CT Testing Prior to Bone Scan Testing - Research Paper Example

Introduction: The Purpose of this research project, is to identify whether or not CT contrast, when administered for CT testing prior to bone scan testing, has an effect on image quality and diagnosis following a bone scan, in the event that both tests are administered on the same day. This is often done for the convenience of the patient but is possibly affecting testing outcomes and diagnosis. In many diagnostic situations, the scheduling of a CT scan and a bone scan will occur on the same day, allowing for testing materials to remain in the patient‘s body for not only the desired test appropriate for the material, but for the following test as well. Prior to receiving a CT scan, the patient will require the injection of a dye which allows for better visibility and contrast upon administration of a CT scan also known as a CAT scan which stands for ‘computed axial tomography’. Contrast dye allows for a highlighting to occur of certain parts of the body allowing for better or clearer imaging. The dye may also deflect x-rays which is ultimately how a CT scan works. Patients being viewed on a CT scan are subject to administration of x-rays while a CT machine will measure the amount of x-rays actually passing through certain parts of the body being looked at. The administration of a bone scan will more specifically, seek to expose tumors or other abnormalities associated with the skeletal system. A bone scan requires the administration of radioactive material into the bloodstream of the patient which ultimately disperses through bone tissue allowing for a visual of any abnormal cell activity. This proposal seeks to suggest a study to determine of the contrast dye utilized in CT scan s prior to the administration of bone scans, has an adverse affect on bone scan results and eventual diagnosis. Rationale: The Necessity of this Study When patients are prescribed both a CT scan and bone scan, suspicion of significant physiological abnormalities exist thereby asserting a need for as much clarity in results as possible allowing for as accurate a diagnosis as possible. Patients who are prescribed a bone scan, are usually suspected to have abnormal cellular activity taking place which in many cases, can be cancerous. Clearly locating abnormal growths and efficiently diagnosis such growths is time sensitive and even emergent in some cases. Physicians in conjunction with medical technicians operating diagnostic machinery, must be able to rely heavily on their fractional margin of error and reliability in yielding accurate and sensitive results. Methodology and Research Strategy: In order to conduct a study that would allow for an accurate assessment of whether or not CT contrast effects the outcome of bone scans or not, a sample group must be established. The sample group would need to be relatively small however in light of keeping costs down due to the administration of numerous, expensive diagnostic tests to each person within the sample. It would also be necessary to make sure that the sample group was within a similar age range and health status. For example, if the group was limited to individuals who were between the ages of 30 and 34, with no history of tumors, benign or malignant and no history of bone disease, the results should remain relatively accurate. Once the sample group has been established, the first of three tests could be conducted. The first test administered would be a bone scan. One week later, the second test could be administered for each individual, which would be a CT scan with contrast dye. One week later, the third test in two parts could be administered but would need to be conducted all within the same day. This would include a CT test with contrast dye followed by a bone scan. Once these series of tests were conducted on all 50 participants, the results could be examined and interpreted. The focus of the data interpretation being on the image obtained from the first bone scan in comparison with the second image obtained from the second bone scan which was given on the day of the CT scan with contrast dye administration. This preliminary set of results will most likely serve to establish a trend in whether or not there is a distinct difference between bone scans where CT contrast has been used and then a bone scan conducted on the same individual where no CT contrast was used that same day. As it is expected to see a trend in clarity in imaging when there is an absence of CT contrast, it may be necessary to repeat the same set of experimentation on a new group of similar individuals in order to make sure that there is less degree of freedom within the final collection of data. Statement of the Problem In Medical testing and diagnosis, clear and accurate results are integral to appropriate treatment. Specifically in the realm of cancer diagnosis, time is often of the essence, requiring that the patient receive immediate treatment