Abdomen Flashcards
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)?
Barium Sulfate Air Iodinated contrast (i.e. gastroview)
Ultrasound (non-diagnostic and diagnostic) has a frequency of ________ hertz?
>20,000 Hertz (20 KHz) Higher than threshold of human hearing
Why is IV contrast the best imaging contrast for the Intravenous Pyelogram?
The body doesn’t need the IV contrast, therefore it is quickly filtered out of the body through the urinary system.
where is the stomach
LUQ
What anatomy is seen in the CT Spine?
All boney anatomy and spinal cord in the spinal section scanned
chronic pancreatitis
where are frequent locations of bowel perforations
duodenum (PUD)
colon (diverticulitis, colon cancer, obstruction)
Define SBO by the following three factors
air in the rectum
air in the small bowel
air in the large bowel
no
multiple dilated loops
no
flank stripes
Why is it important for a patient to be NPO for a fluoroscopic examination of the GI tract.
Food particles can mimic lesions within the alimentary canal.
Regarding radiation safety, the CT examination should not be repeated without:
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.
What is Doppler ultrasound?
assesses blood flow (organs, fetus, tumors)
where is the spleen
LUQ
what structures are in the peritoneal cavity
bowel, spleen, most of the liver
What is the sound reflectivity of fluids? How does it appear on the monitor?
Very poor reflectivity Black on monitor
Who is responsible for weighing the benefit vs risk of radiation exposure?
Ordering provider
What is the Federal regulatory principles concerning radiation exposure?
Any dose of radiation might cause cancer.
What are the indications for a barium swallow (esophogram) study?
acid reflux intraluminal lesions strictures obstructions esophageal varicies hiatal hernia foreign bodies
stomach with foreign body
what you look for radiographically for air outside the bowel
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
gall bladder density
What determines the image in ultrasound?
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)
characteristics of functional ileus
one or more loops unable to perform peristalsis
What are indications for a CT Chest with Contrast?
Lung mass Lung disease General Survey Pleural effusion Trauma
kidney and ureter with contrast
abnormalties to look on abdominal xray
masses
gasses
foreign bodies
bones
stones
stomach with barium
What is an example of a higher frequency ultrasound transducer?
Vaginal probes
flank stripes
lines nbetween the back and the colon
small bowel obstruction
small bowel obstruction with air fluid levesl
how will retroperitoneal air look
streak, linear that outlides the retroperitoneal structures
mottle appearance
relatively fixed
five Dx quickly made with abdominal xray
intraperitoneal free air
bowel obstruction
organomegaly
abnormal masses
abnormal calcifications
What is evaluated in a fetal growth assessment?
~Biparietal diameter ~Femur length ~Abdominal circumference ~others
defogram
kidney and ureter density
what are the structures of the large bowel
appendix
cecum
ascending colon
transver colon
splenic flexure
descending colon
signmoid colon
rectum
single cs double contrast enema
what is the percent chance that renal stone will be visible on xray
50-60%
colon cancer (apple core)
barium enema
generalize adyanamic ileus
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
what will the diaphragm look like with air under it
it will look curved and very thin
LLDQ free air
What are disadvantages of ultrasound?
~Can not image through air or bone. ~Sonographer error
free air around falciform ligament
What are indicated for the Barium Enema Examination?
visualize entire large bowel through retrograde filling. Diverticulosis polyps tumor masses
deogram with rectocele
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
what is included in a complete abdominal series
supine
prone
upright
LLDQ
what is seen in the obstetrical evaluation of an early pregnancy?
Pregnancy location Pregnancy viability multiple gestation
what can cause perforation that will lead to retroperitoneal air
ulceratiive disease
ruptured appendix
blunt/penetrating trauma
perforation during sigmoidoscopy
perforated divertuculitis
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.
barium swallow (esophagram)
What gestational age is best visualized with a trans-abdominal approach?
