+88 01796-222222 contact@medinova.com.bd

RESPIRATORY CARE

  • Digital Plain Film X-ray
  • Spirometry
  • High Resolution MDCT
  • 3D Virtual Lung CT scan
  • CT Guided FNAC
  • Bronchoscopy
  • Chest Specialist’s consultation

Digital Plain Film X-ray

An unequivocal advantage of digital computed radiography over conventional film radiography is the linear photoluminescence-dose response, which is much greater than that of conventional film. This extremely wide latitude coupled with the facility for image processing produces diagnostic images over a wide range of exposures.

Observer performance studies have shown that computed radiography is just as useful as conventional film radiography for virtually any relevant application. However, post processing of the digital image has to be used to match the digital radiograph to the specific task. Enhancement of the image for one purpose often degrades it for another but is easily achieved in most PACS reporting systems.

Spirometry-Lung Function Test

Spirometry is a test that can help diagnose various lung conditions, most commonly chronic obstructive pulmonary disease (COPD). Spirometry is also used to monitor the severity of some other lung conditions, and their response to treatment.

What is a Spirometer and Spirometry?

Spirometry is the most common of the lung function tests. These tests look at how well your lungs work. Spirometry shows how well you breathe in and out. Breathing in and out can be affected by lung diseases such as chronic obstructive pulmonary disease (COPD), asthma, pulmonary fibrosis and cystic fibrosis.

Spirometry is the name of the test, whilst a spirometer is the device that is used to make the measurements.

There are various spirometer devices made by different companies, but they all measure the same thing. They all have a mouthpiece that you use to blow into the device. A doctor or nurse may ask you to blow into a spirometer (spirometry) if you have chest or lung symptoms.

How is it done?

If it has not already been done, you will have your weight and height measured. For the spirometry itself, you need to breathe into the spirometer machine. First you breathe in fully and then seal your lips around the mouthpiece of the spirometer. You then blow out as fast and as far as you can until your lungs are completely empty. This can take several seconds. You may also be asked to breathe in fully and then breathe out slowly as far as you can.

The image below is of a portable spirometer.

Portable spirometer

A clip may be put on to your nose to make sure that no air escapes from your nose. The measurements may be repeated two or three times to check that the readings are much the same each time you blow into the machine. Sometimes the tests are performed with you in a separate glass cubicle – this can help to obtain more detailed and precise results.

What does the spirometer measure?

Spirometry measures the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. The most common measurements used are:

  • Forced expiratory volume in one second (FEV1). This is the amount of air you can blow out within one second. With normal lungs and airways you can normally blow out most of the air from your lungs within one second.
  • Forced vital capacity (FVC). The total amount of air that you blow out in one breath.
  • FEV1 divided by FVC (FEV1/FVC). Of the total amount of air that you can blow out in one breath, this is the proportion that you can blow out in one second.

What can the measurements show?

A Spirometry reading usually shows one of four main patterns:

  • Normal.
  • An obstructive pattern.
  • A restrictive pattern.
  • A combined obstructive/restrictive pattern.

Normal Spirometry

Normal readings vary, depending on your age, size, and sex. The range of normal readings is published on a chart, and doctors and nurses refer to this chart when they check your spirometry readings.

Obstructive pattern on spirometry

This is typical of diseases that cause narrowed airways. The main conditions that cause narrowing of the airways and an obstructive pattern of spirometry are asthma and COPD. Spirometry can therefore help to diagnose these conditions.

If your airways are narrowed then the amount of air that you can blow out quickly is reduced. So, your FEV1 is reduced and the ratio of FEV1/FVC is lower than normal. As a rule, you are likely to have a disease that causes narrowed airways if:

  • Your FEV1 is less than 80% of the predicted value for your age, sex and size; or your FEV1/FVC ratio is 0.7 or less.

However, with narrowed airways, the total capacity of your lungs is often normal or only mildly reduced. So, with an obstructive pattern, the FVC is often normal or near normal.

