prelims Diagnostic Test

7/25/2019 prelims Diagnostic Test

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DIAGNOSTIC TESTS

Agnes L. Castillo, PhD


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PLAIN (CONVENTIONAL)X-RAYS / RADIOGRAPHY


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CHEST XRAY

Most frequently used radiography.

Used to diagnose cancer, tuberculosis

and other pulmonary disease anddisorders of the mediastinum and bonythorax

It provides a sequential progress ordevelopment of a disease


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CHEST XRAY

Can also provide valuable informationabout the condition of the heart, lungs,

GI tract, and thyroid gland The routine chest radiography consists

of two images

Frontal view ( postero-anterior[PA])

Left lateral view


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Procedure:

Street clothing that is covering the chest is

removed to the waist.Allow only cloth or paper hospital gownfree of buttons and snaps to be wornduring x-ray.

Remove jewelry on or adjacent to thechest.


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Procedure:

Ensure that monitoring cables and patches

do not obscure the chest area, if possible.Instruct the patient to take a deep breathand to exhale; and to take another deepbreath and to hold it while the x-ray image

is taken.Be aware that the procedure takes only afew minutes.


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Clinical implications:

Presence of foreign bodies

Aplasia

Hypoplasia

Cysts Lobar pneumonia

Bronchopneumonia

Aspiration pneumonia

Pulmonary brucellosis

Viral pneumonia Lung abscess

Middle lobe syndrome

Pneumothorax

Pleural effusion

Atelectasis

Pneumonitis

Congenital pulmonary cyst Pulmonary tuberculosis

Sarcoidosis

Pneumoconiosis (e.g.asbestosis)

Coccidioidomycosis Westermarks sign

(indicates decreased pulmonaryvascularity, sometimes thought tosuggest pulmonary embolus)

Abnormal chest x-ray results may indicate the following lungconditions:


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Abnormal conditions of the bony thorax include the ff.

Scoliosis

Hemivertebrae

Kyphosis

Trauma

Bone destruction ordegeneration

Osteoarthritis

Osteomyelitis

Cardiac Enlargement


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MAMMOGRAPHY (Breast X-ray)

Soft tissue mammography visualizes the breast todetect small abnormalities that could warn of cancer.

Low-energy x-ray beam used for this procedure isapplied to a tightly restricted area and consequentlydoes not produce significant radiation exposure toother areas of the body.

Diagnosis by a mammography is based on theradiographic appearance of gross anatomicstructures.


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Benign lesions tend to push breast tissue aside asthey expand, whereas malignant lesion may invadesurrounding breast tissue.

Although a false-negative and a false-positive readingmay occur, mammography is highly accurate.

The benefits of using low-dose mammography to findearly, curable cancers outweigh possible risks fromradiation exposure.


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Procedure: Suggest patient to refrain from caffeinated

foods and beverages for 5-7 days beforetaking the testing.

Perform mammogram with the person in anupright position, preferably standing.

Expose the breast and lift onto a film holder ordigital plate.

Adjust the breast tissue by hand, smoothingout all skin folds and wrinkles.


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Lower a movable paddle onto a breast,

rigorously compressing the breast tissue. NOTE: rigorously compression is a brief and

uncomfortable but critical step in ensuring a high-quality mammogram. It lowers dose and improvesimage quality.

Make an x-ray exposure quickly, and immediatelylift the compression.

Typically, take two views of the breast

Craniocaudal

Mediolateral

Tell the patient that the complete examinationtakes abut 30 minutes.


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ORTHOPEDIC X-RAY:Bones, Joints, and supporting structure

This examines a particular bone, group of bones, orjoint.

Orthopedic radiography is performed on the following

structures: The extremities

( e.g. hand, wrist, shoulder, foot, knee, hip)

The bony thorax(e.g. ribs, sternum, clavicle)

The spine(e.g. cervical, lumbar, thoracic, sacrum coccyx)

The head and skull(e.g. facial bones, mastoids, sinuses)


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Optimal results from orthopedic x-rayexaminations depend on proper immobilization ofthe area being studied.

To produce a thorough image of the body part,at least two and sometimes more projections are

required.


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Procedure: Inform the patient that dietary restrictions

are not necessary.

Have the patient assume the positionsmost favorable to capturing the bestimages.

The degree of patient mobility and physical

condition may also need to be considered. Skull x-rays require removal of dentures

and partials.


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Fractures Dislocation

Arthritis

Osteoporosis

Osteomyelitis Degenerative joint

disease

Hydrocephalus

Sarcoma

Abscess and asepticnecrosis

Pagets disease

Gout Acromegaly

Metastatic processes

Myeloma

Osteochondrosis Bone infracts

Histiocytosis X

Bone tumors (benignand malignant)

Foreign bodies


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ECHOCARDIOGRAPHY


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Considered by many physicians to be almostequal in value to the standardElectrocardiogram (ECG).

It is based on underwater detection (sonar)that the navy developed during the WorldWar II.

When a sound wave is directed into the heartat various locations, the echo, or reboundingsound wave, graphically reflects each part ofthe heart where it bounces.


