Abdomen Flashcards
1
Q
What are the routine contrasts used on a Barium swallow (esophogram)? What can be used as an alternative contrast if bowel perforation is suspected (or compromised patient where aspiration should be considered)?
A
Barium Sulfate Air Iodinated contrast (i.e. gastroview)
2
Q
Ultrasound (non-diagnostic and diagnostic) has a frequency of ________ hertz?
A
>20,000 Hertz (20 KHz) Higher than threshold of human hearing
3
Q
Why is IV contrast the best imaging contrast for the Intravenous Pyelogram?
A
The body doesn’t need the IV contrast, therefore it is quickly filtered out of the body through the urinary system.
4
Q
where is the stomach
A
LUQ
5
Q
What anatomy is seen in the CT Spine?
A
All boney anatomy and spinal cord in the spinal section scanned
6
Q
A
chronic pancreatitis
7
Q
where are frequent locations of bowel perforations
A
duodenum (PUD)
colon (diverticulitis, colon cancer, obstruction)
8
Q
Define SBO by the following three factors
air in the rectum
air in the small bowel
air in the large bowel
A
no
multiple dilated loops
no
9
Q
A
flank stripes
10
Q
Why is it important for a patient to be NPO for a fluoroscopic examination of the GI tract.
A
Food particles can mimic lesions within the alimentary canal.
11
Q
Regarding radiation safety, the CT examination should not be repeated without:
A
clinical justification and should be limited to the area of interest. for example: Do not order a CT Cervical, Thoracic and Lumbar spine when the lumbar spine is the area of interest.
12
Q
What is Doppler ultrasound?
A
assesses blood flow (organs, fetus, tumors)
13
Q
where is the spleen
A
LUQ
14
Q
what structures are in the peritoneal cavity
A
bowel, spleen, most of the liver
15
Q
What is the sound reflectivity of fluids? How does it appear on the monitor?
A
Very poor reflectivity Black on monitor
16
Q
Who is responsible for weighing the benefit vs risk of radiation exposure?
A
Ordering provider
17
Q
What is the Federal regulatory principles concerning radiation exposure?
A
Any dose of radiation might cause cancer.
18
Q
What are the indications for a barium swallow (esophogram) study?
A
acid reflux intraluminal lesions strictures obstructions esophageal varicies hiatal hernia foreign bodies
19
Q
A
stomach with foreign body
20
Q
what you look for radiographically for air outside the bowel
A
air under the diaphragm
both sides of the bowel wall
visualization of the falciform ligament
LLDQ, air under the right flank or in women under the right illiac bone
21
Q
A
gall bladder density
22
Q
What determines the image in ultrasound?
A
The reflectivity of the tissue. The sharpest images are the generated by a very strong returning echo (the ball bounces straight back off the wall and not deflected to the side)
23
Q
characteristics of functional ileus
A
one or more loops unable to perform peristalsis
24
Q
What are indications for a CT Chest with Contrast?
A
Lung mass Lung disease General Survey Pleural effusion Trauma
25
kidney and ureter with contrast
26
abnormalties to look on abdominal xray
masses
gasses
foreign bodies
bones
stones
27
stomach with barium
28
What is an example of a higher frequency ultrasound transducer?
Vaginal probes
29
flank stripes
lines nbetween the back and the colon
30
small bowel obstruction
31
small bowel obstruction with air fluid levesl
32
how will retroperitoneal air look
streak, linear that outlides the retroperitoneal structures
mottle appearance
relatively fixed
33
five Dx quickly made with abdominal xray
intraperitoneal free air
bowel obstruction
organomegaly
abnormal masses
abnormal calcifications
34
What is evaluated in a fetal growth assessment?
~Biparietal diameter ~Femur length ~Abdominal circumference ~others
35
defogram
36
kidney and ureter density
37
what are the structures of the large bowel
appendix
cecum
ascending colon
transver colon
splenic flexure
descending colon
signmoid colon
rectum
38
single cs double contrast enema
39
what is the percent chance that renal stone will be visible on xray
50-60%
40
colon cancer (apple core)
41
barium enema
42
generalize adyanamic ileus
43
# Define localized ileus by the following three factors
air in the rectum
air in the small bowel
air in the large bowel
yes
2-3 loops distended
yes, in the sigmoid or rectum
44
what will the diaphragm look like with air under it
it will look curved and very thin
45
LLDQ free air
46
What are disadvantages of ultrasound?
~Can not image through air or bone. ~Sonographer error
47
free air around falciform ligament
48
What are indicated for the Barium Enema Examination?
visualize entire large bowel through retrograde filling. Diverticulosis polyps tumor masses
49
deogram with rectocele
50
Differentiate between: Ultrasonography Sonography Sonogram
basically used interchangeably but... the suffix -ography is the field of study the suffix-gram pertains to the images themselves
51
what is included in a complete abdominal series
supine
prone
upright
LLDQ
52
what is seen in the obstetrical evaluation of an early pregnancy?
Pregnancy location Pregnancy viability multiple gestation
53
what can cause perforation that will lead to retroperitoneal air
ulceratiive disease
ruptured appendix
blunt/penetrating trauma
perforation during sigmoidoscopy
perforated divertuculitis
54
What ultrasound frequency shows better detail, 3 MHz or 5-7 MHz? what is the trade off?
