• To diagnose an injury or disease of the liver, gallbladder, spleen, pancreas, kidneys, or other organs inside the abdomen 
• To help determine the cause of abdominal pain 
• To identify gallbladder or kidney stones 
• To assess for tumors, cysts, abscesses, or other masses in the abdominal organs 
• To help determine why an internal organ is enlarged 
• To evaluate the aorta for the presence of an aneurysm 
• To evaluate narrowing of the arteries in the abdomen 
• To assess a spleen injury 
• To evaluate liver disease or pancreatitis 
• To locate a foreign object in the abdomen, such as a bullet 
• Frequent urinary tract infections (Bladder infections) 
• Blood in urine 
• Abnormal blood tests
  

Risk Factors for Complications During Procedure
  • Both obesity and dehydration can make it more difficult to identify organs during the test
   • Air in the intestines may block views of the internal organs
   • The presence of barium or other contrast materials in the intestine can block views of the internal organs (therefore, abdominal ultrasound should be done before other diagnostic imaging tests that require contrast material)

Before The Procedure
Your doctor will likely do the following:
   • Physical exam
   • Sometimes, blood tests and other tests

When making the appointment, ask about dietary instructions. You must not eat or drink anything for 8-12 hours before the test to decrease the amount of gas in the intestines. (If you must take medication the morning of the exam, a small amount of water may be taken to swallow the medications) Improper patient preparation will increase the amount of bowel gas in the abdomen and significantly decrease the quality of the ultrasound images.

For some types of ultrasound, a full bladder helps visualization. In these cases, you will be asked to drink six or more glasses of water, and not to urinate before the scan.

For a gallbladder sonogram, a fat-free meal should be eaten at dinnertime the night before the exam.
Wear comfortable, loose-fitting clothing

What You Will Experience - You will lie still on a flat table in a darkened room. The darkness helps the technologist see images on the screen.The technologist applies a conductive gel to the abdomen, and presses a transducer against the skin. This is a small, handheld device that converts energy from one form to another. The gel helps transmit sound waves between the skin and the transducer, because these waves cannot travel through air.

The transducer sends high-frequency sound waves toward the internal organs, which reflect the sound waves back to the skin. The transducer receives these sound waves and converts them into electrical impulses that become a visible image on the ultrasound machine.

The technologist watches the images as they appear on the machine's screen. The technologist can capture a still image or videotape moving images for review at a later time. To obtain clearer and more complete images, the technologist may move the transducer to different places on the abdomen. You may be asked to change positions or hold your breath during the exam.

How Long Will it Take? About 30 minutes

Will it Hurt? No. An ultrasound is not invasive and not painful. The gel may feel cold when it is first applied, and holding the transducer tightly against the skin produces a sensation of pressure and in
some cases discomfort. For instance, pressure on a full bladder feels uncomfortable.

Outcome
A radiologist analyzes and interprets the images created by the ultrasound and gives a report to your doctor. Your doctor will make recommendations for treatment based on this report.

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Breast Ultrasound
No preparation needed.

Renal Ultrasound
An exam that uses high frequency sound waves to study the renal system, which includes the kidneys, bladder, and ureters

Parts of the Body Involved
   • Kidneys
   • Bladder
   • Ureters
   • Abdomen
   • Back

Reasons for Procedure 

• To look for changes in the bladder wall 
• To look for changes in the kidney size or structure 
• To detect a kidney stone, cyst, mass, or other obstruction in the kidney 
• To look for stones in the urinary tract 
• To look for changes in the ureters 
• To examine the kidneys before performing a renal biopsy (removal of tissue from the kidney for exam) 
• To examine the circulatory system of the kidneys (a Doppler ultrasound)

Risk Factors for Complications During Procedure
Obesity can make this examination more difficult to perform and less accurate

Before The Procedure: 

• Your doctor will do a physical exam 
• Avoid carbonated drinks, such as sodas and seltzers 
• You must have a full bladder for the test; Drink 36 ounces of water to be finished 30 minutes before exam time.Do not empty your bladder until after the ultrasound.You must follow this preparation, or the test results may be inaccurate. Improper preparation will decrease the quality of the test

• Uterus
• Ovaries
• Bladder

Reasons for Procedure

• Evaluate the pelvic structures for any abnormality, including massess or ovarian cysts or fibroids
• To determine the cause of pelvic pain
• Evaluate for dysfunctional uterine bleeding
• Evaluate for ectopic pregnancy
• Determine the cause for irregular menses (periods), or the cessation on menses

Risk Factors for Complications During Procedure
Obesity can make this examination more difficult to perform and less accurate.Fluids other than water may increase the amount of intestinal gas and cause as decrease in image quality.

