What is an X-Ray?
What is an Ultrasound?
What is an MRI?
What is a CT Scan?
What is a PET/CT Scan?
What is Nuclear Medicine?
What is Bone Densitometry?

What is Radiography?
Radiography or x-ray, as it is most commonly known, is the fastest and easiest way for a physician to view and assess broken bones. X-ray images of the skull, spine, joints and extremities are performed daily. The images of the injury may show very fine hairline fractures or bone chips; it can even show proper alignment and stabilization during the healing process.

Radiography involves exposing part of the body to a small dose of radiation to produce an image of the internal organs. When x-rays penetrate the body, they are absorbed in varying amounts by different tissues. For example, ribs are dense and will block much of the radiation and will appear white or light gray on the image. Soft tissue such as the lungs will appear darker because more radiation can pass through it to expose the film.

What does the x-ray equipment look like?
Radiography equipment consists of a large, flat table with a drawer that holds a tray into which an x-ray film cassette is placed. The x-ray tube is mounted from the ceiling so that it can be moved over the body part to be examined.

How should I prepare for my x-ray?
Most bone radiographs don't require any special preparation. You may be asked to remove jewelry, eyeglasses or any metal objects that might be overlying the part to be examined. It is very important for women to inform their physician and Radiologic Technologist if there is any possibility that they are pregnant.

How long will my x-ray examination take?
Depending on the part being examined it can take anywhere from five minutes to a couple of hours.

Exams commonly performed:
Abdomen-Abdomen x-ray is used to evaluate the kidneys, bladder, and gas pattern in the intestines. Chest-Chest x-ray is the most commonly performed diagnostic x-ray examination. A chest x-ray is usually done for the evaluation of lungs, heart and chest wall. Head-Head x-rays can be divided into three different categories. The skull x-ray is used to examine the bones of the skull, including the facial bones, nose and the sinuses. A sinus x-ray is an examination of the air-filled cavities of the skull. Finally, a facial x-ray is a series of pictures of the bones in your face. Lower (leg) and Upper (arm) extremities-Lower Extremities are x-ray exams of the foot, ankle, knee and/or leg. Upper Extremities are x-ray exams of the hand, wrist, and/or arm. Pelvis-Pelvis x-ray is an examination consisting of images of the bones of the lower torso, also known as the pelvic girdle. Spine-Spine x-rays are taken of the neck, upper or lower back and tailbone.Jump to the top of the page



What is Ultrasound?
Ultrasound imaging, sometimes called sonography is a method of obtaining images from inside the human body by using high frequency sound waves. As sound passes through the body, echoes are produces that identify how far away an object is, the size of the object, its shape and consistency (solid, fluid or mixed). Ultrasound can also measure the flow of blood using a specialized method called Doppler ultrasound. No radiation is used with ultrasound imaging. Ultrasound is a useful way of examining many of the body’s internal organs such as the liver, gallbladder, spleen, pancreas, kidneys, bladder, uterus, ovaries, thyroid and testicles.

When is ultrasound used?
Many expectant parents have first seen their unborn child with an ultrasound exam. Ultrasound is used extensively for evaluating pelvic and abdominal organs, blood vessels, and can help a physician determine the source of pain, swelling or infection in many parts of the body. Because ultrasound provides real-time images, it is also useful as a guide for needle biopsies. Ultrasound is also used to evaluate superficial structures such as the breast, thyroid and testicles.

Doppler ultrasound is a special technique used to examine blood flow. Doppler images can help to determine blockages of blood flow (such as a blood clot) and build up of plaque inside a blood vessel.

What does the equipment look like?
Ultrasound scanners consist of a console containing a computer, a video screen and a transducer that is used to scan the body. The transducer is a small, hand-held device that is attached to the console by a cord. The transducer is pressed against the area of interest to obtain images. These images appear immediately on a video screen. The technologist watches this screen continually during the exam and captures specific images for the radiologist to review.

