L15:

Prepara&on of pa&ents
undergoing imaging inves&ga&ons
ICMP Year 3 2018/19
Dr Khor Foo Kiang


•  End of this lecture student will able to
understand about the preparing a pa&ent for
different imaging modali&es specially for the
pa&ents using contrast media.
 Radiology inves&ga&on
•  Request for imaging Ix—proper indica&on.
•  Esp for study with ionizing radia&on.
•  Radia&on should be jus&fiable .
•  Effect of radia&on:
a.  Determinsi&c effects: Radia&on effect if
above the threshold level, erythema.
b.  Stochas&c effect-Carcinoma, by chance.
Probability increase with higher radia&on
dose.
 Before go and request
•  Fill in radiology request form & checklist.
•  Pa&ent par&cular, history, physical findings
and inves&ga&on result.
•  Provisional diagnosis- treatment started in
ward/clinic.
•  Radiograph-no need to request, send form &
will call & perform.
•  If pa&ent not stable—Portable (CXR).
 Radiology inves&ga&on
To discuss with radiology team:
•  Ultrasound including bedside US.
•  Fluoroscopy-the indica&on.
•  CT & MRI

•  Bring previous imaging film & report for

discussion.
•  Repeat imaging must have good indica&on.
 Radiology inves&ga&on
•  Emergency case have to proceed immediately,
even without proper pa&ent prepara&on
(NBM, cover for allergy, Serum Crea&nine
raised).
•  Urgent study- will do within few hours to few
days &me.
•  Early appointment and normal appointment –
as outpa&ent basis.
 General informa&on for pa&ent
1.  NBM
-US HBS- to distend the gallbladder & reduced
air in upper abdomen.
-Contrasted study-CT scan & MRI.
-First allergic reac&on usually is nausea &
vomi&ng.
-Severe lia threatening condi&on-anaphylac&c
reac&on with cardiac arrest, intuba&on is
warranted.
 General informa&on for pa&ent
2. History of bronchial asthma, allergy (esp sea
food) or previous imaging contrast reac&on.
-  IV contrast media is iodine based prepara&on.
May induce BA or allergy reac&on.
-  Oral pregnisolone 40mg 12 hours and 2 hours
before the imaging.
-  Emergency case- give IV hydrocor&sone 200
mg STAT.
 General informa&on for pa&ent
3. Raised serum crea&nine
-Contrast media may further compromise pa&ent
renal func&on.
-Weight the benefits and risks of the study.
-Admit a day before imaging, hydrate pa&ent, give
IV N-acetylecys&ne.
-Monitor renal func&on post imaging.
-ESRF-arrange on the dialysis day, go straight for
dialysis post imaging. Advice to extract fluid.

 General informa&on for pa&ent
4. LMP
-Ask pa&ent ‘when was your last menses’
--NOT ‘are you pregnant now’.
-Main concern especially during 1st trimester of
pregnancy, ongoing organogenesis.
-Risk of future malignancy if high dose radia&on
exposure.
-No available data regarding the effects of contrast
media onto the kidneys of fetus.
 General informa&on for pa&ent
5.Hyperthyroidism
-In ac&ve hyperthyroidsm, risk of thyroid storm
if perform CT/procedure.
-Ensure euthyroid stage.
 Special modali&es
•  US
•  Fluoroscopy
•  CT scan
•  MRI
Request for imaging guided procedure
•  US or CT guided biopsy/tapping/drainage.
•  Informa&on we need:
•  Which modality is best for the procedure?
•  Risk of the procedure high? (lesion adjacent to
great vessels).
•  Blood Ix: Hb, Plt, PT/aPTT/INR.
•  Consent from primary team.
•  Escort Pa&ent for procedure.
•  Handle complica&on.
 CT guided biopsy (thorax/lung)
Complica&ons:
1.Pneumothorax.
2. Heamothorax.

Mx: Chest tube inser&on.

Possible complica&on post procedure, pa&ent
should be admimed a day before and observed in
ward post biopsy.

 US guided procedure
•  Drainage of abscess/collec&on.
•  US will men&on non-liquefied, par&ally liquefied
or fully liquefied.

•  Nephrostomy.
•  IV Line access.

•  FNAC/biopsy of thyroid nodule

•  FNAC/biopsy of breast lesion.
•  Outpa&ent appointment.
 Reference:
•  Guidelines for clinical prac&ce in radiology,
Malaysian Radiological Society.