> 12 weeks gestation ~morphology & development ~health/viability (Biophysical Profile)
What imaging modality has the highest radiation exposure to the patient?
Computerized Axial Tomography (CT Scan)
a complete abdomen ultrasound evaluated what organs?
Liver Gallbladder Spleen Pancreas (sometimes Kidneys, dependent on department protocol)
What ultrasound examination will show renal artery stenosis with questionable accuracy?
Kidneys
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.
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.
is oral contrast used in an Intravenous Pyelogram study?
No… oral contrast will conceal the IV contrast filtering through the urinary system.
what will ileus look like on xray
1-2 persistantly dilated loops of bowel
air fluid levels
gas in the rectum or sigmoid
What are the two different tranducer types for pelvic ultrasound examinations?
Abdominal Vaginal
What is a biophysical profile? what is assessed?
assessment for fetal well-being ~Respiratory movements ~Amniotic fluid volume ~Placenta morphology ~others
liver
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.
what types of densities would be seen on abdominal xray
bony abnormalities or calcification
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.
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
What is an Upper GI (UGI)?
Fluoroscopic examination utilizing oral contrast of the stomach and emptying into the very proximal small bowel
four advantages of abdominal xray
easily obtained
non-invasive
no discomfort
quick Dx of certain conditions
What are indications for CT Angiography of the Chest?
embolism or aortic aneurysm symptoms: Chest pain, SOB, post-op respiratory changes
what will gallstones look like on xray
how often are they seen
circular densities in the RUQ below the ribs
10-15%
what is evaluated in a supine view
overall gas pattern
calcification
masses
Most common image form in diagnostic ultrasound
grey-scale real time ultrasound
what is evaluated in a prone view
gas in the rectum/sigmoid
gas in the ascending or descending colon
Phleboliths
What is the patient prep for abdominal ultrasound?
NPO 8 hours (gallbladder)
pediatic
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.
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
What are the indications for the Intravenous Pyelogram study?
visualization of urinary system. structural changes due to obstruction of flow (i.e. stone, tumor)
Free ABDO
Free fluid
Air outside or inside the bowel
Bowel wall thicking
Densities
ORgans or Fat planes
are kidney stones always visable on Xray
no, they can be seen in the ureter but in the kidneys that can tuck behind things
what will SBO look like radiographically
dilated bowel proximal to obstruction with air fluid levels
collapsed bowel distal
looks like stacked coins
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.
How is ultrasound different than x-ray
~Reflects energy (sound) rather than penetrate (radiation) ~Lower energy levels ~Non-ionizing
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)
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).
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.
what four bony densities can be seen on abdominal xray
vertebrae
pelvis
ribs
femoral heads
calcified uterine fibroid
What are advantages to ultrasound imaging over other diagnostic imaging tests?
Non-invasive Less-cost Real time images Portable No radiation exposure
what is evaluated on an upright view of the abdomen
free air in the peritoneal cavity
air fluid in the bowel
paracolic gutters
recesses formed by the peritoneum and the ascending and descending colon
what energy does fluoroscopy use to obtain images?
radiation (exactly like diagnostic x-rays)
what seen on an upright chest xray indicates intraperitoneal air from ruptured bowel until proven otherwise
a thin diaphragm
two types of mechanical obstruction
small SBO
large LBO
double contrast barium enema
should you see the large bowel on xray
you can, there are usually fluid and air densities
localized ileus
what part of the GI is effected
focal irritation of loops of bowel from visceral organs
usually the small bowel
three typical causes of large bowel obstruction
tumor, hernia, volvulus, diverticulitis
is a calcified splenic artery considered serious
no, it is no uncommon and not always pathogenic
three features to look for with assessing organs for organomegaly
enlargement, abnormality, or loss of contour
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
appendicolith
uterus and ovaries
views used in acute abdominal xray
supine
prone
upright (chest or abdomen)
LLDQ
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.
colon cancer (apple core)
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
three main causes of SBO
bowel cancer
adhesions
hernia
gall bladder density
What is a Barium Enema (BE) exam?
it is a contrast study of the large intestine.
