Chest X-ray (Chest Radiography)
- What is a Chest X-ray (Chest Radiography)?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How does the procedure work?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of Chest Radiography?
What is a Chest X-ray (Chest Radiography)?
The chest x-ray is the most commonly performed diagnostic x-ray examination. A chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of the spine and chest.
An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.
What are some common uses of the procedure?
The chest x-ray is performed to evaluate the lungs, heart and chest wall.
A chest x-ray is typically the first imaging test used to help diagnose symptoms such as:
- shortness of breath.
- a bad or persistent cough.
- chest pain or injury.
- fever.
Physicians use the examination to help diagnose or monitor treatment for conditions such as:
How should I prepare?
A chest x-ray requires no special preparation.
You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, dentures, eye glasses and any metal objects or clothing that might interfere with the x-ray images.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays.
What does the equipment look like?
The equipment typically used for chest x-rays consists of a wall-mounted, box-like apparatus containing the x-ray film or a specialplate that records the image digitally and an x-ray producing tube, that is usually positioned about six feet away.
The equipment may also be arranged with the x-ray tube suspended over a table on which the patient lies. A drawer under the table holds the x-ray film or digital recording plate.
A portable x-ray machine is a compact apparatus that can be taken to the patient in a hospital bed or the emergency room. The x-ray tube is connected to a flexible arm that is extended over the patient while an x-ray film holder or image recording plate is placed beneath the patient.
How does the procedure work?
X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.
Different parts of the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black.
On a chest x-ray, the ribs and spine will absorb much of the radiation and appear white or light gray on the image. Lung tissue absorbs little radiation and will appear dark on the image.
Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.
How is the procedure performed?
Typically, two views of the chest are taken, one from the back and the other from the side of the body as the patient stands against the image recording plate. The technologist, an individual specially trained to perform radiology examinations, will position the patient with hands on hips and chest pressed against the image plate. For the second view, the patient's side is against the image plate with arms elevated.
Patients who cannot stand may be positioned lying down on a table for chest x-rays.
You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. Thetechnologist will walk behind a wall or into the next room to activate the x-ray machine.
When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained.
The chest x-ray examination is usually completed within 15 minutes.
Additional views may be required within hours, days or months to evaluate any changes in the chest.
What will I experience during and after the procedure?
A chest x-ray examination itself is a painless procedure.
You may experience discomfort from the cool temperature in the examination room and the coldness of the recording plate. Individuals with arthritis or injuries to the chest wall, shoulders or arms may have discomfort trying to stay still during the examination. The technologist will assist you in finding the most comfortable position possible that still ensures diagnostic image quality.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.
The results of a chest x-ray can be available almost immediately for review by your physician.
What are the benefits vs. risks?
Benefits
- No radiation remains in a patient's body after an x-ray examination.
- X-rays usually have no side effects in the diagnostic range.
- X-ray equipment is relatively inexpensive and widely available in emergency rooms, physician offices, ambulatory care centers, nursing homes and other locations, making it convenient for both patients and physicians.
- Because x-ray imaging is fast and easy, it is particularly useful in emergency diagnosis and treatment.
Risks
- There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
- The chest x-ray is one of the lowest radiation exposure medical examinations performed today. The effective radiation dose from this procedure is about 0.1 mSv, which is about the same as the average person receives from background radiation in 10 days. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about radiation dose.
- Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays.
A Word About Minimizing Radiation Exposure
Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the technique standards used by radiology professionals.
State-of-the-art x-ray systems have tightly controlled x-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.
What are the limitations of Chest Radiography?
The chest x-ray is a very useful examination, but it has limitations. Because some conditions of the chest cannot be detected on a conventional chest x-ray image, this examination cannot necessarily rule out all problems in the chest. For example, small cancers may not show up on a chest x-ray. A blood clot in the lungs, a condition called apulmonary embolism, cannot be seen on chest x-rays.
Further imaging studies may be necessary to clarify the results of a chest x-ray or to look for abnormalities not visible on the chest x-ray.
Chest Interventions
- What are Chest Interventions?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of thoracentesis?
What are Chest Interventions?
Chest interventions are minimally invasive procedures used to diagnose and treat pleural effusions, a condition in which there is excess fluid in the pleural space, also called the pleural cavity. This space exists between the outside of the lungs and the inside of the chest wall.
A pleural effusion is caused by several conditions including infection, inflammation, heart failure or cancer. Excess fluid in the pleural space can make it difficult to breathe.
