2. VARIOS DIAGNOSTIC
INVESTIGATION USED FOR
DETECTION OF CANCER
• For the
assessment
of the cancer,
first step is to
obtain
complete
history and
physical
examination
• HISTORY
3. -TIME OF ONSET OF THE DIEASE
-HOW LONG IT OCCURE?
-WHAT IS THE PROGRESS ,EITHER SLOW
OR FAST?
-SEVIARITY OF THE SYSMPTOMS
EITHER IT RECOVER WITH TREATMENT NOR
NON EFFECTIVE
-ANY TREATMENT TAKEN FOR DISEASE?
-ANY DIAGNOSTIC PROCEDURE DONE OR
NOT?
-HOW MANY TIMES FOLLOWUP DONE ?
4. • ANY FAMILY HISTORY OF THE
CANCER
-ANY ABNORMAL HABITS FOR LONG
TIME?
-WHAT IS THE OCCUPATION?
- WHAT IS THE FAMILY BACK
GROUND?
-ANY DRUG ADICTION OR NOT?
-ANY COMMUNICABLE DISEASE
OCCURE OR NOT,IF OCCUR IT IS
CURABLE OR HARMFUL?
-ANY GENETIC ABNORMALITY IN
10. Grade level Cellular characteristics
Grade -1 Low grade malignancy. Cells are similar to normal
parent tissue and have a slow growth rate. Well
differentiated in appearance and function.
Grade -2 Low to moderate grade malignancy. Cells have some
normal and some malignant cell features. The tissue of
origin is apparent.
11. Grade-3 Moderate to high grade
malignancy. Cells have
more malignant feature
than normal cell
features.
Grade-4 High grade malignancy.
Cells have no normal cell
features in appearance and
function. Poorly
differentiated or
undifferentiated. Tissue of
origin may be unknown.
13. STAGE 0 or CARCINOMA IN
SITU;
• Carcinoma in situ is very early cancer. The
abnormal cells are found only in the first layer
of cells of the primary site and do not invade
the deeper tissues.
• STAGE-1:
• Cancer involves the primary site, but has not
spread to nearby tissues.
• STAGE- 1A:
• A very small amount of cancer – visible uncer a
microscope is found deeper in the tissues.
14. • STAGE-1B:
• A larger amount of cancer is found in the
tissues.
• STAGE-2:
• Cancer has spread to nearby areas but is still
inside the primary site.
• STAGE-2A:
• Cancer has spread beyond the primary site.
• STAGE-2B:
• Cancer has spread to other tissue around the
primary site.
15. • STAGE-3:
• Cancer has spread throughout the nearby
area.
• STAGE-4:
• Cancer has spread to other parts of the body.
• STAGE-4A
• Cancer has spread to organs close to the
pelvic area.
• STAGE-4B
• Cancer has spread to distant organs, such as
the lungs.
16. TNM CLASSIFICATION
• The American joint committee of
cancer(AJCC) has developed a
simple classification solid tumors. T
refers to lthe extent primary tumor
(tumors size), N represents regional
lymph node involvement and extent
of metastasis is represented by the
letter M.
18. Mandatory parameters ("T", "N",
and "M")
• T: size or direct extent of the
primary tumor
–Tx: tumor cannot be evaluated
–Tis: carcinoma in situ
–T0: no signs of tumor
• T1, T2, T3, T4: size and/or
extension of the primary tumor
19. • N: degree of spread to regional lymph nodes
– Nx: lymph nodes cannot be evaluated
– N0: tumor cells absent from
regional lymph nodes
– N1: regional lymph node metastasis present;
(at some sites: tumor spread to closest or
small number of regional lymph nodes)
– N2: tumor spread to an extent between N1
and N3 (N2 is not used at all sites)
– N3: tumor spread to more distant or
numerous regional lymph nodes (N3 is not
used at all sites)
20. • M: presence of metastasis
–Mx: distant metastasis cannot be
evaluated
–M0: no distant metastasis
–M1: metastasis to distant organs
(beyond regional lymph node
22. How is cancer diagnosed?
• There is no single test that can
accurately diagnose cancer. The
complete evaluation of a patient
usually requires a thorough history
and physical examination along with
diagnostic testing. Many tests are
needed to determine whether a
person has cancer, or if another
condition (such as an infection) is
mimicking the symptoms of cancer.
24. • Absolute Neutrophil Count (ANC) The
ANC is calculated by multiplying the
percent of neutrophils (plus bands) by the
total number of white blood cells. This
count is used to determine if
chemotherapy can be given.
• Acid Phosphatase Also called: acid
phos, acid f, acid p‘tase. A test of blood
serum to detect a specific enzyme
produced by several tissues, particularly
the prostate.
25. • Blood Count -A blood test used to determine
the number of the various types of blood cells.
• BUN (Blood Urea Nitrogen)- Chemistry study
of blood serum to measure the level of urea in
the blood, a sign of impaired kidney function or
urinary obstruction. Normal range: 10-15
mg/100 ml.
• CA-125 -Tumor marker that may be elevated in
cancers of the ovary, breast, and colon.
• CA-19-9 -A tumor marker that may be elevated
in cancers of the colon and pancreas.
