Modern Diagnostic Imaging strives to provide accurate diagnostic information while minimizing risk and discomfort. Many studies can be performed completely non invasively. There are numerous occasions when some form of X-ray 'contrast' must be administered to obtain the desired images. Mostly this involves an injection into an arm vein as in an Intravenous Pyelogram or contrasted CT Scan. There are other occasions when the contrast is introduced by alternative means. These studies are known as X-ray 'Procedures' and the purpose of this page is to outline the more commonly performed examinations.
A subspecialty of Radiology is known as
Interventional Radiology where the radiologist uses imaging guidance to treat various conditions in a relatively non invasive fashion. These procedures are outlined on this page but more details regarding interventional radiology are available at the QDI
Interventional Radiology web page.
Included on this page is information on Biopsies. Biopsies involve obtaining a small tissue sample from a part of the body under imaging guidance. The tissue is then examined under a microscope by a pathologist to obtain a specific diagnosis. Biopsies can be performed using a variety of imaging techniques.
PAGE LAYOUT
The X-ray Procedures are grouped according to the particular type of X-ray machine utilized. Click on the procedure of interest for a brief overview. In some cases, example images or animations are available for review. If you chose to view an image or animation click the 'Examinations' navigation button at the bottom of the page or click the 'back' button of your browser to return here. Click on the X-ray modalities in the left column of the table to visit the corresponding web page.
ANGIOGRAM
An angiogram is a sequence of X-ray images obtained after the injection of contrast into an artery. The contrast is injected through a small bore catheter inserted into a groin artery and guided to the artery of interest. Details of the procedure and preparation instructions can be found at the
Digital Angiography web page.
Example films available in the
Film Library. Click here to Return to
Procedure List.
ANGIOPLASTY
During an angioplasty, the radiologist dilates up a narrowed artery using a balloon catheter inserted via a groin vessel. The procedure is performed in the Digital Angiography suite. Details of the technique can be found at the
Interventional Radiology web page.
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Procedure List.
ARTHROGRAM
An arthrogram is a study of a joint after contrast has been injected through a small gauge needle inserted into the joint space. Most commonly the shoulder is imaged looking for tendon tears (of the rotator cuff) or injury to the labrum i.e. the cartilage rim around the margin of the joint. Other joints occasionally imaged include the knee, wrist and tempero-mandibular joints. A CT scan can be performed after the introduction of the contrast to increase the information available. MRI has largely replaced arthrography and CT arthrography, being less invasive and often more revealing.
Preparation The region is sterilized and draped prior to introduction of the needle to prevent sepsis. A history of any previous contrast allergy is obtained.
Example film of a CT arthrogram available in the
Film Library. Click here to Return to
Procedure List.
BARIUM ENEMA
In a barium enema a series of films is obtained of the large bowel (Colon) after insertion of barium contrast rectally. After an initial plain film, a soft catheter is inserted into the rectum. Sometimes these catheters have a balloon near the tip which is inflated to keep the catheter in place and to improve the seal. Barium is instilled into the colon under the influence of gravity via tubing connected to the catheter. When enough contrast has passed into the colon, the examination table is tilted foot down to drain some of the barium out. Buscopan, a smooth muscle relaxant may be given via a vein in the arm to relax the bowel. Air is then introduced to distend the colon and to provide additional contrast (Double Contrast technique). After rolling the patient to coat the bowel, films are taken in various positions.
Preparation A thorough bowel prep is required including a light low fibre diet, a period of fasting, laxatives and suppositories. Full instructions are given to patients with a 'Go Kit' bowel prep (A copy of the
Go Kit Preparation Instructions are included at the end of this page). Medications should be continued. A history will be obtained to identify any contraindications to the use of Buscopan i.e. erratic or rapid pulse, glaucoma, urinary retention. Example films available in the
Film Library. Click here to Return to
Procedure List.
