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Radiology > Abdomen > Flashcards

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)

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2
Q

Ultrasound (non-diagnostic and diagnostic) has a frequency of ________ hertz?

A

>20,000 Hertz (20 KHz) Higher than threshold of human hearing

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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.

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4
Q

where is the stomach

A

LUQ

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5
Q

What anatomy is seen in the CT Spine?

A

All boney anatomy and spinal cord in the spinal section scanned

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6
Q
A

chronic pancreatitis

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7
Q

where are frequent locations of bowel perforations

A

duodenum (PUD)

colon (diverticulitis, colon cancer, obstruction)

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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

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9
Q
A

flank stripes

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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.

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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.

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12
Q

What is Doppler ultrasound?

A

assesses blood flow (organs, fetus, tumors)

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13
Q

where is the spleen

A

LUQ

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14
Q

what structures are in the peritoneal cavity

A

bowel, spleen, most of the liver

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15
Q

What is the sound reflectivity of fluids? How does it appear on the monitor?

A

Very poor reflectivity Black on monitor

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16
Q

Who is responsible for weighing the benefit vs risk of radiation exposure?

A

Ordering provider

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17
Q

What is the Federal regulatory principles concerning radiation exposure?

A

Any dose of radiation might cause cancer.

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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

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19
Q
A

stomach with foreign body

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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

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21
Q
A

gall bladder density

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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)

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23
Q

characteristics of functional ileus

A

one or more loops unable to perform peristalsis

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24
Q

What are indications for a CT Chest with Contrast?

A

Lung mass Lung disease General Survey Pleural effusion Trauma

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25
Q
A

kidney and ureter with contrast

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26
Q

abnormalties to look on abdominal xray

A

masses

gasses

foreign bodies

bones

stones

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27
Q
A

stomach with barium

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28
Q

What is an example of a higher frequency ultrasound transducer?

A

Vaginal probes

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29
Q

flank stripes

A

lines nbetween the back and the colon

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30
Q
A

small bowel obstruction

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31
Q
A

small bowel obstruction with air fluid levesl

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32
Q

how will retroperitoneal air look

A

streak, linear that outlides the retroperitoneal structures

mottle appearance

relatively fixed

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33
Q

five Dx quickly made with abdominal xray

A

intraperitoneal free air

bowel obstruction

organomegaly

abnormal masses

abnormal calcifications

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34
Q

What is evaluated in a fetal growth assessment?

A

~Biparietal diameter ~Femur length ~Abdominal circumference ~others

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35
Q
A

defogram

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36
Q
A

kidney and ureter density

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37
Q

what are the structures of the large bowel

A

appendix

cecum

ascending colon

transver colon

splenic flexure

descending colon

signmoid colon

rectum

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38
Q
A

single cs double contrast enema

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39
Q

what is the percent chance that renal stone will be visible on xray

A

50-60%

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40
Q
A

colon cancer (apple core)

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41
Q
A

barium enema

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42
Q
A

generalize adyanamic ileus

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43
Q

Define localized ileus by the following three factors

air in the rectum

air in the small bowel

air in the large bowel

A

yes

2-3 loops distended

yes, in the sigmoid or rectum

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44
Q

what will the diaphragm look like with air under it

A

it will look curved and very thin

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45
Q
A

LLDQ free air

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46
Q

What are disadvantages of ultrasound?

A

~Can not image through air or bone. ~Sonographer error

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47
Q
A

free air around falciform ligament

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48
Q

What are indicated for the Barium Enema Examination?

A

visualize entire large bowel through retrograde filling. Diverticulosis polyps tumor masses

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49
Q
A

deogram with rectocele

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50
Q

Differentiate between: Ultrasonography Sonography Sonogram

A

basically used interchangeably but… the suffix -ography is the field of study the suffix-gram pertains to the images themselves

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51
Q

what is included in a complete abdominal series

A

supine

prone

upright

LLDQ

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52
Q

what is seen in the obstetrical evaluation of an early pregnancy?

A

Pregnancy location Pregnancy viability multiple gestation

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53
Q

what can cause perforation that will lead to retroperitoneal air

A

ulceratiive disease

ruptured appendix

blunt/penetrating trauma

perforation during sigmoidoscopy

perforated divertuculitis

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54
Q

What ultrasound frequency shows better detail, 3 MHz or 5-7 MHz? what is the trade off?

A

5 MHz can only visualize shallower structures Note: the greater the frequency, the shorter the wavelength.

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55
Q
A

barium swallow (esophagram)

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56
Q

What gestational age is best visualized with a trans-abdominal approach?

A

> 12 weeks gestation ~morphology & development ~health/viability (Biophysical Profile)

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57
Q

What imaging modality has the highest radiation exposure to the patient?

A

Computerized Axial Tomography (CT Scan)

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58
Q

a complete abdomen ultrasound evaluated what organs?

A

Liver Gallbladder Spleen Pancreas (sometimes Kidneys, dependent on department protocol)

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59
Q

What ultrasound examination will show renal artery stenosis with questionable accuracy?

A

Kidneys

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60
Q

When would trans-abdominal ultrasound be preferred over endovaginal ultrasound when evaluating a pregnancy?

A

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.

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61
Q

What type of imaging contrast is used for CT Angiography of the Chest? How is it same/different from CT Chest with Contrast?

A

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.

