Procedures

Arthrogram and Arthrography

An arthrogram is an X-ray examination of a bone joint. This examination is commonly performed on the shoulder, wrist and knee. It requires injection of a contrast agent—a type of dye—into the joint being examined.

Follow-up care

Your joint may be tender for up to a day after the exam. Report any increased pain or fever to your doctor promptly.

Barium Enema

A barium enema is a diagnostic X-ray examination of the colon (the large intestine) to check for colon cancer, polyps, diverticula or other abnormalities.

Follow-up care

Barium sometimes causes constipation that can be corrected using an over-the-counter laxative. Drinking plenty of water will help constipation. ‚Äč

How to prepare

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949-764-5573 if you have any questions.

IMPORTANT:

Do not follow these instructions if your diagnosis includes Colitis or Bowel Obstruction. If you have Renal Insufficiency, contact your physician for prep instructions.

Purchase from any Pharmacy the 3 items below:

1. Magnesium Citrate Oral Solution 10oz

2. Bisacodyl Tablets 5mg (3 Tablets)

3. Bisacodyl Suppository

Preparations include:

  • 48 hours before exam – clear liquid diet only, may have coffee (no cream), broth, soft drinks, popsicles and apple juice. Drink one 8oz glass of clear fluid every waking hour. NOTE: Diabetics may also have dry toast throughout day.
  • 24 Hours Before Exam: Continue to drink one 8oz glass of clear fluid every waking hour.
  • Noon Liquid lunch: clear soup, plain gelatin, and clear fluids.
  • 4:00p.m. Drink entire contents of Magnesium Citrate Oral Solution (over ice).
  • 5:00p.m. Drink 8oz of clear fluid.
  • 6:00p.m. Liquid dinner: clear soup, plain gelatin and 8oz of clear fluid.
  • 7:00p.m. Take three (3) Bisacodyl Tablets laxative with 8oz of water.
  • 8:00p.m. 8oz of clear fluid.
  • 9:00p.m. 8oz of clear fluid.
  • 10:00p.m. Insert one Bisacodyl Suppository into rectum as far as possible, retain as long as comfort will permit - usually 10 to 15 minutes - before defecating.
  • On appointment day, do not eat or drink anything. It is okay to take necessary medications. BE SURE TO DRINK ALL THE FLUID SPECIFIED. DO NOT DEHYDRATE!
  • Colostomy – Follow same prep except for suppository, unless ordering physician specifies a different preparation. Please bring an extra colostomy bag on day of appointment.

Please complete, print out and bring with you the following forms to your appointment:

Outpatient Medication Reconciliation - Download pdf

Side effects and complications

Patients occasionally report some mild cramping and flatulence after the exam. Report any new, severe pain to your doctor immediately.

What to expect

An inert natural compound, barium sulfate, is introduced into the colon through a narrow tube placed into the rectum. Air often is put into the colon through the same tube. The barium outlines the interior surface of the colon.


While the colon is being filled, the radiologist watches on a video monitor and takes X-ray images with a fluoroscopic X-ray machine. You may be asked to move into different positions to reveal all parts of your colon on the X-rays.


After your colon is full and the radiologist has taken images with the fluoroscope, the technologist also will take a few additional X-rays. Your colon will feel full at this point in the exam, but unless some cramping occurs, most patients do not experience any pain. After the X-rays are checked, you will be allowed to go to the rest room. The procedure takes 45 to 60 minutes to complete.

Hysterosalpingography (HSG)

Hysterosalpingography (HSG) is an X-ray procedure enabling examination and diagnosis of medical conditions of the uterus and fallopian tubes. A hysterosalpingogram generally is ordered to check for blockage in the fallopian tubes causing infertility, or to perform an examination of the fallopian tubes in preparation for tubal reversal surgery. An HSG examination also can be useful in diagnosing uterine tumors, tubal adhesions or injuries to reproductive tissues.

Follow-up care

Ordinarily, no follow-up care is required. However, if any fever, pain, heavy bleeding or symptoms of infection occur, call your physician immediately.

How to prepare

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949-764-5573 if you have any questions.


No preparation or dietary restrictions are required for this exam. The procedure cannot be performed if any possibility of pregnancy exists.
If patient does not have a regular cycle, schedule on patient’s lightest day

If patient has no cycle, schedule on any day

Patient must be completely finished with menstruation with no spotting or bleeding, and be between days 7-14 of cycle.

Patient must not have any unprotected sex starting the first day of menstruation continuing until after the exam has been completed.

