Programs & Services > Clinical Services > Medical Imaging

Medical Imaging

The Medical Imaging Department at Tulare District Hospital provides a variety of imaging services including general diagnostic radiology, fluoroscopy, CT, MRI, Ultrasound, Mammography, Nuclear Medicine and will soon be offering Stereotactic Breast Biopsy.

TDH has contracted with Mineral King Radiological Medical Group to provide the physician radiological services.

Outpatient services are also available at Family X-ray Center located at 880 East Merritt Avenue in Tulare. Services at this location include general diagnostic imaging, ultrasound, mammography and DEXA Bone Density testing. Conveniently located in its outpatient setting, Family X-ray Center can offer more timely service for these outpatient tests.

Services provided are:

Angiogram
An angiogram is the study of an artery or vein. There are three types of angiograms, depending upon the region of the body affected. Medicine will be administered through an IV to help you relax. You will then be given a local anesthetic to numb the groin area. A catheter is inserted into the artery. X-ray dye is injected, enabling the doctor to view the blood vessel that might be causing problems. This procedure is done in the vascular lab.

Arthograms (Knees, Wrists, etc.)
The patient is brought into the X-ray room and several preliminary films are taken. The radiologist inserts a needle into the joint space. Contrast dye and sometimes air is then injected. Several films are taken with the joint in different positions. Occasionally, a patient will have a CT exam following the arthrogram.

Barium Swallow (Esophagus)
The patient will be given barium to drink to visualize the esophagus and swallowing function. Several films are taken while the patient is drinking.

Colon Exam (Air Con Enema, Barium Enema, Lower GI)
The patient is brought into the room and a history is taken. He or she is placed on the X-ray table on his or her back and a preliminary film is taken. The patient is asked to lie on the left side and an enema tip is inserted into the rectum through which barium or water soluble contrast material is administered. The radiologist then takes several more films of the colon during this process. The films are then checked and the barium is emptied out of the colon. The patient may experience some mild cramping during the procedure and afterward, the patient is instructed to drink plenty of water to avoid constipation.
  
CT or CAT Scan
CT stands for Computed Tomography and CAT stands for Computer Assisted Tomography. CAT scanning produces X-ray images with the aid of a computer to generate cross-sectional views of the anatomy. CAT scanning can identify normal and abnormal structures and can be used during image-guided procedures such as biopsies. The machine does not enclose you and the technologist is always present during the exam.

Tulare District Hospital has one spiral CT scanner that allows for better diagnostic studies and faster scanning. The speed of the scanner permits "real-time" scanning, which aids the interventional radiologist in placing biopsy needles more quickly and accurately. More than 6,000 procedures are performed annually.

Cystogram, Cystourethrogram
The patient lies on the X-ray table on his or her back and a preliminary film is taken. The nurse will insert a urinary catheter. The radiologist instills contrast through the cathete in order to fill the bladder. Pictures of the full bladder are then taken.

Ultrasound
An ultrasound exam is done in the radiology department using high-frequency sound waves to produce images of the organs and structures of the body. The sound waves are sent through body tissues by using a device called a "transducer." The transducer is placed directly on top of the skin, which has a gel applied to the surface. The sound waves that are sent by the transducer through the body are then reflected by internal structures as "echoes." Ultrasound testing is painless and harmless, involving no radiation.
TDH utilizes the latest in harmonic imaging and color Doppler technologies. We have state-of-the-art Acuson equipment, including the latest "Sequoia" unit. Tissue harmonic imaging differentiates tissue without contrast agents. The skilled technical staff performs about 7,000 ultrasound exams annually.

ERCP (Endoscopic Retrograde Cholangiopancreatography)
The patient is brought into the X-ray room and placed on his or her stomach on the fluoroscopy table. The Endoscopy team will give the patient medication to relax. The physician will place an endoscope into the stomach and the duodenum. A catheter is placed through the scope to inject contrast in the pancreatic duct and the common bile duct. Films are taken. When finished, the patient is taken to a recovery area and discharged after observation.

Hysterosalpingogram
The patient is brought into the X-ray room and a history is taken. The patient lies on her back and a preliminary film is taken. The radiologist will inject contrast into the uterus through a specialized catheter. Films are taken of the uterus and Fallopian tubes. The patient may drive home when released; however, some mild cramping and spotting may occur for a short time following the exam.
 
Interventional Radiology
Interventional radiology employs image guidance methods through veins and arteries to gain access to specific organs. The technology includes the use of balloons, catheters, and stents to unclog blood vessels. The specialty of interventional radiology is growing and becoming increasingly diverse. It overlaps with other surgical arenas, including interventional cardiology, vascular surgery, endoscopy, laparoscopy and other minimally invasive techniques such as biopsies. This procedure is done in our vascular lab.

