Diagnostic Tests and Procedures

Imaging Tests

Imaging plays an important role in modern medicine. Medical imaging refers to several different technologies used to view the human body in order to diagnose, monitor or treat medical conditions. Each type of technology gives different information about the area of the body being studied or treated, possible disease or injury, or effectiveness of medical treatment. Some of the most common types include but are not limited to:

• Angiogram
• Bronchoscopy
• Computed Tomography
• Coronary Calcium Scoring
• Echocardiogram
• Endoscopy
• Lung Scan
• Lymphoscintigraphy
• Magnetic Resonance Imaging
• Positron Emission Tomography
• Ultrasound
• Venogram
• X-Rays

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Angiogram

An angiogram is an X-ray procedure that can be both diagnostic and therapeutic. It is considered the gold standard for evaluating blockages in the arterial system. An angiogram detects blockages using X-rays taken during the injection of a contrast material (iodine). The purpose of using the contrast material is to enhance and increase the information that the doctors may already have from other diagnostic tests (e.g. CT scans, ultrasounds, MRIs, etc.) in order to develop a more detailed picture of your current condition.

Angiography can be performed in several body parts, including but not limited to: Coronary (heart), pulmonary (lungs), renal (kidneys), carotid (neck) and cerebral (brain). Angiograms can help diagnose various conditions, including but not limited to: stroke, aneurysms, arteriovenous malformations, tumors, blood clots, and arterial stenosis.

Angiograms are usually performed while you are sedated. Angiograms usually take place at the hospital. The procedure may last 15-20 minutes or up to several hours, depending on how difficult the test is and how much treatment is given. Depending on your condition, you may be able to go home the same day or may need to stay one night in the hospital. Check with your doctor for further details.

Bronchoscopy

Bronchoscopy is a procedure that looks inside the lung airways. It can detect tumors, esophageal strictures, pneumonia, and interstitial pulmonary disease, signs of infection, excess mucus in the airways, bleeding, or blockages in the lungs. It also can allow your doctor to take samples of tissue for other laboratory tests, as well as to insert airway stents, or small tubes, to keep your airway open to treat some lung problems.

During the procedure, the bronchoscope is placed in your nose or mouth. The bronchoscope has a light and a very small camera at its tip that displays pictures on a monitor to help guide your doctor in performing the procedure. The bronchoscope is advanced slowly down the back of your throat, through the vocal cords and into the airways. It may feel uncomfortable, but it shouldn't hurt. Samples of tissue and fluid may be taken and procedures may be performed using devices passed through the bronchoscope.

A bronchoscopy will take place at an outpatient setting or within the hospital. The procedure will take 30-60 minutes. Check with your doctor for further details.

Computed Tomography

A computed tomography (CT scan) is similar to an MRI in that it produces detailed, high-quality images of the body. The CT scan is a more sophisticated and powerful X-ray that takes a 360-degree image of internal organs, the spine and vertebrae. Some of the most common uses for CT scanning include:

• To examine people with internal injuries resulting from car accident or other types of trauma.
• To detect different types of cancers.
• To visualize the heart anatomy, coronary circulation and great vessels (cardiac computed tomography).

CT scans usually take place in an outpatient setting (e.g. doctor’s office, imaging centers) or at the hospital. CT scans will usually take 15 to 30 minutes to complete. Check with your doctor for further details.

Echocardiogram

An echocardiogram (ECHO) uses high-frequency sound waves (ultrasound) to create images specifically within your heart. The images reproduced are of your heart’s chambers, walls, valves and the blood vessels attached to your heart. Using these images, your doctor can identify:

• The size and shape of your heart, and the thickness and movement of your heart’s walls.
• How your heart moves and the heart’s pumping strength.
• If the heart valves are too narrow (stenosis) and/or if they are working correctly.
• If blood is leaking backwards through your heart valves (regurgitation).
• If there is a tumor or infectious growth around your heart valves.
• Potential problems with the outer lining of your heart (pericardium).
• Potential problems with the large blood vessels that enter and leave the heart.
• Blood clots in the chambers of your heart.
• Abnormal holes between the chambers of the heart.

Echocardiograms usually take place in an outpatient setting (e.g. doctor’s office, imaging centers) or at the hospital. ECHOs will usually take 30 to 45 minutes to complete. Check with your doctor for further details.

Endoscopy (Upper Endoscopy)

An endoscopy is used to diagnose and, sometimes, treat conditions that affect the upper part of your digestive system, including the esophagus, stomach and beginning of the small intestine (duodenum). Some of these conditions include gastroesophageal reflux disease (GERD) and achalasia.

