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IV CONTRAST REQUIREMENTS
IV Contrast Requirements All patients requiring IV contrast must be screened prior to receiving contrast! For patients that are diabetic, or have kidney disease, or have lupus and/or other collagen vascular diseases, a BUN and Creatininte must be available, performed within the 30 dyas prior to the exam date. These results are needed before the patient is injected with contrast media. Any patient 70 or older must have a BUN and creatinine done within the last 30 days. NOTE: If the patient is taking Glucaphage, Glucovance, Avandament, Metaglip or any form of Metformin for diabetes, these medications MUST be discontinued for 48 hours after being given the IV contrast. It is recommended by the manufacturers that the medication also be stopped for 48 hours PRIOR to the exam. We are ONLY able to access MMHS lab results. If the labs were performed elsewhere, a written report must be sent with patient or faxed to the Imaging Department prior to the CT exam date.
Contraindications for IV Contrast: • Elevated BUN/Creatinine, ie Cr >=1.7 • Severe allergy to iodine (history of anaphylactic reaction) • Sickle cell crisis • Multiple Myeloma • Pheochromocytoma If the patient is allergic to Iodine, they must follow the premedication protocol per MMHS Radiology Department
Contrast for MRI Patients with end-stage renal failure MUST be evaluated PRIOR to administration of contrast and may require dialysis if contrast is administered.
Radiology Department Protocol for Premedication for IV Contrast • • • •
50 mg Prednisone PO 13 hours prior to exam 50 mg Prednisone PO 7 hours prior to exam 50 mg Prednisone PO 1 hours prior to exam 50 mg Benadryl PO 1 hours prior to exam
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I M P O R TA N T P H O N E N U M B E R S
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Diagnostic Scheduling
(772) 288-5817
Active Fax Scheduling
(772) 223-4514
MRI Scheduling
(772) 221-7226
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Interventional Procedure Scheduling (772) 223-5945 ext. 3137 Diagnostic Scheduling Martin Memorial Diagnostic Center 2396 S.E. Ocean Blvd., Stuart, FL 34996 Main Phone: 223-4959 • Fax: 223-2876 St. Lucie West 1095 St. Lucie West Blvd., Port St. Lucie, FL 34986 Main Phone: 223-5945, ext. 5502 • Fax: 785-5543 Martin Memorial Medical Center 200 S.E. Hospital Ave., Stuart, FL 34994 Main Phone: 223-5945, ext. 3120 • Fax: 223-5908 Martin Memorial Medical Center Cardio and Neurodiagnostics Main Phone: 285-5882 • Fax: 223-5948 Martin Memorial Hospital South 2100 S.E. Salerno Road, Stuart, FL 34997 Main Phone: 223-5714 • Fax: 223-5702 MRI Scheduling Martin Memorial Medical Center MRI 625 Riverside Dr., Stuart, FL 34994 Main Phone: 221-7226 • Fax: 223-5933 St. Lucie West MRI 1095 St. Lucie West Blvd., Suite 224, Port St. Lucie, FL 34986 Main Phone: 785-5567 • Fax: 785-5568 South MRI 2150 S.E. Salerno Road, Suite 104, Stuart, FL 34997 Main Phone: 223-5767 • Fax: 223-5787
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IV CONTRAST REQUIREMENTS . . . . . . . . . . . . .1 SCHEDULING INFORMATION . . . . . . . . . . . . . . 3 MANAGED CARE LIST . . . . . . . . . . . . . . . . . . . 11
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FLUOROSCOPY . . . . . . . . . . . . . . . . . . . . . . . . 13 Call (772) 288-5817 to schedule Esophagram (Barium Swallow) . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Swallowing Evaluation Study (cookie swallow) . . . . . . . . . . . 15 Upper GI Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Small Bowel Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Contrast Enema. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Fistulagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Sniff Test - Chest Fluoroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Cystogram / Voiding Cystourethrogram (VCUG) . . . . . . . . . . 19 Retrograde Urethrogram (Male) . . . . . . . . . . . . . . . . . . . . . . . . . 20 Hysterosalpingogram (HSG). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Intravenous Pyelogram – IVP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
INVASIVE FLUOROSCOPY PROCEDURES . . . . . . . . . . . . . . . . . . . . . . . . 22 Call (772) 223-5945, ext. 3137 to schedule Arthrogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Extremity Venogram – Unilateral or Bilateral. . . . . . . . . . . . . . 23 Catheter Placement Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Myelogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Cisternogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Lumbar Puncture under Fluoroscopy . . . . . . . . . . . . . . . . . . . . 25 T-Tube Cholangiogram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
MAMMOGRAPHY . . . . . . . . . . . . . . . . . . . . . . 27 Call (772) 288-5817 to schedule Mammography – unilateral or Bilateral . . . . . . . . . . . . . . . . . . . 29
COMPUTED TOMOGRAPHY CT . . . . . . . . . . 31 Call (772) 288-5817 to schedule CT of the Head (without contrast or with and without) . . . 33 CT of the Orbits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 CT of the Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 CT of the Temporal Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 CT of the Neck Soft Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 CT of the Cervical Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Diagnostic Imaging Prep Guidelines
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CT of the Thoracic Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 CT of the Lumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 CT of the Chest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 CT of the Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 CT of the Pelvis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 CT of the Extremities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
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INTERVENTIONAL CT . . . . . . . . . . . . . . . . . 42 Call (772) 223-5945, ext. 3137 to schedule CT Guided Biopsy of Drainage. . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 CT Guided Facet Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 CT Guided Bone Marrow Biopsy. . . . . . . . . . . . . . . . . . . . . . . . . . 44
ULTRASOUND . . . . . . . . . . . . . . . . . . . . . . . . . 45 Call (772) 288-5817 to schedule Ultrasound of the Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Ultrasound of the Neonatal Brain. . . . . . . . . . . . . . . . . . . . . . . . . 48 Ultrasound of the Baby Hips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Ultrasound of the Baby Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Ultrasound of the Breast—Unilateral or Bilateral. . . . . . . . . . 49 Ultrasound of the Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Ultrasound of the Pregnancy Limited . . . . . . . . . . . . . . . . . . . . 50 Ultrasound of the Pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Ultrasound of the Prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Ultrasound of the Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Ultrasound of the Renal Artery Doppler . . . . . . . . . . . . . . . . . . 52 Ultrasound of the Evaluation of “TIPS”—Liver Doppler. . . . 53 Ultrasound of the Testicular (Scrotal) . . . . . . . . . . . . . . . . . . . . . 53 Ultrasound of the Chest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
INTERVENTIONAL ULTRASOUND . . . . . . 55 Call (772) 223-5945, ext. 3137 to schedule Ultrasound of the Chest with Thoracentesis . . . . . . . . . . . . . . 55 Ultrasound Guided Paracentesis . . . . . . . . . . . . . . . . . . . . . . . . . 56 Ultrasound Guided Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
NUCLEAR MEDICINE . . . . . . . . . . . . . . . . . . . 57 Call (772) 288-5817 to schedule Nuclear Medicine Whole Body Bone Scan . . . . . . . . . . . . . . . . 59 Nuclear Medicine Triple Phase Bone Scan . . . . . . . . . . . . . . . . 60 Nuclear Medicine GI Bleeding Study . . . . . . . . . . . . . . . . . . . . . 60 Nuclear Medicine Gallium Scan . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Nuclear Medicine Gastric Emptying . . . . . . . . . . . . . . . . . . . . . . 61 Nuclear Medicine Hepatobiliary/Pipida Scan . . . . . . . . . . . . . 62
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Nuclear Medicine Liver/Spleen Scan. . . . . . . . . . . . . . . . . . . . . . 63 Nuclear Medicine Tumor Localization— Sentinel Node Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Nuclear Medicine Ventilation and Perfusion Lung Scan . . . 64 Nuclear Medicine Split Perfusion Lung Scan . . . . . . . . . . . . . . 64 Nuclear Medicine Muga Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Nuclear Medicine Renal Scan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Nuclear Medicine Thyroid Scan. . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Nuclear Medicine Thyroid Uptake and Scan . . . . . . . . . . . . . . 67 Nuclear Medicine Parathyroid Scan. . . . . . . . . . . . . . . . . . . . . . . 68 Nuclear Medicine Cisternogram. . . . . . . . . . . . . . . . . . . . . . . . . . 68 Nuclear Medicine Octreotide Scan . . . . . . . . . . . . . . . . . . . . . . . 69 Nuclear Medicine Prostascint Scan . . . . . . . . . . . . . . . . . . . . . . . 69
ANGIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . 71 Call (722) 223-5945, ext. 3137 to schedule Arteriograms or Angiograms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
CARDIOVASCULAR PROCEDURES . . . . . . 75 Call (772) 288-5817 to schedule Transesophageal Echocardiogram (TEE). . . . . . . . . . . . . . . . . . 77 2-D Echocardiogram with Doppler and Color Flow . . . . . . . 78 Carotid Duplex Color Flow Imaging . . . . . . . . . . . . . . . . . . . . . . 78 Arterial Evaluation of Lower and Upper Extremities (Pulse Volume Recordings “PVR”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Venous B-Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 A-V Access Graft Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Arterial Graft Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Electrocardiogram (EKG) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Holter Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Patient Initiated Event Monitor (PIM) . . . . . . . . . . . . . . . . . . . . . 84 Telephonic Pacemaker Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
NEURODIAGNOSTIC PROCEDURES . . . . . 87 Call (772) 288-5817 to schedule Electroencephlogram (EEG) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Ambulatory Electroencephlogram (EEG) . . . . . . . . . . . . . . . . . 90 Sleep Deprived Electroencephlogram (EEG) . . . . . . . . . . . . . . 91 Visual Evoked Potential (VEP). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Brainstem Auditory Evoked Potential (BAEP) . . . . . . . . . . . . . 93 Electromyography (EMG) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
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STRESS TEXT (GXT) . . . . . . . . . . . . . . . . . . . 94 Call (772) 288-5817 to schedule
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Stress Test Listing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Regular Stress Test (Exercise only, without nuclear imaging) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Cardiolite Stress Test (Exercise with nuclear imaging) . . . . . . . . . . . . . . . . . . . . . . . . 96 Persantine Cardiolite Stress Test (Pharmacological Stress test, pt. is laying down, with nuclear imaging.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Adenosine Cardiolite Stress Test (Pharmacological Stress test, pt. is laying down, with nuclear imaging.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Dobutamine Cardiolite Stress Test (Pharmacological Stress test, pt. is laying down, with nuclear imaging.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Dobutamine Stress Echo Test (Pharmacological Stress test with 2-D Echo. Pt is lying down, without nuclear imaging.) . . . . . . . . . . . 100 Stress Echo Test (Exercise with 2-D Echo-Imaging, without nuclear imaging.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Call (772) 288-5893 to schedule PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
MAGNETIC RESONANCE IMAGING . . . . . 107 Call (772) 221-7226 to schedule MRI/MRA/MRCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
CATHETERIZATION LAB . . . . . . . . . . . . . . . 111 Call (772) 223-5919 to schedule Cath Lab. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
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MANAGED CARE LIST
MARTIN MEMORIAL HEALTH SYSTEMS DIAGNOSTIC CENTER CONTRACTS Aetna US HealthCare (PPO, MC - No HMO) BC/BS - PPS/PPC/NETWORKBLUE BC/BS-Health Options (HMO) Beech Street (PPO & WC - Network) Choice Managed Networks (WC) CIGNA (PPO/POS/HMO) Corvel/CorCare (W/C) Coventry (PPO-Includes First Health & Southcare) ECN/WebTPA PPO & EPO Evercare (United Healthcare Medicare Special Needs Plan) Evolutions Healthcare Systems, Inc. (PPO & WC - Network) First Health (PPO & WC - Network) First National Bank (TPA: CoreSource, Inc.) Florida Health Administrators (PPO - Network) GreatWest Healthcare HealthEase (Medicaid HMO/ Healthy Kids Program:Martin County ONLY)
Heritage/Summit Healthcare (W/C) Humana Health Care Plans Hygeia Travel Health (PPO - Network) Interplan Health Group/Accountable (PPO Network) Marriott Casualty (WC) Metcare Health Plans, Inc. (Medicare HMO) MetraComp (WC) (Partnership with Focus HealthCare effective 6/6/02)
Multiplan (PPO Network) Private Healthcare Systems (PPO - Network) Protegrity Services (WC) Provider Management Group Network (PMG) (WC) Prudential (PRUNET) QRS Managed Care Services (WC) Secure Horizons (United Healthcare Medicare PPO) SouthCare (PPO - Network) United HealthCare (PPO/POS/EPO/HMO) Diagnostic Imaging Prep Guidelines
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FLUOROSCOPY SECTION AND
INVASIVE FLUOROSCOPY PROCEDURES Call (772) 288-5817 to schedule
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FLUOROSCOPY . . . . . . . . . . . . ESOPHAGRAM (BARIUM SWALLOW) Description Images of the esophagus are taken while a patient swallows a barium drink.
