Patient Education

At Valence Medical Imaging we offer the full range of general ultrasound examinations. Our staff can answer any questions you have regarding the examination your doctor has ordered. This section offers an overview of various exam procedures to allow patients to develop a better understanding of their indications and value to further health outcome.

Abdominal Ultrasound

Ultrasound Overview

Ultrasound imaging is a non-invasive medical test that helps physicians diagnose and treat medical conditions. Ultrasound is safe and painless. It produces pictures of the inside of the body using sound waves. Ultrasound imaging is also called ultrasound scanning or sonography. It uses a small probe called a transducer and gel placed directly on the skin. High-frequency sound waves travel from the probe through the gel into the body. The probe collects the sounds that bounce back. A computer uses those sound waves to create an image. Ultrasound exams do not use ionizing radiation that is used in x-rays. Because images are captured in real-time, they can show the structure and movement of the body’s internal organs. They can also show blood flowing through blood vessels.

What is Abdominal Ultrasound Imaging?

Ultrasound imaging of the abdomen uses high frequency sound waves to produce pictures of the structures within the upper abdomen. It is used to evaluate the kidneys, liver, gallbladder, bile ducts, pancreas, spleen, abdominal aorta and to help diagnose pain or distention (enlargement). Ultrasound images are captured in real time which help diagnose a variety of conditions and damage caused by injury or illness. Ultrasound is safe, non-invasive and does not use ionizing radiation.

A Doppler ultrasound study may be part of an abdominal ultrasound examination. Doppler ultrasound is a special ultrasound technique that evaluates blood flow through the arteries and veins in the body. Abdominal ultrasound imaging is performed to evaluate the kidneys, liver, gallbladder, bile ducts, pancreas, spleen, abdominal aorta and other blood vessels of the abdomen.

Abdominal ultrasound exams can assist with diagnosing a variety of conditions including but not limited to: abdominal pain or distention (enlargement); abnormal liver function, enlarged abdominal organs, gallstones, kidney stones, and an abdominal aortic aneurysm (AAA).

Doppler ultrasound images can help the physician to evaluate: blockages of blood flow, i.e. blood clots; narrowing of blood vessels; tumors and congenital vascular malformations; reduced or absent blood flow to various organs, such as the testes or ovary and increased blood flow, which may be a sign of infection.

Preparing for the Procedure

Wear comfortable, loose-fitting clothing. You may need to remove all clothing and jewelry in the area to be examined. You may be asked to wear a gown during the procedure.

Preparations depend on the type of ultrasound you are having.

For a study of the liver, gallbladder, spleen, and pancreas, you may be asked to eat a fat-free meal on the evening before the test and then to avoid eating for eight to 12 hours before the test.
For ultrasound of the kidneys, you may be asked to drink four to six glasses of liquid about an hour before the test to fill your bladder. You may be asked to avoid eating for eight to 12 hours before the test to avoid gas buildup in the intestines.
For ultrasound of the aorta, you may need to avoid eating for eight to 12 hours before the test.

What Does the Ultrasound Equipment Look Like?

Ultrasound scanners consist of a computer console, video display screen and attached transducers. The transducers are small, hand-held devices that resemble a microphone. Some exams may use different transducers that have different capabilities during a single exam.

The ultrasound image is immediately visible on the ultrasound screen which looks like a computer screen. The sonographer or radiologist will continue to capture the necessary number of images that will then be digitally sent to the radiologist for review and reporting.

What To Expect During and After The Procedure

For most ultrasound exams, you will lie face-up on an exam table that can be tilted or moved. Patients may be turned to either side to improve the quality of the images.

After you are positioned on the examination table, the radiologist (a physician specifically trained to supervise and interpret radiology examinations) or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.

There is usually no discomfort from pressure as the transducer is pressed against the area being examined. However, if scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.

If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.

Once the imaging is complete, the ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry quickly. The ultrasound gel does not usually stain or discolor clothing. Most ultrasound exams are painless, fast and easily tolerated. Abdominal ultrasound is usually completed within 30 minutes. You should be able to resume your normal activities immediately.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be needed to determine if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. the Risks

Benefits

The benefits of ultrasound include:

Easy to administer and widely available
Painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Use NO ionizing radiation and is extremely safe
Uses real-time imaging which is useful for guiding minimally invasive procedures such as cortisone injections, aspiration of fluid from joints and needle biopsies
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
An important alternative diagnostic tool than magnetic resonance imaging (MRI) for patients who have cardiac pacemakers, fragments within their body, ferromagnetic implants and/or who are claustrophobic.
Advantages over MRI to visualize tendon structures

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Limitations of Abdominal Ultrasound Imaging

Ultrasound waves are disrupted by air or gas. Therefore, ultrasound is not an ideal imaging technique for the air-filled bowel or organs obscured by the bowel. Ultrasound is not as useful for imaging air-filled lungs, but it may be used to detect fluid around or within the lungs. Similarly, ultrasound cannot penetrate bone, but may be used for imaging bone fractures or for infection surrounding a bone.

Large patients are more difficult to image by ultrasound because greater amounts of tissue attenuate (weaken) the sound waves as they pass deeper into the body and need to be returned to the transducer for analysis.

Source: acr.org, mayoclinic.org

Pelvis Ultrasound

Ultrasound Overview

Ultrasound imaging is a non-invasive medical test that helps physicians diagnose and treat medical conditions. Ultrasound is safe, non-invasive and does not use ionizing radiation. It produces pictures of the inside of the body using sound waves. Ultrasound imaging is also called ultrasound scanning or sonography. It uses a small probe called a transducer and gel placed directly on the skin. High-frequency sound waves travel from the probe through the gel into the body. The probe collects the sounds that bounce back. A computer uses those sound waves to create an image. Ultrasound exams do not use ionizing radiation that is used in x-rays. Because images are captured in real-time, they can show the structure and movement of the body’s internal organs. They can also show blood flowing through blood vessels.

What is Pelvic Ultrasound Imaging?

Ultrasound imaging of the pelvis uses sounds waves to produce images of the structures and organs in the lower abdomen and pelvis. These exams are used to evaluate the reproductive and urinary systems. There are three types of pelvic ultrasound exams:

Abdominal (transabdominal)
Vaginal (transvaginal/endovaginal) for women
Rectal (transrectal) for men

A Doppler ultrasound exam may be part of a pelvic ultrasound examination. Doppler ultrasound is a special ultrasound technique that evaluates movement of materials in the material. It allows doctors to evaluate blow flow through arteries and veins in the body.

In women, a pelvic ultrasound is most often performed to evaluate the: uterus, cervix, ovaries, fallopian tubes and bladder. Pelvic ultrasound exams are also used to monitor the health and development of an embryo or fetus during pregnancy (see the Obstetric Ultrasound page for more information).

Ultrasound examinations can help diagnose symptoms experienced by women such as pelvic pain, abnormal vaginal bleeding, other menstrual problems as well as palpable masses (ovarian cysts and uterine fibroids) and ovarian and uterine cancers.

A transvaginal ultrasound is usually performed to evaluate the endometrium (the lining of the uterus), the ovaries and the myometrium (muscular walls of the uterus).

In men, a pelvic ultrasound is used to evaluate the: bladder, seminal vesicles and prostate.

Transrectal ultrasound, a special study usually done to provide detailed evaluation of the prostate gland, involves inserting an endocavity transducer into a man’s rectum. (See the prostate ultrasound page for more information).

In men and women, a pelvic ultrasound exam can help identify kidney stones, bladder tumors and other disorders of the urinary bladder.

In children, pelvic ultrasound can help evaluate: pelvic masses, pelvic pain, ambiguous genitalia, anomalies of pelvic organs and early or delayed puberty in girls.

Pelvic ultrasound is also used to guide procedures such as needle biopsies in which needles are used to extract a sample of cells from organs for laboratory testing.

Doppler ultrasound may also be used which helps evaluate: blockages to blood flow (such as clots), narrowing of vessels, tumors and congenital vascular malformations, reduced or absent blood flow to various organs (such as the testes or ovary) and increased blood flow (which may be a sign of infection).

