Traditionally, medical images were captured on film and stored physically, leading to cumbersome and time-consuming processes for retrieval and sharing. PACS digitizes these images, allowing healthcare providers to access them instantly from any location within the healthcare network, facilitating rapid diagnosis and treatment decisions.

One of the primary roles of PACS is to enhance diagnostic capabilities by providing healthcare professionals with immediate access to high-quality images. This quick access to medical images enables radiologists, physicians, and specialists to review and interpret images promptly, leading to faster diagnosis and improved patient outcomes. Additionally, PACS facilitates comparison of current images with previous studies, aiding in the detection of subtle changes over time and enhancing diagnostic accuracy.

PACS also plays a critical role in promoting collaboration and communication among healthcare providers. Through PACS, medical images can be easily shared between different departments, healthcare facilities and even remote locations, fostering interdisciplinary teamwork and enabling consultations among specialists. This seamless exchange of information accelerates the decision-making process, particularly in complex cases where input from multiple experts is required. PACS contributes to operational efficiency within healthcare organizations by optimizing workflow management.

With PACS, images can be electronically routed to the appropriate personnel for review and interpretation, eliminating the need for manual transport of physical films and reducing the risk of errors or delays. This automation streamlines the imaging process, improves productivity and allows healthcare professionals to focus more time on patient care.

PACS eliminates the need for physical storage space required for film archives, reducing costs associated with film procurement, maintenance and retrieval. Moreover, digital images stored within PACS are easily searchable and can be archived securely for long-term retention, ensuring accessibility for future reference and research purposes.

PACS serves as a foundation for advanced imaging technologies and innovations, such as 3D reconstruction, computer-aided diagnosis (CAD), and artificial intelligence (AI) applications. These technologies leverage the digital infrastructure provided by PACS to enhance diagnostic accuracy, automate image analysis and assist healthcare providers in making more informed decisions.

Shivangi Sharma
Faculty of Radiology

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The fistula is an abnormal connection between two hollow structures. The fistula may be congenital or develops after surgery or injury of an organ.

Indication 

• Opening near sutures wound or any body part like anus or vagina.
• Pus , fluid, waste leak from the opening.
• Throbbing pain
• Swelling near the affected area.

Contraindication 

• Hypersensitivity to contrast
• Suspected pregnancy

Equipment

• Fluoroscopy unit with tilting table 
• Local anesthesia
• Catheter 
• Contrast
• Normal saline 
• Gauze 
• Sterile towel 
• Antiseptic solution

Patient  preparation

• The patient should not eat or drink after midnight.
• Patient KFT reports must be reviewed prior to the examination.
• Describe whole procedure to the patient.
• Ask the patient to remove clothing and wear hospital gown. 
• An IV line is inserted into the patient arm and sedative medication is given through line to make patient relax.

Procedure

• Place the patient on the X- ray Fluoroscopic table .
• Clean the fistula with an antiseptic solution.
• Local anesthesia is injected near the fistula for numbing the area.
• Then the radiologist advances a catheter according to the size of fistula into the fistula tract.
• After insertion of a catheter, the radiologist slowly injected 5ml diluted ionic contrast mixed with normal saline into the fistula tract under fluoroscopy guidance.
•  After filling the fistula  tract with the contrast media, several x ray or spot films are taken in AP , Lateral and Oblique position to access the fistula tract.
• After completion of examination the catheter is removed and the wound must be cleaned and covered with the dressing.

Aftercare

• Patient will be allowed to leave the examination room after completion of the examination.

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One of the primary challenges in diagnostic testing is ensuring the accuracy of results. This requires medical laboratories follow strict protocols and adhere to a code of conduct. Medical laboratory professionals must also be trained to properly collect, handle and analyze samples to avoid contamination and ensure the validity of results.

Another challenge is maintaining the confidentiality of patient information. In diagnostic testing, sensitive information about a patient’s health can be revealed and it is the responsibility of healthcare providers to ensure that this information is protected and not disclosed to unauthorized individuals.

In addition to these practical challenges, there are also important ethical considerations to keep in mind. The diagnostic process must be guided by the principles of medical ethics, which emphasize on the importance of treating patients with dignity and respect, and balancing their right to know with the need to protect their privacy. The ethical principles of autonomy, beneficretion and informed consent must be upheld, giving patients the right to make informed decisions about their health and medical treatment.

