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technique used in radiology to visualize internal structures of the body in detail. MRI makes use of the property of nuclear magnetic resonance (NMR) to image nuclei of atoms inside the body. An MRI scanner is a device in which the patient lies within a large, powerful magnet where the magnetic field is used to align themagnetization of some atomic nuclei in the body, and radio frequency fields to systematically alter the alignment of this magnetization. This causes the nuclei to produce a rotating magnetic field detectable by the scanner—and this information is recorded to construct an image of the scanned area of the body.:36 Magnetic field gradients cause nuclei at different locations to rotate at different speeds. By using gradients in different directions 2D images or 3D volumes can be obtained in any arbitrary orientation. MRI provides good contrast between the different soft tissues of the body, which makes it especially useful in imaging the brain,muscles, the heart, and cancers compared with other medical imaging techniques such as computed tomography (CT) or X-rays. Unlike CT scans or traditional Xrays, MRI does not use ionizing radiation. The principle behind the use of MRI machines is that they make use of the fact that body tissue contains lots of water (and hence protons) which gets aligned in a large magnetic field. Each water molecule has two hydrogen nuclei or protons. When a person is inside the powerful magnetic field of the scanner, the average magnetic moment of many protons becomes aligned with the direction of the field. A radio frequency current is briefly turned on, producing a varying electromagnetic field. This electromagnetic field has just the right frequency, known as the resonance frequency, to be absorbed and flip the spin of the protons in the magnetic field. After the electromagnetic field is turned off, the spins of the protons return to thermodynamic equilibrium and the bulk magnetization becomes realigned with the static magnetic field. During this relaxation, a radio frequency signal (electromagnetic radiation in the RF range) is generated, which can be measured with receiver coils. MRI is used to visualize the body to assist doctors in their efforts to diagnose certain diseases or conditions and to evaluate injuries. For pediatric imaging, MRI is used for a variety of purposes, including the following: diagnosing diseases of the central nervous system, including the brain and spine detecting musculoskeletal disorders and injuries identifying complications of infectious diseases, such as those associated with Lyme disease or acquired immunodeficiency syndrome (AIDS) imaging the cardiovascular system detecting congenital heart defects in neonates determining the stage of certain types of cancer evaluating bone marrow disease assessing blood vessels in the brain for stroke and other abnormalities assisting in the planning of surgery and cancer treatment evaluating the urinary tract MRI provides images with excellent contrast that allow clinicians to clearly see details of soft tissue, bone, joints, and ligaments. MRI angiography is an imaging technique used to evaluate the blood vessels, for example, to detect aneurysms or cardiovascular problems. Because MRI does not use ionizing radiation to produce images, like x ray and CT, it is often the examination of choice for pediatric imaging and for imaging the male and female reproductive systems, pelvis and hips, and urinary tract and bladder.
MRI can also be used to evaluate brain function for assessing language, senses, neurologic disorders, and pain . This technique, called functional MRI, involves rapid imaging to display changes in the brain's blood flow in response to tasks or visual and auditory stimuli. Functional MRI is being researched to image neurologic disorders, such as attention deficit hyperactivity disorder (ADHD), delayed cognitive development , and epilepsy. MRI spectroscopy is another emerging imaging technique for evaluating pediatric brain disorders. In MRI spectroscopy, chemicals in the brain are measured and brain tissue is imaged. This technique is being investigated to evaluate traumatic brain injury, speech delay, creatine deficiency syndromes, and mood disorders in young children.
Read more: Magnetic Resonance Imaging - Definition, Purpose, Description, Risks http://www.healthofchildren.com/M/Magnetic-Resonance-Imaging.html#b#ixzz22S7k029e Preparation Preparation Prior to any MRI scan, patients are required to remove all metal objects and remove any clothing with metal on them (zippers, snaps). In most cases, parents have to complete a survey regarding their child's past surgical procedures and medical history to indicate whether the child has any metallic implants. Metallic implants include artificial joints, pacemakers, aneurysm clips, metal plates, pins or screws, and surgical staples. Children with metallic implants are likely to undergo a computed tomography (CT) examination instead of an MRI. Unlike CT, no fasting or laxatives are required prior to an MRI scan. Only one type of MRI scan, called a magnetic resonance cholangiopancreatography (MRCP), which scans the bile ducts, requires that the child not eat or drink anything for two to three hours prior to the scan. During the examination, the child must lie still. The MRI scanner does make loud noises throughout the examination, which can be frightening for some children. Before the examination, the procedure should be explained to the child, and it should be emphasized that the examination is painless. Most facilities have specially designed music systems so that patients can wear headsets and listen to music during the scan; some facilities even have special video goggles so children can watch a cartoon or movie during the scan.
return to top How to prepare for the MRI examination. There’s no special preparation necessary for the MRI examination. Unless your doctor specifically requests that you not eat or drink anything before the exam, there are no food or drink restrictions. Continue to take any medication prescribed by your doctor unless otherwise directed. You won’t be allowed to wear anything metallic during the MRI examination, so it would be best to leave watches, jewelry or anything made from metal at home. Even some cosmetics contain small amounts of metals, so it is best to not wear make-up. In order to prevent metallic objects from being attracted by the powerful magnet
of the MR system, you will typically receive a gown to wear during your examination. Items that need to be removed by patients before entering the MR system room include: Purse, wallet, money clip, credit cards, cards with magnetic strips Electronic devices such as beepers or cell phones Hearing aids Metal jewelry, watches Pens, paper clips, keys, coins Hair barrettes, hairpins Any article of clothing that has a metal zipper, buttons, snaps, hooks, underwires, or metal threads Shoes, belt buckles, safety pins Before the MRI procedure, you will be asked to fill out a screening form asking about anything that might create a health risk or interfere with imaging. You will also undergo an interview by a member of the MRI facility to ensure that you understand the questions on the form. Even if you have undergone an MRI procedure before at this or another facility, you will still be asked to complete an MRI screening form. Examples of items or things that may create a health hazard or other problem during an MRI exam include: Pacemaker Implantable cardioverter defibrillator (ICD) Neurostimulator Aneurysm clip Metal implant Implanted drug infusion device Foreign metal objects, especially if in or near the eye Shrapnel or bullet wounds Permanent cosmetics or tattoos Dentures/teeth with magnetic keepers Other implants that involve magnets Medication patch (i.e., transdermal patch) that contains metal foil Check with the MRI technologist or radiologist at the MRI center if you have questions or concerns about any implanted object or health condition that could impact the MRI procedure. This is particularly important if you have undergone surgery involving the brain, ear, eye, heart, or blood vessels. Important Note: If you are pregnant or think that you could be pregnant, you must notify your physician and the radiologist or the MRI technologist at the MRI center prior to the MRI procedure. Before entering the examining room, any friend or relative that might be allowed to accompany you will be asked questions to ensure that he or she may safely enter the MR system room and will likewise be instructed to remove all metallic objects. Additionally, this individual will need to fill out a screening form. Post-Procedure Care
Following your MRI, you can resume your normal activities. (Please contact your doctor if you have any questions about your intended activities, or if you have any questions about restricted activities.) If you were given an injection of contrast media as part of your MRI scan today, you should: Drink an extra 24 ounces of water (three extra glasses). Contact your physician immediately if you experience any or the following: Trouble breathing Dizziness or lightheadedness Slow or irregular heartbeat Any other sudden change that concerns you Your injection of contrast media required a puncture through your skin. Even though proper steps were taken to prevent infection as a result of this skin puncture, an infection in this area is possible. Please seek medical care if: The injection site becomes red, painful to the touch, or hot to the touch. A lump that was not present when you finished your scan develops at the injection site, or a small lump that was present becomes larger over time. If you were given (or took) a sedative for this exam, please do not drive or operate machinery until its effects have worn off (please contact your doctor with any questions). Nsg resp Preparing equipment
Gathering and preparing equipment is often done by nurses. Their responsibilities include checking the equipment to assure it is working properly and is ready for use on patients. Cleaning equipment before and after each use to prevent the spread of infection is done by the nursing staff. Another service they provide is assisting technicians who specialize in specific equipment use to make sure the testing is performed on the patient without difficulty. They must also report any broken or damaged equipment and prevent it from being used on patients before it is fixed. Preparing patients Preparing a patient for diagnostic testing is a nurse's responsibility. Drawing blood or administering medication prior to testing is one way nurses help prepare patients. Another way they help is by collecting specimens, such as sputum or urine samples, and sending them to the lab. Patients may need to have an area sterilized or shaved for a surgical procedure or the application of electrodes. Nurses assist with mentally preparing patients for testing by answering questions, explaining the procedure or test and possible outcomes. Sponsored Links OBD 2 Software for OSX Check Engine Light On? Diagnose and Clear yourself. www.yhasi.com Assist with testing
Assisting both patients and other health care providers during diagnostic testing is done by nurses. They provide patient care during the test which may include administering medicines
when needed. Nurses must help position patients properly, like rolling the patient over, in order to complete the necessary diagnostic testing. Transporting patients to and from the test can be part of their job. This helps ensure the patient arrives at the testing site safely and on time. Monitor patients during testing Patients are monitored by nurses during diagnostic testing. This includes monitoring their current medical condition, especially in those patients deemed unstable. They must check a patient's vital signs (blood pressure, pulse, breathing rate), assess physical condition and keep an eye on any monitors that the patient needs to remain hooked up to during the tests, such as a heart monitor or ventilator. Nurses may also be required to connect or disconnect any monitors or devices that can interfere with the testing. Reporting results
Test results are reported to the patient's doctor, specialists and others in need of the information by nurses. Results may be phoned in, faxed or sent electronically via a computer. It may be the nurse's responsibility to check for the results of the tests as well. They may be in charge of entering the results into the patient's medical record. Nurses must also notify the patient's physician when abnormal or critical results that require an immediate response, such as abnormal blood work with critical potassium levels, are found.
Read more: Nursing Responsibilities for Diagnostic Testing | eHow.com http://www.ehow.com/list_7278200_nursing-responsibilities-diagnostictesting.html#ixzz22SA8MRO5 Preparation for the MRI Scan • Bring your referral letter or request form and all x-rays taken in the last 2 years with you. Page 2 of 6 Last udpated 4 May 2009 • Leave the x-rays with the radiology staff as the doctor may need to look at them. The MRI staff will tell you when these are ready to be picked up. Wear comfortable, loose clothing. Leave all jewellery and valuables at home (metal objects, such as watches, keys, coins and jewellery cannot be taken into the MRI room. Cards with magnetic strips such as bank cards will be erased by most MRI scanners). • •
The sedative will relax you and may make you feel sleepy. allergies and asthma (some conditions such as kidney disease may mean you cannot have an MRI with dye). If you are having ‘dye’ tell the staff about any medical conditions you have. The MRI machine makes a lot of noise during the scan. Straps or pillows may be used to help you keep still during the scan. If you are having dye or sedative injected. If you don’t like closed in spaces (claustrophobic). If the doctor has decided you need a sedative and written it on the request form. Your doctor may then discuss the possibility of you being given something to relax you just before the scan (sedative). Page 3 of 6 Last udpated 4 May 2009 Possible side effects of ‘dye’: • You may feel a slight coolness and a flushing for a few seconds. • You may be given a sedative if you don’t like closed in spaces. however you will be able to remain comfortable. • Just before the MRI Scan: • You may be given a gown to wear during the procedure. (claustrophobic). • You will be asked to remove any metal objects. PROCEDURE What happens during a MRI Scan The staff will ask you to lie on the bed. and will place a receiver around the part of your body being scanned. you will need to let the staff know when you book your scan. tell the staff.if this bothers you. including kidney disease.If you are having ‘dye’: • You may be asked not to eat or drink for a few hours before the MRI Scan Important to tell your doctor before the scan • • If you are or may be pregnant. MRI staff will put a needle into a vein in your hand or arm. which may sound like . • Part of your body may feel warm .
including getting you ready. The MRI staff will use a remote control to slowly move you into the tunnel of the MRI scanner. When will I get the results? The amount of time it takes for you to get your results will differ depending on where you get your scans done. The staff will leave the room where they can control the movement of the bed from behind a screen. When the scanning is finished you will be asked to wait while the staff check the pictures. Drink plenty of fluid to help get rid of the dye. You must not drive a car or take public transport and must have someone with you for 24 hours afterwards. After the MRI Scan You will be able to go soon after the MRI is finished and can continue with normal activities. Your doctor will need to discuss the report with you. You will be able to speak to them at all times. Staff will give you any special instructions The dye will pass out of your body in your urine. The radiology doctor will look at the pictures and write a report.thumping or humming. You will be given earplugs or headphones to block out the noise or listen to music. takes between 30 minutes to one hour. You will not notice it as it is colourless. You will need to make an appointment to do this. The scan. If you had a sedative: Staff will need to take out the needle if it is still in your arm. need to move or are feeling closed in (claustrophobic). If you get stiff. (In most MRI centres you can bring your own CD to listen to). when to hold still and if you need to take a deep breath and hold it. If you had ‘dye’: Staff will need to take out the needle if it is still in your arm. . tell the staff. They will tell you what is happening. They can see. The pictures may be on films or on a CD. or whether they will be sent to your doctor. hear and speak to you at all times. Ask whether you should wait to take the pictures and report with you.