BARIUM MEAL
A barium meal consists of a series of films obtained after the ingestion of flavoured barium. At the beginning of the procedure, a small quantity of two liquids is administered. These liquids together effervesce producing carbon dioxide gas which distends the stomach. It is important not to burp after this stage. Barium is then ingested, the progress of which the radiologist observes on a television screen. The patient is requested to roll to coat the stomach and duodenal lining. Buscopan, a smooth muscle relaxant may be given via a vein in the arm to relax the stomach and duodenum. Films are obtained in various positions. Finally some water is administered through a straw to detect any reflux of barium back into the oesophagus.
Preparation A complete fast is required for 6 hours prior to the examination. Medications should be continued. Cessation of smoking during this period helps to improve coating of the stomach lining. A history will be obtained to identify any contraindications to the use of Buscopan i.e. erratic or rapid pulse, glaucoma, urinary retention. Example Films available in the
Film Library. Click here to Return to
Procedure List.
BARIUM SMALL BOWEL STUDY
The purpose of a small bowel study is to obtain a series of films of the small bowel, particularly the jejunum and ileum. In its simplest form, about three cups of a dilute barium solution is ingested and films are obtained at varying intervals to observe the progress through the bowel. Between films, the patient is required to lie right side down to encourage emptying of the stomach. Maxalon may be administered to speed up the procedure. It can take anywhere from half an hour to several hours for the barium to enter the colon. At this stage, some images are obtained in the fluoroscopic screening room of the last part of the ileum which is a more common site of small bowel pathology. Compression of this region may be used to separate adjacent bowel loops. A variation is the small bowel enema where a small bore flexible tube is inserted via the nose into the second part of the small bowel i.e. the jejunum. Barium is then injected directly into the catheter and the progress observed on a television monitor. This technique is faster and more predictable but creates discomfort associated with the insertion of the tube. Local anaesthetic is used in the nose to reduce the discomfort.,
Preparation A complete fast is required for 6 hours prior to the examination. Medications should be continued. A history will be obtained to identify any previous reaction to Maxalon. Example films available in the
Film Library. Click here to Return to
Procedure List.
BARIUM SWALLOW
In a barium swallow, the radiologist observes a television monitor while the patient swallows flavoured barium. At the beginning of the procedure, a small quantity of two liquids may be administered. These liquids together effervesce producing carbon dioxide gas which distends the stomach and oesophagus. It is important not to burp after this stage. A series of films are taken in various positions. A videotape of the procedure may also be obtained. Finally some water is administered through a straw to detect any reflux of barium back into the oesophagus.
Preparation A complete fast is required for 6 hours prior to the examination. Medications should be continued. Example films available in the
Film Library. Click here to Return to
Procedure List.
BIOPSY
A biopsy involves the procurement of a small sample of tissue for examination under a microscope by a pathologist. Various techniques have been devised using different imaging modalities to guide the biopsy. CT or Ultrasound are most commonly used to guide the procedure. With breast biopsies either ultrasound or stereotactic mammography guidance are used. Biopsies may be obtained using a fine needle, less than the size of a blood test needle. The sample from a fine needle aspiration biopsy is examined for abnormal cells by a specialized pathologist known as a cytologist. Core biopsies use larger cutting needles often with an automated spring loaded device to obtain an actual piece of intact tissue. Core biopsies are used where a more precise pathological diagnosis is required. Local anaesthetic is used if a core biopsy is required. The skin is prepared with an antiseptic solution. Several images are obtained to determine the best site of entry and to confirm positioning of the biopsy needle. Following the procedure there may be a need for a period of observation especially with core biopsies of abdominal organs.
Preparation Depending on the region to be biopsied, a blood clotting test may be required prior to the biopsy. A consent from may be requested for deeper core biopsies. The site of skin puncture is sterilized and local anaesthetic used for core biopsies or where multiple fine needle biopsies are needed.
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Procedure List.
CATHETER PLACEMENT
Under fluoroscopic guidance, Radiologists can accurately place catheters or tubes. Usually this involves inserting a central venous line or a nasogastric tube where difficulty has been encountered without imaging guidance.
