What are X-rays?
X-rays are electro-magnetic radiation, which are produced by special machines called X-ray machines. These cannot be seen, felt or heard.

How do X-rays work?
Different parts of the body behave differently with X-rays. Structures such as bone absorb X-rays, whereas air in the lungs lets all X-rays pass through. Thus, when X-rays pass through the body, when they come out, they have different strengths, depending on what parts of the body they have passed through. When these X-rays hit a film (like a photographic film), that film gets exposed depending upon this variation. Like a photographic film, this special film also needs to be developed, before we can see the final picture.

Where are X-rays useful?
X-rays have been used to look at all parts of the body. Specifically, they are required for the chest, all bones and joints and for the abdomen.

Are there any dangers?
Since, X-rays involve radiation, there is a theoretical risk, though none in practice. In women who are pregnant, X-rays should be performed only after weighing all risks and benefits.

What are the dyes used with X-rays?
Sometimes, artifical dyes are used to improve our ability to see internal structures. These usually form part of a "procedure". The common dyes used are either barium containing (barium sulphate) or iodine containing. Barium sulphate is used for all barium examinations to study the stomach and intestines. Iodine containing dyes are usually injected in the veins to study the kidneys, during mammography, etc.

Are there any complications of the dye?
Five % of patients may get nausea and redness of skin. Though severe reactions are known, these are very rare and uncommon. However, in patients having a previous history of allergy, those who are asthmatics, those with renal and cardiac failure, a special dye which is more expensive, but safer should be used, to prevent a reaction.

Who is qualified to report X-rays?
Only radiologists are trained to read X-rays and all X-rays should carry a radiologist's report. Other physicians and non-radiology centres may also perform X-rays, but they are usually not qualified. Before going for an X-ray, ask the centre, whether it will be done under the radiologist's supervision.

Are there any newer advances in X-rays?
X-rays are used in CT scanning (computed tomography). Digital radiography uses X-rays for directly producing images on a computer, bypassing the film - this is very helpful in emergency situations, such as the trauma centre or intensive care unit.

What are Digital X-rays?
All images obtained using digital systems are digital x-rays. The commonest digital method used is the CR system that produces digital X-rays on a computer. See the accompanying picture for an idea of how this works.

What are the advantages of Digital X-rays
Digital X-rays are superior to conventional X-rays in resolution and quality.

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What are Full Length Digital X-rays?
Full-length radiographs are important radiographs in orthopedics, where x-rays of the whole spine or the entire lower limbs are obtained. These are mainly indicated for measurements of length and angles and important prior to some types of surgeries.

Why are Full Length X-rays such a big deal?
Traditionally, it has been difficult to obtain full-length radiographs in our part of the world on a regular basis - many of us have tried local, ingenious methods of getting those three or two radiographs and taping them together.With the digital x-ray technology, we are now able to "stitch" multiple radiographs to obtain full-length images, which are then printed on one film. Two representative examples are given alongside.

Q1. How is it performed?
A. The echocardiogram will be performed and recorded by a specially trained cardiologist. It usually takes approximately one-half hour. Since the transducer must be placed directly on the chest wall or upper abdomen, you will be asked to disrobe from the waist up.

You'll be asked to lie down and small adhesive patches will be attached to your body to record your electrocardiogram. The electrocardiogram is useful for timing of the heart cycle. Your physician may request that an echocardiogram be performed simultaneously with an exercise test. This procedure will be thoroughly explained by the physician or Cardiologist.

At times during the test you may be asked to hold your breath, change position or refrain from talking in order to get a better picture. The Cardiologist  will tell you if this is necessary.

Q2. Is it dangerous?
A. Ultrasound cannot be felt and does not hurt. There are no known harmful or proven side effects from ultrasound. If you are pregnant during the time an echocardiogram is performed there is no known danger to either mother or baby from this procedure.

Q3. What are the procedures involved that one should know about beforehand?
A. To improve the quality of the picture, a harmless, odorless and water-soluble gel is applied to the area of your skin where the transducer will be placed. This may feel cool and a bit moist, but the gel will be wiped off thoroughly after the examination.

During the procedure you might feel a slight pressure and/or vibrations from the transducer. This should not be painful. Tell the Cardiologist if you become uncomfortable. The room lights will be dimmed to reduce any glare and to better see the monitor.

Q4. What happens after the procedure?
A. Although the Cardiologist who is performing this test may explain what is being seen on the screen as the examination is in progress, it is essential to obtain precise measurements from the paper and videotape recordings. If you have had previous echocardiograms, the new ones will be compared with those and the cardiologist will analyze any differences.

