Non- Invasive Diagnostic Procedures for Cancer

1. Magnetic Resonance Imaging (MRI)

Definition: MRI is an imaging test that uses powerful magnets and radio waves to create images or pictures of your body in detail. It has become the preferred procedure for diagnosing a large number of potential problems in many different parts of the body. It does not use radiation (x-rays). It is also called Nuclear magnetic resonance (NMR) imaging. Procedures:

You may be asked to wear a hospital gown or clothing without zippers or snaps (such as sweatpants and a t-shirt). Certain types of metal can cause blurry images. You will lie on a narrow table, which slides into a large tunnel-shaped scanner. Some exams require a special dye (contrast). Most of the time, the dye be given through a vein (IV) in your hand or forearm before the test. The dye helps the radiologist see certain areas more clearly. Small devices, called coils, may be placed around the head, arm, or leg, or other areas to be studied. These help send and receive the radio waves, and help the quality of the images.

During the MRI, the person who operates the machine will watch you from another room. The test lasts about 30-60 minutes, but may take longer. Nursing Responsibilities: a. Before the procedure

1. Patient may be asked not to eat or drink anything for 4 - 6 hours before the scan. 2. Asked patient if they are afraid of close spaces or claustrophobia and inform the doctor. Patient may be given a medicine to help them feel sleepy and less anxious, or the doctor may suggest an "open" MRI, in which the machine is not as close to the body. 3. Before the test, asked the patient if they have the following:

Artificial heart valves Brain aneurysm clips Heart defibrillator or pacemaker Inner ear (cochlear) implants Kidney disease or dialysis (patient may not be able to receive contrast) Recently placed artificial joints Vascular stents Worked with sheet metal in the past (patient may need tests to check for metal pieces in their eyes)

4. Asked patients to remove the following:

Items such as jewellery, watches, credit cards, and hearing aids - may be damaged. Pens, pocketknives, and eyeglasses - may fly across the room. Pins, hairpins, metal zippers, and similar metallic items - can distort the images. Removable dental work should be taken out just before the scan. Because the MRI contains strong magnets, metal objects are not allowed into the room with the MRI scanner. It is important to inform the health care provider of any pregnancy or suspected pregnancy prior to the procedure. b. During the procedure

Patient will be asked to remain perfectly still during the time the imaging takes place, but between sequences some minor movement may be allowed. The MRI Technologist will advise accordingly. When MRI procedure begins, patient may breathe normally, however, for certain examinations it may be necessary for you to hold your breath for a short period of time. Monitoring is indicated to patients who are great potential for change in physiologic status (respiratory rate, oxygen saturation, temperature, heart rate and blood pressure) during the procedure or whenever a patient requires observations of vital physiologic parameters due to an underlying health problem.

Monitoring is imperative to patients who are using sedative or anesthesia to ensure patient safety Patients that require monitoring and support during MRI procedures.

Physically or mentally unstable patients. Patients with compromised physiologic functions. Patients who are unable to communicate. Neonatal and pediatric patients. Sedated or anesthetized patients. Patients undergoing MR-guided interventional procedures. Patients who may have a reaction to an MRI contrast agent. Critically ill or high-risk patients.

c. After the procedure There is no recovery time, unless you were given a medicine to relax. After an MRI scan, you can resume your normal diet, activity, and medications. If patient is sedated, patient is transferred to the recovery room for continue monitoring. Especially important for pediatric patients because certain medications have relatively long halflives (e.g., chloral hydrate, pentobarbitol, etc.). 2. Computed Tomography (CT) Scan

Definition: Computed tomography (CT) is an imaging procedure that uses special x-ray equipment to create a series of detailed pictures, or scans, of areas inside the body. It is also called computerized tomography and computerized axial tomography (CAT) scanning. In cancer, CT may be used to help detect abnormal growths; to help diagnose tumors; to provide information about the extent, or stage, of disease; to help in guiding biopsy procedures or in planning treatment; to determine whether a cancer is responding to treatment; and to monitor for recurrence. Procedures:

You may be given a large drink to consume before the procedure. This drink is an oral contrast agent that helps to enhance pictures of the stomach, small intestines and bowel. In some cases, the contrast agent is administered as an enema. You will be asked to undress and wear a hospital gown. You must remove all metal objects including jewellery. You lie down on the scanner table. The radiographer may use straps and foam pillows to position your body and help keep you still. You may be given an intravenous injection of an iodinated contrast medium (a type of dye) to help produce better images. This substance may cause a strange warm feeling that lasts for a few seconds, a funny metallic taste in the mouth or the sensation that you have wet yourself. The table slides into the circular hole in the machine. Depending on the body part and particular condition being investigated, a number of images may be taken as the table moves in and out of the circular hole. The gantry moves in a circle around you as it takes the x-ray images. Each revolution (turning) of the gantry takes less than a second and there may be a number of revolutions depending on the examination. Lie very still. This is very important, as movement will blur the images. You may be asked to hold your breath for a few seconds while the CT machine takes the images. The equipment makes clicks and buzzes while taking the images. Dont be alarmed this is normal. Depending on the type of medical investigation, the CT scan may take anywhere from a few minutes to half an hour or more.

Nursing Responsibilities: a. Before the procedure 1. Instruct the patient to wear comfortable, loose-fitting clothing to your exam. Or you may provide a gown to wear during the scan. 2. Ask the patient if she/he has claustrophobia, if yes immediately inform the doctor so that patient may be given a medicine to help them feel sleepy and less anxious.

3. Ask the patient to remove metal objects including jewellery, eyeglasses, dentures and hairpins because it may affect the CT images. Ask to also remove hearing aids and removable dental work. 4. Instruct the patient not to eat or drink anything for several hours before the scan, especially if a contrast material will be used in the exam. Instruct the patient to inform the physician of any medications he/she is taking and if he/she have any allergies, especially to contrast materials.

b. During the procedure 1. Instruct the patient to relax while the procedure is being done. c. After the procedure 1. After the CT scan is completed, instruct the patient that he/she may resume all of his/her normal activities. There should be no ill-side effects and the patient will be able to drive. 2. Encourage the patient to drink plenty of liquids/water after the test is complete (if given contrast). This is so that the contrast dye can be quickly flushed from the body and you do not become dehydrated.

3. Bone Scan

Definition: A bone scan is a test that detects areas of increased or decreased bone turnover. These may indicate bone injury or disease. Radioactive isotopes and tracer chemicals are used to highlight the problem areas. A bone scan is usually done by a nuclear medicine technologist. The scan pictures are usually interpreted by a radiologist or nuclear medicine specialist.

Procedures: You will need to remove any jewelry that might get in the way of the scan. You may need to take off all or most of your clothes. You will be given a cloth or paper covering to use during the test. Your arm will be cleaned where the tracer will be injected. A small amount of the tracer is injected. It takes about 2 to 5 hours for the tracer to bind to your bone so that pictures can be taken with a special camera. During this time, you may be asked to drink 4 to 6 glasses of water so your body can wash out the tracer that does not collect in your bones. Just before the scan begins, you will probably be asked to empty your bladder to prevent any radioactive urine from blocking the view of your pelvic bones during the scan. You will lie on your back on a table, and a large scanning camera will be above you. It may move slowly above and around your body, scanning for radiation released by the tracer and producing pictures. The camera does not produce any radiation. You may be asked to move into different positions. You need to lie very still during each scan to avoid blurring the pictures. A bone scan takes about 1 hour.

Nursing Interventions: a. Before the procedure 1. Assess the clients understanding of the procedure, providing 2. Explanation, clarification, and emotional support as needed. 3. Radioactive material (technetium-99m phosphate) is injected Intravenously for 2 to 3 hours so that it concentrates in the bone. 4. Observe the injection site for redness or swelling. If a hematoma forms, apply warm soaks to the area. 5. Have the client drink four to six glasses of water in the 2- to 3- hour waiting period before the procedure to facilitate renal clearance of any circulating radioactive material. 6. The client is not restricted to foods or fluids prior to the exam. 7. Have the client empty the bladder prior to testing; a full bladder will mask the pelvic bones and make the client uncomfortable. 8. The scan takes about 30 to 60 minutes to complete. The client must remain still during the scanning. 9. The client may be active during the waiting period.

10. A sedative should be ordered and administered to any client who may have difficulty lying quietly. b. During the procedure No specific care is needed after the procedure. c. After the procedure 1. Encourage in drinking liquids and frequent activity in the first 6 hours after the procedure to help reduce excess radiation to the bladder and gonads. 2. Instruct that family members will not be affected by the radionuclide, nor will urine or feces need special handling before, during, or after the procedure.

