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CCP 212 Radiology ☢️ Flashcards

1
Q

CCP approach to CXR interpretation

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Patient Information
  2. Previous Imaging
  3. Technique
  4. Adequacy
  5. Heart
  6. Mediastinum
  7. Lungs and Lung Borders
  8. Soft Tissues
  9. Bones
  10. Lines and Tubes
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2
Q

ensuring CXR “adequacy”

definition and specific markers

A
  1. Before interpreting a chest X-ray it is important to assess the quality of the image
  2. Image quality influences your interpretation

The three items one must confirm to ensure a CXR image is “adequate” are:

  1. Penetration
  2. Rotation
  3. Inspiration
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3
Q

CXR “penetration” definition and anatomic markers

A
  1. Lower thoracic vertebral bodies should be visible through heart
  2. intervertebral discs of the mid-thoracic spine should be clearly visible
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4
Q

CXR “rotation” definition and anatomic markers

A

Spinous process should be centred between clavicular heads

The spinous processes of the thoracic vertebrae should be in the midline at the back of the chest. They should form a vertical line that lies equidistant from the medial ends of the clavicles, which are at the front of the chest.

Rotation of the patient will lead to off-setting of the spinous processes so they lie nearer one clavicle than the other

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5
Q

CXR “Inspiration”

A

Posterior 10th rib (or anterior 6th rib) at right cardiophrenic sulcus

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6
Q

Cardiothoracic Ratio

A

the ratio of maximal horizontal cardiac diameter to maximal horizontal thoracic diameter (inner edge of ribs/edge of pleura). A normal measurement is 0.42-0.50

  • CT Ratio > 0.5 on PA View
  • CT Ratio > 0.6 on AP View
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7
Q

Mediastinum definition and anatomic markers

A

Midline of the chest between the pleura of each lung and extends from sternum to the vertebral column

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8
Q

Widened mediastinum differential diagnoses

A
  1. Widening of vessels (dissection, for example)

2. Mass (tumor)

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9
Q

Silhouette Sign

A

Sign refers to pathological loss of a structure’s silhouette

i.e. Heart borders against the adjacent lung segments as seen with patchy lung infiltrates

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10
Q

Focal Airspace Disease

A

Increased Pulmonary Opacity

  1. Pneumonia, Atelectasis,
  2. Pulmonary embolism (i.e. infarct or hemorrhage)
  3. Neoplasm
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11
Q

Diffuse or Multi-Focal Airspace Disease

A

Increased Pulmonary Opacity

  1. Pulmonary edema (CHF or non-cardiogenic) → Central opacification with peripheral clearing (bat-wing)
  2. Pneumonia
  3. Hemorrhage (i.e. trauma, immunologic)
  4. Neoplasm
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12
Q

Fine Reticular Pattern

A

Increased Pulmonary Opacity

  1. Interstitial pulmonary edema
  2. Interstitial pneumonitis
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13
Q

Air bronchogram

A

air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white).

It is almost always caused by a pathologic airspace/alveolar process, in which something other than air fills the alveoli.

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14
Q

Radiographic Stages of CHF on CXR

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Cephalization (redistribution)
  2. Interstitial Pulmonary Edema (interstitial edema)
  3. Airspace Pulmonary Edema (alveolar edema)
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15
Q

definition of “Cephalization” on CXR

A

Abnormal thickening of upper lung vascular markings relative to lower lung vasculature

also known as: “vascular re-distribution” or “upper lobe blood diversion”

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16
Q

Interstitial Pulmonary Edema findings on CXR

A
  1. Increased interstitial markings
  2. Pulmonary venous hypertension (upper zone hilar
    venous distension)
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17
Q

Airspace Pulmonary Edema findings on CXR

A

Air space filling → diffuse or patchy distribution

“Bat-wing” central distribution is typical

Perihilar haze is early sign

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18
Q

Signs of Interstitial Edema on CXR

A
  1. Peri-bronchovascular connective tissue thickening
  2. Peri-bronchial cuffing
  3. Septal connective tissue thickening
  4. Kerley B Lines (thickened interlobular septae)
  5. Pronounced inter-lobar thickening
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19
Q

Peribronchial cuffing definition

A
  1. haziness or increased density around the walls of a bronchus or large bronchiole seen end-on
  2. sometimes described as a “doughnut sign”.
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20
Q

vascular re-distribution (CHF) definition

A
  1. blood vessels in the upper lung zones become larger than the ones in the lower lung zones (the inverse of normal..)
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21
Q

ARDS definition

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Respiratory symptoms within 1 week of known clinical insult
  2. Bilateral opacities on chest imaging not explained by other pulmonary pathology
  3. Respiratory failure not explained by heart failure or volume overload
  4. Decreased P/F Ratio
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22
Q

Bones assessment in CXR interpretation

A
  1. Ribs
  2. Shoulders
  3. Vertebral column
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23
Q

