MRI

MRI (magnetic resonance imaging) is used to provide detailed imaging of the body to aid in the diagnosis of a variety of medical conditions.   

Unlike CT, MRI uses no x-rays or radiation. MRI uses a strong magnetic field and radio frequency waves to produce signals that are reconstructed into a viewable image by a computer.

How to prepare

Before your exam:

• You will be required to fill out screening and medical history forms when you check in. These forms include specific information about allergies and medications you take, prior surgeries, and any medical implants you may have. This implant information is necessary to ensure your safety during the MRI exam. Please bring this information, if available, to your appointment.
• MRI exams require that the patient hold still for the duration of the exam. If you have concerns about your ability to hold still because of pain or claustrophobia, please contact your physician prior to your scheduled MRI appointment to discuss possible premedication options. If premedicated, please arrange transportation to and from your MRI appointment.

Your physician will explain the procedure to you, but if you have more questions, don’t hesitate to call Salem Health imaging services at 503-814-5293.

What to expect at an MRI appointment

After check in, MRI staff will bring you to the MRI changing area. You may be asked to change out of clothing that has zippers, snaps or hooks. MRI-safe gowns, pants, and a robe will be provided. Your personal items will be secured in a locked dressing room. One person may accompany you in the MRI room upon request. Your visitor will need to fill out a brief screening form before entering the room to ensure their safety.

Most MRI exams take 20 to 40 minutes. The technologist will make you as comfortable as possible. The MRI scanner generates considerable noise during normal operation. Hearing protection will be provided. During the exam, you will be able to communicate with the technologist by a speaker system and a call button will be provided to you.

Your exam may require a contrast injection to better interpret your images. The active element in MRI contrast is gadolinium. If you have known kidney disease, please inform your technologist. Nephrogenic systemic fibrosis (NSF), a rare condition, can arise in patients that have compromised renal function and that receive gadolinium contrast. 

Our desire is to make your experience as safe and comfortable as we possibly can. At any time in the process, feel free to ask questions and point out anything that concerns you.

After the exam

Once the exam is complete, the technologist will escort you to the changing area and provide access to your secured belongings.

Your images will be interpreted by our radiologist and a detailed report will be sent to your provider, usually within 2 business days.

Contact your provider to make arrangements to receive your results.  

Where is this procedure done?

MRIs are available at the following Salem Health locations:

• Salem Health Orthopedics (State St. location): 1.5T system
• Salem Hospital: 1.5T and 3T Wide Bore systems
• West Valley Hospital: 1.5T system
  

CT scan

Computed axial tomography (CT or CAT scan) scans combine X-rays with advanced computer technology to take images of bones, soft tissue, organs, and blood vessel in thin slices.

How to prepare        

Before your exam:

• We recommend that you wear comfortable clothing without metal zippers, snaps, buttons, or underwire bras so you won’t have to change into a gown.
• Some exams require an IV injection of iodinated contrast to better visualize the organs and blood vessels. Should you need this injection, you will be asked to stay on a clear liquid diet for two hours before your CT appointment, but you still may take your prescribed medications. Notify the scheduler and CT technologist if you know you are allergic to CT contrast or iodine.
• To help prepare for your appointment, it is best to drink extra clear fluids (especially water) before your appointment to ease the process of starting an IV (should you need one for the exam).
• If you have further questions, contact Salem Health imaging services at 503-814-5293.

What to expect at a CT appointment

You may be asked to drink two bottles of oral contrast an hour before you enter the CT suite if you are having a CT scan on your abdomen or pelvic area. This allows us to view some of the abdominal and pelvic organs.

The technologist will bring you back to the CT suite to lie on the exam table. We will ask you to remove any metal you have in the area of the scan field. Pillow and positioning devices will be provided for your comfort.

During the brief scan, the technologist will be outside near the CT controls. Through the speaker in the scanner, they may ask you to hold your breath for about 10 seconds as images are taken. Most exams take 10 to 45 minutes. Most people who are claustrophobic do fine with our quick and open CT scanners.

If you need the iodinated contrast injection, an IV line will be placed in a vein in your arm before the procedure. All of our CT technologists are skilled in IV placement and will work with you to make the process as quick and painless as possible.

After the exam

Once the exam is complete, your IV line (if placed) will be removed. If you take metformin, you may be asked to discontinue use for 48 hours after the CT, depending on your lab results, if you received the iodinated contrast injection. Otherwise, you may resume your normal activities.

A radiologist will review the images and provide a detailed report to your physician. Reports are generally available within two business days.

Frequently asked questions

What can I expect with a CT colonography?

You will need to do a laxative and clear liquid diet prep for the two days prior to your exam. If you are having any concerns or problems with this prep, please call your ordering physician’s office. They may have you stop the prep and reschedule the exam.

Once you arrive for your CT, we will take one image to ensure your colon is clean enough to obtain diagnostic images. If your colon is cleaned out enough, an enema tip will be inserted and we will fill your colon with air. Your abdomen will feel full, and you may experience some mild cramping during the procedure. We will take images as you lay on your stomach, then while on your back.

The total exam takes about 30 to 45 minutes. You can drive home and resume normal activities immediately after. It is common to experience gas and/or diarrhea after the study, but it should not be painful.

What can I expect with a CT of the heart/coronary arteries?

You will be admitted to our prep/recovery area before your CT exam. The nurses will start an IV, check your heart rate and give you a beta blocker medication to help lower your heart rate an hour before the CT scan. You will be transported by stretcher to the CT suite where you will lie on the CT table.

Our team will monitor your heart rate and give additional medications (if needed) to bring your heart rate within the appropriate range for the study. You will be instructed to relax as much as possible and hold your breath when images are taken. The CT scan takes about 45 minutes, depending on your heart rate.

