Imaging

Bone Densitometry

Bone densitometry, also called dual-energy x-ray absorptiometry, DEXA or DXA, uses a very small dose of ionizing radiation to produce pictures of the inside of the body (usually the lower (or lumbar) spine and hips) to measure bone loss. It is commonly used to diagnose osteoporosis, to assess an individual's risk for developing osteoporotic fractures. DXA is simple, quick and noninvasive. It's also the most commonly used and the most standard method for diagnosing osteoporosis.

On the day of the exam, you may eat normally. You should not take calcium supplements for at least 24 hours before your exam.

You should wear loose, comfortable clothing, avoiding garments that have zippers, belts or buttons made of metal. Objects such as keys or wallets that would be in the area being scanned should be removed.

You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, and any metal objects or clothing that might interfere with the x-ray images.

Inform your physician if you recently had a barium examination or have been injected with a contrast material for computed tomography (CT) scan. You may have to wait 10 to 14 days before undergoing a DXA test.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.

CT

Computed tomography (CT) is a diagnostic imaging test used to create detailed images of internal organs, bones, soft tissue, and blood vessels. The cross-sectional images generated during a CT scan can be reformatted in multiple planes and can even generate three-dimensional images. CT scanning is often the best method for detecting many different cancers since the images allow your doctor to confirm the presence of a tumor and determine its size and location. CT is fast, painless, noninvasive, and accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save lives.

You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.

Metal objects, including jewelry, eyeglasses, dentures, and hairpins, may affect the CT images and should be left at home or removed prior to your exam. You may also be asked to remove hearing aids and removable dental work. Women will be asked to remove bras containing metal underwire. You may be asked to remove any piercings, if possible.

You will be asked not to eat or drink anything for a few hours beforehand, as contrast material will be used in your exam. You should inform your physician of all medications you are taking and if you have any allergies. If you have a known allergy to contrast material, or "dye," your doctor may prescribe medications (usually a steroid) to reduce the risk of an allergic reaction. These medications generally need to be taken 12 hours prior to administration of contrast material. To avoid unnecessary delays, contact your doctor before the exact time of your exam.

Also inform your doctor of any recent illnesses or other medical conditions and whether you have a history of heart disease, asthma, diabetes, kidney disease or thyroid problems. Any of these conditions may increase the risk of an unusual adverse effect.

Women should always inform their physician and the CT technologist if there is any possibility that they may be pregnant.

3D Mammography

Mammography is specialized medical imaging that uses a low-dose x-ray system to see inside the breasts. A mammography exam, called a mammogram, aids in the early detection and diagnosis of breast diseases in women.

Digital mammography, also called full-field digital mammography (FFDM), is a mammography system in which the x-ray film is replaced by electronics that convert x-rays into mammographic pictures of the breast. These systems are like those found in digital cameras and their efficiency enables better pictures with a lower radiation dose. These images of the breast are transferred to a computer for review by the radiologist and for long term storage. The patient's experience during a digital mammogram is like having a conventional film mammogram.

Before scheduling a mammogram, the American Cancer Society (ACS) and other specialty organizations recommend that you discuss any new findings or problems in your breasts with your doctor. In addition, inform your doctor of any prior surgeries, hormone use, and family or personal history of breast cancer.

Do not schedule your mammogram for the week before your menstrual period if your breasts are usually tender during this time. The best time for a mammogram is one week following your period. Always inform your doctor or x-ray technologist if there is any possibility that you are pregnant.

The ACS also recommends you:

• Do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. These can appear on the mammogram as calcium spots.
• Wear a two-piece outfit, as shirt and bra will have to be removed and a gown will be provided
• Describe any breast symptoms or problems to the technologist performing the exam.
• Obtain your prior mammograms and make them available to the radiologist if they were done at a different location. This is needed for comparison with your current exam and can often be obtained on a CD.
• Ask when your results will be available; do not assume the results are normal if you do not hear from your doctor or the mammography facility.

Epidural Injection

An epidural injection provides temporary or lasting relief from pain or inflammation in the spine or extremities (legs). Imaging guidance may be used to place the needle in the right location for maximum benefit. The injection may also help confirm the exact site of the pain.

An epidural injection is an injection of medication into the space around the spinal cord, also known as the epidural space, to provide temporary or prolonged relief from pain or inflammation. The epidural space is the outermost part of the spinal canal. Steroids, anesthetics, and anti-inflammatory medications are typically delivered in an epidural injection. The injection may reduce pain and swelling in and around the spinal nerve roots, as well as around damaged nerves which in time may heal.

