General Radiology

What are X-ray studies?

X-ray or diagnostic radiology covers a wide area of exams. Basically, it consists of an exam that uses small amounts of radiation that pass through the body and strikes a sheet of X-ray film. The thickness of the body part determines the shadowing or contrast and density of the image on the film. Since bone is dense, it does not let much radiation pass through to the film. This causes it to be white on the image. Lungs, which are mostly air, let almost all of the radiation pass, which results in a black area on the film. These areas of varying shades produce an image that allows radiologists (X-ray doctor) to interpret what the inside of the body looks like.

Are X-rays safe?

While large amounts of radiation may post a health risk, the small amounts used in diagnostic radiology clearly shows the benefits far outweigh the risks. Radiologic technologists and radiologists are trained in radiation physics and radiation biology and strive to administer radiation safety. New advances in equipment and improved film quality have resulted in less exposure per exam.

How is barium used and what is its purpose?

Barium given orally or rectally allows for visualization of the esophagus, stomach and bowel. It is a thick white liquid that is chalky in appearance. Sometimes air is added to see the lining of these structures. Any study utilizing barium is called a fluoroscopic study. When barium is used for any study, the patient must drink extra liquids and take a mild laxative afterward to clear it from the body system.

What is X-ray dye?

Iodine contrast is sometimes used to visualize certain blood vessels or the urinary system. It may be used to diagnose a blockage in a vessel or a stone in the urinary system. Iodine contrast may be given intravenously (in a vein) or in an artery. Iodine contrast is not painful in most cases, but may cause a warm sensation upon injection. If you have an allergy to iodine, kidney failure, sickle cell disease or diabetes, please inform the technologist before having your exam.

What is fluoroscopy?

Fluoroscopy is a type of X-ray that allows the radiologist to view the studied body part in "real time." The image is displayed digitally on a high-resolution TV monitor.

How do I prepare for my exam?

IVP - extra fluids and a light evening meal the night before the exam. Take two ounces of oral fleets or one bottle of magnesium citrate at 6 p.m. the night before your exam. Drink extra fluids until midnight. Nothing to eat or drink afterward.
Upper GI, SBFT (small bowel follow through) - No food or drinks after midnight.
Barium enema - the preparation material can be bought as a kit (Fleet prep kit). Patient should have extra fluids and a liquid meal the night before exam. Liquid meals contain no milk products, no Jell-O and solid foods. You may have strained soups and juices. 1.5 ounces of fleets (or one bottle of magnesium citrate) at 6 p.m. Four fleet tablets (or three Dulcolax tablets) at 9 p.m., and one fleet suppository at 6 a.m. the morning of the exam. No food or drinks after midnight.
Hysterosalpingogram - exam should be performed between six and 11 days after menstruation. Patient must have a negative pregnancy test less than two weeks old. Patient must have no ongoing pelvic infection.
Myelogram - (see section on Interventional Radiology) Nothing to eat or drink after midnight. No Compozine or Thorazine medications for 24 hours prior to test, or 48 hours afterward. Patient will have bed rest all day. No driving, or lifting for one week. Recovery time is 3-5 hours.
Anteriogram - (see section on Interventional Radiology). Nothing to eat or drink after midnight. No aspirin containing medications for ten days prior to exam. Plan to stay in the hospital for one day for recovery time.
Venogram - Nothing to eat or drink for four hours prior to exam.
Arthrogram - Nothing to eat or drink for four hours prior to exam.

What exams must be scheduled and how long does it take?

Esophagram - 20 minutes
Upper GI - 20 minutes
Small bowel follow through - 1.5 to 2 hours
Barium Enema - one hour
Voiding cystogram - 30 minutes (30 min. preparation time)
Intravenous Pyelogram (IVP) - one to two hours
Tomograms - 30 minutes
Hysterosalpingogram - one hour
Snif test - 15 minutes
Venogram - one hour
Myelogram - one hour (one hour preparation time and about four hours of recovery time)
Arthrogram - one hour
Arteriogram - two or more hours (1-2 hour preparation time and 8-12 hours of recovery time)

What can I expect from my exam?

