This is a kind of x-ray in which a special machine (the fluoroscope) takes a continuous x-ray so that the doctor can see the movement of internal organs. A fluorescent screen, coated with a special substance, is mounted in front of an x-ray tube. The x-ray shadow is cast on the screen. The fluoroscopic image can be amplified and displayed on a television screen. Fluoroscopy can show the expansion of the lung or a barium liquid passing through a patient's esophagus to his stomach. Fluoroscopic techniques sometimes provide important information which cannot be obtained in any other way.
How much radiation exposure will I get from a fluoroscope?
Fluoroscopes take longer to perform and often expose you to more radiation than do the conventional x-ray exams recorded on film. There are new machines which give better images with less exposure, particularly those which amplify the light from the fluoroscopic screen and then provide a brighter image on a TV monitor, but the exposure is still higher than for a standard x-ray film. Make sure this procedure is done only by a board certified radiologist and only when necessary.
Will the doctors use x-rays taken by someone else?
Some doctors will not use them because they are not aware they are available, they don't want to be bothered asking for them, they don't trust the manner in which they were taken, or the resulting film is not clear or detailed enough. There may be good reason for having x-rays retaken, such as if the first set is on poor-quality film. But you should make sure that your x-rays are being redone for good reasons and not just because a doctor or hospital does not want to share them. You should keep a record of your own x-ray history so that you can tell the doctor what has already been done, especially on high-dose film such as gallbladder or GI series. More and more doctors are accepting x-rays taken by others.
How is the dose of radiation measured?
You will hear the terms rad or rem used in describing the dose of radiation. Rad stands for radiation absorbed dose. A rem is equivalent to a rad. The terms apply to all types of radiation and take into account the energy actually imparted to the tissue. (Sometimes the terms millirads and millirems are used to describe the dosage.) The effects of diagnostic x-rays on the body depend in a complex way on a number of factors, such as the distribution of energies of x-ray photon in the beam, the total intensity or quality of radiation, the distance between the x-ray tube and the individual being x-rayed, the type and location of tissues and organs in the main beam, and the age and sex of the person being examined. The unit of exposure is the roentgen, named after Wilhelm Roentgen, who discovered x-rays in 1895. However, most radiologists now measure the absorbed dose, which is the amount of energy dumped by incident radiation into a gram of material. The dose absorbed by a gram of skin or muscle can be much less than that absorbed by a gram of bone placed in the same x-ray beam. This is because the heavy atoms of calcium in the bone absorb xrays more easily than lighter elements abundant in tissue. X-rays pass through tissue more easily and don't leave as much energy behind.
Radiation Dose, Dosimetry, and Background Radiation
What is skin dose?
This refers to the dose of radiation immediately on the surface of the skin. The outer layers of skin absorb x-rays readily; thus, particularly with older machines, the exposure inside a body will be less than the exposure at the skin. The absorbed dose in the outer layers of skin is often referred to as the skin dose, while x-ray energy deposited in a gram of bone, tissues, or an organ at a certain location inside the body is referred to as the depth dose at that location.
Reducing peak skin dose on patients undergoing interventional procedures
What x-rays give relatively high overall radiation doses?
Several examinations are of special concern because they involve relatively high overall radiation doses. They include examinations of the gastrointestinal system (upper and lower), thoracic spine (middle and dorsal), lumbosacral spine (lower), lumbar spine, cervical spine, gallbladder, kidney, ureter, bladder, skull, pelvis and hip or upper thigh, and fluoroscopic procedure.
What other things should I watch for when having x-rays taken?
A good operator will measure carefully the thickness of the part of your body which is to be exposed and consult a technique chart to set the tube current, voltage, and exposure time for each type of x-ray. If the operator hurries, there is more likelihood that a poor exposure will require additional x-rays. You must be careful not to move, since blurred images mean additional x-rays. The operator must also carefully align the beam, using the minimum beamsize possibilities.
When are lead shields used?
Shielding can help reduce the amount of scattered radiation absorbed, especially by reproductive organs. There are several kinds of shields such as lead aprons, lead lined panels, scrotal cups, flexible lead lined drape cloths, and shadow shields. If they are not offered to you, ask about them before being x-rayed. Newer machines have built in shields to avoid scattering.
What kind of x-ray is a mammogram?
A mammogram is a soft tissue x-ray of the breast. It is but one of several techniques used in diagnosis ofbreast cancer.
What is endoscopy?
Endoscopy is the examination through optical instruments of the interior of the body. There are many different kinds of instruments designed to perform this examination on different parts of the body. Several new tools use fiberoptics for this procedure tiny flexible fibers that carry a powerful light and a telescope which allows the doctor to peer inside the body. These instruments allow the diagnosis of various kinds of cancer without performing a major operation. Sometimes they are used in combination with other tests, such as x-rays, to confirm the diagnosis.
What are some of these endoscopic instruments called?