Preparing for the Procedure

Wear comfortable, loose-fitting clothing. You may need to remove all clothing and jewelry in the area to be examined. You may be asked to wear a gown during the procedure.

Ultrasound examinations are very sensitive to motion, and an active or crying child can prolong the examination process. To ensure a smooth experience, it often helps to explain the procedure to the child prior to the exam.

What Does the Ultrasound Equipment Look Like?

The ultrasound technologist (sonographer) or radiologist will apply a small of amount lubricating gel on the area being examined and then press the transducer against the skin to start the exam. The gel allows sound waves to travel back and forth between the transducer and the area under examination.

The ultrasound image is immediately visible on the ultrasound screen which looks like a computer monitor. The sonographer or radiologist will continue to capture the necessary number of images that will then be digitally sent to the radiologist for review and reporting.

Some ultrasound procedures, such as transvaginal or transrectal exams, require insertion of the transducer. In these cases, the device is first covered with a lubricated cover prior to insertion. The endocavity transducer has a more prolongated appearance compared to the other transducers.

What to Expect During and After The Procedure Transabdominal

For most ultrasound exams, you will lie face-up on an exam table that can be tilted or moved. Patients may be turned to either side to improve the quality of the images.

If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.

Once the imaging is complete, the ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry quickly. The ultrasound gel does not usually stain or discolor clothing.

Transvaginal:

Transvaginal ultrasound involves the insertion of the transducer into the vagina after you empty your bladder. A protective cover is placed over the transducer, lubricated with a small amount of gel, and then inserted into the vagina. Only two to three inches of the transducer end are inserted into the vagina. The images are obtained from different orientations to get the best views of the uterus and ovaries. Transvaginal ultrasound is usually performed with you lying on your back with a triangular pillow under your lower back and buttock.

Transrectal:

For a transrectal ultrasound, a protective cover is placed over the transducer and it is lubricated and then placed into the rectum.

Usually, you lie on your side, facing away from the examiner, with your knees and hips slightly flexed.

Doppler sonography is performed using the same transducer.

The Results and Final Report

The interpretation of the images is done by a radiologist – a doctor trained to interpret radiology exams – who produces a final report with findings and their impression. This report is sent to the referring physician who ordered the exam. The referring physician will share and discuss the results with you. Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be needed to determine if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. the Risks

Benefits

The benefits of ultrasound include:

Easy to administer and widely available
Painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Uses no ionizing radiation and is extremely safe
Uses real-time imaging which is useful for guiding minimally invasive procedures such as cortisone injections, aspiration of fluid from joints and needle biopsies
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
An important alternative diagnostic tool than magnetic resonance imaging (MRI) for patients who have cardiac pacemakers, fragments within their body, ferromagnetic implants and/or who are claustrophobic.
Ultrasound is the preferred imaging modality for the diagnosis and monitoring of pregnant women and their unborn babies.
Pelvic ultrasound can help to identify and evaluate a variety of urinary and reproductive system disorders in both sexes without x-ray exposure.

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Limitations of Pelvic Ultrasound Imaging

Ultrasound waves are disrupted by air or gas. Therefore, ultrasound is not an ideal imaging technique for the air-filled bowel or organs that are obscured by the bowel. Similarly, ultrasound cannot penetrate bone, but may be used for imaging bone fractures or for infection surrounding a bone. Large patients are more difficult to image by ultrasound because greater amounts of tissue attenuate (weaken) the sound waves as they pass deeper into the body and need to be returned to the transducer for analysis.

Source: acr.org, mayoclinic.org

Musculoskeletal Ultrasound

Ultrasound Overview

An ultrasound, also called diagnostic medical sonography, is a procedure that uses high frequency sound waves to produce images of structures within your body. Ultrasound can provide valuable information to assist in diagnosing and treating a variety of conditions.

It works by bouncing high-energy sound waves off internal tissues or organs to make echoes. The patterns made by the echoes form a picture of the body tissues. This is what is called a sonogram.

Ultrasound utilizes no ionizing radiation to capture images in real-time to show movement of internal tissues/organs as well as the blood flow in arteries and veins.

What is Musculoskeletal Ultrasound Imaging?

Musculoskeletal (MSK) ultrasound exams allows radiologists to assess muscles, ligaments, joints, tendons and soft tissue. Since the images are captured in real time, MSK ultrasound enables radiologists to diagnose damage after injury or illness as well as a range of abnormalities and conditions.

For example, MSK ultrasound can assist with diagnosing: tendon tears, i.e. tears in the Achilles tendon in the ankle, or rotator cuff shoulder tears; abnormalities of the muscles such as soft tissue masses and tears; and fluid collections or bleeding in muscles, joints and bursae.

There are some limitations of MSK ultrasound as ultrasound does not penetrate bone and images the outer surface of bony structures. Other modalities such as magnetic resonance imaging (MRI) can be used for further visualization of internal structure of bones or certain joints.

Preparing for the Procedure

You should wear loose-fitting, comfortable clothing. Clothing as well as jewelry will have to be removed in the area being examined. You may be asked to wear a patient gown.

No preparations needed for MSK US.

Ultrasound Equipment

What to Expect During and After The Procedure

The patient will be taken to a private examination room where they will be asked to lie down on the examination table. A clear gel will be applied to the area being examined which allows for the proper contact between the transducer and skin. The technologist will press the transducer against the skin, at times firmly, and sweep back and forth to capture images of interest. The patient may need to change positions, sit and/or stand up during the exam so that the sonographer can capture the necessary images.

There is usually no discomfort from pressure as the transducer is pressed against the area being examined. There may be some discomfort if the transducer is pressed over an area of tenderness when the technologist is capturing images. Patients are encouraged to communicate with their sonographer if there is any pain so that the technologist reduces pressure. For the most part, the procedures are painless and well tolerated.

Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry quickly. The ultrasound gel does not usually stain or discolor clothing.

Depending on the area being examined and the number of exams ordered by your referring physician, the length of the exam may vary. Most individual procedures can be completed within 30 minutes.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. the Risks

Benefits

Ultrasound benefits include:

Easy to administer and widely available
Painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Use NO ionizing radiation and is extremely safe
Uses real-time imaging which is useful for guiding minimally invasive procedures such as cortisone injections, aspiration of fluid from joints and needle biopsies
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
An important alternative diagnostic tool than magnetic resonance imaging (MRI) for patients who have cardiac pacemakers, fragments within their body, ferromagnetic implants and/or who are claustrophobic.
Advantages over MRI to visualize tendon structures

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

What are the limitations of Ultrasound Imaging of the Musculoskeletal System?

Ultrasound has difficulty penetrating bone and, therefore, can only see the outer surface of bony structures and not what lies within (except in infants who have more cartilage in their skeletons than older children or adults). For visualizing internal structure of bones or certain joints, other imaging modalities such as MRI are often used.

There are also limitations to the depth that sound waves can penetrate; therefore, deeper structures in larger patients may not be seen easily.

Source: acr.org, mayoclinic.org

Thyroid Ultrasound

Ultrasound Overview

Thyroid ultrasound uses sound waves to produce pictures of the thyroid gland within the neck. It does not use ionizing radiation and is commonly used to evaluate lumps or nodules found during a routine physical or other imaging exam.

This procedure requires little to no special preparation. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

What is Thyroid Ultrasound Imaging?

An ultrasound of the thyroid produces images of the thyroid gland and the adjacent structures in the neck. The thyroid gland is a butterfly structure located in the front of the neck. It is one of the nine endocrine glands located throughout the body that makes and sends hormones into the bloodstream. Ultrasound can detect nodules in the thyroid that are benign the majority of the time. In a small percentage of cases, the nodules are malignant and further diagnosis and treatment are warranted.

An ultrasound of the thyroid can be used to:

Determine if a palpable mass in the neck is arising from the thyroid of an adjacent structure
Look for additional nodules in patients who present with nodules on clinical examination
Analyze the appearance of thyroid nodules to determine if further investigation is warranted
Determine if the thyroid nodule has substantially grown over time
Ultrasound can be used to guide needles into the thyroid to extract tissue or biopsy suspicious nodules.

