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EXPLAINING PROCEDURES COMPLETE

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EXPLAINING PROCEDURES COMPLETE Powered By Docstoc
					 EXPLAINING
PROCEDURES


1.    Bronchoscopy
2.    Gastroscopy (OGD- Oesophagogastroduodenoscopy)
3.    Colonoscopy
4.    Sigmoidoscopy
5.    Chest X-ray
6.    Abdominal X-ray
7.    Barium Meal (Barium Swallow, Barium Follow Through)
8.    Barium Enema
9.    IV Urogram (IV Pyelogram)
10.   CT scan – Computed Tomography scan
11.   MRI scan- Magnetic Resonance Imaging
12.   Ultrasound Scan
13.   Echocardiography
14.   Doppler scan
15.   ERCP- Endoscopic Retrograde Cholangio Pancreatography
16.   Isotope Scans (Lung, Bone, Thyroid)
                              1
Explain Procedure: Bronchoscopy

 Introduction                                                                                                     Done
1. Introduction (full name & role), state purpose.
2. Take consent, gain patient’s name and DOB.
3. Ask if they’ve had a bronchoscopy before and what they already know.
4. Ask the patient what they would like to know and if they have any concerns.
5. Tell the patient briefly what the procedure is and why it is being done
    This is where an operator looks into your airways using flexible telescope which is as thin as a pencil. It
    is passed through the nose, down the back of the throat and into the windpipe. It has a bright light and
    a camera on the end which allows the operator to see down your wind pipe and into your airways. The
    pictures will appear on a screen.
    May be passed through mouth if nasal passage is too narrow.
    You may want to ask the patient if they have nosebleeds.
 Before the Procedure
6. Patient should not eat 4-6 hours before the bronchoscopy; sips of water are okay up to 2 hours before.
7. Doctor may need to review your medication- eg pts on warfarin and aspirin must stop. May do a blood
    test to check clotting.
8. The operator will numb the inside of your nose and back of throat by spraying some anaesthetic –
    bitter.
9. You will be given a sedative to relax, which will be injected into the back of your hand (cannula)- it will
    make you drowsy, but not put you to sleep. You will not be able to drive home- bring someone with
    you or arrange transport.
10. You may be connected to a monitor to check heart rate, blood pressure, oxygen content of the blood.
    A nurse will also be there to assist the doctor/bronchoscopist.
 During the Procedure
11. You will be asked to sign a consent form to ensure you understand the procedure.
12. Bronchoscope is gently guided through your nose and down your wind pipe- it might make you cough
    and be a bit uncomfortable.
13. It will not affect your breathing at all.
14. The operator may take a sample of tissue (biopsy), which is painless- you might feel a slight tugging.
15. Bronchoscope is then removed gently and painlessly.
16. The procedure lasts 20 – 30 minutes.
 After the Procedure
17. Allowed to rest for a short while and then can go home as soon as the procedure has finished, but need
    to be accompanied due to the sedative.
18. You should not drive, operate machinery or drink alcohol 24hours after having the sedative.
    ?ask about work and taking time off if appropriate
19. They can eat normally 2 hours after the procedure.
20. Risks/ Complications:
              a. Sore nose or throat (1 day usually)
              b. Tired after sedative.
              c. Slightly increased risk of throat or chest infection.
              d. If biopsy taken you may cough up a small amount of blood- if >1 tablespoon, go to GP.
              e. A collapsed lung may occur, but this is rare.
21. Will be followed up in clinic in a few weeks.
22. Ask the patient if they have anymore questions and tell them to let the nurse know if they’re coughing
    up blood (>1 tablespoon) immediately or to go to your doctor.
23. Ask the patient to repeat almost everything you have said.

Indications
 ?Bronchial CA                                                     Biopsy a mass
 Abnormalities on CXR eg shadowing                                 Rigid bronchoscope used to remove foreign
 Persistent cough                                                   bodies eg peanut
 Coughing up blood (haemoptysis)
                                                            2
Explain Procedure: Gastroscopy (OGD)

Introduction                                                                                                  Done
    1. Introduction (full name & role), state purpose
    2. Take consent, gain patient’s name and DOB
    3. Ask if they’ve had a gastroscopy before and what they already know
    4. Ask the patient what they would like to know and if they have any concerns
    5. Tell the patient briefly what the procedure is and why it is being done
        This is where an operator passes a flexible telescope which is as thin as a pencil down the back of
        your throat to have a look at your food pipe/gullet, stomach and a part of your small intestine. It
        has a bright light and a camera on the end which allows the operator to see into your gut. The
        pictures will appear on a screen.
Before the Procedure
    6. Should not eat 4-6 hours before the gastroscopy because the stomach needs to be empty.
    7. The operator will numb the back of the throat by spraying some anaesthetic – bitter.
    8. Will be given a sedative to relax, by injecting it into the back of the hand (cannula).
    9. Patient will be given a plastic mouth guard between their teeth to keep the airway open and to
        stop biting the endoscope.
    10. May be connected to a monitor to check heart rate, blood pressure, oxygen content of the blood.
        Nurses will be there to assist the doctor/operator and help you with anything if you need it.
    11. You will be given advice about medication which may need to be stopped before the test. (e.g.
        Aspirin, Warfarin – bleeding)
During the Procedure
    12. You will be asked to sign a consent form to ensure you understand the procedure.
    13. Endoscope is gently passed through your mouth and down your food pipe.
    14. It will not affect your breathing.
    15. Air is passed into the endoscope to make the stomach lining easier to see, and this may make the
        patient feel full and want to burp.
    16. The doctor/operator may take a sample of tissue (biopsy), which is painless.
    17. The procedure lasts 20-30 minutes, when finished the endoscope will be removed gently and
        painlessly.
After the Procedure
    18. You can go home as soon as the procedure has finished, but need to be accompanied due to the
        sedative.
    19. Should not drive, operate machinery or drink alcohol 24 hours after having the sedative.
    20. Can eat normally after the procedure.
    21. Risks/ Complications:
             a. Sore throat (1 day).
             b. Tired due to sedative.
             c. Slight risk of throat or chest infection.
             d. Damage to the gut can rarely occur, but see a doctor if there is abdominal pain, fever,
                 SoB, vomiting blood or any other problems.
             e. A small number of elderly people have a heart attack or stroke during or soon after.
    22. They will be followed up in clinic in a few weeks.
    23. Ask the patient if they have anymore questions- anything you would like me to clarify.
    24. Ask the patient to repeat almost everything you have said

Indications:
 Peptic or duodenal ulcers                                       Recurrent indigestion
 ? Oesophageal or gastric CA                                     Upper abdominal pains
 Oesophagitis or gastritis                                       Difficulty swallowing (dysphagia)
 Abnormalities seen in other investigations eg                   Recurrent vomiting
    barium swallow