Patient should take 2-3 tablets of Aleve or Naproxen prior to exam, unless your physician prescribes a different medication. If you have any questions regarding these medications, please speak with your physician.

Be sure to inform your physician if you have any allergies. If you have been told you are allergic to contrast media or have ever had a reaction to Iodine or any form of contrast media, your doctor may prescribe medications to reduce the risk of an allergic reaction. A Radiology nurse should contact you. If you have not been contacted by a Radiology nurse at least 24 hours prior to your appointment, please contact the Imaging Scheduler immediately.

Please complete, print out and bring with you the following forms to your appointment:

Side effects and complications

Some women experience cramping similar to menstrual cramps following the exam. A small amount of spotting after the exam is a normal reaction. Be sure to tell your physician or the radiologist if you previously experienced allergic reactions to contrast media.

What to expect

You will be asked to recline on an X-ray table and will receive preparation similar to that for a pelvic exam. Under sterile conditions, the doctor will insert a speculum into your vagina, clean your cervix, and then insert a catheter (a slender tube) into your uterus. A small amount of a contrast dye is injected via the catheter through the cervix, filling the uterus and fallopian tubes. The dye makes the organs visible under X-ray exposure. The radiologist or technologist will take a few X-ray images to document what appears on the video monitor.


The actual procedure requires only 20 to 30 minutes to complete, but you should expect your visit to the X-ray department to last about 45 minutes, including registration and preparation.

Intravenous Pyelogram - IVP

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949.764-5573 if you have any questions.

IMPORTANT: Do not follow these instructions if you have Renal Insufficiency, contact your physician for prep instructions:
Purchase from any Pharmacy the 3 items below:

  1. Magnesium Citrate Oral Solution 10oz
  2. Bisacodyl Tablets 5mg (3 Tablets)
  3. Bisacodyl Suppository

Preparations include:

  • Starting at noon the day before your exam, start a clear liquid diet, no dairy products or food. You may have coffee (no cream), broth, soft drinks, popsicles and clear juices, no juice with pulp. Note: Diabetics may also have dry toast throughout the day.
  • 24 Hours Before Exam: Continue to drink one 8oz glass of clear fluid every waking hour.
  • Noon liquid lunch: Clear soup, plain gelatin and clear liquids.
  • 4:00 pm: Drink entire contents of Magnesium Citrate Oral Solution over ice.
  • 5:00 pm: Drink 8 oz. of clear liquid.
  • 6:00 pm: Liquid dinner, clear soup, plain gelatin and 8 oz of clear liquid.
  • 7:00 pm: Take 3 Bisacodyl tablets laxative with 8 oz. of water
  • 8:00 pm: 8 oz. clear fluid
  • 9:00 pm: 8oz clear fluid
  • 10:00 pm: Insert one Bisacodyl Suppository into rectum as far as possible, retain as long as comfort will permit – usually 10-15 mnutes, before eliminating.
  • On appointment day, please drink two 8 oz glasses of water or clear fluid before you arrive.
  • It is ok to take necessary medication.
  • BE SURE TO DRINK ALL THE FLUID SPECIFIED. DO NOT DEHYDRATE.

You should inform your physician if you have any allergies. If you have been told you are allergic to contrast or have ever had a reaction to Iodine or any form of contrast media, your doctor may prescribe medications to reduce the risk of an allergic reaction. A Radiology nurse should contact you. If you have not been contacted by a Radiology nurse at least 24 hours prior to your appointment, please contact the Imaging Scheduler immediately.

If you have diabetes, kidney problems, lupus, surgery on your kidneys or multiple myeloma, you must have lab work that includes a BUN and Creatinine performed within 30 days of your exam. If you are over the age of 65 you must have lab work within 90 days of your exam. This provides us with information regarding your current kidney function. Please call your physician if you have not had this blood work.


If you have been diagnosed with diabetes and/or you are currently taking any of the following medications: Metformin, Gluicophage, Glucophage XR, Fortamet, Riomet, Metaglip, Glucovance, Actoplus Met, Avandament or Junamet, stop taking your medication for a total of 48 hours after your exam. You must contact your physician for alternative medications and instructions prior to your exam.


If you are currently receiving Dialysis; please schedule your dialysis to follow your procedure with Contrast or the following day. It is imperative you have dialysis no later than the following day after you have received contrast for your procedure.

Please complete, print out and bring with you the following forms to your appointment:

Lumbar Puncture

Lumbar puncture (also called a spinal tap) is a minimally invasive, image-guided diagnostic test that involves the removal of a small amount of cerebrospinal fluid—the fluid that surrounds the brain and spinal cord—or an injection of medication or other substance into the lumbar (or lower) region of the spinal column.

