Specialist tests and assessments

What is an incisional biopsy?

An incisional biopsy is when a small cut (incision) is made into an area of abnormal tissue and a small piece of it is removed from the body. The piece of tissue that has been removed (biopsy sample) is then sent off to the laboratory for analysis.

Why is it done?

It is usually performed to confirm the cause of the abnormality (i.e. to confirm the diagnosis) before deciding on the best type of treatment.

Do I have to come into hospital for the biopsy?

If it is an easily accessible part of your body (mouth, skin), you are happy to go ahead with it at the time of your appointment and the surgeon has the time and facilities to be able to perform the procedure, it may be done at the time of your clinic visit under a local anaesthetic. If it is more complicated or down your throat for example, you may need to come back to a special clinic or be admitted to have it done under general anaesthetic.

How is it done?

This again depends on the part of the body to be biopsied. If it is easy to perform the biopsy with you awake, the area will first be numbed with a spray, cream or an injection of local anaesthetic. The surgeon will check that you cannot feel the area and then make a small cut into the abnormal tissue. A small piece will be removed and sent off to the lab to be analysed. You may require a small stitch to close the wound but often the tissues will heal on their own.

Is it painful?

The procedure itself should not be painful as it will have been numbed using an anaesthetic. When the anaesthetic wears off the area may be sore and you may need to take some simple painkillers such as paracetamol or ibuprofen. Your surgeon or nurse will advise you about this before you leave.

What are the risks?

In general the risks of an incisional biopsy of very small. The biggest risk be an infection of the surrounding tissues. There is a small chance of bleeding and visible scarring of the tissues. Other risks depend on the area being biopsied and will be discussed with you by your surgeon.

Can I return to all my normal activities after the biopsy?

This depends on the area biopsied and whether you required a local or general anaesthetic. It is usually possible to eat and drink normally afterwards and you may be able to return to work or normal activities the following day. Sometimes it is important to keep the area dry and to avoid strenuous activity but you will be advised about this after the procedure by the surgeon or nurse.

When will I get the results?

This varies from the next day to up to 2 weeks. This depends on many factors but the aim is always to give you the results as soon as possible.

Do I need to come back to clinic after the procedure?

Probably, because it will be necessary to explain the results to you and discuss the need for any further tests or treatment that you might need. You should be given a follow up appointment will be made for you before you leave the hospital or occasionally sent to you in the post.

Do I need to see my GP or the Practice Nurse after the procedure? 

Not normally. You may need to if in the unlikely event you need sutures removing or you develop any complications such as a wound infection or chest infection. Your GP will be informed about your admission and/or procedure.

What is an excisional biopsy?

An excisional biopsy is when all of the abnormal tissue is removed (excised) at the time of the surgery compared to an incisional biopsy when just a piece of the tissue is removed.

Why is it done?

Is it usually only done when the abnormal tissue is relatively small and removing it will help improve your symptoms regardless of whether it is benign or cancerous. The piece of tissue that is removed (biopsy sample) is then sent off to the laboratory for analysis.

What are the advantages and disadvantages of an excisional biopsy?

The main advantage is that in one operation it is possible to find out the cause of the abnormal tissue (make a diagnosis) and remove it at the same time compared to an incisional biopsy where a piece of the tissue is removed to make a diagnosis but it will probably still then need to be treated. The disadvantage is that too much normal tissue can be removed than is necessary occasionally causing complications or more scarring or the surgeon does remove all the abnormal tissue and further treatment (e.g. another operation or radiotherapy) is still required. The reason all the tissue may not removed is that it is often difficult to be see this with the naked eye and it is only when the tissue is looked at under the microscope that these abnormal cells can be seen.

How do I decide whether I should have an incisional or excisional biopsy?

Sometimes it is an easy choice and sometimes it is more difficult to decide. The pros and cons of each method will be discussed with you by the surgeon.

Do I have to come into hospital for the biopsy?

If it is an easily accessible part of your body (mouth, skin), you are happy to go ahead with it at the time of your appointment and the surgeon has the time and facilities to be able to perform the procedure, it may be done at the time of your clinic visit under a local anaesthetic. If it is relatively large, more complicated needing special equipment (e.g. a laser) or down your throat, you may need to come back to a special clinic or be admitted to have it done under general anaesthetic.

How is it done?

