A "CT" or "CAT" Scan is a term used to describe a radiological test known as " Computerized Axial Tomography". The CT Scanner is a doughnut-shaped machine that takes pictures of cross-sections of your body. CT can "see" inside your brain, other parts of the body and into areas that cannot be seen on regular X-Rays. CT makes it possible to diagnose certain diseases earlier and more accurately than is possible with the conventional X-Ray.

The test itself is completely painless. You will be asked to lie on the CT Scanner's 'patient couch" during the study. Depending on the type of study being done, you may be injected with or be asked to drink contrast material. A contrast material is a chemical that blocks the X-Rays and therefore outlines the organ or the blood vessel under study. This procedure may be uncomfortable because of the pain during injection or due to the taste in case of the drink.
CT Scanners use X-Rays. For your safety, the amount of radiation is kept to an absolute minimum. However, because X-Rays can harm a developing foetus, be sure to tell your doctor if your are pregnant while a CT Scan is being planned for you.

From start to finish, the picture-taking part of the test usually lasts only 10 to 15 minutes. However, some additional films may be taken if required.

Contrast materials contain iodine, which could cause an allergic reaction in some individuals. Be sure to tell the technologist, nurse or radiologist if you have had an allergic reaction to iodine earlier. Please mention if you have any other allergies too.
Should you have any discomfort during the test or after the injection, tell the technologist. All our CT personnel are trained and certified in managing any allergic reaction due to the contrast agent.

Please do not eat solid food for four hours prior to your CT appointment. You can have clear liquids (coffee or tea without milk, clear soups or juices) during this time in moderate amounts.

Plan to arrive at the CT scan suite at least 15 minutes before your scheduled appointment. This will allow the necessary time to prepare for your paperwork. You will be asked to fill out a brief questionnaire about your medical history, medications and allergies.
However, if you are having a CT Scan of your abdomen or pelvis, you need to arrive 1 hour and 15 minutes before your appointment. You will be asked to drink contrast fluid that helps mark your intestinal tract so that radiologist may interpret your scans properly. It takes 45 minutes to one hour for the contrast to coat your stomach and small intestine.
The CT technician will explain the test to you and answer any questions. Depending on the part of the body being scanned, you may be asked to remove any metal objects such as belts, jewellery etc.

The technician will bring you into the CT Scan room where you will lie down on the "patient couch" (usually on your back). The couch will slide to take you in to the machine. After adjusting the position of the couch, the technician will start taking "pictures" of the body part that is to be examined. It is very important that you do not move during the test.
For example, if your abdomen is being scanned, a series of pictures will be taken from your lower chest down to the upper pelvis. During such a study, you will be asked to hold your breath so that pictures do not get blurred. The machine will make some noise and the couch may move slightly after each picture.

Once enough information has been collected, you may leave and go about your normal activities without restriction.

Your CT films will be reviewed by radiologist who specialize in this type of test. A formal written report is then sent to your referring doctor. Contact your doctor if you want to know about the results.

Extra corporeal sound wave lithography or ESWL sound waves which are high energy, pressure waves are used to break the stones into small pieces, as small as grains of sand. The sound waves which are generated outside the body can break up urinary stones within the body. The stone fragments because of their small size, can pass out of the body along with the urine.

The patient is placed on top of a water filled cushion through which the sound waves pass. By using the Flouroscopy monitors the body is positioned in such a way that the stones are targeted precisely. The shock waves are focused on the stones. Approximately one sound wave is generated per second. Depending on the size of the stone about a couple of treatment sessions are needed to powder the stones. The entire procedure takes about 45-60 minutes.

The main advantages of ESWL is that many patients are treated for urinary stones without surgery.This procedure is painless and doesnot require anaesthesia. This procedure has no complications. Complication of conventional urinary stones surgery and complications of anaesthesia could be avoided. Hospital stay and cost could be greatly reduced. Recovery time is so much reduced that the patient can get back to work in couple of hours.

Generally this procedure is performed on an out patient basis. In contrast, patients who have surgery to remove urinary stones require 10- 12 days of hospital stay, followed by two to five weeks of recuperation at home.

ESWL is a procedure without any major complication. No damage to the kidney has been reported. However some patients have pain, fever or nausea as the stone fragments pass. The symptoms are usually mild and do not last long. They can be relieved with Analgesics. A few patients might pass little blood in the urine, which does not require any special treatment. It will stop on its own in 24 hours time to 48 hours time.urinary tract infection from bacteria may rarely occur.

