Please report for the examination at least 30 minutes prior to its scheduled time; do remember to bring the referral form with you.
Necessary additional examinations:

• None required.

Preparation for the examination:
• No food for 8 hours preceding the examination
• No liquids, smoking or chewing gum for 4 hours preceding the examination
• In patients from the risk group, including those with artificial heart valves, history of endocarditis, vascular grafts or significantly lowered white blood cell counts, administration of an antibiotic may be necessary immediately prior to the procedure. The decision on the need and mode of administration of the antibiotic is taken by the referring physician.
• Examination cannot be performed without a written consent of the patient.
• Immediately prior to the endoscope insertion, the nurse will anaesthetise the patient's throat by spraying it with 2% lignocaine. It is possible to perform the procedure under general anaesthesia upon prior anaesthesiological consultation.

NOTE - the binding principles of disinfection and sterilisation of endoscopic instruments limit to the minimum the risk of infectious disease transfer (including hepatitis) during endoscopic procedures. In view of the above, current vaccination against infectious diseases (including hepatitis A and/or B) are not mandatory for the procedure.

Drugs
• On the day of examination, take all the routinely taken drugs. The only exception are those lowering the blood glucose level used by diabetics - the manner of taking such drugs should be defined by the referring physician.

Necessary information for the physician
• The patient should provide the documentation of previous endoscopic procedures and medical history reports from the hospital
• Provide information on all diseases and taken drugs.

During the procedure
• Inform about sudden complaints

After the procedure
• Do not eat, drink or smoke for 2 hours after the examination.
• If analgesics and/or hypnotics were used, driving vehicles is not recommended for several hours post the examination.

Necessary additional examinations:
• Not required.

Preparation for the examination:
• The material for Papanicolaou test is collected prior to a gynaecological examination, transvaginal ultrasound examination, bacteriological (culture) or virological tests on vaginal and/or cervical specimens.
• The Papanicolaou test may be performed 2 days after the last menstruation at the earliest and 4 days before the expected menstruation at the latest (best between days 10 and 12 of the cycle - with the 1st day of the cycle being the 1st day of menstruation).
• Discontinue the use of intravaginal drugs/preparations, tampons or vaginal irrigation at least 4 days before the Papanicolaou test.
• Abstain from sexual intercourse at least 24 hours before the Papanicolaou test.
• At least 24 hours before the Papanicolaou test, no gynaecological examination, transvaginal ultrasound examination, or collection of vaginal and/or cervical specimens for bacteriological (culture) or virological tests should be performed.
• In cases of vaginatis, its curing is necessary prior to the collection of Papanicolaou test specimen.

Drugs:
• On the day of examination, all the routinely administered drugs should be taken, with the exception of intravaginal drugs.

Necessary information for the physician:
• Date of last menstruation
• Duration of menstrual cycles (menstrual cycle is counted from the first menstruation day until the first day of the next menstruation)
• History of births, miscarriage, reproductive organ surgeries, treatment of cervical, vaginal or vulvar lesions
• Previous Papanicolaou test, colposcopy and histology results
• Taken drugs, particularly hormone ones

During the procedure:
• Inform the physician/midwife about sudden complaints (e.g. pain) experienced during or immediately after the collection of Papanicolaou test specimen.

Contraindications:
• None - the Papanicolaou test may be performed in females of any age, also in pregnant women; the Papanicolaou test may be repeated numerous times depending on the medical indications specified by the physician.

1. The material for the examination should be provided in the container specially intended for it, available at any pharmacy or treatment room.
2. The container should be clearly signed (first name, surname, age).
3. The spatula included with the container should be used for the specimen collection.
4. The amount of the material placed in the container should correspond to the size of a hazelnut.
5. The container should be closed tightly and placed in a plastic bag.
6. The material for Giardia lamblia testing should be fresh. In the case of longer storage, it should be frozen.

MRI is the most modern and dynamically developing imaging technique using the phenomenon of different behaviour of chemical molecules building the tissues under the influence of strong magnetic field.

The advantage of MRI over other diagnostic methods is the excellent possibility of imaging soft tissues and lesions within them (also blood vessels) and the possibility of obtaining images of layers of individual body parts in any selected plane. This technique is particularly useful in the diagnostics of cerebral and spinal diseases (it enables direct visualisation of spinal disc herniation and the spinal cord) and all the structures forming the joints.

