Computed Tomography Resource Information For Patient

Magnetic resonance imaging (MRI) uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the body's internal structures that are clearer, more detailed and more likely in some instances to identify and accurately characterize disease than other imaging methods. It is used to evaluate the body for a variety of conditions, including tumors and diseases of the liver, heart, and bowel. It may also be used to monitor an unborn child in the womb. MRI is noninvasive and does not use ionizing radiation. For the benefits and risks of a specific MRI procedure, how to prepare, and more, select a topic below.

Peripheral Angiography

What is Peripheral Angiography?

Angiography is a minimally invasive medical test that uses x-rays and an iodine-containing contrast material to produce pictures of blood vessels in the Upper limb/lower limb

In peripheral angiography, a thin plastic tube called a catheter is inserted into an artery in the leg or arm through a small incision in the skin. Using x-ray guidance, the catheter is navigated to the area being examined. Once there, contrast material is injected through the tube and images are captured using ionizing radiation (x-rays).

What are some common uses of the procedure?

Physicians use the procedure to detect or confirm abnormalities within the blood vessels in the Upper limb/lower limb, including:

  • • an aneurysm, a bulge or sac that develops in an artery due to weakness of the arterial wall.
  • • atherosclerosis, a narrowing of the arteries.
  • • vasculitis, an inflammation of the blood vessels, generally narrowing them.
  • • a tumor.
  • • a blood clot.
  • • a tear in the wall of an artery, known as a vascular dissection.

A Peripheral angiogram may be performed:

  • • to evaluate arteries of the Upper limb/lower limb before surgery.
  • • to provide additional information on abnormalities seen on MRI or CT of the Upper limb/lower limb, such as the blood supply to a tumor.
  • • to prepare for other medical treatment, such as in the surgical removal of a tumor.
  • • in preparation for minimally invasive treatment of a vessel abnormality.

How should I prepare?

You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications,general anesthesia or to contrast materials containing iodine (sometimes referred to as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure.

Also inform your doctor about recent illnesses or other medical conditions.

If you are going to be given a sedative during the procedure, you may be asked not to eat or drink anything for four to eight hours before your exam. If so, you should have a relative or friend accompany you and drive you home afterward.

You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.

You will likely be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning.

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

If you are breastfeeding at the time of the exam, you should ask your radiologist how to proceed. 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, about 24 hours after the test.

What does the equipment look like?

In this procedure, x-ray equipment will be used.

A catheter is a long, thin plastic tube that is considerably smaller than a "pencil lead", or approximately 1/8 inch in diameter.

Other equipment that may be used during the procedure includes an intravenous line (IV), ultrasound machine and devices that monitor your heart beat and blood pressure.

How does the procedure work?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

Different parts of the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.

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. When used with a contrast material, which clearly defines the area being examined by making it appear dark (or by electronically reversing the image contrast to white), this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. Still images or movies are also captured and stored electronically on a computer.

How is the procedure performed?

This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.

Prior to your procedure, your blood may be tested to determine how well your kidneys are functioning and whether your blood clots normally.

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. Moderate sedation may be used. As an alternative, you may receive general anesthesia.

In children up to mid-teens, peripheral angiography is usually performed with the patient under general anesthesia.

Devices to monitor your heart rate and blood pressure will be attached to your body.

You will be positioned on the examining table.

The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.

Your physician will numb the area with a local anesthetic.

A very small skin incision is made at the site.

Using x-ray-guidance, a catheter (a long, thin, hollow plastic tube) is inserted into a blood vessel through a tiny hole in the skin made by a needle and directed to the area to be examined.

The contrast material is then injected through the catheter. A special machine, called a power injector, is used to deliver the contrast material at a precise rate and volume. The injector is attached to the catheter for this purpose. When the contrast material reaches the blood vessels being examined, several sets of x-rays will be taken.

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.

Your intravenous line will be removed.

The procedure is usually completed within one to three hours. Additional time may be required for exam preparation, setup and post-procedure care.

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 arteries have no sensation. Most of the sensation is at the skin incision site which is numbed using local anesthetic.

If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.

You may feel slight pressure when the catheter is inserted, but no serious discomfort.

