The NeoVista® MRI has been designed to diagnose thoracic outlet syndrome in a unique way in each TOS patient. At Vanguard Specialty Imaging, we have performed more thoracic outlet syndrome tests than anybody in the field. NeoVista® is recommended by TOS specialists around the country. We are proud to provide this unique service to TOS patients and their doctors. Learn why the NeoVista® MRI is the premiere thoracic outlet syndrome test, and how we can help you.

Doctors know that the clinical diagnosis of neurogenic thoracic outlet syndrome is typically quite challenging. TOS specialists find provocative diagnostic tests for TOS, like Adson’s test or the Wright test, inaccurate and insensitive. Some doctors use scalene injections to help with the diagnosis of thoracic outlet syndrome, but significant questions surround these TOS injections.

Even when an experienced TOS specialist makes an accurate clinical diagnosis of thoracic outlet syndrome, they cannot prove the underlying anatomic cause. Perhaps abnormal scalene muscles compress the brachial plexus. Or the clavicle is too close to the first rib on arm motion. Maybe there is a venous blood clot or an arterial aneurysm. Medical research over 200 years has proven the existence of a multitude of causes of neurogenic thoracic outlet syndrome in different patients. We believe that every TOS patient deserves a complete and accurate thoracic outlet syndrome test. These challenges led to the creation of the NeoVista® MRI thoracic outlet syndrome test.

First of all, confirming or ruling out TOS is a critical starting point.

Second, understanding which type of TOS is present is critical. This information can help doctors decide whether to begin conservative therapy or if the patient needs to go to surgery.

Third, if surgery is indicated, a surgeon would want to know ahead of time what structures need to be removed, and what structures need to be repaired. For example, a patient with a subclavian artery aneurysm would require a different surgeon than would a patient with isolated brachial plexus compression. It should be obvious that removing a cervical rib requires a different approach than does releasing an abnormal anterior scalene muscle.

Fourth, the presence of any other cause of nerve compression or vascular damage would change treatment decisions.

No clinical thoracic outlet syndrome test can provide this information in such great detail. Even if a doctor diagnoses TOS on clinical examination, they cannot see or feel all of the underlying anatomic causes of thoracic outlet syndrome. Dedicated and detailed imaging of TOS is a critical thoracic outlet syndrome test.

The NeoVista® MRI is unique and different from any other MRI thoracic outlet syndrome test. We have built this value into the NeoVista® MRI based on our foundation of four critical components:

We first developed the NeoVista® MRI thoracic outlet syndrome test in 2004. Since then, we have examined thousands of thoracic outlet syndrome patients. We have used this class-leading experience to refine and advance our scanning technology. The U.S. Patent and Trademark Office has awarded us three patents to date. And we are still improving the technology.

The NeoVista® thoracic outlet syndrome test demonstrates the nerves, arteries and veins of each thoracic outlet in detail. NeoVista® reveals normal and abnormal ribs, and all of the known soft tissue anomalies that can cause TOS. In addition, our unique thoracic outlet syndrome test measures and calculates the complexnchanges that occur with arm motion. NeoVista® gathers all of this information in a single 45-minute exam. Allow us to show you a few examples of the NeoVista® difference.

Most MRI imaging centers can perform single components of the NeoVista® MRI thoracic outlet syndrome test. For example, some imaging centers will perform an MRA (MR angiogram) of the subclavian arteries for the diagnosis of neurogenic thoracic outlet syndrome.

This image from a NeoVista® MRA demonstrates two important details. First, the image shows both subclavian arteries with good detail. Most imaging centers using standard injected gadolinium contrast material will achieve good quality on one side only. For example, Raptis, Thompson, et al published in 2016 that, “The intravenous catheter should be placed on the side opposite the symptoms…”, with the intent to image one side only. Most imaging centers can only consistently achieve good imaging quality on one side, and must avoid the symptomatic side. But what do they do if the patient has symptoms on both sides? The NeoVista® examination overcomes this limitation. One injection, one set of images, and excellent quality.

Second, not only are the arteries in this NeoVista® MRA bright, all other tissues are darkened as much as possible. While this darkening or suppression is fine for evaluating the arteries, there is no way to tell if extrinsic structures adjacent to the arteries are compressing the arteries. Since TOS is caused by extrinsic structures in the thoracic outlet, suppression of adjacent tissues creates a significant limitation. The NeoVista® examination acquires all essential imaging components in one comprehensive thoracic outlet syndrome test. Thus, the radiologist can match abnormal arteries seen only on these MRA images with abnormal adjacent structures seen only on other images without visualization of the arteries.