Spirometry can also help to assess if treatment (for example, inhalers) opens up the airways. The spirometry readings will improve if the narrowed airways become wider after medication. This is called reversibility. Generally, asthma has more of a reversible element to the airways obstruction, compared with COPD. However, COPD is graded according to severity, in terms of the FEV1 measurement after a bronchodilator medication has been given to open up the airways. This response is not as big as that seen in asthma. As a guide, the following values help to diagnose COPD and its severity:

  • Mild COPD – FEV1 is 80% or more of the predicted value. This effectively means that someone with mild COPD can have normal spirometry after bronchodilator medication.
  • Moderate COPD – FEV1 is 50-79% of the predicted value after a bronchodilator.
  • Severe COPD – FEV1 is 30-49% of the predicted value after a bronchodilator.
  • Very severe COPD – FEV1 is less than 30% of the predicted value after a bronchodilator.

Restrictive pattern on Spirometry

With a restrictive spirometry pattern your FVC is less than the predicted value for your age, sex and size. This is caused by various conditions that affect the lung tissue itself, or affect the capacity of the lungs to expand and hold a normal amount of air. Conditions that cause fibrosis or scarring of the lungs give restrictive patterns on spirometry. Some physical deformities that restrict the expansion of the lungs can also cause a restrictive defect. Your FEV1 is also reduced but this is in proportion to the reduced FVC. So, with a restrictive pattern the ratio of FEV1/FVC is normal.

A combined obstructive and restrictive pattern on Spirometry

In this situation you may have two conditions – for example, asthma plus another lung disorder. Also, some lung conditions have features of both an obstructive and restrictive pattern. An example is cystic fibrosis where there is a lot of mucus in the airways, which causes narrowed airways (the obstructive part of the Spirometry results), and damage to the lung tissue may also occur (leading to the restrictive component).

What preparation is needed before having Spirometry?

You should get instructions from the doctor, nurse, or hospital department that does this test. Always follow these carefully. The instructions may include such things as not to use a bronchodilator inhaler for a set time before the test (several hours or more, depending on the inhaler). Also, not to have alcohol, a heavy meal, or do vigorous exercise for a few hours before the test. Ideally, you should not smoke for 24 hours before the test.

Is there any risk in having spirometry?

Spirometry is a very low-risk test. However, blowing out hard can increase the pressure in your chest, tummy (abdomen) and eyes. So, you may be advised not to have spirometry if you:

  • Have unstable angina.
  • Have had a recent pneumothorax (air trapped between the outside of the lung and the chest wall – often incorrectly called a punctured lung).
  • Have had a recent heart attack or stroke.
  • Have had recent eye or abdominal surgery.
  • Have coughed up blood recently and the cause is not known.

Reversibility testing

Reversibility testing is done in some cases where the diagnosis of the lung condition is not clear. For this test, you will be asked to do spirometry as described above. You will then be given a medicine by inhaler or nebuliser which may open up the airways. A nebuliser allows a medicine to be inhaled like a fine mist, through a mask. The spirometry test is then repeated 30 minutes or so afterwards. The aim of this is to see if your airways open wider with medication or not. Generally, asthma has more of a reversible element to the airways obstruction, compared with COPD.

Bronchoscopy

Bronchoscopy is a procedure that allows your doctor to look inside your lungs’ airways, called the bronchi and bronchioles. The airways carry air from the trachea, or windpipe, to the lungs.

During the procedure, your doctor inserts a thin, flexible tube called a bronchoscope into your nose or mouth. The tube is passed down your throat into your airways. If you have a breathing tube, the bronchoscope can be passed through the tube to your airways. You’ll be given medicine to make you relaxed and sleepy during the procedure.

The bronchoscope has a light and small camera that allows your doctor to see your windpipe and airways and take pictures.

If you have a lot of bleeding in your lungs or a large object stuck in your throat, your doctor may use a bronchoscope with a rigid tube. The rigid tube, which is passed through the mouth, is wider. This allows your doctor to see inside it more easily, treat bleeding, and remove stuck objects.

A rigid bronchoscopy usually is done in a hospital operating room using general anesthesia. The term “anesthesia” refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.

Overview

Bronchoscopy can help find the cause of a lung problem. For example, during the procedure, your doctor may see:

  • A tumor
  • Signs of infection
  • Excess mucus in the airways
  • The site of bleeding
  • A blockage (such as a piece of food) in your airway

Your doctor also may take samples of mucus or tissue from your lungs to test in a laboratory.

Sometimes doctors use bronchoscopy to treat lung problems. For example, the procedure might be done to insert a stent in an airway. An airway stent is a small tube that holds the airway open. It might be used if a tumor or other condition blocks the airway.