You can identify these instruments because they end in the suffix scope: cystoscope, hysteroscope, colposcope, laparoscope, peritoneoscope, bronchoscope, proctosigmoidoscope, esophagogastroduodenoscope, etc.
Why are these instruments important in diagnosing cancer?
For many years, these procedures have offered a fairly simple method of detecting malignancies, precancerous growths, and non cancer related diseases without the necessity for major exploratory surgery. This means you can return to work, be free from postoperative complications, and save money. The exact location of tumors can be determined and cytology can be done without a major operation. Since the introduction of fiberoptic equipment in the 1970s, new areas of the body can be examined without surgery.
What is a cystoscopy?
A cystoscopy exam allows the doctor to inspect the lining of the urinary bladder for the presence of diverticula, fistulas, stones, or tumors in the bladder. The bladder is first enlarged by filling it with air or water. A cystoscope a thin, hollow tube with a light at the end of it is inserted through the urethra. The doctor can then actually look at the walls of the bladder. Cystoscopic brushes can be passed along to the tract to obtain cells for microscopic examination. Small tumors can sometimes be removed through the hollow tube. This test is usually done if you have repeated urinary tract infections or if you have bleeding associated with urination.
When is a hysteroscope used?
A hysteroscope can determine the presence of fibroid and endometrial tumors; it can also be used to help locate lost IUDs or treat cases of infertility. The hysteroscope looks somewhat like a skin diver's spear gun, with an eyepiece and a trigger that controls a flexible tip that provides a full view inside the uterus. The instrument is inserted through the vagina and threaded through the cervix into the uterus to view the uterine cavity and entrance to the fallopian tubes.
What is malignant melanoma? Malignant melanoma is a less common form of skin cancer . When diagnosed early, it is easily cured. But if it is not found soon enough, it can be very difficult to treat. It is dangerous because, unlike the other skin cancers, it mestastasizes early and spreads quickly. It is one of the more uncontrollable cancers. The cell involved is the melanocyte, the cell which produces melanin, the dark protective pigment of the skin . What is the difference between an ordinary mole and melanoma? An ordinary mole is evenly colored, and either brown, tan or black. It may be flat or raised. It is round or oval and its edges are sharply defined. An ordinary mole is usually less than 6 millimeters in diameter about the size of a pencil eraser. Ordinary moles may be present at birth. Sometimes several appear at the same time, usually on areas of the skin which have been exposed to the sun. Once the mole develops, it usually stays the same size, shape and color for ma...
What kinds of cancers are found in the mouth? The cancers of the mouth (oral cavity) include the lip, tongue, floor of the mouth, cheeks (buccal mucosa), and gums (gingivae). Who is at high risk to get cancer of the mouth? This cancer is predominantly found in men between the ages of 60 and 70. People who are heavy smokers (more than a pack a day), drink alcohol heavily, are over 45, and have a family history of this kind of cancer are at a higher risk to develop cancers of the oral cavity, the mouth, and the throat. Is cancer of the mouth easy to detect? Yes, it is usually discovered early, since it can be seen easily. White patches ( leukoplakia ), velvety red spots (erythroplasia), or dark patches are symptoms which should be seen by a doctor, who will do a biopsy of them. Many cancers of the mouth are first discovered by dentists. What are the symptoms of oral cancer? The warning signs of oral cancer are as follows: • A lump in the cheek that can be felt with the ...
Yes. After prostatectomy , the ability to ejaculate through the penis is lost. What happens is that ejaculation occurs but it is directed backward into the bladder , rather than forward through the urethra. The semen remains in the bladder until urination, and is carried out via that route. The man who ejaculates in this manner has the very same sensations during sex that he had before except that there is no discharge through the penis. Can a total prostatectomy be done without impairing the ability to have an erection? Dr. Patrick C. Walsh, a surgeon at Johns Hopkins University Hospital in Baltimore, Maryland, has developed a way of removing the prostate which preserves potency by bypassing the intricate nerve branches of the pelvic plexus. This technique is now being adopted by many surgeons for patients with early stage prostate cancer. Until the advent of this type of surgery, 90 percent of those having prostatectomies lost their sexual ability, and 2 to 5 percent becam...
Fractures of the Ankle How do ankle fractures occur? Ankle fractures are caused by a forceful and excessive twisting of the ankle , either in or out. The twist comes from stumbling, catching the foot in a crevice, or falling, in which the weight of the body is unevenly distributed. Many skiers suffer fractured ankles, and some of the best treatments have been evolved by surgeons practicing near ski slopes. The stress and strain factors in the ankle are so uniform that the pattern of the injury, dislocation and deformity is specific. Many varieties of ankle fractures are grouped together under the name of Pott's fracture. What shall I do, Doctor? I'm at a gas station phone and my wife just fell down and twisted her ankle. If it is painful and she can't walk, it may be a fracture. Don't manipulate it, don't pull it. Just wrap a towel or pillow around it and take her to a hospital for an X ray. It is best if she does not walk. You can carry her in a chair. ...
