X Ray Information: What is An IVP?

Medical terminology can be very confusing and somewhat intimidating to patients, or people who are not trained in medicine. We have big, long names for procedures, medications and even for xray exams themselves. One of the more common questions from patients is "What is an IVP?"
IVP stands for Intravenous Pyelogram. Simply put, this is an exam to demonstrate the entire Urinary System by means of an IV injection. The technologist will inject an xray dye, or contrast agent, into a vein in order to demonstrate the kidneys, ureters and bladder. It's a relatively painless procedure. Probably the biggest complaint is having to lie on the xray table for perhaps 45 minutes to an hour. We have a special pad that we use on our table to make it a bit more comfortable. Pictures are taken immediatley after the injection is given, and then at designated times after that. The first few pictures demonstrate the kidneys. Delayed pictures will visualize the ureters and eventually the bladder. The number of pictures will vary according to the preference of each Radiologist. Certain conditions can dictate the length of the exam as well. Patients with a kidney stone that is obstructing a ureter can often have to wait several hours to see if the kidney will eventually empty the contrast. The Xray technologist will explain and inform the patient if these delays are necessary.
Many physicians today will order CAT Scans instead of IVP's. There are still many reasons why they are still done on a regular basis. A majority of our patients present with a history of hematuria, or blood in the urine. There are a multitude of reasons for that, sometimes it's an infection, a kidney stone, possibly a tumor. We do IVP's for kidney stones quite often. It is a very informative exam for the physician. I hope this has provided some useful information for you.

What is Nuclear Medicine

Just the name sounds scarey but Nuclear Medicine is nothing to be afraid of. In fact, it is one of the most informative tools the physician has to diagnose patients. I am sure you have heard of Bone scans, thyroid scans, etc. There are a host of exams that are performed in this department, and that list is still growing. Today doctors can examine the function of the heart with a SPECT scan, which is done in NM. It's an amazing area that is seeing new technology every day.
When you ask just How this all works, well..it is pretty complicated. Basically, the patient is injected with a Radioisotope that is mixed with a substance specifically targeted to a certain organ or body part. Then the patient lies on a table underneath a camera which will rotate around them while taking pictures. It is a simple and painless procedure and in many cases not very lengthy. There are some constraints on eating, etc..but they are explained prior to the procedure. The only radiation you get from these procedures is from the radioisotopes, and it is not very much. It will vary for each procedure so you can ask the technologist about it if you are concerned.
Nuclear Medicine can be used for a variety of things, such as, to check for metastisis or spreading of cancers, gall bladder function, heart function,loosening of hardware. Doctors can actually use a radioisotope to treat patients with hyperthyroidism. So, if your physician recommends a procedure to be done in Nuclear Medicine don't be alarmed, and I hope this has provided some insight for you.

