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Common Tests and Procedures

Sometimes getting a medical test can be a little unnerving. Here, we've listed a few of the more common tests with information to help you better understand how and why they’re done.

Click on the procedure name for more specific procedure information.

If you have any questions about a particular test or your ability to participate, please consult your physician or contact Central Scheduling at 281.401.7000, Monday through Friday, 8:00 a.m. until 6:00 p.m.

Bone Density

What is a Bone Density Test?

A bone density test measures the mineral density (such as calcium) in the spine, wrist and/or hip. These are the most common sites of fracture because of osteoporosis, a disorder where the bones become lighter, less dense, and more porous. This makes the bones weaker and increases their risk of fracture. The tests are painless, noninvasive and safe.

Why would I need a Bone Density Test?

Loss of bone mass occurs as part of the natural process of aging. Bones naturally become thinner (called osteopenia) as you grow older, because existing bone is broken down faster than new bone is made. As this occurs, the bones lose minerals, heaviness (mass), and structure, making them weaker. With further bone loss, osteopenia develops into osteoporosis. The thicker your bones are, the longer it takes to develop osteoporosis. Although osteoporosis can occur in men, it is most common in women older than 65. Many women are unaware that they have low bone densities or osteoporosis until they suffer a fracture.

A Bone Density test is recommended for the following:

  • Women 65 or older, regardless of other osteoporosis factors.
  • Perimenopausal women who have a family history of osteoporosis, adhere to a low-calcium diet, drink alcohol and/or smoke, have low body weight or are physically inactive and have other risk factors.

Regular X-rays cannot detect mild bone loss. A bone must lose at least a quarter of its weight before a regular X-ray can detect the problem.

How do I prepare for a Bone Density Exam?

Wear comfortable clothing with no metal zippers, buttons or buckles. Also, remove your jewelry or metal items beforehand. A brief medical history is required, which may include: family history of osteoporosis, radiographic findings of osteoporosis, recent fractures and post-menopause or early menopause information. Let the bone density technologist know if you are pregnant or think you may be; have any metal implants inside your body or recent fractures or have had a recent nuclear medicine scan or a barium enema.

What can I expect during the Bone Density Exam?

This depends on what type of scan you are having. If you are having a DEXA bone density scan, you will be asked to lie on a table or sit down. The scanner arm will move back and forth over the part of your body being scanned. Typical DEXA exams are completely painless and only take 10 minutes to perform.

If you are having your heel bone scanned, you put your foot into a small box, where the sound waves penetrate the heel bone for 10 seconds.

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Breast Biopsy

What Is a Breast Biopsy?

A breast biopsy is the removal of a sample of breast tissue to be examined under a microscope for signs of cancer. A biopsy is recommended when a significant abnormality is found, either during a physical examination and/or a mammogram or ultrasound. Examples of abnormality can include a breast lump felt during physical self-examination or tissue changes noticed from a mammogram test.

What type of Biopsy do I need?
The type of biopsy recommended will depend on whether the area can be felt, how well it can be seen on mammogram or ultrasound, and how suspicious it feels or appears. Specialized equipment is needed for different types of biopsies. Generally, needle biopsy is less invasive than surgical biopsy. It is appropriate for most, but not all, situations.

There are several ways to do a breast biopsy:

A fine-needle aspiration biopsy is done by inserting a thin needle into the suspicious lump and removing cells that are then examined under a microscope. Needle aspiration is sometimes done to distinguish between a solid lump and a fluid-filled lump (cyst). If the lump is a cyst, it will collapse and disappear after the fluid is removed. If there is little or no fluid, the lump probably is not a cyst and another type of biopsy will be done.

A core needle biopsy is done by using a large needle fitted with a special cutting tip. As the needle goes through the skin toward the lump (or suspicious area found during a mammogram or breast ultrasound), it collects a core of tissue about the size of a pencil lead.

A stereotactic biopsy evaluates a lump that cannot be felt during a breast examination but is seen on mammogram or ultrasound. It is done using a special type of X-ray instrument that can precisely locate the area of the breast from which the biopsy sample is to be taken. A small incision is then made in the skin of the breast and the instrument guides a needle to the exact biopsy site to collect a tissue sample. Stereotactic biopsy may not be appropriate for all types of breast lumps.