Your doctor will review with you the results and final diagnosis.

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Q1. What is Bone Densitometry?
A. Bone Densitometry (BMD) is currently accepted as being a quick, simple, painless examination that is currently the most sensitive screening tool used to detect bone loss in early stages of osteoporosis. It also is the least expensive and most cost effective method for this type of examination.

Q2. Is there any radiation involved?
A. BMD uses an extremely small amount of X-rays (less than 1/10 that used for a chest X-ray) to measure the thickness or density of your bones. The exam takes less than 15 minutes.

Q3. How does it work?
A. Bone Densitometry is a tool used to predict the possibility of a fracture. The resulting measurements of your bone density are compared to what is expected of someone your age, sex, size and ethnic background. It is also compared to what is estimated to be bone density of a young healthy adult of the same sex.
The information allows your doctor to determine if you have osteoporosis and the likelihood of a fracture happening. The best course of treatment can then be determined.
The ability of BMD to predict fractures is undisputed. It is similar to blood pressure predicting strokes and is more effective than using cholesterol to predict heart disease.
What is the procedure involved in the examination?
A DXA scan involves laying on a couch for approximately 10 minutes while a tiny X-ray detector scans your spine, your hip or both. The scan itself is safe and painless.

Q4. Who is at Risk?
A. In India, 1 in 6 women over 50 years old will break their femur (hip), while 1 in 4 will suffer severe fractures in one or more bones.
The death rate from osteoporosis-related fractures is greater than deaths caused by breast and ovarian cancer combined!

Some authorities believe you may be at risk for osteoporosis if you have one or more of the following:

• Family history of osteoporosis
• Early menopause either natural or surgical
• Amenorrhea (lack of periods) particularly in young woman
• Anti-seizure medicine for many years
• Hyperthyroidism or hyperparathyroidism
• Cushing's syndrome
• Kidney failure colitis
• Stomach or intestinal surgery
• High intake of alcohol, coffee, tea or soft drinks
• Heavy smoking
• Low dietary intake of calcium
• European or Asian ancestry

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Q1. What is Color Doppler?
A. Color Doppler is a special ultrasound technique, which allows us to evaluate blood vessels.

Q2. What is the principle?
A. Using the Doppler principle of changing pitch with velocity, ultrasound waves that reflect from the red blood corpuscles in arteries and veins are evaluated for velocity and amplitude and color maps of the vessels can be generated.
Is special equipment required?
An ultrasound machine equipped with color Doppler facilities is required. These are now readily available at many centers.

Q3. What is its utility?
A. Color Doppler is very useful in evaluating the carotid arteries in the neck, the heart (echocardiography), the arteries and veins in the abdomen and the arteries and veins in the upper and lower limbs.

Q4. What is power Doppler?
A. It is a type of color Doppler.

Q5. Is any special preparation required?
A. No

Q6. What is the cost?
A. The cost varies from type to type depending on the kind of Colour Doppler being done.

Q7. Who is qualified to perform color Doppler?
A. A qualified radiologist is the only one who should perform color Doppler examinations.
However, Cardiac Color Dopplers are performed by qualified cardiologists.

Q8. What are the contraindications in Color Doppler?
A. There are no contraindications for color Doppler but like all other forms of cardiac ultrasound, technically poor studies may be obtained in patients with chronic lung disease or obesity. Additionally, the registration of color Doppler decreases in the far field and flow abnormalities may not be obvious in areas distant to the transducer.

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Q1. Is Fasting required for routine investigations?
A. Yes fasting is required for most of the routine hematology and biochemical investigations unless specified otherwise by the doctor.

Q2. When can I get the report?
A. 90% of reports can be given on the same day evening and certain specialized investigations can be done in a day or two.

Q3. Do you use disposable collection device?
A. Yes, for every patient fresh blood collection device is used which is then disposed with due precautions.

Q4. Do you offer home visit for blood collection?
A. Yes, with prior notice, we send technicians for home visits within vicinity of our  centres.

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Q1. Is it uncomfortable? Is it dangerous?
A. The test itself is completely painless. You will be asked to lie quietly on the CT scanner's "patient couch" during the study. Depending on the type of study being done, you may be injected with, or be asked to drink, contrast material.
Because contrast agents contain iodine, which causes an allergic reaction in some individuals, be sure to tell the technologist, nurse or radiologist if you have had an allergic reaction to these agents before, or if you have any other allergies.
CT scanners use x-rays. For your safety, the amount of radiation is kept to an absolute minimum and our equipment is kept in top shape. Because x-rays can harm a developing foetus, however, be sure to tell your doctor if you are, or think you may be, pregnant before preparing for the CT exam. Even if you haven't told your doctor, be certain to tell the CT scan technologist who prepares you for the study.

