Special Procedures

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Special procedures are mildly invasive procedures and require an order from your physician and may also require pre-authorization from your health insurance provider.  A co-pay and/or deductible may apply.  Please check with your health insurance provider regarding your specific plan benefits.

Most often, these studies involve prior imaging studies related to your diagnosis and/or treatment plan.  We request that you obtain copies, or sign a release for us to obtain copies, of any previous related imaging studies and reports not performed with Vancouver Radiologists for us to use for comparison.    We will do our best to coordinate your appointment to accommodate these requirements.

If one of these special procedures is recommended, you will receive a call from our office to provide additional information, and to answer any questions you may have a day or two before your procedure.

Be sure to tell a member of the health care team if you:                                     

  • are pregnant or think you may be (studies involving radiation and/or MRI)
  • have any known allergies, including previous reaction to x-ray contrast
  • have any known medical conditions such as asthma
  • have any known heart disease such as angina, congestive heart failure, or other heart condition which inhibits your activity
  • have any known kidney disease, failure, transplant, or other kidney surgery
  • have any known liver disease, or bleeding problems
  • take specific blood thinners, or other medications on a routine basis
  • are diabetic, and take metformin /glucophage
  • *are needle phobic or claustrophobic (for MRI)

*Anti-anxiety (mild sedation) medication is available and requires additional observation time post procedure.  Sedation requests require a driver upon discharge.  If you arrive without a driver, your procedure may be rescheduled.

Procedure time from patient check in to exit can vary and is based on the exam ordered as well as the individual.  As always, if you have questions or concerns before or after your procedure, please contact us and ask to speak to one of our Patient Navigators at (360)254-4914.

A member of our health care team will review your clinical history and discuss the procedure with you prior to the examination.  If you have any questions or concerns regarding your exam, please ask your technologist.  The technologist will ensure the images taken are complete and accurate, before you leave the clinic; however please note, the technologist does not interpret the images.

In most cases, when fluid or tissue specimens are obtained during the procedure, they are sent the same day to Legacy Laboratory Services, unless noted otherwise.  Please check with your health insurance provider for benefits.

Our radiologist will review and interpret your images.  Procedure and laboratory results will be communicated to your healthcare provider to discuss with you.  If you have not been contacted with results within 72 hours, please contact your healthcare provider.

Before your appointment:

  • Please plan to arrive 30-45 minutes prior to your procedure time.
  • The day before procedure, you should drink more fluids than usual, such as water, juice, herbal teas to ensure you are well hydrated.
  • You may continue to take your regular pain medications, as needed.
  • If instructed, you may be asked to stop taking some medications before your test.
  • For lumbar punctures/myelograms and all procedures using sedation, patients should not eat solid foods for at least 4 hours prior to the test, but you may sip water or other clear liquids, as needed.
  • If the procedure is for a lower extremity joint, or if sedation is used, please arrange for transportation/driver after the exam.  If you arrive without a driver, the procedure may need to be rescheduled.

General Post-Procedure Care Instructions:

*You will be provided specific discharge instructions based on the procedure performed.  The following information is provided only as general guidelines, and is not all inclusive:

  • For pain and discomfort, you may take a mild non-aspirin medication such as Tylenol or Advil for pain relief; use as directed.
  • Refrain from strenuous activity for the first 24 hours post procedure.
  • Drink plenty of water for at least 24 hours post procedure.  You may resume your normal diet, as long as nausea doesn’t exist.
  • You may resume your normal medications, unless told otherwise.
  • Call your healthcare provider with any signs of infection, abnormal swelling or unrelieved pain.

Arthrogram / Joint Injection

An arthrogram is a procedure using fluoroscopy guidance to insert a needle into the joint space and obtain pictures after the injection of contrast media.  Fluoroscopy is a form of “live x-ray” that enables a radiologist to take images via x-ray.  The contrast media increases the visibility of the joint space, or a specific area of concern, as a radiologist watches on a television screen.  Arthrograms are commonly ordered to evaluate ligament and/or a meniscus tear in shoulder and knee joints.

Arthrograms can be completed alone, or may be performed with a CT or MRI scan following the injection.

