X-Ray Exams

X-ray exams are a form of electromagnetic radiation that is used to capture images of internal organs or bones. The two-dimensional images produce images on a film that helps diagnose conditions or diseases. X-rays are traditionally used to diagnose fractured bones, dislocations, chest conditions and detection of foreign objects. These exams are performed by Computerized Radiography (CR) and Digital Radiography (DR).

Barium Enema/Air Contrast Barium Enema - Be or Lower GI
The type of preparation varies with the indications for the examination:
  • Suspected Hirschsprung (severe chronic constipation): No preparation. If the signs of Hirschsprung are not found on the initial BE, the examination will be stopped and the child rescheduled for a barium enema after suitable preparation.
  • Acute abdominal conditions (including intussusception): No preparation.
  • Ulcerative Colitis: Patients will need to use a Fleet's Enema Prep Kit.
  • Colostomy patients need to use a Fleet’s Enema Prep Kit, irrigate their colostomy prior to arrival, and bring a new colostomy bag with them to their appointment.   
ADULTS:
PREPARATION (Day Before Exam):
  • Breakfast: Non-residue diet. No sugar. No dairy products.
  • Noon: Light lunch. Clear soup. Unsweetened fruit juice, plain Jell-O, black coffee or plain tea.  NO MILK OR CREAM.
  • 1:00 p.m. – 9:00 p.m. drink 1 glass of water each hour.
  • 5:00 p.m. clear liquid dinner.
  • 5:30 p.m. Citrate of Magnesia mixed with 1/2 glass of water. (Disregard instructions in the Fleet Prep Kit).
  • 9:30 p.m. take 4 Bisacodyl tablets with water. DO NOT CHEW.
  • Nothing to eat or drink from midnight on.

PREPARATION (Morning of Exam):

  • No breakfast.
  • Administer Bisacodyl suppository (colostomy patients do not use)
CHILDREN: PREPARATION (Day Before Exam):
  • Children under 2 years may continue formula and baby food.
  • Children over 2 years, a low-residue diet:
    • Grain Products: White bread, bagels, english muffins, plain cereals such as Cheerios, Rice Krispies, Cornflakes, Arrowroot cookies, soda crackers, melba toast, white rice.
    • Fruit: Fruit juices, applesauce, apricots, peaches, watermelon, banana (1/2). NO BERRIES OR RAISINS.
    • Vegetables: Vegetables juices, potatoes (no skin), green beans, carrots, celery, cucumbers, squash, zucchini, lettuce.
    • Meat: Tender meat, fish, and eggs.
    • NO MILK OR DAIRY PRODUCTS.
  • NPO for 4 hours before the examination.
  • Magnesium Citrate is to be given the evening preceding the examination in the following dosages:

              Less than 12 months                        None
1 - 3 years                                            1.5 oz.
4 - 5 years                                            2.5 oz.
6 - 8 years                                            3 oz.
9 - 12 years                                          4 oz. 
13 - 14 years                                        5 oz.

PREPARATION FOR CHILDREN OVER 90 POUNDS, USE ADULT PREP Stools should be loose, but if no substantial bowel movement occurs, then give a saline or Pediatric Fleet Enema. Inpatients where a Pediatric Fleet Enema is contraindicated use one Dulcolax suppository in place of the Pediatric Fleet Enema in children over 2 years. Children under 2 years, use 1/2 Dulcolax suppository.

Bone Densitometry, DEXA

PREPARATION: 
No prep is necessary. (No oral or IV Contrast, barium, or Nuclear Medicine tests for 7 days prior to exam.)

EXAM DESCRIPTION:
Patient must be able to lie flat on back as the machine records measurements of bone mass.

LENGTH OF TIME INVOLVED: 
Scanning time is approximately 20-30 minutes

Defecography, Defogram

PREPARATION: 
Patient must take a Fleet's enema the day of and 1 hour prior to the exam. Retained fecal matter in the bowel may give the appearance of a lesion, polyps or other mucosal lining defects.

EXAM DESCRIPTION: 
The Radiologist will observe under fluoroscopy while a barium sulfate mixture is introduced via the rectum. The patient will be asked to demonstrate rectal abnormalities by relaxing, straining and bearing down on the rectal muscle. The patient is then allowed to evacuate the barium under fluoroscopy to demonstrate evacuation abnormalities.

LENGTH OF TIME INVOLVED: 
The entire exam takes approximately 30-45 minutes.