Another important ethical consideration in diagnostic testing is the principle of non-maleficence, which requires healthcare providers to avoid causing harm to patients. This is especially important in the context of diagnostic testing, as patients may experience psychological or emotional harm as a result of receiving results that are unexpected or difficult to understand.

Finally, it is important to remember that diagnostic testing is a complex process that must be carried out in a way that respects human values and ethics. Healthcare providers must work together to ensure that patients are treated with kindness and compassion and that the diagnostic process is guided by the highest standards of ethics and professionalism.

In conclusion, the challenges and ethical considerations in diagnostic testing are numerous and complex. It is the responsibility of healthcare providers, medical laboratories, hospitals and all involved parties to ensure that this important process is carried out in a way that protects the well-being of patients and upholds the highest standards of medical ethics. By doing so, we can ensure that patients receive the best possible care and that the diagnostic process contributes to their physical and emotional well-being.

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• Accurate and consistent radiographic positioning requires certain landmarks or reference points, that can be used to center the image receptors (IR) correctly to ensure that all essential anatomy is included on that specific projection.
• These landmarks should be parts of the body that can easily be located in patients, such as part of the bony thorax 
• For chest positioning, the landmarks are:-
• Vertebral Prominent ( Seventh Cervical Vertebra):-

• The vertebral prominence is an important landmark for determining the central ray (CR) location on a posteroanterior (PA) chest projection.
• It is the spinous process of the 7th cervical vertebrae.
• It can be palpated readily on most patients by applying light pressure with the fingertips at the base of the neck. 

• Jugular Notch :-

• The suprasternal notch, also known as the fossa jugularis sternalis, or jugular notch.
• It is important for determining the CR placement anteroposterior (AP) chest projections.
• This is palpated easily as a deep notch or depression on the superior portion of the sternum

• Sternal Angle:-
• The sternal angle is formed at the articulation of the manubrium and the body of the sternum. It is also called the angle of Louis.

Mid Thorax:-

• It is a prominent landmark that is easily palatable at the mid sternum and posteriorly at the level of T7.
• It can be seen at the level of the inferior angle of the scapula.
• It is used in chest PA and AP. 

PA(Posterior – Anterior) VIEW

The Posteroanterior (PA) chest X ray examines the lungs, bony thoracic cavity, mediastinum, and great vessels. 

Indication of this x-ray is 

• Pneumonia-  It is a condition in which air is filled in alveoli.
• Pneumothorax – It is a condition in which air is filled in the pleural cavity.
• Cardiomegaly  – Heart size enlargement 
• Hemoptysis – bleeding in cough 
• Pleural effusion- It is a condition in which fluid is filled in the pleural cavity.
• Tuberculosis  it is a bacterial disease 

Contraindication of this x-ray is 

• Pregnancy because radiation will harm the fetus.

Patient Preparation

• remove some or all of his/her clothes and wear a  hospital gown
• Asked to remove all of the jewelry, removable dental appliances, eyeglasses, and any metal objects or clothing that might interfere with the x-ray images.
• In female patients check LMP to follow the 10-day rule.
• Explain the whole procedure to the patient and ask them to feel comfortable.

Patient Positioning  

• The patient is in an erect position facing upright bucky.
• MSP(mid sagittal plane ) is perpendicular to the IR(image receptor). 
• Chin is raised above the IR.
• Shoulders are rotated anteriorly to allow the scapulae to move laterally off the lung fields and this can be achieved by either:
  • Hands placed on the posterior aspect of the hips, elbows partially flexed rolling anterior

                                            or

• Hands are placed around the image receptor in a hugging motion with a focus on the lateral movement of the scapulae

Central Ray

• The centering point at the level of the 7th thoracic vertebra, is approximately the inferior angle of the scapulae. 

Image Evaluation

• The entire lung fields should be visible from the apices down to the lateral costophrenic angles. 
• The chin should not be superimposing any structures.
• Arms are not superimposed over the lateral chest wall.
• Minimal to no superimposition of the scapulae borders on the lung fields.
•  A maximum of ten posterior ribs are visualized above the diaphragm.

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This procedure is performed after the period but before ovulation probably between days 1 and 14.

Indications

• If the female is infertile or there is any kind of history of recurrent miscarriage 
• If any kind of pain is noticed in the pelvic region.
• Congenital or acquired uterine anomalies which include septic.
• If there is any kind of irregularities in menstrual cycles, that includes polyps, fibroids, and adenomyosis.

