19415 Deerfield Avenue
Lansdowne, Virginia 20176
Updates on this page will be posted with the most recent at the top. If this is your first visit to this page, you may wish to read all of the posts, not just the most recent post, for full information.
The CDC on April 4, 2020 has recommended that you cover your face when going out. You do not need to have a medical type mask to accomplish this. Please wear a covering over your nose and mouth when coming to the office. There is a link below to a really easy way to accomplish this. Wearing a mask does not replace social distancing, and just to be clear, a mask or face covering is to help keep the wearer from spreading the virus, if the wearer is a COVID carrier without symptoms. Wearing a mask does not protect you from getting the virus from someone else. To lower that risk, again, hand washing, distancing, keeping hands away from the face, and completely avoiding those who are ill or may have been exposed is your best protection. (The mask comments here of course do not apply to medical personnel wearing specialized medical masks to help reduce their own risk of infection while caring for sick patients).
or go to www.youtube.com and search for "DIY No Sew Face Mask Easy"
June 11, 2020
Hello lovely people. I just deleted a lengthy post from June 4 as it no longer applies. It concerned difficulties with my seeing actual images from the former RIA via the physician web portal, but this seems to have been resolved. The May 15 post below is very detailed about which imaging I can see without your having to bring any to your appointment, so I refer you there to review.
If you put off your anual mammogram becasue of the quarantine, PLEASE GO GET YOUR (POTENTIALLY LIFE- SAVING) MAMMOGRAM ASAP!!!
June 10, 2020
Just to reiterate, on May 29 the Governor created an executive order requiring faces to be covered in public as per below. I personally am certain that we will see a bump with increasing the COVID cases this fall, and I hope this will help reduce that risk. Here are the details:
May 31, 2020
Hope you are continuing to be safe and keeping your face mask on when you go out!
Just want to let you know that imaging centers are opening their schedules to screeninng mammograms now. The Peterson Family Breast Center on the Inova Loudoun Hospital Campus is still currently closed. As you may know, Inova in partnership with Fairfax Radiology has taken over what used to be RIA, and a reorganization of breast imaging services is in progress. This is part of that reorganization. All the breast imaging services previoulsy offered at the Peterson Center are currently available across the street at the the former RIA Lansdowne office, and images from the Peterson center studies are availble to the radiologists at that Lansdowne location.
May 15, 2020
Hello out there....
Radiology facilities are starting to open for screening mammograms, so if you have put this care off, please go ahead and make your appointment. Do not put off important preventative care. We are already seeing patients coming in with more advanced issues because they have put off care during this time.
I wish to update you regarding what you need to bring imaging to the office with regard to your breast images. This info is copied from another page in the website, just to be certain as many of you can see it as possible.
Breast images are now accessible to physicians through secure portals at all radiology centers. This allows images to be accessed through a computer. Because of this, we no longer require that you pick up any films or CDs of imaging for your office visit, unless the imaging was done out of the area. We also access the radiology reports in this manner. Below is a list of facilities for which we have computer portal access. If your facility is not on the list, please call our office:
Reston Radiology: Loudoun Imaging in Ashburn, Fair Oaks Imaging Center, Womens Imaging Center of Reston (on the Reston Hospital Campus)
Fairfax Radiology - all locations are accessible, including Inova Loudoun Hospital, the Cornwall campus, and what used to be called RIA in Lansdowne and CountrySide/Sterling (these are now part of Inova/Fairfax Radiology)
Washington Radiology - all locations are accessible
Progressive Radiology in Winchester
I DO NOT have computer access to imaging from: Winchester Medical Center, Novant facilities including Haymarket, Prince William Hospital, Fauquier Hospital, Virginia Hospital Center, George Washington Hospital system, Medstar Georgetown Hospital system, Medstar Washington Hosptial Center, Johns Hopkins System/Sibley. Imaging from these sites MUST be provided on CD.
AN IMPORTANT WORD ABOUT DIGITAL AND 3D BREAST IMAGING:
When viewing breast images via computer, please be aware that the image quality is NOT THE SAME as what the interpreting radiologist sees, as the radiology viewing system is very sophisticated and of significantly higher resolution than monitors outside of the imaging center. In that regard, it is sometimes difficult for me to render a completely independent review of your images. If that is true in your case, I will discuss it with you after I review your images in the office.