After the CT scan, you will return to prep/recovery until ready for discharge. You will need a family member or friend to drive you home. Patients should expect to be at the hospital for about four hours from start to finish.

What can I expect with a CT biopsy or drain placement?

You will be admitted to our prep/recovery area before your CT exam. The nurses will start an IV and order lab work if needed. Once you arrive in CT, the physician will explain the procedure and then have you sign a consent form. A nurse will be assigned to give IV sedation medications to help keep you comfortable throughout the procedure.

The CT scanner will be used to locate the applicable area and then the radiologist will inject lidocaine to help numb the area of interest. A small needle or tube will then be inserted and then a tissue sample will be collected and/or a tube placed.

The study itself takes about 45 minutes. You will return to prep and recovery after the procedure until you are fully recovered from the sedation. You will need a family member or friend to drive you home. Expect to be at the hospital for six to eight hours.

Where is this procedure done?

CT scans are available at the following Salem Health locations:

• Salem Hospital
• West Valley Hospital

Ultrasound imaging

Ultrasound, or sonography, uses very high frequency, low power sound waves to make an image of fluid and organs within the body. Ultrasound images are obtained using a transducer (the camera of ultrasound). Ultrasound does not use ionizing radiation (like X-rays) and has been shown to be safe and cost-effective for patients of all ages.

Because of the way images are taken, ultrasound is highly operator-dependent. Salem Health only employs diagnostic medical sonographers registered through an independent, national licensing body — the American Registry of Diagnostic Medical Sonographers (ARDMS).

In general, ultrasound creates images of soft tissues and organs, as well as provides guidance for invasive procedures such as biopsies and fluid drainages.



Abdomen

Why would my physician order this procedure?

To evaluate the aorta, inferior vena cava, liver, gallbladder and bile ducts, pancreas, kidneys and spleen. Some reasons providers order an abdominal ultrasound are for unexplained abdominal pain, hepatitis, nausea, vomiting, jaundice and gallstones.

Exam preparation

Do not to eat or drink for eight hours before your exam. Fatty foods can contract your gallbladder and result in false readings and food in your stomach can interfere with the ultrasound beam. It is okay to take your medications with water if needed.

If you are diabetic, please consult with your physician.

What to expect

You will lie on your back while the sonographer takes images with the ultrasound transducer and a warm gel.

The sonographer will sometimes press firmly to obtain appropriate images and will have you hold a deep breath while they take images.

Often the sonographer will take additional images while you lie on your right and/or left side.

Your sonographer will not give you results or make a diagnosis. The interpretation is the responsibility of the radiologist, who will send a report to your doctor in one to two business days.

How long will it take?

In general, abdominal ultrasounds take about 30 minutes.

Possible complications or side effects

No complications are expected from the ultrasound.



Appendix

Why would my physician order this procedure?

Physicians usually order appendix ultrasounds in cases where appendicitis is suspected.

Exam preparation

No prep is needed to evaluate the appendix.

What to expect

You will lie on your back while the sonographer takes images by pressing with the ultrasound transducer and warm gel. Often the sonographer will take additional images while you lie on your left side.

Your sonographer will not give you results or make a diagnosis. The interpretation is the responsibility of the radiologist, who will send a report to your doctor in one to two business days.

How long will it take?

Ultrasounds of the appendix generally take between 15 and 30 minutes.

Possible complications or side effects

No complications are expected from the ultrasound.



Biopsies

Overview

There are many organs and tissues that can be biopsied under ultrasound, including the thyroid, liver, kidneys and lymph nodes under the skin. Ultrasound is used to view the area to be biopsied and confirm the biopsy needle is placed appropriately. Ultrasound is preferred because no ionizing radiation is used, and because the needle can be visualized in real-time.

Exam preparation

Each biopsy has specific preparation requirements. The scheduling department or your physician’s office will instruct you regarding exam prep. If you are on any anti-coagulants or ‘blood-thinners’ talk to your physician about whether you should stop the medicine before the procedure.

What to expect

Each biopsy is different. Before the procedure the nurse and the sonographer will completely explain your specific biopsy, possible complications and what to expect. The radiologist will numb the area to be biopsied. The numbing medication will burn and sting, but this only lasts a short time. The radiologist then uses a small biopsy needle through the numbed area to take a tissue sample.

Biopsies of deeper areas like the liver or kidneys are more involved. The radiologist will usually have the nurse administer a sedative and pain medication. The medications will make you sleepy and relaxed, but you will still be awake so we can speak with you during the procedure.

How long will it take?

Ask the scheduler or your doctor’s office for specific details, but generally plan to be at the hospital for anywhere from one to four hours. Each biopsy can vary, but generally from the time you are numbed up until the doctor is finished is only 15 minutes. The remainder of the time is for the nurses to review your health history and medications, prepare you for the biopsy, and to monitor you after the procedure.

Possible complications or side effects

Your nurse and the radiologist will thoroughly review the possible complications for your specific biopsy before the procedure begins.



Obstetrical (fetal, first trimester)

Overview

Ultrasounds in the first trimester of pregnancy are commonly ordered if the provider wishes to confirm the baby’s gestational age or if the mother has pain or bleeding.

Exam preparation

We ask you to drink 20 ounces of water 30 minutes before the exam to ensure you have a full bladder.

What to expect

You will lie on your back on ultrasound bed. The sonographer will scan through the pelvis with the ultrasound transducer and warm gel. Depending on how far along the pregnancy is, or when additional detail is needed, a special ultrasound probe is used to image the fetus through the vaginal cavity. This procedure is similar to a pelvic exam at your gynecologist.

Ultrasound is very technical and the sonographers are highly trained, but they are not qualified to give you results or make a diagnosis. The interpretation is the responsibility of the radiologist, who will send a report to your provider in one to two business days.