Magnetic Resonance Imaging is also an excellent supplementary examination (after the performance of X-ray, ultrasound and computed tomography scans) in certain diseases of chest, abdominal or lesser pelvic organs. The performance of second phase of the examination, after the intravenous contrast agent administration, is ordered by a radiologist. The contrast agent used in MRI is completely safe for the patient. Its administration is necessary for the posing of unambiguous diagnosis.

The additional advantage of Magnetic Resonance Imaging is the extremely small adverse effect of magnetic radiation as compared with X-rays.

Necessary additional examinations
• As determined by the attending physician.

Preparation for the examination
• Fasting status is not necessary.
• For the trunk examination, a two-piece outfit is recommended, devoid of any metal elements. Any jewellery or removable bridge should be taken out. No external hearing aids, keys, magnetic cards or mobile phones are allowed in the MRI examination room.
• Patients suffering from claustrophobia (fear of staying in small, confined spaces) may take mild sedatives to reduce anxiety.

Drugs
• On the day of examination, all the routinely administered drugs should be taken.

Necessary information for the physician
• The patient should provide the documentation of previous imaging examinations and medical history reports from the hospital.
• The physician should be informed of any allergy to contrast agents or other allergies and renal disorders (particularly patients with the creatinine clearance (GFR) below 30 ml/min) and acute inflammation.

The examination
• During the examination (lasting at least 15-20 min, with possible prolongation depending on the type of diagnosed pathology) the patient should remain immobile, breathe calmly and not very deeply.
• Occasionally, an intravenous contrast agent based on the chemical element, gadolinium, is administered during the examination. Contrast agents used in MRI diagnostics are different from iodine agents applied in computed tomography. The decision on the administration of intravenous contrast agent is made by a radiologist based on the recommendations from the attending physician and patient's status.

During the procedure
• Inform about sudden complaints.

Contraindications
• Contraindications against the examination are medical devices containing electronic elements (e.g. a pacemaker, cochlear implant, brainstem stimulator, insulin pump).
• An absolute contraindication against the examination are ferromagnetic metal filings (that can be magnetised) in the body - particularly in the eye.
• In the case of other metal elements in the patient body, information is required on when they have been implanted and of what alloy they are made. If insufficient information is provided, the technician/physician may refuse the performance of the examination for patient's safety reasons.
• The following do not constitute contraindications against the examination: fixed bridges and dental implants, fixed dental braces, orthopaedic stabilisers (plates and uniting wires, screws), artificial joints, intrauterine devices. It should, however, be borne in mind that the above elements may distort the MRI image and hinder its interpretation if they are located in the examination field.

Computed tomography (CT) uses X-rays to visualise body parts in the horizontal plane with the option of obtaining secondary image reconstruction of other plains as well as 2D and 3D reconstructions. This technique is often used in the diagnostics of bone lesions, particularly small and delicate structures, e.g. ears and sinuses. The examinations are performed at our Medical Centres with the use of latest-generation spiral apparatus by Picker. The short time required for the examination of a relatively large body part, e.g. chest or abdomen with the pelvis, enables the performance of the entire procedure on held breath. Owing to this, results of high quality are obtained, devoid of distortions caused by movement.

Performed examinations: brain, ears, sinuses, chest, abdomen with lesser pelvis, bones and joints (according to the specialist recommendations) also in post-traumatic cases or spinal disc herniation, if there are contraindications against the MRI examination.
Disease entity differentiation or ruling out of pathologies usually requires the second phase of examination after the intravenous contrast agent administration, the decision on which is made by the radiologist. In view of the above, the last (light) meal may be taken 6 hours prior to the planned examination. Diabetic patients undergo the CT scan in the morning.

Immediately prior to the abdominal and lesser pelvic examination, the patient receives oral intestinal agent, necessary for obtaining images of diagnostic value. We only use top-quality contrast agents, safe for the patient. Any potential contraindications against their application are determined by a radiologist.

X-rays are not neutral for the human body, and thus computed tomography examinations are performed when there are rational medical indications for it. The contraindication against the performance of CT scan is pregnancy, while in children it is performed only on the basis of referral from a specialist deciding on the need for this procedure.
Preparation for the examination - computed tomography

Please bring the referral form when reporting for the examination.

Necessary tests
• creatinine and urea

Preparation for the examination
• Light meal is allowed - 3 hours prior to the examination at the latest.
• Adequate hydration prior to the examination is required (still water, neutral liquids).

Drugs
• On the day of examination, all the routinely administered drugs should be taken.
• Patients treated with metformin preparations should discontinue its use 48 h before and 24 h after the examination.