• You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.
• You may be instructed not to eat or drink anything for several hours before your procedure to prevent you from having an upset stomach following the injection.
• You may be asked to wear a gown during the procedure.
• You will probably be asked to use the restroom before the procedure.
• You will then be positioned on your stomach or side on a special fluoroscopic or CT table that will give the doctor easy access to the injection site(s). The technologist will help to make you as comfortable as possible, both during & after the procedure.
• You should plan to have a relative or friend drive you home after your procedure.

MRI

Magnetic resonance imaging (MRI) uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the body's internal structures that are clearer, more detailed, and more likely in some instances to identify and accurately characterize disease than other imaging methods. It is used to evaluate the body for a variety of conditions, including tumors and diseases of the liver, heart, and bowel. MRI is noninvasive and does not use ionizing radiation.

You may be asked to wear a gown during the exam, or you may be allowed to wear your own clothing if it is loose-fitting and has no metal fasteners.

Guidelines about eating and drinking before an MRI exam vary with the specific exam and also with the imaging facility. Unless you are told otherwise, you may follow your regular daily routine and take food and medications as usual.

Some MRI examinations may require you to receive an injection of contrast material into the bloodstream. The technologist may ask if you have allergies of any kind, such as an allergy to iodine or x-ray contrast material, drugs, food, or the environment, or if you have asthma. The contrast material most commonly used for an MRI exam contains a metal called gadolinium. Gadolinium can be used in patients with iodine contrast allergy but may require pre-medication. It is far less common for a patient to have an allergy to a gadolinium-based contrast agent used for MRI than the iodine-containing contrast for CT. However, even if it is known that the patient has an allergy to the gadolinium contrast, it may still be possible to use it after appropriate pre-medication. Patient consent will be requested in this instance.

You should also let the technologist know if you have any serious health problems, or if you have had any recent surgeries. Some conditions, such as severe kidney disease, may prevent you from being given gadolinium contrast for an MRI. If you have a history of kidney disease or liver transplant, it will be necessary to perform a blood test to determine whether the kidneys are functioning adequately.

Women should always inform their physician or technologist if there is any possibility that they are pregnant. MRI has been used for scanning patients since the 1980s with no reports of any ill effects on pregnant women or their unborn babies. However, because the unborn baby will be in a strong magnetic field, pregnant women should not have this exam in the first trimester of pregnancy unless the potential benefit from the MRI exam is assumed to outweigh the potential risks. Pregnant women should not receive injections of gadolinium contrast material except when absolutely necessary for medical treatment.

If you have claustrophobia (fear of enclosed spaces) or anxiety, you may want to ask your physician for a prescription for a mild sedative prior to your scheduled examination.

Jewelry and other accessories should be left at home if possible or removed prior to the MRI scan. Because they can interfere with the magnetic field of the MRI unit, metal and electronic items are not allowed in the exam room. These items include:

• jewelry, watches, credit cards and hearing aids, all of which can be damaged
• pins, hairpins, metal zippers and similar metallic items, which can distort MRI images
• removable dental work
• pens, pocket knives and eyeglasses
• body piercings

In most cases, an MRI exam is safe for patients with metal implants, except for a few types. People with the following implants cannot be scanned and should not enter the MRI scanning area:

• cochlear (ear) implant
• some types of clips used for brain aneurysms
• some types of metal coils placed within blood vessels
• nearly all cardiac defibrillators and pacemakers

You should tell the technologist if you have medical or electronic devices in your body. These objects may interfere with the exam or potentially pose a risk, depending on their nature and the strength of the MRI magnet. Many implanted devices will have a pamphlet explaining the MRI risks for that particular device. If you have the pamphlet, it is useful to bring that to the attention of the technologist or scheduler before the exam. Some implanted devices require a short period of time after placement (usually six weeks) before being safe for MRI examinations. Examples include but are not limited to:

• artificial heart valves
• implanted drug infusion ports
• artificial limbs or metallic joint prostheses
• implanted nerve stimulators
• metal pins, screws, plates, stents or surgical staples

In general, metal objects used in orthopedic surgery pose no risk during MRI. However, a recently placed artificial joint may require the use of another imaging procedure. If there is any question of their presence, an x-ray may be taken to detect and identify any metal objects.