• CA15-3 -A tumor marker that may be elevated
in breast cancer.
26. • Calcium Elevated in cancer that has spread to
the bone, with tumors that produce parathyroid
hormone-like protein and in multiple myeloma,
as well as in some non-malignant diseases.
• CEA (Carcinogenic Embryonic Antigen) A
tumor marker found in the blood that may
indicate the presence of certain types of cancer
cells. Tumor marker substances may be
produced by the tumor itself or by the body in
response to a cancer.
• Creatinine Waste product in blood; is a
measure of kidney function; if elevated may
signify kidney disease..
27. • Ferritin Measures iron storage protein in sialic
acid; low levels suggest good prognosis in head
and neck malignancies.
• Leukocyte Another name for white blood cells.
A type of cell in the blood which helps defend
the body against diseases caused by bacteria,
virus, or parasites. There are three types of
leukocytes: monocyte, granuloctye, and
lymphocytes.
28. • Platelet Count Measures the number of
platelets in a drop of blood. Platelet counts
increase during strenuous activity and certain
conditions called myeloproliferative disorders:
infections, inflammations, malignancies, and
when the spleen has been removed
• Ploidy Analysis A test to measure the amount
of DNA contained in a cell. Most cancer cells
are aneuploid, which means they contain an
abnormal amount of DNA.
29. • Proliferation Index High rates indicate actively
growing tumors and a greater risk of relapse.
• PSA (Prostate Specific Antigen) A substance
(tumor marker) in the blood derived from the
prostate gland. Its level may rise in prostatic
cancer and is useful as a marker to monitor the
effects of treatment.
• S-Phase (Cell Cycle Analysis) Percentage of
tumor cells synthesizing DNA; patients with
high S-phase fraction have less favorable
prognosis.
30. • Thyroid Hormones T3 Thyroxine (T4). The
other 20% is triiodothyronine measures as T3.
Sometimes the diseased thyroid gland will start
producing very high levels of T3 but still
produce normal levels of T4. And TSH.
• Thyroblobulin Elevated levels of this serum
hormone are found in follicular carcinoma and
return to normal following treatment if all tumor
is removed; useful for monitoring residual
disease and recurrence of follicular carcinoma.
31. • Tumor Markers Chemicals in the blood that
are produced by certain cancers. Measuring the
markers is useful for diagnosis, but especially
useful for following the course of treatment.
• White Blood Count (WBC) Measures the
number of white cells; WBC elevated during
infection, inflammation, burns, leukemia, low
WBC indicates bone marrow depression–may
be present with some viruses, toxic
reactions, German measles, infectious
hepatitis, and other diseases.
33. • Tumor Marker is a molecule or process
or a substance that can be measured
with an examination (assay) both
qualitatively and quantitatively in
precancerous condition and cancer.
Changes in these levels can be caused
by tumors and normal tissue in
response to the tumor. Tumor
markers can be DNA, mRNA, protein o
parts of proteins ( such as te process o
proliferation, angiogenesis, apoptosis,
34. • Tumor markers can be found in
significant amounts in the blood or
urine of patients with cancer and can
also be found in the blood and urine
of patients with no cancer. Beside that
Tissue, saliva, body fluids, and the
cell itself can be used as a specimen
for the tumor marker test
36. • Growth hormone (GH), which is produced in the
pituitary gland under control of the
hypothalamic factors growth-hormone-releasing
hormone (GHRH) and somatostatin (SMS), is a
key stimulator of IGF-1 production. Various
IGF-binding proteins (IGFBPs) are also
produced in the liver. In IGF-responsive
tissues, the ligands IGF-1 and IGF-2 as well as
IGFBPs can be delivered through the circulation
from the liver (an 'endocrine' source), but IGFs
and IGFBPs can also be locally produced
through autocrine or paracrine mechanisms
38. Bone Marrow Biopsy and
Aspiration
• A needle is inserted into the bone of the hip or
breast bone to obtain a sample of bone marrow
for study under a microscope.
• Bone Marrow Tests
• Bone marrow tests check whether your bone
marrow is healthy. Bone marrow is a sponge-
like tissue inside the bones. It contains stem
cells that develop into the three types of blood
cells that the body needs:
39. Stereotactic Needle Biopsy
• A procedure used in the diagnosis of
brain tumors. A special frame is used
to hold the patients head stationary
while the biopsy needle is directed to
exactly the right spot. A CT scanner is
used to find the correct position. This
method has also been applied to very
small breast cancers
40. Different Types Of Biopsy
Procedures
• Some of the more common types of breast
biopsy procedures include Fine Needle
Aspiration Biopsy, Core Needle Biopsy,
Stereotactic Core Needle Biopsy, Vacuum
Assisted Core Biopsy, Circular Rotating ‗Cookie
Cutter‘ Knife, MRI (Magnetic Resonance
Imaging) guidance, Ultrasound Guided Biopsy
and Excisional Biopsy.
41. HISTOPATHOLOGY
Biopsy
• The surgical removal of a small piece
of tissue to determine if the area is
cancerous.
• A biopsy is the removal of a small
piece of tissue for laboratory
examination.
• There are several different types of
biopsies.
42. • Basically, biopsies can be divided in to 07
groups on the basis of method of removal of
tissue form the body .
