DIAGNOSTIC TESTS

Agnes L. Castillo, PhD

PLAIN (CONVENTIONAL)
X-RAYS / RADIOGRAPHY

CHEST XRAY

Most frequently used radiography.

Used to diagnose cancer, tuberculosis
and other pulmonary disease and
disorders of the mediastinum and bony
thorax
It provides a sequential progress or
development of a disease

CHEST XRAY

Can also provide valuable information

about the condition of the heart, lungs,
GI tract, and thyroid gland
The routine chest radiography consists
of two images
Frontal view ( postero-anterior
[PA])
Left lateral view

Procedure:
Street clothing that is covering the chest is
removed to the waist.
Allow only cloth or paper hospital gown
free of buttons and snaps to be worn
during x-ray.
Remove jewelry on or adjacent to the
chest.

Procedure:
Ensure that monitoring cables and patches
do not obscure the chest area, if possible.
Instruct the patient to take a deep breath
and to exhale; and to take another deep
breath and to hold it while the x-ray image
is taken.
Be aware that the procedure takes only a
few minutes.

Clinical implications:
Abnormal chest x-ray results may indicate the following lung
conditions:

Presence of foreign bodies

Aplasia
Hypoplasia
Cysts
Lobar pneumonia
Bronchopneumonia
Aspiration pneumonia
Pulmonary brucellosis
Viral pneumonia
Lung abscess

Middle lobe syndrome

Pneumothorax

Pleural effusion
Atelectasis
Pneumonitis
Congenital pulmonary cyst
Pulmonary tuberculosis
Sarcoidosis
Pneumoconiosis (e.g.
asbestosis)
Coccidioidomycosis
Westermarks sign
(indicates decreased pulmonary
vascularity, sometimes thought to
suggest pulmonary embolus)

Abnormal conditions of the bony thorax include the ff.

Scoliosis
Hemivertebrae
Kyphosis
Trauma
Bone destruction or
degeneration
Osteoarthritis
Osteomyelitis

Cardiac Enlargement

MAMMOGRAPHY

(Breast X-ray)

Soft tissue mammography visualizes the breast to

detect small abnormalities that could warn of cancer.
Low-energy x-ray beam used for this procedure is
applied to a tightly restricted area and consequently
does not produce significant radiation exposure to
other areas of the body.
Diagnosis by a mammography is based on the
radiographic appearance of gross anatomic
structures.

Benign lesions tend to push breast tissue aside as

they expand, whereas malignant lesion may invade
surrounding breast tissue.
Although a false-negative and a false-positive reading
may occur, mammography is highly accurate.
The benefits of using low-dose mammography to find
early, curable cancers outweigh possible risks from
radiation exposure.

Procedure:
Suggest patient to refrain from caffeinated
foods and beverages for 5-7 days before
taking the testing.
Perform mammogram with the person in an
upright position, preferably standing.
Expose the breast and lift onto a film holder or
digital plate.
Adjust the breast tissue by hand, smoothing
out all skin folds and wrinkles.

Lower a movable paddle onto a breast,

rigorously compressing the breast tissue.

NOTE: rigorously compression is a brief and

uncomfortable but critical step in ensuring a highquality mammogram. It lowers dose and improves
image quality.

Make an x-ray exposure quickly, and immediately

lift the compression.
Typically, take two views of the breast

Craniocaudal
Mediolateral

Tell the patient that the complete examination

takes abut 30 minutes.

ORTHOPEDIC X-RAY:
Bones, Joints, and supporting structure

This examines a particular bone, group of bones, or

joint.
Orthopedic radiography is performed on the following
structures:
The extremities
( e.g. hand, wrist, shoulder, foot, knee, hip)

The bony thorax

(e.g. ribs, sternum, clavicle)

The spine
(e.g. cervical, lumbar, thoracic, sacrum coccyx)

The head and skull

(e.g. facial bones, mastoids, sinuses)

Optimal results from orthopedic x-ray

examinations depend on proper immobilization of
the area being studied.
To produce a thorough image of the body part,
at least two and sometimes more projections are
required.

Procedure:

Inform the patient that dietary restrictions

are not necessary.
Have the patient assume the positions
most favorable to capturing the best
images.
The degree of patient mobility and physical
condition may also need to be considered.
Skull x-rays require removal of dentures
and partials.

Clinical implications:

Fractures
Dislocation
Arthritis
Osteoporosis
Osteomyelitis
Degenerative joint
disease
Hydrocephalus
Sarcoma
Abscess and aseptic
necrosis
Pagets disease

Gout
Acromegaly
Metastatic processes
Myeloma
Osteochondrosis
Bone infracts
Histiocytosis X
Bone tumors (benign
and malignant)
Foreign bodies

ECHOCARDIOGRAPHY

Considered by many physicians to be almost

equal in value to the standard
Electrocardiogram (ECG).
It is based on underwater detection (sonar)
that the navy developed during the World
War II.
When a sound wave is directed into the heart
at various locations, the echo, or rebounding
sound wave, graphically reflects each part of
the heart where it bounces.

The analysis allows a three-dimensional

visualization of the heart, the heart valves,
the muscular structures, and even the blood
as it passes through.
It can also indicate the size of each heart
chamber, whether there are any masses in
the heart, and especially whether there is
excess fluid in the sac around the heart.

