Top INDEX
• - Article : What Causes Scar Tissue in the Lungs?
• - Article : How to interpret CT scans of your lung.
• - Article : Scars can lead to Lung Disease.
• - Article : What Are the Effects of Tuberculosis on Lung Tissue?
• - Article : What Are the Causes of Cavity in the Lungs?
• - Article : Blockages in the Lungs.
• - Article :

• Response: Can TB scar be removed from the lung?
• Response: Lung Scar Cure for OFW Applicants.

• Technical: Patient DI/Lab Results Report, 2020-11-26
• Technical: Impax Viewer.
• Technical: Zeroviewer.
• Technical: NM Biliary HIDA Scan.

• Comment: Personal motivations to know more.

  Insight: Symptoms of Cavity Formation from released bacteria.

  Insight: Symptoms of interstitial lung disease (ILD).

  Insight: Symptoms of Pulmonary Embolism.

  Insight: Symptoms of Tuberculosis Pleurisy.

  Insight: Some mets cause Pain; some cause Heavy Breathing.

  Insight: Bronchoconstriction can cause Wheezing.

  Insight: Causes of lung scarring.

  Insight: Causes of bacteria reactivation in the lungs.

  Insight: Scarring can occur where macrophages wall off bacteria.

  Insight: Aspergillus fungus can cause lung cavitations.

  Insight: Periodontal disease bacteria & other causes of cavitations.

  Insight: Cancer tumors can cause lung cavitations.

  Insight: Unclean Energy Sources creates respiratory problems.

  Insight: Unresolved bacterial infections can lead to Empyema.

  Insight: Chest X-rays may initially appear normal.

  Insight: CT scans make mirror images,

  Insight: It may take Time for your eyes to adapt to see features.

  Insight: Ground-glass opacity of hazy scans & its meaning.

  Insight: Ayurvedic treatment to resolve ACC (Adenoid Cystic Carcinoma)

  Insight: Lungs are still scarred even if you are (medically) cured.

  Insight: There is no (medical) treatment to remove a lung scar.

• -Focus-: Monographs on Toxins and Enhancers.

Article : What Causes Scar Tissue in the Lungs? INDEX
https://lunginstitute.com/blog/
what-causes-scar-tissue-in-the-lungs/
by Lung Health Institute --- 866-832-6901
Blog, Interstitial Lung Disease
July 28, 2018

Do you have any scars somewhere on your skin?
Most people do. Some scars are small and hard to notice, while others are large and obvious.
Now picture scarring like this in your lungs.
Unfortunately, scarring like this can happen with the development of chronic lung diseases.
Lung scarring is a serious issue because scars cannot be reversed.
When your lungs are scarred, the scar tissue inhibits the ability for your lungs to take in air and process it into oxygen for your blood.

Many chronic lung conditions cause scar tissue to develop.

Some of the most common ones include:

• Pulmonary fibrosis
• Tuberculosis
• Pneumonia
• Sarcoidosis
• Pneumoconiosis and more

Hundreds of serious lung conditions can cause scarring and permanent damage to the lungs.
These may all be identified under one blanket term, interstitial lung disease.
Typically, these conditions develop as the body’s immune system reacts to some sort of irritation or viral attack. These immune system reactions often develop into inflammation. It’s this inflammation that leads to scarring.

Preventing interstitial lung disease
Interstitial lung disease cannot be cured, and lung scarring and damage are irreversible.
Medical professionals, like the team at the Lung Health Institute, may provide treatments to assist with reducing symptoms and slowing the progression of the disease.

Some cases of interstitial lung disease are genetic and cannot be avoided, but many cases can be prevented. The following are risk factors that may lead to the development of a chronic lung disease that scars your lungs:

Smoking


Working with hazardous chemicals


Working in poorly ventilated, dusty areas

If you begin exhibiting symptoms, such as

difficulty breathing,

shortness of breath,

fatigue and

persistent coughing,

you should seek medical assistance.

Medical professionals, like those at the Lung Health Institute, may diagnose and treat lung conditions.
Treatments will vary depending on the severity of your condition, but
the general goal of treatment is to manage your symptoms and help you breath easier again to live a better quality of life.

Article: How to interpret CT scans of your lung. INDEX
http://www.website-go.com/acc/
info@accoi.org

Adenoid Cystic Carcinoma (ACC)
(MET) metastases (focal rounded pulmonary opacities also called "nodules" or "lesions")

The following pictures show different lung scans from various ACC patients with lung metastases (focal rounded pulmonary opacities also called "nodules" or "lesions"). Most pictures are taken from a CT scan where a contrast agent was used. They show the different appearances of ACC lung mets. ACC has a tendency to spread to the lungs among other organs. ACC metastases are commonly random spread over the lobes of the lung.

A brightly lightened nodule seems to be faster growing than a greyish nodule.
The white colour indicates a higher uptake of the tracer/ contrast agent.
It seems that the brighter the nodule "shines" the more round it grows (probably high malignancy).
Dark spots on the lesion are unclear.
Shady lesions seem to be stable or slow growing (low malignancy).
"Spready" lesions have a tendency to be stable, inactive or slowly growing.
They might even decrease or vanish.

