The different types of radiological examinations run the gamut of subjective experience; some are relatively benign, others have varying degrees of discomfort, pain, and inconvenience associated with them. Below is a list of several examinations using various imaging modalities; the potential for discomfort will be described and rated using a completely arbitrary scoring system (the "uh, that sounds about right" method). Scores are out of 10, with 0 being not uncomfortable at all and 10 being so uncomfortable that you might be temped to leave during the procedure.

Plain chest x-ray, PA (postero-anterior, also known as "frontal") and lateral views: This one’s a cinch – all you have to do is take a deep breath and hold it during the exposure for the frontal view and raise your hands over your head and hold your breath during the exposure for the lateral view. Most people have no problem with a chest x-ray, but asthma, bronchitis, pneumonia, COPD, and other obstructive lung diseases may pose a challenge when holding one’s breath. Also, debilitating illness may make you too weak to stand up. But overall, the plain chest x-ray is pretty benign. Rating: 1 (4 if you have an obstructive lung disease or are just debilitated enough to stand but not debilitated enough that your doctor ordered a portable AP view of the chest.)

Transabdominal pelvic ultrasound: This exam is painless; it’s the preparation for the exam that can pose a problem. In order to visualize the pelvic organs through the structures of the lower abdomen, the bladder has to be full. Sometimes the filling of your bladder may not coordinate with a backlogged ultrasound department schedule, leaving you with an urgent need to void. But if you void, you’ll just have to fill your bladder again and you might lose your place in the schedule. So you’ll squirm in your seat in the waiting room, and once it’s your turn, the examiner will squirt gel all over your belly and then push down on the region of your distended bladder. Most people do not enjoy this. Rating: 3

Transvaginal pelvic ultrasound: Here’s the trade-off: you don’t have to fill your bladder, but you do have to have a transducer a bit bigger and longer than a super-size tampon inserted into your vagina and moved around as images are taken. If you have pelvic pain, this could incite more pain. If you don’t, it’s just your own comfort level with having things placed in your vagina in the name of medicine that will frame your experience during this examination. Rating: 2

Transrectal ultrasound of the prostate (TRUSP): Men usually don’t like this one. A medium-to-large sized probe is covered with a condom and loaded up with lubrication, then it’s inserted into the rectum to visualize the prostate gland. Some pictures are taken and then you’re done – except if you have a suspiciously high level of PSA or a nodule. Then a special biopsy tool (called a "gun" in the world of radiology) will be loaded with a biopsy needle and threaded through the top of the probe and a minimum of 6 specimens will be taken. Each time, you will feel the pressure of the insertion of the needle, and then you’ll hear a loud click as the mechanism is released. Immediately thereafter, you will feel a sharp pinch in the region of your prostate. After the examination, you will not be able to leave the ultrasound suite until you can produce a bloodless urine specimen. Ratings - without biopsy: 4; with biopsy: 8

Mammogram: Have you heard the saying "If it doesn’t hurt, it’s not a good mammogram"? Unfortunately, this is true. Here’s why: a complete mammogram should cover all the breast tissue, some of which extends up into the area of the armpit; this tissue needs to be pulled down and held in place for proper imaging. Also, the more compressed the breast tissue is, the easier it is to read the mammogram; the results will also be more accurate. So this relegates women of mammogram age (recommendations seem to vary year to year) to experiencing painful tugging and squishing of their breasts about once a year. Rating: 7

Upper GI series: This study involves drinking barium and having multiple images taken of your esophagus, stomach, and duodenum. If a "small bowel follow-through" is ordered, you will have to wait around as the barium moves through the jejunum and ileum and have more pictures taken. Besides the chalky taste of the barium that has never been successfully masked by cherry, strawberry, or pina colada flavoring by manufacturers, there are a few other components of this exam that may be uncomfortable to endure. In some institutions, patients are given a shot of glucagon to increase the emptying time of the stomach (and allow for more fluoroscopic examination); this will be administered with a tiny needle directly into a vein. Some people faint when they see their own blood pulled back into the syringe, but most people are just fine. Prior to the ingestion of the barium, you may be given a cup of water into which a packet of "fizzies" (technical radiological term) has been poured; you will be asked to drink it down in one big gulp and then you will be instructed not to burp. This can be a challenge for some people, who will invariably belch and release all that air meant to expand the stomach to allow for better visualization of its morphology. After you drink the fizzies, you will be given the barium. Some people drink it down without a problem; others throw it up. Most people are somewhere in between these two extremes. The radiologist will be using the fluoroscope to watch you swallow the barium (you are standing up at this point); once it’s all down, the table will be rotated and you will find yourself on your back in the dark with a big machine hovering over your chest. You will be asked to turn this way and that, roll over, and hold your breath each time an image is taken. If bowel gets in the way, the radiologist may push on your abdomen with a paddle designed especially for pushing bowels around during barium studies. When the exam is over, you will be allowed to belch and leave, unless you are having a small-bowel follow-through. In this case, you will need to be imaged every 30 minutes or so until there’s barium in the cecum. That can take up to 2 hours or thereabouts. Rating: 5

Air-contrast barium enema: This is not a comfortable examination. The night before, you will have taken a laxative and you will have stopped eating after midnight. Upon arrival at the radiology suite, a plain film of the abdomen will be taken; if necessary, you will receive a cleansing enema. The radiologist will then insert a long enema tube with a balloon tip; the balloon will be inflated so that the tube will not dislodge during the examination. This will feel like firm pressure in your rectum. Then the radiologist will begin to fill your colon up with barium. As the colon is a twisty organ, you will be asked to roll around a lot to cover all the surfaces. Once the barium reaches the cecum, the table will be angled to assist in the drainage and removal of as much of the contrast as possible. Then the air will be insufflated into the colon. Many people experience varying degrees of cramping pain as more and more air is introduced into the barium coated colon. A series of images will be taken; you will have to lie on the table with your colon full of barium and air until the radiographs are developed and the radiologist is satisfied that the anatomy has been sufficiently documented. Then the air will be released and you will be given a towel and shown to the restroom. Rating: 8

CT scan of the abdomen: People generally tolerate CT examinations relatively well; they are quick and the imaging mechanism doesn’t pose a problem for people with claustrophobia. A proper CT scan of the abdomen involves the drinking of contrast material; while it’s not as distasteful as the barium for an upper GI series, it’s far from delicious. You generally get about an hour to drink it, so it’s not too bad. If visualization of the vasculature is necessary, you will get an injection of iodinated contrast material; some people report a flushing feeling throughout the body immediately after its intravenous injection. Rating: 2

MRI: The only people who have a problem with an MRI are claustrophobics. There are several imaging facilities that have “open MRI” devices that are less daunting and people who have had problems with closed systems usually do well with the open ones. MRI exams are noisy, but they give you earplugs. They can take a long time, depending on which part of the body that’s being imaged. You may be given an injection of gadolinium, but that’s pretty straightforward and doesn’t have the warm sensation of an iodinated contrast injection. Rating: 1

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