What We Do

The Department of Radiology at Hackensack University Medical Center provides a comprehensive array of diagnostic and therapeutic imaging services for both inpatients and outpatients. All imaging procedures are performed using state-of-the-art equipment that is subject to stringent regulatory standards. The healthcare professionals who administer and interpret these procedures are committed to obtaining the most accurate diagnostic information possible

• Imaging Services
   
• Interventional Radiology/Special Procedures
   
• Pediatric Accomodations
   
• Scheduling Appointments
   
• Receiving Results / Billing Procedure
   
• Picture Archives Communication Systems (PACS)
   
• Radiation Safety
   
• Educational Resources/Web Links

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Imaging Services

• Magnetic Resonance Imaging (MRI)
   
• Computed Tomography (CT)
   
• Nuclear Medicine (NM)

Positron Emission Tomography (PET/CT)

Nuclear Cardiology

                      General Nuclear Medicine 

• Ultrasound (US)
   
• General Radiology

Plain X-Ray / IVP

  GI Series / Barium Enema

• Special Procedures/Interventional Radiology 

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Magnetic Resonance Imaging (MRI)

Description: Magnetic Resonance Imaging (MRI or MR) utilizes magnetic fields instead of radiation to take highly detailed pictures of the body. The images are obtained by surrounding the area of study with a magnet, which causes the water molecules inside the body to move. A computer picks up the movements and converts them into pictures. The images can be displayed on a computer screen, stored within the computer, or transferred to film. The medical center has two high-field strength magnets, which are scanners that fully surround the body so that optimal images are obtained.

What To Expect During an MRI Scan:

• You will lie on a table that glides into the MRI scanner.
• While the scan is in progress, you will hear banging noises that are caused by the changing magnetic fields.
• For your comfort, you will be offered earplugs to block the noise or headphones if you want to listen to music during your scan. Eye masks are also available.
• The two-way microphone and speakers inside the MRI machine allow you and the technologist to speak to each other during the scan.
• An MRI takes 30 to 45 minutes or longer, depending on the area of the body being scanned.

Patient Preparations for an MRI: There are several precautions that are needed before you enter a strong magnetic field:

• You will be asked several questions regarding your medical history because the magnet may affect certain types of medical devices, such as a pacemaker or surgical clips.
• No metal may be brought into the MRI room, so it is very important that you do not wear any type of pins or hair clips. You must remove your watch and all other jewelry. Also, credit cards must not be brought into the room because the scanner will damage the magnetic strip.

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Computed Tomography (CT)

Description: A CT scanner obtains detailed, cross-sectional X-ray images of very specific areas of your body. The scanner is a round, donut-shaped machine that is open in the middle.

What To Expect During a CT Scan:

• You will lie on a table that glides into the opening of the scanner.
• You will hear humming and swooshing noises as the pictures are taken.
• CT scans sometimes require the use of contrast, either intravenously or by mouth, to enhance blood vessels and organs and highlight the area being imaged. If the contrast material is to be administered intravenously, a catheter tube is inserted into an arm vein, and you can expect to feel a warm, flushing sensation that lasts one to two minutes as the contrast enters your body.
• A CT takes 10 to 15 minutes, depending on the area of the body being scanned.

Patient Preparations for a CT Scan: Intravenous contrast is sometimes administered for CT scans.

• If contrast is required, you will be required to fast for two (2) hours before your CT scan. (No food or liquids should be taken during this time, and your physician will advise you about taking medications during the fasting period.)
• If your abdomen or pelvis is being scanned, you will need to drink a flavored liquid that coats the stomach to allow for better visualization of these organs. If this is the case, you will be asked to come to the medical center prior to your test date to pick up two bottles of this liquid. You must drink the first one three hours before your procedure, half of the second bottle one hour beforehand, and the remaining contents at some point during the procedure.
• Once your CT scan is completed you may resume your normal diet, but it will be necessary to increase the amount of fluids you drink for several hours so that the contrast material is flushed from your system. You may resume normal activity immediately following this procedure.
• Persons with diabetes who are taking metformin (some of the brand names include Glucophage®, Glucovance®, or Metaglip®) must STOP the medication on the day of the exam and 48 hours after receiving intravenous contrast. The combination of the drug with the contrast material that is used for CT scans could cause serious side effects. Be certain to discuss this with your physician.