Preparing for the Procedure

Wear comfortable, loose-fitting clothing. You may need to remove all clothing and jewelry in the area to be examined. You may be asked to wear a gown during the procedure.

What Does the Ultrasound Equipment Look Like?

What to Expect During and After The Procedure

The patient will be taken to a private examination room where they will be asked to lie down on the examination table. A clear gel will be applied to the area being examined which allows for the proper contact between the transducer and skin. A pillow may be placed behind the shoulders to help position the neck during the exam.

Depending on the area being examined and the number of exams ordered by your referring physician, the length of the exam may vary. The thyroid exam is usually completed within 30 minutes.

The Results and Final Report

The interpretation of the images is done by a radiologist – a doctor trained to interpret radiology exams – who produces a final report with findings and their impression. This report is sent to the referring physician who ordered the exam. The referring physician will share and discuss the results with you. Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. the Risks

Benefits

Ultrasound benefits include:

Easy to administer and widely available
Painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Use NO ionizing radiation and is extremely safe
Uses real-time imaging which is useful for guiding minimally invasive procedures such as needle biopsies and fluid aspiration.
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
An important alternative diagnostic tool than magnetic resonance imaging (MRI) for patients who have cardiac pacemakers, fragments within their body, ferromagnetic implants and/or who are claustrophobic.
Advantages over MRI to visualize tendon structures

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Limitations of Thyroid Ultrasound

Ultrasound will not provide information regarding thyroid function, i.e. whether the thyroid is underactive, overactive or normal. To determine thyroid function, a blood test or radioactive iodine uptake test can be ordered by our doctor.

An ultrasound can help detect nodules but cannot always decipher whether a nodule is benign or malignant. As such, a fine needle biopsy may be required.

Source: acr.org, mayoclinic.org

Obstetric Ultrasound

Ultrasound Overview

What is Obstetrical Ultrasound Imaging?

Obstetrical ultrasound uses sound waves to produce pictures of a baby (embryo or fetus) within a pregnant woman, as well as the mother’s uterus and ovaries. It does not use ionizing radiation, has no known harmful effects, and is the preferred method for monitoring pregnant women and their unborn babies. A Doppler ultrasound study – a technique that evaluates blood flow in the umbilical cord, fetus or placenta – may be part of this exam.

This procedure requires no special preparation. Since only your lower abdominal area needs to be exposed for this exam, you may want to wear a loose-fitting, two-piece outfit. Leave jewelry at home.

Obstetrical ultrasound is a useful clinical test to:

establish the presence of a living embryo/fetus
estimate the age of embryo/fetus
diagnose congenital abnormalities of the fetus
evaluate the position of the fetus
evaluate the position of the placenta
determine if there are multiple pregnancies
determine the amount of amniotic fluid around the baby
check for opening or shortening of the cervix
assess fetal growth
assess fetal well-being

Preparing for an Obstetrical Ultrasound?

It is recommended to wear a loose-fitting, two-piece outfit for the examination since only the lower abdominal area needs to be exposed during this procedure.

If an ultrasound is required early in pregnancy, then you will be required to have a full bladder for the examination. Air interferes with sound waves so if your bladder is distended, the air-filled bowel is pushed out of the way and an image of the uterus and embryo/fetus is obtained. A full bladder is not necessary in most cases after the first 3 months of pregnancy.

The sonographer or radiologist may elect to examine an early pregnancy or the cervix by means of a transvaginal ultrasound which requires an empty bladder. For more information on transvaginal ultrasound, refer to the page on Pelvic Ultrasound.

What Does the Ultrasound Equipment Look Like?

The computer creates the image based on the loudness (amplitude), pitch (frequency) and time it takes for the ultrasound signal to return to the transducer. It also takes into account what type of body structure and/or tissue the sound is traveling through.

What to Expect During and After The Procedure

Sometimes a transvaginal scan is performed to provide more detailed images of the uterus, ovaries and fetus in early pregnancy.

The movement of the embryo or fetus and his/her heartbeat can be seen as an ongoing ultrasound movie. Ultrasound devices also use Doppler, a special application of ultrasound, which processes echoes produced by blood flowing through the fetal heart, blood vessels and umbilical cord and turns them into audible sound.

Depending on the area being examined and the number of exams ordered by your referring physician, the length of the exam may vary. The obstetrical exam is usually completed within 40 minutes.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. the Risks

Benefits

Ultrasound benefits include:

Easy to administer and widely available
Painless and non-invasive Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Uses NO ionizing radiation and is extremely safe
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
Preferred modality for the diagnosis and monitoring of pregnant women and their unborn images.
Used to evaluate pregnancy for nearly four decades and there has been no evidence of harm to patient, embryo or fetus.
Providing much information about the pregnancy by seeing inside the uterus

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Limitations of Obstetrical Ultrasound Imaging

Obstetrical ultrasound imaging can help to identify certain fetal abnormalities but not all fetal abnormalities. As such, when there is suspicion of a possible abnormality, other non-radiologic testing, i.e. blood tests or amniocentesis, may be needed to further assess the health of the fetus.

Source: acr.org, mayoclinic.org

Breast Ultrasound

Ultrasound Overview

What is Breast Ultrasound Imaging?

Breast ultrasound uses sounds waves to produce images of the internal structures of the breast. The most common use of breast ultrasound is to diagnose lumps or other abnormalities of the breast which a doctor may have found during a physical examination, mammogram or breast magnetic resonance imaging (MRI).

Ultrasound imaging can help to determine if an abnormality is: solid (which could be noncancerous (benign) or cancerous (malignant); fluid-filled (such as benign cysts) or both solid and cystic.

During a breast ultrasound examination, the sonographer or physician performing the test may use Doppler techniques to evaluate blood flow or lack of flow in a breast mass. This technique may provide additional information as to the cause of the mass.

Other supplemental breast cancer screening tools include mammography and magnetic resonance imaging.

Mammography is currently the screening tool for breast cancer that is known to reduce deaths due to breast cancer through early detection. However, mammograms do not detect all breast cancers because certain lesions and abnormalities are not visible on mammogram or difficult to interpret. For example, breasts that are dense have less fatty tissue and more glandular and connective tissues that makes it harder to detect cancer.

MRI studies of the breast can help supplement mammography by detecting breast cancers that are not visible with mammography. MRI is more sensitive in detecting breast cancer but may not be available to all women. If MRI is used for screening then ultrasound screening is not needed though ultrasound may be required to characterize, and biopsy abnormalities detected on MRI. When ultrasound is used for screening, abnormalities that were not detected on a mammogram may be identified. Many of the abnormalities identified of ultrasound are not cancerous.Ultrasound-guided breast biopsy may be recommended if a suspicious breast abnormality is revealed upon examination.

Preparing for the Procedure

There is no special preparation required but patients should leave jewelry at home and wear loose comfortable clothing. Patients will be asked to remove their clothing from the waist up and wear a gown during the procedure.

What Does the Ultrasound Equipment Look Like?

What to Expect During and After the Procedure

If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.

You may be asked to change positions during the exam.

Depending on the area being examined and the number of exams ordered by your referring physician, the length of the exam may vary. The breast exam is usually completed within 30 minutes.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. the Risks

Benefits

Easy to administer and widely available
Painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Uses NO ionizing radiation and is extremely safe
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
Ultrasound imaging is useful to detect lesions in women with dense breast.
Ultrasound imaging is useful to detect and classify a breast lesion that cannot be adequately interpreted through mammography alone.
Ultrasound imaging helps physicians determine if an area of clinical concern is due to normal tissue or benign cysts.
Breast ultrasound is a useful screening tool for women who have dense breasts which have less fatty tissue and more glandular and connective tissue.
For women 30 years and older, a mammogram is used together with ultrasound. For women under 30 years of age, ultrasound alone is often sufficient to identify if an area of concern needs biopsy or not.
Pregnant women who need breast imaging and should not be exposed to x-rays (which is necessary for a mammogram).