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62
Q

is oral contrast used in an Intravenous Pyelogram study?

A

No… oral contrast will conceal the IV contrast filtering through the urinary system.

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63
Q

what will ileus look like on xray

A

1-2 persistantly dilated loops of bowel

air fluid levels

gas in the rectum or sigmoid

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64
Q

What are the two different tranducer types for pelvic ultrasound examinations?

A

Abdominal Vaginal

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65
Q

What is a biophysical profile? what is assessed?

A

assessment for fetal well-being ~Respiratory movements ~Amniotic fluid volume ~Placenta morphology ~others

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66
Q
A

liver

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67
Q

What is a transducer?

A

~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.

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68
Q

what types of densities would be seen on abdominal xray

A

bony abnormalities or calcification

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69
Q

What is a alternative imaging test to the CT Angiography Chest when contrast is contraindicated?

A

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.

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70
Q

In addition to the anatomy identified in the CT Chest with Contrast examination, what anatomy will be enhanced on the CT Angiography Chest?

A

Heart Aorta (and branches) Pulmonary Arteries

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71
Q

What is an Upper GI (UGI)?

A

Fluoroscopic examination utilizing oral contrast of the stomach and emptying into the very proximal small bowel

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72
Q

four advantages of abdominal xray

A

easily obtained

non-invasive

no discomfort

quick Dx of certain conditions

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73
Q

What are indications for CT Angiography of the Chest?

A

embolism or aortic aneurysm symptoms: Chest pain, SOB, post-op respiratory changes

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74
Q

what will gallstones look like on xray

how often are they seen

A

circular densities in the RUQ below the ribs

10-15%

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75
Q

what is evaluated in a supine view

A

overall gas pattern

calcification

masses

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76
Q

Most common image form in diagnostic ultrasound

A

grey-scale real time ultrasound

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77
Q

what is evaluated in a prone view

A

gas in the rectum/sigmoid

gas in the ascending or descending colon

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78
Q
A

Phleboliths

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79
Q

What is the patient prep for abdominal ultrasound?

A

NPO 8 hours (gallbladder)

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80
Q
A

pediatic

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81
Q

Who is the ACR and what do they do?

A

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.

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82
Q

What is the patient prep for the Intravenous Pyelogram study?

A

bowel prep of laxatives (stool patterns can conceal IV contrast filtering through the urinary system) NPO 12 hours prior to exam

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83
Q

What are the indications for the Intravenous Pyelogram study?

A

visualization of urinary system. structural changes due to obstruction of flow (i.e. stone, tumor)

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84
Q

Free ABDO

A

Free fluid

Air outside or inside the bowel

Bowel wall thicking

Densities

ORgans or Fat planes

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85
Q

are kidney stones always visable on Xray

A

no, they can be seen in the ureter but in the kidneys that can tuck behind things

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86
Q

what will SBO look like radiographically

A

dilated bowel proximal to obstruction with air fluid levels

collapsed bowel distal

looks like stacked coins

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87
Q

What is an Intravenous Pyleogram? Is it a fluoroscopic examination?

A

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.

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88
Q

How is ultrasound different than x-ray

A

~Reflects energy (sound) rather than penetrate (radiation) ~Lower energy levels ~Non-ionizing

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89
Q

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?

A

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)

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90
Q

Iodinated contrast can take two different forms, what are they?

A

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).

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91
Q

The WHO states that ultrasound is harmless. What is the more cautious approach?

A

as currently used, diagnostic ultrasound does not appear to harm biologic tissues.

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92
Q

what four bony densities can be seen on abdominal xray

A

vertebrae

pelvis

ribs

femoral heads

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93
Q
A

calcified uterine fibroid

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94
Q

What are advantages to ultrasound imaging over other diagnostic imaging tests?

A

Non-invasive Less-cost Real time images Portable No radiation exposure

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95
Q

what is evaluated on an upright view of the abdomen

A

free air in the peritoneal cavity

air fluid in the bowel

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96
Q

paracolic gutters

A

recesses formed by the peritoneum and the ascending and descending colon

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97
Q

what energy does fluoroscopy use to obtain images?

A

radiation (exactly like diagnostic x-rays)

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98
Q

what seen on an upright chest xray indicates intraperitoneal air from ruptured bowel until proven otherwise

A

a thin diaphragm

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99
Q

two types of mechanical obstruction

A

small SBO

large LBO

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100
Q
A

double contrast barium enema

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101
Q

should you see the large bowel on xray

A

you can, there are usually fluid and air densities

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102
Q

localized ileus

what part of the GI is effected

A

focal irritation of loops of bowel from visceral organs

usually the small bowel

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103
Q

three typical causes of large bowel obstruction

A

tumor, hernia, volvulus, diverticulitis

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104
Q

is a calcified splenic artery considered serious

A

no, it is no uncommon and not always pathogenic

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105
Q

three features to look for with assessing organs for organomegaly

A

enlargement, abnormality, or loss of contour

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106
Q

What are some pathological conditions that can be seen on the CT Abd/pel with Contrast?

A

Cancer Chrohn’s dx Small bowel obstruction colitis appendicitis Cirrhosis Laceration Lymphoma Pancreatitis Gallstones (U/S preferred) Hernia

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107
Q
A

appendicolith

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108
Q
A

uterus and ovaries

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109
Q

views used in acute abdominal xray

A

supine

prone

upright (chest or abdomen)

LLDQ

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110
Q

What imaging contrast can be used for a Barium Enema.

