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(Myocardial Infarction)
•
Heart attack
Muscle continues to die for six to eight hours at which time the heart
attack usually is "complete." The dead heart muscle is eventually
replaced by scar tissue.Approximately one million Americans suffer a
heart attack each year. Four hundred thousand of them die as a result of
their heart attack.
Atherosclerosis
Atherosclerosis is a gradual process by which plaques
(collections) of cholesterol are deposited in the walls of arteries.
Cholesterol plaques cause hardening of the arterial walls and
narrowing of the inner channel (lumen) of the artery. Arteries that are
narrowed by atherosclerosis cannot deliver enough blood to maintain
normal function of the parts of the body they supply.
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can begin as early as the teenage years, but symptoms or health
problems usually do not arise until later in adulthood when the arterial
narrowing becomes severe.
Diseases caused by the reduced blood supply to the heart muscle from
coronary atherosclerosis are called coronary heart diseases (CHD).
Coronary heart diseases include heart attacks, sudden unexpected
death, chest pain (angina), abnormal heart rhythms, and heart failure
due to weakening of the heart muscle.
An insufficient supply of oxygen to the heart muscle causes angina. Angina that
occurs with exercise or exertion is called exertional angina. In some patients,
especially diabetics, the progressive decrease in blood flow to the heart may
occur without any pain or with just shortness of breath or unusually early fatigue.
Both resting and nitroglycerin decrease the heart muscle's demand for oxygen,
thus relieving angina. Exertional angina may be the first warning sign of
advanced coronary artery disease. Chest pains that just last a few seconds
rarely are due to coronary artery disease.
Angina also can occur at rest. Angina at rest more commonly indicates
that a coronary artery has narrowed to such a critical degree that the
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heart is not receiving enough oxygen even at rest. Angina at rest
infrequently may be due to spasm of a coronary artery (a condition
called Prinzmetal's or variant angina). Unlike a heart attack, there is no
permanent muscle damage with either exertional or rest angina.
The cause of rupture that leads to the formation of a clot is largely unknown, but
contributing factors may include cigarette smoking or other nicotine exposure,
elevated LDL cholesterol, elevated levels of blood catecholamines (adrenaline),
high blood pressure, and other mechanical and biochemical forces.
Unlike exertional or rest angina, heart muscle dies during a heart attack and loss
of the muscle is permanent, unless blood flow can be promptly restored, usually
within one to six hours.
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While heart attacks can occur at any time, more heart attacks occur
between 4:00 A.M. and 10:00 A.M. because of the higher blood levels
of adrenaline released from the adrenal glands during the morning
hours. Increased adrenaline, as previously discussed, may contribute
to rupture of cholesterol plaques.
• Electrocardiogram.
Blood tests.
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Cardiac enzymes are proteins that are released into the blood by
dying heart muscles. These cardiac enzymes are creatine
phosphokinase (CPK), special sub-fractions of CPK (specifically, the MB
fraction of CPK), and troponin, and their levels can be measured in
blood.
The changes in their levels over time also correlates with the amount
of heart muscle that has died.
Large and active medical centers often have a "chest pain unit" where
patients suspected of having heart attacks are rapidly evaluated. heart
attack is diagnosed, prompt therapy is initiated.
This can save time and reduce damage to the heart. At present, the
accepted best treatment for a heart attack is identification promptly of
the diagnosis, and transport to a hospital that can perform prompt
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catheterization and PTCA or stenting within the first 90 minutes of the
cardiac event.
Research also has shown that inflammation may play a role in the
development of atherosclerosis, and this is an active area of current
investigation.
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Start slow and easy:For the first week or two, exercise at an easy
pace for no more than 10 to 20 minutes at a time.
Cool down – Rapid muscle movement helps pump blood back to the
heart. If you stop exercising abruptly, the heart's blood supply may
drop abruptly.
Do not eat and run – During and after a meal, the body sends extra
blood to the digestive organs, leaving less blood for the heart and
muscles. Try to wait at least two hours after a heavy meal before
exercising.