                                                          3
Explain Procedure: Colonoscopy

Introduction                                                                                                  Done
    1. Introduction (full name & role), state purpose
    2. Take consent, gain patient’s name and DOB
    3. Ask if they’ve had a colonoscopy before and what they already know
    4. Ask the patient what they would like to know and if they have any concerns
    5. Tell the patient briefly what the procedure is and why it is being done
        This is where an operator places a flexible telescope, which is as thin as pencil, up the back
        passage to have a look at the large intestine. It has a bright light and a camera at the end so we
        can see into you intestines/bowel. The pictures will appear on a screen.
Before the Procedure
    6. No food 6 hours before, but plenty of clear liquids. IDDM?
    7. Patient will be given powerful laxatives to clear the colon.
    8. Patient will be given a sedative to relax, by injecting it into the back of the hand (cannula).
        Arrange transport in order to get home as you will be drowsy after the procedure.
During the Procedure
    9. You will be asked to sign a consent form to ensure you understand the procedure.
    10. You will be given a hospital gown. You will be asked to lie on a bed on your side during the
        procedure with your knees to your chest.
    11. Monitored throughout- HR, BP, oxygen.
    12. Doctor/nurse will insert a gloved, lubricated finger into your back passage to check for blockages.
    13. Colonoscope gently passed into the back passage inside the colon liquid jelly used to make it
        easier-may feel a bit cold. Process may be uncomfortable, but won’t be painful.
    14. May feel like passing faeces or wind, but this is natural so please don’t feel embarrassed!
    15. Air is passed into the colonoscope to make the colon lining easier to see, and this may make the
        patient feel full and want to pass wind.
    16. The doctor/operator may take a sample of tissue (biopsy), or remove polyps, which are both
        painless
    17. The colonoscope is gently removed from your back passage.
    18. The procedure lasts 20-30 minutes.
After the Procedure
    19. They can go home as soon as the procedure has finished, but need to be accompanied due to the
        sedative.
    20. They should not drive, operate machinery or drink alcohol 24hours after having the sedative
    21. They can eat normally after the procedure
    22. Risks/Complications:
        a. Tired due to the sedative.
        b. Damage to the bowel can rarely occur, but see a doctor if you experience abdominal pain,
             fever, SOB, vomiting blood.
        c. Feeling bloated and having “wind-pains” (usually passes quickly).
        d. After a biopsy a small amount of blood may be visible in the stool.
        e. Damage/perforation of bowel- rare.
        f. In a few cases the colonoscopy may have to be repeated.
    23. They will be followed up in clinic in a few weeks.
    24. Ask the patient if they have any more questions.
    25. Ask the patient to repeat almost everything you have said

Indications
 Bleeding from the anus                                          Colorectal cancer
 Lower abdominal pains                                           IBD
 Persistent diarrhoea                                            Diverticular disease
 Abnormalities seen on other scans such as a                     Polyps
    barium enema


                                                          4
Explain Procedure: Sigmoidoscopy

Introduction                                                                                                      Done
    1. Introduction (full name & role), state purpose.
    2. Take consent, gain patient’s name and DOB.
    3. Ask if they’ve had a sigmoidoscopy before and what they already know.
    4. Ask the patient what they would like to know and if they have any concerns.
    5. Tell the patient briefly what the procedure is and why it is being done
        The operator will gently insert a thin, flexible telescope the size of a pencil into your back passage.
        It has a bright light and a camera at the end which is used to look into your rectum and lower
        colon. The pictures will appear on a screen.
        Samples of tissue may be taken if necessary. Not painful, but may be slightly uncomfortable.
Before the Procedure
    6. For the 12 hours before the procedure have fluids only (no solids in diet), but you can eat a light
        breakfast on the morning just before the procedure.
    7. Patient will be given powerful laxatives (eg Picolax) for 1-2 days before the procedure and/or
        enema on arrival.
During the Procedure
    8. You will be asked to sign a consent form to ensure you understand the procedure.
    9. You will be given a hospital gown and asked to lie on your side with your knees to your chest.
    10. Doctor/nurse will insert a gloved, lubricated finger into your back passage to check for blockages.
    11. Sigmoidoscope is lubricated and gently passed through the rectum.
    12. Air is blown into the back passage which may make you want to pass wind- don’t feel
        embarrassed!
    13. The doctor/operator may take a sample of tissue (biopsy), which is painless.
    14. Sigmoidoscope is then gently pulled out and procedure is done.
    15. The procedure lasts 20 – 30 minutes.
After the Procedure
    16. You will be able to dress yourself and then rest until you are ready to go home.
    17. No sedation given  no restrictions.
    18. Can eat normally after the procedure.
    19. Risks/Complications:
             a. Bloating
             b. Wind pains
             c. Small amount of blood in stool
             d. Damage/perforation of lower part of bowel
             e. May require colonoscopy or repeat sigmoidoscopy.
    20. They will be followed up in clinic in a few weeks.
    21. Ask the patient if they have anymore questions.
    22. Ask the patient to repeat almost everything you have said

Indications
     Bleeding from back passage especially anus
     Pain from back passage
     Cancer or inflammation of rectum/sigmoid
     Removal of polyps
     Lower abdominal pain
     Persistent diarrhoea
     Abnormalities seen on other scans eg Barium Enema




                                                            5
Explain Procedure: Chest X-Rays

Introduction                                                                                                 Done
    1. Introduction (full name & role), state purpose
    2. Take consent, gain patient’s name and DOB
    3. Ask if they’ve had an x-ray before and what they already know
    4. Ask the patient what they would like to know and if they have any concerns
    5. Tell the patient briefly what the procedure is and why it is being done
        An x-ray machine produces short bursts of x-rays that pass easily through fluids and soft tissues of
        the body, but are blocked by dense tissues such as bone. Overall it will create a picture and will
        enable the doctors to have a look at the structures inside your chest.
        Usually done erect and PA.
Before the Procedure
    6. Ask the patient if there is a chance they are pregnant- (small risk the x-rays may cause harm to the
        unborn child). She may be advised not to have the x-ray.
    7. You won’t need to do anything to prepare- just turn up for the appointment.
    8. Explain that the patient will have to change into a gown.
During the Procedure
    9. You will be asked to sign a consent form to ensure you understand the procedure.
    10. Explain that the patient will be standing against part of a machine in the x-ray room and that the
        radiographer will be behind a screen- pt will be seen and heard at all times.
    11. You have to place your hands on your hips and move your elbows forward, so your shoulder
        blades don’t obscure your lungs.
    12. A lead apron will be worn to protect the lower part of your body.
    13. You will be asked to stay still to prevent blurring the images.
    14. Then you take a deep breath and hold while the radiographer presses a button, that passes the X-
        rays through you for a fraction of a second.
    15. You might hear a slight whirring noise as the machine becomes fully running, but you will be
        unaware of the fraction of a second when the X-ray source is active.
    16. Completely painless. You cannot see or feel the x-rays.
    17. Explain to the patient that this is a completely painless procedure
    18. The process of taking the film will last only a few minutes, but the radiographer may need to take
        further X-rays at different exposures or positions. This usually takes no more than 5 - 10 minutes.
After the Procedure
    19. You are free to leave once the procedure is complete and resume all normal activity.
    20. X-ray pictures are then analysed and a report is sent from the x-ray doctor to whoever requested the x-ray.
    21. This may take some time to reach your referring doctor, but is normally available in less than 14 days. You
        could ask the radiographer or radiologist for some indication of time.
    22. Risks/Complications:
        a. explain to the patient that there is a very small chance the x-ray damage may cause cancer
        b. may cause harm to the unborn child of pregnant women
    23. Explain to the patient that they can go home on the same day and carry on as normal
    24. Tell the patient that they will be followed up in clinic in a few weeks.
    25. Ask the patient if they have any more questions anything needing clarification?
    26. Ask the patient to repeat almost everything you have said

 Despite all the newer, more sophisticated forms of scanning, a plain X-ray is still one of the most sensitive ways
  of detecting many problems.
 It may be all that is needed to diagnose or assess various problems or monitor treatment.

