CT Scan with Contrast

CT scan with contrast
A CT scan is a technique that gives detailed images of the inside of the body. This is a painless procedure that combines the power of a sophisticated X-ray machine with that of a computer, to generate a 3D view of the inside of the body. This advanced method provides an easy way to inspect any organ of the body in much finer detail. In this procedure, the X-ray equipment rotates around the body and sends several beams to take multiple pictures of the same area from different angles, which are then put together by the computer to reveal an extremely detailed cross-sectional 3D image of the body part under examination. A normal X-ray machine uses only one radiation beam to produce an image that is not capable of giving a clear idea about the disease.

Before the procedure actually begins, you will be advised to lie down on a rectangular table. The table is then pushed until you come exactly at the center of the CT scanner machine. During the procedure, the CT scanner is seen revolving around you, clicking images from different angles. While the imaging is going on, one should not move as the resultant images appear distorted.

CT Scan Benefits

– CT scans have been extremely useful to diagnose diseases and disorders in the early stages of development. Doctors find this procedure beneficial to detect tumors early, which in turn helps to plan the treatment to prevent further complications.
– CT scanning could determine whether an artery wall has swollen, as well as find out the severity of internal injuries.
– CT scanning can also be used to know how the body is responding to treatments, like radiation therapy and chemotherapy.
– In order to diagnose diseases related to bones, such as osteoporosis, the bone mineral density needs to be ascertained, which can be effectively done using a CT scan.

CT Scan With Contrast

No doubt, CT scanning depicts sharp images of different organs but when it comes to evaluating small structures of the body, better visibility is necessary, which unfortunately CT scan alone does not provide. CT scanning that is done with the help of contrast agents can play a significant role to improve the images of the area to be examined. For better visualization of a specific area within an organ, a CT scan with contrast is a good option. Detecting inflammation in a specific part of an organ due to an infection may not be possible in the absence of contrasting agents. Unless the portion is highlighted, diagnosing it is not easy. For instance, CT scan of gastrointestinal tract shows the stomach, small and the large intestine. But, scanning with a contrasting agent will allow doctors to differentiate these organs clearly.

Contrasting agents enhance the visualization, which helps to correctly diagnose the condition. So, when it comes to making the structure of interest more visible, what better way than CT scan with contrast. This method provides superior images that allows doctors to get a better assessment of the condition. The contrast, also known as a dye, is basically a substance that is administered intravenously or taken orally during the CT scan test. These substances have the capability to weaken (attenuate) X-rays. When these substances are taken, they travel in the body and are absorbed by the organs. When the radiation beams pass through the organ containing the contrast, these X-rays attenuate significantly. As a result, the organs or the tissues that contain the contrast are highlighted, which appear as white areas on the final CT images.

– This method that involves use of contrasting agents increases the visibility of the organ to be studied. For diagnosing tumors, and to know the exact location of the tumor, sometimes a CT scan with contrast is used.
– A blood clot deep into the venous system, or blood vessel defects can be easily detected with this procedure. In other words, to find out blockages in tiny blood vessels, use of CT scan with contrast is necessary.
– This new innovative technique enhances particular structures of the organ which helps to identify the abnormalities in the organ.
– Patients undergoing this type of CT scan are instructed not to consume solid food for at least 4-6 hours before the test.
However, the patient is allowed to drink clear liquids such as water, apple juice, tea, or clear soda, prior to the CT scan.

Contrast Agents

During a CT scan, the patient may be advised to take a contrast (dye) so that resultant images of a specific part of the body have greater clarity. This may be essential to detect the presence of a foreign object, or to diagnose any minute defects in a specific organ. When the image of a specific body part is produced using a contrast agent, certain areas of the image are highlighted. In other words, a precise visualization of the specific area of the organ is achieved, which in turn helps to asses complications in the organ. Some of the most commonly used contrasts are barium, iodine, barium sulfate, and gastrografin. Contrasts are mainly administered in 4 different ways which are listed below:

– Intravenous (injected through a vein to highlight blood vessels and to get a clearer image of the structure of the organs such as the spine, liver, and the brain)
– Oral (taken by mouth for an abdomen CT scan)
– Rectal contrasts to highlight large intestines
– Inhalation

Administration of contrast agents by allowing the patient to inhale a gas, namely xenon, is an uncommon method and is followed when highly sharp images of the lungs or the brain are required. Also, this procedure is conducted at very few locations worldwide and only in rare cases.