5 MHz can only visualize shallower structures Note: the greater the frequency, the shorter the wavelength.
55
barium swallow (esophagram)
56
What gestational age is best visualized with a trans-abdominal approach?
\> 12 weeks gestation ~morphology & development ~health/viability (Biophysical Profile)
57
What imaging modality has the highest radiation exposure to the patient?
Computerized Axial Tomography (CT Scan)
58
a complete abdomen ultrasound evaluated what organs?
Liver Gallbladder Spleen Pancreas (sometimes Kidneys, dependent on department protocol)
59
What ultrasound examination will show renal artery stenosis with questionable accuracy?
Kidneys
60
When would trans-abdominal ultrasound be preferred over endovaginal ultrasound when evaluating a pregnancy?
Best for fetus \> 12 weeks Best for placenta \> 12 weeks Note: endovaginal probes have a very high frequency and can not penetrate the sound to the depths needed in large gravid uterus.
61
What type of imaging contrast is used for CT Angiography of the Chest? How is it same/different from CT Chest with Contrast?
The same iodinated IV contrast is used. The difference is the rate (bolus) at which it is administered. It is administered faster and will have a greater concentration in the blood that enhances the vascular structures with precision.
62
is oral contrast used in an Intravenous Pyelogram study?
No... oral contrast will conceal the IV contrast filtering through the urinary system.
63
what will ileus look like on xray
1-2 persistantly dilated loops of bowel
air fluid levels
gas in the rectum or sigmoid
64
What are the two different tranducer types for pelvic ultrasound examinations?
Abdominal Vaginal
65
What is a biophysical profile? what is assessed?
assessment for fetal well-being ~Respiratory movements ~Amniotic fluid volume ~Placenta morphology ~others
66
liver
67
What is a transducer?
~the hand held device that converts energy (what makes contact with the patient). Step 1-It converts electrical energy to the ultrasounds that are introduced into the patient. Step 2-It listens for returning echoes. Step 3-converts returning ultrasound echoes into electrical energy for the machine to process.
68
what types of densities would be seen on abdominal xray
bony abnormalities or calcification
69
What is a alternative imaging test to the CT Angiography Chest when contrast is contraindicated?
Ventilation-Perfusion Study A VQ Scan is done in Nuclear Medicine and will only diagnose pulmonary embolism... it does not evaluate the aorta or other vascular structures of the chest.
70
In addition to the anatomy identified in the CT Chest with Contrast examination, what anatomy will be enhanced on the CT Angiography Chest?
Heart Aorta (and branches) Pulmonary Arteries
71
What is an Upper GI (UGI)?
Fluoroscopic examination utilizing oral contrast of the stomach and emptying into the very proximal small bowel
72
four advantages of abdominal xray
easily obtained
non-invasive
no discomfort
quick Dx of certain conditions
73
What are indications for CT Angiography of the Chest?
embolism or aortic aneurysm symptoms: Chest pain, SOB, post-op respiratory changes
74
what will gallstones look like on xray
how often are they seen
circular densities in the RUQ below the ribs
10-15%
75
what is evaluated in a supine view
overall gas pattern
calcification
masses
76
Most common image form in diagnostic ultrasound
grey-scale real time ultrasound
77
what is evaluated in a prone view
gas in the rectum/sigmoid
gas in the ascending or descending colon
78
Phleboliths
79
What is the patient prep for abdominal ultrasound?
NPO 8 hours (gallbladder)
80
pediatic
81
Who is the ACR and what do they do?
American College of Radiology They set appropriateness criteria for procedures and have resources available online. They are a GREAT resource for clinicans and all imaging protocols are based on these principles.
82
What is the patient prep for the Intravenous Pyelogram study?
bowel prep of laxatives (stool patterns can conceal IV contrast filtering through the urinary system) NPO 12 hours prior to exam
83
What are the indications for the Intravenous Pyelogram study?
visualization of urinary system. structural changes due to obstruction of flow (i.e. stone, tumor)
84
Free ABDO
Free fluid
Air outside or inside the bowel
Bowel wall thicking
Densities
ORgans or Fat planes
85
are kidney stones always visable on Xray
no, they can be seen in the ureter but in the kidneys that can tuck behind things
86
what will SBO look like radiographically
dilated bowel proximal to obstruction with air fluid levels
collapsed bowel distal
looks like stacked coins
87
What is an Intravenous Pyleogram? Is it a fluoroscopic examination?
It is a imaging study of the urinary system. It is not a fluoroscopic examination. it is a series of supine abdomen images taken at various timed sequences.
88
How is ultrasound different than x-ray
~Reflects energy (sound) rather than penetrate (radiation) ~Lower energy levels ~Non-ionizing
89
Lung windows are an algorithm that is applied to the display of the CT workstation. What is the benefit of the lung window versus the soft tissue window?
The display of the lung window will show the lungs parenchyma with greatest detail. The soft tissue will display as washed out and white. (slide 26 in Clinicians Guide to CT differentiates window leveling types)
90
Iodinated contrast can take two different forms, what are they?
Oral (gastroview, gastrograffin) Iodinated oral contrast is oily, bitter tasting, and non sterile. IV (Omnipaque, visipaque, many others) Iodinated IV contrast is sterile, viscous (sticky). It is an injectable water-soluble solution with suspended iodine particles throughout. It is never used as an oral contrast but will also be used in contrast enhanced studies of body orifices (uterus, fallopian tubes, fistulas).