This again depends on the part of the body to be biopsied. It may be performed under a general anesthetic but if it is easy to perform the procedure with you awake, the area will first be numbed with a spray, cream or an injection of local anaesthetic. The surgeon will check that you cannot feel the area and then make a small cut around the abnormal tissue. The tissue will be removed will be sent off to the lab to be analysed. You may require a few stitches to close the wound but sometimes the tissues are left to heal on their own.

Is it painful?

The procedure itself should not be painful as it will have been numbed using an anaesthetic or you will be having a general anaesthetic. When the anaesthetic wears off the area may be sore and you may need to take some simple painkillers such as paracetamol or ibuprofen. Your surgeon or nurse will advise you about this before you leave.

What are the risks?

In general the risks of an excisional biopsy of small. The biggest risks are infection of the surrounding tissues and bleeding from the wound. There is a chance of visible scarring of the tissues. If the lesion is more extensive than originally thought some disease may be left behind requiring a further operation or treatment. Other risks depend on the area being biopsied and will be discussed with you by your surgeon.

Can I return to all my normal activities after the biopsy?

This depends on the area biopsied and whether you required a local or general anaesthetic. It is usually possible to eat and drink normally afterwards and you may be able to return to work or normal activities the following day. Sometimes it is important to keep the area dry and to avoid strenuous activity but you will be advised about this after the procedure by the surgeon or nurse.

When will I get the results?

This varies from the next day to up to 2 weeks. This depends on many factors but the aim is always to give you the results as soon as possible.

Do I need to come back to clinic after the procedure?

Probably, because it will be necessary to explain the results to you and discuss the need for any further tests or treatment that you might need. You should be given a follow up appointment will be made for you before you leave the hospital or occasionally sent to you in the post.

Do I need to see my GP or the Practice Nurse after the procedure?

Not normally. You may need to if you need sutures removing or in the unlikely event you develop any complications such as a wound infection or chest infection. Your GP will be informed about your admission and/or procedure.

A nasendoscopy is a way of examining your nose, throat and voice box. It involves passing a small, thin flexible telescopic tube through your nostril. It is performed by trained doctors and Speech & Swallowing therapists. 

Why is it necessary?
It allows a doctor to see inside your nose, back of nose (nasopharynx) throat (pharynx and larynx) and to assess your voice or swallowing. It provides extra information to what is seen on the scan.

Is it painful?
Doctors will insert the tube gently to minimise any discomfort or pain. Since it is an unusual feeling, it can make your eyes water (it's best to avoid eye make up, if you wear any!).

Is an anaesthetic used? 
An anaesthetic spray may be used to numb the nose and/or throat, but is generally unnecessary. Sometimes the nasal anaesthetic spray is combined with a decongestant (to shrink the lining) to make it easier to pass the nasoendoscope. It has a bitter taste and gives an unpleasant sensation in the throat (similar to having an injection at the dentist's making it seem difficult to swallow). Very rarely it may cause irritation and swelling of the lining of the throat. 

Can there be complications?
Yes but they are very rare and occur in less than 1 in 100 people. Some people have reported a feeling of light-headedness, nosebleeds, coughing and spasms of the vocal cords. Any effects are temporary and should not last more than a minute or two.

Is there an alternative? 
Nasoendoscopy is by far the most useful and most common way of examining your throat. It is normally well-tolerated although people may be anxious. Some doctors may use a 'rigid telescope' or 'mirror' inserted through the mouth which you may fine easier to tolerate- you can always ask about this option. Putting you to sleep (i.e having the examination under a general anaesthetic) is sometimes necessary but is time consuming and only done if essential. It is best to discuss any worries with your own doctor/nurse in clinic as they are there to help you.

What if I don't want a nasoendoscopy?
We strongly recommend that you have it done as it is the most effective way of checking your throat. Often it is the thought of the unknown procedure that is more worrying than the actual procedure itself. You do of course have to give your consent for the professional to go ahead with the examination. Even if you give your consent and then during the examination you find you cannot tolerate it, you can ask the professional to stop the procedure at any time.

A CT (computerised tomography) scan also known as a CAT (computerised axial ­tomography) scan uses multiple X-ray images taken from different angles, to produce pictures that look like slices through your body. It is a scan that allows doctors to see inside the body differently. 