Endoscopic Retrograde Cholangiopancreatogram (ERCP)

PREPARATION: 
The patient must have a contrast free abdomen and must remain nothing by mouth (NPO) from midnight the night before the exam until the exam time. The patient must remain NPO to avoid aspiration of stomach contents. An IV is started for medications to be given during the exam. Any barium in the Gastrointestinal tract would obscure visualization.

EXAM DESCRIPTION:  
A gastroenterologist performs this exam with assistance of a radiologist with fluoroscopy.  Moderate sedation is administered to the patient and then a side-viewing duodenoscope is passed to the duodenum. The Ampulla of Vater is cannulated and an injection is made to visualize the pancreatic duct and the biliary tract for patency. Images are taken to record the information.

LENGTH OF TIME INVOLVED: 
The exam takes approximately 2 hours. Delay depends on patient's condition and cooperation and ease of the cannulation of the ampulla for injection.

Esophogram, Barium Swallow

PREPARATION:  
Patients under 2 years of age are nothing by mouth (NPO) for 4 hours and those over 2 years of age, NPO from midnight on starting the evening before until the exam time.

EXAM DESCRIPTION: 
While a Radiologist observes under fluoroscopy, the patient is instructed to drink 8-12 ounces of barium. Only the esophagus and esophageal gastric junction are imaged. During an esophogram, should it appear necessary to image the stomach, this could be accomplished at the same time.

LENGTH OF TIME INVOLVED: 
The exam takes approximately 30 minutes. Patient's condition and inability to cooperate may cause delays. The patient may be in the department up to 1 hour.

Hysterosalpingogram, Salpingogram, SALP, HSG

PREPARATION: 
None.

EXAM DESCRIPTION: 
The patient is placed on the radiographic table on their back with both legs positioned in stirrups. The attending physician performs a pelvic exam, inserts a speculum and cleans the vaginal vault with a cleansing solution. A syringe containing radiopaque contrast material is attached to a cannula and inserted into the cervix. The speculum is then removed and while the Radiologist observes the pelvic area under fluoroscopy, the physician injects the contrast. The uterus is visualized filling with contrast and if the tubes are still inside the patient they also fill with contrast material. The exam is terminated when contrast is observed spilling out into the abdominal cavity. Non-visualization of the tubes or lack of spill indicates blocked fallopian tubes. The size and shape of the uterus is also demonstrated.

This is a radiographic procedure for evaluating infertility in women. The uterine cavity and the fallopian tubes are opacified following the injection of contrast material into the uterus. In a normal woman, with patent fallopian tubes, contrast material spills into the pelvic peritoneal cavity. Developmental anomalies or fibrosis from pelvic inflammatory disease may cause occlusion of one or both of the fallopian tubes. The patient may experience some bleeding after the examination.

LENGTH OF TIME INVOLVED: 
Approximately 30 minutes.  Patient may be in the department up to 1 hour.

Intravenous Pyelogram (IVP) (Urogram, IV Pyelogram)

PREPARATION (Day Before Exam):
Prep done to remove fecal material, gas and barium in the GI Tract will limit detail and obstruct visualization of the urinary tract and kidneys. Without the prep to clean out the colon then the kidneys would not be visualized, resulting in rescheduling of the exam. Occasionally, the contrast causes nausea. An empty stomach will help reduce the possibility of vomiting.

ADULTS: PREPARATION (Day Before Exam):
  • Breakfast: Non-residue diet. No sugar. No dairy products.
  • Noon: Light lunch (clear soup, unsweetened fruit juice, plain Jell-O, black coffee or plain tea). NO MILK OR CREAM
  • 1:00 p.m. – 9:00 p.m. drink 1 glass of water each hour.
  • 5:00 p.m. – clear liquid dinner.
  • 5:30 p.m. – Citrate of Magnesia mixed with 1/2 glass of water.
  • 9:00 p.m. – take 4 Bisacodyl tablets with water. DO NOT CHEW

PREPARATION (Morning of Exam):

  • NPO 4 hours prior to exam (for afternoon appointment only).
  • Nothing to eat or drink from midnight on for A.M. appointments.
CHILDREN: PREPARATION (Day Before Exam):
  • Children under 2 years may continue formula and baby food.
  • Children over 2 years, a low-residue diet:
    • Grain Products: White bread, bagels, english muffins, plain cereals such as Cheerios, Rice Krispies, Cornflakes, Arrowroot cookies, soda crackers, melba toast, white rice.
    • Fruit:  Fruit juices, applesauce, apricots, peaches, watermelon, banana (1/2).  NO BERRIES OR RAISINS.
    • Vegetables: Vegetables juices, potatoes (no skin), green beans, carrots, celery, cucumbers, squash, zucchini, lettuce.
    • Meat: Tender meat, fish, and eggs.
    • NO MILK OR DAIRY PRODUCTS.
  • NPO for 4 hours before the examination.
  • Magnesium Citrate is to be given the evening preceding the examination in the following dosages:

              Less than 12 months                        None
1 - 3 years                                            1.5 oz.
4 - 5 years                                            2.5 oz.
6 - 8 years                                            3 oz.
9 - 12 years                                          4 oz. 
13 - 14 years                                        5 oz.

