Kimberson M.
Albay
BSN IIIA
Submitted to:
Mrs. Elenita
Arthroscopy
Definition
Arthroscopy is the
examination of a
joint, specifically, the
inside structures. The
procedure is
performed by
inserting a
specifically designed illuminated device
into the joint through a small incision. This
instrument is called an arthroscope. The
procedure of arthroscopy is primarily
associated with the process of diagnosis.
However, when actual repair is performed,
the procedure is called arthroscopic
surgery.
Purpose
Arthroscopy is used primarily by doctors who
specialize in treating disorders of the bones and
related structures (orthopedics) to help diagnose
joint problems. Once described as essential for
those who primarily care for athletic injuries,
arthroscopy is now a technique commonly used
by orthopedic surgeons for the treatment of
patients of all ages. This procedure is most
commonly used to diagnose knee and shoulder
problems, although the elbow, hip, wrist, and
ankle may also be examined with an
arthroscope.
A joint is a complex system. Within a joint,
ligaments attach bones to other bones, tendons
attach muscles to bones, cartilage lines and
helps protect the ends of bones, and a special
fluid (synovial fluid) cushions and lubricates the
structures. Looking inside the joint allows the
doctors to see exactly which structures are
damaged. Arthroscopy also permits earlier
diagnosis of many types of joint problems which
had been difficult to detect in previous years.
Precautions
Most arthroscopic procedures today are
performed in same-day surgery centers where
the patient is admitted just before surgery. A few
hours following the procedure, the patient is
allowed to return home, although usually
someone else must drive. Depending on the
Carandang
type of anesthesia used, the patient may be told
not to eat for several hours before arriving.
Before the procedure, the anesthesiologist will
ask if the patient has any known allergies to
local or general anesthetics. Airway obstruction
is always possible in any patient who receives a
general anesthesia. Because of this, oxygen,
suction, and monitoring equipment must be
available. The patient's cardiac status should
always be monitored in the event that any
cardiac abnormalities arise during the
arthroscopy.
Description
The arthroscope is an instrument used to look
directly into the joint. It contains magnifying
lenses and glass-coated fibers that send
concentrated light into the joint. A camera
attached to the arthroscope allows the surgeon
to see a clear image of the joint. This image is
then transferred to a monitor located in the
operating room at the time of the arthroscopy.
This video technology is also important for
documentation of the arthroscopic procedure.
For example, if the surgeon decides after the
arthroscopic examination that a conventional
approach to surgically expose or "open" the joint
(arthrotomy) must be used, a good photographic
record will be useful when the surgeon returns to
execute the final surgical plan.
The procedure requires the surgeon to make
several small incisions (portals) through the
skin's surface into the joint. Through one or two
of the portals, a large-bore needle, called a
cannula, is attached to tubing and inserted into
the joint. The joint is inflated with a sterile saline
solution to expand the joint and ensure clear
arthroscopic viewing. Often, following a recent
traumatic injury to a joint, the joint's natural fluid
may be cloudy, making interior viewing of the
joint difficult. In this condition, a constant flow of
the saline solution is necessary. This inflow of
saline solution may be through the cannula with
the outflow through the arthroscope, or the
positions may be reversed. The arthroscope is
placed through one of the portals to view and
evaluate the condition of the joint.
Preparation
Before an arthroscopy can take place, the
surgeon completes a thorough medical history
and evaluation. Important for the accuracy of
this diagnostic procedure, a medical history and
evaluation may discover other disorders of the
joint or body parts, proving the procedure
unnecessary. This is always an important
preliminary step, because paincan often be
referred to a joint from another area of the body.
Anatomical models and pictures are useful aids
to explain to the patient the proposed
arthroscopy and what the surgeon may be
looking at specifically.
Proper draping of the body part is important to
prevent contamination from instruments used in
arthroscopy, such as the camera, light cords,
and inflow and outflow drains placed in the
portals. Draping packs used in arthroscopy
include disposable paper gowns and drapes with
adhesive backing. The surgeon may also place
a tourniquet above the joint to temporarily block
blood flow to the area during the arthroscopic
exam.