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Limitations of Breast Ultrasound Imaging

Ultrasound is a useful tool to screen the breast, but it does not replace annual mammography. Calcifications which are seen on mammography are not always detected on ultrasound, especially early breast cancers. Accordingly, many cancers are not visible on ultrasound. MRI findings that are due to cancer are not always seen with ultrasound. Biopsy may be recommended to determine if a suspicious abnormality is cancer. Often suspicious findings on ultrasound that require biopsy are not cancers. Source: acr.org, mayoclinic.org

Prostate Ultrasound

Ultrasound Overview

What is Prostate Ultrasound Imaging?

Ultrasound of the prostate uses sound waves to produce images of a man’s prostate gland and to help diagnose symptoms such as difficulty urinating or an elevated blood test result. It’s also used to investigate a nodule found during a rectal exam, detect abnormalities, and determine whether the gland is enlarged. Ultrasound is safe, non-invasive, and does not use ionizing radiation.

Prostate ultrasound, which includes a transrectal ultrasound, provides images of a male’s prostate gland and surrounding tissue. The exam often requires the insertion of an ultrasound transducer into the rectum of the patient.

A transrectal ultrasound of the prostate gland may be used to diagnose symptoms such as: a nodule found by a physician on physical examination; an elevated blood test result (prostate-specific antigen) or difficulty urinating.

A transrectal ultrasound of the prostate gland is performed to detect disorders within the prostate, detect an abnormal growth within the prostate, determine the cause of male infertility and determine if the prostate is enlarged (also known as benign prostatic hyperplasia).

Preparing for the Procedure

Leave jewelry at home and wear loose, comfortable clothing.

You will be asked to wear a gown and lie on our side with your knees bent towards your chest. An endocavity transducer, that is a thin cylindrical shape, will be inserted a short distance into the rectum. The probe sends and receives sound waves through the wall of the rectum into the prostate gland which is situated right in front of the rectum.

What Does the Ultrasound Equipment Look Like?

For ultrasound procedures such as transrectal exams that require insertion of an imaging probe, also called a transducer, the device is covered and lubricated with a gel.

What to Expect During and After The Procedure

The prostate gland is located directly in front of the rectum in men, so the ultrasound exam is performed transrectally in order to position the imaging probe as close to the prostate gland as possible.

For a transrectal ultrasound, you will be asked to lie on your side with your knees bent. A disposable probe cover is placed over the transducer, it is lubricated, inserted through the anus and placed into the rectum.

The images are obtained from different angles to get the best view of the prostate gland.

When the transducer is inserted into the rectum there may be minimal discomfort.

If a suspicious lesion is identified with ultrasound or with a rectal examination, an ultrasound-guided biopsy can be performed. This ultrasound examination is usually completed in less than 20 minutes.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. the Risks

Benefits

Easy to administer and widely available
Painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Uses NO ionizing radiation and is extremely safe
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
Ultrasound does not cause health problems and can be repeated as often as is required.

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Limitations of Prostate Ultrasound Imaging

Men who have had the tail end of their bowel (rectum) removed during prior surgery are not good candidates for ultrasound of the prostate gland because this type of ultrasound typically requires placing a probe into the rectum. However, the radiologist may attempt to examine the prostate gland by placing a regular ultrasound imaging probe on the perineal skin of the patient, between the legs and behind the scrotum of the patient. Sometimes the gland can be examined by ultrasound this way, but the images may not be as detailed as with the transrectal probe. An MRI of the pelvis may be obtained as an alternative imaging test, because it may be obtained with an external receiver coil.

Source: acr.org, mayoclinic.org

Scrotal Ultrasound

Ultrasound Overview

What is Scrotal Ultrasound Imaging?

Ultrasound imaging of the scrotum uses sound waves to produce images of a male’s testicles and surrounding tissues. Scrotal ultrasound is the primary method used to help evaluate disorders of the testicles, epididymis (tubes immediately next to the testicles that collect sperm) and scrotum.

Scrotal imaging is used to:

Determine if a mass in the scrotum felt on physical exam is cystic or solid and its location.
Diagnose causes of testicular pain or swelling such as inflammation or torsion.
Diagnose results of trauma to the scrotal area.
Evaluate the cause of infertility such as varicocele.
Determine the location of undescended testis.

Any sudden onset of pain in the scrotum should be taken seriously. A common cause of scrotal pain is epididymitis which is inflammation of the epididymis that is treatable with antibiotics. If left untreated, epididymis, can lead to an abscess or blood flow loss to the testicles.

Ultrasound can often detect an absent or undescended testicle. Approximately three percent of full-term baby boys have an undescended testicle. The testicle normally migrates from the abdomen down a short passage called the inguinal canal and then into the usual position in the scrotal sac before birth. If not present in the scrotal sac, the testicle may have stopped in the inguinal region, in which case the ultrasound examination should find it. If the testicle has not left the abdominal cavity, it may not be seen on ultrasound.

Scrotal ultrasound imaging can identify testicular torsion, the twisting of the spermatic cord that contains the vessels that supply blood to the testicle. Testicular torsion is caused by abnormally loose attachments of tissues that are formed during fetal development.

Ultrasound also can be used to locate and evaluate masses (lumps or tumors) in the testicle or elsewhere in the scrotum. Collections of fluid and abnormalities of the blood vessels may appear as masses and can be assessed by ultrasound. Masses both outside and within the testicles may be benign or malignant and should be evaluated as soon as they are detected.

Preparing for the Procedure

This procedure requires little to no special preparation. Leave jewelry at home and wear loose, comfortable clothing. You will be asked to wear a gown.

What Does the Ultrasound Equipment Look Like?

In order to perform a scrotal sonogram, most commonly a linear small parts transducer is used.

What to Expect During and After the Procedure

For most ultrasound exams, you will lie face-up on an exam table that can be tilted or moved. Patients may be turned to either side to improve the quality of the images.

After you are positioned on the examination table, the radiologist or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.

This ultrasound examination is usually completed within 20 minutes.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. the Risks

Benefits

Easy to administer and widely available
Painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Uses NO ionizing radiation and is extremely safe
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
Ultrasound does not cause health problems and can be repeated as often as is required.

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Limitations of Scrotal Ultrasound Imaging

Scrotal ultrasound imaging is useful for finding abnormalities such as masses in the scrotum or testicles; however, it does not always offer an exact diagnosis, i.e. type of tissue mass. Images of blood flow of the testicles are not always reliable in determining the presence or absence of blood supply to a testicle that has twisted. Ultrasound may not always find an absent testicle that is located in the abdomen because gas filled bowel loops may block visualization.

Source: acr.org, mayoclinic.org

Vascular Ultrasound

Ultrasound Overview

What is Vascular Ultrasound Imaging?

Vascular ultrasound uses sound waves to evaluate the body’s circulatory system and help detect blood clots as well as identify blockages in the arteries and veins. A Doppler ultrasound study – a technique that evaluates blood flow through a blood vessel – is usually part of this exam. Ultrasound does not use ionizing radiation, has no known harmful effects, and provides images of soft tissues that don’t show up on x-ray images.

A Doppler ultrasound study is usually part of a vascular ultrasound examination that evaluates movement of blood flow through arteries and veins in the body.

Vascular ultrasound is performed to:

monitor the blood flow to organs and tissues throughout the body.
locate and identify blockages (stenosis) and abnormalities, like emboli or plaques.
assist with effective treatment plans for identified conditions.
detect blood clots (deep venous thrombosis (DVT) in the major veins of the legs or arms.
determine whether a patient is a good candidate for a procedure such as angioplasty.
evaluate the success of procedures that graft or bypass blood vessels.
evaluate the success of procedures that graft or bypass blood vessels.
determine if there is an enlarged artery (aneurysm).
evaluate varicose veins.

In children, vascular ultrasound is used to:

aid in the placement of a needle or catheter into a vein or artery to help avoid complications such as bleeding, nerve injury or pseudo-aneurysm (abnormal outpouching of an artery with the risk of rupture).
evaluate a connection between an artery and a vein which can be seen in congenital vascular malformations (arteriovenous malformations or fistula) and in dialysis fistula.

