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Patient Information

Diagnostic Testing

X-rays

What is an X-ray?

An x-ray or radiograph is similar to having a photograph taken in a portrait studio. Our doctors use non-visible x-rays (shorter wavelength) to expose film similar to a photographer using visible light to expose film. The exposed radiographic film demonstrates the body structures. X-rays, demonstrate body structures proportionally with their density. The denser the tissue, (bone versus fat) less x-ray reaches the film. This difference in body tissue density is why bone (high body tissue density) is white on a radiograph, as compared to fat (low body tissue density) which is gray or air (no density) which is black.

Why did my doctor order an X-ray?

Radiographs are a reliable and accurate means of obtaining information to help your physician diagnosis the cause of your pain. An x-rays examination is commonly used to determine the presence or absence of disease, a bony fracture, joint mis-alignment, arthritis, or source of other painful conditions.

What should I do to prepare for the examination?

For a routine x-ray examination, no preparation is required. If you are pregnant or think you may be pregnant, be sure to inform your physician, prior to the start of the x-ray examination. Most examinations using x-ray will not be performed on pregnant women unless the benefits of the examination outweigh the risks of radiation exposure to the fetus.

What are the risks?

X-ray uses ionizing radiation. Our doctors are experts in utilizing the minimal dose to achieve optimal results. Lead aprons and shields are used, and the equipment is routinely inspected by the State of New Jersey, for safety and adequate shielding. All examinations are well within permissible levels of diagnostic radiation dosage.

  • Weight bearing X-rays are performed and read on premise.

Magnetic Resonance Imaging (MRI)

What is it?

Magnetic Resonance Imaging (MRI) is a fairly new test that does not use radiation. Rather, magnetic and radio waves are used to create computer-generated images. MRI pictures can scan multiple layers of the spine and show abnormalities of bones and soft tissues, such as nerves and ligaments. The MRI is probably the most commonly used to evaluate the spine.

Why is it done?

The MRI shows the spine in very clear detail, including information about the bones, ligaments, muscles, nerves and discs. It can show if there is a loss of water in the nucleus pulposus, which occurs in the earliest stage of disc degeneration. An MRI can be used to show facet joint arthritis, spinal stenosis (narrowing of the spinal canal), or a herniated disc (protrusion or rupture of the intervertebral disc). The test is useful for diagnosing any condition in which the anatomy of the spine and its soft tissues need to be seen clearly.

How is it done?

You will be asked to lie on a table that slides into a machine with a large, round tunnel. The machine's scanner takes many pictures that are watched and monitored by a technician. The MRI scanner is noisy. You might be offered headphones to listen to music while the scan is taking place. The tunnel that you lie in is narrow and may cause some patients to feel claustrophobic. You might be given a mild sedative to make the experience more tolerable. Newer MRI machines, called open MRI scanners, are sometimes more comfortable for patients who experience claustrophobia. The procedure takes 30-60 minutes.

What are the limitations?

There is little the MRI does not show. However, X-rays and CT scans have a role in adding helpful information in spine conditions that require them.

What are the risks?

There appear to be no known risks associated with exposure to the magnetic waves used during an MRI. These waves can cause problems however, if you have any metal objects in your body that could be attracted to the strong magnetic field. For example if you had any type of metal clips or implants used in a previous surgery, including a pacemaker, make sure to inform the technician. X-rays may be taken of your head before the test to verify there are no metal fragments in your eyes or brain that could move when the magnet is turned on.

All MRI’s are pre-certed by our insurance department and Montvale Health has a personal relationship with the top open and closed MRI facilities in the area allowing patients to be seen immediately and reports generated within 24 hours.

Nerve Conduction Study (NCV)

Nerve Conduction studies test the flow of electrical currents across your nerves. This test will help your physician detect if there is an abnormal nerve condition. NCV is usually ordered in patients who are experiencing weakness or numbness in the arms or legs and can help determine the severity of a nerve injury. NCV is often combined with an Electromyelogram.

How is NCV performed?

Small electrodes are placed on the skin using a water-based gel. The technologist will then stimulate the nerves with an electrical impulse. The reaction of the nerve to the impulse will be recorded by a computer. The results are calculated by the computer to determine the speed of the nerve signal. There may be a slight discomfort during the electrical stimulation portion of the test.

Is there any preparation for a Nerve Conduction Study?

Please keep the area being tested free of any lotions or oils. Wearing these types of products may keep the electrodes from adhering to your skin and will interfere with the results. Also make sure to shower before coming in for the test to also ensure proper electrode adhesion.

Electomyelogram (EMG)

EMG testing, is a two-part electro-diagnostic test that is used to study nerve and muscle function, and it can provide your doctor with specific information about the extent of nerve and/or muscle injury. The test consists of a nerve conduction study and a needle exam for muscle testing.

The nerve conduction study entails stimulating the nerves at different points with small electric shocks, artificially activating them so their function can be measured.

The needle exam involves inserting very fine needles into several muscles with determine normal and abnormal electrical signals given off by the muscles.

EMG testing usually takes anywhere from 30 to 90 minutes, depending on the condition being tested and findings of the study.

Commonly performed by a physiatrist or neurologist trained in this procedure, EMG testing can provide your doctor with specific information about the extent of nerve and/or muscle injury and can also determine the exact location of injury and give some indication whether the damage is reversible.

What should you expect?

There are two parts to EMG testing: a nerve conduction study and a needle exam for muscle testing. Both may result in some discomfort, but are usually well tolerated without the need for medication beforehand. The nerve conduction study entails stimulating the nerves at different points with small electric shocks, artificially activating them so their function can be measured. The needle exam involves inserting very fine needles into several muscles. The needle has a microscopic electrode that picks up both the normal and abnormal electrical signals given off by a muscle. Routinely, your doctor will perform both parts of the procedure, but there are situations where only the nerve conduction or muscle testing is performed.

What you should know before the exam?

An EMG test is extremely safe. EMG needles are used for only one patient, are not recycled, and are immediately disposed of following use. Side effects may include some muscle soreness, which rarely lasts more than an hour or two after the exam. Patients on anticoagulation or blood thinners and those with pacemakers or implanted defibrillators should notify the physician performing the test, but generally this is not a contraindication. Patients with joint replacements or other artificial components in their body do not need to take antibiotics specifically for the EMG. Patients on medication should take their usual medication on the day of the test. No special preparation is necessary.

Why has this test been ordered?

If you have numbness, decreased sensation, tingling, radiating pain, or burning, your doctor may refer you for an EMG. Symptoms such as muscle spasms, weakness, and difficulty buttoning clothes, handling objects, or walking may also indicate the need for an EMG. Conditions that EMG testing helps diagnose include carpal tunnel syndrome, a pinched nerve, radiculopathy, sciatica, neuropathies, muscle diseases, muscular dystrophy, Lou Gehrig’s disease, and myasthenia gravis.

An EMG may be ordered in order for the physician to measure the electrical activities in the muscle.

How is an EMG performed?

A physician will insert small needles (like acupuncture needles) into the muscles of the arms or legs. The needles will be used to measure the electrical signals from the muscles. There is no electrical current applied through the needle.

Is there any preparation for an EMG?

Take your medications as normal unless otherwise instructed. You may follow your regular routine prior to this test. You may eat as normal and can drive yourself to this appointment.

How long will it take for me to have the NCV/EMG tests done?

It will take between 45 – 60 minutes to have both tests completed.

What do I do afterward?

You will be scheduled a follow up appointment with the physician who ordered your test. Go about your regular activities. Results will be discussed with your physician at the time of your follow up.