Spinal X-ray Test
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Mammogram
14.19 If a mammogram shows signs of a mass or cyst, what would you expect the healthcare provider to order?
A breast ultrasound might be ordered to determine if a mass is a cyst or solid mass.
14.20 Is a mammogram used to diagnose breast cancer?
No. Suspicious masses are biopsied to determine if the mass is cancerous.
14.21 What would you tell a pregnant woman who wants a mammogram?
A mammogram is not normally performed if the patient is pregnant. If the mammogram must be performed, a lead apron is placed over the patient’s abdomen.
14.22 Which has the higher degree of accuracy: a digital mammogram or an X-ray mammogram?
A digital mammogram is considered to have the same accuracy as an X-ray mammogram.
14.23 What would you say to a pregnant woman who wants to have a mammogram a few weeks after giving birth?
A mammogram is not performed if the patient is breast-feeding.
14.24 What must be assessed before the patient is given a mammogram?
Assess if the patient:
• Is pregnant
• Is breast-feeding
• Has breast implants
• Removed all powders, deodorant, ointments, or perfume from the breast, since these may appear on the X-ray image
• Was scheduled within 2 weeks after the end of the patient’s menstrual period to reduce tenderness of the patient’s breasts
• Had any previous breast biopsies; identify their locations 14.25 What might an abnormal mammogram reveal?
An abnormal mammogram might reveal signs of a cyst, signs of a solid mass, or signs of calcification.
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C H A P T E R 1 5
Computed Tomography (CT) Scan
15.1 Definition
Acomputed tomography(CT) scan makes detailed images of structures within the body using a doughnut- shaped X-ray machine. As the patient lies within the scanner, an X-ray beam rotates around the patient, creat- ing an image that represents a thin slice of the patient. Each rotation takes less than a second. All slices are stored on a computer. The computer is used to reassemble slices of the patient, enabling the healthcare provider to identify any abnormalities. Typically, the healthcare provider will print the image of any slices that indicate an abnormality, which are then saved with the patient’s chart. The patient may be administered contrast mate- rial, such as iodine dye. The contrast material makes structures within the patient’s body stand out on the com- puter by differentiating them in white, black, and shades of gray. Contrast material is administered intravenously or into joints or cavities of the body. The patient may also be asked to ingest other kinds of contrast material.
A CT scan may be used for staging cancer to assess if the cancer has spread to other sites in the body. CT scans are also used to identify masses or tumors, as well as fluid and the infection process. CT scans guide the health- care provider when performing a procedure such as a biopsy.
15.2 Full Body CT Scan
A full body CT scan creates an image of the patient’s entire body. A healthcare provider orders a full body CT scan if:
• It is suspected that the patient may have disorders throughout the body.
• The healthcare provider is unable to narrow the disorder to specific areas of the body, such as if the patient is involved in a severe motor vehicle accident.
Typically, a healthcare provider orders a CT scan for a specific part of the body rather than ordering a full body scan. A full CT scan is time consuming and usually provides more information than is necessary for the health- care provider to diagnose the patient’s disorder. Some healthcare providers feel that a full body scan identifies benign growths and other disorders that do not adversely affect the patient and could lead to additional tests and surgery that are unnecessary. The result of a CT scan is commonly compared to the results of a positron emis- sion tomography (PET) to identify cancer. Determine if the patient is allergic to shellfish or iodine. Contrast mate- rial may contain iodine and other substances that could cause the patient to have an allergic reaction. Also determine if the patient will be administered a sedative to relax him or her during the CT scan. If so, the make sure the patient does not drive following the CT scan until the sedative has worn off.
Why the Test Is Performed
The test assesses for growths, obstructions, inflammation or infection, foreign objects, bleeding, fluid collection, and pulmonary embolism.
