Procedural sedation may involve one or a combination of the following: a topical numbing medication for the site of needle insertion, a light sedative, anesthetic or medication to reduce your child's memory of discomfort. General anesthesia involves using medication to cause the complete absence of sensation and consciousness by putting the patient to sleep. General anesthesia is only delivered by specially trained pediatric anesthesiologists.

We will always explain the exact procedure to you and answer any questions you may have prior to performing any of the following tests.

Biopsy
A procedure that collects a sample of suspicious tissue which is later examined under a microscope by a pediatric hematopathologist for abnormal cells. There are three types of biopsies used to collect tissue samples:

Needle Biopsy
A method used to diagnose whether cancer cells are present by inserting a needle through the skin into the suspicious site. Your child may feel pressure or discomfort when the needle is inserted. We usually use procedural sedation or general anesthesia to help relax your child and use a local anesthetic to numb the needle insertion site.

Minimally Invasive Surgery
A method of using very small instruments to collect a sample of the suspicious tissue through a small incision. Although this method minimizes trauma to the body, it usually requires procedural sedation or general anesthesia to make your child more comfortable. Some examples of minimally invasive surgery include endoscopy, thorocoscopy or laparoscopy.

Surgical Biopsy
A method used to diagnose whether cancer cells are present by removing a sample of the suspicious site by surgical incision. The biopsy is performed in the operating room, and your child will be put to sleep with general anesthesia during the procedure.

Bone Marrow Aspiration and Biopsy
A procedure that collects a sample of bone marrow, the substance in the center of bones that produces white blood cells, red blood cells and platelets, from your child's hip bone. For an aspiration, a needle is placed in the hip and a syringe is used to withdraw a sample of the bone marrow. If a biopsy is done, a small sliver of bone is taken from the same insertion site. The sample is then examined for abnormalities or to monitor your child's response to treatment. This procedure is usually performed in the clinic, the treatment room of the hospital or the operating room, and your child will receive procedural sedation or general anesthesia so they will be asleep.

Bone Scan
A nuclear medicine test to look at the bones for tumors, metastases, fractures or infection. Your child will receive a small amount of radioactive dye through an intravenous (IV) line 2 hours before the scan. The bones are then examined by a special camera. The dye contains a small amount of radiation (about the same as an X-ray), and your child may need procedural sedation or general anesthesia if they cannot lie still.

Computerized Axial Tomography (CAT or CT) Scan
A CAT or CT scan is an X-ray that takes pictures to provide imaging that helps identify and measure the presence of abnormal cells throughout the body. This is a non-invasive procedure, but procedural sedation or general anesthesia may be used if needed to help your child remain still. In many cases, children will have to swallow and/or receive a contrast by IV to help visualize certain body areas. The procedure takes about 20 minutes.

Creatinine Clearance
A test to measure how well the kidneys are working by collecting all of your child's urine in a container for 24 hours and comparing it to the level of creatinine, a protein, in the blood.

Echocardiogram
An "echo" records movements of the heart's chambers and valves and shows how well your child's heart is functioning. It uses painless ultrasound waves without risk to your child. Sometimes, procedural sedation is needed for

Gallium Scan
Your child will receive a radioactive isotope injected by IV that is only absorbed by certain tissue types. After 72 hours, pictures will show where these cells are present within the body. There is no risk to your child from the radioactive isotope. Often, additional pictures are taken another
2-4 days later.

Glomerular Filtrate Rate (GFR)
A GFR measures kidney function. It is done before and after some chemotherapy treatments. Your child will receive a radioactive dye by IV and undergo a series of timed blood collections to measure how much radioactive dye remains in the blood. Because the kidneys remove waste from the blood, the test helps understand how well the kidneys are working by measuring how quickly the radioactive dye is removed from the blood.

Lumbar Puncture
A procedure that collects a sample of cerebrospinal fluid, also called CSF, which surrounds the brain and spinal cord to determine the presence of cancer cells or progress of treatment. A needle will be inserted between your child's vertebrae to collect a sample to send to the lab for analysis. If your child needs chemotherapy into the spinal fluid, it will be injected slowly through the needle that is already in place. The procedure is usually done in the clinic , the treatment room of the hospital or operating room, and your child will receive procedural sedation or general anesthesia. They may or may not be asleep during the procedure. Some children may get a headache that can be prevented by lying flat for 30 minutes after the procedure.

MIBG Scan
Your child will receive an injection of a radioactive isotope that is only absorbed by certain cells, particularly those that are found in neuroblastoma and pheochromocytoma. After 24 hours, pictures will be taken to identify where activity is occurring within the body. There is no risk to your child from the radioactive isotope.

Positron Emission Tomography (PET) Scan
An imaging technique that produces three dimensional images of the living heart, brain and other organs and measures the metabolic activity of cells in the human body. This test is unique because it produces images of the body's basic biochemistry or function. It is used for diagnosis and management of patients with cancer because cancerous tissues may have different metabolic characteristics than normal tissue. The procedure is non-invasive, but your child may need procedural sedation or general anesthesia if they cannot remain still. Children may not eat or drink for several hours before the procedure. An injection is given right before the test.

Ultrasound
A test that creates a moving picture of the inside of the body to measure blood flow and indicate other necessary diagnostic tests. It utilizes painless ultrasound waves that present no risk to your child.

X-rays
An X-ray takes an internal picture of the bones and organs. They show size and shape, and can be used for many reasons, including diagnosing a possible infection, blockage or tumor.