Q2. How is a CT Scan done?
A. The technologist will bring you into the CT scan room where you will lie down on the patient couch (usually on your back). You should get comfortable because it is very important that you not move during the test. CT examinations differ depending on your medical problem and the part of your body being studied. The radiologist will plan an examination that is best suited for you.
For example, if your abdomen is being studied, a series of pictures will be taken from your lower chest down to the upper pelvis. During such a study, you will be asked to hold your breath so that the pictures will not be blurred. The machine will make some noise, and the couch may move slightly after each picture. Also, you may receive signals from the technologists (or from the machine) about your breathing. As part of your test, before or during the study, you may be given an injection (by a nurse, technologist or doctor) of a contrast agent. This allows the radiologist to obtain clearer images of your organs. Should you have any discomfort during the test or after the injection, tell the technologist. All the CT personnel are trained and certified and know how to help you.

Q3. What happens after the scan?
A. Once the CT staffs are sure that enough information has been collected, you may leave and go about your normal activities without restriction.

Q4. When do I get the results?
A.Our radiologists who specialize in this type of imaging will review your exam. Reports will be made available online.

Q5. What the patient should tell the doctor:
A. The patient should volunteer information to the radiologist if he has ailments like asthma, heart or kidney disorders, history of allergy, diabetes, or a previous reaction to contrast media. It is most important for the radiologist to have this information so that he can choose a contrast medium most suitable to the patient.

Q6. What if I have other questions?
A. If you have any questions about your CT scan, please ask any of our personnel (physicians, nurses, technologists, receptionists). We will try our best to explain the procedure clearly and to make your visit to the CT suite as comfortable and speedy as possible.

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Why is it called Ultra-Fast CT?
A regular CT has tube rotation speed of 1 or .75 seconds. This CT has tube rotation speed of 330ms, i.e. approximately 3 rotations per second. This allows extremely fast scans of the body, such that routine chest and abdomen sequences can be completed in 3-5 seconds. That is why it is called Ultra-Fast CT.

How does cardiac CT work?
With such a fast scanner, it is possible to "freeze" the heart. The new 64-slice scanner obtains almost 194 slices per second. After gating with the ECG, it is possible to scan the heart in 10-12 seconds and to extract information about the coronary arteries and cardiac function from the dataset.

What preparation is involved?
4 hours fasting before the procedure
Stabilization of heart rate with a beta-blocker
Getting all old cardiac related information.

What does the procedure involve?
Once the heart rate is stabilized
A vein is cannulatedo Breathing instructions are given so that the patient can hold his/her breath for around 12 seconds
A calcium scoring study is performed
The "dye" is injected and the angiogram study is performed
The angiogram time is 10-12 seconds. The entire procedure takes between 15-60 minutes depending on the heart rate.

What are the various parts of the study?
The following 3 parameters are studied

• Calcium scoring
• Coronary artery assessment
• Functional assessment (wall motion and ejection fraction)

What are the indications?
Patients at high risk for developing coronary artery disease (high triglycerides, family history, smoking)
Follow-up of known mild to moderate untreated disease
Post-bypass assessment

Are there any dangers of CT scanning?
Though X-rays involve radiation, there are no dangers, in practice. In women who are pregnant, however, CT scanning should be done after weighing all the risks and benefits.

What is the injection that I will receive?
The majority of patients will be injected with a "dye" which enhances the ability of CT scans to pick up abnormalities. This is routine. Only a non-ionic dye (the safest) is used.

Are there any complications of the "DYE"?
0.5% of patients may get nausea and redness of the skin. Though severe reactions are known, these are very rare and uncommon.

Q1. What is mammography?
A. Mammography is x-rays of the breasts so as to enable one to detect early breast cancer.

How is it performed?
It is similar to taking X-rays of the chest or any other X-rays. However, a special dedicated machine with a special X-ray tube is required for doing mammography. There are compression paddles which compress the breast and then X-rays are taken. Usually, two views of each breast are performed, with a total of four X-ray films per patient.

Why should it be done?
Mammography is performed for screening for breast cancer. Also, in patients with lumps in the breast, mammography helps in the diagnosis of the lump, i.e. whether it is benign or malignant. In simple words, it helps to know whether it is cancer or not.
If I have no complaints relating to the breast, should mammography be done?
Yes. The most important role of mammography is for screening normal women for early breast cancer. Breast cancer can be picked up by mammography much before it develops into a palpable lump.

