Chesapeake Fire Department Cardiovascular Disease and Cancer Screening

Chesapeake Fire Department Cardiovascular Disease and Cancer Screening
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Exam Descriptions:

Carotid screenings are designed to detect plaque development in carotid arteries that can result in cerebrovascular accidents (Stroke) and Transient Ischemic Attacks (TIA/Mini stroke). A detailed carotid ultrasound exam can identify structural and blood flow abnormalities. Carotid screenings have the ability for early detection of undiagnosed abnormalities. Participants will be required to expose the neck on both sides. An ultrasound probe will be moved along the side of the neck to evaluate the carotid arteries.

An echocardiogram is an ultrasound of the heart that helps diagnose damaged cardiac tissue and heart chamber enlargement. It can also detect fluid around the heart and poorly functioning heart valves as well as abnormal masses in the heart muscle. A detailed echocardiogram can detect poorly functioning heart valves abnormalities in the heart muscle. Participants will be required to remove their shirt; a drape will be placed over the chest for privacy. Gel will be placed on the chest. An ultrasound probe will be moved along the left side of the chest and under the breast.

A thyroid ultrasound is used to evaluate the soft tissue and vasculature of the gland. A detailed analysis of tissue density has been shown to have a greater than 95% accuracy at detecting malignancy. Multiple longitudinal and cross-sectional images are used to assess the thyroid for suspicious tumors and cysts. Participants will be required to expose the neck on both sides. An ultrasound probe will be moved along the side of the neck to evaluate the thyroid gland.

The pelvic ultrasound is used to evaluate the endometrium, uterus and ovaries. This exam is capable of providing views of these pelvic contents. The transabdominal pelvic ultrasound involves moving a specialized transducer, outside the body, across the lower half of the abdomen and pelvis. A transabdominal exam provides a view of the pelvic organs, but there may be limitations in measuring cysts and masses.

Abdominal Ultrasound includes the liver, gall bladder, kidneys, and spleen. The abdomen provides the largest opportunity for the development of pathology. The abdominal organs are often either the origin of cancerous lesions or the direct target of metastasis. Abdominal Ultrasound evaluates the liver, gall bladder, kidney, and spleen. Participants will be required to expose the abdomen. An ultrasound probe will be moved along the length and the sides of the abdomen organs. In an abdominal complete ultrasound, all organs are identified and surveyed in multiple planes of view, color flow doppler is also used to evaluate masses.

The abdominal aorta ultrasound screenings evaluate the risk of abdominal aorta aneurysm and potential aorta tumors. This exam surveys the abdomen from the sternum to the pelvis and bifurcation of the 63abdominal aorta. The detailed abdominal aorta ultrasound involves evaluating the size and characteristics of the aorta. Participants will be required to expose the abdomen. An ultrasound probe will be moved along the length of the abdomen to assess the aorta.

A scrotal ultrasound is often the first test performed to evaluate the possibility of testicular cancer. Ultrasound has been proven to be instrumental in detecting lesions in the testicle. Imaging includes multiple views in the transverse and longitudinal and oblique planes to evaluate the testicle with color doppler imaging as well. The test requires disrobing to expose the scrotum. Measurements of the size of the scrotum and any abnormalities are recorded and communicated to the reading radiologist. This examination is intensely sensitive for the participant and require complete privacy as the client will be required to disrobe and expose the scrotum.

Bladder Ultrasound can evaluate the lining of the bladder and the musculature of the organ to determine if there are tumors, cysts or obstructive stones. The bladder ultrasound involves moving a specialized transducer, outside the body, across the lower half of the abdomen and pelvis. This ultrasound provides a view of the bladder and its contents.
I hereby release the screening physician, Hampton Roads Ultrasound and all other healthcare volunteers/employees and contractors from all responsibility in connection with this screening exam. I understand that I will only be screened for risk factors or symptoms of cardiovascular disease and that this screening does not constitute a complete medical exam or diagnosis, and that I do not have a physician-patient relationship with the screening physician by virtue of this screening exam. I further understand that I will receive a copy of my screening results. I may receive a follow-up phone call from a licensed medical provider. It is solely my responsibility to seek any appropriate follow-up medical treatment as indicated by my screening results. No one may use my examination results for any purpose, other than statistical study as long as no identifying information is published. I consent to ultrasound testing performed by Hampton Roads Ultrasound. I have read and understand this form and understand the information presented.

To view our full HIPPA agreement click here
Acknowledgement - Receipt of Notice of HIPPA Agreement and Privacy Practices and Exam Descriptions and Release.*

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Allergies:
Surgical History:
Risk Factors*

Tobacco UseHigh Blood PressurePrevious stroke/TIADiabetesObesityFamily history of strokeHigh cholesterolHeart DiseaseFamily history of abdominal aorta aneurysmVascular surgeryExcessive alcohol useFamily history of cancerPrevious diagnosis of any type of cancerNone
Current Symptoms*

Leg cramps with walking/pain with walkingTenderness in abdomenDifficulty speakingBack painDizzinessHeadachesNumbness or weakness on one side of bodyLoss of balance or coordinationSudden loss of visionAbnormal hot or cold sensitivityChest painPalpitationsShortness of breath at restAbnormal shortness of breath on exertionEasy bruisingSwollen lymph nodesHallucinationsConfusionNose bleedsNone
Please select an appointment for the test you would like to have. Each calendar allows for a different choice. Options are as follows: Cardiac Screening only, Cancer screening only. Please choose one test for the time slot. If you are eligible for both (you have never had either screening or are over the age of 40) choose different times for each calendar.
Cardiac Screening Only: Please choose if you are over 40 years of age.
Cancer and Cardiovascular Screening*
Cardiac Screening Only
Cancer Screening Only: Please choose if you have been in service for more than 7 years, or have never had a Cancer Ultrasound Screening.
Cardiac Screening Only
Saturday Cancer Screening Only
I agree to share my screening results with Chesapeake Fire Department Employee Health located at NowCare 725 Volvo Parkway, Chesapeake VA 23320.*

YesNo
If needed, Hampton Roads Ultrasound may share my result with my primary care physician.*

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Primary Care Physician's Name

First NameLast Name
I certify that all the information provided is accurate to the best of my ability, and I consent to the cardiovascular and cancer screening examinations.
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