In most cases, solution laced with diluted barium (that acts as an oral contrast ) is given to the patient before undergoing abdominal CT scan. Around 1/2 to 1 liter of oral contrast has to be consumed in a span of two hours. However, those receiving contrast intravenously (through injection) should avoid consuming both solid and liquid products as there is a high probability of suffering from stomach upset.

Chest CT/Contrast
A chest CT scan using contrast gives detailed images taken at varying angles of the different parts of the chest. The contrast media is generally given intravenously. It is a non-invasive procedure that provides increased visibility of the structures of the chest that include the lungs, heart, and surrounding bones. This method gives precise images that help to determine the presence and extent of injury. Chest CT scanning with contrast gives an in-depth view of inside the chest. This multiple-angled X-ray technique takes many sharp images of the chest.

– People having chest pain or symptoms of lung disease or difficulty in breathing may require chest CT scans with contrast.
– The procedure helps to diagnose the root cause of the problem. It looks for abnormalities such as lung tumors, blood clots, or excess accumulation of fluid around the lungs. Even conditions like pneumonia and tuberculosis can be detected with this method.
– Patients advised to undergo chest CT scans need to wear loose-fitting clothing and remove items like jewelry and other metal objects as they may interfere with the working of the machine.

Abdominal CT Contrast
In order to scan the abdomen and the large intestines, rectal CT contrasts are often administered using an enema. The most commonly used rectal contrast are gastrografin and barium sulfate, which help to enhance the images of the large intestines as well the bladder, uterus (womb) in women, and other organs contained in the pelvis. When gastrografin as a contrast is used, gastrointestinal organs that are within the abdomen are highlighted clearly in the resultant image. Sometimes, gastrografin, available as a water-based drink, is consumed to about 1000cc or 1500cc 1-2 hours prior to CT scan to get the desired result. Pregnant women are advised to stay away from abdominal scans as exposing the fetus to several beams of radiation can cause health complications in the unborn child.

Head CT Scan with Contrast
Head CT scan is often used to detect abnormalities in the brain such as tumors. The scan can help to diagnose a stroke by pointing out blood circulation problems in a specific part of the brain. It can pinpoint the arteries where blood flow has been obstructed. A head CT scan is also used to investigate jaws, sinuses (the hollow air-filled spaces around the nose) for infections such as sinusitis. People suffering from frequent dizziness, chronic headaches, or neurological disorders such as seizures may also be advised to undergo a CT head scan.

One cannot wear hearing aids, dentures, braces, and other such metal objects during a head CT scan as they can distort the resultant images. Barrettes (hair clips), eye glasses, and contact lenses are also not allowed in the CT scanner.

CT Scan Duration
The amount of time that you will spend lying still during the CT scan depends on the size of area under investigation. Larger the area of CT scan, more will be the duration of examination. Also, scanning that involves use of contrast agents is more time-consuming. In general, the CT scan examination takes a minimum of 15 minutes but the duration can extend up to 60 minutes.

Results
Although the images are generated in seconds and the procedure lasts about an hour, you do not get the results immediately nor in a couple of days. The radiologist studies and interprets the images and finally conveys it to your health care provider. So, it may take a couple of weeks before the doctor gives you the CT scan report.

Side Effects
Contrast agents that are either given orally or intravenously are eliminated out of the body through urine. So, as such bothersome side effects are unlikely to occur. However, serious health complications will occur if the patient is allergic to the contrast dye. After contrast is administered intravenously, you may experience a warm feeling that usually goes away in a short while. It is observed that oral contrasts have a bitter taste that lasts for a few minutes. In general, the side effects that may occur by using this type of CT scan are listed below:

– Vomiting and nausea
– Chills
– Fatigue
– Sneezing
– Dizziness
– Flushing
– Metallic taste in mouth
– Skin problems such as hives
– Constipation, in case of rectal contrasts
– Allergic reactions, such as swelling of the throat and difficulty in breathing

In case the patient is allergic to contrast agents, the doctor should be immediately informed so that he can take precautionary measures to prevent any adverse reactions.

CT Scan With Contrast Risks

Kidney Damage
It is crucial that people recommended for CT scan with contrast are not suffering from kidney diseases. The contrast agents that are administered either intravenously or orally will be flushed off through the urine, only if the kidneys are working correctly. The iodine contrast can cause serious damage in people with compromised kidney function. So, a blood test that evaluates kidney function is mandatory, 3 days prior to CT scan with contrast. In case, the test indicates impaired kidney function, use of contrast agents is avoided.