The scan will be of your head, neck, chest and occasionally of your abdomen (head and neck cancers rarely go to the liver or other structures in the abdomen). The CT/CAT scan is done because it shows:-

• exactly where the cancer is

• the size of the cancer

• whether there are any enlarged lymph nodes in the neck (lymph node metastases)

• whether the cancer has spread to the lungs

• if there is a secondary cancer

• if there are any other major problems with the lungs or heart.

If you have been diagnosed with or treated for cancer, you may need to have another CT/CAT scan:

• to help with planning for radiotherapy or further surgical treatment

• to check whether the cancer has come back or spread

Why am I having a CT/CAT scan rather than an MRI scan?

• A CT/CAT scan gives better information about:
  • cancers
  • the bony structures in the head and neck region
  • the lungs

• You may not be able to have an MRI scan because:
  • you have certain types of metal surgical clips, cardiac monitors or pacemakers inserted in your body (an MRI uses powerful magnets to produce the pictures)
  • they are much quicker (taking about 30 seconds scan time), easier and also cheaper to do
  • you may not be able to tolerate an MRI scan if you suffer from claustrophobia, as you will have to be in an enclosed noisy machine for about 20-45 minutes.

(For more details click on the following link: What are reasons why I may not be able to have an MRI scan?)

How do I prepare for a CT scan?
There are no special precautions you have to take before having a CT scan and you can eat and drink normally beforehand (unless instructed otherwise). It is better to wear clothing that can be removed easily as you will be asked to remove your top clothing and wear a hospital gown. Women may need to remove their bra as the metal clips and underwire can show up on the scan. You should take off all jewellery (or not wear any, if possible) and removable metal objects or clothing that might interfere with the CT images: the radiographer will tell you exactly what you need to wear /remove.

If there is any chance you could be pregnant please inform the doctor requesting the scan and radiographer as the X-rays could affect your developing baby. You will be asked about: allergies, whether you have had any previous adverse reaction to iodine products or any previous scans that involved giving the contrast drug. You will have a small tube (cannula) placed in one of the veins in your arms so that the contrast drug can be given.

What does having a CT scan involve?
Having a CT scan is a quick and painless test and the actual scan takes about 30 seconds to do, although getting everything ready will take 5-10 minutes. You will be asked to lie on a special couch which is moved slowly backwards and forwards through the hole of a large doughnut-shaped machine. To see a short video on what happens when you have a CT scan click on the following link: http://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/ct-scan

Is a CT scan harmful?
No, The actual risk of the radiation causing any problems in the future is very small and you shouldn't worry about this!

However, performing a CT scan exposes you to a relatively high dose of radiation compared to a Chest X ray but not enough to make you feel unwell.  Doctors try and keep the radiation dosage and number of CT scans down to a minimum. You will have been advised to have a CT scan because your consultant wants specific information about you that can only be obtained from this particular type of scan. Pregnant women should not have a CT scan. If it is possible you that may be pregnant, you should contact the radiology department for advice as soon as you can before the scan.

You may also have a special 'dye' called a 'contrast medium' injected into one of your veins. This provides better detail of the internal structures.

Very rarely the dye may leak outside the vein and cause swelling and pain in your arm.Contrast materials are safe drugs. However a very small number of patients are sensitive to the contrast medium which can cause an allergic or in extremely rare instances a serious reaction (anaphylactic reaction). The reaction most often starts with a rash, weakness, sweating and difficulty breathing. If you feel ill during or after the test, tell the radiographer/doctor straight away. The doctors and radiographers will know what to do if you have this type of reaction and will treat you immediately.

For more information about radiation doses and the risk please click on the following link:
https://www.gov.uk/government/publications/medical-radiation-patient-doses/patient-dose-information-guidance


Where is it done?
QMC Campus

(Directions, Contact)

City Campus

(Directions, Contact)

Kings Mill Hospital Campus

(Directions, Contact)

If you are an in-patient at the QMC Campus (or City Campus) you will be taken down to the CT scanning department.

When will I get the results?

You may have to wait until your next appointment at the hospital to get the results of your scan. The CT scan will need to be reported by a Radiologist and this will be then made available to the requesting doctor before being discussed with you.

For further information please click on the following link:
http://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/ct-scan

A PET-CT scan is two scans in one: a PET scan and a CT scan.  