A

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.

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111
Q
A

colon cancer (apple core)

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112
Q

When should a CT Angiography study be ordered instead of the CT Chest with Contrast?

A

Embolism or Aneurysm any time your primary focus in on vascularity

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113
Q

three main causes of SBO

A

bowel cancer

adhesions

hernia

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114
Q
A

gall bladder density

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115
Q

What is a Barium Enema (BE) exam?

A

it is a contrast study of the large intestine.

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116
Q

What is coupling gel?

A

a water soluble gel used to eliminate the air interface between the transducer and patient skin.

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117
Q

what is free fluid in the peritoneal cavity indicative ove

A

ascities (CHF, malignancy, liver disease, pancreatic disease)

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118
Q

when presented with an acute abdominal complaint, what two modalities are most commonly used

A

CT and Ultrasound

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119
Q
A

calcified splenic artery

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120
Q

two cavities in the abdomen

A

peritoneal

retroperitoneal

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121
Q

What is the difference from a barium swallow and a modified barium swallow?

A

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.

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122
Q

What is a common complication of the small bowel follow through exam?

A

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.

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123
Q

In the exams name, what type of contrast does “with contrast” or “without contrast” indicate?

A

IV contrast

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124
Q

What is the routine order for a Chest CT?

A

CT Chest with Contrast

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125
Q

when evaluating CT for an acute abdomen, what specific conditions are you looking for

A

appendicitis

diverticulitis

urinary tract stones

abdominal trauma

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126
Q

describe the flow of blood in the abdomen

A

aorta

mesentaric arteries (to bowel)

portal vein

liver

inferior vena cava

general circulation

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127
Q

What can be seen in the ovarian evaluation with U/S?

A

~ovarian sizes and locations ~follicles (fertility treatment, polycystic ovary) ~Detect and analyze ovarian enlargements ~vacularity (r/o torsion)

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128
Q
A

acid reflux

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129
Q
A

polyp

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130
Q

abnormal bowel gas patterns

A

functional ileus

mechanical obstruction

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131
Q

what is evaluated in the LLDQ abdominal xray

A

free air

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132
Q

what will a LBO look like radiographically

A

dilation proximal to the obstruction

no air fluid levels

generally no air in the rectum

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133
Q

What is an indication for CT Angiography Abdomen Pelvis?

A

known or suspected aneurysm of the abdominal aorta (and it’s branches)

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134
Q

What are the advantages of endovaginal ultrasound over transabdominal pelvic ultrasound?

A

~Higher frequency provides excellent resolution ~excellent visualization of uterus and EARLY gestations (<12 weeks) ~good resolution of adnexa ~full bladder not required.

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135
Q

CT Chest with Contrast: What areas are the body are imaged?

A

Slices of the thorax starting just above the lung apices through the adrenal glands. Lungs, vascular structures, pleura, upper abdomen

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136
Q

what would cause calcification of the aorta that makes it visible on xray

what does it look like

A

atherosclerosis

curved calcificatios adjected to the lumbar spine

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137
Q

What types of contrast are used in imaging?

A

barium iodinated air

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138
Q

define generalized adynamic ileus

what is cause

how will it sound on PE

A

entire bowel with diminished peristalsis (paralysis)

sequela from surgery or DKA

absent or hypoactive bowel

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139
Q
A

aortic aneurysm

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140
Q

what will happen to movement in the small bowel during SBO

what will it sound like on PE

A

dilation proximal to the obstruction, empty bowel below the obstruction

high pitched hyperactive bowel

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141
Q

what to look for in a normal abdomen

A

structures

gas pattern

calcifications

soft tissues

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142
Q
A

generalized adyanmic ileus

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143
Q

What imaging moadlities (discussed in this unit) have radiation exposure? Rank highest to lowest…

A

CT Scan Fluoroscopy X-ray

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144
Q
A

small bowel obstruction with air fluid levesl

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145
Q

What type imaging contrast of can be used intravenously?

A

Iodinated only

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146
Q
A

calcified mesentaric lymph nodes

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147
Q
A

tomogram

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148
Q

What are common pathologies seen in CT spine?

A

Fractures Lesions Subluxations Spinal Stenosis

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149
Q

what is an important indication of ascities

A

a flank stripe larger than pinky

air in the colon will cause it to float in the abdomen

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150
Q

is gas in the bowel ok

A

yes as long as the bowel is not dilated

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151
Q

What are indications for the CT Abd/Pel with Contrast?

A

Pain Nausea Vomiting Distention Cancer

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152
Q

What is seen in the obstetrical evaluation of a late term pregnancy?

A

~monitor fetal growth ~placenta location ~fetal lie (presentation) ~well being (Biophysical Profile) ~Amniotic fluid volume ~Fetal respiratory movements

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153
Q
A

free air under the diaphragm

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154
Q

areas of the small bowel

A

duodenum

jejunum

ileum

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155
Q

CT Chest with Contrast: What does “with Contrast” mean?

A

iodinated IV contrast will be used. The contrast will enhance normal vascular structures and abnormalities that have blood supply.

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156
Q

What are radiation reduction methods in CT?