Here is another example: some imaging centers will perform isolated images of the brachial plexus, sometimes referred to as an MR neurogram.

Again, you can see the brachial plexus is bright, and the background is dark. Similar to the challenges of an isolated MRA, it is almost impossible to know if an adjacent structure is compressing or stretching the brachial plexus, because adjacent structures are intentionally suppressed. The NeoVista® MRI thoracic outlet syndrome test overcomes this limitation.

It is important to remember that none of these individual imaging components can tell the entire story by itself. TOS is complex and multi-factorial, and multiple contemporaneous imaging components are necessary to tell the entire story.

And that is exactly what NeoVista® achieves. The NeoVista® thoracic outlet syndrome test includes every one of these components in a single comprehensive thoracic outlet syndrome test, taking only 45 minutes. The US Patent and Trademark Office has awarded three patents to date for this unique technology.

So far, we have performed and interpreted thousands of dedicated TOS MRI thoracic outlet syndrome tests. Our unique experience includes patients who have suffered trauma, work-related activities, and recreational activities. We have consulted on high-level athletes who were diagnosed with thoracic outlet syndrome. And we have consulted on many medical-legal cases involving thoracic outlet syndrome.

That’s not all. Since our earliest days, we have observed many TOS surgical procedures, to learn what surgeons look for and what they need to know. We have provided invited presentations at national medical conferences around the country in different medical specialties. Dr. Werden previously served on the Board of Directors of the largest TOS patient advocacy group. In addition, we travel around the country to meet physicians and other care providers involved in TOS.

Most authorities believe that you have to practice your skill for thousands of hours to be good at it. And we have done a lot of TOS imaging. Moreover, we believe that we have evaluated more TOS images than any other person or organization. That experience means a lot to TOS patients and their doctors. We take great pride in our ability to provide valuable information that patients and doctors cannot get elsewhere.

Involvement in the TOS community has proven to be tremendously beneficial. We have built relationships with thoracic outlet syndrome specialists, both locally and around the country. Through our relationships, we learn what challenges doctors and patients face when diagnosing and treating TOS. While we spread valuable TOS knowledge amongst our network, we all help to raise awareness in different cities and communities.

Our partners ask questions, share their experience and knowledge with us, and make suggestions for improving TOS care. We believe this network of providers with commitment to TOS patients is a valuable resource for moving TOS care forward. We also believe that our growing network produces growing TOS awareness, which will lead to earlier diagnosis of TOS.

We have studied and practiced TOS for more than two decades. TOS is our passion. We work endlessly to improve our technology, grow our relationships, and advance our knowledge. We do this for all the TOS patients out there, including those with the diagnosis, and those who have never heard of TOS. We keep moving because we care.

Use our interactive map to find a NeoVista® imaging partner near you. Check back often, and follow our progress as we bring NeoVista® to new locations around the country.

Almost any MRI imaging center can produce images of the chest, neck and shoulder. But only licensed NeoVista® partners have the patented tools to create the NeoVista® study. And only our experienced TOS radiologists can deliver the unique information from the NeoVista® study. Lots of people make dresses, but only Versace makes their unique fashions. Their combination of materials, technology, experience and skills results in a unique style that is more than a simple dress. And only NeoVista® results in the valuable health information that helps patients and their doctors with this challenging disease.

Our NeoVista® TOS MRI report is created in the same style as an MRI of the knee or spine, and is delivered to one or all of your doctors as you require or request. We offer a unique teleconferencing review of your study for your doctor. We are always available to speak with your doctor about your report, about TOS, or about connecting with our network of TOS providers.

In most cases, a NeoVista® MRI examination is completed in 45 minutes. Prior to the examination, a technologist will insert a small IV in your arm. An injection of gadolinium contrast is performed at the beginning of the examination. Most patients experience no discomfort with this injection. You will be asked to raise your arms for part of the examination, so we can measure the changes caused by arm motion.

If you think you have TOS, or if you have already been diagnosed with TOS, you have a lot of questions. We offer a personal consultation service with Dr. Scott Werden to review your TOS medical history, and to help guide you to the right answers. Get a TOS patient consultation now.

