Chest X-Ray (Chest Radiography) - non-invasive diagnostic test - indirect visualization - oldest and most frequently used form

of medical imaging - helps physicians diagnose and treat medical conditions - involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside body - to look for abnormalities of the heart, lungs, bones, or blood vessels in the chest Who needs Chest X-ray? > chronic or persistent cough > difficulty in breathing > chest pain > chest injury > fever > tuberculosis > who will undergo surgery Chest X-ray (Chest Radiography) - requested/recommended by doctors - usually takes about 15 minutes - two types of Chest X-ray views: frontal view lateral view Two parts of X-ray equipment: > x-ray machine - holds the x-ray film or a special plate that records the picture digitally > x-ray tube - located about 6 feet away PROCEDURE test is done wait technician checks the quality of the x-ray pictures make sure that the pictures are good enough for the doctor to use radiologist send a report doctor (who requested the x-ray test) discusses the results In an emergency: > can get the x-ray results right away > Otherwise, it may take 24 hours or more Principle Involved - Electromagnetic/EM waves do not require a medium - most common source: acceleration of highenergy electrons bombarding a metal target - pass through most objects, including the body - aimed at the part of the body machine produces a small burst of radiation passes through the body recording an image on photographic film or a special digital image recording plate

x-rays (form of ionizing radiation) strongly interact with biological matters - Parts of the body absorb the X-rays in varying degrees: dense bone (e.g. ribs, spine) ABSORBS much of the radiation; white or light gray - soft tissue (e.g. muscle, fat, organs) allow more of the x-rays to PASS through them; shades of gray - air black/dark *** Radiopaque or Radiodense Whiter areas Radiolucent Darker areas Preparation for Procedure - to undress from the waist up and to wear a gown during the exam - to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x-ray images - Let the x-ray technician (person specially trained to do x-ray tests) know if you have any body piercings on your chest - Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant ***Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. - The technologist will ask the patient to hold the patients breath during the actual time of exposure ***It is important that the patient does not move while the procedure is ongoing so that the quality and sharpness of the picture is good. - The patients are preferred standing up during the procedure especially when diagnosing the patient with collection of fluids in the lungs Nursing Responsibilities - Ask about previous medical history or any recent x-ray procedures done - Ask the client for possibility of pregnancy - Assess vital signs before and after testing - Remove any metal items and any other accessories - Maintain privacy at all times - If x-ray is necessary for pregnant woman, protective lead apron should be worn - Instruct the patient to take a deep breath and hold it during the chest x-ray

-------------------------------------------------------------Mammography Types of mammography (according to purpose) - 3D, 2D and Screen Field (Analog) - Screening mammography: for general screening breast cancer - Diagnostic Mammography: for closer look and more precise assessment of the breast. Principles of Mammography (Electromagnetic Radiation, Low Energy X-rays, Compression) Electromagnetic and Ionizing Radiation - Radiation: Transfer of energy in the form of particles or waves. - Electromagnetic radiation is a form of pure energy which is carried by waves of photons. Lower energy X-rays, Higher X-rays exposure - High contrast, High resolution film - To differentiate by amplifying cancer from normal tissue because breast cancer appears similar(with very little difference or physical contrast) to normal breast tissue so it needs high contrast sensitivity, high detail, and low visual noise to produce visible images. But each of these characteristics requires a relatively high X-ray exposure. - 24kV to 32kV (Kilovolts) o Penetrating power of the x-ray beam o The higher the voltage setting, the more energetic will be the beam of the x-ray. The more energetic the beam, the less effect to different levels of tissue density will have in weakening that beam. - BREAST o Relatively high sensitivity to some adverse effects of radiation o Composed of soft tissues(no bones or air) and has very low contrast. Therefore, more radiation is required to produce visible images of both normal breast anatomy and signs of disease. Compression - Flatten the breast so there is less tissue overlap for better visualization. - Allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged - Immobilize the breast in offer to eliminate motion blur. - Reduce X-ray scatter which also leads to image degradation.

Types of mammography (according to imaging) - 3D, 2D and Screen Film (Analog) - Screen Film Mammography (Analog) - In screen-film mammography, X-ray beams are captured on a film cassette. - Special X-ray machines developed exclusively for breast imaging are used to produce mammography films. - The procedure produces an image of the breast tissue on a film, which is examined by a radiologist. 2D Digital Mammography - In 2D digital mammography, X-ray beams are captured on a specially designed digital camera and a computer to produce an image. - Unlike film-based mammography, digital mammograms produce images that appear on the technologist's monitor in a matter of seconds. - The images are then sent electronically to the radiologist to review. Screen Film Mammography 2D Digital Mammography - Screen Film Mammography Digital Mammography - Study showed that digital mammography is better than screen-film mammography for the following women: - Women under the age of 50, no matter what level of breast tissue density they had - Women of any age with very dense breast tissue - Pre-op peri-menopausal women (defined as women who had a last menstrual period within 12 months of their mammogram) - Screen-film and digital mammography were equally beneficial to all other women in the study. 3D Digital Mammography - In 3D digital mammography (tomosynthesis), high-powered computing is used to convert digital breast images into a stack of "slices," building what is essentially a "3-dimensional mammogram." - This allows doctors to examine breast tissue detail one slice at a time to help find breast cancer at its earliest stages, when it is most treatable. ** Whether you have a 3D digital mammogram, 2D digital mammogram or screen-film, the most