A CT scan makes mirror images.
The right side of the lung is on the left side on the picture.
The clear white stripes, branches and spots are blood vessels.
To see the difference between a blood vessel and a nodule you must scroll the pictures in the viewer frequently up and down many times. If it is a blood vessel, it will have a connection to the next picture level and fade out slowly in a blood vessel that appears as a branch. Metastases commonly "pop up" when you scroll up and down. Make sure that there is no equivalent blood vessel leading to it.

You are also able to see the different lobes.
A very fine greyish outline is the border between two lobes.
It takes some time to see clearly, but just be patient.

NOTE: The comments and interpretations of what is shown on the pictures is what the patients were told by their radiologists. In many cases the interpretation has not been validated by a biopsy or by a surgery. The pictures of lung metastasis shall only give you an impression and overview of what you might see on your own CT scan pictures of the lung. The examples on this website might enable you to check your lung scans on your own and understand better the context for your physician’s comments.

... If a met grows very close to the chest wall it is likely to cause pain.

... some mets that are placed very close to the mayor airways and are suspicious to cause heavy breathing.

Vanishing lesions
... In some cases spanning many cancer types, tumors gradually disappear without any medical treatment, either conventional or alternative. In other cases, these “spontaneous regressions” coincide with changed dietary practices and/or alternative treatments. Spontaneous regressions are not common, but have been documented

The CT pictures below, provided by an ACC patient, appear to catalogue such a case.
In this case, the patient travelled to a small Sri Lankan village for 3 months to be treated by a local doctor trained in traditional Ayurvedic medicine. The treatment involved the institution of radical dietary changes for 4 months, including

the elimination of proteins,
reduced carbohydrates,
Kasaya (a herbal decoction/tea),
Ayurvedic pills and
plentiful organic green leaves and
fresh vegetables.
Meditation was also part of the treatment.

Afterloading.
a kind of hollow needle placed through the chest into a lung met.
The needle is used for the afterloading technique which is a subtype of a brachytherapy and will be withdrawn after the radiation. The radiation is provided via the hollow core of the needle. One met is very close to the heart and the other is placed near an airway.

RFA (Radiofrequency Ablation) Treatment
a needle-like RFA probe that is placed through the chest inside the tumor.
Commonly CT imaging is used for positioning.
Once the probe is placed in the tumor, the radiofrequency energy is delivered.
The radiofrequency waves passing increase the temperature within the met that results in destruction of the tumor. The needle will be withdrawn after the RFA.

Risk of pneumothorax
RFA, Brachytherapy and Afterloading have a common risk of pneumothorax (air getting into the chest cavity). The risk is similar to a CT guided lung biopsy procedure. This common complication is normally not serious and usually goes away on its own with no treatment.

But even if the patient needs a chest tube to drain the air, the patient can go home after 1 or 2 days in hospital. You may experience some discomfort or pain in the treatment area for a few days and may also have a slight temperature and feel a bit tired and weak. Sometimes you will spit some blood for a few days. All this is not a serious complication though. Some other more rare side effects (e.g. bleeding, injury of a nearby organ, flu-like fever) may occur.

Ground-glass opacity (not metastases)
Ground-glass opacity is a non-specific term that refers to the presence of increased hazy opacity within the lungs that does not obscure the associated pulmonary vessels. It is a parenchymal abnormality and can reflect minimal thickening of the septal or it can be an alveolar wall inflammation or the presence of cells or fluid filling the air spaces, or a combination. If it is acute, it can represent pulmonary edema, pneumonia, or diffuse alveolar damage among others.

Article: Scars can lead to Lung Disease. INDEX
https://msih.bgu.ac.il/cured-tuberculosis-scar-tissue-chronic-lung-disease/
Even if a patient is cured of tuberculosis,
remaining scar tissue usually leads to chronic lung disease.
Medical School for International Health,
Caroline House, 3rd Floor
Faculty of Health Sciences
Ben-Gurion University of the Negev
P.O. Box 653
Beer Sheva, ISRAEL 8410501
By Dr. Neil Schluger.
December 11th, 2017

In his presentation to MSIH students in November, visiting professor, Dr. Neil Schluger gave an overview of his work in Ethiopia where he is part of the East Africa Training Initiative in Pulmonary Medicine (EATI). The Initiative, a fellowship training program, is the brainchild of Dr. Schluger and Dr. Charles Sherman of Brown University and is funded by Vital Strategies (a U.S. based NGO that works to improve health in low and middle income countries) and the Swiss Lung Foundation. It aims to:

Address the dire need for pulmonary and critical care specialists in Ethiopia
Ensure the program is self-sustainable by EATI-trained physicians by the year 2020
To provide expertise and consultation to the Ethiopian Ministry of Health

Dr. Schluger, Prof of Medicine, Epidemiology and Environmental Health Science Columbia University, is an annual visitor to MSIH where he participates in the 2nd year Respiratory Clerkship, training MSIH students as they study the thorax “system” in anatomy. He is an enthusiastic supporter of MISH, impressed by the global health content of the medical degree program.

In his talk, Dr. Schluger went on to explain that air pollution is a major contributor to respiratory problems.

Unclean Energy Sources
“Like so many other parts of the developing world, the fuels used for cooking and heating in Ethiopia are ‘unclean energy sources”. Imagine living in a mud hut during the winter. Cow dung and wood may be used for heating and cooking – creating horrendous breathing conditions for everyone inside, especially as there’s poor ventilation. This leads to all sorts of respiratory problems – including TB.”