Cancer
A CT scan with contrast exposes you to radiation that is significantly more in magnitude than that of conventional X rays. So, frequent exposure to CT scan can put you in the risk zone of cancer. Attending just one session of CT scan also carries a small amount of cancer risk. Although high radiation exposure from CT scan is not a major risk factor in the development of cancer, unnecessary usage of this radiation-based procedure needs to be avoided. CT scan generates radiation that is 100 to 500 times more intense than the radiation delivered by the X-rays. Exposure to such high-intensity rays may inflict damage to DNA and cause cancer in the long run. So, to be on the safer side, excessive use of CT scan has to be curbed.

Protecting Kidneys from Contrast Dye

A study published in the Annals of Internal Medicine showed that taking a N-acetylcysteine tablet before a CT scan can substantially reduce the risk of kidney damage resulting from iodine contrast agents. As aforementioned, exposure to intravenous contrast dye can lead to kidney problems. This is also true for people with healthy kidney function, although the risk is minimal. However, taking this medication can help to keep the kidneys safe from contrast-induced nephropathy.

CT Scan Vs. MRI Scan

A CT scan is not the same as an MRI scan. This is because an MRI scan uses magnetic fields to generate images of internal organs as compared to X-ray beams used in CT scans. Also, MRI scans are used only in a few situations, like diagnosing brain tumors and primary bone tumors. CT scans, on the other hand, still remain one of the best medical tests and tools for early detection of various diseases.

Types of Intravenous Catheters

Types of intravenous catheters
When patients are unable to take medication or food, orally, the doctor may recommend the use of intravenous catheter or IV therapy. Catheters are flexible tubes constructed from medical-grade plastic material. They are introduced into a vein through the skin. They allow access to the venous system to administer medication or fluids to provide intravenous nutrition. Depending upon the site of access, intravenous catheters are classified into the following types:

Peripheral Intravenous Catheter

Simply put, these catheters are inserted into the veins located in the peripheral areas of the body, such as the arms and legs. Peripheral veins lie in the extremities, away from the central part of the body. So, when it comes to administering medication through these veins, peripheral intravenous (PIV) catheters are an obvious choice. Although they can be placed easily, expert help is necessary for proper insertion. These catheters are short and their length varies from 2.5 cm to 7 cm. They are manufactured in a variety of diameters from 14 gauge to 26 gauge. Also, these catheters are designed to be used for a short duration only. So, usually after a period of 72-96 hours, the catheter is removed from the site of insertion.

✦ Midline Peripheral Intravenous Catheters
When medication needs to be delivered for a longer duration, say 2 to 4 weeks, replacing PIV lines after every 3 to 4 days is not a feasible option. In such situations, midline peripheral catheters may be recommended. They are used when the duration of treatment varies from 1 to 6 weeks. The catheter, usually inserted in the upper arm, is pushed until its other end reaches the axillary region (armpit). These catheters are longer than PIV lines, with their length varying from 3 to 10 inches.

Central Venous Catheters

When larger veins located in the central circulatory system need to be accessed, experts opt for central venous catheters (CVC). This type of catheters are often introduced into the chest and pushed until their tip reaches the superior vena cava―a large diameter vein that supplies deoxygenated blood to the heart. They are also used to access the internal jugular vein (located in the neck) and the femoral vein that lies in the groin area.

Unlike peripheral catheters, the central venous catheters are longer and designed for long-term use. When access to a specific vein is needed for a longer duration, ranging from a few weeks to several months, central venous catheters are recommended. Also, their size is larger, which helps deliver large volumes of medication, blood and nutrients in a short amount of time. People suffering from chronic ailments may require long-term intravenous administration of medication. For instance, long-term treatment of antibiotics or chemotherapy may be given using central catheters. Kidney dialysis, that involves purifying the blood and removing the waste from the body, is also carried out using these catheters. The following are the main types of central venous catheters.

✦ Peripherally Inserted Central Catheter (PICC Line)
Similar to peripheral catheters, the PICC line is inserted from the extremities, such as the upper arm. However, it does not terminate into a peripheral vein. Rather, it is pushed through these veins, until it reaches the inner larger diameter veins that are in proximity to the heart. The PICC line terminates at the superior vena cava or cavoatrial junction.