General or local anesthesia may be used during
arthroscopy. Local anesthesia is usually used
because it reduces the risk of lung and heart
complications and allows the patient to go home
sooner. The local anesthetic may be injected in
small amounts in multiple locations in skin and
joint tissues in a process called infiltration. In
other cases, the anesthetic is injected into the
spinal cord or a main nerve supplying the area.
This process is called a "block," and it blocks all
sensation below the main trunk of the nerve. For
example, a femoral block anesthetizes the leg
from the thigh down (its name comes from
femur, the thighbone). Most patients are
comfortable once the skin, muscles, and other
tissues around the joint are numbed by the
anesthetic; however, some patients are also
given a sedative if they express anxiety about
the procedure. (It's important for the patient to
remain still during the arthroscopic examination.)
Key terms
Hemarthrosis — A condition of blood within a
joint.
Pulmonary embolus — Blockage of an artery of
the lung by foreign matter such as fat, tumor,
tissue, or a clot originating from a vein.
Thrombophlebitis — Inflamation of a vein with
the formation of a thrombus or clot.
General anesthesia, in which the patient
becomes unconcious, may be used if the
procedure may be unusually complicated or
painful. For example, people who have relatively
"tight" joints may be candidates for general
anesthesia because the procedure may take
longer and cause more discomfort.
Aftercare
The portals are closed by small tape strips or
stitches and covered with dressings and a
bandage. The patient spends a short amount of
time in the recovery room after arthroscopy.
Most patients can go home after about an hour
in the recovery room. Pain medication may be
prescribed for a short period; however, many
patients find various over-the-counter pain
relievers sufficient.
Following the surgical procedure, the patient
needs to be aware of the signs of infection,
which include redness, warmth, excessive pain,
and swelling. The risk of infection increases if
the incisions become wet too early following
surgery. Because of this, it is good practice to
cover the joint with plastic (for example, a plastic
bag) while showering after arthroscopy.
The use of crutches is commonplace after
arthroscopy, with progression to independent
walking on an "as tolerated" basis by the patient.
Generally, a rehabilitation program, supervised
by a physical therapist, follows shortly after the
arthroscopy to help the patient regain mobility
and strength of the affected joint and limb.
Risks
The incidence of complications is low compared
to the high number of arthroscopic procedures
performed every year. Possible complications
include infection, swelling, damage to the
tissues in the joint, blood clots in the leg veins
(thrombophlebitis), leakage of blood into the joint
(hemarthrosis), blood clots that move to the lung
(pulmonary embolus), and injury to the nerves
around the joint.
Normal results
The goal of arthroscopy is to diagnose a joint
problem causing pain and/or restrictions in
normal joint function. For example, arthroscopy
can be a useful tool in locating a tear in the joint
surface of the knee or locating a torn ligament of
the shoulder. Arthroscopic examination is often
followed by arthroscopic surgery performed to
repair the problem with appropriate arthroscopic
tools. The final result is to decrease pain,
increase joint mobility, and thereby improve the
overall quality of the patient's activities of daily
living.
Abnormal results
Less optimal results that may require further
treatment include adhesive capsulitis. In this
condition, the joint capsule that naturally forms
around the joint becomes thickened,
forming adhesions. This results in a stiff and less
mobile joint. This problem is frequently corrected
by manipulation and mobilization of the joint with
the patient placed under general anesthesia
Computed Tomography
Scan
A computed tomography (CT) scan is an
imaging method that uses x-rays to create
cross-sectional pictures of the body.
How the test is performed?
You will be asked to lie on a narrow
table that slides into the center of the
CT scanner. Depending on the study
being done, you may need to lie on
your stomach, back, or side.
Once you are inside the scanner, the
machine's x-ray beam rotates around
you. (Modern "spiral" scanners can
perform the exam in one continuous
motion.)
Small detectors inside the scanner
measure the amount of x-rays that
make it through the part of the body
being studied. A computer takes this
information and uses it to create
several individual images, called
slices. These images can be stored,
viewed on a monitor, or printed on
film. Three-dimensional models of
organs can be created by stacking the
individual slices together.
You must be still during the exam,
because movement causes blurred
images. You may be told to hold your
breath for short periods of time.
