TESTS

PROCEDURE

NORMAL RANGE A normal MRI, MRA, MRS, or MRCP result is one that shows the patient's physical condition to fall within normal ranges for the target area scanned.

INTERPRETATION S Generally, MRI is prescribed only when serious symptoms or negative results from other tests indicate a need. There often exists strong evidence of a condition that the scan is designed to detect and assess. Thus, the results will often be abnormal, confirming the earlier diagnosis. At that point, further testing and appropriate medical treatment is needed. For example, if the MRI indicates the presence of a brain tumor, an MRS may be prescribed to determine the type of tumor so that aggressive treatment can begin immediately without the need for a surgical biospy.

You will be positioned on the moveable examination table. Straps and bolsters may be used to help you stay still and maintain the correct position during imaging. Devices that contain coils capable of And sending and CT SCAN- an receiving radio imaging waves may be method that placed around or uses x-rays to create pictures adjacent to the of crossarea of the body sections of the being studied. body. If a contrast material will be used in the MRI exam, a nurse or technologist wi ll insert an intravenous (IV)catheter, also known as an IV line, into a vein in your hand or arm. A saline solution may be used. The solution will drip through the IV to prevent blockage of the IV catheter until the contrast material is injected. You will be moved into the magnet of the MRI unit and the radiologist and technologist will leave the room

MRI (magnetic resonance imaging) scan is a imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not use radiation (xrays).

NURSING RESPONSIBILI TIES BEFORE: Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. If your procedure involves the use of contrast dye, you will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear. Generally, there is no special restriction on diet or activity prior to an MRI procedure. Before the examination, it is extremely important that you inform the technologist if any of the following apply to you:

You are claustrophobic and think that you will be unable to lie still while inside the scanning machine, in which case you may be given a sedative You have a

while the MRI examination is performed. If a contrast material is used during the examination, it will be injected into the intravenous line (IV) after an initial series of scans. Additional series of images will be taken during or following the injection. When the examination is completed, you may be asked to wait until the technologist or radiologist checks the images in case additional images are needed. Your intravenous line will be removed. MRI exams generally include multiple runs (sequences), some of which may last several minutes. Depending on the type of exam and the equipment used, the entire exam is usually completed in 30 to 50 minutes.

pacemaker inserted, or have had heart valves replaced

You have any type of implanted pump, such as an insulin pump You have metal plates, pins, metal implants, surgical staples, or aneurysm clips You have any metallic fragments anywhere in the body You have permanent eyeliner or tattoos You are pregnant or suspect you may be pregnant You have ever had a bullet wound You have ever worked with metal (for example, a metal grinder or welder) You have any body piercing You have an intrauterine device (IUD) You are wearing a medication

patch As there is a possibility that you may receive a sedative before the procedure, you should plan to have someone drive you home afterward. Based upon your medical condition, your doctor may request other specific preparation.

DURING: Generally, MRI of the spine and brain follows this process:

You will be asked to remove any clothing, jewelry, eyeglasses, hearing aids, hairpins, removable dental work, or other objects that may interfere with the procedure. If you are asked to remove clothing, you will be given a gown to wear. If you are to have a procedure done with contrast, an intravenous (IV) line will be started in the hand or arm for injection of the

contrast dye.

You will lie on a scan table that slides into a large circular opening of the scanning machine. Pillows and straps may be used to prevent movement during the procedure. The technologist will be in another room where the scanner controls are located. However, you will be in constant sight of the technologist through a window. Speakers inside the scanner will enable the technologist to communicate with and hear you. You will have a call button so that you can let the technologist know if you have any problems during the procedure. The technologist will be watching you at all times and will be in constant communication. You will be given earplugs

or a headset to wear to help block out the noise from the scanner. Some headsets may provide music for you to listen to.