Chest interventions include:
- thoracentesis, in which excess fluid in the pleural space is removed by a needle attached to a syringe and a sample of the fluid is analyzed under a microscope.
- pleurodesis, in which a medication is injected into the pleural space to shrink the cavity and minimize the amount of fluid that can collect there.
- pleural biopsy, in which tissue samples are removed from the pleural membrane, the layer of tissue that lines the outside of the lungs and inside of the chest wall, with a hollow needle and analyzed under a microscope.
What are some common uses of the procedure?
Thoracentesis is performed to:
- relieve pressure on the lungs
- treat symptoms such as shortness of breath and pain
- determine the cause of excess fluid in the pleural space.
Pleurodesis is performed to prevent the collection of pleural fluid following thoracentesis.
A pleural biopsy is performed when the cause for excess fluid in the pleural space cannot be determined by thoracentesis. The tissue sample removed from the pleural membrane during a biopsy is further analyzed for evidence of:
- tuberculosis
- cancer cells
- the presence of viral, fungal or parasitic disease.
How should I prepare?
Prior to your procedure, your blood may be tested to determine how well your liver and kidneys are functioning and whether your blood clots normally.
You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications,general anesthesia or to contrast materials (also known as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or a blood thinner for a specified period of time before your procedure.
Also inform your doctor about recent illnesses or other medical conditions.
You should tell your physician if you have:
- bleeding problems or take blood thinners, such as aspirin, Lovenox® or Coumadin®
- had lung surgery
- lung disease, such as emphysema.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays.
You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.
You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images.
You may want to have a relative or friend accompany you and drive you home afterward.
What does the equipment look like?
These procedures are typically performed with ultrasound guidance. Occasionally, CT-guidance will be used.
Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body and blood vessels. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.
The ultrasound image is immediately visible on a nearby video display screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer and the type of body structure the sound travels through.
The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination.
A biopsy needle is generally several inches long and the barrel is about as wide as a large paper clip. The needle is hollow so it can capture the tissue specimen.
One of two instruments will be used:
- A fine needle attached to a syringe or bottle, about the same size as needles used to draw blood.
- A core needle, also called an automatic, spring-loaded needle, which consists of an inner needle connected to a trough, or shallow receptacle, covered by a sheath and attached to a spring-loaded mechanism.
How is the procedure performed?
All chest interventions:
A chest x-ray may be performed before the procedure.
This procedure is often done on an outpatient basis. However, some procedures may require admission. Please consult with your physician.
You will be positioned on the edge of a chair or bed with your head and arms resting on an examining table.
Your physician will numb the area with a local anesthetic.
The area of your body where the needle is to be inserted will be shaved, sterilized and covered with a surgical drape.
Thoracentesis:
The needle is inserted through the skin between two ribs on your back. When the needle reaches the pleural space between the chest wall and lung, the pleural fluid is removed through a syringe.
Thoracentesis is usually completed within 15 minutes.
Pleurodesis:
A pleurodesis procedure is performed following a thoracentesis, usually through a chest tube placed at the time of the thoracentesis.
A medication such as doxycycline is injected into the pleural space, which triggers an inflammatory reaction on the pleural membrane that lines the outside of the lung and the inside of the chest wall. This causes the membranes to stick together, eliminating or reducing the space where excess fluid can collect.
Pleurodesis adds one hour to a thoracentesis procedure.
Pleural Biopsy:
Following the same preparation used for a thorcentesis procedure, a hollow needle is placed through the skin on your back and into the chest cavity. When the needle reaches the chest wall, up to three samples of tissue are removed.
Tissue samples will then be removed using one of two methods.
- In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.
- In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with ‘cores' of pleural tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated three to six times.
A pleural biopsy is usually completed within 30 minutes.
At the end of the procedure, the needle will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed.
A chest x-ray is performed after chest interventions to detect any complications.
What will I experience during and after the procedure?
You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected.
You will be asked to remain still during the procedure and not to cough or breathe deeply in order to avoid injury to the lung.
You may feel pressure when the needle is inserted into the pleural space.
Thoracentesis:
When the pleural fluid is removed, you may feel a pulling sensation or pressure in your chest. Tell your doctor or nurse if you feel faint or if you have any shortness of breath, chest pain or the need to cough.