Indications
 Pneumonia, pneumothorax, lobar collapse,                        Interstitial lung disease
    pleural effusion, TB, pulmonary oedema,                       Bone fractures
    pulmonary embolism                                            Hiatus hernias
 Congestive heart failure

                                                          6
Explain Procedure: Abdominal X-Rays

Introduction                                                                                                 Done
    1. Introduction (full name & role), state purpose.
    2. Take consent, gain patient’s name and DOB.
    3. Ask if they’ve had an x-ray before and what they already know.
    4. Ask the patient what they would like to know and if they have any concerns.
    5. Tell the patient briefly what the procedure is and why it is being done.
        An x-ray machine produces short bursts of x-rays that pass easily through fluids and soft tissues of
        the body, but are blocked by dense tissues such as bone. Overall it will create a picture and will
        enable the doctors to have a look at the structures inside your tummy.
        Usually done supine and AP.
Before the Procedure
    6. Ask the patient if there is a chance they are pregnant- (small risk the x-rays may cause harm to the
        unborn child). She may be advised not to have the x-ray.
    7. You won’t need to do anything to prepare- just turn up for the appointment.
    8. Explain that the patient will have to change into a gown.
During the Procedure
    9. You will be asked to sign a consent form to ensure you understand the procedure.
    10. Explain that the patient will be standing against part of a machine in the x-ray room and that the
        radiographer will be behind a screen- pt will be seen and heard at all times.
    11. You will be asked to stay still to prevent blurring the image.
    12. Will be asked to take a deep breath in and hold it for a few seconds.
    13. Then you take a deep breath and hold while the radiographer presses a button, that passes the X-
        rays through you for a fraction of a second.
    14. You might hear a slight whirring noise as the machine becomes fully running, but you will be
        unaware of the fraction of a second when the X-ray source is active.
    15. Completely painless. You cannot see or feel the x-rays.
    16. The process of taking the film will last only a few minutes, but the radiographer may need to take
        further X-rays at different exposures or positions. This usually takes no more than 5 - 10 minutes.
After the Procedure
    17. You are free to leave once the procedure is complete and resume all normal activity.
    18. Risks/Complications:
        a. explain to the patient that there is a very small chance the x-ray damage may cause cancer
        b. may cause harm to the unborn child of pregnant women
    19. Tell the patient that they will be followed up in clinic in a few weeks
    20. Ask the patient if they have anymore questions.
    21. Ask the patient to repeat almost everything you have said

Indications:
 Diagnostic purposes eg for acute abdominal pain
 Progression of an illness or after treatment

   Renal colic: KUB
   Intestinal obstruction: erect and supine films may be used; may also see fluid levels
   Perforated bowel: erect film will show gas under the diaphragm
   Appendicitis: ltd value at point of mgmt
   Intussusceptions: characteristic gas patterns; USS is better
   Detection of foreign bodies




                                                           7
Explain Procedure: Barium Meal

Introduction                                                                                                      Done
    1. Introduction (full name & role), state purpose
    2. Take consent, gain patient’s name and DOB
    3. Ask if they’ve had a barium swallow before and what they already know
    4. Ask the patient what they would like to know and if they have any concerns
    5. Tell the patient briefly what the procedure is and why it is being done
        X-rays are taken of your oesophagus, stomach and small intestine as you drink a white liquid that
        contains some barium sulphate. The barium meal helps the stomach and intestine to show up
        more clearly. You will then be asked to lie on a couch. You may be asked to swallow some
        bicarbonate powder and citric acid before swallowing the barium- these fizz in the stomach and
        make gas. The gas expands the stomach and duodenum.
Before the Procedure
    6. Tell the patient that they will be asked not to eat or drink for 4-6 hours before the test.
    7. Ask the patient if they are allergic to any medication and that they are able to continue with their
        own meds.
    8. Tell your doctor if you have IDDM so that they can arrange the best time for you to stop eating
        and for the test to be done.
    9. Ask the patient if there is a chance they are pregnant- (small risk the x-rays may cause harm to the
        unborn child). She may be advised not to have the procedure.
    10. Tell the patient they will need to change into a gown and their obs will be taken.
During the Procedure
    11. You will be asked to sign a consent form to ensure you understand the procedure.
    12. Explain that the patient will have to swallow some fruit-flavoured barium liquid, which is safe.
    13. May be given an injection to relax the muscles in your gut.
    14. Barium swallow: Explain that the patient will then have to stand in front of an x-ray machine
        whilst x-rays are taken
    15. Barium meal: you lie on a couch (similar to barium enema). May be given bicarbonate powder
        and citric acid before swallowing barium- these fizz up when they mix in the stomach and make
        some gas. You may be asked to move around in different positions. You may also be given an
        injection of a drug that makes the muscles in the stomach and gut relax.
    16. Barium follow through: they look at the small intestine so you wait 10-15 minutes before x-rays
        are taken
    17. Explain that x-rays are then taken, which are quite small dose and safe
    18. Explain that the procedure lasts 15-30 minutes.
After the Procedure
    19. They can eat normally.
    20. May feel a bit sickly and constipated afterwards. Drink lots of fluid and eat plenty of fruit for a day
        or so. Go to your GP if you haven’t passed any stools for 3-4 days.
    21. They will be able to go home on the same day, but they may want to stay by a toilet for an hour
    22. They should be escorted home and not operate any heavy machinery or drive
    23. Risks/Complications:
        a. Some people get sick for a few hours
        b. Barium might make them constipated – so see a doctor if they haven’t passed stool for 3 days
        c. Their stool may be white/pale due to the barium, and that this will last for about 1 day
        d. The injection to relax their muscles may cause some vision blurring – so do not drive
    24. They will be followed up in clinic in a few weeks
    25. Ask the patient if they have anymore questions.
    26. Ask the patient to repeat almost everything you have said

Indications
     Assess stomach problems that cannot be seen                       Vomiting blood
        on a normal x-ray                                               Difficulty swallowing (dysphagia)
     Vomiting a lot

                                                            8
Barium Swallow
 Drink barium liquid- often pleasant to taste (fruity)!
 Stand in front of X-ray whilst pictures taken as you swallow.
 Test aims to look for problems in the oesophagus (gullet), such as a stricture (narrowing), hiatus hernias,
    tumours, reflux from the stomach, disorders of swallowing, etc.
 You will usually be asked not to eat or drink for a few hours before this test.
 A barium swallow test takes about 10 minutes.

