You believe that you have gallbladder issues, what now?

Diagnostic tests are very important to determine the health of your gallbladder if you believe you are having issues.

CT scans, MRI’s, and ultrasounds can be used to create pictures of your gallbladder to determine if you have gallstones, bile duct issues, or tumors.

A HIDA scan can be used to determine the functionality of your gallbladder.

Finally, endoscopic retrograde cholangiopancreatography are magnetic resource cholangiopancreatography used to diagnose bile duct issues and ERC can remove gallstones from the ducts if needed.

CT Scan ^{1 2}

CT scans were introduced to the medical diagnostic world in the 1970s. Since then, they have become one of the most common scanning procedures done today. CT scans should only be used when needed and when an MRI, x-ray, or ultrasound cannot be used for diagnosis. This precaution should be noted because of the increased ionizing radiation, which occurs during the CT scan.

During a CT scan, you will be placed on a mobile platform that goes into a rotating machine and uses ionizing radiation and cameras to take pictures of your body during the scan. As far as its diagnostic potential, CT Scans produce a 3D x-ray picture, and produce better quality pictures of your organs than all other scans.

The problems with using a CT scan for diagnostics are the excess ionizing radiation and contrast dye. The excess ionizing radiation, depending on the exposed area, magnifies the amount absorbed by the body. For example, the average amount of background radiation your average person absorbs is 2.4 mSv a year. When you receive an abdomen CT, you get at least four years of background radiation at one time concentrated on a specific location on the body. It does not seem like a lot, but some people have multiple CT Scans over a period of time. The radiation exposure from a CT scan and contrast dyes are cumulative.

The contrast dye used for CT scans is known to cause allergic reactions in some people (radioactive iodine more than barium.) Radioactive iodine should only be used in people with properly functioning kidneys. The use of barium is fine for most people, but it should be used cautiously in if you have elevated blood pressure.

Endoscopic Retrograde Cholangiopancreatography ^{3 4}

Endoscopic retrograde cholangiopancreatography is a complex diagnostic procedure that combines the use of endoscopy and fluoroscopy to diagnose and even treat gallbladder and pancreatic duct issues. ERC can be helpful in the diagnosis of bile duct issues, tumors, pancreatic dysfunction, and pancreatitis. ERC is a very invasive procedure and has major risks including pancreatitis (occurs in up to 5% of procedures,) injury to the bile ducts, gut perforation, infection, and issues that arise from surgical sedation. Magnetic resource cholangiopancreatography has replaced ERC as the diagnostic gold standard of bile duct health. ERC can still be used to remove stones blocking the bile duct as needed and might be safer than other methods and surgeries to remove them.

HIDA Scan ^{5 6}

HIDA scan is a diagnostic scan used to determine the total functionality of the gallbladder. During the exam a radioactive tracer is injected into your body. Your body handles the tracer like bile, and sends the tracer through your biliary cycle. A gamma camera takes pictures and tracks the flow of the tracer throughout your digestive system. A HIDA scan can be useful in estimating gallbladder and liver health, bile duct health, and diagnosing bile duct obstructions, abnormality, and leaks. The rate at which bile is released from your gallbladder is your gallbladder ejection fraction. Normal gallbladder ejection fraction ranges from 35 – 75% and may fluctuate depending on when the test was performed. The test takes about an hour to perform.

If you have gallstones and they are removed, your gallbladder ejection fraction percentage and health might improve if they were causing issues. Treating duodenum, gallbladder, or bile duct overgrowth can also improve your score. Finally, improving liver and pancreatic function if you are having issues with those organs might improve a low score as well.

Risks associated with a HIDA scan are low but include allergic reactions to the tracer element, bruising at the injection site, anxiety from the injected CCK, and rash development. A small amount of radiation is dosed to you through the radioactive tracer but it should be low enough to not warrant much concern. The gamma camera gives off no radiation during the study.

HIDA scan should not be the end all test to determine if your gallbladder should be removed.

MRI ^{7 8}

MRI is an imaging technology this is used to visualize internal structures of the body in great detail. An MRI does not use ionizing radiation when imaging but instead uses magnetic fields. Even though, MRI use has been associated with RF radiation exposure I still believe that it is a safer alternative to CT scan ionizing radiation. During an MRI, a person lies on a moveable platform that moves the person into a tunnel. A powerful magnet and imaging equipment is housed within the chassis. Contrast dyes are occasionally given during the MRI to improve imaging quality but I do not recommend the use of gadolinium contrast dye for any MRI diagnostic procedure because of the risk of severe side effects.

An MRI provides good contrast images between different soft tissues of the body, and it does not use ionizing radiation like CT scans and X-rays. There are some complications of using an MRI, however. MRI machines are not as widely available as CT scans, are slower and cost more than other scans. In addition, if you have any ferromagnetic material in your body, an MRI is contraindicated because the magnetic field might pull the metal out of your body severely injuring you. Some people become claustrophobic in the MRI machine because they are placed into a confined space. Finally, there have been some reports of people dying from metal (oxygen tanks) being placed in the room when a MRI scan has taken place, so make sure your technician spot checks that all magnetic metal is removed from the room before your MRI starts.

MRI can be used to do magnetic resource cholangiopancreatography which is non invasive and is considered safer than endoscopic retrograde cholangiopancreatography. Contrast material may have to be used during the procedure for a proper diagnosis.

Ultrasound ^{9 10}

Ultrasound is one of the safest diagnostic imaging techniques that is both noninvasive to the body itself most of the time and uses no ionizing radiation. An ultrasound machine uses sound waves to penetrate tissues to a desired depth and send back images. Ultrasounds do expose the body to an excess of RF radiation, but I still believe that the amount the body would absorb from the ultrasound is safer than using ionizing radiation scans.

Ultrasound is great for imaging muscle, soft tissue, and organs. It can also render “live” images, which can be more useful than X-rays or CT scans that must be developed for later viewing. Ultrasounds are a lot less expensive to perform compared to MRI’s or CT scans.

The main limitation of ultrasounds is that bone provides too much resistance to the RF radiation; this makes ultrasound imagery of organs like the brain limited because of the skull. Gas in the gastrointestinal tract also might cause some distortions and can make organs like the pancreas hard to see. Body fat may also distort the image. Finally, the ultrasound technician must be highly qualified so that the quality images are assured. Accurate images will help physicians recommend the best treatment.

During an ultrasound, you will be instructed to lie on an examination table. The ultrasound probe is coated in conductive lubricate and placed near the area that needs to be examined. Images are then taken of the area. Ultrasounds usually run ten to twenty minutes.