Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Many different types of imaging studies are available.
Plain film radiography (X-rays)
Plain X-rays are still the primary means of looking
for trauma to bones involving the cervical spine. They have the advantages
of low cost, wide availability, and good anatomic resolution. X-rays do not give a good image of soft tissue structures (muscles and ligaments).
The technician will customarily obtain multiple views.
The actual reading of cervical spine radiographs is
a science in itself and may be performed by any knowledgeable doctor with
the backup of a radiologist.
This painless, noninvasive technique produces cross-sectional images of tissues.
CT scans offer far better tissue contrast resolution when compared to plain
X-rays and are excellent for displaying bony architecture, although soft tissues are seen less well.
It is useful in assessing for complex fractures and
dislocations, disk protrusions, disease of the joints of the vertebrae, and spinal stenosis (a narrowing of the space containing the spinal cord).
Myelography (spinal cord imaging)
In this technique, a water-soluble contrast dye is injected into the epidural space via lumbar puncture and allowed to flow to different levels of the spinal cord.
Plain X-rays, or more commonly CT scan, are then performed, to indirectly visualize structures outlined by the dye.
This technique is very sensitive at detecting disk
disease, disk herniation, nerve entrapment, spinal stenosis, and tumors of the spinal cord. Side effects of the procedure include headache, dizziness, nausea, vomiting, and seizures.
MRI is another noninvasive, painless imaging
technique used to obtain images of bone and soft tissue. It uses magnetic
fields and is based on detecting the effect of a strong magnetic field on
hydrogen atoms contained in water.
So-called T1 images show very good anatomic detail, whereas T2 images demonstrate any soft tissue problems that alter tissue water content. Both offer excellent tissue contrast and have no known side effects, although claustrophobia is a problem in some people.
MRI cannot be used for people with implanted or other metallic foreign bodies not firmly fixed to bone but is reportedly safe with prosthetic joints and internal fixation devices. It is often preferred over myelography
for the assessment of disk disease because it is noninvasive.
This involves the injection of radiopaque dye into the center of an intervertebral disk (nucleus pulposus), using radiographic guidance, and may be used to determine disk disruptions.
It is uncommonly performed but is sometimes used in cases where the precise cause of your symptoms is difficult to ascertain to see whether the injection brings on your symptoms.
This technique uses a very short-lived radioactive isotope (technetium 99m) administered by IV and are absorbed by actively metabolizing bone
tissue during bone turnover. The amount of uptake is proportional to the
amount of metabolism.
Localized "hot spots" may then be visualized through the use of a special camera, which can detect the gamma rays emitted by the radioisotope. This technique is very sensitive for detecting fractures or other bone problems.