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Radiology & Medical Imaging

Your comfort during these procedure is very important to the staff at Morristown-Hamblen Healthcare System.  Please let the technologist know if there is something that can be done to make you more comfortable during this procedure.  If you have other questions not answered on this sheet, please don’t hesitate to call the Imaging Services Department at (423) 492-6800.  Thank you for allowing us to service your healthcare needs.

Your understanding of the treatments and tests you receive is very important to everyone at Morristown-Hamblen Healthcare System. Therefore, this information sheet is meant to acquaint you with standard procedures followed in a routine barium enema exam. This document provides you with the basic facts and information about this test.  Read the material, share it with your family and ask any clarifying questions of the nurse or technologist.


Barium Enema
Nuclear Medicine Bone Scan
CT Scan
Calcium Score
IVP
Nuclear Medicine Liver Scan
Nuclear Medicine Lung Scan
Nuclear Medicine Stress Test
Ultrasound
Upper GI Series

 

Barium Enema

Description:

A barium enema is an x-ray examination of the large intestine (colon), which is the final portion of the digestive tract. The large intestine becomes visible on an x-ray after a solution of barium is put into the colon by means of an enema. X-rays are directed toward you that bounce off the barium inside and cast shadows on the x-ray film. The film serves as a permanent record, and is studied by a radiologist, who is trained in reading x-rays.

Preparation:

Please obtain one bottle of Magnesium Citrate and one box of Dulcolax Suppositories from any pharmacy (over-the-counter, no prescription required) and then follow the instructions below.

The day before the test:

1. Your diet will be restricted to clear liquids. Liquids are considered clear if they can be held up to the light and seen through.  This can include clear fruit juices, clear soup, plain black coffee, tea, and JELL-O.
2. Drink a lot of fluid that day. Drink no less than one 8 oz. glass of water every 2 hours from noon to midnight.
3. At 4:00 PM- drink one bottle of Magnesium Citrate over ice, follow with 8 oz. water adults (12 years and older) – 10 fluid oz. Or 1 whole bottle children 11-6 years old – 7 fluid oz. children 5-2 years old – 3 fluid oz.
4. At 5:00 PM- dinner- clear liquids of any amount. You are not to eat, drink, smoke or chew gum after midnight.
5. Insert one Dulcolax suppository at least one hour before bedtime.

The day of the test:

1. Do not eat breakfast before your x-ray.  Drink 1 ½ 12 oz glasses of water.
2. Insert one Dulcolax suppository at least one hour before leaving home.
3. Have nothing else to eat, drink, smoke or chew gum until after the exam. 
4. Necessary medications may be taken with a sip of water. 
5. You may brush your teeth but avoid swallowing any water.
6. Arrive at Morristown-Hamblen Healthcare System’s Admissions 30 minutes prior to your appointment time.

Procedure:

1. The x-ray technologist will position you on the table and will explain the procedure in more detail. An enema tip will be placed into your rectum in order to pass fluids into your colon.
2. The radiologist will administer the barium solution. If your doctor also ordered an air contrast study, thicker barium will be used to coat the bowel. Air is then carefully pumped into the bowel through the enema tip to distend it. X-rays are taken during this time.
3. From time to time, you will be asked to remain perfectly still and to hold your breath. You may be rotated into slightly different positions during the examination. The doctor may put in additional barium if needed.
4. When the examination is over, most of the time barium is drained out.  Your x-rays are checked, and you will be free to leave. Occasionally, more x-rays may be needed if some necessary information was omitted.  Once you leave you may have breakfast.
5. It is important to eat well and drink plenty of fluids to help evacuate the barium. Before bedtime you may use a laxative to help clear the digestive tract of the barium.
6. The radiologist will study your x-rays and give his/her impression to your doctor. Your doctor will then discuss the results with you and what they mean in relation to your health.


Nuclear Medicine Bone Scan


Definition:

A bone scan is a picture taken of your skeleton after IV injection of a radioactive isotope. The injected radiation is a very small amount, approximately what is obtained when receiving a chest x-ray. This film serves as a permanent record and is studied by a radiologist, who is trained to interpret scans.

Preparation:

1. You do not need to restrict food or fluids before the test.
2. You need to drink extra liquids after the IV injection.

