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Apex- Radiology Flashcards

1
Q

Which unit of measurement quantifies occupational exposure to electromagnetic radation?

A. Curie
B. Rad
C. Rem
D. Roentgen

A

Rem

Roentgen (R) = unit of radiation exposure
Rad (Radation absorbed dose): quantity of radiation received by individual
Rem (Radiation equivalent man): unit of occupational radiation exposure
Curie (Ci): a quantity of radioactive material

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2
Q

Xrays are a form of (long/short) wavelength, (high/low) frequenciy ionizing radation that prenetrate matter at the molecular level

A

short wavelength
high frequency

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3
Q

T/F- xray exposure can damage ceullular compontents such as RNA and DNA

A

true + create reactive oxidative species and predispose a person to cancer

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4
Q

What is the unit of radiation exposure

vs. unit of OCCUPATIONAL radiation exposure

A

The Roentgen (R)

describes the output intensity of the xray machine

Rem - Raidation equivalent man

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5
Q

what describes the quantity of radiation received by an individual

A

Radiation absorbed dose (Rad)

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6
Q

What is the unit of OCCUPATIONAL radation exposure

A

Radiation equivalent man (Rem)

Roentgen is the unit of ration exposure - not occupational

Rem sleep - sleep while your work- work = occupation, occupational radiation expsoure

Rems account for the differences in types of radiation exposure based on a weighting factor

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7
Q

What is Curie (Ci)

A

a quantity of radioactive material

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8
Q

3 very highly sensitive body areas to radiation
3 highly sensitive

A

very highly sensitive = bone marrow, intestinal epitherlium, reproductive cells

highly senstive = optic lens, thyroid epithelium, mucous membranes

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9
Q

you should stand at least how many feet away from the xray source

A

3 feet

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10
Q

What is XRAY?

why is it called “ionizing radiation”

A

It’s high energy electromagnetic radiation

because they ionize atoms (remove electrons from the outer shell)

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11
Q

Match: radiology terms: Rem, Roentgen, Rad

“the total dose administered”

“total dose received at tissue level”

“effective dose”

A

“the total dose administered” = Roentgen

“total dose received at tissue level” = Rad

“effective dose” = Rem

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12
Q

Yearly maximum radiation exposure for adults

for fetus (per year and per month)

A

adults = 5rem per year

fetus = 0.5rem/year
0.05rem/month

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13
Q

What defines the amount of ardioactive substance that decays at the same rate with 1g radium?

what describes decay in one second?

A

Curie (Ci)

Becquerel (Bq)

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14
Q

What describes the number of electrons used to generate the X-ray beam?

What describes the quality of xrays produced?

A

Milliamperes

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15
Q

T/F: Radiation obeys the inverse square law

A

True

states the amount of exposure is inversely proportional to the square distance of the distance of the source

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16
Q

3 ways to limit radiation exposure

A
  1. distance
  2. duration
  3. shielding
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17
Q

minimum safe distance from the radiation source

this is how many inches of concrete
and how many mm of lead

A

6 feet of air

9 inches of concrete
2.5mm of lead (lead aprons usually contaon 0.25-0.5mm of lead - perfect)

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18
Q

Which features will be present in a normal chest X-ray? (select 2):

  • domed hemidiaphragm
  • heart borders > 60% chest width
  • Blunted costophrenic angles
  • Left hilum slightly larger than the right
A

Domed hemidiaphragm
Left hilum slighlty higher than the right

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19
Q

Order of increasing density (darkest to lightest):

Water (soft tisssue), bone (metal, fat, gas (air)

densest = lightest

A
  1. Gas/Air (xray passes most easily thru - darkest)
  2. Fat
  3. Water (soft tissue)
  4. bone (metal) ( denest - xray passes less easily thru - lightest)
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20
Q

label cxr

A
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21
Q

T/F: the best image quality is obtained when the film is taken with teh patient in the upright position

A

True

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22
Q

Three most common CXR views

*which one is most common

A
  1. Posterior Anterior* -xray passes from back to front (PA)
  2. Anterior Posterior (AP) - xray passes from front to back
  3. Lateral- xays pass from one side ot the other
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23
Q