Pleurodesis:
The procedure is started the same as a thoracentesis. You will feel more pressure when the chest tube is inserted. Some patients may experience chest pain during and after the introduction of the medication. You will be given pain medicine for this.
Pleural biopsy:
As tissue samples are taken, you may hear clicks. You may also experience a tugging sensation.
You should avoid strenuous activity for 24 hours after returning home, but then usually will be able to resume normal activities.
Who interprets the results and how do I get them?
The interventional radiologist or physician treating you will determine the results of the procedure and will send a report to your referring physician, who will share the results with you.
What are the benefits vs. risks?
Benefits
- Thoracentesis is generally a safe procedure.
- No surgical incision is needed.
Risks
- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
- Complications may include:
- pneumothorax or a partial collapse of the lung caused by the needle puncturing the lung allowing air to flow into the pleural space.
- pulmonary edema, which may occur if a large amount of fluid is removed.
- infection and bleeding.
- breathing difficulty.
What are the limitations of thoracentesis?
Chest interventions may not be performed on patients who have an uncorrectablebleeding disorder.
The accuracy of a thoracentesis may be affected by a patient's:
- use of antibiotics.
- inability to remain still.
Percutaneous Abscess Drainage
- What is Percutaneous Abscess Drainage?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
What is Percutaneous Abscess Drainage?
An abscess is an infected collection of fluid in the body. In general, people who have an abscess will experience fever, chills and pain in the approximate location of the area that is involved. If a patient has these symptoms, it is not uncommon that they will undergo an x-ray test (usually a CT scan) or an ultrasound exam, to assist in making the correct diagnosis. Once the diagnosis of an abscess has been made, an assessment is made by your physician and an interventional radiologist to decide which therapy is appropriate. As long as it is deemed safe, percutaneous abscess drainage, a minimally invasive therapy, can be used to help abscess treatment.
In percutaneous abscess drainage, physicians use imaging guidance to place a thin needle to remove or drain infected fluid (abscess) from an area of the body such as the chest, abdomen or pelvis.
During the procedure, an interventional radiologist places a thin needle into the fluid using imaging guidance such as computed tomography (CT) scanning. Usually, a drainage tube is left in place to drain the abscess fluid. Occasionally, abscesses that cannot be safely treated by percutaneous drainage may require more extensive surgical drainage in the operating room.
What are some common uses of the procedure?
Percutaneous abscess drainage is generally used to remove infected fluid from the body, most commonly in the abdomen and pelvis. The abscess may be a result of recent surgery or secondary to an infection such as appendicitis. Less commonly, percutaneous abscess drainage may be used in the chest or elsewhere in the body.
How should I prepare?
Patients who undergo percutaneous abscess drainage fall into two general categories:
- those who are hospitalized, frequently recovering from surgery.
- those who are not hospitalized and have symptoms as described above. In these cases, you may be admitted to the hospital on the day of your procedure.
You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications,general anesthesia or to contrast materials (also known as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or a blood thinner for a specified period of time before your procedure.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays.
You may be instructed to not eat or drink anything for several hours before your procedure.
You will be given a gown to wear during the procedure.
You should plan to stay overnight at the hospital following your procedure.
What does the equipment look like?
A catheter is a long, thin plastic tube, about as thick as a strand of spaghetti.
Percutaneous abscess drainage is typically performed with the guidance of CT, ultrasound or x-ray fluoroscopic imaging.
CT
The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination.
Ultrasound
Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body and blood vessels. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.
The ultrasound image is immediately visible on a nearby video display screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer and the type of body structure the sound travels through.
X-ray
The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts x-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured either electronically or on film.
Other equipment that may be used during the procedure includes an intravenous line (IV) and equipment that monitors your heart beat and blood pressure.
How is the procedure performed?
Image-guided, minimally invasive procedures such as percutaneous abscess drainage are most often performed by a specially trained interventional radiologist in aninterventional radiology suite or under CT guidance in a separate area of the radiology department.
You will be positioned on the examining table.
You will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously.
Your physician will numb the area with a local anesthetic.
The area of your body where the catheter is to be inserted will be shaved, sterilized and covered with a surgical drape.
A very small nick is made in the skin at the site.
Using image-guidance, a catheter (a long, thin, hollow plastic tube) is inserted through the skin and manipulated to the site of the abscess to allow for drainage of the infected fluid.
Your intravenous line will be removed.
This procedure is usually completed in 20 minutes to an hour.
