First Quarter 2023 Imaging Advances covers news about advanced medical imaging tests and interventional radiology treatments in the Fredericksburg, Virginia, region. It is published quarterly. Sign up for our e-news for video clips, shareable content and breaking stories: [email protected] Follow Us on Social Media Managing dialysis access is critical for local patients The importance of dialysis access management cannot be overstated, according to medical professionals at VIVA who pride themselves on excellence in patient care. Their work involves the placement and long-term maintenance of devices used to connect kidney disease patients to dialysis machines. MRI is an essential tool in multiple sclerosis diagnosis Neuroradiologists at RAF regularly play a role in the diagnosis and treatment of local patients with multiple sclerosis. These highly trained physicians analyze MRI studies on an almost daily basis to identify the disease, rule out other conditions, and monitor progression. Radiologist Spotlight: Nisha Alle, MD Dr. Alle’s specialty area is women’s imaging, in her words, “the perfect blend of image interpretation and meaningful patient interaction, whether it be through diagnostic workups in real time, procedural work, or discussion of results after a biopsy.” Her work for RAF benefits patients at the Imaging Center for Women. page 2 page 3 page 3 Dr. Alle hiking in Hawaii PHOTO BY JARED WOOD/VIVA
2 Imaging Advances Managing dialysis access is critical for local patients with kidney disease The importance of dialysis access management cannot be overstated, according to the medical professionals at Virginia Interventional & Vascular Associates (VIVA) who pride themselves on excellence in patient care. Dialysis access management involves the placement and longterm maintenance of devices used to connect kidney patients to dialysis machines. Keeping dialysis access sites viable is a critical part of the process for men and women whose kidneys are failing and who must undergo this life-saving procedure to cleanse their blood and keep their body in the proper balance. Preventing an infection or clot in a fistula, graft or catheter is key, said Dr. Samer Hijaz, a board-certified and fellowship-trained Interventional Radiologist with VIVA. “Dialysis access management is a central part of dialysis care,” he explained. “As interventional radiologists, we care for patients when they’re first diagnosed with end-stage renal disease by placing a catheter so they can start their dialysis. And then, as they graduate into having a fistula, or a more permanent access, we see them for placement and maintenance of that access. So, we get to know this patient population very well throughout their journey.” Ensuring the proper functioning of those devices is a must, according to VIVA, a multi-specialty practice that provides comprehensive vascular care as well as a full complement of interventional radiology services. The need for this specialized service is clear: the National Kidney Foundation reports that 37 million Americans have chronic kidney disease, and many of them require dialysis. Millions of others are at increased risk. Dialysis access management services offered by VIVA include the following: Placement of grafts or fistulas for access (fistulas join an artery and vein in the arm to create access) Fistulagrams (an X-ray procedure to examine blood flow and check for clots or other blockages in a fistula) Declots Catheter exchanges Surgical revision “We work closely with nephrologists and vascular surgeons and dialysis centers. It’s a pretty extensive involvement,” Dr. Hijaz said. “Patients rely on us to care for them. They might have dialysis three times a week, and we have to make sure they have an access that is open and ready for use. Or sometimes a patient needs urgent dialysis, and we have to be present and ready to establish access for them. Then we see them for maintenance of that access to avoid anything becoming problematic for the patient.” Dr. Hijaz performs a full variety of interventional radiology procedures but has a special interest in dialysis access management, which he learned during his radiology training at Virginia Commonwealth University and fellowship at MedStar Georgetown University Hospital. These days, he sees kidney patients ranging in age from twentysomethings to senior citizens. High-quality care is the goal for all patients at VIVA, the interventional radiology and vascular surgery group of Radiologic Associates of Fredericksburg. For more information about the practice or services provided, please go to www.vivassociates.com. Referring providers who would like to reach a VIVA physician can contact the physician concierge at 1-855-RAF-LINE (1-855-723-5463). Dr. Hijaz performs a full variety of interventional radiology procedures but has a special interest in dialysis access management. PHOTO BY JARED WOOD/VIVA
3 Radiologist Spotlight: Nisha Alle, MD Board-certified, Fellowship-trained Radiologist By the time she was a teen, Nisha Alle, MD, knew one thing for certain: she wanted to be a physician. Fascinated by human physiology, she excelled academically in the biological sciences and charted her course toward medical school. “If I hadn’t chosen medicine, perhaps I would have pursued a career with the U.S. State Department, as I find geopolitics and foreign policy interesting,” she said. “Or maybe I would have ended up in the culinary arts. I love cooking and the many details that go into creating distinctive cuisine.” Dr. Alle grew up in Baton Rouge, Louisiana, with her father, a chemical engineer; her mother; and an older brother and sister. Today, all family members live in Virginia and all three siblings are physicians. Dr. Alle’s brother, Dr. Srinesh Alle, is a neuroradiologist in Chesapeake. Her sister, Dr. Darshana Alle, is an allergist and immunologist in Stafford, and her brother-in-law, Dr. Deepak Raghavan, is a neuroradiologist with Radiologic Associates of Fredericksburg (RAF). Dr. Alle received her medical degree from David Geffen School of Medicine at the University of California, Los Angeles (UCLA). She completed her internship at California Pacific Medical Center, her radiology residency in diagnostic radiology at Ronald Reagan UCLA Medical Center, and her fellowship in breast/body imaging at Memorial Sloan Kettering Cancer Center. “I was attracted to radiology initially