Before Administering the Test
Assess if the patient:• Has allergies (to shellfish, iodine)
• Is breastfeeding; since contrast material can pass to the baby in breast milk, the patient should be prepared to use formula instead of breast milk for 2 days following the CT scan if contrast material is administered
• Has heart disorder, asthma, thyroid disorder, kidney disorder, or diabetes
• Takes Glucophage
• Has taken Pepto-Bismol four days prior to the CT scan Determine if the patient:
• Is claustrophobic
• Can lie still during the test
How the Test Is Performed
• Depending on the area or region of the body that is being scanned, the patient may be administered an enema or asked not to eat after midnight prior to the CT scan.
• If contrast material is required for the test, then the patient is administered the contrast material before the test. The method for administering the contrast material depends on the nature of the CT scan:
• Approximately 40 minutes before the test, the patient may be asked to ingest contrast material.
• Contrast material may be administered in a vein or in a cavity such as the bladder or rectum immediately before the test.
• The patient removes jewelry and clothes and is given a gown to wear during the test.
• The patient lies on the CT scanner table.
• The patient must lie still during the test.
• The patient will be in the CT room alone.
• The CT scan technician is in the next room observing through a window.
• The patient and the CT scan technician are able to converse during the test using an intercom.
• The CT scanner table moves into the opening of the CT scanner.
• The CT scanner moves around the patient when taking images of the patient.
• The patient hears a clicking sound as the CT scanner moves.
• The CT scan can take up to two hours.
• A radiologist who is a medical doctor interprets the results of the CT scan and writes a report that is given to the patient’s healthcare provider.
• For 24 hours following the CT scan, the patient is asked to drink large amounts of water and other fluids to flush the contrast material from his or her body.
Teach the Patient
Explain why the CT scan is being administered, what the CT scan test does, and why contrast material may be administered. Explain that the contrast material may leave a metallic taste and that the patient may feel flushed when the contrast material is administered intravenously. Also explain that the healthcare provider may ask the patient to stop taking Glucophage several days before the CT scan, since there might be a reaction with contrast material, and that some patients may be allergic to the contrast material. It should be explained to the patient that the healthcare team is ready to take measures to reverse any adverse reaction to the contrast material. Inform the patient that the healthcare provider may ask the patient to stop breastfeeding for 2 days following the CT scan if contrast material is administered, that the patient will be asked to drink a large amount of water for 24 hours following the CT scan if contrast material is administered, and that the healthcare provider may admin- ister a sedative prior to the test if the patient is unable to relax during the test. If a sedative is administered, the patient should arrange for someone else to drive him or her home following the test.
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Understanding the Test Results
The result is available within 2 days.• Normal:
• Normal size organs and blood vessels
• No blockages
• No bleeding
• No abnormal fluid collection
• No growths
• No inflammation
• Abnormal:
• Abnormal size of organs and blood vessels
• Blockages
• Bleeding
• Abnormal fluid collection
• Growths
• Inflammation
15.3 CT Scan of the Head
The CT scan of the head produces sliced images of the patient’s skull and brain. The patient’s head is placed into the CT scanner as the CT scanner takes sliced images of the patient’s skull, brain, and other parts of the patient’s head. The healthcare provider may order a perfusion CT. A perfusion CT is used to determine the blood supply to areas of the brain. Contrast material is administered intravenously. Areas of the brain that receive blood are highlighted on the computer image by the contrast material. Areas without blood flow are not highlighted.
Why the Test Is Performed
The test assesses for growths, obstructions, inflammation or infection, foreign objects, bleeding, fluid collection, headache, vertigo, vision problem, broken bones, the result of facial surgery, temporomandibular disorder, Paget’s disease, stroke, and reasons for a change in the patient’s level of consciousness. The test also provides baseline images before surgery.
Before Administering the Test
• See Full Body CT Scan
• Assess if the patient has removed glasses, contact lenses, and hearing aids
How the Test Is Performed
• See Full Body CT Scan.
• The CT scan of the head takes approximately 30 minutes.
Teach the Patient
See Full Body CT Scan. Explain that contrast material may be administered intravenously and flow throughout blood vessels in the brain, showing the areas of the brain that are receiving blood and those not receiving blood.