If needed, the catheter may be connected to a drainage bag outside of your body. The tube will remain in place until the fluid has stopped draining and your infection is gone. It may take several days to drain the abscess.
What will I experience during and after the procedure?
Devices to monitor your heart rate and blood pressure will be attached to your body.
You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected.
If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
You may feel slight pressure when the catheter is inserted but no serious discomfort.
You will remain in the recovery room until you are completely awake and ready to be moved to your hospital bed.
In general, patients who undergo percutaneous abscess drainage will remain hospitalized for a few days. Further follow up is usually done on an outpatient basis and you will be seen by your interventional radiologist at regular intervals to ensure that the healing process is proceeding according to plan. Once you have recovered and your interventional radiologist is satisfied that healing is complete, the catheter will be removed.
Who interprets the results and how do I get them?
The interventional radiologist can advise you as to whether the procedure was a technical success when it is completed.
What are the benefits vs. risks?
Benefits
- No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.
- The procedure is minimally invasive and the recovery period is usually faster than after open surgical drainage.
Risks
- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
- There is a very slight risk of an allergic reaction if contrast material is injected.
- Very rarely, an adjacent organ may be damaged by percutaneous abscess drainage.
- Occasionally bleeding may occur. This can typically be treated by minimally invasive techniques, if necessary.
- The catheter placed at the time of percutaneous abscess drainage may become blocked or displaced requiring manipulation or changing of the catheter. In addition, a very large or complex fluid collection may require more than one abscess drain.
Needle Biopsy of Lung Nodules
- What is Needle Biopsy of Lung (Chest) Nodules?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How does the procedure work?
- How is the procedure performed?
- What will I experience during and after procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of Needle Biopsy of Lung Nodules?
What is Needle Biopsy of Lung (Chest) Nodules?
A lung nodule is relatively round lesion, or area of abnormal tissue located within the lung. Lung nodules are most often detected on a chest x-ray and do not typically cause pain or other symptoms.
Nodules or abnormalities in the body are often detected by imaging examinations. However, it is not always possible to tell from these imaging tests whether a nodule isbenign (non-cancerous) or cancerous.
A needle biopsy, also called a needle aspiration, involves removing some cells—either surgically or in a less invasive procedure involving a hollow needle—from a suspicious area within the body and examining them under a microscope to determine a diagnosis.
In a needle biopsy of lung nodules, imaging techniques such as computed tomography (CT) and fluoroscopy are often used to help guide the interventional radiologist's instruments to the site of the abnormal growth.
What are some common uses of the procedure?
Although more than half of single (called solitary) nodules within the chest are determined to be benign, these lesions are considered potentially malignant until proven otherwise, usually through a needle biopsy.
When a nodule is detected, imaging tests may be performed to help determine if it isbenign (non-cancerous) or malignant (cancerous). If imaging studies cannot clearly define the abnormality, a biopsy may be necessary.
When a physician orders a needle biopsy, the nodule is usually believed to be unreachable by other diagnostic techniques, such as bronchoscopy.
How should I prepare?
You may be instructed not eat or drink for eight hours before your biopsy. However, you may take your routine medications with sips of water. If you are diabetic and take insulin, you should talk to your doctor as your usual insulin dose may need to be adjusted.
Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anesthesia. Your physician may advise you to stop taking aspirin or a blood thinner three days before your procedure.
Also, inform your doctor about recent illnesses and other medical conditions.
You may be asked to wear a gown during the procedure.
Women should always inform their physician if there is any possibility that they are pregnant. Some procedures using image-guidance are typically not performed during pregnancy because radiation can be harmful to the fetus. See the Safety Page (www.RadiologyInfo.org/safety/) for more information on pregnancy and x-rays.
You may want to have a relative or friend accompany you and drive you home afterward. This is recommended if you have been sedated.
What does the equipment look like?
A biopsy needle is generally several inches long and the barrel is about as wide as a large paper clip. The needle is hollow so it can capture the tissue specimen.
One of two instruments will be used:
- A fine needle attached to a syringe, smaller than needles typically used to draw blood.
- A core needle, also called an automatic, spring-loaded needle, which consists of an inner needle connected to a trough, or shallow receptacle, covered by a sheath and attached to a spring-loaded mechanism.
Needle biopsies are often performed with the guidance of computed tomography (CT),fluoroscopy or ultrasound.
CT
The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination.
Fluoroscopy
The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts x-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured either electronically or on film.
Ultrasound
Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body and blood vessels. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.