No, the size, the number, location, composition of the stones and anatomical abnormalities of the collecting system are factors that must betaken into account when explaining treatment option. Through USG examination, X-ray and other tests, the Doctor can decide whether ESWL is the best way of treatment. In other cases ESWL may have to be continued with other forms of treatment. Patients with uncontrolled urinary inflections are not the candidates for ESWL treatment. ESWL treatment cannot be done if, the kidney with the stone has little or no function. Patients with a life threatening cardiac condition or cardiac pacemaker, pregnant women are not suitable for this treatment. After treatment some patients may still have stone fragments that are too large to be passed. These can be treated in two or three sessions and powdered adequately.

Talk to your Doctor about ESWL at ELBIT DIAGNOSTICS. Ask about the preliminary tests that determine whether you are a candidate for lithography.

Although a fair amount is known about a urinary stone, we still do not know the exact reason why stones form. Your Doctor will help you in under standing the cause of stone formation and how to prevent stone formation in the future.

Depending upon the size of the stone, your Doctor will be able to help you.

Elbit has two scanning equipments from two well renowned companies of the world. They are the most advanced and high end equipments currently available.

Almost all region of the body can be scanned except for certain limitations. Ultrasound cannot penetrate the bone and hence structures inside skull like brain cannot be imaged. Ultrasound will be completely reflected by air interface and hence lungs cannot be imaged.

Generally most of the diseases of the abdomino-pelvic organs can be diagnosed by ultrasonography. Many diseases of thyroid, scrotum and breast can be conveniently diagnosed. Certain condition of joints and other abnormalities of limbs can also be diagnosed. In infants, even the brain can be scanned through the normal gaps in the skull bones.

Ultrasound is currently the only effective way to study a growing baby inside the mother. The growing baby can be studied for many morphological abnormalities and hence rule out congenital abnormalities. Most of the structures and organs of the baby can be studied for the structural abnormality. Growth of the baby to be assessed and any deficiency in growth can be diagnosed early, so that appropriate measures can be installed. Complications of pregnancy can also be diagnosed, some of which may be life threatening to mother and baby as well, so that early treatment can be installed.

ABSOLUTELY NO. The ultrasound waves used in scanning do not cause any harm to the body. Till date no harmful effect has been determined to the growing baby by ultrasound scanning.

For abdominal scanning the bowel must be prepared so as to remove gas and faecal matter, so that visualisation of deeper structures becomes easier. Fasting for atleast 6 hrs. is also essential. For pelvic scanning, the urinary bladder should be full and patient should have an urge to pass urine. Scrotum region should be cleanly shaved.

This is a special modified technique in ultrasonography, wherein flowing blood can be imaged through the doppler principle. The flowing blood appear in various colours depending on its direction and velocity and hence the name colour doppler imaging.

The blood circulation to various organs of the body can be assessed by Colour Doppler Images. Of particular use is in upper and lower limbs, kidneys, liver, brain, testis etc., In addition, as a supplement to regular ultrasonography it helps in more accurately diagnosing certain disease. The blood circulation to the growing baby within the mother's womb can also be assessed and hence any deficiencies of it can be corrected. The functioning of the heart is also evaluated and perhaps one of the most usefulness of Colour Doppler Imaging is in echocardiography.

Ultrasound can diagnose most of the abnormalities of the breast. In young women where x-ray - mammography's are not advisable because of radiation, ultrasonography is an very effective method of diagnosing diseases of breast. Currently according to international practice, women below 35 yrs should be imaged only be ultrasonography for any breast abnormalities, so as to prevent radiation.

In males the testicles and genitalia can be studied for abnormalities. The blood circulation to the testicles can also be assessed. With the use of Colour Doppler Imaging, any abnormalities of erection can be assessed. In females abnormalities of internal genital organs like uterus and ovaries can be diagnosed. Ultrasonography is also helpful in assisted conception in infertile couples. With the use of ultrasongraphy guidance and special techniques artifical conception can be achieved in certain conditions.