Doppler ultrasound images can help the physician to see and evaluate:

blockages to blood flow (such as clots)
narrowing of vessels
tumors and congenital vascular malformations
reduced or absent blood flow to various organs, such as the testes or ovary
increased blood flow, which may be a sign of infection

Preparing for the Procedure

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined. You may be asked to wear a gown during the procedure.

If your abdominal vessels are being examined, unless the examination is performed on an urgent basis, it is best to fast before the procedure.

Ultrasound Equipment

The ultrasound technologist (sonographer) or radiologist will apply a small amount of lubricating gel on the area being examined and then press the transducer against the skin to start the exam. The gel allows sound waves to travel back and forth between the transducer and the area under examination. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body.

The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured. The ultrasound image is immediately visible on the ultrasound screen which looks like a computer monitor. The sonographer or radiologist will continue to capture the necessary number of images that will then be digitally sent to the radiologist for review and reporting.

What to Expect During and After The Procedure

Depending on the area being examined and the number of exams ordered by your referring physician, the length of the exam may vary. Most individual procedures can be completed within 30 minutes.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

What are the Benefits Vs. the Risks

Benefits

Ultrasound benefits include:

Easy to administer and widely available
Generally painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Uses no ionizing radiation and is extremely safe
Uses real-time imaging which is useful for guiding minimally invasive procedures such as cortisone injections, aspiration of fluid from joints and needle biopsies
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
An important alternative diagnostic tool, other than magnetic resonance imaging (MRI), for patients who have cardiac pacemakers, fragments within their body, ferromagnetic implants and/or who are claustrophobic.
Advantages over MRI to visualize tendon structures

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Limitations of Vascular Ultrasound

Vessels deeper in the body are harder to image than superficial vessels. Specialized ultrasound equipment, CT or MRI may assist with proper visualization. Also, smaller vessels are more difficult to image and evaluate than larger vessels. Finally, calcifications that occur as a result of atherosclerosis may obstruct the ultrasound beam.

Source: acr.org, mayoclinic.org

Venous Ultrasound (Extremities)

Ultrasound Overview

What is Venous Ultrasound Imaging?

Venous ultrasound uses sound waves to produce images of the veins in the body. It is commonly used to search for blood clots, especially in the veins of the leg – a condition often referred to as Deep Vein Thrombosis (DVT). If these clots break off and travel into the lungs, this can cause a dangerous condition called pulmonary embolism. If a blood clot in the leg can be found early, treatment can be started to prevent the clot from passing to the lung.

Venous ultrasound provides images of the veins throughout the body and is performed to:

determine the cause of long-lasting leg swelling. Varicose veins are a common condition which may indicate that valves which normally keep blood flowing back to the heart may be damaged. Venous ultrasound can help identify the damaged valves and abnormal blood flow.
assist in guiding placement of a needle or catheter into a vein.
map out the veins in the leg or arm so that pieces of vein may be removed and used to bypass a narrowed or blocked blood vessel. For example, the use of parts of veins from the leg to surgically bypass narrowed coronary (heart) arteries.
observe a blood vessel graft used for dialysis and if it is no longer working as expected which may indicate the graft is narrowed or blocked.

In children, venous ultrasound is used to:

assess the connection between an artery and vein which can be seen in congenital vascular malformations (arteriovenous malformations or fistula) and in dialysis fistula.

Doppler ultrasound images blood flow through the arteries and veins in the body which can assist with evaluating:

blockages to blood flow, such as blood clots
increased blood flow which could be a sign of infection
narrowing of vessels
tumors and congenital vascular malformations
reduced or absent blood flow to various organs, such as the ovary or testes

A venous ultrasound study is also performed to:

determine the cause of long-lasting leg swelling. Varicose veins are a common condition which may indicate that valves which normally keep blood flowing back to the heart may be damaged. Venous ultrasound can help identify the damaged valves and abnormal blood flow.
assist in guiding placement of a needle or catheter into a vein. Ultrasound can help locate the exact site of the vein and avoid complications, such as bleeding or damage to a nearby nerve or artery.
map out the veins in the leg or arm so that pieces of vein may be removed and used to bypass a narrowed or blocked blood vessel. For example, the use of parts of veins from the leg to surgically bypass narrowed coronary (heart) arteries.
observe a blood vessel graft used for dialysis if it is not working as expected which may indicate the graft is narrowed or blocked.

In children, venous ultrasound is used to:

assess the connection between an artery and vein which can be seen in congenital vascular malformations and in dialysis fistula.

Doppler ultrasound images blood flow through the arteries and veins in the body which can assist with evaluating:

blockages to blood flow, such as blood clots
increased blood flow which could be a sign of infection
narrowing of vessels
tumors and congenital vascular malformations
reduced or absent blood flow to various organs, such as the ovary or testes

Preparing for the Procedure

Wear comfortable, loose-fitting clothing. You may need to remove all clothing and jewelry in the area to be examined.

You will be asked to wear a patient gown.

If an examination of veins in your abdomen is requested, there is no food and drink except for water for six to eight hours. Otherwise, there is no other special preparation for a venous ultrasound.

Ultrasound Equipment

The ultrasound technologist (sonographer) or radiologist will apply a small amount lubricating gel on the area being examined and then press the transducer against the skin to start the exam. The gel allows sound waves to travel back and forth between the transducer and the area under examination. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.

What to Expect During and After the Procedure

For most ultrasound exams, you will lie face-up on an exam table and may be asked to turn to either side during the exam to improve the quality of images. The exam is painless, and well tolerated.

A clear water-based gel is applied to the area of the body being studied and the transducer makes contact with the skin. The technologist or radiologist will move the transducer back and forth to capture the images. Doppler sonography is performed using the same transducer. This helps the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The technologist or radiologist places the transducer on the skin in various locations, sweeping over the area of interest. There is usually no discomfort from pressure as the transducer is pressed against the area being examined though there may be some discomfort if scanning is performed on a tender area.

If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.

Once the imaging is complete, the clear ultrasound gel will be wiped off your skin and should not stain or discolour clothing.

After an ultrasound examination, you should be able to resume your normal activities immediately. The ultrasound exam takes approximately 30-60 minutes – the more complex exams may take longer.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

What are the Benefits Vs. the Risks

Benefits

Ultrasound benefits include:

Easy to administer and widely available
Painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Uses no ionizing radiation and is extremely safe
Uses real-time imaging which is useful for guiding minimally invasive procedures such as cortisone injections, aspiration of fluid from joints and needle biopsies
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
Venous ultrasound helps to detect blood clots in the veins of the legs before they become dislodged and pass to the lungs. Sonography also shows the movement of blood within blood vessels.
Venous ultrasound is accurate for identifying venous blood clots of the thigh down to the knee versus venography which requires injection of contrast material into a vein.

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Limitations of Venous Ultrasound Imaging

Veins lying deep beneath the skin, especially small veins in the calf, may be hard to see. Nonetheless, typical venous clots that are potentially dangerous are often found in the larger veins.

Source: acr.org, mayoclinic.org

Carotid Ultrasound

Ultrasound Overview

Ultrasound imaging is also called ultrasound scanning or sonography It uses a small probe called a transducer and gel placed directly on the skin. High-frequency sound waves travel from the probe through the gel into the body. The probe collects the sounds that bounce back. A computer uses those sound waves to create an image. Ultrasound exams do not use ionizing radiation that is used in x-rays. Because images are captured in real-time, they can show the structure and movement of the body’s internal organs. They can also show blood flowing through blood vessels.

What is Carotid Ultrasound Imaging?

Carotid ultrasound uses sound waves to produce pictures of the carotid arteries in the neck which carry blood from the heart to the brain. The carotid arteries are located on each side of the neck. Carotid ultrasound is often used to screen patients for blockage or narrowing of the carotid arteries, also known as stenosis, which substantially increase the risk of stroke. If a significant narrowing is identified on sonography, a comprehensive treatment plan can be initiated.