Nuclear Medicine (NM)

• Positron Emission Tomography (PET/CT)
   
• Nuclear Cardiology
   
• General Nuclear Medicine

Positron Emission Tomography (PET)

Description: Positron Emission Tomography (PET) is an imaging technology that has the unique ability to detect the metabolic (chemical) processes of the body. While other imaging modalities show anatomical or structural changes in the body, a PET scan can reveal chemical changes in the tissues — often before anatomical or structural changes have occurred or are evident on other imaging modalities, such as CT. This is especially significant in the diagnosis of cancer, since cancerous tissue is more metabolically active than normal tissue.

How does PET detect these tissue changes? A PET scan detects chemical changes in the tissues after a small amount of isotope — a compound that contains radioactive molecules bound to a glucose (sugar-like) substance — is injected into a vein in the arm. As the tracer circulates, it concentrates in higher levels in cancerous tissue and other areas with abnormal tissue activity. These areas of accumulation are displayed as bright spots on the PET images, which are then correlated (compared) with anatomical studies, such as CT scans, to determine the location of the abnormal tissue activity. This combination of PET and CT provides a powerful diagnostic tool, especially for cancer detection, staging, and monitoring.

For more detailed information about PET/CT

Patient Preparations for a PET Scan:

• You must fast for at least four hours before your appointment (no food or drink).
• You are required to drink extra water the night before the exam and the day of the exam. Drink at least three 8-ounce glasses of water the night before the exam and an additional three 8-ounce glasses of water on the day of your exam.
• It is recommended that you consume a high-protein, low-carbohydrate meal just prior to your scan. Foods to avoid include pasta, bread, rice, or other foods with high carbohydrate content. Avoid all beverages that contain sugar.
• Continue to take any prescribed medications with water.
• Refrain from all exercise for 48 hours prior to the scan in order to decrease muscle activity on the scan.
• If you have diabetes, discuss the timing of your scan with your physician so that it is scheduled when you are at your lowest glucose levels.
• If you are having a Cardiac PET Scan it is required that no caffeine be consumed 24 hours prior to the test, including chocolate, soda, tea, and even decaffeinated tea and coffee (since these products have traces of caffeine in them).
• Patients will be asked to bring previous films, such as CT or MRI, with them, unless they were performed at Hackensack University Medical Center or Hackensack Radiology Group’s private facility at Newman Street Imaging Center, in which case the images are available on the medical center’s Picture Archiving and Communication System (PACS), a centralized computerized system where images and data are stored in a central archive.

What to Expect During a PET Scan:

• An intravenous (I.V.) tube will be placed into a vein in your arm and a small amount of tracer substance is injected into the body.
• While the tracer circulates throughout your body, which takes about one hour, you will be asked to rest quietly.
• To help you pass the time while waiting for the tracer to circulate and while being scanned, a television is installed in each room and you are given a remote control to watch what you wish.
• When it is time for your scan, you will lie on a table that glides into the PET scanner, which is a doughnut-shaped machine similar to a CT scanner.
• The table will move slowly through the scanner. You will not feel any discomfort while this takes place.
• A PET scan takes 45 minutes, depending on the area of the body being studied. Melanoma cases take longer since the whole body (including the legs) is scanned.
• Claustrophobic patients may request a site visit prior to their appointment so they can feel at ease with the scanner.
• You do not need to change into a hospital gown. You are scanned in your own clothes, so wear comfortable attire.

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Nuclear Cardiology

Cardiac scanning, called nuclear stress testing, is an imaging modality that shows the blood flow through the heart after the injection of a radiopharmaceutical tracer During nuclear stress testing, specialized images of the heart and the distribution of this tracer are obtained as the body moves through a scanner. The two types of nuclear stress tests are:

• Exercise Stress Test
   
• Pharmaceutical Stress Test

Exercise Stress Test

Description: An Exercise Stress Test consists of two components: nuclear scanning of your heart and exercise on a treadmill. The nuclear scan captures images of the chemical changes in your heart after an injection of the radioactive tracer. The exercise portion of the test places a higher demand on the heart’s pumping capacity so blood flow through the coronary arteries to the heart can be evaluated.

What To Expect During an Exercise Stress Test:

• Several electrodes (small adhesive patches) will be applied to your chest. To ensure good electrode contact with your skin, the area will be cleansed with an alcohol pad to remove any oils or dry skin.
• An intravenous (I.V.) tube will be placed into a vein in your arm.
• During the first part of the test, resting views of the heart will be obtained. First, a small amount of the tracer will be given intravenously. After it has been absorbed in the body for approximately 30 minutes your heart will be scanned. A special camera is used to detect the tracer that has circulated to your heart during rest.
• Approximately three hours later you will have the exercise portion of the test at which time you will be asked to walk on a treadmill to increase the blood flow to the heart.
• Shortly before the treadmill is stopped, another dose of the tracer substance is given through the I.V.
• After time is allowed for this tracer to be absorbed by the body (at least 30 minutes), your heart will again be scanned.
• A cardiac nuclear stress test takes approximately five hours to complete. For accuracy, it is important that adequate time be allowed for the resting dose of tracer to clear the heart before the second dose is given.