91
The WHO states that ultrasound is harmless. What is the more cautious approach?
as currently used, diagnostic ultrasound does not appear to harm biologic tissues.
92
what four bony densities can be seen on abdominal xray
vertebrae
pelvis
ribs
femoral heads
93
calcified uterine fibroid
94
What are advantages to ultrasound imaging over other diagnostic imaging tests?
Non-invasive Less-cost Real time images Portable No radiation exposure
95
what is evaluated on an upright view of the abdomen
free air in the peritoneal cavity
air fluid in the bowel
96
paracolic gutters
recesses formed by the peritoneum and the ascending and descending colon
97
what energy does fluoroscopy use to obtain images?
radiation (exactly like diagnostic x-rays)
98
what seen on an upright chest xray indicates intraperitoneal air from ruptured bowel until proven otherwise
a thin diaphragm
99
two types of mechanical obstruction
small SBO
large LBO
100
double contrast barium enema
101
should you see the large bowel on xray
you can, there are usually fluid and air densities
102
localized ileus
what part of the GI is effected
focal irritation of loops of bowel from visceral organs
usually the small bowel
103
three typical causes of large bowel obstruction
tumor, hernia, volvulus, diverticulitis
104
is a calcified splenic artery considered serious
no, it is no uncommon and not always pathogenic
105
three features to look for with assessing organs for organomegaly
enlargement, abnormality, or loss of contour
106
What are some pathological conditions that can be seen on the CT Abd/pel with Contrast?
Cancer Chrohn's dx Small bowel obstruction colitis appendicitis Cirrhosis Laceration Lymphoma Pancreatitis Gallstones (U/S preferred) Hernia
107
appendicolith
108
uterus and ovaries
109
views used in acute abdominal xray
supine
prone
upright (chest or abdomen)
LLDQ
110
What imaging contrast can be used for a Barium Enema.
Barium Sulfate (single contrast) OR Dual contrast: Barium Sulfate and Air (introduced rectally) Don't let the name fool you! just like all other fluoro GI exams, iodinated contrast (gastroview) can be used in compromised patients instead of barium.
111
colon cancer (apple core)
112
When should a CT Angiography study be ordered instead of the CT Chest with Contrast?
Embolism or Aneurysm any time your primary focus in on vascularity
113
three main causes of SBO
bowel cancer
adhesions
hernia
114
gall bladder density
115
What is a Barium Enema (BE) exam?
it is a contrast study of the large intestine.
116
What is coupling gel?
a water soluble gel used to eliminate the air interface between the transducer and patient skin.
117
what is free fluid in the peritoneal cavity indicative ove
ascities (CHF, malignancy, liver disease, pancreatic disease)
118
when presented with an acute abdominal complaint, what two modalities are most commonly used
CT and Ultrasound
119
calcified splenic artery
120
two cavities in the abdomen
peritoneal
retroperitoneal
121
What is the difference from a barium swallow and a modified barium swallow?
Barium swallow is an evaluation of the entire esophagus but NOT the swallowing mechanism. Modified Barium Swallow is an evaluation of the swallowing mechanism and not the entire esophagus. done with speech pathologist present.
122
What is a common complication of the small bowel follow through exam?
transit time can be very lengthy. some exams can last over \>1-5 hours. I've had patient's go home and come back the next day.
123
In the exams name, what type of contrast does "with contrast" or "without contrast" indicate?
IV contrast
124
What is the routine order for a Chest CT?
CT Chest with Contrast
125
when evaluating CT for an acute abdomen, what specific conditions are you looking for
appendicitis
diverticulitis
urinary tract stones
abdominal trauma
126
describe the flow of blood in the abdomen
aorta
mesentaric arteries (to bowel)
portal vein
liver
inferior vena cava
general circulation
127
What can be seen in the ovarian evaluation with U/S?
~ovarian sizes and locations ~follicles (fertility treatment, polycystic ovary) ~Detect and analyze ovarian enlargements ~vacularity (r/o torsion)
128
acid reflux
129
polyp
130
abnormal bowel gas patterns
functional ileus
mechanical obstruction
131
what is evaluated in the LLDQ abdominal xray
free air
132
what will a LBO look like radiographically
dilation proximal to the obstruction
no air fluid levels
generally no air in the rectum
133
What is an indication for CT Angiography Abdomen Pelvis?
known or suspected aneurysm of the abdominal aorta (and it's branches)
134
What are the advantages of endovaginal ultrasound over transabdominal pelvic ultrasound?
~Higher frequency provides excellent resolution ~excellent visualization of uterus and EARLY gestations (\<12 weeks) ~good resolution of adnexa ~full bladder not required.
135
CT Chest with Contrast: What areas are the body are imaged?
Slices of the thorax starting just above the lung apices through the adrenal glands. Lungs, vascular structures, pleura, upper abdomen
136
what would cause calcification of the aorta that makes it visible on xray
what does it look like
atherosclerosis
curved calcificatios adjected to the lumbar spine
137
What types of contrast are used in imaging?
barium iodinated air
138
# define generalized adynamic ileus
what is cause
how will it sound on PE
entire bowel with diminished peristalsis (paralysis)
sequela from surgery or DKA
absent or hypoactive bowel
139
aortic aneurysm
140
what will happen to movement in the small bowel during SBO
what will it sound like on PE
dilation proximal to the obstruction, empty bowel below the obstruction
high pitched hyperactive bowel
141
what to look for in a normal abdomen
structures
gas pattern
calcifications
soft tissues
142
generalized adyanmic ileus
143
What imaging moadlities (discussed in this unit) have radiation exposure? Rank highest to lowest...
