HIDA scan

• A HIDA scan is an imaging test used to examine the gallbladder and the ducts leading into and out of the gallbladder. 
• How it is done
  • The patient receives an intravenous injection of a radioactive material called hydroxy iminodiacetic acid (HIDA).
  • The HIDA material is taken up by the liver and excreted into the biliary tract.
  •  In a healthy person, HIDA will pass through the bile ducts and into the cystic duct to enter the gallbladder. 
  • It will also pass into the common bile duct and enter the small intestine, from which it eventually makes its way out of the body in the stool.
  • HIDA imaging is done by a nuclear scanner, which takes pictures of the patient's biliary tract over the course of about two hours. 
  • The images are then examined by a radiologist, who interprets the results. 
• Safety
  • It is generally a very safe test and is well tolerated by most patients.
• Indication
  • Usually, HIDA scans are ordered for patients who are suspected of having an obstruction in the biliary tract, most commonly those who are thought to have a stone blocking the cystic duct leading out of the gallbladder.
  • Such a scenario is consistent with acute cholecystitis, which often requires surgical removal of the gallbladder.
  • In cholecystitis, HIDA will appear in the bile ducts, but it will not enter the cystic duct or the gallbladder -- a finding that indicates obstruction.
  • If the HIDA enters the bile ducts but does not enter the small intestine, then an obstruction of the bile duct (usually due to stones or cancer) is suspected.
• Cost
  • $$

Bone scan

• A bone scan is a test that detects areas of increased or decreased bone metabolism (turnover). 
• How it is done
  • A radiotracer (bone-seeking radionuclide) is injected into the bloodstream through a peripheral vein. 
  • As it decays, the radiotracer emits gamma radiation, which is detected by a camera that slowly scans body. 
  • The camera is used to capture images to be used to determine how much of the radiotracer collects in the bones.
  • If a bone scan is performed to evaluate possible fracture or infection, images will be performed shortly after the radiotracer injection, as well as after a 3-hour delay, when the tracer has collected in the bones. 
  • This is called a 3-phase bone scan.
  • To evaluate metastatic bone disease, images are obtained only after the 3-hour delay. Information from the camera is recorded in a computer, which then processes the data and creates an image.
  • The scanning part of the test will last about an hour and may require moving to various positions.
• Indication
  • The test is performed to identify abnormal processes involving the bone such as tumor, infection, fracture, or an underlying metabolic disorder.
• Normal 
  • Normal distribution areas appear uniform and gray throughout all the bones in body.
• What abnormal results mean
  • There should be no areas of asymmetric increased or decreased distribution of the radionuclide. 
  • "Hot spots" are areas where there is increased bone uptake (accumulation) of the radiotracer; these appear black.
  • "Cold spots" are areas where there is less uptake of the radiotracer. 
  • These appear light or white.
• Safety
• Cost
  • $