Patients who might have metal objects in certain parts of their bodies may also require an x-ray prior to an MRI. You should notify the technologist or radiologist of any shrapnel, bullets, or other pieces of metal which may be present in your body due to prior accidents. Foreign bodies near and especially lodged in the eyes are particularly important. Dyes used in tattoos may contain iron and could heat up during MRI, but this is rarely a problem. Tooth fillings and braces usually are not affected by the magnetic field, but they may distort images of the facial area or brain, so the radiologist should be aware of them.

Infants and young children usually require sedation or anesthesia to complete an MRI exam without moving. Whether a child requires sedation will depend on the child’s age and the type of exam being performed. Moderate and conscious sedation can be provided at most facilities. A physician or nurse specializing in the administration of sedation or anesthesia to children should be available during the exam to ensure your child's safety. You will be given special instructions for how to prepare your child for the sedation or anesthesia.

Nuclear Medicine

Nuclear medicine is an imaging modality that is unique, because it provides doctors with information about both structure and functional assessment of most organs. It is a way to gather medical information that would otherwise be unavailable, require surgery, or necessitate more expensive diagnostic tests. Nuclear medicine imaging procedures often identify abnormalities very early in the progress of a disease long before many medical problems are apparent with other diagnostic tests.

You may be asked to wear a gown during the exam, or you may be allowed to wear your own clothing.

Women should always inform their physician or technologist if there is any possibility that they are pregnant or if they are breastfeeding.

You should inform your physician and the technologist performing your exam of any medications you are taking, including vitamins and herbal supplements. You should also inform them if you have any allergies and about recent illnesses or other medical conditions.

Jewelry and other metallic accessories should be left at home if possible or removed prior to the exam because they may interfere with the procedure.

You will receive specific instructions based on the type of scan you are undergoing. In some instances, certain medications or procedures may interfere with the examination ordered.

Stereotactic Biopsy

Stereotactic breast biopsy uses mammography – a specific type of breast imaging that uses low-dose x-rays – to help locate a breast lump or abnormality and remove a tissue sample for examination under a microscope. It’s less invasive than surgical biopsy, leaves little to no scarring and can be an excellent way to evaluate calcium deposits or tiny masses that are not visible on ultrasound.

You may be asked to remove some or all your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eyeglasses and any metal objects or clothing that might interfere with the x-ray images.

Women should always inform their physician if there is any possibility that they are pregnant. Some procedures using image-guidance are typically not performed during pregnancy because radiation can be harmful to the fetus.

You should not wear deodorant, powder, lotion, or perfume under your arms or on your breasts on the day of the exam.

Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anesthesia. Your physician may advise you to stop taking aspirin or a blood thinner three days before your procedure.

Also, inform your doctor about recent illnesses or other medical conditions. You may want to have a relative or friend accompany you and drive you home afterward. This is recommended if you have been sedated.

Ultrasound

Ultrasound imaging uses a transducer or probe to generate sound waves and produce pictures of the body's internal structures. It does not use ionizing radiation, has no known harmful effects, and provides a clear picture of soft tissues that don't show up well on x-ray images. Ultrasound is often used to help diagnose unexplained pain, swelling and infection. It may also be used to provide imaging guidance to needle biopsies or to see and evaluate conditions related to blood flow. It's also the preferred imaging method for monitoring a pregnant woman and her unborn child.

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.

You may be asked to wear a gown during the procedure.

Preparation for the procedure will depend on the type of examination you will have. For some scans your doctor may instruct you not to eat or drink for as many as 12 hours before your appointment. For others you may be asked to drink up to six glasses of water two hours prior to your exam and avoid urinating so that your bladder is full when the scan begins.

X-ray

X-ray or radiography uses a very small dose of ionizing radiation to produce pictures of the body's internal structures. X-rays are the oldest and most frequently used form of medical imaging. They are often used to help diagnosed fractured bones, look for injury or infection and to locate foreign objects in soft tissue. Some x-ray exams may use an iodine-based contrast material or barium to help improve the visibility of specific organs, blood vessels, tissues or bone.

You may be asked to remove some or all your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eyeglasses and any metal objects or clothing that might interfere with the x-ray images.

Women should inform their physician and x-ray technologist, an individual specially trained to perform radiology examinations, if they have an intrauterine device (IUD) inserted for pregnancy prevention.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant.

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