• Needle biopsy
• Punch biopsy
• Incisional biopsy
• Excisional biopsy
• Currettage biopsy
• Extracting tissue piece by piece
• Endoscopic biopsy
43. • Prior to removal of tissue, the most
appropriate type of biopsy going to be
made should be determined. This
depends on varieties of factors.
• Tissue to be sampled.
• how suspicious the abnormality appears.
• Size, shape and other characteristic of
abnormalities
• The location of abnormalities
• Number of abnormalities
•
44. 1. Needle Biopsy
• A needle is inserted
through the skin to
the suspicious area
and cells are
extracted. The
needle biopsy
includes Fine Needle
Aspiration (FNA),
vacuum assist
biopsy and core
needle biopsy.
45. • Fine Needle
Biopsy
• A long thin needle
is inserted to the
suspicious area
and fluid collected
into a syringe. This
fluid is sent to the
cytology laboratory
for cellular studies.
(FNA Thyroid
46. Vacuum Assist Biopsy
• A vacuum pressure is
used to collect tissue
through a specially
designed hollow needle.
This procedure
facilitates to collect
multiple or large
samples from the same
biopsy site without
having to insert the
needle more than once.
(Example : Breast
47. Core Needle Biopsy
• Core needle biopsy is performed by
inserting a hollow core needle through the
skin to the lesion. This needle is larger
than the one used in fine needle biopsy
(gauge 16,14 or 11) and it has been
designed with a cutting tip to extract a
column or cylinder shaped of tissue from
the abnormality. The core needle biopsy is
performed when the fine needle biopsy
didn‘t provide a definitive diagnosis.
(Example : Trephine biopsy)
49. . Punch Biopsy
• A punch or circular tool
is used to extract about
6 mm deep skin layers.
This technique is
usually used by
dermatologists. The
punch biopsy is made
on exposed areas
especially oral mucosa.
(Example : Skin
biopsy, Rectum biopsy
and Oral biopsy)
50. Incisional Biopsy
• A scalpel is used
to remove a small
piece of tissue
from large lesion.
Incisional biopsy
may be used for
soft tissues.
(Example : Biopsy
from Tumors).
53. 6. Extracting Tissue piece by
piece
• Example :
Transurethral
Reaction of
the Prostate
(TURP
54. Endoscopic Biopsy
• Endoscope is a fine flexible tube with a
camera used to view the inside of the body
either through a natural body orifice or a
small surgical incision. The endoscope used
to visualize the different parts of body is
named in different names.
57. • The endoscope
can visualize the
abnormal area on
the lining of the
organ and pinch off
a tiny piece of
tissue with forceps
attached to a long
cable that runs
inside the
endoscope.
59. Conization
• A small wedge
shaped tissue
sample is
surgically removed
from the cervix
and examined for
the detection of
cancer cells.
60. Cervical Conization
• Definition
• Cervical conization is both a diagnostic and
treatment tool used to detect and treat
abnormalities of the cervix. It is also known as a
cone biopsy or cold knife cone biopsy.
• Purpose
• To found a precancerous condition in the cervix.
• Cervical conization also may be performed if
there is an abnormal cervical smear test A
biopsy is a diagnostic test in which tissue or
cells are removed from the body and examined
61. Precautions
• As with any operation that is
performed under general
anesthesia, the patient must
not eat or drink anything for
six to eight hours before
surgery
63. Procedure
• The patient lies on the table with her legs raised
in stirrups, similar to the position when having a
Pap test.
• The patient is given general anesthesia, and
the vagina is held open with an instrument
called a speculum.
• Using a scalpel or laser the doctor removes a
cone-shaped piece of the cervix containing the
area with abnormal cells.
• The resulting crater is repaired by stitching flaps
of tissue over the wound.
64. • Aftercare
• An overnight stay in the hospital may be
required. After the test, the patient may
feel some cramps or discomfort for about
a week. Women should not have sex, use
tampons, or douche until after seeing their
physician for a follow up appointment (a
week or more after the procedure).
65. RADIOLOGICAL
ASSESSMENT
• What are the different types of
diagnostic imaging?
• There are three types of imaging used for
diagnosing cancer: transmission
imaging, reflection imaging, and emission
imaging. Each uses a different process.
66. transmission imaging
• X-rays, computed tomography scans (CT
scans), and fluoroscopy are radiological
examinations whose images are produced by
transmission. In transmission imaging, a beam
of high-energy photons is produced and passed
through the body structure being examined.
The beam passes very quickly through less
dense types of tissue such as watery
secretions, blood, and fat, leaving a darkened
area on the x-ray film.
67. 1- x-ray
• X-rays are diagnostic
tests that use invisible
electromagnetic
energy beams to
produce images of
internal
tissues, bones, and
organs on film. X-rays
may be taken of any
part of the body to
detect a tumor (or
cancer).
68. How do we "see" using X-ray
light?
• when X-ray light
shines on us, it goes
through our skin, but
allows shadows of
our bones to be
projected onto and
captured by film
70. 2-computed tomography scan
(Also called a CT scan)
• A CT scan is a diagnostic imaging
procedure that uses a combination of x-
rays and computer technology to produce
cross-sectional images (often called
slices), both horizontally and vertically, of
the body. A CT scan shows detailed
images of any part of the body, including
the bones, muscles, fat, and organs. CT
scans are more detailed than general x-
rays.