How does it do that?
There are early signs of breast cancer like microcalcifications and small densities which can be seen on mammography much earlier than when it forms a mass which can be felt.

When should mammography be performed?
The American Cancer Society suggests that between 40 - 49 years, mammography should be performed every 1-2 years. At and over 50 years of age, mammography should be performed yearly.

Is there any preparation required for mammography?
No. You can just do it at any time. No preparation or fasting is required. Please do not use any powders or deodorants on the breasts or arm-pits prior to this procedure as these give rise to artefacts on X-Rays.

Who will be doing it on me?
Only trained women personnel will be performing it. Not only will they be understanding and compassionate while performing it, but also they can counsel you on regular Breast Self-Examination if you have not understood it with the other pamphlets provided.

Who will be interpreting these mammograms?
The interpretation will be done by qualified radiologists with specialised training in mammography. Also, the doctor will be available for any queries on the subject and please do not hesitate to clear any doubts that you may have.

Q2. Does mammography itself cause breast cancer because of radiation?
A. The radiation exposure with mammography is very less. Also if the pros and cons of mammography are weighed, the pros outweigh the cons by far. The radiation effect on the breasts decreases exponentially after 35 years of age. The only precaution to be taken is that the patient should be sure that she is not pregnant.

Q3. Does the procedure of mammography cause pain?
A. With newer equipment very little discomfort is felt by the patient. The patient should preferably come after the period is over, as the likelihood of pain will be the least. However there will be no changes in the findings on mammography during any stage of the menstrual cycle.

Q4. What is sonomammography? Why do mammography when everything is seen on sonomammography?
A. Sonomammography is sonography of the breasts. It is usually done as a complementary procedure to mammography. It helps in distinguishing a cystic mass from a solid mass. Cysts are usually benign. Mammography is required as the earliest of cancers are seen only on this modality.

Q5. Can one definitely tell whether a mass is benign or malignant?
A. It is not possible to tell 100% whether a mass is benign or malignant on either mammography or sonography. To be 100% sure, a biopsy is required. Sonography and mammography, both together are 95% accurate in diagnosing a lesion.


Q6. If a close relative has breast cancer, what are the chances of a person getting it?
A. The chances are 5-15% if it is a first degree relative particularly on the maternal side. The person is at a high risk & should start doing mammography 10-15 years earlier than the age at which the relative got breast cancer.

Q7. How does breast cancer usually present itself?
A. Breast cancer usually presents itself as a lump. Therefore a patient should regularly do a monthly self-breast examination particularly after the period is over. Sometimes there might be a bloody nipple discharge. Occasionally in 10% of the patients, there is associated pain.

Does breast cancer occur in men also?
Yes. 1% of all breast cancers do occur in males. But since the incidence is quite low, they need not do screening mammography. However, if a lump occurs in the breast region of a man, mammography can be performed.

What is Breast Self-Examination?
Breast Self-Examination or BSE is palpation of the breast by women with their own fingers to look-out for lumps.

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Q1. What is an MRI scan?
A. "MRI," which stands for "Magnetic Resonance Imaging," uses a powerful magnet and precisely programmed radio signals to "see" inside the body, beyond what an x-ray can see. MRI shows normal anatomic structures (brain, organs, blood vessels, etc.) as well as structural or chemical alteration of tissue by disease. With MRI, it is often possible to diagnose disease at a very early stage, before it is visible by other means. Because most diseases are better treated when found early, MRI scans are becoming increasingly useful.

Q2. Is it uncomfortable? Is it dangerous?
A. MRI is completely painless and safe for most people. However, MRI cannot be performed in a few cases on certain individuals, such as those who have cardiac pacemakers or certain other metal implants. If you have had any surgical implants, please discuss this with your doctor. With technological advances though, today most surgical implants are MRI compatible so one need not worry about the same.

Q3. How long does it take?
A. An MRI scan typically takes from 30 to 60 minutes to complete. However the time differs depending on the type of MRI being done.

Q4. What happens on the day of the scan?
A. Plan to arrive at the MRI suite at least 15 minutes before your scheduled appointment. This will allow time to prepare the necessary paperwork. You will be asked to fill out a brief questionnaire about your medical history, medications, and allergies.
An MRI technologist will introduce herself/himself to you, explain the test you have having, and answer your questions. You will be asked to change into a gown and to remove any metal objects (belt buckle, watch).