Indications Swallowing difficulty, dysphagia, suspected stricture
Prep Patients should have nothing by mouth for 2 hours prior to the exam.
Length Minimum 20 minutes.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
SWALLOWING EVALUATION STUDY (COOKIE SWALLOW) Description Images are taken during a speech therapy evaluation. The patient chews and swallows barium and/or food of various consistencies, and occasionally an inert pill.
Indications To evaluate problems of chewing, swallowing, or aspiration; often on stroke patients.
Prep No prep necessary.
Length Minimum 30 minutes.
Facility Martin Memorial Medical Center Appointment must be made in conjunction with Speech Pathology. Please page (772) 335-6432.
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UPPER GI SERIES Description The patient drinks a contrast media, (Barium or Gastrografin) and images of the esophagus and stomach are taken (may be performed with Small Bowel Series)
Indications To look for reflux, strictures, ulcers, source of GI bleeding, upper abdominal pain.
Prep Nothing by mouth after midnight. No chewing gum, cigarette smoking, or tooth brushing on morning of exam. May take medications with a small amount of water 4 hours prior to exam.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
SMALL BOWEL SERIES Description Patient drinks a contrast media (barium) and, images are taken serially as the barium passes through the small intestines.
Prep Nothing by mouth after midnight prior to test.
Length Minimum 1 hour (exam may take up to 5 or more hours depending on the transit of the barium through the small intestine. Avg. – 2 hours)
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
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CONTRAST ENEMA 1. Air contrast w/ Barium (ACBE) 2. Barium Enema (BE) 3. Gastrografin Enema
Description An enema of contrast media is performed and images of the colon are taken.
Indications Anemia, GI bleed, polyps, colon cancer screening, constipation, abdominal pain, diarrhea, diverticulosis Notes: The best study is an Air Contrast Barium Enema (ACBE). This is the test of choice unless the patient can not move enough (roll over) to have this test, and then a single contrast Barium enema is done. The air and barium outline any tumors or polyps in the colon. A bowel prep is REQUIRED for this type of enema. A Gastrografin enema is performed in cases of suspected obstruction, perferation or cases of constipation. Gastrografin enemas are occasionally done WITHOUT any prep.
Prep Two days before the exam * Eat a clear liquid diet, which includes: • Water, clear broth, bouillon, fruit juices with no pulp, soft drinks, black coffee, tea, honey, sugar, jello, clear hard candy. You may have as much of these liquids as desired until the time of the exam. The fluid prevents your body from becoming dehydrated and aids in cleaning your bowel for the exam. No milk products or cream except skim milk. Day before the Exam • Continue clear liquid diet. Patient to stay well hydrated. • Drink one 10 oz bottle of magnesium citrate at 12:00 noon followed with one full glass of water and continue liquid diet. • At 5:00 pm, have a liquid meal followed by four (4) Dulcolax tablets (Bisacodyl). Swallow tablets whole with a full glass of water. DO NOT chew tablets. Continue clear liquid diet. Day of Exam • Breakfast should consist of clear fruit juice, coffee or tea.
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Length Minimum 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
FISTULAGRAM Description Contrast media is injected into the sinus or fistulous tract through a catheter under fluoroscopy for evaluation.
Indications stoma evaluation, fistulas to skin from bowel or bladder
Prep No prep necessary.
Length Minimum 1 hour
Facility Martin Memorial Medical Center Martin Memorial Hospital South
SNIFF TEST — CHEST FLUOROSCOPY Description Evaluation of the diaphragm movement under fluoroscopy.
Indications Recurrent infections or possible diaphragm paralysis
Prep No prep necessary
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
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CYSTOGRAM/VOIDING CYSTOURETHROGRAM (VCUG) Description A catheter is inserted through the urethra into the bladder, and the bladder is filled with contrast, and images are then taken of the bladder. When a VOIDING study is ordered, the patient will empty their bladder DURING the procedure under fluoroscopy.
Indications Recurrent UTIs; difficulty voiding; bladder leakage, hydronephrosis
Prep No prep necessary.
Length Minimum 45 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Children under the age of 12 must be scheduled at the Medical Center only, and the catheter will be placed by Pediatrics. Child must not be medicated prior to exam.
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RETROGRADE URETHROGRAM (MALE) Description A catheter is inserted into the tip of the penis and the penile urethra is evaluated under fluoroscopy.
Prep None
Length Minimum 45 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South
HYSTEROSALPINGOGRAM (HSG) Description A Pelvic exam is performed and a speculum placed in the vagina. Contrast media is injected into the uterus and the fallopian tubes through a catheter to evaluate patency of the fallopian tubes and to outline the uterine cavity.
Indications Infertility
Prep ONLY performed on days 7 through 10 days after last day of menstrual cycle.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Note: Patient should bring a panty liner for after the examination.
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INTRAVENOUS PYELOGRAM (IVP) Description Evaluation of the kidneys, ureters, and bladder with IV contrast injection and serial imaging of the abdomen.
Indications Kidney stones, blood in urine, infections, hydronephrosis
Prep The Day before the Exam • Patient should pick-up prep from Imaging department at any Martin Memorial facility or purchase at any local pharmacy. • At 2:00 pm take two (2) Dulcolax (Bisacodyl) laxative tablets by mouth. • Drink 10 oz bottle of Magnesium Citrate at 6:00 pm • Patient should not eat or drink after midnight Day of Exam • No eating or drinking the morning of the exam. • Patients should take all scheduled a.m. medications with a small amount of water.
Length Minimum 1 hour
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL.
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INVASIVE FLUOROSCOPY PROCEDURES . . . . . . . . . . . . . Scheduling through Interventional Radiology Coordinator
Call (772) 223-5945, ext. 3137 to schedule ARTHROGRAM May be performed with an ASPIRATION or INJECTION
Description Contrast media is injected under fluoroscopic guidance into a specific joint to evaluate the joint space, i.e., knee, shoulder, hip, ankle, wrist, etc. An ASPIRATION will be performed when requested if there is fluid present and infection or Gout is suspected. A PRESCRIPTION for lab orders should be brought to the exam as well. An INJECTION of steroid and anesthetic can be placed in the joint at this time as well, if ordered by the requesting MD (typically an Orthopedist). If an injection is to be performed, it MUST BE noted on the prescription.
Indications Joint pain to evaluate for tears, arthritis, loose bodies, infection, gout
Prep No prep necessary
Length Minimum 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South
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EXTREMITY VENOGRAM — UNILATERAL or BILATERAL Description Intravenous contrast media is injected into a peripheral vein of the extremity (usually the leg), and images of the extremity are taken to look for clots in the venous system. This exam is only done after a Doppler has been done and is inconclusive.
Indications Detection of blood clots; swelling.
Prep Nothing to eat or drink 1 hour prior to test
Length Minimum 1 hour
Facility Martin Memorial Medical Center (Fluoroscopy suite or Interventional Suite) Martin Memorial Hospital South SEE STANDARD IV CONTRAST PROTOCOL.
CATHETER PLACEMENT CHECK Description Patient is given an injection of contrast media into an existing catheter to check placement under fluoroscopy.
Prep No prep necessary. If the catheter is UNDER the skin, it must be accessed prior to the exam.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center (Fluoroscopy suite or Interventional Suite) Martin Memorial Hospital South SEE STANDARD IV CONTRAST PROTOCOL.
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MYELOGRAM (ordering physician typically a Neurologist or Neurosurgeon) • • •
Cervical Thoracic Lumbar
Description Contrast media is injected into the spinal canal, for the evaluation of the spinal cord, nerve root branches and/or disc herniation.
Prep Nothing to drink or eat after midnight.
Length Minimum 30-60 minutes – then usually followed by CT which will be additional imaging time
Facility Martin Memorial Medical Center Martin Memorial Hospital South Attention physician offices: • Patient must stop taking Plavix 7 days prior to exam. • Patient must stop taking Coumadin 7 days prior to exam. • Patient must stop taking Aspirin, minimum 5 days prior to exam. Lab: All patients must have PT and PTT drawn within 7 days prior to exam.
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CISTERNOGRAM Description The injection of the radionuclide for a Cisternogram is performed in fluoroscopy the same as for a Myelogram above.
