This section gives you information on some of the medical investigations. We hope the information will help you understand the procedure and prepare for it and also help you to relax and feel at ease in the hospital. Please do not hesitate to ask questions that are not covered.

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ERCP ( Endoscopic Retrograde Cholangio Pancreatography)

What is a ERCP?

Your doctor has recommended that you have a medical procedure called an ERCP

This brochure will help you understand why ERCP is performed and what you can expect from the procedure.

Endoscopic refers to the use of an instrument called an endoscope – a thin, flexible tube with a tiny video camera and light on the end. The endoscope is used by highly trained sub specialist, the gastroenterologist to diagnose and treat various problems of the GI tract.

The GI tract includes the stomach, intestine and other parts of the body that are connected to the intestine, such as the liver, pancreas and gallbladder.

Retrograde refers to the direction in which the endoscope is used to inject a liquid enabling X-rays to be taken of the parts of the GI tract called the bile duct system and pancreas.

The process of taking these X-rays is known as cholangipancreatography. Cholangio refers to the bile duct system, pancreatic duct to the pancreas.

ERCP may be useful in diagnosing and treating problems causing jaundice (a yellowing of the whites of the eyes) or pain in the abdomen. To understand how ERCP can help, its important to know more about the pancreases and the bile duct system.

Bile is a substance made by the liver that is important in the digestion and absorption of fats. Bile is carried from the liver by a system of tubes known as bile ducts. One of these , the cystic duct connects the gallbladder to the main bile duct. The gall bladder stores the bile between meals and empties back in to the bile duct when food is consumed.

The common bile duct the empties in to a part of the small intestine called duodenum. The common bile duct enters the duodenum through a nipple like structure called the papilla.

Joining the common bile duct to pass through the papilla is the main duct from the pancreas. This pathway allows digestive juices from the pancreas to mix with the food in the intestine.

Problems that affect the pancreas and bile duct system can in many cases be diagnosed and corrected with ERCP.

How Do I prepare for the procedure?

Prior to having ERCP , there are a number of things you will need to remember:

First don’t eat or drink anything for atleast 6 hours beforehand or after midnight if your ERCP is scheduled first thing in the morning.

Be sure to tell your doctor all the medications you are taking including aspirin, aspirin containing drugs, blood thinners etc.

Identify any allergies or reactions you have had to drugs, particularly antibiotics or pain medications.

Follow all of your doctor’s instructions regarding preparation for the procedures. ERCP can be done either as an out patient procedure or may require hospitalization.

What can you expect during an ERCP?

Everything will be done to ensure your comfort. A sedative will be given through a vein in your arm. An endoscope is passes down your throat in to your esophagus and through the stomach in to your duodenum.

The doctor will use it to inspect the lining of your stomach and duodenum. You should not feel any pain but you may have a sense of fullness since air may be introduced to help advance the scope.

In the duodenum the instrument is positioned near the papilla the point at which the main ducts empty in tot the intestine. A small tube known as a cannula is threaded down through the endoscope and can be directed in to either the pancreatic or commoin bile duct. The cannula allows a special liquid contrast material a dye to be injected backwards – that is retrograde through the ducts.

X ray equipment is then used to examine and take pictures of the dye outlining the ducts. In this way widening, narrowing or blockage of the ducts can be pinpointed.

Some of the problems that may be identified during ERCP can also be treated through the endoscope. For example if a stone is blocking the pancreatic or common bile duct it is usually possible to remove it.

First the opening in the papilla is cut open and enlarged. Then a special device can be inserted to retrieve the stone. Narrowing or obstruction can also have other causes such as scarring tumors. In some cases a plastic or metal tube (called stent) can be inserted to provide an opening. If necessary a tissue sample or biopsy can be obtained or a narrow area dilated.

What can you expect after your ERCP?

When your ERCP is completed on an out patient basis you will need to remain under observation until your doctor or health care team has decided you can return home. Sometimes admission to the hospital is necessary.

When you do go home be sure you have arranged for someone to drive you since you are likely to be sleepy or drowsy due to the sedative.

Because of the air used during ERCP, you may continue to feel full and pass gas for a while and it is not usual to have soft stool etc. however if you notice bleeding from your rectum or black tarry stools, call your doctor.

You should report vomiting, severe abdominal pain weakness or dizziness and fever over 100 degrees.

UGI Endoscopy

What is upper GI Endoscopy?

The term ‘endoscopy’ refers to a special technique for looking inside a part of the body. Upeer GI is the portion of the gastrointestinal tract, the digestive system that includes the esophagus, the swallowing tube leading to the stomach, which is connected to the duodenum, the beginning of the small intestine.

The esophagus carries food from the mouth for digestion in the stomach and duodenum.

Upper GI endoscopy is a procedure performed to diagnose and in some cases treat problems of the upper digestive system

The endoscope is a long, thin, flexible tube with a tiny video camera and light on the end. By adjusting the various controls on the endoscope, the gastroenterologist can safely guide the instrument to carefully examine the inside lining of the upper digestive system.

The high quality picture from the endoscope is shown on a TV monitor; it gives a clear, detailed view. In many cases, upper GI endoscopy is a more precise examination than X-ray studies.

Upper GI endoscopy can be helpful in the evaluation or diagnosis of various problems, including difficult or painful swallowing, pain in the stomach or abdomen and bleeding, ulcers and tumors.

How Do I Prepare for the Procedure?

Regardless of the reason upper GI endoscopy has been recommends for you; there are important steps you can take to prepare for and participate in the procedure. First, be sure to give your doctor a complete list of all the medicines you are taking and any allergies you have to drug or other substances.

Your medical team will also want to know if you have any heart, lung or other medical conditions that may need special attention before, during or after upper GI endoscopy. You will be given instructions in advance that will outline what you should not do in preparation for the upper GI endoscopy. Be sure to read and follow these instructions

One very important step in preparing for upper GI endoscopy is that you should not eat or drink prior to six to eight hours of your procedure. Food in the stomach will block the view through the endoscope, and it could cause vomiting.

Upper GI endoscopy can be done in either a hospital or out patient setting. You’ll be asked to sign a form that verifies that you consent to having the procedure and that you understand what is involved.

