Approach to Radiology Flashcards
What are the steps in reviewing a plain radiograph?
- View: PA/AP/Lateral
- Inspiratory Effort: can you count 8-10 ribs?
- Trachea and Mediastinum: trachea should be midline, open. Mediastinum is considered wide if >8cm at aortic arch.
- Heart and Great Vessels: Look at the intersection of the diaphragm contour with the right and left heart borders. Look at the curvature of the aorta and the aortic knob.
- Lungs: Look at the structures visible within the lungs (pulmonary vessels, bronchial walls, fissures, interstitial lines). 90% of markings are vascular and there should be less markings on the outer 1/3 of the lung.
- Costophrenic angles/Diaphragm: Look at the sulci where the diaphragm meets the chest wall. The right hemidiaphragm should be higher than the left.
- Bones, pleura, soft tissue: Sometimes it is not necessary to comment on these structures.
ABCDEF System
A - airways B - bones (and soft tissues) C - cardiac silhouette D - diaphragm (and gastric bubble) E - effusion (i.e pleura) F - fields (i.e lung fields)
(Lines, Tubes, Devices, Surgeries) –> last
How do you determine if a CXR is technically adequate?
- Penetration: spine should be visible through the heart.
- Inspiratory Effort: at least 8-10 ribs visible.
- Rotation: spinous process should be equidistant between medial ends of clavicle.
- Magnification: AP film will magnify heart.
- Angulation: clavicle should have an S-shaped appearance.
System for abdominal radiograph interpretation
- Assess gas pattern - diameter & air fluid levels
- Assess for extraluminal air - subdiaphragmatic, between bowel loops, in the bowel wall (intraluminal air)
- Assess for abnormal calcifications - stones of foreign bodies
- Soft tissue masses
Musculoskeletal Radiograph Interpretation
- View: PA, lateral, oblique
- Joint Space: wide, narrow, normal
- Soft Tissue: swelling, air, fluid, foreign body
- Bone Density: normal, moth eaten, osteopenic, osteoporotic
- Bone Integrity/Alignment: prosthetic joint? is the cortex intact, thickened, smooth? alignment - displacement medial or lateral? angulation - how is it away from the midline? rotation - internal or external?
Spine alignment/Curvature: sometimes not necessary to comment on unless reviewing c-spine.
What will a supine position look like on a CXR?
higher diaphragms
decreased lung volume
Usually AP view
What will a upright position look like on a CXR?
lower diaphragms
Will shows 8 - 10 posterior ribs
increased lung volume
usually PA or lateral view
What are the types of diagnostic imaging
conventional radiography (xray) CT ultrasound MRI Nuclear Imaging/PET Mammography Angiography Flouroscopy
What is the density on conventional radiography (listed by increasing density)
Air Fat Soft Tissue/Fluid Bone/Material Metal/Contrast
What will air appear like on xray
Black (radiolucent)
What will Metal/contrast appear like on xray
white (radiopaque)
How many views are needed to consider abnormality in a musculoskeletal radiology
2 views at 90 degrees
What are the types of fractures
Transverse Oblique Spiral Comminuted Pathological Greenstick Torus Compression
How are CT scans viewed
from feet to head in supine position
How is density viewed on a CT scan
higher density is white
low density is black