✦ Tunneled Catheter
This long, flexible tube is inserted surgically―one extremity of the catheter lies close to the heart, while the other extremity of the catheter is seen danging outside the body. With the help of ultrasound and fluoroscopy, the catheter is introduced into a vein in the neck area, and then advanced into a large vein close to the heart. The other end of the catheter is tunneled subcutaneously and eventually comes out from the side of the chest. Tunneling helps to hold the catheter firmly in its position as well as decreases the chances of an infection.

✦ Implanted Port
An implanted port consists of 2 parts; the reservoir that is shaped like a disc, through which medicines or fluids are delivered. The second part is the catheter, a slender tube connected to the reservoir and placed into a large vein. An implanted port is placed in such a way that no part of it lies outside the skin. Even the disc-shaped opening of the catheter from where the medication are delivered lies completely inside the skin. Although the skin at the site of insertion may appear slightly protruding, it is hardly noticeable. The port can be placed in the extremities, but it is usually inserted in the upper chest area. With the help of a special needle, fluids and medication are delivered subcutaneously into the catheter.

Tips to Use a Stethoscope in a Proper Way

While conducting a physical assessment, doctors need skills such as inspection, palpation, percussion, auscultation, and olfaction. The term ‘auscultation’ is derived from the Latin word Auscultaure, which means ‘to listen’. In the field of medicine, auscultation is performed with the help of a stethoscope. The term ‘stethoscope’ is derived from two Greek words called stethos and scopos. While the former refers to the chest, the latter means examination. An acoustic medical instrument, the stethoscope is integral to the diagnosis. This instrument is extremely useful, when it comes to diagnosing medical conditions associated with the organs located in the chest cavity. While the stethoscope that was designed by René Laennec was made of wood, the advancement of medical science has led to the development of several designs with added features. However, even the modern acoustic stethoscopes have simplistic designs. Doctors now also have the option of using electronic stethoscopes that can even amplify sounds.

Parts of a Stethoscope

Doctors are aware of the intensity, quality, or pitch of sounds that is normally associated with certain parts of the body. If they hear any variation from the normal sounds, they can perform other diagnostic tests to confirm the diagnosis. A stethoscope helps the doctors ascertain the presence and location of abnormal sounds. At times, the absence of sounds could help in the diagnosis. For instance, the absence of bowel sounds can be an indicator of bowel problems.

Parts of a stethoscope
The components of a stethoscope include:

✦ Earpieces/eartips
✦ Binaurals (ear tubes or curved metal pipes that connect the earpieces to the tubes of stethoscope)
✦ Air-filled tube
✦ Chest piece

The headset comprises the two earpieces and ear tubes. The chest piece consists of a bell and a diaphragm. While the bell is the cup-shaped side that is used for listening to low frequencies or low-pitched sounds, the diaphragm is the flatter side that is used for high frequencies. A removable chill ring prevents the chest piece from coming in contact with the skin, and also keeps the diaphragm in place. In case of dual-frequency, tunable stethoscopes, the bell and the diaphragm are combined on one side of the chest piece. All the user needs to do is apply varying pressure to listen to low or high frequencies. Low pressure and high pressure needs to be applied to listen to low frequency and high frequency sounds, respectively.

In case of the two-sided chest piece, the user can switch between the bell and the diaphragm, depending on the frequency. It must be noted that only one part of the chest piece can work at a time. The sound can be amplified either through the bell or the diaphragm. If the sound is barely audible through the bell, it implies that the diaphragm is in the position for use. There are certain types of stethoscopes that don’t have a bell.

When the diaphragm is placed on the skin, it vibrates due to the sounds from the body. This leads to the creation of the acoustic pressure waves, which in turn travel up through the tube. The sound is transmitted from the bell or the diaphragm to the earpieces, which fit in snugly in the ears, thereby preventing other sounds from entering the ears.

How to Use a Stethoscope Properly

There are a few aspects that you need to keep in mind in order to use a stethoscope properly. Basically, you need to put the earpieces in such a way that they create an airtight seal with the ears. This is to block the noises from the outside environment, so that you can focus or clearly listen to the sounds emanating from the internal organs. Here are a few pointers on using a stethoscope in a correct way:

Eartips should point forward
✦ After placing the earpieces in the ears, adjust them so that they point slightly forward. Usually, binaurals or the ear tubes are positioned at an angle of 15°, so that earpieces can point forward and align with the ear canal. Ensure that the earpieces are a snug fit.

