CT Scans

Computed tomography (CT) is an X-ray technique that produces more detailed images of your internal organs than a conventional X-ray can. The CT computer displays detailed picture images of organs, bones and other tissues. This procedure is also called CT scanning, computerized tomography, or computerized axial tomography (CAT).


What is it?

CT is a noninvasive way to view your internal organs and tissues.

CT is used to help:
• Diagnose muscle and bone disorders, such as osteoporosis
• Pinpoint the location of a tumor, infection or blood clot
• Guide procedures such as surgery, biopsy and radiation therapy
• Detect and monitor certain diseases such as cancer and heart disease
• Detect internal injuries and internal bleeding

How do I prepare?

If intravenous contrast material is required for your CT scan, you may be instructed to have a blood test before your CT appointment. The blood test is to assure your physician that the appropriate contrast agents may be given for accurate diagnosis.

Drink only clear liquids after midnight the night before your scan. Clear liquids include clear broth, tea, strained fruit juices, strained vegetable soup, black coffee, plain Jell-O, tomato juice and ginger ale.

What to expect

Please plan to arrive 15 minutes before your scheduled appointment time. This will help ensure that your CT scan can be completed on schedule.

For four hours immediately before your scan, take nothing by mouth other than your regular medication(s). Consult your physician if you have questions.

If you are instructed to drink a special solution to prepare for your scan, you will receive the solution and instructions. Please follow the instructions carefully.

You may be asked to change into a hospital gown because snaps and zippers in street clothes can interfere with the scan. Please do not wear jewelry or a watch. They also will interfere with the scan.

Please do not bring valuables such as credit cards.

Please allow one hour for your CT scan. Most scans take from 15 to 60 minutes.

During the test

During the CT scan, you will be asked to lie very still on a table because movement can blur the images. You may be asked to hold your breath briefly at intervals as the images are taken. The table slowly passes through the center of a large X-ray machine. You may hear whirring and clicking sounds during the procedure. A technologist will be in a separate room supervising your exam and monitoring the images as they appear on the computer screen. The technologist can see and hear you, and you can communicate via intercom.

If a contrast material is injected intravenously (into your vein), you may feel flushed, or you may have a metallic taste in your mouth. These are common side effects. If you experience shortness of breath or any unusual symptoms, please tell the technologist.

After the test

Generally, you can resume your usual activities and normal diet immediately. If a contrast medium was used, your doctor or the radiography staff will give you any special instructions. These will likely include drinking lots of fluids to help pass the medium from your body.

Results

CT images usually are printed from the computer onto film. A radiologist interprets these images and sends a report to your doctor. Your doctor will contact you to discuss the results.
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Understanding Myelograms

A myelogram is a type of X-ray that uses a dye or contrast material and a special machine called a fluoroscope that takes moving X-rays and displays them on a monitor.

Myelograms have many uses, including:

• Herniated discs (spinal discs that stick out beyond their normal area) that press on nerves
• Spinal stenosis (a narrowing of the bones of the spine that is often caused by osteoarthritis)
• Spinal tumors and lesions
• Infection
• Inflammation

What happens during a myelogram?

A myelogram is usually done as an outpatient procedure, and you can go home with someone who can care for you after the procedure is finished.

Before the myelogram begins, you will be injected with the contrast material, which is a substance that improves X-ray images. This material is injected into the area around the spine, usually in the lower lumbar part of the spine which is down near your hips. Sometimes your doctor may need to look more closely at the spine near your neck, so the contrast is injected into the cervical spine.

Your doctor will thoroughly clean and prepare the area for the injection. First, a local numbing medicine will be injected. Once that starts to work, the doctor will carefully insert a needle into the area around the spine. The contrast material will be injected through this needle. In some cases, a small amount of spinal fluid may be taken for study in the laboratory. To make it easier to get the needle placed correctly, you may need to either:
• lie on your side with your knees pulled up to your chest,
• lie face-down with pillows under your stomach, or
• sit on the edge of the table and lean forward.