How long will it take?

Ultrasounds in the first trimester generally take less than 30 minutes.

Possible complications or side effects

No complications are expected from the ultrasound.



Obstetric (fetal, second and third trimesters)

Overview

Most ultrasounds in the second trimester are the “20-week scans” or anatomy screens. These are routinely ordered on all pregnancies to confirm the gestational age of the fetus and to evaluate fetal anatomy. Additional, similar exams are sometimes ordered by the provider to evaluate fetal growth later in the pregnancy, follow up a previous finding or to check fetal well-being and amniotic fluid. Most people are familiar with this ultrasound because this is when it is possible to determine the baby’s sex.

Exam preparation

The scheduling department will give you specific exam preparation instructions, but generally we recommend drinking 20 ounces of water 30 minutes before the exam to ensure you have a full bladder.

What to expect

The routine 20-week anatomy scans are one of the most in-depth exams that we perform at Salem Hospital. Many images of fetal anatomy including multiple growth measurements are taken for the radiologist to evaluate. The sonographer will scan through the pelvis with the ultrasound transducer and warm gel. Often additional pictures are taken with you on your left and/or right side.

Ultrasound is very technical and the sonographers are highly trained, but they are not qualified to give you results or make a diagnosis. The interpretation is the responsibility of the radiologist, who will send a report to your provider in one to two business days.

How long will it take?

Because this is one of the most involved studies that we perform, they can last anywhere from 45 to 90 minutes. Follow-up ultrasounds later in the pregnancy are often quicker.

Possible complications or side effects

No complications are expected from the ultrasound.



Paracentesis

Overview

Certain conditions or recent surgeries can cause fluid to build up in the abdomen called ascites. When it becomes necessary to drain the fluid, the radiologist can perform a paracentesis.

Exam preparation

If you are on any anti-coagulants speak to your provider about whether you should hold the medicine before the procedure.

What to expect

You will lie on your back on a bed while the sonographer uses ultrasound to find a safe place on your abdomen to access the fluid. The radiologist and nurse will discuss the procedure and its complications before they begin. The radiologist will numb the area with a local anesthetic. After you are numb, the doctor advances a small needle catheter just far enough to access the abdominal fluid. Often, a sample is taken to the lab for analysis at your provider’s request. Once the fluid is drained the catheter is removed and the nurse will evaluate you before you leave.

How long will it take?

Expect to be at the hospital for 60 to 90 minutes. The actual drainage portion varies greatly — 30 to 60 minutes is typical.

Possible complications or side effects

If a large volume of fluid is drained you may feel weak or lightheaded immediately after the procedure. Please discuss any concerns you have with the nurse or radiologist. The nurse will review potential complications and warning signs before you leave the department.



Pelvis

Overview

Pelvic ultrasounds evaluate the uterus, ovaries and the adjacent pelvic space for abnormalities. In some cases Doppler ultrasound is used to confirm the presence of blood flow in the ovaries.

Exam preparation

We ask that you drink 20 ounces of water 30 minutes before the exam to ensure you have a full bladder.

What to expect

You will lie on your back on the ultrasound bed. The sonographer will scan through the pelvis with the ultrasound transducer and warm gel. When additional detail is needed (on adults only), a special ultrasound probe is used to scan the pelvis through the vaginal cavity. This is similar to a pelvic exam at your gynecologist.

Ultrasound is very technical and the sonographers are highly trained, but they are not qualified to give you results or make a diagnosis. The interpretation is the responsibility of the radiologist, who will send a report to your provider in one to two business days.

How long will it take?

Ultrasounds of the pelvis generally take about 30 minutes.

Possible complications or side effects

No complications are expected from the ultrasound.



Renal (kidney)

Overview

Providers commonly order a renal ultrasound to evaluate the kidneys when there is renal failure or if there is pain in your side. The exam includes images of the bladder, and physicians often order a renal ultrasound when they wish to evaluate the bladder.

Exam preparation

We ask that you drink 20 ounces of water 30 minutes before the exam to ensure you have a full bladder.

What to expect

You will lie on your back and/or your side while the sonographer takes images with the ultrasound transducer and warm gel. The sonographer will sometimes press firmly to obtain appropriate images and will have your hold a deep breath while they take images.

Ultrasound is very technical and the sonographers are highly trained, but they are not qualified to give you results or make a diagnosis. The interpretation is the responsibility of the radiologist, who will send a report to your provider in one to two business days.

How long will it take?

Renal ultrasounds generally take less than 20 minutes.

Possible complications or side effects

No complications are expected from the ultrasound.



Scrotum

Overview

Ultrasound is an excellent way to evaluate any organ or soft tissue, especially tissue that is close to the surface. Ultrasound is especially ideal to image the scrotum because there is no ionizing radiation like X-rays, high resolution, and ability to evaluate for proper blood flow.

Exam preparation

No special preparation is needed.

What to expect

You will lie on you back on the ultrasound bed while the sonographer uses a transducer and warm gel  to take around 15 images of each testicle and the surrounding tissue. Doppler ultrasound is used to evaluate the blood flow, so you may hear a noise that sounds like a heartbeat as the measurement is taken.

Ultrasound is very technical and the sonographers are highly trained, but they are not qualified to give you results or make a diagnosis. The interpretation is the responsibility of the radiologist, who will send a report to your provider in one to two business days.

How long will it take?

Scrotal ultrasounds are generally less than 20 minutes.

Possible complications or side effects

No complications are expected from the ultrasound.



Thoracentesis

Overview

Certain conditions or recent surgeries can cause fluid to build up in the chest cavity between the lung and the chest wall, called a pleural effusion. When the effusion is large enough or is clinically significant it can be drained by a radiologist in a procedure called a thoracentesis. The procedure is performed in the ultrasound department because ultrasound is used to find the best site to access the fluid.