Procedure:

1. You will be injected with a radioisotope at your appointment time.
2. Four hours after your injection, you will be asked to return to the nuclear medicine department where pictures of your skeleton will be taken with a special camera. This will take about 40 minutes.
3. When the scan is over, you will be free to leave the facility.
4. A radiologist will study your bone scan and report the findings to your doctor. Your doctor will then discuss these results with you and explain what they mean in relation to your health.


CT Scan

Description:
A Computed Tomography (CT or CAT) scan is a test in which horizontal sections of a body part are examined at various angles with an x-ray beam.  A computer calculates the absorption of the x-ray beams, and these calculations are converted into an image on a computer screen.  These pictures are also printed on x-ray film. A CT scan is valuable in diagnosing conditions not visible on conventional x-rays and may make other procedures such as exploratory surgery unnecessary.

Preparation: 
Please follow the prep information carefully as it will allow you and your physician to obtain the best possible exam.  If your exam is not listed below, then your exam does not have a specific prep to follow.

CT Pelvis Routine or Both CT Abdomen and Pelvis at the same time or CT Abdomen/Pelvis for Bowel Obstruction
Obtain 2 bottles of Redicat Prep from Radiology.  Drink one whole bottle of Redicat the night before your exam.  Drink ½ of the other bottle one hour before your scheduled exam.  Bring the rest of the second Redicat bottle with you to your exam, and the CT Technologist will inform you when to finish the bottle.

CT Abdomen Routine
Obtain 1 bottle of Redicat Prep from Radiology.  Drink ½ of the other bottle one hour before your scheduled exam.  Bring the rest of the Redicat bottle with you to your exam, and the CT Technologist will inform you when to finish the bottle.

Organ Biopsy using CT – Have nothing to eat or drink 2 hours before you arrive for your biopsy.  Following your biopsy, you will remain in Radiology for a minimum of 2 hours.

The following exams also have intravenous contrast that will be administered during your CT exam.
CT Head with and without contrast CT Abdomen
Aneurysm CT Abdomen
Routine CT Abdomen
Bowel Obstruction CT Chest
Mass CT Chest
PE study CT Chest
Aneurysm CT Chest
Dissection CT Pelvis
Routine CT Neck

Procedure for all CT exams:
1. Arrive at Morristown-Hamblen Healthcare System’s Admissions.
2. You will be taken to the x-ray department by wheelchair, on a cart, or by walking there on your own. 
3. The technologist will help you position yourself on the CT table.  He/She will also explain the procedure in more detail. If you are having a CT scan of your head, your head will be positioned in a special cradle to assist you in keeping your head still for the scan.
4. If you have an injection of the contrast media, you may experience a warm sensation throughout your body. This will not be long lasting and usually is not very uncomfortable.  If you develop any shortness of breath or itching, notify the technologist immediately. 
5. During the actual scanning process, you will be alone in the room but there is an intercom, which allows you to communicate with the technologist at all times.
6. The table moves slightly with each scan.  Simply relax and lie still. You may be asked to periodically hold your breath during various phases of the scan.
7. As the equipment scans, you may hear the sounds of gears and motors.  These are normal sounds that the machine makes while operating.
8. Following the procedure, you will be free to leave the facility and resume normal activity.  The radiologist will examine your CT scans and report the findings to your doctor who will then discuss them with you.


Calcium Score


If you’re a man over 40, a woman over 50 or are at risk for heart disease, you should be aware of a revolutionary, pain-free, non-invasive procedure that gives you important information that is key to the long-term health of your heart.  The procedure is called “Calcium score” and it will, in just a few minutes, determine the presence or absence of coronary calcium in your heart and the degree of the calcification.

Why is a Calcium Scoring test important?
The primary cause of heart disease is atherosclerosis, the build-up of calcium — or plaque — in the arteries of your heart.  This build-up can cause the arteries to narrow.  Plaque can also break away from the artery walls and cause a blockage.  In both instances, the heart does not receive enough blood flow and oxygen, thus a heart attack can occur.  By knowing the amount of calcium present well in advance of a heart attack, steps can be taken to prevent a heart attack from occurring.