If there is anything you don’t understand, ask for more information.

What can you expect during an upper GI endoscopy?

During the procedure, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored. Your doctor may give you a sedative medication if require; the drug will make you relaxed and drowsy, but you will remain awake enough to cooperate.

You may also have your throat sprayed or be asked to gargle with a local anesthetic to help keep you comfortable as the endoscope is passed. A supportive mouthpiece will be placed to help you keep your mouth open during the endoscopy. Once you are fully prepared, your doctor will gently maneuver the endoscope into position.

As the endoscope is slowly and carefully inserted, air is introduced through it to help your doctor see better. During the procedure, you should feel no pain and it will not interfere with your breathing.

Your doctor will use the endoscope to look closely for any problems that may require evaluation, diagnosis or treatment.

In some cases it may be necessary to take a sample of tissue, called a biopsy, for later examination under the microscope. This too is a painless procedure. In other cases, this endoscope can be used to treat a problem such as active bleeding from an ulcer.

What are the possible complications from an upper GI Endoscopy?

Years of experience have proved that upper GI endoscopy is a safe procedure. Typically it takes only few minutes to perform.

Complications rarely occur. These include
Perforation- a puncture of the intestinal wall, which could require surgical repair
Bleeding – This requires transfusion
Be sure to discuss any specific concerns with your doctor

When your endoscopy is completed you will be cared for in a recovery area until most of the effects of the medication have worn off

Your doctor will inform you about the results of the procedure and additional information you need to know.

What can I expect after my upper GI Endoscopy?

You will be given instruction regarding how soon you can eat and drink, plus other guidelines for resuming your normal activity.

Occasionally, minor problems may persist, such as mild sore throat bloating or cramping; these should disappear in 24 hours or less

By the time you are ready to go home; you will feel stronger and more alert. Nevertheless, you should plan on resting for the reminder of the day. This means not driving so you will need to have a family member or friends take home

In a few days, you will hear from your doctor with additional information such as results of the biopsy or you may have questions you want to ask the doctor directly.


Bronchoscopy is a procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope. During bronchoscopy, your doctor will examine your throat, larynx, trachea and lower airways.

Bronchoscopy may be done to diagnose problems with the airway or to remove an object or growth from the airway.

Bronchoscopy may be used to:

  • Identify the cause of airway problems, such as bleeding, difficulty breathing, or inflammation from other lung disease.
  • Take tissue samples when other tests, such as a chest X-ray or CT scan, show areas of the lungs.
  • Diagnose lung diseases by collecting tissue or mucus (sputum) samples for biopsy.
  • Diagnose and determine the extent of lung cancer.
  • Remove objects blocking the airway.
  • Evaluate and treat growths in the airway
  • Control bleeding (hemoptysis).

How to Prepare

You will be asked to sign a consent form before a bronchoscopy. Talk to your doctor about any concerns you have regarding the need for the procedure, its risks, how it will be done, or what the results will indicate.

Before you have a bronchoscopy, tell your doctors if you:

  • Are taking medications.
  • Are allergic to any medications, including anesthetics.
  • Have had bleeding problems or take blood- thinners, such as aspirin,    clopidogrel (lavix), or warfarin (Coumadin)
  • Are or might be pregnant.

Your doctor may order other tests before your bronchoscopy, such as complete blood count (CBC), bleeding factors, arterial blood gas (ABG), or pulmonary function tests (PFT)

Do not eat or drink for at least 8 to 10 hours before the procedures.

Arrange to have someone drive you home after the procedure.

How It Is Done

You may be given some medications before the procedure to dry up the secretions in your mouth and airways.

You may be asked to remove your dentures, eyeglasses or contact lenses, hearing aids, wigs, makeup and jewelry before the biopsy. You will empty your bladder before the biopsy. You will need to take off all or most of your clothes (you may allowed to keep on your underwear if it does not interfere with the biopsy). You will be given a cloth for covering to use during the biopsy.

The procedure is done by a pulmonologist and an assistant. Your heart rate, blood pressure, and oxygen level will be checked during the procedure.

A chest X-ray may be done before and after the bronchoscopy.


Bronchoscopy is generally a safe procedure. Although complications are rare, your doctor will discuss any risks with you. Complications that may ocure include:

  • Spasms of the bronchial tubes, which can impair breathing.
  • Irregular heart rhythms (arrhythmias)
  • Infections, such as pneumonia. These can usually can be treated with antibiotics.
  • Ongoing hoarseness.
  • Bubbles under the skin that crackle and pop when pressed.

If a biopsy was done during bronchoscopy complications that may occur include:

  • A tear in the lung from the needle used to collect a tissue sample. This will allow air flow into the pleural space, producing a partial collapse of the lung (pneumothorax).
  • Bleeding caused by the needle used to collect the tissue.
  • An infection from the biopsy procedure.
  • If you receive general anesthesia, there is a small chance of death from complications associated with general anesthesia. However, this is very rare.

(Barium Swallow, Barium Meal and Follow Through)

What is BAFT?

Also called an upper gastrointestinal (GI) series or simply an upper GI, upper gastrointestinal tract radiography is an x-ray examination of the esophagus, stomach and first part of the small intestine. However, in order for the anatomy to show up on radiographic

images, the upper gastrointestinal tract must be coated or filled with a contrast material called barium, an element that appears bright white on radiographs. The barium is given to the patient to drink. This procedure is called upper gastrointestinal tract radiography when the esophagus, stomach, and duodenum are evaluated, or a barium swallow when only the pharynx and esophagus

are evaluated. Additionally, some patients are asked to swallow baking-soda crystals to create gas and further improve the images; this procedure has the modified name of air-contrast or double-contrast upper GI.

Why is BAFT done?

An upper GI procedure is done to observe digestive function or to detect abnormalities such as ulcers, tumors or inflammation of the esophagus, stomach and proximal small intestine. Patients who undergo this procedure are usually those who have difficulty swallowing, are complaining of chest and abdominal pain or reflux (a backward flow of partially digested food and digestive juices), or have unexplained vomiting, severe indigestion, or blood in the stool (indicating internal bleeding).

How is the test performed?