Contraindications

• The primary contraindication is pregnancy, for that reason the woman is asked to report on the second or third day after her period’s end. 
• Patient with active pelvic infection is at a high-risk factor for infection following this procedure and is therefore considered a contraindication.
• This procedure is not advised during the menstrual period or immediately after it, due to the increased risk of intravasation of contrast with open uterine vessels.

• Hypersensitivity to contrast agents is also a contraindication to its use in this procedure.
• Active bleeding from the vagina or if there is suspected malignancy is also considered a contraindication.

Preparation for HSG

 The doctor may advise taking Antibiotic and pain medication an hour before HSG

Procedure 

 The gynecologist will perform the test Patient start by lying down on a table under an X-ray imager called a fluoroscope.  A speculum is inserted into the vagina to keep it open and then cleans the cervix.

A thin tube known as a cannula is inserted inside the cervix and the speculum is removed. The uterus is then filled with a liquid containing iodine as a contrast media. 

Finally, images will be taken with the fluoroscope X-ray. The contrasting liquid will show the outline of your uterus and fallopian tubes and the movement of fluid.

 The doctor may ask patients to move around so they can get side views. When the imaging is completed cannula is removed. 

Vaginal spotting is noticed for a few days after the procedure. Cramps, dizziness, and stomach discomfort are also possible.

What Are the Risks?

• Patients may have allergic reactions due to contrast media. 
• Pelvic infection or injury to the uterus is also possible. 
• Vaginal discharge that smells unpleasant
• Fainting

• Severe pain or cramping in the abdomen
• Vomiting
• Heavy vaginal bleeding

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Working as an X-ray technician means you have to learn the basics and intricacies of this profession. It is a demanding and challenging profession. You might have to work for long and unpredictable hours. The time you will spend in training will help you take your career to the next level. Once you have earned a degree or diploma, you can find a job. As you will gain experience, your salary package will increase too. According to industry experts, an X-ray technician’s job is considered one of the highest-earning professions in the healthcare sector. In the last few years, outpatient care and diagnostic care have emerged as one of the most developing branches of medicine.

The present times are technology-driven. Doctors and surgeons make the best use of these technologies to prescribe the best treatment options. Most medical procedures demand the requirement for an X-ray. The profession of X-ray technician includes several areas of specialization – such a professional might choose to focus on specific areas such as ophthalmology, breast, vascular technology, neurosonology, echocardiography, gynaecology and obstetrics. It is a dynamic profession that has developed by leaps and bounds in recent years. With modern technologies and easy accessibility to X-ray technician courses, aspiring candidates can find a promising job in this field.

The Indian healthcare scenario has witnessed rapid change in the last few years. The number of hospitals, medical colleges, research facilities, clinics and other medical facilities has increased like never before, further triggering the demand for skilled and trained medical professionals. Hospitals and healthcare facilities look for candidates who are certified in this profession. Institutes across the country offer several X-ray technician courses. All you have to do is choose the one that best suits your requirements and budget.

An increasing number of students wish to take up a career in the medical field. For such students, the X-ray technician course is a blessing. The entire course is designed to polish the skills of aspirants. You can choose the method depending on your needs. You can enrol for either degree or certification course and embark on the X-ray technician profession. The time you invest in training will help you get an insight into different aspects of this profession. So, if you dream of having a career in the medical field, then consider enrolling on an X-Ray technician course.

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This exam requires little to no special preparation. You should not take calcium supplements for at least 24 hours before your exam.

Bone density scanning (DXA) or bone densitometry is an enhanced form of x-ray technology that is used to measure bone loss. DXA is today’s established standard for measuring bone mineral density (BMD).

An x-ray exam helps doctors diagnose and treat medical conditions. X-rays are the oldest and most often used form of medical imaging.

DXA is most often performed on the lower spine and hips. In children and some adults, the whole body is sometimes scanned. Peripheral devices that use x-ray or ultrasound are sometimes used to screen for low bone mass, mostly at the forearm. In some communities, a CT scan with special software can also be used to diagnose or monitor low bone mass (QCT). This is accurate but less commonly used than DXA scanning

DXA scans are also interpreted by other physicians such as rheumatologists and endocrinologists. A clinician should review your DXA scan while assessing the presence of clinical risk factors such as:

• Rheumatoid arthritis
• chronic renal and liver disease
• respiratory disease
• inflammatory bowel disease

Your test results will be in the form of two scores:

T score — This number shows the amount of bone you have compared with a young adult of the same gender with peak bone mass. A score of -1 and above is considered normal. A score between -1.1 and -2.4 is classified as osteopenia (low bone mass). A score of -2.5 and below is defined as osteoporosis. The T score is used to estimate your risk of developing a fracture and also to determine if treatment is required.

