Diagnostic Procedures: Plain X-Ray

• A diagnostic procedure is a medical test or examination conducted to identify a disease or condition
• Diagnostic procedures include plain X-rays, kidney, ureters and bladder X-rays (KUB), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound studies

Plain X-Ray

• Assess organs of the body
• Diagnose body disorders
• Assesses the size and position of the organs
• Can be used as chest X-ray to asses lung condition or abdominal X-ray
• Patients must explain the procedure to the patient
• Patients must change into a hospital gown and remove jewelry
• Patients must position the patient depending on which view the physician would like to obtain
• Patients may have to lie on their side, face up, or stand
• Lead apron is sometimes placed over parts of the body that are not undergoing the X-ray
• Technician may need to wear a pron
• Once the patient is positioned correctly, the X-ray machine is directed at the body, the patient must remain still as the images are taken
• Patient may need to hold breath especially in chest and abdominal x-ray
• X-ray's are generally contraindicated in pregnancy to prevent deformities

Kidney, Ureters, and Bladder X-Ray (KUB)

• Assesses the organs of the urinary system and gastrointestinal system
• Diagnoses urinary disorders
• Often diagnoses cases of abdominal pain
• Views the size and position of the bladder, kidneys, and the ureter
• Pretest nursing care is the same as for plain X-rays
• Patients must take plenty of fluids to fill the bladder

Computed Tomography (CT)

• CT scanner is a large, square machine with a hole in the center
• The patient lies still on a table and can move up or down and slide into and out from the center of the hole
• An X-ray tube on a rotating gantry moves around the patient's body to produce the image
• Tomography comes from Tomos which means slice and graphein which means to write, its imaging of an object by analyzing its slices
• Used for; head trauma and stroke and intra-abdominal conditions; intestinal obstruction, pancreatitis, and abdominal aneurism
• Explain the procedure and purpose to the patient
• Consent is required and witnessed
• Evaluate the client's ability to lie still, supine for up to 1 hour
• Assess for claustrophobia
• Assess for allergy to iodine or other contrast agents if they will used
• Renal function tests should be done before a CT scan
• Hemodialysis is recommended after a contrast CT for patients with renal failure
• Start IV if dye is to be through a large diameter cannula usually green color
• Arrange transportation to radiology
• Patients need to lie still, won't be aloud to move
• Warn patients not to be afraid of whirring and clicking noises
• Patients need to breathe deeply and relax
• Oral/IV fluids are increased (about 2 liters)
• Access site to be assessed if contrast medium implemented
• Asses patient for sedation

Magnetic Resonance Imaging (MRI)

• Uses radio frequency waves and a strong magnetic field rather than X-ray, allowing for internal organs and structures to be seen using magnetic forces rather than radiation
• The large electromagnet senses the change in alignment of the hydrogen atoms in the body and sends the information to a computer, where billions of mathematical calculations are made which will produce clear images on the television monitor
• Useful for diagnosing pathologic lesions in any organ or tissue showing the contrast between normal and abnormal tissue
• MRI procedure takes about a half hour
• Spinal and joint problems
• Diagnosis of heart problems
• Examination of male and female reproductive systems, pelvis and bladder
• Brain tumor, meningitis, encephalitis, hemorrhage, and ischemic stroke
• Contraindicated for patients with: total hip and total knee replacements, screws and plates, peacemakers and artificial valves, and dental prostheses.
• Explain the procedure and provide instructions to remove metallic objects to reduce artifacts on the scan
• Tell patient that the procedure is painless and contrast dye may be needed
• Limit the intake of fluid to prevent the patient from urinating for 60 to 90 minutes during the test
• The client must void prior to the procedure as they will not be able to move during the procedure
• Tell the client that the machine will make various humming and loud thumping noises
• Ask the client to verbalize his knowledge and feelings about the procedure
• Sedation may be used for unconscious patients
• Assistants will help onto the table by electromagnet to provide correct positioning for the study
• Secure the client on the table with Velcro straps to keep them from moving during the study
• Provide the client with earplugs, intercom, or earphones to decrese noises of the machine and provide communication between the client and technologist
• If the head is to be scanned, place a special helmet around the head to provide accurate imaging
• Observe clients for signs of claustrophobia or the inability to remain still, it may necessitate the administration of a sedative during the procedure
• If contrast medium is injected during the procedure, assess for allergic reaction to provide immediate treatment for a life-threatening emergency
• After the study is completed, assist the client to a sitting position, when the client is ready, assist them to a standing position to decrease the risk of orthostatic hypotension
• In case of contrast medium; increase fluid intake, and observe urine color until it returns to normal
• If a sedative is used, observe the patient for 1-2 hours to evaluate patient and provide safety
• Magnetic Resonance Angiography (MRA) is a form of MRI used to evaluate diseases of blood vessels as atherosclerosis and plaque. Contrast may be used.
• MRI with Diffusion measures the random motion of water molecules in tissues and is useful for diagnosing tumors and cerebral ischemia

Ultrasound Studies

• Diagnostic ultrasound imaging depends on the computerized analysis of reflected ultrasound waves, which non-invasively build up fine images of internal body structures
• Abdominal and pelvic examination
• Blood vessels conditions as; deep vein thrombosis (DVT)
• Three main categories include: pregnancy ultrasound, diagnostic ultrasound, and ultrasound guidance for procedures
• In general, no preparation is needed for an ultrasound examination; however, for certain examinations of the abdomen
• A period of fasting is useful or necessary for a minimum of 8 hours to fully dilate the gall bladder and improve anatomic visualization of all structures (abdominal ultrasound), no gas-producing foods and even premedication (antifoaming agents) are recommended
• In case of urinary ultrasound; increase fluid intake
• Before the exam, the patient will change into a hospital gown and lie down on a table with a section of his body exposed for the test
• An ultrasound technician, called a sonographer, will apply a special lubricating jelly to the patient's skin to prevent friction
• Gel helps transmit the sound waves
• The transducer sends high-frequency sound waves through the body
• Waves echo as they hit a dense object, such as an organ or bone
• Those echoes are then reflected back into a computer and create sounds that are at too high of a pitch for the human ear to hear
• The patient will need to change positions during the procedure
• After the procedure, the gel will be cleaned off from abdomen, and the whole procedure typically lasts less than 15 minutes
• Normal diet and fluid are resumed
• Interpret test outcome and counsel appropriately