Exam preparation

If you are on any anticoagulants (blood thinners), talk to your physician about whether you should hold the medicine before the procedure.

What to expect

You will sit on a bed with your arms resting on a table at shoulder height. The sonographer will use the ultrasound transducer to scan on your back to find the fluid around your lung.

The radiologist and the nurse will explain the procedure and possible complications before beginning. The doctor will then numb a spot on your back. The radiologist then uses a small needle catheter to go through the skin just far enough to access the fluid. Often a fluid sample is taken to the lab for analysis. The catheter is left in while the fluid drains, then is removed and a bandage placed at the site. The nurse will evaluate you before you leave.

You can expect to feel the need to cough during the procedure, and will sometimes feel chest pressure. Be sure to keep your nurse informed of any symptoms you are having during the procedure so he or she can monitor you.

How long will it take?

Expect to be at the hospital for 60 to 90 minutes. The actual drainage portion takes around 10 to 15 minutes.

Possible complications or side effects

Any time a needle is placed there is a risk of bleeding or infection. Additionally with a thoracentesis there is a risk of puncturing the lung. This is a rare complication and the nurse and the radiologist are highly experienced and trained to deal with this possibility. The nurse will review potential complications and warning signs before you leave the department.



Thyroid

Overview

The thyroid is an important metabolic organ in the neck. Physicians often order an ultrasound when the thyroid is enlarged or if certain thyroid blood tests are abnormal. Thyroid ultrasounds also evaluate for the presence of thyroid nodules.

Exam preparation

Because the thyroid gland is low on the neck, wear a low-collared or button-up shirt that can easily expose the neck to the collar bone.

What to expect

You will lie on your back on the ultrasound bed with a pillow under your neck. This will help straighten your neck and make it easier to image. The sonographer takes images with the ultrasound transducer and warm gel.

Ultrasound is very technical and the sonographers are highly trained, but they are not qualified to give you results or make a diagnosis. The interpretation is the responsibility of the radiologist, who will send a report to your provider in one to two days.

How long will it take?

A complete examination or follow-up of the thyroid can take anywhere from 15 to 30 minutes.

Possible complications or side effects

No complications are expected from the ultrasound.

Where is this procedure done?

Ultrasounds are available at the following Salem Health locations:

• Salem Hospital

• West Valley Hospital

Ultrasound guided breast biopsy

Ultrasound-guided breast biopsy is a minimally invasive procedure that uses sound waves (ultrasound) to pinpoint suspicious areas in the breast so that tissue samples may be withdrawn with a needle.

You will lie on your back, and your breast will be cleaned. The sonographer applies gel to your skin and locates the area of the biopsy.

Once the physician finds the suspicious area, he or she will numb the tissue. A small nick in the skin is made which allows a hollow needle to be placed directly into the tissue being biopsied.

The physician will draw out small tissue samples in the case of a biopsy, or perform an aspiration in the case of a cyst. Very often a small marker (clip) is left in the tissue to mark the biopsy site for future reference.

There is no need for stitches. A small bandage is applied and you will usually be able to return immediately to your normal activity. In some cases there may be a small amount of bruising and discomfort. The tissue samples will be sent to pathology for analysis.

Mammography/Breast Health Center

Mammography, combined with a clinical breast exam and breast self-examination, is an effective screening tool to maintain breast health.

What is a mammogram?

A mammogram is an X-ray examination of the breast that is used to identify and diagnose any changes in breast tissue. Mammograms today use far less radiation than those used in the past. It is the most effective screening tool for identifying early stages of breast cancer.

What to expect

When you arrive for your exam, you’ll be asked to undress above the waist and wear an open cape, which a technologist will provide for you. We offer our patients the choice of a cape that has been in a warmer or one that is room temperature. One of our technologists help position you in front of the machine and position each breast, one at a time, on the mammography equipment. A paddle is then used to gently compress the breast so that the tissue is flattened. If you have tender breasts or have had negative experiences during your mammograms in the past, please notify your technologist.

Compressing the breast is necessary to get the best image of all the breast tissue. We use soft mammography pads, which helps patients tolerate the compression. Compression also prevents the breast from moving during the procedure, thus reducing or eliminating blurry images. Breast compression lasts for only a few seconds. Some women find breast compression to be uncomfortable, but it should not be painful.

We also use digital mammography, which provides quicker imaging and reduces the radiation dose to the patient.

The entire exam should take about 15 to 20 minutes. If additional images are needed, it may take a bit longer than that.

Possible complications or side effects

There are no expected side effects from a mammogram.

Results are sent to the ordering provider as well as placed in the mail to the patient within two business days (Monday through Friday).

Breast Biopsy

A breast biopsy is a procedure where small samples of tissue are removed from a suspicious area within the breast using a hollow needle guided with ultrasound or X-ray imaging. The tissue sample is then sent to pathology for testing.

How to prepare

On the day of the exam, wear a comfortable, two-piece garment. We recommend wearing a supportive, soft bra. You may eat a light meal prior to your procedure and may take your regularly prescribed medications, with the following exceptions.

Do not take any of the following for the three days prior to your procedure:

• Aspirin or anything containing aspirin
• Advil, ibuprofen or other anti-inflammatory products
• Coumadin/warfarin — you will need to contact your physician to discuss an alternative therapy

What to expect

During the exam, you will lie on your back or rest on your side against a wedge-shaped sponge pillow if the biopsy is done using ultrasound guidance. If the exam is done using X-ray guidance, you will lie on your abdomen during the exam. The technologist and a nurse will assist with your exam.

