RADIOLOGICAL

PROCEDURES
By Kathleen Wanjiru ( BScN & PH KU)
INTRODUCTION
 Radiology, also called diagnostic imaging, is a series of different tests that take pictures or
images of various parts of the body.
 Many of these tests are unique in that they allow doctors to see inside the body. A number
of different imaging exams can be used to provide this view, including X-ray, MRI,
ultrasound, CT scan and PET scan.
1. X-RAYS
 It is a painless, non-invasive test that uses electromagnetic waves to
produce visual images of the heart, lungs, bones and blood vessels
of the chest.
 A basic CXR includes a posterior-anterior view in which X-rays
pass from the front to the back, other views include: lateral view,
lordotic view and oblique views.
 Nurse are responsible for ensuring a patient’s comfort during the
procedure.
INDICATIONS FOR AN X-RAY
 Diagnose diaphragmatic hernia, lung tumors, metastasis.
 Detect known or suspected pulmonary, cardiovascular and skeletal disorders.
 Identify Chest Trauma ( pneumothorax,
 Correct or Confirm placement of endotracheal tube, tracheostomy tube, chest tubes,
central venous catheters, pacemaker wires, intra-aortic balloon pump.
 Evaluate Mantoux test for Tuberculosis
 Monitoring progression, resolution or maintenance of a disease
 Evaluate patient’s response to therapeutic regimen.
CONTRAINDICATIONS FOR AN
X-RAY
 Patients who are pregnant or suspected of being pregnant unless the potential benefits of a
procedure using radiation outweigh the risk of maternal and fetal damage
PROCEDURE
 Items are removed – patients are requested to remove any clothing, jewelry or other
articles that may interfere with the procedure
 Appropriate clothing is given – patients are provide with a suitable gown
 Positioning the patient - The patient in a standing or sitting position will face the cassette
or image detector with hands on hips, inhale deeply, hold one’s breath until the X-ray
image is made. For a lateral view, the chest is position on the left side against the image
holder with hands raised above the head.
 Imaging – the technician will stand behind a protective shield while the films are
developed
 NURSING CARE
Before the procedure
 Remove all metallic objects. Items such as jewelry, pins, buttons etc can hinder the visualization of the
chest.
 No preparation is required. Fasting or medication restriction is not needed unless directed by the health
care provider.
 Ensure the patient is not pregnant or suspected to be pregnant. X-rays are usually not recommended for
pregnant women unless the benefit outweighs the risk of damage to the mother and fetus.
 Assess the patient’s ability to hold his or her breath. Holding one’s breath after inhaling enables the lungs
and heart to be seen more clearly in the x-ray.
 Provide appropriate clothing. Patients are instructed to remove clothing from the waist up and put on an
X-ray gown to wear during the procedure.
 Instruct patient to cooperate during the procedure. The patient is asked to remain still because
any movement will affect the clarity of the image.
 Educate the patient about the procedure. This will held alley anxiety and increase cooperation.
 Check that the patient has emptied the bladder before the test commences
 .

During the procedure

Leaving the room during X-ray exposures whenever possible
Keep the time they are exposed to X-rays as short as possible;
.

After the procedure

 No special care. Note that no special care is required following the procedure
 Provide comfort. If the test is facilitated at the bedside, reposition the patient properly.
 Whilst most contrast medium allergies are instantaneous, nurses should be aware of possible longer-
term reactions over the next few hours or days, and observe patients accordingly.
2. COMPUTED TOMOGRAPHY
 Computed tomography (CT) scan, also known as computerized axial tomography
(CAT), or CT scanning computerized tomography is a painless, non-invasive diagnostic
imaging procedure that produces cross-sectional images of several types of tissue not
clearly seen on a traditional X-ray.
 CT scans may be performed with or without contrast medium. A contrast may either be an
iodine-based or barium-sulfate compound that is taken orally, rectally, or intravenously
which can enhance the visibility of specific tissues, organs, or blood vessels. The duration
of the procedure will depend on the area being scanned.
 This Photo by Unknown Author is licensed under CC BY-SA-NC
This Photo by Unknown Author is licensed under CC BY
This Photo by Unknown Author is licensed under CC BY-SA
 INDICATIONS FOR A CT SCAN
Abdomen and Pelvis
 CT scan of the abdomen and pelvis combines radiologic and computer technology to determine the cause
of unexplainable abdominal or pelvic pain and diseases of the bladder, uterus, liver, colon, small bowel,
and other internal organs.
 Detects inflammatory process
 Inspect soft tissue and organs of the abdomen, pelvis and retroperitoneal space
 Evaluates trauma
 Helps in the staging of neoplasms
 Detects edema, hemorrhage, cysts, and tumors
 Measures effectiveness to chemotherapy
.

Bone and Skeletal

 Identify any joint abnormalities
 Determine abnormalities in the upper and lower spine
 Detect unusual active bone formation
 Establish the presence and extent of fractures, ligament, or tendon injuries, primary bone tumors,
skeletal metastases, and soft tissue tumors
.