During an endoscopy, your doctor will insert the endoscope (flexible tube with a camera) in your mouth. Your doctor may ask you to swallow as the scope passes down your throat. You may feel some pressure in your throat, but you generally shouldn't feel pain. As the endoscope continues down your throat, the tiny camera at the tip transmits images to a video monitor in the exam room. Your doctor watches this monitor to look for abnormalities in your upper digestive tract. If abnormalities are found in your digestive tract, your doctor may record images for later examination.

An endoscopy is sometimes combined with other procedures, such as:

• Endoscopic ultrasound. If needed, an ultrasound probe may be attached to the endoscope to create specialized images of the wall of your esophagus or stomach. An endoscopic ultrasound may also help your doctor create images of hard-to-reach organs, such as your pancreas.

• Upper endoscopy with tissue biopsy. If needed, a biopsy will also be acquired. Your doctor will pass special surgical tools through the endoscope to collect a tissue sample or remove a polyp.

Endoscopy will take place at an outpatient setting or within the hospital. The test will take 15 to 30 minutes. Check with your doctor for further details.

Lung Scan

A lung scan uses a special camera to take pictures of the lungs after a radioactive tracer is put into the body. This radiotracer substance is typically injected into the bloodstream, inhaled or swallowed. The radiotracer travels through the area being examined and gives off energy in the form of gamma rays which are detected by a special camera and a computer to create images of the inside of your body. Lung scans are typically often used to find a pulmonary embolism. This is a blood clot that prevents normal blood flow in the lung.

Two types of lung scans are usually done together: Ventilation and perfusion scans. A ventilation scan looks at how air moves in and out of your lungs. While a perfusion scan looks at the blood flow within your lungs.

If both scans are done, the test is called a V/Q scan. In most cases, if the lungs are working as they should, both scans will show that the parts of the lungs that are getting air are also getting blood. If the two scan results don't match, the differences can help your doctor diagnose a problem with your lungs.

Lung scans usually take place at the hospital. Lung scans will usually take 15 to 30 minutes to complete. However, it may take longer if both scans are done. Check with your doctor for further details.

Lymphoscintigraphy

Lymphoscintigraphy helps evaluate your body's lymphatic system for disease using small amounts of radioactive materials called radiotracers that are typically injected into the bloodstream, inhaled or swallowed, or in the case of lymphoscintigraphy, injected into the skin. The radiotracer travels through the area being examined and gives off energy in the form of gamma rays which are detected by a special camera and a computer to create images of the inside of your body. Because it is able to pinpoint molecular activity within the body, lymphoscintigraphy offers the potential to identify lymphatic disease in its earliest stages. It can also help plan for a biopsy or surgery that will help assess the stage of a type of cancer. Lymphoscintigraphy is also helpful in identifying points of blockage in the lymphatic system, such as lymph flow in an arm or leg, or lymphedema.

A lymphoscintigraphy usually takes place at the hospital. A lymphoscintigraphy usually takes 1 to 2 hours to complete. Consult with your doctor for further details.

Magnetic Resonance Imaging

Magnetic Resonance Imaging (MRI) uses a powerful magnet and radio waves to create detailed, high-resolution cross-section images of bones and soft structures inside the body. MRI, similar to an ultrasound, does not include radiation, as X-rays and CT scans do.

MRIs allow your health care provider to evaluate various parts of the body, including but not limited to:

• Brain
• Heart and blood vessels (cardiac MRI)
• Bones and joints

MRIs can also determine the presence of certain diseases and monitor how well you are doing with treatment. MRIs usually take place in an outpatient setting (for example, doctor’s office, imaging centers) or at the hospital. MRIs usually take up to 1 hour to complete. Check with your doctor for further details.

Positron Emission Tomography

A positron emission tomography (PET) scan is an imaging test that helps reveal how your tissues and organs are functioning. This scan can sometimes detect disease before it shows up on other imaging tests. A PET scan uses a radioactive drug (tracer) to show this activity. The tracer may be injected, swallowed or inhaled, depending on which organ or tissue is being studied. The tracer collects in areas of your body that have higher levels of chemical activity, which often correspond to areas of disease. On a PET scan, these areas show up as bright spots. Often, PET images are combined with CT or MRI scans to create special views.

The procedure will take place at an outpatient setting or within the hospital. The procedure takes 30-60 minutes. Check with your doctor for further details.