Eartips should be a perfect fit
✦ If you have placed the earpieces properly, the external noise will become faint. Earpieces are available in small, as well as large sizes. So, make sure that you opt for a size that is a perfect fit.
✦ Make sure that you check the earpieces on a regular basis. Look for cracks. Also, it is essential to clean the earpieces, so that auscultation is not affected by the accumulation of earwax, lint, or dirt.

Don’t place the fingertips on the edge of the diaphragm/bell
✦ The chest piece should also be held in the right manner. It must be held between the index finger and the middle finger of the dominant hand. Fingertips should not be placed on the edge of the diaphragm or bell, as that can lead to noise, which in turn will affect one’s ability to listen to the sounds from the internal organs. Make sure that the stethoscope tube doesn’t rub against the patient’s skin.

Double-sided stethoscope with a bell and diaphragm
✦ If you are using a double-sided stethoscope that has a bell and diaphragm, you will need to rotate the chest piece, so as to open the bell or diaphragm. If the diaphragm is open, the bell will be closed, and vice versa. This is to ensure that sound doesn’t come through the other part. This prevents noise interference, thereby allowing doctors to hear high or low frequency sounds properly.

Tunable stethoscope
✦ If you are using a tunable stethoscope, move the chest piece in a half circle. Once you hear a click, tap the bell and diaphragm to check which one of them is open.
✦ Make sure that the parts of the chest piece are not loose. Look for signs of damage.
✦ Do not touch the tube (tube that runs from the chest piece to the headset) while examining a patient with a stethoscope.

Place the stethoscope on bare skin to minimize noise interference
✦ Placing the diaphragm or the bell on bare skin would also help avoid noise interference that could occur due to the mixing of sounds from the body and clothes.

On a concluding note, it is essential to clean the stethoscope to ensure optimal acoustical performance, as well as reduce the risk of transmission of pathogens. It is advisable to disinfect the bell/diaphragm of the stethoscope before using it on another patient. It can be wiped with a 70% isopropyl alcohol solution. Also, make sure that it is not exposed to extreme temperature, solvents, and oils. Remove the earpieces from the tubes regularly for thorough cleaning.

List of Basic Surgical Instruments and their Uses

Surgical instruments
A surgery cannot be carried out without medical tests and tools. There are a variety of surgical instruments, each designed for a specific purpose. Some are used for making an incision while others are made to hold tissues. Using them correctly is necessary to prevent any irreversible damage to the internal organs of the body.

Basic Surgical Instruments and their Uses

– Scalpel
– Surgical Staples
– Surgical Suture
– Hemostat
– Dilator
– Scissors
– Curette
– Forceps
– Retractors
– Surgical Elevator
– Probe
– Needle Holder

Information about the most frequently used surgical instruments with their pictures is given below:

Scalpel
This is a surgical knife that comes with a sharp stainless steel blades. Whether it is a minor or a major surgery, a correct surgical incision is a must, which is not possible without a scalpel. Each and every surgery has its own specific needs. For instance, a minor surgery will require a small incision whereas a major surgery may demand an incision deep into the skin tissues. So taking this into consideration, scalpels are manufactured in a variety of sizes. The blades of scalpel are detachable and many times this instrument is designed for one time use only.

Surgical Staples
Talking about list of surgical instruments and one simply cannot forget to mention about surgical staples. Normally, an incision made or an open wound that occurs during surgery cannot be left open as it can trigger internal bleeding. A common practice is to seal these cuts using stitches but nowadays surgeons prefer to use surgical staples instead of stitches. The main advantage is that the possibility of blood leaking from a wound closed by a surgical staple is minimal. Apart from closing the incision, surgical staples are also useful to reattach and remove portions of certain organs. For instance, a bowel surgery may demand cutting certain parts of the intestine and reconnecting the remaining portion of the intestine. This can be effectively and precisely done using surgical staples.

Surgical Suture
As we all know, during surgery incisions are made to carry out the procedure. Surgical sutures, which are nothing but stitches, are commonly used to reconnect the tissues so as to close the incision after the surgical procedure is over. Sutures also help to join wound edges after an injury. This closing of wound helps to facilitate healing of the injury. Modern sutures are made from synthetic material that can be either absorbable or non-absorbable one.

As the name suggests, absorbable sutures are absorbed by the body over a course of time. The duration of absorption varies according to the type of suture material but lasts anywhere between 10 days to 2 months. When the suture is placed deep inside the body or the patient is not in a position to visit the hospital again to remove sutures, then the absorbable sutures are used. Absorbable sutures are primarily constructed from synthetic material like polylactic acid, polyglycolic acid, and caprolactone.