important thing is to get your annual mammogram. Mammogram Procedure Screening mammography - Women over 50 are invited for screening by mammography every three years as part of the NHS Breast Screening Programme in England. The programme is being extended to women aged 47 to 50, but it wont be phased in everywhere until 2016. A screening mammography is carried out at a breast cancer screening unit, which may be at a hospital, clinic or in a mobile unit. You can also have a screening mammography at an independent facility. Diagnostic mammography - Diagnostic mammography is carried out at a special breast assessment clinic, usually based in a hospital. You may be referred for a diagnostic mammography if a routine screening mammography shows up any breast changes, if you or your GP have found a change in your breasts, or if you have noticed any breast symptoms. ** Ultrasound is an alternative to mammography Risks - Mammography exposes you to a small amount of radiation - Sometimes signs of breast cancer can be missed - Sometimes, a screening mammography can show possible signs of breast cancer when in fact there is no problem. Benefits - Imaging of the breast improves a physician's ability to detect small tumors. - The use of screening mammography increases the detection of small abnormal tissue growths confined to the milk ducts in the breast, called ductal carcinoma in situ (DCIS). - No radiation remains in a patient's body after an x-ray examination. - X-rays usually have no side effects in the typical diagnostic range for this exam. Nursing Intervention - Explain the procedure to the patient thoroughly. - Answer the patients questions about the test. - Advice the patient to reschedule appointment if the patient is on her menstrual period. - Clothe the patient to a hospital gown.

Provide privacy to the patient. Make the patient feel comfortable after the procedure. - Prepare to educate the patient about her diagnosis. - Prepare the patient for further testing or surgery, as indicated --------------------------------------------------------------MRI (Magnetic Resonance Imaging) - Magnetic resonance imaging (MRI) can be used to produce detailed images of almost any part of the body. - MRI scans are often used to examine the: - brain and spinal cord - bones and joints - breasts - heart and blood vessels - It is also possible for an MRI scan to be used to examine other internal organs, such as the lungs or liver. Principles Involved: Net magnetisation - MRI is based on the interaction between an applied magnetic field and a nucleus with a nuclear magnetic moment or spin. / precission protons (1H) are the most abundant nuclei in living organisms and they have the best MRI sensitivity. For this reason protons are the most frequently studied nuclei. - Nuclear (proton) spins are like small magnets. When placed in an external magnetic field (B0) a large number of proton spins will be aligned parallel like groscopes to B0, with a somewhat smaller number oriented antiparallel (1). - Magnetic moment is being created by the H nuclei alignment . M which is parellel to Bo This frequency is known as the Larmor Frequency\ precession (W0) and is given by W0 = B0, is the gyromagnetic ratio; a constant having a characteristic value, for protons = 42.58 MHz/T. (nuclei specific for H) B0 is the strength of applied magnetic field. Next RF pulse ( radio frequency), Brf is aapplied perpendicular to Bo. This pulse cause M to tilt wqay from Bo. When the RF pulse is switched off, nuclei return to equilibrium such aas M is parllel to Bo. The nuclei loss energy because they emit their own RF signal which is called FID . Free induction decay. This return is called RELAXATION.

1. T1 relaxation times / longitudinal relaxation - describe how long it takes for - most of the spins to return to their - equilibrium states. - increases with an increase in the - magnetic field strength (B0) 2. T2 relaxation/ transverse relaxation time - time required for FID response signal from a given tissue type decay. - protons have the same direction: they are said to be in-phase. - relatively unchanged with increasing magnetic field strength (B0). MRI Procedure Before the procedure: - The patient is requested to do the ff: - to swallow or be injected - with a contrast material - not to eat or drink for several hours before the test - remove all metallic objects Pretest: - Identify the patient before providing care, treatment, or services. - Inform the patient that this procedure can assist in assessing organs and structures inside the chest. -Instruct the patient to remove jewelry and all other metallic objects from the area to be examined prior to the procedure. - Determine if the patient has ever had any device implanted into his or her body, including copper intrauterine devices, pacemakers, ear implants, and heart valves. - Review the procedure with the patient. Address concerns about pain related to the procedure and explain that no pain will be experienced during the test, but there may be moments of discomfort. - If the patient has a history of allergic reactions to any substance or drug, administer ordered prophylactic steroids or antihistamines before the procedure. - Note any recent procedures that can interfere with test results, including examinations using barium- or iodine-based contrast medium. - Tell the patient to expect to hear loud banging from the scanner and possibly to see magnetophosphenes (flickering lights in the visual field); these will stop when the procedure is over.

There are no food, fluid, or medication restrictions unless by medical direction. During the Test - Ensure that the patient has removed all external metallic objects from the area to be examined prior to the procedure. - Instruct the patient to cooperate fully and to follow directions. - Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided. - Instruct the patient to remain still throughout the procedure because movement produces unreliable results. - Supply earplugs to the patient to block out the loud, banging sounds that occur during the test. - Place the patient in the supine position on an examination table - Instruct the patient to communicate with the technologist during the examination via a microphone within the scanner. Post Test - Observe for delayed allergic reactions, such as rash, urticaria, tachycardia, hyperpnea, hypertension, palpitations, nausea, or vomiting. - Instruct the patient to immediately report symptoms such as fast heart rate, difficulty breathing, skin rash, itching, chest pain, persistent right shoulder pain, or abdominal pain. Immediately report symptoms to the appropriate HCP. - Instruct the patient to apply cold compresses to the puncture site as needed to reduce discomfort or edema. - Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patients lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.