Prep Nothing to drink or eat after midnight.
Length Minimum 30-60 minutes – then usually followed by CT which will be additional imaging time
Facility Martin Memorial Medical Center Martin Memorial Hospital South Attention physician offices: • Patient must stop taking Plavix 7 days prior to exam. • Patient must stop taking Coumadin 7 days prior to exam. • Patient must stop taking Aspirin, minimum 5 days prior to exam. Lab: All patients must have PT and PTT drawn within 7 days prior to exam. SEE STANDARD IV CONTRAST PROTOCOL.
LUMBAR PUNCTURE UNDER FLUOROSCOPY Description Cerebrospinal fluid is drained from around the spinal cord from the lower back. The needle is placed in the fluoroscopy suite and the fluid can be sent to the lab for testing.
Indications Sometimes performed to measure intracranial pressure, to look for meningitis, or to relieve hydrocephalus, or to evaluate for Multiple Sclerosis or other central nervous system diseases. The ordering physician MUST provide a prescription or orders for what tests should be performed on the obtained fluid.
Prep Nothing to drink or eat after midnight.
Length Minimum 30-60 minutes – then usually followed by CT which will be additional imaging time Diagnostic Imaging Prep Guidelines
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Facility Martin Memorial Medical Center Martin Memorial Hospital South Attention physician offices: • Patient must stop taking Plavix 7 days prior to exam. • Patient must stop taking Coumadin 7 days prior to exam. • Patient must stop taking Aspirin, minimum 5 days prior to exam. Lab: All patients must have PT and PTT drawn within 7 days prior to exam.
T-TUBE CHOLANGIOGRAM Description Contrast media is injected into an existing biliary T-Tube to check placement under fluoroscopy.
Prep No prep necessary
Length Minimum 30 minutes
Facility Martin Memorial Medical Center (Fluoroscopy suite or Interventional Suite) Martin Memorial Hospital South
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MAMMOGRAPHY Call (772) 288-5817 to schedule
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MAMMOGRAPHY . . . . . . . . . . Call (772) 288-5817 to schedule MAMMOGRAPHY /UNILATERAL/BILATERAL Description A series of x-ray images of the breasts, performed to detect abnormalities. • • •
•
Screening: Routine exam which can only be bilateral. Diagnostic Unilateral: One breast is imaged for an area of concern, or because the other breast is absent. Diagnostic Bilateral: Both breasts are imaged because of clinical or physical exam findings. Images are evaluated by the reading radiologist before the patient leaves to ensure complete evaluation of the area of concern Male mammogram: Always bilateral and diagnostic based on clinical exam.
Prep Do not use powder, lotions or deodorant prior to exam. Patient may want to take Tylenol or Advil 30 minutes prior to exam, if approved by their physician, to help with discomfort. Patient should wear two piece clothing that can easily be removed from the waist up.
Length Minimum 30 minutes
Facility Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center Scheduler * ask the patient if they have breast implants, if “yes,” schedule TWO time slots. • If the patient has had any prior mammograms performed outside of Martin Memorial Health Systems, please have the patient send or bring their films to the appointment, as they will be needed for comparison to read the current exam. • The patient MUST have their prescription at the time of their appointment. NOTE: DIGITAL MAMMO has NO differences in prep or compression time versus standard mammography. Diagnostic Imaging Prep Guidelines
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COMPUTED TOMOGRAPHY (CT) Call (772) 288-5817 to schedule
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COMPUTEDTOMOGRAPHY (CT) Call (772) 288-5817 to schedule GENERAL: A CT or CAT SCAN is a machine which uses a moving x-ray tube to generate images that look like slices through the patient’s body. The center of the hole is where the imaging takes place. These images can be manipulated into 3-Dimensional pictures if a high enough resolution is obtained.
CT of the HEAD — Without contrast or With & Without contrast Description Thin axial images obtained through the brain and skull. Contrast is added if there is suspicion of a mass, aneurysm, metastatic disease, or infection.
Prep Clear liquids 4 hours prior to exam if receiving IV contrast.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL.
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CT of the ORBITS — WITH and/or WITHOUT CONTRAST Description Axial CT imaging is performed through the eyes usually before and after giving IV contrast. Coronal images may also be taken if the patient can lie on their stomach. For fracture or trauma evaluation NO contrast is used.
Prep Clear liquids 4 hours prior to exam if receiving IV contrast.
Length Minimum 30 minutes
Facility: Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL.
CT of the PARANASAL SINUSES • • •
Routine Limited Complete with contrast (ordered by ENT for Cancer evaluation)
Description •
• •
The LIMITED study is a quick low radiation study priced comparable to a Sinus X-ray series, but more detailed, without evaluating all of the area of the sinuses. The ROUTINE exam evaluates the sinuses completely, and creates images in two planes. The COMPLETE is ordered typically by an ENT for evaluation of a mass, tumor, or in preparation for surgery, and will usually be performed WITH and WITHOUT contrast.
Prep Clear liquids 4 hours prior to exam if receiving IV CONTRAST.
Length Minimum 30 minutes
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Facility: Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL.
CT of the TEMPORAL BONES Description Axial and Coronal CT imaging is performed through the temporal bones at the level of the ears.
Indication Hearing loss, ear pain, cholesteatoma
Prep Clear liquids 4 hours prior to exam.
Length Minimum 30 minutes
Facility: Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL.
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CT of the NECK SOFT TISSUES Description CT imaging is performed through the neck from the level of the ears to the upper chest. This test is much less sensitive if not performed with IV CONTRAST, and the STANDARD study is done WITH IV CONTRAST.
Indication Neck swelling, mass, adenopathy, voice changes or vocal cord paralysis, cheek or gland swelling, nose, throat or neck cancer.
Prep Clear liquids 4 hours prior to exam if IV CONTRAST is ordered.
Length Minimum 30 minutes
Facility: Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL. Note: This study is NOT directed towards the spine or vertebrae, and if a spinal cord problem is suspected, a CT of the Cervical Spine should be ordered.
CT of the CERVICAL SPINE — WITH Coronal and Sagittal reformats (standard) Same study POST MYELOGRAM (North/South only)
Description Axial CT images are obtained through the spine from the skull base to the top of the chest and the images are also processed into sagittal and coronal slices.
Indication Neck pain, radiculopathy, bone lesions in spine (usually in patients who can NOT have an MRI)
Prep No prep necessary.
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Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center Note: This study looks primarily at the spinal cord and vertebral bodies and does NOT cover the entire neck and soft tissues. If the patient has had any previous spine imaging done outside Martin Memorial Health Systems, such as plain x-rays, MRI, myelograms or bone scans, please have the patient send or bring their films to the appointment. These images will be needed for comparison.
CT of the THORACIC SPINE — WITH Coronal and Sagittal reformats (standard) Same study POST MYELOGRAM (North/South only)
Description Axial CT images are obtained through the spine from the neck to the mid back and the images are also processed into sagittal and coronal slices.
Indication Back pain, radiculopathy, bone lesions in spine
Prep No prep necessary.
Length Minimum 30 minutes
Facility: Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center If the patient has had any previous spine imaging done outside Martin Memorial Health Systems, such as plain x-rays, MRI, myelograms or bone scans, please have the patient send or bring their films to the appointment. These images will be needed for comparison.
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CT of the LUMBAR SPINE — WITH Coronal and Sagittal reformats (standard) Same study POST MYELOGRAM (North/South only)
Description Axial CT images are obtained through the spine from the mid back to the top of the buttocks and the images are also processed into sagittal and coronal slices.
Indication Back pain, radiculopathy, bone lesions in spine (usually in patients who can NOT have an MRI)
Prep No prep necessary.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center If the patient has had any previous spine imaging done outside Martin Memorial Health Systems, such as plain x-rays, MRI, myelograms or bone scans, please have the patient send or bring their films to the appointment. These images will be needed for comparison.
CT of the CHEST • • • •
WITHOUT CONTRAST WITH IV CONTRAST PE (Pulmonary Embolus) Protocol (specialty – requires IV CONTRAST) High Resolution (ordered by a Pulmonologist, usually with a routine CT)
Description Cross-sectional CT images are taken through the chest, from the neck to below the diaphragm.
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Indications Respiratory symptoms, abnormal chest x-ray, nodule, fibrosis, COPD, smoking history, bronchitis, heart failure, chest pain, infection, cancer. The PE PROTOCOL is specifically targeted to the pulmonary artery tree and evaluates for a possible pulmonary embolus. CONTRAST is MANDATORY for this study as it is the only way to identify the emboli. The study uses a greater amount of radiation to the chest, and does not cover the entire area that is covered in a routine chest CT and should only be used in patients where there is a HIGH SUSPICION for PE. Spiral CT is NOT an acceptable order as all chest CTs are performed spirally. High Resolution CT is used to evaluate interstitial diseases, alveolar changes, fibrosis and bronchiectasis, and is added to a routine CT in specific cases.
Prep Clear liquids after midnight and NPO 4 hours prior to exam.
Length Minimum 30 minutes.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL. Notes: The standard evaluation of the Chest is performed WITH IV CONTRAST. The contrast helps to evaluate the complex mediastinal vessels and lymph nodes, and better evaluates the aorta and pulmonary vessels. Contrast also helps increase sensitivity in infections and evaluation of pleural effusions.
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CT of the ABDOMEN • • • • • •
WITH CONTRAST WITHOUT CONTRAST WITH AND WITHOUT CONTRAST AAA — Abdominal Aortic Aneurysm Stone Protocol Hematuria Protocol (only ordered by Urologists)
NOTES: The standard Abdominal CT is performed with ORAL contrast to opacify the bowel loops, and with IV CONTRAST to enhance the detail of the liver and solid organs, to assess the kidneys and their function, and to evaluate for inflammation, infection, vascular compromise, aneurysm, trauma, leakage and metastatic disease.
Description The patient will lie down in the CT scanner while images are taken of the abdomen, from the diaphragm to the iliac crests of the pelvis. ORAL CONTRAST will be given to ALL abdomen studies EXCEPT the specialty protocols (Stone, AAA, and Hematuria). These specialty protocols will ALWAYS be performed with a CT PELVIS of the same type. IV CONTRAST is given for the WITH CONTRAST, AAA and Hematuria protocols.
Prep Clear liquids after midnight and NPO 4 hours prior to exam.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL.
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CT of the PELVIS • •
WITH CONTRAST WITHOUT CONTRAST
Description The patient will lie down in the CT scanner while images are taken of the pelvis, from the iliac crests through the upper thigh. The patient will be asked to drink oral contrast 2 1/2 to 3 hours before scan. For the WITH CONTRAST exam, they will also be given an injection of IV CONTRAST during the scan. Notes: Usually ordered WITH a CT abdomen. The standard CT of the Pelvis is with ORAL and IV CONTRAST. May be ordered alone in work ups for pelvic pain or prostate cancer.