A Doppler ultrasound study, which evaluates blood flow through arteries and veins in the body, is often part of a carotid ultrasound examination.

A carotid ultrasound is performed to:

Evaluate a patient with high blood pressure or a carotid bruit
Prepare for coronary artery bypass surgery
locate a hematoma which is a collection of clotted blood that may slow and eventually stop blood flow.
check the state of the carotid artery after surgery to restore normal blood flow.
verify the position of a metal stent placed to maintain carotid blood flow.
Evaluate patients with high risk factors including diabetes, elevated blood cholesterol and a family history of stroke or heart disease

Doppler ultrasound images can assist with evaluating:

blockages to blood flow, such as blood clots
increased blood flow which could be a sign of infection
narrowing of vessels
tumors and congenital vascular malformations
reduced or absent blood flow to various organs, such as the ovary or testes

In children, Doppler ultrasound is used to:

evaluate blood flow.
predict a higher risk of stroke in children with sickle cell disease.
detect abnormalities in the blood vessels, lymph nodes and lymphatic vessels.

Preparing for the Procedure

Wear comfortable, loose-fitting clothing. You may need to remove all clothing and jewelry in the area to be examined. You will be asked to wear a patient gown.

Ultrasound Equipment

What to Expect During and After The Procedure

After an ultrasound examination, you should be able to resume your normal activities immediately. The ultrasound exam takes approximately 30-60 minutes – the more complex exams may take longer.

After the ultrasound examination, you should be able to resume your normal activities immediately.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

What are the Benefits Vs. the Risks

Benefits

Ultrasound benefits include:

Easy to administer and widely available
Painless and non-invasive. Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
Uses no ionizing radiation and is extremely safe
Uses real-time imaging which is useful for guiding minimally invasive procedures such as cortisone injections, aspiration of fluid from joints and needle biopsies
Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
Can identify a narrowing of one or both carotid arteries leading to initiate f treatment to restore blood flow to the brain ultimately preventing a stroke.

Risks

There are no known harmful effects on humans from standard diagnostic ultrasound.

Source: acr.org, mayoclinic.org

Chest X-Ray (Radiography)

Chest X-Ray Overview

X-ray or radiography uses a very small dose of ionizing radiation to produce images of the body’s internal structures. X-rays are the oldest and most frequently used form of medical imaging, often used to diagnose fractured bones, search for injury or infection and to locate foreign objects in soft tissue.

What is Chest X-Ray (Radiography)?

Chest x-ray is the most commonly performed diagnostic x-ray exam that uses a very small dose of ionizing radiation to produce images of the inside of the chest.

X-rays are a form of radiation like light or radio waves that pass through most objects including the human body. An x-ray image is produced when a small burst of radiation that passes through the body, records an image on a special detector.

X-rays are absorbed in varying degrees by different parts of the body. For instance, dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them. As a result, bones appear white on x-ray, soft tissue appear shades of gray and air appears black. Accordingly, the ribs appear white or light gray and the lungs dark on an x-ray image.

The x-ray images are digital files that are stored and accessible electronically.

Before the technologist takes the picture, he/she will walk behind a wall barrier or next room to do the exposure.

Chest radiography is used to:

evaluate the lungs, heart and chest wall.
diagnose shortness of breath, persistent cough, fever, chest pain or injury.
help diagnose and monitor treatment for a variety of lung conditions such as pneumonia, emphysema and cancer.

Chest x-ray is fast and easy making it particularly useful in emergency diagnosis and treatment.

Chest x-ray is often used to help diagnose symptoms of difficulty breathing, persistent cough, and chest pain or injury.

Chest x-ray is indicated to help diagnose/monitor treatment for: pneumonia, heart failure, lung cancer, emphysema, positioning of medical devices, fluid around the lungs and other medical conditions.

Preparing for the Procedure

No special preparation is required for chest x-ray. You will be asked to remove jewelry and any other metal object that may interfere with the x-ray images. You may be asked to wear a patient gown.

Female patients must inform the technologist if there is any possibility that they are pregnant. Imaging with radiography is avoided during pregnancy so that the fetus is not exposed to radiation. In certain circumstances an x-ray may be necessary and the precautions will be taken to minimize radiation exposure to the fetus.

What Does the X-Ray Equipment Look Like?

The x-ray equipment consists of a wall-mounted, chest stand that has a box-like apparatus that contains the digital x-ray detector. The x-ray producing tube is positioned approximately six feet away.

The equipment may also be arranged with the x-ray tube suspended over a table on which the patient lies. A drawer under the table holds the digital x-ray detector.

Modern x-ray systems have controlled x-ray beams and dose control methods to minimize scatter radiation thereby minimizing radiation exposure of patient’s body not being imaged.

What to Expect During and After the Procedure

The chest x-ray exam is a painless procedure. The standard chest x-ray involves taking two views of the chest, one from the back and the other from the side of the body as the patient stands against the image detector. The x-ray technologist, who is trained and licenced to perform radiography exams, assists the patient to position their body properly for optimal images. The first view will require the patient to stand with their hands on their hips and their chest pressed against the chest stand. The second view is taken with the patient’s side to the image plate with arms elevated.

For patients who are unable to stand, they will be positioned lying down on an x-ray table. The technologist will assist you in finding the most comfortable position possible that still ensures diagnostic image quality.

When the image is being taken, the patient must remain very still and keep from breathing for a few seconds to reduce the possibility of a blurred image.

The Results and Final Report

The images of a chest x-ray can be available almost immediately for review by your physician.

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. The Risks

Benefits

Benefits of chest x-ray include:

radiation exposure is very low and no radiation remains in the patient’s body after the exam.
No side effects in the typical diagnostic range for this exam.
Fast and accessible which is helpful in emergency diagnosis and treatment.

Risks

Excessive exposure to radiation poses a slight risk of cancer.
Female patients must inform the technologists if there is any possibility of pregnancy.

Limitations of Chest X-ray

Certain conditions of the chest cannot be detected on a conventional chest x-ray. For instance, small cancers may not show up on chest x-ray as well as a blood clot in the lungs (pulmonary embolism) is not seen on chest x-rays.

Source: acr.org, mayoclinic.org

Abdomen X-Ray (Radiography)

Abdomen X-Ray Overview

Abdominal x-ray uses a very small dose of ionizing radiation to produce images of the inside of the abdominal cavity. It is used to evaluate the stomach, liver, intestines and spleen and may be used to help diagnose unexplained pain, nausea or vomiting. A KUB x-ray is used to examine the kidneys, ureters and bladder. An abdominal x-ray and fast and accessible making it useful in emergency diagnosis and treatment.

This exam requires little to no special preparation. Tell your doctor and the technologist if there is a possibility you are pregnant, you have an intrauterine device (IUD), or you have recently had a barium sulfate contrast material x-ray or taken medicines such as Pepto Bismol. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

What is an Abdominal X-Ray?

An x-ray (radiograph) is a non-invasive medical test that involves exposing a part of the body to a small dose of ionizing radiation to produce images of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

Abdominal x-ray is a commonly performed diagnostic x-ray examination that produces images of the organs in the abdominal cavity including the stomach, intestines, liver and spleen.

Abdominal x-ray is often the first imaging test used to evaluate and diagnose the source of acute pain in the abdominal region and/or lower back as well as unexplained nausea and vomiting.

Abdominal x-ray is also performed to help diagnose conditions such as:

Intestinal blockages
Kidney and urinary bladder stones and gallstones
Perforation of the stomach and intestine
Ingestion of foreign objects

Preparing for the Procedure

No special preparation is required though you may be asked to empty your bladder before the test. You may be asked to remove you clothes and wear a gown for the exam. You may also be asked to remove jewelry, removable dental appliances, eye-glasses and any metal objects or clothing that might interfere with the x-ray images.

Patients who have taken barium sulfate contrast material or medicines such as Pepto Bismol within the last few days may be advised to delay the test as these materials can interfere with the abdominal x-ray.