Watch the weather – Blood vessels in the skin and the limbs
constrict when it is cold outside, making it more difficult for the heart
to pump blood throughout the body.
Working out in hot weather can also threaten the heart, since heavy
sweating decreases the total volume of blood, and in turn, the amount
flowing to the heart muscle.
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SWINE FLU(H1N1)
Swine flu produces most of the same symptoms in pigs as human flu
produces in people. Swine flu can last about one to two weeks in pigs
that survive. Swine influenza virus was first isolated from pigs in 1930
in the U.S. and has been recognized by pork producers and
veterinarians to cause infections in pigs worldwide.
Investigators think the 2009 swine flu strain, first seen in Mexico,
should be termed novel H1N1 flu since it is mainly found infecting
people and exhibits two main surface antigens, H1 (hemagglutinin type
1) and N1 (neuraminidase type1). Recent investigations show the eight
RNA strands from novel H1N1 flu have one strand derived from human
flu strains, two from avian (bird) strains, and five from swine strains.
In 1976, there was an outbreak of swine flu at Fort Dix. This virus is not
the same as the 2009 outbreak, but it was similar insofar as it was an
influenza A virus that had similarities to the swine flu virus. There was
one death at Fort Dix.
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The government decided to produce a vaccine against this virus, but
the vaccine was associated with neurological complications (Guillain-
Barré syndrome) and was discontinued.
Many researchers now consider that two main series of events can
lead to swine flu (and also avian or bird flu) becoming a major cause
for influenza illness in humans.
A human (or bird) influenza virus can infect a pig respiratory cell at
the same time as a swine influenza virus; some of the replicating RNA
strands from the human virus can get mistakenly enclosed inside the
enveloped swine influenza virus. For example, one cell could contain
eight swine flu and eight human flu RNA segments.
The total number of RNA types in one cell would be 16; four swine and
four human flu RNA segments could be incorporated into one particle,
making a viable eight RNA segmented flu virus from the 16 available
segment types.
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It is even possible to include RNA strands from birds, swine, and
human influenza viruses into one virus if a cell becomes infected with
all three types of influenza
For example, two bird flu, three swine flu, and three human flu RNA
segments to produce a viable eight-segment new type of flu viral
genome).
Second, pigs can play a unique role as an intermediary host to new flu
types because pig respiratory cells can be infected directly with bird,
human, and other mammalian flu viruses.
Bird flu viruses, which usually infect the gastrointestinal cells of many
bird species, are shed in bird feces. Pigs can pick these viruses up from
the environment and seem to be the major way that bird flu virus RNA
segments enter the mammalian flu virus population.
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Symptoms of swine flu (H1N1)
In Mexico, many of the patients are young adults, which made some
investigators speculate that a strong immune response may cause
some collateral tissue damage.
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Swine flu in Mexico (as of April 2009) has had about 160 deaths and
about 2,500 confirmed cases, which would correspond to a mortality
rate of about 6%, but these initial data have been revised and the
mortality rate currently in Mexico is estimated to be much lower.
Fortunately, the mortality rate as of October 2009 has been low but
higher than for the conventional flu (average conventional flu mortality
rate is about 36,000 per year; projected novel H1N1 flu mortality rate
is 90,000 per year in the U.S. as determined by the president's
advisory committee).
The test can be negative (no flu infection) or positive for type A and B.
If the test is positive for type B, the flu is not likely to be swine flu
(H1N1). If it is positive for type A, the person could have a conventional
flu strain or swine flu (H1N1).
However, the accuracy of these tests has been challenged, and the
U.S. Centers for Disease Control and Prevention (CDC) has not
completed their comparative studies of these tests.
Because of the large number of novel H1N1 swine flu cases (as of
October 2009, the vast majority of flu cases [about 99%] are due to
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novel H1N1 flu viruses), the CDC recommends only hospitalized
patients' flu virus strains be sent to reference labs to be identified.
