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Kimberson M.

Albay
BSN IIIA
Submitted to:
Mrs. Elenita Carandang

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 type of anesthesia used, the patient may be told
procedure of arthroscopy is primarily not to eat for several hours before arriving.
associated with the process of diagnosis. Before the procedure, the anesthesiologist will
However, when actual repair is performed, ask if the patient has any known allergies to
the procedure is called arthroscopic local or general anesthetics. Airway obstruction
surgery. is always possible in any patient who receives a
general anesthesia. Because of this, oxygen,
Purpose suction, and monitoring equipment must be
Arthroscopy is used primarily by doctors who available. The patient's cardiac status should
specialize in treating disorders of the bones and always be monitored in the event that any
related structures (orthopedics) to help diagnose cardiac abnormalities arise during the
joint problems. Once described as essential for arthroscopy.
those who primarily care for athletic injuries, Description
arthroscopy is now a technique commonly used The arthroscope is an instrument used to look
by orthopedic surgeons for the treatment of directly into the joint. It contains magnifying
patients of all ages. This procedure is most lenses and glass-coated fibers that send
commonly used to diagnose knee and shoulder concentrated light into the joint. A camera
problems, although the elbow, hip, wrist, and attached to the arthroscope allows the surgeon
ankle may also be examined with an to see a clear image of the joint. This image is
arthroscope. then transferred to a monitor located in the
A joint is a complex system. Within a joint, operating room at the time of the arthroscopy.
ligaments attach bones to other bones, tendons This video technology is also important for
attach muscles to bones, cartilage lines and documentation of the arthroscopic procedure.
helps protect the ends of bones, and a special For example, if the surgeon decides after the
fluid (synovial fluid) cushions and lubricates the arthroscopic examination that a conventional
structures. Looking inside the joint allows the approach to surgically expose or "open" the joint
doctors to see exactly which structures are (arthrotomy) must be used, a good photographic
damaged. Arthroscopy also permits earlier record will be useful when the surgeon returns to
diagnosis of many types of joint problems which execute the final surgical plan.
had been difficult to detect in previous years. The procedure requires the surgeon to make
several small incisions (portals) through the
skin's surface into the joint. Through one or two
Precautions of the portals, a large-bore needle, called a
Most arthroscopic procedures today are cannula, is attached to tubing and inserted into
performed in same-day surgery centers where the joint. The joint is inflated with a sterile saline
the patient is admitted just before surgery. A few solution to expand the joint and ensure clear
hours following the procedure, the patient is arthroscopic viewing. Often, following a recent
allowed to return home, although usually traumatic injury to a joint, the joint's natural fluid
someone else must drive. Depending on the may be cloudy, making interior viewing of the
joint difficult. In this condition, a constant flow of Thrombophlebitis — Inflamation of a vein with
the saline solution is necessary. This inflow of the formation of a thrombus or clot.
saline solution may be through the cannula with General anesthesia, in which the patient
the outflow through the arthroscope, or the becomes unconcious, may be used if the
positions may be reversed. The arthroscope is procedure may be unusually complicated or
placed through one of the portals to view and painful. For example, people who have relatively
evaluate the condition of the joint. "tight" joints may be candidates for general
Preparation anesthesia because the procedure may take
Before an arthroscopy can take place, the longer and cause more discomfort.
surgeon completes a thorough medical history Aftercare
and evaluation. Important for the accuracy of The portals are closed by small tape strips or
this diagnostic procedure, a medical history and stitches and covered with dressings and a
evaluation may discover other disorders of the bandage. The patient spends a short amount of
joint or body parts, proving the procedure time in the recovery room after arthroscopy.
unnecessary. This is always an important Most patients can go home after about an hour
preliminary step, because paincan often be in the recovery room. Pain medication may be
referred to a joint from another area of the body. prescribed for a short period; however, many
Anatomical models and pictures are useful aids patients find various over-the-counter pain
to explain to the patient the proposed relievers sufficient.