based on accurate testing and diagnosis. There are certain factors which we know interfere with the accuracy of a bone scan; one of them being the introduction of barium into the body. The dye used in a ct contrast may act in a similar way and block the view which an unadulterated bone scan may typically yield. It is also known that movement of the patient or a full bladder can alter the results of a bone scan as they will either blur the view or inhibit view of the pelvis bones. This preliminary data allows us the information to assume that bone scans are somewhat sensitive and require a patient to be free of materials used in other medical testing, to ensure clarity in results. Phenomenon, Hypothesis, Theories and Research Questions to be Investigated: The Phenomenon which is the basis for this research project, is the fact that CT contrast dye may be interfering with accurate bone scan results, when administered the same day of a bone scan. The unique quality of utilizing the bone scan test, is that a bone scan is often able to detect abnormalities or problems months before an x-ray would be able to, “A bone scan is a nuclear scanning test that identifies new areas of bone growth or breakdown. It can be done to evaluate damage to the bones, detect cancer that has spread (metastasized) to the bones, and monitor conditions that can affect the bones (including infection and trauma). A bone scan can often detect a problem days to months earlier than a regular X-ray test”(Nissi, 2006). Bone scan testing uses a radioactive material known as a ‘tracer’ which when injected into the patient intravenously, makes its way into the skeletal structure. At this time, a gamma ray camera takes photos of the radioactive substance within the bones in order to identify any abnormalities. What will happen is that in areas where a tumor or cancerous activity is taking place, a large amount of tracer absorption will take place due to the extra blood flow. This indicates on the scan. The presence of a problem. In other areas, a lack of tracer absorption or uptake, may indicate a lack of blood flow which could be indicative of an infarction or other problem. In the event of a ct scan prior to a bone scan, where ct contrast dye is used, it is hypothesized that results will be skewed or unclear. In many ct contrast dyes, the base of the dye is either iodine or barium. As earlier mentioned, barium presence in the body will yield false or altered results on a bone scan as it can be mistaken for the radioactive tracer used in bone scans. This could either cause a technician to overlook a ‘hot’ spot assuming that it is a portion of the body which has simply absorbed the barium from the previous ct scan. It can also yield false positives as the barium uptake may suggest the presence of a tumor or irregular cellular activity which in fact does not exist. Either way, the data obtained from this research project is hoped to provide qualitative and quantitative data that ct scans with the use of contrast dye administered on the same day as a bone scan, will only yield inaccurate results and will require a repeat of both tests to be administered on different days. Delimitations and limitations of the Study: As with most scientific experimentation, there are projected problems with this project. First of all, the issue of how expensive the nature of the testing is will certainly effect the ability to utilize large sample groups. Each person will require a minimum of 4 tests; 2 ct scans with contrast and 2 bone scans. It is hoped that the first round of testing will yield results free of impairment in clarity. This will only be possible if each subject remains totally still during the tests. This is also assuming that all subjects will be reminded to empty their bladders prior to testing and will give honest answers as to whether they are currently pregnant. This may require all females within the sample group to undergo a pregnancy test prior to being admitted into the study. Results may also become more difficult to analyze if any of the subjects is identified as having a skeletal abnormality which they were not previously aware of; such as a bone infarction or a bone tumor. Subject cooperation will also be extremely important to the study as the subjects will be required to be present and accounted for prior to each test. Like all scientific experimentation, this study will also be subject to human error be it in the operation of the diagnostic equipment or in the analysis of the data. One essential means of decreasing the possibility of human error is to establish checkpoints throughout the process. In other words, if the project currently has 7 experimenters on board, it would be important to double that number ensuring that at least 2 individuals are responsible for monitoring each stage of the data acquisition and testing. Definition of terms: CT or CAT Scan - A CT scan, also called a cat scan, is an acronym for the phrase ‘computed axial