Once the exact area is located, our radiologist will clean and numb the skin of your breast with a local anesthetic using a small needle. The radiologist will then make a small nick in the skin, which allows a sampling needle to be placed, and then guide the needle directly into the area of concern. The technologist will provide an image on the machine to ensure accurate placement of the needle.

As samples are taken, you may hear clicking as from three to six small tissue samples are removed. After the tissue samples have been retrieved, a small breast marker (clip) is often placed in the tissue at the area of concern for future reference. To confirm the placement of the breast marker, a light compression mammogram is performed immediately after the biopsy. The procedure takes about one hour.

Possible complications or side effects

After the exam, there may be some bleeding or bruising where the biopsy needle was placed. We recommend using cool packs, provided at the time of the procedure, on the area affected for the first 24 hours to minimize swelling and bruising. You may take a non-aspirin pain reliever, but no aspirin for 48 hours following the procedure. Discharge instructions will be discussed with you in detail at the end of your exam.

The final results of the test are usually available within three business days. To discuss the findings, please contact the physician who referred you for this procedure.

Where are these procedures done?

Mammograms and breast biopsies are available at the following Salem Health locations:

• Salem Hospital
• West Valley Hospital

X-ray imaging and fluoroscopy

X-rays are images of your bones and soft tissue. The x-ray tube is like a camera that produces light particles that go through your body to give your provider a picture of your body to aid in a diagnosis.

Fluoroscopy x-ray machines take real time x-rays — similar to having a video camera that takes live x-rays. We have two fluoroscopy rooms and take all necessary precaution to keep our patients’ radiation exposure to a minimum.

What to expect: General x-ray

Upon arriving at the Salem Health imaging/lab check-in desk, you will be welcomed by our friendly receptionists who will check you in for your exam.

After checking in you will be asked to be seated in our lobby. The average wait time to get back to the x-ray room is less than 15 minutes.  

A technologist will position your body to get all the necessary images needed. Based on what part of the body is being scanned, the technologist may ask you to lie down or stand.

Pillows may be used to help position you more comfortably. During the x-ray scan, you’ll need to remain still for about five minutes as the image is taken.

What to expect: Fluoroscopy

Below you will find some common fluoroscopy procedures we do and what you can expect for each exam.

UGI (upper-gastrointestinal series)

UGI procedures look at patients’ esophagus, stomach and start of the small intestine. You should take nothing by mouth for six hours prior to your procedure. You’ll be required to drink barium to make the image clearer and will be standing during the procedure. It will take about 15 minutes.

UGI with a small bowel follow through

This procedure is the same as the standard UGI, except it looks at the entire small intestine. The preparation is the same but this exam normally ranges from one to four hours, so bring some reading material or an electronic device to take advantage of Salem Health’s free Wi-Fi.

Barium enema

This procedure looks at the patient’s large intestine. A two-day prep is required. A prep kit can be picked up at either Salem Health’s imaging services reception desk on the first floor of Building A or at West Valley Hospital. A technologist will give you the prep kit with instructions and will be able to answer any questions.  Expect your procedure to last 45 minutes.

Esophogram

There is no prep required for this exam. You will be required to drink barium. For a portion of this exam you will be asked to stand for about 15 minutes.

Myelogram

Take nothing by mouth starting at midnight the night before the exam. This exam requires placing a needle in the spinal canal and injecting X-ray contrast. You’ll be laying on your stomach. It also involves a CT scan. You may be instructed by your physician’s office to stop taking certain medications before and after this exam (please ask your physician for specific instructions about when to stop taking your medications). Plan to spend six hours here. You will recover in a hospital bed after your exam.

Lumbar puncture

Take nothing by mouth starting at midnight the night before the exam. This exam is used to retrieve spinal fluid for specific testing. The fluoroscope helps the doctor see where to insert the needle. You’ll be required to lie on your stomach. Plan to stay about four hours. You will recover in a hospital bed after your exam.

Arthrogram

This is a two-part procedure and no preparation time is required. You will be required to lie on your back for this exam. Fluoroscopy is used to guide the injection of contrast mixture into one of your joints. This part takes about 30 minutes. After the injection, you will be taken for an MRI or CT for the second part of the procedure. MRI exams last 35 to 45 minutes and CT exams last five to 10 minutes.

Joint injections

No preparation time is required for this procedure. You will lie on your back. Fluoroscopy is used to guide the injection of a mixture of drugs prescribed by your doctor into your joint. The procedure, including recovery, will take about 90 minutes. Hip injection patients may need to stay longer.

Where are these procedures done?

X-rays and fluoroscopies are available at the following Salem Health locations:

• Salem Hospital

• West Valley Hospital

Why would my physician order this procedure?

This exam helps your physician evaluate metabolic changes to your bones.

It can be used to assess a variety of skeletal diseases including but not limited to: infections, inflammation, active arthritis, trauma, cancers, reflux sympathetic dystrophy, and otherwise unexplained bone pain.

How to prepare

You can eat and take your normal medications.

If you are on dialysis, special arrangements must be made around your dialysis times. Please notify our appointment desk (503-814-5293) immediately.

To perform this exam we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

A technologist will explain the entire process before starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

Depending on the reason for your scan, your intravenous (IV) injection will be given to you either under our cameras while we take immediate images or in our injection room.

There is approximately a three-hour wait in-between injection and image time while the injection finds its way to your bones. You are free to go anywhere you want during this time.

We’ll place our cameras around you in different ways depending on which bones we are imaging. The technologist will describe the imaging format when you are injected.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

A report will be sent to your physician.

How long will it take?

There is about a three-hour wait from when you are injected to your image time. Image time can vary from 40 to 50 minutes.

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

To help in the assessment of a functional problem with a cerebrospinal fluid shunt.

How to prepare

There is no special preparation for this exam; however, we ask that patients be prepared to remain very still as the technologist captures the image.