A PET (Positron Emission Tomography) scan is used to help show up cancers. It involves having a very small amount of a radioactive glucose (known as FDG-18) injected into the bloodstream.  A special scanner helps create a 3D map of areas of increased radioactivity (emissions of positrons) in the body. The FDG-18 is taken up by tissues in the body that use glucose as their main source of energy. For example, the brain and heart muscle use a lot of glucose to function normally.

Cancers generally use more glucose than the normal tissues so a PET scan can help show where they are in the body.

Unfortunately the FDG-18 will also be taken up in tissues that are inflamed or infected sometimes making it difficult to distinguish them  from cancers. Radiologists and your specialist cancer doctors discuss the results and use all the other information from their examination of you and other tests you may have had to help decide whether any abnormal areas highlighted by the scan are likely to be a sign of cancer or not.  

PET scans do not show details of the organs in the body. For this you need a CT scan.

The CT scan is a standard CT scan using X- rays to produce a series of slices which can be placed one on top of the other to create a detailed 3D picture of the inside of the body.

Combining the PET scan images with the pictures from the CT (Computed Tomography) scan in the form of a PET-CT scan means that it is much easier to see exactly which tissues or lumps are using the radioactive glucose and potentially where the cancer may be in the body.

 

Why is a PET-CT scan done?

A PET scan can help to:

Show whether a lump is cancer or not

Show whether a cancer has spread to other parts of the body

Help decide the best treatment for your cancer

Show how well you have responded to radiotherapy or chemoradiation treatment,

Show the difference between scar tissue and active cancer tissue

Is a PET-CT safe to have?

Yes. Although having a radioactive injection may sound dangerous, you only have a small amount of radiation given to you.

It is equivalent to a period of a few years’ natural background radiation. The injected radiation decays within 6 hours and it does not make you feel unwell.

Drinking plenty after the scan will help flush the drug out of your system.

Before having any test, doctors make sure the benefits outweigh any possible risks.

 

How do I prepare for a PET-CT scan?

Eating and drinking

You must not eat anything for the 6 hours before the scan appointment time 

You must also not drink any meal supplements, liquid food (such as Ensure, Fortisip) tea or coffee, flavoured water or squash during the 6 hours before your appointment time 

You must drink plenty of plain water 

You must continue to take your usual medication, with the exception of insulin if you are diabetic (see below)

If you are diabetic:

You should take your usual insulin dose 6 hours before the scan appointment time together with your usual breakfast and then take no more insulin or food

You must take food and drink with you in case you have a “hypo” and to eat before you leave the hospital to travel home.

Physical Activity

You should avoid strenuous physical activity e.g. swimming, exercise classes, going to the gym for the 24 hours before your appointment time. This is because muscles use glucose and it will then make it harder to see abnormal areas of radioactivity on the scan.

Pregnancy or breast feeding

If you are pregnant or think that you might be pregnant or you are breast feeding, please contact the Patient Referral Centre on 0333 202 0300

If you are pregnant, you are unlikely to have a PET scan. This is because the radioactive drug could cross the placenta and affect the baby.

If you are breast feeding you may need to stop for a length of time after having the radioactive injection. You may need to store enough expressed milk for at least one feed.

Clothing and jewellery

You will not normally have to change into a gown for the scan and will be scanned in your own clothes.

Please:

wear comfortable clothes socks and flat shoes (a tracksuit and trainers are ideal)

avoid wearing clothes with metal zips or an under-wired bra as these interfere with the scan

bring additional warm clothes, such as a fleece or a jacket with a hood as some patients feel cold on the units even on a warm day

leave jewellery at home

Travelling abroad

If you are travelling abroad within a few days of your scan, it may be a good idea to take your appointment letter with you to show that you have had a scan.

Most airports have sensitive radiation monitors which may pick up the trace of radiation following your test.

 

What should I bring with me to my appointment?

Any medication that you would normally take during the day

A book or personal music/radio device

A warm jacket or fleece and a warm hat

A snack and drink to have after the scan before you travel home.

Can I bring a partner, relative or friend?

Yes and it is generally a good idea to have someone with you. There are several waiting areas or coffee shops where they can wait whilst you have your scan. They will be informed how long they will need to wait and when they can collect you from the scanning unit.

