ANGIOGRAM / ARTERIOGRAM

Angiogram/Arteriogram uses a scan to capture images of blood vessels. This type of study is designed to discover troublesome vascular conditions like an aneurysm (enlarged blood vessel), blockages, or stenosis (narrowing blood vessel).

A Venogram utilizes fluoroscopy to view veins in legs and arms which are highlighted by an injected contrast. Peripheral Vascular Procedures such as Laser Atherectomy, Balloon Angioplasty, and Stent Placement are used when patients suffer long term plaque build-up that partially blocks the arteries. Peripheral artery disease occurs when arthrosclerosis or blockage due to fatty material occurs in the arms or legs.

The procedure starts by patients receiving mild sedation through an IV in the arm. Next, the Interventional doctor inserts a tiny narrow balloon tipped catheter into the artery of the blocked vessel. The inflated balloon is installed to open the artery to increase blood flow. The balloon is deflated, and if the balloon angioplasty is unproductive, then the vascular stent placement occurs. After the artery is opened by the balloon, it remains open by inserting a small wire tube to keep it open. Lastly, the catheter is removed once the angioplasty or stent placement is finalized.

Patients’ must have a driver to drop off and pick up, and also needs to be prepared to spend approximately 8 hours at Gateway St Pete. Patients are placed in a recovery area for 4 hours where they are given food and drink to assist with resting process. Overnight stay is not necessary, and patients are expected to rest and take it easy for the next 3-4 days. Gateway will contact the patient the next day to confirm that the recovery is on pace for the patient to be resume normal activity within a week. A one week follow up consultant appointment is mandatory simply to make sure the healing process is successful.

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ANGIOGRAM / ARTERIOGRAM

  • CT Angio Abd/Pelvis Aorta w/ Runoff (75635/Q9967)
  • Aortagram w/ Runoff
  • Renal Angiogram ___Uni ___Bilat ___ w/Stent
  • Mesenteric

PERIPHERAL VASCULAR PROCEDURES

  • ____L ____R ____ Bilat
  • Laser Atherectomy
  • Balloon Angioplasty
  • Laser Atherectomy
  • Stent Placement for Peripheral Vascular Disease (PVD)

VENOGRAM / VENOGRAPHY

  • Interior Vena Cavagram
  • Superior Vena Cavagram
  • Upper Extremity Venogram ___L ___R ___ Bilat
  • Lower Extremity Venogram ___L ___R ___ Bilat
  • Iliac Venography ___L ___R ___ Bilat

IVC FILTERS

A patient who has a history of being high risk of developing blood clots in the legs is a good candidate to receive Inferior Vena Cava (IVC) filters. IVC filters are typically placed and removed for patients who experience deep vein thrombosis (DVT) with pulmonary embolus. Patients who receive IVC placement / removal need to plan to spend 3 hours at Gateway St. Pete.

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IVC FILTER PROCEDURES

  • IVC Filter Placement
  • IVC Filter Removal

PORT PROCEDURES

A Port or port-a-cath is usually placed in the chest under the skin, and is used to draw blood and give treatments for intravenous fluids, drugs, or blood transfusion. The device is attached to a catheter that is threaded into a large vein above the right side of the heart called the superior vena cava. Once installed Ports can remain inplace for weeks, months or even years. Patients who receive Port placement or removal need to plan to spend 3 hours at Gateway St. Pete.

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PORT / PICC PROCEDURES

  • Port Placement 36561, 76937, 36598, 77001
  • Port Removal 36590, 36598, 76937, 77001
  • Port Replacement 36590, 36561, 36598,76937, 77001
  • Portogram 36598
  • Port Flush 96523, 36593

DIALYSIS TREATMENT

  • A/V Fistulagram __ w/ Intervention
  • Permanent Dialysis Catheter ___ Placement ___Exchange ___Removal
  • Temporary Dialysis Catheter ___ Placement ___Exchange ___Removal
  • Dialysis Catheter Patency Check

PICC Procedures

A PICC (peripherally inserted central catheter) line helps access the blood stream for patients that need intravenous medication for several weeks or months for treatments like Cancer, Diabetes, and Lyme disease. Your doctor may also recommend you have a PICC line inserted for long term IV antibiotic administration for an infection.

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PORT / PICC PROCEDURES

  • PICC Placement 36569, 76937, 71046, 77001
  • PICC Replacement 36569, 76937, 77001, 71046
  • PICC Flush 96523, 36593

DIALYSIS TREATMENT

  • A/V Fistulagram __ w/ Intervention
  • Permanent Dialysis Catheter ___ Placement ___Exchange ___Removal
  • Temporary Dialysis Catheter ___ Placement ___Exchange ___Removal
  • Dialysis Catheter Patency Check

ESI – Epidural Steroid Treatment

An epidural steroid injection is a type of injection in which cortisone is delivered to the outermost section of the spinal column, called the epidural space. It is used to treat radiating nerve pain from the low back, middle back, or neck.

Epidural steroid injections are used to relieve nerve pain caused by spinal nerve compression. Typically used to treat pain that is commonly referred to as a “pinched nerve” in areas where pain is radiating from the neck to the arm (cervical radiculopathy), the middle back to the chest (thoracic radiculopathy), or the low back to the leg (referred to as sciatica or lumbar radiculopathy).

Gateway uses a 64 slice CT scanner to provide guidance in order to identify the exact location of the compressed nerve root and ensure the needle is correctly placed in the epidural space. Gateway Radiology offers Epidural injections from top to bottom of the spine as well as hip and sacroiliac joints.