It is done usually as an outpatient procedure and scheduled in the morning to reduce your time of fasting. You will be asked to drink a cup of liquid barium, which resembles a light-colored milkshake. You may be asked to swallow baking-soda crystals (sometimes called fizzies), which will create gas in your stomach.

The radiologist will note the passage of barium into your esophagus and stomach on the fluoroscopic monitor. Once the upper gastrointestinal tract is adequately coated with the barium, still radiographs are obtained.
The examination is usually completed within 30 minutes.

On the day of the test……

  • Please wear comfortable clothing while coming for the test.
  • Please do not bring valuables such as jewelry and credit cards.
  • The quality of the images obtained during this procedure can be degraded if the stomach is not empty of food. Therefore, you will likely be asked not to eat or drink anything (including orally administered medications, especially antacids) after midnight on the morning of the examination. Nor should you chew gum or smoke after this time as these activities can cause stomach secretions, which also may degrade the quality of the images.
  • Your test is performed by a registered technician.
  • The images will be interpreted by a board-certified radiologist.

During the Test……

The liquid barium has a chalky taste, although the taste can be masked somewhat by added flavors such as strawberry or chocolate. If you receive gas producing crystals, you may feel the need to belch. However, the radiologist or technologist will tell you to hold the gas in as its presence in the stomach enhances the detail in the radiographic images.

First you will be standing up, then lying down, as the radiologist obtains pictures of your esophagus and stomach. You will be asked to hold your breath to prevent blurring of the still images. Also, periodically you will be asked to move into different positions while standing, and to roll into different positions while lying on the examining table. The technologist or the radiologist may want you to drink more barium.

Once the examination is complete, you will be asked to wait. At this time, the radiologist will preliminarily examine the images to be sure they contain the necessary information.

After the examination, you can resume a regular diet and take orally administered medications unless told otherwise by your doctor. The barium may color stools gray or white for 48 to 72 hours after the procedure. Sometimes the barium can cause temporary constipation.

After the test…….

You will be able to resume your usual activities. Date and time for the collection of the report shall be communicated to you. Your physician will discuss the test results with you.

For more information please contact Radiology Department
Extension: 4020



Bone Dexa

What is Radiography-based (X-ray) Bone Densitometry?

Every day, physicians use radiography, or x-rays, to view and evaluate bone fractures and other injuries of the musculoskeletal system. However, a plain x-ray test is not the best way to assess bone density. To detect osteoporosis accurately, doctors use an enhanced form of x-ray technology called dual-energy x-ray absorptiometry (DXA or DEXA).

DEXA bone densitometry is today's established standard for measuring bone mineral density (BMD). DEXA is a quick, painless procedure for measuring bone loss. Measurement of the lower spine and hips are most often done. More portable devices that measure the wrist, fingers or heel are sometimes used for screening, including some that use ultrasound waves rather than x-rays.

What are some common uses of the procedure?

DEXA bone densitometry is most often used to diagnose osteoporosis, a condition that often affects women after menopause but may also be found in men. Osteoporosis involves a gradual loss of calcium, causing the bones to become thinner, more fragile and more likely to break. The DEXA test can also assess your risk for developing fractures.

If your bone density is found to be low, you and your physician can work together on a treatment plan to help prevent fractures before they occur. DEXA is also effective in tracking the effects of treatment for osteoporosis or for other conditions that cause bone loss. Bone density testing is strongly recommended if you:

  • Are a post-menopausal woman and not taking estrogen.
  • Have a personal or maternal history of hip fracture or smoking.
  • Are a p-ost-menopausal woman who is tall (over 5 feet 7 inches) or thin (less than 125 pounds).
  • Are a man with clinical conditions associated with bone loss.
  • Use medications that are known to cause bone loss, including corticosteroids such as Prednisone, various anti-seizure medications such as Dilantin and certain barbiturates, or high-dose thyroid replacement drugs.
  • Have type 1 (formerly called juvenile or insulin-dependent) diabetes, liver disease, kidney disease or a family history of osteoporosis.
  • Have high bone turnover, which shows up in the form of excessive collagen in urine samples.
  • Have a thyroid condition, such as hyperthyroidism.
  • Have experienced a fracture after only mild trauma.
  • Have had x-ray evidence of vertebral fracture or other signs of osteoporosis.

How should I prepare for the procedure?

On the day of the exam eat normally, but don't take calcium supplements for at least 24 hours beforehand. Wear loose, comfortable clothing, avoiding garments that have zippers, belts or buttons made of metal.

Inform your physician if you recently had a barium examination or have been injected with a contrast material for a computed tomography (CT) scan or radioisotope scan; you may have to wait 10 to 14 days before undergoing a DEXA test. Women should always inform their physician or x-ray technologist if there is a possibility they are pregnant.

What does the DEXA equipment look like?

There are two types of DEXA equipment: the central device and the peripheral device. Central DEXA devices measure bone density in the hip and spine, while peripheral devices measure it in the wrist, heel or finger.
The central DEXA device is used in hospitals and medical offices, while the smaller peripheral device is available in drugstores and on mobile health vans in the community. CT scanners also can be used effectively to evaluate the spine and hip for osteoporosis.

Central devices have a large, flat table and an "arm" suspended overhead. The arm swings away so that the table can be used as a treatment table or exam chair for routine patient examinations.

The peripheral DEXA (pDEXA) device weighs only about 60 pounds. It is a portable box-like structure that includes a space to insert your foot or forearm for imaging.

How does the procedure work?

The DEXA machine sends a thin, invisible beam of low-dose x-rays with two distinct energy peaks through your bones. One peak is absorbed mainly by soft tissue and the other by bone. The soft tissue amount can be subtracted from the total and what remains is a patient's bone mineral density.

All devices feature special software to compute the data and display them on a computer monitor, allowing your doctor to make an accurate diagnosis. The amount of radiation used is extremely small—less than one-tenth the dose of a standard chest x-ray.

How is the procedure performed?

The DEXA bone density test takes 10 to 30 minutes, depending on the equipment used and the parts of the body being examined. You may be asked to undress and put on a hospital gown. Then you'll lie on a padded table with an x-ray generator below and a detector (an imaging device) above.