Surgeons and emergency physicians use ultrasound at the bedside to assess abdominal pain or other concerns. The technology is especially accurate at seeing the interface between solid and fluid filled spaces. For example ultrasound in obstetrics is used to diagnose growths or tumors of the ovary. The physics of sound can place limits on the test. Using their understanding of human anatomy and the machine. the technician can evaluate specific structures and try to answer the question asked by the patient's physician. For example. Pelvic ultrasounds can be obtained trans-abdominally where the probe is placed on the abdominal wall. the heart's valve function. Should the intestine be distended with bowel gas. aradiologist will oversee the ultrasound test and report on the results. The goal will be to "paint" a shadow picture of the inner organ that the health care practitioner has asked to be visualized. This may take a fair amount of time and require the probe to be repositioned and pointed in different directions. Cardiology Echocardiography Echocardiography (echo=sound + cardio=heart + graphy=study) evaluates the heart. Sound waves cannot penetrate deeply. organs behind it may not be easily seen. It also evaluates the heart wall motion and the amount of blood the heart pumps with each stroke. A skilled ultrasound technician is able to see inside the body using ultrasonography to answer questions that may be asked by the medical practitioner caring for the patient. Diagnostic uses Obstetrics Ultrasound routinely for assessing the progression of pregnancy. ultrasound works poorly in the chest. The ability to measure different echoes reflected from a variety of tissues allows a shadow picture to be constructed. and blood flow through them. Similarly. This can allow the technician to measure blood flow in organs such as the heartor liver. is used to project and receive the sound waves and the return signals. where the probe is placed in the vagina. Ultrasound does poorly when gas is present between the probe and the target organ.You must not operate machinery on the day of the scan Ultrasound Ultrasound produces sound waves that are beamed into the body causing return echoes that are recorded to "visualize" structures beneath the skin. The accuracy of the test is very much operator dependent. but can also be used in screening for disease and to aid in treatment of diseases or conditions. Purpose For what purposes are ultrasounds used? Ultrasound is not limited to diagnosis. Ultrasound does not penetrate bone easily. or trans-vaginally. This means that the key to a good test is the ultrasound technician. and an obese patient may be imaged poorly. Fallopian tubes.uterus. the technician may need to vary the amount of pressure used to push the probe into the skin. or probe. Usually. These are actually the same principles that allow SONAR on boats to see the bottom of the ocean. obstetricians use ultrasound to assess the fetus duringpregnancy. Echocardiography can be performed in two ways: . Ultrasound can be enhanced by using Doppler technology which can measure whether an object is moving towards or away from the probe. Ultrasonography is body imaging using ultrasound in medical diagnosis. where the lungs are filled with air. The quality of the picture depends on many factors. or within specific blood vessels. A transducer. As well. A gel is wiped onto the patient's skin so that the sound waves are not distorted as they cross through the skin. but other types of physicians may use ultrasound as a diagnostic tool.
and it can be detected in the abdomen by ultrasound (abdominal aortic aneurysm). deep vein thrombosis (DVT) or another cause. uterine fibroids. gallbladder.trans-thoracic: the probe is place on chest wall to obtain images. ultrasound may be used to look for diseases like appendicitis or kidney stones. the esophagus sits near the heart and allows clearer images. may weaken and widen. bladder. and endometriosis. Some examples of ultrasound testing include: Carotid ultrasound is performed in patients with transient ischemic attacks (TIAs) or strokes to determine whether the major arteries in the neck are blocked causing the decreased blood supply to the brain. Abdominal structures Aside from its use in obstetrics. Pelvic ultrasound is used in gynecology to help assess non-pregnancy related issues like lower abdominal pain. Ultrasound is the preferred to test to screen for gallstones or an infected gallbladder. uterine growths. uterus. this approach is a little more invasive. The heart muscle pumps blood to the body. testicles. The aorta is the large blood vessel leaving the heart that supplies blood to the rest of the body. ultrasound can evaluate most of the solid structures in the abdominal cavity. blood is pumped from the left ventricle through the aortic valve into the aorta and the rest of the body. The ultrasound may find blockage in the bile ducts. Veins can also be evaluated by ultrasound and it is a common test to assess whether swelling in a leg is due to a blood clot. and trans-esophageal: where the probe is placed through the mouth into the esophagus. and ovaries. Blood vessels Ultrasound can detect blood clots in veins (superficial or deep venous thrombosis) or artery blockage (stenosis) and dilatation (aneurysms). The walls of the aorta are under significant pressure from the force of the heartbeat and over time. prostate. which assists in determining whether medications are needed. For those patients where the radiation of a CT scan (computerized tomography) is a potential risk (pregnant patients or children). insufficient). By following how the patient fares clinically. However. Echocardiography also can detect abnormal fluid collections (pericardial effusions) in the pericardium. For example. the amount of blood it pumps with each beat can decrease. Echocardiograms are used to diagnose and monitor pulmonary artery hypertension. The ultrasound can reveal the stones as well as signs of infection. For those patients with small aneurysm. leading tocongestive heart failure. Anatomically. The echocardiogram can measure the efficiency of the heart beat and how much blood it pumps. This includes the liver. when the heart beats. The aortic valve prevents blood from back-flowing into the heart as it fills for the next beat. This is called an aneurysm. In other situations. observation may be recommended and the aneurysm size followed over time by repeated tests. The neck . kidneys. If the heart weakens. Echocardiography can visualize the heart chambers to detect blood clots in conditions such as atrial fibrillation (an irregular heart rhythm). Ultrasound is the test of choice to diagnose testicular torsion. The same principles apply to the mitral valve which keeps blood flowing from the left atriumto the left ventricle. It also is used to monitor how well medications are working. Echocardiography can determine if the valve is narrow or leaking (regurgitating. ovarian cysts. Different groups of illnesses can be assessed by echocardiography: Valves in the heart keep blood flowing in one direction when the heart pumps. repeated echocardiograms can help determine whether valve replacement or repair is warranted. including thickening of the gallbladder wall and fluid surrounding the gallbladder. the test can help diagnose endocarditis (an infection of the heart valves) by visualizing "vegetations" (an infected mass) on the valves themselves.pancreas.
These tests may be indicated for an individual patient or they may be offered as a community wide health screening assessment. called a Baker's cyst. by measuring the diameter of the aorta in the abdomen. diagnose a variety of heart conditions and to assess damage after a heart attack or diagnose for valvular heart disease. By measuring blood flow and blockage in the carotid arteries. the test can predict potential risk for future stroke.cfm?pg=breastbius)). growths. Ultrasound may be used to screen for blood vessel diseases.RadiologyInfo. Ultrasound is used to help physicians evaluate symptoms such as: pain swelling infection hematuria (blood in urine) Ultrasound is a useful way of examining many of the body's internal organs. or tumors. Knee joint Ultrasound can be used to detect bulging of fluid from a swollen knee joint into the back of the knee. What are some common uses of the procedure? Click to play Ultrasound examinations can help to diagnose a variety of conditions and to assess organ damage following illness. including the abdominal aorta and its major branches liver gallbladder spleen pancreas kidneys bladder uterus. in which needles are used to extract sample cells from an abnormal area for laboratory testing. and unborn child (fetus) in pregnant patients eyes thyroid and parathyroid glands scrotum (testicles) brain in infants hips in infants ltrasound: Liver Ultrasound is also used to: guide procedures such as needle biopsies. image the breasts and to guide biopsy of breast cancer (see the Ultrasound-Guided Breast Biopsy page (www. including but not limited to the: heart and blood vessels.org/en/info. . Similarly. ultrasound can screen for aneurysm (abnormal dilatation) and the risk of rupture.The thyroid gland can be imaged using ultrasound looking for nodules. ovaries.
You may be asked to wear a gown during the procedure. sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern. Transvaginal ultrasound. for example. The transducer is inserted into the esophagus to obtain images of the heart. Most ultrasound examinations are completed within 30 minutes to an hour. With knowledge about the speed and volume of blood flow gained from a Doppler ultrasound image. When the examination is complete. Other preparation depends on the type of examination you will have. top of page How should I prepare? You should wear comfortable. the transducer is attached to a probe and inserted into a natural opening in the body. the room may be dimmed so that the pictures on the screen can be seen more clearly. Doppler sonography is performed using the same transducer. The sonographer (ultrasound technologist) or radiologist then presses the transducer firmly against the skin in various locations. A gel will be applied to your skin over the area to be scanned. For some scans your doctor may instruct you not to eat or drink for as many as 12 hours before your appointment. tumors and congenital vascular malformation.Doppler ultrasound images can help the physician to see and evaluate: blockages to blood flow (such as clots). Transrectal ultrasound. The gel allows the sensor to slide easily over the skin and helps to produce clearer pictures. You may be asked to take deep breaths and to hold your breath for a few moments. In some ultrasound studies. These exams include: Transesophageal echocardiogram. the patient may be asked to dress and wait while the ultrasound images are reviewed. and wait while the bladder . You may need to remove all clothing and jewelry in the area to be examined. the abdomen. For a scan of the bladder. top of page Procedure A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. the bladder may occasionally not be full enough for the examination and you may be asked to drink more fluid. The transducer is inserted into a man's rectum to view the prostate. The transducer is inserted into a woman's vagina to view the uterus and ovaries. narrowing of vessels (which may be caused by plaque). loose-fitting clothing for your ultrasound exam. You will be taken into a room where you will be asked to lie down on a couch. 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. the physician can often determine whether a patient is a good candidate for a procedure like angioplasty.