The exam begins when the contrast material starts moving through the spine. The fluoroscope will take pictures of the contrast material as it makes its way through the spine. Some still X-rays also will be taken. The exam table will be moved so that the contrast material moves up or down your spine. Velcro straps will help support you as the table is tilted.

You also may need to have a computed tomography (CT) scan after the myelogram. The CT will be done while the contrast material is still in your system to help give the best images possible.

The myelogram itself takes around an hour to complete. If you have a CT myelogram as well, that would add another 30 to 60 minutes to the exam time.


Special Instructions

Your doctor will give you specific instructions that you need to follow before your myelogram. Please tell us if you have an allergy to the contrast material, iodine or shellfish. Please tell us if you have a history asthma. Also, let your doctor know if you are or might be pregnant.

There are certain medications that you should not take before a myelogram. Your doctor will tell you when you should stop taking these medications and when you can start taking them again after the procedure. These medications include blood thinners (anti-coagulants) and anti-seizure drugs. Other medications that your doctor may want you to stop taking may include tranquilizers, antidepressants, MAO inhibitors and central nervous stimulants. Please make sure and give your doctor a complete list of any medications including over-the-counter medicines, vitamins and herbal preparations that you are taking.

Generally, you should not eat solid food at least three to four hours before the exam. You should drink plenty of fluids especially the day before and the day of the exam.

After the Myelogram

You’ll need to rest and have your progress monitored by our staff immediately after the exam. Your head will be elevated while you rest. You will need to drink plenty of fluids after the exam to help your body flush the contrast material from your system. This will help prevent a headache.

A friend or family member should drive you home. You may want to lie down in the car with your head supported by a pillow on the drive home. You will need to rest in bed with your head elevated for about eight hours after returning home. We recommend that you have someone stay with you during this time.

One of the main side effects from a myelogram is a headache caused by the contrast material. Occasionally, these headaches can be quite severe. You can help prevent this by drinking lots of fluids and by resting quietly with your head elevated. The more you can rest, the less likely you will be to have a headache. If you do develop a headache, and it lasts for more than 24 hours please call your doctor’s office.

Other side effects may include reactions to the contrast material such as itching, rash, sneezing, nausea or anxiety. If you develop hives or start to wheeze, please call your doctor’s office. In a few rare instances, patients may have injury to the nerves around the injection site or experience seizures.
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Ultrasound

Most of us are familiar with at least one use of ultrasound – those black and white first “pictures” of a baby. Ultrasound, which uses high frequency sound waves to produce images, has many more medical applications.

Ultrasound is similar to the sonar that ships and submarines use to show what’s in the water around them. With medical ultrasound, a wand-like instrument called a transducer sends out waves of high frequency sound. As these sound waves pass through the body, certain structures like organs, tissues and tumors reflect the wave back. That reflection or echo is then used to create a picture of what’s ahead.

Medical uses of ultrasound

In addition to taking those early pictures of a developing baby, ultrasound has many uses including helping doctors determine the causes of pain, swelling and infection. Doctors also can use ultrasound to view organs including
• Heart and blood vessels including the flow of blood and potential narrowing of vessels
• Liver
• Gallbladder
• Spleen
• Pancreas
• Kidneys
• Bladder
• Uterus and ovaries
• Eyes
• Thyroid and parathyroid glands
• Scrotum

Ultrasound can help doctors with a number of medical procedures such as a biopsy of a suspicious mass. A breast ultrasound may be one of the tools used to check areas found during a screening mammogram.

Advances in ultrasound
Today there are many types of ultrasound used in the medical field.
• Color Doppler helps doctors see the speed and direction of blood flow through a vessel.
• Power Doppler has more sensitivity than a color Doppler and provides even more detailed pictures of the blood flow but doesn’t indicate the direction of the flow.
• Spectral Doppler develops graphs that show the distance blood flows over a period of time.
• 3-D and 4-D Ultrasound Imaging give doctors nearly real-time views of the body thanks to computer advances. These new ultrasounds not only show detailed pictures of babies in the womb, but also provide faster and more accurate views of the body and on a wider array of patients.