CT Scan Fluoroscopy X-ray
144
small bowel obstruction with air fluid levesl
145
What type imaging contrast of can be used intravenously?
Iodinated only
146
calcified mesentaric lymph nodes
147
tomogram
148
What are common pathologies seen in CT spine?
Fractures Lesions Subluxations Spinal Stenosis
149
what is an important indication of ascities
a flank stripe larger than pinky
air in the colon will cause it to float in the abdomen
150
is gas in the bowel ok
yes as long as the bowel is not dilated
151
What are indications for the CT Abd/Pel with Contrast?
Pain Nausea Vomiting Distention Cancer
152
What is seen in the obstetrical evaluation of a late term pregnancy?
~monitor fetal growth ~placenta location ~fetal lie (presentation) ~well being (Biophysical Profile) ~Amniotic fluid volume ~Fetal respiratory movements
153
free air under the diaphragm
154
areas of the small bowel
duodenum
jejunum
ileum
155
CT Chest with Contrast: What does "with Contrast" mean?
iodinated IV contrast will be used. The contrast will enhance normal vascular structures and abnormalities that have blood supply.
156
What are radiation reduction methods in CT?
~appropriateness of exam ~consider alternative exams ~prior study performed with same information ~radiation dose history
157
calcified uterine fibroid
158
What is the sound reflectivity of tissue transition zones? How does it appear on the monitor?
Good reflectivity White on monitor
159
UGI with contrast
160
What is fluorosopy?
live x-rays (continuous "on" time) visualized on a monitor during examination
161
What type of contrast can be used both orally and intravenously?
Iodinated
162
what will free fluid look like on radiograph
large amounts of fluid will look grayer than normal and it will follow gravity
163
What is the prep for a abdomen ultrasound (specifically gallbladder)?
NPO 8 hours
164
What is the patient prep for an esophogram?
None Be aware that the Esophogram is sometimes ordered with the Upper GI (UGI) in which the patient must be NPO...
165
what causes retroperitoneal air
perforation of the duodenum, ascending/decending/sigmoid colon
166
small bowel with contrast
167
T/F a gas filled bowel is not uncommon while soft tissue shadows are not
false, its the other way
168
Will/Can you order a CT Chest without contrast?
rarely... it was not discussed in lecture. It is an alternative if the patient has severe allergy to iodine. Sometimes can be ordered for special procedures...
169
CT enterogram
170
What types of CT examinations can be performed on abdomen/pelvis?
~CT Abd/Pel without contrast ~CT Abd/Pel with contrast ~CT Abd/Pel with and without contrast
171
What is a Modified Barium Swallow?
~a fluoroscopic examination to assess swallowing mechanisms. ~done with the assistance of a speech pathologist. ~multiple consistency food will be mixed with barium and watched fluoroscopically for aspiration and movement of food bolus past epiglottis down esophagus
172
radiographic signs of generalized adyanmic ileus
entire bowel dilation with air
many air fluid levels
gas in the rectum of sigmoid
173
diverticuli
174
What is evaluated in a limited abdomen U/S
one of the following structures: Liver Gallbladder Spleen Pancreas Appendix Pylorus
175
what is assessed in an upright view
free air in peritoneal cavity
air fluid levesl
176
4 quadrants of the abdomen
RU
RL
LU
LL
177
what is evaluated in LLDQ
free air
178
What are indications for the small bowel follow through examination?
motility of small intestine dueodenum jejunum ileum obstruction ileus intramural lesions Crohn's disease
179
small bowel obstruction
180
small bowel obstruction with air fluid levels
181
intravenous pyelogram (IVP)
182
peritoneum
thin laer of tissue that lines the peritoneal cavity
183
when would you be able to see the gallbladder on xray
when there is distention or calcified stones
184
Why is contrast not used when evaluating the abdomen/pelvis for kidney stones on CT?
The contrast collected in the urinary system has a similar density as a stone. Therefore, the contrast will conceal the stone.
185
retroperitoneal air
186
what is the process of dysfunction that leads to disease in localized ileus
inflammation
no peristalsis
dilated bowel
187
Contraindications to the Intravenous Pyelogram study?
allergy to the iodinated IV contrast. compromised kidney function (elevated BUN Creatnine)
188
(trans) Abdominal Ultrasound (for female pelvis) is best for \_\_\_\_\_\_\_\_.
evaluation of pregnancy in 2nd and 3rd trimester.
189
What is an example of a lower frequency ultrasound transducer?
abdominal probe
190
aortic aneurysm
191
free air under the diaphragm
192
large bowel obstruction
193
when using ultrasound to evaluate an acute abdomen, what three conditions are you looking for
acute cholecystitis
appendicitis
gynecological conditions
194
appendicolith
what percent of patients present with this
a calcification in the appendix formed by feces stuck in the lumen
10%
195
how large should flank stripes be
no larger than a pinkie
196
Dow you want low or high ultrasound frequency to get the deeper structures.
