BALLARAT HEALTH SERVICES

BASEHOSPITAL

Radiology Department Information

Procedures and Preparations

This document is intended as a resource for nursing and medical staff. It describes pre-procedure requirements and post procedure care. Please note that indications are a guideline only and although it lists most of the procedures performed in the department it is not an exclusive list.

For any other procedures or enquires please contact the department for further information.

Reviewed JANUARY 2010

Table of Contents

About The Radiology Department

Hours of Service

Radiology Department Contact Details

Services Provided

Booking Requirements

Availability of Results

Contrast Media

Contrast Media Protocols

Acute Renal failure Secondary to Contrast Media Nephrotoxicity

Extravasation of Contrast Protocol

Metformin and Contrast Media Protocol

Premedication of patients with previous known Allergy to non-ionic Contrast Media

Interventional Procedures and anti-coagulation

CT Scanning

CT Abdomen and Pelvis

CT Chest Abdomen and Pelvis

CT IV Cholangiogram

CT Upper Abdomen

CT Renal - Abdomen for Renal Stones

CT Brain (Routine)

CT Brain (6 Years and Under)

CT Facial Bones

CT Internal Auditory Meati

CT Orbits

CT Pituitary Fossa

CT Sinuses

CT Larynx

CT Neck - Soft Tissue

CT Chest (Routine)

CT Chest - High Resolution

CT Pelvis - Bony

CT Pelvis - Soft Tissue

CT Pelvimetry

CT - Cervical, Thoracic or Lumbar (Non Contrast)

CT - Cervical, Thoracic or Lumbar with Myelography

Discogram

Facet Joint Injection

Limited Epidural Injections

CT Shoulder

CT of Bony Extremities

CT Angiography

CT Guided Biopsy

CT Guided Drainage

CT COLONOSCOPY

CT CORONARY ANGIOGRAM

Radiological Procedures

IVC (Intravenous Cholangiogram)

Percutaneous Biliary Drainage and Stenting

Sialogram

Pericardial Tap

US Guided Thoracentesis - Pleural Tap

Liver Biopsy – Ultrasound Guided

US Guided Ascites Tap - Abdominal Paracentesis

US Guided Breast Cyst Aspiration or Lesion Biopsy

US Guided Breast Hook Wire Localisation

US Guided Thyroid Cyst Aspiration or Lesion Biopsy

IVP (Intravenous Pyelogram)

Micturating Cysto Urethrogram (MCU)

Nephrostogram

Percutaneous Nephrostomy

Ultrasound Hysteroinflation.

HSG (Hystero-Salpingogram)

Lumbar Puncture – Fluoroscopic Guidance

Medial Branch Nerve Ablation

Myelogram - Cervical, Thoracic, Lumbar

Nerve Root Injection

Neural Ablation

Vertebroplasty

Hip Injection

Arthrogram

Armport Insertion

Angiography - DSA

IVC (Inferior Vena Cava) Filter

Leg Segmental Pressure Studies

Permacath Insertion

Permacath Check with/without Urokinase Lock

Peripheral Angioplasty or Stenting

PICC (Peripherally Inserted Central venous Catheter) Line Insertion

ERCP-Endoscopic retrograde cholangiopancreatography

Percutaneous Biliary Drainage and Stenting

Pericardial Tap

Sialogram

Sinugram

Fluoroscopic procedures

Barium Enema (air or double contrast)

Barium Follow Thorough

Barium Meal

Naso-Jejunal Tube Insertion

Barium Swallow

Video Fluoroscopy

Ultrasound Scanning

Neonate Abdominal Ultrasound

Upper Abdominal Ultrasound

Upper Abdomen and Pelvic Ultrasounds

Bladder Ultrasound - Pre and Post Micturition

Prostatic Coil / Memokath Ultrasound

Renal Ultrasound

Pelvic Ultrasound

Pelvic TV (Trans-vaginal) Ultrasound

Transvaginal Ultrasound Information

Obstetric Ultrasound – less than 15 weeks gestation.

Obstetric Ultrasound - after 15 weeks gestation.

Obstetric Ultrasound – 12 week / Nuchal Translucency

Ultrasound of Small Parts

Arterial Leg Doppler

A/V Fistulogram

Aorta or IVC (Inferior Vena Cava) Ultrasound

Doppler Abdomen

Doppler Renal

DVT Ultrasound - Leg Veins Doppler

Echocardiogram

Varicose Veins Ultrasound - Doppler

Liver Biopsy – Ultrasound Guided

US Guided Ascitic Tap - Abdominal Paracentesis

US Guided Breast Cyst Aspiration or Lesion Biopsy

US Guided Breast Cyst Aspiration or Lesion Biopsy

US Guided Breast Hook Wire Localisation

US Guided Thoracentesis - Pleural Tap

US Guided Thyroid Cyst Aspiration or Lesion Biopsy

MRI Scanning

You must have a specialist provider number to order these scans.