Treating conditions with the use of ultrasongraphy guidance is called interventional ultrasongoraphy. Also samples from the diseased sites can be obtained for pathological diagnoses by procedures like Fine Needle Aspiration Cytology / Biopsy. Accumulation of pus inside the body organs can be drained using ultrasound guidance without the need for surgery. Certain condition caused by kidney stones, biliary stones can be relieved by intervention under ultrasound guidance. The most significant advantage of ultrasound intervention is in pregnancy, wherein some abnormalities of the baby can be temporally corrected till it is delivered. Also samples can be obtained for accurately diagnosing certain genetic and other abnormalities of the body.

Yes. All the equipments and the expertise needed is available at Elbit. It has all the sophisticated instrumentation and the most qualified and trained specialists available.

Conventional radiography (X-ray imaging) is performed using a film directly, which is exposed to the x-rays. When this exposed film is developed the image appears on the film. CR is a technology wherein this image is digitalised. Instead of the film a special plate is exposed to the x-rays. An invisible image is formed on it. This plate is processed by a digitizer which can read the image on it. The digitizer transfers the image to a computer, where it can be stored, altered (post processing) and manipulated.

The image, which is stored in the computer, can be printed onto a film using a laser camera. This film is developed by a automatic processor. This is the hard copy to the patient. This film is similar to conventional x-ray film, but very superior in quality and resolution.

X-ray images will have two important qualities - resolution and contrast, which are important for diagnosis. Resolution is the clarity, which determines visualisation of minute details. Contrast is the appearance of different structures which further adds to resolve minute details. The resolution and contrast of CR is much superior to that of conventional x-ray films. In addition these can be manipulated on the computer (post processing) to further improve them.

Altering the image on the computer to suitably aid in diagnosing conditions is called post processing. Post processing is like changing brightness and contrast on a T.V, monitor to improve appearance of image.

The image will have enormous amount of information in it. By post processing certain details can be made to appear prominent which helps in accurate diagnosis. This is not possible in conventional x-ray images. In addition, there is no need to repeat the x-ray, if there is minor variation in the exposure leading to sub-optimal image. The image can be suitably post processed to make it optimal, unlike in conventional x-ray imaging wherein it has to be repeated. The radiation to the patient is thus reduced.

The radiation exposure to patient in CR is 1/10th of that to conventional x-ray imaging. This is the most significant advantage to the patient as radiation is hazardous.

Whole body (any part of the body) can be imaged with CR similar to conventional x-ray imaging. In fact, the advantage of CR is excellent quality of images of certain parts of body which are difficult to image - like spine, ear structures, orbits etc., In addition, special radiological procedures like Barium studies (Barium Swallow / Barium Meal / Barium Meal Follow Through / Barium Enema etc.,) urological studies (Intra Venous Urography, Micturating Cysto-Urethrogram, Dynomic Retrograde Urethrograms), Hysterosalpingograms, Sinograms/ Fistulograms etc., can be performed.

Regular general X-ray of the body do not require any special preparation. Only thing there should not be any high density objects (like metals) on the part to be imaged. Special x-rays like KUB and special procedures like Intra Venous Urography and certain Barium studies will need bowel preparation to clear the abdominal, gas and faecal matter. These medications and the procedure needed for these preparation will be advised by the technical staff at Elbit when the patient comes for appointment.

Regular general X-ray of the body do not require any special preparation. Only thing there should not be any high density objects (like metals) on the part to be imaged. Special x-rays like KUB and special procedures like Intra Venous Urography and certain Barium studies will need bowel preparation to clear the abdominal, gas and faecal matter. These medications and the procedure needed for these preparation will be advised by the technical staff at Elbit when the patient comes for appointment.

It is useful for diagnosing diseases of breasts, particularly cancer. Breasts cancer ranks 1st among all cancers in a female. Being one of the leading causes of death, its early detection increases the survival rate. One in every 20 women after 40 years of age is found and have breast cancer.

Mammography needs sophisticated equipment. Individual breasts are examined separately. The breast is positioned between two plate like structures and gentle compression is applied to spread it out. The film when appropriately processed produces the image.

• Every women above 20 yrs who has:

1. Palpable breast mass.
2. Breast symptoms such as pain, tenderness, discharge etc.,

• Every women above 30 yrs who has family history of breast cancer like mother / sister having breast cancer.
• Every women above 40 yrs should undergo screening mammography once in every two years, even if there are no palpable masses or breast symptoms - because early cancers are not palpable and do not produce any symptoms.

