DIAGNOSTIC EXAMINATIONS/

PROCEDURES
• X-RAY
X-rays are a type of radiation called electromagnetic waves.
X-ray imaging creates pictures of the inside of your body.
The images show the parts of your body in different shades of black and white.
This is because different tissues absorb different amounts of radiation.
• An X-ray, or X-radiation, is a penetrating form of high-energy electromagnetic
radiation.
• In many languages, X-radiation is referred to as Röntgen radiation, after the
German scientist Wilhelm Röntgen, who discovered it on November 8, 1895.
• He named it X-radiation to signify an unknown type of radiation.
• The original use of X-rays was for imaging bones, which
were easily distinguishable from soft tissues on the film
that was available at that time.
• However, more accurate focusing systems and more
sensitive detection methods, such as improved
photographic films and electronic imaging sensors, have
made it possible to distinguish increasingly fine detail
and subtle differences in tissue density, while using much
lower exposure levels.
• X-ray imaging
• Due to their ability to penetrate certain materials, X-rays are used for several
nondestructive evaluation and testing applications, particularly for identifying
flaws or cracks in structural components. According to the NDT Resource
Center, "Radiation is directed through a part and onto [a] film or other detector.
The resulting shadowgraph shows the internal features" and whether the part is
sound. This is the same technique used in doctors' and dentists' offices to create
X-ray images of bones and teeth, respectively.[Images: Stunning Fish X-rays]
• X-rays are also essential for transportation security inspections of cargo, luggage
and passengers. Electronic imaging detectors allow for real-time visualization of
the content of packages and other passenger items.
• X-ray therapy
• Radiation therapy uses high-energy radiation to kill cancer cells by damaging
their DNA. Since the treatment can also damage normal cells, the National
Cancer Institute recommends that treatment be carefully planned to minimize
side effects.
• According to the U.S. Environmental Protection Agency, so-called ionizing
radiation from X-rays zaps a focused area with enough energy to completely
strip electrons from atoms and molecules, thus altering their properties. In
sufficient doses, this can damage or destroy cells. While this cell damage can
cause cancer, it can also be used to fight it. By directing X-rays at cancerous
tumors, it can demolish those abnormal cells.
• B. ULTRASOUND
• An ultrasound scan is a medical test that uses high-frequency
sound waves to capture live images from the inside of your body.
It’s also known as sonography.
• The technology is similar to that used by sonar and radar, which
help the military detect planes and ships. An ultrasound allows
your doctor to see problems with organs, vessels, and tissues
without needing to make an incision.
• Unlike other imaging techniques, ultrasound uses no radiation. For
this reason, it’s the preferred method for viewing a developing fetus
during pregnancy.
• Why an ultrasound is performed

• Most people associate ultrasound scans with pregnancy. These scans can provide an expectant
mother with the first view of her unborn child. However, the test has many other uses.

• Your doctor may order an ultrasound if you’re having pain, swelling, or other symptoms that
require an internal view of your organs. An ultrasound can provide a view of the:

• Bladder kidneys liver blood vessels

• brain (in infants) ovaries pancreas

• eyes spleen thyroid

• gallbladder uterus testicles

• An ultrasound is also a helpful way to guide surgeons’ movements during certain medical
procedures, such as biopsies.
• Preparation for an ultrasound
• The steps you will take to prepare for an ultrasound will depend on the area or
organ that is being examined.
• Your doctor may tell you to fast for eight to 12 hours before your ultrasound,
especially if your abdomen is being examined. Undigested food can block the
sound waves, making it difficult for the technician to get a clear picture.
• For an examination of the gallbladder, liver, pancreas, or spleen, you may be told
to eat a fat-free meal the evening before your test and then to fast until the
procedure. However, you can continue to drink water and take any medications
as instructed. For other examinations, you may be asked to drink a lot of water
and to hold your urine so that your bladder is full and better visualized.
• Be sure to tell your doctor about any prescription drugs,
over-the-counter medications, or herbal supplements that you take
before the exam.
• It’s important to follow your doctor’s instructions and ask any
questions you may have before the procedure.
• An ultrasound carries minimal risks. Unlike X-rays or CT scans,
ultrasounds use no radiation. For this reason, they are the
preferred method for examining a developing fetus during
pregnancy.
• How an ultrasound is performed
• Before the exam, you will change into a hospital gown. You will most likely be
lying down on a table with a section of your body exposed for the test.
• An ultrasound technician, called a sonographer, will apply a special lubricating
jelly to your skin. This prevents friction so they can rub the ultrasound
transducer on your skin. The transducer has a similar appearance to a
microphone. The jelly also helps transmit the sound waves.
• The transducer sends high-frequency sound waves through your body. The
waves echo as they hit a dense object, such as an organ or bone. Those echoes are
then reflected back into a computer. The sound waves are at too high of a pitch
for the human ear to hear. They form a picture that can be interpreted by the
doctor.
• Depending on the area being examined, you may need to change positions so the
technician can have better access.
• After the procedure, the gel will be cleaned off of your skin. The whole procedure
typically lasts less than 30 minutes, depending on the area being examined. You
will be free to go about your normal activities after the procedure has finished.
• After an ultrasound
• Following the exam, your doctor will review the images and check for any
abnormalities. They will call you to discuss the findings, or to schedule a
follow-up appointment. Should anything abnormal turn up on the ultrasound,
you may need to undergo other diagnostic techniques, such as a CT scan, MRI,
or a biopsy sample of tissue depending on the area examined. If your doctor is
able to make a diagnosis of your condition based on your ultrasound, they may
begin your treatment immediately.
C. MRI ( MAGNETIC REASONANCE IMAGING)
• Magnetic resonance imaging (MRI) is a medical imaging technique that
uses a magnetic field and computer-generated radio waves to create detailed
images of the organs and tissues in your body. Most MRI machines are large,
tube-shaped magnets.
• A magnetic resonance imaging (MRI) scan is a common procedure around the
world.
• MRI uses a strong magnetic field and radio waves to create detailed images of
the organs and tissues within the body.
• Facts on MRI scanning
• MRI scanning is a non-invasive and painless procedure.
• Raymond Damadian created the first MRI full-body scanner, which he
nicknamed the Indomitable.
• The cost of a basic MRI scanner starts at $150,000 but can exceed several
million dollars.
• Japan has the most MRI scanners per capita, with 48 machines for every
100,000 citizens.
• The following are examples in which an MRI scanner would be used:
• anomalies of the brain and spinal cord
• tumors, cysts, and other anomalies in various parts of the body
• breast cancer screening for women who face a high risk of breast cancer
• injuries or abnormalities of the joints, such as the back and knee
• certain types of heart problems
• diseases of the liver and other abdominal organs
• the evaluation of pelvic pain in women, with causes including fibroids and endometriosis
• suspected uterine anomalies in women undergoing evaluation for infertility
Peparation before an MRI scan.
• On arrival at the hospital, doctors may ask the patient to change into a gown. As
magnets are used, it is critical that no metal objects are present in the scanner.
The doctor will ask the patient to remove any metal jewellery or accessories that
might interfere with the machine.
• A person will probably be unable to have an MRI if they have any metal inside
their body, such as bullets, shrapnel, or other metallic foreign bodies. This can
also include medical devices, such as cochlear implants, aneurysm clips, and
pacemakers.
• Individuals who are anxious or nervous about enclosed spaces should tell their
doctor. Often they can be given medication prior to the MRI to help make the
procedure more comfortable.
• Patients will sometimes receive an injection of intravenous (IV) contrast liquid
to improve the visibility of a particular tissue that is relevant to the scan.
• The radiologist, a doctor who specializes in medical images, will then talk the
individual through the MRI scanning process and answer any questions they
may have about the procedure.
• Once the patient has entered the scanning room, the doctor will help them onto
the scanner table to lie down. Staff will ensure that they are as comfortable as
possible by providing blankets or cushions.
• Earplugs or headphones will be provided to block out the loud noises of the
scanner. The latter is popular with children, as they can listen to music to calm
any anxiety during the procedure.
• During an MRI scan
• Once in the scanner, the MRI technician will communicate with the patient via
the intercom to make sure that they are comfortable. They will not start the scan
until the patient is ready.
• During the scan, it is vital to stay still. Any movement will disrupt the images,
much like a camera trying to take a picture of a moving object. Loud clanging
noises will come from the scanner. This is perfectly normal. Depending on the
images, at times it may be necessary for the person to hold their breath.
• If the patient feels uncomfortable during the procedure, they can speak to the
MRI technician via the intercom and request that the scan be stopped.
• After an MRI scan
• After the scan, the radiologist will examine the images to check whether any
more are required. If the radiologist is satisfied, the patient can go home.
• The radiologist will prepare a report for the requesting doctor. Patients are
usually asked to make an appointment with their doctor to discuss the results.
Side effects
• It is extremely rare that a patient will experience side effects from an MRI scan.
• However, the contrast dye can cause nausea, headaches, and pain or burning at
the point of injection in some people. Allergy to the contrast material is also
seldom seen but possible, and can cause hives or itchy eyes. Notify the technician
if any adverse reactions occur.
• People who experience claustrophobia or feel uncomfortable in enclosed spaces
sometimes express difficulties with undergoing an MRI scan.
• An MRI scanner contains two powerful magnets. These are the most important
parts of the equipment.
• The human body is largely made of water molecules, which are comprised of
hydrogen and oxygen atoms. At the center of each atom lies an even smaller
particle called a proton, which serves as a magnet and is sensitive to any
magnetic field.
• Normally, the water molecules in the body are randomly arranged, but on
entering an MRI scanner, the first magnet causes the water molecules to align in
one direction, either north or south.
• The second magnetic field is then turned on and off in a series of
quick pulses, causing each hydrogen atom to change its alignment
when switched on and then quickly switch back to its original
relaxed state when switched off.
• Passing electricity through gradient coils, which also cause the coils
to vibrate, creates the magnetic field, causing a knocking sound
inside the scanner.
• Although the patient cannot feel these changes, the scanner can
detect them and, in conjunction with a computer, can create a
detailed cross-sectional image for the radiologist.
• Functional magnetic resonance imaging (fMRI)