Barium Meal
 Aims to look for problems in the stomach and duodenum such as ulcers, polyps, tumours, etc.
 You drink some barium liquid, but you then lie on a couch whilst X-ray pictures are taken over your abdomen. It
    may take a little longer to do than a barium swallow.
 So that the barium coats all around the lining of the stomach, the doctor doing the test (radiologist) may do one
    or more of the following:
        o Ask you to swallow some bicarbonate powder and citric acid before swallowing the barium. These 'fizz
            up' when they mix in the stomach and make some gas. (You may have to resist the urge to burp.) The
            gas expands the stomach and duodenum and also pushes the barium to coat the lining of the stomach
            and duodenum. This makes the X-ray pictures much clearer, as it is the shape and contours of the lining
            of the stomach and duodenum which need to be seen most clearly on the pictures.
        o Ask you to turn over on to your stomach on the couch. Various X-ray pictures may be taken whilst you
            are in different positions.
        o Give you an injection of a drug that makes the muscles in the stomach and gut relax.
 You will usually be asked not to eat anything for several hours before this test. (Food particles in the gut can
    make it difficult to interpret the X-rays.) However, you may be allowed sips of water up to two hours before the
    test.


Barium Follow Through
 This test is similar to a barium meal but aims to look for problems in the small intestine.
 You drink the barium liquid but then need to wait 10-15 minutes before any X-rays are taken. This allows time
    for the barium to reach the small intestine.
 You may then have an X-ray every 30 minutes or so until the barium is seen to have gone through all the small
    intestine and reached the large intestine (colon).




                                                          9
Explaining Procedure: Barium Enema

Introduction                                                                                                   Done
    1. Introduction (full name & role), state purpose
    2. Take consent, gain patient’s name and DOB
    3. Ask if they’ve had a barium enema before and what they already know
    4. Ask the patient what they would like to know and if they have any concerns
    5. Tell the patient briefly what the procedure is and why it is being done
        X-rays are taken of your large intestine, and to make the images much clearer we will place what
        we call an enema up the back passage which contains a liquid that makes x-rays come up very
        clearly – this contains barium, and we need to do this to find out why you have your symptoms.
Before the Procedure
    6. Explain that the patient must take powerful laxatives (eg Picolax) to clear the stool from the gut.
    7. Ask the patient if they are allergic to any medication and tell them that they are able to continue
        with their own meds.
    8. If you’re taking iron tablets, please stop taking them a day before the test.
    9. You will also be advised on the kind of food to eat 24 hours before the test. You will most likely be
        advised to eat light food.
    10. Tell your doctor if you have IDDM, so that you can arrange for the best time for you to stop eating
        and for the test to be done.
    11. Ask the patient if there is a chance she is pregnant- (small risk the x-rays may cause harm to the
        unborn child). She may be advised not to have the procedure.
    12. Tell the patient they will need to change into a gown and their obs will be taken
During the Procedure
    13. You will be asked to sign a consent form to ensure you understand the procedure.
    14. You will lie on their side a small tube will be put up the back passage by a few centimetres.
    15. Barium liquid and some air are passed into the large intestine- trapped wind (“wind pains”).
    16. May have to move around to help the barium reach the caecum.
    17. May be given an injection to relax the bowel muscles.
    18. Explain that x-rays are then taken with you in different positions, which are quite small dose and
        safe. Allows looking at the bowel from different angles.
    19. Explain that the procedure only lasts 20 minutes.
After the Procedure
    20. Risks/Complications:
        a. Some people get sick for a few hours
        b. Barium might make them constipated – so see a doctor if they haven’t passed stool for 3 days
        c. Stools are white/pale due to the barium, and that this will last for about 1 day
        d. The injection to relax their muscles may cause some vision blurring – so do not drive
        e. Tell the patient that very rare complications include perforation of the colon and an allergic
             reaction to the injection.
    21. Tell the patient they will be able to go home on the same day, but they may want to stay by a
        toilet for an hour
    22. Tell the patient that they should be escorted home and not operate any heavy machinery or drive
    23. Tell the patient that they will be followed up in clinic in a few weeks
    24. Ask the patient if they have any more questions.
    25. Ask the patient to repeat almost everything you have said


Indications
  Continuous diarrhoea                                            Inflammation
  Anal bleeding                                                   Narrowing of colon
  Lower abdominal pains                                           Tumours
  Polyps                                                          Diverticular disease



                                                          10
Explain Procedure: Intravenous Urogram (aka Intravenous Pyelogram)

Introduction                                                                                                 Done
    1. Introduction (full name & role), state purpose.
    2. Take consent, gain patient’s name and DOB.
    3. Ask if they’ve had an IVU before and what they already know.
    4. Ask the patient what they would like to know and if they have any concerns.
    5. Tell the patient briefly what the procedure is and why it is being done
        The urinary system does not show up well on ordinary x-ray pictures, but with intravenous
        urography a contrast dye is injected into a vein. The dye travels in the bloodstream, concentrates
        in the kidneys and then a series of x-ray pictures are taken. The dye is then passed out into the
        bladder with urine made by the kidneys.
Before the Procedure
    6. The patient may have a blood test to check that they are not in renal failure, because kidneys
        need to work. Let the doctors know if you have any kidney problems.
    7. Tell your doctor if you have any allergies, especially allergy to contrast dyes such as iodine.
    8. You cannot eat for several hours before the test (discuss with doctor if you’re IDDM).
    9. You may be given laxatives to clear the bowel.
    10. Patients should stop Metformin for 2 days before the procedure because of the interaction with
        iodine in the dye affects the kidneys.
    11. Pregnant women, if possible, should not have an x-ray as there is a small risk that it may cause
        harm to the unborn child.
During the Procedure
    12. You will be asked to sign a consent form to ensure you understand the procedure.
    13. The patient will have a contrast dye injected into a vein, which may sting slightly.
    14. X-rays are taken every 5-10 minutes, and they may be asked to empty their bladder before the
        final picture.
    15. The procedure lasts 30-60 minutes.
After the Procedure
    16. They can go home as soon as the procedure has finished.
    17. They can eat normally after the procedure.
    18. Risks/ Complications:
        a. The dye may cause a warm feeling and metallic taste in the mouth (short term).
        b. A small number of people get an allergic reaction to the dye (anaphylaxis) VERY RARE.
        c. A rare complication can be kidney failure.
    19. They will be followed up in clinic in a few weeks.
    20. Ask the patient if they have anymore questions or if anything needs clarifying?
    21. Ask the patient to repeat almost everything you have said.