How To Prepare

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949.764-5573 if you have any questions.

Please drink fluids starting at 24 hours prior to your exam, so that you are well hydrated.

Drink clear liquids only after midnight the night before until 2 hours before your procedure, and then nothing by mouth.
You will need a driver to drive you home.


If this is also for chemotheraphy treatment, you will need to check in 1 1/2 hours prior to your procedure time.
Beginning several days before the procedure, you will need to discontinue certain medications.

If you are taking Plavix, Coumadin, Warfarin or Pradaxa, must stop 5-7 days prior to your procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.

If you are taking Aspirin, Naprosyn, Ecotrin, Ibuprofen, Advil, Motrin, Aleve, Naproxen or Celebrex on a regular basis, we ask you to stop 5-7 days before your exam procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.


If you take Lovenox, you must stop 12 hours before your procedure.

Stop taking fish oil, flax seed oil, vitamin E, 5 days prior to your procedure.

Tylenol or acetaminophen are not an issue if you are currently taking them.


If your physician has ordered your procedure with radiographic contrast:

  • You should inform your physician if you have any allergies. If you have been told you are allergic to contrast or have ever had a reaction to Iodine or any form of contrast media, your doctor may prescribe medications to reduce the risk of an allergic reaction. A Radiology nurse should contact you. If you have not been contacted by a Radiology nurse at least 24 hours prior to your appointment, please contact the Imaging Scheduler immediately.
  • If you have diabetes, kidney problems, lupus, surgery on your kidneys or multiple myeloma, you must have lab work that includes a BUN and Creatinine performed within 30 days of your exam. If you are over the age of 65 you must have lab work within 90 days of your exam. This provides us with information regarding your current kidney function. Please call your physician if you have not had this blood work.
  • If you are currently receiving Dialysis; please schedule your dialysis to follow your procedure with Contrast or the following day. It is imperative you have dialysis no later than the following day after you have received contrast for your procedure.
  • If you have been diagnosed with diabetes and/or you are currently taking any of the following medications:Metformin, Gluicophage, Glucophage XR, Fortamet, Riomet, Metaglip, Glucovance, Actoplus Met, Avandament or Junamet, stop taking your medication for a total of 48 hours after your exam.You must contact your physician for alternative medications and instructions prior to your exam.
  • We encourage you to hydrate with oral fluids at least 24 hours prior to your study. You may have only clear liquids as well as your necessary medications 2 hours before your exam.
  • If you have prior studies outside of Hoag for a comparison, please bring them to your appointment.
  • You may receive additional specific instructions when you schedule your appointment depending upon the type of procedure that will be performed.

Please complete, print out and bring with you the following forms to your appointment:

Myelography and Myelogram

Myelography is an X-ray examination of the structures within the spinal column.

Follow-up care

We encourage you to lie down, as flat as possible, for at least 24 hours. You may get up to go to the bathroom, but return to bed as soon as possible. We recommend no heavy exercise (including running or lifting) for at least 48 hours.

Please discuss your work activity for the following day with the radiologist or your primary-care physician.

We encourage oral fluids and diet as tolerated. Fluid will help eliminate the contrast medium from your body and help prevent headaches. Persistent nausea and vomiting may cause dehydration and should be reported promptly to your primary-care physician.

You may take over-the-counter headache medication if you develop a slight headache, are not allergic to the product and if you do not have other conditions that would make such medication inadvisable. If you develop a severe headache that over-the-counter medication does not help, or you still have a headache on the second morning following the myelogram, please call the radiologist.

You may return to normal activity after 48 hours, provided you do not experience any abnormal symptoms from the myelogram.

How to prepare

When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949.764-5573 if you have any questions.

Drink fluids starting at 24 hours prior to your exam, so that you are well hydrated. Drink clear liquids only after midnight the night before until 2 hours before your procedure. Then, have nothing by mouth 2 hours prior to procedure.

Please check in 1.5 hours prior to your procedure time. You will be monitored for 2-4 hours after the procedure. You will need a driver to drive you home. You will be instructed not to drive until the following day.
Beginning several days before the procedure, you will need to discontinue certain medications.