arthroscopy and what the surgeon may be Following the surgical procedure, the patient
looking at specifically. needs to be aware of the signs of infection,
Proper draping of the body part is important to which include redness, warmth, excessive pain,
prevent contamination from instruments used in and swelling. The risk of infection increases if
arthroscopy, such as the camera, light cords, the incisions become wet too early following
and inflow and outflow drains placed in the surgery. Because of this, it is good practice to
portals. Draping packs used in arthroscopy cover the joint with plastic (for example, a plastic
include disposable paper gowns and drapes with bag) while showering after arthroscopy.
adhesive backing. The surgeon may also place The use of crutches is commonplace after
a tourniquet above the joint to temporarily block arthroscopy, with progression to independent
blood flow to the area during the arthroscopic walking on an "as tolerated" basis by the patient.
exam. Generally, a rehabilitation program, supervised
General or local anesthesia may be used during by a physical therapist, follows shortly after the
arthroscopy. Local anesthesia is usually used arthroscopy to help the patient regain mobility
because it reduces the risk of lung and heart and strength of the affected joint and limb.
complications and allows the patient to go home
sooner. The local anesthetic may be injected in Risks
small amounts in multiple locations in skin and The incidence of complications is low compared
joint tissues in a process called infiltration. In to the high number of arthroscopic procedures
other cases, the anesthetic is injected into the performed every year. Possible complications
spinal cord or a main nerve supplying the area. include infection, swelling, damage to the
This process is called a "block," and it blocks all tissues in the joint, blood clots in the leg veins
sensation below the main trunk of the nerve. For (thrombophlebitis), leakage of blood into the joint
example, a femoral block anesthetizes the leg (hemarthrosis), blood clots that move to the lung
from the thigh down (its name comes from (pulmonary embolus), and injury to the nerves
femur, the thighbone). Most patients are around the joint.
comfortable once the skin, muscles, and other Normal results
tissues around the joint are numbed by the The goal of arthroscopy is to diagnose a joint
anesthetic; however, some patients are also problem causing pain and/or restrictions in
given a sedative if they express anxiety about normal joint function. For example, arthroscopy
the procedure. (It's important for the patient to can be a useful tool in locating a tear in the joint
remain still during the arthroscopic examination.) surface of the knee or locating a torn ligament of
Key terms the shoulder. Arthroscopic examination is often
Hemarthrosis — A condition of blood within a followed by arthroscopic surgery performed to
joint. repair the problem with appropriate arthroscopic
Pulmonary embolus — Blockage of an artery of tools. The final result is to decrease pain,
the lung by foreign matter such as fat, tumor, increase joint mobility, and thereby improve the
tissue, or a clot originating from a vein.
overall quality of the patient's activities of daily organs can be created by stacking the
living. individual slices together.
Abnormal results You must be still during the exam,
Less optimal results that may require further because movement causes blurred
treatment include adhesive capsulitis. In this
condition, the joint capsule that naturally forms
images. You may be told to hold your
around the joint becomes thickened, breath for short periods of time.
forming adhesions. This results in a stiff and less Generally, complete scans take only a
mobile joint. This problem is frequently corrected few minutes. The newest
by manipulation and mobilization of the joint with multidetector scanners can image
the patient placed under general anesthesia your entire body, head to toe, in less
than 30 seconds.
Computed Tomography
How to Prepare to the Test?
Scan 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.
A computed tomography (CT) scan is an
Contrast can be given several ways,
imaging method that uses x-rays to create
cross-sectional pictures of the body. and depends on the type of CT being
performed.
How the test is performed? It may be delivered through a vein (IV) in your
hand or forearm.
You will be asked to lie on a narrow It may be given through the rectum using an
table that slides into the center of the enema.
You might drink the contrast before your scan.
CT scanner. Depending on the study When you actually drink the contrast depends
being done, you may need to lie on on the type of exam being done. The contrast
your stomach, back, or side. liquid may taste chalky, although some are
Once you are inside the scanner, the flavored to make it taste a little better. The
machine's x-ray beam rotates around contrast eventually passes out of your body
you. (Modern "spiral" scanners can through your stools.
perform the exam in one continuous If contrast is used, you may also be
motion.) asked not to eat or drink anything for
Small detectors inside the scanner 4-6 hours before the test.
measure the amount of x-rays that If you weigh more than 300 pounds,
make it through the part of the body have your doctor contact the scanner
being studied. A computer takes this operator before the exam. CT
information and uses it to create scanners have a weight limit. Too
several individual images, called much weight can cause damage to the
slices. These images can be stored, scanner's working parts.
viewed on a monitor, or printed on Since x-rays have difficulty passing
film. Three-dimensional models of through metal, you will be asked to
remove jewelry and wear a hospital
gown during the study.
contrast, nausea, sneezing, vomiting, itching,
How The Test will Feel or hives may occur.
