Diagostic Procedures

DIAGNOSTIC
PROCEDURES
JOICE JOSEPH
Diagnostic procedures
 It means any kind of medical procedures performed to aid in the diagnosis or detection of
disease.
 To diagnose disease
 To measure the progress or recovery from the disease
 To confirm that a person is free from disease.
Diagnosis : The act of determining the nature of a patients disease

Types
 Divided into:
 Pathological Examination
 Radiological Examination
 Laboratory tests
Pathological examination
A series of tests and examinations conducted by a pathologist to determine the cause of

changes in the structure or function of the body part or tissue.
 The procedures may be:
 Invasive – This technique use equipment placed into a body cavity or use substances
injected into body structures.
 Non invasive- Non-invasive techniques use equipment placed on or near the patients
skin but outside body tissues.
 Interventional- This technique involve invasive diagnostics and procedures performed in
a speciality department such as radiology.
Patient care consideration for diagnostics procedures
1. Patients should be assessed for their physical condition.

2. Clear instructions and consent
3. Pre procedure preparation of the patient
4. Sterile and aseptic technique in invasive procedures
5. The emergency equipments should be readily available
Pathologic examination
 Clinical pathology is the use of laboratory methods to establish a clinical diagnosis of a

disease by examining tissue and organs.
Surgical pathology is the study of alteration in body tissues removed by the surgical
intervention.
Biopsy
 Procedure for obtaining a representative tissue sample for gross and or microscopic
examination.
 The specimen can be obtained surgically or by other means.

Smear
 Cells and small pieces of tissue are suspended in liquid and smeared on glass microscope
slides.
 The specimen is fixed by suspending in fixative .
 The fixed slide is then stained and examined under microscope by the pathologist.
 This technique is useful for the examination of fine needle aspirate or scrapings.
Aspiration biopsy
 Fluid is aspirated through a 22- 25 gauge needle placed in a lesion, such as cyst or
abscess or in a joint or body cavity.
 The lesions are: Breast, Thyroid, lymph nodes or soft tissues.
 Several hundreds of cells are drawn into the syringe .
 The cells are chemically fixed and then examined under microscope.
 This can be performed under CT or ultrasound
Guidance with LA.
Bone marrow biopsy
 A trocar needle is placed into bone , through a small skin incision or percutaneous
puncture.
Sites: Sternum and iliac sites are common.
Percutaneous needle biopsy
 Tissue is obtained from an internal organ or solid mass by a hollow syringe inserted
through the body wall.
 The percutaneous puncture into the lesion is guided by fluoroscopy , CT or ultrasound.
Punch biopsy
 An instrument with a 3-4 mm circular , sharp hollow tip is used to sample the skin
lesions in a cookie cutter manner.
 The circular wound is closed with suture.
 Dermatologist or plastic surgeons use this method for skin biopsy.
Brush biopsy
 Stiff brushes of nylon or steel are passed through an endoscope to the interior of the
respiratory or urinary tract.
 Samples are collected as brush rubs.
 Smear prepared.
 Histological procedures done.
Excisional biopsy
 A mass or entire structure is cut from the biopsy .

E.g. Lymph nodes to diagnose lymphoma.
Incisional biopsy
 A portion of a mass is removed.

 Soft tissue masses incised for diagnosis include muscle, fat or other connective tissues.
Frozen Section
 Done for immediate diagnosis.

 The specimen is excised an placed in a basin without adding any preservative.
 The pathologist directly comes with OT suite to OT to do frozen section.
 When the examination finishes within few minutes , the pathologist report the result
directly to the surgeon.
Permanent section
 The specimen is placed in fixative for several hours to cause the cells to become
firm.
 The fixed specimen is placed in a machine that removes all of the water from the
tissues, replacing with paraffin.
 When this procedure is complete , the specimen is embedded into a block of wax.
It is placed in a microtome and is sliced to thin .
 The slices are placed in slides. Stained and examined
Surgical specimen
All tissue removed during surgery is sent to the pathology for verification of the diagnosis.
Radiological Examination
DIAGNOSTIC IMAGING
1. Myelography
2. Plain X ray
3. CT scan
4. MRI scan
5. Ultrasound
6. Isotope Study e.g. Bone scan
7. Angiogram
Radiology & Diagnostic Imaging Overview
 X-Rays
High-energy electromagnetic waves

Travel in straight lines
Shorter wave length than visible light
Able to penetrate solid materials of varying
densities
Capable of exposing a photographic plate (x-ray
film)
Much the same way as a camera exposes film
29
Radiology & Diagnostic Imaging Overview
(continued)
 X-Rays (continued)
Used to visualize internal organs and

structures of body
Provide valuable means for verifying presence
of illness or disease
 Radiology
Study of the diagnostic and therapeutic uses of

x-rays
30
Angiocardiography
(Cardiac Catheterization)
 Defined
A specialized diagnostic procedure in which a

catheter is introduced into a large vein or artery,
usually of an arm or a leg, and is then threaded
through the circulatory system to the heart
31
Angiocardiography
Angiography
Defined
A series of x-ray films allowing visualization
of internal structures after the introduction of
a radiopaque substance
33
Coronary angiography MRI angiography
Cerebral Angiography
Injection of a radiopaque contrast medium into an

arterial blood vessel (carotid, femoral, or brachial) to
make visualization of the cerebral vascular system via
x-ray possible
35
Cerebral Angiography
Renal Angiography
Defined
X-ray visualization of the internal anatomy of the
renal blood vessels (blood vessels of the kidney) after
injection of a contrast medium
37
Renal angiography
Arteriography
 Defined
X-ray visualization of arteries following the introduction

of a radiopaque contrast medium into the blood stream
through a specific vessel by way of a catheter
39
Hepatic arteriography
Computed Tomography (CT)
Defined
A painless, noninvasive diagnostic x-ray
procedure using ionizing radiation that produces
a cross-sectional image of the body
41
Computed Tomography (continued)
42
Computed Tomography
Fluoroscopy
Defined
Radiological technique used to examine the
function of an organ or a body part using a
fluoroscope
44
Magnetic Resonance Imaging (MRI)
Defined
A noninvasive scanning procedure that provides
visualization of fluid, soft tissue, and bony
structures without the use of radiation
45
Magnetic Resonance Imaging
Mammography
 Defined
Process of taking x-rays of the soft tissue of the breast to

detect various benign and/or malignant growths before
they can be felt
47
Mammography
Radiation Therapy
The delivery of ionizing radiation to accomplish one or
more of the following:
Destruction of tumor cells
Reduction of tumor size
Decrease in pain
Relief of obstruction
To slow or stop the spread of cancer cells
49
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DIAGNOSTIC

Diagnosis : The act of determining the nature of a patients disease

A series of tests and examinations conducted by a pathologist to determine the cause of

1. Patients should be assessed for their physical condition.

 Clinical pathology is the use of laboratory methods to establish a clinical diagnosis of a

 The specimen can be obtained surgically or by other means.

 A mass or entire structure is cut from the biopsy .

 A portion of a mass is removed.

 Done for immediate diagnosis.

High-energy electromagnetic waves

Used to visualize internal organs and

Study of the diagnostic and therapeutic uses of

A specialized diagnostic procedure in which a

Injection of a radiopaque contrast medium into an

X-ray visualization of arteries following the introduction

Process of taking x-rays of the soft tissue of the breast to

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