Generally, complete scans take only a
few minutes. The newest
multidetector scanners can image
your entire body, head to toe, in less
than 30 seconds.
How to Prepare to the Test?
Certain exams require a special dye,
called contrast, to be delivered into
the body before the test starts.
Contrast can highlight specific areas
inside the body, which creates a
clearer image.
Some people have allergies to IV
contrast and may need to take
medications before their test in order
to safely receive this substance.
Contrast can be given several ways,
and depends on the type of CT being
performed.
It may be delivered through a vein (IV) in your
hand or forearm.
It may be given through the rectum using an
enema.
You might drink the contrast before your scan.
When you actually drink the contrast depends
on the type of exam being done. The contrast
liquid may taste chalky, although some are
flavored to make it taste a little better. The
contrast eventually passes out of your body
through your stools.
If contrast is used, you may also be
asked not to eat or drink anything for
4-6 hours before the test.
If you weigh more than 300 pounds,
have your doctor contact the scanner
operator before the exam. CT
scanners have a weight limit. Too
much weight can cause damage to the
scanner's working parts.
Since x-rays have difficulty passing
through metal, you will be asked to
remove jewelry and wear a hospital
gown during the study.

How The Test will Feel
Some people may have discomfort
from lying on the hard table.
Contrast given through an IV may
cause a slight burning sensation, a
metallic taste in the mouth, and a
warm flushing of the body. These
sensations are normal and usually go
away within a few seconds.
Why the Text is Performed
CT rapidly creates detailed pictures of the body,
including the brain, chest, spine, and abdomen.
The test may be used to:
Guide a surgeon to the right area during a
biopsy
Identify masses and tumors, including cancer
Study blood vessels
Normal Results
Results are considered normal if the organs and
structures being examined are normal in
appearance.
What Abnormal Results Mean
The significance of abnormal results depends on
the part of the body being studied and the nature
of the problem. Consult your health care
provider with any questions and concerns.
Risks
CT scans and other x-rays are strictly monitored
and controlled to make sure they use the least
amount of radiation. CT scans do create low
levels of ionizing radiation, which has the
potential to cause cancer and other defects.
However, the risk associated with any individual
scan is small. The risk increases as numerous
additional studies are performed.
In some cases, a CT scan may still be done if
the benefits greatly out weigh the risks. For
example, it can be more risky not to have the
exam, especially if your health care provider
thinks you might have cancer.
An abdominal CT scan is usually not
recommended for pregnant women, because it
may harm the unborn child. Women who are or
may be pregnant should speak with their health
care provider to determine if ultrasound can be
used instead.
The most common type of contrast given into a
vein contains iodine. If a person with an iodine
allergy is given this type of
contrast, nausea, sneezing, vomiting, itching,
or hives may occur.
If you absolutely must be given such contrast,
your doctor may choose to treat you with
antihistamines (such as Benadryl) or steroids
before the test.
The kidneys help filter the iodine out of the body.
Therefore, those with kidney disease or diabetes
should receive plenty of fluids after the test, and
be closely monitored for kidney problems. If you
have diabetes or are on kidney dialysis, talk to
your health care provider before the test about
your risks.
Rarely, the dye may cause a life-threatening
allergic response called anaphylaxis. If you have
any trouble breathing during the test, you should
notify the scanner operator immediately.
Scanners come with an intercom and speakers,
so the operator can hear you at all times.
What is a cerebral
angiogram?
An angiogram or angiography is a minimally
invasive procedure that uses X-rays to view the
blood vessels (arteries and veins). When used
to view the blood vessels leading to the brain,
the procedure is called a cerebral angiogram.
Carotid Cerebral Cerebral
Artery Angiogram - Angiogram -
Angiogr AP Lateral
am
When is a cerebral angiogram performed?
Interventional neuroradiologists use cerebral
angiograms to more accurately diagnose
abnormalities in the brain's blood vessels, such
as aneurysms, arteriovenous malformations
(AVMs), and ruptures or blockages that can
result in a stroke. An angiogram is sometimes
performed after another diagnostic test, e.g., a
CT scan, has already detected an abnormality.
The results of an angiogram will guide further
treatment.