The ultrasound image is immediately visible on a nearby video display screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer and the type of body structure the sound travels through.
How does the procedure work?
Using imaging guidance, the physician inserts the needle through the skin, advances it into the lesion.
Tissue samples will then be removed using one of two methods.
- In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.
- In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with 'cores' of tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated three to six times.
How is the procedure performed?
Imaging-guided, minimally invasive procedures such needle biopsy of lung nodules are most often performed by a specially trained interventional radiologist.
Needle biopsies are usually done on an outpatient basis.
A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedation or relaxation medication may be given intravenously during the procedure. You may be also given a mild sedative prior to the biopsy.
A local anesthesia will be injected to numb the path of the needle.
If the procedure is being performed with fluoroscopy, you will lie down or stand for the procedure.
If the procedure is performed with CT, you will lie down during the procedure. A limited CT scan will be performed to confirm the location of the nodule and the safest approach. Once the location of the nodule is confirmed, the entry site is marked on the skin. The skin around the insertion site will be scrubbed and disinfected, and a clean and sterile drape will be applied.
For nodules that are small and deep within the lung, or located near blood vessels, airways or nerves, CT allows better planning of the needle path for a safe biopsy.
CT-guided biopsies require patients to be able to hold still on the CT table for up to 30 minutes. Fluoroscopy and ultrasound allow real-time monitoring of the needle and are often easier for patients who have difficulty holding their breath.
A very small nick is made in the skin at the site where the biopsy needle is to be inserted.
Using imaging guidance, the physician will insert the needle through the skin, advance it to the site of the nodule and remove samples of tissue. Several specimens may be needed for complete analysis.
After the sampling, the needle will be removed.
Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed.
You will be taken to an observation area for several hours. X-ray(s) or other imaging tests may be performed to monitor for complications.
This procedure is usually completed within one hour.
What will I experience during the procedure?
When you receive the local anesthetic to numb the skin, you will feel a slight pin prick from the needle. You may feel some pressure when the biopsy needle is inserted.The area will become numb within a short time.
You may be given a mild sedative prior to the biopsy, and in addition, sedation or relaxation medication may be given intravenously during the procedure if needed.
You will be asked to remain still and not to cough during the procedure. You also will be asked to hold your breath multiple times during the biopsy. It is important that you try to maintain the same breath-hold each time to insure proper needle placement.
Aftercare instructions vary, but generally your bandage may be removed one day following the procedure and you may bathe or shower as normal.
You should not exert yourself physically (such as heavy lifting, extensive stair climbing, sports, etc.) the night of and for one full day following your biopsy. On the second day, if you feel up to it, you may return to your normal activities. If you are considering air travel soon after the biopsy, consult your radiologist.
You may experience some soreness at the biopsy site as the local anesthesia fades, but this should improve. You may also cough up a little blood, but this should be minimal. These symptoms will gradually fade over the 12 to 48 hours following the procedure.
Signs of a collapsed lung, which sometimes occurs following a needle biopsy of the chest, include shortness of breath, difficulty in catching your breath, rapid pulse (heart rate), sharp chest or shoulder pain with breathing, and/or blueness of the skin. If you experience any of these symptoms, go to the nearest Emergency Room and contact your physician as soon as possible.
Who interprets the results and how do I get them?
A pathologist examines the removed specimen and makes a final diagnosis so that treatment planning can begin. Depending on the facility, the radiologist or your referring physician will disclose the results to you.
What are the benefits vs. risks?
Benefits
- Needle biopsy is a reliable method of obtaining tissue samples that can help diagnose whether a nodule is benign (non-cancerous) or malignant.
- A needle biopsy is less invasive than open and closed surgical biopsies, both of which involve a larger incision in the skin and local or general anesthesia.
- Generally, the procedure is not painful and the results are as accurate as when a tissue sample is removed surgically.
- Recovery time is brief and patients can soon resume their usual activities.
Risks
- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
- Bleeding.
- Coughing up blood (hemoptysis).
- An air leak from the punctured lung into the chest cavity that causes the lung to collapse (pneumothorax). If a collapsed lung should occur and is large enough to be considered harmful, a small tube may be inserted into the chest cavity to drain away the air. This tube is generally removed the next day.
- Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays.
- This procedure may involve exposure to x-rays. However, radiation risk is not a major concern when compared to the benefits of the procedure. See the Safety page(www.RadiologyInfo.org/en/safety/) for more information about radiation dose from interventional procedures.
