The document provides guidance on patient preparation for various radiological procedures. It emphasizes the importance of preparing the patient to improve accuracy, safety, and minimize anxiety. Key aspects of preparation include fasting, removing metallic objects, emptying bowels and bladder, obtaining consent, and explaining the procedure to relieve anxiety. Proper preparation differs for specific exams and patient populations but aims to provide clear images while reducing risks.

1. MR. ROHIT BANSAL
ASSISTANT PROFESSOR
MAMC (AGROHA)

2. *Patient preparation is essential for the accuracy and reliability
of every radiologic procedure. Preparation can minimize the
anxiety of the patient.
*It provides awareness to the patients about the procedure,
setting up equipment and improves patient safety.
*Proper preparation is very important as it makes adequate
diagnosis and avoids repeat examination.

3. *
*REMOVE ALL METALIC (RADIO-OPEQUE) OBJECTS FROM SCAN
AREA AND WEAR HOSPITAL GOWN.
*The technologist should describe the whole procedure to the
patient.
*CONSENT FORM SHOULD BE FILLED.
*CONSULT YOUR DOCTOR BEFORE THE PROCEDURE. IT IS
ESSENTIAL THAT YOU TALK TO YOUR DOCTOR BEFORE GETTING
AN X-RAY, ESPECIALLY IF YOU ARE BREASTFEEDING OR IF YOU
ARE OR THINK YOU MIGHT BE PREGNANT. YOU WILL BE EXPOSED
TO SMALL AMOUNTS OF RADIATION THAT CAN BE DANGEROUS
FOR THE DEVELOPING FETUS.
* BE AWARE THAT YOU MAY HAVE TO HOLD YOUR BREATH FOR A
FEW SECONDS DURING THE X-RAY. (CHEST X-RAY)

4. *THE SPECIAL PRECAUTIONS LIKE PROPER COLLIMATION AND
RADIATION PROTECTION DEVICES SHOULD BE USED TO
MINIMIZE THE RISK OF RADIATION EXPOSURE.
*FOAM HEADREST, STRAPS, POSITIONING SPONGE OR SANDBAG
IS USED TO REDUCE PATIENT MOTION THE PATIENT IS ASKED TO
KEEP STILL DURING THE PROCEDURE.
*THE TECHNOLOGIST SHOULD FOLLOW THE 10 DAY RULE
BEFORE TAKING THE RADIOGRAPH.
*CHECK THE PATIENT POSITION / PATIENT ANGULATION.
*AREA OF SCAN SHOULD BE INSIDE THE IMAGE DETECTOR AREA.
*CHECK TUBE ANGULATION AND SOURCE TO OBJECT DISTANCE
BEFORE EXPOSURE.

5. *
For Adults
*Ask for any history of Diabetes mellitus, Pheochromocytoma, Renal
disease, or allergy to drugs and any specific foods.
*Fasting for 4 hours.
*Consent form should be filled.
*Do not dehydrate the patient.
*Bowel preparation:
• Low residue diet like Dal-chapati/Non-vegetation food and plenty of oral
fluids.
• Bowel wash is given till bowel is clear of fecal matter on the previous
night. Conventional enema is not desirable because it is inadequate for
colon cleansing and leave residual air and fluid in the bowel. However,
distal colon enemas can be used to clean the distal bowel and can be
utilized in the place of 'he suppository.
• Laxatives is recommended to eliminate fecal matter from the colon and
to reduce amount of gas in the bowel. Dulcolax (Biscodyl) is given 2-4
tablets at bedtime for 2 days prior to the I.V.U. If this does not cause
adequate bowel cleansing then give castor oil.

6. *Castor oil is an effective catharsis when administered in the dose of
30-60 ml. Castor oil is contraindicated in cases of abdominal pain of
unknown cause, old and debilitated patients. In older patients it is
advisable to use a suppository in the morning in addition to oral
laxatives.
*Ask the patient to remove all metallic object from scan area and
wear hospital gown.
*Patient blood urea and serum creatinine must be reviewed prior to
the examination.
For Children
* No pediatric patient should ever be purposely dehydrated as it is
hazardous to do so.
*Colon should be empty for I.V.U. For this, laxatives can be given.
However, results of laxatives are unpredictable and the compliance in
their administration by parents is erratic. Suppositories are better for
this purpose. Cleansing enemas are used in children older than 2
years. A preliminary film is taken. If it shows undue gas or feces in
colon the nurse can administer a cleansing enema using soap suds.
*The child posted for urography must not have a full stomach to avoid
vomiting. So the child should not be given anything by mouth for 3-4
hours prior to the procedure.