A series of radiographs are taken as the contrast agent spreads through the brain's arterial system. the gel will be wiped off and you will be free to get dressed. Explain that the gel is applied over the area where the transducer is place Cerebral angiography Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain. For some applications this method may yield better images than less invasive methods such as computed tomography angiography and magnetic resonance angiography. cerebral angiography allows certain treatments to be performed immediately. Typically a catheter is inserted into a large artery (such as the femoral artery) and threaded through the circulatory system to thecarotid artery. for example. over time these coils encourage formation of connective tissue at the site. then a second series as it reaches the venous system. In addition. based on the its findings. It was pioneered in 1927 by the Portuguese physicianEgas Moniz at  the University of Lisbon. Records of selected images will be made so that they can be viewed later. strengthening the vessel walls. If. metal coils may be introduced through the catheter already in place and maneuvered to the site of aneurysm. cerebral angiography is required to confirm brain death. the images reveal an aneurysm. where a contrast agent is injected. Upon completion. The doctor/sonographer will slowly move the sensor over your skin while viewing the images on the screen.   What are some common uses of the procedure? Physicians use the procedure to detect or confirm abnormalities within the blood vessels in the brain. Drink five to six full glasses of fluid approximately 1 to 2 hours before the test. In some jurisdictions.fills up. including: . thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms. NURSING RESPONSIBILITIES For best visualization. schedule abdominal ultrasonography before any examinations that usebarium. who also helped develop thorotrast for use in the procedure.
a blood clot. to prepare for other medical treatment. an inflammation of the blood vessels. general anesthesia or to contrast materials containing iodine (sometimes referred to as "dye" or "x-ray dye"). nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure. in preparation for minimally invasive treatment of a vessel abnormality. atherosclerosis. such as: severe headaches memory loss slurred speech dizziness blurred or double vision weakness or numbness loss of coordination or balance. . Also inform your doctor about recent illnesses or other medical conditions. especially to local anesthetic medications. known as a vascular dissection. an aneurysm. vasculitis. a tear in the lining of the artery. generally narrowing them. such as in the surgical removal of a tumor. including herbal supplements. a bulge or sac that develops in an artery due to weakness of the arterial wall. arteriovenous malformation. Your physician may advise you to stop taking aspirin. The procedure may also be used to help diagnose the cause of symptoms. a tangle of dilated blood vessels that disrupts normal blood flow in the brain. to provide additional information on abnormalities seen on MRI or CT of the head. a tumor. How should I prepare? You should report to your doctor all medications that you are taking. and if you have any allergies. A cerebral angiogram may be performed: to evaluate arteries of the head and neck before surgery. a narrowing of the arteries. such as the blood supply to a tumor. a stroke.
smaller than a pencil. If so. x-ray equipment and a catheter may be used.If you are going to be given a sedative during the procedure. is used to watch and guide progress of the procedure. You will likely be instructed not to eat or drink anything after midnight before your procedure.RadiologyInfo.RadiologyInfo. What does the equipment look like? View larger with caption In this procedure. visit the Anesthesia page (www. If an x-ray is necessary. you should ask your radiologist how to proceed. . You will receive specific instructions on how to prepare. you may be asked not to eat or drink anything for four to eight hours before your exam. an x-ray tube and a television-like monitor that is located in the examining room. A catheter is a long. precautions will be taken to minimize radiation exposure to the baby. thin plastic tube. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. you may want to have a relative or friend accompany you and drive you home afterward. Your doctor will tell you which medications you may take in the morning. including any changes that need to be made to your regular medication schedule.org/en/safety/). Fluoroscopy. The video is produced by the x-ray machine and an image intensifier that is suspended over a table on which the patient lies. For more information about sedation. The equipment typically used for this examination consists of a radiographic table. which converts x-rays into video images. about 24 hours after the test. Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. If you are breastfeeding at the time of the exam. See the Safety page (www. It may help to pump breast milk ahead of time and keep it on hand for use after contrast material has cleared from your body.org/en/safety/) for more information about pregnancy and x-rays.
some patients may require admission following the procedure. x-ray images were maintained as hard film copy (much like a photographic negative). which clearly defines the area being examined by making it appear bright white. top of page How does the procedure work? X-rays are a form of radiation like light or radio waves. top of page How is the procedure performed? This procedure is often done on an outpatient basis. bones appear white on the x-ray. an x-ray machine produces a small burst of radiation that passes through the body. your blood may be tested to determine how well your liver and kidneys are functioning and whether your blood clots normally. When used with a contrast material. allow more of the x-rays to pass through them. Today.Other equipment that may be used during the procedure includes an intravenous line (IV) and equipment that monitors your heart beat and blood pressure. Please consult with your physician as to whether or not you will be admitted. X-rays pass through most objects. recording an image on photographic film or a special digital image recording plate. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management. . Prior to your procedure. Once it is carefully aimed at the part of the body being examined. Until recently. most images are digital files that are stored electronically. Still images are also captured and stored either on film or electronically on a computer. such as muscle. Fluoroscopy uses a continuous or pulsed x-ray beam to create a sequence of images that are projected onto a fluorescent screen. or television-like monitor. However. Dense bone absorbs much of the radiation while soft tissue. fat and organs. this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. soft tissue shows up in shades of gray and air appears black. including the body. Different parts of the body absorb the x-rays in varying degrees. As a result.
Alternatively. Your intravenous line will be removed. the catheter will be removed and pressure will be applied to stop any bleeding. You will be positioned on the examining table. Additional time may be required for exam preparation. In children up to mid-teens. top of page . setup and post-procedure care. thin. A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. Your physician will numb the area with a local anesthetic. sterilized and covered with a surgical drape. tape or a foam head holder so you cannot move it during the procedure. hollow plastic tube) is inserted through the skin into a blood vessel and navigated to the area to be examined. The opening in the skin is then covered with a dressing.Because the cerebral angiogram and recovery period may last for several hours. No sutures are needed. The area of your body where the catheter is to be inserted will be shaved. you may receive general anesthesia. several sets of x-rays will be taken. A very small nick is made in the skin at the site. a catheter (a long. Using x-ray-guidance. cerebral angiography is usually performed with the patient under general anesthesia. When it reaches the blood vessels being studied. Your head will be held in place using a strap. Devices to monitor your heart rate and blood pressure will be attached to your body. The procedure is usually completed within one to three hours. The contrast material is then injected through the catheter. you will be asked to empty your bladder before the procedure begins. At the end of the procedure.
You will remain in the recovery room for observation for a few hours following the procedure before you return home. depending on how deeply you are sedated. the intravenous (IV) sedative will make you feel relaxed and sleepy. If the catheter was placed in the groin area. In either case. This will vary based on the technique used to repair the hole created in order to insert the catheter. You may resume your normal diet immediately after the exam. arms or legs slurred speech vision problems signs of infection at the catheter site dizziness chest pain . The most difficult part of the procedure may be lying flat for several hours. it takes about 10 minutes for the tiny hole in the artery to close. the catheter will be removed by the radiologist. Pressure is immediately applied to the puncture site to ensure there is no bleeding. Once the procedure is complete. You may or may not remain awake. As the contrast material passes through your body. You will be asked to remain very still while the x-ray images are taken. You may feel slight pressure when the catheter is inserted but no serious discomfort. You should report to your physician immediately if you experience any of the following after your procedure: weakness or numbness in the muscles of your face. If the case is done with sedation. you may get a warm feeling. You may apply ice to the site where the catheter was inserted to relieve pain and swelling.What will I experience during and after the procedure? You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected. The pressure may be either applied by hand or with a special clamp. You will be able to resume all other normal activities eight to 12 hours after the exam. you will be given specific instructions regarding how long you may need to keep your leg straight.
15 minutes to stop the bleeding. After that time. who will share the results with you. A follow-up examination may be necessary so that any change in a known abnormality can be detected over time.6 hours after the procedure. An area of your body. which monitor your heart activity during the test. or sandbags. Follow-up examinations are often necessary. The health care provider will attach electrocardiogram(ECG) leads to your arms and legs. The dye helps highlight any blockages in blood flow. X-ray images are taken to see how the dye moves through the artery and blood vessels of the brain. hollow tube called a catheter is placed through an artery and carefully moved up through the main blood vessels in the belly area and chest and into an artery in the neck. Before the test starts. a physician specifically trained to perform. Pressure is immediately applied on the leg at the site of insertion for 10 . Once the catheter is in place. Your head is positioned and held still using a strap. Watch the area for bleeding for at least the next 12 hours. will analyze the images and send a signed report to your primary care or referring physician. the needle and catheter are withdrawn. . usually the groin. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable over time. Moving xray images help the doctor position the catheter. A thin. is cleaned and numbed with a local numbing medicine (anesthetic). Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. and your doctor will explain the exact reason why another exam is requested. a special dye (contrast material) is injected into catheter. You will be asked to lie on an x-ray table. After the x-rays are taken. difficulty breathing rash top of page Who interprets the results and how do I get them? A radiologist. OR/other ref How the Test is Performed Cerebral angiography is done in the hospital or large radiology center. tape. Your leg should be kept straight for 4 . supervise and interpret radiology examinations. the area is checked and a tight bandage is applied. so you do not move during the procedure. you will be given a mild sedative to help you relax.
How the Test Will Feel The x-ray table may feel hard and cold. There is a feeling of pressure as the catheter is moved into the body. When you arrive at the testing site. You will feel a brief. Your doctor may order this test if you have symptoms or signs of: Abnormal blood vessels (vascular malformation) Aneurysm Narrowing of the arteries in the brain Vasculitis .Digital subtraction angiography (DSI) uses a computer to "subtract" or take out the bones and tissues in the area viewed. Routine blood tests and examination of the nervous system will be done before the procedure. sharp pain as the catheter is inserted. You may have slight tenderness and bruising at the site of the injection after the test. You may wish to ask for a blanket or pillow. You must remove all jewelry. Your health care provider will explain the procedure and its risks. you will be given a hospital gown to wear. Tell the health care provider if you: Are allergic to shellfish or iodine substances Have a history of bleeding problems Have had an allergic reaction to x-ray contrast dye or any iodine substance May be pregnant You may be told not to eat or drink anything for 4 to 8 hours before the test. Some people feel a warm or burning sensation of the skin of the face or head when the contrast dye is injected. so that only the blood vessels filled with the contrast dye are seen. Why the Test is Performed Cerebral angiography is most frequently used to identify or confirm problems with the blood vessels in the brain. How to Prepare for the Test You must sign a consent form. Some people feel a sting when the numbing medicine (anesthetic) is given.
this procedure may be used to get more detailed information after something abnormal has been detected by an MRI or CT scan of the head. or arteriovenous malformation. This test may also be done in preparation for medical treatment (interventional radiology procedures) by way of certain blood vessels. Abnormal results may also be due to: Intracerebral hemorrhage Metastatic brain tumor Neurosyphilis Optic glioma Pituitary tumor Primary brain tumors Risks There is the possibility of significant complications. Narrowed arteries may suggest cholesterol deposits. including: Allergic reaction to the contrast dye Blood clot or bleeding at the needle stick site. What Abnormal Results Mean Contrast dye flowing out of the blood vessel may be a sign of internal bleeding. aneurysm (bulging of the artery walls).It is sometimes used to: Confirm a brain tumor Evaluate the arteries of the head and neck before surgery Find a clot that may have caused a stroke In some cases. Out of place blood vessels may be due to brain tumors. which can block blood flow and cause a stroke (rare) Considerations Tell your health care provider immediately if you have: Facial weakness Numbness in your leg during or after the procedure Slurred speech . which could partly block blood flow to the leg Damage to an artery or artery wall from the catheter. a spasm. bleeding within the skull. or inherited disorders.
When the contrast dye is being injected some patients report feeling a warm flushing sensation to their face or a salty taste in their mouth. by visualizing the path on a TV like monitor. The neurosurgeon will pass this catheter slowly through the arteries and vessels to the neck. heart rate. Please do not hesitate to communicate any discomfort during the procedure. and oxygen level. The contrast dye allows the blood vessels to be visible while x-ray pictures are being taken. If a closure device is used. If needed. the doctor may choose to close the artery puncture with a closure device. What happens after the angiogram is completed? DISCHARGE!!!! When the study is completed. You will receive a local anesthetic prior to the incision and insertion of the catheter. You must stay in bed for the next 2 to 6 hours. You may feel a burning sensation briefly. These sensations are brief and a normal response to the contrast dye. . You then will be transported to the Day Care Unit for observation. After cleansing and numbing your groin area. You may also experience a hot or flushed feeling when the dye is injected. During the procedure a registered nurse will monitor your blood pressure. Will I be in pain? The procedure is generally not painful. the catheter will be removed from your artery and pressure will be applied at the point of entry. but you will be able to communicate with the surgeon if needed. You may communicate to your doctor or nurse if you feel anxious or uncomfortable at anytime throughout the procedure and medication will be given to help you feel more comfortable. where contrast dye will be injected. You are sedated so that you are still and comfortable. a small incision will be made and a catheter will be inserted into your femoral artery. Vision problems TEACHING During your Angiogram: You will be sedated and comfortable. Your doctor will determine how long you should stay in bed.