What should I expect during my exam?
You will be expected to lie on your back on a comfortable exam table. Gel is applied to the patient’s body in the area to be examined. The gel assures that there is direct contact with the skin. The technologist presses the transducer firmly against the skin and sweeps it back and forth to obtain images of the area of interest. When the exam is complete you may be asked to wait in the room while the images are reviewed.

Most exams are painless, fast and easy. To obtain the appropriate images the technologist may have to apply some pressure, which may cause varying degrees of discomfort.

How do I get the results of my exam?
After the technologist has completed your exam, the images are reviewed by a radiologist – a physician specially trained to diagnose conditions by interpreting medical images. A written report is then faxed to your referring physician within 24 hours of completion of the exam. Once your physician receives and reviews the results of your exam, they will contact you to inform you of the results. You will not receive results at the time of your examination.

What are the benefits and risks of ultrasound?
Ultrasound has many benefits. It is noninvasive (does not use any needles or injections) and is usually painless. Ultrasound is easily available. It uses no ionizing radiation (x-ray), which makes it the preferred method to image pregnant women and their unborn children. Ultrasound can provide real-time imaging which makes it useful for guiding biopsy procedures.

There are no known harmful effects on humans.

What are the limitations of ultrasound?
Ultrasound does not penetrate bone. For visualization of bone, other imaging modalities, such as MRI may be used.

Ultrasound does not pass through air. Therefore, it is not useful in evaluating the organs that contain gas such as the stomach, small intestine or large intestine. Intestinal gas may also prevent visualization of deeper structures such as the pancreas and aorta. Patients suffering from obesity are more difficult to image because extra tissue weakens the sound waves as they pass deeper into the body.Jump to the top of the page



What is MRI?
Magnetic Resonance Imaging (MRI) uses radiowaves and a strong magnetic field rather than xrays to produce detailed images of body tissues and organs. The magnetic field “excites” and then “relaxes” protons in the body, emitting radio signals. The radio signals are processed by a computer to form an image.

How should I prepare for my MRI?
The magnetic field used in MRI will pull on certain metal objects implanted into the body. The technologist will ask whether you have a pacemaker, brain aneurysm clips, artificial limbs, or any metal screws or plates. A patient with a pacemaker cannot have an MRI. In most cases, metal used in orthopedic surgery pose no risk during an MRI. You will also be asked if you have ever had a bullet or shrapnel in your body or ever worked with metal. If there is a possibility of metal shrapnel in the eyes, you will be asked to do an xray prior to the MRI.

Clothing should be free of metal. Watches and hearing aids must be removed. You may also be asked to remove hairpins, jewelry, removable dental work, glasses, body piercings or any other metal in the region of the body being scanned. Scrubs are provided to change into with private dressing rooms and secured lockers for valuables.

How long will my MRI examination take?
Usually the entire process will take an average of 45 minutes to 1 hour, allowing time also for paperwork and patient care. The exam time may vary from exam to exam. If you are having multiple exams allow extra time for each region being scanned.

Who interprets my MRI examination and how do I get the results?
The radiologist on site at AMI will interpret the MRI. A radiologist is a physician who specializes in interpreting MRI's and other radiologic exams for the detection of abnormalities of bone and internal organs and tissues. A signed report of the radiologists interpretation will be available to your physician 24 hours after your exam. Your physician's office will inform you on how to obtain your results. Some physicians are able to obtain images and reports over the internet.

Contrast agents used in MRI
Gadolinium may be injected by a small needle into a vein in the patient's arm during certain exams. The contrast will enhance abnormal tissue in the body, such as scar tissue in the spine after surgery, or tumors. The contrast is different than that used with Cat Scans. The risk of an allergic reaction and kidney damage is very low. The amount of the contrast injected is determined by the patient's weight.

Commonly performed exams in MRI
* MRI Brain
* MRI Spine- Cervical, Thoracic and Lumbar Spine
* MRI Extremities-Wrist, Elbow, Foot, Ankle, Hip, Shoulder, Knee, etc
* MRI Abdomen
* MRI Pelvis
* MRI Breast (not performed at FCH)

MRI Brain
MRI of the brain is useful in detecting brain tumors, strokes and certain disorders such as multiple sclerosis. MRI can also detect abnormalities of the eyes or inner ear. Most exams of the brain will require an injection of contrast material to enhance the visibility of certain tissues or blood vessels. A small needle is placed into a vein of the hand or arm for the injection.