Patient Preparations for an Exercise Stress Test:

• Do not eat or drink anything for three hours prior to your test.
• If you are taking medications, it is up to your physician to decide whether you should stop any of them prior to the test. If you are instructed to continue taking your medications, only a small sip of water should be consumed.
• If you are a diabetic on insulin or oral hypoglycemic medications, please contact your physician for special instructions.
• NO caffeine or dairy products should be consumed after midnight. This includes chocolate, coffee, tea, soft drinks and even those beverages labeled “caffeine free” (since these products have traces of caffeine in them).
• Wear comfortable, loose-fitting clothes.
• Wear a comfortable pair of walking shoes or sneakers if you will be walking on the treadmill.
• Do not apply any creams, lotions or powder to your chest area on the day of your test.

Pharmaceutical Stress Test

Description: A Pharmaceutical Stress Test consists of two components: a nuclear scan of your heart both before and after the injection of a radioactive tracer which is then measured as it is metabolized within the body. Images also are taken both before and after the administration of a vasodilator such as Persantine™, which increases the blood flow to the heart — without making it work harder — so that the supply of blood to the coronary arteries can be evaluated. This type of nuclear stress test is usually recommended for those who are unable to exercise or who have conduction defects.

What To Expect During a Pharmaceutical Stress Test:

• Several electrodes (small adhesive patches) will be applied to your chest. To ensure good electrode contact with your skin, the area will be cleansed with an alcohol pad to remove any oils or dry skin.
• An intravenous (IV) tube will be placed into a vein in your arm.
• During the first part of the test, resting views of the heart will be obtained. First, a small amount of the tracer will be given intravenously. After it has been absorbed in the body for approximately 30 minutes your heart will be scanned. A special camera is used to detect the tracer that has circulated to your heart during rest.
• Approximately three hours later you will be given a vasodilator through your IV. This medication will increase the blood flow to your heart without making it work harder. The dose administered is measured according to your weight.
• Shortly after the vasodilator is administered, another dose of the tracer is given through the IV.
• After time is allowed for this tracer to be absorbed by the body (at least 30 minutes), your heart will again be scanned.
• A Pharmaceutical Stress Test takes approximately five hours to complete. For accuracy, it is important that adequate time be allowed for the resting dose of tracer to clear the heart before the second dose is given.

Patient Preparations for a Pharmaceutical Stress Test:

• Do not eat or drink anything for three to six hours prior to your test. The length of the time you need to fast will depend upon whether your test is done in one day or scheduled over a two-day period.
• If you are taking medications, it is up to your physician to decide whether you should stop any of them prior to the test. If you are instructed to continue taking your medications, only a small sip of water should be consumed.
• If you are a diabetic on insulin or oral hypoglycemic medications, please contact your physician for special instructions.
• NO caffeine or dairy products should be consumed after midnight. This includes chocolate, coffee, tea, soft drinks and even those beverages labeled “caffeine free” (since these products have traces of caffeine in them).
• NO medications that contain caffeine should be taken after midnight. Some of these medications include Anacin, Excedrin, NoDoz, Fiorinal, Cafergot, Darvon, etc.
• If you have a history of wheezing, asthma, or chronic lung disease (such as emphysema), please contact your physician for specific instructions. If you use a respiratory inhaler or take medications containing any form of Theophylline (some of these medications include Constant-T, Primatene, Quibron, Elixophyllin, Slo-Bid, Slo-Phylline, or Theo-dur, etc.), your physician will need to know this as well so he or she can provide specific instructions.
• Wear comfortable, loose-fitting clothes.
• Do not apply any creams, lotions or powder to your chest area on the day of your test.

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General Nuclear Medicine

Description: Nuclear Medicine scanners obtain images after a small amount of radioactive tracer has been absorbed in the body. The tracer is administered either orally or through an injection or intravenous tube. A special gamma camera detects the distribution of the tracer in your body, and specialized images of this metabolic activity enable the radiologist to study the function of tissues in addition to its anatomy.