It is very important that you do not bring children or pregnant friends with you because the PET-CT scan uses radiation and children and pregnant women are particularly susceptible to radiation.

What happens on the day of the appointment?

You should arrive 15 minutes before your scan appointment time

If you realise that you will be late or unable to attend the unit please contact the Patient Referral Centre on 0333 202 0300

After you have been greeted at reception, a member of staff will explain the procedure and answer any questions you may have

A member of staff will then take a short medical history from you to assist the doctor who reports the scan

The Radiographer or Nuclear Medicine Technologist will then inject a small amount of a colourless liquid called FDG-18 (a very small dose of radioactive glucose) into a vein in your arm.

You will then rest for approximately one hour prior to your scan. The rest period is to allow the body time to take up the injection. During this rest period you will be asked not to move or talk, as this can affect the quality of the scan. Depending on the type of scan your doctor has requested, you may be able to read or listen to music during this period so please bring a book or personal music device with you.

You will then be asked to visit the toilet to empty your bladder before your scan. This is to ensure the bladder is empty and gives a good view of the pelvic region.

Following this you will be taken to the scanner for your scan, where you will be asked to lie flat and still on a narrow scanning table during the scan for approximately 30 minutes.

You will then be free to leave the PETCT unit.

After your appointment

It is a good idea to eat and drink before you leave the hospital. You may want to bring a packed meal or snack with you in case you cannot find something you like in the hospital cafe

You should continue to drink plenty of fluids for the remainder of the day

We recommend that you avoid close contact with children and pregnant women for 6 hours after your scan.

How do I get my results?

The staff on the PETCT unit cannot discuss the results of your scan with you.

The scan is usually reviewed within a few days and the report will be sent to the doctor who referred you for the PET-CT scan. Once the results have been discussed with the hospital team caring for you the results will be explained to you.

Where is it done?

The PETCT Centre is situated on the City Hospital Campus on Hucknall Road, close to the junction with Valley Road (A6514). Enter the hospital through Gate 1 (the third gate from the roundabout). The PETCT Centre is situated in Heathfield Way which is on the left just inside Gate 1. For more information about the PETCT centre click on the following link:

https://www.inhealthgroup.com/location/nottingham-petct-centre

More information:

To see a short video on what happens when you have a PET- CT scan click on the following link: 

http://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/pet-scan

To find out more about having a PET-CT or hear more information in the about preparing for a CT-PET scan and what to expect on the day of the scan click on the following link:

https://www.inhealthgroup.com/services/petct

If you are unable to play the files please contact the patient referral centre on 0333 202 0300 and they will send you a CD.

An ultrasound scanner uses high frequency sound waves to create images of the internal soft tissues of the face and neck. It is the same type of scan that is performed on pregnant women to view images of their unborn babies.

Why is it done?
Ultrasound is relatively quick and simple test that gives very useful information about the soft tissues in the head and neck region including the lymph glands, salivary glands, thyroid gland and any abnormal lumps. It can be used with a fine needle aspiration test or core biopsy test to accurately direct the tip of the needle into the lump. As ultrasound examinations do not involve X-rays they are very safe and useful for checking whether benign lumps are changing in size.

What are the risks or side effects of an ultrasound test?
There are no known risks to ultrasound imaging. If you may be allergic to silicon gel or latex gloves please let the person performing the ultrasound know.

How do I prepare for an ultrasound test?
There is no special preparation required. You may eat and drink normally beforehand. It is useful to wear clothing that can easily be removed from around the neck and not to wear jewellery such as necklaces and dangly earrings.

If you cannot attend your appointment for whatever reason please contact the Ultrasound department on: so that your appointment slot can be used by another patient.

What does this involve?
It’s painless and only takes a few minutes. The radiologist or sonographer will put some gel on the skin of your neck and pass a small probe gently over the area. The gel may feel cold to start with but soon warms up. They will look at the images on a computer monitor while doing the test. The test takes about 20-30 minutes depending on whether you need a fine needle aspirate or not.

After your appointment
You should be able to go home straight away. You can eat and drink and carry on with all your normal activities straightaway.

How do I get my results?
The radiologist sometimes may be able to give you the results immediately after the test but sonographers will need to discuss the results with a Radiologist first before sending out the report. A written report will be sent to the doctor who referred you who will then discuss the results with you when you are seen back in the clinic or let you know by letter.