Why should people hold their breath on inspiration with cxrs

A

bc inspiration seperates the soft tissues and vessels, making the structures easier to see

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24
Q

what happens if the cxr is taken on expiration?

lungs and heart

A

lungs will appear cloudy and heart will appear larger than it actually is

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25
How is adequate inspiratory effort indicated?
by identifying the right hemidiaphragm at the 9th or 10th rib posteriorly
26
if the right hemidiaphrgam is elevated at which ribs, overinflation would be likely (either iatrogenic or pathologic)
11th or 12th
27
what 2 things could widened intercostal spaces indicate?
1. overinflated lungs 2. ipsilateral PTX
28
Which view provides the most accurate assessment of heart size: AP. PA, or lateral
PA | heart wideth < 50% of thorax wideth
29
PA vs AP view and cardiac assessment
PA = width of heart is < 50% of thorax width AP = width of heart is < 60% of thorax width
30
How is cardiac assessment altered in the AP view?
heart is relatively further when AP view is used, creating a shadow that can cause a 20% false increase in size
31
T/F: the heart can appear englarged (regardless of which view) if the xray beam does not encounter the chest at a 90 degree angle
True | *pt position is important!
32
label structures cxr
33
Which side of the diaphragm sits higher left or right | why
right | bc of the liver
34
T/F- a domed diaphragm is normal
true
35
What would unilateral depressed or flattened hemidiaphragm indicate? | what about b/l flattening?
tension PTX | COPD or chornic asthma
36
label differences in COPD cxr
37
What is the most common cause of free air under the diaphrgam?
hollow viscus **perforation** | ie) loss of GI wall integrity
38
label cxr | what is the signficance of this?
## Footnote pleural fluid tends to rise higher along the edges producing a meniscus or U shape - good indicator of pleural effusion (increased density at the costophrenic angle)
39
what are costophrenic angles?
arcs where the chest wall and diaphragm meet ## Footnote normal - sharp and clearly defined blunted may indicate pleural effusions
40
what might blunted costophrenic angles indicate
pleural effusions | costophrenic angles are arcs wehre the chest wall and diaphragm meet
41
intersistial pulmonary edema (LV failure) is characterized by what 2 findings
peribronchial cuffing and/or lineal patterns (kerley lines) | increased intersistial markings ## Footnote vessels should branch and taper from the hilum (center) to the periphery, where they are nearly invisible, if they become visible,
42
what are kerley lines typically caused by?
thickening of the interlobular septa ## Footnote whatever the fuck that means
43
what do you see here
intersistial pulmonary edema
44
The right minor fissure can be seen as a thin line running horizontally from the edge of the right lung towards the right hilum at approximately the level of which rib?
the anterior 4th rib ## Footnote *in the right lung, the minor fissue seperates the middle and lower lobes and can be seen on frontal and lateral views
45
cxr- label
## Footnote seperates the middle and lower lobes in the r ight lung
46
T/F: the left lung has no minor fissure
True ## Footnote bc it only has 2 lobes ; the right has 3 and the minor fissure seperates the middle and lower lobes
47
In the right lung, the major (oblique) fissue seperates what ## Footnote what does it seperate in the left lung?
right - seperates upper and middle lobes ## Footnote left - seperates upper and lower lobes
48
t/f- major fissures can only be seen on PA vieiw
false- lateral
49
cxr label
50
What is the aortic knob ## Footnote what may enlargement of it indicate (4)
The distal aortic arch that becomes the descending thoracic aorta ## Footnote 1. aortic dissection 2. valvular insufficency 3. PDA 4. Severe tetralogy of fallot
51
t/F: a radiolucent region under the left hemidaphgram is a normal finding
True - gas in the fundus of the stomach
52
What is the hila and what does it consist of (2)
lung **hila** = lung roots consist of: pulmonary vessels & major bonchi
53
cxr label
54
Does the left or right hilum sit higher
left sits higher
55
what would cause mediastinum widening?
aortic dissection