If there is any concern regarding the patient’s ability to hold very still, please notify our appointment desk (503-814-5293) before appointment day.

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

A technologist will explain the entire process to you prior to starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

You will be asked to identify the location of your shunt reservoir. You will be placed on our scanning bed. Following appropriate sterile protocol, the area will be shaved and cleaned.

Our imaging cameras will be positioned over the shunt reservoir while a small amount of radioactive materials is injected into the reservoir by a radiologist.

Depending upon how the shunt is operating, our imaging cameras will be moved to different positions during the procedure.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

A report will be sent to your physician.

How long will it take?

Exam time might vary depending upon the function of the shunt. The average time in the department is about 60 minutes.

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

To help your physician evaluate if there are any problems with how your stomach empties food (gastric motor functions).

How to prepare

Since this is a functional test, your cooperation with the preparation is very important.

Do not take anything by mouth for four hours prior to your appointment. This includes no water, pills, gum chewing or smoking.

Do not take metociopramide (Reglan or Zelnorm) for 24 hours before your appointment.

You will be given a “controlled meal” of egg whites with butter, bread and water. This is a set menu, so please notify the scheduler if you are vegan or allergic to eggs.

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

A technologist will explain the entire process to you before starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

You will be given a controlled meal (as explained above) to eat in 10 minutes or less. We will start taking images immediately upon completion of your meal. The images are taken with you standing in front of a camera every hour for four hours.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

How long will it take?

You will be in our department for about four and a half hours.

Since you will have time between images, you can bring a book or a handcraft if you wish.

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

To help your physician determine if you have a urinary tract obstruction.

How to prepare

There are no diet restrictions. We do want you to drink at least three glasses of water in the hour before your appointment.

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

A technologist will explain the entire process prior to starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

A technologist will place an intravenous (IV) line in your arm. We will have you lie flat on our imaging bed while our camera is positioned under you.

The radiopharmaceutical reagent will be injected through the IV line and images will be acquired immediately. Then 10 minutes after the injection you will be given a diuretic that will “flush” your kidneys out.

Images will continue for another 20 minutes once you are given the diuretic.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

A report will be sent to your physician.

How long will it take?

You will be in our department around one hour.

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

To assist your physician in evaluating either your kidney blood supply or unusual kidney anatomy.

How to prepare

We will need you to drink at least three glasses of water in the hour before your appointment. You may empty your bladder as frequently as needed.

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you nursing.

What to expect

A technologist will explain the entire process before starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

A technologist will place an intravenous (IV) line in your arm. We will have you lie flat on our imaging bed while our camera is positioned under you. The radioactive material will be given to you through the IV line and images will be taken for about 20 minutes.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

A report will be sent to your physician.

How long will it take?

You will be in our department about 30 minutes.

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

To help your physician in the diagnosis of acute or chronic cholecystitis (inflammation of the gallbladder).

How to prepare

This is a functional test, therefore your cooperation in the preparation is very important.

You can have nothing by mouth for four hours before your appointment time. If you have had nothing except water for greater than 24 hours, please notify our appointment desk at 503-814-5293.

You must not take any of the following narcotics for at least four hours before your appointment time: Morphine, codeine, darvon, darvocet, demerol, dilaudid, herion, longtabs, methadone, percocet or percodan.

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

A technologist will explain the entire process before starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

A technologist will place an intravenous (IV) line in your arm. You will be asked to lie flat on our imaging bed while our camera is positioned over your stomach.

You will be given an injection of a radioactive material that is filtered out by your liver and travels through your gallbladder and out your gastrointestinal (GI) tract.

Depending upon how your gallbladder fills, we will either have you return later for additional delayed images or begin measuring immediately.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

A report will be sent to your ordering physician.

How long will it take?

Depending upon how your gallbladder functions, you could be with us anywhere from 90 to 120 minutes.

In certain cases you might need to return about three hours after your injection for additional images (usually 15 minutes of camera time).

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

To help your physician assess the presence, location, extent and severity of coronary heart disease.

How to prepare

You may have only clear liquids and no caffeine four hours before your appointment.

Do not exercise before your appointment if you are having a resting exam.

If you are having an exercise exam, we recommend being off of the following medications before exercise time. (Contact your physician before discontinuing any cardiac medication on your own.)

• Beta-blockers (Inderal, Tenormin, Lopressor, or Corgard) for 24 to 48 hours prior
• Nitroglycerine for at least one hour
• Long lasting nitrates for at least four hours

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

A technologist will explain the entire process to you before starting the exam. He/she will also ask you some health history questions, which will help us interpret your exam.

An IV will be placed followed by an injection of a radioactive material and a 45-minute wait. The patient will then have a scan of the heart, which takes about 25 minutes.

Next is the stress test which is completed by the nuclear technologist. You will be taken to the stress lab, attached to a 12 lead EKG and blood pressure monitor. Once the physician arrives the stress test will begin and the technologist will inject the second dose of the radioactive material. After the stress test is complete there will be another hour (approximate) wait, in which you are allowed food and caffeine, followed by another scan that takes about 20 minutes.

A report will be sent to your physician within two business days.

How long will it take?

For a one-day test, it takes about three and a half hours.

Possible complications or side effects

Since we will be stressing your heart, a physician will be present during the stress portion of your exam.

Why would my physician order this procedure?

To help your physician detect the presence of a parathyroid adenoma (benign tumor).

How to prepare

There is no special preparation. However if you have a multinodular goiter, we are unable to perform this exam.

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

A technologist will explain the entire process to you before starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

A technologist will give you an intravenous (IV) injection of our radioactive imaging material. You will be asked to drink some water. You will then lie flat on our imaging bed while our camera will be placed over your neck area. The images will take about five to 15 minutes per view.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

A report will be sent to your ordering physician.