4. Ultrasound

Definition: It is also called as ultrasonography or echography. It uses high frequency sound waves to depict soft tissues; quite harmless and can be safely used in the region of a pregnant uterus or active ovaries and is most accurate in showing position and type of lesion. Procedures: A radiologic technologist often performs the abdominal ultrasound exam. A radiologic technologist is a medical professional who is trained in medical imaging and the care of patients during imaging procedures.

After the radiologic technologist performs the abdominal ultrasound exam, a radiologist will look at the images produced during the exam. A radiologist is a doctor who is specialized in medical imaging. He or she will then provide your physician with a diagnosis based on the ultrasound images. The procedure takes a half hour or less and generally includes these steps: You will dress in a patient gown and lie on a table in the ultrasound room. In some cases, you can wear your own loose-fitting clothing. The room will be dark so that the images are easier to read on the ultrasound screen. The technologist will squeeze a water-based jelly onto your abdomen to help the ultrasound wand slide across your skin. The ultrasound wand is called a transducer. The wand sends and receives the sound waves to produce the image. The technologist will move the wand gently back and forth across your skin. At times, he or she will gently press the wand down to obtain more accurate readings. While this is happening, you may have to shift your position or hold your breath for short periods to help with the imaging. The technologist watches the ultrasound screen during the procedure. This ensures that he or she captures the right type and amount of images, which helps diagnose your condition. Once the exam is complete, the technologist will wipe off the gel. The gel is water-based and washes away easily. You may wait a short period of time while the radiologic technologist or radiologist verifies that the imaging is complete. Usually, you can go home immediately after the exam. Nursing Interventions: a. Before the procedure
1. Instruct the patient to wear comfortable, loose-fitting clothing to your exam. Or you may

provide a gown to wear during the scan. 2. Instruct the patient to be NPO 8- 12 hour. Air or gas car reduce quality of image. Assess abdominal distention for it may affect quality of image during procedure. 3. Keep patient in supine position. b. During the procedure No specific care is needed after the procedure. c. After the procedure 1. Remove the conductive gel from the patients skin. 2. Assist the patient to a comfortable position.

5. Thyroid Scan

Definition: It is also known as Technetium thyroid scan.

A thyroid scan uses a radioactive tracer and a special camera to measure how much tracer the thyroid gland absorbs from the blood. The tracer can be swallowed or can be injected into a vein. It travels through your body, giving off radiation signals. The camera "sees" the signals and can measure how much tracer the thyroid absorbs from the blood.

A thyroid scan can show the size, shape, and location of the thyroid gland . It can also find areas of the thyroid gland that are overactive or underactive. The camera takes pictures of the thyroid gland from three different angles. The radioactive tracer used in this test is either iodine or technetium. Procedures:

Do not eat for 2 hours before the test. Do not take any antithyroid medicine for 5 to 7 days before the test. Your doctor may ask you to eat a low-iodine diet for several days if this test is being done to check for thyroid cancer. For a thyroid scan, you will either swallow a dose of radioactive iodine or be given technetium in a vein (intravenously) in your arm. When and how you take the radioactive tracer depends on which tracer is used.

Iodine can be taken as a capsule or a fluid 24 hours before the test. Iodine has little or no taste.

Technetium is given 2 hours before the test. Special instructions: You should not have had any I.V. contrast for at least 4 weeks before this study. Do not eat any seaweed (as in sushi) for 4 weeks before the scan. (I.V. contrast and seaweed contain a lot of iodine, which will interfere with the test.) If you take thyroid medications, these should usually be stopped before this test. Ask your doctor if and when you should stop taking these medications because it uses radioactivity, this study is not performed in pregnant women. Nursing Interventions: a. Before the procedure 1. Ask the patient to remove his/her dentures and all jewellery or metal objects from around your neck and upper body. 2. Before a thyroid scan, make the patient sign consent form that says he/she understand the risks of the thyroid scan and agree to have it done. Encourage the patient to talk to his/her doctor about any concerns he/she have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help him/her understand the importance of this test, fill out the medical test information form. b. During the procedure No specific care is needed after the procedure. c. After the procedure 1. After a thyroid scan, instruct the patient that he/she can do his/her regular activities. But, ask him/her to take special precautions when he/she urinates because the body gets rid of the radioactive tracer through urination. This takes about 24 hours. It is important to flush the toilet and wash hands thoroughly after each time of urination.