V/Q scan; Ventilation/perfusion scan; Lung ventilation/perfusion scan

• A pulmonary ventilation/perfusion scan is a pair of nuclear scan tests that use inhaled and injected radioactive material (radioisotopes) to measure breathing (ventilation) and circulation (perfusion) in all areas of the lungs.
• How it is done
  • A pulmonary ventilation/perfusion scan is actually two tests that may be performed separately or together.
  • The perfusion scan is performed by injecting radioactive albumin into a vein. 
  • The patient is immediately placed on a movable table that is positioned under the arm of a scanner. 
  • The lungs are scanned to detect the location of the radioactive particles as blood flows through the lungs.
  • The ventilation scan is performed by scanning the lungs while having the person inhale radioactive gas. 
  • A mask is placed over the nose and mouth, and the patient is asked to breathe the gas while sitting or lying on the table beneath the arm of the scanner.
  • A chest X-ray is usually performed prior to or following a ventilation and perfusion scan.
• Indication
  • The ventilation scan is used to evaluate the ability of air to reach all portions of the lungs. 
  • The perfusion scan measures the supply of blood through the lungs.
  • A ventilation and perfusion scan is most often performed to detect a pulmonary embolus. 
  • It is also used to evaluate lung function in people with advanced pulmonary disease such as COPD and to detect the presence of shunts (abnormal circulation) in the pulmonary blood vessels.
• Normal 
  • A ventilation and perfusion scan should be correlated with a chest X-ray.
  • There should be uniform uptake of radioisotope in all portions of the lungs with equal distribution in both lungs.
• What abnormal results mean
  • A decreased uptake of radioisotope during a perfusion scan indicates a problem with blood flow, including occlusion of the pulmonary arteries. 
  • A localized decreased in perfusion scan uptake (particularly when ventilation scan is normal) may indicate pulmonary embolus. 
  • Larger areas of decreased perfusion scan uptake may indicate a condition such as pneumonitis.
  • A decreased uptake of radioisotope during a ventilation scan may indicate reduced breathing and ventilation ability or airway obstruction. 
  • A decreased ventilation uptake (plus X-ray evidence of consolidation) may indicate pneumonia.
  • Larger areas of poor uptake may indicate damage from chronic smoking or COPD.
• Safety
• Cost
  • $$$

CAT scan; Computed axial tomography (CAT) scan

• Computed tomography (CT) a method of body imaging in which a thin x-ray beam rotates around the patient. 
• Small detectors measure the amount of x-rays that make it through the patient or particular area of interest.
• A computer analyzes the data to construct a cross-sectional image. 
• These images can be stored, viewed on a monitor, or printed on film. 
• In addition, three-dimensional models of organs can be created by stacking the individual images, or "slices."
• How it is done
  • The patient will be asked to lie on a narrow table (gantry) that slides into the center of the scanner. 
  • Depending on the study being performed, the patient may need to lie on his/her stomach, back, or side. 
  • If contrast media (dye) is to be administered, an IV will be placed in a small vein of a hand or arm.
  • Much like standard photographic cameras, subject motion causes blurred images in CT. 
  • Therefore, the technologist operating the scanner and supervising the patient will give instructions through an intercom when to hold one's breath and not move.
  • As the exam takes place, the gantry will advance small intervals through the scanner. 
  • Modern "spiral" scanners can perform the examination in one continuous motion of the gantry. 
  • Generally, complete scans will only take a few minutes, however, additional contrast-enhanced or higher-resolution scans will add to the scan time. 
  • The newest multidetector scanners can image the entire body, head to toe, in less than 30 seconds.
  • CT provides rapid, detailed cross-sectional imaging of the patient which can then be reconstructed into three-dimensional models, as needed.
  •  Intravenous contrast enhanced scans allow for evaluation of vascular structures and further evaluation of masses and tumors.
• Indication
  • CT is often utilized in the trauma setting to evaluate the brain, chest, and abdomen. 
  • As well, CT can be used to guide interventional procedures, such as biopsies and placement of drainage tubes
• Safety
• Cost
  • $$