As the contrast material passes through your body, you may get a warm feeling.

You will be asked to remain very still while the x-ray images are taken.

The most difficult part of the procedure may be lying flat for several hours.

Once the procedure is complete, the catheter will be removed by the radiologist. Pressure is immediately applied to the puncture site to ensure there is no bleeding. The pressure may be either applied by hand or with a special clamp. In either case, it takes about 10 minutes for the tiny hole in the artery to close.

You will remain in the recovery room for observation for a few hours following the procedure before you return home.

If the catheter was placed in the groin area, you will be given specific instructions regarding how long you may need to keep your leg straight. This will vary based on the technique used to repair the hole created in order to insert the catheter. You may apply ice to the site where the catheter was inserted to relieve pain and swelling.

You may resume your normal diet immediately after the exam. You will be able to resume all other normal activities eight to 12 hours after the exam.

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, arms or legs
  • • slurred speech
  • • vision problems
  • • signs of infection at the catheter site
  • • dizziness
  • • chest pain
  • • difficulty breathing
  • • rash
  • • difficulty in using the extremity where the puncture/incision was made

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to perform, supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

What are the benefits vs. risks?

Benefits
  • • Angiography may eliminate the need for surgery. If surgery remains necessary, it can be performed more accurately.
  • • Peripheral angiography presents a very detailed, clear and accurate picture of blood vessels in the Upper limb/lower limb .
  • • This is especially helpful when a surgical procedure or other treatment is being considered
Risks
  • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • There is a very slight risk of an allergic reaction if contrast material is injected.
  • If you have a history of allergy to x-ray contrast material, your radiologist may advise that you take special medication for 24 hours before cerebral angiography to lessen the risk of allergic reaction. However, the risk of an allergic reaction from contrast material injected into an artery is less than if it is introduced into a vein.
  • Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
  • Nursing mothers should wait for 24 hours after contrast material injection before resuming breastfeeding.
  • The risk of serious allergic reaction to contrast materials that contain iodine is extremely rare, and radiology departments are well equipped to deal with them.
  • If you have diabetes or kidney disease, the kidneys may be injured due to the contrast material. In most cases, the kidneys will regain their normal function within five to seven days.
  • Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
  • There is a small risk that blood will form a clot around the tip of the catheter, blocking the artery and making it necessary to operate to reopen the vessel.

A Word About Minimizing Radiation Exposure

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

When performing Peripheral angiography in children or young adults, care is often taken to minimize radiation to the ovaries and testes by placing a lead drape under the pelvis.

What are the limitations of Peripheral Angiography?

Patients with impaired kidney function may not be good candidates for this procedure.

Patients who have previously had allergic reactions to iodine-containing x-ray contrast materials are at risk of having a second reaction to similar contrast agents.

Renal Angiography

What is Renal Angiography

Angiography is a minimally invasive medical test that uses x-rays and an iodine-containing contrast material to produce pictures of blood vessels in the brain.

In renal angiography, a thin plastic tube called a catheter is inserted into an artery in the leg or arm through a small incision in the skin. Using x-ray guidance, the catheter is navigated to the area being examined. Once there, contrast material is injected through the tube and images are captured using ionizing radiation (x-rays).

What are some common uses of the procedure?

Physicians use the procedure to detect or confirm abnormalities within the blood vessels in the kidneys, including:

  • • an aneurysm, a bulge or sac that develops in an artery due to weakness of the arterial wall.
  • • atherosclerosis, a narrowing of the arteries.
  • • vasculitis, an inflammation of the blood vessels, generally narrowing them.
  • • a tumor.
  • • a blood clot.

A renal angiogram may be performed:

  • • to evaluate arteries of kidneys before surgery.
  • • to provide additional information on abnormalities seen on MRI or CT of the kidney such as the blood supply to a tumor.
  • • to prepare for other medical treatment, such as in the surgical removal of a tumor.
  • • in preparation for minimally invasive treatment of a vessel abnormality.

How should I prepare?

You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications,general anesthesia or to contrast materials containing iodine (sometimes referred to as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure.

Also inform your doctor about recent illnesses or other medical conditions.