What can I expect during the procedure?
The procedure is performed on an X-ray table in
the Interventional Neuroradiology suite. Your
groin area will be shaved and cleaned, and
drapes will be placed over you. A local
anesthetic is then injected into the area, which
could cause a slight pinch and/or some burning
from the medication. After that, you should feel
no pain. The doctor will insert a catheter (a long,
narrow, flexible tube) into the groin area and
navigate it to the carotid arteries, the vessels of
the neck that lead to the brain, where a
contrasting dye is injected. You could feel heat
or a warm sensation in your head when the dye
is injected. The dye allows the interventional
neuroradiologist and his team to view and take
pictures of the blood vessels in your brain
through X-ray imaging. Although you are awake
during the procedure, an anesthesiologist could
give you medication to relax you. The
technologist, nurse and doctors will talk to you at
different times during the procedure to make
sure you are comfortable. You will be asked to
remain very still during the angiogram, as this
will improve the results of your X-ray images and
minimize the length of the procedure.
An angiogram typically lasts from one to two
hours, and you can usually go home the same
day. Your Lahey health care team will answer all
your questions and talk to you in detail about
what to expect before, during and after your
procedure.
Continous Passive Motion Device
Definition
Continuous passive motion (CPM) is a
modality of postoperative treatment
intended to assist recovery following joint
surgery or injuries of upper or lower
extremities. CPM equipment covers a
range of mechanical devices designed to
move the patient's joint or extremity
without the use of the patient's muscles
through a prescribed range of motion over
extended periods of time. These devices
were first introduced in the 1980s by Dr.
Robert Salter, an orthopedic surgeon.
Purpose
CPM is used to reduce the adverse effects
of trauma or immobilization following
surgery. In physiological terms, synovial
fluid is diffused without hindering tissue
repair; the joint receives nutrition, the
flow of venous blood is increased, and the
cartilage is prevented from deteriorating.
From a clinical perspective, joint swelling
(edema) is decreased, range of motion
(ROM) is maintained, tissue repair is
accelerated, and the patient experiences
less pain.
CPM devices are used as alternatives and
adjuncts to conventional physical therapy
following surgery or injury. CPM devices
may also be used in bedridden surgical
patients to reduce the incidence of deep
vein thrombosis, to treat abnormal muscle
shortening that occurs due to prolonged
immobilization, and in patients with burns
or joint sepsis.
Electroencephalograph (EEG)
Lumbar Puncture (Spinal
Tap)
What It Is
A lumbar puncture (also called a spinal tap) is a
common medical test that involves taking a
small sample of cerebrospinal fluid (CSF) for
examination. CSF is a clear, colorless liquid
that delivers nutrients and "cushions" the brain
and spinal cord, or central nervous system. In a
lumbar puncture, a needle is carefully inserted
into the lower spine to collect the CSF sample.
Why It's Done
Medical personnel perform lumbar punctures
and test the cerebrospinal fluid to detect or
rule out suspected diseases or conditions. CSF
testing looks for signs of possible infection by
analyzing the white blood cell count, glucose
levels, protein, and bacteria or abnormal cells
that can help identify specific diseases in the
central nervous system.
Most lumbar punctures are done to test for
meningitis, but they also can determine if there
is bleeding in the brain, detect certain
conditions affecting the nervous system such
as Guillain Barré syndrome and multiple
sclerosis, and administer chemotherapy
medications.
Preparation
After the procedure is explained to you, you'll
be asked to sign an informed consent form —
this states that you understand the procedure
and its risks and give your permission for it to
be performed.
The doctor doing the lumbar puncture will
know your child's medical history but might ask
additional questions, such as whether your
child is allergic to any medicines.
You might be able to stay in the room with your
child during the procedure, or you can step
outside to a waiting area.
Electromyography
Electromyography (EMG) is a test that checks
the health of the muscles and the nerves that
control the muscles.
How the Test is Performed
The health care provider will insert a very thin
needle electrode through the skin into the
muscle. The electrode on the needle picks up
the electrical activity given off by your muscles.
This activity is displayed on a special monitor
called an oscilloscope, and may be heard
through a speaker.