71. How a CT scanner works
• CT scan (or CAT scan) stands
for Computerised (Axial) Tomography
scan. This means a scan that takes a
series of X-rays and uses a computer
to put them together. The scan is is
painless. The CT machine takes
pictures of your body from different
angles and gives a series of cross
sections or 'slices' through the part of
the body being scanned.
73. Preparation
• Change own cloth and wear hospital dress.
• Remove jwellery,pin and metal from the body.
• Remove artificial denture.
• Some CT scans need special preparation
beforehand. This is explained below for scans
of different parts of the body.
• For some scans, you will have a drink or
injection of 'contrast medium'. This is a dye that
shows up body tissues more clearly on the
scan. Before you have this, ask you about
allergies or asthma as some people can be
allergic to it. The injection may make you feel
74. Abdominal CT scans
• Not to eat or drink
after midnight the
night before the scan
• To drink a liquid
contrast medium
some time before the
scan
• To drink more of the
liquid in the X-ray
department
75. CT scans of the head
• For some brain
scans, you may
be given an
injection of the
'contrast
medium' dye
beforehand to
make the scan
clearer
76. CT scans of the chest
• For some chest
(thoracic) scans, you
may be given an
injection of the
'contrast medium' dye
beforehand. This is to
help show up the
tissues close to the
area containing the
cancer, for example
blood vessels
77. Pelvic CT scans
• Not to eat or drink for some time before the
scan
• To have an injection of 'contrast medium' just
beforehand
• Depending on the part of your pelvis being
scanned, you may have an injection of a drug to
slow down the normal movement of your bowel.
This movement (called 'peristalsis') can distort
the scan and make it more difficult to read.
78. • There is a very
detailed scan of the
bowel called a 'virtual
colonoscopy' (also
called a CT
colonography).
Instead of having a
tube and a camera
put into your bowel to
look inside (a
colonoscopy).
79. 3---- Bone scan
• How the Test is Performed
• A bone scan involves injecting a radioactive
material (radiotracer) into a vein. The
substance travels through your blood to the
bones and organs. As it wears off, it gives off
a little bit of radiation. This radiation is
detected by a camera that slowly scans your
body. The camera takes pictures of how
much radiotracer collects in the bones.
81. How to Prepare for the Test
• You must remove jewelry and other metal
objects. You may be asked to wear a hospital
gown.
• Tell your doctor if you are or may be pregnant.
• Do not take any medicine with bismuth in it,
such as Pepto-Bismol, for 4 days before the
test.
82. Why the Test is needed
• Diagnose a bone tumor or cancer
• Determine if a cancer that began elsewhere
in your body has spread to the bones;
common cancers that spread to the bones
include breast, lung, prostate, thyroid, and
kidney.
• Diagnose a fracture, when it cannot be seen
on a regular x-ray (most commonly hip
fractures, stress fractures in the feet or legs,
or spine fractures)
83. • Diagnose a bone infection
(osteomyelitis)
• Diagnose or determine the cause of
bone pain, when no other cause has
been identified
• Evaluate metabolic disorders, such as
osteomalacia, renal
osteodystrophy, primary
hyperparathyroidism, osteoporosis, co
mplex regional pain syndrome, and
84. PROCEDURE OF BONE SCAN
• First part – 20 to 30 minutes including time
taken to get ready. This will
• include injection of the radioactive liquid and
may include having some
• pictures taken straight after the injection.
• • 3 – 6 hours waiting time between
• • Second part – 30 to 60 minutes including time
taken to get ready.
• (Total 4 – 7 hours altogether)
• Injection of radioactive liquid
85. • After the Bone Scan
• You will be able to go soon after the bone scan
has finished and can continue with normal
activities.
• Staff will need to take out the needle if it is still
in your arm.
• Staff will give you any special instructions
• The radioactive liquid will pass out of your body
in your urine within 2 days. You will not notice it
as it is colourless.
• Drink plenty of fluid to help get rid of the
radioactive liquid
87. 4- lymphangiogram (LAG)
• Lymphangiography
• radiographic examination of the lymphatic
system by injection of contrast medium. The
procedure serves to visualize lymph vessels in
the upper and
lower extremities, thethoracic duct and
regional lymph nodes, particularly the
axillary, inguinal, external and common iliac and
para-aortic (lumbar) groups.
88. Indications
• 1. Oily lymphangiography has been performed
for a) detection of regional lymph node
metastases (pelvic tumours
and malignant melanomas) and in staging
of malignantlymphomas, and b) chylothorax
and pathologies of the thoracic duct (injuries,
infectious diseases, tumour invasion).
• 2. Water-soluble lymphangiography is indicated
for investigation of primary and secondary
lymphoedema.
89. 5- Mammogram
• A mammogram is an x-ray examination of the
breast. It is used to detect and diagnose breast
disease in women who either have breast
problems such as a lump, pain, or nipple
discharge, as well as for women who have no
breast complaints.
91. Types of memmography
• Digital mammography, also called full-field
digital mammography (FFDM), is a
mammography system in which the x-ray film
is replaced by solid-state detectors that
convert x-rays into electrical signals.