If you absolutely must be given such contrast,
your doctor may choose to treat you with
Some people may have discomfort antihistamines (such as Benadryl) or steroids
from lying on the hard table. before the test.
The kidneys help filter the iodine out of the body.
Contrast given through an IV may Therefore, those with kidney disease or diabetes
cause a slight burning sensation, a should receive plenty of fluids after the test, and
metallic taste in the mouth, and a be closely monitored for kidney problems. If you
warm flushing of the body. These have diabetes or are on kidney dialysis, talk to
your health care provider before the test about
sensations are normal and usually go your risks.
away within a few seconds. Rarely, the dye may cause a life-threatening
allergic response called anaphylaxis. If you have
Why the Text is Performed any trouble breathing during the test, you should
CT rapidly creates detailed pictures of the body, notify the scanner operator immediately.
including the brain, chest, spine, and abdomen. Scanners come with an intercom and speakers,
The test may be used to: so the operator can hear you at all times.
Guide a surgeon to the right area during a
biopsy What is a cerebral
Identify masses and tumors, including cancer
Study blood vessels angiogram?
An angiogram or angiography is a minimally
Normal Results invasive procedure that uses X-rays to view the
Results are considered normal if the organs and blood vessels (arteries and veins). When used
structures being examined are normal in to view the blood vessels leading to the brain,
appearance. the procedure is called a cerebral angiogram.

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 Carotid Cerebral Cerebral
amount of radiation. CT scans do create low Artery Angiogram - Angiogram -
levels of ionizing radiation, which has the Angiogr AP Lateral
potential to cause cancer and other defects. am
However, the risk associated with any individual When is a cerebral angiogram performed?
scan is small. The risk increases as numerous Interventional neuroradiologists use cerebral
additional studies are performed. angiograms to more accurately diagnose
In some cases, a CT scan may still be done if abnormalities in the brain's blood vessels, such
the benefits greatly out weigh the risks. For as aneurysms, arteriovenous malformations
example, it can be more risky not to have the (AVMs), and ruptures or blockages that can
exam, especially if your health care provider result in a stroke. An angiogram is sometimes
thinks you might have cancer. performed after another diagnostic test, e.g., a
An abdominal CT scan is usually not CT scan, has already detected an abnormality.
recommended for pregnant women, because it The results of an angiogram will guide further
may harm the unborn child. Women who are or treatment.
may be pregnant should speak with their health What can I expect during the procedure?
care provider to determine if ultrasound can be The procedure is performed on an X-ray table in
used instead. the Interventional Neuroradiology suite. Your
The most common type of contrast given into a groin area will be shaved and cleaned, and
vein contains iodine. If a person with an iodine drapes will be placed over you. A local
allergy is given this type of anesthetic is then injected into the area, which
could cause a slight pinch and/or some burning without the use of the patient's muscles
from the medication. After that, you should feel through a prescribed range of motion over
no pain. The doctor will insert a catheter (a long, extended periods of time. These devices
narrow, flexible tube) into the groin area and were first introduced in the 1980s by Dr.
navigate it to the carotid arteries, the vessels of Robert Salter, an orthopedic surgeon.
the neck that lead to the brain, where a
Purpose
contrasting dye is injected. You could feel heat
or a warm sensation in your head when the dye CPM is used to reduce the adverse effects
is injected. The dye allows the interventional of trauma or immobilization following
neuroradiologist and his team to view and take surgery. In physiological terms, synovial
pictures of the blood vessels in your brain fluid is diffused without hindering tissue
through X-ray imaging. Although you are awake repair; the joint receives nutrition, the
during the procedure, an anesthesiologist could flow of venous blood is increased, and the
give you medication to relax you. The cartilage is prevented from deteriorating.
technologist, nurse and doctors will talk to you at From a clinical perspective, joint swelling
different times during the procedure to make (edema) is decreased, range of motion
sure you are comfortable. You will be asked to (ROM) is maintained, tissue repair is
remain very still during the angiogram, as this
accelerated, and the patient experiences
will improve the results of your X-ray images and
minimize the length of the procedure. less pain.