Most often, doctors focus on bone loss in the spine and hip where most osteoporosis-related fractures happen. During an examination of the spine, your legs will be supported on a padded box to flatten your pelvis and lower (lumbar) spine. To assess your hip, the technologist will place your foot in a brace that rotates the hip inward. In both cases the detector is slowly passed over the area, generating images on a computer monitor.

The peripheral DEXA (pDEXA) test is even simpler. You place your finger, hand, forearm or foot in a small device, and a bone density reading is obtained within a few minutes. These tests may not be as sensitive—especially in younger people—and cannot be used to monitor response to treatment.

Lateral Vertebral Assessment (LVA)

An additional procedure called Lateral Vertebral Assessment (LVA) is now being done at many centers. This is a low dose x-ray examination of the spine to screen for vertebral fractures. It is performed on the DEXA machine. Vertebral fractures are common in older individuals and may indicate increased risk for additional fractures if they are present. They are often asymptomatic.

The test is painless and adds only a few minutes to the DEXA procedure. It may be recommended for older patients, especially if they have lost more than an inch of height, have unexplained back pain, or if the DEXA scan gives borderline readings and the increased risk if the patient has evidence of fracture would influence the decisions in regard to treatment.

What will I experience during the x-ray procedure?

DEXA bone densitometry is a simple, non-invasive procedure. Once on the table you may be asked to hold an awkward position for a short time while the arm of the machine passes over your body taking measurements.

It is important that you stay as still as possible during the procedure to ensure a clear, useful image. No anesthesia is required. The procedure is painless and radiation exposure is minimal.

Who interprets the results and how do I get them?

The results of a DEXA bone density exam are interpreted by a radiologist*, who is a physician specially trained to diagnose conditions and diseases by obtaining and interpreting medical images.

The radiologist will send an interpretation of your results and a signed report to your primary care physician who will work with you to develop a treatment plan. Usually available within a few days, your test results will be in the form of two scores:

T score — This number shows the amount of bone you have compared with a young adult of the same gender with peak bone mass. A score above -1 is considered normal. A score between -1 and -2.5 is classified as osteopenia, the first stage of bone loss. A score below -2.5 is defined as osteoporosis. It is used to estimate your risk of developing a fracture.

Z score — This number reflects the amount of bone you have compared with other people in your age group and of the same size and gender. If it is unusually high or low, it may indicate a need for further medical tests.
* Many DEXA scans are interpreted by other physicians such as rheumatologists and endocrinologists.

What are the benefits vs. risks?


DEXA bone density testing is the most accurate method available for the diagnosis of osteoporosis. It is also considered an accurate estimator of fracture risk. It will not tell whether you will or will not have a fracture, but gives relative risk of suffering a fracture, just as cholesterol and blood pressure help determine risk for heart disease.

A low reading should not cause you to be anxious but may help you set healthy goals. As with other diseases and conditions, early detection is the key to prevention of further bone loss and eventual fractures. DEXA equipment is widely available making DEXA bone densitometry testing convenient for patients and doctors alike.


No complications are expected with the DEXA procedure.

What are the limitations of DEXA Bone Densitometry ?

Despite its effectiveness as a method of measuring bone density DEXA is of limited use in people with a spinal deformity or those who have had previous spinal surgery. The presence of vertebral compression fractures or osteoarthritis may interfere with the accuracy of the test. CT scans may be more useful in such instances. DEXA cannot predict who will experience a fracture but can provide indications of relative risk.

Central DEXA devices are more sensitive than pDEXA devices but they are also somewhat more expensive. The peripheral devices don't accurately follow changes in your bones during therapy. A test done on a peripheral location, such as your heel or wrist, may help predict the risk of fracture in your spine or hip. But because bone mass tends to vary from one location to the other, measuring the heel is not as accurate as measuring the spine or hip.

Small changes may normally be observed between scans due to differences in positioning and may not be significant. As with mammograms, the examination must be done with great care to maximize accuracy.


What is CT SCAN?

A CT (computerized tomography) scanner is a special kind of X-ray machine. Instead of sending out a single X-ray through your body as with ordinary X-rays, several beams are sent simultaneously from different angles.

The scanner is particularly good at testing for bleeding in the brain, for aneurysms (when the wall of an artery swells up), brain tumors and brain damage. It can also find tumors and abscesses throughout the body and is used to assess types of lung disease.

In addition, the CT scanner is used to look at internal injuries such as a torn kidney, spleen or liver; or bony injury, particularly in the spine. CT scanning can also be used to guide biopsies and therapeutic pain procedures.

How is the test performed?

During a CT scan, the person lies very still on a table. The table slowly passes through the center of a large x-ray machine. The person might hear whirring sounds during the procedure. People may be asked to hold their breath at times, to prevent blurring of the pictures.

Often, a contrast agent, or “dye,” may be given by mouth, injected into a vein, given by enema, or given in all three ways before the CT scan is done.

The contrast dye can highlight specific areas inside the body, resulting in a clearer picture (Please inform the Radiologist or Technologist if you have any allergies especially to medications or iodine or if you have any history of diabetes, asthma, kidney problems, etc as such conditions indicate a higher reaction to the contrast material).

Most scans take about half an hour.

On the day of the test……

  • Please wear comfortable clothing while coming for the test.
  • Metal objects can affect the image so avoid clothing with zippers and snaps. Please do not bring valuables such as jewelry.
  • You may be asked not to eat or drink anything for four hours before the exam.
  • Any possibility of pregnancy should be brought to the notice of the doctor.
  • Please bring any old scans, if you have, for the comparative study with the previous one(s).
  • Your test is performed by a registered technician.
  • The images will be interpreted by a board-certified radiologist.
  • You may be asked to change into a hospital gown.
  • A CT technologist will introduce herself/himself to you, explain the test you are having, and answer your questions. 
  • If your radiographers know you are nervous, they will take extra care in making sure you are comfortable and understand what is going on. Keeping your eyes closed sometimes helps.

After the test…….

You will be able to resume your usual activities. Date and time for the collection of the report shall be communicated to you. Your physician will discuss the test results with you.

Are there any risks associated with the test?

The amount of radiation a person receives during a CAT scan is minimal. In men and non-pregnant women, it has not been shown to produce any adverse effects. If a woman is pregnant, there may be a potential risk to the fetus, especially in the first trimester of the pregnancy.

