Imaging

Vascular & General Ultrasounds

Vascular ultrasound and physiologic vascular procedures are scheduled for our patients with The Surgical Clinic in the Vascular Lab. 

This convenient and comfortable setting allows Registered Vascular Technologists (RVTs) to evaluate the blood supply to and from various parts of the body. We’re able to obtain this information without any invasive procedures. This means that you’ll be able to return to your regular schedule of activities after your appointment.

What’s an RVT ultrasound?

It’s important to point out that your care will be delivered by a medical professional with an RVT certification. The RVT certification, not required in many labs, is the standard at The Surgical Clinic’s labs and helps to assure you that your tests are being conducted by people specialized in these diagnostic procedures.

What’s a vascular lab?

At TSC, we understand that patients will typically want to get things moving as fast as possible. Our mission is to help give patient’s the most specialized and convenient care possible, which is why we offer vascular labs in many of our locations. These locations allow you to access advanced laboratory professionals without the congestion of a hospital setting. While appointments are required, it’s often possible to make a ‘same-day’ appointment. Your test results will be sent to your Surgeon to help determine a recommended course of treatment.
Our state-of-the-art vascular labs are accredited by the Intersocietal Accreditation Commission 
and each of the RVT’s are registered through the American Registry of Diagnostic Medical Sonographers (ARDMS).

Vascular Health Screening

The key to excellent vascular care is proper diagnosis along with treatment options. TSC’s ICAVL (Intersocietal Commission for the Accreditation of Vascular Laboratories) accredited vascular laboratories offer vascular screening services to assure that you receive proper diagnosis and treatment of your vascular condition.

Benefits of a vascular lab:

→ accredited ICAVL vascular lab assures that you receive proper diagnosis and treatment of your vascular condition

→ vascular ultrasound screening services are painless, fast and accurate

→ vascular screenings will help identify unnoticed vascular conditions *screenings do not replace the need for a physical exam

General Ultrasound

What does general ultrasound include?

An ultrasound is created when high frequency sound waves are exposed to a body part. These waves are assembled to create a picture of the inside of the body. Sometimes this type of imaging is called ultrasound scanning or sonography.

The risk of exposure by using ultrasounds is very low since unlike an x-ray, there is no ionizing radiation. The technique allows images of the inside of your body to be captured in real time while they are working. This reveals the structure and movement of the internal organs as well as lets doctors watch blood flowing through your vessels.

3 Types of Ultrasounds:

→ a conventional machine displays images in thin, flat sections

→ a three-dimensional (3-D) image or an image that shows the entire structure to be studied from all angles

→ a four-dimensional technology (4-D) image can allow the radiologist to put a 3-D image in motion

What’s a Doppler Ultrasound?

You may also be scheduled for a Doppler ultrasound. This is a special technique that examines blood flowing through a vessel. Areas of your body where a Doppler might be used are major arteries (the vessels that carry blood away from the heart) and veins in the abdomen, arms, legs and neck.

By watching the tissues at work, doctors can observe abnormalities, diagnose problems and develop treatment plans. Since the procedure is just tracking sound waves, there is no recovery time for you from this procedure.

Testing & Diagnostics

See below for a variety of testing & diagnostics options offered at The Surgical Clinic. 

PHYSIOLOGIC (NON-IMAGING) TESTING

PHYSIOLOGIC (NON-IMAGING) TESTING

Physiologic arterial testing is the evaluation of the amount of blood flow to the arms or legs. If narrowing in an artery reduces the amount of blood flow to the arms or legs, we can detect this with physiologic testing. First we listen to the arterial flow and record waveforms of the flow pattern. We take blood pressures at different levels on the arms or legs, and we may have you walk on a treadmill for approximately five minutes to see if blood flow to the legs is reduced further with walking. All of this data helps your physician determine the overall significance of any narrowing and how much blood flow is getting to the legs or arms.
ANKLE/BRACHIAL INDEX

ANKLE/BRACHIAL INDEX

This is a simple physiologic test that involves taking a blood pressure from your arms and your ankles. We obtain a ratio of the ankle pressure to the arm pressure that tells us if the blood flow to your ankles is normal or abnormal. This test is the first step in evaluating the blood flow to your legs and is used to determine which further testing is performed.
ARTERIAL DOPPLER WITH SEGMENTAL PRESSURES UPPER AND LOWER EXTREMITIES