Q5. What happens during the scan?
A. In the MRI suite you will be asked to lie on a narrow, movable table that will gradually slide you through the circular bore of a large, doughnut-shaped magnet. You should get comfortable because it is very important that you not move during the scan.
MRI procedures differ depending on your medical problem and the part of your body being studied. The radiologist plans an examination that is best suited for you. For example, if we are studying your abdomen, we will examine from your lower chest down to the upper pelvis, producing several series of images. During such a study, expect the machine to make loud noises, the tables to move occasionally, and the technologist to instruct you about your breathing.
In some cases, in order to enhance the MRI images and to visualize diseased tissues, the doctor will request the injection of an MR contrast agent, which is injected intravenously. Side effects are rare.
Anyone who has had recent surgery with surgical staples needs to be able to communicate with the technologists to tell us if there are any burning sensations. Anyone with a reprogrammable shunt must have the shunt reprogrammed after the MRI. And anyone with the possibility of having metal in their eyes (for example, one who does metal work as a career may have tiny bits of metal in the eyes that can be affected by the MRI), should have an ORBITS (x-ray of the eye) to rule out foreign bodies.
Remember, each examination is tailored to individual requirements. Additional pictures are usually taken after the first series is completed.

Q6. What happens after the scan?
A. Once enough information has been collected, you can leave and go about your normal activities without restriction.

Q7. How do I get the results?
A. Radiologists who specialize in this type of imaging will review your exam. You will then be asked to collect your report online.

Q8. Any questions?
A. If you have any questions about your MRI scan, please ask any of our personnel including doctors, nurses, or technologists. We will try our best to explain the procedure clearly and to make your visit to the MRI suite as comfortable and speedy as possible.

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Q1. How significant is the radiation in an X-ray?
A. The average amount of exposure to an X-ray is very low and is well within the acceptable amount recommended.

Q2. What does one do if an X-ray is required during pregnancy?
A. The X-ray technician should be informed and he should cover the lower abdomen with a lead apron. In case one's pregnancy status is unknown, it is still a good idea to ask for protective cover.

What are barium studies?
These are studies of the gastro-intestinal performed using barium sulphate and x-rays.

Why are there different types of barium studies?
Depending on the area being examined, we have barium swallow, meal, meal-follow-through, enema and small bowel enema.

What are these?
Barium swallow is a study for the esophagus, barium meal for the stomach, barium meal follow-through for the small bowel, barium enema for the large bowel and small bowel enema for the small bowel. In swallow, meal and meal-follow-through examinations, the patient has to drink barium. In barium enema examinations, barium is injected using an enema tube. In small bowel enema examinations (enteroclysis), a tube is inserted from the nose to the duodenum and barium is injected.

How do barium examinations work?
Barium is an inert substance that coats the internal lining of the bowel and fills up its lumen. It is radio-opaque and thus seen very well on x-rays.

Is there any danger?
Barium by itself is an inert substance and completely harmless. However if it escapes into the abdominal or thoracic cavity through a perforation, it can cause severe inflammation. Thus barium studies should not be done in patients with suspected perforation.

What preparation is required?
For barium swallow, none. For barium meal, at least six hours fasting. For barium meal follow-through, overnight fasting with Dulcolax tablets for clearing the bowel. For small bowel and barium enema, overnight fasting with liquid diet the day before and aggressive clearing of the bowel with Dulcolax tablets the night before and in the morning.

Q3. Isn't barium awful to taste?
A. No it is pleasantly flavoured.

Q4. How long does a barium test take to perform?
A. An upper G.I. series takes 30 minutes.
A full study takes 3-4 hours.

Q5. In these days of hi-tech investigations, are X-rays getting redundant?
A. No, X-rays are a very cost effective means of diagnosis, particularly where diseases of chest, bones & joints are concerned.

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1. Fat content in various common foods
2. Calorific values of some indian/continental/fast foods
3. High protein foods
4. Dietary sources rich in calcium
5. Foods high in cholesterol
6. Foods to avoid for gout trouble (high uric acid levels)

Fat content in various common foods

Calorific values of some Indian / Continental /Fast foods

High Protein Foods

Dietary sources rich in calcium

Foods high in Cholesterol

Foods to avoid for gout trouble (high uric acid levels)

• Organ meats
• Other meat and meat products
• Poultry and sea foods mainly fish
• Dried peas
• Beans and whole pulses
• Lentils (masoor)
• Mushrooms
• Spinach
• Cashew nuts and peanuts
• Alcohol
• Sweet bread and cheese