Very, very rarely, someone has an allergic reaction to the contrast injection. The reaction most often starts with weakness, sweating and difficulty in breathing. It is possible to react to any injection in this way, and the doctors and radiographers will know what to do if you do have this type of reaction.

For more information please contact Radiology Department
Extension: 4002

Intravenous Pyelogram (IVP)

What is IVP?

An Intravenous Pyelogram (IVP) is an x-ray examination of the kidneys, ureters, and urinary bladder. Most people are familiar with x-ray images, which produce a still picture of the body's interior by passing small, highly controlled amounts of radiation through the body, and capturing the resulting shadows and reflections on film.

Why is IVP done?

A radiologist can use an IVP study to find the cause of a wide variety of disorders, including frequent urination, blood in the urine, or pain in the side or lower back. The IVP exam can enable the radiologist to detect problems within your urinary tract resulting from kidney stones; enlarged prostate; tumors in the kidney, ureters, or urinary bladder; and other changes.

How is the test performed?

You should tell your doctor about any allergies you have to foods or medications, as well as any recent illnesses or other medical conditions. If you are diabetic, make sure your doctor is aware of your condition and the medications you take. Women should always inform their doctor or x-ray technologist if there is any possibility that they are pregnant.

Your doctor will give you detailed instructions on how to prepare for your IVP study. You will likely be instructed not to eat or drink after midnight the night before your exam. You may also be asked to take a mild laxative (in either pill or liquid form) the evening before the procedure. Follow your doctor's instructions.

On the day of the test……

  • Please wear comfortable clothing while coming for the test.
  • Please do not bring valuables such as jewelry and credit cards.
  • Your test is performed by a registered technician.
  • The images will be interpreted by a board-certified radiologist.

During the test….

An IVP examination is usually done on an outpatient basis. The patient is positioned on the table, and a contrast material is injected, usually in a vein in the patient's arm. Images are taken before and after the injection of the contrast material. As the contrast material is processed by the kidneys, a series of images is captured.

A typical IVP study usually takes about an hour.

After the test…….

You will be able to resume your usual activities. Date and time for the collection of the report shall be communicated to you. Your physician will discuss the test results with you.

Are there any risks associated with the test?

Aside from a minor sting from the injection of contrast material, an IVP causes no pain. When the contrast material is injected, some people report feeling a flush of heat and, sometimes, a metallic taste in the mouth. These common side effects usually disappear within a minute or two and are no cause for alarm. Some people experience a mild itching sensation.

If it persists or is accompanied by hives, the itch can be treated easily with medication. In rare cases, a patient may become short of breath or experience swelling in the throat or other parts of the body. These can be indications of a more serious reaction to the contrast material that should be treated promptly, so tell the radiologist immediately if you experience these symptoms.

During the imaging process, you may be asked to turn from side to side and to hold several different positions, to enable the radiologist to capture views from several angles. Near the end of the exam, you may be asked to empty your bladder so that an additional film can be taken of your urinary bladder after it empties.

The contrast material used for IVP studies will not discolor your urine or cause any discomfort when you urinate. If you experience such symptoms after your IVP exam, they are likely to indicate some other problem. Let your doctor know right away.

For more information please contact Radiology Department
Extension: 4020

Litho Tripsy

What is Lithotripsy?

LITHO = Stone , TRIP = To Break. Breaking a stone is called Lithotripsy. ESWL ( Extra Corporeal Shock Wave Lithotripsy) is breaking the stones inside the patients body by Shock Waves.

It is a Non Invasive procedure. Shock waves are produced by a sophisticated machine called Lithotripter by passing a high voltage electrical discharge through a spark gap under water. The shock waves thus produced are focused on the stone inside the patient’s body, which is localized with the help of a machine called C-Arm Image Intensifier.

The shock waves produce a compressive force and the brittle stones start to crumble into small sand like particles which are passed out in urine. Kidney, Ureter or bladder stones can all be treated thus.

Q) How long does the treatment take?

A) The actual treatment takes around 45 to 60 minutes.

Q) How much time do I have to stay at the Hospital and when can I go back to work?

A) Most patients are discharged after 2 hours and can return to work after that. It is an outdoor procedure and No admission is required. No prolonged rest is required. Rather we encourage plenty of oral liquids to speed up the passage of crushed stones.

Q) Is there any pain during the treatment?

A) Some sensitive patients have to be administered Analgesic Injections prior to treatment, but most patients do not require any analgesia or sedation. The treatment itself causes very little pain. No anesthesia is generally required during Lithotripsy with most of the modern Machines.

Some older Lithotripters do cause pain and patients have to be anaesthetized prior to treatment. Minimal movement on the patient's part is important as this makes the treatment much more effective by keeping the stone always in focus.

Q) Does the patient remember anything about the procedure or know what is going on during the treatment?

A) The patient is fully conscious and is able to see and hear everything during the treatment.

Q) What is the purpose of ESWL (Extracorporeal Shock Wave Lithotripsy), and is it safe?

A) The purpose is to safely fragment kidney stones so the stone fragments can be passed naturally in the urine. The treatment is safe and complications of treatment are rare.

Q) What happens after the treatment?

A) The patient is discharged and allowed to resume his normal activities within 2 hours.

Q) Can Large and Staghorn Stones be treated this way?

A)Lithotripsy is ideal treatment for stones upto 2 Cms diameter but larger stones can also be treated, specially in Patients unfit for Surgery or Anaesthesia, Patient having Cardiac problems or Diabetic Patients.

In Larger stones, a 'Pigtail' Stent or a 'Double J' Stent has to be passed through the Urethra till the Kidney to facilitate the passage of stone fragments. After the stone is passed out, the stent is removed.


What is Mammography?

Mammography is a specific type of imaging that uses a low-dose x-ray system for examination of the breasts. It plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them.

Current guidelines from the U.S. Department of Health and Human Services (HHS), the American Cancer Society (ACS), the American Medical Association (AMA) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40.

