X-Ray Imaging

X-Ray Imaging

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    A technology known as linear tomography is used during urography. The x-ray tube and film cassette move over part of the body while the exposure takes place. This motion blurs the overlapping tissues and renders a sharp image of the selected tissue plane. Several of these images are taken as well as other films in different positions. Near the end of the exam, the technologist escorts the patient to the toilet to empty the bladder. Once back on the table, a film is taken of the patient's emptied bladder. After the films are checked by the radiologist, the exam is complete.
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    Intravenous urography (IVU) and pyelography (IVP) are different names for x-ray examination of the kidneys, ureters, and bladder. This test yields information about the function of the kidneys, the presence of stones in the urinary tract, and the passage of urine from the kidneys, ureters, and bladder.
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    The intravenous pyelogram (IVP) test is one of a series of imaging tests that can be done to determine whether a patient has bladder cancer.

    With IVP, a contrasting dye is injected into the patient and then the urinary tract is evaluated with serial X-rays. This X-ray shows the collecting system of the kidneys and helps the physician determine the presence of any irregularities. This is good for seeing small cancer locations and the upper urinary tract, and offers especially good details of the kidneys, ureters and bladder.

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    An arthrogram is a special kind of x-ray of a joint, usually a hip, shoulder, or wrist. During the procedure, a contrast material (also called dye) is injected into the joint. The contrast material is visible on the x-ray image and helps the radiologist and your doctor to recognize specific abnormalities (or to confirm the absence of abnormalities).
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    During an arthrogram x-ray:
    1. You will meet with a radiologist (a resident may also be present). You will be asked why the examination has been requested and whether you have any allergies. The radiologist will explain the procedure to you.
    2. You will be positioned on the x-ray table and asked to maintain the position.
    3. Local anesthesia (similar to Novocain) will be injected into the joint. This may burn momentarily but will numb the area within a few minutes.
    4. Contrast, air, and (sometimes) adrenaline will be injected into the joint.
    5. The radiologist will use fluoroscopy (a set of x-rays in real time) to monitor the flow of the injected materials. The technologist will take a set of x-rays when the radiologist is finished.
    The entire procedure takes approximately 45 to 60 minutes
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    Arthrography may be useful in diagnosing a number of conditions including rotator cuff tear, abnormalities in the cartilage of a joint, and adhesive cartilitis (frozen joint). Unlike a plain radiograph (x-ray), an arthrogram demonstrates the interior anatomy of the joint.
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    A venogram is used to confirm a diagnosis of deep vein thrombosis (DVT) and to distinguish clot formation from other venous obstructions. It can also be used to evaluate congenital (present at birth) venous malformations or to locate a vein for arterial bypass graft surgery. It may be used to determine the cause of swelling or pain in the extremity and also to determine the source of pulmonary emboli (blood clots that have traveled to the lung).
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    You may want to ask your physician about the amount of radiation used during the venogram procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of x-rays, so that you can inform your physician. Risks associated with radiation exposure may be related to the cumulative number of x-ray examinations and/or treatments over a long period of time.

    If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.

    Because contrast dye is used, there is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications, contrast dye, or iodine should notify their physician.

    Patients with kidney failure or other kidney problems should notify their physician. In some cases, the contrast dye can cause kidney failure, especially if the person is taking Glucophage (a diabetic medication).

    Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting.

    For certain individuals, a venogram may be contraindicated. These include persons with a known allergy to contrast dye, severe congestive heart failure, and severe pulmonary hypertension.

    There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.
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    A venogram may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

    Generally, the venogram follows this process:
    • You will be asked to remove your jewelry or other objects that interfere with the procedure.
    • You will be asked to remove clothing and will be given a gown to wear.
    • A pen may be used to mark various sites of pulses on the leg before the procedure. This will allow easier monitoring of the pulses after the procedure.
    • You will lie on your back on the x-ray table.
    • After cleansing the area, an intravenous (IV) line will be inserted into a vein in your foot.
    • An injection of contrast dye will be given. You may feel some effects when the dye is injected into the IV line. These effects include a flushing sensation, a brief headache, or nausea and/or vomiting. These effects usually last for a few moments. Also, let the physician know if you are having difficulty breathing, itching of the skin, or hives.
    • X-rays will be taken at timed intervals as the dye travels through the lower extremities.
    • A tourniquet may be placed on the extremity to control the speed of blood flow.
    • The intravenous site will be flushed with heparin/saline solution, and the needle will be removed from the vein.
    • A pressure dressing will be placed over the puncture site.
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    The following steps will precede a venogram:

    • Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
    • You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.
    • Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine.
    • Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
    • You may be asked to stop eating and/or drinking for at least four hours before the procedure.
    • Notify your physician if you are pregnant or suspect you may be pregnant.
    • Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
    • Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
    • If a sedative is given before or during the procedure, you may need to have someone drive you home afterwards.
    • Based upon your medical condition, your physician may request other specific preparation.