Prep Clear liquids after midnight and NPO 4 hours prior to exam.
Length Minimum 30 minutes
Facility: Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL.
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CT of the EXTREMITIES Description CT imaging can be performed of any joint or bone as needed. Each segment will be imaged separately. Some joints will be images with additional techniques. A CT Arthrogram will require an injection of contrast prior to the CT study, and is used in the shoulder and knee to evaluate patients who can not have an MRI. If an infection is suspected, and an MRI can not be obtained, imaging of the extremity will be performed with IV CONTRAST.
Indication Bone or joint pain, fracture or surgical planning, suspected infection, tumor or mass
Prep Clear liquids 4 hours prior to exam if receiving IV CONTRAST.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center SEE STANDARD IV CONTRAST PROTOCOL.
INTERVENTIONAL CT . . . . . . Call (772) 223-5945, ext. 3137 to schedule CT GUIDED BIOPSY or DRAINAGE The CT scanner allows for visualization of deep structures, allowing biopsy of tumors that can not be clearly felt of localized superficially. CT also allows visualization of adjacent structures such as bowel or blood vessels that should be avoided during biopsy.
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Before any biopsy can be scheduled, a lesion must be known to exist, and an interventional radiologist MUST APPROVE the case as one that can be performed safely. The patient must provide all outside images to the radiology staff through Interventional scheduling at x3137 for evaluation. Most imaging studies performed in MMHS can be reviewed on PACS.
Procedure The type of biopsy will be determined by the radiologist performing the procedure. The patient will be placed on the CT table in a position to provide easy access to the lesion (tumor). The CT will localize the lesion and the needle as the procedure is performed. Patients will be monitored by a nurse during the procedure, will receive local anesthetic, and MAY require additional sedation and pain control.
Prep Clear liquids 4 hours prior to exam.
Length Minimum 1 1/2 hours
Facility Martin Memorial Medical Center Martin Memorial Hospital South Attention physician offices: • Patient must stop taking Plavix 7 days prior to exam. • Patient must stop taking Coumadin at least 3 days prior to exam. • Patient must stop taking Aspirin, minimum 5 days prior to exam. Lab: All patients must have PT and PTT drawn within 7 days prior to exam. We are ONLY able to access MMHS lab results. If labs taken elsewhere, written report must be sent with patient or faxed to Imaging Department prior to exam date.
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CT GUIDED FACET BLOCK Description CT imaging is performed over the segment of the spine to be treated. An anesthetic and steroid cocktail is injected into the facet joint affected.
Prep Clear liquids 4 hours prior to exam.
Length Minimum 1 1/2 hour
Facility: Martin Memorial Medical Center Note: Must be ordered by neurosurgeon, neurologist or an orthopedic surgeon and must be scheduled through Interventional Radiology at x3137. Prior imaging studies must be reviewed by the performing radiologist before the procedure can be scheduled.
CT GUIDED BONE MARROW BIOPSY Description CT imaging is performed over the lower pelvis with the patient on their stomach. The bones of the pelvis are localized, and the skin anesthetized, and a biopsy needle is used to obtain a marrow smear, fluid and core specimen.
Prep Clear liquids 4 hours prior to exam.
Length Minimum 1 1/2 hour
Facility Martin Memorial Medical Center Martin Memorial Hospital South Note: Must be scheduled through Interventional Radiology at ext. 3137.
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ULTRASOUND Call (772) 288-5817 to schedule
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ULTRASOUND . . . . . . . . . . . . . Call (772) 288-5817 to schedule GENERAL: An Ultrasound probe produces high frequency sound waves, which can not be felt or heard and have no radiation, to generate multiple images of soft tissues. The probe is moved over the surface of the skin using a water soluble gel, and images or organs, and assessment of blood flow can be obtained. Fat in the skin decreases the sensitivity and penetration of the sound waves. Gas in the bowel distorts the sound waves and obstructs visualization. Ultrasound can not image through solid bones.
ULTRASOUND of the ABDOMEN • •
Complete (standard) Limited • Renal • Right Upper Quadrant • Retroperitoneal (AAA)) • Pylorus (Pyloric Stenosis)
COMPLETE: The major organs of the abdomen are evaluated including the liver, gallbladder, pancreas, spleen, kidneys, inferior vena cava and Aorta. RENAL: The kidneys ONLY are evaluated. RUQ: The structures of the Right Upper Quadrant are evaluated, excluding the spleen and left kidney and Aorta, compared to a complete abdomen. Retroperitoneal: Usually performed for evaluation of the Aorta and kidneys for an aneurysm or a suspected retroperitoneal hematoma or abscess. Pylorus: Performed on very young infants to evaluate for obstruction of the stomach. Infants must be NPO for 2 hours prior to Pylorus US exam.
Prep Nothing by mouth after midnight (for Complete and RUQ only)
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Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center May take medications with small amount of water.
ULTRASOUND of the NEONATAL BRAIN Description The imaging probe is placed over a front of the head for evaluation of structure, position and development of the neonatal brain.
Prep No prep necessary.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center
ULTRASOUND — BABY HIPS Description The imaging probe is placed over a neonates hips for evaluation of structure, position and mobility. Only infants LESS THAN 5 month of age can be evaluated with this technique.
Prep No prep necessary.
Length Minimum 45 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South
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ULTRASOUND — BABY SPINE Description The imaging probe is placed over a neonates lower spine for evaluation of structure, position and mobility of the lower spinal cord, in cases of suspected tethered cord or for evaluation of a sacral dimple. Typically performed on very young infants less than SIX months of age, as older than this age, the cord may NOT be visible by US.
Prep No prep necessary.
Length Minimum 45 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South East Ocean Diagnostic Center
ULTRASOUND of the BREAST (Unilateral or Bilateral) Description The Ultrasound probe is placed directly on the breast to identify any unusual masses. Specifically used to differentiate between solid and cystic lesions.
Prep No prep necessary.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center If patient had a previous mammogram, breast Ultrasound, or breast MRI done outside Martin Memorial Health Systems, the patient MUST send or bring their films to the appointment. These images will need to be reviewed to ensure accuracy of the study. Not performed as a screening exam. Diagnostic Imaging Prep Guidelines
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ULTRASOUND of PREGNANCY Description The Ultrasound probe is placed directly on the mother’s abdomen to evaluate the fetal anatomy, amniotic fluid, heart rate, cervix, placenta and fetal presentation.
Prep Drink 32 oz of water one hour prior to exam. A full urinary bladder is needed.
Length Minimum 60 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
ULTRASOUND of PREGNANCY — LIMITED Description: The Ultrasound probe is placed directly on the mother’s abdomen to evaluate amniotic fluid index, size and dates, cervical length and placenta location.
Prep Drink 32 oz of water one hour prior to exam. A full urinary bladder is needed.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
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ULTRASOUND of the PELVIS Description The Ultrasound probe is placed directly on the pelvis to evaluate the pelvic contents. Male - the bladder and prostate gland are evaluated. Female – the bladder, uterus, and ovaries are evaluated (FEMALE exam may require placement of the probe inside the vagina for better evaluation of internal structures).
Indications • •
Male – Prostate enlargement, voiding problems, stones, UTI Female – Bleeding, pain, mass, infection, UTI, urinary problems
Prep Drink 32 oz. of water one hour prior to exam. A full urinary bladder is needed.
Length Minimum 45 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center Same prep is required for male and female
ULTRASOUND of the PROSTATE Description The Ultrasound probe is placed inside the rectum to evaluate the prostate gland.
Prep Fleets enema 2 hours prior to exam.
Length Minimum 30 minutes
Facility East Ocean Diagnostic Center
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ULTRASOUND of the THYROID Description The Ultrasound probe is placed directly on the lower neck to evaluate the thyroid gland.
Prep No prep necessary.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center No neck jewelry can be worn during the exam.
ULTRASOUND — RENAL ARTERY DOPPLER Description The Ultrasound probe is placed directly on the abdomen to evaluate the kidneys. Doppler studies measure the speed and direction of flow in the renal arteries and in the kidneys.
Indication Hypertension, suspected Renal Artery Stenosis
Prep Nothing by mouth after midnight. Patient to take over the counter anti-gas medication 2 hours prior to exam.
Length Minimum 60 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South
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ULTRASOUND EVALUATION OF “TIPS” — LIVER DOPPLER Description The Ultrasound probe is placed directly on the abdomen to evaluate the blood flow into and from the liver, or to evaluate a venous shunt in a patient who has had a TIPS procedure performed. Doppler studies measure the speed and direction of flow in the hepatic veins, portal veins, IVC, and hepatic artery.
Prep The patient should be NPO for four hours prior to the exam, and should take over the counter anti-gas medication 2 hours prior to exam.
Length Minimum 60 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
ULTRASOUND — TESTICULAR (SCROTAL) Description The Ultrasound probe is placed directly on the scrotum to evaluate the testes, and scrotal contents. May include Doppler imaging to assess blood flow to each testis.
Indication Scrotal pain, mass, suspected torsion, infection, swelling, hernia
Prep No prep necessary.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
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ULTRASOUND of the CHEST Description The Ultrasound probe is placed directly on the chest from the back to determine the presence and volume of pleural effusions. This area may be marked for possible thoracentesis (drainage) either by the Radiologist or the Pulmonologist.
Prep No prep necessary.
Length Minimum 30 minutes
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
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INTERVENTIONAL ULTRASOUND . . . . . . . . . . . . . Call (772) 223-5945, ext. 3137 to schedule ULTRASOUND of the CHEST with THORACENTESIS Description The Ultrasound probe is placed directly on the chest from the back to determine the presence and volume of pleural effusions. This area may be marked for possible thoracentesis (drainage) either by the Radiologist or the Pulmonologist.
Prep PT and PTT required prior to procedure, must be less than 30 days old.
Length • •
Minimum 30 minutes for chest ultrasound Minimum 60 minutes for thoracentesis procedure
Facility Martin Memorial Medical Center Martin Memorial Hospital South Note: If scheduled by a Pulmonologist, times must be coordinated with US and the MD
ULTRASOUND guided PARACENTESIS Description The Ultrasound probe is placed directly on the abdomen to determine the
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presence and volume of ascites (abdominal fluid). The area will be marked for possible paracentesis (drainage) by the Radiologist if there is felt to be enough fluid present.