If you are going to be given a sedative during the procedure, you may be asked not to eat or drink anything for four to eight hours before your exam. If so, you should have a relative or friend accompany you and drive you home afterward.

You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.

You will likely be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning.

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

If you are breastfeeding at the time of the exam, you should ask your radiologist how to proceed. 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, about 24 hours after the test.

What does the equipment look like?

In this procedure, x-ray equipment will be used.

A catheter is a long, thin plastic tube that is considerably smaller than a "pencil lead", or approximately 1/8 inch in diameter.

A catheter is inserted by a radiologist, usually through a tiny hole made by a needle in an artery in the groin. Using x-ray guidance, it is painlessly guided through the body to various vessels in the neck that supply blood to the brain.

Other equipment that may be used during the procedure includes an intravenous line (IV), ultrasound machine and devices that monitor your heart beat and blood pressure.

How does the procedure work?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

Different parts of the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.

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. When used with a contrast material, which clearly defines the area being examined by making it appear dark (or by electronically reversing the image contrast to white), this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. Still images or movies are also captured and stored electronically on a computer.

How is the procedure performed?

This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.

Prior to your procedure, your blood may be tested to determine how well your kidneys are functioning and whether your blood clots normally.

Because the renal angiogram and recovery period may last for several hours, you will be asked to empty your bladder before the procedure begins.

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. Moderate sedation may be used. As an alternative, you may receive general anesthesia.

In children up to mid-teens renal angiography is usually performed with the patient under general anesthesia.

Devices to monitor your heart rate and blood pressure will be attached to your body.

You will be positioned on the examining table.

Your head will be held in place using a strap, tape or a foam head holder so you cannot move it during the procedure.

The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.

Your physician will numb the area with a local anesthetic.

A very small skin incision is made at the site.

Using x-ray-guidance, a catheter (a long, thin, hollow plastic tube) is inserted into a blood vessel through a tiny hole in the skin made by a needle and directed to the area to be examined.

The contrast material is then injected through the catheter. A special machine, called a power injector, is used to deliver the contrast material at a precise rate and volume. The injector is attached to the catheter for this purpose. When the contrast material reaches the blood vessels being examined, several sets of x-rays will be taken.

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.

Your intravenous line will be removed.

The procedure is usually completed within one to three hours. Additional time may be required for exam preparation, setup and post-procedure care.

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 arteries have no sensation. Most of the sensation is at the skin incision site which is numbed using local anesthetic.

If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.

You may feel slight pressure when the catheter is inserted, but no serious discomfort.

As the contrast material passes through your body, you may get a warm feeling.

You will be asked to remain very still while the x-ray images are taken.

The most difficult part of the procedure may be lying flat for several hours.

Once the procedure is complete, the catheter will be removed by the radiologist. Pressure is immediately applied to the puncture site to ensure there is no bleeding. The pressure may be either applied by hand or with a special clamp. In either case, it takes about 10 minutes for the tiny hole in the artery to close.

You will remain in the recovery room for observation for a few hours following the procedure before you return home.

If the catheter was placed in the groin area, you will be given specific instructions regarding how long you may need to keep your leg straight. This will vary based on the technique used to repair the hole created in order to insert the catheter. You may apply ice to the site where the catheter was inserted to relieve pain and swelling.

You may resume your normal diet immediately after the exam. You will be able to resume all other normal activities eight to 12 hours after the exam.

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, arms or legs
  • • slurred speech
  • • vision problems
  • • signs of infection at the catheter site
  • • dizziness
  • • chest pain
  • • difficulty breathing
  • • rash
  • • difficulty in using the extremity where the puncture/incision was made

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to perform, supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

What are the benefits vs. risks?