Dr. Schluger explained that about 20% of the people coming to EATI’s clinic have chronic lung disease.
“This is because even if you’re cured of tuberculosis, your lungs are still scarred,”

Surprising Facts
As an aside, Dr. Schluger surprised the audience with the little-known fact that Ethiopia is the only African country that was never colonized.
“It was occupied for a while by Italy, ...”.

Another surprising fact that came across is that Delhi in India is the world’s most polluted city,
and that nine of the world’s ten most polluted places are in India.

Article: What Are the Effects of Tuberculosis on Lung Tissue? INDEX
https://healthfully.com/what-are-the-effects-of-
tuberculosis-on-lung-tissue-4641831.html
Written by Sharon Perkins
18 December, 2018

Tuberculosis, an airborne disease caused by Mycobacterium tuberculosis, primarily affects the lungs though it can spread to other organs. More than 13,000 new cases of tuberculosis, or TB, were reported in the United States in 2007, according to Merck Manuals Online Medical Library. Tuberculosis affects the lungs tissues in many ways, depending on the severity of the disease.

Scarring
In latent TB, a dormant form of tuberculosis, bacteria breathed into the lungs are surrounded by white blood cells. If the white blood cells, called macrophages, contain the infection, bacteria remain walled off in areas called granulomas and active infection doesn’t develop. Small scars appear in the lungs where the bacteria are walled off. Immune substances released from the soft, crumbly center kill off most of the bacteria, although some may remain.

In latent TB, a dormant form of tuberculosis, bacteria breathed into the lungs are surrounded by white blood cells.

If the white blood cells, called macrophages, contain the infection, bacteria remain walled off in areas called granulomas and active infection doesn’t develop.

Tuberculosis Pleurisy
If the granuloma ruptures and leaks fluid into the space between the lung and the chest wall, called the the pleural cavity, tuberculosis pleurisy can develop. Fluid within the space increases, causing shortness of breath and chest pain that worsens when the person breathes in. Most cases resolve spontaneously but about two-thirds will develop active tuberculosis pleurisy within 5 years, Healthcommunities.com reports

Cavity Formation
The bacteria in the lungs may re-activate if the immune system is damaged by diseases such as alcoholism or malnutrition, by treatments such as chemotherapy or by prolonged use of medications such as corticosteroids that cause immune suppression. Advanced age can also impair the immune system and cause re-activation of latent TB. When this happens, granuloma starts to break down and liquefied material escapes in the airway. A cavity forms in the lung, which allows oxygen and carbon dioxide to enter. Since these provide an excellent medium for bacterial growth, the TB bacteria reproduce rapidly. Cavity formation causes destruction of lung tissue, with coughing, spitting up blood, fever, night sweats and weight loss.cause:

• Cavity formation causes destruction of lung tissue
• with coughing
• spitting up blood
• fever
• night sweats
• weight loss

The bacteria in the lungs may re-activate if the immune system is damaged by diseases such as alcoholism or malnutrition, by treatments such as chemotherapy or by prolonged use of medications such as corticosteroids that cause immune suppression.

A cavity forms in the lung, which allows oxygen and carbon dioxide to enter.

Nodule Formation
In miliary TB, small nodules that look like millet seeds form throughout the lung shortly after the initial infection.

The chest X-ray may initially appear normal, making diagnosis difficult.
Miliary TB is a serious form of TB that can result in death.

Article: What Are the Causes of Cavity in the Lungs? INDEX
https://healthfully.com/what-are-the-effects-of-
tuberculosis-on-lung-tissue-4641831.html
Written by Melissa Lingohr-Smith
05 December, 2018

Cavities in the lungs are formed by inflammation of lung tissue leading to the development of an abscess. When the abscess ruptures, the contents are expectorated, leaving behind an air- and fluid-filled cavity. Chest X-rays and computer tomography, or CT, scans can detect lung cavitations. Several infections and diseases cause lung cavitation.

Bacterial Causes
Tuberculosis, periodontal disease and necrotizing pneumonia are bacterial causes of lung cavities. ...
The infection can cause the formation of granulomas, which is a protective response by the body.
In granulomas, immune system cells collect in order to destroy the invading pathogen.
Sometimes the granulomas can become abscesses that lead to lung cavitation.

Bacteria found in the oral cavity--most often with periodontal disease
-- can be aspirated into the lungs where they cause an abscess.

Necrotizing pneumonia, a rare disorder that can cause rapid lung cavitation, is caused by bacteria normally found in hospital.

Even more rarely, certain fungi of the genus Aspergillus cause lung cavitation.

Inflammatory Disease
Sarcoidosis and Wegener’s granulomatosis are inflammatory diseases that can cause the formation of cavities in the lungs. Like tuberculosis, these diseases cause formation of granulomas in the lungs. The Merck Manuals Online Medical Library reports that Sarcoidosis is most common in African Americans and those of Scandinavian descent, and that Wegener’s granulomatosis in most often observed in Caucasians. Both diseases are rare and tend to affect people younger than 40.