Before The Procedure:

• Your doctor will do a physical exam
• Avoid carbonated drinks, such as sodas and seltzers
• Drink 32 ounces of water to be finished 30 minutes before exam time.Do not empty your bladder until after the ultrasound.You must follow this preparation, or the test results may be inaccurate. Improper preparation will decrease the quality of the test.

What You Will Experience
You will lie on a table and the technologist applies a sound-conducting jelly to your abdomen over your bladder and kidneys.
The ultrasound machine has a handheld instrument called a transducer, which looks like a microphone or wand. The transducer is passed over the skin where the jelly was applied. The transducer sends sound waves into the body, which bounce off the internal organs and echo back to the transducer. The echoes are converted to images that are displayed on a screen. The technologist examines the images on the screen and may make a photograph for further assessment. This procedure can be done in an examination room in a doctor's office or in a hospital room.

After The Procedure - A radiologist examines the ultrasound image for any abnormality in the pelvis.
You may empty your bladder after the exam, and all necessary images are obtained.


How Long Will it Take? 30 - 40 minutes

Outcome
If the doctor or radiologist detects an abnormality, additional tests will be done to determine the exact problem and cause.
 
Foot and Extremity Ultrasound
No preparation needed.

Carotid Doppler Ultrasound
No preparation needed.

Venous Doppler Extremity Ultrasound
No preparation needed.

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Digital Mammography
(Breast x-ray, Mammogram)

What Is Mammography?
Mammography is the use of low-dose x-rays (radiation) to make a picture of the tissue inside the breast. The resulting picture is called a mammogram.

Reasons for Mammography
Mammography is used to screen for and diagnose breast cancer by detecting tumors or other changes in breast tissue.
Specifically, mammography:
•Aids in early detection of cancer, which improves chances of successful treatment.
•Can identify abnormalities up to two years before a lump can be felt.
•Provides the only reliable method of locating abnormal growths in the milk ducts.
•Identifies a lump's location prior to a biopsy or surgery.

Screening mammograms should be done every year after the age of 40, and at earlier ages if you have a family history of breast cancer, especially pre-menopausal breast cancer.

Preparation
In the time leading up to your mammogram, some considerations:

• Schedule a mammogram when breast tissue is least tender, typically a week after your period
• Some women report less discomfort if they avoid caffeinated beverages and take 400 IU of vitamin E per day for several weeks before the exam
• If you have breast implants, ask if the facility uses special techniques to accommodate implants, before making an appointment; implants make it more difficult to see all the breast tissue
• No diagnostic tests are necessary before a mammogram, although monthly self-exams and yearly breast exams by your regular practitioner are recommended.

The day of your mammogram:

• Do not apply deodorant, talcum power, lotion, or perfume near your breasts or under your arms.
• Some women experience less discomfort during breast compression if they take two ibuprofen tablets about an hour before the test.
• Wear a two-piece outfit; you will need to remove all of your clothing and jewelry from the waist up and change into a gown that opens in the front. If you have previous mammograms reports, bring them with you .
• Inform the technologist if you are pregnant or have breast implants.
• Describe any breast problems to the technologist before x-rays are taken.

What You Will Experience - You will stand in front of a special x-ray machine, which has a platform to place your breast on. The technologist adjusts the height of the platform, then lifts and positions one breast between a special cassette that holds the film and a clear plastic plate. The plate is brought close to the platform and compresses the breast to hold it in place and allow for a clearer image. Tell the technologist if the plate compresses so tightly that it feels painful.

