Diagnostic Procedures

We treat and educate patients before a serious problem arises though the following non-invasive procedures:

• EKG

  EKG/Electrocardiography is a technique where by the hearts electrical impulses are measured through electrical leads that are attached to the chest and extremities. The information is written as a "tracing" which can be interpreted by your physician. EKG testing is useful as a "spot check" for certain types of cardiac rhythm abnormalities, and acute injury to the heart as would be the case with a "heart attack". We perform EKG's 24 hours per day. The procedure is non-invasive and totally painless.

• Exercise EKG (or Stress Test)

  Exercise EKG or stress testing is performed by obtaining a "continuous" EKG tracing while a patient is walking on a treadmill device. This is in contrast to a "resting" EKG. When a patient exercises, the heart works harder, and depending on the degree of exercise it is sometimes possible to see, via continuous EKG tracings certain types of "stress" including changes in the cardiac rhythm, or changes in blood circulation to the heart muscle.
  
  Exercise EKG (or Stress) testing is performed in a special part of the hospital using an exercise treadmill and a monitoring device that will record a "continuous" EKG tracing. The procedure is non-invasive and painless. Patients normally wear loose fitting or exercise clothing and jogging shoes during the testing procedure.

• Cardiac Nuclear Medicine Testing

  Nuclear medicine is a healthcare specialty involving the use of radioactive compounds to perform diagnostic imaging examinations that can lead to the effective treatment of many diseases. Although nuclear medicine is often considered an independent discipline, it is closely related to radiology in that radiation is used to develop images of human anatomy. Cardiac nuclear medicine refers to these diagnostic tests that are used to examine the anatomy and function of the heart.

• Cardiac Perfusion Scans

  Cardiac nuclear medicine tests are indicated for individuals with unexplained chest pain or chest pain brought on by exercise (called angina) to permit the early detection of heart disease. The most common cardiac nuclear medicine procedure, called a cardiac perfusion scan or myocardial perfusion scan, enables the visualization of blood-flow patterns to the heart walls. The test is important for evaluating the presence and extent of suspected or known coronary artery disease (blockages) as well as the results of previous injury to the heart from a heart attack, called a myocardial infarction. It also can be done to evaluate the results of bypass surgery or other percutaneous revascularization procedures designed to restore the blood supply to the heart.

  How does the procedure work?

  Coronary arteries are best evaluated by determining the changes in blood flow to the heart due to exercising. Consequently, you will undergo a stress test — either through physical exercise or pharmaceutical injection — to make your heart work harder than normal. Then you will be given a radioactive compound, called a radiopharmaceutical agent or tracer. This compound will collect in parts of your heart with good blood flow and will give off gamma rays. The gamma camera detects the rays. Subsequently, a computer will construct images of the heart based on the detected gamma rays.

  How is the procedure performed?

  Myocardial perfusion scans involve making two sets of images: rest images and stress images. Rest images are taken while the person is at rest and stress images are taken after the heart has been stressed either through exercise (treadmill) or by using a medication called adenosine. Then the resting images and the stress images are compared. Medication stress testing may be done instead of exercise stress testing for people with conditions that may make exercise difficult. A gamma camera is used to obtain images of both the rest and stress studies. The gamma camera will move slowly and automatically in an arc over the front of your chest after it is positioned initially by the technologist. The imaging takes approximately 15 minutes, during which time you must lie completely still.

  For the resting scan, a small amount of the radioactive tracer is injected into a vein. Approximately one hour later you will lie on your back on a table and a gamma camera will then be used to obtain images.

  For the stress part of the examination, you will exercise by walking on a treadmill for a few minutes. While you exercise, the electrical activity of your heart will be monitored by electrocardiography (ECG), and your blood pressure will be measured frequently. Before you stop exercising, you will be given the radiopharmaceutical through an IV leading into a vein in your arm. The compound is given when the blood flow to the heart is at its peak because of your exercising. This provides the best opportunity to identify regions of the heart that are not receiving adequate blood flow.

  One minute later, you will stop exercising. You will then be asked to go eat a small meal and then return to the department approximately one hour later for imaging.

  If you are unable to use a treadmill, you will not exercise, but you will be given a drug that will cause your heart to work as hard as if you had exercised. You will then be given the radiopharmaceutical.

  What will I experience during the procedure?

  You will be asked to exercise until you are either too tired to continue or short of breath, or if you experience chest pain, leg pain, or other discomfort that causes you to want to stop.

  If you are given a medication to increase blood flow because you are unable to exercise, the medication may induce a brief period of feeling anxious, dizzy, nauseous, shaky or short of breath. In rare instances, if the side effects of the medication are severe or make you too uncomfortable, other drugs can be given to stop the effects.

  Most patients can resume regular activities immediately after the procedure. The radioactivity in your body will decrease due to the natural process of radioactive decay. In addition, radioactivity will decrease because the radiopharmaceutical passes out of the body in the urine or stool.