• Computer-aided detection (CAD) systems
use a digitized mammographic image that can
be obtained from either a conventional film
mammogram or a digitally acquired
mammogram. The computer software then
searches for abnormal areas of density, mass,
or calcification that may indicate the presence
92. • common uses of the procedure
• Mammograms are used as a
screening tool to detect early
breast cancer in women
experiencing no symptoms and to
detect and diagnose breast
disease in women experiencing
symptoms such as a lump, pain or
nipple discharge.
93. • Screening Mammography
Mammography 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.
• Diagnostic Mammography
Diagnostic mammography is used to evaluate a
patient with abnormal clinical findings—such as
a breast lump or lumps.
94. Preparation of patient
• 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
mammogram as calcium spots.
• Describe any breast symptoms or
problems to the technologist
performing the exam.
•
95. How does the procedure
work?
• X-rays are a form of radiation like light or radio
waves. X-rays pass through most objects,
including the body. Once it is carefully aimed at
the part of the body being examined, an x-ray
machine produces a small burst of radiation
that passes through the body, recording an
image on photographic film or a special digital
image recording plate.
96. Benefits
• to detect small tumors. When cancers are
small, the woman has more treatment options
and a cure is more likely.
• The use of screening mammography increases
the detection of small abnormal tissue growths..
It is also useful for detecting all types of breast
cancer, including invasive ductal and invasive
lobular cancer.
• No radiation remains in a patient's body after an
x-ray examination.
• X-rays usually have no side effects in the
97. Reflection imaging
Reflection imaging refers to the type of
imaging produced by sending high-
frequency sounds to the body part or
organ being studied. These sound
waves "bounce" off of the various types
of body tissues and structures at
varying speeds, depending on the
density of the tissues present.
99. • Ultrasound, or sonography, is the most
commonly used type of reflection imaging.
This technique uses high-frequency sound
waves and a computer to create images,
called sonograms, of blood vessels,
tissues, and organs. Sonograms are used
to view internal organs as they function
and to assess blood flow through various
vessels. Tumors in the abdomen, liver,
and kidneys can often be seen with an
ultrasound.
100. • Ultrasound Uses
• Ultrasound can be used as a
diagnostic or screening tool to
confirm medical disorders or to
assist in performing medical
procedures. It is also used as a
therapeutic tool in treating
musculoskeletal problems, renal
stones (kidney
stones), and gallstones
101. • Diagnostic or Screening Uses
• Obstetrics and gynecology: Pregnancy
ultrasound (or fetal ultrasound) is used to assess
the progression of the fetus. Vaginal ultrasound,
pelvic ultrasound, or transvaginal ultrasound is
used to diagnose growths or tumors of the ovary,
uterus, and Fallopian tubes. It can be used to
assess non-pregnancy related issues as well:
– lower abdominal pain
– ovarian cysts
– uterine fibroids
– uterine growths
– endometriosis
102. • Cardiology: . It is used to evaluate the flow
of blood through the chambers and valves of
the heart. It also assesses the strength of the
heart beat and the volume of blood pumped
through. Echocardiography is often used for the
following:
– heart valve problems, such as mitral valve
prolapse or aortic stenosis;
– congestive heart failure;
– blood clots due to irregular heart beats such as
in atrial fibrillation;
– abnormal fluid collections around the heart, such as
pericardial effusions; and
– pulmonary artery hypertension.
103. • Blood vessels: . Using Doppler ultrasound
technology, the flow of blood through the
vessels can be observed and measured.
Narrowing of vessels (stenosis) or widening of
vessels (dilatation, also referred to as
aneurysms) can be detected. Ultrasound testing
of blood vessels includes:
– carotid ultrasound,
– abdominal aorta ultrasound for
abdominal aortic aneurysm, and
– blood clots in veins (superficial or deep
venous thrombosis, or DVT).
104. • Abdominal structures: Abdominal
ultrasound is used to evaluate the solid organs
within the abdominal cavity, including the liver,
gallbladder, pancreas, kidneys, and bladder.
–Renal ultrasound is used to evaluate the
function and structure of the kidneys.
Swelling around the kidney with
blockage in the urinary tract can be
seen with ultrasound, making abdominal
ultrasound useful in detecting kidney
stones.
105. • Testicular ultrasound: Used to
diagnose testicular
torsion, epididymitis(testicle infection),
and testicular masses.
• Neck ultrasound: The thyroid and
parathyroid glands can be imaged to
detect nodules, growths, and tumors.
• Breast ultrasound: Used to image
the breasts and to guide biopsy of
breast masses to evaluate for breast
106. • Knee ultrasound: Ultrasound can be used to
evaluate the structures in the back of the knee
to determine if a Baker's Cyst is present.
• Eye ultrasound: An eye ultrasound is used to
look at the back of the eye (retina). It is often
used when a patient has cataracts that make
looking into the eye difficult. The test may help
diagnose retinal detachmentSkin
ultrasound: Ultrasound can be used to help
find certain types of foreign bodies that may
become lodged in the skin.
107. –Liver ultrasound is used to find
abnormalities in the liver tissue and
ducts.