7. *On the day of examination explain the whole procedure to the
patient.
*Technologist should obtain consent from the patient for
permission of procedure.
*Ask the patient to remove clothing and metallic objects and
wear hospital gown.
*An intravenous line is inserted into patient arm and sedative
medication is given through line to make patient relax.
*The patient should not eat or drink after midnight.
*Ask the patient to take low residual diet for two days.
*Bisacodyl and castor oil (laxatives) are given night before the
examination to eliminate fecal matter.
*Ask the patient to stop taking anticoagulant before exam.
*The patient should micturate prior to the procedure.

8. *Ideal time of procedure is between 8th and 10th day of
menstrual cycle, i.e., 2-3 days after stoppage of menstruation so
that menstruation tissue or fluid is not carried either into the
oviduct or the peritoneal cavity and the incidence of
intravasation of contrast is low. Done before 12th day because
oocyte undergoes meiosis during this time and is radiosensitive.
Thus radiation exposure during this time should be avoided.
*The patient should be advised to abstain from intercourse
between booking the appointment and the time of examination
unless a reliable method of contraception is used to avoid the
possibility of irradiating an early pregnancy.
* Patient should be fasting 4 hours prior to the procedure.
*Informed consent should be obtained.
*On the day of examination describe the whole procedure to the
patient.

9. *Premedication is not required in majority of the cases. When
the patient is very anxious, 5-10 mg of I.V. diazeparn 30
minutes before procedure is helpful to prevent the tubal
spasm which can be provoked by anxiety. Morphine and
Pethidine should not be given as they stimulate the
contraction of the fallopian tubes. However Baralgan, which
contains analgin and pitafemone HCl in 2 ml ampoule or 0.6
mg atropine sulphate in 1 ml ampoule can be given I.V. 10 to
15 minutes before starting the procedure.
*The bladder should be emptied prior to HSG. A full bladder
will elevate the fallopian tubes and may cause apparent tubal
blockage with the spurious radiological appearance of a
hydrosalpinx.
*Ask the patient to remove all ,metallic objects and wear a
hospital gown.
*An intravenous line should be inserted into patient arm and
sedative medication is given through line to make patient
relax.

10. *Describe the whole procedure to the patient.
*A fat free diet suggested to the patient, two days prior to the
examination.
*Technologist should obtain consent from the patient for permission of
procedure.
*The examination is done 7-10 days after operation/ earlier if there is
indication for this such as hemorrhage from T-tube/failure of T-tube
drainage.
*All dressings and metallic objects are removed from the liver area and
wear hospital gown.
*A preliminary film of right upper quadrant should be obtained before
injection to establish the position of tube and identify unusual air
collections.
*Nil orally for 6-8 h prior to procedure.
*Antibiotic cover for patients with biliary obstruction, pseudocyst or high
risk of endocarditis.

11. *Previous biliary track investigation report (T-tube
cholangiography).
*Check the patient previous history, medication report.
*Check the liver function test report before the
examination.
*The chest x-ray report, blood urea, serum creatinine,
previous cholangiography report, USG report, LFT report,
bleeding disorder report and blood sugar report must be
reviewed by Radiologist and Gastroenterologist. (PTHC)
*An intravenous line should be inserted into patient arm and
sedative medication is given through line to make patient
relax.

12. *HISTORY OF THE PREVIOUS REACTION OF IODINATED CONTRAST
MEDIA.
*2. HISTORY OF ALLERGY FROM OTHER MEDICINE.
*3. DIABETES.
*4. CARDIAC DISEASE.
*5. ASTHMA.
*6. RENAL FAILURE.
*7. SICKLE CELL ANAEMIA
*8. POLYCYTHAEMIA
*9. MULTIPLE MYELOMAS
*10. HEPATIC FAILURE

13. *Describe the whole procedure to the patient before examination.
*Ask the patient to remove metallic object from scan area and wear
hospital gown.
*Technologist should obtain consent from the patient for permission for
procedure.
*Ask the patient to take low residual diet for two days prior to the
examination.
*Laxative may be given to the patient, the night before examination.
*Instruct the patient, not to smoke or chew gum because it prevent
proper coating of barium sulphate on the mucosa.
*Fasting may be employed for 4-6 hours and do not eat or drink after
midnight.