X Ray Information and Radiation

There really is alot of information out currently about x-rays, Ct's and all this radiation we're getting. I think it is great to inform the public as long as you are giving them accurate information on all the aspects concerned. Sure radiation is not "good for you", however it is the only way to perform x-ray examinations, and CT examinations. These diagnostic tools save thousands of lives every day, so I don't think they deserve ALL the bad publicity they are getting right now. The issue IS and Should Be, that radiation when "deemed necessary" is an extremely valuable tool.The problem area is that necessary part. Sometimes what a patient feels is necessary, and what a Doctor feels is necessary, are two different things. The difference is that the Doctor has been schooled and highly trained for 6-10 years in the practice of medice. The patient may have spent a few hours possibly, on the Internet learning ALL about what they have..or don't have. The Doctor will know all the tests that can be utilized for a series of symptoms. The patient may see one or two online. So, in my eyes this is merely a publicity thing. Newspapers, TV, they all go after anything that can be made the least bit controversial and they beat it to death. IF it's Britany Spears, fine..she can handle that. This is however a much different arena. Some patient may read all this hype and decide they just won't have a CT scan, it could cause them cancer someday. IF this person has a serious problem and it doesn't get detected for a prolonged period of time, the result could be fatal. This goes back to the "necessary" part. IF you have problems and your Doctor feels a CT scan is necessary to diagnose if you have appendicits or whatever, then I feel you should definitley have that scan. IF you have a stomach ache for 3 hrs. and feel you "need" a CT scan, I definitley think you should NOT have that scan and I'm 99% sure your Doctor would agree. Most Doctors will try the least invasive tests first, depending on how severe your symptoms are. That is the Proper course of treatment. Trust your physician. No one is perfect, sure, but he is highly trained and I am sure he ..or she...will be happy to explain why they do or don't want to do a CT exam. Remember that not everything you hear on TV is accurate and honest. We wish that it were, but unfortunatley it is not. I am a Registered XRay Technologist and have been for 32 years so I know what is true and what is not. I think it is great when patients read up and are able to ask questions about their health care. I do not think it is wise to tell a Doctor what or order. Instead, establish a rapport with your Doctor where you can sit down and discuss your symptoms and perhaps the different treatments for those symptoms. Most all Doctors I know welcome an informed discussion and will be happy to participate in one with you. It is in their best interest, as well as yours, to have you healthy again. So, instead of throwing all this negative information at your Doctor on your next visit, you might try asking a few questions and presenting some positive xray information along with them.

What Is a PET Scan?

Many people call to ask exactly "What is a PET scan?" Positron Emission Tomography is a relatively new modality to the medical scene. It was introduced in 1974 but was still considered "experimental" in 2001. Today, however it has advanced to a highly diagnostic tool for physicians to use for diagnosis and treatment. The procedure is performed in the Nuclear Medicine Dept..(most often) where a radioactive isotope is injected into the bloodstream. This material is tagged, or mixed, with another agent to enable it to enhance a particular organ. After the injection the patient is placed
on a table, most often on their back, and moved into a machine. This machine is open on the sides so it isn't as constraining as the MRI machine. The machine scans the patient and sends information to a computer where it is processed and sent to the Radiologist for interpretation.
PET scanning has become a vital tool in the treatment of cancer patients. It can provide the Oncologist and Radiologist detailed information regarding the stages of cancer as well as the effectiveness of chemotherapy and radiation therepy treatments.Many times it is performed along with a CT exam. CAT scans can provide excellent detail of the anatomy in a 3-D representation. PET scans don't show the anatomy as well, but can provide great information regarding the functioning of the organs demonstrated.

More Questions/ X-Ray Information

Living in a small town is sometimes a bad thing. Everyone knows you..AND knows where you work. I have people calling me quite often to ask about their x-ray reports, the preparations, who's in the hospital, you name it. But, here are a few of the more popular questions I am asked.
When will MY doctor get the report? Truthfully, that's a very complex question. Most all x-rays performed before 5:00 pm will be read that same day(at my hospital anyway) The reports are transcribed & sent to the ordering physician..that day. Some places have the orders faxed over to the physician. At our hospital the Dr's office has to come over to pick up reports. And therein lies part of the problem. IF the office is very busy they may not have time to come and pick up reports..that day. Invariably, the patient calls us to say that the x-rays were not read and so they just don't have results yet. In most hospitals the x-rays are read the same day or the day after so you should definitley have results within 2 days.
Why do I have to remove jewelery when having an x-ray? This is an easy one. X-ray will pass through clothing but it cannot penetrate metallic objects. These objects will be white blobs on the x-ray film and can possibly cover up some pathology. We also have patients remove zippers, buttons, etc. for the same reason. It is advisable to wear clothing suitable, such as sweat pants, or elastic waist pants. Shirts with no buttons, and for women a sports bra, as it has no metal.
Will an x-ray show a torn cartilege? Simply put, an x-ray primarily shows bones. Granted, the Radiologist can tell alot, but typically to see a torn cartilege, usually in the knee, the patient needs to have an MRI. MRI shows exquisite detail of the tissues and ligaments, whereas x-ray cannot.This is also very helpful for patients that may have a rotator cuff problem.
Why do I have to hold my breath for x-rays? It really depends on which type of x-ray you are having. Basically, when a person breathes the diaphragm moves up and down. If I am x-raying the kidneys and my patient breathes, the kidneys look blurred because they do in fact move when the patient breathes. If I am x-raying a patient's chest to see the lungs,heart, etc..I need the patient to take a really deep breath and hold it in. The reason is that on deep inspiration the lungs are completely filled with air, and I can also see more of the heart shadow.