You will be instructed to keep your leg straight to prevent any bleeding from the incision site. seafoods. . your vital signs will be monitored regularly. ( 1 ) R e v i e w t h e patient's clinical r eco rd to d etermine t h e r ea s o n (p urp o se) fo r t h e specific patient's s c h e d u l e d cerebral an gio gr ap h y a n d w h a t t h e patient h a s b e e n to ld a b o u t t h e p r o ced ur e. You may shower the day after your angiogram.the period that you lie flat is shorter. or t h e d y e s u s e d f o r o t h e r lo cal tests. ( 6 ) Exp lai n to t h e patient e v e n t s t h a t wi l l o c c u r prior to t h e cerebral an g io grap h y p r o ced ur e. You will be able to eat a light snack. You should NOT lift. ( 5 ) As indicated. (3) Ap p ro ach a n d identify t h e patient. You should not drive or operate heavy machinery 24 hours after the procedure. Please talk to the doctor prior to restarting Coumadin. ( 2 ) C h e c k t h e patient's medication hi s to r y f o r hyp ersensitivity to iodine. During your stay. e xp l ai n to t h e patient t h e specific p urp o se of t h e cerebral an g io grap h y in hi s/ h er situatio n. You will be given IV fluids and will be encouraged to drink plenty of fluids. ( a ) Patient wil l be required to fas t 8 -1 0 h o u r s b efore test. You may resume your normal activities 7 days after your procedure. Do not lift anything heavier than 10 lbs. Thomas will be scheduled to review your results. pull. a n d report significant findings to t h e Professio nal N u r s e . You may resume your normal medication regimen. Do not engage in any strenuous activities. or strain your abdominal muscles for at least 7 days after your procedure. or Metformin. A follow-up appointment with Dr. push. Some bruising at the incision site is normal. No baths or swimming until incision is completely healed (10-14 days). Nsg resp ZZZZZZZZZ c. E xp l ai n p urp o se in a m a n n e r co nsistent w i t h t h a t o ffered by t h e p hysicia n to avo id co n f u s i n g t h e patient. You may take Tylenol if appropriate. It is normal to have some discomfort to the incision site after the angiogram. Lovenox. ( 4 ) I n t e r v i e w t h e p atient to d eter mi ne h i s/ h er k n o wl e d g e of t h e p urp o s e of t h e cerebral antio gr ap h y p r o ced ur e. The registered nurse will also check the incision site and pedal pulses regularly. N u r s i n g implications.
or very rarely as a treatment ("therapeutic lumbar puncture") to relieve increased intracranial pressure. ( b ) The p atient wi ll be p laced in a s u p i n e position on t h e x . (e) Patient ( o r responsible f a mi l y m e m b e r ) m u s t s i g n a c o n s e n t f o r m . ( d ) Patient wil l be asked to e m p t y hi s / her b lad der prior to t h e proced ure. Contents [hide] 1 Indications 2 Contraindications 3 Procedure 4 Risks 5 Diagnostics 6 History 7 References 8 External links Indications The most common purpose for a lumbar puncture is to collect cerebrospinal fluid in a case of suspected meningitis. a life-threatening but highly treatable condition. can be excluded. ( g ) If ordered. d e n t u r e s . and colloquially known as a spinal tap) is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical. microbiological.r a y tab le a n d asked to r e ma i n still Lumbar puncture A lumbar puncture (or LP. medication s u c h as a sedative may be ad ministered prior to t h e test.r a y d ep ar t me n t. as they have a much higher risk of meningitis than older persons and do not reliably show signs of meningeal irritation (meningismus). (c) Patient wil l w e a r a hospital g o w n . In any age . ( a ) Patient wil l be tr anspor ted to t h e x . a n d hair p i n s wi l l be r e m o v e d a n d p laced in safekeeping. ( 7 ) Exp lai n to t h e patient e v e n t s t h a t wi l l o c c u r d u r i n g t h e cerebral an g io grap h y p r o ced ur e. and cytological analysis. (f) The test wi ll ta ke ap p r o ximatel y t w o h o u r s . since there is no other reliable tool with which meningitis. Young infants commonly require lumbar puncture as a part of the routine workup for fever without a source.( b ) A l l j e we l r y .
group. hydrocephalus.  Procedure . It may also be used to detect the presence of malignant cells in the CSF. Contraindications Lumbar puncture should not be performed in the following situations Idiopathic (unidentified cause) increased intracranial pressure (ICP) Rationale: lumbar puncture in the presence of increased ICP may cause uncal herniation Exception: therapeutic use of lumbar puncture to reduce ICP Precaution CT brain is advocated by some. as in carcinomatous meningitis or medulloblastoma. benign intracranial hypertensionand many other diagnoses may be supported or excluded with this test. Lumbar punctures may also be done to inject medications into the cerebrospinal fluid ("intrathecally"). especially in the following situations Age >65 Reduced GCS or conscious state Recent history of seizure Focal neurological signs Ophthalmoscopy for papilledema Bleeding diathesis Coagulopathy Decreased platelet count (<50 x 10 /L)  9 Infections Skin infection at puncture site Sepsis Abnormal respiratory pattern Hypertension with bradycardia and deteriorating consciousness Vertebral deformities (scoliosis or kyphosis). in hands of an inexperienced physician. subarachnoid hemorrhage. particularly for spinal anesthesia or chemotherapy.
In the past. the patient would often be asked to lie on his/her back for at least six hours and be monitored for signs of neurological problems. It is also possible to have the patient sit on a stool and bend his/her head and shoulders forward. except that spinal anesthesia is more often done with the patient in a seated position. first the patient is usually placed in a left (or right) lateral position with his/her neck bent in full flexionand knees bent in full flexion up to his/her chest. local anaesthetic is infiltrated under the skin and then injected along the intended path of the spinal needle. A spinal needle is inserted between the lumbar vertebrae L3/L4 or L4/L5 and pushed in until there is a "give" that indicates the needle is past the ligamentum flavum. Once the appropriate location is palpated. In performing a lumbar puncture. especially if the person holds their breath. approximating a fetal position as much as possible. Since the arachnoid membrane and the dura mater exist in flush contact with one another in the living person's spine (due to fluid pressure from CSF in the subarachnoid space pushing the arachnoid membrane out towards the dura). Patient anxiety during the procedure can lead to increased CSF pressure. tenses their muscles or flexes their knees too tightly against their chest.Merritt's Neurology (10th edition). though there is no scientific evidence that this provides any benefit. Diagnostic analysis of changes in fluid pressure during lumbar puncture procedures requires attention both to the patient's  condition during the procedure and to theirmedical history. notes that intravenous caffeine injection is often quite effective in aborting these so-called "spinal headaches. The technique described is almost identical to that used in spinal anesthesia.Spinal needles used in lumbar puncture. Reinsertion of the stylet may decrease the rate of post lumbar puncture headaches. It is preferred by some practitioners when a lumbar puncture is performed on an obese patient where having them lie on their side would cause a scoliosis and unreliable anatomical landmarks. once the needle has pierced the dura mater it has also traversed the thinner arachnoid membrane and is now in the subarachnoid space. The procedure is ended by withdrawing the needle while placing pressure on the puncture site. this has not been borne out in modern studies involving large numbers of patients. The upright seated position is advantageous in that there is less distortion of spinal anatomy which allows for easier withdrawal of fluid." Contact between the side of the lumbar puncture needle and a spinal nerve root can result in anomalous sensations (paresthesia) in a leg during the procedure. The stylet from the spinal needle is then withdrawn and drops of cerebrospinal fluid are collected. It was long taught that this complication can often be prevented by strict maintenance of a supine posture for two hours after the successful puncture. The opening pressure of the cerebrospinal fluid may be taken during this collection by using a simple column manometer. this is harmless and patients  . Risks Post spinal headache with nausea is the most common complication. opening pressures are notoriously unreliable when measured on a seated patient and therefore the left or right lateral (lying down) position is preferred if an opening pressure needs to be measured. it often responds to analgesics and infusion of fluids. On the other hand. The needle is again pushed until there is a second 'give' that indicates the needle is now past the dura mater. in the section on lumbar puncture. The area around the lower back is prepared using aseptic technique.
severe dehydration. resulting in catastrophic epidural hemorrhage. meningeal inflammation. The latter is exceedingly rare. They include spinal or epidural bleeding. or hydrocephalus . It can be treated by more bedrest. hydrocephalus. where the patient's own blood is injected back into the site of leakage to cause a clot to form and seal off the leak. There are case reports of lumbar puncture resulting in perforation of abnormal dural arterio-venous malformations. this is exceedingly rare. leakage of spinal fluid. since the level at which the spinal cord ends (normally the inferior border of L1. Its clinical significance is uncertain. Increased CSF pressure can indicate congestive heart failure. although it is slightly lower in infants) is several vertebral spaces above the proper location for a lumbar puncture (L3/L4). adhesive arachnoiditis and trauma to thespinal cord or spinal nerve roots resulting in weakness or loss of sensation. others believe that such events are merely coincidental in time. A headache that is persistent despite a long period of bedrest and occurs only when sitting up may be indicative of a CSF leak from the lumbar puncture site. hyperosmolality. Significant changes in pressure during the procedure can indicate tumors or spinal blockage resulting in a large pool of CSF. purulent meningitis or tuberculous meningitis.can be warned about it in advance to minimize their anxiety if it should occur. when topical infections or dermatological conditions pose a risk of infection at the puncture site or in patients with severe psychosis or neurosis with back pain. Decreased CSF pressure can indicate complete subarachnoid blockage. or pseudotumor cerebri. or by an epidural blood patch. computed tomography of the brain is often performed prior to lumbar puncture if an intracranial mass is suspected. Some authorities believe that withdrawal of fluid when initial pressures are abnormal could result in spinal cord compression or cerebral herniation. hypo-osmolality resulting fromhemodialysis. orcirculatory collapse. Removal of cerebrospinal fluid resulting in reduced fluid pressure has been shown to correlate with greater reduction of cerebral blood flow among patients with Alzheimer's disease. subarachnoid hemorrhage. Serious complications of a properly performed lumbar puncture are extremely rare. occurring independently as a result of the same pathology that the lumbar puncture was performed to diagnose. cerebral edema. The procedure is not recommended when epidural infection is present or suspected. or even paraplegia. In any case. Diagnostics  Lumbar puncture in a child suspected of having meningitis.