Calcium Scoring can:
- Detect the build-up of calcium earlier than any other technology
- Help your doctor develop an appropriate prevention strategy
- Provide a tool to measure the progression or regression of calcium build-up
- Give you peace of mind

What does the Calcium scoring procedure involve?
The complete procedure takes less than an hour. The scan itself takes less than a minute.  First, we will ask you to complete a brief risk factor questionnaire.  We will then ask you to lie down on the imaging table.  Unless you are wearing certain metal buttons or other closures, you will not even need to undress.  Our certified technologist will place a few EKG leads on you, you will be asked to hold your breath, and the images will be taken.  There are no needles, no dye and no pain whatsoever.  A board certified radiologist will calculate your calcium score based on the images taken.  The evaluation of your results will be available the same day.

What if my Calcium scoring test shows a lot of calcium?
The calcium build-up process can be slowed, stabilized or even, in some cases, reversed.  Working with your doctor, you will probably be given some lifestyle modification recommendations and/or medications.

What are the risk factors I should be aware of?
The American Heart Association has designated the following as cardiac risk factors:
- Family history of heart disease
- High cholesterol
- Obesity
- Smoking
- Diabetes
- Sedentary lifestyle
- High emotional stress
- High blood pressure
- Menopausal but not on Estrogen
- Age over 65

Does insurance cover a Calcium score exam?
At this time, most insurance considers this a non-covered service.  Payment is due at the time of your scan.  There is a single charge for both the scan and the scoring.


IVP

Definition:

An IVP is an x-ray examination of the urinary system including the kidneys, ureters, and bladder. A special contrast solution, administered through an IV in your arm, will circulate through your blood and be excreted by your kidneys. This contrast solution will show up on your x-rays and will enable the doctor to determine how well your kidneys are functioning and if there is any physical abnormality present.

Preparation:

Please obtain one bottle of Magnesium Citrate and one box of Dulcolax Suppositories from any pharmacy (over-the-counter, no prescription required) and then follow the instructions below.

The day before the test:

1. Your diet will be restricted to clear liquids. Liquids are considered clear if they can be held up to the light and seen through.  This can include clear fruit juices, clear soup, plain black coffee, tea, and JELL-O.
2. Drink a lot of fluid that day. Drink no less than one 8 oz. glass of water every 2 hours from noon to midnight.
3. At 4:00 PM- drink one bottle of Magnesium Citrate over ice, follow with 8 oz. water adults (12 years and older) – 10 fluid oz. Or 1 whole bottle children 11-6 years old – 6 fluid oz. children 5-2 years old – 3 fluid oz.
4. At 5:00 PM- dinner- clear liquids of any amount. You are not to eat, drink, smoke or chew gum after midnight. 5. Insert one Dulcolax suppository at least one hour before bedtime.

The day of the test:

1. Do not eat breakfast before your x-ray.  Drink 1 ½ 12 oz glasses of water.
2. Insert one Dulcolax suppository at least one hour before leaving home. (for children, ask your referring doctor)
3. Have nothing else to eat, drink, smoke or chew gum until after the exam.
4. Necessary medications may be taken with a sip of water. You may brush your teeth but avoid swallowing any water.

Procedure:

1. Arrive at Morristown-Hamblen Healthcare System’s Admissions 30 minutes prior to your appointment time.
2. You will be asked to put on a special gown without snaps and to remove all jewelry. Do not wear undergarments because they may have buttons, snaps or elastic that will show up on x-rays.
3. You will be placed on an x-ray table and asked to lie flat on your back. An x-ray picture or series of x-ray pictures will be taken of your abdomen.
4. A contrast solution will be injected through the IV in your arm.  You may experience a brief warm sensation or metallic taste in your mouth when this contrast solution is injected.
5. Several pictures will be taken as this contrast moves through your urinary tract. You may be asked to empty your bladder for a final picture to determine bladder function.
6. When the procedure is completed and the pictures are checked by the radiologist you will be free to leave the facility.
7. The radiologist will review your pictures and report the findings to your doctor that will discuss the results with you and explain what they mean to your health.


Nuclear Medicine Liver/Spleen Scan


Definition:

A liver and spleen scan is a picture taken of your liver and spleen after IV injection of a radioactive isotope. The injected radiation is a very small amount, approximately what is obtained when receiving a chest x-ray.  This film serves as a permanent record and is studied by a radiologist, who is trained to interpret scans. Preparation: 1. You do not need to restrict food or fluids before the test.

