CT SCAN CT GUIDED LUNG BIOPSY

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1 CT SCAN CT GUIDED LUNG BIOPSY Information Leaflet Your Health. Our Priority.

2 Page 2 of 8 An appointment has been made for you: Please attend Ward...at.. on. Procedure will be at in the CT department If you are unable to attend this appointment please ring (Monday to Friday, 9am-5pm) as soon as you receive this appointment, so that we can offer it to another patient. Introduction This leaflet tells you about the procedure known as lung biopsy. It explains what is involved and what the possible risks are. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. If you are having the biopsy done as a pre-planned procedure, then you should have plenty of time to discuss the situation with your Consultant and the Radiologist who will be doing the biopsy, and perhaps even your own GP. If you need the biopsy done as a relative emergency, then there may be less time for discussion, but none the less you should have had sufficient explanation before you sign the consent form. Do make sure that you have had enough information before you sign the consent form What is a biopsy? This is a procedure where the Doctor obtains a small sample of tissue so that it can be examined more closely under a microscope by a Pathologist, an expert in making diagnosis from tissue samples. This allows your Consultant to best plan your treatment. What is a CT scan? This is a Computer Tomography scan; you may have already had one. It is a special way of producing pictures of your body using x-rays and a computer. The CT scan enables the Doctor to locate accurately the area of tissue he wants to biopsy. Why do I need a lung biopsy? Other tests that you probably have had performed, such as an x-ray, ultrasound scan or a CT scan, will have shown that there is an area of abnormal tissue inside or immediately next to your lung. From the scan, it is not always possible to say exactly what the abnormality is due to, and the simplest way of finding out is by removing a small piece for a pathologist to examine.

3 Page 3 of 8 Who has made the decision? The Consultant in charge of your case and the radiologist doing the procedure have discussed the situation, and feel that this is the best thing to do. However, you will also have the opportunity for your opinion to be considered. If after discussion with your doctor you don t want the procedure carried out, then you can decide against it. Who will be doing the biopsy? A specialist trained doctor called a Radiologist. Radiologists have special expertise in using scanning equipment, and also in interpreting the images produced. They need to look at these images while carrying out the procedure to guide the biopsy needle to the correct place. Where will the procedure take place? The procedure will take place in the CT scan department on the CT scanner table. How do I prepare for a lung biopsy? You need to be an in-patient in the hospital for the day but you should be discharged about four hours after the procedure. Occasionally you may be asked to stay overnight. Please bring an overnight bag with you just in case. We recommend that you do not wear jewellery as we may have to ask you to remove this during your examination. You should not eat six hours before the biopsy. If you are diabetic special arrangements should be made by your Consultant as it may be difficult for you to starve for that length of time. You need to have some blood taken before the biopsy to check your clotting. You can take your regular medication with small sips of water but no solid food. If you are taking any of the following oral anticoagulants: - Clopidogrel, Warfarin, Apixaban, Rivaroxaban, Dabigatran or Sinthrome, these will need to be stopped prior to the procedure. If no arrangement has been made with you to do this, please contact the Department on If you have any allergies you must let your doctor know. What will happen on arrival on the ward? You will be greeted at the ward Reception and asked to sit in the waiting area. A Nurse will then take you onto the ward to check your details, blood tests will be take in preparation. You will be asked to undress and will be given a cotton gown to wear. You may leave your underwear on but ladies should remove their bra. For your own comfort please bring your own dressing gown and slippers.

4 Page 4 of 8 When it is time, a Porter will take you to the CT scan department where the Radiographer (person trained to operate X-Ray equipment) will escort you into the CT scan room. You will be welcomed into the CT room and introduced to the radiographers, nurses and the Radiologist who will be doing the procedure. The Radiologist (doctor who is specially trained to interpret x-ray images) will explain the procedure to you. You will be given the opportunity to ask any questions you have from reading the information you have been sent. Once the Radiologist is sure you understand he will ask you to sign that you consent to the biopsy being performed. This may have already been done in chest clinic a few days before the biopsy or on the ward before you get transferred to the x- ray department. You will be asked to sit down on the CT scanner table. Depending on the approach used by the Radiologist you will be asked to lie on your back, on your front, or on your side.the Radiology nurse throughout the procedure will monitor your blood pressure, heart rate and oxygen levels. Who will perform the scan? A Radiographer will perform your scan. You will need to lie on the CT table. You may be asked to lie on your back, your front or your side depending on where we need to biopsy. You will be asked to keep very still. When you are comfortable the CT table will move you very slowly towards the hole in the centre of the "polo" shaped scanner; it is not a tunnel. You will be asked to hold your breath at certain time whilst the images are being taken. The scanner will then produce the x-ray 'pictures'. You will not feel anything. These x-ray pictures enable the Radiologist to accurately locate the correct area to obtain the tissue. He will mark the skin surface with a felt tip marker pen. What happens during the biopsy? The Radiologist will clean a small area of skin on your body with an antiseptic solution. You will then have a small injection of local anaesthetic to numb the area concerned. Once the area is numb a tiny cut will be made in your skin and a special needle will be used to withdraw a small amount of tissue. You will be awake during the procedure and fully aware of what is going on and will be required to hold your breath for a few seconds when requested. You may feel a slight pressing sensation as the tissue is collected, as a general rule you will not feel any pain. Occasionally it is necessary to take multiple samples. Following the procedure these samples are taken to the Pathology Department and examined under a microscope.