Necessary information for the physician
• The patient should provide the documentation of previous imaging examinations and medical history reports from the hospital.
• The physician should be informed of any allergy to contrast agents or other allergies and renal disorders (particularly patients with the creatinine clearance (GFR) below 30 ml/min).
• The white personnel (physician, nurse, technician) should be informed about pregnancy.

The examination
• Prior to the examination, the patient may be asked to remove jewellery, glasses or external hearing aid - if located near the examined area.
• Intravenous contrast agent administration may be necessary. The decision on administering the intravenous contrast agent is made by the radiologist based on the recommendations from the attending physician and patient's status.

During the procedure
• Inform about sudden complaints.

Contraindications
• An absolute contraindication against the examination is the first trimester of pregnancy. The second and third trimester and relative contraindications - depending on medical recommendations. In case of doubts, the female patient should perform a pregnancy test on her own.

Mammography is a radiological examination of the breast with the use of soft X-rays, i.e. with the voltage of less than 30 kV in the X-ray lamp.

The examination consists in taking X-ray images in two projections for each breast: angle side (mediolateral) and head-to-foot (craniocaudal). In the case of clinical indications, targeted images may be taken. The objective of mammography is obtaining the images of soft tissues of the breast, and thus identification of any irregularities associated with the breast structure and presence of tumours, including primarily cancer. The examination enables the detection of primary focus of less than 1 cm, which after surgery gives complete remission or 5-year symptom-free survival in 90% of patients.

Mammography also enables the visualisation of microcalcifications the identification of which is of high importance in breast cancer diagnostics.
The examination should be performed routinely starting from the age of 35 every 2 years, and above the age of 50 - once a year.

Please bring the referral form when reporting for the examination. The examination is indicated after the age of 35.

Necessary additional examinations
• None required.

Preparation for the examination
• Two-piece outfit is preferred to facilitate undressing from the waist up.
• Bath on the day of examination; do not use talc deodorant, skin balm or cream.
• The optimal time for menstruating women is day 5-10 of the cycle (recommendation increasing the examination value but not the condition for its performance).
• Post-menopausal women may undergo the examination on any day.

Drugs
• On the day of examination, all the routinely administered drugs should be taken.

Necessary information for the physician
• Inform the physician about pregnancy
• Hormone replacement therapy (HRT)
• History of breast surgery.
• The patient should provide the documentation of previous imaging examinations and medical history reports from the hospital.

During the procedure
• Inform about sudden complaints.

Contraindications
• Pregnancy

1. The material for the examination should be provided in the container specially intended for it, available at any pharmacy or treatment room. The container should be clearly signed (first name, surname, age).
2. In the case of urine culture, a special container for this examination is used. The container should be sterile, opened immediately before use, with no interior surfaces being touched.
3. Urine should be collected in the morning, after the morning washing routine of genitourinary area.
4. Unless the physician orders otherwise, urine should be collected from the middle stream (the first portion of urine should be released to the toilet, and the next one collected).
5. The collected material should be delivered to the treatment room within a maximum of 2 hours, if it is stored in a cool place.

Please bring the referral form when reporting for the examination.

Necessary additional examinations
• None required, although the need for an examination should in each case be discussed with a physician.

Preparation for the examination
• Sugar-free liquid diet 2 days prior to examination
• On the day preceding the examination:
- Neutral liquids (still water, bitter: coffee, tea).
- Starting from approx. 2 p.m., the laxative preparation, Fortrans (available on prescription, issued by the referring physician; please read the Patient Information Leaflet before using FORTRANS) should be drunk. It is dissolved in water at the ratio of 1 sachet to 1 litre. Drink 4 litres of Fortrans solution within 5-6 hours. The taste may be improved by adding lemon juice. The preparation should not be given to patients with intestinal obstruction or with symptoms of acute abdomen.
o children and underweight patients - preparation should be discussed with the referring physician.
• No food or drink on the day of examination.

Drugs
• On the day of examination, all the routinely administered drugs should be taken.

Necessary information for the physician
• The patient should provide the documentation of previous imaging examinations and medical history reports from the hospital.
• The patient should inform about pregnancy.

During the procedure
• Inform about sudden complaints.

Contraindications
• Pregnancy

Please bring the referral form and resting ECG results no older than 1 month when reporting for the examination.

Necessary additional examinations
Referral for resting ECG examination performed prior to cardiac stress test is not necessary, since it is performed as the initial phase of the test. The physician performing the cardiac stress test evaluates the preliminary ECG record and makes the final decision on the test performance.

Preparation for the examination
Report 2 h prior to the examination, after a light meal.
Sports outfit is required: sports shoes with soft soles, tracksuit pants or shorts.