MRI Spine
MRI is frequently used to determine the causes of back pain, leg pain and numbness. The exam can detect a bulging, degenerated or herniated intervertebral disk. MRI can be done to help plan surgeries of the spine. MRI performed after surgery will show whether infection or post-op scarring is present. Patients that have had surgery of the spine may require an injection of contrast material.

MRI Extremities
MRI is frequently used to scan major joints in the body. Including shoulders, wrists, knees and hips. MRI can locate and identify the cause of pain, swelling, and bleeding in the tissues around joints and bones. The images can see tears and injuries to tendons, ligaments and muscles. MRI can also show arthritis and tumors involving bones and joints.

Magnetic Resonance Angiography (MRA)
MRA provides detailed images of blood vessels with or without the use of contrast material. MRA can detect blocking or narrowing of arteries, and can also detect aneurysms, an enlarged artery.

Exams commonly performed with MRA
* MRA Brain
* MRA Carotids (neck)
* MRA Renal arteries
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What is CT?
Computed Tomography(CT), also known as CAT scan, uses a limited beam of x-ray to obtain image data. The data is then interpreted by a computer to show cross sectional images of the body tissues and organs. Dense tissues, such as bones, appear white in the pictures produced by a CT scan. Less dense tissues, such as brain tissue or muscles, appear in shades of gray. Air-filled spaces, such as in the bowel or lungs, appear black.

What does the CT scanner look like?
The CT scanner has a large opening in which a table moves up and slowly through. As the patient moves through the large opening, an x-ray tube rotates around the patient obtaining images, which are then sent to a computer for interpretation.

How should I come prepared for my CT?
Clothing should be free of metal in the region being scanned. For example, for scanning of the chest shirts should have no metal buttons and bras should have no metal clips or clasps. For scanning of the pelvis pants should not have zippers or metal buttons. You may also be asked to remove jewelry, hairpins, hearing aids, removable dental work, body piercings, or any other metal in the region being scanned. Correct attire is available with private changing rooms and secured lockers. You may also be asked to refrain from drinking or eating anything 1 hour or longer before your exam. Women should inform their physician or the technologist if there is a chance of pregnancy.

How long will my CT examination take?
Allowing for paperwork and patient care time the entire process will take an average of 40 minutes. In most cases the actual time to obtain the CT images can be done in 10 to 30 seconds. The quick scan time allows us to gather information without the chance of voluntary or involuntary motion, which can degrade the images.

Contrast agents used in CT:
There are two commonly used contrast media in CT. One commonly used contrast to opacify the GI tract (stomach, small bowel, colon) is barium sulfate. This is usually taken orally, but can be administered-in some cases-rectally. The volume of CT barium sulfate to be administered will depend on the degree and the extent of contrast required in the area under examination. Your physician will inform you of the amount and the time to drink your contrast when the exam is scheduled.

Another contrast medium that contains iodine is often injected into the blood intravenously (IV) during the scan. This contrast makes blood vessels and other structures or organs more visible on the CT images. It may also be used to evaluate blood flow, detect tumors, and locate areas of inflammation. Intravenous contrast material is often used to obtain images of the brain, chest, abdomen, and pelvis; an oral contrast material is commonly given for an abdominal and/or pelvis CT scan. Contrast material may be injected in to the area around the spinal cord (intrathecally) for spinal scans.

Before the administration of IV contrast the technologist will ask the patient if they have any medicine or iodine allergies. A patient who has allergies is at higher risk of allergic reaction with the administration of IV contrast. If the patient is over 60 years of age and is having a CT exam with IV contrast, we require lab test to evaluate kidney function within the last 30 days. Poor kidney function could cause potential problems in the elimination of the IV contrast from the patient's body. At the time your physician's office schedules the appointment, they will inform you if you need lab work.