which are often associated with high levels of the enzyme. hydrocephalus. and their ratio will be the same as that in the peripheral blood. IgG synthetic rate is calculated from measured IgG and total protein levels. The finding of erythrophagocytosis. brain abscess. hypocapnia or bacterial meningitis. polio. Glucose is usually present in the CSF. Therefore. neurosyphilis. low serum phosphorus. reactions to prior injections of medicines or dyes. or hypoglycemia. A large number of granulocytes often heralds bacterial meningitis. lymphomas.white blood cells will be present along with erythrocytes. A small number of monocytes can be normal. cirrhosis and hypercapnia.) The presence of white blood cells in cerebrospinal fluid is called pleocytosis. Several substances found in cerebrospinal fluid are available for diagnostic measurement. further investigations are warranted. the presence ofgranulocytes is always an abnormal finding.associated with large volumes of CSF. Very high levels of protein may indicate tuberculous meningitis or spinal block. White cells can also indicate reaction to repeated lumbar punctures. leukemia spreading to the meninges. leakage of CSF. respiratory alkalosis. heritable mitochondrial disease. a common procedural complication. A glucose level of less than one third of blood glucose levels in association with low CSF lactate levels is typical in hereditary CSF glucose transporter deficiency also known as De Vivo disease. increases in intracranial pressure or hyperthyroidism. Increased levels of glutamine are often involved with hepatic encephalopathies. hepatic coma. multiple sclerosis. low blood pressure. Reye's syndrome. it is elevated in immune disorders such as multiple sclerosis. including imaging and viral culture. A fingerstick or venipuncture at the time of lumbar puncture may therefore be performed to assess peripheral glucose levels in order to determine a predicted CSF glucose value. from those of viral origin in which the enzyme is low or absent. brain abscesses. the level is usually about 60% that in the peripheral circulation. Increased levels of lactate can occur the presence of cancer of the CNS. collagen disease or Guillain-Barré syndrome. central nervous system hemorrhage. erythrophagocytosis suggests causes other than a traumatic tap. subarachnoid hemorrhage. tuberculous or pyogenic infections. signifies haemorrhage into the CSF that preceded the lumbar puncture. Decreased glucose levels can indicate fungal. In which case. When peripheral blood contaminates the withdrawn CSF. transverse myelitis. and neuromyelitis optica of Devic. traumatic brain injury. recent epileptic seizure. or a metastatic tumor. Lumbar puncture for the purpose of reducing pressure is performed in some patients with idiopathic intracranial hypertension (also called pseudotumor cerebri. idiopathic seizures. such as intracranial haemorrhage and haemorrhagic herpetic encephalitis. although the 60% rule still applies. Measurement of chloride levels may aid in detecting the presence of tuberculous meningitis. Changes in total protein content of cerebrospinal fluid can result from pathologically increased permeability of the blood-cerebrospinal fluid barrier. cerebral ischemia. meningoencephalitic mumps. obstructions of CSF circulation. meningitis. where phagocytosed erythrocytes is observed. The enzyme lactate dehydrogenase can be measured to help distinguish meningitides of bacterial origin. Increased glucose levels in the fluid can indicate diabetes. leukemia.  . when erythrocytes are detected in the CSF sample.
treponemal titers for the diagnosis of neurosyphilis and Lyme disease. and others. you will be asked to sign a consent form. It has high sensitivity and specificity for many infections of the CNS. Some medications(such as Coumadin or Plavix) should not be taken before your procedure. please call (310) 423-4125 early in the morning of your procedure (such as 6 a. so you should arrange for someone to help you get home. is fast. Please leave your jewelry and valuables at home and please wear comfortable clothing.m. Coccidioides antibody. . You should plan to arrive two hours before your scheduled procedure (three hours if you have not had all your pre-op lab work done). You should consult with your physician about taking your regular medications prior to your exam. You should not eat anything from the midnight before your procedure. Consider bringing your favorite magazine.) and given instructions on how you should prepare and what time you should arrive. If you are not contacted.m. giving us permission to perform the test. and can be done with small volumes of CSF. After Arriving A physician specialist in interventional radiology will discuss your procedure with you and answer any questions you might have.) You should have your doctor's office fax all orders and lab results to Cedars-Sinai the day before your procedure: (310) 423-0108. but the cryptococcal antigen (CrAg) test has a higher sensitivity. book or music player to help you pass the time. You will not be allowed to drive after the procedure. The India ink test is still used for detection of meningitis caused by Cryptococcus neoformans. After this discussion. Patient teaching\ Before Arriving for Your Procedure You will be contacted by a member of our team the day before your exam (between 4 and 6 p. CSF can be sent to the microbiology lab for various types of smears and cultures to diagnose infections. Even though testing is expensive. Numerous antibody-mediated tests for CSF are available in some countries: these include rapid tests for antigens of common bacterial pathogens. it saves cost of hospitalization. We want to make your waiting time as pleasant as possible. Polymerase chain reaction (PCR) has been a great advance in the diagnosis of some types of meningitis.
. You will be asked to either lay on your side or sit leaning forward in a chair. and might experience a headache after the procedure. and some fluid will be removed. A local anesthetic will be used to numb the skin on your back.You must tell the technologist. The report will be sent to your physician who will discuss the results with you. The lumbar puncture procedure usually takes 15 to 30 minutes. Lie flat for the rest of today. You should avoid strenuous activity for 24 hours. or physician of any allergies you may have. and whether you are or might be pregnant. nurse. If you are using a small pillow and begin to get a headache. If a sample of fluid was taken it will be tested and a report written. Discharge instruction LUMBAR PUNCTURE Discharge Instructions 1. but if you have to. A needle will be inserted into the space between two of the bones in your back. This will help prevent you from developing a headache. A special gauge might be attached to the needle to test the pressure of your spinal fluid. The needle will remain in place for a couple of minutes. During Your Procedure You will be asked to change into a hospital gown. make if a small one. Your back will be cleaned. Try not to use a pillow. remove the pillow and lie completely flat. After Your Procedure You will be asked to lay flat for a few hours.
you should call your doctor or X-Ray Department as Mission Radiology. herbs. Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Carry your medicine list with you in case of an emergency.2. and if you want to quit taking or change your medicine. If you get up during this 24-hour period. Use a bedpan or urinal. lie completely flat for 24 hours. you must lie flat for another 24 hours beginning from the time you got up. If the headaches last for more than 24 hours. Do NOT get out of bed to eat or to go to the bathroom. Take the list or the pill bottles to follow-up visits. 3.NSG RESPONSIBILITIES AFTER YOU LEAVE: Medicines: Keep a current list of your medicines: Include the amounts. how. Throw away old medicine lists. NO pillows. or St. Joseph’s Radiology . . or food supplements only as directed. 4. Drink as much as you can today. Get up to go to the bathroom only. 7.) 5. . Use vitamins. and why you take them. Tell him about any medicine allergies. Fluids like Gatorade or K-10 help to replace the fluids in your body lost. and when. 6. Have someone bring your meals to you. (Be careful not to drink so much that you make yourself sick. If you develop a headache when you get up. You may take your regular medications. go to bed.
The following may help ease or prevent a postlumbar puncture headache: Drinking liquids: You may be asked to drink more liquid than usual after your LP. or home services. treatments. which will decrease your headache pain. Follow your caregiver's instructions on how to take your medicine. This happens when the amount of CSF and the CSF pressure are decreased. You may need to be given caffeine intravenously (IV) through a tube placed in your vein. Post-lumbar puncture headache: You may develop a headache during the first few hours after your LP. a blood patch procedure may be needed. such as a heart or kidney condition. You may have neck or back pain as well. . Pain medicine: You may need medicine to relieve or decrease your headache pain. This procedure uses a small amount of your blood. As CSF pressure decreases. Drink caffeinated drinks. Lying down: You may need to lie flat for some time after your LP. Tell your caregiver if the pain medicine does not help or if you have any questions about your medicine. and juices. Treatment options: You may have any of the following: o o Medicines: Caffeine: Caffeine may be used to treat a LP headache. to patch (seal) the LP leak. This procedure may need to be repeated if your headache is not relieved. You will need to lie in bed for 1 to 2 hours after this procedure. blood vessels in the brain will dilate (get bigger) to get more fluid to the brain. ask for more information. If this does not relieve your headache. acetaminophen. These medicines may include NSAIDS (non-steroidal anti-inflammatory medicine). good liquids to drink include water. Ask your caregiver how long you need to lie down. Caffeine causes the blood vessels in the brain to narrow (get smaller).Ask for information about where and when to go for follow-up visits: For continuing care. such as coffee or soda. The blood is put through a needle into your spinal canal in the same way that the LP was done. such as with a leak. that is taken from a vein. or medicine that your caregiver orders (prescription) for you. such as ibuprofen. which may last up to several days. Your caregiver will decide which medicine is best for you to take for your headache. The headache may range from mild to severe (very bad) and may get worse when you sit or stand. Procedures: You may need to have any of the following if your headache is not relieved by the treatments above: o o Blood patch: If your headache is caused by a leakage of CSF from the LP site. Do not drink alcohol. Tell your caregiver if you cannot drink a lot of liquid because of another medical condition. milk. Ask your caregiver when the results of your procedure will be available. For most people. call your caregiver. such as with a CSF leak. Headache pain is caused by the blood vessels getting bigger. every 4 to 6 hours.
4% of current cancers in the United States are due to CTs performed in the past and that this may increase to as high as 1. however.5-2%   with 2007 rates of CT usage. or weak. or other parts below the waist feel numb. Your legs. CT Scan Ventriculogram X-ray computed tomography. You have questions or concerns about your procedure or medicine. Although historically the images generated were in the axial or transverse plane. Usage of CT has increased dramatically over the last two decades in many countries. It is estimated that 0. This procedure puts saline (an IV fluid) back into your spinal canal to increase CSF pressure. You have bleeding or a discharge coming from the area where the needle was put into your back. CONTACT A CAREGIVER IF: You have severe (bad) pain in your back or neck. You have a fever. The saline is put through a needle into your spinal canal in the same way that the LP was done. such as nondestructive materials testing. You have a stiff neck or have trouble thinking clearly. CT is also used in other fields. through a process known as "windowing". tingly. Kidney problems following intravenous contrast agents may also be a concern in some types of studies. SEEK CARE IMMEDIATELY IF: You have a headache that is very bad and does not get better after lying down. An estimated 72  million scans were performed in the United States in 2007. Although most common in medicine.  Purpose . Another example is archaeological uses such as imaging the contents of sarcophagi. is a medical imaging procedure that utilizes computer-processed X-rays to produce tomographic images or 'slices' of specific areas of the body. perpendicular to the long axis of the body. in order to demonstrate various bodily structures based on their ability to block the X-ray beam. this estimate is disputed. modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures. The increased pressure may help to seal the leak. also computed tomography (CT scan) or computed axial tomography (CAT scan). These cross-sectional images are  used for diagnostic and therapeutic purposes in various medical disciplines.o Saline epidural: A saline epidural may be given if your headache is caused by low CSF pressure due to a leak. CT produces a volume of data that can be manipulated. feet. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of  two-dimensional X-ray images taken around a single axis of rotation.
and so forth). hyperdense (bright) structures indicate calcifications and haemorrhage and bone trauma can be seen as disjunction in bone windows. Lungs CT can be used for detecting both acute and chronic changes in the lung parenchyma. that is. Head Main article: CT head Computed tomography of human brain. This special technique is called high resolution CT. it produces a sampling of the lung and not continuous images. often scans are performed both in inspiration and expiration. A variety of techniques are used. for example CT colonography for patients with a high risk of colon cancer. Of the above.Diagnostic use Typical CT Scout view as used for planning an exam Since its introduction in the 1970s. or full-motion heart scans for patients with high risk of heart disease. haemorrhage and bone trauma. Taken with intravenous contrast medium. from base of the skull to top. For evaluation of chronic interstitial processes (emphysema. Bone reconstructed in 3D CT scanning of the head is typically used to detect infarction. CT has become an important tool in medical imaging to supplement Xrays and medical ultrasonography. Pulmonary angiogram . Ambulances equipped with small bore multi-sliced CT scanners respond to cases involving stroke or head trauma. Therefore. thin sections with high spatial frequency reconstructions are used. calcifications. It is particularly relevant here because normal two-dimensional X-rays do not show such defects. hypodense (dark) structures indicate infarction or tumours. A number of institutions offer full-body scans for the general population. It has more recently been used for preventive medicine or screening for disease. the internals of the lungs. depending on the suspected abnormality. fibrosis. tumours.