These are just a few of many questions. Post me if you have any you would like answered.

What About Contrast-X-ray Information

There is definitley a big buzz right now concerning contrast and X-ray Information.Television ads with Legal advice concerning anyone who has had MRI contrast. What's it all about and why is it so popular right now? That's a pretty good question. I have been an x-ray technologist for 35 years and have used IV Contrast materials..of one form or another, from the very beginning. Years ago the IV (meaning Intravenous..or through a vein) used to contain almost 60% iodine. The good thing was that this worked well for the x-rays..it helped everything to show up well. The bad part was that alot of patients either became very nauseated during the exam, or some developed hives,etc.. Not everyone had problems, but quite a few did. This was the "best" that we had at the time and the standard contrast agent to use. Keep in mind that Contrast agents are very necessary for some x-ray tests because Organs within the body are hollow and will not show up. The Contrast media fills the organ and it is demonstrated on the x-ray. As mentioned on a previous blog post..there are 2 types of Contrast. One is the Oral type that you drink and it rarely causes any problems other than occasional diarrhea. The IV contrast goes into the bloodstream and can present a problem for some patients.
It is required by every Hospital X-ray Dept. that a patient fill out a history sheet and present a list of medications they are currently taking. Most patients view this as a chore, un-necessary paperwork, or whatever. It could not be further from the truth. Each question on the history sheet is vitally important to the technologist performing your exam and to the Radiologist who is reading it. First question is "Have you ever had IV contrast material before?"...This is very important because IF you have had it previously, and IF you had ANY type of problem with it, the Radiologist will probably tell you that you CANNOT have the x-ray contrast ever again. WHY you ask? IF you had a few hives the first time, your body is telling you something is wrong and not to do it again. We take that seriously and know that the next time it could be much worse and possibly fatal. I usually tell my patients that have had a prior reaction to Contrast that they should consider obtaining a Medic ALert bracelet, or necklace. IF perhaps you were in a serious accident you may not be able to inform medical personnell that you are allergic to the contrast. They might send you directly for a CAT scan with IV contrast, and that could have some serious consequences. So, I think that's important. We also require patients to have current blood work for BUN & Creatinine..This tells us how the kidneys are functioning. Patients who are over 70 or diabetic are at risk for problems here. We cannot..or will not..administer the contrast without a recent BUN/creatinine. IF you fail to give correct history to the technologist you can cause serious problems for yourself. Many times these problems with Contrast are caused by improper information from the patient themselves. Always carry a current list of medications you are taking so we can be sure the contrast will not conflict with them. Try to pay very close attention to x-ray information,either written or oral, so you can work with the technologist to provide the best and safest exam possible. IF you have any questions always call ahead and ask the X-ray technologist. Most hospitals staff 24 hours every day and they are more than happy to explain anything you need. It's our goal to provide you with the most accurate information so you can assist us with your care. I hope this x-ray information has helped you to better understand Contrast and x-rays.