because it involves putting together the clinical ‘big picture’ for a patient,” she said. “Each puzzle piece is offered in the form of imaging. Radiologists in essence assist medical colleagues with difficult diagnoses that are not readily apparent on a physical exam – and can effectively direct the course of disease management.” Dr. Alle’s specialty area is women’s imaging, in her words, “the perfect blend of image interpretation and meaningful patient interaction, whether it be through diagnostic workups in real time, procedural work, or discussion of results after a biopsy.” Her brother-in-law, Dr. Raghavan, was instrumental in her decision to join the RAF practice in 2018. “He described the organization as a highly collegial group of radiologists who could help me develop as a newly minted radiologist – and further thrive with the backing of a strong support staff. I have found his description to be totally on target.” At the Imaging Center for Women in Fredericksburg, Dr. Alle works in three different rotations: screening, diagnostics, and procedures. On screening days, she interprets screening mammograms for women who come in for their annual mammograms, providing results in a typical 24-hour turnaround time. She also performs MRI-guided needle biopsies. On diagnostic days, she works in real time with patients who have felt a breast lump or have other concerns, such as pain. Dr. Alle interprets their imaging, and provides a plan of action during their appointment. On procedure days, she performs wire localizations for preoperative patients, stereotactic biopsies (biopsies that involve mammographic guidance), and ultrasound-guided needle biopsies for patients whose imaging results require follow-up tissue sampling. In time away from her practice, Dr. Alle follows her other passions: going to the theater for plays and stand-up comedy; cooking at home and discovering new restaurants; and travelling and hiking. “Because I spend many working hours in a dark reading room, being outdoors whenever I can is especially refreshing for me,” she said. Most recent adventure: exploring the varied landscapes of Iceland and New Zealand. MRI is an essential tool in diagnosing multiple sclerosis Neuroradiologists at Radiologic Associates of Fredericksburg (RAF) regularly play a role in the diagnosis and treatment of local patients with multiple sclerosis (MS). These highly trained physicians analyze magnetic resonance imaging (MRI) studies on an almost daily basis to identify the disease, rule out other conditions, and monitor progression. That’s because this nerve-degenerating condition is more prevalent than many people realize. “We see that day in and day out. MS is more common than most people think. It affects many young people in the prime of life, and for some it is very debilitating,” said Dr. Deepak Raghavan, a board-certified, fellowshiptrained neuroradiologist with RAF. Dr. Raghavan is one of nine RAF neuroradiologists who interpret results for MS-related MRI studies performed at Mary Washington Hospital, Stafford Hospital, Medical Imaging of Fredericksburg, Medical Imaging at Lee’s Hill and Medical Imaging of North Stafford. Their findings help neurologists and other medical providers care for MS patients. 1 million Americans MS can vary in symptoms and severity. While its exact cause is unknown, MS triggers a patient’s immune system to damage myelin, the protective outer layer that insulates nerve fibers, which disrupts signals to and from the brain. The damage can cause symptoms ranging from numbness to tingling, mood changes, memory problems, pain, fatigue, blindness and/ or paralysis. “Everyone’s experience with MS is different and those losses may be temporary or long lasting,” according to the National Multiple Sclerosis Society. The society reports that: Of the four main types of MS, Relapsing-Remitting Multiple Sclerosis is the most common course, characterized by clearly defined attacks of new or increasing neurological symptoms. continued on page 4
4 www.rafimaging.com www.vivassociates.com (540) 361-1000 Ed Swager, Chief Executive Officer Radiologic Associates of Fredericksburg (RAF) is the largest provider of medical imaging services in the Fredericksburg, Stafford and Spotsylvania area. RAF’s interventional radiology and vascular surgery group, Virginia Interventional & Vascular Associates (VIVA), performs minimally invasive procedures, vascular lab studies and vascular surgery. RAF publishes Imaging Advances periodically for referring physicians and the greater medical community. For more information, please contact Paige Bishop, Director of Marketing, [email protected], (540) 361-1000. Radiologic Associates of Fredericksburg 10401 Spotsylvania Avenue, Suite 200 Fredericksburg, VA 22408 Nearly 1 million people in the United States live with the disease, including high-profile patients such as actresses Christina Applegate and Selma Blair. While MS can occur at any age, the average age of onset is around 20 to 50 years. Diagnosis and follow-up There is no cure yet for MS, but there are treatments. Early diagnosis tends to improve patient outcomes. MRI studies help eliminate the possibility of conditions that cause similar symptoms, and other diseases that damage myelin. “MRI is a critical tool in MS diagnosis. You need to document neurologic insults affecting at least two different locations in the central nervous system, occurring on at least two different dates, to make an MS diagnosis. You are documenting a relapsing and remitting process, and we use McDonald Criteria to do this,” Dr. Raghavan explained. McDonald Criteria outline clinical, laboratory and MRI guidelines for diagnosing MS. They also provide options for identifying MS even earlier, before a patient has a second attack, through MRI and spinal-fluid testing. Once a diagnosis is made, MS patients periodically undergo MRI testing to inform treatment decisions, monitor the efficacy of medications and assess their conditions when the disease flares. For example, MRI contrast can be used to identify lesions responsible for an acute attack, and the appearance of these plaques can inform the prognosis, Dr. Raghavan noted. For consultations Medical providers can consult with a RAF neuroradiologist on MS cases by contacting the physician concierge at: 855-RAF-LINE (855-723-5463). MRI is an essential tool in MS diagnosis continued from page 3