A

~appropriateness of exam ~consider alternative exams ~prior study performed with same information ~radiation dose history

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157
Q
A

calcified uterine fibroid

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158
Q

What is the sound reflectivity of tissue transition zones? How does it appear on the monitor?

A

Good reflectivity White on monitor

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159
Q
A

UGI with contrast

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160
Q

What is fluorosopy?

A

live x-rays (continuous “on” time) visualized on a monitor during examination

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161
Q

What type of contrast can be used both orally and intravenously?

A

Iodinated

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162
Q

what will free fluid look like on radiograph

A

large amounts of fluid will look grayer than normal and it will follow gravity

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163
Q

What is the prep for a abdomen ultrasound (specifically gallbladder)?

A

NPO 8 hours

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164
Q

What is the patient prep for an esophogram?

A

None Be aware that the Esophogram is sometimes ordered with the Upper GI (UGI) in which the patient must be NPO…

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165
Q

what causes retroperitoneal air

A

perforation of the duodenum, ascending/decending/sigmoid colon

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166
Q
A

small bowel with contrast

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167
Q

T/F a gas filled bowel is not uncommon while soft tissue shadows are not

A

false, its the other way

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168
Q

Will/Can you order a CT Chest without contrast?

A

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…

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169
Q
A

CT enterogram

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170
Q

What types of CT examinations can be performed on abdomen/pelvis?

A

~CT Abd/Pel without contrast ~CT Abd/Pel with contrast ~CT Abd/Pel with and without contrast

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171
Q

What is a Modified Barium Swallow?

A

~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

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172
Q

radiographic signs of generalized adyanmic ileus

A

entire bowel dilation with air

many air fluid levels

gas in the rectum of sigmoid

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173
Q
A

diverticuli

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174
Q

What is evaluated in a limited abdomen U/S

A

one of the following structures: Liver Gallbladder Spleen Pancreas Appendix Pylorus

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175
Q

what is assessed in an upright view

A

free air in peritoneal cavity

air fluid levesl

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176
Q

4 quadrants of the abdomen

A

RU

RL

LU

LL

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177
Q

what is evaluated in LLDQ

A

free air

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178
Q

What are indications for the small bowel follow through examination?

A

motility of small intestine dueodenum jejunum ileum obstruction ileus intramural lesions Crohn’s disease

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179
Q
A

small bowel obstruction

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180
Q
A

small bowel obstruction with air fluid levels

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181
Q
A

intravenous pyelogram (IVP)

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182
Q

peritoneum

A

thin laer of tissue that lines the peritoneal cavity

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183
Q

when would you be able to see the gallbladder on xray

A

when there is distention or calcified stones

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184
Q

Why is contrast not used when evaluating the abdomen/pelvis for kidney stones on CT?

A

The contrast collected in the urinary system has a similar density as a stone. Therefore, the contrast will conceal the stone.

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185
Q
A

retroperitoneal air

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186
Q

what is the process of dysfunction that leads to disease in localized ileus

A

inflammation

no peristalsis

dilated bowel

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187
Q

Contraindications to the Intravenous Pyelogram study?

A

allergy to the iodinated IV contrast. compromised kidney function (elevated BUN Creatnine)

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188
Q

(trans) Abdominal Ultrasound (for female pelvis) is best for ________.

A

evaluation of pregnancy in 2nd and 3rd trimester.

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189
Q

What is an example of a lower frequency ultrasound transducer?

A

abdominal probe

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190
Q
A

aortic aneurysm

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191
Q
A

free air under the diaphragm

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192
Q
A

large bowel obstruction

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193
Q

when using ultrasound to evaluate an acute abdomen, what three conditions are you looking for

A

acute cholecystitis

appendicitis

gynecological conditions

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194
Q

appendicolith

what percent of patients present with this

A

a calcification in the appendix formed by feces stuck in the lumen

10%

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195
Q

how large should flank stripes be

A

no larger than a pinkie

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196
Q

Dow you want low or high ultrasound frequency to get the deeper structures.

A

Lower frequency (3 MHz)

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197
Q

What imaging study should be done before a Chest CT?

A

routine chest x-ray

198
Q

Vaginal Ultrasound is best for _______ and ________.

A

GYN problems Early pregnancy

199
Q

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?

A

Obstruction of the left ureter possibly due to stone or stricture (tumor)

200
Q
A

small bowel obstruction

201
Q

What types of imaging contrast are NEVER used intravenously.

A

Barium Sulfate Air

202
Q
A

stomach

203
Q

indication that a calcified aorta will develop into an AAA

A

if the distance between calcifications is +3cm

204
Q

where is bile produced

what is its path to the digestive system

A

in the liver

liver, biliary system, duodenum

205
Q
A

kidney density

206
Q

What is CT Myelogram?

A

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
Q

T/F large amounts of fluid can displace the colon medially

A

true

208
Q

Diagnostic Ultrasound (done in imaging) utilizes an ultrasound frequency within what range?

A

3-9 megahertz (3-9 MHz)

209
Q
A

retroperitoneal air

210
Q

What Imaging contrast is used in the Intravenous Pyelogram Study?

A

Iodinated IV contrast.

211
Q
A

gall bladder US

212
Q

What are common cancer types associated with radiation exposure.

A

Leukemia Thyroid Cancer Breast Cancer Lung Cancer Bone Cancer Skin Cancer

213
Q

Why is a full bladder needed for a transabdominal pelvic ultrasound

A

Creates a window for sound waves by pushing the air filled bowel up and out of the way.