ARTERIAL DOPPLER WITH SEGMENTAL PRESSURES UPPER AND LOWER EXTREMITIES

This test involves taking blood pressures from different levels of your legs or arms. We also record waveforms of the blood flow to determine the quality of the blood flow. The blood pressures and waveforms help determine where any arterial narrowing is located.
ARTERIAL DOPPLER WITH TREADMILL

ARTERIAL DOPPLER WITH TREADMILL

This test may assess your blood pressures in your arms and ankles after you have walked for 5 minutes on a Treadmill. This measures how exercise affects the blood flow to your legs. It is usually conducted after the Ankle/Brachial Index and Segmental Pressure testing is completed.
GALLBLADDER ULTRASOUND

GALLBLADDER ULTRASOUND

The gallbladder is a sac-like organ that lies below the liver and is used for storage of bile. When eating, the gallbladder releases bile to the intestines to help digest food. Gallbladder ultrasound is performed to evaluate the cause of abdominal pain which could be caused by gallstones, inflammation of the gallbladder, or obstruction of the bile ducts. For this test the patient is asked to not eat or drink anything for at least 8 hours prior to the exam. The patient will be asked to remove any clothing or objects that interfere with the scan and will be given a gown to wear. The patient will be asked to lie on their back initially and then may be asked to change into a sitting or other positions for optimal view of the gallbladder. Ultrasound gel is placed on the upper abdomen and the sonographer will use a transducer to move around the abdomen to obtain images of the gallbladder.
RENAL ULTRASOUND

RENAL ULTRASOUND

The kidneys are bean-shaped organs located on each side that filter blood. Renal ultrasound is performed to evaluate the size of the kidneys, to look at related structures such as the ureters and bladder, and to detect cysts, tumors, obstructions, fluid collections, kidney stones, and possible infections. For this test the patient may be asked to wear a gown and remove any clothing or objects that may interfere with the scan. The patient may lie on the exam table either on their back or stomach in order to capture the best images. Ultrasound gel is placed on the abdomen and the sonographer will use a transducer to move around the abdomen, sides, or around the back to look for the best image of the kidneys. The patient may be asked to not eat or drink anything overnight prior to the procedure or 4-8 hours prior to the procedure. They patient may also be asked to drink a lot of water, or to not empty their bladder, prior to the procedure
RENAL ULTRASOUND

THYROID ULTRASOUND

The thyroid is a gland in the front of the neck shaped like a butterfly. This gland helps regulate metabolism. A thyroid ultrasound is performed to look for any abnormal growths or lumps and can help determine if the growth is a cyst, thyroid enlargement, nodule, or tumor. Thyroid ultrasound is also done to monitor known growths to see if they are getting larger over time. Characteristics of the thyroid ultrasound will help your doctor determine if any other tests may be needed. For this test the patient lies on their back with the neck extended. Ultrasound gel is placed on the neck which helps the sound waves enter the body. The ultrasound transducer is then moved around your neck, which creates an image on the ultrasound machine. There is no preparation necessary for this test.
Abdominal Ultrasound

Abdominal Ultrasound

An abdominal ultrasound is an imaging test that uses sound waves to form pictures of your abdominal organs. It can help find organ problems, such as gallstones, kidney stones, or liver disease. Ultrasound does not use ionizing radiation (like an X-ray does) and does not have any known risks. It can also see many blood vessels in the belly (abdomen). If needed as part of your exam, the blood flow in these blood vessels can also be evaluated.

Before your test

  • What you need to do to get ready for the test depends on the area of your body that will be looked at. Follow any directions you’re given for not eating or drinking before the procedure. Your healthcare provider will give you instructions if required.

  • Follow all other instructions given by your provider.

For best results, be ready to answer questions about your health history, including the following:

  • Past abdominal surgery

  • Past abdominal imaging tests, including ultrasound, CT, or MRI studies

During your test

  • You may be asked to put on a gown.

  • You will lie on an exam table with your abdomen exposed.

  • A nongreasy gel will be put on your skin.