What is coupling gel?
a water soluble gel used to eliminate the air interface between the transducer and patient skin.
what is free fluid in the peritoneal cavity indicative ove
ascities (CHF, malignancy, liver disease, pancreatic disease)
when presented with an acute abdominal complaint, what two modalities are most commonly used
CT and Ultrasound
calcified splenic artery
two cavities in the abdomen
peritoneal
retroperitoneal
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.
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.
In the exams name, what type of contrast does “with contrast” or “without contrast” indicate?
IV contrast
What is the routine order for a Chest CT?
CT Chest with Contrast
when evaluating CT for an acute abdomen, what specific conditions are you looking for
appendicitis
diverticulitis
urinary tract stones
abdominal trauma
describe the flow of blood in the abdomen
aorta
mesentaric arteries (to bowel)
portal vein
liver
inferior vena cava
general circulation
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)
acid reflux
polyp
abnormal bowel gas patterns
functional ileus
mechanical obstruction
what is evaluated in the LLDQ abdominal xray
free air
what will a LBO look like radiographically
dilation proximal to the obstruction
no air fluid levels
generally no air in the rectum
What is an indication for CT Angiography Abdomen Pelvis?
known or suspected aneurysm of the abdominal aorta (and it’s branches)
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.
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
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
What types of contrast are used in imaging?
barium iodinated air
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
aortic aneurysm
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
what to look for in a normal abdomen
structures
gas pattern
calcifications
soft tissues
generalized adyanmic ileus
What imaging moadlities (discussed in this unit) have radiation exposure? Rank highest to lowest…
CT Scan Fluoroscopy X-ray
small bowel obstruction with air fluid levesl
What type imaging contrast of can be used intravenously?
Iodinated only
calcified mesentaric lymph nodes
tomogram
What are common pathologies seen in CT spine?
Fractures Lesions Subluxations Spinal Stenosis
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
is gas in the bowel ok
yes as long as the bowel is not dilated
What are indications for the CT Abd/Pel with Contrast?
Pain Nausea Vomiting Distention Cancer
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
free air under the diaphragm
areas of the small bowel
duodenum
jejunum
ileum
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.
What are radiation reduction methods in CT?
~appropriateness of exam ~consider alternative exams ~prior study performed with same information ~radiation dose history
calcified uterine fibroid
What is the sound reflectivity of tissue transition zones? How does it appear on the monitor?
Good reflectivity White on monitor
UGI with contrast
What is fluorosopy?
live x-rays (continuous “on” time) visualized on a monitor during examination
What type of contrast can be used both orally and intravenously?
Iodinated
what will free fluid look like on radiograph
large amounts of fluid will look grayer than normal and it will follow gravity
What is the prep for a abdomen ultrasound (specifically gallbladder)?
NPO 8 hours
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…
what causes retroperitoneal air
perforation of the duodenum, ascending/decending/sigmoid colon
small bowel with contrast
T/F a gas filled bowel is not uncommon while soft tissue shadows are not
false, its the other way
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…
CT enterogram
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
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
radiographic signs of generalized adyanmic ileus
entire bowel dilation with air
many air fluid levels
gas in the rectum of sigmoid
diverticuli
What is evaluated in a limited abdomen U/S
one of the following structures: Liver Gallbladder Spleen Pancreas Appendix Pylorus
what is assessed in an upright view
free air in peritoneal cavity
air fluid levesl
4 quadrants of the abdomen
RU
RL
LU
LL
what is evaluated in LLDQ
free air
What are indications for the small bowel follow through examination?
motility of small intestine dueodenum jejunum ileum obstruction ileus intramural lesions Crohn’s disease
small bowel obstruction
small bowel obstruction with air fluid levels
intravenous pyelogram (IVP)
peritoneum
thin laer of tissue that lines the peritoneal cavity
when would you be able to see the gallbladder on xray
when there is distention or calcified stones
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.
retroperitoneal air
what is the process of dysfunction that leads to disease in localized ileus
inflammation
no peristalsis
dilated bowel
Contraindications to the Intravenous Pyelogram study?
allergy to the iodinated IV contrast. compromised kidney function (elevated BUN Creatnine)
(trans) Abdominal Ultrasound (for female pelvis) is best for ________.
evaluation of pregnancy in 2nd and 3rd trimester.