An open biopsy is done by making an incision in the skin and removing a sample of the suspicious lump, or the entire lump. If the lump contains cancer cells, all or part of the breast can be removed immediately (however, this is not commonly done). If the doctor cannot feel an obvious lump, a needlelike probe can be placed in the suspicious area during a mammogram done just before surgery. The probe then guides the doctor to the correct area for collecting a biopsy sample.

After the Breast Biopsy

After a surgical biopsy, the incision will be closed with stitches, and covered with a bandage. The bandage can usually be removed in one or two days. Stitches are taken out approximately one week afterward. Depending on the extent of the operation, normal activities can be resumed in approximately one to three days. Vigorous exercised may be limited for one to three weeks.

The skin opening for a needle biopsy is minimal. It may be closed with thin, clear tape, called a steristrip, or covered with a Band-Aid and a small gauze bandage. The patient can return to her usual routine immediately after the biopsy. Strenuous activity or heavy lifting is not recommended for 24 hours. Any bandages can be removed one or two days after the biopsy.

What do the Breast Biopsy results mean?

Normal results

A normal pathology report indicates no malignancy is present. The tissue sample may be further classified as a benign breast condition, such as tumor of the breast or connective tissue that resembles fiber (fibrosis). Studies have demonstrated that approximately 80 percent of all breast biopsies result in a benign pathology report.

Abnormal results

An abnormal pathology report indicates a cancer is present. If a fine needle aspiration biopsy was performed, the pathologist has viewed individual cells under a microscope to see if they appear cancerous. Large core needle biopsy and surgical biopsy will be able to give more information. This includes the type of cancer, whether it has invaded surrounding tissue, and how likely it is to spread quickly. There are some conditions, that are not malignant but indicate high risk for future development of breast cancer. If these are identified, more frequent monitoring of the area may be recommended.

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Computer Tomography (CT)

What is Computer Tomography?

A computed tomography (CT) scan uses X-rays to produce detailed pictures of structures inside the body. A CT scan is also called a computer axial tomography (CAT) scan.

During this procedure you are positioned in the CT ring, which contains an X-ray tube and a receptor mounted opposite each other. The tube sends X-rays and the receptor measures the amount of X-rays absorbed during each rotation of the ring. The measurements are fed into a computer, which produces a visual image of each "slice" of information. The images are monitored on a video screen during the exam, and later photographed for your radiologist to study.

Dense tissues, such as bones, appear white in the pictures produced by a CT scan. Less dense tissues, such as brain tissue or muscles, appear in shades of gray. Air-filled spaces, such as in the bowel or lungs, appear black.

A dye known as Contrast Media, that contains iodine is often injected into the blood (intravenously) during a CT scan. The dye makes blood vessels and other structures or organs more visible on the CT scan pictures. The dye may be used to evaluate blood flow, detect tumors, and locate areas of inflammation. Intravenous contrast material is often used to obtain images of the chest and pelvis; an oral contrast material is given for an abdominal CT scan. Contrast material may be injected into the area around the spinal cord (intrathecally) for spinal scans. CT images may be taken before and after injection of the contrast material.

General Preparations for the CT Exam

  • Tell your doctor and technologist if you are pregnant, or think you may be, and if you are allergic to iodine or to contrast media.
  • A medication, special diet, or both, may be prescribed prior to the examination.
  • You may be asked to wear a hospital gown.
  • Wear loose-fitting, comfortable clothes without zippers or snaps.
  • Remove hairpins, earrings and any metal objects. Metal objects create artifacts on the images.

What to expect during a CT Scan

The procedure can last anywhere from 10 minutes to 45 minutes, depending on what your physician requested. You will lie down on a table that is connected to the CT scanner. The technologist will be in constant communication with you throughout the procedure. During a CT scan, the area being studied is positioned inside a doughnut-shaped CT scanner. The CT scanner is not enclosed, thus claustrophobia is not an issue. You will feel slight movement and a low humming sound from the machine. The noise is due to the scanner tilting and rotating to obtain the necessary views.

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Coronary Computer Tomography (Coronary CTA)

What is a Coronary Computer Tomography?

A Coronary CTA is a heart-imaging test currently undergoing rapid development and evaluation for non-invasively determining whether either fatty deposits or calcium deposits have built up in the coronary arteries, which supply blood to the heart muscle. If left untreated, these areas of buildup, called plaques, can cause heart muscle disease. Heart muscle disease, in turn, can lead to fatigue, shortness of breath, chest pain and/or heart attack.