This vaccine consists of a live attenuated H1N1 virus and should not
be used in anyone who is pregnant or immunocompromised. The
injectable vaccine, made from killed H1N1, became available in the
second week of October. This vaccine is approved for use in ages 6
months to the elderly, including pregnant females.
Both of these vaccines have been approved by the CDC only after they
had conducted clinical trials to prove that the vaccines were safe and
effective.
Two antiviral agents have been reported to help prevent or reduce the
effects of swine flu. They are zanamivir (Relenza) and oseltamivir
(Tamiflu), both of which are also used to prevent or reduce influenza A
and B symptoms.
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hours or more, although hospitalized patients may still be treated past
the 48-hour guideline.
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6. Take a special care of children because they easily get
infected with the Swine flu. It is okay if you don’t send them to
school for few days. Many schools have even announced holidays.
8. Don’t use the public urinals because many people spit there,
which could lead to the spreading of the disease.
Tuberculosis
Tuberculosis
TB most commonly affects the lungs but also can involve almost any
organ of the body. Many years ago, this disease was referred to as
"consumption" because without effective treatment, these patients
often would waste away. Today, of course, tuberculosis usually can be
treated successfully with antibiotics.
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Anyone can get TB, but certain people are at higher risk, including
symptoms of tuberculosis
Thus, the immune system can make the lung infection inactive
(dormant). On the other hand, if the body's immune system cannot
contain the TB bacteria, the bacteria will reproduce (become active or
reactivate) in the lungs and spread elsewhere in the body.
It may take many months from the time the infection initially gets into
the lungs until symptoms develop. The usual symptoms that occur with
an active TB infection are a generalized tiredness or weakness, weight
loss, fever, and night sweats.
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TB can be diagnosed in several different ways, including chest x-rays,
analysis of sputum, and skin tests. Sometimes, the chest x-rays can
reveal evidence of active tuberculosis pneumonia.
Several types of skin tests are used to screen for TB infection. These
so-called tuberculin skin tests include the Tine test and the Mantoux
test, also known as the PPD (purified protein derivative) test. In each of
these tests, a small amount of purified extract from dead tuberculosis
bacteria is injected under the skin.
If a person is not infected with TB, then no reaction will occur at the
site of the injection (a negative skin test). If a person is infected with
tuberculosis.
however, a raised and reddened area will occur around the site of the
test injection. This reaction, a positive skin test, occurs about 48 to 72
hours after the injection.
The reason for a false negative test with a recent infection is that it
usually takes two to 10 weeks after the time of infection with
tuberculosis before the skin test becomes positive.
The skin test can also be falsely negative if a person's immune system
is weakened or deficient due to another illness such as AIDS or cancer,
or while taking medications that can suppress the immune response,
such as cortisone or anticancer drugs.
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A special test to diagnose TB called the PCR (polymerase chain
reaction) detects the genetic material of the bacteria. This test is
extremely sensitive (it detects minute amounts of the bacteria) and
specific (it detects only the TB bacteria)
The side effects occur infrequently, but a rash can develop, and the
patient can feel tired or irritable. Liver damage from isoniazid is a rare
occurrence and typically reverses once the drug is stopped.
A person with a positive skin test along with an abnormal chest x-ray
and sputum evidencing TB bacteria has active TB and is contagious. As
already mentioned, active TB usually is accompanied by symptoms,
such as a cough, fever, weight loss, and fatigue.
Then the number is usually reduced to two drugs for the remainder of
the treatment based on drug sensitivity testing that is usually available
by this time in the course.
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Streptomycin, a drug that is given by injection, may be used as well,
particularly when the disease is extensive and/or the patients do not
take their oral medications reliably (termed "poor compliance").
Successful treatment of TB is dependent largely on the compliance of
the patient.
drug-resistant TB
. Prevention of Tuberculosis
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identified as soon as possible so that they can be isolated from others
and treated.