PREPARATION FOR CHILDREN OVER 90 POUNDS, USE ADULT PREP (see above) Stools should be loose, but if no substantial bowel movement occurs, then give a saline or Pediatric Fleet Enema. Inpatients where a Pediatric Fleet Enema is contraindicated use one Dulcolax suppository in place of the Pediatric Fleet Enema in children over 2 years. Children under 2 years, use 1/2 Dulcolax suppository.

EXAM DESCRIPTION: 
An initial radiograph is taken of the abdomen to demonstrate any stones that might be visible prior to contrast injection. The patient is then given contrast media intravenously. Serial radiographs are then taken after injection. If obstruction is present, delayed films may be needed. The entire urinary tract is demonstrated. Size, shape and contour of kidneys and bladder are noted as well as any filling defects or obstruction. If the patient is in Sickle Cell crisis, they cannot be injected with IV contrast media.

LENGTH OF TIME INVOLVED: 
Exam takes approximately 90 minutes. Patient may be in the Department up to 2 hours.

Loopogram

PREPARATION:  
Nothing by mouth (NPO) after midnight prior to the exam.

EXAM DESCRIPTION: 
The patient is placed on their back on the imaging table. An injection of contrast is made into the stoma opening, looking for obstruction.

LENGTH OF TIME INVOLVED: 
20 – 40 minutes.

Metastic Bone Survey

PREPARATION:
No preparation is necessary. Patient must be free of contrast (CT dye, barium). Retained barium or other contrast material in the colon will interfere with visualization of bony structures in the spine and pelvis areas.

EXAM DESCRITPION: 
Multiple radiographs of the skull, ribs, cervical, thoracic, lumbar spine and pelvis are taken.  Nuclear Medicine Bone Scans are the most common method of surveying for bone metastasis. However, in some cases of multiple myeloma, when the Bone Scan is negative, a Metastatic Bone Survey may demonstrate lesions not sensitive to isotopes.

LENGTH OF TIME INVOLVED: 
The exam takes approximately 45-60 minutes depending on patient ability to cooperate. 

Modified Barium Swallow, MBS

PREPARATION: 
No preparation unless the exam is ordered to include an Esophogram exam. Patients under 2 years of age need to be nothing by mouth (NPO) 4 hours prior.

EXAM DESCRIPTION: 
While a Radiologist observes under fluoroscopy, the patient is instructed to drink 4-6 ounces of barium. The patient will then be given small amounts of food with barium mix to demonstrate esophageal motility.

LENGTH OF TIME INVOLVED: 
The exam takes approximately 20 minutes. The patient's condition and inability to cooperate may cause delays.

Routine X-Rays: Non-Prep Exams
Abdomen                                       Mastoids
Acromioclavicular Joints                   Nasal Bones
Ankle                                             Optic Foramen
Bone Length Measurement               Orbits
Cervical Spine                                 Os Calcis
Chest                                             Patella
Clavicle                                          Pelvis/LS Spine
Elbow                                            Ribs
Eye for Foreign Body                       Scapula     
Facial Bones                                   Sella Turcica
Femur                                           Shoulder
Fingers/Thumb                               Sinuses (Paranasal)
Foot                                              Skull
Forearm                                        Sternoclavicular Joints
Hand                                             Sternum
Hip                                                Temporal Bones
Humerus                                        Thoracic Spine
Knee                                             Temporal Mandibular Joints
Lower Leg                                      Toes
Lumbar Spine                                 Wrist

 

Mandible/Panelipse

PREPARATION: 
The above examinations require no preparation and can be scheduled in conjunction with any other Radiology exam. For head studies, the hair must be free of metal clips, hairpins or braids and washed following an EEG. Please note on the requisition whether wraps, splints or other bandages may be removed for x-rays.

 

EXAM DESCRIPTION:
During the above exams you will be asked by the technologists to be positioned in different positions depending on the area of interest. They will ask and explain the positioning prior to placing you in those positions and obtaining the images. Most images are done very quickly with just a couple of views.

Retrograde Cystourethrogram

PREPARATION: 
None.