Lower frequency (3 MHz)
197
What imaging study should be done before a Chest CT?
routine chest x-ray
198
Vaginal Ultrasound is best for _______ and \_\_\_\_\_\_\_\_.
GYN problems Early pregnancy
199
You are viewing an image taken during an IVP. You see a normal appearing right kidney with contrast filling the total right ureter. The bladder is enhanced suggesting that some contrast has entered the bladder as well. The left kidney looks different than the right, the renal calyxes look blunted and enlarged in comparison to the right. You see only partial filling of the left ureter. What could you conclude?
Obstruction of the left ureter possibly due to stone or stricture (tumor)
200
small bowel obstruction
201
What types of imaging contrast are NEVER used intravenously.
Barium Sulfate Air
202
stomach
203
indication that a calcified aorta will develop into an AAA
if the distance between calcifications is +3cm
204
where is bile produced
what is its path to the digestive system
in the liver
liver, biliary system, duodenum
205
kidney density
206
What is CT Myelogram?
CT of the Spine is performed after administration of an iodinated contrast is injected into the subarachnoid space and bathes the spinal cord (slide 42)
207
T/F large amounts of fluid can displace the colon medially
true
208
Diagnostic Ultrasound (done in imaging) utilizes an ultrasound frequency within what range?
3-9 megahertz (3-9 MHz)
209
retroperitoneal air
210
What Imaging contrast is used in the Intravenous Pyelogram Study?
Iodinated IV contrast.
211
gall bladder US
212
What are common cancer types associated with radiation exposure.
Leukemia Thyroid Cancer Breast Cancer Lung Cancer Bone Cancer Skin Cancer
213
Why is a full bladder needed for a transabdominal pelvic ultrasound
Creates a window for sound waves by pushing the air filled bowel up and out of the way.
214
What is the patient prep for the barium enema study.
Bowel prep (enemas as indicated by department protocol) NPO
215
small bowel obstruction
216
ascities
217
What is the sound reflectivity of bone? How does it appear on the monitor?
Excellent reflectivity White on monitor
218
What are some pathological conditions that can be seen on Chest CT?
Cancer, Pneumonia, pleural and pericardial effusions, pneumothorax, hemothorax
219
colon with gaseous contrast
220
what is a common ordering error for ultrasounds noted by the ultrasound lecturer?
R/out. The reason for exam should be specific and never use a "rule out" reason for exam.
221
What is a Small Bowel Follow Through (SBFT/SBS) Examination? Is it fluoroscopy or regular xray?
a transit study of the small bowel. a series of images are taken to show how fast (or slow) contrast is progressing through the small bowel. It is a series of regular supine abdomen x-rays. The ileocecal valve (end of the small bowel) is hidden in a mess of bowel. Only then will the radiologist enter the exam to palpate the RLQ under fluoroscopy to open up the area for evaluation.
222
What are contrasts that can be used for an Upper GI (UGI) exam?
Barium Sulfate Air Iodinated contrast (2nd choice to barium in compromised patient)
223
enterocolitis
224
what is an apple core lesion indicative of
colon cancer
225
modified barium swallow
226
Does the ultrasound tranducer transmit sound or listen for returning echoes longer?
Listens 9 times longer than it transmits.
227
What are some pathological conditions seen on the CT Angiography Chest?
Pulmonary Embolism Aneurysm Dissection as well as: Cancer Pneumonia Pleural and Pericardial effusions Pneumothorax Hemothorax
228
What is the patient prep for the Upper GI (UGI) exam?
NPO (a must) Patient will be rescheduled if not!
229
large bowel obstruction with barium
230
What are clinical indications for CT Spine?
pain trauma injury
231
What imaging contrast is used in the small bowel follow through exam?
thin barium iodinated contrast (2nd choice compromised patient)
232
why would organs be visible on xray
what organs can you see
they are surrounded by fat which provides an interface
liver, spleen, kidneys, bladder
233
What are alternative imaging tests to the CT Angiography Abd/Pel?
MR Angiography (done in MRI) Ultrasound Aorta
234
tree signs of motility disturbances
springs, tunnels, and turtles
235
where is the retroperitoneal cavity
what is in it
behind the peritoneal cavity
pancreas, psoas, kidneys, aorta, bladder, ascending/descending colon, rectum
236
Is IV contrast used on an Upper GI (UGI) exam?
Nope
237
# Define LBO by the following three factors
air in the rectum
air in the small bowel
air in the large bowel
no
none, unless there is an incompetant ileocecal valve
yes, with dilation
238
What is the scan area of the CT Abd/Pel with Contrast?
Above the diaphragm through the symphysis pubis. The abdomen is from the diaphragm to the iliac crest. The pelvis is from the iliac crest to the symphysis pubis. This is the same scan area for all types of CT abd/pel. The abdomen and pelvis are almost always scanned at the same time... it is VERY rare to do just one.
239
bowel lumen limits that indicate dilation
\>2.5cm for the small bowel
\>6cm for the large bowel
\>9cm for the cecum
240
Why is barium contraindicated in GI studies when bowel perforation or obstruction is suspected.
Barium is not sterile Barium is not water soluble Patient could develop peritonitis (perforation) or concrete stool (constipation from absorption of water from barium)
241
What are effects of radiation damage to the cell?
cell death cell survival with no harm cell survival with mutation
242
What is used in an fluoroscopy examination to enhance detail of strutures?