• Functional magnetic resonance imaging or functional MRI (fMRI) uses MRI technology to
measure cognitive activity by monitoring blood flow to certain areas of the brain.

• The blood flow increases in areas where neurons are active. This gives an insight into the
activity of neurons in the brain.

• This technique has revolutionized brain mapping, by allowing researchers to assess the brain
and spinal cord without the need for invasive procedures or drug injections.

• Functional MRI helps researchers learn about the function of a normal, diseased, or injured
brain.

• fMRI is also used in clinical practice. Standard MRI scans are useful for detecting anomalies in
tissue structure. However, an fMRI scan can help detect anomalies in activity.

• In short, fMRI tests what tissues do rather than how they look.
• As such, doctors use fMRI to assess the risks of brain surgery by identifying the
regions of the brain involved in critical functions, such as speaking, movement,
sensing, or planning.
• Functional MRI can also be used to determine the effects of tumors, stroke, head
and brain injuries, or neurodegenerative diseases, such as Alzheimer’s.
• How long will an MRI scan take?
• MRI scans vary from 20 to 60 minutes, depending on what part of the body is
being analyzed and how many images are required.
• If, after the first MRI scan, the images are not clear enough for the radiologist,
they may ask the patient to undergo a second scan straight away.
• Can I move while I am in the MRI tunnel?
• It is important to stay as still as possible while in the MRI scanner. Any
movement will distort the scanner and, therefore, the images produced will be
blurry. In particularly long MRI scans, the MRI technician may allow a short
break halfway through the procedure.
• I am claustrophobic, what can I do?
• The doctor and radiologist will be able to talk the patient through the whole
procedure and address any anxieties. Open MRI scanners are available in some
locations for certain body parts to help patients who have claustrophobia.
• A person can take medication prior to the test to ease anxiety.
• Do I need an injection of contrast before my MRI scan?
• A contrast dye can improve diagnostic accuracy by highlighting certain tissues.
• Some patients may need to have a contrast agent injected before the scan.
• Can I have an MRI scan if I am pregnant?
• Unfortunately, there is no simple answer. Let a doctor know about the pregnancy
before the scan. There have been relatively few studies on the effect of MRI scans
on pregnancy. However, guidelines published in 2016 have shed more light on
the issue.
• Typically, doctors do not recommend contrast material for women who are
pregnant.
• Typically, doctors do not recommend contrast material for women who are
pregnant.
• MRI scans should be restricted during the first trimester unless the information
is considered essential. MRI scans during the second and third trimester are safe
at 3.0 tesla (T) or less. The tesla is a measurement of magnetic strength.
• The guidelines also state that exposure to MRI during the first trimester is not
linked to long-term consequences and should not raise clinical concerns.
• D. CT SCAN
• A computerized tomography scan (CT or CAT scan) uses computers and rotating X-ray
machines to create cross-sectional images of the body. These images provide more detailed
information than normal X-ray images. They can show the soft tissues, blood vessels, and
bones in various parts of the body. A CT scan may be used to visualize the:

• Head Chest Heart Knee

• Shoulders Abdomen Spine

• During a CT scan, you lie in a tunnel-like machine while the inside of the machine rotates and
takes a series of X-rays from different angles. These pictures are then sent to a computer,
where they’re combined to create images of slices, or cross-sections, of the body. They may also
be combined to produce a 3-D image of a particular area of the body.
• A CT scan has many uses, but it’s particularly well-suited for diagnosing diseases
and evaluating injuries. The imaging technique can help your doctor:
• diagnose infections, muscle disorders, and bone fractures
• pinpoint the location of masses and tumors (including cancer)
• study the blood vessels and other internal structures
• assess the extent of internal injuries and internal bleeding
• guide procedures, such as surgeries and biopsies
• monitor the effectiveness of treatments for certain medical conditions, including
cancer and heart disease
• The test is minimally invasive and can be conducted quickly.
• How Is a CT Scan Performed?
• Your doctor may give you a special dye called a contrast materialto help internal
structures show up more clearly on the X-ray images.
• The contrast material blocks X-rays and appears white on the images, allowing it
to highlight the intestines, blood vessels, or other structures in the area being
examined. Depending on the part of your body that’s being inspected, you may
need to drink a liquid containing the contrast.
• Alternatively, the contrast may need to be injected into your arm or
administered through your rectum via an enema. If your doctor plans on using a
contrast material, they may ask you to fast for four to six hours before your CT
scan.
• When it comes time to have the CT scan, you’ll be asked to change into a hospital
gown and to remove any metal objects. Metal can interfere with the CT scan
results. These items include jewelry, glasses, and dentures. Your doctor will then
ask you to lie face up on a table that slides into the CT scanner. They’ll leave the
exam room and go into the control room where they can see you and hear you.
You’ll be able to communicate with them via an intercom.
• While the table slowly moves you into the scanner, the X-ray machine will rotate
around you. Each rotation produces numerous images of thin slices of your
body. You may hear clicking, buzzing, and whirring noises during the scan. The
table will move a few millimeters at a time until the exam is finished. The entire
procedure may take anywhere from 20 minutes to one hour.
• It’s very important to lie still while CT images are being taken because
movement can result in blurry pictures.
• Your doctor may ask you to hold your breath for a short period during the test to
prevent your chest from moving up and down. If a young child needs a CT scan,
the doctor may recommend a sedative to keep the child from moving.
• Once the CT scan is over, the images are sent to a radiologist for examination. A
radiologist is a doctor who specializes in diagnosing and treating conditions
using imaging techniques, such as CT scans and X-rays.
• Your doctor will follow-up with you to explain the results.
• What Are the Risks Associated with a CT Scan?
• There are very few risks associated with a CT scan. Though CT scans expose you
to more radiation than typical X-rays, the risk of cancer caused by radiation is
very small if you only have one scan.
• Your risk for cancer may increase over time if you have multiple X-rays or CT
scans. The risk of cancer is increased in children receiving CT scans, especially to
the chest and abdomen.
• Some people have an allergic reaction to the contrast material. Most contrast
material contains iodine, so if you’ve had an adverse reaction to iodine in the
past, make sure to notify your doctor.
• Your doctor may give you allergy medication or steroids to counteract any
potential side effects if you’re allergic to iodine but must be given contrast.
• It’s also important to tell your doctor if you’re pregnant. Though the radiation
from a CT scan is unlikely to harm your baby, your doctor may recommend
another exam, such as an ultrasound or MRI scan, to minimize risk.
• What Do CT Scan Results Mean?
• CT scan results are considered normal if the radiologist didn’t see any tumors,
blood clots, fractures, or other abnormalities in the images. If any abnormalities
are detected during the CT scan, you may need further tests or treatments,
depending on the type of abnormality found.
• What is the difference between CT scan and MRI?
• The difference between an MRI and CT scan

CT scans and MRIs are both used to capture images within your body. The
biggest difference is that MRIs (magnetic resonance imaging) use radio waves
and CT (computed tomography) scans use X-rays.
• ECG
• It is a record or display of a person's heartbeat produced by electrocardiography.
• An electrocardiogram (EKG) test is a simple, painless procedure that
measures electrical signals in your heart. Each time your heart beats, an
electrical signal travels through the heart. An EKG can show if your heart is
beating at a normal rate and strength.
• There is no difference between an ECG and an EKG. Both refer to the same
procedure, however one is in English (electrocardiogram – ECG) and the
other is based on the German spelling (elektrokardiogramm – EKG).
F. 2-DIMENTIONAL- ECHOCARDIOGRAM
• Purpose of Echocardiogram