Non-absorbable sutures are non-biodegradable; hence cannot be broken down by the body and absorbed. The material used in making non-absorbable sutures is usually polypropylene, nylon, or polyester. Stainless steel wires that exhibit high tensile strength are often preferred to close the sternum following heart surgery. In general, Non-absorbable sutures have an advantage over their counterparts, as they cause minimal scarring. Usually these sutures are removed after a specified duration but in some cases, they are allowed to remain in position.

Hemostat
During any surgical procedure, some amount of bleeding is a given. A slight incision here and there is followed by bleeding. In order to prevent any sort of major complications, the surgeon often uses a hemostat. This is a clamp-like surgical tool that is utilized to constrict a blood vessel, which helps to minimize or stop the flow of blood during any surgical procedure.

Dilator
Surgical procedures involving the esophagus, urethra, or the cervix often require the surgeon to enlarge the opening of these tubular structures. This can be done using dilators, instruments that expand the passage, thereby allowing the surgeon to access the organ and perform the surgeon properly. These tools induce dilation to open up a tube, duct or cavity for surgical purposes.

Scissors
As the name suggests, this surgical instrument is mainly used to cut body tissues. Scissors used in surgery come in two main types: Mayo and Metzenbaum scissors. When it comes to cutting or dissecting soft delicate tissues, surgeons prefer the metzenbaum scissors. The Mayo scissors are used for cutting hard tissues such as joints. Thick tissues located in the breast and the muscles can also be cut using Mayo scissors. Usually, these scissors are made up of stainless steel and are manufactured in variable lengths.

Needle Holder
As we all know, stitching the body tissues that are cut at the time of surgery is a very important task. Even a slight mistake while sewing the tissue is likely to make the patient uncomfortable days after completing the surgery. An improperly sewn skin tissue can be a cause of great pain and may require another surgery to correct it. To avoid all these complications and to carry out sewing of tissues accurately, surgeons often make use of needle holders. These instruments allow the surgeon to hold the needle firmly while stitching the required tissue.

A needle holder that has a shape similar to a scissor, consists of straight, smooth jaws, joints and handles. It comes with a tungsten carbide inserts that are attached at the end of both the jaws. They ensure that the needle does not move while sewing tissues. In simple words, these instruments are designed to provide a strong grip on the needle, thereby substantially reducing the chances of any error during this stage of surgery.

Forceps
Forceps are like kitchen tongs that allow the surgeon to grasp and hold the skin tissues firmly. Whether it is holding a part of intestine or clamping the arteries during operation, one can always rely on these forceps. Also, this surgical instrument comes in a range of sizes so that the surgeon can choose one depending upon his specific needs. Forceps that are designed to hold a baby’s head are quite large and their main purpose is to safely remove the baby from the birth canal during a cesarean.

Curette
This surgical tool resembling to a spoon is used for taking out unwanted tissue from internal body cavities. Using the tool, the surgeon simply scrapes to scoop out the abnormal tissue. Cleaning procedure such as removing cancer growth may require use of curette.

Retractors
When an incision is made, it has to be kept open during surgery. This job of keeping the incision wide open is done by retractors. These instruments are used to pull back the tissues so that the surgeon can easily access the operation site and perform the surgery without any hindrance. Sometimes even the organs have to be held back using retractors, so as to expose the surgical site to the desired level. Retractors are made available in different sizes and shapes. Also, there are different types of retractors and each one is designed to retract a specific organ. For instance, lung retractors may be used to push aside the lungs gently for getting an unobstructed view of the surgical site. So, be it a gallbladder surgery or a breast reduction surgery, it cannot be done without retractors.

Surgical Elevator
When it comes to performing oral surgery such as tooth extraction, it is not possible without a surgical elevator. This tool is commonly used in dentistry for removing or separating affected teeth from their sockets. It is also used for separating bones from their tissues.

Probe
A probe is a long, flexible surgical tool that has a blunt end and is used for probing a wound and body cavities such as sinus tract. The instrument helps to evaluate the wound such as how deep the wound is. The direction of wound can also be assessed using this tool. As the instrument is inserted in the wound or cavity, excessive usage can trigger pain and cause pain in patients.

These are some of the basic surgical instruments and their uses. Keep in mind that it is important to choose a surgical tool that is appropriate for the procedure. Choosing the wrong tools can not only be traumatic for the patient but can also prevent the surgeon from doing his best work.