What is a bone marrow transplant? Bone marrow transplantation is an approach used over the past 10 years for the treatment of acute leukemia and lymphoma. It is a complex procedure and should be undertaken only by physicians with the experience and resources needed to get the best results. When is a bone marrow transplant used? It may be used in some cases of several types of diseases aplastic anemia (when patients do not have enough red cells to carry oxygen, enough white cells to fight bacteria, or enough platelets to help clotting), in some types of acute and chronic leukemia, for some lymphomas, for severe combined immunodeficiency syndrome, and for certain inherited blood disorders such as thalassemia. A bone marrow transplant replaces a patient's abnormal or diseased marrow with healthy marrow from a donor. Can any leukemia patient undergo a bone marrow transplantation? No. When patients and doctors consider the possibility of treatment with a bone marr...
Would the doctor prescribe estrogen if my ovaries were removed because of cancer? No. If there is any sign of a cancerous condition, estrogen would probably not be prescribed. What is the estrogen controversy? Estrogen is a female hormone produced by the ovaries. Scientists have also developed chemical estrogen. Both regulate the development of female sexual characteristics. For a number of years, estrogens have been prescribed for women during and after menopause to make up for the decline in this hormone normally produced by the ovaries. Estrogen has been found helpful in relieving symptoms associated with menopause, such as hot flashes, in overcoming drying of vaginal tissues and in retarding osteoporosis (thinning of bones). However, the use of estrogen during and after menopause has been linked to an increase in endometrial cancer (cancer of the lining of the uterus), and it may be linked to other cancers as well. At this time,scientists do not agree a...
Head Injuries The brain is man's most vital possession. Recent details about organ transplants have centered on the definition of death. These discussions have emphasized that, even though the heart may continue to beat, the individual is considered dead if there is no brain activity. Nature provides a thick scalp and skull to protect the brain and further encloses it in envelopes called the meninges. Some injuries to the head may be trivial, others may be fatal. The surgeon who is called upon to evaluate the patient with a head injury tackles the problem from within out. Damage to the brain and its envelope is most important; injury to the skull is of concern in only some instances. Bleeding from the scalp is the most apparent manifestation of injury but is the least important. Survival and the late effects of a head injury depend on the extent of the injury to the brain and not to its coverings. The best possible supportive medical crre is provided to those who will reco...
Chest Injuries The chest consists of the bony thorax and the organs that lie within it. The thorax comprises twelve ribs on each side of the chest, each of which attaches to the bony spine in the back and to the chest bone ( sternum ) in front. Each chest cavity has a smooth delicate lining ( pleura ) within which the lung rhythmically expands and deflates. The diaphragm is the dome shaped muscle that seals off the lower end of the chest from the abdomen. Its upand down motion provides the bellows action for the expansion of the lungs that fills them with air. The function of the lungs is to provide ventilation. Air is moved in to provide oxygen, and carbon dioxide is moved out as a waste product. The heart is in its own envelope in the center of the chest, behind the breastbone. The heart functions solely as a pump. It circulates the blood into the lung for oxygenation and delivers oxygenated blood to the entire body. The chest also harbors the large blood vessels and the br...
Hodgkin's Disease and Non-Hodgkin's Lymphoma What are lymphomas? Lymphomas are cancers that affect the white blood cells of the immune system. They are characterized by the abnormal growth of lymphocytes, the infection fighting cells in the lymph nodes, spleen, and thymus. The tonsils, stomach, small intestine, and skin may also be affected. Lymphomas are usually classified as Hodgkin's disease, the most common form, or non-Hodgkin's lymphoma. There are also other rare forms of the disease, such as mycosis fungoides, a primary skin lymphoma. Burkitt's lymphoma , rare in most of the world, is the most common childhood cancer in central Africa and is one of the fastest growing human cancers. What is the role of the lymph system in the body? The lymph system is made up of nodes and thin walled tubelike veins along which the nodes lie. Its job is to help fight diseases and infection, and it serves as part of the body's drainage system. Lymph nodes are ...
Hand Injuries Most of us earn our living with our hands. The goal of the treatment of hand injuries is maximum preservation of function. In terms of possible permanent disability, there is no minor surgery in this area. The magnitude of the problem is apparent in the frequency with which it appears in the statistics of the Workmen's Compensation Board and insurance companies. The best treatment is prevention. One must be constantly alert to the possibility of punctures, door slams, burns, pressure injuries, and the perverse potential of certain mechanical tools. Failing this, early treatment to prevent infection is best. There are relatively clearly defined methods of managing various types of injury. The patient can describe the site of the injury by indicating its relation to the various creases in the palm or to the knuckles and nails on the back of the hand. Physicians can treat all hand and finger injuries under some form of nerve blocking anesthesia, so the patient feels...
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