  • If you are taking Plavix, Coumadin, Warfarin or Pradaxa, must stop 5-7 days prior to your procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
  • If you are taking Aspirin, Naprosyn, Ecotrin, Ibuprofen, Advil, Motrin, Aleve, Naproxen or Celebrex on a regular basis, we ask you to stop 5-7 days before your exam procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
  • If you take Lovenox, you must stop 12 hours before your procedure.
  • Stop taking fish oil, flax seed oil, vitamin E, 5 days prior to your procedure.
  • Tylenol or acetaminophen are not an issue if you are currently taking them.
  • This procedure requires radiographic contrast:
  • You should inform your physician if you have any allergies. If you have been told you are allergic to contrast or have ever had a reaction to Iodine or any form of contrast media, your doctor may prescribe medications to reduce the risk of an allergic reaction. A Radiology nurse should contact you. If you have not been contacted by a Radiology nurse at least 24 hours prior to your appointment, please contact the Imaging Scheduler immediately.
  • If you have diabetes, kidney problems, lupus, surgery on your kidneys or multiple myeloma, you must have lab work that includes a BUN and Creatinine performed within 30 days of your exam. If you are over the age of 65 you must have lab work within 90 days of your exam. This provides us with information regarding your current kidney function. Please call your physician if you have not had this blood work.
  • If you have been diagnosed with diabetes and/or you are currently taking any of the following medications: Metformin, Gluicophage, Glucophage XR, Fortamet, Riomet, Metaglip, Glucovance, Actoplus Met, Avandament or Junamet, stop taking your medication for a total of 48 hours after your exam. You must contact your physician for alternative medications and instructions prior to your exam
  • If you are currently receiving Dialysis; please schedule your dialysis to follow your procedure with Contrast or the following day. It is imperative you have dialysis no later than the following day after you have received contrast for your procedure.
  • We encourage you to hydrate with oral fluids at least 24 hours prior to your study. You may have only clear liquids as well as your necessary medications 2 hours before your exam.

Please complete, print out and bring with you the following forms to your appointment:

What to expect

The myelogram examination requires injection of a contrast medium (dye) into the spinal canal to enable it to appear on the X-rays. First the skin of the lower back is cleansed, and an NHRA radiologist injects a small amount of local anesthetic to numb the area. That’s followed by an injection of the contrast material into the lower spine, guided by a fluoroscope. The radiologist then studies the spinal canal with the patient in various positions.

The radiologist may tilt the table somewhat to move the liquid along the spinal canal. You will be asked to assume specific positions and to hold your breath while film exposures are being made. Following the examination, the contrast material will dissipate harmlessly. A CT scan of the spine is always ordered to follow a myelogram.

Your visit to the X-ray department probably will last 60 to 90 minutes, although the actual exam takes about 45 minutes. When combined with a CT scan, the procedure requires more time.

Following the procedure, you will be escorted to a recovery area where vital signs and general patient conditions are observed for one to two hours. You will be encouraged to take fluids at this time to help eliminate the contrast material from your body and to prevent headache
One of our neuroradiologists will interpret the films and prepare a report, which will be sent to your physician.

Upper Gastrointestinal – UGI Tract Examination

The upper gastrointestinal (UGI) tract extends from the esophagus to the end of the small bowel. Three separate X-ray examinations may be done, either alone or in combination, to produce images of this system. The exams are:
Esophagram, an examination of the canal in the throat that leads from the mouth to the opening of the stomach
Upper GI (UGI), an examination of the stomach
Small-bowel follow-through (SBFT), an examination of the small intestine


Follow-up care

Drink plenty of water after your exam.


How to prepare


When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949-764-5573 if you have any questions.

  • Do not eat or drink anything (including water) from midnight the night before until after your exam the next day.
  • Do not take any medication, smoke, chew gum, brush your teeth or eat breath mints the day of your exam

Please complete, print out and bring with you the following forms to your appointment:

Side effects and complications


Barium occasionally causes constipation, which can be alleviated by taking an over-the-counter laxative. The barium may produce light-colored stools for several days following the examination


What to expect
Each of these exams requires drinking a contrast medium to make the organs visible on X-rays. You will be given either a barium solution (a thick, chalky substance) or a thinner iodine-based drink. The radiologist will determine which contrast will be used, based on your symptoms and history.
For an esophagram or UGI, the radiologist will use a fluoroscope to watch and take images while you drink. For an SBFT examination, you’ll first drink the contrast and then a technologist will periodically take films of your abdomen until the contrast has traversed the entire length of your small intestine (about 33 feet). When the contrast reaches your large intestine, the radiologist will take some fluoroscopic images.


Esophagrams and UGI exams take about 15 to 30 minutes. A small-bowel exam may take one to three hours, depending upon the speed with which the contrast moves through your small intestine. You will be allowed to sit up, walk around and drink small amounts of water during the intervals between image-taking.


A radiologist will interpret the images and send a report to your physician.