Magnetic resonance imaging; Nuclear magnetic resonance (NMR) imaging

• MRI is a non-invasive procedure that uses powerful magnets and radio waves to construct pictures of the body. 
• Unlike conventional radiography and Computed Tomographic (CT) imaging, which make use of potentially harmful radiation (X-rays), MRI imaging is based on the magnetic properties of atoms. 
• A powerful magnet generates a magnetic field roughly 10,000 times stronger than the natural background magnetism from the earth. 
• A very small percentage of hydrogen atoms within a human body will align with this field. 
• When focused radio wave pulses are broadcast towards the aligned hydrogen atoms in tissues of interest, they will return a signal. 
• The subtle differences in that signal from various body tissues enables MRI to differentiate organs, and potentially contrast benign and malignant tissue. 
• Any imaging plane (or "slice") can be projected, stored in a computer, or printed on film. MRI can easily be performed through clothing and bones. 
• However, certain types of metal in the area of interest can cause significant errors in the reconstructed images.
• How it is done
  • Since MRI makes use of radio waves very close in frequency to those of ordinary FM radio stations, the scanner must be located within a specially shielded room to avoid outside interference. 
  • The patient will be asked to lie on a narrow table which slides into a large tunnel-like tube within the scanner.
  • In addition, small devices may be placed around the head, arm, or leg, or adjacent to other areas to be studied. 
  • These are special body coils which send and receive the radio wave pulses, and are designed to improve the quality of the images.
  •  If contrast is to be administered, an IV will be placed, usually in a small vein of the hand or forearm. 
  • A technologist will operate the machine and observe you during the entire study from an adjacent room.
  • Several sets of images are usually required, each taking from 2 to 15 minutes. 
  • A complete scan, depending on the organs studied, sequences performed, and need for contrast enhancement may take up to one hour or more. 
  • Newer scanners with more powerful magnets utilizing updated software and advanced sequences may complete the process in less time.
  • An MRI can provide additional imaging information for the clinician based upon its superior tissue contrast resolution. 
  • Combined with other imaging methods, a more definitive diagnosis can be given in the work up of a patient's disease.
  • Sequences performed with intravenous contrast may provide additional data about the blood vessels within masses.
• An MRA, or magnetic resonance angiogram, is a special type of MR that creates three-dimensional reconstructions of vessels containing flowing blood and is often utilized when conventional angiography cannot be performed due to renal failure or other contraindications
• Indication
• Normal
• Abnormal
• Safety
• Cost
  • $$$$

Ultrasound (Sonogram)

• Ultrasound involves the use of high-frequency sound waves to create images of organs and systems within the body.
• How it is done
  • An ultrasound machine creates images that allow various organs in the body to be examined. 
  • The machine sends out high-frequency sound waves, which reflect off body structures. 
  • A computer receives these reflected waves and uses them to create a picture. 
  • Patient will be lying down for the procedure. 
  • A clear, water-based conducting gel is applied to the skin over the area being examined to help with the transmission of the sound waves. 
  • A handheld probe called a transducer is then moved over the area being examined. 
  • Patient may be asked to change position so that other areas can be examined.
• Indication
• Normal
• Abnormal
• Safety
  • Unlike with an X-ray, there is no ionizing radiation exposure with this test.
  • The test is usually done in the ultrasound or radiology department but it can be done at bed side.
• Cost
  • $

Duplex/Doppler ultrasound

• These tests measure blood flow and blood pressure. 
• A duplex study is a test which uses Doppler ultrasound to assess and/or monitor blood flow through arteries or veins. 
• Plethysmography measures changes in blood volume in a blood vessel.
• How it is done
  • For the Duplex/Doppler ultrasound:
    • Clothing from the area being monitored is removed, and a probe with a conductive gel (like vasoline) on the tip is placed on various points along the vessel being tested. 
    • This enables the technician to evaluate blood flow through the vessels. 
    • The information is relayed to the ultrasound monitor to be viewed and recorded.
  • For a plethysmography:
    • Blood pressure is first monitored in both arms.
    • The clothing from the extremity being tested is removed and the patient lies on his or her back. 
    • A blood pressure cuff is applied to the extremity being tested and inflated until the pulsatile flow is no longer heard. 
    • Then the pressure is released from the cuff until the flow returns. 
    • The blood pressure when flow returns is recorded and the information is transmitted to a computer which records and interprets the information.
    • The blood pressure cuff may be moved to other positions on the same or other extremities during the test. 
    • After the readings are taken, the patient may be re-tested while in another position such as sitting or standing.
• Indication
  • These tests are noninvasive (external) tests used to determine if there is significant disease in either arteries or veins, if adequate blood is reaching an extremity, to evaluate trauma to a blood vessel, or to monitor patients with arterial reconstruction or graphs. 
  • These tests can also detect blood clots.
• Normal 
• As part of a duplex ultrasound, the doctor may calculate an ABI or ankle-brachial index. 
• This number is obtained by dividing the Doppler or systolic pressure of the ankle by the pressure in the arm. 
• A value of 0.9 or greater is normal. 
• Your doctor will also evaluate the flow of blood in the vessels with the ultrasound.
• Safety
• Cost
  • $