In children, bronchoscopy most often is used to remove an object blocking an airway. Sometimes it’s used to find out what’s causing a cough that has lasted for at least a few weeks.

Researchers are studying new types of flexible bronchoscopy. They might make it easier to detect tumors and other lung problems, especially in the lungs’ small airways. These procedures also might make it easier to take fluid and tissue samples from your lungs.

Newer types of bronchoscopy include:

  • Endobronchial ultrasound. This procedure uses sound waves to create pictures of the insides your airways.
  • Fluorescence bronchoscopy. This procedure uses fluorescent light instead of white light to look inside your airways.
  • Virtual bronchoscopy. This procedure uses a new method of computed tomography (to-MOG-rah-fee) scan, or CT scan. Virtual bronchoscopy can create detailed pictures of your airways.

Outlook

Bronchoscopy is a safe procedure. Side effects and complications usually are minor. You may feel hoarse and have a sore throat after the procedure. Minor bleeding, infection, and fever also can occur.

A rare, but more serious risk is a pneumothorax, or collapsed lung. In this condition, air collects in the space around the lungs, which causes one or both lungs to collapse.

Who Needs Bronchoscopy?

Your doctor may recommend bronchoscopy if you have an abnormal chest x ray or chest CT scan. These tests may show a tumor, a pneumothorax(collapsed lung), or signs of an infection.

A chest x ray creates a picture of the structures in your chest, such as your heart and lungs. A chest CT scan uses special x rays to create detailed pictures of the structures in your chest.

Other reasons for needing bronchoscopy include coughing up blood or having a cough that lasts more than a few weeks.

Sometimes doctors use bronchoscopy to treat lung problems. For example, the procedure might be used to:

  • Remove something that’s stuck in an airway (like a piece of food).
  • Place medicine in a lung to treat a lung problem.
  • Insert a stent (small tube) in an airway to hold it open. A stent might be used if a tumor or other condition blocks an airway.

Doctors also can use bronchoscopy to check for swelling in the upper airways and vocal cords of people who were burned around the throat area or who inhaled smoke from a fire.

In children, the procedure most often is used to remove an object blocking an airway.

What To Expect Before Bronchoscopy

Bronchoscopy is done in a hospital or special clinic. To prepare for the procedure, tell your doctor:

  • What medicines you’re taking, including prescription and over-the-counter medicines. It’s helpful to give your doctor a list of your medicines.
  • Whether you’ve had any bleeding problems.
  • Whether you have any allergies to medicines or latex.
  • You’ll be given medicine before the procedure to help you relax. The medicine will make you sleepy, so you should arrange for a ride home after the procedure.

You’ll have to fast (not eat or drink anything) for 6–12 hours before the procedure. Your doctor will let you know the exact amount of time you should fast.

What To Expect During Bronchoscopy

Your doctor will do the bronchoscopy in an exam room at a hospital or special clinic. The procedure usually lasts about 30 minutes. But the entire process, including preparation and recovery time, takes about 4 hours.

Your doctor will give you medicine through an intravenous (IV) line in your bloodstream or by mouth. The medicine will make you relaxed and sleepy.

Your doctor also will squirt or spray a liquid medicine into your nose and throat to numb them. This helps prevent coughing and gagging when the bronchoscope (long, thin tube) is inserted.

Next, your doctor will insert the bronchoscope through your nose or mouth, down your throat, and into your airways. As the tube enters your mouth, you may gag a little. Once it enters your throat, that feeling will go away.

Your doctor will look at your vocal cords and airways through the bronchoscope (which has a light and a small camera).

The animation below shows a bronchoscopy procedure. Click the “start” button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

During the procedure, your doctor may take a sample of lung fluid or tissue for further testing. Samples can be taken using:

  • Bronchoalveolar lavage. For this method, your doctor passes a small amount of saline solution (salt water) through the bronchoscope and into part of your lung. He or she then suctions the salt water back out. The fluid picks up cells and bacteria from the airway, which your doctor can study.
  • Transbronchial lung biopsy. For this method, your doctor inserts forceps into the bronchoscope and takes a small tissue sample from inside the lung.
  • Transbronchial needle aspiration. For this method, your doctor inserts a needle into the bronchoscope and removes cells from the lymph nodes in your lungs. These nodes are small, bean-shaped masses. They trap bacteria and cancer cells and help fight infections.