IVP
The patient lies on his or her back on the X-ray table and a few preliminary films are taken. A detailed history is taken. The radiologist or technologist will place a needle in a vein in the patient’s arm so that contrast may be injected. After a few minutes, the technologist begins taking X-rays of the kidneys, ureters and bladder as the contrast is excreted. The needle is removed when all the contrast is injected. The radiologist determines how many films are to be taken. The patient is encouraged to drink plenty of water after the exam.
 
Lung Biopsy
A radiologist or pulmonologist inserts a special needle through the chest wall into the lung using CT guidance. With this needle, a biopsy sample is taken of tissue that will be sent to the lab for analysis. The patient will have a chest X-ray taken immediately following the biopsy and possibly one and two hours later to check the status of the lung. The patient is usually released after a few hours in a recovery area.

MRI (Magnetic Resonance Imaging)
MRI scanning is painless and does not use radiation to create images. Instead, it uses a magnetic field and radio waves to create a very clear picture of internal body structures. MRI uses sensitive instruments and specially designed computers to create images of the entire area being scanned. The scanner allows for quick, accurate scanning of head, neck, spine, joints, abdomen, pelvis, chest and veins and arteries.
Patients with heart pacemakers, metal implants, metal chips or clips in or around the eyes can not be scanned with MRI because of the effect of the magnet. You should advise your physician, if you are claustrophobic, because this sensation can occur with MRI scanning.
Annually, more than 1,500 MRI scans are performed by our certified MRI technologists.

Myelogram, Epidural Injection
The patient is placed on the X-ray table on his or her stomach. The patient’s physician or a radiologist will place a spinal needle in the spinal canal. X-ray contrast is then injected and several X-rays are taken. The patient is taken to a recovery area for a few hours afterward, then discharged. (Occasionally, a patient will have a CT exam following the myelogram.) The patient should arrange transportation for the ride home.

Nuclear Medicine
Nuclear medicine technology is the branch of medicine concerned with diagnostic and therapeutic uses of radiopharmaceuticals. Disease of such anatomical structures as the thyroid, brain, lung, liver, spleen, bone, pancreas, kidneys, heart and gastrointestinal system can be diagnosed using nuclear medicine. The patient inhales, ingests or is injected with a small quantity of a radiopharmaceutical. An image of the organ under study is created when a radiation detection instrument records the distribution and concentration of the radiopharmaceuticals within the organ.
The Nuclear Medicine Department is strictly monitored by the US Nuclear Regulatory Department to ensure safety for patients and employees. Adherence to state and federal radiation regulations is monitored quarterly by radiation physicist consultants.

Radiology
The radiology area offers a full range of diagnostic testing to patients of all ages. Each year, our certified technologists perform more than 29,000 diagnostic procedures. A team of board-certified radiologists interpret all diagnostic radiology tests and exams. Procedures include general X-rays, fluoroscopic exams, contrast-enhanced testing and special procedures.

Small Bowel Series
The patient is brought into the X-ray room and a preliminary film is taken. The patient is given barium to drink and films are then taken at timed intervals as the barium passes through the entire small intestinal tract. The exam is complete when the barium goes through the last portion of the small intestine to the large intestine. The patient is encouraged to drink plenty of water afterward to avoid constipation. (The length of time for this exam varies. Patients should be prepared to remain in the department for three to four hours.)

Stereotactic Breast Biopsy - Available later in 2006.
This is a procedure offered as an alternative to conventional excisional breast biopsy, which is typically performed in the operating room. Stereotactic Breast Biopsy uses a specialized prone mammographic biopsy table in conjunction with a vacuum biopsy system. The system is capable of pinpointing small to medium sized lesions which are extracted through the use of a biopsy needle. Patients can undergo the procedure without the use of general anesthesia and recovery time is very short.

Upper GI (Upper Gastrointestinal series, UGI)
The patient is brought into the X-ray room. A history and a preliminary film are taken. The patient is often given "crystals" to swallow, creating air in the stomach along with a solution of barium sulfate. The radiologist then takes films as the patient drinks the contrast material. The technologist will take several more films to be reviewed by the radiologist, and then the patient is released. The patient is instructed to drink plenty of water following the exam to avoid constipation.

X-ray Exam Preparations
For some of the exams described here, "exam preps" are needed to be followed prior to the exam ordered. Several "preps" call for nothing to eat and/or drink for specific amounts of time before the exam. Other exams require the drinking of special liquids and/or taking pills to cleanse the bowel. Information will be given at the time of scheduling as to which prep the patient will need to follow.

X-ray Contrast
In order for internal body parts (such as the stomach, colon and kidneys) to be seen on X-rays, they need to be enhanced. This is done by giving the patient X-ray "contrast." There are two basic types: one type you may drink or receive through an enema, and the other type is injected into a vein through a catheter, or injected into a joint.

The most common contrast is barium. It is a white, thick liquid that can be seen when taking X-rays. The second is an injectable X-ray contrast (dye). This material is more dense than your body tissue and can also be seen on X-rays.

For more on Medical Imaging procedures please click HERE.