How long will it take?

Total time for this exam is about three hours. There is about a 15-minute wait after injection time to our first image. You are free to go anywhere until the second or delayed image two hours after injection.

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

A PET scan (positron emission tomography) uses specialized imaging cameras and a radioactive type of sugar to produce pictures of the function and metabolism of the cells of the body.

A CT scan generates a detailed view of the anatomy and structure of organs and tissues in the body.

PET/CT merges both technologies into a single machine. It provides a picture of body function (PET), a picture of anatomy (CT) and a merged picture of both the body’s metabolism and structure.

The result is a full-body view, showing the presence or absence of disease, how active it is, whether it has spread and precisely where and how large an area is affected.

How to prepare

All patients:

• You are not to engage in strenuous activity or exercise the day before and day of the test. If your job is not too labor extensive, you may attend work. Since this is a metabolic test, strenuous activity can affect the results.
• No caffeine or nicotine products five hours before test.
• No diuretics the day of the test (water pills, Lasix, etc. If unsure, please refer to your pharmacist).
• No gum chewing, no hard candy, and no breath mints the day of the test.
• Drink 16 to 24 ounces of water prior to test.

Non-diabetic patients:

• The day before the test, you should eat a low carbohydrate diet.
• For a low carb/high protein diet for 12 to 24 hours prior to PET CT metabolic scan, you may eat protein foods such as meat/eggs/cheese/tofu/fish/ chicken and non-starchy veggies such as salad, broccoli, green beans, asparagus, cabbage, carrots, etc.
• Avoid bread, cereal, pasta, potatoes, fruit, and milk. (This information provided by Denise Cedar, RD, CDE, Salem Hospital diabetes and nutrition education).

Type II Diabetic patients on oral medication:

• Low carb diet the day before test (your diabetic diet should be appropriate).
• No food four hours before the test. You may have water only during this four hour period.
• If your scheduled exam time is very early in the morning (7 a.m. for example), you must fast and not take oral medication.
• If your scheduled exam time is later in the day, you should eat a light, low carb meal and take your oral medications four hours before the test.

Type I Diabetic patients on insulin injections:

• Low carbohydrate diet the day prior to test (your diabetic diet should be appropriate).
• No food four hours prior to the test.
• You may have water only during this four hour period.
• If your scheduled exam time is very early in the morning (7 a.m. for example), you must fast and not take their insulin injection.
• If your scheduled exam time is later in the day, you should eat a light, low carb meal and take half of your insulin injection at least four hours before the test. You should bring the other half of your insulin injection with you to take after the test.

What to expect

A technologist will explain the entire process to you before starting the exam. They will also ask you some health history questions, which will help our radiologist interpret your exam.

The technologist will then check your blood sugar by a small poke at the end of your finger, place an IV and give you an intravenous (IV) injection of our radioactive imaging material.

Following the injection you will be asked to wait in a small room for about an hour before taken in for the scan.

For the scan you will be asked to lay on your back and hold still for about 30 minutes until the exam is complete.

How long will it take?

This entire process will take about two hours.

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

This is a treatment (not a diagnostic test) for thyroid cancer (papillary or follicular).

How to prepare

A radioactive iodine solution will be ordered specifically for your treatment. Your cooperation with the preparation is very important so that the radiologist can perform the treatment in the safest manner possible.

Female patients between the childbearing ages of 12 to 50 years should have a pregnancy test before treatment (unless they have had a prior sterilization procedure).

If you are breastfeeding, you will need to completely stop breastfeeding.

Special written instructions (“Admission Instructions for Thyroid Therapy Patients”) will be faxed to your physician’s office when your exam is scheduled.

If you still have questions, please contact Salem Health’s imaging services appointment desk at 503-814-5293.

What to expect

A radiologist, approved to perform radioactive iodine treatments, will explain the entire process to you before the treatment.

This may be done as an inpatient (staying in the hospital) or outpatient (going home afterward).

If done as an inpatient, a special room will be prepared for your stay.

You may have someone accompany you to the hospital. They can stay with you through the radiologist consultation; however, they must leave before the treatment starts. No visitors are allowed during the remainder of your hospital so that all safety precautions are taken.

After the treatment, written guidelines will be provided to you.

You will need to return to the hospital for whole body images, usually seven to 10 days after the start of your treatment. You will be given written instructions for this appointment as well.

If you have any technical questions about how the treatment is done, please don’t hesitate to ask the technologist at dosing time. All medical questions should be directed to the treating radiologist or your ordering physician.

A report will be sent to your ordering physician.

How long will it take?

In most cases, you will need to be admitted to the hospital under strict radiation isolation conditions. You will be an inpatient for one to three days.

Possible complications or side effects

A radiologist will discuss possible complications or side effects with you before your treatment.

Why would my physician order this procedure?

As a treatment for an overactive thyroid gland, not a diagnostic test.

How to prepare

Your cooperation with the preparation is very important so that the radiologist can perform the treatment in the safest manner possible.

A special order radioactive iodine capsule will be ordered specific for you.

You are allowed to have clear liquids only for three hours before your appointment time.

You must be off the following interfering medications for the defined periods:

• PTU or Tapazol: one week
• Seaweed tablets (kelp): two weeks
• Cytomel or Amiodarone (cardiac med): two weeks
• Synthroid or Levothroid: three weeks
• Desiccated thyroid or L-thyroxine: six weeks

You must not have an exam with contrast in the time intervals below:

• IVP, gallbladder, angiogram, arteriogram or CT: two weeks
• Myelogram with Metrizamide: two weeks
• Myelogram with Pantopaque: two years
• Bronchogram: one year

Female patients between the childbearing ages of 12 to 50 years should have a pregnancy test prior to treatment (unless they have had a prior sterilization procedure).