What is MRI

Preparing for the Test

Information on and Preparation for Sedation

What Happens During the Scan

After the Test

Mammography

Needle localisation of Breast Lesion

Restricted Medication

Appendix (Contrast Protocols Ballarat Health Services)………………………………………………….46-54

About The Radiology Department

Hours of Service

Monday to Friday (excluding Public Holidays) - 8am to 6pm

Saturday, Sunday and Public holidays- 9am to 12noon

A twenty-four hour EMERGENCY Radiology service is available. Patients must attend via the Emergency Department for their safety and to coordinate with the hospital’s needs. After 6pm weekdays or after 12noon on weekends and public holidays all services must be arranged via the Emergency Department. To arrange this service contact the Emergency Department on 03 5320 4000.

An emergency service only is available on Christmas Day.

Radiology Department Contact Details

Our direct numbers are: 03 5320 4270 or 5320 4271.

Our Fax number is: 03 5340 4830

Our e-mail address is:

Services Provided

Angiography

Ultrasound

CT

MRI

Fluoroscopy

OPG

and General X-ray.

Booking Requirements

All CT scans, Ultrasounds or procedures requiring preparation or contrast require an appointment. Contact the department on 03 5320 4270 or 5320 4271 or the patient may book in person at the department.

All general x-rays do not require an appointment and can be undertaken any time during the office hours above. In-patients require an appointment time for the orderlies to collect them from the ward area.

Children may require special preparation for procedures not listed in this book, please contact the department for this information.

Please ensure that the department is made aware of any patient who has diabetes and is required to fast for a procedure. Meals and administering of insulin can be arranged. If the patient is on Metformin please read the section on Contrast Media.

Any further information or specific enquires please contact the department.

Availability of Results

We endeavour to have results available within 24-48 hours of the examination. Results should be available on the hospital computer system prior to this. An ‘Unverified result’ means that the radiologists have not yet validated the report.

Urgent results are available via phone or fax. Please state clearly on the request form if urgent notification of results is required. Images and results are available electronically via the BHS intranet.

Contrast Media

All intra-vascular contrast media used is iodine based. If your patient has a previous known reaction, please contact the department to discuss appropriate pre-medication to ensure that the procedure is completed safely and without delay.

If your patient is on Metformin please ensure a recent renal function test is available. Metformin is excreted via the same pathway as contrast media and it is recommended that Metformin is ceased for 48 hours following contrast media injection.

Preparation, prior to contrast media injection, may be required for patients with abnormal renal function.

If your patient has a Estimated Glomerular Filtration Rate below 50mls/hr please follow the Radiology Department protocol for abnormal renal function or contact the departmentfor further information. Iodinated contrast media is nephrotoxic and excreted unchanged via the kidneys.

Contrast Media Protocols

(see appendix)

Acute Renal failure Secondary to Contrast Media Nephrotoxicity p.46

Extravasation of Contrast Protocolp.52

Metformin and Contrast Media Protocolp.48

Premedication of patients with previous known Allergy to non-ionic Contrast Media p.50

Interventional Procedures and anti-coagulation

Some interventional procedures require clotting times to be done prior to the procedure.

Ceasing anticoagulants prior to an interventional procedure should only be done at the discretion of the treating medical officer.

General Guidelines: Please contact the department with any queries.

Warfarin should be ceased 4-5 days prior to procedure. Depending on indication for warfarin, patients may or may not need to be heparinised.IV Heparin should then be ceased 4 hours prior to the procedure.

Therapeutic doses of Clexane should be ceased 24 hours prior to a procedure.

Sub-therapeutic doses of clexane should be ceased 12 hours prior to a procedure.

Clopidogril should be ceased 10 days prior to a procedurein most patients depending on indication.

Aspirin should be withheld on the day of the procedure

CTScanning

Multi-slice 3 dimensional scanning is performed at Ballarat Health services. This allows for the isotropic reconstruction of the images in coronal, sagittal and the standard axial planes. This allows for more accurate interpretation of the CT images.

Bookings are required for CT Studies, though exceptions are made for urgent requests.

CT Abdomen and Pelvis

Possible indications include:

Trauma, abdominal pain, appendicitis, tumour evolution/oncology.