What is an example of a lower frequency ultrasound transducer?
abdominal probe
aortic aneurysm
free air under the diaphragm
large bowel obstruction
when using ultrasound to evaluate an acute abdomen, what three conditions are you looking for
acute cholecystitis
appendicitis
gynecological conditions
appendicolith
what percent of patients present with this
a calcification in the appendix formed by feces stuck in the lumen
10%
how large should flank stripes be
no larger than a pinkie
Dow you want low or high ultrasound frequency to get the deeper structures.
Lower frequency (3 MHz)
What imaging study should be done before a Chest CT?
routine chest x-ray
Vaginal Ultrasound is best for _______ and ________.
GYN problems Early pregnancy
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)
small bowel obstruction
What types of imaging contrast are NEVER used intravenously.
Barium Sulfate Air
stomach
indication that a calcified aorta will develop into an AAA
if the distance between calcifications is +3cm
where is bile produced
what is its path to the digestive system
in the liver
liver, biliary system, duodenum
kidney density
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)
T/F large amounts of fluid can displace the colon medially
true
Diagnostic Ultrasound (done in imaging) utilizes an ultrasound frequency within what range?
3-9 megahertz (3-9 MHz)
retroperitoneal air
What Imaging contrast is used in the Intravenous Pyelogram Study?
Iodinated IV contrast.
gall bladder US
What are common cancer types associated with radiation exposure.
Leukemia Thyroid Cancer Breast Cancer Lung Cancer Bone Cancer Skin Cancer
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.
What is the patient prep for the barium enema study.
Bowel prep (enemas as indicated by department protocol) NPO
small bowel obstruction
ascities
What is the sound reflectivity of bone? How does it appear on the monitor?
Excellent reflectivity White on monitor
What are some pathological conditions that can be seen on Chest CT?
Cancer, Pneumonia, pleural and pericardial effusions, pneumothorax, hemothorax
colon with gaseous contrast
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.
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.
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)
enterocolitis
what is an apple core lesion indicative of
colon cancer
modified barium swallow
Does the ultrasound tranducer transmit sound or listen for returning echoes longer?
Listens 9 times longer than it transmits.
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
What is the patient prep for the Upper GI (UGI) exam?
NPO (a must) Patient will be rescheduled if not!
large bowel obstruction with barium
What are clinical indications for CT Spine?
pain trauma injury
What imaging contrast is used in the small bowel follow through exam?
thin barium iodinated contrast (2nd choice compromised patient)
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
What are alternative imaging tests to the CT Angiography Abd/Pel?
MR Angiography (done in MRI) Ultrasound Aorta
tree signs of motility disturbances
springs, tunnels, and turtles
where is the retroperitoneal cavity
what is in it
behind the peritoneal cavity
pancreas, psoas, kidneys, aorta, bladder, ascending/descending colon, rectum
Is IV contrast used on an Upper GI (UGI) exam?
Nope
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
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.
bowel lumen limits that indicate dilation
>2.5cm for the small bowel
>6cm for the large bowel
>9cm for the cecum
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)
What are effects of radiation damage to the cell?
cell death cell survival with no harm cell survival with mutation
What is used in an fluoroscopy examination to enhance detail of strutures?
Contrast
When is MRI of the Spine preferred over CT of the Spine?
mass lesions
What are the contraindications for a Modified Barium Swallow?
possibility of aspiration of non-water soluble barium
What can be seen in the uterine evaluation with U/S?