An angiogram typically lasts from one to two CPM devices are used as alternatives and
hours, and you can usually go home the same adjuncts to conventional physical therapy
day. Your Lahey health care team will answer all following surgery or injury. CPM devices
your questions and talk to you in detail about may also be used in bedridden surgical
what to expect before, during and after your patients to reduce the incidence of deep
procedure. vein thrombosis, to treat abnormal muscle
shortening that occurs due to prolonged
Continous Passive Motion Device immobilization, and in patients with burns
or joint sepsis.
Electroencephalograph (EEG)

Lumbar Puncture (Spinal


Tap)

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
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
Electromyography (EMG) is a test that checks
examination. CSF is a clear, colorless liquid the health of the muscles and the nerves that
that delivers nutrients and "cushions" the brain control the muscles.
and spinal cord, or central nervous system. In a
lumbar puncture, a needle is carefully inserted How the Test is Performed
into the lower spine to collect the CSF sample. The health care provider will insert a very thin
Why It's Done needle electrode through the skin into the
Medical personnel perform lumbar punctures muscle. The electrode on the needle picks up
and test the cerebrospinal fluid to detect or the electrical activity given off by your muscles.
rule out suspected diseases or conditions. CSF This activity is displayed on a special monitor
testing looks for signs of possible infection by called an oscilloscope, and may be heard
analyzing the white blood cell count, glucose through a speaker.
levels, protein, and bacteria or abnormal cells After placement of the electrodes, you may be
that can help identify specific diseases in the asked to contract the muscle. For example,
central nervous system. bending your arm. The presence, size, and
Most lumbar punctures are done to test for shape of the wave form -- the action potential --
meningitis, but they also can determine if there produced on the monitor provide information
is bleeding in the brain, detect certain about your muscle's ability to respond when the
conditions affecting the nervous system such
nerves are stimulated.
as Guillain Barré syndrome and multiple
A nerve conduction velocity test is usually
sclerosis, and administer chemotherapy
medications. performed along with an EMG.
Preparation
How to Prepare for the Test
After the procedure is explained to you, you'll
be asked to sign an informed consent form —
No special preparation is usually necessary.
this states that you understand the procedure Avoid using any creams or lotions on the day of
and its risks and give your permission for it to the test.
be performed. How the Test Will Feel
The doctor doing the lumbar puncture will You may feel some pain or discomfort when the
know your child's medical history but might ask electrodes are inserted, but most people are
additional questions, such as whether your able to complete the test without significant
child is allergic to any medicines. difficulty.
You might be able to stay in the room with your Afterward, the muscle may feel tender or bruised
child during the procedure, or you can step for a few days.
outside to a waiting area. Why the Test is Performed
EMG is most often used when people have
Electromyography 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
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
Magnetic resonance imaging (MRI) is a pacemakers cannot have an MRI and should not
noninvasive way to take pictures of the body. enter an MRI area.
Unlike x-rays and computed tomographic (CT) You may not be able to have an MRI if you have
scans, which use radiation, MRI uses powerful any of the following metallic objects in your
magnets and radio waves. The MRI scanner body:
contains the magnet. The magnetic field Brain aneurysm clips
produced by an MRI is about 10 thousand times Certain artificial heart valves
greater than the earth's. Inner ear (cochlear) implants
The magnetic field forces hydrogen atoms in the Recently placed artificial joints
body to line up in a certain way (similar to how Some older types of vascular stents
the needle on a compass moves when you hold Tell your health care provider if you have one of
it near a magnet). When radio waves are sent these devices when scheduling the test, so the
toward the lined-up hydrogen atoms, they exact type of metal can be determined.
bounce back, and a computer records the Before an MRI, sheet metal workers or any
signal. Different types of tissues send back person that may have been exposed to small
different signals. metal fragments should receive a skull x-ray to
Single MRI images are called slices. The images check for metal in the eyes.
can be stored on a computer or printed on film. Because the MRI contains a magnet, metal-
One exam produces dozens or sometimes containing objects such as pens, pocketknives,
hundreds of images. and eyeglasses may fly across the room. This
can be dangerous, so they are not allowed into
How the Test is Performed the scanner area.