Pediatric X-Ray Information

CT, or Cat Scans, are a very important tool for physicians to use when diagnosing children. This is however, a two edged sword. Children are at a greater risk because they a longer life span to get a radiation related cancer. Fortunatley, there are ways to reduce radiation to children when they are sent for examinations. The National Cancer Institute recommend several steps for reducing radiation dosage to patients.
The First Step: Only Ct examinations that are very necessary should be performed. Pediatricians and Radiologists should speak together regarding the use of CT as opposed to other modalities that would not require radiation.
The Second Step: IF CT is the preferred route, then exposure settings should be adjusted accordingly so as to optimize the study and Minimize radiation exposure. This can be done by: a) Limit the area to be scanned to the smallest possible area.
b) Adjust the MA settings for the organ area to be scanned, ie..lower MA settings for bone and lung fields.
c) Adjust the technique for the child's size and weight.
d)Determine the correct scan resolution( lower resolution may be ok for some diagnostic purposed )
Physicians should be extremely vigilant when ordering CT examinations for children. They should refrain from ordering multiple scans for contrast enhancement.
Speaking with the Radiologist or the CT Technologist can help to minimize unnecessary exams and radiation dosage.
A recent study found that from 1991 to 2002 there had been a 4 fold increase in the number of CT examinations ordered. It also found that the cumulative dose per patient had doubled during that time frame. While this should not be alarming to us, it should definitley be an alert. It is too easy to go to the physician stating such and such a problem & that you want a Cat Scan for it. Most physicians go along with the patient a good percentage of the time because patients will just go somewhere else to get it done. The important thing to remember is that the physician is trained, highly trained, to diagnose and treat his patients. There are many ways to diagnose problems, and CT is but one of those methods. Point being, IF your Dr. wants to start out with blood work, or an Ultrasound exam, then go with that. Anytime you can find the cause with an invasive test or without radiation exposure, by all means, Go for it! This is true with adults and even more so with children.

This information was taken from an ASRT article/ October 2007/Patient Dose From CT

X-ray and Kids

I have been an x-ray tech for almost 32 years...if you count my two years of training. To say that I have a soft spot for kids and old people would be an understatement. It's hard to describe really, but there's just something precious about them, all of them, that makes my day. Most kids, even though they are scared, will do better with injuries than adults. Seriously, I have gone over to the Emergency Room to x-ray a child with a broken arm. It may be broken and severely displaced..(meaning not straight at all)..The child will be laying there trying to be very still and very quiet. Some will be screaming but most will not. Adults on the other hand, with the slightest sign of trauma they are screaming for pain medicine. Hard to believe..but it is very true. Kids are much tougher than we are! Old people, I mean from 75-95, they do great too. Most do not complain. A little lady I x-rayed the other night was 88. Cute as a button too. She had fallen and it appeared that her hip was probably broken. I explained to her what we had to do. She just smiled and said "Honey, do what you have to do"..She never yelled, just the opposite...she did her best to help me the entire time. I have a great respect for the older generation. They have been through so much in their lifetime and they handle it all with such grace. They have alot to teach us and I think that children do as well. INstead of US trying to teach them, perhaps we should stop and actually look at how they handle things. I really think we could learn alot.

X-Ray CT Questions Often Asked

There are a multitude of questions asked by patients and caregivers every single day. Many of the topics I could not begin to explain, and many others aren't really appropriate for this forum. Some of the following questions are asked most frequently and I hope they will help you too.

What will a CT of the brain show?
A CAT scan of the brain, or head, will show a number of things. It will demonstrate a number of vascular problems, ie..strokes, cerebral hemmorrage, or an abnormality of vessels that you could have been born with. It can identify masses or tumors, foreign bodies, or fractures of the skull. In some cases fractures or abnormalities of the facial bones are demonstrated. If there is fluid within the sinuses it will be seen as well.