Contrast
243
When is MRI of the Spine preferred over CT of the Spine?
mass lesions
244
What are the contraindications for a Modified Barium Swallow?
possibility of aspiration of non-water soluble barium
245
What can be seen in the uterine evaluation with U/S?
Size and position Endometrium Myometrial pathology Masses, fluid and foreign bodies
246
free air under the diaphragm
247
should there be air outside the bowel in the peritoneal space
no, except after abdominal surgery
248
why cant the portal vein or the bile duct be seen in the liver
the liver is a homogenous fluid density so the bile duct and the portal vein silhoutte with the rest of the liver
249
flank stripes
250
# Define fucntional ileus by the following three factors
air in the rectum
air in the small bowel
air in the large bowel
yes
multiple distended loops
yes, with distension
251
single contrast axial barium enema
252
classifications of air in on abdominal xray
free intraperitoneal air
free retroperitoneal air
air inside the lumen (dilated bowel or air fluid levels
253
uterine fibroid
254
Normal grey scale ultrasound is 2-dimensional. What two types of ultrasound does Dr. Dodge term as "fancy"
3-dimensional 4-dimensional
255
What modality is preferred when evaluating the appendix
CT scan is preferred. a bad appendix can be missed on U/S due to the gas in the bowel.
256
What imaging test would you order if your patient complained of flank pain, hematuria and a history of kidney stone?
CT Abd/Pel without contrast
257
what is evaluated in a prone view
gas in the rectum and or sigmoid coolon
gas in the ascending or descending colon
258
what is evauluated on a supine abdominal xray
overall gas pattern
calcification
masses
259
crohns
260
nine calcifications seen on abdominal x ray
1. appendicolith
2. gallbladder stones
3. renal stones
4. pancreatic stones
5. liver
6. aortic
7. calcified mesentary lymph nodes
8. fibroid tumors
9. calcified splenic artery
261
What is the patient prep for the small bowel follow through examination?
NPO 8 hours
262
What imaging modalities (discussed in this unit) have no radiation exposure?
Magnetic Resonance Imaging (MRI) Ultrasonography (U/S)
263
What are some contraindications for an Upper GI (UGI) examination?
aspiration nausea/vomitting bowel obstruction (distal obstruction) constipation
264
two types of stones on xray and what quadrant they are in
gallstones (RUQ)
Renal/uretal stones (bilateral)
265
localized ileus
266
what is this and what does it indicate
riglers sign
air in the bowel and outside in the perioneal cavity
267
what intraperitoneal air indicative of
perforation or penetrative trauma
268
kidney stine
269
should you see the small bowel
no it should be silhoutted and filled with fluid
270
What are some deterministic effects of radiation that are associated with radiation dose thresholds?
Usually seen in VERY large doses, not in diagnostic imaging (i.e. chernoble) Radiation-induced abortion Cataract formation Sterility Hair Loss Skin Erythema Death
271
Why is the NPO prep for the abdomen ultrasound (specifically gallbladder) important.
A constricted (due to eating) gallbladder and a constricted (due to disease) gallbladder look the same.
272
What is the patient prep for the Modified Barium Swallow examination?
No Prep Note: the stomach is not visualized, therefore food does not get in the way of area of interest
273
free air
274
gall bladder US
275
What is seen in the obstetrical evaluation of a mid term pregnancy?
congenital anomalies confirm multiple gestation gender determination
276
What is an alternative oral contrast that can be used when barium is contraindicated?
Iodinated contrast (i.e. gastroview)
277
What is the cheapest special modality in imaging (besides routine x-rays)?
ultrasound
278
Do you want low or high ultrasound frequency to show better detail?
Higher frequency (5-7 MHz)
279
barium aspiration
280
What imaging test would you order if you wanted to evaluate the abdominal aorta with CT?
CT Angiography Abdomen and Pelvis
281
gallbladder density
282
colon cancer (apple core)
283
What patient prep is needed for a transabdominal pelvic ultrasound?
full bladder
284
What are some indications for an Upper GI (UGI) examination?
hiatal hernia reflux ulcers tumors vomitting hematemesis
285
Can a barium enema be done with oral contrast administration? Can the small bowel examination be done with retrograde filling?
No... it must be done with retrograde filling No... contrast in the small bowel should not be visualized on the barium enema examination. Barium in the small bowel would mean a compromised ileocecal valve.
286
What is a common complication with administering oral contrast?
Barium tastes like chalky shit Iodinate contrast (gastroview) taste like oily shit
287
calcified pancreas
288
two types of ileus
localized ileus
generalized adynamic ileus
289
What is the sound reflectivity of muscle/liver? How does it appear on the monitor?