What are the limitations of Needle Biopsy of Lung Nodules?
In a small number of cases, the tissue obtained during a biopsy may not be adequate for diagnosis.
Needle biopsy is not cost-effective for small lesions one to two millimeters in diameter. Nodules this small cannot provide enough tissue for an accurate diagnosis and are also too difficult to target with a needle.
For patients with certain conditions associated with emphysema, lung cysts, blood coagulation disorder of any type, insufficient blood oxygenation, pulmonary hypertension, and certain heart failure conditions, a needle biopsy may not be recommended. In these situations, your physician and the physician performing the biopsy will work together to help decide the best course of treatment.
Alternatives to lung biopsy usually include continued follow-up with imaging and surgical removal of the abnormality.
Radiofrequency Ablation of Lung Tumors
- What is Radiofrequency Ablation of Lung Tumors?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How does the procedure work?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
- What are the limitations of Radiofrequency Ablation of Lung Tumors?
What is Radiofrequency Ablation of Lung Tumors?
Radiofrequency ablation, sometimes referred to as RFA, is a minimally invasive treatment for cancer. It is an image-guided technique that heats and destroys cancer cells.
In radiofrequency ablation, imaging techniques such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) are used to help guide a needle electrode into a cancerous tumor. High-frequency electrical currents are then passed through the electrode, creating heat that destroys the abnormal cells.
What are some common uses of the procedure?
Radiofrequency ablation is used to treat early-stage lung cancer.
Radiofrequency ablation is a viable and effective treatment option if you:
- wish to avoid conventional surgery.
- are too ill to undergo surgery.
- have a small number of metastases in your lungs. These are tumors that have spread from a cancer located elsewhere in your body, such as the kidney, intestine or breast.
- have a large tumor that is too large to be removed surgically.
RFA is also used to:
- reduce the size of a tumor so that it can be more easily eliminated bychemotherapy or radiation therapy.
- provide relief when a tumor invades the chest wall and causes pain.
RFA is not intended to replace surgery, radiation therapy or chemotherapy in all patients. It may be effective when used alone or in conjunction with these treatments.
How should I prepare?
You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications,general anesthesia or to contrast materials (also known as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or a blood thinner for a specified period of time before your procedure.
Prior to your procedure, your blood may be tested to determine how well your liver and kidneys are functioning and whether your blood clots normally.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays.
You may be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning.
You should plan to have a relative or friend drive you home after your procedure.
You may be asked to wear a gown during the procedure.
What does the equipment look like?
In this procedure, computed tomography (CT) imaging,needle electrodes, an electrical generator and grounding pads are used.
There are two types of needle electrodes: simple straight needles and a straight, hollow needle that contains several retractable electrodes that extend when needed.
The radiofrequency generator produces electrical currents in the range of radiofrequency waves. It is connected by insulated wires to the needle electrodes and to grounding pads that are placed on the patient's back or thigh.
The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination.
Other equipment that may be used during the procedure includes an intravenous line (IV) and equipment that monitors your heart beat and blood pressure.
How does the procedure work?
Radiofrequency ablation works by passing electrical currents in the range of radiofrequency waves between the needle electrode and the grounding pads placed on the patient's skin. These currents create heat around the electrode, which when directed into the tumor, heats and destroys the cancer cells. At the same time, heat from radiofrequency energy closes small blood vessels and lessens the risk of bleeding. The dead tumor cells are gradually replaced by scar tissue that shrinks over time.
Ultrasound, computed tomography or magnetic resonance imaging may be used to help the physician guide the needle electrode into the tumor.
How is the procedure performed?
Image-guided, minimally invasive procedures such as radiofrequency ablation are most often performed by a specially trained interventional radiologist in an interventional radiology suite or occasionally in the operating room.
Radiofrequency ablation is often done on an outpatient basis.
You will be positioned on the examining table.
You will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedation medication can be given intravenously.
Your physician will use CT scanning to precisely locate the tumor. Your skin will be marked at the proper chest wall site.
The area where the electrodes are to be inserted will be sterilized and covered with a surgical drape.
Your physician will numb the area with a local anesthetic.
A very small nick is made in the skin at the site.
Radiofrequency ablation is performed using one of three methods:
- Surgically.
- Percutaneous, in which needle electrodes are inserted through the skin and into the site of the tumor.
