Departments

Magnetic Resonance Imaging (MRI) is an advanced, non-invasive radiological imaging method that, using a strong magnetic field, radio waves, and a computer, produces detailed images of the human body based on the magnetic properties of protons when exposed to magnetic fields.

The examination is very safe because it does not use ionising radiation (unlike X- rays and CT scans that use radiation) and is not associated with cancer induction - to date, there have been no documented significant side effects from the use of magnetic fields and radio waves in the human body.

The "Ygeia Florinas - Tomodiagnosi Ltd." centre has a modern MRI scanner, the Signa HDxt 1.5T by the American manufacturer GE Healthcare, which allows the performance of high-quality – common as well as (some) specialised - MRI examinations:

• Common MRI scans (of the central and peripheral nervous system, musculoskeletal system, neck, thorax, upper & lower abdomen, retroperitoneal area)

• Specialised MRI scans (magnetic resonance mammography, magnetic resonance cholangiopancreatography, magnetic resonance urography, multiparametric magnetic resonance imaging of the prostate)

• Magnetic Resonance Angiography (of the brain & body vessels).

Due to the strong magnet used, objects containing metal are not allowed in the MRI scanner room, as:
1. they may get damaged (e.g., watches, electronic cards, mobile phones or other personal electronic devices, hearing aids).
2. they may cause artifacts and distort the images (e.g., keys, coins, jewellery, pins, zippers, removable dental appliances or orthodontic treatments, metallic ink tattoos).
3. they may be attracted by the magnetic field and moved within the room.

There have been cases of injury to individuals (e.g., glasses, pens, nail clippers). It is necessary to remove all metal objects from the individual before entering the scanner room. Additionally, individuals may be asked to remove clothing and use a single-use medical gown.

MRI can be performed on individuals of all ages with appropriate indications.

The strong magnetic fields generated during magnetic resonance imaging (MRI) can interfere with and affect implants that may be present inside the patient's body. For this reason, no one is allowed to enter the scanning room without first answering a series of safety questions. Although newer implants developed in the last 10-15 years are generally compatible with MRI scanners, official documentation from the manufacturer or surgeon certifying their compatibility is required.

Additionally, individuals with implanted conventional cardiac pacemakers or automatic defibrillators are not permitted to undergo MRI scans and should not enter areas where such examinations are conducted.

! People with the following conditions may not be eligible for magnetic resonance imaging (MRI):
- Aneurysm clips in the brain
- Certain types of artificial heart valves
- Cochlear implants
- Recently implanted artificial joints
- Certain types of vascular stents (patients who had a stent placed in the last trimester should avoid undergoing the examination)
- Intrauterine contraceptive device (IUD)

! Anyone who may have been exposed to metallic residues or shavings in the workplace (e.g., metal processing areas or explosive testing areas) or elsewhere (e.g., presence of metal shards or other metallic elements following injury) requires a skull radiograph to rule out the presence of metal in the eyes. Magnetic resonance imaging can cause serious damage.

Magnetic resonance imaging is not recommended for pregnant women during the first trimester of pregnancy. For the rest of the pregnancy, the examination is only performed in consultation with the clinician and based on indications, while it is not prohibited during the postpartum period.

Magnetic resonance imaging is usually not recommended in cases of acute trauma: life support equipment cannot safely enter the MRI room, and since it is a lengthy examination, valuable time may be wasted.

In special cases, depending on the indication and findings, the administration of intravenous contrast medium may be required for better and clearer imaging - the most common type of contrast agent is gadolinium, which is considered very safe:

! In case of a history of hypersensitivity reactions, relevant information about the possible administration of antiallergic treatment should be provided.
! In the event of impaired kidney function, the potential risk is discussed between the treating physician and the radiologist.

The main disadvantages of magnetic resonance imaging include:

Claustrophobia: A significant drawback for many - approximately 20% of patients have difficulty completing the examination.

Immobility: Patients must remain completely still during the examination - any movements (involuntary or voluntary), even minimal ones, negatively affect image quality. Some individuals may be unable to remain still due to their psychology (e.g., anxiety, fear), age (e.g., young children), or illness (e.g., pain, tremor).

Noise: The MRI machine generates noise due to the changing magnetic fields and is normal. Earplugs or (if the head is not included in the examination) special headphones may be used to address the issue.

** For patients with claustrophobia and those who are unable to remain still, mild sedative medications may be administered, or the examination may be scheduled with mild intravenous sedation by an anaesthesiologist.

** Additionally, there are open MRI scanners that do not create the sensation of confinement and are better suited for individuals with claustrophobia (and for excessively obese individuals).

Computed Tomography (CT), also known as Computed Axial Tomography (CAT), is a non-invasive radiological method used for medical imaging and diagnosis, utilising X- ray radiation. With the use of a special X- ray-generating machine, widely known as a CT scanner, and advanced computer technology for processing results, detailed two-dimensional cross-sectional images of the human body are produced. These images can be stored digitally (on CD) and printed on film.

At "YGEIA FLORINAS - TOMODIAGNOSI EE," a department equipped with a modern multidetector CT scanner is operational. The LightSpeed VCT, manufactured by the American company GE Healthcare, produces high-quality images with high resolution (clarity and contrast). Belonging to the latest generation of CT scanners, it is significantly faster compared to conventional ones, allowing examinations with lower radiation exposure and enabling three-dimensional (3D) reconstructions of sections thinner than a millimetre.