If you are breastfeeding, you will need to stop.

What to expect

A radiologist approved to perform radioactive iodine treatments will explain the entire process (including radiation safety issues) to you before the treatment.

You will be asked to swallow a radioactive capsule with some water. You will only be allowed clear liquids for another two to three hours.

A report will be sent to your physician.

How long will it take?

You will be in our department about 20 minutes.

Possible complications or side effects

A radiologist will discuss possible complications or side-effects with you before your treatment.

Why would my physician order this procedure?

This procedure helps your physician determine function and morphology (size and shape) of the thyroid gland.

How to prepare

This is a functional test. Your cooperation with the preparation is very important. You must be off the following interfering medications for the defined periods:

• PTU or Tapazol: one week
• Seaweed tablets (kelp) or multiple vitamins that contain iodine: two weeks
• Cytomel or Amiodarone (cardiac medication): two weeks
• Synthroid or Levothroid: three weeks
• Desiccated thyroid or L-thyroxine: six weeks

You must not have an exam with contrast in the time intervals below:

• IVP, gallbladder, angiogram, arteriogram or CT: two weeks
• Myelogram with Metrizamide: two weeks
• Myelogram with Pantopaque: two years
• Bronchogram: one year

You are allowed clear liquids only on the morning of your first day. You can resume your normal diet two hours after you get your radioactive capsule.

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

A technologist will explain the entire process to you before starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

For the first day a technologist will give you a capsule containing a tracer amount of radioactive iodine. You will be instructed not to eat for another four hours.

We will do an uptake test where you will be sitting in a chair while we measure how much of the radioactive iodine your thyroid has taken up (uptake portion of exam). If your thyroid measurement is too low, we will not be able to proceed with the scan portion.

For the images, you will be lying flat on our scanning bed while the camera is rotated to different positions around your neck area. These images will take about another 30 minutes.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

The following day you will need to return at your scheduled time to do another uptake test.

A report will be sent to your physician.

How long will it take?

An uptake and scan is a two-day procedure. For the first day you will probably be in our department for about 20 minutes, return about four hours later for 45 minutes. On day two you will be in the department for about 15 minutes.

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

To assist your physician in the diagnosis of Helicobacter pylori (H. pylori) infection in your stomach.

How to prepare

Your cooperation with the preparation for this test is very important so that the technologist can get accurate results from your test.

You are not allowed anything by mouth for six hours before your appointment time.

You must be off the following medications for the defined times:

• Antibiotics (including any treatment for H. Pylori): 1 month
• Any proton pump inhibitors (omeprazole “Prilosec/Aciphex” or lansoprazole “Prevacid”): 2 weeks
• Any bismuth containing medications (Pepto-Bismol; Bismatrol; Pink Bismuth; Devrom; K-C; or Kaodine): 1 month
• Carafate (Sucralfate): 2 weeks
• Any histamine H2 receptor anatgonists (radnitidine “Zantac”; cimetidine “Tagament”; famotidine “Pepcid”; nizatidine “Axid”) or antacids: 24 hours

What to expect

A technologist will explain the entire process to you before starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

A technologist will give you a pill to swallow with some water. You will then be breathing into two separate bags over the next 15 minutes.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist before the test. All medical questions should be directed to your physician.

This exam is sent off site for interpretation. A report will be sent to your physician within two weeks.

How long will it take?

You will be in our department for about 20 minutes.

Possible complications or side effects

No complications are expected from this procedure.

Why would my physician order this procedure?

To help your physician in the evaluation and follow-up of urinary tract infections (UTIs) and reflux.

How to prepare

There is no special preparation, unless you are a candidate for sedation. The exam is performed by inserting a catheter (tube) through the urethra into the bladder. Some people are more comfortable being sedated while that is happening. Please contact our appointment desk at 503-814-5293 if sedation will be required.

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

An imaging nurse will attempt to contact you a couple of days before your scheduled appointment to explain the procedure.

When you arrive, an imaging nurse will discuss the exam with you. Before starting the exam, an nurse will place a catheter into your bladder.

Depending on your age and physical limitations, you may be standing upright or lying flat while the images are taken. We will start taking images immediately as we fill your bladder and watch it empty.

There might be some discomfort as your bladder fills. This filling process will only last a couple of minutes.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

A report will be sent to your physician.

How long will it take?

Total time in our department will be about one hour. You may need to stay a little longer if you have sedation.

Possible complications or side effects

There is a small risk of a urinary tract infection after catheterization.

The imaging nurse will talk to you about this risk before you leave the appointment.

Why would my physician order this procedure?

To help your physician in the diagnosis of pulmonary embolus (blood clots to your lung) or to assess lung function.

How to prepare

There is no special preparation. A chest X-ray within 24 hours might be required.

To perform this exam, we must give you a small amount of radioactive materials. Tell your doctor if you might be pregnant, if you are pregnant, or if you are nursing.

What to expect

A technologist will explain the entire process to you before starting the exam. He/she will also ask you some health history questions, which will help our radiologist interpret your exam.

The exam will be performed with you lying flat on our imaging bed.

For the ventilation (air supply) portion of the exam you will be asked to breathe into a closed breathing device for about five minutes. You will be breathing in and out a colorless and odorless radioactive gas.

For the perfusion portion you will be asked to lie flat on our scanning bed. A technologist will be giving you an intravenous (IV) injection of a radioactive material that shows us how the blood supply to your lungs is functioning. We will take six more images after the injection.

If you have any technical questions about how the procedure works, please don’t hesitate to ask the technologist at scan time. All medical questions should be directed to your physician.

A report will be sent to your physician.

How long will it take?

The exam takes about 45 minutes.

Possible complications or side effects

No complications are expected from this procedure.