We always make ourselves available to physicians who are providing TOS care to their patients. We can discuss TOS, connect you with our network of TOS providers, review TOS imaging studies, or provide detailed videoconference reviews of your patient’s NeoVista® studies. Schedule a TOS physician consultation with Dr. Werden for your patient.

Perhaps you have had CT scans, x-rays, ultrasound studies, or MRIs as part of your workup. Our TOS radiologist, Dr. Scott Werden, can interpret all of your pertinent prior imaging studies, explain the findings on each, and advise you on best steps forward. Learn more about our review of imaging studies now.

Many TOS patients need legal advice to battle their disease and the delivery and cost of health care at the same time. We have worked with disability attorneys, personal injury attorneys, and workers compensation attorneys many times, with great success. As a result, we know that good legal advocacy is vital for many TOS patients. We offer guidance to attorneys based on our experience in many prior cases. Contact us to learn about our free first TOS consultation for attorneys working on behalf of their TOS clients.

Medical Director, Vanguard Specialty Imaging

I am the founder and medical director of Vanguard Specialty Imaging. I invented the NeoVista MRI examination for patients with TOS. At present, I hold three patents for this work.

I trained at SUNY Stony Brook, Duke University, Boston University, Mallinckrodt Institute of Radiology, and Johns Hopkins. After training, I achieved board certification in both internal medicine and diagnostic radiology. Since 1998, I have practiced radiology in the San Francisco Bay area.

I saw my first TOS patient in 2003. In a moment, I became intrigued with learning more about the disease and helping TOS patients. Since then, I have studied over 2000 TOS patients with my unique MRI examination.

I speak on TOS at national meetings, and in community and university Grand Rounds. I served as a board member for the country’s largest TOS Patient Advocacy Group.  I participated on the steering committee of a national multi-center grant application to the National Institutes of Health. I authored the chapter on MRI of TOS for the state of the art textbook on TOS.

I devote much of my clinical practice and energy to TOS. For one thing, I greatly enjoy outreach with TOS patients and their providers. Further, I am an active and perpetual student of TOS. I teach myself, and then reach out to expand awareness and knowledge of the disease to patients and physicians. I founded the NeoVista® Multi-specialty Group, and the Thoracic Outlet Society, a group dedicated to the study of TOS.

TOS is my passion. I deeply enjoy expanding TOS knowledge, helping patients, raising awareness, and providing doctors the best TOS diagnostic and treatment tools. Each and every patient success brings me tremendous professional and personal satisfaction.

Marketing and Business Development

I have been with Vanguard Specialty Imaging virtually from its inception.I understand the barriers that patients with TOS face when seeking care for this diagnosis.This awareness drives me to seek solutions to improve care for these motivated patients.

I founded my own healthcare consulting company, Vision United Associates, in 2003. Before this, I learned over a 5-year stint with a large, national health care organization. My areas of competence include relationship development, employee education and training, transition management, sales team and program development and market analysis and positioning. I developed and implemented numerous successful marketing and physician outreach teams and campaigns. My efforts have enhanced many outpatient imaging center and physician specialty clinic clients. These range from large organizations like Insight Health to high-profile institutions like Lucille Packard Children’s Hospital.

I have managed teams large and small and provided leadership for multiple consumer-facing healthcare web launches. My central vision for Vision United Associates is to enable and empower health care providers. I bring this vision forward through concerted marketing and physician relations outreach effort.Shorten with AI

I aim to use my broad experience and skillset to empower TOS patients and physicians. To begin with, I understand the tremendous growth potential and the current challenges for TOS patients and doctors. At the same time, I relish the opportunity to help so many people recover their full health. I independently developed the https://www.toseducation.org website to guide patients through the challenges of TOS.

I spend my free time doing yoga, hiking, traveling, reading, or stargazing with my family.

We often hear the question, “why do you spend so much time and effort on thoracic outlet syndrome?” The answer is simple: we care about all thoracic outlet syndrome patients. We see how the diagnosis of thoracic outlet syndrome affects the lives of patients and their families. We believe we can help, and we want to help.

We also care about the thoracic outlet syndrome patients we haven’t yet met, and the thoracic outlet syndrome patients we might never meet. We work hard to move forward thoracic outlet syndrome awareness, understanding, and the availability of care for all future thoracic outlet syndrome patients.