Benefits
  • • Angiography may eliminate the need for surgery. If surgery remains necessary, it can be performed more accurately.
  • • Renal angiography presents a very detailed, clear and accurate picture of blood vessels in the kidneys. This is especially helpful when a surgical procedure or other treatment is being considered.
  • • Results from renal angiography are more accurate than those produced by renal Doppler ultrasound or other noninvasive imaging of the blood vessels.
  • • Use of a catheter makes it possible to combine diagnosis and treatment in a single procedure.
  • • No radiation remains in a patient's body after an x-ray examination.
  • • X-rays usually have no side effects in the typical diagnostic range for this exam.
Risks
  • • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • • There is a very slight risk of an allergic reaction if contrast material is injected.
  • • If you have a history of allergy to x-ray contrast material, your radiologist may advise that you take special medication for 24 hours before renal angiography to lessen the risk of allergic reaction. However, the risk of an allergic reaction from contrast material injected into an artery is less than if it is introduced into a vein.
  • • Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
  • • Nursing mothers should wait for 24 hours after contrast material injection before resuming breastfeeding.
  • • The risk of serious allergic reaction to contrast materials that contain iodine is extremely rare, and radiology departments are well equipped to deal with them.
  • • If you have diabetes or kidney disease, the kidneys may be injured due to the contrast material. In most cases, the kidneys will regain their normal function within five to seven days.
  • • Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
  • • There is a small risk that blood will form a clot around the tip of the catheter, blocking the artery and making it necessary to operate to reopen the vessel.

Rarely, the catheter punctures the artery, causing internal bleeding. It also is possible that the catheter tip will separate material from the inner lining of the artery, causing a block downstream in the blood vessel. Given that children do not usually have plaque in their arteries, they would not be as susceptible as adults to have such a complication.

A Word About Minimizing Radiation Exposure

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

When performing cerebral angiography in children or young adults, care is often taken to minimize radiation to the ovaries and testes by placing a lead drape under the pelvis.

What are the limitations of Renal Angiography?

Patients with impaired kidney function may not be good candidates for this procedure.

Patients who have previously had allergic reactions to iodine-containing x-ray contrast materials are at risk of having a second reaction to similar contrast agents.

Pulmonary Angiography

What is pulmonary Angiography

Angiography is a minimally invasive medical test that uses x-rays and an iodine-containing contrast material to produce pictures of blood vessels in the lungs

In pulmonary angiography, a thin plastic tube called a catheter is inserted into an artery in the leg or arm through a small incision in the skin. Using x-ray guidance, the catheter is navigated to the area being examined. Once there, contrast material is injected through the tube and images are captured using ionizing radiation (x-rays).

What are some common uses of the procedure?

Physicians use the procedure to detect or confirm abnormalities within the blood vessels in the lungs, including:

  • • an aneurysm, a bulge or sac that develops in an artery due to weakness of the arterial wall.
  • • atherosclerosis, a narrowing of the arteries.
  • • vasculitis, an inflammation of the blood vessels, generally narrowing them.
  • • a tumor.
  • • a blood clot.
  • • a tear in the wall of an artery, known as a vascular dissection.

A pulmonary angiogram may be performed:

  • • to evaluate arteries of the lungs before surgery.
  • • to provide additional information on abnormalities seen on MRI or CT of the lungs, such as the blood supply to a tumor.
  • • to prepare for other medical treatment, such as in the surgical removal of a tumor.
  • • in preparation for minimally invasive treatment of a vessel abnormality.

How should I prepare?

You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications,general anesthesia or to contrast materials containing iodine (sometimes referred to as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure.

Also inform your doctor about recent illnesses or other medical conditions.

If you are going to be given a sedative during the procedure, you may be asked not to eat or drink anything for four to eight hours before your exam. If so, you should have a relative or friend accompany you and drive you home afterward.

For more information about sedation, visit the Anesthesia page.

You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.

You will likely be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning.

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

If you are breastfeeding at the time of the exam, you should ask your radiologist how to proceed. 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, about 24 hours after the test.

What does the equipment look like?

In this procedure, x-ray equipment will be used.

A catheter is a long, thin plastic tube that is considerably smaller than a "pencil lead", or approximately 1/8 inch in diameter.

A catheter is inserted by a radiologist, usually through a tiny hole made by a needle in an artery in the groin. Using x-ray guidance, it is painlessly guided through the body to various vessels in the neck that supply blood to the brain.

Other equipment that may be used during the procedure includes an intravenous line (IV), ultrasound machine and devices that monitor your heart beat and blood pressure.