Prep PT and PTT are required prior to the procedure, and must be less than 30 days old.
Length: • •
Minimum 30 minutes for abdominal ultrasound Minimum 60 minutes for paracentesis procedure
Facility Martin Memorial Medical Center Martin Memorial Hospital South
ULTRASOUND GUIDED BIOPSY Description The Ultrasound probe is placed directly on the area being biopsied (thyroid gland or breast are typical). The Ultrasound can show the lesion and shows the location of the biopsy needle helping the physician guide the needle to a specific site.
Length: Minimum 90 minutes
Facility Martin Memorial Medical Center Must be scheduled through Interventional Scheduling (x3137) Labs may be necessary prior to test, PT-PTT (depending on site of biopsy)
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NUCLEAR MEDICINE Call (772) 288-5817 to schedule
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NUCLEAR MEDICINE Call (772) 288-5817 to schedule GENERAL Nuclear Medicine cameras can image small amounts or radioactive compounds called tracers that are injected into the body. The tracers are attached to specific compounds to image specific internal functions, such as liver function, bone growth, thyroid uptake, and blood flow. The cameras used identify the sites and amount of activity in the body to determine anatomy and function.
NUCLEAR MEDICINE WHOLE BODY BONE SCAN Description A radioactive bone-seeking material is injected into a vein where it enters the bloodstream and is carried to the bone. The patient is encouraged to drink fluids between injection and scan. Imaging is done a minimum of 2 hours after injection. Usually the entire body is imaged, and extra views (images) may be taken to provide as much information as possible about a specific area.
Indication Cancer, bone pain, abnormal calcium or enzyme levels, parathyroid problems
Prep No prep necessary.
Length Patient receives injection (approximately 30 minutes) and returns in 2-3 hours. Imaging takes approximately 1 hour after patient returns.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
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NUCLEAR MEDICINE TRIPLE PHASE BONE SCAN Description A radioactive bone-seeking material is injected into a vein where it enters the bloodstream and is carried to the bone. Imaging is done during the injection, over an area of suspected infection, and shortly thereafter, and of the whole body after a minimum of 2 hours delay.
Indication Osteomyelitis (infection of bone), Raynaud’s disease, Reflex Sympathetic Dystrophy (RSD)
Prep No prep necessary.
Length Patient gets injected and returns in 2-3 hours. Test takes approx. 1 hour after patient returns and maybe longer if extra Image are needed.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
NUCLEAR MEDICINE GI BLEEDING STUDY Description Blood is drawn from the patient. The blood sample is then mixed with a radioactive tracer that attaches to the red blood cells. 20 minutes later the patient will be re-injected with their own tracer labeled blood, and images will be taken for at least 1 hour. Delayed images can be taken up to 24 hours later.
Indication Suspected or active GI bleed.
Prep No prep necessary.
Length Minimum 3-4 hours.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
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NUCLEAR MEDICINE GALLIUM SCAN Description The patient is injected with a tracer which localizes in areas of inflammation or infection, and then is imaged to look for infection or abscesses Depending on the diagnosis and the initial images, the patient may be scanned at 24, 48, and 72 hours post injection.
Indication Fever of unknown origin, suspected abscess, Hodgkin’s disease, tumor staging, or localization, Sarcoid.
Prep If needed, the patient will be given a bowel prep kit and clear liquid diet by the Nuclear Medicine Department.
Length Minimum 45 minutes for 3 consecutive days or as radiologist orders.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
NUCLEAR MEDICINE GASTRIC EMPTYING Description The patient will eat a small amount of oatmeal with a radiotracer present. The meal fills the stomach and imaging determines the rate at which food leaves the stomach.
Indication Gastroparesis, suspected gastric outlet obstruction
Prep Nothing by mouth after midnight.
Length Minimum 2 hours.
Facility Martin Memorial Medical Center Martin Memorial Hospital South
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NUCLEAR MEDICINE HEPATOBILIARY/PIPIDA SCAN (HIDA SCAN) Description The patient is injected with a tracer that is processed in the liver and excreted into the bile ducts. Images are taken over the liver and abdomen to look for obstructions of the biliary tract, and assess liver function.
Indications Cholecystitis, gallbladder or upper abdomen pain,
Prep Nothing by mouth after midnight. May take meds with a sip of water. Hold Demerol or any morphine based medication for 6 hours prior to exam, as it interferes with gall bladder visualization. GALL BLADDER EJECTION FRACTION — in addition, the same exam can be used with a drug, Cholecystokinin (CCK), to force the gallbladder to contract, and the amount of excretion can be measured. (only done at MMMC and MMHS)
Length Minimum 3 hours.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
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NUCLEAR MEDICINE LIVER/SPLEEN SCAN Description A tracer which localizes to the liver, spleen, and blood-producing marrow is injected into a vein, and images are taken 15 minutes later. This study evaluates the liver and spleen and marrow function.
Prep No barium for 48 hours before exam.
Length Minimum 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
NUCLEAR MEDICINE TUMOR LOCALIZATION — SENTINEL NODE STUDY Description A tracer which follows the drainage around a tumor is injected around the tumor and images are obtained to localize “sentinel” lymph nodes.
Indications ONLY scheduled with surgery schedule for same day, typically for melanoma or breast cancer.
Length Minimum 1 hour.
Facility Martin Memorial Medical Center
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NUCLEAR MEDICINE VENTILATION AND PERFUSION LUNG SCAN Description The patient is asked to breathe a air which contains a tracer evaluating the lung ventilation. When this is completed, the patient is injected with particles of albumin labeled with a tracer, which are carried by the blood to the lungs. Images are then taken over the chest to assess perfusion of the lungs.
Indication Suspected pulmonary embolus.
Prep Must have chest x-ray within 24 hours prior to exam or can be done at time of exam if none available.
Length Minimum 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South
NUCLEAR MEDICINE SPLIT PERFUSION LUNG SCAN Description The patient is injected with particles of albumin labeled with a tracer, which are carried by the blood to the lungs. Images are then taken over the chest to assess perfusion of the lungs, and calculations are performed over each segment of the lungs.
Indication Evaluation of function prior to surgery.
Length Minimum 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
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NUCLEAR MEDICINE MUGA SCAN Description The patient’s blood is labeled to evaluate the function and output of the heart. Imaging is performed over the chest while an EKG records the activity of the heart.
Indication Determine ejection fraction of left ventricle for chemotherapy or post MI
Prep No prep necessary.
Length Minimum 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
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NUCLEAR MEDICINE RENAL SCAN Description The patient is injected with tracer for visualization of the kidneys. Imaging is performed over the back during injection, and after to assess blood flow to the kidneys, and their output and function.
Indications Renal failure, acute or chronic; Hypertension. WITH LASIX — additional imaging can be performed after Lasix is given to assess hydronephrosis (only done at MMMC and MMHS) WITH CAPTOPRIL —imaging can be performed with a Captopril administration in cases of suspected renal artery stenosis. (only done at MMMC) The patient MUST be off of ACE inhibitors at least 48 hours prior to test, and must be NPO for 4 hours prior.
Prep No prep necessary. (except Captopril, see above)
Length Minimum 45 minutes.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
NUCLEAR MEDICINE THYROID SCAN Description The patient receives a tracer injection into a vein, and 15 minutes post injection the thyroid gland is imaged.
Prep No prep necessary.
Length Minimum 40 minutes.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
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NUCLEAR MEDICINE THYROID UPTAKE AND SCAN This is a 2 day exam.
Description Day 1 A small amount of radioactive iodine (I-123) is given by mouth as a capsule. Day 2 The thyroid function is measured with a thyroid probe. The patient is injected with a radioactive tracer and imaging takes place 5 – 10 minutes later.
Approximate Length 2 Day Procedure Day 1: 15 minutes; Day 2: 45 Minutes to 1 hour
Prep • •
No thyroid medications for 6 weeks prior to test. No IV contrast in the 4 – 6 weeks prior to the exam
48 Hours prior to test: • No seafood (primarily shellfish) • No strawberries • No Chinese food - soy sauce • No antihistamines • No vitamins containing iodine. • No iodized salt.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
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NUCLEAR MEDICINE PARATHYROID SCAN Description The patient receives a tracer injection into a vein, and the neck is imaged immediately and after a delay to assess for a parathyroid adenoma.
Prep No prep necessary.
Length Minimum 40 minutes.
Facility Martin Memorial Medical Center
NUCLEAR MEDICINE CISTERNOGRAM Description The patient must come to the fluoroscopy suite at the Main Hospital and a Lumbar puncture is performed under fluoroscopy to access the spinal fluid. A radiotracer is injected into the fluid, and a series of images are then obtained with a nuclear medicine camera, after four hours, and on sequential days, up to 3 days following, based on each days images. Only scheduled on Monday and Tuesday and must be scheduled in both fluoro and nuclear medicine.
Length Minimum 5 hours (initial visit only), approximately 30 minutes for followup
Facility Martin Memorial Medical Center Attention physician offices • Patient must stop taking Plavix 7 days prior to exam. • Patient must stop taking Coumadin 3 days prior to exam. • Patient must stop taking Aspirin, minimum 5 days prior to exam. Lab: All patients must have PT and PTT drawn within 7 days prior to exam.
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NUCLEAR MEDICINE OCTREOTIDE SCAN Description The patient receives a tracer injection into a vein, and the abdomen is imaged after a delay to assess for tumors in the endocrine family, such as carcinoid, and pancreatic tumors.
Prep No prep necessary.
Length The initial dosing visit requires approximately 30 minutes. Images will be taken at 24 and possibly 48 hours.
Facility Martin Memorial Medical Center MUST be scheduled through Lynn Hageman, ext.1540
NUCLEAR MEDICINE PROSTASCINT SCAN Description The patient receives a tracer injection into a vein, and the pelvis is imaged immediately and after a delay to assess for prostate cancer recurrence after surgery. Note: ONLY performed on patients who have had TOTAL surgical prostate removal.
Prep Bowel prep necessary.
Length The initial dosing visit requires approximately 30 minutes. Images will be taken at 24 and possibly 48 hours and 72 hours.