With time cancer spreads to surrounding structures and to distant organs also. Breast cancer has a tendency to spread to lymph glands in axilla, bones, lungs, liver, ovaries etc., Early detection and treatment before it spreads gives a complete cure.

Mammograms are performed using X-Rays and X-Rays are known to be harmful. However, the dose of X-Rays used in mammography is very negligible as to cause any harm. In fact the benefits of mammogram are far outweighing than the radiation by it.

Contact the staff at Elbit Medical Center for an appointment for mammogram. Consult the doctors (Radiologists) and get your worries cleared.

It is a functional imaging modality that helps to see and evaluate an Organ by virtue of its function.
For most of the imaging procedures using this modality, an I V Injection of the required dose of radioactive tracer is given. This tracer then localizes in the organ of interest and emits Gamma - Rays from there. The work of imaging is done by the Gamma-Camera which is so called as it detects the Gamma-Rays emanating from that Organ. Thus, we get an image of the organ of interest. The Gamma-Camera can also detect and follow the movement of the tracer in the body and thus help in evaluating the function of that organ.
As nuclear Imaging is based on the Functional Integrity of an Organ - disease process can be identified very early- before any anatomical damage has occurred - thus it is a very sensitive imaging modality.

For most of the diagnostic procedures, a low dose of Gamma-emitters are used. The radiation dose to the patient is minimal - comparable to that of an ordinary chest X-Ray. These investigations at appropriate dosage are safe to be performed even in new-born babies. Also, as the medicines are prepared in Normal Saline, there is no chance of occurrence of any allergic reactions or anaphylaxis.

Nuclear medicine investigations performed at Elbit Medical Diagnostics Limited are:-

1. Thyroid Scan
2. Bone Scan
3. Renal Scan (Scanning of Kidneys)
4. Myocardial Perfusion Scan (Scanning of the heart to identify the presence of blocks in the blood vessels supplying the heart)
5. Lung perfusion Scan
6. Tc-99m RBC Abdominal Scan - (to identify sites of bleeding in the intestines)
7. Meckel's Diverticulum Scan
8. Parathyroid Scan
9. Brain SPECT Scan
10. Liver -Spleen Scan
11. Hepato - Biliary Scan
12. Gastro Oesophaegeal Reflux Studies
13. Testicular Studies
14. Lympho Scinitigraphy
15. Whole body Iodine Scan in Thyroid Cancer
16. Gallium Scan

THERAPEUTIC PROCEDURES Performed are :-

1. I-131 Therapy for Hyperthyroidism
2. Strontium - 89 therapy for Bone pain in patients with metastases to the skeleton
3. Samarium-153-EDTMP therapy for Bone pain in patients having metastases to the skeleton.

An appointment has to be obtained from the Nuclear Medicine department of Elbit Medical Diagnostics limited. Any preparation or restrictions will be conveyed to the patient at this time. You can come at the appointed time and get the test done. Report of the scintigraphic procedure will be available in the same evening at 5:00 p.m If you have any queries or doubts, you can speak to the consultant of Nuclear Medicine in the center.

EEG is a noninvasive procedure & can be done as an out patient procedure. There are no complications of the procedure. The person after having shampoo head bath without applying oil to the hairs can have his usual food & shouldn't be starving. EEG comprises a 30-40 minute recording during awake, resting state, sleep or sometimes sleep deprivation recording using a 10-20 system of electrode placement over the scalp. The recording also includes activation procedures like, over breathing (hyper ventilation) for 5 minutes and phonic stimulation, which enhance the chances of occurrences of seizure discharges. In small children or uncooperative persons sedative drug needs to be given.

EEG is the most preferred cost investigation in patients with epilepsy or seizure disorder, which gives function information of the brain. (C.T. Scan & M.R.I gives structural information of the brain.)

The principle objectives are:

• To clarify the diagnosis of epilepsy or seizure disorder.
• To determine the nature of seizure types and epilepsy syndrome
• In case of partial seizure to identify the localization of seizure onset and in evaluation of surgical treatment of intractable seizure disorder.
• To identify the cause of epilepsy
• To monitor the progression of the condition & consequence of the treatment.
• Does the patient has photo sensitivity or is there is evidence of encephalopathy

EEG is the most preferred cost investigation in patients with epilepsy or seizure disorder, which gives function information of the brain. (C.T. Scan & M.R.I gives structural information of the brain.)