On the day of the test……

  • Inform your doctor of any prior surgeries, hormone use, and family or personal history of breast cancer.
  • Do not schedule your mammogram for the week before your period if your breasts are usually tender during this time. The best time is one week following your period.
  • Please wear comfortable clothing while coming for the test.
  • Please do not bring valuables such as jewelry and credit cards.
  • Do not wear deodorant, talcum powder, or lotion under your arms or on your breasts on the day of the exam. These can appear on the x-ray film as calcium spots.
  • Describe any breast symptoms or problems to the technologist performing the exam.
  • Please bring any old mammograms, if you have, for the comparative study with the previous one(s).
  • Your Mammography is performed by a registered technician.
  • The images will be interpreted by a board-certified radiologist.

How is the test performed?

A specially qualified radiologic technologist will position you to image your breast. The breast is first placed on a special platform and compressed with a paddle.

The technologist will go behind a glass shield while making the x-ray exposure, which will send a beam of x-rays through the breast to the film behind the plate, thus exposing the film.

You will be asked to change positions slightly between images. The routine views are a top-to-bottom view and a side view. The process is repeated for the other breast.The examination process should take about half an hour.

When the mammography is completed you will be asked to wait until the technologist examines the images to determine if more are needed.

After the test…….

You will be able to resume your usual activities. Date and time for the collection of the report shall be communicated to you. Your physician will discuss the test results with you.

Are there any risks associated with the test?

You will feel pressure on the breast as it is squeezed by the compressor. Some women with sensitive breasts may experience discomfort. If this is the case, schedule the procedure when your breasts are least tender.

The technologist will apply compression in gradations. Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression will be used.

For more information please contact Radiology Department:
Extension: 4020


What is MRI ?

An MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. An MRI scan can be used as an extremely accurate method of disease detection throughout the body.

Why is MRI done ?

An MRI scan can be used as an extremely accurate method of disease detection throughout the body. In the head, trauma to the brain can be seen as bleeding or swelling. Other abnormalities often found include brain aneurysms, stroke, tumors of the brain, as well as tumors or inflammation of the spine.

Neurosurgeons use an MRI scan not only in defining brain anatomy but in evaluating the integrity of the spinal cord after trauma. It is also used when considering problems associated with the vertebrae or intervertebral discs of the spine.

An MRI scan can evaluate the structure of the heart and aorta, where it can detect aneurysms or tears. It provides valuable information on glands and organs within the abdomen, and accurate information about the structure of the joints, soft tissues, and bones of the body. Often, surgery can be deferred or more accurately directed after knowing the results of an MRI scan.

MRI is widely used to diagnose sports-related injuries, especially those affecting the knee, shoulder, hip, elbow, and wrist.

How is the test performed ?

Patients lie within a closed environment inside the magnetic machine. Relaxation is important during the procedure and patients will be asked to breathe normally. Interaction with the MRI technologist is maintained throughout the test. There are loud, repetitive clicking noises which occur during the test as the scanning proceeds.

The MRI scanning time depends on the exact area of the body studied, but ranges from half an hour to an hour and a half.

On the day of the test……

  • Please wear comfortable clothing while coming for the test.
  • Please do not bring valuables such as jewelry and credit cards.
  • Please bring any old scans, if you have, for the comparative study with the previous one(s).
  • It is also important for the patient to inform medical staff if they use electrical appliances, such as a hearing aid or pacemaker, or have any metal in their body such as surgical clips, but orthopedic metal ware such as artificial hips or bone screws is not normally a problem. 
  • Your MRI is performed by a registered technician.
  • The images will be interpreted by a board-certified radiologist.

After the test…….

You will be able to resume your usual activities. Date and time for the collection of the report shall be communicated to you. Your physician will discuss the test results with you.

Are there any risks associated with the test ?

There are no known dangers or side effects connected to an MRI scan. The test is not painful; you cannot feel it. Since radiation is not used, the procedure can be repeated without problems. There is a small theoretical risk to the foetus in the first 12 weeks of pregnancy, and therefore scans are not performed on pregnant women during this time.

Because patients have to lie inside a large cylinder while the scans are being made some people get claustrophobic during the test. Patients who are afraid this might happen should talk to the doctor beforehand, who may give them some medication to help them relax.

The machine also makes a banging noise while it is working, which might be unpleasant.

For more information please contact Radiology Department
Extension: 6316


What is ultrasound?

Ultrasound is used to create images of soft tissue structures, such as the gall bladder, liver, heart, kidney, female reproductive organs-- and even of babies still in the womb. Ultrasound can also detect blockages in the blood vessels.

This helps the physician to find out the reasons for pain, swelling or any kind of infection in the body.

How is the test performed?

You will be asked to lie down and a clear water based conducting gel is applied over the abdomen to help with the transmission of sound waves.

The ultrasound transducer (a hand held probe) is then moved over the abdomen. You may be asked to hold your breath for short periods of time during the procedure. There may be varying degrees of discomfort from pressure as the transducer is moved from one area to another. The gel will be wiped off your skin after the test.

The whole examination takes usually less than 30 minutes except pregnancy scans (especially with multiple pregnancies).

Transvaginal ultrasound involves the insertion of the transducer, a long probe, covered with a condom and a sterile lubricant that is inserted into the vagina. The probe will then be moved within the vaginal cavity to scan the pelvic structures.

In Transrectal Ultrasound a protective cover is placed over the transducer lubricated and then placed into the rectum to obtain the images of the prostarte gland.

Doppler ultrasonography helps to detect moving blood cells or other moving structures and measure their speed and direction of movement. It helps in evaluating blood flow through the major arteries and veins of the arms, legs and neck.

On the day of the test……

Preparation for the Test



Whole or upper abdomen

6-8 hrs fasting. Bladder to be full and can drink water / coconut water.

Pelvis/ Lower Abdomen or pregnancy/ KUB

Fasting not required. Bladder to be full. Can eat or drink.

Chest, Breast, Neck, Thyroid, Brain, TRUS, Scrotum, Color Doppler Transplant/ Fetal/ Upper or lower limb

No preparation

Color Doppler Renal

Fasting required. Should avoid gaseous food for one day

Failure to follow the above preparation will result in delays or possible cancellation of your examination.