Facility Martin Memorial Medical Center MUST be scheduled through Lynn Hageman, ext.1540
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ANGIOGRAPHY Call (772) 223-5945, ext. 3137 to schedule
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ANGIOGRAPHY . . . . . . . . . . . . Call (772) 223-5945, ext. 3137 to schedule ARTERIOGRAMS or ANGIOGRAMS Schedule with Interventional Radiology at ext. 3137. When scheduling an outpatient arteriogram. Please inform the patient of the following information prior to his arrival for the exam: 1. If the patient usually takes insulin in the morning, tell the patient to hold his/her insulin and breakfast until after the arteriogram. Check with the physician regarding insulin dose. If the patient takes an oral hypoglycemic agent instead of insulin, give them the same instructions. 2. Instruct the patient to take all blood pressure or cardiac medication they usually take in the morning, with the exception of Aspirin and blood thinners (heparin, and/or Coumadin). If the patient is taking antihypertensive medication, stress the importance of taking those as prescribed by their doctor. 3. The patient will need a driver and can NOT drive following the procedure 4. Mention that if the approach (of the arteriogram site) is to be brachial, that the patient will have one arm incapacitated with an arm board and an ace wrap for at least two to four hours following the procedure. 5. Patients may be required to stay for monitoring up to six hours following their procedure. Attention physician offices • Patient must stop taking Plavix 7 days prior to exam. • Patient must stop taking Coumadin 7 days prior to exam. • Patient must stop taking Aspirin, minimum 5 days prior to exam. Lab: All patients must have PT and PTT drawn within 7 days prior to exam. Please See Standard IV Contrast requirements.
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CARDIOVASCULAR PROCEDURES Call (772) 288-5817 to schedule
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CARDIOVASCULAR PROCEDURES . . . . . . . . . . . . . Call (772) 288-5817 to schedule TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE) Description This test involves the patient swallowing a small, flexible, probe (which sends off sound waves). A Cardiologist uses the probe to take images of the heart from inside the esophagus. During the procedure, the patient will be sleeping, and breathing on their own, and will have no awareness of the pictures being taken. The procedure will take place in a recovery room setting. The patient will be placed on a monitor which records heart rate, blood pressure, and oxygen saturation.
Prep Nothing to eat or drink after midnight.
Length Approximately 5-6 hours for admission, assessment, procedure, and recovery time.
Facility Only at the main medical centers. Martin Memorial Medical Center Martin Memorial Hospital South *PATIENT WILL NEED A DRIVER. The patient will be scheduled at either North or South Hospital. It is expected that the patient arrive in the Outpatient Department on the day of the procedure, two (2) hours prior to the actual starting time of the procedure. This will allow sufficient time for the staff to complete the admission process, start an IV line, and draw lab work and/or give medications, if necessary. It is important that the patient has a driver to take them home, as the patient will be receiving light anesthesia during the procedure. The patient will generally be sent home with their driver approximately 2 hours after procedure time.
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2-D ECHOCARDIOGRAM WITH DOPPLER AND COLOR FLOW Description A non-invasive ultrasound examination of the heart. It provides the cardiologist with a view of the valves, walls, chamber size, and movement of the heart. A Doppler and Color Flow study aids in the visualization of blood flow irregularities.
Indication Doppler may be used to determine if valves are leaking, or to determine if there is a congenital heart problem.
Prep No prep necessary.
Length Approximately 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic Ensure that ordering Physician wants Doppler and Color Flow study, as this will be charged separately.
CAROTID DUPLEX COLOR FLOW IMAGING Description This is an ultrasound exam of the carotid arteries used to visualize artherosclerotic plaque that may be present. The patient will lie on a stretcher in a darkened room. A technologist moves the transducer up and down the sides of the neck obtaining images of the arteries and the blood flow through the arteries.
Indication Doppler spectral analysis is performed to measure blood flow frequency that assists the physician in determining the severity of disease.
Prep No prep.
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Length Approximately 45 minutes to 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
ARTERIAL EVALUATION OF LOWER AND UPPER EXTREMETIES (Pulse Volume Recordings “PVR”) Description The patient will lie on a stretcher for this procedure. Blood pressure cuffs are applied to either the upper or lower extremities (depending on what is being evaluated) to measure blood flow and pressure. If the patient is being evaluated for lower extremities then they might be asked to walk on a treadmill for a few minutes.
Indication This study enables the Physician to evaluate circulation in the legs and arms.
Prep No prep.
Length Approximately 45 minutes to 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
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VENOUS B-SCAN Description This is an ultrasound examination to evaluate venous circulation. The patient will lie on a stretcher in a darkened room. The technologist moves the transducer up and down the extremity looking at the vessels and measuring the blood flow. The patient may be asked to change positions. The images are recorded on videotape or digitally captured so the physician may review the images later.
Indication To visualize blood clots and/or check for phlebitis.
Prep No prep.
Length Approximately 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic Specify “bilateral” or “unilateral” study. If “unilateral” study, specify “right” or “left”.
A-V ACCESS GRAFT IMAGING Description This is color-flow, ultrasound imaging of an arterial venous access graft used for dialysis. The technologist moves the transducer up and down the extremity looking at the vessels and measuring the blood flow. The patient may be asked to change positions.
Indication To evaluate if there is any narrowing of the graft, or if there is an out-flow obstruction which may shorten the life of the graft.
Prep No prep.
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Length Approximately 45 minutes to 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South
ARTERIAL GRAFT ASSESSMENT Description This is an ultrasound examination to evaluate lower or upper extremity arterial bypass graft. The patient will lie on a stretcher in a darkened room. The patient will be covered while the area is being studied. To improve the quality of the pictures, a colorless gel is applied to the area where the transducer will be placed. This may feel cool and moist, but the gel will be wiped off at the end of the test. The technologist moves the transducer up and down the extremity looking at the vessels and measuring the blood flow. The patient may be asked to change positions. The images are recorded on videotape or digitally captured so the physician may review the images later.
Indication It assists in determining the graft’s patency and hemodynamics, and also helps identify correctable lesions.
Prep No prep.
Length Approximately 45 minutes to 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic
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ELECTROCARDIOGRAM (EKG) Indication To determine abnormal heart rhythms.
Description This is a study that interprets the electrical activity of the heart. The patient will lie down for this procedure. The technician will place several electrodes (small sticky patches) on the patient’s chest. Men may need to have areas of their chest shaved, to ensure that the electrodes stay in place. The technician will enter the patient’s information into the machine, ask the patient to hold real still for a minute. An EKG will print out and then the technician will remove the electrodes off the patient.
Prep No prep.
Length Approximately 30 minutes.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic East Ocean Diagnostic Center
HOLTER MONITORING Indication To diagnose abnormal heart rhythms.
Description Holter monitoring is a continuous recording of your heart rhythm, usually for 24 hours, while you go about your usual daily activities. Electrodes are attached to your chest and connected by wires to the recorder. It is very important that all electrodes remain attached for the entire recording period. The technician will give the patient written instructions to take home. The patient with keep the recorder with them at all times for the duration of the test. The patient can do anything they would normally do, except take a bath or shower.
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The patient will carry a diary in which they will enter their activities, any symptoms them may experience during the recording period, and the time at which their symptom occurred. At the end of the recording, the display goes blank. The patient may take the electrodes off, put wires, recorder and diary into a bag and return to where it was put on. Several areas on the chest will be cleansed with alcohol, rubbed with abrasive paper and abrasive gel, to ensure good electrode contact. Men may need to have areas of their chest shaved. The patient can do anything they would normally do, except take a bath or shower.
Prep Wear a loose-fitting blouse or shirt, with the buttons in the front.
Length Approximately 30 minutes.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial Diagnostic Center Martin Memorial St. Lucie West Diagnostic IMPORTANT!!! Patient should be informed that Medicomp is an outsourced company that will be scanning the information that is recorded. Medicomp will bill the patient’s insurance separately for this service. If the patient’s insurance does not cover this, Medicomp will bill the patient separately for this service.
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PATIENT INITIATED EVENT MONITOR (PIM) Description This recorder has the capability to record the patient’s EKG for short periods of time and enables the patient to transmit this information over the phone to a monitoring company, who will alert the physician if there are any abnormal rhythms. The technician will go through with the patient the process of attaching the monitor and call ing in when feeling symptoms.
Prep Wear a loose fitting blouse or shirt, with the buttons in the front.
Length Approximately 30 minutes.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic IMPORTANT!!! Patient should be informed that Medicomp is an outsourced company that will be monitoring the patient’s transmissions. Medicomp will bill the patient’s insurance company separately for this service. If the patient’s insurance does not cover this, Medicomp will bill the patient separately for monitoring from the hook up and physician interpretation.
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TELEPHONIC PACEMAKER CHECKS Description This study determines if a patient’s pacemaker is functioning correctly. Patient will initially come in to receive a transmitter and be scheduled to call into the hospital and using the transmitter, over the phone allow the technician to check the parameters of their pacemaker. The technician will give the patient directions over the phone. Pacemaker checks are covered by Medicare and other health insurance. MMMC will file all insurances. The patient will be billed initially for a phone check. Separate physician interpretation charge is also covered by Medicare. It will be the patient’s responsibility to obtain from their physician yearly a new prescription for their phone checks.
Prep No prep.
Length Approximately 30 minutes.
Facility Martin Memorial Medical Center
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NEURODIAGNOSTIC PROCEDURES Call (772) 288-5817 to schedule
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NEUROGIAGNOSTIC PROCEDURES . . . . . . . . . . . . . Call (772) 288-5817 to schedule ELECTROENCEPHLOGRAM (EEG) Description An EEG records the electrical activity of the brain. Electrodes are placed on the patient’s scalp and other areas of the body. You may be asked to do certain things during the recording, such as breathe deeply and rapidly for several minutes or be exposed to a bright flickering light.
Indication To assist physicians in the diagnosis of a variety of neurological problems.
Prep • •
•
You will need to wash your hair the night before the test. Do not use any oils, sprays, or conditioner on your hair before the test. Your health care provider may want to discontinue some medications before the test. Do not change or stop medications without first contacting your health care provider. You should avoid all foods containing caffeine for 8 hours before the test.
Length Approximately 1 hour.
Facility Martin Memorial Medical Center Martin Memorial Hospital South
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AMBULATORY ELECTROENCEPHLOGRAM (EEG) Description An EEG records the electrical activity of the brain. Electrodes are placed on the patient’s scalp and other areas of the body. In ambulatory EEG monitoring, the person is able to move around, and the test allows for prolonged reading of electrical activity in the brain. Fewer electrodes are attached to the person, and the person carries a small, mobile recording unit. The recording may last for a full day or more, and the person is allowed to leave the testing facility.
Indication To assist physicians in the diagnosis of a variety of neurological problems.
Prep • •
•
You will need to wash your hair the night before the test. Do not use any oils, sprays, or conditioner on your hair before the test. Your health care provider may want to discontinue some medications before the test. Do not change or stop medications without first contacting your health care provider. You should avoid all foods containing caffeine for 8 hours before the test.