After placement of the electrodes, you may be
asked to contract the muscle. For example,
bending your arm. The presence, size, and
shape of the wave form -- the action potential --
produced on the monitor provide information
about your muscle's ability to respond when the
nerves are stimulated.
A nerve conduction velocity test is usually
performed along with an EMG.
How to Prepare for the Test
No special preparation is usually necessary.
Avoid using any creams or lotions on the day of
the test.
How the Test Will Feel
You may feel some pain or discomfort when the
electrodes are inserted, but most people are
able to complete the test without significant
difficulty.
Afterward, the muscle may feel tender or bruised
for a few days.
Why the Test is Performed
EMG is most often used when people have
symptoms of weakness, and examination shows
impaired muscle strength. It can help to
differentiate primary muscle conditions from
muscle weakness caused by neurologic
disorders.
Normal Results
Muscle tissue is normally electrically silent at
rest. Once the muscles quiet down after the
needles are inserted, there should be little EMG; Myogram
muscle cell electrical activity noted on the
screen.
When the muscle is voluntarily contracted,
Neurologic Assessment
activity begins to appear. As contraction is
increased, more and more muscle fibers
produce action potentials until a disorderly group
of action potentials of varying rates and
amplitudes (complete recruitment and
interference pattern) appears with full
contraction.
What Abnormal Results Mean
Disorders or conditions that cause abnormal
results include the following:
Alcoholic neuropathy
Amyotrophic lateral sclerosis (ALS)
Axillary nerve dysfunction
Becker's muscular dystrophy
Brachial plexopathy
Carpal tunnel syndrome A neurological examination is the
Cervical spondylosis assessment of sensory
Common peroneal nerve dysfunction neuron and motor responses,
Denervation (reduced nervous stimulation)
Dermatomyositis especially reflexes, to determine
Distal median nerve dysfunction whether the nervous system is impaired.
Duchenne muscular dystrophy [1] It can be used both as a screening
Facioscapulohumeral muscular dystrophy tool and as an investigative tool, the
(Landouzy-Dejerine) former of which when examining the
Familial periodic paralysis patient when there is no expected
Femoral nerve dysfunction
neurological deficit and the latter of
Friedreich's ataxia
Guillain-Barre which when examining a patient
Lambert-Eaton Syndrome where you do expect to find
Mononeuritis multiplex abnormalities.[2] If a problem is found
Mononeuropathy either in an investigative or screening
Myopathy (muscle degeneration caused by a process then further tests can be
number of disorders, including muscular carried out to focus on a particular
dystrophy)
aspect of the nervous system (such
Myasthenia gravis
Peripheral neuropathy as lumbar punctures and blood tests).
Polymyositis Generally a neurological examination
Radial nerve dysfunction is focused towards finding out if there
Sciatic nerve dysfunction are lesions in thecentral and peripheral
Sensorimotor polyneuropathy nervous systems or whether there is
Shy-Drager syndrome another diffuse process which is
Thyrotoxic periodic paralysis
Tibial nerve dysfunction
troubling the patient.[2] Once the
Ulnar nerve dysfunction patient has been thoroughly tested, it
is then the role of thephysician to
Risks determine whether or not these
Bleeding (minimal) findings combine to form a
Infection at the electrode sites (minimal risk) recognizable medical syndrome such
as Parkinson's disease or motor neurone
Considerations
Trauma to the muscle from EMG may cause disease.[2] Finally, it is the role of the
false results on blood tests, including creatine physician to find the etiological
kinase, a muscle biopsy, or other medical tests. reasons for why such a problem has
Alternative Names occurred, for example finding if the
problem was due to inflammation or its use. If the patient has an
congenital.[2] endotracheal tube in place, they
cannot talk. For this reason, many
Glasgow Coma Scale prefer to document the score by its
individual components; so a patient
with a Glasgow Coma Score of 15
would be documented as follows: E4
V5 M6. An intubated patient would be
scored as E4 Vintubated M6. Of these
individual factors, the best motor
response is probably the most
significant.
