DIAGNOSTIC TESTS

Aleth Therese L. Dacanay, MSc

PLAIN (CONVENTIONAL) X-RAYS / RADIOGRAPHY

CHEST XRAY

Most frequently used radiography. Used to diagnose cancer, tuberculosis and other pulmonary disease and disorders of the mediastinum and bony thorax It provides a sequential progress or development of a disease

CHEST XRAY

Can also provide valuable information about the condition of the heart, lungs, GI tract, and thyroid gland The routine chest radiography consists of two images Frontal view ( postero-anterior [PA]) Left lateral view

Procedure: Street clothing that is covering the chest is removed to the waist. Allow only cloth or paper hospital gown free of buttons and snaps to be worn during x-ray. Remove jewelry on or adjacent to the chest.

Procedure: Ensure that monitoring cables and patches do not obscure the chest area, if possible. Instruct the patient to take a deep breath and to exhale; and to take another deep breath and to hold it while the x-ray image is taken. Be aware that the procedure takes only a few minutes.

Clinical implications:
Abnormal chest x-ray results may indicate the following lung conditions:

Presence of foreign bodies Aplasia Hypoplasia Cysts Lobar pneumonia Bronchopneumonia Aspiration pneumonia Pulmonary brucellosis Viral pneumonia Lung abscess

Pleural effusion Atelectasis Pneumonitis Congenital pulmonary cyst Pulmonary tuberculosis Sarcoidosis Pneumoconiosis (e.g. asbestosis) Coccidioidomycosis Westermarks sign
(indicates decreased pulmonary vascularity, sometimes thought to suggest pulmonary embolus)

Middle lobe syndrome Pneumothorax

Abnormal conditions of the bony thorax include the ff.

Scoliosis Hemivertebrae Kyphosis Trauma Bone destruction or degeneration Osteoarthritis Osteomyelitis

Cardiac Enlargement

MAMMOGRAPHY

(Breast X-ray)

Soft tissue mammography visualizes the breast to detect small abnormalities that could warn of cancer.
Low-energy x-ray beam used for this procedure is applied to a tightly restricted area and consequently does not produce significant radiation exposure to other areas of the body. Diagnosis by a mammography is based on the radiographic appearance of gross anatomic structures.

Benign lesions tend to push breast tissue aside as they expand, whereas malignant lesion may invade surrounding breast tissue. Although a false-negative and a false-positive reading may occur, mammography is highly accurate.
The benefits of using low-dose mammography to find early, curable cancers outweigh possible risks from radiation exposure.

Procedure: Suggest patient to refrain from caffeinated foods and beverages for 5-7 days before taking the testing. Perform mammogram with the person in an upright position, preferably standing. Expose the breast and lift onto a film holder or digital plate. Adjust the breast tissue by hand, smoothing out all skin folds and wrinkles.

Lower a movable paddle onto a breast, rigorously compressing the breast tissue.

NOTE: rigorously compression is a brief and

uncomfortable but critical step in ensuring a highquality mammogram. It lowers dose and improves image quality.

Make an x-ray exposure quickly, and immediately lift the compression. Typically, take two views of the breast

Craniocaudal Mediolateral

Tell the patient that the complete examination takes abut 30 minutes.

ORTHOPEDIC X-RAY:
Bones, Joints, and supporting structure

This examines a particular bone, group of bones, or joint. Orthopedic radiography is performed on the following structures: The extremities
( e.g. hand, wrist, shoulder, foot, knee, hip)

The bony thorax

(e.g. ribs, sternum, clavicle)

The spine
(e.g. cervical, lumbar, thoracic, sacrum coccyx)

The head and skull

(e.g. facial bones, mastoids, sinuses)

Optimal results from orthopedic x-ray examinations depend on proper immobilization of the area being studied.
To produce a thorough image of the body part, at least two and sometimes more projections are required.

Procedure:

Inform the patient that dietary restrictions are not necessary. Have the patient assume the positions most favorable to capturing the best images. The degree of patient mobility and physical condition may also need to be considered. Skull x-rays require removal of dentures and partials.

Clinical implications:

Fractures Dislocation Arthritis Osteoporosis Osteomyelitis Degenerative joint disease Hydrocephalus Sarcoma Abscess and aseptic necrosis Pagets disease

Gout Acromegaly Metastatic processes Myeloma Osteochondrosis Bone infracts Histiocytosis X Bone tumors (benign and malignant) Foreign bodies

ECHOCARDIOGRAPHY

Considered by many physicians to be almost equal in value to the standard Electrocardiogram (ECG). It is based on underwater detection (sonar) that the navy developed during the World War II. When a sound wave is directed into the heart at various locations, the echo, or rebounding sound wave, graphically reflects each part of the heart where it bounces.

The analysis allows a three-dimensional visualization of the heart, the heart valves, the muscular structures, and even the blood as it passes through.
It can also indicate the size of each heart chamber, whether there are any masses in the heart, and especially whether there is excess fluid in the sac around the heart.