and desired resolution and image quality. allowing excellent imaging of the coronary arteries (cardiac CT angiography). CT is regarded as a moderate. Second. First. coronal. differences between tissues that differ in physical density by less than 1% can be distinguished. It is also a useful test to investigate acute abdominal pain.2 mm resolution. or sagittal planes. compared to conventional radiography. Abdominal and pelvic CT Scan of 11 cm Wilms' tumor of right kidney in 13 month old patient. which may have advantages. Advantages There are several advantages that CT has over traditional 2D medical radiography. demonstrating a saddle embolus (dark horizontal line) occluding the pulmonary arteries (bright white triangle) CT pulmonary angiogram (CTPA) is a medical diagnostic test used to diagnose pulmonary embolism (PE). This is referred to as multiplanar reformatted imaging.Example of a CTPA. CT Colonography (also known as Virtual Colonoscopy or VC for short) may be as useful as a barium enema for detection of tumors. for example. Finally. In addition. because of its ability to reconstruct the area of interest in multiple planes. Extremities CT is often used to image complex fractures. CT is a sensitive method for diagnosis of abdominal diseases. especially ones around joints. The improved resolution of CT has permitted the development of new investigations. because of the inherent high-contrast resolution of CT. depending on the diagnostic task. patient build. but may use a lower radiation dose. CT VC is increasingly being used in the UK as a diagnostic test for bowel cancer and can negate the need for a colonoscopy. two helical CT scanning parameters that can be adjusted easily and that have a profound effect on radiation dose are . It employs computed tomography and an iodine based contrast agent to obtain an image of the pulmonary arteries. Fractures. The radiation dose for a particular study depends on multiple factors: volume scanned.to high-radiation diagnostic technique. number and type of scan sequences. ligamentous injuries and dislocations can [ easily be recognised with a 0. high resolution and high speed can be obtained at the same time. Cardiac Main article: Cardiac CT With the advent of subsecond rotation combined with multi-slice CT (up to 320-slices). It is used frequently to determine stage of cancer and to follow progress. CT completely eliminates the superimposition of images of structures outside the area of interest. CT angiography avoids the invasive insertion of a catheter. data from a single CT imaging procedure consisting of either multiple contiguous or one helical scan can be viewed as images in the axial.
spinal infection. or for assessing foreign bodies within the eye socket (orbit). Such damage to the DNA occasionally lead to cancer. size. The estimates of harm from CT are partly based on similar radiation exposures experienced by those present during theatomic  bomb explosions in Japan during the second world war and those of nuclear industry works. CT of the spine is indicated in cases of suspected disc herniation. This and othertypes of DNA damage are occasionally not corrected properly by cellular repair mechanisms. Studies support informing parents of the risks of pediatric  CT scanning. Chest CTs are most commonly used to detect suspected cancers (malignancies) and to determine the extent to which the cancer has spread (metastasis). thyroid cancer. however. The International Commission on Radiological Protection estimates that the risk to a fetus being exposure to 10 mGy increases the rate of cancer before 20 years of age from 0. certain conditions can require  children to be exposed to multiple CT scans. and involvement of abnormal structural changes.  effects Reason for Procedure CT scans are indicated to detect or confirm the characteristics. fractures of the facial structures. Adverse Cancer The ionizing radiation in the form of x-rays used in CT scans are energetic enough to directly or indirectly damage DNA.000 new cancer  cases in the United States due to the number of scans done in 2007 and 2100 new cancers in the  United Kingdom. There is a small increased risk of cancer with CT scans. Or 29.04% (for  reference a CT pulmonary angiogram exposes a fetus to 4 mGy). A head CT can provide direct information about bruises (contusions) or blood clots (hematomas) within or outside (epidural or subdural hematomas) the brain. breast cancer. It is estimated that 0. The most common cancers caused by radiation exposure are thought to be lung  cancer. Computed tomography (CT) scan has been shown to be more accurate than  radiographs in evaluating anterior interbody fusion but may still over-read the extent of fusion. This additional risk is still low compared to the background risk of dying from cancer  of ~20%. Furthermore. or intraspinal tumor.4% of current cancers in the United States are due to CTs performed in the past and that this may increase to as high as 1. Wherever the location. The risk for someone who is 40 years old is half that of someone who is 20 years old with substantially less risk in the  elderly. A 2012 review did not find an association between medical radiation and cancer risk in children noting however the existence of  limitations in the evidences over which the review is based. stomach cancer and leukemia. A person's age plays a significant role in the subsequent risk of cancer.5-2% with   2007 rates of CT usage.tube current and pitch. CT scans can be performed with different settings for lower exposure in children with most manufacturers  of CT scans as of 2007 having this function built in. this estimate is disputed. This would be equivalent to one in 1000  to one in 2000 increased risk of developing a fatal cancer per 10mSv CT scan. trauma. High-resolution CT can help evaluate lung diseases . a tumor can be evaluated before definitive treatment is begun. CT is used to define the presence and extent of the ballooning of a vessel due to weakness of the vessel wall (traumatic aneurysms) and the splitting of an aortic vessel wall (aortic dissections).03% to 0. Estimated lifetime cancer  mortality risks from an abdominal CT of a 1-year-old is 0.1% or 1:1000 scans. A face or neck CT is indicated for inflammation or infection.
to withdraw a core of tissue withdrawn through a large-bore needle. or urine leaking into the abdominal cavity. for through the skin (percutaneous) drainage of abdominal abscesses. CT may also be useful in differentiating a kidney tumor from a faintly calcified stone that may not be visible on plain x-ray. The CT may not be diagnostically helpful for people who cannot lie still (due to some neurological diseases). MRI uses a different technology to create the images. CT can also be used to guide the placement of various catheters or surgical instruments. when used with dye (intravenous contrast). hematomas. Scans that focus on the bladder require the bladder to be full prior to scanning. . It can also help in the classification of kidney injuries by defining the extent of lacerations. If an intravenous contrast medium is required. a temporary catheter or needle is placed into a vein for injection of that medium. or for those who have a fear of being surrounded by or contained within a machine (this later would be unusual because of the openness of the scanner). CT can provide information regarding the extent of tumors in the lymphatic system and their relationship to normal structures. for the extremely obese. or for other fluid collections. Scans are painless. While bone fractures are usually evaluated by standard x-ray. but CT continues to be the best imaging test in select situations. and ankle. can be used to confirm an inflammation of the pancreas (acute pancreatitis). It's important to note that MRI scanning also creates an image of body structures by combining a series of pictures taken at different levels and angles. shoulder. orientation. for microscopic examination (core biopsy). However. location. and relationship of fracture fragments in complex anatomic regions such as the pelvis. Source: Medical Disability Advisor How Procedure is Performed The individual being scanned must lie still on a padded metal couch that is encircled by the CT scanner. CT can provide precise locations and help guide the needle to sample of cells withdrawn through a needle for microscopic examination (aspirationbiopsies). and most take between 10 to 30 minutes.and. foot. MRIs have replaced CT scans for many soft tissue conditions. although some abdominal scans may require that the individual fast for a short period of time. In the pelvis. CT scan provides more precise information about the presence. There is usually no need for specific pre-procedure preparation. The individual is positioned in the scanner so that the correct part of the body is located in the center of the scanner.
abdomen and pelvis because it provides detailed. CT is rarely used to diagnose tumors of the lung or pancreas as well as abdominal aortic aneurysms. In pediatric patients. feet and other skeletal structures because it can clearly show even very small bones as well as surrounding tissues such as muscle and blood vessels. liver. performed on patients with acute symptoms such as abdominal pain or difficulty breathing. kidney failure or even death. For children. diagnosis and treatment of vascular diseases that can lead to stroke. since the image allows a physician to confirm the presence of a tumor and measure its size. kidneys and blood vessels cystic fibrosis complications of acute appendicitis . CT imaging is more often used to evaluate: lymphoma neuroblastoma kidney tumors congenital malformations of the heart. precise location and the extent of the tumor's involvement with other nearby tissue. cross-sectional views of all types of tissue. kidney and pancreatic cancer. CT is commonly used to assess for pulmonary embolism (a blood clot in the lung vessels) as well as for abdominal aortic aneurysms (AAA).What are some common uses of the procedure? CT imaging is: View larger with caption one of the best and fastest tools for examining the chest. used to examine patients with severe injuries from incidents such as a motor vehicle accident. invaluable in diagnosing and treating spinal problems and injuries to the hands. an examination that plays a significant role in the detection. often the best method for detecting many different cancers. including lung.
You may also be asked to remove hearing aids and removable dental work. such as organ transplants or gastric bypass. bowel or other internal organs in cases of trauma. dentures and hairpins may affect the CT images and should be left at home or removed prior to your exam. especially if a contrast material will be used in your exam. measure bone mineral density for the detection of osteoporosis. guide biopsies and other procedures such as abscess drainages and minimally invasive tumor treatments. If you have a known allergy to contrast material. Metal objects including jewelry. liver. kidneys. Also inform your doctor of any recent illnesses or other medical conditions and whether you have a history of heart disease. See the Safety . You may be asked not to eat or drink anything for several hours beforehand. kidney disease or thyroid problems. loose-fitting clothing to your exam. eyeglasses. complications of pneumonia inflammatory bowel disease severe injuries Physicians often use the CT examination to: quickly identify injuries to the lungs. Women should always inform their physician and the CT technologist if there is any possibility that they are pregnant. plan for and assess the results of surgery. heart and vessels. plan and properly administer radiation treatments for tumors as well as monitor response to chemotherapy. spleen. You may be given a gown to wear during the procedure. top of page How should I prepare? You should wear comfortable. You should inform your physician of all medications you are taking and if you have any allergies. diabetes." your doctor may prescribe medications to reduce the risk of an allergic reaction. Any of these conditions may increase the risk of an unusual adverse effect. stage. or "dye. asthma.
page (www. where the technologist operates the scanner and monitors your examination. Rotating around you. box-like machine with a hole. in the center.RadiologyInfo. The computer workstation that processes the imaging information is located in a separate control room. or short tunnel. You will lie on a narrow examination table that slides into and out of this tunnel. the x-ray tube and electronic x-ray detectors are located opposite each other in a ring. top of page What does the equipment look like? View larger with caption The CT scanner is typically a large. top of page How does the procedure work? View larger with caption CT scan showing the liver View larger with caption CT slice through mid abdomen . called a gantry.org/en/safety/) for more information about pregnancy and x-rays.
Modern CT scanners are so fast that they can scan through large sections of the body in just a few seconds. For some CT exams. a small amount of radiation is aimed at and passes through the body. the CT scanner technique will be adjusted to their size and the area of interest to reduce the radiation dose. At the same time. A special computer program processes this large volume of data to create two-dimensional cross-sectional images of your body. CT imaging is sometimes compared to looking into a loaf of bread by cutting the loaf into thin slices. resulting in more detail and additional view capabilities. allow thinner slices to be obtained in a shorter period of time. With CT scanning. For children. Such speed is beneficial for all patients but especially children. soft tissue. which are then displayed on a monitor. so that the x-ray beam follows a spiral path. the examination table is moving through the scanner. the elderly and critically ill. the result is a very detailed multidimensional view of the body's interior. Bones appear white on the x-ray. These scanners. recording an image on photographic film or a special image recording plate. called multislice CT or multidetector CT. numerous x-ray beams and a set of electronic x-ray detectors rotate around you. When the image slices are reassembled by computer software. top of page . a contrast material is used to enhance visibility in the area of the body being studied. such as organs like the heart or liver. In a conventional x-ray exam. Different body parts absorb the x-rays in varying degrees. measuring the amount of radiation being absorbed throughout your body. X-rays are a form of radiation—like light or radio waves—that can be directed at the body.In many ways CT scanning works very much like other x-ray examinations. shows up in shades of gray and air appears black. and even faster in small children. This technique is called helical or spiral CT. Refinements in detector technology allow new CT scanners to obtain multiple slices in a single rotation.