Bronchiectasis
Bronchiectasis can be caused by recurrent lung infections and inflammation, which ultimately lead to irreversible damage of the airways in the lungs. The Merck Manuals Online Medical Library states that CT scans of patients with bronchiectasis are characterized by “tramlines” that depict thickening of the airways and cysts that may be associated with cavitation

Cancer
Tumors that have arisen in the lungs or that have metastasized to the lungs can cause lung cavitation by obstructing the airways and leading to mucus accumulation in pockets of the lungs. Bacteria sometimes can infect these areas behind the tumors and form an abscess. A study published in the “Journal of Vascular and Interventional Radiology” reported that lung cavitation can also occur in patients that have had their tumors ablated.

Article: Blockages in the Lungs. INDEX
https://healthfully.com/161607-active-vs-inactive-tuberculosis.html
Written by Valerie Liles
05 December, 2018

When an airway in the lungs becomes blocked and causes such alarming symptoms as breathlessness, wheezing, chest tightness and coughing, immediate medical intervention is necessary. A blockage significantly reduces the lungs’ ability to provide oxygen to the cells and release carbon dioxide if it is not removed or resolved. Blockages can result from trauma, infection, disease or inflammation.

Pulmonary Embolism
A pulmonary embolism usually occurs when a blood clot that has developed in the deep veins of the legs or the pelvis breaks loose and travels to the lungs and lodges within the pulmonary artery. According to the American Lung Association, the clot can block blood flow through a vessel and deprive the lung tissue of blood. The most common symptom of a pulmonary embolism is

• sudden breathlessness; ...
• chest pain,
• palpitations,
• a slight fever and
• wheezing, ...
• coughing up bloodstained mucus ....

Bronchoconstriction
Many factors can cause the walls of the small bronchi and bronchioles to become inflamed and swollen, blocking the airway. The inflammation causes a number of changes, all contributing to airway narrowing. Doctors believe this inflammatory response occurs because the body releases histamine to destroy the inhaled allergens, chemicals, virus spores or bacteria.

Contraction of smooth muscle in the wall of the airway produces a narrowed channel, while the blood vessels become wider within the walls of the airway, further blocking the airway. This response often causes wheezing as the air tries to pass through a significantly narrower opening.

Aspiration Pneumonia
According to MayoClinic.com, aspiration pneumonia occurs when a person inadvertently inhales food or vomit into the lungs. This sometimes happens when a person is unconscious because of trauma or illness. It can also occur if a person has difficulty swallowing, sometimes resulting from a neurological illness such as a stroke. Bacteria in the inhaled material can infect the lungs, requiring in-patient treatment to remove the cause if necessary, or possible, and to treat the bacterial infection with antibiotics.

Empyema
Empyema is the accumulation of pus in the space between the membranes of the pleura, a two-layered membrane that lines the inside of the chest cavity and the outside of the lungs. According to the University of Maryland Medical Center, the most common cause of empyema is an unresolved bacterial infection that spreads to and infects the pleural space. A person may experience persistent fever and chest pain. To reach a diagnosis, the doctor uses imaging techniques and withdraws pus from the pleural space for examination. This accumulation of pus can compress and block lung tissue from within the pleural space, minimizing lung volume making it difficult to breathe.

Response: Can TB scar be removed from the lung? INDEX
https://www.healthcaremagic.com/premiumquestions/
Can-TB-scar-be-removed-from-the-lung/188948
Answered by Dr. Kaushal Bhavsar
peer-reviewed by: Dr. Chakravarthy Mazumdar
Tues, 21 July 2015

Question: How a TB scar can be removed from lung?....
" X Ray result: Fibrohazed densities are seen in d right upper lobe."
The idea is how to remove the scars in such a way that an Xray exam result clean enough
to be accepted by authorities for residence visa like in Middle East for example

Brief Answer: Once a scar always a scar.

Detailed Answer:
... I can understand your situation and problem.
You might be having tuberculosis in the past.
And taken treatment for the same and get cured.

Now, TB lesion after treatment heals with any of the following mechanism. 1. Fibrosis 2. Calcification 3. Fibro calcification 4. Bronchiectesis 5. Rarely complete resolution.

First three are very common.
And these are healed inactive scar tissue which remain as it is through out your life.
So for visa application, you need to prove that these lesions are old, fibrotic scars and not active, infectious lesions.

For this you have to consult pulmonologist and get done 1. CT thorax with Contrast. 2. Bronchoscopy and XXXXXXX (bronchoalveolar lavage) analysis.

If both these are negative for active tuberculosis than you can argue with visa authority
about not having active, infectious disease and thus eligible for visa.

Response: Lung Scar Cure for OFW Applicants. INDEX
https://tech.technobound.com/2019/12/
lung-scar-cure-for-ofw-applicants/
By Kyle (Blog post)
Dec 31, 2019

OFWs or Overseas Filipino workers enjoy better income abroad as compared to local job offers in the Philippines. This is the reason many Filipinos sacrifice and work hard abroad for their families and their future. Just like Pinoy local employee equipped with proper financial planning, an OFW can also save and prepare for retirement while sending money for family needs. OFWs earn more anyway, and becoming an OFW someday would have been a dream of a typical working Filipino.

Philippine jobs in our opinion only have very few high paying titles that seem to be reserved to well connected employees, employees that engage in dirty office politics, well experienced, or those hardworking and honest staffs. It could be rare blessing to land a high paying job in the Philippines. Most jobs here simply suck, to be honest. Most HR just asks for your current salary and will not select you if you ask for more when switching jobs (of course they may, if you have the talent and experience that is rare in the industry).