Lupus:
Types of lupus
. Sometimes lupus can cause disease of the skin, heart, lungs, kidneys,
joints, and/or nervous system. When only the skin is involved, the
condition is called lupus dermatitis or cutaneous lupus erythematosus.
A form of lupus dermatitis that can be isolated to the skin, without
internal disease, is called discoid lupus. When internal organs are
involved, the condition is referred to as systemic lupus erythematosus
(SLE).
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Both discoid and systemic lupus are more common in women than
men (about eight times more common). The disease can affect all ages
but most commonly begins from 20 to 45 years of age. Statistics
demonstrate that lupus is somewhat more frequent in African
Americans and people of Chinese and Japanese descent.
CAUSES OF LUPUS:
The precise reason for the abnormal autoimmunity that causes lupus is
not known. Inherited genes, viruses, ultraviolet light, and certain
medications may all play some role.
It also is known that some women with SLE can experience worsening
of their symptoms prior to their menstrual periods. This phenomenon,
together with the female predominance of SLE, suggest that female
hormones play an important role in the expression of SLE. This
hormonal relationship is an active area of ongoing study by scientists.
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and the heart (pericarditis), and poor circulation to the fingers
and toes with cold exposure (Raynaud's phenomenon).
Complications of organ involvement can lead to further
symptoms that depend on the organ affected and severity of the
disease.
Over half of the patients with SLE develop a characteristic red, flat
facial rash over the bridge of their nose. Because of its shape, it is
frequently referred to as the "butterfly rash" of SLE. The rash is
painless and does not itch. The facial rash, along with inflammation in
other organs, can be precipitated or worsened by exposure to sunlight,
a condition called photosensitivity. This photosensitivity can be
accompanied by worsening of inflammation throughout the body,
called a "flare" of the disease.
Most patients with SLE will develop arthritis during the course of their
illness. Arthritis in SLE commonly involves swelling, pain, stiffness, and
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even deformity of the small joints of the hands, wrists, and feet.
Sometimes, the arthritis of SLE can mimic that of rheumatoid arthritis
(another autoimmune disease).
Kidney inflammation in SLE can cause leakage of protein into the urine,
fluid retention, high blood pressure, and even kidney failure. This can
lead to further fatigue and swelling of the legs and feet. With kidney
failure, machines are needed to cleanse the blood of accumulated
poisons in a process called dialysis.
Many patients with SLE experience hair loss (alopecia). Often, this
occurs simultaneously with an increase in the activity of their disease.
The hair loss can be patchy or diffuse and appear to be more like hair
thinning.
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Some patients with SLE have Raynaud's phenomenon. In these
patients, the blood supply to the fingers and/or toes becomes
compromised upon exposure to cold, causing blanching, whitish and/or
bluish discoloration, and pain and numbness in the exposed fingers
and toes.
Since patients with SLE can have a wide variety of symptoms and
different combinations of organ involvement, no single test establishes
the diagnosis of systemic lupus. To help doctors improve the accuracy
of the diagnosis of SLE, 11 criteria were established by the American
Rheumatism Association. These 11 criteria are closely related to the
symptoms discussed above. Some patients suspected of having SLE
may never develop enough criteria for a definite diagnosis. Other
patients accumulate enough criteria only after months or years of
observation. When a person has four or more of these criteria, the
diagnosis of SLE is strongly suggested. Nevertheless, the diagnosis of
SLE may be made in some settings in patients with only a few of these
classical criteria, and treatment may sometimes be instituted at this
stage. Of these patients with minimal criteria, some may later develop
other criteria, but many never do.
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• brain irritation (manifested by seizures [convulsions] and/or
psychosis),
Patients with SLE need more rest during periods of active disease.
Researchers have reported that poor sleep quality was a significant
factor in developing fatigue in patients with SLE. These reports
emphasize the importance for patients and physicians to address sleep
quality and the effect of underlying depression, lack of exercise, and
self-care coping strategies on overall health. During these periods,
carefully prescribed exercise is still important to maintain muscle tone
and range of motion in the joints.