When MRI follows an arthrogram injection:  Due to the strong magnetic field, all metallic objects must to be removed prior to exam. We prefer patients leave valuables, including jewelry and/or piercings, at home.  All patients are required to change into scrubs or a gown regardless of the exam scheduled for MRI.

A joint injection may use fluoroscopy, ultrasound, or CT as image guidance to insert a needle into a joint space to administer medication(s) at the request of your physician.  At times, fluids may also be obtained from the joint space and sent to the lab for further evaluation.

After the Procedure:

Expect some post -procedure observation time.  For lower extremities joint(s), use of a wheelchair may be necessary until numbness at the site has reduced, or mobility has returned to normal while at the clinic.

Fine Needle Aspiration / Cyst Aspiration / Core Biopsy

A fine needle aspiration (FNA) or cyst aspiration may be recommended to provide fluid analysis by an off-site laboratory in those situations when the prior imaging studies provided incomplete data due to the presence of symptoms or a suspicious area that requires further evaluation.

With the added availability of a trained cytotechnologist on-site during your FNA procedure, Vancouver Radiologists, P.C. is able to provide a valuable next step to complete your diagnostic imaging work-up with the trust and confidence you have come to rely on.

A core biopsy (CB) may be recommended to provide tissue analysis by an off-site laboratory in those situations when prior imaging studies provided incomplete data due to the presence of symptoms or a suspicious area that requires further evaluation.

Using ultrasound, or other preferred imaging guidance to pinpoint the exact location of the biopsy area, the radiologist will prepare the skin and administer a numbing agent before inserting the biopsy needle through the skin and advancing it into the fluid or lesion to remove multiple samples.  This will be repeated, as necessary.

After the procedure:

Expect some post -procedure observation time.  Because a biopsy involves the cutting of tissue, you may have a small amount of bleeding and/or bruising at the biopsy site.  A small dressing and cold pack may be applied before you leave.

Lumbar Puncture / Myelogram with CT to Follow

A lumbar puncture is a procedure using fluoroscopy guidance to insert a needle into the spinal canal.  Your spinal canal is a tunnel-like structure within the bony spine that holds your spinal cord.  The radiologist will prepare the skin and administer a numbing agent before inserting a needle through the skin.  A small amount of spinal fluid is withdrawn and sent to an off-site laboratory for further testing.  Follow up images may be taken in x-ray.

A myelogram is the same procedure as a lumbar puncture using fluoroscopy guidance to insert a needle into the spinal canal.  The radiologist will prepare the skin and administer a numbing agent before inserting a needle through the skin.  A small amount of spinal fluid may be withdrawn and contrast media is injected through this needle.  Follow up images are taken in x-ray before you are transported to CT for additional images.

After the procedure:

Expect some post -procedure observation time.  It’s important to rest, with your head elevated, after having a lumbar puncture or myelogram procedure.  Although rare, if you experience a spinal headache, lie completely flat, drink increased fluids, take pain relievers, and if tolerated drink one serving of a caffeinated beverage.  In addition to resting at home, you should not drive or operate power equipment for 24 hours post-procedure.  Refrain from strenuous activity such as bending or lifting for 24 hours.

If you have a headache that lasts 2+ days; have unrelieved pain in your back or tingling in your groin/legs; or develop an oral temperature of 101 degrees or higher, please contact your healthcare provider.

Paracentesis

A paracentesis may be recommended to empty fluid that has collected in the abdominal cavity (peritoneal fluid).  Often, fluid collection in the abdominal cavity may be caused by infection, inflammation, an injury, or other conditions such as cirrhosis or cancer.  A sample of the fluid may be sent to an off-site laboratory for additional analysis in those situations where the prior imaging studies provided incomplete data and suggests further evaluation is needed.

Using ultrasound, or other preferred imaging guidance to pinpoint the exact location of the fluid, the radiologist will prepare the skin and administer a numbing agent before inserting a needle through the skin and advancing it into the fluid for removal.  This will be repeated, as necessary.

After the procedure:

Expect some post -procedure observation time.  Because fluid drainage involves the cutting of tissue, you may have a small amount of bleeding and/or bruising at the procedure site.  A small dressing and cold pack may be applied before you leave.