Washington Health System Washington Hospital takes great pride with the recent installation of a Picture Archiving Communication Systems (PACS) and Computed Radiography (CR). This technology now displays general diagnostic radiographs on computer screens instead of creating traditional sheets of film. In addition, the hospital recently purchased a Digital Radiography (DR) room. The new room provides exceptional quality images along with a more efficient workflow, thus reducing the time that patients wait.
Our "filmless" environment enables authorized staff members to view images from multiple locations throughout the facility. Changing the settings so different areas of the body parts can be magnified or perhaps made lighter or darker is just one of the many benefits this advanced system allows physicians to do. CR, DR and PACS work together to create quality x-rays for improved patient care.
A major improvement to the diagnostic accuracy of radiography has been the addition of contrast agents, which can be administered in a vein or instilled in a duct or hollow organ, such as barium sulfate in the alimentary tract.
A contrast medium contains relatively dense material of a high atomic number that absorbs more of the x-rays than the surrounding tissues, hence making the stomach, colon, or vessel appear white on the x-ray film. One can then look for structural changes such as polyps, stones, or ulcerations.
Examples of exams involving contrast agents are: Upper GI, Barium Enema and IVP.
Upper Gastrointestinal Series (UGI)
The UGI is an x-ray examination of the esophagus and stomach and is sometimes followed by images of the small bowel. You should arrive with an empty stomach (no food or drink after midnight). The radiologist will ask you to drink a barium mixture, which coats the digestive tract so that it becomes more visible. The radiologist views the movement of barium on a television monitor and may take several images while moving the patient to different positions. Occasionally, patients will also be asked to swallow crystals that will add gas to the UGI tract, helping to delineate the mucosal layers of the stomach. After the radiologist’s examination, the technologist will take more images and may ask the patient to drink more barium. The barium is similar to milk of magnesia in consistency and taste.
The exam should take approximately 30-60 minutes. Additional images of the barium moving through the small intestine may be taken if requested by the referring physician. This can add anywhere from 45 minutes to several hours. Throughout these procedures, the patient usually feels no discomfort or pain.
The lower GI tract, including the colon and rectum, are also important areas to examine. The x-ray procedure for that area is called the barium enema.
In addition to not eating breakfast, a bowel-cleansing prep must be administered the day before the procedure to permit clearer images of the large bowel and surrounding tissues.
At the time of examination, a barium mixture is instilled through an enema tip placed in the rectum by the technologist. This procedure may cause some discomfort but is not painful. As it is instilled, the radiologist will examine and image the flow of barium. Sometimes, air is added to the barium mixture. The patient will be asked to move to several different positions. Patients should try to relax and hold their breath when instructed so as to avoid blurred images. When the radiologist has completed his or her portion of the exam, a radiologic technologist will take several more images to demonstrate various portions of the large bowel. Once the image sequence is finished, the technologist will assist the patient to the toilet. Afterward, one or more images will be taken to demonstrate the emptied bowel.
Intravenous Pyelogram (IVP)
To examine the urinary tract, a contrast agent (x-ray dye) is injected intravenously (usually into a vein in the arm). This test yields information about the function of the kidneys, the presence of stones in the urinary tract, and the passage of urine from the kidneys, ureters, and bladder.
In addition to not eating breakfast the day of the exam, a bowel cleansing prep and special diet must be followed the day prior to the exam. Also, just prior to the exam you will have a blood test drawn, a creatinine, to determine kidney function and your ability to excrete the contrast. You will be asked a series of screening questions and asked to sign a consent form before beginning the exam. If you are diabetic, you may need to stop taking your medication for 48 hours following the exam. The technologist will provide you with this information. If you have an allergy to iodine or have had a past reaction to the contrast, you must be pre-medicated.
The test takes approximately one hour. Some patients may experience a brief sensation of warmth or a metallic taste in the mouth after the contrast injection, but should not have any discomfort or pain. Any patient who experiences itching, hives or other effects should alert the technologist.
The technologist will take several images at specified intervals, per the radiologist protocol, after injection. The patient will be asked to move to several positions and to hold their breath when instructed so as to avoid blurred images. The exam is complete once the contrast reaches the bladder and the technologist must acquire images with the bladder full, and then emptied.