  • Please wear comfortable clothing while coming for the test.
  • Please do not bring valuables such as jewelry and credit cards.
  • Your ultrasound test is performed by a registered diagnostic sonographer.
  • The ultrasound images will be interpreted by a board-certified radiologist.
  • You may be asked to change into a hospital gown.
  • The guidelines as per the Pre- Natal Diagnostic Techniques Act (PNDT) shall be adhered to in totality, regarding the sex of the fetus.

After the test…….

You will be able to resume your usual activities. Date and time for the collection of the report shall be communicated to you. Your physician will discuss the test results with you.

Are there any risks associated with the test?

There may be little discomfort. No harmful radiations exposure is involved.

For more information please contact Radiology Department
Extension: 5511/4001




Positron Emission Tomography (PET) is a powerful imaging technique that holds great promise in the diagnosis and treatment of many diseases, particularly cancer. A non-invasive test, PET scans accurately image the cellular function of the human body.

In a single PET scan your physician can examine your entire body. PET scanning provides a more complete picture, making it easier for your doctor to diagnose problems, determine the extent of disease, prescribe treatment, and track progress.|

PET (Positron Emission Tomography) and CT (Computed Tomography) scans are both standard imaging tools that physicians use to pinpoint disease states in the body.

A PET scan demonstrates the biological function of the body before anatomical changes take place, while the CT scan provides information about the body's anatomy such as size, shape and location. By combining these two scanning technologies, a PET/CT scan enables physicians to more accurately diagnose and identify cancer, heart disease and brain disorders.

Coping With Kidney Diseases

KIDNEY: We have two kidneys. Each kidney is capable of sustaining life independently.

LOCATION: Kidneys are located on either side of spine at the level of rib cage.

CIRCULATION: Your kidneys convert over 1500 liters of blood per day into about 1.2 to 1.5 liter of concerted urine. (The rate of urine aformation is about 1 ml/min.)

In an adult of normal weight (60-65) about 1200ml of blood flows through both the kidneys every minute.(this is about 20-25 % of heart output).

The urine is removed from the kidney by the URETERS (two twin tubes) and stored in the BLADDER and discharged through URETHRA (intervals).

The main function of the urinary system is REMOVAL OF LIQUID WASTE PRODUTS from the body. This is done to a certain extent by the skin also. Kidney also move excess water from our body and maintains normal salt and water balance.

Warning Symptoms & Signs of Kidney Disease

  • Burning sensation while urinating
  • Frequent and excessive urination (especially in the the night time)
  • Blood in the urine. (Brown or coffee color).
  • Puffiness or oedema on face and body.
  • Hypertension. (High blood pressure).
  • Asymptomatic.

The above symptoms /sign are given to you as a warning and should be used as general guideline only. Contact your doctor if you notice any of the above. The doctor would advice you further on investigation and treatment.

Kidney disease is detected only when you go for urine/blood check up.

Doctor’s advice is a must for any treatment.

Symptoms & signs of kidney failure
How do i know my kidney has failed?

  • Symptoms of kidney failure are so general that most of the times they are not suspected as threatening.

(Note: These symptoms may occur due to other reason also).

Symptoms of sign of kidney failure

  • Nausea and Vomiting
  • Loss of Appetite
  • Headache
  • Anaemia
  • Increased blood pressure
  • Skin itching
  • Increase/Decreased frequency of urination(Especially at night)
  • Lower back pain
  • Swelling of face and leg
  • Physical weakness

As soon as kidney failure is detected, patients must get Hepatitis-B vaccination.

Test to detect kidney disease/failue

When you contact nephrologists for any of the symptom mentioned earlier, doctor might recommend for one or more of the fallowing test to detect kidney problems.

Common Tests

Urine Examination: For proteinuria (Albuminoidal) Real blood cells or pus cell and casts.

Urine for Culture and Sensitivity- For infection

Blood Urea Nitrogen (BUN) - This is a waste product produced from protein metabolism.

Serum Creatinine - This is produced from muscle metabolism.

Complete Blood Count CBC ) - Generally blood count (Hemoglobin) level falls with onset of kidney failure.

Plain X-ray Abdomen (KUB) - Generally gives information about kidney stones.
Ultrasonography (USG) - This is one of the non-invasive tests. It gives information to doctors about kidneys, tumors or even whether kidney disease is of long standing duration or not. Unfortunately it does not tell any thing about kidney function.

Intravenous Pyelography (IVP or IVU) - This involves giving injection of iodinated dye in vein followed by kidney x-rays. It gives valuable information about kidney function, size etc. It is an invasive test. At times patient can get a reaction (rarely fatal) with dye. It is not done if kidney function is already compromised greatly with creatine greater than 3 to 4 mg/dl.1
Renal Scan (Nuclear) - it gives you information about kidney size and function also. Sensitively is decreased in renal failure.

CT Scan Kidney- This is occasionally done when tumor is suspected. This is commonly used.

Kidney Biopsy- This involves removal of a tiny piece of kidney tissue for microscopic examination of the kidney. This guides the doctors about the cause and treatment if any.
Special Tests-

  • Creatine Clearance Tests : To determine exact percentage of kidney function.
  • Quantification proteinuria : Urine is collected to see how munch protein is lost in 24 hrs.

Types of Kidney Failure

Acute Kidne Failure (Reversible) Kidney Fails Suddenly Over A Short Time DUE To

  • Dehydration (Due to servere diarrhea or vomiting).
  • Sudden significant drops in blood pressure.
  • Massive Bleeding
  • Acute glomerulonephritis
  • Snake bite
  • Drug overdose
  • Food Poisoning etc.

This is generally reversible and kidney recovers in a matter of three days to three weeks time. Till kidney function recovers, patient should be under observation and may require hospitalization for few days and might require few sessions of dialysis.