Exams commonly performed in CT:
* CT head
* CT sinus
* CT neck
* CT spine
* CT chest
* CT abdomen/pelvis
* CT bone/extremities (wrist, ankles, etc..)

Computed Tomography Angiography (CTA)
CT angiography or CTA is an examination to visualize blood flow in the major arteries throughout the body. An iodinated contrast is injected through a peripheral vein instead of an artery like in conventional catheter angiography. Scans are obtained in a quick and timely manner to help diagnose conditions such as aneurysms, pulmonary embolisms, and renal artery stenosis.

Exams commonly performed with CTA:
* CTA Head (not performed at FCH)
* CTA Chest (not performed at FCH)
* CTA Aorta (not performed at FCH)
* CTA Abdomen (not performed at FCH)
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What is PET/CT?
PET scan uses a camera along with radioactive tracers injected intravenously (IV) to obtain images of the human body's function and reveal information of health and disease. The scanner records signals that the tracer emits as it journeys through the body and is collected by targeted organs. A computer then interprets the signals into actual images, which then show biological maps of normal organ function and failure of an organ system.

What does the PET/CT scanner look like?
The PET scanner has a large opening, which a table moves slowly through. As the patient moves through the opening a camera records signals emitted by the radioactive tracers. A computer then interprets the signals into actual images.

How should I come prepared for my PET/CT?
If possible your clothing should be free of metals such as zippers, buttons, brassiere clips, and snaps. For your convenience correct attire is available with private changing rooms and secured lockers. You may also be asked to remove jewelry, hairpins, and body piercings. You will also be asked to have nothing to eat or drink except water 4 hours prior to your scan time.

How long will my PET/CT examination take?
With patient registration time, patient instruction time, time after intravenous administration, and actual scan time you average stay at our facility can be from 2 to 3 hours.

Exams commonly performed in PET/CT?
PET scans are used most often to detect cancer and to examine the effects of cancer therapy by characterizing biochemical changes in the cancer. These scans are performed on the whole body. PET scans of the heart can be used to determine blood flow to the heart muscle and help evaluate signs of coronary artery disease. PET scans of the heart can also be used to determine if areas of the heart that show decreased function are alive rather than scarred due to a prior heart attack, called a myocardial infarction. Combined with a myocardial perfusion study, PET scans differentiate nonfunctioning heart muscle from heart muscle that would benefit from a procedure, such as angioplasty or coronary artery bypass surgery, which would reestablish adequate blood flow and improve heart function. PET scans of the brain are used to evaluate patients who have memory disorders of an undetermined cause; who have suspected or proven brain tumors; or who have seizure disorders that are not responsive to medical therapy and, therefore, are candidates for surgery. Jump to the top of the page



What is Nuclear Medicine?
Nuclear medicine is a separate modality within the field of radiology. It uses radioactive tracers to show the function of different organs within the body. These tracers are most often given to the patient by intravenous injection, although some studies require the swallowing of a radioactive capsule. The camera used in nuclear medicine then detects the gamma rays being emitted from the patient, forming an image on the computer screen. For most studies performed in nuclear medicine, the radiation to the patient is comparable to that of a chest x-ray. As with any study in radiology, the patient should tell the technologist if there is a chance of pregnancy or if the patient is breastfeeding.

What does the Nuclear Medicine camera look like?
The nuclear medicine gamma camera at AMI is a large metallic ring comprised of two cameras that sit 180 degrees of each other. The scanner is open on all sides, and the patient table is positioned in between the two scanners. The cameras are able to translate up and down the length of the table, and are also able to rotate around the table.

How should I come prepared for my Nuclear Medicine Scan?
There are many different studies in nuclear medicine requiring many different preparations by the patient. Most often your doctors office will give you specific directions for your test at the time of scheduling. Directions can also be found for some of the more common studies on the back of the order sheet that your doctors office may have given you, and also on this web site. If you have any questions regarding your test and the preparation required, please feel free to give us a call.

You will generally not have to change out of your clothes for a nuclear medicine procedure, but you will be required for some studies to remove any metal object such as loose change, pocket knives, belt buckles, and some jewelry.