During the scanning process, a clicking noise will sound as the magnetic field is created and pulses of radio waves are sent from the scanner. It will be important for you to remain very still during the examination, as any movement could cause distortion and affect the quality of the scan. At intervals, you may be instructed to hold your breath, or to not breathe, for a few seconds, depending on the body part being examined. You will then be told when you can breathe. You should not have to hold your breath for longer than a few seconds. If contrast dye is used for your

procedure, you may feel some effects when the dye is injected into the IV line. These effects include a flushing sensation or a feeling of coldness, a salty or metallic taste in the mouth, a brief headache, itching, or nausea and/or vomiting. These effects usually last for a few moments.

You should notify the technologist if you feel any breathing difficulties, sweating, numbness, or heart palpitations. Once the scan has been completed, the table will slide out of the scanner and you will be assisted off the table. If an IV line was inserted for contrast administration, the line will be removed.

AFTER: You should move slowly when getting up from the scanner table to avoid any

dizziness or lightheadedness from lying flat for the length of the procedure. If any sedatives were taken for the procedure, you may be required to rest until the sedatives have worn off. You will also need to avoid driving. If contrast dye is used during your procedure, you may be monitored for a period of time for any side effects or reactions to the contrast dye, such as itching, swelling, rash, or difficulty breathing. If you notice any pain, redness, and/or swelling at the IV site after you return home following your procedure, you should notify your physician as this could indicate an infection or other type of reaction. Otherwise, there is no special type of care required after a MRI scan of the spine and brain. You may resume your usual diet and activities, unless your physician advises you differently. Your doctor may give you additional or alternate

instructions after the procedure, depending on your particular situation.

BIOPSY - is the removal of a small piece of tissue for laboratory examination.

There are various kinds of biopsy procedure, including: Bone marrow biopsy - a small sample of bone marrow (usually from the hip) is removed via a slender needle. This type of biopsy helps to diagnose diseases such as leukaemia. Colposcopydirected biopsy a colposcope is a small microscope used to examine a womans cervix while a tissue sample is taken. This biopsy is usually performed to investigate the reasons for an abnormal Pap test result. Endoscopic biopsy - the endoscope is a flexible tube that can be inserted into an orifice (such as the mouth or anus) or through a small skin incision. Once the lump is reached, cutting tools are threaded through the endoscope so that a sample of tissue can be taken. Excisional

The tissue removed is normal.

An abnormal biopsy means that the tissue or cells have an unusual structure, shape, size, or condition. This may mean you o have a disease, such as cancer, but it depends on your biopsy.

o o

BEFORE: Before the biopsy, your doctor may order urine tests, blood tests, and xrays of your kidneys. You should ask your doctor when you can expect to know the biopsy results. Arrange for a ride home after your biopsy. Your doctor may ask you to fast or eat lightly before your biopsy. Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like: Anti-inflammatory drugs (eg, aspirin ) Blood thinners like clopidogrel (Plavix) or warfarin (Coumadin) Anesthesia You will receive a local anesthetic to numb your skin. You may also receive a light sedative. DURING:
A needle biopsy is called a percutaneous biopsy. It removes tissue using a hollow

biopsy - the lump is entirely removed. Depending on the location of the lump, the patient may need to undergo general anaesthesia. This type of biopsy may be used for breast lumps. Incisional biopsy - only a small slice of the lump is removed. Depending on the location of the lump, a general or local anaesthetic may be needed. This type of biopsy may be used for lumps located in connective tissue such as muscle. Needle biopsy - a small sample of the lump is removed via a slender hypodermic needle. This can be done either with or without local anaesthetic. This type of biopsy may be used to diagnose conditions of the liver or thyroid. Punch biopsy - a special tool is used to punch a hole through the uppermost layers of the skin. The anaesthetic used may be local or topical. This type of biopsy can help diagnose various skin conditions. Stereotactic biopsy - a series

tube called a syringe. The needle is passed several times through the tissue being examined. The surgeon uses the needle to remove the tissue sample. Needle biopsies are often done using CT scan or ultrasound. These imaging tools help guide the surgeon to the right area. An open biopsy is surgery that uses local or general anesthesia. This means you are relaxed (sedated) or asleep and pain-free during the procedure. It is done in a hospital operating room. The surgeon makes a cut into the affected area, and the tissue is removed. Closed biopsy uses a much smaller surgical cut than open biopsy. A small cut is made so that a camera-like instrument can be inserted. This instrument helps guide the surgeon to the right place to take the sample.