Other factors which alter the patients
level of consciousness interfere with
the scale's ability to acurately reflect
the severity of a traumatic brain
injury. So, shock, hypoxemia, drug
Glasgow Coma Score
use, alcohol intoxication, metabolic
Eye Opening Verbal Motor disturbances may alter the GCS
(E) Response (V) Response (M) independently of the brain injury.
4=Spontaneous 5=Normal 6=Normal Obviously, a patient with a spinal cord
3=To voice conversation 5=Localizes to injury will make the motor scale
2=To pain 4=Disoriented pain invalid, and severe orbital trauma may
1=None conversation 4=Withdraws make eye opening impossible to
3=Words, but to pain assess. The GCS also has limited utility
not coherent 3=Decorticate in children, particularly those less than
2=No posture 36 months. In spite of these
words......only 2=Decerebrate limitations, it is quite useful and is far
sounds 1=None and away the most widely used
1=None scoring system used today to assess
patients with traumatic brain injury.
Total =
E+V+M

The Glasgow Coma Scale is the most

widely used scoring system used in
quantifying level of consciousness
following traumatic brain injury. It is
used primarily because it is simple,
has a relatively high degree of
interobserver reliability and because it
correlates well with outcome following
severe brain injury.
It is easy to use, particularly if a form MRI
is used with a table similar to the one
above. One determines the best eye
opening response, the best verbal
response, and the best motor
response. The score represents the
sum of the numeric scores of each of
the categories. There are limitations to

Magnetic resonance imaging (MRI) is a
noninvasive way to take pictures of the body.
Unlike x-rays and computed tomographic (CT)
scans, which use radiation, MRI uses powerful
magnets and radio waves. The MRI scanner
contains the magnet. The magnetic field
produced by an MRI is about 10 thousand times
greater than the earth's.
The magnetic field forces hydrogen atoms in the
body to line up in a certain way (similar to how
the needle on a compass moves when you hold
it near a magnet). When radio waves are sent
toward the lined-up hydrogen atoms, they
bounce back, and a computer records the
signal. Different types of tissues send back
different signals.
Single MRI images are called slices. The images
can be stored on a computer or printed on film.
One exam produces dozens or sometimes
hundreds of images.
How the Test is Performed
You may be asked to wear a hospital gown or
clothing without metal fasteners (such as
sweatpants and a t-shirt). Certain types of metal
can cause inaccurate images.
You will lie on a narrow table, which slides into
the middle of the MRI machine. If you fear
confined spaces (have claustrophobia), tell your
doctor before the exam. You may be prescribed
a mild sedative, or your doctor may recommend
an "open" MRI, in which the machine is not as
close to the body.
Small devices, called coils, may be placed
around the head, arm, or leg, or other areas to
be studied. These devices help send and
receive the radio waves, and improve the quality
of the images.
Some exams require a special dye (contrast).
The dye is usually given before the test through
a vein (IV) in your hand or forearm. The dye
helps the radiologist see certain areas more
clearly.
During the MRI, the person who operates the
machine will watch you from another room.
Several sets of images are usually needed, each
taking 2 - 15 minutes. Depending on the areas
being studied and type of equipment, the exam
may take 1 hour or longer.
How to Prepare for the Test
Depending on the area being studied, you may
be asked not to eat or drink anything for 4 - 6
hours before the scan. Other preparations are
usually not needed.
The strong magnetic fields created during an
MRI can interfere with certain implants,
particularly pacemakers. Persons with cardiac
pacemakers cannot have an MRI and should not
enter an MRI area.
You may not be able to have an MRI if you have
any of the following metallic objects in your
body:
Brain aneurysm clips
Certain artificial heart valves
Inner ear (cochlear) implants
Recently placed artificial joints
Some older types of vascular stents
Tell your health care provider if you have one of
these devices when scheduling the test, so the
exact type of metal can be determined.
Before an MRI, sheet metal workers or any
person that may have been exposed to small
metal fragments should receive a skull x-ray to
check for metal in the eyes.
Because the MRI contains a magnet, metal-
containing objects such as pens, pocketknives,
and eyeglasses may fly across the room. This
can be dangerous, so they are not allowed into
the scanner area.
Other metallic objects are also not allowed into
the room:
Items such as jewelry, watches, credit cards,
and hearing aids can be damaged.