How does the procedure work?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

Different parts of the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.

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. When used with a contrast material, which clearly defines the area being examined by making it appear dark (or by electronically reversing the image contrast to white), this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. Still images or movies are also captured and stored electronically on a computer.

How is the procedure performed?

This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.

Prior to your procedure, your blood may be tested to determine how well your kidneys are functioning and whether your blood clots normally.

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. Moderate sedation may be used. As an alternative, you may receive general anesthesia.

In children up to mid-teens, pulmonary angiography is usually performed with the patient under general anesthesia.

Devices to monitor your heart rate and blood pressure will be attached to your body.

You will be positioned on the examining table.

Your head will be held in place using a strap, tape or a foam head holder so you cannot move it during the procedure.

The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.

Your physician will numb the area with a local anesthetic.

A very small skin incision is made at the site.

Using x-ray-guidance, a catheter (a long, thin, hollow plastic tube) is inserted into a blood vessel through a tiny hole in the skin made by a needle and directed to the area to be examined.

The contrast material is then injected through the catheter. A special machine, called a power injector, is used to deliver the contrast material at a precise rate and volume. The injector is attached to the catheter for this purpose. When the contrast material reaches the blood vessels being examined, several sets of x-rays will be taken.

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.

Your intravenous line will be removed.

The procedure is usually completed within one to three hours. Additional time may be required for exam preparation, setup and post-procedure care.

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 arteries have no sensation. Most of the sensation is at the skin incision site which is numbed using local anesthetic.

If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.

You may feel slight pressure when the catheter is inserted, but no serious discomfort.

As the contrast material passes through your body, you may get a warm feeling.

You will be asked to remain very still while the x-ray images are taken.

The most difficult part of the procedure may be lying flat for several hours.

Once the procedure is complete, the catheter will be removed by the radiologist. Pressure is immediately applied to the puncture site to ensure there is no bleeding. The pressure may be either applied by hand or with a special clamp. In either case, it takes about 10 minutes for the tiny hole in the artery to close.

You will remain in the recovery room for observation for a few hours following the procedure before you return home.

If the catheter was placed in the groin area, you will be given specific instructions regarding how long you may need to keep your leg straight. This will vary based on the technique used to repair the hole created in order to insert the catheter. You may apply ice to the site where the catheter was inserted to relieve pain and swelling.

You may resume your normal diet immediately after the exam. You will be able to resume all other normal activities eight to 12 hours after the exam.

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, arms or legs
  • slurred speech
  • vision problems
  • signs of infection at the catheter site
  • dizziness
  • chest pain
  • difficulty breathing
  • rash
  • difficulty in using the extremity where the puncture/incision was made

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to perform, supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

What are the benefits vs. risks?

Benefits
  • • Angiography may eliminate the need for surgery. If surgery remains necessary, it can be performed more accurately.
  • • Pulmonary angiography presents a very detailed, clear and accurate picture of blood vessels in the lungs . This is especially helpful when a surgical procedure or other treatment is being considered
Risks
  • • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • • There is a very slight risk of an allergic reaction if contrast material is injected.
  • • If you have a history of allergy to x-ray contrast material, your radiologist may advise that you take special medication for 24 hours before cerebral angiography to lessen the risk of allergic reaction. However, the risk of an allergic reaction from contrast material injected into an artery is less than if it is introduced into a vein.
  • • Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
  • • Nursing mothers should wait for 24 hours after contrast material injection before resuming breastfeeding.
  • • The risk of serious allergic reaction to contrast materials that contain iodine is extremely rare, and radiology departments are well equipped to deal with them.
  • • If you have diabetes or kidney disease, the kidneys may be injured due to the contrast material. In most cases, the kidneys will regain their normal function within five to seven days.
  • • Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
  • • There is a small risk that blood will form a clot around the tip of the catheter, blocking the artery and making it necessary to operate to reopen the vessel.

A Word About Minimizing Radiation Exposure

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

When performing pulmonary angiography in children or young adults, care is often taken to minimize radiation to the ovaries and testes by placing a lead drape under the pelvis.

What are the limitations of Pulmonary Angiography?

Patients with impaired kidney function may not be good candidates for this procedure.