Brain
 Identify intracranial abnormalities and lesions
 Determine focal neurological abnormalities
 Guides brain surgery or biopsy of brain tissue
 Evaluate suspected head injury such as subdural hematoma
 Monitor the effectiveness of chemotherapy, radiotherapy, or surgery, as part of the management of
intracranial tumors
.

Liver and Biliary Tract

 Differentiate obstructive and nonobstructive jaundice
 Detect intrahepatic tumors and abscesses, subphrenic and subhepatic abscesses, cysts, and
hematomas
.

Pancreas
 Diagnose or evaluate pancreatitis
 Identify pancreatic carcinoma or pseudocyst
 Differentiate pancreatic disorders and retroperitoneum disorders
.

Renal
 Identify and diagnose renal abnormalities, such as calculi, obstruction, tumor, polycystic
disease, congenital anomalies, and abnormal fluid accumulation
 Evaluate retroperitoneal pathologies
.

Spinal
 Diagnose lesions and abnormalities of the spine
 Detect or rule out spinal damage in patients with injury
 Monitor the results of spinal surgery or therapy
 .

Thoracic
 Diagnose a dissection or leak of an aortic aneurysm or aortic arch aneurysm
 Diagnose the invasion of a neck mass in the thorax
 Differentiate emphysema or bronchopleural fistula from a lung abscess
 Distinguish tumors adjacent to the aorta from aortic aneurysms
 Differentiate tumors from calcified lesions (signifies tuberculosis)
 Detect the mediastinal lymph nodes
 Assess primary malignancy that may metastasize to the lungs, especially in the patient with a primary bone
tumor, soft-tissue sarcoma, or melanoma
 Identify the extent of lung diseases such as bronchiectasis, emphysema, and diffuse interstitial lung disease
 Locate observed neoplasms (e.g., Hodgkin’s disease), especially with the mediastinal involvement
 Plan radiation therapy
CONTRAINDICATIONS
 Pregnant patient (absolute contraindication)
 Patients with a known allergy to iodine
 Patients with claustrophobia
 Patients with renal impairment unless the benefits outweigh the risks
 Patients with hyperthyroidism or toxic goiter (induce thyrotoxic crisis)
 Patients with complications after a previous administration of a contrast
 Patients with severe obesity (usually more than 130 kgs)
 PROCEDURE
 The patient is positioned on an adjustable table inside an encircling body scanner (gantry);
straps and pillows may be used to help in maintaining the correct position.
 The patient may be instructed to hold his breath during the scanning.
 A series of transverse radiographs are taken and recorded
 The information is reconstructed by a computer and selected images are photographed.
 Once the images are reviewed, an I.V. contrast enhancement may be ordered and additional
images are obtained.
 The patient is assessed carefully for adverse effects to the contrast medium.
 NURSING CARE
Before the procedure
 Informed Consent. Obtain an informed consent properly signed.
 Look for allergies. Assess for any history of allergies to iodinated dye or shellfish if contrast media is to be used.
 Get health history. Ask the patient about any recent illnesses or other medical conditions and current medications
being taken. The specific type of CT scan determines the need for an oral or I.V. contrast medium
 Check for NPO status. Instruct the patient to not to eat or drink for a period amount of time especially if a contrast
material will be used.
 Get dressed up. Instruct the patient to wear comfortable, loose-fitting clothing during the exam.
 Provide information about the contrast medium. Tell the patient that a mild transient pain from the needle
puncture and a flushed sensation from an I.V. contrast medium will be experienced.
 Instruct the patient to remain still. During the examination, tell the patient to remain still and to immediately
report symptoms of itching, difficulty breathing or swallowing, nausea, vomiting, dizziness, and headache.
 Inform about the duration of the procedure. Inform the patient that the procedure takes from five (5) minutes to
one (1) hour depending on the type of CT scan and his ability to relax and remain still.
.

During the procedure

 Alley anxiety by talking to and reassuring the patient.
.

After the procedure

 Diet as usual. Instruct the patient to resume the usual diet and activities unless otherwise
ordered.
 Encourage the patient to increase fluid intake (if a contrast is given). This is so to
promote excretion of the dye.
3. MAGNETIC RESONANCE IMAGING

 Magnetic resonance imaging (MRI) has the ability to see it through bone and to
delineate fluid-filled soft tissue in great detail and produces images of organs and vessels
in motion
 In this noninvasive procedure, the patient is placed in a magnetic field into which
a radiofrequency beam is introduced. Resulting energy changes are measured and used by
the MRI computer to generate images on a monitor. Cross-sectional images of the anatomy
are viewed in multiple planes and recorded for the permanent record.
This Photo
by
Unknown
Author is
licensed
under
CC BY-ND
INDICATIONS FOR AN MRI

Abdominal and Pelvic

 Visualize the liver, pancreas, adrenals, spleen, kidneys, blood vessels, and reproductive
organs, vulvar, and cervical carcinoma, and prostate cancer
.

Blood Vessels ( angiography)

 Detect, diagnose, and assists in the treatment of heart disorders, stroke, and blood vessels
diseases
 Screen for familial tendency for an arterial aneurysm
.

