Earplugs are placed to dampen the noise created by the MRI machine. Prior to the exam, an i.v. is placed in the arm to allow intravenous injection of contrast.

How and where can I schedule an appointment for ASBMRI?

ASBMRI is offered at Novant Health Maplewood Imaging Clinic in Winston-Salem. We ask that you obtain a referral from your physician. Appointments can be scheduled by calling 336-397-6033.

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