Size and position Endometrium Myometrial pathology Masses, fluid and foreign bodies
free air under the diaphragm
should there be air outside the bowel in the peritoneal space
no, except after abdominal surgery
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
flank stripes
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
single contrast axial barium enema
classifications of air in on abdominal xray
free intraperitoneal air
free retroperitoneal air
air inside the lumen (dilated bowel or air fluid levels
uterine fibroid
Normal grey scale ultrasound is 2-dimensional. What two types of ultrasound does Dr. Dodge term as “fancy”
3-dimensional 4-dimensional
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.
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
what is evaluated in a prone view
gas in the rectum and or sigmoid coolon
gas in the ascending or descending colon
what is evauluated on a supine abdominal xray
overall gas pattern
calcification
masses
crohns
nine calcifications seen on abdominal x ray
- appendicolith
- gallbladder stones
- renal stones
- pancreatic stones
- liver
- aortic
- calcified mesentary lymph nodes
- fibroid tumors
- calcified splenic artery
What is the patient prep for the small bowel follow through examination?
NPO 8 hours
What imaging modalities (discussed in this unit) have no radiation exposure?
Magnetic Resonance Imaging (MRI) Ultrasonography (U/S)
What are some contraindications for an Upper GI (UGI) examination?
aspiration nausea/vomitting bowel obstruction (distal obstruction) constipation
two types of stones on xray and what quadrant they are in
gallstones (RUQ)
Renal/uretal stones (bilateral)
localized ileus
what is this and what does it indicate
riglers sign
air in the bowel and outside in the perioneal cavity
what intraperitoneal air indicative of
perforation or penetrative trauma
kidney stine
should you see the small bowel
no it should be silhoutted and filled with fluid
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
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.
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
free air
gall bladder US
What is seen in the obstetrical evaluation of a mid term pregnancy?
congenital anomalies confirm multiple gestation gender determination
What is an alternative oral contrast that can be used when barium is contraindicated?
Iodinated contrast (i.e. gastroview)
What is the cheapest special modality in imaging (besides routine x-rays)?
ultrasound
Do you want low or high ultrasound frequency to show better detail?
Higher frequency (5-7 MHz)
barium aspiration
What imaging test would you order if you wanted to evaluate the abdominal aorta with CT?
CT Angiography Abdomen and Pelvis
gallbladder density
colon cancer (apple core)
What patient prep is needed for a transabdominal pelvic ultrasound?
full bladder
What are some indications for an Upper GI (UGI) examination?
hiatal hernia reflux ulcers tumors vomitting hematemesis
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.
What is a common complication with administering oral contrast?
Barium tastes like chalky shit Iodinate contrast (gastroview) taste like oily shit
calcified pancreas
two types of ileus
localized ileus
generalized adynamic ileus
What is the sound reflectivity of muscle/liver? How does it appear on the monitor?