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and sulindac (Clinoril). Since the individual response to NSAIDs varies
among patients, it is common for a doctor to try different NSAIDs to
find the most effective one with the fewest side effects. The most
common side effects are stomach upset, abdominal pain, ulcers, and
even ulcer bleeding. NSAIDs are usually taken with food to reduce side
effects. Sometimes, medications that prevent ulcers while taking
NSAIDs, such as misoprostol (Cytotec), are given simultaneously.
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For resistant skin disease, other antimalarial drugs, such as
chloroquine (Aralen) or quinacrine, are considered and can be used in
combination with hydroxychloroquine. Alternative medications for skin
disease include dapsone and retinoic acid (Retin-A). Retin-A is often
effective for an uncommon wart-like form of lupus skin disease. For
more severe skin disease, immunosuppressive medications are
considered as described below.
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Most recent research is indicating benefits of rituximab (Rituxan) in
treating lupus. Rituximab is an intravenously infused antibody that
suppresses a particular white blood cell, the B cell, by decreasing their
number in the circulation.
B cells have been found to play a central role in lupus activity, and
when they are suppressed, the disease tends toward remission. This
may particularly helpful for patients with kidney disease
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CT SCAN:
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CT scanning combines special x-ray equipment with sophisticated
computers to produce multiple images or pictures of the inside of the
body. These cross-sectional images of the area being studied can then
be examined on a computer monitor or printed.
CT scans of internal organs, bone, soft tissue and blood vessels provide
greater clarity and reveal more details than regular x-ray exams.
CT imaging is:
one of the best and fastest tools for studying the chest, abdomen
and pelvis because it provides detailed, cross-sectional views of
all types of tissue.
often the preferred method for diagnosing many different
cancers, including lung, liver and pancreatic cancer, since the
image allows a physician to confirm the presence of a tumor and
measure its size, precise location and the extent of the tumor's
involvement with other nearby tissue.
an examination that plays a significant role in the detection,
diagnosis and treatment of vascular diseases that can lead to
stroke, kidney failure or even death. CT is commonly used to
assess for pulmonary embolism (a blood clot in the lung vessels)
as well as for abdominal aortic aneurysms (AAA).
invaluable in diagnosing and treating spinal problems and
injuries to the hands, feet and other skeletal structures because
it can clearly show even very small bones as well as surrounding
tissues such as muscle and blood vessels.
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guide biopsies and other procedures such as abscess drainages
and minimally invasive tumor treatments.
plan for and assess the results of surgery, such as organ
transplants or gastric bypass.
stage, plan and properly administer radiation treatments for
tumors as well as monitor response to chemotherapy.
measure bone mineral density for the detection of osteoporosis.
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CAT scan: liver
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CT imaging is sometimes compared to looking into a loaf of bread by
cutting the loaf into thin slices. When the image slices are reassembled
by computer software, the result is a very detailed multidimensional
view of the body's interior.
Modern CT scanners are so fast that they can scan through large
sections of the body in just a few seconds. Such speed is beneficial for
all patients but especially children, the elderly and critically ill.
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Next, the table will move quickly through the scanner to determine the
correct starting position for the scans. Then, the table will move slowly
through the machine as the actual CT scanning is performed.
You may be asked to hold your breath during the scanning. Any
motion, whether breathing or body movements, can lead to artifacts
on the images. This is similar to the blurring seen on a photograph
taken of a moving object.
When the examination is completed, you will be asked to wait until the
technologist verifies that the images are of high enough quality for
accurate interpretation.
CT exams are generally painless, fast and easy. With helical CT, the
amount of time that the patient needs to lie still is reduced.
If the contrast material is swallowed, you may find the taste mildly
unpleasant;
however, most patients can easily tolerate it. You can expect to
experience a sense of abdominal fullness and an increasing need to
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expel the liquid if your contrast material is given by enema. In this
case, be patient, as the mild discomfort will not last long.