Length Approximately 1-2 hours to set up.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Patient returns 24 — 48 hours later to have monitor removed.
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SLEEP DEPRIVED ELECTROENCEPHLOGRAM (EEG) Description An EEG records the electrical activity of the brain. The patient will lie on a stretcher for this procedure. Electrodes are then placed on the patient’s scalp and other areas of the body. For a sleep deprived EEG, the patient will be awakened at 2:00 am and then kept awake for the rest of the night. The patient is brought to the EEG Department at about 7:30 am and will have a routine EEG for which they must try to stay awake. Then the technician will make the patient comfortable so that they are able to fall back asleep. Then a sleep tracing is recorded while they sleep.
Indication EEG’s assist physicians in the diagnosis of a variety of neurological problems.
Prep • •
•
You will need to wash your hair the night before the test. Do not use any oils, sprays, or conditioner on your hair before the test. Your health care provider may want to discontinue some medications before the test. Do not change or stop medications without first contacting your health care provider. You should avoid all foods containing caffeine or sugar for 8 hours before the test.
Length Approximately 2 hours.
Facility Martin Memorial Medical Center Martin Memorial Hospital South
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VISUAL EVOKED POTENTIAL (VEP) Description A VEP is a recording of electrical activity from the brain, spinal nerves and sensory receptors. The patient will be sitting in a chair for this procedure. Electrodes are placed on the patient’s scalp. Once the electrodes are placed, an eye patch is placed over one eye. The room is then darkened, and the patient will then look on a checkerboard image on a screen, with their unpatched eye. The same procedure will be done to the other eye. A computer records the neurological responses to stimuli which are plotted on a graph and interpreted by a physician.
Indication Evoked potentials are helpful in evaluating a number of different neurological problems.
Prep • •
•
You will need to wash your hair the night before the test. Do not use any oils, sprays, or conditioner on your hair before the test. Your health care provider may want to discontinue some medications before the test. Do not change or stop medications without first contacting your health care provider. You should avoid all foods containing caffeine for 8 hours before the test.
Length Approximately 30 minutes.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Patient needs to ensure that they bring eyeglasses if needed.
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BRAINSTEM AUDITORY EVOKED POTENTIAL (BAEP) Description A BAEP is a recording of electrical activity from the brain, spinal nerves and sensory receptors. The patient will be sitting in a chair, or lying on a stretcher for this procedure. Electrodes are then placed on the patient’s scalp. Once the electrodes are placed, earphones or ear plugs are placed over each ear. A click or a swishing sound is generated in one ear at a time. The stimulus (click or swish) will continue for a few minutes, producing a response in the brain that is picked up by the electrodes on the head. A computer records the neurological responses to stimuli which are plotted on a graph and interpreted by a physician. There is no pain associated with this test.
Indication Evoked potentials are helpful in evaluating a number of different neurological problems.
Prep • •
•
You will need to wash your hair the night before the test. Do not use any oils, sprays, or conditioner on your hair before the test. Your health care provider may want to discontinue some medications before the test. Do not change or stop medications without first contacting your health care provider. You should avoid all foods containing caffeine for 8 hours before the test.
Length Approximately 45 minutes.
Facility Martin Memorial Medical Center Martin Memorial Hospital South
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ELECTROMYOGRAPHY (EMG) Description The patient will lie on a stretcher for this procedure in an operating room setting. A physician inserts a needle into a muscle and electrodes are placed on the surface. The electrical activity of the muscle is examined during insertion of the needle, at rest, and during contraction.
Indication An EMG is used to detect denervation and myopathies.
Prep No body lotion.
Length Approximately 1 hour.
Facility Martin Memorial Medical Center.
STRESS TEST (GXT) . . . . . . . . Purpose To aid in the diagnosis of coronary artery disease, evaluate the severity of coronary artery disease, and/or evaluate the effectiveness of drug, exercise, surgical, or other forms of therapy on patients with known coronary artery disease. • • • • • • •
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Regular Stress Test (Exercise only, without nuclear imaging.) Cardiolite Stress Test (Exercise with nuclear imaging.) Persantine Cardiolite Stress Test (Pharmacological Stress test, pt. is lying down, with nuclear imaging.) Adenosine Cardiolite Stress Test (Pharmacological Stress test, pt. is lying down, with nuclear imaging.) Dobutamine Cardiolite Stress Test (Pharmacological Stress test. Pt is lying down, with nuclear imaging.) Dobutamine Stress Echo Test (Pharmacological Stress test with 2-D Echo. Pt is lying down, without nuclear imaging.) Stress Echo Test (Exercise with 2-D Echo-Imaging, without nuclear imaging.)
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REGULAR STRESS TEST Description The patient will be exercising to the best of their ability on a motor-driven treadmill, (in some instances, the physician may use a stationary, Airdyne bicycle instead). The patient will be wearing an EKG monitor with electrodes attached. In order to achieve the desired heart rate, the test begins with treadmill at a constant speed and elevation for a predetermined period of time. The treadmill may then increase in speed and/or elevation, as indicated by the Cardiologist. The test will be terminated earlier if the patient and/or cardiologist indicate that it is necessary to do so. Reasons for termination include, but are not limited to anginal pain, inappropriate breathlessness, faintness, dizziness, lightheadedness, confusion, leg pain (claudication) or the patient request the need for the test to be terminated.
Prep Nothing to eat or drink after midnight. Please wear comfortable walking shoes and comfortable clothing.
Length Approximately 1 hour.
Facility Martin Memorial Medical Center Martin Memorial St. Lucie West Diagnostic Martin Memorial Hospital South Do not take a hot shower or bath two hours after this test.
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CARDIOLITE STRESS TEST Description This is a two-day test. On day one: The patient will be exercising to the best of their ability on a motor-driven treadmill, (In some instances, the physician may use a stationary, Airdyne bicycle instead). The patient will be wearing an EKG monitor with electrodes attached. An IV will be inserted, and a solution of sterile Normal Saline will be started at a very slow rate. In order to achieve the desired heart rate, the test begins with treadmill at a constant speed and elevation for a pre-determined period of time. The treadmill may then increase in speed and/or elevation, as indicated by the Cardiologist. The test will be terminated earlier if the patient and/or cardiologist indicate that it is necessary to do so. Reasons for termination include, but are not limited to anginal pain, inappropriate breathlessness, faintness, dizziness, lightheadedness, confusion, leg pain (claudication) or patient requests the need for the test to be terminated. When the desired heart rate is achieved, or when the Cardiologist determines it necessary, the nuclear technician will inject a small amount of radioactive tracer, called Cardiolite, into the prepared IV site. The Cardiolite is slightly radioactive, and enables pictures to be taken of the heart. The pictures taken on Day 1 will be called “Exercise pictures”. The Cardiolite is absorbed through the patient’s system, and is quickly eliminated. After exercising, it is necessary for the Cardiolite to circulate in the patient’s system. How long this will take will be individually determined, but generally speaking it takes approximately 30 - 45 minutes to circulate. During this “waiting period”, the patient is encouraged to have something to eat or drink, as long as the patient is not having any other procedure that requires them to remain fasting. The Nuclear images are taken in the Nuclear Medicine Department. The patient will be asked to lie flat on a table, where the nuclear camera will take pictures over the chest area. After the nuclear images are taken, someone from the Nuclear Medicine Department will instruct the patient as to when they need to return on Day 2 for another set of pictures, called the “resting pictures.” The images will be compared with each other to determine if there are any changes.
Prep Nothing to eat or drink after midnight. Please wear comfortable walking shoes and comfortable clothing.
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Length Approximately 3 hours.
Facility Martin Memorial Medical Center Martin Memorial St. Lucie West Diagnostic Martin Memorial Hospital South Do not take a hot shower or bath two hours after this test.
PERSANTINE CARDIOLITE STRESS TEST Description This is a two-day test. On day one: The patient will be lying on a stretcher throughout the test. The patient will be wearing an EKG monitor with electrodes attached. An IV will be inserted, and a solution of sterile Normal Saline will be started at a very slow rate. During this 15 minute, timed procedure, a medication called Persantine will be infused into this sterile saline line to achieve a desired dilation effect. When the Cardiologist determines it necessary, the nuclear technician will inject a small amount of radioactive tracer, called Cardiolite, into the prepared IV site. The Cardiolite is slightly radioactive, and enables pictures to be taken of the heart. The pictures taken on Day 1 will be called “Exercise pictures”. The Cardiolite is absorbed through the patient’s system, and is quickly eliminated. If the patient is having discomfort, a reversal agent called Aminophylline is administered. which in essence “turns it off ”. The procedure continues with EKG, HR and Blood Pressure monitoring, and this is called the “Recovery Phase”. The Nuclear images are taken in the Nuclear Medicine Department. The patient will be asked to lie flat on a table, where the nuclear camera will take pictures over the chest area. After the nuclear images are taken, someone from the Nuclear Medicine Department will instruct the patient as to when they need to return on Day 2 for another set of pictures, called the “resting pictures”. The images will be compared with each other to determine if there are any changes.
Prep Make certain that patient is not on Aminophylline, Aminophyllinecontaining medications, or long acting Theophylline compounds 24 hours prior to procedure. Nothing to eat or drink after midnight, especially no Diagnostic Imaging Prep Guidelines
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coffee, tea, caffeinated or decaffeinated beverages of any kind. No chocolate.
Length Approximately 3 hours.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic *ALLERGY TO PERSANTINE IS AN ABSOLUTE CONTRAINDICATION. Do not take a hot shower or bath two hours after this test.
ADENOSINE CARDIOLITE STRESS TEST This test must be ordered by a cardiologist
Description This is a two-day test. On day one: The patient will be lying on a stretcher throughout the test. The patient will be wearing an EKG monitor with electrodes attached. An IV will be inserted, and a solution of sterile Normal Saline will be started at a very slow rate. During this 15 minute, timed procedure, a medication called Adenocard will be infused into this sterile saline line to achieve a desired dilation effect. After the Adenocard is started, the nuclear technician will inject a small amount of radioactive tracer, called Cardiolite, into the prepared IV site. The Cardiolite is slightly radioactive, and enables pictures to be taken of the heart. The pictures taken on Day 1 will be called “Exercise pictures”. The Cardiolite is absorbed through the patient’s system, and is quickly eliminated. If the patient is having discomfort, a reversal agent called Aminophylline may be administered, in essence “turns it off ”. It cannot eliminate symptoms encountered prior to procedure. The procedure continues with an EKG, HR and Blood Pressure monitoring, and this is called the “Recovery Phase”. The Nuclear images are taken in the Nuclear Medicine Department. The patient will be asked to lie flat on a table, where the nuclear camera will take pictures over the chest area.