The 3D portion of a 3D mammogram is read dynamically by scrolling through a series of images rapidly, much like a video, and your eye is drawn in and out of the tissue uncovering the anatomy better than a single flat (2D) image. Until recently, the 3D portion of a mammogram study could be scrolled through ONLY ON THEY SYSTEM WHERE IT WAS RECORDED, ie, only in the imaging center where it was taken, NOT via computer outside of the imaging system. HOWEVER, Loudoun Imaging Center in Ashburn and FairOaks Imaging Center have software that allows me to scroll through the images remotely, thankfully! The only other site for which I can do this is Progressive Radiology in Winchester. Therefore, for local imaging needs you may wish to consider having your imaging done at Loudoun Imaging in Ashburn, (or Fair Oaks Imaging Center for our Reston/Herndon/Chantilly area patients) so I can see what the radiologist sees, and not just the 2D portion of your study. When our new office facility opens and the imaging department in the office is up and running, I will have an actual complete radiology workstation on which to view images, and will be able to see everything the radiologists from Loudoun Imaging or Fair Oaks Imaging can see, including the dynamic 3D imaging, with the same high resolution with which they interpret breast images!
APRIL 10, 2020
The office will close at noon today and will be closed on Monday April 13.
APRIL 3, 2020
The office will close at noon today, and reopen at 9 on Monday.
During this time, please be advised that if you are cleared for an office visit, we will be seated as far apart as the exam room will allow, which may be 4 but perhaps not 6 feet. If I get closer to you (as in when I do an exam) I will be then wearing a mask.
The latest information I have read does confirm that the virus is transmitted in respiratory droplets, so gloves are not necessary as long as one washes hands frequently, which I will do, as usual, before touching you. Please do the same.
I am taking my temperature every morning. If it goes up, I will cancel visits, so if this happpens, I apologize for cancelling on the day of your visit. This is a daily check and for both of our benefits.
Please do your part to help protect me, as well (I am over 60 so in the at-increased-risk age group): Do not come to the office if you have a temperature of 100 or greater. Do not bring children or friends to your visit. If you need a support person during your visit, one person only with you is fine, and they have to abide by safety rules as well.
Do not come to the office if you have cough or any respiratory symptoms, fever, new body aches, nausea/GI upset, have been near a "healthy" person who has tested positive, if you have been near a COVID sufferer, if you have anyone near to you who has been to the highest affected areas such as New York, or other large cities.
We are here to help, but also please realize that I have no staff in the office, my assistant Rana answers the phones and works remotely, and as a one man band the phones are in constant use, please do not be upset if you get voicemail.
Please take the directive to stay home seriously. No imaging centers are doing screening mammograms right now, but imaging is available for acute problems. We can hep quarterback that if you need it. We hope the peak incidence of the viral spread will hit in the next couple of weeks, but there is no certainty of this. In the meantime, although the directives to stay home do make the exception of going out for medical care, please consider if this is the right time for you to be seen if you are only seeking routine follow up, and do not be offended if we decline your routine visit, we will certainly see you as soon as deemed safer to do so.
We need to work together to kick this thing in the pants. Be safe, keep each other safe, and do not believe the snake oil salesmen when there is information about supplements or treatments you can buy to prevent or cure this illness. NONE of it is medically proved to help. PREVENTION is our best protection.
Best meme I've seen lately: "Do not change your behavior to avoid being infected, assume you are infected and change your behavior to avoid transmitting".
MARCH 26, 2020
Hello out there!
So I received this communication today, and as a member of the American Society of Breast Surgeons (ASBrS), I will follow their lead on the recommendation at this time to delay routine mammograms, as in this joint statement with the American College of Radiology (ACR), printed below.
Be assured, however, that if you have a breast symptom or new concern, I am available to you, so please call the office. I am still doing cancer surgery, and of course no one is suggesting that you not seek care if you have a symptom or self exam change. Radiology facilities are still providing imaging workups for those with clincal concerns, biopsies are still being performed. It is just the routine imaging that is being affected. Please feel free to call the office if you are unsure of how to proceed.