How does a Coronary CTA work?

A Coronary CTA comes from a special type of X-ray examination. Patients undergoing a Coronary CTA scan receive an iodine-containing contrast dye as an IV solution to ensure the best images possible. Oral medication may be given to slow or stabilize the patient’s heart rate for better imaging results. During the examination, which usually takes about 15 minutes, X-rays pass through the body and are picked up by special detectors in the scanner. Typically, higher numbers (especially 16 or more) of these detectors result in clearer final images. For that reason, Coronary CTA often is referred to as “multi-detector” or “multi-slice” CT scanning. The information collected during the Coronary CTA examination is used to identify the coronary arteries and, if present, plaques in their walls with the creation of 3D images on a computer screen.

How is a Coronary CTA different from other Heart Tests?

One of the most common heart tests is the coronary angiogram, or cardiac catheterization. This test is more invasive and requires more patient recovery time than a Coronary CTA. Patients who receive coronary angiograms must have a catheter, or small transport tube, threaded into their coronary arteries, which run along the outside of the heart. The catheter typically is inserted into a blood vessel in the upper thigh and then maneuvered up to the coronary arteries. The catheter then is used to inject the iodine dye needed for the test, which uses X-rays to record “movies” of the interior of the coronary arteries.

Although Coronary CTA examinations are growing in use, coronary angiograms remain the “gold standard” for detecting coronary artery stenosis, which is a significant narrowing of an artery that could require catheter-based intervention (such as stenting) or surgery (such as bypassing). On the other hand, this new technology has consistently shown the ability to rule out significant narrowing of the major coronary arteries and can non-invasively detect “soft plaque,” or fatty matter, in their walls that has not yet hardened but that may lead to future problems without lifestyle changes or medical treatment.

Who should consider a Coronary CTA?

The single most important step for patients trying to determine whether they should consider a Coronary CTA is consultation with their primary physician. This is because some Coronary CTA uses are more appropriate than others, and the scan carries some risk from X-ray exposure (potential for stimulating cancer) and contrast dye exposure (allergic reactions and kidney damage).

Overall, Coronary CTA examinations have tended to help determine a lack of significant narrowing and calcium deposits in the coronary arteries, as well as a presence of fatty deposits. This has been found to be particularly valuable in asymptomatic patients with higher risk for coronary disease, in patients with atypical symptoms but lower risk of coronary disease, or in patients with unclear stress-test results. Tomball Regional Medical Center currently supports the careful use of Coronary CTA for patients who have:

  • Intermediate to high-risk profiles for coronary artery disease, but who do not have typical symptoms (especially chest pain, shortness of breath, or fatigue during heavy physical activity.)
  • Unusual symptoms for coronary artery disease (such as chest pain unrelated to physical exertion), but low to intermediate risk profiles for coronary artery disease.
  • Unclear or inconclusive stress-test (treadmill test) results.

For these types of patients, Coronary CTA can provide important insights to their primary physician into the extent and nature of plaque formation with or without any narrowing of the coronary arteries. Coronary CTA also can noninvasively exclude narrowing of the arteries as the cause of chest discomfort and detect other possible causes of symptoms. But again, initial consultation with their primary physician is key for patients seeking to determine the appropriateness of Coronary CTA.

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Echocardiogram (ECHO)

What is an Echocardiogram?

An echocardiogram is a type of ultrasound test that uses high-pitched sound waves to produce an image of the heart. The sound waves are sent through a device called a transducer and are reflected off the various structures of the heart. These echoes are converted into pictures of the heart that can be seen on a video monitor.

An echocardiogram generally is used to evaluate heart wall thickness and motion as well as the structure and function of the heart valves. An echocardiogram can also be used to estimate the amount of blood pumped out of the left ventricle with each heartbeat.

An echocardiogram can help identify areas of poor blood flow in the heart, areas of heart muscle that are not contracting normally, previous injury to the heart muscle caused by impaired blood flow, or evidence of heart failure, especially in people with chest pain or a possible heart attack. In addition, an echocardiogram can detect a blood clot in the heart, evaluate the heart valves for abnormalities and identify pericardial effusion.