• Epilepsy or any seizure disorder.
• Syncope (fainting or loss of consciousness), which is a common disorder due to various causes EEG, is the most useful test.
• Non epileptic attack disorder(pseudo seizures or hysterical seizures) EEG is the most important test in diagnosis. Panic attacks with autonomic changes, corporeal spasm and twitching of face and limbs mimicking seizures.
• Giddiness, transient cerebral ischaemia/, hypoglycemia, metabolic disorder or encephalopathy.
• Drug poisoning especially antiseptic drugs or sedative drug consumption.
• Infections like Herpes Simplex encephalitis or slow Virus diseases (Kuru)
• Intermittent psychosis (mimicking complex partial seizures), tics, vocal outbursts, migraine movement disorders, drop attacks (mimicking seizure phenomenon).
• Sleep disorders or child having abnormal movements of limbs during sleep appearing like convulsions. Head injury due to road traffic accidents which could be due to faulty riding or a person can have convulsions leading to accident and secondary head injury.

To establish brain death when patients are on life support measures like ventilators. Since, EEG studies are performed between seizure episodes(interictal) , EEG may be normal. A normal EEG does not exclude a diagnosis of seizure disorder. Sometimes serial or many EEG's are done which enhances the likelihood of abnormal recording. Knowledge about patient's age, current medication usage state of consciousness, etc., are needed to appropriately interpret the EEG. It always correlate with patient clinical data. Earlier only analog EEG machines were available and with the availability of computerized EEG machines EEG recording has greatly improved both quantitatively and qualitatively.

Diagnosis and treatment of brain lesions, involved opening of skull and patient had to undergo a major surgery with prolonged hospital stay. Stereotactic Neuro Surgery is a CT Scan assisted precise surgical procedure through a keyhole opening in the skull. This is done by specially trained Neuro Surgeons.

Patient undergoes a CT Scan with contrast after a head ring fixed to the scalp. The brain lesion is identified in relation to the head ring. A keyhole is done under local anesthesia on the skull and the lesion is either biopsied or aspirated as the case may be. The patient is fit to be discharged on the same day or the day after. A repeat scan is done after the surgery to confirm that there is no bleeding at the operated site.

The main advantages are,

• Short Procedure
• Patient is fully conscious during surgery
• Key hole Surgery with no need to open skull
• Short hospital stay
  

The patient needs to be admitted on the same day of surgery and is fit to be discharged the same evening.

This procedure causes minimal brain damage, as it is a precise surgery. Bleeding at the site of surgery and rarely fits are the only few complications.

No. Not all the lesions can be treated. There are specific indications for the surgery. Gliomas, Secondary Malignant Tumor, Infections, Abscess and Fluid Collections in the brain can be treated. The neuro surgeon decides the need for the procedure based on the scan reports.

Meet your neurosurgeon. After preliminary CT Scan/MRI Scan he will decide if you are a candidate for Stereotactic Surgery.

Although most often the amount of tissue removed from the brain is sufficient to diagnose the condition, occasionally the diagnosis will be in conclusive resulting in need for conventional surgery.

Elbit Medical Diagnostics Limited.
No.6/1, Infantry Road, Bangalore - 01
Tel : 080 - 2860365 / 761
Tele Fax : 080 - 2860768

There exists a natural cycle in our bodies which causes a continuous degeneration of old bone cells with a simultaneous building of new ones. These processes are usually in balance, so that the amount of bone loss is about equal to the amount that is replaced. Osteoporosis is caused when there is an imbalance due to which the degeneration outpaces the rebuilding.

Menopause is the single most important cause of Osteoporosis, but you are also at risk if you

• Have a family history of Osteoporosis
• Had menopause before you were 45 years old
• Are thin or small in stature
• Have used steroids ( commonly used to treat asthma and arthritis)
• Have used high doses of thyroid hormones · Smoke · Drink excessive alcohol
• Do not exercise enough
• Have calcium deficiency

In women, the balance between bone building and bone loss is disturbed during menopause due to the hormonal changes occurring at this time. When you are younger, your body produces hormones like estrogen to prepare you for pregnancy. During menopause, however, the level of estrogen produced in your body begins to drop. This drop leads to a faster breakdown of bone tissue and the tissue being replaced can not keep pace with it. In fact, during the first five years after menopause, some women may lose as much as 25 percent of their bone density. In many women, this bone loss is severe enough to make bones weak and fragile. This causes Osteoporosis.
A surgical menopause, which occurs in women who have undergone a surgical removal of ovaries, leads to similar hormonal changes and thereby increases risk of Osteoporosis.