What To Expect During a Nuclear Medicine Scan: A Nuclear Medicine scan takes from 30 minutes to one hour. Sometimes there is a delay of two to three hours between the tracer administration and your scan. The gamma camera is a large disk-shaped piece of equipment that is positioned as close to the body as possible. Depending on the type of scan prescribed, you may be sitting, standing, or lying down during the procedure.

Patient Preparations for a Nuclear Medicine Scan: Some of the more common types of nuclear scans are listed below. For those types of scans not listed, you will be given specific instructions when you schedule your exam.

• Bone Scans — Following the administration of the tracer, you will be required to drink one quart of fluid during a two to four hour period while you wait for it to be absorbed in your body.
• Thyroid Scans — These scans typically require that you fast for eight hours prior to the test. No seafood should be eaten for three days prior to the study. Patients must stop taking all thyroid medications and any other medications containing iodine for two to four weeks prior to the test. This should be coordinated and supervised by your referring physician.
• Liver Scans — Nothing by mouth, including water, for eight hours prior to the scan.
• Lung Scans — No preparations are required for this type of scan.
• Renal Scans — Certain anti-hypertension medications must be stopped for two days under the supervision and care of your referring physician.
• Gallium Scans — These scans require a longer waiting period for the tracer to be absorbed by the body. You will receive an injection, and then, depending on the individual case, be asked to return 24, 48, or 72 hours later to be scanned.

Ultrasound (US)

Description: Ultrasound, sometimes called a sonogram, is an imaging modality that visualizes internal structures by recording the pulsating “echoes” of harmless and painless sound waves that are directed to a specific area of the body. These high frequency sound waves are transmitted through a transducer, which is a device that converts them into electrical impulses. A computer converts the electrical impulses into images that are displayed onto a monitor and recorded so that a radiologist can view them and interpret the results.

What to Expect During an Ultrasound:

• The transducer will be coated with a colorless gel to help it glide over your skin.
• The transducer is moved to various positions on the area of your body being studied so that different views can be obtained.
• You will feel slight pressure while the transducer is glided over your skin.

Patient Preparations for a Pelvic or Obstetrical Ultrasound: Pelvic and obstetrical ultrasounds require the following preparations:
Empty your bladder two hours before the exam, then drink three, 8-ounce glasses of water, finishing one hour prior to your appointment.
Do not urinate before your exam. The bladder needs to be full in order to obtain the best images.

Patient Preparations for an Abdominal Ultrasound: If you are having an abdominal ultrasound, you must fast for 12 hours prior to the exam. No food or beverages should be consumed, except for small amounts of water.

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General Radiology

Some of the more common general radiological procedures include: 

• Plain X-Ray
• Intravenous Pyelogram (IVP)
• Upper Gastrointestinal (GI) Series
• Barium Enema

Plain X-Ray

Description: X-rays are taken using ionizing electromagnetic radiation that penetrates the body, impinges on a solid metallic background, and results in images that are captured on film.

What to Expect During an X-ray: The area of study will be positioned against a metallic table or wall. You will be asked to hold your breath while the X-ray is taken because movement will create a blurry image.

Patient Preparations for an X-ray:

• No patient preparations are needed for this exam.
• Pregnant women should avoid exposure to X-rays due to the risk of harm to their unborn child

Intravenous Pyelogram (IVP)

Description: An intravenous pyelogram (IVP) obtains X-ray images of the urinary tract system (kidneys, ureters, and bladder) following the injection of a contrast material that enhances the images.

What to Expect During an IVP: Prior to the exam, an intravenous (IV) tube will be placed into a vein in your arm. After preliminary films are taken, the contrast material is injected into the IV. The remaining images are then taken. An IVP takes approximately one hour to complete.

Patient Preparations for an IVP: No patient preparations are needed for this exam.

Upper Gastrointestinal (GI) Series

Description: An upper gastrointestinal (GI) series, commonly called a GI series, is a procedure that obtains X-ray images of the gastrointestinal tract (esophagus, stomach, and small intestine) after the ingestion of contrast, liquid called barium sulfate, which coats the walls of the GI tract and enhances the images.

What to Expect During a GI Series: Prior to the X-rays being taken, you will be asked to drink the liquid barium mixture. As the barium mixture flows through your gastrointestinal tract, you will be asked to turn into different positions while on the X-ray table and some gentle pressure may be applied to your abdomen. The table also may be slightly tilted while some of the images are taken.

Following this procedure, it is normal for the barium to give a whitish color to your stool for a day or two. Some patients may experience constipation. If this occurs, consult your physician who may tell you to increase your water intake or to take a laxative. The time that it takes to complete a GI series varies according to the extent of the study that has been ordered. The approximate time for a GI series is 30 minutes.