Indications
 Stones- kidneys, ureters.
 Recurrent infections of the bladder or kidney.
 Haematuria- blood in urine.
 Any obstruction or damage to any part of the urinary tract can often be seen on an IVU.
 Renal cell carcinoma
 Hydronephrosis




                                                         11
Explain Procedure: CT scan (Computed Tomography scan)

Introduction                                                                                                 Done
    1. Introduction (full name & role), state purpose
    2. Take consent, gain patient’s name and DOB
    3. Ask if they’ve had a CT scan before and what they already know
    4. Ask the patient what they would like to know and if they have any concerns
    5. Tell the patient briefly what the procedure is and why it is being done
        A CT scan is a special x-ray test which can give extremely good pictures of the inside of your body
        which do not show up on normal x-ray pictures. You will be asked to lie on a bed and keep still as a
        ring rotates around your body, taking pictures with x-rays as it does so.
Before the Procedure
    6. Ask female patients if there is a chance she is pregnant- (small risk the x-rays may cause
        abnormalities in the unborn child). She may be advised not to have the CT scan.
    7. If you are diabetic- speak to your doctor about fasting for a few hours.
    8. Asked to remove all metal objects from their body. Do not to wear clothes with metal zips, studs.
    9. Patient will not be allowed to eat or drink for a few hours before the procedure.
    10. Abdominal & Pelvic scans: 1 hour before test, you may be asked to drink a ‘special contrast’ – this
        will help show your gut better.
    11. Pelvic scans: you may have contrast enema given before the procedure where fluid is pushed into
        your rectum through a tube that is gently placed into your anus. Women may be asked to insert a
        tampon in their vagina.
    12. Urinary scans: IV line placed into your arm and contrast dye injected through it- may sting, cause
        warm feeling or leave a metallic taste temporarily.
During the Procedure
    13. You will be asked to sign a consent form to ensure you understand the procedure.
    14. May have contrast dye injected into a vein- may sting slightly, warm feeling, metallic taste.
    15. Some patients feel anxious or claustrophobic, so are given a sedative to help them relax.
    16. Asked to stay as still as possible on the bed as otherwise the scan pictures may be blurred.
    17. The x-ray machine and x-ray detector both rotate around your body, always being opposite each
        other. This allows various images from different angles to be taken
    18. Completely painless- may be uncomfortable keeping still for so long.
    19. The procedure lasts 20 – 60 minutes.
After the Procedure
    20. They can go home as soon as the procedure has finished, but need to be escorted if they were
        given a sedative may be unable to drive.
    21. They can eat normally after the procedure.
    22. Should not drive, operate machinery or drink alcohol until 24 hours after the procedure.
    23. Risks/Complications:
             a. X-ray dose is generally quite low in CT so risk of harm is small.
             b. Drowsy- sedative.
             c. Warm feeling and metallic taste in the mouth (short term).
             d. A small number of people get an allergic reaction to the dye (anaphylaxis) this can be
                 treated immediately.
             e. A rare complication can be kidney failure due to the dye.
    24. They will be followed up in clinic in a few weeks.
    25. Ask the patient if they have any more questions.
    26. Ask the patient to repeat almost everything you have said
Indications
A CT scan can be done on any section of the head or body to give clear images of bones, muscles, organs.
     Detect suspected abnormalities in the body.
     To give a surgeon a clear picture of an area of your body before certain types of surgery.
     To pinpoint the exact site of tumours prior to radiotherapy.
     Study brain and CSF- including after strokes.


                                                        12
Explain Procedure: MRI Scan (Magnetic Resonance Imaging Scan)

Introduction                                                                                                      Done
    1. Introduction (full name & role), state purpose.
    2. Take consent, gain patient’s name and DOB.
    3. Ask if they’ve had an MRI scan before and what they already know.
    4. Ask the patient what they would like to know and if they have any concerns.
    5. Tell the patient briefly what the procedure is and why it is being done:
        An MRI scan is a special scan that is safe and painless and provides detailed pictures of the structures
        inside your body. You lie on a bed/couch that moves you through a small tunnel and the MRI
        machine takes pictures around you. It may be a bit noisy- given headphones/music.
        Important that you keep still to prevent blurring the images.
        Sometimes you may need a dye injected in a vein in your arm to give better pictures of the
        structures.
Before the Procedure
    6. Patient will not be able to eat and drink normally and take your medication before the procedure.
    7. You may be asked to fill a safety questionnaire before the scan. Tell the doctor if you have any
        allergies.
    8. Ask the patient if there is a chance they are pregnant- it is advised not to perform MRIs on pregnant
        women as the effects of strong magnetic fields on a developing baby are not yet known.
    9. Patient will be asked to remove all metal objects from their body- let the operator know if you have
        any metal in your body (pacemakers/defibrillators, hearing aids, surgical clips, artificial heart valves,
        metal limbs/joint, pins, screws, staples, etc) or if you have any tattoos that have metal inside.
    10. In some cases you may need to have an X-ray before the MRI to identify metal.
During the Procedure
    11. You will be asked to sign a consent form to ensure you understand the procedure.
    12. The patient may have a contrast dye injected into a vein in your arm (may sting slightly) - gives better
        pictures.
    13. You will have to lie down on a couch and keep completely still- this may be a bit uncomfortable. The
        couch will then gently slide into the scanner, which looks like a tunnel surrounded by a large circular
        magnet.
    14. The scan itself is painless.
    15. Operator will be in next room observing through a window- you can talk to them.
    16. Monitoring your heart rate, blood pressure and oxygen levels.
    17. Some patients feel anxious so may be given a sedative to help them relax.
    18. Scanner is quite noisy so you may be given headphones to protect your ears- music.
    19. The procedure lasts 15-40minutes.
After the Procedure
    20. Can go home immediately after procedure, but need to be escorted if they were given a sedative.
    21. They can eat normally and carried on as normal after the procedure.
    22. Risks/ Complications:
        a. MRIs are painless. Unlike other scans, MRIs do not use radiation.
        b. The dye may cause a warm feeling and metallic taste in the mouth (short term).
        c. A small number of people get an allergic reaction to the dye (anaphylaxis).
        d. A rare complication can be kidney failure.
        e. Pregnant women may be advised not to have the scan, as the effects of strong magnetic fields on
             a developing baby are not yet known.
    23. They will be followed up in clinic in a few weeks
    24. Ask the patient if they have anymore questions.
    25. Ask the patient to repeat almost everything you have said
Indications:
 Whether other tests eg X-rays do not give enough information.
 Detailed pictures of brain and spinal cord, slipped discs, brain tumours, blood flow in BVs, kidney transplants
 Torn ligaments around joints (used a lot in sports injuries).
 Diagnosis and planning for treatment of CA