Procedure:

1. Arrive at Morristown-Hamblen Healthcare System’s Registration Department.
2. The nuclear medicine technologist will position you under a camera and will administer an IV injection of radioactive isotope.
3. Pictures of your liver and spleen immediately following the injection. The scan will take approximately 30 minutes.
4. You will be free to leave the facility.
5. A radiologist will study your liver and spleen scan and report the findings to your doctor. Your doctor will then discuss these results with you and explain what they mean in relation to your health.  


Nuclear Medicine Lung Scan

Definition:  

A lung scan is a picture taken of your lungs after the IV administration of a radioactive isotope.  The injected radiation is a very small amount, approximately what is obtained when receiving a chest x-ray.  This film serves as a permanent record and is studied by a radiologist, who is trained to interpret scans.

Preparation:

1. You do not need to restrict food or fluids before the test.

Procedure:

1. Arrive at Morristown-Hamblen Healthcare System's Registration Department.
2. The nuclear medicine technician will place an oxygen mask on you and position you under a camera.
3. You will breathe oxygen mixed with a radioactive gas as pictures of your lungs are taken.  This will last about 10 minutes.  The oxygen mask is then removed.
4. You will be given an IV injection of radioactive isotope.
5. More images of your lungs will be made during and after the injection. The entire scan will last approximately 45 minutes.
6. Occasionally, a chest x-ray will be taken before or after the lung scan.
7. You will be free to leave the facility.
8. A radiologist will review your lung scan results and report the findings to your doctor.  Your doctor then will discuss the results with you and explain what they mean in relation to your health.


Nuclear Medicine Stress Test


Definition:

A nuclear medicine stress test is done for the doctor to take pictures of your heart while you are stressed (exercising) as well as during rest. This test involves the injection of a radioactive 'tracer' that allows the heart muscle to be seen on the NM camera. This is especially useful in diagnosing coronary heart disease, the presence of blockages in the coronary arteries that supply oxygen-rich blood to the heart muscle. The amount of radioactive 'tracer' that is used is a very small amount and safe. However, if you are pregnant, suspect you may be or are a nursing mother, be sure to let your doctor or technologist know.

Preparation:

1. Arrive at Morristown-Hamblen Healthcare System’s Heart, Lung & Vascular Center for registration.
2. This test takes approximately 4 hours to complete.  You may want to bring a book or some “time-occupying” distraction with you.  You will be at the hospital for almost the entire time.
3. You will be able to drive yourself home after the test is completed.
4. Eat a small, fatty breakfast before coming to the hospital for the exam.  This may include items such as bacon, peanut butter, cream cheese, sausage, whole milk, and butter.
5. If your doctor’s office has advised you to stop certain medications for this test, please do so at the time they advise.  DO NOT STOP ANY MEDICATIONS UNLESS YOU ARE TOLD.
6. PLEASE DO NOT HAVE ANY CHOCOLATE, CAFFEINE, OR DECAFFEINATED PRODUCTS FOR 24 HOURS PRIOR TO THE TEST TIME. This includes even “caffeine-free” items and some prescription and over-the-counter medications.  If you have questions about whether a medicine may contain caffeine, contact your pharmacy.  The only acceptable drinks are water, fruit juice, white milk, Sprite, and/or 7-Up.
7. Wear loose and comfortable clothing. Men don't usually wear a shirt during the test. Women usually wear a light gown or blouse.  If you will be walking on the treadmill, please wear comfortable pants or shorts with walking shoes such as tennis shoes.