How long will my Nuclear Medicine examination take?
Studies in nuclear medicine vary in time, ranging from several minutes to several hours. Some studies involve scanning at different times during a single day, or some studies are carried out over several days.

Exams commonly performed in Nuclear Medicine

Bone scan:
This is a study that looks for stress fractures, loosening of prosthesis, bone infection, or spread of cancer to the bones. An injection is given into the vein of an arm, and pictures are obtained 3 hours later. The scan takes about 45 minutes to 1 hour. There is no special prep for the test, but the patient is instructed to drink plenty of fluids during the 3 hour break.

Hepatobiliary Scan:
This is a gallbladder study, sometimes referred to as a HIDA or PIPIPDA scan. This study looks at the function of the gallbladder and is sometimes performed after an ultrasound report shows normal anatomy. This study involves two different injections given through an IV. The first is the radioactive tracer for imaging and the second is an agent that stimulates the gallbladder to contract. The total scan time varies between 1.5 to 2 hours. Patients should not have anything to eat or drink at least 8 hours prior to the study.

Renal Scan:
This is a study that looks at the blood flow and function of both kidneys. An injection is given into the vein of the arm and pictures take approximately 45 minutes to 1 hour. There is no required preparation, although it's best if patients are well hydrated.

Lung Scan:
This is a study that looks at both the air flow and blood flow to the lungs, evaluating shortness of breath, the lungs prior to lung reduction surgery or looking for a pulmonary embolism (clot) in the lungs. It involves both inhaling a radioactive tracer and an injection into the vein of an arm. The pictures take approximately 1 hour. There is no special preparation.

Thyroid Uptake and Scan: (not performed at FCH)
This is a study that looks at the function of the thyroid. It is used to evaluate patients with abnormal thyroid lab values and/or symptoms of thyroid disorder. A radioactive capsule is given to the patient and the patient returns 4 hours later for a quick check, and then again 24 hours later for 1 hour of imaging. Patients should not have anything to eat at least 4 hours before taking the capsule and for 1 hour after. Patients should be off of any thyroid medications at least 3-4 weeks prior to the study. A serum pregnancy test is required for this test on all females within childbearing age, unless proof of hysterectomy or tubal ligation is present.

Radioiodine Therapy (Ablation) of the Thyroid: (not performed at FCH)
This is a therapeutic study involving a dose of radioactive iodine designed to destroy abnormal thyroid tissue. Both your doctor and our radiologist will review your thyroid condition to make the best determination in the amount of therapy required. Patients receiving a higher dose (thyroid cancer patients) will be given specific instructions to follow for 3-4 days after the ablation. They will be consulted by a radiation physicist and our radiologist prior to receiving the capsule. Patients with hyperthyroidism will have a few minor restrictions and will be consulted by our radiologist. Patients should not have anything to eat at least 4 hours before the test and for 1 hour after the test. Patients should be off of any thyroid medication at least 3-4 weeks, and a serum pregnancy test is required for all females within childbearing age unless proof of hysterectomy or tubal ligation is present.

I-131 Whole Body Scan:
This is a study done to evaluate the presence of thyroid tissue in patients that have undergone a thyroidectomy due to carcinoma of the thyroid gland. A radioactive capsule (non therapeutic, diagnostic only) is given and the patient returns 2 days later for the scan. The scan takes about 45 minutes to 1 hour. Patients should not have anything to eat 4 hours prior to the capsule and for 1 hour afterward. Confirmation by lab work that TSH is greater than 35 is required, as patients should be off of their thyroid replacement long enough to achieve this. A serum pregnancy test is required for all women within childbearing age unless proof of hysterectomy or tubal ligation is present.