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CHOLANGIOGRAM
A cholangiogram is a contrast study of the bile ducts. There are several ways of performing a cholangiogram. The simplest technique involves the infusion of special iodine containing contrast material into an arm vein via a drip set. After around half to one hour the contrast will have concentrated in the bile ducts. In the past, a series of
Tomograms were then obtained to image the contrasted bile ducts. This conventional intravenous cholangiogram technique has been superseded with the availability of
Spiral CT. A spiral CT Cholangiogram simply involves obtaining a continuous series of CT images through the contrasted bile ducts during a single breath hold. The data is then reconstructed into a three dimensional picture of the bile ducts. An example film is available in the
Film Library.
An intraoperative cholangiogram is obtained by directly injecting the bile ducts with contrast in an operating theatre during gall bladder surgery. X-ray pictures are obtained using a mobile X-ray machine. A T-Tube cholangiogram is a post operative examination of the bile ducts where contrast is injected down a drainage tube inserted into the ducts by the surgeon at the time of gall bladder surgery.
Preparation A history of any previous allergy or asthma is obtained. Click here to Return to
Procedure List.
CT ANGIOGRAM
In this study, a spiral CT scanner is used to obtain a rapid series of images through the region of interest while contrast is injected via a vein in the arm using a pressure injector. The images can be reconstructed into a three dimensional picture of the blood vessels. The technique is used particularly for evaluating the arteries of the brain (Circle of Willis), the arteries of the neck, the thoracic aorta and the abdominal arteries including the aorta and iliac arteries, the coeliac artery, superior mesenteric artery and the renal arteries. Learn more about the technique of Spiral CT by visiting the
CT Scan web site.
Example films available in the
Film Library. Click here to Return to
Procedure List.
DACROCYSTOGRAM
This procedure outlines the lacrimal duct (tear duct) which runs from the inner corner of the eye downwards into the nasal passages. The procedure is used in patients with blocked or narrowed ducts in which tears overflow the lower eyelid onto the cheek. Local anaesthetic may be used in the region of the punctum i.e. the opening of the duct. A small cannula is inserted into the punctum and between .5 to 2mls. of contrast injected. Usually two X-ray exposures are taken immediately after the injection.
Preparation There is no preparation required. Click here to Return to
Procedure List.
DEFAECOGRAM
This examination is used to investigate disorders of defaecation. A thick barium paste is inserted into the rectum. Images are obtained in the lateral projection while the barium is expelled into a receptacle.
Preparation A thorough bowel prep is required including a light low fibre diet, a period of fasting, laxatives and suppositories. Full instructions are given to patients with a 'Go Kit' bowel prep (A copy of the
Go Kit Preparation Instructions are included at the end of this page). Click here to Return to
Procedure List.
DIAPHRAGM SCREENING
This simply involves observing the movement of the diaphragm during fluoroscopic screening. This enables a diagnosis of paralysis of the diaphragm in patients where the diaphragm appears elevated on a chest X-ray
Preparation There is no preparation required. Click here to Return to
Procedure List.
DISCOGRAM
A discogram is a diagnostic test which attempts to identify the a degenerative disc as a source of back pain. The skin is prepared with antiseptic and local anaesthetic applied to the puncture site. Under CT or fluoroscopic guidance, a thin needle is inserted into the suspect disc in the cervical or lumbar region and a small quantity of contrast injected. Any leakage of contrast from the centre of the disc is noted. If the injection causes pain that is similar in nature to the presenting pain then it is assumed that the disc is the underlying cause of the symptoms. Several discs may be injected during the procedure.
Preparation A history of any previous allergy or asthma is obtained. Click here to Return to
Procedure List.
DRAINAGE PROCEDURE
Under imaging guidance and using either CT or Ultrasound, this technique involves the percutaneous drainage of fluid collections usually from the thorax, abdomen or pelvis or from cysts in the kidney, liver, breast etc. 'Percutaneous' means via a puncture through the skin. After injection of local anaesthetic into the skin, a small to medium gauge needle is inserted into the cyst or collection under aseptic conditions. In some cases the cyst or collection is simply drained by aspiration through this needle as in the drainage of breast cysts. In large infected collections particularly in the abdomen or pelvis, a flexible 'pigtail' catheter may be inserted into the collection using guidewires and dilators to assist in the placement of the catheter. This catheter is left in place and attached to a drainage bag to enable complete resolution of the collection. Material obtained from the aspiration is sent for pathology tests to identify infecting organisms or sometimes to check for abnormal cells. Some large cysts of the kidney may be treated with an alcohol injection after the drainage. The alcohol irritates the cyst lining and helps prevent recurrence.
