Diagnostic Services diagnosticTesting

At Beth Israel, you benefit from today's most advanced diagnostic techniques and state-of-the-art screening technology for thoracic diseases. In reality, tests are only as good as the doctors reviewing them. You can feel confident at Beth Israel, knowing that New York City’s most talented and diagnostically sensitive doctors are “reading” your test results.

Here are a few of the diagnostic tests we offer:

Arterial blood gas testing
This test measures the acidity (pH) as well as the levels of oxygen and carbon dioxide in your blood, taken from an artery. As blood passes through your lungs, oxygen moves from the lungs into the blood, while carbon dioxide passes from the blood into your lungs. The test is used to check how well your lungs move oxygen into the blood and remove carbon dioxide from the blood.

Barium swallow
This special type of X-ray is used to view abnormalities in the esophagus and stomach that may be causing symptoms such as painful swallowing and abdominal pain. After you swallow a chalky substance containing barium sulfate, X-rays track the solution’s path through your digestive system.

Problems that can be detected with this test include: narrowing or irritation of your esophagus; swallowing disorders; hiatial hernia; ulcers; tumors; and polyps (possibly precancerous growths).

During a biopsy, a small piece of tissue is taken from your body so it can be examined more closely under a microscope. A doctor recommends a biopsy when there is a suspicion of normality. The suspicious area might have been noticed during a physical examination or seen inside the body on an imaging test (for example, a CT or MRI scan).

Biopsies are most often done to look for cancer. But they can also help diagnose a problem or help choose the best treatment in other types of medical situation. There are many kinds of biopsies. The following are those most likely to be recommended by one of our thoracic surgeons:

  • Bronchoscopy
    A lung specialist takes cells from your lung using a long, thin, lighted tube called a bronchoscope, which may be flexible or rigid. It is inserted through your mouth or nose and into your lungs. A tiny camera at its tip lets your doctor see inside your lungs to get the cells.

  • Needle aspiration
    Using a needle, your doctor withdraws tissue from a mass (or “lump”) inside your chest area to determine whether cells are malignant (cancerous) or benign (noncancerous).

  • Thoracentesis(also called a pleural fluid aspiration or a pleural tap)
    The doctor uses a needle to take fluid from around your lungs. The fluid contains the cells that will be studied under the microscope. This type of biopsy can be used to make a diagnosis of lung cancer.

  • Thoracotomy
    This type of biopsy involves surgery, in which the doctor opens up your chest to look for lung cancer. It is used when no other method can provide a diagnosis. While you are under general anesthesia, the surgeon cuts between your ribs to expose your lungs and extract diseased tissue. This will be checked for cancer by the lab.

Bone Scan
This test helps the doctor find the cause of your back pain. It can show damage to the bones, find cancer that has spread to the bones, and keep an eye on infection or trauma to your bones. During the scan, a radioactive substance is injected into a vein in your arm. Over the next few hours, this “tracer” travels through your bloodstream and into your bones. A special camera takes pictures of the tracer in your bones, with bright (“hot”) or dark (“cold”) spots indicating various problems, such as lack of blood supply to the bones, cancer, arthritis or a fracture. Often, a bone scan finds a problem days or even months before it’s revealed by a regular X-ray.

Chest X-ray
An X-ray uses electromagnetic energy beams to produce images of internal tissues, bones and organs on film. A chest X-ray produces images of your chest, lungs, heart, large arteries, ribs and diaphragm. Two views are usually taken: X-rays pass through your chest from the back; and through your chest from one side to the other. A chest X-ray may be ordered if you have signs of tuberculosis, lung cancer or other chest or lung disease.

CT scan
A CT scan (or CAT, as it’s pronounced) stands for "computerized axial tomography." For this test, you lie on a table that slides into a scanning machine. Inside, an X-ray beam rotates around the body while detectors measure how much of the rays pass through the tissues and organs, indicating density. From this information a computer creates images called slices. Slices can be studied individually, or placed together to form a three-dimensional model of the area of the body being studied. A CT scan usually takes just a few minutes, and is painless. CT scans provide excellent information about parts inside the body and tissue density. They permit doctors to detect tumors, and to distinguish between malignant and benign tumors.