  • The sonographer will use a handheld probe (transducer) against your abdomen. This probe helps create images of your abdominal organs.

  • You may see the pictures of your organs on screen.

  • Certain organs, like the liver, can be biopsied during an ultrasound. This will require additional steps and your provider can discuss these details with you.

The person who does the ultrasound is called a sonographer. He or she can answer questions about the test. But only a doctor can explain the results.

Ultrasound-Guided Biopsy

Ultrasound-Guided Biopsy

Image-Guided Biopsy

A biopsy is a small sample of tissue or fluid taken from your body. This sample is then studied in a lab. Image-guided biopsy lets your healthcare provider take a sample from an abnormal lump (mass) without using surgery. Image-guided biopsies use ultrasound, X-ray, CT scan, or MRI images to find exactly where to place the needle and do the biopsy. This procedure is done by a radiologist. It can also be done by a specially trained doctor called an interventional radiologist.

Closeup of needle inserted into abnormal tissue for biopsy. Ultrasound probe on skin surface.
A needle is used to take a sample of tissue from inside the body.

Before your procedure

  • Tell your healthcare provider about any health conditions you have
  • Tell your provider about all medicines you are taking. This includes all prescription and over-the-counter medicines, vitamins, herbs, or supplements. This also includes any illegal drugs.
  • Tell your provider if you’re allergic to any medicines.
  • Tell your provider if you’re pregnant or think you may be pregnant.
  • Follow any directions you’re given for not eating or drinking before the procedure.
  • Follow any other instructions from your provider.

During your procedure

  • You’ll change into a hospital gown and lie on a special table. The table that’s used will depend on the type of imaging that will guide the biopsy. You may lie on your back, front, or side. Your position depends on where the biopsy is to be done.
  • An IV (intravenous) line may be started. This will give you fluids and medicines. You may be given medicine through the IV to help you relax.
  • The skin over the biopsy site is cleaned. Medicine is put on the site to numb the skin.
  • The radiologist will use CT scan, MRI, X-ray, or ultrasound images as a guide. They’ll put a thin, hollow needle through the skin. It will be guided to the area where the biopsy will be done.
  • The needle will take a sample of tissue or fluid from the area. The needle is then taken out. The sample is sent to a lab. It will be checked for cells that aren’t normal.

After your procedure

  • You’ll most likely be able to go home in a few hours.
  • You may need to have a friend or family member drive you home.
  • Care for the insertion site as directed.

Possible risks

Possible risks and complications of an image-guided biopsy include:

  • Bleeding inside your body
  • Bruising or bleeding at the place where the needle was put in
  • Damage to body areas along the path of the needle
 
 
What is Duplex Ultrasound Duplex Ultrasound: What to Expect

What is Duplex Ultrasound 
Duplex Ultrasound: What to Expect 

Duplex Ultrasound: What to Expect

Duplex ultrasound uses sound waves to get images of your blood vessels. It also helps determine the speed and the direction of blood flow through the vessels. Your healthcare provider may want to do a duplex ultrasound to find out if you have any problems with the vessels that carry blood to and from the major organs in your body.

Man lying on exam table. Health care provider is holding ultrasound probe to man's leg.
Duplex ultrasound can be used to view blood vessels in different areas of the body, such as the legs.

Before your test

Here is what to expect:

  • Follow instructions you are given to prepare for the test. If you are told to not eat or drink before the test, follow these directions carefully. If you don’t, your test may need to be rescheduled.
  • Tell your healthcare provider what medicines you are taking. Ask if you should stop taking any of these medicines before the test. Also, bring a list of your medicines on the day of your test to show the technologist.
  • Allow time to check in.

What to tell the technologist

Tell the technologist if you’ve had:

  • A previous procedure, such as a bypass, balloon angioplasty, or stent placement.
  • Symptoms of stroke, including sudden short-term loss of strength, speech, or vision.

You may be asked other questions about your health. The information you give helps the technologist be sure the test is safe for you.