                                                         13
Explain Procedure: Ultrasound Scan

Introduction                                                                                                  Done
    1. Introduction (full name & role), state purpose
    2. Take consent, gain patient’s name and DOB
    3. Ask if they’ve had an ultrasound before and what they already know
    4. Ask the patient what they would like to know and if they have any concerns
    5. Tell the patient briefly what the procedure is and why it is being done
        This is a painless test that uses sound waves to create images of organs and structures inside your
        body. It is a harmless test because there is no radiation. A small hand-held sensor, which is
        pressed carefully against the skin surface, both generates sound waves and detects any echoes
        reflected back creating a picture of your internal organs. The sensor can be moved over the skin to
        view the organ from different angles, the pictures being displayed on a screen.
Before the Procedure
    6. The patient should eat and drink normally before the test, unless:
         May be asked not to eat for a few hours if certain parts of abdomen being scanned-see
            below).
         May be asked to eat a low fibre diet 2-3 days before ultrasound to decrease gas in gut.
         Gallbladder/ Pancreas: do not eat for 12 hours before scan- drink only clear fluids.
         Liver/ Kidneys: avoid fizzy drinks and beans for 1-2 days before test (wind/gas in bowel may
            obstruct view).
         Bowel: need to eat a low fibre diet and may be given enema.
         Bladder/Pelvis: may need to have a full bladder- drink 1-2 pints of water before test.
    7. You may be asked to change into a hospital gown.
During the Procedure
    8. You will be asked to sign a consent form to ensure you understand the procedure.
    9. Lubricating jelly is put onto your skin.
    10. A probe (like a thick, blunt pen) is then put over the jelly and onto your skin.
    11. The probe is moved around at different angles and you may also be asked to move around.
    12. When enough images are taken, probe will be removed from your chest and the jelly wiped off.
    13. Completely painless- only discomfort is if the operator needs to press the probe firmly.
    14. The scan takes 15-45 minutes.
After the Procedure
    15. They can go home as soon as the procedure has finished.
    16. They can eat normally after the procedure.
    17. There are no complications- no radiation.
    18. They will be followed up in clinic in a few weeks
    19. Ask the patient if they have anymore questions anything needs clarification.
    20. Ask the patient to repeat almost everything you have said

Indications
  Size, shape and consistency of organs, structures and abnormalities.
  During an operation, if the surgeon needs to inspect a structure or monitor.
  Monitor the growth of an unborn child, and check for abnormalities- ultrasound scans are routine in pregnancy.
  Appendicitis
  Gynaecological symptoms
  Gallstones
  Cysts
  Free fluid around the kidney
  Pancreatitis
  Abscess- especially liver
  Breast Pathology
  Aneurysms
  Infections
  Blocks in blood vessels (see Doppler)
                                                        14
Explain Procedure: ECHO (Echocardiogram)

Introduction                                                                                                          Done
    1. Introduction (full name & role), state purpose.
    2. Take consent, gain patient’s name and DOB.
    3. Ask if they’ve had an Echo before and what they already know.
    4. Ask the patient what they would like to know and if they have any concerns.
    5. Tell the patient briefly what the procedure is and why it is being done
        This is a painless test that uses sound waves to create images of the heart. It is a harmless test
        because there is no radiation. A small hand-held sensor, which is pressed carefully against the skin
        surface, both generates sound waves and detects any echoes reflected back creating a picture of
        your heart. The sensor can be moved over the skin to view the heart from different angles, the
        pictures being displayed on a screen.
Before the Procedure
    6. You can eat and drink normally and take your medication.
    7. Tell your doctor if you have any allergies, even though this test will only involve a cool jelly being
        rubbed onto your chest.
    8. You will be asked to change into a hospital gown and/or prepare to undress down to your waist.
During the Procedure
    9. You will be asked to sign a consent form to ensure you understand the procedure.
    10. Your chest will need to be exposed.
    11. The operator will spread some lubricating jelly (cool) over your skin and then move the probe
        (which looks like a thick, blunt pen) over your skin to get a clear picture. The probe is connected
        by a wire to a monitor, which displays the picture.
    12. You may hear a ‘whooshing’ noise as the probe detects your blood flowing if the volume is on.
    13. The probe is moved around at different angles and you may also be asked to move around.
    14. When enough images are taken, probe will be removed from your chest and the jelly wiped off.
    15. Completely painless- only discomfort is if the operator needs to press the probe firmly.
    16. The procedure lasts 15- 30 minutes.
After the Procedure
    17. They can go home as soon as the procedure has finished
    18. They can eat normally and continue medication normally after the procedure.
    19. Risks/Complications:
        Very safe procedure. No significant risks other than perhaps an allergic reaction to the jelly.
    20. They will be followed up in clinic in a few weeks.
    21. Ask the patient if they have any more questions or if anything needs clarifying?
    22. Ask the patient to repeat almost everything you have said.

Indications:
      Valve function (stenosis or regurgitation)                  LV hypertrophy
      Heart failure                                               Coronary Artery Disease & Ischaemic Heart Disease
      Pericardial effusion                                        Congenital heart disease
      Post-MI looking at function and damage                      Aortic aneurysm/ aortic dissection
      Hypertrophic cardiomyopathy                                 Masses within heart

Doppler echocardiography
     This can measure variations in blood flow in different parts of the heart (eg it can detect turbulent flow next to a
         damaged valve) and can assess how well the heart valves are working.
Stress echocardiogram
     This test is done to see how the heart responds to 'stress' such as exercise.
     In this test your doctor may do an ECHO as described above during or soon after exercise. Or you may be given a
         medication that causes the heart to beat harder and faster.
Transoesophageal echocardiography
     In this test you swallow a probe that is attached to a thin tube connecting it to the ultrasound machine. This views the
         heart from within the oesophagus (gullet) which lies just behind the heart. Imager clearer than normal echocardiogram.
         Done when a very detailed picture is needed. For example, to assess valves before surgery is done to repair damaged
         valves, or to assess the extent of infection of a heart valve.
                                                              15
Explain Procedure: Doppler

Introduction                                                                                                   Done
    1. Introduction (full name & role), state purpose
    2. Take consent, gain patient’s name and DOB
    3. Ask if they’ve had a Doppler before and what they already know
    4. Ask the patient what they would like to know and if they have any concerns
    5. Tell the patient briefly what the procedure is and why it is being done
        This is a painless test that uses sound waves to measure the blood flow in your blood vessels. It is
        a harmless test because there is no radiation. A small hand-held sensor is pressed carefully against
        the skin surface after lubricating jelly has been spread over it. The sensor both generates sound
        waves and detects any echoes reflected back information on your blood vessels. The sensor can
        be moved over the skin to get a clear picture. You may hear a ‘whooshing’ sound if the volume is
        on.
Before the Procedure
    6. You can eat and drink normally before the test and continue to take your usual medication.
    7. You may be asked to change into a hospital gown. It is better to wear a top with short or loose
        sleeves and bottoms that can be rolled up.
    8. You may be asked to remove socks/stockings and shoes.
During the Procedure
    9. You may be asked to sign a consent form to ensure you understand the procedure.
    10. Your abdomen and legs will need to be exposed.
    11. The operator will spread some lubricating jelly (cool) over your skin and then move the probe
        (which looks like a thick, blunt pen) over your skin to get a clear picture. The probe is connected
        by a wire to a monitor, which displays the picture.
    12. You may hear a ‘whooshing’ noise as the probe detects your blood flowing if the volume is on.
    13. The probe is moved around to get different views of the blood vessel.
    14. When enough images are taken, probe will be removed from your chest and the jelly wiped off.
    15. Completely painless- only discomfort is if the operator needs to press the probe firmly.
    16. Usually takes about 30 minutes, but you may need to allow 1 hour for time to rest before your
        blood pressure is recorded (ABPI may be conducted).
After the Procedure
    17. Can go home straight away.
    18. Can eat and drink normally. Take your medication normally.
    19. Risks/Complications: Dopplers are very safe- no radiation.
    20. They will be followed up in clinic in a few weeks.
    21. Ask the patient if they have anymore questions or if anything needs clarifying?
    22. Ask the patient to repeat almost everything you have said.


