Female radiology

MRI is an examination that allows diagnostic images to be obtained using a magnetic field and radiofrequency pulses. Unlike CT, it does not involve the use of ionizing radiation. In some cases, depending on the clinical question, the use of gadolinium-based contrast medium is involved.

MRI for gynecological issues
MRI is often suggested as a follow-up examination after an ultrasound scan for in-depth study of the uterus and cervix (cervix), adnexa (fallopian tubes and ovaries), and vagina.
It is used to study individual organs, their anatomy, pathology, and relationships between lesions and neighboring organs. It may be indicated for the detailed study of pathologies such as uterine myomas, ovarian cysts, endometriosis, and in the suspicion of oncological pathologies.

How it is performed
The MRI examination is of medium duration (about 20-40 minutes), not painful except for discomfort due to the placement of the needle cannula in the vein in case it is necessary to administer contrast medium. It can, however, give a feeling of claustrophobia induced by the machine (a large tube with open ends) in which the patient must lie supine. In some cases, on the doctor's indication, Buscopan may be administered intravenously especially to reduce uterine and bowel loop contractility.
In case of contrast medium administration, it would be preferable-but not mandatory-to fast for at least 4-6 hours, also to reduce bowel loop movement. It is always permissible to drink water before the examination. It is important to alert medical and paramedical staff if you have any known or suspected allergies to the contrast medium.
This is a rather noisy examination, so the patient is provided with headphones to wear. Despite the background noise, the patient can still communicate with staff outside the room due to the presence of special microphones, and she is provided with a bell with which to call attention at any time. During the examination the patient may be asked to perform apneas of short duration.

After the examination is completed, all daily activities can be resumed immediately; it is not necessary to refrain from driving or sports activities.
It is an examination that can be performed during pregnancy (starting in the second trimester), but it is still necessary to have precise medical indications before performing it.

CT (computed tomography) is a radiologic examination that involves the use of ionizing radiation emitted from a source (X-ray tube) that, as it passes through organs, allows radiologic images to be obtained that are suitable for the diagnosis of disease.
In some cases, there is the administration of an iodine-based contrast agent administered intravenously through a needle cannula usually placed in a vein of the upper extremity.

CT scan for gynecological problems
In the study of gynecological problems, CT is used primarily to assess the extent of pathology and possible involvement of nearby organs (bowel, peritoneum, ureters) at the time of diagnosis.
It is also used in the follow-up of oncologic diseases of gynecologic origin to monitor response to therapies both during and after treatments.

How it is performed
The CT examination is an examination of variable duration, between 2 and 20 minutes (depending on the extent of the region to be studied), not painful except for the discomfort due to the placement of the needle cannula in the vein and the sensation of heat due to the administration of the contrast medium.
Also in the case of contrast medium administration, fasting for at least 4-6 hours is required; drinking water before the examination is allowed. It is important to alert medical and paramedical staff if you have known or suspected allergies to iodinated mdc.
The patient is asked to lie down on the CT table, usually in a supine position. The examination lasts a few minutes, in which the patient must follow the directions of the radiology technician, remaining very still to obtain images of good diagnostic quality. During the exam, the patient is asked to perform apneas (inhale and hold air) for a few seconds. After the examination, all daily activities can be resumed immediately; it is not necessary to refrain from driving or sports activities.
It is an examination to be avoided during the period of pregnancy unless there is a strict and proven need, because of the use of ionizing radiation that could be harmful to the fetus.

Technique to obtain diagnostic images through the use of ultrasound.
This examination is indicated to investigate a clinical symptom, for young women and, as a supplement to mammography, for women with a high radiographic density of the breast. Ultrasound allows detection and characterization of benign (cysts, benign nodules) and malignant breast changes and is used as a guide for performing interventional procedures.

Breast ultrasound examination also includes evaluation of the axillary cords to identify the presence of any pathological lymph nodes.

Mammography is theradiographic examination of the breast. Using low-dose ionizing radiation (X-rays), X-ray images are obtained that allow breast specialists to identify small breast changes even at a subclinical stage, that is, when they are not yet palpable. Generally, to obviate the likely discomfort brought about by breast compression, mammography is preferred to be performed immediately after the menstrual cycle in women of childbearing age.

The breasts will be compressed between a mobile compressor and a fixed detector (surface on which to rest the breast). At least two projections will be performed for each breast (CC projection and MLO projection). The radiologist will then evaluate the mammogram. In order to provide an adequate evaluation it may be necessary to perform additional projections or even an ultrasound examination of the breast. The radiologist directly informs the patient of the examination result while still sending a report to the referring physician.