Where is the ultrasound test done?

QMC Campus

City Campus

KMH

A Chest X-ray is simple test used to look internally at your lungs and rib cage. It is done for lots of different reasons and could be done on more than one occasion: 

• When you first seen in outpatients
  • as a screening test to check for tumours such as metastases in the lungs or ribs or a second cancer such as lung cancer

• Before having a operation
  • as a screening test to check for additional chest or heart problems such as emphysema, COPD an enlarged heart or heart failure

• After an operation
  • to look for signs of infection (including pneumonia), a build up of fluid (pleural effusion), collapse of the lung (pneumothorax). If a nasogastric tube has been inserted to help with feeding it can also be used to check that it is in the correct position.

• After treatment when your being followed up
  • if you develop new symptoms such as shortness of breath, coughing up blood (haemoptysis), chest or rib pain

Why has the doctor asked for chest X Ray rather than a CT scan?
If you have a very small tumour with a very small risk of it spreading to the lungs and you do not have any chest or heart problems then the evidence is that a chest X Ray is all you need. In these situations the chance of finding another medical problem is extremely low a chest X ray is a good screening test in these situations.

Is a chest X ray harmful?
A chest X ray does involve receiving a small dose of radiation but not enough to make you feel unwell. The risk of the radiation causing any problems in the future is very small. The benefits of checking there are no problems with your chest or finding out what is wrong will far outweigh any risk there may be from radiation.

For more information about radiation doses and the risk please click on the following link:
https://www.gov.uk/government/publications/medical-radiation-patient-doses/patient-dose-information-guidance

How do I prepare for a chest X ray?
There are no special precautions you have to take before having a Chest X ray and you can eat and drink normally beforehand. It is better to wear clothing that can be removed easily as you will be asked to remove your top clothing and wear a hospital gown. Women may need to remove their bra as the metal clips and underwire can show up on the X-ray. You should take off all jewellery and removable metal objects or clothing that might interfere with the x-ray images: the radiographer will tell you exactly what you need to wear and remove.  If there is any chance you could be pregnant please inform the doctor requesting the X ray and radiographer as the X-rays could affect your developing baby. If you can’t delay having the X-ray, the radiographer may be able to shield the baby with a lead block.

What does having a Chest X ray involve?
Having a chest X ray is a quick and painless test and only takes a fraction of a second. The radiographer will take a couple of minutes to get you into the right position. Please keep still during this time and breathe normally. You will need to stand with the front of your chest pressed against an image recording plate with your hands placed on your hips. If you can't stand you may have to lie down on an X ray couch. You must remain very still and may be asked to hold your breath for a few seconds while the x-ray picture is taken otherwise the image may become blurred.  The radiographer will walk behind a screen to take the X-ray but they can still see and hear you.

When the examination is complete, you may be asked to wait until the Radiographer has made sure a good enough quality image has been obtained and decide whether further images need to be taken.  The whole process takes approximately 15 minutes.

Where is it done?
QMC Campus

(Directions, Contact)

City Campus

(Directions, Contact)

Kings Mill Hospital Campus

(Directions, Contact)

If you are an in-patient at the QMC Campus (or City Campus) and are not well enough to go down to the X Ray department then the X Ray may be occasionally done by a radiographer on the ward.

When will I get the results?
Unfortunately you will not be given the results by the Radiographer at the time of the test. The chest X ray will need to be reported by a Radiologist and this will be then made available to the requesting doctor. You may have to wait until your next appointment at the hospital to get the results.

Fine needle aspiration biopsy (FNA) is also called ' a needle biopsy test' or simply 'needle test'. It is done because you have an abnormal lump in your neck. It is like a blood test but instead of putting a needle in a vein it is put into the lump.

It is a way of taking out some of the cells in the lump to find out the cause of it and is a very useful way of detecting cancer.

Does the test mean I find out the cause of the lump? 
It is helpful in approximately 80% of cases.  Sometimes however there are not enough cells to analyse or it can be difficult for the pathologist to make an accurate diagnosis. Sometimes the test needs to be repeated and or a piece of the tissue (rather than just cells) needs to taken for histology (see core biopsy, incisional biopsy, excisional biopsy).  

When is it done?
Some of the Head and Neck surgeons will do it when you attend for your outpatient appointment. Alternatively it is done at the same time as your ultrasound examination of your neck when it will be done by a Radiologist (Ultrasound-guided FNA).