14. *BARIUM EXAMINATION AVOIDED IN CASE OF:
*RECENT BIOPSY
*INCOMPLETE BOWL PREPARATION
*SUSPECTED FISTULA
*SUSPECTED PERFORATION
*COMPLETE BOWL OBSTRUCTION
*IF PERFORATION AND FISTULA ARE SUSPECTED OR
WHERE BARIUM IS CONTRAINDICATED, NON-IONIC
WATER-SOLUBLE IODINATED CONTRAST MEDIA IS USED
TO PERFORM THE EXAMINATION.

15. *The Radiologist must check the previous investigation and
medication reports.
*As prolonged fasting is harmful for patients with diabetes,
early morning appointment should be arranged.
*A 'dry' fluid free stomach is essential. Double contrast study
should not be done if secretions exist in the stomach. The
secretions will prevent adequate mucosal coating and may
mimic tumors. (Double Contrast study)
*If the patient is taking tranquilizers, antispasmodics and
codeine, they should be stopped for 24-48 hours before the
examination.
*No rectal enema should be given because the enema fluid
may reflux into the small bowel and create confusing small
bowel patterns when it mixes with the Barium suspension.
(Small bowel studies)

16. *Necessary tests
• creatinine and urea
*Preparation for the examination
• Light meal is allowed - 3 hours prior to the examination at the latest.
• Adequate hydration prior to the examination is required (still water,
neutral liquids).
*Drugs
• On the day of examination, all the routinely administered drugs should
be taken.
• Patients treated with metformin preparations should discontinue its use
48 h before and 24 h after the examination.
*Necessary information for the physician
• The patient should provide the documentation of previous imaging
examinations and medical history reports from the hospital.
• The physician should be informed of any allergy to contrast agents or
other allergies and renal disorders (particularly patients with the
creatinine clearance (GFR) below 30 ml/min).
• The white personnel (physician, nurse, technician) should be informed
about pregnancy.

17. *The examination
• Prior to the examination, the patient may be asked to
remove jewelry, glasses or external hearing aid - if located
near the examined area.
• Intravenous contrast agent administration may be necessary.
The decision on administering the intravenous contrast agent
is made by the radiologist based on the recommendations
from the attending physician and patient's status.
*During the procedure
• Inform about sudden complaints.
*Contraindications
• An absolute contraindication against the examination is the
first trimester of pregnancy. The second and third trimester
and relative contraindications - depending on medical
recommendations. In case of doubts, the female patient
should perform a pregnancy test on her own.

18. *Preparation for the examination
• Fasting status is not necessary.
• For the trunk examination, a two-piece outfit is recommended,
devoid of any metal elements. Any jewelry or removable bridge
should be taken out. No external hearing aids, keys, magnetic cards
or mobile phones are allowed in the MRI examination room.
• Patients suffering from claustrophobia (fear of staying in small,
confined spaces) may take mild sedatives to reduce anxiety.
*Drugs
• On the day of examination, all the routinely administered drugs
should be taken.
*Necessary information for the physician
• The patient should provide the documentation of previous imaging
examinations and medical history reports from the hospital.
• The physician should be informed of any allergy to contrast agents
or other allergies and renal disorders (particularly patients with the
creatinine clearance (GFR) below 30 ml/min) and acute
inflammation.

19. *The examination
• During the examination (lasting at least 15-20 min, with
possible prolongation depending on the type of diagnosed
pathology) the patient should remain immobile, breathe
calmly and not very deeply.
• Occasionally, an intravenous contrast agent based on the
chemical element, gadolinium, is administered during the
examination. Contrast agents used in MRI diagnostics are
different from iodine agents applied in computed
tomography. The decision on the administration of
intravenous contrast agent is made by a radiologist based on
the recommendations from the attending physician and
patient's status.
*During the procedure
• Inform about sudden complaints.