During your test

The duplex ultrasound is done in an ultrasound lab. The lab may be in your healthcare provider’s office, a hospital, or an outpatient imaging center. The test is typically done by a vascular technologist. It can take from 15 minutes to 2 hours, depending on what’s being tested. During your test:

  • You may be asked to change into a hospital gown or to remove clothing from the area being examined.
  • You will likely lie on an exam table.
  • A gel is applied to the area being tested. This helps sound waves move through your skin.
  • The technologist slides the ultrasound probe (transducer) over the gel.
  • You may hear a “whooshing” sound. This is the sound of your blood flowing. You may also see tracings of your blood flow on a screen.
  • A blood pressure cuff may be put on your arm or leg and inflated during the test.
  • You may be asked to stand up or even exercise during the test.

Be aware that

Be prepared for the following:

  • The gel will feel wet. It won’t harm your skin or clothing, but it’s a good idea to wear washable clothes.
  • The pressure from the probe may feel slightly uncomfortable. If you have any pain, tell the technologist.

After your test

Here is what to expect:

  • Before leaving, you may need to wait briefly while your images are being reviewed.
  • You can return to normal activities unless your healthcare provider tells you otherwise.
  • Your healthcare provider will let you know when the test results are ready.
Raynaud Disease

Raynaud Disease

Your healthcare provider has told you that you have Raynaud disease. It’s also called Raynaud phenomenon or Raynaud syndrome. There’s no cure for Raynaud disease, but you can manage it to help prevent attacks.

Hand and foot showing discolored tips of fingers and toes.

What are the symptoms of Raynaud disease?

A Raynaud disease attack is often triggered by cold or stress. During an attack, blood vessels suddenly narrow (called vasospasm). This most often happens in fingers and toes. In rare cases, the nose, ears, nipples, or even tongue are affected. Narrowed blood vessels reduce the blood supply to the area. The area then turns white, blue, or red. The area may feel tingling, numb, or painful. As the attack passes, the blood vessels open. The affected area may turn bright red as it warms up, then returns to normal color.

What is the cause of Raynaud disease?

With Raynaud disease, it’s believed that blood vessels in the affected areas respond too strongly to certain triggers, such as cold. This makes them narrow (called vasospasm) much more than in people without the disease. Experts don’t know what causes the blood vessels to react so strongly to certain triggers. In between attacks, the blood vessels are normal and healthy. Attacks don’t permanently damage the blood vessels. But they may thicken the artery walls.

In some cases, Raynaud disease happens along with another disease or condition. This is often a connective tissue disorder, such as lupus, scleroderma, or rheumatoid arthritis. This is called secondary Raynaud disease (as opposed to primary Raynaud disease discussed above) and may be more severe. If this is the case for you, you and your healthcare provider can discuss treatment for the underlying condition.

What are the risk factors?

Risk factors for Raynaud disease include:

  • Women are more likely to get Raynaud disease than men.
  • Younger people are at higher risk, usually ages 15 to 30.
  • Living in colder climates increases risk.
  • Having a family member with Raynaud disease increases your risk.
  • Underlying rheumatoid conditions may increase your risk.

What are possible triggers?

Triggers for Raynaud disease include:

  • Cold
  • Stress
  • Caffeine
  • Smoking
  • Repetitive movements
  • Certain medicines, such as beta-blockers, migraine medicine, birth control pills, and others
  • Injury
  • Emotions

How is Raynaud disease diagnosed?

Your description of your symptoms, a health history, and a physical exam are often enough for a diagnosis. Blood tests and other tests may be done to see if any underlying conditions are present and rule out other problems.

How is Raynaud disease treated?

There is no known cure for Raynaud disease. But you can learn to manage symptoms and reduce the number and severity of attacks. For most people, avoiding triggers may be enough to limit attacks. Your healthcare provider may suggest the following:

  • Take safety steps to help prevent your hands and feet from losing circulation. This includes:
    • Dressing warmly in cold weather.
    • Wearing gloves or mittens when your hands may become cold, such as when you use the refrigerator or freezer.
    • Avoiding stress and caffeine.
    • Exercising regularly. This may reduce the number and severity of attacks.
    • If you smoke, quitting may improve the condition. This is because smoking causes your blood vessels to narrow and reduces blood flow.
  • Soak your hands or feet in warm (not hot) water. Do this at the first sign of an attack. Keep soaking until your skin color returns to normal.