Intermediate reflectivity Various degrees of grey
290
two features that would indicate osteoarthritis
narrowed joint space with osteophytes
291
common view for the knee
AP
lateral
oblique
sunrise
292
what is the pathogenesis of pagets disease
hypermetabolic bone that breaks down and repairs bone over and over, making it prone to breaks
293
absolute and relative indications for an IVC filter
absolute: presence of DVT or PE, contraindication to coags, recurrent PE despite coags, anticoagulation related complications
relative: free floating thrombus, prophylaxis, poor compliance with anticoagulation
294
why can iodine be used for radioactive ablation of the thyroid
because the thyroid is the only place that takes up large amounts of iodine
295
salter harris I fibula
296
calcaneus fracture
297
talus
300
degenerative arthritis
302
pubic ramus fracture
303
what is a HIDA scan used for
to evaluate the function of the gallbladder after a negative ultrasound when apin, bloating, nausea, chest pain persist
304
what is an AFR (IR)
what are the indications
aorta femoral runoff
claudcations with positive ABI, CTA, or MRA used to plan intervention
306
subtrochanteric
307
are stable or unstable pelvic fracture smore common
stable
308
distal fibula fracture
310
outlet view
311
what disease process can lead to bowleggedness
degenerative arthritis of the knees
312
bone to bone apposision medial
313
what is this
is it pathlogic
bipartite patella
no, its a normal variant
314
prep for an arteriogram
NPO
coags
creatinine and GFR
315
what is a nucelar stress test used for
presence, location, extent of CAD
assessment of ischemia
monitoring
316
segmental fracture of the left tibia
317
avulsion fracture
319
open book fracture
320
pubic ramus fracture
321
osteoarthritis
322
comminuted right calcaneus fracture
323
navicular
324
hip arthritis
325
navicular
326
avascular necrosis
327
hip arthritis
328
what is needed for every IR proceedure
NPO
coags
GFR
330
degenerative arthritis
331
what would normal heart perfusion look like in a nuclear stress test
ischemia
infarct
evenly distributed blood flow
hypoperfusion on stress
hypoperfusion with stress and rest
333
medial cuneiform
334
what is this
is it pathologic
fabella, a sesamoid bone in the gastroc tendon
no, but it can be mistaken for one
335
what are the indications for a mesentaric arteriogram
ischemia, GI bleed
336
subcapital
337
calcaneus fracture
339
medial condyle
340
what is this
is it pathological
os trigonum
no, its a non union of the talus that can be mistaken for an avulsion
342
why would being diabetic be of consideration for PET scan
it uses radioactive sugar
343
pubic symphysis
344
straddle fracture
345
patella
346
lesser trochanter
347
when assessing for arthritis in the knee what is needed
AP and lateral that is weight bearing
349
cuboid
351
stradle fracture
352
ischial tuberosity
353
degenerative arthritis
354
talus
355
femoral neck ffracture
356
intertrochanteric fracture
357
prep for IVC
NPO
check for allergy
creatinine and GFR
coags
358
fibular neck
359
judet view
360
intercondylar eminence
361
avulsion fracture 5th metatarsal
363
legg-calve-perth
364
SI joint
365
sacrum
366
acetabular fracture
367
arthritic knee
370
sub trochanteric
373
femoral neck fracture
374
patella fracture
375
arthritic knee
376
open book fracture
377
distal tibia fracture
380
lateral condyle
381
lateral epicondyle
382
intertrochanteric fracture
383
pagets disease
384
avascular necrosis
385
avulsion fracture
386
femoral neck fracture
388
calcaneus fracture
389
intertrochanteric fracture
390
391
malgiagne
393
what on a radiograph would indicate vertical shear on the pelvis
complex pattern of fractures directed toward the head
394
frank fracture
a fracture between the 1st and 2nd metatarsal
396
what is the sunrise view for
patellar tracking issues
397
intertrochanteric fracture
398
arthritic knee
399
joint space
400
F - J
F head of femur
G neck
H greater trochanter
I lesser trochanter
J ischial tuberosity
401
bucket handle
402
tibial plateau fracture
403
femur fracture
404
cuboid
405
arthritic knee
406
avulsion fracture 5th metatarsal
407
what is most likely true if one side of the pelvic ring is fractured
there will be a fracture on the other side
408
hallux valgus and small toe dislocation
410
avulsion fracture
411
inlet view
413
intermediate cuneiform
414
acetabular fracture
415
femoral neck fracture
416
iliac crest
417
5th metatarsal
418
views of the hip
AP and Frog leg lateral
420
head of the fibula
421
greenstick fracture
423
lateral condyle
424
arthritic knee
425
indications for IR venous access
prep
long term adminstration of chemo, blood products, antibiotics
NPO, coags
428
degenerative arthritis
429
what radiographic sign would indicate an issue at the pubic symphysis
SI joint
PS \>5mm
SI\>4mm
430
pubic ramus fracture
431
T/F a fracture above the mortise that disturbs the mortise is unstable
true
432
femoral neck fracture
435
jones fracture
437
femur fracture
438
head of the femur
439
acetabular fracture
441
why do femur fractures tend to be bayonetted
muscle contraction pulls the ends of the bones past each other
442
tibial plateau fracture
443
medial epicondyle
444
what is a DSA (IR)
digital subtracted arteriogram, takes out everything but the vascular structure
446
calcaneus fracture
447
contraindications for an exercise stress test
physical/neurological limitations
meds that preclude stress increases (CA blockers, beta blockers)
usntable angina
recent MI
uncontrolled systemic or pulmonary hypertension
449
calcaneus
450
acetabular fracture
451
obturator foramen
452
head of the talus
454
avascular necrosis
457