Z score — This number reflects the amount of bone you have compared with other people in your age group and of the same size and gender. If this score is unusually high or low, it may indicate a need for further medical tests.

Small changes may normally be observed between scans due to differences in positioning and usually are not significant.

Benefits

• DXA bone densitometry is a simple, quick and non-invasive procedure.
• No anesthesia is required.
• The amount of radiation used is extremely small—less than one-tenth the dose of a standard chest x-ray, and less than a day’s exposure to natural radiation.
• No radiation stays in your body after an x-ray exam.
• X-rays usually have no side effects in the typical diagnostic range for this exam.

What are the limitations of Bone Densitometry (DEXA, DXA)?

• A DXA test cannot predict who will experience a fracture but can provide a relative risk and it is used to determine whether treatment is required.
• Despite its effectiveness as a method of measuring bone density, DXA is of limited use in people with a spinal deformity or those who have had previous spinal surgery. The presence of vertebral compression fractures or osteoarthritis may interfere with the accuracy of the test; in such instances, CT scans may be more useful.
• Central DXA devices are more sensitive and better standardized than pDXA devices but they are also somewhat more expensive.
• A test done on a peripheral location, such as the heel or wrist, may help predict the risk of fracture in the spine or hip. These tests are not as helpful in following response to treatment, however, and if they indicate that drug therapy is needed, a baseline central DXA scan should be obtained.
• Follow-up DXA exams should be performed at the same institution and ideally with the same machine. Bone density measurements obtained with different DXA equipment cannot be directly compared.

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1)Transudate- This happens when there is an imbalance of pressure in certain blood vessels. It causes extra fluid to leak into the pleural space. Transudate pleural effusion is most often caused by heart failure or cirrhosis.

2) Exudate- This happens when there is an injury or inflammation of the pleura. It can make excess fluid leak out of certain blood vessels. Exudate pleural effusion has many causes. These include infections- such as pneumonia, cancer, kidney disease, and autoimmune diseases. It commonly affects only one side of the chest.

Symptoms of pleural effusion. These include:

• Chest pain
• Dry, non-productive cough (a cough that doesn’t bring up mucus)
• Trouble breathing
• Fatigue

Some people with pleural effusion don’t have symptoms right away. But may order this test if anyone had a chest X-ray for another reason and it shows signs of pleural effusion.

A procedure called thoracentesis is used to get a sample of pleural fluid. The health care provider examines the sample to look for:

• Cancerous (malignant) cells
• Other types of cells (for example blood cells)
• Levels of glucose, protein and other chemicals
• Bacteria, fungi, viruses and other germs that can cause infections
• Inflammation
• No special preparation is needed before the test. An ultrasound, CT scan, or chest X-ray will be performed before and after the test.
• DO NOT cough, breathe deeply, or move during the test to avoid injury to the lung.
• Tell the provider if taken any medicines to thin the blood.

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If you are planning to upgrade your ordinary job for a thrilling and extraordinary career, you are just at the right place. Here we bring to you a few benefits of being an X-ray technician. Find out if it catches your attention. So, read on to explore the reasons to enroll in an X-ray technician course. 

A well-compensated profession.

As stated above, X-ray technologists get paid well for the work they do. Depending on your specialization and skills, you will get paid by a hospital, diagnostic center, or clinic. You might find salary package less during initial years. However, as you gain experience, you can be assured to get hefty compensation. 

You do not have to wait for four years to get a job.

People who want to make a career healthcare sector usually think they have to spend years in a medical school to have a promising and lucrative career. However, that is not true at all. You can kick start your career into the exciting world of radiography by enrolling in an X-ray technician training program with as little as one or two years of study and hard work. In recent times, being an X-ray technologist means getting one of the highest salaries in the healthcare sector.

The demand for such professionals will grow in the coming years. 

The demand for healthcare professionals has increased in recent times. As the sector grows and starts requiring more specialized and frequent medical care, the requirement for diagnostic imaging professionals is likely to boost. Research indicates that the demand for such professionals will increase by manifolds in the coming years.

So, if you are looking for a career in the medical field then without having to think much, you can think of applying for an X-Ray technician course. Be it a diploma or certificate course, it can help you walk the road to success. Choose an institute that provides a promising platform to aspiring candidates. The time you will spend learning about X-ray machines and readings will determine your future graph. Read More

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