The CT examination is usually completed within 30 minutes. the table will move quickly through the scanner to determine the correct starting position for the scans. In special cases. If contrast material is used. Depending on the type of CT scan. Depending on the part of the body being scanned. usually lying flat on your back or less commonly. Motion will degrade the quality of the examination the same way that it affects photographs. This is similar to the blurring seen on a photograph taken of a moving object. depending on the type of examination.How is the CAT scan performed? Click to play The technologist begins by positioning you on the CT examination table. can lead to artifacts on the images. Then. You may be asked to hold your breath during the scanning. you will be asked to wait until the technologist verifies that the images are of high enough quality for accurate interpretation. Many scanners are fast enough that children can be scanned without sedation. whether breathing or body movements. on your side or on your stomach. the machine may make several passes. The portion requiring intravenous contrast injection usually lasts only 10 to 30 seconds. it will be swallowed. you may be asked to keep your hands over your head. Next. When the examination is completed. top of page . Straps and pillows may be used to help you maintain the correct position and to hold still during the exam. injected through an intravenous line (IV) or administered by enema. the table will move slowly through the machine as the actual CT scanning is performed. sedation may be needed for children who cannot hold still. Any motion.
you will hear only slight buzzing. You can expect to experience a sense of abdominal fullness and an increasing need to expel the liquid if your contrast material is given by enema.What will I experience during and after the procedure? View larger with caption CT scan: appendicitis View larger with caption CT scan: normal appendix CT exams are generally painless. special light lines may be seen on your body and are used to ensure that you are properly positioned. as the mild discomfort will not last long. clicking and whirring sounds as the CT scanner revolves around you during the imaging process. If the contrast material is swallowed. When you enter the CT scanner. You may have a warm. With modern CT scanners. be patient. Some patients may experience a sensation like they have to urinate but this subsides quickly. you may find a CT exam to be stressful. may offer you some medication to help you tolerate the CT scanning procedure. If you have a hard time staying still. fast and easy. flushed sensation during the injection of the contrast materials and a metallic taste in your mouth that lasts for a few minutes. under the direction of a physician. With helical CT. you may find the taste mildly unpleasant. The technologist or nurse. there may be some discomfort from having to remain still for several minutes. however. In this case. If an intravenous contrast material is used. are claustrophobic or have chronic pain. most patients can easily tolerate it. the amount of time that the patient needs to lie still is reduced. Though the scanning itself causes no pain. . you will feel a pin prick when the needle is inserted into your vein.
After a CT exam. the technologist will always be able to see. and your doctor will explain the exact reason why another exam is requested. top of page Who interprets the results and how do I get them? A physician. With pediatric patients. risks? View larger with caption Benefits CT scanning is painless. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable over time.You will be alone in the exam room during the CT scan. a parent may be allowed in the room but will be required to wear a lead apron to minimize radiation exposure. top of page What are the benefits vs. unless there are special circumstances. hear and speak with you at all times. If you received contrast material. usually a radiologist with expertise in supervising and interpreting radiology examinations. A follow-up examination may be necessary so that any change in a known abnormality can be detected over time. you may be given special instructions. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. . will analyze the images and send a signed report to your primary care physician or the physician who referred you for the exam. However. noninvasive and accurate. Follow-up examinations are often necessary. you can return to your normal activities. who will discuss the results with you.
Unlike conventional x-rays. CT scanning provides very detailed images of many types of tissue as well as the lungs. CT is less sensitive to patient movement than MRI. Large population studies have shown a slight increase in cancer from larger amounts of radiation. the expected benefit of this test outweighs the potential risk from radiation. in emergency cases. Women should always inform their physician and x-ray or CT technologist if there is any possibility that they are pregnant. soft tissue and blood vessels all at the same time. No radiation remains in a patient's body after a CT examination.RadiologyInfo. See the Safety page (www. CT can be performed if you have an implanted medical device of any kind. there is always concern that this risk may also apply to the lower amounts of radiation delivered by a CT exam. A major advantage of CT is its ability to image bone. CT imaging provides real-time imaging. and blood vessels. abdomen. CT scanning is. A diagnosis determined by CT scanning may eliminate the need for exploratory surgery and surgical biopsy.org/en/safety/) for more information about radiation dose. particularly the lungs.org/en/safety/) for more information about pregnancy and x-rays. Thus. See the Safety page (www. making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspirations of many areas of the body. they can reveal internal injuries and bleeding quickly enough to help save lives. pelvis and bones. CT has been shown to be a cost-effective imaging tool for a wide range of clinical problems. such as from radiation therapy. . in general. bones. Risks There is no conclusive evidence that radiation at amounts delivered by a CT scan causes cancer.RadiologyInfo. not recommended for pregnant women unless medically necessary because of potential risk to the baby. unlike MRI. X-rays used in CT scans usually have no immediate side effects. CT examinations are fast and simple. When a CT scan is recommended by your doctor. The effective radiation dose for this procedure varies. You are encouraged to discuss the risks versus the benefits of your CT scan with your doctor. and to explore whether alternative imaging tests may be available to diagnose your condition.
while CT can be performed safely. internal pelvic organs. infarct. Area of Application: Brain.acr. CT scans in children should always be done with low-dose technique. they should have a CT exam only if it is essential for making a diagnosis and should not have repeated CT exams unless absolutely necessary. Brain General Synonym/Acronym: Computed axial tomography (CAT) of the head. Because children are more sensitive to radiation. However. helical/spiral CT. . and edema. other imaging exams not involving radiation. such as ultrasound or MRI. top of page What are the limitations of CT Scanning of the Body? Soft-tissue details in areas such as the brain. (www. structural changes. infection. and surgical interventions. Manufacturers of intravenous contrast indicate mothers should not breastfeed their babies for 24-48 hours after contrast medium is given. computed transaxial tomography (CTT) of the head. A person who is very large may not fit into the opening of a conventional CT scanner or may be over the weight limit—usually 450 pounds—for the moving tabl Computed Tomography. and joints (such as knees and shoulders) can often be better evaluated with magnetic resonance imaging (MRI). In pregnant women. and radiology departments are well-equipped to deal with them. bleeding. both the American College of Radiology (ACR) and the European Society of Urogenital Radiology note that the available data suggest that it is safe to continue breastfeeding after receiving intravenous contrast. Also valuable in evaluation of medical. brain CT. is preferred if they are likely to be as good as CT in diagnosing your condition. For further information please consult the ACR Manual on Contrast Media and its references.org/Quality-Safety/Resources/Contrast-Manual) The risk of serious allergic reaction to contrast materials that contain iodine is extremely rare. Common Use: To visualize and assess the brain to assist in diagnosing tumor. radiation.
Tumor progression. cystic. cerebral) and determine extent of edema. subdural. subdural. as evidenced by changes in tissue densities Determine cause of increased intracranial pressure Determine presence and type of hemorrhage in infants and children experiencing signs and symptoms of intracranial trauma or congenital conditions such as hydrocephalus and arteriovenous malformations (AVMs) Determine presence of multiple sclerosis. Indications Detect brain infection. and effectiveness of medical interventions may be monitored by CT scanning. Description Computed tomography (CT) of the brain is a noninvasive procedure used to assist in diagnosing abnormalities of the head. epidural. or vascular lesions. or surgical therapies Potential Diagnosis Normal Findings: Normal size. cerebrospinal fluid. before and after therapy. The procedure is repeated after intravenous injection of iodinated contrast medium for vascular evaluation. It becomes invasive if contrast medium is used. Cine scanning is used to produce a series of moving images of the area scanned..g. as evidenced by higher blood densities Differentiate between cerebral infarction and hemorrhage Evaluate abnormalities of the middle ear ossicles. The scanner uses multiple x-ray beams and a series of detectors that rotate around the patient to produce cross-sectional views in a threedimensional fashion. Differences in tissue density are detected and recorded and are viewable as computerized digital images for the health-care provider (HCP) to look at. as evidenced by decreased density on the image Detect ventricular enlargement or displacement by increased cerebrospinal fluid Determine benign and cancerous intracranial tumors and cyst formation.Contrast: With or without IV iodinated contrast medium. as evidenced by sclerotic plaques Determine lesion size and location causing infarct or hemorrhage Differentiate hematoma location after trauma (e. Slices or thin sections of certain anatomic views of the brain and associated vascular system are viewed to allow differentiations of solid. and blood circulation. The patient lies on a table and is moved in and out of a doughnut-like device called a gantry. which houses the x-ray tube and associated electronics. and optic nerve Monitor and evaluate the effectiveness of medical. inflammatory. or necrosis. as well as identification of suspected hematomas or aneurysms.. Images can be recorded on photographic or x-ray film or stored in digital format as digitized computer data. position. epidural. abscess. intracerebral) Hemorrhage . auditory nerve.g. brain tissue. and shape of intracranial structures and vascular system Abnormal Findings: Abscess Aneurysm AVMs Cerebral atrophy Cerebral edema Cerebral infarction Congenital abnormalities Craniopharyngioma Cysts Hematomas (e. radiation.
Patients with a known hypersensitivity to the medium may benefit from premedication with corticosteroids or the use of nonionic contrast medium. Patients who are pregnant or suspected of being pregnant. or mental status.. Hydrocephaly Increased intracranial pressure or trauma Infection Sclerotic plaques suggesting multiple sclerosis Tumor Ventricular or tissue displacement or enlargement Critical Findings Abscess Acute hemorrhage Aneurysm Infarction Infection Tumor with significant mass effect It is essential that critical diagnoses be communicated immediately to the appropriate HCP. significant pain. dentures. infection at the IV needle insertion site.g. Patients who are claustrophobic. Interfering Factors This procedure is contraindicated for: Patients with allergies to shellfish or iodinated dye. . and cardiac arrhythmias. jewelry. Patients with extreme claustrophobia unless sedation is given before the study. Other considerations: Complications of the procedure may include hemorrhage. body rings) within the examination field. which may inhibit organ visualization and cause unclear images. Patients who are in renal failure. Inability of the patient to cooperate or remain still during the procedure because of age. The procedure may be terminated if chest pain or severe cardiac arrhythmias occur. Young patients (17 yr and younger). because of their risk of contrast-induced renal failure. Patients who are very obese or who may exceed the weight limit for the equipment. Factors that may impair clear imaging: Metallic objects (e. Elderly and other patients who are chronically dehydrated before the test. Note and immediately report to the HCP abnormal results and related symptoms. A listing of these diagnoses varies among facilities. unless the potential benefits of the procedure far outweigh the risks to the fetus and mother. The contrast medium used may cause a life-threatening allergic reaction. unless the benefits of the x-ray diagnosis outweigh the risks of exposure to high levels of radiation.
Record the date of the last menstrual period and determine the possibility of pregnancy in perimenopausal women. or leave the area while the examination is being done. Review the procedure with the patient. Consultation with the HCP should occur before the procedure for radiation safety concerns regarding younger patients or patients who are lactating. and after the procedure. is important in providing psychological support before. and results of previously performed laboratory tests and diagnostic and surgical procedures. Nursing Implications and Procedures Pretest: Positively identify the patient using at least two unique identifiers before providing care. BUN and creatinine results are also needed if contrast medium is to be used. Explain that an IV line may be inserted to allow infusion of IV fluids. including a list of known allergens. Protocols may vary among facilities. Failure to follow dietary restrictions and other pretesting preparations may cause the procedure to be canceled or repeated. iodine. Personnel working in the examination area should wear badges to record their level of radiation exposure. If contrast media is scheduled to be used. Obtain a history of the patient's musculoskeletal system. with support staff. patients receiving metformin (Glucophage) for non-insulin-dependent (type 2) diabetes should discontinue the drug on the day of the test and continue to withhold it for 48 hr after the test. dye. Usually contrast medium and normal saline are infused. Patient Teaching: Inform the patient this procedure can assist in assessing the brain. . seafood. Obtain a list of the patient's current medications including anticoagulants. as well as concern for modesty. or a transient headache after injection of contrast medium. especially allergies or sensitivities to latex. a salty or metallic taste. Note any recent procedures that can interfere with test results. a feeling of warmth. nutritional supplements. Failure to do so may result in lactic acidosis. aspirin and other salicylates. Risks associated with radiation overexposure can result from frequent x-ray procedures. Inform the patient the procedure is usually performed in a radiology suite by an HCP specializing in this procedure. and nutraceuticals (see Appendix F). treatment. including examinations using barium. stand behind a shield. Inform the patient that he or she may experience nausea. Make sure a written and informed consent has been signed prior to the procedure and before administering any medications. herbs. Obtain a history of the patient's complaints or clinical symptoms. Personnel in the room with the patient should wear a protective lead apron. Sensitivity to social and cultural issues. or sedatives. or services. Address concerns about pain and explain that there may be moments of discomfort and some pain experienced during the test. contrast medium. Intratest: Ensure the patient has complied with medication restrictions and pretesting preparations. Instruct the patient to remove dentures and jewelry and other metallic objects from the area to be examined. There are no food or fluid restrictions unless by medical direction. symptoms. Note the last time and dose of medication taken. anesthetics. Ensure that barium studies were performed more than 4 days before the CT scan. Instruct the patient to avoid taking anticoagulant medication or to reduce dosage as ordered prior to the procedure.or iodine-based contrast medium. during. or contrast medium. Ensure results of coagulation testing are obtained and recorded prior to the procedure. and takes approximately 15 to 30 min.