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After the nuclear images are taken, someone from the Nuclear Medicine Department will instruct the patient as to when they need to return on Day 2 for another set of pictures, called the “resting pictures”. The images will be compared with each other to determine if there are any changes.
Prep Make certain that patient is not on Aminophylline, Aminophyllinecontaining medication, or long acting Theophylline compounds 24 hours prior to procedure. Nothing to eat or drink after midnight, especially no coffee, tea, caffeinated or decaffeinated beverages of any kind. No chocolate.
Length Approximately 3 hours.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic Do not take a hot shower or bath two hours after this test.
DOBUTAMINE CARDIOLITE STRESS TEST Description This is a two-day test. On day one: The patient will be lying on a stretcher throughout the test. The patient will be wearing an EKG monitor with electrodes attached. An IV will be inserted, and a solution of sterile Normal Saline will be started at a very slow rate. During the procedure, a medication called Dobutamine will be infused into this sterile saline line to achieve an exertional effect. The patient may feel sensations as though he /she is exercising, e.g. faster / pounding heart rate. When the desired heart rate is achieved, or when the Cardiologist determines it necessary, the nuclear technician will inject a small amount of radioactive tracer, called Cardiolite, into the prepared IV site. The Cardiolite is slightly radioactive, and enables pictures to be taken of the heart. The pictures taken on Day 1 will be called “Exercise pictures”. The Cardiolite is absorbed through the patient’s system, and is quickly eliminated. When the Dobutamine infusion has been stopped, the patient will remain in the Cardiology Department for a few minutes to take EKG, HR and Blood Pressure readings. This is called the “Recovery Phase” the procedure. Diagnostic Imaging Prep Guidelines
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The Nuclear images are taken in the Nuclear Medicine Department. The patient will be asked to lie flat on a table, where the nuclear camera will take pictures over the chest area. After the nuclear images are taken, someone from the Nuclear Medicine Department will instruct the patient as to when then need to return on Day 2 for another set of pictures, called the “resting pictures”. The images will be compared with each other to determine if there are any changes.
Prep Nothing to eat or drink after midnight.
Length Approximately 3 hours.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Do not take a hot shower or bath two hours after this test.
DOBUTAMINE STRESS ECHO TEST This test must be ordered by a cardiologist
Description The patient will be lying on a stretcher throughout the test. The patient will be wearing an EKG monitor with electrodes attached. An IV will be inserted, and a solution of sterile Normal Saline will be started at a very slow rate. During the procedure, a medication called Dobutamine will be infused into this sterile saline line to achieve an exertional effect. The patient may feel sensations as though he /she is exercising, e.g. faster / pounding heart rate. Prior to the Dobutamine infusion, A 2-D Echocardiogram will be performed to obtained preliminary, or “resting” echo images. This study is an ultrasound examination of the heart. It provides the cardiologist moving images that shows any part of the heart muscle that does not move properly which indicates that part is not receiving enough blood because of a blocked or narrowed artery.
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After 2-D Echo images are taken, the Dobutamine infusion begins. When the desired heart rate is achieved, another set of 2D Echo images are taken during peak exercise, and are called “exercise images”. These images are compared to the resting images to see if there are any changes. When the Dobutamine infusion has been stopped, the patient will remain in the Cardiology Department for a few minutes to take EKG, HR and Blood Pressure readings. This is called the “Recovery Phase” of the procedure. Afterwards, the patient will be permitted to go home.
Prep Nothing to eat or drink after midnight.
Length Approximately 1-2 hours.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Do not take a hot shower or bath two hours after this test.
STRESS ECHO TEST Description The patient will be exercising to the best of their ability on a motor-driven treadmill. The patient will be wearing an EKG monitor with electrodes attached. In order to achieve the desired heart rate, the test begins with treadmill at a constant speed and elevation for a pre-determined period of time. The treadmill may then increase in speed and/or elevation, as indicated by the physician. The test will be terminated earlier if the patient and/or physician indicate that it is necessary to do so. Reasons for termination include, but are not limited to patient requests the need for the test to be terminated, anginal pain, inappropriate breathlessness, faintness, dizziness, lightheadedness, confusion or leg pain (claudication)
Prior To Exercising A 2-D Echocardiogram will be performed to obtain preliminary or “resting” echo images. This study is an ultrasound examination of the heart. It provides the cardiologist moving images of the heart to look at any parts that do not move properly which could indicate that part of the heart muscle may not be receiving enough blood because of blocked or narrowed artery.
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The patient will then begin the exercise portion of the procedure. When the desired heart rate is achieved, the patient will transfer from the treadmill to the stretcher where another set of 2D Echo images are taken. These peak exercise images are called “exercise images”. These images are then compared to the resting images to see if there are any changes. After the procedure, the patient will remain in the Cardiology Department for a few minutes to take EKG, HR and Blood Pressure readings. This is called the “Recovery Phase” of the procedure. Afterwards, the patient will be permitted to go home.
Prep Nothing to eat or drink after midnight.
Length Approximately 1-2 hours.
Facility Martin Memorial Medical Center Martin Memorial Hospital South Martin Memorial St. Lucie West Diagnostic Do not take a hot shower or bath two hours after this test.
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PET/CT Call (772) 288-5817 to schedule
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PET/CT Call (772) 288-5817 to schedule Description Positron Emission Tomography is a diagnostic imaging procedure which is used for early diagnosis, staging, treatment planning and monitoring of cancer. It can also be used for evaluation of brain function, and even for cardiac viability. It is based on monitoring labeled sugar molecules within the patient and looking at the activity of cells and groups of cells. Imaging is done lying down on a machine that looks just like a CT, only slightly longer. The patient will be on a movable table that slides into a large square machine with a central circular hole. Patients will be lying down on the table for about 20-30 minutes for the images to be acquired. When the patient arrives in Radiology, an IV will be started and the patient’s blood sugar level must be checked. The Glucose (blood sugar) level must be under 200, or we will NOT be able to perform the study. The patient will be injected with the radiopharmaceutical, called FDG. The patient is made comfortable in an easy chair in a private waiting room so that the body’s natural absorption of the sugar may begin. This takes approximately 1 hour. The patient is encouraged to rest and refrain from ANY activity during this time to obtain the best results. Patients may listen to music on a CD player, but cannot read during the 1 hour preparation time.
Preparation (these are CRITICAL to performing a good test): Day before test: * Drink plenty of water * Eat • Beef, chicken or fish (protein) • Vegetables (no potatoes or yams – AVOID starch) • Tossed Salad (no carrots or tomatoes – these contain sugars) • LOW carbohydrate diet (no pasta, rice, bread, potatoes, etc) • Avoid sweets, desserts, fresh fruit; fast, fried, or breaded food; milk, fruit juice or any sugar drink; wine, beer or spirits.
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Day of test: • Do not eat at least 6 hrs prior to appointment. Continue drinking plenty of water. Diabetics should take their diabetes control medication up to 6 hours PRIOR to their appointment. If medications are a part of their daily routine, have them check with their physician. Most of the time they CAN take their medication, UNLESS eating a meal is part of the regimen. On RARE occasions a patient may want medication for anxiety; a prescription for this medication must be obtained and filled from their physician BEFORE the exam. Bring this medication with you to your appointment. Show it to the technician who will advise you of the best time to take the medication. Normally, the imaging portion of the test will take from 25 to 30 minutes. If a whole body is indicated (such as for melanoma) it will take between 30 and 45 minutes. If a whole body scan is indicated, please schedule at 12:30 PM or book 2 consecutive appointments. Patient needs to arrive 45 minutes before their appointment time. Any prior films or CD’s must be made available for comparison.
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MAGNETIC RESONANCE IMAGING Call (772) 221-7226 to schedule
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MRI/MRA/MRCP . . . . . . . . . . . Call (772) 221-7226 to schedule MRI/MRA/MRCP Description Magnetic Resonance Imaging uses radiofrequency waves and a strong magnetic field to provide clear and detailed pictures of internal organs and tissues. MRI’s enable the detection of abnormalities that might not be seen with other imaging methods. Patients will be called in advance for pre-screening.
Day of the exam Patients are comfortably placed on the table and moved partially into the scanner by the technologist and/or nurse. The patient is not exposed to any radiation. MRI’s are non-invasive, but on site nurses are available to administer IV medication for claustrophobic patients that have a driver.
Indication MR imaging and MR angiography are state of the art in the detection, diagnosis, and treatment of acute stroke and vascular disease. MR imaging is the most sensitive exam for spinal and joint problems and is a powerful tool for locating tumors and diagnosing many types of cancer.
Prep • •
No prep necessary for MRI and MRA patients NPO for 4 hours prior to appointment time for MRCP patients only
Length Average 15 to 45 Minutes
Facility Martin Memorial Medical Center (behind the Emergency Room) Martin Memorial Medical Office Building (next to the South Hospital) Martin Memorial St. Lucie West No patients with a pacemaker, cochlear implants, or that have had a stapes implant. CONTRAST FOR MRI: MRI contrast does NOT contain iodine, but patients with end-stage renal failure MUST be evaluated PRIOR to administration of contrast and may require dialysis if contrast is administered. Diagnostic Imaging Prep Guidelines
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CARDIAC CATHETERIZATION Call (772) 288-5882 to schedule
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CARDIAC CATHETERIZATION . . . . . . . . Call (772) 223-5919 to schedule Cardiac Catherization When scheduling a cardiac catherization, please inform the patient of the following information prior to his or her arrival for the exam: 1. Please DO NOT eat or drink after midnight the night before the procedure. 2. Please take your usual morning medications ( including aspirin and plavix ) the morning of the procedure with a sip of water. 3. If you are a diabetic, DO NOT TAKE ANY ORAL DIABETIC MEDICATIONS. If you take insulin injections, only take HALF of your usual long-acting insulin dose (NPH) and take NO regular insulin. 4. If you are taking Glucophage or Coumadin, inform your Cardiolist immediately. 5. If you have a history of allergy (hives, rash, swelling, shortness of breath) to x-ray dye, fish, shellfish, or iodine, inform your cardiologist immediately. 6. Wear loose-fitting clothing so you will be comfortable on the way home. 7. Please make arrangements for someone to drive you home.
Facility Martin Memorial Medical Center Please see Standard IV Contrast requirements.
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Stuart • St. Lucie West • Port St. Lucie • Jensen Beach • Palm City • Hobe Sound MEDICAL CENTER 200 S.E. Hospital Ave. • Stuart, FL 34994 (772) 287-5200 • www.mmhs.com