Clinical implication:

To diagnose:

Heart valve disease

Enlarged heart
Heart tumors
Congenital heart defects in infants

To follow the patients with heart valve

replacement

Echocardiogram machine

CONTRAST
ECHOCARDIOGRAPHY

Virtualization of the right chambers of

the heart is enhanced by the injection
of contrast agents.

M-MODE
ECHOCARDIOGRAPHY

Records the motion of the heart over

time.

It is used to evaluate the structures of

the heart throughout the cardiac cycle.

ELECTROCARDIOGRAPHY
(ECG)

Formerly known as the EKG because of the

original German spelling of the word:

Electrokardiagramma

Is a graphic measure of the hearts muscular

activity and a reflection of the self-generated
electrical impulses that pass through the
heart muscle, causing contraction and
relaxation.

Electrodes called leads are placed on the

body, one on each wrist and ankle and one
on the chest that can be moved over the
entire heart area.
The recorded electrocardiograph shows the
rate and regularity of the hearts rhythm.

It can also show the force or effectiveness of

each heartbeat, the extent and location of
any heart muscle and the effect of certain
drug.
There should be no pain or discomfort while a
standard ECG is performed but some patients
find it uncomfortable to lie still for long period
of time.

ELECTROENCEPHALOGRAPHY
(EEG)

It is a graphic recording of the minute electric

current given off by the brain cell activity.
The current is amplified, translated into wavy
lines (waves), and recorded on paper.
The waves represent intermittent brain cell
activity.

The height of the waves as well as the distance

between each peak depends on body activity
From 10 to 24 electrodes are applied to the scalp in
specific positions to aid in locating any abnormal lesion
that might be reflected on the EEG.
The patient lies quietly with eyes closed and no body
movements.
The waves of the brain are represented by Greek
letters.

Clinical implications:
With hyperactive brain cell are those with
epilepsy and interface with brain cell
activity as seen with tumors.

ELECTROMYOGRAPHY (EMG)

It is a diagnostic neurological test to study

the potential of muscle at rest, the reaction of
muscle to contraction, and the response of
muscle to insertion of a needle.
The patient lies at rest while the peripheral
nerves in various areas are stimulated
through electrodes, and the electrical activity
in muscles and nerves is recorded.

The test is sometimes employed as a

measure of the muscle tension produced by
nervous stress; usually the muscle of the
forehead is tested, since they can indicate
relaxation or generalized body tension.

Clinical implication:

The test is an aid in ascertaining whether a

patients illness is directly affecting the
spinal cord, muscles, or peripheral nerves.
To aid in the diagnosis of hysterical
weakness and paralysis.

ANGIOGRAM

It is an X-ray contrast study designed to

visualize blood vessels and nearby organs.
Angio-blood vessels. The term angiogram is
synonymous with the term arteriogram,
which refers to the study of arteries s
opposed to veins.

The general principle of the angiogram is to thread

catheter into an artery and inject an X-ray contrast
agent into it while taking x-rays of the area of interest.
Before taking the test: some doctors prefer an
overnight fast, whereas others allow a clear liquid diet.
After the test: you will be kept in bed rest for a
number of hours and your vital signs will be taken
frequently.

COMPUTED TOMOGRAPHY

A technique that uses a computerized x-ray

system to produce detailed sectional x-ray
images.
The system is very sensitive to differences in
tissue density and produces detailed, two
dimensional planar images
The tissue attenuation can be increased with
the use of contrast agents.

Patient lies while doing

the angiogram testing.

BONE SCAN

The bone scan is a type of radionuclide scan

used to visualize the skeleton.
The test takes several hours, of which about
an hour is spent under the camera.

Before the test: do not drink large quantities

of water or other liquid before the injection.

Clinical implications:

Detect cancer in bones

Monitor bone diseases
To assess the progress of bone grafts
Diagnose bone infections
Detect fractures
Evaluate unexplained bone pain

Example of a Bone Scan result

BRAIN SCAN

It is a type of radionuclide scan which is used

to visualize the brain to evaluate symptoms
such as paralysis, seizures, dementia, or
certain types of severe headaches.

The test takes about 4-5 minutes.

The images are taken with a gamma camera,

a computerized device which will rotate very
close to your head and shoulders.
Thirty minutes to two hours later another
scan, taking about thirty minutes, will be
performed, again you will be asked to lie still.

BRONCHOGRAPHY

Bronchography is an x-ray contrast study

used to visualize the bronchial tubes.

The general procedure is similar to that of

bronchoscopy, with an x-ray contrast material
being instilled as part of that procedure.

X-ray of your chest will then be taken.

After the test: You will be encouraged to
cough in order to eliminate the contrast
medium.
Fever is fairly common after bronchography.

Example of a Bronchography
Result

CHOLECYSTOGRAM

Cholecystogram is an x-ray study designed to visualize

the gallbladder.
It is obtained to evaluate symptoms suggestive of
gallbladder disease, such as abdominal or right
shoulder pain, jaundice or fatty food intolerance.

You will be given a contrast dye pill form to be taken

orally the evening before the examination.

THANK YOU!!!