An echocardiogram can be used as part of a stress test and in combination with electrocardiogram (EKG) monitoring to help your health professional gain additional information about your heart.

Types of Echocardiograms are

Transthoracic Echocardiogram (TTE). This is the most commonly used method of echocardiogram. Views of the heart are obtained by moving the transducer to different locations on the chest or abdominal wall.

Transesophageal Echocardiogram (TEE). For a TEE, the transducer is passed down the esophagus instead of being moved over the outside of the chest wall. A TEE shows clearer pictures of your heart, because the transducer is located closer to the heart and because the lungs and bones of the chest wall do not interfere with the sound waves produced by the transducer. This test requires a sedative and an anesthetic applied to the throat to ease discomfort.

Stress Echocardiogram. This test involves a transthoracic echocardiogram both before and after your heart is stressed, either by having you exercise or by injecting a medication (dobutamine) that makes your heart beat harder and faster. A stress echocardiogram is usually done to determine whether you may have a significantly reduced flow of blood to your heart.

Doppler Echocardiogram. A Doppler echocardiogram is an ultrasound technique used to evaluate the flow of blood through the heart chambers, heart valves, and blood vessels. The movement of red blood cells reflects sound waves to the ultrasound transducer. Doppler echocardiograms create a representation of your blood flow from these sound waves.

To produce blood flow images, the ultrasound computer measures the direction and speed of the blood flowing through your heart and blood vessels by comparing normal (stationary) echoes with the echoes that have been altered by blood movement. Doppler measurements may be displayed in black and white or in color.

A doppler echocardiogram can be done during a TTE, TEE, or a stress echocardiogram.

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Electrocardiogram Tracing (EKG, ECG)

What is Electrocardiography?

Electrocardiography (EKG, ECG) tracings show a characteristic pattern of electrical impulses that are generated by the heart. The different parts of an EKG tracing of a heartbeat are called the P wave, the QRS complex, the ST segment and the T wave.

The P wave is a record of the movement of electrical activity through the upper heart chambers (the atria) and is recorded when they contract.

The QRS complex is a record of the movement of electrical impulses through the lower heart chambers (the ventricles) and is recorded when they contract.

The ST segment appears as a straight, level line between the QRS complex and the T wave. Elevated or lowered ST segments may mean the heart muscle is damaged or not receiving enough blood.

The T wave corresponds to the period when the lower heart chambers are relaxing and preparing for their next muscle contraction.

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Mammogram

image

What is a Mammogram?

A mammogram is an X-ray of the breasts used to screen for breast problems or diagnose breast cancer, such as a lump, and whether a lump is fluid-filled (a cyst) or a solid mass. Cancer is most easily treated and cured when it is discovered in an early stage.

For your safety and to get the best test results, let the technologist know if:

  • You are pregnant or think you may be
  • You have breast implants
  • You have any scars or moles on or near your breasts
  • You've had a breast biopsy or surgery
  • You're breastfeeding

For your comfort during the exam,

  • Remain as relaxed as you can during compression.
  • Know that any discomfort will be very brief.

Before your Test

Make sure to bring your last mammogram images if you had the mammogram performed somewhere other than Tomball Regional Medical Center. The radiologist needs to compare both sets of images. On the morning of your test, wash your breasts and underarms, but don't use deodorant, powder, or perfume. Wear a blouse or sweater that you can remove easily. Arrive 30 minutes early to complete registration paperwork.

During your Test

You will need to undress from the waist up. The technologist will then position your breast to get the best test results. During the exam, each of your breasts will be compressed. You may feel some discomfort, but compression helps get the most complete x-ray image. To ease most of the discomfort, Tomball Regional Medical Center utilizes thin foam pads under the breast. Once the exam is done, the technologist may have you wait a few minutes to make sure the images are readable.

After the Test

You can return to your normal activities right away, unless otherwise indicated. About 5 to 10 percent of screening mammograms will require more testing. This may include another mammogram of specific breast tissue (compression view) or another test, such as an ultrasound or biopsy.

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Magnetic Resonance Imaging (MRI)

What is Magnetic Resonance Imaging (MRI)?

MRIs are one of the most accurate methods of diagnostic imaging available today. An MRI is a test that uses a magnetic field and pulses of radio-wave energy to provide pictures of organs and structures inside the body. In many cases, an MRI provides information that cannot be obtained from an X-ray, ultrasound or CT scan.

