เทคโนโลยีการรักษา

Electroencephalogram (EEG)

Electroencephalogram (EEG)

Electroencephalogram (EEG) Physicians, in conjunction with past medical history and physical examinations, rely on electroencephalogram or EEG to diagnose, distinguish, and provide the correct treatment plans for specific types of epilepsy. A number of electrodes with wires are attached to the patient’s scalp, and will detect as well as record any changes in electrical activity by neurons in the brain. Results will be amplified and presented as a graph (on paper and screen), and then physicians can analyze and detect abnormalities.    Uses for EEG 1. Patients with suspected epilepsy, symptoms including loss of consciousness, seizures, uncontrollable jerking, headaches, vertigo, behavioral changes, and psychological symptoms with no known cause. 2. Diagnosing different types of epilepsy such as absence seizures, generalized seizures, and pseudoseizures. 3. Diagnosing conditions such as hepatic encephalopathy, Creutzfeldt-Jakob Disease (CJD) or mad cow disease, and brain tumors. 4. Using EEG as a monitoring device to provide treatment plans for patients with status epilepticus. 5. To find suitable antiepileptic drugs for patients. 6. To help plan the discontinuation of antiepileptic drugs in epilepsy patients. 7. Using video EEG monitoring to help prepare for surgery in patients with refractory epilepsy. 8. Diagnosing and planning suitable treatments for patients suffering from sleep disorders such as obstructive sleep apnea and narcolepsy, via polysomnography (sleep study). 9. To confirm brain death. 

(Transcranial Magnetic Stimulation, TMS)  

(Transcranial Magnetic Stimulation, TMS)  

Transcranial Magnetic Stimulation (TMS) Transcranial magnetic stimulation is a noninvasive procedure using electromagnetic induction through a coil, to diagnose and treat neurological disorders such as paralysis, paresis, Parkinson’s disease, neuropathy, migraine, and depression.   Stimulation through electromagnetic induction can be done in 2 ways: 1. Repetitive TMS uses high frequency stimulation applied for more than 1 cycle per second. Suitable for patients with paresis, paralysis, Parkinson’s disease, and depression. 2. Single pulse TMS uses low frequency stimulation applied less than 1 cycle per second to help inhibit activity of the brain in migraine patients. Indications for TMS: Depression, mood instability after brain trauma, sudden and chronic pain, neuropathic pain, neurological disorders such as paralysis, paresis, Parkinson’s disease, and so on. How it’s done: Physicians will use the TMS device to stimulate patient’s brain once a day for 20-30 minutes. For best results, it is advised to receive treatment for 5-10 consecutive days. During the stimulation, physicians will observe and ask for feedback throughout the session. Results The magnetic stimulation is beneficial for the neural circuits in the brain and has a direct effect on neurotransmitters like serotonin; found to be related to migraine headaches, pain, stress, muscle tension, and depression. Contraindications Those with a pacemaker, those who have metal implants in the skull such as surgical clipping following a brain aneurysm or anywhere else in the body, and those with epilepsy. Adverse effects Warm sensation at the site of stimulation as the procedure can slightly increase intracranial temperature, headaches and scalp discomfort, nausea, and dizziness. More serious adverse effects include seizures and mood disturbances in psychiatric patients. What you need to know before the procedure 1. Your physician will inform you about the indications, contraindications, and general advice regarding TMS. 2. Before the actual procedure, your physician will stimulate your peripheral nerves to help you get accustomed to the sensation, strength, and rate of the stimulation used in TMS. 3. When you feel comfortable, your physician will continuously stimulate the brain area in rounds; corresponding to specific issues such as paralysis, paresis, and the opposite hemisphere for muscle weakness. For more information please contact Vibhavadi Hospital Neuroscience Center                                                                                Tel. 0-2561-1111 ext. 1214

Electromyography (EMG)

Electromyography (EMG)