tomography’. This is usually a scan of the body administered by a radiologist, in hopes of acquiring pictures of the body indicative of abnormalities or injuries. CT scans can be used to look at organs, soft tissue, bone tissue or blood vessels. Bone Scan- A bone scan is type of diagnostic test often used to identify problems or irregular cellular activity within the skeletal structure. The key to understanding a bone scan is to know that this type of test looks at differing densities. While bone tissue is of a certain density, irregularities such as bone tumors are of a different density. They radioactive material injected into patients prior to a bone scan, will automatically be taken up by the bone tissue. The technicians skilled in administering bone scans expect for normal, healthy bone tissue to show up on a bone scan with a specific amount of radioactive material uptake and resulting brightness. In the event that a patient has an irregular growth, illness within the bone or injury to the bones; uptake of radioactive material will be different than normal bone tissue uptake. This is how the identification of problem areas within the bones are identified. CT contrast - CT contrast is similar to the radioactive dye provided for patients undergoing a bone scan except that this material is usually either barium or iodine based. Its purpose is similar in examining soft tissue and organs within the body, providing a picture for a physician to utilize for diagnosis. Radioactive material - Radioactive material is material which is highly unstable and therefore constantly releasing electrons or energy. We know energy is synonymous with heat and light making a very small amount of radioactive material administration within a patient, a helpful diagnostic tool for certain tests. Gamma rays - Gamma rays have the smallest wavelengths in the spectrum of wavelengths but also possess the most energy. This makes them ideal in diagnostic testing within nuclear medicine. x-rays - X-rays act in a similar fashion to gamma rays in that they have short wavelengths but give off quite a bit of energy. The manner in which x-rays allow photographs of the inside of the body to take place is centrifugal to the density of material. We know the normal density of healthy tissue within the body nd due to tits density, we are able to clearly identify it on an x-ray slide. When abnormalities or injuries are present, a disfigurement in the x-ray picture will identify the irregularity due mainly to a density change or difference from the expected norm. Bone tumor - A bone tumor may be either malignant or benign just like any other tumor. In cases of benign bone tumors, a bone tumor may be identified as a ‘large cell bone tumor’ which is actually a very aggressive type of tumor which can cause orthopedic damage but is not capable of metastasizing and is not malignant. Bone infarction - Like other anatomical infarctions, a bone infarction is one where blood supply has been cut off to a certain region of the skeletal structure. This can often cause cell death and excruciating pain in the earea in which the infarction occurred. Barium - Barium is a radioactive substance often used in different diagnostic procedures to illuminate various parts of the inside of the body. Iodine - Iodine is also a material which can be used in CT scans and other diagnostic testing. Metastasized - When a tumor is said to have metastasized, it is mean that the malignant or cancerous tumor, has grown in size and released cancerous cells from the original tumor site allowing for the cancer to spread to other areas of the body. This is often a bleak event with an equally bleak prognosis. Skeletal Abnormalities - A skeletal abnormality can be anything from a broken or fractured bone to a bone tumor or bone infarction. Other skeletal abnormalities can be related to calcium buildup, osteoporosis or scoliosis (diseases which particularly effect the musculoskeletal system). Bone Fracture - The term ‘fracture’ in reference to bones, is similar to what a twig may look like after being trampled. It may not split in half in a clean manner but may have a line of damage that travels laterally up through the twig. This is similarly the case with bone fractures. In cases of injury, the bone may ‘crack’ long ways or rather parallel to the length of the bone without allowing the bone to split into two separate pieces. Irregular Cellular Activity - Irregular cellular activity in most cases, equates to cancer. When cells lose certain ‘built in’ mechanisms such as ‘check points’ or programmed cell death (apoptosis), they become what know as cancer. Cancer cells are really just our own body cells which have gone rogue and have begun to deviate from the rules of normal cellular behavior. A cell has a life cycle which when complete, the cell becomes aware of its need to self destruct. Cancer cells are cells which do not undergo programmed cell death but rather continue to divide through mitosis. At