Preparation There is no preparation required. Click here to Return to
Procedure List.
EMBOLIZATION
In this procedure, an
angiogram catheter is passed into a particular artery or into an abnormal dilatation or communication of an artery. The vessel is then occluded using small coils of wire or small balloons inflated with acrylic glue. The technique can be used to close off abnormal communications between an artery and a vein, to occlude an aneurysm in the brain or to stop bleeding e.g. in fractures of the pelvis. The technique is also useful before surgery to reduce the blood supply to a vascular tumour such as a kidney tumour. In these cases an injection of alcohol might be used to block off the tumour circulation.
Preparation There is no preparation required. Click here to Return to
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FACET BLOCK
Facet blocks can be performed under CT or fluoroscopic guidance. Facet joints are joints in the spine that lie behind the main body of the vertebrae. Patients with pain due to arthritis in a facet joint can benefit from this procedure. Local anaesthetic is infiltrated into the skin at the site of puncture. A long, small gauge needle is inserted into the painful joint. A combination of a local anaesthetic and a long acting steroid with anti-inflammatory properties is injected to relieve the pain.
Preparation There is no preparation required. Click here to Return to
Procedure List.
GALACTOGRAM
Patients with a discharge from a single breast duct can be investigated with a Galactogram. After cleansing the skin, a fine cannula is inserted into the discharging duct and a small quantity of contrast injected. A mammogram is then obtained showing the duct system and identifying a possible cause for the discharge.
Preparation There is no preparation required. Example film available in the
Film Library. Click here to Return to
Procedure List.
HOOKWIRE LOCALIZATION
This procedure is designed to assist surgeons in the excision of lumps in the breast that have been identified on mammography or ultrasound. Local anaesthetic is infiltrated into the skin at the site of puncture. A fine sterile wire with a hook on the end is guided into the lesion under mammographic or ultrasound control. At the end of the procedure, additional mammograms are performed to confirm the position of the wire.
Preparation There is no preparation required. Click here to Return to
Procedure List.
HYSTEROSALPINGOGRAM
A hysterosalpingogram is used to evaluate infertility. Contrast is injected via a catheter or cannula into the uterus to outline the uterine cavity and to delineate the fallopian tubes. A normal study will show contrast spilling out of the tubes into the pelvis. The test must be performed within ten days of the onset of menstruation to ensure there is no chance of pregnancy. The patient is placed in a standard gynae position on the edge of the screening table. The entrance to the vagina is cleansed with an antibacterial solution. A vaginal speculum is inserted to obtain a view of the cervix. A small gauge rubber catheter or a cannula is inserted into the cervical canal. After repositioning, contrast is injected and several films obtained. Following the procedure some discharge and minimal bleeding may occur. Although uncommon, increasing discharge, pain or fever could indicate a developing infection requiring treatment with antibiotics. The attached diagram is of a normal hysterosalpingogram.
Preparation There is no preparation required. Example film available in the
Film Library. Click here to Return to
Procedure List.
INTRAVENOUS PYELOGRAM (IVP)
An IVP is an examination of the kidneys, ureters and bladder. An injection of contrast is given via an arm vein. The contrast is rapidly excreted by the kidney. A series of films is obtained in sequence to follow the contrast from the kidneys, down the ureters and into the bladder. About 9 exposures in all are obtained in a routine series. Around four of these exposures may be 'Tomograms' where a selected plane is brought into focus by moving the X-ray tube and X-ray film tray in a smooth arc during the exposure. A tight compression band is often used across the middle of the abdomen during the procedure to better distend the upper ureters and kidney collecting systems. The technique may be modified in patients with acute pain (renal colic) or for follow up studies.
Preparation A bowel prep is required including a light low fibre diet, a period of fasting and laxatives. Full instructions are given to patients with a 'Go Kit' bowel prep (A copy of the
Go Kit Preparation Instructions are included at the end of this page). Medications should be continued. A history of any previous allergy or asthma is obtained. Note that no preparation is required for urgent cases. Example films available in the
Film Library. Click here to Return to
Procedure List.