Esophagram, Upper GI - The radiologist will have you drink 1-2 cups of barium while standing. Pictures will be taken while you are drinking. You will then lie down and follow the instructions from the radiologist, while he/she is taking pictures. This exam shows the inside of the esophagus and the stomach. Be sure to drink extra fluids for a couple of days after the exam.
Small bowel follow through - You will drink two cups of barium and then lie down on the X-ray table. The technologist will take one picture every 15 minutes for up to one or 1.5 hours. The radiologist will take special pictures afterward with the fluoroscope. This test shows small intestinal abnormalities. Be sure to drink extra fluids for a couple of days after the exam.
Barium Enema - You will be asked to change into an X-ray gown and remove all your underclothes. After you lie down on the X-ray table, a small enema tip will be inserted into you rectum and left there for the exam. This enema tip will allow us to fill your colon with barium and possibly some air. The radiologist will take pictures with the fluoroscope and the technologist will take several more afterward. You will change positions frequently and the exam can be quite uncomfortable for some people, but we move as fast as possible and still provide a quality exam. This exam is used to evaluate the entire colon.
Voiding Cystogram - you will need to arrive in outpatient surgery one hour prior to the exam time to be catheterized (insert a small tube into the urethra). During the exam, the technologist will fill your bladder with iodine contrast until you are very full and then the catheter will be removed. Several pictures will be taken. A small urinal device will be placed between your legs to empty the contrast. You will be kept covered and pictures will be made while the bladder is emptying. Every effort will be made to protect your privacy during this exam. This exam is usually conducted for recurrent urinary tract infections and will show if there is reflux of urine into the ureters. The bladder's ability to empty effectively will be evaluated. This exam is not painful, but the introduction of the catheter into the bladder may be uncomfortable.
Intravenous Pyelogram (IVP) - You will be asked to lie on an X-ray table and will be given an injection of iodine contrast. Pictures will be taken every few minutes and you may be asked to change positions occasionally. You will need to empty your bladder before and after the exam. This exam is used to study the kidneys, ureters and the bladder. It is not painful, but the needle stick for the injection may be slightly painful.
Tomograms - This exam is frequently used in conjunction with an IVP or may be performed as a separate exam on certain joints. You will lie still on an X-ray table while pictures are taken. The machine will be moving above you during each picture. If you have tomograms of your kidneys, a band will be placed around your abdomen with a small balloon device in the front. The purpose of this is to compress your ureters in order to highlight your kidneys better. This exam is not painful. Tomograms allow us to see the studied organ in small cross sectional detail.
Hysterosalpingogram (HSG) - This is much like a pelvic exam in that a speculum will be inserted into your vagina. The radiologist will place a small catheter through the cervix into the uterus. A small amount of iodine contrast will be injected through the catheter to fill the fallopian tubes, then, several pictures will be taken. This exam evaluates the patency of the uterus and fallopian tubes. Exam ranges from slight discomfort to moderate pain. The patient may bleed slightly afterward.
SNIF Test - The radiologist will fluoroscope you while you make "sniffing" motions. This evaluates the movement of the diaphragm (the muscle between your lungs and abdomen) and is used to rule out paralysis of that muscle.
Venogram - These are usually performed on the leg or the arm. An IV will be placed on the lowest part of the arm or leg and iodine contrast will be injected and studied fluoroscopically. It evaluates the vein in question to rule out blockage. While the exam is not painful, placement of the IV may be a little uncomfortable.
Myelogram - You will be placed on your stomach and your lower back will be surgically draped and cleaned with antiseptic solution. A local anesthetic will be given by the radiologist in the lower back to relieve the pain of the spinal needle that will be inserted. Some pressure will be felt during insertion, but usually no pain. Once the contrast is in the spinal canal, images will be taken. This exam shows any stenosis or squeezing of the spinal cord by bulging disks or bone. You will have 3-5 hours of recovery time and will be asked to lie on your back with your head elevated during recovery. You may not drive home, and no lifting for one week. Some myelograms require a CAT scan afterward to confirm the initial diagnosis.
Anthrogram - This exam is usually done on the shoulder joint. You will lie on your back for the exam. Antiseptic solution will be used to clean the area and an anesthetic will be given to lessen the pain caused by the injection of the contrast in the shoulder joint. The patient may feel some pain or pressure in the joint afterward for several hours after the exam. This test shows if there is a tear of the rotator cuff or if any parts of the shoulder are rubbing together.
Anteriogram – The patient usually is admitted for 23 hours observation. The patient is sedated and covered with sterile drapes and the groin area is surgically prepared. A catheter will be inserted into an artery in the groin area. This is the area where the hip bends when flexed. The catheter will follow the artery up into the body until it reaches the area of interest. Iodine contrast will be injected while pictures are taken to evaluate patency of the arteries. This exam is uncomfortable, but usually not painful. You will be required to have bed rest for the remainder of the day and will not be able to bend the leg that the catheter was inserted into in order to let the injection site heal and to prevent blood clots.

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