this time, a cell has turned and become a cancer cell and is taking part in irregular cellular activity. Bone Density - The density of bone tissue is somewhat of a constant. With this knowledge, doctors are able to assess problems within a patient’s bones by pescribing tests which look at bone density and varying density among bone tissue which will suggest abnormalities. Blood flow with respect to bone tissue - The life giving part of our body can be said to be blood. Blood is required throughout the body, including the bones. When the supply of blood is cut off or minimized, an infarction or blood clot may be the culprit. When a bone scan shows a high volume of blood supply to an area of bone tissue, the presence of a blood demanding tumor may be the culprit. Diagnosis - Once a physician has all of the required data provided by prescribed diagnostic testing, he/she can then make an educated guess as to what is ailing the patient, this is a diagnosis. MRI - An MRI is an acronym for the term ‘magnetic resonance imaging’ which is usually a test used to examine soft tissue such as muscles. This type of test does not use short length, high energy rays like a CT scan or a bone scan but rather uses a very large and heavy magnet to gather visible information about the patient in question. Orthopedic Specialist - An orthopedic specialist is a physician who specializes in the musculoskeletal system. An orthopedic specialist is most likely the best physician to consult when the concern of irregularity or disease of the bones, is a concern for the patient and is evident through diagnostic testing up to this point. Literature Review: Ell M.D, Ph.D, Peter. J., “Comments and Perspectives, Nuclear Medicine in Europe” This particular article provided by Dr. Ell of the Journal of Nuclear Medicine, elaborates on the importance as well as the need for nuclear medicine not only in Europe but globally. This article also allows one to recognize how truly important the advent of nuclear medicine has been in the field of diagnostics to the tune of quick and accurate diagnoses. The Mayo Clinic, “Using Nuclear Medicine to find Bone abnormalities” The Mayo Clinic has often been on the cutting edge of medical research and provides a large database for medically related information pertinent to studies and clinical trials. This particular article explains in depth, how a bone scan is meant to opperate and why it is a critical test to utilize in the diagnostic process. NASA, “Gamma Rays” This portion of the NASA website is specific to gamma rys and their constructive uses. It is important to understand the tools which are utilized in these high technology medical protocol testing procedures and the use of short length, high energy rays such as gamma and x rays, make our current understanding and application of medicine as advanced as it is today. NASA, “X-rays” NASA was also a valuable recourse in determining the function and necessity of the x-ray in nuclear medicine. X-rays are again, a short wave length containing high energy and are thus useful in forming images of the body though the use of particles passing though the body and encountering various levels of density. Unusual density will appear as a shadow or irregularity on an x-ray allowing physicians to identify a problem. Nissi, Jan, “Bone scan” Nissi provides all of the information pertinent to bone scans and their uses as well as problems or issues which can occur with their use such as things which may inhibit the accurate results of a bone scan. Radiology Info, “What is CT Scan of the body?” This bit of literature essentially outlines the purpose and use of CT scans. The appropriateness of their use and variations of manners in which they may be used, “one of the best and fastest tools for studying the chest, abdomen and pelvis because it provides detailed, cross-sectional views of all types of tissue”. Imagins, “Information about intravenous and oral contrasts used in CT” This particular website focuses on women’s health but provides accurate descriptions and information pertinent to CT contrast used in CAT scans. Identification of the Potential Contribution of the Proposed Study: Assuming that the study will go as planned and that the end result will yield a difference in bone scan results acquired the same day of administration of a CT scan, and bone scans administered on a day with no prior CT scan contrast administered that same day, the study will serve to begin the school of thought that certain tests particularly those of a nuclear medical nature, should be routinely scheduled on different days despite the convenience factor to the patient. It is hoped that this study will ultimately show a connection in the presence of CT contrast dye and skewed or inconclusive bone scan results allowing for a more rigid protocol to surround both tests in the spirit of allowing for more accuracy in the results of both diagnostic tools. Overview of Research Methodology: The research