Exam Information: SMIL - Scottsdale Medical Imaging

CT 'CAT' Scan
Computed Tomography provides detailed images of the body, including information about bones, soft tissues, and internal organs. Although virtually any body part can be studied with CT, the most common scans are of the head, neck, chest, and/or the abdomen/pelvis.

You may be asked to drink an 'oral prep', prior to arriving at SMIL for your CT. If this is needed, you will be advised by scheduling. An Intravenous contrast agent (dye) may be administered through an IV in your arm during the study in some cases.

You should advise the technologist if you are allergic to IV contrast material.

As with any study please inform the technologist if there is any possibility that you may be pregnant.

Preparation
Please do not eat any food for 6 hours before your CT study. You may only have clear liquids (water, juice, black coffee, jello, bouillon soup). If you need to take an oral prep ('READI-CAT') for you CT, you will be advised at the time of scheduling. Do not hesitate to call (480)425-5000 if you have any questions.

How long does it take?
Although the actual scanning time for a particular study is typically only one to ten minutes, the total exam time may range from 30 to 45 minutes depending on the number of body parts studied, and the time necessary to set up for the exam.

Fluoroscopy
A variety of fluoroscopic examinations are commonly performed.

-Barium enema involves insertion of a small tube into the rectum to fill the colon with liquid barium. Images of the abdomen show the entire colon, and may show polyps, diverticula, or other colonic processes.

-Esophagram/Upper GI Exam involves drinking liquid barium so that pictures of the esophagus, stomach, and proximal small intestine can be obtained. Occasionally your doctor may ask that the entire small intestine be imaged (small bowel follow-through), which simply invloves imaging the abdomen for a longer period of time.

-Cystogram/VCUG/Retrograde Urethrogram involves insertion of a small tube into the urethra to fill the bladder and urethra with a contrast (dye) material.

-Hysterosalpingogram involves insertion of a small tube into the cervix with injection of contrast material into the uterus, to determine if the fallopian tubes are open/functioning.

Preparation
Nothing to eat or drink 6 hours prior to any fluoroscopic examination.

A 24 hour bowel prep to clean out your colon is needed prior to a barium enema, and will be discussed with you when you schedule your examintaion. The bowel prep kit should be obtained from any SMIL location at least 2 days prior to your exam.

How long does it take?
Typically 30 to 60 minutes. A small bowel follow-through may take up to three hours.

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DEXA (Bone Mineral Densitometry)
DEXA scans evaluate the bone density of the lumbar spine, hip, and occasionally the wrist, in an attempt to estimate one's risk of developing fractures due to osteoporosis. Follow-up scans can be performed annually or bi-annually to determine if lifestyle or medication changes have had an impact on bone density.

FREQUENTLY ASKED QUESTIONS ABOUT BONE DENSITY TESTS
What is Dual Energy X-Ray Absorptiometry (DEXA)?
How do I prepare for a DEXA scan?
Who should have a DEXA scan?
What is osteopenia?
What do the numbers on the DEXA scan mean?
What should I do if I have an abnormal DEXA scan?
When should the DEXA scan be repeated?
Are there other kinds of bone density tests?
What other information can the DEXA scan provide?

What is Dual Energy X-Ray Absorptiometry (DEXA)? DEXA is a simple, noninvasive test that measures the density of bone. It uses a small amount of x-rays (1/30 of the radiation dose of a standard chest x-ray) to measure the density of bone, usually in the hip and spine and wrist. These sites in the body were chosen because they are the most frequent sites of fracture in patients with osteoporosis. Return to FAQs

How do I prepare for a DEXA scan? There is no special preparation needed for a DEXA scan. It does not involve injections, needles, or shots. You can be on your regular diet and do not need to fast. You will be asked to remove any metallic objects on your clothing, but in most cases you will not need to remove your clothing. The test takes about 15 minutes to perform. Return to FAQs

Who should have a DEXA scan? A DEXA scan is considered the best method of measuring bone mineral density for the diagnosis of osteoporosis and for monitoring osteoporosis therapy. Anyone who wants an accurate measurement of bone density or who has high risk for osteoporosis should obtain a DEXA scan. Patients who are under osteoporosis treatment can use DEXA scans to monitor the effectiveness of treatment. The International Society of Clinical Densitometry recommends that bone density tests be done for:

All women age 65 and older
All men age 70 and older
Anyone with a fragility fracture (a fracture caused by minimal or no trauma)
Anyone with a disease, condition, or medication associated with osteoporosis
Anyone who is considering therapy for osteoporosis if bone density testing will facilitate the decision
Women who have been on hormone replacement therapy for prolonged periods
Anyone being treated for osteoporosis to monitor the effects of therapy
Please consult with your physician if you think you may benefit from obtaining a DEXA scan. Return to FAQs

What is osteopenia? Osteopenia is a condition where the bone density is lower than normal but has not yet reached the stage of osteoporosis. The risk for an osteoporotic fracture in this condition is mildly increased. It is important to identify patients with osteopenia, as treatment for low bone density may slow further loss of bone density and could potentially prevent subsequent fractures. Return to FAQs

What do the numbers on the DEXA scan mean? In order to diagnose osteopenia and osteoporosis, the bone mineral density readings on a DEXA scan are compared to a database of young normal adults and a database of age-matched controls.

The comparison with the age-matched controls is called the Z-score. The Z-score compares your bone mineral density with what is expected in someone your age and body size.

However, because all people lose bone density after approximately age 30 or so, comparing bone mineral density with age-matched controls can be misleading in older adults.

The comparison between your bone mineral density with young adults is referred to as the T-score. The T-score provides an estimate of the amount of bone density loss from what is estimated to be the peak bone mass achieved at approximately age 30. The T-score is the accepted measurement for determining the presence of osteoporosis and osteopenia according to the World Health Organization diagnostic categories. The T-score is expressed in terms of standard deviations (SD) above or below the peak bone mass. For example:

Normal is considered to be bone mineral density denser than 1 standard deviation below the mean for young adults. In other words, normal is a T-score greater than –1.0.

Osteopenia is considered to be between 1 and 2.5 standard deviations below the mean for young adults, in other words a T-score of between –1.0 and –2.5.

Osteoporosis is considered bone mineral density equal to or less than 2.5 standard deviations below the mean for young adults. In other words, osteoporosis is a T-score of less than or equal to –2.5.

Severe or established osteoporosis is defined by the World Health Organization criteria as a T-score of equal to or less than 2.5 and with one or more osteoporotic fractures.

The lower the bone mineral density result and the lower the T-score and Z-score, the higher the risk is for osteoporotic fractures. Return to FAQs

What should I do if I have an abnormal DEXA scan? Any results of the DEXA scan should be discussed with your referring physician. Treatment, calcium supplementation, exercise, and diet can potentially slow further bone loss and may be able to decrease the risk of subsequent fractures. In some patients, in addition to calcium supplementation and exercise, medication and hormone replacement therapies may be of use but these treatments should be discussed with your referring physician. Return to FAQs

When should the DEXA scan be repeated? In most patients with age or menopause-related osteoporosis and osteopenia, loss of bone mineralization is very gradual and slow and patients are usually monitored every one to two years or longer, as it may take this long to show a significant change in the bone density. However, in some patients who are suspected to have more rapid bone loss, more frequent testing may be necessary. Return to FAQs

Are there other kinds of bone density tests? Yes. DEXA scan is considered the gold standard for measuring central bone mineral density and is the only accepted method by the World Health Organization for diagnosis of osteoporosis and osteopenia.

However, bone density can also be determined utilizing quantitative computerized tomography (QCT). QCT utilizes larger doses of x-ray and has the advantage of being able to measure the bone density in a three-dimensional manner. However, QCT is not widely used and is less commonly available.

Bone density can be measured utilizing ultrasound of the peripheral skeleton (forearm, heel, or the shin). However, peripheral ultrasound is most often used to identify patients at risk for osteopenia and osteoporosis but cannot diagnose osteopenia or osteoporosis and should not be used to monitor the effects of therapy. Peripheral ultrasound cannot assess the bone mineralization of the central skeleton, especially the hip and spine, where many significant fractures occur. Return to FAQs

What other information can the DEXA scan provide? In addition to measuring bone mineral density, the DEXA scan is a very accurate measurement tool for the presence of fat in the body and is considered the best and most accurate for measuring body fat percentage (body composition). Return to FAQs

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Vascular & Interventional Radiology
Interventional radiology uses minimally invasive techniques - needles instead of scalpels - to evaluate and treat a broad variety of diseases in the body. The procedures range from angiograms/angioplasties, biopsies, abscess drainage, and even treatment of spinal compression fractures.

Because there are so many different procedures available, you will need to discuss your scheduled procedure with an interventional technologist, nurse, or physician prior to your procedure to get pre-procedure instructions and to answer any questions.

Preparation
Varies by procedure. You will get instructions/contacts from scheduling.