OFW career path is a good choice nowadays.
However, there is a reason that could stop you from obtaining that work permit and visa- its your medical report. Health is wealth. We know that. But if you are found to have a lung scar, chances of being able to be an OFW is slim. Gulf coast countries or GCC includes Saudi Arabia, Yemen, Qatar, etc. They are a trick when a person have a lung scar. Along with other medical condition, they do not let you work there if you have such lung scar.

The cure eludes many Filipinos stuck with lung scar.
Lung scar may not go away after tuberculosis treatment.
33% is your chance of having lung scar gone after a treatment,
33% chance that lung scar size shrink size, and
33% it does not change size after treatment.
There is no treatment to remove the scar.

The chance we get is applying to other countries like USA, Canada, Australia and South East Asian countries.

There is a cure for tuberculosis.
It is important to consult a pulmonologist.
Cure for lung scar might not be available now even if you had TB.
But our hopes of becoming OFW and uplift our families will not be hampered by lung scar.
(Depending upon which country you apply to)

Technical: Patient DI/Lab Results Report, 2020-11-26 INDEX
Received in printed format.

QUOTED for CT, Chest X-ray, Ultrasound, and Bili Hida Scans

All results performed dates from 2020 Nov 13/26
Images are not diagnostic.
Higher quality images are available in eroviewer and Impax

Technical: Impax Viewer. INDEX
https://www.carilionclinic.org/sites/default/
files/2017-08/Impax%20User%20Guide.pdf --- 18 pages
Agfa Impax A Picture Archiving and Communication System (PACS)
Quick Reference Guide

LINK 2: VA Technical Reference Model v 20.10
https://www.oit.va.gov/Services/TRM/ToolPage.aspx?tid=5628
USA Dept of Veteran's Affairs
08/26/2020
This technology is not portable as it runs only on Windows platforms.

LINK 3: IMPAX Client Installation.
http://impaxupdater.palmettohealth.org/clientinstaller/en/
Microsoft .NET Framework 4.6.1 is also required.

LINK 4: agfa impax cd viewer.
https://www.updatestar.com/en/topic/agfa%20impax%20cd%20viewer
Searches for same and similar viewers with Download LINKS.
12/03/2020

LINK 5: https://impax.tech/about-us

LINK 6: Free DICOM Viewer for Windows.
https://dicom-viewer.en.softonic.com/

Innovation and Modernization Patuxent River (IMPAX)
As a Partnership Intermediary Agreement between the Naval Air Warfare Center Aircraft Division (NAWCAD) and the Georgia Tech Research Institute (GTRI), IMPAX has the ability to communicate directly with government agencies, industry, academia, and the public to assist with completing complex technological projects at a faster rate, with higher returns.

IMPAX is a picture archiving and communication system (PACS) solution.
IMPAX is a proprietary software for use at medical facilities using a digital radiology imaging system and supporting both local and remote access. The software allows clinicians to enhance their workflow through various image and communication functions. The client can connect to the PACS server from across office locations via thin and fat client technology.

Data is stored on the IMPAX Database Server which is compatible with Oracle Database or Microsoft Structured Query Language (SQL) Server database. The IMPAX Database Server stores the central database used by all components in the cluster and maintains a record of all database transactions in transaction log files.

The IMPAX Client software is used to view, interpret, and distribute medical reports and images.
The IMPAX Client installation program installs the full Client, excluding any integrated applications (such as TalkStation, IMPAX Reporting, Volume Viewing, the Orthopaedic application, or other clinical applications). To install it, you must be logged in as a Windows administrator.

The IMPAX Client focuses on the integration of PACS, RIS, and Reporting applications into a single delivery of information. A single IMPAX Client application can be used by a range of users on any appropriate, networked workstation they have access to.

Impax is set to log a user off the system after 20 minutes of inactivity.
If a user leaves the work-station for a long period of time, or if the workstation is simply idle for a while, IMPAX shuts down and returns to the Login screen

From the List AreaList AreaList AreaList Area, you can do a simple search for a study by Patient name, Patient ID, Accession Number, Study Date or Modality.

Select the desired study from your search results. The selected study highlights.

Double-clicking the desired study opens the Image Area Image Area Image Area Image Area with the image(s) as well.

From the TOP Toolbar at the top of the display screen,
Select the Window Level Window Level Window Level Window Level tool.
Using the mouse, click once on the image.
Move the mouse up and down and left to right to adjust the window level.
Click once on the Image again to set the window/level
---- Hint: Moving the mouse vertically (up and down) adjusts the brightness of the window/level.
---- Moving the mouse horizontally (right and left) adjusts the contrast of the window/level.

Impax’s Geometry tools allow users to change the orientation of the images.
Images can be rotated and flipped vertically and horizontally.

After selecting the Zoom Drop-down Tool from the Top of display toolbar ..
Increase or decrease the magnification in the Magnify Glass window, use the mouse scroll wheel.
Or Use the Page up or Page down keys on the keyboard.

To resize the Magnify Glass window, place the cursor over any part of the frame.
A double-arrow displays. Click and drag the window frame to a desired size.

It is important to close images as you are done viewing them.
Impax remembers what Studies are left open in the Image Viewing Area and will open them the next time you login in to Impax. Leaving images open in the viewing are will slow the login process for your next session because images must load in order for you to per-form your next search.