Ultrasound

A “traditional” ultrasound uses high-frequency sound waves to create images of the inside of the body. Similar to an MRI, an ultrasound does not use ionizing radiation, unlike X-rays and CT scans do. Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels. Ultrasounds are often used to evaluate:

• Pregnancy
• Abnormalities in the heart and blood vessels.
• Organs in the pelvis and abdomen.
• Symptoms of pain, swelling and infection.
• Assess joint inflammation (synovitis).
• Detect genital and prostate problems.
• Diagnose gallbladder disease.
• Evaluate metabolic bone disease.
• Examine a breast lump.

Ultrasounds usually take place in an outpatient setting (e.g. doctor’s office, imaging centers) or at the hospital. An ultrasound usually takes 30-45 minutes to complete. Check with your doctor for further details.

• Duplex ultrasound. This type of ultrasound evaluates the blood flow through your arteries and veins. Your doctor is able to see the speed and direction of your blood flow and where your blood flow may be blocked. Veins are also tested to help detect a clot or reflux. A duplex ultrasound combines two types of ultrasounds:
  • Traditional ultrasound. Described above.
  • Doppler ultrasound. This type of ultrasound is used to estimate how fast blood flows through your blood vessels. This is compared to a traditional ultrasound, which only produces images but is unable to show blood flow.
  A duplex ultrasound is used to diagnose many conditions, including:
  • Blood clots
  • Poorly functioning valves in your leg veins, which can cause blood or other fluids to pool in your legs (venous insufficiency).
  • Heart valve defects and congenital heart disease
  • A blocked artery (arterial occlusion).
  • Decreased blood circulation into your legs (peripheral artery disease).
  • Bulging arteries (aneurysms)
  • Narrowing of an artery, such as in your neck (carotid artery stenosis).
  • Varicose veins
  • Renal vascular disease

Venogram

A venogram is an X-ray test that involves injecting contrast material into a vein to show how blood flows through your veins. This will enable your doctor to determine the condition of your veins. A venogram is commonly used to: Assess the status of a vein or system of veins; find blood clots within the veins; assess varicose veins before surgery; find a vein in good condition to use for a bypass procedure or dialysis access; place an IV or a medical device; and guide treatment of diseased veins.

The procedure will take place at an outpatient setting or within the hospital. Check with your doctor for further details.

X-Rays

X-rays are the most common and widely available diagnostic imaging technique. An X-ray is a form of electromagnetic radiation that can pass through solid objects, including the body. X-rays are used to take pictures of the structures inside of your body, including organs, tissues and bones of the body.

X-rays penetrate different objects more or less according to their density. For example, the calcium in your bones makes them denser, so they absorb more radiation and appear white on X-rays. Thus when a bone is broken (fractured), the fracture line will appear as a dark area within the lighter bone on an X-ray film. Less dense tissue such as muscle or fat absorbs less, and these structures appear in shades of gray on X-ray film. Air absorbs little of the X-rays, so the lungs and any air-filled cavities appear black on an X-ray film.

X-rays usually take place in an outpatient setting (e.g. doctor’s office, imaging centers) or at the hospital. X-rays usually take less than 30 minutes to complete. Check with your doctor for further details.

• Chest X-rays: Chest X-rays can help spot abnormalities or diseases of the airways, blood vessels, bones, heart and lungs. Chest X-rays can also determine if you have fluid in your lungs, or fluid or air surrounding your lungs. You might also need a chest X-ray if you go to the emergency room with chest pain or if you’ve been involved in an accident that included force to your chest area. Other situations when a chest X-ray may be recommended include:
  • To monitor your progress after surgery to the chest area.
  • To see the size and shape of your heart. Abnormalities in the size and shape of your heart can indicate issues with heart function.
  • To check that all implanted materials are in the right place (i.e. pacemakers and implantable cardioverter defibrillators).
• X-rays (barium swallow test): A barium swallow test is a special type of imaging test that uses barium and X-rays to create images of your upper gastrointestinal (GI) tract. Your upper GI tract includes the back of your mouth and throat (pharynx) and your esophagus. It is typically done to look for and diagnose cancer of the head and neck, pharynx or esophagus; hiatal hernia; esophageal strictures; enlarged veins; dysphagia or spams; achalasia; gastroesophageal reflux disease (GERD); among others.
  During the procedure, you will swallow a barium drink. As you swallow the barium, your doctor will take pictures and a series of X-rays, and watch the barium moving through your mouth and throat. This will help identify the exact location of the problem.
  The procedure will take place in an outpatient setting or within the hospital. The test will only take a few minutes. Check with your doctor for further details.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.