How long will my exam take?
Varies by procedure.

For more information, please visit our Vascular and Interventional Radiology web site .

IVP
An intravenous pyelogram (IVP) allows evaluation of the kidneys, urinary system, and bladder. A contrast (dye) is injected into a vein initially, followed by multiple x-rays of the kidneys and bladder over a 35 to 55 minute period.

Preparation
Nothing to eat or drink six hours prior to exam. Children (2-10 years): clear fluids only for four hours prior to exam. Inform the technologist if you have an allergy to IV contrast material.

How long will my exam take?
Typically 35 to 55 minutes.

X-Rays
Radiographs - or x-rays as they are commonly called - provide a snapshot of the chest, bones, or virtually any other body part x-rays are analogous to a photograph.

Preparation
No preparation is needed unless specifically directed by you doctor.

How long will my exam take?
Most x-rays can be completed in five to 25 minutes.

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Mammography / Breast Imaging
Mammography uses low dose x-rays to screen for early breast cancer or other disorders of the breasts. The breasts are placed in compression during imaging, which can be slightly uncomfortable for some patients, but the compression is only for a few brief minutes, and compression films result in superior images.

Depending on your symptoms, findings of your mammogram, or the request of your referring physician, you may be recalled for additional images and/or an ultrasound of the breasts for further evaluation. If you are recalled for such additional imaging, it does not necessarily mean that there is a problem. In fact, the majority of such additional imaging demonstrates normal breast tissue.

If a suspicious area is ultimately discovered and a biopsy needed, SMIL offers a full range of minimally invasive (needle) biopsy options including stereotactic and ultrasound-guided core biopsies.

Preparation
Please do not place any deodorant on your armpits the day of your mammogram. No other preparation is needed. Wearing a two piece outfit is suggested.

How long will my exam take?
A screening mammogram can typically be completed in 15 minutes. Diagnostic (further work-up) studies may take 30 to 60 minutes, depending on whether ultrasound is performed.

MRI Scan
MRI uses a magnetic field and radio waves to produce very high resolution images of the body. Virtually any body part can be imaged.

An intravenous contrast agent (Gadolinium) may be administered through an IV in your arm during the study in some cases.

Contraindications
Because of the strong magnetic field, certain items may not be safe within the MRI. If you have any of the following, please let us know well in advance of your exam: pacemaker, inferior vena cava filters, aneurysm clips, metal implants, artificial heart valves, shrapnel, cochlear (inner ear) implants, history as a metalworker

Other additional information we would like to know would include: pregnancy, claustrophobia

Preparation
Please do not have any food or drink for three hours before your MRI study, aside from necessary medications.

How long will my exam take?
Most studies take 30 to 45 minutes to perform, although more complicated (or multiple body part) studies may take an hour or more.

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Nuclear Medicine
Nuclear Medicine studies use very tiny amounts of radioactivity which are administered (swallowed, inhaled, or injected), and gather in specific parts of the body depending on the molecule used for the particular study. A special (gamma) camera can show exactly where the molecules accumulate, providing important information to your doctor about potential disease in various specific parts of the body.

Because there are so many different nuclear medicine studies available you will need to ask your physician or a SMIL nuclear medicine technologist about the specifics of your particular study. In most cases, you will lie or sit in front of a camera for ten to 60 minutes following administration of a nuclear agent, and may need to return at various intervals for additional images.

Preparation
You will need to get instructions from a nuclear technologist prior to your particular study. This will be arranged when you schedule your exam.

PET
Positron Emission Tomography (P.E.T.) is an innovative new technology which can non-invasively determine many important characteristics of structures in the body. For example, PET can determine whether a nodule (spot) on your chest x-ray is metabolically active and thus worrisome for a potential tumor, versus a non-active nodule, which is likely benign. For a more detailed description of how PET works and what it is applied to, please see recent advances.

Preparation
Varies by exam. You will get instructions/contacts from scheduling

How long will my exam take?
Typically about an hour, though this varies by specific exam.

Ultrasound
Ultrasound is a safe noninvasive means of imaging the abdomen, pelvis, neck, or blood vessels using soundwaves. No radiation is used, which is why ultrasound is safe in pregnancy for evaluation of the fetus.

Preparation
For abdomen studies, one should have no food or drink for six hours prior to your exam, except for necessary medications.

For pelvic studies, one should try to arrive with a full bladder and not urinate until after the exam. A full bladder is needed for optimal imaging.

How long will my exam take?
Most ultrasound studies take approximately 30 to 60 minutes.

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