Free DICOM Viewer.
Anyone in the field of medicine knows the importance of DICOM.
An acronym for Digital Imaging and Communications in Medicine,
DICOM is a standard for medical imaging which allows users to store, print, and share data.
However, viewing one is not something you can easily do, as the usual image viewers do not support such a file.
You need to have a separate application to do such a task.
Free DICOM Viewer is one of those programs that can view DICOM files.
It is one of the better-known health applications that have several useful features.
If you want to access DICOM files and garner information about any disease, this app is worth a try.

DICOM represents the universal and fundamental standard in digital medical imaging.
It provides all the needed tools to represent and process diagnostically-accurate medical imaging data.
Contrary to popular opinion, DICOM is not just an image or file format.
It is an all-encompassing data transfer, storage, and display protocol designed and built to cover all functional aspects of digital medical imaging. This is why many view DICOM as a set of standards, rather than a single standard.

Media Freeware’s Free DICOM Viewer is an ideal choice when you want to view DICOM images.
The app comes with an interface that is easy to use, even by a novice user.
Its comprehensive set of functions—like zoom, rotate, and color change --- are laid out simply in the window.
Parameters, such as width and image size, are also adjustable.
The angle in which you can see the image is flexible, as well, and can be modified within the interface itself.
Free DICOM Viewer also allows the users to tag the image and reset it according to individual requirements.
It also lets the users manage the files easily since settings such as lighting can be adjusted.

Free DICOM Viewer supports quite a few formats, including PNG and JPEG.
It is a small-sized tool that requires less disk space. Moreover, its response time is very impressive, with little to no chances of crashing or freezing.

Technical: Zeroviewer. INDEX
https://morton.co.za/xeroviewer/

LINK 2: XERO® Viewer.
https://www.agfahealthcare.com/he/usa/en/
binaries/XERO%20sheet%202013_tcm561-113934.pdf --- 2 pages

LINK 3: Quick Start Guide. 11 page pdf
Morton and Partners, Radiologists
https://morton-web.s3.amazonaws.com/XERO%20Final.pdf
(021) 276 2019 --- support@morton.co.za
Business Hours: 07:00-17:30
Afterhours (emergency) number: (083) 607-4613

Agfa HealthCare Corp.
10 S. Academy Street
Greenville, SC 29601 USA
Agfa and the Agfa rhombus are trademarks of Agfa-Gevaert N.V., Belgium, or its affiliates.
IMPAX, XERO, and ICIS are trademarks of Agfa HealthCare NV, Belgium or its affiliates.

XERO is a web-based medical imaging service intended for use by all our referring physicians or healthcare professionals. It provides access to radiology images and reports.

XERO enables authenticated users to search for and display available patient studies (reports and images) using a browser on a PC or mobile device. XERO is designed for reviewing medical imaging studies, and not for primary diagnosis.

Access XERO Viewer by going to https://mobile.morton.co.za/ and using your login details to access the patient’s information.

If you have not yet accessed XERO before, please contact our PACS support centre to help register your profile.
Contact them on: (021) 276 2019 or imaging@morton.co.za

System Preferences:
Xero Viewer is a web-based imaging platform and is thus system agnostic (i.e. will work on Windows, MacOS, iOS and Android). Our IT team recommends using Chrome to access XERO for an optimal user experience.

In the delivery of care today, health systems around the world find themselves struggling to identify and dissemi-nate medical images data from various departments and dif-ferent locations to the caregivers who need that data. As the use of images grow, so does the challenge of providing all care providers have access to images. Yet, as more depart-ments generate imaging data and more providers value its use in patient care, simply consolidating storage does not solve the problem.

Based on innovative, no-application download technology, Agfa HealthCare’s XERO enterprise imaging viewer is a tech-nological breakthrough that allows any clinical user to view patient images, regardless of department or region of origin, at any time from any web-enabled device.

Any clinician can now request, and quickly receive, the images from multiple sources within a single, patient-centric view. It doesn't matter where the images are, or what ven-dor’s solution is hosting them. XEROVERSE, Agfa’s new multi-source discover technology will combine them all, in an instant, into one view. XERO is multi-patient ID domain capable.

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The PATIENT ID field is Morton & Partner's QP number and not the patient's ID number.
The format should be: QP-123456
Do not enter more than 2 fields in the search fields, as it slows down the search request.
The OFFLINE button reflects your CHAT STATUS with other users and not the system status.
The icon will change to ONLINE (green) if you are able to use this function.

Technical: NM Biliary HIDA Scan. INDEX
What you should know about the HIDA scan.
https://www.medicalnewstoday.com/articles/320496
Medically reviewed by Suzanne Falck, M.D., FACP
Written by Jayne Leonard on January 3, 2018

LINK 2:What Is a Hepatobiliary (HIDA) Scan And How Is It Conducted?
https://www.medicalhealthtests.com/medical-tests/hepatobiliary-scan.html
Submitted on March 27, 2012

LINK 3: What Is a HIDA Scan with CCK?
https://www.wisegeek.com/what-is-a-hida-scan-with-cck.htm
by Mary McMahon (with figures, pix)
Last Modified Date: November 23, 2020

LINK 4: Radiology Questionnaire, 1 page
https://ereferrals.bcbsm.com/bcn/news-archive/
pdf/Questionnaire_MRI_NuclearHIDA.pdf
Blue Care Network of Michigan
February, 2012

Technetium-99M DISIDA (200 MBq) was injected.
2020-11-27--Calgary Foothills Medical Centre.