How do I prepare for a FNA test?
There is no special preparation necessary. You can eat and drink normally before and after the test. Please tell the doctor performing the test if you are on any blood thinning tablets as there may be a slight increase in risk of bleeding or bruising.

What happens during the test?
The doctor will explain what's going to happen and ask you permission to do the test. You will either be sitting in a chair or lying down - if you faint easily it may be best to lie down!. The skin is wiped clean with a disinfectant and a very thin the needle put into the lump. On most occasions a local anaesthetic is not required or used. The doctor then 'sucks out' cells and fluid, removed the needle and puts it on glass microscope slides and into small pot to be sent off to the laboratory for analysis.  It takes just a few minutes to do. You will be asked to press on the area for a few minutes to reduce the risk of bleeding. 

Are there any side effects from the test?
The area can be painful or tender to touch for a few days. There are very few complications but occasionally

• there may be some bruising of the skin

• the lump may get bigger if there is bleeding into it

• you can get an infection at the site of the test

It is probably best to avoid strenuous exercise for 48hrs after the test.

Where is it done?
QMC Campus

(Directions, Contact)

City Campus

(Directions, Contact)

Kings Mill Hospital Campus

(Directions, Contact)

If you are an in-patient at the QMC Campus (or City Campus) you will be taken down to the CT scanning department.

When will I get the results?
The cells need to be prepared and then analysed by a Pathologist who will be then made available to the requesting doctor. You may have to wait until your next appointment at the hospital to get the results.

An MRI (Magnetic Resonance Imaging) scan is different from a CT scan in that it uses magnetism and radio waves rather than radiation to build up a picture of inside your body. The pictures look like slices through your body. The most likely scan you will have will be of your neck but occasionally it will be of your head and/or abdomen.

In some situations, your specialist doctor may recommend an MRI:

• because it can give clearer, more detailed information than a CT scan in some parts of the body and for some types of tissues such as the brain, salivary glands, tongue, nerves and blood vessels 

• if a CT scan hasn't been able to give all the information they need and particularly if you have a lot of fillings in your teeth (CT scans can be unclear in this situation)

It is not so good for looking at the lungs and bones and also not everyone can have one or is able to tolerate the scanning.

What are the reasons I may not be able to have an MRI scan?

Because an MRI scan involves the use of very strong magnets you may not be able to have this type of scan if you:

• have a pacemaker
  
  
• have an artificial heart valve
  
  
• ever had brain surgery or major surgery on your head
  
  
• have any metallic implants like joint replacements
  
  
• ever had metal fragments in your eyes from welding or metalwork
  
  

OR:

• If you are female aged between 12 & 55 and
  
  

• are pregnant
  
  
• are breast feeding

• YOU ARE LATER THAN THE 28th DAY OF YOUR LAST PERIOD

OR:

• suffer with claustrophobia - if it is really important to have an MRI scan occasionally they are done with sedation (giving you medication beforehand to make you relaxed) or under a general anaesthetic (with you asleep)
  
  
• are unable to lie very still for up to 30-60 minutes
  
  
• have problems with your kidneys so cannot have the injection of the contrast medium, gadolinium(see below)
  
  
• you have had any previous adverse reaction to gadolinium, the contrast medium

You must let the doctors or radiology staff know if any of these apply to you. Please ring the MRI department on:

0115 875 4583. If you don't your scan may not be done.

Is a MRI scan harmful?

MRI scans are very safe and they do not involve ionising radiation that is used for CT scans. However:

• Because you are exposed to very strong magnets it is very important to check you have no metal objects in your body beforehand. You will be asked by the doctor you see in outpatients and the staff in the MRI department about this. If there is doubt an simple X-ray will be done first as this will show up metal objects.

• Generally an MRI scan won't be done if you are pregnant as the effects of MRI scanning of the developing baby are unknown. It is usually avoided in the first 3 months of pregnancy, but it can be done if absolutely necessary. If you are or it is possible you may be pregnant, you should contact the MRI department for advice before the scan by ringing 0115 875 4583.

• You may also have a special 'dye' called a 'contrast medium' injected into one of your veins. This is called gadolinum and is different from the one used in CT scans.  It makes the MRI pictures clearer.

