What is an X-ray?
An X-ray is a painless, low-risk procedure that uses electromagnetic energy to generate images of the internal structures of the body. As X-rays pass through a patient they are absorbed in varying degrees (depending on the density of the objects they encounter) before being captured on film or digital media on the other side. Dense objects, such as bones or tumours, appear white on an X-ray, while soft tissues, such as skin, fat and muscle, look grey.

Depending on the body part being investigated, technicians may take more than one image, targeting structures that are perpendicular to one another to provide as much information as possible. “It’s the first test we use for most things but it’s not the most complex test,” Dr. Kielar says. “It can answer some questions but not everything. If we don’t see anything on an X-ray and the symptoms are significant, then we’ll move on to another test like a CT scan. It’s more accessible than other tests and there’s less radiation compared to a CT scan.”

What does an X-ray show?
X-rays are particularly good for examining bones (for fractures, osteoporosis or cancer), teeth (dental decay), the chest (breast cancer, blocked blood vessels or lung infections) and the abdomen (digestive issues or blockages).

How long does an X-ray take?
Usually, only a matter of minutes.

How can patients prepare for an X-ray?
There’s nothing they really need to do in advance, Dr. Kielar says. “The technologist will ask you to remove anything, if necessary. If you’re getting an X-ray of your wrist, you don’t want to be wearing a bracelet. If you’re getting a chest X-ray you don’t want to wear a necklace. If you have things that are pierced that you can’t remove, then you leave them.”

Is there anything patients should do after an X-ray?
It depends on the results of the procedure but patients can generally go about their day as normal.

Are there any concerns or risks that accompany an X-ray?
As with any procedure involving low levels of radiation, there are some considerations. “We try to avoid it in people who are pregnant,” Dr. Kielar says. “We won’t X-ray the abdomen if we can help it, but it depends on the situation. We always try not to radiate people who are pregnant and we try to avoid it in children for the same reason. But if you have a fractured wrist, the radiation to the fetus is nothing, essentially, so we can still do the X-ray. We always have lead around and we collimate — meaning the X-ray is very specific to that area — so it’s not all over the place. It only goes to the section we’re interested in.”

How long does it take for results to come back?
“It usually takes a few days, depending on how many X-rays are taken at a particular site and when the radiologist is able to get to it,” Dr. Kielar says. “In the emergency department the results are almost immediate.”

Has the pandemic changed the way X-rays are performed?
“We just clean more in between, that’s it.”

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What is a mammogram?
A mammogram is a screening test that uses X-rays to detect cancer. During the procedure, each breast is compressed between two plates, horizontally and then vertically, for about 10 to 15 seconds while images are taken. “They’re three-dimensional structures that we’re trying to make two-dimensional,” Dr. Kielar says. “We take two images of each breast so we can see it from the front and the side. If you see a picture head on, you can’t tell exactly what’s going on until you look sideways to see what it is you’re actually seeing.”

What does a mammogram show?
Mammograms produce black-and-white images that radiologists examine for signs of cancer. Dense objects, such as bones or tumours, appear white on an X-ray, while soft tissues, such as skin, fat and muscle, look grey. “It’s basically all these different shades of grey,” Dr. Kielar says. “A woman’s breasts can be very dense, so they appear all white like a snowstorm, or they can be almost all fat and look black. The ones that are all fat make it much easier to find cancer. Cancer has a sort of grey or white colour. If somebody has dense breast tissue then it’s already a background of white so it makes it really hard to find cancer.”

How long does a mammogram take?
“Only a few minutes,” Dr. Kielar says. “As long as it takes to squish a breast and take two pictures and then do the other breast.”

How can patients prepare for a mammogram?
Age guidelines vary for the procedure, so patients should talk to their doctor about when they need to start getting mammograms. While some feel age 50 is appropriate, most radiologists believe the process should begin 10 years earlier, at age 40, as younger women tend to get more aggressive cancers. Women who are still of menstrual age should avoiding booking the procedure just before their period as their breasts may be more sensitive.

If they are going for their first mammogram, they should also be aware that their likelihood for being called back for additional images is higher than after the second, third or fourth time. “We don’t want them to feel anxious if they get called back,” Dr. Kielar says. “We’re looking at subtle things in the breast and if you don’t have anything to compare it to we like to be safe rather than sorry. If there’s something concerning we’ll do a biopsy. But even if you’re having a biopsy there’s still a really good chance that it’s nothing, so women need to be aware of that.”