214
Q

What is the patient prep for the barium enema study.

A

Bowel prep (enemas as indicated by department protocol) NPO

215
Q
A

small bowel obstruction

216
Q
A

ascities

217
Q

What is the sound reflectivity of bone? How does it appear on the monitor?

A

Excellent reflectivity White on monitor

218
Q

What are some pathological conditions that can be seen on Chest CT?

A

Cancer, Pneumonia, pleural and pericardial effusions, pneumothorax, hemothorax

219
Q
A

colon with gaseous contrast

220
Q

what is a common ordering error for ultrasounds noted by the ultrasound lecturer?

A

R/out. The reason for exam should be specific and never use a “rule out” reason for exam.

221
Q

What is a Small Bowel Follow Through (SBFT/SBS) Examination? Is it fluoroscopy or regular xray?

A

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
Q

What are contrasts that can be used for an Upper GI (UGI) exam?

A

Barium Sulfate Air Iodinated contrast (2nd choice to barium in compromised patient)

223
Q
A

enterocolitis

224
Q

what is an apple core lesion indicative of

A

colon cancer

225
Q
A

modified barium swallow

226
Q

Does the ultrasound tranducer transmit sound or listen for returning echoes longer?

A

Listens 9 times longer than it transmits.

227
Q

What are some pathological conditions seen on the CT Angiography Chest?

A

Pulmonary Embolism Aneurysm Dissection as well as: Cancer Pneumonia Pleural and Pericardial effusions Pneumothorax Hemothorax

228
Q

What is the patient prep for the Upper GI (UGI) exam?

A

NPO (a must) Patient will be rescheduled if not!

229
Q
A

large bowel obstruction with barium

230
Q

What are clinical indications for CT Spine?

A

pain trauma injury

231
Q

What imaging contrast is used in the small bowel follow through exam?

A

thin barium iodinated contrast (2nd choice compromised patient)

232
Q

why would organs be visible on xray

what organs can you see

A

they are surrounded by fat which provides an interface

liver, spleen, kidneys, bladder

233
Q

What are alternative imaging tests to the CT Angiography Abd/Pel?

A

MR Angiography (done in MRI) Ultrasound Aorta

234
Q

tree signs of motility disturbances

A

springs, tunnels, and turtles

235
Q

where is the retroperitoneal cavity

what is in it

A

behind the peritoneal cavity

pancreas, psoas, kidneys, aorta, bladder, ascending/descending colon, rectum

236
Q

Is IV contrast used on an Upper GI (UGI) exam?

A

Nope

237
Q

Define LBO by the following three factors

air in the rectum

air in the small bowel

air in the large bowel

A

no

none, unless there is an incompetant ileocecal valve

yes, with dilation

238
Q

What is the scan area of the CT Abd/Pel with Contrast?

A

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
Q

bowel lumen limits that indicate dilation

A

>2.5cm for the small bowel

>6cm for the large bowel

>9cm for the cecum

240
Q

Why is barium contraindicated in GI studies when bowel perforation or obstruction is suspected.

A

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
Q

What are effects of radiation damage to the cell?

A

cell death cell survival with no harm cell survival with mutation

242
Q

What is used in an fluoroscopy examination to enhance detail of strutures?

A

Contrast

243
Q

When is MRI of the Spine preferred over CT of the Spine?

A

mass lesions

244
Q

What are the contraindications for a Modified Barium Swallow?

A

possibility of aspiration of non-water soluble barium

245
Q

What can be seen in the uterine evaluation with U/S?

A

Size and position Endometrium Myometrial pathology Masses, fluid and foreign bodies

246
Q
A

free air under the diaphragm

247
Q

should there be air outside the bowel in the peritoneal space

A

no, except after abdominal surgery

248
Q

why cant the portal vein or the bile duct be seen in the liver

A

the liver is a homogenous fluid density so the bile duct and the portal vein silhoutte with the rest of the liver

249
Q
A

flank stripes

250
Q

Define fucntional ileus by the following three factors

air in the rectum

air in the small bowel

air in the large bowel

A

yes

multiple distended loops

yes, with distension

251
Q
A

single contrast axial barium enema

252
Q

classifications of air in on abdominal xray

A

free intraperitoneal air

free retroperitoneal air

air inside the lumen (dilated bowel or air fluid levels

253
Q
A

uterine fibroid

254
Q

Normal grey scale ultrasound is 2-dimensional. What two types of ultrasound does Dr. Dodge term as “fancy”

A

3-dimensional 4-dimensional

255
Q

What modality is preferred when evaluating the appendix

A

CT scan is preferred. a bad appendix can be missed on U/S due to the gas in the bowel.

256
Q

What imaging test would you order if your patient complained of flank pain, hematuria and a history of kidney stone?

A

CT Abd/Pel without contrast

257
Q

what is evaluated in a prone view

A

gas in the rectum and or sigmoid coolon

gas in the ascending or descending colon

258
Q

what is evauluated on a supine abdominal xray

A

overall gas pattern

calcification

masses

259
Q
A

crohns

260
Q

nine calcifications seen on abdominal x ray

A
  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
Q

What is the patient prep for the small bowel follow through examination?

A

NPO 8 hours

262
Q

What imaging modalities (discussed in this unit) have no radiation exposure?