Clinical implication:

To diagnose:

Heart valve disease Enlarged heart Heart tumors Congenital heart defects in infants

To follow the patients with heart valve replacement

Echocardiogram machine

CONTRAST ECHOCARDIOGRAPHY

Virtualization of the right chambers of the heart is enhanced by the injection of contrast agents.

M-MODE ECHOCARDIOGRAPHY

Records the motion of the heart over time.

It is used to evaluate the structures of the heart throughout the cardiac cycle.

ELECTROCARDIOGRAPHY (ECG)

Formerly known as the EKG because of the original German spelling of the word:

Electrokardiagramma

Is a graphic measure of the hearts muscular activity and a reflection of the self-generated electrical impulses that pass through the heart muscle, causing contraction and relaxation.

Electrodes called leads are placed on the body, one on each wrist and ankle and one on the chest that can be moved over the entire heart area. The recorded electrocardiograph shows the rate and regularity of the hearts rhythm.

It can also show the force or effectiveness of each heartbeat, the extent and location of any heart muscle and the effect of certain drug.
There should be no pain or discomfort while a standard ECG is performed but some patients find it uncomfortable to lie still for long period of time.

ELECTROENCEPHALOGRAPHY (EEG)

It is a graphic recording of the minute electric current given off by the brain cell activity. The current is amplified, translated into wavy lines (waves), and recorded on paper.
The waves represent intermittent brain cell activity.

The height of the waves as well as the distance between each peak depends on body activity From 10 to 24 electrodes are applied to the scalp in specific positions to aid in locating any abnormal lesion that might be reflected on the EEG. The patient lies quietly with eyes closed and no body movements. The waves of the brain are represented by Greek letters.

Clinical implications: With hyperactive brain cell are those with epilepsy and interface with brain cell activity as seen with tumors.

ELECTROMYOGRAPHY (EMG)

It is a diagnostic neurological test to study the potential of muscle at rest, the reaction of muscle to contraction, and the response of muscle to insertion of a needle.
The patient lies at rest while the peripheral nerves in various areas are stimulated through electrodes, and the electrical activity in muscles and nerves is recorded.

The test is sometimes employed as a measure of the muscle tension produced by nervous stress; usually the muscle of the forehead is tested, since they can indicate relaxation or generalized body tension.

Clinical implication:

The test is an aid in ascertaining whether a patients illness is directly affecting the spinal cord, muscles, or peripheral nerves. To aid in the diagnosis of hysterical weakness and paralysis.

ANGIOGRAM

It is an X-ray contrast study designed to visualize blood vessels and nearby organs. Angio-blood vessels. The term angiogram is synonymous with the term arteriogram, which refers to the study of arteries s opposed to veins.

The general principle of the angiogram is to thread catheter into an artery and inject an X-ray contrast agent into it while taking x-rays of the area of interest. Before taking the test: some doctors prefer an overnight fast, whereas others allow a clear liquid diet. After the test: you will be kept in bed rest for a number of hours and your vital signs will be taken frequently.

COMPUTED TOMOGRAPHY

A technique that uses a computerized x-ray system to produce detailed sectional x-ray images. The system is very sensitive to differences in tissue density and produces detailed, two dimensional planar images The tissue attenuation can be increased with the use of contrast agents.

Patient lies while doing the angiogram testing.

BONE SCAN

The bone scan is a type of radionuclide scan used to visualize the skeleton.
The test takes several hours, of which about an hour is spent under the camera. Before the test: do not drink large quantities of water or other liquid before the injection.

Clinical implications:

Detect cancer in bones Monitor bone diseases To assess the progress of bone grafts Diagnose bone infections Detect fractures Evaluate unexplained bone pain

Example of a Bone Scan result

BRAIN SCAN

It is a type of radionuclide scan which is used to visualize the brain to evaluate symptoms such as paralysis, seizures, dementia, or certain types of severe headaches. The test takes about 4-5 minutes.

The images are taken with a gamma camera, a computerized device which will rotate very close to your head and shoulders.

Thirty minutes to two hours later another scan, taking about thirty minutes, will be performed, again you will be asked to lie still.

BRONCHOGRAPHY

Bronchography is an x-ray contrast study used to visualize the bronchial tubes. The general procedure is similar to that of bronchoscopy, with an x-ray contrast material being instilled as part of that procedure.

X-ray of your chest will then be taken.

After the test: You will be encouraged to cough in order to eliminate the contrast medium.

Fever is fairly common after bronchography.

Example of a Bronchography Result

CHOLECYSTOGRAM

Cholecystogram is an x-ray study designed to visualize the gallbladder.

It is obtained to evaluate symptoms suggestive of gallbladder disease, such as abdominal or right shoulder pain, jaundice or fatty food intolerance.

You will be given a contrast dye pill form to be taken orally the evening before the examination.

THANK YOU!!!