Since 2000, BRG has provided teleradiology services to imaging centers, hospitals, multi-specialty and single specialty physician offices. Our teleradiology cases are interpreted by highly experienced, U.S. based, fellowship trained, Board-Certified subspecialty radiologists with expertise in musculoskeletal, rheumatology, body, spine, neuroradiology, and women's imaging.
Pediatric Care
Smoking Cessation
Osteoporosis affects more than 30 million Americans. Compression fractures occur in more than 500,000 patients per year in the US, are more frequent than hip fractures, and often result in prolonged disability. Risk factors include advanced age, Caucasian or Asian race, low weight, diseases such as kidney failure, and medication use such as prednisone. Current preventative measures include calcium and vitamin D supplementation, exercise, smoking cessation, and medications such as biphosphonates. Management includes pain control with acetaminophen (Tylenol), non-steroidals (Motrin), narcotics (Percocet), and bracing. Unfortunately, the compression fractures often progress and develop at other levels resulting in loss of height, disability, and secondary complications from immobilization including pneumonia and pulmonary embolism. Percutaneous vertebroplasty has recently been introduced into the US as an effective therapeutic and preventative treatment for the pain and progressive loss of height in compression fractures.
Family Practice
Emergency Care
Echocardiography can be very useful in the acute setting such as in the emergency department and hospital as well as in outpatient settings such as a cardiologist’s office. It is particularly useful in assessing heart muscle and valve function. It can also detect abnormalities of structures near the heart such as the pericardium, aorta, etc. More advanced software packages allow better quantification and visualization of abnormalities. When combined with pharmacological stress testing, it is possible to detect coronary artery blockages by noting wall motion abnormalities when the heart muscle is stressed. This modality cannot reliably visualize the coronary arteries except in very small children.
Colonoscopy
Virtual Colonoscopy definition - The computerized rendering of CT data into a format, which mimics the visualization (virtual reality) of the colon obtained from within by gastroenterologists using an endoscope (fiberoptic tube with a camera at its end).
Constipation
Erectile Dysfunction
Electrocardiogram
First, you complete a brief risk factor questionnaire. Next, you lie down on the imaging table while a CT technologist places a few EKG leads on you. You are then asked to hold your breath while the images are taken. That's it. You can return to your regular routine.
Urinary Incontinence
PAE is a minimally invasive, outpatient procedure performed through a quarter inch incision in the right grown or left wrist enabling you to return to your normal activities quickly without any risk of urinary incontinence or sexual disfunction.
As a result, recommendations have been made for large scale screening programs for persons beginning at the age of 50 (American Cancer Society/ACS). Colorectal cancer screening guidelines given in the journal Gastroenterology in 1997 suggest that the screening modality must be safe, available, acceptable to the patient and cost effective. In March, 2000, the ACS recommended fecal occult blood testing every year, optical sigmoidoscopy every 5 years, or complete evaluation of the colon with air contrast barium enema or optical colonoscopy every 10 years. More recently published articles in the New England Journal of Medicine in July, 2000 showed that both air contrast barium enema and sigmoidoscopy are not very effective screening tests because they both miss more than 50% of colonic polyps, while sigmoidoscopy would miss more than 52% of proximal cancers. Thus optical colonoscopy is now the only established effective method of colon cancer screening. Polyps can be removed and thereby decrease the chance of subsequent development of colon cancer. It however, does not satisfy the previously mentioned screening criteria in that many patients and physicians avoid it, it is expensive, carries a risk of perforation and even death.
Colon Cancer
A large multicenter trial of 1233 patients at low risk for colon cancer has now shown that the Viatronix software allows a radiologist using a primary 3D interpretation to have accuracy similar to optical colonoscopy.
Prostate Cancer
Multiparametric, 3 Tesla, prostate MRI (mpMRI) consists of a precise combination of imaging sequences used to screen for prostate cancer. Findings on each imaging sequence are scored, enabling determination of an overall PI-RADS category, utilized to determine the likelihood of the presence of clinically significant prostate cancer.
Lung Cancer
Effective in 2015, Medicare guidelines will now cover annual low dose CT lung cancer screening for enrollees who meet all of the following criteria: they are age 55 to 74 years old; and are either current smokers or have quit smoking within the last 15 years; have a tobacco smoking history of at least 30 “pack years” (an average of one pack a day for 30 years); and they receive a written order from a physician or qualified non-physician practitioner that meets certain requirements.
A standard transrectal prostate biopsy is performed under ultrasound guidance. A total of twelve core biopsy samples are obtained from pre-determined regions of the prostate gland.
MRI
We feel this exciting new test best fits as a supplemental screening exam for those patients who are intermediate risk, or who are highrisk but cannot get an MRI.
Radiology
With her training complete and certified by the American Board of Radiology, Dr. Wolf and her family relocated to South Florida, where she joined Boca Radiology Group, PA and began working at Boca Raton Regional Hospital as an Interventional Radiologist.
X-Rays
Nuclear Medicine
PEM is a nuclear medicine exam which uses intravenous injectable FDG, (fluoro-deoxyglucose), a glucose analog, which accumulates in glucose avid cells. FDG will accumulate in both inflammatory and cancerous states as they have higher metabolic rate than normal cells. This glucose analog is phosphorylated but does not proceed through the entire cellular energy production cycle or Krebs cycle so it maintains its presence within the cell which permits image acquisition.