Breast
 Detect breast tumors in a woman with implants
 Visualize complex breast lesions
 Differentiate between benign and malignant breast tumors
 Stage breast cancer
.

Cardiac
 Visualize cardiac structures, valves, and coronary arteries
 Evaluate cardiac wall motion
.

Intracranial
 Helps diagnose intracranial and spinal lesions and soft- tissue abnormalities
.

Musculoskeletal
 Delineate bones, muscles, and ligaments
 Contrast body tissues and sharply define healthy, benign, and malignant tissues
 Identify primary and metastatic bone tumors
.

Spinal
 Assess for spinal infection or tumors that arise in, or have spread to the spine
 Detect a bulging, degenerated, or herniated intervertebral disk
 Visualize disease of the spinal canal and cord
 Help visualize needle placement for steroids to relieve spinal pain
.

Urinary Tract
 Detect prostate stones and cysts
 Detect cancer invasion into seminal vesicles and pelvic lymph nodes
 Evaluate genitourinary tumors and abdominal or pelvic masses
CONTRAINDICATIONS FOR AN
MRI
 Patients with severe obesity (usually more than 130kgs)
 Patients with claustrophobia
 Patients who are confused or agitated
 Patients who are unstable and require continuous life-support equipment, because most
monitoring equipment cannot be used inside the scanner room. Magnet adaptive equipment
is becoming available for use in the MRI scanner room.
 Patients with implantable metal objects such as pacemakers, infusion pumps, aneurysm
clips, inner ear implants, and metal fragments in one or both eyes, because the magnet may
move the object within the body and injure the patient.
PROCEDURE
 If indicated, an IV line is started to administer a contrast medium before the procedure begins.
 The patient is placed in a supine position on a narrow, padded, nonmetallic bed that slides to the
desired position inside the scanner.
 The patient is asked to remain still.
 Radiofrequency energy is directed at the area being tested. The radiologist may vary the waves
and use the computer to manipulate and enhance the images.
 The resulting images are displayed on a monitor and recorded on film or magnetic tape for
permanent storage.
 The patient is advised to keep his eyes closed to promote relaxation and prevent a closed-in-
feeling.
 If nausea occurs because of claustrophobia, the patient is encouraged to take deep breaths.
 If the test is prolonged with the patient lying flat, monitor him for orthostatic hypotension.
 NURSING CARE
Before the procedure
 Explain to the patient the purpose of the test. Tell him who will perform the test and where it will take place.
 Inform the patient that he’ll need to lie flat on a narrow bed, which slides into a large cylinder that houses the
MRI magnets. Tell him that the scanner will make clicking, whirring, and thumping noises as it moves inside its
housing and that he may receive earplugs.
 Explain to the patient that MRI is painless and involves no exposure to radiation from the scanner. A radioactive
contrast dye may be used, depending on the tissue being studied.
 For MRI of the urinary tract, advise the patient to avoid alcohol, caffeine-containing beverages, and smoking for
at least 2 hours and food for at least 1 hour before the test. Explain to the patient that he can continue taking
medications, except for iron, which interferes with the imaging.
 Advise the patient that he’ll have to remain still for the entire procedure.
 Explain to the patient who’s claustrophobic or anxious about the test’s duration that he’ll receive a mild sedative
to reduce his anxiety or that he may need to be scanned in an open MRI scanner, which may take longer but is
less confining. Tell him that he’ll be able to communicate with the technician at all times and that the procedure
will be stopped if he feels claustrophobic.
 If contrast media will be used, obtain a history of allergies or hypersensitivity to these agents. Mark any
sensitivities on the chart and notify the practitioner.
 Instruct the patient to remove all metallic objects, including jewelry, hairpins, and watches.
.

 Ask the patient if he has any implanted metal devices or prostheses, such as vascular clips,
shrapnel, pacemakers, joint implants, filters, and intrauterine devices. If so, the test may not be
able to be performed.
 Make sure that the patient or a responsible family member has signed an informed consent form.
 Administer the prescribed sedative if ordered.
 At the scanner room door, recheck the patient one last time for metal objects.
 Just before the procedure, have the patient urinate.
During the procedure
 Remind the patient to remain still throughout the procedure.
 Assess how the patient responds to the enclosed environment. Provide reassurance if necessary.
 Monitor the cardiac function for signs of ischemia (chest pressure, shortness of breath, or
changes in hemodynamic status).
 If the patient is unstable, make sure an IV line with no metal components is in place and that all
equipment is compatible with MRI. If necessary, monitor the patient’s oxygen saturation, cardiac
rhythm, and respiratory status during the test. An anesthesiologist may be needed to monitor a
heavily sedated patients.
.

After the procedure

 Tell the patient that he may resume his usual activities as ordered.
 If the test took a long time and the patient was lying flat for an extended period, observe
him for orthostatic hypotension.
 Provide comfort measures and pain medication as needed and ordered because of
prolonged positioning on the scanner.
 Monitor the patient for the adverse reaction to the contrast medium (flushing, nausea,
urticaria, and sneezing).
THANK YOU
.