Endobronchial ultrasound (EBUS)
EBUS is a procedure that aids in the diagnosis and staging of cancers of the chest. The management of lung and other thoracic cancers depends heavily on the extent of disease, which is based on the involvement of lymph nodes in the center of the chest (the mediastinum). Historically, evaluation of these lymph nodes required an invasive surgical procedure called mediastinoscopy, which entails an incision in the neck and dissection of the lymph nodes off the major vascular and airway structures. In selected cases, mediastinoscopy has been replaced, at least as an initial diagnostic test, by EBUS. EBUS involves passing a long, thin flexible camera called a bronchoscope into the airway under light anesthesia. The airway is visualized and extensively inspected for any abnormalities. Suspicious lymph nodes previously identified on CT scan are located using an ultrasound probe built into the bronchoscope. A thin needle is passed out of the bronchoscope, through the wall of the airway and into the lymph node and a biopsy is taken. Depending on the results of the biopsy, mediastinoscopy may be avoided, but it may still be necessary if the EBUS biopsy is non-diagnostic. Some lymph nodes are difficult to reach using EBUS, and a similar procedure with the probe in the esophagus instead of the airway, called endoscopic ultrasound or EUS, may also be necessary.

The word literally means, looking inside. The procedure involves examining the interior of a hollow organ or cavity (in this case, the chest cavity, or thorax), by inserting an instrument called an endoscope directly into the organ. An endoscopy offers your surgeon and you certain advantages beyond imaging tests like X-rays and CT scans. Imaging tests show the size, shape and location of abnormal features within an organ. However, an endoscopy lets your surgeon also see the color and surface texture of abnormal areas. This gives your surgeon a very clear idea of the problem.

An endoscopy is particular useful in showing if certain cancers have spread into the chest cavity.

During an endoscopy of your chest cavity, while you are under sedation, the endoscope is inserted into your thorax through a small incision. The endoscope typically consists of a tube (rigid or flexible) with a light source and a lens system that lets the surgeon see images of the inside of your chest. An endoscope can have an additional channel through which medical instruments are passed into the body.

This is a technique for examining the esophagus (your food tube), that can also be used to diagnose and even treat certain conditions. The viewing instrument, called an esophagoscope, is a long flexible tube fitted with an eyepiece, lenses and its own light source that illuminates the interior of the esophagus. The procedure is used if you have difficulties swallowing, hoarseness and breathing problems. In cases when a foreign object lodged in the esophagus is causing the problem, it can often be seen and removed by the esophagoscope, thereby letting the patient avoid surgery. The viewing scope can also clip a tissue sample (biopsy) from the esophagus lining, and of a benign (non-cancerous) or malignant (cancerous) growth.

Esophageal Ultrasound (EUS)
In this procedure, the doctor passes an endoscope down your throat and into the esophagus. An endoscope is a lighted, flexible tube-like device that lets the doctor view internal parts and perform certain tasks. The esophagus is located just behind the windpipe, close to certain lymph nodes in the chest where lung cancer can spread. Through a transducer attached to the endoscope, ultrasound images are taken from inside the esophagus to determine if there are enlarged lymph nodes that could contain cancer. If the lymph nodes appear diseased, a hollow needle can be passed though the endoscope to take samples of tissue from them (a biopsy) for examination under a microscope.

Lymph node biopsies and wedge biopsies

Lymph node biopsy: Lymph nodes are part of your immune system, and are found in the neck, behind the ears, in the armpits, in the chest, belly and groin. In healthy people, they are usually hard to feel. When they swell and become tender, it usually indicates an infection, but this can also be caused by cancer. The biopsy involves removing tissue from the node and examining it under a microscope for signs of infection or disease. Tissues can be extracted in several ways:

  • Fine-needle aspiration biopsy in which your doctor inserts a thin needle into your lymph node to remove a sample of cells;

  • Core needle biopsy, in which your doctor inserts a needle with a special tip and removes a tissue sample;

  • Open (surgical) biopsy, in which your doctor makes a small cut in the skin and removes a lymph node – a bigger sample than possible with a needle biopsy.