Electromyography (EMG) is an electrodiagnostic procedure used to measure the health and response of muscles and nerves. This procedure can detect dysfunction of the nerves, allowing physicians to provide the correct and accurate treatment for patients who are suffering from symptoms such as numb hands and feet, and muscle weakness. What is EMG and how does it work? EMG relies on our understanding of the electrical impulses present in motor neurons, for diagnosis purposes. Generally, there are 3 types of tests available: 1. Nerve conduction study A diagnostic procedure using weak and safe electrical impulses to stimulate different nerves in the body. It can detect abnormalities and dysfunction, which may be present in patients with diabetes neuropathy, or pinched nerve in the wrists and elbows. 2. Needle Electromyographic Study A diagnostic procedure using small needles to detect abnormalities in the muscles and nerves, resulting from pinched nerves in the neck and back area. It can also be used to detect nerve damage and neuromuscular abnormalities. 3. Evoked Potentials (Eps) A diagnostic procedure using sensory stimulation such as electricity, light, touch, and sound to stimulate activity in the brain, which signals will then travel through the nerves and allow for any abnormalities to be detected. Benefits of the aforementioned tests EMG tests are beneficial for the accurate diagnosis of neuromuscular diseases and disorders, furthermore it can be a very useful tool for treatment planning. How safe is the test? EMG tests are considered safe, in both children and adults. Patients undergoing the test may feel mild electric shocks or slight pain in procedures involving intramuscular needles. Potential risks and side effects Soreness in areas tested using needles, however the discomfort should go away in a few days. Though rare and manageable, iatrogenic pneumothorax can be a possible complication of tests involving superficial muscular needles in the chest area. Symptoms include chest tightness, pain, and shortness of breath. Inform your physician prior to scheduling a test if you: Have a history of bleeding disorders such as hemophilia, or are taking medication that can cause bleeding (for EMG tests that require needles) Have a pacemaker implanted Have skin inflammation or infection at the site of test Note: Patients who are taking Mestinon (for Myasthenia gravis) must stop taking the medication 1 day prior to testing No fasting necessary For more information please contact Rehabilitation Center, Vibhavadi Hospital Tel: 02-561-1111 ext. 1118-9        

Cardiac Catheterization Lab

Cardiac Catheterization Lab

Cardiac catheterization done in the Cardiac Catheterization Lab is a non-sedating and minimally invasive procedure using a very thin and flexible tube, called a catheter, for the diagnosis and treatment of cardiovascular diseases. It is not considered as a surgical procedure and only uses local anesthesia at the site of insertion, therefore patients who undergo cardiac catheterization tend to recover quickly, with little to no wound. Diagnostic purposes will require patients to be admitted to the hospital for 1 night, while treatment purposes such as repairing heart defects or angioplasty with stent placement will require patients to be admitted to the hospital for 1-3 nights, for close observation. Patients who wish to undergo cardiac catheterization can inquire their physicians about details of the procedure as well as risks involved prior to making the decision.   Cardiac Catheterization Lab procedures include: 1. Coronary angiogram using dye and x-ray to diagnose and detect any abnormalities in the vessels of the heart and treatments such as stent placement, balloon angioplasty, heart valve dilation, and clot removal via suction. Coronary angiogram can treat: Coronary artery disease and blocked vessels Carotid artery disease Renal artery disease caused by high blood pressure or kidney diseases Peripheral artery disease in diabetic patients   2. Diagnosis and treatment of heart’s electrical system malfunction such as: Advanced 3D Cardiac Mapping Cardiac Radiofrequency Ablation Pacemaker implantation Implantable Cardioverter Defibrillator (ICD) insertion Cardiac Resynchronization Therapy     

Ultrasound

Ultrasound

Ultrasound or sonography is an imaging test that uses high-frequency sound waves that echo and create pictures of organs or structures inside the body. Ultrasounds are safe and commonly used in all stages of pregnancy, and even with newborn babies. Some uses are: Cranial ultrasound in children under 2 years old, to detect abnormalities inside the skull through the part that has yet to close, called the open fontanelles. Neck Ultrasound used to detect abnormalities in thyroid glands, salivary glands, parotid glands, lymph nodes, carotid arteries, and lumps in the neck. Chest ultrasound used to examine organs inside the chest cavity, such as the pleural fluid, lesions, or any abnormal growth. Abdominal ultrasound used to detect abnormalities or diagnose lesions in the abdomen. Others used to detect abnormalities and diagnose lesions in soft tissues such as muscles, breasts, legs, large blood vessels, Doppler ultrasound to observe rate of blood flow through the vessels, and any deep vein thrombosis, etc. How to prepare for procedure Cranial ultrasound – No preparation necessary, though sedation may be advised in some cases. Neck and chest ultrasound – No preparation necessary. Abdominal area: Upper abdomen ultrasound - avoid eating and drinking for at least 6-8 hours prior to getting an ultrasound. In children, avoid 1 meal or milk before procedure, for image clarity especially of the gall bladder. Lower abdomen ultrasound – no fasting necessary (unless otherwise directed by physician), drink lots of water 3 hours before appointment and avoid emptying bladder for image clarity, especially the uterus and other organs in the pelvic cavity. Whole abdomen ultrasound – avoid eating and drinking at least 6-8 hours prior to getting an ultrasound. Drink lots of water 3 hours before appointment and avoid emptying bladder until after the scan. Other parts – no preparation necessary. Suggestions: It is advised to fast (N.P.O. = Nothing per Oral) at least 6-8 hours before ultrasound appointment. Babies and toddlers should avoid drinking milk 4 hours before ultrasound. Reason for avoiding water and other liquids: any liquid and gas in the gastro-intestinal tract can affect imaging quality during the procedure. Patients with excess bowel gas are advised to wait 2-3 hours for best results. Reason for avoiding food: undigested food in the gastro-intestinal tract can affect imaging quality during the procedure. Oily foods can also cause the gall bladder to empty which can give an unclear image of the organ.