Procedure:

1. Before the test, you will be given a description of the test and asked to sign a consent form.
2. You will be escorted to the Nuclear Medicine Department.  An IV line will be inserted in a vein in your arm, and you will get an injection of a radioactive tracer.  This tracer will allow pictures of your heart to be taken on a special camera.
3. You will be asked to wait in the waiting area for about 1-1½ hours.  After that time, you will lay down on the scan table with both arms above your head.  The camera moves slowly around you, and this part of the test takes about 20 minutes.  In some cases, the test will be performed over a 2-day period.
4. You will be escorted to the Cardiovascular Laboratory.  Several electrodes will be placed on your chest.  This allows the recording of your heart’s electrical activity.
5. If you are walking on the treadmill, the exercise activity you are asked to do will slowly become more difficult as the test continues.  When you reach your target heart rate, you will receive another injection of the radioactive tracer.  You will walk for one more minute.
6. If you are receiving a medicine stress test, you will get the injection at a specific time during the infusion.
7. If during this period of exercise or medicine you experience any chest pain, discomfort, dizziness, or shortness of breath, let the nurse or doctor know immediately.
8. After the end of the stress portion, you will be allowed to leave the hospital until the time for the second set of pictures.  You may eat or drink during this time, which is typically 1½ hours.
9. The pictures are compared to determine if there is a blockage in the blood supply to the heart muscle. Your doctor will discuss these results with you at a future office visit.  The test results will give the doctor important information to better develop the best plan of care for you.


Ultrasound

Definition:
An ultrasound uses high frequency sound waves, inaudible to the human ear. These sound waves pass through body tissues and cause echoes. These echoes are different dependent upon the density of the body tissues. The echoes are recorded and translated into a video or photographic images. These images help in the diagnosis of a wide range of diseases.

Preparation:
Typically, there is little or no preparation for an ultrasound, but for some ultrasound exams, you may be asked to follow specific preparations listed below.

Ultrasound of the Abdomen
Ultrasound of the Kidneys
Ultrasound of the Gallbladder
Ultrasound of the Liver
Ultrasound of the Abdominal Aorta


Day before the exam: 
Have nothing to eat, drink, smoke, or chew after midnight the evening before the exam. 

Infants:
Ultrasound for Pyloric Stenosis - Nothing to eat or drink 3 hours prior to exam

Pelvic Ultrasound and Uterine (OB) Ultrasound
Day of exam:
Drink 32 ounces of fluid (anything except milk, please) one hour before the exam.  Do not go to the bathroom and empty your bladder until after the exam is completed.

Prostate (Transrectal) Ultrasound
Day of exam: 
Please obtain one box of Dulcolax Suppositories from any pharmacy (over-the-counter, no prescription required).  Insert Dulcolax into rectum on the morning of your exam.
Procedure:

1. Arrive at Morristown-Hamblen Healthcare System’s Registration Department.
2. You will be asked to put on a special gown.
3. You will be asked to lie on your back on a table.
4. A small amount of gel will be applied to the skin of the area to be examined. This gel is not harmful to the skin and will be removed after the examination is completed.
5. A wand-like device, called a transducer, is gently applied against the skin. The transducer transmits the high-frequency sound waves needed to perform the exam.
6.You may be asked to hold your breath several times during the exam.

Results:
A radiologist will review the images taken during your ultrasound. He/She will let your doctor know his findings. Your doctor will discuss these findings and what they mean about your health with you during a later visit.


UGI (Upper Gastrointestinal) Series

Definition:

A UGI series is a group of pictures taken of your esophagus, stomach, and small intestine. A special liquid called barium is swallowed. X-rays are directed toward you, which bounce off the barium inside and cast shadows on the x-ray film. This film serves as a permanent record and is studied by a radiologist, who is trained to interpret x-rays.

Preparation:

1. The evening before the x-ray you are not to eat, drink, smoke or chew gum after midnight.
2. Necessary medication may be taken with a sip of water.
3. You may brush your teeth, but avoid swallowing any water.
4. Do not eat breakfast before your x-ray.

Procedure:

1. Arrive at Morristown-Hamblen Healthcare System’s Registration Department.
2. The staff will ask you to put on a special gown without snaps and to remove jewelry.
3. You will give given a cup of chilled liquid called barium to drink.
4. You will be placed on an x-ray table and x-rays will be taken of your esophagus and stomach.  From time to time, you will be asked to remain perfectly still and to hold your breath. You may be asked to drink more barium.
5. When the x-ray is over and the films are checked by the radiologist, you will be free to leave the facility.  Once you leave, you may have breakfast.
6. Before bedtime you may take a laxative to help clear your digestive tract of the barium.
7. A radiologist will study your x-rays and report the findings to your doctor. Your doctor will then discuss these results with you and explain what they mean in relation to your health.