–Gallbladder ultrasound can screen
for gallstones or an infected
gallbladder.
–Appendix ultrasound is used in
children or pregnant women, where
it is necessary to avoid radiation
from a CT scan (computerized
108. Emission imaging
• Emission imaging occurs when
tiny nuclear particles or magnetic
energy are detected by a scanner
and analyzed by computer to
produce an image of the body
structure or organ being
examined.
109. 8- Magnetic resonance
imaging (MRI)
• Definition
• Magnetic resonance imaging
(MRI) is the newest, and perhaps
most versatile, medical imaging
technology available. Doctors can
get highly refined images of the
body's interior without surgery,
using MRI.
111. • Purpose
• MRI was developed in the 1980s. The
latest additions to MRI technology
are angiography (MRA) and
spectroscopy (MRS). MRA was
developed to study blood flow, while
MRS can identify the chemical
composition of diseased tissue and
produce color images of brain
function.
112. Prescribe an MRI scan of
different areas of the body.
• Brain and head. -MRI may be needed for
patients with symptoms of a brain
tumor, stroke, or infection (like meningitis).
MRI also may be needed when cognitive
and/or psychological symptoms suggest
brain disease (like Alzheimer's or
Huntington's diseases, or multiple
sclerosis), or when developmental
retardation suggests a birth defect.
113. • Spine-MRI is particularly useful for
identifying and evaluating
degenerated or herniated spinal discs.
• Joint. -MRI scanning is most
commonly used to diagnose and
assess joint problems. MRI can
provide clear images of the bone,
cartilage, ligament, and tendon that
comprise a joint.
114. • Skeleton-The properties of MRI that allow it to
see through the skull also allow it to view the
inside of bones.
• Preparation
• In some cases (such as for MRI brain scanning
or an MRA), a chemical designed to increase
image contrast may be given by the radiologist
immediately before the exam. If a patient
suffers from anxiety or claustrophobia, drugs
may be given to help the patient relax.
115. • The patient may be asked to wear
clothing without metal snaps,
buckles, or zippers, unless a
medical gown is worn during the
procedure. The patient may be
asked to remove any hair spray,
hair gel, or cosmetics that may
interfere with the scan.
116. Positron emission tomography
(PET)
• PET is a specialized radiology procedure
used to examine various body tissues to
identify certain conditions. PET may also
be used to follow the progress of the
treatment of certain conditions. PET is a
type of nuclear medicine procedure. This
means that a tiny amount of a radioactive
substance, called a radionuclide
(radiopharmaceutical or radioactive
tracer), is used during the procedure to
assist in the examination of the tissue
117. What is PET?
• The name "PET" comes
from Positron Emission Tomograp
hy. It is a new scanning technique
in medical research. PET allows
us, for the first time, to measure in
detail the functioning of distinct
areas of the human brain while the
patient is comfortable, conscious
118. How does it work?
• A conventional "X-
ray" is taken by firing
X-rays through a
person and onto a
film. This "shadow"
image shows some
structures in the
body, such as
cartilage and bone.
119. What does a PET scan
show?
• Oxygen-15 can be used to label
oxygen gas for the study of oxygen
metabolism, carbon monoxide for the
study of blood volume, or water for
the study of blood flow in the brain.
Similarly, fluorine-18 is attached to a
glucose molecule to produce FDG for
use in the observation of the brain�s
sugar metabolism.
121. How much radiation does a
patient get?
• PET scans using radioactive fluorine
in FDG would result in patients
receiving exposures comparable to
(or less than) those from other
medical procedures, such as the
taking of X-rays. Other scanning
agents - for instance, 6-F-dopa or
radioactive water - normally cause
even less exposure.
123. DIAGNOSTIC TESTS
• Barium Enema An x-ray examination of the
colon using barium sulfate. Laxatives or
enemas may be required beforehand.
• What is Lower GI Tract X-ray Radiography
(Barium Enema)?
• Lower gastrointestinal (GI) tract radiography,
also called a lower GI or barium enema, is
an x-ray examination of the large intestine,
also known as the colon. This examination
evaluates the right or ascending colon, the
transverse colon, the left or descending colon,
125. • common uses of the
procedure-
• A physician may order a lower
GI examination to detect:
• benign tumors (such
as polyps).
• cancer.
• causes of other intestinal
illnesses
126. • The procedure is frequently performed to help
diagnose symptoms such as:
• chronic diarrhea.
• blood in stools.
• constipation.
• irritable bowel syndrome.
• unexplained weight loss.
• a change in bowel habits.
• suspected blood loss.
• abdominal pain.
• to diagnose inflammatory bowel disease, a
group of disorders that includes Crohn's
127. prepare for the procedure
• On the day before the procedure ,asked not
to eat, and to drink only clear liquids like
juice, tea, black coffee, cola or broth, and to
avoid dairy products. After midnight, you
should not eat or drink anything.
• Instructed to take a laxative and to use an
over-the-counter enema preparation the
night before the examination and possibly a
few hours before the procedure.
128. • take your usual prescribed oral
medications with limited amounts
of water.
• to remove some or all of your
clothes and to wear a gown during
the exam.