• Gadolinium is a safe drug but a very small number of patients are sensitive to it. Some of the more common side effects include pain at the site of the injection, nausea, vomiting, itching, rash, headache and paresthesia (abnormal skin sensation, such as prickling, burning or tingling).
  
  
• It can very rarely a serious reaction (anaphylactic reaction). The reaction most often starts with a rash, weakness, sweating and difficulty breathing. If you feel ill during or after the test, tell the radiographer straight away. The doctors and radiographers will know what to do if you have this type of reaction and will treat you very quickly.
  
  Rarely the dye may leak outside the vein and cause swelling and pain in your arm (known as extravasation). If this happens let the doctor injecting the drug or radiographer know immediately
• Gadolinium should not be used in patients with reduced kidney function, or hepatorenal syndrome (a condition involving reduced function of the liver and kidneys) since it cause serious damage to the kidneys (nephrogenic systemic fibrosis). It is important that you tell the doctors or radiographer before your scan if you have any history of kidney problems

 How do I prepare for a MRI scan?

There are no special precautions you have to take before having a MRI scan and you can usually eat and drink normally beforehand. It is better to wear clothing that can be removed easily as you may be asked to remove your top clothing and wear a hospital gown. Women may need to remove their bra as the metal clips and underwire can show up on the scan. The radiographer will tell you exactly what you need to wear and remove but you should:

• take off all jewellery or clothing containing metal (zips, buttons, shoes)
  
  
• remove any metal objects from your body such as piercings
  
  
• empty your pockets of coins or keys
  
  
• credit cards, travel cards or similar cards that have a magnetic strip as the scanner may stop them working

What will happen during my scan?

You will have a small tube (cannula) placed in one of the veins in your arms so that the contrast medium can be given into your bloodstream. A specially trained member of staff will ask you to lie on the scanner bed where you will be made as comfortable as possible. If this is not comfortable, please tell the staff as you will need to keep very still during the scan.

Having a MRI scan is a painless test but the machine is very noisy. You will be given some special headphones to wear to protect your ears and reduce the noise. You can listen to music while being scanned so please feel free to bring a CD of your choice

The scanner itself is quite short and is fully open at both ends. There are lights inside the scanner which make it feel quite bright and open and there is a fan that allows plenty of air to flow through. You will be given a buzzer so that you can contact the radiographer at any time. You will be able to speak to the staff and hear them through the headphones.

When you are comfortable and ready, you will be moved on the scanner table by remote control into a narrow scanner tunnel. Staff will continue to talk with you using an intercom.

To see a short video on what happens when you have a MRI scan click on the following link:

http://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/mri-scan

How long does the scan take?

This varies a bit depending on the information the doctors want. Most scans take between 20 to 40 minutes but please be prepared to be in the department for at least one hour.

Will I feel anything?

The scan should be completely painless. The most difficult bit is keeping still. If you move the pictures will be blurred and make it more difficult for the doctors to see what is going on. Make sure that you are as comfortable as possible before the scan starts and try to relax.

Will there be anyone else in the room with me during the scan?

Generally no but the radiographer can see you and can talk to you during the scan to let you know what is happening. If you are particularly anxious, a friend or relative can stay in the room during the scan.

Can I bring my children?

Unfortunately, we are not able to offer childcare facilities and your children cannot go into the scan room with you. If you need to bring children with you, please bring along an adult who can look after them while you are having the test.

What happens after my scan?

You should be able to go home as soon as the scan is over. There are no after-effects from the scan so you will not need any time to recover so you can resume your normal activities as soon as you wish.

Who do I contact if I cannot make or need to change my appointment?

It is really important that you let us know if you cannot attend your appointment so that it can be used by someone else. Please give us as much notice as possible and ring: 0115 875 4583

When will I get the results?

Unfortunately you will not be given the results by the Radiographer at the time of the test. The MRI scan will need to be reported by a Radiologist and this will be then made available to the requesting doctor. You may have to wait until your next appointment at the hospital to get the results.

 

Where is it done?
QMC Campus

City Campus

Kings Mill Hospital Campus

If you are an in-patient at the QMC Campus (or City Campus) you will be taken down to the MRI scanning department.

For further information please click on the following link:
http://www.cancerresearchuk.org/about-cancer/cancers-in-general/tests/mri-scan