You may be asked to wear a hospital gown or Other metallic objects are also not allowed into
clothing without metal fasteners (such as the room:
sweatpants and a t-shirt). Certain types of metal Items such as jewelry, watches, credit cards,
can cause inaccurate images. and hearing aids can be damaged.
You will lie on a narrow table, which slides into Pins, hairpins, metal zippers, and similar metallic
the middle of the MRI machine. If you fear items can distort the images.
confined spaces (have claustrophobia), tell your Removable dental work should be taken out just
doctor before the exam. You may be prescribed before the scan.
a mild sedative, or your doctor may recommend
an "open" MRI, in which the machine is not as
close to the body. How the Test Will Feel
Small devices, called coils, may be placed An MRI exam causes no pain. Some people
around the head, arm, or leg, or other areas to may become anxious inside the scanner. If you
be studied. These devices help send and have difficulty lying still or are very anxious, you
receive the radio waves, and improve the quality may be given a mild sedative. Excessive
of the images. movement can blur MRI images and cause
Some exams require a special dye (contrast). errors.
The dye is usually given before the test through The table may be hard or cold, but you can
a vein (IV) in your hand or forearm. The dye request a blanket or pillow. The machine
helps the radiologist see certain areas more produces loud thumping and humming noises
clearly.
when turned on. You can wear ear plugs to help Magnetic resonance imaging; Nuclear magnetic
reduce the noise. resonance (NMR) imaging
An intercom in the room allows you to speak to
the person operating the scanner at any time. Positron Emission Tomography Scan
Some MRIs have televisions and special (PET Scan)
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. What is Positron Emission Tomography?
An MRA, or magnetic resonance angiogram, is a Positron emission tomography, also called PET
form of magnetic resonance imaging, that imaging or a PET scan, is a diagnostic examination
that involves the acquisition of physiologic images
creates three-dimensional pictures of blood based on the detection of positrons. Positrons are
vessels. It is often used when tiny particles emitted from a radioactive substance
traditional angiography cannot be done. administered to the patient. The subsequent views of
the human body developed by this technique are
Normal Results used to evaluate a variety of diseases.
Results are considered normal if the organs and
structures being examined are normal in What are some common uses of the
appearance. procedure?
PET scans are used most often to detect cancer and
to examine the effects of cancer therapy by
What Abnormal Results Mean characterizing biochemical changes in the cancer.
Results depend on the part of the body being These scans are performed on the whole body. PET
examined and the nature of the problem. scans of the heart can be used to determine blood
Different types of tissues send back different flow to the heart muscle and help evaluate signs of
MRI signals. For example, healthy tissue sends coronary artery disease. PET scans of the heart can
back a slightly different signal than cancerous also be used to determine if areas of the heart that
tissue. Consult your health care provider with show decreased function are alive rather than
scarred due to a prior heart attack, called a
any questions and concerns. myocardial infarction. Combined with a myocardial
perfusion study, PET scans differentiate
Risks nonfunctioning heart muscle from heart muscle that
MRI contains no ionizing radiation. To date, would benefit from a procedure, such as angioplasty
there have been no documented significant side or coronary artery bypass surgery, which would
effects of the magnetic fields and radio waves reestablish adequate blood flow and improve heart
used on the human body. function. PET scans of the brain are used to evaluate
patients who have memory disorders of an
The most common type of contrast (dye) used is undetermined cause; who have suspected or proven
gadolinium. It is very safe. Allergic reactions to brain tumors; or who have seizure disorders that are
the substance rarely occur. The person not responsive to medical therapy and, therefore,
operating the machine will monitor your heart are candidates for surgery.
rate and breathing as needed.
MRI is usually not recommended How should I prepare for the procedure?
for acute trauma situations, PET is usually done on an outpatient basis. Your
doctor will give you detailed instructions on how to
because traction and life-support equipment
prepare for your examination. You should wear
cannot safely enter the scanner area and the comfortable, loose-fitting clothes. You should not eat
exam can take quite a bit of time. for four hours before the scan. You will be
People have been harmed in MRI machines encouraged to drink water. Your doctor will instruct
when they did not remove metal objects from you regarding the use of medications before the
their clothes or when metal objects were left in test.
the room by others.