A

Magnetic Resonance Imaging (MRI) Ultrasonography (U/S)

263
Q

What are some contraindications for an Upper GI (UGI) examination?

A

aspiration nausea/vomitting bowel obstruction (distal obstruction) constipation

264
Q

two types of stones on xray and what quadrant they are in

A

gallstones (RUQ)

Renal/uretal stones (bilateral)

265
Q
A

localized ileus

266
Q

what is this and what does it indicate

A

riglers sign

air in the bowel and outside in the perioneal cavity

267
Q

what intraperitoneal air indicative of

A

perforation or penetrative trauma

268
Q
A

kidney stine

269
Q

should you see the small bowel

A

no it should be silhoutted and filled with fluid

270
Q

What are some deterministic effects of radiation that are associated with radiation dose thresholds?

A

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
Q

Why is the NPO prep for the abdomen ultrasound (specifically gallbladder) important.

A

A constricted (due to eating) gallbladder and a constricted (due to disease) gallbladder look the same.

272
Q

What is the patient prep for the Modified Barium Swallow examination?

A

No Prep Note: the stomach is not visualized, therefore food does not get in the way of area of interest

273
Q
A

free air

274
Q
A

gall bladder US

275
Q

What is seen in the obstetrical evaluation of a mid term pregnancy?

A

congenital anomalies confirm multiple gestation gender determination

276
Q

What is an alternative oral contrast that can be used when barium is contraindicated?

A

Iodinated contrast (i.e. gastroview)

277
Q

What is the cheapest special modality in imaging (besides routine x-rays)?

A

ultrasound

278
Q

Do you want low or high ultrasound frequency to show better detail?

A

Higher frequency (5-7 MHz)

279
Q
A

barium aspiration

280
Q

What imaging test would you order if you wanted to evaluate the abdominal aorta with CT?

A

CT Angiography Abdomen and Pelvis

281
Q
A

gallbladder density

282
Q
A

colon cancer (apple core)

283
Q

What patient prep is needed for a transabdominal pelvic ultrasound?

A

full bladder

284
Q

What are some indications for an Upper GI (UGI) examination?

A

hiatal hernia reflux ulcers tumors vomitting hematemesis

285
Q

Can a barium enema be done with oral contrast administration? Can the small bowel examination be done with retrograde filling?

A

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
Q

What is a common complication with administering oral contrast?

A

Barium tastes like chalky shit Iodinate contrast (gastroview) taste like oily shit

287
Q
A

calcified pancreas

288
Q

two types of ileus

A

localized ileus

generalized adynamic ileus

289
Q

What is the sound reflectivity of muscle/liver? How does it appear on the monitor?

A

Intermediate reflectivity Various degrees of grey

290
Q

two features that would indicate osteoarthritis

A

narrowed joint space with osteophytes

291
Q

common view for the knee

A

AP

lateral

oblique

sunrise

292
Q

what is the pathogenesis of pagets disease

A

hypermetabolic bone that breaks down and repairs bone over and over, making it prone to breaks

293
Q

absolute and relative indications for an IVC filter

A

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
Q

why can iodine be used for radioactive ablation of the thyroid

A

because the thyroid is the only place that takes up large amounts of iodine

295
Q
A

salter harris I fibula

296
Q
A

calcaneus fracture

297
Q
A

talus

300
Q
A

degenerative arthritis

302
Q
A

pubic ramus fracture

303
Q

what is a HIDA scan used for

A

to evaluate the function of the gallbladder after a negative ultrasound when apin, bloating, nausea, chest pain persist

304
Q

what is an AFR (IR)