20. *Contraindications
• Contraindications against the examination are medical
devices containing electronic elements (e.g. a pacemaker,
cochlear implant, brainstem stimulator, insulin pump).
• An absolute contraindication against the examination are
ferromagnetic metal filings (that can be magnetized) in the
body - particularly in the eye.
• In the case of other metal elements in the patient body,
information is required on when they have been implanted
and of what alloy they are made. If insufficient information is
provided, the technician/physician may refuse the
performance of the examination for patient's safety reasons.
• The following do not constitute contraindications against
the examination: fixed bridges and dental implants, fixed
dental braces, orthopedic stabilizers (plates and uniting
wires, screws), artificial joints, intrauterine devices. It
should, however, be borne in mind that the above elements
may distort the MRI image and hinder its interpretation if they
are located in the examination field.

21. * Preparation for the examination
• Two-piece outfit is preferred to facilitate undressing from the waist up.
• Bath on the day of examination; do not use talc deodorant, skin balm or cream.
• The optimal time for menstruating women is day 5-10 of the cycle (recommendation
increasing the examination value but not the condition for its performance).
• Post-menopausal women may undergo the examination on any day.
* Drugs
• On the day of examination, all the routinely administered drugs should be taken.
* Necessary information for the physician
• Inform the physician about pregnancy
• Hormone replacement therapy (HRT)
• History of breast surgery.
• The patient should provide the documentation of previous imaging examinations and
medical history reports from the hospital.
* During the procedure
• Inform about sudden complaints.
* Contraindications
• Pregnancy

22. *The technologist will verify your identification and exam requested.
*The preparation for this test will depend on the type of ultrasound
procedure your doctor has ordered. Some preparations include
drinking a quart of water before the test to obtain better images.
Your doctor will instruct you.
*If you are having a biopsy, you will be asked to not eat or drink
anything past midnight the night before the exam. Your doctor will
instruct you.
*Renal or Kidney Ultrasound Drink three 8 oz. glasses of water. You
must finish drinking all of the water 1 hour prior to arriving for your
imaging study. DO NOT empty your bladder. NOTE: These imaging
studies require a full urinary bladder in order to be able to obtain a
successful image. If your bladder is not full at the time of your
appointment, then your appointment may be
postponed/rescheduled. Pregnant patients should drink the water
slowly.
*All dressings and metallic objects are removed from the scan area
and wear hospital gown.

23. *Pelvis or Lower Abdomen, OG/GYN, Male Lower Ultrasound
Studies
Drink four 8 oz. glasses of water. You must finish drinking all of the
water 1 hour prior to arriving for your imaging study. DO NOT empty
your bladder. NOTE: These imaging studies require a full urinary
bladder in order to be able to obtain a successful image. If your
bladder is not full at the time of your appointment, then your
appointment may be postponed/rescheduled. Pregnant patients
should drink the water slowly.
*Upper Abdomen, General Survey Ultrasound Study (Aorta, gall
bladder, inferior vena cava, liver, pancreas, renal stenosis,
retro-peritoneal, spleen)
Nothing to eat or drink after midnight the day prior to your US
appointment.
*Renal Transplant, Thyroid, and Vascular Ultrasound Studies
No preparation is necessary.

24. *Avoid nicotine products like cigarette and tobacco for about 2-
4 hours prior to the Doppler test procedure. Nicotine causes
the blood vessels to constrict and this may be mistaken for a
pathological constriction. (Doppler Scan)
*For abdominal scan, the patient would be asked to eat low-
fiber diet for a day before the test, to minimize gas in the gut.
*If endovaginal imaging is required, you’ll be asked to empty
your bladder prior to the additional endovaginal imaging.

25. • The patient must be instructed to remove facial jewelry in the
beam path (for instance, nose rings or large earrings),
eyeglasses and intraoral prostheses. With panoramic imaging,
all metallic objects from the head and neck region must be
removed including tongue rings, necklaces, napkin chains,
barrettes, false teeth, hairpins, intraoral prostheses and
hearing aids must be removed. These items would produce
radiopaque artifacts on the image if left in place during
exposure..
• Ask the patient to clean mouth and teeth properly as any stray
food particles stuck in teeth will show up in your x-rays.

