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Beyond the X-Ray: Radiology and The Use of Imaging Guidance For Tissue Sampling

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This posting provides additional information regarding some of the interventional procedures that radiologists perform. Specifically, this discussion is on tissue sampling, which refers to various procedures that are performed under image guidance to obtain bodily fluids or tissue (e.g., bone, muscle, etc.) for analysis. Percutaneous needle biopsies and aspirations, sinus tract aspiration/injections, arthrograms and joint aspirations/injections are performed with imaging guidance. There are of course precautions with any invasive procedure and these are some things to keep in mind when undergoing tissue sampling.

Allergies

If you have any allergies, especially to medications, contrast agents, local anesthesia, Betadine soap, or latex, be sure to inform your physician at the time of scheduling the procedure. Also be sure to inform the x-ray technologist and radiologist before the start of the procedure.

Laboratory Tests

Blood tests may be ordered within two weeks of the procedure in order to evaluate your blood count and to check your clotting profile. If you are taking a blood thinner (anti-coagulant medication) such as Coumadin, Heparin or Lovenox, be sure to inform your doctor when the radiographic examination is scheduled so that arrangements can be made to stop the medications before the procedure (for Coumadin this may be as long as 2 or 3 days). Aspirin and nonsteroidal anti-inflammatory medication may also need to be stopped at least 2 days prior to the procedure. Your physician should be contacted before stopping any prescribed medication.

Pregnancy
If you are pregnant or think that you might be pregnant, be sure to inform your physician, the technologist, and the radiologist prior to the procedure. Most procedures/examinations using x-rays will not be performed on pregnant women unless the benefits of the procedure/examination are felt to outweigh the risks of radiation exposure to the fetus. Procedures utilizing ultrasound can be performed safely during pregnancy.

Any time a needle penetrates the skin, there are risks. The major risks associated with these procedures are as follows:

Infection
Any time a needle is placed through the skin, there is a risk of introducing bacteria that can cause infection. Sterile technique and sterile equipment are used to minimize the possibility of introducing infection and the risk of infection is very low.

Contrast Reaction

The risk of contrast reaction is extremely low. Contrast reactions include itching, hives, and in some cases cardiac and respiratory failure.

Soreness

Discomfort at the needle puncture site is not unusual and usually lasts no more than a few hours.

Bleeding
Bleeding may occur at the site of needle placement and result in soft tissue swelling and/or a black and blue appearance. Bleeding at the biopsy or aspiration site may produce compression of nearby structures such as nerves or blood vessels.

Fracture
This is a very uncommon complication of bone biopsies but may occur, especially in bones that are weakened by an underlying disease process.

What happens with the results?

A board certified radiologist will generate a written report which will be sent to the doctor who referred you for the examination. This report becomes part of your medical record. If fluid or tissue is removed, it will be sent to the laboratory for analysis which will be sent to your referring physician.

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