Other 'Special' Examinations
Photo: Imaging Dept, CRH
ERCP (Endoscopic Retrograde Cholangio-Pancreatography)
This is a method whereby the pancreatic duct or biliary ducts are directly catheterized from the descending duodenum via a flexible fibre-optic endoscope, with the patient heavily sedated. Contrast media is then injected under x-ray screening control.
This is an image taken during an ERCP procedure which we do jointly with the endoscopy department. This visualises the common bile duct for patients with gall stones. The doctor then uses these pictures to remove the gallstones where possible using baskets and balloons.
IVP (Intravenous Pyelogram)
An IVP (Intravenous Pyelogram) is an x-ray to show the kidneys and bladder and the tubes connecting them (ureters).
A preliminary x-ray will be taken and the patient will then be given an injection into a vein in their arm. The fluid from the injection passes through the blood stream and then through the kidneys to the bladder. Whilst this is happening films will be taken.
Apart from the minor discomfort of the injection, this examination is not usually unpleasant. The examination takes about one hour but this could vary depending upon the number of x-rays films the doctor may require. The patient is asked not to drink for three hours before their appointment.
For this procedure a fine tube needs to be put into an artery. The Radiologist will do this by giving the patient a small anaesthetic injection to freeze the skin around the area.
Once the tube is positioned correctly in the artery, it will be connected to a machine, which injects a special dye into the arteries. This liquid shows up the arteries on the x-ray television system. A recording is made and the Radiologist will study it later to make a diagnosis. The results will be returned to the patient’s Consultant and will be available at their next out-patient appointment. The patient may have several injections to show up various parts of their arteries.
The patient will usually stay in the hospital for the day. However, they may be asked to stay overnight if they are not well enough to go home. The patient is asked not to have any food or drink on the night before their appointment.
This examination is performed to show any defects inside the joint. The most common arthograms undertaken are of the knee and shoulder.
When the patient arrives for their appointment they will be taken to a special x-ray room where the examination can be monitored on a television screen. A fine needle is inserted into the joint so that a special dye and some air can be introduced to show the joint capsule. This will be done by an Radiologist after giving the patient a local anaesthetic to freeze the skin.
After this x-ray, films may be taken of the joint in different positions or the examination may be continued in the CT scanner. The whole examination only takes about 30 minutes but allowing for waiting times the patient can expect to be in the Department for about one hour. Once the examination is finished the patient may find the joint feels strange for a few hours after, until the dye and air are absorbed. Patients are therefore advised not to drive or operate machinery for the remainder of the day.
This examination is similar to an internal examination. A special dye is introduced into the neck of the womb in order to outline the uterus and fallopian tubes. This examination itself usually takes about 15 minutes, but patients may be in the Department for up to one hour.
All women in the UK aged between 50 and 70 who are registered with a GP will receive an invitation to attend a screening centre for mammography every three years. On arrival at the hospital a Radiography Practitioner will explain to the patient what will happen and ask a few questions.
The Radiographer Practitioner will then compress each breast in turn between two special plates and take x-rays. Many women find the test uncomfortable but this should last no longer than the test, which only takes a few minutes.
Photo: Imaging Dept, CRH
These examinations are similar to ultrasound scans but Doppler ultrasound measures blood flow and direction. A Doppler test should be painless and may take up to 30 minutes. A small probe will be held against the skin and sound waves used to measure blood flow.
For a bone scan a small amount of radioactivity is used to obtain pictures which will help the doctor diagnose the problems.
The radioactive dose is injected into a vein in the patient’s arm. They may then have to wait before pictures are taken. The waiting time depends on the type of scan they are having. It varies between a few minutes and four hours. If the appointment letter tells them that there is more than one hour to wait, they may be able to leave the department during the interval.
The pictures are taken with a machine called ‘Gamma Camera’ which picks up the spots of radiation, producing a map of the body showing areas of activity. During the scan they will either have to lie on a bed or, depending on the procedure, sit in a chair. The process of taking the pictures will take about thirty minutes.
Photo: Imaging Dept, CRH