Transthoracic echocardiogram (TTE); Echocardiogram - transthoracic; Doppler ultrasound of the heart; Surface echo

• Echocardiogram is a test that uses sound waves to create a moving picture of the heart. 
• The picture is much more detailed than X-ray image and involves no radiation exposure.
• How it is done
  • A trained sonographer performs the test, then your physician interprets the results. 
  • An instrument that transmits high-frequency sound waves called a transducer is placed on your ribs near the breast bone and directed toward the heart. 
  • The transducer picks up the echoes of the sound waves and transmits them as electrical impulses. 
  • The echocardiography machine converts these impulses into moving pictures of the heart.
  • Echocardiogram works well for most patients and allows doctors to see the heart beating and to visualize many of the structures of the heart. 
  • Occasionally, because your lungs, ribs, or body tissue may prevent the sound waves and echoes from providing a clear picture of heart function, the sonographer may administer a small amount of a dye through an IV to better see the inside of the heart.
  • Very rarely, more invasive testing using special echocardiography probes may be necessary.
  • If the echocardiogram is unclear due to a barrel chest, congestive obstructive pulmonary disease, or obesity, your health care provider may choose to perform a transesophageal echocardiogram, or TEE. With TEE, the back of your throat is anesthetized and a scope is inserted down your throat. 
  • On the end of the scope is an ultrasonic device that an experienced technician will guide down to the lower part of the esophagus, where it is used to obtain a more clear two-dimensional echocardiogram of your heart.
• Indication
  • This test is performed to evaluate the valves and chambers of the heart in a noninvasive manner. 
  • The echocardiogram allows doctors to evaluate heart murmurs, check the pumping function of the heart, and evaluate patients who have had heart attacks. 
  • It is a very good screening test for heart disease in certain groups of patients.
• Normal 
  • A normal echocardiogram reveals normal heart valves and chambers and normal heart wall movement.
• Safety
• Cost
  • $

RNV; Cardiac blood pooling imaging; Nuclear heart scan; Radionuclide ventriculography; MUGA

• A test that uses radioactive tracers to delineate heart chambers and major blood vessels leading to and from the heart.
• The procedure is non-invasive
• The heart structures are not touched by instruments.
• How it is done
  • A radioactive isotope is injected into the vein.
  • Commonly used isotopes include technetium and thallium.
  • Radioactive isotopes attach to red blood cells and pass through the heart in the circulation. 
  • The radioactive isotope can be traced through the heart using special cameras or scanners
  • The images may be synchronized with an electrocardiogram. 
  • The test is often given at rest then repeated with exercise or after administering certain medications.
  • The test may be performed to detect a heart attack, to evaluate those at risk of coronary artery disease without invasive testing (coronary angiography and heart catheterization), and to evaluate heart wall motion and pumping function of the heart.
• Normal
  • Normal results indicate normal heart valve and chamber structure and function, or a normal cardiac response to exercise.
• Safety
• Cost
  • $