Bone Scan Cost

Factors affecting bone scan cost
A bone scan, which is also called bone scintigraphy, is one of the common types of nuclear medicine imaging procedure. Basically, nuclear medicine is a branch of imaging where radiopharmaceuticals are used for examining the function and structure of tissues and organs. Bone scintigraphy helps check the structure and function of bones. This procedure involves the administration of a small amount of radiopharmaceutical into a vein. This radioactive substance is also referred to as a radioactive tracer. Tc-99m MDP (where Tc stands for Technetium and MDP stands for methylene diphosphonate) is one of the commonly used radioactive tracers. The standard dose for adults is around 740 Mbq.

The radioactive component of the medication becomes radioactive as it breaks down. This substance causes the body part that is being studied to become radioactive for a short duration. When the ionizing radiation is emitted from the body, it is detected and measured using a gamma camera. This imaging procedure can help detect tumors, infection, or abnormalities in bones. It can also determine the extent of spread of cancer. Also, this scan can help the doctors ascertain if cancer treatment is working or not.

How Is a Bone Scan Performed

The procedure is performed under the supervision of a radiologist who has completed specific training in nuclear medicine.

➠ In the first phase, which is called blood flow phase, images are taken with the gamma camera immediately after the administration of radioactive tracer. This allows the radiologist to analyze the blood flow to the area being scanned.

➠ In the second phase, which is also called blood pool phase, the images are taken about 5 minutes after the administration of the injection. These images can help reveal any soft tissue involvement.

➠ The third phase is also called delayed phase. The radioactive tracer usually takes 2-3 hours to circulate in the blood and get absorbed in the bone. Thus, the patient is asked to come back after 2-4 hours. The person undergoing the scan is asked to empty the bladder, and remove jewelry or metallic items that he/she might be wearing. Thereafter, he/she will have to lie down on the imaging table. During this time, pictures are taken by the gamma camera. A whole body scan can take about 30-45 minutes.

While the task of measuring and administering the radioactive tracer, as well as using the equipment (gamma camera/computer) is performed by the nuclear medicine technologist, the images are interpreted by the radiologist. A bone problem is suspected when hot spots are observed. Basically, hot spots are areas of the bones that absorb more than normal amount of radioactive tracer.

Factors Affecting the Cost of a Bone Scan

A bone scan normally costs anywhere between USD 150 and USD 600. However, the overall cost might vary, depending on certain factors. These include:

Location
It’s likely that hospitals or clinics that are located in metropolitan areas charge more for the bone scan. A radiologist who has completed specific training in nuclear medicine supervises the procedure, whereas a certified nuclear medicine technologist administers the radioactive tracer and handles the equipment. The hospital/clinic charges, radiologist’s fee, and technician’s charges are likely to be higher in cities that have a higher cost of living. However, even in the metropolitan areas or big cities, one can look for non-profit hospitals that provide monetary aid to patients who are poor/uninsured. Also, certain hospitals and imaging centers with a larger patient base might perform the procedure at a lower cost.

Insurance Coverage
Many health insurance companies cover the cost of bone scintigraphy. However, those who are insured must contact their health insurance company to find out whether the full cost or a part of the cost of the bone scan is covered under their plan. You might have to pay nearly 10% to 40% less than the actual cost, depending on the type of health insurance.

Additional Cost
The overall cost is bound to increase, if an additional imaging procedure called single-photon emission computerized tomography (SPECT) is recommended. SPECT is suggested in cases where the two-dimensional images don’t suffice. For instance, imaging procedures such as the SPECT or SPECT-CT (a combination of SPECT and CT) might be recommended by the doctor when he/she suspects infections, fracture, or cancer deep within the bone. SPECT or SPECT-CT provide the three-dimensional images of the part of the body being scanned, thereby providing valuable diagnostic information, which two-dimensional (planar) images cannot provide.

Condition of the Patient
If the patient is affected by a serious medical condition, additional care needs to be taken. Under such circumstances, the patient’s condition has to be monitored while the scan is in progress. Though minimal risks are involved in bone scintigraphy, immediate medical assistance would be required, if the patient develops an allergic reaction. This might contribute to the overall cost.

On a concluding note, a bone scan is a useful imaging technique that enables the early detection of bone-related conditions. It must be noted that this procedure is not recommended for pregnant women and nursing mothers. So, consult your healthcare provider about the risks associated with this imaging procedure. Also, clarify any doubts related to its cost with the hospital/clinic and your insurance company. Those who are uninsured can find out if the hospital offers any financial assistance program.