Investigations:
     Blood flow in arteries and veins
     To diagnose Stenosis
     Used regularly in Obstetrics




                                                          16
Explain Procedure: ERCP (Endoscopic Retrograde Cholangio Pancreatography)

Introduction                                                                                                                   Done
    1. Introduction (full name & role), state purpose
    2. Take consent, gain patient’s name and DOB
    3. Ask if they’ve had an ERCP before and what they already know
    4. Ask the patient what they would like to know and if they have any concerns
    5. Tell the patient briefly what the procedure is and why it is being done
    6. ERCP stands for Endoscopic Retrograde Cholangio Pancreatography.
        This is where an operator passes a flexible telescope which is as thin as a pencil down the back of your throat to
        have a look at your bile ducts, pancreas, gallbladder and liver. It has a bright light and a camera on the end which
        is connected to a screen showing the pictures and allows the operator to get a good view. They may take samples
        of tissue (biopsy) if needed.
         X-rays will also be taken- also painless.
Before the Procedure
    7. Explain that the patient must not eat for at least 6 hours before the procedure, but can have small sips
        of water up until 2 hours before the procedure. Ask pt if they are IDDM.
    8. Ask the patient if there is a chance they are pregnant- (small risk the x-rays may cause harm to the
        unborn child). She may be advised not to have the procedure.
    9. You may need a blood test to check how well your blood clots a day or two before the ERCP.
    10. You may be required to stop medications such as blood-thinners (Aspirin, Warfarin)
    11. Ask the patient if they are allergic to any medication.
    12. You will be given a gown to change into and their obs will be taken.
During the Procedure
    13. You will be asked to sign a consent form to ensure you understand the procedure.
    14. Local anaesthetic (numbs) sprayed into back of throat- bitter.
    15. You may be given a dye (may sting).
    16. May be given a mild sedative (drowsy) - arrange for someone to drive you home.
    17. You will be asked to lie down on a bed/couch.
    18. Endoscope passed gently through mouth  stomach  duodenum and air passed through (burp).
    19. X-rays will then be taken with a dye to visualise the organs.
    20. Explain the possibility of stent insertion if narrowing is found.
    21. Explain that if gallstones are found and are too large, we may use a diathermy.
    22. Painless, but may be uncomfortable.
    23. 30 minutes- >1 hour (depending on what is done)
After the Procedure
    24. Allowed to rest for a short while and then can go home as soon as the procedure has finished, but
        need to be accompanied due to the sedative.
    25. If had interventional ERCP (stone removed, stent inserted) may have to stay in hospital overnight.
    26. You should not drive, operate machinery or drink alcohol 24hours after having the sedative.
    27. Risks/ Complications: most ERCPs are done without any problems
       a. Sore throat (mild, only a day or so).
       b. Tired due to sedative. No driving, operating machinery or drinking alcohol for 24 hours.
       c. Slight risk of chest infection.
       d. Damage to gut, bile duct or pancreatic duct- may cause bleeding, infection, perforation. See a doctor if you
          have any of the following within 48 hours post-ERCP: abdominal pain (inc unusual indigestion pains), fever,
          difficulty breathing, vomiting blood (haematemesis).
       e. Pancreatitis
    28. Tell the patient that they will be followed up in clinic in a few weeks.
    29. Ask the patient if they have anymore questions.
    30. Ask the patient to repeat almost everything you have said.
Indications:
 Choledocholithiasis (gallstones in CBD)                               Dx of pancreatic or biliary malignancy (endoscopic USS
 Acute/ chronic pancreatitis                                            may be better)
 Pancreatic divisum                                                    Dilatation of benign structures
                                                                        Manometry measures in sphincter of Oddi dysfunction

                                                               17
Explain Procedure: Isotope Lung Scan (VQ scan)

Introduction                                                                                                     Done
    1. Introduction (full name & role), state purpose.
    2. Take consent, gain patient’s name and DOB.
    3. Ask if they’ve had an isotope scan before and what they already know.
    4. Ask the patient what they would like to know and if they have any concerns.
    5. Tell the patient briefly what the procedure is and why it is being done
        A very small amount of radioisotope (thought to be relatively harmless) is put into the body,
        usually by an injection into a vein. Sometimes you may be asked to breathe it in/swallow, instead
        of or along with the injection- if required. You will have to wait a few hours for the radioisotope to
        travel to the lungs. Cells which are most 'active' in the target tissue or organ will take up more of
        the radioisotope. This emits gamma rays which are detected by a gamma camera and a picture is
        generated. Hot spots= where a lot of rays are taken up; cold spots= less uptake.
        The term ‘radioactive’ might seem alarming- please do not worry, the substances we use are safe.
Before the Procedure
    6. Ask the patient if there is a chance they are pregnant or breastfeeding- she may be advised not to
        have the procedure. If you have contact with children or pregnant women- let your doctor know.
    7. You may eat and drink normally and take medication.
    8. A chest x-ray may be taken before the isotope lung scan- very small risk of radiation. Pregnant?
    9. No need to undress¸ but must remove metal objects and jewellery.
During the Procedure
    10. You will be asked to sign a consent form to ensure you understand the procedure.
    11. Will have an injection in the vein of a small quantity of radioisotope, which is held up in lungs.
    12. It then takes some time - sometimes several hours (depending on what is being scanned) - for the
        radioisotope to travel to the target organ. You may want to bring something to read.
    13. You may be asked to have lots to drink to help to flush the radionuclide from your body.
    14. You may be asked to empty your bladder of urine before the scanning begins.
    15. You may have to breathe in special gas to give an image of the air supply to the lungs, which is
        delivered through a mask.
    16. You will be asked to lie still on the couch whilst each picture is taken (prevent blurring)- you may
        sometimes be asked to sit up.
    17. Completely painless procedure- other than sharp scratch when injection given.
    18. The procedure lasts 20- 30 minutes- depends on how many pictures are taken.
After the Procedure
    19. They can go home as soon as the procedure has finished- generally no after effects; okay to drive.
    20. They can eat normally after the procedure.
    21. Radioisotope will be passed out through your urine/faeces (colourless and rid in about 3 days)-
        you may be advised to flush the toilet twice and wash your hands rigorously for a few days.
    22. If you feel something is not right then please contact the GP immediately.
    23. Risks/ Complications:
             a. There is a small risk that the gamma rays may harm an unborn child. Women who are
                 pregnant or breastfeeding may be advised not to have the scans.
             b. Very slight increase in the risk of cancer due to the radiation- similar with X-rays.
             c. If iodine is injected, it can cause an allergic reaction. (rare)
             d. Theoretically, you can receive an overdose when the chemical is injected- very very rare!
    24. They will be followed up in clinic in a few weeks.
    25. Ask the patient if they have anymore questions.
    26. Ask the patient to repeat almost everything you have said.