In general, the HIDA test has been replaced by high quality ultrasound of the liver and gallbladder.
However, in some situations it can be a valuable test to evaluate liver and gallbladder functional status.

A HIDA scan, also called cholescintigraphy or hepatobiliary scintigraphy,
is an imaging test used to view the liver, gallbladder, bile ducts, and small intestine.

The scan involves injecting a radioactive tracer into a person’s vein.
The tracer travels through the bloodstream into the body parts listed above.
A special camera takes pictures to track the tracer’s movement and transmit images onto a computer screen for observation and diagnosis.

To prepare for a HIDA scan, a person may need to fast for 4 to 12 hours before the scan.

After the scan .. A person should drink plenty of water to help speed up the radioactive tracer’s movement out of the body through urination and bowel movements.

A HIDA scan may be done to:
• measure the rate at which the gallbladder releases bile,
  ----- commonly referred to as gallbladder ejection fraction
• check the liver’s bile-excreting function
• follow the path of bile from the liver to the small intestine
• assess the outcome of a liver transplant
• find the cause of pain originating in the right side of the abdomen
• uncover the cause of jaundice or a yellowish hue to the skin

HIDA scans can help diagnose the following:
• biliary atresia, a rare congenital or inherited bile duct abnormality
• cholecystitis or inflammation of the gallbladder
• complications of operations, such as bile leaks or fistulas,
  ----- which are abnormal connections between two organs obstruction of the bile duct

During the procedure:

• The person will lie down on a table and be instructed to remain still throughout the scan.

• A specialist will insert an intravenous (IV) line into the person’s arm or hand and inject a radioactive tracer.
  The person may experience a slightly cold sensation, which may feel like one is urinating, or feeling of pressure while this is happening.

• A technician will position a gamma camera above the person’s stomach to capture images.

• The tracer will move through the IV line into the bloodstream.
  From there, it will travel to the liver. At this stage, bile-making cells in the liver absorb the tracer and carry it through the gallbladder, bile duct, and small intestine. This process may take approximately 60 to 90 minutes, although it can take up to 4 hours in some cases.

• A technician will control the camera, and a radiologist will view the images on a screen.

Results

HIDA scan results can be classed as:

• Normal:
  This means the tracer moved freely from the liver into the gallbladder and small intestine.

• Slow movement:
  If the tracer moved slowly through the body, this might suggest an obstruction or blockage in the gallbladder or bile duct, or it indicates below optimal liver function.

• Not present:
  If there is no sign of the radioactive tracer in the gallbladder, it can be a sign of acute inflammation of the gallbladder or acute cholecystitis.

• Low gallbladder ejection fraction:
  If a person takes CCK to empty the gallbladder, yet the amount of the radioactive tracer leaving the gallbladder is abnormally low, it can indicate chronic inflammation of the gallbladder or chronic cholecystitis.

• Radioactive tracer detected in other parts of the body:
  In cases where the tracer makes its way to other areas of the body, it suggests a leak in the biliary system.

How much does it cost?
HIDA scans vary in price. In some cases, insurance may cover the cost.
Healthcare Bluebook quotes USA $1,120 as the fair price for a HIDA scan.

Hepatobiliary scan or HIDA scan is conducted to examine the functioning of the liver.
It checks if bile is being made and excreted, if the bile ducts or drainage system are functioning appropriately, and if there is any malfunction in the gallbladder.

Typically, a hepatobiliary scan is coupled with an ultrasound of the gallbladder for a comprehensive evaluation.
HIDA scan is also referred to as a hepatobiliary iminodiacetic acid scan or an NM hepatobiliary scan.
This scan is an imaging process through which your doctor can track bile movements, its production and its flow into the small intestines from you liver. Basically, this scan generates pictures of your biliary tract, liver, gallbladder, and small intestine. It falls under the imaging study called nuclear medicine scans (NM scans). Nuclear medicine scans use a tracer, which are radioactive chemicals to highlight particular organs in the imaging scans.

The liver is one of the most complicated organs of the human body.
This organ is responsible for many different functions including some functions on which the life of the individual depends. No person can live without a liver that is partially functional. One of the many different functions of the liver is the production of bile. Bile is a fluid that is used to break down fatty foods in the digestive system. This fluid is produced in the liver and passed into the gall bladder where it is stored until the individual needs to digest food.

When digestion takes place, bile flows directly from the liver into the small intestine.
At the same time, bile from the gall bladder will also enter the area.
This increases the amount of bile available, thus ensuring that even large quantities of food get broken down effectively.

What Is a Hepatobiliary Scan?
The hepatobiliary scan is a scan used to determine the effectiveness of the liver’s functioning, particularly relating to its production and release of bile. A person may even have to go through a hepatobiliary scan with gallbladder ejection fraction in certain cases. The hepatobiliary scan is a nuclear medicine scan. This means that a radioactive tracer substance needs to be injected into the body. Tracer substances are used to mark out various organs and tissues in the body. This makes it possible for them to be seen clearly on any subsequent scan. The liver is used to filter out waste products from the blood. Thus, the tracer material will make the parts of the liver very clear in any scan.