AFTER: You will be monitored for a few hours after your biopsy. You will be asked to remain lying down to reduce the

of x-rays help to guide the surgeons needle to the lump. This type of biopsy is usually performed whenever the lump is hard to see or feel.

chance of bleeding. Your pulse and blood pressure will be monitored. Your biopsy samples will be sent to the laboratory for testing. Once you are feeling well and the doctor feels it is safe, you will be sent home. At Home When you return home, do the following to help ensure a smooth recovery:

Rest to prevent bleeding. You should usually rest for the first 24-48 hours after the biopsy. Do not lift or exercise until your doctor says it is okay. Keep your biopsy site clean and dry. Check your urine. You may notice some blood in your urine. This is normal for the first 24 hours. If there is bleeding for longer than 24 hours or a lot of bleeding, call your doctor. Be sure to follow your doctor's instructions . BEFORE: Do not eat or drink 2 hours before or 1 hour after you receive the dose of the compound. You may have only a thyroid scan, or a

Thyroid Scan uses a radioactive tracer and a special camera to measure how much tracer the thyroid gla nd absorbs

A radionuclide is The thyroid A thyroid that is either injected appears the enlarged or pushed off into a vein or correct to one side could be a given to you as a size, shape, sign of a tumor. pill. Timing of the and in the test then depends proper Nodules will absorb on the type of location. It more or less iodine and radionuclide your appears an will look darker or doctor uses, and even gray lighter on the scan whether you will color on (usually lighter if there

from the blood. The tracer can be swallowed or can be injected into a vein. It travels through your body, giving off radiationsi gnals. The camera "sees" the signals and can measure how much tracer the thyroid absorbs from the blood.

also have an uptake test. If you are having only a thyroid scan and your doctor prefers to give a radionuclide by intravenous injection, the scan can be done within 30-60 minutes. If you are given radioactive iodine in pill form, you need to wait four to six hours, and possibly as long as a day, before having the scan. (This gives the radioactive iodine time to reach your thyroid.) If you're having both a scan and the uptake test, you are likely to receive radioactive iodine in pill form. This allows one radionuclide to be used for both the scan and uptake test, instead of two, and eliminates the need for an injection. After you've received the radionuclide and have waited the appropriate amount of time, a technician places a radioactivity detector-a camera specially designed to take pictures of radioactive objects - against your neck and takes several

the computer image.

is a tumor). If part of the thyroid appears lighter, it could be a thyroid problem. The computer will also show the percentage of iodine that has collected in your thyroid gland. If your gland collects too much or too little of the radiotracer, this can be due to an underactive or overa ctive thyroid gland.

thyroid scan with thyroid uptakes DURING: You will be given a small amount of radioactive iodine to take by mouth 4 hours before the scan. After this time, the scan will be started. You will lie down on an examination table. A pillow will be placed under your shoulders to extend your neck so that the thyroid can be easily scanned. Pictures will be taken with a very sensitive machine, called a gamma camera, that receives and records the radiation in your thyroid gland. You will be given a small amount of radioactive iodine by mouth. You will be asked to return either 4 hours and 24 hours later, or only 24 hours later. You will be asked to sit in a chair while a small probe is placed in front of your neck. This probe detects any change from normal in your thyroid gland. The scan, without uptake, lasts about 1 hour. The scan, with uptake, lasts about 1 1/2 hours.

images. The camera itself doesn't expose you to any radiation. This portion of the test usually takes about half an hour. An uptake test only takes several minutes and is performed while you are sitting up. Using a device that resembles a Geiger counter, the doctor or technician places a probe several inches in front of your neck, where the thyroid gland is located, and measures the percentage of radioactivity that is retained by the thyroid gland. You return the next day for follow-up testing to obtain a second set of uptake readings, which are then compared with the first set to determine how much hormone has been formed and secreted in the interim.