EXAM DESCRIPTION: 
The patient must have a small catheter inserted prior to the exam. The radiologist will insert contrast material into the urethra while watching under fluoroscopy for abnormalities, stricture, etc.

LENGTH OF TIME INVOLVED: 
30-40 minutes.

Shoulder Arthrogram

PREPARATION: 
There is no preparation necessary for this exam.

EXAM DESCRIPTION: 
An Arthrogram is an x-ray examination of a joint after an injection of x-ray contrast or air (or both) has been made. 

The radiologist will clean the affected area with an antiseptic and will use a local anesthetic to numb the area where the contrast will be injected.

After the needle is inserted into the joint space the contrast will be injected. The needle will be removed and the joint will be manipulated (moved) to help distribute the contrast material throughout the joint space. Images will then be taken with the joint in various positions.

LENGTH OF TIME INVOLVED: 
The exam takes approximately 45-60 minutes. The patient's condition and inability to cooperate may cause delays.

Sialogram, Salivary Duct Injection

PREPARATION: 
No preparation is necessary.

EXAM DESCRIPTION: 
A Radiologist will insert a small catheter into the affected duct. A radiopaque contrast material is injected into the duct and images are taken to visualize the affected gland. Masses, stones, or calculi and blockage of the duct are some of the abnormalities demonstrated.

LENGTH OF TIME INVOLVED: 
The examination can take anywhere from 30-60 minutes.

Sinus Tract Injection

PREPARATION: 
This procedure is performed in the abdominal region and requires a barium-free Gastrointestinal (GI) Tract. Patient is to be nothing by mouth (NPO) after midnight prior to the exam. Barium in the GI Tract could obscure visualization.

EXAM DESCRIPTION: 
The tip of a flexible catheter is placed into the opening of the fistula or sinus tract. Contrast is injected; fluoroscopic images are followed to determine existence of a fistula or the extent of a sinus tract.

LENGTH OF TIME INVOLVED: 
The length of this procedure will vary in time due to location of fistula and how extensive it is. The procedure takes an average of 20-40 minutes. 

Small Bowel, Upper GI and Small Bowel

PREPARATION: 
Patients under 2 years of age are nothing by mouth (NPO) for 4 hours and those over 2 years of age, NPO from midnight on, starting the evening before. Food matter in the small bowel can inhibit progress of the barium and appear as polyps or lining defects.

EXAM DESCRIPTION: 
The patient will drink approximately 4-16 ounces of barium. A series of radiographs are taken at timed intervals to demonstrate the progress of barium through the entire small bowel. The examination is terminated when the ileocecal junction is visualized.

LENGTH OF TIME INVOLVED: 
Length of time involved is difficult to estimate per individual patient. The majority of small bowel examinations takes about 90 minutes but could take up to several hours. The patient may be in the department from 3 - 5 hours.

T-Tube Cholangiogram

PREPARATION: 
There is no preparation necessary for this exam.

EXAM DESCRIPTION: 
While a Radiologist observes under fluoroscopy, a small amount of radiopaque contrast media is injected via the T-Tube (T-Tube is inserted in surgery during the removal of the gallbladder.)  The biliary tree is imaged for size, patency and to rule out retained stones.

LENGTH OF TIME INVOLVED: 
The examination takes approximately 30 minutes.

Upper GI, not a swallow

PREPARATION: 
Patients under 2 years of age are nothing by mouth (NPO) for 4 hours and those over 2 years of age are NPO from midnight on, starting the evening before. This is an X-ray examination of the esophagus, stomach, and duodenum.  It involves drinking liquid barium that coats the stomach and allows the stomach to show up on x-ray.

EXAM DESCRIPTION: 
While the Radiologist observes under fluoroscopy, the patient drinks 4-8 ounces of barium. The oral introduction of barium aids in demonstrating size, shape and motility of the stomach. The mucosal lining is evaluated for defects. 

LENGTH OF TIME INVOLVED: 
The exam takes approximately 20-30 minutes. Delays may be caused by patient slow peristalsis and patient condition. Patient may be in the Department for 1 hour.

Voiding Cystourethrogram, Cystogram

PREPARATION: 
Patients will have a Foley catheter inserted prior to this exam. Catheterization of bladder is necessary to facilitate filling of the bladder with contrast material. This allows for visualization of the bladder.

EXAM DESCRIPTION: 
A radiopaque contrast material is instilled into the bladder via the catheter. Several images are taken of the bladder in various positions to demonstrate filling defects such as tumors and reflux. If voiding films are ordered, the patient is instructed to void while images are taken to demonstrate the urethra.