March 26, 2020
With the COVID-19 situation evolving quickly, we must act decisively. As such, out of an abundance of caution, to help stem the spread of this disease in our communities and to protect our patients and our staff, The American Society of Breast Surgeons (ASBrS) and the American College of Radiology (ACR) recommend that medical facilities postpone all breast screening exams (to include screening mammography, ultrasound, and MRI) effective immediately.
The recommendation above should be effective immediately and continue until the pandemic is under control and then be re-evaluated on a weekly basis based upon each community’s impact by the current pandemic.
In addition to screening mammograms, routine breast visits and consultations for non-urgent breast abnormalities should also be delayed.
These are unprecedented times and call for extraordinary measures. These actions during this pandemic are for the utmost protection of our patients and staff. There is no evidence that delaying screening mammography for the proposed short time period will affect mortality but there is plenty of evidence that being exposed to the coronavirus can impact mortality.
ASBrS Board of Directors
ACR Board of Directors
MARCH 20, 2020
Happy Friday everyone.
I need to comment here about how you should handle having a screening mammogram that might be due for at this time.
Some radiology sites have discontinued doing screening mammograms until the quarantine is over.
We cannot predict how long the recommendations for "social distancing" will be in place.
Having a screening mammogram is not a "social event". It is important health care. It should not be postponed.
The considerations for going to any location outside the home, whether it be the grocery store, the lab to have your blood drawn, or any other personal or medical necessity, should be followed for your screening mammogram:
DO NOT go out if you have respiratory symptoms, fever, have traveled to an area where COVID is rampant, or if you have close proximity to someone who is sick.
Every healthcare facility is asking screening questions to decide which patients should not enter the facility. Those who "fail" the screening questions are told to stay away.
I do not recommend that you skip or postpone your screening mammogram. Mammogram machines are routinely disinfected between each and every patient, this has always been done well before this virus outbreak. Yes, the mammography technologist will be touching you. Every medical professional has had the need for handwashing between patients beaten into their brain from their first day of training, and clearly with the heightened awareness of COVID, there will be more diligence than ever.
You should also strongly consider having your mammogram performed in an outpatient facility that is not attached to a hospital. This will reduce the possibility that anyone sick may have been in that location. Outpatient free-standing imaging locations are getting people in and out rapidly and in many cases no one stops in the waiting room.
I am not yet due for my annual mammogram, but if I were, I would definitely go. We need to protect ourselves from other important medical conditions besides COVID, conditions that just like COVID can be symptomless.
Of course, you must make the medical decisions with which you are most comfortable. I am not supportive of a facility making that decision for you, by taking away your choice or denying important health screenings that can be done in a manner that minimizes contact with others. I am here, however, to support you however I may. Feel free to call the office if you need help with decision making in this regard, or if you want an imaging center referral.
MARCH 18, 2020
As this situation evolves, things can change on an almost daily basis until we discover the new (and hopefullly temproary!) normal. Check back here frequently for updates.
For the immediate time, here are some guidelines:
The office will NOT be taking appointments for routine annual follow ups for established patients with no new breast problems for now. Stay home and be safe.
NEW PATIENTS will be able to be seen in the office for the following problems: BIRADS 4 or 5 mammograms, already performed biopsies that have abnormal results, mastitis/breast infections not responsive to treatment by your PCP or OB/GYN.
What is BIRADS 4 or 5? If you look at the radiology report from your mammogram, this will be printed at the very bottom. Washington Radiology uses the term "Final Assessment" rather than BIRADS on their reports. If you were given a sheet of paper with boxes checked by hand by the radiologist, it would have the box marked saying that a biopsy has been suggested. If you are a patient seen by another practice within Loudoun Medical Group, most LMG practices share an electronic medical records system, and my staff can check to see if your report(s) are already available to us. If th reports are not, you will need to call the imaging center where you had your mammogram/ultrasound/biopsy, and have them fax the reports, including any pathology report, to my office fax, 571-346-1921. We will look at the reports and respond back to you on they same day the reports are received.