What is a Renal Stone Ct?
This is a CAT scan specifically looking for a kidney store/ & or a subsequent blockage of the kidneys. There is no need for any contrast or dye so it is a Non-invasive type test. Kidney stones will most often show and if there is any blocking of the kidneys (hydronephrosis)

Will a CT show appendicitis?
Many times a CAT scan will show the inflamed appendix (appendicitis). The idea test is an Abdomen/Pelvic CT with contrast. Sometimes the physician will ask for Oral contrast to coat the stomach and intestines and also an IV contrast. This contrast is given through a vein, and it will demonstrate the urinary system. It also helps to enhance vessels around inflamed areas. The appendix may appear enlarged, have thickened walls, or sometimes it may have a calcification inside it called an appendicolith. Occasionally the appendix may not be clearly seen but there will much edema or swelling around the area. This is often a signal of appendicitis. The physician will consult lab results, a clinical evaluation, and often the CT scan before he makes the decision to do surgery.According to the New England Journal of Medicine in 100 consecutive cases of suspected appendicitis Ct scans prevented 13 cases of UN necessary surgery.

What is a CAT Scan?

A CAT Scan is a very popular, yet painless test that helps the physician in diagnosing and treating patients. The machine is a rather large, dougnut shaped machine that allows passage of a slender table so as to take a series of pictures. The machine takes a series of pictures, or slices, of a targeted area. These images
are then linked together by a computer program. The end result is a series of 3
dimensional pictures of the subject area.
The most common reasons for performing CT examinations are:
1) The ability to have a 3-D look at areas within the body, chest, abdomen,etc
2) CT is very helpful in detecting and differentiating different kinds of cancers. The suspected area can be measured and analyzed on different slices, & also compared with surrounding organs & tissues.
3) CT is very good at finding subtle fractures that may not be seen with a regular
x-ray. Spinal problems can often be detected with CT as well.
#4) Ct is great at demonstrating vascular problems such as a stroke, kidney failure, etc.

These are but a few of the most common reasons for doing a CAT scan. Always seek your Doctor's advice to be sure the exam is medically necessary.

The Most Popular X-Ray Ordered

By far the most popular x-ray exam is the Chest x-ray. We do millions of them every year. They are a very simple procedure but the information they provide can often be life saving. Most often the chest exam consists of 2 pictures. One picture we refer to is the PA. This is an abbreviation for Posterior to Anterior. What this means is that they are shooting the x-ray from back to front. You are facing a board that holds the cassette and film so your front side is closest to the film. The second picture is called a Lateral. This simply means that you will be turned to one side & your arms will be brought up out of the way. The x-ray shows a different projection of the chest & heart. It also gives a good look at the Thoracic spine. Occasionally if a person cannot stand or they are done as an Emergency patient, the exam will be done sitting upright and shooting AP, anterior to posterior.

A chest x-ray can tell the doctor a multitude of things. First off, is there fluid in the lungs? Is the heart enlarged? Are there any nodules or tumors seen? Does the patient have emphysema or COPD? Sometimes they look at the bony features. Are there any broken ribs seen? How does the Thoracic or upper spine look? The shoulder joints & clavicles may be seen on some patients & they will check those out as well.

Radiographic exposure for a chest x-ray is very limited. Since the lungs contain only air the x-rays pass through easily to get to the film.

A Short Lesson About Xrays

Most everyone has probably had an x-ray at some time or another. Whether it be for a broken bone, or perhaps a chest x-ray to check for bronchitis or pneumonia. In these modern times x-rays are a very popular tool in the physician's medical bag. One thing to note is that x-rays are formed by Ionizing Radiation. It's a bit complicated to explain but very important to remember that radiation is NOT good for you. It can cause damage to cells & tissues of the body & depending on the amount of radiation it can be serious. Do not panic about that. NO exam that is done medically uses that much radiation. However, the dose of radiation is cumulative, which means it can add up over time. Basically, what you need to know is you don't always "have to have" an x-ray, or Cat Scan. Sometimes patients come in expecting all these tests to be done when they may not be necessary. That is why we go to Doctors. They are trained to understand the symptoms & causes of different diseases or viruses & they are also trained to take care of them. So, if your doctor doesn't think you need an x-ray or CT, take him at his word. If in a week or so you are not feeling better then perhaps he will decide that is the appropriate action.