Preparing for an ultrasound
The preparation you’ll need for an ultrasound exam depends on the type of exam you’ll be having. In general, you should wear loose, comfortable clothing that is easy to remove. You may need to undress and wear a patient gown for the exam. Please leave any jewelry and valuables at home.

Please ask your doctor for specific instructions about whether you should eat or drink before the exam. For some exams, you will need to have a full bladder so that we can get a better look at your abdominal organs. For others, you may need to refrain from eating and drinking for up to 12 hours before the exam.

What’s an ultrasound exam like?

Ultrasound exams are generally painless and don’t take a lot of time. If you are having a standard, diagnostic ultrasound, there are no known harmful effects.

You’ll lie down on a table next to the ultrasound machine. The technologist will rub some gel on your skin around the area to be examined. Then he or she will press the transducer firmly against your body and begin moving it back and forth to produce the images needed.

You may feel some minor discomfort from the pressure of the transducer.

Some ultrasounds require a probe into your body in order to get a better view. A transesophageal echocardiogram is a type of ultrasound where the transducer is inserted into the esophagus in order to view the heart. Men with prostate problems may need a transrectal ultrasound that inserts a transducer into the rectum in order to view the prostate. A transvaginal ultrasound uses a transducer that is placed into a woman’s vagina in order to look at the uterus and ovaries.

Most ultrasound exams take between 30 minutes and one hour, and you usually can return to your normal activities after the exam.

Scheduling
You’ll need a doctor’s order for an ultrasound exam. If you need to schedule an exam, please call the Nurse Navigator at 866-SPINE-55
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Vertebroplasty: Non-surgical treatment for spinal fractures

Each year about 750,000 spinal fractures occur in the United States. Most occur in women over the age of 60 due to osteoporosis. However, younger people may have a spinal fracture. People who received long-term treatment for rheumatoid arthritis, lupus and asthma using steroids or other drugs also may be prone to spinal fractures.

Conservative treatments including rest, medications to relieve pain, bracing and physical therapy may be used for compression fractures of the spine. When these methods don’t work, surgical methods may be considered. Traditional surgical treatment of spinal fractures can be difficult and pose potential risks.

Today interventional radiologists may have a minimally invasive, non-surgical treatment for spinal fractures. Vertebroplasty (pronounced ver-TEE-bro-plasty) may help reduce or eliminate the pain associated with spinal fractures. This treatment helps stabilize spinal factures caused by osteoporsis.

Special cement injected into spine
With vertebroplasty, a small needle is inserted through the skin into the area of the spine that has been broken. Doctors then inject a special bone cement directly into the bone. This procedure doesn’t require surgery. Doctors use special X-ray equipment to guide them to the exact place on the spine that needs to be stabilized. More than one area of the spine can be treated at the same time.

You may be given a local anesthetic to numb the area being treated or have a general anesthetic which puts you to sleep. Generally, the procedure takes about two hours and you can go home afterwards, although you need to have someone else drive. In some cases, your doctor may want you to stay in the hospital overnight as a precaution.

After the procedure, you should rest in bed for the first 24 hours. You can gradually increase your activities.

Many report pain relief
Many patients report that the pain associated with spinal factures is gone or they have significant improvement within 48 hours after having vertebroplasty. According to the Society of Cardiovascular and Interventional Radiology, about two-thirds of the patients treated with vertebroplasty regain some of their mobility and are able to increase their activity levels. Most patients also report that they have less pain after the procedure.

Vertebroplasty isn’t for everyone. Those with chronic back pain or herniated disks can’t be treated with this procedure. Those with a recent fracture that causes moderate to severe back pain are considered to be the best candidates.

Risks and benefits
The benefits of vertebroplasty for people with compression fractures of the spine due to osteporosis may include strengthening or stabilizing the spine and reducing the pain associated with the fracture. Complications are relatively rare but may include some leakage of the bone cement into surrounding tissues, bleeding at the injection site, infection, numbness or tingling.
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As with any treatment, you should discuss the benefits and the risks with your physicians. To learn more about vertebroplasty, call the Nurse Navigator at 866-SPINE-55.