5 Page 5 of 8 A small plaster will be placed on the skin where the biopsy was taken. The CT guided biopsy will take about 20 minutes. Will it hurt? Most patients undergoing lung biopsy do not complain of any pain. When the local anaesthetic is injected, it may sting to start with, but this soon passes off, and the skin and deeper tissues should then feel numb. Later, you may be aware of some pressure, but the procedure is generally done so quickly, that it does not cause any discomfort at all. There will be a nurse, or another member of clinical staff, standing next to you to look after you. If the procedure does become painful for you, please let them know. What happens after the procedure? You will be taken back to your ward on a trolley or in a chair. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure to make sure that there are no problems. You may cough a little bit of blood after a lung biopsy. This is normal and it should settle down after 10 or 15 minutes. Please let the nurse know if you have coughed up blood. It is important that you rest in bed after your lung biopsy to minimize the risk of complications. Occasionally mild or moderate pain may be experienced following the procedure; this can easily be treated with pain relievers. You may have to have two chest x-rays before you go home to check your lungs for any complications, one x-ray one hour after the procedure and one 4 hours after the procedure. You will probably be allowed to eat and drink 1 hour after the test and may be discharged at approximately 5.00pm on the same day. Sometimes it may be necessary for you to stay in overnight for observation, but we will not know this until after you have had the biopsy. When you go home We strongly advise you not to drive home after this test. Please arrange for someone to collect you from the hospital. If you are discharged at 5.00pm you should rest until the following morning. * For 24 hours following the examination it is IMPORTANT that you are not alone. Please arrange to have an adult friend or relative at home with you. You should not go to work for at least a couple of days following the examination and should not do anything strenuous. You may eat and drink normally. You must not fly for 72 hours after the biopsy; this time limited may be extended if there is a complication from the biopsy. The doctor will tell you before you go home how soon you can fly; please let us know if you have a holiday involving a flight in the weeks following the biopsy. If you experience any new pain or shortness of breath when you are at home, you should report promptly to the Emergency Department taking your discharge slip with you.

6 Page 6 of 8 Are there any risks or complications? A lung biopsy is a safe and common procedure. Unfortunately, like any procedure there is always the risk that a complication may develop, such as pain, bleeding or infection. Sometimes there could be a small collapse of the lung caused by air getting into the space around the lung (pneumothorax). A small collapse does not need any treatment but will be closely monitored by taking chest x- rays following the procedure. Very occasionally the air will need to be drained, either with a needle or with a small tube, put in through the skin which may result in a stay in hospital for a few days. Risks are minimised by performing the procedure under x-ray control, and by using a fine needle. It is very important that you comply fully with the instructions given to you. There is a small risk of bleeding; you may cough up a small amount of blood. Serious bleeding or other problems are rare. Unfortunately, not all biopsies are successful. This may be because, despite taking every possible care, the piece of tissue which has actually been obtained is normal tissue rather than abnormal. Alternatively, although abnormal tissue has been obtained, it may not be enough for the Pathologist to make a definite diagnosis. The Radiologist doing your biopsy may be able to give you some idea as to the chance of obtaining a satisfactory sample. Despite these possible complications, a lung biopsy is normally very safe and is designed to save you from having further procedures. If, you have any further questions regarding the procedure feel free to ask the Radiologist when you arrive in the Department. What are the benefits of a lung biopsy? The results of the samples analysed in the laboratory will give your doctor valuable information about your condition. This information will enable your doctor to provide you with the most appropriate treatment. Are there any alternatives? Lung biopsies can also be done under ultrasound guidance. In this case an ultrasound machine is used to guide the needles into the lung. Some patients are suitable for bronchoscopy where a thin telescope is passed through the nose or mouth to reach the lungs. How do I get the results of my scan? If you have not heard from the Consultant who referred you within three weeks please telephone the Secretary of the Consultant. Do not assume there is nothing you need to know just because you have not been contacted.

7 Page 7 of 8 Finally Some of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Do satisfy yourself that you have received enough information about the procedure before you sign the consent form. For further information visit the Royal College of Radiologist s website at: Contact us If you need any further information about this appointment please contact the CT Department during normal office hours on

8 Page 8 of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number RAD12 Publication date January 2016 Review date October 2018 Department CT Scan, X-Ray A Location Stepping Hill Hospital