Pins, hairpins, metal zippers, and similar metallic
items can distort the images.
Removable dental work should be taken out just
before the scan.
How the Test Will Feel
An MRI exam causes no pain. Some people
may become anxious inside the scanner. If you
have difficulty lying still or are very anxious, you
may be given a mild sedative. Excessive
movement can blur MRI images and cause
errors.
The table may be hard or cold, but you can
request a blanket or pillow. The machine
produces loud thumping and humming noises
when turned on. You can wear ear plugs to help
reduce the noise.
An intercom in the room allows you to speak to
the person operating the scanner at any time.
Some MRIs have televisions and special
headphones that you can use to help the time
pass.
There is no recovery time, unless you need
sedation. After an MRI scan, you can resume
your normal diet, activity, and medications.
Why the Test is Performed
Combining MRIs with other imaging methods
can often help the doctor make a more definitive
diagnosis.
MRI images taken after a special dye (contrast)
is delivered into the body may provide additional
information about the blood vessels.
An MRA, or magnetic resonance angiogram, is a
form of magnetic resonance imaging, that
creates three-dimensional pictures of blood
vessels. It is often used when
traditional angiography cannot be done.
Normal Results
Results are considered normal if the organs and
structures being examined are normal in
appearance.
What Abnormal Results Mean
Results depend on the part of the body being
examined and the nature of the problem.
Different types of tissues send back different
MRI signals. For example, healthy tissue sends
back a slightly different signal than cancerous
tissue. Consult your health care provider with
any questions and concerns.
Risks
MRI contains no ionizing radiation. To date,
there have been no documented significant side
effects of the magnetic fields and radio waves
used on the human body.
The most common type of contrast (dye) used is
gadolinium. It is very safe. Allergic reactions to
the substance rarely occur. The person
operating the machine will monitor your heart
rate and breathing as needed.
MRI is usually not recommended
for acute trauma situations,
because traction and life-support equipment
cannot safely enter the scanner area and the
exam can take quite a bit of time.
People have been harmed in MRI machines
when they did not remove metal objects from
their clothes or when metal objects were left in
the room by others.
Alternative Names
Magnetic resonance imaging; Nuclear magnetic
resonance (NMR) imaging
Positron Emission Tomography Scan
(PET Scan)
What is Positron Emission Tomography?
Positron emission tomography, also called PET
imaging or a PET scan, is a diagnostic examination
that involves the acquisition of physiologic images
based on the detection of positrons. Positrons are
tiny particles emitted from a radioactive substance
administered to the patient. The subsequent views of
the human body developed by this technique are
used to evaluate a variety of diseases.
What are some common uses of the
procedure?
PET scans are used most often to detect cancer and
to examine the effects of cancer therapy by
characterizing biochemical changes in the cancer.
These scans are performed on the whole body. PET
scans of the heart can be used to determine blood
flow to the heart muscle and help evaluate signs of
coronary artery disease. PET scans of the heart can
also be used to determine if areas of the heart that
show decreased function are alive rather than
scarred due to a prior heart attack, called a
myocardial infarction. Combined with a myocardial
perfusion study, PET scans differentiate
nonfunctioning heart muscle from heart muscle that
would benefit from a procedure, such as angioplasty
or coronary artery bypass surgery, which would
reestablish adequate blood flow and improve heart
function. PET scans of the brain are used to evaluate
patients who have memory disorders of an
undetermined cause; who have suspected or proven
brain tumors; or who have seizure disorders that are
not responsive to medical therapy and, therefore,
are candidates for surgery.
How should I prepare for the procedure?
PET is usually done on an outpatient basis. Your
doctor will give you detailed instructions on how to
prepare for your examination. You should wear
comfortable, loose-fitting clothes. You should not eat
for four hours before the scan. You will be
encouraged to drink water. Your doctor will instruct
you regarding the use of medications before the
test.
Note: Diabetic patients should ask for any specific
diet guidelines to control glucose levels during the
day of the test.
What does the equipment look like?