Patients who develop thoracic outlet syndrome symptoms may follow one of two pathways. If the patient is lucky, they find a doctor knowledgeable about TOS, a true TOS specialist. This specialist makes the correct clinical diagnosis of thoracic outlet syndrome and confirms the diagnosis with good imaging. The patient starts appropriate treatment for thoracic outlet syndrome, and resumes their normal healthy life. However, if the patient isn’t quite as lucky, they might visit a number of doctors, one after the other, without a proper diagnosis. These doctors may not be aware of the symptoms of thoracic outlet syndrome or the diagnosis of thoracic outlet syndrome. Without an accurate diagnosis or appropriate treatment, the patient’s symptoms worsen, affecting their lifestyle.

In the latter case, patients often try to help themselves. They might search for online help, often unable to find a unifying diagnosis. How many patients have heard the term, ‘thoracic outlet syndrome?’ We often wonder how a thoracic outlet syndrome patient would know how to search for this disease?

Have you ever searched online for ‘arm pain,’ ‘neck pain,’ or ‘shoulder pain?’ If so, you have become inundated with a large number of broad and non-specific diagnoses. It is hard to imagine how a patient could help themselves with this broad information.

So, our first goal is to raise awareness of thoracic outlet syndrome. We want the general public to hear the words ‘thoracic outlet syndrome’ enough to have a basic understanding of the symptoms of thoracic outlet syndrome and the causes of thoracic outlet syndrome. Even if a patient hasn’t heard about thoracic outlet syndrome, hopefully a family member, co-worker, neighbor, or parent will have.

Second, we realize that many physicians do not recognize the symptoms of thoracic outlet syndrome. If we successfully raise awareness of thoracic outlet syndrome, we hope to see growth in the number of thoracic outlet syndrome specialists. Since we hear many stories from thoracic outlet syndrome patients about their search for a physician who recognizes and diagnoses thoracic outlet syndrome, there is room for improvement.

We travel across the country to speak with physicians about TOS. Interestingly, many physicians simply do not know enough about the disease or have experience diagnosing thoracic outlet syndrome to feel comfortable. Now they have a resource for information.

We spend a lot of time communicating with thoracic outlet syndrome patients and their families. In general, they ask for thoracic outlet syndrome education resources to learn more on their own. Frequently, they also ask about a local thoracic outlet syndrome specialist.

So our third important goal is to build networks to connect thoracic outlet syndrome patients and thoracic outlet syndrome specialists. We are happy to help patients find a local, regional, or national thoracic outlet syndrome specialist.

Finally, we spend a lot of time and effort producing educational videos and blog posts to help raise awareness of thoracic outlet syndrome and to help TOS patients learn more to help themselves. Visit our video webpage or the TOS MRI YouTube channel.

TOS is complex. We get that. We know there are still doctors out there who don’t ‘believe’ in TOS, for no good scientific reason. Still other doctors don’t feel comfortable diagnosing or treating thoracic outlet syndrome. Even among the thoracic outlet syndrome specialists who regularly diagnose and treat thoracic outlet syndrome patients, there exists a fair amount of disagreement in best practices of diagnosis and treatment. The medical literature highlights a significant number of unresolved questions regarding TOS.

So TOS is a complex disease with an emotional overlay, professional preferences, and unresolved questions of fact. Obviously, the best step forward for both patients and thoracic outlet syndrome specialists is to create and foster an environment favoring ongoing healthy and productive discussions.

Towards this goal, we have designed our website to provide a wide variety of thoracic outlet syndrome education resources. To begin with, our visitors can take basic thoracic outlet syndrome anatomy lessons. Visitors can walk through the underlying causes of thoracic outlet syndrome. Additionally, visitors can view detailed graphics and images. These learning resources certainly help patients to visualize the complex anatomy and complex disease process we know as thoracic outlet syndrome.

In the long run, we aim to grow knowledge and understanding of TOS for all interested patients and thoracic outlet syndrome specialists. Not only do we wish to share our understanding and progress, but also to encourage discussion and recent advancements in the field from all TOS specialists. Additionally, we target consistency. Thoracic outlet syndrome diagnosis and thoracic outlet syndrome treatment should not be decided by city, state or institution. Each TOS patient should receive the same diagnosis and treatment.