Preparation:

Routine 4 hour fast.

1 hour prior to examination the patient must start drinking the dilute Gastrografin or barium preparation. The drinking of the contrast fluid is undertaken in the department to ensure that an appropriate quantity is taken over an appropriate period of time.

The patient is then asked to change and given the opportunity to go to the toilet prior to the procedure.

Post procedure care:

If IV contrast is given encourage oral fluids.

CT Chest Abdomen and Pelvis

Possible indications include:

Trauma, appendicitis/generalised abdominal pain, lymphoma, lymph node enlargement, staging mass, hernia evaluation.

Preparation:

Routine 4 hour fast.

1 hour prior to examination the patient must start drinking the dilute gastrografin or barium preparation. The drinking of the contrast fluid is undertaken in the department to ensure that an appropriate quantity is taken over an appropriate period of time.

The patient is then asked to change and given the opportunity to go to the toilet prior to the procedure.

Post procedure care:

If IV contrast is given encourage oral fluids.

CT IV Cholangiogram

Possible indications include:

Visualisation of the Common Bile Duct, e.g. post cholecystectomy with continuing pain.

This is undertaken in conjunction with a standard IV Cholangiogram.

Abnormal liver function tests may affect the absorption of the contrast media.

Preparation:

Low residue diet the day prior to the procedure and a laxative in the evening following the evening meal. Nothing further to eat after this time. Drinking clear fluids is important, as dehydration is a contraindication to the procedure.

Post procedure care:

Encourage fluids.

CT Upper Abdomen

Possible indications include:

Upper abdominal pain, liver lesions.

Preparation:

Routine 4 hour fast.

1 hour prior to examination the patient must start drinking the dilute Gastrografin or barium preparation. The drinking of the contrast fluid is undertaken in the department to ensure that an appropriate quantity is taken over an appropriate period of time. The patient is then asked to change and given the opportunity to go to the toilet prior to the procedure.

If the patient is having a scan to follow up on a known liver lesion, oral contrast is not required and the patient attends the department 15 minutes prior to the examination.

Post procedure care:

If IV contrast is given encourage oral fluids.

CT Renal - Abdomen for Renal Stones

Possible indications include:

Renal colic, haematuria

Preparation:

Full bladder required. IV and oral contrast are not required.

Post procedure care:

None.

CT Brain (Routine)

Possible indications include:

Trauma, CVA, infarct, hydrocephalus, headaches, seizures, possible pathology.

Preparation:

Routine 4 hour fast.

Post procedure care:

If contrast is given, encourage oral fluids.

CT Brain (Infant or child)

Possible indications include:

Trauma ,possible pathology

Preparation:

Many children need sedation or a general anaesthetic for CT scans. The child will need to be admitted to the hospital for the day. If required, anaesthetic care will need to be organised.

FASTING: If the child’s procedure is in the morning they must not eat solid food or drink milk after 4am and must have nothing else to drink after 6am. For an afternoon procedure, the child must not eat solid food or drink milk after 9 am and they must not drink anything after 11am. Between 9am and 11am small amounts of water or juice may be taken. Breastfeeding must cease 4 hours prior to the scan.

A CONSENT FORM is required.

Post procedure care:

As requested by Anaesthetist

CT Facial Bones

Possible indications include:

Trauma

Preparation:

Nil required.

Post procedure care:

None.

CT Internal Auditory Meati

Possible indications include:

Vertigo, suspected acoustic neuroma.

Preparation:

Routine 4 hour fast.

Post procedure care:

If contrast is given, encourage oral fluids.

CT Orbits

Possible indications include:

Visual disorders, proptosis, foreign bodies, trauma.

Preparation:

Routine 4 hour fast.

Post procedure care:

If contrast is given, encourage oral fluids.

CT Pituitary Fossa

Possible indications include:

Hormonal disorders, visual disturbances.

Preparation:

Routine 4 hour fast.

Post procedure care:

If contrast is given, encourage oral fluids.

CT Sinuses

Possible indications include:

Chronic sinusitis, polyps, trauma, bone destruction.

Preparation:

Nil required.

Post procedure care:

None.

CT Larynx

Possible indications include:

Vocal chord abnormality, as directed by the radiologist.

Preparation:

Routine 4 hour fast.

Post procedure care:

If contrast is given, encourage oral fluids.

CT Neck - Soft Tissue

Possible indications include:

Palpable neck mass.

Preparation:

Routine 4 hour fast.

Post procedure care:

If contrast is given, encourage oral fluids.

CT Chest (Routine)

Possible indications include:

Lung Disease.