- Thoracoscopic, in which needle electrodes within a thin, plastic tube is threaded through a small hole in the skin in a procedure called a thoracoscopy.
Using imaging-guidance, your physician will insert the needle electrode through the skin and advance it to the site of the tumor.
Once the needle electrode is in place, radiofrequency energy is applied. For a large tumor, it may be necessary to do multiple ablations by repositioning the needle electrode into different parts of the tumor to ensure no tumor tissue is left behind.
At the end of the procedure, the needle electrode will be removed and pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed.
Your intravenous line will be removed.
A chest x-ray will be taken to make sure that the lung has not collapsed from an air pocket created during the procedure. If a collapse has occurred, it may be necessary to insert a small tube into the area to remove the air pocket. The tube may need to remain in place for one to several days.
Each radiofrequency ablation takes about 10 to 30 minutes, with additional time required if multiple ablations are performed. The entire procedure is usually completed within one to three hours.
What will I experience during and after the procedure?
Devices to monitor your heart rate and blood pressure will be attached to your body.
You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected.
If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
Pain immediately following radiofrequency ablation can be controlled by pain medication given through your IV or by injection. Afterward any mild discomfort you experience can be controlled by oral pain medications. Patients may feel nauseous, but this can also be relieved by medication.
You will have a chest x-ray approximately two hours after the procedure to check for a lung collapse. This occurs in approximately 30% of patients, but only one in 10 patients will need to have a tube inserted in the space between the collapsed lung and the chest wall to remove the air and allow the lung to re-expand. If such a tube is placed, you may or may not need to stay in the hospital for further management. Many patients can go home with this small tube and have it removed within one or two days.
You will remain in the recovery room until you are completely awake and ready to return home.
You should be able to resume your usual activities within a few days.
Only about ten percent of patients will still have pain a week following radiofrequency ablation.
Who interprets the results and how do I get them?
Computed tomography (CT) or magnetic resonance imaging (MRI) of the lung is performed within a few hours to a week following radiofrequency ablation. A radiologistwill interpret these CT or MRI scans to detect any complications and to ensure that all of the tumor tissue has been destroyed.
What are the benefits vs. risks?
Benefits
- Radiofrequency ablation (RFA) is much less invasive than open surgery when treating primary or metastatic lung tumors. Side effects and complications are less frequent and less serious when RFA is carried out.
- Patients who have multiple tumors or tumors in both lungs usually are not considered to be candidates for surgery. They may, however, be candidates for RFA.
- Lung function is better preserved after RFA than after surgical removal of a tumor. This is especially important for those whose ability to breathe is impaired, such as current or former cigarette smokers.
- When part of the tumor persists after RFA, the procedure may be repeated, or radiation therapy may eliminate the remaining tumor cells. RFA very effectively destroys the central part of a tumor—the area that tends not to respond well to radiotherapy.
- If a tumor recurs in the same region, it usually can be retreated by RFA. The procedure may be repeated multiple times if necessary.
- Even when RFA does not remove all of a tumor, a reduction in the total amount of tumor may extend life for a significant time.
- It takes much less time to recover from RFA than it does from conventional surgery.
- RFA is a relatively quick procedure and recovery is rapid so that chemotherapy may be resumed almost immediately in patients who need it.
- Radiofrequency ablation is less expensive than other treatment options.
- No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.
Risks
- It is not uncommon for passage of the radiofrequency electrode to produce a condition called pneumothorax. This occurs when a collection of air or gas in the chest cavity collapses part of the lung. Usually no treatment is needed, but some patients may have a chest tube placed for up to a few days to drain the air.
- Significant bleeding into the lung is an uncommon complication of radiofrequency ablation (RFA).
- Fluid may collect in the space between the lung and its covering membrane. If the patient becomes short of breath, the fluid will have to be removed using a needle.
- Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays.
- This procedure may involve exposure to x-rays. However, radiation risk is not a major concern when compared to the benefits of the procedure. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about radiation dose from interventional procedures.
- Severe pain after RFA is uncommon, but may last a few days and require a narcotic to provide relief.
- Though rare, an occasional patient with certain types of underlying lung disease may become worse after RFA, and in severe cases this may be fatal.
- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
What are the limitations of Radiofrequency Ablation of Lung Tumors?
Radiofrequency ablation (RFA) may not be practical if the tumor being treated is close to a critical organ such as the central airways, blood vessels, or heart. Large lung tumors and those that are difficult to reach may require repeated RFA treatments.
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