If you are a new patient and feel you need to be seen, but you do not fit the above criteria, please ask your referring provider to contact me directly.
Established patients who are coming in for office ultrasound follow ups WILL be able to make appointments for that.
We are investigating the use of telemedicine and how it might be appropriately used in a breast surgery practice. For right now, this is being reserved for ESTABLISHED patients (whom I have already met in person and examined) whom I have sent for additional imaging or testing, or for preop visits with those for whom surgery is being planned.
Again, this is a fluid situation. The phones are open. Be sensible and be safe. Call us if you are uncertain. We are here to help, but also have our families and the greater community to protect. Thanks for your patience and understanding.
Virginia Chiantella MD FACS
ORIGINAL POST 03/15/2020:
Physicians are in uncharted territory when it comes to how to manage their practices in the midst of the COVID virus outbreak.
You are all, I am sure, aware of the personal precautions you should take to help reduce your infection risk: strict and frequent handwashing for at least 20 seconds with soap and water, using hand sanitizer if soap and water are not available, covering your cough or sneeze with a tissue or sleeve (not your hands), avoiding crowds, avoiding touching your eyes, nose and mouth, avoiding non-essential travel, staying at home when you are sick, and cleaning and disinfecting frequently touched objects and surfaces. Much more comprehensive detail about the COVID virus outbreak is available on the Virginia Department of Health's website, vdh.virginia.gov, and I strongly recommend you take a look there, as well as the website Loudoun.gov, for local responses and recommendations.
It is not the purpose of my entry here to repeat the information on the above sites. However, I do need to address some issues that have a direct impact on my office practice, and your visits there.
First, my office is a shared office with a primary care practice. That practice is actively screening their sick patients on the phone before they come to the office, and any patient with symptoms suggestive of this viral illness are being directed to the ER and not being seen in the office. Any patient with an acute illness, who then is permitted to come to the office, is being taken directly from the waiting room into an exam room and is not being kept in the waiting room. Although I do share that waiting room for my patients, I DO NOT share any exam rooms, or any staff, with the primary care office.
Second, there is consideration being given to putting elective surgery on hold. This is current recommendation of the American College of Surgeons:
"Each hospital, health system, and surgeon should thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs".
As of today, none of the facilities where I do surgery (Inova Loudoun Hosptial, Reston Hospital, StoneSprings Hospital, or Reston Surgery Center) has directed its surgeons to reschedule any elective surgical procedures. This MAY happen, I just do not know at this time. However, I cannot forsee that cancer surgery would be considered elective.
My office staff and I are, of course, personally impacted by this event, just as you are. Kids are home from school, we have elderly parents (90+ years old in my case). It is indeed a challenging time.
We will be contacting our patients in advance of their appointments just to do a quick wellness check. If any symptoms are detected, we may reschedule you for a later time.
Please do not come to the office if you do not feel well. Please call us if you can not keep your appointment, and please do not bring children or babies to your appointment. Please consider not bringing anyone else to your appointment unless strictly necessary for emotional suport or for transportation needs. If someone else wishes to hear my discussion with the patient, they are welcome to call in during the visit.
If you prefer to reschedule your appointment, please feel free to call us.
We are looking into certain telemedicine options which will allow virtual visits, with the patient being outside the office, via FaceTime or similar applications.
We may also be consolidating our office hours schedule to certain days of the week in order to make the days more efficient and help my staff with their childcare needs while the kids are home from school.
This is an unprecedented time in my almost 32 years of practice. We have tried over these years to always put the needs of our patients first. Now we must also consider our families, our office staff, and those with whom I personally come in contact in the hospital (both patients and staff), and right now there is no clear answer as to how long these restrictions may go on.
We need to face this with calm and understanding, together. We will find creative ways to navigate this unprecedented time. Please feel free to call the office with your concerns, or suggestions. The phones will be open for the full work week just as they are now. As you might guess, the phones will be busier than usual, so please be aware that we do listen to, and respond to, all of our voice messages. We are also developing email commmunications through our electronic medical records system, and we will announce that on this page when it goes live.
Check back to this page frequently, I will keep it updated as things evolve.
Thanks in advance for your patience.
Virginia Chiantella MD FACS 03/15/2020