Cardiac angiography; Angiography - heart

• Coronary angiography is a procedure in which a contrast material that can be seen using X-ray equipment is injected into one of the arteries of the heart. 
• This allows you to view the flow of blood through your heart.
• How it is done
  • Coronary angiography is usually performed in conjunction with cardiac catheterization. 
  • Patient will be given a mild sedative prior to the test to help you relax.
  • The study is carried out in a laboratory by a trained cardiologist or radiologist and technicians or nurses. 
  • An intravenous (IV) line is inserted into one of the blood vessels in your arm or groin after the site has been cleansed and numbed with a local anesthetic.
  • A catheter is then inserted through the IV and into your blood vessel. 
  • The catheter is carefully threaded into the heart using an X-ray machine that produces real-time pictures (fluoroscopy).
  • Once the catheter is in place, contrast material is injected and pictures are taken.
  • Coronary angiography is performed to detect obstruction in the coronary arteries, which can lead to heart attack. 
• Indication
  • It may be performed if you have unstable angina, atypical chest pain, aortic stenosis, or unexplained heart failure.
  • The test may also be performed for other reasons.
• Normal 
  • Adequate blood supply to the heart is a normal finding with a coronary angiogram.
• Safety
• Cost
  • $
• A Cardiac Cathetherization (also called a heart cath or heart angiogram) is a test to show the inside of your heart and coronary blood vessels. A long, thin, tube is placed in a blood vessel in your groin or arm and advanced toward the heart. Once it is in the right location in the heart or blood vessel, a dye is injected and xrays and videos are taken. The test is done by a cardiologist (heart specialist) who is assisted by nurses and technicians in the Cardiac Cath lab. The test takes about 1 hour.

Angiogram; Angiography

• Arteriography is a procedure in which a contrast material that can be seen using X-ray equipment is injected into one of the arteries, allowing your health care provider to see the vessel.
• How it is done
  • An arteriogram can be used to examine almost any artery, including those of the head, kidneys, heart, or lungs.
  • The study is carried out in a laboratory by a trained cardiologist or radiologist and technicians or nurses.
  • First the doctor will need insert an intravenous (IV) line into one of the blood vessels in your arm, chest, neck, or groin.
  • A catheter is then inserted through the IV and into your blood vessels using an X-ray machine that produces "live" pictures.
  • Once the catheter is placed into the blood vessel of interest, contrast material is injected and pictures are taken.
• An arteriogram can be used to examine almost any artery, including those of the head, kidneys, heart, or lungs.
  • Cerebral angiography (head)
  • Extremity angiography (arm or leg)
  • Renal angiography (kidneys)
  • Pulmonary angiography (lungs)
  • Lymphangiography (lymph vessels)
  • Right heart ventriculography (looking at the right side of the heart)
  • Left heart ventriculography (looking at the left side of the heart)
  • Coronary angiography (looking at the vessels of the heart)
  • Aortic angiography or aortography (looking at the aorta, the major artery from the heart)
  • Eye angiography
  • Cardiac catheterization
• Indication
  • The reasons for this test depend on the type of arteriogram that will be performed.
  • In general, arteriograms give the best pictures of the body's blood vessels.
  • Arteriograms are used to make specific diagnoses and to help determine what the best treatment is in a particular case.
  • Often, the treatment itself can be performed using the same type of catheters used in the arteriogram, instead of requiring a more extensive surgery in an additional procedure.
  • It is sometimes used as part of a procedure to repair the blood vessels called balloon angioplasty.
• Safety
• Cost
  • $

What Is a DEXA Scan?           A Bone Density or DEXA scan uses x-rays to measure the amount of minerals in your bones.

What Is a Bone Scan?   A bone scan shows any damage or activity within your bones by using a small amount of radioactive material which is taken up by the bones. A scanner produces a picture that can show very small amounts of changes in the bone. The radioactive material is eliminated from your body very rapidly.

What is a F-18 FDG study?    

A F-18 FDG study shows how different organs and tissues in the body us (metabolize) sugar (glucose). 

What Is a Lung Scan?  A lung scan shows the pattern of blood flow to lungs by using a small amount of radioactive material injected into vein.

What Is a MUGA Study?   A MUGA scan shows how your heart is working. By using a small amount of radioactive material, the camera can produce a picture that shows the heart at work.

What Is a Myoview Exercise Stress Test?   The Myoview Stress Test shows how much blood is being supplied to your heart muscle while at rest and during exercise.