Patients who have previously had allergic reactions to iodine-containing x-ray contrast materials are at risk of having a second reaction to similar contrast agents.

Cardiac CT for Calcium Scoring

Tell your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you’re taking, and allergies. You will be instructed to not eat or drink anything several hours beforehand. If you have a known allergy to contrast material, your doctor may prescribe medications to reduce the risk of an allergic reaction. These medications must be taken 12 hours prior to your exam. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown. If you are breastfeeding, talk to your doctor about how to proceed.

What is Cardiac CT for Calcium Scoring?

Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical test that, like traditional x-rays, produces multiple images or pictures of the inside of the body.

The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images. These images can be viewed on a computer monitor, printed on film or transferred to a CD or DVD.

CT images of internal organs, bones, soft tissue and blood vessels typically provide greater detail than traditional x-rays, particularly of soft tissues and blood vessels.

A cardiac CT scan for coronary calcium is a non-invasive way of obtaining information about the presence, location and extent of calcified plaque in the coronary arteries—the vessels that supply oxygen-containing blood to the heart muscle. Calcified plaque results when there is a build-up of fat and other substances under the inner layer of the artery. This material can calcify which signals the presence of atherosclerosis, a disease of the vessel wall, also called coronary artery disease (CAD). People with this disease have an increased risk for heart attacks. In addition, over time, progression of plaque build up (CAD) can narrow the arteries or even close off blood flow to the heart. The result may be chest pain, sometimes called "angina," or a heart attack.

Because calcium is a marker of CAD, the amount of calcium detected on a cardiac CT scan is a helpful prognostic tool. The findings on cardiac CT are expressed as a calcium score. Another name for this test is coronary artery calcium scoring.

What are some common uses of the procedure?

if there are no symptoms. It is a screening study that may be recommended by a physician for patients The goal of cardiac CT scan for calcium scoring is to determine if CAD is present and to what extent, even with risk factors for CAD but no clinical symptoms.

The major risk factors for CAD are:

  • • high blood cholesterol levels
  • • family history of heart attacks
  • • diabetes
  • • high blood pressure
  • • cigarette smoking
  • • overweight or obese
  • • physical inactivity

How should I prepare?

No special preparation is necessary in advance of a cardiac CT examination. You should continue to take your usual medications, but should avoid caffeine and smoking for four hours prior to the exam.

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

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

Women should always inform their physician and the CT technologist if there is any possibility that they may be pregnant. See the Safety page for more information about pregnancy and x-rays.

What does the equipment look like?

The CT scanner is typically a large, box-like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate control room, where the technologist operates the scanner and monitors your examination in direct visual contact and usually with the ability to hear and talk to you with the use of a speaker and microphone.

How does the procedure work?

In many ways CT scanning works very much like other x-ray examinations. X-rays are a form of radiation—like light or radio waves—that can be directed at the body. Different body parts absorb the x-rays in varying degrees.

In a conventional x-ray exam, a small burst of radiation is aimed at and passes through the body, recording an image on photographic film or a special image recording plate. Bones appear white on the x-ray; soft tissue shows up in shades of gray and air appears black.

With CT scanning, numerous x-ray beams and a set of electronic x-ray detectors rotate around you, measuring the amount of radiation being absorbed throughout your body. The scanner will take a set of images and then the table will move (axial scan). Sometimes the examination table will move during the scan so that the x-ray beam follows a spiral path (spiral or helical scan). A special computer program processes this large volume of data to create two-dimensional cross-sectional images of your body, which are then displayed on a monitor.

CT imaging is sometimes compared to looking into a loaf of bread by cutting the loaf into thin slices. When the image slices are reassembled by computer software, the result is a very detailed multidimensional view of the body's interior.

Refinements in detector technology allow new CT scanners to obtain multiple slices in a single rotation. These scanners, called multislice CT or multidetector CT, allow thinner slices to be obtained in a shorter period of time, resulting in more detail and additional view capabilities.

Modern CT scanners are so fast that they can scan through large sections of the body in just a few seconds. Such speed is beneficial for all patients but especially children, the elderly and critically ill.

How is the procedure performed?