56
T/F: tracheal deviation can be caused from a large goiter
True - or ptx
57
When would the medistinum shift towards vs away from the affected side
shift **towards** affected side with **volume loss** (massive atelectasis) shift* away *from affected side with *increased volume (PTX) * ## Footnote so volume loss = atlectasis, medastium shifts twoards that side, bc theres no volume to keep it in place increased volume = ptx, more air in the intrapleural space, pushes mediastinum away from it
58
what does mediastinal air indicate?
pneumopericardium (pericardial laceration)
59
Whats the menumonic for CXR interpretation
ABCDEFGHI ## Footnote Assess film quality and Airway Bones and soft tissue Cardiac Diaphragm Effusion Fields, fissures, and foreign bodies Great vessels & Gastric bubble Hila and mediastinum Impression
60
hows the ETT?
T3-T4 | i think thats good? carina is T5 and lung fields are equal ## Footnote 2-5cm (depending on pt size) above the carina (T4-5 interspace)
61
What type of appliance is present on this CXR (Select 2): -central line -PICC line -PAC -ETT -
ETT and PAC
62
Where should an ETT be seen on CXR?
about 4-5cm (depdning on pt size) above the carina | mid-trachea ## Footnote carina = T4-T5 interspace
63
Where is the carina on a CXR
T4-T5 interspace | ett should be 4-5cm above it
64
A tip of a ventral venous line should be where in the SVC and no fruther than what?
distal 1/3rd of the SVC no further than the SVC to RA junction
65
PAC should be visualized coursing from where to where
SVC > RA > RV > PA in Wests zone 3
66
T/F: the medial ends of the clavicles are consistent for proper ETT placement
True 4-5cm above the T4-T5 interspace (carina)
67
Just to appreciate the goof view of the left and right bronchi on this cxr image (right) black - gas filled
wow i can actually see what i'm looking for here ## Footnote just stop and note things like.... how the aorta arches over the left bronchi and how the left pulm artiers are right below the aorta, then the end of the bronchus, then the veins below , then left atrium, lv on thr right you can appreciate the SVC over the bronchi, then the right arteries sticking out, then the vein, then RA below that, and RV in front
68
label
## Footnote * Tip of central venuos line should be in the distal 1/3 of the SVC b/t the RA and most proximal venous valves
69
What's wrong with the tip of a CVL being in the proximal 1/3rd of the SVC? | central venous line
it is 16x more likely to thrombose
70
## Footnote *film exposure has been altered to help you more easily visualize the PAC -- systematic assessment reveals first that the ETT is likely abutting the carina; the trachea and mainstem bronchi cannot be visualized, but by counting the posterior ribs, the ETT tip appears to be ~ T4 ....sure
71
T/F: two views are required to diagnose a misplaced pacer lead
True | ie) PA + lateral
72
T/F- the tips of the pacer leads should be embedded in the endocardium
True
73
T/F: with pacer wires, you can see the tip and ring electrodes for both leads ## Footnote whats the difference between the tip and ring electrode
True ## Footnote tip electrode is active (postivie polarity) - cathode ring electrode is neutral (negative polarity) - anode
74
75
what 3 things can be noted here
1. wide intercostal spaces 2. right subclavian line with tip of cath in SVC 3. pt is slightly rotated
76
what kind of pacer does this pt have?
dual chamber with RA lead and RV lead. you can see the tip and ring electrodes in both leads
77
Hows the heart look?
big af
78
Whats wrong with the lungs
RUL and LLL opacities Blunted right costophrenic angle (pleural effusion)
79
Hows the ETT?
in good position ## Footnote not as I originally thought LOL but trace the clavicals down to where they meet and thats wehre the ETT should be and it is
80
What is the FIRST radiographic sign of pulmonary edema? A. Cardiac enlargement B. Cephalization C. Kerley B lines D. Pleural effusion
B. Cephalization | wtf ## Footnote 1st stage = cephalization - redistibution of vascular markings to the upper lung 2nd stage = peribronchial cuffing and Kerley lines (A & B) 3rd stage = alveolar edema, pleural efffusion and increased cardiac size
81
stages of cardiogenic pulmonary edema (3)