methodology governing this project has gone and will go accordingly: It was necessary to isolate a problem within this particular aspect of diagnostic medicine. It was then necessary to postulate what the problem was in rendering inaccurate or inconclusive bone scans. The logical scenario dictates that in the past, scheduling patients for both a CT scan with contrast and a bone scan with radioactive material, have routinely taken place on the same day. The given is that radioactive materials such as barium cannot be present in the patient’s body when undergoing a bone scan without yielding inaccurate results. Due to this given knowledge, it is safe to assume that the presence of CT contrast is just as detrimental to the results of a bone scan and should therefore be studied further. At this time, it is necessary to draft a hypothesis and then challenge that hypothesis with a proactive set of trials such as the one described previously. Additionally, gathering pertinent medical data to aid in clarifying the facts and protocols surrounding the topic, is a requirement. Once the draft of the project, its requirements and cost projections have been assembled, the research can then begin. Recruitment Methods/Target Populations: The ideal thing to do would be to isolate a group within a larger population such as a small population recruited from a college campus. If an advertisement could be publicized explaining the need for both men and women in good health between the ages of 31 and 35, a group of 50 could be selected. The individuals in the over 30 category would most likely be in a graduate program or a Ph.D program. It would be ideal to have 25 females and 25 males. A college type population would allow for a divere population within a greater population and would illuminate a cultural drift. The subjects would need to be chosen without regard to ethnicity or place of origin. The only limiting factors would need to be 25 women and 25 men all between the 31 and 35 age group with no known prior health problems. Detail of Data Collection Process: The aspect of data collection would come into play essentially when the diagnostic tests began. The first set of preliminary data could be a brief check up for each patient to clear them of any preexisting condition or to obtain a memorandum from their family doctor providing such proof. Pregnancy would also have to be eliminated. Once the preliminary data had cleared the 50 subjects fro the tests, the data retrieved from the nuclear medicine tests would be the integral portion of the data collection and analysis. Proposed Methods of Data Analysis: Essentially, the data analysis portion of the project may prove to be the easiest. The comparison each subject’s bone scan given on the day of the CT scan with contrast would need to be compared to the bone scan given on a day where no other tests had been administered. This portion of the data will ultimately lend information as to whether CT contrast dye interferes with the outcome of bone scan imaging, Cost Estimation and Time Table: Time Spent establishing criteria for and isolating potential subjects - 1week Cost-$200 Time spent interviewing subjects, administering pregnancy tests and narrowing down the 50 finalists - 2 weeks Cost- pregnancy testing- $250, checkups $2000, staffing, $1,800 =$4,050 Actual Test Administration: Week three: All 50 subjects, one CT scan with contrast and one bone scan (different days) - $250,000 Week 4 All subjects undergo both tests again but on the same day, - $250,000 Data Analysis- 1week Total Time: about 5-6 weeks Total cost: $600,000.00 Works Cited: Ell M.D, Peter J. “Comments and perspectives. Nuclear medicine in Europe”, Journal of Nuclear Medicine Vol. 46 No. 6 903, 2005. Imigins, “Information about intravenous and oral contrast used in CT”, retrieved from website at: http://www.imaginis.com/ct-scan/contrast.asp. 2008. Nissl R.N., Jan, “Bone Scan”, retrieved from website at: http://www.revolutionhealth.com/conditions/breast-cancer/bone- scan. 2008. The Mayo Clinic, “Bone scan: Using nuclear medicine to find bone abnormalities”, retrieved from website at:http://www.mayoclinic.com/health/bone-scan/CA00020. 2008. Medicine.net, “What is a CT scan”, retrieved from website at: http://www.medicinenet.com/cat_scan/article.htm NASA, “X-Rays in Nuclear Medicine”, retrieved from website at: http://www.unesco.org/webworld/public_domain/tunis97/com_35/com_35. Html. 2008 NASA, “Gamma rays”, retrieved from website at: http://science.hq.nasa.gov/kids/imagers/ems/gamma.html Radiology Info, “What is CT scanning of the body”, retrieved from website at: http://www.radiologyinfo.org/en/info.cfm?pg=bodyct&bhcp=1 Cluet M.D., Jonathan, “About contrast dye”, retrieved from website at: http://orthopedics.about.com/cs/tumors/g/contrastdye.htm. 2008 Zaidi, Habib, “Current Status and Future Perspectives”, retrieved from website at: http://www.unesco.org/webworld/public_domain/tunis97/com_35/com_35. html. 2008. Read More