All conventional and some specialised CT examinations are performed, including:

• - Classical CT scans (of the brain, skull base, temporal bone, neck, thorax, upper and lower abdomen, retroperitoneal area, spine, bones, and soft tissues).
  - CT angiography (of the brain, neck, thoracic and abdominal cavities, upper and lower extremities).

CT can be performed on all interested individuals following appropriate indications.

For radiation protection reasons (CT scans rely on X-ray radiation), CT is contraindicated during pregnancy. Additionally, it is avoided in children, adolescents, and young individuals without a significant medical indication.

! Depending on the indications and/or findings, intravenous iodinated contrast medium may be administered:

* In cases of an patient with a history of allergic or anaphylactic reactions to previous administration of iodinated contrast agents (such as in CT or intravenous pyelography), or with a history of hypersensitivity reactions in general, it is essential to disclose this information so as to provide instructions for anti-allergic preparation—administration of antihistamines and corticosteroids in combination with gastric protection if deemed necessary.
* In cases of a patient with pre-existing renal insufficiency or with diabetes mellitus with confirmed diabetic nephropathy, there is a risk of acute kidney injury (increase in creatinine levels >25% or >2mg/dl compared to pre-administration levels): recent (within the last two months) blood urea/creatinine examination is necessary.
* In cases of a patient with hyperthyroidism or bronchial asthma, there is an increased risk of precipitating a thyrotoxic crisis.
* In cases of a patient with Myasthenia Gravis, there is an increased risk of exacerbating symptoms.
* In cases of a patient with pheochromocytoma, there is an increased risk of precipitating a hypertensive crisis.

Bone densitometry, also known as bone density measurement, is a radiological examination used to quantitatively determine bone mass in a specific area of the skeleton over a given period, using ionising radiation.

Bone density measurement is currently the most widely accepted diagnostic examination for osteoporosis, a systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, resulting in increased bone fragility and fracture risk – particularly in the hip, spine, and wrist, though other areas may also be affected.

The role of radiology in the study of osteoporosis includes: 1. Early diagnosis 2. Assessment of fracture risk 3. Monitoring therapeutic outcomes. There are various methods for measuring bone density.

According to existing Greek and international guidelines, the diagnosis of osteoporosis relies on bone density measurement using dual-energy X-ray absorptiometry (DXA), which is the most commonly used method and the method of choice:

• Bone densitometry, also known as bone density measurement, utilises a specialised machine, the bone densitometer, and specific software to determine whether an individual is healthy or suffering from osteopenia or osteoporosis. At "Ygeia Florinas - Tomodiagnosi Ltd", one of the most reliable, effective, and popular DXA systems in the world is used: the Lunar Prodigy from the American company GE Healthcare.

• Modern machines perform examinations in minimal time – typically 5-10 minutes – and with extremely low radiation doses – approximately 10% of the dose required for a simple chest X-ray and lower than the daily dose of radiation received unintentionally by individuals from the environment.

• The recommended measurement sites include the lumbar spine and the (less dominant) hip ("central" DXA) – for individuals unable to be measured in the above anatomical positions, overweight individuals, and those with hyperthyroidism, the examination is performed at the peripheral end of the radius-ulna ("peripheral" DXA). The selection of these sites is based on: 1. bones in these areas being more susceptible to osteoporotic fractures. 2. fractures occurring in these areas causing more serious problems, having a longer recovery time, causing significant and persistent pain, and potentially leading to disability.

Bone density measurement using DXA is recommended for individuals who, depending on their age, have at least one of the following risk factors related to their medical history and lifestyle:

Age < 50 years

• Low-trauma fracture
• Hypogonadism
• Early menopause (<45 years)
• Malabsorption syndromes
• Primary hyperparathyroidism
• Medication associated with bone loss and/or fracture risk (steroids, aromatase inhibitors, etc.)
• Other diseases associated with bone loss and/or fracture risk (rheumatoid arthritis, Cushing's syndrome, type I diabetes mellitus, severe chronic obstructive pulmonary disease, etc.)

Age 50-64 years

• Low-trauma fracture after the age of 40 years
• Parental hip fracture
• Vertebral fracture and/or osteopenia seen on X-rays
• Low Body Mass Index (<20) and/or weight loss >10% within one year
• Alcohol abuse and/or active smoking
• Other factors and diseases (as in the age group <50 years)

Age > 65 years

• All individuals, both men and women
• Recommendations:
  - Bone density measurement using DXA is indicated for individuals of any age, both sexes, if it is deemed that such measurement will contribute to therapeutic decision- making. Postmenopausal women without an indication for initiating therapy are recommended to undergo DXA measurement every two years to evaluate potential changes in bone density.
  - Postmenopausal women under therapy are recommended to undergo DXA measurement every year for efficacy assessment/ evaluation of specific treatment.

Contraindications:

- Pregnancy
- Recent radiographic examinations with barium
- Presence of bone prosthetic materials – measurement in an alternative anatomical position is recommended.
- Severe obesity – peripheral DXA measurement is recommended.