1st stage = cephalization - redistibution of vascular markings to the upper lung 2nd stage = peribronchial cuffing and Kerley lines (A & B) 3rd stage = alveolar edema, pleural efffusion and increased cardiac size
82
Basilar atelectasis occurs in what percent of patients under general anesthesia
90% ! ## Footnote usually not dectectably by cxr*
83
Where is radiographic evidnece of aspiration most liklley to be seen (2 places)
RUL (posterior segment) or RLL (superior segment)
84
What is atelectasis?
parts of the lung that don't fullly expand - decrease gas exchange
85
What typically presents as segmental, subsegmental, or lobar **opacities** with loss of volume and displacement of fissues on the affected side ## Footnote 4 potential causes
Atelectasis ## Footnote aspiration, PNA, foreign body aspiration, tumor
86
T/F: anesthesia-induced bibasilar atelectasis is typically not visible on CXR
True
87
What is it called when air collects in the anterior inferior thorax, adjacent to the diaphragm? | when would you see it?
Deep Sulcus Sign | simple ptx ## Footnote *an abnormal lucency appears over the costophrenic angle of the affected side and can sometimes extend over the upper quad of the abdomen
88
label cxr & what is it?
Simple PTX ## Footnote *Deep sulcus sign - air collection in the anterior inferior thorax, adjacent to the diaphragm + abnormal lucency over the costophrenic angle of the affected side
89
Tension PTX has the same signs of a simple ptx + what 3 things
1. depressed diaphragm 2. flattenting of the cardiac border 3. mediastinal shift to the contralateral side with tracheal deviation
90
label cxr, + what is it
Tension PTX
91
t/F: with cardiogenic pulmonary edema, pulmonary blood vessels are larger in the lower lobes compared to the upper lobes
False- larger in the upper lobes
92
What is pericronchial cuffing | what stage of cardiogenic pulm edema would it be in
intersistial edema around the bronchial walls | stage 2
93
cxr label
94
ARDS is a clinical syndrome defined by what 3 things
1. degree of hypoxia (PaO2 to FiO2 ratio) 2. Timing (within 7 days of the presumed insult) 3. Radiographic findings
95
What are the 3 stages of ARDS? ## Footnote timing of the first 2 stages
Stage 1- Exudative → diffuse patchy alveolar infiltrates peripherally Stage 2- Proliferative → primarily alveolar infiltrates with atelectasis and air bronchograms Stage 3- Fibrotic → complete alveolar consolidation ## Footnote 1. ~ 12 hrs after initial insult 2. 24-48 hrs after
96
cxr ARDS label
97
What is this patient's primary problem?
Simple PTX on the left side ## Footnote - theres a clear pleural line on the left beyond which no vascular markings are noted (compare this to the vascular markings on the patients right) - ddep sulcus sign ((circle)
98
what is this patient's primary problem
Pulmonary edema ## Footnote * increased upper hilar blod vessel prominence and a beginning alveolar pattern in the lower lobes (due to fluid filling the air spaces) * *blunted costophrenic angles * -there is also a PICC line thats correctly positioned
99
What's happening here ## Footnote 2 things that cause it
complete alveolar consolidation ## Footnote stage 3 cardiogenic pulmonary edema & stage 3 ARDS (fibrotic stage)
100
Which tissue types are MOST sensitive to the ionizing effects of radiation? (select 2): -Bone marrow -Lung -Glial cells -optic lens
Bone marrow (WBCs) & optic lens
101
What significant findings are present in this chest radiograph (select 2): -misplaced right subclavian line -unresolved left PTX -tracheal deviation -correctly placed left chest tube
-tracheal deviation -unresolved left PTX ## Footnote chest tube is poorly placed and not in the apex of the pleural space the right subclavian line is noted in the proximal 1/3 of the SVC
102
Identify the significant features on this CXR (select 2): -Left PTX - Right lung volume loss - central line malposition - perihilar infiltrates
Perihilar infiltrates (B/L) right lung volume loss ## Footnote an elevated right hemidiaphragm due to volume loss in the right upper lobe, posterior segment - a left pleural effusion evidenced by loss of the costophrenic angle and a depdent opacity with a lateral upward sloping (meniscus-shaped contour) - central line correctly positionedin hte proximal 1/3 of the SVC

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