Monitor vital signs and neurological status every 15 min for 1 hr. persistent right shoulder pain. Instruct the patient to immediately report symptoms such as fast heart rate. who will discuss the results with the patient. anaphylaxis. nerve fiber analysis. and a pressure dressing is applied over the puncture site. The needle is removed. observe for delayed allergic reactions. Post-test: A report of the examination will be sent to the requesting HCP. or hematoma formation. Instruct the patient to increase fluid intake to help eliminate the contrast medium. hyperpnea. MR angiography. Inform the patient that diarrhea may occur after ingestion of oral contrast medium. Compare with baseline values. deep breaths if nausea occurs during the procedure. If contrast media is used. EEG. and follow the general guidelines in Appendix A. Administer an antianxiety agent. if the patient has claustrophobia. CBC. CT angiography. EMG. inflammation. as ordered. Monitor temperature every 4 hr for 24 hr. Reinforce information given by the patient's HCP regarding further testing. Observe/assess the needle insertion site for bleeding. Answer any questions or address any concerns voiced by the patient or family. If contrast was used. or vomiting. Protocols may vary from facility to facility. difficulty breathing. PET brain. Evaluate test results in relation to the patient's symptoms and other tests performed. Notify the HCP if temperature is elevated. and sedatives. additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. such as rash. PT/INR. Ensure the patient has removed dentures and all external metallic objects from the area to be examined prior to the procedure. MRI brain. as ordered. or abdominal pain. nausea. Monitor the patient for complications related to the procedure (e. otoscopy. Use nonionic contrast medium for the procedure.. Instruct the patient in the care and assessment of the site. Immediately report symptoms to the appropriate HCP. a rapid series of images is taken during and after injection. spondee speech reception threshold. then every 2 hr for 4 hr. skin rash. administer ordered prophylactic steroids or antihistamines before the procedure. Refer to the Musculoskeletal System table at the end of the book for related tests by body system. creatinine. Instruct the patient to take slow. evoked brain potentials. Discuss the implications of abnormal test results on the patient's lifestyle. or referral to another HCP. audiometry hearing loss. and tuning fork tests. Instruct the patient to resume medications and activity. If the patient has a history of allergic reactions to any substance or drug. as directed by the HCP. Depending on the results of this procedure. Monitor intake and output at least every 8 hr. allergic reaction. or hematoma formation. Establish an IV fluid line for the injection of contrast medium. . emergency drugs. Place the patient in the supine position on an examination table. CSF analysis. Instruct the patient to apply cold compresses to the puncture site as needed. Related Monographs Related tests include angiography carotid. Instruct the patient to cooperate fully and to follow directions. tachycardia. Renal function should be assessed before metformin is resumed. palpitations. if used. CBC hematocrit. and then as ordered by the HCP. Observe standard precautions. bronchospasm) if contrast is used. Provide teaching and information regarding the clinical implications of the test results.g. Administer a sedative to a child or to an uncooperative adult. Have emergency equipment readily available. treatment. CBC hemoglobin. Observe/assess the needle insertion site for bleeding. if contrast was used. inflammation. as appropriate. BUN. to reduce discomfort or edema. urticaria. Recognize anxiety related to test results. Instruct the patient to remain still throughout the procedure because movement produces unreliable results. chest pain. hypertension. itching.
Client and Family Teaching • (If applicable) Do not drink or eat anything before the test except for the ordered medications. • The test is painless. The scanner makes a clicking noise. • Give medications up to 2 hours before test. and the scanner revolves around the body part to be examined. Clients are usually on NPO status (except for the medications ordered as part of the test) for 8 hours before the test if it is done in the morning. You are strapped to a special table. If the test is done in the afternoon. Document any allergy and inform the physician and radiology department. clips. the client may have a liquid breakfast. and a wide rubber strap will be applied snugly across the forehead during the test (to keep your head immobilized). • The CT scanner is circular with a round opening. • Check hospital policy on withholding food and fluids.Preparation of Client • Ensure a signed consent form. • Someone is always immediately available during the test. and earrings. • You may be given an intravenous infusion. SKULL XRAY . you may feel warm and have a metallic taste in the mouth. • Assess for possible reaction to iodine dye (by asking about allergy to seafood). When the contrast dye is injected. • Your head will be positioned in a cradle. • Remove metal hairpins. • The exam lasts from 30 to 90 minutes.
depending on the amount of X-rays that penetrate the tissues. X-rays are made by using external radiation to produce images of the body. Bones of the skull . different parts of the body allow varying amounts of the X-ray beams to pass through. other related procedures that may be used to diagnose problems involving the skull and/or brain include positron emission tomography (PET) and bone scan. Images are produced in degrees of light and dark. Please see these procedures for additional information.X-rays of the Skull (Skull X-ray Studies) Procedure overview What are X-rays of the skull? X-rays use invisible electromagnetic energy beams to produce images of internal tissues. due to the use of newer technologies such as computed tomography (CT scans) and magnetic resonance imaging (MRI). which is denser than the soft tissues. bones. skin. A bone or a tumor. At a break in a bone. and muscle) allow most of the X-ray to pass through and appear dark gray on the film. its organs. The soft tissues in the body (such as blood. X-rays pass through body tissues onto specially treated plates (similar to camera film) and a "negative" type picture is made (the more solid a structure is. When the body undergoes X-rays. and other internal structures for diagnostic purposes. In addition to CT scans and MRI. they remain valuable for evaluating the bones of the skull for fractures and detecting other conditions of the skull and brain. While X-rays of the skull are not used as often as in the past. the X-ray beam passes through the broken area and appears as a dark line in the white bone. and organs on film. Standard X-rays are performed for many reasons. allows few of the X-rays to pass through and appears white on the X-ray. the whiter it appears on the film). including diagnosing tumors or bone injuries. fat.
Bones that provide the framework for the face and mouth. All bones comprising the skull are attached to each other via immovable joints. which holds and protects the brain. sphenoid bone. temporal bones. cheeks. Two sets of bones comprise the skull: Cranial bones. also called the cranium. and detect cerebral calcification (calcifications within the brain). Bones that protect and enclose the brain. ethmoid bone. and nasal area. except for the mandible. such as previous scans and other . Reasons for the procedure X-rays of the skull may be performed to diagnose fractures of the bones of the skull. There may be other reasons for your physician to recommend an X-ray of the skull. consists of eight bones (frontal bone. evaluate the nasal sinuses. and occipital bone). and certain metabolic and endocrine disorders that cause bone defects of the skull. It is a good idea to keep a record of your past history of radiation exposure. Risks of the procedure You may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. parietal bones. Facial bones. The skeleton of the face has 14 bones. is the bony structure of the head. The cranium.Click Image to Enlarge The skull. which is attached via a movable joint. pituitary tumors. congenital anomalies (birth defects). Skull X-rays may also be used to detect tumors. which include those that make up the jaws.
There may be other risks depending upon your specific medical condition. such as fasting or sedation. If it is necessary for you to have a skull X-ray. Notify the radiologic technologist if you have a prosthetic (artificial) eye. If you are pregnant or suspect that you may be pregnant. an X-ray procedure of the skull follows this process: . you should notify your physician. is required. no prior preparation. Based upon your medical condition.types of X-rays. During the procedure An X-ray may be performed on an outpatient basis or as part of your stay in a hospital. Risks associated with radiation exposure may be related to the cumulative number of X-ray examinations and/or treatments over a long period of time. your physician may request other specific preparation. Be sure to discuss any concerns with your physician prior to the procedure. Generally. because the prosthesis can create a confusing shadow on an X-ray of the skull. Radiation exposure during pregnancy may lead to birth defects. so that you can inform your physician. special precautions will be made to minimize the radiation exposure to the fetus. Generally. Before the procedure Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. Notify the radiologic technologist if you are pregnant or suspect you may be pregnant. Procedures may vary depending on your condition and your physician's practices.
5. hearing aids. 3. If the X-ray is being performed to determine an injury. SKULL X-RAYS a. The radiologic technologist will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain. You will be asked to remove any clothing. Nsg 2-17. non-invasive neurological test used to evaluate the bones. your physician may give you additional or alternate instructions after the procedure. as any movement may distort the image and even require another X-ray to be done to obtain a clear image of the body part in question. you will be given a gown to wear. Diagnostic uses for skull X-rays: (1) To detect fractures in patient's with head trauma. 8. a neck brace may be applied if a cervical spine fracture is suspected. the manipulation of the body part being examined may cause some discomfort or pain. hairpins. eyeglasses. The X-ray beam will be focused on the area to be photographed. jewelry. The radiologic technologist will step behind a protective window while the image is taken. or other metal objects that might interfere with the procedure. special care will be taken to prevent further injury. depending on your particular situation.1. You will be positioned on an X-ray table that carefully places the part of the skull that is to be x-rayed between the X-ray machine and a cassette containing the X-ray film. The radiologic technologist will ask you to hold still in a certain position for a few moments while the X-ray exposure is made. It is extremely important to remain completely still while the exposure is made. 4. While the X-ray procedure itself causes no pain. 2. there is no special type of care following an X-ray of the skull. which make up the skull. 9. For example. b. particularly in the case of a recent injury or invasive procedure such as surgery. If you are asked to remove clothing. Because of complex anatomy of the skull. After the procedure Generally. a series of films is usually required for a complete evaluation. Body parts not being imaged may be covered with a lead apron (shield) to avoid exposure to the X-rays. 6. . However. 7. Skull X-rays are the oldest. Some skull X-ray studies may require several different positions.
(b) A headband. (7) Explain to the patient events. (6) Explain to the patient events which will occur during the skull x-ray procedure. bleeding. (a) Patient will be placed in a supine position on a radiographic table. (b) All jewelry and other metal objects must be removed from patient's head and neck and placed in safekeeping. which will occur after the procedure. tumors. (3) To aid diagnosis of pituitary tumors. (a) Patient is not required to restrict food and fluids before x-rays. Explain purpose in a manner consistent with that offered by the physician to avoid confusing the patient. and infection. or seated in a chair. (4) As indicated. (b) Physician will report the results of the x-rays to the patient when they are available. and instructed to remain still. c. (c) Tell the patient where and when the x-rays will be performed. explain to the patient the specific purpose of the skull x-rays in his/her situation. (3) Interview the patient to determine his/her knowledge of the purpose of the skull x-rays. (1) Review the patient's clinical record to determine the reason (purpose) for the specific scheduled skull x-rays. foam pads.(2) To help detect and assess increased intracranial pressure. (5) Explain to the patient the events which will occur prior to the skull x-rays. or sandbags may be used to immobilize the patient's head and increase patient comfort. (e) Films will be developed and checked before patient leaves the x-ray department. (2) Approach and identify the patient. (c) Tell the patient that several (usually five) x-ray films of the skull will be taken from various angles. (4) To detect congenital anomalies. . Nursing implications. (a) Patient will be returned to his/her room. (d) Reassure patient that the procedure will cause no discomfort.