Note: Diabetic patients should ask for any specific
Alternative Names
diet guidelines to control glucose levels during the What will I experience during the
day of the test. procedure?
The administration of the radioactive substance will
What does the equipment look like? feel like a slight pinprick if given by intravenous
You will be taken to an examination room that injection. You will then be made as comfortable as
houses the PET scanner, which has a hole in the possible on the examination table before you are
middle and looks like a large doughnut. Within this positioned in the PET scanner for the test. You will be
machine are multiple rings of detectors that record asked to remain still for the duration of the
the emission of energy from the radioactive examination. Patients who are claustrophobic may
substance in your body and permit an image of your feel some anxiety while positioned in the scanner.
body to be obtained. While lying on a cushioned Also, some patients find it uncomfortable to hold one
examination table, you will be moved into the hole of position for more than a few minutes. You will not
the machine. The images are displayed on the feel anything related to the radioactivity of the
monitor of a nearby computer, which is similar in substance in your body.
appearance to the personal computer you may have
in your home. Who interprets the results and how do I
get them?
How does the procedure work? Patients undergo PET because their referring
Before the examination begins, a radioactive physician has recommended it. A radiologist who has
substance is produced in a machine called a specialized training in PET will interpret the images
cyclotron and attached, or tagged, to a natural body and forward a report to your referring physician. It
compound, most commonly glucose, but sometimes usually takes one to three days to interpret, report,
water or ammonia. Once this substance is and deliver the results. In order to facilitate
administered to the patient, the radioactivity interpretation, you may be asked to bring any
localizes in the appropriate areas of the body and is outside examinations with you, such as recent CT
detected by the PET scanner. (CAT) scans or MRI scans.

Different colors or degrees of brightness on a PET What are the benefits vs. risks?
image represent different levels of tissue or organ Because PET allows study of body function, it can
function. For example, because healthy tissue uses help physicians detect alterations in biochemical
glucose for energy, it accumulates some of the processes that suggest disease before changes in
tagged glucose, which will show up on the PET anatomy are apparent on other imaging tests such
images. However, cancerous tissue, which uses more as CT or MRI scans.
glucose than normal tissue, will absorb more of the Because the radioactivity is very short-lived, your
substance and appear brighter than normal tissue on radiation exposure is extremely low. The substance
the PET images. amount is so small that it does not affect the normal
processes of the body.
How is the procedure performed? The radioactive substance may expose radiation to
A nurse or technologist will take you into a special the fetus of patients who are pregnant or the infants
PET examination room. You will lie down on an of women who are breast-feeding. The risk to the
examination table and be given the radioactive fetus or infant should be considered related to the
substance as an intravenous injection (although, in potential information gain from the result of the PET
some cases, it will be given through an existing examination. If you are pregnant you should inform
intravenous line or inhaled as a gas). It will then the PET imaging staff before the examination is
take approximately 30 to 60 minutes for the performed.
substance to travel through your body and be
absorbed by the tissue under study. During this What are the limitations of Positron
time, you will be asked to rest quietly in a partially
Emission Tomography?
darkened room and to avoid significant movement or
PET can give false results if a patient's chemical
talking, which may alter the localization of the
balances are not normal. Specifically, test results of
administered substance. After that time, scanning
diabetic patients or patients who have eaten within
begins. This takes an additional 30 to 45 minutes.
several hours prior to the examination can be
adversely affected because of blood sugar or blood
Some patients, specifically those with heart disease,
insulin levels.
may undergo a stress test in which PET scans are
obtained while they are at rest, and again after
Also, because the radioactive substance decays
undergoing the administration of a pharmaceutical to
quickly and is effective for a short period of time, it
alter the blood flow to the heart.
must be produced in a laboratory near the PET
scanner. It is important to be on time for the
Usually, there are no restrictions on daily routine
appointment and to receive the radioactive
after the test, although you should drink plenty of
substance at the scheduled time. PET must be done
fluids to flush the radioactive substance from your
by a radiologist who has specialized in nuclear
body.
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