ระบบ PACS

ระบบ PACS

Picture Archiving and Communication System (PACS) Picture Archiving and Communication System or PACS, is the preferred medical imaging system at Vibhavadi Hospital, Radiology Department. Since January of 2006, PACS was the main system used at the hospital instead of the traditional film imaging. Medical images can be sent through the network and stored digitally in the system as the universal DICOM (Digital Imaging and Communications in Medicine) format, therefore it is both convenient and efficient for technicians and patients alike. Comparison between conventional film system and PACS Conventional film system require radiographers to perform an x-ray, develop the film, prepare a film envelop, and then send it to the radiologist to interpret results. After that, the film will be stored in the film storage room, only retrieved when physicians require it; in which they must borrow the film from the storage room to look at in the ward or the OPD. All these processes require staff and may take up time to locate and store the films, unfortunately, films can also be dislocated which can complicate the process. Since Vibhavadi Hospital switched to PACS, the process of medical imaging has become highly efficient. After radiographers perform an x-ray with an imaging plate, it can be converted by a computed radiography into a digital format, which can then besent through the PACS server. Once in the server, radiologists and physicians can bring up the image anytime without hassle. Benefits of using PACS        1. Benefits to the medical processes               - Time efficient for all processes including: diagnosis, waiting for the results, no film development necessary, and does not require film to be located in the storage room.              - Faster diagnosis and medical treatment received.              - Medical history can be retrieved anytime, especially to aid with the diagnosis and progression of the medical condition, allowing for the appropriate treatment plans to be put in place.              - Lower radiation exposure to both patients and radiographers in case x-ray images need to be retaken, due to technical errors.            2. Resource efficiency and environmental friendly              - Decrease the amount of x-ray waste, all images from the procedure are digital and can be adjusted for brightness and contrast.             - Prevent films from being misplaced.             - Environmental friendly; no more chemical x-ray waste.             - No film storage needed.             - Digital images will not deteriorate like   the conventional film method.

Mammogram

Mammogram

Mammogram Following cervical cancer, breast cancer is the 2nd most common type of cancer diagnosed in Thai women and has the tendency to increase every year. Causes of breast cancer There are no known specific cause. Non-modifiable risk factors for breast cancer Women over 35 years old History of being diagnosed with breast cancer Early period (before 12 years old) in puberty and late menopause Having female family members diagnosed with breast cancer Women who had children after the age of 30, or have not had a full-term pregnancy Preventable risk factors Repeated radiation exposure to the chest area before 30 years old Drinking alcohol Using continuous oral contraceptives for 4 years before first pregnancy Lack of exercise Overeating or eating unhealthy food Breastfeeding for less than 3 months How to prevent breast cancer There are no direct ways to prevent breast cancer Early screening for the detection and treatment of breast cancer is the best option Breast cancer screening for average-risk women Ages 20-40 years old, self-exam every month and clinical exam every 3 years Ages 40 and up, self-exam every month and clinical exam every year Breast cancer screening for high-risk women Self-exam every month and clinical exam every year Getting a mammogram every 2 years How to prepare for a mammogram Avoid drinking beverages or taking medication with caffeine, to prevent breast tenderness causing discomfort during the procedure Avoid using antiperspirants, deodorants, and body powder as the particles can show up on the image as microcalcification and give the wrong results. Breast untrasound Used in cases where the mammogram provided an unclear image of any lumps. Separating solid and cystic masses, as cystic masses can be diagnosed better via ultrasound. Limitations: it is a poor screening method, as it cannot detect microcalcification, calcium deposits that can possibly become cancerous.