Female patients should always inform the technologist if there is any possibility of pregnancy as abdominal x-rays are not usually performed on pregnant women. Female patients should inform the technologists if they have an intrauterine device inserted.

What does the Equipment Look Like?

The x-ray room will consist of an x-ray table on which the patient lies on and an x-ray machine with an arm attached to a track. There is a Bucky, a drawer like compartment, under the x-ray table that houses the digital x-ray detector.

What to Expect During and After the Procedure

The x-ray images are digital files that are stored and accessible electronically.

The technologist will ask you to lie on the x-ray table and assist you to position yourself properly. The technologist may ask you to wear a lead shield to protect certain parts of your body. The x-ray machine will be positioned above your abdominal area. The technologist may ask you to lie on your side or stand up for additional images. The standing images help detect blockages or perforations in the digestive tract.

The technologist will ask you to hold still and keep from breathing for a few seconds while the x-ray is being captured. It is important to stay as still as possible to avoid a blurred image.

Before the technologist takes the picture, he/she will walk behind a wall barrier or next room to do the exposure.

The abdominal x-ray examination, including positioning, obtaining and verifying images usually takes 10-15 minutes, though the actual exposure to radiation is less than a second.

The child can be accompanied by a guardian into the x-ray room. The child and guardian will be asked to wear a lead apron to protect certain parts of his/her body.

An abdominal x-ray examination is painless though you may find that the positions you need to hold are uncomfortable or even painful, especially if you have an injury.

The technologist will assist you in finding the most comfortable position possible to ensure diagnostic image quality.

The Results and Final Report

The images of a chest x-ray can be available almost immediately for review by your physician.

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. The Risks

Benefits

Benefits of an Abdominal x-ray include:

Abdominal x-ray imaging is non-invasive and painless
No side effects in the typical diagnostic range for this exam.
Fast and accessible which is helpful in emergency diagnosis and treatment.

Risks

Excessive exposure to radiation poses a slight risk of cancer. The benefit of an accurate diagnosis outweighs the risk.
Female patients must inform the technologists if there is any possibility of pregnancy.

Limitations of Abdominal X-ray

Abdominal x-ray serves as an initial step to imaging work-up but lacks details compared to computed tomography (CT) of the abdomen and pelvis or magnetic resonance imaging (MRI) of the abdomen and pelvis.

Source: acr.org, mayoclinic.org

Bone X-Ray (Radiography)

Bone X-Ray (Radiography) Overview

Bone x-ray is a non-invasive test that uses a very small dose of ionizing radiation to produce images of any bone in the body. It is commonly used to diagnose fractured bones or joint dislocation. Bone x-rays are the fastest way to view and assess bone fractures, injuries and joint abnormalities. X-rays are the oldest and most frequently used form of medical imaging.

A bone x-ray makes images of any bone in the body, including the hand, wrist, arm, elbow, shoulder, spine, pelvis, hip, thigh, knee, leg (shin), ankle or foot.

A bone x-ray is used to:

diagnose fractured bones or joint dislocation.
demonstrate proper alignment and stabilization of bony fragments following treatment of a fracture.
guide orthopedic surgery, such as spine repair/fusion, joint replacement and fracture reductions.
look for injury, infection, arthritis, abnormal bone growths and bony changes seen in metabolic conditions.
assist in the detection and diagnosis of bone cancer.
locate foreign objects in soft tissues around or in bones.

Preparing for the Procedure

Most bone x-rays requires no special preparation. You may be asked to wear a gown. You may also be asked to remove jewelry, removable dental appliances, eye-glasses and any metal objects or clothing that might interfere with the x-ray images.

What does the Equipment Look Like?

What to Expect During and After the Procedure

The x-ray images are digital files that are stored and accessible electronically.

The technologist will position the patient on the x-ray table and places the x-ray detector on the table or in the drawer like holder under the table. When necessary, positioning pillows or sandbags may be used to assist with proper positioning. A lead apron may be placed over your pelvic area or breasts when feasible to protect from radiation. The technologist may ask you to wear a lead shield to protect certain parts of your body.

The technologist will ask you to hold still and keep from breathing for a few seconds while the x-ray is being captured. It is important to stay as still as possible to avoid a blurred image.

Before the technologist takes the picture, he/she will walk behind a wall barrier or next room to do the exposure.

You may be repositioned for another view and the process is repeated. Two or three images (from different angles) will typically be taken.

The child can be accompanied by a guardian into the x-ray room. The child and guardian will be asked to wear a lead apron to protect certain parts of his/her body.

An x-ray may also be taken of the unaffected limb, or of a child’s growth plate (where new bone is forming), for comparison purposes.

A bone x-ray examination is painless though you may find that the positions you need to hold are uncomfortable or even painful, especially if you have an injury. The technologist will assist you in finding the most comfortable position possible to ensure diagnostic image quality.

A bone x-ray examination is usually completed within five to 10 minutes.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. The Risks

Benefits

Benefits of bone x-ray include:

Bone x-ray imaging is non-invasive and painless
No side effects in the typical diagnostic range for this exam.
Fast and accessible which is helpful in emergency diagnosis, i.e. factures and treatment, i.e. arthritis.

Risks

Excessive exposure to radiation poses a slight risk of cancer. The benefit of an accurate diagnosis outweighs the risk.
Female patients must inform the technologists if there is any possibility of pregnancy.

Limitations of Bone X-ray

Bone x-ray is helpful to provide clear and detailed images of the bone but provide little information about muscles, tendons and joints. Magnetic Resonance Imaging (MRI) is superior in identifying certain bone and joint injuries and imaging the spine. CT is being used widely to assess trauma patients in emergency departments. A CT scan can image complicated fractures, subtle fractures or dislocations.

Ultrasound imaging, which uses sound waves to create diagnostic images with no ionizing radiation, is useful finding injuries around joints, and in evaluating the hips of children with congenital problems.

Source: acr.org, mayoclinic.org

Small Bowel Follow-Through

Small Bowel Follow-Through Overview

Small bowel follow-through uses a form of real-time x-ray called fluoroscopy and a barium-based contrast material to produce images of the small intestine. It is safe, non-invasive and may be used to help accurately diagnose bowel disease, obstructions, polyps, cancer and other symptoms.

Before the exam, the patient has to drink a liquid that contains barium and an iodine-based contrast that enhances the x-ray images. The fluoroscopy exam looks for abnormalities as the contrast moves from the stomach into the small intestine.

Small-bowel follow-through can be done by itself but is often done after an Upper Gastrointestinal (GI) fluoroscopic test of the esophagus, stomach and duodenum.

During the exam, you may be asked to change positions on the x-ray table in order to coat all the surfaces of your bowel with the contrast.

What is Small Bowel Follow-Through?

Small bowel follow-through is performed to evaluate the small intestine for abnormalities as well as how waste matter moves through it.

Small bowel follow-through may be performed to diagnose:

Small bowel obstruction
Crohn’s disease
Abnormal masses or polyps
Cancer of the small intestine

Fluoroscopy uses a continuous or pulsed x-ray beam to create a sequence of images that are projected onto a television-like monitor. When used with a contrast material, which it clearly defines the area being examined by making it appear dark (or by electronically reversing the image contrast to white), this special x-ray technique makes it possible to view joints or internal organs in motion. Still images are also captured and stored electronically on a computer.

Preparing for the Procedure

Do not eat or drink anything for 8 hours prior to the exam. Patients should inform their doctor if they have any known allergies to iodinated contrast materials.

A female patient should inform the technologist if there is any possibility she is pregnant.

You will be asked to change into a patient gown and to remove jewelry any metal objects or clothing that might interfere with the x-ray images.

What does the X-Ray Equipment Look Like?

The x-ray equipment consists of a radiographic table that rotates and tilts up and down and a television-like monitor that is located in the examining room.

What to Expect During and After the Procedure

The x-ray images are digital files that are stored and accessible electronically.

Before the imaging exam begins, you will be asked to drink two or more large cups of contrast material which is a thick, white, chalky drink or a clear thin liquid. Some patients feel some bloating and nausea from the contrast material.