Patient Preparations for a GI Series:

• Do not eat or drink after midnight.
• Do not chew gum or smoke after midnight.
• Do not take medications on the day of your exam — unless specifically instructed to do so by your physician.

Barium Enema

Description: A barium enema is an examination of the large bowl (part of the intestines) with the use of a fluoroscope, which uses X-rays to capture a moving image of an organ while it is functioning. These images are taken after the administration of an enema, which fills the colon with barium sulfate, a contrast substance that coats the walls of the colon and enhances the images.

What to Expect During a Barium Enema: As the barium fills your colon, the radiologist will be taking fluoroscopic films and asking you to turn in various positions. The technologist will then proceed to complete the exam with a series of X-rays. After the exam, you will be allowed to go to the bathroom and expel the barium. You may then be asked to return to the examination room for one or two additional films.

Following this procedure, it is normal for the barium to give a whitish color to your stool for a day or two. Some patients may experience constipation. If this occurs, consult your physician who may tell you to increase your water intake or to take a laxative. A barium enema exam takes approximately 45 minutes to complete.

Patient Preparations for a Barium Enema:

• Do not eat or drink after midnight.
• Laxatives are usually prescribed, which are to be taken the day before the exam so that the lower digestive tract is completely empty.

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Interventional Radiology / Special Procedures

Interventional Radiologists diagnose and treat numerous types of medical conditions by using imaging techniques to guide them as they thread narrow tubes (catheters) and other very small instruments through blood vessels and other pathways of the body to the site of a problem.

Some of the conditions that can now be successfully treated with these types of procedures may have previously required surgery. Interventional Radiology procedures rarely require general anesthesia or hospitalization and often involve less pain and smaller incisions than traditional surgery.

For information about some of the more common
interventional procedures performed at the medical center,
click Interventional Radiology Procedures.

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Pediatric Accomodations

The Department of Radiology makes every effort to accommodate the special needs of children who need imaging services. The medical staff includes physicians who are board-certified in the sub-specialty of pediatric radiology, and arrangements can be made for children who need sedation for their procedure.

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Scheduling Appointments

Click How to Contact Us for a listing of phone numbers that will connect you to the reservation specialist for each procedure. You will receive specific instructions at the time you make your appointment about patient preparations, insurance coordination, and where to go for your procedure.

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Receiving Results / Billing Procedure

Your physician will receive the results of your procedure via fax or mail. Also, you will receive two bills for imaging procedures performed at the medical center, one from Hackensack Radiology Group for interpretative services and the other from Hackensack University Medical Center for the technical component.

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Picture Archives Communication System (PACS)

The Department of Radiology at Hackensack University Medical Center is equipped with a computerized digital image management system known as a Picture Archiving and Communication System (PACS). This technology enables radiologists to view, store, display, and distribute images from one department to another — wherever they are needed for point of care reference. PACS provides clear, sharp image resolution and its flexibility promotes faster turnaround time for interpretation and reporting. The system also is cost effective since no film is required.

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Radiation Safety

The Radiation Protection Program ensures the safety of employees who may be exposed to radiation in the course of their job. It also protects patients so that they are not exposed to unnecessary radiation during their procedures. The goal of any imaging procedure is to produce the best image with the least amount of radiation.

The Radiation Safety Committee, which oversees the program, is comprised of the Radiation Safety Officer and representatives of the Radiology Department, Nuclear Medicine, Radiation Oncology, Nursing, and Administration.

The Radiation Safety Committee is responsible for oversight of the following:

• Ensure that licensed material and equipment are used safely.
• Maintain the medical center’s compliance with the Nuclear Regulatory Commission regulations and NJ State licenses.
• Control all licensed material in the medical center.
• Keep an inventory of all licensed material.
• Monitor the storage and disposal of radioactive waste.
• Provide radiation monitoring equipment and maintain radiation exposure records for all monitored employees.
• Provide radiation protection training to staff members.

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Educational Resources / Web Links

The Radiological Society of North America provides a patient information web site reviewed by a committee that is comprised of physicians from the American College of Radiology and the Radiological Society of North America. Click RadiologyInfo (www.radiologyinfo.org) for patient information about radiologic procedures and the role of radiologists in healthcare. Concise, accurate descriptions of diagnostic, interventional and therapeutic radiology procedures, how each is performed and what patients might experience.

The Society of Interventional Radiology provides online information about medical advances in this field.
Society of Interventional Radiology
(Linked with permission of the Society of Interventional Radiology ©2003.)

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