 Indications
  Lung perfusion scan (also called a 'VQ scan') can detect blood clots in the lungs (pulmonary embolus).




                                                           18
Explain Procedure: Isotope Bone Scan

Introduction                                                                                                     Done
    1. Introduction (full name & role), state purpose.
    2. Take consent, gain patient’s name and DOB.
    3. Ask if they’ve had an isotope scan before and what they already know.
    4. Ask the patient what they would like to know and if they have any concerns.
    5. Tell the patient briefly what the procedure is and why it is being done
        A very small amount of radioisotope (thought to be relatively harmless) is put into the body,
        usually by an injection into a vein. Sometimes you may be asked to breathe it in/swallow, instead
        of or along with the injection- if required. You will have to wait a few hours for the radioisotope to
        travel to the bone. Cells which are most 'active' in the target tissue or organ will take up more of
        the radioisotope. This emits gamma rays which are detected by a gamma camera and a picture is
        generated. Hot spots= where a lot of rays are taken up; cold spots= less uptake.
        The term ‘radioactive’ might seem alarming- please do not worry, the substances we use are safe.
Before the Procedure
    6. Ask the patient if there is a chance they are pregnant or breastfeeding- she may be advised not to
        have the procedure. If you have contact with children or pregnant women- let your doctor know.
    7. You may eat and drink normally and take medication.
    8. A chest x-ray may be taken before the isotope lung scan- very small risk of radiation. Pregnant?
    9. No need to undress¸ but must remove metal objects and jewellery.
During the Procedure
    10. You will be asked to sign a consent form to ensure you understand the procedure.
    11. Will have an injection in the vein of a small quantity of radioisotope, which is held up in lungs.
    12. It then takes some time - sometimes several hours (depending on what is being scanned) - for the
        radioisotope to travel to the target organ. You may want to bring something to read.
    13. You may be asked to have lots to drink to help to flush the radionuclide from your body.
    14. You may be asked to empty your bladder of urine before the scanning begins.
    15. You may have to breathe in special gas through a mask.
    16. You will be asked to lie still on the couch whilst each picture is taken (prevent blurring)- you may
        sometimes be asked to sit up.
    17. Completely painless procedure- other than sharp scratch when injection given.
    18. The procedure lasts 20- 30 minutes- depends on how many pictures are taken.
After the Procedure
    19. They can go home as soon as the procedure has finished- generally no after effects; okay to drive.
    20. They can eat normally after the procedure.
    21. Radioisotope will be passed out through your urine/faeces (colourless and rid in about 3 days)-
        you may be advised to flush the toilet twice and wash your hands rigorously for a few days.
    22. If you feel something is not right then please contact the GP immediately.
    23. Risks/ Complications:
             a. There is a small risk that the gamma rays may harm an unborn child. Women who are
                 pregnant or breastfeeding may be advised not to have the scans.
             b. Very slight increase in the risk of cancer due to the radiation- similar with X-rays.
             c. If iodine is injected, it can cause an allergic reaction. (rare)
             d. Theoretically, you can receive an overdose when the chemical is injected- very very rare!
    24. They will be followed up in clinic in a few weeks.
    25. Ask the patient if they have anymore questions.
    26. Ask the patient to repeat almost everything you have said.

Indications:
A radioisotope is used which collects in areas where there is a lot of bone activity (where bone cells are breaking
down or repairing parts of the bone). So a bone scan is used to detect areas of bone where there is cancer, infection,
or damage. These areas of activity are seen as 'hot spots' on the scan picture.



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Explain Procedure: Isotope Thyroid Scan

Introduction                                                                                                   Done
    1. Introduction (full name & role), state purpose.
    2. Take consent, gain patient’s name and DOB.
    3. Ask if they’ve had an isotope scan before and what they already know.
    4. Ask the patient what they would like to know and if they have any concerns.
    5. Tell the patient briefly what the procedure is and why it is being done
        A very small amount of radioisotope (thought to be relatively harmless) is put into the body,
        usually by an injection into a vein. Sometimes you may be asked to breathe it in/swallow, instead
        of or along with the injection- if required. You will have to wait a few hours for the radioisotope to
        travel to the thyroid. Cells which are most 'active' in the target tissue or organ will take up more
        of the radioisotope. This emits gamma rays which are detected by a computer and a picture is
        generated. Hot spots= where a lot of rays are taken up; cold spots= less uptake.
        The term ‘radioactive’ might seem alarming- please do not worry, the substances we use are safe.
Before the Procedure
    6. Ask the patient if there is a chance they are pregnant or breastfeeding- she may be advised not to
        have the procedure. If you have contact with children or pregnant women- let your doctor know.
    7. You may eat and drink normally and take medication.
    8. A chest x-ray may be taken before the isotope lung scan- very small risk of radiation. Pregnant?
    9. No need to undress¸ but must remove metal objects and jewellery.
During the Procedure
    10. You will be asked to sign a consent form to ensure you understand the procedure.
    11. Will have an injection in the vein of a small quantity of radioisotope, which is held up in lungs.
    12. It then takes some time - sometimes several hours (depending on what is being scanned) - for the
        radioisotope to travel to the target organ. You may want to bring something to read.
    13. You may be asked to have lots to drink to help to flush the radionuclide from your body.
    14. You may be asked to empty your bladder of urine before the scanning begins.
    15. You may have to breathe in special gas through a mask.
    16. You will be asked to lie still on the couch whilst each picture is taken (prevent blurring)- you may
        sometimes be asked to sit up.
    17. Completely painless procedure- other than sharp scratch when injection given.
    18. The procedure lasts 20- 30 minutes- depends on how many pictures are taken.
After the Procedure
    19. They can go home as soon as the procedure has finished- generally no after effects; okay to drive.
    20. They can eat normally after the procedure.
    21. Radioisotope will be passed out through your urine/faeces (colourless and rid in about 3 days)-
        you may be advised to flush the toilet twice and wash your hands rigorously for a few days.
    22. If you feel something is not right then please contact the GP immediately.
    23. Risks/ Complications:
             a. There is a small risk that the gamma rays may harm an unborn child. Women who are
                 pregnant or breastfeeding may be advised not to have the scans.
             b. Very slight increase in the risk of cancer due to the radiation- similar with X-rays.
             c. If iodine is injected, it can cause an allergic reaction. (rare)
             d. Theoretically, you can receive an overdose when the chemical is injected- very very rare!
    24. They will be followed up in clinic in a few weeks.
    25. Ask the patient if they have anymore questions.
    26. Ask the patient to repeat almost everything you have said.
Indications:
Areas of overactivity will show as 'hot spots' on the picture; areas which emit low levels of gamma rays may be
shown as blue ('cold spots’).
     Check gland function                                          Spread of thyroid CA
     Dx: hyperthyroidism, CA, other growths                        Evaluate changes after surgery, radiotherapy,
     Assess nature of a nodule/lump                                   chemotherapy
     Detect abnormality- nodules/lumps, inflammation
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