• to remove jewelry, removable
dental appliances, eye glasses and
any metal objects or clothing that
might interfere with the x-ray
129. • Women should always inform
their physician and x-
ray technologist if there is any
possibility that they are
pregnant. Many imaging tests
are not performed during
pregnancy so as not to expose
the fetus to radiation.
130. • Infants and children may
undergo lower GI radiography.
Usually, there is no special
preparation, but your doctor will
give you detailed instructions to
prepare your child for the
examination. The use of barium
and the taking of x-ray images
is similar to that described for
adults.
131. • How does the procedure work?
• X-rays are a form of radiation like light
or radio waves. X-rays pass through
most objects, including the body.
Once it is carefully aimed at the part
of the body being examined, an x-ray
machine produces a small burst of
radiation that passes through the
body, recording an image on
photographic film or a special digital
image recording plate.
132. What will I experience during
and after the procedure?
• feel abdominal pressure or even
minor cramping. Most people tolerate
the mild discomfort easily. The tip of
the enema tube is specially designed
to help you hold in the barium.
133. • several different positions. At
times, pressure may be applied to
your abdomen. With air contrast
studies of the bowel the table may
be moved to an upright position.
• After the examination, you may be
given a laxative or enema to wash
the barium out of your system.
134. • regular diet and take orally
administered medications unless
told otherwise by your doctor.
• to return to a normal diet and
activities immediately after the
examination.
• to drink additional water for 24
hours after the examination.
135. • Your stools may appear white for a
day or so as your body clears the
barium liquid from your system.
• Some people experience constipation
after a barium enema. If you do not
have a bowel movement for more
than two days after your exam or are
unable to pass gas rectally, call your
physician promptly.
136. Barium Swallow
• IT IS THE SAME PROCEDURE
AS BARIUM ENEMA BUT THE
PROCEDURE DONE FOR
UPPER GI TRACT DISEASE
• SAME PREPARATION ,SAME
METHOD AND SAME TYPE X-
RAY DONE FOR UPPER GI
TRACT.
137. ERCP (Endoscopic
Retrograde Cholangio-
pancreatography)
• An examination of the pancreas
where a tube is inserted down the
throat, through the stomach and into
the pancreas. A dye is injected and x-
rays are taken to show abnormalities.
The ERCP can also be used to obtain
tissue samples for biopsy.
138. • Upper gastrointestinal
(GI) endoscopy
• Upper GI endoscopy is
a procedure that uses a
lighted, flexible
endoscope to see and
perform procedures
inside the upper GI
tract. The upper GI tract
includes the
esophagus, stomach,
and duodenum—the
first part of the small
139. • The bile and pancreatic ducts
• Ducts are tubelike structures in the
body that carry fluids. The bile
ducts carry bile, a liquid the liver
makes to help break down food. A
group of small bile ducts—called
the biliary tree—in the liver
empties bile into the larger
common bile duct.
141. INDICATION FOR ERCP
• tumors
• gallstones that form in the gallbladder and
become stuck in the ducts
• inflammation due to trauma or illness, such as
pancreatitis—inflammation of the pancreas
• infection
• valves in the ducts, called sphincters, that won‘t
open properly
• scarring of the ducts, called sclerosis
• pseudocysts—accumulations of fluid and tissue
142. Person prepare for ERCP
• The health care provider usually
provides written instructions about
how to prepare for ERCP.
• The upper GI tract must be empty.
Generally, no eating or drinking is
allowed 8 hours before ERCP.
• Smoking and chewing gum are also
prohibited during this time.
143. Medications and vitamins that
may be restricted before and
after ERCP include
• nonsteroidal anti-inflammatory drugs, such
as aspirin, ibuprofen (Advil), and naproxen
(Aleve)
• blood thinners
• high blood pressure medication
• diabetes medications
• antidepressants
• dietary supplements.
144. • Patients should tell their health care provider
about all health conditions they have, especially
heart and lung problems, diabetes, and
allergies.
• Patients should also tell their health care
provider about all medications they take.
• Patients may be asked to temporarily stop
taking medications that affect blood clotting or
interact with sedatives, which are usually given
during ERCP to help patients relax and stay
comfortable.
145. PROCEDURE
• . Patients receive a local anesthetic
that is gargled or sprayed on the back
of the throat. The anesthetic numbs
the throat and calms the gag reflex.
• An intravenous needle is inserted into
a vein in the arm if sedatives will be
given. Doctors and other medical staff
monitor vital signs while patients are
sedated.
146. • Recovery from ERCP
• After ERCP, patients are moved to a recovery
room where they wait for about an hour for the
sedatives to wear off.. During this time, patients
may feel bloated or nauseous. Patients may
also have a sore throat, which can last a day or
two.
• Patients can go home after the sedatives wear
off. Patients will likely feel tired and should plan
to rest for the remainder of the day.
147. • Eating, Diet, and Nutrition
• Unless otherwise
directed, patients may
immediately resume their
normal diet and medications
after having an ERCP. The
health care provider can
answer any specific questions
about eating, diet, and nutrition.
148. • Risks associated with ERCP
• Significant risks associated with ERCP
include
• infection
• pancreatitis
• allergic reaction to sedatives
• excessive bleeding, called hemorrhage
• puncture of the GI tract or ducts
• tissue damage from radiation exposure
• death, in rare circumstances.
