Radiology

X-rays

If your doctor has scheduled you to have an x-ray exam, it is important that you understand why you have been asked to undergo this test and what steps are needed for a proper preparation.

A chest x-ray and x-rays of the bones are often taken to check your general health and see if there has been any spread of the cancer to other parts of the body.

Barium studies

The organs of the digestive system don’t show up on x-ray unless they are ‘outlined’ by barium meal. This is a medical test used to examine the condition of the digestive tract using a heavy, white, radio-opaque powder called barium sulphate. This powder is usually flavoured and mixed with a liquid which is then swallowed by the patient. The mixture passes quickly into the digestive tract and its progress is followed by taking x-rays over different periods of time, depending on which part of the digestive tract the doctor wants to observe.

Barium meal is a test that allows your doctor to view the upper part of your bowel, using a white fluid called barium to outline the shape of the throat and stomach, and a fizzy drink to open up the walls of the stomach.

A barium swallow involves x-ray examination of the oesophagus, and is used to help diagnose swallowing or reflux problems.

A barium meal-barium swallow test-is ordered for people who are having trouble swallowing, or having unexplained pain or vomiting. It provides useful information about the condition of your gullet and stomach, and can make or confirm a diagnosis.

A similar examination of the large intestine, or colon, is called a Barium enema, or Lower GI. Of course, in this instance, the barium is not swallowed, but is given rectally as an enema – thus the more common name, Barium Enema. This examination takes less than an hour and requires fasting as well as an unpleasant laxative and dietary preparation the day or two before. Prep instructions vary and will be provided and be sure to follow them exactly so the test need not be repeated.

Ultrasound

Ultrasound (US) imaging, also called ultrasound scanning or sonography, is a method of obtaining images of internal organs by sending high-frequency sound waves into the body. The reflected sound waves’ echoes are recorded and displayed as a real-time, visual image. No ionizing radiation (x-ray) is involved in ultrasound imaging.

Common uses of Ultrasound

Ultrasound imaging is used extensively for evaluating the kidneys, liver, gallbladder, pancreas, spleen, and blood vessels of the abdomen. Because it provides real time images, it can also be used to:

• A sample of cells (biopsy) can be taken at the same time for examination under the microscope by a pathologist.
• Help a physician determine the source of many abdominal pains, such as stones in the gall bladder or kidney, or an inflamed appendix.
• Help identify the cause for enlargement of an abdominal organ e.g., liver and spleen

Doppler ultrasound is a special type of ultrasound study that examines major blood vessels. These images can help the physician to see and evaluate:

• Blockages to blood flow, such as clots
• Build-up of plaque inside the vessel
• Congenital malformation

CT Scan (CAT Scan)

CT SCAN is basically an x-ray tube that rotates in a circle around the patient and takes a series of pictures as it rotates. The multiple x-ray pictures are reconstructed by a computer in axial slice images at different levels. Each level can be examined separately.

A CT scan may show if the cancer has spread beyond the liver or to other parts of the body such as the lymph nodes.

The scan takes from 10-30 minutes. You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.

You will probably be able to go home as soon as the scan is over.

Magnetic Resonance Imaging (MRI or NMR Scan)

Magnetic Resonance Imaging (MRI) is a noninvasive imaging technique. This test is similar to a CT scan but uses magnetism instead of X-rays to build up cross-sectional pictures of your body. It is used to view organs, soft-tissue, bone, and other internal body structures. In an abdominal MRI, the person’s body is exposed to radio waves while in a magnetic field. Cross-sectional pictures of the abdomen are produced by energy emitted from hydrogen atoms in the body’s cells.

An individual is not exposed to harmful radiation during this test.

Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

What is ERCP?

ERCP is a procedure that enables your physician to examine the pancreatic and bile ducts. A  bendable, lighted tube (endoscope) about the thickness of your index finger is placed through your mouth and into your stomach and first part of the small intestine (duodenum). In the duodenum a small opening is identified (ampulla) and a small plastic tube (cannula) is passed through the endoscope and into this opening. Dye (contrast material) is injected and X-rays are taken to study the ducts of the pancreas and liver.

Why is an ERCP Performed?

ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts, and is also used to treat those conditions. It is used to evaluate symptoms suggestive of disease in these organs, or to further clarify abnormal results from blood tests or imaging tests such as ultrasound or CT scan. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice (yellowing of the skin), or an ultrasound or CT scan that shows stones or a mass in these organs. ERCP may be used before or after gallbladder surgery to assist in the performance of that operation. Bile duct stones can be diagnosed and removed with an ERCP. Tumors, both cancerous and noncancerous, can be diagnosed and then treated with indwelling plastic tubes that are used to bypass a blockage of the bile duct. Complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.

In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can be removed by ERCP.

What Preparation is Required?

Your stomach must be empty, so you should not eat or drink anything for approximately 8 hours before the examination. Your physician will be more specific about the time to begin fasting depending on the time of day that your test is scheduled. Your current medications may need to be adjusted or avoided. Most medications can be continued as usual. Medication use such as aspirin, Vitamin E, non-steroidal anti-inflammatories, blood thinners and insulin should be discussed with your physician prior to the examination as well as any other medication you might be taking. It is therefore best to inform your physician of any allergies to medications, iodine, or shellfish. It is essential that you alert your physician if you require antibiotics prior to undergoing dental procedures, since you may also require antibiotics prior to ERCP. Also, if you have any major diseases, such as heart or lung disease that may require special attention during the procedure, discuss this with your physician. To make the examination comfortable, you will be sedated during the procedure, and, therefore, you will need someone to drive you home afterward. Sedatives will affect your judgment and reflexes for the rest of the day, so you should not drive or operate machinery until the next day.

How thing happen during the ERCP?

Your throat will be sprayed with a local anesthetic before the test begins to numb your throat and prevent gagging. You will be given medication intravenously to help you relax during the examination. While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your esophagus, and into your stomach and duodenum. The procedure usually lasts about an hour, but this may vary depending on the planned intervention. The endoscope does not interfere with your breathing. Most patients fall asleep during the procedure or find it only slightly uncomfortable. You may feel temporarily bloated during and after the procedure due to the air used to inflate the duodenum. As X-ray contrast material is injected into the pancreatic or bile ducts, you may feel some minor discomfort.

What Happens after ERCP?

You will be monitored in the endoscopy area for 1-2 hours until the effects of the sedatives have worn off. Your throat may be sore for a day or two. You will be able to resume your diet and take your routine medication after you leave the endoscopy area, unless otherwise instructed.

Your physician will usually inform you of your test results on the day of the procedure. Biopsy results take several days to return, and you should make arrangements with your physician to get these results. The effects of sedation may make you forget what you were instructed to do after the procedure. Call your surgeon’s office for the results or any further questions.