The hepatobiliary scan is done in order to check if there is any obstruction in the bile ducts of the liver.
This scan is also done to check if there is any obstruction or inflammation of the gall bladder.
There may even be a situation where bile leaks into the intestines when it is not needed for digestion.
This sort of test will be able to determine if that is the case.

As the procedure begins, you would need to be in the supine position.
A radioactive chemical (tracer) will be injected through an IV line in a vein in your arm.
Cameras will be positioned over the table, above your gallbladder, to be precise, and images will be recorded for 60 to 90 minutes. The injected tracer will highlight areas of the gallbladder and make it visible to the NM camera.

The camera captures images every few minutes to track gallbladder enlargement.
This takes about an hour after which, CCK is injected to contract your bladder thereby highlighting gallbladder functioning for image capture.

Comment: Personal motivations to know more. INDEX

When I was in my late teens or early 20's, mid-1960s, I was given a Chest X-ray as part of a job application.

The doctor, Dr. Bill Arkinstall, of Newmarket District Hospital, reported to me that a SCAR was on my lungs and was probably a healed tuberculosis infection.

I lightly smoked filter cigarettes, about a pack a week or 10 days, for about a year in my mid-teens.
I have never smoked anything since. I am not significantly overweight, except for the 10 pounds I added when prescribed and taking the drug Elavil, (the symptom was acknowledged in the medical literature a decade later as a permanent change) for about 2 months, almost 4 decades ago ... and, for the 30 pounds of weight and bulk that I suddenly added in August, 2016 in about a week or 3 (with no changes in diet or lifestyle). That has disabled me for the past 5 years and has likely impacted my lungs.

In the past 20 years, since 2000, I have likely had as many as 7 Chest X-rays.
Some have been for a symptom of coughing and chest pain; another was for wheezing and lack of breath; many have been for what was diagnosed in Lethbridge, Alberta, as "Blood clots on the Lung." This latter set of images were taken to ascertain HOW to treat the symptoms I had.

In one situation, I was coughing almost continuously, and of such an INTENSITY that it could result in a spinal subluxation. I had no particular Pain, although I have developed a HIGH pain threshold over the years with my exposure to a number of Intense Pain experiences. I was placed on blood thinner medication, which did stop the coughing, yet, produced life threatening side effect of continual tachycardia, chest pains, and DAILY reocurrences of one or other leg or foot or arm going Numb. Sometimes I had numbness in my chest. I was told by my Family Physician that if I stopped taking the medications I would die in 24 hours. After 2 months, I stopped the medication abruptly. Most of the significant symptoms stopped within hours; the rest stopped within a week.

In mid-September of 2020, I had another dramatic episode in which I developed a recurrent Pain behind and below my Right shoulder blade which became more frequent and more intense as the days passed. Within 2 weeks there was hardly a position I could lie down in and be able to breath or relax, or sleep. October 1 I went to the Emergency Department and was eventually told, after many tests and hours, that I had Blood Clots on my Lungs, again. As you can tell, the Symptoms between the two episodes were highly different and seemingly unrelated. Again I was prescribed blood thinner medication .. a newer and more advanced one than had been previously available. This medication did not have any of the negative side effects of the earlier ones, although I did eventually connect an Edema-like ballooning of my legs, feet, abdomen and arms to the High doses I needed to take of it in order to avoid a return of the symptoms.

Another term, seemingly used interchangeably by the local medical staff with "Blood Clots on the Lung" is "Pulmonary Embolism."

The point of all this is that in ALL the readings of my Chest X-rays for the past 20 years, there has NEVER been any reference to the presence of one or more SCARS on my lungs. What happened to it? Did I seemingly cure myself of the scar, which western medicine uniformly states is impossible? Or, are radiology technicians and respiratory specialists simply skimming over the (many) images and missing some obvious health problems.

I have mentioned many times to doctors the possibility of finding WHAT is causing the blood clots so that it could be remedied and bring greater health overall. No one seems interested in even considering such an apparently unusual attitude and tactic as part of a strategy for RECOVERY. Everyone I have met, is only interested in REDUCING the Symptoms ... so patients can continue to be recurring sources of appointments and payment to justify the necessity for so many doctors, the high cost of healthcare, and the minimum benefit of the medical system to many citizens ... who are not allowed, legally, in Canada, to access privately funded healthcare professionals, if they could afford to.

I discovered the Disclaimer mentioned above when I attended a Calgary Alberta Foothills Medical Centre Emergency Department to seek treatment for why I had blacked out in addition to other long-term symptoms. I received a number of medical scan, and, the printed 10 page Report ... that essentially noted that without using a special Viewer, the scans were USELESS for Diagnosing.

When I later queried a Respirologist about if he, or someone he knew would use either of the noted Viewers to Diagnostically view the images, he expressed the BELIEF that all such technicians and assessment personnel would, of course, use the viewers. This has been a common attitude of doctors: ALWAYS expect the Best of the colleagues you depend upon, and NEVER question their procedures or accuracy. This is one reason why we hear of patients getting as many as a DOZEN assessments (in the USA) before finding one that can lead to RECOVERY, and, why fraudulent, incompetent, or legally responsible for as many as a DOZEN needless deaths perform their death dealing deeds for so long under sanction of the bureaucracy.

If they can miss a Lung Scar, what else are they missing.
If they interpret their job as limited to Reducing (or hiding) Symptoms, how are people ever to RECOVER?