Myocardial Perfusion Imaging (Cardiolite Stress test):
Myocardial Perfusion Imaging (cardiolite stress test) is used to assess the blood flow to the heart, in order to determine the amount of coronary artery disease, to diagnose the cause of chest pain and to evaluate the extent of muscle damage after a heart attack. This test includes two phases: rest and stress while monitoring blood pressure and heart rhythm. This test takes approximately 2 to 5 hours and may be completed on 1 day or 2 separate days. The rest phase includes an injection of the imaging tracer and images that take place 30 minutes to 1.5 hour after injection. The resting images take about 30-45 minutes to complete and are acquired while the patient is lying down on their back with their arms raised above their head. The stress phase s usually performed with exercise on the treadmill with an injection of the imaging tracer during exercise and stress images take place 15 minutes to 1.5 hours after exercise. But if a patient is unable to exercise a medication stress may be performed. The patient should wear loose fitting comfortable clothing and tennis shoes suitable for exercise. Depending on the purpose of the test, one or more cardiac medications may need to be stopped for 24-48 hours before the test. Please check with your physician before the test. The patient will be asked to not eat or drink 3 hours prior to the test, avoid caffeine for 24 hours before the test, avoid nicotine 8 hours prior to the test and bring a list of all their medicines or all their medicines with them. Jump to the top of the page



What is Bone Densitometry?
Bone densitometry is a widely used technique for measuring bone mineral density and diagnosing the presence of osteoporosis. To detect osteoporosis, doctors use a form of x-ray technology called dual- energy x-ray absorptiometry (DEXA). DEXA is a quick and painless procedure for measuring bone loss. Measurement of the spine and hip are most commonly done.

When is Bone Densitometry used?
Bone densitometry is commonly used to diagnose osteoporosis, a condition that often affects women after menopause, but also can be found in men. Osteoporosis is a gradual loss of calcium that causes the bones to become thinner, more fragile and more likely to break. Bone densitometry can assess your risk for developing fractures. If your bone density is low, your physician can work with you on developing a treatment plan to help prevent fractures. Bone densitometry can also track the effects of treatment for osteoporosis.

Some of the reasons your doctor may recommend a bone density test include:
* You are post-menopausal and not taking estrogen
* You have a history of hip fracture or smoking
* You are a male with clinical conditions associated with bone loss
* You use medications known to cause bone loss, including steroids, anti-seizure medications or high-dose thyroid replacement drugs.
* You have type 1 diabetes, liver disease, kidney disease or a family history of osteoporosis
* You have a thyroid condition, such as hyperthyroidism
* You received a fracture from only minimal trauma
* You have had a recent x-ray that shows a vertebral fracture or signs of osteoporosis.

How do I prepare for the procedure?
Wear loose, comfortable clothing. Try to avoid clothes that have zippers, belts or buttons made of metal. Inform your physician if you have recently had a test that required you to drink barium or be injected with contrast material (such as a CT scan or nuclear medicine test); you may have to wait several days after these tests to have a bone density test. There are no restrictions on what you can eat before the exam.

What does the DEXA equipment look like?
Our DEXA device has a large flat table with an arm suspended overhead.

What should I expect during my exam?
The exam will last approximately 15-30 minutes. Depending on what you wear to the exam, you may be asked to change into a gown or scrub pants. If your clothes do not have any metal on them, you won’t need to change. You will lie on your back on a padded table.

We will examine your spine and left hip. During the examination of you spine, your legs will be supported on a padded box in order to flatten your pelvis and lower spine. Sometimes we look at the spine from the side. For that picture, you will be asked to lie on your left side. During the exam of the hip, your feet will be placed in a brace that helps to rotate the legs inward. Once you are in position, a detector moves slowly over the area to be imaged and sends information to a computer.

While the exam is in progress, you will be asked to hold as still as possible to ensure a clear and useful image. The procedure is painless. The amount of x-ray used is very small – equivalent to about 1/10 the dose received from a chest x-ray.

How do I get the results of my exam?
After your exam is completed, the results of your bone density exam will be printed out and given to your physician. It may take a few days to reach your doctor. When he/she receives the results, they will discuss them with you and develop a treatment plan for you if necessary.

What are the limitations of Bone Densitometry?
DEXA Bone Densitometry is of limited use in people with spinal deformity or those who have had previous spinal surgery. It is also limited in patients who have had bilateral hip replacements. Osteoarthritis and verterbral compression fractures may also interfere with the accuracy of the test. Jump to the top of the page