In some people, symptoms are persistent or troubling. For these cases, other treatments are a choice. Your healthcare provider can tell you more about the following:

  • Prescription medicines. Some medicines that relax and widen blood vessels, such as calcium channel blockers. These may help ease symptoms.
  • Nerve surgery. This is used for severe cases that don’t respond to other treatments. Surgery removes the nerves around the blood vessels in the hands and feet. Without nerve stimulation, the blood vessels stay more relaxed. They’re less likely to become very narrow due to stimuli. Nerves may be blocked using injections in some cases.

If attacks are severe, last for a long time, or occur very often, skin damage and sores (skin ulcers) may result. Controlling attacks can help prevent this.

When to get medical care

The following problems happen rarely, but they can be serious. Call your healthcare provider right away if you notice any of these:

  • Skin infection or sores
  • A finger or toe turns black
  • The skin breaks open on its own
  • A rash develops
  • A finger or toe joint becomes painful or swollen
Understanding Thoracic Outlet Syndrome

Understanding Thoracic Outlet Syndrome

Thoracic outlet syndrome is a set of symptoms in the shoulder, arm, or hand. It occurs from a narrowing of the thoracic outlet. This is the space between your collarbone and your first rib. It can result from injury, disease, or a problem present from birth. Thoracic outlet syndrome is not common. It can occur in people of any age.

What is the thoracic outlet?

The thoracic outlet is a narrow space between your collarbone (clavicle) and your first rib. Nerves and blood vessels pass from your chest to your arm through this area. The nerves and blood vessels include:

  • A bundle of nerves (brachial plexus) that serve your shoulder, arm, and hand
  • A large and important vein (subclavian vein)
  • A very large important artery (subclavian artery)

What causes thoracic outlet syndrome?

Your shoulder muscles normally keep your clavicle raised and in place. But with thoracic outlet syndrome, the upper rib and clavicle are closer. This makes the thoracic outlet smaller. Nerves and blood vessels going through the area can be compressed. Conditions that can cause thoracic outlet syndrome include:

  • Having an extra rib at birth
  • An abnormality in the neck muscles at birth
  • Neck injury
  • Injury to the first rib or collarbone
  • Repetitive overhead arm movements that may cause inflammatory changes

Poor posture and obesity may raise your risk for thoracic outlet syndrome. People who do repetitive overhead arm movements, such as swimmers or pitchers, may also have a higher risk.

Symptoms of thoracic outlet syndrome

Your symptoms may come and go. This may be partly based on your activity level. Overhead activities may make your symptoms worse. You most likely have symptoms on only 1 side. In some cases thoracic outlet syndrome can cause symptoms on both sides of the body.

Symptoms can include:

  • Aching in your neck, shoulder, arm, or hand
  • Pain, numbness, or tingling of your forearm or fingers, most often the pinky.
  • Hand weakness
  • Limited range of motion of your arm
  • A depression in your shoulder
  • Pain in your neck muscles
  • Swelling and redness of your arm
  • Pale and cool arm and hand

Diagnosing thoracic outlet syndrome

Thoracic outlet syndrome is often more difficult to diagnose than other shoulder problems. Your healthcare provider will ask about your health history and your symptoms. You will also have a physical exam. Your healthcare provider may move your hand and arm in different positions.

A specific test may be done to help diagnose thoracic outlet syndrome. Your healthcare provider may have you raise your arms and then open and close your fist for a few minutes. This often brings on symptoms.

You may have other tests, such as:

  • Nerve conduction tests. This is done to see how your nerves are affected.
  • Needle electromyography (EMG), This is often done with nerve conduction tests. It assesses the nerve signals going to the muscles.
  • Doppler ultrasound. This looks at blood flow through your arm and hand.
  • Chest X-ray. This is done to check for abnormal bone such as an extra rib.
  • CT scan. This may be done if your healthcare provider needs to see more detail.
  • CT angiography. This is done to get more information about blood flow through your arm.

Treatment for thoracic outlet syndrome

Depending on the cause of thoracic outlet, different treatments may be needed:

  • Physical therapy to improve range of motion and strength
  • NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen or naproxen
  • Lifestyle changes such as weight loss
  • Surgery to relieve pressure on the nerve
  • Surgery to open up blood vessels

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