Lines and Tubes assessment in CXR interpretation

A
  1. Endotracheal Tube
  2. Central Line
  3. Gastric Tube
  4. Chest Tube
  5. Pacemaker and Leads
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24
Q

Three basic views for cervical spine XR

A
  1. Lateral
  2. AP
  3. Open mouth (odontoid view)
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25
Q

approach to CT-Head interpretation

A

“ABBCS”

  1. Asymmetry
  2. Blood
  3. Brain
  4. CSF Spaces
  5. Skull and Scalp
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26
Q

FAST exam 4 areas

this is the “classic” FAST windows, not the updated/new school “eFAST”

A
  1. Peri-hepatic and hepato-renal space
  2. Peri-splenic
  3. Pelvis
  4. Pericardium
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27
Q

FAST Perihepatic Scan location

A

Probe placed in right mid to posterior axillary line at level of 11th and 12th ribs

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28
Q

FAST Perisplenic Scan location

A

Probe placed on left posterior axillary line between 10th and 11th ribs

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29
Q

FAST Pelvis Scan Technique

A
  1. Ultrasound probe in transverse plane, immediately above symphysis
    pubis.
  2. Starting at 0°, slowly sweep caudally to 30°.
  3. Demonstrate the bladder.
  4. Optional: Rotate probe 90° so beam in sagittal plane to provide another view of bladder, rectum, rectovesicular pouch.
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30
Q

FAST Pericardial Scan Technique

A

SUBCOSTAL VIEW

  1. Ultrasound probe placed in coronal plane, in subxiphoid region of chest.
  2. Place moderate pressure on abdominal wall, perform AP sweep until heart visualized.
  3. Sweep through heart slowly, from anterior to posterior until heart disappears at each
    extreme.
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31
Q

coronal/frontal plane

A

plane dividing the body into dorsal and ventral parts.

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32
Q

axial/transverse plane

A

plane that divides the body into superior and inferior parts

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33
Q

saggital/longitudinal plane

A

anatomical plane which divides the body into right and left parts.

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34
Q

anechoic

A

black

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35
Q

hypoechoic

A

dark

36
Q

hyperechoic

A

bright

37
Q

ETT Height should be ‘x’ above carina?

A
  1. 5cm above carina.

2. This allows for head flexion and extension without “pushing” the tube into the R bronchus.

38
Q

NG versus OG tube on CXR

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A

NG tube appears larger because it has two radiopaque line that create the illusion of a bigger structure

39
Q

Silhouette sign

A

Blurring of the interface between structures on CXR

40
Q

right heart border on CXR

A

right atrium

41
Q

left heart border on CXR

A

LA and LV

LA top 1/4, LV bottom 3/4

42
Q

Air bronchograms can be described as

A

A region of bronchiole that is surrounded by increased opacity, highlighting the air-filled bronchiole.

43
Q

The 3 radiographic stages of CHF are:

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Stage 1 = Cephalization (thickening of upper lung vascular markings relative to lower lung vasculature)
  2. Stage 2 = Interstitial Pulmonary Edema (increased interstitial markings + pulmonary venous HTN)
  3. Stage 3 = Airspace Pulmonary edema (air space filling with diffuse and patchy distribution; “bat wing”)
44
Q

Non-central distribution patterns of pulmonary edema on CXR can usually be attributed to:

A

Non-cardiogenic causes of pulmonary edema (ie. negative pressure from choking/laryngospasm, ARDS, etc).

45
Q

The two main indications for abdominal XR are:

A
  1. Perforation

2. Obstruction

46
Q

Free air under the diaphragm indicates ____.

A

Perforation.

Air should always be contained within the bowel.

47
Q

Free air in the abdomen post-surgery (from CO2 injection) may last for up to __ days.

A

10 days.

Free air should not be increasing over serial abdominal XRs.

48
Q

Rigler’s sign

A

Visible bowel wall from air on both sides of the bowel wall

49
Q

Large bowel vs small bowel identification on XR

A

Large bowel = Presence of haustra.

Small bowel = Presence of valvulae conniventes.

50
Q

Haustra

A

Sac-like pockets that make up the large bowel.

Mucous folds DO NOT cross the full width of the large bowel.

51
Q

Valvulae conniventes

A

Mucousal folds of the small bowel.

They cross the full width of the small bowel on abdominal XR.