What Is a Adenoscan-Myoview Stress Test?   The Adenoscan - Myoview Stress Test shows how much blood is being supplied to your heart muscle at rest and later while you receive a medication (Adenoscan) through an intravenous line.. The test is for people who are unable to perform an exercise stress test on a treadmill. This medication increases your heart's blood flow as if you were exercising.

What is a Prostascint Scan?  A Prostascint scan can detect cancer cells in/and around the prostate gland or cells that spread from the prostate. A special radioactive substance is injected into a vein and is taken up by prostate cancer cells. The cells then can be detected 96-120 hours after the injection.

What is a Renal Scan with Lasix?  A Renal Scan with Lasix helps to decide how well kidneys are working and if they are obstructed.

What is a Renal Scan with Vasotec?   This Nuclear Medicine test helps decide if altered blood flow to kidney is the cause of your high blood pressure.

What is a Renal Scan with Lasix?   A Renal Scan with Lasix helps to decide how well kidneys are working.

What Is an Angiogram?        An angiogram is a test that evaluates blood vessels. To outline the blood vessels so they can be seen on x-ray, a solution containing iodine (called contrast media) is injected into a blood vessel. As the blood and contrast flows through the smaller blood vessels, x-rays are taken.

What Is a Barium Enema?      A Barium Enema is a study of the colon or large bowel. A solution of barium is given as an enema to coat the bowel walls and x-ray images or pictures are taken.

What Is an Air Contrast Barium Enema?   An Air Contrast Barium Enema is a study of the colon or large bowel. A solution of barium is given as an enema to coat the bowel walls; then air is injected to distend the colon, and x-ray images or pictures are taken.

What Is a Chest X-Ray?

A Chest x-ray produces a picture of the lungs, heart, windpipe and ribs.

What is a CT Scan?  A CT Scan is a series of computerized x-rays taken by a CT scanner, which is a specialized x-ray machine.  The scanner resembles a large doughnut with an examination table through the center. The patient lies on the table and when the scans are taken, the table moves slowly through the scanner. Scans can be done on any part of the body. Common CT scans are of the chest, abdomen, pelvis, head spine and or blood vessels. These scans allow doctors to see inside some areas of the body, which cannot be seen using conventional x-rays.

What is a Cystogram/Voiding Cystogram?       A Cystogram/Voiding Cystogram is an x-ray test which shows the urinary bladder and urethra by using a contrast media (a liquid containing iodine which outlines the organs). This contrast material will be inserted into the bladder by a radiologist through a catheter. The catheter is usually inserted through the urethra by the radiologist or nurse. Several images will be taken.

What is an IVP (Intravenous Pyelogram)?      An intravenous pyelogram (IVP) is an x-ray test which examines the kidneys, ureters and bladder by using contrast media (a a liquid which contains iodine and is injected into a blood vessel).  Several pictures or images will be taken.

What Is a Mammogram?  A mammogram is an x-ray of the breast. The exam is performed using a special machine in which the breast can be positioned to obtain a clear picture.

What Is a Myelogram?   A myelogram is an x-ray examination of the spinal canal. A contrast solution, containing iodine, is injected into the fluid around the spinal cord. This solution outlines the spinal cord so an image of it can be taken.

What is an UGI?   An UGI (Upper gastrointestinal) is a study of the esophagus and the stomach (the upper part of the digestive system). A solution of barium is swallowed to coat the organs so that they can be seen, and x-ray images or pictures are taken to show the lining of the stomach and esophagus.

What is an UGI?  An UGI/Small Bowel (Upper GastroIntestinal/Small Bowel) is a study of the esophagus and the stomach (the upper part of the digestive system) and the small bowel. A solution of barium is swallowed to coat the intestines so that they can be seen, and x-ray images or pictures are taken to show the movement of the solution through the intestines.

What Is an Ultrasound?    An ultrasound is a test that uses sound waves to "see inside" body. The ultrasound does NOT use any radiation, special dyes or medications. Almost any organ of the body can be "seen" by ultrasound.