Mammography
In Sept, 2006, the Center for Breast Care brought new technology to assist in the evaluation of our patients with newly diagnosed breast cancer. PEM or Positron Emission Mammography, is an organ specific high resolution PET scanner which will uniquely give our physicians the capability of functional imaging for breast cancer detection. Rather than relying on morphology or the "appearance" of a cancer, PET relies on identifying its metabolism for its diagnosis. By so doing we would anticipate detecting cancers earlier, at a more easily curable stage.
Computed Tomography
Boca Raton Regional Hospital is proud to have been the first hospital in Palm Beach County to operate a 64 slice CT scanner, and then operated the first Dual Source 128 slice FLASH CT scanner, and now the dual 196 slice FORCE, which is the fastest scanner in the world. We have fellowship trained radiologists with extensive experience and have performed over 20,000 cardiac CT scans to date and do the largest volume of functional and anatomic cardiac scans in S. Florida.
Chemotherapy
According to Dr. Roger Goldwyn, faculty member in FAU's department of mathematical sciences and director of the proposed Center for the Development of Computational Clinical Imaging at FAU, "Our approach is to use innovative image-processing tools to find additional tumors and to help determine patient management outcomes. These techniques have also led to biopsies directed by these image-processing tools, surgical planning modifications, and monitoring effectiveness of chemotherapy."
Radiation Therapy
A new, recently FDA-approved follow-up treatment option, MammoSite breast brachytherapy is now available for the first time in South Florida. MammoSite breast brachytherapy more effectively targets radiation to the tumor site, sparing healthy surrounding tissue. It shortens the course of radiation therapy to five days, rather than the five weeks that is typical of standard external radiation. It also significantly reduces patient discomfort.
Interventional Radiology
Usually, the procedure is performed in an interventional radiology suite with special x-ray equipment (c-arm fluoroscopy) with nurses and technologists to help sedate the patient and operate the equipment. The patient is placed prone on the x-ray table and made as comfortable as possible. Sedation usually includes a narcotic (fentanyl) and a benzodiazopine (versed), which are short acting and can be reversed if necessary.
Her training continued with a one year internship in General Surgery and subsequently a four year residency in Diagnostic Imaging, both at Rhode Island Hospital/Brown Medical School. With a strong interest in performing minimally invasive, image-guided procedures, Dr. Wolf chose to pursue a one year fellowship in Vascular and Interventional Radiology at Rhode Island Hospital/Brown Medical School. With an additional desire to perfect her diagnostic skills, focusing on CT and MRI of the abdomen and pelvis, Dr. Wolf completed an additional one year fellowship in Body Imaging at Rhode Island Hospital/Brown Medical School. During her second year of fellowship, she was able to further her initial research pursuits in image-guided tumor ablation, while gaining increased clinical experience.
Hysterectomy
Disadvantages: Same potential surgical complications as hysterectomy; only part of uterus is treated and recurrence can occur; 15 to 25 % need repeat procedure, usually hysterectomy; not all fibroids amenable to myomectomy; adhesions can lead to infertility
Endometrial Ablation
Laparoscopy
Reconstructive Surgery
Patients often choose to have our hi ghly skilled plastic surgeons reconstruct a breast during the mastectomy procedure.
Percutaneous breast biopsy has become the standard of care for nearly all non-palpable breast abnormalities in our community. The majority of lesions are BIRADS Category 4 of which 20-40% are found to be cancer. Due to the high rate of finding a benign lesion in this population, surgical excision should be avoided. The BIRADS Category 5 patients are found to have a cancer 75-90% of the time. A preoperative diagnosis improves the care of these patients. Occasionally, we are asked to biopsy w patient with BIRADS Category 3 abnormality. 0.5-2% of these patients are found to have a cancer. These patients are only done if follow-up is considered unlikely, prior to breast augmentation or pregnancy or in the high risk patient or one with extreme anxiety.
Breast Surgery
In women with newly diagnosed breast cancer who are thought to be candidates for lumpectomy surgery, mammography and clinical breast examination often do not depict the full extent of cancer. As a result, positive margins are common at the initial treatment surgery. Magnetic resonance imaging (MRI) has been shown to be highly sensitive in depicting the full extent of tumor in both the breast with cancer and the opposite breast, and is often used in planning treatment. There are, however, many noncancerous lesions that show up as suspicious on MRI. Positron emission mammography (PEM) is another way to image breast cancer, using a high-resolution PET scanner to image areas where there is increased metabolism of glucose. In preliminary studies, PEM appears to be equivalent to MRI at showing cancer, but it may be less likely to show noncancerous lesions. In this clinical research study, participants will have both a contrast-enhanced MRI of the breast(s) and a PEM study. The MRI is billed to insurance as part of usual care. The PEM study is performed at no charge. The purpose is to determine whether MRI or PEM is better at predicting the actual extent of tumor and at helping surgeons to perform the most appropriate breast surgery at the time of initial diagnosis thereby reducing positive margins and multiple surgeries.
Molecular Breast Imaging, or MBI, is the latest imaging technology we have to aid us in the diagnosis of breast cancer. It utilizes radioactive tracer (technium 99 sestambi) injected into the patient. This radiotracer localizes to the mitochondria (the "powerhouse") of a cell which allows us to identify lesions that are metabolically active, such as breast cancer. As such, its a way to assess for lesion physiology and is another functional imaging tool.
The Center for Breast Care rounds out its healthcare program for patients by providing comprehensive risk assessment, wellness education, rehabilitation programs, and counseling opportunities. In addition to physical therapy, including lymphatic massage therapy, the Center for Breast Care also Offers psychosocial counseling and a variety of support groups for patients and their families. We also offer a resource and referral network, as well as a health resource library.