The technologist will situate you on the x-ray table and position the x-ray machine above your abdominal area. You may be asked to wear a lead shield to help protect certain parts of your body.

Once the contrast reaches your small intestine, the technologist will observe its flow via fluoroscopy. Spot x-rays will be taken of any significant abnormalities.

The technologist will ask you to hold still and keep from breathing for a few seconds until the x-ray is being captured. It is important to stay a still as possible to avoid a blurred image.

Before the technologist takes the picture, he/she will walk behind a wall barrier or next room to do the exposure.

You will continue to drink the contrast material throughout the exam to ensure that the technologist can properly assess the full length of the small intestine. You may be asked to lie on your right side between x-rays in order to encourage fluid to pass from the stomach into the small intestine.

Once the contrast has reached the colon, you will be asked to use the bathroom. You will then receive a single additional x-ray in order to provide a general picture of how the contrast is distributed within the small and large intestines.

The duration of the examination depends on the amount of time it takes for the contrast to pass from the stomach to the large intestine. This procedure takes approximately one to two hours – for some patients it may take much longer.

Patients should be able to return to normal activities soon after the procedure. Stool may remain a whitish colour in the days following the exam.

The Results and Final Report

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

The Benefits Vs. The Risks

Benefits

Benefits of small bowel follow-through include:

No side effects in the typical diagnostic range for this exam.

Risks

Excessive exposure to radiation poses a slight risk of cancer. The benefit of an accurate diagnosis outweighs the risk.
Female patients must inform the technologists if there is any possibility of pregnancy.
Barium may cause constipation.

Limitations for Small Bowel Follow-Through

Patients with extreme abdominal pain or a recent biopsy of the colon may want to avoid ingesting barium. Small masses and less severe strictures, or abnormal areas of narrowing, may be difficult to see.

Source: acr.org, mayoclinic.org

Bone Densitometry (DEXA, DXA)

Bone Densitometry (DEXA, DXA) Overview

Bone densitometry, also called dual-energy x-ray absorptiometry, DEXA or DXA, uses a very small dose of ionizing radiation to produce images of the inside of the body (usually the lower (or lumbar) spine and hips) to measure bone loss. It is commonly used to diagnose osteoporosis, to assess an individual’s risk for developing osteoporotic fractures. DXA is simple, quick and non-invasive. It’s also the most commonly used and the most standard method for diagnosing osteoporosis.

Female patients must advise their doctor and the technologist if there is a possibility of pregnancy. Patients who have recently had a barium exam or received an injection of contrast material for a computed tomography or radioisotope scan also must inform their physician and technologist.

What is a Bone Mineral Density Scan (DEXA, DXA)?

A bone density scan is a type of x-ray used to measure bone loss. Today, DXA remains the gold standard for measuring bone mineral density (BMD).

An x-ray (radiograph) is a non-invasive medical exam that assists physicians with diagnosing and treating medical conditions. X-ray imaging uses a small dose of ionizing radiation to produce images of the inside the body. X-rays are the oldest and most frequently used form of medical imaging.

The DXA equipment sends a thin, invisible beam of low-dose x-rays with two distinct energy peaks through the bones being examined. One peak is absorbed mainly by soft tissue and the other by bone. The soft tissue amount can be subtracted from the total and what remains is a patient’s bone mineral density.

DXA machines feature special software that compute and display the bone density measurements on a computer monitor.

DXA is most often performed on the lower spine and hips. In children and some adults, the whole body is sometimes scanned. Peripheral devices that use x-ray or ultrasound are sometimes used to screen for low bone mass, mostly at the forearm.

The most common use of DXA is to diagnose osteoporosis which is a condition that more often impacts women (after menopause) compared to men and children. Bone mass is lost faster than it is created as people age. Osteoporosis involves a gradual loss of bone, as well as structural changes, causing the bones to become thinner and more brittle so that even a fall or mild stress can cause a break or fracture.

DXA is also effective in tracking the effects of treatment for osteoporosis and other conditions that cause bone loss.

The DXA test can also assess an individual’s risk for developing fractures. Some risk factors for osteoporosis include gender, age, race, family history, body weight and a previous history of facture(s).

DXA testing is recommended for:

post-menopausal women who are not taking estrogen.
individuals with a history of smoking or hip fracture.
have experienced a fracture after mild trauma
post-menopausal women who are tall and thin (taller than 5ft7” and less than 125 lbs).
men who have clinical conditions associated with bone loss such as rheumatoid arthritis and liver disease,
use medications such as steroids which cause bone loss
have liver or kidney disease, insulin-dependent diabetes, celiac disease, or cancer
have a family history of osteoporosis
have hyperthyroidism or hyperparathyroidism.

Preparing for the Procedure

Do not take calcium supplements for at least 24 hours before your exam.

Wear loose clothing and leave jewelry at home.

Patients will be asked to remove some of their clothes and to wear a gown during the exam.

Patients who have recently had a barium study or have been injected with a contrast material used for a computed tomography (CT) scan or radioisotope scan must wait 14 days before undergoing a DXA study.

Female patients must inform the technologist if there is a possibility, they may be pregnant as many imaging tests are avoided during pregnancy to avoid exposing the fetus to radiation.

What does the Bone Density Equipment Look Like?

The DXA being offered in the clinic is a central device that has a flat table and an arm suspended overhead.

What to Expect During and After the Procedure

Bone density exams are non-invasive, fast and painless. Routine follow-up studies may be warranted for higher risk patients every year whereas lower risk patients usually require follow tests every 3-5 years.

Each patient will be asked to complete a questionnaire prior to the exam. In the central DXA examination, which measures bone density of the hip and spine, the patient lies on a padded table. An x-ray generator is located below the patient and an imaging device is positioned above.

To assess the spine, the patient’s legs are supported on a padded box to flatten the pelvis and lower (lumbar) spine. To assess the hip, the patient’s foot is placed in a brace that rotates the hip inward. In both cases, the detector is slowly passed over the area, generating images on a computer monitor.

While the x-ray is being captured, the patient needs to remain still and may be asked to hold their breath for a few seconds to reduce the possibility of a blurred image.

The Results and Final Report

DXA studies are also reported by other trained physicians including rheumatologists and endocrinologists.

Your test results will be in the form of two scores:

T score — The T-score is a comparison of a person’s bone density with of a healthy 30-year old of the same gender. A T-score between -1 and -2.5 indicates that you have low bone mass. A T-score of -2.5 or lower indicates that you have osteoporosis. The greater the negative number, the more extensive the bone loss. The T score is used to estimate your risk of developing a fracture and also to determine if treatment is required.

Z score — A Z-score compares your bone density to the average values for a person of you same age and gender. A low Z-score (below -2.0) is a warning sign that you hae less bone mass than expected for someone your age.

Small changes may normally be observed between scans due to differences in positioning and usually are not significant.

Follow-up DXA exams should be performed on the same bone densitometry machine as measurements obtained on different units cannot be directly compared.

The Benefits Vs. the Risks

Benefits

The benefits of DXA include:

very low amount of radiation exposure (approximately one tenth of the dose of a chest x-ray)
fast, non-invasive and painless procedure and widely accessible
DXA bone density testing is currently the best standardized method available to diagnose osteoporosis and is also considered an accurate estimator of fracture risk.
DXA is helpful to assist treatment decisions and to monitor the effects of treatment.
No radiation remains in a patient’s body after an x-ray examination.
X-rays usually have no side effects in the typical diagnostic range for this exam.

Risks

Excessive exposure to radiation poses a slight risk of cancer. The benefit of an accurate diagnosis outweighs the risk.
Female patients must inform the technologists if there is any possibility of pregnancy.
No complications are expected with the DXA procedure.

Limitations for Bone Densitometry

DXA helps predict relative fracture risk not whether someone will experience a fracture.
DXA has limited use in people with spinal deformity or who have had spinal surgery. The presence of vertebral compression fractures or osteoarthritis may interfere with the accuracy of the test; in such instances, CT scans may be more useful.

Source: acr.org, mayoclinic.org

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