The technologist begins by positioning you on the CT examination table, usually lying flat on your back. Straps and pillows may be used to help you maintain the correct position and to help you remain still during the exam.

Electrodes (small, sticky discs) will be attached to your chest and to an electrocardiograph(ECG) machine that records the electrical activity of the heart. This makes it possible to record CT scans when the heart is not actively contracting.

Next, the table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine as the actual CT scanning is performed. Depending on the type of CT scan, the machine may make several passes.

Patients are asked to hold their breath for a period of 10 to 20 seconds while images are recorded.

When the examination is completed, you will be asked to wait until the technologist verifies that the images are of high enough quality for accurate interpretation.

The entire procedure including the actual CT scanning is usually completed within 10 minutes.

What will I experience during and after the procedure?

This CT exam is painless, fast and easy.

Though the scanning itself causes no pain, there may be some discomfort from having to remain still for several minutes and with placement of an IV. If you have a hard time staying still, are very nervous or anxious or have chronic pain, you may find a CT exam to be stressful. The technologist or nurse, under the direction of a physician, may offer you some medication to help you tolerate the CT scanning procedure.

For exams (excluding head and neck) your head will remain outside the hole in the center of the scanner. The scanner is approximately 24 inches wide, therefore, your entire body will be "inside" the scanner at one time such as with MRI.

When you enter the CT scanner room, special light lines may be seen projected onto your body, and are used to ensure that you are properly positioned. With modern CT scanners, you will hear only slight buzzing, clicking and whirring sounds as the CT scanner's internal parts, not usually visible to you, revolve around you during the imaging process.

You will be alone in the exam room during the CT scan, unless there are special circumstances. For example, sometimes a parent wearing a lead shield may stay in the room with their child. However, the technologist will always be able to see, hear and speak with you through a built-in intercom system.

After the CT exam, you can return to your normal activities.

Who interprets the results and how do I get them?

A radiologist with expertise in supervising and interpreting radiology examinations will analyze the images and send an official report to your primary care physician or physician who referred you for the exam, who will discuss the results with you.

A negative cardiac CT scan for calcium scoring shows no calcification within the coronary arteries. This suggests that CAD is absent or so minimal it cannot be seen by this technique. The chance of having a heart attack over the next two to five years is very low under these circumstances.

A positive test means that CAD is present, regardless of whether or not the patient is experiencing any symptoms. The amount of calcification—expressed as the calcium score—may help to predict the likelihood of a myocardial infarction (heart attack) in the coming years and helps your medical doctor or cardiologist decide whether the patient may need to take preventive medicine or undertake other measures such as diet and exercise to lower the risk for heart attack.

The extent of CAD is graded according to your calcium score:

Calcium ScorePresence of CAD
0 No evidence of CAD
1-10 Minimal evidence of CAD
11-100 Mild evidence of CAD
101-400 Moderate evidence of CAD
Over 400 Extensive evidence of CAD

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable or changed over time.

What are the benefits vs. risks?

Benefits
  • • Cardiac CT for calcium scoring is a convenient and noninvasive way of evaluating whether you may be at increased risk for a heart attack.
  • • The exam takes little time, causes no pain, and does not require injection of contrast material.
  • • No radiation remains in a patient's body after a CT examination.
  • • X-rays used in CT scans should have no immediate side effects.
Risks
  • • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • • The effective radiation dose for this procedure varies. See the Safety page for more information about radiation dose.
  • • Women should always inform their physician and x-ray or CT technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.
  • • CT scanning is, in general, not recommended for pregnant women unless medically necessary because of potential risk to the baby in the womb.
  • • A high calcium score may sometimes be followed by other diagnostic tests for heart disease, which may or may not provide results with clinical value and can be associated with side effects.

What are the limitations of Cardiac CT for Calcium Scoring?

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 table.

CAD, especially in people below 50 years of age can be present without calcium (non-calcified plaque) and may not be detected by this exam.

Not all health insurance plans cover cardiac CT for calcium scoring.

A high heart rate may interfere with the image quality of the test.

Exactly how your treatment or prevention for heart attacks should be modified according to your calcium score remains uncertain.

 

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