Intermediate reflectivity Various degrees of grey
two features that would indicate osteoarthritis
narrowed joint space with osteophytes
common view for the knee
AP
lateral
oblique
sunrise
what is the pathogenesis of pagets disease
hypermetabolic bone that breaks down and repairs bone over and over, making it prone to breaks
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
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
salter harris I fibula
calcaneus fracture
talus
degenerative arthritis
pubic ramus fracture
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
what is an AFR (IR)
what are the indications
aorta femoral runoff
claudcations with positive ABI, CTA, or MRA used to plan intervention
subtrochanteric
are stable or unstable pelvic fracture smore common
stable
distal fibula fracture
outlet view
what disease process can lead to bowleggedness
degenerative arthritis of the knees
bone to bone apposision medial
what is this
is it pathlogic
bipartite patella
no, its a normal variant
prep for an arteriogram
NPO
coags
creatinine and GFR
what is a nucelar stress test used for
presence, location, extent of CAD
assessment of ischemia
monitoring
segmental fracture of the left tibia
avulsion fracture
open book fracture
pubic ramus fracture
osteoarthritis
comminuted right calcaneus fracture
navicular
hip arthritis
navicular
avascular necrosis
hip arthritis
what is needed for every IR proceedure
NPO
coags
GFR
degenerative arthritis
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
medial cuneiform
what is this
is it pathologic
fabella, a sesamoid bone in the gastroc tendon
no, but it can be mistaken for one
what are the indications for a mesentaric arteriogram
ischemia, GI bleed
subcapital
calcaneus fracture
medial condyle
what is this
is it pathological
os trigonum
no, its a non union of the talus that can be mistaken for an avulsion
why would being diabetic be of consideration for PET scan
it uses radioactive sugar
pubic symphysis
straddle fracture
patella
lesser trochanter
when assessing for arthritis in the knee what is needed
AP and lateral that is weight bearing
cuboid
stradle fracture
ischial tuberosity
degenerative arthritis
talus
femoral neck ffracture
intertrochanteric fracture
prep for IVC
NPO
check for allergy
creatinine and GFR
coags
fibular neck
judet view
intercondylar eminence
avulsion fracture 5th metatarsal
legg-calve-perth
SI joint
sacrum
acetabular fracture
arthritic knee
sub trochanteric
femoral neck fracture
patella fracture
arthritic knee
open book fracture
distal tibia fracture
lateral condyle
lateral epicondyle
intertrochanteric fracture
pagets disease
avascular necrosis
avulsion fracture
femoral neck fracture
calcaneus fracture
intertrochanteric fracture
malgiagne
what on a radiograph would indicate vertical shear on the pelvis
complex pattern of fractures directed toward the head
frank fracture
a fracture between the 1st and 2nd metatarsal
what is the sunrise view for
patellar tracking issues
intertrochanteric fracture
arthritic knee
joint space
F - J
F head of femur
G neck
H greater trochanter
I lesser trochanter
J ischial tuberosity
bucket handle
tibial plateau fracture
femur fracture
cuboid
arthritic knee
avulsion fracture 5th metatarsal
what is most likely true if one side of the pelvic ring is fractured
there will be a fracture on the other side
hallux valgus and small toe dislocation
avulsion fracture
inlet view
intermediate cuneiform
acetabular fracture
femoral neck fracture
iliac crest
5th metatarsal
views of the hip
AP and Frog leg lateral
head of the fibula
greenstick fracture
lateral condyle
arthritic knee
indications for IR venous access
prep
long term adminstration of chemo, blood products, antibiotics
NPO, coags
degenerative arthritis
what radiographic sign would indicate an issue at the pubic symphysis
SI joint
PS >5mm
SI>4mm
pubic ramus fracture
T/F a fracture above the mortise that disturbs the mortise is unstable
true
femoral neck fracture
jones fracture
femur fracture
head of the femur
acetabular fracture
why do femur fractures tend to be bayonetted
muscle contraction pulls the ends of the bones past each other
tibial plateau fracture
medial epicondyle
what is a DSA (IR)
digital subtracted arteriogram, takes out everything but the vascular structure
calcaneus fracture
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
calcaneus
acetabular fracture
obturator foramen
head of the talus
avascular necrosis
slipped capital femoral epiphysis
femur fracture
contraindications for IVC
lack of venous access
total thombosis of the IVC
sepsis
caval diameter <15mm
malgiagne
slipped capital femoral epihpysis
medial condyle
calcaneus fracture