AFTER: There are no adverse effects. Your body rids itself of the compound as it does the food you eat. If you have questions about the procedure, please ask. Your nurse and doctor are ready to assist you at all times.

Radioactive Iodine Uptake - is a test of thyroid function. It measures how much radioactive iodine is taken up by the thyroid gland

You are asked to swallow a liquid or capsule containing radioactive iodine. After a certain period of time (usually 6 and 24 hours later), you

6 hou rs: 316 % 24 hou rs: 8-

Increased hormone levels may be due to an overactive thyroid gland caused by:

Before: Do not eat for 8 hours before the test. Your health care provider will instruct you, if needed, to stop taking drugs that may affect the test

An enlarged thyroid gland that contains nodules producing too

in a certain time period.

must return to the testing center so that the amount of radioactivity in the thyroid gland can be measured. This is done using a device called a gamma probe.

25 %

Note: Some laboratories only measure at 24 hours. Values The probe is may vary Decreased levels may placed over your depending be due to: thyroid gland on the along the outside amount of Factitious of your neck. You iodine in hyperthyroidism will be asked to Iodine overload your diet. lie on a table Subacute Normal while the scanner value thyroiditis moves over your Silent (or ranges may neck. painless) vary thyroiditis slightly The scan takes among about 30 minutes. different laboratories . Talk to your doctor about the meaning of your specific test results.

much thyroid hormone (toxic nodular goiter) A single thyroid nodule that is producing too much thyroid hormone Graves disease

results. Tell your doctor if you have:

Diarrhea (may decrease absorption of the radioactive iodine) Recent xray test using iodinebased contrast (within the past 2 weeks) Too little or too much iodine in your diet DURING:
For this test, you take a small, oral dose of radioactive iodine (radioiodine) . Over time, the iodine collects in your thyroid gland because your thyroid uses iodine to manufacture hormones. You'll be checked after two, six or 24 hours and sometimes after all three time

periods to determine how much iodine your thyroid gland has absorbed.

AFTER:
You can eat beginning about 1 - 2 hours after swallowing the radioactive iodine. You can go back to a normal diet when the test is finished. The radioactive iodine leaves your body through your urine. You may need to take special precautions, such as flushing twice after urinating, for 24 - 48 hours after the test. Ask your health care provider or the radiology/nu clear medicine tea m performing the scan.

Thyroid Suppression used to diagnose difficult cases of hyperthyroidis m, now largely replaced by the thyrotropinreleasing hormone stimulation test; triiodothyroni ne is administered for a week to 10 days, and a reduction of its uptake by the thyroid gland to less than half of the initial uptake is a normal response.

Patients treated for differentiated thyroid cancer take a daily thyroid hormone replacement pill called levothyroxine (also known as T4). They take it both to avoid hypothyroidism (underactive thyroid condition) and to prevent growth or recurrence of their thyroid cancer. Usually they receive a T4 dose large enough to suppress their blood level of thyroid stimulating hormone (TSH) below the normal TSH range.

Normal reference range is approximat ely 0.5 to 5.0

Levels below 0.5 are considered possible evidence of hyperthyroidism, and levels above 5.0 would be considered possible evidence of hypothyroidism. TSH suppression to < 0.1 mU/L is indicated in intermediate and high-risk disease TSH maintenance at or slightly below the lower-normal limit (0.3-2 mU/L) may be considered for lowrisk disease

In patients with persistent disease, the serum TSH should be maintained below 0.1mU=L indefinitely in the absence of specific contraindications. In patients who are clinically and biochemically free of disease but who presented with high risk disease, consideration should be given to maintaining TSH suppressive therapy to achieve serum TSH levels of 0.10.5mU=L for 510 years. In patients free of disease, especially those at low risk for recurrence, the serum TSH may be kept within the low normal range (0.32mU=L). In patients who have not undergone remnant ablation who are clinically free of disease and have undetectable suppressed serum Tg and normal neck ultrasound, the serum TSH may be allowed to rise to the low normal range (0.32mU=L).