149. Estrogen Receptor Assay
• A test that determines if breast
cancer is stimulated by the
hormone estrogen.
• a microscopic examination of
breast tumor tissue used to
determine the probable response
of a tumor to endocrine therapy.
150. Frozen Section
• A diagnostic technique done by
a pathologist on a piece of
tissue removed by a surgeon.
The tissue is quick frozen,
stained, and then examined
under a microscope to
determine if it is benign or
malignant.
152. Holding the brush
Hold the brush like a pen in the
left hand and stabilize the hand
by gently resting the side of the
fifth finger on the stage (or where
ever you can find a place
depending on your hand size and
cryostatwhich approximates the
angle I hold the brush in my hand.
This results in the brush meeting
the tissue flat over its 1/4 ''
length.
153. • Turning the wheel
• Turn the wheel in a continuous
uniform motion without
hesitation. I have seen many
frozen sectionists using a brush
stop at the beginning of the
section, slowly grab the tissue
and then start to turn the wheel.
154. • Movement of the brush
•
As the block begins to move toward the knife
the brush moves downward in pace with the
block. The brush can gently rest on the bottom
2mm of the block and "ride the block" pulling
away just as the block meets the knife. It is the
downward movement of the brush that allows
you to keep a continuous motion as you grab
the section.
155. As the block
descends toward the
brush the brush
keeps pace with the
block by gently
resting on the bottom
2-3 mm of the block
and ―Riding the
156. As the block
meets the blade
and the sections
begins it‘s curl
the brush leaves
the block while
catching the
curling edge of
the
section. "Catchin
g the curl"
157. • The brush
jumps off
the block
with the
curl. "The
brush
jumps over
the blade"
158. • The brush holding
the curl pulls the
section
horizontally over
the stage like a
pulling the covers
over you in bed
without pressing
the tissue to the
stage. "Pull over
the blanket"
159. • Retrieving from stage
• Slide levers down to
gently touch the section
which will float onto the
slide with static or
cohesive attraction. Try
avoid stretching or
folding the section
during this process by
keeping the a steady
hand and the transverse
axis of the slide parallel
to the section.
160. • Retrieving
from the block
• 1) A section
is cut leaving
an attachment
of medium at
the top
161. • 2) The
wheel is
turned in
opposite
direction
bring the
section
back to the
face of the
block.
162. • 3) Section
is retrieved
by placing
the slide
over the
tissue on
the face of
the block.
164. • 1) Kidney
tubules -15
seconds
drying
• 2) Same
tissue
immediately
fixed in 95%
ETOH
165. Gallium Scan
• Radiographic imaging of the body
which measures the amount of the
radioisotope gallium that is
concentrated in a specific part of the
body. It is most useful in detecting
nodal disease above the diaphragm.
Also called: Gallium-67 scintigraphy,
Ga67 scan, high dose (8-11 mCi)
gallium scan.
167. • Preparation
• • Before you receive the
injection, there is no
preparation. You may eat and
drink
• whatever you like.
168. • Procedure
• • After you receive the injection and
before the pictures are taken, be sure
to have
• a good bowel movement. If you need
a laxative to do this, please ask for
one.
• • A small amount of the radioisotope
will be injected into a vein. You will
feel a
169. • Depending on the purpose of the scan,
it may be done 24 or 48 hours after the
• injection. Sometimes the scan is
repeated daily, over 3 to 4 days, but
no additional
• injection will be given.
• • During the scan, lie on your back on
a firm table with your head flat.
170. • very sensitive machine
(scanner) that receives and
records radiation, will move
• over your body from your
head to your toes. Many
pictures will be taken as the
• scanner moves.
171. • After the procedure
• There are no side effects, but a small amount
of radioisotope may still be present in your body
for up to 4 weeks.
• You may urinate in the toilet as usual. Your
urine and blood will be labeled
• ―Radioactive‖ if sent to the laboratory during the
first 4 weeks after the injection.
• Your body rids itself of the compound as it does
the food you eat..
172. Nuclear Scan
• A diagnostic procedure in
which a weak radioactive
substance is injected into the
blood stream. The body then
absorbs the substance. A
machine, like a giant Geiger
counter, moves over the area
being tested and takes
pictures.
173. • Nuclear Medicine Scan
• This is a test in which a small
amount of radioactivity is used
to obtain pictures of your body
with a gamma camera. These
pictures will help your doctor
make a diagnose.
174. • A small
amount of
radioactive
tracer is
injected into a
vein, usually
in your arm.
The injection
is no more
painful than a
blood test.
175. • Is the radiation dangerous?
• The amount of radiation you receive is
small; it is comparable to that of an X-
ray examination. The substances we
inject are non-toxic and will not make
you feel sick or drowsy. However, for
radiation safety reasons
children should not be brought to the
Nuclear Medicine Department.
176. • Pap Smear A microscopic examination of
cells of the cervix. This test can detect
cancer of the cervix in the early stages.
• Progesterone Receptor Assay
• A test done of a breast cancer tissue
specimen to determine if it is dependent
on female hormones for growth.
• IT IS SAME AS EOSTROGEN
RECEPTOR ASSAY PROCEDURE.