Two pictures of each breast are taken during a screening mammogram. During one, you face toward the platform and the image is taken looking down at the breast. For the second, you stand beside the machine, to allow for a side view. The x-rays are repeated on the other breast. Extra images, from different angles, may be necessary if you have breast implants.

The test normally takes about 30-45 minutes. When you are done, you'll be asked to wait at the facility until the radiologist views the exam, in case more images are needed.

Will it Hurt? Most women do feel discomfort, and some feel pain. Tell the technologist about any pain so the plastic plate can be adjusted.
Post-procedure Care - Continue monthly breast self-exams. If you are not familiar with self-exam techniques, ask your doctor to show you, or check the American Cancer Society Website.

When The Procedure Is Finished
The radiologist analyzes the images and may speak with you at the end of the appointment.
Your doctor will receive a report describing anything out of the ordinary and suggesting a possible diagnosis. Depending on the results, additional views or tests may be ordered.
Call Your Doctor if Any of the Following Occurs

• Changes in a breast, including a lump or thickening
• Skin discoloration or discharge from the nipple

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Outcome
A radiologist will examine the x-rays. (In rare cases, if the x-rays are blurred, the test may have to be repeated.) Usually within a few days, your doctor will tell you the results. If results are abnormal, your doctor will recommend follow-up testing and treatment options.

Call Your Doctor If Any of the Following Occurs
Severe pain
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Intravenous Pyelogram (IVP)
(Excretory Urography, Intravenous Urography [IVU])
An intravenous pyelogram (IVP) is a test that uses contrast dye and x-rays to evaluate problems in the urinary tract. The urinary tract includes the kidneys, ureters, and bladder.

Parts of the Body Involved

• Arm (for insertion of the intravenous line)
• Urinary tract

Reasons for Procedure
An IVP is done to identify:

• Tumors
• Kidney stones
• Damage to the urinary tract from injury or infection
• Other problems causing kidney malfunction or obstruction

Possible Risk Factors for Complications During Procedure

• Allergy to contrast dye or shellfish
• Impaired kidney function, which may occur with:
• Aging
• High blood pressure
• Diabetes
• Heart disease
• Dehydration
• Pregnancy; pregnant women should never be exposed to abdominal or pelvic x-rays

Before The Procedure - Preparation for an IVP varies depending on whether it is done as an emergency procedure or on an outpatient basis.
If you are 70 years old or over, have renal disease, high blood pressure, or diabetes, you may have to have blood work done before this procedure . If you do, the lab work will be ordered by the doctor referring you for the test.
An IV (intravenous) line is inserted for providing contrast dye, and medications as necessary.

When Done As Emergency - Blood is taken for kidney function tests. An intravenous (IV) line inserted. The IV line will provide medication to alleviate pain, nausea, or vomiting. Fluids and the IVP dye are also administered through this IV line. You will lie down and rest before the IVP is done.

When Done As Outpatient - In the days leading up to the procedure:

• Blood is taken for kidney function tests. 
• The day before, you may be asked to use laxatives and possibly enemas to clean out the colon. This is because stool in the colon may interfere with interpretation of the IVP. 
• You will fast for 8-12 hours before the test.

What You Will Experience - You will lie on your back on a table, and an x-ray is taken. Contrast dye is injected into the IV line inserted in your arm or hand. For the next 30-60 minutes, x-rays are taken at regular intervals. You will be asked to hold your breath each time an x-ray is taken. The dye highlights your urinary system on the x-ray, so your doctor can see these body parts at work and detect problems. Before the last x-ray, you will empty your bladder in a bathroom. The procedure normally takes about 60-90 minutes

Will it Hurt? The procedure is not painful, but you will feel a sensation of warmth or heat as the contrast dye travels through your body.

Possible Complications:

• Allergic reaction (rare)
• Flushing, vomiting, or nausea
• Kidney failure (often preventable by evaluating kidney function before the test)
• Rash (Hives)
• Low blood pressure
• Difficulty breathing
• Loss of consciousness
• Difficulty speaking or swallowing
• As with all x-rays, there is a small exposure to radiation
  

When You Are Done - Most people can resume normal activities and diet after the IVP is completed. Your doctor will tell you if there are any restrictions you should follow.

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