Drugs
Take all the recommended drugs on the day of examination. Occasionally, the physician may recommend discontinuance of certain drugs (beta blockers) 48 h prior to the examination. In such cases, the drug should be brought to the test in order to take it after the examination is finished.

Necessary information for the physician
The patient should present the resting ECG results no older than 1 month, and possibly, for inspection (if performed): echocardiography, Holter ECG and previous cardiac stress test results.

During the procedure
• Inform about sudden complaints.

Contraindications
• recent myocardial infarction
• advanced left ventricular failure
• unstable ischaemic heart disease
• atrial fibrillation, serious arrhythmia
• significant heart defect (aortic stenosis)
• mocarditis
• severe arterial hypertension
• pulmonary embolism
• left bundle branch block
• venous thrombosis
• acute infection
• lack of patient consent

Please report for the examination 30 minutes prior to its scheduled time; do remember to bring the referral form with you.
Diabetes sufferers should provide information about the disease at the registration desk while scheduling the examination, since in those patients the procedure should be performed early in the morning.

Necessary additional examinations
• None required.

Preparation for the examination
If the preparations described below cannot be applied, an alternative manner of preparing for the procedure will be determined by the referring physician.

7 days before the examination
• Discontinue iron preparation use.
• Persons taking antiplatelet agents - e.g. Aspirin, Acard, Ticlid - should discontinue them upon prior consultation with the prescribing physician.
• Persons taking anticoagulants - e.g. Sintrom, Syncumar, Acenocoumarol, Warfarin - should contact their attending physician and change the drugs to low-molecular-weight heparin.

4 days before the examination
• Avoid eating raw fruit and vegetables, particularly those with fine seeds, e.g. grapes, raspberries, currants, strawberries, kiwi, figs, tomatoes, cucumbers, and preserves made from them.
• Avoid eating beetroot, wholegrain bread, poppy seed.

The day before the procedure
• Breakfast should be light and not contain carbonated drinks or milk.
• Small lunch is allowed in the early afternoon. This should consist of semi-liquid and easily absorbed produce (e.g. kissel, custard, gruel, yoghurt). Dinner should not be eaten.
• If colonoscopy is scheduled in the morning, the whole preparation should be conducted in the afternoon and evening of the preceding day. In particular:
- at approx. 2 p.m., the main preparations start, i.e. the taking of FORTRANS preparation (available on prescription; the prescription is issued by the referring physician; please read the patient information leaflet prior to using it);
- each Fortrans sachet (four in total) should be dissolved in 1 l of still water (4 l in total); this should be drunk within 5-6 hours;
- to improve the flavour, the solution may be chilled or lemon juice added;
- from the moment of starting taking the Fortrans preparation, do not eat anything; drinking of still water or tea is allowed.
• If colonoscopy is scheduled in the afternoon or evening, the necessary amount of the laxative should be divided in such a manner that the 3 Fortrans sachets dissolved in 3 l of still water should be drunk in the afternoon/evening of the preceding day, while the last Fortrans sachet dissolved in 1 l of still water should be drunk in the morning on the day of the procedure.
The body's response to taking the Fortrans solution will be frequent defecation - ultimately with liquid content.
In the event of difficulties in the preparation for the examination, particularly deterioration in the general feeling, contact with a physician is necessary.

On the day of the procedure
• If colonoscopy is scheduled for the afternoon/evening, drink 1 l of still water with 1 Fortrans sachet dissolved in it, in the morning of the day of the examination.
• If the procedure is to be performed under general anaesthesia - do not eat anything 8 hours before the examination. Do not drink anything either 6 h before the examination!

NOTE - the binding principles of disinfection and sterilisation of endoscopic instruments limit to the minimum the risk of infectious disease transfer (including hepatitis) during endoscopic procedures. In view of the above, current vaccination against infectious diseases (including hepatitis A and/or B) are not mandatory for the procedure.

Drugs
• On the day of examination, take all the routinely taken drugs. The only exception are those lowering the blood glucose level used by diabetics - the manner of taking such drugs should be defined by the referring physician.

Necessary information for the physician
• The patient should provide the documentation of previous endoscopic procedures and medical history reports from the hospital.
• Provide information on all taken drugs.

During the procedure
• Inform about sudden complaints.

After the procedure
If the examination is performed under general anaesthesia:
• the patient stays in the clinic for approx. 2 hours after the procedure,
• the patient should leave the facility under the care of an accompanying person,
• the patient should not drive vehicles for 12 hours after the procedure.