52
Q

“Free ABDO” acronym for abdominal XR interpretation

A 
Free air
Air 
Bowel wall 
Density 
Organs
53
Q

The “ABCS” of cervical spine XR

A

Alignment
Bone
Cartilage
Soft tissue

54
Q

Cervical XR Odontoid view is used for:

A

Visualization of C1 and C2

through open mouth

55
Q

When assessing alignment on cervical spine XR, identify these four lines:

A
  1. Anterior vertebral line.
  2. Posterior vertebral line.
  3. Spinolaminar line.
  4. Posterior spinous line (curved).
56
Q

The “ABBCSS” of CT head

A
  1. Asymmetry
  2. Blood
  3. Brain
  4. CSF
  5. Skull
  6. Scalp
57
Q

Subdural hematoma generalized CT features

A
  1. typically unilateral
  2. crescent distribution around the periphery
  3. not limited by sutures
  4. fill dural reflections (falx cerebri, tentorium)
58
Q

Epidural hematoma CT (aka Extradural hematoma) features:

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. bi-convex (or lentiform) in shape (this means convex on both sides. curving or bulging outward)
  2. beneath the squamous part of the temporal bone
  3. EDHs are hyperdense, somewhat heterogeneous, and sharply demarcated
59
Q

SAH CT features:

A
  1. Diffuse blood across subarachnoid space
  2. blood within the cisterns and sulci
  3. May blunt the appearance of the cerebral peduncles
  4. May present with obstructive hydrocephalus.
60
Q

intra parenchymal hemmorhage CT features:

A

Focal opacity in haemorrhage location of parenchyma

61
Q

DAI findings on CT

A

Loss of grey/white differentiation

62
Q

Hypoechoic appearance on ultrasound

A
  1. Dark (poor echogenicity)

2. example: blood/fluid

63
Q

anechoic appearance on ultrasound

A
  1. black (no echogenicity)

2. example: blood/fluid

64
Q

hyperechoic appearance on ultrasound

A
  1. white (high echogenicity)

2. example: bone

65
Q

Describe “acoustic shadowing” on ultrasound

A
  1. occurs when a dense structure produces a shadow behind it
66
Q

Describe “acoustic enhancement” on ultrasound

A

Sound bounces between the proximal and distal walls of a cyst or fluid-filled space.

Produces a brighter image on the distal wall of tissue.

67
Q

Describe mirror image artifact on ultrasound

A
  1. A mirror image is reflected on the opposite side of a dense structure
  2. This occurs in images that have air on the distal side of a dense structure (ie. bladder)
68
Q

Linear probe is best for assessing

A

Shallow structures

69
Q

Phased array or curvilinear probes are best for assessing

A

Deeper structures (ie. IVC or organs)

70
Q

“Optimizing” an U/S image

A

Centring the image in the screen, adjusting the gain, adjusting the depth

71
Q

Explain what “Spine sign” is

A

Being able to see the spine through a fluid-filled space

abnormal finding when assessing the lung bases, because air will reflect reverberation, rather than producing spine imaging

72
Q

BART mnemonic (ultrasound)

A

“Blue away, red towards”

Mnemonic for doppler imaging

73
Q

ONSD ultrasound depth target

A

3mm behind the optic disk

This ensures the area is undistorted by the optic disk

74
Q

Why is ONSD a reliable surrogate for ICP?

A

only area outside the cranium that is subject to the same pressure that ICP elicits

The ONS is continuous with the subarachnoid space

75
Q

Ultrasound guided ONSD evaluation for ICP contraindications

A
  1. Depressed skull fracture
  2. Globe trauma
  3. Hydrocephalus
76
Q

IVC collapsibility index equation

A

( [IVC max - IVC min] / IVC max ) x 100

77
Q

Classic case COPD features found on CXR

A
  1. Radiolucent and hyperinflated lungs
  2. Flat diaphragms
  3. Narrow heart shadow
  4. Increased anteroposterior chest diameter seen on lateral X-ray
78
Q

5 major densities seen on CXR

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Black (gas)
  2. Dark-grey (fat)
  3. Light-grey (soft tissue/fluid)
  4. Nearly-white (bone/calcification)
  5. White (metal)
79
Q

mediastinum measurement PA vs AP

A

normal range for mediastinum

  1. 6cm PA
  2. 8cm AP
80
Q

deep sulcus sign on CXR is indicative of….

A

pneumothorax

81
Q

direction of flow in doppler ultrasound

A

B - Blue
A - Away
R - Red
T - Towards

82
Q

ACUTE subdural bleed CT image characteristics

A
  1. typically unilateral
  2. hyperdense crescent distribution around the periphery
  3. central hypodensity represents active bleeding
  4. acute bleed mixed with CSF may appear less dense
  5. density is variable in coagulopathic patients, e.g. warfarinised
83
Q

SUB-ACUTE subdural bleed CT image characteristics

A
  1. over the first couple of weeks, the blood is broken down
  2. density approaches that of the brain
  3. may be tricky to see
84
Q

CHRONIC subdural bleed CT image characteristics

A
  1. over time, the hematoma approaches CSF density
85
Q

aortic knob (aka aortic knuckle) definition and anatomic markers

A
  1. distal aortic arch as it curves posterolaterally to continue as the descending thoracic aorta
  2. It appears as a laterally-projecting bulge, as the medial aspect of the aorta cannot be seen separate from the mediastinum
  3. It forms the superior border of the left cardiomediastinal contour

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