What to expect during an MRI

For an MRI test, the area of the body being studied is positioned inside a strong magnetic field. The MRI can detect changes in the normal structure and characteristics of organs or other tissues. These changes may indicate diseases caused by trauma, infection, inflammation, or tumors.

In some cases, a contrast media may be used during the MRI scan to enhance the pictures of certain structures. The contrast media may help evaluate blood flow, detect some types of tumors, and locate areas of inflammation.

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Magnetic Resonance Angiogram (MRA)

What is a Magnetic Resonance Angiogram (MRA)?

MRA is a type of MRI that uses a magnetic field and pulses of radio-wave energy to provide pictures of blood vessels inside the body.

An MRA can detect problems with the blood vessels that may be causing reduced blood flow. With an MRA, both the blood flow and the condition of the blood vessel walls can be seen. The test is often used to evaluate the blood vessels leading to the brain, kidneys, and legs.

During an MRA, the area of the body being studied is positioned inside an MRI machine. Contrast media is often used to make blood vessels show up more clearly.

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Myelogram

What is a Myelogram?

A myelogram uses X-rays and fluoroscopy to provide pictures of the cavity within the bones of the spine (spinal canal). A myelogram may be done to detect blockage of the spinal canal caused by a tumor, infection, a herniated disc or arthritis.

The spinal canal contains the spinal cord and nerve roots surrounded by a fluid­filled space called the subarachnoid space. For a myelogram, contrast media that contains iodine is injected into the subarachnoid space. X-ray pictures are taken as the contrast media moves into different areas of the subarachnoid space.

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Nuclear Medicine

What is Nuclear Medicine?

Nuclear medicine uses computer technology and low-dose radioactive substances to produce images of the body and treat disease. It is particularly useful for detecting tumors, aneurysms, irregular blood flow to tissues and inadequate functioning of certain organs.

Before the Test

Before an examination, the patient will be given a radioactive tracer to make tissues visible on the scans. Bones, organs, glands and blood vessels each use a different radioactive compound as a tracer, which is either ingested or injected, depending on the type of test. The radioisotopes have very low radiation levels that decay in minutes or hours and do not harm the body.

Common Uses

Common uses of nuclear medicine include diagnosis and treatment of hyperthyroidism (Grave's disease) and with cardiac stress tests to analyze heart function, bone scans for orthopedic injuries, lung scans for blood clots and liver and gall bladder procedures to diagnose abnormal function or blockages.

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Positron Emisson Tomography CT Scan (PET/CT SCAN)

What is Positron Emission Tomography CT Scan?

A Positron emission tomography (PET scan) is a test that combines CT and nuclear scanning. During a PET/CT scan, a radioactive substance called a tracer is combined with a chemical (such as glucose); this mixture is injected into a vein (usually in the arm). The tracer emits tiny positively charged particles (positrons) that produce signals. The chemical substance and radioactive tracer chosen for the test vary according to which area of the body is being studied.

A camera records the tracer’s signals as it travels through the body and collects in organs. A computer then converts the signals into 3D images of the examined organ. The 3D views can be produced from any angle and provide a clear view of an abnormality.

A PET/CT scan is often used to detect and evaluate cancer, such as cancer of the lung or breast. It also can be used to evaluate the heart's metabolism and blood flow and examine brain function.

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Ultrasound

What Is an Ultrasound?

An Ultrasound is a test that uses reflected sound waves to produce an image of organs and other structures in the body. It does not use X-rays. Ultrasound is most useful for looking at organs and structures that are either uniform and solid (like the liver) or fluid-filled (like the gallbladder). Mineralized structures (like bones) or air-filled organs (like the lungs) do not show up well on a sonogram.

For ultrasound testing, gel or oil is applied to the skin to help transmit the sound waves. A small, handheld instrument called a “transducer” is passed back and forth over the area of the body being examined. The transducer sends out high-­pitched sound waves (above the range of human hearing) that are reflected back to the transducer. A computer analyzes the sound waves and converts them into a picture that is displayed on a screen. The picture produced by ultrasound is called a sonogram, echogram, or ultrasound scan. Pictures or videos of the ultrasound images may be made for a permanent record.

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