26. FOR IODINATED CONTRAST
*THE PATIENT IS ASKED TO TAKE A LOW RESIDUE DIET FOR TWO DAYS
PRIOR TO THE EXAMINATION AND DRINK CLEAR LIQUIDS THE DAY
BEFORE THE EXAMINATION. FASTING MAY BE EMPLOYED FOR 4-6
HOURS BEFORE EXAMINATION.
*THE PATIENT SHOULD INFORM ABOUT THE HISTORY OF POOR KIDNEY
FUNCTIONS. THE CONTRAST MATERIAL USED DURING THE PROCEDURE
CAN CAUSE KIDNEY DAMAGE. TO AVOID THIS COMPLICATION, THE
KIDNEY FUNCTION TESTS BLOOD UREA AND SERUM CREATININE
SHOULD BE PERFORMED.
*IF THE PATIENT HAS A HISTORY OF CONTRAST MEDIA REACTION,
CONTRAST MEDIA IS AVOIDED.
*BISACODYL AND CASTOR OIL (LEXATIVES) ARE GIVEN NIGHT BEFORE
THE EXAMINATION TO ELIMINATE FECAL MATTER.

27. *CHECK THE LIVER FUNCTION TEST REPORTS, BLOOD SUGAR, REVIEW
OF USG, CT REPORTS, BT/CT, PLAIN X-RAY ETC.
*THE RADIOLOGIST MUST OBTAIN A HISTORY OF ALLERGY, PREVIOUS
MEDICATION, DISEASE, AND BLEEDING DISORDER.
*WOMEN SHOULD INFORM ABOUT ANY POSSIBILITY OF PREGNANCY.
PREGNANT WOMEN SHOULD NOT HAVE A RADIOLOGIC EXAMINATION
BECAUSE OF THE RISK OF RADIATION EXPOSURE TO THE UNBORN BABY.
*BREASTFEEDING WOMEN SHOULD ALWAYS INFORM THE TECHNOLOGIST
BECAUSE RADIOLOGIC CONTRAST MATERIAL CAN G AFFECTS BREAST
MILK.
*THE PATIENT IS INSTRUCTED TO REMOVE ALL METALLIC OBJECTS AND
METALLIC JEWELLERY FROM THE BODY. THE PATIENT IS ASKED TO
REMOVE CLOTHING AND WEAR A HOSPITAL GOWN.
*THE TECHNOLOGIST SHOULD DESCRIBE THE WHOLE PROCEDURE TO
THE PATIENT AND OBTAIN CONSENT FROM THE PATIENT, FOR
PERMISSION OF THE PROCEDURE.
*AN INTRAVENOUS LINE IS INSERTED INTO THE PATIENT ARM FOR THE
ADMINISTRATION OF CONTRAST MEDIA.

28. BARIUM STUDIES
*THE PATIENT IS ASKED TO TAKE A LOW RESIDUE DIET FOR TWO DAYS
PRIOR TO THE EXAMINATION AND DRINK CLEAR LIQUIDS THE DAY
BEFORE THE EXAMINATION.
*A LAXATIVE MAY BE GIVEN TO THE PATIENT, THE NIGHT BEFORE THE
EXAMINATION. THE LAXATIVE IS GIVEN FOR BOWEL PREPARATION AND
CLEANSING PRIOR TO THE EXAMINATION BECAUSE RESIDUE (FAECES)
AND GAS CAN OBSCURE THE IMAGE.
*INSTRUCT THE PATIENT, NOT TO SMOKE OR CHEW GUM BECAUSE IT
PREVENTS PROPER COATING OF BARIUM SULPHATE ON THE MUCOSA.
*WHEN POSSIBILITY OF PREGNANCY, WOMEN SHOULD INFORM.
PREGNANT WOMEN SHOULD NOT HAVE A RADIOLOGIC EXAMINATION
BECAUSE OF THE RISK OF RADIATION EXPOSURE TO THE UNBORN
BABY.
*THE PATIENT IS ASKED TO REMOVE ALL METALLIC OBJECTS AND
METALLIC JEWELLERY FROM THE BODY. THE PATIENT IS ASKED TO
REMOVE CLOTHING AND WEAR A HOSPITAL GOWN.
*THE TECHNOLOGIST SHOULD DESCRIBE THE WHOLE PROCEDURE TO
THE PATIENT AND OBTAIN CONSENT FROM THE PATIENT, FOR
PERMISSION OF THE PROCEDURE.