Electrocardiogram and Echocardiogram – Know the Basic Differences

Difference between electrocardiogram and echocardiogram

Electrocardiogram (ECG or EKG) and echocardiogram (echo) are two important tests that investigate the heart’s functioning. Both tests provide an easy way to determine the health of your heart. These procedures can help diagnose an underlying abnormality in the working of the heart.

Electrocardiogram vs. Echocardiogram

Working
Electrocardiogram
✦ In an electrocardiogram, electrodes (small sensors) are attached to the chest, which measure the electrical activity of the heart. The electrodes are connected to a machine that plot a graph from the information it receives from the sensors. The graph plotted indicates the strength and pattern of electrical signals.
Echocardiogram
✦ Echo is done by keeping a small device (transducer) on the chest. The device generates high frequency sound waves that pass through the heart walls and are reflected back from the structures within the heart. The transducer receives these returning sound waves, which are then processed by a computer to generate a 2D moving image of the heart.
Function
✦ The ECG test checks your heart’s electrical system. It is this system that generates electrical signals that convey the heart when to beat. These tiny electrical pulses that regulate heartbeats are recorded by the ECG device. The test also measures the signal strength and verifies whether the heart is sending steady electrical signals.
An ECG also records the timing of your electrical signals, which indicates how fast your heart is beating. It evaluates the basic rhythm of the heart, and any disturbances in it can be easily recorded by the ECG.
✦ An echocardiogram can check the pumping capacity of your heart. It determines how well your heart pumps blood around the body, when it beats. It can check whether the heart’s pumping action is becoming weaker, a symptom associated with heart failure. It can calculate the amount of the blood that is pumped out with every heartbeat, thus, indicating the heart’s pumping strength.
Output or Results
✦ As aforementioned, the output of the ECG device is a graph that indicates the intensity and direction of electrical signals generated in the heart. The heart function is evaluated depending upon how the electrical signals get traced on the graph.
✦ With an echo, you see the live pictures of the insides of your heart. The echo test shows a 2D cone-shaped real-time motion of the heart on a monitor. Experts can actually view how the heart is beating. As a result, they are in a better position to evaluate the functioning of the heart. With advancements in the medical field, now an echo test can also show a moving 3D image of the heart. However, it is usually used to diagnose some rare complications of the heart.
Issues that Can Be Detected
✦ An ECG test can help diagnose heart rhythm problems such as heart arrhythmia that causes irregular heartbeats. It can detect if the heart is beating too hard (tachycardia) or too slowly (bradycardia). These issues often arise when the heart’s electrical activity is not working properly.
✦ A moving 2D image generated by an echo test allows accurate assessment of the heart valves. There are 4 valves, each one ensuring one-directional blood circulation through the heart. Heart valve disorders such as stenosis, atresia, and regurgitation that disturb the blood flow through the heart can be detected using echo. It can also determine how severe the valve disease is.
An echo scan can also detect sections of the heart muscle that are not working properly. It can also identify the causes of poor heart muscle function, such as inadequate blood circulation from an earlier heart attack. An echo can also help assess the heart function after a heart attack. Possible blood clots within the heart can also be located using the test.
Similarity
✦ Both ECG and echo tests can evaluate the size of the chambers of the heart. For instance, heart conditions, such as left or right atrial enlargement, can be detected through an ECG test. These tests can also identify abnormal positioning of the heart. Other cardiac structural abnormalities, such as myocarditis (swelling of the heart muscle) and pericarditis (inflammation of the tissue surrounding the heart), can also be diagnosed using an ECG and echo.
Why an Echocardiogram is Better
✦ As an echo scan provides accurate moving 2D visuals of different structures within the heart, the test is more reliable at judging heart health and its pumping action as opposed to an ECG. The direct visualization of the heart chambers in an echo scan is what makes the procedure more accurate in diagnosing heart ailments.
✦ The clarity with which the results are obtained through an echo is something that one cannot expect from an ECG test. Structural abnormalities, such as thickened heart muscle, that need to be interpreted on an ECG, are distinctly visible on an echo test. However, an ECG is better at detecting abnormal heart rhythms that cause heart palpitations, but even then, the doctor may recommend an echo rest to find out the cause of heart rhythm irregularities. On the whole, though an ECG can detect abnormalities in the heart structure, a confirmation is often necessary through an echocardiogram.