What is a lumbar puncture used to diagnose? When are x-rays used in diagnosis?

What is a lumbar puncture? 

A lumbar puncture is a diagnostic procedure sometimes referred to as a spinal tap, usually performed under local anesthesia. A thin needle is inserted in the space between the two lower vertebrae of the spine to remove fluid that normally is in this area. Lumbar punctures are used in cancer, for instance, to diagnose leukemia in the central nervous system. This examination indicates the pressure within the spinal fluid system and can show evidence of tumor, infection, or inflammation in the central nervous system. If spinal fluid is being removed, a headache following the procedure is not unusual.

When are x-rays used in diagnosis? 

X-rays are an important part of the diagnostic workup. Xrays are used to detect and diagnose many forms of cancer, including cancer of the lung, digestive tract, and breast. They are also used to determine whether the cancer has spread to places such as the lung or the bone. Properly taken and read, x-rays are one of the doctor's most valuable diagnostic tools.

How are computers being used for x-rays? 

Computers, which up to now have only been used in special diagnostic procedures such as CT scans, are starting to be used for routine x-rays. In what is called digital radiography, the technique uses computer monitors to view the image. Doctors can zoom in on a specific area of the x-ray, adjust the contrast in too dark or too light areas, and tell the difference between soft tissue and bone. Some systems stand alone, and others are used in conjunction with standard xray equipment. All work by converting x-ray images to digital signals, electronic data that can be stored and examined by a computer. Digital radiography is still in its early stages, but someday its use should reduce the number of x-rays that need to be taken again as well as lowering radiation levels for those systems using filmless methods.

What are the main kinds of x-rays? 

There are two major types of diagnostic x-rays: plain films and contrast films.

What are plain films? 

These are regular, standard x-rays you have always known. They are ordinary films of various parts of the body. A chest x-ray is an example of a plain film. For a tumor to be seen on a standard x-ray it must be big enough and it must be more dense than the surrounding normal tissues. Tumors are not always detectable on an x-ray.

What are contrast films? 

A contrast film is used when some foreign substance is put into the body to contrast with normal body tissues. For example, a chemical dye or air or a radioactive material may be introduced into the body to allow some organ to be outlined on the x-ray. A barium enema x-ray is an example of a contrast film.

What is an air contrast x-ray? 

An air contrast x-ray is produced when air is introduced into a selected part of the body. The air is used to outline soft-tissue structures within the body. Since air does not absorb x-rays like the surrounding tissues, it provides a contrast on the film. Depending on the test, the air may be inhaled, swallowed, injected, or obtained from carbonated beverages. For example, a deep breath held during a chest x-ray fills the lungs with air. X-rays pass through the air readily, so the tissues surrounding the lungs will show up, and any areas where the lungs do not readily fill up with air will be cloudy on the x-rays.

What are the names of some of the different kinds of contrastfilm tests using dye? 

There are many of them, and their names normally correspond with the part of the body being tested.

• Barium enema (BE) outlines the colon (intestines) and rectum. Barium is given rectally by enema.

• Barium swallow outlines the upper digestive tract including the pharynx and esophagus. Barium is swallowed.

• Bronchogram outlines the bronchial tree. Dye is injected into the lung bronchi (air passages). High risk procedure.

• Cerebral angiogram outlines the blood vessels in the neck and brain. Dye is injected into carotid and or vertebral arteries in the neck. Also called an arteriogram. High risk procedure.

• Coronary angiogram outlines the heart chambers, valves, and surrounding arteries in the veins. Dye is injected into the chambers of the heart. Also called an arteriogram. High risk procedure.

• Cholecystogram outlines the biliary tract (gallbladder and bile ducts). Contrast medium is given as pills 12 hours before x-rays are taken.

• Cystogram outlines urinary bladder (cystourethogram outlines bladder and urethra). Dye is placed in bladder by means of urinary catheter.

• GI series outlines the stomach, duodenum, and remainder of the small intestine. The contrast medium is swallowed.

• Hysterogram outlines the stomach, duodenum, and remainder of the small intestine. The contrast medium is swallowed.

• Hysterogram outlines inside of uterus and the fallopian tubes (hysterosalpingogram outlines uterus and oviducts). Dye is injected through a vaginal catheter into uterus.

Intravenous pyelogram (IVP) outlines the urinary tract (kidneys, ureters, and bladder). Dye is injected into the arm vein.

• Lienography outlines the spleen. Dye is injected.

Lymphangiogram outlines the lymph nodes. Dye is injected into involved lymph system. Usually used for patients with Hodgkin's disease, lymphomas, or testicular cancer.

Myelogram outlines the spinal cord and adjacent structures. Dye is injected by needle into the fluid surrounding the spinal cord.

Pneumoencephalogram (PEG) outlines the chambers and surface of the brain. Air is injected and rises into the brain. High-risk procedure.

• Pulmonary angiogram outlines blood vessels (arteries and veins) in the lungs. Dye is injected into the pulmonary arteries as they leave the heart. High risk procedure.

• Venogram outlines the venous system of the body. Dye is injected into vein.

Why are some of the contrast films noted as high risk procedures? 

Most of the contrast films involve little risk. The high risk procedures are those in which a stroke might be induced, nerve damage may be caused, or other complications may occur when the dye is being introduced into the body. Those which involve more risk include the bronchogram, cerebral angiogram, coronary angiogram or arteriogram, pneumoencephalogram, and pulmonary angiogram. These tests demand skilled personnel. Also, some people are allergic to the dye, particularly that used in the intravenous pyelogram (IVP.)


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