When you enter the CT scanner, special lights may be used to ensure
that you are properly positioned. With modern CT scanners, you will
hear only slight buzzing, clicking and whirring sounds as the CT
scanner revolves around you during the imaging process.
You will be alone in the exam room during the CT scan. However, the
technologist will be able to see, hear and speak with you at all times.
With pediatric patients, a parent may be allowed in the room but will
be required to wear a lead apron to prevent radiation exposure.
USES OF CT SCAN:
CT scans are used to study areas of the body and the arms or legs.
Chest (thorax).
A CT scan of the chest can look for problems with the lungs, heart,
esophagus, the major blood vessel (aorta), or the tissues in the center of
the chest.
Some common chest problems a CT scan may find include infection, lung
cancer, a pulmonary embolism, and an aneurysm. It also can be used to
see if cancer has spread into the chest from another area of the body.
Abdomen.
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A CT scan of the abdomen can find cysts, abscesses, infection, tumors, an
aneurysm, enlarged lymph nodes, foreign objects, bleeding in the belly,
diverticulitis, inflammatory bowel disease, and appendicitis.
Urinary tract.
Liver
A CT scan can find liver tumors, bleeding from the liver, and liver
diseases. A CT scan of the liver can help determine the cause of jaundice.
Pancreas.
A CT scan can be used to check for blockage of the bile ducts. Gallstones
occasionally show up on a CT scan. But other tests, such as ultrasound,
usually are used to find problems with the gallbladder and bile ducts.
Adrenal glands
Spleen.
A CT scan can be used to check for an injury to the spleen or the size of
the spleen.
Pelvis
A CT scan can look for problems of organs in the pelvis. For a woman,
these include the uterus, ovaries, and fallopian tubes. For a man, the
pelvic organs include the prostate gland and the seminal vesicles.
Arm or leg
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A CT scan can look for problems of the arms or legs, including the
shoulder, elbow, wrist, hand, hip, knee, ankle, or foot.
Benefits vs Risks:
Benefits:
CT scanning is painless, noninvasive and accurate.
A major advantage of CT is its ability to image bone, soft tissue
and blood vessels all at the same time.
Unlike conventional x-rays, CT scanning provides very detailed
images of many types of tissue as well as the lungs, bones, and
blood vessels.
CT examinations are fast and simple; in emergency cases, they
can reveal internal injuries and bleeding quickly enough to help
save lives.
CT has been shown to be a cost-effective imaging tool for a wide
range of clinical problems.
CT is less sensitive to patient movement than MRI.
CT can be performed if you have an implanted medical device of
any kind, unlike MRI.
CT imaging provides real-time imaging, making it a good tool for
guiding minimally invasive procedures such as needle biopsies
and needle aspirations of many areas of the body, particularly
the lungs, abdomen, pelvis and bones.
A diagnosis determined by CT scanning may eliminate the need
for exploratory surgery and surgical biopsy.
No radiation remains in a patient's body after a CT examination.
X-rays used in CT scans usually have no side effects.
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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 effective radiation dose from this procedure ranges from
approximately two to 10 mSv, which is about the same as the
average person receives from background radiation in three to
five years. See the Safety page for more information about
radiation dose.
Women should always inform their physician and x-ray or CT
technologist if there is any possibility that they are pregnant.
See the Safety page for more information about pregnancy and
x-rays.
CT scanning is, in general, not recommended for pregnant
women unless medically necessary because of potential risk to
the baby.
Nursing mothers should wait for 24 hours after contrast material
injection before resuming breast-feeding.
The risk of serious allergic reaction to contrast materials that
contain iodine is extremely rare, and radiology departments are
well-equipped to deal with them.
Because children are more sensitive to radiation, they should
have a CT study only if it is essential for making a diagnosis and
should not have repeated CT studies unless absolutely
necessary.
A person who is very large may not fit into the opening of a
conventional CT scanner or may be over the weight limit for the
moving table.
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