comminuted displaced medial tibial plateau fracture with disruption of the knee joint
lateral cuneiform
what pathology is shown here
degenerative arthritis
lateral malleolus
subcapital
medial malleleous fracture
distal fibula fracture
straddle fracture
medial malleolus
jones fracture
subcappital
diastasis of the pubic symphysis
A - E
A iliac crest
B iliac wing
C SI joint
D ASIS
E acetabulum
K - N
K superior pubic ramus
L inferior pubic ramus
M obturator foramen
N pubic symphysis
epiphyseal line of the tibia
axial view of calcanues
legg-calve-perth
hallux rigidus
arthritis of the big toe that causes pain on push off
first metatarsal
calcaneus fracture
what is an axial view of the foot used for
the evaluate the calcaneus for fracture
four types of arteriogram
AFR
cerebral
carotid
mesentaric
renal
two ways to allow for dialysis access
AV fistula
central catheter
three conditions associated with unstable pelvis fractures
pevic organ damage
hemorrhage
shoch
what is the hardest part of a thyroid scan
it lasts two days and requires lots of prep
three feature to help identify avascular necrosis
snow cap, bite lesion, collapse of the femoral head
what are the indications for a renal arteriorgram
Uncontrolled HTN from stenosis or fibromuscular dysplasia
tumor emobolization
truama
TIPS procedure
transhepatic portosystemic shunt
relieve portal hypertension leading to varices
contraindications for a chemical nuclear stress test
brochospasm
systemic hypotension
mitral valve disease
when would a judet view be used
when looking for fractures
two types of interventions from IR
stents
embolizations
what percent of pelvic fractures will include the acetabulum
if you suspect acetabular fracture what imaging will you need to do
20%
CT
four types of cancer and molecular imaging fround in NM
thyroid cancer and ablation
SM153 and Sr89 for pain relief
PET scan
Bone scan
cardaic uses for pet
mycardial perfusion
viability
scaroidosis
three main vectors associated with pelvic injuries
AP compression
Lateral compression
vertical shear
common x rays of the pelvis
AP
inlet
outlet
judet
what would cause lateral compression of the pelvis
two radiographic signs
side impact
sacral buckle and horizontal pubic rami fracture
what are Y90 microspheres used to treat
unresectable hepatic carcinoma
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
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
how many PET scans are patients allowed eachyear
3
why would a V/Q scan be ordered
unable to do a CT because of IV size, renal failure, patient size, contrast allergy
T/F suspected Si joint pain my require CT
true, some small disruptions may only be visible on CT
what is a possible complication of a pubic ring fracture
hemorrhage
why is the frog leg view useful
it lets you see the lesser trochanter
what are the indications for a cerebral arteriogram
ischemia, hemorrhage, stroke, aneurysm
5 types of stable pelvis fractures
ramus fractures
avulsion fractures
isolated sacral fractures
sacrocaccygeal fractures
win fractures
lovers fracture
a fracture of the calcaneus commonly cuased by landing on the feet from a height
what is an IVC filter used for
the help catch blood clots from DVT
what does aneurysm coiling entail
threading a wire up through the femoral artery into the bubble and filling it with wire
neurology uses for PET
trauma
tumor
plaques
dementia
what should you consider doing in the case of elderly falls
bilateral hip films
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
indications for a carotid arteriogram
when is it used
TIA, stroke
for stenting, or when other testing is unclear
what is the difference between nuclear medicine and other imaging
it uses small amounts of radioactive material to test function of body structures
if occult fracture, infection, or tumor is suspected in the hip what should be done
MIR
three locations of avulsion fractures in the plevis
iliac spine
iliac crest
ischial tuberosity
common views used to image the foot
AP
lateral
oblique
weight bearing
axial
what is a mortise view used for
the evaluated the talotibial joint
oncology uses for PET
FDG for metabolic cancers
fluccicovine for prostate
what are the indications for a percutaneous nephrostomy
obstructed ureter
large stone
hydronephrosis
why are tibial plateau fractures particularly challenging
its hard to get the contour of the joint back together
what two modalities are used in interventional radiology
fluoro
US
what is an NM renal scan used for
to determine if a renal issue is mechanical or physical
hypertension
transplany
four types of unstable pelvis fractures
malgaigne
open book
bucket handle
straddle
what are stents used for
what about embolizations
ischemia
tumors, GI bleeds, trauma