what are the indications

A

aorta femoral runoff

claudcations with positive ABI, CTA, or MRA used to plan intervention

306
Q
A

subtrochanteric

307
Q

are stable or unstable pelvic fracture smore common

A

stable

308
Q
A

distal fibula fracture

310
Q
A

outlet view

311
Q

what disease process can lead to bowleggedness

A

degenerative arthritis of the knees

312
Q
A

bone to bone apposision medial

313
Q

what is this

is it pathlogic

A

bipartite patella

no, its a normal variant

314
Q

prep for an arteriogram

A

NPO

coags

creatinine and GFR

315
Q

what is a nucelar stress test used for

A

presence, location, extent of CAD

assessment of ischemia

monitoring

316
Q
A

segmental fracture of the left tibia

317
Q
A

avulsion fracture

319
Q
A

open book fracture

320
Q
A

pubic ramus fracture

321
Q
A

osteoarthritis

322
Q
A

comminuted right calcaneus fracture

323
Q
A

navicular

324
Q
A

hip arthritis

325
Q
A

navicular

326
Q
A

avascular necrosis

327
Q
A

hip arthritis

328
Q

what is needed for every IR proceedure

A

NPO

coags

GFR

330
Q
A

degenerative arthritis

331
Q

what would normal heart perfusion look like in a nuclear stress test

ischemia

infarct

A

evenly distributed blood flow

hypoperfusion on stress

hypoperfusion with stress and rest

333
Q
A

medial cuneiform

334
Q

what is this

is it pathologic

A

fabella, a sesamoid bone in the gastroc tendon

no, but it can be mistaken for one

335
Q

what are the indications for a mesentaric arteriogram

A

ischemia, GI bleed

336
Q
A

subcapital

337
Q
A

calcaneus fracture

339
Q
A

medial condyle

340
Q

what is this

is it pathological

A

os trigonum

no, its a non union of the talus that can be mistaken for an avulsion

342
Q

why would being diabetic be of consideration for PET scan

A

it uses radioactive sugar

343
Q
A

pubic symphysis

344
Q
A

straddle fracture

345
Q
A

patella

346
Q
A

lesser trochanter

347
Q

when assessing for arthritis in the knee what is needed

A

AP and lateral that is weight bearing

349
Q
A

cuboid

351
Q
A

stradle fracture

352
Q
A

ischial tuberosity

353
Q
A

degenerative arthritis

354
Q
A

talus

355
Q
A

femoral neck ffracture

356
Q
A

intertrochanteric fracture

357
Q

prep for IVC

A

NPO

check for allergy

creatinine and GFR

coags

358
Q
A

fibular neck

359
Q
A

judet view

360
Q
A

intercondylar eminence

361
Q
A

avulsion fracture 5th metatarsal

363
Q
A

legg-calve-perth

364
Q
A

SI joint

365
Q
A

sacrum

366
Q
A

acetabular fracture

367
Q
A

arthritic knee

370
Q
A

sub trochanteric

373
Q
A

femoral neck fracture

374
Q
A

patella fracture

375
Q
A

arthritic knee

376
Q
A

open book fracture

377
Q
A

distal tibia fracture

380
Q
A

lateral condyle

381
Q
A

lateral epicondyle

382
Q
A

intertrochanteric fracture

383
Q
A

pagets disease

384
Q
A

avascular necrosis

385
Q
A

avulsion fracture

386
Q
A

femoral neck fracture

388
Q
A

calcaneus fracture

389
Q
A

intertrochanteric fracture

390
Q
A
391
Q
A

malgiagne

393
Q

what on a radiograph would indicate vertical shear on the pelvis

A

complex pattern of fractures directed toward the head

394
Q

frank fracture

A

a fracture between the 1st and 2nd metatarsal

396
Q

what is the sunrise view for

A

patellar tracking issues

397
Q
A

intertrochanteric fracture

398
Q
A

arthritic knee

399
Q
A

joint space

400
Q

F - J

A

F head of femur

G neck

H greater trochanter

I lesser trochanter

J ischial tuberosity

401
Q
A

bucket handle

402
Q
A

tibial plateau fracture

403
Q
A

femur fracture

404
Q
A

cuboid

405
Q
A

arthritic knee

406
Q
A

avulsion fracture 5th metatarsal

407
Q

what is most likely true if one side of the pelvic ring is fractured

A

there will be a fracture on the other side

408
Q
A

hallux valgus and small toe dislocation

410
Q
A

avulsion fracture

411
Q
A

inlet view

413
Q
A

intermediate cuneiform

414
Q
A

acetabular fracture

415
Q
A

femoral neck fracture

416
Q
A

iliac crest

417
Q
A

5th metatarsal

418
Q

views of the hip

A

AP and Frog leg lateral

420
Q
A

head of the fibula

421
Q
A

greenstick fracture

423
Q
A

lateral condyle

424
Q
A

arthritic knee

425
Q

indications for IR venous access

prep

A

long term adminstration of chemo, blood products, antibiotics

NPO, coags

428
Q
A

degenerative arthritis

429
Q

what radiographic sign would indicate an issue at the pubic symphysis

SI joint

A

PS >5mm

SI>4mm

430
Q
A

pubic ramus fracture

431
Q

T/F a fracture above the mortise that disturbs the mortise is unstable

A

true

432
Q
A

femoral neck fracture

435
Q
A

jones fracture

437
Q
A

femur fracture

438
Q
A

head of the femur

439
Q
A

acetabular fracture

441
Q

why do femur fractures tend to be bayonetted

A

muscle contraction pulls the ends of the bones past each other

442
Q
A

tibial plateau fracture

443
Q
A

medial epicondyle

444
Q

what is a DSA (IR)

A

digital subtracted arteriogram, takes out everything but the vascular structure

446
Q
A

calcaneus fracture

447
Q

contraindications for an exercise stress test

A

physical/neurological limitations

meds that preclude stress increases (CA blockers, beta blockers)

usntable angina

recent MI

uncontrolled systemic or pulmonary hypertension

449
Q
A

calcaneus

450
Q
A

acetabular fracture

451
Q
A

obturator foramen

452
Q
A

head of the talus

454
Q
A

avascular necrosis

457
Q
A

slipped capital femoral epiphysis

460
Q
A

femur fracture

461
Q

contraindications for IVC

A

lack of venous access

total thombosis of the IVC

sepsis

caval diameter <15mm

462
Q
A

malgiagne

463
Q
A

slipped capital femoral epihpysis

464
Q
A

medial condyle

465
Q
A

calcaneus fracture

466
Q
A

comminuted displaced medial tibial plateau fracture with disruption of the knee joint