Chronic Kidney Disease (Irreversible) :
Common Causes:

  • Long standing diabetes
  • Uncontrolled high blood pressure for a long time
  • Chronic glomerulonephitis
  • Chronic infection of kidney pyelonephritis.
  • Polycystic kidney disease
  • Frequent stone formation in urinary tract
  • Enlarged prostage gland.
  • Excessive use of medicines over years (mainly pain killers

Prevention Of Kidney Failure
A Few Suggestions To Prevent Kidney Failure:

  • Proper treatment of diabetes for diabetic patient
  • Normal blood sugar level is 80 to 120 mgs%. Tight control of diabetes can prevent kidney failure.
  • Regular check up of blood pressure
  • Normal level is 120/80 mm of hg . If high blood pressure is present, control it with salt restriction and medicines as per doctor’s service

Treatment Options
Treatment of Chronic Kidney Disease (CKD)


 Tips for new dialysis patients

  • It’s not the end of the world. You have to only change your life style, you can still enjoy life.
  • If your job is physical, you probably felt weak long ago. You’ll feel better now
  • If you do intellectual work, your brain is not dead yet
  • You can still perform intellectual work.
  • Learn everything about how the kidney functions, your disease, and the dialysis.
  • Ask questions. What is your blood pressure? Lab values and what do they mean
  • Maintain your weight as recommended
  • Learn what diet you need to take
  • Never miss treatment


Hemodialysis is a process by which blood is purified by taking it out of the body with the help of a machine and passing it through a ‘Dialyser’ (Artificial Kidney)

Blood is taken out of the body via a needle (A.V.F). in the dialyser blood and dialyzing fluid flow on either side of a semi permeable membrane. This removes the toxic waste and excess water from the blood. The pure blood is returned to the body.

This process if taking out and putting in the blood continues for 3-4 hours. The dialysis has to be repeated at-least 3 times a week.


Preparation of patient for Hemodialysis:

When a patient has moderately severe renal failure (i.e when kidney is 80% damaged) plan should be made to do A.V fistula access.

Vascular Access: this means that to receive hemodialysis treatment there must be a way to enter the blood vessels easily atleast three times a week. The accesses are:

  • Arterio Venus Fistula (A.V.F)
  • Jugular Catheter
  • Subclavian Catheter
  • Femoral Catheter
  • Shunt

Last four procedures are done when urgent dialysis is needed. The first procedure is ideal for long term dialysis.

Anterio Venus Fistula (A.V.F)

A fistula is made from sewing two blood vessels together. Two of blood vessels, an artery and a vein, are connected underneath the skin. It is generally done under local anesthesia. It takes about 3 to 4 weeks for A.V Fistula to mature before it can be used.

This new connection will build a vein with large flow of blood. This new path for blood is called a fistula. The fistula is placed between the wrist and the elbow of the arm, which you don not use for writing.

Normally the flow of the blood in veins has almost no pressure, but when these new connection is made between the artery and vein this fistula has a flow of blood with pressure. The fistula is used for hemodialysis by placing two needles in different places in to the fistula.

The needles have special tubing attached. Blood flows through the other needle and tubing. Patients should take following precautions for care of fistula.

  • Do not allow blood pressure to be recorded on that arm
  • Do not allow blood to be drawn or intravenous injections to be started
  • Do not wear a watch or tight clothing with elastic or bands
  • Do not sleep on top of your fistula arm

Jugular, Subclavian and Femoral Vein Cannulation

This is a simple procedure and done when a patient needs urgent dialysis and A-V Fistula is not done or not matured. Now days-double lumen catheters are available so that we can do dialysis without any problems.

Part of the tube lies in vein and part is outside the skin. It is used only when there is no other means of vascular access available.


This type of vascular access is done occasionally for urgent dialysis. In this silastic tube is inserted in to the artery and vein and both tubes are secured in place by sutures.

When not in use, both tubes are connected with each other so that blood flows continuously through the tubes and prevents from clotting. Shunt can be used immediately for dialysis. Only problem with this frequent clotting and infections in majority of the patients.

Advantages of Hemodialysis:

  • It is a treatment provided under the supervision of the professional personnel.
  • Treatment is usually 3 times a week.
  • Chances of infection are low
  • Comparably low cost

With regular dialysis most patients feel better to a great extent and many patients can be rehabilitated. With recent advances anemia can be corrected by injection of erythropoietin and using calcium carbonate with vitamin D3 can minimize bone problems. Patient does not require major surgical procedure.

Patient has to follow diet, fluid, salt and potassium restriction to a great extent (like avoiding dry fruits, fruits, juices, coconut water)

Even with dialysis patient feels weak due to anemia. This can be corrected but will involve additional expenses. Traveling also will be restricted due to need for regular dialysis.

Peritoneal Dialysis

Peritoneal dialysis is a procedure in which one or two liters of dialysis solution is instilled in to abdominal cavity through peritoneal catheter.

About 4 to 6” of catheter is in abdominal cavity while remaining lives outside.

Dialysis solution is instilled in to the abdominal cavity and is kept there for sometime and subsequently drained out. Diffusion of waste product occurs from the blood passing through abdominal cavity in to the dialysis solution through peritoneal membrane.

After fluid is removed fresh solution is instilled again and procedure is repeated tilt desirable effect is obtained.

In short we can say that this is another method of removing excess of water and impurities from the blood. It is done with the help of PERITONEUM, which surrounds the intestine and other organs in the stomach area.

Types of Peritoneal Dialysis

CARD: (Continuous Ambulatory Peritoneal Dialysis)

This is the therapy in which dialysis is done through the peritoneum, manually.

CCPD: (Continuous Cyclic Peritoneal Dialysis)

This is the therapy in which dialysis is done through the peritoneum with the help of a cycled machine.

IPD: (Intermittent Peritoneal Dialysis)

This is the therapy which is mostly used to treat acute renal failure when hemodialysis treatment is not possible.

CARD & CCPD can be done by the patient himself or by his attendant.
The dialysate is introduced and drained through a soft elastic tube (catheter). Time between the filling and draining is the dwell time, in which excess water, urea and other toxic wastes diffuse from blood across the peritoneal membrane in to dialysate.

Kidney Transplantation

Kidney Transplantation means placing a kidney from another person (Donor) in to the patients (recipients) body through a major surgery.

After the successful transplant, no life long dialysis treatment is needed. The patient feels better and has more energy to enjoy life. Many restrictions that were imposed during dialysis are lifted.


For Nutrition/ Diet

For kidney failure patients, diet plays a very important role. All food contains proteins, fat, carbohydrate and minerals in varying proportion.

Please speak to our dietician for a balanced diet for you.

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