You may feel short of breath during bronchoscopy, but enough air is getting to your lungs. Your doctor will check your oxygen level. If the level drops, you’ll be given oxygen.

If you have a lot of bleeding in your lungs or a large object stuck in your throat, your doctor may use a bronchoscope with a rigid tube. The rigid tube, which is passed through the mouth, is wider. This allows your doctor to see inside it more easily, treat bleeding, and remove stuck objects.

A rigid bronchoscopy usually is done in a hospital operating room using general anesthesia. The term “anesthesia” refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.

After the procedure is done, your doctor will remove the bronchoscope.

Newer Types of Bronchoscopy

Researchers are studying new types of flexible bronchoscopy. They might make it easier to detect tumors and other lung problems, especially in the lungs’ small airways. These procedures also might make it easier to take fluid and tissue samples from your lungs.

Endobronchial Ultrasound

This procedure is done the same way as a standard flexible bronchoscopy. However, an ultrasound probe is attached to the end of the flexible tube. The probe uses sound waves to create pictures of your lungs. Your doctor can see these pictures on a computer screen.

Fluorescence Bronchoscopy

This procedure also is done the same way as a standard flexible bronchoscopy. However, a fluorescent light is attached to the bronchoscope instead of a white light. Under fluorescent light, tiny tumors look dark red, and healthy tissue looks green.

During the test, your doctor can remove cells from the lymph nodes in your lungs for testing.

Virtual Bronchoscopy

This procedure uses a new method of computed tomography (CT) scan to look inside your lungs. Virtual bronchoscopy uses special x rays to create detailed pictures of your lungs’ airways. A bronchoscope is not used for this procedure.

During the scan, you lie on a table that slides through the center of a tunnel-shaped x-ray machine. X-ray tubes in the scanner rotate around you and take pictures of your lungs and airways.

What To Expect After Bronchoscopy

After bronchoscopy, you’ll need to stay at the hospital or clinic for up to a few hours. If your doctor uses a bronchoscope with a rigid tube, the recovery time is longer. While you’re at the clinic or hospital:

  • You may have a chest x ray if your doctor took a sample of lung tissue. This test will check for a pneumothorax and bleeding. A pneumothorax is a condition in which air collects in the space around the lungs. This can cause one or both lungs to collapse.
  • A nurse will check your breathing and blood pressure.
  • You can’t eat or drink until the numbness in your throat wears off, which will take about 1–2 hours.

After recovery, you’ll need someone to drive you home because you’ll be too sleepy to drive.

If samples of tissue or fluid were taken during the procedure, they’ll be tested in a laboratory (lab). Talk to your doctor about when you’ll get the lab results.

Recovery and Recuperation

Your doctor will let you know when you can return to your normal activities, such as driving, working, and physical activity.

For the first few days, you may have a sore throat, cough, and hoarseness. Call your doctor right away if you:

  • Develop a fever
  • Have chest pain
  • Have trouble breathing
  • Cough up more than a few tablespoons of blood

What Does Bronchoscopy Show?

  • During bronchoscopy, your doctor may see a tumor, signs of an infection, excess mucus in the airways, the site of bleeding, or a blockage in your airway.
  • Endobronchial ultrasound can show enlarged lymph nodes and tumors in and near the airways. Enlarged lymph nodes can suggest an infection or other problem. The procedure also is used to determine the extent of lung cancer.
  • Fluorescence bronchoscopy can show an abnormal lesion that can’t be seen with standard flexible bronchoscopy. Some lesions may become cancerous. When lesions are detected early, they may be easier to treat.
  • Virtual bronchoscopy can show lung problems in the tiny branches of the airways and outside of the airways.
  • Your doctor will use the results of your bronchoscopy to decide how to treat any lung problems that were found. He or she may recommend other tests or procedures.

What Are the Risks of Bronchoscopy?

Bronchoscopy is a safe procedure, and complications usually are minor. They might include:

  • A drop in your oxygen level during the procedure. Your doctor will give you oxygen if this happens.
    Minor bleeding, infection, and fever.
  • A rare, but more serious risk is a pneumothorax, or collapsed lung. In this condition, air collects in the space around the lungs, which causes one or both lungs to collapse.

A small pneumothorax might go away on its own. However, if it interferes with breathing, your doctor may use a chest tube to remove the air.

After bronchoscopy, your doctor may suggest that you have a chest x-ray to check for complications.