467
Q
A

lateral cuneiform

468
Q

what pathology is shown here

A

degenerative arthritis

469
Q
A

lateral malleolus

470
Q
A

subcapital

471
Q
A

medial malleleous fracture

472
Q
A

distal fibula fracture

474
Q
A

straddle fracture

475
Q
A

medial malleolus

477
Q
A

jones fracture

478
Q
A

subcappital

479
Q
A

diastasis of the pubic symphysis

480
Q

A - E

A

A iliac crest

B iliac wing

C SI joint

D ASIS

E acetabulum

482
Q

K - N

A

K superior pubic ramus

L inferior pubic ramus

M obturator foramen

N pubic symphysis

483
Q
A

epiphyseal line of the tibia

484
Q
A

axial view of calcanues

485
Q
A

legg-calve-perth

487
Q

hallux rigidus

A

arthritis of the big toe that causes pain on push off

490
Q
A

first metatarsal

492
Q
A

calcaneus fracture

495
Q

what is an axial view of the foot used for

A

the evaluate the calcaneus for fracture

496
Q

four types of arteriogram

A

AFR

cerebral

carotid

mesentaric

renal

498
Q

two ways to allow for dialysis access

A

AV fistula

central catheter

499
Q

three conditions associated with unstable pelvis fractures

A

pevic organ damage

hemorrhage

shoch

505
Q

what is the hardest part of a thyroid scan

A

it lasts two days and requires lots of prep

506
Q

three feature to help identify avascular necrosis

A

snow cap, bite lesion, collapse of the femoral head

514
Q

what are the indications for a renal arteriorgram

A

Uncontrolled HTN from stenosis or fibromuscular dysplasia

tumor emobolization

truama

519
Q

TIPS procedure

A

transhepatic portosystemic shunt

relieve portal hypertension leading to varices

520
Q

contraindications for a chemical nuclear stress test

A

brochospasm

systemic hypotension

mitral valve disease

521
Q

when would a judet view be used

A

when looking for fractures

522
Q

two types of interventions from IR

A

stents

embolizations

523
Q

what percent of pelvic fractures will include the acetabulum

if you suspect acetabular fracture what imaging will you need to do

A

20%

CT

534
Q

four types of cancer and molecular imaging fround in NM

A

thyroid cancer and ablation

SM153 and Sr89 for pain relief

PET scan

Bone scan

536
Q

cardaic uses for pet

A

mycardial perfusion

viability

scaroidosis

539
Q

three main vectors associated with pelvic injuries

A

AP compression

Lateral compression

vertical shear

545
Q

common x rays of the pelvis

A

AP

inlet

outlet

judet

546
Q

what would cause lateral compression of the pelvis

two radiographic signs

A

side impact

sacral buckle and horizontal pubic rami fracture

549
Q

what are Y90 microspheres used to treat

A

unresectable hepatic carcinoma

552
Q

what would cause AP compression of the pelvis

two radiographic signs on xray

A

impact from the front or back

diastasis of the pubic symphysis or SI joint shifting

553
Q

in what population is a slipped capital femoral epiphysis common

what happens

what is the prognosis

A

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
Q

how many PET scans are patients allowed eachyear

A

3

556
Q

why would a V/Q scan be ordered

A

unable to do a CT because of IV size, renal failure, patient size, contrast allergy

558
Q

T/F suspected Si joint pain my require CT

A

true, some small disruptions may only be visible on CT

560
Q

what is a possible complication of a pubic ring fracture

A

hemorrhage

561
Q

why is the frog leg view useful

A

it lets you see the lesser trochanter

563
Q

what are the indications for a cerebral arteriogram

A

ischemia, hemorrhage, stroke, aneurysm

567
Q

5 types of stable pelvis fractures

A

ramus fractures

avulsion fractures

isolated sacral fractures

sacrocaccygeal fractures

win fractures

568
Q

lovers fracture

A

a fracture of the calcaneus commonly cuased by landing on the feet from a height

571
Q

what is an IVC filter used for

A

the help catch blood clots from DVT

572
Q

what does aneurysm coiling entail

A

threading a wire up through the femoral artery into the bubble and filling it with wire

574
Q

neurology uses for PET

A

trauma

tumor

plaques

dementia

575
Q

what should you consider doing in the case of elderly falls

A

bilateral hip films

580
Q

what is legg-calve-perthes

what is the prognosis

A

avascular necrosis commonly seen in pediatric males

with crutches and physical therapy the joint will regenerate

582
Q

indications for a carotid arteriogram

when is it used

A

TIA, stroke

for stenting, or when other testing is unclear

583
Q

what is the difference between nuclear medicine and other imaging

A

it uses small amounts of radioactive material to test function of body structures

585
Q

if occult fracture, infection, or tumor is suspected in the hip what should be done

A

MIR

586
Q

three locations of avulsion fractures in the plevis

A

iliac spine

iliac crest

ischial tuberosity

588
Q

common views used to image the foot

A

AP

lateral

oblique

weight bearing

axial

600
Q

what is a mortise view used for

A

the evaluated the talotibial joint

603
Q

oncology uses for PET

A

FDG for metabolic cancers

fluccicovine for prostate

608
Q

what are the indications for a percutaneous nephrostomy

A

obstructed ureter

large stone

hydronephrosis

613
Q

why are tibial plateau fractures particularly challenging

A

its hard to get the contour of the joint back together

614
Q

what two modalities are used in interventional radiology

A

fluoro

US

615
Q

what is an NM renal scan used for

A

to determine if a renal issue is mechanical or physical

hypertension

transplany

616
Q

four types of unstable pelvis fractures

A

malgaigne

open book

bucket handle

straddle

618
Q

what are stents used for

what about embolizations

A

ischemia

tumors, GI bleeds, trauma

Radiology (14 decks)

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