• Look for heart disease

• Monitor heart valve disease over time

• See how well medical or surgical treatments are working

• Your doctor may suggest an echocardiogram to: Check for problems with the valves or chambers

of your heart. Check if heart problems are the cause of symptoms such as shortness of breath or

chest pain. Detect congenital heart defects before birth (fetal echocardiogram)

• An average echocardiogram will take around 20 minutes to 1 hour to complete. Around 5 minutes
will be spent on preparing and positioning the patient for the echocardiogram. 15 minutes on average
will be spent acquiring the relevant images of the heart.
• 2-Dimensional Echocardiogram (Cardiac Ultrasound)
• This is a safe and painless procedure that uses a transducer (a small,
microphone-type device) to send high frequency sound waves to the heart. The
technologist can view the heart valves and pumping strength, look for structural
defects, heart enlargement and/or fluid buildup. A Doppler exam and Color Flow
exam are also performed. This allows doctors to evaluate blood flow through the
heart. The technologist will videotape parts of the study for later diagnosis by the
cardiologist.
• An echocardiogram is a test that uses ultrasound to show how your heart muscle
and valves are working. The sound waves make moving pictures of your heart so
your doctor can get a good look at its size and shape. You might hear them call it
“echo” for short.
• Time Required=1 hour in the Cardiovascular Department.
• Preparation and Procedure
• You will lie on your back and left side.
• Electrodes (small, adhesive patches) will be attached to your chest to record your heart's
electrical activity (EKG) during the test.
• Gel will be applied to your chest.
• The transducer will be placed on your skin and moved around the area to view the heart from
different angles.
• Wear clothing that is easy to remove from the waist up.
• Avoid the use of creams and lotions on the chest area.
• There are no diet restrictions.
• Please bring a list of medications with you.
• G. EEG
• Electroencephalogram (EEG)
• This safe and painless test records the electrical activity of the brain using special
sensors, called electrodes that are attached to your head. An EEG can help
diagnose, monitor, or rule out some brain problems such as epilepsy, head
injury, brain dysfunction, inflammation of the brain, stroke, and dementia
among others.
• Time:
• Approximately 90 minutes. More time will be allotted for young children.
• Preparation:
• 1.Routine EEG
• Wear comfortable clothing.
• Shampoo and dry hair without using sprays, gels or oils. No braids or intricate
hair designs as they will need to be removed prior to the test.
• Continue taking medications as prescribed by your physician.
• Bring a list of your medications you are taking.
• Arrive 15 minutes prior to your appointment.
• Children should be scheduled so EEG corresponds with their nap times and
prevented from napping prior to having their study.
• 2. Ambulatory EEG (24/48/72 Hour)
• Follow instructions for a Routine EEG, and wear a button up shirt, as the EEG
equipment will be left on for 24 hours, limiting your ability to change clothing.
• You will leave wearing electrodes and a small recorder (somewhat larger than a
"smart phone"). You will be scheduled to return within the next 24-72 hours to
have the electrodes removed.
• 3.Sleep-Deprived EEG
• Sleep deprived patients will need to have no more than 4 hours of total sleep the night
before (i.e. 12 a.m. (midnight) to 4 a.m. or 1 a.m. to 5 a.m.).
• Parents of young children, please schedule appointment for nap time and bring child's
favorite toys, tablet, blankets, bottles, etc., to help them feel as relaxed and comfortable
as possible during the test.
• Avoid caffeine, chocolate or any other food/drink products that may contain caffeine,
as this will negatively impact your ability to complete the study.
• Research has proven people who are sleep deprived may have their driving adversely
affected; therefore, we recommend that you do not drive and have someone drive you
to and from your appointment.
• Shampoo and dry hair without using sprays, gels or oils. No braids or intricate hair
designs as they will need to be removed prior to the test.
• Continue taking medications as prescribed by your physician.
• Bring a list of your medications you are taking.
• Arrive 15 minutes prior to your appointment.
• Your Results:
• All neuro diagnostic test results will be interpreted by a neurologist, and results
will be sent to your physician. Your physician is responsible for communicating
your results to you and helping you understand what they mean. If you have any
questions about your test results, please call your doctor.