It’s important to remember that, according to the American Cancer Society, only about two to four screening mammograms out of 1,000 result in a cancer diagnosis. Our job is to try to find stuff early on and if we find something that’s looks a little bit different, we have to investigate it.”

Is there anything patients should do after a mammogram?
“They can go about their day,” Dr. Kielar says. “They just need to follow up with their family physician to make sure they get the results.”

Are there any concerns or risks that accompany a mammogram?
Mammograms are generally safe with any risks from the low levels of radiation outweighed by the benefits of the procedure.

How long does it take for results to come back?
Typically, two to three days.

Has the pandemic changed the way mammograms are performed?
Many mammography clinics were forced to close during the first wave of COVID-19 and again during the rise of the omicron variant. “Wait lists have gone up significantly,” Dr. Kielar says. “I don’t know how much they’ve caught up — it’s been tough.”

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What is an angiogram?
An angiogram encompasses a series of diagnostic tests that use X-rays and a contrasting agent, or dye, to generate images of the body’s blood vessels. During the procedure, a long tube called a catheter may be inserted into an artery — usually in the arm, groin or neck — and threaded through blood vessels to help diagnose any issues. “They are usually done by interventional radiologists, which are radiologists who perform more procedures,” says Dr. Kielar. “You go into a room that looks a little like an operating room but it’s got a very fancy machine that moves around you. They may be able to fix things on the spot but they are basically looking at your blood vessels.”

What is a contrast agent?
A contrast agent, or dye, is required for a coronary angiogram — the most common form of angiogram — to make blood vessels more visible to X-rays. Patients may be required to have a blood test prior to the procedure to ensure they are not allergic to the agent and that their blood is able to clot properly.

What does an angiogram show?
Angiograms are extremely useful for detecting the source of abnormalities in blood vessels, including any narrowing or blockages of the body’s arteries. They can help diagnose a wide range of issues, including heart disease, stroke (or the risk of stroke), kidney and liver issues and many forms of vascular disease. “They can try to open up a vessel if its closed or they can put in wires, tubes or stents,” Dr. Kielar says. “It really just depends on what the issue is.”

How long does an angiogram take?
Generally between 30 minutes and two hours. “It just depends on what they’re doing,” Dr. Kielar says.

How can patients prepare for an angiogram?
Clothing/jewelry — Patients will be required to change into a gown before the procedure but angiograms can be invasive tests, so it’s best to have loose-fitting, comfortable clothing to change into afterwards. Jewelry and other valuables should be left at home.
Dietary requirements — “You will probably be asked not to eat for a few hours beforehand if not the night before,” Dr. Kielar says. “They’ll give specific instructions but it really depends on the procedure.”
Bloodwork — Blood tests may be required before the procedure to ensure a patient does not have an allergy to the contrast agent and that their blood has the ability to properly clot.
Medications — Be sure to follow your doctor’s instructions prior to an angiogram as some medications must not be taken before certain procedures.
Support — Patients should arrange to have someone take them to and from their appointment.

Is there anything patients should do after an angiogram?
Patients will typically be monitored for a few hours following the procedure and given instructions to take home with them. They should avoid any strenuous activity after their angiogram and drink plenty of water to help clear the contrast agent from their system.

How long does it take for results to come back?
Results generally take a few days — around the same amount of time as a CT scan or an MRI, according to Dr. Kielar. “We do the procedure, we write the report and we sign off, usually by the end of the day but it can take a couple of days depending on what’s happening. Then the doctor will get it a day or two later. A lot of patients can now read their own reports online. You just have to remember as a patient that it’s going to be written in medicalese.”

Are there any other concerns or risks that accompany an angiogram?
Any procedure performed this close to the heart or brain has some level of risk but major issues are rare and will be discussed with patients ahead of time. Potential complications include stroke, heart attack, kidney damage, infection and excessive bleeding. “Generally speaking, nothing that we do is particularly high risk but I think people at least need to know what they’re getting into,” Dr. Kielar says. “For example, if you’re having something done in your brain, for an aneurism, they may intubate you like they would for a regular surgery. Whereas for most other things, it’s almost nothing.”

How has the pandemic changed the way angiograms are performed?
Like all scans performed by a radiologist, wait times for an angiogram have generally gone from bad to worse, Dr. Kielar says. Interventional radiologists — the professionals who conduct angiograms — have been particularly busy over the past two years. “These guys have probably had the most work required because they also put in chest tubes and pick lines and a lot of people who have COVID need a lot of long-term medication. They have been doing a ton of work for a very long time during COVID.”

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