Preparation:

Routine 4 hour fast.

Post procedure care:

If contrast is given, encourage oral fluids.

CT Chest - Aortic Dissection

Possible indications include:

Dissecting aneurysm.

Preparation:

Routine 4 hour fast if the patient’s condition permits.

Post procedure care:

Encourage fluids if the patient’s condition permits.

CT Chest - High Resolution

Possible indications include:

Diffuse lung disease.

Preparation:

No fast required. If the patient takes regular broncho-dilators these should be taken as normal.

Post procedure care:

None.

CT Pelvis - Bony

Possible indications include:

Fractured pelvis or hips, pathology

Preparation:

None required.

Post procedure care:

None.

CT Pelvis - Soft Tissue

Possible indications include:

Pelvic pathology

Preparation:

Routine 4 hour fast.

1 and a ½ hours prior to examination the patient must start drinking the dilute gastrografin or barium preparation. The drinking of the contrast fluid is undertaken in the department to ensure that an appropriate quantity is taken over an appropriate period of time. The patient is then asked to change and given the opportunity to go to the toilet prior to the procedure.

Post procedure care:

If IV contrast is given encourage oral fluids.

CT Pelvimetry

Possible indications include:

Post Partum evaluation.

Preparation:

None required.

Post procedure care:

None.

CT - Cervical, Thoracic or Lumbar (Non Contrast)

Possible indications include:

Trauma, neural deficit, back pain/ sciatica.

Preparation:

None required

Post procedure care:

None.

CT - Cervical, Thoracic or Lumbar with Myelography

Possible indications include:

Back pain, disc lesion, canal stenosis, neural loss, previous surgery or previous scan without contrast where further information may be gained with Myelography.

An MRI scan may be the procedure of first choice.

Preparation:

See Myelography.

Discogram

Possible indications include:

Evaluation of the structure and functional integrity of the nucleus/annulous. Especially useful in assessing the severity of disc herniation or degeneration.

Preparation:

Light diet for the meal prior to the examination. An escort is required to drive the patient home following the procedure.

Post procedure care:

The patient meeds to rest for 24 hours post procedure, standing as much as possible in the first 12 hours. Standing aids the reabsorption of the fluids injected into the disc.

Facet Joint Injection

Possible indications include:

To determine if a facet joint is causative in patients’ back or leg pain.

Preparation:

Light diet for the meal prior to the examination. An escort is required to drive the patient home following the procedure.

Post procedure care:

Return to usual activities.

Limited Epidural Injections

Possible indications include:

Therapeutic procedure for symptomatic central disc herniation or degeneration.

Preparation:

Light diet for the meal prior to the examination. An escort is required to drive the patient home following the procedure.

Post procedure care:

As for a myelogram.

CT Shoulder

Possible indications include:

Recurrent dislocations, rotator cuff injuries, tendon tears, fractures, bony abnormality

Preparation:

If for bony examination, no preparation is required.

If soft tissues are to be studied the patient should have a shoulder arthrogram prior to CT.

Post procedure care:

None.

CT of Bony Extremities

Possible indications include:

Trauma/pathology.

Preparation:

None required.

Post procedure care:

None.

CT Angiography

Possible indications include:

Pathology of major arteries - pulmonary, carotid, renal and intra-cranial and aorta.

Preparation:

4 hour fast.

Post procedure care:

Encourage fluids.

CT Guided Biopsy

Possible indications include:

Known lesion visible and accessible under CT for pathology assessment.

Preparation:

Routine 6 hour fast. The region should have had previous imaging and these films and reports must be available.

Patient may be booked into the hospital at the discretion of the requesting medical practitioner. Some biopsies may be appropriate to be performed on an outpatient basis. The patient must be aware of the risk of having to stay in hospital overnight and resting for the remainder of the day if they return home.

Clotting times are required for all biopsies and should be done the day before.

Post procedure care:

In-patients are returned to the ward with a post biopsy care sheet.

If the procedure is being performed on an outpatient basis the patient is kept in the department resting and monitored for at least an hour prior to being released into the care of another person. Lunch or a drink will be provided.

CT Guided Drainage

Possible indications include:

Drainage of an abscess or fluid filled structure requiring CT guidance. This may be therapeutic, diagnostic or both.

Preparation:

Routine 6 hour fast. The region should have been previously imaged and these films and reports must be available.

Patient may be booked into the hospital at the discretion of the requesting medical practitioner. Some drainages may be appropriate to be performed on an outpatient basis. The patient must be aware of the risk of having to stay in hospital overnight and resting for the remainder of the day if they return home.