You will be taken to an examination room that
houses the PET scanner, which has a hole in the
middle and looks like a large doughnut. Within this
machine are multiple rings of detectors that record
the emission of energy from the radioactive
substance in your body and permit an image of your
body to be obtained. While lying on a cushioned
examination table, you will be moved into the hole of
the machine. The images are displayed on the
monitor of a nearby computer, which is similar in
appearance to the personal computer you may have
in your home.
How does the procedure work?
Before the examination begins, a radioactive
substance is produced in a machine called a
cyclotron and attached, or tagged, to a natural body
compound, most commonly glucose, but sometimes
water or ammonia. Once this substance is
administered to the patient, the radioactivity
localizes in the appropriate areas of the body and is
detected by the PET scanner.
Different colors or degrees of brightness on a PET
image represent different levels of tissue or organ
function. For example, because healthy tissue uses
glucose for energy, it accumulates some of the
tagged glucose, which will show up on the PET
images. However, cancerous tissue, which uses more
glucose than normal tissue, will absorb more of the
substance and appear brighter than normal tissue on
the PET images.
How is the procedure performed?
A nurse or technologist will take you into a special
PET examination room. You will lie down on an
examination table and be given the radioactive
substance as an intravenous injection (although, in
some cases, it will be given through an existing
intravenous line or inhaled as a gas). It will then
take approximately 30 to 60 minutes for the
substance to travel through your body and be
absorbed by the tissue under study. During this
time, you will be asked to rest quietly in a partially
darkened room and to avoid significant movement or
talking, which may alter the localization of the
administered substance. After that time, scanning
begins. This takes an additional 30 to 45 minutes.
Some patients, specifically those with heart disease,
may undergo a stress test in which PET scans are
obtained while they are at rest, and again after
undergoing the administration of a pharmaceutical to
alter the blood flow to the heart.
Usually, there are no restrictions on daily routine
after the test, although you should drink plenty of
fluids to flush the radioactive substance from your
body.
What will I experience during the
procedure?
The administration of the radioactive substance will
feel like a slight pinprick if given by intravenous
injection. You will then be made as comfortable as
possible on the examination table before you are
positioned in the PET scanner for the test. You will be
asked to remain still for the duration of the
examination. Patients who are claustrophobic may
feel some anxiety while positioned in the scanner.
Also, some patients find it uncomfortable to hold one
position for more than a few minutes. You will not
feel anything related to the radioactivity of the
substance in your body.
Who interprets the results and how do I
get them?
Patients undergo PET because their referring
physician has recommended it. A radiologist who has
specialized training in PET will interpret the images
and forward a report to your referring physician. It
usually takes one to three days to interpret, report,
and deliver the results. In order to facilitate
interpretation, you may be asked to bring any
outside examinations with you, such as recent CT
(CAT) scans or MRI scans.
What are the benefits vs. risks?
Because PET allows study of body function, it can
help physicians detect alterations in biochemical
processes that suggest disease before changes in
anatomy are apparent on other imaging tests such
as CT or MRI scans.
Because the radioactivity is very short-lived, your
radiation exposure is extremely low. The substance
amount is so small that it does not affect the normal
processes of the body.
The radioactive substance may expose radiation to
the fetus of patients who are pregnant or the infants
of women who are breast-feeding. The risk to the
fetus or infant should be considered related to the
potential information gain from the result of the PET
examination. If you are pregnant you should inform
the PET imaging staff before the examination is
performed.
What are the limitations of Positron
Emission Tomography?
PET can give false results if a patient's chemical
balances are not normal. Specifically, test results of
diabetic patients or patients who have eaten within
several hours prior to the examination can be
adversely affected because of blood sugar or blood
insulin levels.
Also, because the radioactive substance decays
quickly and is effective for a short period of time, it
must be produced in a laboratory near the PET
scanner. It is important to be on time for the
appointment and to receive the radioactive
substance at the scheduled time. PET must be done
by a radiologist who has specialized in nuclear
medicine and has substantial experience with PET.
Most large medical centers now have PET services
available to their patients. Medicare and insurance
companies cover many of the applications of PET, is part of a larger diagnostic work-up. This often
and coverage continues to increase. entails comparison of the PET scan with other
imaging studies such as CT or MRI.
Finally, the value of a PET scan is enhanced when it