Wedge biopsy: This involves removing a small, wedge-shaped portion of abnormal tissue along with healthy tissue surrounding the area, for study under a microscope for various diseases, including cancer.

Pulmonary arteriography (or pulmonary angiography)
This procedure uses a special dye and X-rays to evaluate how blood is flowing through the arteries of your lungs (blood vessels carrying blood away from the heart). Your physician can see inside the arteries, and the dye helps detect any blockages to the blood flow. While it also tests for other conditions, pulmonary arteriography is considered the most accurate for detecting a pulmonary embolism—a blockage in an artery of the lung by a substance that has traveled there from elsewhere in the body through the bloodstream, usually a blood clot.

During the procedure, the radiologist inserts a catheter (a thin hollow tube) through a vein, then carefully moves it up into the artery that leads to the lungs. The doctor watches live X-ray images of the area on a monitor, using them as a guide. Once the catheter is in place, dye is injected into it, and X-ray images are taken to see how the dye moves through the lungs’ arteries, testing for free passage.


Pulmonary function testing
This group of tests measures how well your lungs take in and release air. The main test is called a spirometry. By measuring how much air you exhale, and how quickly, the doctor can use the results to diagnose a range of lung diseases. During the test, you are sitting, and breathe into a mouthpiece connected to an instrument called a spirometer.

Spiral CT
During this new type of CT (or CAT) scan, just as with a conventional CT scan, you lie on a table that slides into a scanning machine. Inside the machine, X-ray beams pass through the organs and tissues of your body. A computer uses this information to create images of the area of your body being examined. What is new about the spiral CT scan, is that rather than rotating completely around your body, the X-ray machine follows a spiral path to make cross-sectional pictures of the interior of your body. Benefits include: it makes 3-dimensional pictures of areas within the body; it can detect small abnormal areas better than a conventional CT scan; and the test takes less time than a conventional CT, which typically takes from 15 minutes to an hour.

Spiral CT
If you are having surgery, your doctor may recommend you take a stress test to determine whether your heart will tolerate surgery and anesthesia. The test evaluates your heart function by stressing it with carefully monitored exercise. This pre-surgery cardiac stress test is often performed by a cardiologist, even if you’re not having heart surgery.

Chest Xray

During the stress test, wires to an ECG machine are attached to your chest, and you’ll wear a blood pressure cuff on your arm. As the test starts, you’re asked to perform a low level of exercise, either by walking on a treadmill or pedaling a stationary bike. Every three minutes, the level of exercise goes up. At each stage of exercise, your pulse, blood pressure, and ECG are recorded, along with any symptoms you may be experiencing.

Upper GI series
This series of X-rays helps diagnose problems of the upper GI tract, which includes your esophagus, stomach and duodenum (the first part of the small intestine). The X-rays can help detect ulcers; abnormal growths/ scars or abnormally narrowed areas; hiatal hernia; bulges in the esophagus or intestine wall (called diverticula) and enlarged veins in the esophagus. It can help determine the cause of the following: abdominal pain, nausea, vomiting, swallowing problems; gastroesophageal reflux (the backflow of strong, irritating stomach acids into the esophagus); and unexplained weight loss.

For an Appointment Call
Raja Flores
Andrew J. Kaufman, MD
Chief, Department of Thoracic Surgery
Daniel Nicastri
Ram Reddy
Dong-Seok Lee
Henry Tannous
Andrea Wolf

FREE Lung Cancer Screening

You can get a FREE low-dose CT scan of your chest, which is recognized as the best test for spots (nodules) on the lungs. See if you qualify for a FREE test by calling 212.636.3333