Since 2017, diagnostic evaluation with 3D digital mammography (digital breast tomosynthesis - DBT) has been performed at all EOC radiology sites. Tomosynthesis is a mammographic examination perceived by the patient in the same way as traditional mammography (same equipment and mode of execution, two projections for each breast) but it is a three-dimensional imaging technique that allows reconstructing "layered" images of the breast. This technology is also used in some cases to supplement screening mammography.

MRI of the breast is the most sensitive examination for breast cancer, and is considered a level three examination for most of its indications. It is therefore used to investigate unclear findings highlighted on conventional imaging (mammography and ultrasonography). It is, however, the primary examination for screening some patients, including women with a high genetic risk or with extremely dense breasts (i.e., with a preponderant glandular component). In all of these cases, gadolinium-based contrast medium is injected intravenously through a cannula needle placed prior to the examination. It represents the most appropriate examination in cases where ruptured breast prosthetic implants are suspected, and in these cases it is not necessary to administer contrast medium.

The duration of performance is about 40 minutes, but rapid protocols of about 20 minutes are available for selected cases.
MRI image quality is affected by the menstrual cycle, so it is necessary to perform MRI only at a particular stage in women of childbearing age(between days 5 and 15 of the cycle).

Diagnostic technique that through the use of a shearing needle allows the removal of tissue frustules (histologic examination) from a breast lesion or even a lymph node. The examination is performed on an outpatient basis and under local anesthesia. It does not require sutures.

Percutaneous biopsy generally is performed under ultrasound guidance. Following the sampling, a marker is usually released at the site with the aim of monitoring the lesion over time, if it is benign, or to serve as a guide for the surgeon to remove the already marked lesion. At the end of the procedure, a compression dressing is placed on the examined breast.

Procedure lasting about 30 minutes.

Procedure to localize a breast finding performed before surgery. The breast radiologist under ultrasound or mammography guidance will insert a b in the breast that will be used by the surgeon to locate and remove the finding to be sent to the pathologist for final diagnosis. Sometimes it is necessary to place more than one wire (bracketing).

The procedure lasts 30-45 minutes.

Diagnostic technique that allows more tissue to be harvested (histologic examination) than tru-cut biopsy to characterize doubtful lesions or remove benign lesions while avoiding surgery in some cases.

It can be performed under mammographic, ultrasound, or MRI guidance.

Biopsy performed under mammographic guidance, under local anesthesia. The breast will be lightly compressed, and a few low-dose mammographic projections will be performed to localize the finding. This type of diagnostic sampling is indicated to clarify the nature of microcalcifications or areas of parenchymal distortion. At the end of the sampling, a clip is inserted at the biopsy site for the purpose of marking the biopsy site. Radiographs are taken of the harvested frustules and specimens are prepared to be sent to the pathologist for diagnosis. No sutures are required; a compression dressing is placed on the examined breast at the end of the procedure.

The procedure lasts about 45 minutes.

This procedure can be performed with a diagnostic purpose or with an excisional, therapeutic intent. Biopsy performed under ultrasound guidance under local anesthesia, the procedure is displayed in real time on the ultrasound monitor.

After the diagnostic sampling or excision is performed, a marking clip is inserted at the site of sampling/excision. At the end of the procedure, a compression dressing is placed on the examined breast.

The duration of the procedure generally depends on the size of the lesion to be excised (45-60 minutes). The harvested tissue is then sent to the pathologist, for histologic evaluation.

Examination performed on the MRI table. An agocannula is set up in the arm for injection of the gadolinium-based contrast agent. The patient is positioned lying on her stomach on the MRI bed with the breast to be sampled placed in a designated space, slightly compressed.

Next, the breast site to be sampled is identified, local anesthesia is performed, the needle is placed, and the biopsy is performed. Finally, a marking clip is issued at the site of the sampling. At the end of the procedure, a compression dressing is placed on the examined breast. No sutures are required.
The harvested frustules are sent to pathology for diagnosis.

The procedure takes about 60 minutes.

A technique that through the use of a fine needle-similar to an intramuscular puncture needle-allows cells to be taken (cytological examination) from a breast lesion or even a lymph node.

At the end of the procedure, slides are set up that will be analyzed under a microscope by the cytologist for diagnosis.

Procedure lasting about 20 minutes.