The early stages of Osteoporosis are relatively painless and symptom free. In fact, many women who have undergone menopause do not even realize it when this ailment begins to set in.
But once the symptoms of Osteoporosis begin to surface, these could include

• Pain in the back
• Loss in height · A curving in spine
• A broken bone or a history of broken bones

An X-Ray for some other medical reason could reveal Osteoporosis, although X-Rays only reveal signs of Osteoporosis when bone loss is quite advanced.

Osteoporosis can be detected at an early stage with a routine " Bone Density Test", also called Bone Densitometry.

This may be recommended as a routine test after menopause. You must visit your doctor for a regular check up if you

• Are above 40 years of age
• Have undergone menopause
• Have back pain, height loss or a bone that fractures easily

Bone Densitometry is the most accurate and sensitive method of measuring loss of bone tissue to detect Osteoporosis at an early stage. In addition, periodic repetition of this test can also track the rate of bone loss.

Bone Densitometry is performed with an instrument called a Bone Densitometer. This machine is based on a technology called C-XA which is very accurate, fast, easy to perform and painless.

Care and Guidance

• Calcium plays an important role in maintaining the health of your bones. Make sure you get your daily dose of calcium through a minimum of 3 cups of milk or equivalent in cheese and curd. You could also take a dose of calcium tablet (1000-1500mg/day)
• Regular brisk walking, running, tennis and low-impact aerobics can help increase the strength of your bones.

• From the blood sample serum or plasma is separated and all tests are done using the serum or plasma. The no. of symptoms can be identified through bio chemical tests.
• Elevated Glucose level indicates Diabetes.
• Elevated Cholesterol and Triglycerides indicates risk of Coronary Disease.
• Elevated Bilirubin level indicates Jaundice.
• Elevated Urea, Creatinine levels indicate problems related to Kidneys.
• Abnormal level of hormones indicates malfunctioning of Gonads and Endocrine systems.

Early detection of any form of disorder will help early remedy for that disease, which will other wise leads to serious health complications or eventually to death. Automation is the key to get accurate and precise results that is also available at higher speed.

Department has highly sophisticated fully automated ELISA system TRITURUS, which is the first of its kind installed in India. It has facility to test communicable diseases, Autoimmune diseases, viral diseases etc. Early detection of the disease will not only help in correct treatment but also help in preventing the spreading of the disease in the community.

Haematology deals with study of whole blood and its components. Knowing the blood group is essential, as it is needed in emergencies, either to donate blood or to receive blood.
Low levels of blood-called Anaemia-will help one to know the cause and to correct any to restore the normalcy. Blood cancers are also detected through simple blood test, where early detection is of great help to treat the malice.

Simple chemical, physical and microscopic examinations of urine, stool, sputum, pus and other body fluids help us to know quiet bit different disease status, because of its speed, simplicity and economy many people can afford these tests.

Studying the different disease causing agents through culture and further studying its susceptibility to the antibodies help in a great way to correctly treat the infection through correct medicine.

Study of cells using different staining techniques under microscope will help in detection of diseases at cellular level - mainly many forms of cancers. Early detection help in curing the defect easily and stopping the spread of the disease to other parts of the body.

It is the study of biopsy specimens removed from the body through some surgical procedure. Study will help ascertain the cause and extent of the damage to tissues.

State of art equipments like, Hitachi-902 Autoanalyzer, Hitachi-704 Autoanalyzer, Elecsys-1010- Electrochemiluminiscence Autoanalyzer for hormone and Tumor Marker Assay, Triturus- Fully automated analyzer for ELISA, Swelab cell counter for Haematology, All these Hitech equipments help us to get accurate results.

Prevention in first place, Monitoring of the existing ailment, Prognosis of the treatment etc.

Whenever your physicians suggest or on a periodic time Interval for health check up.

Hardly, 5 min needed to give the samples No hospitalizations or rest needed.

Fasting status is required for many lab tests. But not mandatory for all. A phone call to lab will tell you the exact requirement.