  Who interprets the results and how do I get them?

  Generally, patients undergo a nuclear medicine examination because a referring physician has recommended it. A physician who has specialized training in nuclear medicine will interpret the images. It usually takes one to three days to interpret, report, and deliver the information to your referring physician. Your referring physician will then inform you of the results.

  What are the benefits vs. risks?

  
  

     Benefits

  • The functional information regarding blood flow to the heart and the pumping function of the heart is well demonstrated. This information may be used to determine what treatment or additional testing, if any, is needed.
  • Computers are involved in the generation of the images, so measurements or quantification of function, as well as the determination of abnormalities, are possible.
  • Because the procedure is generally performed according to standardized protocols, the type of examination done at one hospital is likely to be similar to that performed at other hospitals, making the information easy to understand or to transfer to all doctors who may be involved in your care.

     Risks

  • If you have coronary artery disease, it is possible that you could experience chest pain, or angina, when stress due to exercise or a drug is applied to your heart. However, your test will be carried out under the supervision of a specialist trained to monitor you and your heart by using information being provided by the electrocardiogram, by your heart rhythm, and by your blood pressure. If necessary, medication can be given for your chest pain. You will be monitored long enough to ensure that you are at your baseline; that is, the condition you were in when you came for the test.
  • The use of a radioactive substance will result in exposure to a small amount of radiation to the heart and to the body. However, the amount of radioactivity administered is the smallest amount necessary to provide adequate images. Cardiac nuclear medicine procedures have been done for more than three decades, and no long-term adverse effects have been reported from such low-dose studies. Allergic reactions to radiopharmaceuticals can occur but are extremely rare.

• Magnetic Resonance Imaging

  Staff of the imaging department have led Santa Rosa Memorial Hospital through a virtual revolution in the way diagnostic images are saved and interpreted, according to Manager Martha Geiger.  Now, from twelve locations throughout the hospital, a doctor can call up immediate results of a patient's x-ray, CT scan, ultrasound, Nuclear Medicine study, or MRI through the Picture Archiving and Communication System (PACS), Geiger said. The images are also available, via the Internet, to doctors in their offices. 
  "Every system we've been used to for the last 25 years has changed as we converted to digital technology," she said. Technologists have all been retrained to acquire and process digital images which has  been a tremendous learning curve. Physicians have also relearned processes as we  made the leap away from film.

  A year ago, the department made the leap from x-ray film to Computed Radiography, Geiger said. Technologists capture an image of the patient's anatomy on a digital plate, develop it in a CR reader and. then send it to PACS. The radiologist types a preliminary report into PACS, making results immediately available to other clinicians. Physicians can now look at the studies and results at any location throughout the hospital and in their offices or homes.

  Emergency room doctors are ordering more images, especially CT scans, to diagnose patients, Geiger said. And her technologists are frequently called to the operating room with their equipment to offer a crucial inside look at the patient. "We're a huge presence in the OR," Geiger said. Surgeons may be guided by the images the technologist projects onto a screen. There are eight mobile pacs workstations in the operating room. The technologist wheels the workstation into the OR suite and the surgeon can review images during the operation.
  

  In addition to x-rays, the imaging department offers computerized axial tomography (CAT scan), CT angiograms, ultrasound, echocardiagrams, nuclear medicine and magnetic resonance imaging (MRI).  Safety is a priority in a department where many employees work with technology that involves radiation, Geiger said. Technologists shield themselves and their patients with lead aprons or thyroid collars when needed and staff wear radiation badges that are monitored each month. 

  Patient safety is a priority in the imaging department as there has been an increase in the acuity of our patient mix. Technologists, transporters and nurses work together to ensure patients are cared for timely and safely.

• Electrocardiography (Including Trans-esophageal Echocardiograph)

  Echocardiography is a technique where by high frequency sound waves "ultrasonic or ultrasound" are transmitted through the chest wall using a small device called a "transducer". The transducer "transmits" ultrasonic waves into the chest, and then collects information about the density of the materials that the ultrasonic waves pass through. Echocardiography is used to gather information about the structure of the heart, it's various valves and chambers. Echocardiography is used to diagnose certain valvular disorders such as leakage, and also the dimensions, size. We can also determine how well and how efficiently the heart if pumping. The procedure is non-invasive and totally painless
  
  In certain instances the heart valves can be studied in more detail by placing the ultrasonic transducer on the tip of a special "scope" that is used to examine the esophagus and stomach. In these instances, under light sedation a special "scope" (tube) is passed through the mouth and into the stomach. Once the tube is passed, the location of the ultrasonic transducer is very near the heart, and in these circumstances excellent images of the heart valves can be obtained. This procedure is used to study heart valves in detail. This procedure is known as a "trans-esophageal echocardiogram", or "TEE". It is mildly invasive and requires sedation. We do this procedure in a special area of the hospital.