MICTURATING CYST URETHROGRAM (MCU)
In this study, a small bore soft sterile rubber catheter is inserted under aseptic conditions through the urethra and into the bladder. The bladder is allowed to drain of urine. X-ray contrast is then instilled via a drip set. When the bladder is fully distended with contrast, the patient micturates and X-ray images are obtained to delineate the bladder and urethra. Any reflux of contrast into the ureters or kidneys is recorded.
Preparation There is no preparation required. Example films available in the
Film Library. Click here to Return to
Procedure List.
MYELOGRAM
In a myelogram, contrast is injected into the fluid surrounding the spinal nerves and X-ray images obtained to investigate the spinal cord and nerve roots. The skin puncture site on the back is cleansed with antibacterial solution and infiltrated with local anaesthetic. A small gauge lumbar puncture needle is inserted between two vertebrae into the fluid around the spinal nerves. Some fluid may be obtained for analysis in a pathology lab. Around 10 to 15 mls of contrast is injected and the needle removed. A series of films is taken. After the procedure the patient is required to rest in bed with the head elevated to prevent excessive amounts of contrast entering the head. An hour or so after the procedure, CT scans of the region of interest are obtained. (CT myelogram). MRI has reduced the reliance on myelograms and has the advantage of being non invasive. Some patients experience headaches after this procedure. If persistent, the headaches are likely to be due to leakage of spinal fluid from the puncture site. A 'blood patch' may be required to alleviate this problem. This technique uses an injection of the patient's own blood at the site of the lumbar puncture to secure a seal.
Preparation A consent form is required. Antidepressant medication must be ceased before the procedure. Example films available in the
Film Library. Click here to Return to
Procedure List.
NEPHROSTOMY
A nephrostomy involves the insertion of a 'pigtail' catheter into the collecting system of a kidney to relieve an obstruction. CT, Ultrasound and Fluoroscopy can all be used to assist in the placement of the catheter. The skin puncture site on the flank is cleansed with antibacterial solution and infiltrated with local anaesthetic. A needle is inserted into the dilated kidney and the position confirmed. A guide wire is inserted into the kidney and dilators used to enlarge the tract. The pigtail catheter is inserted over the guidewire and secured in place. A drainage bag is connected to the catheter.
Preparation A consent form is required. Click here to Return to
Procedure List.
PAIN BLOCKS (including nerve root blocks)
Pain blocks are usually performed under fluoroscopic or CT guidance and occasionally with ultrasound. Patients with pain due to inflammation in a ligament or joint or irritation of a nerve root can benefit from this procedure. A
facet block is a specific type of pain block targeting inflamed facet joints in the spine. Other joints that can be treated include the shoulder, sacroiliac and hip joints. Patients with inflammation in the foot (plantar fasciitis) can be similarly treated. Local anaesthetic is infiltrated into the skin at the site of puncture. A small gauge needle is inserted into the painful joint or adjacent to the irritated nerve. A combination of a local anaesthetic and a long acting steroid with anti-inflammatory properties is injected to relieve the pain. In the case of a 'frozen shoulder', the distention of the joint due to the injection is thought to assist in improving joint mobility.
Preparation There is no preparation required. Click here to Return to
Procedure List.
RECANNALISATION
Radiologists are sometimes requested to attempt to reopen the lumen of a thrombosed (clotted) artery often as a limb saving procedure. This can be done using guide wires and dilators. For fresh thrombus, a catheter may be placed above the occlusion and a special drug called a thrombolytic agent infused through the catheter to dissolve the clot. More information can be found at the
Interventional Radiology web page.
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Procedure List.
RETROGRADE PYELOGRAM
In this study, a small catheter is placed in a ureter in theatre by a specialist surgeon (urologist). The patient is sent to X-ray following recovery from the general anaesthetic. Contrast is injected into the kidney and ureter via the catheter and X-ray images obtained. This technique is useful where an
IVP cannot be performed due to poor kidney function or obstruction.
Preparation A history of any previous allergy or asthma is obtained. Click here to Return to
Procedure List.