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The analysis allows a three-dimensionalvisualization of the heart, the heart valves,

the muscular structures, and even the bloodas it passes through.

It can also indicate the size of each heart

chamber, whether there are any masses inthe heart, and especially whether there isexcess fluid in the sac around the heart.


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Clinical implication:

To diagnose:

Heart valve disease

Enlarged heart

Heart tumors

Congenital heart defects in infants

To follow the patients with heart valvereplacement


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Echocardiogram machine


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CONTRASTECHOCARDIOGRAPHY

Virtualization of the right chambers of

the heart is enhanced by the injectionof contrast agents.


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M-MODEECHOCARDIOGRAPHY

Records the motion of the heart overtime.

It is used to evaluate the structures ofthe heart throughout the cardiac cycle.


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ELECTROCARDIOGRAPHY(ECG)


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Formerly known as the EKG because of theoriginal German spelling of the word:Electrokardiagramma

Is a graphic measure of the hearts muscularactivity and a reflection of the self-generated

electrical impulses that pass through theheart muscle, causing contraction andrelaxation.


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Electrodes called leads are placed on thebody, one on each wrist and ankle and oneon the chest that can be moved over the

entire heart area.

The recorded electrocardiograph shows the

rate and regularity of the hearts rhythm.


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It can also show the force or effectiveness ofeach heartbeat, the extent and location ofany heart muscle and the effect of certain

drug.

There should be no pain or discomfort while a

standard ECG is performed but some patientsfind it uncomfortable to lie still for long periodof time.


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ELECTROENCEPHALOGRAPHY(EEG)


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It is a graphic recording of the minute electriccurrent given off by the brain cell activity.

The current is amplified, translated into wavylines (waves), and recorded on paper.

The waves represent intermittent brain cellactivity.


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The height of the waves as well as the distancebetween each peak depends on body activity

From 10 to 24 electrodes are applied to the scalp in

specific positions to aid in locating any abnormal lesionthat might be reflected on the EEG.

The patient lies quietly with eyes closed and no bodymovements.

The waves of the brain are represented by Greekletters.


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With hyperactive brain cell are those with

epilepsy and interface with brain cellactivity as seen with tumors.


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ELECTROMYOGRAPHY (EMG)


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It is a diagnostic neurological test to studythe potential of muscle at rest, the reaction ofmuscle to contraction, and the response of

muscle to insertion of a needle.

The patient lies at rest while the peripheralnerves in various areas are stimulatedthrough electrodes, and the electrical activityin muscles and nerves is recorded.


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The test is sometimes employed as ameasure of the muscle tension produced by

nervous stress; usually the muscle of theforehead is tested, since they can indicaterelaxation or generalized body tension.


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Clinical implication:

The test is an aid in ascertaining whether a

patients illness is directly affecting thespinal cord, muscles, or peripheral nerves.

To aid in the diagnosis of hystericalweakness and paralysis.


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ANGIOGRAM


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It is an X-ray contrast study designed tovisualize blood vessels and nearby organs.

Angio-blood vessels. The term angiogram issynonymous with the term arteriogram,which refers to the study of arteries s

opposed to veins.


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COMPUTED TOMOGRAPHY


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A technique that uses a computerized x-raysystem to produce detailed sectional x-ray

images. The system is very sensitive to differences in

tissue density and produces detailed, twodimensional planar images

The tissue attenuation can be increased withthe use of contrast agents.


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Patient lies while doingthe angiogram testing.


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BONE SCAN


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The bone scan is a type of radionuclide scanused to visualize the skeleton.

The test takes several hours, of which aboutan hour is spent under the camera.

Before the test: do not drink large quantitiesof water or other liquid before the injection.


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Detect cancer in bones

Monitor bone diseases

To assess the progress of bone grafts

Diagnose bone infections

Detect fractures Evaluate unexplained bone pain


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Example of a Bone Scan result


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BRAIN SCAN


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It is a type of radionuclide scan which is usedto visualize the brain to evaluate symptoms

such as paralysis, seizures, dementia, orcertain types of severe headaches.

The test takes about 4-5 minutes.


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The images are taken with a gamma camera,a computerized device which will rotate very

close to your head and shoulders.

Thirty minutes to two hours later anotherscan, taking about thirty minutes, will be

performed, again you will be asked to lie still.


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BRONCHOGRAPHY


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Bronchography is an x-ray contrast studyused to visualize the bronchial tubes.

The general procedure is similar to that ofbronchoscopy, with an x-ray contrast materialbeing instilled as part of that procedure.


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X-ray of your chest will then be taken.

After the test: You will be encouraged tocough in order to eliminate the contrastmedium.

Fever is fairly common after bronchography.


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Example of a BronchographyResult


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CHOLECYSTOGRAM


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Cholecystogram is an x-ray study designed to visualizethe gallbladder.

It is obtained to evaluate symptoms suggestive ofgallbladder disease, such as abdominal or rightshoulder pain, jaundice or fatty food intolerance.

You will be given a contrast dye pill form to be takenorally the evening before the examination.


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