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PAIN MANAGEMENT

  • ESI Cervical / Thoracic 77012/62310/64479/64480
  • ESI Lumbar / Sacral77012/62311/64483/64484
  • Hip Injection – Major Joint20610/77012
  • Sacroiliac Joint (SI) Injection27096/77012

Kyphoplasty

A minimally invasive procedure, Balloon Kyphoplasty repairs spinal fractures that may be caused by benign lesions, osteoporosis or cancer. Performed in an outpatient setting, Gateway radiologists treat the fracture with a balloon that kindly raises the fractured vertebra to return it to its original position. The fracture becomes stabilized once the bone cement is injected into vertebra, and after 1 hour the patient is feeling immediate relief on each treated level.

The patient will receive conscious sedation to assist with the procedure and requires the patient lay flat on stomach for 1 hour during the procedure, and to lay flat on back for 2 hours after the procedure. Majority of patients feel immediately relief after the procedure is finalized. Patient needs to be prepared to spend 4 hours at Gateway Radiology.

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KYPHOPLASTY

  • Thoracic 22513, 22515
  • Lumbar 22514, 22515

CT MYELOGRAM

Gateway’s 64 slice CT Myelogram provides high quality nerve detail for a back pain. The examination provides an abundant amount of information about the patient’s nerve roots.

A myelogram consists of injecting contrast or X-ray dye into the sac around the nerve roots, which in turn highlights the nerve roots. Gateway’s 64 slice CT scan clearly displays how the bone is affecting the nerve roots. This sensitive test for nerve impingement takes approximately 30 minutes, and demonstrates very subtle lesions (injuries). The patient needs to be prepared to lie flat on their stomach allowing the fluoroscopy camera to be placed above the patient. Cleansed with an antiseptic solution, the area to be injected will have a generous portion of local anesthetic applied to completely numb the area. A small needle placed in the spinal canal in order to obtain a sample of fluid. Then contrast is injected through the needle which few patients notice that it creates a light pressure sensation during this process. Once the injection is complete, images will be captured by the 64 slice CT scanner presenting magnificent detail of the internal structure of the spinal cord.

The medical team will exit the CT scanner area, and the CT tech will control the movement of the bed from the control. Fully visible from both sides, the patient will hear and be able to speak to each other the entire time throughout the scanning process. The patient will be instructed to take a deep breath and when to hold / exhale when needed. Any discomfort by the patient will be assisted by simply asking the tech for assistance. The CT Myelogram process takes approximately 45 minutes, and then the patient is expected lay flat on for up to 1 hour. From check in to check out, the total time spent equates to 3 hours at Gateway.

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CT MYELOGRAM

  • Lumbar 62304

MRI ARTHROGRAM

Arthrogram is a type of diagnostic imaging test used by an MRI to see the structure and function details of a shoulder knee or hip joint. This is performed by using a long, thin need to place contrast dye directly into the concerned joint in various positions. The reason why a patient may need an arthrogram is to treat nagging unexplained pain, discomfort, loss of range of motion, or how the joint functions. Additional reasons is tears in the soft tissues of the joint, ligaments, tendons, cartilage, and joint capsules.

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MRI ARTHROGRAM

  • Shoulder 77012, 73201, 23350, 73222, 73040
  • Hip 77012, 73701, 27093, 73722, 73525
  • Knee 77012, 73701, 27370, 73722, 73580

Biopsies

A biopsy is performed to test for potential disease by using a needle to remove a small sample of tissue considered suspicious. MRI, CT, or Ultrasound are used for imaging guidance to locate the abnormality to be sampled. Minimally invasive biopsy procedures are commonly performed in an outpatient setting, and is a same-day procedure with a very quick recovery time.

Biopsy patients should plan to spend approximately 3 hours at Gateway, and need to be picked up by a driver. Gateway will only perform a biopsy after the radiologist completes a patient review of the prior imaging and report along with a patient consultation. Biopsy patients are required to have blood work completed within the past 30 days that display levels for CBC, CMP, PT, and INR. Biopsy patients are to be NPO (No food or drink) 2 hours prior to their appointment time. Patients who are taking Blood thinners must stop 5 days prior to the biopsy appointment.

During the procedure the biopsy area is generously numbed with a local anesthetic like lidocaine to ensure a pain free biopsy. Because we use a small needle to take the sample, stitches are not required after the biopsy. The site is easily covered up by a single Band-Aid, making aftercare a much simpler process. After the required 1 hour recovery time is completed at Gateway, biopsy patients are typically expected to make a full recovery. The patient should continue to rest throughout the day and not drive. Well rested biopsy patients should plan on performing everyday light activities the following day. Lab Corp, Ameripath, and Inform Diagnostic typically take 5 business days to produce biopsy test results; however, depending on the criteria of the sample, labs reserve the right for more time if additional research needs to be performed for accuracy purposes.

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MRI GUIDED BIOPSY

  • Breast 19085/19086

CT GUIDED BIOPSY

  • Abdominal Mass 49180, 77012
  • Adrenal Gland 77012,49180
  • Bone Marrow 77012, 38220, 38221
  • Cervical Lymph Node 77012, 38505, 99152
  • Liver 77012, 47000
  • Lung 77012, 32405, 32557, 71045 (x3)
  • Retroperitoneal 76942,49180
  • Soft Tissue Neck Mass 20206, 77012

ULTRASOUND GUIDED BIOPSY

  • Breast / Aspiration 19083, 19084 x2, 19000, 19001, 10022
  • Fine Needle Aspiration Abdominal Cyst 10022, 99203
  • Liver 76942, 47000
  • Retroperitoneal 76942, 49180
  • Soft Tissue Lower Extremity 20206, 76942, 99203
  • Thyroid 76942, 60100, 10022

DRAINAGE PROCEDURES

  • Paracentesis 49083
  • Thoracentesis 32555, 32557, 71045 x3