slipped capital femoral epiphysis
460
femur fracture
461
contraindications for IVC
lack of venous access
total thombosis of the IVC
sepsis
caval diameter \<15mm
462
malgiagne
463
slipped capital femoral epihpysis
464
medial condyle
465
calcaneus fracture
466
comminuted displaced medial tibial plateau fracture with disruption of the knee joint
467
lateral cuneiform
468
what pathology is shown here
degenerative arthritis
469
lateral malleolus
470
subcapital
471
medial malleleous fracture
472
distal fibula fracture
474
straddle fracture
475
medial malleolus
477
jones fracture
478
subcappital
479
diastasis of the pubic symphysis
480
A - E
A iliac crest
B iliac wing
C SI joint
D ASIS
E acetabulum
482
K - N
K superior pubic ramus
L inferior pubic ramus
M obturator foramen
N pubic symphysis
483
epiphyseal line of the tibia
484
axial view of calcanues
485
legg-calve-perth
487
hallux rigidus
arthritis of the big toe that causes pain on push off
490
first metatarsal
492
calcaneus fracture
495
what is an axial view of the foot used for
the evaluate the calcaneus for fracture
496
four types of arteriogram
AFR
cerebral
carotid
mesentaric
renal
498
two ways to allow for dialysis access
AV fistula
central catheter
499
three conditions associated with unstable pelvis fractures
pevic organ damage
hemorrhage
shoch
505
what is the hardest part of a thyroid scan
it lasts two days and requires lots of prep
506
three feature to help identify avascular necrosis
snow cap, bite lesion, collapse of the femoral head
514
what are the indications for a renal arteriorgram
Uncontrolled HTN from stenosis or fibromuscular dysplasia
tumor emobolization
truama
519
TIPS procedure
transhepatic portosystemic shunt
relieve portal hypertension leading to varices
520
contraindications for a chemical nuclear stress test
brochospasm
systemic hypotension
mitral valve disease
521
when would a judet view be used
when looking for fractures
522
two types of interventions from IR
stents
embolizations
523
what percent of pelvic fractures will include the acetabulum
if you suspect acetabular fracture what imaging will you need to do
20%
CT
534
four types of cancer and molecular imaging fround in NM
thyroid cancer and ablation
SM153 and Sr89 for pain relief
PET scan
Bone scan
536
cardaic uses for pet
mycardial perfusion
viability
scaroidosis
539
three main vectors associated with pelvic injuries
AP compression
Lateral compression
vertical shear
545
common x rays of the pelvis
AP
inlet
outlet
judet
546
what would cause lateral compression of the pelvis
two radiographic signs
side impact
sacral buckle and horizontal pubic rami fracture
549
what are Y90 microspheres used to treat
unresectable hepatic carcinoma
552
what would cause AP compression of the pelvis
two radiographic signs on xray
impact from the front or back
diastasis of the pubic symphysis or SI joint shifting
553
in what population is a slipped capital femoral epiphysis common
what happens
what is the prognosis
obese pediatric males
the top of the femoral head slides off
surgery is needed to keep the slip from getting worse and there is a higher risk of hip replacement
554
how many PET scans are patients allowed eachyear
3
556
why would a V/Q scan be ordered
unable to do a CT because of IV size, renal failure, patient size, contrast allergy
558
T/F suspected Si joint pain my require CT
true, some small disruptions may only be visible on CT
560
what is a possible complication of a pubic ring fracture
hemorrhage
561
why is the frog leg view useful
it lets you see the lesser trochanter
563
what are the indications for a cerebral arteriogram
ischemia, hemorrhage, stroke, aneurysm
567
5 types of stable pelvis fractures
ramus fractures
avulsion fractures
isolated sacral fractures
sacrocaccygeal fractures
win fractures
568
lovers fracture
a fracture of the calcaneus commonly cuased by landing on the feet from a height
571
what is an IVC filter used for
the help catch blood clots from DVT
572
what does aneurysm coiling entail
threading a wire up through the femoral artery into the bubble and filling it with wire
574
neurology uses for PET
trauma
tumor
plaques
dementia
575
what should you consider doing in the case of elderly falls
bilateral hip films
580
what is legg-calve-perthes
what is the prognosis
avascular necrosis commonly seen in pediatric males
with crutches and physical therapy the joint will regenerate
582
indications for a carotid arteriogram
when is it used
TIA, stroke
for stenting, or when other testing is unclear
583
what is the difference between nuclear medicine and other imaging
it uses small amounts of radioactive material to test function of body structures
585
if occult fracture, infection, or tumor is suspected in the hip what should be done
MIR
586
three locations of avulsion fractures in the plevis
iliac spine
iliac crest
ischial tuberosity
588
common views used to image the foot
AP
lateral
oblique
weight bearing
axial
600
what is a mortise view used for
the evaluated the talotibial joint
603
oncology uses for PET
FDG for metabolic cancers
fluccicovine for prostate
608
what are the indications for a percutaneous nephrostomy
obstructed ureter
large stone
hydronephrosis
613
why are tibial plateau fractures particularly challenging
its hard to get the contour of the joint back together
614
what two modalities are used in interventional radiology
fluoro
US
615
what is an NM renal scan used for
to determine if a renal issue is mechanical or physical
hypertension
transplany
616
four types of unstable pelvis fractures
malgaigne
open book
bucket handle
straddle
618
what are stents used for
what about embolizations
ischemia
tumors, GI bleeds, trauma