SIALOGRAM
A sialogram is a study of a parotid or of a submandibular salivary gland. After obtaining preliminary plain films, the duct of the selected gland is cannulated and a small amount of contrast injected into the duct system. A series of X-ray films is obtained. Sometimes it is necessary to dilate the orifice of the duct before a cannula can be inserted. Lemon juice or an equivalent substitute is useful to encourage salivation which aids in the identification of the duct orifice.
Preparation There is no preparation required. Example film available in the
Film Library. Click here to Return to
Procedure List.
SINOGRAM
A sinogram involves the injection of contrast down a discharging sinus on the skin surface to delineate any associated abscess cavity or to show a communication with a segment of bowel. A small cannula or catheter is inserted into the sinus through which the contrast is injected. Conventional X-ray images may be obtained in the screening room or CT sections taken through the region of interest (CT Sinogram)
Preparation There is no preparation required. Click here to Return to
Procedure List.
STENTING
This procedure is performed in the digital angiography suite as an adjunct to balloon dilatation of a narrowed artery (
Angioplasty). After the narrowed artery is dilated, an expandable metal stent is placed across the narrowing and expanded. The stent helps prevent recurrence of the narrowing. Details of the technique and a picture of a stent can be found at the
Interventional Radiology web page.
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Procedure List.
URETHROGRAM
In a urethrogram a small rubber catheter is inserted into the penis under aseptic conditions. Contrasted is injected into the penis to delineate the penile urethra to look for narrowings, leakage of contrast indicating a rupture or abnormal passages.
Preparation There is no preparation required. Click here to Return to
Procedure List.
VENOGRAM
A venogram requires an injection of contrast into a vein usually in the arm or foot with the aim of delineating the anatomy of the veins. Tourniquets are used to slow the rate of flow of contrast in the veins and to direct flow into the deeper veins. The technique was used frequently to look for blood clots in the leg veins and also to display incompetent or varicose veins. This information is now more easily obtained using
Vascular Ultrasound.Preparation A history of any previous allergy or asthma is obtained. Click here to Return to
Procedure List.
GO KIT PREPARATION INSTRUCTIONS
GO KIT PLUS Preparation instructions for an IVP, Barium Enema or Air Contrast Examination of the colon. This preparation is to completely empty the bowels so that the best results can be obtained at the X-ray examination you are going to have. Go Kit will cause you to have frequent loose motions and you may have a number of bowel actions during the night. Follow these directions exactly, taking only the medication, food and water in the amounts shown and at the times given. If you wish you may add clear cordial of your choice to the water you must drink. Begin at 12 noon the day before the appointment date. Tick off each step as completed, and bring this paper with you when reporting for the examination.
To prepare the solution of Magnesium Citrate required at 8 pm, pour one large drinking glassful of hot water into a deep sided mixing bowl. Stir in all the powder contained in the sachet and when completely dissolved and frothing and effervescence ceased, pour back into drinking glass, cover and keep in a cool place until required at 8 pm.
12Noon Eat only the following:- 1 cup clear soup with dry crackers, 1 white chicken or vegemite sandwich (no butter, lettuce or additions), 1/2 glass clear apple or grape juice, 1 serving plain jelly (no cream or other additives), I glass skimmed milk
1 PM Drink one full glass or more of water with or without clear cordial
3 PM Drink one full glass or more of water with or without clear cordial
5 PM 1 cup clear soup 1 glass clear apple or grape juice I serving plain jelly (no cream or other additives)
7 PM Drink one full glass or more of water with or without clear cordial
8 PM Drink the cold solution of Magnesium Citrate previously prepared
1O PM Take the three (3) tablets with one full glass or more of water
12 am Drink one full glass or more of water with or without clear cordial
If this examination is for the kidneys (an IVP), take nothing further by mouth and disregard the following instructions which are only for barium enema and air contrast examinations.
7am Drink 1 1/2 glasses of water. Unwrap the suppository and insert, pointed end first into the rectum, as high as possible, and try to retain the suppository for up to 15 minutes. A bowel evacuation usually occurs in 15 minutes to an hour. Take nothing further by mouth.
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