LUMBAR PUNCTURE A lumbar puncture is a procedure done to obtain a small sample of cerebral spinal fluid (CSF), which is the fluid that surrounds and protects our brains and spinal cords. CSF is made continually by our bodies, so the small amount removed is quickly replaced. The central nervous system (brain, spinal cord, and CSF) can be a hiding place for leukemia cells, and this test can help determine if any cancer cells have spread to the brain or spinal cord or if there is an infection in the central nervous system. In a lumbar puncture, also referred to as a spinal tap, a needle is inserted into the back between the spaces of the spinal bones (vertebrae) to obtain a sample of CSF. The needle enters the spinal column below the spinal cord to avoid injuring the cord. This test can be uncomfortable, so some children are sedated to help them lie still. The results will help the physicians determine the type of treatment your child will receive. In certain types of cancers, especially leukemia and some lymphomas, a lumbar puncture may be used to deliver chemotherapy directly into the central nervous system. If a bone marrow biopsy is ordered or due at the same time as the lumbar puncture, these procedures will be done together to limit your child’s exposure to sedation. CHEST X RAY Chest X rays have many uses. For instance, they can be used to look for enlarged lymph nodes inside the chest or lungs, to diagnose infections or spread of disease in the lungs, or to check the placement of tubes and that were put in for treatment. CT SCAN A CT (computerized or computed tomography) scan is a computer-assisted X ray that creates detailed pictures of internal organs and tumors. It used to be called a CAT (computerized axial tomography) scan. The CT machine is a doughnut-shaped X-ray camera that moves around a table that the patient lies on. Every second, the camera moves a very small distance around the patient while taking an X ray. A computer puts these X rays together to help the doctors see a cross-sectional, 3-D image from all angles. CT scans are very helpful in diagnosing and following the stage and location of cancer. CT scans are very useful in diagnosing tumors, infections, blood clots, and areas of abnormal bleeding. Some tumors are regularly checked by CT scan during and after treatment to see how effective the treatment has been and if a relapse has occurred. CT scans are painless, but the patient must lie still during the scan. Some children require sedation to help them lie still. If your child’s belly is being scanned, they may be asked to drink a dye that allows organs to be seen more clearly. Some patients may be given a small amount of dye through an intravenous (IV) line, which puts the dye right into their veins. The dye allows organs to be seen more clearly. The dye can cause a warm, flushing feeling. Generally, there are no side effects from either type of dye; however, allergic reactions are possible. Because there is some radiation exposure with this test, your child’s healthcare team will try to minimize how often it is done.
MRI MRI (magnetic resonance imaging) uses radio waves and magnetic fields instead of X rays to create very detailed pictures of parts of the body. A computer translates the pattern of radio waves into images. MRI images are so clear that they are sometimes more useful than X rays or CT scans. This is true for areas of the brain and spinal cord, blood vessels, bones, and some organs of the body. Certain tumors are regularly checked by MRI during and after treatment to determine how effective the treatment is and if a relapse has occurred.
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Association of Pediatric Hematology/Oncology Nurses (APHON)
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